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Background: To assess the presence, quality and impact of gender-related discrepancies in academic vascular surgery at a national level., Methods: This was an anonymous national structured nonvalidated cross-sectional survey on gender disparity perceptions, named "I love it when you call me Señorita", distributed to 645 participants from academic Italian vascular centers. Endpoints were related to job-related characteristics, satisfaction, and sexual harassment., Results: The survey yielded a 27% response rate (n = 174, 78 males and 96 females). Significant differences between male and female responders were found in terms of job satisfaction (83.3% vs. 53.1%, P < 0.001), perception of career opportunities (91.7% vs. 67.9%, P < 0.001), surgical activity in the operating theater (34.6% vs. 7.3%, P < 0.001), involvement in scientific activities (contribution in peer-reviewed articles: 37.2% vs. 9.4%, P < 0.001; scientific meeting attendance/year: 42.3% vs. 20.8%, P = 0.002), and perception of lower peer support at work (2.6% vs. 22.9%, P < 0.001). In addition, female physicians more frequently suffered sexual harassment from male peers/colleagues (10% vs. 34%, P < 0.001), male health-care workers (7% vs. 26%, P = 0.001), or patients/caregivers independently from their sex (6% vs. 38.5%, P < 0.001 for males and 5% vs. 22%, P = 0.001 for females)., Conclusions: A significant number of the female vascular surgeons in Italian academic vascular centers responding to the survey have experienced workplace inequality and sexual harassment. Substantial efforts and ongoing initiatives are still required to address gender disparities, emphasizing the need for the promotion of specific guidelines within scientific societies., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: To retrospectively evaluate the feasibility and effectiveness of the endovascular treatment of patients with abdominal aortic aneurysm and chronic kidney disease (CKD) without the need for using iodinated contrast media throughout the diagnostic, therapeutic, and follow-up pathway., Methods: A retrospective review of prospectively collected data concerning 251 consecutive patients presenting an abdominal aortic or aorto-iliac aneurysm who underwent endovascular aneurysm repair (EVAR) from January 2019 to November 2022 at our academic institution was performed in order to identify patients with feasible anatomy with respect to manufacturer's instructions for use and with CKD. Patients whose preoperative workout included duplex ultrasound and plain computed tomography for preprocedural planning were extracted from a dedicated EVAR database. EVAR was performed with the use of carbon dioxide (CO 2 ) as the contrast media of choice, whereas follow-up examinations consisted of either duplex ultrasound, plain computed tomography, or contrast-enhanced ultrasound. Primary endpoints were technical success, perioperative mortality, and early renal function variations. Secondary endpoints were all-type endoleaks and reinterventions, midterm aneurysm-related and kidney-related mortality., Results: Forty-five patients had CKD and were treated electively (45/251, 17.9%). Of them, 17 patients were managed with a total iodinated contrast media-free strategy and constituted the object of the present study (17/45, 37.8%; 17/251, 6.8%). In 7 cases, an adjunctive planned procedure was performed (7/17, 41.2%). No intraoperative bail-out procedures were needed. This extracted cohort of patients presented similar mean preoperative and postoperative (at discharge) glomerular filtration rate values, 28.14 (SD 13.09; median 28.06, interquartile range (IQR) 20.25) ml/min/1.73 m 2 and 29.33 (SD 14.61; median 27.35, IQR 22) ml/min/1.73 m 2 , respectively (P = 0.210). Mean follow-up was 16.4 months (SD 11.89; median 18, IQR 23). During follow-up, no graft-related complications occurred in terms of either thrombosis, type I or III endoleaks, aneurysm rupture, or conversion. The mean glomerular filtration rate at follow-up was 30.39 ml/min/1.73 m 2 (SD 14.45; median 30.75, IQR 21.93), with no significant worsening in comparison with preoperative and postoperative values (P = 0.327 and P = 0.856 respectively). No aneurysm- or kidney-related deaths occurred during follow-up., Conclusions: Our initial experience shows that total iodine contrast-free abdominal aortic aneurysm endovascular management in patients with CKD may be feasible and safe. Such an approach seems to guarantee the preservation of residual kidney function without increasing the risks of aneurysm-related complications in the early and midterm postoperative periods, and it could be considered even in the case of complex endovascular procedures., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: To describe the outcomes of the endovascular reconstruction of TASC C/D lesions involving the infrarenal aorta and aortic bifurcation with different techniques., Methods: This is an observational, retrospective, single-center