Arcuate Arteries Research Articles

Something old, something new: digital quantification of uterine vascular remodelling and trophoblast plugging in historical collections provides new insight into adaptation of the utero-placental circulation.

What is the physiological extent of vascular remodelling in and trophoblast plugging of the uterine circulation across the first half of pregnancy? All levels of the uterine vascular tree (arcuate, radial and spiral arteries (SAs)) dilate ∼2.6- to 4.3-fold between 6 and 20 weeks of gestation, with significant aggregates of trophoblasts persisting in the decidual and myometrial parts of SAs beyond the first trimester. In early pregnancy, endovascular trophoblasts form 'plugs' in the SAs, transiently inhibiting blood flow to the placenta, whilst concurrently the uterine vasculature undergoes significant adaption to facilitate increased blood delivery to the placenta later in gestation. These processes are impaired in pregnancy disorders, but quantitative understanding of the anatomical changes even in normal pregnancy is poor. Serial sections of normal placentae in situ (n = 22) of 6.1-20.5 weeks of gestation from the Boyd collection and Dixon collection (University of Cambridge, UK) were digitalized using a slide scanner or Axio Imager.A1 microscope. Spiral (n = 45), radial (n = 40) and arcuate (n = 39) arteries were manually segmented. Using custom-written scripts for Matlab® software, artery dimensions (Feret diameters; major axes; luminal/wall area) and endovascular trophoblast plug/aggregate (n = 24) porosities were calculated. Diameters of junctional zone SAs within the myometrium (n = 35) were acquired separately using a micrometre and light microscope. Decidual thickness and trophoblast plug depth was measured using ImageJ. By all measures, radial and arcuate artery dimensions progressively increased from 6.1 to 20.5 weeks (P < 0.01). The greatest increase in SA calibre occurred after 12 weeks of gestation. Trophoblast aggregates were found to persist within decidual and myometrial parts of SA lumens beyond the first trimester, and up to 18.5 weeks of gestation, although those present in the second trimester did not appear to prevent the passage of red blood cells to the intervillous space. Trophoblasts forming these aggregates became more compact (decreased in porosity) over gestation, whilst channel size between cells increased (P = 0.01). Decidual thickness decreased linearly over gestation (P = 0.0003), meaning plugs occupied an increasing proportion of the decidua (P = 0.02). N/A. Although serial sections were assessed, two-dimensional images cannot completely reflect the three-dimensional properties and connectivity of vessels and plugs/aggregates. Immersion-fixation of the specimens means that vessel size may be under-estimated. Uterine vascular remodelling and trophoblast plug dispersion is a progressive phenomenon that is not completed by the end of the first trimester. Our quantitative findings support the concept that radial arteries present a major site of resistance until mid-gestation. Their dimensional increase at 10-12 weeks of gestation may explain the rapid increase in blood flow to the placenta observed by others at ∼13 weeks. Measured properties of trophoblast plugs suggest that they will impact on the resistance, shear stress and nature of blood flow within the utero-placental vasculature until mid-gestation. The presence of channels within plugs will likely lead to high velocity flow streams and thus increase shear stress experienced by the trophoblasts forming the aggregates. Quantitative understanding of utero-placental vascular adaptation gained here will improve in silico modelling of utero-placental haemodynamics and provide new insights into pregnancy disorders, such as fetal growth restriction. This work was supported by a Royal Society Te Aparangi Marsden Grant [18-UOA-135]. A.R.C. is supported by a Rutherford Discovery Fellowship [14-UOA-019]. The authors have no conflict of interest to declare.

The effect of hyperfiltration mechanism on kidney function in Living-Donor Kidney Transplantation in Cipto Mangunkusumo Hospital, Jakarta, Indonesia: study on renal arterial resistive index, urinary vascular endothelial growth factor, neutrophil gelatinase-associated lipocalin, and heparan sulfate

