The Journal of cardiovascular surgery, Jan 17, 2014
Eric J. Topol, in his popular book, "The creative destruction of medicine: How the Digital R... more Eric J. Topol, in his popular book, "The creative destruction of medicine: How the Digital Revolution Will Create Better Health Care", claims that medicine will inevitably be Schumpetered in the coming years. Interestingly, while we can afford to digitize the genome, to record any single heartbeat, and provide real--time measures of myriads of medical data, we are still missing a crucial catalyzer for strongly accelerating the Schumpetering: The "Web of Clinical Data". In this paper, we hypothesized its birth as the outcome of a viral collection of anonymized personal health records, that are made publicly available to scientists and professionals in medicine. Such a universal collection would not represent only a truly paradigm shift on the access to clinical data, but it would open the doors to the new grand challenge of building decision support systems that operate on a universal repository on the basis of the content of the health records and on clinical sim...
We evaluated the outcomes of revascularization in patients with chronic limb-threatening ischemia... more We evaluated the outcomes of revascularization in patients with chronic limb-threatening ischemia (CLTI) treated in real-world settings. This is a prospective multicenter cohort study with 12-month follow-up enrolling patients (n = 287) with CLTI undergoing open, endovascular, or hybrid lower extremity revascularization. The primary end point was amputation-free survival (AFS) at 12 months. Cox proportional analysis was used to determine independent predictors of amputation and restenosis. At 30 days, major adverse cardiovascular and major adverse limb events (MALE) rates were 3.1% and 2.1%, respectively. At 1 year, the overall survival rate was 88.8%, the AFS was 86.6%, and the primary patency was 70.5%. Freedom from MALE was 62.5%. After multivariate analysis, smoking (hazard ratio [HR] = 2.2, P = 0.04), renal failure (HR = 2.3, P = 0.03), Rutherford class (≥5) (HR = 3.2, P = 0.01), and below-the-knee disease (HR = 2.0, P = 0.05) were significant predictors of amputation; iloprost...
International angiology : a journal of the International Union of Angiology, 2005
Iloprost, usually administered through intravenous infusion for 6 hours per day for at least 21 d... more Iloprost, usually administered through intravenous infusion for 6 hours per day for at least 21 days, is the main medical treatment for critical limb ischemia in patients unsuitable for surgical or endovascular approach. We evaluated the tolerance and the short-term and long-term effects of a single 1-week treatment in critical limb ischemia patients. Twenty-nine patients in Leriche-Fontaine III and IV stage were treated with iloprost infusions for 16 hours per day for 7 days, achieving a maximal dose of 1.5 ng/kg/min. Tolerance and clinical assessment after treatment discontinuation and after 1 and 6 months were recorded; clinical evaluation (rest pain, trophic lesions), ankle/brachial pressure index (ABPI) and treadmill exercise test were performed before, immediately after treatment and after 1 and 6 months. No discontinuation of treatment occurred because of intolerance to iloprost. At the end of the treatment 69% of patients were responders, 55.2% at 1 month, 37.9% after 6 mont...
Implantation of a vascular prosthesis increases surgical site infection risk by producing a micro... more Implantation of a vascular prosthesis increases surgical site infection risk by producing a microenvironment conducive to bacterial attachment and biofilm formation, which sustains bacterial colonization and protects encased organisms from host defenses and antimicrobial therapy. Many maneuvers are used in an attempt to reduce infection in arterial reconstructions, but there are no clear guidelines on the most appropriate or effective. As well, there is no good evidence to guide management. A general principle is that indication for removal of the entire infected graft is mandatory when a suture line is involved in the infectious process, an infected anastomotic aneurism and a suture-line hemorrhage is evident, or when a graft-enteric fistula is diagnosed. Conservative, non-resectional management of graft infection is still a respectable solution for selected patients, as those with significant comorbidities, or those where the implanted aortic graft is in a location that precludes ...
Primary varicose veins affect between 10 and 12 per cent of the adult population [1,2,3]. Recurre... more Primary varicose veins affect between 10 and 12 per cent of the adult population [1,2,3]. Recurrence is defined as persistence or reemergence of varicosities after previous operative treatment. Varicose veins that recur after treatment remain one of the greatest challenges facing modern phlebology practice. The 5-year recurrence rate after surgery is around 50% and for compression sclerotherapy around 90% [4].
