Luigi Venturini

Endovascular repair for acute mesenteric ischemia: case report

Methods We present a case of a 75-year-old patient with acute occlusive mesenteric ischemia that was successfully treated with endovascular intervention. Angiography revealed high-grade stenosis of the proximal tract of the SMA. Immediate option for endovascular therapy was made, and a MARIS self-expandable 6x40 mm stent was positioned. The patient was discharged 2 days after with full recovery from the symptoms.

A Rare Presentation of an Isolated Internal Iliac Artery Aneurysm: Report of a Case and Literature Review

Isolated internal iliac artery aneurysms (IIIAAs) are extremely rare. We present the case of a 75-year-old white Caucasian male patient admitted for right lower limb deep venous thrombosis and low-risk pulmonary embolism due to the compression of the external iliac vein from an IIIAA. A review of the literature was also performed to identify the epidemiologic, clinical characteristics and diagnostic and operative strategies of this disease. At present, a recommendation for the best operative strategy in the presence of an IIIAA is difficult. Our analysis demonstrated controversial results, but we are confident to recommend the endovascular treatment in an elective setting.

A Steerable Sheath to Deploy Hypogastric Bridging Stent by Contralateral Femoral Approach in an Iliac Branch Procedure after Endovascular Aneurysm Repair

Aneurysmal degeneration of distal landing zones after endovascular aneurysm repair (EVAR) can be a potential cause of late failure of this technique. Aneurysmal degeneration of common iliac arteries increases the risk of rupture of the iliac aneurysm itself as well as of the abdominal aortic aneurysm owing to aneurysms reperfusion as a type Ib endoleak. Reoperation consists in plugging and covering the internal iliac artery (IIA), by extension into the external iliac artery, or preservation of antegrade flow in IIA by iliac branch devices (IBDs) or sandwich technique. The management of common iliac aneurysms after EVAR with the purpose of preserving antegrade flow into IIA generally requires a brachial or axillary access. However, this approach may be theoretically associated with local or systemic complications. We report a case of IBD implantation after EVAR, using a steerable sheath for IIA bridging stent deployment via contralateral femoral approach.

Considerations: When More is Not Necessarily Better

The erroneous perception that the more procedures are performed the more is the economic income of a surgical unit can lead some surgeons to be less observant to the international guidelines. We would like to address the attention of the readers over 3 intriguing topics of vascular surgery. Carotidsurgeryisapreventiontreatmentforischemicstrokein asymptomaticpatients.Nowadays,itisdemonstratedthatthereis arealbenefitofsurgeryoverconservativemedicaltherapyonlyin male patients with asymptomatic carotid stenosis 70% and younger than 75 years. We should remember that the benefit, in termsofabsoluteriskreductioninstrokeisonly1%peryear,and it increases with subsequent years of follow-up. 1 Therefore, life expectancy and a lower than 3% cumulative mortality and morbiditycomplicationrateofthecentershouldbekeptinmindwhen patients affected with an asymptomatic carotid artery stenosis undergo tromboendarterectomy or stent positioning. 2 How many

Emergency abdominal surgery in the elderly: a ten-year experience.

The mean age of the population is increasing in the western countries. In particular, in Italy 14% of the population are over 70 years old. The rising of the older population is associated to the increase of the number of emergency abdominal surgical procedures. Postoperative morbidity and mortality are strictly dependent on comorbidities. The aim of this study was to analyze morbidity and mortality in older patients who underwent emergency abdominal surgery.

Spontaneous Deep Femoral Artery False Aneurysm Simulating a Neoplasm: A Rare Case and Literature Review

A 70-year-old woman presented to our attention with a painless pulsating mass at the level of the upper left thigh without any previous history of trauma, arterial surgery, or puncture of the femoral artery. Duplex ultrasound showed a nodular angiomatous-like formation with deep venous compression; computed tomographic angiography and magnetic resonance imaging reported the presence of capsulated lesion vascularized by muscular branch of deep femoral artery (DFA). The patient underwent surgical excision of a very rare thrombized DFA branch false aneurysm. Spontaneous DFA false aneurysm, although rare, will be considered in absence of trauma or vascular catheterization or previous aneurysmal rupture.

