Aortic surgery in Rome
Francesco Speziale, Enrico Sbarigia, Maria FabriziaGiannoni and Laura Capoccia
Vascular and Endovascular Surgery
Department of Surgery “ParideStefanini”
“Sapienza” University of Rome
People
The history of Vascular Surgery in Rome in its early years of life is closely linked to the history and development of General Surgery.
The first pioneer of General Surgery, Surgical Specialties and, above all,Vascular Surgery in Rome was Professor ParideStefanini (Rome,1904-1981).
Before becoming Director of the Second Surgical Clinic of the Policlinico Umberto I – University “La Sapienza” of Rome at the end of the academic year 1959-60, ProfessorStefaniniworked in L’Aquila at the Public Hospitaland later in Pisa, where he served at the University as Full-Professor.
He demonstrated to be an excellent and innovative surgeonand a vigorous proponent as well as an excellent organizer, with a huge professional experience and many scientific interests:ProfessorStefaninihasanticipated modern Surgery.
His professional lifehas been characterizedby the passion and theconstant search forinnovation. Withthese qualitiesandwith the impulsescoming from arestless andbrilliantcharacter, he realizedthe promotion ofGeneral SurgeryandSurgical Specialties, first of all Vascular Surgery.
ProfessorStefaninihad also the meritto devote himselfpersonallyto theVascular Surgeryin apioneeringperiodand to entrustthe developmentof this Disciplineto his pupilPaoloFiorani.
Paolo Fiorani was born in Ancona in 1934; he graduated in Medicine at University “La Sapienza” of Rome in 1958. In the early years of his career, he was interested in all aspects of surgery and lately he entirely concentrated himself on the development of Vascular Surgery.
In 1962hewona fellowshipfundedby NATO andtook advantage ofthisopportunityin the best way. He spentthe entire1962 as afellow at the“BaylorCollegeof Medicine” in Houston, TX-USA, in the Department headed by ProfessorMichael EllisDeBakey (Lake Charles, LU-USA,1908 - Houston, TX-USA, 2008).During this period,he livedin the beating heartof vascular surgeryat that time,being able tounderstand itspotentialand future applications. All thisallowed himto transplantinItalythe concept ofamodernVascular Surgery.
Once returned in Italy, Professor Fiorani was immediately interested inrenovascular hypertension and cerebrovascular insufficiency. He was also one of the pioneers of aortic surgery in our Country.
In 1973, he became Director of the second Post-degree School of Vascular Surgery at the University “La Sapienza” of Rome; in 1974,full-professor of Vascular Surgery and Chief of the Vascular Surgery Unit.In the same year another disciple of Professor Stefanini, Fabrizio Benedetti Valentini, became Full Professor of Vascular Surgery at L’Aquila University.
In 1976 he became member of the Society for Vascular Surgery (SVS) and, in the same period, he was the first Italian Surgeon to have a talk to the Annual Meeting of the SVS.
His careerallowed to him to be President of the Italian Society for Cardiac and Vascular Surgery in 1985/86 and he was one of the founding members of the Italian College of Full-Professor in Vascular Surgery.
He received also many honors outside from Italy: member of the editorial board of Annals of Vascular Surgery, International Angiology, Journal of Vascular Surgery and European Journal of Vascular Surgery (now, European Journal of Vascular and Endovascular Surgery); in 1990, ProfessorFiorani was President of the Local Organising Committee of the European Society for Vascular Surgery (ESVS) Annual Meeting in Rome and, in 1992, served (first Italian Surgeon ever) as President of ESVS.
After such brilliant career,since 2004 Paolo Fioranienjoys retirement with his wife Paola; his desire to do and to innovate turned him into a producer of high quality wines, spirits and oil at his farm in Scansano, Grosseto.
Aortic Surgery
Modern aortic surgery in Rome was started atPoliclinico Umberto I by Professor Fiorani andsince 1987at Policlinico Tor Vergataby Professor Giuseppe RaimondoPistolese, until then his first assistant.
The first report of aortic interventions in Rome was published in 1976[1] and this clinical, surgical and scientific activity remained unchanged during decades to come.
In the very early period, mortality related to aortic surgery was about 8% but results progressively improved. In facts, in 1989 Professor Fiorani was proud to announce a reduction in mortality rate to 2.3%, a result comparable with the best current clinical practice.
Yet in ‘80s, aortic pathology was investigated under many innovative aspects and most of them are still object of debate and scientific research.
