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Sample records for vein graft restenosis

  1. Diagnostic value of myocardial perfusion SPECT in the prediction of restenosis after coronary artery bypass graft surgery

    International Nuclear Information System (INIS)

    Paeng, J. C.; Lee, D. S.; Kang, W. J.; Kim, K. B.; Chung, J. K.; Lee, M. C.

    2002-01-01

    Myocardial SPECT has been reported to be sensitive in the detection of restenosis after revascularization. However, the diagnostic value is not well established in bypass graft surgery (CABG), due to significant influences of characteristics of graft vessels and the time interval between CABG and the SPECT. In this study, we evaluated the diagnostic value of myocardial SPECT for the restenosis after CABG. A total of 160 patients with coronary artery disease (M:F=118:42, 60±8 yr) who had undergone CABG were included. Rest T1-201/ dipyridamole stress Tc-99m-MIBI SPECT was performed 3 months (103±16 days) after CABG. Segmental perfusion was quantified using a 20-segment model, and segments of reversible perfusion defect (REV) were defined. Follow-up coronary angiography was performed 1 year (397±104 days) after CABG. The segments of REV were compared between arterial and venous graft groups. And the diagnostic power of 3-month SPECT was evaluated for the prediction of restenosis. On the 3-month SPECT, 620 segments showed REV. The segments of REV were 37% of artery-grafted segments and 36% of vein-grafted segments (p=n.s.). On 1-year coronary angiography, 113 graft vessels (28%) showed restenosis. The overall sensitivity and specificity of REV on 3-month SPECT for the prediction of restenosis were 46% and 67%, respectively, but 52% and 68%, in artery-graft group. REV detected on 3-month SPECT has a predictive value, especially, high specificity for the prediction of restenosis after CABG, which was more definite in artery-graft group

  2. Rapamycin treatment is associated with an increased apoptosis rate in experimental vein grafts.

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    Schachner, Thomas; Oberhuber, Alexander; Zou, Yping; Tzankov, Alexandar; Ott, Harald; Laufer, Günther; Bonatti, Johannes

    2005-02-01

    Rapamycin is an immunosuppressive agent with marked antiproliferative properties and is effective in reducing in stent restenosis and vein graft neointimal hyperplasia. Apoptosis is one mechanism counterbalancing cellular proliferation. We therefore investigated the role of apoptosis in rapamycin treated vein grafts in a mouse model. C57BL6J mice underwent interposition of the inferior vena cava from isogenic donor mice into the common carotid artery using a cuff technique. In the treatment group 200 microg of rapamycin were applied locally in pluronic gel. The control group did not receive local treatment. Vein grafts were harvested at 4 weeks postoperatively and underwent morphometric analysis as well as immunohistochemical analysis for apoptosis (TUNEL). In grafted veins without treatment (controls) neointimal thickness was 50 (12-58) microm at 4 weeks postoperatively. In 200 microg rapamycin treated grafts the neointimal thickness was 17 (5-55) microm. Rapamycin treated vein grafts showed a significantly increased rate of apoptosis in the adventitia as compared with controls (P=0.032). In the neointima the apoptosis rate was lower in both groups with no significant difference between rapamycin treated grafts and controls. We conclude that treatment of experimental vein grafts with rapamycin is associated with an increased apoptosis rate in the vascular wall and a trend towards reduction of neointimal hyperplasia. These results suggest that apoptosis may be a beneficial antiproliferative component for the treatment of vein graft disease.

  3. Vein grafting in fingertip replantations.

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    Yan, Hede; Jackson, William D; Songcharoen, Somjade; Akdemir, Ovunc; Li, Zhijie; Chen, Xinglong; Jiang, Liangfu; Gao, Weiyang

    2009-01-01

    In this retrospective study, the survival rates of fingertip replantation with and without vein grafting were evaluated along with their postoperative functional and cosmetic results. One hundred twenty-one-fingertip amputations were performed in 103 patients between September 2002 and July 2007. Thirty-four amputated fingertips were replanted without vein grafting, while 87 amputated fingertips were replanted with vein grafting for arterial and/or venous repairs. The overall survival rates of the replantations with and without vein grafting were 90% (78/87) and 85% (29/34), respectively. The survival rates were 88% (36/41) with venous repair, 93% (25/27) with arterial repair, and 89% (17/19) with both. Nineteen patients without vein grafting and 48 patients with vein grafting had a follow-up period of more than one year. Good cosmetic and functional outcomes were observed in both groups of patients. The results show that vein grafting is a reliable technique in fingertip replantations, showing no significant difference (P > 0.05) in survival between those with and without vein grafting. Furthermore, no significant difference (P > 0.05) in survival was found between cases with vein grafts for arterial and/or venous repairs. In fingertip replantations with vein grafting, favorable functional and esthetic results can be achieved without sacrificing replantation survival. (c) 2009 Wiley-Liss, Inc.

  4. Outcomes of AV Fistulas and AV Grafts after Interventional Stent-Graft Deployment in Haemodialysis Patients

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    Schmelter, Christopher, E-mail: christopher.schmelter@klinikum-ingolstadt.de; Raab, Udo, E-mail: udo.raab@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany); Lazarus, Friedrich, E-mail: friedrich.lazarus@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Nephrology (Germany); Ruppert, Volker, E-mail: volker.ruppert@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Vascular Surgery (Germany); Vorwerk, Dierk, E-mail: dierk.vorwerk@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany)

    2015-08-15

    PurposeThe study was designed to assess outcomes of arteriovenous (AV) accesses after interventional stent-graft deployment in haemodialysis patients.Materials and Methods63 haemodialysis patients with 66 AV fistulas and AV grafts were treated by interventional stent-graft deployment from 2006 to 2012 at our hospital. Data of these patients were retrospectively analysed for location of deployed stent-grafts, occurrence and location of (re-)stenosis and (re-)thrombosis. Complex stenosis was the most frequent indication for stent-graft deployment (45.5 %), followed by complications of angioplasty with vessel rupture or dissection (31.8 %).ResultsA high rate of procedural success was achieved (98.5 %). The most frequent location of the deployed stent-graft was the draining vein (66.7 %). Stent-graft deployment was more frequent in AV grafts than in AV fistulas. Primary patency was 45.5 % at 6 month, 31.3 % at 12 month and 19.2 % at 24 month. Primary patency was significantly better for AV fistulas than for AV grafts with deployed stent-grafts. Patency of the deployed stent-graft was much better than overall AV access primary patency with deployed stent-graft. Re-stenosis with thrombosis was the most frequent indication for re-intervention. Most frequent location of re-stenosis was the draining vein (37.1 %), followed by stenosis at the AV access (29.5 %) and the deployed stent-graft (23.5 %).ConclusionRe-stenosis and re-thrombosis remain frequent in AV fistulas and AV grafts in haemodialysis patients despite stent-graft deployment. Re-stenosis of the deployed stent-graft is, only in the minority of the cases, responsible for AV access dysfunction.

  5. Improving the Outcome of Vein Grafts: Should Vascular Surgeons Turn Veins into Arteries?

    OpenAIRE

    Isaji, Toshihiko; Hashimoto, Takuya; Yamamoto, Kota; Santana, Jeans M.; Yatsula, Bogdan; Hu, Haidi; Bai, Hualong; Jianming, Guo; Kudze, Tambudzai; Nishibe, Toshiya; Dardik, Alan

    2017-01-01

    Autogenous vein grafts remain the gold standard conduit for arterial bypass, particularly for the treatment of critical limb ischemia. Vein graft adaptation to the arterial environment, i.e., adequate dilation and wall thickening, contributes to the superior performance of vein grafts. However, abnormal venous wall remodeling with excessive neointimal hyperplasia commonly causes vein graft failure. Since the PREVENT trials failed to improve vein graft outcomes, new strategies focus on the ada...

  6. Kinetics of vein graft hyperplasia

    International Nuclear Information System (INIS)

    Zwolak, R.M.; Adams, M.C.; Clowes, A.W.

    1986-01-01

    Human aortocoronary vein grafts fail due to accelerated occlusive disease. The possibility that this is related to cellular hyperplasia was investigated in a rabbit model where kinetics of vein graft thickening, endothelial (EC) repair, and smooth muscle cell (SMC) proliferation were measured from 2 days to 24 weeks after implanting jugular vein segments in the carotid artery. Immediately after graft placement focal EC denudation was observed. These defects were repaired within 1 week and did not recur. By 4 weeks intimal area had increased 30 fold from 0.028 +/- 0.004 to 0.705 +/- 0.021 mm 2 , and a 24 weeks was 0.93 +/- 0.21 mm 2 . This response did not produce a reduction in graft lumen area. EC and SMC thymidine-labeling index were measured by en face and cross-section autoradiography after injection of 3 H-thymidine and perfusion fixation. Despite rapid EC surface repair EC labeling index remained elevated and only returned to normal levels at 12 weeks; SMC labeling was 10 fold greater than baseline even at 24 weeks (0.22% vs 0.02%). SMC mass demonstrated morphometrically increased between 2 and 12 weeks. Intimal thickening in vein grafts is due to SMC proliferation and develops after the EC layer has been restored. In contrast, intimal SMC proliferate in damaged arteries when the EC layer is absent and cease when the EC layer is regenerated

  7. Beta irradiation inhibits neo-intimal formation in vein grafts

    International Nuclear Information System (INIS)

    Lang Xiaoou; Ji Shenquan; Zeng Ke; Li Jun; Liu Bingbing; Ma Wenfeng; Zhang Qiang

    2002-01-01

    Objective: The study was to evaluate the effect of beta irradiation on intimal proliferation response in vein grafts. Methods: An autogenous vein graft model was established in 40 rats by transplanting internal branch of jugular vein to carotid artery by end-to-end anastomosis. The vein was irradiated by 32 P before anastomosis. Four dose schedules were studied: (1) control graft (nonirradiated); (2) irradiated with 8 Gy; (3) 18 Gy; and (4) 36 Gy. The grafted veins were harvested at 2 weeks after the operation. IH (intimal hyperplasia) and SMC (smooth muscle cell) proliferation were histologically and immuno-histochemically observed and analyzed by a computer digitalising system. Results: In 18 Gy and 36 Gy-irradiated grafts compared with the control, there was a significant decrease in the average intimal thickness (P 0.05). Immunohistochemical analysis of PCNA indicated decrease of positive cells in both 18 Gy and 36 Gy groups compared with 8 Gy and the control group (P 0.05) groups, and there was also no significant difference between 8 Gy and the control group (P > 0.05). Conclusion: These preliminary results demonstrate that proper dose of beta irradiation in vein graft inhibits smooth muscle cells proliferation and neo-intimal hyperplasia in rat

  8. Surgery for acquired cardiovascular disease: antiseptic treatment of contaminated vein grafts.

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    Schmidt, F P; Peivandi, A A; Kohnen, W; Jansen, B

    2014-04-01

    Saphenous vein grafts harvested for use as bypass conduits can be contaminated intraoperatively, e.g. by being inadvertently dropped to the floor of the operating room (OR). This study was performed to investigate microorganisms most likely contaminating vein grafts and to assess the possible efficacy of measures to treat potentially contaminated vein grafts antiseptically for further use. In a first step we determined the microbiological flora of the OR using surface cultures and cultures from intentionally dropped vein grafts. Several antiseptic agents (PVP-iodine 10%, octenidinhydrochloride 0.1%, polyhexanide 1%) were evaluated for their in vitro efficacy to disinfect artificially contaminated vein segments. The most promising antiseptic regimen was tested on veins contaminated in a real OR setting. Finally, we tested for possible alterations in mechanical properties of the veins caused by antiseptic treatment. Coagulase-negative staphylococci where the predominant bacteria recovered from the OR with 59.9%. Antiseptic treatment with a combination of octenidine and PVP-iodine resulted in a higher rate of negative cultures than any single agent. Treatment of 50 saphenous vein grafts contaminated in the OR with the combination regimen resulted in only 3 positive cultural results within 7 days. Mechanical tear-stress testing comparing antiseptically treated vein grafts with controls showed no difference in their resistance to tear stress. Antiseptic treatment of contaminated vein grafts was shown to be effective in a high percentage of cases without altering mechanical properties of grafts and may be an option for the surgeon in case of a contamination.

  9. Fingertip Replantation Using Y-Shaped Vein Graft to Pulp Artery.

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    Kim, Jun Hyuk; Lee, Young Man

    2015-10-01

    Re-establishing adequate venous outflow is the most important factor for success of fingertip replantation. However, in zone I level, replantation is very difficult, especially in repairing venous circulation. The authors have made an attempt to replantation using Y-shaped vein (YSV) graft to identify and repair veins easily in fingertip replantation. From January 2007 to December 2012, a total of 46 fingertip replantations in 44 consecutive patients with amputations in the Tamai zone I level were performed by using YSV graft. In all patients, arterial anastomosis was performed using YSV graft, and interpositional vein grafts were used for venous repair. The overall success rate of the YSV-grafted replantations was 91.3% (42/46). Postoperative vascular complications occurred in 6 YSV-grafted replantations (13%), and pulp atrophy in the YSV-grafted digits was 9.5% (4/42). Fingertip replantation in zone I level is a difficult territory to a microsurgeon, especially anastomosing veins. However, our YSV grafting technique has shown value in this setting, enabling better esthetic and functional results.

  10. A Rabbit Model for Testing Helper-Dependent Adenovirus-Mediated Gene Therapy for Vein Graft Atherosclerosis.

    Science.gov (United States)

    Bi, Lianxiang; Wacker, Bradley K; Bueren, Emma; Ham, Ervin; Dronadula, Nagadhara; Dichek, David A

    2017-12-15

    Coronary artery bypass vein grafts are a mainstay of therapy for human atherosclerosis. Unfortunately, the long-term patency of vein grafts is limited by accelerated atherosclerosis. Gene therapy, directed at the vein graft wall, is a promising approach for preventing vein graft atherosclerosis. Because helper-dependent adenovirus (HDAd) efficiently transduces grafted veins and confers long-term transgene expression, HDAd is an excellent candidate for delivery of vein graft-targeted gene therapy. We developed a model of vein graft atherosclerosis in fat-fed rabbits and demonstrated long-term (≥20 weeks) persistence of HDAd genomes after graft transduction. This model enables quantitation of vein graft hemodynamics, wall structure, lipid accumulation, cellularity, vector persistence, and inflammatory markers on a single graft. Time-course experiments identified 12 weeks after transduction as an optimal time to measure efficacy of gene therapy on the critical variables of lipid and macrophage accumulation. We also used chow-fed rabbits to test whether HDAd infusion in vein grafts promotes intimal growth and inflammation. HDAd did not increase intimal growth, but had moderate-yet significant-pro-inflammatory effects. The vein graft atherosclerosis model will be useful for testing HDAd-mediated gene therapy; however, pro-inflammatory effects of HdAd remain a concern in developing HDAd as a therapy for vein graft disease.

  11. Neointima development in externally stented saphenous vein grafts

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    Przemysław Węglarz

    2016-11-01

    Full Text Available Introduction : The main limitation of coronary artery bypass grafting (CABG is rapid neointimal hyperplasia leading to graft failure. Aim : To assess plaque formation in saphenous vein grafts (SVG covered by an external Dacron stent in comparison with the classical technique. Material and methods : In the study group vein grafts covered by external stent mesh made of Dacron were implanted. An intravascular ultrasonography (IVUS study was performed in 35 aorto-coronary SVG covered by an external Dacron stent and in 64 normal SVG during the first year after CABG. In each SVG 25 mm of good quality IVUS image, volumes of lumen, plaque (neointima, outer border of the vein graft (external SVG and adventitia were calculated in three time periods: 0–130 days, 130–260 days and 260–390 days. Results : Between the first and second time period, lumen volume (mm3 was reduced from 10.33 ±4.4, to 6.80 ±2.23 in the second period and 5.69 ±1.26 in the third one. This effect was much less marked in normal grafts. The corresponding lumen volume (mm3 was: 10.90 ±3.9, 9.15 ±2.94 and 8.92 ±2.93 in consecutive time periods. Plaque volume (mm3 did not change in control grafts during the course of the study, but it increased very significantly in stented grafts from 0.86 ±1.24 in the first period to 2.70 ±1.58 in the second and 3.29 ±2.66 in the third one. Conclusions : The experimental technique of implanting SVG covered with an external elastic Dacron stent seems to be inferior to traditional ones. This is probably due to the more complicated process of vein implantation and higher micro-injury occurrence during the surgery.

  12. A Rabbit Model for Testing Helper-Dependent Adenovirus-Mediated Gene Therapy for Vein Graft Atherosclerosis

    Directory of Open Access Journals (Sweden)

    Lianxiang Bi

    2017-12-01

    Full Text Available Coronary artery bypass vein grafts are a mainstay of therapy for human atherosclerosis. Unfortunately, the long-term patency of vein grafts is limited by accelerated atherosclerosis. Gene therapy, directed at the vein graft wall, is a promising approach for preventing vein graft atherosclerosis. Because helper-dependent adenovirus (HDAd efficiently transduces grafted veins and confers long-term transgene expression, HDAd is an excellent candidate for delivery of vein graft-targeted gene therapy. We developed a model of vein graft atherosclerosis in fat-fed rabbits and demonstrated long-term (≥20 weeks persistence of HDAd genomes after graft transduction. This model enables quantitation of vein graft hemodynamics, wall structure, lipid accumulation, cellularity, vector persistence, and inflammatory markers on a single graft. Time-course experiments identified 12 weeks after transduction as an optimal time to measure efficacy of gene therapy on the critical variables of lipid and macrophage accumulation. We also used chow-fed rabbits to test whether HDAd infusion in vein grafts promotes intimal growth and inflammation. HDAd did not increase intimal growth, but had moderate—yet significant—pro-inflammatory effects. The vein graft atherosclerosis model will be useful for testing HDAd-mediated gene therapy; however, pro-inflammatory effects of HdAd remain a concern in developing HDAd as a therapy for vein graft disease.

  13. Sarpogrelate hydrochloride reduced intimal hyperplasia in experimental rabbit vein graft.

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    Kodama, Akio; Komori, Kimihiro; Hattori, Keisuke; Yamanouchi, Dai; Kajikuri, Junko; Itoh, Takeo

    2009-05-01

    The selective 5-HT(2A) receptor antagonist sarpogrelate has been clinically used for treatment in atherosclerotic diseases. However, it remains unknown whether administration of sarpogrelate inhibits intimal hyperplasia seen in autologous vein grafts. Therefore, we sought to clarify this question using an experimental rabbit vein graft model. Male rabbits were divided into two groups: a control group and a sarpogrelate-treated group. The jugular vein was interposed in the carotid artery in reversed fashion for 4 weeks and intimal hyperplasia of the grafted vein was measured (n = 8, in each group). Acetylcholine (ACh)-induced endothelium-dependent relaxation was tested by precontraction with prostaglandin F(2alpha) (PGF(2alpha), 5 muM) (n = 5, in each). endothelial nitric oxide synthase (eNOS) protein expression and superoxide production of these veins were also assessed. The suppression of intimal hyperplasia was significantly greater in the sarpogrelate-treated group than in the control group. ACh induced an endothelium-dependent relaxation in the sarpogrelate-treated group (but not in the control group). In endothelium-intact strips from the sarpogrelate-treated group, the nitric oxide (NO) synthase inhibitor nitroarginine enhanced the PGF(2alpha)-induced contraction and blocked the ACh-induced relaxation. Immunoreactive eNOS protein expression was similar between the two groups but superoxide production (estimated from ethidium fluorescence) in endothelial cells was significantly smaller in the sarpogrelate-treated group. The present results indicate that in vivo blockade of 5-HT(2A) receptors leads to an inhibition of intimal hyperplasia in rabbit vein graft. It is suggested that an increased function of endothelium-derived NO through a reduction in endothelial superoxide production may be a possible underlying mechanism for this. These novel findings support the clinical usefulness of sarpogrelate for preventing intimal hyperplasia in vein graft after bypass

  14. C1-esterase inhibitor protects against early vein graft remodeling under arterial blood pressure.

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    Krijnen, Paul A J; Kupreishvili, Koba; de Vries, Margreet R; Schepers, Abbey; Stooker, Wim; Vonk, Alexander B A; Eijsman, Leon; Van Hinsbergh, Victor W M; Zeerleder, Sacha; Wouters, Diana; van Ham, Marieke; Quax, Paul H A; Niessen, Hans W M

    2012-01-01

    Arterial pressure induced vein graft injury can result in endothelial loss, accelerated atherosclerosis and vein graft failure. Inflammation, including complement activation, is assumed to play a pivotal role herein. Here, we analyzed the effects of C1-esterase inhibitor (C1inh) on early vein graft remodeling. Human saphenous vein graft segments (n=8) were perfused in vitro with autologous blood either supplemented or not with purified human C1inh at arterial pressure for 6h. The vein segments and perfusion blood were analyzed for cell damage and complement activation. In addition, the effect of purified C1inh on vein graft remodeling was analyzed in vivo in atherosclerotic C57Bl6/ApoE3 Leiden mice, wherein donor caval veins were interpositioned in the common carotid artery. Application of C1inh in the in vitro perfusion model resulted in significantly higher blood levels and significantly more depositions of C1inh in the vein wall. This coincided with a significant reduction in endothelial loss and deposition of C3d and C4d in the vein wall, especially in the circular layer, compared to vein segments perfused without supplemented C1inh. Administration of purified C1inh significantly inhibited vein graft intimal thickening in vivo in atherosclerotic C57Bl6/ApoE3 Leiden mice, wherein donor caval veins were interpositioned in the common carotid artery. C1inh significantly protects against early vein graft remodeling, including loss of endothelium and intimal thickening. These data suggest that it may be worth considering its use in patients undergoing coronary artery bypass grafting. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  15. Laser-assisted fibrinogen bonding of umbilical vein grafts.

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    Oz, M C; Williams, M R; Souza, J E; Dardik, H; Treat, M R; Bass, L S; Nowygrod, R

    1993-06-01

    Despite success with autologous tissue welding, laser welding of synthetic vascular prostheses has not been possible. The graft material appears inert and fails to allow the collagen breakdown and electrostatic bonding that results in tissue welding. To develop a laser welding system for graft material, we repaired glutaraldehyde-tanned human umbilical cord vein graft incisions using laser-assisted fibrinogen bonding (LAFB) technology. Modified umbilical vein graft was incised transversely (1.2 cm). Incisions were repaired using sutures, laser energy alone, or LAFB. For LAFB, indocyanine green dye was mixed with human fibrinogen and the compound applied with forceps onto the weld site prior to exposure to 808 nm diode laser energy (power density 4.8 W/cm 2). Bursting pressures for sutured repairs (126.6 +/- 23.4 mm Hg) were similar to LAFB anastomoses (111.6 +/- 55.0 mm Hg). No evidence of collateral thermal injury to the graft material was noted. In vivo evaluation of umbilical graft bonding with canine arteries demonstrates that LAFB can reliably reinforce sutured anastomoses. The described system for bonding graft material with laser exposed fibrinogen may allow creation or reinforcement of vascular anastomoses in procedures where use of autologous tissue is not feasible.

  16. A dynamical system that describes vein graft adaptation and failure.

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    Garbey, Marc; Berceli, Scott A

    2013-11-07

    Adaptation of vein bypass grafts to the mechanical stresses imposed by the arterial circulation is thought to be the primary determinant for lesion development, yet an understanding of how the various forces dictate local wall remodeling is lacking. We develop a dynamical system that summarizes the complex interplay between the mechanical environment and cell/matrix kinetics, ultimately dictating changes in the vein graft architecture. Based on a systematic mapping of the parameter space, three general remodeling response patterns are observed: (1) shear stabilized intimal thickening, (2) tension induced wall thinning and lumen expansion, and (3) tension stabilized wall thickening. Notable is our observation that the integration of multiple feedback mechanisms leads to a variety of non-linear responses that would be unanticipated by an analysis of each system component independently. This dynamic analysis supports the clinical observation that the majority of vein grafts proceed along an adaptive trajectory, where grafts dilate and mildly thicken in response to the increased tension and shear, but a small portion of the grafts demonstrate a maladaptive phenotype, where progressive inward remodeling and accentuated wall thickening lead to graft failure. © 2013 The Authors. Published by Elsevier Ltd. All rights reserved.

  17. A free vein graft cap influences neuroma formation after nerve transection.

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    Galeano, Mariarosaria; Manasseri, Benedetto; Risitano, Giovanni; Geuna, Stefano; Di Scipio, Federica; La Rosa, Paola; Delia, Gabriele; D'Alcontres, Francesco Stagno; Colonna, Michele R

    2009-01-01

    : Neuroma formation is a major problem in nerve surgery and consensus about its prevention has not been reached. It has been suggested that vein covering can reduce neuroma formation in transected nerves. In this article, the Authors propose an easy and novel method of covering by nerve stump capping with a free vein graft. : Neuroma-like lesions were created on the rat thigh sectioning the femoral nerve above its division in 16 animals. The proximal nerve stump was invaginated into the lumen of a 1.5 cm long femoral free vein graft on the right side, and the vein was closed on itself by microsurgical sutures to form a cap for the nerve stump. On the left side acting as the control neuroma, the nerve was cut and left uncovered. Histological and immunohistochemical assessment was used to quantify the degree of neuroma formation. : Significant differences were found in both neuroma size and axon-glia organization between the treated and control sides indicating that free vein graft capping reduced neuroma formation in comparison to uncovered nerve stumps. : Our results confirm that vein-covering of a transected nerve stump can be effective in reducing neuroma formation. Moreover, unlike previous works that buried the nerve into an adjacent vein left in place, our experiments showed that also the use of a free vein graft cap can hinder neuroma formation. Although translation of rat experiments to the clinics should be dealt with caution, our data suggest a careful clinical use of the technique. (c) 2009 Wiley-Liss, Inc. Microsurgery, 2009.

  18. A new design concept for knitted external vein-graft support mesh.

    Science.gov (United States)

    Singh, Charanpreet; Wang, Xungai

    2015-08-01

    Autologous vein-graft failure significantly limits the long-term efficacy of coronary artery bypass procedures. The major cause behind this complication is biomechanical mismatch between the vein and coronary artery. The implanted vein experiences a sudden increase (10-12 fold) in luminal pressures. The resulting vein over-distension or 'ballooning' initiates wall thickening phenomenon and ultimate occlusion. Therefore, a primary goal in improving the longevity of a coronary bypass procedure is to inhibit vein over-distension using mechanical constriction. The idea of using an external vein-graft support mesh has demonstrated sustained benefits and wide acceptance in experimental studies. Nitinol based knitted structures have offered more promising mechanical features than other mesh designs owing to their unique loosely looped construction. However, the conventional plain knit construction still exhibits limitations (radial compliance, deployment ease, flexibility, and bending stresses) which limit this design from proving its real clinical advantage. The new knitted mesh design presented in this study is based on the concept of composite knitting utilising high modulus (nitinol and polyester) and low modulus (polyurethane) material components. The experimental comparison of the new design with a plain knit design demonstrated significant improvement in biomechanical (compliance, flexibility, extensibility, viscoelasticity) and procedural (deployment limit) parameters. The results are indicative of the promising role of new mesh in restoring the lost compliance and pulsatility of vein-graft at high arterial pressures. This way it can assist in controlled vein-graft remodelling and stepwise restoration of vein mechanical homoeostasis. Also, improvement in deployment limit parameter offers more flexibility for a surgeon to use a wide range of vein diameters, which may otherwise be rendered unusable for a plain knit mesh. Copyright © 2015 Elsevier Ltd. All rights

  19. Rule-based model of vein graft remodeling.

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    Minki Hwang

    Full Text Available When vein segments are implanted into the arterial system for use in arterial bypass grafting, adaptation to the higher pressure and flow of the arterial system is accomplished thorough wall thickening and expansion. These early remodeling events have been found to be closely coupled to the local hemodynamic forces, such as shear stress and wall tension, and are believed to be the foundation for later vein graft failure. To further our mechanistic understanding of the cellular and extracellular interactions that lead to global changes in tissue architecture, a rule-based modeling method is developed through the application of basic rules of behaviors for these molecular and cellular activities. In the current method, smooth muscle cell (SMC, extracellular matrix (ECM, and monocytes are selected as the three components that occupy the elements of a grid system that comprise the developing vein graft intima. The probabilities of the cellular behaviors are developed based on data extracted from in vivo experiments. At each time step, the various probabilities are computed and applied to the SMC and ECM elements to determine their next physical state and behavior. One- and two-dimensional models are developed to test and validate the computational approach. The importance of monocyte infiltration, and the associated effect in augmenting extracellular matrix deposition, was evaluated and found to be an important component in model development. Final model validation is performed using an independent set of experiments, where model predictions of intimal growth are evaluated against experimental data obtained from the complex geometry and shear stress patterns offered by a mid-graft focal stenosis, where simulation results show good agreements with the experimental data.

  20. A novel technique for distal fingertip replantation: Polypropylene suture guided interpositional vein graft.

    Science.gov (United States)

    Dadaci, Mehmet; Ince, Bilsev; Altuntas, Zeynep; Bitik, Ozan; Uzun, Hakan; Bilgen, Fatma

    2015-05-04

    Despite current advances in microsurgery, fingertip replantation is still controversial, mainly due to its difficulty and cost. The purpose of this study is to describe a new technique of interposition vein graft guided by polypropylene suture in distal fingertip replantation. A total of eight consecutive Tamai zone 1 fingertip replantations performed by the same author were included. All replantations were performed using interposition vein graft guided by polypropylene suture. This technique involved a vein graft of ∼ 2 cm, with appropriate calibration, obtained from the volar part of the forearm and a 2-0 polyprolene suture passed through the interposition vein graft. Then, a polypropylene suture guide carrying the vein graft was inserted into the artery. The anastomosis was easily performed with the aid of 10-0 or 11-0 nylon in a bloodless medium and without encountering the posterior wall problem. Average surgery time was 2.5 hours (range = 2-3 hours). Among eight Tamai zone 1 replantations, six were successful (75%). There were two replantations lost because of arterial failure. This technique may ease fingertip replantations and increase the success rate for Tamai zone 1 injuries.

  1. Saphenous vein grafts for perforator flap salvage in autologous breast reconstruction.

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    Flores, Jaime I; Rad, Ariel N; Shridharani, Sachin M; Stapleton, Sahael M; Rosson, Gedge D

    2009-01-01

    Although the use of saphenous vein grafts in free-flap salvage and extremity replantation is relatively common, their use in breast reconstruction is rare. These two case reports represent extreme alternatives for breast reconstruction flap salvage. In our normal daily practice, the overwhelming majority of elective breast reconstructions proceed smoothly. However, the occasional patient may require saphenous vein graft flap rescue for completion of the reconstruction. (c) 2008 Wiley-Liss, Inc.

  2. The effects of vasoactive agents on flow through saphenous vein grafts during lower-extremity peripheral vascular surgery.

    Science.gov (United States)

    Maslow, Andrew D; Bert, Arthur; Slaiby, Jeffrey; Carney, William; Marcaccio, Edward

    2007-06-01

    The purpose of this study was to assess the effects of hemodynamic alterations on vein graft flow during peripheral vascular surgery. It was hypothesized that vasopressors can be administered without compromising flow through the vein grafts. Tertiary care center, university medical center. Randomized placebo-controlled double-blinded study. The effects of phenylephrine, epinephrine, milrinone, intravenous fluid, and placebo on newly constructed peripheral vein grafts were assessed in 60 patients (12 patients in each of 5 groups). Systemic and central hemodynamics were measured by using intra-arterial and pulmonary artery catheters. Vein graft flow was measured by using a transultrasonic flow probe (Transultrasonic Inc, Ithaca, NY). Phenylephrine increased systemic mean blood pressure (mBP) (68.2-94.0 mmHg, p < 0.01), systemic vascular resistance (SVR) (1,091-1,696 dynes x sec x cm(-5), p < 0.001), and vein graft flow (39.5-58.9 mL/min, p < 0.01), whereas cardiac output remained unchanged. Epinephrine resulted in increased cardiac output (4.4-6.9 L/min, p < 0.01) and mBP (72.7-89.1 mmHg, p < 0.01), whereas vein graft flow was reduced in 6 of 12 patients. Intravenous fluid administration resulted in a relatively smaller increase in graft flow (37.6-46.0 mL/min, p < 0.05), an increase in cardiac output, and an insignificant decrease in SVR. Other treatments had either little or no effect on vein graft flow. The study hypothesis was partly supported. Although both phenylephrine and epinephrine increased blood pressure, only the former increased vein graft flow in all patients. In conjunction with increases in graft flow after fluid administration, these data suggest that factors affecting vein graft flow are not just simply related to systemic hemodynamics.

  3. Topical application of sodium hyaluronate for preventing perivascular adhesion of the vein grafts in rabbits: An experimental study

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    Ming-ke GUO

    2017-10-01

    Full Text Available Objective To explore the effect of topical application of sodium hyaluronate on preventing perivascular adhesion of the vein grafts in rabbits. Methods Thirty-six male New Zealand white rabbits, aged 5 months, were randomly and equally divided into 2 groups: groups A and B. Arterial defect model was established by cutting about 1cm artery from the middle part of the dissected left common carotid artery. A section about 3cm was cut from the right external jugular vein, and the harvested vein was inverted and anastomosed end-to-end to the artery defect. After the anastomosis, the adventitia and two anastomoses of the grafted veins in group A were coated locally with 0.2ml sodium hyaluronate. The grafted veins were obtained 1, 2 and 4 weeks after the operation, with the perivascular adhesion of the vein grafts being examined macroscopically before the resection. HE staining and Masson staining were preformed for histological changes of grafted vein wall and the perivascular adhesion of the vein grafts. At 2, 4 weeks postoperation, the perivascular adhesions of the vein grafts were graded by the grading criteria of adhesion in macroscopic evaluation and histological evaluation. Results At 1, 2 and 4 weeks postoperatively, the macroscopic and histological observation found that the perivascular adhesions in group A were looser than those in group B. The macroscopic grade and histological grade were lower in group A than in group B, there was a significant difference between the two groups at 2 and 4 weeks postoperation (P<0.05. Conclusion Topical application of sodium hyaluronate can reduce the perivascular adhesion and is an ideal treatment strategy for preventing perivascular adhesion of vein grafts. DOI: 10.11855/j.issn.0577-7402.2017.08.14

  4. An unusual case of fistula formation and thrombosis between arteriovenous graft and a native vein

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    Young Sub Kim

    2016-03-01

    Full Text Available Arteriovenous graft for hemodialysis vascular access is a widely used technique with many advantages. However, it has crucial complications with graft thrombosis and infection. We recently experienced an unusual case of arteriovenous graft complication involving graft thrombosis related to fistula formation between the graft and the natural vein with infection. We diagnosed this condition using Doppler ultrasound and computed tomography angiography. Successful surgical treatment including partial graft excision and creation of a secondary arteriovenous fistula using an inadvertently dilated cephalic vein was performed. The dialysis unit staff should keep this condition in mind and try to prevent this complication.

  5. Effect of Ticagrelor Plus Aspirin, Ticagrelor Alone, or Aspirin Alone on Saphenous Vein Graft Patency 1 Year After Coronary Artery Bypass Grafting: A Randomized Clinical Trial.

