Tension-based abdominal aortic aneurysm rupture risk assessment improves its accuracy and reduces the time of analysis.

The biomechanical rupture risk assessment (BRRA) of abdominal aortic aneurysms (AAA) has higher sensitivity than maximal diameter criterion (DSEX) but its estimation is time-consuming and relies on an uncertain estimation of wall thickness. The aim of this study is to test tension-based criterion in the BRRA of AAA which removes the necessity of wall thickness measurement and should be faster. For that, we retrospectively analyzed 99 patients with intact AAA (25 females). Nineteen of them experienced a rupture later. BRRA was performed with wall tension PRRIT as a primary criterion. The ability of criterion to separate intact and ruptured AAAs at 1,3,6,9 and 12 months was estimated. Next, the receiver operating characteristics and the percentage of true negative cases for a different time to an outcome were estimated. Finally, the computational time was recorded. The results were compared to stress-based criterion PRRI and DSEX which served as a reference. All three criterions were able to discriminate between intact and ruptured AAAs up to 9 months (p < 0.05) while none of them could do for a 12 month prediction. PRRIT exhibited a significantly higher percentage of true negatives for 12 and 9 month predictions (45 % and 20 % respectively) and similar to other criteria for other prediction times. The mean computational time for estimating PRRIT was 19 h per patient compared to 67 h for PRRI. The tension- based BRRA of AAA leads to better outcomes for a 9 and 12 month prediction while the computational time drops by more than 70 % compared to PRRI.

Autologous Alternative Vein Grafts for Infrainguinal Bypass in the Absence of Single-Segment Great Saphenous Vein: A Single-Center Study.

BACKGROUND: Alternative autologous veins can be used as a conduit when adequate great saphenous vein is unavailable. We analyzed the results of our infrainguinal bypasses after adopting upper extremity veins in our practice. METHODS: This is a single-center observational study involving all patients whose infrainguinal bypass involved the use of upper extremity veins between April 2019, when we began using arm veins, and February 2023. RESULTS: During the study period, 49 bypasses were done in 48 patients; mean age 68.1 ± 9.8; men 32 (66.7%); body mass index 28.0 ± 4.8; indications for surgery: chronic limb threatening ischemia 41 (83.7%); acute limb ischemia 3 (6.1%); complications of previous prosthetic 3 (6.1%), or autologous 2 (4.1%) bypass grafts. Vein splicing was used in 43 (87.8%) bypasses with 3-segment grafts being the most common (26; 53.1%). There were 24 (49.0%) femorotibial, 11 (22.4%) femoropopliteal, 9 (18.4%) femoropedal, and 5 (10.2%) extension jump bypass procedures. Eighteen (36.7%) operations were redo surgeries. Twenty-one (42.9%) bypasses were formed using only arm veins. The median follow-up was 12.9 months (4.5-24.2). Two bypasses occluded during the first 30 postoperative days (2/49; 4.1%). Overall 30-day, 1-year, and 2-year primary patency rates were 93.7% ± 3.5%, 84.8% ± 5.9%, and 80.6% ± 6.9%, and secondary patency (SP) rates were 95.8% ± 2.9%, 89.2% ± 5.3%, and 89.2% ± 5.3%. One-segment grafts had better patencies than 2-, 3-, and 4-segment grafts (1-year SP 100% ± 0% vs 87.6% ± 6.0%). Two-year amputation-free survival was 86.8% ± 6.5%; 2-year overall survival was 88.2% ± 6.6%. CONCLUSIONS: Integration of arm vein grafts in infrainguinal bypass practice can be done safely with low incidences of perioperative graft failure. One-segment grafts had better patencies than spliced vein grafts. The achieved early patency and amputation-free survival rates strongly encourage their use. In the absence of a single-segment great saphenous vein, upper extremity vein grafts should be the preferred conduit choice.

Kinetics of d-lactate and ischemia-modified albumin after abdominal aortic surgery and their ability to predict intestinal ischemia.