study. In a 5-year period, we selected all the patients treated with an endovascular procedure for an aorto-iliac TASC C/D lesion involving the infrarenal aorta and/or the aortic bifurcation. Early (<30 days) outcomes were mortality, major amputation, and thrombosis. Late mid-term (1 and 3 years) outcomes were primary, assisted primary and secondary patency, limb salvage rate, and freedom from reintervention., Results: A total of 87 patients were treated during the index period. Kissing covered stent (cKS), covered reconstruction of aortic bifurcation (CERAB), and unimodular bifurcated AFX Unibody stent-graft (Bif-SG) implantation were performed in 35 (40.4%), 26 (29.8%), and 26 (29.8%) cases, respectively. Bif-SG group included 11 (11/26, 42.3%) patients treated for abdominal aortic aneurysm associated with the obstruction of the aortic bifurcation. Technical success was achieved in all cases and no ruptures or conversions to open surgery were recoded. Median follow-up age was 18 months (interquartile range [IQR], 8-34). Overall primary patency rate was 91.2% (95% confidence interval [CI]: 81.3-95.9) at 1 year and 83.5% (95% CI: 69.6-91.4) at 3 years. Assisted primary patency was 96.9% (95% CI: 87.8-99.2) at 1 and 3 years. Secondary patency was 97.8% (95% CI: 85.5-99.6) at 3 years. Limb salvage rate was 98.6% (95% CI: 90.1-99.7) at 1 and 3 years and, freedom from reintervention was 98.4% (95% CI: 88.9-99.7) at 1 year and 87% (95% CI: 66.1-95.4) at 3 years. Univariate analysis did not identify any factor affecting primary patency rate., Conclusions: Endovascular reconstruction in severe aorto-iliac obstructions using advanced techniques offered promising mid-term patency rates and profiles of safety. The variety of reconstructive configurations allows surgeons to customize on patients' anatomies the type of revascularization., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The aim of this study was to retrospectively analyse perioperative and long-term outcomes of carotid endarterectomy (CEA) performed in symptomatic patients in a high-volume academic vascular centre, stratifying them according to the type of preoperative symptoms and the timing of surgery with respect to the indexed neurological event., Methods: From January 2014 to December 2020, 1,369 consecutive CEAs were performed at our institution. Data concerning these interventions were prospectively collected in a dedicated database including data concerning preoperative assessment, surgical details, perioperative (<30 days) outcomes, and long-term outcomes. A retrospective analysis of the database was performed, and 213 interventions performed in symptomatic patients were found. We identified 2 subgroups of patients: patients with stable neurological symptoms (not recent transient ischemic attack (TIA) or stable major disabling stroke, stable group, and 157 patients) and patients with unstable neurological symptoms (recent TIA, crescendo TIAs, stroke in evolution, acute/recent minor stroke, unstable group, and 56 patients). Perioperative outcomes were analysed in terms of mortality, major neurological events, and local or systemic complications The results were compared using the χ 2 test; these were also analysed on the basis of the presenting symptom (isolated TIA, crescendo TIA, stroke in evolution, acute/recent minor stroke, stabilized stroke) and the timing of the intervention relative to the onset of the symptom. Long term results were analysed using the life-table analysis and Kaplan-Meier curves in terms of survival, stroke-free survival, absence of neurological symptoms, and absence of significant restenosis., Results: Overall, 30-day stroke and death rate were 4.2%. (3.1% vs. 7%, P = 0.2). Two deaths occurred at 30 days, both in the stable group (mortality 1.2%, P = 0.4 compared to the unstable group), but no fatal strokes were recorded in the overall sample. No differences were found in terms of new perioperative neurological events and local complications between the 2 groups. We found a trend toward poorer perioperative results in patients operated on within 48 hr from the indexed event and in patients operated on for stroke in evolution or acute/recent stroke, whereas we found a trend toward better results in favour of patients operated on between 8 and 14 days (P = 0.08). The median duration of follow-up was 24.8 months (range 1-78); at 5 years we did not find significant differences in terms of survival and stroke-free survival rates between 2 groups., Conclusions: In our experience, carotid surgery in symptomatic patients provided satisfactory results, particularly in patients with stable neurological status. Among unstable patients, the rate of complications significantly increases, mainly among treated in the very early (<48 hr) period for stroke in evolution or acute/recent stroke. Once the perioperative risk is overcome, the results in the long-term setting are similarly good, both in stable and in unstable patients., (Copyright © 2022 Elsevier Inc. All rights reserved.)

