Patent Lumen Research Articles

Catastrophic Consequence of Hypoperfusion Syndrome after Redo Off-Pump Internal Thoracic Artery Grafting

Hypoperfusion syndrome may be defined as non-functioning of bypass graft, despite a patent graft lumen and presence of myocardial ischemia, and typically occurs in operation room or intensive care unit after coronary artery bypass grafting(CABG). A 33-year-old woman had exertional chest pain. She had previously undergone modified Bentall operation using a mechanical valve for annuloaortic ectasia at the age of 20 years. Coronary angiography showed that the left coronary artery had severe stenosis at the the origin. She underwent CABG with the left ITA to the anterior descending artery bypass through left anterior thoracotomy. At the 7th day, she had severe dyspnea and hypotension. Emergent catheter angiography showed that the ITA was patent, but blood flow into left anterior descending branch looked extremely poor. Finally intraaortic balloon pumping and cardiopulmonary circulatory support were introduced. At 11th postoperative day, she was transferred to our hospital to receive implantation of left ventricular assist device. Contrast-enhanced computed tomography revealed broad subendocardial myocardial infarction in the territory of left coronary artery. The emergent implantation of assist devise was successfully done through a median sternotomy, as preparation for receiving heart transplantation. In-situ ITA grafting implies the risk of hypoperfusion syndrome. Bilateral ITAs or concomitant aortocoronary bypass may ensure postoperative coronary circulation, especially for a young patient without chronic atherosclerotic coronary artery disease.

Recommended acquisition-parameters in achieving successful evaluation of coronary lumen patency surrounded by XIENCE of diameters < 3.0 mm in 1st generation 320-slice CT. XIENCE Phantom Study Part 1

Recommended acquisition-parameters in achieving successful evaluation of coronary lumen patency surrounded by XIENCE of diameters b3.0 mm in 1st generation 320-slice CT. XIENCE Phantom Study Part 1 Nobusada Funabashi ⁎, Yasuaki Namihira , Ryosuke Irie , Yoshihide Fujimoto , Toshihiro Shoji , Hiroyuki Takaoka , Hironori Kondo , Kanako Atou , Joji Ota , Yoshitada Masuda , Takashi Uno , Yoshio Kobayashi a

Optical stent-sizes in evaluating patency of coronary lumen surrounded by XIENCE of actual diameters 2.21–2.85 mm in 1st-generation 320-slice-CT using Pulsating-Phantom XIENCE phantom study part 5

Optical stent-sizes in evaluating patency of coronary lumen surrounded by XIENCE of actual diameters 2.21–2.85 mm in 1st-generation 320-slice-CT using Pulsating-Phantom XIENCE phantom study part 5 Nobusada Funabashi ⁎, Yasuaki Namihira , Ryosuke Irie , Yoshihide Fujimoto , Toshihiro Shoji , Hiroyuki Takaoka , Hironori Kondo , Kanako Atou , Joji Ota , Yoshitada Masuda , Takashi Uno , Yoshio Kobayashi a

Recommended acquisition parameters in achieving successful evaluation of coronary lumen patency surrounded by XIENCE of diameters < 3.0 mm in 2nd-generation 320-slice CT. XIENCE Phantom Study part 2

By ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography (CT) [ [1] Taylor A.J. Cerqueira M. Hodgson J.M. Mark D. Min J. O'Gara P. Rubin G.D. American College of Cardiology Foundation Appropriate Use Criteria Task Force Society of Cardiovascular Computed Tomography American College of Radiology American Heart Association American Society of Echocardiography American Society of Nuclear Cardiology North American Society for Cardiovascular Imaging Society for Cardiovascular Angiography and Interventions Society for Cardiovascular Magnetic Resonance Kramer C.M. Berman D. Brown A. Chaudhry F.A. Cury R.C. Desai M.Y. Einstein A.J. Gomes A.S. Harrington R. Hoffmann U. Khare R. Lesser J. McGann C. Rosenberg A. Schwartz R. Shelton M. Smetana G.W. Smith Jr., S.C. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J. Am. Coll. Cardiol. 2010; 56: 1864-1894 Abstract Full Text Full Text PDF PubMed Scopus (776) Google Scholar ], evaluation of patency of coronary arteries surrounded by a stent <3 mm diameter is inappropriate. We previously reported the improvement and problems in appropriate use of cardiac CT: 2003, 2007 and 2011 actual use of CT-based on ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac CT [ [2] Ozawa K. Funabashi N. Takaoka H. Kobayashi Y. Improvement and problems in appropriate use of cardiac CT: 2003, 2007 and 2011 use of CT-based on ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac CT. Int. J. Cardiol. 2014; 174: 385-388 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar ]. Furthermore we also reported the impairment factors for evaluating the patency of drug-eluting stents and bare metal stents in coronary arteries by 64-slice CT versus invasive coronary angiography [ [3] Nakamura K. Funabashi N. Uehara M. Suzuki K. Terao M. Okubo K. Mita Y. Maeda F. Komuro I. Impairment factors for evaluating the patency of drug-eluting stents and bare metal stents in coronary arteries by 64-slice computed tomography versus invasive coronary angiography. Int. J. Cardiol. 2008; 130: 349-356 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar ].

