Publications by authors named "Ettore Dinoto"

23 Publications

  • Page 1 of 1

Position Paper on Young Vascular Surgeons Training of the Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS): State of the Art and Perspectives.

Ann Vasc Surg 2021 Aug 25. Epub 2021 Aug 25.

Vascular Surgery Division, Thorax Institute, Hospital Clinic, Barcelona, Spain.

The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded in 2018, with the aim to promote cooperation among vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic peripheral artery was selected as the very first topic to be investigated by the federation. In this second paper, different experiences from delegates of participating countries were shared to define common strategies to harmonize, standardize, and optimize education and training in the Vascular Surgery specialty.
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http://dx.doi.org/10.1016/j.avsg.2021.08.002DOI Listing
August 2021

Simultaneous Hybrid Treatment of Multilevel Peripheral Arterial Disease in Patients with Chronic Limb-Threatening Ischemia.

J Clin Med 2021 Jun 28;10(13). Epub 2021 Jun 28.

Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy.

Background: Hybrid treatments (HT) aim to reduce conventional open surgery invasiveness and address multilevel peripheral arterial disease (PAD). Herein, the simultaneous HT treatment in patients with chronic limb-threatening ischemia (CLTI) is reported.

Methods: Retrospective analysis, for the period from May 2012 to April 2018, of patients presenting multilevel PAD with CLTI addressed with simultaneous HT. The outcomes of these interventions were measured the following metrics: early technical successes (within 30 days following treatment) and late technical successes (30 days or more following treatment) and included mortality, morbidity symptoms recurrence, and amputation. Survival and patencies were estimated. The median follow-up was 43.77 months.

Results: In the 45 included patients, the HT consisted of femoral bifurcation patch angioplasty followed by an endovascular treatment in 38 patients (84.4%) and endovascular treatment followed by a surgical bypass in 7 patients (15.6%). Technical success was 100% without perioperative mortality. Eight (17.8%) patients presented early complications without major amputations. During the follow-up, seven (15.6%) deaths occurred and six patients (13.3%) experienced symptoms recurrence, with five of those patients requiring major amputation. An estimated survival time of 5 years, primary patency, and secondary patency was 84.4%, 79.2%, and 83.3% respectively.

Conclusions: Hybrid treatments are effective in addressing patients presenting with multilevel PAD and CLTI. The common femoral artery involvement influences strategy selection. Larger studies with longer-term outcomes are required to validate the hybrid approach, indications, and results.
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http://dx.doi.org/10.3390/jcm10132865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268200PMC
June 2021

Efficacy and one-year outcomes of Luminor® paclitaxel-coated drug-eluting balloon in the treatment of popliteal artery atherosclerosis lesions.

Ann Vasc Surg 2021 May 2. Epub 2021 May 2.

Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Vascular Surgery Unit, AOUP "P. Giaccone", Palermo, Italy.

Purpose: Reporting outcomes with a new generation paclitaxel eluting balloon (Luminor®; iVascular, Vascular, S.L.U., Barcelona, Spain) in the popliteal district. Endovascular treatment of popliteal artery atherosclerotic disease is still debated without definitive evidences.

Methods: From January to June 2019, patients' data presenting popliteal artery atherosclerotic diseases and treated with the Luminor® (iVascular) drug eluting balloon (DEB) were prospectively collected. Critical limb ischemia (CLI) or severe claudication associated with popliteal artery stenosis >50% were the inclusion criteria. Measured outcomes were technical success, early and late results; including mortality, morbidity, symptoms recurrence, amputation, ankle-brachial index (ABI), survival, primary patency, secondary patency, freedom from restenosis. Median follow-up was 22.43 ± 4 (mean:21.58; IQR:20-24) months.

Results: Of the 33 included patients, 28 (85%) were diagnosed with CLI, with a mean preoperative run-off score of 5.39 (r:0-10; SD:3) and a chronic popliteal occlusion in 21 (64%). Technical success was achieved in all cases. Perioperative mortality was observed in 1 (3%) patient and perioperative complications in 2 (6%). During the follow-up were reported 2 symptoms recurrence; a significant ABI increase (0.57; IQR:0.41-0.47 vs. 0.69; IQR:0.50-0.67; P < 0.01); 1 (3%) major and 2 (6%) minor amputations. Estimated 24 months survival, primary patency, secondary patency, and freedom from restenosis were 97%, 96.9%, 100%, and 93.8% respectively.

