27 results on '"Calio FG"'
Search Results
2. Seat-belt related injuries to the supraaortic arteries
- Author
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Illuminati, Giulio, Calio', Fg, Bertagni, A, Mangialardi, N, and Martinelli, V.
- Published
- 1999
Catalog
3. The effects of sulodexide on both clinical and molecular parameters in patients with mixed arterial and venous ulcers of lower limbs
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Serra R, Gallelli L, Conti A, De Caridi G, Massara M, Spinelli F, Buffone G, Caliò FG, Amato B, Ceglia S, Spaziano G, Scaramuzzino L, Ferrarese AG, Grande R, and de Franciscis S
- Subjects
Therapeutics. Pharmacology ,RM1-950 - Abstract
Raffaele Serra,1,2,* Luca Gallelli,3,* Angela Conti,1 Giovanni De Caridi,4 Mafalda Massara,4 Francesco Spinelli,4 Gianluca Buffone,1 Francesco Giuseppe Caliò,5 Bruno Amato,6 Simona Ceglia,7 Giuseppe Spaziano,8 Luca Scaramuzzino,9 Alessia Giovanna Ferrarese,10 Raffaele Grande,1 Stefano de Franciscis1,2 1Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy; 2Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy; 3Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy; 4Cardiovascular and Thoracic Department, University of Messina, Messina, Italy; 5Unit of Vascular Surgery, S Anna Hospital, Catanzaro, Italy; 6Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy; 7Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy; 8Department of Experimental Medicine, Second University of Naples, Naples, Italy; 9University Campus BioMedico of Rome, Rome, Italy; 10Department of General Surgery, University of Turin, Turin, Italy *These authors contributed equally to this work Background: Mixed venous and arterial ulcers account for approximately 15%–30% of all venous leg ulcerations. Several studies have shown that matrix metalloproteinases (MMPs) and neutrophil gelatinase-associated lipocalin (NGAL) play a central role in the pathophysiology of venous and arterial diseases. Some studies have shown the efficacy of glycosaminoglycans, such as sulodexide (SDX), in treating patients with leg ulcers. The aim of this study was to evaluate clinical effects of SDX and its correlation with MMPs and NGAL expression in patients with mixed arterial and venous leg ulcers. Methods: Patients eligible for this study were of both sexes, older than 20 years, and with a clinical and instrumental diagnosis of mixed ulcer. Results: Fifty-three patients of both sexes were enrolled and divided into two groups by means of randomization tables. Group A (treated group) comprised 18 females and ten males (median age: 68.7 years) treated with standard treatment (compression therapy and surgery) + SDX (600 lipoprotein lipase-releasing units/day intramuscularly) for 15 days followed by SDX 250 lipase-releasing units every 12 hours day orally for 6 months as adjunctive treatment. Group B (control group) comprised 17 females and eight males (median age: 64.2 years) treated with standard treatment only (compression therapy and surgery). The type of surgery was chosen according to anatomical level of vein incompetence: superficial venous open surgery and/or subfascial endoscopic perforating surgery. In all enrolled patients, blood samples were collected in order to evaluate the plasma levels of MMPs and NGAL through enzyme-linked immunosorbent assay. These results were compared to another control group (Group C) of healthy individuals. Moreover, biopsies of ulcers were taken to evaluate the tissue expression of MMPs and NGAL through Western blot analysis. Our results revealed that SDX treatment is able to reduce both plasma levels and tissue expression of MMPs improving the clinical conditions in patients with mixed ulcers. Conclusion: Inhibition of MMPs could represent a possible therapeutic intervention to limit the progression of leg ulceration. In particular, our findings demonstrate the efficacy of SDX in patients with mixed arterial and venous chronic ulcers of the lower limbs. Keywords: mixed ulcer, arterial ulcer, metalloproteinases, neutrophil gelatinase-associated lipocalin more...
- Published
- 2014
4. Simultaneous Laparoscopic Cholecystectomy and Endovascular Infrarenal Aortic Aneurysm Repair.
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Illuminati G, Calio' FG, Pasqua R, Nardi P, Fratini C, and Urciuoli P
- Abstract
Background/Aim: With the increasing use of endovascular aneurysm repair (EVAR) and the availability of laparoscopic cholecystectomy (LC) for treating abdominal aortic aneurysms (AAA) and cholelithiasis, respectively, the association between these elective treatments is not yet well-defined. Thus, this study aimed to evaluate the results of elective and simultaneous EVAR and LC. Methods: Thirteen patients (mean age, 72 years) with concomitant large and asymptomatic AAA and asymptomatic cholelithiasis underwent simultaneous EVAR and LC. Results: Post-operative mortality was absent, and the morbidity rate was 7%. The mean total duration of the procedure was 142 min. The mean duration of fluoroscopy was 19 min, and the mean radiation dose was 65 mGy. The mean amount of iodinated contrast injected was 49 mL. The timing of oral fluid intake was 28 h (range, 24-48 h) and that of the oral low-fat diet was 53 h (range, 48-72 h). No patient presented with an aortic graft infection during the entire follow-up period (mean duration, 41 months). The mean length of post-operative hospital stay was 6 days (range, 5-8 days). Late survival was 85%, and the exclusion of AAA was 100%. Conclusion: Simultaneous EVAR and LC can be performed safely, allowing effective and durable treatment under both AAA and cholelithiasis conditions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Illuminati, Calio', Pasqua, Nardi, Fratini and Urciuoli.) more...
- Published
- 2021
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5. Results of resection of carotid body tumors with and without lymphnodes' dissection.
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Illuminati G, Pasqua R, Nardi P, Fratini C, Minni A, and Calio' FG
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- Adult, Aged, Carotid Body Tumor diagnostic imaging, Carotid Body Tumor pathology, Female, Humans, Male, Middle Aged, Operative Time, Patient Selection, Retrospective Studies, Treatment Outcome, Young Adult, Carotid Body Tumor surgery, Lymph Node Excision
- Abstract
Background: Carotid body tumor (CBT) is a slow-growing tumor arising from the carotid body, a chemoceptor organ lying behind the carotid artery bifurcation. Although rarely, metastases can occur distally through the hematogenous route and through the lymphatic route.to the cervical lymphnodes. The purpose of this study was to assess whether lymphnodes' resection should systematically be associated with the primary resection of a CBT., Methods: A retrospective analysis of 82 patients, 52 women of a mean age of 42 years undergoing resection of 88 CBT from 1994 to 2019. CBT were divided into 2 groups. Tumors in group A (n = 23, 26%) were treated by resection of the mass followed by a selective latero-cervical lymphadenectomy; tumors in group B (n = 65, 74%) underwent isolated resection of the mass. The study's primary endpoints were postoperative stroke/mortality rate, disease-specific survival and rate of local and distant recurrence of the disease., Results: Postoperative stroke-mortality rate was nil. One patient in group A (4.3%) presented a minor weakness of the contralateral arm, completely regressive within 12 h. One patient in group B (1.5%) died of liver and lung metastases 51 months after operation, no patient died of recurrent disease in group A (p = .62). No nodal recurrence was observed in group A, whereas one patient in group B (1.5%) presented nodal recurrence 39 months after primary tumor resection (p = .58) CONCLUSION: Selective lymphadenectomy associated with CBT resection does not increase the overall long-term survival and cannot be considered mandatory. It may help to better define the stage of the disease and to plan eventual adjuvant treatments., (Copyright © 2021. Published by Elsevier Ltd.) more...
