E. Sbarigia | Università degli Studi "La Sapienza" di Roma (original) (raw)
Papers by E. Sbarigia
International angiology : a journal of the International Union of Angiology, 2005
To determine the best treatment for high-risk patients with abdominal aortic aneurysms (AAA). We ... more To determine the best treatment for high-risk patients with abdominal aortic aneurysms (AAA). We reviewed a prospective database of all patients who underwent conventional (OPEN) or endovascular aneurysm repair (EVAR) between January 1998 and December 2002. Patients were preoperatively classified according to the American Society of Anesthesiology (ASA). Comorbidities and medical risk factors were categorized according to the Ad Hoc Committee on Reporting Standards. Perioperative mortality and morbidity rates were analyzed according to the type of surgical procedure (OPEN vs EVAR) and ASA class. Patients in ASA classes I and II were excluded. Continuous data were expressed as mean +/- standard deviation. All data were calculated using the cumulated actuarial method of event outcome probability. Kaplan-Meier curves were constructed and the log-rank statistic and chi squared test were used for comparative data. P values less than 0.05 were considered to indicate statistical significan...
Minerva cardioangiologica, 1999
Vascular, 2010
The purpose of this study was to seek factors predicting outcome after open surgical repair of ju... more The purpose of this study was to seek factors predicting outcome after open surgical repair of juxtarenal abdominal aortic aneurysms (AAAs). From a series of 733 patients treated for AAAs, 92 patients underwent elective conventional open repair with suprarenal clamping. We assessed postoperative cardiorespiratory and renal morbidity and mortality and survival at 1, 3, and 5 years. One patient (1.1%) died after an acute myocardial infarction. Postoperative complications including myocardial infarction and renal failure arose in 22 patients (23.9%). Significant predicting factors of renal failure were a preoperative creatinine clearance ≤ 40 mL/min ( p = .03) and female sex ( p = .004). Kaplan-Meier survival analysis showed an overall survival rate of 98.9% at 1 year and 88.6% at 3 and 5 years. In patients carefully selected by preoperative imaging criteria to undergo open juxtarenal AAA repair, appropriate intraoperative management guarantees a good immediate postoperative outcome.
Circulation, 2000
Background —Accumulation of LDL within the arterial wall appears to play a crucial role in the in... more Background —Accumulation of LDL within the arterial wall appears to play a crucial role in the initiation and progression of atherosclerotic plaque. The dynamic sequence of this event has not been fully elucidated in humans. Methods and Results —In 7 patients with previous transient ischemic attack or stroke and critical (>70%) carotid stenosis, autologous native [ 125 I]-labeled LDL or [ 125 I]-labeled human serum albumin were injected 24 to 72 hours before endarterectomy. Carotid specimens obtained at endarterectomy were analyzed by autoradiography and immunohistochemistry. Autoradiographic study showed that LDL was localized prevalently in the foam cells of atherosclerotic plaques, whereas the accumulation in the lipid core was negligible. Immunohistochemistry revealed that foam cells that had accumulated radiolabeled LDL were mostly CD68 positive, whereas a small number were α-actin positive. No accumulation of the radiotracer was detected in atherosclerotic plaques after inj...
European Journal of Vascular and Endovascular Surgery, 2014
Response to 'Re. Benefits of Remote Ischemic Preconditioning in Vascular Surgery' The authors mak... more Response to 'Re. Benefits of Remote Ischemic Preconditioning in Vascular Surgery' The authors make a good point: discrepancy between animal and clinical data is multifactorial, and the factors they cite are likely to be an influence. The most recent, properly powered randomised controlled trial (RCT) of remote ischaemic preconditioning (RIPC) in cardiac surgery avoided the use of volatile anaesthetic agents to avoid pharmacological preconditioning. 1 This trial showed no difference between the RIPC and no RIPC groups. Conversely, the large RIPCON (Remote Ischemic Pre-Conditioning) trial of RIPC in cardiac surgery is currently recruiting using volatile agents to avoid remifentanyl, 2 which is also associated with pharmacological preconditioning. 3 This highlights one of the problems with medications and RIPC: it might be impossible to avoid those that effect RIPC completely, but trials can adjust for the least powerful. Additionally, patients might fare worse with the preconditioning effect of RIPC than they would have done with the preconditioning effect of the medication being withheld. Another problem is that the mechanisms of interference are still poorly understood, and it is likely that additional, commonly prescribed medicines have an effect on RIPC. 3,4 Other factors such as diabetes are common in vascular patients should be corrected for if trials are properly powered. Protocols for other trials currently or about to recruit are heterogeneous in their approach to correcting for these factors. To date, 102 trials of remote ischaemic preconditioning are registered on ClinicalTrials.gov. It is imperative that trialists recognise and attempt to correct for these factors as early as possible. Without this, we risk publishing large, flawed trials that essentially destroy all interest in RIPC without a rigorous method.
