Patency Flow Research Articles

The effects of different positions on lower extremity hemodynamics during robot-assisted laparoscopic radical prostatectomy for prostate cancer

PurposeThis study aimed to investigate the effects of two different positions on lower extremity hemodynamics during robot-assisted laparoscopic radical prostatectomy (RARP) for prostate cancer.MethodsA total of 196 patients who underwent RARP in our hospital from February 2020 to March 2022 were included in this study. Among them, 98 patients who underwent surgery with the Trendelenburg position and split-leg position with calf reverse arch from March 2021 to March 2022 were assigned to the observation group, while 98 patients who underwent surgery with the Trendelenburg position and low lithotomy position from February 2020 to February 2021 were assigned to the control group. Using an ultrasound diagnostic instrument to detect the internal diameter, mean blood flow velocity, and mean blood flow volume of the left deep femoral vein at different times, such as the supine position (T0), after 5 minutes of placing the patient in the leg spilt or low lithotomy position (T1), after 5 minutes of pneumoperitoneum (T2), after 5 minutes of head-down tilt or head-down tilt and calf reverse arch (T3), 1.5 hours after the start of surgery (T4), before the removal of CO2 gas (T5), and before the patient left the operating room (T6). As well as the patency of deep venous blood flow in both lower extremities before leaving the operating room,ResultsAfter establishment of pneumoperitoneum, the internal diameter of the deep femoral vein increased significantly, while the mean blood flow velocity and mean blood flow volume decreased significantly in both groups(T0) (P<0.001). With the prolongation of surgical time, the impact on lower extremity hemodynamics in the observation group was smaller than that in the control group. From T2 to T6, the internal diameter of the femoral vein in the observation group was smaller than that in the control group, while the mean blood flow velocity and mean blood flow volume were increased compared to the control group (P<0.05). Before leaving the operating room, the patency of deep venous blood flow in the observation group was better than that in the control group (P=0.003).ConclusionPlacing patients in the Trendelenburg position and split-leg position with calf reverse arch during RARP for prostate cancer has a smaller impact on lower extremity hemodynamics than the low lithotomy position, and can relatively reduce the risk of postoperative deep vein thrombosis.

Application of Acoustic Radiation Force Pulse Imaging Technology in the Evaluation of the Efficacy of Calf Intermuscular Vein Thrombosis.

The continuous advancement in ultrasound technology has given rise to Acoustic Radiation Force Impulse (ARFI) elastography, which boasts non-invasiveness, ease of operation, rapid inspection, and high accuracy. It has been successfully employed in detecting tissue hardness across various diseases. This study aims to investigate the application of acoustic radiation force pulse imaging technology in evaluating the efficacy of calf intermuscular vein thrombosis. This study is retrospective in nature, involving a total of 120 patients diagnosed with calf intermuscular venous thrombosis (MCVT) who were admitted to our hospital. These patients were selected retrospectively as the subjects for our research. They were subsequently divided into two groups: the control group and the observation group. The control group received standard nursing care and simple pressure therapy, while the observation group underwent anticoagulant drug treatment. The shear wave elastic hardness of both groups was measured, with the recording of ultrasonic elasticity scores and the average elastic modulus value (E-mean, in kPa). Furthermore, a comparison was made between the two groups regarding thrombus disappearance time, blood flow patency, and the clinical treatment effect. At the 1, 3, and 6-month marks of the treatment period, the ultrasonic elasticity scores in the observation group were consistently higher compared to those in the control group. Additionally, the shear wave elastic hardness in the observation group was consistently lower than that in the control group, and these differences were found to be statistically significant (p < 0.05). The total effective rates for the control and observation groups were 83.33% and 95.00%, respectively. Notably, the clinical total effective rate in the observation group was significantly higher than that in the control group, and this difference was statistically significant (p < 0.05). The thrombus disappearance time in the observation group was significantly shorter than that in the control group, and the blood flow rate was significantly higher than in the control group, with both differences being statistically significant (p < 0.05). ARFI plays a crucial role in assessing the efficacy of MCVT by effectively revealing the hardness and location of the patient's thrombus tissue. This technology aids doctors in gaining a more precise understanding of the deep vein thrombosis condition. Notably, ARFI is characterized by high safety levels and exhibits positive effects due to its painless and non-invasive nature.

How do Different Types of River Maintenance Works Affect the Ichthyofauna of Small European Watercourses?