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- 2021
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6. Intravascular Ultrasound-Assisted Endovascular Exclusion of Penetrating Aortic Ulcers.
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Illuminati G, Pasqua R, Nardi P, Fratini C, Calio FG, and Ricco JB
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- Aged, Aorta, Thoracic diagnostic imaging, Aortic Diseases diagnostic imaging, Blood Vessel Prosthesis, Endoleak etiology, Female, Humans, Length of Stay, Male, Middle Aged, Operative Time, Retrospective Studies, Stents, Time Factors, Treatment Outcome, Ulcer diagnostic imaging, Aorta, Thoracic surgery, Aortic Diseases surgery, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation instrumentation, Endovascular Procedures adverse effects, Endovascular Procedures instrumentation, Ulcer surgery, Ultrasonography, Interventional
- Abstract
Background: Penetrating aortic ulcer (PAU) is an atherosclerotic lesion penetrating the elastic lamina and extending into the media of the aorta. It may evolve into intramural hematoma, focal dissection, pseudoaneurysm, and eventually rupture. The purpose of this study was to evaluate the effectiveness of a totally intravascular ultrasound (IVUS)-assisted endovascular exclusion of PAU., Methods: Thirteen consecutive patients (median age 66 years) underwent IVUS-assisted endovascular exclusion of PAU. The primary end points were fluoroscopy time, radiation dose, and occurrence of type I primary endoleak. Secondary end points were postoperative mortality and morbidity, arterial access complications, postoperative length of stay in the hospital, and occurrence of type II endoleaks., Results: The median fluoroscopy time was 4 min (4-5). The median radiation dose was 4.2 mGy (3.9-4.5). A proximal and distal landing zone of at least 2 cm could be obtained in all the patients. No patient presented a type I endoleak. No postoperative mortality, no morbidity, or arterial access complication was observed. The median length of postoperative stay in the hospital was 2 days (2-3). The median length of follow-up was 25 months (9.2-38.7). One late type II endoleak was observed (7.7%), because of reflux from the intercostal arteries, without the need for additional treatment., Conclusions: IVUS-assisted endovascular treatment of PAU allows durable exclusion of PAU with a short fluoroscopy time and no need for injection of contrast media. Further series are needed to confirm the results of this preliminary study., (Copyright © 2020 Elsevier Inc. All rights reserved.) more...
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- 2021
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7. Long-term results of polytetrafluoroethylene versus saphenous vein repair of degenerative carotid artery aneurysm.
- Author
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Illuminati G, Pizzardi G, Pasqua R, Nardi P, Calio' FG, and Ricco JB
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- Aged, Aneurysm mortality, Blood Vessel Prosthesis adverse effects, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation instrumentation, Carotid Artery Diseases mortality, Coronary Artery Bypass adverse effects, Coronary Artery Bypass instrumentation, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Polytetrafluoroethylene adverse effects, Postoperative Complications etiology, Saphenous Vein transplantation, Treatment Outcome, Vascular Patency, Aneurysm surgery, Blood Vessel Prosthesis Implantation methods, Carotid Artery Diseases surgery, Coronary Artery Bypass methods, Postoperative Complications epidemiology
- Abstract
Objective: To compare the results of polytetrafluoroethylene (PTFE) and great saphenous vein (GSV) bypass after resection of a degenerative aneurysm of the carotid artery., Methods: From January 1994 to November 2017, 37 patients (27 men) with a mean age of 58 years (range, 39-82 years) with a degenerative aneurysm of the carotid artery (median diameter, 28 mm; range, 19-42 mm), underwent resection of the aneurysm followed by a bypass with either a GSV (n = 10) or a PTFE prosthesis (n = 27). Although 31 patients were asymptomatic, 6 patients were symptomatic: transient ischemic attack (n = 4), minor stroke (n = 1), and compression of the hypoglossal nerve (n = 1). The preoperative workup included duplex ultrasound examination of the arteries to the head, and angiography or computed tomography angiography. All patients were operated under general anesthesia and six were intubated through the nose. Sixteen patients were monitored through transcutaneous oximetry. No shunt was used in this series. In 10 patients receiving a PTFE graft, the external carotid artery was implanted in the prosthesis. Mean follow-up was 16.9 ± 2 years (95% confidence interval, 14.5-19.3 years). Primary end points were the 30-day combined stroke/death rate, graft infection, late graft patency, and late stroke-free survival. Secondary end points were cranial nerve injury and length of postoperative hospital stay., Results: Postoperative mortality was nil in both groups. One postoperative stroke was observed in the PTFE group, whereas none occurred in the GSV group (P = .84). No graft infection was observed in either group. At 10 years, survival in the GSV group was 80 ± 12%, and survival in the PTFE group was 76 ± 8% (log-rank [Mantel-Cox], P = .85). In the GSV group, graft patency at 7 and 10 years was 85 ± 13%. In the PTFE group B, graft patency was 100% (log-rank [Mantel-Cox], P = .12). No late stroke was observed. Two transient cranial nerve injuries were observed in the GSV group (20%) and two in the PTFE group (8%) (P = .97). Length of hospital stay was comparable in both groups (GSV group, 6 days; PTFE group, 5 days; P = .12)., Conclusions: This study suggests that, after resection of a degenerative aneurysm of the carotid artery, bypass with a PTFE prosthesis gives comparable results to those obtained with the GSV. We recommend sparing the GSV and instead using a PTFE prosthesis in patients with a degenerative aneurysm of the carotid artery., (Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.) more...
- Published
- 2020
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8. Laparoscopic lavage/drainage as a bridge treatment for perforated diverticulitis with purulent peritonitis associated with an abdominal aortic aneurysm A retrospective case-control study.