Background: While adequate donors’ kidney function after donation is desired, some may recover incompletely and develop chronic kidney diseases. Hyperfiltration is an adapting mechanism to overcome nephrectomy-related kidney function loss. This study aims to explain adaptive and maladaptive hyperfiltration mechanism during the first 30 days postnephrectomy. Methods: Longitudinal observational study was conducted on 46 kidney donors in Cipto Mangunkusumo Hospital in April-De cember 2019. Estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) were examined serially. Subjects were divided into adaptive (eGFR >60 mL/min/1.73 ㎡ and/or ACR 30 mg/g on day 30). Kidney resistive index (RI), urinary vascular endothelial growth factor (VEGF), and heparan sulfate (HS) were examined prenephrectomy and on day-2, day-7, and day-30 postnephrectomy. Urinary neutrophil gelati nase-associated lipocalin (NGAL) level was measured before and 6-hour postnephrectomy. Donors’ characteristic variables were analyzed using chi-square or Fisher test and logistic regression. Difference of RI, VEGF, NGAL, and HS between two groups were analyzed using Mann-Whitney or independent t-test. Results: Out of 46 subjects, 40 were included in the final analysis. Nineteen donors (47.5%) underwent maladaptive hyperfil tration. Prenephrectomy eGFR was significantly different with value of 111.17 (11.38) mL/min/1.73 ㎡ and 92.94 (13.21) mL/ min/1.73 ㎡ and cutoff of 104.60 mL/min/1.73 ㎡. Outcomes of donors aged >45 years and arterial stiffness >50th percentile were significantly different (P=0.03 and P=0.01). Hyperfiltration was evidenced by significant changes in RI, VEGF, NGAL, and HS after nephrectomy. Significant difference between arcuate artery RI on day-2 and day-30 was found only in adaptive group. Conclusions: Hyperfiltration does not alter kidney function on day-30 postnephrectomy. Prenephrectomy eGFR, age >45 years, and arterial stiffness are associated with day-30 postnephrectomy kidney function. RI of arcuate artery changes more promi nently and rapidly in adaptive group. Further study evaluating kidney function and interfering variables within longer period is necessary.

Macroanatomical Investigations on Renal Arteries of Southern Karaman Sheep

In this study, it was aimed to investigate the arterial vascularization of the kidneys in the South Karaman sheep breed. Twelve South Karaman sheep kidneys were used in the study. The course of the renal arteries in the kidney was examined by means of dissection and corrosion cast techniques. The kidneys were vascularized with right renal artery and left renal artery to the arteries originating from the abdominal aorta. Right renal artery was seen to be slightly more prominent than the left renal artery. Left renal artery was measured longer and thicker than the right renal artery. The renal artery entering the renal hilus, dorsal and ventral part of the renal artery were detected. However, in several materials, the left renal artery was shown to have a third branch. The dorsal and ventral branches gave interlobar artery with numbers ranging from 2-5. Each interlobar artery had multiple arcuate artery. These arteries ended by giving the interlobular artery. Anastomosis was not observed between the renal arteries. Although there were some important variations in the distribution of renal arteries of South Karaman sheep, similar findings were reported in the literature.

Risk Factors for Major Hemorrhage Following Percutaneous Image-Guided Renal Biopsy: What is the "core" of the Problem? A Retrospective Case-control Study.

Objectives:Percutaneous renal biopsy (PRB) plays a critical role in the work-up of renal parenchymal disease. Although it is considered a low-risk procedure, additional interventions may be required in about 7% of the cases following biopsy. The purpose of this study was to identify risk factors for major hemorrhage by microscopic analysis of the cores obtained following PRB, with an intent to enhance the sensitivity and specificity of the risk stratification process, especially in patients undergoing this procedure in an outpatient setting.Material and Methods:A retrospective review identified 17 of 179 patients (9.50%) with major hemorrhage following PRB between July 2014 and June 2019. Using propensity score matching, 26 controls (without major hemorrhage) were matched to 17 cases (with major hemorrhage). The biopsy cores obtained from the cases and controls were analyzed by a single pathologist for medullary, cortical, total (medullary + cortical) lengths, and the number of arcuate arteries (AAs). Medullary:cortical (M:C), cortical:total (C:T), and medullary:total (M:T) length ratios were then calculated.Results:A stratified version of logistic regression was used to test for an association between each of the variables identified on the cores and the probability of a major hemorrhage. The analysis revealed that there was a statistically significant association between the number of AAs per specimen with the risk of major hemorrhage (P = 0.0006). When 0, 1, or >2 AAs were identified, the frequency of major hemorrhage was 13.04%, 66.67%, and 75.00%, respectively. The odds of major hemorrhage were 6 times higher with one AA and (95% CI, 1.28–32.30) and 15 times higher with >2 AAs (95% CI, 1.41–169.57). No significant association was found between medullary length (P = 0.228), medulla:cortex (M:C) (P = 0.089), medulla:total (M:T) (P = 0.108), or cortex:total (C:T) (P = 0.112) length ratios and major hemorrhage.Conclusion:There was a strong and incremental correlation between major renal hemorrhage following PRB and the number of AAs per core specimen. Identification of AAs by the pathologist, while assessing for sample adequacy, in the US suite can help predict major hemorrhage in patients undergoing PRBs.