    Science.gov (United States)

    Zhao, Qiang; Zhu, Yunpeng; Xu, Zhiyun; Cheng, Zhaoyun; Mei, Ju; Chen, Xin; Wang, Xiaowei

    2018-04-24

    The effect of ticagrelor with or without aspirin on saphenous vein graft patency in patients undergoing coronary artery bypass grafting (CABG) is unknown. To compare the effect of ticagrelor + aspirin or ticagrelor alone vs aspirin alone on saphenous vein graft patency 1 year after CABG. Randomized, multicenter, open-label, clinical trial among 6 tertiary hospitals in China. Eligible patients were aged 18 to 80 years with indications for elective CABG. Patients requiring urgent revascularization, concomitant cardiac surgery, dual antiplatelet or vitamin K antagonist therapy post-CABG, and who were at risk of serious bleeding were excluded. From July 2014 until November 2015, 1256 patients were identified and 500 were enrolled. Follow-up was completed in January 2017. Patients were randomized (1:1:1) to start ticagrelor (90 mg twice daily) + aspirin (100 mg once daily) (n = 168), ticagrelor (90 mg twice daily) (n = 166), or aspirin (100 mg once daily) (n = 166) within 24 hours post-CABG. Neither patients nor treating physicians were blinded to allocation. Primary outcome was saphenous vein graft patency 1 year after CABG (FitzGibbon grade A) adjudicated independently by a committee blinded to allocation. Saphenous vein graft patency was assessed by multislice computed tomographic angiography or coronary angiography. Among 500 randomized patients (mean age, 63.6 years; women, 91 [18.2%]), 461 (92.2%) completed the trial. Saphenous vein graft patency rates 1 year post-CABG were 88.7% (432 of 487 vein grafts) with ticagrelor + aspirin; 82.8% (404 of 488 vein grafts) with ticagrelor alone; and 76.5% (371 of 485 vein grafts) with aspirin alone. The difference between ticagrelor + aspirin vs aspirin alone was statistically significant (12.2% [95% CI, 5.2% to 19.2%]; P aspirin alone was not statistically significant (6.3% [95% CI, -1.1% to 13.7%]; P = .10). Five major bleeding episodes occurred during 1 year of follow-up (3 with

  6. Sequential Vein Bypass Grafting is Not Associated with an Increase of Either In-hospital or Mid-term Adverse Events in Off-pump Coronary Artery Bypass Grafting

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    Fucheng Xiao

    2015-01-01

    Full Text Available Background: The impact of sequential vein bypass grafting on clinical outcomes is less known in off-pump coronary artery bypass grafting (CABG. We aimed to evaluate the effects of sequential vein bypass grafting on clinical outcomes in off-pump CABG. Methods: From October 2009 to September 2013 at the Fuwai Hospital, 127 patients with at least one sequential venous graft were matched with 127 patients of individual venous grafts only, using propensity score matching method to obtain risk-adjusted outcome comparison. In-hospital measurement was composite outcome of in-hospital death, myocardial infarction (MI, stroke, requirement for intra-aortic ballon pump (IABP assistance and prolonged ventilation. Major adverse cardiac events (MACEs: Death, MI or repeat revascularization and angina recurrence were considered as mid-term endpoints. Results: No significant difference was observed among the groups in baseline characteristics. Intraoperative mean blood flow per vein graft was 40.4 ml in individual venous grafts groups versus 59.5 ml in sequential venous grafts groups (P < 0.001. There were no differences between individual and sequential venous grafts groups with regard to composite outcome of in-hospital mortality, MI, stroke, IABP assistance and prolonged ventilation (11.0% vs. 14.2%, P = 0.45. Individual in-hospital measurement also did not differ significantly between the two groups. At about four years follow-up, the survival estimates free from MACEs (92.5% vs. 97.3%, P = 0.36 and survival rates free of angina recurrence (80.9% vs. 85.5%, P = 0.48 were similar among individual and sequential venous grafts groups with a mean follow-up of 22.5 months. In the Cox regression analysis, sequential vein bypass grafting was not identified as an independent predictor of both MACEs and angina recurrence. Conclusions: Compared to individual vein bypass grafting, sequential vein bypass grafting was not associated with an increase of either in

  7. Adolescent External Iliac Artery Trauma: Recurrent Aneurysmal Dilatation of an Iliofemoral Saphenous Vein Graft Treated by Stent-Grafting

    International Nuclear Information System (INIS)

    Lenton, James; Davies, John; Homer-Vanniasinkam, S.; McPherson, Simon

    2008-01-01

    An adolescent male sustained a severe penetrating injury to the external iliac artery. Emergency surgical revascularization was with a reversed long saphenous vein interposition graft. The primary graft and the subsequent revision graft both became aneurysmal. The second graft aneurysm was successfully excluded by endovascular stent-grafts with medium-term primary patency. A venous graft was used initially rather than a synthetic graft to reduce the risk of infection and the potential problems from future growth. Aneurysmal dilatation of venous grafts in children and adolescents is a rare but recognized complication. To the best of our knowledge, exclusion of these aneurysms with stent-grafts has not been previously reported in the adolescent population.

  8. Prospectively randomized clinical trial to compare in situ and reversed saphenous vein grafts for femoropopliteal bypass.

    Science.gov (United States)

    Harris, P L; How, T V; Jones, D R

    1987-04-01

    Two hundred and fifteen femoropopliteal bypass procedures using autologous saphenous vein grafts were randomly allocated to either the reversed or in situ technique. Eleven veins (5 per cent) were rejected at operation on the basis of their small size, nine in the reversed group and two in the in situ group, and there were two (2 per cent) perioperative deaths in each group, leaving 102 reversed and 98 in situ grafts for further study. The cumulative patency at 3 years of the reversed grafts was 77 per cent and that of the in situ grafts was 68 per cent (n.s.). The patency of all grafts was affected adversely by small veins (P less than 0.005), long grafts (P less than 0.05), low volume of blood flow in the grafts (P less than 0.001) and poor run-off (P less than 0.05). These factors influenced the outcome of the in situ and reversed operations to a similar degree and there was no statistically significant difference between them within any subgroup. The mean compliance of the in situ grafts measured 3 months or more after operation with an ultrasonic echo-tracking system was 0.024 +/- 0.01 per cent/mmHg (+/- s.d.) compared with 0.017 +/- 0.01 per cent/mmHg for the reversed grafts (t = 2.43, P less than 0.02). The incidence of fibrous stricture formation as shown by intravenous digital subtraction angiography was 29 per cent in both the reversed and the in situ grafts. The results of the study to date indicate that reversed and in situ vein grafts are equally effective for femoropopliteal bypass.

  9. Leiomyosarcoma of inferior vena cava involving bilateral renal veins: Surgical challenges and reconstruction with upfront saphenous vein interposition graft for left renal vein outflow

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    Rishi Nayyar

    2010-01-01

    Full Text Available Leiomyosarcoma of inferior vena cava (IVC involving bilateral renal veins presents a surgical challenge. Herein, we report the successful management of two such cases using restoration of left renal venous outflow by saphenous vein interposition graft as first step of surgery. Then radical resection of tumor and right kidney was done. IVC was lastly reconstructed using Gore-Tex graft. This report highlights the surgical challenges to ensure radical resection. Furthermore, the importance of restoring left renal outflow in presence of concomitant right nephrectomy is discussed. Both the patients were disease free at six months with no loss of left renal glomerular filtration rate.

  10. Detection of imminent vein graft occlusion: what is the optimal surveillance program?

    Science.gov (United States)

    Tinder, Chelsey N; Bandyk, Dennis F

    2009-12-01

    The prediction of infrainguinal vein bypass failure remains an inexact judgment. Patient demographics, technical factors, and vascular laboratory graft surveillance testing are helpful in identifying a high-risk graft cohort. The optimal surveillance program to detect the bypass at risk for imminent occlusion continues to be developed, but required elements are known and include clinical assessment for new or changes in limb ischemia symptoms, measurement of ankle and/or toe systolic pressure, and duplex ultrasound imaging of the bypass graft. Duplex ultrasound assessment of bypass hemodynamics may be the most accurate method to detect imminent vein graft occlusion. The finding of low graft flow during intraoperative assessment or at a scheduled surveillance study predicts failure; and if associated with an occlusive lesion, a graft revision can prolong patency. The most common abnormality producing graft failure is conduit stenosis caused by myointimal hyperplasia; and the majority can be repaired by an endovascular intervention. Frequency of testing to detect the failing bypass should be individualized to the patient, the type of arterial bypass, and prior duplex ultrasound scan findings. The focus of surveillance is on identification of the low-flow arterial bypass and timely repair of detected critical stenosis defined by duplex velocity spectra criteria of a peak systolic velocity 300 cm/s and peak systolic velocity ratio across the stenosis >3.5-correlating with >70% diameter-reducing stenosis. When conducted appropriately, a graft surveillance program should result in an unexpected graft failure rate of <3% per year.

  11. One-step reconstruction of the right inferior hepatic veins using auto-venous grafts in living-donor liver transplantation.

    Science.gov (United States)

    Ikegami, Toru; Shirabe, Ken; Yoshiya, Shohei; Soejima, Yuji; Yoshizumi, Tomoharu; Uchiyama, Hideaki; Toshima, Takeo; Motomura, Takashi; Maehara, Yoshihiko

    2013-07-01

    Reconstruction of the right inferior hepatic vein (RIHV) presents a major technical challenge in living donor liver transplantation (LDLT) using right lobe grafts. We studied 47 right lobe LDLT grafts with RIHV revascularization, comparing one-step reconstruction, performed post-May 2007 (n = 16), with direct anastomosis, performed pre-May 2007 (n = 31). In the one-step reconstruction technique, the internal jugular vein (n = 6), explanted portal vein (n = 5), inferior vena cava (n = 3), and shunt vessels (n = 2) were used as venous patch grafts for unifying the right hepatic vein, RIHVs, and middle hepatic vein tributaries. By 6 months after LDLT, there was no case of occlusion of the reconstructed RIHVs in the one-step reconstruction group, but a cumulative occlusion rate of 18.2 % in the direct anastomosis group. One-step reconstruction required a longer cold ischemic time (182 ± 40 vs. 115 ± 63, p one-step reconstruction and 83.9 % with direct anastomosis, respectively. One-step reconstruction of the RIHVs using auto-venous grafts is an easy and feasible technique promoting successful right lobe LDLT.

  12. Endoscopic Vein Harvesting for Coronary Bypass Grafting: A Blessing or a Trojan Horse?

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    Ryan Accord

    2011-01-01

    Full Text Available Conventional open harvest of the great saphenous vein (GSV during CABG results in approximately 7% donor-site complications. Using endoscopic vein harvesting (EVH the full GSV length can be harvested through a 3 cm incision. This nonsystematic review discusses several key issues concerning EVH, based on an extensive Pubmed search. Found studies show that EVH results in reduced number of wound complications, less postoperative pain, earlier postoperative mobilisation, reduced length of hospital stay, and is more cost-effective. Initial studies did not find significant differences in graft histology, patency, or clinical outcome. However, in 2009 convincing evidence of inferior histological graft properties became available. Furthermore, an observational study showed that EVH resulted in significantly more graft stenosis, was associated with higher mortality, more myocard infarction, and more reinterventions. Most recent publications could not confirm these findings, however larger randomised controlled trials focusing on graft quality are being awaited.

  13. Comparison of fractional flow reserve of composite Y-grafts with saphenous vein or right internal thoracic arteries.

    Science.gov (United States)

    Glineur, David; Boodhwani, Munir; Poncelet, Alain; De Kerchove, Laurent; Etienne, Pierre Yves; Noirhomme, Philippe; Deceuninck, Paul; Michel, Xavier; El Khoury, Gebrine; Hanet, Claude

    2010-09-01

    Composite Y-grafts, using the left internal thoracic artery as the inflow, allow a more efficient use of conduits without the need to touch a diseased ascending aorta. Among other conduits, the saphenous vein graft may be an alternative to the radial artery in elderly patients. We evaluated the hemodynamic characteristics of 17 composite Y-grafts made with the left internal thoracic artery anastomosed to the left anterior descending coronary artery in all cases and with either the free right internal thoracic artery (RITA group, n = 10) or a saphenous vein graft (SVG group, n = 7) implanted proximally to the left internal thoracic artery and distally to the circumflex territory 6 months after the operation. At baseline, the pressure gradient measured with a 0.014-inch pressure wire was minimal between the aorta and the internal thoracic artery stem (2 +/- 1 mm Hg), the internal thoracic artery and left anterior descending (4 +/- 2 mm Hg), the internal thoracic artery and left circumflex (3 +/- 1 mm Hg), and the saphenous vein graft and left circumflex (2 +/- 2 mm Hg). During hyperemia induced by adenosine, the pressure gradient increased significantly to 6 +/- 2 mm Hg in the internal thoracic artery stem, 9 +/- 4 mm Hg in the internal thoracic artery and left anterior descending artery, 9 +/- 3 mm Hg in the internal thoracic artery and left circumflex, and 7 +/- 4 mm Hg in the saphenous vein graft and left circumflex. Fractional flow reserve was 0.94 +/- 0.02 in internal thoracic artery stem, 0.90 +/- 0.04 mm Hg in the internal thoracic artery and left anterior descending, 0.91 +/- 0.03 mm Hg in the internal thoracic artery and left circumflex, and 0.92 +/- 0.06 mm Hg in the saphenous vein graft and left circumflex. No difference between the two types of composite Y-grafts was observed for pressure gradients or fractional flow reserve measured in internal thoracic artery stem or in distal branches. Composite Y-grafts with saphenous vein or right internal thoracic

  14. Reinforced long saphenous vein bypass graft for infrainguinal reconstruction procedures: case series and literature review.

    LENUS (Irish Health Repository)

    Hynes, Niamh

    2006-03-01

    Poor rehabilitation rates and the high-cost of managing postamputation patients justify an aggressive revascularization policy in critical lower limb ischemia. Endovascular therapy is our first choice for limb salvage in these patients. However there are patients for whom endovascular therapy is not feasible. When bypass is necessary, autologous vein is a superior conduit to synthetic material. However, varicosities usually contraindicate autologous vein bypass because of the risk of aneurysm formation, rupture and increased intimal hyperplasia compared with nonvaricose venous grafts. We report the use of varicosed long saphenous vein (LSV) with external Dacron support in infrainguinal bypass procedures for limb salvage, where endovascular therapy was not feasible. The external Dacron tube was not brought close to the distal anastomotic area itself. With a mean follow-up of 18 months, duplex ultrasonography and computed tomography angiography showed no evidence of stenosis of the reinforced vein segments or aneurysmal degeneration of the residual vein. External reinforcement with Dacron prosthesis allows the use of autogenous greater saphenous veins with varicose dilatation without compromising graft patency and limb salvage.

  15. Association of Angiotensin-Converting Enzyme Genotype, Insertion/Deletion Polymorphism and Saphenous Vein Graft Atherosclerosis in Iranian Patients

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    Neda Zeinali

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVE: The aim of this study was to evaluate possible interactions among Angiotensin-I converting enzyme genotype, insertion/deletion polymorphism and atherosclerosis of vein grafts in Iranian patients, and characterize their clinical and demographic profile. METHODS: In this cross-sectional study, patients who underwent coronary artery bypass graft surgery more than five years ago, were included for angiographic analysis. Atherosclerosis was determined by quantitative angiography and adjusted Gensini score. The gene angiotensin converting enzyme I/D polymorphism was detected by polymerase chain reaction. RESULTS: A total of 102 patients participated in this study. Eighty-four patients were male. The frequency distribution of DD, ID and II polymorphism were 23.6%, 62.7% and 13.7% respectively. There were no differences among genotypic groups in age, sex, number of risk factors, number of vein grafts and months since bypass surgery. According to adjusted Gensini score [0.18±0.12 (II vs. 0.11±0.09 (ID and 0.1±0.09 (DD P=0.021] the II genotype was associated with severity of vein graft atherosclerosis. CONCLUSION: Although there are conflicting results about gene angiotensin converting enzyme I/D polymorphism and the degree of venous bypass graft degeneration, this study suggests an association between ACE genotype II and atherosclerosis of saphenous vein grafts, however, large samples considering clinical, demographic and ethnic profile are necessary to confirm these results.

  16. Arterial Blood Pressure Induces Transient C4b-Binding Protein in Human Saphenous Vein Grafts.

    Science.gov (United States)

    Kupreishvili, Koba; Meischl, Christof; Vonk, Alexander B A; Stooker, Wim; Eijsman, Leon; Blom, Anna M; Quax, Paul H A; van Hinsbergh, Victor W M; Niessen, Hans W M; Krijnen, Paul A J

    2017-05-01

    Complement is an important mediator in arterial blood pressure-induced vein graft failure. Previously, we noted activation of cell protective mechanisms in human saphenous veins too. Here we have analyzed whether C4b-binding protein (C4bp), an endogenous complement inhibitor, is present in the vein wall. Human saphenous vein segments obtained from patients undergoing coronary artery bypass grafting (n = 55) were perfused in vitro at arterial blood pressure with either autologous blood for 1, 2, 4, or 6 hr or with autologous blood supplemented with reactive oxygen species scavenger N-acetylcysteine. The segments were subsequently analyzed quantitatively for presence of C4bp and complement activation product C3d using immunohistochemistry. Perfusion induced deposition of C3d and C4bp within the media of the vessel wall, which increased reproducibly and significantly over a period of 4 hr up to 3.8% for C3d and 81% for C4bp of the total vessel area. Remarkably after 6 hr of perfusion, the C3d-positive area decreased significantly to 1.3% and the C4bp-positive area to 19% of the total area of the vein. The areas positive for both C4bp and C3d were increased in the presence of N-acetylcysteine. Exposure to arterial blood pressure leads to a transient presence of C4bp in the vein wall. This may be part of a cell-protective mechanism to counteract arterial blood pressure-induced cellular stress and inflammation in grafted veins. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Impact of Short Hepatic Vein Reconstruction in Living Donor Adult Liver Transplantation Using a Left Liver Plus Caudate Lobe Graft

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    Koji Mikami

    2010-01-01

    Conclusion: Although no definite advantage from the V1 reconstruction was demonstrated, hepatic vein reconstruction with a significantly-sized short hepatic vein might provide an additional margin of safety for marginally-sized liver grafts during the early phase of graft regeneration.

  18. Ligation of superior mesenteric vein and portal to splenic vein anastomosis after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy - Case report.

    Science.gov (United States)

    Tang, Jianlin; Abbas, Jihad; Hoetzl, Katherine; Allison, David; Osman, Mahamed; Williams, Mallory; Zelenock, Gerald B

    2014-12-01

    62 year old Caucasian female with pancreatic head mass abutting the superior mesenteric vein (SMV) presented with fine needle aspiration biopsy confirmed diagnosis of ductal adenocarcinoma. CT scan showed near complete obstruction of portal vein and large SMV collateral development. After 3 months of neoadjuvant therapy, her portal vein flow improved significantly, SMV collateral circulation was diminished. Pancreaticoduodenectomy (PD) and superior mesenteric portal vein (SMPV) confluence resection were performed; A saphenous vein interposition graft thrombosed immediately. The splenic vein remnant was distended and adjacent to the stump of the portal vein. Harvesting an internal jugular vein graft required extra time and using a synthetic graft posed a risk of graft thrombosis or infection. As a result, we chose to perform a direct anastomosis of the portal and splenic vein in a desperate situation. The anastomosis decompressed the mesenteric venous system, so we then ligated the SMV. The patient had an uneventful postoperative course, except transient ascites. She redeveloped ascites more than one year later. At that time a PET scan showed bilateral lung and right femur metastatic disease. She expired 15 months after PD. The lessons we learned are (1) Before SMPV confluence resection, internal jugular vein graft should be ready for reconstruction. (2) Synthetic graft is an alternative for internal jugular vein graft. (3) Direct portal vein to SMV anastomosis can be achieved by mobilizing liver. (4) It is possible that venous collaterals secondary to SMV tumor obstruction may have allowed this patient's post-operative survival.

  19. A randomized comparison of the Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft (SAVE RITA) trial: early results.

    Science.gov (United States)

    Hwang, Ho Young; Kim, Jun Sung; Oh, Se Jin; Kim, Ki-Bong

    2012-11-01

    The Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft trial was designed to evaluate the saphenous vein compared with the right internal thoracic artery as a Y-composite graft anastomosed to the side of the left internal thoracic artery. In this early analysis, we compared early angiographic patency rates and clinical outcomes. From September 2008 to October 2011, 224 patients with multivessel coronary artery disease were randomized prospectively to undergo off-pump revascularization using the saphenous vein group (n = 112) or the right internal thoracic artery group (n = 112) as Y-composite grafts. Early postoperative (1.4 ± 1.1 days) angiographic patency and clinical outcomes were compared. There was 1 operative death in the right internal thoracic artery group. No statistically significant differences in postoperative morbidities, including atrial fibrillation and acute renal failure, were observed between the groups. The number of distal anastomoses using the side-arm Y-composite graft (saphenous vein vs right internal thoracic artery) were 2.3 ± 0.8 and 1.9 ± 0.7 in the saphenous vein and right internal thoracic artery groups, respectively (P < .001). A third conduit was used in 44 patients (saphenous vein group vs right internal thoracic artery group, 4/109 vs 40/110; P < .001) to extend the side-arm Y-composite graft for complete revascularization. Early angiography demonstrated an overall patency rate of 99.4% (771 of 776 distal anastomoses). Patency rates of the side-arm Y-composite graft (saphenous vein vs right internal thoracic artery) were 98.8% (245 of 248) and 99.5% (207 of 208) in the saphenous vein and right internal thoracic artery groups, respectively (P = .629). A third conduit was needed to extend the right internal thoracic artery composite graft and reach the target vessels in 36.4% (40/110) of the patients. The saphenous vein composite graft was comparable with the right internal thoracic artery composite graft

  20. Efficacy of duplex ultrasound surveillance after infrainguinal vein bypass may be enhanced by identification of characteristics predictive of graft stenosis development.

    Science.gov (United States)

    Tinder, Chelsey N; Chavanpun, Joe P; Bandyk, Dennis F; Armstrong, Paul A; Back, Martin R; Johnson, Brad L; Shames, Murray L

    2008-09-01

    Controversy regarding the efficacy of duplex ultrasound surveillance after infrainguinal vein bypass led to an analysis of patient and bypass graft characteristics predictive for development of graft stenosis and a decision of secondary intervention. Retrospective analysis of a contemporary, consecutive series of 353 clinically successful infrainguinal vein bypasses performed in 329 patients for critical (n = 284; 80%) or noncritical (n = 69; 20%) limb ischemia enrolled in a surveillance program to identify and repair duplex-detected graft stenosis. Variables correlated with graft stenosis and bypass repair included: procedure indication, conduit type (saphenous vs nonsaphenous vein; reversed vs nonreversed orientation), prior bypass graft failure, postoperative ankle-brachial index (ABI) < 0.85, and interpretation of the first duplex surveillance study as "normal" or "abnormal" based on peak systolic velocity (PSV) and velocity ratio (Vr) criteria. Overall, 126 (36%) of the 353 infrainguinal bypasses had 174 secondary interventions (endovascular, 100; surgery, 74) based on duplex surveillance; resulting in 3-year Kaplan-Meier primary (46%), assisted-primary (80%), and secondary (81%) patency rates. Characteristics predictive of duplex-detected stenosis leading to intervention (PSV: 443 +/- 94 cm/s; Vr: 8.6 +/- 9) were: "abnormal" initial duplex testing indicating moderate (PSV: 180-300 cm/s, Vr: 2-3.5) stenosis (P < .0001), non-single segment saphenous vein conduit (P < .01), warfarin drug therapy (P < .01), and redo bypass grafting (P < .001). Procedure indication, postoperative ABI level, statin drug therapy, and vein conduit orientation were not predictive of graft revision. The natural history of 141 (40%) bypasses with an abnormal first duplex scan differed from "normal" grafts by more frequent (51% vs 24%, P < .001) and earlier (7 months vs 11 months) graft revision for severe stenosis and a lower 3-year assisted primary patency (68% vs 87%; P < .001). In 52

  1. A different management of saphenous vein graft failure related to cardiac tamponade following coronary surgery

    Directory of Open Access Journals (Sweden)

    Hamit Serdar Başbuğ

    2016-03-01

    Full Text Available Cardiac tamponade is a state of constriction of the heart with an excessive fluid or hematoma resulted from various conditions. Postoperative tamponade can occur after coronary bypass surgery. Despite it is uncommon, its results may have a high risk of mortality and morbidity. Acute postoperative cardiac tamponade reveals a vast spectrum of symptoms. Moreover, a compression over the saphenous vein graft is the worst complication that should be managed without delay. We report a rare case of saphenous vein graft failure due to the cardiac tamponade following a coronary surgery and its management with a practical measure.

  2. [Value of preserved saphenous vein graft for the creation of access ports in hemodialyzed patients: report of 309 cases].

    Science.gov (United States)

    Schneider, Marc; Barrou, Benoît; Cluzel, Philippe; Hamani, Aziz; Bitker, Marc-Olivier; Richard, François

    2003-09-01

    Biological grafts are rarely used for the creation of vascular access, despite their many advantages. Our group prefers to use distal vascular accesses with interposition of a biological graft when direct access cannot be achieved. The objective of this study was to determine the long-term patency and the complication rate of a series of 309 vascular access procedures using a preserved saphenous (PS) vein homograft. 410 (27%) of the 1,500 vascular access procedures performed by our group required the use of a graft, including 376 PS vein homografts (25%). This retrospective study comprised complete data collection for 309 arteriovenous fistulas (AVF) using preserved saphenous (PS) vein graft in the forearm performed in 267 patients between 1985 and 2000. Primary patency was defined as the interval between creation of the vascular access and the first complication requiring surgical or radiological correction; secondary patency was defined as the interval between creation and loss of the graft, with or without revision of the fistula. Survival rates were calculated according to the Kaplan-Meier method. Inter-group comparison was performed by the Logrank test and analysis of variance was performed by logistic regression. Primary patency rates were 77%, 40% and 27% at 1,2 and 5 years, respectively. Secondary patency rates were 79% and 47% at 1 year and 5 years, respectively. The thrombosis rate was 42%. Two episodes of thrombosis occurred in 25% of grafts and 3 episodes were observed in 10% of cases. Infection rates were 1.9% postoperatively and 5% after dialysis, respectively. An aneurysm occurred on 10% of grafts. The operator's experience (RR = 1.58; p creation of vascular accesses with similar patency rates to those of prosthetic grafts. Vein grafts present a number of advantages, particularly a greater ease of use facilitating distal implantation of the graft and a low infection rate.

  3. Clinicopathological comparisons of open vein harvesting and endoscopic vein harvesting in coronary artery bypass grafting patients in Mashhad.

    Science.gov (United States)

    Amouzeshi, Ahmad; Teshnisi, Mohamad Abbassi; Zirak, Nahid; Shamloo, Alireza Sepehri; Hoseinikhah, Hamid; Alizadeh, Behzad; Moeinipour, Aliasghar

    2016-01-01

    Harvesting of the greater saphenous vein is almost an inevitable part of coronary artery bypass grafting (CABG) operations, and it is done by two main techniques, i.e., conventional or open vein harvesting (OVH) and the minimally-invasive endoscopic vein harvesting (EVH). This study aimed to compare these two techniques in off-pump CABG procedures with respect to clinical and pathological outcomes. This cohort study was conducted on CABG candidates during a one-year period from October 2013 through September 2014 in the Department of Cardiac Surgery at Mashhad University of Medical Sciences. Eighty-seven patients voluntarily underwent EVH, and another 86 patients matched for age, gender, and other cardiovascular risk factors were selected for OVH. They were followed up for six weeks, and the main outcome measures were infections of the wound, pain, duration of hospital stay, and the costs of hospitalization. Paired sample t-test, independent t-test, or their non-parametric equivalents and the chi-squared test were used by SPSS version 17.0 for data analysis. The mean duration of time for vein harvesting was shorter in the EVH group (p < 0.001), and the pain score was lower (p = 0.04). No infections occurred at the site of the wound. The length of hospital stay was not significantly different for the two groups (OVH versus EVH: 8.5 ± 3.3 versus 8.4 ± 3.2 days; p-value: 0.08). Hospitalization costs were significantly higher in the EVH group (OVH versus EVH: 5.8 ± 4.7 versus 7.3 ± 2.0 million Tomman; p-value: 0.008), yet no difference was diagnosed with respect to endothelial damage in the vein grafts harvested by the EVH and OVH techniques. EVH is considered as a minimally invasive and safe vein harvesting technique in our Center, and it can reduce the harvesting time and post-operative pain. In addition, its efficiency was similar to that of OVH.

  4. Ligation of superior mesenteric vein and portal to splenic vein anastomosis after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy – Case report

    Science.gov (United States)

    Tang, Jianlin; Abbas, Jihad; Hoetzl, Katherine; Allison, David; Osman, Mahamed; Williams, Mallory; Zelenock, Gerald B.

    2014-01-01

    62 year old Caucasian female with pancreatic head mass abutting the superior mesenteric vein (SMV) presented with fine needle aspiration biopsy confirmed diagnosis of ductal adenocarcinoma. CT scan showed near complete obstruction of portal vein and large SMV collateral development. After 3 months of neoadjuvant therapy, her portal vein flow improved significantly, SMV collateral circulation was diminished. Pancreaticoduodenectomy (PD) and superior mesenteric portal vein (SMPV) confluence resection were performed; A saphenous vein interposition graft thrombosed immediately. The splenic vein remnant was distended and adjacent to the stump of the portal vein. Harvesting an internal jugular vein graft required extra time and using a synthetic graft posed a risk of graft thrombosis or infection. As a result, we chose to perform a direct anastomosis of the portal and splenic vein in a desperate situation. The anastomosis decompressed the mesenteric venous system, so we then ligated the SMV. The patient had an uneventful postoperative course, except transient ascites. She redeveloped ascites more than one year later. At that time a PET scan showed bilateral lung and right femur metastatic disease. She expired 15 months after PD. Conclusion The lessons we learned are (1) Before SMPV confluence resection, internal jugular vein graft should be ready for reconstruction. (2) Synthetic graft is an alternative for internal jugular vein graft. (3) Direct portal vein to SMV anastomosis can be achieved by mobilizing liver. (4) It is possible that venous collaterals secondary to SMV tumor obstruction may have allowed this patient's post-operative survival. PMID:25568802

  5. Optimal Covering Material for Stent-Grafts Placed in the Portal Vein in a Canine Model

    International Nuclear Information System (INIS)

    Ishii, Seigo; Sato, Morio; Sonomura, Tetsuo; Yamada, Katsuyuki; Tanihata, Hirohiko; Ishikawa, Hime; Terada, Masaki; Sahara, Shinya; Kawai, Nobuyuki; Kimura, Masashi; Mori, Ichiro

    2005-01-01

    Purpose. We evaluated the suitability of Dacron, polytetrafluoroethylene (PTFE), and small intestinal submucosa (SIS) as a covering material for stent-grafts placed in the portal vein as compared with a bare stent. Methods. Using 24 beagle dogs, either bare stents or stent-grafts covered with Dacron, PTFE, or SIS were placed in the main trunk of the portal vein in 6 animals each. Portography was performed immediately after stent placement, and at 2, 4, and 12 weeks thereafter. Next, the extracted stents or stent-grafts were examined histopathologically. Neointimal thickness adjacent to the stent wire and at the midportion between the stent wires was compared among the groups. Then, the neointimal thickness at the sub- and supragraft sites was compared between each stent-graft group. Serial changes in the histologic features of the thickened neointima were also investigated. Results. No significant difference was noted in the mean stenotic ratio of the portal vein diameter between the bare stent and PTFE groups, whereas it was significantly higher in the Dacron and SIS groups compared with the bare stent group. In neither of the studies on neointimal thickness adjacent to the stent wire and at the midportion between the stent wires were any significant differences noted between the neointimal thickness of the bare stent group and the sum of the neointimal thickness of the PTFE group, whereas the sum of the neointimal thickness of the Dacron and SIS groups was significantly greater than that of the bare stent group at both sites. In the comparison of the supragraft neointimal thickness, the SIS group showed significantly greater thickness than the PTFE group, while the difference between the Dacron and PTFE groups was not significant. In the comparison of the subgraft neointimal thickness, the Dacron and SIS groups showed significantly greater thickness than the PTFE group. Conclusion. The present results indicate that of the three covering materials examined here

  6. PTFE Graft as a "Bridge" to Communicating Veins Maturation in the Treatment of an Intrahepatic Cholangiocarcinoma Involving the 3 Hepatic Veins. The Minor-but-Complex Liver Resection.

    Science.gov (United States)

    Urbani, Lucio; Balestri, Riccardo; Sidoti, Francesco; Bernardini, Juri Riccardo; Arces, Francesco; Licitra, Gabriella; Leoni, Chiara; Forfori, Francesco; Colombatto, Piero; Boraschi, Piero; Castagna, Maura; Buccianti, Piero

    2016-12-01

    Parenchyma-sparing liver surgery allows resecting hepatic veins (HV) at the hepatocaval confluence with minor (PTFE graft can be used as a bridge to communicating-veins maturation to ensure the correct outflow of the spared liver. We present a video of an intrahepatic cholangiocarcinoma (IC) involving the three HV at the hepatocaval confluence treated with this approach. In a 50-year old obese (BMI 44.8) male a 6-cm IC involving the hepatocaval confluence was identified during the follow-up for a kidney malignancy. At the preoperative CT scan the left HV was not detectable, the middle HV was incorporated within the tumor, and right HV had a 3-cm contact with the tumor. No communicating veins were evident at preoperative imaging. After a J-shape thoracophrenolaparotomy, the resection of segments II-III-IVa was partially extended to segment VIII-VII and I. The right HV was detached from the tumor, and the middle HV was reconstructed with a 7-mm ringed-armed PTFE graft anastomosed to V8. Surgery lasted 20 h and 55 min with an estimated blood loss of 3500 ml, but the postoperative course was uneventful and the patient was discharged on the 14th postoperative day. One month later the CT scan showed a patent PTFE graft with the maturation of communicating-veins. One year later a complete thrombosis of the PTFE graft was observed with normal liver perfusion and function, and the patient was disease-free. PTFE-based parenchyma-sparing liver resection is a new tool to treat tumors located at the hepatocaval confluence exploiting the maturation of intrahepatic communicating-veins between main HV.

  7. Angiographic predictors of 3-year patency of bypass grafts implanted on the right coronary artery system: a prospective randomized comparison of gastroepiploic artery, saphenous vein, and right internal thoracic artery grafts.

    Science.gov (United States)

    Glineur, David; D'hoore, William; de Kerchove, Laurent; Noirhomme, Philippe; Price, Joel; Hanet, Claude; El Khoury, Gebrine

    2011-11-01

    Saphenous vein, in situ right gastroepiploic artery, and right internal thoracic artery grafts are routinely used to revascularize the right coronary artery. Little is known about the predictive value of objective preoperative angiographic parameters on midterm graft patency. We prospectively enrolled 210 consecutive patients undergoing coronary revascularization. Revascularization of the right coronary artery was randomly performed with the saphenous vein grafts in 81 patients and the right gastroepiploic artery in 92 patients. During the same study period, 37 patients received right coronary artery revascularization with the right internal thoracic artery used in a Y-composite fashion. All patients underwent a protocol-driven coronary angiogram 3 years after surgery. Preoperative angiographic parameters included minimum lumen diameter percent stenosis measured by quantitative angiography. A graft was considered "not functional" with patency scores of 0 to 2 and "functional" with patency scores of 3 or 4. Angiographic follow-up was 100% complete. A significant difference in the distribution of flow patterns was observed in the 3 groups. In multivariate analysis, the use of a saphenous vein graft was associated with superior graft functionality compared with the other conduits (odds ratio, 6.1; 95% confidence interval, 2.4-15). Graft function was negatively influenced by the minimum lumen diameter (odds ratio, 0.11; confidence interval, 0.05-0.25). In the right gastroepiploic artery and right internal thoracic artery groups, the proportion of functional grafts was higher when the minimum lumen diameter was below a threshold value in the third minimum lumen diameter quartile (0.64-1.30 mm). Preoperative angiography predicts graft patency in the right gastroepiploic artery and right internal thoracic artery, whereas the flow pattern in saphenous vein grafts is significantly less influenced by quantitative angiographic parameters. Copyright © 2011 The American

  8. Left-main restenosis in the DES era-a call for action.

    Science.gov (United States)

    di Palma, Gaetano; Cortese, Bernardo

    2017-11-10

    Percutaneous treatment of the unprotected left main trunk (ULM), defined as a vessel without patent bypass graft either to the left circumflex (LCX) or left anterior descending (LAD) artery, has gained a precise role thanks to recent scientific evidence. Although new generation drug-eluting stents have already proven to be safer, there is still a consistent risk of restenosis and late adverse events. The optimal management of a ULM restenosis is still debated. Here we aim at presenting a review of the available data in literature and show our choice for treating it. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Ligation of superior mesenteric vein and portal to splenic vein anastomosis after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy – Case report

    Directory of Open Access Journals (Sweden)

    Jianlin Tang

    2014-12-01

    Conclusion: The lessons we learned are (1 Before SMPV confluence resection, internal jugular vein graft should be ready for reconstruction. (2 Synthetic graft is an alternative for internal jugular vein graft. (3 Direct portal vein to SMV anastomosis can be achieved by mobilizing liver. (4 It is possible that venous collaterals secondary to SMV tumor obstruction may have allowed this patient's post-operative survival.

  10. Superior Lower Extremity Vein Graft Bypass Patency among Married Patients with Peripheral Artery Disease.

    Science.gov (United States)

    Lagergren, Emily; Kempe, Kelly; Craven, Timothy E; Kornegay, Susan T; Hurie, Justin B; Garg, Nitin; Velazquez-Ramirez, Gabriela; Edwards, Matthew S; Corriere, Matthew A

    2017-10-01

    Outcome disparities associated with lower extremity bypass (LEB) for peripheral artery disease (PAD) have been identified but are poorly understood. Marital status may affect outcomes through factors related to health risk behaviors, adherence, and access to care but has not been characterized as a predictor of surgical outcomes and is often omitted from administrative data sets. We evaluated associations between marital status and vein graft patency following LEB using multivariable models adjusting for established risk factors. Consecutive patients undergoing autogenous LEB for PAD were identified and analyzed. Survival analysis and Cox proportional hazards models were used to evaluate patency stratified by marital status (married versus single, divorced, or widow[er]) adjusting for demographic, comorbidity, and anatomic factors in multivariable models. Seventy-three participants who underwent 79 autogenous vein LEB had complete data and were analyzed. Forty-three patients (58.9%) were married, and 30 (41.1%) were unmarried. Compared with unmarried patients, married patients were older at the time of their bypass procedure (67.3 ± 10.8 years vs. 62.2 ± 10.6 years; P = 0.05). Married patients also had a lower prevalence of female gender (11.6% vs. 33.3%; P = 0.02). Diabetes, hypertension, hyperlipidemia, and smoking were common among both married and unmarried patients. Minimum great saphenous vein conduit diameters were larger in married versus unmarried patients (2.82 ± 0.57 mm vs. 2.52 ± 0.65 mm; P = 0.04). Twenty-four-month primary patency was 66% for married versus 38% for unmarried patients. In a multivariable proportional hazards model adjusting for proximal and distal graft inflow/outflow, medications, gender, age, race, smoking, diabetes, and minimum vein graft diameter, married status was associated with superior primary patency (hazard ratio [HR] = 0.33; 95% confidence limits [0.11, 0.99]; P = 0.05); other predictive covariates

  11. Long-term engraftment of bone marrow-derived cells in the intimal hyperplasia lesion of autologous vein grafts.

    Science.gov (United States)

    Diao, Yanpeng; Guthrie, Steve; Xia, Shen-Ling; Ouyang, Xiaosen; Zhang, Li; Xue, Jing; Lee, Pui; Grant, Maria; Scott, Edward; Segal, Mark S

    2008-03-01

    Intimal hyperplasia of autologous vein grafts is a critical problem affecting the long-term patency of many types of vascular reconstruction. Within intimal hyperplasia lesions, smooth muscle cells are a major component, playing an essential role in the pathological process. Given that bone marrow-derived cells may differentiate into smooth muscle cells in the neointima of injured arteries, we hypothesized that the bone marrow may serve as a source for some of the smooth muscle cells within intimal hyperplasia lesions of vein grafts. To test this hypothesis, we used an established mouse model for intimal hyperplasia in wild-type mice that had been transplanted with bone marrow from a green fluorescent protein (GFP+/+) transgenic mouse. High-resolution confocal microscopy analysis performed 2 and 8 weeks after grafting demonstrated expression of GFP in 5.4 +/- 0.8% and 11.9 +/- 2.3%, respectively, of smooth muscle cells within intimal hyperplasia lesions. By 16 weeks, GFP expression in smooth muscle cells was not detected by immunohistochemistry; however, real-time PCR revealed that 20.2 +/- 1.7% of the smooth muscle cells captured from the neointima lesion by laser capture microdissection at 16 weeks contained GFP DNA. Our results suggest that bone marrow-derived cells differentiated into smooth muscle cells within the intimal lesion and may provide a novel clinical approach for decreasing intimal hyperplasia in vein grafts.

