Patency In Women Research Articles

Efficacy of 2D/3D HyCoSy with new contrast medium lignocaine and saline comparing with HSG - A single centre prospective study

Tubal patency significantly impacts female infertility, with a substantial portion of cases linked to tubal damage. This hinders gamete and embryo transfer. While laparoscopic chromo-pertubation is the gold standard, its invasiveness prompts the search for alternatives. Common methods for assessing tubal health are Hysterosalpingography (HSG) and Hysterosalpingo Contrast Sonography (HyCoSy).The objective of this study is to assess and compare the efficacy of a budget-friendly 2D/3D HyCoSy method using a unique contrast agent with traditional HSG for diagnosing tubal patency in women with infertility issues.A prospective observational study was conducted within a single clinical setting over a five-year duration. A total of 117 infertile women underwent assessment using both the 2D/3D HyCoSy and HSG techniques.Participants had a mean age of 27.7 years (standard deviation: 4.2, range: 19-45 years). The diagnostic accuracy of 2D/3D HyCoSy was determined with a sensitivity of 91.86%, specificity of 89.18%, a positive predictive value of 90.40%, and a negative predictive value of 90.82%. Comparative analysis revealed that when evaluating tubal patency in both tubes collectively with HyCoSy, the sensitivity, specificity, and overall accuracy were 91.86%, 89.18%, and 90.59%, respectively. The study findings demonstrated that employing 2D/3D HyCoSy with lignocaine gel proved to be a superior diagnostic approach compared to HSG for assessing tubal patency in women experiencing infertility.

Age-related features of the respiratory system functioning in women who experienced chronic stress caused by war

As ageing progresses, conditions are created for the pulmonary pathology development and exacerbation of its course. On the other hand, chronic stress leads to a disruption of the respiratory system's adaptive capabilities, which may contribute to pathological conditions development and accelerated ageing. Aim of the Study: the study aimed to assess the lung ventilation function state and bronchial patency in women who have experienced chronic stress caused by war (CSW). Subjects and Methods. A total of 91 women aged 31-78 years who experienced CSW and 79 women in the age group of 29-74 years who did not experience CSW were examined. To diagnose the state of stress, the anxiety level (personal and situational) was determined using the Spielberger-Hanin test. The biological age of the respiratory system was calculated using a developed formula. Results. The impact of CSW did not significantly affect lung ventilation function and bronchial patency in middle-aged and older women. In young women who experienced CSW, there was a decrease in bronchial patency compared to women who did not experience CSW. At the same time, in young women who experienced CSW, the ageing of the respiratory system was accelerated. Conclusions. CSW by war significantly does not affect lung ventilation function and bronchial patency in middle-aged and older women. However, in young women, CSW leads to a reduction in some indicators of bronchial patency. The impact of CSW results in the ageing of the respiratory system in young women. _________________________________________________________________________________________ Keywords: chronic stress caused by war (CSW), ageing, women, ventilation, bronchial patency

Diagnostic Accuracy of Sonosalpingography for Assessing Tubal Patency in Women with Infertility Taking Laparoscopy as the Gold Standard

Objective: To evaluate the diagnostic validity of Sonosalphingography as a tubal patency test in infertile women using laparoscopy as gold standard. Methodology: This study was carried out at the Shifa International Hospital Islamabad, and the duration of this study was from January 2021 to June 2021. We used the WHO method for sample size by taking the prevalence of tuboperitoneal factors as 30%, sensitivity 72.9%, specificity 81.22%, margin of error 12%, and 95% confidence interval. It was a cross-sectional study that lasted for 6 months and assessed a total of 178 patients. Additionally, a non-probability, sequential sampling strategy was utilized to acquire the sample. Results: Our patients aged between 18-45 years, out of which 30% of the participants aged 18 to 25 years, 55% were between 26 and 35 years, and 15% were between 36 and 45 years. Standard deviation was 1.26, with a mean age of 27. The data collected from both the diagnostic tests was analyzed, diagnostic accuracy of Sonosalphingography was calculated as a sensitivity of 81%, specificity of 76%, positive predictive value of 90%, negative predictive value of 60%, and diagnostic accuracy of 79%. Conclusion: According to the results of our study, Sonosalphingography is a very helpful supplemental diagnostic tool for evaluating tubal disease in patients with infertility, though direct laparoscopic assessment is the gold standard. Sonosalphingography and laparoscopy can be used to evaluate patients with secondary infertility. This spares the patient from being exposed to radiations and the discomfort of contrast administration in HSG. Keywords: Diagnostic Accuracy, Sonosalphingography, Tubal Patency, Infertility, Laparoscopy

