Arterial Lesions In Patients Research Articles

Diagnostic value of cervical vascular ultrasound in large arterial lesions of the neck in patients with transient ischemic attack

Objective To assess the diagnostic value of cervical vascular ultrasound in identifying large arterial lesions in patients with transient ischemic attack (TIA). Methods The current study matched 84 TIA patients (disease group) with 66 healthy controls (control group). The baseline patient profiles and biochemical indices of the patients were analyzed. All patients received color Doppler ultrasonography, and outcome measures of its diagnostic efficiency included plaque status, plaque properties, and the degree of carotid stenosis. The patients in the disease group were assigned to group A (TIA of the internal carotid artery system, n = 40) and group B (TIA of the vertebrobasilar artery system, n = 44), and the plaque distribution of the patients was analyzed. Results TIA patients had higher rates of diabetes, hypertension, hyperlipidemia, obesity, and smoking compared to controls (p < 0.05). Their serum TC, LDL-C, and FBG levels were significantly elevated, while HDL-C levels were decreased (p < 0.05). TIA patients had more plaques, especially soft plaques, than controls (p < 0.05). They also showed higher rates of moderate to severe carotid stenosis (p < 0.05). TIA involving the internal carotid artery system was associated with a higher risk of plaques at the entrance of the subclavian artery compared to TIA involving the vertebrobasilar artery system (p < 0.05). Conclusion The diagnostic value of cervical vascular ultrasound in patients with TIA is remarkable, and it provides a reliable monitoring approach as well as an essential screening modality for TIA. The rational use of this technique will markedly benefit the diagnosis, treatment, and prevention of TIA.

Combined Duplex Guided Angioplasty with Contrast-free Fluoroscopy for Treatment of Femoro-popliteal Arterial Lesions in Patients with Renal Insufficiency. A multicenter experience

Combined Duplex Guided Angioplasty with Contrast-free Fluoroscopy for Treatment of Femoro-popliteal Arterial Lesions in Patients with Renal Insufficiency. A multicenter experience

Mönkeberg's sclerosis: role of calcification in arterial lesions in patients with diabetes mellitus

The number of patients with diabetes mellitus has steadily been increasing. This disease is associated with the risk for the development of micro- and macroangiopathies. One of the variants of macroangiopathy is Mönkeberg's sclerosis characterized by the presence of calcification of the media of the arterial wall. This article is a literature review reflecting the role of calcification in arterial lesions in patients with diabetes mellitus, also covering the historical aspect of studying Mönkeberg's sclerosis. Special attention is paid to its morphological forms, aetiopathogenetic mechanisms of development, taking into account contemporary studies, demonstrating mechanisms of the effect of medial arterial calcification on haemodynamics and the risk for the development of cardiovascular complications. Also presented herein are the main non-invasive and invasive methods of its diagnosis.

Factors Influencing the Recurrence of Arterial Involvement After Surgical Repair In Behçet'S Disease

Introduction: Arterial involvement in Behçet's disease (BD) is rare and its surgical management is a major concern because of the high rate of recurrence as thrombosis or false aneurysm. The aim of this study was to identify factors influencing the postoperative recurrence of arterial lesions in patients with non-pulmonary arterial BD. Methods: Single centre retrospective study conducted in 23 patients meeting the International Study Group of BD criteria, who underwent surgery for arterial involvement between May 1996 and September 2015. Recurrence was defined as the occurrence of arterial aneurysm or thrombosis confirmed by ultrasound or CT-scan during follow-up. The nature of perioperative medical treatment and the surgical technique were reported. Results: Forty-seven surgical procedures were performed with a mean number of 2.4 ± 0.6 procedures in 16 patients with recurrences. Mean follow-up was 8.4±7.5 years. Initial arterial lesions were aneurysms and thrombosis in 85% and 15% of cases respectively. Arterial lesions were aortic in 48% of cases and peripheral in 52%. Recurrence rate was 51%. Recurrences occurred within less than one year in 24%, at the same anatomical site in 92% of cases. Preoperative medical treatment consisting in colchicine or steroids or immunosupressants significantly decreased recurrence rate of arterial lesions: 28% (7/25) versus 75% (15/20) in untreated patients (P = 0.002). The recurrence rate was 42.5% (17/40) in patients treated postoperatively versus 80% (4/5) in untreated patients. The nature of the device used did not change the risk of recurrence (vein, prosthetic graft allograft, stentgraft or direct anastomosis). When anastomosis where protected using prosthetic sleeving technique during surgery, the risk of recurrence was decreased by three (P = 0.034). Conclusion: Relapse is a main concern after surgical repair of arterial BD. But the risk seems to be reduced when a medical treatment is applied with vascular procedure. This study suggests the need for targeted perioperative medical management to reduce the risk of arterial recurrence in BD patients. To this end, a multidisciplinary approach combining rheumatologists and vascular surgeons is mandatory. The use of sleeve anastomosis is associated with a decrease in risk of recurrence in the form of anastomotic pseudo aneurysms and should be generalized when technically feasible. Disclosure: Nothing to disclose

