BACKGROUND: Hybrid iliofemoral revascularization has emerged as an alternative to extensive open reconstruction in patients with complex aorto-ilio-femoral occlusive disease. This study reports a bicentric real-world experience, focusing on mid-term outcomes and the impact of iliac stent configuration on patency and reintervention. METHODS: A retrospective bicentric analysis included consecutive patients undergoing hybrid iliofemoral revascularization between January 2010 and December 2023. All procedures combined common femoral artery (CFA) reconstruction with endovascular iliac revascularization. Primary endpoints were technical success, restenosis, and reintervention. Secondary endpoints included peri-operative complications, limb loss, and mortality. Time-to-event analyses were performed on an available-case basis. RESULTS: A total of 174 patients were included (mean age 65.8 +/- 8.7 years; 83.3% male). Chronic limb-threatening ischemia was present in 65.5%, and iliac lesions were predominantly TASC D (85.0%). Technical success was achieved in 95.4%. Peri-operative complications occurred in 6.9%, with two major amputations and two deaths within 30 days. During a median follow-up of 24 months, restenosis occurred in 21.8% and reintervention in 16.1%. Freedom from restenosis or reintervention was approximately 84% at 1 year and 76% at 5 years. Among stented patients, covered or mixed covered + bare stent configurations were associated with a significantly lower hazard of restenosis or reintervention compared with bare-metal stents (adjusted HR 0.21, 95% CI 0.06-0.72; P0.013), with a particularly strong association for reintervention alone (adjusted HR 0.08, 95% CI 0.01-0.59; P0.013). CONCLUSIONS: Hybrid iliofemoral revascularization is safe and durable in a high-risk population with advanced disease. Iliac stent configuration appears to be a modifiable determinant of mid-term outcomes, supporting a tailored hybrid strategy beyond the binary open-versusendovascular paradigm.
BACKGROUND: The choice of anesthetic technique may influence outcomes following lower extremity revascularization, yet high-quality evidence remains limited. The aim of this study was to compare the impact of regional anesthesia (RA) versus general anesthesia (GA) on 30-day vascular patency and limb salvage rates in patients undergoing lower extremity revascularization. METHODS: This retrospective cohort study included 628 patients who underwent lower extremity revascularization between January 2018 and December 2023. Patients were categorized into GA (N.=342) and RA (N.=286) groups. RA included spinal, epidural, or peripheral nerve blocks with or without light sedation. Propensity score matching (PSM) at a 1:1 ratio was performed to balance baseline characteristics. Primary outcomes were 30-day vascular patency and limb salvage rates. Secondary outcomes included reintervention rate, cardiovascular complications, ICU admission rate, and hospital length of stay. Kaplan-Meier survival analysis and Cox proportional hazards regression were performed. RESULTS: After PSM, 256 patients were included in each group. The RA group demonstrated significantly higher 30-day vascular patency (94.1% vs. 88.7%, P=0.018) and limb salvage rates (96.5% vs. 92.2%, P=0.024) compared to the GA group. The RA group also had lower reintervention rates (5.5% vs. 10.9%, P=0.021), fewer cardiovascular complications (3.9% vs. 9.4%, P=0.009), reduced ICU admission (8.2% vs. 18.4%, P<0.001), and shorter hospital stay (7 days [IQR 5-10] vs. 9 days [IQR 7-13], P<0.001). Multivariable Cox regression identified RA as an independent protective factor for both vascular patency (HR=0.52, 95%CI: 0.31-0.87, P=0.013) and limb salvage (HR=0.48, 95%CI: 0.25-0.91, P=0.025). CONCLUSIONS: RA significantly improves 30-day vascular patency and limb salvage rates compared to GA in patients undergoing lower extremity revascularization, while reducing perioperative cardiovascular complications and hospital length of stay. In the absence of contraindications, RA should be considered the preferred anesthetic technique for lower extremity revascularization.
