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Background: Identifying sex-related differences/variables associated with 30 day/1 year mortality in patients with chronic limb-threatening ischemia (CLTI). Methods: Multicenter/retrospective/observational study. A database was sent to all the Italian vascular surgeries to collect all the patients operated on for CLTI in 2019. Acute lower-limb ischemia and neuropathic-diabetic foot are not included. Follow-up: One year. Data on demographics/comorbidities, treatments/outcomes, and 30 day/1 year mortality were investigated. Results: Information on 2399 cases (69.8% men) from 36/143 (25.2%) centers. Median (IQR) age: 73 (66–80) and 79 (71–85) years for men/women, respectively (p < 0.0001). Women were more likely to be over 75 (63.2% vs. 40.1%, p = 0.0001). More men smokers (73.7% vs. 42.2%, p < 0.0001), are on hemodialysis (10.1% vs. 6.7%, p = 0.006), affected by diabetes (61.9% vs. 52.8%, p < 0.0001), dyslipidemia (69.3% vs. 61.3%, p < 0.0001), hypertension (91.8% vs. 88.5%, p = 0.011), coronaropathy (43.9% vs. 29.4%, p < 0.0001), bronchopneumopathy (37.1% vs. 25.6%, p < 0.0001), underwent more open/hybrid surgeries (37.9% vs. 28.8%, p < 0.0001), and minor amputations (22% vs. 13.7%, p < 0.0001). More women underwent endovascular revascularizations (61.6% vs. 55.2%, p = 0.004), major amputations (9.6% vs. 6.9%, p = 0.024), and obtained limb-salvage if with limited gangrene (50.8% vs. 44.9%, p = 0.017). Age > 75 (HR = 3.63, p = 0.003) is associated with 30 day mortality. Age > 75 (HR = 2.14, p < 0.0001), nephropathy (HR = 1.54, p < 0.0001), coronaropathy (HR = 1.26, p = 0.036), and infection/necrosis of the foot (dry, HR = 1.42, p = 0.040; wet, HR = 2.04, p < 0.0001) are associated with 1 year mortality. No sex-linked difference in mortality statistics. Conclusion: Women exhibit fewer comorbidities but are struck by CLTI when over 75, a factor associated with short- and mid-term mortality, explaining why mortality does not statistically differ between the sexes.

Background: To investigate the effects of the COVID-19 lockdowns on the vasculopathic population. Methods: The Divisions of Vascular Surgery of the southern Italian peninsula joined this multicenter retrospective study. Each received a 13-point questionnaire investigating the hospitalization rate of vascular patients in the first 11 months of the COVID-19 pandemic and in the preceding 11 months. Results: 27 out of 29 Centers were enrolled. April-December 2020 (7092 patients) vs. 2019 (9161 patients): post-EVAR surveillance, hospitalization for Rutherford category 3 peripheral arterial disease, and asymptomatic carotid stenosis revascularization significantly decreased (1484 (16.2%) vs. 1014 (14.3%), p = 0.0009; 1401 (15.29%) vs. 959 (13.52%), p = 0.0006; and 1558 (17.01%) vs. 934 (13.17%), p < 0.0001, respectively), while admissions for revascularization or major amputations for chronic limb-threatening ischemia and urgent revascularization for symptomatic carotid stenosis significantly increased (1204 (16.98%) vs. 1245 (13.59%), p < 0.0001; 355 (5.01%) vs. 358 (3.91%), p = 0.0007; and 153 (2.16%) vs. 140 (1.53%), p = 0.0009, respectively). Conclusions: The suspension of elective procedures during the COVID-19 pandemic caused a significant reduction in post-EVAR surveillance, and in the hospitalization of asymptomatic carotid stenosis revascularization and Rutherford 3 peripheral arterial disease. Consequentially, we observed a significant increase in admissions for urgent revascularization for symptomatic carotid stenosis, as well as for revascularization or major amputations for chronic limb-threatening ischemia.

Background: To investigate the effects of the COVID-19 lockdowns on the vasculopathic population. Methods: The Divisions of Vascular Surgery of the southern Italian peninsula joined this multicenter retrospective study conducted through cross-sectional survey. Each received a 13-point questionnaire, investigating the hospitalization rate of vascular patients in the first 11 months of the COVID-19 pandemic and in the preceding 11 months. Results: 27 out of 29 Centers were enrolled. April-December 2020 (7092 patients) vs 2019 (9161 patients): post-EVAR surveillance, treatment for Rutherford category 3 peripheral arterial disease, and asymptomatic carotid stenosis revascularization significantly decreased [1484 (16.2%) vs 1014 (14.3%), p=0.0009; 1401 (15.29%) vs 959 (13.52%), p=0.0006; and 1558 (17.01%) vs 934 (13.17%), p

