Transluminal Angioplasty Research Articles

A case report with literature review: long-term follow-up of kidney autotransplantation in fibromuscular dysplasia.

Fibromuscular dysplasia is a rare, idiopathic, systemic, non-inflammatory, and non-atherosclerotic vascular disease that primarily affects young women. It often presents as renal artery stenosis. Fibromuscular dysplasia can induce tissue damage in the post-stenotic kidney. Treatment options include antihypertensive therapy, surgical revascularization, and transluminal angioplasty with stent implantation. However, kidney autotransplantation is an alternative when these treatments are not feasible. This study presents a case report of a 22-year-old woman with fibromuscular dysplasia, highlighting the long-term success of kidney autotransplantation and reviewing the related literature. A multidisciplinary approach was employed in the treatment of this patient presenting with intermittent headaches, hypertension, and acute kidney disease, andwho was diagnosed with fibromuscular dysplasia. She underwent left aorta-renal bypass and right autotransplantation. Following the procedure, her serum creatinine level decreased from 2.74 to 1.1mg/dL, with an eight-year follow-up confirming the favorableoutcome. Renal artery stenosis is a significant contributor to secondary hypertension, with fibromuscular dysplasia being a rarecause. While medical and interventional treatments are usually effective, complex cases may necessitate alternative approaches. Kidney autotransplantation, albeit uncommon, is an effective option for patients who are unresponsive to conventional therapies. This case demonstrates the successful management of fibromuscular dysplasia-associated renovascular hypertension via kidney autotransplantation, resulting in controlled blood pressure and preserved kidney function. In conclusion, kidney autotransplantation represents a valuable therapeutic option for severe renal artery stenosis caused by fibromuscular dysplasia, particularly when percutaneous procedures are impractical.

Radiation-induced Renal Artery Stenosis

We present a case of a 33 year old male presenting with uncontrolled hypertension, requiring four drugs and renal dysfunction. Investigations revealed calcific atherosclerosis of abdominal aorta and bilateral renal artery stenosis. He had received radiotherapy for abdominal Non-Hodgkin’s lymphoma 14 years ago. Transluminal angioplasty was done on the right side resulting in improved renal function and normalization of blood pressure. Radiotherapy for intra-abdominal malignancy induces atherosclerosis process in arteries within field of irradiation and they manifest after many years of the initial insult.

MP31-03 VASCULAR COMPLICATIONS AFTER 3035 LIVE-DONOR RENAL TRANSPLANTS: INCIDENCE, RISK FACTORS, MANAGEMENT AND A FOCUS ON THROMBOTIC AND STENOTIC EVENTS

