Artery Compression Research Articles

Enhancing heart and circulatory well-being through optimized radial artery techniques: a meta-analysis of hemostasis and patient comfort

ObjectiveThis meta-analysis elucidates the efficacy of the Transradial Band Device (TR Band) in minimizing complications like radial artery occlusion and hematoma, preserving heart health, and enhancing blood flow post-transradial catheterization.MethodsA comprehensive literature search across databases including PubMed, Cochrane, and Embase examined the impact of radial artery compression techniques and decompression times on complications. Data from 13 studies were analyzed using R 4.1.2 with fixed-effects and random-effects models. The Newcastle-Ottawa Scale assessed the risk of bias in observational cohort studies.ResultsIn our meta-analysis, we evaluated data from various studies encompassing different air volumes in transradial band devices across several outcomes including bleeding, hematoma, radial artery occlusion (RAO), Visual Analog Scale (VAS) scores, and compression time. The collective analysis integrated findings from 11 studies, totaling 4,679 patients. No significant difference in bleeding risk (OR 1.04, 95% CI 0.60–1.82, p > 0.05, I2 = 78%), hematoma incidence (OR 0.96, 95% CI 0.78–1.19, p > 0.05, I2 = 0%), or RAO incidence (OR 0.96, 95% CI 0.78–1.19, p > 0.05, I2 = 0%) was observed between the “Less air” and “15 ml air” groups. However, the “Less air” group reported significantly higher VAS scores indicating increased pain or discomfort (Mean Difference 0.25, 95% CI 0.09–0.41, p < 0.05, I2 = 0%). Compression time analyses showed no significant difference between groups (Mean Difference −17.73, 95% CI −54.65–19.20, p > 0.05, I2 = 99%). Sensitivity analyses confirmed the stability of these findings, and Egger's test indicated no significant publication bias across the outcomes. This synthesis highlights the nuanced impact of air volume adjustments in transradial bands on patient outcomes, emphasizing the necessity for further research and standardized protocols to optimize patient safety and comfort post-intervention.ConclusionThe TR Band, when utilized with optimized air volume/pressure, maintains an essential balance between ensuring hemostasis and enhancing patient comfort without elevating the risk of radial artery complications. These findings support the careful selection of TR Band settings to optimize clinical outcomes in patients undergoing transradial cardiac procedures. Further research is warranted to establish standardized guidelines for the most effective use of TR Band in various clinical scenarios.

Cardiac strangulation by epicardial pacing wires in adults.

Like children, adult patients with active or abandoned epicardial pacing leads are also at risk of developing life-threatening cardiac ischemia due to mechanical compression of the coronary arteries. As this complication is amenable to surgical removal, these patients require periodic evaluation for myocardial ischemia even if they are asymptomatic.

Anaesthetic management of a large multi-nodular goitre with dynamic bilateral carotid artery compression.

Dynamic carotid compression arising from a change in patient position is a rare complication of goitre, with the potential for cerebral ischaemia and infarction. In this report, a 37-year-old woman presented with a multi-nodular goitre with clinical features concerning for transient cerebral ischaemia. The anaesthetic management and neurological monitoring used to mitigate the risk of cerebral ischaemia during thyroidectomy is described and the literature surrounding this rare complication is explored.

Endograft-specific hemodynamics after endovascular aneurysm repair: a CFD analysis

