Filippo Benedetto

Anti-inflammatory and Antioxidant Effects of Flavonoid-Rich Fraction of Bergamot Juice (BJe) in a Mouse Model of Intestinal Ischemia/Reperfusion Injury

The flavonoid-rich fraction of bergamot juice (BJe) has demonstrated anti-inflammatory and antioxidant activities. The aim of work was to test the beneficial effects of BJe on the modulation of the ileum inflammation caused by intestinal ischemia/reperfusion (I/R) injury in mice. To understand the cellular mechanisms by which BJe may decrease the development of intestinal I/R injury, we have evaluated the activation of signaling transduction pathways that can be induced by reactive oxygen species production. Superior mesenteric artery and celiac trunk were occluded for 30 min and reperfused for 1 h. The animals were sacrificed after 1 h of reperfusion, for both histological and molecular examinations of the ileum tissue. The experimental results demonstrated that BJe was able to reduce histological damage, cytokines production, adhesion molecules expression, neutrophil infiltration and oxidative stress by a mechanism involved both NF-κB and MAP kinases pathways. This study indicates that BJe could represent a new treatment against inflammatory events of intestinal I/R injury.

Natural killer cells in the innate immunity network of atherosclerosis.

Natural killer (NK) cells are innate lymphocytes which have recently been proposed to play an immunoregulatory role in the pathogenesis and progression of atherosclerosis. Although several studies have evaluated the frequency and the functions of NK cells both in human and in experimental animal models of atherosclerosis, it is yet not clear whether NK cells might behave as protective or pro-atherogenic effectors. Here, we review current knowledge regarding the role of NK cells in atherosclerosis and discuss the potential interactions that might occur in atherosclerotic lesions between NK cells and antigen presenting cells, such as macrophages and dendritic cells. A clearer depiction of the innate immune cell network operating in atherosclerosis might pave the way to novel interesting approaches for the prevention and treatment of this disease.

Type A aortic dissection involving the carotid arteries: carotid stenting during open aortic arch surgery

Aortic dissection involving the arch can be complicated by extension to the supra-aortic branches. Carotid dissection may be symptomatic or asymptomatic at the time of surgery. Dissection or re-dissection of repaired carotid may happen later, with symptoms occurring days after the surgical repair, increasing the morbidity and mortality of those patients. We report a case of a patient with type A aortic dissection involving the aortic arch and extending to the supra-aortic branches. During surgery the dissection was seen extending to the distal carotid arteries with tears in the inner wall. After use of surgical glue as a sealant, seeing the persistent fragility and the presence of spiral form tears in the internal wall of the carotid arteries, intraoperative stenting of the common carotid arteries was performed using two stents to prevent carotid re-dissection and ischemic stroke in the postoperative period. In patients with aortic dissection and extension into the carotid arteries, especially with presence of tears of the inner wall, after use of a glue as a sealant of the two dissected layers, if the repaired artery wall results are still fragile, use of intraoperative carotid stenting may be of help in preventing late re-dissection.

Interleukin-23 serum levels in patients affected by peripheral arterial disease.

OBJECTIVES To clarify whether interleukin (IL)-23 is involved in peripheral arterial disease (PAD). DESIGN AND METHODS We evaluated IL-23 serum levels, in 29 patients suffering from lower extremity PAD and in 30 healthy subjects. RESULTS IL-23 serum levels were higher during the three times (T0, T1 and T2) compared to the control group, although only statistically significant for T0 and T2: T0 (15.83 ± 22.08 vs. 8.08 ± 8.62 pg ml, p=0.026), T1 (16.10 ± 23.71 vs. 8.08 ± 8.62 pg/ml, p=0.101), T2 (15.06 ± 16.72 vs. 8.08 ± 8.62 pg/ml, p=0.005). CONCLUSION For the first time, our data gives us reason to believe there is an involvement of IL-23 in PAD.

Involvement of the aorta in brucellosis: the forgotten, life-threatening complication. A systematic review.