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Illuminati G, Krizzuk D, Calio FG, Urciuoli P, Pizzardi G, and Pasqua R
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- Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal complications, Case-Control Studies, Diverticulitis complications, Female, Humans, Intestinal Perforation complications, Male, Peritonitis complications, Retrospective Studies, Suppuration complications, Suppuration surgery, Therapeutic Irrigation methods, Diverticulitis surgery, Drainage methods, Intestinal Perforation surgery, Laparoscopy, Peritonitis surgery
- Abstract
Aim: Laparoscopic lavage /drainage (LALA) or surgical resection are both methods of treatment for perforated diverticulitis with purulent peritonitis (Hinchey Stage III). In case of associated abdominal aortic aneurysm (AAA), laparoscopic lavage/drainage could be an interesting bridge option to treat sepsis before endovascular exclusion of the aneurysm and resection of the sigmoid. We performed LALA as a bridge treatment of peritonitis before elective, staged endovascular exclusion of the aneurysm (EE) and elective resection of the colon., Material and Methods: Seven patients presenting a perforated diverticulitis with purulent peritonitis (Hinchey III), associated with an uncomplicated AAA of a mean diameter of 6 cm, underwent LALA followed by staged EE and resection. They were retrospectively reviewed for a case-control study. The mean length of follow-up after completing all the procedures was 28 months. Primary endpoints were mortality and morbidity of each procedure, complications related to each procedure and to the untreated disease in the interval between each one of them, late outcome and complications related to each treatment method. As secondary endpoints, the mean length of surgery for resection, of stay in the hospital, of the interval between each procedure, and of time required for the treatment of both the diseases were considered., Results: Postoperative mortality was absent. Morbidity consisted of a sigmoido-vescical fistula 18 days after resolution of peritonitis and sepsis, not hindering EE,and a delayed healing of the surgical wound for access to the common femoral artery (28.6%). No complications of untreated disease in the interval between each procedure were observed. No late complications of both diseases occurred. The mean interval between LALA and EE,and between EE and resection was, respectively, 19 days and 18 days. Both the diseases were treated within a mean delay of 37 days after LALA (range, 24-61 days)., Conclusions: LALA, as a bridge treatment, before EE and resection, in patients presenting a perforated diverticulitis with purulent peritonitis, associated with an uncomplicated AAA, may be an effective treatment option., Key Words: Perforated diverticulitis, Purulent peritonitis, Abdominal aortic aneurysm. more...
- Published
- 2019
9. Results of subclavian to carotid artery bypass for occlusive disease of the common carotid artery: A retrospective cohort study.
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Illuminati G, Pizzardi G, Calio FG, Masci F, Pasqua R, Frezzotti F, and Peschillo S
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- Aged, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Carotid Artery, Common surgery, Carotid Stenosis surgery, Coronary Artery Bypass methods, Subclavian Artery surgery
- Abstract
Background: Optimal treatment of significant atherosclerosis of the common carotid artery (CCA) is not well-defined. The purpose of this study was to evaluate the long-term results of prosthetic subclavian to carotid bypass for occlusive disease of the CCA., Material and Methods: From January 1994 to December 2015, 45 patients, mean age 67 years, underwent an ipsilateral subclavian to carotid bypass for occlusive disease of the CCA. Thirty-eight patients (84%) presented with neurologic symptoms, including transitory ischemic attacks in 29 cases and minor strokes in 9 cases. The graft material consisted of a 7 mm polytetrafluoroethylene conduit, and the distal anastomosis was done on the carotid bulb in 21 patients, on the internal carotid artery in 19 cases, and on the distal CCA in 5 cases. Median length of follow-up was 58 months. Study endpoints were the combined postoperative stroke/mortality rate, graft infection, overall late survival, freedom from ipsilateral stroke, and graft patency., Results: Postoperative stroke/mortality rate was 2%. No graft infection was observed throughout follow-up. At 60 months, overall survival, freedom from stroke, and graft patency were 71% (standard error [SE] = 0.07), 98% (SE = 0.02), and 95.5% (SE = 0.06), respectively., Conclusions: Subclavian to carotid bypass allows very good patency rates and excellent protection from postoperative and late stroke, remaining a benchmark for any other treatment method., (Copyright © 2018. Published by Elsevier Ltd.) more...
- Published
- 2018
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10. Response to: reimplanting the superior mesenteric artery on the infra-renal aorta.
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Illuminati G, Pizzardi G, Calio' FG, Pasqua R, Masci F, and Vietri F
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- Aorta, Abdominal, Kidney, Mesenteric Arteries, Aorta, Mesenteric Artery, Superior
- Published
- 2018
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11. Results of Infrageniculate Bypasses Using the Profunda Femoris Artery as Inflow Source.
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Illuminati G, Calio' FG, Pizzardi G, Pasqua R, Masci F, Frezzotti F, Palumbo P, and Vietri F
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- Aged, Aged, 80 and over, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation instrumentation, Computed Tomography Angiography, Female, Femoral Artery diagnostic imaging, Femoral Artery physiopathology, Humans, Limb Salvage, Male, Middle Aged, Peripheral Arterial Disease diagnostic imaging, Peripheral Arterial Disease physiopathology, Polytetrafluoroethylene, Prosthesis Design, Regional Blood Flow, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Vascular Patency, Femoral Artery surgery, Peripheral Arterial Disease surgery, Saphenous Vein transplantation
- Abstract
Background: When the common femoral artery is not accessible for infrainguinal bypass grafting, the profunda femoris artery (PFA) can be a valuable alternative inflow source for distal arterial revascularization. The purpose of this retrospective study was to evaluate the results of infrageniculate bypass grafting via the PFA as inflow source for critical limb ischemia., Methods: Between 1994 and 2016, 68 patients, 51 men of a mean age of 74 years, underwent an infrageniculate arterial bypass grafting for critical limb ischemia, using the PFA as inflow site. PFA was exposed at the Scarpa's triangle in 38 patients (56%) and at its medio-crural segment in 30 patients (44%). The distal anastomosis was performed on the infragenicular popliteal artery in 33 patients (48%), the peroneal artery in 14 patients (20%), the tibioperoneal trunk in 8 patients (12%), the posterior tibial artery in 8 patients (12%), and the dorsalis pedis artery in 5 patients (8%). The graft material consisted of a reversed great saphenous vein (GSV) in 62 patients (91%) and a 6-mm polytetrafluoroethylene graft in 6 patients (9%). The median duration of follow-up was 51 months (range, 6-72 months). As main results, postoperative mortality and morbidity, overall late patients' survival, primary grafts' patency, and limb salvage rate were considered., Results: Operative mortality and morbidity were 3% and 4%, respectively. Overall patients' survival, primary patency and limb salvage rate, at 36 and 60 months were, respectively, 62% and 53%, 66% and 59%, and 92% and 77%., Conclusions: The PFA, both exposed at the Scarpa's triangle and at mid-thigh, is an excellent inflow source for infrageniculate revascularizations. It should remain an important part of the technical armamentarium of vascular surgeons, even in the endovascular era., (Copyright © 2017 Elsevier Inc. All rights reserved.) more...
