Role of Pelvic Ischemia in Human Lower Urinary Tract Symptoms and Sexual Function Among Patients With Common Iliac Artery Obstruction Undergoing Revascularization Surgery

Purpose In this case-control study, we explored the relationships among pelvic ischemia, lower urinary tract symptoms (LUTS), and sexual function in patients with common iliac artery steno-occlusive disease, along with the potential therapeutic role of revascularization. Methods We recruited 33 men diagnosed with radiologically documented common iliac artery stenosis (>80%) who underwent endovascular revascularization, and 33 healthy controls. Five patients had obstruction of the abdominal aorta (Leriche syndrome). The International Prostate Symptom Score (IPSS), Overactive Bladder Questionnaire, and International Index of Erectile Function were used to evaluate LUTS and erectile function. Medical history, anthropometrics, urinalysis, and blood tests, including levels of serum prostate-specific antigen, urea, creatinine, triglycerides, cholesterol, low-density lipoprotein, high-density lipoprotein, and hemoglobin A1c, were recorded. Uroflow (maximum flow, average flow, voided volume, and voiding time) and ultrasound parameters (prostate volume and postvoid residual [PVR]) were also measured. Patients with moderate-to-severe LUTS (IPSS>7) underwent complete urodynamic investigation. Patients were examined at baseline and 6 months postoperatively. Results Patients exhibited poorer total IPSS (P<0.001), storage (P=0.001) and voiding symptom (P<0.001) subscores, as well as worse OAB-bother (P=0.015), OAB-sleep (P<0.001), OAB-coping (P<0.001), and OAB-total (P<0.001) scores than control participants. Additionally, erectile function (P=0.002), sexual desire (P<0.001), and satisfaction from intercourse (P=0.016) deteriorated in the patient group. Six months postoperatively, significant improvements were observed in erectile function (P=0.008), orgasm (P=0.021), and desire (P=0.014). Similarly, PVR significantly improved (P=0.012), while fewer patients experienced increased bladder sensation (P=0.035) and detrusor overactivity (P=0.035) upon postoperative urodynamic study. No significant differences were found between patients with bilateral and unilateral obstruction or between either of those groups and Leriche syndrome patients. Conclusions Patients with steno-occlusive disease of the common iliac artery experienced more severe LUTS and sexual dysfunction than healthy controls. Endovascular revascularization alleviated LUTS in patients with moderate-to-severe symptoms and improved bladder and erectile function

Polymer Free Amphilimus Drug Eluting Stent for Infrapopliteal Arterial Disease in Patients with Critical Limb Ischemia: A New Device in the Armamentarium

Background and Objectives: Endovascular technologies have significantly improved the outcome of patients with critical limb ischemia (CLI). Drug eluting stents (DES) have documented their efficacy against percutaneous transluminal angioplasty (PTA) and bare metal stents (BMS) in infrapopliteal arterial occlusive disease. However, late in-stent neoatherosclerosis may lead to vascular lumen loss and eventually thrombosis. Polymer free DES constitute a new technology aiming to improve long term patency which their action is still under investigation. The purpose of this study is to report the mechanism of action and to provide a literature review of a novel polymer free amphilimus eluting stent (Cre8, Alvimedica, Instabul, Turkey) in infrapopliteal arterial disease. Methods: Publications listed in electronic databases, European Union Drug Regulating Authorities Clinical Trials Database, as well as scientific programmes of recent interventional vascular conferences were searched. Three studies were included. We analyzed primary and secondary patency, major amputation rate, freedom from CD-TLR, and mortality. Results: Cre8 was implanted in 79 patients with CLI. Most of the patients (n = 65) were Rutherford class 5&ndash;6 (82.3%), and diabetes mellitus (DM) was present in 66 patients (83.5%). Mean primary patency was 82.5% at 12 months. Mean lesion stented length was 20 mm and 35 mm in two studies. Mean limb salvage was 91.3% at 12 months. Freedom from CD-TLR was reported in two out of the three studies and was 96% and 83.8%. Mortality was 15% and 23.8% in the same studies, whilst it was not reported in one study. Conclusion: Stenting of infrapopliteal arteries with Cre8 is safe and feasible in patients with CLI and diabetes. All studies have shown very good primary patency and freedom from CD-TLR at 12 and 24 months. Larger observational prospective studies and randomized trials are necessary to establish long term effectiveness and clinical outcomes using the non-polymer Cre8 DES

Comparative efficacy and outcomes of DCB Lutonix 0.14 and DES Cre8 angioplasty of infrapopliteal arteries in diabetic patients with critical limb ischemia

