ITalian Excluder Registry and results of Gore Excluder endograft for the treatment of elective infrarenal abdominal aortic aneurysms

BackgroundTo report the midterm results of elective endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAAs) in a multicenter, clinical unsponsored registry using the Gore Excluder endograft.MethodsThis study is a retrospective analysis of a multicenter, prospective registry that involved nine centers in Italy. Periodic clinical and radiographic follow-up with computed tomography scans were performed at 1, 6, and 12 months after the procedure, and on a yearly basis thereafter.ResultsA total of 872 patients underwent elective EVAR. Primary technical success was 97.5%, and hospital mortality was 1.0% (9/872). At least 816 (93.6%) patients underwent a follow-up control. Freedom from all-cause death was estimated to be 97.9% at 1 year, 93.4% at 3 years, and 88.5% at 5 years. Aneurysm-related mortality was 1.6% (n = 13) with only two late AAA-related deaths observed at 21 and 36 months. Significant predictors of all-cause mortality included age (P < .001) and AAA maximum diameter (P = .027). Overall conversion rate was 2.3% (n = 19). Mean elapsed time from initial intervention to surgical conversion was 23 ± 18 months (range, 0-52 months). Late rupture was detected in four (0.5%) cases: two of these patients died after conversion. The rate of any reintervention was 9.4% (n = 77); most of them were required within the first 24 months. The leading cause of reintervention was endoleak (n = 41; 5.0%). Limb thrombosis occurred in nine (1.1%) cases. Freedom from reintervention at 1, 3, and 5 years of follow-up were 98.6%, 94.6%, and 86.5%.ConclusionsThe ITalian Gore Excluder Registry is the largest clinical unsponsored registry using a single device, with the longest follow-up period so far. The present experience confirms the effectiveness of EVAR using the Gore Excluder with low rates of mortality, migration, reintervention, and limb thrombosis

Purification of a factor from human peritoneal fluid that is able to immobilize spermatozoa

Human peritoneal fluid has been claimed to influence sperm motility. This report gives evidence for the presence in mid-cycle peritoneal fluid of a protein-bound, lipidic (hydrophobic) component able to immobilize spermatozoa as a function of time. This component was extracted from molecular weight-sieving and ion-exchange/high pressure liquid chromatography (HPLC)-purified peritoneal fluid fractions by either chloroform/methanol or charcoal treatments; resuspension of the chloroform/methanol extract with BWW-buffer and subsequent testing on spermatozoa resulted in sperm immobilization. Sequential or step-down chromatographic procedures (molecular weight-sieving→cation-exchange→anion-exchange HPLC separations of native peritoneal fluid) and extensive dialysis against double distilled water allowed the purification of the sperm immobilizing factor, as evidenced by the shorter incubation times necessary for sperm immobilization. Furthermore, the active fraction was found to immobilize spermatozoa without affecting its viability. Separation of the chloroform/methanol extracted immobilizing fraction on thin layer chromatography under conditions for phospholipid detection allowed the identification of a characteristic band which, after re-extraction, was found to be the sperm immobilizing substance. This factor does not contain choline, ethanolamine or serine. These results suggest that some lipidic peritoneal fluid components may influence sperm motilit

Giant Aneurysm of the Extracranial Carotid Artery: Case Report

AbstractWe report a case of giant extracranial carotid aneurysm treated by carotid aneurysmectomy. A 70-year-old female was referred with a palpable swelling on left lateral region of the neck, associated with dizziness and dysarthria. Spiral-CT scan showed a 5-cm aneurysm of the internal carotid artery (ICA), kinking of ICA and increased flow in the right vertebral artery. Angiography showed, a fusiform ICA aneurysm, with lengthening and tortuosity of intracranial vessels. An aneurysmectomy was performed with end-to-end repair of ICA. The patient was discharged on the 12 post-operative day. Twelve months after the operation, the patient showed a complete recovery from the neurological deficit and patency of ICA. We recommend surgical treatment in order to avoid rupture, thromboembolism and cerebrovascular insufficiency

Successful endovascular management with a covered stent of an external iliac pseudoaneurysm following allograft nephrectomy using CO 2 as contrast medium: a case report.

Iodinated contrast agents for angiography in chronic kidney disease (CKD) patients could further deteriorate their renal function leading to adverse sequelae. The use of carbon dioxide (CO2) is reported in the literature and has been safely used for a variety of angiographic procedures, particularly to guide aortic and renal interventions. We report the case of the successful endovascular treatment with a covered stent of a right external iliac artery pseudoaneurysm following graft nephrectomy in a CKD patient, using CO2 as contrast medium

Effects of asphericity and substructure on the determination of cluster mass with weak gravitational lensing

Weak gravitational lensing can be used to directly measure the mass along a line-of-sight without any dependence on the dynamical state of the mass, and thus can be used to measure the masses of clusters even if they are not relaxed. One common technique used to measure cluster masses is fitting azimuthally-averaged gravitational shear profiles with a spherical mass model. In this paper we quantify how asphericity and projected substructure in clusters can affect the virial mass and concentration measured with this technique by simulating weak lensing observations on 30 independent lines-of-sights through each of four high-resolution N-body cluster simulations. We find that the variations in the measured virial mass and concentration are of a size similar to the error expected in ideal weak lensing observations and are correlated, but that the virial mass and concentration of the mean shear profile agree well with that measured in three dimensional models of the clusters. The dominant effect causing the variations is the proximity of the line-of-sight to the major axis of the 3-D cluster mass distribution, with projected substructure only causing minor perturbations in the measured concentration. Finally we find that the best-fit "universal" CDM models used to fit the shear profiles over-predict the surface density of the clusters due to the cluster mass density falling off faster than the r^{-3} model assumption.Comment: 10 pages, 10 figures, accepted by MNRA

