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R Adovasio

Publications and source records attributed to R Adovasio.

31 records · Page 2Linked to original sources
PubMedDate not supplied

[The subclavian-carotid bypass as a method for treating obstruction of the common carotid].

Common carotid artery occlusion is a relatively uncommon lesion (0.5-5% of patients with cerebral ischaemia). Cerebral revascularization is possible only in case of patent carotid bifurcation, three patients, all of them symptomatic (2 TIA's and 1 amaurosis fugax) with a complete common carotid artery occlusion have been treated with a subclavian-carotid artery by-pass (2 PTFE, 1 reversed saphenous vein). Among the patients one death occurred in the fourth postoperative day by bronchopneumonia, no stroke was detected, in the remaining two, the by-pass was patent one year and respectively three years post-operatively. In case of common carotid artery occlusion, visualization of bifurcation is usually better obtained through a color-duplex than arteriography. Several operations have been proposed in these patients (retrograde thrombectomy, carotid to carotid by-pass, carotid-subclavian reimplantation), but subclavian to carotid by-pass is the most safe and common used procedure.

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[Intraoperative iliac angioplasty and distal revascularization: is it an efficacious method in the high-risk patient?].

The fact that iliac femoro-popliteal areas are both simultaneously interested in some high risk patients, frequently is cause of several problems in the indication of the surgical treatment. So, we have decided to practice an iliac Angioplasty peroperatively as a method of iliac revascularization in association with the surgical repairment of the femoro-popliteal area. Results of 20 patients with 23 surgical procedures during a period of two years is reported.

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Acute thrombosis of the infrarenal aorta. Therapeutic problems.

Acute thrombosis of the infrarenal aorta is a rare event, usually complicating aortic atherosclerotic lesions or aortic aneurysms. During the last twelve years, we treated 10 acute aortic thromboses out of 353 acute ischemias of the lower limbs (2.8%). The high mortality of our series (60%) is related to advanced age (71 years on average), severe underlying cardiopathy, and the frequent involvement of the renal and mesenteric vessels. In our experience Fogarty catheter thrombectomy is usually ineffective, and the surgical approach in high risk patients should be confined to axillobifemoral bypass graft.

Acute Disease↗
PubMedDate not supplied

Long term results of extra anatomical bypasses.

The authors discuss their own experience with extra anatomical bypasses. It is composed by 214 patients who underwent 224 extra anatomical bypasses: 167 axillofemoral bypasses, 50 femorofemoral bypasses and 7 trans-obturator bypasses. The indications included the presence of infections, or a previously thrombosed aortic prosthesis, or infected aneurysm, in 12.1% of the cases; in 6.2% of the cases the extra anatomical bypass was due to acute ischaemia of limb. In 81.7% it was chosen because of the presence of some general or local contraindication to direct aortoiliac reconstruction. The results are comparable to those reported in the literature. The only unusually high datum is the rate of early infections in femorofemoral bypasses (12%). On the ground of these results, the Authors stress the value of extra-anatomical bypasses as an alternative to direct aortoiliac reconstructions.

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PubMedDate not supplied

[By-pass operations in obstructions of the aorto-iliac axis].

The A. report their own experience about 226 cases of by-pass and 46 cases of T.E.A. for aorto-iliac disease performed by the Department of Surgical Semeiotics in the University of Trieste. The results of 116 direct bilateral implants and of 23 monolateral implants are discussed. Intraoperatory mortality was about 8%. Early complications occurred in 9, 4%: thrombosis and prosthesis infections (5 cases) were the most important accidents. Late complications were thrombosis (19 cases), infection (1 case) and 2 A-E fistulas. It is possible to obviate late thrombosis with early reoperations. Long-term follow-up (106 patients) shows good results in 70, 8%, while thrombosis of the by-pass occurred in 17, 9%; 12 patients showed a distal ischemia of the limbs and required complementary reoperations. On the basis of their experience the A. stress that the results of aorto-femoral by-pass should be considered quite satisfactory.

Aortic Diseases↗
PubMedDate not supplied

[Multiple carcinomas of the large intestine].

Authors stress that multiple carcinomas of the large bowel are not exceptional at all and report 5 cases of metachronous cancers and 1 case of synchronous cancers. They are 4,4% of all the colo-rectal neoplasms operated by the "Istituto di Semeiotica Chirurgica dell'Università di Trieste". The Authors discuss the most important pathogenetic, pathological and diagnostic problems and emphasize the usefulness of a very careful intra-operative evaluation of the entire colon and of a post-operative follow-up for the early discovery and treatment of a second cancer in another tract of the large bowel.

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[Local excision of rectal cancer in early phase as an alternative to major surgery].

The authors analyse the role of local excision as curative procedure of low rectal early cancer. In their opinion it's very important to select the patients in accordance with some characteristics of the tumor (site, grading, mobility, depth, size, stage, involvement of locoregional nodes, ploidia). Intrarectal ultrasonography is thought be the most important diagnostic tool, both in preoperative diagnosis and in postoperative follow-up; it has a high sensibility to define the parietal invasion of rectal cancer and to recognize metastatic nodes. They review various surgical techniques used to make local excision by several authors (transsacral approach by Kraske, transsphinteric approach by Mason and transanal approach by Bailey), as well as the alternative methods (surgical diathermy by Strauss, endocavitary irradiation by Papillon and cryosurgery by Heberer). The authors point out the technique of Bailey and coll. is getting the major approvals owing to its simplicity, low mortality and morbidity rates, poor incidence of recurrences and good survival. The most recent therapeutic protocols provide only local excision for the lesions limited into mucosa and submucosa (stage T1), also postoperative radio- and chemotherapy for tumors involving muscolaris propria (stage T2). On the other hand, advanced rectal cancer (stage T3) may be managed best by major operations. Recurrences rates (5-22%) and five-years survival rates (78-90%) are obviously conditioned by tumor features. Finally, the authors reaffirm, with their personal experience as well, the importance of local excision as curative operation for low rectal early cancer, provided that a careful case selection is made in accordance with macro- and microscopical features of the tumor.

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