The sac evolution imaging follow-up after endovascular aortic repair: An international expert opinion-based Delphi consensus study

Objective: Management of follow-up protocols after endovascular aortic repair (EVAR) varies significantly between centers and is not standardized according to sac regression. By designing an international expert-based Delphi consensus, the study aimed to create recommendations on follow-up after EVAR according to sac evolution. Methods: Eight facilitators created appropriate statements regarding the study topic that were voted, using a 4-point Likert scale, by a selected panel of international experts using a three-round modified Delphi consensus process. Based on the experts’ responses, only those statements reaching a grade A (full agreement $75$80% and full disagreement <5%) were included in the final document. Results: One-hundred and seventy-four participants were included in the final analysis, and each voted the initial 29 statements related to the definition of sac regression (Q1-Q9), EVAR follow-up (Q10-Q14), and the assessment and role of sac regression during follow-up (Q15-Q29). At the end of the process, 2 statements (6.9%) were rejected, 9 statements (31%) received a grade B consensus strength, and 18 (62.1%) reached a grade A consensus strength. Of 27 final statements, 15 (55.6%) were classified as grade I, whereas 12 (44.4%) were classified as grade II. Experts agreed that sac regression should be considered an important indicator of EVAR success and always be assessed during follow-up after EVAR. Conclusions: Based on the elevated strength and high consistency of this international expert-based Delphi consensus, most of the statements might guide the current clinical management of follow-up after EVAR according to the sac regression. Future studies are needed to clarify debated issues. (J Vasc Surg 2024;80:937-45.

INDIGO-DataCloud: a Platform to Facilitate Seamless Access to E-Infrastructures

[EN] This paper describes the achievements of the H2020 project INDIGO-DataCloud. The project has provided e-infrastructures with tools, applications and cloud framework enhancements to manage the demanding requirements of scientific communities, either locally or through enhanced interfaces. The middleware developed allows to federate hybrid resources, to easily write, port and run scientific applications to the cloud. In particular, we have extended existing PaaS (Platform as a Service) solutions, allowing public and private e-infrastructures, including those provided by EGI, EUDAT, and Helix Nebula, to integrate their existing services and make them available through AAI services compliant with GEANT interfederation policies, thus guaranteeing transparency and trust in the provisioning of such services. Our middleware facilitates the execution of applications using containers on Cloud and Grid based infrastructures, as well as on HPC clusters. 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Insight from an Italian Delphi Consensus on EVAR feasibility outside the instruction for use: the SAFE EVAR Study

BACKGROUND: The SAfety and FEasibility of standard EVAR outside the instruction for use (SAFE-EVAR) Study was designed to define the attitude of Italian vascular surgeons towards the use of standard endovascular repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) outside the instruction for use (IFU) through a Delphi consensus endorsed by the Italian Society of Vascular and Endovascular Surgery (Societa Italiana di Chirurgia Vascolare ed Endovascolare - SICVE). METHODS: A questionnaire consisting of 26 statements was developed, validated by an 18 -member Advisory Board, and then sent to 600 Italian vascular surgeons. The Delphi process was structured in three subsequent rounds which took place between April and June 2023. In the first two rounds, respondents could indicate one of the following five degrees of agreement: 1) strongly agree; 2) partially agree; 3) neither agree nor disagree; 4) partially disagree; 5) strongly disagree; while in the third round only three different choices were proposed: 1) agree; 2) neither agree nor disagree; 3) disagree. We considered the consensus reached when >70% of respondents agreed on one of the options. After the conclusion of each round, a report describing the percentage distribution of the answers was sent to all the participants. RESULTS: Two -hundred -forty-four (40.6%) Italian Vascular Surgeons agreed to participate the first round of the Delphi Consensus; the second and the third rounds of the Delphi collected 230 responders (94.3% of the first -round responders). Four statements (15.4%) reached a consensus in the first rounds. Among the 22 remaining statements, one more consensus (3.8%) was achieved in the second round. Finally, seven more statements (26.9%) reached a consensus in the simplified last round. Globally, a consensus was reached for almost half of the proposed statements (46.1%). CONCLUSIONS: The relatively low consensus rate obtained in this Delphi seems to confirm the discrepancy between Guideline recommendations and daily clinical practice. The data collected could represent the source for a possible guidelines' revision and the proposal of specific Good Practice Points in all those aspects with only little evidence available

The value of fetal fibronectin in cervical and vaginal secretions and of ultrasonographic examination of the uterine cervix in predicting premature delivery for patients with preterm labor and intact membranes

