Arterial System Research Articles

Anatomic pattern of perforator arteries from proper digital arteries in human triphalangeal digits

IntroductionThe localization of the perforator artery for the performance of digital artery perforator (DAP) flaps poses a challenge. This study aims to describe the anatomical pattern of the perforator arteries originating from the proper digital artery in fresh cadaveric triphalangeal digits and to use this pattern as a point of reference for performing these flaps. Material and methodWe performed a descriptive anatomical study on 28 fresh cadaveric hands (14 male, 14 female; 10 right hands, 18 left hands) after injecting the arterial system with latex. Digital photographs were taken of each specimen after dissection and the number of perforator arteries in each finger (second to fifth), phalanx (proximal, middle and distal) and finger side (radial or ulnar) were obtained by analysis in Adobe Photoshop CS6. ResultsWe obtained statistically significant results when comparing the means of the number of perforator arteries between fingers, phalanx, finger side, gender and laterality. When analyzing the number of perforator arteries in each phalanx third in each finger, we found that more than 75% of specimens had at least one perforator artery in the two distal thirds of the proximal phalanx and the three-thirds of the middle phalanx and more than 50% had at least one in the proximal third of the distal phalanx. ConclusionsWe present a homogeneous perforator artery anatomic pattern, by finger, phalanx, finger side, gender and laterality, consisting of a high density of perforator arteries in the distal proximal phalanx region, throughout the middle phalanx and in the proximal distal phalanx region, which would be the areas of greatest certainty to help predict the favorable evolution of a digital artery perforator flap in the fingers.

Increased incidence of napkin-ring sign plaques on cervicocerebral computed tomography angiography associated with the risk of acute ischemic stroke occurrence.

Carotid atherosclerosis plays an essential role in the occurrence of ischemic stroke. This study aimed to investigate whether a larger burden of napkin-ring sign (NRS) plaques on cervicocerebral computed tomography angiography (CTA) increased the risk of acute ischemic stroke (AIS). This retrospective, single-center, cross-sectional study enrolled patients with NRS plaques identified in the subclavian arteries, brachiocephalic trunk, carotid arterial system, and vertebrobasilar circulation on contrast-enhanced cervicocerebral CTA. Patients were divided into AIS and non-AIS groups based on imaging within 12h of symptom onset. Univariate and multivariate logistic regression analyses were performed to determine the risk factor of AIS occurrence. A total of 202 patients (66.72years ± 8.97, 157 men) were evaluated. Plaques with NRS in each subject of the AIS group (N = 98) were significantly more prevalent than that in the control group (N = 104) (1.96 ± 1.17 vs 1.41 ± 0.62). In the AIS group, there were substantially more NRS plaques on the ipsilateral sidethan contralateral side (1.55 ± 0.90 vs. 0.41 ± 0.66). NRS located on the ipsilateral side of the AIS showed an area under the receiver curve (AUC) of 0.86 to identify ischemic stroke. NRS plaque amounts were an independent risk factor for AIS occurrence (odds ratio, 1.86) after adjusting for other factors. Increased incidence of napkin-ring sign plaques on cervicocerebral CTA was positively associated with AIS occurrence, which could aid in detecting asymptomatic atherosclerotic patients at high risk of AIS in routine screening or emergency settings. Napkin-ring sign plaque provides an important imaging target for estimating acute ischemic stroke risk and identifying high-risk patients in routine screening or emergency settings, so that timely anti-atherosclerotic therapy can be used for prevention. • This cross-sectional study investigated the association between high-risk carotid artery plaques and acute ischemic stroke. • Increased incidence of napkin-ring sign plaques on cervicocerebral computed tomography angiography is positively associated with acute ischemic stroke occurrence. • Napkin-ring signs help identify risky patients prone to acute ischemic stroke to facilitate prevention.

