Dott. Valerio Tolva
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Urgent hybrid repair of a symptomatic dissection-related type II thoracoabdominal aortic aneurysm.
Eur J Cardiothorac Surg2024 Oct;66(4):. doi: ezae361.
Monzio-Compagnoni Nicola, Tuveri Andrea, Russo Giovanna, Tolva Valerio Stefano
Abstract
Emergency repair of type II thoracoabdominal aortic aneurysms is burdened by high perioperative morbidity and mortality. We report the case of a symptomatic type II post-dissection thoracoabdominal aortic aneurysm that was treated using a hybrid technique. The repair was carried out in 2 stages. In the first stage, we deployed 2 imbricated stent grafts in the descending thoracic aorta. A left carotid-to-left subclavian artery bypass was pre-emptively performed to obtain a proper proximal landing zone and as part of the manoeuvres to protect the spinal cord. The endovascular first stage was effective in obtaining proximal sealing but, as expected, it did not prevent distal reperfusion of the aneurysmatic false lumen. A few hours later, we moved on to the second stage in which we repaired the aneurysmal distal thoracic and abdominal aortic segment by means of a multibranched synthetic graft. The repair was carried out through a left thoracophreno-laparotomy in the seventh intercostal space. A left passive arterial bypass and selective cold renal and warm visceral perfusion were adopted to provide organ protection. Technical success was achieved and confirmed radiologically. The patient experienced mild postoperative paraplegia, which almost completely regressed after a neuromotor rehabilitation program.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Preliminary experience of the isolate left subclavian artery in-situ fenestration during 'zone 2' thoracic endovascular aortic repair.
Eur J Cardiothorac Surg2024 Oct;66(4):. doi: ezae332.
Piffaretti Gabriele, Gaggiano Andrea, Pratesi Giovanni, Tolva Valerio, Pacini Davide, Pulli Raffaele, Trimarchi Santi, Bertoglio Luca, Angiletta Domenico,
Abstract
OBJECTIVES:
To evaluate the results of isolated left subclavian artery in-situ fenestration (ISF) during 'zone 2' thoracic endovascular aortic repair (TEVAR) using a new adjustable needle puncturing device system.
METHODS:
It is a multicentre, retrospective, physician-initiated cohort study of patients treated from 28 July 2021 to 3 April 2024. Inclusion criteria were isolate left subclavian artery revascularization for elective or urgent/emergent 'zone 2' TEVAR. The primary outcome was technical success and freedom from ISF TEVAR-related reintervention or endoleak.
RESULTS:
We treated 50 patients: 28 (56.0%) atherosclerotic thoracic aneurysms, 12 (24.0%) type B aortic dissection and 10 (20.0%) penetrating aortic ulcers. Elective intervention was carried out in 46 (92.0%) cases. ISF was successful in all cases, with a procedural primary technical success in 47 (94.0%) cases. The median time of intervention was 184?min (interquartile range 135-220) with a median fenestration time of 20?min (interquartile range 13-35). Operative mortality did not occur. We observed 1 case of spinal cord ischaemia and 2 cases of bilateral posterior non-disabling stroke. Mortality at 30?days occurred in 1 (2.0%) patient (not aorta-related). The median follow-up was 4?months (interquartile range 1-12.25). Bridging stent graft patency was 100% with no ISF-related endoleak. ISF-related reintervention was never required.
CONCLUSIONS:
ISF TEVAR using the Ankura?-II device with the self-centring adjustable needle system showed high technical success, promising stability and stable aortic-related outcomes. Owing to these results, it represents a safe and effective alternative for standard 'zone 2' TEVAR.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Corrigendum to "Acute venous problems: Integrating medical, surgical, and interventional treatments" [Seminars in Vascular Surgery Volume 36, Issue 2, June (2023) Pages 307-318].
Semin Vasc Surg2024 Jun;37(2):277. doi: 10.1053/j.semvascsurg.2023.09.001.
Bissacco Daniele, Mandigers Tim J, Romagnoli Silvia, Aprea Tiziana, Lomazzi Chiara, D'Alessio Ilenia, Ascenti Velio, Ierardi Anna Maria, Domanin Maurizio, Tolva Valerio Stefano, Carrafiello Gianpaolo, Trimarchi Santi
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Acute aortoiliac thrombosis and mitral valve regurgitation as acute onset of eosinophilic granulomatosis with polyangiitis in a 26-year-old patient.
J Vasc Surg Cases Innov Tech2024 Aug;10(4):101515. doi: 101515.
Galassi Luca, Lerva Giulia, Passolunghi Davide, Marchetto Giovanni, Pozzi Maria Rosa, Tolva Valerio Stefano
Abstract
We present a rare case of eosinophilic granulomatosis with polyangiitis (EGPA), involving a 26-year-old woman with a history of asthma and nasal polyps. The patient presented with acute aortoiliac thrombosis and mitral insufficiency, which was successfully treated with thrombolysis, aortic thromboendarterectomy, and valve replacement. Peripheral hypereosinophilia with eosinophilic infiltration of the heart led to the diagnosis of antineutrophilic cytoplasmic antibody-negative EGPA. Treatment with prednisone and mepolizumab was started, resulting in a positive outcome. This case showcases an unusual manifestation of EGPA with large size vessel involvement and requiring surgical and pharmacological treatment. It also highlights the importance of early detection for timely intervention and an improved prognosis.
© 2024 The Authors.
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Development and Validation of a Risk Prediction Tool for In-hospital Mortality After Thoracic Endovascular Repair in Patients with Blunt Thoracic Aortic Injury Using the Aortic Trauma Foundation Registry.
Ann Vasc Surg2024 Feb;99():422-433. doi: 10.1016/j.avsg.2023.09.076.
D'Oria Mario, Pipitone Marco D, DuBose Joseph, Azizzadeh Ali, Miller Charles C, Starnes Benjamin W, Tolva Valerio S, Arbabi Cassra N, D'Alessio Ilenia, Lepidi Sandro,
Abstract
BACKGROUND:
The objective of our present effort was to use an international blunt thoracic aortic injury (BTAI) registry to create a prediction model identifying important preoperative and intraoperative factors associated with postoperative mortality, and to develop and validate a simple risk prediction tool that could assist with patient selection and risk stratification in this patient population.
METHODS:
For the purpose of the present study, all patients undergoing thoracic endovascular aortic repair (TEVAR) for BTAI and registered in the Aortic Trauma Foundation (ATF) database from January 2016 as of June 2022 were identified. Patients undergoing medical management or open repair were excluded. The primary outcome was binary in-hospital all-cause mortality. Two predictive models were generated: a preoperative model (i.e. only including variables before TEVAR or intention-to-treat) and a full model (i.e. also including variables after TEVAR or per-protocol).
RESULTS:
Out of a total of 944 cases included in the ATF registry until June 2022, 448 underwent TEVAR and were included in the study population. TEVAR for BTAI was associated with an 8.5% in-hospital all-cause mortality in the ATF dataset. These study subjects were subsequently divided using 3:1 random sampling in a derivation cohort (336; 75.0%) and a validation cohort (112; 25.0%). The median age was 38 years, and the majority of patients were male (350; 78%). A total of 38 variables were included in the final analysis. Of these, 17 variables were considered in the preoperative model, 9 variables were integrated in the full model, and 12 variables were excluded owing to either extremely low variance or strong correlation with other variables. The calibration graphs showed how both models from the ATF dataset tended to underestimate risk, mainly in intermediate-risk cases. The discriminative capacity was moderate in all models; the best performing model was the full model from the ATF dataset, as evident from both the Receiver Operating Characteristic curve (Area Under the Curve 0.84; 95% CI 0.74-0.91) and from the density graph.
CONCLUSIONS:
In this study, we developed and validated a contemporary risk prediction model, which incorporates several preoperative and postoperative variables and is strongly predictive of early mortality. While this model can reasonably predict in-hospital all-cause mortality, thereby assisting physicians with risk-stratification as well as inform patients and their caregivers, its intrinsic limitations must be taken into account and it should only be considered an adjunctive tool that may complement clinical judgment and shared decision-making.
Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.
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Incidence and Long-Term Implications of Type 2 Endoleak after Endovascular Repair of Abdominal Aortic and Aortoiliac Aneurysms.
Int J Angiol2024 Dec;33(4):282-287. doi: 10.1055/s-0043-1771344.