OBJECTIVE: We compared the diagnostic performances of fetal fibronectin assay of cervical and vaginal secretions and of transvaginal ultrasonographic evaluation of the uterine cervix in the prediction of preterm delivery of patients presenting with preterm labor and intact membranes. STUDY DESIGN: One hundred eight patients admitted to the hospital for preterm labor and with intact membranes underwent assay of fibronectin in the cervical and Vaginal secretions and transvaginal ultrasonographic evaluation of the uterine cervix. The ultrasonographic parameters evaluated were cervical length, presence of funneling, and cervical index ([Funnel length +1]/Cervical length). Outcome measures were occurrence of preterm delivery, defined as birth before the thirty-seventh week of gestation, and the admission-to-delivery interval. RESULTS: Forty-seven patients (43.5%) were delivered preterm. Receiver characteristic curve analysis showed that a level of fetal fibronectin in cervical secretions greater than or equal to 60 ng/ml had the highest diagnostic performance in predicting preterm delivery (sensitivity 80.9%, specificity 83.6%). Multiple stepwise logistic regression analysis indicated that the cervical index significantly improved the prediction of preterm delivery achieved by the fetal fibronectin assay. In patients with cervical secretion fibronectin levels greater than or equal to 60 ng/ml, survival analysis showed a shorter admission-to-delivery interval in the presence of an abnormal cervical index (p less than or equal to 0.001). CONCLUSIONS: The assay of fetal fibronectin in cervical secretions is more accurate than ultrasonographic evaluation of the uterine cervix in the prediction of preterm delivery. Combined use of the fetal fibronectin assay and the cervical index improves the diagnostic efficiency and allows prediction of the admission-to-delivery interval, identifying a subgroup of patients who may require aggressive treatment

Chronic contained rupture of abdominal aortic aneurysms [Aneurismi dell'aorta addominale rotti cronici tamponati]

Background. To evaluate on the basis of our experience in 12 patients with chronic contained rupture (CCR) of an abdominal aortic aneurysm, the aetiopathogenesis of the disease, its clinical presentation, its diagnosis and the results of surgery. Methods. From January 1990 to June 1999 a total of 768 patients underwent surgery for abdominal aortic aneurysm: 662 (86.2%) were operated electively and 106 (13.8%) in emergency. Six hundred and fifty- four (85.1%) patients presented an aneurysm without fissuration or rupture (Group A), 102 (13.3%) showed a fissured aneurysmatic sac (Group B) and 12 (1.6%) presented CCR (Group C). Age, gender, risk factors, associated vascular disease and outcome of surgery were compared in the three groups and the anatomic and clinical characteristics of patients with CCR were examined. Results. No statistically significant differences were found between the 3 groups for risk factors or associated vascular disease. Patients with CCR are often normotensive and show smaller retroperitoneal haematoma compared to patients in Group B. Operative mortality in Groups A, B and C was respectively 3, 41.2 and 8.3%. Conclusions. Owing to its possible evolution into free rupture, CCR calls for rapid diagnosis and treatment. CT is the most reliable means of diagnosis. Patients with CCR are more often normotensive and present smaller retroperitoneal haematomas compared to ruptured aneurysm. Retroperitoneal drainage is recommended, together with bacterial culture of the haematoma and more frequent postoperative controls to prevent graft infection

Chronic contained rupture of abdominal aortic aneurysms [Aneurismi dell'aorta addominale rotti cronici tamponati]

Background. To evaluate on the basis of our experience in 12 patients with chronic contained rupture (CCR) of an abdominal aortic aneurysm, the aetiopathogenesis of the disease, its clinical presentation, its diagnosis and the results of surgery. Methods. From January 1990 to June 1999 a total of 768 patients underwent surgery for abdominal aortic aneurysm: 662 (86.2%) were operated electively and 106 (13.8%) in emergency. Six hundred and fifty- four (85.1%) patients presented an aneurysm without fissuration or rupture (Group A), 102 (13.3%) showed a fissured aneurysmatic sac (Group B) and 12 (1.6%) presented CCR (Group C). Age, gender, risk factors, associated vascular disease and outcome of surgery were compared in the three groups and the anatomic and clinical characteristics of patients with CCR were examined. Results. No statistically significant differences were found between the 3 groups for risk factors or associated vascular disease. Patients with CCR are often normotensive and show smaller retroperitoneal haematoma compared to patients in Group B. Operative mortality in Groups A, B and C was respectively 3, 41.2 and 8.3%. Conclusions. Owing to its possible evolution into free rupture, CCR calls for rapid diagnosis and treatment. CT is the most reliable means of diagnosis. Patients with CCR are more often normotensive and present smaller retroperitoneal haematomas compared to ruptured aneurysm. Retroperitoneal drainage is recommended, together with bacterial culture of the haematoma and more frequent postoperative controls to prevent graft infection