A Arpesani

University of Milan

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P. L. Giorgetti

IRCCS Policlinico San Donato

U Ruberti

University of Milan

Vincenzo Rampoldi

IRCCS Policlinico San Donato

Giorgetti Pl

Ospedale Maggiore

M Cugnasca

Istituti di Ricovero e Cura a Carattere Scientifico

E Bortolani

University of Milan

Attilio Odero

Policlinico San Matteo Fondazione

S Selva

University of Bologna

A Rignano

University of Milan

F Giordanengo

University of Milan

Cooperative Institutions

University of Milan

Istituti di Ricovero e Cura a Carattere Scientifico

Ospedale Maggiore

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico

University of Pavia

Ospedale San Donato

IRCCS Policlinico San Donato

University of Milano-Bicocca

University Medical Center Utrecht

Policlinico San Matteo Fondazione

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Abdominal aortic aneurysms surgery in over 75 years old patients. Experience in 142 cases treated between 1980-1989.

PubMed (1991)

P. L. Giorgetti A Arpesani E Bortolani Vincenzo Rampoldi A Rignano

The paper describes the Authors' experience of abdominal aortic aneurysm surgery in over 75-year-old patients. One hundred and forty-two cases were operated over a 10-year period (1980-89). Seventy-two patients were treated electively and 70 underwent emergency surgery following rupture of the aneurysm. Operative mortality during elective surgery was comparable to that in younger patients, whereas the mortality rate during emergency surgery was notably higher than that in under 75-year-old patients. Follow-up confirmed that the life expectancy of operated patients is significantly better than that of patients with untreated abdominal aortic aneurysms.

Emergency Surgery

Elective surgery

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Citations (4)

[Atheromatous material mobilization syndrome after thrombolytic therapy with streptokinase in acute myocardial infarct].

PubMed (1991)

A Arpesani Luigi Beretta P. L. Giorgetti C Varesi Luigi Matturri

Streptokinase fibrinolysis is a widely accepted and applied therapy in acute myocardial infarction with good clinical and ECG results. Nevertheless this therapy is not devoid of complications that sometimes can be very serious. In this paper the Authors report the case of a patient 52 years old who has been treated with streptokinase for an acute myocardial infarction with good ECG results but that about eight hours later showed an important cholesterol embolization syndrome with visceral and lower extremity lesions. The patient died about 36 hours later. The Authors emphasize the necessity to exclude aortic aneurysm before using thrombolytic agents and to evaluate carefully the possibility to abstain from this procedure in the presence of certain aneurysmal lesions.

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[Wall stress in the assessment of left ventricular function in surgery of abdominal aortic aneurysm. Validity and importance of transesophageal echocardiography (TEE) in intraoperative monitoring].

PubMed (1994)

Gian Battista Anguissola R. Mangiarotti A Pierini L Lubatti Elena Conti

To verify the applicability and the clinical significance of left ventricular wall stress determinations by intraoperative transesophageal echocardiography (TEE) during resections of abdominal aortic aneurysms.Prospective comparison of changes in left ventricular wall stress between two groups of patients with and without coronary artery disease.Operatory room of Universitary Institute.Twenty-three patients with abdominal aortic aneurysms; 8 had clinically evident coronary artery disease (CAD+); 15 patients did not have clinical or electrocardiographic evidence of coronary artery disease (CAD-).Resection of the aortic aneurysm and insertion of a synthetic prosthesis.During operation transesophageal monitoring of left ventricular volumes and wall stress was performed during induction of anesthesia (T1), for two minutes after aortic clamping (T2), at the end of the proximal anastomosis (T3), for two minutes after aortic declamping (T4) and at the end of the procedure (T5). Circumpherential stress at end systole (sES) and end diastole (sED) was more sensitive than hemodynamic and volumetric parameters in detecting changes i function of the ischemic myocardium. In detail we observed: a significant increase of sES in CAD+versus CAD- at T2: 98 (sd 18) vs 83 (sd 14) 10(3) dyne/cm2. a significant increase of sED in CAD + versus CAD- at T2: 28.5 (sd 6) vs 22 (sd 4.5) 10(3) dyne/cm3. a similar trend of sES and sED at T4: 73 (sd 20.5) vs 46 (sd 15) 10(3) dyne/cm2 and 31 (sd 12) vs 16 (sd 7.7) 10(3) dyne/cm2 respectively. a significant increase of sED in CAD + at T5 (about 20' after T4): 26.5 (sd 9.5) vs 16 (sd 5.2) 10(3) dyne/cm2 which is expression of a persistent reduction of ventricular compliance in the ischemic patients.Wall stress modifies MVO2 and subsequently is sensitive in detecting changes in myocardial performance. TEE could valuably integrate routine hemodynamic monitoring of patients with coronary heart disease who undergo surgical resection of abdominal aortic aneurysms.

Abdominal aorta

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[Clinical observations on 38 cases of inflammatory aneurysm of the abdominal aorta out of a total of 2014 operated cases].

