"Early" and "definitive" taking charge of subjects positive to SARS-CoV2: the experience of an Italian Local Health Authority.

Abstract: During the second covid-19 pandemic wave in November-December 2021 Prevention Departments had to face a hardly-sustainable workload of contact tracing and taking charge of the sars-cov2 positive case and of his or her close contacts. Also laboratories have been stressed in their ability to process timely the extraordinary load of swabs performed. In this context of hazardous delays, the Prevention Department of Belluno (Italy) tested its resilience: a simple and effective method of taking charge was implemented, by initially phoning to the positive case and imposing the isolation measure on him or her and later on proceeding with the conventional contact tracing.

Extreme endovascular revascularization for limb salvage in critical limb ischemia.

AIM: Distal bypass has been considered as a primary choice for the treatment of critical limb ischemia (CLI). When bypass failed with limb threatening ischemia, the amputation rate is high in patients with increased surgical risks and lack of conduit. Percutaneous transluminal angioplasty (PTA) has been shown to be effective and safe in the setting of CLI even in patients with failed bypass graft. The aim of this study was to review our experience and results of extreme endovascular revascularization in patients with CLI following occluded lower limb bypass graft. METHODS: Retrospective review from January 2005 to June 2008 of patients with CLI following occluded bypass graft who underwent PTA was performed. All patients were studied by Duplex scanning and dual-energy computed tomographic angiography (DE-CTA) bone removal technique. Stents were used in cases of residual stenosis or dissection. Technical success was defined as a residual stenosis less than 30%. Demographics, comorbidities, functional status, details of the procedure information were recorded. Descriptive, logistic regression and life-table analyses performed. RESULTS: Thirty-six patients with occluded bypass grafts were treated. The mean age was 69 years (range 56-89), 44% were older than 80 years, 83% had diabetes mellitus, 88% of limbs treated had multiple lesions included Tasc C and D lesions. Technical success was achieved in 91%. Mean follow-up was 24 months. At follow-up, there were 19 PTA failures which were followed by subsequent procedures: redo PTA in 16 limbs, redo bypass in 2, amputation in 5. Cumulative primary patency was 60% (±0.08 SE) and 24% (±0.07 SE). Secondary patency was 96% (±0.03 SE) and 83% (±0.08 SE). Limb salvage was 84% (±0.06 SE) and 70% (±0.10 SE). Freedom from surgical revision was 78% (±0.07 SE) and 54% (±0.11 SE). Overall survival was 89% (±0.05 SE) and 58% (±0.11 SE) at 12 and 24 months, respectively. CONCLUSION: Endovascular revascularization of patients with CLI and occluded bypass graft is a safe and feasible procedure with reasonable technical and clinical success and limb salvage. PTA may be the only alternative to amputation in these patients with extensive comorbidities and limited life expectancy.

The efficacy of Iloprost for the treatment of chronic venous ulcers of the lower limbs.

BACKGROUND: The purpose of this study was to assess the effect of Iloprost in the treatment of venous ulcers. PATIENTS AND METHODS: We recruited 52 patients with uncomplicated venous ulcers of the lower limbs. They were divided into two groups: the first (29 patients) was given Iloprost in saline solution for three weeks, while the second (23 patients) received saline solution only. The size and number of ulcers were determined at the start of the treatment and then every 15 days for six months. RESULTS: Ulcer size diminished faster in the patients treated with Iloprost, with 100% healed within 120 days. In the placebo group, 82.60% had healed by the end of the 180-day observation period. This difference was statistically significant. Ulcer cicatrization was also faster in the treatment group (65.51% after 60 days, 86.20% after 90 days and 100% after 120 days), whereas in the placebo group, the ulcers had still not healed in 17.40% of patients by the study end. CONCLUSIONS: Iloprost can significantly reduce healing time for venous leg ulcers without any specific complications.

Infrainguinal revascularization based on duplex ultrasound arterial mapping.

AIM: Recent reports have advocated duplex ultrasound arterial mapping (DUAM) as the sole preoperative imaging modality for planning infrainguinal revascularization. This study reports the outcome of arterial revascularization procedures for chronic limb ischemia based on DUAM. METHODS: From January 2002 to December 2004, 253 patients (175 men, 78 women) underwent infrainguinal revascularization based on DUAM. The indications for surgery were severe claudication (11%), rest pain (15%), gangrene (40%), non-healing ulcer (34%). Preoperative evaluation consisted of DUAM alone in 208 cases (82%) or a combination of DUAM and contrast arteriography (CA) in 30 (12%) and intraoperative angiography or direct exploration in 15 (6%). DUAM allowed imaging from the distal aorta to the pedal arteries and the selection of inflow and outflow bypass anastomosis sites. CA was deemed necessary due to technical difficulties or medico-legal reasons. RESULTS: DUAM procedure time averaged 90+30 min. Proximal anastomosis was located in common femoral arteries in 202 cases, popliteal in 51. Distal anastomosis was to the tibial arteries in 144 cases and pedal arteries in 109. Primary patency was 89% and 67% at 12 and 36 months. Secondary patency was 93% and 82% at 12 and 36 months. CONCLUSIONS: This experience shows that DUAM may be a safe alternative to CA for patients with chronic limb ischemia. Adequate training and experience is necessary to utilize this technique as the sole preoperative imaging modality for planning infrainguinal revascularization.

Primary aortoduodenal fistula including the afferent loop of a Billroth II anastomosis. A case report.

Primary aortoenteric fistula is a very rare consequence of the evolution of an abdominal aortic aneurysm (AAA). The 3rd and 4th portion of the duodenum are involved in up to 80% of all cases. Frequently, gastrointestinal bleeding represents the first symptom, and diagnosis is difficult because of the aspecific clinical presentation and course, characterized by alternating remission and relapse; this is the reason why surgical treatment is usually delayed and therefore such events are managed as emergencies with a preoperative and intraoperative high death rate. We report the case of a 76-year-old man with a primary aortoduodenal fistula, who was submitted to gastric resection according to Billroth II 20 years before. This case could be interesting for its anatomical peculiarities favourable to the formation of the fistula.