Monzio-Compagnoni Nicola, Zuccon Gianmarco, Barbosa Fabiane, Rampoldi Antonio Gaetano, Tolva Valerio Stefano
Abstract
Type 2 endoleak has been proved not to significantly increase the risk of aneurysm rupture. However, it is associated with aneurysm enlargement and may require secondary interventions. Its role has been widely investigated, but a definitive consensus about its management has still not been obtained. We performed a retrospective, single-center observational study that investigates the incidence of type 2 endoleak and its implications in the long-term follow-up in all the patients who underwent endovascular aortic repair (EVAR) for abdominal aortic aneurysm from 2011 to 2016 at our institution. A total of 216 patients who underwent EVAR during the specified time period were enrolled, and 85 of them (39%) developed type 2 endoleak in their follow-up. Thirty-one of the patients who developed type 2 endoleak faced an aneurysm sac growth?>?10?mm and required secondary intervention. Only nine of them showed resolution of the leak. In the long-term follow-up, patients who developed type 2 endoleak after EVAR did not show a significantly increased mortality compared with those who did not, but some of them required late open conversion due to aneurysm sac enlargement and some other developed a secondary type 1 endoleak which required correction. The management of type 2 endoleak remains debated, despite consensus exist regarding the need for intervention when a?>?10-mm aneurysm sac growth is observed. Further studies are necessary to better define which are the "high-risk" type 2 endoleaks and identify the patients who would benefit more from correction.
International College of Angiology. This article is published by Thieme.
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Acute venous problems: Integrating medical, surgical, and interventional treatments.
Semin Vasc Surg2023 Jun;36(2):307-318. doi: 10.1053/j.semvascsurg.2023.04.013.
Bissacco Daniele, Mandigers Tim J, Romagnoli Silvia, Aprea Tiziana, Lomazzi Chiara, D'Alessio Ilenia, Ascenti Velio, Ierardi Anna Maria, Domanin Maurizio, Tolva Valerio Stefano, Carrafiello Gianpaolo, Trimarchi Santi
Abstract
"Acute venous problems" refers to a group of disorders that affect the veins and result in sudden and severe symptoms. They can be classified based on the pathological triggering mechanisms, such as thrombosis and/or mechanical compression, and their consequences, including symptoms, signs, and complications. The management and therapeutic approach depend on the severity of the disease, the location, and the involvement of the vein segment. Although summarizing these conditions can be challenging, the objective of this narrative review was to provide an overview of the most common acute venous problems. This will include an exhaustive yet concise and practical description of each condition. The multidisciplinary approach remains one of the major advantages in dealing with these conditions, maximizing the results and the prevention of complications.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry.
J Pers Med2023 Feb;13(2):. doi: 316.
Martelli Eugenio, Zamboni Matilde, Sotgiu Giovanni, Saderi Laura, Federici Massimo, Sangiorgi Giuseppe M, Puci Mariangela V, Martelli Allegra R, Messina Teresa, Frigatti Paolo, Borrelli Maria Pia, Ruotolo Carlo, Ficarelli Ilaria, Rubino Paolo, Pezzo Francesco, Carbonari Luciano, Angelini Andrea, Galeazzi Edoardo, Di Pinto Luca Calia, Fiore Franco M, Palmieri Armando, Ventoruzzo Giorgio, Mazzitelli Giulia, Ragni Franco, Bozzani Antonio, Forliti Enzo, Castagno Claudio, Volpe Pietro, Massara Mafalda, Moniaci Diego, Pagliasso Elisa, Peretti Tania, Ferrari Mauro, Troisi Nicola, Modugno Piero, Maiorano Maurizio, Bracale Umberto M, Panagrosso Marco, Monaco Mario, Giordano Giovanni, Natalicchio Giuseppe, Biello Antonella, Celoria Giovanni M, Amico Alessio, Di Bartolo Mauro, Martelli Massimiliano, Munaó Roberta, Razzano Davide, Colacchio Giovanni, Bussetti Francesco, Lanza Gaetano, Cardini Antonio, Di Benedetto Bartolomeo, De Laurentis Mario, Taurino Maurizio, Sirignano Pasqualino, Cappiello Pierluigi, Esposito Andrea, Trimarchi Santi, Romagnoli Silvia, Padricelli Andrea, Giudice Giorgio, Crinisio Adolfo, Di Nardo Giovanni, Battaglia Giuseppe, Tringale Rosario, De Vivo Salvatore, Compagna Rita, Tolva Valerio S, D'Alessio Ilenia, Curci Ruggiero, Giovannetti Simona, D'Arrigo Giuseppe, Basile Giusi, Frigerio Dalmazio, Veraldi Gian Franco, Mezzetto Luca, Ippoliti Arnaldo, Oddi Fabio M, Settembrini Alberto M
Abstract
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 ( 75 (HR = 3.63, = 0.003) is associated with 30 day mortality. Age > 75 (HR = 2.14,
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.
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Extrapleural approach for thoracoabdominal infected aortic endograft: surgical and circulatory strategies.
Interact Cardiovasc Thorac Surg2022 Aug;35(3):. doi: ivac208.
Cazzaniga Matteo, Torre Massimo, Lista Alfredo, Tolva Valerio Stefano
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Caffeic Acid-Grafted PLGA as a Novel Material for the Design of Fluvastatin-Eluting Nanoparticles for the Prevention of Neointimal Hyperplasia.
Mol Pharm2022 Nov;19(11):4333-4344. doi: 10.1021/acs.molpharmaceut.2c00693.
Bellosta Stefano, Selmin Francesca, Magri Giulia, Castiglioni Silvia, Procacci Patrizia, Sartori Patrizia, Scarpa Edoardo, Tolva Valerio, Rossi Clara, Puoci Francesco, Rizzello Loris, Cilurzo Francesco
Abstract
Drug-eluting nanoparticles (NPs) administered by an eluting balloon represent a novel tool to prevent restenosis after angioplasty, even if the selection of the suitable drug and biodegradable material is still a matter of debate. Herein, we provide the proof of concept of the use of a novel material obtained by combining the grafting of caffeic acid or resveratrol on a poly(lactide--glycolide) backbone (-CA-PLGA or -RV-PLGA) and the pleiotropic effects of fluvastatin chosen because of its low lipophilic profile which is challenging for the encapsulation in NPs and delivery to the artery wall cells. NPs made of such materials are biocompatible with macrophages, human smooth muscle cells (SMCs), and endothelial cells (ECs). Their cellular uptake is demonstrated and quantified by confocal microscopy using fluorescent NPs, while their distribution in the cytoplasm is verified by TEM images using NPs stained with an Ag-PVP probe appositely synthetized. -CA-PLGA assures the best control of the FLV release from NP sizing around 180 nm and the faster SMC uptake, as demonstrated by confocal analyses. Interestingly and surprisingly, -CA-PLGA improves the FLV efficacy to inhibit the SMC migration, without altering its effects on EC proliferation and migration. The improved trophism of NPs toward SMCs, combined with the excellent biocompatibility and low modification of the microenvironment pH upon polymer degradation, makes -CA-PLGA a suitable material for the design of drug-eluting balloons.
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Plasminogen activator-coated nanobubbles targeting cellbound ?2-glycoprotein I as a novel thrombus-specific thrombolytic strategy.
Haematologica2023 Jul;108(7):1861-1872. doi: 10.3324/haematol.2022.281505.
Macor Paolo, Durigutto Paolo, Argenziano Monica, Smith-Jackson Kate, Capolla Sara, Di Leonardo Valeria, Marchbank Kevin, Tolva Valerio Stefano, Semeraro Fabrizio, Ammollo Concetta T, Colucci Mario, Cavalli Roberta, Meroni Pierluigi, Tedesco Francesco
Abstract
?2-glycoprotein I (?2-GPI) is a serum protein widely recognized as the main target of antibodies present in patients with antiphospholipid syndrome (APS). ?2-GPI binds to activated endothelial cells, platelets and leukocytes, key players in thrombus formation. We developed a new targeted thrombolytic agent consisting of nanobubbles (NB) coated with recombinant tissue plasminogen activator (rtPA) and a recombinant antibody specific for cell-bound ?2-GPI. The therapeutic efficacy of targeted NB was evaluated in vitro, using platelet-rich blood clots, and in vivo in three different animal models: i) thrombosis developed in a rat model of APS; ii) ferric chloride-induced mesenteric thrombosis in rats, and iii) thrombotic microangiopathy in a mouse model of atypical hemolytic uremic syndrome (C3-gain-of-function mice). Targeted NB bound preferentially to platelets and leukocytes within thrombi and to endothelial cells through ?2-GPI expressed on activated cells. In vitro, rtPA-targeted NB (rtPA-tNB) induced greater lysis of platelet-rich blood clots than untargeted NB. In a rat model of APS, administration of rtPA-tNB caused rapid dissolution of thrombi and, unlike soluble rtPA that induced transient thrombolysis, prevented new thrombus formation. In a rat model of ferric chloride triggered thrombosis, rtPA-tNB, but not untargeted NB and free rtPA, induced rapid and persistent recanalization of occluded vessels. Finally, treatment of C3-gain-of-function mice with rtPA-tNB, that target ?2-GPI deposited in kidney glomeruli, decreased fibrin deposition, and improved urinalysis data with a greater efficiency than untargeted NB. Our findings suggest that targeting cell-bound ?2-GPI may represent an efficient and thrombus-specific thrombolytic strategy in both APS-related and APS-unrelated thrombotic conditions.
