Type IV Thoraco-Abdominal Aortic Aneurysm (TAAA IV) with Occlusion of Celiac and Superior Mesenteric Arteries in a High Risk Patient: Successful Treatment with a Hybrid Traditional Vascular and Endovascular Procedure

Abstract We describe a novel hybrid open and endovascular repair for a dumbbell shaped lower thoracic and abdominal aortic aneurysm (AAA) in a high risk patient, with celiac trunk and superior mesenteric artery occlusions. We used a two-staged approach consisting of an open infrarenal AAA repair with a by-pass to superior mesenteric artery and reimplantation of inferior mesenteric artery. This was followed by an antegrade insertion of a thoracic endograft via a PFTE graft on the thoracic aorta to allow precise deployment of the stent graft above the renal arteries

Intentional coverage of the left subclavian artery during endovascular repair of traumatic descending thoracic aortic transection

ObjectiveThis single-center, prospective study aimed to investigate the technical success and outcome of intentional coverage of the left subclavian artery (LSA) in patients undergoing thoracic endovascular aortic repair (TEVAR) for traumatic rupture of the aortic isthmus at a tertiary care medical center.MethodsFrom January 2005 to June 2011, patients who presented with traumatic aortic transection underwent TEVAR with coverage of the LSA when the distance between the artery and the rupture was <2 cm. At 12, 24, and 72 hours postoperatively, clinical and neurologic evaluation including transcranial Doppler insonation of the brachial artery was performed. A decrease in peak systolic velocity (PSV) >60% with respect to the contralateral one was considered relevant. Functional status of the left arm was evaluated using a provocative test. Thoracoabdominal computerized tomographic angiography was performed postoperatively at 3-, 6-, and 12-month follow-up.ResultsThirty-one patients (mean age 35 years) underwent emergency TEVAR for traumatic aortic transection with intentional LSA coverage during the study period. In four cases (12.9%) coverage was partial. Two patients (6.4%) died during the postoperative period due to associated lesions. No signs of vertebrobasilar insufficiency, stroke, or paraplegia were observed in any of the patients. Nine patients (36%) had severe arm claudication (ischemic pain within 60 seconds of beginning arm exercise and decrease of PSV between 50% and 60%). Risk factors for the condition were left vertebral artery diameter <3 mm (P < .0001). A significant correlation was found between the degree of PSV reduction and left arm symptoms (P < .0001). There was an improvement in ischemic arm symptoms (P < .0001) during mean follow-up of 36 months (range, 6-65 months), with only one patient (4.2%) presenting with severe claudication. Freedom from reintervention at 48 months was 93.5%. No signs of endoleaks or graft migrations were detected on computerized tomographic angiography control scans.ConclusionsCoverage of the LSA during TEVAR for traumatic aortic injuries appears to be a feasible, safe method for extending the endograft landing zone without increasing the risk of paraplegia, stroke, or left arm ischemia. Left vertebral artery diameter can be used to identify patients at risk for postoperative left arm ischemia

Elderly patient: which vascular access? Choice and management of vascular access in the elderly patient:

The optimal vascular access for elderly patients remains a challenge due to the difficult balance between risks and benefits in a population with increased comorbidity and decreased survival. Long dependence to central vein catheter, patient comorbidities, life expectancy, and complication rates are important influencing the indications for arteriovenous fistula or an arteriovenous graft. Although central vein catheters are simpler way to start a hemodialysis treatment, elderly patients are also at higher risk of death from infection or other complications associated with them more than for younger patients. The discussion revolves around the following key questions: What are the limiting factors for a vascular access in the elderly patients? Central venous catheter—is it still an option for elderly patients? Is still the autologous arteriovenous fistula playing a pivotal role as hemodialysis access in the elderly patients? Are there any real surgical contraindication to perform a vascular access in elderly patients? Is the old age a limiting factor for the vascular access management

Coll del Moro (Gandesa, Tarragona) and its territorial context: formation and development of a protohistoric urban settlement

