Drug-Coated Balloon Versus Plain Balloon Angioplasty for Hemodialysis Dysfunction: A Meta-Analysis of Randomized Controlled Trials.

Background Both drug-coated balloon (DCB) angioplasty and conventional plain balloon angioplasty (PBA) can be implemented to treat hemodialysis dysfunction. The present study aims to compare the safety and efficacy of these 2 approaches by conducting a meta-analysis of available randomized controlled trials. Methods and Results PubMed, Cochrane Library, and Embase databases were queried from establishment to January 2021. A total of 18 randomized controlled trials including 877 and 875 patients in the DCB and PBA groups, respectively, were included in the present meta-analysis. Target lesion primary patency, circuit patency, target lesion revascularization, and mortality were pooled. Odds ratios (ORs) were reported with 95% CIs. Publication bias was analyzed with funnel plot and Egger test. Target lesion primary patency was higher among patients who underwent DCB (OR, 2.93 [95% CI, 2.13-4.03], P<0.001 at 6 months; OR, 2.47 [95% CI, 1.53-3.99], P<0.001 at 1 year). Also, the DCB group had a higher dialysis circuit patency at 6 months (OR, 2.42; 95% CI, 1.56-3.77 [P<0.001]) and 1 year (OR, 1.91; 95% CI, 1.22-3.00 [P=0.005]). Compared with the PBA group, the DCB group had lower odds of target lesion revascularization during follow-up (OR, 0.43 [95% CI, 0.23-0.82], P=0.001 at 6 months; OR, 0.74 [95% CI, 0.32-1.73], P=0.490 at 1 year). The OR of mortality was comparable between 2 groups at 6 months (OR, 1.18; 95% CI, 0.42-3.33 [P=0.760]) and 1 year (OR, 0.93; 95% CI, 0.58-1.48 [P=0.750]). Conclusions Based on evidence from 18 randomized controlled trials, DCB angioplasty is superior to PBA in maintaining target lesion primary patency and circuit patency among patients with dialysis circuit stenosis. DCB angioplasty also reduces target lesion revascularization with a similar risk of mortality compared with PBA.

Concomitant Gluteal and Thigh Compartment Syndrome Following Atraumatic Injury.

Gluteal compartment syndrome is a rare diagnosis associated with pelvic trauma and subsequent surgical intervention. Herein, we discuss the case and management of gluteal and thigh compartment syndrome following prolonged immobilization secondary to alcohol. To our knowledge, we present the first case of concomitant gluteal and thigh compartment syndrome following atraumatic injury.

Bariatric surgery is associated with reduced admission for aortic dissection: a nationwide case-control analysis.

BACKGROUND: Aortic dissection (AD) is an uncommon but life-threatening condition associated with high morbidity and mortality. Hypertension (HTN) and hyperlipidemia (HLD) are common modifiable risk factors. OBJECTIVES: Since bariatric surgery is associated with remission of obesity-related co-morbidities, we hypothesize that surgical weight loss might be protective against this feared aortic pathology. SETTING: A cross-sectional analysis was performed using the National Inpatient Sample database from 2010 to 2015. METHODS: The treatment group included bariatric patients and the control group patients with obesity (body mass index [BMI] ≥ 35kg/m2) without previous bariatric surgery. Analyzed covariates included demographics, co-morbidities, aortic diseases, and AD. A multivariate logistic regression analysis (MLRA) was performed to assess the odds of admission for AD in both groups. RESULTS: A total of 2,300,845 patients were identified (2,004,804 controls and 296,041 cases). The mean (SEM) age was 54.4 (.05) versus 51.9 (.05) years, for the control and treatment groups, respectively (P < .0001). Bariatric patients posed a significantly lower prevalence of type 2 diabetes (T2D), HTN, HLD, aortic aneurysm, and bicuspid aortic valve (P < .0001) than control subjects. In the control group, 1411 individuals (.070%) had AD, whereas only 94 patients (.032%) in the bariatric surgery group had such diagnosis (P < .0001). The MLRA showed that non-bariatric obese patients had a significantly higher likelihood of suffering from AD (OR = 1.8 [95%CI 1.44-2.29] P < .0001). Considering different age groups, bariatric surgery was found to be less associated with admission for AD for individuals below and above 40 years of age (OR = 2.95 [95%CI 1.09-7.99] P = .0345) and (OR = 1.75 [95%CI 1.38-2.22] P < .0001), respectively. CONCLUSIONS: Bariatric surgery could be a protective factor against aortic dissection and should be considered in patients with obesity and risk factors for this cardiovascular complication.

