Left Femoral Artery Research Articles

Endovascular management of aortic aneurysm with severe neck angulation and/or iliac artery tortuosity using multiple stiff wire technique: a case series

Background: Suitable aortic neck is one of the essential components for thoracic endovascular aortic repair (TEVAR) and endovascular aortic repair (EVAR). Advanced techniques were developed to adjust and compromise the aneurysm neck angulation but with adding additional devices and complexity to the procedure. We proposed a simple technique to modify severe neck angulation and/or iliac artery tortuosity by using the multiple stiff wire (MSW) technique. Method: Two femoral accesses were required for the MSW technique. A guidewire with a support catheter was inserted through the right and left femoral arteries and positioned in the abdominal or thoracic aorta. Wire exchanges were done with extra stiff wire in both femoral accesses. It can be considered to add multiple stiff wires to align the torturous neck / iliac artery. Delivery of the stent graft main body can be done via one of the accesses. Result: Six patients with different aortic pathology were admitted to our hospital. Four patients undergo EVAR procedure and two patients undergo TEVAR procedure. All patients had aortic neck angulation problems with one patient having iliac artery tortuosity. MSW technique was performed on the patients with good results. Follow-up CTA after 3 months revealed a good stent position without stent migration and no endoleak was found in all but one patient. Conclusion: MSW technique is a simple and effective technique to modify aortic neck/artery angulation in TEVAR or EVAR procedure.

Prominent myocardial bridging as a first clue to recognize haemorrhagic shock during percutaneous coronary intervention: a case report

Abstract Background Haemorrhage at the puncture site is a serious complication of percutaneous coronary intervention (PCI). Case summary A 73-year-old man underwent transfemoral intervention because of stable angina pectoris. After a rotational atherectomy, an everolimus-eluting stent was implanted from the left main trunk to the proximal site of the left anterior descending (LAD) artery. We also recognized that myocardial bridging was significantly induced at the middle portion of the LAD, which was not evident before the PCI. We suspected puncture-related haemorrhage and immediately performed lower limb arteriography. As a result, contrast media extravasation was observed at the branch of the right inferior epigastric artery. Finally, we performed coil embolization into the left common femoral artery, and the extravasation successfully disappeared. Four months later, he underwent coronary angiography. There were no findings of myocardial bridging. Discussion Myocardial bridging during a PCI procedure may indicate hypercontraction because of haemorrhage.

Takotsubo Cardiomyopathy: Broken Heart Syndrome in A Tertiary Teaching & Referral Hospital in East Africa: Case Report & Literature Review

Purpose: Takotsubo cardiomyopathy (TC), also known as broken heart syndrome, refers to an abrupt and short-lived cardiac syndrome that encompasses dramatic left ventricular apical akinesia. besides mirroring acute coronary syndrome. Patients with Takotsubo cardiomyopathy (broken heart syndrome) usually present with symptoms that are similar to acute coronary syndrome. The patient commonly presents with chest pain, dyspnea, palpitation, nausea and vomiting, syncope as well as cardiogenic shock. However, Takotsubo cardiomyopathy usually occurs in association with a preceding physical or emotional stressful event.
 Methodology: A 25-year-old black female presented to the largest teaching & referral hospital in Kenya with chest pain, dyspnea, palpitations, nausea and vomiting. The patient was received in the emergency room where she was stabilized, a battery of investigations ordered and a diagnosis of TC was made after reviewing the results. She was managed as an inpatient on appropriate medication
 Findings: Patient generally responded positively to the treatment and tolerated well the surgical procedures. Follow up echocardiograms performed weekly revealed progressive reduction in size of the thrombus, which had completely resolved at 4 weeks. There was no more thrombi formation after thromboembolectomy of the left femoral artery.
 Recommendations: TC is a rescindable type of cardiomyopathy that is associated with good prognosis and an exceptional morphological characteristic of the left ventricle, that is defined by apical inflating appearance that has been recognized for nearly a quarter a century. We also recommend that patients with identified LV thrombus ought to be anticoagulated till LV function normalizes in addition to the thrombus no longer being present on echocardiogram.

A combined pig model to determine the net absorption of volatile fatty acids in the large intestine under different levels of crude fiber.

