Segmental Obstruction Research Articles

Flow reduction due to arterial catheterization during stroke treatment - A computational study using a distributed compartment model.

The effectiveness of various stroke treatments depends on the anatomical variability of the cerebral vasculature, particularly the collateral blood vessel network. Collaterals at the level of the Circle of Willis and distal collaterals, such as the leptomeningeal arteries, serve as alternative avenues of flow when the primary pathway is obstructed during an ischemic stroke. Stroke treatment typically involves catheterization of the primary pathway, and the potential risk of further flow reduction to the affected brain area during this treatment has not been previously investigated. To address this clinical question, we derived the lumped parameters for catheterized blood vessels and implemented a corresponding distributed compartment (0D) model. This 0D model was validated against an experimental model and benchmark test cases solved using a 1D model. Additionally, we compared various off-center catheter trajectories modeled using a 3D solver to this 0D model. The differences between them were minimal, validating the simplifying assumption of the central catheter placement in the 0D model. The 0D model was then used to simulate blood flows in realistic cerebral arterial networks with different collateralization characteristics. Ischemic strokes were modeled by occlusion of the M1 segment of the middle cerebral artery in these networks. Catheters of different diameters were inserted up to the obstructed segment and flow alterations in the network were calculated. Results showed up to 45% maximum blood flow reduction in the affected brain region. These findings suggest that catheterization during stroke treatment may have a further detrimental effect for some patients with poor collateralization.

Robot-assisted transposition of aberrant lower polar renal vessels in a 14-year-old child with vasorenal hydrophnerosis

This study presents a patient with pyeloureteral segment obstruction caused by aberrant inferior polar vessels using the robotic Hellström – Chapman procedure and reports its short-term results. A 14-year-old girl was admitted to Irkutsk Regional Children’s Clinical Hospital because of obstruction of the pyeloureteral junction caused by external compression by aberrant lower polar vessels. The diagnosis was established by ultrasonography and Doppler sonography and confirmed by contrasted computed tomography. Surgery was performed using the Versius surgical robot manufactured by CMR (UK). Delicate actions were used to mobilize the abnormal vessels and move them to the anterior wall of the pelvis. Then, they were “wrapped” with the anterior wall of the pelvis. Postoperative follow-up included clinical evaluation and renal ultrasound examination 1, 3, and 6 months after surgery. The operative duration was 65 min. During the robot-assisted Hellström – Chapman operation, no intraoperative complications, such as damage to the vessels supplying the kidney and neighboring organs, were noted. The patient did not require internal or external drainage of the upper urinary tract or perinephric space. The anteroposterior diameter of the pelvis decreased from 30 to 8 mm. The resistive index of the blood flow in the renal vessels decreased from 0.74 to 0.58. The Hellström – Chapman robotic procedure is a safe and effective procedure for the correction of vasorenal hydronephrosis. However, this surgery requires patient selection to ensure future treatment success.

Improved Health-Related Quality of Life with Superficial Femoral Artery Stenting in Intermittent Claudication Done Prior to Medical Treatment: A Case Report

In cases involving TASC A lesions of the superficial femoral artery (SFA), the conventional approach typically starts with medical therapy and supervised exercise. When these measures fail to yield the desired results, endovascular procedures may be contemplated. However, in the distinctive case of a 68-year-old male, endovascular therapy was employed to reestablish blood flow through the obstructed SFA segment. This intervention substantially improved the patient’s ability to walk. Subsequently, the patient continued with optimal medical therapy. This integrated approach, beginning with SFA stenting followed by conservative care, promptly alleviated claudication-related symptoms, ultimately resulting in an enhanced quality of life

Mechanisms of Coronary Artery Spasm.

Recent clinical trials have highlighted that percutaneous coronary intervention in patients with stable angina provides limited additional benefits on top of optimal medical therapy. This has led to much more attention being paid to coronary vasomotion abnormalities regardless of obstructive or non-obstructive arterial segments. Coronary vasomotion is regulated by multiple mechanisms that include the endothelium, vascular smooth muscle cells (VSMCs), myocardial metabolic demand, autonomic nervous system and inflammation. Over the years, several animal models have been developed to explore the central mechanism of coronary artery spasm. This review summarises the landmark studies on the mechanisms of coronary vasospasm demonstrating the central role of Rho-kinase as a molecular switch of VSMC hypercontraction and the important role of coronary adventitial inflammation for Rho-kinase upregulation in VSMCs.

