Acute thoracoabdominal aortic aneurysms (aTAAA) are an uncommon and lethal condition associated with an extremely high mortality and morbidity rates. Both endovascular and open repair may be offered in emergency. aim of this study is to report our results and present a literature review regarding endovascular and open surgical repair of aTAAA.MEDLINE, EMBASE, and the Cochrane Library CENTRAL databases were searched from 1991 to 2016. Also, a retrospective analysis of all consecutive patients who underwent aTAAA open and endovascular treatment at our Institution between 1993 and 2016 was performed.From the literature search 671 patients who underwent open repair and 26 patients treated with endovascular techniques were found. Contained rupture (56.98%) was the most common clinical presentation of aTAAA and operative mortality ranged from 11.7% to 27.4%. The overall 30-days survival rate ranged from 73.5% to 87.5%. At 5-year and 10-years, survival rate was 48% and 35%, respectively. At our Institution, 12 patients were operated for an aTAAA; mortality rate was 58.3% (7/12 cases). Since 2014, 7 additional patients have been treated by means of endovascular techniques. The 30-day survival was 100%.aTAAA is a threatening condition, however, the overall literature results do not reflect this scenario because stable patients and cases limited to the descending thoracic aorta are usually considered together with TAAA ruptures. The endovascular treatment may be a very valuable alternative although it is still limited by anatomic and logistic issues and only case reports and short series are reported in literature.
Background During the first phase of coronavirus disease-2019 (COVID-19) pandemic in Italy, several strategies have been taken to deal with the pandemic outbreak. Aim of the study To report the remodeling of the Vascular Surgery Department of San Raffaele Hospital as regards the strategies of preparation, escalation, and return to normal activities during the COVID-19 pandemic. Preparation, escalation, de-escalation The Regional Authority of Lombardy remodeled the hospitalization system to allocate appropriate resources to treat patients with COVID-19 and to identify "Hub/Spoke" hospitals for highly specialized medical activities. The Hubs hospitals were required to guarantee full-time evaluation of all patients presenting with cardiovascular diseases with an independent pathway for patients with suspect or confirmed COVID-19 infection. San Raffaele Hospital was identified as Hub for cardiovascular emergencies and the Vascular Surgery Department was remodeled to face this epidemic situation. Surgical treatment was reserved only to symptomatic, urgent, or emergent cases. Large areas of the hospital were simultaneously reorganized to assist patients with COVID-19. Results During this period, 135 patients were referred to San Raffaele Vascular Surgery Department. COVID-19 was diagnosed in 24 patients and, among them, acute limb ischemia was the most common cause of admission. At this time, the COVID-19 trend is in decline in Italy, and the local authorities reorganized the healthcare system to return to normal activities avoiding new escalations of COVID-19 cases. The COVID-19 pandemic will be remembered in Lombardy as a cataclysm. Nevertheless, the HUB/spoke system has proven to be a valid model in the management of ischemic emergencies. Continuous surveillance, cooperation, coordination, and communication to effectively respond to COVID-19 pandemic is crucial because COVID-19 reference centers could face similar issues in the near future.
Endovascular treatment of complex thoracic pathologic conditions involving the aortic arch can often be appropriate and safe; however, minimally invasive procedures are not always feasible, especially in emergent cases. We report the case of a 78-year-old woman who emergently presented in hemorrhagic shock with a ruptured chronic dissecting aneurysm that involved the aortic arch. Eight years earlier, she had undergone aortic valve replacement and plication of the ascending aorta, which was complicated a day later by Stanford type B dissection, malperfusion, and ischemia that required an axillobifemoral bypass. At the current admission, we successfully treated her surgically through a left thoracotomy, using moderate hypothermic extracorporeal circulation and advanced organ-protection methods. We discuss the surgical indications and our operative strategy in relation to open surgical repair versus endovascular treatment in patients with complex conditions.
During the first phase of COVID-19 pandemic in Italy, several strategies have been taken to deal with the pandemic outbreak. The Regional Authority of Lombardy remodeled the hospitalization system in order to allocate appropriate resources to treat COVID-19 patients and to identify "Hub/Spoke" hospitals for highly specialized medical activities. The Hubs hospitals were required to guarantee full time evaluation of all patients presenting with cardiovavascular diseases with an independent pathway for patients with suspect or confirmed COVID-19 infection. San Raffaele Hospital was identified as Hub for cardiovascular emergencies and the Vascular Surgery Department was remodeled to face this epidemic situation. Surgical treatment was reserved only to symptomatic, urgent or emergent cases. Large areas of the hospital were simultaneously reorganized to assist COVID-19 patients. During this period, 135 patients were referred to San Raffaele Vascular Surgery Department. COVID-19 was diagnosed in 24 patients and, among them, acute limb ischemia was the most common cause of admission. At this time, the COVID-19 trend is in decline in Italy and the local authorities reorganized the health care system in order to return to normal activities avoiding new escalations of COVID-19 cases. Several strategies have been taken to ensure the safety of the San Raffaele hospital, and maintaining potentially suspected patients with COVID-19 separated from other patients. The aim of this paper is to report the remodeling of the Vascular Surgery Department of San Raffaele Hospital as regards the strategies of preparation, escalation, de-escalation and return to normal activities during the COVID-19 pandemic.