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Cardiac and Aortic Modifications After Endovascular Repair for Blunt Thoracic Aortic Injury: A Systematic Review.
Eur J Vasc Endovasc Surg2022 ;64(2-3):176-187. doi: 10.1016/j.ejvs.2022.05.004.
Mandigers Tim J, Bissacco Daniele, Domanin Maurizio, D'Alessio Ilenia, Tolva Valerio S, Piffaretti Gabriele, van Herwaarden Joost A, Trimarchi Santi
Abstract
OBJECTIVE:
Blunt thoracic aortic injury (BTAI) is a devastating condition that commonly occurs in healthy and young patients. Endovascular treatment is the first choice; however, it has also been demonstrated to alter cardiovascular haemodynamics. The aim of this systematic review was to describe the cardiovascular modifications after thoracic endovascular aortic repair (TEVAR) for BTAI.
DATA SOURCES:
PubMed (MEDLINE), Scopus, and Web of Science were systematically searched for eligible studies reporting on modifications in aortic stiffness, blood pressure, cardiac mass, and aortic size.
REVIEW METHODS:
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. The Newcastle-Ottawa Scale was used to assess the methodological quality of included studies.
RESULTS:
A total of 12 studies reporting on 265 patients were included. Severe heterogeneity existed among the included studies with regard to demographics, BTAI grade, endograft specifications, reported outcomes, and the method of evaluation. Regarding aortic stiffness, two studies found a significant increase in pulse wave velocity (PWV) in patients after TEVAR compared with a control group, while one did not find a significant increase in PWV and augmentation index after > 3 years of follow up. Five studies reported an increase in the incidence of post-TEVAR hypertension up to 55% (range 34.8% - 55.0%) vs. baseline. One study found a statistically significant increase in left ventricular mass and left ventricular mass index during follow up. Nine studies report data regarding aortic dilatation or remodelling after TEVAR. One found a 2.4 fold faster growth rate in ascending aortic diameter vs. controls, while other studies described significant changes in aortic size at different locations along the aorta and endograft after TEVAR.
CONCLUSION:
This systematic review highlights adverse cardiac and aortic modifications after TEVAR for BTAI. The results stress the need for lifelong surveillance in these patients and the necessity of developing a more compliant endograft to prevent cardiovascular complications in the long term.
Copyright © 2022 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
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Pleural effusion: a potential surrogate marker for higher-risk patients with acute type B aortic dissections.
Eur J Cardiothorac Surg2022 Mar;61(4):816-825. doi: 10.1093/ejcts/ezab540.
Reutersberg Benedikt, Trimarchi Santi, Gilon Dan, Kaiser Clayton, Harris Kevin, Shalhub Sherene, Reece T Brett, Nienaber Christoph, Ehrlich Marek, Isselbacher Eric, De Oliveira Nilto, Montgomery Daniel, Eagle Kim, Tolva Valerio, Chen Edward P, Eckstein Hans-Henning,
Abstract
OBJECTIVES:
Pleural effusions (PEffs) are known to occur in type B acute aortic dissection (TBAAD). We investigated the relationship between pleural effusion and the development of early or late complications following TBAAD.
METHODS:
The incidence of PEff (defined as at least an obliteration of the costophrenic angle in a frontal projection) diagnosed on their initial chest X-ray in patients with TBAAD enrolled in the International Registry of Acute Aortic Dissection was examined. We analysed in-hospital outcomes and long-term survival separately for patients with and without PEffs (PEff+ versus PEff-, respectively).
RESULTS:
Included were 1252 patients with TBAAD, of whom 224 (17.9%) had PEff. Compared with patients without PEff in the initial chest X-ray, these were significantly older [mean age 67 (SD: 14.7) vs 63.4 (SD: 14.2) years, P?=?0.001] and more often female (42.4% vs 34.2%, P?=?0.021) and had more comorbidities (known aortic aneurysm, chronic obstructive pulmonary disease, chronic renal failure, diabetes, congestive heart failure or mitral valve disease). PEff was associated with higher in-hospital mortality (16.1% vs 9.1%, P?=?0.002) and increased rates of neurological complications (16.6% vs 11.1%, P?=?0.029), acute renal failure (27.2% vs 19.7%, P?=?0.017) and hypotension (17.4% vs 9.6%, P?=?0.001). In addition, patients with PEff underwent aortic repair more frequently (44.6% vs 32.5%, P?0.001). In the long-term patients with PEff showed lower 5-year post-discharge survival (67.6% vs 77.6%, P?=?0.004). Multivariable analysis with propensity-matched data showed that PEff was not an independent risk factor for in-hospital mortality (odds ratio 1.9, 95% CI 0.8-4.4, P?=?0.141).
CONCLUSIONS:
Patients with TBAAD and evidence of PEff showed a higher in-hospital mortality, are more likely to develop additional in-hospital complications and have a decreased likelihood of survival during follow-up. However, according to propensity-matched analysis, PEff remained not as an independent predictor of worse outcome but might serve as an early surrogate marker to identify higher-risk patients.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Risk factors for short and long-term great saphenous vein recanalization in patients treated with endovenous radiofrequency ablation.
Vascular2023 Feb;31(1):131-141. doi: 10.1177/17085381211058587.
Bissacco Daniele, Malloggi Chiara, Domanin Maurizio, Lomazzi Chiara, Tolva Valerio, Odero Andrea, Trimarchi Santi, Casana Renato
Abstract
PURPOSE:
The aim of this retrospective single-center study is to describe and analyze short-, mid-, and long-term risk factors for great saphenous vein (GSV) recanalization after endovenous radiofrequency ablation (RFA).
MATERIALS AND METHODS:
All consecutive patients with GSV incompetence and varicose veins underwent RFA were enrolled between 2009 and 2018. Data on demographic, pre- and postoperative color Doppler scan (CDUS) findings, perioperative complications, and follow-up were prospectively collected. Primary outcome was GSV recanalization rate at 1 week after RFA. Secondary outcomes were postoperative complication rate, as well as GSV recanalization rate at 1, 3, and 5 years after RFA. Risk factors for recanalization were also analyzed, for each follow-up assessment, identifying differences in recanalized (Rec) and non-recanalized (nRec) groups.
RESULTS:
During the study period, 1297 patients were treated. Among these, 1265 had at least 1 week of follow-up. Mean follow-up time was 3.0 ± 1.9 years. Recanalization rate at 1 week, 1, 3, and 5 years was 2.4%, 4.3%, 9.3%, and 17.5%, respectively. After multivariate analysis for each follow-up evaluation, CEAP classes C4 and 5, as well as preoperative GSV diameter >6 mm and history of smoking were found to be independent predictors of recanalization. Furthermore, age >61 years and postoperative complications such as pigmentation, edema, and paresthesia were found to be dependent risk factors.
CONCLUSION:
RFA remains a safe and durable technique to ablate incompetent GSV. Despite this, particular attention should be paid to patients with high CEAP classes to avoid short and long-term recanalization.
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Oxygen Partial Pressure in Cerebrospinal Fluid as a Potential Parameter to Identify Spinal Cord Ischaemia.
Eur J Vasc Endovasc Surg2022 Feb;63(2):352-353. doi: 10.1016/j.ejvs.2021.09.023.
Monzio-Compagnoni Nicola, Romani Federico, Mondino Michele G, Rampoldi Antonio G, Trimarchi Santi, Tolva Valerio S
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Complex Regional Pain Syndrome with Aortic Distress after Thoracic Endovascular Aortic Repair and False Lumen Exclusion with "Candy Plug" Technique.
Aorta (Stamford)2021 Jun;9(3):113-115. doi: 10.1055/s-0041-1730007.
