Treatment of Common Femoral Artery Lesions Involving the Superficial and Profunda Femoral Artery Bifurcation: Is the Snow Too Melted to Plow With New Endovascular Devices?

Surgical endarterectomy for common femoral artery bifurcation obstructive atherosclerotic disease repre- sents the "gold standard" therapy, with excellent long-term results and minimal complications. On the other hand, recent advances in endovascular therapy have led to a safer and similar effective results, with a potential reduction in hospital stays, quicker recovery to normal functional status, good short- and long-term clinical outcomes, and consequent lower morbidity and mortality. Percutaneous directional atherectomy and intravascular lithotripsy are game-changer medical devices for the treatment of peripheral arterial disease related to complex and severely calcific atherosclerotic plaque encroaching the common femoral artery bifurcation segment. The application of these devices, technical execution, and clinical experience is reported in two exemplary cases

Endovascular therapy for erectile dysfunction: current knowledge and future perspectives

Erectile dysfunction (ED) is defined as the inability to attain or maintain penile erection sufficient for successful sexual intercourse. ED carries a notable influence on quality of life, with significant implications for family and social relationships. Because atherosclerosis of penile arteries represents one of the most frequent causes of ED, patients presenting with it should always be investigated for potential coexistent coronary or peripheral disease. Up to 75% of patients with ED have a stenosis of the iliac-pudendal-penile arteries, supplying perfusion of the male genital organ. Recently the potential treatment of this pathological condition by percutaneous approaches has emerged with good angiographic results and with a significant improvement in symptoms and quality of life. This review will focus on the normal anatomy and physiology of erection, the pathophysiology of ED, the relation between ED and cardiovascular diseases and, lastly, on new treatment modalities aimed at restoration of normal erectile function

Cardiovascular Risk Profile of Patients Hospitalized for Myocardial Infarction is Undestimated by Traditional Risk Factors and is Better Estimated by a Genetic Analysis Based Upon Single Nucleotide Polymorphisms: A Retrospective Study

Aims: Acute myocardial infarction (AMI) may occur in patients without traditional cardiovascular risk factors (TRFs). The aim of our study was to compare, in patients with AMI, the cardiovascular risk estimate obtained from the analysis of TRF with the integrated genetic risk (IGR), calculated in the same population by the addition to TRF of the genetic analysis of 11 single-nucleotide polymorphisms (SNPs), which have been previously associated with cardiovascular disease (CVD) in genome-wide association studies (GWAS). Methods: We evaluated 118 patients hospitalized for AMI in our institution from June 2016 to June 2017. In these patients, a retrospective analysis of the risk of CV events at 5 years was done using a dedicated software. In this population, the IGR was compared to the TCR. Results: In the study population, the retrospective estimate of the CV risk according to TRFs yielded a high-risk profile (5-year CV events risk >20%) in only 16 patients (14%). When CV risk was estimated by the genetic analysis, the prevalence of high-risk patients increased significantly (41 patients, 35%, P < 0.0001 vs. TRF-based analysis). However, we observed no association between any single SNP and a family history of CVD. Conclusions: In a population of AMI patients, IGR analysis based on 11 SNP associated with CVD in GWAS recognized a high cardiovascular risk status in a significantly higher proportion of patients otherwise classified at low risk by TRF. We speculate that the prospective application of the IGR analysis to primary prevention might improve CV risk stratification

A multidisciplinary consensus document on follow-up strategies for patients treated with percutaneous coronary intervention

The number of percutaneous coronary interventions (PCI) is increasing worldwide. Follow-up strategies after PCI are extremely heterogeneous and can greatly affect the cost of medical care. Of note, clinical evaluations and non-invasive exams are often performed to low risk patients. In the present consensus document, practical advises are provided with respect to a tailored follow-up strategy on the basis of patients' risk profile. Three strategies follow-up have been defined and types and timing of clinical and instrumental evaluations are reported. Clinical and interventional cardiologists, cardiac rehabilitators, and general practitioners, who are in charge to manage post-PCI patients, equally contributed to the creation of the present document