This study aimed to develop a combined model to quantify the net absorption of volatile fatty acids (VFA) in the large intestine (LI) of pigs. Fifteen female growing pigs (Duroc × Large White × Landrace) were ranked by body weight (30 ± 2.1 kg) on day 0 and assigned to one of three treatments, namely the basal diet containing different crude fiber (CF) levels (LCF: 3.0% CF, MCF: 4.5% CF, and HCF: 6.0% CF). The pigs were implanted with the terminal ileum fistula and the cannulation of the ileal mesenteric vein (IMV), portal vein (PV), and left femoral artery (LFA) from days 6 to 7. [13 C]-Labeled VFA and P-aminohippuric acid were constantly perfused into the terminal ileum fistula and the cannulation of the IMV (day 15), respectively. Blood samples were collected from the PV and the LFA during perfusion (5 h), and LI samples were collected. The net flux of [12 C]-acetic acid in the PV was greater for LCF versus MCF (p = 0.045), but no difference was observed in the net flux of [12 C]-propionic acid (p = 0.505) and [12 C]-butyric acid (p = 0.35) in the PV among treatments. The deposition of [12 C]-acetic acid in the LI was greater for LCF versus MCF (p = 0.014), whereas the deposition of [12 C]-propionic acid (p = 0.007) and [12 C]-butyric acid (p = 0.037) in the LI was greater for LCF versus HCF. In conclusion, this pig model was found conducive to study the net absorption of VFAs in the LI, and LCF had more net absorption of VFAs in the LI than MCF and HCF.

Bike stunt gone wrong – Fatal Impalement by Liquor Bottle, landing into the death

Sharp force injuries are the leading cause of death worldwide. Accidental deaths due to sharp force wounds are extremely rare compared to homicide and suicide cases. Therefore, their exact incidence or prevalence is not accurately known. This paper presents an accidental death due to massive blood loss resulting from the sharp cutting of the left femoral artery by glass fragments that impaled the left groin region of a young male. He was allegedly performing a bike stunt under the influence of alcohol. The body was found in a pool of blood, surrounded by multiple glass fragments from a broken alcohol bottle that was lying shattered next to the body. The autopsy revealed a near-total transection of the left femoral artery and significant glass injuries to the skin. Evidence of self-mutilation and scarification in multiple body regions highlighted risky behavior. To determine the circumstances of death in cases of accidental glass injuries, a thorough medico legal investigation, including details of the death scene, post-mortem examination, and chemical analysis of viscera for any intoxicants or stupefying agents, is always necessary.

Establishment of a Rat Model of Capillary Leakage Syndrome Induced by Cardiopulmonary Resuscitation After Cardiac Arrest.

Cardiopulmonary resuscitation (CPR) after cardiac arrest (CA) is one of the main causes of capillary leakage syndrome (CLS). This study aimed to establish a stable CLS model following the CA and cardiopulmonary resuscitation (CA-CPR) model in Sprague-Dawley (SD) rats. We conducted a prospective, randomized, animal model study. All adult male SD rats were randomly divided into a normal group (group N), a sham operation group (group S), and a cardiopulmonary resuscitation group (group T). The SD rats of the three groups were all inserted with 24-G needles through their left femoral arteries and right femoral veins. In group S and group T, the endotracheal tube was intubated. In group T, CA induced by asphyxia (AACA) was caused by vecuronium bromide with the endotracheal tube obstructed for 8 min, and the rats were resuscitated with manual chest compression and mechanical ventilation. Preresuscitation and postresuscitation measurements, including basic vital signs (BVS), blood gas analysis (BG), routine complete blood count (CBC), wet-to-dry ratio of tissues (W/D), and the HE staining results after 6 h were evaluated. In group T, the success rate of the CA-CPR model was 60% (18/30), and CLS occurred in 26.6% (8/30) of the rats. There were no significant differences in the baseline characteristics, including BVS, BG, and CBC, among the three groups (P>0.05). Compared with pre-asphyxia, there were significant differences in BVS, CBC, and BG, including temperature, oxygen saturation (SpO2), mean arterial pressure (MAP), central venous pressure (CVP), white blood cell count (WBC), hemoglobin, hematocrit, pH, pCO2, pO2, SO2, lactate (Lac), base excess (BE), and Na+ (P<0.05) after the return of spontaneous circulation (ROSC) in group T. At 6 h after ROSC in group T and at 6 h after surgery in groups N and S, there were significant differences in temperature, heart rate (HR), respiratory rate (RR), SpO2, MAP, CVP, WBC, pH, pCO2, Na+, and K+ among the three groups (P<0.05). Compared with the other two groups, the rats in group T showed a significantly increased W/D weight ratio (P<0.05). The HE-stained sections showed consistent severe lesions in the lung, small intestine, and brain tissues of the rats at 6 h after ROSC following AACA. The CA-CPR model in SD rats induced by asphyxia could reproduce CLS with good stability and reproducibility.