Tolva Valerio S, Kahlberg Andrea, Bertoglio Luca, Trimarchi Santi, Miloro Riccardo, Casana Renato, Chiesa Roberto
Abstract
A 41-year-old male presented for pain treated with oxycodone. A zone-2 thoracic endovascular aortic repair with distal PETTICOAT (provisional extension to induce complete attachment) for complicated Type-IIIB aortic dissection was performed 18 months before. Repeated hospitalizations did not show any issues to justify the recurrent pain. The aortic nature of the pain was suspected considering the plug as a pain trigger. Through a left thoracoabdominal incision in the eighth intercostal space, the candy plug was removed. Pain diminished after thoracoabdominal surgery steadily.
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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Sheath Size Up and Down With Single Proglide - A Technique for Achieving Hemostasis With Use of Large Size Delivery System During Endovascular Graft Placement.
Ann Vasc Surg2022 Jan;78():190-196. doi: 10.1016/j.avsg.2021.06.024.
Singh Gurbhej, Scalise Filippo, Bianchi Paolo, Cireni Lea, Sorropago Giovanni, Casana Renato, Tolva Valerio
Abstract
BACKGROUND:
A total percutaneous approach for management of aortic pathologies with endovascular grafts requires the use of large size delivery-systems. The diameter of these delivery systems usually exceeds the recommended sizes for most of the currently available percutaneous closure devices. A safe, effective and simple vascular access site closure device is desirable for success for percutaneous procedures for aortic pathologies. Hence, we aim to study safety and effectiveness of the use of a single suture based vascular access closure device (ProGlide) using a technique involving serial up and downsizing of the sheath size to achieve access site hemostasis in patients undergoing endovascular graft placement using femoral artery approach.
MATERIALS AND METHODS:
We studied all consecutive patients who underwent endovascular grafting from January 2018 to December 2019. It is a retrospective observational study comparing procedural and short-term outcomes between single ProGlide use and surgical cut-down for femoral access site closure. We excluded patients with femoral artery minimal luminal diameter less than 5 mm, the presence of an aneurysm of the femoral artery, ?180 degrees of calcium present at femoral/ external iliac artery and history of any vascular closure device use in the last six months.
RESULTS:
We included 30 patients in single ProGlide group and 30 patients in the surgical cut-down group. One-third of the procedures were urgent procedures in the single Proglide group. Single ProGlide was successful in 93.34% patients and failure (6.66%) was seen due to hematoma and pseudoaneurysm in one patient each detected before discharge. The primary end-point defined by the success of procedure did not differ between the two groups. There were higher complications in the surgical group till 30 days as evidenced by infection, hematoma and neuronal injury. The secondary end-point, defined by the composite of complication events after discharge till 30 days was significantly higher in the surgical group (P-0.005) CONCLUSION: In patients with suitable femoral artery anatomy who undergo endovascular graft placement, effective hemostasis can be achieved safely using up and downsizing of the sheath with a single suture-based technique (Proglide). The results of the study could be considered hypothesis generating and needs to be confirmed in a randomized controlled trial before being adopted in clinical practice.
Copyright © 2021. Published by Elsevier Inc.
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Surgical Single Stage Treatment for Obstructive Hypertrophic Cardiomyopathy and Aortic Arch Aneurysm.
Aorta (Stamford)2020 Oct;8(5):144-147. doi: 10.1055/s-0040-1714124.
Margonato Davide, Tolva Valerio Stefano, Vaccari Giuseppe, Bianchi Paolo, Casana Renato, Parati Gianfranco, Ferrazzi Paolo
Abstract
Coexistence of obstructive hypertrophic cardiomyopathy and severe aortic pathology is extremely rare; nonetheless, the association between these two diseases is fascinating. Here we present a unique case report of a patient with obstructive hypertrophic cardiomyopathy and aortic arch aneurysm treated by a single surgical procedure.
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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Influence of contralateral carotid artery occlusions on short- and long-term outcomes of carotid artery stenting: a retrospective single-center analysis and review of literature.
Int Angiol2021 Apr;40(2):87-96. doi: 10.23736/S0392-9590.20.04525-3.
Casana Renato, Domanin Maurizio, Malloggi Chiara, Tolva Valerio S, Odero Jr Andrea, Bissacco Daniele, Trimarchi Santi, Silani Vincenzo, Parati Gianfranco
Abstract
BACKGROUND:
In the current literature, correlations between a contralateral carotid artery occlusion (CCO) with mortality and major adverse cardiac or cerebrovascular events (MACCE) rates after carotid artery stenting (CAS) are often described with controversial conclusions. Moreover, long-term results of mortality, MACCE and restenosis rate are scarcely reported. This study examined the association between a CCO and the short- and long-term outcomes after CAS.
METHODS:
One hundred and forty-six patients with CCO and without (No-CCO) who underwent between 2010 and 2017 to a CAS procedure in a single institution were retrospectively evaluated. The primary aim of the study was to evaluate mortality and MACCE rates in the short-term (defined as the occurrence during hospitalization and within 30-day) and after 3-year follow-up. The secondary aim of the study was to examine the restenosis rates in the short- and long-term period.
RESULTS:
The overall success of CAS was 99.3% and the 30-day all-cause mortality rate was 0.7% (one death). About MACCE, there were no major strokes in the CCO groups and 1 (1.4%) in the No-CCO group (P=1.00). The rate of 30-day minor strokes was 1.4% (1 patient) in the CCO group and 2.7% (2 patients) in the No-CCO group (P=1.00). In the 3-year follow-up, death occurred in 11 CCO vs. 6 No-CCO patients, respectively (15.1% vs. 8.2%, P=0.30). Regarding MACCE, major stroke occurred in 6 CCO vs. 2 No-CCO patients (8.2% vs. 2.7%, P=0.27), minor stroke in 6 CCO vs. 6 No-CCO (8.2% vs. 8.2%, P=1.0) and myocardial infarction in 6 CCO (8.2%) vs. 3 No-CCO patients (8.2 vs. 4.1%, P=0.49), respectively. Regarding the 30-day restenosis rate, it was observed in one patient (1.4%) in the CCO group while no cases were recorded in the No-CCO group, respectively (P=1.00). In the 3-year follow-up, greater than >50% restenosis was observed in 7 patients (9.6%) in the CCO group and in one patient (1.4%) in the No-CCO group (P=0.06), respectively. Kaplan-Meier survival analysis revealed that CCO patients had a lower 3-year freedom from restenosis rate with respect to the No-CCO group (87.6% vs. 98.6%, P=0.024). A Cox regression model on 3-year restenosis highlighted female gender and hypertension to be statistically significant predictors of restenosis.
CONCLUSIONS:
Patients with a preexisting CCO did not show a significative increased risk of procedural adverse events after CAS both in the immediate and long-term follow-up, but on the long term they are more likely to experience restenosis. CCO condition should be considered always as a clinical manifestation of a more aggressive carotid atherosclerosis.
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Aortic arch types and postoperative outcomes after carotid artery stenting in asymptomatic and symptomatic patients.
Int Angiol2020 Dec;39(6):485-491. doi: 10.23736/S0392-9590.20.04494-6.
Casana Renato, Bissacco Daniele, Malloggi Chiara, Tolva Valerio S, Odero Andrea, Domanin Maurizio, Trimarchi Santi, Silani Vincenzo, Parati Gianfranco
Abstract
BACKGROUND:
The aim of this study was to investigate the influence of the aortic arch type on technical and clinical success of carotid artery stenting (CAS) procedure.
METHODS:
Clinical and anatomical data of consecutive patients who underwent CAS from 2010 to 2018 were prospectively collected and retrospectively analyzed. Primary outcome was technical success, define as successful stent delivery and deployment and
RESULTS:
During the study period, 523 patients were enrolled and analyzed. Among these, 176 (33.6%) had Type I, 227 (43.4%) had Type II and 120 (23.0%) had Type III or bovine aortic arch (BAA) type. Technical success rate was achieved in 96.0% of cases. At 30 days, if compared with Type I or II, patient with Type III or BAA experienced a higher death rate (0 vs. 0 vs. 1.8%, respectively; P=0.056) and combined postoperative stroke/TIA rate (3% vs. 2.8% vs. 9.9%, respectively; P=0.012). No differences for same outcomes between asymptomatic and symptomatic patients were described, although the latter group experienced more postoperative MI. A multivariate analysis revealed Type III or BAA as an independent risk factor for postoperative stroke/TIA (HR 3.23, IC95% 1.40-7.45; P=0.006).
