Publications by authors named "David Barilla"

30 Publications

  • Page 1 of 1

Cross-sectional analysis of peripheral blood mononuclear cells in lymphopenic and non-lymphopenic relapsing-remitting multiple sclerosis patients treated with dimethyl fumarate.

Mult Scler Relat Disord 2021 Jul 7;52:103003. Epub 2021 May 7.

Division of Neurology, Department of Medicine, University of Alberta, Alberta Canada T6G 2M8, Edmonton, Canada. Electronic address:

Background: Relapsing-remitting multiple sclerosis (RRMS) is an autoimmune disorder of the central nervous system. Dimethyl Fumarate is a disease-modifying medication used to treat RRMS patients that can induce lymphopenia. We aimed to immunophenotype peripheral blood mononuclear cells (PBMC) in RRMS patients cross-sectionally and examine the characteristics and modifications of lymphopenia over time.

Methods: Characterization of PBMC was done by multiparametric flow cytometry. Patients had been on treatment for up to 4 years and were grouped into lymphopenic (DMF-L) and non-lymphopenic (DMF-N) patients.

Results: Lymphopenia affected the cell population changes over time, with other patient characteristics (gender, age, and previous treatment status) also having significant effects. In both lymphopenic and non-lymphopenic patients, PBMC percentages were reduced over time. While overall T and B cells frequencies were not affected, males, older patients and untreated patients had significant changes in B cell subpopulations over time. CD4 to CD8T cell ratio increased significantly in lymphopenic patients over time. CD4CD8T cell population was similarly reduced in both lymphopenic and non-lymphopenic patients, over time. While the monocyte and NK overall populations were not changed, non-classical monocyte subpopulation decreased over time in lymphopenic patients. We also found CD56CD16 and CD56CD16 NK cells frequencies changed over time in lymphopenic patients. Immune populations showed correlations with clinical outcomes measured by EDSS and relapse rate. Analysis of the overall immunophenotype showed that, while groups divided by other patient characteristics showed differences, the lymphopenia status overrode these differences, resulting in similar immunophenotype within DMF-L.

Conclusions: Our data provide evidence that under the same therapy, lymphopenia affects how the immunophenotype changes over time and can override the differences associated with other patient characteristics and possibly mask other significant changes in the immune profile of patients.
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http://dx.doi.org/10.1016/j.msard.2021.103003DOI Listing
July 2021

Initial single-center experience with a new external support device for the creation of the forearm native arteriovenous fistula for hemodialysis.

J Vasc Access 2021 Mar 16:11297298211002570. Epub 2021 Mar 16.

Unit of Vascular Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino, University of Messina, Messina, Italy.

Objective: To assess and compare the maturation rate of the native radiocephalic arteriovenous fistula (RC-AVF) created with and without a nitinol external support (VasQ™ Laminate Medical Technologies Ltd, Tel Aviv, Israel).

Methods: Data of all consecutive patients who underwent the creation of native RC-AVFs at our center between October 2018 and January 2020 was prospectively collected and retrospectively analyzed.Selected patients who had a suitable vein and a radial artery with triphasic flow at preoperative duplex ultrasound exam and were selected for the creation of a radiocephalic fistula were included. Exclusion criteria were: malignant tumors, acute renal failure, previous upper limb revascularization, and septic status. Patency and maturation, vein, and artery diameter and blood flow rate were assessed at the following intervals: post-operatively, 24 h post-operatively, 1 month, 3 months, and 6 months post-operatively.

Results: Forty-nine patients (31 males, mean age 65.7 years old) were included. Patients who received VasQ™ devices were 25 (VasQ group), the other 24 formed the control group. All patients underwent radio-cephalic AVF placement (21 on the wrist, 20 on the forearm, 8 on the proximal forearm). There were no perioperative complications and fatalities. At 1, 3, and 6 months, primary patency rates were 96 ± 4%, 96 ± 4%, 91 ± 6% (VasQ group) versus 87 ± 7%, 87 ± 7%, 80 ± 9% (control group, P 0.17), secondary patency rates were 96 ± 4%, 96 ± 4%, 91 ± 6% (VasQ group) versus 95 ± 4%, 90 ± 7%, 90 ± 7% (control group, P 0.79). A significantly larger vein diameter increase postoperatively (P 0.009) and a greater maturation rate (96% vs 74%, 0.044) were found in the VasQ group compared to the control group.

Conclusions: The use of the VasQ™ device was associated with higher maturation rates and larger vein diameters postoperatively. The patency rates were slightly higher but not significantly. Further studies are needed to confirm these findings.
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http://dx.doi.org/10.1177/11297298211002570DOI Listing
March 2021

How Should I Treat Aortoesophageal Fistula.

Ann Thorac Surg 2021 Jan 23. Epub 2021 Jan 23.

Unit of Vascular Surgery, Policlinico G. Martino, University of Messina, Via Consolare Valeria, 98125, Messina, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.athoracsur.2020.10.075DOI Listing
January 2021

Inframalleolar bypass for chronic limb-threatening ischemia.

Vasc Med 2021 Apr 6;26(2):187-194. Epub 2021 Jan 6.

Vascular Surgery Unit, Campus Bio-Medico of Rome University, Rome, Italy.

