Alessandro Bacuzzi - Academia.edu (original) (raw)

Papers by Alessandro Bacuzzi

International angiology : a journal of the International Union of Angiology, 2015

AIM The aim of this paper was to evaluate the efficacy, safety, and clinical outcomes of supersel... more AIM The aim of this paper was to evaluate the efficacy, safety, and clinical outcomes of superselective embolization using ethylene-vinyl alcohol copolymer (Onyx Liquid Embolic System; ev3 Neurovascular, Irvine, CA, USA) as the primary treatment in active peripheral emergency arterial bleeding. METHODS Between January 2014 and June 2014, all patients with active peripheral arterial bleeding who were treated by embolization were retrospectively analyzed. We selected 15 (age 37-91 year old) patients embolized with Onyx, chosen as embolic agent in an intention-to-treat fashion. Multidetector computed tomography was performed in all patients. RESULTS Active bleeding was detected in all cases. Digital subtraction angiography confirmed CT findings in all cases. The causes of bleeding were traumatic in 8 patients, angiodysplasia in 1 patient, duodenal ulcer in 1, chronic pancreatitis in 1 and unknown in 4 patients. Nine patients were under anticoagulant or antiplatelet therapy. Embolizatio...

Indian Journal of Anaesthesia, 2019

© 2019 Indian Journal of Anaesthesia | Published by Wolters Kluwer Medknow without any physical s... more © 2019 Indian Journal of Anaesthesia | Published by Wolters Kluwer Medknow without any physical sequels. The patient had difficult airway as described in Figure 1. After premedication with ranitidine (50 mg intravenous), we administered to the patient an aerosol of 1% lidocaine (100 mg) and instilled further 5 mL of 1% lidocaine into the oral cavity for the suppression of the gag reflex and the control of cough. We proceeded with remifentanil infusion with incremental steps from 0.06 to 0.1 μg/kg/min to achieve a Ramsay scale sedation of 2–3. Using the flexible fibreoptic bronchoscope (Olympus MAF-GM Airway MobilescopeTokyo Japan), we visualised the glottis and we additionally instilled 3 ml of 1% lignocaine. The anaesthesiologist noted oedema of soft tissue with hypomobility of the right arytenoid. After several attempts owing to anatomical challenges, the fibrescope entered into the trachea. We advanced the ETT (Shiley Hi-Contour Oral/Nasal Tracheal Tube Cuffed 7.0 mm I.D.  Minneapolis, USA) into the trachea, but there was an impingement of the tracheal tube onto soft tissue structures. For this reason, we inserted a guidewire (Cook Staged Extubation set G24073 , length 145 cm, diameter 0.035 inch Limerick Ireland) through the operative fibreoptic channel and then we withdrew the flexible fibrescope. We inserted an exchange tube (Cook Staged Extubation set G24073 /C-CAE-14.0-83-EXTU, length 83 cm, 14.0 Fr Limerick Ireland), and over the exchange tube, we placed a smaller ETT (Shiley Hi-Contour Oral/Nasal Tracheal Tube Cuffed 6.5 mm I.D. Minneapolis, USA). Further, we advanced the ETT without any resistance. We removed the exchange tube and we administered, intravenous, Awake fibreoptic intubation with a wire‐guide to reduce the impingement of endotracheal tube onto airway soft tissue