Changes in Renal Resistive Index Values in Healthy Puppies during the First Months of Life.

Simple SummaryThe renal resistive index (RRI) is probably the most commonly used parameter to evaluate blood flow in kidney vessels. Alterations in this parameter have been noted in a range of conditions affecting the kidney, such as acute variations in renal vascular resistance and renal damage in multiple-organ dysfunction syndrome. In order to interpret changes of the RRI in pathologic conditions, the normal values of intrarenal arterial RI should be known. In adult healthy dogs, the RRI values have been well established. However, there is little information regarding the RRI values of puppies. The objective of this study is to establish the RRI of normal kidneys in puppies aged from newborn to 20 weeks of age and to determine the age at which RRI reaches adult dog values. The highest value was obtained in the first three weeks of life and then it gradually declined with increasing age reaching adult dog values at 12 weeks of age.The purpose of this study is to establish renal resistive index (RRI) of normal kidneys in puppies aged from newborn to 20 weeks of age and to determine the age at which RRI reaches adult dog values. Six healthy adult intact beagles and six puppies from 1 day after birth to 20 weeks of age were used. In the adult dogs, the ultrasonographic scans were performed once, and in the puppies, the ultrasonographic studies were performed on the first day after birth and at 1, 2, 3, 4, 6, 8, 12, 16, and 20 weeks of age. RRI was obtained at the interlobular and arcuate arteries in each kidney. There were no statistical differences between the RRI values obtained between the right and left kidney nor between intrarenal arteries (interlobar and arcuate). The RRI was the highest during the first weeks of life, after which it declined gradually with increasing age reaching adult dog values at 12 weeks of age. In conclusion, the normal mean RRI is age dependent in dogs. Twelve weeks can be regarded as the age at which adult mean RRI criteria can be applied to puppies.

Enhanced Myogenic Constriction in the SHR Preglomerular Vessels Is Mediated by Thromboxane A2 Synthesis.

BackgroundSpontaneously Hypertensive Rats (SHR) have chronically elevated blood pressures at 30 weeks of age (systolic: 191.0 ± 1.0, diastolic: 128.8 ± 0.9). However, despite this chronic malignant hypertension, SHR kidneys remain relatively free of pathology due to having an augmented myogenic constriction (MC). We hypothesized that the enhanced MC in the SHR preglomerular vessels was due to increased prostaglandin and decreased nitric oxide (NO) synthesis, providing renal protection.MethodsSHR and Wistar Kyoto (WKY) arcuate and mesenteric arteries were treated with indomethacin (prostaglandin synthesis inhibitor), N omega-nitro-L-arginine (L-NNA, NO synthase inhibitor), and nifedipine (L-type calcium channel blocker); and MC was measured in these vessels. The role of endothelium in MC was examined by removing endothelium from WKY and SHR preglomerular and mesenteric arteries using human hair, and measuring MC. We also studied the source of prostaglandin in the SHR by treating endothelium-removed arcuate arteries with indomethacin and furegrelate (thromboxane synthase inhibitor).ResultsMC was enhanced in the SHR preglomerular vessels but not the mesenteric arteries. Indomethacin and LNNA removed the enhanced MC in the SHR. Nifedipine also inhibited MC in both WKY and SHR arcuate and mesenteric arteries. Removing endothelium did not change MC in either arcuate or mesenteric arteries of WKY and SHR rats; and did not remove the augmented MC in the SHR arcuate arteries. Indomethacin and furegrelate decreased MC in endothelium-removed SHR arcuate arteries and obliterated the enhanced MC in the SHR.ConclusionThe enhanced MC in the SHR arcuate arteries was due to thromboxane A2 synthesis from the tunica media and/or adventitia layers. MC was not dependent on endothelium, but was dependent on L-type calcium channels. Nevertheless, SHR arcuate arteries displayed differential intracellular calcium signaling compared to the WKYs.

