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Background/Objectives: Transarterial chemoembolization (TACE) is a widely accepted and minimally invasive treatment for primary and metastatic liver cancer. Performing TACE with drug-eluting beads helps obtain a greater drug concentration in the target lesion, significantly reducing systemic drug leakage, liver toxicity, and adverse events. The aim of this study is to describe the safety and feasibility of TACE performed with BioPearlTM, the first biodegradable drug-eluting microspheres. Methods: This was a retrospective observational study on 13 consecutive patients affected by hepatocellular carcinoma (HCC) treated with doxorubicin-loaded-BioPearlTM-TACE. Data on safety, feasibility, and tumor response were collected. Results: One intra-procedural catheter blockage was registered, as well as two post-treatment bilomas that required additional treatment. No severe general drug-related side effects were detected at the follow-up. The 1-month overall disease control was 90.9%, with six complete responses. Conclusions: Data suggest that chemoembolization with BioPearlTM is feasible and safe for the treatment of HCC as indicated by good tolerability.

Purpose These guidelines are intended for use in assessing the standard for technical success and safety in aorto-iliac percutaneous endovascular interventions. Methods Any recommendation contained in the text comes from the highest level and extension of literature review available to date. Results The success of endovascular procedures is strictly related to an accurate planning based mainly on CT- or MR-angiography. TASC II A through C lesions have an endovascular-first option Pre-procedure ASA antiplatelet therapy is advisable in all cases. The application of stents improves the immediate hemodynamic and most likely long-term clinical results. Cumulative mean complication rate is 7.51 % according to the most relevant literature. Most of the complications can be managed by means of percutaneous techniques. Conclusion The design and quality of devices, as well as the easy and accuracy of performing these procedures, have improved over the last decades, leading to the preferential treatment of aorto-iliac steno-obstructive disease via endovascular means, often as first-line therapy, with high technical success rate and low morbidity. This is mirrored by the decreasing number of patients undergoing surgical grafts over the last years with patency, limb salvage, and survival rates equivalent to open reconstruction.

Chronic limb-threatening ischemia (CLTI) significantly increases the risk of major adverse limb events (MALE) and major adverse cardiac events (MACE) after lower extremity revascularization (LER). This study aims to identify novel biomarkers that help to further reduce the risk of postoperative cardiovascular complications. In this prospective, nonrandomized, observational study, baseline serum levels of sirtuin 1 (SIRT1) were assessed in 147 diabetic patients scheduled for LER due to CLTI, and participants were followed for the occurrence of MALE and MACE over 12 months. Fifty-three patients experienced MALE, and 33 experienced MACE within the follow-up period. Lower baseline SIRT1 levels were significantly associated with an increased risk of MALE and MACE, independent of other risk factors. The ROC curve analysis identified a SIRT1 cutoff of 3.79 ng/mL for predicting the risk of MALE. Moreover, incorporating SIRT1 into predictive models significantly enhanced the accuracy of predicting adverse outcomes. Results suggest serum SIRT1 is a potential independent marker for predicting MALE and MACE in diabetic patients with CLTI undergoing LER. Further research is needed to clarify the mechanistic pathways in which SIRT1 may influence cardiovascular outcomes, and the role of this novel biomarker in the management of PAD and CLTI among patients with diabetes.

Background Cardiovascular complications represent the major cause of morbidity and mortality of type 2 diabetes mellitus (T2DM) patients. In particular, peripheral artery disease (PAD) represents a frequent T2DM vascular complication and a risk factor for the development of major adverse cardiovascular events (MACE). Among adipokines, omentin-1 serum levels are reduced in T2DM patients with PAD and are inversely related to disease severity. Objective To study the relationship between omentin-1 levels, at baseline, with outcomes after endovascular procedures in T2DM patients with PAD and chronic limb-threatening ischemia (CLTI). Research design and methods We enrolled for our prospective non-randomized study, 207 T2DM patients with PAD and CLTI, requiring revascularization. Omentin-1 serum levels were collected before revascularization and patients incidence outcomes were evaluated at 1, 3, 6 and 12 months. Results Omentin-1 was reduced in patients with more severe disease (27.24 ± 4.83 vs 30.82 ± 5.48 ng/mL, p < 0.001). Overall, 84 MACE and 96 major adverse limb events (MALE) occurred during the 12-month follow-up. We observed that omentin-1 levels were lower in patients with MACE (26.02 ± 4.05 vs 31.33 ± 5.29 ng/mL, p < 0.001) and MALE (26.67 ± 4.21 vs 31.34 ± 5.54 ng/mL, p < 0.001). The association between omentin-1, MACE and MALE remained significant after adjusting for major risk factors in a multivariate analysis. Receiver operating characteristics (ROC) curve using omentin-1 levels predicted incidence events (area under the curve = 0.80). Conclusions We demonstrated that reduced omentin-1 levels, at baseline, are related with worse vascular outcomes in T2DM patients with PAD and CLTI undergoing an endovascular procedure.