Hematological disorders as a complication of COVID-19

Background. Coronavirus disease (COVID-19) can affect the blood and hemostasis systems and lead to complications that require intensive care. The aim is to detect such common complications by studying literary sources and clinical experience. Materials and methods. The search for relevant literature was conducted in PubMed, and in the other databases such as Science Direct, Google Scholar, Scopus and Web of Science. The literature search was done using the keywords “COVID-19”, “SARS-CoV-2” in combination with “coagulation dysfunction”, “coagulopathy”, “hematological manifestations”, “hematological parameters”, “deep vein thrombosis”, “pulmonary embolism”, “arterial thrombosis”, “D-dimer”, “fibrinogen”, “lymphopenia”, “thrombocytopenia”. Results. COVID-19-associated coagulopathy is characterized by high levels of D-dimer and fibrin degradation products in blood plasma, changes in prothrombin time, activated partial thromboplastin time, fibrinogen, and platelet count. Endothelial dysfunction caused by coronavirus leads to an increased risk of thrombotic complications, both in venous and arterial systems, additionally to the existing higher risk of thrombosis in the intensive care unit. The venous thromboembolism frequency among unvaccinated hospitalized patients and during ultrasound screening is significantly higher. Coronavirus disease can lead to arterial thrombosis in areas such as the aorta, kidneys, cerebral and peripheral arteries. COVID-19 can cause enhanced-fibrinolytic-type disseminated intravascular coagulation or limited thrombotic microangiopathy. According to research, patients with severe COVID-19 usually had leukocytosis, lymphopenia, and an elevated neutrophil-to-lymphocyte ratio. Thrombocytopenia is observed not only during the acute coronavirus disease, but also in the post-COVID-19 period. Both thrombosis and bleeding can occur in patients undergoing extracorporeal membrane oxygenation. Conclusions. A high level of D-dimer, a prolongation of prothrombin time, an increase or a quick decrease in fibrinogen level, lymphopenia, neutrophilia, and an increase in the neutrophil-to-lymphocyte ratio are considered prognostic factors for the severity of coronavirus disease. Deep vein thrombosis and pulmonary embolism are the most common thrombotic events in patients with COVID-19. Arterial thrombosis occurs more often in the cerebral arteries and arteries of the extremities.

Worse glycemic control is associated with an impaired arterial energy transfer pattern in elderly with diabetes

Abstract Background Worse glycaemic control is known to exacerbate endothelial insult, increasing macro- and microvascular complication risks in diabetes. Impaired intracranial haemodynamics have been frequently reported in patients with diabetes alongside with malperfusion causing structural abnormalities, and poor cognitive and cortical functionality (1-2).Assessment of the alterations in energy transfer characteristics derived from hemodynamic signals may provide novel mechanistic information about how worse glycaemic control may affect cerebrovascular perfusion. Wave reflection index(WRI) is a previously proposed measure of arterial energy transfer efficiency which reflects distal impedance mismatch(3-4). Purpose We aim to interrogate potential relationship between a worse glycaemic control and a less efficient arterial energy transfer, which could enhance our understanding of the cerebrovascular-cortical functional coupling on a mechanistic basis in elderly with diabetes. Methods Left middle cerebral artery wave intensity (WI) was computed with arterial blood pressure and flow velocity (transcranial Doppler) signal as previously described (WI = (dP/dt)*(dU/dt)) (Figure 1). Standard statistical tests were used to interrogate the relationship between glycated haemoglobin levels (HbA1c) and WI parameters. Results In 36 patients with diabetes mellitus type-2 (DM2) (mean age = 65.7 ± 8.8 years), backward compression wave intensity (BCWI) and wave reflection ratio (WRI= BCWI/FCWI) were significantly correlated with HbA1c levels before (rBCWI: 0.409 pBCWI:0.013; rWRI:0.345 pWRI:0.040) and after (rBCWI: 0.410 pBCWI:0.018, rWRI:0.351 pWRI:0.045) adjusting for age, sex and mean arterial pressure (Figure 2). Conclusion(s) In elderly patient with DM2, higher HbA1c values indicating worse glycaemic control are significantly correlated with altered cerebrovascular energy transfer characteristics as assessed by MCA wave intensity analysis. Continuous relationship between worse glycaemic control and higher wave reflection index (a measure of less efficient energy transfer in arterial system and distal impedance mismatch) may imply that the use of energy transfer related indices alongside with conventional hemodynamic indices may help providing a more comprehensive pathophysiological understanding about how cardiovascular risk factors interfere with perfusion.Computation of Wave IntensityMain Results

Prolonged turbulence and deposition of LDL cholesterol caused atherosclerotic lesion in femoral arteries and spared the iliac arteries. Why? A dynamic angiography and machine learning analysis