A Rare Case of Duodenal Obstruction: Annular Pancreas in a 22 Years Old Patient: Case Report

Annular pancreas is a rare congenital condition in which a ring of ectopic pancreatic tissue partially or completely surrounds the second part of the duodenum [1]. This Congenital anomaly is usually presented in infants and newborn, rarely in adult life. It can present in a wide range of clinical severities making it difficult to diagnose. CT scan can illustrate the pancreatic tissue encircling the duodenum. Surgery still remains necessary to confirm diagnosis and bypassing the obstructed segment. We report the case of a 22 years old female patient who presented with history of vomiting and weight loss causing a stature weight growth delay, the diagnosis was made by the CT scan. Then the patient was scheduled for a gastroenteroanastomosis. The evolution was favorable.

ЛАПАРОСКОПИЧЕСКАЯ ПИЕЛОПЛАСТИКА ПРИ ГИДРОНЕФРОЗЕ ПОДКОВООБРАЗНОЙ ПОЧКИ У МАЛЬЧИКА 3 ЛЕТ

Authors describe a clinical case of a combination of a horseshoe kidney and hydronephrosis of its left half in a 3-year-old male patient and laparoscopic pyeloplasty of the identified pathology. Based on the results of preoperative CT, the diagnosis was confirmed and obstruction of the pyeloureteral segment was found as a source of hydronephrosis. Laparoscopic surgery made it possible to clarify the anatomy of the horseshoe kidney and the reason for the pyeloureteral segment obstruction in the form of a high discharge of the ureter from the pelvis. The Anderson-Hynes pyeloplasty with pelvic stenting was performed. The duration of the surgical intervention was 70 minutes. The need for analgesia persisted for 1 day (paracetamol 15 mg/kg/8 h). The drainage tube was removed after a follow-up ultrasound examination on the 3rd day, after which the patient was discharged for outpatient follow-up. The duration of follow-up was 6 months. The patient was asymptomatic throughout the control period. Repeated ultrasound performed 6 months after the surgical intervention revealed a decrease in the anteroposterior diameter of the pelvis to 8 mm. Conclusion: laparoscopic pyeloplasty is a feasible and safe procedure in patients with complex renal anatomy accompanied by the pyeloureteral segment obstruction. Accurate preoperative planning and standardized technique are the keys to successful treatment.

A Silicone-Covered Self-Expanding Metal Stent with Anti-migration Features for Treating Malignant Ureteral Obstruction.

To evaluate the effectiveness and safety of the Urexel stent for treating malignant ureteral obstruction (MUO). This retrospective study included 129 patients (mean age: 57.9 ± 11.8years; men: n = 64, 49.6%; ureteral units [UUs]: N = 175) who underwent Urexel stent placement to treat MUO between March 2013 and April 2021. The Urexel stent is a fully covered self-expanding metal stent. To reduce stent migration, the proximal end of the stent has an additional layer of stent mesh and is flared mildly. Eighty-three patients (64.3%) had unilateral MUO (right side: n = 47, 36.4%; left side: n = 36, 27.9%), and 46 patients (35.7%) had bilateral MUO. Successful Urexel stent placement after successful guidewire passage of the obstructed ureteral segment was achieved in 172 UUs, rendering a technical success rate of 98.3%. Stent malfunction occurred in 37 UUs (21.4%) during follow-up, including tumor overgrowth (n = 29), tumor ingrowth (n = 3), stent migration (n = 3), and stent collapse (n = 2). A total of 120 patients (93.0%) died during a median follow-up of 4.1months (range: 0.2 - 33.5). The median survival of the patients was 4.4months (interquartile range [IQR] 2.0 - 8.8). The median malfunction-free survival of the patients was 3.6months (IQR: 1.6 - 7.9). Fifteen grade 3 or higher complications occurred in 14 patients (10.9%), including flank pain (n = 10), gross hematuria (n = 4), and dysuria (n = 1). Urexel stent placement may be effective and safe for treating MUO.

