Publications by authors named "Grego F"

Objective: Carbon dioxide (CO) angiography has emerged as a viable alternative to regular iodinated contrast medium (ICM) for guiding endovascular aneurysm repair (EVAR) procedures. This study aimed to evaluate the feasibility and safety of a standardised EVAR procedure using only CO angiography.

Methods: A prospective, multicentre, national study enrolled consecutive patients between January 2023 and January 2024 with asymptomatic abdominal aortic aneurysms measuring ≥ 55 mm and for whom a standard endovascular graft (instructions for use) was anatomically feasible.

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  • * This text discusses the effectiveness of using carbon-dioxide (CO) instead of iodinated contrast for enhancing CBCT imaging during these interventions.
  • * The study found that CO-CBCT posed no adverse effects and delivered good imaging quality for assessing endograft integrity and vessel patency, especially in patients with serious kidney issues.
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Background: Intravenous thrombolysis (IVT) is the mainstay of treatment for patients presenting with acute ischemic stroke, whereas carotid endarterectomy (CEA) is indicated in patients with symptomatic carotid stenosis. However, the impact of prior IVT on the outcomes of CEA (IVT-CEA) is not clear. The aim of this study was to determine whether IVT may create additional stroke and death risk for CEA, compared with CEA performed in the absence of a history of recent IVT, and to determine the optimal timing for CEA after IVT.

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  • The study analyzed readmission rates and costs for patients with aorto-iliac occlusive disease (AIOD) who underwent either aorto-bifemoral bypass (ABF) or covered kissing stent (CKS) procedures from May 2008 to February 2018.
  • It found that readmission rates were similar for both procedures (ABF at 16%, CKS at 18%), with the primary cause being prosthesis limb or stent occlusion.
  • Although the CKS group showed a trend toward higher readmission and treatment costs, the ABF group experienced a longer time before readmission (35 months compared to 13.5 months for CKS).
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  • The study evaluates the use of the Excluder iliac branch endoprosthesis as an alternative to standard endovascular aortic repair for patients with specific conditions.
  • It was applied successfully in 13 cases involving abdominal/iliac aneurysms, occlusive disease, or complex aneurysms, achieving 100% technical success without adverse events.
  • At a follow-up of three months, all grafts demonstrated stability, highlighting the procedure's feasibility and safety in carefully selected cases.
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  • - The study evaluates a standardized method for using a specific type of endograft (four-fenestrated PMEG) to treat complex abdominal aortic aneurysms safely and effectively, focusing on specific anatomical criteria and techniques.
  • - Six patients (with various types of aneurysms) were treated, and the procedure was successful in all cases, with no complications or deaths reported within 30 days.
  • - Post-surgery imaging showed complete exclusion of the aneurysms without complications, indicating that this standardized approach may serve as a reference for future research.
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  • This study aimed to assess how effective intravascular ultrasound (IVUS) is in evaluating and improving the placement of kissing stents (KSs) and covered endovascular reconstruction in treating severe aortoiliac obstructive disease.
  • Researchers conducted a retrospective review of 102 patients receiving endovascular treatments from 2019 to 2023, focusing on cases with specific conditions that warranted IVUS use during procedures.
  • The findings revealed that IVUS identified significant technical issues in 25% of patients, leading to successful corrective measures, with higher risks associated with severely calcified lesions and narrow aortic bifurcations among the patients.
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  • * Microinvasive endovascular repair (Ar-TEVAR) has shown favorable outcomes for high-risk individuals and is typically done under general anesthesia.
  • * An 83-year-old man with a pseudoaneurysm from previous surgery underwent Ar-TEVAR using a single-branch stent graft, utilizing monitored anesthesia care to reduce stress on his body and enhance recovery.
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The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suffering from aneurysmal pathology of the visceral and renal arteries. The methodology applied was the GRADE-SIGN version, and followed the instructions of the AGREE quality of reporting checklist. Clinical questions, structured according to the PICO (Population, Intervention, Comparator, Outcome) model, were formulated, and systematic literature reviews were carried out according to them.

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Carotid artery stenting (CAS) represents today an accepted option for the treatment of severe carotid artery stenosis. The evolution of materials, techniques, perioperative medical management and patients' selection, has allowed to progressively reduce CAS complications. However, the main drawback of CAS is still represented by the risk of cerebral embolization, that may occur during several steps of the procedure and also in the early postoperative period.

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Purpose: To describe the endovascular treatment of a symptomatic juxtarenal abdominal aortic aneurysm (JAAA) using a combination of endoanchors (Heli-FX EndoAnchor, Medtronic, Minneapolis, Minnesota) and a physician-modified single-fenestrated endograft.

Technique: An 85 year-old patient unfit for open aortic repair presented for a symptomatic JAAA, characterized by an infrarenal neck with 0.6 cm in length and 23 mm in diameter.

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Objective: This single centre, retrospective study (2014 - 2022) on juxta-, pararenal, or thoraco-abdominal aortic aneurysms treated by fenestrated endovascular aortic repair (FEVAR) was conducted to investigate the clinical impact and determinants of fenestration to target vessel misalignment in FEVAR.

