Patrizio Castelli

Midterm Outcomes of Carotid-to-Carotid Bypass for Hybrid Treatment of Aortic Arch Disease

BACKGROUNDnThe purpose of this study was to compare midterm results of carotid-to-carotid bypass (CCB) after hybrid repair of aortic arch disease.nnnMETHODSnBetween October 2001 and April 2012, all patients undergoing hybrid aortic arch repair with CCB were enrolled. CCBs were positioned in the subcutaneous or in the retropharyngeal position. Hybrid aortic arch repair was performed in a single-stage intervention.nnnRESULTSnWe treated 19 (82.6%) men and 4 women; mean age was 74 ± 6 years (range, 58-83 years). Subcutaneous tunnelization was performed in 15 (65.5%) cases and the retropharyngeal route in 8 (34.5%). In-hospital mortality was 8.7% (n = 2); causes of death were major stroke (n = 1) and respiratory failure (n = 1). Cranial nerve injuries (transient or permanent), dysphagia, or local problems were not observed. Tracheostomy was never required. Early outcomes did not differ between the 2 types of bypass. Mean follow-up was 44 months (range, 1-118; median 24). Survival rate at 1, 3, and 5 years was 70% ± 9.6%, 55% ± 10.7%, and 50% ± 11.1%, respectively. At the time of the last follow-up control, all bypasses were patent: stenosis and thrombosis were not recorded. Bypass graft or endograft infection were not registered. Shrinkage of the aortic lesion was observed in 15 (71.4%) cases.nnnCONCLUSIONSnCCBs are durable at midterm follow-up. No relevant superiority was identified between the 2 types of CCB; subcutaneous and retropharyngeal routes proved to be equally safe.

Initial Experience with Analogues of Prostaglandins for Haemodialysis Access-Induced Distal Ischemia

Introduction: Haemodialysis access-induced distal ischemia (HAIDI) is a common disabling complication that can be ascribed to an excess of blood flow through a haemodialysis vascular access, to the lack of arterial adaptation to the fistula and/or to arterial stenoses. Aim of the present study is to describe a preliminary experience with two analogues of prostaglandins, iloprost and misoprostol, for HAIDI treatment. nMaterials and methods: Patients with HAIDI stage 1 and 2a were treated for 10 weeks with misoprostol 400 μg once per day. Patients with HAIDI stage 2b and 3 received a selective intra-arterial injection of iloprost 0.025 mg and subsequently an intravenous continuous injection of iloprost 1.25 ng/kg/min for 72 h, finally misoprostol 400 μg once per day for 10 weeks. Evaluation of treatment benefit included vascular fluorescence quality control, pain evaluation and QOL assessment. nResults: Sixteen patients were treated with PG: twelve with HAIDI stage 1 and 2a, four with HAIDI stage 2b and 3, major local or systemic morbidity and adverse effects to the drugs were not observed. In all cases symptoms, QOL and vascular fluorescence improvement was observed. At the end of the study 25% of the patients did not present HAIDI symptoms while 75% negligible symptoms. All the patients refused surgical option. nConclusion: The treatment of HAIDI has demonstrated to be safe and effective in a selected cohort of patients

Concomitant Abdominal Aortic Aneurysm and Malignancy: Simultaneous Minimally Invasive Repair

Gabriele Piffaretti1, Luigi Boni2, Matteo Tozzi1, Nicola Rivolta1, Giovanni Mariscalco3 and Patrizio Castelli1 1Vascular Surgery – Department of Surgical Sciences, University of Insubria School of Medicine, Varese 2General Surgery 1 – Department of Surgical Sciences, University of Insubria School of Medicine, Varese 3Cardiac Surgery – Department of Surgical Sciences, University of Insubria School of Medicine, Varese, Italy