Dorsal Artery Research Articles

Nail reconstruction using an osteo-onychocutaneous flap with the dorsal digital artery of the hallux as the pedicle: Techniques and anatomical insights

Nail reconstruction with preserved pulp tissue can be challenging due to the use of oversized flaps and nail deformities often resulting from bone resorption. This study describes a novel technique using the dorsal digital artery of the hallux as a pedicle for an osteo-onychocutaneous flap. A preoperative handheld Doppler was used to identify the course of the dorsal digital artery, and intraoperatively, the flap was elevated without disturbing the plantar tissue, thereby minimizing the risk of foot complications. A prospective study was conducted on all partial toe transplantation cases between September 2020 and March 2023 to analyze the anatomical variations of the dorsal digital artery. Thirty-one patients were included in the study. The dorsal digital artery was successfully identified preoperatively and confirmed intraoperatively in all cases. It branched from the first dorsal metatarsal artery in 24 cases and from the plantar digital artery in seven cases. The branching location was found to be 24.3 ± 4.5mm proximal to the web in the former group and 3.9 ± 3.9mm (p < 0.001) in the latter group. The vascular diameter at the branching site was measured to be 0.8 ± 0.2mm, with no significant difference based on the location. Nail reconstruction procedures were successfully performed using this flap for defects in the thumb, index finger, and little finger. Stable nails were reconstructed in all cases with minimal foot complications. In conclusion, this technique offers a reliable approach to nail reconstruction, minimizing donor site morbidity and preserving natural nail morphology.

Study of variations in the origin and branching of the human dorsal pancreatic artery

In surgical practice, the human pancreas is conventionally divided into two major anatomical and surgical segments: the right (cephalo-cervical) and the left (corpore-caudal). Both of these segments are abundantly supplied with blood. The artery-first approach is widely used in pancreatic resections to avoid venous stasis and achieve reduced blood loss. The dorsal pancreatic artery participates in the blood supply of both segments with its branches, which makes its anatomical study relevant and promising for clinical medicine. The aim was to describe the main branches of the dorsal pancreatic artery and to determine the frequency of their occurrence in the studied cases. Materials and Methods. The work was performed on archival fixed material (n = 60) of duodenum-pancreas-spleen organ complexes with extra-organ vessels taken from the collection of the Department of Anatomy, RyazSMU. All organ complexes belonged to mature age people without pronounced pathology of the organs of the investigated area. The division by sex was not performed. Results. The dorsal pancreatic artery was identified in all cases studied. Most often (n = 40; 67%) it originated from the branches of the ventral trunk, less often (n = 18; 30%) it was a branch of the superior mesenteric artery and in two cases (3%). Despite the place of origin, its trunk diameter averaged 1.8 mm (min 1.6; max 2.0). The branches of this artery were most often directed towards the gland body (85% of cases), less often - towards the head (15%). Conclusion. The dorsal pancreatic artery is the main artery feeding the body and tail of the human pancreas. In the present study, its branches were more frequently recorded towards the body of the gland, despite the origin of the vessel. Despite the accumulated anatomical and clinical knowledge about the peculiarities of the origin and branching of the human dorsal pancreatic artery, the understanding of the principles of the direction of its branches remains open to researchers.

Dorsal Carpal Artery Perforator Flaps: An Anatomical and Clinical Study.

Hand injuries pose challenges due to complexity and aesthetic-functional concerns. Dorsum of hand injuries are difficult to treat due to thin skin cover and increased propensity to exposure of underlying structures. Perforator-based flaps can provide better outcomes with minimal donor site morbidity. This study aims to bridge the gap in anatomical knowledge and explore the potential benefits of dorsal carpal artery perforator flap. A prospective study was done from July 2021 to June 2023, focused on study of dorsal carpal artery perforators on 12 fresh frozen cadaveric hands. Anatomical study involved injection of red latex into arteries at the wrist, followed by dissection and measurements. During the clinical phase, we used the inferences gained from the anatomical study to identify and mark perforator of dorsal carpal arteries. We performed V-Y advancement flap based on the DCPs in 5 patients who had dorsum of hand defects due to trauma. The study was carried out on 6 fresh frozen cadavers (12 hands). Anatomical findings revealed the anatomical location, caliber, and consistent number of dorsal carpal artery perforators supplying the dorsum of the hand arranged in 2 rows. Clinically, we applied this insight to create V-Y flaps in 5 patients with successful outcomes, thus, offering DCP-based flap as an alternative to distant flaps. DCP-based flaps offer an efficient solution for reconstructing proximal hand defects over the dorsum, with minimal complications, enhancing our understanding of hand reconstruction options. The study's comprehensive anatomical insights and clinical outcomes contribute to improving hand defect management and surgical techniques.

