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Biomedical subjects

F Benedetti-Valentini

Publications and source records attributed to F Benedetti-Valentini.

At least 19 recordsLinked to original sources
PubMed2003

[Carotid-carotid bypass. Indications and results].

AIM: The aim of this study is to evaluate the indications for a carotid-carotid bypass and its therapeutic efficacy. METHODS: Between January 1995 and December 2001, 42 out of 782 patients with obstructive lesions of carotid vessels were submitted to carotid-carotid bypass. Preoperative investigations included Duplex scanning, transcranial Doppler and cerebral CT in all the patients, angiography in 24, spiral CT in 8, MR angiography in 6. Carotid bypass was planned pre-operatively in 13 cases due to internal carotid occlusion in 4, to pseudo-occlusion in 8 and to restenosis in 1. In the remaining 29, due to a too thin residual wall or to the lack of a good clivage plane, a carotid bypass was planned intraoperatively. A PTFE graft was employed in 30 cases while the autologous saphenous vein in 12. Four patients were lost in a 12-80-month follow-up. No intra or postoperative mortality was recorded. RESULTS: Three patients died during the follow-up. In 1 patient the death followed an ischemic stroke due to bypass occlusion. Four bypasses became occluded, in 3 cases without clinical signs. Eight patients suffered by transient superior laryngeal nerve iniury. CONCLUSIONS: Carotid bypass, as an alternative to CEA, provides good results in the treatment of the patients with carotid stenosis, pseudo-occlusion or segmental occlusion. In most of the cases the surgical technique is planned intraoperatively but in selected cases angiographic findings, spiral CT and color flow duplex can suggest in the preoperative phase that carotid bypass is the best choice.

Carotid Arteries↗
PubMed2001

[Elective and emergency surgical treatment of popliteal aneurysms. Indications and results].

BACKGROUND: The aim of this paper is to evaluate the long term results related to surgical technique and to prosthetic material in planned and emergency conditions. METHODS: From January 1990 to December 1999, fourty-five patients with popliteal aneurysms were observed. Eighteen patients (40%) were asymptomatic; eleven (24.4%) suffered from claudicatio; six had an acute ischemia (13.3%) and four presented (8.9%) clinical signs of rest pain; in four cases (8.9%) symptoms were related to venous compression and to rupture in two (4.4%). Diagnosis was obtained by ultrasounds, angiography and CT-scan. All patients were operated on and in four cases (8.9%) the procedure involved both legs. The prosthetic material was reversed autologous saphenous vein (ASV) in 30 patients (61.2%), PTFE-EXS-TW in 16 (32.6%), homologous vein in one (2%), composite graft in one (2%), and a Dacron in the last one (2%). RESULTS: Six patients died for causes not related to the operation and eight bypasses (18.2%) became occluded. Amputation was needed in two patient, in relation to late bypass occlusion. In one cases an amputation was carried out for acute thrombosis of the contralateral aneurysm which was not treated for patients refusal. The long term patency rate was 81.8%. CONCLUSIONS: Popliteal aneurysms must be considered for reconstructive surgery, also when asymptomatic and with a diameter over 2 cm. The routinely use of the ASV improves the long-term patency rate. Best long term results are obtained in elective surgery.

Aneurysm↗
PubMed2000

Carotid surgery without angiography is possible and safe.