The aims of this study were to analyze the results of inframalleolar bypass for chronic limb-threatening ischemia (CLTI) and to identify outcome-predicting factors. All consecutive patients undergoing inframalleolar bypass for CLTI between 2015 and 2018 were included in this retrospective, single-center study. Outflow artery was the most proximal patent vessel segment in continuity with inframalleolar arteries. Bypasses originating from the popliteal artery were defined as 'short bypasses'. Sixty patients underwent inframalleolar bypass, with four patients undergoing bilateral procedures, making a total of 64 limbs included. The mean age was 73 ± 14 and 52 (81%) were male. The great saphenous vein was the preferred conduit ( = 58, 91%), in a devalvulated fashion ( = 56, 88%). Superficial femoral artery was the most common inflow artery for 'long' grafts ( = 22, 34%), while popliteal artery was the inflow artery for all 'short' grafts ( = 25, 39%). Dorsalis pedis artery was chosen as an outflow artery in 41 patients (63%). Median follow-up was 21 months. Two-year primary and secondary patency, limb salvage, amputation-free survival, and overall survival rates were 67 ± 6%, 88 ± 4%, 84 ± 4%, 72 ± 6%, and 85 ± 4%, respectively. At multivariate analysis, dialysis was an independent predictor for poor primary patency (HR, 4.6; 95% CI, 1.62-13.05; = 0.004), whereas a short bypass was independently associated with an increased primary patency (HR, 0.3; 95% CI, 0.10-0.89; = 0.03). In conclusion, bypass grafting to the inframalleolar arteries resulted in good patency rates, limb salvage and overall survival. Dialysis patients had lower primary patency but still had good limb salvage and survival. Short bypass was a predictor of improved primary patency.
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http://dx.doi.org/10.1177/1358863X20978468DOI Listing
April 2021

Evaluation of the Italian transport infrastructures: A technical and economic efficiency analysis.

Land use policy 2020 Dec 18;99:104961. Epub 2020 Aug 18.

Department of Economics, University of Messina, Piazza Pugliatti, Messina, 1, 98122, Italy.

•The deregulation process played a key role in terms of airport efficiency.•The technical efficiency of 32 Italian airports has been evaluated•The methodological approach has been twofold: DEA and Tobit model•The main results show that efficiency is independent of an airport's size.•The findings highlight the decisive role of public shareholders in small airports.
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http://dx.doi.org/10.1016/j.landusepol.2020.104961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7434470PMC
December 2020

Re: "Trans-iliac Bypass Grafting for Vascular Groin Complications".

Eur J Vasc Endovasc Surg 2020 06 31;59(6):1034-1035. Epub 2020 Mar 31.

Unit of Vascular Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino, University of Messina, Messina, Italy.

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http://dx.doi.org/10.1016/j.ejvs.2020.03.008DOI Listing
June 2020

Mathematical determination of the HIV-1 matrix shell structure and its impact on the biology of HIV-1.

PLoS One 2019 12;14(11):e0224965. Epub 2019 Nov 12.

Department of Medicine, Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada.

Since its discovery in the early 1980s, there has been significant progress in understanding the biology of type 1 human immunodeficiency virus (HIV-1). Structural biologists have made tremendous contributions to this challenge, guiding the development of current therapeutic strategies. Despite our efforts, there are unresolved structural features of the virus and consequently, significant knowledge gaps in our understanding. The superstructure of the HIV-1 matrix (MA) shell has not been elucidated. Evidence by various high-resolution microscopy techniques support a model composed of MA trimers arranged in a hexameric configuration consisting of 6 MA trimers forming a hexagon. In this manuscript we review the mathematical limitations of this model and propose a new model consisting of a 6-lune hosohedra structure, which aligns with available structural evidence. We used geometric and rotational matrix computation methods to construct our model and predict a new mechanism for viral entry that explains the increase in particle size observed during CD4 receptor engagement and the most common HIV-1 ellipsoidal shapes observed in cryo-EM tomograms. A better understanding of the HIV-1 MA shell structure is a key step towards better models for viral assembly, maturation and entry. Our new model will facilitate efforts to improve understanding of the biology of HIV-1.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224965PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850549PMC
March 2020

Simultaneous Superficial Femoral Artery Angioplasty/Stent Plus Popliteal Distal Bypass for Limb Salvage.

Ann Vasc Surg 2020 Feb 25;63:443-449. Epub 2019 Oct 25.

Unit of Vascular Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino, University of Messina, Messina, Italy.

Background: Treatment of severe critical limb ischemia (CLI) due to superficial femoral artery (SFA) and below-the-knee (BTK) vessels' involvement could be compromised by the lack of a great saphenous vein (GSV) suitable in its entire length. The purpose of this study is to assess the efficacy of a hybrid endovascular and open lower limbs arterial reconstruction in these patients with multilevel, advanced CLI.

Methods: From 2005 to 2019, we performed hybrid endovascular and surgical treatment for limb salvage in SFA-BTK CLI. This consisted of percutaneous transluminal angioplasty (PTA) with or without stenting of the SFA, along with distal origin vein graft bypass. Inclusion criteria were Rutherford category 5 or 6, lack of a suitable GSV, patency of the popliteal artery, steno-obstructive lesions of the SFA, lesions of the 3 crural vessels >5 cm in length each. The follow-up was performed with duplex scan surveillance of both the bypass graft and PTA sites.

