A novel technique for preventing distal embolism during endovascular therapy for femoropopliteal lesions: The flow-controlled anti-embolic technique.

Analysis of the Characteristics of Peripheral Artery Disease in Patients with Hemiplegia After Ischemic Stroke and Their Mid- and Long-Term Outcomes.

Simultaneous hypoxemia and hypercapnia frequently occur in conditions such as obstructive sleep apnea, which may cause peripheral and cerebral vascular dysfunction. However, how hypoxemia and hypercapnia interact in regulating peripheral and cerebral vascular responses remains incompletely understood. Eleven healthy young adults (4 females) completed three resting gas-inhalation trials (5-6 min) under different arterial O2 and CO2 conditions: 1) hypoxemic normocapnia (percutaneous arterial oxygen saturation ∼85%; Hypoxemia), 2) normoxic hypercapnia (end-tidal CO2 partial pressure ∼55 mmHg; Hypercapnia), and 3) hypoxemic hypercapnia (Combined). Femoral artery blood flow and middle cerebral artery mean blood velocity were continuously assessed using Doppler ultrasound and transcranial Doppler ultrasonography, respectively. These values were divided by mean arterial pressure measured by finger photoplethysmography to calculate leg vascular conductance and cerebrovascular conductance index (CVCi). Total vascular conductance was calculated as cardiac output (model-flow method) divided by mean arterial pressure. Relative to before gas inhalation, leg vascular conductance remained unchanged in all trials, whereas total vascular conductance increased during Hypoxemia. CVCi increased during Hypercapnia and Combined. When comparing the summed isolated responses (Hypoxemia + Hypercapnia) with the Combined, changes from baseline (Δ values) of leg vascular conductance tended to be lower (P = 0.054), and total vascular conductance was lower (P = 0.031) in Combined. By contrast, Δ CVCi did not differ between the summed isolated vs. Combined (P = 1.000). We show that hypoxemia and hypercapnia interact to augment systemic vasoconstriction, whereas hypercapnia-induced cerebral vasodilation is well preserved when combined with hypoxemia.NEW & NOTEWORTHY Combined hypoxemia and hypercapnia, which occurs in obstructive sleep apnea, tended to produce greater reductions in leg vascular conductance and a significantly greater reduction in total vascular conductance compared with the sum of the isolated effects. Cerebral vascular conductance index increased to a similar extent during the combined compared with the summed conditions. We show that hypoxemia and hypercapnia interact to augment systemic vasoconstriction, whereas hypercapnia-induced cerebral vasodilation is maintained when combined with hypoxemia.

Forced hemostasis via enhanced erythrocyte adhesion: A procyanidin-based composite sponge for managing hemorrhage in coagulopathic conditions.

Comparison of biaxial mechanical and microstructural properties between human femoral arteries and surrogate models for stent development.

Femoral artery collapse ratio as a real-time physiologic marker of cardiopulmonary resuscitation quality: A case series.

The m6A demethylase FTO suppresses perivascular adipose tissue browning and exacerbates vascular injury via m6A-mediated destabilization of Irx3 mRNA and the IRX3/UCP1 axis.

To evaluate the effect of saline boost injections on angiographic contrast. Angiographic examinations were performed using a SIEMENS ArtisQ Celling (VD11E) system with syngo Workplace (VD20B) and a PRESS DUO elite autoinjector (Nemoto Kyorindo, Tokyo). Standard injection parameters, assuming non-selective angiography from the abdominal aortic bifurcation to the common femoral artery, were 5.0 mL/s for 2.0s. Five boost conditions were assessed: injection speed of 5.0, 7.0, and 10.0 mL/s with total volumes of 5.0, 10.0, and 15.0 mL (1.0-3.0× standard), and 7.0 and 10.0 mL volumes corresponding to the amount delivered within 1.0s. Time-enhancement curves (TECs) were generated from identical regions of interest placed in the proximal, middle, and distal portions of a vascular phantom to measure maximum signal intensity and enhancement duration. Additional quantitative analysis was performed using iFlow color-coded maps. Changes in the saline-flush boost volume resulted in minor differences compared with the baseline TECs. At a boost speed of 7.0 mL/s, maximum signal intensity increased by 7.2%, 8.1%, and 7.0% in the proximal, middle, and distal segments. At 10.0 mL/s, increases were 11.5%, 11.3%, and 11.1%, respectively. On iFlow analysis, the reference time-to-peak significantly shortened at 10.0 mL/s-3.49, 4.01, and 4.17s-compared with 3.68, 4.22, and 4.26s at baseline (p < 0.01). Boosting double-speed saline injection improved the efficiency of contrast agent delivery to distal regions. Further improvements in injection efficiency may reduce the required amount of contrast agent and the number of frames.

