Coronavirus pandemic started in China in December 2019 and spread worldwide infecting more than two million people causing more than 100,000 deaths. 1 The first case of COVID-19 infection in Italy was reported in a small center in Lombardy on 20 February 2020 and then the infection was able to spread to all Italian regions. Lombardy resulted as the most affected area due to its high density of population and the high number of old age citizens. The regional healthcare authorities decided to create dedicated COVID-19 hospitals and to identify a Hub/ Spoke system for vascular emergencies, where four large centers (Hubs) would provide service to whole region for emergency cases. San Raffaele Hospital was identified as Hub for cardiovascular emergencies and simultaneously as referral center for COVID-19 patients. At our hospital, six divisions of Medicine were converted to COVID-19 patient care and more than 30 new intensive care unit (ICU) beds were set up. A dedicated emergency room with "COVID free" access was prepared in 24 h in order to create different pathways for non-infected patients. Elective cases were suspended and consequently all cases of chronic venous disorders postponed, continuous vascular diagnostic service was exclusively maintained for emergency cases with acute deep vein thrombosis (DVT). Interesting patterns have emerged: during the initial days, the patient reluctance to mix-up in hospitals with COVID-19 patients determined a reduction of all vascular emergencies. After two weeks, a sensible increase of arterial limb ischemia was observed requiring both open and endovascular interventions as well as an increase of DVT cases. Two patients with acute ilio-caval DVT were treated by means of thrombectomy and stenting; one case of secondary iliofemoral DVT due to extrinsic abdominal compression from a lymphoma was managed conservatively because unsuitable for thrombolysis or venous thrombectomy.

Background Stenting has become the first-line treatment of obstructive venous disease because of poor results of balloon angioplasty. This preclinical study aimed to investigate the safety and efficacy profile of a novel compliant venous scaffold (CVS) denominated Petalo CVS, specifically designed for venous diseases. Materials and Methods Twelve healthy pigs weighing 90 kg were used to test Petalo CVS. The devices were implanted into the internal jugular veins (IJVs) using a femoral vein percutaneous approach. The safety profile including the success rate of device releasing, anchoring, and positioning was evaluated immediately. Fracture, migration, primary patency, and endothelial response were assessed at 1, 2, 3, and 6 months after the study procedure. Results A total of 32 devices were successfully released in both IJVs. No procedure- or device-related complications were reported, and all pigs successfully completed the different scheduled follow-up periods. The primary patency rate was 100%, and no fracture or migration of the device into the brachiocephalic trunk was reported. Histological examination revealed only minimal lesions with minimal or absent inflammatory reaction surrounding the incorporated metallic rods. Conclusions This porcine model study showed a promising safety and efficacy profile of Petalo CVS, a novel endovenous device based on specific concepts.

Early source control using OA management significantly improves outcome of patients with severe IAIs. This damage control approach well fits to the treatment of time-related conditions, particularly in case of critically ill patients.

Objectives A high rate of thrombotic events has been reported in COVID-19 population. The study aims to assess the incidence of deep vein thrombosis (DVT) in COVID-19 patients admitted to a single tertiary hospital. Methods From April 2nd to April 18th, 2020, hospitalized patients with SARS-CoV-2 infection were screened by lower limb duplex ultrasound (DUS). Patients were on (low molecular weight heparin) LMWH prophylaxis in medical wards, and on therapeutic anticoagulation in intensive care unit (ICU). DVT risk factors, reported by the Padua prediction score and blood tests, were retrieved from institutional electronic charts. The study primary endpoint was the incidence of DVT in the in-hospital COVID-19 population and its association with clinical and laboratory risk factors. The secondary endpoint was the association of DVT with mortality. Results Two hundred patients (median age 62 years, 72% male, 40 in ICU) received DUS screening. DVT was observed in 29 patients (14.5%), with proximal extension in 16 patients, and in association with symptoms in four patients. The DVT rate was similar in ICU (12.5%) and non-ICU patients (15%). Eighty-seven patients underwent a computed tomography angiography (CTA) that showed pulmonary embolism in 35 patients (40.2%) not associated with DVT in 25/35 cases (71.4%). DVT in the ten patients with pulmonary embolism were symptomatic in four and with a proximal localization in eight cases. A D-dimer level ≥5 mg/l at admission was predictive of DVT (OR 1.02; IC95% 1.03-1.16; p  = .003). At the multivariate analysis in-hospital mortality was predicted by age (OR 1.06; 95% CI 0.02-1.15; p  = .004) and by being an ICU patient (OR 1.23; 95% CI 0.30-2.25; p  = .01). Conclusions Despite LMWH prophylaxis or full anticoagulant therapy, the incidence of DVT, mainly asymptomatic, in hospitalized COVID-19 patients was 14.5%. Further research should focus on the appropriate antithrombotic therapy for COVID-19 patients.

The results of our study suggest that a conservative approach, with EES, seems feasible in selected patients with CLI and infrapopliteal artery occlusive disease.

The growing demand for organ donors to supply the increasing number of patients on kidney waiting lists has led most transplant centers to develop protocols that allow safe use of organs from donors with special clinical situations previously regarded as contraindications. Deceased donors with previous hepatitis B may be a safe resource to increase the donor pool even if there is still controversy among transplantation centers regarding the use of hepatitis B surface antigen-positive donors for renal transplantation. However, when allocated to serology-matched recipients, kidney transplantation from donors with hepatitis B may result in excellent short-term outcome. Many concerns may arise in the long-term outcome, and studies must address the evaluation of the progression of liver disease and the rate of reactivation of liver disease in the recipients. Accurate selection and matching of both donor and recipient and correct post-transplant management are needed to achieve satisfactory long-term outcomes.

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