The Italian trial of endovascular AAA exclusion using the Parodi endograft.

PURPOSE: To report the outcome of the prospective 11-center Italian Parodi Trial using straight and tapered endografts for the endovascular exclusion of abdominal aortic aneurysms (AAA). METHODS: From April 1994 to July 1995, 27 patients were evaluated and selected for endovascular AAA exclusion. The Parodi devices were delivered through femoral arteriotomies using 18 to 22F introducers and deployed by balloon expansion of the terminal stents. RESULTS: Of 27 cases attempted, 24 endografts (15 tube, 9 aortomonoiliac) were implanted (1 deployment and 2 access failures [11.1%] were converted). Three endoleaks (12.5%) were treated intraoperatively with covered stents, two successfully, and the third sealed within 30 days. Three (12.5%) of the 24 treated patients died in-hospital of device-(n = 2) and procedure-related (n = 1) causes; the remaining 21 patients were discharged within 8 days. Of the 8 aortomonoiliac grafts in follow-up, only 1 (12.5%) failed in the mean 23-month (range 18 to 30) follow-up: however, 4 (31%) of 13 tube graft patients were converted to surgery within 18 months. Of the 16 (66.7%) surviving endografts at 2 years, 6 (38%) showed no change in the AAA diameter, while 10 (62%) had shrunk. CONCLUSIONS: The tube graft was applicable in only about 5% of cases, and accurate endograft sizing and distal fixation were problematic. The aortomonoiliac design was not appealing to surgeons but fared better in the long term. Given the advent of newer endograft models, the Italian Parodi Trial has been terminated.

[Vascular traumatic lesions in childhood and adolescence]. / Lesioni traumatiche vascolari in età pediatrica e adolescenziale.

The authors report their experience about 35 peripheric vascular injuries in childhood and adolescence. They analyze the epidemiological and clinical data and underline the usefulness of careful clinical and instrumental diagnosis. In order to obtain the best result they stress the importance of early revascularization by suturing in short lesions and by autologous tissue in longer lesions. Furthermore, they stress the importance of repairing venous injuries. Bone fractures have to be stabilized before vascular repair, subject to this not requiring prolonged ischemia. The authors conclude that only a multidisciplinary approach can ensure better results.

Mammographic findings after stereotaxic biopsy of the breast performed with large-core needles.

PURPOSE: To evaluate changes seen on mammograms obtained after large-core stereotaxic biopsy of the breast. MATERIALS AND METHODS: Twenty-seven patients underwent stereotaxic breast biopsy performed with large-core, 14-gauge needles. At least five core samples were obtained from each lesion. The mammograms obtained before biopsy were compared with those obtained 6 months later in the 24 patients in whom follow-up was performed. RESULTS: The only changes seen on the postbiopsy mammograms were due to tissue sampling (ie, fewer microcalcifications or defects were seen in areas of lesions from which tissue had been extracted). CONCLUSION: Large-core needle biopsy of the breast does not produce change or deformity that can be recognized on mammograms. Parenchymal scarring, architectural distortion, fat necrosis, or other identifiable changes seen after surgical biopsy of the breast are not seen after large-core, stereotaxic breast biopsy.

[Carotid endarterectomy with placement of a PUR (polyurethane) patch]. / La TEA carotidea con posizionamento di patch in PUR.

In this study, 40 patients who underwent surgery for cerebro-vascular insufficiency were considered. Carotid endarterectomy was the procedure of choice in all of the patients; the arteriotomy was always closed using a PUR patch, a new material that, for its chemical and physical characteristics seems to be a good alternative to PTFE. All of the patients underwent surgery under loco-regional anesthesia, allowing a perioperative monitoring of the neurological status through the patient's active collaboration. During the postoperative period, non local or systemic pathology related to the use of the patch has been observed. During the short and half term follow-up, the patients underwent echo-Doppler of the supra-aortic trunks that didn't show either false aneurysms or thrombosis on the patch surface.