Fillet of toe flap coverage for non-traumatic foot amputations: A retrospective review of 70 patients

Fillet of toe flap (FTF) leverages the “spare parts” algorithm in reconstructive surgery–utilizing tissue from amputated or otherwise non-salvageable body parts, thus avoiding donor-site morbidity. This study assesses the efficacy of FTF coverage in non-traumatic foot amputations. A retrospective review of patients undergoing foot amputation with FTF coverage between January 2013 to August 2023 was conducted. Patient characteristics, operative details, and outcomes were collected. Primary outcome was FTF survival (no necrosis ≤7 days postoperatively). Secondary outcome was acute complications (≤42 days postoperatively). A total of 70 patients were included. Mean age was 65.0±13.7 years. Median Charlson Comorbidity Index was 6.0 (interquartile range [IQR]: 4.0-7.0). The most common wound location was the hallux (n=34). In 45 (64.2 %) patients with preoperative angiography, the patency rates were: first dorsal metatarsal artery (n=10, 22.2 %), lateral plantar artery (n=7, 15.6 %), medial plantar artery (n=6, 13.3 %), and dorsalis pedis artery (n=4, 8.9 %). Mean follow-up duration was 9.0 (IQR: 32) months. Fifteen (21.4 %) patients experienced at least one acute complication: deep surgical site infection (SSI; i.e., abscess, gangrenous necrosis; n=13, 18.6 %) and cellulitis (n=7, 10.0 %). Eleven (15.7 %) patients required reoperation for debridement (n=4, 5.7 %), wound closure (n=4, 5.7 %), flap necrosis (n=3, 4.3 %), incision and drainage (n=1, 1.4 %), split-thickness skin grafting (n=1, 1.4 %), and foreign body exploration (n=1, 1.4 %). FTF survival was 94.2 % (n=66). FTF facilitates reconstruction in complex cases and should be integrated into each chronic LE wound algorithm to avoid additional donor-site morbidity, and to facilitate stump-length preservation or limb salvage.

TCT-996 A Comparative Study of Dorsal Radial Artery Access vs Classical Radial Artery Access for Percutaneous Coronary Angiography

TCT-996 A Comparative Study of Dorsal Radial Artery Access vs Classical Radial Artery Access for Percutaneous Coronary Angiography

An analysis of a cadaver with a rare anatomical variation of thyrocervical trunk

IntroductionThe course of the branches of the thyrocervical trunk (TT) such as the inferior thyroid artery (ITA), suprascapular artery (SSA), transverse cervical artery (TCA) and ascending cervical artery (ACA) has a range of anatomical variations. The available literature distinguishes between 4 to 9 types of TT variation and its branches.AimThe following paper presents an anatomical variation that was not included in any known classifications.Case studyDuring routine dissection of a body of a 84-year-old woman located in the Department of Anatomy of the University of Warmia and Mazury in Olsztyn, a following course of TT was observed. In the described case the SSA derives directly from the subclavian artery (SA), while the TT gives away ITA, ACA and TCA, which further bifurcates into two dorsal scapular arteries (DSA).Results and discussionThe analysis of the described cadaver showed that this anatomical variation of TT cannot be included in any known classification. This indicates, that it is a very rare anatomical variation of the TT.ConclusionsKnowledge of the course of the branches of TT has some significant clinical importance, inter alia during endovascular procedures, during which any mistakes may result in serious consequences for the operated patient. The most accurate understanding of the course of TT vessels and the dissemination of knowledge on this subject may reduce the risk of complications after the treatment.

