Journal of Cardiovascular Emergencies Feed

Inflammation as a Cornerstone in the Early Diagnosis and Treatment of Pulmonary Embolism

Wed, 24 Jun 2026 00:00:00 GMT

BackgroundPulmonary embolism (PE) is a major cause of cardiovascular death and was increasingly diagnosed during and after the COVID-19 pandemic, highlighting the role of inflammation alongside genetic and acquired risk factors. Despite effective therapies, PE remains underdiagnosed. This study analyzed patient characteristics, risk factors, inflammatory markers, and management strategies.Materials and MethodsWe conducted a retrospective study of 97 patients with PE admitted to the Cardiology Department of the County Emergency Clinical Hospital Brașov between March 2021 and April 2022. Clinical, biological, and therapeutic data were systematically evaluated.ResultsThe mean age was 66.8 years, with near-equal sex distribution. The most frequent symptoms were dyspnea, unilateral lower limb edema, and chest pain; hemodynamic instability was rare. Major risk factors included age >60 years, hypertension, and obesity. One-third of patients had recent SARS-CoV-2 infection or vaccination (<4 months). Inflammatory and thrombotic markers (leukocytosis, CRP, fibrinogen, D-dimer) were frequently abnormal. Most patients received low-molecular-weight heparin; thrombolysis was used selectively.ConclusionsPE management during the pandemic emphasized the importance of inflammation in risk stratification, monitoring, and prognosis. Identifying patient-specific risk factors and refining treatment strategies remain essential for improving outcomes in this high–risk population.

Biomechanical Characterization and Remodeling of Pulmonary Arteries in Chronic Thromboembolic Pulmonary Hypertension

Wed, 24 Jun 2026 00:00:00 GMT

Chronic thromboembolic pulmonary hypertension (CTEPH) is a distinct and potentially curable form of pulmonary hypertension that develops following incomplete resolution of acute pulmonary embolism, leading to persistent fibrotic obstruction of the pulmonary arteries and progressive microvascular disease. Although CTEPH has traditionally been assessed using steady-flow hemodynamic parameters such as mean pulmonary arterial pressure and pulmonary vascular resistance, growing evidence suggests that pulmonary artery stiffness and altered vascular biomechanics are critical contributors to disease severity, right ventricular dysfunction, and patient outcomes. This narrative review summarizes current knowledge on the structural remodeling and biomechanical behavior of pulmonary arteries in CTEPH, with emphasis on changes affecting arterial compliance, impedance, and right ventricle–pulmonary artery coupling. Key mechanisms include thrombus organization, endothelial dysfunction, smooth muscle cell proliferation, extracellular matrix deposition, and mechanobiological feedback loops that reinforce vascular stiffening. The review further discusses available experimental and computational approaches used to characterize pulmonary vascular mechanics and highlights the clinical relevance of biomechanical markers in improving prognostic stratification and therapeutic decision-making. Finally, it outlines gaps in current evidence regarding reversibility of vascular stiffness and the long-term impact of surgical, interventional, and medical therapies, supporting the need for integrated biomechanical assessment in future CTEPH research and management.

Predictors of Abnormal Transfontanelle Ultrasound Findings in Neonates with Congenital Heart Disease

Wed, 24 Jun 2026 00:00:00 GMT

BackgroundAdvances in neonatal cardiac care have improved survival in infants with congenital heart disease (CHD), shifting clinical attention toward early neurological morbidity. While cardiac anatomical complexity has traditionally been considered a major determinant of brain injury, emerging evidence suggests that genetic and systemic factors may play a more important role. Transfontanellar ultrasound (TFUS) is widely used as a bedside screening tool for early detection of neonatal brain abnormalities.AimTo assess the incidence of abnormal TFUS findings in neonates with CHD and identify clinical and genetic predictors of early neurological vulnerability independent of cardiac anatomy.Materials and MethodsWe conducted an observational cohort study including 138 neonates with CHD who underwent TFUS evaluation at a tertiary care center in Iași, Romania. Demographic, perinatal, clinical, genetic, and therapeutic data were collected retrospectively. CHD complexity was classified using the Bethesda classification. Univariate and multivariate logistic regression analyses were performed to identify predictors of abnormal TFUS findings.ResultsAbnormal TFUS findings were identified in 42 neonates (30.4%), most commonly ventricular dilatation, intracranial hemorrhage, and choroid plexus cysts. In multivariate analysis, positive genetic testing was the strongest independent predictor (OR 3.9, 95% CI 1.5–10.2), followed by mechanical ventilation dependence (OR 2.7, 95% CI 1.1–6.5) and high Bethesda risk category (OR 2.2, 95% CI 1.0–4.8). Cardiac anatomical classification and gestational age were not independently associated with abnormal TFUS findings.ConclusionsIn neonates with CHD, early TFUS abnormalities appear to be driven mainly by genetic and systemic factors rather than cardiac anatomy alone, supporting integrative risk stratification approaches for targeted neurological surveillance.

