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INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection represents a serious threat to public health because it leads to a wide spectrum of clinical manifestations. The region Lombardia (Italy) has suffered from severe problems during the acute phase of the outbreak in Italy (March-April 2020). The aim of our analysis is to report the experience of the Department of Vascular Surgery of Pavia, including the learned lessons and future perspectives, considering that the COVID-19 outbreak is in its acute phase in other continents. MATERIAL AND METHODS: Single-center, retrospective, observational study based on extracted data from the medical records of all consecutive COVID-19 patients observed in our Vascular Department between March 1st and April 30th, 2020. We reviewed the records for demographic information, comorbidities, laboratory tests, and anticoagulation treatment at the time of hospital admission. RESULTS: We observed an important reduction in elective and urgent interventions compared to the same period of the previous year; in parallel, we observed an increase in the diagnosis of deep vein thrombosis (DVT) in hospitalized patients, especially with severe infection. In our department, four infections were reported among health workers. CONCLUSIONS: The impact of the COVID19 pandemic on health-care delivery has been massive. A wave of vascular-related complications is expected. Regular SARS-CoV-2 screening, adequate protection, and quick reorganization of health-care resources are still needed.

Primary tumors originating within the wall of the arteries are rare and they frequently manifest late, making effective treatment a challenge. We describe here a case of Abdominal Aorta AngioSarcoma masqueraded as an infected EndoVascular Aortic Repair. The knowledge of this pathology from vascular surgeons and radiologist is crucial, because a prompt diagnosis and treatment can improve the prognosis.

Introduction The Lombardy region (Italy) suffered severe problems during the acute phase of the outbreak of COVID-19 in Italy (March-April 2020) with 16,000 diagnosed COVID-19 related deaths (49% of the total COVID-19 related deaths in Italy). In the area surrounding Pavia during the critical stage of the outbreak (March-April), 1,225 of the documented 4,200 deaths were related to COVID-19 infection, with a mortality rate of 181/100,000 inhabitants and an increase in deaths of 138% compared to the same period in previous years. Aim Our aim was to report the experience of the Department of Vascular Surgery of Pavia (Lombardy), including the lessons learned and future perspectives regarding the management of COVID-19 patients who developed severe acute ischemia with impending lower limb loss or deep vein thrombosis (DVT). Materials and Methods We carried out a retrospective data collection of COVID-19 patients with severe acute ischemia of the lower limbs or DVT observed in our Department during the period March 1st to April 30th 2020. Primary outcomes of the analysis were postoperative mortality for all patients and amputation rates only in those COVID-19 patients suffering from acute lower limb ischemia. Secondary outcomes were the prevalence of the disease among admitted COVID-19 patients, and any possible correlation between inflammatory parameters, thrombolytic status, and the presence of acute ischemia or DVT. Results We observed 38 patients (28 male) with severe COVID-19 infection (6 with lower limb arterial thrombosis and 32 with DVT). The median age was 64 years (range 30-94 years). In the arterial group, 3 had thrombosis on plaque and 3 on healthy arteries ("simple" arterial thrombosis). All underwent operative or hybrid (open/endo) revascularization; 1 patient died from major organ failure (MOF) and one patient underwent major amputation. In the DVT group, 9 (28%) patients died from MOF, despite aggressive medical therapy. In patients with "simple" arterial thrombosis and those with DVT, we observed a decrease in inflammatory parameters (CRP) and in D-dimer and fibrinogen after aggressive therapy (p, Highlights TOC Statement- 20201240 Our study confirms that critically ill, COVID-19 patients who develop arterial and deep vein thrombosis are at high risk of mortality, but if treated properly, there is an improvement in overall survival rate, especially in patients sixty years of age or younger.

Little or nothing is known about the correlation between the upper limb deep vein thrombosis (UL-DVT) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe the increased risk of UL-DVT in 3 patients with SARS-CoV-2 who require continuous positive airway pressure with a hood and the need for early adequate antithrombotic prophylaxis.

The 10-30% of iliac aneurysms involve the internal iliac arteries (IIAs), and their repair still remains a challenge. The endovascular techniques have become the treatment of choice in relation to the improvement of materials, techniques, and less morbidity/mortality compared with open surgery. Regardless of the use of open or endovascular surgery, the preservation of hypogastric blood flow is strongly recommended in the case of occlusion of the contralateral. We describe a case of the use over the instructions for use (IFU), of the GORE Excluder iliac extension for the total successful endovascular exclusion of a voluminous IIA aneurysm in chronic contralateral occlusion. This use over the IFU is applicable and effective in selected patients.

Between 1987 and 1989 data were collected to evaluate risk factors for pelvic endometriosis.A case-control study was conducted on 241 cases with laparoscopically or laparotomically confirmed peritoneal or ovarian endometriosis consecutively admitted to three teaching hospitals in Northern Italy. The control group consisted of 437 women admitted to hospitals for acute conditions covering similar catchment areas.Compared with nulliparous women, the risk of endometriosis decreased with increasing number of births: the point estimates were 0.4 and 0.3, respectively, for those with one and two or more births (X2(1) trend = 50.3, P less than 0.001). No relation emerged with age at first birth and spontaneous miscarriages. Relative to women whose menarche occurred at age 11 or younger, the risk of endometriosis was slightly lower in those who experienced later menarche, but the trend in risk was not significant. Women with irregular menstrual cycles showed a lower frequency of the disease (relative risk, 0.3; 95% confidence interval, 0.2 to 0.5). The role of various factors was largely similar for different disease locations (ovary, peritoneum, and both) and indication for diagnostic surgery (sterility, pelvic pain, and other reasons).This study found that parity and irregular/long menses lower the risk of endometriosis. These findings were similar in different subgroups of disease location and indication for surgery, giving strong evidence of the consistency of the general results.

We have studied the effect of active and passive smoking during pregnancy on post-ischemic vascular reactivity in 40 mother-infant pairs (table). 10 mothers (controls) did not smoke and were not exposed to involuntary smoking; 20 mothers (active smokers) had smoked at least 10 cigarettes/day during pregnancy; and 10 mothers (passive smokers) had been exposed to tobacco smoke from their husbands who smoked more than 10 cigarettes/day. The mothers and the infants were healthy and no complications were recorded during pregnancy delivery or the 1st 5 days after birth. Post-ischemic vascular reactivity was evaluated during the 2nd day after birth. Transcutaneous PO2 (cPO2) was monitored with an Oxymonitor" (Hellige); the skin electrode (Transoxode) was fixed on the forearm and set at 37 degrees Celsius; a pneumatic cuff was applied to the upper arm and inflated to 50 mm Hg above systolic pressure to occlude forearm circulation for 4 minutes. The post-occlusive peak tcPO2 was taken as a measure of post-ischemic reactive hyperemia. This technique has proven useful for evaluating vascular abnormalities in diabetic children. A significant reduction in tcPO2 was found for both the smoking mothers and their infants for mothers indirectly exposed to tobacco smoke and their infants (table). Reactive hyperemia in response to arterial occlusion lasting more than 3 minutes is due to a fall in vessel wall PO2 to O causing direct vascular smooth-muscle relaxation by reduction in oxidative phosphorylation and the local production of vasodilator metabolites such as adenosine histamine or prostaglandins. The reduction in reductive hyperemia in mothers exposed to tobacco smoke and in their infants may therefore be partly related to impairment of prostacyclin production by endothelial cells. The vascular alterations caused by smoke can produce a dysfunction of placental blood flow similar to that observed in the chronic placental insufficiency syndromes; this may explain the reduction of birthweight observed in infants of mothers exposed to active or involuntary tobacco smoking. (full text)