. Double-microcatheter technique through tortuous anatomy for coil embolization of a saccular splenic aneurysm: a technical report

We report on a case of an asymptomatic splenic artery aneurysm (SAA) with a large neck in a 53-year-old female with an extreme vessel tortuosity which was treated with a Double Microcatheter Technique. This endovascular procedure consists of embolization of the aneurysm using detachable coils with no application of any glue, stent or balloon. At the end of procedure, no complications occurred. At the three-month follow-up an MRI showed the aneurysm’s complete exclusion and patency of the splenic artery

Harmonic focus versus conventional electrocautery for femoral artery exposure: a "direct" comparison on the same patients

Surgical access complications during endovascular aneurysm repair (EVAR) are reported relatively frequent. HARMONIC FOCUS® (HF; Ethicon EndoSurgery Inc., Cincinnati, Ohio, USA) is a device developed to improve bleeding control and reduce heat-related damage stemming from surgical preparation. The aim of this study was to evaluate outcomes and safety of HF versus conventional haemostasis with electrocautery, both techniques used in the same patient. Five patients developed bilateral wound’s thickening (13.9%) demonstrated at the CT scan, two of whom had no clinical manifestation while in three cases the thickening was associated with lymphocele (4.54%), 2 of which were in the side where the EC was used (5.5%), and 1 case (2.7%), in the HF applied side. One isolated lymphocele occurred at the left groin (2.7%) (tables n.2-3). A Fisher’s exact test was conducted between EC and HF on the occurrence of wound healing complications (3/36 for EC and 1/36 for HF) that resulted statistically significant at p<0.05. Focus Harmonic Scalpel has certain advantages than conventional haemostasis in avoiding surgical access complications

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

How the First Year of the COVID-19 Pandemic Impacted Patients’ Hospital Admission and Care in the Vascular Surgery Divisions of the Southern Regions of the Italian Peninsula

Background: To investigate the effects of the COVID-19 lockdowns on the vasculopathic population. Methods: The Divisions of Vascular Surgery of the southern Italian peninsula joined this multicenter retrospective study. Each received a 13-point questionnaire investigating the hospitalization rate of vascular patients in the first 11 months of the COVID-19 pandemic and in the preceding 11 months. Results: 27 out of 29 Centers were enrolled. April-December 2020 (7092 patients) vs. 2019 (9161 patients): post-EVAR surveillance, hospitalization for Rutherford category 3 peripheral arterial disease, and asymptomatic carotid stenosis revascularization significantly decreased (1484 (16.2%) vs. 1014 (14.3%), p = 0.0009; 1401 (15.29%) vs. 959 (13.52%), p = 0.0006; and 1558 (17.01%) vs. 934 (13.17%), p &lt; 0.0001, respectively), while admissions for revascularization or major amputations for chronic limb-threatening ischemia and urgent revascularization for symptomatic carotid stenosis significantly increased (1204 (16.98%) vs. 1245 (13.59%), p &lt; 0.0001; 355 (5.01%) vs. 358 (3.91%), p = 0.0007; and 153 (2.16%) vs. 140 (1.53%), p = 0.0009, respectively). Conclusions: The suspension of elective procedures during the COVID-19 pandemic caused a significant reduction in post-EVAR surveillance, and in the hospitalization of asymptomatic carotid stenosis revascularization and Rutherford 3 peripheral arterial disease. Consequentially, we observed a significant increase in admissions for urgent revascularization for symptomatic carotid stenosis, as well as for revascularization or major amputations for chronic limb-threatening ischemia

Model-based energy monitoring and diagnosis of telecommunication cooling systems

A methodology is proposed for on-line monitoring of cooling load supplied by Telecommunication (TLC) cooling systems. Sensible cooling load is estimated via a proportional integral controller-based input estimator, whereas a lumped parameters model was developed aiming at estimating air handling units (AHUs) latent heat load removal. The joint deployment of above estimators enables accurate prediction of total cooling load, as well as of related AHUs and free-coolers energy performance. The procedure was then proven effective when extended to cooling systems having a centralized chiller, through model-based estimation of a key performance metric, such as the energy efficiency ratio. The results and experimental validation presented throughout the paper confirm the suitability of the proposed procedure as a reliable and effective energy monitoring and diagnostic tool for TLC applications. Moreover, the proposed modeling approach, beyond its direct contribution towards smart use and conservation of energy, can be fruitfully deployed as a virtual sensor of removed heat load into a variety of residential and industrial applications

Development of free-cooling detection procedures to support energy intelligence actions within telecommunication environments