Italian Journal of Vascular and Endovascular Surgery, 2018
Venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, is the third ... more Venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, is the third leading vascular disease after acute myocardial infarction and stroke. This review is focused on the treatment of venous thromboembolism, the current guidelines and the devices available for the endovascular procedures
Aortic Dissections classification systems have always been an argument of debate. It is well know... more Aortic Dissections classification systems have always been an argument of debate. It is well known that none of the described classifications is complete and easy at the same time. While the more used classification is currently the Stanford classification, it is clear that type A and B dissections prognosis can dramatically vary, depending on many different characteristics that they can present. The aim of this study is to propose a new severity score system that could reflect the risk of in hospital mortality of acute aortic dissections. Through a review of the literature, studies describing significant predictors of in hospital mortality of any type of aortic dissection were searched and selected by predefined selection criteria. 9 studies met the criteria and were finally analyzed. The Odds Ratios of the reported predictors were the basis to the drawing of the score system. 16 main in hospital mortality predictors were found, 14 of which described in more than one study. They were combined into a new severity score system that we named VI2TA2 S2C2ORE. This is a simple risk score that we propose as a first assessment risk-evaluating tool. We look forward to validate it and to describe specific in hospital mortality risk ranges once it will be adopted.
Aortic Dissections classification systems have always been an argument of debate. It is well know... more Aortic Dissections classification systems have always been an argument of debate. It is well known that none of the described classifications is complete and easy at the same time. While the more used classification is currently the Stanford classification, it is clear that type A and B dissections prognosis can dramatically vary, depending on many different characteristics that they can present. The aim of this study is to propose a new severity score system that could reflect the risk of in hospital mortality of acute aortic dissections. Through a review of the literature, studies describing significant predictors of in hospital mortality of any type of aortic dissection were searched and selected by predefined selection criteria. 9 studies met the criteria and were finally analyzed. The Odds Ratios of the reported predictors were the basis to the drawing of the score system. 16 main in hospital mortality predictors were found, 14 of which described in more than one study. They were combined into a new severity score system that we named VI2TA2 S2C2ORE. This is a simple risk score that we propose as a first assessment risk-evaluating tool. We look forward to validate it and to describe specific in hospital mortality risk ranges once it will be adopted.
Nowadays patients affected by deep vein thrombosis (DVT) and pulmonary embolism (PE) are studied ... more Nowadays patients affected by deep vein thrombosis (DVT) and pulmonary embolism (PE) are studied widely but the challenge for physicians is when and how they are to be treated. Most patients present serious comorbidities that can potentially make treatment difficult. An increasing cohort of patients cannot be treated with systemic fibrinolysis but fortunately today, physicians can utilize a number of different instruments to resolve acute DVT and PE.
European Journal of Vascular and Endovascular Surgery, 2021
OBJECTIVE The aim was to evaluate the short term safety and effectiveness of the Penumbra/Indigo ... more OBJECTIVE The aim was to evaluate the short term safety and effectiveness of the Penumbra/Indigo aspiration thrombectomy Systems (Penumbra Inc.) in patients with acute lower limb ischaemia. (ALLI). Recently, endovascular vacuum assisted thrombectomy devices, similar to those used in the management of acute ischaemic stroke, have become available for peripheral arteries, but data are still scarce. METHODS To assess vessel patency, a modified Thrombolysis in Myocardial Infarction (TIMI) classification, called TIPI (Thrombo-aspiration In Peripheral Ischaemia), is proposed. The TIPI flow is assessed at presentation, immediately after treatment with the study device, and after all adjuvant procedures. The primary outcome is the technical success of the thrombo-aspiration with the investigative system, defined as near complete or complete revascularisation TIPI 2 - 3. Safety and clinical success rate were collected at one month. RESULTS One hundred and fifty patients were enrolled. The mean age was 72.4 years and 73.3% were male. Rutherford grade on enrolment was I in 16%, IIa in 40.7%, and IIb in 43.3% with a mean ankle brachial index of 0.19. Primary technical success (TIPI 2 - 3 flow) was achieved in 88.7% of patients. Adjunctive procedures included angioplasty/stenting of chronic atherosclerotic lesions (n = 39), thrombolysis (n = 31), covered stenting (n = 15), and supplementary Fogarty embolectomy (n = 6). After all interventions, assisted primary technical success was 95.3% (TIPI 2 - 3 in 143/150). No systemic bleeding complications or device related serious adverse events were reported. At one month follow up, one death, and one below the knee amputation were recorded. Primary patency was 92% (138/150), and the re-intervention rate was 7.33%, resulting in an assisted primary and secondary patency of 94% and 99.33%, respectively. CONCLUSION Results from the INDIAN registry reveal that mechanical thrombectomy using the Indigo system is safe and effective for revascularisation of ALLI as a primary therapy.
A case of bone stone in association with a papillary transitional cell carcinoma of the renal pel... more A case of bone stone in association with a papillary transitional cell carcinoma of the renal pelvis is reported. This type of lithiasis, actually representing bone metaplasia, is rare in the urinary tract and has never been reported in true epithelial urinary tumors.
