Mean Diameter Of Artery Research Articles

Safety and Efficacy of LVIS Jr Stent-assisted Coiling of Intracranial Aneurysms in Small-diameter Parent Arteries : ASingle-center Experience.

To investigate the safety and efficacy of LVIS Jr stent-assisted coiling (SAC) of intracranial aneurysms (IAs) in small-diameter parent arteries and determine the factors influencing incomplete aneurysm occlusion. Clinical and imaging data of 130 patients with IAs in small-diameter parent arteries that were treated with LVIS Jr SAC were retrospectively analyzed. Stent apposition was evaluated by high-resolution flat detector CT, and aneurysm embolization density was evaluated using 2D-DSA. Perioperative complications were recorded. Multivariate logistic regression analyses were performed to determine possible factors for incomplete aneurysm occlusion. In this study, 130 patients (60and 70patients with ruptured and unruptured aneurysms, respectively) were successfully treated with LVIS Jr SAC. Immediate digital subtraction angiography (DSA) showed that the aneurysm occlusion was Raymond-Roy classI, II, IIIa, and IIIb in 93(71.5%), 24(18.5%), 8(6.2%), and 5(3.8%) cases, respectively. There were three cases of acute in-stent thrombosis and two cases of severe vasospasm observed during the perioperative period. The 6‑month follow-up angiograms indicated that complete aneurysm occlusion in 122 patients was 79.5% (97/122). Multivariate logistic regression analyses showed that an aneurysm size > 10.0 mm, parent artery mean diameter < 2.0 mm, and incomplete stent apposition at the aneurysm neck were possible risk factors for incomplete aneurysm occlusion. The LVIS Jr SAC is effective for managing IAs in small-diameter parent arteries. An aneurysm size > 10.0 mm, parent artery mean diameter < 2.0 mm, and incomplete stent apposition at the aneurysm neck are possible risk factors for incomplete aneurysm occlusion.

Arterial involvement of lower limbs in peripheral artery disease - the difference between diabetics and non-diabetics.

To detect peripheral artery disease in diabetic and non-diabetic individuals. The case-control study was conducted from October 2018 to September 2019 at Ruth K.M. Pfau Civil Hospital, Karachi, and comprised diagnosed diabetic patients with random blood sugar ≥200mg/dl in group A, and healthy non-diabetic subjects in group B. Ankle brachial pressure index was measured and mean luminal diameters of lower limb arteries were compared using colour Doppler ultrasonography. Data was analysed using SPSS 21. Of the 82 subjects, 41(50%) were in each of the 2 groups. The sample had 42(51.2%) males and 30(48.8%) females with overall mean age of 53.9±5.07 years (range 44-60 years). There was significant difference in the ankle brachial pressure index values between the groups (p=0.004). There was also a significant difference in the mean luminal diameters of distal arteries (p=0.001), while there was no significant difference in proximal arteries (p>0.05). The diabetics were more prone to developing peripheral arterial disease than nondiabetics.

The Free Medial Sural Artery Perforator Flap for Microsurgical Reconstruction of Limbs: A Systematic Review and Meta-Analysis of Flap Characteristics and Outcomes

The medial sural artery perforator (MSAP) continues to gain popularity. Providing a versatile, thin and pliable alternative for commonly used workhorse flaps, it can be used to reconstruct extremities, with reduced donor site morbidity. This meta-analysis was conducted to analyse the current literature to help identify flap characteristics and outcomes. A systematic review was performed following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines and a literature search was conducted using Medline, Google Scholar and the Cochrane Library. The aim was to identify the outcomes of free MSAP flap reconstructions of upper and lower limb defects over a 10-year period from January 2010 to July 2020. The data was then tabulated and a meta-analysis was carried out. A total of 11 studies for lower limbs and 7 studies for upper limbs were reviewed and analysed with a total number of 257 patients. Limb reconstructions were primarily due to trauma. The most common site of reconstruction of the upper limb was the hand or wrist and the lower limb was the ankle or feet. The mean length of the flap was 9.6 cm. The mean width was 5.4 cm. The mean pedicle length was 9.7 cm. The mean flap thickness was noted as 5.9 mm. The number of perforators was an average of 1.5. The pedicle’s mean arterial diameter was 1.9 mm (mean) and the vein’s mean arterial diameter was 2.9 mm. 80% of donor sites were closed directly. Overall, the flap success rate was 98%. Our results find the MSAP flap to be a versatile, reliable, functionally and aesthetically good reconstructive option for both lower and upper limb defects with low donor site morbidity.

