Giancarlo Bracale

Intracardiac migration of nitinol TrapEase vena cava filter and paradoxical embolism

The nitinol TrapEase inferior vena cava filter is a new device for pulmonary embolism prophylaxis. No cases of filter migration or filter-related complications with this type of device have so far been described. We report a case of intracardiac migration of this filter in a patient with a patent foramen ovale, resulting in severe cardiogenic shock, cerebral and right arm paradoxical embolism. Surgical treatment, results, causes of these complications are discussed.

Decreased Paraoxonase-2 Expression in Human Carotids During the Progression of Atherosclerosis

Objective—Many gene products involved in oxidation and inflammation are implicated in the pathogenesis of atherosclerosis. We investigated paraoxonase 2 (PON2), 5-lipoxygenase (5-LO), and 5-LO activating protein (FLAP) expression and malondialdehyde (MDA) levels in carotid lesions to assess their involvement in plaque formation. Methods and Results—We measured gene expression and MDA levels in atherosclerotic plaques from 59 patients undergoing carotid endarterectomy, and in plaque-adjacent tissue from 41/59 patients. Twenty-three fetal carotids and 6 mammary arteries were also investigated. Real-time polymerase chain reaction and immunohistochemistry revealed decreased PON2 expression in plaques versus adjacent regions (P<0.005, P<0.001, respectively), mammary arteries (P<0.031, P<0.001, respectively), and fetal carotids (both P<0.001). mRNA levels of 5-LO and FLAP were higher (P<0.038, P<0.005, respectively) in lesions versus fetal carotids. MDA was higher in plaques versus plaque-adjacent tissue and fetal carotids. PON2 mRNA was downregulated by oxidative stress in 5 ex vivo experiments, thereby indicating its possible atheroprotection role. Conclusions—We demonstrate that PON2 mRNA and protein are decreased in plaques versus plaque-adjacent tissue, mammary arteries, and fetal carotids. Our data indicate that the protective effect of PON2 could fail during atherosclerosis exacerbation; this was confirmed by the increase of MDA levels. The increase of 5-LO and FLAP mRNA expression confirms their role as inflammatory markers associated to atherosclerosis.

External iliac artery pseudoaneurysm complicating renal transplantation

OBJECTIVES To assess the etiology, management and outcome of iliac pseudoaneurysms following renal transplantation. METHODS Eleven patients who underwent repair between 1982 and 2007 were identified. Five (Group 1) presented pseudoaneurysm at the anastomosis of the donor renal and native iliac arteries, and six (Group 2) presented iliac pseudoaneurysm following transplant nephrectomy. Intraoperative cultures and immunohistochemical examinations were obtained from all surgical cases to determine the existence of a relationship between infection or transplant rejection and pseudoaneurysm formation. RESULTS Endovascular repair (EVR) was used to treat three patients, while eight patients underwent open repair (OR). Transplant nephrectomy was needed in all cases but one after anastomotic pseudoaneurysm repair. After pseudoaneurysm excision, arterial reconstruction was performed in all cases, with a limb salvage rate of 100%. At 30 days, no patients died in the EVR subgroup. In the OR subgroup, one patient died of sepsis (12.5%). Cultures taken from the pseudoaneurysm wall and content grew Candida albicans and E. coli in two febrile patients. Pathologic evaluation of donor renal arteries revealed evidence of chronic rejection in three patients (60%) in Group 1, and in two (33.3%) in Group 2. No patients in either Group presented late infection, failure of vascular reconstruction nor pseudoaneurysm recurrence. The follow-up ranges from 20 to 89 months. CONCLUSIONS The etiology of pseudoaneurysms in this location is multifactorial, however, an association with chronic rejection must be considered. Though rare, the development of pseudoaneurysms at the donor renal-external iliac artery anastomosis results in high rates of transplant nephrectomy. Less invasive endovascular techniques offer a new therapeutic option in this challenging scenario notwithstanding the fact that they require further validation.

