Mechanical rotational thrombectomy in long femoropopliteal artery and stent occlusion in COVID-19 patient: Case report

Introduction: Coronavirus disease-19 (COVID-19) has been increasingly associated with thromboembolic complications. COVID-19 infection has a thrombogenic potential for stents. Herein, we report a case of stent thrombosis in diabetic obese patient COVID-19 positive where was previously released a Multilayer Flow Modulator stent (MFM) for large popliteal aneurysm. Case report: A 78-year-old male was referred to our hospital for fever and acute pain in the left leg. At history, the same patient had endovascular procedure for a large symptomatic popliteal aneurysm, treated through release of three MFM. The pulmonary CT scan showed COVID-19 infection with confirm of rhino-laryngeal swab. Duplex ultrasound and CT-angiography showed complete thrombosis of stents. The treatment consisted of mechanical thrombectomy using an 8Fr catheter Rotarex plus release of Vibahn stent-graft. Discussion: COVID-19 patients can present arterial occlusion. In literature are not reported cases about thrombosis peripheral stent. Minimally invasive approaches in redo-procedure reduce risk of infection. Rotarex device was used in revascularization of acute and subacute iliac and femoropopliteal arteries. The goal is to have a debulking, to avoid an incomplete deployment of stent-graft. In our precedent experience, MFM and stent-graft to treatment of popliteal aneurism were safe. It is important to monitor these patients for early identification of failure and rapprochement. In this case, the COVID-19 infection was determinant in promoting thrombosis. Conclusions: COVID-19 increases risk of thrombosis stent. In our experience debulking through Rotarex and stenting, were decisive factors for revascularization and limb salvage

Multilevel diabetic foot revascularization in COVID 19 patient: Case report

Introduction: Coronavirus 2019 (COVID-19) has been associated with endothelial dysfunction. This hypercoagulable state coming from the endothelial injury pones COVID-19 patients to a higher risk for thrombosis. COVID 19 diabetic patients are more exposed to peripheral vascular disease progression. Multilevel peripheral arterial disease is the main cause of critical limb ischemia. Vascular interventions are required to increase distal blood flow and reduce the risk of amputation. Presentation of case: We report a case of complex revascularization in a diabetic patient with aggressive right foot lesions evolution after COVID-19 infection. The patient presenting a Peripheral arterial ischemic involving the infrarenal aorta, iliac, femoral. The simultaneous intervention consisted of an endovascular aortic stent-graft placement and angioplasty of femoral artery. Discussion: Diabetes is a risk factor of severity and deaths in patients infected with pulmonary viruses. In our experience, COVID 19 virus can accelerate the ulcers generation and progression in diabetic patient. Hybrid interventions can be performed simultaneously or staged with benefit given by the complementary role of endovascular and surgical treatments. In the reported case, a complex simultaneous treatment in a patient presenting Multilevel peripheral arterial disease in association to COVID 19 infection was feasible in the same operation. Conclusion: Hybrid procedures are safe with high degree of efficacy in terms of revascularization, reduced morbidity and shorter intensive care. In our experience, the use of a hybrid procedure is technically feasible and allowed the treatment of complicated diabetic COVID-19 patient with a good outcome

Type 1A endoleak detachable coil embolization after endovascular aneurysm sealing: Case report

Introduction: Endovascular aneurysm sealing (EVAS) with the Nellix system was introduced to reduce endovascular aneurysm repair (EVAR) perioperative complications, especially endoleaks. Herein we report a case of successful type 1A endoleak managed with detachable coils embolization after EVAS. Presentation of case: A 77-year-old male was referred for abdominal pain. The angio-CT scan confirmed the previous EVAS procedure and showed a type Is2 endoleak below the right renal artery resulting in a 2.5 cm aortic blister with contrast medium filling the space between the aortic wall and the endobags. The patient was considered unfit for conventional open surgery and an endovascular approach with coil embolization Concerto Helix Detachable Coil System was chosen under local anesthesia. After intervention, a complete abdominal pain regression was registered. The 12- month CT follow-up showed endoleak sealing and Nellix system stability. Discussion: EVAS has been associated to a high endoleaks and complications incidence when compared to EVAR. The EVAS different device concept led to a different endoleak classification and management. Endoleak management main options include the Nellix system explantation or the Nellix in Nellix application, however these are nearly always not applicable, respectively, due to the high surgical risk condition and the Nellix system availability, especially in emergent setting. Despite the use of coil embolization is controversial, this tool is off-the-shelf and leads to a disease resolution in most of patients without other surgical options. Conclusion: Proximal type Is2 embolization after EVAS is feasible with limited invasiveness

TEVAR and periscope graft technique to treatment of huge aneurysm of aortic isthmus: Case report

Introduction: Thoracic endovascular aortic repair (TEVAR) has revolutionized the treatment of thoracic aortic aneurysms. Innovative techniques as chimney and periscope grafts can improve the outcomes of procedure. Herein, we report a case in emergency of huge Thoracic aortic aneurism. Presentation of case: An 86-year-old male with hypertension, diabetes mellitus, was referred to our hospital for chest pain. CT-angiography showed a huge aneurysm of aortic isthmus with signs of rupture. The patient was considered unfit for open surgery and an endovascular approach was chosen. This patient underwent endovascular repair with TEVAR, using the periscope graft technique to preserve patency in left subclavian artery (LSA). Discussion: Symptomatic ischemia from LSA coverage has been reported to occur in only a modest 6–10% of patients and is often sacrificed with impunity given coverage rates between 10 and 50%. In this case reported the lack of revascularization of LSA increased the risk of neurological manifestations or stroke. Periscope technique is feasible and safe to maintain perfusion to the subclavian artery, with a 93% primary patency at 2 years. Conclusions: Our experience using TEVAR with periscope graft technique as solution to address thoracic aneurysm of aortic isthmus was feasible and safe

