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Background The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded on October 1, 2018, to enhance cooperation among vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic arteriopathy has been selected as the very first topic to be investigated by the federation. Methods MeFAVS members were asked to reply to a questionnaire on the management of diabetic ischemic foot. Results were collected and analyzed statistically. The questionnaire consisted of 15 multiple choice answers regarding diabetic foot (DF) diagnosis and treatment. The questionnaire was submitted to 21 centers on April 20, 2019. Results Response rate was 62%. The survey revealed that vascular surgeons, diabetologists, and wound care nurses made-up the core of the diabetic teams present in 76.9%, 69.3%, and 92.3% of the centers, respectively. Diabetic teams were most often led by vascular surgeons (53.8%) and diabetologists (42.2%), but only in 7.9% of cases by nurses. Duplex ultrasonography and computed tomographic angiography were the most commonly available tools used to assess diabetic peripheral arterial disease (PAD). Surgical wound care was undertaken by vascular surgeons in the majority of cases, and only in 46.2% of the cases to orthopedic or plastic surgeons, while nonsurgical wound care was handled by specialized nurses (76.6%) and diabetologists (53.8%). First-line revascularization was preferred over conservative treatment (61.5% vs 53.8%) and endovascular strategy (45.3%) over open (33.7%) or hybrid (21.0%) surgery. Vascular surgeons and interventional radiologists were found to be the most common performers of endovascular revascularization (92.3% and 53.8%, respectively). Amputations had an overall rate of 16.6% (range 4–30%) and a mean reintervention rate of 22.5%, and were usually performed by vascular surgeons for both minor and major interventions (84.6%) followed by orthopedic surgeons (15.4% minor and 30.8% major). The availability of a DF clinic (84.6%) and endovascular (53.8%) and open surgery (46.2%) capabilities were considered fundamental to reduce amputation rates. Conclusions Especially since the introduction and spreading of new endovascular techniques for the treatment of DF, it is a common consensus amongst vascular surgeons that a standardized approach to the discipline is necessary in order to improve outcomes such as amputation-free survival and mortality and it is with this perspective and purpose that transnational cooperation amongst vascular professionals and residents in training are aiming for greater proficiency in endovascular and open surgery.

Objectives The Amplatzer Vascular Plug (AVP) is a vascular occlusion device designed to provide optimal embolization in several fields of the endovascular surgery. A full literature review was conducted to analyze AVPs in comparison with coils for the prevention of endoleaks during endovascular abdominal aortic aneurysm repair. Methods A systematic review was designed under PRISMA statement guidelines for systematic reviews and meta-analyses. The results were updated with a subsequent electronic search using Medline and Scopus databases up to December 2019. Results Eighteen articles making this comparison were found. In 79.7% of the cases, the target vessel was the internal iliac artery; in 1.6%, the common iliac artery; and in 16.7%, the inferior mesenteric artery. Risk of complications (buttock claudication, groin hematoma, endoleaks, and erectile dysfunction) after AVP was low. A cost comparison revealed that the mean cost for coils was around US$2262, while the average cost for the AVP was US$310. Conclusions The AVP is an effective and safe device for occluding peripheral vessels, proved to have lower complications rates. Compared with coil embolization, the AVP technique is potentially associated with lower procedural costs.

Ancient Schwannoma is a type of peripheral neurogenic tumor formed by the Schwann cells presenting mainly as a benign and asymptomatic lesion. The neurilemmoma tumor appears in different sites and, in cases of cervical location, can mimic a carotid body tumor. Herein we describe a clinical case of a 51-year-old woman with latero-cervical swelling. A contrast-enhanced computed tomography scan revealed a classical wineglass image mimicking a carotid body tumor. During surgery the tumor appeared connected to the cervical sympathetic trunk without carotid involvement. The histological exam confirmed the nature of the mass which consisted of an ancient schwannoma. A subsequent systematic review of the literature on ancient schwannoma incidence and treatment confirms it being a benign and rare lesion primarily treatable with open surgery. KEY WORDS: Ancient Schwannoma, Carotid body tumor, Carotid artery, Vascular surgery.L’ancient schwannoma è un tumore che origina dalle cellule di Schwann presenti nella guaina dei nervi periferici. Si presenta solitamente come lesione benigna ed asintomatica. Questo tipo di tumore può essere riscontrato in differenti sedi, e nei casi in cui si localizza a livello cervicale, tale lesione può apparire come un tumore del glomo carotideo. Descriviamo in questo articolo un caso clinico di una donna di 51 anni con una tumefazione latero-cervicale. La TC preoperatoria mostrava la classica immagine “wineglass”, a calice, tipica del tumore del glomo carotideo con divaricazione della biforcazione carotidea. Durante l’intervento chirurgico la lesione sembrava adesa alla catena cervicale del simpatico senza coinvolgimento dei vasi carotidei. L’esame istologico ha confermato che tale massa era uno schwannoma del tipo “ancient”. Infine abbiamo effettuato una revisione sistematica della letteratura sull’incidenza e il trattamento dell’ancient schwannoma, confermando quest’ultima come una lesione benigna e rara, trattabile preferibilmente con la chirurgia aperta.

