Purpose: The Manta Vascular Closure Device is a novel collagen-based vascular closure device that has been designed specifically for closure of large-bore percutaneous arterial accesses. The aim of this retrospective study is to evaluate the immediate and 30-day outcome of Manta at the completion of endovascular aneurysm repair (EVAR) or thoracic endovascular aortic repair (TEVAR). The hypothesis is that Manta is not inferior in obtaining hemostasis compared with the Perclose ProGlide Suture-Mediated Closure System device. Materials and Methods: We recruited all the percutaneous accesses for (T)EVAR performed from January 2021 to April 2023 by all the Italian Divisions of Vascular Surgery using Manta at the time of data collection (May 2023). The primary outcome is to evaluate the incidence of complications at the puncture site after Manta implantation and at 1 month, and compare this with ProGlide. We applied the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria for observational studies. Results: Overall, 524 consecutive femoral accesses for (T)EVAR procedures were collected: 355 in the Manta cohort and 169 in the ProGlide cohort, respectively. The size of the sheath was 17.2±2.7 Fr for Manta, 15.7±2.3 Fr for ProGlide (p<0.001). No statistically significant differences between the groups regarding age, sex, body mass index, ultrasound-guided access, femoral calcifications, intraoperative, and 30-day complications. Successful arterial closure at groin puncture sites for (T)EVAR using Manta is 90.5% and 93.1% using ProGlide. Freedom for any reintervention for any complication is 95.5% for Manta and 96% for ProGlide. Conclusion: The 2 vascular closure devices have proved to be similar in terms of complications, without any statistically significant difference, although the median size of the sheaths for (T)EVAR was statistically significantly larger when Manta has been used, compared with ProGlide. Clinical Impact Manta® is effective in the hemostasis of the access sites following the completion of (T)EVAR in this multicenter, retrospective, case-control study on 524 percutaneous femoral accesses. Compared to the more popular Proglide®, the average size of the introducers in the Manta® group was significantly larger than in the Proglide® group.

Introduction: Vascular graft infections (VGIs) are challenging and potentially life-threatening complications following femoropopliteal bypasses. The treatments of choice in peripheral VGIs are antimicrobial therapy, surgical excision, and in-situ reconstruction with an autologous superficial vein. An extraanatomical homograft bypass and antimicrobial therapy could be resolutive in patients presenting with recurrent VGIs and unavailable autologous veins.Case Report: We present the case of a 74-year-old Caucasian man with a history of a below-the-knee (BTK) right femoropopliteal bypass using polytetrafluoroethylene (PTFE) for chronic peripheral artery disease (Rutherford Grade 3). He presented at the emergency department with septic arthritis of the right knee involving the previous PTFE femoropopliteal bypass. The graft was excised, and an insitu saphenous vein BTK femoropopliteal bypass was performed. Due to multiple recurrences of graft infection of the proximal anastomosis, an extra-anatomical cryopreserved arterial homograft reconstruction from the external iliac artery to the profunda femoral artery was necessary as a definitive treatment. At three years follow-up the patient is alive, with patency of both vascular reconstructions.Conclusion: Despite aggressive treatment, managing vascular graft infections can be challenging, typically requiring a blend of surgical and medical interventions. Patient-specific surgical approaches, such as graft removal, infected tissue debridement andextra-anatomical reconstruction with biological grafts is crucial. In those patients with unavailable autologous veins, consideration could be given to a cryopreserved homograft due to its resistance against infections.

Objective: Cardiac myxomas (CMs) are the most common primary cardiac tumour in adults. They are a rare cause of peripheral embolisation and may present as acute lower limb ischaemia (ALI). A scoping review was undertaken and a case of ALI due to CM embolisation is presented in this paper. Methods: MEDLINE, Scopus, and Embase were systematically searched for studies reporting data on ALI as a presentation of CM embolisation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was followed. Results: A healthy 26 year old female presented to the emergency department with bilateral ALI. Urgent bilateral aorto-iliac embolectomy and distal embolectomy of the left femoropopliteal axis were performed. The retrieved embolic material exhibited a yellowish appearance and jelly like consistency, and histological analysis provided a diagnosis of a myxomatous embolus. Transoesophageal echocardiography confirmed fi rmed the left atrial origin of a myxomatous tumour, but the residual mass was considered too small for further excision. At a two year clinical follow up, the patient was alive and well without recurrence. Between 1989 and 2023, 59 patients with ALI due to CM embolisation were identified fi ed in the literature. An in hospital mortality rate of 12.1% (n n = 7) was reported, while the in hospital complication and re-intervention rates were 34.5% (n n = 20) and 27.6% (n n = 16), respectively. No post-discharge deaths, complications, or re-interventions were reported; fasciotomies were the most reported (n n = 10). Post-discharge follow up was reported in 22 (37.3%) patients. Mean follow up was 18.0 +/- 18.8 months (range 1-120),- 120), and 86.4% of patients (n n = 19) were alive and well at last follow up. Conclusion: This review and the associated case report underline that CM embolisation should be considered in healthy young patients presenting with cryptogenic ALI. Early transoesophageal echocardiography and histological analysis of the retrieved embolus are recommended to minimise misdiagnosis in these populations.

