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1.
World J Cardiol ; 15(4): 142-153, 2023 Apr 26.
Artículo en Inglés | MEDLINE | ID: mdl-37124976

RESUMEN

The recent shift of the concept of cardiovascular disease as a chronic progressive condition, potentially involving multiple districts, has driven attention to the optimal management of patients with concomitant coronary and peripheral artery disease, representing a subset of patients with an increased risk of events and impaired survival. Recent pharmacological achievements in terms of antithrombotic therapy and lipid-lowering drugs allow multiple therapeutical combinations, thus requiring optimizing the treatment in a tailored fashion according to patients' risk profiles. Nevertheless, data dedicated to this specific subset of patients are still modest. We summarize currently available strategies and indications for the management of antithrombotic and lipid-lowering drugs in patients with the poly-vascular disease.

2.
J Pers Med ; 13(2)2023 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-36836550

RESUMEN

BACKGROUND: Identifying sex-related differences/variables associated with 30 day/1 year mortality in patients with chronic limb-threatening ischemia (CLTI). METHODS: Multicenter/retrospective/observational study. A database was sent to all the Italian vascular surgeries to collect all the patients operated on for CLTI in 2019. Acute lower-limb ischemia and neuropathic-diabetic foot are not included. FOLLOW-UP: One year. Data on demographics/comorbidities, treatments/outcomes, and 30 day/1 year mortality were investigated. RESULTS: Information on 2399 cases (69.8% men) from 36/143 (25.2%) centers. Median (IQR) age: 73 (66-80) and 79 (71-85) years for men/women, respectively (p < 0.0001). Women were more likely to be over 75 (63.2% vs. 40.1%, p = 0.0001). More men smokers (73.7% vs. 42.2%, p < 0.0001), are on hemodialysis (10.1% vs. 6.7%, p = 0.006), affected by diabetes (61.9% vs. 52.8%, p < 0.0001), dyslipidemia (69.3% vs. 61.3%, p < 0.0001), hypertension (91.8% vs. 88.5%, p = 0.011), coronaropathy (43.9% vs. 29.4%, p < 0.0001), bronchopneumopathy (37.1% vs. 25.6%, p < 0.0001), underwent more open/hybrid surgeries (37.9% vs. 28.8%, p < 0.0001), and minor amputations (22% vs. 13.7%, p < 0.0001). More women underwent endovascular revascularizations (61.6% vs. 55.2%, p = 0.004), major amputations (9.6% vs. 6.9%, p = 0.024), and obtained limb-salvage if with limited gangrene (50.8% vs. 44.9%, p = 0.017). Age > 75 (HR = 3.63, p = 0.003) is associated with 30 day mortality. Age > 75 (HR = 2.14, p < 0.0001), nephropathy (HR = 1.54, p < 0.0001), coronaropathy (HR = 1.26, p = 0.036), and infection/necrosis of the foot (dry, HR = 1.42, p = 0.040; wet, HR = 2.04, p < 0.0001) are associated with 1 year mortality. No sex-linked difference in mortality statistics. CONCLUSION: Women exhibit fewer comorbidities but are struck by CLTI when over 75, a factor associated with short- and mid-term mortality, explaining why mortality does not statistically differ between the sexes.

