Iliac Artery Research Articles

Challenging the angiosome concept: Delineating peripheral arterial disease patterns in diabetic foot ulcers.

The angiosome concept has significantly impacted diabetic foot ulcer management by highlighting the vascular anatomy's role in wound healing. However, its clinical applicability and validity remain debated due to complexities in foot blood supply and ulcer location determination. A cross-sectional study was conducted on 84 individuals with diabetic foot ulcers undergoing lower limb angiography. Demographics, ulcer characteristics, and angiographic data were collected and analyzed using descriptive statistics and relevant tests. Digital subtraction angiography assessed 89 limbs with diabetic foot ulcers; males comprised 54.8%, primarily type 2 diabetes (96.4%), averaging 64.36 ± 10.09 years. Of 129 angiosomes, angiosome 2 (40.3%) had the highest ulcer incidence. Posterior tibial artery (PTA) involvement was predominant (72.9%), while external iliac artery (EIA) and profunda femoris artery (PFA) were least affected (2.4% each). Posterior tibial artery showed 46.5% complete occlusion. Angiosome 2 correlated notably with anterior tibial artery (ATA), peroneal artery (CPA), and PTA, but categorizing angiosomes by supply patterns showed no significant artery correlation (p > .05). The research indicates inconsistent support for below-the-knee artery involvement correlating with foot ulcer locations in angiosomes. While aiding vascular comprehension, the angiosome concept may not fully elucidate lower limb vascular complexities and ulcer genesis. Factors like collateral circulation should be noticed to understanding ulcer localization and severity, extending beyond angiosomal arterial supply.

Recanalization of superficial femoral artery chronic total occlusion through retrograde popliteal approach recanalization of superficial femoral artery chronic total occlusion

PurposeThis retrospective study aims to evaluate the safety, practicality, and efficacy of the independent retrograde popliteal approach for recanalization superficial femoral artery (SFA) occlusions when the bilateral common femoral artery approach is unavailable, such as after endovascular aneurysm repair or common iliac artery stenting. MethodsThis treatment was considered for patients with contralateral iliac artery occlusion, severe iliac tortuosity, or those who had previously undergone endovascular aneurysm repair or common iliac stenting. Patients with SFA lesions extending into the P1–P2 segment of the popliteal artery or with calcification in the P3 segment were excluded. Angioplasty and stenting were conducted via the popliteal artery approach, with hemostasis at the puncture site achieved using an EXOSEAL vascular closure device. Patients were routinely followed up at 3, 6, and 12 months, and annually thereafter. ResultsForty-eight consecutive patients with SFA occlusion who underwent endovascular treatment via the retrograde popliteal artery approach were included in this study. Retrograde puncture of the popliteal artery was successful in all cases. Six-French sheaths were utilized in all procedures. The EXOSEAL vascular closure device was successfully applied in all 48 cases. No instances of pseudoaneurysms, arteriovenous fistulas, major bleeding, or embolic complications were observed. The technical success rate for SFA recanalization was 100 %. All patients experienced clinical improvement. The ankle-brachial index significantly increased from an initial 0.33 ± 0.11 at admission to 0.81 ± 0.19 at discharge (P < 0.001). The mean follow-up period was 25.1 ± 11.7 months. Kaplan-Meier analysis revealed primary patency rates of 82.5 % at 12 months and 71.8 % at 24 months. No patients required major amputation during the follow-up period. ConclusionThe endovascular treatment of SFA occlusions via the independent retrograde popliteal approach is a viable alternative, demonstrating a low incidence of puncture-related complications and a high success rate of recanalization.

Determining risk factors for vascular and bleeding complications after TAVR using CT angiography

