Arterial System Research Articles

Cerebral Arterial Inflow and Venous Outflow Assessment Using 4D Flow MRI in Adult and Pediatric Patients

Background and Purpose: The cerebral circulation is highly regulated to maintain brain perfusion, keeping an equilibrium between the brain tissue, cerebrospinal fluid (CSF) and blood of the arterial and venous systems. Cerebral venous drainage abnormalities have been implicated in multiple cerebrovascular diseases. The purpose of this study is to evaluate the relationship between the arterial inflow (AI) and the cerebral venous outflow (CVO) and their correlation with the cardiac outflow in healthy adults and children to understand the role of the emissary veins in normal venous drainage. Materials and Methods: A total of 31 healthy volunteers (24 adults (39.5 ± 16.0) and seven children (3.4 ± 2.2)) underwent intracranial 4D flow with full circle of Willis coverage and 2D PC-MRI at the level of the transverse sinus for measurement of the AI and CVO, respectively. The AI was calculated as the sum of the flow values in the bilateral internal carotid and basilar arteries. The CVO was calculated as the sum of the flow values in the bilateral transverse sinuses. The cardiac outflow was measured via 2D PC-MRI with retrospective ECG gating with images acquired at the proximal ascending aorta (AAo) and descending (DAo) aorta. The ratios of the AI/AAo flow and CVO/AI were calculated to characterize the fraction of cerebral arterial inflow in relation to cardiac outflow and venous blood draining through the transverse sinuses, respectively. Results: The AI and CVO were significantly correlated (r = 0.81, p < 0.001). The CVO constituted approximately 60–70% of the AI. The CVO/AI ratio was significantly lower in children versus adults (p = 0.025). In adults, the negative correlation of the AI with age remained strong (r = −0.81, p < 0.001). However, the CVO was not significantly associated with age. Conclusion: The CVO/AI ratio suggests an important role of the emissary veins, accounting for approximately 30–40% of venous drainage. The lower CVO/AI ratio in children, although partially related to decreased AI with age, suggests a greater role of the emissary veins in childhood, which strongly decreases with age.

BN SO31 - Pedicle First; a Paved Laparoscopic Approach for Huge Splenomegaly

Abstract Background Since its introduction for the first time by Delaitre et al1 in 1991, laparoscopic splenectomy (LS) has become the minimal invasive approach of choice for the management of the hematological splenic disorders2. Many agreed benefits have been achieved with this approach regarding the hospital stay, blood loss, duration of recovery, aesthetic results and quality of life; however, massive spleens remain a real technical challenge in front of achieving those benefits. The complex and non-typical variable configurations of the vascular system for the pancreatic body and tail which come from the splenic artery represents another faced point of anatomical complications3. Method From March 2020 to February 2024, a prospective study has included 30 patients presented with benign hematological disorders and massive splenomegaly (more than 20 cm longitudinal axis) who underwent laparoscopic splenectomy in our institution. Detailed data regarding their demographics, splenic size, operative time, blood loss, conversion rate, postoperative serum amylase and hospital stay were collected. Standardized anterior approach operative steps were adopted by the same surgeon for all patients with early control of the arterial system of the splenic circulation before mobilization (short gastric vessels and splenic artery 2 to 4 cm away from hilum). Results Thirty patients presented with huge splenomegaly have underwent laparoscopic splenectomy with a conversion rate of 6.6% (2 patients due to extensive perisplenic adhesions). The mean longitudinal splenic dimension was 24 ± 1.5 cm (range from 20 to 27 cm), mean operative time was 110 ± 16 minutes, mean operative blood loss was 160 ± 20 ml, mean hospital stay was 4 ± 1.5 days, postoperative rate of hyperamylasemia in 20% (asymptomatic 6 patients with no operative evidence of pancreatic injury), respiratory complications in 16.6 % (5 patients), and reactive thrombocytosis in 6.6% (2 patients). Conclusion Early laparoscopic control of the arterial system away from the splenic hilum can enable us to lessen the conversion rate for massive splenomegaly patients and achieve successfully the benefits of laparoscopy for those patients on the expense of the elevated postoperative hyperamylasemia rate.