You have accessJournal of UrologyCME1 Apr 2023MP31-03 VASCULAR COMPLICATIONS AFTER 3035 LIVE-DONOR RENAL TRANSPLANTS: INCIDENCE, RISK FACTORS, MANAGEMENT AND A FOCUS ON THROMBOTIC AND STENOTIC EVENTS Bedeir Ali-El-Dein, Mohamed Shehata, Mohamed Zahran, Yasser M Osman, Mohamed Atteya, Ahmed Harraz, Ahmed El-Hefnawy, and Atallah A Shaaban Bedeir Ali-El-DeinBedeir Ali-El-Dein More articles by this author , Mohamed ShehataMohamed Shehata More articles by this author , Mohamed ZahranMohamed Zahran More articles by this author , Yasser M OsmanYasser M Osman More articles by this author , Mohamed AtteyaMohamed Atteya More articles by this author , Ahmed HarrazAhmed Harraz More articles by this author , Ahmed El-HefnawyAhmed El-Hefnawy More articles by this author , and Atallah A ShaabanAtallah A Shaaban More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003264.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Vascular complications after renal transplantation are serious events that affect patient/graft survival. The objectives are to report on risk factors linked to these complications and their salvage, diagnosis, treatment and outcome and to describe graft-saving procedures in thrombotic and stenotic events. METHODS: Between March 1976 and February 2019, 3035 consecutive live-donor kidney transplantations were performed. A retrospective analysis of post-transplant vascular complications, including risk factors, diagnosis, treatment and outcome was conducted. The graft-saving management of thrombotic and stenotic events and its outcome were focused on. RESULTS: 127 patients developed 136 complications including 22 (0.7%) renal artery thrombosis (RAT), five (0.2%) renal vein thrombosis (RVT), ten (0.3%) renal artery stenosis (RAS) and 99 (3.3%) hemorrhagic events. Two deaths occurred because of hemorrhage. The median time to diagnosis of thrombotic events was 3.5 days. On multivariate analysis, ATN, ischemia time (>48 minutes) and Wallace technique for arterial reconstruction were significant factors in vascular complications. Graft-saving procedures were successful in 17 thrombotic events (63%), including open revascularization for 15 cases with RAT, percutaneous trans-luminal thrombolysis and thrombectomy in two cases with RVT. Transluminal angioplasty was successful in three patients with RAS. On multivariate analysis, longer time to diagnosis > 3.5 days was the only factor linked to failure of graft salvage after thrombotic events (p=0.002), although other factors were significant on univariate analysis (Table 1). Apart from salvage procedures, vascular complications had a negative impact on graft survival after a median follow up of 82 months. CONCLUSIONS: With the advances of diagnostic and therapeutic techniques, a good sector of grafts with thrombotic and stenotic complications can be successfully salvaged. The risk factors for these complications are ATN, ischemia time longer than 48 minutes and Wallace technique for arterial reconstruction. Recently, interventional angiographic thrombolysis and transluminal angioplasty have been helpful. The earlier the management of thrombotic events, the better is the outcome. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e430 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bedeir Ali-El-Dein More articles by this author Mohamed Shehata More articles by this author Mohamed Zahran More articles by this author Yasser M Osman More articles by this author Mohamed Atteya More articles by this author Ahmed Harraz More articles by this author Ahmed El-Hefnawy More articles by this author Atallah A Shaaban More articles by this author Expand All Advertisement PDF downloadLoading ...

Percutaneous Transluminal Renal Angioplasty and Nephrectomy as A Mean to Control Treatment Resistant Hypertension and Save Kidney Function

Percutaneous Transluminal Renal Angioplasty and Nephrectomy as A Mean to Control Treatment Resistant Hypertension and Save Kidney Function

Percutaneous Transluminal Renal Angioplasty and Nephrectomy as A Mean to Control Treatment Resistant Hypertension and Save Kidney Function

Percutaneous Transluminal Renal Angioplasty and Nephrectomy as A Mean to Control Treatment Resistant Hypertension and Save Kidney Function

Hospital readmissions and economic burden associated with multivessel disease in the early period following acute myocardial infarction

Abstract Background There is emerging evidence that particularly high rates of major adverse cardiovascular events (MACE) occur in the 90-day period after acute myocardial infarction (AMI). Post-AMI MACE are associated with additional resource utilization and economic burden for healthcare systems, with multivessel disease (MVD) conferring a 3- to 4-fold increase in risk of recurrent MACE in the first year post AMI vs. single vessel disease. Thus, characterizing the prevalence and outcomes of patients with MVD and various comorbidities is crucial to predict and mitigate clinical risk and associated costs. Purpose To describe post-AMI readmissions and economic burden in MVD patients at 30, 90, and 365 days. Methods This was a retrospective cohort study (1st January, 2008 to 31st December, 2018). Patients with MVD were identified by a confirmed diagnosis code from a longitudinal, representative UK population health dataset comprising primary care data from the Clinical Practice Research Datalink (CPRD), which was linked to secondary care data from the Hospital Episode Statistics (HES) and Office of National Statistics (ONS) databases. Patients who experienced at least one AMI after their first recorded MVD diagnosis were defined as MVD+. A MACE was defined as any one of non-fatal MI, non-fatal stroke, or cardiovascular death. Readmissions were defined as non-elective admissions with a MACE outcome diagnosis occurring up to 28 days from a previous admission with the same treatment speciality. Results The study population included 78,128 MVD+ patients (4.2% of the total patient population). In the MVD+ cohort, 3,753 (4.8%) patients were readmitted with at least one MACE event or other non-elective admission within the cardiovascular specialty: 2,394 (63.8%), 2,562 (68.3%), and 2,830 (75.4%) readmissions occurred within 30, 90, and 365 days, respectively. The mean length of hospital stay per patient, per readmission for MACE within 30, 90, and 365 days was 7.22, 7.46, and 7.74 days, respectively. The mean cost per MACE admission within 90 days of index AMI was £3,926.52. Non-fatal MI was the most common reason for readmission at all timepoints. Percutaneous transluminal balloon angioplasty and saphenous vein graft procedures (coronary artery bypass graft, CABG) were among the most common cardiac procedures in MVD+ patients, at 70,276 (22.7%) and 15,418 (5.0%), respectively. Conclusions In patients with MVD who suffer an AMI, there is high resource utilization and cost, particularly in the first 90-days post AMI; therefore, the 90-day post-AMI period represents significant economic costs to healthcare systems. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): CSL Behring

