- 1999 BRACHIO FEMORAL LOOP AND CABLE TECHINQUE
I started my career as general surgeon and my limited knowledge and familiarity about endovascular
methods and procedures led me to use (in EVAR) the brachio-femoral loop and cable technique to make device
introduction and placement easier and to be able to advance on a “straight track system “ fixed in two
points.
BRACHIO FEMORAL LOOP-Description technique-
BRACHIO FEMAORAL LOOP AND THROMBIZATION OF ANEURYSM AND SAC - 2000-2001 BELL BOTTOM TECHNIQUE - HIGHLIGHT IN CITTADELLA (PADUA-ITALY) -Triple aneurysm-
- THE ORIGIN OF BELL BOTTOM TECHNIQUE: WHEN, WHERE AND HOW
- HIGHLIGHT IN CITTADELLA (PADUA-ITALY) -Triple aneurysm-
Abdominal aortic aneurysms with ectatic common iliac arteries have always been a risk to endovascular treatment. The lack of a vascular graft that would allow for a proper sealing, forced surgeons to rule out a high number of patients. I tried to find a solution to this problem and the result of my work has been the BELL BOTTOM TECHNIQUE of which I had been for years its stubborn promoter. In 2008, on the basis of my good results MEDTRONIC (Medtronic CardioVascular 3576 Unocal Place Santa Rosa CA 95403 USA) began to collaborate with me on my unrefined project . This cooperation resulted in TALENT flared extensions in BELL BOTTOM conformation that are now routinely used in the correction of abdominal aortic aneurysms with endovascular ectatic common iliac arteries.
Triple thoracic abdominal and iliac aneurysm treated with endovascular and bilateral Bell Bottom techniques in a single session (first case published in literature) - 2002 HIGHLIGHT IN CITTADELLA (PADUA-ITALY) -Traumatic rupture of the thoracic aorta isthmus dell'istmo-
Emergency treatment with endovascular technique (TEVAR) of traumatic rupture of the thoracic aorta isthmus (the first case in the Venetian Region) - 2003-2005: TYPE II EL PREVENTION - FIRST CASE STUDIES AND EXPERIENCE
Since the beginning of EVAR, type II endoleak was the most frequent complication of treatment (20-30%), which, due to little experience and brief follow-up, initially was interpreted as a non dangerous complication. Indeed the operators (surgeons, interventional cardiologists, radiologists) were mostly focused on the success of the procedure and not able to predict medium and long-term complications.
But centers that were following up patients closely, began to realize that in the presence of type II endoleak some aneurysm sacs had increased in volume and occasionally they would rupture with dramatic consequences. So I became convinced that type II endoleak was not as innocent as we thought and that the solution to the problem was not the treatment of complication, but its prevention. Assuming that type II endoleak was the result of the partial and incomplete thrombosis of the aneurysm sac associated with retrograde perfusion by collateral branches, I have developed a method to stimulate and accelerate the complete thrombosis injecting a biocompatible pro-coagulant substance inside the sac during EVAR.“FIBRIN GLUE ANEURYSM SAC EMBOLIZATION AT THE TIME OF ENDOGRAFTING” - 2006-2009 TYPE II EL PREVENTION: REFINING OF TECHNIQUE - HIGHLIGHT IN CITTADELLA (PADUA-ITALY) -Funnel Techinque-
- 2006-2009 TYPE II EL PREVENTION: REFINING OF TECHNIQUE
- 2006 HIGHLIGHT IN CITTADELLA (PADUA-ITALY) -Funnel Techinque-
After analyzing the first results,to stabilize and improve the thrombosis process, in 2006 I started to introduce in the aneurysm sac, together with fibrin glue, a synthetic suture wire, subsequently replaced by spirals, to form a scaffold of a structure similar to “concrete”.PRESENTATION AT CONGRESS SICVE 2009 (MILANO-ITALY)
PREVENTIVE TREATMENT OF TYPE II ENDOLEAK THROUGH THE USE OF BIOMATERIALS
First case of endovascular treatment of abdominal aortic aneurysm in patient with proximal neck ectasia: FUNNEL TECHNIQUE - 2007 ABDOMINAL AORTA ANEURYSM WANTED - HIGHLIGHT IN CITTADELLA (PADUA-ITALY) -Elephant Trunk complication-
- 2007-2013 ABDOMINAL AORTA ANEURYSM WANTED
- HIGHLIGHT IN CITTADELLA (PADUA-ITALY) -Elephant Trunk complication-
In 2007, with the support and collaboration of the Strategic Direction ( Dr. Pietro Gonnella and Dr. Maria Giacobbo), I thought up a prevention project, the first and only in Italy, for the early diagnosis of abdominal aorta aneurysm. The project was called “A.A.A… WANTED” and began in October 2007, it involved the population of the territory of ULSS 15 Alta Padovana and it was free of charge. The primary objective was the prevention of death from ruptured aneurysm of the abdominal aorta through the identification of asymptomatic aneurysms. Secondary objectives were observation and study of the risk factors distribution in the population. The project continued until December 2013 when it was “abruptly” suspended for current Strategic Direction decision (Dr. Francesco Benazzi e Dr. Sandro Artusi).