Integrated interventional bronchoscopy for endobrohchial tuberculosis in 45 children

Objective To investigate the efficacy and safety of integrated interventional treatment for children with endobronchial tuberculosis by electronic bronchoscopy. Methods From January of 2011 to August of 2014, 45 cases(31 boys and14 girls)were enrolled, their age ranged from 4 months to 12 years old.On the basis of the conventional anti-tuberculosis treatment in all the patients, electrocoagulation under the bronchoscopy was performed, together with laser, refrigerant or balloon expansion.The tracking observation of curative effect and adverse reaction were observed.Based on the main symptoms of patients after treatment, and the conditions of chest imaging, bronchoscopy, the lesion repair, airway mucosa, lumen patency, therapy efficacy were evaluated.All patients underwent 6-12 months follow-ups. Results Among 45 cases of endobronchial tuberculosis in children, there were 9 cases suffering from ulcers and cheese necrotic changes (20.0%), granulation proliferative changes in 8 cases, accounting for 17.8%, stenosis scar changes in 7 cases(15.5%); 44 mixed cases (97.8%) were observed under the microscope, of which 20 cases had tuberculosis lesions by bronchial biopsy, and of them acid-fast staining was positive in 12 cases(60.8%) confirmed by bronchoscopy combined with anti-tuberculosis treatment, and they received 8 to 13 times of treatment, 32 cases were markedly effective, accounting for 71.1%, 10 cases were effective, accounting for 22.2%; 3 cases lost follow-up, and the total efficiency was 93.3%; all patients had no pneumothorax, pulmonary secondary infection, hemoptysis and other adverse reactions. Conclusions In addition to conventional anti-tuberculosis treatment, local comprehensive interventional treatment under the bronchoscopy can effectively remove cheese-like necrosis and reduce granulation hyperplasia and relieve the airway obstruction, promote the absorption of lesions and atelectasis recovery.The therapy is safe and reliable and worth of clinical application. Key words: Endobronchial tuberculosis; Bronchoscopy; Interventional therapy; Child

Degree of bioresorbable vascular scaffold expansion modulates loss of essential function

Drug-eluting bioresorbable vascular scaffolds (BVSs) have the potential to restore lumen patency, enable recovery of the native vascular environment, and circumvent late complications associated with permanent endovascular devices. To ensure therapeutic effects persist for sufficient times prior to scaffold resorption and resultant functional loss, many factors dictating BVS performance must be identified, characterized and optimized. While some factors relate to BVS design and manufacturing, others depend on device deployment and intrinsic vascular properties. Importantly, these factors interact and cannot be considered in isolation. The objective of this study is to quantify the extent to which degree of radial expansion modulates BVS performance, specifically in the context of modifying device erosion kinetics and evolution of structural mechanics and local drug elution. We systematically varied degree of radial expansion in model BVS constructs composed of poly dl-lactide-glycolide and generated in vitro metrics of device microstructure, degradation, erosion, mechanics and drug release. Experimental data permitted development of computational models that predicted transient concentrations of scaffold-derived soluble species and drug in the arterial wall, thus enabling speculation on the short- and long-term effects of differential expansion. We demonstrate that degree of expansion significantly affects scaffold properties critical to functionality, underscoring its relevance in BVS design and optimization. Statement of SignificanceBioresorbable vascular scaffold (BVS) therapy is beginning to transform the treatment of obstructive artery disease, owing to effective treatment of short term vessel closure while avoiding long term consequences such as in situ, late stent thrombosis – a fatal event associated with permanent implants such as drug-eluting stents. As device scaffolding and drug elution are temporary for BVS, the notion of using this therapy in lieu of existing, clinically approved devices seems attractive. However, there is still a limited understanding regarding the optimal lifetime and performance characteristics of erodible endovascular implants. Several engineering criteria must be met and clinical endpoints confirmed to ensure these devices are both safe and effective. In this manuscript, we sought to establish general principles for the design and deployment of erodible, drug-eluting endovascular scaffolds, with focus on how differential expansion can modulate device performance.