Conclusions: In this prospective study, the use of the Luminor® (iVascular) was safe and effective in addressing atherosclerotic popliteal artery lesions. Larger studies with longer term-outcomes are required to assess the durability of this device in the popliteal artery.
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http://dx.doi.org/10.1016/j.avsg.2021.04.015DOI Listing
May 2021

Single staged hybrid approach for multilevel aortic-iliac-femoral-popliteal disease.

Int J Surg Case Rep 2020 22;77S:S166-S169. Epub 2020 Sep 22.

Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy.

Introduction: Multilevel peripheral arterial disease (MPAD) is the main cause of critic limb ischemia (CLI). Vascular interventions are required to increase distal blood flow and reduce the risk of lower limb amputation.

Presentation Of Case: We report a case of complex hybrid revascularization in a patient presenting a Rutherford V MPAD involving the infrarenal aorta, iliac, femoral and popliteal segments. The simultaneous hybrid intervention consisted of an endovascular aortic stent-graft placement and a surgical above-the-knee prosthetic femoro-popliteal bypass. In the same operation a renal stenting was performed due to a significant renal artery stenosis associated to a systemic hypertension non-responder to medical management.

Discussion: Hybrid interventions can be performed simultaneously or staged with benefit given by the complementary role of endovascular and surgical treatments allowing the correction of eventually inadequate results of both approaches. Reports of simultaneous hybrid treatments are limited but, despite the complexity of such procedures, primary success rate is reported high. Also in the reported case, a complex simultaneous treatment in a patient presenting MPAD in association to a significant and symptomatic renal artery disease was feasible in the same operation.

Conclusion: Hybrid procedure are safe with high degree of efficacy in terms of revascularization procedure, reduced morbidity and shorter intensive care and hospital stay. In our experience, the use of hybrid procedure is technically feasible and allowed the treatment of MPAD with a good outcomes.
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http://dx.doi.org/10.1016/j.ijscr.2020.09.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876840PMC
September 2020

Simultaneous endovascular treatment of synchronous symptomatic acute type B aortic dissection and large infrarenal aortic aneurysm. Technical tips and case report.

Int J Surg Case Rep 2020 11;77S:S157-S161. Epub 2020 Aug 11.

Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy.

Introduction: Data from the literature suggest that in patients with acute type B aortic dissection (ATBAD), associated with AAA, rupture risk is higher at the confluence tract than isolated lessions. Herein, we report a case of ATBAD and AAA managed with simultaneous intervention.

Case Presentation: We report a complicated case of a symptomatic patient presenting with a type B aortic dissection and false lumen extension into superior mesenteric artery (SMA) with an infrarenal abdominal aortic aneurysm (AAA). Severe back pain and hypertension were the patient's initial complaints. This patient underwent endovascular repair with a thoracic and infrarenal aortic endograft.

Discussion: AAA rupture has been detected at admission in three-fourths of patients with ATBAD that extended to or involved a coexisting unoperated atherosclerotic aneurysms. Prompt surgical intervention is essential to deal with this dreadful aortic emergency.

Conclusion: In our experience a totally endovascular solution to treat a complicated ATBAD plus AAA was a rapid solution with low invasivity, no complication and complete healing of patients.
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http://dx.doi.org/10.1016/j.ijscr.2020.07.060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876933PMC
August 2020

A rare case of infrarenal aortic coarctation in a young female.

Int J Surg Case Rep 2020 24;77S:S152-S156. Epub 2020 Aug 24.

Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences - University of Palermo, Italy.

Introduction: Infrarenal abdominal aortic coarctation (AAC) is an extremely rare disease. It can be associated with renal artery stenosis determining secondary renal hypertension.

Presentation Of Case: We report a case of AAC in young female patient presenting systemic hypertension non-responder to medical treatment. Diagnostics revealed the involvement of the right renal artery as the cause of hypertension. The management consisted of percutaneous renal artery stenting and close surveillance for the aortic segment. The treatment was uneventful with resolution of the hypertensive condition.

