Treatment Of Artery Research Articles

Bioengineering Strategies for Treating Neointimal Hyperplasia in Peripheral Vasculature: Innovations and Challenges.

Neointimal hyperplasia, a pathological response to arterial interventions or injury, often leads to restenosis and recurrent narrowing or occlusion, particularly in the peripheral vasculature. Its prevalence and negative impact on the long-term success of vascular interventions have driven extensive research aimed at better understanding the condition and developing effective therapies. This review provides a comprehensive overview of emerging bioengineering strategies for treating neointimal hyperplasia in peripheral vessels. These approaches include novel therapeutics and cell-based technologies designed to promote re-endothelialization, modulate vascular smooth muscle cell (VSMC) phenotype, reduce inflammation, scavenge reactive oxygen species (ROS), and enhance biomechanical compatibility between grafts and native vessels. Furthermore, advanced therapeutic delivery modalities are highlighted for their potential to achieve targeted, localized treatment at injury sites. This review also explores underrepresented therapeutic targets beyond traditional approaches, offering new opportunities for intervention. The multifaceted examination underscores the challenge of neointimal hyperplasia and presents a promising roadmap toward more effective treatments, ultimately aiming to improve patient outcomes after vascular interventions.

Factors influencing forearm swelling after transradial artery intervention and establishment of a predictive model: a prospective study.

Forearm swelling is a common complication following transradial artery interventions. Identifying the factors that influence this swelling and developing predictive models for it are crucial yet underexplored issues. This study was performed to investigate the risk factors for forearm swelling after transradial artery puncture and construct a predictive model. In total, 209 inpatients who underwent coronary angiography and/or interventional therapy at a tertiary hospital in Beijing between June and November 2023 were consecutively enrolled in this prospective study. The patients were divided into two groups: those who developed forearm swelling after puncture (swelling group) and those who did not (non-swelling group). The groups were compared, and logistic regression was used to identify risk factors for forearm swelling. The predictive accuracy of the model was evaluated using receiver operating characteristic analysis and the area under the curve. Among the 209 patients [132 (63.2%) men, 77 (36.8%) women], 27 developed forearm swelling. Independent predictors of swelling were the operation time, radial artery access, irregular tourniquet compression, number of tourniquet compressions, inappropriate wrist movement, and timing of the first tourniquet deflation. The predictive model achieved an area under the curve of 0.971 (95% confidence interval, 0.949-0.992). This single-centre diagnostic study demonstrated that the predictive model has excellent accuracy. Its application could help prevent unnecessary forearm swelling following radial artery interventions.

Model of the Venous System for Training Endovascular Treatment in Interventional Neuroradiology

Background: Endovascular treatment of venous disease is introducing new therapeutic options in neuroradiology. These procedures are technically challenging and require extensive physician training. Currently, training is mainly conducted on animal models, which presents drawbacks such as ethical concerns and anatomical differences from human vascular architecture. There is no training model that simulates treating intracranial venous disease using original instruments in a real angiography suite. Methods: This work presents the development of a venous system model for endovascular training simulations for integration into the existing Hamburg ANatomical NEurointerventional Simulator (HANNES) for arterial interventions. Results: The manufacturing process established at HANNES and the material used for the arterial vascular models were successfully transferred to the larger 3D-printed vein models. The application test was conducted in a real angiography suite with original instruments by an experienced neurointerventional physician to evaluate the system in terms of geometric mapping, flow, haptics and probing. Conclusion: This newly developed model provides a first approach to simulate an endovascular intervention in the venous system within the HANNES environment. Future expansions might include specific treatment simulations for conditions such as arteriovenous malformations, dural arteriovenous fistulas, sinus vein thrombosis and hydrocephalus.