Abstract Watercourses serve the needs of agriculture in certain sections and are subject to strong anthropopressure. When agriculture prevails in the catchment, it often has abundant vegetation, macrophytes in particular, and the bottom is covered by a substantial layer of silt. In order to ensure patency of flow and access to water, small watercourses are very often subject to river maintenance works. The aim of the study was to assess the impact of 3 types of works on the diversity of fish species and density of fish in the 1 and 2 year after the works at 21 sites located on 8 rivers in the European Central Plains Ecoregion. As a result of the works, especially in the 1 year after the works, significant changes were found in hydrochemical and hydrological parameters, especially with the increase in velocity and mean depth in watercourses. Additionally, habitat change contributed to differences in the composition of the ichthyofaunal. After 1 year, the diversity of fish species and fish population density increased or remained unchanged after dredging and removal of plants from the river channel, but they decreased after the removal of macrophytes from river banks. After year 2, a decrease in the diversity of fish species and density was observed, associated with re-infestation and siltation of the watercourses. Particularly in the case of dredging and removal of macrophytes from the river bank, maintenance works should not be done too frequently, because some species of natural value disappear.

Dynamics of cerebrospinal fluid pressure alterations and bilateral transverse-sigmoid sinus morphologies in Asian patients with venous pulsatile tinnitus.

This study was performed to investigate the dynamics of intracranial pressure (ICP) alterations and bilateral transverse-sigmoid sinus morphologies in patients with venous pulsatile tinnitus (PT). This retrospective study involved 27 patients with venous PT associated with sigmoid sinus wall anomalies. ICP and ICP metrics were measured by cerebrospinal fluid manometry and internal jugular vein compression tests. Correlation analysis was performed to determine the statistical correlation between ICP and the morphological metrics. The mean ICP was 212.5 ± 47.3 mmH2O. The median was 130 (range, 55-150) mmH2O. The was linearly correlated with the open lumbar pressure, and a significant difference was found between patients with normal and elevated cerebrospinal fluid pressure. The was linearly correlated with the and . was linearly correlated with Complete obstruction of flow patency should be avoided in patients with low ICP and large volumetric/patency differences in the bilateral transverse-sigmoid sinus systems.

Management strategy of femoral artery pseudoaneurysm combined with infectious wounds

Objective: To investigate the surgical treatment methods of femoral artery pseudoaneurysm combined with infectious wounds and to evaluate the clinical effects. Methods: The retrospective observational research method was used. Twelve patients with femoral artery pseudoaneurysm combined with infectious wounds who met the inclusion criteria were admitted to Nanjing University of Chinese Medicine Wuxi Integrated Traditional Chinese and Western Medicine Hospital (Affiliated Hospital of Jiangnan University) from October 2014 to September 2022, including 6 males and 6 females, aged from 46 to 78 years. In the primary operation, debridement, tumor resection, and artery suture/venous grafting to repair the artery/artery ligation were performed, and the wound area after tumor resection ranged from 4.0 cm×1.5 cm to 12.0 cm×6.5 cm. Wounds that could be sutured were treated with tension reduction suture and extracutaneous continuous vacuum sealing drainage (VSD), while large wounds that could not be sutured were treated with VSD to control infection. In the secondary operation, tension reduction suture was performed to repair the wounds that could be sutured; large wounds were repaired with adjacent translocated flaps with area of 9.0 cm×5.0 cm to 15.0 cm×7.0 cm. Additionally, when the length of the exposed femoral artery was equal to or over 3.0 cm, the wounds were repaired with additional rectus femoris muscle flap with length of 15.0 to 18.0 cm. The donor areas of the flaps were directly sutured. The wound with artery ligation was treated with stamp skin grafting and continuous VSD. The bacterial culture results of the wound exudate samples on admission were recorded. The intraoperative blood loss, the location of femoral artery rupture, the artery treatment method, and the wound repair method in the primary operation were recorded, and the durations of catheter lavage, catheter drainage, and VSD treatment, and the drainage volume after the operation were recorded. The repair method of wounds in the secondary operation, the durations of catheter drainage and VSD treatment, and the total drainage volume after the operation were recorded. The survivals of flap/muscle flap/stamp skin grafts were observed, and the wound healing time was recorded. Follow-up after discharge was performed to evaluate the quality of wound healing and the walking function and to check whether the pulsatile mass disappeared. B-ultrasound or computed tomography angiography (CTA) was performed again to observe potential pseudoaneurysm recurrence and evaluate the patency of blood flow of the femoral artery. Results: The bacterial culture results of wound exudate samples of all the patients were positive on admission. The blood loss was 150 to 750 mL in the primary operation. The arterial ruptures were located in the femoral artery in 8 cases, in the external iliac artery in 2 cases, and in the femoral arteriovenous fistula in 2 cases. Six cases received direct artery suture, 4 cases received autologous great saphenous vein grafting to repair the artery, 1 case received autologous great saphenous vein bypass surgery, and 1 case received artery ligation. The primary wound suture was performed in 4 cases, along with catheter lavage for 3 to 5 days, catheter drainage for 4 to 6 days, VSD treatment for 5 to 7 days, and a total drainage volume of 80 to 450 mL after the surgery. In the secondary operation, the wounds were sutured directly in 3 cases along with catheter drainage for 2 to 3 days, the wound was repaired with scalp stamp skin graft and VSD treatment for 5 days in 1 case, the wounds were repaired with adjacent translocated flaps in 2 cases with catheter drainage for 2 to 3 days, and the wounds were repaired with rectus femoris muscle flaps+adjacent translocated flaps in 2 cases with catheter drainage for 3 to 5 days . The total drainage volume after the secondary operation ranged from 150 to 400 mL. All the skin flaps/muscle flaps/skin grafts survived after operation. The wound healing time ranged from 15 to 36 days after the primary operation. Follow-up of 2 to 8 months after discharge showed that the wounds of all patients healed well. One patient who underwent femoral artery ligation had calf amputation due to foot ischemic necrosis, and the rest of the patients regained normal walking ability. The pulsatile mass disappeared in inguinal region of all patients. B-ultrasound or CTA re-examination in 6 patients showed that the blood flow of femoral artery had good patency, and there was no pseudoaneurysm recurrence. Conclusions: Early debridement, tumor resection, and individualized artery treatment should be performed in patients with femoral artery pseudoaneurysm combined with infected wounds. Besides, proper drainage and personalized repair strategy should be conducted according to the wound condition to achieve a good outcome.

