Michał Macech

Purpose: Atherectomy may provide benefit by debulking lesions before angioplasty in patients with in-stent restenosis or stent thrombosis. This study evaluated immediate luminal gain, measured by intravascular ultrasound, achieved with excimer laser, solid-state laser, and rotational excisional atherectomy when treating femoropopliteal in-stent restenosis or stent thrombosis before angioplasty. Six-month patency was assessed by duplex ultrasound. Materials and Methods: We retrospectively analyzed 120 consecutive femoropopliteal interventions for >70% in-stent restenosis or chronic (>14 days) stent thrombosis (Rutherford class 3-5) performed in an office-based laboratory. Patients underwent atherectomy with excimer laser, solid-state laser, or rotational excisional atherectomy, followed by balloon angioplasty without drug-based devices or embolic protection. Intravascular ultrasound measured percent area stenosis before and after atherectomy to calculate luminal gain. Patency and >70% restenosis were assessed by duplex ultrasound at 1 and 6 months or earlier if symptom recurrence prompted target lesion revascularization. Statistical analysis used t tests, Mann-Whitney tests, analysis of variance, and chi-square tests, with significance set at P < .05. Results: Mean age was 74.5 years (95% CI, 72.9-76.2). Twenty-one patients (17.5%) were treated with excimer laser, 15 (12.5%) with solid-state laser, and 84 (70%) with rotational excisional atherectomy. Sixty-seven patients (55.8%) presented with in-stent restenosis and 53 (44.2%) with stent thrombosis. Stent length, number of stents, stent diameters, and Tosaka classes were similar across groups. Mean luminal gain did not differ between excimer laser (28.9%; 95% CI, 24.5-30.1) and solid-state laser (28.8%; 95% CI, 25.6-29.9). Rotational excisional atherectomy achieved significantly greater luminal gain (39.1%; 95% CI, 36.4-41.9) ( P < .001) and outperformed laser atherectomy for both in-stent restenosis ( P = .014) and stent thrombosis ( P < .001) subgroups. Six-month stenosis-free patency was highest with rotational excisional atherectomy (94%), compared with excimer laser (71.4%) and solid-state laser (73.3%) ( P < .004). Conclusions: Rotational excisional atherectomy was associated with greater immediate luminal gain and higher 6-month patency compared with excimer and solid-state laser atherectomy in the treatment of femoropopliteal in-stent restenosis and stent thrombosis. These findings suggest that rotational excisional atherectomy may have advantages over laser atherectomy for managing stent-related stenosis or thrombosis. Clinical Impact: Rotational excisional atherectomy provides greater luminal gain and higher observed short-term patency compared with laser atherectomy in femoropopliteal in-stent restenosis and stent thrombosis. These findings suggest that rotational atherectomy may offer meaningful advantages in managing stent-related stenosis and thrombosis in the femoropopliteal segment.

Background: Endovascular repair with covered stent is an established minimally invasive treatment for popliteal artery lesions, particularly in elderly or high-risk patients. Infectious complications are exceptionally rare but may result in arterial destruction, limb loss, and death. Salmonella species demonstrate a well-recognized affinity for diseased arterial walls and prosthetic vascular material. Case Presentation: An 82-year-old man with stage G4 chronic kidney disease and previous nephrectomy for renal cell carcinoma, complicated by Salmonella Enteritidis septic shock 20 years earlier, presented with acute left lower limb ischemia caused by a post-traumatic popliteal artery pseudoaneurysm. Urgent endovascular repair was performed using a 6 × 100 mm covered stent (Viabahn) with adjunctive angioplasty of the anterior tibial artery. Two weeks later, he was readmitted with fever, severe popliteal pain, local erythema, and elevated inflammatory markers. Imaging demonstrated early stent occlusion with a large peri-graft abscess and contained arterial rupture. Emergency open conversion included radical debridement, complete graft explantation, and popliteal-to-posterior tibial bypass using an autologous great saphenous vein. Cultures grew Salmonella Enteritidis. Retrospective history revealed a previously undocumented episode of Salmonella Enteritidis bacteremia approximately 20 years earlier. At 2-year follow-up, the patient remained free of recurrent infection with a patent vein graft and preserved ambulatory function. Conclusions: Early Salmonella Enteritidis infection of a popliteal covered stent is an exceptionally rare but life-threatening complication. This case suggests that remote Salmonella bacteremia may represent a potential, hypothesis-generating risk factor for prosthetic graft infection. Prompt graft explantation followed by radical debridement and autologous venous reconstruction remain essential for durable limb salvage.