World Journal of Surgery, 2018

Background Surgical decision making remains difficult in several patients with aneurysmal disease... more Background Surgical decision making remains difficult in several patients with aneurysmal disease of the descending thoracic (DT) or thoracoabdominal (TA) aorta. Despite previous studies that have investigated aneurysms treated non-operatively using a prospective growth analysis, completeness and accuracy of follow-up were inconsistent. We aim to describe the survival and freedom from adverse aortic events in patients with DT and TA who did not undergo operative repair. Methods This is a single-center retrospective analysis of all patients with either a descending degenerative atherosclerotic or dissection-related DT or TA aortic lesion who were treated non-operatively from April 2002 to December 2016. We studied patients who did not undergo operative repair of descending degenerative atherosclerotic or dissection-related DT or TA aortic lesion. Primary end points were overall survival and freedom from aorticrelated mortality (ARM). Results Of the 315 patients diagnosed with DT or TA disease, 56 (18%) did not undergo surgical repair. Mean aneurysm diameter was 65 mm ± 15 (range 50-120; IQR 5.4-7.15). Extent of the aortic aneurysms was DT in 36 (11%) patients and TA in 20 (6%). Median duration of follow-up was 12 months (range 1-108; IQR 3-36). Over the course of the study, 41 (73%) patients died for an overall survival rate of 53% ± 7 at 1 year (95% CI 40-65) and 23% ± 7 at 3 year (95% CI 17-42.5). Aortic-related mortality was 27% (n = 15), significantly higher in patients with aneurysms C 60 mm [n = 13, (39%) vs. n = 2, (9%); P = 0.025; OR = 5.04]. Overall, estimated freedom from ARM was 81% ± 5.5 at 1 year (95% CI 68-89) and 66.5% ± 9 at 3 year (95% CI 48-81). Only TA extent was independently associated with freedom from ARM during the follow-up (P = 0.005; HR: 5.74; 95% CI 1.711-19.729). Conclusions Thoracoabdominal extent of the aneurysmal aortic disease is the most important predictor of ARM in unrepaired DT or TA aortic diseases. Mortality from aortic-related events was significantly more premature than mortality from non-aortic-related mortality.

Annals of Thyroid, 2018

Thyroidectomy is the main endocrine surgical procedure carried out in the world. Recently, transo... more Thyroidectomy is the main endocrine surgical procedure carried out in the world. Recently, transoral endoscopic thyroidectomy vestibular approach (TOETVA) has showed its beneficial results. The main intraoperative challenges are to avoid events such as pneumothorax and pneumomediastinum due to air insufflation. The anesthetist has to be aware about intraoperative alarming signals and promptly alert surgical staff. Additionally, an adequate preoperative assess is essential to investigate and to treat uncontrolled health status. The primary objective of postoperative pain management is to diminish patient discomfort guarantying an optimal analgesia during speech, chewing and swallowing into postoperative period. A practical approach is described in this manuscript.

The Journal of thoracic and cardiovascular surgery, Jan 22, 2017

The study objective was to describe the results of thoracic endovascular aortic repair with the i... more The study objective was to describe the results of thoracic endovascular aortic repair with the intentional coverage of the celiac artery and distal supramesenteric landing zone for extent type 1 and type 5 thoracoabdominal aortic aneurysms. Inclusion criteria were thoracic endovascular aortic repair with celiac artery coverage to treat elective or urgent extent type 1 and 5 thoracoabdominal aortic aneurysms. Primary end points were in-hospital and follow-up survival, freedom from aortic-related mortality, and freedom from reintervention. Thoracoabdominal disease extent was type 1 in 12 patients (71%) and type 5 in 5 patients (29%). Urgent repair was performed in 4 patients (23.5%). Primary technical success was 100%. Early mortality and visceral ischemia did not occur. Permanent spinal cord ischemia rate was 6% (n = 1). Follow-up ranged from 3 to 120 months (interquartile range, 12-36.5). Survival estimate was 85% ± 9% (95% confidence interval, 67-94) at 1 year and 49% ± 17% (95% c...

The Journal of cardiovascular surgery, Jan 30, 2016

Aim of this study is to report the results of thromboembolectomy (ThEmb) for acute thromboembolic... more Aim of this study is to report the results of thromboembolectomy (ThEmb) for acute thromboembolic lower limb ischemia (ATLI) in native arteries and to create a predictive score for amputation-free survival (AFS) at 30 days. It is a single center, retrospective analysis of a four years period. All patients had ThEmb: adjunctive procedures included femoral and/or popliteal endarterectomy in 30 (18.3%) cases, PTA- stent in 24 (14.6%), and femoral endarterectomy plus PTA-stent in 12 (7.3%). Fasciotomies were performed in 6 (3.6%) patients. Predictors of AFS identified on univariate screen (inclusion threshold, P < .20) were included in a multivariable model. The resulting significant predictors were assigned an integer score to stratify patients into risk groups. Authors analyzed 164 limbs in 164 patients. Mean age was 80 ± 10 years (range, 40-99). In-hospital mortality was 9.8% (n = 16); AFS at 30 days was 84.7% (n = 139). The anatomic level (iliac vs. femoro-popliteal vs. infrapopl...