Cadaveric study on the arterial blood supply to the middle third nasal skin: implications for aesthetic and reconstructive surgery.

To provide a detailed examination of the arterial blood supply to the middle third of the nasal skin through cadaveric dissections, identifying the primary arterial sources and their precise locations. Cadaveric dissections were performed on 14 hemifaces from fresh specimens. The main feeding arteries and their branches were carefully dissected under magnification. Morphometric characteristics of the specimens, along with the caliber of the arteries and their branches vascularizing the mid-third nasal skin were recorded, and statistically analyzed. Four main arteries were identified as responsible for the blood supply to the mid-third of the nasal skin: the facial artery, the nasal branch of the infra-orbital artery (nbIOA), the dorsal nasal artery, and the upper branches of the columellar plexus. The lateral nasal artery (LNA) and the nbIOA were the main contributors, each providing significantly larger arterial branches than the other sources (1.8 ± 0.8 branches of 0.67 ± 0.2mm for the LNA, p-value < 0.001-1 ± 0 branches of 0.55 ± 0.17mm for the nbIOA, p-value < 0.01). The largest arterial branch consistently penetrated the lateral and inferior angle of the mid-third nasal skin, originated either from the LNA or nbIOA. The LNA and nbIOA endorse crucial roles in the arterial blood supply to the mid-third nasal skin. Despite the variability in vascular anatomy, a consistent pattern of arterial supply with convergence in the depth of the alarfacial groove was observed. Understanding these patterns is vital for improving surgical precision and reducing the risk of complications in both aesthetic and reconstructive surgeries.

Factors effecting the success of retrograde tibiopedal access and recanalization in infrapopliteal artery occlusions.

Peripheral arterial disease (PAD) is increasingly prevalent, particularly among the aging population. Retrograde tibiopedal access (RTPA) has emerged as a useful endovascular treatment for PAD. However, there is limited research examining factors that influence the efficacy of RTPA. To investigate factors affecting the access, crossing, and recanalization success rates of RTPA for infrapopliteal PAD treatment. A retrospective study was conducted on 720 patients who underwent endovascular treatment for PAD. Of these, 104 patients (mean age: 65.5 ± 16.2; 89 men) with 131 RTPA trials were included in the final evaluation. The disease and its duration, Rutherford score, smoking status, access site, and its occlusion status, access, crossing, and recanalization success were noted. Data were analyzed using Pearson's chi-square and Mann-Whitney U tests and multivariate logistic regression to evaluate the impact of various factors on success rates. The access success rate was 82.6%, the crossing success rate was 95.4%, and the recanalization success rate was 74%. Access success was significantly higher when the dorsal pedal artery (DPA) was the access artery compared with the posterior tibial artery (91.3% vs. 74.2%, P = 0.009). Access success was notably lower in patients with thromboangiitis obliterans compared with patients with diabetes mellitus (DM) and non-DM atherosclerosis (68.6% vs. 90.3% and 80.3%, P = 0.019). Recanalization success was higher when the puncture site was non-occluded (76.7% vs. 53.5%, P = 0.023). The study suggests that RTPA is a generally effective and safe technique for infrapopliteal PAD treatment. The most favorable outcomes are observed in individuals with DM who have a non-occluded DPA at the puncture site. Recanalization success is only affected by the patency of the artery at the puncture site. These findings offer targeted guidance for clinicians and highlight areas requiring further investigation.

A case of preoperative embolization for a giant hypervascular pancreatic serous cystic neoplasm in pancreaticoduodenectomy