Abstract Background In the care of patient with atherosclerotic disease, some arterial segments were more prone to have lesion, while the whole arterial system was exposed with the same risk factors (hypertension, diabetes or hyperlipidemia, etc). Our team used the principles and practices of fluid mechanics to investigate the mechanism of atherosclerotic disease. In short, laminar flow protects the pipes or arteries while the turbulent flow damages the intima and starts the atherosclerotic process. In this study, our question is: Why many patients with peripheral arterial disease (PAD) had diffuse lesions in the femoral arteries while the iliac arteries showed only minimal or no lesion? Could a new dynamic angiographic review and Deep Learning analysis answer the above question? Method All patients who underwent diagnostic coronary angiogram or interventions were selected. After the procedure, an iliac and femoral angiogram were performed for vessel closure device deployment. At first, the iliac and femoral artery was filled completely with contrast, then the blood (in white color) moved down and replaced the black contrast. All images were recorded at 15 frames per second. The movement of blood flow, its shape (laminar or turbulent), direction (antegrade or retrograde) were identified and tabulated. At the same time, the Deep Learning models were trained based on the convolutional neural network. The U-net combined Densenet121 was used to train model number one to recognize the coronary and detect the stenosis area. Next, the CNN model was used to classify the stagnant flow. The patients with lesions in the iliac or femoral arteries were selected. The characteristics of the flow proximal and at the lesion site were selected and compared. Results 50 cases (70% male) met our criteria with 80% lesions at femoral arteries (figure 1) while only 20 % had lesions in the iliac arteries. The turbulent flow was seen in both arteries however it was persistent in the femoral arteries while in the iliac arteries, turbulent flow was intermittent with 40% of the time in laminar flow. The analysis by the Deep learning model had sensitivity in the detection of turbulent flow 0.91 and the sensitivity was 0.96. The explanation was that the persistent turbulent flow in the femoral arteries injured the intima However the laminar (non-turbulent flow) in the iliac arteries carried the LDL particle further distally and deposited them at the femoral level. This is why there were more atherosclerotic plaques in the femoral level than in the iliac arteries. Conclusion Persistent turbulence causes more damage to the intima in the femoral arteries while intermittent turbulence did less damage to the iliac arteries. LDL cholesterol while in suspension at the iliac level were carried and deposited in the femoral arteries. This sequence of event explained the predilection of femoral arteries diffuse lesions. Larger studies with more patients are needed to confirm the above results.Diffuse lesion in femoral artery

Bridging therapy and risk of major bleeding and thrombosis in continuous-flow left ventricular assist device patients: a quasi-experimental study

Abstract Background Bridging with low molecular weight heparin (LMWH) on top of vitamin K antagonist treatment is recommended in continuous-flow left ventricular assist device (CF-LVAD) patients during subtherapeutic anticoagulation. However, the consequence of bridging on the risk of bleeding and thrombosis are unknown. Aim To assess the risk of major bleeding and thrombosis associated with bridging in CF-LVAD patients, through a regression discontinuity (RD) design, a quasi-experimental design. Methods We included CF-LVAD patients implanted at our university medical center between 2010-2021. Outcomes were major bleeding (INTERMACS type 3, 4, 5) and thromboembolic events (pump thrombosis, arterial non-central nervous system and venous thromboembolism). We estimated incidence rates and hazard ratios (HR) with 95% confidence intervals (95%CI) by time-dependent Cox regression. Using an RD design, a quasi-experimental design, we compared patients using LMWH due to a subtherapeutic international normalized ratio (INR) to patients with no LMWH and an INR just in target range. As LMWH treatment is initiated based on an INR threshold (i.e., when INR is below the lower target range) and INR is subject to random variability, patients just below and in the INR target range are comparable, mimicking a randomized trial. Analyses were performed five times including INRs±0.1, ±0.2, ±0.3, ±0.4 and ±0.5 around the INR threshold. Results 77 patients were included, with a median age at implantation of 69 years, 60 (78%) were male, 45 (58%) had ischemic heart failure and 35 (45%) had INTERMACS classification 3. We included 35,466 INRs during 91 patient-years of follow-up. Bridging was associated with increased major bleeding rates compared to no-bridging in all analyses (Figure 1). In particular, the risk of major bleeding was 6.9-fold increased (95%CI 1.2-38.9) during bridging compared to no-bridging considering INR+0.1, and 3.4-fold (95%CI 1.4-8.2) considering INR±0.5 (Figure 2A). While thrombotic events were infrequent, the risk of thrombosis was around unity during bridging compared to no-bridging considering INR±0.5 (HR 1.1, 95%CI 0.1-9.9, Figure 2B). Conclusions During bridging with LMWH, CF-LVAD patients had a 6.9-fold increased risk of major bleeding, while the risk of thrombosis was around unity compared to no-bridging.Incidence ratesHazard ratios

HDAC inhibitor CS014 inhibits platelet activity, small and large vessel thrombosis while maintaining haemostasis in a dose-dependent manner