Results: The hybrid treatment could be performed in 34 patients. Fifty-six percent of the SFA steno-obstructive lesions were treated with simple PTA, except for the application of a bare metal stent in one patient (3%), while in all the SFA occlusions PTA was completed with covered stents (41%). Thirty-four popliteal-to-distal vein bypass grafts bypass grafts have been performed. There were no perioperative PTA or bypass graft failures. Clinical improvement was achieved in 26 (76%) patients. Overall, primary and secondary patency, limb salvage, and survival rates were 65%, 68%, 75%, and 75% at 5 years, respectively.

Conclusions: A hybrid strategy in multilevel SFA-BTK CLI is a well-established approach. Additional studies are warranted to validate these results.
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http://dx.doi.org/10.1016/j.avsg.2019.10.032DOI Listing
February 2020

Isthmic Aortic False Aneurysm Post-Patch Coarctation Aortoplasty: A Hybrid Solution.

Ann Vasc Surg 2019 Nov 31;61:467.e7-467.e9. Epub 2019 Jul 31.

Cardiac Surgery Department, Clinica San Gaudenzio-Gruppo Policlinico of Monza, Novara, Italy.

We report a case of a 57-year-old female with dextrocardia and a solitary kidney. A patch aortoplasty for isthmic aortic coarctation repair was performed 40 years before when she was admitted to our department for dyspnea. Computed tomography scan showed a giant and saccular 10-cm diameter patch false aneurysm. The ascending aortic diameter was 34 mm and the echocardiography confirmed a severe aortic regurgitation of a bicuspid aortic valve. We decided to perform a 2-step approach: biologic aortic valve and ascending aorta replacement with total debranching of the epiaortic vessels and thoracic endovascular aneurysm repair for complete false aneurysm exclusion.
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http://dx.doi.org/10.1016/j.avsg.2019.04.041DOI Listing
November 2019

Long-term Results of Endovascular Treatment of TASC C and D Aortoiliac Occlusive Disease with Expanded Polytetrafluoroethylene Stent Graft.

Ann Vasc Surg 2019 Apr 17;56:254-260. Epub 2018 Oct 17.

Unit of Vascular Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.

Background: The aim of this study is to retrospectively analyze the early and long-term outcomes of endovascular treatment of Trans-Atlantic Inter-Society Consensus II class C and D (TASC II) aortoiliac occlusive disease with an expanded polytetrafluoroethylene-covered stent graft.

Methods: Between January 2006 and November 2017, 61 patients (53 males, 8 females), with symptomatic aortoiliac stenotic and/or occlusive disease, were treated with VIABAHN (W.L. Gore and Associates, Flagstaff, Ariz) at 2 University medical centers. The morphology of the lesions was evaluated and classified by contrast-enhanced computed tomography angiography. Demographic data, operation details, and postoperative outcomes were collected. Follow-up data were analyzed by a life-table analysis (Kaplan-Meier test).

Results: Mean age of the patients was 64.89 ± 10.77 years (range 44-89). Thirty-seven patients (60.7%) presented with severe claudication (Rutherford 3), whereas 21 (34.4%) were in Rutherford class 4 and the remaining 3 patients (4.9%) suffered from necrotic lesions (Rutherford 5/6). Fifty-six patients were smokers (91.8%), 38 (62.3%) had hypertension, 23 (37.7%) had coronary artery disease, 30 (40.2%) had dyslipidemia, 18 (29.5%) had chronic obstructive pulmonary disease, 6 (9.5%) had renal insufficiency (serum creatinine>2.0 mg/dL) and 24 (39.3%) had diabetes. Technical success was achieved in 59/61 patients (96.7%) with 16 patients (26.2%) requiring combined percutaneous brachial access to obtain iliac recanalization. Perioperative mortality was 1.6%, whereas postoperative major complications occurred in 2 patients (3.6%). The mean number of VIABAHN placed was 1.77/patient. Mean follow-up was 31.5 months (range 1-108) and primary patency at 36 months was 94.9%. Two major amputations of the lower limbs occurred during the follow-up.

Conclusions: Open surgery with the aortobifemoral bypass has been the gold standard treatment for complex aortoiliac occlusive disease although complications and mortality still remain significant issues. Our results suggest that endovascular therapy of TASC C and D iliac lesions using the VIABAHN stent graft is feasible, effective, and has good, long-term patency.
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http://dx.doi.org/10.1016/j.avsg.2018.07.060DOI Listing
April 2019

Editor's Choice - Long-term Survival and Risk Analysis in 136 Consecutive Patients With Type B Aortic Dissection Presenting to a Single Centre Over an 11 Year Period.

Eur J Vasc Endovasc Surg 2019 May 4;57(5):633-638. Epub 2018 Oct 4.

Aortic Centre, CHRU de Lille, France; Aortic Centre, Hôpital Marie Lannelongue, Le Plessis-Robinson, Université Paris Sud, France. Electronic address:

Objectives: To evaluate, in patients with acute type B aortic dissection, the results of medical and endovascular treatment in a large single centre experience and to investigate the clinical and imaging features on presentation that relate to poor outcome.

