Ippolito Donini

This paper is part of the monographic issue: 'Did the Masters of the past know the future? History and update of Italian Phlebolymphology' Guest editor: Alberto Macciò (Phlebology - Part I edited by G. Agus; Phlebology - Part II edited by P. Bonadeo; Lymphology edited by F. Boccardo

The social and aestetical aspects of venous and lymphatics disorders: Professor Dino De Anna

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Dispositivo per la prevenzione della trombosi venosa profonda

Il sistema ideato, per la prevenzione della TVP, utilizza una portante RF che di per se stessa non crea attività ne nervosa ne muscolare. Tale portante viene modulata in BF il che sposta la potenza spettrale del segnale anche in BF,che quindi interessa l’ area di stimolazione muscolare, ottenendo da un lato l’ attivazione nervosa e muscolare richiesta, e dall’ altro mantiene le caratteristiche di penetrazione e direzionabilità della RF

Hemodynamics of the sapheno-femoral junction: Mathematical modeling and clinical implications in chronic venous disease

Background: The incompetence of the sapheno-femoral junction (SFJ) represents a major point in the actual discussion on the venous hemodynamics of lower limbs in chronic venous disease (CVD). Methods: From 2014 June to 2017 June in the laboratory of non-invasive vascular diagnostics of the Operative Vascular Surgery Unit of the University Hospital of Ferrara we recruited 122 patients (sex: 37 males, 85 females; age range: 22-72 years; median age: 51 years). All patients were subjected to morphologic and geometric evaluations; vessels diameters, speed and direction of hematic flow were evaluated by Doppler echocardiography (DECG) technique. We performed a mathematical modeling among different hemodynamic evaluations through the use of DECG in order to evaluate local fluid dynamical parameters. Results: The analysis of numerical results allowed the identification of three different hemodynamic situations that are particularly critical for the SFJ circulation. Conclusions: The present experience represents an evidence based medicine study that in the next future could be useful for clinical decision-making process in CVD in order to simplify the choice of the therapeutic options, specific for each patient and based on objective, controllable and reproducible parameters

Biosynthetic graft failure to replace infected infrainguinal bypass as developing infection due to Morganella morganii leading to disrupture of the anastomosis. Case report

Introduction Biosynthetic prosthesis has become the trend to carry out arterial reconstruction in infected sites since considered to be resistant to infection. Late graft occlusion is the only complication reported in literature so far. We report a case of biosynthetic graft infection which led to early detachment of the femoral anastomosis of a femoral-popliteal above-knee bypass. Material A 76-year-old man developed groin infection 3 months later after performing an ePTFE femoral-popliteal above-knee bypass for critical limb ischemia. He was re-admitted for groin infection involving the vascular structures. Explantation of the existing bypass and its replacement with a biosynthetic graft (omniflow II) was performed. Detachment of the proximal anastomosis occurred 6 days later leading to groin haematoma. Consequently, retroperitoneal access was performed for clamping the external iliac artery so as to control haemorrhage followed by explantation of the biosynthetic graft. An external iliac-popliteal above-knee bypass was tailored in order to save the limb and it was performed using a transobturator approach avoiding the infected site. In both cases bacterial cultures resulted positive for Morganella Morganii. The groin wound was treated separately with negative pressure medication healing definitively within 20 days and after 3-month follow-up the bypass was still patent. Conclusion This is the first report of biosynthetic graft infection used for infrainguinal reconstruction leading to haemorrhage due to anastomosis disrupture. Using an extra-anatomical access for providing blood inflow to the leg avoiding the infected site and treating safely the groin wound with VAC therapy revealed to be a valid approach

The role of diamagnetic pump (CTU mega 18) in the physical treatment of limbs lymphoedema. A clinical study

Lymphoedema represents a chronic pathology, that renders patients physically and psychologically disabled, it is not easy to control, and shows a marked tendency to spontaneously set in complications. For such reasons lymphoedema demands for a novel early, targeted and lasting diagnostic and therapeutic approach. In this paper, the role of a diamagnetic pump of new generation in the early treatment of lymphoedema is investigated. A clinical trial shows that the diamagnetic pump, alone or together the classical compressive treatment, leads to an improvement in all the CEAP disease characteristic values

Venous thoracic outlet syndrome: Single center five years experience

BACKGROUND: Patients with thoracic outlet syndrome. can present neurogenic, venous, and/o arterialsymptoms due to compression of the neurovascular structures by the scalene muscle, first rib, or fibrous bands. METHODS: Twenty-six patients underwent decompressive surgery of the thoracic outlet via the supraclavicular approach. The indication for operation was compression of the subclavian artery in 7 instances (5 females and 2 males, aged 44±9), axillo-subclavian venous thrombosis in 6 instances (5 females and 1 male, aged 22±4), and brachial plexus irritation in 13 instances (9 females and 4 males, aged 35±6). Operation consisted of resection of the anterior scalene and medial aspect of the middle scalene muscles and brachial plexus neurolysis for neurogenic indication, with first rib resection reserved for vascular complications. RESULTS: Clinical evaluation including a history and physical examination followed by catheter-based venography to confirm or exclude the diagnosis and allowing for immediate treatment using thrombolysis. After thrombolysis, to prevent early recurrent thrombosis, patients should be maintained with systemic anticoagulation and surgery should be performed earlier in patients with severe residual SCV stenosis. CONCLUSIONS: Early diagnosis and thrombolytic therapy followed by operative first-rib resection produces the most favorable long-term outcome for the patients

Silent Contained Rupture of an Inflammatory IgG4-Related Abdominal Aortic Aneurysm

This report describes a case of a 66-year-old male patient with accidental diagnosis of chronic contained rupture of an aortic aneurysm. Surgery was performed through a median laparotomy. A thick periaortic tissue with fibrosis and lymphnodes covered the AAA. Immunohistochemical examination of the aneurismatic aortic wall revealed intense positivity for inflammatory markers and a large number of immunoglobulin G4 (IgG4) positive cells. The postoperative course was uneventful and patient was discharged in the fifth postoperative day. Patient was then followed periodically at the outpatient rheumatologic clinic. No adverse events occurred during 3 and 6 months follow up. Conclusion: Identification of IgG4-inflammatory aneurysms as an expression of the IgG4-related systemic disease is essential both for clinical follow up and surgical and pharmacological treatment considering the possibility of aneurysm rupture and the involvement of other organs