Endovascular Materials and Their Behavior in Peripheral Vascular Surgery

Endovascular techniques have progressively become the first option for the treatment of stenosis and occlusions of both aorto-iliac and femoro-popliteal district. The development of new technologies and new materials has broadened the applicability of the endovascular techniques, allowing the treatment of each lesion with the most suitable material. A knowledge of the behavior of endovascular materials when treating peripheral arterial disease (PAD) is, therefore, crucial for optimization of the results. Here, we aim to review the most important technical features of the actually available endovascular materials for treating PAD

Partial Eversion Carotid Endarterectomy versus Conventional Techniques for Significant Carotid Stenosis

Background: To compare the outcomes of patients who were submitted to partial carotid endarterectomy (P-CEA) to those of patients who underwent standard conventional CEA with patch closure (C-CEA) and eversion CEA (E-CEA) for a significant carotid stenosis. Methods: Data of patients who consecutively underwent CEA from January 2014 to December 2018 for a significant carotid stenosis were retrospectively collected. Primary outcomes included mortality and the occurrence of neurologic and cardiologic complications, both at 30 days and during follow-up. Secondary outcomes included the occurrence of perioperative local complications (i.e. cranial nerve injuries, hematomas) and restenosis during follow-up. P values < 0.5 were considered statistically significant. Results: Three-hundred twenty-seven patients (241 males, 74%) underwent CEA for carotid stenosis (28.6% symptomatic). P-CEA was performed in 202 patients (61.8%), while C-CEA and E-CEA were performed in 103 and 22 cases respectively. At 30 days, neurologic complications were not significantly different among the 3 groups (2.8% in the group of C-CEA, 2.4% after P-CEA and 0% in E-CEA patients, P = 0.81), neither during follow-up. Perioperative local complications also were not significantly different among the 3 groups (P = 0.16). Conclusions: P-CEA had similar outcomes if compared to C-CEA and to E-CEA in terms of perioperative mortality, occurrence of neurologic and cardiologic complications, and occurrence of local complications. Also, in the long-term, P-CEA, C-CEA, and E-CEA were burdened by similar rates of mortality, neurologic, and cardiologic complications and restenosis

Endovascular Materials and Their Behavior in Peripheral Vascular Surgery

Endovascular techniques have progressively become the first option for the treatment of stenosis and occlusions of both aorto-iliac and femoro-popliteal district. The development of new technologies and new materials has broadened the applicability of the endovascular techniques, allowing the treatment of each lesion with the most suitable material. A knowledge of the behavior of endovascular materials when treating peripheral arterial disease (PAD) is, therefore, crucial for optimization of the results. Here, we aim to review the most important technical features of the actually available endovascular materials for treating PAD.</jats:p

Partial Eversion Carotid Endarterectomy versus Conventional Techniques for Significant Carotid Stenosis

&lt;p&gt;Mazzaccaro D, Righini P, Giannetta M, Modafferi A, Malacrida G, Nano G. Partial Eversion Carotid Endarterectomy versus Conventional Techniques for Significant Carotid Stenosis. Ann Vasc Surg. 2023 Jul;93:252-260. doi: 10.1016/j.avsg.2023.01.041. Epub 2023 Feb 2. PMID: 36739080.&lt;/p&gt; &lt;h2&gt;Abstract&lt;/h2&gt; &lt;div&gt; &lt;p&gt;&lt;strong&gt;Background:&nbsp;&lt;/strong&gt;To compare the outcomes of patients who were submitted to partial carotid endarterectomy (P-CEA) to those of patients who underwent standard conventional CEA with patch closure (C-CEA) and eversion CEA (E-CEA) for a significant carotid stenosis.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods:&nbsp;&lt;/strong&gt;Data of patients who consecutively underwent CEA from January 2014 to December 2018 for a significant carotid stenosis were retrospectively collected. Primary outcomes included mortality and the occurrence of neurologic and cardiologic complications, both at 30 days and during follow-up. Secondary outcomes included the occurrence of perioperative local complications (i.e. cranial nerve injuries, hematomas) and restenosis during follow-up. P values &lt; 0.5 were considered statistically significant.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results:&nbsp;&lt;/strong&gt;Three-hundred twenty-seven patients (241 males, 74%) underwent CEA for carotid stenosis (28.6% symptomatic). P-CEA was performed in 202 patients (61.8%), while C-CEA and E-CEA were performed in 103 and 22 cases respectively. At 30 days, neurologic complications were not significantly different among the 3 groups (2.8% in the group of C-CEA, 2.4% after P-CEA and 0% in E-CEA patients, P = 0.81), neither during follow-up. Perioperative local complications also were not significantly different among the 3 groups (P = 0.16).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusions:&nbsp;&lt;/strong&gt;P-CEA had similar outcomes if compared to C-CEA and to E-CEA in terms of perioperative mortality, occurrence of neurologic and cardiologic complications, and occurrence of local complications. Also, in the long-term, P-CEA, C-CEA, and E-CEA were burdened by similar rates of mortality, neurologic, and cardiologic complications and restenosis.&lt;/p&gt; &lt;/div&gt

Blunt Thoracic Aortic Injury

Blunt thoracic aortic injury (BTAI) is a potentially fatal condition that needs prompt recognition and expedited management. Clinical manifestations of BTAI are not straight forwarding and may be misdiagnosed. The grade of aortic injury is an important determinant of perioperative mortality and morbidity, as well as the indication of treatment, along with the presence of concomitant lesions of other involved organs. The mainstay of treatment nowadays for hemodynamically stable patients who survive the trauma scene is represented by delayed endovascular repair whenever anatomically and clinically feasible. Endovascular repair, in fact, is burdened by lower perioperative mortality and morbidity rates if compared to open surgical repair, but concerns remain about the need for long-term surveillance and radiation exposure in patients who are at a younger age than patients treated for the aneurysmal disease. The aim of the paper is to provide an update on the diagnostic modalities and strategies of treatment for patients affected by BTAI

Are Endoleaks Type Ia Predictable?

Objectives Aortic proximal (type Ia) endoleak (EL) is one of the possible complications of endovascular aneurysm repair (EVAR) and usually needs a further reintervention. The aim of our study was to assess any preoperative factor which could predict the development of EL Ia and whether it is treatable through an endovascular approach. Methods Data of patients consecutively treated between January 2012 and December 2015 with EVAR for nonruptured abdominal aortic aneurysm (AAA) were retrospectively collected. For each patient, demographic and anatomical factors (sex, age, proximal aortic neck diameter, angulation and length, AAA diameter) and structural characteristics of different endograft (presence of barbs, free flow, and radial force) were analyzed and related to the development of EL Ia using JMP 5.1.2 software. Results We analyzed 190 patients (32 females [16.8%]; mean age, 75.7 years). The mean follow-up time was 19 months. Patients\u2019 mean AAA diameter was 55.9 mm (range, 30-130 mm). A late EL Ia developed in 13 patients (7%), with a mean time of development of 30%, radial force, and the presence of suprarenal free flow and barbs were not significantly associated to the development of EL Ia. Female sex, age >77 years and a neck length <21 mm were statistically significant (P = .01, P = .02, and P = .02, respectively). Conclusions Among factors analyzed, female sex, age >77 years, and a proximal neck <21 mm were significantly associated with the occurrence of late EL Ia