Carotid Near-Occlusion: Surgical or Conservative Management? Retrospective Multicenter Study.

BACKGROUND: Carotid near-occlusion (CNO) represents an anatomical-functional condition characterized by severe (more than 90%) internal carotid artery stenosis which can lead to a distal lumen diameter greater or less than 2 mm. CNO can be divided into a less severe subgroup (without lumen full collapse: diameter >2 mm) and a more severe subgroup (with lumen full collapse: diameter <2 mm). The decision for revascularization is still highly debated in Literature. The aim of the present multicenter retrospective study is to analyze the incidence of perioperative (30 days) and follow-up complications in 2 groups of patients with or without distal internal carotid lumen full collapse. METHODS: Between January 2011 and March 2023, in 5 Vascular Surgery Units, 67 patients (49 male, 73% and 18 females, 27%) with CNO underwent carotid endarterectomy: 28 (41.7%) with lumen diameter <2 mm and 39 (58.3%) with diameter >2 mm. 19 patients were symptomatic and 48 asymptomatic. The outcomes considered for comparative analysis were: perioperative neurological and cardiac complications, carotid restenosis or occlusion at follow-up. Both groups were homogeneous in terms of risk factors, morphological features and pharmacological treatments. RESULTS: In the group with lumen <2 mm, 3 perioperative major events (10.7%) occurred (1 ischemic stroke, 1 hemorrhagic stroke, 1 myocardial infarction) and 2 (7.1%) at follow-up (average 11 ± 14.5 months; 1 asymptomatic carotid occlusion, 1 hemodynamic restenosis treated with stenting). No event was recorded in the group with lumen >2 mm. CONCLUSIONS: According to our results CNO patients show different complication risk according to the presence or not of distal lumen collapse. The later seems to play a significant role in perioperative and follow-up complication rate. These results therefore support a surgical treatment only in patients with CNO without lumen full collapse.

Pancreas sparing duodenectomy and aortic reconstruction with custom-made bovine pericardial tubular graft for primary aorto duodenal fistula. Case report.

Primary aorto-duodenal fistula (PADF) is a rare life-threatening condition consisting in a direct communication between the abdominal aorta and the gastrointestinal tract without any previous vascular intervention. PADF results most commonly from an abdominal aortic aneurism (AAA) or aortic bacterial/mycotic infection, with the fistula forming between the native aorta and the third or fourth portion of the duodenum. Symptoms are nonspecific and the diagnosis is often delayed after AAA rupture with high rate of morbidity and mortality. We present a case of 69-year-old-male with a history of untreated abdominal aortic aneurysm who came to the attention of the emergency department for Abdominal aortic aneurysm rupture (RAAA). The patient was successfully treated with staged therapy: endovascular aneurysm repair (EVAR) to control hemorrhage rapidly, followed by pancreas sparing duodenectomy and aortic reconstruction with xenopericardial tube grafts. KEY WORDS: Biological graft, Bovine pericardial tubular graft, Primary aorto-duodenal fistula, Pancreas sparing duodenectomy.