Type A Thoracic Aortic Dissection Following Endovascular Repair of a Common Iliac Artery Aneurysm.

We discuss a rare case of acute Type A thoracic aortic dissection (TAAD) following endovascular aneurysm repair (EVAR) of a common iliac artery aneurysm, which likely resulted from complications due to aberrant anatomy. Valve replacement, ascending aortic arch graft, and entry tear suture repair were necessary to contain the TAAD. Postoperative computed tomography with angiography (CTA) demonstrated stable disease, and the patient remained asymptomatic. Open and endovascular repair of the descending abdominal aorta was avoided. Few cases in the literature report TAAD following EVAR. Detection and repair of the entry site was crucial for containing the TAAD.

Complex Reconstruction of a Mangled Forearm Following Washing Machine Trauma.

Automatic washing machine injuries are more commonly associated with minor injuries in the pediatric population but may cause life and limb-threatening adult injuries in rare instances. This case describes a severe upper extremity injury after a schizophrenic patient placed her arm into a running machine. Herein, we describe the management, complex reconstruction, and repair of radial, ulnar, and metacarpal fractures in addition to transected tendons and vasculature. The patient had an excellent functional outcome with minor restrictions in motion and complete recovery of sensation.

POCUS and POCDUS: essential tools for the evaluation and management of carotid artery pseudoaneurysms after a gunshot wound.

BACKGROUND: Evaluation of asymptomatic penetrating vascular injuries can be done with Point-of-care ultrasound (POCUS) and Point-of-care Doppler ultrasound (POCDUS). CASE PRESENTATION: A 21-year-old woman was admitted to the Emergency Department with a small wound and pain on the left side of her neck. The patient stated she was standing outside her home and suddenly felt acute pain in the neck. She denied trauma or being assaulted and reported no significant past medical or surgical history. On physical exam the only positive finding was a small gunshot entry wound on the left side of her neck without hard signs of vascular injury. Bedside POCUS demonstrated soft tissue swelling and a hematoma next to the left carotid artery. A round in shape bullet was visualized in contact with the posterior left common carotid artery wall and two small saccular pseudoaneurysms were seen at left common carotid artery wall. POCDUS showed a patent left carotid artery and turbulent flow in the two saccular aneurysms. A computed tomography angiogram (CTA) was performed confirming the findings and a stent in left carotid artery was placed. The patient tolerated the procedure well and was discharged 4 days after the procedure. At the sixth month follow-up, Doppler ultrasound showed patent stent and resolution of the muscular hematoma. CONCLUSIONS: Penetrating trauma-related vascular injuries are complex cases to handle within an acute setting. POCUS and POCDUS are increasingly being used for the workup and decision-making process of gunshot-related vascular injuries to the neck and are a fundamental part of the follow-up after definitive therapy.

SPG7 Is an Essential and Conserved Component of the Mitochondrial Permeability Transition Pore.

Mitochondrial permeability transition is a phenomenon in which the mitochondrial permeability transition pore (PTP) abruptly opens, resulting in mitochondrial membrane potential (ΔΨm) dissipation, loss of ATP production, and cell death. Several genetic candidates have been proposed to form the PTP complex, however, the core component is unknown. We identified a necessary and conserved role for spastic paraplegia 7 (SPG7) in Ca(2+)- and ROS-induced PTP opening using RNAi-based screening. Loss of SPG7 resulted in higher mitochondrial Ca(2+) retention, similar to cyclophilin D (CypD, PPIF) knockdown with sustained ΔΨm during both Ca(2+) and ROS stress. Biochemical analyses revealed that the PTP is a heterooligomeric complex composed of VDAC, SPG7, and CypD. Silencing or disruption of SPG7-CypD binding prevented Ca(2+)- and ROS-induced ΔΨm depolarization and cell death. This study identifies an ubiquitously expressed IMM integral protein, SPG7, as a core component of the PTP at the OMM and IMM contact site.