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1.
Minerva Cardioangiol ; 64(4 Suppl 2): 1-80, 2016 Aug.
Article in Italian | MEDLINE | ID: mdl-27713392

ABSTRACT

Phlebology is not a specialty for its own in Italy. Phlebological patients are treated by vascular and general surgeons, dermatologists, phlebologists, angiologists, internists and even general practitioners. Even tough guidelines present a series of recommendations based on evidence-based medicine, guidelines may also be a tool to unify the diagnostic and therapeutic approach in a vast medical field like phlebology. Since vascular surgeons and phlebologists are particularly involved in phlebology-related pathologies the scientific societies of the Italian Society of Phlebology (SIF) and the Italian Society for Vascular and Endovascular Surgery (SICVE) decided to cooperate for the preparation of phlebo-lymphological guidelines. These guidelines comprehend also an important chapter dealing with the lymphology of the lower extremities; phlebological active physicians are often faced with lymphatic pathologies and a good differential diagnosis can be sometimes very helpful. Sclerotherapy and Surgery as the major therapeutical alternatives are extensively analyzed, but also the compression therapy, the medical and physical therapy are presented under the critical view of evidence based analyses. Separate chapters deal with the treatment alternatives for superficial and deep venous thromboses and the recommendations for the treatment of venous ulcers. The current scientific evidences were confronted with the experiences of Italian specialists and the particular practice and reality in Italy. They represent therefore the actual valid positions and recommendations in Italy which shall be updated regularly.


Subject(s)
Phlebotomy , Varicose Veins , Humans , Leg Ulcer/etiology , Leg Ulcer/therapy , Lymphedema/surgery , Lymphedema/therapy , Physical Therapy Modalities , Sclerotherapy/methods , Sclerotherapy/standards , Varicose Veins/diagnosis , Varicose Veins/surgery , Varicose Veins/therapy , Vascular Surgical Procedures , Venous Thrombosis/surgery , Venous Thrombosis/therapy
2.
Ann Vasc Surg ; 29(6): 1151-9, 2015 Aug.
Article in English | MEDLINE | ID: mdl-26004961

ABSTRACT

BACKGROUND: Fast-track recovery programs have led to reduced patient morbidity and mortality after surgery. Minimally invasive surgery and anesthesia, with programs of early postoperative recovery are the main aspects of fast-track recovery programs. The optimization of pain control, early mobilization, and oral feeding allows for a rapid functional rehabilitation, which leads to minor morbidity and early discharge from the hospital to home. METHODS: We enrolled all nonemergent patients treated for elective abdominal aortic surgery for an aneurysm or obstructive disease from April 2000 to June 2014. The fast-track protocol was applied to all these patients. A transperitoneal aortic approach was used through a left subcostal incision and was complemented with epidural anesthesia-analgesia and a protocol of early rehabilitation. RESULTS: A total of 1,014 patients were treated for elective aortic surgery. For 980 patients (96.6%), clear liquids followed by a semisolid diet were tolerated starting on the afternoon of the day of intervention (day 0). Nine hundred eighty-seven patients (97.3%) began early ambulation on day 0, and for 81.2% of the population, regular colonic function returned within the second postoperative day. Seventeen deaths (1.7%) occurred. Nine hundred ten patients (89.7%) had no complications. The median hospital length of stay was 3 days for the entire series, and 80.4% of patients (n = 815) were discharged to their homes between the second and fifth days after surgery. CONCLUSIONS: The fast-track program can be efficiently and safely applied to aortic surgery and that this program improves surgical outcomes, allows for earlier discharge, and reduces costs.


Subject(s)
Aorta, Abdominal/surgery , Aortic Aneurysm, Abdominal/surgery , Aortic Diseases/surgery , Arterial Occlusive Diseases/surgery , Vascular Surgical Procedures , Adult , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/diagnosis , Aortic Aneurysm, Abdominal/mortality , Aortic Diseases/diagnosis , Aortic Diseases/mortality , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/mortality , Elective Surgical Procedures , Female , Humans , Length of Stay , Male , Middle Aged , Patient Discharge , Postoperative Complications/etiology , Recovery of Function , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/mortality
3.
Cardiovasc Intervent Radiol ; 33(4): 853-6, 2010 Aug.
Article in English | MEDLINE | ID: mdl-19572169

ABSTRACT

Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA). We report the endovascular repair of an AAA rupture into the inferior vena cava. A 78-year-old woman was admitted to our hospital for acute hypotension. She presented with a pulsatile abdominal mass and became rapidly anuric. Abdominal computed tomography (CT) showed an AAA rupture into the inferior vena cava. The features of the AAA made it suitable for endovascular repair. To prevent pulmonary embolism caused by the presence of sac thrombosis near the vena cava lumen, a temporary vena cava filter was deployed before the procedure. A bifurcated stent-graft was placed with the patient under local anaesthesia, and the AAA was successfully treated. A transient type II endoleak was detected on CT 3 days after endograft placement. At routine follow-up 6 and 12 months after the procedure, the patient was in good clinical condition, and the type II endoleak had sealed completely. Endovascular treatment offers an attractive therapeutic alternative to open repair in case of ACF; however, only small numbers of patients have been treated, and long-term follow-up interval is lacking.


Subject(s)
Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/surgery , Arteriovenous Fistula/etiology , Blood Vessel Prosthesis , Endovascular Procedures , Stents , Aged , Aorta/abnormalities , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Rupture/diagnostic imaging , Aortography/methods , Arteriovenous Fistula/diagnostic imaging , Blood Vessel Prosthesis Implantation/methods , Contrast Media , Female , Follow-Up Studies , Humans , Radiographic Image Enhancement/methods , Tomography, X-Ray Computed/methods , Treatment Outcome , Vena Cava Filters , Venae Cavae/abnormalities , Venae Cavae/diagnostic imaging
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