The association between air pollution and cardiovascular diseases (CVDs) is well-established. However, only a few studies focused on the relationship between air pollution and peripheral arterial disease (PAD) were reported in the literature. Notwithstanding that PAD is one of the essential presentations of CVD and a predictor of CVD-related mortality, its incidence is rising in the general population, and it affects the quality of life because of the evolution to critical limb ischemia and the risk of limb amputation. The aim of this study is to estimate the association between long-term exposure to air pollutants and the incidence of PAD in the Rome population-based cohort in the period 2011-2019. We excluded prevalent cases in the 10 years before enrolment (October 9, 2011) from the population at risk. Using the Health Information Systems, we defined incident cases as subjects with at least a hospital discharge for PAD, a surgery (evaluated through ICD codes) or a drug prescription from 2011-2019. We assigned an estimated 1-year average of PM2.5, NO2, and black carbon (BC) from the ELAPSE Europe-wide hybrid land-use regression (LUR) models at 100 m2 spatial resolution (for 2010) to the participants based on their geocoded addresses at baseline. We applied Cox regression models adjusted for individual and area-level covariates. The estimates were expressed as hazard ratios (HRs) and 95% confidence intervals (95% CIs) per pollutant-specific interquartile range (IQR) increase. We also analyzed effect modification by socio-demographic variables and explored concentration-response curves using a natural spline with 3 degrees of freedom. Starting from a population at risk made of 1,719,475 subjects aged 30 years or above, a total of 14,629 cases were defined as incidents for PAD. An IQR (1.13 μg/m3) increase in PM2.5 was associated with a HR of 1.011 (95% CI, 0.988-1.034), and positive results were also obtained for NO2 ([IQR, 7.86 μg/m3] HR, 1.022; 95% CI, 0.998-1.048) and BC ([IQR, 0.39 μg/m3] HR, 1.020; 95% CI, 0.994-1.047). Effect modification analysis underlines stronger associations when considering subjects in the 55-69 age class or with anintermediate deprivation index. The dose-response curve for NO2 shows a linear shape, with higher risks at high concentration levels. These results suggest that long-term exposure to PM2.5, NO2, and BC is associated with an increased incidence of PAD, and subjects with intermediate deprivation index and aged between 55 and 69 years are more at risk.

INTRODUCTION:The association between air pollution and cardiovascular diseases is well established. However, fewer studies focused on the relationship between air pollution and peripheral artery disease (PAD), notwithstanding that not only it is a predictor of CVD mortality but also that incidence is globally rising, particularly in low-middle income countries. OBJECTIVES:The aim of this study is to estimate the association between long-term exposure to air pollutants and the incidence of PAD in the Rome Longitudinal Study (RLS) during 2011-2019. METHODS:Using the Health Information Systems, we identified the first episodes of hospitalizations with discharge diagnosis for PAD (ICD-9 codes: 440.20-24; 444.0; 444.21; 444.22; 444.81; 447.1), lower limb vascular surgery (ICD-9 codes: 38.18; 39.29; 39.50; 39.90; 84.11; 84.12; 84.15; 84.17) or drug prescription (ATC code: B01AC23) in the period 2011-2019. In order to focus on incidence, we excluded from the population at risk prevalent cases based on hospital discharges in the 10 years before enrolment (October 9th, 2011). We assigned to the participants one-year average exposure to PM2.5, NO2 and black carbon (BC) from the ELAPSE Europe-wide hybrid land-use regression (LUR) models at 100 m2 spatial resolution on the basis of their baseline geocoded addresses. We also applied Cox regression models adjusted for individual and area-level covariates. The estimates were expressed as hazard ratios (HR) and 95 % confidence intervals (95 % CI) per pollutant-specific interquartile range (IQR) increase. We also analyzed any effect modification by socio-demographic and comorbidity variables and explored concentration-response curves using natural splines with 3 degrees of freedom. RESULTS:Starting from a population at risk of 1,719,475 subjects aged 30 years or above, a total of 14,629 incident cases were identified. An IQR (1.13 μg/m3) increase in PM2.5 was positively associated with a HR of 1.011 (95 % CI: 0.988, 1.034). Positive associations were also obtained for NO2 ([IQR 7.86 μg/m3] HR: 1.022 (95 % CI: 0.998, 1.048)) and black carbon ([IQR 0.39 x10-5/m] HR: 1.020 (95 % CI: 0.994, 1.047)). Effect modification analysis showed stronger associations when considering males and individuals in the 55-69 age class. Concentration-response curve for NO2 showed a linear shape, with increases of risk already at low concentrations. CONCLUSIONS:Long-term exposure to PM2.5, NO2 and BC is associated with an increased incidence of PAD, and male subjects and individuals aged between 55-69 years were at greater risk.