Endoscopy-assisted tracheal reconstruction of post-traumatic obstruction in a cat: a case report

A domestic shorthair cat was referred with a history of dyspnoea and lethargy that had arisen gradually within the last few days. The cat had been hit by an automobile 10 days earlier. A thoracic radiograph suggested stenosis of the intrathoracic trachea, proximal to the tracheal bifurcation. Endoscopic examination confirmed a narrowing of the tracheal lumen due to the presence of a fibrotic ring, with remaining patent lumen of about 2 mm. A surgical treatment with a right lateral thoracotomy approach and resection of the narrowed portion of the trachea (a length of about 1 cm) was performed under endoscopic vision. The procedure was unsuccessful because of the size of the tissue removed and the laxity of the remaining tracheal tissue that caused dehiscence of sutures between the tracheal stump and tracheal bifurcation. After consultation with the cat’s owners, an intraoperative euthanasia was performed.

The application of free anterolateral thigh flap with a reporter skin paddle in the reconstruction of circumferential hypopharyngeal defects

To study the short-term results and technological improvement of free anterolateral thigh (ALT) flaps in the reconstruction of circumferential hypopharyngeal defects. The free ALT flap with a reporter skin paddle was used in 22 cases with circumferential hypopharyngeal defects. The short-term results of reconstructive surgeries and key points, advantages and complications of this technique were summarized. The length of circumferential hypopharyngeal defects ranged from 7 to 9 cm. ALT flap with an area of (8-9) cm × (11-18) cm was harvested. A reporter skin island with the skin area of (2.0-3.0) cm × (2.5-4.0) cm was designed. 91% (20/22) of ALT flaps survived. Two cases with flap necrosis underwent second reconstruction with a pedicled pectoralis major flap. All the patients had patent anastomotic lumen. Good postoperative subjective swallowing evaluation was obtained in 59% (13/22) of patients; 41% (9/22) of patients had acceptable swallowing results. Three patients (14%) presented with postoperative pharyngocutaneous fistula. One case recovered spontaneously in short-term and other two cases received the second reconstructive surgery. The application of free ALT flap with a reporter skin paddle in the reconstruction of circumferential hypopharyngeal defect is technologically easy and reliable, with satisfying swallowing function and limited trauma.

Defective pericyte recruitment of villous stromal vessels as the possible etiologic cause of hydropic change in complete hydatidiform mole.

The pathogenetic mechanism underlying the hydropic change in complete hydatidiform moles (CHMs) is poorly understood. A growing body of data suggests that pericytes play a role in vascular maturation. Since maturation of villous stromal vessels in CHMs is markedly impaired at early stages, we postulated that a defect in pericytes around stromal vessels in chorionic villi might cause vascular immaturity and subsequent hydropic change. To investigate this, we examined several markers of pericytes, namely, α-smooth muscle actin (α-SMA), platelet-derived growth factor receptor-β (PDGFR-β), and desmin, in 61 normally developing placentas and 41 CHMs with gestational ages of 4–12 weeks. The ultrastructure of villous stromal vessels was also examined. Mature blood vessels from normal placentas show patent vascular lumens and formed hematopoietic components in the villous stroma. α-SMA and PDGFR-β expression in the villous stroma gradually increased and extended from the chorionic plate to peripheral villous branches. The labeled cells formed a reticular network in the villous stroma and, after week 7, encircled villous stromal vessels. In comparison, α-SMA and PDGFR-β expression in the villous stroma and stromal vessels of CHMs was significantly lower (p<0.05). Ultrastructurally, endothelial cells in villous stromal vessels in normal placentas were consistently attached by pericytes after week 7 when the vessels formed distinct lumen, whereas the villous stromal vessels in CHMs consisted of linear chains of endothelial cells, often disclosing primitive clefts without hematopoietic cells inside, and neither pericytes nor basal lamina surrounded the endothelial cells at any gestational age studied. This suggests that pericytes recruitment around villous stromal vessels is defective in CHMs and links to the persistent vascular immaturity of the villous stroma in CHMs, which in turns leads to hydropic villi.

