Papers by Enrico Barbanti
Annals of Vascular Surgery, 2015
The aim of this study was to evaluate the outcome of tapered balloon use in recanalization of lon... more The aim of this study was to evaluate the outcome of tapered balloon use in recanalization of long occlusions of below-the-knee (BTK) arteries in diabetic patients with critical limb ischemia (CLI). Forty-nine occluded BTK arteries in 35 diabetic patients with CLI were revascularized in our Diabetic Foot Center between January and September 2014 using tapered balloons. Twelwe-month outcomes were evaluated in terms of healing of the lesions, survival, limb salvage, primary patency, primary assisted patency, and secondary patency. The patients were predominantly male (27/35, 77.1%) with a mean age of 70.9 years (± 10.3 SD). During the follow-up (mean duration 12.4 months ± 4 SD), healing of the lesions was obtained in 27/35 cases (77.1%). Estimated 12-month survival and limb salvage were 85.7% and 91.1%, respectively. Estimated 12-month primary patency, primary assisted patency, and secondary patency were 78.3%, 79%, and 88.9%, respectively. Univariate analysis demonstrated that the presence of chronic renal failure affected survival (P=.005), and assignment to Rutherford class 6 affected limb salvage (P=.005), primary patency (P<.001), and primary assisted patency (P<.001). Furthermore, presence of coronary artery disease affected primary patency (P=001) and primary assisted patency (P=.05). Tapered balloons are a safe and effective means to recanalize long occlusions of BTK arteries in diabetic patients with CLI. Outcomes are poorer in patients with major tissue loss and with a history of coronary artery disease. Further experience with larger groups is needed to validate these outcomes.
Objective: The aim of this study was to retrospectively evaluate our experience in urgent carotid... more Objective: The aim of this study was to retrospectively evaluate our experience in urgent carotid endarterectomy (CEA) in patients with acute neurological symptoms comparing them with results obtained in stable symptomatic patients in a case-control study. Materials and methods: From January 1996 to December 2005, 3336 consecutive CEAs were performed at our department. In 70 cases CEA was carried out
Interactive CardioVascular and Thoracic Surgery, 2007
The aim of this study was to retrospectively evaluate our experience in urgent carotid endarterec... more The aim of this study was to retrospectively evaluate our experience in urgent carotid endarterectomy (CEA) in patients with acute neurological symptoms comparing them with results obtained in stable symptomatic patients in a case-control study. From January 1996 to December 2005, 3336 consecutive CEAs were performed at our department. In 70 cases CEA was carried out in patients with acute neurological deficit; in all these patients, clinical presentations were recent (<24 h) or crescendo (defined as two or more episodes in 24 h, with complete recovery after each episode) TIAs (group 1). The control group was randomly obtained from our historical database and consisted of 352 stable symptomatic patients operated on in the same period (group 2). Early (30-day) results in the two groups were compared by chi(2) and Fisher exact tests; follow-up data were analysed by life-table analysis (Kaplan-Meier test) and results in subgroups were compared by means of log-rank test. Considering mortality and any neurological morbidity, the patients of group 1 showed a cumulative rate of death and neurological complication significantly higher than those in group 2 (5.4% and 0.3%, respectively; P=0.005); however, when analysing 30-day disabling strokes and deaths, the patients of group 1 had a cumulative complication rate of 1.4%, whereas in group 2 the corresponding figure was 0.3% (P=n.s.). In patients of group 1, univariate analysis and logistic regression for multivariate analysis for 30-day risk of stroke and death did not show any influence of comorbidities, clinical status, anatomical and surgical features. Estimated cumulative 36-month survival was significantly better in group 2 than in group 1. Considering the absence of ipsilateral stroke at 36 months, there were no differences between the two groups; however, analysing the estimated absence of any neurological events, both ipsilateral and contralateral, at 36 months, patients of group 1 had a higher risk than those of group 2. Urgent CEA in patients with recent/crescendo TIA and appropriate carotid artery lesion, carries good early and long-term results, which, however, remain slightly poorer than those obtained in symptomatic patients with a stable neurological status.