Intraluminal prosthetic graft thrombus (IPT) has been described in case of endovascular aortic pathology repair. This study aimed to assess hemodynamic indicators associated with various anatomical morphologies following endovascular aortic repair (EVAR), aiming to offer further references for the choice of clinical therapy. Six model models (normal, iliac compression, aortic compression, aortoiliac compression, iliac distortion, and long-leg stent) were established based on common anatomical morphologies following EVAR. Hemodynamic indicators, such as flow velocity, time-average wall shear stress (TAWSS), oscillatory shear stress index (OSI), and relative residence time (RRT), were captured using computational fluid dynamics (CFD), and the differences between the six models were examined. The peak blood flow velocity at the compressed side iliac artery and the uncompressed side iliac artery corresponding to the aortoiliac artery compression model and the aortic compression model decreased by 30.63% to 48.62%, compared with that in the normal model. Compared with that in the normal model, the peak blood flow velocity at the aorta and the distorted side iliac artery in the iliac distortion model decreased by 7.89% and 41.13%, respectively. The length of the iliac artery stent has little effect on the blood flow velocity. The TAWSS at Iliac grafts showed varying degrees of decline in the other three compression models, particularly in the aortic compression model compared to the normal model. The TAWSS increases at the corner of the artery showing distortion but exhibited a significant decrease toward the distal end of the corner. The areas with higher OSI, and longer RRT were concentrated in the aortoiliac compression model and the iliac distortion model. We found that endograft compression and distortion may be risk factors for IPT. Moreover, the influence of longer stents on the hemodynamics inside stent-grafts is negligible. However, future real-world studies should be conducted to test and verify this speculation.

Tumor-induced rotational vertebral artery occlusion in the upper cervical spine: illustrative case

BACKGROUND Rotational vertebral artery occlusion, or bow hunter’s syndrome (BHS), is a rare but clinically important cause of vertebrobasilar insufficiency. Extrinsic compression of the artery is usually caused by osteophytes, fibrous bands, or lateral disc herniation and typically occurs in the setting of anatomical variations, leading to dynamic compromise of the posterior circulation. Neoplastic causes of BHS are rare. OBSERVATIONS The authors present the case of a 72-year-old man with a left vertebral artery–dominant posterior circulation and isolated small right vertebral artery terminating in the posterior inferior cerebellar artery (PICA). He developed progressively worsening dynamic insufficiency of his right PICA circulation due to compression of the right vertebral artery at C2 from an intradural-extradural dumbbell-shaped lesion. This patient was successfully treated via surgical debulking of the lesion and cervical spine fixation and experienced no neurological deficits postoperatively. LESSONS This neoplastic change represents an exceedingly rare presentation for BHS, which warrants further study on its etiology and treatment. https://thejns.org/doi/10.3171/CASE24415

Minimizing the landing zone of complex aortic repair using a physician-modified endograft to preserve a prominent Adamkiewicz artery

AbstractThere are increasing number of clinical cases with physician-modified endograft (PMEG) endograft for urgent reconstruction of large pararenal aneurysms to reduce the perioperative complication risks of fragile patients, but the risk of spinal cord ischemia due to the coverage of longer segment of thoracic aorta is relatively high.We demonstrate an expedited endovascular treatment of an 88 mm pararenal aneurysm by performing a 4-vessel fenestrated endovascular aortic repair. A prominent Adamkiewicz artery, ectatic supraceliac aortic segment, median arcuate ligament compression of the celiac artery and severe tortuosity of the common iliac arteries made the endovascular repair more challenging. A PMEG was implanted with simultaneous deployment technique to achieve a short proximal landing zone to preserve the Adamkiewicz artery.The proper risk assessment and preparation of the patient based on the clinical evaluation and procedure planning is essential for the clinical success of PMEG in urgent indication.

Robotic median arcuate ligament release prior to pancreatoduodenectomy.