Carotid sinus syndrome in carotid angioplasty with stenting

Introduction. Significant progress has been made in primary stroke prevention, including through the widespread use of carotid angioplasty with stenting (CAS). At the same time, there is a growing number of publications reporting the development of carotid sinus syndrome (CSS) (haemodynamic instability) in the periope- rative period, as well as cerebral and cardiac complications and death, which requires in-depth study to improve the quality of medical care for patients with carotid artery stenosis.
 The aim of the study was to determine the frequency, risk factors, clinical features and outcomes of CSS in patients with carotid artery stenosis undergoing CAS.
 Materials and methods. The study included 120 patients with carotid artery disease, who underwent an elective surgical intervention consisting of transluminal balloon angioplasty. All patients underwent comprehensive clinical and laboratory tests and imaging studies.
 Results. CSS developed in 70% of cases (n = 84) of carotid artery stenosis, and was significantly more common in men than women (71.4% vs. 28.6%, respectively) (p 0.05). The median age of all patients with CSS was 68 (4491) years. Mixed form of CSS was significantly more common than the cardioinhibitory or vasodepressor forms (p 0.05). In more than half of all cases, symptoms developed during balloon dilatation or within an hour afterwards. The duration of CSS was 3040 hours. Contralateral carotid occlusion was detected in 12 (10%) patients, significantly (p 0.05) more often in patients with CSS (13%) compared to patients without CSS (2.8%).
 Conclusion. Regardless of stenosis severity or symptoms, CAS is accompanied by CSS in 2/3 of cases. The CSS is predominantly a mixed type and can be accompanied by loss of consciousness in rare cases. CSS appears both intraoperatively and in the early postoperative period, and its average duration is 1.5 days. A factor that may be associated with CSS development is contralateral carotid artery occlusion (p 0.05).

Fibromuscular dysplasia with recurrence after \u201clong-term\u201d following percutaneous transcatheter renal angioplasty: two case reports with a review of 26 patients

BackgroundFibromuscular dysplasia (FMD) often causes renal artery stenosis with renovascular hypertension. Recent clinical outcomes encourage percutaneous transluminal renal angioplasty (PTRA) to treat FMD; however, the necessary follow-up period remains unclear. Moreover, previous studies have not revealed the difference in the period until recurrence between two major types of FMD—multifocal and focal.Case presentationWe describe two patients with multifocal FMD who developed hypertension during their teenage years and had recurrence of FMD > 10 years after PTRA. We further examined the types of FMD and age of onset in 26 patients who underwent PTRA. The period until recurrence of multifocal FMD was longer than that of focal FMD. Moreover, patients with early-onset multifocal FMD are likely to have a delayed recurrence after PTRA compared to other types.ConclusionsOur report suggests that patients with multifocal FMD, especially those with onset at an early age, may need long-term follow-up for at least ≥ 10 years.

