Annals of Vascular Surgery

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The off-label use of a leg endoprosthesis for internal iliac artery aneurysm treatment.

The 10-30% of iliac aneurysms involve the internal iliac (IIA) ones 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 to 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.

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Successful Catheter-Directed Thrombolysis for Acute Lower Limb Ischemia Secondary to COVID-19 Infection

A 49-year-old man was admitted to his local hospital with left leg pain and breathing difficulties. He had negative nasopharyngeal polymerase chain reaction tests for severe acute respiratory syndrome coronavirus 2. Chest X-ray and Computed tomography pulmonary angiogram displayed typical coronavirus disease 2019 (COVID-19) radiological features as ground-glass opacities and bronchovascular thickening. His respiratory symptoms resolved after four days of supportive treatment, whereas his left leg became more painful and discolored.

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Endovascular Surgery during COVID-19 Virus Pandemic as a Valid Alternative to Open Surgery

As August 8, 2020, in Italy, more than 35,000 deaths from COVID-19 have been diagnosed. The acute phase of the outbreak seems resolving in Italy. The region Lombardia has suffered from severe problems during the acute phase of the outbreak (March–April 2020) with 16,000 diagnosed COVID-19–related deaths (49% of the COVID-19–related deaths in Italy). In the area surrounding Pavia during the acute phase of the outbreak (March–April), out of the documented 4,200 deaths, 1,225 were related with COVID-19 infection with a mortality rate of 181/100,000 inhabitants and an increase in deaths of 138% in comparison with the same period of the previous years.

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A rare case of dysplastic axillary artery aneurysm associated to arteriovenous malformation.

Axillary artery aneurysms are rare conditions and their causes are various. They can determine severe complications, so the treatment is extremely important.We report the case of a young man affected by a saccular axillary artery aneurysm associated to intramuscular arterio-venous malformation, without symptoms except for the presence of a pulsatile mass. Duplex scan and CT scan have been essential for a correct diagnosis and planning of the treatment. At first, the patient was submitted to coil embolization of an efferent vessel and then he was treated surgically through ligation and detachment of the aneurysm and replacement of part of the axillary artery with a Dacron graft (Vascutek, Inchinnan, Renfrewshire, Scotland, UK).

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Carotid Endarterectomy in Asymptomatic Patients with Carotid Artery Stenosis

In carotid endarterectomy (CEA), debates are still continuing on various issues such as surgical indications, surgical techniques and strategies, and selection of diagnostic modalities.1 Therefore, the results of the article entitled “Contemporary trends in physician utilization rates of CEA and CAS for asymptomatic carotid stenosis among Medicare beneficiaries” by Sorber et al 2 and published in Annals of Vascular Surgery in September, 2020, are of significant value. The authors found that there is a growing tendency for CEA not to be performed in asymptomatic patients with carotid artery stenosis.

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Contemporary Review to Reduce Groin Surgical Site Infections in Vascular Surgery

Surgical site infection (SSIs) in lower extremity vascular procedures is a major contributor to patient morbidity and mortality. Despite previous advancements in preoperative and post-operative care, surgical infection rate in vascular surgery remains high, particularly when groin incisions are involved. However, targeting modifiable risk factors successfully reduces the surgical site infection incidence in vascular surgery patients. We conducted an extensive literature review to evaluate the efficacy of various preventive strategies for groin surgical site infections.

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The impact of the COVID-19 pandemic on vascular surgery trainees in the United States

The impact of the Coronavirus Disease 19 (COVID-19) pandemic on healthcare workers has been substantial. However, the impact on vascular surgery trainees have not yet been determined. The goals of our study were to gauge the impact of COVID-19 on vascular surgery trainees’ personal and professional life and to assess stressors, coping, and support structures involved in these trainees response to the COVID-19 pandemic.

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3. Staged, Fenestrated Endovascular Aortic Repair of Previously Treated Pararenal Abdominal Aortic Aneurysm

Endovascular repair of pararenal abdominal aortic aneurysms is associated with increased complexity after failed infrarenal aortic endovascular repair. Patient comorbidities and aberrant vascular anatomy further complicate the decision to treat and treatment modality. Here we describe the successful treatment of a pararenal abdominal aortic aneurysm previously addressed with multiple endovascular interventions and complicated by advanced cirrhosis and absent celiac trunk with a staged splenic artery embolization and subsequent fenestrated approach.

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2. Tibial Chronic Total Occlusions: Evolving Endovascular Strategies

Revascularization of tibial chronic total occlusions (CTO) in patients with critical limb ischemia (CLI) can be challenging and require advanced endovascular techniques. Recent literature has shown the importance of intact pedal flow and angiosome revascularization for limb salvage and effective management of foot wounds. However, these lesions are not always amenable to antegrade recanalization. Alternative options include retrograde treatment with the use of a patent pedal arch or trans-collateral retrograde revascularization (pedal-plantar loop technique) or direct retrograde tibiopedal access.

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