Increased FGF23 serum level is associated with unstable carotid plaque in type 2 diabetic subjects with internal carotid stenosis.

BACKGROUND: The object of this study was to investigate the potential role of FGF23 on plaque stability in type 2 diabetic patients with internal carotid artery stenosis. METHODS: In this retrospective observational study, we analyzed FGF23 serum level in 361 type 2 diabetic patients with internal carotid artery stenosis undergoing carotid endarterectomy and in 598 diabetic controls without carotid atherosclerosis. RESULTS: We found that FGF23 median serum levels was significantly higher in patients than in diabetic controls [67.7 (59.5-77.8) pg/mL and 43.89 (37.5-50.4), P < 0.001] and was significantly and independently associated with unstable plaque in patients with internal carotid artery stenosis [OR, 5,71 (95% CI, 2.09-15.29]. CONCLUSIONS: We have found, for the first time, that FGF23 could be associated with unstable plaque in type 2 diabetic patients with internal carotid artery stenosis

Parametric Color Coding of Digital Subtraction Angiography in the Evaluation of the Type B Chronic Aortic Dissection During Tevar: A Preliminary Study

Angiographic assessment of type B chronic aortic dissection (TBCAD) can be complex in TEVAR procedures, due to the presence of true and false lumen. Quantitative digital subtraction angiography (Q-DSA) with a parametric color-coding provides a novel approach for encoding temporal information and enabling quantitative measurements. The potential value of the use of color in the display of these parametric images was recognized, particularly useful in situations in which there is a complex flow pattern. The aim of this study was to evaluate whether the use of parametric color-coding in the post-processing of DSA series is advantageous in the evaluation of TBCAD during TEVAR procedures

Long-Term Results of Complex Abdominal Aortic Aneurysm Open Repair

This study investigated the long-term outcomes of patients treated with open surgical repair for complex abdominal aortic aneurysms (c-AAAs). A total of 119 patients with c-AAAs undergoing repair between January 2010 and June 2016 in a high-volume aortic center were included. The long-term imaging follow-up consisted of yearly abdominal ultrasound examinations and 5-year computed tomography angiography. At a median follow-up of 76 months (IQR 38 months), forty-three deaths (37%) and three (2.5%) aortic-related deaths were observed. Long-term chronic renal decline was observed in fifty (43.8%) patients, significantly correlated with post-operative acute kidney injury. During the follow-up, five reinterventions (4.3%) were performed. The present study suggests that open c-AAA repair can be performed with acceptable operative risk with durable results. To achieve the best possible long-term outcome, the open surgery repair of complex AAA should be performed in high-volume aortic centers and tailored to the patient

A New Mini-Invasive Approach for a Catastrophic Disease: Staged Endovascular and Endoscopic Treatment of Aorto-Esophageal Fistulas

Aorto-esophageal fistula (AEF) is an uncommon but usually fatal disorder. Surgery with resection of an aneurysm and esophagus, in situ reconstruction of the descending aorta and omental flap installation offers the gold standard for the reduction of infections, but it is burdened by high intraoperative and perioperative mortality rates. We report our experience with a combined minimally invasive approach for the multi-stage treatment of three cases of aorto-esophageal fistula caused by thoracic aneurysm rupture. In all of the patients, the aneurysm was treated with thoracic endovascular aortic repair and the esophageal lesion was treated with esophageal endoprosthesis placement. According to our experience, the combined strategy of thoracic endovascular aortic repair (TEVAR) and esophageal less invasive endoscopic treatments represents an alternative solution in frail patients with high surgical risk

Open surgical treatment of total occlusions of the abdominal aorta

Objectives: To analyze the perioperative results and long-term follow-up of open surgery among patients with a total chronic occlusion of the abdominal aorta. Material and methods: The data from 87 consecutive patients treated by open surgery for a total occlusion of the abdominal aorta in our center between 1998 and 2018 were collected prospectively. Thirty-nine patients presented a distal infrarenal aortic occlusion and 48 a proximal juxta/suprarenal occlusion. A thrombosed infrarenal aneurysm was associated in five cases. In eight cases a previous endovascular approach failed. 48 patients had an aorto-bifemoral bypass, 15 patients had a thrombo-endarterectomy and an enlargement angioplasty, and 24 patients had an extra-anatomical bypass (including 20 cases with axillo-bifemoral bypass and four cases of thoraco-bifemoral bypass). A suprarenal clamping was necessary in 28 cases (32.2%) of abdominal aortic surgery. Two cases required an aorto-renal bypass for aortic lesions extending up to the ostium of a renal artery. One case required a bypass to treat a preexistent occlusion of the superior mesenteric artery. Results: Perioperative morbidity included cardiac (3.4%) and respiratory (2.3%) complications, as well as acute impaired renal function (2.3%). The significant renal complications were reported only in case of suprarenal crossclamping. After an average follow-up of 74 months we observed primary and secondary patency rates of 94.3%, 92% and 88.5% at 12, 24, and 36 months, respectively. In the cases treated by thrombo-endarterectomy and enlargement angioplasty there was no arterial thrombosis. In the patients with a preoperative renal malperfusion we observed an improvement of the renal function and of the control of arterial hypertension or visceral ischemic symptomatology in all the cases. Conclusion: Open surgical treatment of the total occlusions of the abdominal aorta offers an acceptable rate of mortality and morbidity and an excellent long term patency especially in the cases of direct aortic surgery. In the event of a proximal obstruction the need for a suprarenal clamping and repair of the renal arteries is often necessary