Long-term outcome of percutaneous transluminal renal angioplasty (PTRA) versus PTRA with stenting (PTRAS) in transplant renal artery stenosis

BackgroundEndovascular treatment is standard of care for transplant renal artery stenosis (TRAS). No study has evaluated long-term outcomes compared between percutaneous transluminal renal angioplasty (PTRA) and PTRA with stenting (PTRAS). Accordingly, this study aimed to investigate the 1-year clinical success, and short- and long-term event-free survival between PTRA and PTRAS in patients diagnosed with TRAS at Thailand’s largest national tertiary referral center.MethodsThis single-center retrospective study included kidney transplant patients treated for TRAS during January 2001 to June 2019. Clinical success was defined as (1) increase in estimated glomerular filtration rate (eGFR) > 15%, or (2) reduction in mean arterial pressure (MAP) > 15% with no decrease in antihypertensive medication, or no reduction in MAP or reduction in MAP < 15% with decrease in antihypertensive medication. Incidence of kidney transplant graft failure and transplant renal artery stenosis were also collected.ResultsSixty-five cases of TRAS were identified from 1072 patients who underwent kidney transplantation. The majority (98.5%) had end-to-side anastomosis technique. Thirty-four patients had PTRA, while 31 patients had PTRAS. One-year clinical success according to renal outcome and BP reduction was 78.5% and 49.2%, respectively. Both renal outcome (79.4% vs. 77.4%, p = 0.845) and BP reduction (40.6% vs. 58.1%, p = 0.166) at 1 year were similar between the PTRA and PTRAS groups. Compared between PTRA and PTRAS, event-free survival for composite of kidney transplant graft failure or transplant renal artery restenosis was significantly higher for PTRAS at 1 year (82.4% vs. 100%, p = 0.025), but not significantly different at 10 years (73.5% vs. 71%, p = 0.818).ConclusionsWe demonstrated the 1-year clinical success, and short- and long-term event-free survival between PTRA and PTRAS in TRAS patients. One-year clinical success was found to be similar between groups. Event-free survival for composite of kidney transplant graft failure or transplant renal artery restenosis was significantly higher in PTRAS at 1 year, but similar between groups at 10 years.Trial registration Thai Clinical Trials Registry, TCTR20200626002. Registered 26 June 2020—Retrospectively registered, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trial search&smenu = fulltext&task = search&task2 = view1&id = 6441

Intravascular ultrasound-supported percutaneous angioplasty of post-kidney transplant renal artery bifurcation stenosis.

Transplant renal artery stenosis (TRAS) is an uncommon complication following renal transplantation. Its usual clinical presentation includes worsening hypertension and/or renal function, without any evidence of graft rejection. Bifurcation renal artery stenosis of the transplanted renal artery is rarely encountered. Percutaneous transluminal renal angioplasty (PTRA) with or without stenting is the procedure of choice to treat TRAS. We hereby describe a patient, who presented with impaired renal functions, four months following the renal transplantation. He underwent intravascular ultrasound-guided PTRA of the bifurcation lesion of TRAS.Results and conclusion: Superior renal artery had coronary drug-eluting stent implantation, while inferior renal artery and side branch of the superior renal artery had balloon angioplasty, alone. Post-intervention, the raised serum creatinine level decreased from 2.9 mg% to 1.7 mg%. The index case described the successful PTRA and stenting of the bifurcation lesion of TRAS, the technical results of which was optimized with the use of intravascular ultrasound.

Variant Anatomy of Popliteal Vessels- A Cadaveric Study

Introduction: The popliteal fossa is a narrow intermuscular space posterior to knee joint. This area is vulnerable during knee arthroplasty or high tibial osteotomy. Therefore, awareness of anatomical variations in the popliteal fossa is important for anatomists, radiologists and surgeons. Popliteal Artery (PA) is frequently affected by penetrating and blunt trauma involving the lower extremity. Therefore, exposure of this artery is often required in both emergency and elective vascular procedures. The Popliteal Vein (PV) is formed at the distal border of popliteus. Pulmonary embolisms originate in deep vein thrombosis in lower extremities. The thrombus forms in the calf veins and subsequently embolize to the lungs. With continued increase of interventional procedures, the anatomical variations in the region of popliteal fossa may have an influence on the success of surgical reconstruction, transluminal angioplasty or embolectomy. Aim: To study the morphology and variations in popliteal vessels by dissection. Materials and Methods: The present study was a cadaveric study which was conducted on 30 lower limbs belonging to 15 formalin fixed adult human cadavers. Properly embalmed adult human cadavers were included in the study. Cadavers with any lower limb deformity or with history of surgery in popliteal fossa were excluded from the study. The data was entered in Microsoft excel sheet and expressed in percentage. Results: According to the classification given by Kim D et al., 96.6% cases were classified as Type IA. Higher bifurcation of PA into posterior tibial and common trunk of anterior tibial and peroneal was described as Type IIB. In addition, the PV was seen to be formed at the lower border of popliteus in 28 specimens (93.33%). Two specimens (6.67%) showed a variable level of formation. Conclusion: Considering such variable morphology of structures in the popliteal fossa, the surgeons operating around the knee joint should be aware of the possible variations in order to avoid undue complications.

