Papers by Giuseppe Asciutto
Cerebrovascular Diseases Extra, Jan 15, 2018
Background: Echolucent carotid plaques have been related to an increased risk of ischemic cerebro... more Background: Echolucent carotid plaques have been related to an increased risk of ischemic cerebrovascular events. The aim of the present study was to evaluate whether a new objective ultrasonographic parameter, the statistical geometric feature (SGF), reflecting spottiness of carotid plaques, can be associated with cerebrovascular symptoms and with a rupture-prone plaque phenotype. Methods: The plaques of 144 patients who underwent carotid endarterectomy were included in this study. SGF and plaque area were estimated by outlining the plaque on ultrasound (US) images. The correlation coefficient for inter-and intraobserver variability was 0.69 and 0.93, respectively. The SGF values were normalized to the degree of stenosis (SGF/DS). The plaques collected at surgery 1 day after the US were analyzed histologically, and inflammatory markers and matrix metalloproteinases (MMPs) were measured. Results: Patients with ipsilateral hemispheric symptoms had higher SGF/DS compared to patients without symptoms (0.82 [0.59-1.16] vs. 0.70 [0.56-0.89], p = 0.01). Analysis of plaque components revealed a positive correlation between SGF/DS and the percentage of the plaque area stained for lipids, macrophages, and hemorrhage. A correlation was also found between SGF/DS and plaque expression of interleukin-6, monocyte chemoattractant protein-1, macrophage inflammatory protein-1β, vascular endothelial growth factor A, CC motif chemokine 3 and 20, and MMP-9. An inverse correlation was found with plaque levels of osteoprotegerin. Conclusions: The present study supports the concept that spottiness is a feature of the carotid plaques rich in inflammation and can be associated with the typical phenotype of high-risk plaques.
Elsevier eBooks, 2022
Abstract The market of aortic endografts is in continuous development. Several endografts that ha... more Abstract The market of aortic endografts is in continuous development. Several endografts that have gained the CE mark are under investigation by the FDA before launching in the US market. This chapter describes their peculiarities and the evidence acquired with the use of these endografts. Since the majority of the devices described in this chapter have been recently introduced, the evidence on the feasibility of their use in the treatment of aortic aneurysm is limited. The available data report of short-term results in terms of patency, freedom from Types I and III endoleak (EL), and freedom from aneurysm sac enlargement is comparable to those of devices that have been longer in use.
EJVES Short Reports, 2015
Introduction: Failed antegrade endovascular recanalization of occluded mesenteric arteries has tr... more Introduction: Failed antegrade endovascular recanalization of occluded mesenteric arteries has traditionally been dealt with by open mesenteric bypass or by hybrid solutions. This article describes a totally endovascular retrograde approach for recanalization of occluded mesenteric arteries through the pancreaticoduodenal arcade. Surgical technique: A femoral or brachial approach is used to gain access to the patent visceral artery. A microcatheter is advanced in a retrograde fashion into the distal main stem of the occluded artery through the gastroduodenal artery and inferior pancreaticoduodenal arcade. A combination of .014 00 and .018 00 wires is used to cross the occlusion in a retrograde fashion and to land into the aortic lumen. The guide wire is then snared through the brachial access, establishing a through and through wire. A micro-catheter is then advanced on the through and through wire across the occlusion from the brachial access. The distal occluded artery is then catheterized by advancing a second wire parallel to the through and through wire. The remaining procedure is performed as a standard antegrade approach. Discussion: The totally endovascular retrograde approach through collaterals can be helpful for the recanalization of mesenteric artery occlusions. This technically complex procedure should be reserved for cases in which the traditional antegrade approach has failed.
Atherosclerosis, Aug 1, 2015
Expression of fibromodulin in carotid atherosclerotic plaques is associated with diabetes and cer... more Expression of fibromodulin in carotid atherosclerotic plaques is associated with diabetes and cerebrovascular events.
