Kissing stenting of aortic bifurcation for aorto-iliac obstructive disease: a comparison between bare metal stents and covered stents

INTRODUCTION Aim of this multicentric study:to compare the short-and mid-term results of bare metal stents(BMS)and covered stents(CS)in the Kissing Stent(KS)technique. METHODS Patients undertaking a KS with BMS or CS between January 2017-August 2021 included. Morphological features of plaques were classified as per the extension of calcifications and thrombosis. Every endpoint and outcome was compared in relation to BMS or CS. All patients included received dual anti-platelets DAPT)for at least one month. RESULTS Thirty-four patients enrolled,17 treated with BMS and 17 with CS. Average age 66 years. The 80% of patients were part of TASC C-D categories. DAPT was administered to 82.4%(28/34)of patients with a mean duration of 4.4±1.6 months. Mean follow-up 32.1±17.8 months. Technical Success was 100%. Immediate Clinical Success was reached in 29 cases(85.3%). Immediate and 30-day Clinical Success was higher in CS(64.7% vs 100%, p=.01). Overall Clinical Success at 1-year follow-up was 91.2%,and resulted significantly higher in CS(82.4% vs 100%,p .04). Overall Primary Patency,Assisted Patency,and Secondary Patency at 30 days were 97.1%,97.1%,and 100%,without differences between BMS and CS(94.1% vs 100%,94.1% vs 100%,and 100% vs 100%;p =.7). Two cases(5.9%)of thrombosis were registered,and both occurred within 3 months after the procedure and both in the BMS,without statistical differences with the CS group(11.8% vs 0%,p .48). Both cases of thrombosis occurred in patients who were not treated with dual antiplatelet therapy(33.3% vs 0%,p .027). Survival statistically differed only at the mean follow-up in favour of CS(70.6% and 100%,p .04). CONCLUSIONS The endovascular approach is currently safe and effective in the treatment of AIOD,and KS offers excellent results in particular if performed with CS; however,no statistically significant differences emerged between the two types of stents in terms of patency,reintervention,and complications. DAPT seems to warrant the best results in terms of patency,although there is still no consensus about the ideal duration of administration.

Algorithms for network design and routing problems

In this thesis we study three combinatorial optimization problems belonging to the classes of Network Design and Vehicle Routing problems that are strongly linked in the context of the design and management of transportation networks: the Non-Bifurcated Capacitated Network Design Problem (NBP), the Period Vehicle Routing Problem (PVRP) and the Pickup and Delivery Problem with Time Windows (PDPTW). These problems are NP-hard and contain as special cases some well known difficult problems such as the Traveling Salesman Problem and the Steiner Tree Problem. Moreover, they model the core structure of many practical problems arising in logistics and telecommunications. The NBP is the problem of designing the optimum network to satisfy a given set of traffic demands. Given a set of nodes, a set of potential links and a set of point-to-point demands called commodities, the objective is to select the links to install and dimension their capacities so that all the demands can be routed between their respective endpoints, and the sum of link fixed costs and commodity routing costs is minimized. The problem is called non- bifurcated because the solution network must allow each demand to follow a single path, i.e., the flow of each demand cannot be splitted. Although this is the case in many real applications, the NBP has received significantly less attention in the literature than other capacitated network design problems that allow bifurcation. We describe an exact algorithm for the NBP that is based on solving by an integer programming solver a formulation of the problem strengthened by simple valid inequalities and four new heuristic algorithms. One of these heuristics is an adaptive memory metaheuristic, based on partial enumeration, that could be applied to a wider class of structured combinatorial optimization problems. In the PVRP a fleet of vehicles of identical capacity must be used to service a set of customers over a planning period of several days. Each customer specifies a service frequency, a set of allowable day-combinations and a quantity of product that the customer must receive every time he is visited. For example, a customer may require to be visited twice during a 5-day period imposing that these visits take place on Monday-Thursday or Monday-Friday or Tuesday-Friday. The problem consists in simultaneously assigning a day- combination to each customer and in designing the vehicle routes for each day so that each customer is visited the required number of times, the number of routes on each day does not exceed the number of vehicles available, and the total cost of the routes over the period is minimized. We also consider a tactical variant of this problem, called Tactical Planning Vehicle Routing Problem, where customers require to be visited on a specific day of the period but a penalty cost, called service cost, can be paid to postpone the visit to a later day than that required. At our knowledge all the algorithms proposed in the literature for the PVRP are heuristics. In this thesis we present for the first time an exact algorithm for the PVRP that is based on different relaxations of a set partitioning-like formulation. The effectiveness of the proposed algorithm is tested on a set of instances from the literature and on a new set of instances. Finally, the PDPTW is to service a set of transportation requests using a fleet of identical vehicles of limited capacity located at a central depot. Each request specifies a pickup location and a delivery location and requires that a given quantity of load is transported from the pickup location to the delivery location. Moreover, each location can be visited only within an associated time window. Each vehicle can perform at most one route and the problem is to satisfy all the requests using the available vehicles so that each request is serviced by a single vehicle, the load on each vehicle does not exceed the capacity, and all locations are visited according to their time window. We formulate the PDPTW as a set partitioning-like problem with additional cuts and we propose an exact algorithm based on different relaxations of the mathematical formulation and a branch-and-cut-and-price algorithm. The new algorithm is tested on two classes of problems from the literature and compared with a recent branch-and-cut-and-price algorithm from the literature.

Resonances in the two centers Coulomb system

In this work we investigate the existence of resonances for two-centers Coulomb systems with arbitrary charges in two and three dimensions, defining them in terms of generalized complex eigenvalues of a non-selfadjoint deformation of the two-center Schrödinger operator. After giving a description of the bifurcation of the classical system for positive energies, we construct the resolvent kernel of the operators and we prove that they can be extended analytically to the second Riemann sheet. The resonances are then defined and studied with numerical methods and perturbation theory.