Perforation of pulmonary arteries during transluminal balloon angioplasty

Perforation of pulmonary arteries during transluminal balloon angioplasty

Manejo endovascular de la estenosis de la arteria renal en el trasplante renal

INTRODUCCIÓN: La estenosis de la arteria renal es la complicación vascular más frecuente del trasplante renal y una de las principales causas de pérdida del injerto y muerte prematura en los pacientes trasplantados. A pesar de ser potencialmente tratable, es frecuentemente infradiagnosticada, por lo que su diagnóstico precoz y manejo terapéutico adecuado resulta fundamental para evitar la pérdida de función renal. MATERIAL Y MÉTODOS: Analizamos retrospectivamente el caso de dos pacientes de 72 años trasplantados en nuestro centro en 2017. Ambos pacientes, con antecedentes de hipertensión arterial, cardiopatía isquémica crónica y enfermedad renal crónica terminal secundaria a nefroangioesclerosis y glomerulonefritis membranosa, respectivamente; presentaron un empeoramiento de la creatinina en el postoperatorio inmediato del trasplante renal. Ante este hallazgo y la evidencia de velocidades pico sistólicas &gt;200 cm/s en la ecografía-doppler se sospechó una estenosis de la arteria del injerto, posteriormente confirmada con angiografía y angio-TC, respectivamente. Por lo que se realizó una revascularización percutánea e implante de stent. RESULTADOS: Se realizó la angioplastia con balón y colocación de stent, bajo anestesia local, obteniendo un buen resultado morfológico, sin complicaciones inmediatas. Tras el procedimiento ambos pacientes presentaron una mejoría progresiva de la función renal manteniendo un buen ritmo de diuresis, siendo dados de alta a los 8 y 11 días del mismo. Desde entonces, la función renal de ambos pacientes se ha mantenido estable presentando a los 12 meses un filtrado glomerular alrededor de 67 mL/min/1.73m2 y 60 mL/min/1.73m2, respectivamente. Sin evidencia de complicaciones tras 14 meses del procedimiento. CONCLUSIONES: La angioplastia con balón y colocación de stent en la estenosis de la arteria renal en el trasplante es una técnica segura y efectiva. Sin embargo, es necesaria una elevada experiencia para disminuir el número de complicaciones y optimizar los resultados de esta técnica. Palabras clave: trasplante renal, estenosis arterial, manejo mínimamente invasivo, cirugía endovascular.

A 6-year experience of the Ross procedure in children with congenital aortic valve disease

Background: The choice of an optimal method for correction of aortic valve stenosis or insufficiency remains the matter of debate. Some clinicians prefer transluminal balloon angioplasty, some would perform an open type commissurotomy, or aortic valve replacement, or to valve leaflets repair with various materials, while others opt for the Ross procedure. Each of these techniques has its advantages and disadvantages both in the early postoperative period and in the long-term.Aim: To assess the results of the Ross procedure, its complications, survival, and probability of reoperations in the long-term.Materials and methods: We retrospectively analyzed the results of 32 Ross procedures performed from the end of 2012 to the beginning of 2019 in children aged from 3 days to 18 years. Eight children were below 1 year of age, including one newborn. A pulmonary autograft was placed into the aortic position in all children. In 31 children, a homograft was placed into the pulmonary artery. In one patient, an aortic autograft was implanted instead of the pulmonary artery valve. The mean patient age was 6.8 years, mean bodyweight 27.7 kg (range, 3.9–74.6 kg).Results: Two patients died in the early postoperative period (mortality 6.25%). We examined 26 patients at the follow-up, with its mean duration of 2.5 years. There were no indications for replacement of the homograft during the follow-up. One patient, in whom we had implanted an aortic autograft into the pulmonary position, required its replacement after 4.5 years. We have no data on death rates in the long-term.Conclusion: The Ross procedure provides satisfactory results in the early and intermediate postoperative period. Continuous follow-up is needed to determine the time points and the proportion of repeated interventions with a pulmonary homograft and aortic valve.