Celiac artery stenosis presents significant risks in pancreatoduodenectomy (PD), including elevated incidences of postoperative hepatic ischemia and clinically relevant pancreatic fistulae. Addressing this stenosis preoperatively is crucial to avoid complication. While stenosis predominantly arises from vasculopathy, managed with stenting, median arcuate ligament syndrome (MALS) is an atypical cause characterized by the median arcuate ligament's extrinsic compression of the celiac artery. Pre-PD surgical release of this ligament has demonstrated nearly 90% success rate in resolving ischemic complications. The celiac axis can be decompressed through open or minimally invasive techniques. Robotic-assisted celiac artery decompression is an attractive approach due to superior visualization and enhanced dexterity, which facilitate the complex dissection required at the diaphragmatic hiatus. The patient is a 49-year-old male diagnosed with pancreatic adenocarcinoma, who also exhibited severe celiac axis stenosis on preoperative imaging. Median arcuate ligament release prior to PD was pivotal in preventing hepatic ischemia consequent to the ligation of the gastroduodenal artery during PD and in re-establishing normal arterial flow to the upper gastrointestinal tract, thereby circumventing otherwise preventable complications. The patient underwent an uneventful robotic PD following the median arcuate ligament release. Robotic-assisted median arcuate ligament release prior to pancreatoduodenectomy is a safe and effective technique for decompression of celiac axis stenosis. This procedure facilitates meticulous dissection while minimizing postoperative complications and helps to circumvent otherwise preventable outcomes.

Coeliac artery compression syndrome as a rare cause of recurrent abdominal pain

AbstractCoeliac artery compression syndrome is a rare cause of recurrent abdominal pain. This article describes two cases of coeliac artery compression syndrome that initially diagnosed on ultrasound. Follow by the subsequence CT or MRI angiography that confirmed the diagnosis. This article also discussed the ultrasound diagnosis criteria, and treatment options of coeliac artery compression syndrome. With additional knowledge of the clinical symptoms and ultrasound presentations of coeliac artery compression syndrome can help sonographers to diagnose this condition in the clinical settings.

Expression of Concern: Rare Ewingoid Dedifferentiated Liposarcoma of the Spermatic Cord Causing Testicular Artery Compression: A Case Report

Expression of Concern: Rare Ewingoid Dedifferentiated Liposarcoma of the Spermatic Cord Causing Testicular Artery Compression: A Case Report

Near-Infrared Spectroscopy (NIRS) to Assess Infection Complications During the Acute Phase of Acute Pancreatitis.

Acute pancreatitis (AP) severity is correlated with systemic infection incidence in the acute phase, and it is important to assess inflammation during the disease course and to recognize infection at an early stage. As in sepsis, inflammation in AP impairs tissue oxygen metabolism and disrupts microcirculation. We performed a vascular occlusion test (VOT) via near-infrared spectroscopy (NIRS), which noninvasively monitors local oxygen in peripheral tissues, to evaluate tissue oxygen metabolism and blood circulation during the acute AP phase. Tissue oxygen metabolism was measured via an NIRS probe attached to the thenar eminence at admission and 7 days after admission. The upper arm was wrapped with a sphygmomanometer cuff while avoiding brachial artery compression for 3 min. The minimum desaturation value was defined as the minimum tissue oxygen index (TOI), the maximum reactive hyperemia value after release was defined as the maximum TOI, and the difference was defined as the ∆TOI. The time from the minimum TOI to maximum TOI was defined as the TOI interval. Fifteen healthy volunteers, 13 patients with AP, and 12 patients with sepsis were included. The TOI at baseline and ∆TOI (parameter describing tissue oxygen metabolism) decreased in a stepwise manner, and the TOI interval (measure of peripheral vasodilatory capacity) was protracted in a stepwise manner among the three groups. In a subgroup analysis, no significant differences in the NIRS-derived variables between patients with AP complicated by infection and those without infection were observed at admission; however, after 7 days, the groups significantly differed. Additionally, blood lactate concentrations were significantly correlated with the ∆TOI and TOI. Mild tissue oxygen metabolism impairment and tissue perfusion occurred in AP compared with sepsis, and changes similar to those in sepsis occur in AP complicated by infection. Further research is needed to evaluate whether these values can be applied to treating this group of patients.

A Unique Cause of Chronic Right Hip Pain and Unilateral Leg Swelling 10 Years Following Total Hip Arthroplasty.