Duplex Ultrasound Defined Angiosome With the Use of Pedal Acceleration Time as a Predictor to Wound Healing

We have established that pedal acceleration time (PAT) in nondiabetic limbs are highly correlative with ankle-brachial indices. We propose that PAT can be utilized in diabetic patients with noncompressible vessels and is an excellent predictor of wound healing. We performed a retrospective analysis in a prospective data base of diabetic patients with chronic limb-threatening ischemia (CLTI). We focused on patients with diabetes and isolated infrapopliteal arterial occlusive disease. Fifty-four limbs with WIFI score and documented CLTI who underwent angiographic interventions were analyzed. A complete pedal arch duplex was performed, PAT (milliseconds) was measured in the arcuate artery, dorsal metatarsal artery, medial, lateral, and deep plantar arteries. These measurements correspond to the angiosome of tissue loss which were obtained before and after interventions. A Fisher's exact test was used for data analysis. Based on previous report, PAT was categorized into four classes (Table). All CLTI patients were in class 4, which is defined as a PAT of greater than 225 ms. Of the 54 diabetic limbs, 44 achieved wound healing and 10 required higher level amputation. Patients with wounds prior to intervention had a mean PAT 237.6 + ms in the targeted artery of the foot. Complete wound healing was associated with a mean PAT of 114.2+ ms in the target angiosomic artery of the foot, regardless of direct or in-direct revascularization of the tibial arteries (P < .001). Limb loss was associated with a mean PAT of 278.4+ ms (P < .001) following intervention. Our group established that PAT demonstrates a high correlation with ABI in patients with compressible arteries. Based on current data, PAT is also a reliable noninvasive examination for patients with CLTI. This novel use of duplex-specific angiosome in the area of foot wounds demonstrate high predictability of wound healing. We conclude that duplex imaging of the pedal vessels, using PAT in particular, should be performed in all CLTI patients to aid in treatment of these complex patients.TablePedal acceleration time (PAT) classificationNo ischemia class 1Mild ischemia class 2Moderate ischemia class 3Severe ischemia class 4Clinical SymptomsAsymptomatic>2 blocks claudication>2 blocks claudicationCritical Limb Ischemia (Tissue loss, rest pain)PAT20-120 ms121-180 ms181-224 msGreater than 225 msABI1.3-0.900.89-0.690.68-0.500.49-0.00 Open table in a new tab

Ultrasound-histopathologic features of the utero-placental interface in placenta accreta spectrum

IntroductionThe objective of this study was to evaluate the relationship between utero-placental vascular changes on ultrasound imaging and histopathologic findings according to the grade of villous invasion in placenta accreta spectrum (PAS). MethodsThe ultrasound features of 31 patients with singleton pregnancies diagnosed prenatally with low-lying/placenta previa accreta were compared with histopathology findings following caesarean hysterectomy (n = 25) or partial myometrial resection (n = 6). The number and degree of transformation of arteries within the superficial layer of myometrium were recorded. Cytokeratin 7 (CK7) immunohistochemistry was used to complement H&E analysis. ResultsAll 31 patients presented with loss of clear zone, myometrial thinning and placenta lacunae. Subplacental hypervascularity and lacunae feeder vessels were found in 25 and nine cases, respectively. Large recent intervillous thromboses were found in one case with adherent villi and 12 cases with invasive villi, and showed a significantly different distribution according to lacunae scores. Thick basal plate fibrinoid deposits were found in all the areas of abnormally adherent and invasive villous tissue There was no significant difference in the mean count of partially remodeled vessels or vessels completely lacking remodeling according to the lacunae score and grade of placental invasiveness. EVT cells were arranged in superficial confluent sheets or superficial irregular clusters, or were scattered deep below the basal plate. ConclusionPlacental ultrasound and histopathologic features associated with PAS are more pronounced in invasive cases suggesting that they are secondary to the haemodynamic effects of abnormally deep placentation and transformation of the radial and arcuate arteries.

Anatomical study of dorsalis pedis artery

Background: The dorsalis pedis artery is the dorsal artery of the foot. The knowledge of any variation in the course and distribution of the artery is clinically important and it is used to record peripheral pulsation. The aim of this study was to study origin, course, relation and branches of the artery. The length and diameter of surgically important branch were recorded.&#x0D; Methods: An observational cross-sectional study was conducted at dissection hall of anatomy department at Chitwan medical college. Thirty lower limbs from fifteen cadavers were dissected for the study. Photographs were taken at different site of dissection and on finding anomalies. Newborn specimens and Conical enlargements if present were excluded.&#x0D; Results: The diameter of the artery ranged from 3.0 to 4.6mm and its length ranged between 5.6cm to 8.4cm.The length of deep plantar artery was between 5.6cm to 8.4cm. Double lateral tarsal artery was found in (24)80% of the studied specimen and (6)20% were with single lateral tarsal artery. In 90% of the specimen medial tarsal artery originated as proximal and distal branch form medial aspect of dorsalis pedis. The arcuate artery emerged directly from dorsalis pedis artery in (100%) all studied specimen. The 2nd ,3rd and 4th metatarsal artery were placed on their corresponding intermetatarsal space.&#x0D; Conclusions: Awareness of anatomical variation of vasculature of foot is important for the vascular surgeons, angiographers and reconstruction surgeons. Dorsalis pedis artery is excellent for the revascularization since it is the largest artery below the ankle joint.

