Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry.

BACKGROUND: Identifying sex-related differences/variables associated with 30 day/1 year mortality in patients with chronic limb-threatening ischemia (CLTI). METHODS: Multicenter/retrospective/observational study. A database was sent to all the Italian vascular surgeries to collect all the patients operated on for CLTI in 2019. Acute lower-limb ischemia and neuropathic-diabetic foot are not included. FOLLOW-UP: One year. Data on demographics/comorbidities, treatments/outcomes, and 30 day/1 year mortality were investigated. RESULTS: Information on 2399 cases (69.8% men) from 36/143 (25.2%) centers. Median (IQR) age: 73 (66-80) and 79 (71-85) years for men/women, respectively (p < 0.0001). Women were more likely to be over 75 (63.2% vs. 40.1%, p = 0.0001). More men smokers (73.7% vs. 42.2%, p < 0.0001), are on hemodialysis (10.1% vs. 6.7%, p = 0.006), affected by diabetes (61.9% vs. 52.8%, p < 0.0001), dyslipidemia (69.3% vs. 61.3%, p < 0.0001), hypertension (91.8% vs. 88.5%, p = 0.011), coronaropathy (43.9% vs. 29.4%, p < 0.0001), bronchopneumopathy (37.1% vs. 25.6%, p < 0.0001), underwent more open/hybrid surgeries (37.9% vs. 28.8%, p < 0.0001), and minor amputations (22% vs. 13.7%, p < 0.0001). More women underwent endovascular revascularizations (61.6% vs. 55.2%, p = 0.004), major amputations (9.6% vs. 6.9%, p = 0.024), and obtained limb-salvage if with limited gangrene (50.8% vs. 44.9%, p = 0.017). Age > 75 (HR = 3.63, p = 0.003) is associated with 30 day mortality. Age > 75 (HR = 2.14, p < 0.0001), nephropathy (HR = 1.54, p < 0.0001), coronaropathy (HR = 1.26, p = 0.036), and infection/necrosis of the foot (dry, HR = 1.42, p = 0.040; wet, HR = 2.04, p < 0.0001) are associated with 1 year mortality. No sex-linked difference in mortality statistics. CONCLUSION: Women exhibit fewer comorbidities but are struck by CLTI when over 75, a factor associated with short- and mid-term mortality, explaining why mortality does not statistically differ between the sexes.

Mud Pack With Menthol and Arnica Montana Accelerates Recovery Following a High-Volume Resistance Training Session for Lower Body in Trained Men.

ABSTRACT: Bartolomei, S, Nigro, F, D'Amico, A, Cortesi, M, and Di Michele, R. Mud pack with menthol and Arnica montana accelerates recovery following a high-volume resistance training session for lower body in trained men. J Strength Cond Res 36(7): 1909-1915, 2022-The aim of this study was to compare the effects of a mud pack, containing menthol and Arnica montana, on the recovery responses following a high-volume resistance protocol. Ten resistance-trained men (mean ± SD: age = 25.3 ± 6.1 years; body mass = 79.1 ± 10.6 kg; height = 178.9 ± 7.5 cm) performed a high-volume resistance workout for lower body squat and leg extension, (5 sets of 10 reps at 70% of one repetition maximum for both exercises). All the subject used mud (MUD) or a placebo (PL) in randomized counterbalanced crossover design. MUD or PL were applied 4 times: 3, 19, 27, and 45 hours after the workout, on the skin surface above the quadriceps muscle of both legs. Muscle performance (countermovement jump power [CMJP], isokinetic leg press at 75 cm·s-1 and 25 cm·s-1 [ISOK75 and ISOK25, respectively], isometric squat [ISQ]), and morphology (muscle thickness of vastus lateralis [VLMT]), were measured before exercise (baseline [BL]), and 15 minutes (15P), 24 hours (24P), and 48 hours (48P) postexercise. In addition, muscle soreness was assessed at the same time points using a visual analog scale (VAS). No significant interactions (p > 0.05) between the trials were detected for CMJP, ISOK75, ISQ, and VLMT. A significant interaction between trials was noted for ISOK25 (p = 0.022) and for VAS (p = 0.001). ISOK25 was significantly (p < 0.01) reduced from BL at 15P, 24P and 48P in PL, whereas changes were significant (p < 0.05) at 15P and 24P only in MUD. The present findings indicate that MUD may enhance the recovery rate of strength and reduce muscle soreness after high-volume exercise. Muscle morphology do not seem to be influenced by mud packs.