Spontaneous Pseudoaneurysm of the Left Superficial Femoral Artery: An Unusual Case Report and Review of Literature

Pseudoaneurysms are rare to occur and the rarest to occur in those who have not undergone surgical/endovascular procedures like catheterization. Such pseudoaneurysms are known as spontaneous pseudoaneurysms which are very less reported and reviewed. This generally occurs due to underlying pathological causes, the most common being atherosclerotic disease. The most common clinical presentation is a femoral artery pseudoaneurysm. Other less common presentations include aortic and visceral pseudoaneurysms. We describe here the occurrence of a pseudoaneurysm in a patient who has no history of endovascular procedures in the past and has a pseudoaneurysm showing a secondary change along with superadded infection of Acinetobacter baumannii. The case was radiologically diagnosed by a computed tomography scan of the abdomen and thigh, after which a surgical excision of the pseudoaneurysm was performed and the specimen was sent for the histopathological examination, which revealed secondary changes.

Acute Limb Ischemia Rutherford Classification III and COVID-19: A Case Report

Background: COVID-19 is caused by SARS-CoV-2 infections, which are responsible for the recent pandemic. COVID-19 infection increases thromboembolic events, including Acute Limb Ischemia (ALI) by causing elevated cytokine levels, systemic inflammation, hypercoagulation state, and hyperinflammation responses. This complication might cause loss of limbs. Case description: We report a case of a 61-year-old male with COVID-19 who developed an ALI. He presented to the emergency department with acute left leg pain since a day before admission and shortness of breath three days before admission. His left foot was bluish-discolored, cold to the touch, and mottled in appearance. Chest x-ray showed bilateral inhomogeneous consolidation. Left lower limb X-ray revealed a gangrenous appearance. CT-Angiography suggested severe distal stenosis of the left femoral artery with complete occlusion of its distal aspect. COVID-19 was diagnosed based on RT-PCR testing. He received antibiotics and anticoagulation. Unfortunately, he underwent an amputation procedure. Conclusion: A high index of suspicion should be maintained for ALI in COVID-19 patients, which is a vascular emergency. Some patients can achieve revascularization with observation or medical and/or surgical intervention, but other patients succumb to either amputation or death.

CARD10: Transapical Left Ventricular Assist Device Implantation Using a Novel Accessory in Swine

Background: Conventional left ventricular assist devices (LVADs) require an anastomosis of the outflow graft to the ascending aorta. We developed and tested a LVAD accessory, which combines pump in- and transaortic outflow in a dual lumen adapter, thus, allowing LVAD implantation solely via the left ventricular apex. Methods: The LVAD accessory (Fig. A) consisted of a 3D printed titanium inflow and a 12 mm outflow stent graft. The accessory in combination with a centrifugal LVAD (HeartMate 3, HM3, Abbott, USA) was implanted in 10 adult female Landrace pigs (104 ± 13 kg). A balloon catheter (14 mm Atlas Gold PTA Dilatation Catheter, BD, USA) was introduced via the left femoral artery and placed in the left ventricle. After lower partial sternotomy, pericardiotomy and fixation ring attachment, apical coring was performed in a standard fashion on the beating heart using cardiopulmonary bypass. The balloon was exteriorized, inflated in the outflow graft and both, the accessory with the attached outflow graft, were pulled into the left ventricle and the aorta. The accessory was attached to the fixation ring. The LVAD was connected and deaired, and the balloon catheter was removed. Results: After successful LVAD implantation in all animals, echocardiography revealed no signs of aortic or mitral regurgitation. In eight animals ramp testing was performed. The HM3 flow estimate increased from 3.7 ± 1.2 L/min at 4’500 rpm to 5.4 ± 1.2 L/min at 7’200 rpm (Fig. B). Post-mortem examination (Fig. C) revealed correct placement of the LVAD accessory with the inflow in the left ventricle (blue arrow) and the outflow graft across the aortic valve (yellow arrow). There were neither signs of damage of the aortic (*) or mitral valve (+) nor signs of thrombosis. Conclusion: The novel accessory in combination with a centrifugal LVAD allowed safe and less-invasive LVAD implantation. Ramp testing revealed effective left ventricular support in the acute swine model. Further testing in a chronic heart failure model will be performed to validate these results.