BackgroundPreoperative vascular embolization is an effective strategy for managing meningiomas, neck paragangliomas, renal cell carcinomas, and bone metastasis by reducing the intraoperative bleeding volume and operation time. Although hypervascular tumors also occur in the pancreas, preoperative embolization for these tumors is not commonly practiced. We herein present a case of a giant serous cystic neoplasm (SCN) of the pancreas with significant arterial vascularity that was managed with preoperative interventional radiology and subsequently resected via pancreaticoduodenectomy.Case presentationA 60-year-old man presented with an 8-cm hypervascular tumor located at the head of the pancreas, identified as an SCN on pathologic examination. The tumor had increased by 13 mm over 5 years, necessitating surgical intervention. Computed tomography revealed a substantial blood supply to the tumor from the dorsal pancreatic artery and gastroduodenal artery, both branches of the superior mesenteric artery. To mitigate the risk of severe intraoperative bleeding from this giant hypervascular tumor, branches of the dorsal pancreatic artery and gastroduodenal artery were embolized using metallic coils and further secured using a gelatin sponge 1 day prior to pancreatectomy. During the laparotomy, the tumor appeared to have decreased in size, likely because of reduced distension and congestion. Despite significant adhesions to surrounding tissues secondary to prolonged compression and inflammation, the pancreaticoduodenectomy was completed successfully in 5 h and 15 min with blood loss of 763 mL. The patient was discharged on postoperative day 15 without complications.ConclusionsPreoperative arterial embolization for hypervascular pancreatic tumors might control the risk of massive intraoperative bleeding, contributing to a favorable postoperative outcome. Utilizing interventional radiology for preoperative inflow control is one of the beneficial strategies for pancreatectomy in patients with a giant SCN.

Abstract P166: Genetic Ablation of the Bile Acid Receptor- Takeda G-protein Coupled Receptor 5 (TGR5) Promotes Weight Gain but Lowers Hypertension

Introduction: TGR5 belongs to G-protein coupled receptor family, that mediates bile acid signaling. Activation of TGR5 by bile acids triggers intestinal glucagon-like peptide-1 secretion, whereby pharmacological activation of TGR5 constitutes a promising incretin-based strategy for the treatment of metabolic disorders. Hypertension is one of the hallmark features of metabolic disorders. We previously reported that hypertension is associated with lower conjugated bile acids, which are ligands for TGR5. Therefore, we hypothesized that lack of activation of TGR5-mediated bile acid signaling promotes not only body weight gain, but also hypertension. Methods: CRISPR/Cas9 technology was used to generate Tgr5 -/- rats from hypertensive Dahl Salt-sensitive (S) rats. Twenty-four-hour blood pressure (BP) readings of 8-weeks-old control female Tgr5 +/+ S rats and age-matched female Tgr5 -/- S rats (n=7/group) were monitored by radiotelemetry for 4 weeks. Body weight, food intake, and water intake were recorded every week. At the end of the study, vascular function was examined using wire myography of dorsal and mesenteric resistance arteries, cardiac function was assessed by echocardiography, and microbiota profiling was conducted via fecal 16S rRNA gene sequencing using Miseq. Results: In support of our hypothesis, despite no difference in food and water intake, at 4 weeks, the body weights of Tgr5 -/- S rats were significantly higher compared to Tgr5 +/+ S rats (236.3gm vs. 225.4gm; p&lt;0.01). Surprisingly, in contrast to our hypothesis, at 4 weeks, Tgr5 -/- S rats had significantly lower systolic BP (151.8mmHg vs. 156.9mmHg, p&lt;0.0001), diastolic BP (107.9mmHg vs. 115.5mmHg, p&lt;0.0001), and mean arterial BP (128.8mmHg vs. 134.9mmHg, p&lt;0.0001) compared to Tgr5 +/+ S rats. However, no significant differences were observed either in vascular reactivity or cardiac function between the groups. Interestingly, fecal microbiota analysis revealed that Tgr5 -/- S rats presented with significant remodeling of gut microbiota with lower α-diversity (observed features; p=0.05), b-diversity (Bray-Curtis; p&lt;0.05, Jaccard; p&lt;0.01), and higher relative abundance of the BP-lowering genera Akkermansia . Conclusion: Our study revealed that deletion of TGR5 resulted in weight gain but lowered BP. It implies that activation of TGR5 may be a risk factor for raising BP. The mechanism by which TGR5 regulates BP seem independent of changes in vascular or cardiac function but is likely mediated by gut microbiota.