Background: To report the comparative safety and efficacy of infrapopliteal angioplasty with a polymer-free drug eluting stent and a paclitaxel drug coated balloon in diabetic patients with critical limb ischemia (CLTI). Methods: Consecutive patients with diabetes and CLTI requiring infrapopliteal endovascular intervention were recruited prospectively in a tertiary centre to undergo angioplasty and primary stenting using the Cre8 sirolimus-eluting stent or paclitaxel balloon angioplasty between January 2018 - October 2020. All patients were followed-up for at least 12 months. All patients were Rutherford category V and had at least one patent infrapoliteal artery. Forty-three infrapopliteal arteries had stenosis and 15 are occluded. The primary outcome measure was target lesion patency (50%) επιβεβαιωμένο με υπερηχογράφημα Duplex και οι μείζονες ακρωτηριασμοί στους 12 μήνες. Δευτερεύοντα τελικά σημεια της μελέτης ήταν η θνητότητα, η επανεπέμβαση της αρτηρίας λόγω επιδείνωσης της κλινικής εικόνας και η βελτίωση κατά κατηγορία Rutherford στους 12 μήνες μετά την επέμβαση. Αποτελέσματα: Η τεχνική επιτυχία ήταν 100%. Το μέσο μήκος της βλάβης ήταν 20 χιλιοστά (εύρος 15-40mm) στην ομάδα DES και 80 χιλιοστά στην ομάδα DCB (εύρος 40-200mm).Σαράντα τέσσερεις ασθενείς ολοκλήρωσαν τον επανέλεγχο στους 12 μήνες, 23 ασθενείς στην ομάδα DES και 21 ασθενείς στην ομάδα DCB. Σύγχρονη αγγειοπλαστική της επιπολής μηριαίας ή ιγνυακής αρτηρίας αρτηρίας πραγματοποιήθηκε στο 61% της ομάδας Cre8 και στο 78% της ομάδας Lutonix. Η πρωτογενής βατότητα με τον αερονάρθηκα Cre8 ήταν 81% και με τον αεροθάλαμο Lutonix 71%, (OR: 1.76, 95% CI: 0.45-6.83, p=0.498) και οι μείζονες ακρωτηριασμοί ήταν 15% (4/27) στην ομάδα DES και 11% (3/27) στην ομάδα DCB, (OR: 0.71, 95% CI: 0.14-3.56, p=1) στους 12 μήνες. Δέκα ασθενείς απεβίωσαν, 4 στην ομάδα Cre8 (15%) και 6 στην ομάδα DCB (22%), (OR:1.64,95% CI:0.40-6.63, p= 0.726), η επαναγγείωση της αρτηρίας στόχου στους 12 μήνες ήταν 4% (1/23) στην ομάδα Cre8 και 9.5% (2/21) στην ομάδα Lutonix, (OR: 2.31, 95% CI: 0.19-27.58, p=0.599) και η αλλαγή στην ταξινόμηση κατά Rutherford παρουσίασε σημαντική βελτίωση την ομάδα Cre8 έναντι της ομάδας Lutonix στους 12 μήνες (p=0.039). Συμπέρασμα: Η αγγειοπλαστική των κνημιαίων αρτηριών με τον αερονάρθηκα Cre8 είναι εφικτή και ασφαλής στους διαβητικούς ασθενείς με κρίσιμη ισχαιμια των κα΄τω άκρων. Σε σύγκριση τους αεροθάλαμους με έκλυση πακλιταξέλης δεν υπ΄ήρχαν στατιστικά σημαντικές διαφορές όσον αφορα την βατότητα, τους μείζονες ακρωτηριασμούς, τη θνητότητα και την επαναγγείωση της αρτηρίας στόχου. Οι ασθενείς στην ομάδα Cre8 παρουσίασαν σημαντική βελτίωση στην ταξινόμηση κατά Rutherford

“Bailout” Endovascular Treatment of Acute Aortic Occlusion

A 37-year-old man who had a recent history of acute myocardial infarction (AMI) 3 months ago presented to the emergency department with acute ischemia of lower limbs. A CT aortography was performed, where left ventricle thrombi and acute thromboembolic occlusion of aortoiliac bifurcation were depicted. He was urgently transferred to the operation theatre, where Fogarty embolectomy was initially unsuccessful. He was managed by primary deployment of balloon expandable (BE) covered stents in the aortic bifurcation followed by thrombectomy of the left ventricle (LV) under extracorporeal circulation by cardiothoracic surgeons 2 days after initial operation. He was discharged in good general condition after 20 days under warfarin and aspirin therapy

Endovascular Repair of Aortobronchial Fistula due to Saccular Aneurysm of Thoracic Aorta