Coronary Arteries Injury in a Model of Pulmonary Fat Embolism Syndrome (PES)

Lung inflammation, vasculitis, and fibrosis occur in FES following bone fractures, surgical procedures, and liposuction. We reported the onset of myocardial damage in a rat model of FES with pulmonary fibrosis. This study continues our earlier work with attention to the evolution of the inflammatory process of the coronaries.Of 28 male SD rats, 14 received 0.2 mL IV triolein (FES model) and 14 received IV saline. Six weeks later, Losartan (0.3 mg/kg) was given IP to half of each group up to ten weeks. At necropsy, the tissues were stained for H&amp;E, SMA‐1, and Trichrome for collagen. Six photos at 400x were made of each heart. The coronary vasculitis was assessed by measurement of the medial thickening and lumen patency.In addition to the lung fibrosis, the heart of the triolein treated rats showed intense SMA‐1 staining of the coronary media, intima, and adventitia. Lumen patency was reduced versus saline controls (p &lt; 0.05). Losartan and saline treated rats did not differ from controls. Losartan protected the triolein treated rats from the heart damage with mild medial staining and wider lumen patency (p = 0.05). A small rim of collagen (trichrome) was seen in the adventitia of all the rats with more intensity in the triolein treated groups. Losartan reduced its presence.SMA‐1 staining by evidencing the transformation of fibroblasts and myofibroblasts shows the beginnings of collagen‐induced fibrosis. Would a longer treatment result in a more severe coronaropathy? The protective effect of Losartan was again confirmed underlining the role of the Renin‐Angiotensin system in this disease. Information from this model may help treating patients with FES.

Smooth Muscle Actin (SMA1) Stain Lungs and Heart on a Strain of CUX‐1 Transgenic mice

Cux‐1 is a gene controlling G1‐S phase by repressing cyclin‐kinase inhibitors p21 and p27. CUX mice develop fibrotic damage in kidneys, testis, and liver by aberrant repression of p27. These mice showed pulmonary inflammation, vasculitis, bronchitis, bronchiectasis, and fibrosis (trichrome staining) in the bronchial basal membrane and arterial media. The heart shows inflammation, small myocardial infarctions, and a reduction of the lumen patency of coronary arteries with increase of media thickness.For fibrosis, the expression of the same conditions in lungs and heart are reported by using SMA stain. Wild type mice were controls. An average of 7 photographs at 400x were taken on both organs of each mouse.Histopathologically, with SMA1 stain, damage was present in lungs with staining in the bronchial musculature, epithelium, and media of small caliber arteries, and alveolar septa.Measurement of lumen patency of lung arteries of CUX1 mice indicated a significant reduction of their lumena. Adventitia showed fibroblasts and macrophages. The myocardium showed presence of macrophages in the myocardial fibers, coronary vasculitis with a reduced lumen patency.In conclusion, SMA1 staining, another indicator of fibrosis was seen in both lungs and heart of these mice. Differences in the thickness of these arteries, especially the adventitia was seen when SMA1 stain was compared to H&amp;E. Little amount of collagen was seen in the coronary arteries of the mice, while present in lung vessels. No collagen was seen in the coronary arteries of controls.