The Algorithm for the Study of Deep Femoral Vessels Using Ultrasound Duplex Angioscanning

The deep femoral vessels are the main branches/donor vessels of the femoral vessels. Their branches penetrate the entire array of muscles of the posteromedial group and descend almost to the popliteal region, so they are able to both largely compensate for blood flow disorders in obliterating atherosclerosis of the arteries of the lower extremities, and in the presence of an anastomosis with the popliteal vein, influence the course of acute and chronic vein diseases. The modern standard for studying the vascular system of the lower extremities is duplex scan, but it allows deep femoral vessels to be examined only in the ostium segment up to 5–6 cm.AIM OF STUDY To determine the patency and state of blood flow in the deep femoral vessels throughout the entire length using ultrasound duplex angioscanning.MATERIAL AND METHODS The analysis of the results of 30 computed tomograms and 100 ultrasound scans of patients (aged 20 to 85 years) who underwent routine examination of the vascular system of the lower extremities in a polyclinic setting was carried out. The study was performed according to the original method (Patent for invention No. 2751819).RESULTS In the upper third of the thigh, the deep femoral vessels are located most superficially, 2.3±0.15 cm from the skin surface and 0.5±0.08 cm from the posterior wall of the femoral artery. In the middle third of the thigh, the depth of the deep femoral vessels is 3.5±0.9 cm from the skin surface and 4.3±0.24 cm from the posterior wall of the femoral artery. The deep femoral vessels are located between the vastus medialis and adductor longus muscles closer to the femur. In the lower third of the thigh, deep femoral vessels are located at a distance of 4.3±0.4 cm from the skin surface and 1.8±0.5 cm from the posterior wall of the femoral artery. Therefore, for ultrasound examination, a linear probe is first used, which is placed along the projection line of the femoral vessels in the upper third of the thigh, and then the orifice of the deep femoral vessels is visualized. Next, a convex probe is used, and in the middle and lower third of the thigh, it is drawn along a line located 2 cm medially to the projection line of the femoral vessels, while the probe itself deviates posteriorly by ~ 15°.CONCLUSION The research algorithm helps increase the length of the areas of the deep femoral artery and vein available for research and help the physician choose the optimal method of treating the patient.