Evaluation of renal arteries in hypertensive patients by multi-detector computed tomography

Introduction: Among various causes of hypertension, only 1 to 2% is renovascular hypertension which may be characterized by the various reasons in renal vascular supply. Multi-detector computed tomography is used to know about the details of the vascular structures in patients. This study aims to evaluate the renal arteries in hypertensive patients. Methods: A prospective observational study was conducted among 93 hypertensive patients. Contrastenhanced computed tomography of the abdomen and pelvis was conducted, and measurements were obtained from the axial section of the maximum intensity projection image. Data were analyzed using SPSS version 23.0. Independent t-test and Pearson’s Correlation were used. The level of statistical significance was set at p&lt;0.05. Results: The study found mean lengths for the right and left main renal arteries to be 40.33±10.26 mm and 32.36±9.55 mm, and diameters were 4.31±0.86 mm and 4.16±0.81 mm. No significant sex-based differences were observed. However, a significant age-related difference was noted in the length (p=0.012) and diameter (p=0.036) of the right main artery within the 20 to 29 and 80 to 89 years age groups. Weak correlations were observed between left renal artery length and age (r=0.221, p=0.33) and mean right renal artery diameter and age (r=-0.218, p=0.036). Prevalence of accessory renal arteries and early branches was 19.35% and 16.10% respectively. Conclusions: This study found that there were no statistically significant differences in renal arteries dimensions of hypertensive patients with different age groups and genders. Although the proportion of early renal artery branching and accessory arteries are found to be similar to previous studies there may be other associated factors for all hypertensive patients who don’t have early renal branches or accessory arteries.

Assessment of Cerebral Arterial Flow Volume Changes with Carotid Vertebral Artery Duplex Doppler Ultrasound in Young-Middle-aged Subclinical Hashimoto Thyroiditis Patients.

To demonstrate cerebral arterial flow volume changes during the hypothyroid, euthyroid, and hyperthyroid phases and comparing between laboratory findings and cerebral arterial flow changes with carotid-vertebral duplex Doppler ultrasound (CVA-DUSG) in subclinical Hashimoto thyroiditis (HT) patients. According to the TSH level, 3 groups were constructed between patient cases. Group 1 (n=29) was the subclinical hyperthyroid group. In this group, the TSH level was between 0.0005 and 0.3 IU/ml. Group 2 (n=175) was the euthyroid group. TSH level in this group was between 0.3 and 4.2 IU/ml. Group 3 (n=76) was the subclinical hypothyroid group. In this group, the TSH level was above 4.2 IU/ml. The control-group (group 4) (n=71) included healthy people. In this group, the TSH level was between 0.3 and 4.2 IU/ml. After obtaining at least three consecutive waves from the bilateral internal cerebral artery and bilateral vertebral artery, volume flows were calculated using CVA-DUSG. Volume flows were calculated as peak systolic velocity + end diastolic velocity/2 × mean arterial diameter. The mean ICA(Internal Carotid Artery) and VA(Vertebral Artery) diameter was measured per ICA and VA. Total cerebral artery flow volume was defined as right ICA + right VA flow volume and left ICA + left VA flow volume. We also demonstrated topographic cerebral artery blood flow changes. Total ICA flow volume was used to assess the anterior part of the brain, total VA flow volume was used to evaluate the posterior part of the brain, right ICA + right VA flow volume was used to assess the right part of the brain, and left ICA + left VA flow volume was used to verify the left part of the brain. There were significant differences between RVA(Right Vertebral Artery) flow volume, LICA (Left Internal Carotid Artery) flow volume, total flow volume, TSH, and T3 and T4 levels in all groups according to the Dunn's multiple comparison test.(p<0.001) Mean TSH level was 0.03 (0.005-0.06) IU/ml in group 1, 2.8 (1.8-3.97) IU/ml in group 2, 7.32 (6.14-9.93) IU/ml in group 3, and 1.76 (1.17-2.49) IU/ml in the control group. The mean T3 level was 4.18 (3.55-5.38) in group 1, 2.88 (2.63-3.16) in group 2, 2.82 (2.49-3.15) in group 3, 3.14 (2.92-3.15) in the control group. The mean T4 level was 1.92 (1.29-2.5) in group 1, 1.16(1.03-1.31) in group 2, 1.01 (0.91-1.16) in group 3, 1.12 (0.97-1.30) in the control group (group 4). Mean total flow volume was 793 (745-898) ml/min in group 1, 742 (684.25-822.5) ml/min in group 2, 747 (692-824) ml/min in group 3, and 700 (673-675) ml/min in the control group. We also demonstrated topographic cerebral arterial volume flow changes with CVA-DUSG. There was a significant difference among all groups in the right and anterior parts of the brain (p < 0.001), and there was a significant difference between groups 1 and 4 in the left part of the brain (p = 0.009). This study demonstrated that total cerebral arterial volume flow increased in the hyperthyroid phase of subclinical HT cases without any internal carotid and vertebral artery diameter changes compared with the euthyroid and hypothyroid phases of subclinical HT and healthy cases. We also verified topographic cerebral arterial blood flow changes in subclinical HT cases with a real-time, easily applicable modality (CVA-DUSG) that does not include X-ray or contrast agents. There was a significant difference between all groups in the right and anterior parts of the brain and there was a significant difference between groups 1 and 4 in the left part of the brain.

