15 research outputs found

    How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

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    COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

    Carotid Artery Geometry Modifications and Clinical Implications after Carotid Artery Stenting

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    Background: Carotid artery stenting (CAS) could lead to a modification of the carotid bifurcation geometry with possible clinical implications. This study aimed to clarify the geometrical impact of three carotid stents with different designs on the carotid bifurcation and its clinical consequences. Methods: This was a retrospective single-center study. We included all patients who underwent CAS in a 3-year period. Anatomical changes of the carotid bifurcation were evaluated by reviewing angiographic images. The population was divided into three groups based on the stent implanted: Group 1 (Carotid Wallstent), Group 2 (Roadsaver), and Group 3 (C-Guard). Results: A total of 226 patients were included. The mean age was 77.0 ± 7.4 years and 72.5% (164/226) were male. Three different stents were implanted into three groups: Group 1 (n = 131/226, 58%), Group 2 (n = 57/226, 25.2%), and Group 3 (n = 38/226, 16.8%). The mean pre-stent implantation CCA-ICA angle of the entire population was 155 ± 14.9°, and the post-CAS angle was 167.7 ± 8.7° (p = 0.0001). In every subgroup, the difference was statistically different, with the biggest difference registered in Group 2 (-16.1 ± 13.2°). Regarding stent oversizing, there was a significant relationship between CCA oversizing and CCA-ICA angle modification (p = 0.006). During follow-up, a total of 14 (6.2%) restenoses were registered. The mean CCA-ICA angle modification in the restenosis group was -9.5 ± 14.4° vs. -12.8 ± 11.9° in the no-restenosis group with no significant statistical differences were outlined (p = 0.3). Conclusions: Compared to the Carotid Wallstent and C-Guard, the Roadsaver stent appears to have a lower adaptability to the carotid vascular territory, resulting in a higher CCA-ICA angle modification after implantation, with no impact on the stent restenosis rate

    Protected retrieval of a detached iliac branch device nosecone

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    The detachment of components of endovascular devices is a rare but potentially harmful complication. This report describes a clinical case of nosecone detachment from an iliac branch device delivery system during an aortoiliac aneurysm exclusion in a 73-year-old male patient. After correct deployment, the iliac branch device nosecone detached during the removal of the delivery system. The guidewire was snared from the contralateral side, and two long sheaths were advanced to trap and protect the fractured piece, ensuring nice alignment and enabling its safe removal. This case highlights key strategies for managing serious complications encountered during endovascular aortic repair

    Unconventional retrieval of a guidewire fragment from the pulmonary district following retrograde access for chronic limb-threating ischemia

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    Intraprocedural endovascular device fracture and migration is an uncommon complication, with potential catastrophic outcomes. In a 75-year-old woman, retrograde puncture of the superficial femoral artery led to accidental femoral vein puncture and wire coating fragmentation. The fragment migrated up to a sublobar branch of the left pulmonary artery, and again to the right pulmonary artery during the first retrieval attempt. The final retrieval was performed by twisting three 0.014″ wires around the fragment, together with the support provided by the thromboaspiration Indigo-Penumbra catheter. The triple wire twisting technique supported by an aspiration catheter seems to be safe and effective for this serious pulmonary complication
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