Methods: This was a retrospective analysis of prospectively collected clinical and CT imaging data. Consecutive patients (136) with acute type B aortic dissection were included in the study over an 11 year period. The characteristics of patients receiving endovascular (complicated) or medical treatment (uncomplicated) were compared. Kaplan-Meier estimators were used to estimate cumulative overall survival and survival free of aortic events. Factors associated with overall and aortic event free survival were also explored using Cox proportional hazards models.

Results: The mean follow up was 51 months (1-132), during which time 33 deaths and 48 aortic events occurred. At one and five years, overall survival was 94.0% and 74.8%, respectively, and freedom from aortic events was 75.6% and 58.7%. There was no difference in all cause survival and aortic event free survival at one and five years between the patients treated endovascularly and those receiving medical treatment alone. Risk analysis for aortic events demonstrated the maximum size of the proximal entry tear, the maximum thoracic aortic diameter, and the thoracic aortic false lumen maximum diameter to have a significant effect on the incidence of aortic events.

Conclusions: Active management of patients with type B aortic dissection results in good long-term survival even in the presence of features traditionally associated with adverse outcomes. All patients require close lifetime surveillance as aortic events continue to occur during follow up even after endografting.
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http://dx.doi.org/10.1016/j.ejvs.2018.08.042DOI Listing
May 2019

Characterization of lymphopenia in patients with MS treated with dimethyl fumarate and fingolimod.

Neurol Neuroimmunol Neuroinflamm 2018 Mar 28;5(2):e432. Epub 2017 Dec 28.

Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada.

Objective: Lymphopenia is a common occurrence of disease-modifying therapies (DMTs) for relapsing-remitting MS (RRMS). The aim of this study was to dissect the prevalence of various lymphocyte subsets in patients with RRMS treated with 2 DMTs commonly associated with lymphopenia, dimethyl fumarate (DMF), and fingolimod (FTY).

Methods: Multicolor flow cytometry and multiplex assays were used to identify up to 50 lymphocyte subpopulations and to examine the expression of multiple cytokines in selected patients. We compared patients untreated (NT) or treated with FTY or DMF who did (DMF-L) or did not (DMF-N) develop lymphopenia.

Results: All FTY patients developed lymphopenia in both T-cell and B-cell compartments. CD41 T cells were more affected by this treatment than CD81 cells. In the B-cell compartment, the CD271IgD2 subpopulation was reduced. T cells but not B cells were significantly reduced in DMF-L. However, within the B cells, CD271 cells were significantly lower. Both CD41 and CD81 subpopulations were reduced in DMF-L. Within the remaining CD41 and CD81 compartments, there was an expansion of the naive subpopulation and a reduction of the effector memory subpopulation. Unactivated lymphocyte from DMF-L patients had significantly higher levels of interferon-γ, interleukin (IL)-12, IL-2, IL-4, IL-6, and IL-1β compared with DMF-N. In plasma, TNFβ was significantly higher in DMF-N and DMF-L compared with NT, whereas CCL17 was significantly higher in DMF-L compared with NT and DMF-N.

Conclusions: This study shows that different treatments can target different lymphocyte compartments and suggests that lymphopenia can induce compensatory mechanisms to maintain immune homeostasis.
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http://dx.doi.org/10.1212/NXI.0000000000000432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5746425PMC
March 2018

Distal Ulnar Artery Aneurysm Repair by End-to-End Technique: A Case Report.

Ann Vasc Surg 2018 Jan 21;46:367.e15-367.e17. Epub 2017 Jul 21.

Cardiovascular Surgery, San Gaudenzio Clinic, Novara, Italy.

We report the case of a 33-year-old man presented with a posttraumatic 20-mm left ulnar artery aneurysm without intraluminal thrombus in the left hypothenar eminence. The patient reported left hand paresthesia. Because of symptoms and the embolic risk, we decide to plan an aneurysm resection and an interposition graft with inverted basilic vein for adequacy diameter (∼2 mm), but an end-to-end anastomosis was performed instead. We think that the posttraumatic distal artery aneurysm could be treated without a bypass but, after a meticulous anatomic dissection, with a microvascular anastomosis between the artery stumps.
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http://dx.doi.org/10.1016/j.avsg.2017.07.025DOI Listing
January 2018

Mycotic Pseudoaneurysm of Internal Carotid Artery Secondary to Lemierre's Syndrome, How to Do It.

Ann Vasc Surg 2017 Oct 24;44:423.e13-423.e17. Epub 2017 May 24.

Department of Thoracic and Vascular Surgery, Policlinico Universitario "G.Martino" of Messina, Messina, Italy.

We report the case of a patient with internal carotid artery (ICA) mycotic pseudoaneurysm secondary to Lemierre's syndrome, urgently treated. A 75-year-old man presented to E.R. with a left swelling lesion of the neck and complaining left visions lost since that morning, fever, hypotension, and dyspnea. Since 15 days before developing symptoms, he had sore throat and odynophagia treated with a broad coverage of antibiotic therapy for presumed streptococcal pharyngitis. Preoperative computed tomography angiography images revealed a circular lesion, involving the common carotid artery, carotid bulb, and the proximal part of the internal and external carotid arteries. A pseudoaneurysm of the ICA was detected, and the jugular vein was compressed. A Cormier carotid vein graft bypass was performed. Lemierre's syndrome is a rare syndrome, but it is rarer the carotid artery pseudoaneurysm secondary to Lemierre's syndrome. Surgical treatment is safe and durable in patients with severe infection involving the neck.
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http://dx.doi.org/10.1016/j.avsg.2017.05.026DOI Listing
October 2017

Safe Reentry for False Aneurysm Operations in High-Risk Patients.

