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We report the cases of 2 female patients, 45-year-old and 49-year-old, affected by wide-necked splenic aneurysm. We embolized the 2 lesions assisted by a new scaffolding neurovascular device, the Cascade Net, an innovative –occlusive remodeling device for temporary bridging in endovascular coil embolization of intracranial aneurysms. Visceral artery aneurysms are rare with an estimated prevalence of 2%-3% in imaging series and up to 10% in autopsy series. Most are asymptomatic and their diagnosis is occasionally. Aneurysm spontaneous rupture has been demonstrated in 2%-10% of cases and it can result in significant morbidity and mortality. Conservative management and open repair were the preferred treatment options for many years. Endovascular repair has been increasingly used since 2000; and the most widespread method of treatment has been coiling. Because of tortuosity of the parent artery, wide neck, and unfavorable locations at arterial branch points, 6% of Visceral and renal artery aneurysms VRAA cannot be adequately treated by simple coiling and requires parent artery remodeling through balloon occlusion, stent placement or parent vessel occlusion, leading to, in the latter situation, a compromised organ perfusion. Increasingly, balloon-assisted, and stent-assisted approaches as well as novel scaffolding neurovascular devices such as the Cascade Net, have allowed wide necked aneurysms to be bridged during endovascular treatment with smaller delivery system, averting parent artery occlusion and risk of distal embolization.

To identify the risk factors associated with patency loss after bailout stenting with third-generation hybrid heparin-bonded nitinol stent of the femoropopliteal segment. Prospective, multicenter, single-arm registry including 156 patients (50 females, mean age 72 ± 11 years) subjected, from February 2017 to December 2018, to provisional stenting with Gore Tigris vascular stent of the distal superficial femoral artery, with or without involvement of the popliteal artery, in 9 different centers. The 194 lesions, with Rutherford score ≥ 3, were stented in case of recoil, dissection or residual stenosis not responding to percutaneous trans-luminal angioplasty (PTA). The follow-up (FU) was performed with clinical evaluation and duplex ultrasound (DUS) at 1, 6 and 12 months. The primary patency rate was 99(95%CI 98–100)% at 1 month, 86(80–92)% at 6 months and 81(74–88)% at-12 months. After patency loss, 13/23 (56.5%) patients were re-treated, yielding a primary assisted patency of 91(86–96)% at 6 months and 88(82–94)% at 12 months and a secondary patency of 94(90–98)% at 6 months and 90(84–95)% at 12 months. Rutherford score ≥ 4 (p = 0.03) and previous severe treatments (p = 0.01) were identified as risk factors for early patency loss during FU. The involvement of the popliteal artery was not an independent risk factor for loss of patency. The bailout stenting of the femoropopliteal segment with third-generation nitinol stents is a safe and effective option in case of recoil, dissection or residual stenosis not responding to PTA. Critical limb ischemia and history of previous major treatment at the same level are significant prognostic factors for patency loss during FU.

The aim of our study is to assess the effectiveness of popliteal artery aneurysm (PAA) endovascular treatment. We retrospectively evaluated 48 high-surgical-risk patients that presented at our three departments with evidence of popliteal artery aneurysms, both symptomatic and asymptomatic, and were therefore treated by deployment of stent graft. Immediate technical success was 100%. No periprocedural complications occurred. During a mean follow-up of 24.5 months (range 6–72), 12/48 occlusions of stent graft occurred, five of which occurred in the first 30 days after the procedure while other seven occurred during long-term follow-up. Primary stent patency rate was 70.8% and secondary stent patency rate was 89.6% at 1 year. No limb amputation was witnessed. According to our experience, endovascular approach appeared as an effective treatment for popliteal artery aneurysms, as it appeared affected by a low rate of peri- and post-procedural complications. It could be proposed as treatment of choice in patients with high surgical risk.