Comparison of adequacy of blood flow between proximal forearm AV fistula placed at elbow and distal forearm AV fistula placed at wrist in the early post-operative period

Background: In patients with a failed DRCF or unsuitable for DRCF, the current recommendation is to perform a brachiocephalic fistula. Proximal forearm radiocephalic fistulas are created less frequently. Aims and Objectives: The aim of the present study was to evaluate the outcomes of proximal forearm AV fistula placed at elbow and distal forearm AV fistula placed at wrist in terms of adequacy of blood flow in the early post-operative period. Materials and Methods: The present cross-section study was conducted on patients with end-stage renal disease with proximal or distal AV fistula at wrist for a period of 2 years at radiodiagnosis department. The patients were divided into two groups, those with proximal AVF and those with distal AVF. The Doppler ultrasound findings were analyzed and compared between the two groups to identify any differences that could be associated with the success or failure of the AVF. Results: The difference in mean arterial diameter between the proximal and distal groups may indicate that the proximal fistulas have a better chance of providing adequate blood flow for dialysis. The difference in TAV between proximal and distal group may indicate difference in the location and type of fistula and the blood vessels involved in them. Conclusion: Proximal forearm AV fistula is an appealing option to brachiocephalic fistulas in failed distal forearm AV fistula and patients who cannot obtain a distal radiocephalic fistula because to their much lower initial failure rate, higher patency rate, and reduced complication rate.

Selection Bias in Avoiding Vein Graft in Replantation/Revascularization May Exist in Distal and Proximal Amputations, Respectively.

This is a single-center, noninterventional, retrospective cohort study comprising 229 patients (277 digits) who underwent replantation/revascularization between January 2000 and December 2020 at our institution. Sex, age, smoking history, comorbidities, affected side, level of amputation, complete or incomplete amputation, type of fracture and mechanism, diameter of the artery, needle, warm ischemic time, and results were investigated and compared between the subgroups with and without vein graft. Results were investigated between the subgroups with and without a vein graft in the distal and proximal groups. In the distal group, the mean arterial diameter of the vein graft subgroup was larger than that of the non-vein graft subgroup [0.7 (0.1) mm and 0.6 (0.2) mm, respectively, P < 0.05]. In the proximal group, the vein graft subgroup had higher severity than the non-vein graft subgroup (comminuted fracture, 31.1% versus 13.4%; and avulsion or crush amputation, 57.8% versus 37.1%, respectively, P < 0.05). However, the success rate was not significantly different between the aforementioned subgroups. There was no significant difference between the vein graft and non-vein graft subgroups owing to the selection bias avoiding small arteries in the distal amputation and the absence of said bias in the proximal amputation.

Diagnostic Cerebral Angiography Through Distal Transradial Access: Early Experience with a Promising Access Route.