BACKGROUND: This retrospective-prospective observational study evaluated the technical feasibility, safety and short-term outcomes of carotid artery stenting (CAS) for high-grade symptomatic carotid artery stenosis at a tertiary care centre. METHODS: The study included patients with symptomatic carotid stenosis more than 50%. Clinical data was obtained from the hospital records. Stenosis was assessed on doppler study, MR/CT angiography and digital subtraction angiography. Carotid stenting was performed following a standard procedure. Diffusion weighted MRI was performed 24 hours after the procedure to look for embolic infarcts. Modified Rankin Scores were assessed at discharge and 30 days. RESULTS: The study included 24 patients, 22 of which were males. Technical success was achieved in 23 out of 24 patients (95.8%), with one procedure aborted due to extreme vascular tortuosity. Periprocedural complications occurred in four patients - hyper perfusion related seizures in three and a non-disabling embolic stroke in one patient without any long-term consequences. At 30-day follow-up, all the patients remained free from transient ischemic attack (TIA) or stroke and 82.6% showed significant functional improvement (Modified Rankin Scale 51). CONCLUSIONS: The study underscores that CAS is a technically feasible and safe intervention in this setting, comparable to international benchmarks, emphasizing the importance of meticulous procedural technique and risk factor management. (Cite this article as: Jabeen S, Mohiudin Q, Bhat MH, Wani AH, Choh NA, Shaheen F, et al. Short-term outcomes of carotid stenting: initial experience from a tertiary care center. Ital J Vasc Endovasc Surg 2026;33:10-5. DOI: 10.23736/S1824-4777.26.01726-2)
BACKGROUND: Brachiocephalic arteriovenous fistula (AVF) i s the preferred vascular access for chronic kidney disease (CKD) patients undergoing hemodialysis due to its lower complication rate and superior patency compared to other access types. One potential predictor of cannulation success is vessel wall thickness assessed through intima-media thickness (IMT). However, the association between IMT and cannulation success remains inconclusive. This study aimed to evaluate the relationship between IMT and cannulation success in brachiocephalic AVF. METHODS: This observational analytic study with a cross-sectional design included 60 CKD patients with mature brachiocephalic AVFs undergoing their first cannulation at Cipto Mangunkusumo Hospital and Hermina Depok Hospital (April-September 2025). IMT was measured using ultrasonography, and cannulation success was defined as the absence of complications (hematoma/thrombosis). Statistical analysis was performed using independent T-Test, Mann-Whitney, and x2/Fisher Exact tests, with P<0.001 considered significant. RESULTS: Of 60 patients, 42 (70%) had successful cannulation, while 18 (30%) experienced complications. The mean IMT was significantly higher in the successful group compared to the unsuccessful group (0.117 vs. 0.082 mm; P<0.001). ROC analysis yielded an AUC of 0.972 (95% CI: 0.925-1.000; P<0.001), with an optimal cut-off value of 0.1 mm providing 100% sensitivity and 88.9% specificity. No significant differences in IMT were observed based on diabetes mellitus or hypertension status. CONCLUSIONS: IMT is significantly associated with cannulation success in brachiocephalic AVFs and can serve as a reliable predictor, with a cut-off value of 0.1 mm.
BACKGROUND: Oncovascular surgery (OVS) is a complex surgical approach involving resection of tumors with major vascular involvement, typically offered to patients initially considered inoperable. Despite its radical nature, the effect of OVS on long-term quality of life (QoL) remains insufficiently studied. To evaluate and compare the QoL in patients with advanced tumors involving major vessels who underwent OVS versus those treated with palliative chemotherapy and/or radiotherapy. METHODS: This prospective, observational case-control study included 102 patients treated between 2018 and 2023 in two Bulgarian hospitals. Forty-one patients underwent OVS (intervention group), and sixty-one received only chemoradiotherapy (control group). QoL was assessed at baseline, six months, and twelve months using the EQ-5D-5L instrument, including index scores, five health domains, and visual analogue scale (VAS). RESULTS: Baseline QoL did not differ significantly between groups. At both follow-up points, patients in the OVS group demonstrated significantly higher EQ-5D index scores and better outcomes in all health dimensions. VAS self-rated health also improved or remained stable in the OVS group, while the control group showed progressive deterioration across all metrics. CONCLUSIONS: OVS helps preserve, and in some aspects improve, the QoL in patients with locally advanced malignancies involving major vessels. In contrast, palliative treatment alone is associated with a marked decline in QoL. These findings support the integration of OVS into multidisciplinary cancer care for selected patients and provide a basis for further large-scale research.