BACKGROUND: To evaluate the possibility to perform carotid surgery without angiography. METHODS: From January 1994 to June 1998, 514 patients with carotid obstructive disease were operated upon, 225 of them (43.8%) without previous angiography; 55 out of 68 (80.8%) during the last six months. Eighty-one (36.0%) had lateralizing symptoms, 50 aspecific ones (22.2%) and 94 were asymptomatic (41.8%). All patients were investigated by color-coded duplex sonography (CDS) of the arteries at the neck and by transcranial Doppler (TCD) and computed tomography (CT). One hundred eighty-eight patients were operated upon under local anaesthesia and 37 under general anesthesia; 204 had a carotid endartereotomy (90.7%) with patch angioplasty in 154 (75.5%), and 21 required a bypass graft (9.3%). In 26 patients (11.5%) an indwelling shunt was needed. RESULTS: Findings at surgery were consistent with CDS for plaque composition, ulcerations and degree of stenosis. There were no early deaths. Neurologic or ocular deficits occurred in 2 cases (0.9%). No strokes were observed in follow-up from 6 to 34 months. CONCLUSIONS: Carotid endarterectomy can be done without angiography in selected cases provided CDS plus TCD are of high quality. Under such conditions it can be considered a safer way to deal with carotid obstructive disease.

Aged↗
PubMed1999

Rupture of Dacron aorto-femoral graft. Case report.

A 74-year-old patient was admitted to our department in a serious general condition due to massive bleeding. He had been treated 10 years previously in another hospital with an aorto-bifemoral bypass for obstructive disease using a knitted-Dacron graft. A large pulsating mass was present in the right iliac fossa as well as enormous pulsating enlargement of the scrotum. Echo color-Doppler investigation detected dilation up to 5 cm in diameter of the right branch of the graft and a large perigraft hematoma communicating with a similar mass in the scrotum. The patient was submitted to emergency surgery and a large rupture of the graft was found. The dilated segment was resected and replaced by a new 8 mm Dacron graft. Postoperative course was uneventful.

Aged↗
PubMed1997

Transcranial Doppler in 178 patients before, during, and after carotid endarterectomy.

From July 1991 to March 1995, 178 patients who underwent 198 carotid surgical repairs were investigated preoperatively, intraoperatively, and postoperatively by transcranial Doppler sonography (TCD). Preoperative TCD evaluation showed stenosis of the middle cerebral artery (MCA) in 4 patients (2.2%), siphon stenosis in 3 (1.6%), incomplete circle of Willis in 23 (12.9%), a decrease of mean blood flow velocity more than 70% of the basal value during digital common carotid compression in 31 (17.9%), and a critical reduction of vasomotor reactivity (no significant increase of mean blood flow velocity in the MCA during breath-holding test) in 34 (19.1%). Nine patients (5%) had surgery without preoperative angiography. In those patients the indication for surgery was based on color Doppler imaging and TCD investigations. Ninety surgical procedures were carried out under general anesthesia and 188 under locoregional anesthesia. In 37 surgeries (31.7%) a shunt was inserted. The use of a shunt was based on a decrease of mean blood flow velocity in the MCA below 50% of the basal value under general anesthesia or loss of consciousness combined with a decrease of mean blood flow velocity in the MCA higher than 70% of the basal value when locoregional anesthesia was employed. Intraoperative TCD monitoring showed a decrease of mean blood flow velocity in the MCA due to shunt malfunction in (8.3%) of 36 surgeries, turbulence of blood flow during declamping in 79 procedures (39.8%), and microembolic events in 10 patients (5%) that were related to one transient and one permanent neurological deficit. Another permanent deficit occurred in a patient without TCD signs. After surgery, TCD reliably detected an early asymptomatic occlusion of the carotid artery, hyperperfusion syndrome in 12 (6.0%), and an increase of vasomotor reactivity in 10 (29.4%) of 34 surgeries.

Anesthesia, Conduction↗
PubMed1996

Composite grafts for critical ischaemia.

