Risultati per: Intervalli di sorveglianza per Aneurisma Aorta Addominale (AAA)

“Tenere alti livelli di biosicurezza anche dopo la vaccinazione”

Introduction
Incisional hernia (IH) is a prevalent and potentially dangerous complication of abdominal surgery, especially in high-risk groups. Mesh reinforcement of the abdominal wall has been studied as a potential intervention to prevent IHs. Randomised controlled trials (RCTs) have demonstrated that prophylactic mesh reinforcement after abdominal surgery, in general, is effective and safe. In patients with abdominal aortic aneurysm (AAA), prophylactic mesh reinforcement after open repair has not yet been recommended in official guidelines, because of relatively small sample sizes in individual trials. Furthermore, the identification of subgroups that benefit most from prophylactic mesh placement requires larger patient numbers. Our primary aim is to evaluate the efficacy and effectiveness of the use of a prophylactic mesh after open AAA surgery to prevent IH by performing an individual patient data meta-analysis (IPDMA). Secondary aims include the evaluation of postoperative complications, pain and quality of life, and the identification of potential subgroups that benefit most from prophylactic mesh reinforcement.

Methods and analysis
We will conduct a systematic review to identify RCTs that study prophylactic mesh placement after open AAA surgery. Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase, Web of Science Core Collection and Google Scholar will be searched from the date of inception onwards. RCTs must directly compare primary sutured closure with mesh closure in adult patients who undergo open AAA surgery. Lead authors of eligible studies will be asked to share individual participant data (IPD). The risk of bias (ROB) for each included study will be assessed using the Cochrane ROB tool. An IPDMA will be performed to evaluate the efficacy, with the IH rate as the primary outcome. Any signs of heterogeneity will be evaluated by Forest plots. Time-to-event analyses are performed using Cox regression analysis to evaluate risk factors.

Ethics and dissemination
No new data will be collected in this study. We will adhere to institutional, national and international regulations regarding the secure and confidential sharing of IPD, addressing ethics as indicated. We will disseminate findings via international conferences, open-source publications in peer-reviewed journals and summaries posted online.

PROSPERO registration number
CRD42022347881.

Nuova Circolare, “formare il personale e informare i cittadini”

To the Editor A recent randomized clinical trial on REBOA showed that use of the technique may be detrimental to patients in some major trauma centers in the UK. However, I have some concerns about this study.

In Reply We thank the authors for the letters about our recently published randomized clinical trial of emergency department REBOA in trauma patients.

To the Editor One of the key issues that came to our attention in the recent UK-REBOA study was the high proportion of patients randomized to the REBOA and standard care group who did not have an aortic balloon inserted. In 8 cases (17%), it was reported that clinicians were unable to establish access to the femoral artery.

To the Editor We would like to highlight some concerns surrounding the study design and findings of the UK-REBOA randomized clinical trial that evaluated the effectiveness of REBOA and standard care compared with standard care alone.

To the Editor The results of a recent randomized clinical trial demonstrated that the incorporation of REBOA into standard trauma care in the emergency department “does not reduce, and may increase, mortality compared with standard care alone.” Although these results are of high significance, they partially contradict previously published studies. We have some concerns about this study.

To the Editor We are concerned about the results and interpretation of the UK-REBOA randomized clinical trial. First, this study population may have included cases that were unsuited for resuscitative endovascular balloon occlusion of the aorta (REBOA). The median Abbreviated Injury Scale (AIS) score for the thorax was 4 in both groups, suggesting the presence of severe thoracic trauma. The use of REBOA in patients with thoracic injuries could potentially exacerbate bleeding, thereby raising concerns about the cases in which thoracic trauma was the primary source of severe bleeding.

Ministero della Salute pubblica il piano 2024 sul suo sito

Coinvolto cardiochirurgo del Sant’Orsola, ‘sfida è prevenzione’

Introduction
The best lifestyle for small abdominal aortic aneurysms (sAAA) is essential for its conservative management. Physical exercise can improve the cardiopulmonary function of the patients, but it remains unclear which specific type of exercise is most beneficial for individuals with sAAA. The current study was designed to investigate the effect of physician-guided enhanced physical exercise programme on the aorto-cardiac haemodynamic environment, aneurysm sac wall, cardiac function and growth rate of sAAA by multimodality MRI.

Methods and analysis
AAA MOVE study is a prospective, parallel, equivalence, randomised controlled trial. Eligible individuals will be recruited if they are diagnosed with sAAA (focal dilation of abdominal aorta with maximum diameter

A Bari, la preparazione dell’intervento mentre il paziente è in ambulanza

This randomized clinical trial compares the effectiveness of resuscitative endovascular balloon occlusion of the aorta and standard care in the emergency department vs standard care alone on mortality in trauma patients with exsanguinating hemorrhage.

Circulation, Volume 148, Issue Suppl_1, Page A18241-A18241, November 6, 2023. Introduction:CoA’s complex hemodynamics may lead to post-repair complications such as pseudoaneurysms. Understanding the effects of beta-blockers, successful in adult heart failure and potentially beneficial for children, is critical. We used a high-resolution image-based CFD model to study these effects on aortic WSS and turbulence in CoA patients.Hypothesis:Beta-blocker therapy may favorably influence hemodynamic turbulence stresses.Methods:Patient-specific CT scans informed 3D CoA aorta models. Large eddy simulations were conducted at neonatal heart rates of 100, 120, and 160 bpm. Aortic segments were divided into front and back regions based on jet flow impact.Results:Despite heart rate-induced turbulence, WSS distributions remained consistent across rates. Lower rates notably decreased maximal systolic WSS distal to the coarctation site but reduced localized WSS and its variability(6.49 +/- 3.29Pa). Both front and back segments showed unique WSS patterns and peak systolic WSS increases with heart rate(0.1Pa per 10BPM & 0.07Pa/ per 10BPM, P >0.05). Significantly higher stress was experienced by the front region(max: 95.2%, min: 70.4%).Conclusions:Heart rate changes impact WSS values, indicating heart rate-lowering drugs like beta-blockers may alleviate hemodynamic stress. Despite overall lower WSS, the front region is more susceptible to shear stress at lower rates. This could guide beta-blocker therapy decisions and identify potential beneficiaries.

Circulation, Volume 148, Issue Suppl_1, Page A14746-A14746, November 6, 2023. Introduction:Left atrial (LA) late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) predominates near the aorta(AO); however, LGE does not equate fibrosis and may be artifactual or indicate expanded interstituim.Hypothesis:We sought to examine the association of LA LGE with proximity to the descending and ascending AO and use regional impedance and voltage measurements to dissect the mechanism of LGE .Methods:The retrospective cohort included consecutive patients who underwent pre-procedural CMR and atrial fibrillation (AF) ablation between January 2016 – 2021. The association of voltage amplitude, impedance, and image intensity ratio (IIR) at each electroanatomic map point with distance from the nearest AO point was examined after adjustment for age, sex, AF type, AO stenosis, LA volume, and AO diameter.Results:Included 63 patients (age 65.5±8.8 years, 33% female). Among 42 ablation naive patients, distance from AO was unassociated with bipolar and unipolar voltage amplitudes, but associated with impedance (+0.04 ohm/mm, P=0.011) and IIR (-0.03 /mm, P