Ann Thorac Surg 2017 Jun 1;103(6):1907-1913. Epub 2016 Dec 1.

Department of Cardiac Surgery, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy.

Background: In the absence of a standardized safe surgical reentry strategy for high-risk patients with large or anterior postoperative aortic false aneurysm (PAFA), we aimed to describe an effective and safe approach for such patients.

Methods: We prospectively analyzed patients treated for PAFA between 2006 and 2015. According to the preoperative computed tomography scan examination, patients were divided into two groups according to the anatomy and extension of PAFA: in group A, high-risk PAFA (diameter ≥3 cm) developed in the anterior mediastinum; in group B, low-risk PAFA (diameter <3 cm) was situated posteriorly. For group A, a safe surgical strategy, including continuous cerebral, visceral, and coronary perfusion was adopted before resternotomy; group B patients underwent conventional surgery.

Results: We treated 27 patients (safe reentry, n = 13; standard approach, n = 14). Mean age was 60 years (range, 29 to 80); 17 patients were male. Mean interval between the first operation and the last procedure was 4.3 years. Overall 30-day mortality rate was 7.4% (1 patient in each group). No aorta-related mortality was observed at 1 and 5 years in either group. The Kaplan-Meier overall survival estimates at 1 and 5 years were, respectively, 92.3% ± 7.4% and 73.4% ± 13.4% in group A, and 92.9% ± 6.9% and 72.2% ± 13.9% in group B (log rank test, p = 0.830). Freedom from reoperation for recurrent aortic disease was 100% at 1 year and 88% at 5 years.

Conclusions: The safe reentry technique with continuous cerebral, visceral, and coronary perfusion for high-risk patients resulted in early and midterm outcomes similar to those observed for low-risk patients undergoing conventional surgery.
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http://dx.doi.org/10.1016/j.athoracsur.2016.09.028DOI Listing
June 2017

An Hybrid 2-Stage Technique to Treat a Post-Traumatic Internal Carotid-Jugular Fistula.

Ann Vasc Surg 2017 Jan 12;38:315.e19-315.e22. Epub 2016 Aug 12.

Vascular Surgery Unit, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy.

Penetrating wounds of the neck involving the carotid arteries can lead to 2 possible and important late sequelae: pseudoaneurysm formation and arteriovenous fistula (AVF), if an artery and the adjacent jugular vein are simultaneously lacerated. Traumatic AVF of the neck are rare complications and if untreated may cause congestive heart failure, cerebral ischemia, thromboembolism, or even rupture complications. Current treatment options for carotid-jugular AVF include operative repair, detachable balloon, coiling, or stenting. We present a hybrid 2-stage technique to treat an internal carotid-jugular vein fistula in a young woman, based first on carotid stenting to reduce the bleeding and reestablish an adequate cerebral perfusion, followed by stent removal and safe vessels surgical reconstruction through carotid-to-carotid bypass and vein repair.
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http://dx.doi.org/10.1016/j.avsg.2016.05.094DOI Listing
January 2017

An Uncommon Case of Type III Endoleak Treated with a Custom-made Thoracic Stent Graft.

Ann Vasc Surg 2016 Aug 3;35:206.e1-3. Epub 2016 Jun 3.

Unit of Vascular Surgery, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy.

Endovascular aortic repair (EVAR) has been shown to be a valid and minimally invasive alternative to open abdominal aortic aneurysm repair. A major shortcoming for EVAR is the need to submit patients to regular follow-up to detect potential complications such as endoleak, limb occlusion, aneurysm expansion, aneurysm rupture, infection, structural failure, and migration. In this case report, we describe an uncommon case of late type III endoleak due to complete detachment of the stent-graft main body segment from its suprarenal uncovered fixation stent. It was treated with a custom-made Relay(®) NBS Plus (Bolton Medical, Barcelona, Spain) thoracic stent graft which also provided extra suprarenal fixation of the thoracic stent graft in the proximal neck. The postoperative period was uneventful and a computed tomography scan 1 year later revealed proper positioning of the stent graft and no signs of endoleak. The successful strategy chosen to correct this complication was at the same time original and infrequent, and also avoided potential complications related to open surgical repair and general anesthesia.
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http://dx.doi.org/10.1016/j.avsg.2016.02.023DOI Listing
August 2016

Application of autologous platelet-rich plasma to enhance wound healing after lower limb revascularization: A case series and literature review.

Semin Vasc Surg 2015 Sep-Dec;28(3-4):195-200. Epub 2016 Jan 20.

Unit of Vascular Surgery, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Via Melacrino n.1, 89100, Italy.