Spot Stenting of Supra-aortic Branch Vessels for Residual Type A Dissection

The purpose of this report was to describe the exclusion of the false lumen in a residual type A aortic dissection (TAAD) by the deployment of 2 covered stents: one in the right common carotid artery (RCCA) and one in the left subclavian artery (LSA). A 77-year-old female, already treated with ascending aorta replacement for acute TAAD, was referred to our center for a 97-mm post-dissection arch aneurysm. A computed tomography angiography (CTA) showed false lumen patency by reperfusion from secondary tears located at the level of RCCA and LSA. No primary aortic tear was noted. Under local anesthesia and by transfemoral percutaneous approach, the tears at the level of RCCA and LSA were covered by a 9-mm Viabahn stent graft (Gore, Flagstaff, AZ), and a 10-mm V-12 stent graft (Maquet, Rastatt, Germany), respectively. The false lumen was finally occluded by the deployment of a 6-mm vascular plug at the level of LSA re-entry tear, by left transbrachial puncture. The procedure was completed uneventfully. Twelve-month CTA showed exclusion of the false lumen, patency of all supra aortic trunks, and initial shrinkage of the aneurysm. Spot stenting of secondary re-entry tears, already described for visceral branches, seems to be safe and effective also for supra-aortic trunks in selected patients.

True Aneurysm of the Inferior Thyroid Artery: A Case Report and Literature Review

Aneurysms of the inferior thyroid artery (ITA) are extremely rare and potentially determine severe sequelae. We report a case of true ITA aneurysm in a 45-year-old Caucasian woman treated with endovascular embolization; postoperative course was uneventful and, at 6-month follow-up, the aneurysm is completely thrombized. A systematic review of the literature has been also performed to identify the epidemiologic and clinical characteristics and diagnostic and operative options of this disease. Size alone is not able to predict the fate of the aneurysm and an aggressive treatment seems to be justified because of the high risk of complications in case of rupture. In an emergency setting, the endovascular procedures associated to hematoma evacuation or open surgery should be rapidly performed to save patient life.

Intermittent Claudication: The Importance of Non-Invasive Treatment in the Femoro-Popliteal Tract

The prevalence of intermittent claudication is around 4.5% in general population aged between 55 to 74 years [1]. Even if this condition has a profound and negative impact on patients’ quality of life [2,3], because of a sense of limitation of mobility and the fear of the progression of the disease and limb loss, patient should be reassured on the relatively benign prognosis of the pathology in case of intermittent claudication. Leng et al. [4] reported a remission of symptoms in more than 60% of the patients examined after a period of 5 years. A progression of the disease in only 25%; deterioration is more likely to appear on the first year after diagnosis (7%-9%) compared with 2% to 3% per year thereafter [5] and can be related to poor adherence to treatments and exercise programs.

Surgical treatment for primary hyperparathyroidism in the elderly: a single- center analysis

BackgroundsThe suspicion of a hyperparatiroidism is mostly guidedby the finding of an increase in serum calcium levels byroutine measurements. Primary hyperparathyroidism is acommon disease occurring in 0.2 to 0.5% of the popula-tion. The incidence in the United States is approxi-mately 100000 new cases per year and increases withage affecting up to 2% of elderly people [1].Materials and methodsFrom January 1995 to December 2009, 172 patientsunderwent operations for Hyperparathyroidism, 130 ofthese were Primary Hyperparathyroidism at our Depart-ment of General Surgery. Patients were divided into twogroups: patients of≤ 69 years old (Group A) andpatients of ≥ 70 years old (Group B). The following vari-ables were studied: demographic characteristics, co-mor-bidities, preoperative symptoms, laboratory values,operative procedures, postoperative complications andanatomo -pathological findings.ResultsGroup A: 110 patients operated 25 were male, 85 werefemale with a M:F ratio of 0.3:1. Mean age at admissionwas52.4(SD±12.9).Wereportedamorbidityrateof5.4% (6 patients) and a mortality rate of 0%. Group B:20 patients operated 6 were male, 16 were female with aM:F ratio of 0.25:1. Mean age at admission was 74.2 (SD±3.7). We reported a morbidity rate of 5% (1 patient)and mortality rate 0%.ConclusionsElderly patients with Hyperparathyroidism present avariety of symptoms that are often different from thoseseen in younger patients. They are more likely to mani-fest fatigue and psychiatric symptoms that are difficultto distinguish from those due to their age, therefore inthe majority of cases the suspicion of hyperparathyroid-ism is guided by the finding of an increase in serum cal-cium levels on a routine measurement. If serum calciumlevel is high or if hypercalcaemia is discovered, measure-ment of PTH confirms the diagnosis [2,3]. Cervicotomyand parathyroidectomy is still to be considered as thetreatment of choice in elderly patients with primaryhyperparathyroidism.