  12. Endovascular treatment of external iliac vein stenosis caused by graft compression after kidney transplantation

    Directory of Open Access Journals (Sweden)

    Willamax Oliveira de Sousa

    2013-06-01

    Full Text Available A 57-year old patient presented with approximately 80% stenosis of the left external iliac vein due to compression by the renal graft after kidney transplantation. The initial clinical manifestation of this vascular complication was progressive edema of the left lower limb, starting in the foot during the immediate postoperative period and reaching the thigh. Renal function also deteriorated during the first four months after transplantation. Venous Doppler ultrasound findings were suggestive of a diagnosis of extrinsic compression by the kidney graft and so phlebography was ordered, confirming stenosis of the left external iliac vein. The patient was initially treated with balloon angioplasty, but there was still residual stenosis so a stent was inserted, eliminating the stenosis. The edema reduced over time and the patient's renal function improved. While vascular complications are rare, and potentially severe, events, success rates are good if treatment is started early.

  13. Temporal network based analysis of cell specific vein graft transcriptome defines key pathways and hub genes in implantation injury.

    Directory of Open Access Journals (Sweden)

    Manoj Bhasin

    Full Text Available Vein graft failure occurs between 1 and 6 months after implantation due to obstructive intimal hyperplasia, related in part to implantation injury. The cell-specific and temporal response of the transcriptome to vein graft implantation injury was determined by transcriptional profiling of laser capture microdissected endothelial cells (EC and medial smooth muscle cells (SMC from canine vein grafts, 2 hours (H to 30 days (D following surgery. Our results demonstrate a robust genomic response beginning at 2 H, peaking at 12-24 H, declining by 7 D, and resolving by 30 D. Gene ontology and pathway analyses of differentially expressed genes indicated that implantation injury affects inflammatory and immune responses, apoptosis, mitosis, and extracellular matrix reorganization in both cell types. Through backpropagation an integrated network was built, starting with genes differentially expressed at 30 D, followed by adding upstream interactive genes from each prior time-point. This identified significant enrichment of IL-6, IL-8, NF-κB, dendritic cell maturation, glucocorticoid receptor, and Triggering Receptor Expressed on Myeloid Cells (TREM-1 signaling, as well as PPARα activation pathways in graft EC and SMC. Interactive network-based analyses identified IL-6, IL-8, IL-1α, and Insulin Receptor (INSR as focus hub genes within these pathways. Real-time PCR was used for the validation of two of these genes: IL-6 and IL-8, in addition to Collagen 11A1 (COL11A1, a cornerstone of the backpropagation. In conclusion, these results establish causality relationships clarifying the pathogenesis of vein graft implantation injury, and identifying novel targets for its prevention.

  14. Stent graft placement for dysfunctional arteriovenous grafts

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Gyeong Sik [Dept. of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam (Korea, Republic of); Shin, Byung Seok; Ohm, Joon Young; Ahn, Moon Sang [Chungnam National University Hospital, Daejeon (Korea, Republic of)

    2015-07-15

    This study aimed to evaluate the usefulness and outcomes of stent graft use in dysfunctional arteriovenous grafts. Eleven patients who underwent stent graft placement for a dysfunctional hemodialysis graft were included in this retrospective study. Expanded polytetrafluoroethylene covered stent grafts were placed at the venous anastomosis site in case of pseudoaneurysm, venous laceration, elastic recoil or residual restenosis despite the repeated angioplasty. The patency of the arteriovenous graft was evaluated using Kaplan-Meier analysis. Primary and secondary mean patency was 363 days and 741 days. Primary patency at 3, 6, and 12 months was 82%, 73%, and 32%, respectively. Secondary patency at the 3, 6, 12, 24, and 36 months was improved to 91%, 82%, 82%, 50%, and 25%, respectively. Fractures of the stent graft were observed in 2 patients, but had no effect on the patency. Stent graft placement in dysfunctional arteriovenous graft is useful and effective in prolonging graft patency.

  15. Warfarin improves the outcome of infrainguinal vein bypass grafting at high risk for failure.

    Science.gov (United States)

    Sarac, T P; Huber, T S; Back, M R; Ozaki, C K; Carlton, L M; Flynn, T C; Seeger, J M

    1998-09-01

    Patients with marginal venous conduit, poor arterial runoff, and prior failed bypass grafts are at high risk for infrainguinal graft occlusion and limb loss. We sought to evaluate the effects of anticoagulation therapy after autogenous vein infrainguinal revascularization on duration of patency, limb salvage rates, and complication rates in this subset of patients. This randomized prospective trial was performed in a university tertiary care hospital and in a Veterans Affairs Hospital. Fifty-six patients who were at high risk for graft failure were randomized to receive aspirin (24 patients, 27 bypass grafts) or aspirin and warfarin (WAR; 32 patients, 37 bypass grafts). All patients received 325 mg of aspirin each day, and the patients who were randomized to warfarin underwent anticoagulation therapy with heparin immediately after surgery and then were started on warfarin therapy to maintain an international normalized ratio between 2 and 3. Perioperative blood transfusions and complications were compared with the Student t test or with the chi2 test. Graft patency rates, limb salvage rates, and survival rates were compared with the Kaplan-Meier method and the log-rank test. Sixty-one of the 64 bypass grafts were performed for rest pain or tissue loss, and 3 were performed for short-distance claudication. There were no differences between the groups in ages, indications, bypass graft types, risk classifications (ie, conduit, runoff, or graft failure), or comorbid conditions (except diabetes mellitus). The cumulative 5-year survival rate was similar between the groups. The incidence rate of postoperative hematoma (32% vs 3.7%; P = .004) was greater in the WAR group, but no differences were seen between the WAR group and the aspirin group in the number of packed red blood cells transfused, in the incidence rate of overall nonhemorrhagic wound complications, or in the overall complication rate (62% vs 52%). The immediate postoperative primary graft patency rates (97

  16. Uncommon Case of a Post-Traumatic Portal Vein Pseudoaneurysm Treated with Percutaneous Transhepatic Stent Grafting

    Energy Technology Data Exchange (ETDEWEB)

    Ierardi, Anna Maria, E-mail: amierardi@yahoo.it [Uninsubria, Ospedale di Circolo, Interventional Radiology Unit (Italy); Berselli, Mattia, E-mail: mattia.berselli@ospedale.varese.it [Uninsubria, Ospedale di Circolo, Department of Surgery (Italy); Cuffari, Salvatore, E-mail: salvatore.cuffari@ospedale.varese.it [Uninsubria, Ospedale di Circolo, Anesthesiology Department (Italy); Castelli, Patrizio, E-mail: patrizio.castelli@uninsubria.it [Uninsubria, Ospedale di Circolo, Department of Vascular Surgery (Italy); Cocozza, Eugenio, E-mail: eugenio.cocozza@ospedale.varese.it [Uninsubria, Ospedale di Circolo, Department of Surgery (Italy); Carrafiello, Gianpaolo, E-mail: gcarraf@gmail.com [Uninsubria, Ospedale di Circolo, Interventional Radiology Unit (Italy)

    2016-10-15

    We describe a man who presented with a traumatic portal vein pseudoaneurysm, which was subsequently managed with a percutaneous transhepatic stent graft. This case demonstrates a rarely seen condition in the traumatic population and a novel management strategy, which should be considered in the management of this challenging injury.

  17. Prosthetic bypass for restenosis after endarterectomy or stenting of the carotid artery.

    Science.gov (United States)

    Illuminati, Giulio; Belmonte, Romain; Schneider, Fabrice; Pizzardi, Giulia; Calió, Francesco G; Ricco, Jean-Baptiste

    2017-06-01

    The objective of this study was to evaluate the results of prosthetic carotid bypass (PCB) with polytetrafluoroethylene (PTFE) grafts as an alternative to carotid endarterectomy (CEA) in treatment of restenosis after CEA or carotid artery stenting (CAS). From January 2000 to December 2014, 66 patients (57 men and 9 women; mean age, 71 years) presenting with recurrent carotid artery stenosis ≥70% (North American Symptomatic Carotid Endarterectomy Trial [NASCET] criteria) were enrolled in a prospective study in three centers. The study was approved by an Institutional Review Board. Informed consent was obtained from all patients. During the same period, a total of 4321 CEAs were completed in the three centers. In these 66 patients, the primary treatment of the initial carotid artery stenosis was CEA in 57 patients (86%) and CAS in nine patients (14%). The median delay between primary and redo revascularization was 32 months. Carotid restenosis was symptomatic in 38 patients (58%) with transient ischemic attack (n = 20) or stroke (n = 18). In this series, all patients received statins; 28 patients (42%) received dual antiplatelet therapy, and 38 patients (58%) received single antiplatelet therapy. All PCBs were performed under general anesthesia. No shunt was used in this series. Nasal intubation to improve distal control of the internal carotid artery was performed in 33 patients (50%), including those with intrastent restenosis. A PTFE graft of 6 or 7 mm in diameter was used in 6 and 60 patients, respectively. Distal anastomosis was end to end in 22 patients and end to side with a clip distal to the atherosclerotic lesions in 44 patients. Completion angiography was performed in all cases. The patients were discharged under statin and antiplatelet treatment. After discharge, all of the patients underwent clinical and Doppler ultrasound follow-up every 6 months. Median length of follow-up was 5 years. No patient died, sustained a stroke, or presented with a

  18. Resolution of Large Azygos Vein Aneurysm Following Stent-Graft Shunt Placement in a Patient with Ehlers-Danlos Syndrome Type IV

    International Nuclear Information System (INIS)

    D'Souza, Estelle S.; Williams, David M.; Deeb, G.M.; Cwikiel, Wojciech

    2006-01-01

    Ehlers-Danlos syndrome (EDS) type IV is a rare connective tissue disorder associated with thin-walled, friable arteries and veins predisposing patients to aneurysm formation, dissection, fistula formation, and vessel rupture. Azygos vein aneurysm is an extremely rare condition which has not been reported in association with EDS in the literature. We present a patient with EDS type IV and interrupted inferior vena cava (IVC) with azygos continuation who developed an azygos vein aneurysm. In order to decrease flow through the azygos vein and reduce the risk of aneurysm rupture, a stent-graft shunt was created from the right hepatic vein to the azygos vein via a transhepatic, retroperitoneal route. At 6 month follow-up the shunt was open and the azygos vein aneurysm had resolved

  19. Inhibition of vein graft intimal and medial thickening by periadventitial application of a sulfated carbohydrate polymer

    NARCIS (Netherlands)

    Toes, GT; Barnathan, ES; Liu, HG; Raghunath, PN; Tomaszewski, JE; Caron, RJ; Weisz, PB; vanOeveren, W; Golden, MA

    Purpose: The purpose of this study was to determine whether the wall thickening observed in vein grafts after they were placed into the arterial circulation could be inhibited by periadventitial delivery of an insoluble sulfated polymer of beta-cyclodextrin (P-CDS) capable of tightly binding heparin

  20. Late In-Stent Restenosis of the Abdominal Aorta in a Patient with Takayasu's Arteritis and Related Pathology

    International Nuclear Information System (INIS)

    Ishibashi-Ueda, Hatsue; Yutani, Chikao; Kuribayashi, Sachio; Takamiya, Makoto; Imakita, Masami; Ando, Motomi

    1999-01-01

    This report describes an in-stent restenosis of the infrarenal aorta in a patient with Takayasu's arteritis in a nonactive state. A 10-mm-diameter Wallstent had been deployed 42 months previously. The stented restenosed segment was replaced by a surgical graft. Histopathological examination of the excised aortic segment showed a thin layer of fibrocellular neointima and massive organized and calcified thrombus. To our knowledge, this is the first histopathological report of a late in-stent restenosis of the abdominal aorta in Takayasu's arteritis. RID='''' ID='''' Correspondence to: H. Ishibashi-Ueda, M.D

  1. Hemodynamic effects of spiral ePTFE prosthesis compared with standard arteriovenous graft in a carotid to jugular vein porcine model.

    Science.gov (United States)

    Jahrome, Ommid K; Hoefer, Imo; Houston, Graeme J; Stonebridge, Peter A; Blankestijn, Peter J; Moll, Frans L; de Borst, Gert J

    2011-01-01

    The primary patency rate of arteriovenous (AV) grafts is limited by distal venous anastomosis stenosis or occlusion due to intimal hyperplasia associated with distal graft turbulence. The normal blood flow in native arteries is spiral laminar flow. Standard vascular grafts do not produce spiral laminar flow at the distal anastomosis. Vascular grafts which induce a spiral laminar flow distally result in lower turbulence, particularly near the vessel wall. This initial study compares the hemodynamic effects of a spiral flow-inducing graft and a standard graft in a new AV carotid to jugular vein crossover graft porcine model. Four spiral flow grafts and 4 control grafts were implanted from the carotid artery to the contralateral jugular vein in 4 pigs. Two animals were terminated after 48 hours and 2 at 14 days. Graft patency was assessed by selective catheter digital angiography, and the flow pattern was assessed by intraoperative flow probe and color Doppler ultrasound (CDU) measurements. The spiral grafts were also assessed at enhanced flow rates using an external roller pump to simulate increased flow rates that may occur during dialysis using a standard dialysis needle cannulation. The method increased the flow rate through the graft by 660 ml/min. The graft distal anastomotic appearances were evaluated by explant histopathology. All grafts were patent at explantation with no complications. All anastomoses were found to be wide open and showed no significant angiographic stenosis at the distal anastomosis in both spiral and control grafts. CDU examinations showed a spiral flow pattern in the spiral graft and double helix pattern in the control graft. No gross histopathological effects were seen in either spiral or control grafts. This porcine model is robust and allows hemodynamic flow assessment up to 14 days postimplantation. The spiral flow-inducing grafts produced and maintained spiral flow at baseline and enhanced flow rates during dialysis needle

  2. Follow-up of in situ vein femoral-to-popliteal bypass grafts with intravenous digital subtraction angiography

    International Nuclear Information System (INIS)

    Hemingway, A.P.; Hartnell, G.G.; Smith, J.

    1986-01-01

    The detection of early strictures or occlusion of in situ vein (femoral to popliteal) grafts allows the possibility of surgical or radiological intervention to preserve graft function. Twenty patients have been followed up prospectively with intravenous digital subtraction angiography at 3-month intervals after surgery. Contrast medium is injected via a centrally placed catheter, and five over-lapping positions are examined using a 14-inch intensifier. An average total of 175-200 ml of contrast medium has been given. In all cases it has been possible to visualize the entire graft, the distal anastomoses, and the run-off. In four patients early stenoses have been diagnosed. Three have been treated by percutaneous transluminal angioplasty and one surgically, all with a successful outcome

  3. Simultaneous Iliac Vein Bovine Pericardial Patch Venoplasty and Creation of PTFE Lower Limb Arteriovenous Fistula Graft for Rescue Vascular Access.

    Science.gov (United States)

    Meecham, Lewis; Fisher, Owain; Kirby, George; Evans, Richard; Buxton, Pauline; Legge, Jocelyn; Rajagopalan, Sriram; Asquith, John; Pherwani, Arun

    2016-10-01

    We present a case of external iliac vein patch venoplasty to accommodate rescue vascular access via a polytetrafluoroethylene loop arteriovenous fistula graft (AVG) for a patient with multiple central venous stenoses. A 35-year-old female with anti-glomerular basement membrane antibody disease required rescue vascular access for hemodialysis. Repeated occlusion and/or thrombosis of long-term central venous access cannulae, to facilitate dialysis, had caused stenosis of brachiocephalic veins: right external iliac vein and occlusion of the left common iliac vein. A previous right brachiobasilic fistula had occluded within 1 year. No other upper limb options for arteriovenous fistula (AVF) were available. A right external iliac vein bovine patch angioplasty concurrently with a polytetrafluoroethylene AV graft between common femoral artery and common femoral vein was performed to restore venous patency and allow rescue dialysis access. At 3-year follow-up, the fistula remains widely patent with 2 L/min flow rates and no recurrent stenosis to the treated iliac vein. She has not required any further surgical or interventional radiological procedures to maintain fistula or central venous patency. Central venous stenosis or occlusion is common for patients requiring dialysis, especially those with multiple previous long-term central venous cannulations. If restriction of outflow is present, AVF may fail. Venous patch angioplasty in these cases is a successful technique, allowing AVF formation and long-term patency. Central venous stenosis can be treated successfully with patch venoplasty to accommodate AVF/AVG formation for rescue vascular access; this is a potentially lifesaving intervention for patients requiring dialysis. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Clinical application of endovascular stent-graft in the treatment of portal stenosis of cancerous thrombus

    International Nuclear Information System (INIS)

    Jiang Zaibo; Huang Mingsheng; Wang Jing; Li Zhengran; Qian Jiesheng; Guang Shouhai; Zhu Kangshun; Shan Hong; Zhang Xiongjun

    2007-01-01

    Objective: To explore the approach and early effects of endovascular stent-graft deployment in the treatment of portal stenosis of cancerous thrombus. Methods: Six cases with portal vein stenosis of cancerous thrombus, which caused by primary hepatic carcinoma (5 cases) and cholangiocarcinoma (1 case) and the severity of stenosis showed on contrast enhanced CT were more than 75% or occluded, were performed percutaneous transhepatic or transsplenic portography. FLUENCY TM endovascular stent-graft (10 mm diameter) was placed at the position of stenosis after gastroesophageal varices embolization. Portal pressure was measured pre- and post-deployment. Results: Stents were successfully placed in all patients. The average portal pressure decreased from 50.7 em H 2 O (1 cm H 2 O0.098 kPa) to 41.3 cm H 2 O after endovascular stent-graft deployment. The restenosis were found in 2 cases after one month. Haematemesis and refractory ascites appeared in one case respectively, the other 4 cases showed no significant symptoms above caused by portal hypertension. Conclusion: It is safe and feasible for endovascular stent-graft deployment in the treatment of portal stenosis of cancerous thrombus. Selecting the suitable indications, the symptoms of portal hypertension can be controlled effectively. (authors)

  5. Hemodialysis shunts-related subclavian vein stenosis : treatment with self-expandable metallic stent

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Gyee; Lee, Young Chul; Shin, Sang Soo; Kim, Yun Hyeon; Kim, Jae Kyu; Kang, Heoung Keun; Jeong, Sang Young; Choi, Su Jin Na [Chonnam Univ. College of Medicine, Kwangju (Korea, Republic of)

    1999-04-01

    To evaluate the usefulness of placement of self-expandable stents in hemodialytic shunt-related subclavian vein stenosis. Self-expandable metallic stent was placed in nine patients with hemodialytic shunt-related subclavian vein stenosis. In seven cases, angioplasty was attempted before stent placement; in five, stents were placed immediately after failed angioplasty; and in two, due to restenosis after angioplasty. Procedures involved a 10mm diameter, 7-10cm length Wallstent in eight cases, and a 10mm diameter, 8cm length Hanaro stent in one. In all cases, clinical follow-up, which included physical examination and the measurement of venous resistance pressure during hemodialysis, was performed. The follow-up period was between 5 months and 1 year 7 months. Repeated intervention was performed if restenosis was detected. The stenotic sites were in eight cases the site of a previous subclavian venous line, and in one, the site of anatomic narrowing at the thoracic inlet of the subclavian vein. The technical success rate was 100%;a resulting complication was stent migration into the right atrium in one case in which a Hanaro stent had been used; this was removed by snaring. During follow-up of the eight patients in whon stent placement was successful, restenosis developed in three cases. This occurred during the 7th, 8th, and 15th month, respectively. Two such cases were treated by balloon dilatation. In hemodialytic shunt-related subclavian vein stenosis, treatment involving the use of a self-expandable metallic stent is useful, especially for treating a lesion which has not responded to angioplasty with a high patency rate.

  6. Hemodialysis shunts-related subclavian vein stenosis : treatment with self-expandable metallic stent

    International Nuclear Information System (INIS)

    Kim, Sang Gyee; Lee, Young Chul; Shin, Sang Soo; Kim, Yun Hyeon; Kim, Jae Kyu; Kang, Heoung Keun; Jeong, Sang Young; Choi, Su Jin Na

    1999-01-01

    To evaluate the usefulness of placement of self-expandable stents in hemodialytic shunt-related subclavian vein stenosis. Self-expandable metallic stent was placed in nine patients with hemodialytic shunt-related subclavian vein stenosis. In seven cases, angioplasty was attempted before stent placement; in five, stents were placed immediately after failed angioplasty; and in two, due to restenosis after angioplasty. Procedures involved a 10mm diameter, 7-10cm length Wallstent in eight cases, and a 10mm diameter, 8cm length Hanaro stent in one. In all cases, clinical follow-up, which included physical examination and the measurement of venous resistance pressure during hemodialysis, was performed. The follow-up period was between 5 months and 1 year 7 months. Repeated intervention was performed if restenosis was detected. The stenotic sites were in eight cases the site of a previous subclavian venous line, and in one, the site of anatomic narrowing at the thoracic inlet of the subclavian vein. The technical success rate was 100%;a resulting complication was stent migration into the right atrium in one case in which a Hanaro stent had been used; this was removed by snaring. During follow-up of the eight patients in whon stent placement was successful, restenosis developed in three cases. This occurred during the 7th, 8th, and 15th month, respectively. Two such cases were treated by balloon dilatation. In hemodialytic shunt-related subclavian vein stenosis, treatment involving the use of a self-expandable metallic stent is useful, especially for treating a lesion which has not responded to angioplasty with a high patency rate

  7. The treatment of malignant ventricular tachycardia by aorto-coronary saphenous vein bypass graft

    Science.gov (United States)

    Ikram, H.; Jeffery, R. M.; Parkins, R. A.; Makey, A. R.; Emery, E. R. J.; Stone, D. L.

    1974-01-01

    A 61-year-old man with a previous cardiac infarction had at least fifteen attacks of ventricular tachycardia which finally did not respond to either drug or electrical therapy. Angiography showed a blocked right coronary artery and a non-contractile portion of postero-inferior left ventricular wall. An aorto to right coronary saphenous vein bypass graft was inserted, and although attacks of tachycardia occurred following the operation these were of short duration and reverted spontaneously. He has been free of tachycardia for 5 weeks, with a greatly improved effort tolerance. ImagesFig. 2Fig. 3

  8. Surgical Access to Jejunal Veins for Local Thrombolysis and Stent Placement in Portal Vein Thrombosis

    International Nuclear Information System (INIS)

    Schellhammer, Frank; Esch, Jan Schulte am; Hammerschlag, Sascha; Knoefel, Wolfram Trudo; Fuerst, Guenter

    2008-01-01

    Portal vein thrombosis is an infrequent entity, which may cause high morbidity and mortality. We report a case of portal vein thrombosis due to benign stenosis following partial pancreatoduodenectomy with segmental replacement of the portal vein by a Gore-tex graft. Using a surgical access to jenunal veins, local thrombolysis, mechanical fragmentation of thrombus, and stent placement were successfully performed.

  9. Thrombosed aneurysm of saphenous vein coronary artery bypass grafting

    Energy Technology Data Exchange (ETDEWEB)

    Queiroz, Rodolfo Mendes; Nastri Filho, Rogerio; Ferez, Marcus Antonio; Costa, Mauro Jose Brandao da; Laguna, Claudio Benedini; Valentin, Marcus Vinicius Nascimento, E-mail: rod_queiroz@hotmail.com [Documenta - Hospital Sao Francisco, Ribeirao Preto, SP (Brazil). Departamento de Radiologia e Diagnostico por Imagem; Hospital Sao Francisco, Ribeirao Preto, SP (Brazil). Centro de Terapia Intensiva

    2017-06-15

    We describe the case of a male patient, aged 76 years, referred for cardiac investigation due to retrosternal chest pain and dyspnea. He had a history of acute myocardial infarction and angioplasties in the last 30 years, including a saphenous vein coronary artery bypass grafting (SVCABG). Echocardiogram showed hypoechoic oval formation near the right ventricle, suggesting a pericardial cyst. Computed angiotomography revealed a predominantly fusiform and thrombosed aneurysmal dilation of the SVCABG to the right coronary artery. SVCABG aneurysms are very rare and potentially fatal. They usually appear in the late postoperative period, and patients are often asymptomatic. On radiography, it is frequently presented as enlargement of the mediastinum, with echocardiography, computed tomography and magnetic resonance imaging being very useful for diagnosis. Coronary angiography is the gold standard to detect these cases. Our report illustrates a rare situation arising late from a relatively common surgery. Due to its severity, proper recognition in the routine assessment of patients with a similar history is essential. (author)

  10. Interposition vein cuffs.

    Science.gov (United States)

    Harris, P; Da Silva, T; How, T

    1996-01-01

    A vein cuff interposed at the distal anastomosis between a prosthetic vascular graft and a recipient infrageniculate artery improves the chances of continued patency of the graft, at least in the short and medium term. The mode of effect appears to be suppression or modification of anastomotic myointimal hyperplasia (MIH). In the event of graft failure the recipient artery and run-off vessels remain free from MIH and their patency is preserved thereby improving the prospects for further vascular reconstruction and limb salvage. The mechanisms by which interposition vein cuffs might modulate MIH are reviewed. Experimental evidence is described to show that the geometry of a cuffed anastomosis promotes a characteristic haemodynamic flow structure with a stable vortex. It is suggested that this vortex exerts greater shear stress upon the wall of the artery than the normal laminar flow observed in conventional anastomoses. High shear stress is known to inhibit MIH.

  11. [Free tissue transfers with lengthening of vascular pedicle using interpositional vein grafts. About 10 cases].

    Science.gov (United States)

    Yeo, S; Perrot, P; Duteille, F

    2010-04-01

    The realization of free flaps with lack of reliable vessels nearby the loss of substance is a difficult problem for plastic surgeons. We report 10 cases of free tissue transfers with a one-stage technique lengthening the vascular pedicle of the free flap with interpositional vein grafts. Taking into consideration the good results and the low rate of morbidity, the authors emphasize the use of this technique rather than a two-stage procedure. Copyright 2009 Elsevier Masson SAS. All rights reserved.

  12. Prevention of one-year vein-graft occlusion after aortocoronary-bypass surgery: a comparison of low-dose aspirin, low-dose aspirin plus dipyridamole, and oral anticoagulants. The CABADAS Research Group of the Interuniversity Cardiology Institute of The Netherlands

    NARCIS (Netherlands)

    van der Meer, J.; Hillege, H. L.; Kootstra, G. J.; Ascoop, C. A.; Mulder, B. J.; Pfisterer, M.; van Gilst, W. H.; Lie, K. I.

    1993-01-01

    Aspirin, alone or in combination with dipyridamole, is known to prevent occlusion of aortocoronary vein grafts. The benefit of dipyridamole in addition to aspirin remains controversial, and the efficacy and safety of oral anticoagulants for prevention of vein-graft occlusion have not been

  13. The protective effect of vein cuffed anastomoses is not mechanical in origin.

    Science.gov (United States)

    Norberto, J J; Sidawy, A N; Trad, K S; Jones, B A; Neville, R F; Najjar, S F; Sidawy, M K; DePalma, R G

    1995-04-01

    Intimal hyperplasia (IH) is a proliferative process of vascular smooth muscle cells that occurs after an arterial injury, particularly at outflow anastomoses of prosthetic bypass grafts. IH causes stenosis that leads ultimately to graft flow reduction and thrombosis. We have demonstrated previously that vein cuff interposition between an expanded polytetrafluoroethylene (e-PTFE) graft and artery at distal anastomoses diminished IH formation in the arterial outflow as compared with noncuffed anastomoses. Improved long-term patency rates associated with the placement of an interposition vein cuff at the distal anastomosis of e-PTFE grafts to infrageniculate arteries have also been demonstrated clinically. This study examined the mechanical factors that may contribute to the protective effect of cuffed anastomoses. These factors include the expansibility of the vein cuff as compared with e-PTFE, as well as the angle of the cuffed anastomosis. Compatible animals were selected by use of platelet aggregation studies. Nine dogs, group A, received a 4 mm e-PTFE graft plus a 1 cm long interposition vein cuff at the distal anastomosis in the left carotid artery. The same procedure was done on the right side, and in addition the vein cuff was encircled by an e-PTFE jacket incorporated into the anastomosis to prevent the expansion of the vein cuff with arterial pulsation. To study the effect of distal anastomotic angle and geometry on the formation of IH, five dogs, group B, received a 4 mm e-PTFE graft in both sides. On the left, the distal anastomosis was performed between the graft and the artery at an acute angle as it is commonly done when a bypass graft is placed. On the right side a 1 cm long, 6 mm diameter e-PTFE segment was interposed between the artery and the graft at a perpendicular angle. This geometry mimicked the right angle of a vein cuff-to-artery anastomosis. After 10 weeks the grafts were harvested, and the thickness of IH was measured with an ocular

  14. Simplified one-orifice venoplasty for middle hepatic vein reconstruction in adult living donor liver transplantation using right lobe grafts.

    Science.gov (United States)

    Kim, Joo Dong; Choi, Dong Lak; Han, Young Seok

    2014-05-01

    Middle hepatic vein (MHV) reconstruction is often essential to avoid hepatic congestion and serious graft dysfunction in living donor liver transplantation (LDLT). The aim of this report was to introduce evolution of our MHV reconstruction technique and excellent outcomes of simplified one-orifice venoplasty. We compared clinical outcomes with two reconstruction techniques through retrospective review of 95 recipients who underwent LDLT using right lobe grafts at our institution from January 2008 to April 2012; group 1 received separate outflow reconstruction and group 2 received new one-orifice technique. The early patency rates of MHV in group 2 were higher than those in group 1; 98.4% vs. 88.2% on postoperative day 7 (p = 0.054) and 96.7% vs. 82.4% on postoperative day 14, respectively (p = 0.023). Right hepatic vein (RHV) stenosis developed in three cases in group 1, but no RHV stenosis developed because we adopted one-orifice technique (p = 0.043). The levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in group 2 were significantly lower than those in group 1 during the early post-transplant period. In conclusion, our simplified one-orifice venoplasty technique could secure venous outflow and improve graft function during right lobe LDLT. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. miRNA-21 is dysregulated in response to vein grafting in multiple models and genetic ablation in mice attenuates neointima formation

    NARCIS (Netherlands)

    McDonald, Robert A; White, Katie M; Wu, Junxi; Cooley, Brian C; Robertson, Keith E; Halliday, Crawford A; McClure, John D; Francis, Sheila; Lu, Ruifaug; Kennedy, Simon; George, Sarah J; Wan, Song; van Rooij, Eva; Baker, Andrew H

    AIMS: The long-term failure of autologous saphenous vein bypass grafts due to neointimal thickening is a major clinical burden. Identifying novel strategies to prevent neointimal thickening is important. Thus, this study aimed to identify microRNAs (miRNAs) that are dysregulated during neointimal

  16. Comparison between the STENTYS self-apposing bare metal and paclitaxel-eluting coronary stents for the treatment of saphenous vein grafts (ADEPT trial)

    NARCIS (Netherlands)

    A.J.J. IJsselmuiden (Alexander); C. Simsek (Cihan); Van Driel, A.G. (A. G.); Bouchez, D. (D.); G. Amoroso (Giovanni); P. Vermeersch (Paul); Karjalainen, P.P. (P. P.)

    2018-01-01

    textabstractAims To describe the safety and performance of STENTYS self-expandable bare metal stents (BMS) versus paclitaxel-eluting stents (PES) in saphenous vein grafts (SVGs). Methods and Results A randomised controlled trial was performed in four hospitals in three European countries between

  17. Renal Vein Reconstruction for Harvesting Injury in Kidney Transplantation

    Directory of Open Access Journals (Sweden)

    Birkan Bozkurt

    2014-03-01

    Full Text Available Kidney transplantation is the best treatment choice in the end-stage renal disease. In the renal transplantation, renal vein damage or shortness which occurs during cadaveric or living donor nephrectomy causes technical difficulties for surgeons. The lack of the donors already especially cadaveric, the acquirement of the graft, gets very much importance. In this report, it is aimed to share the clinical experiment by which it seen, how anastomosis can become appropriate by using the renal vein which is damaged in the way that anastomosis cannot be done anyway by using cadaveric vena cava graft. The renal vein brought to length for anostomosis which is repaired by using cadaveric vena cava graft, is anastomosed successfully by becoming an end-to-side of the external iliac vein of the recipient. Vascular anastomoses are applied easily in technique. The time of the warm ischemia was under 2 hours and the kidney was functional in the post-operative period. Renal vein trombosis was not observed. The renal vein damage occured during cadaveric or living donor nephrectomy, can be repaired by some methods. In the kidneys in which vein requirement is done, the success rates are rather high although acute tubular necrosis and delayed function can be seen more.

  18. Effect of ticlopidine on the long-term patency of saphenous-vein bypass grafts in the legs. Etude de la Ticlopidine après Pontage Fémoro-Poplité and the Association Universitaire de Recherche en Chirurgie.

    Science.gov (United States)

    Becquemin, J P

    1997-12-11

    Optimal therapy to prevent late occlusion of arterial bypass grafts in the legs has not been determined. We assessed the effect of ticlopidine, an inhibitor of platelet aggregation, on the long-term patency of saphenous-vein bypass grafts for the treatment of peripheral vascular disease. A total of 243 patients with femoropopliteal or femorotibial saphenous-vein bypass grafts were randomly assigned to receive either ticlopidine (250 mg twice a day) or matching placebo for two years. The primary end point was graft patency at two years, as assessed by physical examination, measurement of the ankle brachial index, and duplex ultrasonography or arteriography. The incidence of death and major ischemic events was also analyzed in the two groups. After two years, 66.4 percent of the patients were alive with a patent graft in the ticlopidine group, as compared with 51.2 percent in the placebo group (95 percent confidence interval for the difference between the two groups, 2.9 to 27.4 percent; P=0.02). The two-year cumulative patency rate was 82 percent in the ticlopidine group and 63 percent in the placebo group (P=0.002). There was no significant difference between groups in overall mortality or major ischemic events. Ticlopidine significantly improved the long-term patency of saphenous-vein bypass grafts in the legs. Since the drug was well tolerated, its use can be recommended after peripheral-vein bypass surgery.

  19. A randomized comparison of the Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft (SAVE RITA) trial: One-year angiographic results and mid-term clinical outcomes.

    Science.gov (United States)

    Kim, Ki-Bong; Hwang, Ho Young; Hahn, Seokyung; Kim, Jun Sung; Oh, Se Jin

    2014-09-01

    The Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft (SAVE RITA) trial was designed to evaluate the noninferiority of the saphenous vein (SV) compared with the right internal thoracic artery ([R]ITA) used as a Y-composite graft. A total of 224 patients who had undergone off-pump revascularization for multivessel coronary artery disease using the SV or RITA as a Y-composite graft based on the in situ left ITA were assigned randomly to the SV Y-composite graft (SV group, n = 112) or free RITA Y-composite graft (RITA group, n = 112). The primary endpoint was the 1-year angiographic patency rate of the second limb conduits (SV or RITA). Postoperative 1-year coronary angiograms were performed in 215 patients (SV group, 108; RITA group, 107). The overall graft patency rate was 97.4% (745 of 765) at 1 year (97.9% in the SV group vs 96.9% in the RITA group, P = .362). The primary endpoint of the study, the 1-year patency rate of the SV composite grafts, was 97.1% (238 of 245) and was noninferior to that of the RITA composite grafts (97.1% [198 of 204]) with a 95% lower confidence limit of -2.6% (P RITA composite grafts in terms of the 1-year angiographic patency rates. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  20. Adult-Brain-Derived Neural Stem Cells Grafting into a Vein Bridge Increases Postlesional Recovery and Regeneration in a Peripheral Nerve of Adult Pig

    Directory of Open Access Journals (Sweden)

    Olivier Liard

    2012-01-01

    Full Text Available We attempted transplantation of adult neural stem cells (ANSCs inside an autologous venous graft following surgical transsection of nervis cruralis with 30 mm long gap in adult pig. The transplanted cell suspension was a primary culture of neurospheres from adult pig subventricular zone (SVZ which had been labeled in vitro with BrdU or lentivirally transferred fluorescent protein. Lesion-induced loss of leg extension on the thigh became definitive in controls but was reversed by 45–90 days after neurosphere-filled vein grafting. Electromyography showed stimulodetection recovery in neurosphere-transplanted pigs but not in controls. Postmortem immunohistochemistry revealed neurosphere-derived cells that survived inside the venous graft from 10 to 240 post-lesion days and all displayed a neuronal phenotype. Newly formed neurons were distributed inside the venous graft along the severed nerve longitudinal axis. Moreover, ANSC transplantation increased CNPase expression, indicating activation of intrinsic Schwann cells. Thus ANSC transplantation inside an autologous venous graft provides an efficient repair strategy.