Dermal tissue loss in patients affected by critical limb ischemia represents a serious wound-healing problem, with high morbidity, prolonged hospital stay, and high patient care costs. Treatment of ischemic foot lesions requires limb revascularization by endovascular or open surgical intervention and individualized patient-specific wound care, including antibiotic therapy; devitalized/infected wound debridement; and advanced wound dressing. In selected patients, spinal cord stimulation, vacuum-assisted closure therapy, and bioengineered tissue or skin substitutes and growth factors have been shown to improve wound healing. In this study, we present our preliminary results on topical application of autologous platelet-rich plasma to enhance the process of wound healing after revascularization of lower limbs in patients affected by critical limb ischemia.
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http://dx.doi.org/10.1053/j.semvascsurg.2016.01.002DOI Listing
April 2017

Old and New Techniques as a Safe Hybrid Approach for Carotid Tandem Lesions.

Ann Vasc Surg 2016 Apr 22;32:132.e9-12. Epub 2016 Jan 22.

Vascular Surgery Department, Ospedali Riuniti "Bianchi Melacrino Morelli", Reggio Calabria, Italy.

Background: Carotid revascularization is performed to prevent stroke. Carotid tandem lesions represent a challenge for treatment, and a hybrid approach may result effective.

Case Report: A high-risk 65-year-old woman presented with a "tandem lesion" of left common and internal carotid artery. She was deemed unfit for "simple" standard carotid endarterectomy (CEA). A "single-step" safe hybrid procedure was scheduled for the patient. A "Cormier" carotid vein graft bypass with a retrograde stenting was performed under local anesthesia.

Conclusions: The "safe hybrid procedure" for tandem lesions of the common and internal carotid artery is effective and suitable in high-risk patients in a high-volume centers.
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http://dx.doi.org/10.1016/j.avsg.2015.11.006DOI Listing
April 2016

The role of procalcitonin as a marker of diabetic foot ulcer infection.

Int Wound J 2017 Feb 28;14(1):31-34. Epub 2015 Oct 28.

Unit of Vascular Surgery, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy.

Foot ulcers are frequent in diabetic patients and are responsible for 85% of amputations, especially in the presence of infection. The diagnosis of diabetic foot ulcer infection is essentially based on clinical evaluation, but laboratory parameters such as erythrocyte sedimentation rate (ESR), white blood count (WBC), C-reactive protein (CRP) and, more recently, procalcitonin (PCT) could aid the diagnosis, especially when clinical signs are misleading. Fifteen diabetic patients with infected foot ulcers were admitted to our department and were compared with an additional group of patients with non-infected diabetic foot ulcers (NIDFUs). Blood samples were collected from all patients in order to evaluate laboratory markers. In the current study, the diagnostic accuracy of PCT serum levels was evaluated in comparison with other inflammatory markers such as CRP, ESR and WBC as an indicator to make the distinction between infected diabetic foot ulcers (IDFUs) and NIDFUs. CRP, WBC, ESR and especially PCT measurements represent effective biomarkers in the diagnosis of foot infections in diabetic patients particularly when clinical signs are misleading.
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http://dx.doi.org/10.1111/iwj.12536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7950008PMC
February 2017

Mini-invasive aortic surgery: personal experience.

Innovations (Phila) 2014 Sep-Oct;9(5):354-60; discussion 360

From the *Unit of Vascular Surgery, Department of Cardiovascular and Thoracic Sciences, and †Department of Neuroscience, Psychiatric and Anaesthesiological Sciences, University of Messina, Messina, Italy.

Objective: In this study, we retrospectively evaluated our experience in minilaparotomy (MINI) and compared the results with conventional open repair (OPEN).

Methods: From January 2005 to December 2012, we surgically treated 234 consecutive patients with elective infrarenal abdominal aortic aneurysms, 195 men and 39 women, with a mean age of 74 years. Inclusion criteria for MINI were not ruptured abdominal aortic aneurysm, increased surgical risk, anatomical limits for endovascular repair, no previous surgical invasion of the abdominal cavity, and no requirement for concomitant abdominal surgical invasion. Surgical treatment was OPEN in 113 patients (48.3%) and MINI through an 8- to 14-cm incision in 121 patients (51.7%). Epidural anesthesia has been added in 26.5% and in 19.3% of the MINI and OPEN patients, respectively. Mortality, complications, aortic clamping time, operative time, need for postoperative morphine therapy, time to solid diet, and length of hospital stay were registered.

Results: The MINI has been performed in all patients selected, with 72 aortoaortic grafts and 49 aortobisiliac grafts. Early mortality was 1.6% versus 3.5% (P > 0.5); 1-, 3-, and 5-year mortality were 7% versus 9%, 19% versus 22%, and 29% versus 34% (P > 0.5); complications were 12.2% versus 26.6% (P > 0.05); mean (SD) clamping time was 48 (12) versus 44 (14) minutes (P > 0.5); mean (SD) operative time was 218.72 (41.95) versus 191.44 (21.73) minutes (P > 0.025); mean (SD) estimated intraoperative blood loss was 425.64 (85.95) versus 385.30 (72.41) mL (P > 0.1); mean (SD) morphine consumption in the group given epidural and the group not given epidural was 0 (2) and 2 (2) mg intravenously (IV) versus 2 (4) (P < 0.5) and 4 (3) mg IV (P > 0.1); mean (SD) ambulation was 2.1 (0.6) versus 4.1 (2.7) (P < 0.5); mean (SD) time to solid diet was 2.1 (0.4) versus 3.5 (1.6) (P < 0.5); and mean (SD) length of hospital stay was 4.9 (1.64) versus 7.35 (1.95) days (P > 0.05), in the MINI and OPEN groups, respectively. Postoperative hernia at 3 years was 18% versus 23% in the MINI and OPEN groups (P < 0.5), respectively.