Discussion: AAC etiology is unknown. There are no studies comparing the long-term treatment outcome in adult patients. The long-term prognosis depends mainly on blood pressure control and the underlying disease. In the reported case the treatment of the renal lesion was adequate to control the secondary hypertension. This approach does not preclude future intervention in the aortic segment and provides a fast-recovery and less invasive approach to the major clinical manifestation.

Conclusion: In this case the treatment of the specific vascular lesion was adequate to address the main clinical hypertensive manifestation. This less-invasive approach did not preclude future intervention in the aortic segment where the evolution of the disease is unknown.
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http://dx.doi.org/10.1016/j.ijscr.2020.07.083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876927PMC
August 2020

Case report of a large cephalic vein aneurysm inducing heart failure in a renal transplant patient with radio-cephalic fistula for haemodialysis.

Int J Surg Case Rep 2020 27;77S:S162-S165. Epub 2020 Aug 27.

Department of Surgical, Oncological and Oral Sciences, Vascular Surgery Unit, University of Palermo, Palermo, Italy.

Introduction: The autologous arteriovenous fistula (AVF) is considered the best vascular access for haemodialysis in patients with chronic kidney disease but in time can lead to several complications.

Presentation Of A Case: Herein we describe a case of a large cephalic vein aneurysm causing heart failure in a renal transplant patient being treated with radio-cephalic AVF for haemodialysis. The patient was judged to be at very high risk for potential catastrophic rupture of the aneurysm and his cardiac function was deteriorating so a surgical resection was offered. Under general anesthesia, a longitudinal incision was performed on the volar side of the forearm and the anastomotic junction was ligated. The cephalic vein aneurysm was isolated and a total resection of the vein, up to the joint of the elbow, was carried out. A specimen was also submitted for histological and immunohistochemical analysis.

Discussion: At present no clear indications pertaining to the need to close an AVF after kidney transplantation exist. Some authors recommend a closing of the fistula in patients with stable renal function to prevent the onset of complications, while others advise never to close the asymptomatic fistula in order to preserve vascular access for haemodialysis in case of graft failure.

Conclusion: Based on our clinical experience, we suggest not ligating vascular access during the first year following transplantation with the exception of patients needing emergent closure. Otherwise, surgical closure to prevent the onset of complications could be considered a viable option in the following subset of patients: those who are 3 or more years from transplantation with good and stable renal function, those with a significant growth of venous aneurysms or have a high AVF flow rate or are young patients.
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http://dx.doi.org/10.1016/j.ijscr.2020.07.055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876928PMC
August 2020

Endovascular Treatment of Spontaneous and Isolated Infrarenal Acute Aortic Syndrome with Unibody Aortic Stent-Grafts.

World J Surg 2020 Dec 3;44(12):4267-4274. Epub 2020 Sep 3.

Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via L. Giuffrè, 5, 90100, Palermo, Italy.

Introduction: Spontaneous acute aortic syndrome (IAAS) is rarely localized in the infrarenal aorta. The endovascular approach is preferred over conventional open surgery with fewer complications. However, dedicated endovascular devices for IAAS treatment are unavailable. The aim was to report a large single-center experience using unibody stent-grafts to address IAAS.

Methods: From April 2016 to March 2019, a retrospective analysis of patients presenting spontaneous and isolated IAAS was performed. Patients addressed with the unibody stent-graft (AFX endovascular AAA system; Endologix Inc., Irvine, CA) were included in the study. Indications to IAAS treatment were persistent symptoms and/or dilated abdominal aorta (>3 cm). The measured outcomes were technical success; early outcomes (<30 days) including mortality, morbidity, symptoms recurrence, and endoleak occurrence; and late outcomes (>30 days) including mortality, symptoms recurrence, endoleak occurrence, stent-graft patency, and survival. Median follow-up was 23.77 ± 10 months.

Results: Twenty-one patients with IAAS were included. Indications to treatment were symptoms in 14 (67%) patients and dilated abdominal aorta in 7 (33%). Technical success was achieved in all cases. No perioperative mortality and 1 (4.8%) early femoral access complication was encountered. During the follow-up were registered 1 (4.8%) aortic unrelated death and 1 (4.8%) stent-graft limb stenosis. The 36 months estimated survival and freedom from reintervention were 92% (CI: 37-43; SE: 1.7) and 94% (CI: 37-44; SE: 1.7), respectively.