- Published
- 2018
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12. True aneurysm of the proximal occipital artery: Case report.
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Illuminati G, Cannistrà M, Pizzardi G, Pasqua R, Frezzotti F, and Calio' FG
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Introduction: True aneurysms of the proximal occipital artery are rare, may cause neurological symptoms due to compression of the hypoglossal nerve and their resection may be technically demanding., Presentation of Case: The case of an aneurysm of the proximal occipital artery causing discomfort and tongue deviation by compression on the hypoglossal nerve is reported. Postoperative course after resection was followed by complete regression of symptoms., Conclusion: Surgical resection, as standard treatment of aneurysms of the occipital artery, with the eventual technical adjunct of intubation by the nose is effective in durably relieving symptoms and preventing aneurysm-related complication., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.) more...
- Published
- 2018
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13. Infrarenal aorta as the donor site for bypasses to the superior mesenteric artery for chronic mesenteric ischemia: A prospective clinical series of 24 patients.
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Illuminati G, Pizzardi G, Calio' FG, Pasqua R, Masci F, and Vietri F
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- Adult, Aged, Aged, 80 and over, Aorta, Abdominal diagnostic imaging, Arterial Occlusive Diseases diagnostic imaging, Celiac Artery pathology, Chronic Disease, Constriction, Pathologic, Female, Humans, Male, Mesenteric Artery, Inferior pathology, Mesenteric Artery, Superior diagnostic imaging, Middle Aged, Prospective Studies, Aorta, Abdominal surgery, Arterial Occlusive Diseases surgery, Blood Vessel Prosthesis Implantation, Mesenteric Artery, Superior surgery, Mesenteric Ischemia surgery
- Abstract
Background: Treatment of symptomatic, chronic mesenteric ischemia is indicated to relieve symptoms and prevent acute ischemia and death. Current therapeutic options include endovascular and open surgery. The purpose of this prospective study was to evaluate the results of bypasses to the superior mesenteric artery arising from the infrarenal aorta or infrarenal aortic grafts., Methods: From January 1999 to December 2016, 24 consecutive patients with a mean age of 61 years underwent a prosthetic bypass to the superior mesenteric artery. Nine patients (37%) presented with an associated clinically important stenosis of the celiac artery and 10 (42%) of the inferior mesenteric artery. Five patients (21%) received preoperative parenteral nutrition. Four patients (17%) underwent dual antiplatelet treatment. The donor site was the infrarenal aorta in 19 patients (79%) and an infrarenal, Dacron graft was used in 5 (21%). The origin of the bypass was from the distal infrarenal aorta or Dacron graft in 19 patients (79%) and from the proximal infrarenal aorta in 5 patients (21%). The graft material consisted of 7 mm polytetrafluoroethylene in 19 cases (79%) and 7 mm Dacron in 5 cases (21%). A concomitant bypass to the inferior mesenteric artery was performed in 4 patients (17%). The primary end points were postoperative mortality, morbidity, graft infection, late survival, primary patency, and symptom-free rate. The secondary end point was postoperative hemorrhagic complications., Results: No postoperative mortality occurred. Postoperative morbidity included a prolonged postoperative ileus in 4 patients (17%), transitory postoperative increases in serum creatinine concentrations in 3 patients (12%), and myocardial ischemia in 2 patients (8%). No postoperative hemorrhagic complications or graft infection were observed. Overall, the cumulative survival rate was 77% at 60 months. The overall late-patency rate and freedom from recurrence of symptoms were both 87% at 60 months., Conclusion: Infrarenal aorta and infrarenal aortic grafts are an excellent source for the revascularization of the superior mesenteric artery. Bypasses to the superior mesenteric artery from the infrarenal aorta, either isolated or associated with adjunctive bypass to the inferior mesenteric artery, yield results that are comparable with those obtained with complete digestive artery revascularization using other donor sources., (Copyright © 2017 Elsevier Inc. All rights reserved.) more...
- Published
- 2017
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14. Dual Antiplatelet Therapy Does Not Increase the Risk of Bleeding After Carotid Endarterectomy: Results of a Prospective Study.
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Illuminati G, Schneider F, Pizzardi G, Masci F, Calio' FG, and Ricco JB
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- Aged, Aged, 80 and over, Anticoagulants administration & dosage, Aspirin adverse effects, Asymptomatic Diseases, Carotid Stenosis complications, Carotid Stenosis diagnostic imaging, Carotid Stenosis mortality, Clopidogrel, Drug Therapy, Combination, Endarterectomy, Carotid mortality, Female, Humans, Ischemic Attack, Transient etiology, Male, Middle Aged, Platelet Aggregation Inhibitors adverse effects, Postoperative Hemorrhage chemically induced, Postoperative Hemorrhage mortality, Prospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Stroke etiology, Ticlopidine administration & dosage, Ticlopidine adverse effects, Time Factors, Treatment Outcome, Aspirin administration & dosage, Carotid Stenosis surgery, Endarterectomy, Carotid adverse effects, Platelet Aggregation Inhibitors administration & dosage, Postoperative Hemorrhage etiology, Ticlopidine analogs & derivatives
- Abstract
Background: The purpose of this study was to evaluate the risk of bleeding and other postoperative complications of carotid endarterectomy (CEA) in patients receiving dual antiplatelet therapy (DAPT)., Methods: From January 2005 to December 2015, 188 consecutive patients undergoing CEA and receiving DAPT (aspirin 100 mg + clopidogrel 75 mg) were enrolled in a prospective study. All of them underwent coronary artery stenting with drug-eluting stents during the 6 months preceding CEA. In the entire series, DAPT was continued until the evening before CEA and resumed on the evening of the operation. All patients received intraoperative heparinization (5,000 IU before carotid clamping), which was reversed in 5 patients. In addition, all of them were given 2,000 units of enoxaparin every 12 hr after the operation, beginning 6 hr after completion of the operation, and until discharge. All the patients presented with carotid artery stenosis >70% (North American Symptomatic Carotid Endarterectomy Trial [NASCET] criteria), which was symptomatic in 42 patients (transient ischemic attack, n = 32; minor stroke, n = 10) and asymptomatic in 146. The CEA technique was standard, with prosthetic patch closure in 109 cases (58%) and eversion in 79 (42%). The primary endpoints of the study were occurrence of a postoperative cervical hematoma requiring surgical hemostasis and occurrence of cranial nerve injuries. The secondary endpoint was the combined rate of postoperative mortality, stroke, and myocardial ischemia., Results: No postoperative cervical hematoma requiring surgical evacuation occurred in this series. One hypoglossal nerve palsy, regressive within 2 weeks, was observed. Postoperative mortality and neurologic and cardiac morbidity were nil., Conclusions: CEA under DAPT yields results comparable with those obtained in patients receiving a single antiplatelet treatment. No hemorrhagic complications were observed in this prospective series., (Copyright © 2017 Elsevier Inc. All rights reserved.) more...