Femoral Artery Leiomyosarcoma: Case Report and Literature Review.

BACKGROUND: Vascular leiomyosarcoma is a rare type of malignant tumor which arises from the smooth muscle tissue of blood vessel walls; it involves veins five times more frequently than arteries. There are only a few cases published in the literature and consequently there is limited experience regarding treatment and prognosis. METHODS: A 66-year-old woman presented with left lower limb swelling and a left inguinal mass. Imaging revealed a seven-by-five cm well-circumscribed oval inguinal mass that incorporated the common femoral artery including its bifurcation and compressed the common femoral vein. Other malignancies or metastatic disease were excluded. The patient underwent en bloc resection of the tumor, including the common femoral artery and its bifurcation and arterial reconstruction, using the inverted contralateral great saphenous vein, was carried out. Histopathological examination of the mass revealed moderately-differentiated leiomyosarcoma arising from the femoral artery wall without invasion of the intima. The postoperative course was uneventful. 12 months after the procedure the patient was in good clinical conditions and a contrast enhanced CT scan showed patency of the arterial reconstruction without local recurrence or metastatic disease. RESULTS: A systematic literature search identified nine cases of femoral artery leiomyosarcoma; in the eight patients for whom follow-up data were reported, recurrent or metastatic disease developed in five and only three were alive and free of disease. CONCLUSIONS: As with any soft tissues sarcoma, complete surgical resection is the cornerstone of treatment and any directly involved adjacent structures must be sacrificed, as well as a margin of uninvolved normal tissue; consequently, a vascular reconstruction is almost always necessary.

Hybrid endografts in 'wide neck' abdominal aortic aneurysm in patients unfit for open surgery: The Funnel Technique - Case report and review of the literature.

OBJECTIVES: Abdominal aortic aneurysms with a wide proximal neck (>32 mm) are a contraindication for the use of conventional abdominal endovascular stent grafts because of their limited maximum proximal diameter (36 mm). In these cases, it is customary to resort to sophisticated techniques such as parallel or fenestrated grafts. In very selected cases, such as symptomatic wide neck aneurysm or patient with limited life expectancy, Funnel Technique may find an indication. METHODS: It consists in placing a bifurcated endograft in the abdominal aorta embricated with a thoracic endograft as a proximal cuff in an infrarenal position. RESULTS: In the literature review, we found 32 cases of this technique, whose characteristics are collected in a table. CONCLUSION: The Funnel Technique, taking advantage of the larger diameters of the thoracic prostheses, may easily treat abdominal aortic aneurysm cases with a wide neck.

PulseCath, a new short-term ventricular assist device: our experience in off-pump coronary artery bypass graft surgery.

We utilized a new ventricular assist device, the PulseCath catheter, to perform an off-pump bypass procedure in a patient with low ejection fraction. The 21 Fr PulseCath catheter, driven by a standard intra-aortic balloon pump console, can generate a pulsatile flow of 2-3 l/min. The PulseCath coupled with an intra-aortic balloon pump device is an important tool for left ventricular assistance.

Surgical strategy for acute type A aortic dissection in octogenarian.

With the progressive aging of Western populations, cardiac surgeons are increasingly faced with octogenarians. In these high-risk patients, owing to high mortality, the surgical strategy has to be adapted to the patient's age. We describe a method by which the cross-clamping technique is associated with a safe and simple maneuver, consisting of stenting the aortic arch and reducing the aortic cross-clamping damages.

Pseudocoarctation as cause of a refractory hypertension.

Pseudocoarctation of the aorta is an abnormality of the descending portion of the aortic arch at the level of the isthmus without a real pressure gradient. We report a case of a stenotic pseudocoarctation causing severe refractory hypertension.

Aortic intramural hematoma: a case report of spontaneous resolution.

Aortic intramural hematoma is an acute aortic syndrome caused by hemorrhage within the aortic wall and characterized by the absence of an intimal tear and false lumen, which are the main features of classic aortic dissection. Although surgical intervention represents the standard management of type A aortic intramural hematoma, the possibility of treating some patients with medical therapy associated with serial imaging evaluations at follow-up has recently been demonstrated.