Early and midterm results of covered balloon-expandable stents (VBX-Gore) for endovascular treatment of chronic aorto-iliac occlusion.

BACKGROUND: Endovascular treatment is nowadays accepted as first-line treatment for most patients with aorto-iliac obstructive disease (AIOD), including those with Trans-Atlantic Inter-Society Consensus II (TASC-II) lesion types C and D. Aim of the study was to evaluate the role of Viabahn VBX (W. L. Gore and Associates, Flagstaff, AZ, USA), in patients with chronic occlusive aorto-iliac disease (ChO). METHODS: A retrospective review of patients undergone elective endovascular repair with VBX (W. L. Gore and Associates) for ChO at five referral vascular institutions in Italy from 2018 to 2022 was conducted. Primary endpoints were technical success and the incidence of any early and midterm procedure-related reintervention. Secondary endpoints were clinical success, primary and secondary patency. RESULTS: Among 89 included patients, technical success was obtained in 87 patients (97.8%). Postoperative complication requiring early surgical reintervention was necessary in 5 (6%), all but one for arterial bleeding. Clinical improvement of at least 3 classes was observed in 49 (55%). After a mean follow-up of 24.1 months ±14.1, primary patency and freedom from any procedure-related reintervention at 12, 24 and 36 months was 83.0% and 94.8%, 80.0% and 91.5%, 77.9% and 89.3%, respectively. Secondary patency was 100%. TASC-II D lesion (OR=3.67, 95% CI: 1.1289-11.9823, P=0.03) and Grade III iliac calcification (OR=3.41, 95% CI: 1.0944-10.6428, P=0.03) were identified as independent predictors for procedure-related reintervention. CONCLUSIONS: Use of VBX (W. L. Gore and Associates) in ChO was safe and effective with low rate of stenosis/occlusion in the early and mid-term follow-up. TASC-II D and Grade III calcifications resulted as independent predictors for procedure-related reintervention.

Clinical risk factors and features on computed tomography angiography in high-risk carotid artery plaque in patients with type 2 diabetes.

BACKGROUND: High-risk carotid artery plaque (HPR) is associated with a markedly increased risk of ischemic stroke. The aims of this study were: 1) to examine the prevalence of HRP in a cohort of asymptomatic adults with type 2 diabetes (T2D); 2) to investigate the relationship between HRP, established cardiovascular risk factors and computed tomography angiography (CTA) profile; and 3) to assess whether the presence of HRP is associated with an increased risk of major adverse cardiovascular events (MACE). METHODS: This was a retrospective cohort study of T2D asymptomatic patients who underwent carotid endarterectomy (CEA) from January 2018 to July 2021. The carotid atherosclerotic plaque (CAP) was assessed for the presence of ulceration, the presence of lipids, fibrosis, thrombotic deposits, hemorrhage, neovascularization, and inflammation. A CAP presenting at least five of these histological features was defined as a HRP (Group A); in all other cases it was defined as a mild to moderate heterogeneous plaque and no-HRP (Group B). CTA features included the presence of rim sign consisting of thin peripheral adventitial calcification (<2 mm) and internal soft plaque (≥2 mm), NASCET percent diameter stenosis, maximum plaque thickness, ulceration, calcification, and intraluminal thrombus were recorded. Binary logistic regression with Uni- and Multivariate was used to evaluate possible predictors for HRP while multivariable Cox Proportional Hazards was used to assess independent predictors for MACE. RESULTS: One hundred eighty-five asymptomatic patients (mean age 73±8 years, 131 men), undergoing carotid endarterectomy, were included. Of these, 124 (67%) had HRP, and the 61 (33%) did not. Diabetic complications (OR 2.4, 95% CI: 1.1-5.1, P=0.01), NASCET stenosis ≥75% (OR 2.4, 95% CI: 1.2-3.7, P=0.02) and carotid RIM sign (OR 4.3, 95% CI: 3.9-7.3, P<0.001) were independently associated with HRP. However, HRP was not associated with a higher risk of MACE (freedom from MACE at 5 years: HRP 83.4% vs. non HRP 87.8%, P=0.72) or a reduction of survival (5-year survival estimates: HRP 96.4% vs. non HRP: 94.6%, P=0.76). CONCLUSIONS: A high prevalence of HRP (67%) was observed in asymptomatic and elderly T2D patients. Independent predictors of HRP were diabetic complications, NASCET stenosis ≥75% and carotid RIM sign (OR 4.3, 95% CI: 3.9-7.3, P<0.001). HRP was not associated with an increased risk of MACE during a mean follow-up of 39±24 years.