Atherosclerosis is the main cause of mortality globally, being at the basis of most cardiovascular diseases. It is a multifactorial disease, arising from complex interactions comprising changes in lipid metabolism, inflammation and oxidative stress. These factors contribute to endothelial damage and dysfunction, the accumulation of immune cells and smooth muscle cells in the intima, ultimately leading to the formation of atherosclerotic plaques, which restricts blood flow through the vessels. Much progress has been made in the last decades in debunking the underlying mechanisms of atherosclerosis development, especially concerning the evaluation and prediction of plaque stability and the understanding of the roles played by each of the involved cell types. As yet, mechanisms that drive plaque development toward specific 'vulnerable' phenotypes remain undiscovered. Based on recent advancements in RNA therapeutics, this review aims to illustrate a comprehensive overview of miRNAs relevant to various aspects of atherosclerosis and emphasizes their theranostic potential, highlighting their dual role as both drug targets and biomarkers.

The Society for Vascular Surgery elected an international, multidisciplinary panel of experts to review the literature and provide evidence-based suggestions for coordinated perioperative care for patients undergoing major limb amputation due to nonreconstructable chronic limb-threatening ischemia. Structured around the Enhanced Recovery After Surgery (ERAS) core elements, 33 suggestions were made and organized into preadmission, preoperative, intraoperative, and postoperative sections. (JVS-Vascular Insights 2024;2:100156.)

The Society for Vascular Surgery and the Enhanced Recovery After Surgery (ERAS) Society formally collaborated and elected an international, multi-disciplinary panel of experts to review the literature and provide evidence-based suggestions for coordinated perioperative care for patients undergoing infrainguinal bypass surgery for peripheral artery disease. Structured around the ERAS core elements, 26 suggestions were made and organized into preadmission, preoperative, intraoperative, and postoperative sections.

Objective: Carotid body tumour (CBT) is the most common tumour in the family of head and neck paragangliomas, making up approximately 60 – 70% of them. They are typically diagnosed in the fourth to fifth decades with a female predilection. CBT present as soft tissue density on non-contrast CT and complete transfemoral angiography is considered the "gold standard" when establishing diagnosis of CBT with a 100% accuracy. Primary treatment consists of surgical resection to reduce tumour mass size and to decrease surgical risks associated with resection of these highly vascularised tumours, pre-operative embolisation of CBT has been proposed in the literature with varying results. There are no universal guidelines regarding pre-operative CBT embolisation and performance is mostly guided by preference of the surgeon and tumour size. The decision to perform pre-operative embolisation, usually 24 – 48 hours before surgery (though timing of surgical CBT resection following prior embolisation varies between 1 and 14 days post embolisation), is largely dependent on tumour size. Embolisation can be done via a transfemoral arterial route, or percutaneous (direct intralesional) route. The aim of this study was to investigate the efficacy of pre-operative embolisation prior to surgical CBT resection regarding intra-operative blood loss, operative time, length of hospital stay, and peri-operative complications (e.g., transient or ischaemic cerebrovascular event, vascular injury, or cranial nerve injury).

EDITORIAL article Front. Surg., 13 October 2023Sec. Vascular Surgery Volume 10 - 2023 | https://doi.org/10.3389/fsurg.2023.1293094

A 74-year-old woman presented with mild, asymptomatic chronic venous disease, C2aEpAsPr according to the Clinical (C), Etiological (E), Anatomical (A), and Pathophysiological (P) classification, mostly in the left lower limb. Her medical history revealed neither previous venous procedures nor recent lower extremity traumas, and no previous episodes of deep or superficial venous thrombosis were reported. The patient provided written informed consent for the report of her case details and imaging studies. An ultrasound examination showed no venous disease on the right and no signs of thrombosis on either side. On the left, a great saphenous vein dissection (GSV-D) was found (A-D/Cover; Supplementary Video, online only). The GSV-D seemed to start at the upper third of the thigh with an entry tear (A, asterisk), creating a brief "retrograde" dissection segment and two lumens (B), continuing down for ∼15 cm, and finishing with a saphenous varicose thigh collateral vessel. With a Valsalva maneuver and calf squeezing, both lumens appeared patent (Supplementary Video, online only). It was challenging to highlight the true and false lumens, although the upper/superficial lumen appeared to have no tunica intima (C, pink), indicating a possible dissection point.

