Notes

[Benefits and also Leads involving VEGF-targeted Anti-angiogenic Treatment along with Immunotherapy pertaining to High-grade Glioma].
The Canadian Cardiovascular Society 2016 guidelines recommend pre-operative measurement of brain natriuretic peptide (BNP) to risk-stratify patients for a 30-day composite outcome of death, myocardial infarction, or asymptomatic myocardial injury after noncardiac surgery (MINS). Whether this practice affects outcomes is unclear. The aim of this study was to examine the clinical utility of brain natriuretic peptide and myocardial injury after noncardiac surgery.

Analysis of a prospectively maintained database identified all elective open vascular surgery cases at an academic teaching hospital from January 2015 to December 2018. Pre-operative BNP values were available from June 2018 onward after becoming institutionally mandated. Co-morbidities were also collected to stratify patients using the Revised Cardiac Risk Index. The composite outcome of 30-day mortality, myocardial infarction, or MINS was determined.

Prior to BNP becoming an institutionally required test, data was available from 1176 open cases.patients with elevated BNP and MINS are required before widely adopting this strategy in vascular surgery patients.
Elevated BNP correlates with increased MINS. An asymptomatic troponin rise is the most commonly observed event, with unclear clinical implications. BNP may over-estimate surgical risk. Further studies on the long-term outcomes of patients with elevated BNP and MINS are required before widely adopting this strategy in vascular surgery patients.To describe a new inner-branched device used to treat two cases of chronic post-dissection aortic thoraco-abdominal aneurysms (PD-TAAAs) after ascending aortic surgery. A 67-year-old male who had undergone an ascending aorta and arch surgical replacement and a 70-year-old male with a previous Bentall procedure for acute type A aortic dissection were admitted at our department with a PD-TAAA diagnosis. Both patients were defined unfit for open surgery by a multidisciplinary team and a totally percutaneous endovascular repair was planned. A prophylactic cerebro-spinal fluid drainage was applied and at least one hypogastric artery was targeted for salvage in order to reduce the risk of spinal cord ischemia. A new inner branch device by Jotec® (GmbH/ Criolife; Hechingen, Germany/Kennesaw, Georgia) was implanted. A TEVAR and a standard EVAR completed the procedures and a double barrel technique was performed in order to achieve the preservation of the selected hypogastric artery. In both patients the complete technical success was achieved. The postoperative period was uneventful and the patients were discharged on the 6th and 7th postoperative day, respectively. The triple-phase angio-CT performed at 6 months showed the complete false lumen exclusion and the patency of the endografts and of the target visceral vessels. The total endovascular treatment of PD-TAAAs is a fascinating technique with encouraging results in experienced centers. Inner branched devices may expand the field of application of this new technology. More data are required to evaluate mid- and long-term results.
Ankle brachial index (ABI)is an essentialdiagnostic test for peripheral artery disease.It has someimportant limitationsso it can´t always be performed.In those cases, tissue oximetry based on near-infrared spectrum could overcome these limitations.

Assessment ofthe relationship between ABI and tissue oximetry tests and the ability of the oximetry to detect postoperative improvement.

Prospective observational study. Several measures were made by both, ankle pressure and tissue oximetry tests, in lower limbs. Absolute values were collected at foot level (anterior and posterior tibial arteries) and the indexes were calculated in relation to a control (upper limbs for ABI and left infraclavicular region for tissue oximetry). In order to evaluate the correlation between ankle pressure and tissue oximetry values, Pearson correlation coefficient and linear regression analyses were applied. T-Student and ROC curve analysis were made to evaluate thepostoperative improvement detected by bothankle pressureandtissue oximetry tests.

60 patients with peripheral artery disease were included. Ankle pressure and tissue oximetry were measured in 70 lower limbs, in 45 of them before and after revascularization. Compared to ankle pressure, tissue oximetry was able to detect improvement in absolute values and indexes after revascularization. This indexes improvement was parallel (p=0,234 for anterior tibial artery and p=0,356 for posterior tibial artery). We weren´t able to determine a cutoff point between both tests (ROC curve analysis).We observed a significative positive correlation in absolute values of both tests (Pearson correlation coefficient, r = 0,281; p < 0,001).

Tissue oximetry is able to detect improvement after revascularization of lower limbs.
Tissue oximetry is able to detect improvement after revascularization of lower limbs.
The purpose of this study was to determine if single injection erector spinae plane blocks are associated with improved pain control, opioid use, numbness, length of stay, or patient satisfaction compared to intraoperatively placed continuous perineural infusion of local anesthetic after decompression of neurogenic thoracic outlet syndrome.

This is a retrospective cohort study at a tertiary academic center of eighty patients that underwent supraclavicular decompression for thoracic outlet syndrome between May 2019 and January 2020. Forty consecutive patients treated with single-injection preoperative erector spinae plane blocks were retrospectively compared to 40 age- and gender-matched controls treated with continuous perineural infusion.

The primary outcome of mean pain scores was not significantly different between the erector spinae and perineural infusion groups over the three-day study period (4.2-5.3 vs 3.0-5.1 P=0.08). On post-operative day 0, mean pain scores were significantly higher in the erinfusion.
Peri-procedural embolic events are the Achilles' heel of carotid stenting. To overcome this complication, transcervical access to the carotid artery was introduced. In this study we describe our "our life" experience with the transcervical approach in a community hospital.