The Journal of cardiovascular surgery, Jan 17, 2014
Eric J. Topol, in his popular book, "The creative destruction of medicine: How the Digital R... more Eric J. Topol, in his popular book, "The creative destruction of medicine: How the Digital Revolution Will Create Better Health Care", claims that medicine will inevitably be Schumpetered in the coming years. Interestingly, while we can afford to digitize the genome, to record any single heartbeat, and provide real--time measures of myriads of medical data, we are still missing a crucial catalyzer for strongly accelerating the Schumpetering: The "Web of Clinical Data". In this paper, we hypothesized its birth as the outcome of a viral collection of anonymized personal health records, that are made publicly available to scientists and professionals in medicine. Such a universal collection would not represent only a truly paradigm shift on the access to clinical data, but it would open the doors to the new grand challenge of building decision support systems that operate on a universal repository on the basis of the content of the health records and on clinical sim...
We evaluated the outcomes of revascularization in patients with chronic limb-threatening ischemia... more We evaluated the outcomes of revascularization in patients with chronic limb-threatening ischemia (CLTI) treated in real-world settings. This is a prospective multicenter cohort study with 12-month follow-up enrolling patients (n = 287) with CLTI undergoing open, endovascular, or hybrid lower extremity revascularization. The primary end point was amputation-free survival (AFS) at 12 months. Cox proportional analysis was used to determine independent predictors of amputation and restenosis. At 30 days, major adverse cardiovascular and major adverse limb events (MALE) rates were 3.1% and 2.1%, respectively. At 1 year, the overall survival rate was 88.8%, the AFS was 86.6%, and the primary patency was 70.5%. Freedom from MALE was 62.5%. After multivariate analysis, smoking (hazard ratio [HR] = 2.2, P = 0.04), renal failure (HR = 2.3, P = 0.03), Rutherford class (≥5) (HR = 3.2, P = 0.01), and below-the-knee disease (HR = 2.0, P = 0.05) were significant predictors of amputation; iloprost...
International angiology : a journal of the International Union of Angiology, 2005
Iloprost, usually administered through intravenous infusion for 6 hours per day for at least 21 d... more Iloprost, usually administered through intravenous infusion for 6 hours per day for at least 21 days, is the main medical treatment for critical limb ischemia in patients unsuitable for surgical or endovascular approach. We evaluated the tolerance and the short-term and long-term effects of a single 1-week treatment in critical limb ischemia patients. Twenty-nine patients in Leriche-Fontaine III and IV stage were treated with iloprost infusions for 16 hours per day for 7 days, achieving a maximal dose of 1.5 ng/kg/min. Tolerance and clinical assessment after treatment discontinuation and after 1 and 6 months were recorded; clinical evaluation (rest pain, trophic lesions), ankle/brachial pressure index (ABPI) and treadmill exercise test were performed before, immediately after treatment and after 1 and 6 months. No discontinuation of treatment occurred because of intolerance to iloprost. At the end of the treatment 69% of patients were responders, 55.2% at 1 month, 37.9% after 6 mont...
Implantation of a vascular prosthesis increases surgical site infection risk by producing a micro... more Implantation of a vascular prosthesis increases surgical site infection risk by producing a microenvironment conducive to bacterial attachment and biofilm formation, which sustains bacterial colonization and protects encased organisms from host defenses and antimicrobial therapy. Many maneuvers are used in an attempt to reduce infection in arterial reconstructions, but there are no clear guidelines on the most appropriate or effective. As well, there is no good evidence to guide management. A general principle is that indication for removal of the entire infected graft is mandatory when a suture line is involved in the infectious process, an infected anastomotic aneurism and a suture-line hemorrhage is evident, or when a graft-enteric fistula is diagnosed. Conservative, non-resectional management of graft infection is still a respectable solution for selected patients, as those with significant comorbidities, or those where the implanted aortic graft is in a location that precludes ...
Primary varicose veins affect between 10 and 12 per cent of the adult population [1,2,3]. Recurre... more Primary varicose veins affect between 10 and 12 per cent of the adult population [1,2,3]. Recurrence is defined as persistence or reemergence of varicosities after previous operative treatment. Varicose veins that recur after treatment remain one of the greatest challenges facing modern phlebology practice. The 5-year recurrence rate after surgery is around 50% and for compression sclerotherapy around 90% [4].
