Translumbar type II endoleak embolization with a new liquid iodinated polyvinyl alcohol polymer: Case series and review of current literature

PurposeTo describe our experience with the use of a novel iodized Polyvinyl Alcohol Polymer liquid agent (Easyx) in type II endoleak treatment with translumbar approach.MethodsOur case series is a retrospective review of patients with type II endoleak (T2E) treated with Easyx from December 2017 to December 2020. Indication for treatment was a persistent T2E with an increasing aneurysm sac ≥5 mm on computed tomography angiography (CTA) over a 6-month interval. Technical success was defined as the embolization of the endoleak nidus with reduction or elimination of the T2E on sequent CTA evaluation. Clinical success was defined as an unchanged or decreased aneurysm sac on follow-up CTA. Secondary endpoints included the presence of artifacts in the postprocedural cross-sectional tomographic imaging and post and intraprocedural complications.ResultsTen patients were included in our retrospective analysis. All T2E were successfully embolized. Clinical success was achieved in 9 out of 10 patients (90%). The mean follow-up was 14 3–20 months. No beam hardening artifact was observed in follow-up CT providing unaltered imaging.ConclusionEasyx is a novel liquid embolic agent with lava-like characteristics and unaltered visibility on subsequent CT examinations. In our initial experience, Easyx showed to have all the efficacy requisites to be an embolization agent for type II EL management. Its efficacy, however, should be evaluated in more extensive studies and eventually compared with other agents

Penumbra Indigo Percutaneous Aspiration Thrombectomy System in the treatment of Aortic Endograft Iliac Limb Occlusion: Results from an Italian Multicentre Registry ★

Objective: This study aimed to evaluate the safety and effectiveness of the Penumbra Indigo percutaneous aspiration thrombectomy (PAT) system in the clinical presentation of iliac limb occlusion (ILO) after endovascular aortic repair (EVAR). Methods: Retrospective, observational, multicentre study conducted in eight Italian vascular centres. Consecutive patients presenting with ILO after EVAR procedure were eligible. To assess vessel revascularisation, Thrombo-aspiration In Peripheral Ischemia (TIPI) classification (score 0-3) was used at presentation (t1), after PAT (t2), and after adjunctive procedures (t3). Successful revascularisation was considered TIPI 2-3 (near complete/complete). Primary intra-operative outcomes were technical success (TS) of Indigo PAT and combined TS of PAT associated with adjunctive procedures when needed. Primary follow up outcomes were safety and effectiveness at 1-, 6-, and 12-months. Results: From September 2019 to December 2021, a total number of 48 ILO occurred overall and 17 patients (35%) [median age 75 years, IQR 71, 83 years; male, 14 (82%); urgent, 8 (47%)] were treated and enrolled. Median time from primary EVAR was 24 months (IQR 0, 42 months). Median clot longevity from diagnosis of ILO to PAT was 3 days (IQR 1, 12 days). Ten patients (59%) presented with threatening limb ischaemia. At t1, TIPI 0 and 1 was present in 13 (76%) and 4 (24%) cases, respectively. At t2, primary TS (TIPI 2-3) was achieved in 14 cases (82%) after Indigo PAT (p < .001). Fifteen patients (88%) required adjunctive procedures (14 relinings, 1 surgical patch angioplasty). At t3, combined TS was achieved in 16 cases (94%). Intra-operative complication included 1 (6%) distal embolisation, treated successfully. The 30-day mortality was one case (6%) due to pneumonia. At 1, 6, and 12 months, clinical success was 100% without recurrence of ILO. Median follow up was 23 months (IQR 11, 41 months): at 18 months, survival and freedom from re-intervention were 91 ± 8% and 90 ± 9%, respectively. Conclusion: This study reports for the first time the efficacy and safety of Penumbra Indigo PAT in the field of application of ILO after EVAR, with promising technical and clinical success up to 1 year

Endovascular treatment of femoro-popliteal disease with the Supera stent: results of a multicenter study

Even though many types of stents have been tested in superficial femoral artery (SFA) and popliteal artery (PA), the vast majority of these devices have provided an unsatisfactory outcome, probably due their unsuitable anatomical and physiological characteristics. The Supera peripheral stent (Abbott Vascular, Santa Rosa, CA, USA) is a braided interwoven nitinol device specifically designed for treating atherosclerotic lesions of the femoro-popliteal segment. The aim of this multicenter retrospective study was to describe the effectiveness of Supera stents in the management of femoral-popliteal atherosclerotic lesions and to critically analyze our findings in the context of current and past literature