BACKGROUND: Diabetic foot amputation severely impacts patient outcomes, while existing risk assessment tools have limited predictive capacity. This study explores the value of inflammatory biomarkers in predicting amputation risk among diabetic foot patients and constructs a high-precision prediction model. METHODS: A multicenter prospective cohort study included 856 diabetic foot patients from three tertiary hospitals (training cohort, January 2022-June 2023) and 324 patients from two additional hospitals (validation cohort, July 2023-June 2024). Inflammatory biomarkers including high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and neutrophil-to-lymphocyte ratio (NLR) were measured. Primary outcome was amputation within 18 months. Competing risk models analyzed risk factors and constructed prediction models with external validation. RESULTS: Training cohort amputation rate was 31.2% (267/856); validation cohort 28.4% (92/324). Fine-Gray competing risk regression identified five independent risk factors: age (sHR=1.032, 95%CI: 1.021-1.044), Wagner grade >= 3 (sHR=3.247, 95%CI: 2.318-4.543), hs-CRP >= 18.5 mg/L (sHR=2.683, 95%CI: 1.947-3.699), IL-6 >= 22.3 pg/mL (sHR=2.154, 95%CI: 1.576-2.943), and NLR >= 7.8 (sHR=1.782, 95%CI: 1.314-2.415). The prediction model achieved C-index 0.847 in training and 0.823 in validation cohorts, with sensitivity 90.5%, specificity 72.8%, and negative predictive value 94.7%. CONCLUSIONS: The inflammatory biomarker-based prediction model demonstrates excellent discrimination and calibration, significantly superior to traditional Wagner classification, providing an important tool for individualized risk stratification and treatment decision-making.
BACKGROUND: Thyroid carcinoma, primarily papillary thyroid carcinoma (PTC), is the most common malignancy of the endocrine system, typically associated with an excellent prognosis. However, certain cases present more aggressive behaviors, and complications such as internal jugular vein thrombosis (IJVT) can occur. This retrospective study aims to explore the rare but critical association between thyroid tumors and IJVT. METHODS: We analyzed 169 patients who underwent thyroid surgery at the ENT Clinic of the University Clinical Center of Kosovo from 2021 to 2024. Demographic data, histopathological findings, surgical procedures, and the presence of jugular vein thrombosis were reviewed. RESULTS: Our findings revealed that 24 patients with thyroid tumors also had concurrent IJVT, with a higher prevalence in females. Although the relationship between thyroid tumors and IJVT was not statistically significant, our study highlights the importance of early detection of IJVT in thyroid cancer patients, especially in those with locally invasive or large tumors. Imaging modalities like ultrasound and CT scans are essential in identifying this complication. CONCLUSIONS: The results emphasize the need for comprehensive preoperative assessments and follow-up in patients with thyroid tumors to detect potential vascular complications.
BACKGROUND: Totally implantable venous devices (ports) are essential for patients with malignant neoplasia who require chemotherapy. Implantation through the internal jugular vein has been the preferred route of insertion, however it has been debated in recent years due to its association with severe complications such as pneumothorax, puncture of the subclavian and carotid artery. An alternative to avoid these complications is the use of ports for peripheral insertion in the arm, less invasive procedure and with better aesthetic results. METHODS: It is a prospective study in which 36 patients with neoplastic disease submitted to port implantation through cervical or brachial access, according to medical indications and patient preference. These patients were followed and the primary outcomes were: time of the procedures, complications and discomfort of the patient in the intraoperative period and up to 6 months after. The satisfaction assessment was performed at the end of the study based on the application of a specific questionnaire. RESULTS: In all cases, the procedure was successfully completed and the proper functioning of the catheters was confirmed. Complications observed in patients with brachial access included three cases of local bruise, one case of asymptomatic thrombophlebitis, one case of subcutaneous infection, one case of pain when stretching the arm and one case of extrusion. In patients with cervical access, two cases of malfunctioning catheters were observed, one of which required early port removal, and another case of subcutaneous pocket infection unresponsive to clinical treatment, which also required early port removal. CONCLUSIONS: The implantation of the port through the brachial and cervical access did not present serious complications, and the patients demonstrated high general satisfaction.