Carotid intima-media thickness and plaques in internal carotid artery as surrogate markers of lower limb arterial lesions in Chinese patients with diabetic foot.

Peripheral arterial disease (PAD) can impair healing of diabetic foot (DF) in patients with diabetes mellitus. To determine whether carotid intima-media thickness (CIMT) can predict lower limb arterial lesions in patients with DF, this cross-sectional study enrolled patients with DF at West China Hospital (China) between January 2012 and December 2015. Ultrasonography was used to measure CIMT, assess the internal carotid arteries (ICA) for plaques, and evaluate lower limb segmental arteries for stenosis. The optimal CIMT cutoff for detecting lower limb PAD was determined by receiver operating characteristic (ROC) curve analysis. Factors associated with PAD were identified by logistic regression analyses. A total of 167 patients (mean age: 69.7±10.3 years; 102 men) were included. Patients with PAD were older and had higher levels of total cholesterol and low-density lipoprotein than patients without PAD (P<0.05). The area under the ROC curve was 0.747 (P<0.001). At the optimal CIMT cutoff of 0.71 mm, the sensitivity, specificity, positive predictive value, and negative predictive value were 79.65, 61.11, 81.08, and 58.93%, respectively. Compared with those without PAD, more patients with PAD had CIMT ≥0.71 mm (79.65 vs 38.89%; P<0.001) and ICA plaques (66.37vs 11.11%; P<0.001). Multivariate logistic regression revealed that age (odds ratio [OR]: 1.118; 95% confidence interval [95%CI]: 1.056–1.183; P<0.001), ICA plaques (OR: 13.452; 95%CI: 4.450–40.662; P<0.001), and CIMT ≥0.71 mm (OR: 2.802; 95%CI: 1.092–7.188; P=0.032) were associated with PAD.CIMT may be a surrogate marker of PAD in patients with DF.

Гибридный метод реваскуляризации дистальных поражений артериального русла у пациентов с критической ишемией нижних конечностей

Данный обзор представляет собой анализ литературы по проблеме лечения пациентов с критической ишемией нижних конечностей (КИНК) при многоуровневых, протяженных поражениях артерий нижних конечностей. Описаны три варианта лечения больных с КИНК: бедренно-берцовое шунтирование, эндоваскулярное восстановление кровотока и сочетанный подход – эндоваскулярная ангиопластика артерий оттока после операций бедренно-берцового шунтирования. Анализ литературы по данному вопросу показал, что у пациентов с КИНК целесообразно сочетать открытые реконструктивные операции с эндоваскулярными методами диагностики и восстановления кровотока. Использование бедренно-дистального шунтирования в сочетании с ангиопластикой целевой артерии позволяет улучшить кровоток по шунту и уменьшить риск ранних послеоперационных тромбозов. Также сокращается длительность вмешательства, уменьшаются операционная травма, связанная с доступами, срок и число госпитализаций.

The role of MSCT angiography in early detection of lower limb arterial lesions in patients with antiphospholipid syndrome.

