Reporting Peripheral Artery Disease in Claudicants: Lessons Learned From the TASC-Ability Study.

BACKGROUND: The Trans-Atlantic Inter-Society Consensus Document (TASC II) aims to comprehensively describe the case scenarios of aortoiliac and femoropopliteal lesions to suggest an endovascular or a surgical approach. Over time, it has become a guide for describing the gravity of arterial lesions. PURPOSE: To assess the revised TASC II system for classifying arterial lesions in a large database of patients presenting with claudication. MATERIALS AND METHODS: This study was a retrospective review of the arteriograms of patients with intermittent claudication. Aortoiliac and femoropopliteal lesions were classified according to the TASC II. When no consensus was reached, the lesion was rated as unTASCable. RESULTS: In total, 1454 patients were included (male: 62.1%, 66.8±9.3 years). There were 39% aortoiliac lesions (n=960/2462) and 61% femoropopliteal lesions (n=1502/2462); 33.6% of the patients (n=489/1454) were associated with aortoiliac and femoropopliteal lesions. In addition, 20% of the lesions (n=493/2462) were unTASCable, and 26.7% of the patients (n=388/1454) had at least 1 unTASCable lesion. There were 4 categories of unTASCable lesions: (1) association with a common femoral artery lesion in 53.1% (n=262/493); (2) iliac artery lesions in 23.1% (n=114/493); (3) femoropopliteal lesions whose lengths did not fit into any category in 16.6% (n=82/493); and (4) association with an aortic lesion in 7.1% (n=35/493). The interobserver agreement was 0.97 for anatomically describing the infrarenal arterial tree and 0.85 for TASCing, with the lesions lowering to 0.69 for aortoiliac lesions. CONCLUSION: Using the revised TASC II case scenario, 26.7% of the patients had at least 1 unTASCable lesion. Reporting peripheral artery disease using a comprehensive anatomical description of the infrarenal arterial tree showed better interobserver reproducibility.

The Cupidon's Strike Technique: How to Never Miss a Rendezvous While Going on SAFARI.

One of the difficulties of the subintimal arterial flossing with antegrade-retrograde intervention technique (SAFARI) technique is to properly achieve a rendezvous between both antegrade and retrograde accesses. We propose a new technique to overcome this difficulty. It consists of directly percutaneously puncturing 2 loop snares, placed via each access, which are then both used to snare an externally introduced guidewire introduced through the needle. The snares are then moved en bloc, bringing both snares and the wire into the same channel.

Pulmonary artery compression by hematoma, a rare but life-threatening complication of Stanford type A aortic dissection.

Hemorrhagic extension along the pulmonary arteries should be recognized as a complication of Stanford type A aortic dissection. Radiologists and other physicians with an interest in cardiothoracic imaging should be aware of this rare but life-threatening pathology. The anatomical concept of the pathology is outlined in this text, through high-quality electrocardiogram-gated computerized tomography images.

Lumbar Artery Pseudoaneurysm: A Complication of Percutaneous Nephrostomy.

A 21 year-old male underwent nephrostomy tube insertion for hydronephrosis due to a large para-aortic adenopathy of a testicular tumor. In order to reduce infections during chemotherapy, a ureteral stent was placed. While removing the nephrostomy tube, a pulsatile bleeding was found and a renal angiography was done. A pseudoaneurysm of his first left lumbar (L1) artery communicating with the nephrostomy's access site was found. An embolization was performed with coils in the left L1 artery and one of its subdivisions. Post-embolization controls revealed no bleeding. On the follow-up CT, there were no suspicious retroperitoneal mass.

Genetically proven cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) in a 3-year-old.

Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) has always been considered to be a middle-age-onset disease. Diagnosis is confirmed by genetic testing and the finding of the Notch3 mutation or by skin biopsy. Imaging plays a pivotal and crucial role in confirming this diagnosis by identifying white matter changes early in the disease. This can be useful in screening symptomatic patients with a family history of the disease. CADASIL cases have been reported recently in children. We report our experience with CADASIL in a 3-year-old boy.