Using Haemocoagulase Agkistrodon in Patients Undergoing Transurethral Plasmakinetic Resection of the Prostate: A Pilot, Real-World, and Propensity Score-Matched Study.

Objectives To compare the clinical outcomes of using different hemostatic agents after transurethral plasmakinetic resection of the prostate (TUPKP) in benign prostatic hyperplasia (BPH) patients. Methods The patients were divided into 5 groups according to the hemostatic agents used after TUPKP, including the haemocoagulase agkistrodon for injection (HCA), hemocoagulase for injection (HC), hemocoagulase bothrops atrox for injection (HCB), ethylenediamine diaceturate injection (EDD), and tranexamic acid (TXA). Propensity score matching was performed based on age, body mass index, prostate volume, hypertension status, fasting blood glucose, smoking, and drinking history. The hospitalization time, bladder irrigation time, indwelling catheterization time, the patency of urine flow, and blood transfusion records were used as outcome indicators to compare the clinical effects of these five agents. Results We finally matched 65 pairs receiving HCA or HC, 71 pairs receiving HCA or HCB, 38 pairs receiving HCA or TXA, and 29 pairs receiving HCA or EDD. Compared with HC, HCA given during the perioperative period significantly reduced the median hospitalization time [7.00 days (5.00, 8.00) vs. 9.00 days (8.00, 10.00); p < 0.001] and median catheterization time (109.00 hours [88.00, 129.00] vs. 164.00 hours [114.00, 189.00], p < 0.001). Compared with EDD, the median hospitalization time (7.00 days [6.00, 8.00] vs. 10.00 days [8.00, 11.00]; p < 0.001) and median catheterization time (113.00 hours [95.00, 143.00] vs. 160.00 hours [139.00, 168.00]; p < 0.001) were also significant shorter in HCA group. Compared with HCB, median bladder irrigation time (45.00 hours [27.00, 71.00] vs. 49.00 hours [45.00, 72.00]; p = 0.04) was shorter in the HCA group. However, there were no statistical differences in outcomes between HCA and TXA. Conclusions HCA probably has an advantage over HC, HCB, and EDD in reducing the hospitalization time, catheterization time, and bladder irrigation time among BPH patients undergoing TUPKP.

Intake grille design for an embedded ventilation-and-cooling system in an aircraft

An inlet grille typically needs to be installed at the inlet of the air intake of the ventilation-and-cooling system embedded in airborne electronic equipment to improve pneumatic stealth performance. Here, a typical flying wing model is used as a case study, and a computational fluid dynamics (CFD) simulation is performed. The flow resistance characteristics of the air intake of the opening of the ventilation-and-cooling system on a flat fuselage surface with and without an inlet grille are analyzed at different flow rates and Mach 0.25. The effects of the grille opening shape, diversion angle, thickness, aperture size, and hole shape on the flow resistance characteristics are investigated in detail. The grille is found to effectively guide airflow entry: although the flow resistance at the inlet is increased, the flow resistance at the inlet and outlet of the air intake is significantly reduced. The optimal developments of the outflow and flow resistance characteristics are obtained for a quadrilateral opening. The smaller the diversion angle is, the smoother the airflow entry, and the higher the quality of the internal airflow. The rectification, viscous resistance, and weight exhibit opposing trends with increasing thickness and must be comprehensively considered in designing an optimal scheme. A large-aperture grille ensures good flow patency at low flow rates, whereas a small-aperture grille can reduce flow perturbations and separation at high flow rates by smoothly guiding air into the intake. A grille with round holes has a better spanwise and chordwise balancing effect on the airflow and better flow resistance characteristics than a grille with diamond-shaped holes.

Impact of perioperative vasopressors on lower extremity free flap reconstruction.

Free tissue transfer is a treatment option for soft tissue defects of the lower extremity. For a successful outcome, it is necessary to evaluate the vessel condition and blood flow patency. The administration of a vasopressor could impact the survival rate of free tissue transfer; however, there is a lack of studies on vasopressor use and lower extremity reconstruction. This study aimed to investigate the relationship between the use of a vasopressor and outcomes of free tissue transfer in lower extremity reconstruction. This retrospective, observational study was conducted between March 2010 and February 2019. Data were divided into intraoperative and postoperative variables according to the administration time. Data on patient demographics, risk factors, details of reconstruction, flap outcomes, and duration of intensive care unit (ICU) stay were obtained. Binary logistic regression models were computed to determine the association between flap outcome and vasopressor administration. Of the 338 patients, 186 were administered a vasopressor. Intraoperative and postoperative vasopressor use was not related to the overall complication rate (odds ratio, 1.547; 95% confidence interval, 0.830-2.882; p=.169). Low-intraoperative levels of hemoglobin were associated with the overall complication rate. Postoperative vasopressor administration was associated with prolonged ICU stay. Our results showed that the intraoperative and postoperative use of vasopressors was not significantly associated with the success rate of free flaps. Future studies investigating the relationship between the dose, type, and duration of vasopressors and the complication rate following free tissue transfer are warranted.