La radiologia medica, 2006

Purpose. The purpose of this study was to evaluate the incidence and type of complications connec... more Purpose. The purpose of this study was to evaluate the incidence and type of complications connected with percutaneous nephrostomy (PCN) deployment by comparing two different techniques. Materials and methods. In the last 3 years, 299 procedures of nephrostomy were performed on 201 patients (93 women, 108 men; mean age 65.7 years, range 32-102 years) at our Institute; all patients were affected by malignancy. In 44 cases (14.72%), patients presented grade IV hydronephrosis and in 255 cases (85.28%) grade II-III hydronephrosis. In 68 patients (23.07%), the procedure was carried out under emergency conditions because of the rapid worsening of renal function. All procedures were carried out in the angiography room, with the patient lying in a prone or prone-oblique position, under ultrasound and fluoroscopic guidance. Access to the pyelocalyceal system (intermediate or lower calices) was performed by using a Seldinger technique in 255/299 cases, or a one-step technique (OST) in 44 procedures when grade 4 hydronephrosis was present. Statistical analysis of results was performed using bilateral tests on proportions as well as χ 2 test of independence for contingency tables. Results. We observed no major complications. All in all, the rate of minor complications was 3.01% (9/299 cases): 8/255 (3.13%) cases with the Seldinger technique; 1/44 (2.27%) with OST. We observed 43/299 (14.4%) dislodgements: 32/255 (10.70%) with the Seldinger technique and 11/44 (3,68%) with OST. In 4/299 (1.33%), rupture of the catheter occurred, and in 2/299 (0.67%), kinking occurred (in all cases with OST). From the statistical analysis, we conclude that the examination technique modifies the percentage of complications; in particular, it significantly (p<0.05) influences complications connected with the catheter but not minor complications. In addition, the system of fixing does not affect the percentage of dislodgements. Conclusions. PCN is a method with a high percentage of technical success with low rate of complications thanks to combined use of sonographic and fluoroscopic guidance for the procedure. The OST technique is indicated for a highly remarkable hydronephrosis and in cases where the catheter is only placed for a short period. The Seldinger technique is carried out in patients Riassunto Obiettivo. Valutare l'incidenza e il tipo di complicanze associate alle nefrostomie percutanee (NPC) confrontando due tecniche. Materiali e metodi. Negli ultimi 3 anni, sono state eseguite, presso il nostro Istituto, 299 procedure di nefrostomia in 201 pazienti (93 donne, 108 uomini; età media 65,7 anni, range 32-102 anni); tutti i pazienti erano affetti da patologia neoplastica. In 44 casi (14,72%), i pazienti presentavano idronefrosi di IV grado, nelle restanti 255 procedure (85,28%) idronefrosi di II-III grado. In 68 pazienti (23,07%) la procedura è stata effettuata in urgenza in relazione al rapido deterioramento della funzionalità renale. Tutte le procedure sono state effettuate in sala angiografica con paziente in decubito prono o prono-obliquo, sotto guida ecografica e fluoroscopica. L'accesso al sistema pelvi-caliciale (calici intermedi o del gruppo inferiore) è stato effettuato usando la tecnica di Seldinger in 255/299 casi o "one-step technique" (OST) nelle 44 procedure in cui era concomitante idronefrosi di IV grado. L'analisi statistica dei risultati è stata effettuata utilizzando test bilaterali sulle proporzioni e test χ 2 di indipendenza per tabelle di contingenza. Risultati. Non si sono osservate complicanze maggiori. Complessivamente il tasso di complicanze minori è risultato del 3,01% (9/299 casi); 8/255 (3,13%) casi con tecnica di Seldinger; 1/44 (2,27%) casi con OST. Abbiamo osservato 43/299 (14,4%) sposizionamenti: 32/255 (10,7%) con tecnica di Seldinger e 11/44 (3,68%) con OST. Si sono verificate 4/299 (1,33%) rotture del catetere e 2/299 (0,67%) kinking (tutti i casi con OST). Dall'analisi statistica dei risultati si deduce che la tecnica di esame modifica le percentuali di complicanze; in particolare, influenza significativamente (p<0,05) le complicanze legate al catetere, ma non le complicanze minori. Inoltre il sistema di fissaggio non influenza la percentuale di sposizionamenti. Conclusioni. La NPC si conferma metodica con elevata percentuale di successo tecnico e bassi tassi di complicanze ottenibili grazie all'utilizzo combinato del controllo ecografico e fluoroscopico della procedura. La tecnica OST è indicata nel caso di imponente idronefrosi e nei casi in cui la permanenza del catetere sia di breve durata; la tecnica di Seldinger è eseguibile in pazienti con idronefrosi di grado II e III e in previsione di un URO-GENITAL RADIOLOGY RADIOLOGIA URO-GENITALE