P6: Mechanical Circulatory Support for Acute Severe Aortic Regurgitation and Cardiogenic Shock

Background: We describe a case of cardiogenic and septic shock complicated by acute severe aortic regurgitation (AR) temporized by left-atrial-venoarterial (LA-VA) ECMO. Patient Presentation & Results: A 42-year-old female with end stage renal disease, type 2 diabetes, and osteomyelitis of the right foot on outpatient intravenous antibiotics presented with fevers. On initial evaluation, transthoracic echocardiogram (TTE) demonstrated normal left ventricular (LV) function with no valvular abnormalities and methicillin resistant staphylococcus aureus was identified in blood cultures. Despite several days of antibiotic treatment, the patient decompensated requiring intubation and vasopressors. Vitals were notable for a blood pressure of 80/10 mmHg. A repeat TTE demonstrated severe AR with leaflet perforation consistent with endocarditis. The patient suffered cardiac arrest and after return of spontaneous circulation, she was taken to the catheterization laboratory for mechanical circulatory support. Via the right femoral vein, initial transeptal puncture revealed a LA pressure of 35mmHg with V waves to 45mmHg. A 21Fr transeptal drainage cannula was placed in the LA with a 17Fr return cannula in the left common femoral artery for extracorporeal support with a Tandem Heart (Livanova) system. Right heart catheterization on 5Lpm of support along with epinephrine, levophed, dopamine and vasopressin were as follows: RA 13mmHg, PA 50/22 mmHg (mean 35mmHg, PA sat 53.5%) and CO/CI of 4.49/2.27 L/min/m2. Overnight the transeptal cannula was dislodged and an oxygenator was rapidly spliced converting the system to VA ECMO. On this configuration she underwent bedside guillotine amputation of the right foot and was then taken back to the catheterization laboratory where a second drainage cannula was placed into the LA, this time from the left femoral vein. A Y-connector was used to allow simultaneous inflow from both the displaced right atrial cannula (which was partially pulled into the IVC) and the new LA cannula into the pump (Picture 1). The patient underwent successful surgical aortic valve replacement (SAVR) with a 23mm Edwards Inspirus bioprosthesis. She was successfully weaned off circulatory support and ultimately discharged. Conclusion: Severe AR has been known to be a major contraindication for VA ECMO. In addition to hemodynamic instability and rapidly rising LA pressures with subsequent pulmonary edema, a noncompetent aortic valve makes MCS a unique challenge in cases of acute severe AR. In our case, normal LV function and unloading of the LA allowed for appropriate native LV output despite increased afterload from femoral artery return in the setting of severe AR. LA-VA ECMO created a window of hemodynamic stability to allow for amputation of an infected foot and successful SAVR.

Diet-induced obesity augments ischemic myopathy and functional decline in a murine model of peripheral artery disease