We aimed to perform an anatomical evaluation of the carotid bulb using CT-angiography, implement a new reliable index for carotid stenosis quantification and to assess the accuracy of relationship between NASCET and ECST methods in a large adult population. The cross-sectional areas of the healthy carotid at five levels were measured by two experienced radiologists. A regression analysis was performed in order to quantify the relationship between the areas of the carotid bulb at different carotid bulbar level. A new index (Regression indeX, RegX) for carotid stenosis quantification was proposed. Five different stenoses with different grade in three bulbar locations were simulated for all patients for a total of 1365 stenoses and were used for a direct comparison of the RegX, NASCET, and ECST methods. The results of this study demonstrated that the RegX index provided a consistent and accurate measure of carotid stenosis through the application of the ECST method, avoiding the limitations of NASCET method. Furthermore, our results strongly depart from the consolidated relationships between NASCET and ECST values used in clinical practice and reported in extensive medical literature. In particular, we highlighted that a major misdiagnosis in patient selection for CEA could be introduced because of the large underestimation of real stenosis degree provided by the NASCET method. A reappraisal of carotid stenosis patients’ work-up is evoked by the effectiveness of state-of-the-art noninvasive contemporary carotid imaging.

Cardiovascular complications after lower extremity revascularization (LER) are common in diabetic patients with peripheral arterial disease (PAD) and chronic limb threatening ischemia (CLTI). The Klotho-fibroblast growth factor 23 (FGF23) axis is associated with endothelial injury and cardiovascular risk. We aimed to analyze the relationship between Klotho and FGF23 serum levels and the incidence of major adverse cardiovascular events (MACE) and major adverse limb events (MALE) after LER in diabetic patients with PAD and CLTI. Baseline levels of Klotho and FGF23, and their association with subsequent incidence of MACE and MALE were analyzed in a prospective, non-randomized study in a population of diabetic patients with PAD and CLTI requiring LER. A total of 220 patients were followed for 12 months after LER. Sixty-three MACE and 122 MALE were recorded during follow-up period. Baseline lower Klotho serum levels (295.3 ± 151.3 pg/mL vs. 446.4 ± 171.7 pg/mL, p  < 0.01), whereas increased serum levels FGF23 (75.0 ± 11.8 pg/mL vs. 53.2 ± 15.4 pg/mL, p  < 0.01) were significantly associated with the development of MACE. Receiver operating characteristic (ROC) analysis confirmed the predictive power of Klotho and FGF23 baseline levels. Furthermore, decreased Klotho levels were associated with the occurrence of MALE after LER (329.1 ± 136.8 pg/mL vs 495.4 ± 183.9 pg/mL, p  < 0.01). We found that Klotho and FGF23 baseline levels are a potential biomarker for increased cardiovascular risk after LER in diabetic patients with PAD and CLTI.

Background Chronic limb-threatening ischemia (CLTI) presents a major clinical challenge in patients with Type 2 Diabetes Mellitus (T2DM), requiring lower extremity revascularization (LER) to mitigate adverse cardiovascular and limb outcomes. Lipoprotein(a) (Lp(a)) has been implicated in cardiovascular risk, but its role in patients with T2DM and CLTI undergoing revascularization remains unclear. Thus, this study aimed to investigate the prognostic value of Lp(a) levels in diabetic CLTI patients for major adverse cardiovascular events (MACE), major adverse limb events (MALE), or both after LER. Methods In this prospective cohort study of 158 individuals with T2DM and CLTI undergoing LER, baseline clinical data were collected, including Lp(a) levels. Patients were followed for occurrence of MACE, MALE, or both over a 12-month period. Results During follow-up, 74 patients (46.8%) experienced events (MACE, MALE, or both). Patients with events had significantly higher median Lp(a) levels than those without (48.0 vs. 8.1 mg/dL, p  < 0.01). Lp(a) was independently associated with adverse events (HR 1.07, 95% CI 1.04–1.10; p  < 0.01). In multivariable analysis, elevated Lp(a) was independently associated with both MACE (HR 1.08, 95% CI 1.03–1.13; p  < 0.01) and MALE (HR 1.05, 95% CI 1.02–1.07; p  < 0.01). An empirical Lp(a) cutoff of 29.6 mg/dL conferred a 3.8-fold increased risk of events ( p  < 0.01). Kaplan–Meier survival analysis further confirmed a significantly higher cumulative incidence of events in patients with Lp(a) levels above cutoff ( p  < 0.01). ROC curve comparison analysis showed that the inclusion of Lp(a) significantly improved the predictive performance of the base clinical model (AUC from 0.74 to 0.98, p  < 0.01 for composite outcome; from 0.81 to 0.89, p  = 0.03 for MACE; and from 0.78 to 0.92, p  < 0.01for MALE). Conclusions This study demonstrated that Lp(a) is a strong independent predictor of both cardiovascular and limb events in patients with T2DM undergoing LER for CLTI. These findings support the potential role of Lp(a) as a marker of residual risk in this high-risk population and suggest its utility in risk stratification.