To describe a new inner-branched device used to treat two cases of chronic post-dissection aortic thoraco-abdominal aneurysms (PD-TAAAs) after ascending aortic surgery. A 67-year-old male who had undergone an ascending aorta and arch surgical replacement and a 70-year-old male with a previous Bentall procedure for acute type A aortic dissection were admitted at our department with a PD-TAAA diagnosis. Both patients were defined unfit for open surgery by a multidisciplinary team and a totally percutaneous endovascular repair was planned. A prophylactic cerebro-spinal fluid drainage was applied and at least one hypogastric artery was targeted for salvage in order to reduce the risk of spinal cord ischemia. A new inner branch device by Jotec® (GmbH/ Criolife; Hechingen, Germany/Kennesaw, Georgia) was implanted. A TEVAR and a standard EVAR completed the procedures and a double barrel technique was performed in order to achieve the preservation of the selected hypogastric artery. In both patients the complete technical success was achieved. The postoperative period was uneventful and the patients were discharged on the 6 th and 7 th postoperative day, respectively. The triple-phase angio-CT performed at 6 months showed the complete false lumen exclusion and the patency of the endografts and of the target visceral vessels. The total endovascular treatment of PD-TAAAs is a fascinating technique with encouraging results in experienced centers. Inner branched devices may expand the field of application of this new technology. More data are required to evaluate mid- and long-term results., (Copyright © 2021 Elsevier Inc. All rights reserved.)

A 54-year-old male patient was admitted with acute left lower limb ischemia (ALI). Computed tomography (CT) angiogram showed an isolated abdominal aortic dissection (IAAD) with a single entry tear just proximal to the aortic bifurcation and an intramural hematoma (IMH) extending to the descending thoracic aorta. The IAAD involved the left iliac bifurcation, with a flow limiting dissection flap into the internal iliac artery (IIA) and external iliac artery (EIA) thrombosis with femoro-popliteal embolization. A surgical thrombectomy of the femoral arteries was performed. An unibody bifurcated endograft was deployed into the true lumen to cover the entry tear, and a double-barrel technique was employed to restore the flow into the EIA and to preserve the IIA patency. The postoperative period was complicated by a compartment syndrome of the calf, requiring a fasciotomy. Follow-up imaging after 12 months showed complete resolution of the IAAD and patency of the stented vessels., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Partial thrombosis or total occlusion of aortic or limb graft are possible complications after endovascular aneurysm repair. Different strategies for therapeutic management are available; these include open surgical techniques or endovascular treatments. The choice of the treatment depends on the patient's clinical conditions and on the timing of the thrombosis. Bypass still remains the first choice in case of chronic occlusion but in the last 10 years, the use of percutaneous mechanical/rheolytic thrombectomy systems is increasing. These devices can be used in case of acute or subacute onset of native arterial and venous thrombosis or embolism and in case of graft occlusion. AngioJet is a percutaneous rheolytic mechanical thrombectomy system. Through a pressurized saline solution jet, a low-pressure zone is made up and the thrombus is fragmented and aspirated by the device. Different transient adverse effects caused by lysis of the thrombus are described such as hemoglobinuria but in some cases the release of high doses of the thrombus degradation products such as heme and adenosine diphosphate can lead to fatal consequences for the patient. We reported a case of an acute onset of acute distress respiratory syndrome, pulmonary edema, cardiac shock, and renal failure following AngioJet thrombectomy in an 81-year-old man with an acute occlusion of an aortic endograft., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Endovascular treatment of postdissection aortic aneurysms (PDAAs) is fascinating and challenging. The Colt branched graft (Jotec/Cryolife, Kennesaw, Georgia), because of its characteristics, can be used as an off-the-shelf device especially in urgent/emergency settings. In this report, we describe the first case of a PDAA successfully treated with a Colt device., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The presence of a concomitant aortoiliac occlusive disease and abdominal aortic aneurysm (AAA) is rare and limits the implant of a bifurcated endograft., Background: The objective of the study was to evaluate early and midterm results of an endovascular or a hybrid approach in patients undergoing iliac revascularization and AAA exclusion., Methods: We reviewed our clinical series of patients from January 2016 to February 