Distal Radial Artery Access for Coronary Artery Assessment and Intervention: A Single-Centre Retrospective Experience

Distal Radial Artery Access for Coronary Artery Assessment and Intervention: A Single-Centre Retrospective Experience

Evaluation Of Stent Expansion During Coronary Artery Intervention By Stent Enhancement Compared With Quantitative Coronary Angiography And Intravascular Ultrasound In Diabetic Patients

Evaluation Of Stent Expansion During Coronary Artery Intervention By Stent Enhancement Compared With Quantitative Coronary Angiography And Intravascular Ultrasound In Diabetic Patients

Pre-distance assessment from radial artery to lower extremity arterial lesion.

Endovascular treatment (EVT) for patients with lower extremity artery disease is widely used as a less invasive alternative to surgical bypass. Recently, transradial artery intervention has gained popularity owing to its minimally invasive nature. The distance from the radial artery to the target vessel is critical for success; however, effective pre-assessment methods have not yet been established. This study aimed to evaluate the usefulness of predistance measurements from the left radial artery using simple computed tomography (CT) images. In this study, distance measurements were performed from the left radial artery to the left and right iliac artery bifurcations and from the left radial artery to the common femoral artery at the upper femoral border. These distances, measured using CT images before and after the lower-extremity contrast study, were compared with the distances identified during the lower-extremity contrast study. Distances measured using simple CT images showed a high correlation with the distances identified during the lower-extremity contrast examination (r = 0.9317, p < 0.0001; from the left radial artery to the left and right iliac artery bifurcation; r = 0.9402, p < 0.0001; and from the left radial artery to the right common femoral artery at the upper femoral border). Our results suggest that pre-distance measurement using simple CT images can be a useful tool for EVT using the left radial artery approach. Although future large-scale studies are required, this technique merits consideration owing to its widespread adoption in clinical practice.

Use of the Ostial Flash balloon in aorto-ostial chronic total occlusion percutaneous coronary intervention.

The use of the Ostial Flash balloon (Ostial Corporation) has received limited study in aorto-ostial chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI). The authors evaluated the outcomes of Ostial Flash balloon use in a large CTO-PCI registry (PROGRESS-CTO, NCT02061436). The Ostial Flash balloon was used in 54 of 907 aorto-ostial CTO PCIs in 905 patients (6.0%). The mean patient age was 65.1 ± 10.7 and 80.6% were men, with a high prevalence of diabetes mellitus, hypertension, prior PCI, and prior myocardial infarction. The mean occlusion length was 40.5 ± 25.1 mm, 52.2% had moderate to severe calcification, and the mean Japanese-CTO score was 2.8 ± 1.1. Lesions treated with the Ostial Flash balloon were more frequently located in the right aorto-ostium (79.6% vs 66.0%, P = .002). In the Ostial Flash group, the most common successful CTO crossing technique was antegrade wiring (46.3%), followed by the retrograde approach (40.7%); intravascular imaging was used in 61.1% of cases. Technical success (92.6% vs 87.9%, P = .300) and the incidence of major adverse cardiac events (MACE) (5.6% vs 3.6%, P = .450) was similar in the Ostial Flash vs non-Ostial Flash patients, respectively. In multivariable analysis, PCI of proximal right coronary artery CTOs was independently associated with use of the Ostial Flash balloon (odds ratio 2.2; 95% CI, 1.1-4.8; P = .036). The Ostial Flash balloon is infrequently used in aorto-ostial CTO PCI. Although there were no differences in MACE with use of the balloon, randomized controlled trials are needed to determine its effectiveness.

A Comparative Study for Iohexol and Ioversol Effects on Renal Function in Patients with Coronary Artery Intervention Treatment