Abstract Background It is a significant challenge to develop new targets for prevention of platelet activity and clotting and clot formation leading to occlusive thrombosis remains a significant cause of cardiovascular morbidity and mortality. Using the HDAC inhibitor, CS014, we can show an in vivo benefit in reduced clotting without increased bleeding. Understanding the benefits of epigenetic modulation with CS014 would validate its utility in prevention of life-threatening clot formation in vivo. Purpose Develop a first-in-class HDAC inhibitor, CS014, that prevents clotting without a risk for bleeding. Compared to valproic acid (VPA), CS014 exhibits a better clot prevention profile. Methods Thrombosis and bleeding in mouse models were assessed with VPA and CS014 at multiple doses by labelling platelets and fibrin and measuring accumulation at the site of injury using intravital microscopy. HDAC inhibitor were given IP for 5 days at different doses. Thrombosis in the vessel was assessed in the 1) laser-induced cremaster arteriole thrombosis assay for assessment of clotting in the small vessel, 2) carotid artery FeCl3 thrombosis assay for assessment of clotting in the large vessel, and 3) saphenous vein rebleeding laser-induced assay for assessment of clotting and haemostasis in the vein. Bleeding was assessed in the tail vein bleeding assay. Results CS014 treatment significantly reduced clot formation and fibrin formation at the site of injury in the laser-induced cremaster assay. The observed inhibition of clot formation and fibrin accumulation at the site of injury was significantly greater than the inhibition observed with VPA at lower doses. FeCl3-induced injury of the carotid artery resulted in full occlusion of the vessel within 12-15 minutes. Treatment with CS014 or VPA were able to prevent full occlusion of the carotid artery, supporting their benefit in arterial injury conditions. In the saphenous vein rebleeding assay, fibrin and platelet accumulation at the site of injury wound was significantly inhibited, suggesting that CS014 and VPA function in both arterial and venous systems to attenuate clot and thrombosis. The tail vein bleeding assay confirmed that while the thrombus formation and stability was decreased based on the cremaster and carotid artery assays, no change was observed in bleeding time under these conditions. Conclusions We have shown for the first time that CS014, a first-in-class HDAC inhibitor, results in better inhibition of mouse thrombosis and decreased time to clot resolution without bleeding. This discovery represents a new class of treatment for prevention of platelet activation and thrombosis with potential for protection from myocardial infarction and stroke. Additionally, the decreased fibrin formation in the blood should limit the risk of thromboembolism. CS014 has proven that HDAC inhibition offers a new alternative for protection in the blood from thrombotic risk without an added risk of bleeding.CS014 prevents venous thrombosisCS014 doesn't cause bleeding risk

Abstract 17381: Relationship Between Amaurosis Fugax and Intraplaque Hemorrhage in Patient With Carotid Plaques

Introduction: The term amaurosis fugax is often used interchangeably to describe transient visual loss. However, it is employed widely in medicine to refer to any cause of transient monocular visual loss. Amaurosis fugax is associated with an imminent stroke and it could be linked to vascular thromboembolic events arising from the internal carotid arterial system. The aims of the study are to determine the plaque characteristics of patients who underwent carotid artery revascularization and the relationship of plaque characteristics with amaurosis fugax. Methods: Before elective carotid revascularization 44 patients (mean age 72±8 years; 25 males, 19 females) underwent 3-T MRI. After localization of the carotid bifurcation using phase contrast imaging, Time-of-Flight, 3D T1 weighting, transverse T1 and T2 weightings and proton density sequences were acquired. The different plaque components: lipid rich core, intraplaque hemorrhage, calcification and the characterization of the fibrous cap were assessed. Results: Carotid plaque samples had the following characteristics: Intraplaque hemorrhage (59%), surface defects (38.6%), stable fibrous cap (27.3%), lipid rich necrotic core (18%), and calcifications (11.4%). Amaurosis fugax history was identified in 7 patients (15.9%). Plaque samples from all 7 patients who had experienced amaurosis fugax revealed intraplaque hemorrhage. MRI revealed intraplaque hemorrhage in 19 (51%) patients without history of amaurosis fugax (p=0.016). The rest of the plaque characteristics did not show any statistically significant relationship with history of amaurosis fugax. Conclusions: This study demonstrated that intraplaque hemorrhage may be correlated to amaurosis fugax.

Abstract 18628: Focal Pericoronary Adipose Tissue Evaluated by Electron Density Numbers on Contrast Spectral Computed Tomography Was Associated With Coronary Arterial Plaques: A Site-by-Site Analysis

Introduction: Inflammation in pericoronary adipose tissue (PCAT) around the coronary arterial wall causes coronary arterial sclerosis. Many studies evaluated the relationship between total PCAT volume and coronary arterial sclerosis on a patient-by-patient basis. Hypothesis: Inflammation in PCAT may occur focally in coronary arterial system to which coronary arterial plaques localize. Using novel spectral CT, based on electron density number (EDN) as a new parameter, the focal characteristics of PCAT were evaluated. Methods: 17 patients (10 males, mean age 70 years) underwent cardiac spectral CT (7500, Philips, Tokyo, Japan). From contrast data, EDNs of PCAT were determined at a 1) right side site and 2) left anterior side site of a proximal portion of the right coronary arteries (RCA), 3) anterior side site of the left main coronary arteries, 4) left side site of a proximal portion of the left circumflex artery, and left side site of a distal portion of the RCA (five sites each patient). We also evaluated coronary arterial plaques on enhanced CT images at five corresponding sites for which EDNs were determined. Results: For a total of 85 sites among 17 patients using enhanced CT, 31 sites had no plaques (group 1), 14 sites had only non-calcified plaques (group 2), 20 sites had only calcified plaques (group 3), 16 sites had mixed plaques (group 4), and four sites had stent implantations (group 5). The mean of EDNS (%EDW) for 81 sites, excluding four sites with a stent implantation, were 93.7, 93.9, 94.0, and 94.3 in groups 1-4, respectively (P=NS). For a total of 81 sites, excluding four implantation sites, we evaluated the relationship between age and EDNs in groups 1-4. No correlations were observed in group 1 (R= 0.05), 3 (R= 0.09), and 4 (R= 0,15), however negative correlation was observed in group 2 (R= -0.42) between age and EDNs. No significant differences in EDNs were noted between males and females (P=NS). Conclusions: This is the first study in which focal PCAT was evaluated by EDNs and the relationship to coronary arterial plaques determined by site-by-site analysis. This new CT parameter may evaluate the status of PCAT and be a predictor of the future occurrence of coronary arterial plaques, which are related to PCAT inflammation.