Cardiovascular Pathology, Nov 1, 2013
Text pages: 29 Short title Betablockers are associated with lower levels of Lp-PLA2 and suPAR in ... more Text pages: 29 Short title Betablockers are associated with lower levels of Lp-PLA2 and suPAR in carotid plaques.
BMC Cardiovascular Disorders, Aug 30, 2014
Background: The presence of echolucent carotid plaques as defined by low ultrasound grey-scale me... more Background: The presence of echolucent carotid plaques as defined by low ultrasound grey-scale median (GSM) is associated with a higher risk of stroke and myocardial infarction. Betablockers have shown possible anti-atherosclerotic effects. The aim of the present study was to determine if there is an association between carotid plaque GSM and treatment with betablockers. Methods: The GSM of the carotid plaques of 350 patients who underwent carotid endarterectomy (CEA) for asymptomatic (n = 113) or symptomatic (n = 237) carotid disease was measured. Patients were divided in two groups based on the absence/presence of an ongoing long-term (i.e. at least 6 months) oral treatment with betablockers at the time of CEA. Results: The prevalence and type of preoperative neurological symptoms were similar in the two groups. Patients with betablockers had more frequently arterial hypertension (P < .0001), diabetes (P = .035) and a higher BMI (P = .0004), while patients without betablockers were most frequently smokers (P = .017). Patients with betablockers revealed to have higher GSM (37.79 ± 25 vs 32.61 ± 23.50 P = .036). Echogenic plaques (i.e. with GSM > 30) showed to be more frequent in patients with betablockers also after correction for age, gender, the occurrence of preoperative symptoms, diabetes, hypertension, smoking and statins use (P = .024). Conclusions: These results suggest the use of standardized ultrasound techniques as an important tool in evaluating the effect of anti-atherosclerotic medications and underline the need of.further prospective randomized studies on larger patient cohorts in order to confirm these results.
PubMed, Aug 1, 2012
Aim: The aim of this paper was to define the incidence of disease progression of the contralatera... more Aim: The aim of this paper was to define the incidence of disease progression of the contralateral internal carotid artery (CICA) in patients undergoing carotid endarterectomy (CEA) and to identify factors influencing disease progression. Methods: Patients from our primary catchment area that had undergone CEA between 2002 and 2005 were included. The study cohort was divided in four groups based on the preoperative stenosis grade (normal ICA <40%, N.=56; mild 40-60%, N.=41; moderate 61-80%, N.=12; severe 81-99%, N.=7). Patients initially planned or already submitted to contralateral CEA or with contralateral occlusion were excluded. Results: One hundred and seventeen patients were analysed. Disease progression occurred in 13 (11%) patients after a mean of 47.6 months (SD 1.6 months). A moderate preoperative CICA stenosis was associated with disease progression (P=0.017). Late neurologic events referable to the CICA independently of progression occurred in 13 (11%) patients. There were 4 (30.7%) events in the 13 carotids with progression and only 9 (7%) in the 117 without progression (P=0.060). .Moderate and severe preoperative CICA stenosis and renal insufficiency were associated with postoperative ipsilateral neurological symptoms (P=0.001 and 0.009, respectively). Conclusion: Disease progression of the CICA after CEA is not uncommon. The preoperative degree of CICA stenosis is related to subsequent disease progression and to the occurrence of symptoms. More studies are needed to identify risk factors influencing the progression of ICA disease.
