Raoul Borioni

Emergency endovascular treatment of a ruptured internal iliac artery aneurysm long after abdominal aortic aneurysm surgical repair.

The purpose of this report is to describe the endovascular exclusion of an internal iliac artery (IIA) aneurysm in emergency setting, long after abdominal aortic aneurysm surgical repair. An 85-year-old male presented with a contained rupture of a huge IIA aneurysm, ten years after aortoiliac bifurcated grafting. Because of poor clinical conditions an emergency endovascular treatment was planned. A stent-graft was positioned from the proximal right branch of the bifurcated surgical prosthesis to the distal external iliac artery, covering the hypogastric aneurysm neck. One month after the procedure, CT scan demonstrated the complete exclusion of the aneurysm. Endovascular treatment of IIA aneurysms is an excellent option to reduce perioperative morbidity and mortality in high risk patients, particularly in an emergency setting.

Radical tumor excision and cosmetic balance in the surgical treatment of breast carcinoma : biquadrantectomy

The present trend in favor of conservative surgery is in contrast with histopathological findings of multicentric breast carcinoma, which may be responsible for the occurrence of relapses in spite of the use of radiation therapy. As a consequence, conservative surgery appears to be inadequate, especially when tumor size exceeds 2 cm. Therefore for tumors up to 4 cm in size, which are not adherent to the pectoral fascia, we propose the excision of two quadrants with concomitant operation on the contralateral breast resulting in a more symmetrical and therefore cosmetic effect. This is a more radical procedure than the removal of the one quadrant.

Coronary risk in candidates for abdominal aortic aneurysm repair: a word of caution.

Background Current guidelines do not recommend routine coronary evaluation preceding abdominal aortic aneurysms (AAA) repair in low-risk patients. The purpose of the present study is to report the incidence of coronary lesions in candidates for AAA repair with a Revised Cardiac Risk (Lee) Index (RCRI) < 2, which are usually excluded from preoperative cardiological work-up. Early-term and long-term results of prophylactic myocardial revascularization are also reported. Methods A retrospective, observational, cohort study collecting clinical data on a series of 149 consecutive patients undergoing preoperative coronary angiography and myocardial revascularization (percutaneous coronary intervention, PCI; coronary artery bypass grafting, CABG) before elective open or endovascular AAA repair (January 2005–December 2012). Results Severe coronary artery disease (CAD) was revealed in 43 patients (28.9%), who underwent successful myocardial revascularization by means of PCI (n.35) or off-pump CABG (n.8). The incidence of severe CAD in patients resulted at low risk on the basis of risk models was approximately 25%. The incidence of severe CAD in asymptomatic patients was 29.8%. Endovascular (n.52, 35.1%) and open (n.96, 64.9%) AAA repair was performed with low morbidity (0.6%) and mortality (0.6%) in 148 patients. The long-term estimated survival (freedom from fatal cardiovascular events) was 97% at 60 months and 82% at 90 months. Conclusions The incidence of severe correctable CAD is not negligible in low-risk patients scheduled for AAA repair. Waiting for further recommendations based on large population studies of vascular patients, a more extensive indication to coronary angiography and revascularization should be considered in many candidates for AAA repair.

Re: 'Long-term Results of a Randomized Controlled Trial Analyzing the Role of Systematic Pre-operative Coronary Angiography Before Elective Carotid Endarterectomy in Patients with Asymptomatic Coronary Artery Disease'.

Two meaningful papers by Illuminati et al. have shown real benefits of systematic pre-operative coronary angiography prior to carotid endarterectomy (CEA), suggesting a more aggressive approach to cardiac risk management. However, the high number of inappropriate invasive studies associated with this strategy may be relevant, and the role of prophylactic myocardial revascularization is still under debate. Like Illuminati et al., we routinely performed coronary angiography on a consecutive series of 238 candidates for CEA (January 2005eDecember 2013), which revealed a prevalence of severe coronary artery disease (CAD; left main trunk stenosis >50%, one-, two-, and threevessel stenosis >80%) in a subgroup of 64 patients who had diabetes compared with 174 patients without diabetes (n 1⁄4 35 [54.6%] vs. n 1⁄4 63 [36.2%]; p < .05). Percutaneous (57.1%) and surgical (42.9%) myocardial revascularization were effective in reducing the post-operative risk in patients with diabetes who usually have a higher peri-procedural myocardial infarction rate than patients without diabetes undergoing CEA. Coexisting CAD in patients scheduled for CEA conveys a peri-operative burden that could offset the long-term benefit of surgery. Routine coronary angiography should be advocated for patients with diabetes who will

Surgical stabilization of the flail chest

DOI:€10.1016/0003-4975(92)91421-5 Ann Thorac Surg 1992;54:397-398 Raoul Borioni, Renzo Ciani, Guglielmo M. Actis Dato and Raffaele Garofalo Surgical stabilization of the flail chest http://ats.ctsnetjournals.org located on the World Wide Web at: The online version of this article, along with updated information and services, is