Objective We evaluated sodium-glucose co-transporter2 (SGLT2) expression and the effect of SGLT2 inhibitor (SGLT2i) therapies on carotid plaques of asymptomatic diabetic and non-diabetic patients. Methods Plaques were obtained from 296 non-diabetic patients and 227 patients with type 2 diabetes undergoing carotid endarterectomy. 97 patients with type 2 diabetes were treated with SGLT2 inhibitors for 16 ± 4 months before endarterectomy. After propensity score matching analysis, patients with type 2 diabetes were categorized without (n = 87) and with SGLT2i therapy (n = 87). To investigate SGLT2 expression levels' effects on major adverse endpoints (MACE = stroke, transient ischemic attack, myocardial infarction, and death), we evaluated MACE outcomes at a 2-year follow-up. Results Compared to plaques from patients without diabetes, plaques from patients with diabetes had higher SGLT2 expression, inflammation, and oxidative stress, along with lower SIRT6 expression and collagen content. Compared with plaques from patients with diabetes, SGLT2i-treated patients with type 2 diabetes presented increased SIRT6 expression and collagen content and lowered inflammation and ion and oxidative stress, thus indicating a more stable plaque phenotype. These results supported in vitro observations on human aorta endothelial cells (EC) (TeloHAEC-cells). Indeed, EC treated with high glucose (25 mM) in the presence of SGLT2i (100 nM canagliflozin) presented higher SIRT6 expression and decreased mRNA and protein SGLT2 levels, nuclear factor-kappa B (NF-B(NF-κB), and matrix metallopeptidase 9 (MMP-9) expression compared to cells treated only with high glucose. After two years following endarterectomy, a multivariable Cox regression analysis showed significantly higher 2-year overall survival from MACE in patients without diabetes (P, Highlights • The identification of novel molecular targets of atherosclerosis progression is of utmost importance in diabetic patients. • The occurrence of SGLT2 receptors on the endothelial cells of atherosclerotic plaques may be an attractive therapeutic option for atherosclerosis in patients with diabetes. • SGLT2/SIRT6 represents an attractive option, given its crucial involvement in atherosclerosis progression. • The endothelial SGLT2 inhibition increases the endothelial expression of SIRT6, yielding an improved atherosclerotic plaque phenotype and 2-year outcome. • The impairment of the endothelial SGLT2/SIRT6 pathway worsens outcomes in atherosclerotic patients with diabetes; this may be a potential preventive target.

Morbidity related to impaired leg wound healing after GSV harvest is a neglected problem with inherent social costs. We developed a minimally invasive harvest (MIH) technique without the need of specific devices guided by preoperative echotomography. We tested it in comparison to open harvest in a prospective, randomized study. One hundred and seven patients were prospectively randomized to receive either MI or conventional (C) harvest. Preoperative Doppler echotomography was performed in order to identify vein segments suitable for CABG and surgically attainable. Multiple skin incisions (up to four per patient and each one up to 5 cm in length) parallel to the vein axis were performed. MI had no adverse effects on graft function and associated to higher graft blood flow after anastomosis, probably due to reduced venospasm. MI was more time-expensive, but resulted in a significantly lower incidence of postoperative wound morbidity. This was particularly evident in patients with risk factors for wound complications. The MI approach is safe and reliable for obtaining venous conduits for CABG. Accurate echotomography mapping of the leg veins is pivotal for its efficacy. Given the low costs and evident benefits, MIH should be tested as an alternative approach in the routine surgical practice.

Background Deep venous thrombosis (DVT) is present in about 3–15% of cancer patient. Paraneoplastic thrombosis pathogenesis is multifactorial. Antithrombotic prophylaxis frequently is not oriented to the real thrombotic or haemorragic risk of the patients. Aim Aim of our study is to define the real thrombotic risk in neoplastic patient. With this purpose we considered in our patients complement fraction C3 and C4 and circulating immune-complexes (CIC) because they activate macrophages and platelets and increase tissue factor level. Moreover we evaluated also total cholesterol and triglycerides level, because they are linked with factor VII activation. Chemotherapy dose density and chemotherapeutic agents used were also included in our investigation as pro-inflammatory/pro-thrombotic risk factors. Methods We considered C3, C4, CIC, cholesterol and triglycerides level, dose density and chemotherapeutic agents used in 119 patients with solid neoplasms (62 colon, 27 lung, 18 gastric, 12 others) and without anticoagulant prophilaxis. Of these only 105 were evaluable because in these all the data were available. Median age was 68.5 years (R 57–83). M/F ratio was 72/47. The threshold value of third quartile was chosen as risk cut-off (C3: 130mg/dl; C4: 32mg/dl; ICC: 2.9 mcg/ml; total cholesterol: 205mg/dl; triglycerides 123mg/dl). We elaborated a scoring system in which 1 point was attributed to each value inferior to the third quartile. One point was added or removed if patient received or not Irinotecan. In fact this drug was the only variable that in univariate analysis showed an high Yates corrected chi square test (4, p 0.045). The statistical analysis was conducted with Yates corrected chi square test, Odds Ratio (OR), realtive risk (RR). Furthermore Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP) were also evaluated. Results 27 patients (26%) showed DVT. Of these 23(85%) had a score ≤3 and 4 (15%) ≥4. 78 patients (74%) did not show DVT. Of these 46(59%) had a score ≥4 and 26 ≤3. Yates corrected chi square test is 15.68 (p Summary/Conclusions The neoplastic patient frequently shows haemorrhagic risk (eg in chemotherapy induced thrombocytopenia). Therefore anti-thrombotic prophylaxis should be used considering the real thrombotic and haemorragic risk of neoplastic patient. Our scoring system is useful in distinguishing cancer patient with low thrombotic risk and consent to avoid antithrombotic prophylaxis in patient with higher bleeding and lower thombotic risk. Nevertheless these data need confirmation on a larger cohort of patients.