Complications in Patients with STEMI versus Non-STEMI: A Clinical Comparison

Wed, 24 Jun 2026 00:00:00 GMT

BackgroundAcute coronary syndrome (ACS) includes ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), each with distinct clinical profiles and outcomes. While STEMI is typically associated with more extensive infarcts, emerging data suggest NSTEMI may carry a greater burden of comorbidities and anatomical complexity.ObjectiveTo compare the incidence of ventricular arrhythmias and hemodynamic instability in patients with STEMI vs. NSTEMI and to analyze the distribution of culprit coronary lesions. Methods: This retrospective single-center study included 172 patients who underwent coronary revascularization between April and July 2021. Clinical outcomes, arrhythmias, and hemodynamic instability were compared between groups with STEMI (n = 108) and NSTEMI (n = 64). Culprit lesions were evaluated by angiography and categorized by vessel.ResultsHemodynamic instability was significantly more common in patients with NSTEMI (10.93%) compared to STEMI (0.18%) (p = 0.005). Ventricular arrhythmias occurred in 12.03% of patients with STEMI and 7.81% of patients with NSTEMI, with no significant difference. Left main coronary artery lesions were notably more frequent in NSTEMI (47.4% vs. 2.04%; p < 0.0001), whereas right coronary artery involvement was higher in STEMI (40.81% vs. 7.4%; p < 0.0001). Ventricular arrhythmias were significantly associated with circumflex artery lesions in patients with NSTEMI (p = 0.0001).ConclusionsDespite often being perceived as lower risk, patients with NSTEMI exhibited a higher rate of hemodynamic instability and more complex coronary involvement, particularly left main disease. These findings highlight the need for vigilant monitoring and individualized treatment strategies in populations with NSTEMI.

Reperfusion Delays and Systemic Challenges in ST-Elevation Myocardial Infarction: Insights from a Tertiary Emergency Hospital Registry in Romania

Wed, 24 Jun 2026 00:00:00 GMT

BackgroundTimely reperfusion is the cornerstone of ST-elevation myocardial infarction (STEMI) management. Despite major advances in primary percutaneous coronary intervention (PCI), substantial delays persist, particularly in Eastern Europe.MethodsWe conducted a retrospective, registry-based analysis of 151 consecutive patients with STEMI admitted to a tertiary emergency university hospital in Romania between April and October 2025. Demographic characteristics, cardiovascular risk factors, reperfusion timelines, and in-hospital outcomes were analyzed.ResultsMean total ischemic time was 421 min, driven predominantly by prolonged pain-to-call (229 min) and first medical contact (FMC)-to-door (102 min) intervals. In-hospital door-to-balloon times were largely compliant with European Society of Cardiology recommendations. In-hospital mortality was 8.94%.ConclusionsSTEMI care in Romania is characterized by significant pre-hospital delays despite efficient in-hospital workflows. Targeted public education, optimization of emergency medical service pathways, and broader implementation of pharmaco-invasive strategies may substantially reduce ischemic time and improve outcomes.