Anastomotic Pseudoaneurysm Complicating Renal Transplantation: Treatment Options

INTRODUCTION Anastomotic pseudoaneurysm following renal transplantation is uncommon. Indications for repair, treatment options and outcomes remain controversial. REPORT We present 6 renal transplant recipients with large anastomotic pseudoaneurysms. Five of the patients underwent open repair while one had a stent-grafting and delayed transplant nephrectomy for a ruptured pseudoaneurysm. A transplant nephrectomy was needed in all cases but one. Arterial reconstruction enabled limb salvage in all cases. One patient died of sepsis postoperatively. No patient presented late infection, failure of vascular reconstruction, nor pseudoaneurysm recurrence. CONCLUSIONS Surgical excision of anastomotic pseudoaneurysms results in high rates of allograft loss. Less invasive techniques have a place in selected cases.

Altered expression of inflammation-related genes in human carotid atherosclerotic plaques

OBJECTIVE Inflammation is a pivotal process in atherosclerosis development and progression, but the underlying molecular mechanisms remain largely obscure. We have conducted an extensive expression study of atherosclerotic plaques to identify the inflammatory pathways involved in atherosclerosis. METHODS We studied 11 human carotid plaques, their respective adjacent regions and 7 control arteries from different subjects. Expression of 92 genes was studied by TaqMan low-density array human inflammation panel. Human aortic endothelial and smooth muscle cells were used for in vitro experiments. RESULTS The mRNA levels of 44/92 genes (48%) differed significantly between the tissues examined (13 up-regulated and 31 down-regulated). Dysregulated genes encode molecules belonging to different functional classes although most of them encode enzymes involved in the eicosanoid synthesis pathway. The expression of PTGIS and PTGIR genes was decreased in human aortic endothelial and smooth muscle cells stimulated with oxLDL and TNF-α. CONCLUSIONS This study not only reveals several dysregulated genes in human lesions but also focuses the role played by the genes involved in the eicosanoid synthesis pathway during atherosclerotic development. The decrease of PTGIS and PTGIR expression after oxLDL treatment mirrors the decreased mRNA levels in atherosclerotic lesions versus control arteries, which suggests that oxidation is important for PTGIS and PTGIR regulation in human vessel cells during atherosclerosis development.

Delayed Diagnosis of Leiomyosarcoma of the Common Femoral Artery after Endovascular Repair

PURPOSE To describe a unique case of misdiagnosed leiomyosarcoma of the common femoral artery presenting with signs and symptoms of high-grade stenosis, which was treated with stent placement. CASE REPORT A 31-year-old woman with a history of diabetes and hyperlipidemia had recurrent claudication and showed significant in-stent restenosis of the common femoral artery in a postoperative angiogram at 5 months. The patients clinical stage remained unchanged after repeat percutaneous intervention, and leiomyosarcoma was diagnosed from surgical specimens. The patient underwent resection and repair of the involved artery. She has survived 30 months with no further evidence of local recurrence or systemic metastatic disease. CONCLUSIONS Endovascular repair may cause a long delay in the diagnosis of an arterial leiomyosarcoma mimicking peripheral occlusive disease.

How should I treat concomitant post-endarterectomy carotid pseudoaneurysm and contralateral symptomatic stenosis?

BACKGROUND: A 74-year-old male patient complaining of crescendo TIAs, hypertension and hyperlipidaemia. INVESTIGATION: Duplex ultrasound scan MR angiography. DIAGNOSIS: Pseudoaneurysm stemming from the ICA. TREATMENT: An open or endovascular procedure for the right pECCA repair, or a left CEA or CAS.