Over the last few years, there has been considerable interest in the neurointervention community to use transradial approach for diagnostic and therapeutic neurointerventions. Distal radial approach has been postulated as an effective technique with reduced risk of hand ischemia. Our objective was to assess the safety and feasibility of distal transradial access (DTRA) to perform diagnostic cerebral angiography. A retrospective evaluation of 25 patients who were taken for DTRA through the anatomical snuff box from December 2021 to March 2022 was done. Twenty-five diagnostic cerebral angiographies were attempted with DTRA in 25 patients (age, 23-70 years; mean age, 45.4 years; 10 (40%) females). The right distal radial artery mean diameter was 2.09 mm. The procedure was successful in 21 (84%) procedures. Failure was seen in four cases, with three being converted to the proximal transradial approach without any need for redraping and one was converted to the transfemoral approach. The reason for access conversion was a severe spasm in three cases and dissection in one case. Selective catheterization of the cranial vessels through a distal transradial approach was achieved in 92 (96.8%) of 95 vessels. No significant access site complications were seen in the study cohort. DTRA is a promising approach for diagnostic cerebral angiography. Interventionists should get accustomed to this approach by overcoming the initial learning curve.

Effect of Localized Vibration Massage on Popliteal Blood Flow.

There is a broad scope of literature investigating whole-body vibration (WBV) effects on blood flow (BF). However, it is unclear how therapeutic localized vibrations alter BF. Low-frequency massage guns are advertised to enhance muscle recovery, which may be through BF changes; however, studies using these devices are lacking. Thus, the purpose of this study was to determine if popliteal artery BF increases from localized vibration to the calf. Twenty-six healthy, recreationally active university students (fourteen males, twelve females, mean age 22.3 years) participated. Each subject received eight therapeutic conditions randomized on different days with ultrasound blood flow measurements. The eight conditions combined either control, 30 Hz, 38 Hz, or 47 Hz for a duration of 5 or 10 min. BF measurements of mean blood velocity, arterial diameter, volume flow, and heart rate were measured. Using a cell means mixed model, we found that both control conditions resulted in decreased BF and that both 38 Hz and 47 Hz resulted in significant increases in volume flow and mean blood velocity, which remained elevated longer than the BF induced by 30 Hz. This study demonstrates localized vibrations at 38 Hz and 47 Hz significantly increase BF without affecting the heart rate and may support muscle recovery.

Morphological, histological, and histochemical study of the adult golden hamster (Mesocricetus auratus) spleen.

The golden hamster is a choice model for investigating many visceral and splenic infections and neoplastic and retrospective lesions. To study hamsters' spleen's morphological, histological, and histochemical structure. Samples were collected from eight healthy adult golden hamsters and then fixed with 10% buffered formalin. Later, samples were processed, sectioned, and stained with Hematoxylin and Eosin as well as Masson's Trichrome stain. Other slides were further stained with Periodic Acid Schiff and Alcian blue 2.5 stain (PAS) for histochemical evolution; the gross measurement was performed for the splenic length, width, and thickness, while the histological measures included the splenic capsular and trabecula thickness, diameter of white pulp follicles, splenic sinusoids and central arteries and proportion of white and red pulps. The macroscopic findings revealed that the spleen was red-brown lanciform on the left side of the dorsolateral abdominal wall. The morphological measurements for splenic length, width, and thickness were 26.6 ± 7.67, 4.17 ± 1.65, and 1.70 ± 0.01 mm, respectively. The histological observations showed that the splenic capsule was composed of two layers (serosal and subserosal). The inner layer sends trabeculae dividing the splenic parenchyma irregularly, and the splenic parenchyma comprises the white and red pulp. The white pulp follicles included the mantle, marginal zones, and the PALS (periarterial lymphatic sheath), while the red pulp constituted splenic cords and sinuses. The histomorphological findings showed that white pulp follicles and the central artery mean diameter were 252.62 ± 8.07 µm and 54.45 ± 0.36 µm respectively, the proportion of white to a red pulp was 0.49 ± 0.01, the splenic capsule, trabecula and the wall of splenic arteries showed an intense positive activity to PAS stain and negative or weak in other splenic structures. The similarities and differences in the spleen between the laboratory animals and hamsters were apparent in this article, so understanding the morphological and histological structure of the spleen presents significant assistance with species identification to select the appropriate experimental animal model in future medical research.

