RR5. Surgical Treatment of Popliteal Aneurysms Using a Posterior Approach: Thirteen Years' Follow-up

OBJECTIVES : Long-term results of posterior approach (PA) for the treatment of popliteal artery aneurysms are lacking in the literature. We compared our results with this access with those from a standard medial approach over a 13-years\u2019 period. METHODS: Clinical data of all patients treated for a popliteal aneurysm between 2/1998 and 10/2011 were retrospectively reviewed and outcomes analyzed: Kaplan-Meier method with log-rank, chi2 and Wilcoxon test were employed for analysis. RESULTS : A total of 78 aneurysms were treated in 66 patients (65 men). Mean age was 68 years (range 48-96 years). Thirty-six aneurysms were asymptomatic (46%). Mean sac diameter was 2.9\ub11 cm. A PA was used in 43 cases (55%) and a medial approach (MA) in 35. All PA consisted in aneurysmectomy with an interposition graft with end to end anastomoses; among MA 25 interposition grafts and 10 bypass were performed. A PTFE graft was used mostly (57 cases). The two groups differed for age only (median 65.4 for PA vs. 72.9 for MA p=0.01). Five patients had an early thrombosis and required a Fogarty thrombectomy (2 PA and 3 MA, all PTFE grafts). Mortality rate at 30 days was 0%. One patient suffered a peroneal nerve lesion (permanent) and another one a major wound necrosis with tissue loss (both PA). There were no early amputations. Median follow-up was 58.8 months (range 5 days-166.7 months). Nine patients died during follow-up for unrelated causes. The 5-year primary and secondary patency rates were 58.9%\ub18,7% and 96.4%\ub13.5% respectively for PA, and 67.4%\ub110,4% and 81.3%\ub18,9% respectively for MA (p=0.41 for primary patency rate and 0.28 for secondary patency rate). Limb salvage was 100% and 93.3%\ub16.4% at 5 and 10 years respectively for PA and 91.5%\ub15.6% at both time points for MA (p=0.3). CONCLUSIONS : PA in our experience was burdened by a few more early complications compared to MA. However in the long term it provided results which compare favorably to MA. AUTHOR DISCLOSURES: I. Barbetta, Nothing to disclose; M. Carmo, Nothing to disclose; R. Dallatana, Nothing to disclose; G. Grava, Nothing to disclose; D. Mazzaccaro, Nothing to disclose; A. M. Settembrini, Nothing to disclose; P. Settembrini, Nothing to disclose

Acute Lower Limb Ischaemia as a Presenting Sign of Atrial Myxoma: Case Report and Scoping Review of the Literature

Objective: Cardiac myxomas (CMs) are the most common primary cardiac tumour in adults. They are a rare cause of peripheral embolisation and may present as acute lower limb ischaemia (ALI). A scoping review was undertaken and a case of ALI due to CM embolisation is presented in this paper. Methods: MEDLINE, Scopus, and Embase were systematically searched for studies reporting data on ALI as a presentation of CM embolisation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was followed. Results: A healthy 26 year old female presented to the emergency department with bilateral ALI. Urgent bilateral aorto-iliac embolectomy and distal embolectomy of the left femoropopliteal axis were performed. The retrieved embolic material exhibited a yellowish appearance and jelly like consistency, and histological analysis provided a diagnosis of a myxomatous embolus. Transoesophageal echocardiography confirmed the left atrial origin of a myxomatous tumour, but the residual mass was considered too small for further excision. At a two year clinical follow up, the patient was alive and well without recurrence. Between 1989 and 2023, 59 patients with ALI due to CM embolisation were identified in the literature. An in hospital mortality rate of 12.1% (n = 7) was reported, while the in hospital complication and re-intervention rates were 34.5% (n = 20) and 27.6% (n = 16), respectively. No post-discharge deaths, complications, or re-interventions were reported; fasciotomies were the most reported (n = 10). Post-discharge follow up was reported in 22 (37.3%) patients. Mean follow up was 18.0 ± 18.8 months (range 1–120), and 86.4% of patients (n = 19) were alive and well at last follow up. Conclusion: This review and the associated case report underline that CM embolisation should be considered in healthy young patients presenting with cryptogenic ALI. Early transoesophageal echocardiography and histological analysis of the retrieved embolus are recommended to minimise misdiagnosis in these populations

MicroRNAs in the progression of atherosclerosis: rise and fall of the atherosclerotic plaque

Atherosclerosis is the main cause of mortality globally, being at the basis of most cardiovascular diseases. It is a multifactorial disease, arising from complex interactions comprising changes in lipid metabolism, inflammation and oxidative stress. These factors contribute to endothelial damage and dysfunction, the accumulation of immune cells and smooth muscle cells in the intima, ultimately leading to the formation of atherosclerotic plaques, which restricts blood flow through the vessels. Much progress has been made in the last decades in debunking the underlying mechanisms of atherosclerosis development, especially concerning the evaluation and prediction of plaque stability and the understanding of the roles played by each of the involved cell types. As yet, mechanisms that drive plaque development toward specific ‘vulnerable’ phenotypes remain undiscovered. Based on recent advancements in RNA therapeutics, this review aims to illustrate a comprehensive overview of miRNAs relevant to various aspects of atherosclerosis and emphasizes their theranostic potential, highlighting their dual role as both drug targets and biomarkers

How the First Year of the COVID-19 Pandemic Impacted Patients’ Hospital Admission and Care in the Vascular Surgery Divisions of the Southern Regions of the Italian Peninsula

Background: To investigate the effects of the COVID-19 lockdowns on the vasculopathic population. Methods: The Divisions of Vascular Surgery of the southern Italian peninsula joined this multicenter retrospective study. Each received a 13-point questionnaire investigating the hospitalization rate of vascular patients in the first 11 months of the COVID-19 pandemic and in the preceding 11 months. Results: 27 out of 29 Centers were enrolled. April-December 2020 (7092 patients) vs. 2019 (9161 patients): post-EVAR surveillance, hospitalization for Rutherford category 3 peripheral arterial disease, and asymptomatic carotid stenosis revascularization significantly decreased (1484 (16.2%) vs. 1014 (14.3%), p = 0.0009; 1401 (15.29%) vs. 959 (13.52%), p = 0.0006; and 1558 (17.01%) vs. 934 (13.17%), p < 0.0001, respectively), while admissions for revascularization or major amputations for chronic limb-threatening ischemia and urgent revascularization for symptomatic carotid stenosis significantly increased (1204 (16.98%) vs. 1245 (13.59%), p < 0.0001; 355 (5.01%) vs. 358 (3.91%), p = 0.0007; and 153 (2.16%) vs. 140 (1.53%), p = 0.0009, respectively). Conclusions: The suspension of elective procedures during the COVID-19 pandemic caused a significant reduction in post-EVAR surveillance, and in the hospitalization of asymptomatic carotid stenosis revascularization and Rutherford 3 peripheral arterial disease. Consequentially, we observed a significant increase in admissions for urgent revascularization for symptomatic carotid stenosis, as well as for revascularization or major amputations for chronic limb-threatening ischemia

PS196. Ultrasonic Debridement for the Treatment of Infected Grafts

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