Italian Journal of Vascular and Endovascular Surgery, 2018
Venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, is the third ... more Venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, is the third leading vascular disease after acute myocardial infarction and stroke. This review is focused on the treatment of venous thromboembolism, the current guidelines and the devices available for the endovascular procedures
Aortic Dissections classification systems have always been an argument of debate. It is well know... more Aortic Dissections classification systems have always been an argument of debate. It is well known that none of the described classifications is complete and easy at the same time. While the more used classification is currently the Stanford classification, it is clear that type A and B dissections prognosis can dramatically vary, depending on many different characteristics that they can present. The aim of this study is to propose a new severity score system that could reflect the risk of in hospital mortality of acute aortic dissections. Through a review of the literature, studies describing significant predictors of in hospital mortality of any type of aortic dissection were searched and selected by predefined selection criteria. 9 studies met the criteria and were finally analyzed. The Odds Ratios of the reported predictors were the basis to the drawing of the score system. 16 main in hospital mortality predictors were found, 14 of which described in more than one study. They were combined into a new severity score system that we named VI2TA2 S2C2ORE. This is a simple risk score that we propose as a first assessment risk-evaluating tool. We look forward to validate it and to describe specific in hospital mortality risk ranges once it will be adopted.
Aortic Dissections classification systems have always been an argument of debate. It is well know... more Aortic Dissections classification systems have always been an argument of debate. It is well known that none of the described classifications is complete and easy at the same time. While the more used classification is currently the Stanford classification, it is clear that type A and B dissections prognosis can dramatically vary, depending on many different characteristics that they can present. The aim of this study is to propose a new severity score system that could reflect the risk of in hospital mortality of acute aortic dissections. Through a review of the literature, studies describing significant predictors of in hospital mortality of any type of aortic dissection were searched and selected by predefined selection criteria. 9 studies met the criteria and were finally analyzed. The Odds Ratios of the reported predictors were the basis to the drawing of the score system. 16 main in hospital mortality predictors were found, 14 of which described in more than one study. They were combined into a new severity score system that we named VI2TA2 S2C2ORE. This is a simple risk score that we propose as a first assessment risk-evaluating tool. We look forward to validate it and to describe specific in hospital mortality risk ranges once it will be adopted.
Nowadays patients affected by deep vein thrombosis (DVT) and pulmonary embolism (PE) are studied ... more Nowadays patients affected by deep vein thrombosis (DVT) and pulmonary embolism (PE) are studied widely but the challenge for physicians is when and how they are to be treated. Most patients present serious comorbidities that can potentially make treatment difficult. An increasing cohort of patients cannot be treated with systemic fibrinolysis but fortunately today, physicians can utilize a number of different instruments to resolve acute DVT and PE.
European Journal of Vascular and Endovascular Surgery, 2021
OBJECTIVE The aim was to evaluate the short term safety and effectiveness of the Penumbra/Indigo ... more OBJECTIVE The aim was to evaluate the short term safety and effectiveness of the Penumbra/Indigo aspiration thrombectomy Systems (Penumbra Inc.) in patients with acute lower limb ischaemia. (ALLI). Recently, endovascular vacuum assisted thrombectomy devices, similar to those used in the management of acute ischaemic stroke, have become available for peripheral arteries, but data are still scarce. METHODS To assess vessel patency, a modified Thrombolysis in Myocardial Infarction (TIMI) classification, called TIPI (Thrombo-aspiration In Peripheral Ischaemia), is proposed. The TIPI flow is assessed at presentation, immediately after treatment with the study device, and after all adjuvant procedures. The primary outcome is the technical success of the thrombo-aspiration with the investigative system, defined as near complete or complete revascularisation TIPI 2 - 3. Safety and clinical success rate were collected at one month. RESULTS One hundred and fifty patients were enrolled. The mean age was 72.4 years and 73.3% were male. Rutherford grade on enrolment was I in 16%, IIa in 40.7%, and IIb in 43.3% with a mean ankle brachial index of 0.19. Primary technical success (TIPI 2 - 3 flow) was achieved in 88.7% of patients. Adjunctive procedures included angioplasty/stenting of chronic atherosclerotic lesions (n = 39), thrombolysis (n = 31), covered stenting (n = 15), and supplementary Fogarty embolectomy (n = 6). After all interventions, assisted primary technical success was 95.3% (TIPI 2 - 3 in 143/150). No systemic bleeding complications or device related serious adverse events were reported. At one month follow up, one death, and one below the knee amputation were recorded. Primary patency was 92% (138/150), and the re-intervention rate was 7.33%, resulting in an assisted primary and secondary patency of 94% and 99.33%, respectively. CONCLUSION Results from the INDIAN registry reveal that mechanical thrombectomy using the Indigo system is safe and effective for revascularisation of ALLI as a primary therapy.
A case of bone stone in association with a papillary transitional cell carcinoma of the renal pel... more A case of bone stone in association with a papillary transitional cell carcinoma of the renal pelvis is reported. This type of lithiasis, actually representing bone metaplasia, is rare in the urinary tract and has never been reported in true epithelial urinary tumors.
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