Human brucellosis is a disease of protean manifestations, and has been implicated in complications and focal disease in many human organ systems. However, little is collectively known about the background, the course, the clinical characteristics, the diagnostic issues raised, and the short- and long-term therapeutic approaches in patients with aortic involvement as a complication of brucellosis. With the aim to glean from the literature useful information to better understand and manage this complication, a computerized search without language restriction was conducted using PubMed and SCOPUS. An article was considered eligible for inclusion in the systematic review if it reported data on patients with involvement of the aorta due to a Brucella infection. The epidemiologic and clinical characteristics of 44 cases of brucellar aortic involvement found through the systematic review of the literature were analyzed together with those of two new cases that we treated in the recent past. This complication involved the ascending thoracic aorta in 18 cases (in 16 of them as a consequence of brucellar endocarditis), and the descending thoracic aorta or the abdominal aorta in the remaining 30 cases. In the latter it was associated with spondylodiscitis of the lumbar spine in 13 cases. History of or symptoms indicative of brucellosis were not universally present. Brucellar aortic involvement represents a possibly underdiagnosed and underreported complication with major morbidity and mortality potential. Experience with novel invasive therapeutic approaches remains limited. Early suspicion through detailed history and diagnosis, aided by advances in aortic imaging, would allow for better planning of therapeutic interventions.

Adjuvant spinal cord stimulation improves wound healing of peripheral tissue loss due to steal syndrome of the hand: clinical challenge treating a difficult case

Hand ischaemia due to arterial steal syndrome is an infrequent, but potentially serious complication of arteriovenous fistula (AVF) for haemodialysis.

Femoro-Distal Bypass with Varicose Veins Covered by Prosthetic Mesh

BACKGROUND The great saphenous vein (GSV) is the material of choice in distal bypass for critical limb ischemia (CLI). Varicosities have been reported as the cause of inadequacy of vein in up to 20% of patients. The hypothesis of this study is to consider the external mesh as a technique to use like conduit, in patients with varicose veins and in young patients with ecstatic veins, with results that at least overlap the traditional technique. We report our experience with bypass surgery using autologous varicose vein covered with prosthetic mesh. MATERIALS AND METHODS From May 2005 to July 2008, 249 infrapopliteal bypasses were performed to treat CLI. Twenty-one patients were selected from this group to receive bypass covered by polyester external mesh (ProVena; BBraun, Aesculap, Tuttlingen, Germany). Seventeen patients had varicose veins, four young patients had venous ectasia or previous bypass failure for dilatation. Graft patency was evaluated at 1, 3, 6, and 12 mo, and every 6 mo thereafter. All patients underwent epidural anesthesia with ropivacain 0.75%. RESULTS The mean follow-up time was 32 mo. No dilatation or infection was found in this period. Two early bypass thromboses were recorded and treated immediately. Two lesions were treated at 3 and 8 mo with surgical substitution of the distal portion and PTA of focal intermediate stenosis, respectively. Primary patency at 24 mo was 57.1% (SE ± 3.9), assisted 81% (SE ± 3.2), and had an amputation-free survival rate of 85.7% (SE ± 2.8). In other bypass without mesh, primary patency was 63.8%, secondary 80.5%, and amputation-free survival rate 89.3% at 24 mo. CONCLUSION Polyester external mesh is a valid method to perform bypass with autologous material, as ecstatic or varicose veins. Moreover, in young patients with long-term bypass patency expectancy, it prevents vein dilatation during arterialization process.

Endo First Is Not Appropriate in Some Patients with Critical Limb Ischemia because “Bridges Are Burned”

BACKGROUND The aims of this study were to determine the effect of failed prior endovascular treatment (EV) on early and midterm outcomes of subsequent lower extremity open surgical (OS) bypass. METHODS Patients undergoing infrainguinal bypass for critical limb ischemia (CLI) from January 2008 to December 2011 were retrospectively reviewed. The results after first-line bypass and bypass after failure of EV treatment were compared. A total of 213 patients (65.25% men; average age, 73.30 years) underwent bypass. OS patients were then divided into 2 groups: group 1 consisted of 138 patients who underwent primary OS for CLI without prior EV (control group) and group 2 consisted of 75 patients who had OS after a failed attempt at elective EV for peripheral vascular disease. Of the 213 bypass performed, 34% had a prior infrainguinal failed EV. The primary study end points were early and 1-year major amputations and graft occlusion. The secondary outcomes included early and 1-year mortality and the level of distal revascularization. RESULTS Secondary patency and limb salvage rates were significantly better in group 1 up to 1 year (99% vs. 86%; P < 0.001 at 1 month and 95% vs. 76%, P < 0.05 at 12 months, respectively). CONCLUSIONS Previous failed EV should be predictive of poor outcome in patients undergoing distal OS for CLI.