&amp;lt;i&amp;gt;Objective: &amp;lt;/i&amp;gt;To compare the effects of iohexol and ioversol on the incidence of contrast induced nephropathy (CIN) and renal function in patients who received percutaneous coronary intervention (PCI); to investigate the related risk factors of CIN in patients after PCI; to evaluate the preventative effect of different dose of atorvastatin on the incidence of CIN in the patients after PCI. &amp;lt;i&amp;gt;Methods: &amp;lt;/i&amp;gt;140 patients who received PCI were chosen as research subjects in the Third People&amp;apos;s Hospital of Mianyang from June 2013 to March 2015, which were randomly divided into iohexol group and ioversol group (74 cases for iohexol group, 66 cases for ioversol group). It was recorded that the patients’ general condition, blood routine test, urine examination, renal function, etc before and after PCI. And it was observed after PCI that the dosage of contrast material, the numbers of damaged coronary artery and implanting stent, the exposure time of contrast material, etc. &amp;lt;i&amp;gt;Results: &amp;lt;/i&amp;gt;The incidences of CIN for iohexol and ioversol were not significantly different (&amp;lt;I&amp;gt;P &amp;lt;/I&amp;gt;&amp;gt; 0.05). The differences between the two groups in the Serum creatinine (Scr), blood urea nitrogen (BUN), glomerular filtration rate (GFR), urine β2- microglobulin (β2-MG), and cystatin C (Cys C) before and after PCI were not obvious (&amp;lt;I&amp;gt;P &amp;lt;/I&amp;gt;&amp;gt; 0.05) ; the changes of Scr, β&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt;-MG, CysC, GFR of the patients before and after PCI in the two groups were significant (&amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;&amp;lt;0.05), but the change of BUN was not significant (&amp;lt;I&amp;gt;P &amp;lt;/I&amp;gt;&amp;gt; 0.05).Through multiple regression analysis, it was found that type 2 diabetes (&amp;lt;I&amp;gt;OR&amp;lt;/I&amp;gt; = 9.560, &amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;=0.001), two coronary artery implanting stents (&amp;lt;I&amp;gt;OR&amp;lt;/I&amp;gt; = 6.252, &amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;=0.044), three and above coronary artery implanting stents (&amp;lt;I&amp;gt;OR&amp;lt;/I&amp;gt;=12.499, &amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;=0.009) were independent risk factors of CIN. It was not significantly different that the effects of 20mg atorvastatin and 40mg atorvastatin on the incidence of CIN, Scr and GFR (&amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt;&amp;gt;0.05). &amp;lt;i&amp;gt;Conclusion:&amp;lt;/i&amp;gt; There are no significant differences in the incidence of CIN and renal function for PCI patients with ioversol or iohexol. Moreover, diabetes and two or more coronary artery implanting stents are independent risk factors for CIN in PCI patients. It doesn’t show any benefits for PCI patients to take the large dose of atorvastatin to prevent CIN before operation.

Facial Artery Branch Thrombolysis for Nasal Vascular Embolism Induced by Hyaluronic Acid Injection.

Vascular embolism is a severe complication following hyaluronic acid (HA) filler injections, with hyaluronidase injection being the most effective treatment. The nasal region, including the nose and nasolabial fold, is the most common site of vascular embolism after facial HA injections. Currently, there is insufficient clinical evidence regarding the benefits of facial artery thrombolysis. This article aimed to evaluate the efficacy of hyaluronidase injection via the facial artery as an emergency treatment for vascular embolism induced by facial aesthetic HA fillers. We reviewed 14 patients who experienced nasal vascular embolism following facial HA filler injections. All 14 patients underwent percutaneous facial artery thrombolysis with a combination of hyaluronidase and urokinase administered intravascularly. For patients with longer occlusion duration and severe necrosis, femoral artery interventional thrombolysis was performed, with local injection of platelet-rich plasma to promote recovery. Follow-up ranged from 1 month to 1 year. Following facial artery hyaluronidase injection, all cases showed improvement in nasal skin lesions. Twelve patients fully recovered, while 2 patients were left with minor superficial scars and defects in the nasal wings. Early thrombolysis postnasal embolism is crucial, and percutaneous facial artery puncture is an effective emergency treatment. Arterial intervention targeting the facial artery in the nasolabial fold may offer more precise thrombolysis. The combined use of hyaluronidase and urokinase is both safe and effective.

Long-term outcomes of minimally invasive direct coronary artery bypass vs second generation drug eluting stent for management of isolated left anterior descending artery disease.