Journal of Vascular Surgery, 2012
The purpose of this study was to examine the safety of emergency carotid endarterectomy (CEA) in ... more The purpose of this study was to examine the safety of emergency carotid endarterectomy (CEA) in patients with carotid stenosis and unstable neurological symptoms. Methods: This prospective, single-center study involved patients with stroke in evolution (SIE) or fluctuating stroke or crescendo transient ischemic attack (cTIA) related to a carotid stenosis >50% who underwent emergency surgery. Preoperative workup included National Institute of Health Stroke Scale (NIHSS) neurological assessment on admission, immediately before surgery and at discharge, carotid duplex scan, brain contrast-enhanced head computed tomography (CT) or magnetic resonance imaging (MRI). End points were perioperative (30-day) neurological mortality, NIHSS score variation, and hemorrhagic or ischemic stroke recurrence. Patients were evaluated according to clinical presentation (SIE or cTIA), timing of surgery, and presence of brain infarction on neuroimaging. Results: Between January 2005 and December 2009, 48 patients were submitted to emergency surgery. CEAs were performed from 1 to 24 hours from onset of symptoms (mean, 10.16 ؎ 7.75). Twenty-six patients presented an SIE with a worsening NIHSS score between admission and surgery, and 22 presented >3 cTIAs with a normal NIHSS score ؍( 0) immediately before surgery. An ischemic brain lesion was detected in four patients with SIE and eight patients with cTIA. All patients with cTIA presented a persistent NIHSS normal score before and after surgery. Twenty-five patients with SIE presented an NIHSS score improvement after surgery. Mean NIHSS score was 5.30 ؎ 2.81 before surgery and 0.54 ؎ 0.77 at discharge in the SIE group (P < .0001). One patient with SIE had a hemorrhagic transformation of an undetected brain ischemic lesion after surgery, with progressive neurological deterioration and death (2%). Conclusions: Due to the absence of randomized controlled trials of CEA for neurologically unstable patients, data currently available do not support a policy of emergency CEA in those patients. Our results suggest that a fast protocol, including CT scans and carotid duplex ultrasound scans in neurologically unstable patients, could help identify those that can be safely submitted to emergency CEA.
Minerva Cardioangiologica : a Journal on Cardiovascular Pathophysiology, Clinical Medicine and Therapy, 1999
Annali italiani di chirurgia, 1997
After fourty years of practice in carotid surgery the rate of neurologic complications related to... more After fourty years of practice in carotid surgery the rate of neurologic complications related to technical defects seems not to be reduced and still is responsible of 30-40% of all perioperative strokes. Intraoperative quality control seem at present, of outmost importance to further reduce the impact of technical defects on perioperative neurological complications. Angiography, Duplex Scanning and more recently angioscopy have been utilized as intraoperative assessments. All of them demonstrated imperfections of arterial reconstruction potentially at risk for early and late patency failure and indicated immediate intraoperative correction. In some report this behaviour determined a relevant reduction both on perioperative results and lesser incidence of early restenosis. Concerning postoperative control of carotid endarterectomy early restenosis represent the most important and more common failure after carotid endarterectomy. In spite of the efforts to clear the causes of this ph...