BACKGROUND: The aim of this study is to determine potential clinical and computed tomography (CT) imaging predictors for abdominal aortic aneurysm (AAA) rupture based on a comparative analysis of patients presenting with large (>6.5 cm diameter) unruptured AAA (uAAA) and patients presenting with ruptured AAA (rAAA) respectively. METHODS: Consecutive patients presenting with large unruptured or rAAA and having undergone a contrast-enhanced CT at admission between January 2005 and June 2019 were included. Patients' demographics and CT-imaging characteristics were collected from the institutional electronic medical records. Both patient groups were compared using Fisher's Exact Test for categorical variables and the Mann-Whitney U Test for continuous variables. RESULTS: We included 101 patients, of which 57 patients presenting with a rAAA and 44 patients with a large, uAAA. Patients in the large, uAAA group were younger, mean age of 76 years vs. 83 years (P<0.001), had less coronary artery disease (47.6% vs. 72.5%; P=0.026) and had a lower left common iliac artery to maximum aneurysm diameter ratio (0.15 vs. 0.18; P=0.034), a lower sum of right + left common iliac artery to maximum aneurysm diameter ratio (0.31 vs. 0.39; P=0.028) and a lower infrarenal neck to maximum aneurysm diameter ratio (0.29 vs. 0.35; P=0.039). CONCLUSIONS: Patients with large, uAAA's were younger with less coronary artery disease and presented with lower ratio of right + left common iliac artery to maximum aneurysm diameter as well as a lower ratio of infrarenal neck to maximum aneurysm diameter on CT-imaging compared to patients with rAAA.
BACKGROUND: Endovascular repair of aortic aneurysm (EVAR) is a minimally invasive and effective technique for treating aorto-iliac aneurysms. In recent years, modern technology has allowed the development of increasingly advanced stent grafts, making the procedures less invasive and improving technical success and mortality rates, while reducing mid-and long-term complications. The E-tegra endoprosthesis is an FDA-approved bimodular device consisting of a main body and a contralateral leg. Its flexibility and adaptability allow it to treat difficult vascular anatomies. The aim of this study is to evaluate the results of using the JOTEC E-tegra stent graft system during EVAR in patients with aorto-iliac aneurysms. METHODS: We conducted a retrospective, single-center clinical study involving 62 patients referred to our institution between January 2020 and October 2023 (76.1 +/- 5.3 years; 54 men, eight women). Indications included infrarenal abdominal aortic or aorto-iliac aneurysms (mean diameter 54 +/- 4.3 mm). Of these, 50 patients underwent standard EVAR (all within the IFU) with the JOTEC E-tegra endoprosthesis, eight patients also underwent coil embolization to exclude hypogastric aneurysms, two patients were also treated with the JOTEC E-liac iliac branch due to extension of disease to the iliac bifurcation, four patients had an isolated iliac aneurysm and were therefore treated with the JOTEC E-liac iliac branch only. The primary endpoint of the study was the development of early type I and type III endoleaks. The secondary endpoints were the occurrence of iliac branch occlusion and the development of late type II endoleaks. RESULTS: All procedures were completed successfully. No deaths nor need for surgical conversion were reported. There were no type I ELs. The rate of type IIIa EL was 1.6% (1 of 62 patients was further treated for disconnection of the iliac branch from the main body). Only three patients had a type II EL with a significant (>5 mm) increase in the aneurysmal sac and required embolization. Only one patient presented with iliac branch occlusion requiring reintervention. The mean follow-up was 18 months. CONCLUSIONS: The use of JOTEC E-tegra stent grafts for endovascular exclusion of aorto-iliac aneurysms showed good results in terms of technical success with low rates of major complications in a small cohort of patients. Further studies and longer follow-up are needed to confirm these promising results.