The Prevalence of Fallopian Tube Occlusion in Women with Polycystic Ovary Syndrome Seems Similar to Non-Subfertile Women: A Retrospective Cohort Study.

There are limited data on how non-infectious risk factors influence tubal patency in women with subfertility. With hormonal shifts influencing tubal secretions, it has been argued that subfertile women with polycystic ovary syndrome (PCOS) have lower tubal patency. In a retrospective study, 216 women, who underwent diagnostic evaluation for PCOS and infertility, were included. Fallopian tube patency was tested using HSG, HyCoSy, and laparoscopic chromopertubation in 171 (79.2%), 28 (13.0%), and 17 (7.9%), respectively. Bilateral patency was found in 193 women (89.4%), unilateral patency in 13 (6.0%) and bilateral occlusion in 10 (4.6%) patients. Women with PCOS phenotypes C (odds ratio, OR 0.179, 95% CI: 0.039–0.828) and D (OR 0.256, 95% CI: 0.069–0.947) demonstrated lower risks for Fallopian tube occlusion. In conclusion, our data suggest that about 5% of infertile women with PCOS also have bilateral tubal occlusion, which seems similar to the rate in non-subfertile women. With 11% of participants having unilateral or bilateral tubal occlusion, this should reassure women with PCOS that their hormonal challenges do not seem to increase their risk for tubal factor subfertility.

Diagnostic Accuracy of Sonosalpingography for Assessing Tubal Patency in Women with Infertility Taking Laparoscopy as Gold Standard

Background: Infertility is defined as the failure to conceive after 1 year of unprotected sexual intercourse in women less than 35 years of age and 6 months in women older than 35 years [1, 2]. It affects 10 to 15 % of the couples [1]. Abnormalities of fallopian tubes account for 35 to 40 % of the cases of infertility [3]. Sonosalpingography is a non-invasive, safe and cost- effective diagnostic technique which provides reliable diagnosis of tubal patency [4]. Objective: To evaluate the diagnostic validity of Sonosalpingography as a tubal patency test in infertile women using laparoscopy as gold standard. Methodology: This study was carried out at the Radiology Departments of Khyber Teaching Hospital and Kuwait Teaching Hospital in Peshawar. We used the WHO method for sample size by taking the prevalence of tuboperitoneal factors as 30%, sensitivity 72.9%, specificity 81.22%, margin of error 12%, and 95% confidence interval. It was a cross-sectional study that lasted for 6 months and assessed a total of 178 patients. Additionally, a non-probability, sequential sampling strategy was utilized to acquire the sample. Results: Our patients aged between 18-45 years, out of which 30% of the participants aged 18 to 25years, 55% were between 26 and 35years, and 15% were between 36 and 45years. Standard deviation was 1.26, with a mean age of 27. The data collected from both the diagnostic tests was analyzed, diagnostic accuracy of Sonosalpingography was calculated as a sensitivity of 81%, specificity of 76%, positive predictive value of 90%, negative predictive value of 60%, and diagnostic accuracy of 79%. Conclusion: According to the results of our study, sonosalpingography is a very helpful supplemental diagnostic tool for evaluating tubal disease in patients with infertility, though direct laparoscopic assessment is the gold standard. Sonosalpingography and laparoscopy can be used to evaluate patients with secondary infertility. This spares the patient from being exposed to radiations and the discomfort of contrast administration in HSG. Keywords: Diagnostic Accuracy, Sonosalpingography, Tubal Patency, Infertility, Laparoscopy

