This case presents the novel use of a peripheral self-expanding nitinol stent to treat recurrent coronary stent fractures (SFs) in a saphenous vein graft (SVG) previously treated with 2 layers of drug-eluting stents in an 84-year-old man. Angiographic follow-up at 16 months showed an intact stent. SF is a rare complication, in this case likely owing to shear mechanical forces between the SVG and the ascending aorta, in addition to the extrinsic compression of vessel calcification. Independent of the mechanisms, if the first metallic (ie, stainless steel or cobalt-chromium) balloon-expandable coronary stent does fracture, the second one is likely to fail as well. The implantation of a peripheral self-expanding nitinol stents in this patient overcame those mechanical forces. This may represent a novel approach to treat coronary SF, especially in the SVG. Additionally, this case highlights the importance of intravascular imaging in assessing lesion characteristics and guiding stent implantation, potentially preventing SF.

We discuss four topics among the angiology and hemostasis studies of importance in 2023. The BASIL-2 study provides new data for the management of chronic limb-threatening ischemia by comparing surgical and endovascular treatment. The new classification of antiphospholipid antibody (aPL) syndrome integrates new clinical elements and gives a different weight among the isotype and titer of aPL. Concizumab, an antibody targeting the tissue factor pathway inhibitor, broadens the therapeutic arsenal for hemophilia A and B as evidenced by the results of the EXPLORER 7 study. The PREVENT-CLOT and CASTING study focus on the prevention of thrombosis after trauma, by testing the role of aspirin or the lack of thromboprophylaxis, respectively.

We discuss four topics among the angiology and hemostasis studies of importance in 2023. The BASIL-2 study provides new data for the management of chronic limb-threatening ischemia by comparing surgical and endovascular treatment. The new classification of antiphospholipid antibody (aPL) syndrome integrates new clinical elements and gives a different weight among the isotype and titer of aPL. Concizumab, an antibody targeting the tissue factor pathway inhibitor, broadens the therapeutic arsenal for hemophilia A and B as evidenced by the results of the EXPLORER 7 study. The PREVENT-CLOT and CASTING study focus on the prevention of thrombosis after trauma, by testing the role of aspirin or the lack of thromboprophylaxis, respectively.

Systemic thrombolysis is the first-line treatment for patients with high-risk pulmonary embolism or with haemodynamic deterioration on anticoagulation alone; however, it is associated with a high bleeding risk. Mechanical thrombectomy may significantly reduce right ventricular dysfunction without exposing the patient to systemic bleeding complications. No randomized trials comparing the two treatments are available to date. Therefore, the use of mechanical thrombectomy remains controversial. The aim of this article is to provide an update on mechanical thrombectomy, by describing its mechanism of action, reviewing the literature and proposing a therapeutic algorithm.

BACKGROUND:Chronic venous insufficiency (CVI) and diabetes mellitus (DM) pose significant burdens to patients and healthcare systems. While the two diseases share a number of commonalities in risk factors and pathophysiology, they are often assessed and managed separately. This can lead to a worsening of comorbidities and limitations in a patient's quality of life. This project aims to develop recommendations to enhance the identification and treatment of patients with concomitant CVI and DM.METHODS:Using a modified Delphi method, a panel of experts developed 38 Likert Scale and two multiple choice questions across six key themes. These were used to form an online survey which was disseminated through a convenience sampling approach to CVI and DM healthcare professionals across Europe, Central America, South America, and the Middle East. The threshold for consensus was set at ≥75%.RESULTS:A total of 238 responses were received. 27/38 statements attained >90% agreement, nine of 38 attained between 75-90%, and two failed to meet the threshold (<75%). The awareness around the impact of the two diseases was high, but a gap was highlighted in the identification of patients with concomitant CVI and DM.CONCLUSIONS:The high level of agreement shows that healthcare professionals are aware of the gaps in identification and treatment of patients with concomitant CVI and DM, and of the need to approach this as a combined therapy area. An algorithm is proposed to help the identification of at-risk patients and to provide recommendations on the management of patients with concomitant disease.