BACKGROUND: Coronary artery disease (CAD) can be revealed in many patients with an abdominal aortic aneurysm (AAA). Aim of this study was to evaluate a possible relationship between aneurysm diameter and incidence of CAD in patients scheduled for AAA repair. METHODS: A retrospective, observational, cohort study on a series of 139 patients with no previous myocardial infarction or any coronary revascularization procedures, undergoing preoperative coronary angiography before elective AAA repair (January 2013 to December 2023). According to aneurysm diameter, the population study was classified in eight groups: Group 1 (AAA <= 40), Group 2 (4070). The incidence of CAD and the need of coronary revascularization was determined for each group. RESULTS: CAD was revealed in 78 patients (56.1%), most of them (N.=66, 47.5%) requiring coronary artery revascularization. The incidence of CAD increased in the eight groups from 30.7% in Group 1 (AAA <= 40) to 75% in Group 8 (AAA>70), showing a linear progression according to the aneurysm diameter. Similarly, the need of coronary revascularization increased from 15.3% in Group 1 (AAA <= 40) to 75% in Group 8 (AAA>70). CONCLUSIONS: The present study seems to confirm a direct relationship between aneurysm diameter and incidence of CAD, showing a progressive severity of coronary disease as the diameter of the aneurysm increases. This data suggests to properly consider the coronary risk in most patients with small and large aneurysms.
BACKGROUND: Visceral artery aneurysm (VAA) is a ballooning of a portion of the splenic, renal, hepatic or mesenteric arteries. Although there are various options for treating VAAs, recently, coil embolization has become the most commonly used procedure. However, the endovascular technique remains challenging and not considered as suitable option in patients with tortuous arterial anatomy. METHODS: We report five cases of visceral aneurysms in adult patients presenting with challenging anatomies, all treated with embolization through the Prestige Coil System (Balt, Montmorency, France). RESULTS: In our clinical practice, the Prestige Coil System overcomes the limitations of the traditional endovascular devices, above all, the recanalization of the target aneurismatic vessels. The absence of fibers allows the coils to be softer than fibered coils, achieving a high packing density within the target vascular space, preventing recanalization. Another limitation overcome by the use of Prestige Plus coils is the lower tendency to cause ischemia of the target organ, thanks to their structural features. CONCLUSIONS: Our preliminary observations prove Prestige Coil System to be a reliable, safe and effective tool for endovascular embolization treatment even in cases of tortuous anatomy and challenging VAA exclusion.
BACKGROUND: The preliminary outcomes of the e-Tegra Endograft Italian Registry (TIGRE) confirmed safety and effectiveness of this new-generation device in treating aneurysms with standard and hostile anatomy on the short-term. However, the specific behavior of E-Tegra in aneurysms with different levels of anatomic hostility has not been assessed yet. The aim of this study was to analyze the latest data from the Registry, focusing on the endograft behavior in treating abdominal aortic aneurysms (AAAs) with hostile proximal and distal anatomy. METHODS: The latest available follow-up data of the Registry were analyzed, taking as primary endpoints freedom from aortic-related mortality, any type of postoperative complications and reinterventions at two years. The secondary endpoint was AAA shrinkage, defined as reduction >10 mm during follow-up. Univariate analyses were performed to verify the relation between the outcome measures and four degrees of anatomic hostility. Multivariate analyses were also performed to assess the impact of four covariates: male sex, concomitant iliac aneurysms, presence of >2 pairs of lumbar arteries or a polar renal artery, and urgent/emergent procedure. RESULTS: One hundred forty-four out of 147 patients completed the scheduled follow-up; three patients died for aortic-unrelated causes. Overall complications were 16 (10.88%), in 13 patients: 8 type II endoleaks, 6 iliac limb occlusions and 2 type IB endoleaks. 7 patients (4.76%) underwent reinterventions: 3 type II endoleaks selectively embolized and one treated by open conversion; 2 type IB endoleak, corrected by endovascular relining, and one iliac limb occlusion, revascularized with a cross-over bypass. 106 AAA (72.11%) had a significant aneurysm shrinkage, 35 (23.80%) remained stable and 6 an increase. Univariate analysis found no significant association between any degree of anatomic hostility and the primary and secondary endpoints. Multivariate analysis found a significant association of the number of vessels arising from the aneurysms with complications, but not with reinterventions. CONCLUSIONS: The mid-term outcomes of the Registry confirm optimal safety and effectiveness of the E-Tegra endograft in treating AAAs with hostile and standard anatomy. Univariate and multivariate analyses showed no significant differences in terms of complications or reinterventions based on hostile anatomy levels.