All carotid stent procedures between January 2010 and December 2020 were included in this retrospective analysis. The transcervical approach was compared to the transfemoral approach. In both procedures open-cell, closed-cell design and hybrid stents were used. In-hospital stroke was the primary outcome measure.

A total of 340 procedures were performed, in 184 patients the transfemoral approach was used and in 156 patients the transcervical approach was used. In 12 patients (3.5%) an in-hospital stroke was diagnosed, 4 in the transfemoral group (2.2%) and 8 in the transcervical group (5.1%) (P=0.14). In the multivariate analyses a symptomatic lesion was associated with in-hospital stroke. Neither type of access nor cell design was associated with increased risk of in-hospital stroke.

In contrast to previous studies, we could not confirm the advantages of the transcervical approach. However, conclusions should be carefully drawn, since this study is retrospective and was performed with multiple surgeon and different kind of stents.
In contrast to previous studies, we could not confirm the advantages of the transcervical approach. However, conclusions should be carefully drawn, since this study is retrospective and was performed with multiple surgeon and different kind of stents.
The mechanisms underlying functional impairments in symptomatic PAD patients are controversial and poorly understood. Endothelial dysfunction and arterial stiffness have been proposed as potential mechanisms related to functional impairment in symptomatic PAD patients, however, more studies are needed to confirm these associations.

To analyze the association between vascular function and walking impairment in patients with peripheral arterial disease (PAD) and symptoms of claudication.

This was a cross-sectional study that included 68 patients with symptomatic PAD. All patients underwent an objective (Six-minute walk test [6MWT], 4-meter walk test) and a subjective (Walking Impairment Questionnaire [WIQ]) measurement of walking impairment. Vascular parameters measured were pulse-wave velocity (PWV) and flow-mediated dilation (FMD). Multiple linear regression was performed to investigate the association among walking impairment variables with vascular function parameters.

No significant associations between the claudication onset distance (PWV b=.060, p=.842; FMD b=-.192, p=.456), 6MWT (PWV b=.007, p=.975; FMD b=.090, p=.725), WIQ distance (PWV b=.337, p=.117; FMD b=-.025, p=.895) WIQ speed (PWV b=.320, p=.181; FMD b=-.028, p=.497), WIQ stairs (PWV b=.256, p=.204; FMD b=-.228, p=.230), 4-meter usual walk (PWV b=-.421, p=.107; FMD b=-.338, p=.112), 4-meter fast walk (PWV b=-.496, p=.063; FMD b=-.371, p=.086) and vascular function were found.

In symptomatic PAD patients, vascular function is not associated to walking impairment, even when adjusting for comorbid conditions and diabetes.
In symptomatic PAD patients, vascular function is not associated to walking impairment, even when adjusting for comorbid conditions and diabetes.
Alpha-1-Antitrypsin (AAT) is one of the major plasmatic protease inhibitors. In the last decade, an association between Alpha-1-Antitrypsin Deficiency (AATD) and Abdominal Aortic Aneurysms (AAA) has been hypothesized. Multiple factors may be involved in AAA's etiopathogenesis, and an underlying structural defect of the extracellular matrix (ECM) is always present. AATD could be a reasonable risk factor for AAA because it is related to protease/antiprotease imbalance and enhanced ECM degradation of the vessel wall.

We performed genotyping of 138 patients hospitalized in the Vascular Surgery Division of the ASST-Spedali Civili di Brescia, Italy, for non-traumatic rupture of AAA. The second purpose was to observe the distribution of main non-genetic risk factors for AAA between patients with and without AATD.

Out of 138 patients, 22 were found with AATD 16 MS, 1 SS, 3 MZ, and 2 with a new rare AAT variant. When compared to the general Italian population, our cohort's frequency of deficient S allele was significantly higher (7.8 vs 2.2% respectively, P<0.01), whereas the deficient Z allele was similar (1.1 vs 1.3% respectively, P>0.05). Although we found no differences in age, gender, hypertension, diabetes, and smoke habits between AAA patients with and without AATD, hyperlipidemia was significantly less frequent in patients with AATD (46.4 vs 12.5% respectively, P<0.05).

In our AAA patients' cohort, the S allele frequency was higher than in the general Italian population. CCR inhibitor Our results support the hypothesis that AATD might be a risk factor for AAA.
In our AAA patients' cohort, the S allele frequency was higher than in the general Italian population. Our results support the hypothesis that AATD might be a risk factor for AAA.
Aim of our study is to evaluate the outcomes of mini-laparotomy, suprarenal cross-clamping, and enhanced recovery after elective open surgical repair for juxta-renal abdominal aortic aneurysms (JAAA) in a tertiary referral center.

Data of all consecutive patients with abdominal aortic aneurysms (AAA) electively treated with left sub-costal mini-laparotomy requiring infrarenal or suprarenal cross-clamping between 2013 and 2018 were retrospectively collected. Patients were divided into two groups infra-renal cross-clamping (group A) and JAAA requiring supra-renal cross-clamping (group B). Early and mid-term mortality, postoperative renal dysfunction according to RIFLE criteria and factors affecting postoperative outcome were analysed.

Four hundred one patients, 356 (88.8%) men, mean age 70.8 yrs, underwent open surgical repair (OSR), 343 (85.5%) AAA in group A, 58 (14.5%) JAAA in group B. Mean diameter of the aneurysms was 54 ± 11.4 mm vs. 52 ± 9 mm and mean time of intervention 154.9 ± 56.3 min vs. 180.1 ± 65.
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