Spontaneous pregnancy rates in infertile women after sequential hydrosonography and hysterosalpingo-foam sonography

ObjectiveTo determine the clinical pregnancy rate following sequential hydrosonography and hysterosalpingo-foam sonography (HyFoSy) in tubal patency assessment among women undergoing infertility work-up. Study designProspective follow-up of women referred to our department between July 2019 and October 2020. Sequential hydrosonography and HyFoSy were carried out. ResultsOut of 250 having the procedure, 100 women were excluded from study due to limited infertility, semen abnormal or not examined, evaluation for social egg freezing or they were single. Of the remaining 150 women, 48 (32%) conceived during a 10–24 months follow-up period: 17 (11%) conceived naturally and 7 (4.7%) by IUI. The mean time to conception was 5.5 ± 5.4 months and the pregnancy rate was 52% within 6 months. Among the spontaneous pregnancies 47% occurred within a month and 76% within 3 months. ConclusionSequential hydrosonography and HyFoSy is a promising method for assessing the uterine cavity and tubal patency in women undergoing infertility workup. The findings suggest that the procedure may increase the chance of a spontaneous pregnancy following the procedure. Given the other known advantages of sequential hydrosonography and HyFoSy, this test is worth including in the initial workup for infertile patients.

The effect of acute and chronic iodine excess on thyroid profile and reproductive function of women using Lipiodol during hysterosalpingography and the potential impact on thyroid function of their offspring: The SELFI study protocol

Abstract Background: Hysterosalpingography (HSG) is a radiological procedure using iodinated contrast media to assess tubal patency in women with infertility. HSG using Lipiodol, an oil-soluble contrast medium (OSCM) has been shown to improve pregnancy rates, so its therapeutic use has increased. However, OSCM can cause marked and prolonged iodine excess, potentially impacting thyroid function. If pregnancy occurs, there is also concern regarding possible neonatal hypothyroidism resulting from maternal iodine excess. This study aims to improve knowledge on the safety profile of OSCM HSG in the context of iodine excess. Methods: This is a prospective longitudinal study of 200 consecutively consenting women undergoing an OSCM HSG in Auckland, New Zealand. After informed consent, participants will undergo baseline thyroid function tests and measurement of urine iodine-to-creatinine ratio (UI/Cr) and anti-thyroid antibodies. During the HSG, the volume of OSCM used will be recorded, and a delayed radiograph obtained to check for further spill of the contrast and for a semi-quantitative assessment of peritoneal retention of OSCM. Thyroid function tests, UI/Cr and reproductive hormones will be serially monitored over the next 6 months. If the woman conceives within the study period, the offspring's thyroid function will be tested at 7 days of age, in addition to the routine newborn screening. The primary outcome will be development of subclinical hypothyroidism (SCH) in these women. Secondary outcomes will include the incidence of elevated iodine levels in these women, and a transient or permanent thyroid dysfunction in the neonates conceived within the study period. In addition, mixed-model analyses will attempt to identify ‘high-risk’ groups for thyroid dysfunction. Discussion: This study will explore the acute and chronic effects of iodine excess on thyroid function in women who undergo an OSCM HSG and in their offspring conceived in the immediate cycles following HSG. Further, this study will provide information on the profile of thyroid function abnormalities following an OSCM HSG, and help guide the establishment of international protocols for thyroid monitoring and management in women undergoing this procedure. Trial registration: Trial acronym–SELFI (Safety and Efficacy of Lipiodol in Fertility Investigations) ACTRN: ACTRN12620000738921, retrospectively registered on 14/07/2020

AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography.

AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography.