Arch and access vessel complications in penetrating aortic ulcer managed with thoracic endovascular aortic repair

Background: To analyze our experience and to describe access and arch-related challenges when performing thoracic endovascular aortic repair (TEVAR) for penetrating aortic ulcers (PAUs).Methods: This is a single-center, observational, cohort study. Between October 2003 and February 2019, 48 patients with PAU were identified; 37 (77.1%) treated with TEVAR were retrospectively analyzed. Primary major outcomes were early (&lt; 30 days) and late survival, freedom from aortic-related mortality (ARM), and a composite endpoint of arch/vascular access-related complications.Results: On admission, 17 (45.9%) patients were symptomatic with 4 (10.8%) presenting with rupture. Inhospital mortality was 8.1% (n=3). We observed 10 (27.0%) arch/access-related complications. There were 4 (10.8%) arch issues: 2 transient ischemic attacks and 2 retrograde acute type A dissections which required emergent open conversion for definitive repair. Access issues occurred in 6 (16.2%) patients: 3 (8.1%) required common iliac artery conduit, and 1 (2.7%) patient required iliac artery angioplasty to deliver the stent-graft. In addition, 2 (5.4%) patients developed access complications which required operative repair [femoral patch angioplasty (n=2), and femoral pseudoaneurysmectomy (n=1)]. Arch/access-related mortality rate was 5.4% (n=2) and median follow-up was 24 (range, 1-156; IQR, 3-52) months. Estimated survival was 87.1% (standard error: 0.6; 95% CI: 71.2-84.9%) at 1 year, and 63.3% (SE: 0.9; 95% CI: 44.1-79%) at 4 years. Estimated freedom from reintervention was 88.9% (SE: 0.5; 95% CI: 74.8-95.6%) at 1 year, and 84.2% (SE: 0.7; 95% CI: 67.3-93.2%) at 4 years. No arch/access-related issues developed during the follow-up period.Conclusions: Our experience confirms that vascular access and aortic arch issues are still a challenging aspect of performing TEVAR for PAUs. Our cumulative 27% rate of access/arch issues is lower than previously reported due to both technological advancements and meticulous management of both access routes and arch anatomy

Internal Iliac Artery Embolization within EVAR Procedure: Safety, Feasibility, and Outcome

Background: This study is focused on Internal Iliac Artery (IIA) embolization in patients undergoing Endovascular Aneurysm Repair (EVAR). Our aims were: to establish the feasibility of the procedure; to assess the presence of endoleak (EL) and increase in the size of the sac at follow-up; to define the need for reintervention; and to evaluate mortality rate. Methods: In this retrospective single-center study, EVAR-treated patients with an embolization of IIA were chosen. Coils and vascular plug were used as embolizing agents. Results: A total of 49 participants were enrolled in the study (48 men and one woman) with a median age of 76 +/- 12 years. Patients had no early EL in 87.75% of cases, 8.16% had type 1a EL, 2.04% type 1b EL, and 2.04% type 2 EL, with a comprehensive technical success of 95.91%. In the follow-up, at 1 month 72.22% remained without EL, at 6 months 70.97%, and at 1 year 81.48%. In the same period, the trend of type 1 EL was 5.56% (1 month), 3.23% (6 months), and 0% (1 year). For EL type 2: 22.22% at 1 month, 25.81% at 6 months, and 16.7% at 1 year. The overall mortality was 35.58% and the re-intervention rate was 16.33%. Conclusions: IIA embolization is a feasible and safe procedure. The presence of EL is not superior to EVAR procedures that do not involve embolization

Endovascular retreatment of a splenic artery aneurysm refilled by collateral branches of the left gastric artery : a case report

Introduction: A rare case of a splenic artery aneurysm refilled by a hypertrophic branch originating from the left gastric artery retreated with an endovascular approach is reported. To the best of our knowledge, this is the first such case reported in the literature. Case presentation: A hilum splenic artery aneurysm of a 43-year-old Caucasian woman was treated with endovascular ligature. Contrast-enhanced computed tomography performed after 1 month revealed reperfusion of the aneurysm and a new angiogram demonstrated a hypertrophic vessel from her left gastric artery supplying the sac of the aneurysm. It was catheterized by splenic hilum branches and it was embolized with coil and glue. Contrast-enhanced computed tomography performed after 3 months confirmed complete exclusion of the sac of the aneurysm. Conclusions: Our patient represents the first rare case of a splenic artery aneurysm refilled from a branch of her left gastric artery not visible at first at angiography or at contrast-enhanced computed tomography performed after1 month; it was revealed at the second angiography and it was definitively embolized. These eventualities and possibilities of treatment, although rare, should be kept in mind for each patient with similar presentation