Introduction: Diabetes mellitus (DM) and Chronic Venous Insufficiency (CVI) are significant burden in patient daily life. While the two diseases share common risk factors and pathophysiology, they are often assessed and managed as separate conditions. Aim: To develop recommendations for the identification and treatment of patients with concomitant DM and CVI. Methods: Using a modified Delphi method, a panel of experts developed 38 statements and 2 multiple choice questions. These were used to form an online survey which was disseminated through vascular and diabetes specialists across Europe, Central America, South America, and Middle East. Respondents indicated their level of agreement with each statement. The threshold for consensus was set as ≥75% of agreement. Results: A total of 238 responses were received. Most of the statements (27/38) reached >90% agreement, 9/38 attained between 75-90% agreement, and 2 failed to meet the threshold. The awareness around the impact of the two diseases was high and a gap was highlighted in the identification of patients suffering from concomitant DM and CVI. Seventy-seven (77%) respondents consider overweight (BMI >30) and leg oedema as signs for assessment of the presence of DM and diabetic microvascular complications (DmVC) in patients with CVI, while 63% agreed that three parameters (skin changes, leg burden and oedema) would be required to trigger investigation for coexistent CVI in patients with DM. Treatment of patients with DmVC and CVI should be accomplished with a combination approach, including lifestyle change, non-medical and pharmacological treatments. Venoactive drugs indicated in both DmVC and CVI were recognized as treatment option in this patient population. Conclusion: These results raised the need to consider DM and CVI as a combined therapy area. As outcome, an algorithm is proposed to help the identification of at-risk patients and to provide recommendation on the management of patients with concomitant diseases. Disclosure G.Gastaldi: Advisory Panel; Ascensia Diabetes Care, Insulet Corporation, Novo Nordisk, Lilly, Other Relationship; Abbott Diabetes, AlfaSigma, Research Support; Ypsomed AG, Speaker's Bureau; Dexcom, Inc., Medtronic, Roche Diabetes Care. A.K.Bozkurt: Advisory Panel; OM PHARMA. M.Van rijn: None. E.Bouskela: None. F.Glauser: Consultant; Servier Laboratories. E.Rabe: Consultant; Sigvaris Int., EUROCOM, Mylan, Speaker's Bureau; OM Pharma. A.Mansilha: None. H.Haller: None. J.Rosas-saucedo: None. Funding OM Pharma Ltd.

The abstract book of the 21st Congress of Turkish Society for Vascular and Endovascular Surgery, 24th Congress of Asian Society for Vascular Surgery (ASVS) 18th Asian Venous Forum, 12th Congress of Turkish Society of Phlebology

Mechanical thromboprophylaxis is an important part of hospital prevention of venous thromboembolism. It comprises graduated compression stockings and intermittent pneumatic compression. In this review, we summarize its physiological effect on venous hemodynamics, recent clinical studies that offer contrasting results, and discuss its utility in contemporary clinical practice. Mechanical thromboprophylaxis is currently suggested in patients at high thrombotic and hemorrhagic risk, favoring intermittent pneumatic compression, but does not seem useful in addition to pharmacological thromboprophylaxis.La thromboprophylaxie mécanique est une composante importante de la prévention hospitalière de la maladie thromboembolique veineuse. Elle comprend la compression graduée par bas ou chaussettes et la compression pneumatique intermittente (CPIn). Dans cet article, nous résumons son effet veineux physiologique et revenons sur les études cliniques récentes qui offrent des résultats contrastés. Enfin, nous discutons de sa place en clinique contemporaine. La thromboprophylaxie mécanique est actuellement suggérée chez des patients à hauts risques thrombotique et hémorragique, en privilégiant la compression pneumatique intermittente, mais ne semble pas utile en plus d’une thromboprophylaxie pharmacologique.

Several topics among those that marked the year 2021 are discussed in this article. Factor XI represents an original target for new anticoagulants, and the first results of a phase 2 study of prophylaxis after knee replacement surgery are very promising. A real-life study confirms that the pulmonary embolism exclusion strategy using an age-adjusted D-dimer cut-off is safe and increases the diagnostic yield. Several studies of tranexamic acid provide further insight into the indications for its use and highlight some potential risks. Finally, the concerns regarding a potential risk of increased mortality related to paclitaxel-eluting technology used in lower limb revascularisation are questioned by the results of the latest trials.