ANATOMICAL STUDY OF DORSALIS PEDIS ARTERY

Background: The dorsalis pedis artery is the dorsal artery of the foot. The knowledge of any variation in the course and distribution of the artery is clinically important and it is used to record peripheral pulsation. The aim of this study was to study origin, course, relation and branches of the artery. The length and diameter of surgically important branch were recorded.&#x0D; Methods: An observational cross-sectional study was conducted at dissection hall of anatomy department at Chitwan medical college. Thirty lower limbs from fifteen cadavers were dissected for the study. Photographs were taken at different site of dissection and on finding anomalies. Newborn specimens and Conical enlargements if present were excluded.&#x0D; Results: The diameter of the artery ranged from 3.0 to 4.6mm and its length ranged between 5.6cm to 8.4cm.The length of deep plantar artery was between 5.6cm to 8.4cm. Double lateral tarsal artery was found in (24)80% of the studied specimen and (6)20% were with single lateral tarsal artery. In 90% of the specimen medial tarsal artery originated as proximal and distal branch form medial aspect of dorsalis pedis. The arcuate artery emerged directly from dorsalis pedis artery in (100%) all studied specimen. The 2nd ,3rd and 4th metatarsal artery were placed on their corresponding intermetatarsal space.&#x0D; Conclusions: Awareness of anatomical variation of vasculature of foot is important for the vascular surgeons, angiographers and reconstruction surgeons. Dorsalis pedis artery is excellent for the revascularization since it is the largest artery below the ankle joint.

4:03 PM Abstract No. 206 The risk factors for major bleeding following ultrasound-guided native renal biopsy: what is the “core” of the problem? A case-control study

To identify risk factors for major bleeding following ultrasound (US)-guided random renal biopsy by microscopic analysis and comparison of the cores obtained in patients with and without bleeding. A retrospective review identified 17 of 179 patients (9.50%) with major bleeding complications (per criteria determined by the Society of Interventional Radiology guidelines) post-US-guided native renal biopsy between July 2014 and June 2019. Case-control matching was accomplished by propensity score based on sex, age, body mass index (BMI), blood pressure (BP), international normalized ratio (INR), platelet (PLT), blood urea nitrogen (BUN), and creatinine (Cr) concentration, estimated glomerular filtration rate (eGFR), needle size, and core number. The cores obtained in the bleed and non-bleed patients were analyzed for total length, medullary length, cortical thickness, and number of arcuate/interlobular vessels by the pathologist. 26 controls were matched to 17 cases (with and without major hemorrhage, respectively). Conditional logistic regression was used to explore the statistical significance between core characteristics obtained from random renal biopsies and the probability of a major bleed. Analysis revealed that arcuate artery (AA) quantity per specimen exhibits a significant association with a major bleed (P = 0.0006). When 0, 1, or ≥ 2 AA were identified, the frequency of major bleeding was 13.04%, 66.67%, and 75.00%, respectively. The odds of major bleed are 6 times higher with 1 AA (95% CI, 1.28 – 32.30) and 15 times higher with ≥ 2 AAs (95% CI, 1.41 – 169.57). Despite lacking statistical significance, correlations between medullary length (P = 0.228), medulla-cortex (MC) (P = 0.089), medulla-total (MT) (P = 0.108), and cortex-total (CT) (P = 0.112) length ratios to major bleeding may require a larger population study. A strong and incremental correlation between major renal hemorrhage following native renal biopsy and the number of arcuate arteries per core specimen exists. Identification of arcuate arteries by the pathologist while assessing sample adequacy in the US suite can help predict major hemorrhage in patients undergoing random renal biopsies.

Unusually low arcuate artery in a Kenyan cadaver

The arcuate artery is one of the two major branches of the dorsalis pedis artery that supply the dorsum of the foot including interdigital spaces. The artery’s origin varies but in almost all cases it branches in the proximal third of the dorsum of the foot. During routine dissection of the right foot in a black Kenyan, we encountered a case where the artery was located and branched in the distal third of the dorsum of the foot, at the level of the metatarsophalangeal joint. This is much more distal than previously reported in prevailing literature. This artery did not give off any dorsal metatarsal arteries but gave the digital arteries directly. The dorsalis pedis artery, lateral and medial tarsal arteries had normal course in this foot. Keywords: Translational research; Dorsalis pedis artery; Integration; Arcuate artery

Doppler evaluation of renal resistivity index in healthy conscious horses and donkeys.