Journal of Vascular Surgery, 2014
Background: Neurologic outcome after early or delayed carotid endarterectomy (CEA) has yet to be ... more Background: Neurologic outcome after early or delayed carotid endarterectomy (CEA) has yet to be fully elucidated. The aim of this study was to determine 30-day neurologic improvement with respect to the timing of CEA in symptomatic patients. Methods: Single-institution review of consecutive patients who underwent CEA for symptomatic carotid stenosis 60% in the period between January 2009 and November 2013. Patients recruited had acute neurologic impairment on presentation, defined as <5 points on the National Institutes of Health Stroke Scale (NIHSS). Patients were grouped according to time between the qualifying event and surgery (0e14 days, early CEA and 15e30 days, delayed CEA). Thirty-day neurologic status improvement was defined as a decrease (1) in the 30-day NIHSS score versus NIHSS score immediately before surgery. Results: There were 100 and 222 patients in the early and delayed CEA groups, respectively. The type of qualifying symptoms (stroke versus transient ischemic attack rate) was similar and there were no significant differences in 30-day adverse outcome rates between the 2 cohorts. There were no deaths, 4 strokes (1.2%, 3 vs. 1; P ¼ 0.091), and 4 myocardial infarcts (1.2%, 0 vs. 4; P ¼ 0.315). Thirty-day improvement in neurologic status was associated with early CEA, very early CEA (48 hours), and NIHSS >2 before surgery, with an odds ratio of 4.9 (confidence interval [CI], 0.9e25.7; P ¼ 0.03), 12.9 (CI, 1.4e115.7; P ¼ 0.02), and 2.6 (CI, 1.7e4.1; P < 0.001), respectively. Conclusions: Our results suggest that reducing the time to intervention in selected (NIHSS <5) symptomatic patients is safe and associated with improved neurologic status.
The American Journal of Surgery, 2005
High surgical risk is advocated as a major criterion for carotid artery stenting. To date, defini... more High surgical risk is advocated as a major criterion for carotid artery stenting. To date, definitely accepted criteria to identify &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;high-risk&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; patients for carotid endarterectomy (CEA) do not exist. The aim of this study was to analyze the statistical weight of each single previously described risk factor on early and late results after carotid surgery in our experience. A retrospective review of 1,883 CEAs performed during a 6-year period in a single institution was performed. Early and late results in terms of mortality and neurologic events were recorded. Univariate and multivariate analysis for early and late risk of stroke and death were performed, considering the influence of age, sex, comorbidities, clinical symptoms, and anatomic features. The cumulative 30-day stroke and death rate was 1.3%. Univariate analysis and logistic regression did not show statistical significance for 30-day results in any of the considered variables. The three-year stroke-free survival was 94.5%, and it was significantly affected by chronic renal failure, respiratory insufficiency, and older age. Carotid endarterectomy is a safe procedure also in so-called high-risk subsets of patients. Severe comorbidities seem to affect only long-term survival.
Journal of Vascular Surgery, 2004
A 78-year-old woman was admitted to our department because of the incidental finding during routi... more A 78-year-old woman was admitted to our department because of the incidental finding during routine abdominal ultrasound examination of a large aneurysm of the superior mesenteric artery. Presence of the aneurysm was confirmed at computed tomography and digital subtraction angiography, but its inflammatory origin was not recognized. No other aneurysm localization was found. Macroscopic intraoperative findings suggested the inflammatory nature of the lesion, but only histopathologic examination was diagnostic. Aneurismorraphy with prosthetic in-line reconstruction was performed. This report presents the previously undescribed possibility of an isolated inflammatory aneurysm of the superior mesenteric artery. (J Vasc Surg 2004;39:903-5.)
The Journal of Thoracic and Cardiovascular Surgery, 2002
We sought to determine the results of surgical treatment of patients with tetralogy of Fallot and... more We sought to determine the results of surgical treatment of patients with tetralogy of Fallot and pulmonary atresia with or without major aortopulmonary collateral arteries, to clarify variables affecting early and late mortality, and to expose late, nonfatal events affecting surgical patients.
European Journal of Vascular and Endovascular Surgery, 2002
Objective: to evaluate early and mid-term term results of carotid endarterectomy (CEA) in patient... more Objective: to evaluate early and mid-term term results of carotid endarterectomy (CEA) in patient with and without contralateral carotid occlusion. Methods: between 1996Methods: between and 1999Methods: between , 1324 CEAs were performed. In 82 patients contralateral carotid artery occlusion was present (group I); 1242 patients had patent contralateral carotid (group II). All patients were operated under general anaesthesia, and selective shunting was based on somatosensory evoked potentials (SEPs). Ultrasonographic follow-up was performed at 1, 6 and 12 months and then once a year. Early results and follow-up data were analysed retrospectively. Results: in group I there was a significantly higher incidence of SEPs reduction and shunt insertion; however, there were no differences in terms of perioperative complications. The cumulative stroke and death rate at 30 days in group 1 and group 2 were 2.4% vs 1.4% (p n.s.), respectively. At a mean follow-up of 15 months there were no differences between the two groups in terms of cumulative symptom-free survival. Conclusions: the presence of contralateral carotid occlusion caused an increased use of shunt, but not in early complications rates.