Mechanical thromboprophylaxis is an important part of hospital prevention of venous thromboembolism. It comprises graduated compression stockings and intermittent pneumatic compression. In this review, we summarize its physiological effect on venous hemodynamics, recent clinical studies that offer contrasting results, and discuss its utility in contemporary clinical practice. Mechanical thromboprophylaxis is currently suggested in patients at high thrombotic and hemorrhagic risk, favoring intermittent pneumatic compression, but does not seem useful in addition to pharmacological thromboprophylaxis.

Pregnancy-associated high-risk pulmonary embolism (PE) is among the most frequent causes of maternal mortality in the Western world, by causing hemodynamic instability and circulatory failure through a large thrombotic pulmonary obstruction. The very challenging management of these dramatic situations comprises the need to quickly select a therapy of pulmonary reperfusion or hemodynamic replacement, while taking into account both maternal and fetal risks. In this review, we discuss the role of risk stratification in pregnancyassociated PE and the available evidence to support the use of thrombolysis, catheter-directed thrombectomy/ thrombolysis, surgical embolectomy and extracorporeal membrane oxygenation. Despite the lack of comparative studies and solid evidence, most reported cases of high-risk pregnancy-associated PE have been treated with thrombolysis, with high maternal and fetal survivals, and thrombolysis is suggested by guidelines in lifethreatening PE. For women in the peripartum and early post-partum period, non-fibrinolytic treatments may be preferred as a first-line treatment, if available, because of the particularly high bleeding risk. In all cases, pregnancy-associated high-risk PE requires a multidisciplinary approach involving PE response teams and obstetricians.

Pregnancy-associated high-risk pulmonary embolism (PE) is among the most frequent causes of maternal mortality in the Western world, by causing hemodynamic instability and circulatory failure through a large thrombotic pulmonary obstruction. The very challenging management of these dramatic situations comprises the need to quickly select a therapy of pulmonary reperfusion or hemodynamic replacement, while taking into account both maternal and fetal risks. In this review, we discuss the role of risk stratification in pregnancy-associated PE and the available evidence to support the use of thrombolysis, catheter-directed thrombectomy/thrombolysis, surgical embolectomy and extracorporeal membrane oxygenation. Despite the lack of comparative studies and solid evidence, most reported cases of high-risk pregnancy-associated PE have been treated with thrombolysis, with high maternal and fetal survivals, and thrombolysis is suggested by guidelines in life-threatening PE. For women in the peripartum and early post-partum period, non-fibrinolytic treatments may be preferred as a first-line treatment, if available, because of the particularly high bleeding risk. In all cases, pregnancy-associated high-risk PE requires a multidisciplinary approach involving PE response teams and obstetricians.

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially. Successful percutaneous mechanical thrombectomy of an Impella CP-related femoral artery thrombosis Sophie Degrauwe, Juan F. Iglesias, Frédéric Glauser, Marco Roffi

Lower extremities arterial disease (LEAD) is the third most common manifestation of atherosclerosis. The number of cardiovascular events in this population is similar to that of coronary artery disease. Management consists mainly of strict control of cardiovascular risk factors, optimal pharmacological treatment and supervised exercise training. Supervised exercise training is superior to other exercise modalities in terms of increased walking time, maximum walking distance, pain-free walking distance and quality of life scores. In association with revascularization, the benefits are enhanced. In Switzerland, federal programs have been created on this basis and exist in many cities. They are little known and yet essential.

Arteriopathy of the lower limbs is a frequent pathology. In the face of persistent invalidating claudication or critical ischemia, surgical or endovascular revascularization treatment is necessary. The aim of this article is to review the evolution of the endovascular therapeutic arsenal of the femoropopliteal segment, to present the new endovascular devices available and to give current recommendations for post-interventional antithrombotic treatment.