- Published
- 2017
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15. Outcome of Resection and Chemotherapy versus Chemotherapy Alone for Retroperitoneal Recurrence of Testicular Cancer Involving the Inferior Vena Cava: A Retrospective Cohort Study of 22 Consecutive Patients.
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Illuminati G, Calio FG, Angelici AM, Pizzardi G, Pasqua R, Masci F, and Vietri F
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- Adult, Chemotherapy, Adjuvant, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local therapy, Retroperitoneal Neoplasms mortality, Retroperitoneal Neoplasms secondary, Retrospective Studies, Testicular Neoplasms mortality, Testicular Neoplasms pathology, Treatment Outcome, Vascular Neoplasms secondary, Vena Cava, Inferior surgery, Retroperitoneal Neoplasms therapy, Testicular Neoplasms therapy, Vascular Neoplasms therapy
- Abstract
Background/aim: Optimal treatment strategy for retroperitoneal recurrence of testicular cancer involving the inferior vena cava (IVC) is uncertain. The purpose of this study was to validate the hypothesis that surgical resection, en-bloc with the involved segment of IVC and its subsequent reconstruction followed by chemotherapy, would yield better oncologic results than chemotherapy alone., Patients and Methods: Two consecutive series of patients with retroperitoneal recurrence of testicular cancer involving the IVC, treated with surgical resection plus chemotherapy (group A, n=14) or chemotherapy alone (group B, n=8) were retrospectively reviewed. The mean duration of follow-up was was 65 months (range=8-184). Operative mortality and morbidity in group A, response to chemotherapy in group B, disease-specific survival and quality adjusted life-years (QALY) for both groups, were primary end-points of the study., Results: Postoperative mortality and morbidity (group A) were, respectively, nil and 14%. In group B, two patients (25%) fully responded to chemotherapy and remained free from disease progression. Disease-specific survival at 3 and 5 years was 81% and 54% in group A and 36% in group B both at 3 and 5 years, respectively (p=0.02). QALY was 3.92 in group A and 0.77 for both 3 and 5 years in group B, respectively, (p=0.031)., Conclusion: En bloc resection of retroperitoneal recurrence of testicular tumors invading the IVC, followed by chemotherapy, allows a better survival rate compared to chemotherapy alone., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.) more...
- Published
- 2016
16. Resection of recurrent neck cancer with carotid artery replacement.
- Author
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Illuminati G, Schneider F, Minni A, Calio FG, Pizzardi G, and Ricco JB
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- Adult, Aged, Blood Vessel Prosthesis, Carcinoma, Squamous Cell diagnostic imaging, Carcinoma, Squamous Cell pathology, Carotid Arteries diagnostic imaging, Carotid Arteries pathology, Carotid Arteries physiopathology, Chemotherapy, Adjuvant, Disease Progression, Disease-Free Survival, Female, Head and Neck Neoplasms diagnostic imaging, Head and Neck Neoplasms pathology, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Myocutaneous Flap, Neoplasm Invasiveness, Polytetrafluoroethylene, Prosthesis Design, Quality of Life, Quality-Adjusted Life Years, Radiotherapy, Adjuvant, Risk Factors, Squamous Cell Carcinoma of Head and Neck, Survival Rate, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Vascular Patency, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation instrumentation, Blood Vessel Prosthesis Implantation mortality, Carcinoma, Squamous Cell surgery, Carotid Arteries surgery, Head and Neck Neoplasms surgery, Neck Dissection adverse effects, Neck Dissection mortality, Neoplasm Recurrence, Local
- Abstract
Objective: The management of patients with recurrent neck cancer invading the carotid artery is controversial. The purpose of this study was to evaluate overall survival rate, primary patency of vascular reconstructions, and quality-adjusted life-years (QALYs) after en bloc resection of the carotid artery and tumor with in-line polytetrafluoroethylene (PTFE) carotid grafting, followed by radiotherapy., Methods: From 2000 to 2014, 31 consecutive patients with recurrent neck cancer invading the carotid artery underwent en bloc resection and simultaneous carotid artery reconstruction with a PTFE graft, which was associated in 18 cases with a myocutaneous flap. The primary tumor was a squamous cell carcinoma of the larynx in 17 patients and of the hypopharynx in 7, an undifferentiated carcinoma of unknown origin in 4, and an anaplastic carcinoma of the thyroid in 3. All of the patients underwent postoperative radiotherapy (50-70 Gy), and 10 of them also underwent chemotherapy (doxorubicin and cisplatin)., Results: None of the patients died or sustained a stroke during the first 30 days after the index procedure. Postoperative morbidity consisted of 6 transitory dysphagias, 3 vocal cord palsies, 2 wound dehiscences, 1 transitory mandibular claudication, and 1 partial myocutaneous flap necrosis. No graft infection occurred during follow-up. Fifteen patients (48%) died from metastatic cancer during a mean follow-up of 45.4 months (range, 8-175 months). None of the patients showed evidence of local recurrence, stroke, or thrombosis of the carotid reconstruction. The 5-year survival rate was 49 ± 10%. The overall number of QALYs was 3.12 (95% confidence interval, 1.87-4.37) with a significant difference between patients without metastasis at the time of redo surgery (n = 26; QALYs, 3.74) and those with metastasis (n = 5; QALYs, 0.56; P = .005). QALYs were also significantly improved in patients with cancer of the larynx (n = 17; QALYs, 4.69) compared to patients presenting with other types of tumors (n = 14; QALYs, 1.29; P = .032)., Conclusions: Aggressive en bloc resection of recurrent neck cancer with PTFE grafting can be curative in patients without metastases at the time of redo surgery. In this subset of patients, extensive neck surgery with carotid artery replacement can lead to excellent local control of the disease with improved quality of survival., (Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.) more...
- Published
- 2016
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17. Superiority of resection over enucleation for schwannomas of the cervical vagus nerve: A retrospective cohort study of 22 consecutive patients.