Abstract 18549: Focal Pericoronary Adipose Tissue Evaluated by Atomic Numbers on Contrast Spectral Computed Tomography Was Associated With Coronary Arterial Plaques: A Site-by-Site Analysis

Introduction: Inflammation in pericoronary adipose tissue (PCAT) around the coronary arterial wall causes coronary arterial sclerosis. Many studies evaluated the relationship between total PCAT volume and coronary arterial sclerosis on a patient-by-patient basis. Hypothesis: Inflammation in PCAT may occur focally in coronary arterial system to which coronary arterial plaques localize. Using novel spectral CT, based on atomic number as a new parameter, the focal characteristics of PCAT were evaluated. Methods: 17 patients (10 males, mean age 70 years) underwent cardiac spectral CT (7500, Philips, Tokyo, Japan). From contrast data, atomic numbers of PCAT were determined at a 1) right side site and 2) left anterior side site of a proximal portion of the right coronary arteries (RCA), 3) anterior side site of the left main coronary arteries, 4) left side site of a proximal portion of the left circumflex artery, and left side site of a distal portion of the RCA (five sites each patient). We also evaluated coronary arterial plaques on enhanced CT images at five corresponding sites for which atomic numbers were determined. Results: For a total of 85 sites among 17 patients using enhanced CT, 31 sites had no plaques (group 1), 14 sites had only non-calcified plaques (group 2), 20 sites had only calcified plaques (group 3), 16 sites had mixed plaques (group 4), and four sites had stent implantations (group 5). The mean of atomic numbers for 81 sites, excluding four sites with a stent implantation, were 6.4, 6.8, 6.4, and 6.1 in groups 1-4, respectively (P=NS). For a total of 81 sites, excluding four implantation sites, we evaluated relationship between age and atomic numbers in groups 1-4. Positive correlations were observed in group 1 (R= 0.25) and 3 (R= 0.39), however negative correlation was observed in group 2 (R= -0.37) and 4 (R= -0.40) between age and atomic numbers. No significant differences in atomic numbers were noted between males and females. Conclusions: This is the first study in which focal PCAT was evaluated by atomic numbers and the relationship to coronary arterial plaques determined by site-by-site analysis. This new CT parameter may evaluate the status of PCAT and be a predictor of future occurrence of coronary arterial plaques, which are related to PCAT inflammation.

Abstract 18610: Focal Pericoronary Adipose Tissue Evaluated by Electron Density Numbers on Non-Contrast Spectral Computed Tomography Was Associated With Coronary Arterial Plaques: A Site-by-Site Analysis

Introduction: Inflammation in pericoronary adipose tissue (PCAT) around the coronary arterial wall causes coronary arterial sclerosis. Many studies evaluated the relationship between total PCAT volume and coronary arterial sclerosis on a patient-by-patient basis. Hypothesis: Inflammation in PCAT may occur focally in coronary arterial system to which coronary arterial plaques localize. Using novel spectral CT, based on electron density number (EDN) as a new parameter, the focal characteristics of PCAT were evaluated. Methods: 17 patients (10 males, mean age 70 years) underwent cardiac spectral CT (7500, Philips, Tokyo, Japan). From non-contrast data, EDNs of PCAT were determined at a 1) right side site and 2) left anterior side site of a proximal portion of right coronary arteries (RCA), 3) anterior side site of the left main coronary arteries, 4) left side site of a proximal portion of the left circumflex artery, and left side site of a distal portion of the RCA (five sites each patient). We also evaluated coronary arterial plaques on enhanced CT images at five corresponding sites for which EDNs were determined. Results: For a total of 85 sites among 17 patients using enhanced CT, 31 sites had no plaques (group 1), 14 sites had only non-calcified plaques (group 2), 20 sites had only calcified plaques (group 3), 16 sites had mixed plaques (group 4), and four sites had stent implantations (group 5). The mean of EDNS (%EDW) for 81 sites, excluding four sites with a stent implantation, were 93.5, 93.3, 93.2, and 93.8 in groups 1-4, respectively (P=NS). For a total of 81 sites, excluding four implantation sites, we evaluated the relationship between age and EDNs in groups 1-4. Positive correlations were observed in group 1 (R= 0.40), and 3 (R= 0.40), however negative correlation was observed in group 2 (R= -0.22) and 3 (R= -0.22) between age and EDNs. No significant differences in EDNs were noted between males and females (P=NS). Conclusions: This is the first study in which focal PCAT was evaluated by EDNs and the relationship to coronary arterial plaques determined by site-by-site analysis. This new CT parameter may evaluate the status of PCAT and be a predictor of the future occurrence of coronary arterial plaques, which are related to PCAT inflammation even on non-contrast CT alone.