Il male invisibile sempre più visibile

Se non dovesse risultare chiaro il titolo - a dire il vero non immediatamente evidente - di questo volume, più chiaro è il sottotitolo che si riferisce alle conseguenze immediate e striscianti di questa presenza sull'ambiente nel quale viviamo e sulla nostra salute. Parliamo della logica militare che pervade sempre più il nostro tessuto sociale, con un sistema di valori che desta repulsione nella nostra coscienza civile. Parliamo delle conseguenze devastanti sulla salute e sull'ambiente delle popolazioni cosiddette "nemiche". Parliamo delle conseguenze altrettanto devastanti sui corpi e sulle menti dei "nostri", di chi il militare e la guerra è mandato o comandato a farli senza sapere. Parliamo di un tumore sociale quale il drenaggio delle nostre risorse e del nostro lavoro, un tumore sociale che non fa altro che generare tumori reali: non solo nei nostri corpi, ma anche nella mente nostra e delle generazioni a venire. Crediamo sia arrivato il momento di sollevare il velo di censure, compiacenze, ignoranza coltivata ad arte che ricopre il mondo militare. Vogliamo contribuire a rendere visibile e vivido questo male invisibile che avvelena la nostra società. Occorre andare avanti nello studio e nella ricerca, occorre andare oltr

Machine Learning to Predict In-Hospital Mortality in COVID-19 Patients Using Computed Tomography-Derived Pulmonary and Vascular Features

Pulmonary parenchymal and vascular damage are frequently reported in COVID-19 patients and can be assessed with unenhanced chest computed tomography (CT), widely used as a triaging exam. Integrating clinical data, chest CT features, and CT-derived vascular metrics, we aimed to build a predictive model of in-hospital mortality using univariate analysis (Mann–Whitney U test) and machine learning models (support vectors machines (SVM) and multilayer perceptrons (MLP)). Patients with RT-PCR-confirmed SARS-CoV-2 infection and unenhanced chest CT performed on emergency department admission were included after retrieving their outcome (discharge or death), with an 85/15% training/test dataset split. Out of 897 patients, the 229 (26%) patients who died during hospitalization had higher median pulmonary artery diameter (29.0 mm) than patients who survived (27.0 mm, p < 0.001) and higher median ascending aortic diameter (36.6 mm versus 34.0 mm, p < 0.001). SVM and MLP best models considered the same ten input features, yielding a 0.747 (precision 0.522, recall 0.800) and 0.844 (precision 0.680, recall 0.567) area under the curve, respectively. In this model integrating clinical and radiological data, pulmonary artery diameter was the third most important predictor after age and parenchymal involvement extent, contributing to reliable in-hospital mortality prediction, highlighting the value of vascular metrics in improving patient stratification

Il male invisibile sempre più visibile

Se non dovesse risultare chiaro il titolo – a dire il vero non immediatamente evidente – di questo volume, più chiaro è il sottotitolo che si riferisce alle conseguenze immediate e striscianti di questa presenza sull’ambiente nel quale viviamo e sulla nostra salute. Parliamo della logica militare che pervade sempre più il nostro tessuto sociale, con un sistema di valori che desta repulsione nella nostra coscienza civile. Parliamo delle conseguenze devastanti sulla salute e sull’ambiente delle popolazioni cosiddette “nemiche”. Parliamo delle conseguenze altrettanto devastanti sui corpi e sulle menti dei “nostri”, di chi il militare e la guerra è mandato o comandato a farli senza sapere. Parliamo di un tumore sociale quale il drenaggio delle nostre risorse e del nostro lavoro, un tumore sociale che non fa altro che generare tumori reali: non solo nei nostri corpi, ma anche nella mente nostra e delle generazioni a venire. Crediamo sia arrivato il momento di sollevare il velo di censure, compiacenze, ignoranza coltivata ad arte che ricopre il mondo militare. Vogliamo contribuire a rendere visibile e vivido questo male invisibile che avvelena la nostra società. Occorre andare avanti nello studio e nella ricerca, occorre andare oltre

Intensive care unit patients with lower respiratory tract nosocomial infections: the ENIRRIs project

The clinical course of intensive care unit (ICU) patients may be complicated by a large spectrum of lower respiratory tract infections (LRTI), defined by specific epidemiological, clinical and microbiological aspects. A European network for ICU-related respiratory infections (ENIRRIs), supported by the European Respiratory Society, has been recently established, with the aim at studying all respiratory tract infective episodes except community-acquired ones. A multicentre, observational study is in progress, enrolling more than 1000 patients fulfilling the clinical, biochemical and radiological findings consistent with a LRTI. This article describes the methodology of this study. A specific interest is the clinical impact of non-ICU-acquired nosocomial pneumonia requiring ICU admission, non-ventilator-associated LRTIs occurring in the ICU, and ventilator-associated tracheobronchitis. The clinical meaning of microbiologically negative infectious episodes and specific details on antibiotic administration modalities, dosages and duration are also highlighted. Recently released guidelines address many unresolved questions which might be answered by such large-scale observational investigations. In light of the paucity of data regarding such topics, new interesting information is expected to be obtained from our network research activities, contributing to optimisation of care for critically ill patients in the IC