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.

The use of EndoAnchors in endovascular repair of abdominal aortic aneurysms with challenging proximal neck: Single-centre experience.

OBJECTIVES: The aim of this study was to present a single-centre experience with EndoAnchors in patients who underwent endovascular repair for abdominal aortic aneurysms with challenging proximal neck, both in the prevention and treatment of endograft migration and type Ia endoleaks. METHODS: We retrospectively analysed 17 consecutive patients treated with EndoAnchors between June 2015 and May 2018 at our institution. EndoAnchors were applied during the initial endovascular aneurysm repair procedure (primary implant) to prevent proximal neck complications in difficult anatomies (nine patients), and in the follow-up after aneurysm exclusion (secondary implant) to correct type Ia endoleak and/or stent-graft migration (eight patients). RESULTS: Mean time for anchors implant was 23 min (range 12-41), with a mean of 5 EndoAnchors deployed per patient. Six patients in the secondary implant group required a proximal cuff due to stent-graft migration ≥10 mm. Technical success was achieved in all cases, with no complications related to deployment of the anchors. At a median follow-up of 13 months (range 4-39, interquartile range 9-20), there were no aneurysm-related deaths or aneurysm ruptures, and all patients were free from reinterventions. CT-scan surveillance showed no evidence of type Ia endoleak, anchors dislodgement or stent-graft migration, with a mean reduction of aneurysm diameter of 0.4 mm (range 0-19); there was no sac growth or aortic neck enlargement in any case. CONCLUSIONS: EndoAnchors can be safely used in the prevention and treatment of type Ia endoleaks in patients with challenging aortic necks, with good results in terms of sac exclusion and diameter reduction in the mid-term follow-up.

Ruptured Iliac Pseudoaneurysm after Intravesical Bacillus Calmette-Guérin: Urgent Endovascular Treatment. Case Report and Literature Review.

BACKGROUND: Ruptured mycotic aneurysms are an extremely rare complication of intravesical Bacillus Calmette-Guerin (BCG) immunotherapy. Several cases involving various arterial sites, mostly in the thoracic or abdominal aorta, have been described in the literature. BCG immunotherapy rarely causes false aneurysms and open surgical repair using an in situ prosthetic graft is most commonly performed. Further to this, targeted antituberculous treatment is required for at least one year following surgery. METHODS: A 69-year-old man presented at our clinic with fever, lower back pain and malaise. One year before admission he was treated, again, with intravesical BCG for recurrence of a carcinoma. RESULTS: A large infected pseudoaneurysm of 115mm was treated with the implantation of an aortouniiliac endoprosthesis followed by a crossover femoro-femoral bypass and surgical resection of the mass via an retroperitoneal approach. CONCLUSIONS: Endovascular repair can be considered a valid option in an emergency. A hybrid approach was chosen due to the need for urgent action and the poor condition of the patient who was haemodynamically unstable. In particular, the implantation of an aortouniiliac endoprosthesis at the level of the contralateral iliac axis allowed us to avoid the release of an endoprosthesis at the infected area level. Close patient follow-up with clinical evaluation every three months and a CT-scan yearlyis mandatory following the intervention and during antibiotic therapy. A systematic review of the literature has been subsequently carried out on this specific clinical case, highlighting 47 cases described from 1988. CASE REPORT: A large infected pseudoaneurysm of 115 mm presented at our clinic was treated with the implantation of an aortouniiliac endoprosthesis followed by a crossover femoro-femoral bypass and surgical resection of the mass via a retroperitoneal approach. CONCLUSIONS: Endovascular repair can be considered a valid option in an emergency. A hybrid approach was chosen due to the need for urgent action and the poor condition of the patient who was hemodynamically unstable. In particular, the implantation of an aortouniiliac endoprosthesis at the level of the contralateral iliac axis allowed us to avoid the release of an endoprosthesis at the infected area level. Close patient follow-up with clinical evaluation every 3 months and a computed tomography scan yearly is mandatory following the intervention and during antibiotic therapy. A systematic review of the literature has been subsequently carried out on this specific clinical case, highlighting 47 cases described from 1988.

The Endovascular Management of an Iatrogenic Superior Gluteal Artery Rupture Following Bone Marrow Biopsy.

We herein report an uncommon case of a life-threatening retroperitoneal hematoma after a bone marrow biopsy. Two hours after iliac crest bone harvesting, the patient experienced syncope and severe hypotension. Urgent contrast-enhanced computed tomography demonstrated extravasation from the superior gluteal artery. Transcatheter coil embolization was performed successfully, without complications. Life-threatening complications caused by retroperitoneal bleeding after bone marrow biopsy are very rare. There are few reports on the use of endovascular treatment in the management of life-threatening hemorrhagic complications after bone marrow biopsy.