Conclusions: The MINI gives the patients a significantly shorter period of recovery with the quality and safety of the OPEN. This experience suggested extending the indication to all surgical candidates without local limitations.
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http://dx.doi.org/10.1097/IMI.0000000000000098DOI Listing
June 2015

Vascular access for hemodialysis: current perspectives.

Int J Nephrol Renovasc Dis 2014 8;7:281-94. Epub 2014 Jul 8.

Department of Clinical and Experimental Medicine, Unit of Nephrology, University of Messina, Italy.

A well-functioning vascular access (VA) is a mainstay to perform an efficient hemodialysis (HD) procedure. There are three main types of access: native arteriovenous fistula (AVF), arteriovenous graft, and central venous catheter (CVC). AVF, described by Brescia and Cimino, remains the first choice for chronic HD. It is the best access for longevity and has the lowest association with morbidity and mortality, and for this reason AVF use is strongly recommended by guidelines from different countries. Once autogenous options have been exhausted, prosthetic fistulae become the second option of maintenance HD access alternatives. CVCs have become an important adjunct in maintaining patients on HD. The preferable locations for insertion are the internal jugular and femoral veins. The subclavian vein is considered the third choice because of the high risk of thrombosis. Complications associated with CVC insertion range from 5% to 19%. Since an increasing number of patients have implanted pacemakers and defibrillators, usually inserted via the subclavian vein and superior vena cava into the right heart, a careful assessment of risk and benefits should be taken. Infection is responsible for the removal of about 30%-60% of HD CVCs, and hospitalization rates are higher among patients with CVCs than among AVF ones. Proper VA maintenance requires integration of different professionals to create a VA team. This team should include a nephrologist, radiologist, vascular surgeon, infectious disease consultant, and members of the dialysis staff. They should provide their experience in order to give the best options to uremic patients and the best care for their VA.
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http://dx.doi.org/10.2147/IJNRD.S46643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4099194PMC
July 2014

An endovascular option is the final treatment for a giant arteriovenous malformation.

Ann Vasc Surg 2014 Nov 11;28(8):1932.e5-8. Epub 2014 Jul 11.

Department of Vascular Surgery, Policlinico Universitario "G. Martino" of Messina, Messina, Italy.

We report the case of a 58-year-old man presented with bleeding ulcer of the left arm caused by a high-flow type-C arteriovenous malformation (AVM), feed by branches from both the subclavian arteries. He had been previously treated with AVM sclerotherapy, embolization, humeral artery endografting, and open surgery. We urgently performed coil embolization of the left vertebral artery, and we covered the huge subclavian artery by a thoracic endograft. Then, we embolized the right tyrocervical trunk. The result was an immediate interruption of bleeding. At 12 months, the patient had no neurologic complications, and the upper limb continued to decompress.
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http://dx.doi.org/10.1016/j.avsg.2014.06.069DOI Listing
November 2014

Carotid bypass: a safe and durable solution for recurrent carotid stenosis.

Ann Vasc Surg 2014 Jul 8;28(5):1329-34. Epub 2014 Feb 8.

Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.

Background: The long-term results of carotid artery stenting (CAS) for post-carotid endarterectomy (CEA) restenosis are disappointing (4-year patency rates: ∼75%). Since 1988, our group has offered carotid bypass (CB) as an alternative to redo CEA and later also to CAS in this setting. The aim of this retrospective study was to investigate early and late outcomes associated with CB in this population.

Methods: Data were collected from patients treated with CB in the year 2000-2012 for significant/symptomatic post-CEA restenosis (or intra-stent restenosis [ISR] after CAS for post-CEA restenosis). All patients had good life expectancy. CB was performed under loco-regional anesthesia. With the aid of sequential vessel clamping, the graft (great saphenous vein [GSV] or polytetrafluoroethylene) was anastomosed with the common carotid artery (side-to-end) and the distal internal carotid artery (end-to-side). Patients were followed with clinical and duplex scan assessments at 1, 3, and 6 months and yearly thereafter.

Results: The study population comprised 21 patients (mean age 67.3 years; 17 men). CB was performed for post-CEA restenosis (or ISR after CAS for post-CEA restenosis, n=3) 51.2 months (mean) after the previous operation. GSV grafts were used in half of the cases (n=11; 52.4%); temporary shunting was used in 4 (19%) patients. Intraoperative complications (none fatal) occurred in 4 (19%) patients (3 transient peripheral nerve injuries, 1 cervical hematoma). During follow-up (mean 64.8 months), there were no neurologic complications or restenoses. Overall mortality was 33.3% (6 deaths from acute myocardial infarctions, 1 from a ruptured abdominal aortic aneurysm).