Abstract 170: Worse Patency in Women After Endovascular Peripheral Vascular Intervention

Objectives: Women are suspected to have worse outcomes after lower extremity revascularization. We sought to study how patency differed among men and women undergoing endovascular peripheral vascular intervention (PVI). Methods: We studied patients in the Vascular Quality Initiative who underwent a PVI (angioplasty, stent, or atherectomy) between January 2010 to October 2016. We excluded all reinterventions on a previously treated artery. The primary exposure was gender (men vs women) and our outcomes were reintervention or occlusion in each artery treated. We studied outcomes through 1-year post-procedure using Kaplan Meier survival analysis and Cox regression, stratified by artery treated. We adjusted for patient demographics and disease characteristics. Results: Our cohort included 106,073 eligible arteries treated in 58,247 patients across 66,045 procedures. Among these patients, the mean age was 68 years old, 15% were African-American, and 41% were women. Half (50%) of the arteries were treated with stents, 39% were treated with PTA alone, and 11% were treated with atherectomy. Follow-up data on patency was available in 64% of patients (n=37,442 patients, 67,292 arteries). Women experienced lower reintervention-free survival in the iliac (98.4% vs 98.8%, log rank p=0.01) and femoropopliteal (94.7% vs 95.6%, log rank p<0.001) vascular beds ( Figure ). After adjusted Cox regression, gender difference in the femoropopliteal arteries alone remained statistically significant, where women were 30% more likely to need reintervention to maintain artery patency than men (HR: 1.31, 95% CI: 1.18-1.44). Similarly, women experienced lower occlusion-free survival in iliac (95.0% vs 95.9%, log rank p<0.001) and femoropopliteal (88.5% vs 90.9%, log rank p<0.001) arteries. Again, after adjustment, the gender difference remained statistically significant only in the femoropopliteal arteries, where women were 33% more likely than men to have an artery occlude after intervention (HR: 1.33, 95% CI: 1.16-1.53). Conclusions: Women undergoing PVI in the femoropopliteal arteries are more likely to develop an occlusion or need a reintervention in the treated artery within 1-year after intervention. We need further research and improved follow-up data on patency to understand how and why these sex differences arise.

Conventional and magnetic resonance hysterosalpingography in assessing tubal patency-A comparative study.

Context:Tubal factors, one of the leading causes of female infertility, have been conventionally evaluated by hysterosalpingography (HSG). The role of magnetic resonance imaging (MRI) in assessing female infertility is gaining importance because of its inherent efficiency in detecting structural abnormalities. Magnetic resonance hysterosalpingography (MR HSG) is less invasive and avoids exposure of ovaries to ionizing radiation. Its utility is extrapolated to visualize fallopian tubes.Aims:To assess the diagnostic accuracies of dynamic MR HSG and conventional HSG (cHSG) in identifying tubal patency in women with infertility using diagnostic laparoscopy (DL) as gold standard.Materials and Methods:A prospective study of 40 patients was conducted over a period of 6 months. The patients were subjected to MR HSG followed by cHSG during the preovulatory period. If tubes were blocked, the patients were subjected to DL in the next menstrual cycle. If the tubes were patent and there was failure of conception, they were subjected to DL in the interval of 3 months.Results:Twenty-four patients had bilateral tubal spill which was confirmed using cHSG and DL. One patient had discordant MR HSG and cHSG results and six patients had discordant MR HSG and DL results. No statistical difference was observed between MR HSG and cHSG.Conclusion:Pelvic MRI is an inevitable tool in infertility evaluation. MR HSG can be used in addition as it avoids exposure of the reproductive organs to radiation and has the same efficacy as cHSG.

Association of estradiol with sleep apnea in depressed perimenopausal and postmenopausal women: a preliminary study.

