Treatment of Occluded Peripheral Vessels

The aorta is the vessel that receives blood from the heart, the “pump” of the cardiovascular system, and transports it to the periphery. The aortic root aneurysm is a pathological dilatation in the section closest to the heart: it is a sign of weakness of the wall and therefore an indication of risk of rupture.

This pathology is treated more effectively with the Tirone David technique, which at the Maria Pia Hospital in Turin is also performed with a minimally invasive approach, technically very complex which however has given important results in over 41 cases of application.

Dr. Mauro Del Giglio, heart surgeon of the Maria Pia Hospital, part of GVM Care & Research, introduces us to the topic.

How is an aortic root aneurysm diagnosed?

Diagnosis often occurs randomly during other investigations, such as ultrasound or thoraco-abdominal CT. In fact, the aortic root aneurysm almost never gives symptoms. However, if the patient feels pain, this is a very serious symptom, because it is already a sign of a partial or total rupture of the vessel wall, which in most cases has irreparable results.

There is a family predisposition for which it is right that patients who know they are familiar with this pathology undergo periodic checks. The tests to be performed are CT with contrast medium or, more routinely and less efficiently, ultrasound.

There are also other risk factors to watch out for, such as high blood pressure, high cholesterol, atherosclerosis, obesity. Smokers are also more prone to developing the disease.

What is the Tirone David technique that your team prefers to use?

Tirone David’s technique aims to remove the entire aorta, from the initial portion close to the heart up to the origin of the aortic arch, which is replaced with a vascular prosthesis; the patient’s natural valve is reimplanted in the prosthesis, in addition to the two coronaries that arise in this initial section of the aorta.

The most significant advantage is precisely the preservation of the patient’s native valve, while removing the diseased aorta.

The technique was devised by the Canadian heart surgeon in the early 1990s and was tested for the first time on a pregnant woman, for whom valve replacement would have been too risky.

What is the approach with minithoracotomy to the Tirone David technique, which you perform in Maria Pia Hospital?

The standard approach to Tirone David’s technique is traditional sternotomy surgery, with cutting out of the sternum bone.

Combining the experience gained on the Tirone David technique and mini-thoracotomy approaches (access to the heart through minimal cuts between the intercostal spaces) we have developed a less invasive approach.

We described it for the first time in 2019, making an intervention by Tirone David through a small 5 cm cut. Since then we have performed 41 implants with this technique in mini-thoracotomy, with excellent post-operative results. The advantage compared to traditional surgery lies in the faster recovery and has minor implications even on an aesthetic level.

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