EXPRESSION OF ADIPONECTIN RECEPTORS IN HUMAN CAROTID ATHEROSCLEROTIC PLAQUES Abstracts from the 12th National Congress of the Italian Society of Cardiovascular Prevention (SIPREC), Naples, 6–8 March 2014

Abstracts from the 12th National Congress of the Italian Society of Cardiovascular Prevention (SIPREC), Naples, 6–8 March 2014s from the 12th National Congress of the Italian Society of Cardiovascular Prevention (SIPREC), Naples, 6–8 March 2014 Springer International Publishing Switzerland 2014 LACTOBACILLUS PARACASEI B21060, ARABINOGALATTANO AND XILOOLIGOSACCHARIDES: SYMBIOTIC CANDIDATES TO REDUCE CHOLESTEROL LEVELS Ludovica Leone, Monica Malamisura, Antonia De Matteo, Valentina Bruno, Roberto Berni Canani, Basilio Malamisura Department of Translational Medicine, Pediatric Section and European Laboratory for the Investigation of Food Induced Diseases, University of Naples ‘‘Federico II’’, Via S. Pansini 5, 80131 Naples, Italy, Campus Biomedico University of Rome, Via Álvaro del Portillo 21, Rome, Italy, Department of Pediatrics, University Hospital of Salerno, Via San Leonardo, 1, 84131 Salerno, Italy Introduction: Elevated blood cholesterol is an important risk factor associated with atherosclerosis and coronary heart disease. Probiotics have been proposed for the treatment of dyslipidemia. Aim: To evaluate efficacy, tolerability and safety of a new symbiotic formulation containing a combination of probiotic (Lactobacillus paracasei B21060) and prebiotics (arabinogalattano, xilooligosaccharides) and amine (L-glutamine) in the early treatment of children affected by familial hypercholesterolemia (FH). Methods: FH subjects, aged 6–12 years, consecutively observed a Tertiary Center for Pediatric Nutrition were randomly allocated to two groups of intervention for 6 months: active group, received a low saturated fats diet plus the symbiotic (2.5 9 109 cfu, bid) for 6 months; control group, received low saturated fats diet alone. All children received written indications for low saturated fats diet. The plasmatic lipid profile was assessed by peripheral blood sampling at T0 and T1. Results: 40 FH children were enrolled (20 in active group: 8 male, median age 8.4 yrs, BMI 17.6; 20 in control group: 8 male, median age 7.5 years, BMI 17.0. All subjects completed the study. At T1 a reduction of C-LDL, total cholesterol, LDL/HDL ratio was observed in both groups, but the differences were significant only in active group (median value (IQR) C-LDL: 221 (55) vs 192 (33), p \ 0.01; total cholesterol: 280 (31) vs 260 (43), p \ 0.05; LDL/HDL: 4.0 (1.5) vs 3.5 (1.3), p \ 0.05). The symbiotic preparation was well accepted by the children, the adherence was [90 %, no side effects were observed. Conclusions: The symbiotic containing Lactobacillus paracasei B21060 is able to significantly reduce main laboratory biomarkers in children with FH. The treatment was well accepted and tolerated by patients. Our results open the light on new opportunity for the early treatment of pediatric FH. Further studies are advocated to better define the mechanism of action and the potential of a long term use of this new strategy. ANALYSIS OF THE INFLUENCE OF BASELINE DIABETES DURATION (DD) ON BLOOD PRESSURE RESPONSES TO LIRAGLUTIDE Angela Sciacqua, Francesco Perticone, Vivian Fonseca, Jorge Plutzky, Cristiano Bette, J. Hans DeVries Magna Graecia University, Catanzaro, Italy, Tulane University, New Orleans, LA, USA, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA, Novo Nordisk, Rome, Italy, Academic Medical Centre, University of Amsterdam, The Netherlands Introduction: Across the phase 3 ‘Liraglutide Effect and Action in Diabetes’ (LEAD)1–6 and liraglutide vs sitagliptin (Lira-DPP-4i) trials, once-daily liraglutide (LIRA) consistently reduced systolic blood pressure. In a sub-analysis of LEAD trials, significantly greater reductions in SBP were observed with LIRA in patients aged B65 vs [65 years. Since diabetes duration (DD) was 3–4 years longer in the groups [65 years, this High Blood Press Cardiovasc Prev (2014) 21:151–169 DOI 10.1007/s40292-014-0053-4