Some patients with acute deep venous thrombosis of the lower limbs may present risk factors for recurrent disease. Aims: To analyze the most important conditions related to recurrent deep venous thrombosis of the lower limbs, other than thrombophilias. Patients and methods: We examined 88 consecutive patients (47 males-53.41%, average age 64.9±13.9 years) admitted to a Medical Clinic in 2007. Duplex ultrasonography was performed to assess acute deep venous thrombosis and post-thrombotic syndrome. Anamnesis and physical examination were used to detect risk factors for recurrent disease. The 28 subjects with acute deep venous thrombosis and post-thrombotic syndrome were included in group A (31.82%). Group B comprised 60 patients (68.18%) with acute deep venous thrombosis without postthrombotic syndrome. Results: Risk factors for recurrent disease in groups A and B were the following: personal history of deep venous thrombosis of the lower limbs (17 subjects versus 7, p<0.0001), varicose veins (14 vs 24, p=0.51), obesity (13 vs 18, p=0.21), malignancy (6 vs 8, p=0.25), chronic obstructive lung disease (5 vs 6, p=0.24), prolonged immobilization (1 vs 7, p=0.21), major surgery (1 vs 1, p=0.54), stroke (0 vs 3, p=0.62), family history of deep venous thrombosis, immobilizing plaster cast, and congestive heart failure (0 vs 1, p=0.54). Location of thrombi in patients in groups A and B was as follows: 18 patients in group A vs 25 subjects in group B on the left side and 13 patients in group A vs 20 patients in group B on the right side (p=0.02). Conclusion: Post-thrombotic syndrome correlated with personal history of deep venous thrombosis and previous deep venous thrombosis located in the left lower limb.

Objective: To characterize stenosis and/or occlusion in patients with concomitant peripheral arterial disease (PAD) and medial arterial calcifi cation (MAC). Patients and methods: We performed continuous-wave Doppler technique (to measure the ankle-brachial index-ABI) and duplex ultrasonography in 75 consecutive patients at risk for PAD (57 males, age 72.6±6.3 years) admitted to a Medical Clinic between January and March 2006. Group A was composed of 15 subjects with plaques and ABI higher than 1.3 (MAC-20%). Normal ABI was found in 43 patients (group B-57.33%). Group C included 17 patients with ABI lower than 0.9 (ischemia-22.67%). Results: Nonsignifi cant aortoiliac stenosis (less than 50%) was found in 70 subjects (15 in group A, 39 in group B, and 16 in group C-nonsignifi cant). Signifi cant femoropopliteal stenosis (greater than 50%) was detected in eight patients (fi ve in group A, one in group B, and two in group C-p<0.001). Nonsignifi cant femoropopliteal stenosis was identifi ed in 54 subjects (seven in group A, 42 in group B, and fi ve in group C-p<0.001). Conclusion: Signifi cant femoropopliteal stenosis signifi cantly correlated with presence of MAC. Nonsignifi cant femoropopliteal stenosis was identifi ed in patients with normal ABI.

Introduction: Recent studies have shown that His-bundle pacing could be an alternative in patients requiring cardiac resynchronization therapy as it is comparable or better in terms of amelioration of ventricular activation, narrowing of the QRS complex, or clinical outcomes. However, in case of high threshold at the level of His-bundle or inability to correct conduction through a diseased His-Purkinje system other option should be searched like left bundle pacing. Patient concerns: A 77-year-old man presented to the Emergency Department for dizziness and dizziness and lightheadedness due to an intermittent 2:1 atrioventricular block with a QRS complex morphology of a major left branch block. Diagnosis: Given the documented symptomatic 2:1 AV block, according to the European Guideliness the patient was considered to have a class 1 indication of permanent double chamber cardiostimulation. Interventions: A lead delivery system with a C315 His catheter and a Select Secure 3830 69 cm pacing lead were placed at the His bundle area with important narrowing of the QRS complex but with an unacceptable high threshold. The delivery system was moved towards the apex 1,5 cm and the lead screwed deep into the septum until capture of the left bundle branch was achieved with complete normalization of the conduction troubles. Outcomes: At 3 month follow-up the patient was asymptomatic and the pacing and sensing thresholds remained at same values as during implantation: 0.75/0.4 ms and 14 mV respectively. Conclusion: Left bundle-pacing represents the next step of His-Purkinje system pacing to overcome all difficulties related to His-bundle pacing.

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His bundle pacing (HBP) has several pitfalls, such as the inability to identify the His bundle and lack of capture at acceptable thresholds. The majority of data regarding HBP were obtained using a dedicated non-deflectable delivery system. This study aimed to evaluate the impact of cardiac chamber dimensions on permanent HBP procedural outcomes when using this type of fixed-curve catheter. Seventy-two patients subjected to HBP from the 1st of January to the 31st of December 2021 at our institution were retrospectively reviewed. The baseline clinical characteristics and echocardiographic measurements of all the cardiac chambers were recorded, as well as procedural outcomes (HB electrogram identification and overall procedural success). During the procedure, the HB electrogram was recorded in 59 patients (81.9%) and successful permanent HBP was achieved in 33 patients, representing 45.8% of all the studied patients. Left atrial (LA) and right atrial (RA) volumes were significantly higher in patients without HB electrogram identification. Only LA and RA volumes were statistically associated with HB electrogram localization, while there was no significant association between the echocardiographic parameters and procedural success. LA volumes above 93 mL and RA volumes above 60 mL had an 8.81 times higher chance of failure to localize the HB electrogram compared with patients with lower volumes (p < 0.001). When considering non-deflectable delivery catheters for HBP, careful preprocedural echocardiographic analysis of the atrial volumes could help in the proper selection of implanting tools, thus optimizing the procedural outcomes and costs.