This study aimed to compare the long-term outcomes in a propensity matched population receiving either minimally invasive direct coronary artery bypass (MIDCAB) using left internal thoracic artery (LITA) to the left anterior descending artery (LAD) or percutaneous coronary intervention using second generation everolismus-eluting stents (DES-PCI) in patients treated for isolated proximal LAD stenosis. Between January 2012 and December 2017, 421 patients with a nonemergency status undergoing primary isolated proximal LAD revascularization were retrospectively analyzed and were divided into two groups: 111 patients receiving MIDCAB LITA to LAD and 310 patients receiving DES-PCI. Propensity score matching selected 111 pairs and both groups were comparable for all baseline characteristics and well balanced. In the matched cohort, median follow-up time was 5.19 years (interquartile range, 3.50-6.96). MIDCAB and DES-PCI had comparable long-term outcomes in terms of mortality (Hazard ratio (HR) stratified on matched pairs: 1.60; 95 %CI; 0.58-4.37; P = 0.36), stroke (HR stratified on matched pairs: 0.44; 95 %CI; 0.04-5.13; P = 0.51) and major adverse cardiac and cerebral events (MACCE) (HR stratified on matched pairs:0.57; 95 %CI; 0.26-1.22; P = 0.14). However, MIDCAB was associated with reduced incidence of myocardial infarction (MI) (HR stratified on matched pairs:0.46; 95 %CI; 0.15-0.0.56; P = 0.001) as well as reduced incidence of target vessel repeat revascularization (TVR) (HR stratified on matched pairs: 0.12; 95 %CI; 0.0.01-0.92; P = 0.015). MIDCAB LITA-LAD offers superior freedom from MI rate and TVR with similar mortality, stroke and MACCE compared with second generation DES-PCI in the treatment of isolated proximal LAD disease.

The Importance of Hemostasis in Radial Artery Interventions

The Importance of Hemostasis in Radial Artery Interventions

Feasibility and safety of endovascular interventions via percutaneous access to the axillary artery

Endovascular treatment of peripheral arterial disease requires safe and reliable arterial access. This study evaluates the feasibility and safety of percutaneous axillary artery access for endovascular therapy. A variety of anatomic and logistic obstacles can be overcome with upper extremity access. In this retrospective case review, we describe our experience with percutaneous trans-axillary access for lower extremity peripheral arterial disease intervention. Medical records of all patients undergoing axillary artery percutaneous access from December 2021 to August 2024 were reviewed. Demographic data, procedural details, and complications such as pseudoaneurysm, hematoma, nerve injury, and closure device success were analyzed. Technical success and perioperative complications-including bruising, edema, hematoma, nerve injury, infection, thrombosis, and pseudoaneurysm-were assessed. Clinical outcomes were analyzed via follow-up clinic records. During the study period, 79 axillary artery accesses were performed on 64 patients. The patients were 55% male and had typical vascular comorbidities: hypertension (87%), hyperlipidemia (68%), coronary artery disease (27%), stroke (19%), and diabetes (16%); 58% were active tobacco users, and 80% were former tobacco users. Axillary access facilitated peripheral endovascular procedures, including iliac intervention (55), femoral (44), mesenteric (16), tibial (11), and embolization or visceral aneurysm treatments. A 6F sheath and ultrasound-guided Angio-Seal closure device were uniformly employed, with no major complications, perioperative deaths, or reoperations required. Minor complications of bruising and edema were present in 11 patients (14%). Other minor complications such as hematoma, nerve injury, thrombosis, dissection, pseudoaneurysm, or limb ischemia were absent. Percutaneous axillary artery access demonstrates promise for complex endovascular interventions with a favorable safety profile. Advantages include avoidance of unfavorable femoral anatomy, improved working length compared with radial access, and enhanced control of visceral therapy. Bilateral iliac and lower extremity therapy is feasible in a single treatment as well. Percutaneous axillary artery access is a safe, reliable adjunct for enhancing endovascular arterial intervention capabilities.

Robotic endovascular peripheral arterial interventions: a proposal of a new learning model.