4.
J Vasc Surg ; 64(4): 928-933.e1, 2016 10.
Artículo en Inglés | MEDLINE | ID: mdl-27288101

RESUMEN

OBJECTIVE: The aim of this study was to evaluate the incidence of acute kidney injury (AKI) after open and endovascular abdominal aortic aneurysm repair according to the Aneurysm Renal Injury Score classification. METHODS: We retrospectively evaluated 431 patients undergoing elective open aortic repair (OAR; n = 285) or endovascular repair (n = 146) for infrarenal aortic aneurysm. All data regarding preoperative and postoperative serum creatinine concentrations and postoperative outcomes were assessed. Univariate and multivariate logistic regression models investigated the association between AKI and different risk factors and complications. RESULTS: The incidence of AKI was significantly higher after OAR (26.3% vs 5.5%; P < .001). A significant share of patients who experienced AKI were restored to preoperative renal function at discharge (62.5% vs 77.5% in the endovascular and OAR groups, respectively; P = .37). Preoperative serum creatinine concentration was significantly higher in those patients who further developed AKI (1.25 vs 1.04 mg/dL; P < .001). At the multivariate analysis, AKI was significantly associated with current smoking (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.19-3.52; P = .01), hypertension (OR, 2.46; 95% CI, 1.21-4.3; P = .01), chronic renal disease (OR, 2.53; 95% CI, 1.42-4.53; P < .001), OAR (OR, 7.3; 95% CI, 3.25-16.42; P < .001), and arrhythmias (OR, 3.16; 95% CI, 1.09-9.13; P = .03). AKI stage did not affect postoperative outcomes, except for a longer hospital stay in patients in stage 2 and stage 3 compared with stage 1. CONCLUSIONS: AKI is a common but often reversible complication, especially after OAR. There is an urgent need of a common classification for AKI after aortic surgery. New diagnostic markers for AKI should be evaluated in large-scale studies to assess their reliability.


Asunto(s)
Lesión Renal Aguda/epidemiología , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Procedimientos Endovasculares/efectos adversos , Lesión Renal Aguda/sangre , Lesión Renal Aguda/diagnóstico , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Creatinina/sangre , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Incidencia , Italia/epidemiología , Tiempo de Internación , Modelos Logísticos , Masculino , Análisis Multivariante , Oportunidad Relativa , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
5.
Ann Vasc Surg ; 34: 111-8, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27157798

RESUMEN

BACKGROUND: Aortic aneurysm repair is a resolutive and effective surgical operation, which can be associated with severe postoperative complications. Procalcitonin (PCT) in clinical practice could play a role in early diagnosis and monitoring of therapy for complications, especially infections, making for timely and more effective interventions. Our aim was to investigate whether PCT could be a predictive marker in early diagnosis of infectious complications after open abdominal aortic surgery. METHODS: Eighty-three consecutive patients who underwent elective open aortic repair at our institution were enrolled. Blood samples were taken before surgery, and each day over the 7-day postoperative period, and measurement of serum PCT, C-reactive protein (CRP), and leukocytes levels were carried out. Data regarding clinical progress, instrumental examinations, and blood chemistry were prospectively collected. RESULTS: Postoperative infectious complications occurred in 24 patients. Within 30 days, 1 death occurred. In the study sample, we found a significant difference in PCT curves of patients with and without infectious complications, especially on third postoperative day (POD; P = 0.004). On analysis of the area under the curve (AUC curve), PCT was shown to be a fair predictor in distinguishing cases with infectious complications (AUC, 0.765 on third POD; CI, 0.638-0.877). Conversely, other inflammatory markers commonly used (leucocytes and CRP) had similar trends in patients with and without postoperative infections. CONCLUSIONS: On the basis of the results collected in this pilot study, despite some limitations, PCT could be considered a better marker of infectious complications after open abdominal aortic repair, when compared with other routinely used parameters.


Asunto(s)
Aorta Abdominal/cirugía , Calcitonina/sangre , Infecciones del Sistema Respiratorio/sangre , Infección de la Herida Quirúrgica/sangre , Infecciones Urinarias/sangre , Procedimientos Quirúrgicos Vasculares/efectos adversos , Anciano , Área Bajo la Curva , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Diagnóstico Precoz , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Italia , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Valor Predictivo de las Pruebas , Estudios Prospectivos , Curva ROC , Reproducibilidad de los Resultados , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/mortalidad , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/mortalidad , Factores de Tiempo , Resultado del Tratamiento , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/microbiología , Infecciones Urinarias/mortalidad , Procedimientos Quirúrgicos Vasculares/mortalidad
6.
Ann Vasc Surg ; 33: 228.e9-228.e13, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-26970445

RESUMEN

In this case series, we selected 4 patients with asymptomatic severe carotid stenosis due to unstable plaques, which were identified with contrast-enhanced ultrasound. These patients underwent carotid stenting with a new generation double mesh stent. Diffusion-weighted magnetic resonance imaging (DW-MRI) was executed before and after the procedure to detect early cerebral microembolizations. No early neurological complications occurred nor cerebral microembolizations were detected at DW-MRI. New double mesh carotid stents appear to be a safe option also in asymptomatic patients with unstable plaques at high risk for surgery.