Conclusions: The endovascular treatment of IAAS with unibody stent-graft (AFX endovascular AAA system; Endologix Inc.) is safe and effective with promising mid-term outcomes. The use of unibody stent-grafts expands the endovascular indication, despite the usual anatomic IAAS features. Larger studies with longer follow-up are required to validate the outcomes of the reported technique.
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http://dx.doi.org/10.1007/s00268-020-05754-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599153PMC
December 2020

Endovascular Treatment of Spontaneous Internal Carotid Artery Dissection with Proximal Embolic Protection Device.

Ann Vasc Surg 2020 Jul 2;66:667.e9-667.e14. Epub 2020 Jan 2.

University of Palermo, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Palermo, Italy; Vascular Surgery Unit, Palermo, Italy.

Background: The aim of this study was to report the feasibility and outcomes with the endovascular treatment of spontaneous internal carotid artery dissections (ICADs) using a proximal embolic protection device (EPD).

Methods: This is a retrospective analysis of patients treated for spontaneous symptomatic ICAD using a proximal EPD from January 2017 to December 2018. Indication for treatment was the presence of neurologic symptoms. Early outcomes measured included technical success, perioperative mortality, and major cardiovascular or cerebrovascular complications. Late outcomes were recurrent neurologic symptoms, patency, and reinterventions.

Results: A total of 4 male patients with ICAD were included. A preoperative cerebral computed tomography positive for cerebral ischemic events was reported in all cases. In 3 patients, the neurologic symptoms consisted of a transient ischemic attack; the remaining patient presented an amaurosis fugax and aphasia. In 2 patients, ICAD was associated with a carotid significant stenosis. In all patients, the reported approach was feasible with no complications and complete anatomic dissection resolution. At a mean follow-up of 18 months, all stents are patent and no restenosis recurrence or complications were registered.

Conclusions: The use of proximal EPDs allowed the treatment of ICAD under flow arrest, minimizing the risk of stroke during the endovascular maneuvers. Larger series are required to validate this treatment strategy.
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http://dx.doi.org/10.1016/j.avsg.2019.12.019DOI Listing
July 2020

Single-Center Experience and Preliminary Results of Intravascular Ultrasound in Endovascular Aneurysm Repair.

Ann Vasc Surg 2019 Apr 27;56:209-215. Epub 2018 Nov 27.

Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Vascular Surgery Unit, Palermo, Italy.

Background: Intravascular ultrasound (IVUS) has been introduced as diagnostic adjunct to provide new insights into the diagnosis and therapy of vascular disease. Herein, we compared the outcomes of conventional endovascular aneurysm repair (EVAR) and EVAR with IVUS in patients presenting with infrarenal abdominal aortic aneurysm using a propensity-matched cohort.

Methods: From May 2013 to August 2017, 221 patients were retrospectively analyzed. Of that, 122 patients were eligible for inclusion and underwent propensity score matching. Perioperative mortality and morbidity, renal function impairment, endoleak incidence, mean contrast medium usage, operative time, radiation exposure (including fluoroscopy time, dose-area product [DAP], and digital subtraction angiography [DSA] runs), survival, and freedom from reintervention were the outcomes measured.

Results: After matching, 52 patients were included, 26 in the conventional EVAR group and 26 in the EVAR with IVUS group. No perioperative mortality or type I/III endoleak were registered. One perioperative lymphatic fistula and one iliac limb occlusion were observed. In the EVAR with IVUS group, a significant reduction of contrast medium (92 [vs. 51 ± 17] vs. 51 [20-68] mL; P = 0.003) and radiation exposure including fluoroscopy time (12 [9-16] vs. 20 [12-25] min; P = 0.001), DAP (15 [9-21] vs. 32 [16-44] G*cm; P = 0.002), and DSA runs (2 [1-3] vs. 3 [2-4]; P = 0.04) was reported. No differences were observed in terms of glomerular filtration rate (86 [45-121] vs. 90 [38-117] mL/min; P = 0.14) and operation time (176 [124-210] vs. 179 [120-210]; P = 0.48). Survival at 36 months was 93% for standard EVAR and 92% for EVAR with IVUS (P = 0.845). Freedom from reintervention at 36 months was 85.5% in both the groups (P = 0.834).

