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In their daily practice, vascular specialists face the challenge of treating peripheral artery disease (PAD) of the lower limbs. During the last decade, there has been an increasing adoption of endovascular techniques worldwide and a simultaneous expansion of the endovascular instrument portfolio to improve technical results during PAD treatment. The proper use of dedicated endovascular devices is essential to achieve technical success.To know indication, mechanism of action, and possible complications of different devices is of paramount importance to achieve immediate procedural success in the shortest time possible and long-term patency of the treated vessels.All the re-entry catheters on the market are presented with their own unique characteristics. The pros and cons of the use of these devices is also discussed and compared to other possible recanalization strategies.The re-entry devices have been demonstrated to be effective in increasing the procedural success rate, in limiting the dissection of distal healthy vessel segments and shortening the procedural time. They should therefore be considered part of essential tools in the treatment of lower limb chronic total occlusions especially for clinicians who don't feel comfortable in performing retrograde access.

Resumen Introduccion El manejo del ganglio centinela positivo en cancer de mama sigue siendo un tema de debate. El objetivo es evaluar la incidencia e identificar los factores predictivos de metastasis en ganglios no centinela. Metodos Revision retrospectiva de los pacientes con cancer de mama con axila clinicamente negativa (cN0) tratados entre enero del 2013 y diciembre del 2017, con biopsia de ganglio centinela (BGC) positiva a quienes se les realizo linfadenectomia axilar (LA). Resultados De los 328 pacientes incluidos, la mayoria tenia tumores cT1 o cT2, con invasion linfovascular en el 58,4% de casos. La media de ganglios detectados en BGC fue 2,7, con una media de 1,6 ganglios positivos, el 60,7% con extension extracapsular. En LA, una media de 13,9 ganglios fueron detectados, con media de 2,1 ganglios positivos. No se observo metastasis en LA en el 50,9% de los pacientes y el 18,9% tenia ≥ cuatro ganglios positivos. En analisis multivariado, la invasion linfovascular, la extension extracapsular, la dimension de mayor metastasis (>10 mm) y la ratio de ganglios centinela positivos (> 50%) fueron factores predictivos independientes de metastasis en ganglios no centinela. Estos factores fueron usados para construir un score para predecir la posibilidad de LA positiva despues de BGC positiva. El area bajo la curva ROC (AUC) del modelo fue 0,69 y el 81% de los pacientes con score = 0, y el 65,6% con score = 1 no tenian metastasis en la LA. Conclusion La ausencia de metastasis en ganglios no centinela en la mayoria de los casos con uno a dos ganglios positivos en la BGC con score de bajo riesgo cuestiona la necesidad de hacer LA en estos pacientes. Los factores predictivos identificados pueden ayudar a seleccionar pacientes para omitir la LA.

Objective: In this paper, we examined the relationship between atherosclerotic plaque characteristics and symptomatic carotid artery disease. Material and methods: Twenty-two patients who underwent carotid endarterectomy were enrolled into the study. Thirteen patients were male and remaining 9 patients were female. The mean age was 60.2 +/- 9.6 years. The carotid artery stenosis ranged between 75% and 99%. Eight patients were asymptomatic and remaining 14 patients were symptomatic. Ten patients suffered stroke. One of them had recurrent transient ischemic attacks, 4 patients had dizziness, and one of them had amaurosis fugax. The extracted plaques were evaluated by scanning acoustic microscopy (SAM) and micro-computerized tomography (micro-CT). Results: Smaller acoustic impedance values that reveal collagen-rich plaque formation were detected in patients who had stroke, while higher acoustic impedance values that reveal calcium-rich plaque formation were detected in the asymptomatic patients' plaques. Conclusions: Determination of plaque characteristics with modern radiographic techniques, rather than relying on the degree of stenosis in patients with carotid artery disease, may be helpful to discriminate patients requiring intervention. Cíl: V této studii jsme zkoumali vztah mezi charakteristikami aterosklerotického plátu a symptomatickým postižením karotických tepen. Materiál a metody: Do studie bylo zařazeno 22 pacientů (13 mužů a 9 žen průměrného věku 60,2 ± 9,6 roku) po endarterektomii karotických tepen. Závažnost stenózy karotické tepny se pohybovala v rozmezí 75 % až 99 %. Osm pacientů bylo asymptomatických a zbývajících 14 symptomatických. Deset pacientů prodělalo cévní mozkovou příhodu. V anamnéze měl jeden pacient recidivující tranzitorní ischemické příhody, čtyři pacienti uváděli presynkopální stav a u jednoho byla stanovena diagnóza amaurosis fugax. Odstraněné pláty byly vyšetřeny skenující akustickou mikroskopií (scanning acoustic microscopy, SAM) a mikrovýpočetní tomografi í (micro-computerized tomography, micro-CT). Výsledky: U pacientů po cévní mozkové příhodě byly nalezeny nižší hodnoty akustické impedance ukazující na tvorbu plátů s vysokým obsahem kolagenu, zatímco u asymptomatických pacientů byly vyšší hodnoty akustické impedance spojeny s tvorbou plátů bohatých na vápník. Závěry: Spíše než spoléhání se na závažnost stenózy u pacientů s postižením karotických tepen může při vyhledávání pacientů vyžadujících intervenci napomáhat určení charakteristik plátů moderními radiografi ckými metodami. Türkiye Cumhuriyeti Kalkınma Bakanlığı