Staged acute mesenteric and peripheral ischemia treatment in COVID-19 patient: Case report

Introduction: COVID-19 is an infectious disease that has been associated not only with respiratory complications. The COVID-19 disease includes, also damage to other organ systems as well as coagulopathy. The present report describes a case of COVID-19 presenting with acute mesenteric ischemia (AMI) and subsequent acute limb ischemia (ALI). Presentation of case: An 84-years old hospitalized female patient presenting diabetes and recent COVID-19 reported acute onset of abdominal pain and typical findings of AMI. The CT-angiography confirmed the AMI secondary to a superior mesenteric artery (SMA) occlusion. The patient was managed through an endovascular approach using a SMA mechanical thrombectomy and stenting with a good result. Discussion: Treatment of this life-threatening condition includes surgical resection of the necrotic bowel, restoration of blood flow to the ischemic intestine and supportive measure - gastrointestinal decompression, fluid resuscitation, hemodynamic support. Endovascular management of AMI is preferred over the standard surgical approach due to a reduced mortality and morbidity rates. Imaging findings of intestinal necrosis, however, represent an indication for AMI surgical treatment with explorative laparotomy. Different endovascular solutions have been employed to address AMI including mechanical thrombectomy, local thrombolysis, and PTA-stenting. Conclusion: COVID-19 clinical presentation can be atypical, including gastrointestinal symptoms. If a first embolic event occurs, an aggressive anticoagulation treatment could be inefficient to reduce the risk of subsequent embolization events. The limited life expectancy of such revascularization procedures should orientate towards less invasive treatments

A computational and experimental investigation of the anchoring of organosilanes on the halloysite silicic surface

In this work, the effect of halloysite nanotubes alkali activation on its grafting efficiency with organosilanes was studied by Density Functional Theory and experimental investigations. In particular, computational analysis allowed to enlight the structural properties of the organic molecules attached to the silanol groups on halloysite outer surface. The energetics of the reactions showed that the pretreatment with a base is crucial for the modification of the surface due to the appearance of a high number of active sites which lead to thermodynamically favored exothermic processes. Experimental evidences are in good agreement with calculation hypothesis. For instance, the coating efficiency is higher after the alkali activation of the inorganic counterpart for both the investigated organosilanes. The findings here reported are important in order to improve any functionalization protocols for aluminosilicates without variations or loss of the hollow nanotubular morphological features and it paves the ground to halloysite based technological applications in many fields, from nanotechnology to catalysis

Body condition score (BCS) and metabolic status of shelter dogs

A group of 147 shelter dogs were weighted and assigned a body condition score (BCS) using a 9 point scale system, in order to evaluate the prevalence of obesity in the kennel. More than 60% of the animals showed a BCS³6 (overweight and obese) and this condition was mainly attributed to an excess of carbohydrates and fat in the diet. In 67/147 dogs, a blood sample was drawn and the effects of BCS, age and time spent in the shelter were evaluated on biochemical parameters. Obese dogs showed significantly higher levels of triglycerides (P<0.01), while increasing BCS determined only an increasing non significant trend on cholesterol values. Age influenced creatinine (P<0.05) and the oldest dogs scoring BCS³6 registered significant higher NEFA (P<0.05) and CK (P=0.01) levels. Time spent in the shelter did not affect any parameter. The dogs' metabolic condition reflects the need of taking more care of the quality of feed administered in the shelters to avoid the negative health effects caused by chronic obesity

Lava channel formation during the 2001 eruption on Mount Etna: evidence for mechanical erosion

We report the direct observation of a peculiar lava channel that was formed near the base of a parasitic cone during the 2001 eruption on Mount Etna. Erosive processes by flowing lava are commonly attributed to thermal erosion. However, field evidence strongly suggests that models of thermal erosion cannot explain the formation of this channel. Here, we put forward the idea that the essential erosion mechanism was abrasive wear. By applying a simple model from tribology we demonstrate that the available data agree favorably with our hypothesis. Consequently, we propose that erosional processes resembling the wear phenomena in glacial erosion are possible in a volcanic environment.Comment: accepted for publication in Physical Review Letter

The MEV project: design and testing of a new high-resolution telescope for Muography of Etna Volcano

The MEV project aims at developing a muon telescope expressly designed for the muography of Etna Volcano. In particular, one of the active craters in the summit area of the volcano would be a suitable target for this experiment. A muon tracking telescope with high imaging resolution was built and tested during 2017. The telescope is a tracker based on extruded scintillating bars with WLS fibres and featuring an innovative read-out architecture. It is composed of three XY planes with a sensitive area of \SI{1}{m^2}; the angular resolution does not exceeds \SI{0.4}{\milli\steradian} and the total angular aperture is about $\pm$\SI{45}{\degree}. A special effort concerned the design of mechanics and electronics in order to meet the requirements of a detector capable to work in a hostile environment such as the top of a tall volcano, at a far distance from any facility. The test phase started in January 2017 and ended successfully at the end of July 2017. An extinct volcanic crater (the Monti Rossi, in the village of Nicolosi, about 15km from Catania) is the target of the measurement. The detector acquired data for about 120 days and the preliminary results are reported in this work