CONCLUSIONS:
In this cohort of patients, death and postoperative neurological complications rates were associated with Type III or BAA, irrespective of symptomatic patients' status. Extremely attention is required during perioperative period in patients who were candidate to CAS and with challenging aortic arch anatomy.
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Repeat Surgery in Chronic Aortic Dissection: A New Technique without Touching the Native Aorta.
Aorta (Stamford)2019 Dec;7(6):163-168. doi: 10.1055/s-0039-3402071.
Martinelli Gian Luca, Cotroneo Attilio, Tolva Valerio, Armienti Felice, Bobbio Mario, Musica Gabriele, Visetti Enrico, Tesler Ugo Filippo
Abstract
BACKGROUND:
?Repeat surgery of the chronically dissected aorta following repair of a Type-A acute aortic dissection (AAD) still represents a challenge. The proposed surgical options are as follows: (1) staged procedure with elephant trunk (ET) technique, (2) traditional frozen elephant trunk (FET) intervention, and (3) beating heart cerebral vessel debranching followed by thoracic endovascular aortic repair (TEVAR). However, a marked enlargement of the proximal descending thoracic aorta might make it difficult to perform FET/ET intervention. Furthermore, because in conventional surgery for AAD, a prosthetic graft replacement is generally limited to the ascending aorta, and in repeat surgery, this short Dacron graft rarely provides enough room to allow a beating heart cerebral vessel debranching and obtaining a reliable landing zone for the implantation of a firmly anchored stent graft.
METHODS:
?We retrospectively reviewed all the five consecutive patients treated in our institution, between 2014 and 2017, for chronic aortic dissection after successful surgical treatment of acute Type-A aortic dissection with graft replacement limited to the ascending aorta. The five patients underwent repair utilizing a modified FET technique with total aortic arch and upper descending aorta exclusion without touching the native dissected aorta.
RESULTS:
?No early- or midterm mortality was observed. Mean time interval between the initial and the reoperative procedure was 26 months (range, 3-80 months). No patient had a minor/major neurologic event. Mean circulatory arrest time was 16?minutes (range, 11-25?minutes). Mean follow-up time was 22 months (range, 9-42 months).
CONCLUSIONS:
?We report our initial experience with a modified FET technique realized by anastomosing the stent graft with the previously implanted ascending aortic graft in Hishimaru's zone 0 and by rerouting all cerebral vessels without "touching" the native chronically dissected aorta. A larger number of patients and a longer follow-up will be required to confirm these initial encouraging results.
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Carotid artery stenting is safe and effective for symptomatic patients with acute coronary syndrome.
Catheter Cardiovasc Interv2020 Jul;96(1):129-135. doi: 10.1002/ccd.28445.
Casana Renato, Tolva Valerio Stefano, Odero Andrea, Malloggi Chiara, Silani Vincenzo, Parati Gianfranco
Abstract
BACKGROUND:
Patients with symptomatic carotid stenosis recently treated with percutaneous transluminal coronary angioplasty (PTCA) for acute coronary syndrome (ACS) are always classified as at high risk for surgery, given that they are required uninterrupted dual antiplatelet therapy. In this regard, carotid artery stenting (CAS) may represent a valid alternative.
OBJECTIVE:
The purpose of this study is to overview CAS outcomes in symptomatic patients with and without ACS.
METHODS:
One hundred fifty-one consecutive symptomatic patients who underwent CAS between 2010 and 2017 in a single institution were included in this study, of which 66 (43.7%) were identified as having ACS. All patients were followed-up with carotid duplex ultrasound scan and a neurological assessment of symptoms status at 30-day postprocedure and at 3, 6, and 12?months, with annual follow-up after that for 3?years.
RESULTS:
Among symptomatic ACS patients, common risks factors were active smoking, metabolic syndrome, diabetes, and hypertension. In the short-term follow-up, no significant differences were observed among rates of death, stroke, myocardial infarction (MI), and restenosis, between patients with and without ACS. Mean clinical follow-up was 28.2 (12.3) months. In the long-term follow-up, higher rates of death and MI were recorded in patients with ACS (death: 11.4% vs. 5.4%, p =?.04; MI: 11.4% vs. 3.6%, p?= .02), owing to the complexity of these patients.
CONCLUSIONS:
This single-center study suggested that CAS is a safe and effective treatment for patients with symptomatic carotid artery stenosis, who recently underwent PTCA for ACS, requiring uninterrupted dual antiplatelet therapy.
© 2019 Wiley Periodicals, Inc.
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Three-year outcomes after carotid artery revascularization: Gender-related differences.
Vascular2019 Oct;27(5):459-467. doi: 10.1177/1708538119836312.
Casana Renato, Malloggi Chiara, Tolva Valerio Stefano, Odero Andrea, Bulbulia Richard, Halliday Alison, Silani Vincenzo, Parati Gianfranco
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A new Percutaneous technique for effective vascular Access Site closure in patients undergoing Transfemoral aortic valve implantation and thoraco-abdominal aortic aneurysm rEpair: the PASTE study.
EuroIntervention2018 Dec;14(12):e1278-e1285. doi: 10.4244/EIJ-D-18-00245.
Sorropago Giovanni, Singh Gurbhej, Sorropago Antonio, Sole Andrea, Rossi Jessica, Tolva Valerio Stefano, Stabile Eugenio, Scalise Filippo
Abstract
AIMS:
The success of transfemoral transcatheter aortic valve implantation (TAVI) and thoraco-abdominal aneurysm repair (TAAR) depends on haemostatic control of the access site, which is usually obtained with suture-based closure devices (Prostar or two ProGlide). A single ProGlide/Glubran technique, involving a suture placement on the vessel wall followed by tissue glue injection around the vessel wall, has not been previously investigated in this clinical setting. Our aim was to study the feasibility and safety of a single ProGlide/Glubran technique for vascular access-site closure after transfemoral TAVI and TAAR.
METHODS AND RESULTS:
This technique was used in 250 patients from 2012 to 2017. The primary endpoint was the success of the technique, defined as access-site haemostasis without complications and not requiring any additional intervention within 30 days of the index procedure. Patients had a mean age of 82.4±1.93 years, with a logistic EuroSCORE of 20.2±2.32. A total of 218 TAVI and 32 TAAR procedures were performed with a mean sheath size of 18.09±1.55 Fr. The mean sheath to femoral artery ratio was 1.04±0.16, with mean femoral artery minimal lumen diameter 6.65±0.64 mm. The overall success rate of this technique was 98.4%. Four patients (1.6%) developed critical stenosis of the femoral artery requiring balloon dilatation. No major VARC-2 vascular complications were observed. Thirty-day mortality was 0.4% (non-cardiovascular).
CONCLUSIONS:
The results of this study suggest that the single ProGlide/Glubran technique is a safe and effective method of closing the arterial access site after transfemoral TAVI and TAAR. The results of our study need to be confirmed in a randomised controlled trial before being adopted in routine clinical practice.
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Does metabolic syndrome influence short and long term durability of carotid endarterectomy and stenting?
Diabetes Metab Res Rev2019 Jan;35(1):e3084. doi: 10.1002/dmrr.3084.
Casana Renato, Malloggi Chiara, Tolva Valerio Stefano, Odero Andrea, Bulbulia Richard, Halliday Alison, Silani Vincenzo
Abstract
AIMS:
The metabolic syndrome (MetS) is composed of a cluster of related cardiovascular risk factors. The aim of the present study was to determine how MetS contributes to short- (30-day) and long-term complications and restenosis after carotid endarterectomy (CEA) or stenting (CAS).
METHODS:
A consecutive cohort of 752 patients undergoing CEA (n = 314) and CAS (n = 438) in a single institution was examined, of which 296 (39.4%) were identified as having MetS. All patients were followed-up with carotid duplex ultrasound scan of the supraaortic vessels and a neurological assessment of symptoms status at 30-day postprocedure and at 3, 6, and 12 months, with annual follow-up thereafter for 3 years.
RESULTS:
Patients with MetS had a significant increased risk in their 30-day death, major adverse events (MAE), and restenosis rates, both after CEA and after CAS (death: 0.7% vs 0.0%; MAE: 5.3% vs 2.7%; and restenosis: 1.7% vs 0.2%; p
CONCLUSIONS:
The current study suggested that the presence of MetS is an important risk factor for morbidity and restenosis after CEA and CAS.
© 2018 John Wiley & Sons, Ltd.
