Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM).

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.

Guidelines on the management of abdominal aortic aneurysms: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE).

The objective of these Guidelines was to revise and update the previous 2016 Italian Guidelines on Abdominal Aortic Aneurysm Disease, in accordance with the National Guidelines System (SNLG), to guide every practitioner toward the most correct management pathway for this pathology. The methodology applied in this update was the GRADE-SIGN version methodology, following the instructions of the AGREE quality of reporting checklist as well. The first methodological step was the formulation of clinical questions structured according to the PICO (Population, Intervention, Comparison, Outcome) model according to which the Recommendations were issued.

Endovascular Bail Out for a Failed Transcatheter Aortic Valve Implantation in High Surgical Risk Patient.

The endovascular treatment for acute type A dissection (ATAD) represents an alternative and emerging option in selected high surgical risk patients. We report a successful total endovascular ATAD repair occurred intraoperatively during transcatheter aortic valve implantation (TAVI) placement in 82 years old female, not fit for surgery in emergency setting. The presentation, the diagnostic evaluation, and the technique are discussed.

Evaluation of Clinical Outcomes After Revascularization in Patients With Chronic Limb-Threatening Ischemia: Results From a Prospective National Cohort Study (RIVALUTANDO).

We evaluated the outcomes of revascularization in patients with chronic limb-threatening ischemia (CLTI) treated in real-world settings. This is a prospective multicenter cohort study with 12-month follow-up enrolling patients (n = 287) with CLTI undergoing open, endovascular, or hybrid lower extremity revascularization. The primary end point was amputation-free survival (AFS) at 12 months.

Giant saccular aneurysm of the innominate artery.

We report a rare case of a saccular aneurysm of innominate artery without any apparent causative history. Although the treatment choice remains debatable, due to the poor condition of the patient, the lesion was excluded by using a balloon-expandable covered stent with a satisfactory early-term outcome.

An update of the Italian Stroke Organization-Stroke Prevention Awareness Diffusion Group guidelines on carotid endarterectomy and stenting: A personalized medicine approach.

Although proof-based medicine has generated much valid evidence for the drawing up of guidelines and recommendations for best clinical practice in symptomatic and asymptomatic carotid stenosis, whether and when it is better to employ endarterectomy or stenting as the intervention of choice still remain matters of debate. Moreover, guidelines have been targeted up to now to the 'representative' patient, as resulting from the statistical analyses of the studies conducted on the safety and efficacy of both interventions as well as on medical therapy alone. The Italian Stroke Organization (ISO) and Stroke Prevention and Awareness Diffusion (SPREAD) group has thus decided to update its statements for an 8th edition.

Synchronous Carotid Bifurcation Endarterectomy and Retrograde Kissing Stenting of the Innominate and Left Common Carotid Artery in a Patient with a Bovine Aortic Arch.

Management of the symptomatic multiple stenosis of supra-aortic vessels (MSSVs) in a "bovine" aortic arch (BAA) configuration is infrequently reported. The optimal treatment choice remains debatable. A successful hybrid treatment for a proximal critical stenosis of the innominate and left common carotid artery was performed in a high-risk patient with a tandem symptomatic lesion in the right carotid bifurcation and a concentric vulnerable plaque in the bovine trunk.

Transesophageal ecocardiography: the correct intraoperative way to detect the source of peripheral embolism in an emergency.

Arterial thromboembolism in patients with an unknown source of embolization is associated with significant morbidity and mortality. Once the acute process has been treated, a search of the offending embolic source must be conducted to prevent additional episodes. The most common sources of peripheral embolism include intracardiac thrombi (>85%), thrombus within arterial aneurysm, thrombus overlying complex atherosclerotic plaques, and paradoxical embolization from deep venous thrombus.

SPREAD Italian Guidelines for stroke. Indications for carotid endarterectomy and stenting.

This multidisciplinary guideline provides an overview of the current evidence on the benefits obtained by endoarterectomy and stenting for the surgical treatment of patients with symptomatic and asymptomatic carotid stenosis. A hundred forty-six authors, 37 Italian scientific societies and two Italian patients' associations participated in drafting the Stroke Prevention and Educational Awareness Diffusion (SPREAD) document, which has become the national guideline for the prevention and treatment of stroke in Italy. For the surgical therapy section of this document, the main trials on carotid endoarterectomy and stenting were critically reviewed following The Scottish Intercollegiate Guideline Network Oxford Centre for Evidence-Based Medicine methodology in order to formulate recommendations and syntheses for these procedures.

[Vascular homografts: strategies and operative techniques].

The author propose a detailed analysis of all the critical aspects that must be kept in mind when, in case of graft infection, the choice is to utilize an arterial homograft. Patient suitable to this procedure, as well as clinical and diagnostical relevance of graft infection and characteristics of the donor's material are widely examined. The surgical techniques about a) patient preparation and management, b) infected graft removal and c) homograft implant are specifically discussed and analyzed.

The use of arterial allografts in aortic graft infections. A three year experience on eighteen patients.

Background: We describe our experience in the treatment of aortic graft infections by replacing them with arterial homografts as suggested by the good results recently described.

Methods: Between March 1994 and March 1997 eighteen patients with infections of the aortofemoral bifurcation segments have been treated. All patients underwent a complete explantation of the infected graft and an in situ revascularization with arterial homograft harvested in multiorgan removal.

Fresh and cryopreserved arterial homografts in the treatment of prosthetic graft infections: experience of the Italian Collaborative Vascular Homograft Group.

Following the experience of cardiac surgeons with homografts in the treatment of infective aortic valve endocarditis, cardiovascular surgeons have investigated in situ revascularization by means of homografts in the management of vascular prosthetic graft infections. Preliminary results are encouraging, but their late fate in long-term follow-up and the influence of preservation techniques are still under investigation. This article reports the experience of the Italian Collaborative Vascular Homograft Group, with the use of fresh and cryopreserved arterial homografts for the treatment of prosthetic graft infections.

[Carotid endarterectomy using direct suturing].

The authors report the surgical technique and their experience in direct suture of arterial wall during carotid endarterectomies, comparing their results with reported data from literature. Selective or routinely utilization of direct suture or patch angioplasty are still a matter of discussion and reports from literature are controversial. In the Vascular Surgery Division of Busto Arsizio Hospital from January 1982 to December 1995, 870 carotid endarterectomies have been performed; direct arterial wall suture has been done in the 95.

[Femoro-distal revascularization with the saphenous vein in critical ischemias. An analysis of the results obtained and the criteria for choosing the most appropriate method].

Critical ischemia is a pathology which requires the collaboration of a number of specialists and is often burdened by high morbidity and mortality rates. There are several possible therapeutic solutions, although each has its limits. The authors present a series of operated cases and compare the results of two different but alternative surgical methods (in situ and reversed saphena by-pass) depending on the patient's conditions.

[Our experience in the emergency treatment of secondary aortoenteric fistulae. The preliminary results of the use of aortic homografts].

The digestive prosthetic aortic fistulas are connections between an aortic prosthesis and the duodenum. From January 1988 to January 1994, in the vascular surgery section of Busto Arsizio hospital, 12 patients received emergency treatment for digestive aortic fistulas, with a prosthesis being positioned extra-anatomically. A different treatment was used for three patients who were treated during the period from January 1994 to July 1994.