Women's risk of obstructive sleep apnea (OSA) increases substantially during and after the menopausal transition, when depression risk is also elevated, raising the possibility that estrogen withdrawal contributes to OSA vulnerability, in turn contributing to mood disturbance. We examined the association between estradiol levels and OSA in depressed peri- and postmenopausal women. Thirty depressed peri-/postmenopausal women (mean body mass index [BMI] 30.82 kg/m) without known OSA completed routine polysomnography concurrent with serum estradiol levels. Estradiol in women with apnea-hypopnea indices (AHI) ≥15 indicating moderate-to-severe OSA was compared against those with AHI less than 15 using logistic regression adjusting for age and BMI. Thirteen women (43%) had AHI ≥15 (median AHI 21.6). Estradiol levels were lower (P = 0.02) in those with OSA (median 19, interquartile range 9-25 pg/mL) than without OSA (median 29, interquartile range 19-66 pg/mL). On univariate analysis, higher estradiol was associated with reduced odds of OSA (odds ratio 0.95, 95% CI 0.90-0.99, P = 0.04). After adjusting for age and BMI, estradiol levels remained associated with lower odds of OSA (odds ratio 0.90), but the association was no longer statistically significant (95% CI 0.76-1.05, P = 0.18). Montgomery Åsberg Depression Rating Scale scores did not differ between those with and without OSA. These preliminary results suggest that, in addition to higher BMI and age, lower estradiol may be associated with increased OSA risk in depressed women during the peri- and postmenopause, raising the possibility that estradiol withdrawal associated with menopause influences upper-airway patency in women.

Assessment of Tubal Patency with Tridimensional Coded Contrast Imaging Hysterosalpingo-Contrast- Sonography Compared with Conventional HyCoSy: A Preliminary Study

ABSTRACT Objective The aim of this preliminary study is to analyze and compare tridimensional coded contrast imaging hysterosalpingocontrast- sonography (3D-CCI HyCoSy) with conventional hysterosalpingo-contrast-sonography (HyCoSy) with saline serum for the evaluation of tubal patency in women with sterility. Materials and methods This was a prospective preliminary observational study performed in the Clinica Universidad de Navarra. Intending to compare 3D-CCI HyCoSy with conventional HyCoSy, we decided and perform conventional HyCoSy between 1st of January 2015 and 15th of February 2015 and 3D-CCI HyCoSy between 16th of February and 15th of April 2015, in different sets of patients. Exclusion criteria were: recent vaginal infection, previous pelvic inflammatory disease, previous salpingectomy or hidrosalpinx diagnosed previously or while performing the ultrasound examination. Results Total number of cases was 22 (12 women underwent conventional HyCoSy and 10 a 3D-CCI HyCoSy). The mean age of patients was 33.8 years (SD: 3.2 range: 23–40 years). Three cases (100%) of Fallopian tube obstruction were detected by 3D-CCI HyCoSy and confirmed by laparoscopic tubal chromopertubation (LTC). Four of the six cases (67%) of obstruction detected by conventional HyCoSy were confirmed by hysterosalpingography/LTC (HSG/LTC). Two cases of severe post-procedure pain were reported in women who underwent conventional HyCoSy. Conclusion The results of the study show that 3D-CCI HyCoSy was better to visualize the entire Fallopian tube and evaluate its patency How to cite this article Alcázar JL, Moya M, Caparros M, Salas A, Errasti T, Ruiz-Zambrana A. Assessment of Tubal Patency with Tridimensional Coded Contrast Imaging Hysterosalpingo-Contrast-Sonography Compared with Conventional HyCoSy: A Preliminary Study. Donald School J Ultrasound Obstet Gynecol 2016;10(1):103-106.

Three-Dimensional Hysterosalpingo-Contrast-Sonography for the Assessment of Tubal Patency in Women with Infertility: A Systematic Review with Meta-Analysis

Background/Aims: We aimed at performing a systematic review to determine the diagnostic accuracy of three-dimensional (3D) hysterosalpingo-contrast-sonography (HyCoSy) for detecting tubal occlusion. Methods: A systematic review in Medline database search from January 1989 to October 2015 to identify relevant studies evaluating 3D-HyCoSy. Eligibility criteria were studies assessing the role of 3D-HyCoSy for diagnosing tubal occlusion in infertile women. Index test was 3D-HyCoSy. Reference standard was laparoscopy with dye test or X-ray hysterosalpingography. Quality was assessed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity and specificity for the method were estimated. Results: A total number of 88 papers were identified. After exclusions, nine studies were ultimately included. Pooled estimated sensitivity was 98% (95% CI 91-100) with a moderate heterogeneity (I²: 64.8%, 95% CI 39.6-89.9; and Cochran Q 22.7, p < 0.001). Pooled estimated specificity was 90% (95% CI 83-95) with significant heterogeneity (I²: 80.3%, 95% CI 68.1-92.5; and Cochran Q 40.6, p < 0.001). Positive likelihood ratio was 10.3 (95% CI 5.6-18.7) and negative likelihood ratio was 0.02 (95% CI 0.00-0.21). Conclusion: 3D-HyCoSy is an accurate test for diagnosing tubal occlusion in women with infertility.