OBJECTIVES: Acute intestinal ischemia is a severe complication of abdominal aortic surgery that is difficult to diagnose early and therefore to treat adequately and timely. In this study the perioperative kinetics of d-lactate and ischemia-modified albumin (IMA) are described and the predictive value of these markers for the early diagnosis of acute intestinal ischemia is assessed. DESIGN & METHODS: This non-randomised, single-centre cohort study enrolled 50 patients with abdominal aortic aneurysm (AAA) and 30 patients with aortoiliac occlusive disease (AOID). Serum d-lactate and IMA were assessed pre-, intra-, and postoperatively at eight defined time points. RESULTS: The highest serum d-lactate was at 6 h after complete declamping of the vascular graft. The highest predictive power of d-lactate was at 3 h after complete declamping (AUC 0.857). IMA was found to be higher in the AAA group in ischemic patients 10 min after complete declamping than in the AOID group. The highest predictive values of IMA were at 1 h after aortic cross-clamping (AUC 0.758) and 3 and 6 h after complete declamping (0.745 and 0.721, respectively). Moreover, the multivariate model with both markers at 3 h after complete declamping improved the detection of intestinal ischemia (AUC 0.894). CONCLUSIONS: Serum levels of IMA and d-lactate seem to be influential predictive markers for postoperative intestinal ischemia, especially after 3 h from complete declamping of vascular reconstruction.

Procalcitonin kinetics following abdominal aortic surgery and its value for postoperative intestinal ischaemia detection.

OBJECTIVE: The purpose of our study was to describe perioperative kinetics of procalcitonin (PCT) in patients undergoing aortic surgery, to compare the kinetics in the open abdominal aortic aneurysm (AAA) repair and aortobifemoral bypass for aortoiliac occlusive disease (AIOD), and to evaluate the ability of PCT to detect intestinal ischaemia. METHODS: A prospective non-randomized observational cohort study in 80 patients (62 men and 18 women) undergoing elective aortic surgery was performed. Serum PCT was measured at baseline and defined intraoperative and postoperative timepoints up to postoperative day 7. MRI contrast-enhanced imaging was used to detect intestinal ischaemia. RESULTS: The comparison of the AAA and AIOD cohort did not show any significant difference in PCT levels. Patients with intestinal ischaemia had higher serum PCT at multiple timepoints postoperatively. The most accurate timepoints for early diagnosis were postoperative day 3, followed by 24 h after declamping of the vascular reconstruction, and postoperative day 7. The sensitivity and negative predictive values were 100% in all mentioned timepoints. However, event at the best timepoint the specificity was 89% and the positive predictive value 43%. CONCLUSIONS: Procalcitonin levels in the postoperative period at proper timepoints might help to detect postoperative intestinal ischaemia. The limitation of this marker is its low specificity for intestinal ischaemia and low positive predictive value. The highest value of this marker is that it can rule out this complication because normal PCT levels mean that intestinal ischaemia is very unlikely.

l-lactate kinetics after abdominal aortic surgery and intestinal ischemia - An observational cohort study.

BACKGROUND: Postoperative intestinal ischemia is a severe complication in abdominal aortic surgery. Early diagnosis is needed for adequate and timely treatment. We studied the postoperative kinetics of l-lactate in vascular patients to assess its value as a marker for early postoperative intestinal ischemia detection. MATERIAL AND METHODS: We performed a prospective non-randomized single-center observational cohort study in eighty elective patients, fifty operated on for abdominal aortic aneurysm (AAA) and thirty for aortoiliac occlusive disease (AIOD). Serum l-lactate was measured preoperatively, intraoperatively, and postoperatively at defined timepoints up to postoperative day 7. Intestinal ischemia was detected using MRI enterocolography. We have used univariate logistic regression and receiver operating characteristics curves for the evaluation of marker accuracy. RESULTS: We recorded 6 cases of postoperative intestinal ischemia (7.5%), five non-transmural and one transmural. Two patients died because of this complication (mortality 33%). The comparison of AAA and AIOD cohorts showed a significant difference in l-lactate levels at one intraoperative timepoint, which was attributable to procedure differences. The only preoperative factor associated with higher l-lactate levels at some timepoints was chronic kidney disease. Patients suffering postoperative intestinal ischemia had elevated serum l-lactate levels at multiple timepoints. The most accurate timepoint for diagnosis was 24 h after the declamping of the vascular reconstruction (DC24H), the second was 10 min after declamping. Sensitivity, specificity, positive and negative predictive values at timepoint DC24H were 100%, 82%, 32%, and 100%, respectively. CONCLUSION: Serum l-lactate levels might help in the early detection of postoperative intestinal ischemia after aortic surgery if proper timepoints are used. Cutoff values need to be established in large-scale prospective studies.

