Protein S on the surface of plasma lipoproteins: a potential mechanism for protein S delivery to the atherosclerotic plaques?

The anticoagulant protein S (PS) binds phospholipids with very high affinity, but PS interaction with lipoproteins and lipidrich atherosclerotic plaques remains still poorly defined. We investigated PS in plasma lipoproteins and in atherosclerotic plaques from ten patients undergoing endarterectomy. PS was detected by Western blotting after exposure of the necrotic core to liposomes and was found to maintain its ability to bind phosphatidylserine micelles. The amounts of PS bound to low/very low-density lipoproteins in patient' plasmas were higher and more variable than those detected in healthy subjects. A direct correlation between bound PS and low-density lipoproteins (LDL), plasma levels was found only in patients (r=0.921, p<0.001), thereby leading to hypothesize that the PS-phospholipids binding may increase by oxidative processes of LDL in atherosclerotic patients. The presence of the PS into the necrotic core of atherosclerotic plaques and on the surface of lipoproteins, particularly the atherogenic LDL, suggests a LDL-based delivery of PS to the atherosclerotic plaques and emphasizes the deep link between plasma lipids and coagulation in cardiovascular diseases

Venous thoracic outlet syndrome: Single center five years experience

BACKGROUND: Patients with thoracic outlet syndrome. can present neurogenic, venous, and/o arterialsymptoms due to compression of the neurovascular structures by the scalene muscle, first rib, or fibrous bands. METHODS: Twenty-six patients underwent decompressive surgery of the thoracic outlet via the supraclavicular approach. The indication for operation was compression of the subclavian artery in 7 instances (5 females and 2 males, aged 44±9), axillo-subclavian venous thrombosis in 6 instances (5 females and 1 male, aged 22±4), and brachial plexus irritation in 13 instances (9 females and 4 males, aged 35±6). Operation consisted of resection of the anterior scalene and medial aspect of the middle scalene muscles and brachial plexus neurolysis for neurogenic indication, with first rib resection reserved for vascular complications. RESULTS: Clinical evaluation including a history and physical examination followed by catheter-based venography to confirm or exclude the diagnosis and allowing for immediate treatment using thrombolysis. After thrombolysis, to prevent early recurrent thrombosis, patients should be maintained with systemic anticoagulation and surgery should be performed earlier in patients with severe residual SCV stenosis. CONCLUSIONS: Early diagnosis and thrombolytic therapy followed by operative first-rib resection produces the most favorable long-term outcome for the patients

Silent Contained Rupture of an Inflammatory IgG4-Related Abdominal Aortic Aneurysm

This report describes a case of a 66-year-old male patient with accidental diagnosis of chronic contained rupture of an aortic aneurysm. Surgery was performed through a median laparotomy. A thick periaortic tissue with fibrosis and lymphnodes covered the AAA. Immunohistochemical examination of the aneurismatic aortic wall revealed intense positivity for inflammatory markers and a large number of immunoglobulin G4 (IgG4) positive cells. The postoperative course was uneventful and patient was discharged in the fifth postoperative day. Patient was then followed periodically at the outpatient rheumatologic clinic. No adverse events occurred during 3 and 6 months follow up. Conclusion: Identification of IgG4-inflammatory aneurysms as an expression of the IgG4-related systemic disease is essential both for clinical follow up and surgical and pharmacological treatment considering the possibility of aneurysm rupture and the involvement of other organs

Prevention of post-thrombotic syndrome: Role of fibrinolysis in proximal deep vein thrombosis