Abstract Funding Acknowledgements None. Introduction The use of pre-procedural computed tomography angiography (CTA) of the iliofemoral sector in the planning of transaortic valve replacement (TAVR) has demonstrated a reduction in the risk of vascular complications in patients undergoing TAVR. In this study, we aimed to characterise the clinical and radiological factors associated with bleeding and vascular complications after TAVR. Methods Patients undergoing transfemoral TAVR in a tertiary centre between 2017 and 2019 were included in this analysis. All patients underwent iliofemoral CTA before the procedure and classical CTA-derived data as well as iliofemoral calcium volume were collected. Clinical data and outcomes regarding bleeding events, as well as vascular complications according to Valve Academic Research Consortium 2 (VARC-2) criteria, were also collected. 207 patients were included in this analysis, of whom 53% were women. The median age was 82 years (IQR 76-86) and the median STS mortality risk score was 3.9% (IQR 2.59-5.99). In this population, vascular complications according to the VARC-2 criteria occurred in 33% of patients (19% with major complications). Patients with lower body mass index (BMI) were more likely to suffer vascular complications. Vascular access with fluoroscopy was associated with a higher prevalence of complications compared to ultrasound-guided vascular access (62% vs. 38%, p=0.037). When considering radiological criteria, smaller minimum luminal diameter and area of the common femoral and external iliac arteries were associated with a greater risk of vascular complications, as were increased sheath to external iliac artery ratios and luminal attenuation values (p&amp;lt;0.05 for all). Bleeding complications occurred in 20 patients, with a greater prevalence of bleeding events in female patients (77% vs. 23%, p=0.001). Patients with a lower BMI, a history of obstructive pulmonary disease or coronary artery disease, aortic insufficiency and fluoroscopic valvular access were more likely to have bleeding complications. Regarding radiological criteria, decreased maximal luminal diameter of the common femoral artery and smaller minimal luminal diameters and areas of the external iliac artery were associated with bleeding complications. Increased sheath-to-femoral artery ratios and luminal attenuation values were associated with an increased risk of vascular complications (p&amp;lt;0.05 for all). Conclusion Our study underscores the importance of pre-procedural CTA in TAVR planning and identifies separate risk factors for vascular and bleeding complications.

A Geant Abdominal Aortic Aneurysm Who Hides Others: A Case Report

A 67-year-old man with a history of MCA (middle cerebral artery) aneurysm, smoking, and arterial hypertension, presented to the emergency department with abdominal pain and a pulsatile mass. The patient's vital signs were within normal ranges. On physical examination, the patient was mildly discomforted due to abdominal pain. His abdomen was soft, with tenderness in the right lower quadrant, and a pulsatile mass was present. A CT scan of the abdomen and pelvis with intravenous iodinated contrast revealed an aneurysmal dilatation of the abdominal aorta measuring 7 cm in diameter, beginning inferior to the level of the renal arteries and continuing to the iliac bifurcation with thrombosis of the right common iliac artery extending its branches. Associated with an aneurysmal dilatation of the celiac trunk and the splenic artery. There was extensive mural thrombus, a patent lumen, and no evidence of frank rupture.

Acute Infrarenal Abdominal Aortic and Bilateral Common Iliac Artery Occlusions in an Elderly Female: A Case Report

Acute Infrarenal Abdominal Aortic and Bilateral Common Iliac Artery Occlusions in an Elderly Female: A Case Report

Effect of lidocaine on intraoperative blood pressure variability in patients undergoing major vascular surgery

BackgroundDynamic fluctuations of arterial blood pressure known as blood pressure variability (BPV) may have short and long-term undesirable consequences. During surgical procedures blood pressure is usually measured in equal intervals allowing to assess its intraoperative variability, which significance for peri and post-operative period is still under debate. Lidocaine has positive cardiovascular effects, which may go beyond its antiarrhythmic activity. The aim of the study was to verify whether the use of intravenous lidocaine may affect intraoperative BPV in patients undergoing major vascular procedures.MethodsWe performed a post-hoc analysis of the data collected during the previous randomized clinical trial by Gajniak et al. In the original study patients undergoing elective abdominal aorta and/or iliac arteries open surgery were randomized into two groups to receive intravenous infusion of 1% lidocaine or placebo at the same infusion rate based on ideal body weight, in concomitance with general anesthesia. We analyzed systolic (SBP), diastolic (DBP) and mean arterial blood (MAP) pressure recorded in 5-minute intervals (from the first measurement before induction of general anaesthesia until the last after emergence from anaesthesia). Blood pressure variability was then calculated for SBP and MAP, and expressed as: standard deviation (SD), coefficient of variation (CV), average real variability (ARV) and coefficient of hemodynamic stability (C10%), and compared between both groups.ResultsAll calculated indexes were comparable between groups. In the lidocaine and placebo groups systolic blood pressure SD, CV, AVR and C10% were 20.17 vs. 19.28, 16.40 vs. 15.64, 14.74 vs. 14.08 and 0.45 vs. 0.45 respectively. No differences were observed regarding type of surgery, operating and anaesthetic time, administration of vasoactive agents and intravenous fluids, including blood products.ConclusionIn high-risk vascular surgery performed under general anesthesia, lidocaine infusion had no effect on arterial blood pressure variability.Trial registrationClinicalTrials.gov; NCT04691726 post-hoc analysis; date of registration 31/12/2020.

