BACKGROUND: Transfemoral transcatheter aortic valve implantation (TF TAVI) has recently become an established treatment option for intermediate and high-risk surgical patients with severe aortic stenosis. Despite significant reduction in diameter of valvular delivery systems, access related vascular complications remain a major safety concern. The aim of this study was to evaluate impact of femoral access techniques: surgical versus percutaneous on in-hospital outcomes. METHODS: Polish National TAVI Registry (POL-TAVI) was used as a data source. The analysis included 1680 patients treated with TF TAVI in years 2013-2016.677 patients were treated using percutaneous technique (Group PC) and 1003 using open surgical access (Group S). The two groups were matched and compared. All-cause mortality, length of hospital stay, procedure time and potential risk factors for vascular access site complications after TF TAVI were analyzed. RESULTS: Vascular access site complications were reported in 162 (9.64%) of 1680 patients and were found significantly more often in PC group (13.15% vs. 7.28% P>0.001). There was a significant difference between groups regarding Body Mass Index, arterial hypertension, transient ischemic attack history and NYHA classification. The data analysis showed that increased probability of all vascular complications was associated with percutancous access. In addition, left-side access and female sex were independent risk factors for all vascular complications. CONCLUSIONS: Surgical cut-down in the groin with exposure of the artery and manual suture after the procedure seems to be a safer option for TF TAVI patients.

Introduction Sternum closure techniques have been compared regarding biomechanics, efficacy in high-risk patients and prevention of mediastinitis or sternal dehiscence. There are no papers concerning patients’ comfort and postoperative rehabilitation rate. Aim To establish the best...

Endovascular repair for aortic aneurysms necessitates routine follow up due to potential late complications, such as endograft occlusions, endoleaks, and late aneurysm rupture. Guidelines recommend periodic post-operative imaging, including computed tomography angiography (CTA) or duplex ultrasound, to monitor aneurysm status and stent integrity. The efficacy of these follow up protocols is controversial, with concerns about increased healthcare costs and patient morbidity. This survey aimed to assess global variance in follow up imaging protocols among vascular surgeons, interventional radiologists, and vascular surgery trainees. A global English web based survey was conducted over nine months and distributed through email, social media, and direct messaging to vascular surgeons, interventional radiologists, and other vascular specialists. Procedure specific questions included imaging techniques used and follow up duration. The FOREVAR Survey was completed by 693 respondents from 65 countries. Most participants reported having a standardised follow up imaging protocol following all, or nearly all, elective endovascular aneurysm repairs (EVAR) in their centre (98%). The follow up protocols displayed substantial variation. In addition to completion angiography, other imaging was often performed before discharge (cone beam computed tomography 11%, CTA 27%, or DUS 17%). CTA is most often performed at first follow up (63%), while DUS is most frequently used during later follow up (56%). Median intervals to follow up imaging were eight weeks (first), 39 weeks (second), and 52 weeks (third). Follow up never ceased in 51% of cases. Comparable results were reported for complex EVAR (cEVAR) and thoracic EVAR (TEVAR), but with a greater proportion of patients receiving CTA after cEVAR at long term follow up (74%). Magnetic resonance imaging was used by a minority in the follow up of EVAR, cEVAR, and TEVAR (4%, 1%, and 4%, respectively). This global survey showed substantial variation in follow up imaging protocols after EVAR, cEVAR, and TEVAR. Most of these protocols lead to long term radiation exposure during follow up.

The application and prognostic nature of systemic inflammatory reaction syndrome (SIRS) is still being researched, as using SIRS parameters to predict patient status is cheap, efficient, fast, and easy. The study aimed to determine SIRS markers and postoperative complications occurrence in patients undergoing kidney tumor surgery, and to verify if SIRS occurrence depends on age, sex, BMI (body mass index), comorbidities, patients’ general condition before the surgery, type of surgery, intraoperative blood loss, or intraoperative ischemia time. Body temperature, heart rate, respiratory rate, and leukocyte count were measured in patients (n = 285) operated on due to a kidney tumor on the first (T0) and third (T3) postoperative day. Univariable and multivariable logistic regression were used to analyze the factors affecting postoperative SIRS and complications occurrence. T0: SIRS developed in patients with higher BMI, >2 ASA points, and more substantial intraoperative blood loss. T3: SIRS developed in obese or overweight patients, with >2 ASA points, significantly higher relative HR change, lower relative body temperature change, respiratory rate, and leukocyte count. BMI values, preoperative general health status, and the amount of intraoperative blood loss in patients undergoing surgery due to a kidney tumor can contribute to SIRS occurrence. Patient’s sex, age, tumor size, type of surgery, operated side, and time of intraoperative ischemia do not affect SIRS occurrence.

Summary: Background: Spontaneous peripheral dissections are rare, and in a substantial number of cases, the underlying aetiology remains unclear. Patients and methods: We report the case of a 63-year-old male patient with a recent asymptomatic SARS-CoV-2 infection who presented with sudden-onset intermittent abdominal pain. Imaging studies revealed a dissection of the superior mesenteric artery (SMA) and large-vessel vasculitis involving the SMA as well as the carotid, subclavian, axillary and femoropopliteal arteries. In the absence of other predisposing factors, we supposed an association with prior COVID-19 and performed a systematic review of the literature to search for similar cases with arterial dissection related to acute or recent SARS-CoV-2 infection. Results: We identified 25 cases, including ours: 13 males and 12 females, with a median age of 48 years. In 22/25 patients, arterial dissection occurred within 4 weeks after the diagnosis of COVID-19 and involved the cerebral (11/25; 44%), coronary (10/25; 40%), splanchnic (3/25; 12%) and renal (2/25; 8%) arteries. Conclusions: Although initially known for its respiratory manifestations, it has become evident that SARS-CoV-2 not only infects pneumocytes but also enters the vascular endothelium, leading to endothelial dysfunction and hypercoagulability and – as shown in our case – large-vessel vasculitis, which may predispose patients to intramural haemorrhage and arterial dissection.

Cardiac allograft vasculopathy (CAV) is the leading complication limiting the long-term survival of heart transplant (HTx) patients. The goal of this study was to assess carbohydrate metabolism disorders in relation to CAV intensification in heart transplant patients according to the ISHLT grading scheme. This retrospective study involved 477 HTx recipients undergoing angiographic observation for up to 20 years after transplantation. The patients were assigned to 4 groups on the basis of their carbohydrate metabolism status: without diabetes, with type 2 diabetes prior to HTx, with new-onset diabetes after transplantation, and with transient hyperglycemia. In the study, 62.7% (n=299) of the patients manifested no diabetes after HTx, while 14.3% (n=68) of patients had type II diabetes prior to HTx and 18.4% (n=88) developed new-onset diabetes after transplantation. In total, 1442 coronary angiograms were taken in the specified control periods. CAV incidence increased over time after transplantation, reaching 11% after 1 year, 57% after 10 years, and 50% after 20 years. The longest survival time was observed for patients who had developed type II diabetes prior to HTx, but the difference was not statistically significant. The multivariate analysis failed to identify an independent risk factor for developing cardiac allograft vasculopathy. Despite the relatively high rates of CAV and carbohydrate metabolism disorders in heart transplant patients, our retrospective analysis revealed no statistically significant link between these 2 diseases.