Effect of Antibiotic Therapy in Children with Pyelouretheral Segment Obstruction

The present retrospective study, which was conducted from 2013 to 2018 years, includes data of 131 children with antenatally diagnosed grade III and IV hydronephrosis (SFU). All patients underwent surgical treatment at the age from 3 months to 3 years and did not receive antibiotic prophylaxis. Urinary tract infection was diagnosed in the presence of WBC in urine sample (> 10 WBC/field of view), positive bacterial growth (≥105 CFU/ml) and fever (≥38.5 ° C). Children with duplex system, obstructive megaureter, vesicoureteral reflux, posterior urethral valve, and neurogenic bladder were excluded from this study. Grade III hydronephrosis was detected in 113 children and grade IV in 18 patients. The total incidence of urinary tract infection was 9.2% (12 patients), while in the group of children with grade IV hydronephrosis it was higher (in 3 of 18 - 16.7%) than in children with grade III (in 9 out of 113 - 7.9%) (P <0.05). The incidence of urinary tract infections did not differ significantly depending on the sex or age of the patients. In 7 (58.3%) patients, urinary tract infection was noted before the age of 6 months, with an average age of 2.7 months. A bacteriological study revealed that in eight (66.7%) patients, E. Coli was the causative agent of urinary tract infection. Children with antenatal diagnosed and postnatal confirmed ureteropelvic junction obstruction do not need antibiotic prophylaxis because of the low incidence of urinary tract infection. However, patients with grade IV hydronephrosis under the age of 6 months should be closely follow-up by physicians for the early diagnosis and treatment of urinary tract infection.

Obstrução do intestino grosso por enterólitos e/ou por corpos estranhos em equídeos domésticos: estudo retrospectivo de casos observados de janeiro de 2003 a março de 2020

ABSTRACT This retrospective study was based on data extracted from medical records of 48 horses with intestinal obstruction caused by enteroliths and/or foreign bodies seen over the course of 17 years. Data analysis was aimed at describing the major features of this type of colic. Obstructions caused by enteroliths, foreign bodies or both accounted for 40 (83.34%), 6 (12.50%) and 2 (4.16%) cases in this sample respectively. Affected horses were aged 1 to 32 years (mean age 9.5 years) and 14 horses were fed alfalfa. Alfalfa is thought to contribute to enterolith formation. Foreign bodies and enteroliths were found in the transverse (12 cases, 25%), the large or the small colon (10 cases, 20.83% respectively). Concurrent obstruction of different intestinal segments was also recorded. These involved the small and the large colon in 10 cases (20.83%), the transverse and the large colon in 4 cases (8.33%), the small and the transverse colon in 1 case (2.08%) and the transition from the large to the transverse colon in one case (2.08%). Short term survival was 77.08% overall and 87.50% when only patients submitted to postoperative treatment were accounted for. Survival data are consistent with survival rates of 91% reported in literature.

Primary obstructive megaureter in children; 10 years' experience from a tertiary care center.

Introduction:Primary obstructive megaureter (POM) is a congenital dilatation of the ureter due to an adynamic segment of vesicoureteric junction obstruction. Surgical intervention is needed if nuclear scan shows obstructive curve. We analyzed our data and outcome of conservative and surgical treatment in such cases at our tertiary care hospital.Materials and Methods:We evaluated all cases of POMs during the study period. Investigations included ultrasonography (USG), voiding cystourethrogram, diethylene pentacetic acid (DTPA) scan, and dimercaptosuccinyle acid scan. In antenatal cases, any pelvic dilatation ≥12 mm after 6 weeks were subjected to reonography. Patients with anterior-posterior pelvic diameter (APPD) ≥12 mm had to undergo DTPA scan to look for DRF and drainage. Follow-up USG was done in all cases of mild-to-moderate hydroureteronephrosis, with APPD <12 at 3 months interval.Results:A total of 270 megaureters were registered and treated during the study period (2008–2019). The total number of patients included was 50 (64 ureters). The mean age of presentation in these 30 children was 21.78 ± 18.1 months (range 1–72 months) and the mean weeks of gestation in antenatal cases at presentation as megaureter was 24 ± 7 weeks (range 13–37 weeks). The mean weight of babies was 2.72 ± 0.7 g. The duration of follow-up ranged from 16 to 1W12 months. The mean APPD on the affected side was 19.99 ± 10.3 mm (range 11–43 mm). The mean ureteric diameter was 1.67 ± 0.33 mm (range 0.78–2.66 cm). The mean split function of patients with POM was 34.88% ± 11.5% on the affected side. Twenty patients (40%) had spontaneous resolution over a mean time period of 24.1 ± 11.1 months. Thirty patients underwent surgical procedures. In three children, HTN was observed over a mean follow-up period of 3 years.Conclusion:The babies with POM need a close follow-up. Surgery is indicated in prolonged t½/Tmax on renal scan, function <40% at the initial scan, or >5% split function deterioration in the subsequent renal scan.