Peripheral artery disease (PAD) causes an ischemic myopathy contributing to patient disability and mortality. Most preclinical models to date use young, healthy rodents with limited translatability to human disease. Although PAD incidence increases with age, and obesity is a common comorbidity, the pathophysiologic association between these risk factors and PAD myopathy is unknown. Using our murine model of PAD, we sought to elucidate the combined effect of age, diet-induced obesity and chronic hindlimb ischemia (HLI) on (1) mobility, (2) muscle contractility, and markers of muscle (3) mitochondrial content and function, (4) oxidative stress and inflammation, (5) proteolysis, and (6) cytoskeletal damage and fibrosis. Following 16-weeks of high-fat, high-sucrose, or low-fat, low-sucrose feeding, HLI was induced in 18-month-old C57BL/6J mice via the surgical ligation of the left femoral artery at 2 locations. Animals were euthanized 4-weeks post-ligation. Results indicate mice with and without obesity shared certain myopathic changes in response to chronic HLI, including impaired muscle contractility, altered mitochondrial electron transport chain complex content and function, and compromised antioxidant defense mechanisms. However, the extent of mitochondrial dysfunction and oxidative stress was significantly greater in obese ischemic muscle compared to non-obese ischemic muscle. Moreover, functional impediments, such as delayed post-surgical recovery of limb function and reduced 6-minute walking distance, as well as accelerated intramuscular protein breakdown, inflammation, cytoskeletal damage, and fibrosis were only evident in mice with obesity. As these features are consistent with human PAD myopathy, our model could be a valuable tool to test new therapeutics.

P302 SIMULTANEOUS CORRECTION OF SEVERE LOW–FLOW LOW–GRADIENT AORTIC STENOSIS AND ABDOMINAL AORTIC ANEURYSM BY TAVI + EVAR

Abstract We report the case of a 72–year–old man with arterial hypertension, dyslipidemia, type 2 diabetes mellitus, and severe chronic obstructive pulmonary disease. The patient had a previous stroke with occlusion of both internal carotid arteries about 7 years ago. He presented to the emergency department with dyspnea on exertion (NYHA class III), and the echocardiogram revealed a dilated left ventricle with severe reduction of global systolic function (EF 35%), severe low–flow low–gradient aortic stenosis (AVA on VTI 0.526 cmq/mq, SVi 29.7 ml/mq, Gmax 25.6 mmHg, Gmed 16 mmHg), and abdominal aortic aneurysm. Subsequently, he underwent an angio–CT scan that showed an almost completely thrombosed abdominal aortic aneurysm with a maximum diameter of 65 mm and a longitudinal extension of about 11 cm. The patient also underwent coronary angiography, which showed diffuse calcified atherosclerosis, and he was recommended for medical therapy. After a joint Heart Team consultation with cardio–anesthesiologists, cardiac surgeons, and vascular surgeons, it was decided to perform transfemoral transcatheter aortic valve implantation (TAVI) and endovascular aneurysm repair (EVAR) in the same procedure (EUROSCORE II &amp;gt; 4%). The patient underwent TAVI followed by EVAR of the aorto–bisiliac arteries through a main access site in the left femoral artery guided by ultrasound, a secondary access site in the right femoral artery for placement of a pigtail catheter on the aortic plane, and a venous access site in the right femoral vein for placement of a temporary pacing catheter at the apex of the right ventricle. First, an Edwards Sapien 3 Ultra 26mm valve was implanted, and then the 14Fr sheath in the left femoral artery was exchanged for an 18Fr sheath for the EVAR, which was placed in the aorto–bisiliac region. Hemostasis was achieved using the Manta system on the left femoral artery and two Proglide devices on the right femoral artery. The procedure was completed without complications, and the patient was discharged 10 days later, asymptomatic and in stable clinical condition, with a recommendation for dual antiplatelet therapy with aspirin and clopidogrel. At the 6–week follow–up, the patient remained asymptomatic with an EF of 40%. Conclusion In selected cases, the simultaneous correction of severe low–flow low–gradient aortic stenosis using TAVI and abdominal aortic aneurysm using EVAR can be considered after appropriate discussion and consultation within the Heart Team."

P351 FATAL RECURRING SYSTEMIC THROMBOEMBOLYSM IN A PATIENT WITH CARDIAC AL AMYLOIDOSIS WITHOUT EVIDENCE OF ATRIAL FIBRILLATION

