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Biomedical subjects

Enzo Ballotta

Publications and source records attributed to Enzo Ballotta.

28 records · Page 2Linked to original sources
PubMed2003

Prospective randomized study on bilateral above-knee femoropopliteal revascularization: Polytetrafluoroethylene graft versus reversed saphenous vein.

OBJECTIVE: Some controversy exists as to whether polytetrafluoroethylene (PTFE) is equivalent to reversed saphenous vein (SV) as bypass graft material for above-knee femoropopliteal revascularization. We compared the 5-year patency rate with reversed SV and PTFE grafts in patients with claudication who underwent bilateral above-knee femoropopliteal revascularization. METHODS: Between January 1994 and December 1997, 51 patients (102 limbs) with bilateral disabling claudication due to superficial femoral artery occlusion underwent above-knee femoropopliteal bypass grafting, with SV in one limb and PTFE graft in the other limb. Patients were randomly selected for sequential surgical treatment with either SV-PTFE or PTFE-SV. Kaplan-Meier analysis was used to estimate patency rate, and various factors were analyzed to ascertain any association with revascularization failure. RESULTS: There was no perioperative (30 day) limb loss or death, but five late deaths (late survival rate, 90%). Mean follow-up was 59 months. In the SV group, three bypass grafts failed, requiring repeat operation in only one patient. In the PTFE group, eight bypass grafts failed, leading to five repeat operations. There was no statistically significant difference in primary "assisted" patency rate for the two grafts: 100%, 98%, and 94% for SV grafts, and 96%, 84%, and 84% for PTFE grafts (P =.09), after 1, 3, and 5 years, respectively. CONCLUSIONS: The overall results of this randomized study show that SV and PTFE grafts have a statistically comparable patency rate when used above the knee in patients with claudication. Use of SV, however, leads to fewer occlusions and repeat operations.

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PubMed2002

Carotid endarterectomy contralateral to carotid artery occlusion: analysis from a randomized study.

BACKGROUND AND AIMS: Many studies have reported the benefits of carotid endarterectomy (CEA) contralateral to an occluded internal carotid artery (ICA), with varying results. This study analyzed perioperative and late outcomes in a recent trial in which patients were randomized to carotid eversion endarterectomy (CEE) or traditional CEA with patching (CEAP). PATIENTS AND METHODS: In 336 primary CEAs (310 patients) 68 were contralateral to an occluded ICA (group I). The remaining 268 CEAs served as control group (group II). All patients underwent clinical follow-up and duplex ultrasonography at 1, 6, and 12 months and every year thereafter. Endpoints of the study were early and late neurological events, and deaths. RESULTS: Group I had a significantly higher incidence of perioperative electroencephalic changes and need for shunting. The perioperative stroke rate in group I was almost three times as high as in group II, but the difference was not significant. Similarly, the perioperative minor neurological event and death rates, as with the cumulative stroke-free and survival rates at 1, 3, and 5 years, were comparable in the two groups. CONCLUSIONS: CEA contralateral to an occluded ICA can be implemented with perioperative stroke and mortality rates and late stroke-free and survival rates comparable to CEA with no contralateral ICA occlusion.

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PubMed2002

Carotid eversion endarterectomy: perioperative outcome and restenosis incidence.

Carotid endarterectomy (CEA) for stroke prevention can be performed with minimal perioperative mortality and morbidity rates. The type of surgical technique used is important to achieve optimal outcome from CEA. The purpose of this study was to analyze the perioperative and late results of carotid eversion endarterectomy (CEE) in more than 400 procedures. From August 1992 to December 1999, 402 primary CEEs were performed in 388 selected patients for symptomatic (235/58.4%) and asymptomatic (167/41.6%) carotid lesions. During the same period, 234 primary CEAs with patch closure were performed in 229 selected patients. All CEAs were carried out with continuous electroencephalographic monitoring for selective shunting, using deep general anesthesia. All patients underwent postoperative duplex ultrasound study and clinical follow-up at 1, 6, and 12 months and every year thereafter. The mean follow-up was 50 months (range 3-88). Main end points were perioperative stroke and death, and restenosis. Our results showed that use of the CEE procedure can reduce perioperative mortality and stroke risk rates to around zero and results in no restenosis.

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PubMed2002

Early versus delayed carotid endarterectomy after a nondisabling ischemic stroke: a prospective randomized study.

BACKGROUND: Although many retrospective and a few prospective studies have analyzed the outcome of early and delayed carotid endarterectomy (CEA) after a recent minor or nondisabling stroke (ie, a minimal and stabilized focal neurologic deficit of acute onset persisting for more than 24 hours and not leading to a handicap or to a significant impairment of daily living activities), the optimal timing of surgery remains uncertain. The purpose of this study was to prospectively compare the perioperative death and stroke rates of CEA performed within 30 days (early group) or more than 30 days (delayed group) after a nondisabling ischemic stroke in patients with carotid bifurcation disease. METHODS: During a 4-year period, of 86 patients experiencing a minor stroke, 45 were randomized to undergo early CEA and 41 to undergo delayed CEA. All patients underwent preoperative cerebral computed tomography, duplex ultrasonographic scanning and angiography of the supra-aortic trunks. All CEAs were carotid eversion endarterectomies and were performed by the same surgeon, using deep general anesthesia, with continuous electroencephalographic monitoring for the selective shunting. The perioperative death and stroke rates were compared between the 2 groups. RESULTS: No perioperative deaths occurred in either group. No recurrent strokes occurred during the waiting period in the delayed group. The incidence of perioperative stroke was comparable in the 2 groups (1 of 45, 2% vs 1 of 41, 2%). The mean follow-up was 23 months (range, 6 to 50 months). Survival rates after 1, 2, and 3 years were similar in the 2 groups. CONCLUSIONS: Early CEA after a nondisabling ischemic stroke can be performed safely with perioperative mortality and stroke rates comparable with those of delayed CEA. The timing of surgery does not seem to influence the benefit of the CEA.

Brain Ischemia↗