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Introduction: Venous aneurysms are long-term complications of arteriovenous fistula (AVF) for hemodialysis with an estimated incidence rate of around 5-6%. The purpose of our study is to investigate the role of immunosuppressive therapy in the development of AVF aneurysms in renal transplant patients, and to determine whether AVF closure following transplantation is necessary. Methods: Forty-six patients with symptomatic venous AVF aneurysms underwent ligation and resection of their fistulas between January 2013 and January 2020. Immunohistochemical expression of CD3, CD4 and CD8 was assessed on the surgical specimens to characterize lymphocytic infiltrate in the aneurysm wall. Patients were subdivided into "Group A"- kidney transplant patients undergoing immunosuppressive therapy which was comprised of 39 patients and "Group B" - patients who had not undergone kidney transplant which was comprised of 7 patients. The two groups did not significantly differ in age, sex nor risk factors for aneurysms. Results: Group A showed a significantly higher aneurysm diameter (p

Raffaele Serra,1,2,* Umberto Marcello Bracale,3,* Nicola Ielapi,4 Luca Del Guercio,3 Maria Donata Di Taranto,5 Maurizio Sodo,3 Ashour Michael,6 Teresa Faga,6 Egidio Bevacqua,7 Federica Jiritano,7 Giuseppe Fliberto Serraino,7 Pasquale Mastroroberto,7 Michele Provenzano,8 Michele Andreucci6 1Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University, Catanzaro, Italy; 2Department of Surgical and Medical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy; 3Department of Public Health, University of Naples “Federico II”, Naples, Italy; 4Department of Public Health and Infectious Disease, “Sapienza” University of Rome, Roma, 00185, Italy; 5Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, Naples, Italy; 6Department of Health Sciences, “Magna Graecia” University, Catanzaro, Italy; 7Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, 88100, Italy; 8Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy*These authors contributed equally to this workCorrespondence: Raffaele SerraDepartment of Surgical and Medical Sciences, Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, ItalyTel +39 09613647380Email rserra@unicz.itAbstract: Chronic kidney disease (CKD) is a clinical condition characterized by high morbidity and mortality. Globally, CKD is also increasing in prevalence and incidence. The two principal kidney measures namely estimated glomerular filtration rate (eGFR) and albuminuria have been found to be predictors of renal and cardiovascular (CV) endpoints including peripheral artery disease (PAD). The prevalence of PAD was increased in CKD patients and, particularly, in patients with more severe CKD stages. Despite the fact that revascularization strategies are suitable in CKD patients in similar fashion to non-CKD patients, few CKD patients underwent these procedures. In fact, if it is true that revascularization improves prognosis in PAD patients irrespective of baseline eGFR, it was also demonstrated that CKD patients, who underwent revascularization, were at higher risk for amputations, mortality, re-intervention and perioperative complications. With the present review article, we have examined the association between CKD, PAD and peripheral revascularization highlighting data about epidemiology, pathophysiologic mechanisms, and results from previous observational and intervention studies. We have also examined the future perspectives and challenges of research around the association between CKD and PAD.Keywords: chronic kidney disease, CKD, peripheral artery disease, PAD, ESKD, amputations, albuminuria