Coronary Computed Tomography Angiography in Non-ST Elevation Acute Coronary Syndromes: Present Evidence and Potential Advances

Fri, 27 Mar 2026 00:00:00 GMT

Coronary computed tomography angiography (CCTA) has evolved significantly over the past decade, expanding from stable coronary artery disease (CAD) assessment to diverse cardiovascular applications. However, its role in non-ST-elevation acute coronary syndromes (NSTE-ACSs) remains incompletely defined despite excellent diagnostic accuracy. This review synthesizes current evidence on the performance of CCTA in NSTE-ACS, examining diagnostic capabilities, advanced plaque characterization, clinical outcomes, and knowledge gaps requiring future investigation. CCTA demonstrates high negative predictive value (>90%) for ruling out obstructive CAD in NSTE-ACS, particularly in low-to-intermediate risk patients. Despite this diagnostic performance, contemporary evidence reveals a persistent disconnect between anatomical accuracy and clinical benefit, with CCTA-guided strategies failing to demonstrate improvements in major adverse cardiovascular events or reductions in healthcare costs when compared to standard invasive approaches. Advanced plaque characterization techniques offer potential refinement in risk stratification. Pericoronary adipose tissue analysis via fat attenuation index correlates with vulnerable plaque features and inflammatory markers in NSTE-ACS populations. Critical evidence gaps persist regarding optimal patient selection algorithms, timing strategies across risk stratification, and cost-effectiveness analyses. Future research must prioritize outcome-driven investigations demonstrating that CCTA-guided management improves clinical endpoints, prospective validation of advanced imaging biomarkers, and integration into personalized algorithms to bridge the gap between diagnostic capability and meaningful clinical impact.

Risk Factors Associated with In-hospital Poor Outcomes in Patients with Acute Limb Ischemia

Fri, 27 Mar 2026 00:00:00 GMT

BackgroundAcute limb ischemia (ALI) is a vascular emergency characterized by a sudden reduction in limb perfusion, most commonly resulting from thromboembolism or thrombosis at the site of an atherosclerotic plaque. This study aimed to analyze and identify risk factors associated with major amputation and in-hospital mortality in patients with ALI.Material and methodsWe retrospectively analyzed 177 patients diagnosed with upper or lower limb ALI admitted to the Vascular Surgery Clinic between January 2019 and December 2024. Data collected from electronic medical records included demographic variables, cardiovascular comorbidities, chronic kidney disease, diabetes mellitus, malignancies, preoperative laboratory parameters (within the first 12 h of admission), type of surgical intervention, and anesthesia type.ResultsPatients with lower limb ischemia were significantly older than those with upper limb involvement (p = 0.041). Lower limb ischemia was also associated with a higher prevalence of ischemic heart disease (p = 0.030), chronic heart failure (p = 0.013), and peripheral arterial disease (p < 0.001). Laboratory findings revealed lower red blood cell counts (p = 0.034), hemoglobin (p = 0.010), and hematocrit (p = 0.011), along with higher creatine kinase (p = 0.013), neutrophil (p = 0.017), and monocyte levels (p = 0.034) in patients with lower limb ALI. While surgical intervention types did not differ significantly, lower limb ALI patients underwent local anesthesia less frequently (p < 0.001) and general anesthesia more frequently (p < 0.001). Univariate analysis identified peripheral arterial disease (OR: 2.45, p = 0.046) as a predictor of major amputation, while chronic heart failure (OR: 2.77, p = 0.033), prior myocardial infarction (OR: 3.85, p = 0.024), and diabetes mellitus (OR: 3.23, p = 0.012) were significantly associated with in-hospital mortality.ConclusionsThese findings highlight the critical role of aggressive cardiovascular risk factor management in patients with ALI to improve outcomes following surgical revascularization.

A Rare Cause for Congestive Heart Failure after Myocardial Infarction: A Giant Left Ventricle Pseudoaneurysm

Fri, 27 Mar 2026 00:00:00 GMT

IntroductionLeft ventricular pseudoaneurysm (LVP) is a rare complication of myocardial infarction associated with very high mortality. Patients with LVP may present with heart failure, ventricular arrhythmias, or even cardiac tamponade. If left untreated, the risk of rupture may reach up to 45% within the first year.Case presentationWe present the case of a 76-year-old patient with a recent myocardial infarction, diabetes, renal failure, stroke, and tetraparesis, admitted to the Neurology Department of the Clinical Rehabilitation Hospital in Cluj-Napoca. A cardiology consultation was requested for sudden-onset dyspnea, palpitations, and deterioration of the general condition. Clinical examination showed SpO2 79% and HR 100/min, without cardiac murmurs. Echocardiography revealed mildly reduced LVEF, a giant posterior LVP, dilated right heart chambers with signs of right ventricular overload, and bilateral pleural effusion. CT angiography excluded pulmonary embolism and confirmed the presence of LVP. The symptoms were interpreted as acute heart failure. Surgical closure was considered, but the Heart Team decided on conservative management due to the extremely high perioperative risk. During hospitalization, the patient developed multiple complications and eventually died following pseudoaneurysm rupture and cardiac arrest.ConclusionLeft ventricular pseudoaneurysm is a rare but life-threatening complication of myocardial infarction that requires early diagnosis and prompt management. This case highlights the challenges of treating patients with multiple comorbidities and very high surgical risk, in whom the lack of definitive treatment options may lead to a fatal outcome.