- Author
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Illuminati G, Pizzardi G, Minni A, Masci F, Ciamberlano B, Pasqua R, Calio FG, and Vietri F
- Subjects
- Adult, Aged, Cranial Nerve Neoplasms complications, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Neurilemmoma complications, Operative Time, Postoperative Period, Quality of Life, Retrospective Studies, Treatment Outcome, Vagus Nerve Diseases complications, Vocal Cord Paralysis etiology, Cranial Nerve Neoplasms surgery, Neck Dissection methods, Neurilemmoma surgery, Vagus Nerve surgery, Vagus Nerve Diseases surgery
- Abstract
Introduction: Schwannoma of the cervical vagus nerve is rare. Treatment options include intracapsular enucleation and en bloc resection. The purpose of this study was to compare the outcomes of enucleation and resection in terms of postoperative mortality and morbidity, freedom from vocal cord palsy, freedom from local recurrence, quality-adjusted life-year (QALY) and vocal handicap index (VHI)., Methods: Twentytwo consecutive patients were divided into two groups. Patients in group A (n = 9) underwent intracapsular enucleation, whereas patients in Group B (n = 13) underwent en bloc resection. Main endpoints of the study were postoperative mortality and morbidity, freedom from vocal cord palsy, freedom from local recurrence and quality of life. The quality of life after surgery was assessed according to the quality-adjusted life-year (QALY) EQ-5D-5L methodology, and calculation of the voice handicap index (VHI)., Results: Postoperative mortality was nil. Morbidity included 1 wound dehiscence in group A and 2 transitory dysphagias in group B. Freedom from vocal cord palsy was 22% in group A and zero in group B (p = 0.15). Operation-specific local recurrence rate was 33% (3/9 patients) in group A and nil in group B (0/23 patients) (p = 0.05). QALYs was 0.55 in group A and 0.54 in group B (p = 1.0). VHI was 23.77 in group A and 26.15 in group B (p = 1.00)., Conclusion: Resection is superior to enucleation in terms of freedom from local recurrence. Functional results are comparable for both techniques., (Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.) more...
- Published
- 2016
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18. Fondaparinux for intra and perioperative anticoagulation in patients with heparin-induced thrombocytopenia candidates for peripheral vascular surgery: Report of 4 cases.
- Author
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Illuminati G, Calio' FG, Pizzardi G, Amatucci C, Masci F, and Palumbo P
- Abstract
Introduction: Intra and perioperative anticoagulation in patients with heparin induced thrombocytopenia (HIT), candidates for peripheral vascular surgery remains a challenge, as the best alternative to heparin has not yet been established. We evaluated the off-label use of fondaparinux in four patients with HIT, undergoing peripheral vascular surgery procedures., Presentation of Cases: Four patients of whom 3 men of a mean age of 66 years, with proven heparin induced thrombocytopenia (HIT) underwent two axillo-femoral bypasses, one femoro-popliteal bypass and one resection of a splenic artery aneurysm under fondaparinux. No intra or perioperative bleeding or thrombosis of new onset was observed., Discussion: In the absence of a valid alternative to heparin for intra and perioperative anticoagulation in HIT, several other anticoagulants can be used in an off-label setting. However, no general consensus exist on which should be the one of choice. In this small series fondaparinux appeared to be both safe and effective., Conclusions: These preliminary results seem to justify the off-label use of fondaparinux for intra and perioperative anticoagulation in patients with HIT, candidates for peripheral vascular surgery interventions., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.) more...
- Published
- 2016
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19. Surgical outcomes for liposarcoma of the lower limbs with synchronous pulmonary metastases.
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Illuminati G, Ceccanei G, Pacilè MA, Calio FG, Migliano F, Mercurio V, Pizzardi G, and Nigri G
- Subjects
- Adult, Aged, Female, Follow-Up Studies, Humans, Liposarcoma pathology, Lower Extremity pathology, Lung Neoplasms secondary, Lung Neoplasms surgery, Male, Middle Aged, Neoplasm Staging, Pneumonectomy, Sarcoma pathology, Survival Rate, Treatment Outcome, Young Adult, Liposarcoma surgery, Lower Extremity surgery, Lung Neoplasms mortality, Sarcoma surgery
- Abstract
Background and Objectives: Surgical resection of pulmonary metastases from soft tissues sarcomas has typically yielded disparate results, owing to the histologic heterogeneity of various series and the presentation times relative to primary tumor discovery. It was our hypothesis that with expeditious, curative surgical resection of both, primary and metastatic disease, patients with liposarcoma of the lower limb and synchronous, resectable, pulmonary metastases might achieve satisfactory outcomes., Methods: A consecutive sample clinical study, with a mean follow-up duration of 30 months. Twenty-two patients (mean age, 50 years), each presenting with a liposarcoma of the lower limb and synchronous, resectable, pulmonary metastases, underwent curative resection of both the primary mass and all pulmonary metastases within a mean of 18 days from presentation (range 9-32 days)., Results: Mean overall survival was 28 months, disease-related survival (SE) was 9% at 5 years (±9.7%), and disease-free survival was 9% at 5 years (±7.6%)., Conclusion: Expeditious, curative resection of both--primary and metastatic lesions--yields acceptable near-term results, with potential for long-term survival, in patients with liposarcoma of the lower limb and synchronous pulmonary metastases., (2010 Wiley-Liss, Inc.) more...
- Published
- 2010
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20. Management of carotid Dacron patch infection: a case report using median sternotomy for proximal common carotid artery control and in situ polytetrafluoroethylene grafting.
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Illuminati G, Calio' FG, D'Urso A, Ceccanei G, and Pacilè MA
- Subjects
- Aneurysm, False microbiology, Aneurysm, False surgery, Aneurysm, Ruptured microbiology, Aneurysm, Ruptured surgery, Carotid Artery Diseases complications, Carotid Artery, Common microbiology, Endarterectomy, Carotid instrumentation, Hematoma microbiology, Hematoma surgery, Humans, Male, Middle Aged, Obesity complications, Prosthesis Design, Prosthesis-Related Infections microbiology, Reoperation, Staphylococcus epidermidis isolation & purification, Blood Vessel Prosthesis adverse effects, Blood Vessel Prosthesis Implantation instrumentation, Carotid Artery Diseases surgery, Carotid Artery, Common surgery, Endarterectomy, Carotid adverse effects, Polyethylene Terephthalates, Polytetrafluoroethylene, Prosthesis-Related Infections surgery, Sternotomy
- Abstract
We report on a 58-year-old male who presented with an enlarging cervical hematoma 3 months following carotid endarterectomy with Dacron patch repair, due to septic disruption of the Dacron patch secondary to presumed infection. The essential features of this case are the control of the proximal common carotid artery gained through a median sternotomy, because the patient was markedly obese with minimal thyromental distance, and the treatment consisting of in situ polytetrafluoroethylene bypass grafting, due to the absence of a suitable autogenous saphenous vein. Median sternotomy is rarely required in case of reintervention for septic false aneurysms and hematomas following carotid endarterectomy but should be considered whenever difficult control of the common carotid artery, when entering the previous cervicotomy, is anticipated. In situ polytetrafluoroethylene grafting can be considered if autogenous vein material is lacking. more...