Comparison of long-term outcomes of balloon angioplasty with or without stent placement for hepatic vein type Budd-Chiari syndrome

To compare percutaneous transluminal balloon angioplasty (PTBA) alone with PTBA plus stent placement for Budd-Chiari syndrome (BCS) patients with short-segmental obstruction of hepatic vein. Between May 2001 and December 2010, 91 hepatic vein type BCS patients (mean age, 32.8 ± 10.8; M:F ratio 50:41) were included and divided into two groups (PTBA alone, as group A, n = 48; PTBA plus stent, as group B, n = 43). The incidence of restenosis, long-term patency, and survival were evaluated. All 91 patients were successfully treated with hepatic vein recanalization. During follow-up period (median 161 months, range: 84-234), group B had a significantly higher proportion of hepatic vein restenosis (56%, 24/43) than group A (33%, 16/48; P < 0.05). Cumulative primary patency rates at 1, 5, 10, 15 years were 96%, 81%, 69%, 65% and 91%, 60%, 47%, 47% in group A and group B, respectively (log-rank P < 0.05). Secondary technical success rates of target hepatic vein were 93% and 57% in group A and group B, respectively (P < 0.05). Clinical complete response rates were 94% and 86% in group A and group B, respectively (P > 0.05). The 15-year cumulative survival rates were 98% and 95% in group A and group B, respectively (P > 0.05). Major procedure-related complications occurred in 3 (3%) patients (1 in group A, 2 in group B). Hepatic vein recanalization is safe and efficient for hepatic vein type BCS patients with hepatic vein short segmental obstruction. Restenosis after hepatic vein stenting is more common and difficult to manage than that after hepatic vein balloon angioplasty alone.

CORONARY ARTERY DISEASE ON CT-CORONARY ANGIOGRAM – COMPARISON BETWEEN DIABETIC AND NON-DIABETIC POPULATION

Objective: To evaluate the CT coronary angiograms of patients presenting with symptoms of coronary artery disease (CAD) as well as to compare the results between the diabetics and non-diabetics.&#x0D; Methodology: This descriptive cross-sectional study was carried out in Cardiology department of Chaudhary Pervaiz Elahi Institute of Cardiology, Multan. One hundred and fifty nine patients with history of symptoms of CAD and no previous history of myocardial infarction or revascularization were included in study. The conventional risk factors were noted and 64 slice multi detector CT coronary angiogram was done on all patients. Total calcium score and number of segments with disease, obstructive disease and non-obstructive disease were noted. Results were compared among diabetic and non-diabetic patients.&#x0D; Results: Mean age of the patients was 50.54±7.90 years. Out of 159 patients 118(74.2%) were males and 41 (25.8%) were females. Diabetic patients were 101(63.5%), 64 (40.3%) were hypertensive, 39(24.5%) were smokers, 24.5% (n=39) had positive family history, 18.2% (n=29) were obese and 13.8% (n=22) had dyslipidemia. There was no coronary artery disease in 40 (25.2%) patients while 91 (57.2%) patients had obstructive and 28 (17.6%) patients had non-obstructive disease. 83. 1% diabetics had obstructive CAD and 12.0% of non diabetic patients had obstructive CAD. Mean number of obstructive segments in diabetic patients are 2.36±1.23.&#x0D; Conclusion: CAD was more prevalent in diabetic patients and CAD is easily predicted by non-invasive technique of CT coronary angiography.