Exploring the Significance of Katikataruna Marma: An Ayurvedic Perspective on Vital Energy Center

This review article delves into the intricate concept of Marma points within the framework of Ayurvedic philosophy, with a specific focus on the Katikataruna Marma located in the Prushta region. Marma points, regarded as vital energy centers, house Prana, and hold profound implications for health. The Katikataruna Marma, characterized as a Kalantarapranahara Marma, embodies a delicate balance of Soumya and Agneya qualities, with their interplay dictating the trajectory of life. The precise location of Katikataruna Marma is explored across references, positioned either beside the vertebral column or above the Sphik on the Shronikarna. Anatomically, this Marma amalgamates diverse components: muscular elements such as the gluteal and pelvic muscles, vascular intricacies involving the internal iliac artery, neural and connective structures like sacro-iliac ligaments and lumbo-sacral nerves, skeletal components comprising the iliac bone and sacrum, and the pivotal sacro-iliac joint. Critical insights emerge regarding the aftermath of injuring the Katikataruna Marma. A disruption in the equilibrium of Soumya and Agneya Guna triggers a gradual decline, with blood loss (Shonita kshaya) inducing symptoms like anemia, pallor, malaise, and ultimately, mortality. Prognosis unfolds, emphasizing the manifestation of Pandu, Vaivarna, and Hina Rupa, elucidating the complex interplay between components in the Marma region. By dissecting the intricacies of the Katikataruna Marma, this article contributes to a deeper comprehension of Ayurvedic principles and their holistic approach to wellness. The exploration of Marma points transcends anatomical facets, resonating with Ayurveda's holistic philosophy of harmonizing physical, mental, and spiritual well-being.

Endovascular repair of bilateral common iliac artery aneurysms using intraoperative positioning system

Intraoperative positioning system (IOPS; Centerline Biomedical, Inc) is a novel technology that allows for real-time intravascular navigation of endovascular devices using an electromagnetic field. In this report, we describe the use of IOPS for effective treatment of bilateral common iliac artery aneurysms with endovascular aortoiliac repair using iliac branch endoprostheses. Our experience suggests that this technology has the potential to reduce radiation and contrast use in endovascular procedures, although its application is currently limited. To the best of our knowledge, this is the first reported case of bilateral internal iliac cannulations for iliac branch endoprosthesis placement using IOPS.

Resurfacing of multiple adjacent defects with free multipaddle SCIAP flaps

BackgroundThe efficient resurfacing of multiple adjacent defects (MADs) requires precise reconstructive strategy. Various approaches (e.g., several flap transferring or prelamination of the recipient site) have been reported, but recipient-site impairments, pain, long hospitalization, and low cost-benefit results fatefully considered them as compromise approaches. This study aims to evaluate the feasibility of MADs reconstruction with free multipaddle superficial circumflex iliac artery perforator (SCIAP) flaps. MethodsFrom Dec 2015 to Dec 2020, we enrolled patients with upper and lower extremity defects treated with various multipaddle SCIAP flaps (2-paddle, 3-paddle, and 4-paddle). Patient demographics and outcomes of each group were collected. ResultsThirty-two, 21, and 6 patients underwent 2-paddle, 3-paddle, and 4-paddle SCIAP flaps transfers, respectively. All multipaddle SCIAP flaps survived without vascular problems, and the donor sites were closed directly. Except for 3 cases of 2-paddle SCIAP flaps drained by superficial circumflex iliac vein venous return, most cases (n = 56) were drained by venae comitans. Minor complications, including partial flap necrosis (4 cases) and lateral femoral cutaneous nerve palsies (11 cases), were treated conservatively. All patients were satisfied with the reconstructive outcome. ConclusionMultiple adjacent defects reconstruction is still a Gordian knot and lacks a golden standard. The free multipaddle SCIAP flap was demonstrated as a promising alternative, not only enriching its versatility but also initially highlighting the “replace need with need” reconstructive demand.