This dataset supports the findings of the vascular e-Learning during the COVID-19 pandemic survey (the EL-COVID survey). The General Data Protection Regulation (GDPR) of the European Union was taken into consideration in all steps of data handling. The survey was approved by the institutional ethics committee of the Primary Investigator and an online English survey consisting of 18 questions was developed ad-hoc. A bilingual English-Mandarin version of the questionnaire was developed according to the instructions of the Chinese Medical Association in order to be used in mainland People's Republic of China. Differences between the two questionnaires were minor and did affect the process of data collection. Both questionnaires were hosted online. The EL-COVID survey was advertised through major social media. All national and regional contributors contacted their respective colleagues through direct messaging on social media or by email. Eight national societies or groups supported the dissemination of the EL-COVID survey. The data provided demographics information of the EL-COVID participants and an insight on the level of difficulty in accessing or citing previously attended online activities and whether participants were keen on citing these activities in their Curricula Vitae. A categorization of additional comments made by the participants are also based on the data. The survey responses were filtered, anonymized and submitted to descriptive analysis of percentage.

Background The corona virus disease (COVID-19) pandemic has radically changed the possibilities for vascular surgeons and trainees to exchange knowledge and experience. The aim of the present survey is to inventorize the e-learning needs of vascular surgeons and trainees as well as the strengths and weaknesses of vascular e-Learning. Methods An online survey consisting of 18 questions was created in English, with a separate bilingual English-Mandarin version. The survey was dispersed to vascular surgeons and trainees worldwide through social media and via direct messaging from June 15, 2020 to October 15, 2020. Results Eight hundred and fifty-six records from 84 different countries could be included. Most participants attended several online activities (>4: n = 461, 54%; 2–4: n = 300, 35%; 1: n = 95, 11%) and evaluated online activities as positive or very positive (84.7%). In deciding upon participation, the topic of the activity was most important (n = 440, 51.4%), followed by the reputation of the presenter or the panel (n = 178, 20.8%), but not necessarily receiving accreditation or certification (n = 52, 6.1%). The survey identified several shortcomings in vascular e-Learning during the pandemic: limited possibility to attend due to lack of time and increased workload (n = 432, 50.5%), no protected/allocated time (n = 488, 57%) and no accreditation or certification, while technical shortcomings were only a minor problem (n = 25, 2.9%). Conclusions During the COVID-19 pandemic vascular e-Learning has been used frequently and was appreciated by vascular professionals from around the globe. The survey identified strengths and weaknesses in current e-Learning that can be used to further improve online learning in vascular surgery.

Many patients with COVID-19 have thromboembolic complications that worsen their prognosis. Herein, the authors propose a modified version of the CHA2DS2-VASc score, including 1 point for COVID-19, so that prophylaxis to protect against thromboembolic events would be indicated before the condition becomes severe. The advantages of this modification would be prevention of the patient’s condition worsening due to thromboembolic problems and reduction of the likelihood of a need for intensive care and mechanical ventilation, reducing mortality.

Resumo O conceito de terapia angiogênica surgiu no início da década de 90, o que pode ser feito com genes que codificam fatores de crescimento para promover a formação de novos vasos e o remodelamento de vasos colaterais. Como o procedimento dessa terapia geralmente consiste em apenas injeções locais de vetores, esse processo é pouco invasivo, rápido e de simples realização. Entretanto, desde as primeiras evidências clínicas do efeito de terapia gênica com o fator de crescimento de endotélio vascular (vascular endothelial growth factor, VEGF) vistos nos pacientes com doença arterial obstrutiva periférica até hoje, apenas dois fármacos de terapia angiogênica foram aprovados, um na Rússia e outro no Japão, o que parece um número muito pequeno diante do grande número de investimentos feitos por meio de estudos pré-clínicos e clínicos. Afinal, podemos considerar que a terapia angiogênica já é uma realidade? Abstract The concept of angiogenic therapy emerged in the early 1990s. The method employs genes that encode growth factors to promote formation of new vessels and remodeling of collateral vessels. Since the procedure involved in this therapy usually only consists of local injections of vectors, the process is minimally invasive, quick, and simple to perform. However, since the first clinical evidence of the effects of gene therapy with vascular endothelial growth factor (VEGF) was observed in patients with peripheral artery disease, to date only two angiogenic therapy drugs have been approved, one in Russia and another in Japan, which seem a very small number, in view of the large volume of investment made in pre-clinical and clinical studies. After all, can we conclude that angiogenic therapy is a reality?