CORONARY ARTERY DISEASE ON CT-CORONARY ANGIOGRAM – COMPARISON BETWEEN DIABETIC AND NON-DIABETIC POPULATION

Objective: To evaluate the CT coronary angiograms of patients presenting with symptoms of coronary artery disease (CAD) as well as to compare the results between the diabetics and non-diabetics. Methodology: This descriptive cross-sectional study was carried out in Cardiology department of Chaudhary Pervaiz Elahi Institute of Cardiology, Multan. One hundred and fifty nine patients with history of symptoms of CAD and no previous history of myocardial infarction or revascularization were included in study. The conventional risk factors were noted and 64 slice multi detector CT coronary angiogram was done on all patients. Total calcium score and number of segments with disease, obstructive disease and non-obstructive disease were noted. Results were compared among diabetic and non-diabetic patients. Results: Mean age of the patients was 50.54±7.90 years. Out of 159 patients 118(74.2%) were males and 41 (25.8%) were females. Diabetic patients were 101(63.5%), 64 (40.3%) were hypertensive, 39(24.5%) were smokers, 24.5% (n=39) had positive family history, 18.2% (n=29) were obese and 13.8% (n=22) had dyslipidemia. There was no coronary artery disease in 40 (25.2%) patients while 91 (57.2%) patients had obstructive and 28 (17.6%) patients had non-obstructive disease. 83. 1% diabetics had obstructive CAD and 12.0% of non diabetic patients had obstructive CAD. Mean number of obstructive segments in diabetic patients are 2.36±1.23. Conclusion: CAD was more prevalent in diabetic patients and CAD is easily predicted by non-invasive technique of CT coronary angiography.

Telocytes, c-Kit positive cells, Smooth muscles, and collagen in the ureter of pediatric patients with congenital primary obstructive megaureter: elucidation of etiopathology

ABSTRACT Congenital primary obstructive megaureter (POM) is an uncommon pediatric anomaly that is due to obstructive distal ureter leading to the loss of peristalsis with consequent ureterohydronephrosis causing loss of kidney function. The objectives are to elucidate the etiology of POM by demonstrating the presence of interstitial cells of Cajal (ICC), telocytes, smooth muscles, and collage in the obstructive and dilated ureteral segments. The study was carried out on 15 surgical specimens of congenital POM in pediatric patients, age range was 4 to 24 months, they were operated upon by excision of the obstructed segment, tailoring the dilated ureter, and anastomosing it to the bladder. Specimens included the obstructed ureteral segment and part of the dilated ureter. Specimens were examined with hematoxylin and eosin (H&E) stain, Modified Gomori trichrome stain, immunohistochemistry (IHC) with α-muscle actin, and c-kit (CD117), and transmission electron microscopy (TEM). Obstructed segment showed excess collagen intervening between smooth muscles, excess c-Kit positive cells, and presence of telocytes. The dilated segment of the ureteral wall is formed of smooth muscle bundles with scanty collagen. Staining with c-Kit did not demonstrate positive cells. TEM showed myofibroblasts and close adherence of smooth muscle cells to each other with absence of telocytes. The pathophysiology of POM is multifactorial. Loss of interstitial cells and rarity of collagen result in loss of elasticity of dilated segment leading to massive dilatation. While the obstructed segment had no muscle conductivity due to excess collagen irrespective of presence of telocytes.

Neonatal intestinal obstruction: Type I - Septal atresia of distal small intestine

Congenital Intestinal atresia is common cause of neonatal intestinal obstructions. Small intestinal atresia accounts for majority of cases than colonic atresia. In small intestinal atresia Type I is rare form. The plausible etiology is mainly from intra-uterine mesenteric vascular accident and the extent depends on the time and the site of development of obstruction. A 2-day-old baby with history of maternal antenatal scan suspecting of Hirschsprung’s disease presented with clinical signs of lower intestinal obstruction. Barium enema showed features of distal small intestine obstruction for which baby underwent surgery with resection of obstructed segment with end to end anatomises was done. Type I small intestinal atresia was confirmed on histological examination. Thus intestinal obstruction is an emergency encountered in newborn infants requiring early accurate diagnosis by radio imaging modalities and histopathological evaluation. Keywords: Intestinal obstruction, Small intestine atresia, Histopathology.

Association between the lengths of excised obstructed vas deferens segments at the time of vasovasostomy and surgical outcomes.

