Research areas and methodologies

Our interest is focused on all fields of arterial surgery, from carotid endarterectomy for stroke prevention up to plantar bypasses for limb salvage, including all aortic pathologies. Analyzing the effectiveness of endovascular treatment in case of use within the specific instructions of the products. Vascular reconstruction after en bloc resection for tumor pathologies is our specific field of interest.

The decision flowchart impacts on the survival of patients with critical lower limb ischemia

We have already demonstrated that endovascular methods and the traditional surgical technique are two complementary methods in the treatment of critical ischemia, on different pathological patterns. While most patients with rest pain can be successfully managed by endovascular therapy, regardless of TASC class II, patients with extensive necrosis and loss of substance are best treated with bypass surgery. In the last year we have updated our series and redefined a diagnostic algorithm based on ultrasound criteria. The significant improvement in the survival rate of our patients, compared with the main series, confirmed the goodness of our approach.

EVAR: How to make the conversion of patients with suprarenal coupling endoprosthesis safe

Endovascular treatment of endoleaks is not always possible, and in some cases surgical conversion is necessary. In the case of suprarenal locking endoprosthesis this procedure is more complex. Following the principle of aneurysm repair with the minilaparotomic technique, we have proposed this approach to make conversions safer by avoiding the removal of the entire endoprosthesis. This is based on the following principles:

1 Horizontal clamping of the aorta, close to the renal arteries, without mobilizing the endograft

2 Opening of the aneurysm sac and clamping of the iliac branches with delicate instruments close to the aortic bifurcation.

3 Separation of the graft from the proximal part 5-10 mm below the proximal clamp, and cutting of the iliac branches within the pouch as distally as possible. Metallic stents can be sectioned with the aid of dedicated instruments. Removal of the central part of the graft, leaving the aortic and iliac stumps in place.

4 Removal of the thrombus and suturing of the open lumbar arteries

5 Passing a bending of Teflon around the Aorta close to the proximal clamp and implantation of a new bifurcated prosthesis sewn with the remaining part of the endoprosthesis, the aortic wall and the bending external to obtain a safe and stable proximal anastomosis, reinforced internally by the endoprosthesis and externally by the bending of Teflon, without removal of the suprarenal metal stent.

6 Anastomosis between the iliac branches of the surgical graft with the iliac branches of the endoprosthesis and closure of the bag.

Without the need to gain distal control, minilaparotomy access has proven adequate, and patients have benefited from this minimally invasive technique.

In the last 2 years we have treated 11 patients without complications, with an average blood loss of 380 ml, and an average postoperative stay of 5 days.

Restenosis after CEA: carotid bypass versus CAS

Restenosis after CEA is usually treated by CAS. The latest reports have demonstrated suboptimal results.

We have already reported our experience of carotid restenosis treated by carotid venous bypass in patients with long life expectancy. We updated the data with late controls that are in favor of this technique versus CAS.

The endovascular and surgical treatment of atheroembolism of aortic origin leading to peripheral pathology

Critical peripheral ischemia secondary to atheroembolism of aortic origin is less rare than one might think.

It is an insidious pathology which, if unacknowledged, can lead to treatment failure with bad results. Endovascular coverage, associated with a femoral-distal bypass seems to be a valid and long-lasting solution. We reanalyzed our series of hybrid procedures, described the diagnostic workout, the technique and showed the results.

Collaborations with other research centres

  • UNIVERSITY OF OXFORD; Oxford, UK.
  • UNIVERSITY OF MESSINA AND GENOA FOR MINISTERIAL RESEARCH PROJECT: RF-2018-12367242 ON CAROTID PLATES
  • GEMELLI UNIVERSITY POLICLINICAL FOUNDATION IRCCS, ROME, PROJECT ON COVID OUTCOMES AND FOLLOW-UP IN EVAR
  • UNIVERSITY OF CALIFORNIA, LOS ANGELES, USA. STUDY GROUP ON VERY LOW FREQUENCY VASCULAR DISEASES
  • FACTCATS STUDY GROUP ON NEUROVASCULAR PATHOLOGY