  1. Evaluation of fluency stent-grafts in transjugular intrahepatic portosystemic shunts

    International Nuclear Information System (INIS)

    Zhao Jianbo; Li Yanhao; Chen Yong; He Xiaofeng; Zeng Qingle; Mei Quelin; Lu Wei

    2009-01-01

    Objective: To evaluate the efficacy of Fluency stent-graft (Bard Corp) in transjugular intrahepatic portosystemic shunt (TIPS). Methods: The clinical data of 21 consecutive patients treated by TIPS using Fluency stent-grafts were retrospectively reviewed. All of them were recurrent variceal bleeding secondary to portal vein hypertension, 1 was bleeding secondary to primary hepatic carcinoma with port vein thrombus, and 1 was Budd-Chiari syndrome. They were followed-up after (10.1±4.6) months (2.0 to 24.0 months). Stent-grafts patancy, portal vein pressure and liver function were recorded and compared. Results: Twenty-five stent-grafts were successfully implanted in 21 patients, 23 stent grafts were 8 mm 2 were 10 mm in diameter. The covered length of the stents varied from 6 to 8 cm. The bleeding was stopped and the portal vein pressure decreased significantly from (25.4±3.5) mm Hg to (15.4±2.8) mm Hg (t= 12.495, P 0.05). Conclusion: The Fluency stent-grafts could increase the patency of the TIPS, but its efficacy on the long-term effect and hepatic encephalopathy need further investigation. (authors)

  2. The vein collar

    DEFF Research Database (Denmark)

    Lundgren, F; Schroeder, Torben Veith

    2012-01-01

    Randomized studies evaluating the effect of a vein collar at the distal anastomosis of PTFE-grafts show conflicting results. The study of the Joint Vascular Research Group (JVRG) of UK found improved primary patency while the Scandinavian Miller Collar Study (SCAMICOS) found neither any effect...

  3. Restoration of Failed Renal Graft Function After Successful Angioplasty of Pressure-Resistant Renal Artery Stenosis Using a Cutting Balloon: A Case Report

    International Nuclear Information System (INIS)

    Peregrin, J. H.; Buergelova, M.

    2009-01-01

    This study is the report of a 37-year-old male with a transplanted kidney from a 3.5-year-old donor: the graft had two arteries transplanted with an aortic patch to an external iliac artery. Four months after transplantation, the graft function deteriorated, together with the development of hypertension. Stenosis of both graft arteries was detected and the patient was referred for angioplasty. The angiographic result was suboptimal, nevertheless, the graft function improved and was more or less stable (serum creatinine, 160-200 μmol/l) for 4 years, along with persistently difficult-to-control hypertension. Five years after transplantation, the graft function deteriorated again and severe graft artery restenosis was detected. The restenosis did not respond to dilatation, graft function failed, hypertension decompensated, and left ventricular failure developed. The patient required dialysis. A cutting balloon angioplasty opened the artery, and kidney function was restored after a few days: the serum creatinine level dropped to 140-160 μmol/l, and the glomerular filtration rate (creatinine clearance) to 0.65 ml/min/1.73 m 2 . The graft function has now been stable for more than 2 years, however, the hypertension is still difficult to control.

  4. Cryoplasty for the Prevention of Arterial Restenosis

    International Nuclear Information System (INIS)

    Wildgruber, Moritz G.; Berger, Hermann J.

    2008-01-01

    Restenosis after percutaneous transluminal angioplasty remains the limiting factor for the long-term benefit of endovascular therapies of peripheral arterial occlusive disease. Despite a variety of modifications and adjuncts to angioplasty such as bare metal stents, covered stents, and drug-eluting stents as well as a number of new technologies like laser angioplasty and cutting balloon angioplasty, restenosis rates have not been significantly affected and remain inferior to those for surgery for long lesions in the femoropopliteal segment. Cryoplasty, which combines balloon angioplasty with the application of cryothermal energy to the vessel wall, was suggested as a promising approach to prevent the formation of neointimal hyperplasia after angioplasty procedures. This review discusses the basic principles of cryoplasty, summarizes the current data on restenosis rates after cryoplasty treatment, and evaluates cryoplasty as a new treatment method to solve the problems associated with restenosis development. The results of the clinical studies suggest that cryoplasty is a feasible and safe technique in the treatment of femoropopliteal disease, however, they have failed to prove any superiority of cryoplasty over conventional angioplasty.

  5. PX-18 Protects Human Saphenous Vein Endothelial Cells under Arterial Blood Pressure.

    Science.gov (United States)

    Kupreishvili, Koba; Stooker, Wim; Emmens, Reindert W; Vonk, Alexander B A; Sipkens, Jessica A; van Dijk, Annemieke; Eijsman, Leon; Quax, Paul H; van Hinsbergh, Victor W M; Krijnen, Paul A J; Niessen, Hans W M

    2017-07-01

    Arterial blood pressure-induced shear stress causes endothelial cell apoptosis and inflammation in vein grafts after coronary artery bypass grafting. As the inflammatory protein type IIA secretory phospholipase A 2 (sPLA 2 -IIA) has been shown to progress atherosclerosis, we hypothesized a role for sPLA 2 -IIA herein. The effects of PX-18, an inhibitor of both sPLA 2 -IIA and apoptosis, on residual endothelium and the presence of sPLA 2 -IIA were studied in human saphenous vein segments (n = 6) perfused at arterial blood pressure with autologous blood for 6 hrs. The presence of PX-18 in the perfusion blood induced a significant 20% reduction in endothelial cell loss compared to veins perfused without PX18, coinciding with significantly reduced sPLA 2 -IIA levels in the media of the vein graft wall. In addition, PX-18 significantly attenuated caspase-3 activation in human umbilical vein endothelial cells subjected to shear stress via mechanical stretch independent of sPLA 2 -IIA. In conclusion, PX-18 protects saphenous vein endothelial cells from arterial blood pressure-induced death, possibly also independent of sPLA 2 -IIA inhibition. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Endovascular brachytherapy to prevent restenosis after angioplasty

    International Nuclear Information System (INIS)

    Wohlgemuth, W.A.; Bohndorf, K.

    2003-01-01

    Endovascular radiotherapy is the first effective prophylaxis of restenosis after percutaneous transluminal angioplasty (PTA) and stenting. The FDA recently approved two devices for the delivery of intracoronary radiation following coronary artery stenting. Published multicenter, double-blind, randomized trials of intracoronary radiation therapy report good results for preventing in-stent restenosis, while the data for the peripheral circulation are still inconclusive. Beta-emitters are easier applicable and probably also safer, whereas gamma-emitters have been more extensively evaluated clinically so far. Primary indication for endovascular brachytherapy are patients at high risk for restenosis, such as previous restenoses, in-stent hyperplasia, long stented segment, long PTA lesion, narrow residual vascular lumen and diabetes. Data from coronary circulation suggest a safety margin of at least 4 to 10 mm at both ends of the angioplastic segment to avoid edge restenosis. To prevent late thrombosis of the treated coronary segment, antiplatelet therapy with clopidogrel and aspirin are recommended for at least 6 months after PTA and for 12 months after a newly implanted stent. An established medication regimen after radiotherapy of peripheral arteries is still lacking. (orig.) [de

  7. Complex left profunda femoris vein to renal vein bypass for the management of progressive chronic iliofemoral occlusion.

    Science.gov (United States)

    Anaya-Ayala, Javier E; Adams, Matthew K; Telich-Tarriba, Jose E; Dresser, Kelly L; Ismail, Nyla; Peden, Eric K

    2013-01-01

    Chronic occlusions of the inferior vena cava (IVC) and iliofemoral veins are long-term sequelae of deep venous thrombosis (DVT) that can lead to postthrombotic syndrome (PTS). Patients may present with a wide spectrum of signs and symptoms, ranging from mild discomfort and swelling to severe venous hypertension and ulcerations. We report a 68-year-old man who had a history of left lower extremity DVT after a laminectomy and who developed PTS with nonhealing ulcers. The patient underwent a cross-pubic femorofemoral venous bypass that failed to improve his clinical status. After unsuccessful endovascular attempts for recanalization of the iliofemoral segment, a profunda femoris to IVC bypass was performed. The symptoms recurred 2 years later. Venography revealed restenosis at the caval anastomosis that did not resolve by endovascular means. A surgical revision was performed, and given the quality of the IVC, a jump bypass was created to the left renal vein. The swelling improved and the ulcers healed completely. Twenty-eight months after the complex reconstructions, he remains ulcer-free with mild edema controlled with stockings. Venous reconstructions remain a viable option for patients with symptomatic and recalcitrant nonmalignant obstruction of the large veins. Copyright © 2013 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  8. Continuous Perfusion of Saphenous Vein by Oxygenated Blood during Beating Coronary Surgery

    Directory of Open Access Journals (Sweden)

    Mohammad Hossein Mandegar

    2015-09-01

    Full Text Available Background: The saphenous vein remains the most commonly used conduit for coronary artery bypass surgery (CABG. However, the long-term success of surgical revascularization is largely limited by development of occlusion in vein grafts. Objectives: We sought to reduce graft ischemia by maintaining the blood flow into the harvested vein throughout surgery at lowest costs and without special devices. Patients and Methods: This study was conducted on three hundred patients aged 58.5 ± 8 years undergoing elective first-time off-pump CABG with saphenous veins. Results: In addition to preserving nutritional materials and oxygen, the veins harvested via this novel technique did not go into spasm and were not subjected to high-pressure distension, eventually resulting in minimal damage to the endothelium. Conclusions: This technique confers favorable myocardial function and protection in the presence of left ventricular dysfunction, especially in elderly patients.

  9. Restenosis Prevention Using Photon External Beam Radiation

    International Nuclear Information System (INIS)

    Goldstein, M.

    2002-01-01

    During transluminal coronary angioplasty, the balloon procedure is designed to crush the plaque and to support the weakened arterial wall by using the stent (an expandable metallic mesh). This procedure often tears the arterial wall as well. Some of the cells in the blood vessel respond to this injury by initiating repair which often leads to restenosis (reclosing) of the artery. In many cases restenosis occur despite the stent which become incorporated into the poliferative tissue that form around the lesion. But if the lesion is treated with radiation (8-30 Gy) the restenosis effect is inhibited. In this paper, the Adjoint Monte Carlo (AMC) method is used for external radiation treatment planning of the stent volume (the volume covered by the stent during a full cardiac cycle), while minimizing the damage to the organs at risk (OAR) and surrounding healthy tissue

  10. Prevention of postcoronary angioplasty restenosis by omega-3 fatty acids: main results of the Esapent for Prevention of Restenosis ITalian Study (ESPRIT).

    Science.gov (United States)

    Maresta, Aleardo; Balduccelli, Marco; Varani, Elisabetta; Marzilli, Mario; Galli, Claudio; Heiman, Franca; Lavezzari, Maurizio; Stragliotto, Eduardo; De Caterina, Raffaele

    2002-06-01

    Previous trials of omega-3 fatty acids (omega-3 FA) for restenosis prevention after percutaneous transluminal coronary angioplasty (PTCA) have yielded conflicting results. We tested the hypothesis that long-term administration of omega-3 FA before PTCA may have significant effects on restenosis. We randomized 339 patients in a double-blind, placebo-controlled study of omega-3 FA (as an ethyl ester preparation given as 6 1-g capsules providing 3 g eicosapentaenoic acid and 2.1 g docosahexaenoic acid/d started 1 month before PTCA and given for 1 month thereafter, then continued at half-dose for 6 months) versus an olive oil placebo. Of these, 257 patients (125 on omega-3 FA, 132 on placebo) well matched for risk factors underwent successful balloon-only PTCA (280 total lesions) and were evaluable at 6 months with repeat angiography. Restenosis was defined at quantitative angiography as a recurrence of >50% diameter stenosis in the dilated vessel (Definition I) and as >50% loss of the short-term gain immediately after PTCA (Definition II). Restenosis rates per vessel were 29.4% and 31.6% in the omega-3 FA group, and 39.6% and 35.4% in the placebo group according to Definitions I (P =.04) and II (P = not significant), respectively. Restenosis rates per patient were 31.2% and 33.6% in the omega-3 FA group, and 40.9% and 37.1% in the placebo group according to Definitions I (P =.05) and II (P = not significant), respectively. With a long treatment before PTCA, omega-3 FA produced a small but significant decrease in the restenosis rate compared with placebo.

  11. [Portal perfusion with right gastroepiploic vein flow in liver transplant].

    Science.gov (United States)

    Mendoza-Sánchez, Federico; Javier-Haro, Francisco; Mendoza-Medina, Diego Federico; González-Ojeda, Alejandro; Cortés-Lares, José Antonio; Fuentes-Orozco, Clotilde

    Liver transplantation in patients with liver cirrhosis, portal vein thrombosis, and cavernous transformation of the portal vein, is a complex procedure with high possibility of liver graft dysfunction. It is performed in 2-19% of all liver transplants, and has a significantly high mortality rate in the post-operative period. Other procedures to maintain portal perfusion have been described, however there are no reports of liver graft perfusion using right gastroepiploic vein. A 20 year-old female diagnosed with cryptogenic cirrhosis, with a Child-Pugh score of 7 points (class "B"), and MELD score of 14 points, with thrombosis and cavernous transformation of the portal vein, severe portal hypertension, splenomegaly, a history of upper gastrointestinal bleeding due to oesophageal varices, and left renal agenesis. The preoperative evaluation for liver transplantation was completed, and the right gastroepiploic vein of 1-cm diameter was observed draining to the infrahepatic inferior vena cava and right suprarenal vein. An orthotopic liver transplantation was performed from a non-living donor (deceased on January 30, 2005) using the Piggy-Back technique. Portal vein perfusion was maintained using the right gastroepiploic vein, and the outcome was satisfactory. The patient was discharged 13 days after surgery. Liver transplantation was performed satisfactorily, obtaining an acceptable outcome. In this case, the portal perfusion had adequate blood flow through the right gastroepiploic vein. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  12. The Short Saphenous Vein: A Viable Alternative Conduit for ...

    African Journals Online (AJOL)

    This novel position allowed for two members of the surgical team to operate at the same time, thus ... along the ultrasound-marked vein positions similar to when harvesting the LSV. Once the veins were harvested and ... occlusion compared to LSV grafts utilized in the same procedure,[8] it was brought back to prominence ...

  13. Drug-eluting stents appear superior to bare metal stents for vein-graft PCI in vessels up to a stent diameter of 4 mm

    Directory of Open Access Journals (Sweden)

    Oliver P. Guttmann

    2016-05-01

    Full Text Available BackgroundResearch trials have shown improved short-term outcome with drug-eluting stents (DES over bare metal stents (BMS in saphenous vein graft (SVG percutaneous coronary intervention (PCI, primarily by reducing target vessel revascularization (TVR for in-stent restenosis. We compared the outcomes in patients undergoing SVG stent implantation treated with DES or BMS. In exploratory analyses we investigated the influence of stent generation and diameter.MethodsData were obtained from a prospective database of 657 patients who underwent PCI for SVG lesions between 2003 and 2011. A total of 344 patients had PCI with BMS and 313 with DES. Propensity scores were developed based on 15 observed baseline covariates in a logistic regression model with stent type as the dependent variable. The nearest-neighbour-matching algorithm with Greedy 5-1 Digit Matching was used to produce two patient cohorts of 313 patients each. We assessed major adverse cardiac events (MACE out to a median of 3.3 years (interquartile range: 2.1-4.1. MACE was defined as all-cause mortality, myocardial infarction (MI, TVR and stroke.ResultsThere was a significant difference in MACE between the two groups in favour of DES (17.9% DES vs. 31.2% BMS group; p = 0.0017 over the 5-year follow-up period. MACE was driven by increased TVR in the BMS group. There was no difference in death, MI or stroke. Adjusted Cox analysis confirmed a decreased risk of MACE for DES compared with BMS 0.75 (95% confidence interval (CI 0.52-0.94, with no difference in the hazard of all-cause mortality (hazard ratio: 1.08; 95% CI: 0.77-1.68. However, when looking at stent diameters greater than 4 mm, no difference was seen in MACE rates between BMS and DES.ConclusionsOverall in our cohort of patients who had PCI for SVG disease, DES use resulted in lower MACE rates compared with BMS over a 5-year follow-up period; however, for stent diameters over 4 mm no difference in MACE rates was seen.

  14. Predicting late restenosis after coronary angioplasty by very early (12 to 24 h) thallium-201 scintigraphy: Implications with regard to mechanisms of late coronary restenosis

    International Nuclear Information System (INIS)

    Hardoff, R.; Shefer, A.; Gips, S.; Merdler, A.; Flugelman, M.Y.; Halon, D.A.; Lewis, B.S.

    1990-01-01

    To examine whether late coronary restenosis may be predicted by abnormalities of myocardial perfusion in the early hours after successful percutaneous transluminal coronary angioplasty and to study in greater detail the mechanisms involved in the development of late coronary restenosis after angioplasty, a prospective study was undertaken in 90 consecutive patients. Thallium-201 scintigrams were recorded at rest and during the stress of atrial pacing, 12 to 24 h after angioplasty, and the results were related to the findings at angiography in 70 patients undergoing late cardiac catheterization. A reversible thallium-201 perfusion defect was found in 39 (38%) of 104 myocardial regions supplied by the dilated coronary vessel and identified a subset of patients at high risk of late (6 to 12 months) angiographic restenosis (sensitivity 77%, specificity 67%). In contrast, late coronary restenosis developed in only 7 (11%) of 65 vessels and in 5 (14%) of 37 patients with a nonischemic thallium-201 scintigram on day 1 (p less than 0.005). Multivariate logistic regression analysis of 14 possible preangioplasty and periangioplasty clinical and angiographic variables selected reversible perfusion defect on the thallium-201 scintigram on day 1 (p = 0.016) and immediate postangioplasty residual coronary narrowing (p = 0.004) as significant independent predictors of late restenosis, with younger patient age as an additional less powerful predictor (p less than 0.05). The findings have important implications regarding the pathogenesis of late coronary restenosis in patients undergoing successful angioplasty and they imply that in the majority of these patients pathophysiologic events in the early minutes and hours after angioplasty may determine the development of late restenosis

  15. Modelling and simulating in-stent restenosis with complex automata

    NARCIS (Netherlands)

    Hoekstra, A.G.; Lawford, P.; Hose, R.

    2010-01-01

    In-stent restenosis, the maladaptive response of a blood vessel to injury caused by the deployment of a stent, is a multiscale system involving a large number of biological and physical processes. We describe a Complex Automata Model for in-stent restenosis, coupling bulk flow, drug diffusion, and

  16. CMR diagnosis of coronary graft fistula

    Directory of Open Access Journals (Sweden)

    Bengt Johansson

    2014-01-01

    Full Text Available The patient is a 54-year old man with a previous history of cerebral aqueduct stenosis and hydrocephalus resulting in malignant hypertension who had surgery for permanent ventriculo-peritoneal shunt. At age 41, he had coronary artery bypass graft (CABG surgery with the right internal mammary artery anastomosed to the posterior descending artery and a saphenous vein graft to the first obtuse marginal branch. The patient was recently admitted with pneumonia that rapidly deteriorated and he went in respiratory failure requiring mechanical ventilation. A thoracic CT investigation showed massive bilateral pulmonary infiltrates, pulmonary artery embolism and a large vein graft aneurysm with a maximal diameter of 40 mm (Figure 1 A-B. The management course was complicated with prolonged respiratory failure, persistent infection, despite negative cultures and extended hospital stay. After 50 days of slow recovery the patient was discharged with a need for home oxygen therapy. Ten days later, he was re-admitted with chest pain requiring admission to the coronary care unit where severe pulmonary hypertension was diagnosed with Doppler echocardiography. Troponin-T was mildly elevated, 1,3 ug/L (ref <0,01, CRP was 50 mg/L and chest X-ray showed bilateral lung infiltrates and wide pulmonary vessels. At this point a systo-diastolic murmur was heard at the left lower sternal edge. With a view of potential coronary reintervention and to evaluate the pulmonary hypertension, a coronary angiogram and a pulmonary artery cathetherisation were performed. This showed a new stenosis in the left anterior descending coronary artery and the pulmonary catheterisation showed a “step-up” in oxygen saturation in the pulmonary artery, suggesting a left-to-right shunt. The vein graft aneurysm did not contribute to the coronary circulation. A cardiovascular magnetic resonance scan revealed a communication between the vein graft aneurysm and the left branch pulmonary artery

  17. Use of Reactor-Produced Radioisotopes for Prevention Restenosis After Angioplasty

    International Nuclear Information System (INIS)

    Knapp, F.F.; Pipes, D.W.

    1999-01-01

    Coronary heart disease leads to myocardial infarction and is a major cause of death in the US. Myocardial infarctions result from atherosclerotic plaque deposits in the coronary arteries, reducing blood flow through these arteries which supply oxygen and nutrients to the heart muscle. The two major approaches for restoring adequate blood flow are coronary bypass graft surgery and coronary angioplasty. Angioplasty is a routinely used clinical procedure, where a deflated balloon attached to the end of a long catheter is inserted into an artery in the leg and then advanced through the aorta into the blocked regions of the coronary arteries. After positioning in the occluded region of the artery, the balloon is inflated with a pressurized saline solution which opens the artery restoring blood flow by pressing the atherosclerotic plaque into the vessel wall. Angioplasty is a widely performed procedure with the coronary arteries and is a much less expensive alternative to coronary bypass surgery. The best patients for angioplasty are those with single occlusions and this method is preferred over bypass grafting because of the significantly reduced expense. The reformation of plaque deposits in arteries (restenosis) following angioplasty, however, is a major clinical problem encountered in as high as 40 percent of patients. Because reduction of health care costs is a major national priority, development of effective new preventative methods for restenoses is an important national priority

  18. Restenosis: A Challenge to Angioplasty

    Indian Academy of Sciences (India)

    Smooth muscle cells from the internal elastic membrane and ... atherosclerosis. In addition to LDL other risk factors for athero- ... The present management of restenosis is ... lumen, while the control artery had developed stenosis (Figure 5).

  19. On the Possible Interaction Mechanism between Collateral Vessels and Restenosis

    NARCIS (Netherlands)

    Zun, P.S.; Hoekstra, A.G.

    2015-01-01

    Several clinical studies and their meta-analysis suggest that developed collateral vessels in the heart correlate to an increased risk of in-stent restenosis. The possible physiological interaction between the collateral development and in-stent restenosis is investigated in this study. Based on

  20. Quantification of in-stent restenosis parameters in rabbits by micro-CT

    International Nuclear Information System (INIS)

    Langheinrich, A.C.; Zoerb, C.; Jajima, J.; Lommel, D.; Rau, W.S.; Walker, G.; Mueller, K.M.; Bohle, R.M.

    2005-01-01

    Purpose: The well-defined model of angioplasty and stent implantation in the rabbit aorta is useful in experimental studies of restenosis. This study was performed to evaluate the feasibility of Micro-CT for quantification of in-stent restenosis in a rabbit aortic in-stent restenosis model. Material and Methods: To induce in-stent restenosis seven female New Zealand rabbits underwent balloon dilation and denudation prior to stenting the abdominal aorta. After six weeks on atherogenic diet, animals were killed and the aorta was perfused with contrast agent. Micro-CT morphometric analysis of balloon and stent injured arteries obtained by 700 transverse sections (voxel size 10 μm) was compared to conventional histological analysis. Results: Intimal hyperplasia was present in stented and balloon injured arteries with a moderate intimal area assessed by Micro-CT and conventional histology (3.91±0.5 mm 2 vs. 4.18±0.42; r=0.9). High significant correlations between Micro-CT image analysis and conventional histomorphometry were obtained for lesion size, size of media, size of lumen and stent area (r=0.84 to 0.96). Conclusion: Micro-CT is feasible for quantitative information about restenosis following balloon angioplasty and stent implantation and has the potential to become a standard technique in many laboratories which will augment serial histology as the reference method for ex-vivo studies of restenosis. (orig.)

  1. Straight configuration saphenous vein transposition to popliteal artery for vascular access.

    Science.gov (United States)

    Caco, Gentian; Golemi, Dhurata; Likaj, Eriola

    2017-03-21

    The saphenous vein is commonly used as a vascular graft in peripheral artery surgery but rarely used for vascular access. The literature on straight configuration saphenous vein transposition to the popliteal artery is scarce. Here we present two cases of straight configuration saphenous vein transposition to the popliteal artery for vascular access, the surgical technique and respective follow-up. Two young men, aged 29 and 36 years, were chosen for lower-limb vascular access for hemodialysis. The first patient was paraplegic since birth. He used his arms to move so upper extremity vascular access was avoided. The second patient presented with an infected upper extremity arteriovenous graft (AVG) and after multiple closed AVFs he had no more available arm veins. Both patients received autologous lower extremity straight configuration saphenous vein transpositions to the popliteal artery under spinal anesthesia in May and October 2012, respectively. Cannulation of the fistula was allowed after one month. There were no early complications. Slight swelling on the leg appeared in one of the patients. Both fistulas were still functional after 36 and 32 months, respectively. The straight configuration saphenous vein transposition to popliteal artery is simple to perform, offers a long and straight segment for cannulation and may be a suitable autologous vascular access in selected patients.

  2. Drug eluting stents and modern stent technologies for in-stent restenosis.

    Science.gov (United States)

    Werner, Martin

    2017-08-01

    The implantation of metallic stents has become a standard procedure to improve the outcome after angioplasty of peripheral vessels. However, the occurrence of in-stent restenosis is hampering the long-term efficacy of these procedures and is associated with re-occurrence of symptoms. The optimal treatment modality for in-stent-restenosis in the peripheral vasculature is not well examined. This review discusses the existing evidence for the treatment of in-stent restenosis with drug eluting stents and modern stent technologies.

  3. Early Outcomes of Endoscopic Vein Harvesting during the Initial Learning Period

    Directory of Open Access Journals (Sweden)

    Do Yeon Kim

    2015-06-01

    Full Text Available Background: The endoscopic vein harvesting (EVH method has been used in coronary artery bypass surgery in many countries. We started using the EVH method recently, and investigated the results during the early learning period. Methods: Between March 2012 and June 2014, 75 patients (31 patients in the EVH method group, and 44 patients in the open method group who underwent isolated first-time coronary artery bypass grafting using vein grafts were retrospectively analyzed with respect to the early outcomes including graft patency and risk factors for leg wound complications. For assessing the patency of vein graft, we performed coronary computed tomography angiography during the immediate postoperative period and 6 months later. Results: Mean harvesting time of endoscopic method was about 15 minutes. Patency rate during the immediate operative period and the 6-month patency rate were similar between the two groups (postoperative period: EVH 100% vs. open method 94.4%, p=0.493; at 6 months: EVH 93.3% vs. open method 90.9%, p=0.791. Leg wound complications occurred more frequently in the open method group (EVH 3.2% vs. open method 13.6%, p=0.127. According to the analysis, age was an independent risk factor for leg wound complications. Conclusion: EVH is a feasible method even for beginners and can be performed satisfactorily during their learning period.

  4. Percutaneous Selective Embolectomy using a Fogarty Thru-Lumen Catheter for Pancreas Graft Thrombosis: A Case Report

    International Nuclear Information System (INIS)

    Izaki, Kenta; Yamaguchi, Masato; Matsumoto, Ippei; Shinzeki, Makoto; Ku, Yonson; Sugimura, Kazuro; Sugimoto, Koji

    2011-01-01

    A 57-year-old woman with a history of diabetes mellitus underwent simultaneous pancreas–kidney transplantation. The pancreaticoduodenal graft was implanted in the right iliac fossa. The donor’s portal vein was anastomosed to the recipient’s inferior vena cava (IVC). Seven days after the surgery, a thrombus was detected in the graft veins. Percutaneous thrombolysis was immediately performed; however, venous congestion was still present. We therefore attempted selective embolectomy using a Fogarty Thru-Lumen Catheter. Thrombi were directed from the graft veins toward the IVC and captured in the IVC filter with complete elimination of the thrombus without any major complications. We present our technique for the successful treatment of pancreas graft thrombosis within a short time period by percutaneous selective embolectomy using a Fogarty Thru-Lumen Catheter.

  5. Late-onset renal vein thrombosis: A case report and review of the literature.

    Science.gov (United States)

    Hogan, Jessica L; Rosenthal, Stanton J; Yarlagadda, Sri G; Jones, Jill A; Schmitt, Timothy M; Kumer, Sean C; Kaplan, Bruce; Deas, Shenequa L; Nawabi, Atta M

    2015-01-01

    Renal vein thrombosis, a rare complication of renal transplantation, often causes graft loss. Diagnosis includes ultrasound with Doppler, and it is often treated with anticoagulation or mechanical thrombectomy. Success is improved with early diagnosis and institution of treatment. We report here the case of a 29 year-old female with sudden development of very late-onset renal vein thrombosis after simultaneous kidney pancreas transplant. This resolved initially with thrombectomy, stenting and anticoagulation, but thrombosis recurred, necessitating operative intervention. Intraoperatively the renal vein was discovered to be compressed by a large ovarian cyst. Compression of the renal vein by a lymphocele or hematoma is a known cause of thrombosis, but this is the first documented case of compression and thrombosis due to an ovarian cyst. Early detection and treatment of renal vein thrombosis is paramount to restoring renal allograft function. Any woman of childbearing age may have thrombosis due to compression by an ovarian cyst, and screening for this possibility may improve long-term graft function in this population. Published by Elsevier Ltd.

  6. Pancreas Transplant Venous Thrombosis: Role of Endovascular Interventions for Graft Salvage

    International Nuclear Information System (INIS)

    Stockland, Andrew H.; Willingham, Darrin L.; Paz-Fumagalli, Ricardo; Grewal, Hani P.; McKinney, J. Mark; Hughes, Christopher B.; Walser, Eric M.

    2009-01-01

    Venous thrombosis of pancreas transplant allografts often leads to graft loss. We evaluated the efficacy of emergent endovascular techniques to salvage thrombosed pancreatic allografts in a series of six patients. Of the 76 pancreas transplants performed between 2002 and 2006, six patients were diagnosed with venous thrombosis on MRI between 2 and 28 days posttransplant (mean, 9 days). Five patients were systemic-enteric (donor portal vein anastomosis to recipient iliac vein) and one patient was portal-enteric (donor portal vein anastomosis to recipient superior mesenteric vein). Conventional venography confirmed the diagnosis of venous thrombosis in all patients. One patient was treated with catheter-directed venous thrombolysis and balloon thrombectomy. Another patient was treated with rheolytic thrombectomy alone. The remaining four patients were treated with a combination of these mechanical and thrombolytic techniques. Completion venography revealed >50% clot reduction and resumption of venous drainage in all patients. One patient required additional intervention 16 days later for recurrent thrombosis. Two patients required metal stent placement for anastomotic stenoses or kinks. One patient required pancreatectomy 36 h after attempted salvage secondary to a major hemorrhage and graft necrosis. Two patients recovered pancreatic function initially but lost graft function at 8 and 14 months, respectively, from severe chronic rejection. Patient survival was 100%, long-term graft survival was 50%, rethrombosis rate was 16.6%, and graft loss from rejection was 33%. In conclusion, early recognition and treatment of venous thrombosis after pancreas transplantation has acceptable morbidity and no mortality using short-term endovascular pharmacomechanical therapy.

  7. Early aneurysmal degeneration of femoral vein conduit used for aortoiliac reconstruction in a child

    Directory of Open Access Journals (Sweden)

    Zakariyae Bouziane, MD

    2016-09-01

    Full Text Available We report the case of a 14-year-old boy who underwent an aortobi-iliac bypass with a femoral vein graft. The patient presented with early aneurysmal degeneration of the entire venous graft only 11 months later. He was treated successfully with redo abdominal aortic surgery and a bifurcated Dacron graft.

  8. Midterm Experience of Ipsilateral Axillary-Axillary Arteriovenous Loop Graft as Tertiary Access for Haemodialysis

    Directory of Open Access Journals (Sweden)

    J. P. Hunter

    2014-01-01

    Full Text Available Objectives. To present a series of ipsilateral axillary artery to axillary vein loop arm grafts as an alternative vascular access procedure for haemodialysis in patients with difficult access. Design. Retrospective case series. Methods. Patients who underwent an axillary loop arteriovenous graft from September 2009 to September 2012 were included. Preoperative venous imaging to exclude central venous stenosis and to image arm/axillary veins was performed. A cuffed PTFE graft was anastomosed to the distal axillary artery and axillary vein and looped on the arm. Results. 25 procedures were performed on 22 patients. Median age was 51 years, with 9 males and 13 females. Median number of previous access procedures was 3 (range 0–7. Median followup was 16.4 months (range 1–35. At 3 months and 1 year, the primary and secondary patency rates were 70% and 72% and 36% and 37%, respectively. There were 11 radiological interventions in 6 grafts including 5 angioplasties and 6 thrombectomies. There were 19 surgical procedures in 10 grafts, including thrombectomy, revision, repair for bleeding, and excision. Conclusions. Our series demonstrates that the axillary loop arm graft yields acceptable early patency rates in a complex group of patients but to maintain graft patency required high rates of surgical and radiological intervention, in particular graft thrombectomy.

  9. Quantification of deposition of neutrophilic granulocytes on vascular grafts in dogs with 111In-labeled granulocytes

    International Nuclear Information System (INIS)

    Dewanjee, M.K.; Solis, E.; Mackey, S.T.; Socher, S.; Chowdhury, S.; Wu, F.P.; Kaye, M.P.

    1985-01-01

    A new radioisotopic technique has been developed for quantification of deposition of neutrophilic granulocytes on vascular grafts. Nine healthy mongrel dogs underwent bilateral femoral artery resection and reconstruction with grafts of the femoral vein and Gore-Tex. Pure granulocytes that had been separated from whole blood by centrifugal elutriation were labeled with 111 In-tropolone in plasma. The granulocyte harvesting efficiency was 25 +/- 12%, and the labeling efficiency was 87 +/- 7%. Three hours after injection of labeled granulocytes and 2 hours after reperfusion, the grafts were harvested and cut into several segments for study of areas of anastomoses and midsections. On the basis of the radioactivity in the blood and in anastomotic and graft sections, the area of graft sections, and the neutrophilic granulocyte and differential leukocyte counts, the number of neutrophilic granulocytes adherent to a unit area and the total number of neutrophilic granulocytes on graft sections were calculated. These quantifications of the deposition of neutrophilic granulocytes indicated that the midsections of Gore-Tex grafts retained more neutrophilic granulocytes than did the midsections of vein grafts. Although the anastomotic areas retained more neutrophilic granulocytes than did the midsections of vein grafts, the opposite finding prevailed for the Gore-Tex grafts. A major fraction of neutrophilic granulocytes on Gore-Tex grafts was incorporated into the thrombus. Semiquantitative information obtained by scintigraphy of the deposition of neutrophilic granulocytes on vascular grafts also confirmed this observation

  10. Bypass grafting to the anterior tibial artery.

    Science.gov (United States)

    Armour, R H

    1976-01-01

    Four patients with severe ischaemia of a leg due to atherosclerotic occlusion of the tibial and peroneal arteries had reversed long saphenous vein grafts to the patent lower part of the anterior tibial artery. Two of these grafts continue to function 19 and 24 months after operation respectively. One graft failed on the fifth postoperative day and another occluded 4 months after operation. The literature on femorotibial grafting has been reviewed. The early failure rate of distal grafting is higher than in the case of femoropopliteal bypass, but a number of otherwise doomed limbs can be salvaged. Contrary to widely held views, grafting to the anterior tibial artery appears to give results comparable to those obtained when the lower anastomosis is made to the posterior tibial artery.