Power Doppler flow mapping and four-dimensional ultrasound for evaluating tubal patency compared with laparoscopy

ObjectivesTo study the accuracy of four-dimensional (4D) ultrasound and power Doppler flow mapping in detecting tubal patency in women with sub-/infertility, and compare it with laparoscopy and chromopertubation. Study designA prospective study. The study was performed in the outpatient clinic and infertility unit of a university hospital. The sonographic team and laparoscopic team were blinded to the results of each other. Women aged younger than 43 years seeking medical advice due to primary or secondary infertility and who planned to have a diagnostic laparoscopy performed, were recruited to the study after signing an informed consent. All of the recruited patients had power Doppler flow mapping and 4D hysterosalpingo-sonography by injecting sterile saline into the fallopian tubes 1 day before surgery. Registering Doppler signals, while using power Doppler, both at the tubal ostia and fimbrial end and the ability to demonstrate the course of the tube especially the isthmus and fimbrial end, while using 4D mode, was considered a patent tube. ResultsOut of 50 recruited patients, 33 women had bilateral patent tubes and five had unilateral patent tubes as shown by chromopertubation during diagnostic laparoscopy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for two-dimensional power Doppler hysterosalpingography were 94.4%, 100%, 100%, 89.2%, and 96.2%, respectively and for 4D ultrasound were 70.4%, 100%, 100%, 70.4%, and 82.6%, respectively. ConclusionsFour-dimensional saline hysterosalpingography has acceptable accuracy in detecting tubal patency, but is surpassed by power Doppler saline hysterosalpingography. Power Doppler saline hysterosalpingography could be incorporated into the routine sub-/infertility workup.

Hysterosalpingo-contrast-sonography (HyCoSy) in the assessment of tubal patency in endometriosis patients

ObjectiveTubal patency in women with endometriosis has traditionally been evaluated by laparoscopy. The aim of this study was to investigate the accuracy of hysterosalpingo-contrast-sonography (HyCoSy) in the assessment of tubal patency in these women. Study designA retrospective study was conducted at Physiopathology of Human Reproduction Unit. Infertile women who underwent HyCoSy and then a laparoscopy (dye test) within 6 months from the HyCoSy were included. Tubal patency was assessed by HyCoSy and the findings were compared with the results of laparoscopy, which was considered the gold standard for assessment of tubal patency. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and positive and negative likelihood ratios (Lh+, Lh−) were calculated including the 95% confidence interval (CI). ResultsA total of 1452 women underwent HyCoSy and 126 of them received a laparoscopy within 6 months from the HyCoSy. Of the 126 women, 42 (33.3%) had a diagnosis of pelvic endometriosis and 84 (66.7%) had no endometriosis. In the endometriosis population, HyCoSy showed a sensitivity, specificity, PPV, NPV, Lh+ and Lh− of 85% (95% CI 62–96), 93% (95% CI 82–97), 81% (95% CI 58–94), 94% (95% CI 84–98), 12.6 (95% CI 4.8–33) and 0.15 (95% CI 0.05–0.4) respectively. In the non-endometriosis group, HyCoSy showed a sensitivity, specificity, PPV, NPV, LR+ and LR− of 85% (95% CI 65–95), 93% (95% CI 87–96), 71% (95% CI 53–85), 97% (95% CI 92–99), 13.2 (95% CI 6.9–25) and 0.15 (95% CI 0.06–0.3) respectively. The diagnostic accuracy of HyCoSy was 91% in the endometriosis group and 92% in the non-endometriosis patients. ConclusionsHyCoSy showed high accuracy in evaluating tubal patency in infertile non-endometriosis women and in those affected by endometriosis.