Clinical outcomes of MANTA closure device in percutaneous endovascular aortic aneurysm repair

ObjectiveThe MANTA device is a plug-based vascular closure device (VCD) designed for large bore femoral arterial access site closure. It showed promising results in transcatheter aortic valve replacement cases. In this study, we report our results and evaluate the MANTA VCD in percutaneous endovascular aortic aneurysm repair (pEVAR). MethodsAll data of consecutive patients who underwent an elective pEVAR between October 2018 and December 2022 were retrospectively reviewed. In all patients at least one common femoral artery was intended to close with the MANTA VCD. Depending on the sheath size, the 14Fr or 18Fr MANTA VCD was used. On the preoperative computed tomography scan, the diameter of the common femoral artery (CFA) was measured and the amount of calcification based on the Peripheral Arterial Calcium Scoring System (PACSS) was scored. Primary outcome was procedural technical success. Procedural technical success was defined as placement of the MANTA closure device resulting in vascular closure with patent CFA, without requiring immediate open or endovascular surgery. The secondary outcomes were access site complications requiring reintervention and all-cause mortality at 30-day follow-up. ResultsIn total, 152 consecutive patients underwent pEVAR with 291 common femoral artery closure procedures with the Manta VCD. Mean age was 74.1 ± 6.4 years, with a mean body mass index of 27.7 ± 4.4 kg/m2. The mean diameter of the CFA was 10.5 ± 1.9 mm. In 52.6% of the cases, there were no calcification on the preoperative computed tomography scan. The 18Fr and 14Fr Manta VCD were used 169 and 122 times, respectively. The technical success rate was 96.6%. Major vascular complications were reported in 4.5% of the cases, without any death-related events. ConclusionsThis single-center retrospective cohort study analyzed the procedural technical success, major vascular complications and all-cause mortality at 30-day follow-up of the MANTA vascular closure device in 152 pEVAR patients with 291 common femoral artery closure procedures. The technical success rate was 96,6%. Major vascular complications were reported in 4.5% of the cases, without any death related events. We concluded that the MANTA device is a safe and feasible option with a high rate of technical success in patients undergoing pEVAR.

Analysis of vascular perfusion territory using selective intraarterial injection CT angiography before and after revascularization surgery in patients with moyamoya disease.

In moyamoya disease (MMD), blood flow to the internal carotid artery (ICA) system is supplied via the basal fine vascular network, leptomeningeal anastomoses, and transdural collateral vessels from the external carotid artery (ECA). After revascularization, there is a dramatic change in cerebral perfusion to the ECA system. Understanding this shift in blood supply is important for evaluating treatment efficacy and elucidating the postoperative pathophysiology. However, anatomical and quantitative methods for doing so have not yet been established. In the present study, selective intraarterial injection CT angiography (iaCTA) was performed in patients with MMD, and blood supply changes in each arterial system before and after revascularization surgery were evaluated. This study included 10 hemispheres in 10 patients who underwent combined revascularization surgery for adult MMD. Digital subtraction angiography was performed before and 3 months after surgery, and selective iaCTA was performed from the ICA, ECA, and vertebral artery (VA) at the same times in a hybrid CT/digital subtraction angiography suite. The anatomical distribution of each vessel was determined and perfusion volume was measured quantitatively on contrast-enhanced axial CT images. Selective iaCTA clearly depicted the anatomical distribution of perfusion for each vessel. Conversion of blood supply from the ICA and VA to the ECA system was observed in the cerebral cortices and insulae but not in the basal ganglia. The mean volume of perfusion territories of the ECA (preoperative 0.9 cm3, postoperative 98.8 cm3); ICA (preoperative 225.7 cm3, postoperative 159.3 cm3); and VA (preoperative 244.0 cm3, postoperative 163.6 cm3) in the cerebral hemispheres changed significantly after revascularization. There was a correlation between increase in the ECA territory volume and decrease in the VA territory volume due to revascularization (R = -0.84, p < 0.005). Selective iaCTA enabled clear visualization of anatomical changes in each vascular perfusion territory and quantitative measurement of each perfusion volume. Perfusion conversion to the ECA system after bypass surgery was observed in the cortical regions and in the insulae on the bypass operation sides, but not in the basal ganglia. Combined revascularization promoted the development of ECA-perfused territory, which correlated with a decrease in hemodynamic burden of the posterior cerebral artery.

