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1.
Sci Rep ; 10(1): 706, 2020 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959759

RESUMO

Serum-derived extracellular vesicles (sEV) from healthy donors display in-vivo pro-angiogenic properties. To identify patients that may benefit from autologous sEV administration for pro-angiogenic purposes, sEV angiogenic capability has been evaluated in type 2 diabetic (T2DM) subjects (D), in obese individuals with (OD) and without (O) T2DM, and in subjects with ischemic disease (IC) (9 patients/group). sEV display different angiogenic properties in such cluster of individuals. miRNomic profile and TGFß content in sEV were evaluated. We found that miR-130a and TGFß content correlates with sEV in-vitro and in-vivo angiogenic properties, particularly in T2DM patients. Ingenuity Pathway Analysis (IPA) identified a number of genes as among the most significant miR-130a interactors. Gain-of-function experiments recognized homeoboxA5 (HOXA5) as a miR-130a specific target. Finally, ROC curve analyses revealed that sEV ineffectiveness could be predicted (Likelihood Ratio+ (LH+) = 3.3 IC 95% from 2.6 to 3.9) by comparing miR-130a and TGFß content 'in Series'. We demonstrate that sEV from high cardiovascular risk patients have different angiogenic properties and that miR-130a and TGFß sEV content predicts 'true ineffective sEVs'. These results provide the rationale for the use of these assays to identify patients that may benefit from autologous sEV administration to boost the angiogenetic process.


Assuntos
Doenças Cardiovasculares/sangue , Diabetes Mellitus Tipo 2/sangue , Proteínas de Homeodomínio/genética , MicroRNAs/genética , Fator de Crescimento Transformador beta/metabolismo , Regiões 3' não Traduzidas , Adulto , Idoso , Doenças Cardiovasculares/genética , Doenças Cardiovasculares/metabolismo , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/metabolismo , Vesículas Extracelulares/genética , Vesículas Extracelulares/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
2.
Ann Vasc Surg ; 60: 229-235, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075478

RESUMO

BACKGROUND: One of the most critical phases of carotid endarterectomy (CEA) is the carotid cross-clamping test, which is a concrete evaluation of efficacy of collateral cerebral perfusion. Some studies revealed a strong correlation between tolerance to carotid cross-clamping and postoperative transient ischemic attack (TIA)/stroke complications. The aim of the study is to make a global analysis of supra-aortic trunks (SAT) and circle of Willis (CoW) patency to predict the tolerance to carotid cross-clamping preoperatively. METHODS: We observed retrospectively 503 patients who underwent CEA under local anesthesia between January 2012 and 2017. We analyzed single preoperative risk factors, drug therapy, and vessels patency of the group of patients who did or did not present neurological symptoms at carotid cross-clamping. Afterward, we created a cerebral perfusion score (PTOT) to estimate the efficacy of collateral cerebral perfusion and we compared the results from both groups. The score ranges from 0 (hypothetical total occlusion of the SAT and CoW) to 0.65 in case of patency of all arterial districts. Moreover, we evaluated postoperative complication rates. RESULTS: Patients with previous neurological symptoms, female gender, and diabetes correlate with a lower tolerance to carotid cross-clamping (odds ratio: 2.57, 2.78, and 2.57, respectively; P value < 0.05). The SAT and CoW score revealed that patients with score <0.2 more frequently did not tolerate carotid cross-clamping (P value 0.01). Patients who required an intraoperative shunt presented a higher risk of TIA/stroke within 30 days from surgery than those with a better neurological compensation (P value 0.03). CONCLUSIONS: The efficacy of cerebral mechanisms of compensation during carotid cross-clamping reflects the capability of the brain to adapt to ischemic insults, and this also correlates with the postoperative risk of TIA/stroke. It is possible to identify preoperatively patients with a higher risk of neurological intolerance at carotid cross-clamping. This score could be a useful method to make a further stratification of risk of neurological complications and eventually to prefer a general anesthesia and the use of shunt for those with PTOT < 0.2.