Abstract Backgound: Cardiac amyloidosis is associated with an increased thromboembolic risk. While the need to anticoagulate patients in atrial fibrillation regardless of the CHA2DS2–VASc score is evident, it is not clear whether and which patients in sinus rhythm should be treated with anticoagulant drugs Case Presentation A 51–year–old man presented with repeated episodes of chest pain and exertional dyspnea. The ECG showed synus rhythm, left–axis deviation, 1st degree AV–block, left anterior hemiblock and no significant anomalies of ventricular repolarisation. Transthoracic echocardiography revealed markedly thickened left ventricular (IN) walls (maximum interventricular septum dimension 18 mm) with a granular–sparkling appearance of the myocardium, bi–atrial enlargement, preserved LV ejection fraction (EF 52%), restrictive mitral flow pattern with a very small A–wave, thickened interatrial septum and atrio– ventricular valves; circumferential pericardial effusion ( maximum 11mm). Laboratory tests showed an increase in troponin and NTproBNP levels and serum and urine immunoelectrophoresis showed a monoclonal component in zone kappa. A periumbilical fat biopsy was negative for amyloidosis so the patient underwent an endomyocardial biopsy which showed positive Congo red, and immunohistochemistry positive for kappa light chains and negative for transthyretin. A diagnosis of cardiac amyloidosis AL was then made and the patient was referred to the hematologist to perform specific therapy. One week after discharge he was hospitalized for acute pain in the lower limbs due to acute thrombosis of the left common femoral artery treated with Fogarty embolectomy. Discharged in therapy with low molecular weight heparin after a few days he was again symptomatic for pain in the lower limbs and went to the emergency room where he died of electromechanical dissociation. Conclusions Our case demonstrates that cardiac AL amyloidosis is associated with an increased thromboembolic risk, irrespective of the presence of atrial fibrillation, for the hematological disease itself and for the infiltration of the atrium by the amyloid substance. This suggests that in selected cases, with reduced A–wave amplitude and evidence of impaired atrial mechanics, empirical anticoagulation should be considered even in sinus rhythm.

The first endovascular rat glioma model for pre-clinical evaluation of intra-arterial therapeutics.

Several translational animal models have been described assessing intra-arterial (IA) treatments for malignant gliomas. We describe the first endovascular animal model that allows testing of IA drug delivery as a first-line treatment, which is difficult to do in actual patients. We report a unique protocol for vascular access and IA delivery in the rat model that, unlike prior reports, does not require direct puncture and opening of proximal cerebrovasculature which carries risk of ischemia in the animal brain post-delivery. Wistar rats underwent left femoral artery catherization with a Balt Magic 1.2F catheter or Marathon Flow directed 1.5F Microcatheter with an Asahi Chikai 0.008 micro-guidewire which was navigated to the left internal carotid artery under x-ray. 25% mannitol was administered to test blood brain barrier breakdown (BBBB). Additional rats were implanted with C6 glioma cells in the left frontal lobe. C6 Glioma-Implanted Rats (C6GRs) were monitored for overall survival and tumor growth. Tumor volumes from MRI images were calculated utilizing 3D slicer. Additional rats underwent femoral artery catheterization with Bevacizumab, carboplatin, or irinotecan injected into the left internal carotid artery to test feasibility and safety. A successful endovascular access and BBBB protocol was established. BBBB was confirmed with positive Evans blue staining. 10 rats were successfully implanted with C6 gliomas with confirmed growths on MRI. Overall survival was 19.75 ± 2.21 days. 5 rats were utilized for the development of our femoral catheterization protocol and BBBB testing. With regards to IA chemotherapy dosage testing, control rats tolerated targeted 10 mg/kg of bevascizumab, 2.4 mg/kg of carboplatin, and 15 mg/kg of irinotecan IA ICA injections without any complications. We present the first endovascular IA rat glioma model that allows selective catheterization of the intracranial vasculature and assessment of IA therapies for gliomas without need for access and sacrifice of proximal cerebrovasculature.

A CASE SERIES ON AORTIC DISSECTION – A CODE BLUE MEDICAL EMERGENCY

Introduction: Aortic dissection (AD) is a life-threatening clinical emergency requiring rapid diagnosis and effective intervention to improve patient survival and prognosis. Computed tomography angiography (CTA) can be used to diagnose AD accurately and quickly, making it the rst choice for diagnosing AD in an emergency. Early and accurate diagnosis will save a life. Here we present six cases we faced in sequence over a period of 1 year. A case of extensive dissection involving ascending and descending aorta till left common iliac artery and right proximal femoral artery up to brachiocephalic trunk , left common carotid and left subclavian artery- Stanford Type A/ Debakey Type I , is displayed in detail. Four cases with Stanford type A and one case with Type B Stanford Classication of Aortic Dissection will be discussed here. CTA is the best imaging method for the rapid diagnosis of AD, showing high specicity and sensitivity. Thus, this case series emphasizes the value of CTA as a gold standard diagnostic modality in cases with AD.