INTRODUZIONE L’angioplastica con pallone a rilascio di farmaco (drug eluting balloon – DEB) rappresenta una metodica emergente nel trattamento delle lesioni femoro-poplitee. Lo studio descrive l’esperienza preliminare di un singolo centro nell’utilizzo del DEB Stellarex™. MATERIALE E METODI Dal Luglio 2015 ad Aprile 2017, 27 pazienti (4 F, 23 M), età media 65,2 anni (± 8,5), si sottoponevano a 28 procedure di angioplastica di lesioni femoro-poplitee con pallone medicato con paclitaxel (Stellarex™). I pazienti presentavano i seguenti fattori di rischio: 63% diabete, 59% dislipidemia, 63% ipertensione. Dodici pazienti erano claudicanti (44%), 10 con dolore a riposo (37%) e 5 con lesioni trofiche parcellari (18%); dodici (44%) con lesioni femoro-poplitee TASC B e 15 (55%) TASC C. ABI pre-operatorio: 0,53 (0,3 – 0,8; ± 0,13); post-operatorio: 0,83 (0,5 – 1) (± 0,16). Ventidue pazienti sono stati sottoposti alla sola angioplastica con DEB. In 5 casi (18%) sono state necessarie procedure aggiuntive: 4 stent iliaci ed una tromboendoarteriectomia del tripode femorale. Tutti hanno assunto duplice terapia antiaggregante. Il Follow-up è stato eseguito con: esame clinico, ABI ed ecocolor-Doppler a 1, 3, 6 e 12 mesi e successivamente annualmente. RISULTATI Il successo tecnico immediato è stato del 100% senza complicanze perioperatorie. Il tasso di pervietà primaria è stato del 93%. In due casi si è riscontrata restenosi entro l’anno dalla procedura ed è stata eseguita ulteriore angioplastica con DEB, con tassi di pervietà primaria assistita del 100% a 12 mesi. Un paziente è stato sottoposto ad amputazione maggiore ed un altro del terzo e quarto dito, con un tasso di salvataggio d’arto del 97%. Due pazienti sono deceduti durante il follow-up. CONCLUSIONI L’utilizzo del DEB Stellarex™ è una valida alternativa alle tradizionali procedure endovascolari, con tassi di pervietà primaria ad 1 anno soddisfacenti. Sono tuttavia necessari ulteriori studi con casistiche più ampie per valutarne l’efficacia anche a lungo termine.

Between 1972 and 2012, 25 patients presenting 32 paragangliomas of the neck were observed. Tumor locations included the carotid body (CBTs) in 21 patients and the vagus nerve in 4. Four patients had bilateral CBT and one a bilateral vagal tumor; a metachronous bilateral jugulare paraganglioma was diagnosed in one patient with bilateral CBT Shamblin type III. Five patients presented CBTs type II and three type III. Preoperative embolization was performed in 5 CBTs, with no significant difference in blood loss. Twenty-nine paragangliomas were resected (with three internal carotid artery resection): there were no cerebrovascular accident or perioperative death. Nine patients (36%) had cranial nerve palsy prior to surgery and a postoperative nerve dysfunction occurred in four other tumors (16%). Persistent nerve deficits occurred in 3 patients (12%). No evidence of malignancy was shown, intraoperatively or during a postoperative follow-up period (9 months to 18 years; mean: 8 years).

Femoro-popliteal PTA for the treatment of critical limb ischemia is frequently associated with unsatisfactory procedural success rates while directional atherectomy (DCA) has improved success rate since claudicant patients undergoing percutaneous treatment of femoro-popliteal obstructive disease. The aim of this prospective study is to evaluate the safety, efficacy and procedural success of DCA, at one year, in the percutaneous treatment of femoro-popliteal obstructive disease in patients with critical limb ischemia.Methods. From March 2012 to March 2013 18 consecutive patients with critical limb ischemia were treated with DCA (Turbohawk/ Covidien-ev3 Endovascular Inc., North Plymouth, Minnesota, USA) for the treatment of femoro-popliteal obstructive disease. Patients were evaluated at 12 months. Results. Technical and procedural success was achieved in every patient. No in-hospital major adverse cardiovascular events occurred. Primary endpoint: freedom from any amputation was obtained in all patients. Secondary endpoints: clinical (Rutherford class improvement) and hemodynamic success (Ankle-brachial index improvement) was achieved in all patients. Conclusion. The use of DCA for the treatment of femoro-popliteal obstructive disease is a safe and effective therapeutic strategy for patients with critical limb ischemia. The data included in our study should be considered hypothesis-generating in order to design of a randomized trial comparison with conventional PTA.

