[Mechanical thrombectomy in pulmonary embolism].

Systemic thrombolysis is the first-line treatment for patients with high-risk pulmonary embolism or with haemodynamic deterioration on anticoagulation alone; however, it is associated with a high bleeding risk. Mechanical thrombectomy may significantly reduce right ventricular dysfunction without exposing the patient to systemic bleeding complications. No randomized trials comparing the two treatments are available to date.

[Angiology and hemostasis: what's new in 2023].

We discuss four topics among the angiology and hemostasis studies of importance in 2023. The BASIL-2 study provides new data for the management of chronic limb-threatening ischemia by comparing surgical and endovascular treatment. The new classification of antiphospholipid antibody (aPL) syndrome integrates new clinical elements and gives a different weight among the isotype and titer of aPL.

Enhancing identification and treatment of patients with concomitant chronic venous insufficiency and diabetes mellitus. A modified Delphi study from the CODAC (ChrOnic venous disease and Diabetes Advisory Council) group.

Background: Chronic venous insufficiency (CVI) and diabetes mellitus (DM) pose significant burdens to patients and healthcare systems. While the two diseases share a number of commonalities in risk factors and pathophysiology, they are often assessed and managed separately. This can lead to a worsening of comorbidities and limitations in a patient's quality of life.

[Hospital mechanical thromboprophylaxis].

Mechanical thromboprophylaxis is an important part of hospital prevention of venous thromboembolism. It comprises graduated compression stockings and intermittent pneumatic compression. In this review, we summarize its physiological effect on venous hemodynamics, recent clinical studies that offer contrasting results, and discuss its utility in contemporary clinical practice.

[Selected highlights in angiology and haemostasis for the year 2021].

Several topics among those that marked the year 2021 are discussed in this article. Factor XI represents an original target for new anticoagulants, and the first results of a phase 2 study of prophylaxis after knee replacement surgery are very promising. A real-life study confirms that the pulmonary embolism exclusion strategy using an age-adjusted D-dimer cut-off is safe and increases the diagnostic yield.

Management of high-risk pulmonary embolism in pregnancy.

Pregnancy-associated high-risk pulmonary embolism (PE) is among the most frequent causes of maternal mortality in the Western world, by causing hemodynamic instability and circulatory failure through a large thrombotic pulmonary obstruction. The very challenging management of these dramatic situations comprises the need to quickly select a therapy of pulmonary reperfusion or hemodynamic replacement, while taking into account both maternal and fetal risks. In this review, we discuss the role of risk stratification in pregnancy-associated PE and the available evidence to support the use of thrombolysis, catheter-directed thrombectomy/thrombolysis, surgical embolectomy and extracorporeal membrane oxygenation.

Delayed manifestation of COVID-19 presenting as lower extremity multilevel arterial thrombosis: a case report.

Background: Venous thrombo-embolic events have been described in hospitalized patients with coronavirus disease 2019 (COVID-19), suggesting the presence of coagulopathy induced by the viral infection. To date, only rare cases of arterial thrombosis related to COVID-19 have been reported.

Case Summary: A 54-year-old patient with an influenza-like illness 15 days earlier, which resolved, and no known cardiovascular risk factor presented with acute right lower limb ischaemia.

[Management of a foot ulcer in a patient with diabetes].

Despite a benign appearance, any foot injury occurring in a patient with diabetes requires multidisciplinary management if dreaded complications such as amputation are to be avoided. From a pathophysiological point of view, foot ulcer generally results from the combination of lower extremity neuropathy, mechanical overload, immunopathy and vascular insufficiency. The treatment associates in all cases an offloading and one or more debridements.

[Arteriofit: a supervised exercise training program, recommended as a first-line treatment in intermittent claudication].

Lower extremities arterial disease (LEAD) is the third most common manifestation of atherosclerosis. The number of cardiovascular events in this population is similar to that of coronary artery disease. Management consists mainly of strict control of cardiovascular risk factors, optimal pharmacological treatment and supervised exercise training.

[Evolution in the endovascular management of lower limb arteriopathy].

Arteriopathy of the lower limbs is a frequent pathology. In the face of persistent invalidating claudication or critical ischemia, surgical or endovascular revascularization treatment is necessary. The aim of this article is to review the evolution of the endovascular therapeutic arsenal of the femoropopliteal segment, to present the new endovascular devices available and to give current recommendations for post-interventional antithrombotic treatment.

Venous thromboembolism in COVID-19: systematic review of reported risks and current guidelines.

Aims Of The Study: Many centres have noticed a high number of venous thromboembolism (VTE) events among critically ill inpatients with COVID-19 pneumonia. The aims of this study were (1) to summarise the reported risk of VTE associated with COVID-19 infections and (2) to summarise guidance documents on thromboprophylaxis in COVID-19 patients, in a systematic review.

Methods: We systematically searched for peer-reviewed evidence on the risk of VTE in patients with COVID-19, in PubMed, Embase and Twitter, and for guidelines or guidance documents for thromboprophylaxis, from international or national societies relevant to the field of thrombosis and haemostasis, up to April 30 2020.