BACKGROUND: Endovascular interventions are increasing in the treatment of long femoro-popliteal lesions. Standard laser-cut nitinol stents offer an acceptable midterm patency rate but still controversial in the longterm period, particularly in the setting of complex lesions. The Supera interwoven nitinol stent is designed to have superior radial strength and fractures resistance. METHODS: From January 2016 to July 2018, 32 patients (19 M / 13 F) with femoro-popliteal occlusion were treated at two italian vascular surgery centers. The majority of patients (24/32) were affected by critical limb ischemia (class IV-VI Rutherford). RESULTS: Thirty-eight Supera stents were successfully deployed. The mean length of the femoro-popliteal lesions was 102 ± 25 mm. The primary latency at 30 days was 100% without any stent fracture. During a mean follow-up of 19 months, two patients experienced an intrastent restenosis treated with a drug eluting balloon. In four cases occurred an occlusion of the stent: only two patients were successfully treated with intra-arterial trombolysis. The primary patency rate was 83% at nineteen months. One major amputation was necessary thus determining an overall limb salvage rate of 97%. CONCLUSIONS: The use by vascular surgeons of this relatively new device is feasible in the treatment of long femoro-popliteal lesions. Our results in this small population of diseased patients not suitable for surgery are promising.

Purpose Generally the steal syndrome occurs in proximal arterial-venous fistulas and only exceptionally with distal vascular access because of the high number of arteries supplying the hand. We describe a rare case of steal syndrome of a proximalized distal radio-cephalic fistula stealing from both the radial and ulnar artery through the palmar arch. Methods An 86 year old man was admitted because of a cyanotic, swollen left hand with trophic lesions at the third finger. He had a latero-terminal radio-cephalic fistula performed in 2006 with subsequent proximalization performed four years later after failure of the first one. Duplex ultrasound examination showed a high flow within the fistula (2080 mL/min) and a retrograde perfusion of the radial artery from the ulnar artery through the palmar arch and an angiography excluded stenosis along the radial artery. Results We treated the steal syndrome through a plication technique that was performed with careful flow variations measurement, under duplex evaluation, during the surgical procedure. That procedure was effective to maintain the fistula flow and obtain the symptoms relief. The patient was evaluated the day after the intervention and after 10 weeks. The clinical examination highlighted the resolution of hand ischemia. The Duplex Ultrasound examination showed a lower flow within the fistula (1060 mL/min) and a retrograde perfusion of the radial artery from the ulnar artery through the palmar arch with a three-phase flow. Dialysis access from the fistula was never interrupted from immediately after surgery to the present date. Conclusions Plication is an effective technique for treatment of steal syndrome requiring a short operative time and it is related to satisfying post-operative results

Background The influence of acute cerebral ischemic lesions (CILs) on the revascularization outcome of symptomatic carotid stenosis has been scarcely investigated in the literature. This study evaluated the effect of CILs and their volume on the results of carotid revascularization in symptomatic patients. Methods All patients with symptomatic carotid artery stenosis who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) between 2005 and 2014 were considered. CILs ipsilateral to the stenosis were identified in the preoperative cerebral computed tomography. The volume was quantified in mm 3 and correlated with 30-day rates of stroke and stroke/death by χ 2 , multivariate analysis, Pearson correlation, and receiver operating characteristic curves. Results A total of 489 symptomatic patients were treated by CEA (327 [67%]) or CAS (162 [33%]), 186 (38%) ≤2 weeks and 303 (62%) >2 weeks from symptom onset. CEA and CAS patients had statistically similar rates of stroke (3.3% vs 5.5%; P = .27) and stroke/death (3.8% vs 5.9%; P = .22). CILs were identified in 251 patients (53%) and were associated with similar stroke and stroke/death rate compared with patients without CIL (12 [4.8%] vs 8 [3.5%], P = .46; and 14 [5.6%] vs 8 [3.5%]; P = .26, respectively). The median CIL volume was 1000 mm 3 (interquartile range [IQR], 7000 mm 3 ). Patients with postoperative stroke and stroke/death had a significantly higher preoperative CIL volume of 5100 mm 3 (IQR, 31,000 mm 3 ) vs 1000 mm 3 (IQR, 7000 mm 3 ; P = .01) and 4500 mm 3 (IQR, 17,450 mm 3 ) vs 1000 mm 3 (IQR, 7000 mm 3 ; P = .03), respectively. The receiver operating characteristic curve analysis showed a volume of 4000 mm 3 was predictive of postoperative stroke with 75% sensitivity and 63% specificity. A CIL volume ≥4000 mm 3 was an independent risk factor for postoperative stroke, with a stroke rate of 9.3% (n = 9) vs 1.9% (n = 3) for a CIL volume of 3 (odds ratio, 4.6; 95% confidence interval, 1.1-19.1; P = .03). Conclusions CIL volume in symptomatic carotid stenosis seems to influence the 30-day outcome independently from the timing of carotid revascularization. A CIL volume of ≥4000 mm 3 could be considered a significant predictor for postoperative stroke after carotid revascularization.