Gioele Simonte

Dr
  • Function: Researcher
  • Speciality: Vascular Surgery
  • Country: IT
  • Working place: University of Perugia, Perugia, IT

Activities

Comment on Apr 09, 2020

Ugursay Kiziltepe commented on presentation Surgeon modified Fenestrated EVAR: step by step procedure.

»congratulations its a great case and quite descriptive.. my question will be regarding the alignment of fenestrations to ostium of the renal artery? before deployment how do you make sure that the rotation of the stent graft is correct in order to have the fenestration is aligned to the renal artery? or do you align it after partial deployment? but I believe still there could be a margin of error, how do you prevent this ?«
Comment on Dec 03, 2019

Gioele Simonte replied to your comment on presentation Surgeon modified Fenestrated EVAR: step by step procedure.

»Hello, the circumferential suture serves just for the same porpoise of the reducing tie in the CM Cook grafts. once the graft is deployed it prevents justaposition with the aortic wall so the surgeon is able to rotate the device and adjust height. once the introducer sheat is secured inside the target vessel, ballooning the graft leads to suture rupture with proximal sealing«
Case report

Surgeon modified Fenestrated EVAR: step by step procedure

This is a tutorial about performing on table standard EVAR fenestration and subsequent aneurysm repair in the present case the patient was unfit for surgery and had a large left accessory renal artery. He was treated with infrarenal surgeon modified endograft and accessory renal artery overstenting. Successful treatment and satisfying control CT scan

 

November 30, 2019 3 Comments
Technical note

How to perform Carotid Artery Stenting. Perugia way to do it

Carotid artery stenting is a delicate surgery being sometimes as fast as insidious.

We strongly believe that in order to minimize complications rate an almost obsessive attention to details in each procedural moment is essential.

In this video we report probably the most standardized procedure performed at our institution with 6 operators currently doing each passage exactly the same way.

Of course we don’t claim to show the way it should be done, but just the way we learned to do it after more than 3000 performed cases

August 21, 2019 No Comments
Comment on Jul 08, 2019

Gioele Simonte replied to your comment on presentation Complex multi stage thoracoabdominal aneurysm correction. Branched endograft with forced femoral access and flap perforation.

»Thanks for asking. to fenestrate the septum we used the stiff back end of a standard Terumo wire, into a bended steerable sheat in order to ensure a perpendicular incidence angle. We did not feel necessary to use IVUS since with fusion image guidance we could easily identify the right projection and the right point to perform the fenestration«
Comment on Apr 18, 2019

Gioele Simonte replied to your comment on presentation Complex multi stage thoracoabdominal aneurysm correction. Branched endograft with forced femoral access and flap perforation.

»thanks for the comment, actually the steerable sheats used were two different Oscor . We had to use two devices since once deployed the SMA bridging stent the radius curve of the sheat we used (7 fr) turned out to be too sharp for the advancement of the CT bridging stent as we were not able to push it over the sheat curve. we had than to pick up a 10 fr with a wider curve easily resolving the problem. no experience with the Fustar in my facility«
Case report

Complex multi stage thoracoabdominal aneurysm correction. Branched endograft with forced femoral access and flap perforation

acute type B aortic dissection with thoracic aortic aneurysm. no proximal sealing zone for TEVAR landing and dilated ascending aorta.

-Car-car-sub by pass
-Ascending aortic replacement, ascending to innominate by pass and TEVAR

@ control CTA fast aneurysm enlargement

4 inner branches (two antegrade and two retrograde) custom made endograft.
access to RRA through hole performed in the lamella
forced femoral access (no arch vessel available) with steerable sheat

April 13, 2019 4 Comments
Case report

Aortic dissection treatment with the new Medtronic Navion

Male patient, 68 y.o. presented chronic type a aortic dissection with descending aneurysm 57 mm in axial diameter (20 mm increment during 20 months period)

was treated with carotid-carotid-subclavian by pass. subsequent arch replacement with ascending to innominate artery by pass.
finally controlled flap rupture after deployment of thoracic endograft with very good result at CTA, obtaining complete exclusion of the false lumen (type ll endoleak arising from intercostal arteries)