2018. Inclusion criterion was an iliac occlusion with concomitant aortic aneurysm., Results: We treated 8 male patients: 8 common iliac arteries (CIAs) and 5 external iliac arteries (EIAs). We implanted 8 bifurcated devices and 13 covered stents, 8 in CIA and 5 in EIA. In 5 cases, when the EIA was involved, we also performed a common femoral artery endarterectomy with a patch. During a mean follow-up of 10 months, the primary patency of the recanalized iliac arteries was 100%, no endoleaks, sac growth, or rupture were also recorded., Conclusions: Endovascular or hybrid treatment of the iliac occlusion combined with infrarenal aortic aneurysm is feasible with favorable early and midterm results., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: To retrospectively analyze early and follow-up results of endovascular management of visceral artery aneurysms (VAAs) in a single-center experience., Methods: From 2007 to June 2013, 26 consecutive elective endovascular interventions for VAAs were performed in 26 patients; preoperative, intraoperative, and postoperative data were prospectively collected in a dedicated database. Early (<30 days) and follow-up results were evaluated., Results: The site of aneurysm was splenic artery in 17 patients, common hepatic artery in 3 patients, renal artery and pancreaticoduodenal artery in 2 cases each, and gastroduodenal artery and celiac trunk in one case each. All the lesions were asymptomatic, and the mean diameter was 22.8 mm. Interventions consisted in coiling in 19 cases; in 4 patients a covered stent was placed, whereas the remaining 3 patients had a multilayer stent. Technical success was 89%. There were no perioperative deaths; 1 patient with splenic artery aneurysm had coils migration with symptomatic splenic infarction and underwent successful redo coils packing. Median duration of follow-up was 18 months. During follow-up, 1 aneurysm-unrelated death occurred. One asymptomatic thrombosis of a treated vessel was recorded, with a 2-year estimated patency rate of 91%. Mean aneurysmal diameter at the latest follow-up was 20.2 mm (P = 0.001 in comparison with preoperative values; 95% confidence interval 1.9-5.2). Complete exclusion of the aneurysm occurred in all but 1 patient, who had a limited increasing in the diameter of its splenic aneurysmal sac after coiling. Another patient developed a more distal aneurysm of the splenic artery after 24 months. No reinterventions were required. Freedom from aneurysm-related complications at 2 years was 72.9% (Standard Error, 0.09)., Conclusions: In our experience, endovascular treatment of VAA, when feasible, provided excellent perioperative results with low rates of complications and reinterventions. Even if the risk of developing aneurysm-related complications during follow-up is substantial, most of them can be watched without the need for repeated interventions., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: To retrospectively analyze the early and the midterm results of endovascular management of aortoiliac obstructive disease with the kissing stent technique., Methods: From January 2005 to September 2012, 229 consecutive endovascular interventions for aortoiliac obstructive disease were performed; data from all the interventions were prospectively collected in a dedicated database. In 41 patients, the kissing stent technique at the level of aortic bifurcation was performed (group 1), whereas in the remaining 188 it was not (group 2). Perioperative results were compared with chi-squared test. Follow-up results were analyzed with Kaplan-Meier curves and compared with log-rank test., Results: Trans-Atlantic Inter-Society Consensus II C and D lesions were present in 66% of patients in group 1 and in 28.5% in group 2 (P < 0.001), whereas iliac occlusion rather than stenosis was detected in 78% of patients in group 1 and in 50% in group 2 (P = 0.001). The mean number of placed stents was 2.5 in group 1 and 1.4 in group 2 (P < 0.001). Technical success was 100% in group 1 and 98% in group 2 (P = 0.3). The rate of perioperative complications was 7.3% in group 1 and 4.2% in group 2 (P = 0.4). At 30 days, neither deaths nor major cardiovascular complications occurred. There was no thrombosis or significant restenosis at the early postoperative follow-up visit. Mean duration of follow-up was 22 months. Primary patency rates at 4 years were 70.5% (standard error [SE], 0.09) in group 1 and 75.5% (SE, 0.06) in group 2 (P = 0.7). At the same interval, assisted primary and secondary patency and survival rates were also similar; reintervention rates were 15.5% in group 1 (SE, 0.1) and 19.5% in group 2 (SE, 0.06; P = 0.6)., Conclusions: The kissing stent technique provided satisfactory results in patients with obstructive aortoiliac diseases, without an increase in immediate and midterm complications, representing an effective solution in complex anatomies., (Copyright © 2015 Elsevier Inc. All rights reserved.)