  11. Coated stents to prevent restenosis in coronary heart disease

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2005-11-01

    Full Text Available Background: In-stent-restenosis (ISR is considered to be an essential limiting factor of stenting in coronary heart disease (CHD. The development of coated stents has raised expectations on substantial lowering restenosis after stenting with decreasing the rate of restenosis and a reduction in the rate of clinical events. Objectives: The present analysis addresses the questions on medical effectiveness and cost-effectiveness of the use of various coated stent types in CHD. Methods: The literature was searched in December 2004 in the most relevant medical and economic databases. The medical evaluation was conducted on the basis of published RCT. The data from the studies regarding various angiographic, sonographic and clinical endpoints were checked for methodical quality and summarised in meta-analyses. Within the scope of economic evaluation the primary studies were analysed and modelling was performed, applying clinical effect estimates from the meta-analyses of the medical evaluation and current estimates of German costs. Results: Medical evaluation: Ten different stenttypes were used in the included 26 RCT. The results for heparin, silicon-carbide, carbon and PTFE coated stenttypes could not reveal any significant differences between the medical effectiveness of coated and uncoated stents. The application of sirolimus, paclitaxel, everolimus and 7-hexanoyltaxol eluting stents showed a significant lower restenosis at 6-9 months with decrease in the rate of restenosis for polymer-based sirolimus, paclitaxel and 7-hexanoyltaxol eluting stents. In contrast, the use of gold-coated and actinomycin-D eluting stents was associated with a significantly higher restenosis. The polymer-based sirolimus and paclitaxel eluting stents also showed a significant and considerable reduction in the rate of repeated percutaneous revascularisations at 6-12 months (3.5% vs. 19.7%; p<0.0001, RR=0.19 [95%CI: 0.11; 0.33] and 3.5% vs. 12.2%; p<0.0001, RR=0.30 [95%CI: 0

  12. Saphenous vein graft thrombus findings by scanning electron microscopy in a patient with acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Marcela Dias; Aguillera, André Haraguti [Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP (Brazil); Brilhante, José Joaquim; Caixeta, Adriano [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil)

    2013-07-01

    An eighty-year-old male patient with a history of prior (19 years) coronary artery bypass graft surgery was admitted to the hospital with non ST-segment elevation myocardial infarction (NSTEMI). During the hospital stay he was taking acetylsalicylic acid 100mg per day, a loading dose of 600mg clopidogrel, and low molecular weight heparin 1mg/kg twice a day. Twenty-four hours later the patient underwent coronary angiography, which showed a 90% obstruction in the mid portion of the saphenous vein graft to obtuse marginal with signs of degeneration and local thrombus (Figure 1). Thrombus aspiration was performed with a 6-Fr Export{sup ™} catheter (Medtronic, Santa Rosa, CA, USA), which removed small reddish colored fragments. They were fixed in 2,5% glutaraldehyde in a 0.1M sodium cacodilate buffer. The material was processed following the GOTO protocol in which the fragments were washed with osmium tetroxide and titanic acid, after which they were dried in a critical-point device and a golden bath. Scanning electron microscopy and high definition photos (3,000 to 27,221x magnification) were obtained by the FEI Quanta{sup ™} FEG SEM device (FEI Company, Hillsboro, OR, USA). The images showed that the thrombus was rich in activated platelets, with few erythrocytes or inflammatory cells. Many cholesterol crystals were observed (Figures 2 to). The fibrin networks were sparse and thin, which is compatible with a short ischemic time and recent thrombus formation.

  13. Saphenous vein graft thrombus findings by scanning electron microscopy in a patient with acute myocardial infarction

    International Nuclear Information System (INIS)

    Borges, Marcela Dias; Aguillera, André Haraguti; Brilhante, José Joaquim; Caixeta, Adriano

    2013-01-01

    An eighty-year-old male patient with a history of prior (19 years) coronary artery bypass graft surgery was admitted to the hospital with non ST-segment elevation myocardial infarction (NSTEMI). During the hospital stay he was taking acetylsalicylic acid 100mg per day, a loading dose of 600mg clopidogrel, and low molecular weight heparin 1mg/kg twice a day. Twenty-four hours later the patient underwent coronary angiography, which showed a 90% obstruction in the mid portion of the saphenous vein graft to obtuse marginal with signs of degeneration and local thrombus (Figure 1). Thrombus aspiration was performed with a 6-Fr Export"™ catheter (Medtronic, Santa Rosa, CA, USA), which removed small reddish colored fragments. They were fixed in 2,5% glutaraldehyde in a 0.1M sodium cacodilate buffer. The material was processed following the GOTO protocol in which the fragments were washed with osmium tetroxide and titanic acid, after which they were dried in a critical-point device and a golden bath. Scanning electron microscopy and high definition photos (3,000 to 27,221x magnification) were obtained by the FEI Quanta"™ FEG SEM device (FEI Company, Hillsboro, OR, USA). The images showed that the thrombus was rich in activated platelets, with few erythrocytes or inflammatory cells. Many cholesterol crystals were observed (Figures 2 to). The fibrin networks were sparse and thin, which is compatible with a short ischemic time and recent thrombus formation

  14. Magnetizable stent-grafts enable endothelial cell capture

    Science.gov (United States)

    Tefft, Brandon J.; Uthamaraj, Susheil; Harburn, J. Jonathan; Hlinomaz, Ota; Lerman, Amir; Dragomir-Daescu, Dan; Sandhu, Gurpreet S.

    2017-04-01

    Emerging nanotechnologies have enabled the use of magnetic forces to guide the movement of magnetically-labeled cells, drugs, and other therapeutic agents. Endothelial cells labeled with superparamagnetic iron oxide nanoparticles (SPION) have previously been captured on the surface of magnetizable 2205 duplex stainless steel stents in a porcine coronary implantation model. Recently, we have coated these stents with electrospun polyurethane nanofibers to fabricate prototype stent-grafts. Facilitated endothelialization may help improve the healing of arteries treated with stent-grafts, reduce the risk of thrombosis and restenosis, and enable small-caliber applications. When placed in a SPION-labeled endothelial cell suspension in the presence of an external magnetic field, magnetized stent-grafts successfully captured cells to the surface regions adjacent to the stent struts. Implantation within the coronary circulation of pigs (n=13) followed immediately by SPION-labeled autologous endothelial cell delivery resulted in widely patent devices with a thin, uniform neointima and no signs of thrombosis or inflammation at 7 days. Furthermore, the magnetized stent-grafts successfully captured and retained SPION-labeled endothelial cells to select regions adjacent to stent struts and between stent struts, whereas the non-magnetized control stent-grafts did not. Early results with these prototype devices are encouraging and further refinements will be necessary in order to achieve more uniform cell capture and complete endothelialization. Once optimized, this approach may lead to more rapid and complete healing of vascular stent-grafts with a concomitant improvement in long-term device performance.

  15. Coronary collaterals and risk for restenosis after percutaneous coronary interventions: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Meier Pascal

    2012-06-01

    Full Text Available Abstract Background The benefit of the coronary collateral circulation (natural bypass network on survival is well established. However, data derived from smaller studies indicates that coronary collaterals may increase the risk for restenosis after percutaneous coronary interventions. The purpose of this systematic review and meta-analysis of observational studies was to explore the impact of the collateral circulation on the risk for restenosis. Methods We searched the MEDLINE, EMBASE and ISI Web of Science databases (2001 to 15 July 2011. Random effects models were used to calculate summary risk ratios (RR for restenosis. The primary endpoint was angiographic restenosis > 50%. Results A total of 7 studies enrolling 1,425 subjects were integrated in this analysis. On average across studies, the presence of a good collateralization was predictive for restenosis (risk ratio (RR 1.40 (95% CI 1.09 to 1.80; P = 0.009. This risk ratio was consistent in the subgroup analyses where collateralization was assessed with intracoronary pressure measurements (RR 1.37 (95% CI 1.03 to 1.83; P = 0.038 versus visual assessment (RR 1.41 (95% CI 1.00 to 1.99; P = 0.049. For the subgroup of patients with stable coronary artery disease (CAD, the RR for restenosis with 'good collaterals' was 1.64 (95% CI 1.14 to 2.35 compared to 'poor collaterals' (P = 0.008. For patients with acute myocardial infarction, however, the RR for restenosis with 'good collateralization' was only 1.23 (95% CI 0.89 to 1.69; P = 0.212. Conclusions The risk of restenosis after percutaneous coronary intervention (PCI is increased in patients with good coronary collateralization. Assessment of the coronary collateral circulation before PCI may be useful for risk stratification and for the choice of antiproliferative measures (drug-eluting stent instead bare-metal stent, cilostazol.

  16. Antiplatelet drug selection in PCI to vein grafts in patients with acute coronary syndrome and adverse clinical outcomes

    DEFF Research Database (Denmark)

    Sirker, Alex; Kwok, Chun Shing; Kontopantelis, Evangelos

    2018-01-01

    OBJECTIVE: This study aims to evaluate outcomes associated with different P2Y12 agents in Saphenous Vein graft (SVG) percutaneous coronary intervention (PCI). BACKGROUND: SVG PCI is associated with greater risks of ischemic complications, compared with native coronary PCI. Outcomes associated...... with the use of potent P2Y12 blocking drugs, Prasugrel and Ticagrelor, in SVG PCI are unknown. METHODS: Patients included in the study underwent SVG PCI in the United Kingdom between 2007 and 2014 for acute coronary syndrome and were grouped by P2Y12 antiplatelet use. In-hospital major adverse cardiac events....... CONCLUSIONS: Our real world national study provides no clear evidence to indicate that use of potent P2Y12 blockers in SVG PCI is associated with improved clinical outcomes....

  17. Implantation of Right Kidneys: Is the Risk of Technical Graft Loss Real?

    Science.gov (United States)

    Khan, Taqi T; Ahmad, Nadeem; Siddique, Kashif; Fourtounas, Konstantinos

    2018-05-01

    The left kidney (LK) is preferred by transplant surgeons, because its vein is always of good length and has a thick wall that enables safe suturing. On the other hand, the right renal vein is generally shorter and thinner walled, and well known for its technical difficulty during venous anastomosis, and can result in graft loss. We examined our living (LD) and deceased donor (DD) recipient data and compared the incidence of technical graft loss and early graft function in right and left kidneys. A cohort of 58 adult and pediatric recipients received an LD or DD kidney between January 2015 and December 2016. The donor and recipient data were retrieved and retrospectively analyzed. Technical graft loss was defined as graft thrombosis within the 7 days after transplant. Right kidneys (RKs) were not a risk factor for technical graft loss, and no graft was lost for technical reasons in either LD or DD transplants. Early graft function in LK and RKs was also comparable in the LD cohort, and there were no LKs in the DD cohort. Based on our data, the use of RKs was not a risk factor for technical graft loss and early graft function was comparable to LKs.

  18. Potential advantages of treatment of transplanted saphenous vein aorto-coronary artery bypass grafts with beta irradiation to prevent graft occlusion.

    Science.gov (United States)

    Smith, R G

    1997-01-01

    Intimal proliferation or Neointimal hyperplasia (NIH) is a vascular lesion that often arises in arteries after balloon angioplasty or other vessel wall injuries. FIH is a vascular lesion that develops in autologous saphenous vein grafts (SVG) after transplantation into the aorto-coronary circulation or the peripheral vascular circulation. FIH shares elements of smooth muscle migration, proliferation and fibrous tissue deposition in common with nibrointimal proliferation (NIH). Either NIH of a coronary artery or FIH of a SVG obstruct the vascular lumen and result in myocardial dysfunction. Local radiotherapy has been used for several decades to reduce the post-operative recurrence of the fibrovascular proliferations of pterygia and keloids. Similarly, in animal and human experiments, endovascular radiotherapy has been shown to reduce arterial smooth muscle proliferation. Consideration of the similarities of vascular smooth muscle cell proliferation in NIH and FIH leads one to suggest that endovascular beta irradiation can reduce FIH as well as it reduces NIH. The goal of such treatment is to achieve a clinically significant decrease in the morbidity and mortality resulting from SVG occlusions. The potential for large reduction of the consequences of SVG occlusion, the very large number of patients at risk, and the simplicity of the proposed intervention encourages prompt scientific evaluation of this technique.

  19. Evaluating the cost of therapy for restenosis: considerations for brachytherapy

    International Nuclear Information System (INIS)

    Weintraub, William S.

    1996-01-01

    Costs have become increasingly important in medicine in recent years as demand for services has outstripped readily available resources. Clinical microeconomics offers an approach to understanding cost and outcomes in an environment of economic scarcity. In this article the types of costs and methods for determining cost are presented. In addition, methods for assessing outcome and outcome in relation to cost are developed. Restenosis after coronary angioplasty is a prime example of a clinical problem requiring economic evaluation. This is because it results in little serious morbidity except for recurrent chest pain, but it has serious economic consequences which occur some time after the original angioplasty. This makes the economic assessment of restenosis complicated. The application of health care microeconomic principles to brachytherapy for restenosis in the coronary arteries is presented

  20. Evaluating the cost of therapy for restenosis: considerations for brachytherapy.

    Science.gov (United States)

    Weintraub, W S

    1996-11-01

    Costs have become increasingly important in medicine in recent years as demand for services has outstripped readily available resources. Clinical microeconomics offers an approach to understanding cost and outcomes in an environment of economic scarcity. In this article the types of costs and methods for determining cost are presented. In addition, methods for assessing outcome and outcome in relation to cost are developed. Restenosis after coronary angioplasty is a prime example of a clinical problem requiring economic evaluation. This is because it results in little serious morbidity except for recurrent chest pain, but it has serious economic consequences which occur some time after the original angioplasty. This makes the economic assessment of restenosis complicated. The application of health care microeconomic principles to brachytherapy for restenosis in the coronary arteries is presented.

  1. Arterial grafts balance survival between incomplete and complete revascularization: a series of 1000 consecutive coronary artery bypass graft patients with 98% arterial grafts.

    Science.gov (United States)

    Kieser, Teresa M; Curran, Helen J; Rose, M Sarah; Norris, Colleen M; Graham, Michelle M

    2014-01-01

    Coronary artery bypass grafting (CABG) with incomplete revascularization (ICR) is thought to decrease survival. We studied the survival of patients with ICR undergoing total arterial grafting. In a consecutive series of all-comer 1000 patients with isolated CABG, operative and midterm survival were assessed for patients undergoing complete versus ICR, with odds ratios and hazard ratios, adjusted for European System for Cardiac Operative Risk Evaluation category, CABG urgency, age, and comorbidities. In this series of 1000 patients with 98% arterial grafts (2922 arterial, 59 vein grafts), 73% of patients with multivessel disease received bilateral internal mammary artery grafts. ICR occurred in 140 patients (14%). Operative mortality was 3.8% overall, 8.6% for patients with ICR, and 3.2% for patients with complete revascularization (P = .008). For operative mortality using multivariable logistic regression, after controlling for European System for Cardiac Operative Risk Evaluation category (P System for Cardiac Operative Risk Evaluation category (P reserved.

  2. Interventional therapy and complications after liver transplantation: the obstruction of the hepatic vein and inferior vena cava

    International Nuclear Information System (INIS)

    Li Linsun; Shi Haibing; Zhao Linbo

    2009-01-01

    The occurrence rate of the obstruction of the hepatic vein or the inferior vena cava is very low. Obstruction can develop acutely as a result of technical problems or can present itself much later after the transplantation due to intimal hyperplasia or perianastomotic fibrosis. Clinically, the common presentations include hepatic dysfunction, liver engorgement, ascites, abdominal pain, etc. Percutaneous endovascular treatment with balloon dilation or stent placement is a safe and effective alternative treatment, which can keep the vessels open for a long period of time. Angioplasty can achieve technical success in restoring anastomotic patency almost to 100% of cases, but, unfortunately, restenosis occurs frequently. For, adult patients or pediatric patients with adult-sized hepatic veins, stenting seems to be the optimal choice. (authors)

  3. Results of Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial

    NARCIS (Netherlands)

    D.R. Holmes Jr (David); J.R. Granett (Jeffrey); J.J. Popma (Jeffrey); P.J. Fitzgerald (Peter); D. Fischman (David); J.J. Ferguson (James); A.M. Lincoff (Michael); S. Goldberg (Sheldon); J.A. Brinker; R. Chan; B.R. Davis (Barry); M. Poland; A.M. Zeiher (Andreas); J.T. Willerson (James); S.B. King 3rd (Spencer); L.M. Shapiro; M. Savage (Michael); J.M. Lablanche (Jean Marc); J.E. Tcheng (James); L. Grip (Lars); P.W.J.C. Serruys (Patrick)

    2002-01-01

    textabstractBACKGROUND: Restenosis after percutaneous coronary intervention (PCI) is a major problem affecting 15% to 30% of patients after stent placement. No oral agent has shown a beneficial effect on restenosis or on associated major adverse cardiovascular events. In limited trials, the oral

  4. Magnetizable stent-grafts enable endothelial cell capture

    Energy Technology Data Exchange (ETDEWEB)

    Tefft, Brandon J. [Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (United States); Uthamaraj, Susheil [Division of Engineering, Mayo Clinic, Rochester, MN (United States); Harburn, J. Jonathan [School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees (United Kingdom); Hlinomaz, Ota [Department of Cardioangiology, St. Anne' s University Hospital, Brno (Czech Republic); Lerman, Amir [Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (United States); Dragomir-Daescu, Dan [Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN (United States); Sandhu, Gurpreet S., E-mail: sandhu.gurpreet@mayo.edu [Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (United States)

    2017-04-01

    Emerging nanotechnologies have enabled the use of magnetic forces to guide the movement of magnetically-labeled cells, drugs, and other therapeutic agents. Endothelial cells labeled with superparamagnetic iron oxide nanoparticles (SPION) have previously been captured on the surface of magnetizable 2205 duplex stainless steel stents in a porcine coronary implantation model. Recently, we have coated these stents with electrospun polyurethane nanofibers to fabricate prototype stent-grafts. Facilitated endothelialization may help improve the healing of arteries treated with stent-grafts, reduce the risk of thrombosis and restenosis, and enable small-caliber applications. When placed in a SPION-labeled endothelial cell suspension in the presence of an external magnetic field, magnetized stent-grafts successfully captured cells to the surface regions adjacent to the stent struts. Implantation within the coronary circulation of pigs (n=13) followed immediately by SPION-labeled autologous endothelial cell delivery resulted in widely patent devices with a thin, uniform neointima and no signs of thrombosis or inflammation at 7 days. Furthermore, the magnetized stent-grafts successfully captured and retained SPION-labeled endothelial cells to select regions adjacent to stent struts and between stent struts, whereas the non-magnetized control stent-grafts did not. Early results with these prototype devices are encouraging and further refinements will be necessary in order to achieve more uniform cell capture and complete endothelialization. Once optimized, this approach may lead to more rapid and complete healing of vascular stent-grafts with a concomitant improvement in long-term device performance. - Highlights: • Magnetic stent-grafts were made from 2205 steel stents and polyurethane nanofibers. • Stent-grafts remained patent and formed a thin and uniform neointima when implanted. • Stent-grafts captured endothelial cells labeled with magnetic nanoparticles.

  5. Comparison between mechanical properties of human saphenous vein and umbilical vein

    Directory of Open Access Journals (Sweden)

    Hamedani Borhan

    2012-08-01

    Full Text Available Abstract Background As a main cause of mortality in developed countries, Coronary Artery Disease (CAD is known as silent killer with a considerable cost to be dedicated for its treatment. Coronary Artery Bypass Graft (CABG is a common remedy for CAD for which different blood vessels are used as a detour. There is a lack of knowledge about mechanical properties of human blood vessels used for CABG, and while these properties have a great impact on long-term patency of a CABG. Thus, studying these properties, especially those of human umbilical veins which have not been considered yet, looks utterly necessary. Methods Umbilical vein, as well as human Saphenous vein, are respectively obtained after cesarean and CABG. First, histological tests were performed to investigate different fiber contents of the samples. Having prepared samples carefully, force-displacement results of samples were rendered to real stress–strain measurements and then a fourth-order polynomial was used to prove the non-linear behavior of these two vessels. Results Results were analyzed in two directions, i.e. circumferentially and longitudinally, which then were compared with each other. The comparison between stiffness and elasticity of these veins showed that Saphenous vein’s stiffness is much higher than that of umbilical vein and also, it is less stretchable. Furthermore, for both vessels, longitudinal stiffness was higher than that of circumferential and in stark contrast, stretch ratio in circumferential direction came much higher than longitudinal orientation. Conclusion Blood pressure is very high in the region of aorta, so there should be a stiff blood vessel in this area and previous investigations showed that stiffer vessels would have a better influence on the flow of bypass. To this end, the current study has made an attempt to compare these two blood vessels’ stiffness, finding that Saphenous vein is stiffer than umbilical vein which is somehow as stiff as

  6. Distal vein patch as a form of autologus modification for infragenicular prosthetic bypass.

    Science.gov (United States)

    Totic, Dragan; Rustempasic, Nedzad; Djedovic, Muhamed; Solakovic, Sid; Vukas, Haris; Aslani, Ilijas; Krvavac, Alma; Rudalija, Dzejra; Ahmetasevic, Alen

    2013-01-01

    Preferred graft for infragenicular bypass is autologus vein. The problem is when there is not available autologus vein. Literature suggest that in these situations, prosthetic graft with some form of modification of distal anastomosis with autogenic tissue is valuable adjunctive. Frequently used modifications are Miller's cuff, Taylor's patch and St. Mary's boot. Recently, there are reports on "Distal vein patch" as a form of autologus modification which, due to its simplicity and patency rate, attracted attention. The aim of this study was to evaluate benefits of this novel modification by comparing its patencies with other autologus modification of distal anastomosis. Study was performed on 60 patients, diabetics, with critical limb ischemia (CLI). Patients were divided in two groups: Group with distal vein patch modification; and group with some other form modification - control group. Patients were followed at least 22 months. We examined patency of grafts by physical examination or using Color Doppler. For statistical purposes we used KIaplan Meier analysis and curve. Significance was determined by Mann-Whitney, Fisher's exact, Pearsons chi square or Student T test as appropriate. P value less than 0,05 was considered significant. Groups were fairly matched relative to demographics, risk factors, operative intervention and distal anastomosis site. There was not statistical difference in two year primary patency between distal vein patch and control group--50% vs 53% respectivly (X2 = 0,08; p = 0,773). Also, there was not statistically significant difference in extremity survival (77% vs 77%) and patient survival between groups (89% vs 93%; X2 = 2,458; p = 0,117). This study proved equivalent patencies of infragenicular prosthetic bypasses performed using distal vein patch technique as with any other modification of distal anastomosis.

  7. Influence of Diabetes on Long-Term Coronary Artery Bypass Graft Patency.

    Science.gov (United States)

    Raza, Sajjad; Blackstone, Eugene H; Houghtaling, Penny L; Rajeswaran, Jeevanantham; Riaz, Haris; Bakaeen, Faisal G; Lincoff, A Michael; Sabik, Joseph F

    2017-08-01

    Nearly 50% of patients undergoing coronary artery bypass grafting have diabetes. However, little is known about the influence of diabetes on long-term patency of bypass grafts. Because patients with diabetes have more severe coronary artery stenosis, we hypothesized that graft patency is worse in patients with than without diabetes. This study sought to examine the influence of diabetes on long-term patency of bypass grafts. From 1972 to 2011, 57,961 patients underwent primary isolated coronary artery bypass grafting. Of these, 1,372 pharmacologically treated patients with diabetes and 10,147 patients without diabetes had 15,887 postoperative angiograms; stenosis was quantified for 7,903 internal thoracic artery (ITA) grafts and 20,066 saphenous vein grafts. Status of graft patency across time was analyzed by longitudinal nonlinear mixed-effects modeling. ITA graft patency was stable over time and similar in patients with and without diabetes: at 1, 5, 10, and 20 years, 97%, 97%, 96%, and 96% in patients with diabetes, and 96%, 96%, 95%, and 93% in patients without diabetes, respectively (early p = 0.20; late p = 0.30). In contrast, saphenous vein graft patency declined over time and similarly in patients with and without diabetes: at 1, 5, 10, and 20 years, 78%, 70%, 57%, and 42% in patients with diabetes, and 82%, 72%, 58%, and 41% in patients without diabetes, respectively (early p < 0.002; late p = 0.60). After adjusting for patient characteristics, diabetes was associated with higher early patency of ITA grafts (odds ratio: 0.63; 95% confidence limits: 0.43 to 0.91; p = 0.013), but late patency of ITA grafts was similar in patients with and without diabetes (p = 0.80). Early and late patency of saphenous vein grafts were similar in patients with and without diabetes (early p = 0.90; late p = 0.80). Contrary to our hypothesis, diabetes did not influence long-term patency of bypass grafts. Use of ITA grafts should be maximized in patients

  8. Intraoperative transit-time flow measurement is not altered in venous bypass grafts covered by the eSVS mesh.

    Science.gov (United States)

    Emery, Robert W; Solien, Eric

    2013-01-01

    The aim of this study was to determine whether the eSVS Mesh interferes with transit-time flow measurement (TTFM) assessing intraoperative coronary vein graft patency. In four swine undergoing off-pump bypass grafting to the anterior descending coronary artery, five TTFMs were sequentially obtained on meshed and bare grafts at baseline and under Dobutamine stress at five separate locations on the graft in each animal. The Medistim VeriQ was used for TTFM. The grafts were examined for patency after the swine were killed. There was no difference in hemodynamics or TTFM either at baseline or under Dobutamine stress between the eSVS Mesh covered and uncovered grafts. Dobutamine, however, significantly increased hemodynamics and graft flow parameters measured from baseline. The eSVS Mesh does not interfere with Doppler flow measurement in covered coronary vein grafts.

  9. Assessment of Novel Anti-thrombotic Fusion Proteins for Inhibition of Stenosis in a Porcine Model of Arteriovenous Graft.

    Directory of Open Access Journals (Sweden)

    Christi M Terry

    Full Text Available Hemodialysis arteriovenous synthetic grafts (AVG provide high volumetric blood flow rates shortly after surgical placement. However, stenosis often develops at the vein-graft anastomosis contributing to thrombosis and early graft failure. Two novel fusion proteins, ANV-6L15 and TAP-ANV, inhibit the tissue factor/factor VIIa coagulation complex and the factor Xa/factor Va complex, respectively. Each inhibitor domain is fused to an annexin V domain that targets the inhibitor activity to sites of vascular injury to locally inhibit thrombosis. This study's objective was to determine if these antithrombotic proteins are safe and effective in inhibiting AVG stenosis.A bolus of either TAP-ANV or ANV-6L15 fusion protein was administered intravenously immediately prior to surgical placement of a synthetic graft between the external jugular vein and common carotid artery in a porcine model. At surgery, the vein and artery were irrigated with the anti-thrombotic fusion protein. Control animals received intravenous heparin. At 4 weeks, MRI was performed to evaluate graft patency, the pigs were then euthanized and grafts and attached vessels were explanted for histomorphometric assessment of neointimal hyperplasia at the vein-graft anastomosis. Blood was collected at surgery, immediately after surgery and at euthanasia for serum metabolic panels and coagulation chemistries.No acute thrombosis occurred in the control group or in either experimental group. No abnormal serum chemistries, activated clotting times or PT, PTT values were observed after treatment in experimental or control animals. However, at the vein-graft anastomosis, there was no difference between the control and experimental groups in cross-sectional lumen areas, as measured on MRI, and no difference in hyperplasia areas as determined by histomorphometry. These results suggest that local irrigation of TAP-ANV or ANV-6L15 intra-operatively was as effective in inhibiting acute graft thrombosis

  10. Vascular Adaptation: Pattern Formation and Cross Validation between an Agent Based Model and a Dynamical System.

    Science.gov (United States)

    Garbey, Marc; Casarin, Stefano; Berceli, Scott A

    2017-09-21

    Myocardial infarction is the global leading cause of mortality (Go et al., 2014). Coronary artery occlusion is its main etiology and it is commonly treated by Coronary Artery Bypass Graft (CABG) surgery (Wilson et al, 2007). The long-term outcome remains unsatisfactory (Benedetto, 2016) as the graft faces the phenomenon of restenosis during the post-surgery, which consists of re-occlusion of the lumen and usually requires secondary intervention even within one year after the initial surgery (Harskamp, 2013). In this work, we propose an extensive study of the restenosis phenomenon by implementing two mathematical models previously developed by our group: a heuristic Dynamical System (DS) (Garbey and Berceli, 2013), and a stochastic Agent Based Model (ABM) (Garbey et al., 2015). With an extensive use of the ABM, we retrieved the pattern formations of the cellular events that mainly lead the restenosis, especially focusing on mitosis in intima, caused by alteration in shear stress, and mitosis in media, fostered by alteration in wall tension. A deep understanding of the elements at the base of the restenosis is indeed crucial in order to improve the final outcome of vein graft bypass. We also turned the ABM closer to the physiological reality by abating its original assumption of circumferential symmetry. This allowed us to finely replicate the trigger event of the restenosis, i.e. the loss of the endothelium in the early stage of the post-surgical follow up (Roubos et al., 1995) and to simulate the encroachment of the lumen in a fashion aligned with histological evidences (Owens et al., 2015). Finally, we cross-validated the two models by creating an accurate matching procedure. In this way we added the degree of accuracy given by the ABM to a simplified model (DS) that can serve as powerful predictive tool for the clinic. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Causes and prevention of in-stent restenosis of vertebral artery origin after stenting

    International Nuclear Information System (INIS)

    Zhao Huipin; Li Shenmao; Zhang Guangping

    2010-01-01

    Vertebral artery stenosis is an important cause of posterior circulation stroke. Vertebral artery stenosis most commonly occurs at its origin site. In recent years, balloon angioplasty and stent implantation have been widely employed in the treatment of vertebral artery origin stenosis. However, the long term outcome of stent implantation is affected by in-stent restenosis. Multiple contributory factors have been identified, but clear understanding of the overall underlying mechanism remains an enigma. With the development of pathophysiology, prevention and treatment methods of in-stent restenosis have been improved. In recent years, drug-eluting stents, radioactive stents and magnetic stents have been widely applied. To some extent, these stents and drug therapy can solve the problem of restenosis. This article aims to review the clinical application and the up-to-date research progresses in preventing and managing vertebral artery origin restenosis. (authors)

  12. Graft type for femoro-popliteal bypass surgery.

    Science.gov (United States)

    Ambler, Graeme K; Twine, Christopher P

    2018-02-11

    Femoro-popliteal bypass is implemented to save limbs that might otherwise require amputation, in patients with ischaemic rest pain or tissue loss; and to improve walking distance in patients with severe life-limiting claudication. Contemporary practice involves grafts using autologous vein, polytetrafluoroethylene (PTFE) or Dacron as a bypass conduit. This is the second update of a Cochrane review first published in 1999 and last updated in 2010. To assess the effects of bypass graft type in the treatment of stenosis or occlusion of the femoro-popliteal arterial segment, for above- and below-knee femoro-popliteal bypass grafts. For this update, the Cochrane Vascular Information Specialist searched the Vascular Specialised Register (13 March 2017) and CENTRAL (2017, Issue 2). Trial registries were also searched. We included randomised trials comparing at least two different types of femoro-popliteal grafts for arterial reconstruction in patients with femoro-popliteal ischaemia. Randomised controlled trials comparing bypass grafting to angioplasty or to other interventions were not included. Both review authors (GKA and CPT) independently screened studies, extracted data, assessed trials for risk of bias and graded the quality of the evidence using GRADE criteria. We included nineteen randomised controlled trials, with a total of 3123 patients (2547 above-knee, 576 below-knee bypass surgery). In total, nine graft types were compared (autologous vein, polytetrafluoroethylene (PTFE) with and without vein cuff, human umbilical vein (HUV), polyurethane (PUR), Dacron and heparin bonded Dacron (HBD); FUSION BIOLINE and Dacron with external support). Studies differed in which graft types they compared and follow-up ranged from six months to 10 years.Above-knee bypassFor above-knee bypass, there was moderate-quality evidence that autologous vein grafts improve primary patency compared to prosthetic grafts by 60 months (Peto odds ratio (OR) 0.47, 95% confidence interval (CI

  13. Injuries of the Portal Vein in Patients With Blunt Abdominal Trauma

    Directory of Open Access Journals (Sweden)

    D. Henne-Bruns

    1993-01-01

    four or more organs. Additionally, in 11.8% of these cases (n = 8 a major vascular injury (portal vein n = 5, vena cava n = 2, mesenteric root n = 1 was found. Injuries to the portal vein were always associated with complete rupture of the pancreas, requiring distal pancreatic resection in four cases and a duodenum preserving resection of the head of the pancreas in one. In two of these patients the portal vein had to be reconstructed with a Goretex prosthetic graft. Mortality was 14.7% for the whole group (n = 68 and 0% for patients with additional portal venous injuries.

  14. Successful percutaneous stenting of a right gastroepiploic coronary bypass graft using monorail delivery system: a case report.

    Science.gov (United States)

    Alam, M; Safi, A M; Mandawat, M K; Anderson, J E; Kwan, T; Feit, A; Clark, L T

    2000-02-01

    The right gastroepiploic artery (RGEA) is being successfully used as an arterial conduit in a selected group of patients undergoing coronary artery bypass graft surgery. However, myocardial ischemia may result due to spasm, occlusion, and stenosis of this graft. The anastamosis site at distal right coronary artery (RCA) or posterior descending artery (PDA) is the most common location for stenosis of an in situ gastroepiploic coronary bypass graft. Balloon angioplasty of such stenoses has been reported with optimal short-term results. Stent deployment would decrease the restenosis rate, so that repeat procedures could be minimized for these technically challenging lesions. We describe a case of successful deployment of a stent with monorail delivery system at the anastamotic site stenosis of an in situ gastroepiploic right coronary artery bypass graft. This percutaneous coronary intervention could prevent redo coronary artery bypass graft surgery. Cathet. Cardiovasc. Intervent. 49:197-199, 2000. Copyright 2000 Wiley-Liss, Inc.

  15. One Stage Radical Removal of Intravenous Leiomyomatosis Extending to the Right Atrium via the Bilateral Gonadal Veins

    Directory of Open Access Journals (Sweden)

    X. Gui

    Full Text Available : Background: Intravenous leiomyomatosis is a benign and rare smooth muscle cell tumor. Extension to the right heart is exceptional. Among the reported cases, the tumor is usually known to enter through the lumen of the iliac vein and grows into the inferior vena cava; involvement of bilateral gonadal veins is rarely reported. Complete tumor resection is the key to therapy. Case presentation: A 25 year old female Chinese patient suffering from abdominal distention for 1 month, who was diagnosed with intravenous leiomyomatosis extending to the heart, from pre-operative imaging studies, is presented. A one stage procedure with complete excision of the tumor was performed. Histopathological findings confirmed the diagnosis of intravenous leiomyomatosis. The patient's post-operative recovery was uneventful, without recurrence and re-stenosis at 1 year follow up. Conclusion: Intravenous leiomyomatosis may grow within veins along various routes. This case demonstrated intravenous leiomyomatosis with tumor extension through bilateral gonadal veins extending to the heart. It is believed that one stage radical resection can be a practical and effective alternative for the patients in good clinical condition. Long-term follow up is recommended because of the possibility of recurrence and metastases. Keywords: Intravenous leiomyomatosis, Cardiac extending, Extension pathway, Gonadal veins, One-stage operation

  16. Predictive Factors of In-Stent Restenosis in Renal Artery Stenting: A Retrospective Analysis

    International Nuclear Information System (INIS)

    Vignali, Claudio; Bargellini, Irene; Lazzereschi, Michele; Cioni, Roberto; Petruzzi, Pasquale; Caramella, Davide; Pinto, Stefania; Napoli, Vinicio; Zampa, Virna; Bartolozzi, Carlo

    2005-01-01

    Purpose. To retrospectively evaluate the role of clinical and procedural factors in predicting in-stent restenosis in patients with renovascular disease treated by renal artery stenting. Methods. From 1995 to 2002, 147 patients underwent renal artery stenting for the treatment of significant ostial atherosclerotic stenosis. Patients underwent strict clinical and color-coded duplex ultrasound follow-up. Ninety-nine patients (111 stents), with over 6 months of continuous follow-up (mean 22±12 months, range 6-60 months), were selected and classified according to the presence (group A, 30 patients, 32 lesions) or absence (group B, 69 patients, 79 lesions) of significant in-stent restenosis. A statistical analysis was performed to identify possible preprocedural and procedural predictors of restenosis considering the following data: sex, age, smoking habit, diabetes mellitus, hypertension, serum creatinine, cholesterol and triglyceride levels, renal artery stenosis grade, and stent type, length and diameter. Results. Comparing group A and B patients (χ 2 test), a statistically significant relation was demonstrated between stent diameter and length and restenosis: the risk of in-stent restenosis decreased when the stent was ≥6 mm in diameter and between 15 and 20 mm in length. This finding was confirmed by multiple logistic regression analysis. Stent diameter and length were proved to be significantly related to in-stent restenosis also when evaluating only patients treated by Palmaz stent (71 stents). Conclusion. Although it is based on a retrospective analysis, the present study confirms the importance of correct stent selection in increasing long-term patency, using stents of at least 6 mm in diameter and with a length of approximately 15-20 mm

  17. The Impact of Anastomotic Angle for Re-Occlusion of Brachioaxillary Graft Arteriovenous Fistula after Percutaneous Thromboaspiration

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Keon Young; Jin, Gong Yong; Hwang, Seung Bae; Choi, Eun Jung; Song, Ji Soo; Han, Young Min; Kwon, Keun Sang [Chonbuk National University Hospital and Medical School, Jeonju (Korea, Republic of)

    2013-03-15

    The purpose of this study is to evaluate the factors that affect graft patency in brachioaxillary graft arteriovenous fistula patients. A retrospective study was conducted on 33 patients (20 men, 13 women; mean age, 67.5 years; mean interval to first stenosis, 17 months), who had performed percutaneous angioplasty for first episode of stenosis after brachioaxillary graft surgery. We evaluated the relevant factors affecting the graft patency after first episode of stenosis, such as age, sex, underlying disease (hypertension, diabetes mellitus, hyperlipidemia, cardiovascular disease, cerebrovascular attack), anastomotic angle between graft and axillary vein, and anastomotic angle between the graft and brachial artery. Kaplan-Meier method and log rank test and receiver operating characteristics curve analysis were used in statistical analysis. Graft patency rates after 1 month, 6 months, and 12 months were 75.8%, 39.4%, and 9.1%. There was a correlation between graft-axillary vein anastomotic angle and patency rates (r = 0.372, p = 0.033); larger the venous anastomotic angle, the longer patency rate. However, it does not come up with significant results in patency rates on age, sex, underlying disease, and graft-brachial artery angle. In patients with brachioaxillary graft arteriovenous fistula, as venous anastomotic angle more obtuse, the graft patency may be longer.

  18. Interventions in Infrainguinal Bypass Grafts

    International Nuclear Information System (INIS)

    Mueller-Huelsbeck, S.; Order, B.-M.; Jahnke, T.