Patent Foramen Ovale – from Diagnosis to Treatment. A Literature Review

Fri, 27 Mar 2026 00:00:00 GMT

Patent foramen ovale (PFO) is a common congenital cardiac anomaly, present in approximately 25% of the general population, representing a persistent interatrial communication. This review summarizes current evidence on the clinical manifestations, diagnostic approaches, and management strategies for PFO in accordance with the most recent international guidelines. In patients with high-risk anatomical features or cryptogenic stroke, PFO closure may be indicated. The decision to close a PFO is based on careful risk stratification and comprehensive imaging, typically including contrast-enhanced transesophageal echocardiography. Several randomized controlled trials have demonstrated the efficacy of percutaneous closure devices, and PFO closure is currently considered an effective strategy for secondary prevention of cryptogenic stroke in carefully selected patients aged 18 to 60 years.

Sustained Atrial Fibrillation Induced by Commotio Cordis-Like Event in a Pediatric Patien

Fri, 27 Mar 2026 00:00:00 GMT

IntroductionCommotio cordis (CC), or concussion of the heart, is typically characterized by a sudden impact to the chest wall precipitating ventricular fibrillation arrest. There have been very few documented cases of atrial fibrillation (AF) resulting from this mechanism. A relative consensus exists in the crucial nature of the timing of a blow at the vulnerable ventricular repolarization in the cardiac cycle, with suggestion of the impact occurring during atrial repolarization, triggering paroxysmal atrial fibrillation.Case PresentationWe present the case of a 17-year-old male patient who sustained two significant chest wall blows over the course of 8 months with initial electrocardiogram evidence of both atrial and ventricular irritability, subsequently developing AF, which did not spontaneously resolve.ConclusionsAlthough the focus of CC has been management of immediate and lethal ventricular arrhythmias, atrial arrhythmias such as atrioventricular block, atrial flutter, or AF can occur from abnormal depolarization or occult damage to the conduction system. Detection of these rhythms may be delayed due to lack of initial collapse. Clinicians in the emergency department need to consider the possibility of late complications even in patients who do not exhibit immediate ventricular arrhythmia.

The Value of Optical Coherence Tomography Parameters in Estimating Non-Critical Lesions in Patients with Acute Myocardial Infarction

Fri, 27 Mar 2026 00:00:00 GMT

BackgroundCoronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Accurate assessment of coronary lesion severity is essential for guiding revascularization. Fractional flow reserve (FFR) is the gold standard for functional evaluation of coronary stenoses, but data on intracoronary hemodynamic assessment in patients with acute myocardial infarction are limited. Optical coherence tomography (OCT) provides high-resolution intravascular imaging and may offer additional insights into lesion severity.AimTo investigate the correlation between OCT-derived measurements and FFR values in patients with acute myocardial infarction.MethodsThe study included 114 patients with acute myocardial infarction (STEMI or NSTEMI) undergoing primary percutaneous coronary intervention (PCI) of the culprit lesion. Intermediate stenoses in non-culprit vessels (151 lesions) were evaluated during staged procedures with OCT and FFR. Minimal luminal area (MLA) and percent luminal area stenosis (PAS) were analyzed in relation to FFR values.ResultsOCT-derived parameters showed good correlation with FFR values. In multivariable logistic regression, MLA and PAS were independent predictors of FFR <0.80. The optimal cut-off values were 2.08 mm2 for MLA and 76.85% for PAS.ConclusionsOCT-derived parameters may help identify functionally significant non-culprit lesions in patients with acute myocardial infarction and can complement physiological assessment in clinical practice.