Antiphospholipid syndrome (APS) is an autoimmune disease which is characterized by arterial and venous thromboses, fetal loss, and the presence of antiphospholipid antibodies in the serum. It is characterized by accelerated atherosclerosis. Increased tendency towards thrombosis leads to the occurrence of various vascular events. The objective of our study was to determine if there are subclinical changes on lower limb arteries in APS patients and what the best diagnostic choice for their establishment is. In this study, we analyzed 50 patients with primary antiphospholipid syndrome (PAPS) and 50 patients, who have secondary antiphospholipid syndrome (SAPS). The results were compared to 50 controls. The groups were comparable with respect to age, gender, and traditional risk factors except for the lipid status, since controls had significantly higher levels of cholesterol and triglycerides. Study was conducted on 64-multi-slice computed tomography (64-MSCT), where we analyzed quantitative and morphological characteristics of blood vessel-detected lesions. Patients from the control group had statistically very significant elevated cholesterol and triglyceride levels in regard to the patients with SAPS and PAPS (p<0.001 and p<0.05). Analyzing percentage of diameter stenosis, we have established that lesions from group with 0-30% diameter stenosis (DS) in patients with PAPS (n=47) and SAPS (n=39) are more common than that in control group (n=3, p<0.001). The incidence of lesions higher than 70% DS in control group (n=74) was statistically significant than that in patients with SAPS (n=74, p<0.05), while very statistically significant than that in patients with PAPS (n=48, p<0.001). Analyzing the qualitative characteristics of plaques, we have established significant higher frequency of soft tissue (n=32) and mixed lesions (n=36) in patients with PAPS than the calcified one (n=7, p<0.001). Our study showed that the subclinical manifestation of changes on lower extremity arteries is more common in patients with APS. Because of its safety and accuracy, the method of choice is 64-MSCT angiography in monitoring disease progression.

Factors associated with lower extremity atherosclerotic disease in Chinese patients with type 2 diabetes mellitus: A case-control study.

Early detection and treatment of lower extremity atherosclerotic disease (LEAD), and controlling its risk factors are critical in preventing amputation and death in diabetic patients. This study aimed to investigate the factors associated with LEAD in Chinese diabetic patients.In this case-control study, patients with type 2 diabetes mellitus (T2DM) (N = 1289) were divided into 2 groups according to the ultrasonic Doppler examination: with (LEAD+, n = 737) and without (LEAD−, n = 552) LEAD. In subgroup analysis, the LEAD+ group was divided based on the diameter of lower-extremity arteries: LEAD+A (1%–49% reduction) and LEAD+B (≥50% reduction). Clinical and demographic data of patients were analyzed.Compared with the LEAD− group, serum creatinine levels were significantly increased (P < 0.001), whereas glomerular filtration rate (GFR) was significantly decreased (P < 0.001) in the LEAD+ group. Multivariate analysis results showed that GFR (odds ratio [OR] 0.991, 95% confidence interval [CI] 0.986–0.997, P = 0.003), diabetes duration (OR 1.055, 95% CI 1.026–1.084, P < 0.001), age (OR 1.123, 95% CI 1.104–1.142, P < 0.001), and uric acid (OR 1.002, 95% CI 1.000–1.004, P = 0.031) were independently associated with LEAD in patients with T2DM. Furthermore, multivariate analysis showed that age (OR 1.078, 95% CI 1.048–1.109, P < 0.001) and GFR (OR 0.985, 95% CI 0.975–0.994, P = 0.002) were independently associated with the severity of arterial lesions in patients with T2DM and LEAD.The risk factors of LEAD in Chinese patients with T2DM include age, course of disease, uric acid, and GFR. Patients with T2DM, high uric acid levels, and declined GFR could be listed in the high-risk group for LEAD.

Characteristics of coronary arterial lesions in patients with coronary heart disease and hypertension.

