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Marina di Pisa, Italy

Tolva V.S.,Unit of Vascular Surgery
European review for medical and pharmacological sciences | Year: 2012

To evaluate the benefit of endovascular peripheral revascularization on glucose control in patients with chronic limb ischemia. Over a 12 month period, 61 patients (41 male, range 49-88 years of age) presenting with critical limb ischemia (CLI) were treated according to the Trans Atlantic Inter Society Consensus (TASC II) guidelines. After discharge, all patients were asked to measure their glucose level three times daily, and glycated hemoglobin was checked monthly up to 12 months, as well as to fill a questionnaire to assess their Quality of Life (QoL). The revascularization procedure was successful in 90% of cases. Glycemic control and glycated hemoglobin in 22 diabetic patients subgroup were significantly improved after the treatment and remained stable over the follow-up period. There was a significant improvement in QoL that increased steadily from the operation and to reach a plateau after six months. Peripheral percutaneous angioplasty in subjects with CLI significantly improves glycemic control and ameliorates QoL. Revascularization positively effects also long-term diabetes control as well as QoL. Source

Rango P.D.,Unit of Vascular and Endovascular Surgery | Lenti M.,Unit of Vascular and Endovascular Surgery | Cieri E.,Unit of Vascular and Endovascular Surgery | Simonte G.,Unit of Vascular and Endovascular Surgery | And 3 more authors.
Journal of Vascular Surgery | Year: 2013

Background: Women are recognized to experience inferior outcomes following open surgery for elective or ruptured abdominal aortic aneurysm (rAAA) when compared with men. The objective of this review was to assess whether there is a sex difference on mortality in patients receiving endovascular aneurysm repair (EVAR) for rAAA. Methods: A systematic literature review from 2005 to 2012 was performed to investigate early mortality risk of ruptured endovascular aneurysm repair (rEVAR) stratified by sex. Data were analyzed with random-effect meta-analysis; pooled odds ratios (ORs) were calculated for women compared with men. Results: Thirteen studies provided the required information; in most (n [ 9), data stratified by sex was identified through unpublished data from direct contact with authors. No study was randomized; there were four prospective and 10 retrospective series. Three were United States population studies. The number of women was limited in most articles. Data were available for 5580 patients treated with rEVAR; 1339 were women (23.9%). Perioperative mortality with rEVAR occurred in 473/1339 women (pooled rate 35.6%; 95% confidence interval [CI], 33.1-38.2) and in 1334/4241 men (pooled rate 31.7%; 95% CI, 30.3-33.1) without significant difference between sex categories (pooled odds ratio 1.22; 95% CI, 0.97-1.54; P [ .09). There was no increased mortality risk in women vs men in ancillary analyses stratified by study size and after excluding unpublished data. Conclusions: Women may benefit as much as men from EVAR for rAAA. Nevertheless, current evidence supporting EVAR for female patients with rAAA is weak and requires confirmation by further experiences with a larger female representation. Copyright © 2013 by the Society for Vascular Surgery. Source

Serra R.,University of Catanzaro | Buffone G.,University of Catanzaro | Costanzo G.,University of Catanzaro | Montemurro R.,University of Catanzaro | And 4 more authors.
Annals of Vascular Surgery | Year: 2014

Background: Varicocele, inguinal hernia, and clinical manifestations related to chronic venous disorders are often associated, and collagen metabolism together with metalloproteinases (MMPs) alterations may be implicated. The aim of this study was to analyze the relationship between these factors. Methods: We evaluated tissue and plasma samples from patients with varicocele, inguinal hernia, and great saphenous vein reflux, who underwent surgical treatment for their conditions. We then analyzed and correlated these findings with MMP levels. Results: Significantly higher levels of MMP-1, -2, -12, and -13 were found in patients with inguinal hernia. MMP-9 levels were higher in patients with at least two of the conditions indicated. Conclusion: MMP-9 seems to be the common thread in various clinical conditions and is related to a more general and progressive disorder of collagen metabolism. © 2014 Elsevier Inc. All rights reserved. Source