Renal fibrosis detected by diffusion-weighted magnetic resonance imaging remains unchanged despite treatment in subjects with renovascular disease

Tissue fibrosis is an important index of renal disease progression. Diffusion-weighted magnetic resonance imaging’s (DWI-MRI) apparent diffusion coefficient (ADC) reveals water diffusion is unobstructed by microstructural alterations like fibrosis. We hypothesized that ADC may indicate renal injury and response to therapy in patients with renovascular disease (RVD). RVD patients were treated with medical therapy (MT) and percutaneous transluminal renal angioplasty (MT + PTRA) (n = 11, 3 bilaterally, n = 14 kidneys) or MT (n = 9). ADC and renal hypoxia (R2*) by blood-oxygen-level-dependent MRI were studied before (n = 27) and 3 months after (n = 20) treatment. Twelve patients underwent renal biopsies. Baseline ADC values were correlated with changes in eGFR, serum creatinine (SCr), systolic blood pressure (SBP), renal hypoxia, and renal vein levels of pro-inflammatory marker tumor necrosis-factor (TNF)-α. Renal oxygenation, eGFR, and SCr improved after MT + PTRA. ADC inversely correlated with the histological degree of renal fibrosis, but remained unchanged after MT or MT + PTRA. Basal ADC values correlated modestly with change in SBP, but not in renal hypoxia, TNF-α levels, or renal function. Lower ADC potentially reflects renal injury in RVD patients, but does not change in response to medical or interventional therapy over 3 months. Future studies need to pinpoint indices of kidney recovery potential.

Endovascular Management of Popliteal Artery Occlusive Disease: Long-term Outcomes of Angioplasty, Stenting and Atherectomy

Although significant data exist for improved long-term patency with stent placement over transluminal angioplasty in peripheral arterial disease, excessive curvature of the popliteal artery during knee flexion and concomitant risk for stent kinking or fracture has limited the utilization of stents in this vessel. Atherectomy has proven to be a popular adjunct to angioplasty; however, long-term patency outcomes have not been extensively reported. Optimal endovascular management of popliteal arterial disease remains controversial and unknown.

Results of renal artery revascularization in the post-ASTRAL era with 4 years mean follow-up

Purpose: To investigate contemporary results of percutaneous transluminal renal angioplasty (PTRA).Materials and Methods: A multicentre retrospective study analysing all patients treated with PTRA for primary symptomatic renal artery stenosis (RAS) between 2010 and 2013 at four tertiary centres. Procedures during the preceding four years were counted to evaluate for change in PTRA frequency.Results: The number of PTRA procedures decreased by approximately 50% from 2006 to 2013. Patients treated in the post-ASTRAL period (n = 224) had a significant reduction in mean systolic pressure (168 to 146 mmHg, p < 0.01), diastolic pressure (84 to 76 mmHg, p < 0.01), number of anti-hypertensive drugs (3.54 to 3.05, p < 0.01), and anti-hypertensive treatment index (21.75 to 16.92, p < 0.01) compared to before PTRA. These improvements were maintained at one year and at the last clinical evaluation after a mean follow-up of 4.31 years. Renal function increased transiently without sustained improvement, or deterioration, during later follow-up. Thirteen patients (5.8%) eventually required dialysis, nine of these had eGFR <20 ml/min/1.73 m2 before PTRA. There was no difference in outcomes between subgroups differentiated by different indications for PTRA.Conclusion: The frequency of PTRA has decreased, indicating a higher threshold for invasive treatment of RAS in recent years. The reduction in blood pressures, the reduced need for anti-hypertensive medication, and stabilization of renal function over time suggest a clinical benefit for most patients who are now being treated with PTRA.