Specific Complications after Pancreatoduodenal Resection Depending on the Pancreatic Transection Plane and the Dorsal Pancreatic Artery Origin

Specific Complications after Pancreatoduodenal Resection Depending on the Pancreatic Transection Plane and the Dorsal Pancreatic Artery Origin

Ultrasonographic Anatomical Changes in the Nasal Vasculature after Rhinoplasty: Analysis of a Series of Cases

It is known that surgical procedures can change the vascularization of the face, and these changes can be related in the course and depth of vessels, increasing the risk for complications with injectable products. The goal of this work is to objectively demonstrate the course and variation of these vascular structures through Doppler ultra-sonographic monitoring. In this research 9 patients were studied, of which 7 completed the study. The presurgical ultrasound study detected anatomical variations like agenesy of the angular artery and dorsal nasal artery in 11.12% of tha patients. The post surgical evaluation detected 85.71% of vascular changes mainly in the nasal arteries. This findings confirm the importance of practicing ultrasonographis evaluation in patients with rhinoplasty, previous to practicing new filler injections in the face.

TRANSCUTANEOUS LASER IRRADIATION OF BLOOD IN SIMULTANEOUS MODE (S-ILIB) FOR FATIGUE RECOVERY

The modified transcutaneous laser irradiation on blood (ILIB), a systemic modality of photobiomodulation therapy (PBMT), consists of a laser application on the radial artery or other artery in the body, to improve systemic functions and physiological dynamics of the body. The available therapeutic strategies for the management of fatigue due to daily life stress are mainly focused on lifestyle changes associated with nutrition and exercise. Thus, the present study aims to report a series of cases in which transcutaneous modified ILIB therapy in simultaneous mode (S-ILIB), was used to treat fatigue symptoms. Four healthy patients, without any type of significant comorbidity, reported fatigue related to stress. They were treated by the new PBMT protocol with the modified ILIB technique. The intensity or perception of fatigue was rated using a visual analogue scale (VAS). The "simultaneous technique" used in the present study consisted of laser irradiation in four sites of the body: 1- the radial artery region of the right arm; 2- the radial artery region of the left arm; 3- the right dorsal pedis artery; and 4- the left dorsal pedis artery. For PBMT, two laser device were used at 660 nm, on contact mode, with 100 mW of power. The patients reported a clear recovery in the energy sensation after the S-ILIB session. The PBMT protocol seems to be a promising therapy for managing energy recovery in fatigue-stress-related daily routines; however, complementary studies are required to establish the safest and most efficient protocol

Axilla Reconstruction Post Burn Contracture: Thoracodorsal Artery Flap Versus Local Flap and Skin Grafts

Background: Burns are a prevalent worldwide morbidity that frequently results in contractures that impede function and appearance, especially in the axilla, which has a major impact on upper limb mobility. Aim: To compare the functional results of local flaps with skin transplants versus Thoracodorsal artery flaps for axilla repair following burn contracture. Methods: A prospective comparative study was conducted. In the Department of Plastic and Reconstructive Surgery, thirty patients were split into two groups for a prospective comparative study. Group B underwent local flaps utilizing skin grafts, whereas Group A underwent thoracodorsal artery flaps. An analysis was conducted on pre- and post-operative shoulder joint abduction, complications, and demographic factors. Result: The two groups' post-operative shoulder abduction did not significantly differ, according to the results; however, younger patients and those with concomitant conditions including diabetes and hypertension were more likely to benefit from thoracodorsal artery flaps because of increased vascularization. The study discovered that middle-aged individuals typically had local flaps, but younger patients frequently had thoracodorsal artery flaps. Though not statistically significant, the gender distribution revealed a trend with more males obtaining local flaps and more females receiving thoracodorsal artery flaps. Thoracic dorsal artery flaps were substantially more common in patients with diabetes and hypertension. Practical Implication: The higher prevalence of thoracodorsal artery flaps in patients with diabetes and hypertension underscores importance of choosing flaps that provide better vascular support for patients with compromised vascular health. Conclusion: The findings highlight the significance of considering patient-specific criteria when choosing a flap, as thoracodorsal artery flaps provide better vascular support and are advantageous for patients with compromised vascular health. These results emphasize the need for customized surgical planning to improve results in post-burn contracture axilla repair. To enhance patient care and further improve surgical protocols, future research should concentrate on long-term results.