Resumo Muitos pacientes com COVID-19 apresentam complicações tromboembólicas que acabam piorando seu prognóstico. Os autores propõem uma modificação no escore CHA2DS2-VASc, incluindo 1 ponto para COVID-19, para, desse modo, indicar profilaxia de eventos tromboembólicos antes do agravamento do quadro. As vantagens dessa modificação seriam evitar a piora do paciente por problemas tromboembólicos, bem como a necessidade de internação em unidade de tratamento intensivo e de ventilação mecânica, e diminuir a mortalidade.

Introduction Breast radial scar (RS) management remains controversial. The need for surgical excision is supported by the concern of an associated high-grade lesion missed in the biopsy. The aim of this study was to assess histologic upgrade rate after a percutaneous biopsy, to determine if vacuum assisted biopsy prevents the need for subsequent RS surgical resection and to evaluate the upgrade risk factors. Patients and methods This was a uni-institutional retrospective study of consecutive patients with RS histologically diagnosed from January 2010 to December 2015. Results A total of 113 cases of RS were diagnosed. We verify that there was a histologic upgrade in 22 (19.5%) cases. The upgrade risk factors were the type of biopsy performed, the presence of atypia, the presence of calcifications and the number of fragments obtained in the biopsy ( p The biopsy type was vacuum assisted in 25 (22.1%). The upgrade rate in the vacuum assisted biopsy group was 4.0%, whereas in the standard core needle biopsy group was 23,9% ( p = 0.041). Discussion and conclusion We demonstrated that the risk of upgrade after a RS diagnosis depends on the type of biopsy performed, the presence of atypia, the presence of calcifications and the number of fragments obtained. When a standard core biopsy is performed the risk of upgrade and malignancy is not negligible, and surgery is indicated. When the biopsy is vacuum assisted, the risk of upgrade and malignancy is significantly decreased and so the indication for excisional biopsy seems not to be so imperative.

Introduction: The prevalence of metabolic syndrome (MetS) and MetS-related stroke is set to increase dramatically in coming decades. MetS is a complex disease that includes endothelial dysfunction, insulin resistance, diabetes, hypertension, ectopic obesity, and dyslipidaemia and an increased risk of cardiovascular events. One function of high-density lipoprotein (HDL) cholesterol (HDL-C) is the cholesterol-efflux pathway, which is the pathway where cholesterol is removed from macrophages within the arterial walls back into the bloodstream and out to the liver. As one of the key functions of HDL, their hypothesis was that if they could measure HDL-C-efflux capacity, they would have a better handle on the role of HDL in atherosclerosis. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between HDL-C functionality and MetS. The aim of this study is to examine this association of HDL-C functionality with MetS in different ages and sex. Methods and analysis: The update systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (i.e., PubMed, EMBASE, Web of Science, and Google Scholar). Studies that examined the association between HDL-C functionality and MetS; focused on cohort, case-control, and cross-sectional studies; were conducted among in adults aged 40 to 70 years; provided sufficient data for calculating odds ratio or relative risk with a 95% confidence interval; were published as original articles written in English or other languages; and have been published until January 2018 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators. Ethics and dissemination: Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. Trial registration number: PROSPERO (CRD42018083465).

Purpose: This case report describes a case of abdominal aortic stenotic disease treated with covered balloon- expandable stent with absence of the celiac trunk artery. Technique: Patients are selected for this strategy if they have a lesion without bifurcation involvement located at the mid segment of the infrarenal aorta or stenosis with unfavorable aortic anatomy, or severely diseased and calcified distal aorta. Conclusion: Our result in this case supports the feasibility, safety, and efficacy of stenting for stenosis of the distal infrarenal aorta.

We report a case involving an acute chronic endovascular abdominal aortic stent graft occlusion in which percutaneous angioplasty was performed via bilateral trans femoral approach. This case emphasized that endograft occlusion treatment after endovascular aortic aneurysm repair (EVAR) is feasible.