Neuromodulation: Technology at the Neural Interface, 2001

Objectives. To evaluate the long-term results of different therapies for failed back surgery synd... more Objectives. To evaluate the long-term results of different therapies for failed back surgery syndrome (FBSS). Materials and Methods. From 1992 to 1997, 49 patients were treated for FBSS. Twenty patients were treated medically. Twenty-four patients, who did not respond to medical therapy, underwent spinal cord stimulator (SCS) implant and five underwent further spine surgery. All patients were evaluated by VAS, PDI, and the Oswestry Scales before treatment and at follow-up. Leg pain, back pain, work status or daily activities, drug side effects, and use of analgesic medications after implantation were examined. Follow-up ranged from 24 to 84 months (mean 42 months). Results. At last follow-up, the patients treated medically demonstrated good results on leg and low back pain in eight cases; in other cases, good results were transitory and several therapeutic courses were necessary to control the pain. Two patients treated medically had substantial side effects. All but two patients treated with SCS demonstrated good results for their leg pain; whereas those treated for back pain with SCS had poor results. Two patients still needed continuous drug administration. Conclusions. Medical therapy is effective for leg and back pain; nevertheless, several courses of therapy may be necessary. SCS is an effective treatment for leg pain, however, its effectiveness on back pain appears to be inadequate.

Anesthesiology, 2013

Background: The impact of intraoperative ventilation on postoperative pulmonary complications is ... more Background: The impact of intraoperative ventilation on postoperative pulmonary complications is not defined. The authors aimed at determining the effectiveness of protective mechanical ventilation during open abdominal surgery on a modified Clinical Pulmonary Infection Score as primary outcome and postoperative pulmonary function. Methods: Prospective randomized, open-label, clinical trial performed in 56 patients scheduled to undergo elective open abdominal surgery lasting more than 2 h. Patients were assigned by envelopes to mechanical ventilation with tidal volume of 9 ml/kg ideal body weight and zero-positive end-expiratory pressure (standard ventilation strategy) or tidal volumes of 7 ml/kg ideal body weight, 10 cm H2O positive end-expiratory pressure, and recruitment maneuvers (protective ventilation strategy). Modified Clinical Pulmonary Infection Score, gas exchange, and pulmonary functional tests were measured preoperatively, as well as at days 1, 3, and 5 after surgery. R...

Abdominal Imaging, 2004

Background: This report describes our preliminary experience in endovascular management of 25 rup... more Background: This report describes our preliminary experience in endovascular management of 25 ruptured abdominal aortic aneurysms (rAAAs). Methods: In the past 3 years we treated 46 patients who had rAAA, and 25 (54.3%) were treated with an endovascular approach. PatientsÕ mean age was 76 ± 9 years. The diagnosis was confirmed by computed tomographic angiography in 23 patients (92%). Mean aneurysm diameter was 73 ± 17 mm. We used an infrarenal bifurcated device in 17 patients (68%), a suprarenal bifurcated in four patients (16%), and an aortomonoiliac graft in four patients (16%). Overall, nine patients (36%) required intensive care. Every patient underwent radiologic follow-up according to the Eurostar register, with concomitant evaluation of the D-dimer level (cut-off <200 lg/L) as a biological marker for endoleaks. Results: The primary technical success rate was 100%. Overall in-hospital mortality rate was 20%. Mean hospitalization was 7 days (range, 3-30), and mean followup was 7 months. One occlusion (4%) of the iliac limb and two type II endoleaks (8%) occurred. The mean D-dimer level in type I endoleak was 1045 lg/L (range, 459-2021). Conclusions: In our experience, endovascular management of rAAA is feasible and safe and produces better results than conventional surgery, provided the morphology is suitable and the procedure is carried out by an experienced endovascular team.

