Complex endovascular treatment of a celiac trunk artery aneurysm with splenic artery rescue: Santini et al.: Celiac trunk artery aneurysm treatment - endovascular approach.

Visceral arterial aneurysms are uncommon pathologies, with an uncertain ethology and no clear treatment guidelines. As in our case, where we treated a 70 y.o. male patient, who came to us for un unspecific abdominal pain. So, he practiced a CT total body with contrast, presenting a celiac trunk aneurysm with involvement of the hepatic and splenic artery and therefore the team decided for an endovascular treatment, successfully obtained. Our experience is about the description of a case in its most practical and technical aspect, especially in complicated or rare conditions.

Malignant Gastric Outlet Obstruction Caused by Duodenal Cervix Metastasis in a Young Woman: Rendezvous Technique.

Background: Malignant gastric outlet obstruction (MGOD) is an extremely rare expression of advanced extra-gastrointestinal cancer, such as squamous cell carcinoma (SCC) of the cervix, and only sixcases are described in the literature.Because of the short life expectancyand the high surgical risk involving these patients, less invasive approaches have been developed over time, such asthe use of an enteral stent or less invasive surgical techniques (i.e., laparoscopic gastrojejunostomy). However, MGOD could make it difficult to perform an endoscopic retrograde cholangio-pancreatography (ERCP) for standard endoscopic drainage, so in this case a combined endoscopic-percutaneous technique may be performed. This article, therefore, aims to highlight the presence in the doctor's armamentarium of the "rendezvous technique", few case reports of whichare described in the literature, and, moreover, this article aims to underline the technique'sfeasibility. Case Presentation: The case is that of a 38-year-old woman who presented with MGOD three years after the diagnosis of SCC of the cervix, who successfully underwent the rendezvous technique with the resolution of duodenal obstruction. Endoscopic enteral stenting treatment with the placement of a metal stent (SEMSs) represents the mainstay of MGOD treatment compared withsurgery due to its lower morbidity, mortality, shorter hospitalization and earlier symptom relief. However, in patients with both duodenal and biliary obstruction, a combined endoscopic-percutaneous approach may be necessary because of the difficulty in passing the duodenal stricture or in accessing the papilla through the mesh of the duodenal SEMS. Conclusion: The rendezvous procedure is a technicallyfeasible and minimally invasive approach to the double stenting of biliary and duodenal strictures. It achieves the desired therapeutic result while avoiding the need to perform more invasive procedures that could have a negative impact on the patient'sprognosis.

Recovery of a broken PICC migrated in cardiac chambersan endovascular approach.

Complications related to the placement of a peripherally inserted central catheter are a common phenomenon and they can lead to acute complications which must be treated in an emergency regime. The aim of this study was to describe cases in their most practical and technical aspect, especially in complicated conditions. This was a descriptive case report of a 64 years old female patient who presented with a fractured peripherally inserted central catheter, migrated into the right heart chambers and inferior vena cava, and how the team arranged for its recovery by endovascular technique, in a frail patient who could not undergo to open surgery.The procedure was completed without any complications. The use of the endovascular technique allows a recovery of the foreign body in a short time, essential for a life-saving procedure; the interventional radiological approach allows less invasiveness in fragile patients and shorter hospitalization times.

A cross-sectional study evaluating hospitalization rates for chronic limb-threatening ischemia during the COVID-19 outbreak in Campania, Italy.

The expansion of coronavirus disease 2019 (COVID-19) prompted measures of disease containment by the Italian government with a national lockdown on March 9, 2020. The purpose of this study is to evaluate the rate of hospitalization and mode of in-hospital treatment of patients with chronic limb-threatening ischemia (CLTI) before and during lockdown in the Campania region of Italy. The study population includes all patients with CLTI hospitalized in Campania over a 10-week period: 5 weeks before and 5 weeks during lockdown (n = 453). Patients were treated medically and/or underwent urgent revascularization and/or major amputation of the lower extremities. Mean age was 69.2 ± 10.6 years and 27.6% of the patients were women. During hospitalization, 21.9% of patients were treated medically, 78.1% underwent revascularization, and 17.4% required amputations. In the weeks during the lockdown, a reduced rate of hospitalization for CLTI was observed compared with the weeks before lockdown (25 vs 74/100,000 inhabitants/year; incidence rate ratio: 0.34, 95% CI 0.32-0.37). This effect persisted to the end of the study period. An increased amputation rate in the weeks during lockdown was observed (29.3% vs 13.4%; p < 0.001). This study reports a reduced rate of CLTI-related hospitalization and an increased in-hospital amputation rate during lockdown in Campania. Ensuring appropriate treatment for patients with CLTI should be prioritized, even during disease containment measures due to the COVID-19 pandemic or other similar conditions.

Application of a personal Santini technique in the resolution of a complex celiac trunk aneurysm - endovascular treatment.

Aim Vascular pathologies have been already explored for the most of their aspects. It is a group of pathologies with unclear ethology and with an evolution in time not easy to forecast. Treatment guidelines are conflicting. The aim of this study was to describe cases in their most practical and technical aspect, especially in complicated conditions. Methods This was a descriptive case report of a patient with a hepatic artery aneurysm complicated by a dissection leading up to the splenic artery, and how the team had invented a planned treatment for the patient using a minimally invasive approach. The experience was born with the intention of showing how the endovascular approach is at least as safe as the traditional one despite the complexity of our case. Results The procedure was completed without any complications. After a stay in long day surgery, the patient returned home. Conclusion Using a minimally invasive technique allows to reduce the patient's post-operative suffering and the economic burden on the health system.

Accidental Coverage of Both Renal Arteries during Infrarenal Aortic Stent-Graft Implantation: Cause and Treatment.

The purpose of this paper is to report a salvage maneuver for accidental coverage of both renal arteries during endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA). A 72-year-old female with a 6 cm infrarenal abdominal aortic aneurysm was treated by endovascular means with a standard bifurcated graft. Upon completing an angiogram, both renal arteries were found to be accidentally occluded. Through a left percutaneous brachial approach, the right renal artery was catheterized and a chimney stent was deployed; however this was not possible for the left renal artery. A retroperitoneal surgical approach was therefore carried out with a retrograde chimney stent implanted to restore blood flow. After three months, both renal arteries were patent and renal function was not different from the baseline. Both endovascular with percutaneous access via the brachial artery and open retroperitoneal approaches with retrograde catheterization are feasible rescue techniques to recanalize the accidentally occluded renal arteries during EVAR.