ROLE OF ISCHEMIA IN THE PATHOGENESIS OF DIABETIC VITREOPAPILLARY TRACTION SYNDROME

Objective: to evaluate the role of ischemia in the pathogenesis of diabetic vitreopapillary traction syndrome.Material and methods: The analysis is based on a sample of 30 patients with diabetic vitreopapillary traction syndrome. The study included a standard ophthalmological examination, color doppler mapping, fluorescent angiography. All patients underwent three-port vitrectomy to eliminate traction syndrome.Results: The results of the obtained data indicated that patients with diabetic vitreopapillary traction syndrome had significant changes in the hemodynamics of the eye compared to the normal parameters. А significant difference in a blood flow parameters in the posterior short ciliary arteries system was recorded in eyes with vitreopapillary traction syndrome compaired to paired eyes.Conclusion: The results of the studies indicate that patients with diabetic vitreopapillary traction syndrome have significant changes in regional hemodynamics: a decrease in blood flow velocity in the central retinal artery, posterior short ciliary arteries and an increase in peripheral vascular resistance, which indicates ischemia of the optic nerve head and may also be one of the reasons for the development of vitreopapillary traction.

Successful Transcatheter Closure of an Iatrogenic Axillary Arteriovenous Fistula in a Young Girl: A Delayed Complication of Intervention in a Resource-limited Setup

Abstract Arteriovenous fistula (AVF) is a well-known complication in the adult population following cardiac interventions. Data on the pediatric age group are lacking. Furthermore, there are no guidelines for the management of the pediatric population. We present a case of successful endovascular device closure of iatrogenic axillary AVF in a limited resource setup. A 9-year-old girl had palliative ductal stenting through the left axillary artery for complex congenital cyanotic heart disease 6 months back. She presented with an iatrogenic axillary AVF. We planned to close the defect in catheterization laboratory. After successful device deployment, there was a complete occlusion of the arterial system. To maintain arterial patency stenting was performed subsequently. Successful device closure of complicated axillary AVF in the pediatric population can be achieved even in a recourse-limited setup.

Real-Time Accuracy Evaluation of Arterial Catheter Transducer Systems

IntroductionArterial pressure is currently monitored in ICU with a catheter–transducer fluid line. This fluid filled tubing line distorts the original waveform due to its dynamic characteristics (natural frequency, Fn, and damping coefficient, z), introducing potentially significant errors when calculating the cardiac output from pulse contour signal analysis. MethodsIn our study, we cross-compared Fn and z obtained with our new Fast External Pressure Test (FEPT) and with the Fast Flush Test (FFLT), to the reference technique (Sine wave variable Frequency Analysis Test - SFAT). It was carried on a testbench for 48 hours. Fn and z were measured using the three techniques with two fluid-filled tubing lines (standard, STD, and blood conserving device, BCD). ResultsFn measurements with FEPT and FFLT present similar biases (0.79 vs 0.83 Hz), but lower variability for FEPT, with limits of agreement (LOA) ranging from −3.35 to +4.99 Hz for FFLT vs −2.29 to +3.86 Hz (p<0.0001) for FEPT. For the measurement of z, FEPT has a bias of 0.047 and LOA of −0.063 to +0.157, much lower (p<0.0001) than those measured with the FFLT (bias 0.139 and LOA −0.028 to +0.306). ConclusionWhen automated, the FEPT method will detect potential situations of over/under estimations occurrences. This will prevent false alarms, alarm fatigue and therefore consequences on patient care. Eventually, FEPT turns to be more accurate than FFLT, less scattered, less time-consuming, less invasive and so well suited for use in clinical settings.

The Vascular Anatomical Basis for a Well-Designed Reconstruction of the Ala Nasi by a Microsurgical Preauricular Flap Technique