This study aimed to determine whether the length of the excised obstructed vas deferens at vasovasostomy (VV) performed for fertility is associated with semen parameters and/or pregnancy outcomes postoperatively. The patients who underwent a VV at our institution from September 2004 to December 2018 were contacted via questionnaire and a chart review was performed. Linear and logistic regression models were used to determine the associations between the length of the obstructed vas deferens removed and postoperative outcomes including sperm concentration, motility, and successful pregnancy after reversal. A total of 83/170 questionnaires were returned. After exclusions, a total of 35 patients were included for analysis. The mean age of the patients at the time of surgery was 40.1 years and the mean time since vasectomy 9.3 years. The mean length of the obstructed vas deferens removed during VV was 2.25 cm. The longer the vas deferens segments removed, the more significant was the increase in sperm motility at 3 and 9 months postoperatively (p=0.011 and 0.008, respectively), but decreased sperm motility at 6 months (p=0.029). In 75.9% of the patients, sperm was present postoperatively, 23.2% achieved pregnancy through natural conception, and 55.8% achieved pregnancy using assisted reproductive techniques. There was no significant relationship between the length of the vas deferens removed and sperm concentration or pregnancy achieved after surgery. In this cohort, the length of the excised obstructed vas deferens at VV was associated with improved sperm motility at 3 and 9 months postoperatively but not with pregnancy outcomes.

Heterozygote Triplets. A Rare Case of Wilkie’s Syndrome

Wilkie’s Syndrome is a rare cause of small bowel obstruction that rarely occurs in a familiar setting. We report a rare variant, related to heterozygote triplets in a case that underwent laparoscopic duodenojejunostomy to bypass the obstructed segment. During the patient’s clinical evolution, we collected and discussed preoperative and post-operative studies. In addition, we performed a review of literature.

Comparative Analysis of Stenting and Hybrid Operations in Chronic Venous Obstruction of Iliofemoral Segments in Patients with Postthrombotic Syndrome

Comparative Analysis of Stenting and Hybrid Operations in Chronic Venous Obstruction of Iliofemoral Segments in Patients with Postthrombotic Syndrome

Clear cap-assisted luminal stenting may improve technical success in gastroduodenal and colonic obstruction.

Background Luminal stenting is safe, effective, and at times the preferred method for relieving gastrointestinal obstruction. However, stent placement is not technically feasible when lesions cannot be traversed with a guidewire, resulting in the need for more invasive methods of palliation and urgent/emergent surgical intervention. In this series, we report our experience with cap-assisted stenting to improve lumen visualization in obstructed segments of the gastrointestinal tract and salvage cases that may have otherwise resulted in technical failure. Methods A clear cap (i. e. distal attachment) was affixed to the scope tip to facilitate visualization and stenting in two cases of gastroduodenal obstruction and three cases of colonic obstruction. Indications for stent placement included malignant obstruction, diverticulitis-associated obstruction, and Crohn’s disease-associated stricture. Results In this report, we demonstrate that use of a clear cap facilitated endoscopic stenting in challenging cases of malignant and benign gastroduodenal and colonic obstruction. Conclusions A clear cap for endoscopic stenting can be used in cases in which standard techniques are unsuccessful or those anticipated to be technically difficult at the outset. Cases with tortuous anatomy or particularly tight, friable, or exophytic obstructive lesions may benefit most from this novel technical modification.

The prognostic value of histopathological pattern of the pelviureteric junction in the outcome of pyeloplasty in children

BackgroundThe cause of pyeloplasty failure remains unclear; therefore, increasing interest has been directed to identify the reason for dissatisfactory surgical results. Some studies attempted to investigate the role of the histopathological pattern. The aim of the work is to study the correlation between the histopathological pattern of obstructed pelviureteric junction (PUJ) segment and the outcome of pyeloplasty in children with the PUJ.MethodsFifty-four patients with pelviureteric junction obstruction (PUJO) were included in the study; patients were evaluated preoperative. All patients were operated by the same surgeon using Anderson–Hynes pyeloplasty; the resected obstructed PUJ segment examined histopathological using light microscope and image analyzer system to identify mean renal pelvis smooth muscle thickness (mRPSMT), collagen-to-smooth muscle ratio and elastin content.ResultsThe study includes 50 patients with mean age Mean 24.48 ± 15.3 months. Two patients show no improvement, while 24 improved at 3 months, 16 improved at 6 months, and 8 improved at 12 months. mRPSMT showed significant difference between improvement groups (136.02 ± 44.4, 173.47 ± 49.69 and 258.56 ± 96.82 μm), while elastin content or collagen-to-smooth muscle ratio showed no significant difference.ConclusionsOur data showed a clear relationship between mRPSMT and the time over which radiological improvement occurs; increase in mRPSMT is associated with a delay in postoperative radiological improvement time. We found no relation between elastin content nor collagen-to-smooth muscle thickness and postoperative improvement course.