ENDOTHELIAL PROGENITOR CELLS & VASCULAR ENDOTHELIAL GROWTH FACTOR A IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AFTER PERCUTANEOUS VASCULAR INTERVENTIONS

Endothelial progenitor cells (EPCs) and vascular endothelial growth factors (VEGF) are thought to play a significant role in endothelialization after transluminal angioplasty. The aim of the study was to investigate mobilization of EPCs and VEGF-A in patients with T2DM after elective percutaneous

Reoperations after the correction of partial abnormal venous return: a clinical case series

Rationale: The surgical procedure for partial abnormal pulmonary venous return (PAPV) implies the formation of a tunnel between the orifices of the right pulmonary veins and the left atrial cavity with the interatrial septum repair. To avoid any obstruction of the tunnel, a direct anastomosis between the superior vena cava (SVC) and the right atrial appendage is placed in a number of cases. However, the reparative procedure is potentially associated with such complications as SVC stenosis and/or pulmonary vein stenosis. Aim: To present our experience of reoperations for stenosis of systemic and pulmonary veins after primary PAPV repair. Materials and methods: From 2014 to 2018, seven patients (boys, 4) with SVC stenosis and/or with stenosis of the right pulmonary veins have been admitted to the FCHMT (Kaliningrad). Their mean bodyweight was 29.1 kg (± 12.5 kg), mean age 9.3 years (± 3.6 years). Three patients had an isolated SVC stenosis. In two patients, there was a combination of SVC stenosis and pulmonary vein obstruction (from stenosis to complete occlusion); in one patient the right pulmonary vein stenosis had been caused by thrombosis. SVC stenosis with subaortal obstruction after the repair of double-outlet right ventricle was diagnosed in one case. In six patients, various procedures for correction of SVC and/or pulmonary vein stenosis were performed. Only in one case the obstruction of systemic veins, confirmed by cardiac catheterization, turned out to be non-significant, making a reoperation unnecessary. Results: There were no deaths in this patient group. Endovascular procedures were performed in two patients. In one case, there was an unsuccessful attempt of transluminal balloon angioplasty for SVC stenosis, with subsequent Warden procedure. In another case, a 16-year old patient with SVC stenosis and high pulmonary hypertension was admitted after two previous surgeries had failed. We used a homograft as SVC prosthesis; however, after one year, a re-stenosis was identified. In this case, a SVC stent placement was successful. Due to sick sinus syndrome at one year after the Warden procedure and the repair of pulmonary veins by a homograft, an implantation of electric cardiac pacemaker was necessary in one patient. Conclusion: The curative repair of partial abnormal venous return is a well-established surgical technique with satisfactory shortand long-term results. A potential complication of the procedure is an obstruction of systemic and pulmonary veins. To prevent such complications during primary defect repair, as well as with reoperations for vein stenosis, the Warden procedure seems effective and highly reproducible technique associated with lower surgical risks.

Prevalence of right ventricular outflow tract abnormalities among recipients in twin-twin transfusion syndrome after fetoscopic laser surgery in 90 consecutive cases.

Right ventricular outflow tract obstruction (RVOTO) is a severe complication in recipients in twin-twin transfusion syndrome (TTTS). This study investigated the prevalence of RVOTO in TTTS after laser surgery and examined the risk factors for RVOTO. This retrospective study evaluated 90 patients who had undergone laser surgery and been followed for 6months after birth. The diagnosis of RVOTO was made based on postnatal echocardiography findings. Ultrasound and clinical records, including maternal and neonatal data, were retrieved from our database. Risk factors for developing RVOTO were compared between recipients with and without RVOTO in a statistical analysis. Six surviving recipients were diagnosed with RVOTO. Three recipients had developed severe pulmonary stenosis (PS) that required percutaneous transluminal pulmonary valvuloplasty or balloon pulmonary angioplasty. A total of 6.7% of recipients (6/90) had RVOTO, consisting of PS and tricuspid regurgitation (TR), and 3.3% of recipients (3/90) required invasive treatment. The characteristic factors did not differ significantly between recipients with and without RVOTO. This study revealed that 6.7% of recipients with TTTS had PS, and 3.3% required invasive treatment for PS. However, no significant association was noted between RVOTO development in recipients and maternal clinical data and fetal ultrasound examination findings. It is difficult to predict RVOTO development in recipients using only preoperative ultrasound and clinical information.