This study tests a suitable model for training robot-assisted peripheral vascular interventions and examines the learning curves of endovascular surgeons with different levels of previous experience and main focus of work, analyzing procedure time, fluoroscopy time, use of contrast, and radiation emission. Sixteen endovascular surgeons with different previous experience and training performed nine manual and 18 robotic angioplasties using the CorPath GRX platform on a 3D-printed life-size immersed infragenicular arterial phantom. All participants considered the model reliable. When analyzing manual angioplasty outcomes, the juniors took significantly longer to perform angioplasties than the seniors (p=0.044). Among the seniors, interventionists were faster only on the first angioplasty (p=0.046). Analysis of the robotic angioplasty results showed that only one junior failed to cannulate one of the target arteries once. The total duration, fluoroscopy time, and radiation emission did not differ between juniors and seniors (p=0.095, p=0.60, and p=0.64, respectively). In addition, the learning curves for the maximum benefit required two attempts for procedure duration, one for fluoroscopy time, and three for radiation emission. There were no significant differences between senior vascular surgeons and interventionists. Among juniors, residents had a significantly lower procedure duration (p=0.042) and radiation emission (p=0.046) only for the first angioplasty. The learning curves for robotic peripheral arterial interventions were short, with a plateau for the procedure and fluoroscopy times and radiation emission after the third attempt. We observed no differences in the learning curves in relation to previous experience or training.

Preclinical evaluation of the sirolimus-eluting iron bioresorbable scaffold in canine below-the-knee artery

Background and aimsInfrapopliteal artery intervention has yielded suboptimal results in below-the-knee (BTK) arterial disease. However, bioresorbable scaffolds are a potential treatment for this condition. This study compared the support performance, anti-hyperplastic effects, and histological manifestations between a sirolimus-eluting iron bioresorbable scaffold (IBS) and an everolimus-eluting stent (EES) within 6 months and the corrosion profile during 12 months in canine BTK arteries. MethodsEighteen IBS and twelve EES systems were implanted into nonatherosclerotic BTK arteries in dogs. Support performance and inhibit intimal hyperplasia, histological manifestations, and the corrosion profile were compared between the two systems using angiography, optical coherence tomography (OCT), micro-computed tomography, and histopathologic evaluation at 1, 3, 6, and 12 months. ResultsAll systems were successfully implanted. There was no significant difference in the area of stenosis between the IBS and EES groups within 6 months. Semi-quantitative OCT revealed degradation of the IBS at 3 months, with strut corrosion rates of 24.6 %, 45.0 %, and 69.2 % at 3, 6, and 12 months. Micro-computed tomography showed that the IBS maintained its integrity at 1 month without corrosion, with more struts fractured because of degradation at 6 and 12 months. Endothelialization was complete at 1 month in both groups. There was no significant between-group difference in cell responses during 6 months of follow-up, with the exception of macrophages. ConclusionThis preclinical study suggests that the IBS has performance support, anti-hyperplastic effects, and histological manifestations comparable to those of the EES within 6 months, with a reasonable corrosion profile over 12 months.

Abstract 4145821: Serial Vascular Responses of Balloon-expandable Stent with Biodegradable Film-type Graft in a Rabbit Iliac Artery Dissection Model (BioGard Study)