Assuntos
Aorta/fisiopatologia , Doenças das Artérias Carótidas/cirurgia , Circulação Cerebrovascular , Círculo Arterial do Cérebro , Endarterectomia das Carótidas , Grau de Desobstrução Vascular , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Circulação Colateral , Constrição , Endarterectomia das Carótidas/efeitos adversos , Feminino , Humanos , Ataque Isquêmico Transitório/etiologia , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
3.
Vasc Endovascular Surg ; 52(4): 309-312, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29519202

RESUMO

BACKGROUND: Pseudoaneurysm (PA) after carotid endarterectomy (CEA) is a rare and potentially life-threatening complication, with an incidence lower than 1%. Most of the cases described report PAs after carotid patch angioplasty and are associated with infection, often caused by Staphylococci. The management of PAs can be surgical, endovascular, or hybrid. METHODS: We herein present the case of an infected carotid PA 27 days after an eversion CEA. We performed a common to internal carotid bypass with the interposition of great saphenous vein (GSV) associated with specific polyantibiotic therapy for 4 weeks. We searched the PubMed database for reviews and cases reports for patients who developed carotid PA after primary repair CEA in the period between 1969 and 2017. RESULTS: We identified 21 cases of primary closure post-CEA PAs in the literature. In almost 60% of patients, infection was detected. Open surgery was performed in all the cases; in 1 case, an hybrid approach was preferred. In 52% of cases, a vein graft/patch or primary closure was chosen; in 3 cases, ligation was preferred, and in 1 case, a polyester graft was used. CONCLUSION: In our experience and with the evidence observed in the literature, open surgery with GSV interposition is the safest treatment in infected carotid PAs. The endovascular approach must be performed only in proven noninfectious cases. A bridge technique with the insertion of a stent followed by open surgery repair can be an option in emergency cases.


Assuntos
Falso Aneurisma/etiologia , Aneurisma Infectado/etiologia , Doenças das Artérias Carótidas/cirurgia , Lesões das Artérias Carótidas/etiologia , Endarterectomia das Carótidas/efeitos adversos , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Falso Aneurisma/cirurgia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Implante de Prótese Vascular , Doenças das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/microbiologia , Lesões das Artérias Carótidas/cirurgia , Angiografia por Tomografia Computadorizada , Humanos , Ligadura , Masculino , Veia Safena/transplante , Resultado do Tratamento
4.
Int J Surg ; 51: 180-183, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29412185

RESUMO

OBJECTIVES: The traditional surgical approach to the treatment of the superficial venous insufficiency requires at least 12 h of post-operative monitoring and this often means the necessity of an overnight hospitalization. The introduction of new, less invasive techniques (i.e endovenous laser ablation) reduces the hospitalization stay in a Day Surgery setting. However, the increasing skills of the operators and the patient's selection, allows to propose endovenous laser ablation in an Outpatient setting. The aim of this study is to evaluate the activity of a single high-volume center. METHOD: We enrolled 112 consecutive patients with great sapehous vein insufficiency and indication to endothermal laser ablation, 57 operations (51%) were performed in Day Surgery setting and 55 (49%) in Outpatient setting according to endovascular laser ablation's criteria. Past medical history, CEAP classification, VCSS score, type of symptoms and intervention's data were collected. Post-operative results (success and complications rates, patient's functional and aesthetic satisfaction) were evaluated at 7 and 30 days after intervention. A QoL questionnaire (CIVIQ) was submitted to the patients 30 days after surgery. RESULTS: We did not observe a statistically significant difference between the two groups concerning treatment results and complications onset. The QoL assessment did not differed significantly, except for over 65-year old patients undergoing outpatient treatment that showed a better QoL compared to those undergoing the same treatment in Day Surgery (p 0.05). CONCLUSIONS: The endothermal laser ablation technique allows a safe, comfortable and faster management of the venous disease in Outpatient setting. This would further reduce the costs of the treatment while preserving the functional and aesthetic results and the low complication rate of the Day Surgery setting.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Terapia a Laser/métodos , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estudos Prospectivos , Qualidade de Vida , Insuficiência Venosa/psicologia
5.
J Interv Cardiol ; 31(2): 177-184, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29205487

RESUMO

OBJECTIVES: To compare bleeding and clinical events of patients with stable angina or silent ischemia undergoing percutaneous coronary intervention (PCI) treated with unfractionated heparin (UFH) or bivalirudin. BACKGROUND: Few direct comparisons between UFH monotherapy versus bivalirudin exist for patients with stable ischemic heart disease undergoing PCI. METHODS: A prospective, investigator-initiated, single-center, single-blinded, randomized trial of UFH versus bivalirudin was conducted. The primary endpoint was all bleeding (major and minor) from index-hospitalization to 30 days post discharge. Secondary endpoints included major adverse cerebral and cardiovascular events (MACCE) and net adverse clinical events (NACE). RESULTS: Two-hundred-sixty patients were randomized for treatment with either UFH (n = 123) (47%) or bivalirudin (n = 137) (53%) There were no significant differences in baseline clinical and angiographic characteristics between the two groups. Primary endpoint was similar in both groups (10.9% with bivalirudin vs 7.3% with UFH [P = 0.31]). Major bleeding rates were 5.8% and 2.4%, respectively (P = 0.17). There was a higher MACCE (3.5% vs 0%, P = 0.03) and NACE (8.8% vs 2.4%, P = 0.03) rate with bivalirudin compared to UFH, respectively. Bivalirudin had increased odds of NACE (OR = 3.65, 95% CI: 1.00-13.3.6). Death and stent thrombosis rates were low and similar in both groups. Radial access was associated with fewer bleeding events compared to femoral access but not statistically significant (P = 0.29). CONCLUSIONS: Among patients with stable angina or silent ischemia, there was no difference between UFH and bivalirudin in bleeding rates up to 30-days post-PCI. MACCE and NACE were higher among the bivalirudin group. Radial access was associated with a numerically lower rate of bleeding compared with femoral access.