European Journal of Vascular and Endovascular Surgery, Oct 1, 2017
This study underlines the good mid-term results of endoconduits done with the "pave and crack" te... more This study underlines the good mid-term results of endoconduits done with the "pave and crack" technique for the treatment of aortic aneurysms of varying complexity. They appear to preclude the need for open conduits, allowing instead a totally endovascular approach in patients with advanced atherosclerotic lesions of the iliofemoral arteries, but adjunctive procedures to improve the in-and outflow at ilio-femoral level are frequently needed. The results of the current study will influence future clinical practice in terms of applying this technique in a pre-emptive manner, in order to avoid haemodynamic instability caused by eventual rupture of the access vessels. Objective/Background: The objective was to evaluate the feasibility and mid-term outcomes of endoconduits (EC) with the "pave and crack" technique during endovascular aneurysm repair (EVAR) of varying complexity. Methods: This was a retrospective study. All patients undergoing EC between July 2009 and October 2015 were included. The primary endpoint was technical success of the EC defined as the ability to successfully deliver the aortic stent graft through the EC without rupture, dissection, or thrombosis of the iliac or femoral arteries, and with the absence of haemodynamically significant blood loss related to the EC. Secondary outcomes included EC patency and mortality. Results: Nineteen patients underwent EVAR with EC (16 juxtarenal or thoraco-abdominal, two infrarenal and one thoracic; four were ruptured). Fourteen patients (73.7%) had TASC D lesions. In 10 cases (52.6%) adjunctive open/endovascular procedures to improve the femoral outflow were required. EC was technically successful in all cases and all EC were patent at EVAR completion. Thirty day mortality occurred in two cases (10.5%) One of these patients had been treated for rupture. One patient required two endovascular re-interventions at 1 and 5 years post-operatively to restore patency of the EC. No open re-interventions related to the EC were necessary. After a median follow-up period of 17 (interquartile range 5e37) months, the primary assisted patency of the EC was 88.9% (SE 10.5). No new onset of claudication or lower limb amputations occurred during the follow-up. Conclusion: EC allows EVAR of varying complexity without the need for open surgical ilio-femoral conduits in patients with concomitant advanced iliac occlusive disease. Intra-operative haemodynamic instability was always avoided and mid-term patency was high.
European Journal of Vascular and Endovascular Surgery, Jun 1, 2023
PubMed, Oct 31, 2007
Three cases of cystic adventitial disease (CDA) of the popliteal artery and the results of a lite... more Three cases of cystic adventitial disease (CDA) of the popliteal artery and the results of a literature review are described in order to identify the treatment of first choice of this rare clinical entity. Three male patients (mean age 56,3 years) presented at our Institution due to a sudden abrupt of disabling claudication of the lower limb. The eco-color-Doppler examination showed multiple hypoechoic and anechoic masses arising in the wall of the artery consistent with CAD. The magnetic resonance imaging (MRI) confirmed this finding. In 2 cases a venous interposition grafting was performed and in the remaining patient a duplex-directed punction. The 3 patients are asymptomatic at the clinical control at 9 months after treatment. As it results after a literature review, the MRI seems to be the best diagnostic tool and the vein interposition grafting the treatment of first choice. In cases of young male patients without cardiovascular risk factors and suffering of disabling claudication of recent onset the MRI guarantees a valuable diagnosis in case of ultrasonographic suspect of CAD of the popliteal artery. The surgical resection and the vein interposition grafting represent the treatment of first choice. In selected patients, a duplex-guided punction assures satisfactory clinical results. A strict ultrasonographic follow-up guarantees an early recognition of relapse.
PubMed, Nov 21, 2007
We discuss a case of contained ruptured aortitis due to Clostridium septicum infection in a 71-ye... more We discuss a case of contained ruptured aortitis due to Clostridium septicum infection in a 71-year-old man, who had undergone a right hemicolectomy and cholecystectomy to treat an ascending colon carcinoma. Computed tomography identified a juxtarenal abdominal aneurysm with gas formation in the right psoas muscle. Emergency abdominal exploration revealed a ruptured aortitis. After in situ graft replacement of the abdominal aorta, Clostridium septicum was identified in tissue culture. Antibiotic therapy with penicillin G was administered. The postoperative course was complicated by a retroperitoneal haematoma which necessitated surgical revision. The patient was discharged 2 months afterwards. At clinical monitoring at 6 months he is still doing well.
