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G Faggioli

Publications and source records attributed to G Faggioli.

9 recordsLinked to original sources
PubMed1998

Early and long-term results in the surgical treatment of juxtarenal and pararenal aortic aneurysms.

OBJECTIVE: Surgical treatment of juxtarenal and pararenal aortic aneurysms (JPAA) provide technical problems which may influence short- and long-term results; however few surgical series have been published on this subject. The purpose of this study is to observe predictors of results in a series of JPAA and to analyse long-term survival of these patients. DESIGN, MATERIALS AND METHODS: Patients' epidemiology and surgical technique used in all cases of JPAA were reviewed and correlated with early results through logistic regression analysis. Early results were compared with those of infrarenal aneurysms (IAA) treated in the same period. Long-term results were obtained through our surveillance protocol (3 months after surgery and yearly thereafter) and calculated by life-table analysis. RESULTS: Fifty JPAA were identified over a total of 1450 aortic aneurysms (3.4%). Surgical approach was: anterior transperitoneal in 38 cases (96%), extended retroperitoneal in one (2%) and thoracoabdominal in one (2%). Suprarenal control was obtained in all cases; at the diaphragm in seven (14%), above both renal arteries in 17 (34%) and above one renal artery in 16 cases (32%). Renal revascularisation was performed in 11 cases (22%; nine unilateral and two bilateral). Overall perioperative mortality was 12%, significantly greater than mortality of IAAs: 50/1400, 3.5% (p < 0.02). Mortality in elective cases was 3/42, 7.1% and in ruptured JPAA 3/8, 37.5%. Independent predictors of early mortality were aneurysm rupture, age > 70 years, and coronary artery disease. Gender, smoking, hypertension, diabetes mellitus, site of proximal aortic clamping, type of aortic reconstruction, visceral revascularisation, and technically difficult cases were not associated with early mortality. Three and five year survivals were 66.8% +/- 9.93 and 40.0% +/- 12.64, respectively. CONCLUSIONS: Surgical treatment of JPAAs is associated with a higher risk of early mortality compared to IAAs and reduced long-term survival. Indications for surgery in JPAAs should consider the risk/benefit ratio rather than focusing on technical aspects which do not seem to significantly influence results.

Adult↗
PubMed1995

[In vivo experimental research in vascular surgery. Methodology and current Italian law].

Authors underscore the importance of research in vascular surgery progress and approach some basic aspects on the correct conduction of an experimental research in vascular surgery fields and in particular on synthetic prosthesis of different diameter. Some important aspects of the current Italian law on animal experimentation are shown because they could cause new changes either on methodology or animal selection. Finally some experimental models adopted in the department of experimental surgery of the Rizzoli Orthopaedic Institutes on vascular prosthesis are described.

Animal Welfare↗
PubMed1993

Content and turnover of extracellular matrix protein in human "nonspecific" and inflammatory abdominal aortic aneurysms.

Inflammatory aneurysms (IAs) have peculiar macroscopic and histological aspects which make them very different from nonspecific aneurysms (NSAs). These morphological differences seem to be determined by significant modifications of the extracellular matrix. Extracellular matrix protein component concentrations were determined biochemically in infrarenal aortic biopsies from 10 NSAs, five IAs and five non-aneurysmal aortic controls. The concentration of each wall component was expressed in % w/w (relative concentration) and in mg/wall longitudinal cm (absolute concentration) with reference to total protein recovered after hydrolysis and amino acid analysis. The biochemical results were correlated with the histological and ultrastructural features of the specimens. A significant increase in total collagen was observed in the two groups of aneurysms, with respect to the controls (NSA = 285%, IA = 382%). In contrast the 80-90% decrease in the relative concentration of elastin observed in both types of aneurysm was less marked (NSA = 55%, IA = 39%). This fall was not significant when expressed in mg/cm, although elastin derived peptide (EDP) levels in the plasma of these patients was significantly higher than in age-matched controls. The concentration of the soluble collagen fraction appeared significantly higher (Mann-Whitney, p < 0.05) in the IAs with respect to the NSAs, whilst no differences were observed between the two groups regarding the concentration of insoluble elastin and of wall and plasma EDPs. As well as providing evidence of increased elastin turnover, this study emphasises the conspicuous modifications of collagen deposition in the wall of abdominal aortic aneurysms which appeared more marked in the inflammatory group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Traumatic dissection in an inflammatory aneurysm.

Primary dissections of the abdominal aorta are rare (0.4-4% of aortic dissections) and in most cases are traumatic (accidental or iatrogenic) in origin. The authors describe a case of iatrogenic dissection of the abdominal aorta following arteriography. The macroscopic and histological appearance of the aortic wall was compatible with an inflammatory aneurysm. In this type of aneurysm and in the presence of aortoiliac atherosclerosis, aortic catheterization carries a risk of aortic wall dissection.

Aortic Dissection↗
PubMedDate not supplied

[Thoraco-abdominal aneurysms of type IV].

AIM OF THE STUDY: Aims of the study were: 1. to evaluate the results of surgical treatment of type IV thoraco-abdominal aneurysms (TAA), with relationship to other types, 2. to evaluate results obtained with an approach different from the traditional thoraco-phreno laparatomy, with specific attention to postoperative respiratory function. MATERIAL AND METHODS: We have retrospectively compared type IV TAA with all other types of thoraco-abdominal aneurysms electively treated between January 1st, 1994 and May 31st, 2003. Data on perioperative mortality, spinal cord ischemia and renal failure (both temporary and permanent) occurring in the first 30 postoperative days were considered. Protection from spinal cord ischemia was accomplished through liquor drainage and prostaglandin E1 (PGE1) infusion. When the aneurysm extension was limited to the celiac axis an extrapleuric access with removal of XI rib was performed. In this subgroup of patients we have considered postoperative recovery time of respiratory function (intubation time, number of days in intensive care unit, postoperative pulmonary complications) postoperative renal failure, perioperative mortality and morbidity. RESULTS: Seventy-eight TAA have been treated in the period of time of the study. Twenty cases were type IV TAA (25.6%) of which 2 due to chronic dissection. Cumulative postoperative mortality has been 19.2%. The single perioperative death in the group of type IV TAA (5%) occurred in post-operative day 15 for multiple organ failure. No spinal cord ischemia occurred in this group. Temporary renal failure occurred in 3 cases (15%) with one case requiring dialysis. In 10 cases (50%) an extrapleuric access with removal of XI rib was performed, with adequate control of the proximal aorta. Postoperative respiratory failure requiring and intubation time longer than 12 hours occurred in 2 cases (20%). In the remaining 8 cases the mean intubation time was 5.3 hours (range 4-8 hrs). Tracheostomy was not necessary in any case. Mean time of intensive care unit stay was 3.5 days (range 0-15 days). CONCLUSION: The appropriate treatment of type IV TAA leads to low mortality and morbidity with results similar to those of pararenal aneurysms rather than those of other TAA forms. Left extrapleuric access when feasible allows faster recovery of a normal respiratory function.

Adult↗