Ascending aortic cannulation is the standard arterial inflow strategy for cardiovascular surgery that requires cardiopulmonary bypass. However, this approach can be problematic in patients with extensive atheromatous disease of the ascending aorta, commonly referred to as shaggy aorta, because of the increased risk of thromboembolic complications. Therefore, alternative cannulation strategies are required in such high-risk settings. A 75-year-old woman presented with a 55-mm distal aortic arch aneurysm accompanied by an extensively shaggy aorta involving the ascending aorta. Ascending aortic arch replacement using the frozen elephant trunk technique was performed, and the transatrial left ventricular cannulation technique for arterial inflow. Cardiopulmonary bypass was established while preserving the spontaneous cardiac activity with epicardial pacing during cooling. Additional embolic prevention strategies include temporary retrograde cerebral perfusion before selective antegrade cerebral perfusion and controlled blood evacuation via the femoral artery during reperfusion. The operative, cardiopulmonary bypass, cardiac arrest, and circulatory arrest times were 326, 185, 91, and 61min, respectively. The postoperative course was uneventful, and no thromboembolic complications, including cerebral infarction, were observed. Postoperative imaging confirmed the complete exclusion of the aneurysm without endoleaks. Thoracic aortic aneurysm surgery in patients with a shaggy ascending aorta carries a substantial risk of embolism. The present case demonstrates that transatrial left ventricular cannulation combined with multiple embolic prevention strategies might be a safe and effective option for aortic arch surgery in this high-risk population.

Abdominal aortic aneurysm (AAA) is a progressive degenerative vascular disease with a high risk of rupture and mortality. Endovascular aneurysm repair (EVAR) is a widely used minimally invasive treatment option for anatomically suitable AAA. However, postoperative endoleaks associated with EVAR can precipitate secondary aneurysm rupture. We developed an injectable nanocomposite hydrogel for embolization and local delivery of cycloastragalol (CAG). CAG-loaded aldehyde-functionalized polyurethane nanoparticles (DFPU@CAG) showed uniform morphology, favorable biocompatibility, and enhanced CAG delivery efficiency, and were incorporated into a chitosan (CS)-based dynamically crosslinked hydrogel to form CS-DFPU@CAG. The hydrogel showed suitable injectability and rheological properties for embolization with sustained local drug release. In vivo studies in animal AAA models showed that in situ administration significantly attenuated AAA expansion and reduced matrix metalloproteinase9 (MMP9) expression and enzymatic activity. CS-DFPU@CAG also demonstrated robust embolization performance in vitro and in vivo, maintaining stability under high pressure and achieving blood-flow occlusion in rabbit femoral arteries comparable to a clinical porcine fibrin sealant. These findings provide a preclinical proof-of-concept for CS-DFPU@CAG as a dual-function embolic and local therapeutic platform for AAA management.