The Central Role of Extracellular Vesicles in the Mechanisms of Thrombosis in COVID-19 Patients With Cancer and Therapeutic Strategies.

Cancer patients have increased SARS-CoV-2 susceptibility and are prone to developing severe COVID-19 infections. The incidence of venous thrombosis is approximately 20% in COVID-19 patients with cancer. It has been suggested that thrombus formation has been suggested to correlate with severe clinical manifestations, mortality, and sequelae. In this review, we primarily elaborate on the pathophysiological mechanisms of thrombosis in COVID-19 patients with cancer, emphasize the role of microparticles (MPs) and phosphatidylserine (PS) in coagulation, and propose an antithrombotic strategy. The coagulation mechanisms of COVID-19 and cancer synergistically amplify the coagulation cascade, and collectively promotes pulmonary microvascular occlusion. During systemic coagulation, the virus activates immune cells to release abundant proinflammatory cytokines, referred to as cytokine storm, resulting in the apoptosis of tumor and blood cells and subsequent MPs release. Additionally, we highlight that tumor cells contribute to MPs and coagulation by apoptosis owing to insufficient blood supply. A positive feedback loop of cytokines storm and MPs storm promotes microvascular coagulation storm, leading to microthrombi formation and inadequate blood perfusion. Microthrombi-damaged endothelial cells (ECs), tumor, and blood cells further aggravate the apoptosis of the cells and facilitate MPs storm. PS, especially on MPs, plays a pivotal role in the blood coagulation process, contributing to clot initiation, amplification, and propagation. Since coagulation is a common pathway of COVID-19 and cancer, and associated with mortality, patients would benefit from antithrombotic therapy. The above results lead us to assert that early stage antithrombotic therapy is optimal. This strategy is likely to maintain blood flow patency contributing to viral clearance, attenuating the formation of cytokines and MPs storm, maintaining oxygen saturation, and avoiding the progress of the disease.

Evaluation of Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction with Hypertension by Dynamic Electrocardiogram Feature Data

This work was to study the application value of dynamic electrocardiogram (ECG) feature data in evaluating the curative effect of percutaneous coronary intervention in acute ST-segment elevation myocardial infarction with hypertension, so as to facilitate the early diagnosis and treatment of the disease. In this study, 90 patients with acute ST-segment elevation myocardial infarction accompanied by hypertension were selected as the study subjects and randomly divided into group A (oral aspirin antiplatelet therapy), group B (thrombolytic drug streptokinase (SK) therapy), and group C (percutaneous coronary intervention), with 30 cases in each group. In addition, a P-wave detection algorithm was introduced for automatic detection and analysis of electrocardiograms, and the efficacy of patients was assessed by Holter feature data based on the P-wave detection algorithm. The results showed that the diagnostic error rate, sensitivity, and predictive accuracy of the P-wave detection algorithm for ST-segment elevation myocardial infarction caused by acute occlusion of left main coronary artery (LMCA) were 0.24%, 95.41%, and 92.33%, respectively; the diagnostic error rate, sensitivity, and predictive accuracy for non-LMCA (nLMCA) ST-segment elevation myocardial infarction were 0.28%, 95.32%, and 96.07%, respectively; the proportion of patients with symptom to blood flow patency time &lt;3 h in group C (55.3%) was significantly higher than that in groups A and B (22.1% and 22.6%) ( P &lt; 0.05). Compared with group A, the content of B-type natriuretic peptide (pre-proBNP) at 1 week, 2 weeks, and 3 weeks after treatment in groups B and C was significantly lower and group C was significantly lower than group B ( P &lt; 0.05). In summary, the P-wave detection algorithm has a high application value in the diagnosis and early prediction of acute ST-segment elevation myocardial infarction. Percutaneous coronary intervention in the treatment of acute ST-segment elevation myocardial infarction with hypertension can shorten the opening time of infarction blood flow, so as to effectively protect the heart function of patients.