Novel benzimidazole angiotensin receptor blockers with anti-SARS-CoV-2 activity equipotent to that of nirmatrelvir: computational and enzymatic studies

ABSTRACT Background Hypertension worsens outcomes in SARS-CoV-2 patients. Sartans, a type of antihypertensive angiotensin receptor blocker-(ARB), reduce COVID-19 morbidity and mortality by targeting angiotensin-converting enzyme-2 (ACE2). This study aimed to evaluate the antiviral and antihypertensive effects of nirmatrelvir, commercial sartans (candesartan, losartan, and losartan carboxylic (Exp3174)), and newly synthesized sartans (benzimidazole-N-biphenyl carboxyl (ACC519C) and benzimidazole-N-biphenyl tetrazole (ACC519T)), compared to nirmatrelvir, the antiviral component of Paxlovid. Research design and methods Surface plasmon resonance (SPR) and enzymatic studies assessed drug effects on ACE2. Antiviral abilities were tested with SARS-CoV-2-infected Vero E6 cells, and antihypertensive effects were evaluated using angiotensin II-contracted rabbit iliac arteries. Results Benzimidazole-based candesartan and ACC519C showed antiviral activity comparable to nirmatrelvir (95% inhibition). Imidazole-based losartan, Exp3174, and ACC519T were less potent (75%–80% and 50%, respectively), with Exp3174 being the least effective. SPR analysis indicated high sartans-ACE2 binding affinity. Candesartan and nirmatrelvir combined had greater inhibitory and cytopathic effects (3.96%) than individually (6.10% and 5.08%). ACE2 enzymatic assays showed varying effects of novel sartans on ACE2. ACC519T significantly reduced angiotensin II-mediated contraction, unlike nirmatrelvir and ACC519T(2). Conclusion This study reports the discovery of a new class of benzimidazole-based sartans that significantly inhibit SARS-CoV-2, likely due to their interaction with ACE2.

Predictive Factors for Iliac Limb Occlusions After Endovascular Abdominal Aneurysm Repair: Determined from Aortoiliac Anatomy, Endovascular Procedures, and Aneurysmal Remodeling.

Iliac limb occlusion (ILO) is a serious complication of endovascular abdominal aneurysm repair (EVAR). This study aimed to identify predictive factors for ILO derived from aortoiliac morphology, endovascular procedure-related parameters, and aneurysmal remodeling characteristics. Patient demographics, pre-EVAR anatomical characteristics of the aneurysm, endovascular procedure details, and post-EVAR aneurysmal remodeling outcomes were analyzed and compared using univariate analysis. Statistically significant factors were subsequently subjected to Cox regression and Kaplan-Meier analyses. Between January 2013 and April 2022, 66 patients were included in this study. Fourteen patients presented with ILO and were compared with 52 control patients with patent endograft limb over at least 1-year of follow-up. The tortuosity indices of the common iliac artery (CIA) and endograft iliac limb to vessel oversizing were significantly larger in the ILO group than in the patent endograft limb group. The CIA index of tortuosity ≥1.08, and endograft iliac limb to vessel oversizing ≥18.8% were independent predictors for ILO. During the follow-up of all patients, the proximal aortic neck and CIA diameters increased, aneurysm sac diameter decreased, and aortic neck and aortic length increased. The aortoiliac length increased over time in patients with patent endograft limb but not in patients with ILO. A change in the lowest renal artery-left iliac bifurcation distance ≦0.07 mm increased the risk of ILO. ILO is predisposed to occur when the CIA index of tortuosity ≥1.08 and endograft iliac limb to vessel oversizing ≥18.8% are present. Significant aortoiliac remodeling, including proximal aortic neck dilatation, neck straightening, aneurysmal sac regression, iliac artery enlargement, and aortic lengthening, occurs after EVAR. Aortoiliac elongation was observed in patients with patent endograft limb, but not in patients with ILO. ILO was associated with a change in the lowest renal artery-left iliac bifurcation from the postoperative measurements ≦ 0.07 mm.

Abstract 1154: Length And Proximal Extent Of Occlusion Dictates Severity Of Disease In A Mini-swine Model Of PAD