Objective The aim of this study was to investigate the correlations between risk factors such as hypertension and the complex degrees of coronary arterial lesions (CAL).MethodsWe selected 462 patients with coronary heart disease (CHD) with confirmed the stenosis (≥50 %) in at least one major coronary artery on coronary angiography and divided them into the “CHD with hypertension” group (CHD-HT, n = 306) and the CHD group (n = 156). The characteristics of CAL and the occurrence of 2-year postoperative major adverse cardiac cerebrovascular events (MACCE) in the two groups were observed.ResultsThe mean SYNTAX scores (SS) was higher in the CHD-HT group than in the CHD group (P < 0.05). The proportions of complex, calcified, and diffused long lesions in the PCI patients’ target vascular lesions, as well as the total MACCE incidence, were significantly higher in the CHD-HT group than in the CHD group (P < 0.05). Logistic multifactor regression analysis showed that age, male sex, hypertension, diabetes, hyperlipidemia, and previous history of myocardial infarction were positively correlated with the SS (P < 0.05).ConclusionsThe patients with CHD-HT exhibited complicated and diffused CAL, and arterial hypertension can be considered as a risk factor for the complexity of coronary lesions in patients with ischemic heart disease.

Atteinte macrovasculaire de la sclérodermie systémique : étude descriptive prospective de 20 patients en échodoppler

Systemic sclerosis is characterized by cutaneous sclerosis, vascular disease and immunological dysfunction. The prevalence of macrovascular disease remains controversial. This was a descriptive prospective single-center study conducted in the vascular medicine department of the University Hospital of Bordeaux from July 1 to September 1, 2015. All inpatients followed for systemic scleroderma were included. Each patient had a Doppler ultrasound of the supra-aortic, upper and lower limb, and digital arteries as well as the aorta. The main objective of the study was to describe the presence and location of arterial lesions in patients with systemic sclerosis. Of the twenty patients included, there were 13women and 7men; mean age was 58±16years. Patients exhibited wall thickening (n=16, 80%), calcified plaques (n=10, 50%), hemodynamically significant stenoses (n=3, 15%) and arterial occlusions (n=12, 60%). Ankle brachial pressure index (ABPI) was 0.98±0.16on the right and 0.99±0.21on the left. Two patients had ABPI<0.8. The mean brachial systolic blood pressure was 113±14mmHg. Arterial mapping (860arterial sites) found wall thickening (n=93arteries, 10%), calcified plaques (n=47, 5%), hemodynamically significant stenoses (n=7) and occlusions (n=22). Arterial occlusions were located in the ulnar arteries (n=2), the digital arteries (n=18), the posterior tibial artery (n=1) and the dorsalis pedis artery (n=1). The data of our study correlate with macrovascular disease described in the literature. This finding raises two questions: how does this concept integrate with the severity of Raynaud's phenomenon and the risk of digital ulcers and changes in patients' capillaroscopic landscape during follow-up? What is the cause of these vascular anomalies, some of which are very different from what is observed in atherosclerosis?

META-ANALYSIS OF DRUG-COATED BALLOON VERSUS STANDARD BALLOON ANGIOPLASTY FOR TREATMENT OF INFRAPOPLITEAL LESIONS IN CRITICAL LIMB ISCHEMIA

Drug-Coated Balloon (DCB) angioplasty has emerged as a feasible and effective option for the treatment of infrapopliteal (IP) arterial lesions in patients with CLI. The purpose was to conduct a meta-analysis of the best available evidence comparing the safety and efficacy of DCB versus standard PTA

The meaning of MSCT – angiography in early detection of visceral arterial lesions in patients with antiphospholipid syndrome

