CT angiography for the assessment of EVAR complications: a pictorial review

Aortic aneurysm; Blood vessel prosthesis implantation; Endovascular proceduresAneurisma aórtico; Implantación de prótesis de vasos sanguíneos; Procedimientos endovascularesAneurisma aòrtic; Implantació de pròtesis de vasos sanguinis; Procediments endovascularsEndovascular aneurysm repair (EVAR) is a minimally invasive treatment proposed as an alternative to open repair in patients with abdominal aortic aneurysms. EVAR consists in a stent-graft placement within the aorta in order to exclude the aneurysm from arterial circulation and reduce the risk of rupture. Knowledge of the various types of devices is mandatory because some stents/grafts are more frequently associated with complications. CT angiography is the gold standard diagnostic technique for preprocedural planning and postprocedural surveillance. EVAR needs long-term follow-up due to the high rate of complications. Complications can be divided in endograft device-related and systemic complications. The purpose of this article is to review the CT imaging findings of EVAR complications and the key features for the diagnosis

Carotid Artery Disease in the Era of Biomarkers: A Pilot Study

The intima-media thickness (IMT) and its irregularities or ulcerations in the common carotid artery (CCA) are useful tools as sentinel biomarkers for the integrity of the cardiovascular system. Total homocysteine and lipoprotein levels are the most commonly used elements in cardiovascular risk stratification. Duplex ultrasound (DUS), associated with serum biomarkers, can be used simply to assess the degree of atherosclerotic disease and cardiovascular risk. This study highlights the role of different kinds of biomarkers, showing their usefulness and potentiality in multi-district atherosclerotic patients, especially for early diagnosis and therapy effectiveness monitoring. A retrospective analysis performed from September 2021 to August 2022, of patients with carotid artery disease, was performed. A total of 341 patients with a mean age of 53.8 years were included in the study. The outcomes showed an increased risk of stroke in patients with significative carotid artery disease, nonresponsive to therapy, monitored through a series of serum biomarkers (homocysteine, C-reactive protein, and oxidized LDL). In this reported experience, the systematic use of DUS in association with the multiple biomarkers approach was effective for the early identification of patients at higher risk of disease progression or inefficient therapy

Endovascular treatment with drug-eluting balloon for severe subclavian artery stenosis involving the origin of the vertebral artery

The first line approach for subclavian steal syndrome is PTA-stenting of subclavian artery. When the ipsilateral vertebral artery origin is involved or in closed proximity of the atherosclerotic lesion in the subclavian artery PTA-stenting is at risk of ipsilateral vertebral artery coverage. Herein we report our experience with DEB to address lesions involving the subclavian artery and the origin of the ipsilateral vertebral artery. From January 2017 to February 2019, patients presenting subclavian artery lesion involving the origin of the ipsilateral vertebral artery and treated using primary DEB, were included. Three patients, with left subclavian steal syndrome, were identified. The perioperative mortality and morbidity were outcomes evaluated. Freedom from occlusion, secondary patency, amputation rate was registered. A total of 3 (2 female) patients were included in the study. No complication, symptoms recurrence, restenosis or occlusion were reported at duplex scan during 12-month follow-up. Indication for stenting was arterial dissection. In our limited experience, the use of DEB in association to embolic protection device in the treatment of atherosclerotic subclavian lesion involving the origin of the vertebral artery was safe and technically feasible

Use of the directional atherectomy for the treatment of femoro-popliteal lesions in patients with critical lower limb ischemia

Femoro-popliteal PTA for the treatment of critical limb ischemia is frequently associated with unsatisfactory procedural success rates while directional atherectomy (DCA) has improved success rate since claudicant patients undergoing percutaneous treatment of femoro-popliteal obstructive disease. The aim of this prospective study is to evaluate the safety, efficacy and procedural success of DCA, at one year, in the percutaneous treatment of femoro-popliteal obstructive disease in patients with critical limb ischemia. Methods. From March 2012 to March 2013 18 consecutive patients with critical limb ischemia were treated with DCA (Turbohawk/Covidien-ev3 Endovascular Inc., North Plymouth, Minnesota, USA) for the treatment of femoro-popliteal obstructive disease. Patients were evaluated at 12 months. Results. Technical and procedural success was achieved in every patient. No in-hospital major adverse cardiovascular events occurred. Primary endpoint: freedom from any amputation was obtained in all patients. Secondary endpoints: clinical (Rutherford class improvement) and hemodynamic success (Ankle-brachial index improvement) was achieved in all patients. Conclusion. The use of DCA for the treatment of femoro-popliteal obstructive disease is a safe and effective therapeutic strategy for patients with critical limb ischemia. The data included in our study should be considered hypothesis-generating in order to design of a randomized trial comparison with conventional PTA