Background: A microsurgical auricular flap represents a single-step technique for the reconstruction of full-thickness defects of the ala nasi. To achieve the best surgical outcomes, it is essential to have an exhaustive knowledge of the vascular network to improve the management of the surgical flap. This study aimed to provide an anatomical and surgical guide for a well-designed reconstruction of the ala nasi using a free preauricular flap. Methods: In this study, three fresh-frozen and two formalin-fixed human head specimens injected with red silicone rubber to enhance the arterial facial system were used. The reconstruction of the full-thickness defect of the ala nasi was performed using a microsurgical auricular flap technique, with the dimensions of the ala nasi and the preauricular flap duly noted. In addition, anatomical dissections were conducted, during which the positions and diameters of the main donor and recipient vessels were measured. Results: A presurgical evaluation was performed to define the flap design. A comparison of the shape and mean dimensions of the ala nasi defect (height 9.66 ± 1.40 mm; thickness 3.52 ± 0.53 mm) and the preauricular flap (height 8.50 ± 2.68 mm; thickness 3.92 ± 1.29 mm) indicated that this flap was an optimal option for the reconstruction of the ala nasi. The surgical procedure involved the full-thickness removal of the ala nasi, and the harvesting and insertion of the preauricular flap. The anatomical measurements demonstrated that the facial artery and veins were the optimal recipient vessels, with a diameter of &gt;1 mm (2.08 ± 0.56 and 2.85 ± 0.74 mm), suitable for anastomosis with the superficial temporal artery and vein (1.86 ± 0.58 and 1.66 ± 0.15 mm). In addition, the postsurgical evaluations indicated a slight mean difference in the thickness (1.14 ± 0.65 mm) and height (1.68 ± 1.18 mm) between the ala nasi and helix and a satisfactory VAS score (7.9 ± 0.57). Conclusions: Our surgical and anatomical data provide compelling evidence in favour of free preauricular flap reconstructions of the ala nasi. This procedure allows for the correct choice of recipient vessels and the creation of a well-designed surgical flap.

Duplex-ultrasound as a single imaging test for Global Limb Anatomic Staging System (GLASS) assignment stage and comparison with intraoperative arteriography

Obtaining a prognostic and predictive classification based on the risk of amputation is crucial in ischemic pathology of the lower limbs. Accurate anatomical characterization of arterial lesions is essential for optimal clinical decision-making. The Global Limb Anatomic Staging System (GLASS) provides a comprehensive anatomy assessment of the femoropopliteal and infrapopliteal arterial system. GLASS introduces concepts such as the target arterial path (TAP) and estimated limb-based patency (LBP), crucial for determining the best arterial route to restore blood flow. A prospective study conducted from May to December 2022 involved 66 patients undergoing revascularization surgery for Critical Limb-Threatening Ischemia (CLTI). Preoperative arterial mapping (PAM) using duplex ultrasonography was the sole imaging modality. The TAP was defined in each patient, and GLASS staging was determined. Intraoperative arteriography (IA) was used on the day of surgery for comparison. Agreement between PAM and IA was assessed using Cohen's kappa coefficient, and diagnostic metrics were compared using ROC curves. Doppler ultrasound demonstrated a sensitivity of 98%, specificity and PPV of 100%, and NPV of 94.7% in the femoropopliteal sector, with a Kappa coefficient of 0.98. For the infrapopliteal sector, sensitivity was 95%, specificity 96.5%, PPV 97.3%, and NPV 93.3%, with a Kappa coefficient of 0.89. Combining both sectors, the overall GLASS stage showed a 93.9% concordance with a Kappa coefficient of 0.91. ROC curves revealed no significant differences between ultrasound and arteriography in terms of staging. This study demonstrates that Doppler Ultrasound can serve as the exclusive imaging modality for determining the preoperative GLASS stage.

COVID-19 and COVID-19 Vaccine-Related Skin Ulcerations in the Lower Extremities: A Case Report and Literature Review

Several associations have been made between COVID-19 and vasculitis. Recent data also shows the prevalence and association of de novo vasculitis with either COVID-19 infection or COVID-19 post vaccination. In this article, we present the case of new-onset leukocytoclastic vasculitis, secondary to COVID-19 vaccination, that was complicated by severe infected and nonhealing ulcers in the lower extremities. Case A 53-year-old male patient presented to the dermatology clinics with a three-week history of painful necrotic patches coalescent of the lateral malleolus of the right and left ankles. History goes back to when the patient reported developing pruritic papules two weeks after receiving his second shot of the Pfizer BioNTech COVID-19 vaccine (BNT162b2). Punch biopsy was consistent with leukocytoclastic vasculitis. He was prescribed a four-week course of systemic corticosteroids and antibiotics as per cultures. Vascular assessment confirmed normal peripheral arterial and venous system. Two months later, the patient re-presented with fever and worsening of his lower extremity ulcers. He underwent debridement of his wounds. Intra-operative cultures revealed multidrug resistant bacteria. He required an additional debridement session a few days later and a 14-day course of Piperacillin-Tazobactam. The patient was subsequently discharged on corticosteroids and Azathioprine and followed up in the vascular surgery and rheumatology clinics. At four months follow-up, the patient's wounds were almost completely healed. Conclusion This article highlights a case of severe new-onset COVID-19 vaccine-associated leukocytoclastic vasculitis complicated with infected ulcers that required debridement twice in addition to a prolonged course of antibiotics and immunosuppression therapy. To our knowledge, none of the cases reported in the literature were this severe in nature. In this post-pandemic era, it must remain high on the differential list, and healthcare specialists should maintain a high index of suspicion when evaluating sudden new-onset skin lesions that do not have an immediately apparent etiology.