Patient is a 64-year-old female with a history of right total hip arthroplasty (THA) who presented with progressive painful right lower extremity edema and chronic groin pain for 2 years. A CT scan from October 2021 revealed an expanding, large iliopsoas bursal fluid collection that caused compression of the right common femoral artery and vein in June 2023. Further workup excluded deep venous thrombosis or infectious causes. Iliopsoas fluid collections can result from various conditions such as a rare complication of THA. This is likely due to mechanical irritation from the prosthetic components and was confirmed with resolution of symptoms after undergoing revision of THA in 2024. This case highlights iliopsoas hematoma as a rare but important consideration in patients with unilateral lower extremity edema following THA.

Evaluation of cerebral perfusion heterogeneity by the electrical impedance tomography.

The purpose of this study was to evaluate the ability of global inhomogeneity index (GI) and left-right asymmetry index (AI) based on electrical impedance tomography (EIT) to be used in assessing cerebral perfusion heterogeneity. The diagnostic value of these two indices in identifying abnormalities in the degree of cerebral perfusion heterogeneity was also explored. In this study, Transcranial Doppler (TCD) was used as a control, and unilateral carotid artery was compressed to change the degree of heterogeneity of cerebral perfusion in 15 healthy volunteers. The control group consisted of an additional 15 volunteers without any intervention. EIT perfusion images were obtained by calculating the impedance difference between at the beginning and end of cerebral vasodilation. Subsequently, GI and AI were calculated based on the pixel values of intracranial regions. The GI and AI values in the non-carotid artery compression (NCAC) group were significantly lower than those in the unilateral carotid artery compression (UCAC) group (P < 0.001), whereas there was no significant difference between the left carotid artery compression (LCAC) and right carotid artery compression (RCAC) groups. ROC analysis showed that the area under the curve (AUC), specificity and sensitivity of GI in distinguishing between NCAC and UCAC were 0.94, 0.90 and 0.87, respectively. The AUC, specificity and sensitivity of AI in distinguishing between NCAC and UCAC were 0.86, 0.87 and 0.73, respectively. The results demonstrated that the GI and AI effectively quantify the distribution of intracranial perfusion, demonstrating excellent validity and interindividual comparability, and the ability to detect abnormal cerebral perfusion heterogeneity.

BN SO39 - Laparoscopic Release of Median Arcuate Ligament Syndrome: A Case Series

Abstract Background Median arcuate ligament syndrome (MALS) is a recognized, but rare condition, which is characterized by compression of the celiac artery and ganglion by median arcuate ligament. The entity often presented with chronic post-prandial abdominal pain, vomiting, and weight loss. These patients often undergo comprehensive investigation prior to diagnosis of MALS. This report presents our experience and short-term outcomes of patients with laparoscopic release of MALS at our center. Method Between 2022-2024, five patients with MALS underwent laparoscopic release at a tertiary HPB center under a single surgeon (TS). Data on patient demographics, presenting symptoms and duration, preoperative diagnostic tests, intraoperative findings and complications, postoperative complications, symptom recurrence and follow-up were prospectively maintained. All patients were discussed at a tertiary Vascular and HPB MDT; MALS was confirmed on US doppler (USD) and CT angiogram (CTA) (fish-hook type configuration of Celiac Truck with post-stenotic dilatation). Results Two male and three female patients, with a median (range) age of 41 (25-70) years, underwent laparoscopic MALS release. The median (range) preoperative symptom duration was 54 (24-67) months, with most common presentation of post-prandial abdominal pain and weight loss. The median (range) BMI was 19.61 (18.30-17.82). The median (range) operative time was 313 (166-330) minutes. One patient required conversion to open due to bleeding from celiac trunk. The median (range) LOS was 7 (4-7) days. No postoperative complications occurred. The median follow-up was 10 months. One patient re-experienced abdominal pain, with no evidence of recurrence on USD and CTA. Conclusion Median Arcuate Ligament Syndrome should be considered as a differential in patients presenting with chronic post-prandial abdominal pain and weight loss. Thorough investigation (USD and CTA) along with discussion at Vascular MDT should be undertaken. Laparoscopic release of MALS is a safe and effective treatment option in this cohort.