Introduction and Background: Arterial dissection during endovascular therapy rarely occurs but can be lethal. A significant blood volume extravasation during coronary artery interventions is related to the very high mortality (20-30%). In this hyperacute emergent clinical situation, covered stents have been considered as a primary measure to prevent further serious arterial events. A fabric-based covered graft stents yield poor clinical outcomes. To overcome these challenges, the balloon-expandable stent with biodegradable film-type graft for treating arterial dissection was invented. Research Questions and Objectives: A novel balloon-expandable stent with biodegradable film graft for overcoming these issues would be valid for efficacy and safety in a rabbit iliac artery dissection model. Method and Approach: Eighteen iliac artery dissections were induced by balloon over-inflation on angiography (Ellis type 2 or 3) and treated using the test device (3.0 x 24 mm). Subsequently, twelve animals underwent histologic examinations and micro-computed tomography (CT) at 0, 2, 4, and 8 weeks and 3, 6, 9, and 12 months and angiography at one-year. Results and Data: There were no adverse cardiovascular events during the one-year. Early-stage histologic examination revealed complete sealing of disrupted vessels by the device, exhibiting mural hematoma, peri-stent red thrombi, and dense infiltration of inflammatory cells. Mid- and long-term histologic examination showed patent stents with neointimal hyperplasia over the stents (% area stenosis: 11.8 at 2weeks, 26.1 at 1month, 29.7 at 3months, 49.2 at 9months, and 51.0 at 1year), along with mild peri-strut inflammatory response (Grade: 1-2 at mid-term and 0-1 at long-term). The graft film became scarcely visible after six months. Both CT and angiography revealed no instances of thrombotic occlusion or in-stent restenosis (% diameter stenosis: 5.7 at 2weeks, 12.3 at 1month, 14.2 at 3months, 25.1 at 9months, and 26.6 at 1 year). Conclusion: The novel balloon-expandable stent with a biodegradable film graft demonstrates feasibility in managing severe artery dissection and preventing lethal vascular events in animal model. Future human studies are warranted to validate these findings and elucidate the clinical outcomes of the study.

Abstract 4132742: Fractional flow reserve guided complete revascularization versus Culprit-only percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease. A meta-analysis of randomized controlled trials

Background: Data comparing the efficacy and safety of fractional flow reserve (FFR)-guided complete revascularization (CR) to culprit-only percutaneous coronary artery intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease are limited. Method: Pubmed, Embase and Cochrane were searched for randomized controlled trails (RCTs) comparing FFR-guided CR to Culprit-only PCI in patients with STEMI and multivessel CAD. A meta-analysis was performed on primary outcomes of major adverse cardiac events (MACE) and all-cause mortality. Heterogeneity was examined with I 2 statistics. A random-effects model was used for outcomes with high heterogeneity. Results: We included 4 RCTs with 3173 patients comparing FFR-guided CR with culprit-only PCI in patients with STEMI and multivessel coronary artery diseases. The pooled results of the 4 RCTs showed that MACE (RR=0.66; 95% CI [0.45, 0.99]; p=0.01; 16.8% vs 24.1%), PCI revascularization (RR=0.50; 95% CI [0.37, 0.67]; p&lt;0.00001; 13.1% vs 24.9%) and unplanned revascularization (RR=0.66; 95% CI [0.44, 0.99]; p=0.04; 8.7% vs 12.9%) were significantly reduced in the FFR-guided complete revascularization group compared to culprit-only PCI group. However, all-cause mortality (RR=1.09; 95% CI [0.84, 1.42]; p=0.53; 7.2% vs 6.0%), stroke (RR=1.02; 95% CI [0.38, 2.75]; p =0.97; 2.0% vs 1.8%), major bleeding (RR=0.95; 95% CI [0.54, 1.67]; p=0.87; 1.7% vs 1.7%), death from cardiovascular causes (RR=0.82; 95% CI [0.55, 1.21]; p=0.31; 3.1% vs 3.4%), MI (RR=1.09; 95% CI [0.60, 1.95]; p=0.78; 6.7% vs 6.4%), rehospitalization for HF (RR=0.72; 95% CI [0.44, 1.15]; p=0.17; 3.4% vs 5.3%), death from any cause or MI (RR=1.02; 95% CI [0.61, 1.71]; p=0.95; 14.9% vs 13.6%), any stent thrombosis (RR=1.42; 95% CI [0.35, 5.72]; p=0.62; 2.2% vs 1.4%), contrast induced nephropathy (RR=0.25; 95% CI [0.02, 2.79]; p=0.26), and CABG revascularization (RR=1.25; 95% CI [0.30, 5.15]; p=0.76) were not statistically different between groups. Conclusion: Our meta-analysis suggests that FFR-guided CR is safe and has superior efficacy to Culprit-only PCI in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease with significantly lowered incidence of MACE, PCI revascularization as well as unplanned or urgent revascularization. However, FFR-guided CR showed no beneficial effect on all-cause mortality, stroke, major bleeding and myocardial infarction.