Anatomic Situation of Posterior Superior Alveolar Artery in Cone-Beam Computed Tomography Images in Maxillary Molar Region

Introduction: Bleeding is an important complication during implant placement. The aim of this study was to evaluate the anatomic situation of the posterior superior alveolar artery (PSAA) in cone-beam computed tomography (CBCT) images in maxillary molar region in an Iranian population.&#x0D; Methods: In this descriptive cross-sectional study, CBCT scans of the edentulous regions of the posterior maxilla were participants to examine the location and anatomical features of the PSAA. 300 CBCT scans of patients with the mean age of 48.79 years were used. The CBCT scans had been obtained by Scanora 3D (Soredex, Tuusula, Finland). The diameter and the PSAA distance to the alveolar crest was measured by OnDemand 3D software on cross sectional and coronal sections. Data were analyzed through the Chi-Square, T-Test, ANOVA and Exact Fisher tests using the SPSS software (version 23).&#x0D; Results: Out of 300 images, the PSAA was observed in 203 (67.6%) ones. The artery was slightly more observable in males (68.8%) compared to females (66.4%). Although the difference was not significant (p-value: 0.711). The mean artery diameter and distance to alveolar crest were higher in males (1.33±0.64 mm; 18.016±4.78 mm, respectively) compared to females (1.12 ±0.47 mm; 17.885±4.31 mm). Only the difference between the diameters was significant (p-value: 0.008).&#x0D; Conclusion: According to this study, with the increase of age, the diameter and distance of the artery to bone crest decreases. The mean artery diameter and distance to bone crest is higher in males compared to females.

Therapeutic Neurointervention through Transradial Approach: Preliminary Experience from a Tertiary Care Center

Abstract Aim The aim of this study was to assess the safety and feasibility of radial access for therapeutic neurointervention procedures. Methods The retrospective evaluation of 20 patients taken for therapeutic neurointervention through transradial access at our institute was done from July 2021 to April 2022. Results Therapeutic neurointervention procedures were attempted in 20 patients (age, 24–74 years; mean age, 48.4 years; 13 (65%) females using a transradial approach. The radial artery's mean diameter was 2.135 mm. The right radial access was taken in 18 (90%) cases. Indications for treatment were ruptured aneurysm in 13 (65%), mechanical thrombectomy in 5 (25%), flow diversion for a recanalized aneurysm in 1 (5%), and balloon occlusion test in 1 (5%) case. The procedure was successful through the transradial approach in 18 (90%) procedures. Failure was seen in two cases that were completed after conversion to the transfemoral approach. The reason for access conversion was a severe spasm in both cases. No significant access site complications were seen in the study cohort. Conclusion A radial access route is a promising approach for therapeutic interventions with a high success rate and minimal access site complications. Interventionists should get accustomed to this approach as primary or alternative access for neurointervention.

The impact of acute COVID-19 on the retinal microvasculature assessed with multimodal imaging.

To quantify retinal microvascular findings in the acute phase of COVID-19 using multimodal imaging and compare them with healthy, age-matched controls. Hospitalized patients in the acute phase of COVID-19 without known systemic comorbidities (n = 75) and healthy controls (n = 101) aged 18-65 were enrolled in this prospective cross-sectional study. The retinal microcirculation and microvasculature impairments were assessed using fundus photography, swept-source optical coherence tomography, and swept-source optical coherence tomography angiography in the COVID-19 unit and compared with healthy, age-matched controls. Retinal findings were predominately observed in patients with severe disease (P = 0.006). Patients with severe disease were shown to have increased both mean vein diameter (Coef. = 19.28, 95% CI: 7.34-31.23, P = 0.002) and mean artery diameter (Coef. = 11.07, 95% CI: 0.84-21.67, P = 0.044). Neither blood vessel diameters were correlated with any confounding variables (age, sex, treatment with oxygen, LDH, or ferritin). Patients with severe COVID-19 were shown to have significantly increased retinal nerve fiber layer thickness in the superior and inferior quadrants both in the inner (S: P = 0.046; I: P = 0.016) and outer (S: P = 0.026; I: P = 0.014) ring and significantly increased GCL thickness in the outer temporal quadrant (P = 0.038). There were no statistically significant differences in vessel density or the foveal avascular zone area between the groups. The severity of COVID-19 was significantly correlated with the presence of retinal microangiopathy, which could become a biomarker of angiopathy in patients with COVID-19.