Asunto(s)
Angioplastia/instrumentación , Arterias Carótidas/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/terapia , Medios de Contraste , Imagen de Difusión por Resonancia Magnética , Fosfolípidos , Stents , Hexafluoruro de Azufre , Mallas Quirúrgicas , Ultrasonografía/métodos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Placa Aterosclerótica , Valor Predictivo de las Pruebas , Diseño de Prótesis , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Ultrasonografía Doppler en Color
7.
J Ultrasound Med ; 35(3): 637-41, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26839371

RESUMEN

We report 2 cases of exclusion of visceral artery aneurysms. The first was a common hepatic artery aneurysm treated with a multilayer stent; the second was a celiac trunk aneurysm excluded by a covered stent. Computed tomographic angiography was performed at regular intervals after each procedure, together with echo color Doppler imaging and contrast-enhanced sonography. Computed tomographic angiography and contrast-enhanced sonography were able to detect endoleaks in both patients and the related inflow vessel; moreover, diameter measurements of the sacs were identical. In our preliminary experience, contrast-enhanced sonography appeared to be as accurate as computed tomographic angiography after endovascular visceral artery aneurysm exclusion.


Asunto(s)
Aneurisma/diagnóstico , Aneurisma/cirugía , Arteria Celíaca/diagnóstico por imagen , Arteria Hepática/diagnóstico por imagen , Stents , Ultrasonografía/métodos , Anciano de 80 o más Años , Arteria Celíaca/cirugía , Medios de Contraste , Arteria Hepática/cirugía , Humanos , Aumento de la Imagen/métodos , Masculino , Resultado del Tratamiento
9.
Korean Circ J ; 45(4): 337-9, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-26240589

RESUMEN

Primary aortoenteric fistula is a direct communication between the aorta and intestinal lumen and it represents a rare but potentially lethal complication of an abdominal aortic aneurysm. However, it may occur less frequently in a naive non-aneurysmatic aorta. Diagnosis is often difficult and delayed in most cases, unless there is a high level of clinical awareness. Urgent surgery is still the recommended treatment. We describe the case of primary aortoenteric fistula of a saccular aneurysm. A 55-year-old woman was referred to our center with hematemesis, melena, and severe anemia who was dignosed previously with unknown saccular abdominal aneurysm.

10.
Ann Vasc Surg ; 29(7): 1447.e13-6, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26122417

RESUMEN

The obstructive calcifying aortic disease refers to severe calcifications of the descending aorta that obstruct or slow blood flow. Here, we report the case of a 65-year-old woman with recent onset of a very tight intermittent claudication and concomitant severe and uncontrolled hypertension, treated with a bypass graft between the proximal descending thoracic aorta and the supravisceral abdominal aorta.


Asunto(s)
Aorta Torácica/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Enfermedades de la Aorta/cirugía , Arteriopatías Oclusivas/cirugía , Implantación de Prótesis Vascular , Calcificación Vascular/cirugía , Anciano , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/diagnóstico , Aortografía/métodos , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/diagnóstico , Femenino , Humanos , Hipertensión/etiología , Claudicación Intermitente/etiología , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Calcificación Vascular/complicaciones , Calcificación Vascular/diagnóstico
11.
Biomed Res Int ; 2015: 293163, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26180793

RESUMEN

Contrast-enhanced ultrasound (CEUS) has recently become one of the most versatile and powerful diagnostic tools in vascular surgery. One of the most interesting fields of application of this technique is the study of the carotid atherosclerotic plaque vascularization and its correlation with neurological symptoms (transient ischemic attack, minor stroke, and major stroke) and with the characteristics of the "vulnerable plaque" (surface ulceration, hypoechoic plaques, intraplaque hemorrhage, thinner fibrous cap, and carotid plaque neovascularization at histopathological analysis of the sample after surgical removal). The purpose of this review is to collect all the original studies available in literature (24 studies with 1356 patients enrolled) and to discuss the state of the art, limits, and future perspectives of CEUS analysis. The results of this work confirm the reliability of this imaging study for the detection of plaques with high risk of embolization; however, a shared, user-friendly protocol of imaging analysis is not available yet. The definition of this operative protocol becomes mandatory in order to compare results from different centers and to validate a cerebrovascular risk stratification of the carotid atherosclerotic lesions evaluated with CEUS.