Assuntos
Doença da Artéria Coronariana , Hemorragia , Hirudinas , Isquemia Miocárdica , Fragmentos de Peptídeos , Intervenção Coronária Percutânea , Trombose , Idoso , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/cirurgia , Monitoramento de Medicamentos , Feminino , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Heparina/administração & dosagem , Heparina/efeitos adversos , Hirudinas/administração & dosagem , Hirudinas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiologia , Fragmentos de Peptídeos/administração & dosagem , Fragmentos de Peptídeos/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Estudos Prospectivos , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Trombose/diagnóstico , Trombose/etiologia , Resultado do Tratamento
6.
Ann Vasc Surg ; 45: 62-68, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28546040

RESUMO

BACKGROUND: Many studies confirmed the role of early carotid endarterectomy (CEA) to prevent recurrent stroke or transient ischemic attack; however, the mid-long-term neurological benefit is still not completely investigated. The purpose of the study was to evaluate the role of early CEA on the perioperative and postoperative stroke/death complications of patients with a symptomatic carotid stenosis. METHODS: Ninety consecutive patients were referred to our center for a symptomatic carotid stenosis. They were divided into 2 groups according to the time to surgery: G1 within 2 weeks (39 patients) and G2 from 2 weeks to thereafter (51 patients). Neurological assessment was performed with the National Institutes of Health Stroke Scale (NIHSS) at presentation and at follow-up. Echo color Doppler ultrasound was performed at 1-6 months and then yearly. RESULTS: The presentation of neurological symptoms differed significantly between the 2 groups; in fact, minor stroke was more frequent in G1, whereas transient ischemic attack was more frequent in G2 (P value = 0.027). No significant differences emerged between the 2 groups on the surgical intervention or perioperative complications. The study showed a significant improvement of the neurological impairment (evaluated with a reduction of NIHSS score) of patients in G1 compared with G2 (P value = 0.01). CONCLUSIONS: Neurological recovery after a symptomatic carotid stenosis is strictly correlated to the variable "time to surgery." A higher sensitization of the general population on the early recognition of the symptoms and a strict collaboration with neurologists is mandatory to reduce time to CEA and improve clinical outcomes.


Assuntos
Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Ataque Isquêmico Transitório/etiologia , Acidente Vascular Cerebral/etiologia , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/mortalidade , Avaliação da Deficiência , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Feminino , Humanos , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/mortalidade , Itália , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Recidiva , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores
9.
Korean Circ J ; 45(4): 337-9, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26240589

RESUMO

Primary aortoenteric fistula is a direct communication between the aorta and intestinal lumen and it represents a rare but potentially lethal complication of an abdominal aortic aneurysm. However, it may occur less frequently in a naive non-aneurysmatic aorta. Diagnosis is often difficult and delayed in most cases, unless there is a high level of clinical awareness. Urgent surgery is still the recommended treatment. We describe the case of primary aortoenteric fistula of a saccular aneurysm. A 55-year-old woman was referred to our center with hematemesis, melena, and severe anemia who was dignosed previously with unknown saccular abdominal aneurysm.

10.
Ann Vasc Surg ; 28(7): 1795.e11-4, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24858585

RESUMO

A 59-year-old male, referred to our center with a ruptured aortic aneurysm, underwent urgent endovascular repair and femoro-femoral crossover bypass. An endograft infection because of Aspergillus fumigatus occurred about 20 days after surgery. We removed the endograft and femoral prosthesis and we then performed an aorto-bi-iliac bypass with autogenous reversed superficial femoral veins. Five days after surgery, the patient died. Microbiological examination and postmortem examination showed the presence of A. fumigatus in femoral prosthesis, aortic wall, and periaortic exudate.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Aspergilose/diagnóstico , Aspergillus fumigatus/isolamento & purificação , Prótese Vascular/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Implante de Prótese Vascular/métodos , Remoção de Dispositivo , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade
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