Biomechanical Rupture Risk Assessment in Management of Patients with Abdominal Aortic Aneurysm in COVID-19 Pandemic.

Background: The acute phase of the COVID-19 pandemic requires a redefinition of healthcare system to increase the number of available intensive care units for COVID-19 patients. This leads to the postponement of elective surgeries including the treatment of abdominal aortic aneurysm (AAA). The probabilistic rupture risk index (PRRI) recently showed its advantage over the diameter criterion in AAA rupture risk assessment. Its major improvement is in increased specificity and yet has the same sensitivity as the maximal diameter criterion. The objective of this study was to test the clinical applicability of the PRRI method in a quasi-prospective patient cohort study. Methods: Nineteen patients (fourteen males, five females) with intact AAA who were postponed due to COVID-19 pandemic were included in this study. The PRRI was calculated at the baseline via finite element method models. If a case was diagnosed as high risk (PRRI > 3%), the patient was offered priority in AAA intervention. Cases were followed until 10 September 2021 and a number of false positive and false negative cases were recorded. Results: Each case was assessed within 3 days. Priority in intervention was offered to two patients with high PRRI. There were four false positive cases and no false negative cases classified by PRRI. In three cases, the follow-up was very short to reach any conclusion. Conclusions: Integrating PRRI into clinical workflow is possible. Longitudinal validation of PRRI did not fail and may significantly decrease the false positive rate in AAA treatment.

Constitutive models and failure properties of fibrous tissues of carotid artery atheroma based on their uniaxial testing.

To obtain an experimental background for the description of mechanical properties of fibrous tissues of carotid atheroma, a cohort of 141 specimens harvested from 44 patients during endarterectomies, were tested. Uniaxial stress-strain curves and ultimate stress and strain at rupture were recorded. With this cohort, the impact of the direction of load, presence of calcifications, specimen location, patient's age and sex were investigated. A significant impact of sex was revealed for the stress-strain curves and ultimate strains. The response was significantly stiffer for females than for males but, in contrast to ultimate strain, the strength was not significantly different. The differences in strength between calcified and non-calcified atheromas have reached statistical significance in the female group. At most of the analysed stress levels, the loading direction was found significant for the male cohort which was also confirmed by large differences in ultimate strains. The representative uniaxial stress-strain curves (given by median values of strains at chosen stress levels) were fitted with an isotropic hyperelastic model for different groups specified by the investigated factors while the observed differences between circumferential and longitudinal direction were captured by an anisotropic hyperelastic model. The obtained results should be valid also for the tissue of the fibrous cap, the rupture of which is to be predicted in clinics using computational modelling because it may induce arterial thrombosis and consequently a brain stroke.

Methodology for Estimation of Annual Risk of Rupture for Abdominal Aortic Aneurysm.