Conclusions: In this preliminary experience, the use of IVUS during EVAR was feasible with no registered postoperative complications. A significant reduction of contrast medium usage and radiation exposure was observed with the use of IVUS. The IVUS is an adjunctive tool to consider in the vascular surgeon armamentarium, especially in centers where advanced radiological tools of imaging fusion are not available.
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http://dx.doi.org/10.1016/j.avsg.2018.09.016DOI Listing
April 2019

A different angle in through-and-through body wires in difficult aortic arch stent-graft placement.

J Cardiovasc Surg (Torino) 2019 Feb 12;60(1):144-146. Epub 2018 Mar 12.

Department of Vascular Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK.

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http://dx.doi.org/10.23736/S0021-9509.18.10301-6DOI Listing
February 2019

Symptomatic Deep Femoral Artery Pseudoaneurysm Endovascular Exclusion. Case Report and Literature Review.

Ann Vasc Surg 2017 Jul 5;42:303.e5-303.e9. Epub 2017 Apr 5.

Vascular Surgery Unit, University of Palermo, AOUP "P. Giaccone", Palermo, Italy.

Deep femoral artery pseudoaneurysms (DFAPs) are rare and generally occur after penetrating trauma or surgical procedures. A 36-year-old obese man presented with pain in correspondence of the anterior-lateral thigh after 6 months from gunshot wound. Duplex and computed tomography (CT) showed a bilobed right DFAP (maximal diameter 12.9 cm). The patient was managed urgently, under local anesthesia, by placement in the distal DFA of a Viabahn 8 × 100-mm stent graft (W L Gore & Associates, Inc). The postoperative course was uneventful, and the 24-month CT showed regular stent-graft patency and 20-mm DFAP shrinkage. The literature review reported 8 cases of DFAPs; of these 6 were managed by endovascular mean (3 stent-graft implantations and 3 coil embolization). The remaining 2 cases were managed surgically (one of these after failed coil embolization). In conclusion, the use of covered stent graft was effective to treat a DFAP localized in the medium DFA. This tool allowed maintaining the native DFA patency and the preservation of its main branches.
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http://dx.doi.org/10.1016/j.avsg.2016.11.026DOI Listing
July 2017

Use of the directional atherectomy for the treatment of femoro-popliteal lesions in patients with critical lower limb ischemia.

Transl Med UniSa 2016 Nov 1;15:42-47. Epub 2016 Nov 1.

Vascular Surgery Unit, University of Palermo, Palermo, Italy.

Femoro-popliteal PTA for the treatment of critical limb ischemia is frequently associated with unsatisfactory procedural success rates while directional atherectomy (DCA) has improved success rate since claudicant patients undergoing percutaneous treatment of femoro-popliteal obstructive disease. The aim of this prospective study is to evaluate the safety, efficacy and procedural success of DCA, at one year, in the percutaneous treatment of femoro-popliteal obstructive disease in patients with critical limb ischemia.

Methods: From March 2012 to March 2013 18 consecutive patients with critical limb ischemia were treated with DCA (Turbohawk/Covidien-ev3 Endovascular Inc., North Plymouth, Minnesota, USA) for the treatment of femoro-popliteal obstructive disease. Patients were evaluated at 12 months.

Results: Technical and procedural success was achieved in every patient. No in-hospital major adverse cardiovascular events occurred. Primary endpoint: freedom from any amputation was obtained in all patients. Secondary endpoints: clinical (Rutherford class improvement) and hemodynamic success (Ankle-brachial index improvement) was achieved in all patients.

Conclusion: The use of DCA for the treatment of femoro-popliteal obstructive disease is a safe and effective therapeutic strategy for patients with critical limb ischemia. The data included in our study should be considered hypothesis-generating in order to design of a randomized trial comparison with conventional PTA.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120749PMC
November 2016

Stent-assisted detachable coil embolization of wide-necked renal artery aneurysms.