Mid-term Results of Endovascular Reconstruction of Aortic Bifurcation Using COVERA Stent Graft.

INTRODUCTION: This article aims to evaluate the short-term and mid-term performance of a self-expanding covered stent (COVERA Plus, Bard Tempe, Arizona) during the treatment of Trans-Atlantic Inter-Society Consensus (TASC) C/D aortoiliac obstructive lesions involving the aortic bifurcation. METHODS: A single-center retrospective review of all patients who underwent endovascular reconstruction of the aortoiliac bifurcation for obstructive disease, with the use of Covera, from January 2018 to March 2023. All patients received a postoperative CTA (computed tomography angiography) scan within 1 month from the intervention. Precision of deployment, stent conformation, and stent symmetry were evaluated at the arterial phase of the CTA. Early outcomes were technical success and freedom from open aortic reintervention and/or mortality. Late outcomes were primary and assisted primary patency rates and freedom from reintervention. RESULTS: During the study period, 35 patients underwent primary endovascular treatment of obstructive lesions involving the aortic bifurcation with parallel COVERA stents. Aortoiliac lesions were classified as TASC-IIC in 23 (65.7%) patients and TASC D in 12 (34.2%). Median follow-up was 49 months (interquartile [IQR]: 18-60). Overall survival was 97.1% (95% confidence interval [CI]=91-100) at 60 months. During follow-up, there were one early stent stenosis, treated with an angioplasty and stent relining with an estimated primary patency at 60 months of 97.1% (95% CI=94-100) and a primary-assisted patency of 100%. Estimated freedom from all types of reinterventions at 60 months was 94.3% (95% CI=89-99.3). CONCLUSIONS: The new self-expanding covered Bard COVERA Plus stent used for endovascular treatment of TASC C/D aorto iliac disease proved to be safe and feasible with high technical procedural success rates. Comparison with other types of stents is necessary to further assess the role of the COVERA Plus stent in aortic bifurcation repair. CLINICAL IMPACT: This study investigates the safety and feasibility of the new self-expanding covered Bard Covera Plus stent used for endovascular treatment of TASC C/D aorto iliac disease. The retrospective analysis of 35 patients highlights high technical success and primary patency rate at 60 months. The geometric analysis also helped to underline how this stent can be used precisely in particular conditions. These findings suggest the need for further research to compare COVERA with other types of stents in aortic bifurcation repair.

Acute perioperative complications after arterial and venous femoral access in major vascular and cardiac procedures: Ischemic or hemorrhagic patterns and how to solve them.

A direct percutaneous arterial and venous approach to the common femoral vessel has become the first option in most large-bore percutaneous vascular and cardiac procedures, making the issue of access site-related complications (ASCs) a pressing clinical concern. ASCs represent a potentially limb-threating and/or life-threatening scenario that alters the clinical success of the procedure and contributes to increased length of stay and resource utilization. Preoperative assessment of risk factors for ASCs should be well known before planning an endovascular percutaneous procedure and early diagnosis is necessary for prompt treatment. Several percutaneous and surgical approaches have been reported in case of ASCs, according to the different etiologies of these complications. The aim of this review was to report the incidence of ASCs in vascular and cardiac large-bore procedures, diagnosis, and available treatments according to the latest available literature.

Gram stain and addition of amphotericin B to improve the microbial safety of human donor corneas.

To determine the effectiveness of two methods to improve the microbial safety of human corneas preserved in organ culture. We compared the number of positive preservation solutions of corneas in organ culture in which the initial short-term hypothermic corneal maintenance solution was supplemented with amphotericin B 2.5 µg/mL and the historical data of microbial test results (2015-2019). In addition, we appraised the efficacy of Gram stain to detect bacterial or fungal contamination in the organ culture solutions of corneas from at-risk donors compared to the culture tests of corneas from not-at-risk donors. Statistical analysis was performed using STATA and statistical significance set at p < 0.05. The number of positive culture tests after preservation was 15 (0.5%) in 2020 compared to a mean of 37 (1.2%) in the period 2015-2019 (p < 0.01), with 10 (1.0%) positive samples in the cohort of 998 corneas from at-risk donors and 5 (0.2%) in the 2046 corneas from not-at-risk donors (p < 0.01). All corneas from at-risk donors tested positive at Gram stain and the results were available 1-3 days before those of the conventional culture tests. Amphotericin B supplementation in the short-term maintenance solution markedly reduced the number of positive microbial tests after organ culture and the early detection of contaminants, including slow-growing microorganisms, by Gram stain before the standard culture results. This meant fewer corneas being discarded and a greater likelihood of preventing post-graft infections.