Evaluation of Dorsal Digital Artery Perforator (DAP)Flap in Figer Tip Injury Reconstruction

Evaluation of Dorsal Digital Artery Perforator (DAP)Flap in Figer Tip Injury Reconstruction

Peripheral arterial catheters in extremely preterm infants born at less than 28 weeks of gestation—a single-center experience

The aim of this study was to perform a retrospective data analysis of established peripheral artery catheters (pAC) in extremely preterm infants. The primary outcome was the pAC life span and its correlation to gestational age, birth weight, localizations, and pAC removal. Retrospective data analysis of electronic patient records of all extremely preterm infants (born less than 28 weeks gestation) admitted to the neonatal intensive care unit in Graz (Austria) between January 2014 and December 2020. A total of 196 preterm infants with a median (IQR) gestational age of 25.7 (24.6–26.6) weeks and a birth weight of 730 (614–898) g were included. In 155 (79%) of these preterm infants, 286 pAC and six umbilical artery catheters were inserted successfully. The first pAC was inserted 2.5 (1.4–7.4) h after birth, and the median pAC life span was 57.5 (22.–107.2) h. Gestational age, birth weight, and catheter localization did not correlate with the pAC life span. The pAC localizations were the radial artery (63%), tibial posterior artery (21%), ulnar artery (6%), dorsal artery of the foot (6%), others (1%), and not documented (3%). Adverse reactions including temporarily impaired peripheral perfusion, local inflammation, extravasation, or bleeding were reported in 13% of all pAC, but none of these resulted in long-term sequelae. A median (IQR) of 9 (5–18) arterial blood samples were drawn via pAC, resulting in a notable reduction of pain stimuli.Conclusion: The use of pAC in extremely preterm infants is feasible and safe. Neither gestational age, birth weight nor localization did affect the life span of pAC. No long-term sequelae were observed, and pain events were reduced by using pAC for blood drawing.What is Known:• Peripheral artery catheters can be used for continuous blood pressure measurement and blood draw even in extremely preterm infants.• (Severe) adverse reactions such as bleeding, necrosis, or amputation occur between 1 and 4%.• What is New:• The median peripheral arty catheter life span is 58 h and is not affected by gestational age, birth weight, nor localization.• A median of nine blood samples can be taken per each single pAC and, therefore, prevent pain events in extremely preterm infants.

Dorsal intercostal artery flap; A reliable option for coverage of myelomeningocele defects: A case series.

Meningomyelocele is a common congenital condition and its reconstruction poses a challenge for surgeons. The dorsal intercostal artery (DICA) flap offers a one-stage tension-free closure with adequate results. This study, spanning from January 2019 to September 2022, analyses the outcome of nine DICA flaps for meningomyelocele reconstruction, where the average size of the DICA flap was 6.8 x 4.6 cm for an average defect of 6.33 x 4 cm. Notably, no post-operative blood transfusion was required, nor any complications occurred except for one patient's septic shock-related death. Two had post-operative cerebrospinal fluid (CSF) leak, repaired primarily with one requiring VP shunt. Based on our experience, the DICA flap, with its consistent anatomy, is a reliable option for the reconstruction of meningomyelocele defects.

The Consequences of a Heart Condition: Acute Stroke and Limb Ischemia Secondary to Massive Intracardiac Thrombus in a Young Female with Dilated Cardiomyopathy

Background: Dilated cardiomyopathy (DCM) is associated with the increased occurrence of left ventricular (LV) thrombosis caused by cardiac dysfunction. This condition is associated with significant mortality and morbidity because of its significance as a potential source of systemic emboli. We are reporting a case of Acute Stroke and Limb Ischemia in a Young Female Patient with DCM. Case Illustration: A 20-year-old female was referred to our hospital due to pain in her right lower extremities and weakness in her right limb. She had been diagnosed with peripartum cardiomyopathy five years earlier. A general physical examination found her right lower limbs to be cold and pulseless. A neurological examination revealed hemiparesis involving the right side of her body. The chest radiograph showed cardiomegaly. Electrocardiography indicated sinus rhythm with LVH. The transthoracic echocardiograms revealed significant LV systolic failure with a massive thrombus at LV. The Duplex ultrasound showed a thrombus at the right dorsal pedis artery, and a head CT scan revealed an acute infarct. The patient was started on heparin and bridged with warfarin 5mg orally daily, and she was uneventfully discharged after one week. Conclusion: DCM had been associated with thrombosis, stroke, and an increased risk of thromboembolism. Previous studies had documented decreased thromboembolic events due to administering anticoagulants. Keyword: Acute Stroke, Dilated Cardiomyopathy, Limb Ischemia, Massive Intracardiac Thrombus.