Validation and development of a scoring system for comprehensively evaluating arterial damage in the elderly chinese

Abstract Background and aims Existing assessments on arterial damage focus on specific segments of arterial system (e.g., carotid artery), lacking a comprehensive index to evaluate overall arterial health. We aimed to integrate existing assessments for arterial damage and develop a new score, named Arterial Damage Index (ADI), to comprehensively evaluate arterial health status of the whole-body arterial system. Methods A total of 3075 community-dwelling elderly Chinese (age ≥65 years) from the North Shanghai Study (2014–2022) were included. Assessments on arteries including ankle-brachial index (ABI), pulse wave velocity (PWV), carotid intima-media thickness (CIMT) and plaques, pulse pressure (PP), and inter-arm (IASBPD) and -leg (ILSBPD) systolic blood pressure difference were included for screening. Cox proportional hazards regressions of MACEs (non-fatal myocardial infarction, non-fatal stroke, and all-cause mortality) were conducted to acquire the ADI algorithm. Internal and external validation on ADI were also performed. Results Over a median follow-up period of 6.4 years, 316 individuals (10.3%) experienced an incident of MACE. After screening, PWV, ABI, PP, CIMT, and carotid plaque were included for ADI scoring system. Survival analysis revealed a significant difference in the rates of composite events across different ADI stratifications (p for trend &amp;lt; .05). ADI showed superior discriminative performance (C-index 0.65±0.02) compared to any individual arterial-related indicator. Calibration curve shows the predictive model showed that the predicted and actual probabilities were broadly consistent. Additionally, ADI provided better incremental value when added to the base model (net reclassification improvement, 36.2% [95% CI, 15.3%-52.1%]; p &amp;lt; .05, integrated discrimination improvement, 7.9% [95% CI, 4.9%-11.0%]; p &amp;lt; .05) compared to any individual arterial-related indicator. These findings were confirmed in internal validation sets (p for DeLong tests &amp;gt;0.05), and was externally validated in 2155 participants from a community-based cardiovascular disease cohort among residents in Beijing, China. Conclusion ADI can comprehensively assess arterial damage and provide a valuable tool for further assessment of future cardiovascular risk.central illustration

Trends and patterns in pulmonary arterial hypertension-associated hospital admissions among methamphetamine users: a decade-long study.

Pulmonary arterial hypertension (PAH) is a rare, chronic, progressive form of pulmonary hypertension in which increased arterial pressure causes remodeling of the arterial system and is associated with heart failure. Methamphetamine is a stimulant that has recently become a focus in PAH research, but the recent trends and demographics of this cohort of patients are not known. The study aimed to analyze the overall trends and demographics of PAH patients with and without concurrent methamphetamine usage. The study used the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality (AHRQ) from 2008 to 2020 to calculate nationally weighted estimates for both conditions by ICD-9 and ICD-10 diagnosis codes. We used several statistical measures, including descriptive statistics with design-based chi-square and t-tests, trend analysis with Cochran-Armitage test, generalized linear models, and other data preprocessing measures. A significant increase was evident in patients with pulmonary arterial hypertension (PAH) and concurrent methamphetamine use (9.2-fold). Most of the hospitalized patients were males (59.16%), aged 41-64 (45.77%), White (68.64%), from the West (53.09%), with Medicaid (50.48%), and with median income <$25,000. The rate of increase over the period was higher for males (11.8-fold), race (not sure which race; please check and modify), aged 41-64 (11.3-fold), and in the South (15.1-fold). An overall adjusted prevalence ratio (PR) for PAH hospitalizations among concurrent methamphetamine users was 32.19 (CI = 31.19-33.22) compared to non-users. With respective reference categories, the significantly higher PR was evident for males, patients aged 41-64, White, with Medicare, median income <$25,000, all regions compared to Northeast, length of hospital stays, and conditions, including chronic pulmonary disease, diabetes, hypertension, obesity, and peripheral vascular disorders. This study reveals a national overall and demographic-specific trend of increasing PAH with concurrent methamphetamine usage and associated factors. The findings may help to understand the current patterns and identify the vulnerable sociodemographic cohorts for further research and to take appropriate policy measures.