    2006-01-01

    The interventional radiologist plays an important role in the detection and prevention of infrainguinal bypass failure. Early detection and evaluation of flow-limiting lesions effectively preserve graft (venous bypass and polyester or expanded polytetrafluoroethylene bypass) patency by identifying stenoses before occlusion occurs. Delay in treatment of the at-risk graft may result in graft failure and a reduced chance of successful revascularization. For this reason, surveillance protocols form an important part of follow-up after infrainguinal bypass surgery. As well as having an understanding of the application of imaging techniques including ultrasound, MR angiography, CT angiography and digital subtraction angiography, the interventional radiologist should have detailed knowledge of the minimally invasive therapeutic options. Percutaneous transluminal angioplasty (PTA), or alternatively cutting balloon angioplasty, is the interventional treatment of choice in prevention of graft failure and occlusion. Further alternatives include metallic stent placement, fibrinolysis, and mechanical thrombectomy. Primary assisted patency rates following PTA can be up to 65% at 5 years. When the endovascular approach is unsuccessful, these therapeutic options are complemented by surgical procedures including vein patch revision, jump grafting, or placement of a new graft

  19. Preduodenal superior mesenteric vein and Whipple procedure with vascular reconstruction-A case report.

    Science.gov (United States)

    Höing, Kristina; Ringe, Kristina I; Bektas, Hüseyin; Klempnauer, Jürgen; Jäger, Mark D

    2015-01-01

    Portal vein (PV) disorders are various, but rare. Here, we report a preduodenal superior mesenteric vein (PDSMV) in a patient who underwent a pancreaticoduodenectomy. A 67-year old woman with familial adenomatosis polyposis was suspicious for cancer of the papilla of vater and scheduled for surgery. Pre-operative diagnostic revealed a PDSMV continuing into the left PV. The splenic vein (SV) continued directly into the right PV without forming ananatomic PV confluence. Eight centimetre of the PDSMV were resected during the pancreaticoduodenectomy and reconnected using a polytetrafluoroethylene prosthesis. On day 1, early graft thrombosis was treated by thrombectomy and change to a larger graft. Pathology confirmed a R0-resection of the adenocarcinoma of the papilla of vater (pTis pN0,G2). At three-month follow-up, the patient was cancer-free and clinically asymptomatic, although, a late graft thrombosis with accompanying newly build venous collaterals passing mesenteric blood to the SV were found. Rare PV disorders like a PDSMV do not contradict pancreatic surgery, but should be treated in experienced centres. Skills of SMV/PV reconstruction and its peri-operative management might be beneficial for successful outcome. Despite late graft thrombosis no clinical disadvantage occurred most likely due to preservation of the SV and of potential venous collateral pathways. Extended surgical procedures like a pancreaticoduodenectomy are realisable in patients with PV disorders, but require awareness, adequate radiological interpretation and specific surgical experience for secure treatment. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  20. Efficacy of beta radiation in prevention of post-angioplasty restenosis : An interim report from the beta energy restenosis trial

    NARCIS (Netherlands)

    D. Meerkin; R. Bonan (Raoul); I.R. Crocker; A. Arsenault (André); P. Chougule; V.L.M.A. Coen (Veronique); D.O. Williams (David); P.W.J.C. Serruys (Patrick); S.B. King 3rd (Spencer)

    1998-01-01

    textabstractRestenosis remains a major limitation of coronary angioplasty in spite of major advances in techniques and technology. Recent studies have demonstrated that ionizing radiation may limit the degree of this problem. Gamma radiation has been shown to be effective in reducing in stent

  1. A mechanical argument for the differential performance of coronary artery grafts.

    Science.gov (United States)

    Prim, David A; Zhou, Boran; Hartstone-Rose, Adam; Uline, Mark J; Shazly, Tarek; Eberth, John F

    2016-02-01

    Coronary artery bypass grafting (CABG) acutely disturbs the homeostatic state of the transplanted vessel making retention of graft patency dependent on chronic remodeling processes. The time course and extent to which remodeling restores vessel homeostasis will depend, in part, on the nature and magnitude of the mechanical disturbances induced upon transplantation. In this investigation, biaxial mechanical testing and histology were performed on the porcine left anterior descending artery (LAD) and analogs of common autografts, including the internal thoracic artery (ITA), radial artery (RA), great saphenous vein (GSV) and lateral saphenous vein (LSV). Experimental data were used to quantify the parameters of a structure-based constitutive model enabling prediction of the acute vessel mechanical response pre-transplantation and under coronary loading conditions. A novel metric Ξ was developed to quantify mechanical differences between each graft vessel in situ and the LAD in situ, while a second metric Ω compares the graft vessels in situ to their state under coronary loading. The relative values of these metrics among candidate autograft sources are consistent with vessel-specific variations in CABG clinical success rates with the ITA as the superior and GSV the inferior graft choices based on mechanical performance. This approach can be used to evaluate other candidate tissues for grafting or to aid in the development of synthetic and tissue engineered alternatives. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. The risk and prognostic impact of definite stent thrombosis or in-stent restenosis after coronary stent implantation

    DEFF Research Database (Denmark)

    Thayssen, Per; Jensen, Lisette Okkels; Lassen, Jens Flensted

    2012-01-01

    Aims: Data are limited on the prognostic impact of stent thrombosis and in-stent restenosis in patients treated with coronary stents. We examined the prognostic impact of stent thrombosis and in-stent restenosis in patients treated with percutaneous coronary intervention (PCI). Methods and results......: All patients who underwent stent implantation from 2002 to 2005 were identified in the Western Denmark Heart Registry. The hazard ratio (HR) for death associated with stent thrombosis or in-stent restenosis was estimated with a Cox regression analysis with stent thrombosis or in-stent restenosis...... as time-dependent variables. A total of 12,277 patients were treated with stent implantation. Stent thrombosis was observed in 111 (0.9%) patients and in-stent restenosis in 503 (4.1%) patients within 12 months after the index PCI. Occurrence of stent thrombosis was associated with an increased risk...

  3. Study on the application of big cup membranate stent on restenosis after stenting for carcinoma of esophago cardia

    International Nuclear Information System (INIS)

    Wang Xiuping; Yao Zhongqiang; Liu Jian; Zhang Yan

    2007-01-01

    Objective: To evaluate the clinical value of self-designed big cup membranate stent on restenosis after stenting for carcinoma of esophago-cardia. Methods: 12 cases of restenosis after stenting for carcinoma of esophago-cardia were involved in the study. Self-designed big cup membranate stent made by Nanjing Weichuang Company (the length of the cup was 3.5 cm)was placed into the constricted stent under guidance of fluoroscopy. Clinical effect, restenosis, and complications were observed during followed up. Results: All the 12 cases of big cup membranat stent placement went along smoothly without indigitation of the cup of the stent. Follow-up of 1.5-8 months showed that 2 cases developed severe restenosis on the big cup of the stem, resulting in third grade difficult deglutition. Among them, one occurred 1 month after stenting, caused by hyperplasia of large amount of granulation tissue; another occurred 6 months after stenting, caused by growth of tumor tissue. 3 cases developed mild to moderate restenosis, 2.3-7 months (mean: 4.6 months) after stenting, with result of first grade difficult deglutition. The remaining 7 cases (mean 5.6 months follow-up) did not have difficulty during deglutition. Conclusions: Application of big cup membranate stent on restenosis after stenting for carcinoma of esophago-cardia can effectively prevent the stent from moving downwards and thus lower down the rate of restenosis, and postpone the occurrence of restenosis. (authors)

  4. Matrix metalloproteinase 9 level as an indicator for restenosis following cervical and intracranial angioplasty and stenting

    Directory of Open Access Journals (Sweden)

    Jun-peng Liu

    2015-01-01

    Full Text Available Cervical and intracranial angioplasty and stenting is an effective and safe method of reducing the risk of ischemic stroke, but it may be affected by in-stent restenosis. The present study investigated serum level of matrix metalloproteinase 9 as a predictor of restenosis after 40 patients underwent cervical and/or intracranial angioplasty and stenting. Results showed that restenosis occurred in 30% (3/10 of patients when the serum level of matrix metalloproteinase 9 at 3 days after surgery was 2.5 times higher than preoperative level. No restenosis occurred when the serum level of matrix metalloproteinase 9 at 3 days after surgery was not 2.5 times higher than preoperative level. Restenosis occurred in 12% (2/17 of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for more than 30 days after surgery, but only occurred in 4% (1/23 of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for less than 30 days after surgery. However, the differences observed were not statistically significant (P > 0.05. Experimental findings indicate that when the serum level of matrix metalloproteinase 9 is 2.5 times higher than preoperative level at 3 days after cervical and intracranial angioplasty and stenting, it may serve as a predictor of in-stent restenosis.

  5. Two-stage liver transplantation using auxiliary laparoscopically harvested grafts in adults: Emphasizing the concept of "hypersmall graft nursing".

    Science.gov (United States)

    Scatton, Olivier; Cauchy, François; Conti, Filomena; Perdigao, Fabiano; Massault, Pierre Philippe; Goumard, Claire; Soubrane, Olivier

    2016-11-01

    Living donor liver transplantation is limited by the donor's risk in case of right liver donation and by the risk of small-for-size syndrome on the recipient in case of left lobe transplantation. This study aimed at evaluating the feasibility and results of two-stage liver transplantation using auxiliary hyper small grafts harvested laparoscopically and discussing relevant technical insights and issues that still need to be overcome. Retrospective analysis involving two patients operated at a tertiary referral center. The recipients underwent left lateral sectionectomy and then auxillary liver transplantation using laparoscopically harvested left lateral section. The native right liver was transiently left in place to sustain the initially small functional graft functional during its hypertrophy. No donor experienced postoperative complication. After 7days, the hypertrophy rate was 112% (105-120). Doppler assessments during the first two postoperative weeks showed progressive portal vein inflow decrease in the right native livers and portal vein inflow increase in the grafts. Liver biopsies on postoperative day 7 showed no lesion of overperfusion. No recipient experienced liver failure or small-for-size syndrome. Second stage hepatectomy of the native liver was undertaken in one patient. In the other patient, biliary stenosis on postoperative day 30 precluded second stage hepatectomy. This patient required retransplantation after one year. The current strategy increases donor safety and may allow increasing the pool of available grafts. Refinements in the management of the native right liver are however required to improve the feasibility rate of this strategy. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  6. Brachial artery repair using the basilic vein as a reliable conduit in a 3-year-old child

    Directory of Open Access Journals (Sweden)

    Hyunyoung G. Kim

    2017-04-01

    Full Text Available A supracondylar fracture of the humerus is the most common upper extremity fracture in children with concurrent neurovascular complications. However, bypass grafting in the management of a pediatric open elbow dislocation with an arterial injury has rarely been reported in the literature. Hence, an adequate conduit for a vessel graft interposition remains questionable when a primary anastomosis is limited in an arterial reconstruction. The purpose of this study is to present a brachial artery reconstruction in a 3-year-old patient with an open supracondylar fracture of the humerus. In the clinical and surgical examination of the patient, an open wound in the left antecubital fossa presented with accompanying brachial artery injury. To repair the artery, a reverse end-to-end anastomosis was conducted using basilic vein graft from the ipsilateral arm under general anesthesia. The patient had palpable radial pulses in the postoperative clinical examination and was discharged without complications. The great saphenous vein (GSV has proven to be the most common and the best conduit for arterial reconstruction of the upper extremity in the adult patients. However, the GSV graft is known to have the propensity for becoming aneurysmal in pediatric patients. Some studies have demonstrated the basilic vein as a suitable conduit in pediatric patients, in that it has durable patency, fewer branches, size compatibility for anastomosis, and proximity to the brachial artery. Our case confirms the safety of using this autogenous vein from within the zone of injury for arterial reconstruction, after a supracondylar humeral fracture. The management of pediatric elbow fractures accompanying vascular injuries can be technically demanding due to relatively small, delicate structures and concurrent neurovascular network. Nonetheless, a vascular injury should be treated with high level of suspicion and immediate intervention to avoid any limb ischemia or loss. In

  7. Contact-free monitoring of vessel graft stiffness - proof of concept as a tool for vascular tissue engineering.

    Science.gov (United States)

    Hoenicka, Markus; Kaspar, Marcel; Schmid, Christof; Liebold, Andreas; Schrammel, Siegfried

    2017-10-01

    Tissue-engineered vessel grafts have to mimic the biomechanical properties of native blood vessels. Manufacturing processes often condition grafts to adapt them to the target flow conditions. Graft stiffness is influenced by material properties and dimensions and determines graft compliance. This proof-of-concept study evaluated a contact-free method to monitor biomechanical properties without compromising sterility. Forced vibration response analysis was performed on human umbilical vein (HUV) segments mounted in a buffer-filled tubing system. A linear motor and a dynamic signal analyser were used to excite the fluid by white noise (0-200 Hz). Vein responses were read out by laser triangulation and analysed by fast Fourier transformation. Modal analysis was performed by monitoring multiple positions of the vessel surface. As an inverse model of graft stiffening during conditioning, HUV were digested proteolytically, and the course of natural frequencies (NFs) was monitored over 120 min. Human umbilical vein showed up to five modes with NFs in the range of 5-100 Hz. The first natural frequencies of HUV did not alter over time while incubated in buffer (p = 0.555), whereas both collagenase (-35%, p = 0.0061) and elastase (-45%, p direct measurement of stiffness as an important biomechanical property, obviating the need to monitor surrogate parameters. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  8. Distal anastomotic vein adjunct usage in infrainguinal prosthetic bypasses.

    Science.gov (United States)

    McPhee, James T; Goodney, Philip P; Schanzer, Andres; Shaykevich, Shimon; Belkin, Michael; Menard, Matthew T

    2013-04-01

    Single-segment saphenous vein remains the optimal conduit for infrainguinal revascularization. In its absence, prosthetic conduit may be used. Existing data regarding the significance of anastomotic distal vein adjunct (DVA) usage with prosthetic grafts are based on small series. This is a retrospective cohort analysis derived from the regional Vascular Study Group of New England as well as the Brigham and Women's hospital database. A total of 1018 infrainguinal prosthetic bypass grafts were captured in the dataset from 73 surgeons at 15 participating institutions. Propensity scoring and 3:1 matching was performed to create similar exposure groups for analysis. Outcome measures of interest included: primary patency, freedom from major adverse limb events (MALEs), and amputation free survival at 1 year as a function of vein patch utilization. Time to event data were compared with the log-rank test; multivariable Cox proportional hazard models were used to evaluate the adjusted association between vein cuff usage and the primary end points. DVA was defined as a vein patch, cuff, or boot in any configuration. Of the 1018 bypass operations, 94 (9.2%) had a DVA whereas 924 (90.8%) did not (no DVA). After propensity score matching, 88 DVAs (25%) and 264 no DVAs (75%) were analyzed. On univariate analysis of the matched cohort, the DVA and no DVA groups were similar in terms of mean age (70.0 vs 69.0; P = .55), male sex (58.0% vs 58.3%; P > .99), and preoperative characteristics such as living at home (93.2% vs 94.3%; P = .79) and independent ambulatory status (72.7% vs 75.7%; P = .64). The DVA and no DVA groups had similar rates of major comorbidities such as hypertension chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and dialysis dependence (P > .05 for all). Likewise, they had similar rates of distal origin grafts (13.6% vs 12.5%; P = .85), critical limb ischemia indications (P = .53), and prior arterial bypass (58% vs 47%; P = .08

  9. Oversizing and Restenosis with Self-Expanding Stents in Iliofemoral Arteries

    International Nuclear Information System (INIS)

    Saguner, Ardan M.; Traupe, Tobias; Räber, Lorenz; Hess, Nina; Banz, Yara; Saguner, Arhan R.; Diehm, Nicolas; Hess, Otto M.

    2012-01-01

    Purpose: Uncoated self-expanding nitinol stents (NS) are commonly oversized in peripheral arteries. In current practice, 1-mm oversizing is recommended. Yet, oversizing of NS may be associated with increased restenosis. To provide further evidence, NS were implanted in porcine iliofemoral arteries with a stent-to-artery-ratio between 1.0 and 2.3. Besides conventional uncoated NS, a novel self-expanding NS with an antiproliferative titanium-nitride-oxide (TiNOX) coating was tested for safety and efficacy. Methods: Ten uncoated NS and six TiNOX-coated NS (5–6 mm) were implanted randomly in the iliofemoral artery of six mini-pigs. After implantation, quantitative angiography (QA) was performed for calculation of artery and minimal luminal diameter. Follow-up was performed by QA and histomorphometry after 5 months. Results: Stent migration, stent fracture, or thrombus formation were not observed. All stents were patent at follow-up. Based on the location of the stent (iliac/femoral) and the stent-to-artery-ratio, stent segments were divided into “normal-sized” (stent-to-artery-ratio < 1.4, n = 12) and “oversized” (stent-to-artery-ratio ≥ 1.4, n = 9). All stent segments expanded to their near nominal diameter during follow-up. Normal-sized stent segments increased their diameter by 6% and oversized segments by 29%. A significant correlation between oversizing and restenosis by both angiography and histomorphometry was observed. Restenosis rates were similar for uncoated NS and TiNOX-coated NS. Conclusions: TiNOX-coated NS are as safe and effective as uncoated NS in the porcine iliofemoral artery. All stents further expand to near their nominal diameter during follow-up. Oversizing is linearly and positively correlated with neointimal proliferation and restenosis, which may not be reduced by TiNOX-coating.

  10. Factors inducing in-stent restenosis: an in-vitro model.

    Science.gov (United States)

    Santin, M; Morris, C; Harrison, M; Mikhalovska, L; Lloyd, A W; Mikhalovsky, S

    2004-05-01

    In-stent restenosis is caused by the proliferation of the smooth muscle cells (SMCs) following a host response towards the implanted device. However, the precise biochemical and cellular mechanisms are still not completely understood. In this paper, the behaviour of SMCs has been investigated by an in vitro model where the cells were stimulated by platelet derived growth factor (PDGF) on tissue-like substrates as well as on biomaterials such as stainless steel (St) and diamond-like carbon (DLC)-coated St. The results demonstrated that SMCs have a completely different adhesion mode on St and become particularly prone to proliferation and pro-inflammatory cytokine secretion under PDGF stimulus. This would suggest that restenosis may caused by the accidental contact of the SMC with the St substrate under an inflammatory insult.

  11. Stenting versus endarterectomy for restenosis following prior ipsilateral carotid endarterectomy : An individual patient data meta-analysis

    NARCIS (Netherlands)

    Fokkema, Margriet; Vrijenhoek, Joyce E P; Ruijter, Hester M Den; Groenwold, Rolf H H; Schermerhorn, Marc L.; Bots, Michiel L.; Pasterkamp, Gerard; Moll, Frans L.; De Borst, Gert Jan

    2015-01-01

    Objective: To study perioperative results and restenosis during follow-up of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) for restenosis after prior ipsilateral CEA in an individual patient data (IPD) metaanalysis. Background: The optimal treatment strategy for patients with

  12. Endovascular vein harvest: systemic carbon dioxide absorption.

    Science.gov (United States)

    Maslow, Andrew M; Schwartz, Carl S; Bert, Arthur; Hurlburt, Peter; Gough, Jeffrey; Stearns, Gary; Singh, Arun K

    2006-06-01

    Endovascular vein harvest (EDVH) requires CO(2) insufflation to expand the subcutaneous space, allowing visualization and dissection of the saphenous vein. The purpose of this study was to assess the extent of CO(2) absorption during EDVH. Prospective observational study. Single tertiary care hospital. Sixty patients (30 EDVH and 30 open-vein harvest) undergoing isolated coronary artery bypass graft surgery. Hemodynamic, procedural, and laboratory data were collected prior to (baseline), during, and at it the conclusion (final) of vein harvesting. Data were also collected during cardiopulmonary bypass (CPB). Data were compared by using t tests, analysis of variance, and correlation statistics when needed. There were significant increases in arterial CO(2) (PaCO(2), 35%) and decreases in pH (1.35%) during EDVH. These were associated with increases in heart rate, mean blood pressure, and cardiac output. Within the EDVH group, greater elevations (>10 mmHg) in PaCO2 were more likely during difficult harvest procedures, and these patients exhibited greater increase in heart rate. Elevated CO(2) persisted during CPB, requiring higher systemic gas flows and greater use of phenylephrine to maintain desired hemodynamics. EDVH was associated with systemic absorption of CO(2). Greater absorption was more likely in difficult procedures and was associated with greater hemodynamic changes requiring medical therapy.

  13. Long-Term Type 1 Diabetes Enhances In-Stent Restenosis after Aortic Stenting in Diabetes-Prone BB Rats

    Directory of Open Access Journals (Sweden)

    Geanina Onuta

    2011-01-01

    Full Text Available Type 1 diabetic patients have increased risk of developing in-stent restenosis following endovascular stenting. Underlying pathogenetic mechanisms are not fully understood partly due to the lack of a relevant animal model to study the effect(s of long-term autoimmune diabetes on development of in-stent restenosis. We here describe the development of in-stent restenosis in long-term (~7 months spontaneously diabetic and age-matched, thymectomized, nondiabetic Diabetes Prone BioBreeding (BBDP rats (n=6-7 in each group. Diabetes was suboptimally treated with insulin and was characterized by significant hyperglycaemia, polyuria, proteinuria, and increased HbA1c levels. Stented abdominal aortas were harvested 28 days after stenting. Computerized morphometric analysis revealed significantly increased neointima formation in long-term diabetic rats compared with nondiabetic controls. In conclusion, long-term autoimmune diabetes in BBDP rats enhances in-stent restenosis. This model can be used to study the underlying pathogenetic mechanisms of diabetes-enhanced in-stent restenosis as well as to test new therapeutic modalities.

  14. Restenosis after balloon valvuloplasty in a dog with pulmonary stenosis.

    Science.gov (United States)

    Sunahara, Hiroshi; Fujii, Yoko; Sugimoto, Keisuke; Aoki, Takuma; Sugahara, Gou; Shirota, Kinji

    2015-01-01

    A two-month-old female Chihuahua was diagnosed as severe pulmonary valvular stenosis (PS). Although balloon valvuloplasty (BV) was successfully performed, restenosis was observed 19 months after the procedure. Euthanasia was chosen due to low output syndrome during the surgical repair attempted when the dog was 5 years old. Postmortem examination revealed markedly thickened pulmonary valve due to the increase of extracellular matrix which might be produced by increased α smooth muscle actin-positive myofibroblasts. The thickening of the valve was associated with restriction of the valve's motion, resulting in restenosis in the present case. This is the first case report documented histopathological and immunohistochemical findings of the restenotic pulmonary valve in dogs with PS after BV.

  15. The effect on patency of type, shape and volume of a vein collar used at the distal anastomis of PTFE-bypass to arteries below-knee

    DEFF Research Database (Denmark)

    Lundgren, F; Schroeder, Torben Veith

    2012-01-01

    The aim of this paper was to study the effect on patency rate of different types of vein collar (Miller's original or St Mary's boot), different length/height shapes of vein collar, and different vein collar volumes at the distal anastomosis of PTFE-bypass grafts to below-knee arteries in patients...

  16. Irradiation inhibits vascular anastomotic stenosis in a canine model

    International Nuclear Information System (INIS)

    Saito, Takeshi; Iguchi, Atsushi; Tabayashi, Koichi

    2009-01-01

    The graft patency rate after coronary artery bypass grafting (CABG) correlates with anastomotic stenosis. Intracoronary radiation therapy is effective for preventing restenosis after percutaneous coronary intervention (PCI). We postulated that intracoronary radiation therapy could prevent anastomotic stenosis and tested this hypothesis in an animal model. Femoral arteries and veins of beagle dogs were harvested, and composite arterioarterial and arteriovenous grafts were prepared. After external irradiation of the anastomotic sites, these composite grafts were transplanted into femoral arteries. Histomorphometric and immunohistological analyses of the anastomotic sites were performed. The study groups consisted of controls and animals exposed to 10 Gy, 20 Gy, and 30 Gy (n=5, in each group). In the artery graft model, the ratio of negative remodeling was significantly increased in all groups exposed to ≥10 Gy. The ratio of neointimal hyperplasia was significantly decreased in all groups exposed to ≥10 Gy. Cell density of anti-α-actin antibody-positive cells and anti-proliferating cell nuclear antigen (PCNA) antibody-positive cells was highest in the adventitial layer, and the density decreased as the dosage increased. Experimental results were almost the same in the vein graft models as in the artery graft models. With double immunohistostaining, the anti-PCNA antibody-positive cells expressed α-actin. Irradiation can inhibit anastomotic stenosis in a canine model. Adventitia is a factor in the creation of stenosis, and irradiation appears to target the adventitia. We speculate that there might be a possible role for intracoronary irradiation in the future to prevent anastomotic stenosis. (author)

  17. Axillary artery to left anterior descending coronary artery bypass with an externally stented graft: a technical report

    Directory of Open Access Journals (Sweden)

    Salvador Loris

    2008-02-01

    Full Text Available Abstract With the proliferation of minimally invasive cardiac surgery a number of alternative inflow sites for coronary artery bypass grafting have been utilized, especially in higher risk patients. The use of axillary-coronary artery bypass is a safe and effective alternative especially in the case of patients requiring redo coronary revascularization. However, the length and convoluted course of the axillary-coronary vein graft makes is susceptible to twisting, trauma and neointimal hyperplasia. We therefore report a case of an axillary-coronary artery bypass in a high risk patient in which a Dacron conduit was used to externally support and protect the vein graft to the left anterior descending artery. Surgical technique and considerations are presented and discussed.

  18. Renal vessel reconstruction in kidney transplantation using a polytetrafluoroethylene (PTFE) vascular graft.

    Science.gov (United States)

    Kamel, Mohamed H; Thomas, Anil A; Mohan, Ponnusamy; Hickey, David P

    2007-04-01

    We report a rare experience in reconstructing short renal vessels in kidney transplantation using polytetrafluroethylene (PTFE) vascular grafts. The short renal vessels in three kidney grafts were managed by the interposition of PTFE vascular grafts. Two grafts were from deceased donors and the third was a renal auto-transplant graft. PTFE grafts were used to lengthen short renal veins in two kidney grafts and a short renal artery in one. The warm ischaemia time was under 1 h and all kidneys functioned well post-operatively. Excellent blood perfusion in the three renal grafts was present on postoperative MAG 3 renal scan. No intra-operative or post-operative complications were encountered. In the three described patients, the use of PTFE vascular graft presented no additional morbidity to the kidney transplant operation and no post-oerative complication was related to its use. However, more data are necessary to conclude that PTFE graft can be used safely in kidney transplantation.

  19. Isolated Subclavian Vein Injury: A Rare and High Mortality Case

    Directory of Open Access Journals (Sweden)

    Sahin Iscan

    2013-01-01

    Full Text Available Isolated subclavian vein injuries are rarely seen without concomitant arterial injury, bone fracture, damage to brachial plexus, and thoracal traumas. Our case was brought to the emergency service 6 hours after he had been shot at the shoulder with a firearm. After detection of extravasation from the left axillary and subclavian vein on arteriographic and venographic examinations, he was operated on. An autogenous saphenous vein graft was interposed between subclavian and axillary veins. Cardiac arrest developed twice because of hypovolemia, which was resolved with medical therapy. Subclavian vein injuries have a more mortal course when compared with the injuries to the subclavian arteries. Its most important reason is excessive blood loss and air embolism because of delayed arrival to hospital. As is the case in all vascular injuries, angiography is the most important diagnostic examination. If the general health state of the patient permits, arteriography and venography should be performed in patients potentially exposed to vascular injuries. In patients with extreme blood loss and deteriorated health state, direct surgical exploration of the injury site, containment of the bleeding, and venous repair are life-saving approaches.

  20. Follow-up of coronary artery bypass graft patency: diagnostic efficiency of high-pitch dual-source 256-slice MDCT findings.

    Science.gov (United States)

    Yuceler, Zeyneb; Kantarci, Mecit; Yuce, Ihsan; Kizrak, Yesim; Bayraktutan, Ummugulsum; Ogul, Hayri; Kiris, Adem; Celik, Omer; Pirimoglu, Berhan; Genc, Berhan; Gundogdu, Fuat

    2014-01-01

    Our aim was to evaluate the diagnostic accuracy of 256-slice, high-pitch mode multidetector computed tomography (MDCT) for coronary artery bypass graft (CABG) patency. Eighty-eight patients underwent 256-slice MDCT angiography to evaluate their graft patency after CABG surgery using a prospectively synchronized electrocardiogram in the high-pitch spiral acquisition mode. Effective radiation doses were calculated. We investigated the diagnostic accuracy of high-pitch, low-dose, prospective, electrocardiogram-triggering, dual-source MDCT for CABG patency compared with catheter coronary angiography imaging findings. A total of 215 grafts and 645 vessel segments were analyzed. All graft segments had diagnostic image quality. The proximal and middle graft segments had significantly (P < 0.05) better mean image quality scores (1.18 ± 0.4) than the distal segments (1.31 ± 0.5). Using catheter coronary angiography as the reference standard, high-pitch MDCT had the following sensitivity, specificity, positive predictive value, and negative predictive value of per-segment analysis for detecting graft patency: 97.1%, 99.6%, 94.4%, and 99.8%, respectively. In conclusion, MDCT can be used noninvasively with a lower radiation dose for the assessment of restenosis in CABG patients.

  1. Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial.

    Science.gov (United States)

    Lal, Brajesh K; Beach, Kirk W; Roubin, Gary S; Lutsep, Helmi L; Moore, Wesley S; Malas, Mahmoud B; Chiu, David; Gonzales, Nicole R; Burke, J Lee; Rinaldi, Michael; Elmore, James R; Weaver, Fred A; Narins, Craig R; Foster, Malcolm; Hodgson, Kim J; Shepard, Alexander D; Meschia, James F; Bergelin, Robert O; Voeks, Jenifer H; Howard, George; Brott, Thomas G

    2012-09-01

    In the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), the composite primary endpoint of stroke, myocardial infarction, or death during the periprocedural period or ipsilateral stroke thereafter did not differ between carotid artery stenting and carotid endarterectomy for symptomatic or asymptomatic carotid stenosis. A secondary aim of this randomised trial was to compare the composite endpoint of restenosis or occlusion. Patients with stenosis of the carotid artery who were asymptomatic or had had a transient ischaemic attack, amaurosis fugax, or a minor stroke were eligible for CREST and were enrolled at 117 clinical centres in the USA and Canada between Dec 21, 2000, and July 18, 2008. In this secondary analysis, the main endpoint was a composite of restenosis or occlusion at 2 years. Restenosis and occlusion were assessed by duplex ultrasonography at 1, 6, 12, 24, and 48 months and were defined as a reduction in diameter of the target artery of at least 70%, diagnosed by a peak systolic velocity of at least 3·0 m/s. Studies were done in CREST-certified laboratories and interpreted at the Ultrasound Core Laboratory (University of Washington). The frequency of restenosis was calculated by Kaplan-Meier survival estimates and was compared during a 2-year follow-up period. We used proportional hazards models to assess the association between baseline characteristics and risk of restenosis. Analyses were per protocol. CREST is registered with ClinicalTrials.gov, number NCT00004732. 2191 patients received their assigned treatment within 30 days of randomisation and had eligible ultrasonography (1086 who had carotid artery stenting, 1105 who had carotid endarterectomy). In 2 years, 58 patients who underwent carotid artery stenting (Kaplan-Meier rate 6·0%) and 62 who had carotid endarterectomy (6·3%) had restenosis or occlusion (hazard ratio [HR] 0·90, 95% CI 0·63-1·29; p=0·58). Female sex (1·79, 1·25-2·56), diabetes (2·31, 1·61-3·31

  2. The Dresden in-stent restenosis radiation trial (DIRRT) with liquid-filled 188Re balloon

    International Nuclear Information System (INIS)

    Kropp, J.; Runge, R.R.; Reynen, K.; Koeckeritz, U.; Schmeisser, A.; Strasser, R.H.

    2002-01-01

    Full text: In some studies intracoronary radiation therapy (IRT) to minimize the restenosis rate after PTCA proved to be effective. We evaluated the performance, safety and effectiveness of IRT with 188 Re-perrhenate filled into a standard PTCA balloon. This kind of IRT allows a self-centering homogenous dose distribution to the vessel wall. 107 patients (pts) with a mean age of 63 years (81 m, 26 fin) with in-stent restenosis (type B in 39 %, type C in 61 %) and proven ischemia were included. After routine re-PTCA with or without additional stent implantation a second standard balloon was placed into the PTCA area and filled with β - -emitting liquid 188 Re at 3 atm. Irradiation time was 525 ± 167 sec to achieve a dose of 30 Gy at 0.5 mm depth of the vessel wall. In only one procedure there was a disconnection of the 188 Re containing system and the catheter but no contamination of the cath table or lab was measured. In 16 coronaries 21 stents were additionally implanted. In the follow-up 4 stent thromboses (1 day, 37 days, 2 x 6 months) with subsequent myocardial infarction were noticed, all in pts with additionally implanted stents. 57 pts had control angiography after 4 to 6 months after therapy and 41 after one year. Restenosis (stenosis > 50 % of luminal diameter) was shown in 9 out of 12 pts (75 %) with additionally implanted stents but only in 4 out of 24 pts (17 %) with PTCA alone. Reocclusion was noticed in 3 (25 %) pts with additional stent but only in 1 pt (4 %) without. No re-restenosis occurred in 20 patients which were without finding after 6 months. Intracoronary radiation therapy (IRT) with β - -emitting liquid-filled 188 Re balloon is a safe and effective therapy method which might be used routinely. Long-term results seem satisfactory in a patient group with in-stent restenosis and high risk of re-restenosis. But the positive effect of irradiation is abolished if an additional stent after PTCA is needed. (author)

  3. Neural-differentiated mesenchymal stem cells incorporated into muscle stuffed vein scaffold forms a stable living nerve conduit.

    Science.gov (United States)

    Hassan, Nur Hidayah; Sulong, Ahmad Fadzli; Ng, Min-Hwei; Htwe, Ohnmar; Idrus, Ruszymah B H; Roohi, Sharifah; Naicker, Amaramalar S; Abdullah, Shalimar

    2012-10-01

    Autologous nerve grafts to bridge nerve gaps have donor site morbidity and possible neuroma formation resulting in development of various methods of bridging nerve gaps without using autologous nerve grafts. We have fabricated an acellular muscle stuffed vein seeded with differentiated mesenchymal stem cells (MSCs) as a substitute for nerve autografts. Human vein and muscle were both decellularized by liquid nitrogen immersion with subsequent hydrolysis in hydrochloric acid. Human MSCs were subjected to a series of treatments with a reducing agent, retinoic acid, and a combination of trophic factors. The differentiated MSCs were seeded on the surface of acellular muscle tissue and then stuffed into the vein. Our study showed that 35-75% of the cells expressed neural markers such as S100b, glial fibrillary acidic protein (GFAP), p75 NGF receptor, and Nestin after differentiation. Histological and ultra structural analyses of muscle stuffed veins showed attachment of cells onto the surface of the acellular muscle and penetration of the cells into the hydrolyzed fraction of muscle fibers. We implanted these muscle stuffed veins into athymic mice and at 8 weeks post-implantation, the acellular muscle tissue had fully degraded and replaced with new matrix produced by the seeded cells. The vein was still intact and no inflammatory reactions were observed proving the biocompatibility and biodegradability of the conduit. In conclusion, we have successfully formed a stable living nerve conduit which may serve as a substitute for autologous nerves. Copyright © 2012 Orthopaedic Research Society.

  4. Restenosis after stenting in symptomatic vertebral arterial orifice disease and considerations for better outcome

    Science.gov (United States)

    Chang, Jun Young; Park, Hyun; Kwon, Oki

    2017-01-01

    We have performed stenting in 11 patients with symptomatic vertebral arterial orifice stenosis refractory to medical treatment or impairment in anterior circulation. Three of the 11 patients experienced asymptomatic severe in-stent restenosis or occlusion. Bare metal stents were used in those three patients, two of whom received revascularization therapy. Development of sufficient cervical collateral channels reconstituting the distal vertebral artery was the common feature in patients with asymptomatic in-stent restenosis. In selecting appropriate stents, consideration of mechanical strength and drug-eluting properties of a stent according to characteristics of the target vessel is important to reduce the risk of in-stent restenosis. Any decision to perform revascularization should be based on the presence of abundant cervical collaterals as well as clinical symptoms of vertebrobasilar ischemia. PMID:28304206

  5. Evaluation of temporal windows for coronary artery bypass graft imaging with 64-slice CT

    International Nuclear Information System (INIS)

    Desbiolles, Lotus; Leschka, Sebastian; Scheffel, Hans; Husmann, Lars; Garzoli, Elisabeth; Marincek, Borut; Alkadhi, Hatem; Plass, Andre; Gaemperli, Oliver; Kaufmann, Philipp A.