BACKGROUND AND OBJECTIVE: Estimating patient specific annual risk of rupture of abdominal aortic aneurysm (AAA) is currently based only on population. More accurate knowledge based on patient specific data would allow surgical treatment of only those AAAs with significant risk of rupture. This would be beneficial for both patients and health care system. METHODS: A methodology for estimating annual risk of rupture (EARR) of abdominal aortic aneurysms (AAA) that utilizes Bayesian statistics, mechanics and patient-specific blood pressure monitoring data is proposed. EARR estimation takes into consideration, peak wall stress in AAA computed by patient-specific finite element modeling, the probability distributions of wall thickness, wall strength, systolic blood pressure and the period of time that the patient is known to have already survived with the intact AAA. Initial testing of proposed approach was performed on fifteen patients with intact AAA (mean maximal diameter 51mm±8mm). They were equipped with a pressure holter and their blood pressure was recorded over 24 hours. Then, we calculated EARR values for four possible scenarios - without considering any days of survival prior identification of AAA at computed tomography scans (EARR_0), considering past survival of 30 (EARR_30), 90 (EARR_90) and 180 days (EARR_180). Finally, effect of patient-specific blood pressure variability was analyzed. RESULTS: Consideration of past survival does indeed significantly improve predictions of future risk: EARR_30 (1.04%± 0.87%), EARR_90 (0.67%± 0.56%) and EARR_180 (0.47%± 0.39%) which are unrealistically high otherwise (EARR_0 5.02%± 5.24%). Finally, EARR values were observed to vary by an order as a consequence of blood pressure variability and by factor of two as a consequence of neglected growth. CONCLUSIONS: Methodology for computing annual risk of rupture of AAA was developed for the first time. Sensitivity analyses showed respecting patient specific blood pressure is important factor and should be included in the AAA rupture risk assessment. Obtained EARR values were generally low and in good agreement with confirmed survival time of investigated patients so proposed method should be further clinically validated.

Failure properties of abdominal aortic aneurysm tissue are orientation dependent.

INTRODUCTION: Biomechanical rupture risk assessment of abdominal aortic aneurysm (AAA) requires information about failure properties of aneurysmal tissue. There are large differences between reported values. Among others, studies vary in using either axially or circumferentially oriented samples. This study investigates the effect of sample orientation on failure properties. METHODS: Aneurysmal tissues from 45 patients (11 females) were harvested during open AAA repair, cut into uniaxial samples (90) and tested mechanically within 3 h. If possible, the samples were cut in both axial (49 samples) and circumferential (41 samples) directions. Wall thickness, First Piola-Kirchhoff strength Pult and ultimate tension Tult were recorded. Influence of sample orientation and other clinical parameters were investigated using non parametric tests. RESULTS: Medians of Pult (values 1100 kPa for circumferential vs. 715 kPa for axial direction, p < 10-4) and Tult (17.4 N/cm in circumferential vs. 11.2 N/cm in axial direction, p < 10-4) were significantly higher in circumferential direction. For paired data, the median of difference was 411 kPa (p < 10-3) in Pult and 7.4 N/cm (p < 10-4) in Tult in favor of circumferential direction. CONCLUSIONS: In this first study of anisotropy in AAA wall failure properties using paired comparisons, the strength in circumferential orientation was found to be higher than in axial orientation.

Ischaemic Stroke Caused by a Gunshot Wound to the Chest.

INTRODUCTION: Pneumatic weapons rarely cause severe trauma. However, pellet embolisation can cause severe and unexpected injuries. REPORT: This is the case study of a 32 year old man, who was shot in the chest with a pneumatic rifle. Initially, urgent damage control surgery was performed to resolve pneumothorax and pericardial tamponade, but no projectile was found. Subsequent atypical symptomatology led to more extensive imaging that found a pellet embolised into the right carotid artery, thrombosis of the middle cerebral artery, and development of a large right hemispheric ischaemic area. After an unsuccessful endovascular intervention, the projectile was removed during an open surgical procedure. The right hemisphere oedema required decompressive hemicraniectomy, but long term intensive care and physiotherapy resulted in a satisfactory recovery with moderate neurological sequelae. CONCLUSION: An unusual clinical presentation in combination with an absent exit wound might be symptomatic of projectile embolisation and should lead to a search for it. When the projectile position is convenient, surgical removal is the treatment of choice while an endovascular approach should be reserved for inaccessible locations or asymptomatic cases.

The therapeutic effect of B-type natriuretic peptides in acute decompensated heart failure.

B-type natriuretic peptide (BNP) exhibits roles in natriuresis and diuresis, making it an ideal drug that may aid in diuresing a fluid-overloaded patient with poor or worsening renal function. Several randomized clinical trials have tested the hypothesis that infusions of pharmacological doses of BNP to acute heart failure (HF) patients may enhance decongestion and preserve renal function in this clinical setting. Unfortunately, none of these have demonstrated beneficial outcomes. The current challenge for BNP research in acute HF lies in addressing a failure of concept and a reluctance to abandon an ineffective research model. Future success will necessitate a detailed understanding of the mechanism of action of BNP, as well as better integration of basic and clinical science.

