Background and Objectives: Acute limb ischemia (ALI) is a life-threatening vascular emergency that requires immediate intervention to restore perfusion and prevent limb loss or mortality. Management strategies primarily include thrombolysis and surgical revascularization, each with distinct risks and benefits. This review evaluates and compares the outcomes of thrombolysis and surgical revascularization in ALI management, emphasizing their efficacy, safety, and patient selection criteria. Materials and Methods: A systematic review was conducted in adherence to PRISMA guidelines, analyzing data from 15 studies, including randomized controlled trials and large retrospective analyses, encompassing over 3500 patients with varying demographics and clinical presentations. Study quality was assessed using the Cochrane risk of bias tool and the Newcastle–Ottawa Scale. Results: Thrombolysis, utilizing agents such as urokinase or recombinant tissue plasminogen activator (rt-PA), demonstrated limb salvage rates up to 90% in acute cases, with 30-day mortality rates of 4–6%. It was particularly effective in patients with embolic occlusions or short symptom durations. However, bleeding complications associated with thrombolysis were reported in up to 47% of cases. Conversely, surgical revascularization remains crucial for those with advanced ischemia or contraindications to thrombolysis, offering reliable perfusion restoration but with higher perioperative morbidity, especially in older patients with significant comorbidities. Recent advancements, including hybrid approaches combining catheter-directed thrombolysis with percutaneous mechanical thrombectomy, have shown promise in improving outcomes by reducing procedure times and enhancing clot resolution. Conclusions: While thrombolysis and surgical revascularization are effective, optimizing patient selection remains a key challenge. Future research should focus on refining treatment algorithms, investigating novel thrombolytic agents, and expanding the role of minimally invasive techniques to improve long-term outcomes while mitigating complications such as bleeding and reperfusion injuries.

Background and Objectives: Diabetic ketoacidosis (DKA) represents the most prevalent hyperglycemic emergency and poses a significant life-threatening metabolic risk for individuals with diabetes. The present study examines the predictive role of the leukocyte glucose index (LGI) values at baseline in diagnosing the severity of DKA and their correlation with the presence of diabetes-related microvascular complications. Materials and Methods: A retrospective observational study was conducted involving a total of 94 patients who had previously confirmed diagnoses of either Type I or Type II diabetes mellitus and presented with ketoacidosis upon emergency admission to the Department of Diabetology, Nutrition, and Metabolic Disease. Demographic information, values of arterial systolic and diastolic pressure, known duration and type of diabetes, severity of ketoacidosis, routine laboratory results, and blood gas analyses were retrieved from the hospital’s electronic database. Results: Higher diastolic blood pressure (DBP) values were observed in both mild (p = 0.021) and severe DKA (p = 0.035) compared to moderate DKA. When examining laboratory data, elevated white blood cell (WBC) counts were observed in severe DKA when compared to mild DKA (p = 0.009), as well as increased neutrophil counts in both moderate (p = 0.038) and severe (p = 0.011) DKA relative to mild DKA. Furthermore, patients with severe DKA exhibited lower values of venous blood pH, partial pressure of carbon dioxide (pvCO₂), base excess (BE), and bicarbonate than the other groups (all p < 0.05), alongside higher levels of lactate, anion gap, and LGI (all p < 0.05). Regarding the parameters of arterial blood gas, we identified a negative correlation between LGI values and venous blood pH (r = −0.383, p < 0.001), serum bicarbonate (r = −0.352, p < 0.001), pCO₂ (r = −0.271, p = 0.009), and BE (r = −0.330, p < 0.001). At univariate analysis, elevated LGI values are associated with the severity of DKA (OR: 1.87, p = 0.016) and diabetes-related microvascular complications (OR: 2.16, p = 0.010). Conclusions: The positive correlation between LGI and DKA severity and between LGI and diabetes microvascular complications highlights the potential utility of LGI as a predictive marker, facilitating early risk stratification and clinical decision-making.

Background: Chronic limb-threatening ischemia (CLTI) represents the advanced stages of peripheral arterial disease (PAD) and is caused by atherosclerotic damage in the lower limbs, having a greater risk of major amputation. Aim: The aim of this study was to analyze the impact of systemic immune index (SII), systemic inflammation response index (SIRI), and the aggregate index of systemic inflammation (AISI) on the clinical severity and long-term risk of amputation among patients with CLTI after percutaneous transluminal angioplasty (PTA). Material and Methods: This is a retrospective observational study involving 104 patients diagnosed with CLTI and treated with PTA. Based on clinical severity, the cohort was divided into two groups: stage III Leriche-Fontaine and stage IV Leriche-Fontaine. Results: We observed higher levels of SII (p = 0.027), SIRI (p = 0.0008), and AISI (p = 0.0024) in patients with trophic lesions. Kaplan–Meier analysis showed that patients with values of SII (p = 0.008), SIRI (p = 0.022), and AISI (p = 0.006) above the median at the time of admission are at a higher risk of major amputation in the long term following PTA. At the multivariate regression analysis, high baseline values of SIRI (odds ratio (OR) = 2.28; p = 0.017) and AISI (OR = 2.32; p = 0.043) were associated with stage IV Leriche-Fontaine, but not SII (OR = 1.71; p = 0.055). Additionally, in the Cox regression analysis, we found that SII (hazard ratio (HR) = 1.56; p = 0.010), SIRI (HR = 1.63; p = 0.009), and AISI (HR = 1.55; p = 0.016) are predictive factors for long-term risk of major amputation after endovascular treatment. Conclusions: Elevated levels of SIRI and AISI have been found to be linked with the severity of clinical symptoms and an increased risk of long-term major amputation in patients with CLTI following PTA. Additionally, higher baseline values for SII were associated with a greater risk of major amputation, but not with clinical severity in the same group of patients.

