Superficial femoral artery catheterisation with two parallel guidewires after femoris profunda artery cannulation in antegrade percutaneous femoral access

No abstract availabl

Open repair with resection and reimplantation for popliteal artery aneurysm

Popliteal artery aneurysms are the most frequent type of peripheral arterial aneurysm and can be repaired by either open or endovascular techniques. An 81-year-old man presented with leg swelling and during duplex ultrasound examination was diagnosed a popliteal aneurysm. The transverse diameter was 3.6 × 4.5cm, length 2.8cm, one run-off vessel patent. The popliteal aneurysm was asymptomatic for clinical signs of limb ischaemia. We opted for an open surgical repair through a posterior approach. During dissection of the popliteal artery above and below the aneurysm, the two non-diseased popliteal extremities appeared to be very close, leading to the decision to perform an end-to-end anastomosis between the two arterial extremities. The patient was discharged after three days with no adverse events. Follow-up consisted of duplex ultrasound examination at one, three and six months, and then annually. At the six-month follow-up there was no restenosis at the anastomosis

Coil embolization as an alternative endovascular approach for ruptured superficial femoral artery aneurysms

Purpose: True aneurysms of the superficial femoral artery (SFAA) are rare and, the endovascular approach using covered stents has gained more popularity. We report an endovascular alternative using embolization coils for treatment of a ruptured SFAA. Case description: An 88-old male admitted for a ruptured true SFAA (67×52mm in diameter and 70mm in length) presenting with painful mass pulsating in the proximal third of the left thigh. His surgical history consisted of an infrarenal abdominal aneurysm treated by open surgery and an ipsilateral popliteal aneurysm treated with prosthetic bypass by a medial approach; this was revealed to be occluded at the CT scan evaluation. The patient was asymptomatic for limb ischaemia, therefore we decided to perform embolization of the SFA with coils (MReye®Embolization Coil, Cook Medical, Bloomington,USA). Under local anaesthesia, via a 5-Fr sheath and an antegrade approach, coils were deployed first at the distal neck of the SFAA and then to its proximal neck. On the angiogram, complete aneurysm sac thrombosis with no leaks was achieved. At 6-month follow-up, the SFAA remained occluded, and the patient had not developed any sign of limb ischaemia. Conclusion: Coil embolization of SFAA in selected cases represents a feasible and safe endovascular alternative

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries

Insight from an Italian Delphi Consensus on EVAR feasibility outside the instruction for use: the SAFE EVAR Study

BACKGROUND: The SAfety and FEasibility of standard EVAR outside the instruction for use (SAFE-EVAR) Study was designed to define the attitude of Italian vascular surgeons towards the use of standard endovascular repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) outside the instruction for use (IFU) through a Delphi consensus endorsed by the Italian Society of Vascular and Endovascular Surgery (Societa Italiana di Chirurgia Vascolare ed Endovascolare - SICVE). METHODS: A questionnaire consisting of 26 statements was developed, validated by an 18 -member Advisory Board, and then sent to 600 Italian vascular surgeons. The Delphi process was structured in three subsequent rounds which took place between April and June 2023. In the first two rounds, respondents could indicate one of the following five degrees of agreement: 1) strongly agree; 2) partially agree; 3) neither agree nor disagree; 4) partially disagree; 5) strongly disagree; while in the third round only three different choices were proposed: 1) agree; 2) neither agree nor disagree; 3) disagree. We considered the consensus reached when >70% of respondents agreed on one of the options. After the conclusion of each round, a report describing the percentage distribution of the answers was sent to all the participants. RESULTS: Two -hundred -forty-four (40.6%) Italian Vascular Surgeons agreed to participate the first round of the Delphi Consensus; the second and the third rounds of the Delphi collected 230 responders (94.3% of the first -round responders). Four statements (15.4%) reached a consensus in the first rounds. Among the 22 remaining statements, one more consensus (3.8%) was achieved in the second round. Finally, seven more statements (26.9%) reached a consensus in the simplified last round. Globally, a consensus was reached for almost half of the proposed statements (46.1%). CONCLUSIONS: The relatively low consensus rate obtained in this Delphi seems to confirm the discrepancy between Guideline recommendations and daily clinical practice. The data collected could represent the source for a possible guidelines' revision and the proposal of specific Good Practice Points in all those aspects with only little evidence available

Role of Hybrid Procedures in the Treatment of Iliac Femoral Occlusive Disease

Not Availabl

Revascularisation through the obturator foramen of lower limbs with a compromised ipsilateral groin due to infection

Infra-inguinal vascular reconstruction with active groin infection is a concerning issue. Using resistant grafts to infection is the most adopted approach. However, in absence of these materials in acute situations, the trans-obturator approach allows for limb revascularisation avoiding the infected site. We evaluated the effectiveness of this approach in patients who needed lower limb revascularisation with an ipsilateral groin infection

The effectiveness of the prevention measures on stroke incidence in patients with ipsilateral carotid disease

Background: The aim of this study is to assess the possible causes of cerebral ischemic events for ipsilateral carotid stenosis in the era of the best medical therapy. Methods: This is a retrospective and observational study conducted on patients entered into stroke protocol and subsequently underwent carotid endarterectomy (CEA) for ipsilateral stenosis at the University-Hospital of Ferrara. A 4-year period of time (January 2014 to December 2017) was investigated and demographic data, comorbidities, current medical therapies and instrumental examinations performed prior hospitalization were collected. Results: We identified 78 patients who underwent CEA for symptomatic carotid stenosis. The mean age was 62 (range 52 to 76), 64.1% were male. Among those, 20% presented with acute internal carotid occlusion, 60% had a stenosis >90%, 14% between 70-90%, 6% of 60-69% and 32% had a contralateral stenosis >60%. Moreover, 82.4% of them were not aware of having carotid stenosis since they had never been assessed with duplex ultrasound. Among these patients 49% were not under antiplatelet/anticoagulant medication, 46 patients had systemic hypertension but untreated in 74.5% of them, 31 patients had dyslipidemia without taking statin-therapy in 66.7% of cases, 35 patients had hyperglycemia but untreated in 70% as confirmed measuring glycated hemoglobin and 52.9% were smokers. Among patients who were aware of having hemodynamic carotid stenosis, 33% of them was documented a scarce adherence to the medical therapy and 22% was not set up an adequate one. Conclusions: The non-diagnosed carotid stenosis and insufficient medical treatment due to uninvestigated cardiovascular diseases revealed to be frequent in patients with symptomatic carotid stenosis. This suggests that more should be done to enrich the screening strategies in order to offer better prevention from cardiovascular events

Operative management of recurrent carotid restenosis following open and endovascular repair in the same carotid bifurcation

Surgical treatment of carotid stenosis consists of carotid endarterectomy (CEA) or carotid stenting (CAS). Restenosis after CEA/CAS is a challenging issue that surgeons encounter with increasing frequency. Here, we report a case where we employed several techniques for the treatment of carotid restenosis that were complicated by restenosis. Within 2 years, the patient underwent carotid endarterectomy, stent placement in the common-internal carotid, stent placement in the intracranial internal carotid artery, explantation of an extra cranial stent graft, a saphenous graft interposition and repositioning of the extra cranial carotid stent. A standard for the operative management of recurrent restenosis has not been established. Recurrent restenosis can be treated with different surgical techniques, but those techniques can be complicated by restenosis