Surgical Oncology, 2007

Colonic stents potentially offer effective palliation for patients with bowel obstruction attribu... more Colonic stents potentially offer effective palliation for patients with bowel obstruction attributable to incurable malignancy, and a "bridge to surgery" for those in whom emergency surgery would necessitate a stoma. Literature search of the Medline, Scopus and Cochrane Library was performed to identify comparative studies reporting outcomes on colonic stenting and surgery for large bowel obstruction; and to identify the use of stents as a "bridge to the elective surgery". Colorectal stenting can be considered a safe and effective procedure with a low mortality and morbidity for both preoperative and palliative decompression of colonic obstruction.

World Journal of Gastroenterology, 2009

Allogeneic blood transfusion during liver resection for malignancies has been associated with an ... more Allogeneic blood transfusion during liver resection for malignancies has been associated with an increased incidence of different types of complications: infectious complications, tumor recurrence, decreased survival. Even if there is clear evidence of transfusion-induced immunosuppression, it is difficult to demonstrate that transfusion is the only determinant factor that decisively affects the outcome. In any case there are several motivations to reduce the practice of blood transfusion. The advantages and drawbacks of different transfusion alternatives are reviewed here, emphasizing that surgeons and anesthetists who practice in centers with a high volume of liver resections, should be familiar with all the possible alternatives.

Updates in surgery, Jan 12, 2017

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a feasible novel surgical proc... more Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a feasible novel surgical procedure that does not need visible incisions. We describe our initial experience with TOETVA. We recruited 15 patients who were willing to undergo TOETVA. Inclusion criteria were (a) patients who had a neck ultrasound (US) with a estimated thyroid diameter not larger than 10 cm; (b) US estimated gland volume ≤45 mL; (c) nodule size ≤50 mm; (d) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter; (e) follicular neoplasm; (f) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through a three-port technique placed at the oral vestibule, one 10-mm port for 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO2 insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sternocleidomastoid mus...

Surgical technology international, Jan 7, 2017

We depict the transoral endoscopic thyroidectomy vestibular approach (TOETVA). Patient selection ... more We depict the transoral endoscopic thyroidectomy vestibular approach (TOETVA). Patient selection criteria are (1) ultrasonographically (US) estimated thyroid diameter no larger than 10cm, (2) US estimated gland volume ≥45mL, (3) nodule size ≥5mm, (4) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter, (5) follicular neoplasm, and (6) papillary microcarcinoma without evidence of metastasis. TOETVA is carried out through a three-port technique placed at the oral vestibule, one 10mm port for 30° endoscope and two additional 5mm ports for dissecting and coagulating instruments. CO2 insufflation pressure is set at 6mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sternocleidomastoid muscles bilaterally. Thyroidectomy is done fully endoscopically using conventional endoscopic instruments. Intraoperative neuromonitoring is used for identification and dissecting and monitoring both...

Gland Surgery, 2016

In this video we describe transoral endoscopic thyroidectomy vestibular approach (TOETVA). Inclus... more In this video we describe transoral endoscopic thyroidectomy vestibular approach (TOETVA). Inclusion criteria are (I) patients who had a ultrasonographically (US) estimated thyroid diameter not larger than 10 cm; (II) US estimated gland volume ≤45 mL; (III) nodule size ≤50 mm; (IV) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter; (V) follicular neoplasm; (VI) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through three-port technique placed at the oral vestibule, one 10-mm port for 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO2 insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sterncleidomuscles. Thyroidectomy is done fully endoscopically using conventional endoscopic instruments and intraoperative neuromonitoring (IONM).