Hypertensive Emergencies – Updated Insights into Guidelines, Mechanisms, and Emerging Challenges

Wed, 31 Dec 2025 00:00:00 GMT

Hypertensive emergencies are critical conditions characterized by severe blood pressure (BP) elevations causing acute target organ damage. Despite advancements in hypertension management, these emergencies remain a significant clinical challenge, affecting 1–2% of hypertensive patients and often arising from poor disease control. This review integrates updated guidelines, emerging evidence, and treatment strategies to optimize outcomes. Pathophysiological mechanisms, including failure of autoregulation and renin–angiotensin–aldosterone system activation, contribute to endothelial dysfunction and microvascular injury. Effective management requires rapid, yet cautious BP reduction to prevent further organ damage while preserving perfusion. Intravenous antihypertensive agents, such as labetalol and nicardipine, are emphasized for their safety and efficacy. Comparative studies highlight nicardipine’s superior efficacy in achieving rapid BP control, whereas labetalol offers versatility with fewer cardiac side effects. In specific scenarios, such as ischemic stroke or preeclampsia, treatment is tailored to underlying conditions, reflecting guideline recommendations. Long-term outcomes depend on sustained BP control and the prevention of hypertensive-mediated organ damage. Emerging biomarkers provide insights into disease progression and potential therapeutic targets. Despite progress, research gaps remain in precision medicine and healthcare equity. Future efforts should focus on personalizing treatment and integrating advanced diagnostics to reduce morbidity and mortality in hypertensive emergencies.

Implementation of Artificial Intelligence for Predicting Atrial Fibrillation – A Review

Wed, 31 Dec 2025 00:00:00 GMT

Atrial fibrillation is the most common heart arrhythmia globally, leading to life-threatening complications, reduced quality of life, a high financial burden, and significant healthcare resource utilization. Artificial intelligence is increasingly being integrated into medicine, enhancing clinicians’ ability to screen for, diagnose, and treat various conditions. In recent years, artificial intelligence models have been successfully applied to predict atrial fibrillation by analyzing 12-lead electrocardiogram waveforms, imaging features derived from computed tomography, cardiac magnetic resonance imaging, and echocardiography, as well as other clinical risk factors. The aim of this study is to synthesize current evidence, highlight emerging trends, and identify future directions in this field.

Previous Cardiovascular and Cerebrovascular Events Increase Risk of Depression or Anxiety Disorder in Patients with Chronic Limb-Threatening Ischemia

Wed, 31 Dec 2025 00:00:00 GMT

BackgroundChronic limb-threatening ischemia (CLTI), the most severe type of peripheral arterial disease (PAD), is characterized by rest pain, ischemic ulcers, or gangrene. It is associated with high rates of amputation, hospitalization, and mortality. Depression affects between 16% and 35% of patients with PAD, while anxiety disorders are present in approximately 24.4% to 29%. Aim of the study: This study aims to identify and analyze the risk factors associated with the presence of anxiety or depressive disorders in patients with CLTI.Material and MethodsIn this monocentric, retrospective, observational study, all patients with CLTI admitted to the Vascular Surgery Clinic of the Târgu Mureş County Emergency Clinical Hospital from January 2020 to December 2023 were included. Demographic data, comorbidities, risk factors, and laboratory data were collected from the hospital’s electronic database. Additionally, cardiovascular events (history of myocardial infarction or angina pectoris) and cerebrovascular events (including stroke or transient ischemic attack) were documented, along with the presence of depression or anxiety disorders.ResultsA total of 113 patients with CLTI were enrolled, with a mean age of 70.54 ± 8.96 years. Of the entire cohort, 14 patients (12.39%) were diagnosed with depression or anxiety disorder. Based on the presence of depression or anxiety disorder, no significant differences were observed concerning demographic data, comorbidities, and risk factors, except for cardiovascular events (35.71% vs. 11.11%; p = 0.013) and cerebrovascular events (64.29% vs. 12.12%; p < 0.001). Regarding laboratory findings, only blood urea nitrogen levels were higher in patients with depression or anxiety disorder (p = 0.023). In the univariate analysis, cardiovascular events (OR 4.44; p = 0.020) and cerebrovascular events (OR 13.05; p < 0.001) were linked to depression or anxiety. Conclusions: A history of cardiovascular and cerebrovascular events was strongly linked to an increased risk of depression or anxiety in patients with CLTI. This emphasizes the close connection between vascular disease and mental health, indicating that neurological and cardiac conditions might worsen psychological distress in this at-risk group.

