Vascular graft or endograft infections (VGEIs) pose significant challenges due to their rarity and potential for severe complications. Direct identification of micro-organisms is highly recommended by the European Society for Vascular Surgery guidelines, yet standardised approaches are limited to the literature. Percutaneous drainage followed by lifelong suppressive antimicrobial therapy offers a viable alternative for high risk patients. This study evaluated the diagnostic and therapeutic implications of percutaneous cultures in abdominal and peripheral VGEIs and assessed the efficacy of conservative treatment when surgery is unfeasible. This was a retrospective cohort study of all patients admitted to a tertiary referral centre with suspected abdominal or peripheral VGEI, according to Management of Aortic Graft Infection Collaboration (MAGIC) criteria, and who underwent percutaneous procedures between 2017 and 2023. The diagnostic accuracy of percutaneous cultures was evaluated by comparing their results with the final diagnosis of VGEI based on MAGIC criteria, and analysing the sensitivity, specificity, positive predictive value, and negative predictive value. Additionally, the influence of percutaneous cultures on antibiotic therapy adjustment and conservative treatment choice was investigated. Survival outcomes were compared between patients who were conservatively treated and those who underwent total or partial surgical graft removal. The study included 69 patients: 45 with suspected abdominal VGEI and 24 with suspected peripheral VGEI. Percutaneous culture results statistically significantly correlated with VGEI diagnosis (p = .023 and p = .048, respectively), with a sensitivity and specificity of 50% and 70% in abdominal infections and 80% and 68% in peripheral infections, respectively. Percutaneous procedures statistically significantly impacted the choice of antibiotic therapy (p < .001 and p = .011). Overall survival for conservative treatment was comparable with surgical graft extraction (p= .63 and p = .25). Percutaneous cultures offer high specificity for VGEI diagnosis and can be used to guide effective personalised antibiotic therapy. For inoperable patients, drainage with lifelong antimicrobial treatment is a valuable conservative option.

Objective: The neutrophil–lymphocyte ratio (NLR) is an inexpensive and easily available inflammatory marker for cardiovascular disease. The aim of the present study is to evaluate a possible association between preoperative NLR value and popliteal artery aneurysm (PAA) repair outcomes. Methods: A single-center retrospective study on all patients, who underwent urgent or elective PAA repair from June 2010 to October 2022, was performed. Study outcomes were immediate technical success, 30-day and mid-term primary patency, reintervention, limb salvage, and mortality rates. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count, and, according to the literature, a cut-off of five has been considered as a possible threshold for the analysis. Results: Eighty-two patients (80 male) with a total of 97 popliteal artery aneurysms were enrolled in this study. The mean preoperative NLR was 2.9 ± 2.4. In 10 (10.3%) PAAs, the NRL was >5 (High-NLR group), and, in the remaining 87 (89.7%), the NLR was <5 (Low-NLR group). The preoperative NLR for urgent procedures was higher than elective cases (4.37 vs. 2.30; p < 0.001). However, no significant differences were found as far as immediate 24 h technical success (p = 0.48) and 30-day primary patency (p = 39). At mean follow-up, the primary patency rate was significantly higher in the Low-NLR group (p = 0.0044), without statistical differences for re-operation (p = 0.27), limb salvage (p = 0.09), and mortality rates (p = 0.51). The Kaplan–Mayer analysis showed a significant difference in freedom from major amputation in patients with an NLR > 5 compared to the ones with an NLR < 5 (p = 0.038), without any differences in terms of survival, primary patency, and the need for reintervention rates. The multivariable Cox regression analysis identified the NLR value as an independent predictor of better outcomes regarding freedom from the amputation rate (p = 0.25). Conclusions: Our experience indicates that a preoperative NLR value > 5 can identify high-risk patients affected by a PAA and may negatively influence the surgery’s long-term outcomes. Therefore, this selected group of patients could need a more tailored approach and closer monitoring over time.

Introduction: The neutrophil–lymphocyte ratio (NLR) has proven to be an inexpensive and easily available inflammatory marker for cardiovascular disease. The aim of the present study is to evaluate a possible association between preoperative NLR value and endovascular aneurysm repair (EVAR) outcomes. Methods: A multicentric retrospective study of patients undergoing EVAR in elective setting between 2015 and 2023 was performed. Preoperative NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count, and a cut-off of 5 was used as threshold for the analysis. Primary outcomes (technical success, endograft occlusion, AAA-related reintervention, endoleaks, and mortality rates) were compared between the NLR < 5 and the NLR > 5 group. Kaplan–Meier survival analysis was employed to assess overall survival and the incidence of long-term complications. Results: The study initially considered 1360 patients. Eventually, 823 patients were included in the study, of whom 129 (15.7%) with NLR > 5. The latter group presented a higher AAA diameter (59.1 mm vs. 55, mm; p = 0.004). Technical success was obtained in 98,9% of all enrolled patients. NLR values were significantly associated with ASA class (p = 0.014), involvement of the iliac arteries (p = 0.023), duration of ICU stays (p < 0.001), and overall length of hospitalization ( 5 showed a significant lower survival rates (p = 0.006), while no significant differences were found in terms of endograft occlusion (p = 0.45), AAA-related reintervention (p = 0.63), and endoleaks (p = 0.49). Conclusions: This study highlights the association between the NLR value and an elevated risk of long-term mortality, highlighting its role as an indicator of the patient’s overall clinical condition rather than immediate surgical outcomes. Focusing on this selected group of patients can improve postoperative care and reduce long-term complications.