Aortobronchial fistula (ABF) is a rare condition which can be lethal if left untreated. Open surgical treatment carries high morbidity and mortality. Recent advances in endovascular technology have made thoracic endovascular aortic repair (TEVAR) the treatment of choice. We present a successful endovascular repair of aortobronchial fistula due to a saccular aneurysm of descending thoracic aorta

Right Iliofemoral Venous Thrombosis in a Prothrombin 20210GA carrier with Duplicated Inferior Vena Cava. An Unusual Case Report

Venous thromboembolism, presenting as deep vein thrombosis (DVT) is a disease affected by aging, with a low rate of about 1 per 10,000 annually before the fourth decade of life, rising rapidly after age 45 years, and approaching 5–6 per 1000 annually by age 80. We present the case of a 69-years old woman who presented to our emergency department with unilateral lower limb pain and swelling. Subsequent imaging revealed a right iliofemoral deep vein thrombosis, with associated duplication of her inferior vena cava. Thrombophilic screening revealed a prothrombin 20210A gene mutation. She was treated conservatively with Low Molecular Weight Heparin (LMWH) and elastic stockings.</p

Aortic Arch Floating Thrombus Complicated by Distal Embolization in a Patient with Malignancy

Free floating thrombus of aortic arch in a minimally atherosclerotic or nonaneurysmal aorta is a rare disease entity which carries a potential risk of distal embolization with catastrophic consequences. We present the case of a 52-years-old patient with ovarian cancer and aortic arch floating thrombus who initially managed with low molecular weight heparin and eventually undergone surgical thrombectomy of left external iliac and common femoral artery due to acute ischemia of left lower leg

Polymer Free Amphilimus Drug Eluting Stent for Infrapopliteal Arterial Disease in Patients with Critical Limb Ischemia: A New Device in the Armamentarium

Background and Objectives: Endovascular technologies have significantly improved the outcome of patients with critical limb ischemia (CLI). Drug eluting stents (DES) have documented their efficacy against percutaneous transluminal angioplasty (PTA) and bare metal stents (BMS) in infrapopliteal arterial occlusive disease. However, late in-stent neoatherosclerosis may lead to vascular lumen loss and eventually thrombosis. Polymer free DES constitute a new technology aiming to improve long term patency which their action is still under investigation. The purpose of this study is to report the mechanism of action and to provide a literature review of a novel polymer free amphilimus eluting stent (Cre8, Alvimedica, Instabul, Turkey) in infrapopliteal arterial disease. Methods: Publications listed in electronic databases, European Union Drug Regulating Authorities Clinical Trials Database, as well as scientific programmes of recent interventional vascular conferences were searched. Three studies were included. We analyzed primary and secondary patency, major amputation rate, freedom from CD-TLR, and mortality. Results: Cre8 was implanted in 79 patients with CLI. Most of the patients (n = 65) were Rutherford class 5–6 (82.3%), and diabetes mellitus (DM) was present in 66 patients (83.5%). Mean primary patency was 82.5% at 12 months. Mean lesion stented length was 20 mm and 35 mm in two studies. Mean limb salvage was 91.3% at 12 months. Freedom from CD-TLR was reported in two out of the three studies and was 96% and 83.8%. Mortality was 15% and 23.8% in the same studies, whilst it was not reported in one study. Conclusion: Stenting of infrapopliteal arteries with Cre8 is safe and feasible in patients with CLI and diabetes. All studies have shown very good primary patency and freedom from CD-TLR at 12 and 24 months. Larger observational prospective studies and randomized trials are necessary to establish long term effectiveness and clinical outcomes using the non-polymer Cre8 DES

Open Repair of a 12-cm Posttraumatic Aneurysm of Right Subclavian Artery

PurposeTo present a rare case of a patient with a 12-cm posttraumatic right subclavian artery aneurysm successfully treated with aneurysmectomy and innominate-axillary bypass.Case reportA 54-year-old man presented to the emergency department due to progressive dyspnea and hoarseness of voice. His medical record was unremarkable except that he had right-sided pneumothorax and multiple rib fractures from a car accident 16 years ago. A chest X-ray showed a mass in the upper lobe of the right lung, and the patient was hospitalized for further investigation. A computed tomography (CT) with intravenous contrast of the thorax was performed, which depicted a giant aneurysm of the right subclavian artery. Vascular and cardiothoracic surgeons were consulted immediately, and the operation was scheduled. Aneurysmectomy and innominate-axillary bypass were performed. The patient had an uncomplicated progress and was discharged on 5 days followed by a single antiplatelet therapy and symptom-free.ConclusionPosttraumatic subclavian artery aneurysm is a rare entity. Imaging of the thorax is essential for the diagnosis and surgical preparation of the patient. Open repair remains the gold standard therapy for subclavian artery aneurysm despite the improvements in endovascular surgery in such huge aneurysms