The renal resistive index (RRI) is used as a measurement of downstream resistance in arteries. The aim of this study was to assess the RRI of the arcuate arteries by pulsed-wave Doppler ultrasonography in healthy conscious horses and donkeys, and to verify any differences related to age, breed, bodyweight (BW) or body condition (BCS). Thirty-three healthy conscious horses and nine donkeys had their systolic and diastolic flow velocities at the level of the arcuate arteries estimated by pulsed-wave Doppler ultrasound, and the RRI was calculated. The relationship of RRI with age, breed (Trotters vs. other breeds), bodyweight (BW), and body condition score (BCS) were evaluated. PW Doppler evaluation of RRI was successfully applied in most of the horses, but to date not in the donkeys. In horses, median RRI values for the right kidney (0.58±0.006) were statistically higher than for the left (0.51±0.006). For the donkeys the values were comparable. There was no significant difference in RRI between horses younger or older than 15 years, and between breeds in horses. No correlation with age, BW or BCS was found in either horses or donkeys.

Normal Vascular and Nerve Distribution of the Pes Region in Dogs: An Anatomical and Diagnostic Imaging

To investigate the normal anatomical distribution of the arterial blood supply, venous drainage and innervation on both the dorsal and plantar aspects of pes region including the level of tarsal joint due to its clinical importance with a little data available. Methods: Ten hind paws of five adult apparently healthy domestic dogs of both sexes; six paws injected, through blood vessels with colored latex neoprene for anatomical dissection and the other four paws injected a contrast mixture of red lead oxide and turpentine oil for the radiographic investigation of blood vessels. In addition to five live dogs used to apply the distal limb local anesthesia with the aid of Needle-Guided Ultrasonography. Results: This investigation revealed that the dorsal and plantar aspects of dog pes region supplied by superficial and deep sets of arteries, veins and nerves. The three dorsal metatarsal arteries originated from the arcuate artery. The medial tarsal vein forming characteristic venous arcades. The 3rd plantar metatarsal artery divided into two axial arteries while the 2nd and 4th continued axially without division. The plantar common digital and metatarsal nerves II, III, IV communicated to give origins of the axial and abaxial plantar proper digital nerves except the abaxials of the 2nd and 5th digits which supplied by a branch from medial plantar nerve and lateral plantar nerve respectively. Conclusion: There were little differences between dogs and other carnivores in vascularization of hind paw with the recommendation of using Needle-Guided Ultrasonography in the distal limb local anesthesia to avoid vascular puncture or damage.

Interventional radiology in the management of renal vascular injury: A prospective study.

Introduction:Endovascular and percutaneous interventions are promising alternatives to surgical management of traumatic renal injuries and often avert the need for nephrectomies. In this study, we aimed to evaluate the role of interventional radiology and angiographic interventions in the management of renal vascular injury.Materials and Methods:Our prospective study was performed over a period of 6 months. Twenty-five patients who presented with either persistent hematuria or hemodynamic instability after traumatic or iatrogenic renal injuries were selected. Angiographic embolization using varying combinations of coils, glue, and Gelfoam® was performed to address the vascular injuries, either directly in hemodynamically unstable patients or after preprocedural imaging in hemodynamically stable patients. Patients were then followed up till discharge from hospital 48 h later and at 2 weeks and 4 weeks postprocedure for any recurrence of hematuria or hemodynamic instability. Technical and clinical success rates were calculated using descriptive statistics.Results:Pseudoaneurysms were the most common form of arterial injury (22 cases), followed by arteriovenous fistula (8) and active extravasation (5). Segmental arteries are the most commonly involved (12 cases), followed by interlobar (9) and arcuate (3) arteries. Gelfoam® was used in five patients with active contrast extravasation and was 100% effective in arresting active bleeding. Coiling alone had a 79.16% technical success rate in management, while additional use of glue in four failed cases led to a 95.83% technical success rate in the first attempt. The ultimate technical and clinical success rate of interventional radiology in renal trauma management (after the second attempt in one failed case) was 100%.Conclusion:Endovascular management is an effective and safe alternative to surgical management of both iatrogenic and accidental renal vascular injuries.