Theoretical investigations on a variable-coefficient generalized forced–perturbed Korteweg–de Vries–Burgers model for a dilated artery, blood vessel or circulatory system with experimental support

Recent theoretical physics efforts have been focused on the probes for nonlinear pulse waves in, for example, variable-radius arteries. With respect to the nonlinear waves in an artery full of blood with certain aneurysm, pulses in a blood vessel, or features in a circulatory system, this paper symbolically computes out an auto-Bäcklund transformation via a noncharacteristic movable singular manifold, certain families of the solitonic solutions, as well as a family of the similarity reductions for a variable-coefficient generalized forced–perturbed Korteweg–de Vries–Burgers equation. Aiming, e.g., at the dynamical radial displacement superimposed on the original static deformation from an arterial wall, our results rely on the axial stretch of the injured artery, blood as an incompressible Newtonian fluid, radius variation along the axial direction or aneurysmal geometry, viscosity of the fluid, thickness of the artery, mass density of the membrane material, mass density of the fluid, strain energy density of the artery, shear modulus, stretch ratio, etc. We also highlight that the shock-wave structures from our solutions agree well with those dusty-plasma-experimentally reported.

Hybrid Deep Morpho-Temporal Framework for Oscillometric Blood Pressure Measurement.

Oscillometric blood pressure (BP) measurement devices are widely utilized as the primary automated BP measurement tools in non-specialist environments. However, their accuracy and reliability vary under different settings and for different age groups and health conditions. An essential constraint of current oscillometric BP measurement devices is their analysis algorithms' incapacity to capture the BP information encoded in the pattern of recorded oscillometric pulses to its fullest extent. In this paper, we propose a new 2D oscillometric data representation that enables a full characterization of arterial system and empowers the application of deep learning to extract the most informative features correlated with BP. A hybrid convolutional-recurrent neural network was developed to capture the oscillometric pulses morphological information as well as their temporal evolution over the cuff deflation period from the 2D structure, and estimate BP. The performance of the proposed method was verified on three oscillometric databases collected from the wrist and upper arms of 245 individuals. It was found that it achieves a mean error and a standard deviation of error of as low as 0.08 mmHg and 2.4 mmHg in the estimation of systolic BP, and 0.04 mmHg and 2.2 mmHg in the estimation of diastolic BP, respectively. Our proposed method outperformed the state-of-the-art techniques and satisfied the current international standards for BP monitors by a wide margin. The proposed method shows promise toward robust and objective BP estimation in a variety of patients and monitoring situations.

Automated Measurement of Vascular Calcification in Femoral Endarterectomy Patients Using Deep Learning.

Atherosclerosis, a chronic inflammatory disease affecting the large arteries, presents a global health risk. Accurate analysis of diagnostic images, like computed tomographic angiograms (CTAs), is essential for staging and monitoring the progression of atherosclerosis-related conditions, including peripheral arterial disease (PAD). However, manual analysis of CTA images is time-consuming and tedious. To address this limitation, we employed a deep learning model to segment the vascular system in CTA images of PAD patients undergoing femoral endarterectomy surgery and to measure vascular calcification from the left renal artery to the patella. Utilizing proprietary CTA images of 27 patients undergoing femoral endarterectomy surgery provided by Prisma Health Midlands, we developed a Deep Neural Network (DNN) model to first segment the arterial system, starting from the descending aorta to the patella, and second, to provide a metric of arterial calcification. Our designed DNN achieved 83.4% average Dice accuracy in segmenting arteries from aorta to patella, advancing the state-of-the-art by 0.8%. Furthermore, our work is the first to present a robust statistical analysis of automated calcification measurement in the lower extremities using deep learning, attaining a Mean Absolute Percentage Error (MAPE) of 9.5% and a correlation coefficient of 0.978 between automated and manual calcification scores. These findings underscore the potential of deep learning techniques as a rapid and accurate tool for medical professionals to assess calcification in the abdominal aorta and its branches above the patella.

May-Thurner Syndrome

May-Thurner is a condition characterized by extrinsic venous compression by the arterial system against bone structures in the ileocecal region. MTS is also referred to as an iliocaval venous compression syndrome, iliac vein compression syndrome, Cockett's syndrome, and venous spur. The most common variant of MTS is due to compression of the left iliac vein between the overlying right common iliac artery and the fifth lumbar vertebrae, approach to diagnosis and treatment depends upon whether venous thrombosis is present.