PubMed (1991)

A Arpesani P. L. Giorgetti F Giordanengo S Miani Vincenzo Rampoldi

The paper reviews 2014 cases of aneurysm of the abdominal aorta treated over the past 10 years at the Institute of General and Cardiovascular Surgery of the University of Milan directed by Prof. Ugo Ruberti, and analyses 38 which showed inflammatory characteristics. In spite of the low frequency of this type of aneurysm (1.8%), preoperative diagnosis is important since surgery entails greater technical difficulties than surgery for an atherosclerotic aneurysm of the abdominal aorta. In this respect the study of preoperative ESR and white blood cell levels is important: the review showed an increased ESR in 71% of cases in which the aneurysm was clearly inflammatory (a percentage which was twice that found in patients with atherosclerotic aneurysms) and increased white blood cells in 32% of cases compared to 2.6% in atherosclerotic aneurysms. Contrary to previous reports, CAT and abdominal echography were not particularly important. However, in those cases where the aneurysm was thought to be inflammatory on the basis of these findings, the Authors chose to operate once the diagnosis had been made without waiting for steroid therapy to reduce the extent of inflammation due to the well-known risk of rupture and the controversial efficacy of medical therapy.

Abdominal aorta

White blood cell

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Citations (2)

[Local arteriovenous wash-out in acute ischemia of the extremities. A method of preventing the revascularization syndrome following thromboembolectomy].

PubMed (1987)

Giorgetti Pl L Lubatti M Cugnasca A Arpesani Andrea Odero

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Surgical treatment of abdominal aortic aneurysm. A ten-year experience (1980-1989) referred to 1725 patients operated on.

PubMed (1991)

U Ruberti A Arpesani P. L. Giorgetti E Bortolani G Ghilardi

The authors' experience of surgical management of abdominal aortic aneurysms (AAA), in 1725 consecutive patients, operated on in a ten years period (1980-1989) is presented. Surgical indications, operative technique, and outcome of elective and emergency procedures are analyzed. A ten years follow-up period is also presented. This shows a significantly better survival rate in surgically treated patients than in nonoperated cases.

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Splanchnic artery aneurysms.

PubMed (1993)

S Miani A Arpesani P. L. Giorgetti Vincenzo Rampoldi F Giordanengo

From 1970 to October 1991, 26 patients affected by splanchnic artery aneurysms were observed and treated at the Department of General and Cardiovascular Surgery, University of Milan, Italy. Three splanchnic artery aneurysms were operated on in emergency. Visceral artery aneurysms are often completely silent and are generally detected during diagnostic procedures performed in order to clarify some diagnostic questions. When symptomatic they present a characteristic clinical picture of the involved vascular district. Two patients affected by aneurysmal disease of the proper hepatic artery died after operation. All the other splanchnic aneurysms underwent a successful surgical procedure. This study is aimed at analyzing some characteristic clinical pictures, diagnostic methods, therapeutic procedures and postoperative results.

Splanchnic Circulation

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[Natural history and course of aneurysmal disease in patients operated on for abdominal aortic aneurysms].

PubMed (1994)

S Miani M Boneschi A Arpesani Giorgetti Pl Giuffrida Gf

This study is aimed at analyzing our experience in the evolution of aneurysmatic disease after surgical treatment of the typical subrenal abdominal aortic aneurysm. In fact in some cases we reobserved these patients for the onset of a new important dilatation involving the proximal tract of the abdominal aorta or the common iliac arteries. From 1980 to December 1992, 24 patients out of a group of 1508 patients previously submitted to an aorto-aortic or aorto-iliac reconstructive procedure using dacron prosthetic grafts were reoperated for relapsing aneurysmatic disease. In six cases the dangerous ectasia was located above the proximal aortic anastomosis; in four patients the re-reconstructive procedure was performed clamping the subdiaphragmatic abdominal aorta and performing the proximal anastomosis just below the ostia of the renal arteries. In two cases the aneurysmatic process involved the origins of the visceral vessels and a left thoracophrenolaparotomic access was necessary in order to perform a thoracoabdominal reconstruction reimplanting the visceral arteries on the prosthetic graft. In 18 cases the progressive aneurysmatic process involved the common iliac axis provoking, in some cases, a kinking or a shortening of the aortic prosthetic graft. The results of these reintervention are good with no mortality at operation and a satisfactory middle term (average 3 years) follow-up. Our investigation demonstrates that in a small, but significant (1.6%) percentage of patients the aneurysmatic disease spreads upward and downward involving arterial segments formerly non affected.

Ectasia

Abdominal aorta

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Citations (2)

Cardiological risk in patients undergoing abdominal aortic aneurysm surgery. An analysis of 523 cases.

PubMed (1991)

A Arpesani Giorgetti Pl Rampoldi Bordoni Mg Anguissola Gb

The paper reports a consecutive series of 523 patients undergoing abdominal aortic aneurysm surgery, paying particular attention to the cardiological risk factor. Coronary disease was present in 167 (31.9%) cases and the overall mortality rate was 1.7%: 5 cases (3%) in the group of coronary disease patients; 4 cases (1.2%) in the group of noncoronary disease patients. All fatal cardiac complications during the postoperative period occurred in those patients who presented coronary cardiopathies before surgery. The preoperative cardiological risk was therefore much greater and more significant in this group of patients. This risk factor should therefore be assessed prior to the operation in order to prepare the necessary medical or even surgical therapeutic measures.

Coronary disease

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Locoregional fibrinolysis using tissue plasminogen activator in 2 cases of acute thrombosis of the renal artery.

PubMed (1991)

Giorgetti Pl A Lovaria S Saccheri A Arpesani A Rignano

The use of tissue plasminogen activator gave good results in the treatment of acute coronary thrombosis. Comparable results appear to have been obtained in the first clinical trials in cases of acute thromboses of the peripheral arteries. A successful experiment in the locoregional treatment of acute thrombosis of the renal artery is reported.

T-plasminogen activator

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