Autologous vein and artery remains the first choice for vascular grafting procedures in small-diameter vessels such as coronary and lower limb districts. Unfortunately, these vessels are often found to be unsuitable in atherosclerotic patients due to the presence of calcifications or to insufficient size. Synthetic grafts composed of materials such as expanded polytetrafluoroethylene (ePTFE) are frequently employed as second choice, because of their widespread availability and success in the reconstruction of larger arteries. However, ePTFE grafts with small diameter are plagued by poor patency rates due to surface thrombogenicity and intimal hyperplasia, caused by the bioinertness of the synthetic material and aggravated by low flow conditions. Several bioresorbable and biodegradable polymers have been developed and tested to exploit such issues for their potential stimulation to endothelialization and cell infiltration. Among these, silk fibroin (SF) has shown promising pre-clinical results as material for small-diameter vascular grafts (SDVGs) because of its favorable mechanical and biological properties. A putative advantage in graft infection in comparison with synthetic materials is plausible, although it remains to be demonstrated. Our literature review will focus on the performance of SF-SDVGs in vivo, as evaluated by studies performing vascular anastomosis and interposition procedures, within small and large animal models and different arterial districts. Efficiency under conditions that more accurately mime the human body will provide encouraging evidence towards future clinical applications.

A 37-year-old woman had presented to us for suspicion of a vascular malformation of her leg without any sign of ectasia of the superficial venous vessels or leg pain. She had had two pregnancies, after which apparently varicose veins of the leg had appeared. At 8 months before our evaluation, she had undergone stripping of the great saphenous vein. During surgery, she had experienced massive bleeding from the leg and had required blood transfusions. The patient provided written informed consent for the report of her case details and imaging studies. CorrectionJournal of Vascular Surgery: Venous and Lymphatic DisordersVol. 11Issue 4PreviewIn the May 2023 issue of the Journal of Vascular Surgery: Venous and Lymphatic Disorders, the article by Settembrini et al (Settembrini AM, Bissacco D, Settembrini P. Atypical presentation of Servelle-Martorell syndrome. J Vasc Surg Venous Lymphat Disord 2023;11:657-8) contained an error in the title of this paper. The correct word is “Atypical” and not “A typical” as originally published. Full-Text PDF

Middle-aged adults can start to be affected by some arterial diseases (ADs), such as abdominal aortic or popliteal artery aneurysms, lower extremity arterial disease, internal carotid, or renal artery or subclavian artery stenosis. These vasculopathies are often asymptomatic or paucisymptomatic before manifesting themselves with dramatic complications. Therefore, early detection of ADs is fundamental to reduce the risk of major adverse cardiovascular and limb events. Furthermore, ADs carry a high correlation with silent coronary artery disease (CAD). This study focuses on the most common ADs, in the attempt to summarize some key points which should selectively drive screening. Since the human and economic possibilities to instrumentally screen wide populations is not evident, deep knowledge of semeiotics and careful anamnesis must play a central role in our daily activity as physicians. The presence of some risk factors for atherosclerosis, or an already known history of CAD, can raise the clinical suspicion of ADs after a careful clinical history and a deep physical examination. The clinical suspicion must then be confirmed by a first-level ultrasound investigation and, if so, adequate treatments can be adopted to prevent dreadful complications.

The objective of this study is to evaluate the effect of preoperative embolization on carotid body tumor resection. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, Scopus, and Web of Science were screened for studies published between 2010 and 2022. Primary outcomes investigated were intraoperative blood loss, operative time, length of hospital stay, and perioperative complications such as transient ischemic attack (TIA)/stroke, vascular injury, and cranial nerve injury (CNI). A random effects model was used in cases where study heterogeneity was high. Overall, 25 studies were included in the systematic review, involving 1649 patients: 23 studies were eligible for meta-analysis. The incidence of vascular injury was significantly less in the preoperative embolization group (odds ratio (OR) = 0.60; 95% CI: 0.42-0.84; P = .003). There was no statistically significant difference between the two groups regarding intraoperative blood loss, operative time, length of hospital stay, incidence of TIA/stroke, and CNI. Subgroup analyses did not demonstrate significant difference between Shamblin I, II, and III subgroups regarding operative time. This meta-analysis found preoperative embolization to be significantly beneficial in reducing incidence of vascular injury.