Background: There is ongoing need for large animal models of peripheral artery disease (PAD) that replicate human disease. We present mild (MI), moderate (MD) and Severe (S) phenotypes of PAD in an Ossabaw mini-swine platform. Methods: Metabolic syndrome was induced in swine (N=16; age= 4 mo) with a high fat/fructose/sodium diet for 8 weeks. Ischemia induction (T0) consisted of: (1) open ligation and resection of R Superficial Femoral Artery (SFA) for MI(N=4); (2) endovascular coil occlusion of R External Iliac Artery (REIA), RSFA and popliteal artery for MD (N=9); and (3) coil occlusion of REIA, RSFA, and right internal iliac artery (RIIA) for S (N=4). At 4 weeks (T4) and 8 (T8), all swine underwent angiography via carotid access, and bilateral gastrocnemius biopsy. All swine had measurements of ankle brachial indices (ABIs), and calf muscle tissue oximetry (STO 2 ) measurements at T0, T4 and T8, along with weekly measurement of walking performance on a treadmill (WP). Results: At T4 and T8 R ABI were increasingly decreased from MI to MD to S (table 1). Mean STO 2 difference between R and L calf at T4 and T8 had no changes in MI, while the differences were larger in S compared to MD (table 1). WP was increasingly decreased from MI to MD to S (table 1). The artery that grew the most on angiography at T4 and T8 were R profunda artery (RPFA) in MI; RIIA in MD; and LIIA in S (table 1). In MI, R PFA had faster flow at T4 and T8 compared to L PFA. At T4, MD and S had similar delays of RPFA reconstitution, this improved at T8 in MD but did not in S (table 1). On histology, MI had no obvious myopathy, MD and S had moderate and severe myopathy respectively. All S subjects developed poorly-healing ischemic ulcers. Conclusion: Length and proximal extent of occlusion dictated the characteristics and severity of phenotypes in our Ossabaw swine model of PAD. This mirrors PAD in humans and can be used to develop therapies for different disease severities.

Induction of Controllable Vortex Flow in a New Aorta Stenosis Model for Potential Aorta Mechanobiology Study: A Flow Simulation Platform

Background: Abdominal aortic aneurysms (AAA) are common, particularly among individuals over age 65, with a prevalence of 9%. To better understand the natural history of AAAs, one critical knowledge gap must be filled to elucidate the role of vortical flow in vascular degradation and thrombosis formation. We aimed to induce various types of vortical flow with aneurysm-like hemodynamic environments using a novel aorta stenosis model. Such a model will enable us to investigate the interplays between disturbed hemodynamics and vascular pathological remodeling. Methods: In this study, the hemodynamics and geometry of the aorta in rabbits were used to simulate the physiological flow conditions after two adjacent stenoses were created virtually with varying degrees of area reduction (30-70%) and spacing (5-6.8 mm). A physiological blood flow (rate) waveform measured in rabbits using ultrasound Doppler (normalized to 3.0 mL/s) was prescribed to the inlet (i.e., descending aorta), and zero pressure boundary conditions were applied at two outlets (i.e., iliac arteries). 3D computational fluid dynamics (CFD) simulation in five different stenosis configurations was performed using commercial software (Fluent, Version 20, Ansys Inc., PA). In-house software assessed the evolution of flow vortices over three distinct regions post stenosis using an established method. The total volume of vortex flow, the number of vortices, and the phase-to-phase overlap of vortex flows within different post-stenosis regions were derived to characterize the vortex flow. Results: Quantitative and qualitative flow assessments were performed for all five CFD models. Firstly, in all models, we found consistent patterns of the three vortex flow parameters, indicating that the adjacent stenoses induced three different hemodynamic zones in the post-stenosis regions, namely, stable vortical flow (after first stenosis), transient flow (after second stenosis), unstable vortical flow (further distal to second stenosis). Moreover, increased stenosis degree or reduced spacing led to reduced vortex flow number but increased total volume of vortex flow. The distinctions of the three regions were most significant in the model with 50% and then 30% stenoses, and with a 5 mm (center-to-center) spacing between two stenoses. Conclusions: CFD simulations can offer a powerful tool to predict complex flows using subject-specific vasculature. Such a flow simulation platform is valuable for guiding experimental design or therapy in various diseases. We demonstrated that it is feasible to adjust and achieve multiple types of vortical flows with the novel stenosis model. The three zones with distinct hemodynamic environments allow us to investigate the vascular remodeling regulated by the specifics of the eddies. Our ongoing work is implementing optimized aorta stenosis models to preclinical or in vitro studies to reveal the interplays between varying disturbed flow and aneurysm remodeling. We acknowledge funding support from NIH/NIBIB (R01-EB029570A1) and the Health Research Institute of Michigan Technological University. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Abstract 1153: Adipose-derived Mesenchymal Stem-cell Therapy Improves Arteriogenesis, Hemodynamics, And Walking Performance In A Porcine Model Of Peripheral Artery Disease

