Early results of mechanochemical ablation with Flebogrif® in great saphenous vein insufficiency: does polidocanol concentration affect outcome?

Flebogrif® (Balton, Poland) is a novel mechanochemical ablation (MOCA) device for saphenous vein insufficiency. It combines endothelial damage performed by radial retractable cutting hooks together with chemical ablation through sclerosant injection of 3% polidocanol foam according to its IFU. The objective of this study is to evaluate Flebogrif's efficacy in terms of recanalization rate and recurrence by varying polidocanol foam concentrations

Position Paper on Young Vascular Surgeons Training of the Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS):State of the Art and Perspectives

The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded in 2018, with the aim to promote cooperation among vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic peripheral artery was selected as the very first topic to be investigated by the federation. In this second paper, different experiences from delegates of participating countries were shared to define common strategies to harmonize, standardize, and optimize education and training in the Vascular Surgery specialty

Selective crossectomy combined with mechanochemical ablation in the treatment of great saphenous vein insufficiency: Early results of a single center experience

Background: Selective crossectomy and mechanochemical ablation (MOCA) of great saphenous vein (GSV) have been used, for years, individually in the treatment of chronic venous insufficiency. In this paper, we focus on the advantages of a combination of the two techniques, in order to prevent complications and recurrence. Methods: A preoperative clinical and instrumental screening phase was conducted for the purpose of dividing patients into three groups: "Saph+Cross" group (51/139 patients) underwent saphenectomy and crossectomy; "MOCA" group (44/139 patients) underwent MOCA of GSV with Flebogrif® device; "MOCA + Cross" group (44/139 patients) subjected to both MOCA and crossectomy procedures.Recurrence rate, defined as total recanalization of GSV and/or onset of neosaphena and/or new varicose veins, was used as a primary outcome. Secondary outcomes were procedural time and intra- and post-procedural complications. Results: We conducted a 1-, 6-, and 12-month follow-up with Duplex scan. The recurrence rates were 3.9%, 21.8%, and 4.5% for "Saph+Cross," "MOCA," and "MOCA+Cross," respectively, with a significant difference for the comparison between "MOCA" and "Saph+Cross" (MOCA vs Saph+Cross: OR 5.35, CI95% [0.98; 54.6], p-value .040).The sub-analysis of primary outcome highlighted a lower recanalization rate of GSV when combining the crossectomy with MOCA procedure (2.2% MOCA+Cross vs 15.9% MOCA; 0.12 OR, [0.002; 1.02] CI95%, p-value .029).Among the secondary outcomes, "MOCA" showed a shorter procedural time than the other groups (Saph+Cross: 51.3 ± 11.4; MOCA: 45.1 ± 7.5; MOCA+Cross: 50.4 ± 10; p-value .027). No significant differences were noted in terms of intra- and post-procedural complications. Conclusions: The results showed that patients treated with saphenectomy and crossectomy have a lower recurrence rate compared to MOCA alone and MOCA + crossectomy procedures.The association of crossectomy with MOCA significantly reduces the recanalization rate of GSV, and it is also characterized by a higher free survival from recurrence (SSF) than with MOCA alone

Endovascular treatment of extracranial carotid artery aneurysms with flow diverter stents

Extracranial carotid artery aneurysms (ECAAs) are not a common occurrence. As a result, its natural clinical course and the risk factors associated with an adverse outcome are largely unknown. Herein, we describe the endovascular treatment of two extracranial carotid artery aneurysms with flow diverter stents. Flow-diverter devices are stents placed in the parent artery at the level of the neck aneurysm in order to disrupt the intra-aneurysmal flow, thereby favoring intra-aneurysmal thrombosis. In the first case, an angio-CT scan was performed at one-month follow-up and in the second case a duplex scan was performed after four months. Both cases resulted in good stent positioning with complete exclusion of the aneurysm and complete carotid artery patency. Based upon our own clinical experience, endovascular treatment with flow diverter stents merit to be recognized and considered an option in cases of ECAA acknowledging that larger studies or larger series are needed to concur experience

Endovascular treatment of a wide-necked renal artery aneurysm with a flow diverter stent

Renal artery aneurysm (RAA) is a rare, often asymptomatic disease (0.1% incidence in general population) and can be incidentally diagnosed during an abdominal imaging workup. The traditional, gold standard of treatment is open surgery, carrying with it, however, a high risk of nephrectomy, mortality, and collateral morbidity. The endovascular approach is currently the most valid alternative to treating RAAs reducing, as it does, the risks associated with the surgical approach/open surgery. Herein we report on our experience with a case of wide-necked RAA treated with the Pipeline Vantage (Medtronic) flow diverter stent. Wide-neck aneurysms are defined as having neck diameters greater than 4 mm. Our choice of endovascular treatment was preferred over the surgical option notwithstanding the large size of the neck and the involvement of the branching vessels

Hybrid treatment of Persistent Sciatic Artery Aneurysm: two cases, long term follow-up and literature review