To study the role of growth hormone supplementation on endometrial response and implantation rate in frozen thawed embryo transfer (FET) cycles

Aim: To assess the role of growth hormone in improving endometrial response and clinical outcome. Materials and Methods: A prospective randomised study was conducted with 50 patients who were treated with FET cycles at Ridge IVF, Delhi, between August 2019 and January 2020. Patients were classified into two groups: group A administered simultaneous GH along with hormone-replacement therapy (HRT), for endometrial preparation; while group B received HRT alone. GH four IU subcutaneously was started on the day of HRT (day two/three) and continued till the endometrium reached a thickness of 8 mm. Statistical analysis: Statistical testing was conducted with the statistical software SPSS 20.0. Continuous variables are presented as mean±SD. Categorical variables are expressed as frequencies and percentages. Categorical data was compared using Chi-square test or Fisher’s exact test as appropriate. Results: Patients in group A had a significantly higher endometrial thickness (8.86±1.06 mm) as compared to group B (8.34±1.16 mm) (P value=0.028). However, patients in group A i.e those given GH, had a lower impedance to blood flow as shown by a lower pulsatility index (1.68±0.12 vs 1.92±0.13) (P value=0.028), resistance index (0.73±0.06 vs 0.86±.02) (P value=0.053), and a lower peak systolic velocity/end diastolic velocity of the uterine arcuate artery (2.68±.13 vs 2.93±0.11) (P value=0.066). The clinical pregnancy rate was comparatively more in group A compared to group B (56% vs 48%) (P value=0.588). Conclusion: Growth hormone when given along with HRT can improve FET results by enhancing endometrial perfusion.

Graft failure of IgA nephropathy in renal allografts following living donor transplantation: predictive factor analysis of 102 biopsies

BackgroundTo investigate predictive factors related to graft failure of IgA nephropathy(IgAN) in renal allografts following living donor transplantation.MethodsWe identified a series of 102 biopsies diagnosed as IgAN in renal allografts following living donor transplantation from July 2004 to January 2017 at our center, and assess the predict value of the Lee’s classification and the 2009 Oxford classification in IgAN in renal allografts, clinical, ultrasonic and pathological characteristics at biopsy and the outcomes were retrospectively analyzed.ResultsThe 5-year graft cumulative survival rate after transplantation was 91.4%. The 4-year graft cumulative survival rate after biopsy diagnosis of IgAN in renal allografts was 59.6%. The mean time ± SD to disease was 4.7 ± 3.5 years. The color doppler ultrasound and blood flow imagine showed the echo enhancement, the reduced blood flow distribution, the reduced peak systolic velocity of main renal artery, and the increased resistance index of arcuate renal artery were valuable in evaluating the graft dysfunction. The Cox multivariate analysis revealed that the 24-h urinary protein level (HR 1.6 for 1-g increase, 95%CI 1.2–2.0), estimated glomerular filtration rate (eGFR) (HR 1.0 for 1-mL/min/1.73 m^2 decline, 95%CI 1.0–1.1), and mesangial C1q deposition (HR 3.0, 95%CI 1.2–7.4) at biopsy were independent predictive factors of graft failure of IgAN in renal allografts.ConclusionsIgAN in renal allografts occurred frequently within 5 years after transplantation. The risk of graft failure should be taken seriously in patients who exhibit heavy proteinuria and/or a declined eGFR as the initial symptoms; a high lesion grade (grade IV-V of Lee’s classification) and/or mesangial C1q deposition may also indicated a poor outcome.

Placental blood flow and pregnancy outcomes in women with abnormal placental localization and absence of placental “migration”

Aim We investigated the arcuate artery blood flow in the region of the abnormally localized placenta in women who had undergone insertion of an obstetric pessary and were receiving micronized progesterone. Materials and methods The study included 120 pregnant women with high perinatal risks and abnormal placental localization. The patients were randomized to receive the Arabin’s pessary and vaginal micronized progesterone (Group A, n = 60) or vaginal micronized progesterone only (Group B, n = 60). Randomization was carried based on the order of hospital admission: odd patient numbers were allocated to Group A and even numbers to Group B. Patients underwent a series of ultrasound scans to evaluate the placental migration and presence of abnormal placental attachment. Depending on the results of the scan, study participants were divided into the following groups: (1) patients without placental migration: A1 (n = 23) and B1 (n = 42); and (2) patients with placental migration: A2 (n = 37) and B2 (n = 18). Women in subgroups A1 and B1 were further divided into the subgroups based on the presence of abnormal placental attachment: A1 x (n = 5) and B1 x (n = 12) with abnormal placental attachment; and A1O (n = 18) and B1O (n = 30) without the abnormal placental attachment. Conclusion In patients with abnormal placental attachment, the resistance of blood flow in the arcuate arteries was significantly higher than in those with normal placental attachment. A significant increase in the blood flow resistance occurred between 24 and 28 weeks of gestation. The combined use of the obstetric pessary and vaginal micronized progesterone in women with abnormal placental localization helped maintain the resistivity index at low levels and reduce the rate of abnormal placental attachment by 1.3-fold (OR 0.694 (95% CI: 0.21–2.29)).