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Is diabetes a marker of higher risk after carotid revascularization? Experience from a single centre.
Diab Vasc Dis Res2018 Jul;15(4):314-321. doi: 10.1177/1479164118769530.
Casana Renato, Malloggi Chiara, Odero Andrea, Tolva Valerio, Bulbulia Richard, Halliday Alison, Silani Vincenzo
Abstract
PURPOSE:
This single centre study investigates the influence of diabetes mellitus on outcomes following carotid artery endarterectomy or stenting.
METHODS:
In total, 752 carotid revascularizations (58.2% carotid artery stenting and 41.8% carotid endarterectomy) were performed in 221 (29.4%) patients with diabetes and 532 (70.6%) patients without diabetes. The study outcomes were death, disabling and non-disabling stroke, transient ischaemic attack and restenosis within 36?months after the procedure.
RESULTS:
Patients with diabetes had higher periprocedural risk of any stroke or death (3.6% diabetes vs 0.6% no diabetes; p?0.05), transient ischaemic attack (1.8% diabetes vs 0.2% no diabetes; p?>?0.05) and restenosis (2.7% diabetes vs 0.6% no diabetes; p?0.05). During long-term follow-up, there were no significant differences in Kaplan-Meier estimates of freedom from death, any stroke and transient ischaemic attack, between people with and without diabetes for each carotid artery stenting and carotid endarterectomy subgroup. Patients with diabetes showed higher rates of restenosis during follow-up than patients without diabetes (36-months estimate risk of restenosis: 21.2% diabetes vs 12.5% no diabetes; p?0.05).
CONCLUSION:
The presence of diabetes was associated with increased periprocedural risk, but no further additional risk emerged during longer term follow-up. Restenosis rates were higher among patients with diabetes.
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Three-year follow-up and quality of life of endovenous radiofrequency ablation of the great saphenous vein with the ClosureFast? procedure: Influence of BMI and CEAP class.
Vascular2018 Oct;26(5):498-508. doi: 10.1177/1708538118762066.
Casana Renato, Tolva Valerio Stefano, Odero Andrea, Malloggi Chiara, Parati Gianfranco
Abstract
Purpose Endovascular ablation of the great saphenous vein has been proposed as a less invasive alternative to conventional ligation and stripping of varicose veins. Outcomes of patients treated with the radiofrequency ablation ClosureFast? system over an eight-year period from a single-center were evaluated. Methods Three-year follow-up data included duplex ultrasound scan, complication rate, and questionnaires to assess patients' QOL, level of pain, and days off work. Results A total of 1080 consecutive patients (49.5?±?18.6 years, 72% female, mean body mass index: 25.44?±?4.1?kg?m) underwent radiofrequency ablation for incompetent saphenous veins in a single institution. Occlusion of the great saphenous vein was obtained in 98.6% and 93.8% cases at the end of the procedures and within 36 months, respectively. Only three deep venous thromboses and minor complications occurred in this series throughout the first week from the procedure. A decrease of the external vein diameter, equal to 72.7% and 31.1% of the pretreatment diameter, was observed at 1 week and 36 months, respectively. The average Aberdeen Varicose Vein Questionnaire score improved from 18.06?±?9.47 before treatment to 11.56?±?10.23 at 12 months, with no significant differences in the subsequent follow-up. SF-36 QOL scores significantly improved after the procedure in all domains, while there were no changes over time. Patients reported a prompt return to normal daily activities (1.5?±?0.7 days) and work (3.1?±?1.9 days). Body mass index influenced QOL scores, while it did not affect great saphenous vein diameter reduction during the follow-up. On the contrary, Clinical Etiologic Anatomic Pathophysiologic class significantly influenced both great saphenous vein diameter reduction after the treatment and QOL scores within 36 months. Conclusion Results of this retrospective monocentric, large patients study suggest that radiofrequency ablation of the great saphenous vein may be a safe and efficient alternative to conventional surgery.
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Safety and Efficacy of the New Micromesh-Covered Stent CGuard in Patients Undergoing Carotid Artery Stenting: Early Experience From a Single Centre.
Eur J Vasc Endovasc Surg2017 Dec;54(6):681-687. doi: 10.1016/j.ejvs.2017.09.015.
Casana Renato, Tolva Valerio, Odero Andrea, Malloggi Chiara, Paolucci Aldo, Triulzi Fabio, Silani Vincenzo
Abstract
OBJECTIVE/BACKGROUND:
Plaque protrusion through stent struts represents one of the principal causes of cerebral embolisation during carotid artery stenting (CAS) and the stent healing period. The aim of this study was to evaluate the safety (technical success) and efficacy (clinical success) of the CGuard stent system - a new nitinol stent covered by a closed-cell polyethylene terephthalate mesh designed to prevent embolic events.
METHODS:
Eighty-two consecutive patients who underwent CAS with CGuard from June 2015 were included in this study. The same surgeon performed all procedures. Primary endpoints included technical and clinical success. Clinical success was considered to be absence of death, major or minor stroke. The incidence of new ischaemic brain lesions was also evaluated by diffusion weighted magnetic resonance imaging (DW-MRI) in a subgroup of patients as a secondary endpoint.
RESULTS:
In this study, 82 patients (73.8 ± 8.5 years, 75% male, 19% symptomatic) underwent CAS procedures. Immediate technical success was 100%, with the stenosis diameter reduced from 81.4 ± 4.9% to 11.0 ± 3.5%. There was peri-operative technical and clinical success in 100% of symptomatic patients, and in 98.5% of asymptomatic patients, because of the occurrence of one acute stent thrombosis 4 hours post-CAS followed by a minor stroke. In the post-operative period (30 days), no new events were registered. The most recent 21 patients (24%) underwent DW-MRI in the peri-operative period: new ischaemic brain lesions were recorded in 23.8% of patients and the average lesion volume per patients was 0.039 ± 0.025 cm.
CONCLUSIONS:
The technical and clinical outcomes of this single centre study suggest that the CGuard may be a safe and effective device for endovascular treatment of symptomatic and asymptomatic subjects, independent of aortic arch anatomy. Further larger comparative studies are needed to confirm these benefits.
Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
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Occlusive Shrinkage of Ovation Endograft Presenting as Acute Lower Limb Ischemia: Effective Endovascular Management.
Aorta (Stamford)2017 Feb;5(1):21-26. doi: 10.12945/j.aorta.2017.16.041.
Bianchi Paolo, Scalise Filippo, Mortara Andrea, Lanzillo Guido, Scardina Giuseppe, Trimarchi Santi, Parati Gianfranco, Tolva Valerio
Abstract
The aim of this report is to describe the imaging and successful treatment of an acute shrinkage of the Ovation Abdominal Stent Graft System. The Ovation Prime system utilizes a polymer-filled sealing ring that is cast at the margin of the aneurysm; however, the residual endograft inner volume after ring filling may reduce volume and graft flow. Nevertheless, there are no reports about severe complications using the Ovation Prime system. A 75-year-old male presented to our hospital for acute lower limb ischemia. The patient reported a previous endograft for abdominal aortic aneurysm 1 month previously, which utilized the Ovation device. Computed tomography (CT) angiography demonstrated a critical narrowing of the endograft at the site of the proximal sealing rings. We decided on urgent treatment, delivering a covered stent graft (CP STENT NUMED). Intraoperative intravascular ultrasound showed effective compaction of the proximal rings. Nine-month follow-up with CT angiography demonstrated good patency without ring recoil of the endograft. This is the first report of endovascular treatment for an acute and symptomatic shrinkage of proximal rings in the Ovation trivascular endograft. Angiographic and intravascular ultrasound findings showed that covered stenting is effective and that the ring polymer is safely moldable.
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The Mid-Term Clinical Follow-Up Using Drug-Eluting Balloons on Tibial Artery "De Novo" Lesions in Patients With Critical Limb Ischemia: A Cohort Study.
Vasc Endovascular Surg2016 Jul;50(5):304-8. doi: 10.1177/1538574416647500.
Tolva Valerio, Casana Renato, Huibers Anne, Parati Gianfranco, Bianchi Paolo, Cireni Lea, Ferrero Emanuele, Halliday Allison
Abstract
RATIONALE:
Restenosis due to intimal hyperplasia (IH) is a major clinical issue that affects the success of lower limb endovascular surgery. After 1 year, restenosis occurs in 40% to 60% of the treated vessels. The possibility to reduce IH using local antiproliferative drugs, such as taxols, has been the rationale for the clinical applications of drug-eluting stents and drug-eluting balloons (DEBs). The purpose of this study was to evaluate the clinical and instrumental efficacy of DEBs versus simple percutaneous transluminal angioplasty (PTA) in patients affected by chronic limb ischemia (CLI) with tibial artery "de novo" lesions.