Evaluation of enhanced external counterpulsation for diabetic foot based on a patient-specific 0D-1D cardiovascular system model

Background and objectiveDiabetic foot (DF) complications often lead to severe vascular issues. This study investigated the effectiveness of enhanced external counterpulsation (EECP) and its derived innovative compression strategies in addressing poor perfusion in DF. Although developing non-invasive and efficient treatment methods for DF is critical, the hemodynamic alterations during EECP remain underexplored despite promising outcomes in microcirculation. This research sought to address this gap by developing a patient-specific 0D-1D model based on clinical ultrasound data to identify potentially superior compression strategies that could substantially enhance blood flow in patients with DF complications. MethodsData were gathered from 10 patients with DF utilizing ultrasound for blood flow rate and computed tomography angiography (CTA) to identify lower limb conditions. Clinical measurements during standard EECP, with varying cuff pressures, facilitated the creation of a patient-specific 0D-1D model through a two-step parameter estimation process. The accuracy of this model was verified via comparison with the clinical measurements. Four compression strategies were proposed and rigorously evaluated using this model: EECP-Simp-I (removing hip cuffs), EECP-Simp-II (further removing the cuffs around the lower leg), EECP-Impr-I (removing all cuffs around the affected side), and EECP-Impr-II (building a loop circulation from the healthy side to the affected side). ResultsThe predicted results under the rest and standard EECP states were generally closely aligned with clinical measurements. The patient-specific 0D-1D model demonstrated that EECP-Simp-I and EECP-Impr-I contributed similar enhancement to perfusion in the dorsal artery (DA) and were comparable to standard EECP, while EECP-Simp-II had the least effect and EECP-Impr-II displayed the most significant enhancement. Pressure at the aortic root (AO) remained consistent across strategies. ConclusionsEECP-Simp-I is recommended for patients with DF, emphasizing device simplification. However, EECP-Simp-II is discouraged as it significantly diminished blood perfusion in this study, except in cases of limb fragility. EECP-Impr-II showed superior enhancement of blood perfusion in DA to all other strategies but required a more complex EECP device. Despite increased AO pressure in all the proposed compression strategies, safety could be guaranteed as the pressue remained within a safe range.

Embolization of the Pancreas Using Microspheres: A Proof-of-Safety Study in a Porcine Model

PurposeTo evaluate safety and impact of particle embolization on pancreatic function in a pig model. Materials and MethodsEmbolization of the dorsal pancreatic artery using 100–300-μm particles was performed on 14 Yorkshire pigs. Baseline and post-embolization glucose tolerance testing results and serum amylase/lipase levels were obtained. Pigs were observed for 2 weeks to assess for behavioral signs of pain/distress, bowel changes, and changes to intake/output. After 2 weeks, euthanasia and necropsy with gross and histopathologic assessment of the pancreas were performed. ResultsEmbolization was technically successful in all pigs. All animals survived the 2-week follow-up without evidence of pain/distress. There were significant increases in amylase and lipase at 24 and 48 hours (P < .001), which normalized by 2 weeks. There was minimal change in glucose tolerance testing at 2 weeks. Bowel habits were unchanged without diarrhea. At necropsy, all examined pancreases had fibrosis in the distal body and tail, without gross evidence of ongoing inflammation. On histopathologic evaluation, all pancreases demonstrated fibrosis in the embolized portions without evidence of active inflammation in treated or adjacent pancreatic tissue. ConclusionsParticle embolization of the pancreas was feasible and tolerated by all tested pigs with transient amylasemia, lipasemia, and mildly impaired glucose tolerance but without clinical or histopathologic evidence of acute pancreatitis and no evident impact on pancreatic endocrine or exocrine function.