Diagn Interv Radiol 2017 Jan-Feb;23(1):77-80

Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy.

Renal artery aneurysms (RAAs) are rare with an estimated incidence of 0.1% in the general population, and they represent approximately 25% of all visceral aneurysms. The gold standard of treatment is open surgery, but it is associated with a high risk of nephrectomy, mortality, and morbidity. Less invasive endovascular therapies are becoming increasingly common for the treatment of RAAs. Here, we aimed to report three cases of wide-necked complex renal artery aneurysms treated endovascularly using stent-assisted coil embolization with self-expandable stent nitinol Solitaire AB and Concerto Axium coils. In addition, we describe the use of the waffle-cone technique in a case of wide-necked saccular RAA involving the renal artery bifurcation. Technical success was achieved in all three cases with no early or late complications and no recurrences.
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http://dx.doi.org/10.5152/dir.2016.15551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214082PMC
May 2017

Cinical outcomes of Endurant II stent-graft for infrarenal aortic aneurysm repair: comparison of on-label versus off-label use.

Diagn Interv Radiol 2016 Sep-Oct;22(5):450-4

Vascular Surgery Unit, AOUP "P. Giaccone", University of Palermo, Palermo, Italy.

Purpose: We aimed to compare the outcomes of the Endurant II (Medtronic) stent-graft used under instructions for use versus off-label in high-risk patients considered unfit for conventional surgery.

Methods: Data from patients treated with the Endurant II stent-graft between December 2012 and March 2015 were retrospectively analyzed. Sixty-four patients were included. Patients were assigned to group A if treated under instructions for use (n=34, 53%) and to group B if treated off-label (n=30, 47%). Outcome measures included perioperative mortality and morbidity, survival, freedom from reintervention, endoleak incidence, in-hospital length of stay, and mean stent-graft component used. Mean follow-up was 22.61±12 months (median, 21.06 months; range, 0-43 months).

Results: One perioperative mortality (1.6%) and one perioperative complication (1.6%) occurred in group B. At two months follow-up, one iliac limb occlusion (1.6%) occurred in group A. No type I/III endoleaks were recorded. A type II endoleak was identified in three cases (4.7%). Overall survival at three years was 89% (97% for group A, 82% for group B; P = 0.428). Reintervention-free survival at three years was 97% for both groups (P = 0.991). A longer in-hospital stay was observed in group B (P = 0.012).

Conclusion: The Endurant II (Medtronic) new generation device was safe in off-label setting at mid-term follow-up. The off-label use of the Endurant II (Medtronic) is justified in patients considered unfit for conventional surgery. Larger studies are required in this subgroup of patients.
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http://dx.doi.org/10.5152/dir.2016.15418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5019849PMC
May 2017

Endovascular treatment of large and wide aortic neck: case report and literature review.

Gen Thorac Cardiovasc Surg 2017 Apr 10;65(4):219-224. Epub 2016 Feb 10.

Vascular Surgery Unit, University of Palermo, AOUP "P. Giaccone", Via L. Giuffrè, 5, 90100, Palermo, Italy.

Large (24-34 mm) and wide (≥35 mm) aortic necks are a contraindication to endovascular aneurysm repair (EVAR). A 63-year-old man, unfit for conventional surgery, presented a 79 mm abdominal aortic aneurysm with 36.5 mm aortic neck and a 62 mm right common iliac artery aneurysm. He was treated endovascularly with standard commercially available stent-graft using the so-called 'funnel technique'; by placing a thoracic stent-graft inside a bifurcated device to achieve proximal sealing. The completion angiography and the 6 months follow-up with computed tomography showed no stent-graft migration, limb occlusion or endoleak. The literature review reported 179 cases of large aortic neck managed with EVAR, all cases treated with standard devices. Conversely a wide aortic neck was reported in 9; in 2 cases were employed custom-made devices and in 7 standard stent-graft. The use of EVAR with commercially available stent-grafts is feasible and it represents an option especially in non-elective setting.
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http://dx.doi.org/10.1007/s11748-016-0627-2DOI Listing
April 2017

Extra-anatomic iliac to superior mesenteric artery bypass after bridge endovascular treatment for chronic mesenteric ischemia. A case report.