- Published
- 2009
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21. Prosthetic replacement of the infrahepatic inferior vena cava for leiomyosarcoma.
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Illuminati G, Calio' FG, D'Urso A, Giacobbi D, Papaspyropoulos V, and Ceccanei G
- Subjects
- Adult, Aged, Female, Graft Survival, Humans, Male, Middle Aged, Polytetrafluoroethylene, Postoperative Complications, Survival Analysis, Tomography, X-Ray Computed, Treatment Outcome, Vascular Patency, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation methods, Leiomyosarcoma surgery, Vascular Neoplasms surgery, Vena Cava, Inferior surgery
- Abstract
Hypothesis: Resection of the infrahepatic inferior vena cava associated with prosthetic graft replacement for caval leiomyosarcoma is an acceptable procedure to obtain prolonged and good-quality survival., Design: A consecutive sample clinical study with a mean follow-up of 40 months., Setting: The surgical department of an academic tertiary center and an affiliated secondary care center., Patients: Eleven patients, with a mean age of 51 years, who have primary leiomyosarcoma of the infrahepatic inferior vena cava., Interventions: All of the patients underwent radical resection of the tumor en bloc with the affected segment of the vena cava. Reconstruction consisted of 10 cavocaval polytetrafluoroethylene grafts and 1 cavobiliac graft. An associated right nephrectomy was performed in 2 cases. The left renal vein was reimplanted in the graft in 3 cases., Main Outcome Measures: Cumulative disease-specific survival, disease-free survival, and graft patency rates expressed by standard life-table analysis., Results: No patients died in the postoperative period. The cumulative (SE) disease-specific survival rate was 53% (21%) at 5 years. The cumulative (SE) disease-free survival rate was 44% (19%) at 5 years. The cumulative (SE) graft patency rate was 67% (22%) at 5 years., Conclusion: Radical resection followed by prosthetic graft reconstruction is a valuable method for treating primary leiomyosarcoma of the infrahepatic inferior vena cava. more...
- Published
- 2006
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22. Simultaneous repair of abdominal aortic aneurysm and resection of unexpected, associated abdominal malignancies.
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Illuminati G, Calio' FG, D'Urso A, Lorusso R, Ceccanei G, and Vietri F
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- Aged, Aged, 80 and over, Cardiovascular Surgical Procedures methods, Colectomy, Colonic Neoplasms surgery, Elective Surgical Procedures, Female, Gastrectomy, Humans, Ileal Neoplasms surgery, Kidney Neoplasms surgery, Length of Stay, Male, Middle Aged, Nephrectomy, Retrospective Studies, Stomach Neoplasms surgery, Treatment Outcome, Abdominal Neoplasms surgery, Aortic Aneurysm, Abdominal surgery, Surgical Procedures, Operative methods
- Abstract
Background and Objectives: The management of unexpected intra-abdominal malignancy, discovered at laparotomy for elective treatment of an abdominal aortic aneurysm (AAA), is controversial. It is still unclear whether both conditions should be treated simultaneously or a staged approach is to be preferred. To contribute in improving treatment guidelines, we retrospectively reviewed the records of patients undergoing laparotomy for elective AAA repair., Methods: From January 1994 to March 2003, 253 patients underwent elective, trans-peritoneal repair of an AAA. In four patients (1.6%), an associated, unexpected neoplasm was detected at abdominal exploration, consisting of one renal, one gastric, one ileal carcinoid, and one ascending colon tumor. All of them were treated at the same operation, after aortic repair and careful isolation of the prosthetic graft., Results: The whole series' operative mortality was 3.6%. None of the patients simultaneously treated for AAA and tumor resection died in the postoperative period. No graft-related infections were observed. Simultaneous treatment of AAA and tumor did not prolong significantly the mean length of stay in the hospital, compared to standard treatment of AAA alone., Conclusions: Except for malignancies of organs requiring major surgical resections, simultaneous AAA repair and resection of an associated, unexpected abdominal neoplasm can be safely performed, in most of the patients, sparing the need for a second procedure. Endovascular grafting of the AAA can be a valuable tool in simplifying simultaneous treatment, or in staging the procedures with a very short delay. more...
- Published
- 2004
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23. Results of distal revascularization in elderly patients for critical ischemia of the lower limbs.
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Illuminati G, Calio FG, Bertagni A, Piermattei A, Vietri F, and Martinelli V
- Subjects
- Aged, Aged, 80 and over, Female, Follow-Up Studies, Foot blood supply, Humans, Male, Postoperative Complications, Treatment Outcome, Vascular Patency, Ischemia surgery, Leg blood supply
- Abstract
Thirty eight patients over 75 years of age were operated upon of 40 distal arterial revascularizations for critical ischaemia of the lower limbs. Arterial reconstruction was proposed to ambulatory, self sufficient patients, with a patent artery of the leg or the foot in continuity with pedal arch, at arteriography. The revascularized artery was the peroneal in 14 cases, the anterior tibial in 11, the posterior tibial in 9, the dorsalis pedis in 5, and the external plantar artery in 1 case. Postoperative mortality was 2.6%. No postoperative arterial occlusion occurred and no postoperative amputation needed to be performed. The mean follow-up of 37 patients surviving operation was 21 months (ext. 2-52 months). At 36 months interval, patients' survival was 43%, primary patency rate was 57%, and limb salvage rate was 76%, at life-table analysis. Distal revascularization enables a good number of elderly patients in critical ischaemia of the lower limb, to enjoy an active, independent life, with a viable limb. more...
- Published
- 1999
24. Seat-belt-related injuries to the supra-aortic arteries.
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Illuminati G, Calio FG, Bertagni A, Mangialardi N, and Martinelli V
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- Adult, Aortography, Carotid Artery, Internal diagnostic imaging, Humans, Male, Middle Aged, Saphenous Vein transplantation, Carotid Artery Injuries, Seat Belts adverse effects, Subclavian Artery injuries
- Abstract
Five seat-belt-related injuries occurring in four adults are reported. One injury involved the common carotid artery, two the internal carotid and two the subclavian arteries. Three of the four injured persons were asymptomatic and one had delayed-onset symptoms; none suffered stroke. There was no operative mortality or morbidity. Overall, the functional results of arterial reconstruction were good, with satisfactory patency at follow-up averaging 15 months. more...
- Published
- 1999
- Full Text
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25. Results of bypasses to the anterior tibial artery through the interosseous membrane.