Evaluation of tubal patency with the femvue™ saline-air device: are we ready to move back to the office?

To assess the feasibility of office sonohysterosalpingogram (sono-HSG) with the Femvue™ saline-air device & compare it with traditional fluoroscopic hysterosalpingogram (HSG) for evaluating tubal patency in women presenting with infertility.

Sex-based differences in the inflammatory profile of peripheral artery disease and the association with primary patency of lower extremity vein bypass grafts

This study was conducted to determine if there are sex-based differences in the inflammatory phenotype of patients undergoing lower extremity bypass (LEB) and if they correlate with clinical outcomes. This was a retrospective analysis of a prospective cohort of 225 patients (161 men and 64 women) who underwent autogenous vein LEB between February 2004 and May 2008. Fasting baseline blood samples were obtained before LEB, and the inflammatory biomarkers high-sensitivity C-reactive protein (CRP) and fibrinogen were assessed. All patients underwent ultrasound graft surveillance. CRP levels were dichotomized at 5 mg/L and fibrinogen levels at 600 mg/dL. There were no significant differences in age, race, history of hypertension or diabetes mellitus, body mass index, or coronary artery disease between men and women. Men were more likely to be current smokers (P = .02), have a history of hypercholesterolemia (P = .02), and be taking statins (P = .02). Women were more likely to present with critical limb ischemia (P = .03) and had higher median baseline CRP levels (5.15 mg/L; interquartile range [IQR], 1.51-18.62 mg/L) than men (2.70; IQR, 1.24-6.98 mg/L; P = .02). Median follow-up was 893 days (IQR, 539-1315 days). A multivariable Cox proportional hazards model for primary vein graft patency showed a significant interaction between sex and CRP (P = .03) and fibrinogen (P = .02). After adjustment for key covariates, primary vein graft patency was significantly less in women with CRP >5 mg/L compared with women with CRP <5 mg/L (P = .02). No such difference was seen in men (P = .95). Primary graft patency was also decreased in women with fibrinogen >600 mg/dL vs women with fibrinogen <600 mg/dL (P = .002); again, this pattern was not evident in men (P = .19). Women undergoing LEB for advanced peripheral artery disease have a different inflammatory phenotype than men. Elevated baseline levels of CRP and fibrinogen are associated with inferior vein graft patency in women but not in men. These findings indicate an important interaction between sex and inflammation in the healing response of vein grafts for LEB. Women with elevated preoperative CRP and fibrinogen levels may benefit from more intensive postoperative graft surveillance protocols.

A COMPARATIVE STUDY OF TRANSVAGINAL SONOHYSTEROSALPINGOGRAPHY (TV-SH) AND HYSTERO-SALPINGOGRAPHY (HSG) FOR ASSESSMENT OF TUBAL PATENCY IN INFERTILITY PATIENTS

There has been a significant increase in cases of infertility and sterility in the last decade. Approximately, 10-15% of couples in reproductive age are affected by the inability to conceive and bear a child. Amongst all causes, anatomical defect linked to the fallopian pathological conditions contributes considerably to female infertility. The evaluation of tubal patency is traditionally considered fundamental in the study of cases of infertility and it represents one third of the total cost in the management of infertility. Tubal patency is routinely assessed by hysterosalpingograpgy (HSG) and/or laparoscopy. However, other techniques are nowadays being investigated to obtain high efficacy, with low cost and risk, and also can be used as office procedures at an outpatient infertility clinic. Transvaginal sonohysterosalpingography (Tv-Sh) is one of such promising procedure which can be simultaneously performed in place of HSG at the time of conventional ultrasonogram in the initial workup of infertile patients. It also provides additional information regarding intracavitary and intramyomentrial components of submucous myomas as well as information about adnexae. The present study encompasses the comparative diagnostic accuracy of Tv-Sh and HSG in evaluating uterine cavity and tubal patency in women of reproductive age group. The compatibility between Tv-Sh and HSG was found to be 87% and efficacy in diagnosis of hydrosalpinx by both procedures was the same. There was also no significant difference in the diagnosis of congenital malformations of uterus or intracavity adhesions. The study concludes that Tv-Sh can be used as a “first choice” screening procedure without any risk of ionizing radiation. Acta Medica Medianae 2011; 50(4):29-34.

