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Biomedical subjects

G L Faggioli

Publications and source records attributed to G L Faggioli.

At least 19 recordsLinked to original sources
PubMed2000

[Treatment of aneurysm of the inferior pancreaticoduodenal artery associated with celiac axis occlusion].

A case of the inferior pancreaticoduodenal artery aneurysm, associated with occlusion of the celiac axis is reported. The aneurysm seemed to be related to a high-flow state secondary to the associated occlusion of the celiac axis. The occlusion was typical of the atheromatous disease. The aneurysm was atherosclerotic in origin and was treated with resection and PTFE patching. Eighty months later an angiogram was performed, demonstrating a normal patency of the pancreaticoduodenal arcades. The treatment of these aneurysms is discussed, and the literature on this uncommon disease is reviewed.

Aneurysm↗
PubMed1999

Immune response following fresh arterial homograft replacement for aortoiliac graft infection.

INTRODUCTION: this prospective study defines the immune response to fresh arterial homograft replacement for graft infection. MATERIALS AND METHODS: ten patients who underwent ABO-compatible homograft transplantation were studied for anti-HLA antibody production, and CD3-CD4-CD8-positive lymphocytes subset. Immunological studies were performed preoperatively, and at early (1, 3, 7 days) and late (1, 3, 6, 12, 18, 24 months) follow-up. All patients received immunosuppressive treatment with cyclosporine (1-3 mg/kg/day). Abdominal CT scans were performed postoperatively at the 1, 6, 12, 18, 24 months follow-up. RESULTS: preoperatively, antibodies could not be detected. Postoperatively, as from 1st month post-transplant, a progressive increase in % PRA was observed in all patients, up to the 12th month of follow-up. Subsequently, at 18 and 36 months, a progressive decrease in % PRA was detected. Data showed that the recipient antibodies were directed against donor-specific antigens. During the immediate postoperative period (1, 3, 7 days) CD3- and CD4-positive T lymphocytes slightly increased, whereas CD8 simultaneously decreased. Later, CD3 and CD4 progressively decreased and CD8 increased. Clinically, all patients were cured of infection at late follow-up. CT scans showed thickening of the aortic wall (range: 2.5-4.5 mm), with no signs of aneurysmal degeneration. CONCLUSIONS: fresh arterial homografts are immunogenic. Implanted homografts induce a strong anti-HLA antibody response, similar to chronic rejection, in spite of immunosuppressive treatment.

ABO Blood-Group System↗
PubMed1996

Extracranial internal carotid artery aneurysms: results of a surgical series with long-term follow-up.

PURPOSE: The purpose of this study was to analyze mode of presentation, surgical treatment, and early and long-term results of a series of extracranial internal carotid artery aneurysms (EICAA). METHODS: A retrospective analysis was performed on all cases treated for EICAA in a single institution from March 1974 to March 1995. Patient follow-up was obtained by a surveillance protocol, with duplex scanning performed 3 months after surgery and yearly thereafter. RESULTS: Twenty-four EICAA in 20 patients were treated over a 21-year period. The cause was fibromuscular dysplasia in 12 cases (50%), nonspecific "atherosclerosis" in nine (37.5%), previous carotid artery surgery in two (8.3%), and trauma in one case (4.1%). Neurologic symptoms were present in a total of nine cases (37.5%) and were hemispheric in seven (29.1%) and nonhemispheric in two (8.3%). Operative techniques were performed with patients receiving general anesthetic and included aneurysm excision with internal carotid artery reanastomosis (8 cases [33.3%]) or reimplantation onto the external carotid artery (1 case [4.1%]); interposition graft (10 cases [41.6%]), 7 veins, 3 polytetrafluoroethylene) or simple aneurysmectomy and closure of the wall defect either with (3 cases [12.5%]) or without (2 cases [8.3%]) a patch. Elective surgery was performed in 22 cases, with a 0% mortality rate and 4.5% stroke rate. Emergency operations were performed in two cases of ruptured aneurysms (one spontaneous and one iatrogenic); one patient (50%) died. Cranial nerve morbidity occurred in five cases (20.8%). Mean follow-up was 96.7 +/- 88.15 months (range 4 to 240 months) and included 2 of 7 (28%) complications in saphenous vein grafts, 1 (4.1%) late transient ischemic attack, and a recurrent aneurysm after 19 years. CONCLUSIONS: Symptoms and potential complications caused by EICAA suggest a broad surgical indication. EICAA can be treated safely because of the good early and long-term results.

Aged↗
PubMed1996

Ischemia: reperfusion syndrome of the lower limbs.