Introduction: Antiphospholipid syndrome (APS) is an autoimmune disease which is characterized by arterial and venous thrombosis, fetal loss, and the presence of antiphospholipid antibodies in the serum (aPL). It is characterized by accelerated atherosclerosis and that together with an increased tendency towards thrombosis leading to the occurrence of various vascular events.The aim of study: The goal of our work is to show the results we obtained in MSCT angiography examination of visceral arteries included patients with PAPS (primary APS) and SAPS (secondary APS), comparing them with a control group.Methods: In this study we analyzed 50 patients with primary antiphospholipid syndrome (PAPS) and 50 patients, who have secondary antiphospholipid syndrome (SAPS). The results were compared to 50 controls. The groups were comparable with respect to age, gender, and traditional risk factors except for the lipid status, since controls had significantly higher levels of cholesterol and triglycerides. Study was conducted on 64-multi-sliced computed tomography (64-MSCT), where we analyzed quantitative and morphological characteristics of blood vessels detected lesions.Results: Patients from the control group had statistically very significant elevated cholesterol and triglyceride levels in regards to the patients with SAPS and PAPS (p<0.001 and p<0.05). The results showed that the frequency change is statistically (p < 0.05 and p < 0.001) more frequent in patients with APS than in the control group. Analyzing percentage of diameter stenosis, we have establish that lesions from group with 0%-30% DS and 30%-50% DS are in patients with PAPS (n=48) and SAPS (n=42) are more common than in control group (n=20, p<0.05). Analyzing the qualitative characteristics of plaques we have established significant higher frequency of soft tissue (n=21) and mixed lesions (n=25) in patients with PAPS than the calcified one (n=2, p<0.001).Conclusion: Our study showed that the subclinical manifestation of changes on visceral arteries is more common in patients with APS. Because of its safety and accuracy, the method of choice is 64-MSCT angiography in monitoring disease progression.Key words: antiphospholipid syndrome, vascular manifestations, 64-multi sliced computed tomography

0270: Arterial involvement in Behcet’s disease: a series of 20 cases

While venous manifestations are frequent and have been reported in many publications, data regarding arterial lesions in patients with Behçet’s disease (BD) are rare and often isolated. We report our experience with a rare and interesting subset of BD patients with arterial involvement From 1998 to 2013, 20 cases of arterial involvement were found amongst BD patients in the department of internal medicine of Hedi Chaker Hospital. All these patients fulfilled International Study Group criteria for BD. The mean age when arterial involvement manifested was diagnosed was 32.9±9.9 years, and 18 of the patients were male. Combination of venous and arterial manifestations occurred in 10 patients The artery most often affected is the pulmonary arteries (11 cases) followed by the aorta, the femoral arteries (5 cases) and the coronary arteries (4 cases). The arterial disease was the presenting symptom of Behcet’s disease in 13 cases. Arterial lesions included arterial thromboses (45%), aneurysms (30%), stenosis (20%) and Coronaritis (5%). 15 patients underwent corticosteroids and 4 patients underwent immunosuppressive therapy. Three patients were successfully operated for aneurysms. After a median follow-up of 66.9± 54.4 months, 3 patients had died, in 2 cases directly related to cardiac involvement. Arterial findings are not uncommon in BD. Assessment of the cardiovascular system is advised in patients with BD even if there is no clinically apparent cardiovascular disease.

Role of cardiovascular echo in patients with Takayasu arteritis.

Takayasu arteritis is an important differential diagnosis in young female patients presenting with fever, fatigue, hypertension, and/or neck pain. Aortic arch branch vessels are frequently affected and the carotid artery can have diffuse, homogeneous wall thickening, known as the 'macaroni sign'. The descending aorta can be stenotic with 'pseudo-coarctation'. Cardiovascular echo plays an important role in the screening and characterization of arterial lesions in patients with Takayasu arteritis.

Comparison of duplex scanning and contrast angiography possibilities in the diagnosis of morpho-functional features of arterial lesions (review of the references)

This paper provides an overview of publications that evaluate the effectiveness of color duplex scanning and contrast angiography uses in the preoperative diagnosis of various morphological variants of arterial lesions in patients with occlusive-stenotic vascular lesions.