Establishment of acute hypergravity in vivo model

Introduction: Fighter and acrobatic flight pilots are exposed to short-term cerebral hypoperfusion or cerebral ischemia by hypergravity. Preventive therapy against hypergravity stress in pilots has been sought in recent years and needs to be developed in animal models as translational research. In this study, we developed acute hypergravity in vivo models, which can be gravity loaded arbitrarily, and the blood pressure, pulse rate, and hemodynamics over time during gravity loading can also be measured. Methods/Results: In this model, 9w male SD rats were anesthetized with sevoflurane (induction 5% for 4 min, maintenance 3%) by inserting catheters in the left femoral and right carotid arteries. After intraperitoneal injection including medetomidine 0.15 mg/kg + midazolam 2 mg/kg + butorphanol 2.5 mg/kg, the rats were loaded with+1Gz~ +5 Gz for 2 minutes by a hypergravity system (Tommy Seiko, Bio Research Center). We connected the system to the femoral catheter, and we used Labchart Software (ADInstruments) to monitor blood pressure and heart date during gravity loading. Then, we used i-stat(Abbot) to measure biomarkers, including lactate acid, via the right carotid catheter from 1min to 10min after gravity-loading Conclusion: Our acute hypergravity model enables us to monitor hemodynamics during gravity loading and measure the dynamics of biomarkers with short half-lives, such as lactic acid. This model applies to the evaluation of the kinetics of hypergravity-induced oxidative stress, including hydroxyl radicals and facilitate translational research. No Conflict of Interest This is the full abstract presented at the American Physiology Summit 2023 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.

A comparison between centrally and systemically administered erythropoietin on kidney protection in a model of fixed-volume hemorrhagic shock in male rats.

In this study, a comparison between centrally and systemically administered erythropoietin (EPO) was performed on nephroprotection during hemorrhagic shock (HS) in male rats. Male rats were allocated into four experimental groups. (1) Sham; a guide cannula was inserted into the left lateral ventricle and other cannulas were placed into the left femoral artery and vein. (2) HS; stereotaxic surgery was done to insert a cannula in the left lateral ventricle and after a 7-day recovery; hemorrhagic shock and resuscitation were performed. (3) EPO-systemic; the procedure was the same as the HS group except that animals received 300 IU/kg erythropoietin into the femoral vein immediately before resuscitation. (4) EPO-central; animals was treated with erythropoietin (2 IU/rat) into the left lateral ventricle before resuscitation. Arterial oxygen saturation (SaO2) was measured during experiments. Urine and renal tissue samples were stored for ex-vivo indices assessments. Erythropoietin (systemically/centrally administered) significantly improved SaO2, renal functional and oxidative stress parameters and decreased renal inflammatory (TNF-α and IL-6) mRNA expression compared to the HS group. EPO-treated groups showed a decrease in active form of caspase-3 protein level and an increase in autophagy activity in comparison with the HS group. Considering the fact that the effective dose of systemic EPO (300 IU/kg) was roughly 50 times higher than that of central administration (2 IU/rat), centrally administered EPO was accompanied by more advantageous consequences than systemic way. EPO is likely to act as a neuro-modulator or neuro-mediator in the central protection of organs including the kidneys.

The promotion action of AURKA on post-ischemic angiogenesis in diabetes-related limb ischemia