Early restenosis represent the most important and more common failure after carotid endarterectom... more Early restenosis represent the most important and more common failure after carotid endarterectomy. For this reason, after its first description made in 1976 by Stoney and String, it raised general interest among vascular surgeons. In spite of the efforts to clear the causes of this phenomenon, none of the numerous papers published in the literature has defined a specific cause determining restenosis. Nevertheless, at present, this hyperplastic response of the arterial wall to trauma after operation is generally considered benign because it is rarely responsible for new neurological symptoms or early internal carotid artery occlusion. This unanimous conviction has been achieved after years of instrumental and clinical postoperative follow-up performed all over the world. At the same time and probably for these reasons, recently, a new discussion has begun about the usefulness and cost-effectiveness of prolonged Duplex scanning postoperative surveillance of the endarterectomized caro...
European Journal of Vascular and Endovascular Surgery, 2015
Results: At five years, 7.3% (CI 2.7e11.9%) of the elective intended to treat patients with EVAR ... more Results: At five years, 7.3% (CI 2.7e11.9%) of the elective intended to treat patients with EVAR had an increase in aneurysm diameter. 38.2 % of patients were registered with endoleaks during the follow up period but only 5.7 % had secondary procedures.13 % of patients had secondary procedures for other reasons 12.2 % of patients had early and 6.5 % late complications during the follow up period. Aneurysm rupture was seen in 1.6 % of patients. During the 5 years of follow up there was no statistical difference in standardized mortality ratio in patients treated with elective EVAR compared to the general population. The 1 year mortality of those electively treated with open AAA repair and EVAR was 7.6%, and 6.3 % respectively. There was no statistically significant difference seen in 1 year mortality between elective open operation and elective EVAR. Conclusion: Adhering to proven indications for use of EVAR gives a low long-term risk for increased diameter, low mortality rate and low rate of secondary procedures in treated aortic aneurysms compared to other published results. With this approach no statistical difference in standardized mortality was seen in patients treated with EVAR compared to the general population. This is the case even if the risk for AAA rupture after treatment will still not be entirely excluded with EVAR. The strict application of EVAR does not increase the mortality from AAA even if the number of open repairs will increase.
European Journal of Ultrasound
International angiology : a journal of the International Union of Angiology, 2005
To determine the best treatment for high-risk patients with abdominal aortic aneurysms (AAA). We ... more To determine the best treatment for high-risk patients with abdominal aortic aneurysms (AAA). We reviewed a prospective database of all patients who underwent conventional (OPEN) or endovascular aneurysm repair (EVAR) between January 1998 and December 2002. Patients were preoperatively classified according to the American Society of Anesthesiology (ASA). Comorbidities and medical risk factors were categorized according to the Ad Hoc Committee on Reporting Standards. Perioperative mortality and morbidity rates were analyzed according to the type of surgical procedure (OPEN vs EVAR) and ASA class. Patients in ASA classes I and II were excluded. Continuous data were expressed as mean +/- standard deviation. All data were calculated using the cumulated actuarial method of event outcome probability. Kaplan-Meier curves were constructed and the log-rank statistic and chi squared test were used for comparative data. P values less than 0.05 were considered to indicate statistical significan...
Minerva cardioangiologica, 1999
Vascular, 2010
The purpose of this study was to seek factors predicting outcome after open surgical repair of ju... more The purpose of this study was to seek factors predicting outcome after open surgical repair of juxtarenal abdominal aortic aneurysms (AAAs). From a series of 733 patients treated for AAAs, 92 patients underwent elective conventional open repair with suprarenal clamping. We assessed postoperative cardiorespiratory and renal morbidity and mortality and survival at 1, 3, and 5 years. One patient (1.1%) died after an acute myocardial infarction. Postoperative complications including myocardial infarction and renal failure arose in 22 patients (23.9%). Significant predicting factors of renal failure were a preoperative creatinine clearance ≤ 40 mL/min ( p = .03) and female sex ( p = .004). Kaplan-Meier survival analysis showed an overall survival rate of 98.9% at 1 year and 88.6% at 3 and 5 years. In patients carefully selected by preoperative imaging criteria to undergo open juxtarenal AAA repair, appropriate intraoperative management guarantees a good immediate postoperative outcome.