Initial clinical experience with a polytetrafluoroethylene vascular dialysis graft reinforced with nitinol at the venous end

Objective: The purpose of this study was to examine the outcomes of a vascular hybrid polytetrafluoroethylene (PTFE) graft, provided with a nitinol‐reinforced section (NRS) on one end, in hemodialysis vascular access placement. Methods: A retrospective study was conducted including all the consecutive patients who underwent Gore Hybrid Vascular Graft (GHVG; W. L. Gore & Associates, Flagstaff, Ariz) implantation for hemodialysis access placement between October 2013 and November 2015. A propensity‐matched control group was obtained from consecutive patients who underwent standard PTFE arteriovenous graft implantation between January 2010 and July 2013. The selection criteria were inadequate venous material for autogenous arteriovenous fistula placement, patent deep venous circulation, and vein diameter of 4 to 8.5 mm. The implantation technique involves the insertion of the NRS some centimeters into the target vein. Fluoroscopic guidance helps deploy the device in the desired landing zone (ie, position of the proximal end of the NRS), based on anatomic landmarks. Survival, functional patency rates, and complications were compared with a propensity‐matched historical control group. Vein diameter, previous vascular access placement, and diabetes were tested as predictors of reintervention with a logistic regression analysis. Results: There were 32 patients (14 men; mean age, 69 ± 14 years) who received the GHVG graft. The historical control group included 43 patients. Technical success was 100%. The graft configuration was brachial‐axillary (n = 22 [69%]), brachial‐basilic loop (n = 5 [16%]), brachial‐antecubital loop (n = 3 [9%]), axilloaxillary loop (n = 1 [3%]), and femoral‐femoral loop (n = 1 [3%]). Mean NRS oversize was 20% ± 7% (range, 3%‐34%; median, 19%). Perioperative complications requiring revision included acute limb ischemia treated with thrombectomy (n = 1 [3%]) and graft infection requiring explantation (n = 2 [6%]). Two patients (6%) died in the hospital of unrelated causes. The mean follow‐up was 15 ± 11 months (range, 0‐33 months; median, 15.5). The propensity‐matched groups included 25 patients each. Survival estimates at 24 months for the GHVG and standard PTFE groups were 91% ± 6% and 82% ± 9% (P > .05), respectively. The 12‐month patency estimates were as follows: functional primary patency, 66% ± 10% vs 51% ± 10% (P > .05); functional assisted primary patency, 75% ± 9% vs 51% ± 10% (P > .05); and functional secondary patency, 79% ± 9% vs 67% ± 10% (P > .05). Reduction in vein diameter was associated with reintervention. Conclusions: The GHVG is a safe and effective alternative to standard PTFE in hemodialysis access surgery. Careful planning for the landing zone is advisable, especially for small outflow veins. Larger studies and randomized trials are needed to define the role for this device. A study including a greater number of centers experienced with this device is currently under way.

Endovascular repair of aortic rupture due to Brucella aortitis.

Brucellosis is a zoonosis, caused by bacteria belonging to the genus Brucella. Aortic involvement is a rare complication, often following embolization from infective endocarditis. However, contiguous propagation from vertebral involvement may occur. We report the case of an 81 year old patient abruptly presenting with aortic rupture due to Brucella melitensis infection. The diagnosis of aortic rupture was made by CT. The patient underwent urgent endovascular treatment using endoprosthesis deployment in the abdominal aorta and iliac arteries. Long term antibiotic treatment was given. Resolution of the acute event was obtained without further surgical treatment. 18 months after endovascular treatment, the patient remains in good health.