Application of lateral upper arm free flap in the repair of postoperative defects of oral cancer

Objective: To explore the clinical application and efficacy of lateral upper arm free flap (LUAFF) for one-stage repairing of soft tissue defect after oral cancer surgery. Methods: This article was a retrospective analysis of clinical data of 46 patients receiving treatment of one-stage repairing of soft tissue defect with LUAFF after oral cancer surgery in Hunan Cancer Hospital, from June 2019 to June 2021. Among these cases, 40 were males, and 6 were females. The patients' ages were from 23 to 64 years old. The clinical data of patients were reviewed and outcomes were evaluated. SPSS 23.0 software was used for statistical analysis. Results: In the LUAFF of 46 patients, flap area ranged from 5.0 cm×3.5 cm to 15.0 cm×7.0 cm; the mean pedicle length was 8.15±1.42 cm; the mean artery diameter was 1.20±0.41 mm (range, 1.5 to 2.5 mm); the mean diameter of the largest veins was 2.15±0.52 mm; and the median number of perforators was 2.6 (range, 1 to 4). All donor sites were closed primarily. Two cases had arterial anastomosis thrombosis, but their flaps were successfully saved with urgent re-anastomosis of the vessels. The overall flap survival rate was 93.5%(43/46), with flap necroses after operation in three cases. No patient received tracheotomy. The average hospital stay time of patients after operation was 9.4 days. The follow-up time was 6-24 months, elbow and wrist movements on the operative side were normal, and the upper limb muscle strength was not affected. Conclusions: LUAFF is a suitable choice for the repairs of small-moderate tissue defects in oral cancer surgery, with consistent perforators in the flap, simple harvest method, concealed donor-site scar, and high survival rate.

Comparison of conventional and castroviejo needle holders in terms of vascular anastomosis time in renal transplant

Objective: It is important that the anastomosis time of renal vascular structures is not prolonged to minimize the potentially harmful effect of warm and cold ischemic times. This study aimed to determine the effect of the needle holder design used in vascular anastomosis during renal transplantation on the duration of anastomosis.Material and Methods: Patients that underwent renal transplantation at our clinic between September 2011 and February 2020, were divided into groups according to the two types of needle holders used in anastomoses. In Group 1, a conventional, Hegar-type, straight, 180-mm (7”) Ryder Diadust needle holder was used. In Group 2, a pen-type, straight, 215-mm (8 ½”) Castroviejo Durogrip TC micro needle holder was used. Demographic characteristics, vascular characteristics, and vascular anastomosis times were compared between the two groups. Results: A total of 75 patients were included in the study. There were 39 (52%) patients in Group 1 and 36 (48%) patients in Group 2. The mean number of arteries was 1.2 ± 0.4, and the mean arterial diameter was 5.3 ± 1.2 mm in the whole cohort, with no statistically significant difference between the two groups (p=0.196 and 0.304, respectively). The mean arterial anastomosis time was 15 ± 5.1 minutes in Group 1 and 10 ± 3.9 minutes in Group 2. The mean venous anastomosis times were 18.4 ± 6.1 in Group 1 and 14.7 ± 4 minutes in Group 2. In the statistical analysis, the arterial and vein anastomosis times were found to be significantly shorter in Group 2 than in Group 1 (p=0.038 and p=0.020, respectively).Conclusion: In our study, it was observed that the renal arterial and venous anastomosis times were significantly shorter in the group in which the pen-type Castroviejo needle holder was used in anastomoses performed during renal transplantation.

