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INTRODUZIONE L’angioplastica con pallone a rilascio di farmaco (drug eluting balloon – DEB) rappresenta una metodica emergente nel trattamento delle lesioni femoro-poplitee. Lo studio descrive l’esperienza preliminare di un singolo centro nell’utilizzo del DEB Stellarex™. MATERIALE E METODI Dal Luglio 2015 ad Aprile 2017, 27 pazienti (4 F, 23 M), età media 65,2 anni (± 8,5), si sottoponevano a 28 procedure di angioplastica di lesioni femoro-poplitee con pallone medicato con paclitaxel (Stellarex™). I pazienti presentavano i seguenti fattori di rischio: 63% diabete, 59% dislipidemia, 63% ipertensione. Dodici pazienti erano claudicanti (44%), 10 con dolore a riposo (37%) e 5 con lesioni trofiche parcellari (18%); dodici (44%) con lesioni femoro-poplitee TASC B e 15 (55%) TASC C. ABI pre-operatorio: 0,53 (0,3 – 0,8; ± 0,13); post-operatorio: 0,83 (0,5 – 1) (± 0,16). Ventidue pazienti sono stati sottoposti alla sola angioplastica con DEB. In 5 casi (18%) sono state necessarie procedure aggiuntive: 4 stent iliaci ed una tromboendoarteriectomia del tripode femorale. Tutti hanno assunto duplice terapia antiaggregante. Il Follow-up è stato eseguito con: esame clinico, ABI ed ecocolor-Doppler a 1, 3, 6 e 12 mesi e successivamente annualmente. RISULTATI Il successo tecnico immediato è stato del 100% senza complicanze perioperatorie. Il tasso di pervietà primaria è stato del 93%. In due casi si è riscontrata restenosi entro l’anno dalla procedura ed è stata eseguita ulteriore angioplastica con DEB, con tassi di pervietà primaria assistita del 100% a 12 mesi. Un paziente è stato sottoposto ad amputazione maggiore ed un altro del terzo e quarto dito, con un tasso di salvataggio d’arto del 97%. Due pazienti sono deceduti durante il follow-up. CONCLUSIONI L’utilizzo del DEB Stellarex™ è una valida alternativa alle tradizionali procedure endovascolari, con tassi di pervietà primaria ad 1 anno soddisfacenti. Sono tuttavia necessari ulteriori studi con casistiche più ampie per valutarne l’efficacia anche a lungo termine.

Introduction Venous aneurysm is known as long-term complication of a haemodialysis arteriovenous fistula (AVF), having an estimated incidence of 5-6%. The purpose of our study is to investigate the role of immunosuppressive therapy in the development of AVF aneurysms in renal transplant patients and whether the AVF closure is required following surgery. Methods Twenty-three consecutive patients with symptomatic venous aneurysm of an AVF were submitted to ligation and resection of the fistula, between February 2013 and March 2016. Results Twenty-one patients (kidney transplant group) were still assuming immunosuppressive therapy from a median period of 11 years. In the remaining two patients (control group) the immunohistochemical stain CD4 CD8 demonstrated a significantly lesser lymphocyte infiltrate, almost exclusively located in the adventitial tunica comparing with transplanted group. Discussion According to our results, the AVF closure should be considered in patients with a well functioning kidney graft and estimated lower risk of rejection.

Introduction: The Abdominal Compartment Syndrome (ACS) is a “condition in which increased tissue pressure in a confined anatomic space, causes decreased blood flow leading to ischaemia and dysfunction and may lead to permanent impairment of function” Materials and Methods: between june 2007 and june 2008 we treated surgically 23 cases of AAA (14 in election and 9 in emergency), with indirect intra-abdominal pressure (IAP) monitoring (intra-vescical catheter). Mean age was 68 (64-84) years. Mean transverse diameter was 6,2 cm (min 5,5 e max 9,0). Rise in IAP more then 20 mmHg was considered for surgical decompression. In 1 case we registered preoperatively IAP more than 20 mmHg treated with only skin suture. Discussion: is possible to distinguish an acute and a chronic ACS.In vascular patients the ACS may occur following free intraperitoneal or contained retroperitoneal aneurysm rupture due to increased IAP. Recently ACS was defined as "killer number one" in the vascular surgical treatment of rAAA. The suggested management for patients with raised IAP, or at risk of developing the ACS following aortic surgery, is to consider urgent decompression in any patients with IAP over 20 mmHg or at lower pressures associated with worsening organ dysfunction. Measurement of IAP may be performed directly or indirectly. All this methods have as objective IPA monitoring befor its clinical manifestation. Conclusion: ACS can be considered a reliable predictive factor for aneurysm surgery outcome. Prevention of the ACS, with early recognition of rising IAP and urgent intervention to decompress the tense abdomen can lead to mortality reduction after aneurysm rupture (after both Open or EVAR treatment). The measurement of IAP is simple and non-invasive, and should be a routine component of physiological monitoring in patients following ruptured aneurysm repair in association with hypotensive hemostasis.