. 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’ 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 conducted through cross-sectional survey. 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, treatment 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 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 activities during the COVID-19 pandemic caused a significant reduction in asymptomatic carotid stenosis revascularization, treatment for Rutherford 3 peripheral arterial disease, post-EVAR surveillance. Contestually, we observed a significant increase in urgent revascularization for symptomatic carotid stenosis, and revascularization or major amputations for chronic limb-threatening ischemia

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

A type II endoleak from an accessory renal artery treated with laser assisted, transgraft coil embolization: A case report

The main complications of coverage accessory renal artery (ARA) are renal infarction and potentially renal function impairment and type II endoleak if firm apposition to the aortic wall is not achieved. We describe the management of an ARA type II endoleak treated by laser-assisted, transgraft coil embolization (LATE). A 76-year-old patient underwent a computed tomography scan 4 years after endovascular aneurysm repair. The computed tomography scan showed an increase of sac diameter with type II endoleak originating from the left ARA as an effect of aortic neck dilatation. ARA embolization was performed successfully via fusion-guided laser in situ fenestration and standard coil placement

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

Evaluating the feasibility of contrast-enhanced ultrasound for detecting after preemptive coiling endoleaks in endovascular aortic aneurysm repair: A pilot study

Endovascular aortic aneurysm repair is widely used for the treatment of abdominal aortic aneurysm (AAA), but has a 10% to 40% incidence of type II endoleak during follow-up. There are various techniques to treat these endoleaks in the case of enlarging of the AAA, but the clinical effectiveness is low. In recent years, preemptive AAA sac embolization has shown some encouraging results with significant AAA shrinkage. However, the presence of embolic material can complicate continued endoleak detection making assessment of treatment outcome difficult. We investigate the ability of contrast-enhanced-ultrasound examination to detect endoleaks in patients undergoing preemptive coil embolization of the AAA sac