Duplex echography as an adjuvant tool to clinical examination to detect early postoperative free flap vascular compromise.

Clinical examination remains the cornerstone for postoperative monitoring of free flaps but is highly dependent on the surgeon's ability and experience. Duplex echography provides a noninvasive objective evaluation of tissue perfusion. The authors hypothesized that duplex echography may be a more sensitive and specific monitoring method for early detection of postoperative flap compromise compared to clinical examination alone. The goal was to evaluate any differences between combined duplex echography and clinical examination flap monitoring versus isolated clinical evaluation. A total of 730 free flaps in 700 patients were included in the study. We conducted an intra-subject prospective study of a cohort of patients who underwent free flap reconstruction in our unit to compare clinical examination with duplex echography for postoperative monitoring. An inter-subject study was also undertaken comparing the prospective cohort with a historical control group of patients in whom free flap monitoring was made using clinical examination alone. The patency flow and velocities through the artery and vein of the flap were measured at the donor and recipient vessels of every anastomosis by duplex scanning, by the same plastic surgeon every 4 hr, during the first 18 hr after surgery. Duplex echography and clinical evaluation were used in 175 patients. The historical cohort included a total of 525 flaps. Every patient with suspicion of vascular compromise based on duplex echography was taken back for surgical re-exploration. There were no cases of overdiagnosis using duplex echography (Sensitivity 100%, Specificity 100%). Clinical evaluation detected issues with the vascularan astomoses in 23/175 flaps. However, it failed to detect 12/22 cases which presented with vascular complications and gave a false indication of possible complications in 13 flaps (Sensitivity 45%, Specificity 92%). In our practice, duplex echography is considered a useful adjunct monitoring tool for early detection of postoperative flap compromise, which compliments clinical evaluation. It provides anatomic and hemodynamic information of the vascular status and may therefore increase survival of flaps by allowing earlier detection of vascular compromise, compared to clinical examination alone, in postoperative monitoring of free flaps.

Early results of surgical and Endovascular intervention procedures in Lower extremity arterial disease

Objective : To assess the early results of surgical and endovascular intervention in peripheral arterial disease Materials and methods : Retrospectively, we analysed the early results of treatment of lower extremity arterial diseases, managed at our institute. Depending up on the lesion characters and the distal run-off as evident from imaging, patients underwent either surgical or endovascular intervention for their disease. Over a period of one-year form July 2018 to July 2019, twenty-two patients were managed in total. Nine of them underwent surgical bypass for either aortoiliac or femoro-popliteal lesions. Another thirteen patients underwent endovascular intervention for lesions at aorto-iliac, femoro-popliteal and “Below the Knee” lesions. Procedure related morbidity, procedural success rate, postoperative pain score, hospital stay, flow patency and symptomatic improvement at follow-up at three and six months were analysed. Results: The results were optimistic with ischemic ulcers showing signs of healing, patients symptomatically better with improved walking distance and relieved of rest pain. Due to a smaller study population, limited study time and the study itself being a non- randomised one, no intragroup comparisons were made. The procedural success was 100% for each group, no periprocedural morbidity. The hospital stay was 9 days for surgical aorto bifemoral bypass patients, 5.8 days for femoropopliteal patients. For those who underwent endovascular intervention, average hospital stay was 3.4, 2.5 and 3 days respectively for the aorto-iliac, femoropopliteal and “Below the Knee” level groups. The average pain score was 6.3 and 5.8 for surgical aortobifemoral bypass and femoropopliteal bypass. Pain scores for the endovascular intervention group was 4.4, 3.2 and 4.7 respectively for the aortoiliac, femoropopliteal and “Below the Knee” level groups. The improvement in the Rutherford gradings at six months were Aorto bifemoral Bypass (4.6 to 3.6), Femoro-popliteal (4.1 to 2.6) in the surgical group and Aortiliac (4.4 to 3.4), Femoropopliteal (4.2 to 2) and no change in the score for the “Below the Knee” group. At six-month follow-up, Doppler interrogation revealed a triphasic flow pattern in surgical and endovascular bypasses involving the aortoiliac and femoropopliteal segments. The doppler interrogation for the “Below the Knee” lesions at six-month follow-up was biphasic (n=3) to monophasic (n=1). Conclusion: Surgical bypass and endovascular intervention either as an independent treatment modality or in combination as a Hybrid procedure looks promising in the management of LEAD. Surgical bypass is no doubt morbid, but early results are satisfactory in terms of patency rates and clinical improvement. The early six months results of endovascular intervention, are particularly encouraging in the femoropopliteal segment with poor distal run off. The results are inconsistent for the “Below the Knee” segment disease. TASC II- A and B lesions are addressed by endovascular interventions, whereas TASC II- C and D lesions are addressed by surgical bypass. Multidisciplinary individualised treatment approach should be adopted in deciding which treatment to be provided for a particular patient based on clinical, imaging findings and institutional protocols