Objective: To evaluate the outcome of frail patients electively treated for abdominal aortic aneurysm (AAA) by open surgery with enhanced repair protocol (OSER) or endovascular aneurysm repair (EVAR). Design: A retrospective study on frail AAA patients treated by EVAR and OSER was conducted. Patients were defined as frail if they present a normalized total psoas muscle area (nTPA) <500 mm2/m2. This study aimed to evaluate the association between sarcopenia and AAA-related as well as all-cause mortality rates. Secondary outcomes included reinterventions, operative time, blood transfusion, length of intensive care unit (ICU), and postoperative hospital stay. Results: A total of 403 patients were included in the study, of which 122 (30.3%) had a nTPA < 500mm2/m2. Among them, 272 (67.5%) patients were treated with EVAR while 131 (32.5%) with OSER. Although EVAR was more frequently performed in sarcopenic patients than OSER (P<0.001), there were no significant differences between the 2 groups in terms of intraoperative and postoperative outcomes. Likewise, no statistically significant differences were found regarding mortality and reintervention rates at Kaplan-Meier analysis. However, sarcopenic patients undergoing OSER exhibited a significantly higher all-cause mortality rate at 1 month (P = 0.031) and cumulative follow-up (P = 0.004) compared to all other subgroups. Conclusions: The present experience demonstrates that less invasive approaches, but surgical or endovascular, are viable for AAA patients with no significant difference in intraoperative and immediate postoperative outcomes. Nevertheless, the potential of EVAR as a preferred strategy should be considered for frail patients based on ascertained sarcopenia.

Intravesical Bacille Calmette-Guérin (BCG) immunotherapy is a well-established treatment for bladder cancer. Although generally safe, rare but severe complications such as Mycobacterium bovis-induced infected native arterial aneurysms (INAAs) can occur. These complications present diagnostic and therapeutic challenges due to their delayed onset and nonspecific symptoms. This systematic review aims to evaluate the causes, clinical presentation, diagnostic strategies, and management of BCG-induced INAA and to report an additional clinical case from the present institution. A systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. PubMed was searched for English-language case reports published up to March 2025, describing arterial aneurysms as complications of intravesical BCG immunotherapy. Inclusion criteria required documented BCG treatment, no prior aneurysm, and microbiological or clinical confirmation of INAA. A total of 56 case reports involving 58 patients were included. Most patients were male (98%) with a mean age of 72.2 years (standard deviation (SD) ± 7.7). Abdominal aortic aneurysms were most frequent (70.4%), followed by thoracic and peripheral aneurysms. The median interval between BCG instillations and INAA diagnosis was 12 months (interquartile range (IQR): 7.5-27.5). Treatment included open surgical repair (69%), endovascular repair (24.1%), and conservative management (3.5%). The median duration of antimicrobial treatment was 9 months (IQR 8-12). Overall mortality was 15.7%, and the complication rate was 33.3%. BCG-induced INAA is a rare but life-threatening complication, and early recognition is critical. Optimal management involves targeted antimicrobial therapy and timely surgical intervention, either open or endovascular, based on the patient's condition and aneurysm characteristics.

Background: Parkinson disease (PD) is the second most common neurodegenerative disease, affecting approximately 1% of the world’s population. Increasing evidence suggests that aerobic physical exercise can be beneficial in mitigating both motor and nonmotor symptoms of the disease. In a recent pilot study of the role of exercise on PD, we sought to confirm exercise intensity by monitoring heart rate (HR). For this purpose, we asked participants to wear a chest strap HR monitor (Polar Electro Oy) and the Fitbit Charge 4 (Fitbit Inc) wrist-worn HR monitor as a potential proxy due to its convenience. Polar H10 has been shown to provide highly accurate R-R interval measurements. Therefore, we treated it as the gold standard in this study. It has been shown that Fitbit Charge 4 has comparable accuracy to Polar H10 in healthy participants. It has yet to be determined if the Fitbit is as accurate as Polar H10 in patients with PD during rest and exercise.Objective: This study aimed to compare Fitbit Charge 4 to Polar H10 for monitoring HR in patients with PD at rest and during an intensive exercise program.Methods: A total of 596 exercise sessions from 11 (6 male and 5 female) participants were collected simultaneously with both devices. Patients with early-stage PD (Hoehn and Yahr ≤2) were enrolled in a 6-month exercise program designed for patients with PD. They participated in 3 one-hour exercise sessions per week. They wore both Fitbit and Polar H10 during each session. Sessions included rest, warm-up, intense exercise, and cool-down periods. We calculated the bias in the HR of the Fitbit Charge 4 at rest (5 min) and during intense exercise (20 min) by comparing the mean HR during each of the periods to the respective means measured by Polar H10 (HRFitbit – HRPolar). We also measured the sensitivity and specificity of Fitbit Charge 4 to detect average HRs that exceed the threshold for intensive exercise, defined as 70% of an individual’s theoretical maximum HR. Different types of correlations between the 2 devices were investigated.Results: The mean bias was 1.68 beats per minute (bpm) at rest and 6.29 bpm during high-intensity exercise, with an overestimation by Fitbit Charge 4 in both conditions. The mean bias of the Fitbit across both rest and intensive exercise periods was 3.98 bpm. The device’s sensitivity in identifying high-intensity exercise sessions was 97.14%. The correlation between the 2 devices was nonlinear, suggesting Fitbit’s tendency to saturate at high values of HR.Conclusions: The performance of Fitbit Charge 4 is comparable to Polar H10 for assessing exercise intensity in a cohort of patients with PD (mean bias 3.98 bpm). The device could be considered a reasonable surrogate for more cumbersome chest-worn devices in future studies of clinical cohorts.