Giorgio M. Biasi

Renal artery aneurysm: improved renal function after coil embolization.

Purpose: To describe a case of improved renal function and renovascular hypertension after percutaneous treatment of a renal artery aneurysm. Case report: A 72-year-old hypertensive woman with a hilar saccular aneurysm of the right renal artery underwent percutaneous coil embolization under local anesthesia. Four individual, soft, detachable platinum embolization coils were successfully inserted in the aneurysm with incomplete aneurysm exclusion. Nonetheless, the patients blood pressure and renal function returned to normal. The arteriogram at 3 months demonstrated complete exclusion of the lesion and good renal perfusion. The patient remains normotensive with documented improved renal function at 18 months after treatment. Conclusions: Superselective coil embolization is an effective treatment for renal artery aneurysms that display proper morphological features. The long-term outcome of this less invasive therapy still must be assessed, but it appears plausible that embolotherapy of renal artery aneurysms can correct secondary hypertension and deteriorating renal function.

Diet, lipids and lipoproteins in patients with peripheral vascular disease.

Diet and some metabolic parameters of patients with peripheral vascular disease (PVD) were examined in order to investigate possible pathogenetic factors. Two hundred and eight of these patients (age range: 26-69) had an angiographic diagnosis of atherosclerotic disease (AD); they were age- and sex-matched with a control inpatient population. Evaluation of living and dietary habits, with the aid of appropriate computerized clinical charts, showed that AD patients had a significantly higher consumption of cigarettes, carbohydrates and alcohol than controls. In particular, 45.5 per cent of the patients vs 12.5 per cent of controls smoked more than 20 cigarettes daily; 28 per cent vs 16 per cent consumed more than 40 grams of sugar per day; and 54.5 per cent vs 21.5 per cent drank more than 500 ml of wine daily; these and other differences were statistically significant. Type IV hyperlipoproteinemia was almost three times as frequent among patients than among controls (46 per cent vs 18 per cent). Triglyceride levels were significantly more elevated in all age groups considered, while cholesterol levels were significantly higher only among patients of the 50-59 age group. Thirteen per cent of patients vs 5 per cent of controls had hyperuricemia. The findings of an increased carbohydrate and alcohol consumption, together with hypertriglyceridemia, may explain the higher incidence of PVD in Italy compared to the United States.

The ICAROS Registry of carotid artery stenting

ICAROS (Imaging in Carotid Angioplasties and Risk Of Stroke) is a multicenter international registry of carotid artery stenting designed to determine the criteria for identifying patients at higher or lower risk of periprocedural stroke and restenosis at 1 year. The aim of the registry is to improve patient selection and consequently reduce the risk of cerebral embolization during carotid stenting. The registry is open to all interventionists performing carotid stenting, and the participants are free to apply their own endovascular techniques and devices, including cerebral protection mechanisms. All cerebral ischemic events following the procedure will be reported. Follow-up surveillance to 1 year will include periodic duplex scanning and neurological examinations. Echographic plaque images will be standardized for comparison, processed for echodensity, and analyzed by computer at the Registry Center. Correlation will be investigated between the echographic index (gray-scale median) and the risk of embolism and outcome of carotid stenting.

The ICAROS registry of carotid artery stenting. Imaging in Carotid Angioplasties and Risk of Stroke.

ICAROS (Imaging in Carotid Angioplasties and Risk Of Stroke) is a multicenter international registry of carotid artery stenting designed to determine the criteria for identifying patients at higher or lower risk of periprocedural stroke and restenosis at 1 year. The aim of the registry is to improve patient selection and consequently reduce the risk of cerebral embolization during carotid stenting. The registry is open to all interventionists performing carotid stenting, and the participants are free to apply their own endovascular techniques and devices, including cerebral protection mechanisms. All cerebral ischemic events following the procedure will be reported. Follow-up surveillance to 1 year will include periodic duplex scanning and neurological examinations. Echographic plaque images will be standardized for comparison, processed for echodensity, and analyzed by computer at the Registry Center. Correlation will be investigated between the echographic index (gray-scale median) and the risk of embolism and outcome of carotid stenting.

Increased apoprotein B in very low density lipoproteins of patients with peripheral vascular disease.

Lipoproteln compositional studies were carried out in 20 patients with atherosclerotic peripheral vascular disease. Twelve of these patients were normollpldemlc, the other eight, hypertriglycerldemic. Ten normollpldemlc and 10 hypertriglyceridemlc age-matched subjects were used as controls. High density lipoprotein cholesterol levels were markedly reduced in the hypertriglyceridemlc subjects, both with (35.1 ± 5.0 mg/dl) and without (36.2 ±11.7 mg/dl) peripheral vascular disease, as compared to the normolipldemic patients (47.0 ± 6.3 mg/dl) and controls (48.1 ± 10.0 mg/dl). A decreased relative content of apo C-ll in very low density lipoproteins in the hypertriglyceridemic subjects, as compared to the normolipidemics, was detected by isoelectric focusing. Hypertriglyceridemla in patients with peripheral vascular disease shows a typical Type IV lipoprotein and apoprotein profile. Apoprotein B levels In very low and low density lipoproteins were determined by electroimmunodiffusion and selective precipitation with tetramethylurea (r = 0.981 between the two methods). All the patients with peripheral vascular disease showed an increased apo B content in very low density lipoproteins (VLDL) as compared to controls (apo B cholesterol In VLDL = 0.431 ± 0.124 for peripheral vascular disease patients and 0.236 ± 0.086 for controls, p < 0.001). A significant correlation between VLDL cholesterol and apo B levels was detected both in peripheral vascular disease patients and in controls; however, two distinct populations could be clearly separated (slopes of the regression lines: peripheral vascular disease patients = 0.350; controls = 0.215, p < 0.001). The data suggest a possible discriminatory power of VLDL-apo B levels in patients with peripheral vascular disease independent from other lipoprotein and lipid parameters.

Kinetics of insulin secretion following glucose infusion in patients with atherosclerotic peripheral vascular disease

SummaryKinetics of insulin secretion following an i.v. glucose infusion, according to the protocol described by Cerasi and Luft, were studied in 19 patients with angiographically documented atherosclerotic peripheral vascular disease and in a group of appropriate controls without clinical signs of disease. No significant differences were noted between patients and controls in plasma cholesterol levels and in the K value following a standard i.v. glucose tolerance test. Blood glucose levels were significantly lower in the patients, whereas mean plasma insulin and triglyceride levels were significantly higher. Analysis of the glucose and insulin responses to the glucose infusion test indicated that 31.6% of the patients had a delayed and sluggish insulin response to the glucose load, fitting the criteria suggested for the diagnosis of prediabetes, versus 10% of the appropriate controls. In particular, simulation of the plasma insulin responses by a square-wave glucose stimulus, confirmed that in a significantly higher number of patients the early insulin peak was below normal limits. The results of this study suggest that increased insulin secretion is not present in patients with atherosclerotic vascular disease, in contrast to reports by other authors, and that inefficient insulin secretory mechanisms may be observed in these patients, thus possibly contributing to the development of the atherosclerotic disease.

Training of the Vascular Surgeon for Endovascular Procedures

In the last two decades the most crucial event in the evo- lution of vascular surgery has been the advent of endo- vascular techniques.