Incidence of Pulmonary Fibrosis in Lungs of CUX‐1 Transgenic Mice

CUX‐1 is a transcriptional repressor gene and part of the network controlling G1‐S phase transition by repressing the cyclin‐kinase inhibitors p21 and p27. CUX‐1 transgenic mice develop polycystic kidneys, reduced spermatogenesis, and liver fibrosis as a consequence of aberrant repression of p27. We reported that these mice also show severe pulmonary inflammation with vasculitis, bronchitis, bronchiectasis, and diffuse presence of fibroblasts.This study reports the presence of collagen using Image J software (NIH program) on slides of lungs of CUX‐1 mice stained by trichrome. Wild type mice were used as controls. An average of seven photographs at 400x magnification were taken on the lungs of each mouse.Collagen presence and intensity was 17.06% in lungs of CUX‐1 mice versus 8.73% the wild type mice (p&lt;0.05). Fibrosis was mostly evident in the basal membrane and musculature of the ectasic bronchi and the peribronchial arteries. CUX‐1 mice also showed medial thickening, reduced lumen patency (64% versus 76% in wild type, p 0.015), and reduced media/adventitia ratio (42% versus 64% in wild type, p 0.018). Fibroblasts were particularly evident in the adventitia. Data using a specific rat stain for SMA‐1 confirm those ones observed with trichrome.Our data quantitatively confirms the presence of severe pulmonary fibrosis in these mice. Would some patients with polycystic kidney disease also have aberrant repression of p21 and p27 and develop pulmonary fibrosis?

Renal Effect of Triolein in a Rat Model of Fat Embolism Syndrome

Fat embolism syndrome (FES) is a lung process following bone fracture, surgery, and liposuction, expressed by inflammation, vasculitis, and fibrosis. A rat model of FES is induced by IV injection of triolein. Besides the lung damage at 48‐96 hours post injection, fat emboli were present in renal glomeruli, with vasoconstriction, glomerular and tubular hemorrhages, and increased renin secretion. Captopril and Losartan protected both organs, suggesting a role of the renin‐angiotensin system in injury pathogenesis. The pulmonary damage worsened at six weeks post injection. A second mild injury (i.p. injection of lipopolysaccharides (LPS)) exacerbated the condition. Renin was present in the lungs at this time. &#x0D; Reported is the renal damage following triolein at six weeks. Triolein (0.2mL IV) was given to 18 rats and saline to 18 controls. Six weeks post‐injection, each group received i.p. LPS (3mg/kg) n = 9 or saline n = 9. Two days later at necropsy, kidneys were stained for H&amp;E and renin and damaged scored.&#x0D; Triolein caused severe glomerular damage with basal membrane thickening, crescents, hemorrhages, but no fat globules. Cortical arterial vasculitis with reduced lumen patency was seen in 59% of the triolein‐treated groups vs. 36% for saline (P = 0.003). Renin staining was seen in 32% of glomeruli of rats receiving saline, 53% of LPS‐treated, 54% of triolein‐treated, and 76% of those treated with triolein and LPS. &#x0D; Therefore, triolein not only damages the lungs, but also the kidneys up to six weeks post‐embolization. Only lungs had fat droplets. The increased glomerular secretion of renin underlines its role in the FES pathogenesis; clinically, the renal damage should also be taken in consideration.

V12-06 RETROPERITONEAL LAPAROSCOPIC REIMPLANTATION OF THE LEFT RENAL VEIN FOR NUTCRACKER SYNDROME

You have accessJournal of UrologyReconstruction1 Apr 2015V12-06 RETROPERITONEAL LAPAROSCOPIC REIMPLANTATION OF THE LEFT RENAL VEIN FOR NUTCRACKER SYNDROME Ming Chen, Tao Tao, Bin Xu, Lei Zhang, Shu-qiu Chen, Xiao-wen Zhang, and Yu Yang Ming ChenMing Chen More articles by this author , Tao TaoTao Tao More articles by this author , Bin XuBin Xu More articles by this author , Lei ZhangLei Zhang More articles by this author , Shu-qiu ChenShu-qiu Chen More articles by this author , Xiao-wen ZhangXiao-wen Zhang More articles by this author , and Yu YangYu Yang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2776AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To describe the feasibility of retroperitoneal laparoscopic reimplantation of the left renal vein (LRV) for nutcracker syndrome (NCS). METHODS One patient with NCS underwent the surgery. He complained of gross hematuria and flank discomfort that could not be relieved by resting. He was placed in a supine position and 5 ports were placed in the right abdominal wall. The procedures were performed with a retroperitoneal approach. The LRV was transected and then reimplanted into the distal inferior vena cava. RESULTS The procedures were performed successfully without any major complications. The total operation time was 110 min. Hematuria and flank discomfort were resolved after the surgery. Ultrasonography revealed a patent lumen without compression. CONCLUSIONS Retroperitoneal laparoscopic reimplantation of the LRV appears to be a feasible procedure with minimal invasion, rapid recovery and satisfactory short-term outcomes. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e978 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ming Chen More articles by this author Tao Tao More articles by this author Bin Xu More articles by this author Lei Zhang More articles by this author Shu-qiu Chen More articles by this author Xiao-wen Zhang More articles by this author Yu Yang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Revascularisation of the aorta, of the renal and of the lower limb arterial systems