Chirurgia italiana, Sep 1, 2006
The aim of the study was to determine the effect of comorbidity conditions on the early outcome a... more The aim of the study was to determine the effect of comorbidity conditions on the early outcome and complication rates of thrombolytic treatment of lower limb ischaemia with recombinant tissue plasminogen activator (rt-PA). Clinical and procedural data of 82 patients treated for acute/subacute arterial/graft occlusion were analysed retrospectively. Early results and adverse events were recorded and evaluated statistically. Early resolution of ischemic symptoms was achieved in 67 (82%) patients with a median dose of 25.4 mg of rt-PA. Major bleeding was reported in 9 and minor bleeding in 6 cases (intracranial hemorrhage rate 1%, mortality rate 1%, major amputation rate 1%). Comorbidity conditions and patient characteristics did not statistically influence success and complication rates. Bleeding was observed in patients who received a higher dose of the thrombolytic agent (30.0 mg vs 24.3 mg). Comorbidity conditions have no effect on early outcome and adverse events after thrombolytic management of lower limb ischemia. Higher doses of rt-PA with prolonged infusion times increase the risk of occurrence of treatment-related bleeding.
The Italian journal of urology and nephrology, Mar 1, 2006
Two cases of upper extremity ischemia due to a steal phenomenon occurring after the creation of a... more Two cases of upper extremity ischemia due to a steal phenomenon occurring after the creation of an arterio-venous fistula (AVF) for hemodialysis access are described. A successful treatment with a brachial to brachial artery vein bypass and a ligation of the artery distal to the AVF origin (DRIL-Procedure) was performed in both cases. Complete disappearance of symptoms and healing of the ischemic lesions with maintaining of the angioaccess patency 6 months after the repair reveal that this procedure corrected the stealing.
European Journal of Vascular and Endovascular Surgery, 2007
Objective. We describe our experience with Dacron patch infections after carotid endarterectomy (... more Objective. We describe our experience with Dacron patch infections after carotid endarterectomy (CEA). Report. From 633 patients undergoing carotid endarterectomy with Dacron patching, six represented with prosthetic infections. In 3 of the 6 cases a neck haematoma had necessitated surgical revision after the original carotid surgery. Five patients underwent interposition vein grafting and 1 vein patch angioplasty. Postoperatively, 2 patients developed a repeat infection including the 1 patient with patch angioplasty. All patients were free of infection and neurological symptoms after a maximum follow-up of 56.5 months. Conclusion. Following the development of haemorrhage or wound complications careful clinical surveillance should be carried out after carotid reconstruction.
British Journal of Surgery, Feb 6, 2019
Background: Surgical-site infection (SSI) after groin incisions for arterial surgery is common an... more Background: Surgical-site infection (SSI) after groin incisions for arterial surgery is common and may lead to amputation or death. Incisional negative pressure wound therapy (NPWT) dressings have been suggested to reduce SSIs. The aim of this systematic review with meta-analysis was to assess the effects of incisional NPWT on the incidence of SSI in closed groin incisions after arterial surgery. Methods: A study protocol for this systematic review of RCTs was published in Prospero (CRD42018090298) a priori, with predefined search, inclusion and exclusion criteria. The records generated by the systematic research were screened for relevance by title and abstract and in full text by two of the authors independently. The selected articles were rated for bias according to the Cochrane risk-of-bias tool. Results: Among 1567 records generated by the search, seven RCTs were identified, including 1049 incisions. Meta-analysis showed a reduction in SSI with incisional NPWT (odds ratio (OR) 0⋅35, 95 per cent c.i. 0⋅24 to 0⋅50; P < 0⋅001). The heterogeneity between the included studies was low (I 2 = 0 per cent). The quality of evidence was graded as moderate. Two studies had multiple domains in the Cochrane risk-of-bias tool rated as high risk of bias. A subgroup meta-analysis of three studies of lower limb revascularization procedures only (363 incisions) demonstrated a similar reduction in SSI (OR 0⋅37, 0⋅22 to 0⋅63; P < 0⋅001; I 2 = 0 per cent). Conclusion: Incisional NPWT after groin incisions for arterial surgery reduced the incidence of SSI compared with standard wound dressings. The risk of bias highlighted the need for a high-quality RCT with cost-effectiveness analysis.