Safety Optimization of Injections in Specific Areas of the Scalp: A Cadaveric and 3D-CT Analysis of Arterial Distribution.

An injection method called cranial ceiling elevation is used in Asian countries to reduce facial proportions. Scalp injections carry risks such as arterial embolism or compression, leading to adverse events including scalp necrosis and hair loss. No arterial studies or injection recommendations exist for the injection of specific scalp regions. We aimed to examine blood vessel types and distributions to identify relatively safe areas for scalp injections. Computed tomography scans were used to evaluate the blood vessels in the scalp of 50 cadaver heads and anatomical studies were performed. Each scalp was divided into two segments (L1/L2) and six areas (S1/S1'-S3/S3'). The total number of arteries and the probability of each named artery occurring in each section were recorded. The total number of arteries in L1 was higher than that in L2 (L1, 78.76 ± 31.07; L2, 75.28 ± 28.68). The most frequently distributed artery in both L1 and L2 was the parietal branch of the superficial temporal artery. No significant difference was observed between the total number of arteries and the number of each named artery in the S1/S1'-S3/S3' segments. Except for S2' and S3', the number of named arteries in L1 was higher than that in L2. Large-volume scalp injections are not recommended. For injections within 30° above the ear, it is advisable to inject at L2. For other regions, it is also recommended to inject at L2. The periosteal layer should be selected for injection.

Evaluation of cerebral autoregulation in dogs via transcranial color-coded duplex sonography and transient hyperemia testing.

To evaluate the changes in flow velocities of the middle cerebral artery before and after a carotid compression maneuver using transcranial color-coded duplex sonography (TCCD) in healthy anesthetized dogs under mechanical ventilation. Prospective study. University teaching hospital. Eleven healthy adult dogs. A 5-second carotid occlusion maneuver was performed to evaluate cerebral autoregulation (CA). After 10minutes of stable anesthesia, the middle cerebral artery was evaluated by TCCD. Dogs were positioned in sternal recumbency with the head raised to the level of the phlebostatic axis. The systolic peak velocity (Vp) was measured using pulsed Doppler mode. CA was evaluated through the transient hyperemia test (THT), which assesses changes in the Vp after a 5-second transient compression of the ipsilateral common carotid artery and is expressed as the ratio between the Vp flow before and after carotid compression. The Vp before and after carotid occlusion was compared using the Wilcoxon signed-rank test. The median Vp of the middle cerebral artery after the carotid compression maneuver was significantly higher than the median Vp before compression (median [interquartile range, IQR]: 47.7cm/s [34.3]vs64.1cm/s [24.4]; P=0.003). The median THT obtained was 1.20 (IQR: 0.37). The current study demonstrated a significant increase in the Vp of the middle cerebral artery after a 5-second temporary occlusion of the ipsilateral carotid artery in healthy anesthetized dogs under mechanical ventilation. These findings suggest that the noninvasive TCCD methodology could be valuable for assessing CA in dogs. Additional studies using this technique in neurocritical animals are required to confirm its usefulness.

Abstract 162: Vertebral Artery Stenting for Compression Stenosis Due to Cervical Facet Hypertrophy