Circulation, 2000
Background —Accumulation of LDL within the arterial wall appears to play a crucial role in the in... more Background —Accumulation of LDL within the arterial wall appears to play a crucial role in the initiation and progression of atherosclerotic plaque. The dynamic sequence of this event has not been fully elucidated in humans. Methods and Results —In 7 patients with previous transient ischemic attack or stroke and critical (>70%) carotid stenosis, autologous native [ 125 I]-labeled LDL or [ 125 I]-labeled human serum albumin were injected 24 to 72 hours before endarterectomy. Carotid specimens obtained at endarterectomy were analyzed by autoradiography and immunohistochemistry. Autoradiographic study showed that LDL was localized prevalently in the foam cells of atherosclerotic plaques, whereas the accumulation in the lipid core was negligible. Immunohistochemistry revealed that foam cells that had accumulated radiolabeled LDL were mostly CD68 positive, whereas a small number were α-actin positive. No accumulation of the radiotracer was detected in atherosclerotic plaques after inj...
European Journal of Vascular and Endovascular Surgery, 2014
Response to 'Re. Benefits of Remote Ischemic Preconditioning in Vascular Surgery' The authors mak... more Response to 'Re. Benefits of Remote Ischemic Preconditioning in Vascular Surgery' The authors make a good point: discrepancy between animal and clinical data is multifactorial, and the factors they cite are likely to be an influence. The most recent, properly powered randomised controlled trial (RCT) of remote ischaemic preconditioning (RIPC) in cardiac surgery avoided the use of volatile anaesthetic agents to avoid pharmacological preconditioning. 1 This trial showed no difference between the RIPC and no RIPC groups. Conversely, the large RIPCON (Remote Ischemic Pre-Conditioning) trial of RIPC in cardiac surgery is currently recruiting using volatile agents to avoid remifentanyl, 2 which is also associated with pharmacological preconditioning. 3 This highlights one of the problems with medications and RIPC: it might be impossible to avoid those that effect RIPC completely, but trials can adjust for the least powerful. Additionally, patients might fare worse with the preconditioning effect of RIPC than they would have done with the preconditioning effect of the medication being withheld. Another problem is that the mechanisms of interference are still poorly understood, and it is likely that additional, commonly prescribed medicines have an effect on RIPC. 3,4 Other factors such as diabetes are common in vascular patients should be corrected for if trials are properly powered. Protocols for other trials currently or about to recruit are heterogeneous in their approach to correcting for these factors. To date, 102 trials of remote ischaemic preconditioning are registered on ClinicalTrials.gov. It is imperative that trialists recognise and attempt to correct for these factors as early as possible. Without this, we risk publishing large, flawed trials that essentially destroy all interest in RIPC without a rigorous method.
Journal of Vascular Surgery, 2012
The purpose of this study was to examine the safety of emergency carotid endarterectomy (CEA) in ... more The purpose of this study was to examine the safety of emergency carotid endarterectomy (CEA) in patients with carotid stenosis and unstable neurological symptoms. Methods: This prospective, single-center study involved patients with stroke in evolution (SIE) or fluctuating stroke or crescendo transient ischemic attack (cTIA) related to a carotid stenosis >50% who underwent emergency surgery. Preoperative workup included National Institute of Health Stroke Scale (NIHSS) neurological assessment on admission, immediately before surgery and at discharge, carotid duplex scan, brain contrast-enhanced head computed tomography (CT) or magnetic resonance imaging (MRI). End points were perioperative (30-day) neurological mortality, NIHSS score variation, and hemorrhagic or ischemic stroke recurrence. Patients were evaluated according to clinical presentation (SIE or cTIA), timing of surgery, and presence of brain infarction on neuroimaging. Results: Between January 2005 and December 2009, 48 patients were submitted to emergency surgery. CEAs were performed from 1 to 24 hours from onset of symptoms (mean, 10.16 ؎ 7.75). Twenty-six patients presented an SIE with a worsening NIHSS score between admission and surgery, and 22 presented >3 cTIAs with a normal NIHSS score ؍( 0) immediately before surgery. An ischemic brain lesion was detected in four patients with SIE and eight patients with cTIA. All patients with cTIA presented a persistent NIHSS normal score before and after surgery. Twenty-five patients with SIE presented an NIHSS score improvement after surgery. Mean NIHSS score was 5.30 ؎ 2.81 before surgery and 0.54 ؎ 0.77 at discharge in the SIE group (P < .0001). One patient with SIE had a hemorrhagic transformation of an undetected brain ischemic lesion after surgery, with progressive neurological deterioration and death (2%). Conclusions: Due to the absence of randomized controlled trials of CEA for neurologically unstable patients, data currently available do not support a policy of emergency CEA in those patients. Our results suggest that a fast protocol, including CT scans and carotid duplex ultrasound scans in neurologically unstable patients, could help identify those that can be safely submitted to emergency CEA.