Background This study evaluated the feasibility of lipiodol marking using the left radial artery (LRA) approach prior to cryoablation for small renal cell carcinoma (RCC). Methods This retrospective study included 59 patients who underwent transarterial lipiodol marking before cryoablation between August 2022 and December 2023. The LRA approach was attempted in 46 patients; 13 patients ineligible for LRA underwent femoral artery (FA) puncture as a descriptive comparator. The primary endpoint was technical success without crossover among attempted LRA cases; secondary endpoints included overall feasibility among candidates, failure reasons, adverse events (AEs), and procedural metrics. Results Technical success without crossover was 91.3% (42/46), with overall feasibility of 71.2% (42/59). All four LRA failures resulted from arterial anatomical variation/tortuosity (n = 3) or brachial artery dissection (n = 1), completed via FA crossover. Grade I AEs included forearm haematoma (26.1%), LRA occlusion (2.2%), and brachial artery dissection (2.2%). Procedure and fluoroscopy times were longer in the successful LRA cases than in the FA cohort (median 86 vs. 63 min and 1256 vs. 851 s, respectively). Conclusions LRA-based lipiodol marking achieved technical success in most attempted cases. AEs were manageable but not negligible. Prospective studies are warranted to clarify patient-centred benefits and optimal selection criteria.

Transradial Access for Radial-to-Peripheral Revascularization in Acute Limb Ischemia.

The etiology of type A acute aortic dissection (TAAAD) remains unclear. This study aimed to investigate whether the diameter of the common femoral artery (CFA) could serve as a predictor of TAAAD. This retrospective study included 100 patients aged 20-70 years who underwent surgery for TAAAD and had postoperative contrast-enhanced (CT) performed before discharge (TAAAD group). The control group comprised 100 patients who underwent elective surgery for stage ≤ 2 colorectal cancer without preoperative bowel obstruction or perforation between April 2021 and March 2024. CFA diameters measured on postoperative CT images in the TAAAD group were compared with those measured on preoperative CT images in the control group. The TAAAD group had a higher proportion of men (76% vs. 59%; p = 0.016), larger body surface area (1.78 [1.65-1.91] vs. 1.70 [1.57-1.83]; p = 0.004), younger age (57 [52-64] vs. 60 [54-67]; p = 0.011), and larger CFA diameter (11.2mm [10.1-12.1] vs. 9.0mm [8.5-9.8]; p < 0.001). Receiver operating characteristic curve analysis for CFA diameter demonstrated good discriminatory performance (area under the curve, 0.88; 95% confidence interval, 0.84-0.93). An optimal cutoff value of 10.5mm yielded a sensitivity of 70% and a specificity of 90%. In multivariable logistic regression analysis, CFA diameter remained significantly associated with TAAAD (OR 5.45, 95% confidence interval 3.47- 9.31, p < 0.001). The CFA diameter was significantly larger among patients with TAAAD. These findings suggest that CFA diameter may be associated with the risk of TAAAD.

A free-floating thrombus in the ascending aorta is a rare but clinically significant condition that can cause cerebral and peripheral arterial embolism. Preoperative differentiation from primary aortic tumors, particularly intimal sarcoma, remains challenging even with positron emission tomography-computed tomography (PET-CT). Optimal treatment strategies have not been established. A 49-year-old man presented to our emergency department with acute right lower extremity ischemia. Contrast-enhanced computed tomography revealed acute occlusion of the right common femoral artery, and emergent thrombectomy was performed on the same day. He had experienced a cryptogenic cerebral infarction two months earlier; although echocardiography had shown no intracardiac thrombus, he had been managed with anticoagulation alone. To identify the source of recurrent embolism, contrast-enhanced computed tomography from the neck to the pelvis was performed, revealing a pedunculated mass in the ascending aorta. PET-CT showed no abnormal uptake. On hospital day 10, ascending aortic replacement with a prosthetic graft was performed. Intraoperative epi-aortic echocardiography was used to identify the thrombus location and determine a safe cross-clamp site, thereby avoiding deep hypothermic circulatory arrest. The mass was resected together with a ring-shaped segment of the aortic wall at its attachment site to prevent local recurrence. Pathological examination confirmed an organizing thrombus without neoplastic features. The postoperative course was uneventful, and the patient was discharged on postoperative day 13. At 5-year follow-up, no recurrent embolic events or new thrombus formation has been observed. In patients with a pedunculated free-floating thrombus in the ascending aorta presenting with recurrent systemic embolism, early surgical intervention, including graft replacement, is a reasonable therapeutic option. Graft replacement enables complete excision of the attachment site for recurrence prevention and provides a definitive histopathological diagnosis. However, further accumulation of cases is needed to establish optimal management strategies for this rare condition.