Background Intraprocedural aneurysm sac embolization (embo-EVAR) during endovascular abdominal aneurysm repair (EVAR) using coils and fibrin glue is a technique for preventing type II endoleak (EII). Our aim is to evaluate feasibility, safety and clinical outcome of this promising approach. Materials and Methods A retrospective clinical case analysis of 72 patients who underwent EVAR during the period 2011–2014. Two groups were compared at 6 and 12 months follow-up with contrast media computed tomography scan and contrast-enhanced ultrasound (CEUS) imaging: consecutively, 36 patients (group A) treated with classic EVAR and 36 patients (group B) treated with embo-EVAR. Coils were released filling better as possible the aneurysm sac; the embolization was completed by injecting fibrin glue. Device and materials used, differential systemic and sac pressures, presence of any endoleak, and complication were registered. Results In our experience, we had 100% technical success without surgical conversion. Embo-EVAR was performed, after endograft deployment, in group B patients, all with ratio of Δ-pressures (obtained from Δ-sac pressure/Δ-differential pressure) > 0.16. No early or late complications occurred and mortality was nil. Follow-up was performed with computed tomography-angiography and CEUS at 6 and 12 months. We observed 9 type II and 1 type Ia endoleak in group A and 2 type II and 1 type Ib endoleaks in group B. Mean radiation exposure time was 30.3 min in group A and 43.3 min in group B. EVAR procedure average cost was 9,000 €. The average cost of sac embolization was 1,500€. Conclusions Although a randomized study is necessary, embo-EVAR may be a valid approach to prevent type II endoleaks and further complications. Mild costs and exposure-dose increase could be accepted to avoid reinterventions, and in our experience, it could be routinely performed with excellent results.

PurposeTo report the use of a new type of uncovered stent to treat aortic aneurysms.Case ReportUnder compassionate use, an 81-year-old man with multiple comorbidities and an expanding 63-mm juxtare...

Objectives: The seroprevalence of hepatitis A virus antibodies was investigated in a population of 1051 subjects, of whom 376 were controls and 675 were exposed to different degrees of biological risk. Methods: The exposed group was subdivided into subjects at low (242), intermediate (265), and high (168) biological hazard; all subjects were employed in the biomedical field. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were also determined. Results: The seroprevalence of positive hepatitis A antibodies was 44.9% in all subjects but was significantly higher in males (50.6%) than in females (34.2%) and increased according to age (25.9% in subjects aged ≤40 years and 62.2% in subjects aged >40 years). No difference related to exposure to the biological risk was observed. The prevalence of transaminases at levels above normal values (χ2 = 4.079, P < 0.05 for AST and χ2 = 4.806, P < 0.05 for ALT) and mean values (AST P < 0.05; ALT P < 0.001) appeared significant in hepatitis A virus-positive subjects. On the other hand, excluding individuals with positive hepatitis C virus antibodies (16) and positive hepatitis B virus surface antigen (12), a prevalence of transaminase alterations was not observed, but mean levels of ALT lasted significantly longer in subjects with positive hepatitis A virus antibodies (P < 0.01). Conclusions: The results confirm that hepatitis A virus is not a risk for employees in the biomedical field, but the presence of hepatitis A virus antibodies suggests a possible, though not clinically evident, liver involvement.

Background Hepatitis C virus is an important cause of acute and chronic hepatitis and it is an agent parenterally transmitted. Workers handling biological materials may be exposed to high concentration of virus-infected fluids. Methods The seroprevalence of hepatitis C virus antibodies was investigated in a population of 809 subjects exposed to varying levels of biological risk owing to the handling of human fluids or tissues and in 408 controls. The exposed group was subdivided in three subgroups according to low and occasional (262), intermediate but continuous (311), and high (236) exposure to biological materials. Results The seroprevalence of hepatitis C antibodies was low (1.40%) in all subjects. The risk groups showed no significant differences with respect to the control group; the most exposed group showed a seroprevalence of 1.27%. Age but not sex appeared significantly correlated with seroprevalence of positive antibodies (χ2 = 5.949, P < 0.025). Aspartate aminotransferase and alanine aminotransferase showed a highly significant increase (P < 0.01 and P < 0.001, respectively) in subjects with positive hepatitis C antibodies, other than a high significant prevalence of values above the normal limit (χ2 = 26.613, P < 0.001 and χ2 = 39.164, P < 0.001, respectively). Among 17 positive hepatitis C virus subjects, 8 (47.1%) were positive for hepatitis B virus, but not for its antigen. Conclusions Hepatitis C virus infection appears to be a low risk for people employed in the biomedical field, yet infection is associated with a significant liver involvement. Am. J. Ind. Med. 35:532–535, 1999. © 1999 Wiley-Liss, Inc.