To report the use of endografts to manage multiple aneurysms due to Cogan syndrome (CS). A 38-year-old woman with descending thoracic aorta and right common carotid artery aneurysms due to CS was treated with endovascular grafts. After 4 years, angio computed tomography scan demonstrated complete exclusion of the aneurysms with no signs of endoleak, whereas echo color Doppler showed patency of the carotid graft, no signs of restenosis, no progression of the disease in the landing zones, and complete aneurysm exclusion. Endovascular repair seems to have favorable long-term outcomes and should be considered a viable alternative to surgery in unfit for open surgery patients, even if they are young, and when the aneurysm size and location would pose a higher risk of perioperative and postoperative complications after an open surgical procedure., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: To report the use of an endograft to manage a type Ib endoleak in a patient with a juxtarenal aortic aneurysm previously treated with a multilayer stent., Methods: Under compassionate use, a 68-year-old patient with a juxtarenal aortic aneurysm and multiple comorbidities was treated with a multilayer flow modulating stent. Twelve months later a new computed tomography (CT) scan identified a type Ib endoleak with an increase in the aortic aneurysm size because of the extension of the aneurysmal disease to the aortic carrefour. A new endovascular procedure was then performed, deploying an aorto-biiliac endoprosthesis. After 18 months, serial echocolor duplex and CT scans have shown normal visceral arteries patency, no signs of endoleak, and sac shrinkage of 5 mm., Discussion and Conclusion: In this case, the Multilayer Aneurysm Repair System failed to treat the abdominal aortic aneurysm and required a reoperation with conventional-covered stent graft for distal sealing, which may be considered a feasible solution to manage potential endoleaks., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To evaluate early and long-term results of surgical and endovascular therapy of extracranial carotid artery aneurysms., Patients and Methods: A retrospective study was conducted of 26 aneurysms in 25 patients (19 men and 6 women) who underwent surgery between 1993 and 2010: 18 were atherosclerotic, 3 were from arteritis, 1 was a relapsing mycotic aneurysm from previous carotid surgery, and 4 were posttraumatic. A neurologic event was the presenting symptom in 10 cases (7 transient ischemic attacks, 3 strokes); 13 patients were asymptomatic and a cranial nerve dysfunction (hoarseness) was present in 2; fever was present in 1. A total of 15 aneurysms, located on the carotid bifurcation (CB), were resected and an end-to-end carotid anastomosis was performed. In 6 patients with CB aneurysms, a vein graft was applied in 5, and a polytetrafluoroethylene graft in the other. Aneurysmorrhaphy and a vein patch was the procedure in 2 patients with an aneurysm of the CB. One of these 2 patients had a relapsing mycotic pseudoaneurysm and was treated initially with a vein patch, subsequently with a vein graft, and lastly with a carotid artery ligation. Three common carotid artery aneurysms from arteritis were treated under local anesthesia through implantation of a Viabahn endoprosthesis., Results: A perioperative minor stroke occurred in 1 patient (3.8%) because of intentional ligation of the internal carotid artery from a relapsing mycotic aneurysm, already treated with a vein patch and subsequently with a vein bypass. No permanent cranial nerve injuries were recorded; transient cranial nerve injuries were observed in 2 patients., Conclusions: Surgical treatment is feasible, with an acceptable rate of stroke and cranial nerve injuries, especially when the aneurysm is located on the common carotid artery and carotid bulb. Endovascular therapy is a fascinating option, with satisfactory early and long-term results, and should always be considered when treating aneurysms located in the distal internal carotid artery and when the patient is not a good candidate for open surgery., (Copyright © 2014 Elsevier Inc. All rights reserved.)