Background Vertebrobasilar insufficiency can be caused by various pathologic conditions including atherosclerosis, dissections, steal phenomenon, etc. While endovascular treatment of those conditions is well‐established, stenting of vertebral artery (VA) compression stenosis due to cervical facet hypertrophy is uncommon. We describe a case of VA stenting to address the symptomatic stenosis caused by mass effect from cervical facet hypertrophy. Method A 78‐year‐old male with a history of deep venous thrombosis and paroxysmal atrial fibrillation presented with several episodes of transient loss of awareness triggered by neck movement from side to side. This has restricted his neck mobility. Computed tomography angiography (CTA) revealed stenosis of the left VA at the C3‐C4 level secondary to cervical facet hypertrophy. Decision was made to treat this problem via endovascular means. Results Access was achieved via the right femoral artery, and a guide catheter was parked in the left subclavian artery just proximal to the left VA ostium. The left VA was selected with an intermediate catheter, and angiography revealed a moderate stenosis at the cervical V2 segment, with no evidence of atherosclerosis nor dissection. 3D rotational angiography confirmed the stenosis being caused by a C3‐C4 facet hypertrophy impinging on the artery. We proceeded with angioplasty and stenting at the point of stenosis, using a balloon‐mounted Papyrus stent. Follow‐up angiography showed improvement in the degree of stenosis. At 1‐month follow‐up, patient was symptom‐free, with no recurrence of his symptoms. Conclusion This case illustrates vertebral stenting a potential therapeutic option for vertebral artery compression stenosis caused by cervical facet hypertrophy. Although residual stenosis remained, the intervention improved the patient's symptoms.

Abstract 012: Percutaneous Carotid Access and Closure System for Acute Revascularization and Endovascular Therapy (PCAR)

Introduction/Purpose Tortuosity can infrequently impact femoral or radial vascular access for thrombectomy or thrombaspiration. Direct carotid access (DCA) is a well‐known technique safely used for diagnostic angiography studies for &gt; 60 years. However, the limitation for endovascular procedures using a DCA is that it requires manual artery compression or surgery to close the access site. Off‐label use of currently approved percutaneous closure devices has resulted in more than 20% of dissections, neck hematoma, stroke, and death. More recently, transcarotid artery revascularization (TCAR), which involves an incision in the neck, has been used for direct carotid access for acute stroke patients. Material and Methods We have developed a percutaneous 8 Fr OD, 9 Fr ID, kink‐resistance soft‐tip super flexible thin‐line access sheath using a 0.018” microwire with a unique flush‐through atraumatic dilator for angiography without the need to remove micro‐guide wire and suture DCA closure system based on a single suture with an Auto‐Knot feature. The one‐step integrated access sheath and closure device eliminates external exchanges. The thin‐line access sheath has a distal radiopaque and echogenic marker and a side port for an over‐the‐wire (OTW) deployment of suture, allowing constant preservation of the access to the carotid artery during closure. Results Preclinical benchtop and animal studies using ultrasound for DCA and the access sheath and closure system showed successful reliability of the single suture and Auto‐Knot system and sealing of the 8Fr access. The animals were subjected to arterial hypertension and placed on anticoagulation to simulate clinically challenging conditions. No dissections of the common carotid arteries were seen. A preliminary clinical safety study is ongoing and will be presented. Our experience shows a short learning curve for physicians of less than 5 minutes with shortened procedural time to access the brain for acute revascularization for stroke patients with minimal blood loss during the closure due to the ease of use of the closure device. Conclusions A simplified direct carotid large bore access and closure system may eliminate delay in access for thrombectomy in acute ischemic stroke. It allows for a percutaneous temporary flow arrest and reversal for carotid stenting and enables robotic‐assisted direct access to the carotid artery.

The effect of kaolin on postprocedural radial artery compression - randomized comparison