“Elephant Trunk” Mimicking Thoracic Aortic Dissection The Role of Intravascular Ultrasound. - 2008 HIGHLIGHT IN CITTADELLA (PADUA-ITALY) -First endoprosthesis Endurant-
For the first time in Italy the new endoprosthesis Endurant Medtronic which allowed to treat abdominal aortic aneurysms with complex anatomy was used (intervention 5th September 2008). - 2009 HIGHLIGHT IN CITTADELLA (PADUA-ITALY) -Polianeurysmatic disease-
Treatment of complex case of polianeurysmatic disease in patient with bilateral carotid aneurysm, abdominal aortic aneurysm, popliteal aneurysm.A COMPLEX CASE OF POLIANEURYSMATICA COMPLEX CASE OF MULTIPLE ANEURYSMATIC DISEASE CT SCAN CONTROL - 2010: TYPE II PREVENTION: TEN YEARS OF EXPERIENCE
The members of patients treated and the long term follow-up allowed for an f analysis of the data which showed a statistically significant reduction of the incidence of Type II EL in the group treated with the technique of thrombization of the aneurysm an sac. - 2011 FUNNEL TECHNIQUE - HIGHLIGHT IN CITTADELLA (PADUA-ITALY) -Complications treatment-
Abdominal aortic aneurysms with ectasic proximal neck have always represented a risk for the endovascular treatment. If in the management of the ectatic common iliac arteries the Bell Bottom technique had become a routine, it was still difficult to find a solution for ectatic proximal neck, there not being commercially available grafts that would allow an adequate sealing. For high risk patients and/ or not candidates for traditional surgery, I proposed the FUNNEL TECHNIQUE: our experience..
FUNNEL TECHNIQUE FOR EVAR: ‘‘A WAT OUT’’ FOR ABDOMINAL AORTIC ANEURYSM WITH ECTATIC PROXIMAL NECKS
CD : EVAR management of complications and “way out” solutions in clinical practiceTREATMENT OF COMPLICATION AND “WAY OUT” TO SOLUTION (PRESENTAZIONE DEL PRESIDENTE SICVE)- 2012 TYPE II EL PREVENTION: FROM TREATMENT TO PREVENTION OF COMPLICATION - HIGHLIGHT IN CITTADELLA (PADUA-ITALY) CHIMNEY TECHNIQUE - HYPOGASTRIC ARTERY MANAGEMENT
- TYPE II EL PREVENTION: FROM TREATMENT TO PREVENTION OF COMPLICATION
- 2012 HIGHLIGHT IN CITTADELLA (PADUA-ITALY) -CHIMNEY TECHNIQUE-
- HYPOGASTRIC ARTERY MANAGEMENT
After a longer period of follow up further statistical analysis confirmed the results achieved.TYPE II ENDOLEAK: FROM TREATMENT OF COMPLICATION TO PREVENTION TYPE II ENDOLEAK REPORT: FROM TREATMENT TO PREVENTION OF COMPLICATION
“Chimney technique” in endovascular treatment of abdominal aortic aneurysm involving renal arteries ( first case in the Venetian Region ).
Treating abdominal aortic aneurysms involving common iliac arteries , when it was necessary an external iliac artery landing and an internal iliac artery selective exclusion. I used as an alternative technique the thrombosis of the iliac aneurysm sac with biomaterials: our experience..- 2013 UNCLOGGING TECHNIQUE - EVAR (STRATEGIC PREVENTION OF COMPLICATIONS)
Limb thrombosis after EVAR is one of the complications that can have serious consequences. I used ring Vollmar stripper to resolve cases of stratified thrombosis.
Only when we will be able to reduce the incidence of long-term complications and make EVAR’s primary technical and clinical success similar to that of traditional surgery we can say that is a viable alternative."My" Vascular Surgery
- 2012 TYPE II EL PREVENTION: FROM TREATMENT TO PREVENTION OF COMPLICATION - HIGHLIGHT IN CITTADELLA (PADUA-ITALY) CHIMNEY TECHNIQUE - HYPOGASTRIC ARTERY MANAGEMENT