In the period ranging from 2006 to 2010, 5 endovascular interventions for carotid pseudoaneurysm (4 post-carotid endarterectomy [post-CEA] and 1 posttraumatic), without signs of infection, were carried out. All patients were neurologically asymptomatic. A covered stent was used in 4 cases. The fifth patient, undergoing a third endovascular procedure after a re-do open surgical repair of a post-CEA pseudoaneurysm, was treated with a bare stent. The technical success rate was 100%. A type 1 endoleak at the end of the procedure was observed in 1 patient, but it disappeared before discharging. No perioperative neurologic events occurred. At the most recent mean follow-up of 24 months, all patients are alive, without neurologic symptoms, and all have maintained patency of the internal carotid artery and are pseudoaneurysm-free., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Aim of this study was to retrospectively compare perioperative (<30 days) and 2-year results of open and endovascular management of popliteal artery aneurysms (PAAs) in a single-center experience., Methods: From January 2005 to December 2010, 64 PAAs in 59 consecutive patients were operated on at our institution; in 43 cases, open repair was performed (group 1), whereas the remaining 21 cases had an endovascular procedure (group 2). Data from all the interventions were prospectively collected in a dedicated database, which included main preoperative, intraoperative, and postoperative parameters. Early results in terms of mortality, graft thrombosis, and amputation rates were analyzed and compared by χ(2) text or Fisher exact text. The surveillance program consisted of clinical and ultrasonographic examinations at 1, 6, and 12 months and yearly thereafter. Follow-up results (survival, primary and secondary patency, limb salvage) were analyzed by Kaplan-Meier curves, and differences in the two groups were assessed by log-rank test., Results: There were no differences between the two groups in terms of sex, age, risk factors for atherosclerosis, and comorbidities; PAAs were symptomatic in 48% of cases in group 1 and in 29% in group 2 (P = 0.1). Fifteen patients with mild-to-moderate acute ischemia due to PAA thrombosis underwent preoperative intra-arterial thrombolysis, 13 in group 1 and 2 in group 2. In open surgery group, nine cases were treated with aneurysmectomy and prosthetic graft interposition, and in seven cases, the aneurysm was opened and a prosthetic graft was placed inside the aneurysm. In 27 cases, ligation of the aneurysm with bypass grafting (21 prosthetic grafts and 6 autologous veins) was carried out. In group 2, 20 patients had endoprosthesis placement, whereas in the remaining patient, a multilayer nitinol stent was used. There was one perioperative death in a patient of group 2 who underwent concomitant endovascular aneurysm repair and PAA endografting. Cumulative 30-day death and amputation rate was 4.5% in group 1 and 4.7% in group 2 (P = 0.9). Follow-up was available in 61 interventions (96%) with a mean follow-up period of 22.5 months (range: 1-60). Estimated primary patency rates at 24 months were 78.1% in group 1 and 59.4% in group 2 (P = 0.1). Freedom from reintervention rates at 24 months were 79% in group 1 and 61.5% in group 2 (P = 0.2); estimated 24-month secondary patency rates were 81.6% in group 1 and 78.4% in group 2 (P = 0.9), and freedom from amputation rates were 92.7% and 95%, respectively (P = 0.7)., Conclusions: Endovascular treatment of PAAs provided, in our initial experience, satisfactory perioperative and 1-year results, not significantly different from those obtained with prosthetic open repair in patients with similar clinical and anatomical status. There is, however, a trend toward poorer primary patency rates among patients endovascularly treated, who also seem to require more frequently a reintervention., (Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to evaluate the effectiveness of a standardized preoperative cardiac assessment in reducing the rate of perioperative cardiac complications in patients undergoing aortic surgery, paying particular attention to the analysis of the factors affecting perioperative cardiac outcomes., Methods: Between January 2005 and August 2008, a total of 531 elective interventions for abdominal aortic aneurysms were performed at our institution. All patients underwent preoperative evaluation on an outpatient basis, which included a standardized cardiac assessment protocol to evaluate perioperative cardiac risk. A surgical (open or endovascular) intervention was performed in all patients and perioperative (<30 days) results in terms of overall and cardiac mortality and morbidity rates were recorded., Results: Preoperative electrocardiogram, transthoracic echocardiography, and cardiology consultation were performed in all patients. In 348 cases (65.5%), further evaluation of cardiac functional capacity with noninvasive stress testing was recommended. A positive noninvasive stress test was noted in 86 (24.7%) of 348 patients and coronary angiography was performed in 34 (39.5%) of 86 patients. Thirteen of these patients underwent successful coronary revascularization (11 percutaneous transluminal coronary angioplasty, two coronary artery bypass graft) before