Methods: Pre-operative supracoeliac, pararenal, and infrarenal aortic angles were measured on three dimensional computed tomography angiography (CTA) reconstructions. Two components of misalignment were measured on the first post-operative CTA: horizontal misalignment (angle between the fenestration and the target vessel ostium on perpendicular CTA cuts) and vertical misalignment (vertical distance between the fenestration and the target vessel at its origin).

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  • The study aimed to assess how a narrow paravisceral aorta (NPA) affects the stability of target vessels (TVI) after undergoing fenestrated-branched endovascular aortic repair for aortic aneurysms.
  • A total of 142 patients were analyzed, with 70% having NPA, and both groups displayed high rates of technical success and low mortality within 30 days.
  • The long-term freedom from TVI at 4 years was similar for patients with and without NPA, although having an NPA less than 20 mm and a significant angulation (>30°) was linked to a higher risk of TVI specifically in the FEVAR subgroup.
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Objective: The aim of this study was to investigate the outcomes of primary determinate and indeterminate target vessel endoleaks (TVELs) after fenestrated-branched endovascular aortic repair (F-BEVAR).

Methods: We conducted a single-center retrospective study (2014-2023) on F-BEVAR for thoracoabdominal (TAAAs) or pararenal aortic aneurysms (PRAAs). TVELs were classified as "primary" if present at the first postoperative computed tomography angiogram.

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Background: The carotid stent design may influence the risk of embolization during carotid artery stenting. The aim of the study was to assess this risk by comparing the quantity of embolized material captured by filters during carotid artery stenting, using different stent designs.

Methods: We conducted a single-center retrospective study of patients undergoing carotid artery stenting for asymptomatic carotid stenosis >70% (2010-2022) in a tertiary academic hospital (Padua University Hospital, Italy).

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We describe the feasibility of a technique for temporary aneurysm sac reperfusion after endovascular single-stage thoracoabdominal aortic aneurysm exclusion, to be used in the case of postoperative spinal cord ischemia. Two cases were treated for impending rupture of a thoracoabdominal aortic aneurysm. Before completion of sac exclusion, a supplementary buddy wire (V-18 control guidewire; Boston Scientific) was advanced in parallel fashion from the left percutaneous femoral access into the aneurysmal sac on the posterior aspect of the endograft.

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Multimodal imaging is the incorporation of two or more imaging modalities during the same examination, and it has both diagnostic and treatment applications. The use of image fusion for intraoperative guidance in endovascular interventions is being extended increasingly to the field of vascular surgery, especially in the context of hybrid operating rooms. The aim of this work was to perform a review and narrative synthesis of the available literature in order to report on current applications of multimodal imaging in diagnosis and treatment of emergent vascular conditions.

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  • The study evaluated the occurrence of acute kidney injury (AKI) stages post-fenestrated endovascular aortic repair (FEVAR) in patients with complex aortic aneurysms, using the RIFLE criteria to classify AKI severity.
  • It included 45 patients, primarily elderly males, and found a 11.1% incidence of post-operative injury stage AKI, while examining predictors of AKI and long-term renal function decline.
  • Key predictors of chronic kidney disease onset identified were older age and post-operative injury stage AKI, though some factors showed significance only in univariate analysis and not in multivariate models.
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Purpose: Patients undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS) are at substantially increased risk of short-term and long-term cardiac complications. Still, the role of perioperative troponin in predicting cardiac events remains unclear. The objective was to systematically summarize the existing evidence on the topic and provide directions for further research.

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Background: The aim of this work is to value cost-effectiveness of complex aortoiliac occlusive disease (AIOD) revascularization, by comparing in-hospital clinical outcomes and detailed costs of hospitalization of open and endovascular techniques.

Methods: This observational single-center retrospective cohort study included all patients who underwent AIOD revascularization from May 2008 to February 2018 and met inclusion and exclusion criteria. Patients were divided into 2 groups: open surgical repair and endovascular repair.

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  • - The report discusses the use of intravascular lithotripsy angioplasty to treat severe calcifications in the infrarenal aorta and its bifurcation in two patients.
  • - The first patient had two lithotripsy balloons used together to expand the aorta while keeping the renal artery open, followed by stenting in the iliac arteries.
  • - For the second patient, a single lithotripsy balloon was used first, then covered stenting was applied, suggesting that this technique could improve treatment outcomes for complex aortic conditions.
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Aortic arch pathologies are commonly treated by open surgery which is still the gold standard. Patients that are unfit for surgery can be effectively treated mini-invasively with novel endovascular endograft specifically designed for the arch. Endovascular technology has remarkably improved in recent years and is a valid alternative option for the treatment of aortic arch.

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The use of three-dimensional (3D) printing is gaining considerable success in many medical fields, including surgery; however, the spread of this innovation in cardiac and vascular surgery is still limited. This article reports our pilot experience with this technology, applied as an additional tool for 20 patients treated for complex vascular or cardiac surgical diseases. We have analyzed the feasibility of a "3D printing and aortic diseases project," which helps to obtain a more complete approach to these conditions.

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Objective: In the present report, we have described the prevalence, risk factors, and clinical effects of coronary artery disease (CAD) for patients with asymptomatic bilateral carotid stenosis.

Methods: We conducted a single-center, retrospective cohort study of consecutive patients referred for bilateral carotid stenosis >70% (2014-2021). All the patients had undergone systematic coronary angiography.

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