Background: Peripheral artery disease (PAD), traditionally affecting older adults, is increasingly diagnosed in younger patients, highlighting the need for early, non-invasive biomarkers such as the leukocyte glycemic index (LGI) that reflect the inflammatory mechanisms driving atherosclerosis. The aim of this study was to determine whether the LGI can be associated with the presence of symptomatic atherosclerotic disease on patients under 45 years. Methods: We conducted a retrospective observational study, enrolling all patients under the age of 45 years who were admitted to the Department of Vascular Surgery of Targu Mures County Emergency Clinical Hospital between January 2019 and May 2024. Patients were categorized into two groups based on the presence or absence of systemic atherosclerosis. Results: Patients with systemic atherosclerosis had a higher incidence of cerebrovascular events (p = 0.006) and ischemic heart disease (p = 0.038), as well as elevated counts of white blood cells (WBCs) (p = 0.003), platelets (p = 0.038), neutrophils (p = 0.002), monocytes (p = 0.024), lymphocytes (p = 0.01), and LGI (p = 0,006). At the receiver operating characteristics analysis, we observed a significant correlation between the baseline values of the LGI and systemic atherosclerosis (p = 0.004). The area under the curve (AUC) was determined to be 0.707, with an optimal cut-off value established at 0.683, resulting in a sensitivity of 79.2% and a specificity of 60.6%. Additionally, elevated baseline values for platelets (OR 2.18; p = 0.017), WBCs (OR 2.06; p = 0.020), neutrophils (OR 2.75; p = 0.004), lymphocytes (OR 2.47; p = 0.021), monocytes (OR 2.03; p = 0.021), and LGI (OR 2.90; p = 0.024) were also identified as predictive factors of systemic atherosclerosis. Conclusions: Elevated values of LGI are associated with the presence of symptomatic atherosclerotic disease in patients under 45 years.

We report the case of a 44-year-old man with end-stage kidney disease (ESKD) who has been on chronic hemodialysis via a radio-cephalic arteriovenous fistula (RC-AVF) for one year. The patient arrived at the emergency department due to an inability to continue dialysis through the AVF. Clinical and ultrasound exams reveal an aneurysm in the cephalic vein, measuring 2.3 cm (cm) in diameter and 5 cm long, located in the middle third of the forearm, with intraluminal thrombosis. A surgical procedure is planned to exclude the aneurysmal segment and reconnect the vein, using a graft made from a bovine pericardium patch. Immediately after surgery, a thrill is detectable, and ultrasound shows a flow rate of 651 mL/min. On the second day, dialysis is performed through the distal cephalic vein segment under ultrasound guidance, avoiding the median forearm zone. At one month, the fistula remains functional, with no signs of thrombosis or stenosis. The bovine pericardium tubular graft has shown complete integration. This case supports the feasibility, safety, and potential advantages of using a tubularized bovine pericardial graft as an alternative conduit for RC-AVF reconstruction in select patients. However, further studies on larger cohorts and with extended follow-up are necessary to validate its reproducibility and long-term patency.

Background and Objectives: Atherosclerosis is a chronic inflammatory disease significantly contributing to cardiovascular morbidity and mortality. This study primarily aims to evaluate the role of baseline blood glucose levels and inflammatory markers in the histopathological features of atherosclerotic plaques in the carotid and femoro-popliteal arteries. Materials and Methods: In this retrospective, observational, and monocentric study, 165 patients diagnosed with infrainguinal peripheral arterial disease or carotid artery disease hospitalized in the Vascular Surgery Clinic, between January 2019 and December 2023, were included. From the electronic database of the hospital, we documented demographic data, cardiovascular comorbidities, including hypertension, atrial fibrillation, ischemic heart disease, and chronic heart failure, as well as chronic kidney disease, diabetes, and prevalent risk factors such as active smoking, dyslipidemia, and obesity. Additionally, we recorded the arterial site from which the atherosclerotic plaque was obtained, along with laboratory data obtained at the time of admission prior to the surgery. The patients were divided into “Carotid Artery” and “Femoro-Popliteal Axis” based on anatomical location. Results: A greater prevalence of male patients (p = 0.008) and dyslipidemia (p = 0.002) was found in the group with atherosclerotic plaques from the femoro-popliteal axis. Laboratory data also showed increased lymphocyte (p = 0.020) and PLT (p = 0.028) levels in this group. There was no significant difference in the types of atherosclerotic plaques between the two patient groups. However, those in the Carotid Artery group showed a higher rate of antiaggregant treatment and a reduced incidence of dual therapy (p < 0.001). The Spearman correlation analysis revealed a positive correlation between baseline glucose levels and NLR (r = 0.402, p < 0.001), MLR (r = 0.217, p = 0.005), PLR (r = 0.306, p < 0.001), and LGI (r = 0.693, p < 0.001). Furthermore, the predictive roles of glucose, NLR, MLR, and LGI were assessed through multivariate analysis. Consequently, elevated baseline values of the parameters above were associated with unstable atherosclerotic plaques, independent of demo-graphic data, standard cardiovascular risk factors, site of artery harvest, and chronic vascular treatments at the time of admission (for all p < 0.05). Conclusions: This study highlights the significant relationships between glucose levels and various inflammatory markers in patients with different histopathological diagnoses of atherosclerotic plaques. Additionally, elevated glycemic and systemic inflammation biomarkers were associated with unstable atherosclerotic plaque, independent of demographic data, comorbidities, cardiovascular risk factors, anatomical artery harvest, and vascular chronic medication at the time of admission.