vascular surgery. Thirty-day overall rate and cardiac mortality rate were 1.1% and 0.6%, respectively, and 30-day overall and cardiac morbidity rates were 11.5% and 6.8%, respectively. Univariate analysis demonstrated that in patients aged >80 years, chronic renal failure, congestive heart failure, valvular heart disease, positive noninvasive stress testing, and open surgical treatment significantly affected 30-day cardiac morbidity; however, only valvular heart disease and positive noninvasive stress testing maintained their significance with multivariate analysis (p = 0.005; 95% CI, 1.6-14.4; and p = 0.02; 95% CI, 1.2-8.1, respectively). None of the examined factors significantly affected 30-day cardiac mortality., Conclusion: In our experience, the use of a routine preoperative cardiac assessment allowed us to obtain satisfactory perioperative results in patients undergoing abdominal aortic surgery. Very few patients, however, require cardiac revascularization before abdominal aortic surgery. Patients with positive stress test may benefit from an endovascular treatment if anatomically feasible., (Copyright 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

Background: Aim of this study was to analyze our experience in the last 5 years of combined carotid and cardiac surgery., Methods: During a 5-year period (January 2002-December 2006), 111 patients underwent combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) (group 1), while 1,446 patients underwent isolated CEA (group 2). Perioperative outcomes in the two groups were compared using chi(2) and Fisher's exact tests to analyze neurological deficits, cardiac events, and death at 30 days. Results during follow-up were analyzed using Kaplan-Meier survival curves, and both groups were compared using the log-rank test., Results: Immediate postoperative neurological deficits occurred more frequently in group 1 patients (2.5 vs. 0.4%, p = 0.002), with a higher incidence of transient ischemic attacks in group 1; however, there was no difference in the incidence of stroke (1% group 1 vs. 0.6% group 2, p = n.s.). Mortality rate was increased in the combined surgery group (3.5 vs. 0.5%, p < 0.001). Combined stroke/myocardial infarction/death rate at 30 days was 6.3% in group 1 compared with 1.4% in group 2, p = 0.001. Perioperative stroke/myocardial infarction/death rate was much improved in the 55% (61/111) of patients undergoing CABG off-pump (3.3 vs. 10%, p = 0.001). Mean follow-up was 18.7 months (range, 1-60). Survival at 24 months was significantly higher in patients of group 2 compared with group 1 (99.4 vs. 91.3% respectively, p < 0.001). At 24 months, there was no significant difference between the two groups in the risk of developing ipsilateral or contralateral neurologic events (3.1% group 1 vs. 1.7% group 2)., Conclusion: In our experience, combined CEA and cardiac surgery carries a higher risk of perioperative mortality than patients undergoing isolated CEA. Whenever possible, CEA combined with off-pump CABG seems to be the therapeutic strategy of choice., (Copyright 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

The aim of the study was to evaluate the immediate and long-term results of femoropopliteal bypasses performed with a new bioactive heparin-treated expanded polytetrafluoroethylene (ePTFE) graft in a single-center experience. From March 2002 to April 2006, 51 patients underwent lower limb revascularization with a new bioactive ePTFE prosthetic graft with covalent end-point attachment of heparin to the graft surface. Data concerning preoperative assessment, intraoperative strategy, drug administration, and follow-up surveillance program were prospectively collected in a dedicated database; early results were analyzed in terms of graft patency, amputation rate, and deaths. Follow-up consisted of clinical and duplex scan examination at 1, 6, and 12 months and yearly thereafter. Midterm results in terms of primary and secondary patency, limb salvage, and survival were analyzed. Patients were predominantly male (35 patients, 71%), with a mean age of 71 years (SD = 9.05). Indications for surgical revascularization were critical limb ischemia in 36 patients and severe intermittent claudication in 15 patients. Interventions were performed for occlusion of a native vessel in 35 cases, whereas 12 patients had late thrombosis of a femoropopliteal bypass; the remaining four patients were operated on for an occluded popliteal artery aneurysm. Intervention consisted of below-knee bypass in 34 patients, while the other 17 had an above-knee revascularization. No perioperative deaths occurred. Cumulative 30-day graft patency was 88%, with an amputation rate of 4% (two cases). Results were similar in above- and below-knee revascularizatons. Mean duration of follow-up was 18 months (SD = 7). Cumulative estimated 24-month survival and primary patency rates were 97% and 80.2%, respectively; the corresponding limb salvage rate was 85.7%. Long-term results did not significantly differ in above- and below-knee revascularizatons. In our experience, the use of a modified ePTFE graft with covalent end-point linkage of heparin molecules on the graft surface provides good early and midterm results, with low rates of graft thrombosis and amputation.