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This position paper, written by members of International Union of Angiology (IUA) Youth Committee and senior experts, shows an overview of therapeutical approaches for patients with chronic limb-threatening ischemia (CLTI) and absence of 'standard' solutions for revascularization. The aim was to demonstrate the accurate management of the 'no-option' CLTI patient including the wound treatment and the rehabilitation, considering always the goal of the increase of quality of life of the patients.

Pregnant women and their fetuses represent a high-risk population during infectious disease outbreaks, like current COVID-19 Pandemic, given the fact that consequences of a period of intense stress and anxiety during pregnancy, as spontaneous preterm labor and psychiatric postpartum disorders, are already known. As fetal brain faces neurodevelopmental challenges in a cytotoxic environment of possible inflammation and increased catecholamine levels, mother also has to cope with a hostile environment of uncertainty, rich in bio-social threats that can be devastating for both maternal and fetal health, as well as for Public Health.

The isthmus of the aorta is extremely vulnerable in cases of blunt thoracic trauma caused by deceleration forces. Of the 15% that survive to reach hospital, almost 50% will die within 24 hours without intervention. Hence, the need for early diagnosis and management becomes evident. A 23-year-old male was admitted to our institution after a motor vehicle accident. The CT scan detected a mediastinal haematoma and a large hemothorax, confirming the traumatic rupture of the aorta. The active bleeding necessitated an emergency thoracotomy. The patient was treated with the clamp and sew technique. A systematic literature search was performed to identify relevant reports. The patient presented an uncomplicated postoperative course and was discharged after seven days. A pseudoaneurysm was detected at regular follow-up two months after surgery, and was successfully treated with an endovascular covered stent. In selected cases of contained aortic rupture where there is a lack of necessary equipment and the patient cannot be transferred to a specialized centre, the clamp and sew technique seems to be a valid alternative despite the high operative mortality (9–43%).

It has been proposed that some persons in positions of leadership (whether in business, political, or other fields) experience an acquired personality change, termed “Hubris Syndrome” (HS), in which lack of realism leads to incorrect decision-making along with excessive self-regard.1,2 A key aspect of these personality features, as described by Owen, is that they are acquired; they were not present before attaining a powerful position of leadership. Hence, Owen’s view is that HS represents an acquired personality change. Whether it is sufficiently common and distinguishable from other psychiatric conditions to be seen as an independent illness or “disorder” is a separate question from whether this phenomenon occurs at all, and what its etiological, precipitating, and modulating factors are.

Implants are widely used and are not without complications. The most serious complication is infection with consequent exposure of the implant and is characterized by increased morbidity and mortality. Until recently, infected implants were removed and replaced with another one. These operations are accompanied by increased morbidity and might result in permanent disability. Coverage of the implant with a flap is an alternative solution. The objective of this article is to study the effectiveness of muscle or myocutaneous flaps in covering infected and exposed implants. A series of 17 patients with infected implants, which were treated with coverage of the implant with muscle or myocutaneous flap, is presented. Eight patients had an orthopedic implant, seven a vascular implant, and two had a pacemaker. The flaps ensured immediate coverage of the implant and the biologic ability of eliminating the infectious process with the increased concentration of antibiotics resulting from increased blood flow of the muscle. In all the patients, the implants were preserved and the infectious process was eliminated. The use of muscle and myocutaneous flaps in the treatment of infected implants is therefore effective and in some cases it is superior to other methods because of lower morbidity and cost.

The wide spreading of vascular diseases along with the emergence of minimally invasive endovascular therapies and modern medical therapies is inevitably bringing many disciplines into play. Although by definition, vascular surgery is the clinical and scientific discipline concerned with the diagnosis, treatment, and prevention of vascular diseases, many more radiologists and a significant number of cardiologists become increasingly involved. The question of which specialist among those qualified should carry out medical treatment, open, and endovascular procedures is still suspended, and a professional competition is pronounced. This article discusses the necessity of a vascular specialist who guides the holistic management of vascular diseases: open surgery, endovascular intervention, and medical therapy. The different characteristics of those intending to offer vascular care, the training curricula, the workforce demands, and the role of vascular centers are analyzed to illustrate the keystone role of vascular surgeons who are currently transforming to vascular specialists.

This phase II trial studied the efficacy and toxicity of docetaxel-epirubicin, supported by granulocyte colony-stimulating factor, as first-line chemotherapy in metastatic breast cancer. Patients received epirubicin (60 mg/m2) followed 1 hour later by docetaxel (80 mg/m2) every 3 weeks for a maximum of 8 cycles or until disease progression. Prophylactic granulocyte colony-stimulating factor (5 micrograms/kg) was administered daily for 5 days. Sixty-nine patients were evaluable for efficacy and toxicity. Objective responses occurred in 45 patients (65%; 95% confidence interval: 53-76%), with 11 (16%) complete responses and 34 (49%) partial responses. Responses were observed at all metastatic sites. The median response duration was 8 months (range 4-68), median time to progression was 10 months (range 4-68) and median overall survival was 24 months (range 7-68): neutropenia was dose limiting (46% grade 3-4 toxicity). The left ventricular ejection, fraction measured in 50 patients, fell below normal in 14 patients (28%), 8 patients had grade 1 and 6 grade 2 cardiotoxicity, but none developed congestive cardiac failure. The docetaxel-epirubicin regimen is extremely effective in poor prognosis breast cancer patients with visceral metastases, with significant overall and complete responses, followed by prolonged survival in responders. Although myelosuppression remains the major toxicity, prophylactic GCSF administration was associated with a small percentage of neutropenic fever.

Continuing medical education (CME) can be defined as ''educational activities that serve to maintain, develop, or increase the knowledge, skills and professional performance of a physician to provide services for patients, the public, or the profession''. CME is a major professional responsibility. The European Board of Vascular Surgery of the Union Européenne des Médecins Spécialistes (UEMS) Section of Vascular Surgery has, through its European Vascular CME (EVCME) Committee, accredited 74 congresses during the 5-year period from 2000-2004.Official evaluation forms were completed by the congress participants for a personal appraisal of the quality of the activities. The data in this manuscript focused on questions that were the most relevant and of the greatest interest to the participants. A statistical analysis of the results was performed utilizing ANOVA and Robust tests of equality of means as well as a posthoc analysis for further investigation, and non parametric Wilcoxon signed ranks test.The educational needs of participants regarding new diagnostic and therapeutic modes were stated as ''important'' and ''extremely important'' in the responses at over 80% in total. Over 75% of the participants answered ''extremely important'' and ''important'' to the question ''how important is evidence-based practice to your practice''.This survey indicates that the EVCME approved congresses had a positive impact for the vascular surgeon by updating overall knowledge on vascular surgery; the majority of comments by the participants also indicates that EVCME is fulfilling its aim to bring as much evidence-based practice as possible into the daily work schedule of the surgeon by turning knowledge acquired by CME into performance of the participants.