Professor Fiorani and his co-workers were the first to discuss about graft infection after aortic open surgery[2] and, later in the years, after endovascular repair[3]. Since aortic graft infection was immediately identified as a life-threatening complication, many efforts were made to achieve an early diagnosis[4] and an effective treatment, particularly in case of secondary aortoenteric fistulae[5].
They were also the first to evaluate a “less-invasive” way to approach the aortic surgery with the aim to reduce post-operative pain and discomfort for the patient and, consequently, minimizing postoperative respiratory distress[6].
In 1989, this volcanic research group proposed a “pilot study” on 78 patients about the progression of the small Abdominal Aortic Aneurysms; they conclude, anticipating most recently published papers, that it could be indicated to perform an early surgical repair in order to minimize the risk of aneurism’s progression and rupture. At the same time, a new conception of “high-risk patient” was introduced in aortic surgery: they underlined that advanced age per se couldnot be considered a risk factor, when compared to “biological age” defined by presence of, above all, cardiac comorbidities.
Once more, ProfFiorani and his disciples concentrated on a rare but peculiar aspect of aortic disease such as inflammatory aneurysms, analyzing both pathogenetic[7] and technical aspects[8].
In the “less-invasive surgery” era as well, Rome was also one of the first centre in Italy to perform and study endovascular repair of abdominal aortic aneurysms[9].In October 1994, the first aortic endograft for abdominal aortic aneurysm in Rome was implanted by Paolo Fiorani and Juan Carlos Parodi. In the same year, his collaborators started the first program of contrast-enhanced ultrasound in the follow-up of aortic endovascular surgery[10].
This continue research for innovation in patients’ care is still carried on by Francesco Speziale, first assistant of Professor Fiorani from 1987 until his retirement in 2004.
References
[1]Fiorani P. Surgical treatment of early and late complications of surgery of the abdominal aorta.Minerva Chir. 1976 Nov 15;31(21):1221-2.
[2]Santini C, Baiocchi P, Venditti M, Brandimarte C, Tarasi A, Rizzo L, Speziale F, Fiorani P, Serra P.Aorto-femoralgraftinfections: a clinical and microbiologicalanalysis. J Infect. 1993 Jul;27(1):17-26.
[3]Fiorani P, Speziale F, Calisti A, Misuraca M, Zaccagnini D, Rizzo L, Giannoni MF.Endovascular graft infection: preliminary results of an international enquiry. J EndovascTher. 2003 Oct;10(5):919-27. Review.
[4]Fiorani P, Speziale F, Rizzo L, De Santis F, Massimi GJ, Taurino M, Faraglia V, Fiorani L, Baiocchi P, Santini C, et al. Detection of aortic graft infection with leukocytes labeled with technetium 99m-hexametazime. J VascSurg. 1993 Jan;17(1):87-95; discussion 95-6.
[5]Fiorani P, Speziale F, Rizzo L, Sbarigia E, Massucci M, Rached HA.Treatment of prostheto-digestive fistulas using in situ prosthetic bypass. J Mal Vasc. 1996;21Suppl A:162-6.
[6]Massucci M, Lauri D, Faraglia V, Speziale F, De Santis F, Taurino M, Dotta F, Galantino A, Guerricchio R, Fiorani P. Approach to the abdominal aorta: impairment of respiratory function after supraumbilical transverse and midline laparotomy. Ital J Surg Sci. 1989;19(3):247-53.
[7]Bernucci P, D'Amati G, De Santis F, Di Marzo L, Sapienza P, Cavallaro A, Fiorani P, Gallo P. Inflammatory aneurysm of the abdominal aorta: anatomo-clinical study on 16 cases and pathogenetic hypothesis. G ItalCardiol. 1992 Dec;22(12):1381-8.
[8]Fiorani P, Faraglia V, Speziale F, Lauri D, Massucci M, De Santis F. Extraperitoneal approach for repair of inflammatory abdominal aortic aneurysm. J Vasc Surg. 1991 May;13(5):692-7.
[9]Giannoni MF, Bilotta F, Fiorani L, Fiorani P. Regarding "Reduction in aortic aneurysm size: early results after endovascular graft replacement". J VascSurg. 1998 May;27(5):981-2
[10]Giannoni MF, Bilotta F, Fiorani L, Zaccaria A, Rizzo L, Fiorani B, Fedele F.Ultrasoundecho-enhancers in the evaluation of endovascularprostheses. CardiovascSurg. 1999 Aug;7(5):532-8.