Biomechanical indices are more sensitive than diameter in predicting rupture of asymptomatic abdominal aortic aneurysms.

OBJECTIVE: Several studies of biomechanical rupture risk assessment (BRRA) showed its advantage over the diameter criterion in rupture risk assessment of abdominal aortic aneurysm (AAA). However, BRRA studies have not investigated the predictability of biomechanical risk indices at different time points ahead of rupture, nor have they been performed blinded for biomechanical analysts. The objective of this study was to test the predictability of the BRRA method against diameter-based risk indices in a quasi-prospective patient cohort study. METHODS: In total, 12 women and 31 men with intact AAAs at baseline have been selected retrospectively at two medical centers. Within 56 months, 19 cases ruptured, whereas 24 cases remained intact within 2 to 56 months. This outcome was kept confidential until all biomechanical activities in this study were finished. The biomechanical AAA rupture risk was calculated at baseline using high-fidelity and low-fidelity finite element method models. The capability of biomechanics-based and diameter-based risk indices to predict the known outcomes at 1 month, 3 months, 6 months, 9 months, and 12 months after baseline was validated. Besides common cohort statistics, the area under the curve (AUC) of receiver operating characteristic curves has been used to grade the different rupture risk indices. RESULTS: Up to 9 months ahead of rupture, the receiver operating characteristic analysis of biomechanics-based risk indices showed a higher AUC than diameter-based indices. Six months ahead of rupture, the largest difference was observed with an AUC of 0.878 for the high-fidelity biomechanical risk index, 0.859 for the low-fidelity biomechanical risk index, 0.789 for the diameter, and 0.821 for the sex-adjusted diameter. In predictions beyond 9 months, none of the risk indices proved to be superior. CONCLUSIONS: High-fidelity biomechanical modeling improves the predictability of AAA rupture. Asymptomatic AAA patients with high biomechanical AAA rupture risk indices have an increased risk of rupture. Integrating biomechanics-based diagnostic indices may significantly decrease the false-positive rate in AAA treatment. CLINICAL RELEVANCE: Rupture of abdominal aortic aneurysm (AAA) is the tenth leading cause of death in men older than 60 years; however, the currently used maximal diameter criterion has a high false-positive rate. In this study, we have compared this criterion with biomechanical rupture risk assessment on the unique data set of 43 asymptomatic AAAs, of which 19 ruptured later. Moreover, the AAA outcome was blinded to the operator for the first time. Our data demonstrated that the biomechanical rupture risk assessment is superior to maximal diameter in predicting AAA rupture up to 9 months ahead and significantly decreases the false-positive rate.

Impact of drugs on venous thromboembolism risk in surgical patients.

PURPOSE: This review focuses on the most common drugs administered to surgical patients during the perioperative period that affect the risk of venous thromboembolism (VTE). RESULTS: Among analgesics, the risk of VTE is increased in patients treated with diclofenac, ibuprofen, and rofecoxib, but not naproxen, while metamizole can confer a protective effect. The relationship between sedatives and VTE has not been sufficiently studied. Tricyclic antidepressants, low-potency serotonin reuptake inhibitors, and antipsychotics have been associated with increased risk of VTE. The use of diuretics in the perioperative period is poorly researched; however, hyponatremia is considered a risk factor. Other factors that may influence the risk of VTE include bridging anticoagulation, allogeneic transfusion, and hemostatic management before surgery. Pharmacotherapy for HIV or cancer may also increase VTE risk. CONCLUSION: Increased monitoring for VTE is therefore advisable in surgical patients and those receiving antipsychotics, antidepressants, diuretics, or analgesics.

Current vascular allograft procurement, cryopreservation and transplantation techniques in the Czech Republic.