January 11, 2019 No Comments
Recorded video case

Use of endoanchors for EVAR sealing in case of ruptured AAA

63 y.o. patient treated in the emergency setting for ruptured AAA
Endovascular repair planned despite proximal hostile anatomy and left iliac aneurysm with thrombus.
procedure details:
-bilateral percutaneous access
-bifurcated endurant endograft implant (left hypogastric embolization)
-partial left renal artery coverage @ control angio (intentional aggressive deployment)
-renal stenting
-type Ia endoleak after renal stenting, persistent after re-ballooning
-endoleak correction with endoanchors

December 2, 2018 No Comments
Comment on Nov 22, 2018

Gioele Simonte replied to your comment on presentation Emergency triple chimney in a patient with giant symptomatic pararenal pseudoaneurysm and subsequent gutter embolization.

»Thank you very much Prof Donas, I'm very pleased to receive a comment on the case from a master of chimney technique like you. We used a 36 mm wide endurant graft which actually is the larger available, moreover we considered the fact that we are going to perform a triple chimney implant, thus we forecasted more than 30% oversizing (36 mm graft in 25-26 mm new neck). frankly I would pick the same sizes when facing a similar case. agree with me? Unfortunately going with more than two chimneys can lead to important gutters itself, like you already demonstrated.... About the axillary accesses probably I didn't explain clearly: we actually exposed the arteries surgically and performed a parallel double direct arterial puncture on each side (one access per vessel and one more for through and through wire). We tried in elective case axillary percutaneous access with satisfactory results but I would never perform it in an emergent case like this one«
Comment on Nov 20, 2018

Konstantinos Donas commented on presentation Emergency triple chimney in a patient with giant symptomatic pararenal pseudoaneurysm and subsequent gutter embolization.

»Great case dear Gioele, very impressive with a successful exclusion of the aneurysm. I would like to ask you if you would retrospectively have done more oversizing with the aortic stent-graft to wrap up better the 3 chimney grafts? Can you provide us an information about the degree of oversizing? I noted also that you preferred to puncture the axillary artery? How is your experience with this approach? Do you have nerve injuries and related complications? As you know we prefer to perform in general cut down. Congratulations again for the beautiful demonstration of the utility of ch-EVAR in such demanding cases.«
Recorded video case

Emergency triple chimney in a patient with giant symptomatic pararenal pseudoaneurysm and subsequent gutter embolization

We report a case of pararenal pseudoaneurysm endovascular correction with triple chimney technique and the following gutter embolization procedure

Key points:

-Previous fEVAR attempt (failed because of extremely tortuous accesses)
-Emergency procedure during the night
-Bilateral percutaneous femoral access
-Double axillary puncture on both sides
-Challenging endograft advancement on through and through guidewire
-Triple ChEVAR (SMA, RRA, LRA)
-Subsequent gutter embolization

November 18, 2018 3 Comments
Recorded video case

Step by step bilateral common iliac aneurysm endovascular repair with Gore IBE (iliac branched endograft) and C3 device.

Bilateral common iliac aneurysm endovascular repair with an iliac branched device in a 63 years old patient. This video demonstrates the procedural steps and the CT scan at 3 years of surveillance.
Notice: Intentional cross-leg because of short lowest renal to hypogastric distance.

November 14, 2018 No Comments
Recorded video case

Giant proper hepatic aneurysm endovascular treatment with covered stent deployment

Total endovascular treatment of a huge visceral artery aneurysm (proper hepatic) with covered stent deployment.

-Flexor 6 Fr delivered into common hepatic artery
-Bentley BeGraft 8*37 mm positioned over Rosen guidewire and balloon inflated
-Patency of gastroduodenal artery and both efferent branches @ final angio
-Complete aneurysm exclusion with collateral’s patency at control CT Scan

November 14, 2018 No Comments