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Objective: This retrospective study was performed to assess the clinical and radiological variables associated with proximal type IA endoleak (EL) in patients treated with elective endovascular repair for abdominal aortic aneurysms., Methods: The chi-square test, t-test, and logistic regression analysis were performed as appropriate. A P value of <0.05 was considered statistically significant., Results: The data of 79 patients were analyzed. No mortality occurred. During follow-up (median, 28.5 months; interquartile range, 12.8-43.0 months), 10 patients developed type IA EL. In the logistic regression analysis, undersizing of the endograft diameter by <10% significantly affected the occurrence of type IA EL. When the diameter was used for measurements, less oversizing was significantly associated with a higher risk of type IA EL. When the area was used for measurements, oversizing of >20% significantly affected the occurrence of type IA EL., Conclusion: When sizing endografts, a discrepancy was noted between the measurements of the diameter and area of the proximal neck. The area might represent a more accurate measurement than the axial diameter to optimize the proximal sealing and lower the risk of developing type IA EL.

Background: We report our "real-world" experience of endovascular repair of thoracic/thoraco-abdominal aortic lesions in patients treated from May 2002 to May 2017., Methods: Data of all consecutive treated patients were retrospectively collected in a database and analyzed. Patients were divided into 4 groups: atherosclerotic thoracic/thoraco-abdominal aneurysms (TAA/TAAA) and floating thrombus (group A); acute complicated type B dissection (TBD), penetrating aortic ulcers (PAU) and intra-mural hematomas (IMH) in group B; chronic TBD evolving in TAA (group C); traumatic injuries (group D). Mortality, reinterventions and occurrence of neurological complications, both at 30 days and in the long term, were analyzed as primary outcomes for each group., Results: Ninety-four patients were treated complessively, most for a TAA (55.3%). Thirty-days deaths and neurological complications were observed in group A only (5 cases each, 5.3%). A reintervention was necessary in 6 patients (6.4%) of group A. At 5 years, in group A survival was 62.8%±6.3% and freedom from neurological complication was 88.3%±4.2%. Neither deaths nor neurological complications were recorded in the other groups. No late aortic ruptures were recorded. Freedom from reintervention in group A was 54.7%±7.6% at 5 years and a reintervention was needed in all patients of group D. Overall, the main cause for reintervention was a type I endoleak., Conclusions: The endovascular repair of thoracic/thoraco-abdominal aortic lesions had acceptable mortality and neurological complication rates, both at 30 days and in the long term. Reinterventions in the long term occurred more frequently after TAA/TAAA and traumatic injuries, and were mainly required for a type I endoleak., Key Words: Endovascular thoracic repair, Endovascular thoraco-abdominal repair, Thoracic aneurysms.

Aim: The goal of this study is to evaluate the appropriateness to prescribe venous ultrasound of lower limbs., Material of Study: Over a two months period, 1005 Duplex scans were performed by our Vascular Surgery Unit; out of the total, 225 exams were conducted on venous system of lower limbs. We retrospectively analyzed appropriateness of prescription (according to Lombardy District indications), urgency of prescription, time-lapse between application for the exams and its execution, positive or negative results, National Health System's sustained cost., Results: During the above mentioned period, 87,5% of the exams were conducted as normal screening with no urgency characteristics, 61 exams (27%) were combined with arterial duplex of the same district. General Practitioners' requests accounted for 76,8% while only 9,7% were from vascular surgeons. Following indications of appropriateness, 117 exams (52%) were judged as appropriate. Combining appropriateness and result (χ2 test) we found that if the indication was inappropriate the negative result rate was 90,75%; in the group of exams prescribed with an urgent request the rate of appropriateness raised to 60,7% of whose 94.1% were pathologically positive., Discussion: There is no evidence in Literature about appropriateness of prescription of Duplex ultrasound for vascular districts. While Lombardy District recently published guidelines for prescription, neither vascular surgeon societies nor National Health Service ever provided any indication., Conclusion: Nowadays there is increasing demand for appropriateness in healthcare. This study delivered such significant data to make it a pivotal study for an extended analysis during 2016., Key Words: Appropriateness, Vascular Duplex Ultrasound, Venous System.