BACKGROUND: Vascular allotransplantations are performed worldwide in selected patients suffering from vascular prosthesis infection or critical limb ischemia. Either fresh or cryopreserved vascular allograft may be used. OBJECTIVES: In various points, we address several aspects (allograft procurement, cryopreservation and transplantation technique) of the program of vascular allotransplantations in the Czech Republic. MATERIAL AND METHODS: Vascular grafts retrieval has been done within multiorgan harvests using no-touch technique. Very short time of cold ischemia is achieved due to close cooperation with Tissue Establishment where the following processing of cryopreservation is performed. Meeting all necessary quality criteria is a prerequisity for releasing grafts for clinical application. Standardized thawing protocol and surgical handling aims to minimize microfractures before implantation. RESULTS: Based on experimental and clinical work, the first validation of cryopreserved arterial and venous grafts for clinical use was performed between 2011 and 2013 in the Czech Republic. The developement of storage of vascular tissue in banks was stimulated in 2000-2010 by the issue of EU directives and national harmonized norms, aimed at assurance of high quality and safety of cells and tissues used for transplantations in humans. CONCLUSIONS: There are several crucial moments affecting final quality, including graft retrieval within a multiorgan harvest, short ischemic time, cryopreservation and thawing technique used. The recommended surgical handling during implantation may also affect results and graft-related complications.

Effect of intraluminal thrombus on growth rate of abdominal aortic aneurysms.

BACKGROUND: Abdominal aortic aneurysm (AAA) includes a variety of morphologies with changing properties. Growth rate is one of the most important factors directly linked to the risk of rupture. Intraluminal thrombus (ILT) covering aortic wall is found in the majority of AAAs. Yet, its role in biomechanical processes in AAA remains unclear. From one point of view ILT can serve as protective factor in reducing wall stress of AAA and thus slow down the growth. Modern concept of multilayered ILT proved active inflammatory processes inside, that can significantly affect the quality of the wall and thus lead to a higher growth rate and higher risk of rupture. The goal of this study was to analyze the effect of ILT on growth rate of AAA and support one of these theories. METHODS: Retrospective study of computed tomography angiography scans of AAA of 26 patients was performed. Forty pairs of consecutive scans have been analyzed. Periods between two scans varied. Maximal infrarenal diameter of AAA and size of ILT were measured. AAAs were split into 4 groups according to their initial diameter. Growth rate was calculated for each AAA and linked to the relative size of ILT. These values were statistically evaluated. RESULTS: Negative correlation between relative size of ILT and growth rate was found (P=0.042062). This significant result proved that thicker thrombus slowed down the growth of AAA and vice versa, smaller relative size of ILT was linked to higher growth rate. CONCLUSIONS: This finding shows importance of ILT as one of the key factors influencing biomechanical processes inside an AAA. Results of this study may contribute to future researches of this topic.

Organization model for allotransplantations of cryopreserved vascular grafts in Czech Republic.

The transplantation of fresh or cryopreserved vascular allografts in patients with a prosthetic graft infection or critical limb ischemia is necessary for their limb salvage and, in many cases, represents a lifesaving procedure. While transplantation of fresh allografts has a long history in the Czech Republic, the standard use of cryopreserved vascular allografts was introduced into the clinical practice in 2011 as a result of the implementation of EU Directive 2004/23/EC into national legislation (Human Cell and Tissue Act No. 296/2008 Coll.). The authors present an organizational model based on cooperation between the majority of Czech Transplant Centers with a tissue establishment licensed by the national competent authority. In various points, we are addressing individual aspects of experimental and clinical studies which affect clinical practice. Based on experimental and clinical work, the first validation of cryopreserved arterial and venous grafts for clinical use was performed between 2011 and 2013. The growing number of centers participating in this programme led to a growing number of patients who underwent transplantation of vascular allografts. In 2015 the numbers of transplanted fresh versus cryopreserved allografts in the Czech Republic were almost equal. Cooperation of the participating centers in the Czech Republic with the licensed Tissue Establishment made it possible to achieve a full compliance with the European Union Directives, and harmonized national legal norms and assured a high quality of cryopreserved vascular allografts.

Treatment of infrapopliteal post-PTA dissection with tack implants: 12-month results from the TOBA-BTK study.

