A videograb shows top Mafia boss Matteo Messina Denaro (centre) leaves an Italian Carabinieri barrack soon after his arrest at a private clinic in Palermo, Sicily, on Monday. AP

Italy’s No. 1 fugitive, Matteo Messina Denaro, a convicted Mafia boss who ordered some of the nation’s most heinous killings, was arrested on Monday at a private clinic in Sicily after three decades on the run, Italian paramilitary police said.

Messina Denaro was captured at the Palermo clinic where he was receiving treatment for an undisclosed medical condition, according to Carabinieri General Pasquale Angelosanto, who heads the police force’s special operations squad.

A pair of Carabinieri officers, each holding an arm, walked him down the front steps of the upscale clinic and led him to a waiting black van in pouring rain.

Messina Denaro was wearing a brown leather jacket trimmed in shearling, a matching white-and-brown skull cap and his trademark tinted glasses. His face looked wan and he stared straight ahead.

A young man when he went into hiding, he is now 60. Messina Denaro, who had a power base near in the western Sicilian port city of Trapani, was considered Sicily’s Cosa Nostra top boss even while a fugitive.

He was the last of three longtime fugitive top-level Mafia bosses who had for decades eluded capture, and hundreds of police officers over the years had been tasked with tracking him down.

Italian news reports said that when Carabinieri came up to him in the clinic and asked if he were Messina Denaro, the fugitive admitted that he was.

Palermo Chief Prosecutor Maurizio De Lucia told Rai state TV that the fugitive had been using the pseudonym Andrea Bonafede. The last name roughly means "good faith” in Italian.

Shortly after his arrest, Messina Denaro appeared before a court in Palermo, where a judge sought to confirm his identity and ask basic questions to fill out documents.

Reminded by the judge that he must answer truthfully, Messina Denaro replied: "Aware.”

When asked his occupation, he replied "farmer” and added that his brother was a banker and his four sisters homemakers.

For his residence, he cited Castelvetrano, a farm town near Trapani which was his crime clan’s power base and where he was assured of logistics support during his time as a fugitive, according to investigators.

He also told the court he had six children - investigators believe at least one of them was born while he was a fugitive, according to an audio tape of the hearing transmitted by state TV.

Messina Denaro, who was tried in absentia and convicted of dozens of murders, faces multiple life sentences.

He is set to be imprisoned for two bombings in Sicily in 1992 that killed top anti-Mafia prosecutors Giovanni Falcone and Paolo Borsellino, Falcone's wife and several of their bodyguards.

Other grisly crimes he was convicted of is the murder of a Mafia turncoat's young son, who was abducted and strangled before his body was dissolved in a vat of acid.

Monday's arrest came 30 years and a day after the Jan. 15, 1993, capture of convicted Mafia "boss of bosses” Salvatore "Toto” Riina, in a Palermo apartment after 23 years on the run.

Messina Denaro went into hiding in the summer of that same year, as the Italian state stiffened its crackdown on the Sicilian crime syndicate following the murders of Falcone and Borsellino.

Italian Premier Giorgia Meloni tweeted that Messina Denaro's capture is a "great victory of the state, which shows that it doesn't surrender in the face of the Mafia.”

Associated Press