Total Contact Casting Remains an Effective Modality for Treatment of Diabetic Foot Ulcers.

Total contact casting (TCC) is used to promote wound closure in diabetic foot ulcers (DFUs); however, this technique is underused today. This study aims to further evaluate the efficacy of TCC in a large cohort, including patients with peripheral artery disease (PAD). This was a retrospective analysis of patients with DFUs who underwent TCC from 2017 to 2021. PAD was defined as absence of pedal pulse or ABI <0.9. Demographic data, DFU characteristics, and peripheral arterial intervention were evaluated. Outcomes included complete healing, healing time, and rate of major amputation. Subgroup analysis was performed on patients undergoing peripheral intervention. 152 patients underwent TCC. Mean age was 58.8 ± 12.1years, 79.6% were male, and 26.3% had PAD. Mean DFU size was 8.27 ± 9.9cm2, with mean depth 0.61 ± 0.49cm. 112 patients had palpable pedal pulses on the affected extremity (73.7%). Average ABI was 1.12 ± 0.22 (n = 90). Complete healing was observed in 122 (80.3%) patients, with average healing time of 81.5 ± 57.1days. Thirteen (8.6%) patients eventually required amputation (3 major). When compared to patients with healed DFUs, those without healing had higher rates of amputation (39.1% vs 3.1%, P < .001), intervention (43.4% vs 17.8%, P = .006), and noncompliance (39.1% vs 20.2%, P = .046). Thirty-three patients underwent revascularization, undergoing angioplasty (81.8%), atherectomy (63.6%), stent (15.2%), and/or bypass (9.1%). Interventions were performed in aortoiliac (3.0%), femoropopliteal (45.5%), and tibial (72.7%) segments. Twenty-two (66.7%) patients who underwent revascularization completely healed. Patients requiring revascularization were more likely to have previous intervention (57.6% vs 13.4%, P < .0001) and incompressible vessels (36.4% vs 7.6%, P < .00001), with lower ABIs (0.94 ± 0.25 vs 1.17 ± 0.18, P = .0008) compared to patients without intervention. TCC remains an effective option for treatment of DFUs, as most were completely healed. Patients with PAD may benefit from TCC and revascularization, however, healing rates are lower in this cohort, necessitating the need for close observation.

Safety and effectiveness of ultrasound-guided percutaneous versus open brachial artery access: results of the multicenter prospective ARCHIBAL study Percutaneous/open brachial artery access

Although brachial access (BA) has become increasingly used in percutaneous endovascular procedures, results from head-to-head comparisons between open brachial access (OBA) and ultrasound-guided percutaneous brachial access (PBA) are limited in the literature. The objective of our multicenter, prospective, noninterventional ARCHIv BrachiAL study was to compare the safety and efficacy of OBA and PBA to perform peripheral arterial interventions. From July 2019 to January 2021, all patients needing peripheral endovascular procedures with brachial artery access were consecutively included in the study by 15 surgeons in 14 centers. Procedures were done with 4F-8F (French gauge) introducer sheaths. Arterial closure was done by conventional arterial sutures for OBA and compression or vascular closure devices for PBA. The primary endpoint was the rate of access site complications occurring up to 30days postoperatively. Secondary endpoints were the occurrence of adverse events and the overall rates of clinical success of BA cannulation and technical success. Among the 251 included patients (mean age, 69.9years; males 70.5%), 122 (48.6%) had an OBA and 129 (51.4%) had a PBA, without significant differences in baseline demographic and clinical characteristics. 38.6% of the patients had the procedure for more than one indication. Clinical success was achieved in all patients and technical success in 244 patients (97.2%). No death, cerebral, cardiac, or embolic complications were reported. Access site complications (primarily hematomas) were significantly (P=0.02) more frequent in the PBA (8/129; 6.2%) than the OBA group (1/122; 0.8%) or when using introducer sheaths >6F for OBA or vascular closure devices for PBA. Our prospective study confirmed the safety and effectiveness of BA and showed the benefit in terms of safety of OBA versus PBA even when PBA was ultrasound-guided and performed by trained surgeons. It encourages the use of OBA and ultrasound guidance when using PBA. Large and/or randomized studies should be performed to support these results.