Outcomes of the Gore Excluder Iliac Branch Endoprosthesis for Japanese Patients With Aortoiliac Aneurysms: A Study Based on J-Preserve Registry

Purpose: To evaluate the clinical utility of the Gore Excluder iliac branch endoprosthesis (IBE) for Japanese patients with aortoiliac aneurysms. Materials and Methods: This was a multicenter retrospective cohort study (J-Preserve Registry). Patients undergoing endovascular aortic repair using the Gore Excluder IBE for aortoiliac aneurysms between August 2017 and June 2020 were enrolled. Data pertaining to the baseline and anatomical characteristics, technical details, and clinical outcomes were collected from each institution. The primary endpoints were technical success, IBE-related complications, and reinterventions. Secondary endpoints were mortality, aneurysm size change, and reintervention during follow-up. Technical success was defined as accurate deployment of the IBE without type Ib, Ic, or III endoleaks on the IBE sides on completion angiography. A change in aneurysm size of 5 mm or more was taken to be a significant change. Results: We included 141 patients with 151 IBE implantations. Sixty-five IBE implantations (43.0%) had at least one instruction for use violation. Twenty-two patients (15.6%) required internal iliac artery (IIA) embolization for external iliac artery extension on the contralateral side. Of 151 IBE implantations, 19 exhibited IIA branch landing zones due to IIA aneurysms. Mean maximum and proximal common iliac artery (CIA) diameters were 32.9±9.9 mm and 20.5±6.9 mm, respectively. The mean CIA length was 59.1±17.1 mm. The IIA landing diameter and length were 9.0±2.3 mm and 33.8±14.6 mm. The overall technical success rate was 96.7%. There were no significant differences in IBE-related complications (2.3% vs 5.3%, p=0.86) or IBE-related reinterventions (1.5% vs 5.3%, p=0.33) between the IIA trunk and IIA branch landing groups. The mean follow-up period was 635±341 days. The all-cause mortality rate was 5.0%. There were no aneurysm-related deaths or ruptures during the follow-up. Most patients (95.7%) had sac stability or shrinkage. Conclusion: The Gore Excluder IBE was safe and effective for Japanese patients in the midterm. Extending the IIA device into the distal branches of the IIA was acceptable, which may permit extending indications for endovascular aortic aneurysm repair of aortoiliac aneurysms to more complex lesions. Clinical Impact This study suggests clinical benefits of the Gore Excluder IBE for Japanese patients, despite 43% of the IBE implantations having at least one IFU violation.

Rerouting the internal thoracic vessels as recipient vessels in head and neck reconstruction: Comparison of two anatomic approaches

IntroductionThe vessel-depleted neck situation is a challenge for the surgeon in search of suitable recipient vessels for microvascular reconstruction of the head and neck. The internal thoracic vessels (ITVs) have proven useful as “rescue” recipient vessel resource. The objective of this report is to assess the feasibility of using ITVs by rerouting the pedicle for free flap reconstruction of the head and neck by comparing two different approaches. Material and MethodsTwo surgical approaches were assessed: the classical one is parasternal, but cardiac surgeons commonly use median sternotomy. We conducted an anatomical study, comparing on the same subject the lengths and diameters of both internal thoracic artery (ITA) and internal thoracic vein (ITV) at the sixth, fifth, and fourth intercostal spaces (ICSs) through parasternal approach on one side and by median sternotomy on the other side. ResultsThe study was performed on 13 subjects. We found a superiority of length of the ITVs with the median sternotomy approach. Regarding the mean length of the ITA, the sternotomy approach allowed a significant greater length with 119/89/67 mm, compared with parasternal approach with 91/62/42 mm, respectively at the sixth, fifth, and fourth ICS (p<0.001). Similarly, we observed a significant greater length of the ITV with 116/85/63 mm versus 89/62/42 mm (p<0.001).The mean arterial and venous diameters were 2.9 mm and 2.1 mm in the sixth ICS, 3.3 mm and 2.3 mm in the fifth ICS, and 3.9 mm and 2.9 mm in the fourth ICS, respectively. ConclusionThese results help to guide the choice of surgical approach and the level of harvesting.

Analysis of the radial and ulnar arteries using ultrasound and a vascular visualization device in children.