The ischemia-reperfusion syndrome, first described by Haimovici in 1960, is a severe complication following surgery for acute ischemia. We evaluated the incidence of this complication in 264 patients operated on between 1972 and 1981 (1st group) and compared it with another of 392 patients operated on between 1982 and 1991 (2nd group), our aim being to assess the effects of pharmacological prophyiaxis based on preoperative overhydration followed by an intra-arterial bolus of 250 ml 14/1000 HCO3-, containing 1 g dexamethasone and 2500 I.U. sodium heparin, injected into the femoral artery before suturing the arteriotomy. This regimen was based on the measurement of myoglobin and glutathione levels respectively carried out in two subgroups of 25 patients. The results of experimental ischemia-reperfusion syndromes induced in animal using radical scavengers and membrane-protective compounds were also taken into consideration. Following experimental research on sheep, 5 patients in the second group with very severe ischemia due to aortic occlusion received local dialysis in the extracorporeal circulation using hemodialysis or hemofiltration techniques. Mortality was 6.3% in the first group and 5.4% in the second, while the amputation rate was 3% and 1.8% respectively. The overall incidence of the reperfusion syndrome was 3% in the 1st period and 1.8% in the second. Our findings confirm the protective effect of hyper-hydration, radical scavengers and dexamethasone in the ischemia reperfusion syndrome, and indicate that local hemodialysis is a useful adjunct in very severe ischemia.

Aged↗
PubMed1995

Vascular reactivity in patients with peripheral vascular disease.

Noninvasive techniques have been used to demonstrate a specific pattern of impaired vasoactive response in the normal brachial artery of patients with clinical atherosclerosis. This is a physiologic reflection of the systemic nature of atherosclerosis and may be useful as a marker for identifying patients with preclinical atherosclerotic disease.

Adult↗
PubMed1995

Risk factors for stroke after cardiac surgery: Buffalo Cardiac-Cerebral Study Group.

PURPOSE: The purpose of this study was to identify risk factors for stroke in patients undergoing heart surgery. METHODS: A retrospective chart review of patients who underwent cardiac surgery in three hospitals of the State University of New York at Buffalo system over a 36-month period was completed. Demographics and risk factors were recorded, and stroke and death were determined by chart review. Carotid artery stenosis was determined by duplex examination. Data were analyzed by chi-squared and multiple logistic regression. RESULTS: One thousand one hundred seventy-nine cases were analyzed, with a mortality rate of 2.3%, stroke rate of 1.6%, and combined stroke/death rate of 3.1%. Four variables were found to be associated with an increased risk of stroke: carotid artery stenosis greater than 50%, redo heart surgery, valve surgery, and prior stroke. Five variables were associated with increased mortality rates:; carotid artery stenosis greater than 50%, redo surgery, peripheral vascular disease, longer pump time, and hypercholesterolemia. Carotid artery stenosis greater than 50% was present in 14.7% of cases. Carotid artery stenosis greater than 75% was not itself associated with increased stroke risk. Most strokes occurred more than 24 hours after surgery. Stroke distribution did not correlate with site of carotid artery stenosis greater than 50%. CONCLUSIONS: Most neurologic events after heart surgery occur in a subset of patients who can be defined before operation. Whereas carotid artery stenosis greater than 50% is a strong risk factor, the role of prophylactic endarterectomy is unclear. Future studies should focus on this high-risk subgroup. A prospective study of prophylactic carotid endarterectomy in patients undergoing coronary artery bypass grafting is needed.

Aged↗
PubMed1995

[Problems of indications for the treatment of aneurysm of the visceral arteries].

The authors report the clinical history and the treatment of 5 patients with visceral artery aneurysms. The celiac trunk, the common hepatic artery, the inferior pancreaticoduodenal artery and the splenic artery (in 2 different patients) were affected by the aneurysmal disease. Various techniques have been employed in the successful treatment of these patients: radiological embolization of the celiac trunk aneurysms, Dacron graft reconstruction of the common hepatic artery aneurysm, endosaccular ligature and PTFE patching of the inferior pancreatico-duodenal artery aneurysm, endosaccular ligature in one of the two splenic artery aneurysm and simple ligature and splenectomy in the remainder splenic artery aneurysm. Early diagnosis is important in these lesions, because of the trend toward rupture and subsequent high mortality rate. Ultrasonography (US), Computed Tomography (CT) and Magnetic Resonance (MR) are very helpful as diagnostic tools, however angiography represents the method of choice since it could be the first step of the embolization treatment. Furthermore angiography is useful for detection of associated visceral lesions and for the study of collateral blood supply. Treatment choice depends on visceral artery aneurysms localization, the presence of associate lesions and the possible general contraindications. In the latter case, radiological embolization could be the first-choice treatment.

Aged↗
PubMed1994

Morphology of small aneurysms: definition and impact on risk of rupture.