Safety and feasibility of drug eluting and perfusion therapy for left main disease: JDEPTH-LM pilot study

Abstract Background Reducing cardiovascular events arising from ostial lesions of the left circumflex artery (LCx) remains an issue following percutaneous coronary intervention (PCI) for left main disease (LMD). Despite expert consensus recommendation for the drug coated balloon (DCB) use to address it, there are concerns in using DCB following the standard practice of crossover-stenting from the left main trunk (LMT) to left anterior descending artery (LAD). Specifically, utilizing a DCB in isolation for the ostial LCx after stenting may result in additional carina shift. The combination of a conventional balloon for LMT-LAD and a DCB for LMT-LCx in KBT could potentially cause hemodynamical instability due to prolonged occlusion time for the entire left coronary artery system. Accordingly, we hypothesized the combined usage of DCB and perfusion balloon (PB) could provide a safe and effective approach for drug-eluting therapy in ostial LCx lesion. This approach aims to facilitate prolonged inflation while maintaining coronary blood flow during KBT for LMD. Purpose The aim of this study was to assess the safety and feasibility of prolonged KBT with DCB and PB for LMD. Methods In this single-center prospective observational study, we enrolled patients of de-novo LMD with ostial LCx lesion, requiring crossover stenting for the LMT-LAD followed by conventional KBT (C-KBT). IVUS-guided procedure was mandated as per the study protocol. Following confirming the achievement of optimal left main PCI by IVUS, a double-effect KBT (W-KBT) was employed. This technique involved the use of a PB for the LMT-LAD and a DCB for the LMT-LCx, sized in a 1:1 ratio to the balloons used in C-KBT. Patients in cardiogenic shock, those requiring a two-stent technique for LMD, and individuals without achievement of TIMI3 flow in the LCx after C-KBT were excluded. The primary endpoint was procedural success, defined as device delivery and balloon inflation time ≥30 sec. Secondary endpoints included the total balloon inflation time (W-KBT time), the incidence of ST-change cases, time to ST-change (ST-change time), changes in blood pressure and heart rate (delta BP and delta HR, respectively), and the frequency of inotrope usage following W-KBT. Results Between January 2023 and December 2023, 12 patients were included among 73 patients with LMD who underwent PCI during this study period. Mean age was 73.8±7.2 years (91.7% men) and median SYNTAX score was 29 (IQR: 26.3 to 34.5). The incidence of ACS was 8.3%. Procedural success was achieved in 100% of cases. The results of secondary endpoints were as follows: median W-KBT time: 60 sec (IQR: 60 to 60); the incidence of ST-change: 50% (no cases with ST-elevation); mean ST-change time: 41.2±7.1 sec; mean delta BP: -13.7±11.4 mmHg; mean delta HR: -3.4±5.9 bpm; and the use of inotrope: 0%. Conclusion Within the limited sample size of this pilot study, the safety and feasibility of the "first-in-man" technique of W-KBT were confirmed.Procedure of W-KBTStrength of W-KBT

Treatment of Unruptured Small and Medium-Sized Wide Necked Aneurysms Using the 64-Wire Surpass Evolve: ASubanalysis From the SEASE International Registry.