[Venous thrombotic risk related to SARS-CoV-2 : prevalence, recommendations and perspectives].

Since the SARS-CoV-2 pandemic outbreak, growing evidence suggests that patients suffering from COVID-19 are at increased risk of thrombotic events. The sepsis-related activation of the coagulation combined with a high prevalence of common thrombotic risk factors could contribute to this prothrombotic state. Coagulation biomarkers could help in the identification of patients at risk of complications and mortality.

External validation of the simplified Geneva risk assessment model for hospital-associated venous thromboembolism in the Padua cohort.

Background: The simplified Geneva risk assessment model (RAM) predicts the risk of hospitalization-related venous thromboembolism (VTE) in medical inpatients in its developmental cohort but has not been validated.

Objectives: To externally validate the simplified Geneva RAM.

Patients/methods: For this secondary analysis of a prospective cohort set in Padua, we calculated the simplified Geneva RAM for all participants.

Could the YEARS algorithm be used to exclude pulmonary embolism during pregnancy? Data from the CT-PE-pregnancy study.

Introduction: The recently proposed YEARS algorithm was shown to safely exclude pulmonary embolism (PE) and reduce the use of computed tomography pulmonary angiography (CTPA) among pregnant women with suspected PE. Our aim was to externally validate this finding.

Methods: We performed a post hoc analysis of a prospective management outcome study for PE diagnosis in pregnant women.

Effect of anticoagulant treatment on pain in distal deep vein thrombosis: an ancillary analysis from the cactus trial.

Essentials Management of patients with calf deep vein thrombosis remains controversial. We conducted a post-hoc analysis of a placebo controlled LMWH randomized clinical trial. Pain was assessed using visual analogue scale at inclusion, one and six weeks.

[Peripherally inserted central catheters : indications, contraindications, complications].

Peripherally inserted central catheter (PICC) can be used for short to medium-term administration of intravenous treatments. Their main advantages lie in their ease of insertion and removal, compared with other types of central venous access. Complications of PICC include mechanical complications, infections and vein thrombosis.

[Foam sclerotherapy to treat varicose veins].

The ultrasound-guided foam sclerotherapy (UGFS) involves the injection of a sclerosing agent into a target vein under ultrasonographic guidance. The goal of this treatment is to harm the venous endothelium to achieve the destruction of the vein wall by a fibrosis phenomenon. In this article, we discuss indications and contraindications of UGFS.

[Complications and management of percutaneous femoral arterial access].

Vascular access complications following endovascular procedures remain an important cause of morbidity when using a femoral approach. In this review, we describe the risk factors, clinical presentation and management of hematoma, retroperitoneal bleeding, pseudoaneurysms, arteriovenous fistulae and arterial thrombosis.

[The evolution of imaging techniques for the diagnosis of pulmonary].

Modern diagnostic strategies for pulmonary embolism (PE) rely on the sequential use of clinical probability assessment, D-dimer and thoracic imaging when necessary. Computed tomography pulmonary angiography (CTPA) has become the imaging modality of choice. Diagnostic strategies using CTPA are very safe for the diagnosis of PE and have been well validated in large prospective management outcome studies.

Tip malposition of peripherally inserted central catheters: a prospective randomized controlled trial to compare bedside insertion to fluoroscopically guided placement.

Objective: Peripherally inserted central catheter (PICC) use continues to increase, leading to the development of a blind bedside technique (BST) for placement. The aim of our study was to compare the BST with the fluoroscopically guided technique (FGT), with specific regard to catheter tip position (CTP).

Materials And Methods: One hundred eighty patients were randomized to either the BST or the FGT.

Percutaneous endovascular salvage techniques for implanted venous access device dysfunction.

Purpose: Implanted venous access devices (IVADs) are often used in patients who require long-term intravenous drug administration. The most common causes of device dysfunction include occlusion by fibrin sheath and/or catheter adherence to the vessel wall. We present percutaneous endovascular salvage techniques to restore function in occluded catheters.

Coronary sinus atresia with persistent left superior vena cava: unusual clinical presentation and endovascular management.

Atresia of the coronary sinus (ACS) is a rare congenital anomaly. When associated with persistent left superior vena cava (PLSVC), this defect could have no significant hemodynamic effect, and the patient might remain asymptomatic. However, vascular interventions might induce changes or complications that could show the anomaly.

Interaction between widening of diameter of abdominal aorta and cardiovascular risk factors and atherosclerosis burden.

The aim of this study was to investigate influence of traditional cardiovascular risk factors (CVRF) and subclinical atherosclerosis (ATS) burden on early stages of abdominal aortic diameter (AAD) widening among adults. 2,052 consecutive patients (P) (39 % women), mean age 52 ± 13 years, were prospectively screened for CVRF, ATS, and AAD. B-mode ultrasound was used to evaluate the largest AAD and to detect carotid and femoral atherosclerotic plaques.