Abstract Background Mechanical compression is a standard method of postprocedural radial artery hemostasis. We investigated the use of this method and its combination with kaolin impragnated gauze patch as a new method of hemostasis. Methods We randomized 712 consecutive patients (pts) from our same day discharge program (age 66±8 years, 76% males) after coronary angiography (69%) and intervention (31%) from the proximal (PRA) and distal radial (DRA) approaches. Compression was performed by mechanical inflatable device with or without kaolin gauze : 241 versus (vs) 241 patients in proximal groups and 115 vs 115 pts in distal groups were compared. Postprocedural proximal radial artery patency was evaluated by reverse Barbeau test with finger oximetry testing. Time to hemostasis and access site complications were analyzed. Results Baseline characteristics were similar in all four groups - proximal with kaolin (PK+) and without kaolin (PK-), distal with kaolin (DK+) and without kaolin (DK-). Mean compression time was 57±20 min in PK+ vs 83±19 min in PK- groups (p&amp;lt;0.001) and 48±12 min in DK+ vs 63±12 min in DK- groups (p&amp;lt;0.001). In parallel, compression times were shorter in the distal groups compared to the corresponding proximal groups: (DK+ vs PK+; DK- vs PK-; both p&amp;lt;0.001). Postprocedural EASY grade II (&amp;lt;10cm) and III (&amp;gt; 10cm) hematomas occured more often in PRA (4,7% and 0,8%) in comparison with DRA (1,7% and 0%; p=0,03). There were no other local complications including the absence of proximal radial artery occlusion. Conclusions The use of kaolin in combination with mechanical radial artery compression was associated with shorter compression time in both PRA and DRA compared to mechanical compression alone. DRA was associated with an overall lower incidence of hematomas and also shorter compression time compared to the same PRA groups. No proximal radial artery occlusion was detected in our analysis.

Symptomology of celiac artery compression: Classifying patients by the degree of celiac artery stenosis and secondary changes in collateral branches on computed tomography angiogram

PurposeThis study aimed to analyze the correlation between the degree of celiac artery (CA) stenosis and the secondary changes in collateral branches in patients with CA compression (CAC) by CT and to classify patients by the combination of the two imaging features. MethodsPatients with CAC identified by contrast-enhanced CT from January 2012 to December 2013 were retrospectively enrolled and divided into the symptomatic group and asymptomatic group. CA stenosis was categorized as mild, moderate, or severe, and collateral circulation as invisible, visible, or prominent. The correlation between the imaging features was analyzed with Kendall’s Tau-b. Multivariate regression identified risk factors for symptomatic CAC. And patients were further classified into three subtypes (Type A to C) based on CA stenosis and collateral circulation. ResultsThis study included 150 patients (79 men, 71 women), with 49 (32.7 %) symptomatic. The collateral circulation classification correlated with the CA stenosis (Tau-b = 0.295, p < 0.001). And both imaging features were proven to be independent risk factors for the symptomatic CAC (all p < 0.05). Of the three subtypes of patients, only one patient with Type A (1/26 [3.8 %]) was symptomatic; a small proportion of patients with Type B (23/99 [23.2 %]) were symptomatic; and all patients with Type C (25/25 [100 %]) were symptomatic. ConclusionsThe development of collateral circulation is positively correlated with the degree of CA stenosis. Our proposed classification system based on the combination of the degree of CA stenosis and collateral circulation helps to identify patients with symptomatic CAC.

Pseudocalcinosis Tumorale (Teutschlander Disease) in Chronic Hemodialysis Patients

Pseudotumoral calcinosis (CPT) is a condition characterized by the deposition of calcium phosphate crystals in the periarticular tissues, forming large calcified masses. Although the pathophysiology of CPT is not fully understood, an increase in the calcium-phosphate product beyond the precipitation threshold and severe hyperparathyroidism appear to play a significant role. Treatment remains controversial, with surgical excision often recommended. We report a case of CPT in a 74-year-old diabetic patient undergoing chronic hemodialysis who experienced progressively worsening pain in the left hip for six months, along with mobility difficulties. A CT scan revealed a calcified mass on the posterior thigh, likely explaining the electric shock-like pain, as well as compression of the superficial femoral artery causing decubitus pain resembling critical limb ischemia. The biological assessment showed elevated calcium-phosphate levels and hyperparathyroidism. Surgical excision is not indicated due to the mass’s proximity to vascular and nerve structures. This case highlights the diagnostic and therapeutic challenges of CPT, emphasizing the need for iterative angioplasties, considering that this condition is rare in chronic hemodialysis patients with calcified periarticular masses.