Filippo Maioli

Centre Hospitalier Régional Universitaire de Lille, Lille, Nord-Pas-de-Calais, France

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Publications (5)7.92 Total impact

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    ABSTRACT: To compare the results of the endovascular aneurysm repair (EVAR) in patients considered as unfit for surgery in a "high volume" center with the EVAR-2 trial results. In our center, between January 2006 and December 2008, 469 endovascular aorta treatments were performed in high-risk patients. All the data were prospectively collected in a database. Among 469 patients, we selected 191 patients considered as unfit for open surgery (group 1) corresponding to the EVAR trial criteria. Variables such as postoperative mortality at 30 days and 1 year, complications rates, as well as early and late redo surgery were evaluated. Long-term pharmacological treatment before surgery was listed. These results were compared with the EVAR trial (group 2). Survival during the follow-up was calculated according to the Kaplan-Meier method. Mortality at 30 days was 1.6% and 9% in groups 1 and 2, respectively (p = 0.002). Global complication rate was 44% and 43% in groups 1 and 2, respectively (p = 0.52). Over the follow-up period, the redo surgery rate was 13% and 26% in groups 1 and 2, respectively (p = 0.0102). In our cohort, the survival rate at 2 years was 84% with a residual number of 102 patients. Before surgery, a long-term antiplatelet treatment was prescribed in 89% and 58% of the patients and statins in 74% and 39% of the patients in groups 1 and 2, respectively (p < 0.0001). The EVAR-2 trial conclusions are in opposition to the practice of French vascular surgeons. Endovascular treatment of abdominal aortic aneurysms in high-risk patients is justified. This study confirms the importance of a multidisciplinary treatment for high-risk patients in high-volume centers.
    No preview · Article · Jul 2011 · Annals of Vascular Surgery
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    ABSTRACT: Objectifs Comparer les résultats du traitement endovasculaire des anévrismes de l'aorte abdominale (AAA) chez des patients considérés « inopérables » dans un centre à « haut volume » avec les résultats de l'étude EVAR2. Méthodes Entre janvier 2006 et décembre 2008, 469 traitements endovasculaires de l'aorte ont été réalisés chez des patients à « haut risque chirurgical » dans notre centre. Toutes les données ont été collectées de manière prospective dans une base de données. Parmi les 469 patients, nous avons sélectionnés 191 (groupe 1) « inopérables » correspondant aux critères de l'étude EVAR2. La mortalité postopératoire à 30 jours et 1 an, les taux de complications ainsi que les taux de réinterventions précoce et tardive ont été évalués. Le traitement médicamenteux au long cours avant la chirurgie a été répertorié. Ces résultats ont été comparés aux résultats de l'étude EVAR2 (groupe 2). La survie au cours du suivi a été calculée selon la méthode de Kaplan-Meier. Résultats La mortalité à 30 jours était de 1,6% et 9% respectivement dans les groupes 1 et 2 (p = 0,002). Le taux de complication globale était de 44% et 43% dans les groupes 1 et 2 (p = 0,52). Le taux de réintervention sur la période de suivi était respectivement de 13% et 26% dans les groupes 1 et 2 (p = 0,0102). Le taux de survie de notre cohorte à 2 ans était de 84%, avec un effectif résiduel de 102 patients. Avant l'intervention, un antiagrégant plaquettaire était prescrit au long cours chez 89% et 58% et une statine chez 74% et 39% des patients du groupe 1 et 2 respectivement (p < 0,0001). Conclusion Les conclusions de l'étude EVAR2 sont en contradiction avec la pratique des chirurgiens vasculaires français. Le traitement endovasculaire des AAA chez les patients à haut risque chirurgical est justifié. L'étude que nous avons menée confirme l'intérêt de la prise en charge pluridisciplinaire de ces patients à haut risque chirurgical dans les centres à haut volume.
    No preview · Article · Jul 2011 · Annales de Chirurgie Vasculaire
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    ABSTRACT: To describe our experience with the use of custom-designed branched or fenestrated endoprostheses incorporating an inverted contralateral limb in the bifurcated component. Retrospective analysis was performed of a prospectively maintained database of all patients undergoing endovascular aneurysm repair using modular branched or fenestrated devices at a university teaching hospital between January 2004 and February 2010. Of 102 cases, 7 male patients (mean age 69 years) were treated with modular devices that incorporated an inverted contralateral limb in the bifurcated component. Five patients had thoracoabdominal aortic aneurysm (4 type IV and 1 type II), 1 patient had a pararenal abdominal aortic aneurysm, and another had type I endoleak from a migrated AneuRx stent-graft. The technique was used primarily because of an existing bifurcated prosthesis (n=5), but in 2 patients without prior open surgery, this technique was needed because of anatomical constraints. All devices were implanted as planned. There was no mortality. One patient required temporary hemodialysis prior to discharge; another patient developed permanent paraplegia, likely related to extensive aortic coverage. No device migration, component separation, or type I or III endoleaks were detected during a mean follow-up of 25 months, and no reinterventions have been necessary. The use of an inverted limb in the bifurcated component of modular endografts may allow endovascular treatment in scenarios where there is insufficient space to deploy a standard bifurcated component. This design modification allows an adequate sealing zone between the iliac extension limbs and the bifurcated component.
    No preview · Article · Oct 2010 · Journal of Endovascular Therapy
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    ABSTRACT: To describe the novel use of an Amplatzer occluder device to seal a secondary endoleak arising at a scallop in a fenestrated stent-graft. A 67-year-old man with comorbidities precluding standard endovascular repair of a pararenal aortic aneurysm was treated with a fenestrated endoprosthesis containing one fenestration for the left renal artery and one scallop for the celiac trunk; the right renal and superior mesenteric arteries were occluded at presentation. Interval imaging at 2 years showed a proximal type I endoleak at the celiac trunk scallop associated with expansion of the aneurysm sac. Attempted repair with an aortic extension cuff and a "chimney" stent was unsuccessful. An Amplatzer Patent Foramen Ovale occluder device was deployed across the endoleak to provide aneurysm sac exclusion, which has been maintained at 6-month follow-up. Treatment of a secondary type I endoleak after implantation of a fenestrated endoprosthesis is challenging. The novel use of an Amplatzer occluder in this setting may be applicable to other situations in which an endovascular solution is desirable for complications of complex endovascular aneurysm repair.
    No preview · Article · Aug 2010 · Journal of Endovascular Therapy
  • P. D'Elia · M. Midulla · F. Maioli · N. O'Brien · S. Haulon
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    ABSTRACT: Acute type B aortic dissections (B AD) are managed medically. Up to one-third of the dissections are complicated by a malperfusion syndrome (visceral, renal, spinal, limb ischemia). Intervention (open surgical or endovascular) is reserved for complicated type B AD. Endovascular treatment includes the placement of a stent-graft into the proximal aorta, branch vessel stenting, uncovered stent placement in the abdominal aorta, and aortic fenestration. Recently, the paradigm of the treatment for these acute complicated dissections has shifted in favor of endovascular therapy over open surgical intervention. Although the evidence base for the roles of various approaches is sparse, data is currently being accumulated and must be analyzed to better estimate both the short and long-term benefits.
    No preview · Article · Jun 2010 · Italian Journal of Vascular and Endovascular Surgery