OBJECTIVES: The Tack implant is designed for focal, minimal metal management of dissections. This study evaluated Tacks for treating postpercutaneous transluminal angioplasty (PTA) dissection in patients with below-the-knee (BTK) arterial occlusive disease. BACKGROUND: PTA is the most commonly used endovascular treatment for patients with occlusive disease of the BTK vessels. Post-PTA dissection is a significant clinical problem that results in poor outcomes, but currently there are limited treatment options for managing dissections. METHODS: This prospective, single-arm study evaluated patients with CLI and BTK lesions; 11.4% were Rutherford category (RC) 4 and 88.6% were RC 5. BTK occlusive disease was treated with standard PTA and post-PTA dissections were treated with Tack placement. The primary safety endpoint was a composite of major adverse limb events (MALE) and perioperative death (POD) at 30 days. Other endpoints included: device success; procedure success (vessel patency in the absence of MALE); freedom from clinically driven target lesion revascularization (CD-TLR); primary patency; and changes in RC. Data through 12 months are presented. RESULTS: Thirty-two of 35 (91.4%) patients had post-PTA dissection and successful deployment of Tacks. Procedural success was achieved in 34/35 (97.1%) patients with no MALEs at 30 days. The 12-month patency rate was 78.4% by vessel, 77.4% by patient, and freedom from CD-TLR was 93.5%. Significant (P < .0001) improvement from baseline was observed in RC (75% of patients improved 4 or 5 steps). CONCLUSION: Tack implant treatment of post-PTA dissection was safe and effective for treatment of BTK dissections and resulted in reasonable 12-month patency and low rates of CD-TLR.

Correlation between transversal and orthogonal maximal diameters of abdominal aortic aneurysms and alternative rupture risk predictors.

PURPOSE: There is no standard for measuring maximal diameter (Dmax) of abdominal aortic aneurysm (AAA) from computer tomography (CT) images although differences between Dmax evaluated from transversal (axialDmax) or orthogonal (orthoDmax) planes can be large especially for angulated AAAs. Therefore we investigated their correlations with alternative rupture risk indicators as peak wall stress (PWS) and peak wall rupture risk (PWRR) to decide which Dmax is more relevant in AAA rupture risk assessment. MATERIAL AND METHODS: The Dmax values were measured by a trained radiologist from 70 collected CT scans, and the corresponding PWS and PWRR were evaluated using Finite Element Analysis (FEA). The cohort was ordered according to the difference between axialDmax and orthoDmax (Da-o) quantifying the aneurysm angulation, and Spearman's correlation coefficients between PWS/PWRR - orthoDmax/axialDmax were calculated. RESULTS: The calculated correlations PWS/PWRR vs. orthoDmax were substantially higher for angulated AAAs (with Da-o≥3mm). Under this limit, the correlations were almost the same for both Dmax values. Analysis of AAAs divided into two groups of angulated (n=38) and straight (n=32) cases revealed that both groups are similar in all parameters (orthoDmax, PWS, PWRR) with the exception of axialDmax (p=0.024). CONCLUSIONS: It was confirmed that orthoDmax is better correlated with the alternative rupture risk predictors PWS and PWRR for angulated AAAs (DA-O≥3mm) while there is no difference between orthoDmax and axialDmax for straight AAAs (DA-O<3mm). As angulated AAAs represent a significant portion of cases it can be recommended to use orthoDmax as the only Dmax parameter for AAA rupture risk assessment.

Pseudoaneurysm of the Dorsalis Pedis Artery: Case Report and Literature Review.

Aneurysms and pseudoaneurysms of the dorsalis pedis artery are rare vascular entities usually caused by traumatic injury or iatrogenic intervention, producing a focal soft pulsatile tissue mass in the dorsal foot. Gradual expansion of the fibrous capsule can produce secondary physical signs through the pressure exerted on surrounding structures. We report the case of a 57-year-old male with an idiopathic pseudoaneurysm of the dorsalis pedis artery. A focused history found a low-grade blunt trauma to the dorsal foot that had occurred 2 years previously. The diagnosis of a pseudoaneurysm was confirmed by ultrasound examinations and computed tomography angiograms. The pseudoaneurysm was treated with resection, and a short reversed great saphenous vein interposition graft was placed. He recovered well after surgery and remained free of symptoms 18 months postoperatively. The literature review of this uncommon vascular pathologic entity and the diagnosis and management are discussed.