To identify risk factors for recurrent thromboembolic events (RTEs) and define the optimum duration of treatment with tinzaparin in patients with superficial vein thrombosis (SVT) of the lower limbs. A total of 147 consecutive patients with significant SVT were treated with subcutaneously administered tinzaparin. The composite primary endpoint of the study was RTE, deep-vein thrombosis (DVT) and/or pulmonary embolism (PE) at 120 days. Patients were stratified into group A, where patients received a variable dose of tinzaparin for up to 60 days (n=98), and a subsequent group B-ext, where patients received a standardized intermediate dose of tinzaparin (n=49) for 90 days. RTEs occurred in 15/147 patients (10.2%), including recurrent SVT (n=10), DVT (n=4) and fatal PE (n=1). RTEs were less frequent in group B-ext (0% vs. 15.3% for group A, P=0.004), a difference that remained significant at the one-year follow-up. Clinically extensive SVT was an independent predictor for RTEs (hazard ratio, 5.94; 95% confidence interval, 2.05-17.23; P=0.001, Cox regression). Predictors or DVT or PE in group A included clinically extensive SVT (P=0.004), absence of local pain (P=0.023) and the ultrasound findings of superficial axial vein thrombosis (any, P=0.006 or isolated, P=0.036) and multiple thrombosed superficial venous sites (P<0.001). An extended three-month regimen of tinzaparin in patients with SVT of the lower limbs is more effective than a shorter course and may be desirable in patients with risk factors.

Background: Psychosocial factors such as anxiety, depression, and lack of social support are increasingly recognized as critical determinants of outcomes in cardiac surgery. Up to 32% of patients experience preoperative anxiety, and nearly 20% experience depression, both of which have been associated in observational studies with delayed recovery, increased complications, and higher mortality. Objective: This study aimed to review current evidence on psychosocial aspects of cardiac surgery and evaluate patient-centered care strategies that address these challenges. Methods: A narrative literature review was performed using PubMed, Scopus, and ScienceDirect, focusing on recently published studies. The search covered studies published between January 2009 and June 2024, yielding 76 eligible studies after screening and thematic synthesis. Search terms included patient-centered care, psychosocial factors, cardiac surgery, anxiety, depression, rehabilitation, and telemedicine. Eligible studies included randomized controlled trials, cohort studies, qualitative studies, and systematic reviews. Results: Key themes included preoperative psychological preparation, management of anxiety and depression, promotion of quality of life, effective communication strategies, and integration of psychosocial support into rehabilitation programs. Evidence shows that psychological and social interventions reduce reported pain by up to 33%, as reported in pooled randomized controlled trials and meta-analyses; shorten hospital stay; improve adherence to treatment; and enhance long-term quality of life. Emerging tools such as telemedicine and digital platforms further expand access to psychosocial care. Conclusions: Integrating psychosocial care into cardiac surgery is essential for achieving holistic outcomes. Patient-centered models that emphasize communication, shared decision-making, family involvement, and digital support improve not only survival but also recovery, well-being, and patient satisfaction. Redefining success in cardiac surgery requires attention to both clinical results and the broader human experience of illness and recovery.

Patients who undergo endovascular aortic aneurysm repair (EVAR) may require prolonged radiation exposure affected by several factors. The objectives of this study were to document fluoroscopy time (FT) during EVAR and identify possible factors that influence it. A retrospective analysis of a 180 patients’ database with abdominal infrarenal aortic aneurysms submitted to EVAR during a 7-y period was performed. The FT is evaluated regarding risk factors and comorbidities, graft type and patient-related, clinical and technical parameters. FT’s median (interquartile range) was 1011 (698–1500) s. Excluder and C3 Excluder were associated with significantly lower FT values when compared with other grafts. Hypertension, dyslipidemia, age ≥ 70 y, maximum aneurysm diameter ≥ 6 cm and procedure duration ≥2 h resulted in higher FT values. A significantly lower FT was found for the operations performed in the 7th y of the study’s period compared with the previous 6 y, mainly because of the use of Excluder or C3 Excluder grafts. However, these grafts did not show any significant difference in FT values during the 7 y. A significant correlation between FT with age and procedure duration was found. Nevertheless, procedure duration is a poor FT predictor in linear and logistic regressions, although is significantly correlated with FT. Dyslipidemia, procedure duration and graft type are independent predictors of FT larger than the median, whereas only the procedure duration is a predictor for FT larger than the 75th percentile value. The identified factors regarding radiation protection issues should be considered when contemplating abdominal aortic aneurysm repair, however, without compromising the procedure’s efficacy. Further work is necessary to identify more potential anatomical, clinical and technical factors affecting procedures’ complexity and FT and patient radiation dose during EVAR interventions.