Radial artery is the preferred site for cannulation. Recently, the ulnar artery was chosen as an alternative in adults. We aimed to measure the diameter and depth of the ulnar and radial arteries using ultrasound, and our secondary purpose was to evaluate their anatomical position using a near-infrared transcutaneous illumination device. Forty-eight children (age range: 0-144months) were assigned to the following groups: group Infant (aged <12months), group Preschool (aged ≤12 to <72months), and group School (aged ≥72months). The diameter, depth, and position of the ulnar and radial arteries were compared between groups. There was no significant difference between the diameters of the ulnar and radial arteries. In group Infant, group Preschool, and group School, mean diameters of the ulnar artery were 1.27±0.15mm, 1.62±0.27mm, and 2.03±0.28mm, respectively, and the radial artery were 1.29±0.15mm, 1.69±0.27mm, and 2.06±0.29mm, respectively. The corresponding differences between the diameters of ulnar and radial arteries were -0.02mm, -0.07mm, and -0.02mm [95% CI -0.16mm to 0.12mm, -0.25mm to 0.11mm, and -0.25mm to 0.21mm; p=.776, p=.411, and p=.852]. In groups Preschool and School, the ulnar artery was at the recommended depth of 2-4mm for arterial cannulation compared with the radial artery. In the Infant, Preschool, and School age groups, the ulnar and radial arteries were at the recommended depth of 2-4mm for arterial cannulation in 70.0%, 100.0%, 93.8%, and 80.0%, 65.0%, and 50.0% of the cases, respectively. (difference: -10.0%, 35.0%, and 43.8%, 95%; CI -43.4% to 23.4%, 14.1% to 55.9%, and 19.4% to 68.1%, respectively). The ulnar artery can be considered a promising alternative to the radial artery for facilitating arterial cannulation in children.

Post-occlusive reactive hyperemia and skeletal muscle capillary hemodynamics.

In female Sprague-Dawley rats (n=6), the spinotrapezius muscle was exteriorized for evaluation of capillary hemodynamics pre-occlusion, 5min of feed artery occlusion (Occ), and 5min of reperfusion (Post-Occ). There were no differences in mean arterial pressure (MAP) or capillary diameter (Dc) between pre-occlusion and post-occlusion (P>0.05). During 30s of PORH, capillary fRBC was increased (pre: 59±4 vs. 30s-post: 77±2 cells/s; P<0.05) and VRBC was not changed (pre: 300±24 vs. 30s post: 322±25μm/s; P>0.05). Capillary hematocrit (Hctcap) was unchanged across the pre- to post-occlusion conditions (P>0.05). Following occlusion, there was a 20-30% decrease in the number of capillaries supporting RBC flow at 30s and 300s-post occlusion (pre: 92±2%; 30s-post: 66±3%; 300s-post: 72±6%; both P<0.05). Short-term feed artery occlusion (i.e. 5min) resulted in a more heterogeneous capillary flow profile with the presence of capillary no-reflow, decreasing the percentage of capillaries supporting RBC flow. A complex interaction between myogenic and metabolic mechanisms at the arteriolar level may play a role in the capillary no-reflow with PORH. Measurements at the level of the conduit artery mask significant alterations in blood flow distribution in the microcirculation.

Anatomy of the splenic artery: what does the surgeon need to know?

to determine the prevalence and describe the main morphological and metric variations of the splenic artery in terms of its origin, path and polar and terminal branches. cross-sectional study, carried out at Hospital de Clínicas between July and November 2020. Computed tomography scans were analyzed with intravenous contrast of the patients seen at the Radiology and Diagnostic Imaging Service. The findings were categorized as to origin, path and splenic ramifications. 1,235 patients were evaluated. As for the origin, the splenic artery appears in the celiac trunk in 99.11% of the individuals. Of these, 5.95% have a bifurcated celiac pattern, 92.17% trifurcated and 1.88% tetrafurcated. The mean arterial diameter was 5.92mm (±1.2), the highest one being in white men. As for the path, the splenic artery was unique in the entire sample. The suprapancreatic course was found in 75.63% of the individuals, with a higher occurrence in women, 78.87% (p<0.001). The terminal splitting pattern of the splenic artery was characterized by the bifurcated type (95.47%). The terminal branches seen most frequently were those with three arteries (34.90%) and most individuals did not have polar branches. the splenic artery presents a highly variable pattern of origin and its average caliber is influenced by sex and color. The suprapancreatic path was the most characteristic and predominant in females. The bifurcated pattern of final division, with three terminal branches and the absence of polar arteries, occurs more frequently.