[18F]-Fludeoxyglucose Positron Emission Tomography/Computed Tomography with Radiomics Analysis in Patients Undergoing Aortic In-Situ Reconstruction with Cryopreserved Allografts

The aim of this study was to evaluate the effectiveness of positron emission tomography/computed tomography with [18F]-fludeoxyglucose (FDG-PET/CT) and radiomics analysis in detecting differences between the native aorta and the abdominal aortic allograft after the total eradication of infection in patients undergoing infected graft removal and in situ reconstruction with cryopreserved allografts

Successful extreme foot revascularization with plaque cracking (percutaneous direct needle puncture of calcified plaque) technique of medial tarsal artery

The percutaneous direct needle puncture of calcified plaque technique is a valuable method to allow for extreme revascularization of occluded below-the-ankle vessels. We report the case of an antegrade recanalization technique from the peroneal artery to medial plantar artery to achieve external “cracking” of a calcified plaque of the medial tarsal artery

Chronic Limb-Threatening Ischemia and the Need for Revascularization

Background: Patients presenting with critical limb-threatening ischemia (CLTI) have been increasing in number over the years. They represent a high-risk population, especially in terms of major amputation and mortality. Despite multiple guidelines concerning their management, it continues to be challenging. Decision-making between surgical and endovascular procedures should be well established, but there is still a lack of consensus concerning the best treatment strategy. The aim of this manuscript is to offer an overview of the contemporary management of CLTI patients, with a focus on the concept that evidence-based revascularization (EBR) could help surgeons to provide more appropriate treatment, avoiding improper procedures, as well as too-high-risk ones. Methods: We performed a search on MEDLINE, Embase, and Scopus from 1 January 1995 to 31 December 2022 and reviewed Global and ESVS Guidelines. A total of 150 articles were screened, but only those of high quality were considered and included in a narrative synthesis. Results: Global Vascular Guidelines have improved and standardized the way to classify and manage CLTI patients with evidence-based revascularization (EBR). Nevertheless, considering that not all patients are suitable for revascularization, a key strategy could be to stratify unfit patients by considering both clinical and non-clinical risk factors, in accordance with the concept of individual residual risk for every patient. The recent BEST-CLI trial established the superiority of autologous vein bypass graft over endovascular therapy for the revascularization of CLTI patients. However, no-option CLTI patients still represent a critical issue. Conclusions: The surgeon’s experience and skillfulness are the cornerstones of treatment and of a multidisciplinary approach. The recent BEST-CLI trial established that open surgical peripheral vascular surgery could guarantee better outcomes than the less invasive endovascular approach

Non-reversed Bifurcated Vein Graft Improves Time of Healing in Ischemic Patients Undergoing Lower Limb Distal Bypass

Objective: The aim was to retrospectively compare non-reversed bifurcated versus single vein graft in patients with critical limb-threatening ischemia (CLTI) undergoing lower limb distal bypass. Methods: Between January 2015 and December 2021, 193 patients with lower limb ischemic lesions have been treated at our Center with vein bypass and distal anastomosis performed on one or more tibial/foot vessels. One-hundred-thirty-seven patients (71%) received a single graft (Group SIN), and 56 patients (29%) had a bifurcated bypass (Group BIF). Primary outcome measures were time of healing, primary patency, primary assisted patency, secondary patency, and limb salvage. Two-year outcomes according to Kaplan-Meier curves were evaluated and compared. Results: Both groups were homogeneous in terms of demographic data, preoperative risk factors, and clinical presentation but for an elderly age in Group BIF (77.5 vs. 71.5 years; p <0.001). Intraoperative technical success was achieved in all patients. Overall median duration of follow-up was 19 months (interquartile range 9–36). Wound healing did not differ between the two groups (77.4% Group SIN vs. 73.2% Group BIF; p = 0.33). Mean time to healing was faster in Group BIF (2.4 vs. 6.8 months; p <0.001). At 2-year follow-up there were no differences between the two groups in terms of primary patency (71.4% Group SIN vs. 54% Group BIF; p = 0.10), primary assisted patency (81.7% Group SIN vs. 76.4% Group BIF; p = 0.53), secondary patency (85.1% Group SIN vs. 80.9% Group BIF; p = 0.79), and limb salvage (92.3% Group SIN vs. 87.2% Group BIF; p = 0.64) ([Fig.]). Conclusion: Bifurcated graft improved time to healing in CLTI patients undergoing infrapopliteal non-reversed vein bypass. Two-year overall patencies and limb salvage did not differ according to vein graft configuration (single vs. bifurcated)

RIvaroxaban and VAscular Surgery (RIVAS): insights from a multicenter, worldwide web-based survey

no abstract availabl