Cardiopulmonary bypass (CPB) is one of the most groundbreaking medical innovations in history, enabling safe and effective heart surgery by temporarily replacing the function of the heart and lungs. This review starts with ancient concepts of cardiopulmonary function and then traces the evolution of CPB through important physiological and anatomical discoveries, culminating in the development of the modern heart–lung machine. In addition to examining the contributions of significant figures like Galen, Ibn al-Nafis, William Harvey, and John Gibbon, we also examine the ethical and technical challenges faced in the early days of open heart surgery. Modern developments are also discussed, such as miniature extracorporeal systems, off-pump surgical techniques, and the increasing importance of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS), while the evolving role of perfusionists in diverse cardiac teams and the variations in global access to CPB technology are also given special attention. We look at recent advancements in CPB, including customized methods, nanotechnology, artificial intelligence-guided perfusion, and organ-on-chip testing, emphasizing CPB’s enduring significance as a technological milestone and a living example of the cooperation of science, medicine, and human inventiveness because it bridges the gap between the past and the future.

Background: Cardiothoracic surgery is among the most technologically advanced and resource-intensive medical specialties, placing it at the intersection of rapid digital innovation and growing demands for environmental sustainability. Addressing these parallel pressures requires integrated strategies that reconcile clinical excellence with ecological responsibility. Methods: This narrative review synthesizes PubMed-indexed literature published over the past two decades, supplemented by relevant policy documents and guidelines. The review examines digital transformation and sustainability initiatives in cardiothoracic surgery through the lens of the twin transformation framework, which conceptualizes digitalization and sustainability as interdependent and mutually reinforcing processes. Results: Key domains of digital transformation include artificial intelligence and big data-driven decision-making, robotic and minimally invasive surgical techniques, digital twins and simulation-based training, telemedicine and remote monitoring, and interoperable electronic health records. Sustainability-related themes encompass the substantial environmental burden of operating rooms, green surgical practices, sustainable procurement, and hospital-level decarbonization strategies. Emerging evidence suggests that aligning digital technologies with sustainability objectives can improve clinical outcomes, enhance operational efficiency, and reduce environmental impact. However, current evidence is largely derived from pilot studies and single-center experiences. Conclusions: Twin transformation offers a coherent and forward-looking framework for the future evolution of cardiothoracic surgery, demonstrating that digital innovation and sustainability can be synergistic rather than competing goals. While significant challenges remain—including high implementation costs, limited long-term data, and fragmented regulatory frameworks—integrating digital health technologies with sustainable practices represents a promising pathway toward high-quality, efficient, and environmentally responsible cardiothoracic care.

Background: Common femoral artery aneurysms are rare and are usually associated with aneurysms at other sites, mainly the aorta, iliac, popliteal, superficial femoral, and profunda femoral artery. This combination poses the challenge of synchronous repair for clinically relevant aneurysms. Although endovascular abdominal aortic aneurysm repair is the main type of treatment for abdominal aortic aneurysms nowadays, this is not true for common femoral aneurysms, where open repair remains the gold standard. These two distinct operations could be combined in a one-stage procedure when aortoiliac and common femoral aneurysms present simultaneously. This approach potentially saves time and costs, without increasing complications. Methods: A retrospective search was conducted in the Vascular Surgery Department database of a tertiary referral center for vascular surgery, covering procedures from January 2005 to May 2025. Patients were included if they had undergone simultaneous endovascular abdominal aortic aneurysm repair and open repair of a common femoral artery aneurysm. Clinical records, operative details, imaging studies, and follow-up data were reviewed. We additionally provide a literature review regarding this approach. This review additionally incorporates the current knowledge regarding the treatment of common femoral artery aneurysms. Results: Out of 668 endovascular abdominal aortic aneurysm repair procedures, three patients (0.45%) were identified. These three patients were among five patients who were treated for true common femoral artery aneurysm by open repair in the same time interval. All of the patients are currently in good condition without late complications. One patient, who had not performed any follow-up imaging, was diagnosed with large aneurysms at other sites, 10 years later. Conclusions: The combined one-stage endovascular abdominal aortic repair and open repair of a common femoral artery aneurysm by interposition grafting is technically a simple approach that led to satisfactory outcomes.