BackgroundGastroepiploic artery aneurysms (GEAAs) and their rupture are very rare but often serious. However, emergency management has yet to be standardized.PurposeTo clarify the clinical features of GEAAs and outcomes of transcatheter arterial embolization (TAE).Materials and MethodsThis is a retrospective, single-center 12 case series of GEAAs experienced between 2006 and 2023. We reviewed medical records to determine the case background, angiographic images, TAE techniques and success rate, and outcomes. Abdominal angiography was performed via the femoral artery to identify the inflow and outflow vessels of the GEAAs. Subsequently, a microcatheter was advanced to the target site, and embolization was performed with microcoils and/or NBCA-Lipiodol mixture.ResultsNine ruptured and one unruptured pseudo-GEAA cases were treated by emergency TAE, while the remaining two unruptured cases were treated electively. The average diameter of the ruptured GEAAs was 7.9 mm. The most common underlying diseases were segmental arterial mediolysis in 4 cases. Morphological classification revealed 5 cases of dissecting, 4 of pseudo, and 3 of true. TAE was successful in seven of the nine ruptured and in all three unruptured cases. Two patients with ruptured GEAAs after unsuccessful TAE were subsequently saved by surgery. TAE using the triple coaxial catheter system was performed in 7 cases with good results.ConclusionsEven small-diameter GEAAs can rupture, resulting in life-threatening conditions, but emergency TAE is safe and effective. However, there are some cases in which TAE fails, so it is important to make a prompt decision to proceed to surgical treatment.

Bone is a highly vascularized tissue, which is required for the metabolically demanding process of remodeling. Blood vessels are important in fluid movement occurring during bone mechanoadaptation. We hypothesized that in-vivo mouse tibial loading, which does not involve muscle contraction and exercise-associated cardiovascular effects, would lead to acute and chronic changes in femoral, saphenous, and popliteal artery structure and function, as well as bone vascular porosity coincident with adaptive bone (re)modeling. Sixteen, 26-wk-old female C57BL/6J mice received two weeks of once, daily in vivo cyclic loading to the left tibia, resulting in increased cortical bone formation with minimal changes to trabecular bone. In vivo microCT-based timelapse morphometry revealed that most formation occurred on the endocortical surface. Ultrasonography showed changes to blood velocity after each loading episode (days 1, 3, 7, and 9) in saphenous and popliteal arteries, with the femoral artery adapting later. Chronic changes to blood velocity (Δ from baseline) were seen only in the femoral and popliteal vessels closely associated with the loaded tibia. Microfil contrast agent perfused into the vasculature showed minimal loading-induced changes in overall limb vascularity and confirmed targeted popliteal adaptation. Synchrotron tomography revealed greater cortical bone vascular canal porosity in the metaphysis, but not mid-diaphysis of loaded versus non-loaded tibiae. We measured an increased osteocyte lacunar number density surrounding blood vessels in loaded limbs, with no increase found in the canalicular density. Overall, loading led to both temporal and spatially dependent adaptation in the vasculature in the hindlimb and the bone tissue at the level of the primary limb arteries, intracortical bone blood vessels, as well as the osteocyte lacunocanalicular network architecture surrounding the blood vessels. These results highlight the critical role of local vascular dynamics in orchestrating bone adaptation, with implications for developing precision therapies that modulate the vasculature to enhance skeletal resilience.