Noninvasive detection of coronary artery stents by transthoracic echocardiography postprocessing subtraction technique.

To explore the feasibility and value of transthoracic echocardiography (TTE) postprocessing subtraction technique in the detection of a stent in the coronary artery. Transthoracic echocardiography was used to examine 46 coronary artery stents in 30 patients by two-dimensional ultrasound postprocessing subtraction technique. The shape of each stent and its flow patency were observed. The patency was assessed according to blood flow and mosaic flow in the stent. Then, the results were compared with those of percutaneous coronary intervention (PCI) records and coronary angiography (CAG). Transthoracic echocardiography detected 36 stents among 46 stents (two in the LMCA, 23 in the LAD, seven in the RCA, and two in the LCX); the detection rate was 78.3%. The average length of the stents was 21.8±4.1mm, and the average diameter was 2.4±0.5mm; both are shorter than those from PCI records (P<.001). Of the 36 stents, blood flow could be observed in 27. Compared with the results of CAG, TTE had 75% feasibility and 92.6% accuracy in detecting flow patency in the stents. Transthoracic echocardiography postprocessing subtraction technique could be a noninvasive method for detecting a coronary artery stent and, although the measurements of stent length and diameter were shorter than those of PCI records, an accurate detection of flow patency in the stents was achieved.

Postoperative patency assessment of Cystocisternostomy and Cystoventriculostomy stomas in cases with Arachnoidal cyst.

The goal of this study was to determine stoma and flow patency with 3D SPACE T2 and 3D CISS sequences in cases with cystocisternostomy or cystoventriculostomy. A total of sixty three patients (total 106 MRI examinations) with endoscopic cystocisternostomy or cystoventriculostomy of arachnoid cyst underwent 1.5-3T MRI to determine flow patency between June 2007 and April 2018. Postoperative results, the patients' clinic and arachnoid cyst volume were used to confirm stoma and flow patency in MRI. The stoma was open and functional in forty three patients. Minimal flow was detected in five patients. Fifteen patients with closed stoma (total 17 MR images) were evaluated with the clinician. Patients' clinic, physical examination, and growth (for pediatric patients) were evaluated. Three of fifteen patients were re-operated. Operative findings and postoperative follow-up MR imaging findings were correlated with our preoperative MRI results. The findings were in compliance in both groups (operated-non-operated groups). 3D SPACE T2 and 3D CISS are effective sequences in addition to other routine conventional sequences to evaluate stoma and flow patency.

Microvascular anastomosis using loupes and smartphone magnification: Experimental study for application to limited-resource environments

Finger revascularization has been performed without a microscope in limited-resource environments only when absolutely necessary. This experimental study sought to assess the feasibility of microvascular anastomosis in rats performed using loupes or smartphone magnification. Thirty rats were divided into three groups of 10 individuals according to the magnification method used: operating microscope (control group M), surgical loupes (group L) and smartphone (group S). The infrarenal aorta was dissected under a microscope, then anastomosed by interrupted sutures using the group-specific magnifying device. The main analytical criteria were vessel diameter, anastomosis duration, immediate flow patency (T0), patency after one hour (T1) and anastomosis quality. Anastomosis duration was comparable between groups M and L, but was twice as long in group S. The number of leaks at clamp removal was higher in group S. Patency rates at T0 and T1 were 100% in groups M and L, but were significantly lower in group S. The anastomosis quality was low in group L and poor in group S. Anastomosis of digital arteries using loupes is possible, but the resulting quality is lower than with a microscope. Current smartphones are not adequate for performslt ing microvascular repairs in a living model.

Development of a Shape-Memory Tube to Prevent Vascular Stenosis.