A signal-based diagnostic technique is proposed to enable remote monitoring of free-cooling (FC) systems operation in telecommunication (TLC) environments. The presented activity falls within a comprehensive energy intelligence action, which TIM-Telecom Italia has been carrying-on since more than a decade in its most strategic central offices and data centers. Main aim is to suitably exploit the available information, about temperature and electrical consumptions, so as to reduce its carbon footprint through strategic energy saving actions. The signal based procedure allows identifying in real-time what is the current status (i.e. properly working, not working or inefficient operation) of FCs in telecommunication rooms. Two alternative methodologies are proposed: one based on the analysis of temperature signal, through Discrete Fourier Transform (DFT), and the other on the evaluation of negative temperature time slope. This paper mostly focuses on the second methodology, which turned out to be the most effective one from a real-world deployability point of view. The results and experimental validation confirm the reliability and suitability of the proposed technique as an effective energy monitoring and diagnostic tool for TLC applications, to be deployed for leaner predictive maintenance tasks aimed at reducing FC failure dependent extra-costs. Further benefits include the synergies with control and/or supervisory energy management levels, which are expected to enable immediate counter-actions and upgrade current control logic, as well as the opportunity of supporting the execution of big-data energy intelligence actions within TLC central offices

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

Endovascular treatment of extracranial carotid artery aneurysms with flow diverter stents

Extracranial carotid artery aneurysms (ECAAs) are not a common occurrence. As a result, its natural clinical course and the risk factors associated with an adverse outcome are largely unknown. Herein, we describe the endovascular treatment of two extracranial carotid artery aneurysms with flow diverter stents. Flow-diverter devices are stents placed in the parent artery at the level of the neck aneurysm in order to disrupt the intra-aneurysmal flow, thereby favoring intra-aneurysmal thrombosis. In the first case, an angio-CT scan was performed at one-month follow-up and in the second case a duplex scan was performed after four months. Both cases resulted in good stent positioning with complete exclusion of the aneurysm and complete carotid artery patency. Based upon our own clinical experience, endovascular treatment with flow diverter stents merit to be recognized and considered an option in cases of ECAA acknowledging that larger studies or larger series are needed to concur experience

A case of large renal aneurysm treated with a combined endovascular-laparoscopic approach

A 67-year-old man with pain in his right flank and hematuria over the last few weeks was admitted to our hospital due to right renal calculi revealed by an ultrasound examination of the urinary tract. An abdominal x-ray drew attention to the presence of structures of an uncertain interpretation, that mimicked multiple calculi in the right kidney and renal pelvis, but CT-scan identified a large saccular aneurysm of 76 mm with renal pelvis involvement and urinary statis of the right renal artery. A combined endovascular and laparoscopic surgical approach was chosen. The patient underwent endovascular embolization of the renal artery with an Amplatzer Vascular Plug followed by a video laparoscopic nephrectomy. After few days of hospitalization, the patient was in good general status and was discharged. A review of the literature has highlighted the unicity of our surgical approach, especially within the context of traditional vascular and general surgical practice, due to multidisciplinary consultation

Sequential minimally invasive treatment of concomitant abdominal aortic aneurysm and colorectal cancer: a single-center experience

BACKGROUND The surgical management of concomitant occurrence of abdominal aortic aneurysm (AAA) and colorectal cancer (CCR) is still controversial. Conversely, benefits from a minimally invasive approach are well known concerning the treatment of both AAA and CCR. The aim of this study is to assess safety and feasibility of a sequential two-staged minimally invasive during the same recovery by EVAR technique and laparoscopic colorectal resection. METHODS From January 2008 to December 2020 all patients with concomitant AAA and CRC were consecutively treated by EVAR and laparoscopic colorectal resection. Perioperative data were retrospectively collected in order to evaluate short and long-term outcomes following the sequential two-staged procedures. RESULTS A total of 24 patients were included. The localization of the aneurysm was infrarenal abdominal aortic in 23 cases and in one case of common iliac artery. EVAR procedure has always been performed first. In 18 patients a percutaneous access has been used while in 6 patients a surgical access has been adopted. Twelve patients had cancer in the left colon, 9 in the right colon, and 3 patients had rectal cancer. No conversions or intraoperative complications had occurred during laparoscopic surgery. The major complications rate after EVAR and CRC surgery was 8.3% and 12.5% respectively. The mean interval between EVAR and CRC treatment was 7.8 ± 1 and the mean length of stay was 15,4 ± 3,6. No deaths occurred during hospitalization and between the procedures. Overall mortality was 20.8% with a mean follow up of 39,41 ±19.2 months. CONCLUSION Elective sequential two-staged minimally invasive treatment is a safe and feasible approach with acceptable morbidity and mortality rates and it should be adopted in current clinical practice to manage concomitant AAA and CRC