Background: Persistent Sciatic Artery (PSA) is a rare congenital arterial disease. Patients presenting this condition carry a high risk of acute limb ischemia and ensuing risk of lower limb loss. Although several treatment options have been described and published, a mutual consensus concerning optimal management has not yet been established. Case presentation: Two distinguished cases of successful hybrid repair of the left PSA in a 50-year-old man and an 89-year old woman at our institution are reported herein. Both patients presented in the emergency department with a two-day history of severe left leg pain and subsequently underwent hybrid treatment of PSA with embolization and femoro-popliteal bypass. A review of the literature has since been carried out on this specific topic in order to support our choice of treatment. Conclusions: The hybrid approach is a feasible and reliable treatment strategy for patients with PSA

The use of the Amplatzer Vascular Plug in the prevention of endoleaks during abdominal endovascular aneurysm repair: A systematic literature review on current applications

Objectives: The Amplatzer Vascular Plug (AVP) is a vascular occlusion device designed to provide optimal embolization in several fields of the endovascular surgery. A full literature review was conducted to analyze AVPs in comparison with coils for the prevention of endoleaks during endovascular abdominal aortic aneurysm repair. Methods: A systematic review was designed under PRISMA statement guidelines for systematic reviews and meta-analyses. The results were updated with a subsequent electronic search using Medline and Scopus databases up to December 2019. Results: Eighteen articles making this comparison were found. In 79.7% of the cases, the target vessel was the internal iliac artery; in 1.6%, the common iliac artery; and in 16.7%, the inferior mesenteric artery. Risk of complications (buttock claudication, groin hematoma, endoleaks, and erectile dysfunction) after AVP was low. A cost comparison revealed that the mean cost for coils was around US$2262, while the average cost for the AVP was US$310. Conclusions: The AVP is an effective and safe device for occluding peripheral vessels, proved to have lower complications rates. Compared with coil embolization, the AVP technique is potentially associated with lower procedural costs

The role of immunosuppressive therapy in aneurysmal degeneration of hemodialysis fistulas in renal transplant patients: Aneurysmatic arteriovenous fistula in transplant patients

Introduction: Venous aneurysms are long-term complications of arteriovenous fistula (AVF) for hemodialysis with an estimated incidence rate of around 5-6%. The purpose of our study is to investigate the role of immunosuppressive therapy in the development of AVF aneurysms in renal transplant patients, and to determine whether AVF closure following transplantation is necessary. Methods: Forty-six patients with symptomatic venous AVF aneurysms underwent ligation and resection of their fistulas between January 2013 and January 2020. Immunohistochemical expression of CD3, CD4 and CD8 was assessed on the surgical specimens to characterize lymphocytic infiltrate in the aneurysm wall. Patients were subdivided into "Group A"- kidney transplant patients undergoing immunosuppressive therapy which was comprised of 39 patients and "Group B" - patients who had not undergone kidney transplant which was comprised of 7 patients. The two groups did not significantly differ in age, sex nor risk factors for aneurysms. Results: Group A showed a significantly higher aneurysm diameter (p<0.0001), mean flow (p<0.0001) and required a longer duration of surgery (p=0.0007). A CD3+ lymphocytic infiltrate was significantly more common in Group A than in the Group B (90% vs 29%; p<0.001). No significant differences in localization (adventitia, media or intima) and type (CD4+ vs CD8+) of lymphocytes were found between the two groups. Conclusion: AVF venous aneurysms were significantly larger and with a more intense T-lymphocytic infiltrate in patients undergoing immunosuppressive therapy. This finding suggests that immunosuppressive therapy plays a role in aneurysm formation, supporting the need for AVF closure in patients with an estimated low risk of rejection

Carotid Endarterectomy versus Carotid Artery Stenting with Double-Layer Micromesh Carotid Stent: contemporary results of a single-center retrospective study

Objectives: Severe carotid stenosis (CS) is a major risk factor for stroke. Carotid Endarterectomy (CEA) is the gold standard revascularization technique of CS while carotid artery stenting (CAS) is considered an alternative treatment option, especially in high-risk patients or those with relative contraindications to CEA. The aim of this study was to evaluate the results of CEA and CAS with Roadsaver® stent device. Methods: We made a retrospective analysis of 119 patients undergoing treatment of CS. All CS were evaluated with imaging exams. The patients were divided into CEA group and CAS group. As primary endpoints of the study overall and cardiovascular cause - related mortality, freedom from stroke, and restenosis were considered. All patients were followed up and revaluated with duplex scan over a minimum of 6 months and a maximum of 36 months (follow-up mean time 22.3 ± 3.4 months). Results: In the whole cohort 86/119 patients underwent CEA and 33/119 CAS. Risk factors were superposable in both groups. During follow-up, we observed 4 deaths, 2 cardiovascular events and 12 restenosis. CEA was associated with lower death probability than CAS (p=0.036). Probability of Restenosis and cardiovascular events did not vary between CAS and CEA groups. Conclusions: Albeit CEA remains the gold standard for the treatment of severe CS, CAS with new double layer micromesh stent can be considered a useful and safe alternative in some clinical conditions