Immediate Destiny of Bifurcation Lesions Treated with Biomatrix Alpha Stents.

About 15% of coronary artery interventions are performed on coronary artery bifurcation. Managing these lesions presents a significant therapeutic obstacle in the context of coronary artery issues. Addressing both immediate and lasting side effects of these lesions demands ongoing monitoring and action. The introduction of drug-eluting stents has raised hopes for better outcomes in patients experiencing cardiovascular events. In this study, we selected 51 patients (out of 850) who had received ≥1 cobalt-chromium, biodegradable polymer, Biolimus A9-eluting stent (CoCr-BP-BES) Biomatrix Alpha stent. Immediately after stenting, thrombolysis in myocardial infarction (TIMI) flow score in the coronary artery and its bypass branch, plaque shift, and lateral dissection immediately after angioplasty were evaluated. The mean age for patients was 65 (±10.35) years, where 49.02% of them were male and 45.1% had diabetes. No lateral dissection and death were reported in any of the patients. Also, the TIMI flow grade was 3 for the main branch in all patients. Plaque shifts were compared at different degrees of the TIMI flow coronary artery bypass graft. A statistical study revealed a noteworthy distinction between the groups. There was no discernible change when gender, diabetes, systolic and diastolic blood pressure with plaque changes were all controlled for. We discovered that the Biomatrix Alpha stents' instant clinical results are admissible. Our findings confirm the clinical utility of the recently developed biolimus-eluting (BES) stent technology, which combines the BA-9 medication, a thin-strut CoCr stent platform, and a biodegradable polymer. This aligns with the existing body of research on the most recent generation of drug-eluting stents (DES).

DIAGNOSTIC ACCURACY OF COLOR DOPPLER SONOGRAPHY IN EVALUATION OF RENAL TRANSPLANT REJECTION TAKING HISTOPATHOLOGY AS GOLD STANDARD

Background: Renal transplant rejection occurs when the recipient’s immune system identifies the transplanted kidney as foreign, leading to immune-mediated injury. Timely and accurate diagnosis is essential for preserving graft function and improving patient outcomes. Color Doppler sonography, a non-invasive imaging technique, has shown promise in detecting hemodynamic changes indicative of rejection. However, its diagnostic accuracy compared to histopathology, the gold standard, remains under investigation. Objective: To determine the diagnostic accuracy of Color Doppler sonography in evaluating renal transplant rejection, with histopathology as the gold standard. Methods: This cross-sectional validation study was conducted in six months starting from 1st July 2024 and sample size was achieved in October 2024, at the Department of Radiology, PAF Hospital Islamabad. A total of 226 patients, aged over 20, with clinical diagnoses of renal transplant rejection were included. Exclusion criteria encompassed primary non-functioning transplant kidneys, prior renal artery interventions, glomerulonephritis, renal tumors, active urinary tract infections, and pregnancy. Color Doppler sonography results were recorded alongside histopathological findings. Statistical analysis was performed using IBM SPSS version 26, calculating sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) for Color Doppler sonography. Results: The mean age of participants was 38.31±11.61 years, with a mean transplant duration of 4.31±1.89 months and a mean BMI of 29.85±2.78 kg/m². Color Doppler sonography showed a sensitivity of 71.3%, specificity of 71.2%, diagnostic accuracy of 71.2%, PPV of 61%, and NPV of 80%. Conclusion: Color Doppler sonography is a valuable tool for evaluating renal transplant rejection, though complementary approaches with histopathology are recommended for comprehensive assessment.