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C Novali

Publications and source records attributed to C Novali.

12 recordsLinked to original sources
PubMed1998

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. Between March 1994 and December 1996, 44 patients with prosthetic graft infection were treated with homografts (13 preserved at 4 degrees C, 31 cryopreserved). The mean age of the patients was 65 years. Emergency surgical procedures were performed in eight patients (18%). Sepsis was diagnosed in 11 patients, aortoenteric fistula in 13, and false aneurysms in 10. Staphylococcus was the main cause of infection. The types of vascular reconstruction with homograft were: 32 aortobifemoral, 3 aortoaortic, 2 iliofemoral, 4 peripheral, and 3 axillobifemoral. Human lymphocyte antigen (HLA) and antibody (ABO) blood group system compatibility between donors and recipients was not respected. The mean duration of follow-up was 15 months (range 1-33). Clinical and duplex scanning evaluations were routinely performed. Computed tomography (CT) or magnetic resonance (MR) scanning or arteriography were performed on the basis of duplex scanning results. There were six deaths during the early postoperative period (30 days) with a mortality rate of 13.6%. During the follow-up there were five late deaths with a mortality rate of 11.4%. Eight patients had graft occlusion. Three cases were successfully treated with thrombectomy. Two cases were successfully treated with femoropopliteal bypass with autologous vein. In three cases leg amputation was necessary. The results of fresh and cryopreserved homograft were compared. No significative differences of early postoperative mortality, late mortality, homograft related mortality, and graft occlusion were observed. We have evaluated the actuarial survival of the patients and the actuarial patency of the homografts on the aortoiliac reconstructions. Twelve months after the surgery the actuarial survival of the patients was 73% and the actuarial patency of the homografts was 56%. In our preliminary experience, we have not observed any significant difference in terms of clinical outcome by using fresh rather than cryopreserved homografts. In the near future it will be our policy to employ only cryopreserved homografts. Moreover, we will extend vessel harvesting to nonheart-beating donors, thus maximizing retrieval. The aforementioned solutions will supply the best graft availability to obtain dimensional and ABO compatibility between donors and recipients.

Adult↗
PubMed1998

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. Eight segments were freshly preserved, 10 were cryopreserved. Four patients were operated as emergencies, of which 3 for aorto-enteric fistulas. All others presented a serious septic state. RESULTS: Three patients died in the early postoperative period: one of acute infarction and two of homograft related causes. In the follow-up there was only one death from acute infarction, a branch occlusion and two allograft enteric fistulas successfully treated by surgery. All surviving patients are submitted to periodical haemodynamic and tomographic control with an average follow-up of 22 months (range 3 months to 3 years) and there has been no allograft degeneration so far. CONCLUSIONS: The use of homologue arterial allografts has shown good results in the treatment of serious aortic graft infections resulting in adequate peripheral vascularization. There have been no significant degenerations to date, either in fresh or cryopreserved allografts.

Aged↗
PubMed1996

[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. For the second group the old prosthesis was replaced by a homograft. On the first group of 12 patients, 5 had previously been operated on for obstructive arteriopathy of the legs; the other 7 had previously been operated on for an abdominal aortic aneurysm. In 50% of these 12 cases the prosthesis used was a bifemoral aortic prosthesis, in 30% bisiliac aortic, and in 20% an aorto aortic prosthesis. There was an interval, from one month to 20 years depending on the patient, between the first and the second operations. The average age of the patients was 61.2 years. Six of the patients were extreme emergency cases and were operated on immediately on their arrival at the hospital, while the other 6 were operated on 2-3 days after their arrival. Five patients died whilst they were being operated on (3 from haemorrhagic shock, 2 from sepsis and multi-organ failure). None of the patients who were treated from January 1994 to July 1994 died during their operations. The homograft was removed from a multi-organ donor. In treatment such as this, the most important thing is to remove the old prosthesis. The following is a discussion of the techniques used to clamp the aorta and to provide alternative limb vascularization.

Acute Disease↗
PubMed1996

[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. Perioperative and long-term results were comparable in both groups of patients.

Aged↗
PubMedDate not supplied

[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. Post-operative care and follow-up are discussed and planned. This experience is the result of a aspecific trial begun in Busto Arsizio Vascular Surgery Dept.-Busto Arsizio Hospital-Varese-Italy, where, starting from March 1994 until September 1996 21 homograft have been implanted in 20 patients (19 in aortic district). Population characteristics and results are critically examined, with particular attention to the death rate of 15%.

Blood Vessels↗
PubMedDate not supplied

[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 95.5% of these. The mean follow-up is 72 months, the restenosis rate is 6.6%, but only the 0.7% of the cases required a new surgical intervention with a patch angioplasty. From these data and according to the reports of international literature, we can assume that the use of a patch or direct arterial wall reconstruction, is a factor of less influence on restenosis rate than systemic or local factors (intimal flaps, surgical mistakes). Carotid endarterectomy has to be performed with great accuracy, in order to avoid surgical mismanagements which could negatively influence on early and late results.

Adult↗