METHODS:
A retrospective analysis was performed and included all consecutive patients who underwent endovascular treatment for CLI in our centers between January 2011 and March 2013. Inclusion criteria were (1) "de novo" tibial artery stenosis and (2) Rutherford class >4. Lesions were further divided by TransAtlantic Inter-Societal Consensus (TASC) classification into groups A, B, C, and D.
RESULTS:
Between January 2010 and March 2013, a total of 138 patients underwent simple PTA or DEB for CLI, and the groups were clinically and demographically homogenous. We decided to use DEBs in 70 cases. An improvement in the Rutherford Scale in cumulative and single TASC lesions classification was better in the DEB group (74% vs 51%; P = .024) at 24 months than in the PTA group. In the DEB group, the increase in ankle-brachial index was significantly higher than in the PTA group (P = .039).
CONCLUSIONS:
Our experience in addition to the existing literature supports the use of DEB in patients with CLI Rutherford class >3.
© The Author(s) 2016.
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A successful experimental model for intimal hyperplasia prevention using a resveratrol-delivering balloon.
J Vasc Surg2016 Mar;63(3):788-94. doi: 10.1016/j.jvs.2014.09.035.
Tolva Valerio, Mazzola Silvia, Zerbi Pietro, Casana Renato, Albertini Mariangela, Calvillo Laura, Selmin Francesca, Cilurzo Francesco
Abstract
OBJECTIVE:
Restenosis due to intimal hyperplasia is a major clinical problem that compromises the success of angioplasty and endovascular surgery. Resveratrol (RSV) has demonstrated a beneficial effect on restenosis from angioplasty. Unfortunately, the physicochemical characteristics of RSV reduce the practicality of its immediate clinical application. This work proposes an experimental model aiming to setup an intravessel, elutable, RSV-containing compound.
METHODS:
A 140 ?g/mL RSV sterile injectable solution with a suitable viscosity for intravascular administration by drug-delivery catheter (RSV-c) was prepared. This solution was locally administered in the common iliac artery of adult male New Zealand White rabbits using a dedicated device (Genie; Acrostak, Geneva, Switzerland) after the induction of intimal hyperplasia by traumatic angioplasty. The RSV concentrations in the wall artery were determined, and the thickness of the harvested iliac arteries was measured over a 1-month period.
RESULTS:
The Genie catheter was applied in rabbit vessels, and the local delivery resulted in an effective reduction in restenosis after plain angioplasty. Notably, RSV-c forced into the artery wall by balloon expansion might accumulate in the interstitial areas or within cells, avoiding the washout of solutions. Magnification micrographs showed intimal proliferation was significantly inhibited when RSV-c was applied. Moreover, no adverse events were documented in in vitro or in vivo studies.
CONCLUSIONS:
RSV can be advantageously administered in the arterial walls by a drug-delivery catheter to reduce the risk of restenosis.
Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
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Rat experimental model of myocardial ischemia/reperfusion injury: an ethical approach to set up the analgesic management of acute post-surgical pain.
PLoS One2014 ;9(4):e95913. doi: e95913.
Ciuffreda Maria Chiara, Tolva Valerio, Casana Renato, Gnecchi Massimiliano, Vanoli Emilio, Spazzolini Carla, Roughan John, Calvillo Laura
Abstract
RATIONALE:
During the past 30 years, myocardial ischemia/reperfusion injury in rodents became one of the most commonly used model in cardiovascular research. Appropriate pain-prevention appears critical since it may influence the outcome and the results obtained with this model. However, there are no proper guidelines for pain management in rats undergoing thoracic surgery. Accordingly, we evaluated three analgesic regimens in cardiac ischemia/reperfusion injury. This study was strongly focused on 3R's ethic principles, in particular the principle of Reduction.
METHODS:
Rats undergoing surgery were treated with pre-surgical tramadol (45 mg/kg intra-peritoneal), or carprofen (5 mg/kg sub-cutaneous), or with pre-surgical administration of carprofen followed by 2 post-surgery tramadol injections (multi-modal group). We assessed behavioral signs of pain and made a subjective evaluation of stress and suffering one and two hours after surgery.
RESULTS:
Multi-modal treatment significantly reduced the number of signs of pain compared to carprofen alone at both the first hour (61±42 vs 123±47; p
CONCLUSIONS:
Multi-modal treatment with carprofen and tramadol was more effective in preventing pain during the second hour after surgery compared with both tramadol or carprofen. Our results suggest that the combination of carprofen and tramadol represent the best therapy to prevent animal pain after myocardial ischemia/reperfusion. We obtained our results accordingly with the ethical principle of Reduction.
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Commentary: multilayer stent for the treatment of complex aortic pathologies: a long or short road ahead?
J Endovasc Ther2014 Feb;21(1):113-6. doi: 10.1583/13-4514C.1.
Tolva Valerio S, Casana Renato, Antoniou George A
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Carotid artery stenting in patients with acute coronary syndrome: a possible primary therapy for symptomatic carotid stenosis.
J Endovasc Ther2013 Aug;20(4):546-51. doi: 10.1583/13-4244.1.
Casana Renato, Halliday Alison, Bianchi Paolo, Fresa Emanuele, Silani Vincenzo, Parati Gianfranco, Blengino Simonetta, Cireni Lea, Adobbati Laura, Calvillo Laura, Tolva Valerio S
Abstract
PURPOSE:
To report the results of carotid artery stenting (CAS) in symptomatic patients (stroke/transient ischemic attack) after recent percutaneous transluminal coronary angioplasty (PTCA) for acute coronary syndrome (ACS).
METHODS:
Between January 2009 and July 2011, 28 consecutive patients (18 women; mean age 66 years, range 42-82) underwent protected CAS for symptomatic carotid stenosis following recent PTCA that included bare or drug-eluting stents requiring uninterrupted dual antiplatelet therapy. Primary technical success, neurological complications, major adverse cardiovascular events, and death were evaluated at 30 days and over midterm follow-up.
RESULTS:
Technical success was 96%; 1 patient suffered a nonfatal major stroke (3.5% 30-day stroke rate) during the procedure. During a median 21.6-month follow-up, 4 (14%) patients died of myocardial infarction (all diabetic smokers with ejection fractions 34 kg/m(2).
CONCLUSION:
This preliminary experience demonstrated that CAS is a reasonable, safe, and effective treatment for patients with symptomatic carotid artery stenosis who were recently treated with coronary stents requiring uninterrupted dual antiplatelet therapy.
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Retrograde approach using the right axillary artery for complete endovascular treatment of a symptomatic aberrant right subclavian artery aneurysm.
J Endovasc Ther2012 Dec;19(6):847-8. doi: 10.1583/JEVT-12-4031L.1.
Tolva Valerio S, Trimarchi Santi, Bianchi Paolo G, Cireni Lea Valeria, Lombardo Almarosa, Keller Guido C, Parati Gianfranco, Casana Renato
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Radiofrequency ablation of the great saphenous vein with the ClosureFAST? procedure: mid-term experience on 400 patients from a single centre.
Surg Today2013 Jul;43(7):741-4. doi: 10.1007/s00595-012-0296-4.
Tolva Valerio S, Cireni Lea V, Bianchi Paolo G, Lombardo Almarosa, Keller Guido C, Casana Renato M
Abstract
INTRODUCTION:
Endovascular obliteration of the great saphenous vein (GSV) has been proposed as an alternative to conventional extirpative treatment of varicose veins.
MATERIALS AND METHODS:
This report reviewed the initial experience with the ClosureFAST? procedure in 407 legs over a one-year period. Occlusion of the GSV was seen on 98 % of completion scans and in all patients within 1 week of the procedure. Persistent occlusion was documented in all cases. One had paresthesias and one had skin pigmentation. Three patients had transient superficial thrombophlebitis in a treated segment of a superficial collateral of the GSV. One patient was found to have extension of an asymptomatic, nonocclusive thrombus into the common femoral vein 1 week after the procedure.
CONCLUSION:
Radiofrequency ablation of the GSV appears to be a safe alternative to conventional stripping and ligation. Randomised clinical trials and longer follow-up periods are required to establish the overall superiority of the procedure in comparison to conventional stripping.
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Multiple multilayer stents for thoracoabdominal aortic aneurysm: a possible new tool for aortic endovascular surgery.