European Journal of Vascular and Endovascular Surgery, Oct 1, 2008
To investigate the feasibility of using magnetic resonance venography (MRV) to detect pelvic veno... more To investigate the feasibility of using magnetic resonance venography (MRV) to detect pelvic venous congestion (PVC). Methods: A prospective study of 23 female patients with signs and symptoms of PVC, who underwent duplex sonography, MRV and phlebography (P). Examinations were interpreted in a blinded fashion. Visualization of venous anatomy, presence of venous incompetence and congestion grade were evaluated. Sensitivity and specificity of MRV using P as reference were calculated. Results: MRV agreed with P in 96% (Cohen-K-value 0.646) and in 70% (K 0.555) of the cases respectively in the venous anatomy and congestion grade. Sensitivity and specificity of MRV were 88% and 67% for ovarian veins, 100% and 38% for hypogastric veins and 91% and 42% for the pelvic plexus. Conclusions: In this prospective study MRV showed high sensitivity in the evaluation of patients with suspected PVC. Routine use of this diagnostic method requires further studies in larger patient cohorts.
Journal of Tissue Viability, Feb 1, 2021
While the scientific evidence in favour of negative pressure wound therapy (NPWT) dressings on su... more While the scientific evidence in favour of negative pressure wound therapy (NPWT) dressings on sutured incisions in the prevention of surgical site infections (SSIs) has increased, the cost-effectiveness after vascular surgery has not been evaluated. The aim of this study was to evaluate the cost-effectiveness of NPWT compared to standard dressings for the prevention of SSIs after open inguinal vascular surgery. Materials and methods: Patient data were retrieved from the randomised INVIPS-trial's open arm, which included patients randomised to either NPWT or standard dressings. The patients were surveyed for SSIs for 90 days postoperatively. The patients' individual cost data were included and analysed from a healthcare perspective. The patients' quality of life was measured using the Vascuqol-6 questionnaire pre-and 30 days postoperatively. Cost-effectiveness of NPWT was determined by decreased or equal total costs and a significant reduction in SSI incidence. Results: The mean vascular procedure-related costs at 90 days were €16,621 for patients treated with NPWT (n = 59) and €16,285 for patients treated with standard dressings (n = 60), p = 0.85. The SSI incidence in patients treated with NPWT was 11.9% (n = 7/59) compared to 30.0% (n = 18/60) with standard dressings, p = 0.015. This corresponds to an increased mean cost of €1,853 per SSI avoided. The cost-effectiveness plane of incremental vascular procedure-related costs and difference in Vascuqol-6 score showed that 42% of estimates were in the quadrant where NPWT was dominant. Conclusion: NPWT is considered cost-effective over standard dressings in patients undergoing open inguinal vascular surgery due to reduced SSI incidence at no higher costs.