BACKGROUND: Parietal characteristics of small aortic aneurysms predictive of increased risk of rupture are unknown. METHODS: Prospective morphologic evaluation was performed in 135 consecutive cases of small (< 5 cm) abdominal aortic aneurysm. Twelve cases (9%) were found to be ruptured and sent for emergency surgery. The remaining 123 patients were evaluated with ultrasonography, angiography, and intraoperatively during elective surgery. Ninety-six (78%) also underwent computerized tomography (CT) scanning. The evaluation assessed the thickness of the endoluminal thrombus and arterial wall as well as the presence of saccular outpouchings ("blisters"). Also noted were any areas of impending rupture, defined as discontinuity of the arterial wall with only a thrombus preventing rupture. RESULTS: Blisters were discovered intraoperatively in 12 aneurysms. Digital subtraction angiography (DSA) revealed 3 (25%) of these preoperatively. Eleven of the patients with blisters were examined preoperatively with CT scanning, which detected 3 blisters (27%). Both endoluminal thrombus and wall thickness were measurable by CT scan but not ultrasonography. The incidence of impending rupture was significantly greater in patients with blisters than in those without (71% versus 29%, P = 0.0001). The incidence of impending rupture was similar whether the amount of endoluminal thrombus was more or less than 2 cm (57% versus 40%, P = 0.386). Rupture was no more frequent when aneurysmal walls were thicker or thinner than 0.3 cm (14% versus 20%, P = 0.719). In an analysis using logistic regression, the presence of a blister was the only independent morphologic predictor of impending rupture (P = 0.001, Wald = 15). CONCLUSION: In patients with small aneurysms, increased attention should be directed to the preoperative detection of blisters.

Aged↗
PubMed1994

Failure of thrombolytic therapy to improve long-term vascular patency.

PURPOSE: Few data are available on long-term follow-up of arterial segments subjected to thrombolysis. We reviewed all cases of vascular occlusion treated with urokinase to identify early success and determine the influence of postlysis intervention and the nature of the thrombosed segment (i.e., artery vs graft) on long-term patency. METHODS: Data on 134 cases (58 arteries, 76 grafts) treated with high-dose urokinase infusion in the lower limbs over a 7-year period were analyzed. Limbs were divided into five groups on the basis of therapy after lytic infusion to determine long-term efficacy: group I, success with no additional therapy; group II, percutaneous angioplasty alone; group III, limited surgical procedure (operative angioplasty, jump graft); group IV, extensive procedure (new bypass); and group V, revascularization after lytic failure. Long-term results were assessed by life-table analysis and groups compared by log-rank test (Mantel-Haenszel). RESULTS: Initial patency was established in 87 (64.9%) of 134 cases with 5 deaths (3.7%), 11 amputations (8.2%), and 16 complications (11.9%). Follow-up was available in 68.6% of cases for a mean of 10.9 months. No difference was seen between grafts and native arteries. Patency was analyzed at 6, 12, 18, and 24 months. The 24-month patency rate after lysis alone (group I-25.9%) was inferior (p < 0.05) to results after lysis and any subsequent intervention (groups II, III, and IV). The type of intervention did not influence subsequent patency. Twenty-four-month patency of procedures performed after failed thrombolysis (group V, 41.4%) was not different from those after successful lysis (groups I to IV). Twenty-four-month patency in groups II and III (minor interventions, 62.9%) was not significantly different from that of groups IV and V (major interventions, 53.2%) (p > 0.25). CONCLUSIONS: Operative intervention is required to produce long-term arterial patency, even after successful thrombolysis. No statistically significant benefit of thrombolysis on vascular patency was seen in our series.

Angioplasty↗
PubMed1994

Left-side inferior vena cava and inflammatory abdominal aortic aneurysms: a case report.

The incidence of isolated left-side inferior vena cava ranges from 0.2-0.5%. This anomaly is associated infrequently with an abdominal aortic aneurysm. A case is reported of left-side inferior vena cava associated with a symptomatic, 5-cm inflammatory abdominal aortic aneurysm. Preoperative computed tomography showed a perianeurysmal mantle strongly adherent to a left-side inferior vena cava. This report is the first of an infrarenal inferior vena cava anomaly associated with an inflammatory abdominal aortic aneurysm. The technical details required to perform the aortic reconstruction via a transperitoneal approach are described and discussed.

Aortic Aneurysm, Abdominal↗
PubMed1994

Long-term cryopreservation of autologous veins in rabbits.

