Background and Aims: this multicenter prospective observational study defined the incidence and risk factors of surgical wound infections (Swi) after infrarenal aortic and lower limb vascular surgery procedures and evaluated the severity and costs of these infections.Methods: the study cohort comprised of 184 consecutive patients. postoperative complications were recorded. the additional costs attributable to Swi were calculated.Results: eighty-four (46%) patients had critical ischaemia, 81 (45%) patients underwent infrainguinal bypass surgery and 64 (35%) received vascular prosthesis or prosthetic patch. forty-nine (27%) patients developed Swi. Staphylococcus aureus was the leading pathogen cultured from the wound. forty-seven of the 49 infected wounds responded to and healed with the treatment. Swi was the cause of one major amputation. independent predictors for Swi were infrainguinal surgery (or 7.2, 95% cl 2.92-17.65, p < 0.001), obesity (or 6.1, 95% cl 2.44-15.16, p < 0.001) and arteriography injection site within the operative area (or 2.5, 95% cl 1.13-5.48, p = 0.02). the average cost attributable to Swi was 3320 €.Conclusion: the incidence of Swi after vascular surgery is high. the risk factors for Swi are infrainguinal surgery, obesity and arteriography injection site within the operative area. Swi increases morbidity and costs of operative treatment.

Background and Purpose-Asymptomatic patients with carotid stenosis benefit less from carotid endarterectomy (CEA) than symptomatic patients because the risk of embolic events is lower, but it is not known whether the hemodynamic effect of CEA is different between the groups. We evaluated hemodynamics of symptomatic and asymptomatic patient groups before and after CEA. Methods-Forty-six independent patients with a unilateral high-grade carotid stenosis, 23 asymptomatic and 23 symptomatic, underwent dynamic susceptibility contrast MRI (DSC-MRI) and transcranial Doppler ultrasound (TCD) evaluation before CEA and 3 and 100 days afterward. Quantitative perfusion parameters were calculated separately in selected regions of white and gray matter and watershed regions in each hemisphere, and mean transit time (MTT) maps were assessed visually by 2 independent observers. Vasomotor reactivity was determined with breath-holding index and flow impedance with pulsatility index ipsilaterally. Results-In contrast to the asymptomatic carotid stenosis group, symptomatic carotid stenosis patients had preoperatively increased MTT and lower cerebral blood flow values in the ipsilateral hemisphere, more in white matter and watershed regions than in gray matter. Visually detected perfusion deficits were associated with symptomatic status. The interhemispheric asymmetries were abolished by CEA. The improving trend over time was greater in the symptomatic carotid stenosis group and was best seen in MTT. On TCD, pulsatility index was lower in symptomatic carotid stenosis patients preoperatively, with no postoperative difference, whereas the breath-holding index improved only in the symptomatic carotid stenosis group after CEA. Conclusions-Patients

The use of triclosan-coated sutures does not reduce the incidence of SWI after lower limb vascular surgery.

Prosthetic graft infection as a result of Listeria monocytogenes is an extremely rare event that recently occurred in a 77-year-old man who underwent endoluminal stent grafting for infrarenal abdominal aortic aneurysm. The infected aortic endoluminal prosthesis was removed by means of en bloc resection of the aneurysm and contained endograft with in situ aortoiliac reconstruction. At the 10-month follow-up examination, the patient was well and had no signs of infection.

Objective-We studied by microarray analysis whether symptomatic and asymptomatic carotid plaques from the same patient differ in gene expression and whether the same changes are present in an independent sample set. Methods and Results-Carotid plaques from four patients with bilateral high-grade stenosis, one being symptomatic and the other asymptomatic, were analyzed on Affymetrix U95Av2 arrays. 33 genes showed Ͼ1.5-fold change between symptomatic and asymptomatic plaques in an intraindividual comparison with FDR ranging from 0.28 to 0.40. Three genes involved in iron-heme homeostasis, CD163, HO-1, and transferrin receptor, were further analyzed in 40 independent plaques. HO-1 (fold-change 1.93, 95%CI 1.04 to 3.94, Pϭ0.040) and CD163 (1.58, 1.11 to 2.40, Pϭ0.013) mRNAs were again induced, and also HO-1 protein was overexpressed in symptomatic plaques (4.38, 1.54 to 12.20, Pϭ0.024). The expression of HO-1 and CD163 correlated with tissue iron content but iron itself was not associated with the symptom status. Conclusions-Symptomatic plaques show overexpression of CD163 and HO-1 both in intraindividual and interindividual comparison. Their expression correlates with iron deposits but asymptomatic and symptomatic plaques from isolated patients do not differ in macroscopic hemorrhages or iron deposits. We suggest that symptomatic plaques show a more pronounced induction of CD163 and HO-1 in response to plaque hemorrhages. Key Words: atherosclerosis Ⅲ carotid arteries Ⅲ gene expression Ⅲ microarray Ⅲ stroke S evere atherosclerotic narrowing of the internal carotid artery was found in 20% to 30% of patients with ischemic stroke in its supply territory. 1 Features associated with a symptomatic plaque include the degree of vessel stenosis, prior symptoms, and plaque characteristics, such as ulceration, inflammatory cell infiltration, and a thin fibrous cap. [2][3][4] However, these characteristics are poor predictors of the risk of thromboembolism and, as a result, 80% of patients undergoing carotid endarterectomy are needlessly exposed to surgical risks. 1 Thus better markers for the symptom causing carotid disease are needed. See coverMicroarray technology provides a rapid means to screen gene expression in the tissues of interest. Several efforts have been made to study large-scale gene expression in human atherosclerosis, for example by comparing gene expression in normal and atherosclerotic arteries. 5,6 Changes involved in destabilization of the atherosclerotic plaque have been less in focus. [7][8][9] Whereas symptomatic high-grade carotid plaque remains highly susceptible to recurrent ipsilateral symptoms, the risk of stroke from contralateral asymptomatic plaque is low, comparable to that of asymptomatic carotid stenosis in general. 10 Thus intraindividual differences in the carotid stenoses exist in the same patient causing one plaque to become symptomatic and the other to remain silent. The causes of these differences are unknown. This led us to a microarray study on patients operated due to bilateral sig...