Postoperative Streptococcus constellatus Bacteremia in a 75-Year-Old Patient with Pyometra: A Case Report.

BACKGROUND Pyometra is an accumulation of pus in the uterine cavity. It is rare in the general population but more common in elderly women. If diagnosed in the early stage, life-threating conditions may be avoided. The most common etiological microorganisms of pyometra are Escherichia coli, Bacteroides species, Staphylococci (eg, epidermidis) and Streptococci. Occasionally, atypical bacteria may be the cause. CASE REPORT We present the case of a 75-year-old woman, with multiple risk factors, admitted to the Gynecology Department with a 15-day history of yellowish-brown vaginal discharge. Because of rapid enlargement of the uterine cavity, the patient underwent to endometrial curettage. Three hours after surgery, she developed a high-grade fever, and Streptococcus constellatus was isolated in her blood cultures. A specific antibiotic therapy was administered for a total of 14 days, resulting in complete resolution of the infection. CONCLUSIONS This case report describes a rare case of bacteremia caused by Streptococcus constellatus, that resulted from a pyometra. The classic triad of symptoms (postmenopausal bleeding, vaginal discharge, and lower abdominal pain) may be helpful for diagnosis; however, 50% of patients are asymptomatic. An early recognition of the condition is important to avoid rare but risky consequences, such as perforation of the uterus itself. Nevertheless, surgery can cause dangerous complications such as bacteremia. A different spectrum of bacteria may be involved in the development of pyometra, even in atypical cases, mostly when multiple comorbidities are present. A correct evaluation and management of the patient is essential to guarantee a good prognosis in this rare infection.

Bacterial contamination of human organ-cultured corneas.

PURPOSE: This study was designed to define the risk of contamination of human corneas preserved by the organ-culture method. METHODS: We examined the microbial contaminations in 3,100 corneoscleral rims cultivated in our eye bank. Microbiologic tests were performed in the preservation medium 5 days after the beginning of cornea cultures and in the last day of culture (21.5 +/- 8.1 days), when the corneas were transferred to the deswelling medium. In 1,029 corneas a microbiologic test also was performed 1 day after the beginning of deswelling procedure. RESULTS: We found 206 microbial contaminations (6.65% of total) after 5 days and 17 (0.55%) at the end of the preservation period. The total number of contaminated samples during the cornea culture was 223 corresponding to 7.2% of the samples (95% confidence interval, 6.3-8.1). The 1,029 tests performed during the deswelling step disclosed 26 contaminated cornea cultures despite apparent sterility of the medium (2.5%; 95% confidence interval, 1.5-3.5). CONCLUSIONS: The observation of microbial contaminations in a time close to the transplant (i.e., at the end of the preservation period and in the deswelling step) showed that a fast microbial tests during the deswelling procedure may prevent the grafting of a contaminated cornea. The appearance of bacteria in the deswelling medium despite a negative culture medium suggests that bacteria penetrate the corneal tissues during the culture to be subsequently extruded when the internal fluids move outward.

Cornea preservation in culture with bovine serum or chicken ovalbumin.

PURPOSE: To explore the possibility of replacing bovine serum with chicken ovalbumin in cornea preservation. METHODS: Twenty-one pairs of corneas were cultivated at 31 degrees C in a medium containing either 2% (vol/vol) of newborn calf serum (one cornea) or 2 mg/mL of chicken ovalbumin (the contralateral cornea). The evaluation of corneal endothelium was performed after 7 days (one pair) and between 11 and 37 days (20 pairs). Evaluation included the number and the morphology of endothelial cells, their viability, and the pattern of swelling of the intercellular borders. RESULTS: A preliminary test showed that the incubation of a cornea for 7 days with ovalbumin did not cause acute toxic effects. Subsequent experiments showed that this protein was as efficient as bovine serum in preserving the viability and the density of endothelial cells for long periods of incubation. After a mean of 21 +/- 10 days of culture, the number of endothelial cells was 2,455 +/- 230/mm2 in the serum group and 2,430 +/- 181/mm2 in the ovalbumin group. During the longest incubation period, irregular swelling of cell borders and other signs of endothelial degeneration were occasionally observed. CONCLUSION: Replacing serum with chicken ovalbumin resulted in the efficient preservation of corneal endothelium for at least 3 weeks of culture. These data suggest that ovalbumin may be an effective basic component in the design of a serum-free culture medium.