This study was undertaken to determine the effect of long-term cryopreservation on graft ultrastructure and endothelial cell viability in an animal model. The jugular veins from 12 New Zealand White rabbits were excised with a 'no-touch' technique and divided into four groups: control group (fresh veins); group 1, veins cryopreserved for 1 month; group 2, veins cryopreserved for 2 months; and group 3, veins cryopreserved for 3 months. Cryopreservation was accomplished by rapid freezing (-5 degrees C s-1 to -196 degrees C) in a solution of 17.5% dimethylsulphoxide and 20% fetal bovine serum and by storage in liquid nitrogen. Veins were then implanted as a carotid autograft (three grafts/group). At the time of graft implantation a segment of the paired matched vein was perfusion-fixed and evaluated by scanning and transmission electron microscopy, whereas the remainder were subjected to endothelial cell culture techniques to determine cell viability. Autografts were removed 1 month after implantation and subjected to similar evaluations. Histological changes seen in cryopreserved veins were dependent on preservation time and included focal endothelial cell blebbing, cytoplasmic vacuolization and disruption of cell-to-cell contacts. Smooth muscle cells showed mitochondrial swelling. Patency was identical in all groups (66.6%). Explants at 1 month were similar in histological appearance to fresh veins with a smooth endothelial cell lining arranged longitudinally and intact cell junctions. Endothelial cells could be cultured from fresh veins and 1-month-old explants but not from the cryopreserved graft surface before implantation. the present technique of cryopreservation leads to some damage of graft architecture and loss of endothelial cell viability.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1993

Postoperative course of inflammatory abdominal aortic aneurysms.

Of 779 patients undergoing repair of abdominal aortic aneurysms over a 7-year period (1984-1990), 40 (5.1%) had gross features of inflammatory abdominal aortic aneurysms (IAAAs). Twenty IAAAs were assessed by CT scan preoperatively and postoperatively to evaluate the outcome of the inflammatory layer of the aneurysm in 19 cases. Complete postoperative regression was observed in nine cases (47.3%), partial regression in four (21%), and stable lesions in six (31.7%). No roentgenographic progression was found. The comparison between the roentgenologic outcome and preoperative clinical features (age, sex, erythrocyte sedimentation rate, and abdominal lumbar pain), pathologic findings, and follow-up time revealed a significant correlation (p < 0.05) between the postoperative outcome and the histologic findings in the wall (cell density and cell/fibrosis ratio). Complete regression of inflammation was observed when high cell density (16 +/- 0.7 cells/2116 microns 2) and a cell/fibrosis ratio > 1 were found. On the contrary, little or no regression of inflammation occurred when a low cell density (3.4 +/- 0.3 cells/2116 microns 2) and a cell/fibrosis ratio < 1 were found. Although it is generally thought that inflammation in IAAAs regresses after surgical repair, in our study, 31.7% of the postoperative CT scans showed no change. Histologically, the variability of morphologic aspects seemed to correlate with the relative proportions of cellular infiltrate and interstitial fibrosis in the aneurysmal wall. These proportions determine the postoperative course of the inflammation layer and, most likely, the response of the latter to steroid therapy as well.

Adult↗
PubMed1993

Early results with cryopreserved saphenous vein allografts for infrainguinal bypass.

PURPOSE: Cryopreserved saphenous vein allografts (CSVA) are available for use in arterial reconstructions; however, patency rates in the infrainguinal position are not well described. METHODS: We reviewed our experience with 38 patients who underwent 43 infrainguinal bypasses with CSVA as the conduit. The group includes 21 women and 17 men with a mean age of 69 +/- 11 years. Mean follow-up is 8.2 +/- 5.5 months. Logistic regression was used to analyze five variables in an attempt to identify predictors of success or failure: distal anastomosis to the popliteal artery versus a crural artery, one-vessel versus two- or three-vessel runoff, postoperative anticoagulation versus none, primary reconstructions versus reoperations, and one segment versus two segments of CSVA required. RESULTS: The cumulative patency rate at 12 months by life-table analysis is 66%. Logistic regression revealed that primary reconstructions were more likely to succeed than reoperations (p = 0.03) and operations completed with one segment of CSVA were more likely to succeed than those requiring more than one segment of vein (p = 0.03). CONCLUSIONS: We conclude that (1) the short-term patency of infrainguinal bypasses with CSVA suggests that they may be acceptable alternatives to prosthetic grafts in the below-knee position, and (2) primary reconstructions performed with one segment of CSVA are more likely to succeed.

Aged↗
PubMed1993

True and false aneurysms in Behçet's disease: case report with ultrastructural observations.

One of the most important aspects of Behçet's disease is aneurysmal arteriopathy. The major problem of this complication is its tendency to develop recurrent false aneurysms at anastomotic and traumatic sites, such as angiographic punctures. We present a clinical case in which five aneurysms, some true, some false, were operated on during a period of 6 years, with the aid of ultrastructural observations of the wall of a true and a false aneurysm. One of the true aneurysms, localized in the aorta, was treated by direct aneurysmorrhaphy, and the 6-year follow-up demonstrated the absence of recurrences. Based on both this experience and the data in the literature, we suggest that the most appropriate surgical approach would, when possible, be direct aneurysmorrhaphy.

Adult↗