[spa] Los trabajos realizados entre 2014 y 2019 en este importante núcleo, situado estratégicamente entre las cuencas de los ríos Ebro y Matarraña, han combinado la excavación en extensión, la prospección intensiva del asentamiento y de su entorno inmediato, los análisis interdisciplinares y la revisión de las intervenciones anteriores. Los resultados permiten reinterpretar la evolución del asentamiento entre el Primer Hierro y el Alto Imperio. Su extensión inicial debió de ser reducida, con una función limitada al control del territorio y ejercida desde una gran torre, mientras que en el siglo III a. C. alcanzó su máxima extensión (3 ha) y se erigió una gran mansión aristocrática. Esta evolución refleja el proceso de estratificación y urbanización de la sociedad ibérica de la zona, truncado por la conquista romana. En época romano-republicana se construyó un edificio fortificado que recuperó la función de punto de control, para pasar a ser ocupado esporádicamente en el Alto Imperio.[eng] Research carried out between 2014 and 2019 on this important site, strategically located between the basins of the Ebro and Matarraña rivers, combined extensive excavation, intensive survey of the settlement and its immediate surroundings, interdisciplinary analysis, and a review of previous works. The results throw new light on the evolution of the settlement between the Early Iron Age and the Early Empire. Its initial extension must have been reduced, and aimed to control the territory from a large tower, while in the 3rd century BC the settlement reached its maximum surface (3 ha) and a large aristocratic mansion was erected. This evolution reflects the stratification and urbanisation processes of the Iberian society in the area, which would be truncated by the Roman conquest. In the Roman Republican era, a fortified building was built that recovered the site's function as a control point; this would be sporadically occupied during the early Roman Empire

The Peritoneum as a Natural Scaffold for Vascular Regeneration

Objective: The peritoneum has the same developmental origin as blood vessels, is highly reactive and poorly thrombogenic. We hypothesize that parietal peritoneum can sustain development and regeneration of new vessels. Methods and Results: The study comprised two experimental approaches. First, to test surgical feasibility and efficacy of the peritoneal vascular autograft, we set up an autologous transplantation procedure in pigs, where a tubularized parietal peritoneal graft was covered with a metal mesh and anastomosed end-to-end in the infrarenal aorta. Second, to dissect the contribution of graft vs host cells to the newly developed vessel wall, we performed human-to-rat peritoneal patch grafting in the abdominal aorta and examined the origin of endothelial and smooth muscle cells. In pig experiments, the graft remodeled to an apparently normal blood vessel, without thrombosis. Histology confirmed arterialization of the graft with complete endothelial coverage and neointimal hyperplasia in the absence of erosion, inflammation or thrombosis. In rats, immunostaining for human mitochondri revealed that endothelial cells and smooth muscle cells rarely were of human origin. Remodeling of the graft was mainly attributable to local cells with no clear evidence of c-kit+ endothelial progenitor cells or c-kit+ resident perivascular progenitor cells. Conclusions: The parietal peritoneum can be feasibly used as a scaffold to sustain the regeneration of blood vessels, whic

Darrers resultats del projecte de recerca tunisianocatalà a la ciutat numidoromana d'Althiburos i els seus encontorns

En altres números de la revista AURIGA hem tingut ocasió de donar notícies sobre els resultats obtinguts en el projecte de recerca tunisianocatalà a la ciutat númida, i després romana, d'Althiburos, a la república de Tunísia. Ens limitarem, doncs, a recordar que l'objectiu dels nostres treballs és recuperar documentació rellevant que permeti plantejar hipòtesis mínimament sòlides sobre els processos de formació i desenvolupament dels estats númides que van tenir lloc durant el primer mil·lenni aC

Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM)

: The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suffering from aneurysmal pathology of the visceral and renal arteries. The methodology applied was the GRADE-SIGN version, and followed the instructions of the AGREE quality of reporting checklist. Clinical questions, structured according to the PICO (Population, Intervention, Comparator, Outcome) model, were formulated, and systematic literature reviews were carried out according to them. Selected articles were evaluated through specific methodological checklists. Considered Judgments were compiled for each clinical question in which the characteristics of the body of available evidence were evaluated in order to establish recommendations. Overall, 79 clinical practice recommendations were proposed. Indications for treatment and therapeutic options were discussed for each arterial district, as well as follow-up and medical management, in both candidate patients for conservative therapy and patients who underwent treatment. The recommendations provided by these guidelines simplify and improve decision-making processes and diagnostic-therapeutic pathways of patients with visceral and renal arteries aneurysms. Their widespread use is recommended

El projecte de recerca arqueològica a Althiburos i els seus encontorns (El Kef, Tunísia)

The archaeological digs carried out between 2006 and 2009 at Althiburos has have proved the existence of contacts with the Phoenician world since the end of the eighth century BC, as well as the adoption of Punic hydraulic techniques from the sixth century BC. The relationship with the Punic world became particularly intense from the fourth century BC. It is indicated by a significant increase in the pottery imports. There is also epigraphic evidence that demonstrates the existence of a municipal organization with strong Punic influence at least from the second century BC, when a sanctuary dedicated to Baal Hammon was also created. The intense penetration of the Punic culture raises the issue of what were the political relations between Althiburos and Carthage from the fifth century BC to the time of Massinissa; more precisely, whether the former was included in the territory of the latter, or, on the contrary, it depended on the Numidian kingdom, albeit maybe housing a Carthaginian garrison