BACKGROUND: The aim of this study was to evaluate the accuracy of non-invasive and prolonged blood pressure monitoring using the AK-TIIA device, in patients with uncomplicated Stanford B Aortic dissection. Secondary objective was to obtain hemodynamic stabilization at a systolic pressure less than 130 mmHg, as recommended by guidelines. METHODS: The monitoring is based on the use of a bracelet CE-marking that analyzes the pulsation of the arteries under the surface of the skin. The accuracy of the values obtained was ascertained in intensive care by comparing them with the invasive pressure at the same time. The patients were subsequently re-evaluated 7-15-30-90 days after discharge in order to make the necessary changes to the antihypertensive therapy and verify their state of health. RESULTS: Ten patients aged between 40 and 65 years were enrolled. The blood pressure values measured with AKTIIA were consistent +/- 10 mmHg with respect to invasive values in 100% of cases. The target blood pressure values were reached in 100% of cases. During the followup period, no new hospitalizations occurred for hypertensive crisis or complications related to acute aortic syndrome. One patient with Marfan Syndrome was subsequently subjected to complex open aortic treatment. The remaining 9 patients are still undergoing periodic follow-up. CONCLUSIONS: The AKTIIA system has proven to be accurate in prolonged blood pressure monitoring of these patients. Following this initial positive experience, we will apply this monitoring more extensively and to more areas of Vascular Surgery.
BACKGROUND: Aortic arch diseases represent a challenge for surgeons, especially in patients already submitted to urgent type A aortic dissection repair. Possible alternatives of treatment are represented by redo-surgery, TEVAR associated with supra-aortic debranching, branched or fenestrated endografts. METHODS: Between September 2023 and December 2024 we treated four patients with custom-made fenestrated Najuta endograft: three patients had residual non-A, non-B aortic dissection after type A aortic dissection urgent repair. One patient had a descending thoracic aorta dissection complicated by voluminous aneurysm. RESULTS: All patients were operated in the hybrid room of our hospital under general anesthesia, using the Najuta fenestrated endograft, recurring to the pull through technique. No one had intraoperative complications. Only one patient presented post-operative heart failure, submitted to coronary artery angioplasty and Covid-19 infection. No endoleaks nor collapse/migration of the endograft were detected at 6-12 months. Traditional TEVAR has the limit of an adequate proximal aortic landing zone and often requires supra-aortic debranching, with risk of perioperative stroke and the limit of bird beak phenomenon. Custom-made fenestrated endografts, such as the Najuta endograft, offers the possibility to extend the endovascular treatment to so challenge diseases, reducing the pulmonary and heart complications and the in-hospital stay, preserving antegrade flow to supra-aortic vessels and offering a proximal landing zone from zone 0 to zone 2. CONCLUSIONS: We presents preliminary results about 4 patients affected by aortic arch diseases treated in our Institute with the custom-made fenestrated Najuta endograft, that are promising and encouraging.
BACKGROUND: The aim of the present subanalysis of the GRADUS study was to evaluate patients uptake and adherence to a free supervised exercise program based on aerobic and resistance exercise training provided to patients with peripheral artery disease (PAD) Rutherford categories 1, 2 or 3. METHODS: All patients with infra-inguinal PAD and intermittent claudication (IC) referred to a single center vascular surgery outpatient clinic from April 2021 to December 2023 were offered a free of charge 12-weeks supervised exercise training (SET) program using the BiocircuitT . Primary outcomes were patients' uptake and adherence to the program. Secondary outcome was the maintenance physical activity six months after the end of the study period. RESULTS: A total of 101 patients were offered the SET program, but just 50 (49.5%) accepted to be enrolled. Thirty-two (64%) of them completed the program and underwent the follow-up evaluation. Five (15.6%) of the patients who completed the 12-weeks training continued supervised training on their charge. Only 2 (7.4%) of the remaining 27 patients referred to practicing regular physical activity in their daily life after the end of the training period, while the other 25 (92.6%) progressively returned to a sedentary life. CONCLUSIONS: SET programs are rarely available and often they are not refundable. Even in the presence of free of charge programs, low uptake and high dropout rates are observed due to patients' lack of motivation, logistics, and social factors. There is a lack of data about the continuation of exercise training after the end of SET programs. (Cite this article as: Pomatto S, Pini R, Lordi R, Di Leo A, Morreale S, Grazzi N, et al. Uptake and adherence to supervised exercise training programs: the GRADUS study experience. Ital J Vasc Endovasc Surg 2025;32:18-22. DOI: 10.23736/S1824-4777.24.01686-3)