Int J Gen Med2012 ;5():629-32. doi: 10.2147/IJGM.S33008.
Tolva Valerio Stefano, Bianchi Paolo Guy, Cireni Lea Valeria, Lombardo Alma, Keller Guido Carlo, Parati Gianfranco, Casana Renato Maria
Abstract
PURPOSE:
Endovascular surgery data are confirming the paramount role of modern endovascular tools for a safe and sure exclusion of thoracoabdominal lesions.
CASE REPORT:
A 57-year-old female presented with severe comorbidity affected by a 58 mm thoracoabdominal aortic aneurysm (TAAA). After patient-informed consent and local Ethical Committee and Italian Public Health Ministry authorization, three multilayer stents were implanted in the thoracoabdominal aortic tract, obtaining at a 20-month computed tomography scan follow up, a complete exclusion of the TAAA, with normal patency of visceral vessels.
CONCLUSION:
Multilayer stents can be used in thoracoabdominal aortic aneurysm, with positive results.
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Commentary: a better understanding of the diagnosis and treatment of isolated abdominal aortic dissections.
J Endovasc Ther2009 Feb;16(1):81-3. doi: 10.1583/08-2601C.1.
Trimarchi Santi, Tolva Valerio, Grassi Viviana, Rampoldi Vincenzo, Upchurch Gilbert R
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Descending thoracic and abdominal aortic coarctation in the young: Surgical treatment after percutaneous approaches failure.
J Vasc Surg2008 Apr;47(4):865-7. doi: 10.1016/j.jvs.2007.10.048.
Trimarchi Santi, Tolva Valerio S, Grassi Viviana, Frigiola Alessandro, Carminati Mario, Rampoldi Vincenzo
Abstract
Descending thoracic and abdominal aortic coarctations are characterized by a segmental narrowing that frequently involves the origin of the visceral and renal arteries. Optimal primary treatment is debated, being reported for both surgical and percutaneous complications. We describe our surgical experience with two youths presenting with failure of distal descending aortic stenting and with abdominal aortic coarctation post-balloon angioplasty, and associated thrombosis of a stented right renal artery and stenosis of the origin of the superior mesenteric artery (SMA). In both cases, a longitudinal aortoplasty was performed with a polytetrafluoroethylene (PTFE) patch, using simple aortic cross-clamping. Renal thrombosis and SMA stenosis were managed with eversion technique. In-hospital course was uneventful. Midterm follow-up showed absence of significant restenosis and better control of hypertension. In order to refrain from operating on these patients as long as possible, and also because of the very high risk of a redo-surgery, we think that an initial balloon angioplasty should be considered. Surgical management can be adopted, even after failure of percutaneous treatments, with satisfactory short- and midterm vessels patency.
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Endovascular repair of thoracic aortic disease with the EndoFit stent-graft: short and midterm results from a single center.
J Endovasc Ther2008 Feb;15(1):54-61. doi: 10.1583/07-2158M.1.
Inglese Luigi, Mollichelli Nadia, Medda Massimo, Sirolla Cristina, Tolva Valerio, Grassi Viviana, Fantoni Cecilia, Neagu Ana, Pavesi Marco
Abstract
PURPOSE:
To analyze the outcomes of endovascular treatment of thoracic aortic pathologies performed at a single center with the EndoFit thoracic stent-graft system.
METHODS:
From January 2002 to January 2007, 41 patients (33 men; mean age 69.3+/-9.7 years, range 48-84) were treated for thoracic aortic disease with the EndoFit stent-graft system. Patient data were retrieved from a retrospective review of hospital records. Indications for treatment were progression of aneurysm size in atherosclerotic aneurysms (n = 24, mean aneurysm diameter 7.19+/-1.48 cm), acute contained aortic rupture (n = 5), aortic dissection (n = 6), penetrating atherosclerotic ulcers (n = 4), post-traumatic pseudoaneurysm (n = 1), and post coarctation repair aneurysm (n = 1).
RESULTS:
The EndoFit stent-graft was successfully deployed in all 41 patients. The in-hospital and 30-day mortality rate was 7.3% (3 patients). Three (7.3%) postoperative endoleaks were recorded: a proximal type Ia and a distal Ib both resolved spontaneously at 1 and 3 months, respectively. The third patient had a persistent type Ia endoleak; conversion was necessary after 1 year. There was only 1 case of spinal ischemia, with consequent lower extremity weakness; no paraplegia was observed. During a mean 24.8-month follow-up, 2 secondary type Ia endoleaks were treated with additional stent-grafts. There were 7 (17%) deaths during follow-up. At 2 years, overall patient survival by Kaplan-Meier analysis was 70%; aneurysm-related survival was 89%.
CONCLUSION:
Endovascular treatment of vascular disease involving the descending thoracic aorta can be safely performed with the EndoFit thoracic stent-graft system.
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Role and results of surgery in acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD).
Circulation2006 Jul;114(1 Suppl):I357-64.
Trimarchi Santi, Nienaber Christoph A, Rampoldi Vincenzo, Myrmel Truls, Suzuki Toru, Bossone Eduardo, Tolva Valerio, Deeb Michael G, Upchurch Gilbert R, Cooper Jeanna V, Fang Jianming, Isselbacher Eric M, Sundt Thoralf M, Eagle Kim A,
Abstract
BACKGROUND:
The clinical profiles and outcomes of patients treated surgically for acute type B aortic dissection (ABAD) are often reported for those in small series or for those cared for at a single institution over a long time period, during which a continuous evolution in techniques has occurred. Accordingly, we sought to evaluate the clinical features and surgical results of patients enrolled in the International Registry of Acute Aortic Dissection by identifying primary factors that influenced surgical outcome and estimating average surgical mortality for ABAD in the current era.
METHODS AND RESULTS:
A comprehensive analysis of 290 clinical variables and their relation to surgical outcomes for 82 patients who required surgery for ABAD (from a population of 1256 patients; mean+/-SD age, 60.6+/-15.0 years; 82.9% male) and who were enrolled in the International Registry of Acute Aortic Dissection was performed. The overall in-hospital mortality was 29.3%. Factors associated with increased surgical mortality based on univariate analysis were preoperative coma or altered consciousness, partial thrombosis of the false lumen, evidence of periaortic hematoma on diagnostic imaging, descending aortic diameter >6 cm, right ventricle dysfunction at surgery, and shorter time from the onset of symptoms to surgery. Factors associated with favorable outcomes included radiating pain, normotension at surgery (systolic blood pressure 100 to 149 mm Hg), and reduced hypothermic circulatory arrest time. The 2 independent predictors of surgical mortality were age >70 years (odds ratio, 4.32; 95% confidence interval, 1.30 to 14.34) and preoperative shock/hypotension (odds ratio, 6.05; 95% confidence interval, 1.12 to 32.49).
CONCLUSIONS:
The present study provides insights into current-day clinical profiles and surgical outcomes of ABAD. Knowledge about different preoperative clinical conditions may help surgeons in making treatment decisions among these high-risk patients.
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Open aortic surgical repair for left hemi-arch stent-graft failure.
Ann Thorac Surg2004 Sep;78(3):1075-8.
Rampoldi Vincenzo, Trimarchi Santi, Righini Paolo, Tolva Valerio, Inglese Luigi
Abstract
A surgical technique of endovascular graft explant through an open aortic approach for left hemi-arch stent-graft failure is described. Between January and April 2003, we surgically treated 3 patients previously submitted for stent grafts for isthmic aortic diseases. Two patients had atherosclerotic aneurysm and 1 had a false lumen reperfusion of subacute intramural hematoma. At 6 to 8 months computed tomographic scan follow-ups on all patients showed a rapid enlargement of aortic diameters due to type I endoleaks. The presence of an uncovered proximal stent in the parasubclavian aorta did not allow a simple aortic cross clamping; therefore we performed an open aortic procedure through a left posterolateral thoracotomy, using femoro-femoral bypass and mild hypothermic circulatory arrest. Selective antegrade cerebral perfusion was started within 3 to 5 minutes from aortotomy and graft removal. Left hemi-arch and descending thoracic aortic replacement was then performed with continuous cerebral perfusion. No surgical mortality was observed. Postoperative course was uneventful for neurologic, cardiac, respiratory, and renal complications. The 3-month follow-ups were event free. This approach, associated with rapid stent-graft explant and selective cerebral antegrade perfusion, appears to be a safe and effective surgical strategy for treating this new aortic pathology.
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