Inserting a graft into vessels with different diameters frequently causes severe damage to the host vessels. Poor flow patency is an unresolved issue in grafts, particularly those with diameters less than 6 mm, because of vessel occlusion caused by disturbed blood flow following fast clotting. Herein, successful patency in the deployment of an ≈2 mm diameter graft into a porcine vessel is reported. A new library of property-tunable shape-memory polymers that prevent vessel damage by expanding the graft diameter circumferentially upon implantation is presented. The polymers undergo seven consecutive cycles of strain energy-preserved shape programming. Moreover, the new graft tube, which features a diffuser shape, minimizes disturbed flow formation and prevents thrombosis because its surface is coated with nitric-oxide-releasing peptides. Improved patency in a porcine vessel for 18 d is demonstrated while occlusive vascular remodeling occurs. These insights will help advance vascular graft design.

Safety and completeness of using indocyanine green videoangiography combined with digital subtraction angiography for aneurysm surgery in a hybrid operating theater.

This study aimed to evaluate the safety and completeness of using intraoperative indocyanine green videoangiography (ICGV) combined with intraoperative angiography (IOA) for aneurysm clipping in a hybrid operating room (hOR). All patients who underwent microsurgical clipping in the hOR were identified from prospectively maintained neurosurgical databases. Medical charts and operative videos with ICGV and IOA were reviewed to determine the adequacy of clipping, and clinical and angiographic outcomes were retrospectively analyzed. Fifty-four cerebral aneurysms (ruptured, 31; unruptured, 23) in 50 patients (mean age, 59.4 ± 10.9 y; M:F, 22:28) were evaluated with ICGV and IOA during clipping. Additional IOA led to a clip adjustment during surgery in 9/54 (16.7%) aneurysms for which ICGV had been initially performed. Post-clip perforator compromise occurred in two (3.7%) cases, with a patient with an unruptured aneurysm experiencing permanent injury (grade 3 hemiparesis) and patient with a ruptured aneurysm experiencing transient deficit. Post-clip parent vessel stenosis occurred in one (1.9%) case; however, an ischemic event did not occur because the flow patency was identified by IOA. No other patients with unruptured aneurysms developed new neurologic deficits at discharge. Favorable outcomes (Glasgow Outcome Score [GOS], 4 or 5) were observed in 26/31 patients with ruptured aneurysms. Five patients had unfavorable outcomes (GOS, 2 or 3) from the initial insult. Post-treatment angiography within 1week showed complete occlusion in 52 (96.3%) aneurysms and minor remnants in two (3.7%) aneurysms. Using combined ICGV and IOA in a hOR may improve the safety and completeness of microsurgical aneurysm clipping.

Clipping of a giant partially thrombosed ophthalmic segment aneurysm

Abstract Ophthalmic segment aneurysms (OSA) originate from the paraclinoid portion of the internal carotid artery (ICA) usually at the origin of the ophthalmic artery. OSAs represent 1.5–10% of intracranial aneurysms, and although often asymptomatic, may lead to optic nerve (ON) compression and/or subarachnoid hemorrhage. When the dome is partially or completely thrombosed, microsurgical clipping can provide vascular exclusion and ON decompression through thrombectomy. Nevertheless, high expertise and knowledge of the regional anatomy are required to manage this complex surgical field. In this operative video, we show the management of a giant thrombosed OSA. The 52-year-old male patient presented with a recent history of worsening headache and progressive right visual loss. Neuroimaging revealed a 3 cm partially thrombosed right OSA, with mass effect on the ON and surrounding edema. An incidental 5 mm right middle cerebral artery (MCA) bifurcation aneurysm was also identified. Endovascular occlusion was not feasible, and the patient agreed to microsurgical treatment. A right pterional craniotomy was performed and the sylvian fissure was split, exposing both lesions. Parent vessel control was achieved with temporary clipping of the cervical ICA, and distal to the origin of the aneurysm. After debulking of the thrombosed and calcified dome with ultrasonic aspiration, the aneurysm was secured with combined clipping inside and outside the dome. The MCA aneurysm was subsequently exposed and clipped. Indocyanine green video-angiography confirmed exclusion of both aneurysms and flow patency of the rest of the circulation. The patient was discharged without complications and post-operative angiography showed complete occlusion of both aneurysms.

Abstract No. 466 Mono antiplatelet therapy strategy effectively kept flow patency in acute cardioembolic stroke received stent thrombectomy recanalization

Abstract No. 466 Mono antiplatelet therapy strategy effectively kept flow patency in acute cardioembolic stroke received stent thrombectomy recanalization