Asunto(s)
Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Embolización Terapéutica/métodos , Placa Aterosclerótica/diagnóstico por imagen , Embolización Terapéutica/efectos adversos , Humanos , Ultrasonografía
12.
Radiol Med ; 120(11): 1050-5, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25805183

RESUMEN

OBJECTIVES: Cerebral microembolization, one of the most frequent complications of carotid artery stenting, is associated with an increased risk of peri- and post-procedural stroke and transient ischemic attack and a mid-term risk of neurocognitive decline. A valuable tool to evaluate carotid plaque instability and risk of embolization is contrast-enhanced ultrasound. With this prospective study we sought to determine the correlation between contrast enhancement of the plaque and cerebral microembolization after carotid stent deployment and to evaluate the clinical impact of the neurological injury. MATERIALS AND METHODS: Thirty-five consecutive patients with carotid artery stenosis and indications for endovascular stenting were enrolled. Before the procedure, patients were evaluated with contrast-enhanced ultrasound to define plaque enhancement (signal intensity). All endovascular procedures were performed under cerebral filter protection. Diffusion-weighted magnetic resonance imaging scans to detect microemboli were obtained before and 48 h after the stent deployment. The Ray auditory verbal learning test to assess neurocognitive function was administered before and 1 month after the procedure. RESULTS: Nineteen patients (54 %) developed new cerebral ischemic lesions after carotid artery stenting. Contrast enhancement of the plaque was greater in the patients with post-procedural microembolization than in those without it [maximum signal intensity 26 ± 7.7 vs. 21 ± 5.2, respectively, (p = 0.039), mean signal intensity, 20.7 ± 6.1 vs. 16.5 ± 5.3, respectively (p = 0.048)]. No correlation was found between neurocognitive test scores and microembolization or plaque enhancement. CONCLUSION: Contrast enhancement of the carotid plaque is strongly associated with post-procedural microembolization and for this reason it can be considered a reliable tool for an accurate selection of patients undergoing this endovascular treatment. However, the neurocognitive test scores performed in this study are not enough sensible to appreciate the impact of the neurological injury on the day life activities.


Asunto(s)
Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/cirugía , Embolia Intracraneal/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Stents/efectos adversos , Anciano , Medios de Contraste , Imagen de Difusión por Resonancia Magnética , Dispositivos de Protección Embólica , Femenino , Humanos , Embolia Intracraneal/prevención & control , Masculino , Pruebas Neuropsicológicas , Complicaciones Posoperatorias/prevención & control , Valor Predictivo de las Pruebas , Estudios Prospectivos , Riesgo , Ultrasonografía
14.
Korean J Thorac Cardiovasc Surg ; 47(4): 413-5, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25207255

RESUMEN

The superficial femoral artery (SFA) is a relatively rare location for lower limb aneurysmatic disease. In the literature, this disease is described an association between a relatively high growth rate and/or the rupture of aneurysms and chemotherapeutic agents. We report a case of the rupture of a giant SFA aneurysm in a patient during chemotherapy for acute lymphatic leukemia.

15.
BMC Urol ; 14: 40, 2014 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-24885698

RESUMEN

BACKGROUND: Seminomatous and non-seminomatous Germ Cell Tumors (GCT) of the testis are a rare cancer, with an estimated incidence of 56.3 per million white males and 10 per million black males in the United States.The association between non-seminomatous GCT and horseshoe kidney is a rare event and is seen in about 1.3% of patients requiring retroperitoneal lymph node dissection. To our knowledge, no cases have been reported in which replacement of the IVC was also necessary. CASE PRESENTATION: We report the case of a 22-year-old man with horseshoe kidney and metastatic non-seminomatous germ cell tumor involving the wall of the inferior vena cava.Following post-chemotherapy retroperitonal lymph node dissection, the inferior vena cava was replaced with an expanded polytetrafluoroethylene graft.At 2-years follow-up, the patient was in good health and the graft was patent. No clinical or diagnostic signs of renal impairment or recurrence of neoplastic disease were noted. CONCLUSION: Radical surgery is warranted in patients with non-seminomatous germ cell tumor metastasizing to the retroperitoneal lymph nodes. When vena cava replacement is required, and the situation is further complicated by horseshoe kidney, as in this case, surgical technique will rely on multidisciplinary surgical treatment planning by a team composed of urologists, vascular surgeons and oncologists.