Ultrasound diagnosis and related factors analysis of lower limb arterial lesions in patients with type 2 diabetes

Objective To investigate the color Doppler flow imaging （CDFI） diagnosis value and related factors analysis of lower limb arterial lesions in patients with type 2 diabetes. Methods 70 cases with type 2 diabetes as observation group, 60 not-type 2 diabetes patients as control group in the same period were selected,who were given lower limb artery CDFI examination and comparison. Results Lower limb artery blood wall intima-media thickness （IMT） abnormal, atherosclerotic plaques, luminal stenosis, occlusion detection rate of the observation group were 82. 86% ,60.0% ,22.86% ,they were significantly higher than 28.33%, 16.67% ,5.0% of the control group（ x^2 = 4.38,12.84,7.53, all P 〈 0. 05 ） ; the lower limb artery plaque location of the observation group often was seen in the femoral artery, posterior tibialis artery and the anterior tibialis, dorsalis pedis artery in 42.86%, 10.0% ,42.86%, 48.57% ,compared with 11.67%,6.67%,3.33%,3.33% of the control group, there were significant differences （ x^2 = 4.87,12.75,13.97, all P 〈 0.05 ）. In the observation group, the related factors of type 2 diabetes lower limb arterial pathological including age, blood pressure, glycosylated hemoglobin, blood lipid （ TC, TG, HDL-C）, there were significant differences compared with the control group （t = 13.26,5.34,4.00,89.00,6.54,7.54, all P 〈 0.05 ）. Conclusion The CDFI examination is a reliable diagnosis means of patients with type 2 diabetes lower limb artery lesions,which can determine the lesion site,length,jam extent and vascular anatomical abnormalities, and has an im- portant clinical value. Key words: Uhrasonography, doppler, color; Type 2 diabetes ; Diabetic angiopathies ; Lower limb arterial

Deletion of STAT5a/b in vascular smooth muscle abrogates the male bias in hypoxic pulmonary hypertension in mice: implications in the human disease.

Chronic hypoxia typically elicits pulmonary hypertension (PH) in mice with a male-dominant phenotype. There is an opposite-sex bias in human PH, with a higher prevalence in women, but greater survival (the "estrogen paradox"). We investigated the involvement of the STAT5a/b species, previously established to mediate sexual dimorphism in other contexts, in the sex bias in PH. Mice with heterozygous or homozygous deletions of the STAT5a/b locus in vascular smooth muscle cells (SMCs) were generated in crosses between STAT5a/b(fl/fl) and transgelin (SM22α)-Cre(+/+) parents. Wild-type (wt) males subjected to chronic hypoxia showed significant PH and pulmonary arterial remodeling, with wt females showing minimal changes (a male-dominant phenotype). However, in conditional STAT5(+/-) or STAT5(-/-) mice, hypoxic females showed the severest manifestations of PH (a female-dominant phenotype). Immunofluorescence studies on human lung sections showed that obliterative pulmonary arterial lesions in patients with idiopathic pulmonary arterial hypertension (IPAH) or hereditary pulmonary arterial hypertension (HPAH), both male and female, overall had reduced STAT5a/b, reduced PY-STAT5 and reduced endoplasmic reticulum (ER) GTPase atlastin-3 (ATL3). Studies of SMCs and endothelial cell (EC) lines derived from vessels isolated from lungs of male and female IPAH patients and controls revealed instances of coordinate reductions in STAT5a, STAT5b and ATL3 in IPAH-derived cells, including SMCs and ECs from the same patient. Taken together, these data provide the first definitive evidence for a contribution of STAT5a/b to the sex bias in PH in the hypoxic mouse and implicate reduced STAT5 in the pathogenesis of the human disease.

Renal Interstitial Infiltration and Tertiary Lymphoid Organ Neogenesis in IgA Nephropathy