BackgroundDiabetes-related limb ischemia is a challenge for lower extremity amputation. Aurora Kinase A (AURKA) is an essential serine/threonine kinase for mitosis, while its role in limb ischemia remains unclear.MethodHuman microvascular endothelial cells (HMEC-1) were cultured in high glucose (HG, 25 mmol/L d-glucose) and no additional growth factors (ND) medium to mimic diabetes and low growth factors deprivation as in vitro model. Diabetic C57BL/6 mice were induced by streptozotocin (STZ) administration. After seven days, ischemia was surgically performed by left unilateral femoral artery ligation on diabetic mice. The vector of adenovirus was utilized to overexpress AURKA in vitro and in vivo.ResultsIn our study, HG and ND-mediated downregulation of AURKA impaired the cell cycle progression, proliferation, migration, and tube formation ability of HMEC-1, which were rescued by overexpressed AURKA. Increased expression of vascular endothelial growth factor A (VEGFA) induced by overexpressed AURKA were likely regulatory molecules that coordinate these events. Mice with AURKA overexpression exhibited improved angiogenesis in response to VEGF in Matrigel plug assay, with increased capillary density and hemoglobin content. In diabetic limb ischemia mice, AURKA overexpression rescued blood perfusion and motor deficits, accompanied by the recovery of gastrocnemius muscles observed by H&E staining and positive Desmin staining. Moreover, AURKA overexpression rescued diabetes-related impairment of angiogenesis, arteriogenesis, and functional recovery in the ischemic limb. Signal pathway results revealed that VEGFR2/PI3K/AKT pathway might be involved in AURKA triggered angiogenesis procedure. In addition, AURKA overexpression impeded oxidative stress and subsequent following lipid peroxidation both in vitro and in vivo, indicating another protective mechanism of AURKA function in diabetic limb ischemia. The changes in lipid peroxidation biomarkers (lipid ROS, GPX4, SLC7A11, ALOX5, and ASLC4) in in vitro and in vivo were suggestive of the possible involvement of ferroptosis and interaction between AUKRA and ferroptosis in diabetic limb ischemia, which need further investigation.ConclusionsThese results implicated a potent role of AURKA in diabetes-related impairment of ischemia-mediated angiogenesis and implied a potential therapeutic target for ischemic diseases of diabetes.

Hybrid management of lower limb huge pseudoaneurysm with arteriovenous fistula presenting 8 years after gunshot injury

All over the world, except during the war period, firearm injuries are encountered in daily life at varying rates depending on the region and country. In addition, late-term vascular complications may occur in injuries with a less traumatic appearance. In this present case report, we aimed to evaluate the hybrid treatment of giant pseudoaneurysm and arteriovenous fistula (AVf) in the left superficial femoral artery (SFA), which developed in a patient who had a pellet shot on his left thigh eight years ago. Postsurgical management was straightforward; the patient received antibiotherapy with ampicillin and sulbactam acid for 7 days, acetylsalicylic acid 100mg per day, and anticoagulant treatment with low molecular weight heparin for 1 month. The patient was examined in the cardiovascular surgery polyclinic on the 5th day after discharge uneventfully. Although endovascular treatment methods are widely used today in the treatment of vascular injuries, surgery still maintains its importance. In some special patient groups, a combination of these two treatment methods may be preferred.

Sonoreperfusion with fibrin-targeted phase shift microbubbles for the treatment of microvascular obstruction

More than 1 million Americans yearly have a new or recurrent acute myocardial infarction (AMI). Although the mortality rate from AMI has decreased in recent years, post-MI congestive heart failure is increasing due to microvascular obstruction (MVO), ultimately limiting myocardial salvage. We aim to address this unmet need by devising an image-guided therapy called sonoreperfusion (SRP) to resolve MVO by ultrasound-targeted microbubble cavitation (UTMC). In this study, we hypothesized that fibrin-targeted phase shift microbubbles (FTPSMBs; ∼200 nm) (Microvascular Therapeutics, Inc) would improve SRP efficacy compared to fibrin-targeted microbubbles (FTMBs; 1–3 μm) to treat MVO owing to the smaller size and more efficient microthrombi penetration. A rat hindlimb model of MVO was created by directly injecting freshly prepared porcine microthrombi into the left femoral artery under contrast-enhanced ultrasound imaging (CEUS) guidance, and treated with UTMC (1 MHz, 1.5 MPa, 5 ms pulse duration, 5-sec pulse interval) with concomitant administration of FTPSMBs/FTMBs (3 mL/hr). The treatment effect was accessed with CEUS. UTMC with FTPSMBs caused more rapid and complete reperfusion of rat hindlimb following MVO compared with FTMB, likely owing to their small size and more effective thrombus penetration. Studies to explore the underlying molecular mechanisms associated with SRP treatments are underway.