National survey of current practice in assessing tubal patency in the UK

We conducted a postal survey to find out the current practice in the UK regarding the methods employed to assess tubal patency. A questionnaire was developed to evaluate the methods used to assess tubal patency in women presenting with infertility with or without risk factors suggesting pelvic disease. A total of 496 questionnaires were sent and 174 responded (35%). The survey represented an overall view as both gynaecologists and radiologists from secondary and tertiary centres responded. In the responses from radiologists, a hysterosalpingogram was the investigation of choice for both low risk (61%) and high risk women (50%). However in the responses from gynaecologists, in patients with no past gynaecological history, the majority performed a hysterosalpingogram (58%) or hystero contrast sonography (HyCoSy) (14%) whereas in patients in whom pelvic pathology was suspected, most (84%) performed a laparoscopy and dye test. The survey also showed that HyCoSy was performed in only a few centres in the UK. The responses from the majority of gynaecologists were in accordance with the RCOG guidelines. However, still some centres (28%) offered laparoscopy and dye test in low risk women as the primary test for assessing tubal patency. Given the risks associated with laparoscopy, this should be reserved for cases where pathology is suspected and scheduled to be combined with laparoscopic surgery.

External iliac and common iliac artery angioplasty and stenting in men and women

Objective: The effect of anatomic location of stent placement on the outcome of iliac artery angioplasty and stenting is not defined. Analyses of patency rates of external iliac artery (EIA) and common iliac artery (CIA) stents have provided conflicting results and have not considered men and women independently. The purpose of this study was to estimate the influence of the anatomic location of stenting on the outcome of iliac angioplasty and stent placement in both men and women. Methods: From 1995 to 1999, 247 iliac angioplasty and stent placement procedures (303 stents) were performed in 67 women and 122 men, and all were included in a retrospective cohort study. The criteria prepared by the Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery) were followed. The TransAtlantic Inter-Society Consensus classification was used to characterize the type of iliac lesions. Both univariate (Kaplan-Meier [KM]) and multivariate analyses (Cox proportional hazards model) were used to determine the association among the variables, cumulative patency, limb salvage, and survival. Results: Indications for iliac angioplasty with stenting were disabling claudication (65%), limb salvage (33%), and blue toe syndrome (2%). Primary stenting was performed in 103 procedures (42%). Stents were placed selectively after iliac angioplasty mainly for residual stenosis or pressure gradient (43%). Patients with EIA stents, as compared with those who had CIA stents, had more extensive lesions (TransAtlantic Inter-Society Consensus type C lesions), poorer runoff, smaller vessel size, and less frequency of hyperlipidemia (P <.05). Primary patency rates at 1, 3, and 5 years were 76%, 56%, and 56%, respectively, for patients with EIA stents and 92%, 85%, and 76%, respectively, for those with CIA stents. Although overall primary patency rates were significantly decreased in patients with EIA lesions (KM, log-rank test, P =.001), stratified analyses revealed that women with EIA stents had the poorest outcome, with 61%, 47%, and 23% primary patency rates at 1, 3, and 5 years, respectively, (KM, log-rank test, P <.001). Cox regression analysis identified EIA stenting (relative risk, 4.3; 95% CI, 2.3-7.9; P <.001) as an independent predictor of decreased primary patency in women but not in men. Conclusions: Women undergoing EIA angioplasty with stent placement have significantly reduced primary patency rates. Despite initial technical success, these patients are at increased risk of long-term failure and might require subsequent procedures to obtain clinical success. Conversely, men undergoing EIA stenting have a more favorable outcome than women. (J Vasc Surg 2001;34:440-6.)