Flow diversion has revolutionized the management of wide-necked intracranial aneurysms (IAs). We aimed to assess the effectiveness and safety of the new generation 64-wire Surpass Evolve for the treatment of unruptured small/medium-sized IAs. This is a subanalysis from the SEASE (Safety and Effectiveness Assessment of the Surpass Evolve) registry, an observational cohort study including 15 academic institutions in North America and Europe between July 2020 and October 2022. Patients with wide-necked saccular IAs, measuring <12 mm along the internal carotid artery and vertebrobasilar system, and treated with the Surpass Evolve were included. Primary effectiveness was complete occlusion (Raymond-Roy class 1) at follow-up (core laboratory adjudicated), and primary safety was major stroke (ischemic/hemorrhagic) in the territory supplied by the target artery or death. A total of 129 cases with 135 IAs were included (median age 59 years, 85.3% women). Median maximum IAs size and neck size were 5.1 and 3.9 mm, respectively. Most IAs were in the internal carotid artery C6 (65.9%, 89/135) and C7 (14.1%, 19/135) segments. At a median follow-up time of 10.2 months (interquartile range, 6.4-12.8), complete occlusion was 77.1% (101/131), ≥50% in-stent stenosis was 8.8% (11/125), and retreatment was 0.8% (1/125). Major stroke and mortality were reported in 2 (1.6%) patients and 1 (0.8%) patient, respectively. Size was the only factor associated with higher odds of incomplete occlusion (adjusted odds ratio, 1.2 [95% CI, 1.02-1.5]; P=0.03). Patients with small/medium-sized IAs can be effectively treated using the Surpass Evolve, a new generation, 64-wire, cobalt-chromium flow diverter.

Impact of arterial system alterations due to amputation on arterial stiffness and hemodynamics: a numerical study

Subjects with amputation of the lower limbs are at increased risk of cardiovascular mortality and morbidity. We hypothesize that amputation-induced alterations in the arterial tree negatively impact arterial biomechanics, blood pressure and flow behavior. These changes may interact with other biological factors, potentially increasing cardiovascular risk. To evaluate this hypothesis regarding the purely mechanical impact of amputation on the arterial tree, we used a simulation computer model including a detailed one-dimensional (1D) arterial network model (143 arterial segments) coupled with a zero-dimensional (0D) model of the left ventricle. Our simulations included five settings of the arterial network: (1) 4-limbs control, (2) unilateral amputee (right lower limb), (3) bilateral amputee (both lower limbs), (4) trilateral amputee (lower-limbs and right upper-limb), and (5) quadrilateral amputee (lower and upper limbs). Analysis of regional stiffness, as calculated by pulse wave velocity (PWV) for large-, medium- and small-sized arteries, showed that, while aortic stiffness did not change with increasing degree of amputation, stiffness of medium and smaller-sized arteries increased with greater amputation severity. Despite a staged decrease in cardiac output, the systolic and diastolic blood pressure values increased, resulting in an increase in both central and peripheral pulse pressures but with an attenuation of pulse pressure amplification. The most significant increase in peak systolic pressure and decrease in peak systolic blood flow was observed at the site of the abdominal aorta. Wave separation analysis indicated no changes in the shape of the forward and backward wave components. However, the results from wave intensity analysis showed that with extended amputation, there was an increase in peak forward wave intensity and a rise in the inverse peak of the backward wave intensity, suggesting potential alterations in cardiac hemodynamic load. In conclusion, this simulation study showed that biomechanical and hemodynamic changes in the arterial network geometry could interact with additional risk factors to increase the cardiovascular risk in patients with amputations.

Enhancing Exosomal Delivery to Abdominal Aortic Aneurysms using Magnetically Responsive Chemotactic Nanomotors for Elastic Matrix Regenerative Repair.

Abdominal aortic aneurysms (AAAs) involve localized dilation of the abdominal aorta, with the reversal of this condition being significantly limited by the inherently poor and abnormal regenerative repair of the aortic elastic matrix. Mesenchymal stem cell exosomes (MSCEs) are promising regenerative tools; however, achieving precise targeting of AAA with MSCEs is challenging owing to the high blood flow in the arterial system. In this study, an engineered exosomal nanomotor is developed for magnetic and chemical propulsion. The results demonstrate that this nanomotor effectively enhances the delivery of MSCEs to the AAA through magnetic field navigation and catalase-induced chemotaxis. The nanomotor significantly enhances the elastic matrix repair, reduces oxidative stress, and activates the PI3K/Akt pathway, leading to aneurysm shrinkage and reversal. In addition, the nanomotor possesses magnetic resonance imaging capabilities. The use of this nanomotor offers a novel, targeted drug delivery system in a rat model of AAA and holds promise as a potential therapeutic option for this condition.