Revascularisation aims to create a patent lumen in an acutely or chronically occluded or stenosed vessel. Interventional radiology has developed and used minimally invasive methods for decades concurring surgical methods and medical therapy. Innovative fields in healthcare may be handicapped since revolutionary solutions usually gain wide acceptance slowly and the results of randomized controlled trials are reported late. At present endovascular recanalization, dilatation and stent placement have achieved a well-established role in the treatment of stenosis or occlusion of the aorta, and renal and peripheral arteries.

The impact of surgical strategy on survival after repair of type A aortic dissection

ObjectiveA diverse group of operative strategies are utilized for treatment of acute Stanford type A aortic dissection. We hypothesized that a surgical strategy to prevent cross-clamp injury or false lumen pressurization would be associated with reduced morbidity, mortality, persistent false lumen patency, and improved survival. This study was designed to determine the differences in outcomes between operative techniques. MethodsOutcomes and postoperative imaging were compared in patients who underwent surgery for acute type A aortic dissection. Two groups were compared, based on operative strategy. The surgical strategy for group 1 consisted of no aortic cross-clamp use, use of deep hypothermic circulatory arrest, and use of only antegrade perfusion after aortic replacement. The surgical strategy for group 2 consisted of any other combination that lacked 1 of these 3 technical steps. ResultsBetween January 1, 1996, and December 31, 2012, a total of 196 patients underwent surgery for acute type A aortic dissection. Operative mortality and postoperative morbidity were not statistically different between groups. Mean follow-up time was 3.95 (range: 0-15.4) years. Persistence of a false lumen was not statistically different between groups (P = .78). Overall survival was significantly better in group 1, versus group 2 (P = .0020). Multivariate Cox regression identified preoperative renal failure, chronic lung disease, greater number of packed red blood cells transfused, and being in group 2 as risk factors for poor long-term survival. ConclusionsThe operative strategy of group 1 (no cross-clamp, use of DHCA and antegrade perfusion) was associated with a highly significant improvement in survival, despite a lack of statistical difference in the incidence of persistent false aortic lumen between groups.

International multi-institutional experience with the vessel-sparing technique to reconstruct the proximal bulbar urethra: mid-term results.

To present mid-term outcomes from an international, multi-institutional cohort of patients undergoing vessel-sparing excision and primary anastomosis urethroplasty for the reconstruction of the anterior urethra. From June 2003 to December 2011, 68 patients underwent vessel-sparing anterior urethral reconstruction at five different international institutions using the vessel-sparing technique described by Jordan et al. (J Urol 177(5):1799-1802, 2007). Patients' age range was from 3 to 82 years (mean 51.2). Stricture length ranged from 1 to 3 cm (mean 1.78). After a mean follow-up of 17.6 months, 95.6 % of patients had a widely patent urethral lumen. Three patients failed the procedure, requiring either direct vision internal urethrotomy or urethral dilation, after which all were free of symptoms and did not require further instrumentation. Complications were minimal and as expected following open urethroplasty. Preservation of blood supply is a noble pursuit in surgery; however, it can be technically difficult and often requires more time and effort. This vessel-sparing technique for anterior urethral reconstruction is reproducible and appears to be reliable in this international cohort. Larger studies and longer follow-up are needed to support these encouraging results.

Evaluation of the downstream aorta after frozen elephant trunk repair for aortic dissections in terms of diameter and false lumen status.