There is increasing evidence in the literature that endovascular aneurysm repair is the first-line approach for most of abdominal aortic aneurysms (AAAs). Furthermore aortouniiliac stent graft placement is, in high risk patients or during emergency setting, a safe procedure over the mid- and long-term period and compares well with the results of bifurcated stent grafts. We present a case of a 66 -year-old gentleman, with pneumothorax after therapeutic thoracentesis and a giant AAA, successfully treated with an aortomonoiliac stent grafting and femoro-femoral crossover bypass.

Aims: Atherosclerosis is an inflammator y disease which molecular mechanisms are not been completely investigated. Our aim is to perform a wide expression study of inflammation related genes in human atherosclerotic plaques. Methods: The Human Inflammation Array (Applied Biosystems) was used to perform the mRNA quantification of 92 inflammation-related genes in 12 atherosclerotic plaques, their respective adjacent regions (with a lower grade lesion) and 7 healthy ar teries. The principle of the array is the real-time PCR amplification with a TaqMan probe specific for each gene. Data analysis was performed with SDS 2.3 software with the comparative Ct method using the gene beta-2-microglobulin as housekeeping and one of analysed samples as calibrator. Results: The mRNA levels of 42 genes result to be differently expressed:13 genes were up-regulated in atherosclerotic plaques respect to control ar teries whereas 29 were down-regulated. Their expression levels show an increasing or a decreasing trend from healthy ar teries to plaque adjacent regions and to advanced plaques. These genes belong to many different functional classes. In particular, we observed the dys-regulation of genes encoding for enzymes involved in the arachidonic acid metabolism that lead to generation of prostaglandins and leukotrienes. Conclusions: This is the first study in which the expression of a wide panel of inflammation-related genes was investigated. Results clarify the mechanisms of inflammation involvement during atherosclerotic process and highlight newpossible target for anti-inflammator y therapy in cardiovascular disease.

Aim. The aim of this study was to evaluate the impact of intraoperative cell salvage (ICS) on the early outcome after open repair (OR) of ruptured abdominal aortic aneurysm (rAAA). Methods. This is a retrospective review of 73 consecutive patients who underwent emergency OR of infiarenal rAAA with ICS between 2005 and 2008 (Group tr), compared to 5l repairs from 21lll2-2ll1l4 with no ICS (Group II). In addition, a transfusion protocol of platelets and tiesh frozen plasma (FFP) administration on admission and during surgerv was adopted in patients in Group I to maintain coagulation conrpetence. Results. ICS reduced bank blood demand by 63.6Vc (from I I to 4 units, P

Objective: To assess the etiology, management and outcome of iliac pseudoaneurysms following renal transplantation. Methods: Eleven patients who underwent repair between 1982 and 2007 were identified. Five (Group 1) presented pseudoaneurysm at the anastomosis of the donor renal and native iliac arteries, and six (Group 2) presented iliac pseudoaneurysm following transplant nephrectomy. Intraoperative cultures and immunohistochemical examinations were obtained from all surgical cases to determine the existence of a relationship between infection or transplant rejection and pseudoaneurysm formation. Results: Endovascular repair (EVR) was used to treat three patients, while eight patients underwent open repair (OR). Transplant nephrectomy was needed in all cases but one after anastomotic pseudoaneurysm repair. After pseudoaneurysm excision, arterial reconstruction was performed in all cases, with a limb salvage rate of 100%. At 30 days, no patients died in the EVR subgroup. In the OR subgroup, one patient died of sepsis (12.5%). Cultures taken from the pseudoaneurysm wall and content grew Candida albicans and E. coli in two febrile patients. Pathologic evaluation of donor renal arteries revealed evidence of chronic rejection in three patients (60%) in Group 1, and in two (33.3%) in Group 2. No patients in either Group presented late infection, failure of vascular reconstruction nor pseudoaneurysm recurrence. The follow-up ranges from 20 to 89 months. Conclusions: The etiology of pseudoaneurysms in this location is multifactorial, however, an association with chronic rejection must be considered. Though rare, the development of pseudoaneurysms at the donor renal-external iliac artery anastomosis results in high rates of transplant nephrectomy. Less invasive endovascular techniques offer a new therapeutic option in this challenging scenario notwithstanding the fact that they require further validation. © 2009 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