Position Paper on Young Vascular Surgeons Training of the Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS):State of the Art and Perspectives

The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded in 2018, with the aim to promote cooperation among vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic peripheral artery was selected as the very first topic to be investigated by the federation. In this second paper, different experiences from delegates of participating countries were shared to define common strategies to harmonize, standardize, and optimize education and training in the Vascular Surgery specialty

Inquadramento clinico del paziente vasculopatico

Le patologie vascolari sono uno dei pi\uf9 rilevanti problemi per la sanit\ue0 nazionale e quindi rappresentano una importante branca della medicina. I segni, le manifestazioni e le evoluzioni delle malattie vascolari vanno spesso integrati con altre patologie capaci di influenzarne il percorso. L\u2019aumento della durata della vita, con il conseguente invecchiamento della popolazione, rende il paziente vasculopatico una figura presente costantemente negli ambulatori di medicina. I dati dell\u2019Istituto Nazionale di Statistica (ISTAT) riportano che in Italia l\u2019et\ue0 media della popolazione \ue8 di 44,9 anni e che la fascia di popolazione con et\ue0 superiore a 65 anni \ue8 del 22,3%. Inoltre l\u2019Italia \ue8 il Paese che presenta il tasso di invecchiamento pi\uf9 intenso e veloce rispetto ad altre Nazioni come confermato dell\u2019Organizzazione Mondiale della Sanit\ue0 (OMS) con una aspettativa di vita al 2016 stimata in 80,6 anni negli uomini e 85 anni nelle donne

Insufficienza Celiaco Mesenterica

L’insufficienza celiaco-mesenterica (ICM) è una sindrome clinica in cui il sintomo cardine è rappresentato dal dolore addominale che insorge nella fase post-prandiale, e che è provocata dall’inadeguata vascolarizzazione di uno o più settori dell’apparato digerente. Essa insorge per la presenza di lesioni ostruttive a carico delle tre principali arterie splancniche: il tripode celiaco (TC), l’arteria mesenterica superiore (AMS) e quella inferiore (AMI). Esistono due forme di ICM, una acuta e una cronica, che differiscono dal punto di vista fisiopatologico, oltre che per eziologia e clinica, sottolineando peraltro la possibile evoluzione improvvisa da cronica in acuta, fino all’evoluzione in infarto intestinale più o meno esteso. Circa il 17,5% degli ultrasessantacinquenni presenta una patologia ostruttiva con interessamento significativo di almeno una delle tre arterie splancniche.1 Inoltre, studi autoptici hanno dimostrato che la prevalenza della malattia aterosclerotica a carico delle arterie mesenteriche si attesta attorno al 6-10%, con l’occlusione completa di almeno uno dei tre vasi nel 3% dei soggetti.2 Grazie alla notevole collateralità fisiologicamente presente sia all’interno del circolo splancnico, che tra questo e i distretti adiacenti, la maggior parte dei soggetti affetti da malattia occlusiva mesenterica rimane asintomatica, così che l’incidenza precisa della ICM cronica rimane sconosciuta: negli USA, essa è responsabile di poco meno di 1 ricovero ogni 100,000,3 mentre la forma acuta risulta relativamente più frequente, quasi 1 ricovero ogni 1000.4 Per entrambe le forme, l’incidenza è tre volte superiore nel sesso femminile rispetto al maschile

Single staged hybrid approach for multilevel aortic-iliac-femoral-popliteal disease

Introduction: Multilevel peripheral arterial disease (MPAD) is the main cause of critic limb ischemia (CLI). Vascular interventions are required to increase distal blood flow and reduce the risk of lower limb amputation. Presentation of case: We report a case of complex hybrid revascularization in a patient presenting a Rutherford V MPAD involving the infrarenal aorta, iliac, femoral and popliteal segments. The simultaneous hybrid intervention consisted of an endovascular aortic stent-graft placement and a surgical above-the-knee prosthetic femoro-popliteal bypass. In the same operation a renal stenting was performed due to a significant renal artery stenosis associated to a systemic hypertension non-responder to medical management. Discussion: Hybrid interventions can be performed simultaneously or staged with benefit given by the complementary role of endovascular and surgical treatments allowing the correction of eventually inadequate results of both approaches. Reports of simultaneous hybrid treatments are limited but, despite the complexity of such procedures, primary success rate is reported high. Also in the reported case, a complex simultaneous treatment in a patient presenting MPAD in association to a significant and symptomatic renal artery disease was feasible in the same operation. Conclusion: Hybrid procedure are safe with high degree of efficacy in terms of revascularization procedure, reduced morbidity and shorter intensive care and hospital stay. In our experience, the use of hybrid procedure is technically feasible and allowed the treatment of MPAD with a good outcomes