To analyse the clinical outcomes of surgical repair of DeBakey type I and III aortic dissection (AD) by using the frozen elephant trunk (FET) technique, and to evaluate the postoperative behaviour of the residual aorta. In total, 27 consecutive patients underwent treatment of the thoracic aorta for AD with the FET technique in a tertiary-care hospital in Vienna/Austria between 2005 and 2012, and were enrolled in this case series study. All operations were performed under circulatory arrest and bilateral antegrade cerebral perfusion. During the follow-up, a clinical examination was performed as well as aortic diameters and false lumen (FL) patency evaluated by computed tomography (CT) imaging at following levels: pulmonary bifurcation, diaphragm and coeliac trunk. The mean age of the patient cohort was 56 ± 12 years; 21 patients were male. Twenty-two (82%) and 5 (18%) patients presented with DeBakey type I and type III AD, respectively. The hospital mortality rate was 7% (2/28); 2 patients died due to non-aortic-related reasons during a follow-up period of 48 ± 26 months. Three (11%) patients had a stroke, and 2 (7%) a spinal cord injury. The follow-up CT scans revealed FL thrombosis in 96% of the patients at the level of the pulmonary bifurcation (P < 0.001). Distal to the stent graft, at the level of the diaphragm and coeliac trunk, FL patency was observed in 52% (P = 0.1) and 78% (P = 0.6) of the patients, respectively. The true lumen of all analysed aortic segments increased significantly while the mean aortic diameter remained stable. Compared with conventional surgery for extensive ADs, the FET technique provides a high rate of FL thrombosis of the thoracic aorta.

EARLY SPONTANEOUS RECANALIZATION OF INTERNAL CAROTID ARTERY OCCLUSION

A 70-year-old male was admitted with a history of malignant disease diagnosed 3 years before. Two days after admission the patient became confused and presented with right-sided weakness and aphasia. Color-coded duplex ultrasonography of the cerebral vessels was immediately performed showing occlusion of the origin of the left internal carotid artery (Figure 1A). About 30 minutes later the patient showed spectacular shrinking deficit, and color-coded duplex ultrasonography of the cerebral vessels showed recanalization of the left carotid artery (Figure 1 B). CT showed no alterations in brain density. At follow-up after 7 and 30 days, color Doppler US showed persistent patency of the vessel lumen. The cause of this occlusion may have been cardiac embolism, plaque rupture with consequent thrombosis, vessel dissection with hematoma, embolism of paraneoplastic origin. Knowledge about dynamic vessel wall changes during the hyperacute phase of cerebrovascular diseases requires immediate neurovascular imaging and close follow-up. Detection of a cerebral vessel occlusion depends mainly on the time elapsed from clinical onset to the initial vascular evaluation. Several studies showed that early spontaneous recanalization infrequently occurs during the first few hours of acute stroke [1,2]. In the cerebral vessels examination color-coded duplex ultrasonography offers a clinical tool that can localize occlusion and detect recanalization in real time. It is non-invasive and low cost; furthermore it allows study of hemodynamics at the patient’s bedside and follow up investigations are easily possible [3].

Glaucoma Drainage Device Tube Retraction and Blockage in a Patient with Iridocorneal Endothelial Syndrome Treated With Nd:YAG Membranectomy

Purpose: To report on a case that demonstrates the successful treatment of tube blockage of the Ahmed Glaucoma Valve at its aqueous entry site by Nd:YAG laser membranectomy. Method: We report a case of refractory intraocular pressure elevation in a patient with iridocorneal endothelial syndrome after glaucoma drainage device due to blocked tube from the iridocorneal endothelial syndrome membrane. In July 2014, our patient presented with sudden right eye elevated intraocular pressure to 67 mmHg despite a well-controlled intraocular pressure in the range of teens with timolol alone over the last 2 years. Gonioscopy showed total synechial angle closure and increasing her medical treatment failed to control the intraocular pressure. Ahmed glaucoma valve was implanted successfully. However, recurrence of raised intraocular pressure from partial tube retraction and tube blockage at its aqueous entry site by an endothelial membrane was noted at 2 weeks after the surgery. Nd:YAG laser membranectomy was performed on 2 occasions to restore the patency of the tube shunt. After the second laser membranectomy, the patient’s intraocular pressure returned to, and remained at, normal level since. Conclusion: Tube occlusion by membrane is a well-known complication following glaucoma drainage device tube in patients with iridocorneal endothelial syndrome. Nd:YAG membranectomy is effective to restore the patency of tube lumen without subjecting patients to more invasive surgical interventions including tube extender or another glaucoma drainage device. However, more studies are required to ascertain the long term effect of laser membranectomy to a blocked tube, in comparison to other treatment modalities. To our knowledge, this is the first reported case of using laser membranectomy alone in treating Ahmed glaucoma valve tube obstruction due to a retracted tube blocked by endothelial membrane.