PubMed, Oct 31, 2007
Patients with varicose veins who also had clinical and/or duplex ultrasound findings suspicious o... more Patients with varicose veins who also had clinical and/or duplex ultrasound findings suspicious of pelvic venous incompetence (PVI) underwent selective retrograde catheter phlebography of the pelvic veins. One hundred and one patients (all female, mean age 49.3 years) underwent selective phlebography of the pelvic veins. In 68 cases (67.3%) a varicose vein recurrence after previous stripping of the greater saphenous vein was present, and about half the patients (n=45, 44.6%) were multipara ( > or =2 episodes of childbirth). The presence and extent of any reflux was documented and the ovarian and pelvic veins affected by the reflux were recorded. Retrograde selective phlebography demonstrated a PVI in 75 patients (74.2%). The left ovarian vein and the right hypogastric vein were most frequently affected by reflux (n = 41, 54.6% each). The left hypogastric vein was incompetent in 35 patients (46.6%) and the right ovarian vein in 3 cases (4%). In about half the patients with pelvic venous incompetence, reflux was demonstrated in more than one of the main pelvic veins (n=38, 50.6%). Fifty-one (68%) of the 75 patients with pelvic venous incompetence had varicose vein recurrence after previous stripping of the greater saphenous vein. Extension of the reflux into varicose veins of the groin or lower leg was demonstrated in 44 patients (58.6%). Thirty-nine patients (52%) received treatment for their pelvic venous incompetence (coil embolisation, sclerotherapy or videoscopic ovarian vein ligation). Pelvic venous reflux was present in 75% of our study population. Combined reflux in more than one pelvic vein was common and in about 60% of cases the pelvic reflux was shown to feed varicose veins of the legs. Therefore, typical clinical and/or duplex findings should lead to a strong suspicion of pelvic venous incompetence and reduce the need for selective retrograde catheter phlebography in this selected group of patients.
European Journal of Vascular and Endovascular Surgery, Dec 1, 2019
occlusion was recanalized and crossed intraluminally or subintimally prior to predilatation and s... more occlusion was recanalized and crossed intraluminally or subintimally prior to predilatation and stent deployment. The stent was post-dilated according to instructions-for-use. Patients received 5000 IU systemic heparin during the procedure. Follow-up was 24 months and the primary outcome measure was overall stent or graft patency. Secondary outcome measures were primary and assisted patency as well as amputation-free survival. Follow-up was performed by clinical evaluation for symptoms and by duplex ultrasound to assess patency at 1, 6, 12, and 24 months postoperatively. Results-41 patients were eventually analyzed. 6 month secondary patency was 91 % (DES) vs. 83 % (BSX) (P¼.450). The corresponding numbers at 12-months in the DES and BSX groups were 74 % and 80 % (P¼ .750). At 24 months the respective numbers were 56 % and 71 % (P¼.830) (fig1). There were no statistically significant differences in primary or assisted primary patency at 1, 6, or 12 months. 5 patients were excluded due to unsuccessful recanalization. There were no deaths or major amputations in either group during 12-month follow-up. The number of patients lost to follow-up at 6, 12, and 24 months was 0 (0.0 %), 6 (14.2 %) and 11 (26.2 %), respectively. Conclusion-This is the first randomized trial comparing the DES to prosthetic bypass in above knee femoropopliteal occlusion. At 12 and 24 months after the procedure there was no statistically significant difference in primary patency, assisted primary patency or secondary patency between the groups. Although underpowered, our study suggests non-inferiority of the DES compared to PTFE-bypass in this patient group. Larger studies are needed for more definitive conclusions.
VASA, Aug 1, 2009
We describe the case of a 71 year-old male patient undergoing haemodialysis who presented with se... more We describe the case of a 71 year-old male patient undergoing haemodialysis who presented with severe symptoms of venous hypertension at the left upper extremity due to subclavian and innominate vein obstruction. The patient had a well functioning ispilateral angioaccess. The pain and disabling swelling of the upper extremity developed 12 months after having a radio-cephalic arteriovenous fistula performed and progressively worsened in the last two months. The patient underwent extraanatomic axillo-femoral venous bypass grafting with a 8 mm polytetrafluoroethylene graft to the ispilateral common femoral vein. The postoperative recovery was regular and the patient was discharged 6 days after surgery with a functioning bypass and relief from the venous hypertension symptoms. In this case, surgical bypassing of a central venous obstruction through an extra-anatomical pathway relieved the symptoms of venous hypertension and prolonged the use of the haemodialysis access.
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Papers by Giuseppe Asciutto