Background/Objectives: Static cold storage (SCS) remains the standard method of kidney preservation. As a referral transplant center, we frequently receive kidneys initially preserved with SCS and subsequently initiate prolonged hypothermic machine perfusion (HMP) to extend allocation time and optimize recipient matching. The clinical impact of this sequential preservation strategy remains incompletely defined. To compare outcomes between kidneys preserved with SCS followed by prolonged HMP (SCS+HMP) and SCS alone. Methods: This single-center retrospective study included 200 adult recipients of kidney transplants from brain-dead donors (67 SCS+HMP; 133 SCS). Outcomes were primary graft non-function (PNF), delayed graft function (DGF), patient and death-censored graft survival, and renal function over 24 months. Univariable and multivariable analyses identified predictors of DGF. Propensity score matching was performed to adjust for baseline imbalances. Results: In the SCS+HMP group, grafts underwent a median of 244 min of SCS followed by 1300 min of HMP, resulting in longer total cold ischemia time than SCS alone (1545 vs. 1104 min; p < 0.001). After matching, 51 pairs (n = 102) were analyzed. In the matched cohort, PNF occurred in 2 patients (3.9%) in the SCS+HMP group and 3 patients (5.9%) in the SCS group (p = 1.0). DGF occurred less frequently in the SCS+HMP group than in the SCS group (17.6% vs. 39.2%; p = 0.027). In multivariable Firth penalized logistic regression, HMP was independently associated with lower odds of DGF (OR 0.34; 95% CI 0.13–0.82). During the 24-month follow-up, patient survival, death-censored graft survival, and creatinine trajectories were comparable between groups. Conclusions: Sequential HMP after initial SCS enables extended preservation and was associated with a lower incidence of delayed graft function. This strategy does not compromise patient survival, death-censored graft survival, or renal function at 24 months.

Neutrophils and their extracellular traps (NETs) are pivotal elements of the immune response. This study investigates the dynamics of neutrophil-related markers during the perioperative period of branched endovascular aortic repair (BEVAR) in patients with thoracoabdominal aortic aneurysms (TAAAs) and evaluates their association with one-year clinical outcomes. A prospective, single-center study was conducted on 20 TAAA patients treated with T-branch devices. The analysis focused on surrogate markers associated with NETosis, including double-stranded DNA (dsDNA), single-stranded DNA (ssDNA), and citrullinated histone H3 (citH3). Peripheral venous blood was collected 24 h before BEVAR, and on the third and fifth postoperative days. Patients were monitored for one year to evaluate mortality and hospitalization risks, with predictors identified using Cox regression analysis. Increased postoperative levels of inflammatory markers were significantly associated with higher risks of mortality and hospital readmission. On the third postoperative day, key parameters emerged as predictors of adverse outcomes: dsDNA (HR = 1.000; 95% CI 1.000–1.000; p = 0.027), ssDNA (HR = 1.000; 95% CI 1.000–1.000; p = 0.022), and NLR (HR = 1.226; 95% CI 1.043–1.440; p = 0.013). Markers assessed in the early postoperative period (the third postopearive day) demonstrated superior predictive utility compared to those measured on the fifth postoperative day. CitH3 levels did not show statistical significance as a prognostic factor. Early postoperative evaluation of NET-associated markers, particularly dsDNA and ssDNA, offers prognostic value for predicting mortality and hospitalization risks in TAAA patients undergoing BEVAR. These markers may provide superior predictive accuracy compared to conventional post-implantation syndrome criteria. Enhanced postoperative monitoring of these markers could help identify high-risk patients who may benefit from intensified follow-up.

Purpose: The aim of the study was to evaluate the interventions in endoAVF created with the WavelinQ 4-F EndoAVF system to clarify the role of this method in personalised vascular access strategy for end-stage renal disease patients.Material and methods: Endovascular fistula creation was performed in 16 patients. The type of additional endovascular procedures during fistula creation was evaluated. Postoperative surgical and endovascular intervention was divided into maintenance and enhanced maturation procedures. The necessity of using assisted maturation was examined by Kaplan-Meier analysis, the rate of interventions per patients per year and evaluation of the type, time, and the relationship between intraoperative and postoperative interventions.Results: Access primary patency was significantly lower than access cumulative and functional patency (p < 0.001). During endoAVF creation 73.3% patients required 16 additional endovascular procedures. After endoAVF creation 73.3% patients needed endovascular 22 procedures and 20% underwent surgical interventions. Nine (81.8%) out of 11 patients required intravascular procedures due to lack of fistula maturation – 9 (45%) angioplasties and 11 (55%) vein embolisations. The postoperative venous embolisation rate was significantly dependent on vein embolisation during endoAVF creation (p < 0.04). After endoAVF creation significantly more patients – 11 (73.3%) – required endovascular interventions compared to 3 (20%) with surgical interventions (p < 0.01). Postoperative endovascular and surgical interventions was 0.09 and 0.02 per patients per year, respectively.Conclusions: Maturation of endoAVFs required significantly more endovascular than surgical interventions. Venous embolisation combined with fistula creation reduced postoperative embolisation.

A number types of extracellular DNA (eg, cell-free, cfDNA) circulate in human blood, including mitochondrial, transcriptome, and regulatory DNA, usually at low concentrations. Larger amounts of cfDNA appear in any inflammatory condition, including organ damage due to a variety of reasons. The role of cfDNA in solid organ transplantation is discussed in this review as a valuable additional tool in the standard of care of transplant patients. Post-transplant monitoring requires the use of high-quality biomarkers for early detection of graft damage or rejection to be able to apply early therapeutic intervention. CfDNA complements the traditional monitoring strategies, being a risk stratification tool and an important prognostic marker. However, improving the sensitivity and specificity of cfDNA detection is necessary to facilitate personalized patient management, warranting further research in terms of measurement, test standardization, and storage, processing, and shipping. A diagnostic test (Allosure, CareDx, Inc., Brisbane, CA) for kidney, heart and lung transplant patients is now commercially available, and validation for other organs (eg, liver) is pending. To date, donor-derived cfDNA in combination with other biomarkers appears to be a promising tool in graft rejection as it is minimally invasive, time-sensitive, and cost-effective. However, improvement of sensitivity and specificity is required to facilitate personalized patient management. Whether it could be an alternate to graft biopsy remains unclear.