The Association of Coronary Artery Calcium Score with Heart Failure – a Literature Review

Wed, 31 Dec 2025 00:00:00 GMT

One of the main principles of cardiovascular disease prevention is early intervention. Heart failure represents an end stage of most cardiovascular diseases and is a consequence of persistent damage caused by conditions such as coronary artery disease, hypertension, or valvular heart disease. Since its introduction, the coronary artery calcium (CAC) score has proven to be a comprehensive, reproducible, and accessible measure to quantify atherosclerotic burden. This review aimed to assess the prognostic value of the CAC score in patients with heart failure and its association with heart failure-related mortality. We searched the PubMed, Web of Science, and Google Scholar databases for studies examining the relationship between the CAC score and heart failure. After an initial selection of 32 articles, 23 were deemed eligible for inclusion. Based on the findings of these studies, the CAC score can be considered a useful tool for assessing heart failure risk, either alone or in combination with other parameters, across diverse populations, thereby supporting earlier initiation of pharmacological therapy.

The Impact of Connective Tissue Disorders on Patients with Thoracic Aortic Pseudoaneurysms

Wed, 31 Dec 2025 00:00:00 GMT

IntroductionWe sought to review the clinical presentation, etiologies, diagnostic methods, surgical techniques, and long-term outcomes of patients with thoracic aortic false aneurysms (TAFA) treated at our institution. Although connective tissue disorders (CTDs) are recognized risk factors for aortic aneurysms, their role in the development and management of false aneurysms is less well established. The aim of this study was to compare cohorts of patients with and without CTD.MethodsA total of 116 patients were diagnosed with a thoracic aortic pseudoaneurysm between January 1996 and August 2024 at our institute. Genetic screening confirmed a CTD in 18 patients. Follow-up was obtained for all patients through echocardiographic or computed tomography assessment.ResultsIn all cases, TAFA developed after prior cardiovascular surgery. In the CTD cohort, the most common initial diagnosis was aortic dissection (72%), and the most frequent primary operation was the Bentall procedure (88%). Ten patients with CTD were indicated for reintervention (surgical reoperation, endoluminal graft implantation, or occluder implantation).ConclusionOne-year survival was higher in patients without CTD (98%) than in those with CTD (89%); however, ten-year survival was higher in the CTD cohort (89% vs. 68%). After surgical reoperation, secondary TAFA recurrence was lower in patients without CTD (16% vs. 22%), although recurrence occurred sooner in this group. Operative mortality was 11.1% in patients with CTD and 5.1% in those without CTD.

Peripheral Vascular Access Complications After Percutaneous Procedures: A Single-Center Experience

Wed, 31 Dec 2025 00:00:00 GMT

BackgroundThe Seldinger technique is a fundamental method for percutaneous vascular access in cardiovascular interventions, including extracorporeal membrane oxygenation, transcatheter aortic valve implantation, percutaneous coronary intervention, and coronary angiography. Despite its critical role in hemodynamic monitoring, drug delivery, and device placement, peripheral vascular access is associated with complications such as pseudoaneurysm, hematoma, arteriovenous fistula, thrombosis, and bleeding, which may adversely impact clinical outcomes.Aim of the StudyThis study aimed to evaluate the incidence, risk factors, and management strategies of severe vascular complications requiring surgical intervention following peripheral vascular access in cardiovascular procedures.Materials and MethodsA retrospective analysis was conducted on 81 patients treated at the Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş between 2017 and 2024 for vascular complications after percutaneous interventions. From a total of 23,370 procedures, including 592 cases of transcatheter aortic valve implantation, 73 patients with femoral artery complications were analyzed. Demographic data, comorbidities, procedural history, complication type, and surgical management were recorded.ResultsThe cohort had a mean age of 65.7 ± 13.3 years; 60.2% were male, and 87.6% were over 50 years of age. Frequent comorbidities included cardiopathies (97.5%), anemia (67.1%), peripheral arterial disease (32.8%), and coagulopathies (28.7%). Previous vascular interventions were significantly associated with increased complication risk (p < 0.001). Pseudoaneurysm was the most prevalent complication (43.8%), followed by hematoma and arteriovenous fistula. Arterial suturing constituted the primary surgical management (67.1%).ConclusionsFemoral artery access in cardiovascular interventions carries a measurable risk of severe complications, particularly in older patients with comorbidities and prior vascular procedures. Pseudoaneurysm represents the most frequent adverse event. Optimal outcomes require meticulous patient selection, procedural planning, and early recognition of complications, supported by advanced imaging, closure devices, and prompt surgical intervention when necessary.