Conclusions: For post-CEA restenosis (or ISR after CAS for post-CEA restenosis), CB offers superior long-term patency rates than CAS (or redo angioplasty) and an acceptable risk of cranial nerve damage.
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http://dx.doi.org/10.1016/j.avsg.2013.12.031DOI Listing
July 2014

A simple technique to achieve bloodless excision of carotid body tumors.

J Vasc Surg 2014 May 17;59(5):1462-4. Epub 2013 Dec 17.

Cardiovascular and Thoracic Department, "Policlinico G. Martino" Hospital, University of Messina, Messina, Italy. Electronic address:

We describe a technique for Shamblin II-III carotid body tumor (CBT) resection to reduce bleeding and neurologic complications during surgery. The technique was based on the fact that CBTs are supplied almost exclusively from the external carotid artery. Therefore, we carefully isolated the origin of the external carotid artery and its distal branches outside the tumor and temporarily clamped all of these vessels after heparin administration. This allowed a safe and bloodless resection as the tumor was dissected from the internal carotid artery in the usual subadventitial plane. The internal carotid artery was never clamped, and respect of peripheral nerves was warranted in the clean and bloodless field. From 2007 to 2010, we treated 11 patients with a CBT: six had a Shamblin II and five had a Shamblin III lesion. Neither perioperative neurologic events nor recurrences occurred after a mean follow-up of 42 months.
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http://dx.doi.org/10.1016/j.jvs.2013.10.075DOI Listing
May 2014

Off-the-shelf branched endograft for emergent aneurysm repair.

Ann Vasc Surg 2013 Oct 24;27(7):972.e11-5. Epub 2013 May 24.

Vascular Surgery and Radiology, Hôpital Cardiologique, CHRU de Lille, Lille, France.

A 65-year-old man with a tender, 98-mm-diameter, pararenal aortic aneurysm was referred to our center. This patient was unfit for open repair and could not wait 8 weeks for a custom-made endograft to be manufactured. We describe the endovascular treatment of his aneurysm with a 4-branch endograft that had been constructed for another patient. He had an uneventful recovery. Postoperative CT scan confirmed patency of all visceral branches and exclusion of the aneurysm. Various branched and fenestrated endografts are or will soon be available "off-the-shelf" to treat ruptured or symptomatic pararenal and thoracoabdominal aneurysms. We assess the pros and cons of this new generation of endografts designed to adapt to most aortic anatomies.
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http://dx.doi.org/10.1016/j.avsg.2012.10.017DOI Listing
October 2013

Debate: whether fenestrated endografts should be limited to a small number of specialized centers.

J Vasc Surg 2013 Mar;57(3):875-82

Vascular Surgery, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France.

Until fairly recently, experience with advanced endovascular technologies, including fenestrated endovascular repair (FEVAR), has been limited to a relatively small number of practitioners worldwide. Excellent outcomes have been achieved by these accomplished surgeons who, at least initially, have primarily used custom-made devices constructed by a single endograft manufacturer. Access to this technology has been limited by the skills necessary for such procedures and by the customization process with industry partners. However, several issues are changing rapidly with FEVAR. Increasing numbers of surgeons now have the necessary endovascular skills, and off-the-shelf endografts from several manufacturers have become, or are becoming, available. Also, the regulatory landscape is changing with device approval in the United States. Surgeons and patients alike are anticipating the widespread adoption of this advanced technology that will surely benefit increasing numbers of patients. Or will it? Will widespread adoption in a larger number of smaller-volume hospitals, by less experienced surgeons, result in poor patient outcomes, or will excellent results continue with more patients benefitting from these technologic advances? These are important questions to ask before such adoption and are the subject of this debate.
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http://dx.doi.org/10.1016/j.jvs.2013.01.001DOI Listing
March 2013

A big floating thrombus in the common carotid artery.

J Cardiovasc Med (Hagerstown) 2011 Nov;12(11):819-20

Division of Vascular Surgery, Department of Cardiovascular and Thoracic Sciences, University of Messina, Messina, Italy.

The management of the free-floating thrombus (FFT) is difficult, and it is unclear whether surgical or medical treatment is superior. The common carotid artery is rarely involved. An 80-year-old woman presented with right hand weakness and syncope. Ultrasound showed the presence of FFT in the left common carotid artery. A carotid endarterectomy with Dacron patch angioplasty was immediately performed without complications. In the presence of symptoms, the interventional management of FFT is advised.
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http://dx.doi.org/10.2459/JCM.0b013e32834ba0d4DOI Listing
November 2011

Use of bovine mesenteric vein in rescue vascular access surgery.

J Vasc Access 2010 Apr-Jun;11(2):112-4

Department of Medicine and Pharmacology, University of Messina, Messina, Italy.

We describe a technique for rescue surgery of autologous arterovenous fistula (AVF), using bovine mesenteric vein (BMV), which may be used in patients with autologous AVF malfunction caused by steno-occlusion on the arterial side or by fibrosis of the first portion of the vein. To preserve the autologous AVF, we replaced the diseased portion of the artery, or the first centimeters of the vein, by a segment of BMV, with the aim of saving the patency and functionality of the access. We used this technique in 16 cases. All patients underwent hemodialysis treatment immediately after the procedure. Infection or aneurismal dilatation of the graft in implanted BMV was never observed.
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http://dx.doi.org/10.1177/112972981001100205DOI Listing
May 2011
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