Background and aimsArteriovenous fistula (AVF) maturation failure rates remain high in patients with end-stage renal disease (ESRD). Although preoperative morphological and functional assessment of blood vessels by duplex ultrasonography (DUS) has been shown to improve AVF maturation, there is no consensus regarding the optimal vein (VD) and artery (AD) diameters to be universally used for AVF creation. To improve patient selection, set out to investigate if there is a correlation between preoperative VD/AD and clinical covariates, and postoperative AVF outcome.MethodsThis was a prospective cohort study conducted during January–August 2014. ESRD patients referred to “Niculae Stăncioiu” Heart Institute Cluj-Napoca, who had a VD ≥1.9 mm and AD ≥1.5 mm, as measured by DUS, and underwent AVF creation were enrolled. We assessed whether preoperative VD/AD and clinical covariates were associated with AVF maturation rate and primary patency at 2 years after AVF creation.ResultsOf 115 patients referred for AVF creation, 93 were included in the study. Mean (± standard deviation) VD was 3.3 ± 1.1 mm and VDs were distributed in quartile Q1 <2.55 mm, Q2: 2.56–3.10 mm, Q3: 3.11–3.70 mm and Q4: >3.71 mm. Mean AD was 3.3 ± 1.4 mm and ADs were distributed in Q1 <2.55 mm, Q2: 2.56–3.10 mm, Q3: 3.11–3.70 mm, and Q4, >3.71 mm. AVF maturation rate increased proportionally with VD from Q1 (62%) to Q2 (70%), Q3 (82%) to Q4 (96%) (p=0.03). Based on AD, a higher AVF maturation rate was observed in Q3 (86%), Q4 (83%) vs Q1 (71%) and Q2 (67%). Long-term primary patency of AVFs seemed not to be influenced by VD and AD. In older patients and those with peripheral arterial disease, AVF maturation failure tended to be higher.ConclusionsOur findings suggest that a preoperative VD ≥1.9 mm and AD ≥1.5 mm have a successful maturation rate of AVF greater than 60% in ESRD patients. The maturation rate of surgical AVF increases proportionally with the size of VD used for AVF creation.

An 86-year-old lady with severe aortic stenosis and interventricular membranous septal aneurysm underwent transfemoral transcatheter aortic valve implantation (TAVI). A balloon-expandable valve was deployed after a difficult native valve crossing. Transesophageal echocardiography showed a rapidly accumulating pericardial effusion, with pericardial thrombus and subsequent cardiac tamponade. The angiographic views raised suspicion of aortic root perforation. Median sternotomy was performed because of sudden hemodynamic collapse.The report presents the uncommon association between severe aortic stenosis and interventricular membranous septal aneurysm in an octogenarian and discusses its impact on the development of a post-TAVI major complication.

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Background: This study aims to evaluate the local proteolytic activity from the level of Abdominal Aortic Aneurysm (AAA) wall and correlate the obtained values with the preoperative values of NLRs (Neutrophil-Lymphocyte Ratio), evaluating a possible association between the two variables and, implicitly, between the local proteolysis process and the systemic inflammatory response of those patients diagnosed with AAA. Methods: The current study is monocentric, observational, and prospective, taking place at the Department of Cardiovascular Surgery, Cluj-Napoca, Romania. Patients undergoing elective or emergency classical surgery for unruptured AAA or ruptured AAA were included in the study. During classical surgery, samples from the infrarenal aortic aneurysmal wall were collected in a standardized manner, from the central part of the anterior wall from uAAA and rAAA and were analyzed by gel zymography. Results: The concentration of MMP2 was similar in the ruptured/non-ruptured group, without any statistical significance. In the MMP-9 case, we obtained a mean of 821.35 U arb/µg at the level of unruptured aneurysmal wall and 1411.57 U arb/µg at the level of the ruptured aneurysmal wall. According to the ANOVA test, there is a significant difference between the two categories of aneurysms. The same correlation was observed regarding both the zymogen category, pro-MMP-2, as well as pro-MMP-9: they expressed significant higher quantities of inactive enzymes in rAAA. We splitted the study population into two categories: patients who presented preoperative NLR values < 5 and > 5. MMP-2 collagenase levels did not register statistical differences between the two groups, p = 0.3236. High levels of MMP-9 are positively associated with increased values of NLR, the NLR<5 group had an MMP-9 mean of 902.41(473.71) U arb/µg, statistically lower than the MMP-9 mean indicated in the NLR>5 group, 1474(521.21) U arb/µg. Similarly, MMP-2 and MMP-9 zymogens were found in statistically higher quantities (p < 0.05) in the NLR>5 group of patients. Conclusions: This is the first study that analyzes a possible correlation between the local proteolytic activity at the site of the dilated aneurysmal aortic wall and circulating levels of NLR. Following the results obtained, we conclude that the group of patients presenting with NLR>5 preoperatively, as in the rAAA group, significantly greater levels of MMP-9 and inactive proenzymes were identified. Local metalloproteinase MM9 activity is proportional to the systemic inflammatory activity. Concomitantly, we hypothesize that the increased sensitivity of NLR as a prognostic marker in AAA pathology, which is ensured and confirmed by its strong association with local proteolytic activity, directly implied in the evolution of the disease.