Allergic Acute Coronary Syndrome Without Identifiable Triggers – Kounis Syndrome Type I Associated with Chronic Spontaneous Urticaria. Case Report and Review of the Literature

Tue, 23 Sep 2025 00:00:00 GMT

IntroductionKounis syndrome is a complex clinical entity at the intersection of acute coronary syndromes and allergic reactions.Case presentationWe report the case of a 55-year-old woman with hypertension, autoimmune thyroiditis, and recurrent allergic complaints who was admitted with ST-elevation myocardial infarction and found to have myocardial infarction with non-obstructive coronary arteries (MINOCA), likely due to coronary vasospasm. During hospitalization, she developed cutaneous symptoms and was subsequently diagnosed with chronic spontaneous urticaria. Retrospectively, the diagnosis of Kounis syndrome type I was established.ConclusionsReporting cases with subtle or absent allergic manifestations is essential to improve diagnostic accuracy and guide appropriate management, particularly given the potential for recurrence.

Unpredictable Cause of Renal Infarction in a Young Person – a Case Report

Tue, 23 Sep 2025 00:00:00 GMT

IntroductionRenal artery occlusion is a rare but life-threatening condition that can cause renal infarction and long-term functional impairment if diagnosis and treatment are delayed. It is commonly linked to systemic thromboembolic events, and in certain cases the origin of the thrombus is uncertain. This report presents a case of renal thromboembolism caused by a paradoxical embolism in a young patient.Case presentationWe report the case of a 32-year-old male patient who presented to the emergency department with severe right lumbar pain irradiating to the right thigh and abdomen. The patient had recently experienced a dislocation of the right patella, which had been immobilized without anticoagulation therapy. Clinical and imaging investigations showed almost complete occlusion of the right renal artery, thus causing infarction of two-thirds of the right kidney. A patent foramen ovale with coexisting deep vein thrombosis suggested a paradoxical embolism as the etiology. With catheter-directed thrombolysis and thrombectomy, improvement was obtained through a multidisciplinary approach to care with interventional cardiology, vascular surgery, and nephrology.ConclusionAlthough uncommon, renal artery thrombosis should be considered in patients with flank pain and thromboembolic history. Long-term anticoagulation and follow-up are essential to prevent recurrence.

Neo-Femoral Artery Reconstruction with Autologous Bifurcated Great Saphenous Vein Graft in an 88-Year-Old Patient with a Large Infected Pseudoaneurysm

Tue, 23 Sep 2025 00:00:00 GMT

We present the case of an 88-year-old patient with multiple cardiovascular comorbidities who, on the first day after transcatheter aortic valve implantation (TAVI), developed sudden severe pain in the right lower extremity. Urgent computed tomography angiography (CTA) of the abdominal aorta and lower limbs revealed a patent right common iliac artery with thrombotic occlusion of the external iliac and femoral arteries. A transfemoral thromboembolectomy using a Fogarty catheter was performed at the iliofemoral axis, supplemented by local endarterectomy and patch angioplasty. Over the following three weeks, two additional interventions were required to evacuate an inguinal hematoma and secure hemostasis at the patch level. Three months later, the patient returned to the emergency department with severe groin pain and active bleeding from the wound. CTA revealed a large infected pseudoaneurysm of the common femoral artery, measuring approximately 4 × 2.5 cm. Reconstruction of the neo-femoral artery was carried out using an autologous bifurcated great saphenous vein graft, combined with a proximal sartorius muscle flap. At six months, CTA demonstrated patent femoral arteries without thrombus or hematoma and complete tissue healing.