Intracardiac foreign bodies: Diagnosis and management

&lt;b&gt;Introduction:&lt;i&gt; &lt;/i&gt;&lt;/b&gt;As a result of gunshot wounds due to a bullet or shrapnel entering the system of arteries or veins, direct wounds of the heart or vascular structures, as well as embolisms may occur. After entering one of the systemic veins, the bullet or shrapnel can enter the right heart or the pulmonary artery. Shrapnel embolism is a rare condition, usually asymptomatic and is detected accidentally during routine examinations. Due to the fact that the intensity of occurrence of this type of cases is quite rare, it was decided to present such clinical cases.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;i&gt; &lt;/i&gt;&lt;/b&gt;This article reports about 3 patients with intracardiac foreign body. All 3 patients took part in the battles during the Second Karabakh War and were hospitalized as a result of shrapnel wounds received in different parts of the body. In each of the patients, the lesion area was different, but as a result of venous migration, the movement of a foreign body (metal fragment) in the heart cavity was noted. In two patients, the foreign body was removed by open surgery (connection to a heart-lung machine) due to the presence of symptoms, but one patient was under observation due to the absence of symptoms.&lt;br /&gt; &lt;b&gt;Results:&lt;i&gt; &lt;/i&gt;&lt;/b&gt;Bullet or shrapnel embolism is a very rare complication of gunshot wounds, occurring in about 0.3% of cases. These emboli often cause antegrade migration into the arterial system. However, in about 20% of cases, migration into the venous system can also occur. Venous embolism often results in foreign body migration into the right heart or the pulmonary artery. The diagnosis in these cases is often established by chance, but in some cases, arrhythmias and valve defects can occur due to exposure to a foreign body. The identification of such cases depends on the symptoms. A foreign body can be removed by an open method, as well as by invasive methods. In some cases, it is possible to keep the foreign body under control when it does not cause any symptoms.&lt;br /&gt; In the clinical cases we mentioned, we also mentioned the management of cases of foreign bodies entering the venous system from peripheral zones of penetration.

Practice of Transradial Approach for Interventional Radiology

BACKGROUND: Interventional radiology (IR) is a specialized field within radiology that diagnoses and treats several conditions through a minimally invasive surgical procedure. The transradial approach (TRA) for endovascular interventions was introduced by Lucian Campeau in 1989. TRA gained great popularity in hemodynamics, with studies demonstrating its safety, feasibility, and superiority compared with the transfemoral approach. The use of the radial artery as the primary access vessel into the arterial system is not a new concept. OBJECTIVE: The objective of the study is to evaluate the practice of TRA among interventional radiologists (IRs). AIM: This study was conducted as a cross-sectional study, targeting interventional radiologists (IRs). The data were collected through an online questionnaire between May 2023 and June 2023. The data were analyzed through the Statistical Package for the Social Sciences. RESULTS: Among 43 interventional radiologists in Riyadh, Saudi Arabia, 39.5% are not performing TRA; reasons for underuse among interventional radiologists (52.9%) include lack of training and (23.5%) distance from the access site; and finally, 17.6% have a potential higher risk for neurological complications; while 60.5% of them are performing TRA, mainly for pelvic procedures (80.8%), followed by hepatic procedures (53.8%). CONCLUSION: In our study, the use of TRA was observed, almost among half of our respondents, and this may relate to reasons such as a lack of appropriate training and distance from the access site. On the other hand, TRA has been proven to have less access site complications and lower mortality. Therefore, better understand the real advantages of TRA and how it can offer higher value in patient care.

Distal profunda femoris artery perforator island flap for distal thigh and knee reconstruction: a CT-based anatomical analysis and a case-series study.

Locoregional flap options for reconstructing defects of the anterolateral distal thigh/knee region are limited. The distal profunda artery perforator island (PAPI) flap is a local fasciocutaneous propeller-type flap that utilizes the most distal perforator of the profunda femoris artery. The aim of this study is to conduct a CT-based angiographic analysis of the perforator system of the profunda femoris artery and present outcomes on the application of the PAPI flap in the management of post-oncologic defects of the distal thigh and knee. CT angiograms were utilized on the lower limbs of 25 healthy patients (mean age, 57 years; 76% male) and the number and location of septocutaneous perforators with a diameter greater than 1 mm were measured. A case series of patients undergoing reconstruction of post-ablative defects which involved the anterolateral and posterior knee performed by the senior author were reviewed. CT angiography demonstrated a robust collection (mean 3.5, range 2 to 5) of septocutaneous perforators from the profunda femoris artery with the most distal perforator located 3.3 cm from the superior patella border. The PAPI flap was successfully used in 10 patients (6F; 4M; mean age 60.6 years; range 30 to 88 years) with a mean defect size of 87.5 cm2 (range 48 to 150 cm2 ). Hand-held Doppler was used to detect the perforator. No flap loss was encountered, and no knee function limitation was noted at follow-up. Minor complications include seroma (1) and intra-articular infection (2). We conclude that the distal PAPI flap is a reliable and versatile flap that has potentially wide applications.