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Illuminati G, Calio FG, Bertagni A, and Martinelli V
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- Aged, Aged, 80 and over, Blood Vessel Prosthesis Implantation, Female, Humans, Length of Stay, Male, Methods, Middle Aged, Polytetrafluoroethylene, Retrospective Studies, Vascular Patency, Leg blood supply, Tibial Arteries surgery
- Abstract
The purpose of the present study was to retrospectively evaluate the results of anatomically tunneled grafts to the anterior tibial artery for distal revascularization in terms of patency and limb salvage rates as well as local morbidity, which can lengthen the postoperative hospital stay. Twenty-three patients received 24 bypasses to the anterior tibial artery, with grafts tunneled through the interosseous membrane. The mean age was 67 years; 10 patients were diabetic, 12 were smokers, 9 presented with significant coronary artery disease, and 2 with chronic renal insufficiency. The donor vessel was the common femoral artery in 17 cases, the superficial femoral artery in 4, and the infra-articular popliteal artery in 3. The graft material consisted in the reversed saphenous vein in 4 cases, the non-reversed devalvulated ex situ saphenous vein in 11, composite polytetrafluoroethylene (PTFE) + inversed saphenous vein in 6, and PTFE alone in 3 cases. No postoperative mortality was observed, nor was there postoperative graft occlusion or need for major amputation. The average postoperative length of stay in the hospital was 9.7 days. Two local surgical wound complications were observed, which did not necessitate a postoperative hospital stay exceeding 15 days. Cumulative primary patency and limb salvage rates at 3 years were 50% and 70%, respectively. Anatomic tunneling of grafts to the anterior tibial artery yields patency and limb salvage rates comparable to those reported in the literature for distal bypasses and, considered overall, an acceptably low local morbidity and short hospital stay. Definitive superiority over externally tunneled grafts, however, is not definitely demonstrated by this study and should be prospectively tested. more...
- Published
- 1998
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26. [Acute ischemia of the lower limbs].
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Illuminati G, Bertagni A, Calio FG, Ciulli A, Guglielmi R, Vietri F, and Martinelli V
- Subjects
- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Regional Blood Flow physiology, Retrospective Studies, Ischemia surgery, Leg blood supply
- Abstract
One hundred nineteen patients operated upon for acute ischemia of the lower limbs have been retrospectively reviewed, in order to evaluate the influence of the condition on outcome, and the patterns of treatment. Fifty six per cent of the patients were males and 42% females, 68.4% had an history of aorto-iliac obstructive disease; 51.2% of the ischemias were due to arterial thrombosis and 48.8% to embolism, in 12.5% of the cases etiology was unknown. Thrombosis were more frequent in younger patients' population (mean age 59.8 years) compared to embolism (mean age 69 years), even if the mean age of patients bearing an ischemia of embolic type has risen, in the last 10 years: 62.1% were due to atrial fibrillation and 50% occurred on pathologic arteries, patients with arterial obstructive disease presented a higher incidence of arrest of embolic material at the common femoral artery bifurcation. Women's mean age was significantly higher then that of men (70.9 vs. 59 yrs.). Embolism was more frequent in women than in men (64 vs 42.2), whereas thrombosis was more frequent in men than women (57.8 vs 36%). There were more deaths in women than men (30.8 vs 20.8%), but more amputations in men than women (37.3 vs 17.3%). Embolism of arterial origin include 15.2% of all acute ischemias and 31% of all embolisms, and their site of origin is often unknown, particularly when it is located in the thoracic aorta, which mandate a complete arteriography and eventually a CT-Scan of the thorax and the abdomen. A lower limb phlebitis, associated with an acute ischemia mandates the search of a patent foramen ovale, and an heparin induced thrombocytopenia. Surgical treatment is directed towards obstruction removal (embolectomy, by-pass) and towards the treatment of the causative agent (aortic endarterectomy, caval filter, anticoagulants). Post-operative thrombolysis may be beneficial in case of distal residual thrombus after embolectomy. An higher mortality rate has been observed in acute ischemias due to embolism rather than thrombosis (31 vs 19.6%) and more major amputations in thrombosis than in embolism (37.7 vs 17.2%). Overall mortality rate has been of 25%, with an amputation rate of 28%. Present results have been compared with those of the literature, both agree on some changes over the last 20 years, concerning the incidence of different mechanisms of acute ischemias and their prognosis. more...
- Published
- 1996
27. Results of axillofemoral by-passes for aorto-iliac occlusive disease.
- Author
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Illuminati G, Calio FG, Mangialardi N, Bertagni A, Vietri F, and Martinelli V
- Subjects
- Aged, Aged, 80 and over, Aortic Diseases mortality, Arterial Occlusive Diseases mortality, Female, Follow-Up Studies, Graft Occlusion, Vascular mortality, Humans, Ischemia mortality, Ischemia surgery, Leg blood supply, Male, Middle Aged, Prosthesis Failure, Survival Rate, Aortic Diseases surgery, Arterial Occlusive Diseases surgery, Blood Vessel Prosthesis, Iliac Artery surgery, Polytetrafluoroethylene, Postoperative Complications mortality
- Abstract
The purpose of this study was to review our results with axillofemoral by-passes performed for aorto-iliac occlusive disease. Fifty patients receiving 51 axillofemoral by-passes from January 1989 to December 1994 were retrospectively reviewed. The 30-day post-operative mortality was 4%. Seven patients (14%) presented graft-related local complications and all but one required reoperation. Five patients were lost to follow-up, the mean length of which was 36 months (16-74 months). Forty-nine per cent of the patients died during the follow-up period. At 36 months, the primary patency rate was 51%, the secondary patency rate was 69%, and limb valvage rate was 87%. A statistical difference was seen in the secondary patency rate between axillobifemoral by-pass (87%) and axillo-unifemoral by-pass (56%) at 36 months (P < 0.01), but no difference was seen in the limb salvage rate at 36 months between the two configurations of the by-pass (94% vs 81%) (P = NS). Twenty patients (40%) operated upon for acute ischemia had a significantly higher post-operative mortality rate (10% vs 0), a significantly higher amputation rate (20% vs 6.6%) and a significantly lower patency rate of by-pass (26% vs 63%) (P < 0.01), than the 30 patients (60%) operated on for claudication, rest pain or trophic ulcers. Our findings indicate that the results of axillofemoral by-pass are significantly influenced by the selection of patients for operation, namely the clinical status of ischaemic symptoms, and that since the overall results of axillofemoral by-pass are inferior to those of aortofemoral by-pass, this treatment should be restricted to patients at high risk of aortic clamping. more...
- Published
- 1996
- Full Text
- View/download PDF
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