    2007-01-01

    Temporal windows providing the best image quality of different segments and types of coronary artery bypass grafts (CABGs) with 64-slice computed tomography (CT) were evaluated in an experimental set-up. Sixty-four-slice CT with a rotation time of 330 ms was performed in 25 patients (four female; mean age 59.9 years). A total of 84 CABGs (62 individual and 22 sequential grafts) were evaluated, including 28 internal mammary artery (33.3%), one radial artery with sequential grafting (2.4%), and 54 saphenous vein grafts (64.3%). Ten data sets were reconstructed in 10% increments of the RR-interval. Each graft was separated into segments (proximal and distal anastomosis, and body), and CABG types were grouped according to target arteries. Two readers independently assessed image quality of each CABG segment in each temporal window. Diagnostic image quality was found with good inter-observer agreement (kappa=0.62) in 98.5% (202/205) of all graft segments. Image quality was significantly better for saphenous vein grafts versus arterial grafts (P<0.001) and for distal anastomosis to the right coronary compared with other target coronary arteries (P<0.05). Overall, best image quality was found at 60%. Image quality of proximal segments did not significantly vary with the temporal window, whereas for all other segments image quality was significantly better at 60% compared with other temporal windows (P<0.05). Sixty-four-slice CT provides best image quality of various segments and types of CABG at 60% of the RR-interval. (orig.)

  6. Management of complex pediatric laryngotracheal stenosis with skin graft reconstruction.

    Science.gov (United States)

    Bowe, Sarah N; Wentland, Carissa J; Sandhu, G S; Hartnick, Christopher J

    2018-05-01

    For pediatric patients with laryngotracheal stenosis, the ultimate goal is creation of a safe, functional airway. Unfortunately, wound healing in a hollow structure can complicate repair attempts, leading to restenosis. Herein, we present our experience using skin-grafting techniques in two complex pediatric laryngotracheal stenosis cases, leading to successful decannulation or speech production. A chart review was performed examining the evaluation and management of two pediatric patients with laryngotracheal stenosis despite prior reconstructive attempts. Patient history, bronchoscopic evaluation, intra-operative technique, post-operative management, treatment outcomes, and complications were noted. Harvesting and preparation of the split-thickness skin grafts (STSG) proceeded in a similar manner for each case. Stenting material varied based on the clinical scenario. Using this technique, our patient with a Type 3 glottic web achieved substantial improvement in exercise tolerance, as well as vocal strength and quality. In addition, our aphonic patient could vocalize for the first time since her laryngotracheal injury. Temporary endoluminal stenting with skin graft lining can reproduce epithelial continuity and provide "biological inhibition" to enhance the wound healing process. When previous reconstructive efforts have failed, use of STSG can be considered in the management of complex pediatric laryngotracheal stenosis. Copyright © 2018. Published by Elsevier B.V.

  7. Engineering Radioactive Stents for the Prevention of Restenosis

    International Nuclear Information System (INIS)

    Bruce Thomadsen; Nickles, Robert J.; Larry DeWerd; Douglass Henderson; Jonathan Nye; Wes Culberson; Stephen Peterson; Michael Meltsner; Liyong Lin

    2004-01-01

    Radiation has become an accepted treatment for the prevention of restenosis (re-blockage) of coronary arteries following angioplasty. Radioactive stents could be the easiest method of delivery for the radiation, although clinical trials were disappointing. One likely reason was the choice of P-32 as the radionuclide, which fails to match the biological needs of the problem. What radionuclide would perform best remains unknown. This project established the physical infrastructure necessary for a rational investigation to determine the optimum radiological characteristics for radioactive stents in the prevention of restenosis following angioplasty. The project investigated methods to activate coronary stents with radionuclides that spanned a range of energies and radiation types that could provide a mapping of the biological response. The project also provided calibration methods to determine the strength of the stents, an a process to calculate the dose distribution actually delivered to the patient's artery--quantities necessary for any future scientific study to improve the effectiveness of radioactive stents. Such studies could benefit the thousands of patients who receive angioplasty each year

  8. CT-control of the H-graft interposition mesocaval shunt patency

    Energy Technology Data Exchange (ETDEWEB)

    Partanen, P L.K.; Oksala, I

    1984-02-01

    A method for assessing the patency of the H-graft interposition mesocaval shunts by computerized tomography is described. Five patients with such shunts were examined with a 5.5 second CT scanner. After locating the graft a 50 cc bolus of 76% diatrizoate was injected into a cubital vein and 3-4 scans were executed at a preselected level. A distinct vessel like enhancement appeared if the shunt was open. With dynamic CT-scanning the flow can be demonstrated in graphical form as time-density curves.

  9. Platelet deposition at angioplasty sites and its relation to restenosis in human iliac and femoropopliteal arteries

    International Nuclear Information System (INIS)

    Minar, E.; Ehringer, H.; Ahmadi, R.; Dudczak, R.; Leitha, T.; Koppensteiner, R.; Jung, M.; Stuempflen, A.

    1989-01-01

    The amount and time course of platelet accumulation at angioplasty sites and influence of these platelets on restenosis after percutaneous transluminal angioplasty (PTA) in peripheral arteries were determined in 92 patients, who received either a high or low dose of aspirin. Platelet deposition was quantitated by means of dual-radiotracer scintigraphy and calculation of a platelet accumulation index (PAI). The PAI was higher (P less than .05) 4-6 hours after PTA compared with that on subsequent days. There was a trend toward greater platelet accumulation in vessels with extensive dissection. Platelet accumulation at the PTA site occurred with both doses of aspirin, with no differences between the two dosage groups. Twenty-one of 67 patients who underwent PTA in the femoropopliteal segment developed restenosis during a median follow-up of 14 months. The median PAI at 4-6 and 22-24 hours after PTA was significantly less in these 21 patients than in the 46 without restenosis. The data suggest that use of antiplatelet agents to prevent platelet deposition after PTA may not be useful for prevention of restenosis

  10. The mechanical properties of infrainguinal vascular bypass grafts: their role in influencing patency.

    Science.gov (United States)

    Sarkar, S; Salacinski, H J; Hamilton, G; Seifalian, A M

    2006-06-01

    When autologous vein is unavailable, prosthetic graft materials, particularly expanded polytetrafluoroethylene are used for peripheral arterial revascularisation. Poor long term patency of prosthetic materials is due to distal anastomotic intimal hyperplasia. Intimal hyperplasia is directly linked to shear stress abnormalities at the vessel wall. Compliance and calibre mismatch between native vessel and graft, as well as anastomotic line stress concentration contribute towards unnatural wall shear stress. High porosity reduces graft compliance by causing fibrovascular infiltration, whereas low porosity discourages the development of an endothelial lining and hence effective antithrombogenicity. Therefore, consideration of mechanical properties is necessary in graft development. Current research into synthetic vascular grafts concentrates on simulating the mechanical properties of native arteries and tissue engineering aims to construct a new biological arterial conduit.

  11. [Kidney graft loss as a result of coagulation disorders].

    Science.gov (United States)

    Kulik, Agnieszka

    2012-04-01

    Renal transplantation is a method of choice in the treatment of endstage kidney insufficiency resulting in improved survival and better quality of life. Advances in immunosuppresive therapy, diagnosis and treatment of infective complications, studies on ischemic injury of transplanted organ and preservation show constant improvement in terms of short and long-term results. Early kidney graft loss resulting from thrombotic complications is rare and still challenging for transplantologists. Renal vein thrombosis is responsible for 2-7% cases of early graft loss. Selecting a subset of patients threatened with thromboembolic complications will allow for starting adequate prophylaxis, or early treatment preventing from complications including graft loss. In this paper we tried to summarize the current state of knowledge regarding venous and arterial thrombosis after renal transplantation.

  12. Percutaneous subclavian artery stent-graft placement following failed ultrasound guided subclavian venous access

    Directory of Open Access Journals (Sweden)

    Szkup Peter

    2006-05-01

    Full Text Available Abstract Background Ultrasound guidance for central and peripheral venous access has been proven to improve success rates and reduce complications of venous cannulation. Appropriately trained and experienced operators add significantly to diminished patient morbidity related to venous access procedures. We discuss a patient who required an arterial stent-graft to prevent arterial hemorrhage following inadvertent cannulation of the proximal, ventral, right subclavian artery related to unsuccessful ultrasound guided access of the subclavian vein. Case presentation During pre-operative preparation for aortic valve replacement and aorto-coronary bypass surgery an anesthetist attempted ultrasound guided venous access. The ultrasound guided attempt to access the right jugular vein failed and the ultrasound guided attempt at accessing the subclavian vein resulted in inappropriate placement of an 8.5 F sheath in the arterial system. Following angiographic imaging and specialist consultations, an arterial stent-graft was deployed in the right subclavian artery rather than perform an extensive anterior chest wall resection and dissection to extract the arterial sheath. The patient tolerated the procedure, without complication, despite occlusion of the right internal mammary artery and the right vertebral artery. There were no neurologic sequelae. There was no evidence of hemorrhage after subclavian artery sheath extraction and stent-graft implantation. Conclusion The attempted ultrasound guided puncture of the subclavian vein resulted in placement of an 8.5 F subclavian artery catheter. Entry of the catheter into the proximal subclavian artery beneath the medial clavicle, the medial first rib and the manubrium suggests that the operator, most likely, did not directly visualize the puncture needle enter the vessel with the ultrasound. The bones of the anterior chest impede the ultrasound beam and the vessels in this area would not be visible to ultrasound

  13. A Meta-Analysis of Outcomes After In Situ Reconstructions for Aortic Graft Infection.

    Science.gov (United States)

    Batt, Michel; Feugier, Patrick; Camou, Fabrice; Coffy, Amandine; Senneville, Eric; Caillon, Jocelyne; Calvet, Brigitte; Chidiac, Christian; Laurent, Frederic; Revest, Matthieu; Daures, Jean Pierre

    2018-05-01

    To confirm the advantage of in situ reconstruction (ISR) over extra-anatomic reconstruction (EAR) for aortic graft infection and determine the most appropriate conduit including autogenous veins, cryopreserved allografts, and synthetic prosthesis (standard, rifampicin of silver polyesters). A meta-analysis was conducted with rate of mortality, graft occlusion, amputation, and reinfection. A meta-regression was performed with 4 factors: patients' age, presence of prosthetic-duodenal fistula (PDF), virulent organisms, or nonvirulent organisms. In situ reconstruction over EAR seems to favor all events. For the 5 conduits used for ISR, according to operative mortality, age of the patients looks to have a positive correlation only for silver polyester and no conduit present any advantage in the presence of PDF. Reinfection seems to be not significantly different for the 5 conduits, and only autogenous veins appear to have a positive correlation with infecting organisms. In situ reconstruction may be considered as first-line treatment. Our results suggest that silver polyesters appear to be most appropriate for older patients, and in order to limit reinfection, autogenous veins are probably the most suitable conduit.

  14. Does patency after a vein collar and PTFE-bypass depend on sex and age?

    DEFF Research Database (Denmark)

    Lundgren, F; Schroeder, Torben Veith

    2012-01-01

    Randomized studies evaluating the effect of a vein collar at the distal anastomosis of PTFE-grafts show conflicting results. The study of the Joint Vascular Research Group (JVRG) of UK found improved primary patency while the Scandinavian Miller Collar Study (SCAMICOS) found neither any effect...

  15. Simple balloon dilation for drug-eluting in-stent restenosis: An optical coherent tomography analysis

    Energy Technology Data Exchange (ETDEWEB)

    Arikawa, Ryo [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima (Japan); Yamaguchi, Hiroshi, E-mail: hyamaguchi@tsm.bbiq.jp [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima (Japan); Takaoka, Junichiro; Miyamura, Akihiro; Atsuchi, Nobuhiko; Ninomiya, Toshiko; Atsuchi, Yoshihiko [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima (Japan); Ohishi, Mitsuru [Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima (Japan); Terashima, Mitsuyasu [Department of Cardiology, Toyohashi Heart Center, Toyohashi (Japan); Kaneda, Hideaki [Okinaka Memorial Institute for Medical Research, Tokyo (Japan)

    2015-01-15

    Background: Although drug-eluting stent (DES) has significantly reduced restenosis, the treatment of DES-in-stent restenosis (ISR) remains a challenge with high restenosis rate. Methods: We examined whether morphologic appearance of restenosis tissue by optical coherent tomography (OCT) had an impact on outcomes after balloon angioplasty for DES-ISR. The morphologic appearance of restenosis tissue was qualitatively assessed for tissue structures such as homogeneous, layered, and heterogeneous patterns. Results: Using OCT, 50 patients with DES-ISR were divided into 2 groups: 25 lesions with homogeneous or layered patterns (homo/layered group) and 25 lesions with heterogeneous patterns (hetero group). Acute gain was larger in the hetero group (1.33 ± 0.41 mm vs. 1.06 ± 0.32 mm in the homo/layered group, P = 0.03). On intravascular ultrasound analysis, post-procedural percent neointimal area was smaller in the hetero group (27.4 ± 9.2% vs. 34.0 ± 11.2% in the homo/layered group, P = 0.05). Angiographic follow-up was performed in 37 lesions (74%). Follow-up minimal lumen diameter was larger in the hetero group (1.75 ± 0.89 mm vs. 1.01 ± 0.81 mm in the homo/layered group, P = 0.04). Target lesion revascularization rates tended to be lower in the hetero group (20% vs. 43% in the homo/layered group, P = 0.12). Conclusions: Balloon angioplasty was more effective for DES-ISR with heterogeneous tissue appearance than DES-ISR with homogeneous/layered tissue appearance. OCT assessment of DES-ISR morphology may be a useful adjunct in determining clinical strategies. Simple balloon dilatation is a possible treatment strategy for DES-ISR lesions with a heterogeneous appearance on OCT images.

  16. Brachytherapy for coronary restenosis: state of art in 2003

    International Nuclear Information System (INIS)

    Latorzeff, I.; Delannes, M.; Latorzeff, I.; Carrie, D.; Alibelli, M.J.; Bonnet, J.; Duthil, P.

    2003-01-01

    Based on therapeutic approach for benign diseases, vascular brachytherapy decreases smooth vascular muscle cells proliferation and multiplication which lead to the formation of the neo-intima. The radioactive positive action affects arterial recoil due to post angioplasty vessel injury. Randomized studies has shown good angiographic results up to 6 months of follow-up, with 50% in-stent restenosis rate decrease and on the analysed segment as well. Decrease on Mace and TLR show statistically significance. Results don't correlate with emitter and beta emitters had been introduced in France recently. Vascular brachytherapy is actually indicated for in-stent restenosis, there is no evidence to perform this treatment for de novo lesion. Geographic miss, source centering, late thrombosis and pullback procedure may interfere with treatment quality. IVUS allows best target volume determination to a higher quality level. Internationals guidelines such as Eva-Gec-Estro recommendations could increase treatment safety and enable development of an optimal technique. (authors)

  17. Intravascular radiation for restenosis prevention: could it be the holy grail?

    International Nuclear Information System (INIS)

    King, S.B.

    1996-01-01

    This brief editorial discusses the use of intravascular radiation in preventing restenosis after angioplasty in coronary interventions. Results in porcine coronary arteries and clinical applications are briefly reported. (UK)

  18. [Mesenteric-cava shunt's results with autologous jugular vein graft in children with pre-sinusoidal portal hypertension].

    Science.gov (United States)

    Leal, N; López Santamaría, M; Gámez, M; Murcia, J; Andolfi, G; Berrocal, T; Frauca, E; Jara, P; Tovar, J

    2002-07-01

    Presinusoidal portal hypertension (PPH) in children evaluates without functional hepatic damage, and with the time, trends to compensate through the creation of spontaneous portosystemic shunts. Nevertheless, some patients suffer episodes of gastrointestinal bleeding (GIB) that because of its frequency or severity, force to propose the change of surgical treatment. To evaluate the results of the mesocaval shunt (MCS) with autologous jugular vein in children with PPH. Among the 32 children with PPH treated in our Hospital in the last 7 years, 10 had episodes of GIB that forced to perform a surgical shunt. The types of shunt were distal splenorenal in 3 patients and mesocaval in 7. These 7 cases are the material of this study. The origin of the PPH was a cavernomatosis transformation of the portal vein in 6 cases and a congenital hepatic fibrosis in 1. Before the surgery the average number of episodes of GIB was 9 (range 2-15); all the patients needed transfusion of blood products and variceal sclerosis. In 2 cases a tamponade with the Sengtaken balloon was required and 5 patients were treated with somatostatin and propranolol. The Doppler ultrasounds revealed and intense hepatofugal collateral circulation in all the cases. The initial flow through the shunt was adequate in all the patients except one who required a percutaneous balloon dilatation. Only this patient has suffered an episode of GIB. The hyperesplenism signs disappeared or improved in all the seven cases and the collateral circulation was significantly reduced. The pressure in the splenic territory decreased around 50% in the 4 patients that was measured. There were no cases of encephalopasty and only one child with congenital hepatic fibrosis shows signs of mild hepatic disfunction. The medium follow up post-shunt is 32 months (range 8 m-6 years). The MCS prevents the GIB in the PPH not responsive to the conservative treatment; its effectiveness is related with an adequate permeability though the graft

  19. Brachytherapy on restenosis. 32P radioisotope in animal model

    International Nuclear Information System (INIS)

    Bergoc, R.; Rivera, E.; Cocca, C.; Martin, G.; Cricco, G.; Croci, M.; Guzman, L.

    2000-01-01

    Despite a notorious decline in age-adjusted death rates for cardiovascular pathologies, coronary artery disease still remains as the main cause of mortality above the age of 40 in men and 60 in women. More than 25% of death in persons over the age of 35 are due to coronary disease. In about 50% of men and 30% of women, the first manifestation of the disease is an acute myocardial infarction and 10% a sudden cardiac death. In Argentina it is estimated that in 1998 about 100.000-115.000 people suffered as first manifestation of coronary illness a myocardial acute infarct. Angioplasty has an important and well established site in the treatment of the coronary illness and restenosis represents the principal complication of this method for myocardial re-vascularization. About a 35-40% of treated arteries present restenosis within the first six month the intervention with the concomitant need of re-interventions, re-hospitalizations, by-pass surgery, work discontinuity and the high cost for the health system. A number of drugs were tested as anti-restenosis: anticoagulants, aspirin, antispasmodics and lipid-lowering agents but none was clearly efficient; also, experimental studies in which intravascular irradiation with different source types and energies, radiation doses and doses rate to prevent restenosis was utilized; however, there is no consensus in many aspects of this intravascular brachytherapy. The first step in this work was to induce the experimental model in rabbits. Afterwards, by means of the balloon methodology and stent implantation, brachytherapy experiments were carried out to evaluate the biological effect on different layers of arteries, with different Doses using a beta particle emitting radioisotope ( 32 P). The arteriosclerotic lesions were induced in New Zealand rabbits through the administration of a diet with high cholesterol content. Angioplastic interventions on femoral arteries were done with balloon methodology and controlled by fluoroscopy

  20. Reversible defects on myocardial perfusion imaging early after coronary stent implantation: a predictor of late restenosis

    International Nuclear Information System (INIS)

    Kim, D. E.; Park, S. A.; Kim, C. K.; Chang, J. A.; Jeong, J. W.; Oh, S. G.; Lee, C.

    2007-01-01

    It appears logical that myocardial perfusion should be fixed and not reversible, in the territory supplied by a dilated coronary artery. However, several studies have demonstrated reversible perfusion in the territory supplied by a coronary artery with an optimally implanted stent. The main objective of this study was to evaluate the incidence of reversible defects detected by M-SPECT early after optimal PTCA with stent implantation. Its second objective was to determine the predictive value of detecting reversible defects after stent implantation for late restenosis. Sixty-six patients that underwent M-SPECT within 24 hours of successful PTCA with stent implantation were included. All patients were followed up clinically and angiographically. The incidence of reversible perfusion defects on M-SPECT and the rate of late restenosis in target coronary arteries were evaluated retrospectively. Reversible perfusion defects on M-SPECT were observed in 26% of the patients and in 36% of lesions following successful PTCA with stent implantation. The incidence of late restenosis was significantly higher in patients and lesions with reversible perfusion defects (47% vs. 18%). According to binary logistic regression analysis, the presence of a reversible perfusion defects was the only independent predictor of late restenosis. This study shows that the predictive value of reversible perfusion defects on M-SPECT early after stent implantation with respect to the incidence of late restenosis was 47% in patients with a reversible defect, and 18% in those without it

  1. Similar Outcomes in Diabetes Patients After Coronary Artery Bypass Grafting With Single Internal Thoracic Artery Plus Radial Artery Grafting and Bilateral Internal Thoracic Artery Grafting.

    Science.gov (United States)

    Raza, Sajjad; Blackstone, Eugene H; Houghtaling, Penny L; Koprivanac, Marijan; Ravichandren, Kirthi; Javadikasgari, Hoda; Bakaeen, Faisal G; Svensson, Lars G; Sabik, Joseph F

    2017-12-01

    The purpose of this study was to determine in patients with diabetes mellitus whether single internal thoracic artery (SITA) plus radial artery (RA) grafting yields outcomes similar to those of bilateral internal thoracic artery (BITA) grafting. From January 1994 to January 2011, 1,325 diabetic patients underwent primary isolated coronary artery bypass graft surgery with either (1) SITA plus RA with or without saphenous vein (SV) grafts (n = 965) or (2) BITA with or without SV grafts (n = 360); an internal thoracic artery was used in all patients to graft the left anterior descending coronary artery. Endpoints were in-hospital outcomes and time-related mortality. Median follow-up was 7.4 years, with a total follow-up of 9,162 patient-years. Propensity score matching was performed to identify 282 well-matched pairs for adjusted comparisons. Unadjusted in-hospital mortality was 0.52% for SITA plus RA with or without SV grafts and 0.28% for BITA with or without SV grafts, and prevalence of deep sternal wound infection was 3.2% and 1.7%, respectively. Unadjusted survival at 1, 5, 10, and 14 years was 97%, 88%, 68%, and 51% for SITA plus RA with or without SV grafts, and 97%, 95%, 80%, and 66% for BITA with or without SV grafts, respectively. Among propensity-matched patients, in-hospital mortality (0.35% versus 0.35%) and prevalence of deep sternal wound infection (1.4% versus 1.4%) were similar (p > 0.9) in the two groups, as was 1-, 5-, 10-, and 14-year survival: 97%, 90%, 70%, and 58% for SITA plus RA with or without SV grafting versus 97%, 93%, 79%, and 64% for BITA with or without SV grafting, respectively (early p = 0.8, late p = 0.2). For diabetic patients, SITA plus RA with or without SV grafting and BITA with or without SV grafting yield similar in-hospital outcomes and long-term survival after coronary artery bypass graft surgery. Therefore, both SITA plus RA and BITA plus SV grafting should be considered for these patients. Copyright © 2017 The Society

  2. Laser Atherectomy for Treatment of Femoropopliteal In-Stent Restenosis.

    Science.gov (United States)

    Armstrong, Ehrin J; Thiruvoipati, Thejasvi; Tanganyika, Kundai; Singh, Gagan D; Laird, John R

    2015-08-01

    To investigate if laser atherectomy with adjunctive balloon angioplasty can improve endovascular treatment outcomes for femoropopliteal in-stent restenosis (ISR). A dual center study included 135 symptomatic patients (mean age 71 years; 76 men) who underwent endovascular treatment of femoropopliteal ISR between 2006 and 2013. Of these, 54 (40%) were treated with laser atherectomy and the remaining 81 patients with balloon angioplasty alone. Angiographic images were reviewed for lesion morphology and characteristics, TransAtlantic InterSociety Consensus (TASC) II classification, and distal runoff. Class I ISR was defined as focal lesions ≤50 mm, class II ISR as lesions >50 mm, and class III ISR as stent total occlusion. Recurrent ISR was determined by a peak systolic velocity ratio >2.4 by duplex ultrasound. Patients treated with laser atherectomy had longer mean ISR lesion length (222 vs 114 mm, patherectomy and rates of recurrent restenosis or occlusion for patients with class I/II ISR, but there was a significantly lower rate of target lesion revascularization at 2 years among patients treated with laser atherectomy (14% vs 44%, p=0.05). In comparison, patients with class III ISR treated with laser atherectomy had lower rates of recurrent restenosis at 1 year (54% vs 91%, p=0.05) and 2 years (69% vs 100%, p=0.05). Patients with class III ISR treated with laser atherectomy also had lower rates of recurrent in-stent occlusion at 2-year follow-up (33% vs 71%, p=0.04). When used to treat complex ISR, including in-stent occlusions, laser atherectomy with adjunctive balloon angioplasty may be associated with improved patency. © The Author(s) 2015.

  3. Rotational and aspiration atherectomy for infrainguinal in-stent restenosis.

    Science.gov (United States)

    Beschorner, Ulrich; Krankenberg, Hans; Scheinert, Dierk; Sievert, Horst; Tübler, Thilo; Sixt, Sebastian; Noory, Elias; Rastan, Aljoscha; Macharzina, Roland; Zeller, Thomas

    2013-03-01

    To report feasibility and safety of the Pathway PV™ Atherectomy System during percutaneous peripheral vascular interventions of in-stent restenosis. 33 patients (66.7 % men; mean age 68.7 years; 39.4 % diabetics) with symptomatic infrainguinal in-stent restenosis were enrolled at 5 study sites. Primary study endpoint was the 30-day serious adverse event (SAE) rate. At one study site a subgroup of 13 patients was scheduled for additional follow-up examinations with duplex. Forty lesions with a mean lesion length of 85.7 mm (range 6 - 370 mm) were treated including total occlusions (20 %) and infrapopliteal lesions (5 %). In sixteen target lesions (40 %) procedural success was reached with atherectomy alone, 23 lesions (57.5 %) received adjunctive percutaneous transluminal angioplasty to obtain a sufficient angiographic result. Freedom from device-related SAEs was 100 %. Overall there were 11 unexpected adverse events in 11 patients, two of which were serious (retroperitoneal bleeding and access site infection). The ankle-brachial index increased significantly from 0.65 ± 0.13 at baseline to 0.82 ± 0.15 at 30 days. Mean Rutherford category improved from 2.8 ± 0.7 at baseline to 1.0 ± 1.2. In the subgroup with longer follow- up primary patency was 33 % after 12 months and 25 % after 24 months. Secondary patency was 92 % after 12 and 24 months. The use of the Pathway PV™ System during percutaneous peripheral vascular interventions of in-stent restenosis appears to be feasible and safe but does not seem to offer a sustainable solution regarding long term patency. A combination with drug eluting balloon angioplasty could be an interesting option and should be evaluated in further clinical trials.

  4. Looking beyond oral mucosa: Initial results of everted saphenous vein graft urethroplasty (eSVGU) in long anterior urethral strictures.

    Science.gov (United States)

    Akhtar, Arif; Khattar, Nikhil; Goel, Hemant; Rao, Swatantra; Tanwar, Raman; Sood, Rajeev

    2017-09-01

    To prospectively evaluate the feasibility and initial results of an everted saphenous vein graft (eSVG) as a dorsolateral onlay, in patients with long anterior urethral strictures and/or chronic tobacco users. In all, 20 patients with long anterior urethral strictures (>7 cm) and/or chronic tobacco exposed oral mucosa were included in the study. The harvested SVG was hydro-distended, detubularised, and everted. Substitution urethroplasty using an eSVG was performed using a dorsolateral onlay technique. Symptoms were assessed using the International Prostate Symptom Score (IPSS) and uroflowmetry at 1, 3 and 6 months; and voiding and retrograde urethrograms, and urethroscopy were done at 3 months. Failure was defined as failure to void, need for interventions in form of direct-vision internal urethrotomy or endodilatation. Three patients were excluded because they underwent a staged urethroplasty. In all, 17 patients underwent eSVG substitution urethroplasty. The mean (SD, range) follow-up of our patients was 17.64 (5.23, 10-26) months. The mean (SD, range) length of the strictured segment was 14 (2.5, 10-18) cm and the length of the harvested SVG was 16.3 (2.7, 12-20) cm. The mean (SD) IPSS at 1, 3 and 6 months after catheter removal was 10 (2.8), 10 (3.4) and 10 (1.4) and the quality-of-life score was 1.76 (0.5), 2.05 (1.0) and 2.05 (1.0), respectively. Postoperatively, endodilatation was required in two patients. Complete failure occurred in one patient. An eSVG, as a dorsolateral onlay graft, is a promising and prudent option for long anterior urethral strictures, especially in patients with poor oral hygiene and chronic tobacco use.

  5. Comparative Evaluation of Chitosan Nerve Guides with Regular or Increased Bendability for Acute and Delayed Peripheral Nerve Repair: A Comprehensive Comparison with Autologous Nerve Grafts and Muscle-in-Vein Grafts.

    Science.gov (United States)

    Stößel, Maria; Wildhagen, Vivien M; Helmecke, Olaf; Metzen, Jennifer; Pfund, Charlotte B; Freier, Thomas; Haastert-Talini, Kirsten

    2018-05-08

    Reconstruction of joint-crossing digital nerves requires the application of nerve guides with a much higher flexibility than used for peripheral nerve repair along larger bones. Nevertheless, collapse-resistance should be preserved to avoid secondary damage to the regrowing nerve tissue. In recent years, we presented chitosan nerve guides (CNGs) to be highly supportive for the regeneration of critical gap length peripheral nerve defects in the rat. Now, we evidently increased the bendability of regular CNGs (regCNGs) by developing a wavy wall structure, that is, corrugated CNGs (corrCNGs). In a comprehensive in vivo study, we compared both types of CNGs with clinical gold standard autologous nerve grafts (ANGs) and muscle-in-vein grafts (MVGs) that have recently been highlighted in the literature as a suitable alternative to ANGs. We reconstructed rat sciatic nerves over a critical gap length of 15 mm either immediately upon transection or after a delay period of 45 days. Electrodiagnostic measurements were applied to monitor functional motor recovery at 60, 90, 120, and 150 (only delayed repair) days postreconstruction. Upon explanation, tube properties were analyzed. Furthermore, distal nerve ends were evaluated using histomorphometry, while connective tissue specimens were subjected to immunohistological stainings. After 120 days (acute repair) or 150 days (delayed repair), respectively, compression-stability of regCNGs was slightly increased while it remained stable in corrCNGs. In both substudies, regCNGs and corrCNGs supported functional recovery of distal plantar muscles in a similar way and to a greater extent when compared with MVGs, while ANGs demonstrated the best support of regeneration. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

  6. Comparação da perviedade entre artéria radial e veia safena em pacientes em pós-operatório de cirurgia de revascularização miocárdica com retorno dos sintomas Comparison of patency between radial artery and saphenous vein in a coronary artery bypass grafting post operative with return of the symptoms

    Directory of Open Access Journals (Sweden)

    Herbert Coelho Hortmann

    2010-06-01

    Full Text Available OBJETIVO: Comparar a perviedade da artéria radial e veia safena em pacientes com retorno dos sintomas após cirurgia de revascularização do miocárdio (CRVM. MÉTODOS: Estudo retrospectivo. No período de janeiro de 1998 a dezembro de 2005, foram realizadas 469 CRVMs com o uso da artéria radial dentre os enxertos, no Hospital Vera Cruz, em Belo Horizonte/MG. Destes, 94 pacientes apresentaram alterações isquêmicas no pós-operatório recente ou tardio e foram reestudados com cineangiocoronariografia. Os enxertos foram divididos em três grupos: artéria torácica interna (ATI, artéria radial (AR e veia safena (VS, e foram estratificados segundo a gravidade das lesões: sem lesão grave (OBJECTIVE: To compare the radial artery and saphenous vein's patency in patients with recurrence of symptoms in a coronary artery bypass grafting (CABG. METHODS: Retrospective study. From January 1998 to December 2005, 469 CABGs were performed using the radial artery as a graft, in Vera Cruz Hospital in Belo Horizonte/ MG. Among the patients who underwent those surgeries, 94 presented ischemic changes in early or late postoperative period, which led them to be re-evaluated by coronary angiography. The grafts were divided in three groups: internal thoracic artery (ITA, radial artery (RA and saphenous vein (SV, and they were stratified according to the severity of injury: uninjured or patent (< 70%, severe obstruction (70 to 99% and occlusion. RESULTS: For the 94 patients in the study, 86 grafts of ITA, 94 of RA and 111 of SV were used. For the 86 ITA grafts, 73 (84.88% were found patent. For the 94 RA grafts, 55 (58.51% were found patent, and for the 111 SV grafts, 73 (65.76% were uninjured. A statistically significant difference (P= 0.001 was found between RA and SV grafts, with a higher patency found for VS graft. For the RA grafts, women presented a worse result concerning the RA patency (65.7% and 40.7%, with P = 0.006. Concerning coronary

  7. An unusual case of Y-shaped right renal vein.

    Science.gov (United States)

    Lavy, M; Martin, L; Eouzan, D; Turco, C; Heyd, B; Mantion, G; Parratte, B; Tatu, L

    2015-01-01

    Vascular renal anomalies are frequent, multiple and well described and result from errors in vessel embryogenesis between the 6th and 10th week of gestation. Historically, variations are described in anatomic dissection and currently mostly in image interpretation. We report an anatomic variation concerning the right renal vein which, to our knowledge, has never been described in the literature either by dissection or by radiological examination. This variation was discovered during the routine dissection of an embalmed male body. It consists of a Y-shaped right renal vein and is associated with multiple retroperitoneal variations: a bilateral accessory renal artery, a trident ending of the right renal artery and a left testicular vein variation. Venous and arterial renal anatomy and its variations are fundamentally important in renal surgery, especially concerning living donor renal grafts. These variations may be diagnosed thanks to injected tomodensitometry which has a good sensitivity and specificity for anomalies. Preoperative diagnosis of an anatomic vascular renal variation may reduce morbidity during surgery, which is why precise examination of injected tomography should be mandatory.

  8. Subclavian vein aneurysm secondary to a benign vessel wall hamartoma

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Patrick [Nationwide Children' s Hospital, Section of Pediatric Interventional Radiology, Columbus, OH (United States); Spaeth, Maya [Nationwide Children' s Hospital, Section of Plastic and Reconstructive Surgery, Columbus, OH (United States); Prasad, Vinay [Nationwide Children' s Hospital, Section of Pediatric Pathology, Columbus, OH (United States); McConnell, Patrick [Nationwide Children' s Hospital, Section of Cardiothoracic Surgery, Columbus, OH (United States)

    2013-11-15

    Venous aneurysms are rare clinical entities, particularly in children, and their presentation and natural history often depend on the anatomical location and underlying etiology. We present a single case of a 12-year-old girl who presented with a palpable right supraclavicular mass. Imaging evaluation with CT, conventional venography, MRI and sonography revealed a large fusiform subclavian vein aneurysm with an unusual, mass-like fibrofatty component incorporated into the vessel wall. The girl ultimately required complete resection of the right subclavian vein with placement of a synthetic interposition graft. This case provides a radiology/pathology correlation of an entity that has not previously been described as well as an example of the utility of multiple imaging modalities to aid diagnosis and preoperative planning. (orig.)

  9. Clinical results of Intracoronary Brachytherapy (ICBT) for multiple in-stent restenosis

    International Nuclear Information System (INIS)

    Stadler, P.; Schaefer, C.; Chaber, S.; Putnik, K.; Treutwein, M.; Koelbl, O.; Muders, F.

    2006-01-01

    Background and purpose: treatment of in-stent restenosis (ISR) with percutaneous coronary intervention (PCI) alone is often followed by early re-restenosis. The present study focused on the effect of intracoronary brachytherapy (ICBT) on multiple in-stent restenosis (MISR) after repeated PCI. Patients and methods: 40 patients (27 male, 13 female, age: 66 ± 9 years) with MISR (two to six ISRs, median three ISRs) were retrospectively analyzed. All patients were treated by using the Novoste registered Beta-Cath trademark 3.5F System after PCI. The target vessel received 18.4-25.3 Gy of radiation at a depth of 2 mm from the center of the source. The restenosis-free survival and overall survival were calculated by Kaplan-Meier analysis (log-rank). The time interval between last PCI without ICBT and the consecutive recurrence was compared with the follow-up time after PCI with ICBT. Results: the 3-year overall survival rate after ICBT was 93%. The 0.5-, 1-, 2-, and 3-year ISR-free survival rates after PCI + ICBT were 81%, 72%, 52%, and 38%, respectively. After PCI alone, the 0.5-, 1-, and 2-year ISR-free survival rates were 30%, 13%, and 0%, respectively. This difference was highly significant (p < 0.0001). Patients with more than three ISRs before ICBT had a better outcome (3-year ISR-free survival: 80%) than patients with only two or three ISRs before ICBT (3-year ISR-free survival: 25%; p < 0.05). Conclusion: ICBT is highly effective and safe in patients with ISR. The results of this study are in accordance with the WRIST and BETA-WRIST data. After 6 months both studies revealed an ISR-free survival rate of 86% (WRIST) and 66% (BETA-WRIST), respectively. The ISR rates in the own control group (70%) were comparable to the placebo groups in WRIST (68%) and BETA-WRIST (72%). Interestingly, patients with more than three ISRs before ICBT had the lowest ISR rate after ICBT. (orig.)

  10. Arterial Levels of Oxygen Stimulate Intimal Hyperplasia in Human Saphenous Veins via a ROS-Dependent Mechanism

    Science.gov (United States)

    Joddar, Binata; Firstenberg, Michael S.; Reen, Rashmeet K.; Varadharaj, Saradhadevi; Khan, Mahmood; Childers, Rachel C.; Zweier, Jay L.; Gooch, Keith J.