Improvement of the outcome of the saphenous vein graft when connected to the internal thoracic artery.

Since 2000, we have been grafting the right coronary artery system (RCAs) using the proximal portion of the right internal thoracic artery (RITA) as the inflow of the saphenous vein graft (SVG) to increase the number of patients undergoing beating heart complete myocardial revascularization. From 2000 to 2022, 928 consecutive patients underwent SVG on the RCAs. In 546 patients (58.8%), the inflow was the RITA (I-graft group), and in 382 patients (41.2%), the inflow was the aorta (Ao-graft group). The inclusion criteria were age ≤75 years, ejection fraction >35%, only one SVG per patient, bilateral internal thoracic arteries as a Y-graft on the left system (three-vessel disease, n = 817, 88.0%) or left internal thoracic artery on the left anterior descending artery and RITA + SVG on the RCAs (two-vessel disease, n = 111, 12.0%). Propensity matching identified 306 patients per group. After a median follow-up of 8 (5-10) years, graft patency was assessed by coronary computed tomographic angiography in 132 patients (64 in the I-graft group and 68 in the Ao-graft group). Early results were similar in both groups. The I-graft group had higher 10-year survival and freedom from main adverse cardiac events (90.0 ± 2.0 vs. 80.6 ± 3.8, p = 0.0162, and 81.3 ± 2.7 vs. 64.7 ± 5.6, p = 0.0206, respectively). When RITA was the inflow, SVG had a higher estimated 10-year patency rate (82.8% ± 6.5 vs. 58.8% ± 7.4, p = 0.0026) and a smaller inner lumen diameter (2.7 ± 0.4 vs. 3.4 ± 0.6 mm, p < 0.0001). When the inflow is the RITA, SVG grafted to the RCAs (I-graft) may result in a higher patency rate and better outcome than when the inflow is the ascending aorta (Ao-graft). The continuous supply of nitric oxide by RITA may be the cause of the higher patency rate of the I-graft, which can behave like an arterial conduit.

Practical Step-by-step SYNAPSE VINCENT Rendering of Three-dimensional Graphics in Horseshoe Kidney with Bilateral Varicoceles.

Medical illustration serves as a cornerstone for understanding intricate anatomical anomalies, with three-dimensional (3D) rendering emerging as a pioneering tool for emphasizing basic medical concepts and clinical practices. In Japan, the SYNAPSE VINCENT software package (SVSP; Fujifilm Medical Co., Ltd., Tokyo, Japan), internationally known as "SYNAPSE 3D," is a widely embraced solution for 3D rendering. However, despite its prevalence, resources elucidating its practical usage and offering insightful tips are scarce. In this review, we focus on the use of SVSP for 3D rendering of complex anatomical anomalies, particularly in the field of urology. We demonstrate a step-by-step process of 3D rendering. 3D rendering was performed in a sample case of a patient with horseshoe kidney and coexisting bilateral varicoceles through inputting of multiphase contrast-enhanced CT images into the application, followed by segmentation of the renal parenchyma, image registration, and segmentation of the arterial and venous systems as well as the upper urinary tract. Manual adjustments were made using the "Mask edit" and "Diameter setting" tools to ensure accuracy, particularly in cases of significant anomalies. Then, color-coded structures appeared, including the renal parenchyma, arterial and venous systems, and upper urinary tract, which provided a comprehensive visualization of the anatomical anomalies. This review highlights the effectiveness of the SVSP in visualizing complex anatomical abnormalities and detailing the practical rendering process, which could promote wider adoption of the application among urologists despite the challenges associated with the software.