Background: There are few effective alternatives to revascularization for peripheral artery disease (PAD). We used our porcine model of PAD to test the hypothesis that adipose derived mesenchymal stem cells (ADMSC) injected around the aortic trifurcation in the pelvis improve ischemic limb hemodynamics and walking performance (WP). Methods: In Ossabaw miniswine (N=13, Age=6 mo) with metabolic syndrome, right (R) hindlimb ischemia was induced with R External Iliac and Superficial Femoral artery coil occlusion (T0) via carotid artery access. All swine had weekly testing of WP on a treadmill. At weeks 0 (T0), 4 (T4), and 8 (T8), ankle brachial indices (ABI) and muscle tissue oximetry (STO 2 ) were measured. At T4 and T8 all swine underwent angiography. At T4, in treatment (Tx) swine (N=4) ADMSC were isolated using stromal vascular fractionation of autologous abdominal wall fat. Using jugular vein access, a catheter with a retractable side-deploying needle was inserted in the R iliac vein and stabilized by a juxtaposed angioplasty balloon. The needle was deployed to access the retroperitoneum and ADMSC were infused around the aortic trifurcation. Results: Ischemic controls (IC) had no differences between T4 and T8 in ABIs, and mean STO 2 differences between R and L in calves and thighs. Tx improved both ABI and mean STO 2 measurements (table 1). IC had no changes in WP between T4 and T8, while Tx showed improvements (table1). On angiography, IC had growth of R Internal iliac artery (RIIA, the main inflow to the ischemic R hindlimb) and shorter appearance time (AT) of RIIA compared to L with no difference between T4 and T8. Tx showed increased growth of RIIA and shorter AT at T8 compared to T4 (table 1). Conclusion: In a clinically-relevant (similar to humans in size, anatomy, physiology and comorbidities) porcine model of PAD we found that ADMSC injection around the aortic trifurcation in the pelvis induces arteriogenesis and improves ischemic limb hemodynamics and walking performance.

Mitochondrial and Microvascular Impairments in a Novel Swine Model of Peripheral Artery Disease

Introduction: Impaired skeletal muscle mitochondria and microvascular function have been reported in human peripheral artery disease (PAD). However, no large animal models of PAD have mimicked these impairments. Purpose: The purpose of this study was to examine the skeletal muscle microvasculature and mitochondria in a novel swine model of PAD. Hypothesis: We hypothesized that hindlimb ischemia leads to dysfunction of skeletal muscle microvessels and mitochondria. Methods: Ossabaw swine (n=5) with metabolic syndrome underwent endovascular coil occlusion of the right external iliac artery to generate hindlimb ischemia (ISC). The left leg served as a non-ischemic control (CON). After 4-weeks, biopsies were collected from both legs (lateral gastrocnemius). Skeletal muscle arterioles were assessed using video microscopy. Microvascular vasodilatory function was assessed in response to flow (Shear stress), acetylcholine (ACh), and sodium nitroprusside (SNP). Skeletal muscle mitochondrial function was assessed using high-resolution respirometry. Substrates were administered as follows: malate (M) &amp; glutamate (G), adenosine diphosphate (ADP), succinate (S), oligomycin, and ascorbate (Asc) &amp; N,N,N,N-tetramethyl-phenylenediamine (TMPD). Complex I state 2 (CI-S2) was assessed as M+G, complex I state 3 (CI-S3) was assessed as (M+G+ADP)-(M+G), complex II state 3 (CII-S3) was assessed as (M+G+ADP+S)-(M+G+ADP), complex I&amp;II state 3 (CI&amp;II S3) was assessed as (M+G+ADP+S)-(M+G), state 4 (S4) was assessed after oligomycin, and complex IV (CIV) respiration was assessed after Asc+TMPD. The respiratory control ratio (RCR) was calculated as CI&amp;II-S3/S4. Results: Vasodilation in response to flow was reduced in ISC vs. CON (Δ-13.1±13.7%, p=0.01). but not in response to ACh (Δ-6.2±17.7%, p=0.23) or SNP (Δ1.7±11.0%, p=0.53). Additionally, CI-S2 (Δ-0.3±3.7 pmolO2·s−1·mg−1, p=0.65), S4 (Δ-1.7±4.4 pmolO2·s−1·mg−1, p=0.14), and CIV (Δ-2.8±20.9 pmolO2·s−1·mg−1, p=0.65) were not different between ISC and CON. However, CI-S3 (Δ-4.7±5.0 pmolO2·s−1·mg−1, p&lt;0.01), CII-S3 (Δ-3.5±5.0 pmolO2·s−1·mg−1, p=0.02), CI&amp;II-S3 (Δ-8.5±8.7 pmolO2·s−1·mg−1, p&lt;0.01), and RCR (Δ-0.8±1.3 pmolO2·s−1·mg−1, p=0.04) were all reduced in ISC vs. CON. Conclusions: We found that skeletal muscle microvessels and mitochondria were impaired in our swine model. Based on the present findings, we conclude that our novel porcine model closely replicates the pathophysiology PAD, making it a promising large animal model for studying human PAD. This research was supported by the National Institutes of Health (R01HD106911, R01AG062198, R01AG0778031) and the Great Plains IdeA-CTR (U54 GM115458). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Abstract 2033: Bone Marrow-Derived Macrophage Extracellular Vesicles From Diabetic Mice Suppress Angiogenic Properties In Endothelial Cells