Minerva Cardioangiologica : a Journal on Cardiovascular Pathophysiology, Clinical Medicine and Therapy, 1999
Annali italiani di chirurgia, 1997
After fourty years of practice in carotid surgery the rate of neurologic complications related to... more After fourty years of practice in carotid surgery the rate of neurologic complications related to technical defects seems not to be reduced and still is responsible of 30-40% of all perioperative strokes. Intraoperative quality control seem at present, of outmost importance to further reduce the impact of technical defects on perioperative neurological complications. Angiography, Duplex Scanning and more recently angioscopy have been utilized as intraoperative assessments. All of them demonstrated imperfections of arterial reconstruction potentially at risk for early and late patency failure and indicated immediate intraoperative correction. In some report this behaviour determined a relevant reduction both on perioperative results and lesser incidence of early restenosis. Concerning postoperative control of carotid endarterectomy early restenosis represent the most important and more common failure after carotid endarterectomy. In spite of the efforts to clear the causes of this ph...
Early restenosis represent the most important and more common failure after carotid endarterectom... more Early restenosis represent the most important and more common failure after carotid endarterectomy. For this reason, after its first description made in 1976 by Stoney and String, it raised general interest among vascular surgeons. In spite of the efforts to clear the causes of this phenomenon, none of the numerous papers published in the literature has defined a specific cause determining restenosis. Nevertheless, at present, this hyperplastic response of the arterial wall to trauma after operation is generally considered benign because it is rarely responsible for new neurological symptoms or early internal carotid artery occlusion. This unanimous conviction has been achieved after years of instrumental and clinical postoperative follow-up performed all over the world. At the same time and probably for these reasons, recently, a new discussion has begun about the usefulness and cost-effectiveness of prolonged Duplex scanning postoperative surveillance of the endarterectomized caro...
European Journal of Vascular and Endovascular Surgery, 2015
Results: At five years, 7.3% (CI 2.7e11.9%) of the elective intended to treat patients with EVAR ... more Results: At five years, 7.3% (CI 2.7e11.9%) of the elective intended to treat patients with EVAR had an increase in aneurysm diameter. 38.2 % of patients were registered with endoleaks during the follow up period but only 5.7 % had secondary procedures.13 % of patients had secondary procedures for other reasons 12.2 % of patients had early and 6.5 % late complications during the follow up period. Aneurysm rupture was seen in 1.6 % of patients. During the 5 years of follow up there was no statistical difference in standardized mortality ratio in patients treated with elective EVAR compared to the general population. The 1 year mortality of those electively treated with open AAA repair and EVAR was 7.6%, and 6.3 % respectively. There was no statistically significant difference seen in 1 year mortality between elective open operation and elective EVAR. Conclusion: Adhering to proven indications for use of EVAR gives a low long-term risk for increased diameter, low mortality rate and low rate of secondary procedures in treated aortic aneurysms compared to other published results. With this approach no statistical difference in standardized mortality was seen in patients treated with EVAR compared to the general population. This is the case even if the risk for AAA rupture after treatment will still not be entirely excluded with EVAR. The strict application of EVAR does not increase the mortality from AAA even if the number of open repairs will increase.
European Journal of Ultrasound