A total of 236 femoropopliteal below the knee and 64 femorotibial bypasses were carried out for critical ischaemia of the lower limbs using various prosthetic materials. These were evaluated in order to assess the patency of composite grafts (29 cases) compared with autogenous saphenous veins (189) and polytetrafluoroethylene (PTFE) (82). The composite graft was made by anastomosing a segment of autogenous vein in the distal position and joining it by an end-to-end oblique anastomosis to a PTFE prosthesis in the proximal position. These grafts were employed when an adequate autogenous vein could not be used for the entire length of the bypass. The graft-graft anastomosis was never placed near the knee-joint and if the PTFE segment had to cross the knee, it was always of the externally supported type. There were no early occlusions in the composite grafts. A total of 257 grafts were available for assessment at a mean of 4 years (range 6 months to 15 years). The patency for autologous saphenous vein was: 81.2% (121/142 femoropopliteal and 13/23 femorotibial). The patency for PTFE was 67.1% (41/58 femoropopliteal and 4/9 femorotibial) and for composite grafts was 76% (10/11 femoropopliteal and 9/14 femorotibial). There was no significant difference in patency between the autologous saphenous vein and the composite grafts, both in the femoropopliteal and femorotibial positions. Both were significantly better than PTFE grafts. Composite grafts are the best alternative when an autologous saphenous vein is not available.

Aged↗
PubMed1991

Aorto-iliac/femoral reconstructions in patients with vasculogenic impotence.

One hundred and forty-eight patients out of 386 undergoing aorto-iliac or aortofemoral bypass had preoperative impotence, 37 of these were diabetics. In all of them Doppler studies revealed a penile/brachial pressure index less than 0.6 and an abnormal waveform analysis. Nocturnal penile tumescence was investigated in 44 cases and found to be abnormal. Angiography showed unilateral or bilateral obstructive lesions of the hypogastric arteries in 80%, in addition to aortic, common and external iliac and femoral lesions. One hundred and thirty patients (87.8%) had straight aorto-iliac/femoral bypass grafts inserted without a direct attempt to revascularise the hypogastric arteries but 24 had distal anastomoses to the bifurcation of the common iliac artery. In the remaining 18 patients the hypogastric artery was reconstructed on one side by an additional bypass or reimplantation on the graft. In 22 of 106 patients (20.7%) undergoing aortofemoral bypass, 18 of 24 (75%) with the distal anastomosis to the iliac bifurcation, and 14 of the 18 (77.7%) with revascularisation of the hypogastric arteries, erectile function was regained. A good result was obtained in only five of the diabetic patients (13.5%). Our experience suggests that: (1) impotence, as indicated by non-invasive investigations, was vasculogenic in origin since patients with the most effective revascularisation of the hypogastric arteries had the best results; (2) when it is feasible, revascularisation of the hypogastric arteries should be carried out more often, during the aorto-iliac or aortofemoral reconstructions, particularly in younger impotent patients; (3) aorto-iliac revascularisation restores potency in only a few diabetic patients.

Aorta, Abdominal↗
PubMed1985

Isolated symptomatic lesions of the vertebral artery: cure after surgical repair.

Nine patients with uni-or bilateral stenosis of vertebral arteries, not associated with other lesions of supraaortic trunks are reported. They showed a vertebrobasilar insufficiency syndrome not due to other assessable causes. Seven of them underwent surgical treatment always as reimplantation of the vertebral into the subclavian artery. The procedure was unilateral also in cases with bilateral lesions. In all 7 patients a favourable result was obtained: 5 patients recovered completely and 2 showed a marked improvement. The study demonstrates that the surgical repair of symptomatic unilateral lesions of vertebral arteries is able to cure the vertebrobasilar insufficiency syndrome.

Adult↗
PubMed1981

[Ultrasonics diagnosis of venous thrombosis].

Ultrasound phlebosonometry was employed in the examination of 54 subjects with phlebosonometric acute or recurrent in 20, chronic in 34 cases. The results of one or more phlebosonometric examinations were compared with the phlebograms. It was found that ultrasound investigation was reliable more for high (91%) than for low (65%) lesions and for acute (85%) as opposed to chronic (70%) thrombosis. The method is seen as of great importance in cases of phlebothrombosis, especially in acute femoroiliac forms. Even though it is a qualitative examination, and hence cannot take the place of angiography, it can nevertheless limit the use of the latter in cases where it could be dangerous.

Acute Disease↗