The purpose of this paper is to report a salvage maneuver for accidental coverage of both renal arteries during endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA). A 72-year-old female with a 6 cm infrarenal abdominal aortic aneurysm was treated by endovascular means with a standard bifurcated graft. Upon completing an angiogram, both renal arteries were found to be accidentally occluded. Through a left percutaneous brachial approach, the right renal artery was catheterized and a chimney stent was deployed; however this was not possible for the left renal artery. A retroperitoneal surgical approach was therefore carried out with a retrograde chimney stent implanted to restore blood flow. After three months, both renal arteries were patent and renal function was not different from the baseline. Both endovascular with percutaneous access via the brachial artery and open retroperitoneal approaches with retrograde catheterization are feasible rescue techniques to recanalize the accidentally occluded renal arteries during EVAR.

A 69-year-old man with a history of hypertension and severe pulmonary disease had asymptomatic bilateral common iliac and popliteal artery aneurysms. A bifurcated Talent and two Wallgraft stent-grafts were deployed via open femoral arteriotomies to exclude the aneurysms, respectively. The patient had an uncomplicated recovery, with no transfusion need; the hospital stay was 4 days. After a 5-year follow-up, no complication or endoleak has been detected, with patency of endografts and a mean decrease of 15% in aneurysm transverse diameters. Simultaneous endovascular repair should be considered in the treatment of multiple peripheral aneurysms, to avoid sequential conventional or endovascular procedures.

Background. The Study Aimed To compare the endovascular stent-graft technique with open repair of anastomotic aortic aneurysms following aorto-femoral reconstructions. Methods. Nine patients (mean age = 62.7 years; ASA II: 5 patients, ASA III: 3 patients ASA IV: 1 patient) were treated with standard open repair (group 1) and 14 patients at high surgical risk (mean age=71.8 years; ASA II: 2 patients, ASA III: 3 patients, ASA IV: 9 patients) were treated by endovascular stent-grafting (group II), in both groups for non-infected anastomotic aneurysms located in the abdominal aorta. One patient in the surgical group had frank and 1 had covered rupture of the aneurysm sac. In addition, 1 anastomotic iliac aneurysm was excluded by means of a tube graft and 7 anastomotic femoral aneurysms were repaired by surgery. Results. Surgical treatment was resection of the anastomotic aortic aneurysm and replacement with a new graft. The operative morbidity rate was 25%; mortality rate 14.3% (1 out of 7) for patients with intact aneurysm and 50% (1 of 2) for patients with ruptured aneurysm. All endovascular interventions were completed satisfactorily, with no open conversion; an acute graft thrombosis occurred in 1 patient (7.1%), who required a femoro-femoral crossover graft. There were no procedure-related deaths, and complications (14.3%) included 1 perioperative transient cerebral ischemia and 1 case of postoperative jaundice. During a mean follow-up period of 3.8 years (14-81 months) and 4.3 years (11-79 months), respectively, re-operation has been required in 14.3 % of patients after standard operative repair and in 21.4% after endovascular repair for treatment of limb occlusion or graft migration. There was 1 late conversion to open repair 46 months after the initial procedure. The late mortality rates were almost identical (28.6 % versus 21.4%) in the two groups. Conclusions. Endoluminal repair is a less invasive treatment method and provides benefits to elderly, high-risk patients. Because of concerns related to its long-term effectiveness, elective standard surgical repair can still play a role for younger, lower-risk patients.