980 Renal Resistive Index at the Level of Renal Arcuate Artery as a Predictor of Natriuresis in Cirrhotic Patients

INTRODUCTION: It has been postulated that the vasoconstriction at the level of renal arcuate artery plays a key role in the development of Hepatorenal syndrome(HRS). However, the measure of renal resistive index at the level of renal arcuate artery can provide a direct measure of renal hemodynamics among cirrhotics. The aim of this study is to determine the difference in the renal resistive index amongst both compensated as well as decompensated cirrhotics and to evaluate its association with natriuresis. METHODS: This prospective study included all consecutive cirrhotic patients visited gastroenterology clinic of our hospital from May 2018 to May 2019. After obtaining informed consent, the demographic parameters were noted along with a detailed drug history (Dose and duration of diuretics and beta blocker). Later on an ultrasound abdomen was also performed for documenting the features of chronic liver disease and the renal resistive index was noted. These patients were then stratified into two groups i.e. compensated cirrhosis and decompensated cirrhosis. Chi square test was applied and P value was calculated. RESULTS: A total of 60 patients were included in the study. The mean age of the patients was 40.3 ± 18.1, and were predominantly males 31(51.7%). Hepatitis C was the most common etiology for liver disease seen in 22 patients (36.7%).The mean CTP score, MELD and MELD sodium score were as follows: 7.9 ± 1.93, 15.2 ± 6.6 and 13.3 ± 4.2 respectively. Compensated liver disease was present in 16(26.7%) patients, while decompensated liver disease was present in 44(73.3%) patients. Mean renal resistive index of patient with compensated cirrhosis was 0.59 ± 0.04, while with decompensated cirrhosis was 0.62 ± 0.04. Patients with a higher RI had poor natriuresis as manifested by low urinary sodium potassium ratio &lt; 1.0 and AROC is 0.775. At the cut off value of RI = 0.615 sensitivity, specificity, positive predictive value and negative predictive value for nartriuresis was 65.0%, 70.0%, 73.3% and 60.1% respectively. Patient with higher RI value were having decompensated cirrhosis (P = 0.06, 0.62 vs 0.59) CONCLUSION: The renal resistive index at the level of arcuate artery were found to be higher among patients with decompensated cirrhosis. At a higher RI value ( &gt;0.615) patients had poor natriuresis. Therefore, RI can be used to predictor of natriuresis among cirrhotic patients. Key words:

Non-contrast-enhanced MR angiography of the foot with flow spoiled-fresh blood imaging (FS-FBI): feasibility study and comparison of different scanning parameters

To evaluate the feasibility of foot arteries using flow-spoiled-fresh blood imaging (FS-FBI) and to investigate how the FS-FBI scanning parameters affect the flow sensitivity and impact the depiction of pedal arteries. The study included 46 young healthy volunteers examined by FS-FBI using 1.5T MRI scanner. Additional FS-FBI examination with different flip angles (FA) of the radiofrequency refocusing pulse and echo time (TE) was performed on 36 volunteers. Two radiologists separately analyzed and graded the venous contamination, image quality, displaying rate, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) values of foot arteries. Multi-sample Friedman test and paired two-sided Student’s t test were used for statistical analysis (P < 0.05). Average image quality and venous contamination score of all arteries was good. The demonstration rate of distal anterior and posterior tibial artery, and lateral plantar artery was 100%. Dorsalis pedis artery, first dorsal metatarsal artery, medial plantar artery, and plantar arch were demonstrated at a rate above 90%. The demonstration rate of medial tarsal artery was 73.9%, whereas arcuate artery was detected with a rate of only 5.4%. Significant differences in image quality, SNR, and CNR of distal arterial area were observed between different FA and TE. Non-contrast-enhanced MR angiography of foot using FS-FBI enables clear separation of veins from arteries, and yields reliable depiction of the foot arterial tree in healthy volunteers. Distal arterial branches of foot can be better depicted by appropriate adjustment of the flow-sensitivity parameters.