De Rango P.,University of Perugia | Parlani G.,University of Perugia | Verzini F.,University of Perugia | Giordano G.,University of Perugia | And 3 more authors.
Journal of the American College of Cardiology | Year: 2011

Objectives This study sought to evaluate long-term outcomes of carotid stenting (CAS) versus carotid endarterectomy (CEA) based on physician-guided indications. Background The issue regarding long-term outcome of CAS versus CEA in patients with carotid stenosis is clinically relevant but remains unsettled. Methods Consecutive patients (71% men, mean age 71.3 years) treated by CEA (n = 1,118) or CAS (n = 1,084) after a training phase were reviewed. Selection of treatment was based on better-suitability characteristics (morphology and clinical). Data were adjusted with propensity score analysis and stratified by symptoms, age, and sex. Results Thirty-day stroke/death rates were similar: 2.8% in CAS and 2.0% in CEA (p = 0.27). The risk was higher in symptomatic (3.5%) versus asymptomatic (2.0%) patients (p = 0.04) but without significant difference between CAS and CEA groups. Five-year survival rates were 82.0% in CAS and 87.7% in CEA (p = 0.05). Kaplan-Meier estimates of the composite of any periprocedural stroke/death and ipsilateral stroke at 5 years after the procedure were similar in all patients (4.7% vs. 3.7%; p = 0.4) and the subgroups of symptomatic (8.7% vs. 4.9%; p = 0.7) and asymptomatic (2.5% vs. 3.3%; p = 0.2) patients in CEA versus CAS, respectively. Cox analysis, adjusted by propensity score, identified statin treatment (p = 0.016) and symptomatic disease (p = 0.003) associated with the composite end point. There were no sex- or age-related significant outcome differences. Conclusions When physicians use their clinical judgment to select the appropriate technique for carotid revascularization CAS can offer efficacy and durability comparable to CEA with benefits persisting at 5 years. © 2011 American College of Cardiology Foundation. Source

Pulli R.,University of Florence | Dorigo W.,University of Florence | Castelli P.,University of Insubria | Dorrucci V.,Unit of Vascular Surgery | And 6 more authors.
European Journal of Vascular and Endovascular Surgery | Year: 2013

Introduction: The aim of this study was to analyse early and follow-up results of the treatment of popliteal artery aneurysms (PAAs) performed with open surgical repair or with endovascular exclusion with endografts in a multicentric retrospective registry involving seven Italian vascular centres. Materials and methods: We retrospectively collected data concerning 178 open surgical interventions (OR group) and 134 endovascular exclusions (ER group) for PAAs performed between January 2000 and December 2011. Early and follow-up results were analysed in terms of mortality, graft patency, reintervention and limb preservation. Results: OR patients were more frequently symptomatic (64%, 115 cases) than patients in the ER group (34%, 51 cases; p < 0.001), had more frequently acute limb ischaemia (23% and 6.5%, respectively; p < 0.001) and had more frequently a run-off score <2 (39% and 26%, respectively, p = 0.03). In the OR group there were no perioperative deaths; six thromboses (3.3%) and one amputation occurred. In the ER group mortality was 1.5%; 13 thromboses (9.7%) and one amputation (0.5%) occurred. Mean duration of follow-up was 30.6 ± 27.5 months. In the OR group primary and secondary patency, freedom from reintervention and limb preservation rates at 48 months were 63.5% (standard error (SE) 0.05), 76.5% (SE 0.05), 72.5% (SE 0.06) and 89.7% (SE 0.05), respectively. The corresponding figures in the ER group were 73.4% (SE 0.04), 85% (SE 0.04), 75% (SE 0.04) and 97% (SE 0.04), respectively. Conclusions: In this large multicentric retrospective registry, open and endovascular treatment of PAAs are used in different patients with regard to clinical and anatomical characteristics. Both treatments are feasible and safe, providing satisfactory early and long-term results. © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. Source

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