Ann Ital Chir 2015 Jul 3;86(ePub). Epub 2015 Jul 3.

Unlabelled: A 60 year old patient presenting chronic mesenteric Ischemia (CMI) was managed with superior mesenteric artery (SMA) stenting as bridge therapy to conventional open surgery. At 5 months follow-up, the SMA stent occluded. During this bridge period the patient gained his general condition and the body mass index (BMI) increased from 18 to 22. The patient was managed subsequently with iliac-SMA bypass in C-loop configuration. At 6 months follow-up the bypass is patent, the patient has no CMI symptoms and his BMI is 25. The endovascular approach did not preclude a subsequent conventional open surgery and it can be safely employed as bridge therapy. An improved patient clinical condition, also during a limited bridge period, can improve the conventional open surgery outcomes.

Key Words: Body Mass Index(BMI), Mesenteric artery, Mesenteric ischemia.
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July 2015

Spontaneous symptomatic common carotid artery pseudoaneurysm: case report and literature review.

Ann Vasc Surg 2015 May 11;29(4):837.e9-12. Epub 2015 Feb 11.

Vascular Surgery Unit, University Hospital 'P. Giaccone', Palermo, Italy.

Spontaneous common carotid artery pseudoaneurysm (CCAP) is rare but potentially lethal disease. A 78-year-old man presented with pain in correspondence of right neck side and slight right eye ptosis. No previous surgery, trauma, or venous catheterizations in the neck region were reported. The computed tomographic angiography (CTA) showed a 4-cm saccular CCAP. The patient was managed emergently with surgical CCAP excision. At 6-month follow-up, the patient is neck pain-free with complete ptosis regression, and the CTA shows no pathologic findings. The literature review reported 7 cases of pseudoaneurysm of carotid district. All these cases were managed by surgical approach, and in 1 case, an endovascular embolization procedure was associated before. The CTA was used in all cases but angiography in only one. In these cases, the surgical repair with pseudoaneurysm evacuation is still the treatment of choice.
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http://dx.doi.org/10.1016/j.avsg.2015.01.001DOI Listing
May 2015

Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin.

Cardiovasc Intervent Radiol 2015 Oct 26;38(5):1299-302. Epub 2014 Aug 26.

Vascular Surgery Unit, University of Palermo, AOUP "P. Giaccone" Via Liborio Giuffrè 5, Palermo, Italy.

A 78-year-old man presented with a 7-cm aneurysm in the left superficial femoral artery, which was considered unfit and anatomically unsuitable for conventional open surgery for multiple comorbidities. The patient was treated with stent-graft [Viabhan stent-graft (WL Gore and Associates, Flagstaff, AZ)]. Two years from stent-graft implantation, the patient presented a purulent secretion and a spontaneous external expulsion through a fistulous channel. No claudication symptoms or hemorrhagic signs were present. The pus and device cultures were positive for Staphylococcus aureus sensitive to piperacillin/tazobactam. Patient management consisted of fistula drainage, systemic antibiotic therapy, and daily wound dressing. At 1-month follow-up, the wound was closed. To our knowledge, this is the first case of this type of stent-graft complication presenting with external expulsion.
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http://dx.doi.org/10.1007/s00270-014-0970-6DOI Listing
October 2015

Endograft connector technique to treat popliteal artery aneurysm in a morbid obese patient.

Vascular 2015 Apr 8;23(2):165-9. Epub 2014 May 8.

Vascular Surgery Unit, University Hospital 'P. Giaccone', Palermo, Italy.

Surgical repair of popliteal artery aneurysm in morbid obese patients poses additional challenges. We report a morbid obese patient who had a 59 mm right popliteal artery aneurysm which was successfully treated with the endograft connector technique. This technique was used to perform the distal anastomosis of the below-knee femoro-popliteal bypass. A 10 mm Dacron graft was used as a main graft bypass and an 11 mm/10 cm stentgraft as endograft connector. Following the respective tunnel of the Dacron graft, an end-to-side proximal anastomosis was performed at distal femoral artery. The aneurysm exclusion was obtained through a proximal and a distal ligation. Postoperative duplex showed adequate bypass patency. Knee x-rays demonstrated no signs of stent kinking/fractures. The postoperative course was uneventful and the patient was discharged home on fourth day post operative. The six-month computed tomography scan and the 12-month duplex control showed a patent bypass with no signs of stenosis.
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http://dx.doi.org/10.1177/1708538114533961DOI Listing
April 2015

Endovascular treatment of abdominal aortic anastomotic pseudoaneurysm. The experience of two centers.