Mitochondrial dysfunction in patients with respiratory diseases

The aim of this scientific literature review was to find new solutions to urgent problems of treating respiratory diseases and reducing the associated temporary loss of ability to work and disability. The article presents the results of the analysis of 62 scientific papers published over 23 years (2001 – 2023) on mitochondrial dysfunction (MD), new methods of its diagnosis, and ways of its correction in respiratory diseases. Disorder of the energy function of mitochondria has been identified as an urgent scientific problem of respiratory medicine. It is noted that new methods of pathogenetic therapy for common and currently difficult-to-treat diseases are being developed to solve this problem. The key section of the review is devoted to the results of studies of mitochondrial dysfunction in patients with asthma, chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, and pulmonary hypertension.Conclusion. The article assesses MD diagnostic methods that are potentially applicable in real clinical practice. The results of studying the electric potential of the inner mitochondrial membrane, accumulation of active forms of oxygen, production of adenosine triphosphate in blood cells, alveocytes and epithelium of the respiratory tract, as well as bronchial smooth muscle cells, endothelium and vascular smooth muscle cells in the pulmonary artery system, determination of mitochondrial DNA in biological environments are compared. Proposed methods for the correction of MD syndrome in the clinical picture of respiratory diseases are briefly covered.

Anatomical Variations of the Bifurcation Levels of the Common Carotid Artery and Superior Thyroid Artery.

Variations in the carotid arterial system significantly impact atherosclerosis's clinical and surgical management, which predominantly occurs at arterial bifurcations. This study aimed at evaluating anatomical variations in the bifurcation levels of the common carotid artery (CCA) and the superior thyroidartery (STA), emphasizing clinical relevance. This was an observational cross-sectional study conducted in June 2021 using 32 embalmed cadavers of adult age from medical schools in Khartoum, Sudan. Sixty-four carotids were examined, noting the levels of CCA bifurcation and STA origin, and their symmetry across both sides of the body. Results: Among the cadavers studied, CCA bifurcation most commonly occurred at the superior border of the thyroid cartilage (46.9%), followed by the body of the hyoid bone (40.1%). The STA predominantly originated from the external carotid artery (ECA) (65.6%). Conclusion: No significant correlation was found between the bifurcation levels of the CCA and the origins of the STA. Bilateral symmetry in the bifurcation of the CCA and the origin of the STA was observed in most cases. The study highlights notable variations in the anatomy of the carotid arteries. These findings suggest that pre-surgical imaging and careful planning are crucial to accommodate anatomical diversities.

The Role of Hypertension in Cognitive Dysfunction

Cognitive impairment and subsequent dementia are considered significant health challenges. In patients with established dementia, it is argued that hypertension is the main risk factor for small vessel ischemic disease and additional cortical white matter lesions. Cognitive domains and impairments associated with hypertension include learning, memory, attention, abstract reasoning, mental flexibility, psychomotor skills, and executive function. It is uncontrolled hypertension in midlife—but not late life—that is associated with worse cognitive impairment. Advanced imaging techniques confirm the effect of uncontrolled hypertension in developing dementia. Functional changes in the arterial system and an increase in arterial stiffness could be involved in the onset of dementia. In most studies, it is argued that better blood pressure control and duration of antihypertensive medication are associated with the incidence of dementia. In this review, the available data on the relationship between cognitive dysfunction and hypertension are examined.

Micro- and Macrostructural Language Features in Vertebrobasilar or Carotid System Stroke Without Diagnosis of Aphasia.

This study aimed to investigate the macro- and microstructural features of language in patients with ischemic stroke without aphasia. Participants were grouped according to arterial system damage and given the Aphasia Language Assessment Test (ADD) to detect aphasia. A narrative sample was obtained and analyzed for macrostructural and microstructural features of the language. The study sample consisted of 31 participants with ischemic stroke (15 vertebrobasilar system [VBS] involvement and 16 carotid system [CS] involvement) and 31 healthy participants, totaling 62 individuals. The healthy control group scored higher than the stroke group on the microstructural feature type-token ratio and mean length of utterance in the narrative analysis and on the auditory comprehension, repetition, naming, grammar, speech act, and writing subtests in ADD. Effort behavior, errors, edits, repetitions, and pauses among microstructural features and uncertainty, filler expression, and anomia among macrostructural features were significantly higher in the vertebrobasilar and CS groups than in the healthy control group. The total ADD score and speech fluency and reading subtest scores were significantly higher in individuals with VBS damage than in individuals with CS lesions (p < .05). Language components may be impaired differently in patients with carotid and vertebrobasilar lesions. Speech and language disorders in individuals who have experienced cerebrovascular accidents should be evaluated in the subacute and chronic phases, and the therapeutic needs of patients with ischemic stroke should be determined, regardless of the presence of a clinical aphasia diagnosis.