BACKGROUND: Deep vein thrombosis (DVT) of the lower limbs is a relatively common clinical condition, with an incidence estimated at 1-2 cases per 1000 inhabitants per year. Post-thrombotic syndrome (PTS) is a chronic complication which particularly affects patients with proximal DVT (ilio-femoral); it significantly impacts upon patients' quality of life and it also has major health-economic implications. METHODS: We report our experience with ultrasound accelerated thrombolysis EKOS system in treatment of patients affected by proximal DVT. RESULTS: In our experience, we treated three cases of proximal DVT adopting ultrasound accelerated thrombolysis with EKOS system. Technical success rate was 100% in absence of embolic or hemorrhagic complications. The mean follow-up was 18 months: there were no thrombotic recurrences and none of the three patients had clinical signs of PTS. Loco-regional thrombolysis applied in selected cases of proximal DVT, unlike traditional therapy with oral anticoagulants, is able to ensure a rapid resolution of the thrombotic process, thus limiting valvular damage, that underlies the development of PTS. In recent years new techniques like mechanical, pharmaco-mechanical and ultrasound enhanced thrombolysis were developed. They allow a further reduction in both duration of treatment and drugs dose used, compared to pharmacological thrombolysis alone and also lead to an overall costs' reduction. CONCLUSIONS: In conclusion, from both a review of the literature and our own experience, pharmacological thrombolysis has proven to be a safe and effective technique in the treatment of proximal DVT, in order to prevent the development of PTS; nevertheless, it appears appropriate that those techniques are reserved to highly selected patients and practiced in centers with adequate experience and resources

Endovascular Revascularisation versus Open Surgery with Prosthetic Bypass for Femoro-Popliteal Lesions in Patients with Peripheral Arterial Disease

Aim: Complex atherosclerotic femoro-popliteal lesions have traditionally been treated with bypass surgery. A prosthetic graft is used to save the vein graft for more distal revascularisations or when a vein graft is unavailable. The endovascular approach has gained popularity and is offered as a first-line strategy for complex lesions. This study aimed to evaluate whether endovascular procedures can be used as a first-line treatment strategy for complex native femoro-popliteal lesions over open surgery with prosthetic bypass in patients with peripheral arterial disease (PAD). Methods: This single-centre retrospective observational study was conducted between 2013 and 2021; it included patients with symptomatic PAD who required limb revascularisation at the femoro-popliteal segment and who had complex lesions. The primary endpoints analysed were technical success, primary patency, freedom from clinically driven target lesion revascularisation (cdTLR), freedom from major adverse limb and cardiovascular events (MALE and MACE, respectively), freedom from limb loss, and survival. The secondary endpoints were length of in-hospital stay, and duration and costs of the procedure. Results: We identified 185 limbs among 174 suitable candidates for comparison, wherein 105 were treated with an endovascular procedure and 80 with a femoro-popliteal prosthetic bypass. Most patients in both groups presented with chronic limb-threatening ischaemia, and >90% of them had an American Society of Anesthesiologists (ASA) physical status classification of >3. The endovascular group had more octogenarians (p = 0.02) and patients with coronary disease (p = 0.004). The median follow-up was 30 months. The technical failure rate for endovascular procedures was 4.7%, versus 0% in the open group (p = 0.047). Freedom from MACE was similar in both groups. The endovascular group showed superior primary patency (p p p p = 0.0018) at 24 and 48 months. Further analysis performed for the open above-the-knee sub-group showed that the aforementioned endpoints were similar between the groups at 12 months and were better in the endovascular group at 24 and 48 months. Procedural time and in-hospital stay were longer in the open group than in the endovascular group (p p Conclusions: Endovascular procedures are safe for treating complex femoro-popliteal lesions in patients at a high risk for surgery and show better outcomes at 24 months than prosthetic bypasses do. The latter may be considered as an alternative should endovascular treatment fail

Management of iatrogenic subclavian artery rupture: two case reports

Bleeding of the branches of a subclavian artery can be a life-threatening condition. Subclavian artery bleeding can lead to tracheal obstruction, hemothorax, respiratory failure, hemorrhagic shock, and death if not diagnosed early and treated promptly. Injury to the subclavian artery occurs in multiple different manners including blunt, penetrating, or iatrogenic trauma. Here we reported two cases of injury of the branches of the right subclavian artery (RSA); one following a central venous catheterization and the other following a thoracic drainage tube placement. Herein we describe two endovascular treatment options used in the management of rupture of a subclavian artery. The proximal tract of the subclavian artery and its main branches is also considered a 'border territory' between interventional vascular radiology and interventional neuroradiology because it gives rise to branches both cervical and to the upper limbs