Introduction: Peripheral artery disease (PAD), increased in diabetes, leads to mortality and disability. Diabetes promotes a proinflammatory macrophage phenotype that suppresses repair. Macrophage-derived extracellular vesicles (EVs) have been associated with tissue damage. We hypothesize that diabetes perturbs macrophage EV cargo, thereby contributing to impaired repair responses to PAD/ischemia. Methods: Unilateral ligation of the left femoral artery (FAL) was performed to induce hind limb ischemia (HLI) in diabetic Akita (C57BL/6-Ins2 Akita /J) vs. non-diabetic (NDM, C57BL/6J) male mice. Murine BMDMs were grown in Exo-free medium. Ultracentrifugation was used to isolate EVs. Western blotting, transmission electron microscopy (TEM) and ZetaView nanoparticle tracking analysis were used to characterize EV size, number, concentration, and morphology. We profiled EV microRNA (miRNA) and protein cargos from Akita vs. NDM BMDM mice. Results: BMDMs-EV size was similar in Akita and NDM mice (diameter, 20-200nm). TEM showed cup-shaped morphology. Western blot confirmed known positive and negative control exosomal markers. Comparing Akita vs. NDM BMDM EVs, a total of 3277 proteins were identified; 821 proteins were significantly differentially expressed. Enrichment analysis highlighted pathways predominantly related to oxidative stress, insulin signaling, actin cytoskeleton, CLEAR, lipid metabolism, phagosome maturation, RNA binding and DNA replication. A total of 912 EV miRNAs were identified; 39 were significantly up-regulated and 19 were down-regulated. Preliminary analysis links a number of them to endothelial function and angiogenesis. In vitro , endothelial tube formation was impaired in human iliac artery endothelial cells treated with diabetic vs. NDM BMDM EVs. BMDM treated with diabetic vs. WT EVs displayed increased expression of inflammatory genes (TNF, IL-6,) and reduced expression of mitochondrial complex I and complex II proteins. Conclusion: We identified microRNAs and distinct proteins from diabetic EVs as potential mediators of impaired endothelial function and resolution of inflammation. Targeting macrophage EVs composition might identify therapeutic approaches to prevent and treat PAD in diabetes.

Efficacy and Safety Analyses of Recombinant Factor VIIa in Severe Post-Partum Hemorrhage.

Background: Despite a range of available treatments, it is still sometimes challenging to treat patients with severe post-partum hemorrhage (sPPH). Objective: This study evaluated the efficacy and safety of recombinant activated factor VIIa (rFVIIa) in sPPH management. Methods: An open-label, multi-center, randomized controlled trial (RCT; NCT00370877) and four observational studies (OS; OS-1 (NCT04723979), OS-2, OS-3, and OS-4) were analyzed regarding efficacy (need for subsequent invasive procedures, including uterine compression sutures, uterine or iliac artery ligations, arterial embolization, or hysterectomy) and safety (incidence of thromboembolic events (TE) and maternal mortality) of rFVIIa for sPPH. The RCT, and OS-1 and OS-2, included a control group of women who did not receive rFVIIa (with propensity score-matching used in OS-1 and OS-2), whereas OS-3 and OS-4 provided descriptive data for rFVIIa-exposed women only. Results: A total of 446 women exposed to rFVIIa and 1717 non-exposed controls were included. In the RCT, fewer rFVIIa-exposed women (50% [21/42]) had an invasive procedure versus non-exposed women (91% [38/42]; odds ratio: 0.11; 95% confidence interval: 0.03-0.35). In OS-1, more rFVIIa-exposed women (58% [22/38]) had an invasive procedure versus non-exposed women (35% [13.3/38]; odds ratio: 2.46; 95% confidence interval: 1.06-5.99). In OS-2, 17% (3/18) of rFVIIa-exposed women and 32% (5.6/17.8) of non-exposed women had an invasive procedure (odds ratio: 0.33; 95% confidence interval: 0.03-1.75). Across all included women, TEs occurred in 1.5% (0.2% arterial and 1.2% venous) of rFVIIa-exposed women and 1.6% (0.2% arterial and 1.4% venous) of non-exposed women with available data. Conclusions: The positive treatment effect of rFVIIa on the RCT was not confirmed in the OS. However, the safety analysis did not show any increased incidence of TEs with rFVIIa treatment.