Asunto(s)
Prótesis Vascular , Riñón/anomalías , Seminoma/secundario , Seminoma/cirugía , Neoplasias Testiculares/cirugía , Vena Cava Inferior/cirugía , Humanos , Metástasis Linfática , Masculino , Implantación de Prótesis/métodos , Seminoma/complicaciones , Neoplasias Testiculares/complicaciones , Resultado del Tratamiento , Vena Cava Inferior/patología , Adulto Joven
16.
Ann Vasc Surg ; 28(7): 1789.e9-1789.e12, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24530711

RESUMEN

Popliteal vein aneurysms (PVAs) are rare but may cause severe and even fatal complications, such as pulmonary embolism (PE). A woman at the eighth week of pregnancy came to our attention because of a thrombosis of a previously undetected left PVA, diagnosed after a PE episode. Surgery was delayed until after delivery and breastfeeding, during which anticoagulant therapy was established.


Asunto(s)
Aneurisma/complicaciones , Aneurisma/diagnóstico por imagen , Vena Poplítea/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/etiología , Adulto , Aneurisma/cirugía , Anticoagulantes/uso terapéutico , Femenino , Humanos , Embarazo , Embolia Pulmonar/tratamiento farmacológico , Ultrasonografía Doppler en Color
18.
Case Rep Med ; 2012: 873168, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22454650

RESUMEN

A 33-year-old man presented with a pulsatile mass in the left temporal region; about 1 year before the current presentation, the swelling had arisen on the upper lateral border of the orbital arch and increased in recent months. His medical history was negative for accidental or iatrogenic head injury. Color echo Doppler and angio-computed tomography demonstrated a fusiform aneurysm of the zygomatic orbital artery, a branch of the superficial temporal artery. Blood tests were negative for human immunodeficiency virus (HIV), hepatitis C (HCV), and hepatitis B (HBV) markers. Aneurysmectomy under local anesthesia was performed. Histology of the surgical specimen confirmed the diagnosis of a true aneurysm measuring 8.4 × 5.7 mm, which showed no atherosclerotic degeneration of the vessel walls; the lumen was filled by a recent thrombus but without inflammatory cells. Surgical treatment is indicated for the prevention of rupture, the relief of pain when present, and the removal of facial defects. To the authors' knowledge, this is the first case in the literature of a true aneurysm of the zygomatic orbital artery.

19.
Ann Vasc Surg ; 26(4): 572.e5-9, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22321474

RESUMEN

The popliteal artery (PA) entrapment syndrome, a rare cause of arterial thrombosis, is most often encountered in young male athletes. Here, we report a very unusual case of PA entrapment syndrome in a 14-year-old girl who presented with a 1-month history of calf claudication to our observation facility. Diagnostic work-up revealed obesity, sedentary lifestyle, and an aberrant accessory slip of the medial head of gastrocnemius around the PA. Arterial echo color Doppler ultrasonography and computed tomographic angiography studies were performed. Surgical treatment involved revascularization with resection of the medial head of gastrocnemius, the cause of the arterial entrapment, and enlargement angioplasty using an autologous saphenous vein patch, in combination with antiplatelet therapy, resulting in restitution ad integrum of the affected limb and, finally, an improved quality of life of the patient. This case underscores the importance of clinical suspicion, diagnosis, and treatment of lower-limb claudication in very young patients presenting with unusual symptoms. If missed, the condition may evolve dramatically. Prompt diagnosis and surgical treatment are key to complete recovery and the prevention of irreversible complications that may result in limb loss.


Asunto(s)
Claudicación Intermitente/etiología , Arteria Poplítea , Procedimientos Quirúrgicos Vasculares/métodos , Angiografía de Substracción Digital , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Claudicación Intermitente/diagnóstico , Claudicación Intermitente/cirugía , Angiografía por Resonancia Magnética , Índice de Severidad de la Enfermedad , Síndrome , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler en Color , Adulto Joven
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