Background: Cardiovascular disease remains the leading cause of mortality worldwide. In recent years, several non-invasive imaging techniques have been introduced to improve the assessment of atherosclerotic burden and cardiovascular risk, including computed tomography and vascular ultrasound. Three-dimensional ultrasound has emerged as a promising method for the non-invasive quantification of plaque volume in peripheral arteries. Methods: In this prospective single-centre study, 63 patients with low to moderate cardiovascular risk (6–20% according to the Framingham Risk Score) were included. All participants underwent baseline examinations, and 38 patients completed follow-up after a mean period of 2 years. The assessment included coronary artery calcium scoring (CACS) by computed tomography and three-dimensional ultrasound to measure peripheral plaque volume in carotid and femoral arteries. Baseline values and progression of coronary and peripheral atherosclerosis were analysed using Spearman’s correlation. Results: Sixty-three patients were included in the final analysis. A significant correlation was observed between baseline CACS and peripheral plaque volume (r = 0.32; p = 0.010). In addition, the progression of coronary calcium scores was significantly associated with the progression of peripheral plaque volume (r = 0.34; p = 0.037). Conclusions: Coronary artery calcium is significantly associated with peripheral plaque burden, both at baseline and over time. The parallel progression of coronary and peripheral atherosclerosis suggests that peripheral plaque volume assessed by 3D ultrasound may serve as a surrogate marker for coronary disease progression.

Continuous efforts are made to reduce contrast media, improving patient safety, reducing environmental risks, and addressing recurring supply shortages. The aim of this study was to evaluate contrast agent-reduced CT protocols for transcatheter aortic valve reconstruction (TAVR) planning in photon counting detector CT (PCDCT). 162 BMI-matched examinations with standard dose contrast media (SCD; 80 mL; Iohexol 300 mg/mL; 81 examinations) and reduced contrast media dose (RCD; 50 mL; 81 examinations) for TAVR planning on a PCDCT were included in this retrospective monocentric study. Virtual monoenergetic reconstructions (VMI) at 70 keV, 60 keV and 50 keV of contrast agent-reduced examinations were compared with polyenergetic images. Quantitatively, regions-of-interest (ROIs) were placed in the abdominal aorta, iliac bifurcation, femoral artery, left ventricle and trapezius muscles. Signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR) were calculated. Qualitatively, diagnostic quality and contrast were assessed on a visual grading scale of 1 (non-diagnostic) - 5 (excellent) and contrast agent dose was estimated. Averaged, SNR and CNR decreased by 8.71% and 16.78%, respectively, on PCDCT with reduced contrast dose (RCD vs. SCD; both p < 0.001). VMI50keV increased SNR by 44.10% (p < 0.001) and CNR by 52.73% (p < 0.001) compared with SCD. In the ascending aorta, SNR increased from 19.80 ± 6.24 (SCD) to 35.78 ± 13.20 (RCDVMI50keV) and CNR from 18.84 ± 7.78 to 29.77 ± 16.70. Median contrast intensity was 5 for SCD, 4 for RCDCR, and 5 for RCDVMI50keV. The diagnostic efficacy of TAVR planning assessment using PCDCT with minimized contrast agent dosing is preserved, presenting a practical approach to conserve contrast media. Question The aim of the study was to implement a PCDCT-adapted contrast media dose protocol to reduce contrast agent volume at sufficient diagnostic quality. Findings PCDCT enables substantial contrast dose reduction for TAVR planning with maintained diagnostic image quality. Low-keV virtual monoenergetic image reconstructions compensate for the reduced iodine concentration. Clinical relevance The study demonstrates the potential of contrast media reduction of PCD-CT in clinical routine. This can benefit patients with renal impairment, for example, and reduce the negative effects of iodinated contrast media on the environment.

A systematic review and study-level meta-analysis investigating the association between pre-endovascular intervention C-reactive protein levels and femoropopliteal artery restenosis.

Cryopreserved Superficial Femoral Artery Allografts for Redo Infrainguinal Bypasses: A Single Center Experience.