Posttraumatic Scrotal Reconstruction with a Pedicled "Extended" Superficial Circumflex Iliac Artery Perforator Flap: A Case Report.

The superficial circumflex iliac artery (SCIA) perforator (SCIP) flap has been used for scrotal reconstruction after Fournier's gangrene, skin cancer, or infections. However, there are few publications with regard to penoscrotal reconstruction after a traumatic injury with this flap. In this article, we propose a new SCIP flap variation, the "extended" or "direct" SCIP flap, to effectively reconstruct a wide scrotal defect after a traumatic injury. The "extended" SCIP flap is designed medial and cranial to the anterosuperior iliac spine (ASIS) using the superficial branch of the SCIA as the main pedicle.

Kidney Transplant Loss Due to May-Thurner Syndrome: Case Report and Review of the Literature

May-Thurner syndrome (MTS) is an extrinsic venous compression by the arterial system against bony structures in the iliocaval territory. 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. The prevalence of MTS is unknown; therefore, there are only a few publications about MTS in kidney transplant recipients. Risk factors that may progress from usually asymptomatic to symptomatic MTS are female sex, scoliosis, dehydration, coagulation disorders, and radiation. Clinical presentations include acute extremity pain and swelling, venous claudication, and chronic signs of venous insufficiency. We describe a 63-year-old man who underwent kidney transplantation (left iliac fossa). Four days after transplantation, a graftectomy was done due to graft rupture caused by renal vein thrombosis. After imaging studies, a diagnosis of MTS was established. The patient had no typical symptoms of MTS. However, an incidence of right lower limb thrombosis was observed, and due to vertebral discopathy, the patient underwent surgery with implantation of a vertebral implant. After a successful second transplantation on the right side, incidents of thrombosis were observed: superficial thrombosis of the upper limbs and massive deep vein thrombosis of the right lower limb. Thrombophilia was recognized, the graft function is stable, and anticoagulation therapy is being continued. Asymptomatic MTS in the case of coincidence of other risk factors, such as coagulation disorders, history of vertebral operation, and additional pressure of the graft, can result in graft failure.

Abstract 3088: Inferior Vena Cava (IVC) Thrombosis In A Patient With May Thurner Syndrome: A Rare Case Of Thrombotic Iliocaval Obstruction In Octogenarian Population.

Introduction: May Thurner Syndrome is an extrinsic compression of the left common iliac vein by the right common iliac artery against lumbar spine. It is a rare cause of the lower extremity deep venous thrombosis (DVT) in octogenarian population. There is barely any data to document the association of IVC thrombosis with May Thurner Syndrome. Blood stasis in the setting of venous compression can increase the risk for DVT distally but proximal DVT is rare in absence of any other risk factors of thromboembolism. Case Representation: We present a unique case of 86-year-old female who was incidentally diagnosed with IVC thrombosis, left common iliac vein thrombosis, and left sided May Thurner Syndrome that is never documented before in octogenarian population. She had IVC thrombosis extending to the left common iliac vein with extrinsic compression by the right common iliac artery. This case is unique as our patient did not have any risk factor for venous thrombosis other than May Thurner Syndrome. Conclusion: May Thurner Syndrome can increase the risk for DVT proximal propagation and IVC thrombosis. The management of IVC thrombosis and May Thurner Syndrome in octogenarian population needs to account for risk of pulmonary embolism and mortality when avoiding anticoagulation compared to risk of morbidity and mortality from bleeding with anticoagulation. The decision to further manage depends upon clinical features, risk factors and institutional resources.