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Background: Critical limb ischemia is considered the most severe form of peripheral artery disease. High morbidity and mortality rates are associated with this pathology due to poor economic management of complications. Case summary: A 68-year-old female patient underwent a routine Doppler ultrasound which revealed the obstruction of both the common and superficial right femoral arteries, as well as the right deep femoral artery. In this case, an iliofemoral bypass was performed using the right deep femoral artery as the outflow artery. Conclusion: Revascularization of the deep femoral artery has a reasonable chance of preserving the ischemic lower limb whenever the common and superficial femoral arteries suffer major atherosclerotic blockages.

Introduction: In this report, we present a rare case of aortic aneurysm with associated left ureter obstruction and consequent hydronephrosis. Case presentation: A 62-year-old man was admitted for epigastric and periumbilical pain, extended in the spine, and anuria. As for associated diseases, he presented arterial hypertension stage II/III, chronic ischemic cardiomyopathy, acidosis, hyperpotassemia, spondylosis with radiculopathy, acute renal failure, renal lithiasis, and eating difficulties. After performing a CT scan, the patient was diagnosed with giant abdominal infrarenal aortic aneurysm with ureter compression, and retroperitoneal rupture with common and internal iliac arteries occlusion. We performed a xifo-pubian laparotomy with endoaneurysmorrhaphy and aortoiliac bilateral bypass using silver Dacron vascular prosthesis (16 × 8 mm in diameter). Douglas drainage was necessary, ending with laparoraphy. The patient presented a favorable postoperative evolution. Conclusion: Open surgery remains the gold standard method of treatment for large aortic aneurysms, given the inability of endovascular procedures to solve problems caused by compression.

Abstract. Background: The role of vascular calcifications in iliac arteries for predicting global atherosclerotic burden in still unknown. The aim of this study was to investigate whether iliac calcium score (ICS), a new computed tomographic angiography (CTA) derived biomarker of vascular calcification, can predict the severity and complexity of peripheral arterial disease (PAD) as well as the global atherosclerotic burden. Patients and methods: This was a single centre, non-randomized, observational prospective study on 84 consecutive patients with symptomatic peripheral arterial disease, undergoing peripheral CTA examination of the lower limbs, divided into high (n = 42) and low ICS (n = 42) groups with a median value for ICS of 3934 HU. Results: Patients with high ICS were significantly older (66.2 ± 8.0 vs. 62.8 ± 11.2, p < 0.0001) and were more frequently diabetic (61.9 vs. 38.1 %, p = 0.04). ICS was significantly higher in patients with Rutherford stage 5–6 vs. 1–2 (p = 0.03) and in TASC D or TASC C vs. TASC B class (p = 0.01). Mean iliac intima-media thickness (i-IMT) was significantly higher in the high ICS group compared to the low ICS group (1.3 ± 0.2 vs. 0.9 ± 0.2, p < 0.0001). Linear regression analysis demonstrated a very good correlation between ICS and i-IMT (r = 0.59, p < 0.0001 for right, r = 0.57, p < 0.0001 for left and r = 0.67, p < 0.0001 for both iliac arteries averaged). Patients with high ICS presented a significantly lower left ventricular ejection fraction compared to those with low ICS (45.3 ± 4.3 vs. 53.8 ± 4.8, p < 0.0001). Linear regression analysis demonstrated significant inverse correlation between ICS and left ventricular EF (r = –0.54, p < 0.0001). Conclusions: Increased values of ICS, a new CTA marker of vascular calcification, are associated with a higher severity and complexity of PAD and a more depressed left ventricular function. High ICS values are also associated with increased i-IMT. Both can represent new surrogate markers of an increased atherosclerotic burden.

Over the past years, the Cloud phenomenon had an impressive increase in popularity in both the software industry and research worlds. The most interesting feature that Cloud Computing brings, from a Cloud client's point of view, is the on-demand resource provisioning model. This allows Cloud client platforms to be scaled up in order to accommodate more incoming clients and to scale down when the platform has unused resources, and this can all be done while the platform is running. As a result, the physical resources are used more efficiently and the Cloud client saves expenses. Achieving the above mentioned is not trivial and is done by leveraging more direct functionalities that Clouds provide. Three of these key functionalities are automatic scaling, load balancing and monitoring. They represent the focus of the current work. This report is divided into three main parts, one for each of the three main topics of interest: auto-scaling, load balancing and monitoring. We detail each of the three topics and present details on their presence and implementation in the commercial, open-source and research worlds. Among the commercial Cloud platform providers we have focused on Amazon EC2, Microsoft Azure, GoGrid and RackSpace. From the open-source initiatives we have focused our attention on Nimbus, Eucalyptus and OpenNebula. We have also detailed endeavours in the research world that are relevant to the topic of interest and are not connected to any of the Cloud providers. By studying this report, the reader will be able to understand the role that each of the three Cloud features plays for a Cloud client, will understand their inner workings and will be aware of the state-of-the-art available in current commercial and open-source Cloud platforms.