Ann Ital Chir 2012 Nov-Dec;83(6):509-13

Department of Vascular and Endovascular Surgery, University of Palermo, Palemo, Italy.

Introduction: Abdominal aortic pseudoaneurysms are a rare but serious complication of aortic surgery. Treatment with traditional open surgery is associated with a high rate of perioperative mortality and morbidity. Endovascular treatment is less invasive and guarantees lower mortality and morbidity rates. The aim of this study was to evaluate the role of short-, medium- and long-term endovascular treatment of these pseudoaneurysms.

Materials And Methods: Over the past 10 years, 14 patients with abdominal aortic aneurysms, which developed after prior aortic surgery, underwent endovascular treatment involving implantation of an endoprosthesis at our institutions. Exclusion criteria were emergency treatment and suspicion of an infected prosthesis. A Cheatham-platinum covered stent mounted on a balloon catheter was implanted in one patient and self-expandable stent-graft in the other 13. No fenestrated or custom-made prostheses were used.

Results: The procedure had a 100% technical success rate. There was no postoperative mortality. Two type I endoleaks, observed at aortography at the end of the procedure, were not seen on the CT scan taken one month later. Three patients (21.4%) had major perioperative complications which consisted of early occlusion of a branch of the endoprosthesis, (treated with a femoro-femoral crossover bypass graft), a transient ischemic attack, and jaundice. The long-term mortality rate, at an average follow-up of 37.4 months, was 21.4%. None of the deaths was related to the procedure.

Conclusions: Endovascular treatment of patients who develop anastomotic pseudoaneurysm after surgery of the abdominal aorta is safe and effective both in the short and long term. In our opinion it is the treatment of choice for this category of patients.
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January 2013

Late, giant brachial artery aneurysm following hemodialysis fistula ligation in a renal transplant patient: case report and literature review.

Gen Thorac Cardiovasc Surg 2012 Nov 25;60(11):768-70. Epub 2012 May 25.

Department of Vascular and Endovascular Surgery, University of Palermo, Via L Giuffrè 5, 90127 Palermo, Italy.

Brachial artery aneurysm (BAA) following long-standing arteriovenous fistula ligation after renal transplantation is uncommon. Herein, we describe the case of a 64-year-old man who developed a giant symptomatic BAA 21 years after ligation of the fistula. He was submitted to surgical excision of the aneurysm followed by interposition prosthetic graft.
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http://dx.doi.org/10.1007/s11748-012-0075-6DOI Listing
November 2012

Basal cerebral computed tomography as diagnostic tool to improve patient selection in asymptomatic carotid artery stenosis.

Angiology 2012 Oct 29;63(7):504-8. Epub 2011 Dec 29.

Vascular Surgery Unit, University of Palermo, AOUP P. Giaccone, Italy.

One-hundred patients were included to evaluate the role of cerebral computed tomography (CT) to improve patient selection in asymptomatic internal carotid stenosis. Symptomatic patients were assigned to group A, asymptomatic patients to group B. A cerebral CT pattern A was observed in groups A and B in 60% and 20%, respectively (P < .0001). Between A and B groups, type 6 plaques were found, respectively, in 26.7% and 7.5% of patients (P = .01); a type 5 in 51.7% and 45% (P = .32) of patients; and a type 4 in 21.7% and 47.5% of patients, respectively (P = .006). Within B group, the association of CT pattern A and histological plaque level 4, 5, and 6 was, respectively, 25% (P = .15), 50% (P = .53), and 25% (P = .16). In group B, a 7-fold risk increase in CT pattern A was found in patients with level 6 plaque. In asymptomatic patients with high-risk plaque, a basal cerebral CT scan can be used as diagnostic tool to improve patient selection for intervention.
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http://dx.doi.org/10.1177/0003319711431448DOI Listing
October 2012
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