European Journal of Vascular and Endovascular Surgery, 2006
Objective. Intraoperative quality control after carotid endarterectomy (CEA) has been advocated t... more Objective. Intraoperative quality control after carotid endarterectomy (CEA) has been advocated to improve the results of surgical treatment of extracranial carotid artery disease. The aim of this study was to evaluate the usefulness of completion angiography (CA) in prevention of stroke and restenosis after CEA in a single center experience. Materials and methods. Data concerning 914 consecutive CEAs performed in 3 years (2000e2002) were prospectively collected in a dedicated database. Patients were divided into two groups: in the first group (mandatory-CA group; 430 cases) CA was routinely carried out, except in presence of contraindications to iodinate contrast agents; in the second group (selective-CA group, 484 cases) CA was performed only in selected cases, at surgeon's discretion.
European Journal of Vascular and Endovascular Surgery, 2004
Aim of the study. To assess the feasibility and effectiveness of a modified surgical technique wi... more Aim of the study. To assess the feasibility and effectiveness of a modified surgical technique with early clamping of the distal internal carotid artery (ICA) during carotid endarterectomy in a single centre experience. Study design. Retrospective study, teaching hospital. Material and methods. Between 1996 and 2002, 2235 CEAs were performed. Until April 1999, the intra-operative strategy consisted of standard isolation and dissection of the carotid bifurcation preliminary to ICA clamping (group 1; 1090 interventions). Starting from May 1999, we performed early isolation and clamping of the distal ICA, followed by dissection of the carotid bifurcation and clamping of the external and common carotid artery (group 2; 1145 interventions). Results. The modified technique was feasible in all the patients of group 2. In group 2 there was a significantly lower incidence of neurological deficit on waking than in group 1 (0.4% and 1.8%, respectively; pZ0.02). Conclusions. Early distal control of the internal carotid artery during CEA is feasible and could contribute to reducing intra-operative neurological events.
Cardiovascular Revascularization Medicine, 2013
Subclavian steal syndrome typically presents as angina in patients with internal mammary artery g... more Subclavian steal syndrome typically presents as angina in patients with internal mammary artery grafts. Atypical clinical presentations have been rarely described. We report an unusual case of subclavian steal syndrome presenting as pulmonary oedema with acute left ventricular diastolic dysfunction and preserved ejection fraction in a patient with internal mammary artery graft and severe stenosis of the proximal left subclavian artery. After successful angioplasty and stenting of subclavian artery, the patient remained asymptomatic for six months, but then experienced acute diastolic dysfunction and recurrent pulmonary oedema associated with critical subclavian in-stent restenosis with stent deformation. This report points out that, in patients with internal mammary-to-LAD grafts, subclavian steal syndrome may present as acute left ventricular diastolic dysfunction and pulmonary oedema even in the presence of normal ejection fraction.
The American Journal of Surgery, 2001
Background: This retrospective study was conducted to describe the presentation, surgical treatme... more Background: This retrospective study was conducted to describe the presentation, surgical treatment, and follow-up of patients with splenic artery aneurysms. Methods: From 1982 to 2000, 1,952 patients with abdominal aneurysms were referred to our department; 15 had splenic artery aneurysms. None had ruptured. All were operated on. Results: Fourteen complete and 1 partial aneurysmectomies were carried out. Arterial continuity was restored in 10, by end-to-end anastomosis, and 4 had splenectomies. In 1 patient the spleen was preserved without arterial reconstruction. There were no deaths. Morbidity was restricted to 1 patient with a limited, asymptomatic splenic infarction. Eleven patients were followed up for a mean 19.7 months. No deaths or major complications were recorded. Reconstructed splenic arteries were patent in all cases without atrophy or new cases of splenic infarction. Conclusions: Elective surgery for splenic artery aneurysms is safe. Arterial reconstruction allows good early and long-term results. In some cases splenectomy may be unavoidable.
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Papers by Enrico Barbanti