We previously developed and validated LAPDOCTOR (LAParoscopic-Donor-nephreCTomy-scORe), a novel scoring system for the preoperative assessment of the difficulty of living donor nephrectomy (LDN). To prove its significance, we extended our investigation to a prospective, multicenter, national study. Difficulty was assessed by the operating surgeon using a scale from 1 to 3 (1-standard, 2-moderately difficult, 3-very difficult) based on eight parameters: availability of laparoscopic space, mobilization of the colon, kidney, gonadal, adrenal and renal vein, renal artery, and ureter. Donor CT-scans were blindly reviewed by a radiologist, and the LAPDOCTOR scores were compared with the difficulty levels assigned by the surgeon to investigate the match rates. One hundred eighty-five donors were enrolled, with a mean age of 54 years (range 24–77), BMI 25 kg/m2 (range 17–35), and male/female 59/126. LDN was blindly scored as standard in 45% of the cases, moderately-difficult in 52%, and very-difficult in 3%. The agreement between the LAPDOCTOR and expert donor surgeons’ rate in categorizing LDN into risk groups had a QWK of 0.711 (95% CI 0.577–0.844) with p < 0.001. The LAPDOCTOR enables precise preoperative determination of the difficulty of LDN, particularly in very difficult cases, and assessment of surgical risk in living kidney donors.

The global burden of liver metastases from different primary lesions is increasing, resulting in significant challenges for public health systems. Accordingly, colorectal cancer (CRC) remains a leading cause of cancer-related mortality, with a high incidence of liver metastases. Although surgical resection is considered the standard curative treatment, it is only viable for a limited subset of patients. This review aims to describe a potential alternative nonsurgical intervention, such as electrochemotherapy (ECT), in the treatment of CRC oligometastatic liver disease. ECT has been largely used for the treatment of cutaneous and subcutaneous lesions, while its visceral use is currently a novel approach. ECT consists of the administration of intravenous anticancer drugs, followed by the application of intralesional electrode needles, which release localized electrical pulses to induce electroporation, a process that transiently increases cell membrane permeability, thereby facilitating the intracellular delivery of otherwise membrane-impermeable drugs. The main topics of this review focus on the technical and clinical applications, efficacy, safety, and possible complications of ECT for CRC liver metastases. A comparison with other locoregional treatments is also performed, highlighting possible advantages and disadvantages.

Aim of this study is to evaluate any differences in VWF antigen, VWF activity and ADAMTS-13 activity before and after successful and non-successful Percutaneous Transluminal Angioplasty (PTA) in subjects with type 2 diabetes (T2DM) complicated by Chronic limb-threatening ischemia (CLTI) in diabetic foot vasculopathy. In this prospective observational pilot study, we enrolled 35 T2DM subjects who underwent lower limb PTA. Transcutaneous oximetry was performed in all patients before and 6 weeks after PTA. The change in oxygen partial pressure (TcpO2) before and after PTA was expressed as TcpO2-delta (ΔTcpO2). VWF antigen, VWF activity and ADAMTS-13 activity were measured before and 6 weeks after PTA; changes were expressed as delta and ratio from baseline. Subjects with ∆TcpO2 < 15 mmHg presented higher ΔVWF activity (p = 0.050) and lower ADAMTS-13 activity ratio (p = 0.080). Subjects with ∆TcpO2 < 30 mmHg showed lower ADAMTS-13 activity Δ and ratio (p = 0.028). VWF antigen levels and VWF activity may potentially affect PTA outcome. Higher levels of VWF could derive from VWF release as consequence of PTA-induced mechanical endothelial damage and/or oxidative stress-induced modifications of VWF structure with impairment of VWF-ADAMTS13 interactions. •Diabetic subjects have higher incidence of re-stenosis after lower limb PTA but the mechanisms involved are not well defined•The higher risk of re-stenosis could be due to the development of thrombotic angiopathies•von Willebrand Factor is involved in the onset of thrombotic angiopathies•von Willebrand Factor hyperactivity and/or its altered interaction with ADAMTS-13 could affect the outcome of lower limb Percutaneous Transluminal Angioplasty in diabetic subjects