Skeletal Radiology, 2016

To demonstrate the feasibility of percutaneous nucleoplasty procedures at L5/S1 level using cone ... more To demonstrate the feasibility of percutaneous nucleoplasty procedures at L5/S1 level using cone beam CT (CBCT) and its associated image guidance technology for the treatment of lumbar disc herniation (LDH). We retrospectively reviewed 25 cases (20 men, 5 women) of LDH at L5/S1 levels. CBCT as guidance imaging was chosen after a first unsuccessful fluoroscopy attempt that was related to complex anatomy (n = 15), rapid pathological changes due to degenerative diseases (n = 7) or both (n = 3). Technical success, defined as correct needle positioning in the target LDH, and safety were evaluated; overall procedure time and radiation dose were registered. A visual analog scale (VAS) was used to evaluate pain and discomfort pre-intervention after 1 week and 1, 3, and 6 months after the procedure. Technical success was 100 %; using CBCT as guidance imaging the needle was correctly positioned at the first attempt in 20 out of 25 patients. Neither major nor minor complications were registered during or after the procedure. The average procedure time was 11 min and 56 s (range, 9-15 min), whereas mean procedural radiation dose was 46.25 Gy.cm(2) (range 38.10-52.84 Gy.cm(2)), and mean fluoroscopy time was 5 min 34 s (range 3 min 40 s to 6 min 55 s). The VAS pain score decreased significantly from 7.6 preoperatively to 3.9 at 1 week, 2.8 at 1 month, 2.1 at 3 months, and 1.6 at 6 months postoperatively. CBCT-guided percutaneous nucleoplasty is a highly effective technique for LDH with acceptable procedure time and radiation dose.

Jop Journal of the Pancreas, 2014

Context There is little reported experience of irreversible electroporation (IRE) of locally adva... more Context There is little reported experience of irreversible electroporation (IRE) of locally advanced pancreatic tumors (LAP). In literature, few data reported complications. In particular vascular vasoconstriction miming splenic infarcts in humans has never been found. Case report This report describes the onset of asymptomatic multiple little splenic perfusion defects after the treatment of a LAP localized in the boby tail portion of the pancreas with the application of five percutaneous probes for IRE, in a 79 year-old man. Splenic artery was regularly patent but entirely trapped in the tumor. Conclusion To the best of our knowledge, until now, no experience concerning percutaneous IRE of pancreatic cancer described that phenomenon. The cause could not be established with certainty and "vascular lock" may be a valid hypothesis. Additional studies are necessary to evaluate its frequency and its exact pathophysiological cause in humans.

Langenbeck S Archives of Surgery Deutsche Gesellschaft Fur Chirurgie, Jul 23, 2010

Background Standardisation of the intraoperative neuromonitoring (IONM) technique is a fundamenta... more Background Standardisation of the intraoperative neuromonitoring (IONM) technique is a fundamental aspect in monitored thyroid surgery. Vagal nerve (VN) stimulation is essential for problem solving, recognition of any inferior laryngeal nerve (ILN) lesions and prediction of ILN postoperative function. Issues that have been overlooked in the literature, particularly in terms of prospective approaches, are the topographic relationship of the VN with the carotid and jugular vessels as well as the neurophysiology of the VN and ILN that have been studied, with a prospective approach, in patients with various thyroid diseases. Methods Cooperation with the Human Morphology Department resulted in the completion of a dedicated anatomy report, with the clear objective of providing a detailed anatomic and neurophysiologic description of the VN (n=263). Results VN identification and stimulation was feasible in all cases and did not result in increased morbidity or operative time. Most VNs lay on the posterior region of the carotid ship (73%), i.e. the P position in accordance with our model. Mean amplitudes of EMG signals obtained from VN stimulation were 750±279 μV, lower than those obtained with direct INL stimulation (1,086± 349 μV). Conclusion A better understanding of the variability in the VN may be useful not only to minimise complications but also to guarantee an accurate IONM.

La Radiologia Medica, Jun 1, 2006