Previous studies have identified inflammatory features that enable the prediction of renal outcome of IgA nephropathy (IgAN); however, validation of these findings is still needed. This prospective study was performed to determine the characteristics of renal interstitial infiltration and tertiary lymphoid organ (TLO) neogenesis in a cohort of Chinese patients with IgAN. Adult patients with IgAN were recruited into this study from June 2009 to June 2010. Inflammatory cells in renal biopsy tissues were detected by immunohistochemistry and immunofluorescence. Correlations between the density of interstitial inflammatory cells, grades of TLOs, and clinicopathologic features were evaluated. Of 152 eligible patients, 72 (47%) were successfully followed-up by telephone at 30 months after renal biopsy. Twelve patients were classified as the severe group and 60 patients were classified as the stable group, according to the progression of serum creatinine levels during the follow-up period. A comparison of the severity of interstitial infiltration and the frequency of TLO neogenesis between the two groups was performed. The accumulation of interstitial inflammatory cells was correlated with decreased renal function, heavy proteinuria, and severe glomerular, interstitial, and arterial lesions in patients with IgAN. TLOs, identified as nodular inflammatory infiltrates containing organized DC-SIGN(+), CD4(+), CD8(+), and CD20(+) cells, were observed in 37.5% of patients. Patients with high-grade TLOs exhibited a high percentage of mesangial hypercellularity and crescents as well as severe interstitial and arterial lesions. Patients in the severe group exhibited more severe interstitial infiltration and a higher percentage of TLO neogenesis (83.3% versus 33.3%; P=0.001) compared with patients in the stable group. As contributors to an active local inflammatory response, the severity of interstitial infiltration and the frequency of TLO neogenesis are correlated with glomerular, interstitial, and arterial lesions as well as IgAN progression.

Diagnostic Performance of Computed Tomography Angiography in Peripheral Arterial Injury due to Trauma: A Systematic Review and Meta-analysis

To evaluate the diagnostic accuracy of computed tomography angiography (CTA) in detecting arterial lesions in patients with suspected arterial injury of the upper or lower extremity due to trauma. A systematic review and meta-analysis was carried out. Medline and Embase were searched on August 13, 2012, for studies comparing CTA with surgery, digital subtraction angiography (DSA), or follow-up, which allowed extraction of data into two-by-two tables. The methodological quality of included studies was assessed using the QUADAS tool. Summary estimates of sensitivity and specificity of CTA in identifying or excluding arterial lesions were obtained using a bivariate model. This review included 11 studies making up a total of 891 trauma patients. The included studies were of moderate methodological quality and at risk of misclassification and verification bias. Some 4.2% of all CTA studies were non-diagnostic. The summary estimates of sensitivity and specificity of CTA were 96.2% (95% CI 93.5-97.8%) and 99.2% (95% CI 96.8-99.8%), respectively. Despite methodological flaws, the excellent estimates of sensitivity and specificity indicate that CTA is an accurate modality for evaluating arterial lesions in patients with extremity trauma and can replace DSA.

Smooth muscle hyperplasia due to loss of smooth muscle α-actin is driven by activation of focal adhesion kinase, altered p53 localization and increased levels of platelet-derived growth factor receptor-β

Mutations in ACTA2, encoding the smooth muscle cell (SMC)-specific isoform of α-actin (α-SMA), cause thoracic aortic aneurysms and dissections and occlusive vascular diseases, including early onset coronary artery disease and stroke. We have shown that occlusive arterial lesions in patients with heterozygous ACTA2 missense mutations show increased numbers of medial or neointimal SMCs. The contribution of SMC hyperplasia to these vascular diseases and the pathways responsible for linking disruption of α-SMA filaments to hyperplasia are unknown. Here, we show that the loss of Acta2 in mice recapitulates the SMC hyperplasia observed in ACTA2 mutant SMCs and determine the cellular pathways responsible for SMC hyperplasia. Acta2(-/-) mice showed increased neointimal formation following vascular injury in vivo, and SMCs explanted from these mice demonstrated increased proliferation and migration. Loss of α-SMA induced hyperplasia through focal adhesion (FA) rearrangement, FA kinase activation, re-localization of p53 from the nucleus to the cytoplasm and increased expression and ligand-independent activation of platelet-derived growth factor receptor beta (Pdgfr-β). Disruption of α-SMA in wild-type SMCs also induced similar cellular changes. Imatinib mesylate inhibited Pdgfr-β activation and Acta2(-/-) SMC proliferation in vitro and neointimal formation with vascular injury in vivo. Loss of α-SMA leads to SMC hyperplasia in vivo and in vitro through a mechanism involving FAK, p53 and Pdgfr-β, supporting the hypothesis that SMC hyperplasia contributes to occlusive lesions in patients with ACTA2 missense mutations.