    2015-01-01

    Saphenous veins used as arterial grafts are exposed to arterial levels of oxygen partial pressure (pO2), which are much greater than what they experience in their native environment. The object of this study is to determine the impact of exposing human saphenous veins to arterial pO2. Saphenous veins and left internal mammary arteries from consenting patients undergoing coronary artery bypass grafting were cultured ex vivo for 2 weeks in the presence of arterial or venous pO2 using an established organ culture model. Saphenous veins cultured with arterial pO2 developed intimal hyperplasia as evidenced by 2.8-fold greater intimal area and 5.8-fold increase in cell proliferation compared to those freshly isolated. Saphenous veins cultured at venous pO2 or internal mammary arteries cultured at arterial pO2 did not develop intimal hyperplasia. Intimal hyperplasia was accompanied by two markers of elevated reactive oxygen species (ROS): increased dihydroethidium associated fluorescence (4-fold, ppO2 is suggested by the observation that chronic exposure to tiron, a ROS scavenger, during the two-week culture period, blocked intimal hyperplasia. Electron paramagnetic resonance based oximetry revealed that the pO2 in the wall of the vessel tracked that of the atmosphere with a ~30 mmHg offset, thus the cells in the vessel wall were directly exposed to variations in pO2. Monolayer cultures of smooth muscle cells isolated from saphenous veins exhibited increased proliferation when exposed to arterial pO2 relative to those cultured at venous pO2. This increased proliferation was blocked by tiron. Taken together, these data suggest that exposure of human SV to arterial pO2 stimulates IH via a ROS-dependent pathway. PMID:25799140

  11. Injuries of the Portal Vein in Patients With Blunt Abdominal Trauma

    Science.gov (United States)

    Kremer, B.; Lloyd, D. M.; Meyer-Pannwitt, U.

    1993-01-01

    Between January 1987 and September 1991, 68 severely traumatized patients underwent emergency laparotomy because of blunt abdominal trauma. Intraoperatively, 54.4% of the patients had a major injury to one organ, 23.5% had injuries to two organs, 16.2% had injuries to three organs and 5.9% to four or more organs. Additionally, in 11.8% of these cases (n = 8) a major vascular injury (portal vein n = 5, vena cava n = 2, mesenteric root n = 1) was found. Injuries to the portal vein were always associated with complete rupture of the pancreas, requiring distal pancreatic resection in four cases and a duodenum preserving resection of the head of the pancreas in one. In two of these patients the portal vein had to be reconstructed with a Goretex prosthetic graft. Mortality was 14.7% for the whole group (n = 68) and 0% for patients with additional portal venous injuries. PMID:8489966

  12. Incidence of definite stent thrombosis or in-stent restenosis after drug-eluting stent implantation for treatment of coronary in-stent restenosis. From western denmark heart registry

    DEFF Research Database (Denmark)

    Jensen, Jesper; Jensen, Lisette Okkels; Terkelsen, Christian Juhl

    2012-01-01

    There are limited data on the optimal management of in-stent restenosis after percutaneous coronary intervention (PCI) with bare metal stent (BMS) or drug-eluting stent (DES) implantations. We assessed the clinical presentation, the incidence, and prognosis of definite stent thrombosis...

  13. Sclerotherapy of Varicose Veins and Spider Veins

    Science.gov (United States)

    ... Index A-Z Sclerotherapy of Varicose Veins and Spider Veins Sclerotherapy uses injections from a very fine, ... Sclerotherapy? What is Sclerotherapy of Varicose Veins and Spider Veins? Sclerotherapy is a minimally invasive treatment used ...

  14. The Role Of Inflammation In Stent Restenosis More Than 1 Year Afetr Drug Eluting Stent Implantation

    Directory of Open Access Journals (Sweden)

    Hasan Shemirani

    2011-09-01

    Full Text Available Background: In stent restenosis (ISR following endovascular interventions is the main limitation of their long-term success. Despite advances have been made during recent years to decrease restenosis, it remains a challenging clinical problem.The aim of this study was to evaluate the relationship between angiographic coronary in stent restenosis, inflammation after successful stent implantation. Methods: This study included 78 patients, 35year old and higher who underwent coronary angiography more than 1 year after drug-eluting stent (DES implantation because of symptoms suggestive ischemia. Patients were divided into ISR group (case and patent stent group (control according to angiography results. For all patients blood lipids and high sensitivity C-Reactive Protein (hsCRP were measured simultaneously. Results: Age, sex, hypertension, current smoking, and lipid profile other than High Density Lipoprotein (HDL-C of patients in the case and control groups were similar .However, HDL-C < 40mg/L was more prevalent with ISR (66.7% vs. 30.8%, p=0.002. The hsCRP level was 2.98±2.06 mg/L in the case group and 2.50±1.80 mg/L in the control group. There were no significant differences in mean hsCRP concentration between the two groups (p=0.14, however mean hsCRP level was significantly higher in men of case group than control group (3.35mg/L vs. 2.21mg/L, p<0.05. Conclusion: This study demonstrates that in men but not in women inflammation may be a predictor of in stent restenosis more than 1 year after drug eluting stent implantation. Also, high-density lipoprotein (HDL probably has protective effect against stent restenosis.

  15. Evaluation of coronary artery bypass grafts with magnetic resonance imaging

    International Nuclear Information System (INIS)

    Okamura, Yoshitaka; Yamada, Yasuyuki; Mochizuki, Yoshihiko; Iida, Hiroshi; Mori, Hideaki; Sugita, You-ichi; Shimada, Kou-ichirou

    1997-01-01

    Currently, the efficacy of magnetic resonance imaging (MRI) for evaluating coronary artery disease has been reported. In this study, we have evaluated the usefulness and the problems of MRI for evaluating the patency of coronary artery bypass grafts. Thirty-five patients who received coronary artery bypass grafting (CABG) were evaluated by using MRI for determining the graft patency compared with conventional coronary angiography. There were 30 men and 5 women. The mean age was 61.2 years (range 45 to 75). The 35 patients had a total of 92 grafts (28 internal thoracic artery, 7 gastroepiploic artery and 57 saphenous vein grafts). Magnetic resonance coronary angiogram (MRCA) was performed with SIGNA HORIZON 1.5 T (GE Inc.) by using 2D-FASTCARD sequence. All patients underwent imaging in the transverse and coronal planes, most had imaging in the sagittal plane, and a few had in the oblique plane. By using MRCA, 82 of 90 grafts were diagnosed correctly as patent, and 1 of 2 grafts were diagnosed correctly as occluded. Thirty-four of 40 LAD grafts (85%), 20 of 22 RCA grafts (91%) and 29 of 30 Cx grafts (97%) were correctly evaluated. The efficacy of MRCA for evaluating the patency of coronary artery bypass grafts was recognized. But the sternal wire (stainless steel) and hemoclip interfere with the interpretation and reduce the sensitivity. Higher sensitivity may be obtained by changing the material of the sternal wires and hemoclips at coronary surgery. (author)

  16. Brachytherapy on restenosis. {sup 32}P radioisotope in animal model

    Energy Technology Data Exchange (ETDEWEB)

    Bergoc, R.; Rivera, E.; Cocca, C.; Martin, G.; Cricco, G. [Buenos Aires Univ. (Argentina). School of Pharmacy and Biochemistry; Croci, M.; Guzman, L.

    2000-05-01

    Despite a notorious decline in age-adjusted death rates for cardiovascular pathologies, coronary artery disease still remains as the main cause of mortality above the age of 40 in men and 60 in women. More than 25% of death in persons over the age of 35 are due to coronary disease. In about 50% of men and 30% of women, the first manifestation of the disease is an acute myocardial infarction and 10% a sudden cardiac death. In Argentina it is estimated that in 1998 about 100.000-115.000 people suffered as first manifestation of coronary illness a myocardial acute infarct. Angioplasty has an important and well established site in the treatment of the coronary illness and restenosis represents the principal complication of this method for myocardial re-vascularization. About a 35-40% of treated arteries present restenosis within the first six month the intervention with the concomitant need of re-interventions, re-hospitalizations, by-pass surgery, work discontinuity and the high cost for the health system. A number of drugs were tested as anti-restenosis: anticoagulants, aspirin, antispasmodics and lipid-lowering agents but none was clearly efficient; also, experimental studies in which intravascular irradiation with different source types and energies, radiation doses and doses rate to prevent restenosis was utilized; however, there is no consensus in many aspects of this intravascular brachytherapy. The first step in this work was to induce the experimental model in rabbits. Afterwards, by means of the balloon methodology and stent implantation, brachytherapy experiments were carried out to evaluate the biological effect on different layers of arteries, with different Doses using a beta particle emitting radioisotope ({sup 32}P). The arteriosclerotic lesions were induced in New Zealand rabbits through the administration of a diet with high cholesterol content. Angioplastic interventions on femoral arteries were done with balloon methodology and controlled by

  17. Fatores de risco que afetam as complicações da dissecação da veia safena na revascularização cirúrgica do miocárdio The risk factors affecting the complications of saphenous vein graft harvesting in aortocoronary bypass surgery

    Directory of Open Access Journals (Sweden)

    Monir Abbaszadeh

    2008-09-01

    Full Text Available OBJETIVO: O problema da cicatrização de feridas é comumente observado após procedimentos de revascularização do miocárdio. Nosso objetivo é determinar a prevalência e os indicadores de complicação na dissecação da veia safena após procedimentos de revascularização coronária. MÉTODOS: Após revisão e aprovação pelo comitê de ética da instituição, uma revisão retrospectiva de 4029 procedimentos de revascularização foi realizada com enxerto da veia safena durante um período de seis anos. Treze fatores de risco para aqueles que desenvolveram complicações extensas nas feridas da perna foram analisados e comparados com toda a coorte de pacientes submetidos a procedimentos de revascularização semelhantes durante o mesmo período. RESULTADOS: Complicações nas feridas do membro inferior ocorreram em 68 pacientes (1,7%, 43 deles precisaram de intervenção cirúrgica adicional. Foram realizados 17 desbridamentos de feridas, nove transplantes de pele, uma angioplastia, 11 fasciotomias, três procedimentos vasculares e duas transferências livre de tecidos. Das treze variáveis analisadas pela análise multivariada, sexo feminino, IMC, uso de enxerto de veia torácica interna, doença vascular periférica, o uso de balão intra-aórtico no pós-operatório e hiperlipidemia pré-existente foram identificados como indicadores independentes significativos de complicações extensas nas feridas a perna (pOBJECTIVE: Problem of wound healing is commonly observed after coronary artery bypass graft procedures. Our aim is to determine the prevalence and the predictors of saphenous vein harvesting complication after coronary revascularization procedures. METHODS: After institutional ethical committee review and approval, a retrospective review was undertaken of 4029 bypass procedures with saphenous vein graft performed over a period of six years is conducted. Thirteen risk factors for those who developed major leg wound

  18. High Residual Collagen-Induced Platelet Reactivity Predicts Development of Restenosis in the Superficial Femoral Artery After Percutaneous Transluminal Angioplasty in Claudicant Patients

    Energy Technology Data Exchange (ETDEWEB)

    Gary, Thomas, E-mail: thomas.gary@medunigraz.at [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria); Prüller, Florian, E-mail: florian.prueller@klinikum-graz.at; Raggam, Reinhard, E-mail: reinhard.raggam@klinikum-graz.at [Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics (Austria); Mahla, Elisabeth, E-mail: elisabeth.mahla@medunigraz.at [Medical University of Graz, Department of Anesthesiology and Intensive Care Medicine (Austria); Eller, Philipp, E-mail: philipp.eller@medunigraz.at; Hafner, Franz, E-mail: franz.hafner@klinikum-graz.at; Brodmann, Marianne, E-mail: marianne.brodmann@medunigraz.at [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria)

    2016-02-15

    PurposeAlthough platelet reactivity is routinely inhibited with aspirin after percutaneous angioplasty (PTA) in peripheral arteries, the restenosis rate in the superficial femoral artery (SFA) is high. Interaction of activated platelets and the endothelium in the region of intervention could be one reason for this as collagen in the subendothelium activates platelets.Materials and MethodsA prospective study evaluating on-site platelet reactivity during PTA and its influence on the development of restenosis with a total of 30 patients scheduled for PTA of the SFA. Arterial blood was taken from the PTA site after SFA; platelet function was evaluated with light transmission aggregometry. After 3, 6, 12, and 24 months, duplex sonography was performed and the restenosis rate evaluated.ResultsEight out of 30 patients developed a hemodynamically relevant restenosis (>50 % lumen narrowing) in the PTA region during the 24-month follow-up period. High residual collagen-induced platelet reactivity defined as AUC >30 was a significant predictor for the development of restenosis [adjusted odds ratio 11.8 (9.4, 14.2); P = .04].ConclusionsHigh residual collagen-induced platelet reactivity at the interventional site predicts development of restenosis after PTA of the SFA. Platelet function testing may be useful for identifying patients at risk.

  19. Diagnostic accuracy of 64-slice multidetector CT for detection of in-stent restenosis in an unselected, consecutive patient population

    Energy Technology Data Exchange (ETDEWEB)

    Haraldsdottir, Sigurdis, E-mail: sigurdisha@gmail.com [Boston Medical Center, 72 East Concord Street (Evans 124), Boston, MA, 02118 (United States); Gudnason, Thorarinn, E-mail: thorgudn@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Sigurdsson, Axel F., E-mail: axelfsig@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Gudjonsdottir, Jonina, E-mail: jonina@rd.is [Rontgen Domus Medica, Egilsgata 3, 101 Reykjavik (Iceland); Lehman, Sam J., E-mail: slehman@partners.org [Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114 (United States); Eyjolfsson, Kristjan, E-mail: kristey@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Scheving, Sigurpall S., E-mail: sigurpal@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Gibson, C. Michael, E-mail: mgibson@perfuse.org [Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115 (United States); Hoffmann, Udo, E-mail: uhoffmann@partners.org [Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114 (United States); Jonsdottir, Birna, E-mail: birna@rd.is [Rontgen Domus Medica, Egilsgata 3, 101 Reykjavik (Iceland); Andersen, Karl, E-mail: andersen@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland)

    2010-11-15

    Objectives: To investigate the diagnostic accuracy of 64-slice multidetector computed tomography (64-CT) for detection of in-stent restenosis (ISR) in an unselected, consecutive patient population. Background: Detection of in-stent restenosis by cardiac CT would be a major advance for the evaluation of patients suspected of having ISR. However, the diagnostic accuracy of current generation 64-CT in this context is not fully established. Methods: We conducted a prospective study on patients with stable angina or acute coronary syndrome with no prior history of coronary artery disease. Six months after percutaneous coronary intervention (PCI) with stent placement they underwent a 64-CT scan (Toshiba Multi-Slice Aquilion 64) and consequently a repeat coronary angiography for comparison. Cardiac CT data sets were analyzed for the presence of in-stent restenosis by two independent expert readers blinded to the coronary angiographic data. Results: Ninety-three patients with a total of 140 stents were evaluated. Males comprised 82% of the study group and the mean age was 63 {+-} 10 years. The mean time from PCI to the repeat coronary angiography was 208 {+-} 37 days and the mean time from 64-CT to repeat coronary angiography was 3.7 {+-} 4.9 days. The restenosis rate according to coronary angiography was 26%. Stent diameter, strut thickness, heart rate and body mass index (BMI) significantly affected image quality. The sensitivity, specificity, positive and negative predictive values of 64-CT for detection of in-stent restenosis were 27%, 95%, 67% and 78%, respectively. Conclusions: Current generation, 64-slice CT, remains limited in its ability to accurately detect in-stent restenosis.

  20. Treatment of Portosystemic Shunt Myelopathy with a Stent Graft Deployed through a Transjugular Intrahepatic Route

    International Nuclear Information System (INIS)

    Jain, Deepak; Arora, Ankur; Deka, Pranjal; Mukund, Amar; Bhatnagar, Shorav; Jindal, Deepti; Kumar, Niteen; Pamecha, Viniyendra

    2013-01-01

    A case of surgically created splenorenal shunt complicated with shunt myelopathy was successfully managed by placement of a stent graft within the splenic vein to close the portosystemic shunt and alleviate myelopathy. To our knowledge, this is the first report of a case of shunt myelopathy in a patient with noncirrhotic portal fibrosis without cirrhosis treated by a novel technique wherein a transjugular intrahepatic route was adopted to deploy the stent graft

  1. Aneurismas múltiplos de pontes aorto-coronárias de veia safena com ruptura fatal Multiple aneurysms of aortocoronary saphenous vein grafts with fatal rupture

    Directory of Open Access Journals (Sweden)

    Fábio R. Távora

    2007-05-01

    Full Text Available Aneurismas de pontes aorto-coronárias de veia safena são eventos raros, usualmente assintomáticos e detectados de forma incidental. Rupturas espontâneas de pontes de safena são raras, havendo poucos dados radiológicos disponíveis na literatura. Relatamos o caso de um senhor de 39 anos internado com hematêmese dez anos depois de ter sido submetido a cirurgia de revascularização miocárdica. Imagens tomográficas mostraram três aneurismas nas pontes de safena, mas o exame não detectou ruptura. O paciente veio a falecer e a necropsia revelou que a causa do óbito havia sido ruptura de aneurisma de pontes de safena. Esse caso ilustra a necessidade de tratamento agressivo de aneurismas sintomáticos de pontes coronarianas.Aortocoronary saphenous vein graft (SVG aneurysms are rare, and are usually asymptomatic and detected incidentally. Spontaneous rupture of SVG is rare and imaging data are few. We report on a 39-year old man who was admitted to the hospital with hematemesis 10 years after aortocoronary bypass surgery. CT images revealed 3 aortocoronary SVG aneurysms, but failed to detect any rupture. His subsequent death due to rupture of SVG aneurysm was documented at autopsy, illustrating the need for aggressive treatment of symptomatic coronary graft aneurysms.

  2. Dopexamine increases internal mammary artery blood flow following coronary artery bypass grafting.

    LENUS (Irish Health Repository)

    Flynn, Michael J

    2012-02-03

    OBJECTIVE: Vasoactive agents and inotropes influence conduit-coronary blood flow following coronary artery bypass grafting (CABG). It was hypothesized that dopexamine hydrochloride, a dopamine A-1 (DA-1) and beta(2) agonist would increase conduit-coronary blood flow. A prospective randomized double blind clinical trial was carried out to test this hypothesis. DA-1 receptors have previously been localized to human left ventricle. METHODS: Twenty-six American Society of Anaesthesiology class 2-3 elective coronary artery bypass graft patients who did not require inotropic support on separation from cardiopulmonary bypass (CPB) were studied. According to a randomized allocation patients received either dopexamine (1 microg\\/kg per min) or placebo (saline) by intravenous infusion for 15 min. Immediately prior to and at 5,10 and 15 min of infusion, blood flow through the internal mammary and vein grafts (Transit time flow probes, Transonic Ltd.), heart rate, cardiac index, mean arterial pressure and pulmonary haemodynamics were noted. The data were analysed using multivariate analysis of variance. RESULTS: Low-dose dopexamine (1 microg\\/kg per min) caused a significant increase in mammary graft blood flow compared to placebo at 15 min of infusion (P=0.028, dopexamine group left internal mammary artery (LIMA) flow of 43.3+\\/-14.2 ml\\/min, placebo group LIMA flow at 26.1+\\/-16.3 ml\\/min). Dopexamine recipients demonstrated a non-significant trend to increased saphenous vein graft flow (P=0.059). Increased heart rate was the only haemodynamic change induced by dopexamine (P=0.004, dopexamine group at 85.2+\\/-9.6 beats\\/min and placebo group at 71.1+\\/-7.6 beats\\/min after 15 min of infusion). CONCLUSION: This study demonstrates that administration of dopexamine (1 microg\\/kg per min) was associated with a significant increase in internal mammary artery graft blood flow with mild increase in heart rate being the only haemodynamic change. Low-dose dopexamine may

  3. The role of percutaneous transluminal coronary angioplasty in heart transplant recipients.

    Science.gov (United States)

    Schnetzler, B; Drobinski, G; Dorent, R; Camproux, A C; Ghossoub, J; Thomas, D; Gandjbakhch, I

    2000-06-01

    Review the acute and late results of percutaneous transluminal coronary angioplasty (PTCA) in heart transplant recipients and examine the factors predictive of restenosis. Coronary graft disease (CGD) is the main factor responsible for late graft loss. Medical treatment, surgical revascularization, or retransplantation gives only suboptimal results in this regard. Therefore, PTCA has been attempted in this situation. More than 332 heart transplantations in our institution have been performed since 1992, the date of the first PTCA in our patients. We are currently in charge of 450 patients. All the characteristics, procedure-related information, and clinical outcome of patients needing PTCA were assessed by review of each patient's clinical records. All coronary angiograms were reviewed by an independent cardiologist. Since 1992, 53 coronary sites have been dilated in the course of 39 procedures in 29 patients. Indication for PTCA was asymptomatic angiographic coronary graft disease in 35 sites (64.8%), angina in 9 (16.6%), silent ischemia in 2 (3.7%), acute myocardial infarction in 1 (1.8%), and CHF in 7 (12.9%). Primary success ( 50%) was 32.5% (14/43). Mean follow-up was 1.27 year +/- 1.2 (SD). Five deaths (17. 2%) occurred in follow-up and were all in relation to coronary graft disease. Mean time separating PTCA from death was 0.9 year +/- 1.3 (SD). We also sought to look at factors predictive of restenosis. By multivariate analysis, a positive recipient's serology for cytomegalovirus (CMV) before the graft was the only factor found protective against restenosis (odds ratio 22.4; confidence interval 1.1 to 443.4). PTCA in heart transplant recipients allows a high level of primary success with a low periprocedural-complication rate. Restenosis rate seems equivalent to restenosis rate in native coronary arteries. Mortality during follow-up is increased in this population and is the consequence of a high level of coronary events. Recipient positivity for CMV before

  4. Superior long term outcome associated with native vessel versus graft vessel PCI following secondary PCI in patients with prior CABG.

    Science.gov (United States)

    Mavroudis, Chrysostomos A; Kotecha, Tushar; Chehab, Omar; Hudson, Jonathan; Rakhit, Roby D

    2017-02-01

    Secondary percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass graft surgery is increasingly common. Graft vessel PCI has higher rates of adverse events compared with native coronary vessel PCI. To investigate the clinical outcomes of patients with prior CABG who underwent secondary PCI of either a graft vessel (GV), a native coronary vessel (NV) or both graft and native (NG) vessels. 220 patients (84% male) who underwent PCI in our institution to either GV (n=89), NV (n=103) or both GV and NV (NG group) (n=28) were studied. The study population underwent 378 procedures (GV group; n=126, NV group; n=164 and NG group; n=88). Median follow up was for 36months [range 2-75months]. Target vessel revascularisation (TVR) occurred in 12.5% of the GV group and 3.6% in the NV group [p=0.0004], and was predominantly due to in-stent restenosis. Patients who had PCI due to TVR were more likely to suffer from diabetes and peripheral vascular disease. History of chronic renal failure was associated with higher risk (HR 2.21, p=0.005) whereas preserved left ventricular ejection fraction (LVEF) with lower risk (HR 0.17, p=0.0007) of death. The median survival (interval between CABG and end of follow-up period) was lower in the GV compared with the NV group (315 vs 372months p=0.005). This registry demonstrates inferior long term outcome for patients undergoing secondary PCI of GV versus NV. Where possible, a strategy of NV rather than GV target PCI should be considered in patients with prior CABG. Secondary PCI in patients with prior CABG surgery is increasingly common. Graft vessel PCI has inferior outcomes with high rates of restenosis and occlusion compared with native coronary vessel PCI. We studied the clinical outcomes of 220 patients with prior CABG who underwent secondary PCI to either a graft vessel (GV), a native coronary vessel (NV) or both graft and native (NG) vessels. Target vessel revascularisation was 5 times higher in the GV

  5. Effects of low dose aspirin (50 mg/day), low dose aspirin plus dipyridamole, and oral anticoagulant agents after internal mammary artery bypass grafting: patency and clinical outcome at 1 year. CABADAS Research Group of the Interuniversity Cardiology Institute of The Netherlands. Prevention of Coronary Artery Bypass Graft Occlusion by Aspirin, Dipyridamole and Acenocoumarol/Phenprocoumon Study

    NARCIS (Netherlands)

    van der Meer, J.; Brutel de la Rivière, A.; van Gilst, W. H.; Hillege, H. L.; Pfisterer, M.; Kootstra, G. J.; Dunselman, P. H.; Mulder, B. J.; Lie, K. I.

    1994-01-01

    This study was performed to compare the efficacy and safety of aspirin, aspirin plus dipyridamole, and oral anticoagulant agents in the prevention of internal mammary artery graft occlusion. Antithrombotic drugs increase vein graft patency after coronary artery bypass surgery. Their benefit after

  6. Imaging after vascular gene therapy

    International Nuclear Information System (INIS)

    Manninen, Hannu I.; Yang, Xiaoming

    2005-01-01

    Targets for cardiovascular gene therapy currently include limiting restenosis after balloon angioplasty and stent placement, inhibiting vein bypass graft intimal hyperplasia/stenosis, therapeutic angiogenesis for cardiac and lower-limb ischemia, and prevention of thrombus formation. While catheter angiography is still standard method to follow-up vascular gene transfer, other modern imaging techniques, especially intravascular ultrasound (IVUS), magnetic resonance (MR), and positron emission tomography (PET) imaging provide complementary information about the therapeutic effect of vascular gene transfer in humans. Although molecular imaging of therapeutic gene expression in the vasculatures is still in its technical development phase, it has already offered basic medical science an extremely useful in vivo evaluation tool for non- or minimally invasive imaging of vascular gene therapy

  7. Nasolabial facial artery and vein as recipient vessels for midface microsurgical reconstruction.

    Science.gov (United States)

    Oh, Suk Joon; Jeon, Man Kyung; Koh, Sung Hoon

    2011-05-01

    Although free flap transfer is commonly performed to reconstruct facial defects, the submandibular facial artery and vein have historically been considered as adequate recipient vessels for microsurgical reconstruction. If the vascular pedicles of the free flap are short, vein grafts are necessary. The purpose of this study was to determine the indications for and effectiveness of using the nasolabial facial vessels for midfacial reconstruction. A retrospective chart review of 6 patients undergoing microsurgical reconstruction for defects of the face revealed 6 free tissue transfers in which the nasolabial facial artery and vein were considered for use as recipient vessels. Flap success rates were evaluated. Six patients (5 men and 1 woman) underwent 6 free flap transfers. Five anterior helix free flaps were used for the reconstruction of defects in the lower third of the nose. Nasal defects were due to trauma in 4 patients and squamous cell carcinoma in 1 patient. In 1 neurofibromatosis type 1 case, a radial forearm flap was used for reconstruction of the left orbital defect. The facial artery and vein in the nasolabial fold were used as the recipient artery and vein in every case. The mean length of follow-up was 5.8 years. All flaps survived. All patients were satisfied with the degree of aesthetic improvement after surgery.Use of the facial artery and vein in the nasolabial fold for facial reconstruction is reliable and safe. The nasolabial facial artery and vein should be considered as primary recipient vessels in microsurgical reconstruction of the midface.

  8. In-stent restenosis of innominate artery with critical stenosis of right internal carotid artery

    International Nuclear Information System (INIS)

    Hussain, S.; Raza, A.; Ahmed, W.

    2011-01-01

    A lady with aortitis syndrome developed in-stent restenosis (ISR) of the innominate artery stent and critical stenosis of right internal carotid artery. The therapeutic challenge was gaining access to the carotid vessel, after treating the innominate artery ISR and all the while using distal protection to circumvent potential cerebral embolism. Percutaneous transluminal angioplasty (PTA) with or without stenting is a safe therapeutic option for re-vascularization of the supra aortic vessels. In the event of re-stenosis, re-treatment with PTA and stenting is safe. Ample evidence-base exists now for carotid artery stenting (CAS) in preference to carotid endarterectomy in patients with stenotic lesions of the carotid vessels. (author)

  9. Intravascular ultrasound guided directional atherectomy versus directional atherectomy guided by angiography for the treatment of femoropopliteal in-stent restenosis

    Science.gov (United States)

    Krishnan, Prakash; Tarricone, Arthur; K-Raman, Purushothaman; Majeed, Farhan; Kapur, Vishal; Gujja, Karthik; Wiley, Jose; Vasquez, Miguel; Lascano, Rheoneil A.; Quiles, Katherine G.; Distin, Tashanne; Fontenelle, Ran; Atallah-Lajam, Farah; Kini, Annapoorna; Sharma, Samin

    2017-01-01

    Background: The aim of this study was to compare 1-year outcomes for patients with femoropopliteal in-stent restenosis using directional atherectomy guided by intravascular ultrasound (IVUS) versus directional atherectomy guided by angiography. Methods and results: This was a retrospective analysis for patients with femoropopliteal in-stent restenosis treated with IVUS-guided directional atherectomy versus directional atherectomy guided by angiography from a single center between March 2012 and February 2016. Clinically driven target lesion revascularization was the primary endpoint and was evaluated through medical chart review as well as phone call follow up. Conclusions: Directional atherectomy guided by IVUS reduces clinically driven target lesion revascularization for patients with femoropopliteal in-stent restenosis. PMID:29265002

  10. Re-examining minimal luminal diameter relocation and quantitative coronary angiography - Intravascular ultrasound correlations in stented saphenous vein grafts: Methodological insights from the randomised RRISC trial

    NARCIS (Netherlands)

    O. Semeraro (Oscar); P. Agostoni (Pierfrancesco); S. Verheye (Stefan); G.J.J. van Langenhove (Glenn); P.A. van den Heuvel (Paul); C. Convens (Carl); F. van den Branden (Frank); N. Bruining (Nico); P. Vermeersch (Paul)

    2009-01-01

    textabstractAims: Angiographic parameters (such as late luminal loss) are common endpoints in drug-eluting stent trials, but their correlation with the neointimal process and their reliability in predicting restenosis are debated. Methods and results: Using quantitative coronary angiography (QCA)

  11. Nuclear medicine in the management of renal vein thrombosis post renal transplantation - a case study

    International Nuclear Information System (INIS)

    Waran, L.; Unger, S.

    2005-01-01

    Renal scintigraphy allows the assessment of both perfusion and function of the transplanted kidney. Treatment of renal dysfunction depends on its cause. Nuclear medicine plays an important role in determining the cause of renal dysfunction, thereby providing appropriate intervention. Renal vein thrombosis (RVT) is a rare occurrence (1-2%) in renal transplants, and constitutes a surgical emergency. Early detection of RVT is critical in order to prevent infarction and subsequent loss of the graft. A 43-year-old woman with end stage renal disease as a result of diabetic nephropathy underwent transplantation of a living-related-donor kidney. The patient underwent a post operative Tc-MAG, scan that demonstrated good perfusion to the graft. Three days post-transplantation, the patient complained of acute pain and swelling. Creatinine increased from 0.13 to 0.16. and urine output decreased. The m Tc-MAG, scan revealed dramatic deterioration, with absent perfusion to the kidney. Immediate allograft exploration was performed in theatre and RVT was revealed, followed by thrombectomy. A follow-up renal scan performed the next day demonstrated a viable kidney with improved but patchy perfusion throughout, indicating patchy cortical infarction as well as acute tubular necrosis. On day 19. the patient again complained of severe pain over the graft, and the 99 mTc-MAG, scan again revealed absent perfusion, this time with residual function. Further surgical exploration confirmed re-thrombosis of the renal vein, and subsequent genetic analysis revealed that the patient had a rare mutation of her clotting Factor V gene, leading to an increased thrombogenic tendency. Following full anticoagulation, the patient was finally discharged on day 58. This case illustrates a rare case of renal allograft infarction secondary to renal vein thrombosis. The ability of nuclear medicine to provide immediate functional information helped confirm the diagnosis, and salvage the kidney

  12. Bacterial adherence to vascular grafts after in vitro bacteremia

    International Nuclear Information System (INIS)

    Rosenman, J.E.; Pearce, W.H.; Kempczinski, R.F.

    1985-01-01

    All currently used arterial prosthetics have a greater susceptibility to infection following bacteremia than does autogenous tissue. This experiment compares quantitative bacterial adherence to various prosthetic materials after bacteremia carried out in a tightly controlled and quantitative fashion. Ten centimeters long, 4 mm i.d. Dacron, umbilical vein (HUV), and polytetrafluoroethylene (PTFE) grafts, as well as PTFE grafts with a running suture line at the midportion were tested. Each graft was interposed into a pulsatile perfusion system modified from a Waters MOX 100 TM renal transplant pump. Indium-111-labeled Staphylococcus aureus were added to heparinized canine blood to give a mean concentration of 4.7 X 10(6) bacteria/cc. This infected blood was recirculated through each graft for 30 min at a rate of 125 cc/m, 100 Torr (sys), 60 beats/min. The gamma counts/graft were used to calculate the number of bacteria/cm2 of graft surface. After nine experiments, a mean of 9.63 X 10(5) bacteria/cm2 were adherent to the Dacron, 1.04 X 10(5) bacteria/cm2 to the HUV, and 2.15 X 10(4) bacteria/cm2 to the PTFE. These differences were all significant at the 0.05 level. The addition of a suture line increased bacterial adherence to the PTFE graft by 50%. These results suggest that PTFE is the vascular graft material of choice when a prosthetic graft must be implanted despite a high risk of subsequent clinical bacteremia. An in vitro, pulsatile perfusion model gave accurate and reproducible results, and appears well suited for further studies of bacterial, or platelet adherence to grafts, as well as the biomechanics of vascular conduits

  13. Dobutamine stress echocardiography related sustained ventricular tachycardia in a patient with ischaemic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Amrit S Lota

    2014-01-01

    Full Text Available A 66 year-old Asian man; with a complex history of ischaemic heart disease presented with cardiac and troponin negative chest pain. His ECG showed sinus bradycardia with old left bundle branch block. The transthoracic echocardiography showed severely impaired left ventricular systolic function (EF 30-35%. The patient had had coronary artery bypass grafting at age of 42 years and remained asymptomatic until age of 56 years when he presented with incessant ventricular tachycardia requiring amiodarone, lidocaine and electrical cardioversion. Coronary angiography at that time showed occluded vein grafts to the circumflex and diagonal arteries. The right coronary artery (RCA was small and received collaterals from the left system. A myocardial perfusion scan showed extensive inferolateral infarction but no evidence for reversible ischaemia. An implantable cardiac defibrillator (ICD was thus inserted. Over the following years, the patient underwent multiple PCI procedures with rotational atherectomy to the native LAD and associated vein graft, but subsequently developed in-stent restenosis. He also had PCI to the native RCA. He declined a minimally invasive grafting of the left internal mammary artery (LIMA to the LAD and re-implantation of a new ICD after ex-plantation of the original one due to sepsis. His coronary artery disease remained stable following a recent admission with Troponin positive event which was confirmed by a repeat angiogram, therefore, had up-titrated anti-anginal medications. A low dose beta-blockade was discontinued due to documented sinus pauses up to 3 seconds. Following the recent admission, a joint cardiology-cardiothoracic meeting discussion recommended a stress echocardiogram with highdose dobutamine to guide towards considering re-do bypass grafting.

  14. Recruitable collateral blood flow index predicts coronary instent restenosis after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Thayssen, Per; Lassen, Jens Flensted

    2007-01-01

    AIMS: Collateral flow may influence long-term results after percutaneous coronary intervention (PCI) because of haemodynamic forces compete with the antegrade flow through the dilated lesion. The aim of the study was to assess the influence of recruitable collateral blood flow on restenosis...... in patients undergoing PCI with bare metal stents and using optimal antithrombotic treatment. METHODS AND RESULTS: In 95 patients, 95 de novo lesions were treated with PCI and a bare metal stent. Fractional flow reserve (FFR) at maximum hyperaemia induced by intravenous adenosine was determined. The pressure.......02-1.12, P = 0.016). CONCLUSION: Recruitable collateral blood flow measured during balloon inflation predicts angiographic instent restenosis in PCI patients treated with bare metal stents. Udgivelsesdato: 2007-Aug...

  15. Restenosis after hot-tip laser-balloon angioplasty: histologic evaluation of the samples removed by Simpson atherectomy

    Science.gov (United States)

    Barbieri, Enrico; Tanganelli, Pietro; Taddei, Giuseppe; Perbellini, Antonio; Attino, Vito; Destro, Gianni; Zardini, Piero

    1991-05-01

    Laser balloon angioplasty has been used in recent years to treat peripheral artery disease. Despite a primary success the technique is plagued by a high restenosis rate. Directional atherectomy was performed in a small group of patients affected by primitive stenosis or restenosis after an invasive procedure. Light microscopy, immunohistochemistry, and transmission electron microscopy have identified the cellular component of intimal hyperplasia as smooth muscle cells in an active synthetic phenotype. The arterial healing process after invasive procedures seems to develop similarly independently of the device employed.

  16. Incidence of Central Vein Stenosis and Occlusion Following Upper Extremity PICC and Port Placement

    International Nuclear Information System (INIS)

    Gonsalves, Carin F.; Eschelman, David J.; Sullivan, Kevin L.; DuBois, Nancy; Bonn, Joseph

    2003-01-01

    .Patients with longer catheter dwell time were more likely to develop central vein abnormalities. In order to preserve vascular access for dialysis fistulae and grafts and adhere to Dialysis Outcomes Quality Initiative guidelines, alternative venous access sites should be considered for patients with chronic renal insufficiency and end-stage renal disease

  17. Improved endothelial cell seeding with cultured cells and fibronectin-coated grafts

    International Nuclear Information System (INIS)

    Seeger, J.M.; Klingman, N.

    1985-01-01

    A possible approach to the low seeding efficiency of endothelial cells into prosthetic grafts is to increase the number of cells to be seeded in cell culture and improve seeding efficiency by graft precoating with fibronectin. The effect of cell culture on cell adhesion is unknown, however, and fibronectin also binds fibrin, which may increase the thrombogenicity of the graft luminal surface. To investigate these questions, freshly harvested canine jugular vein endothelial cells from six animals and similar cells harvested from six primary and eight secondary cell cultures were labeled with 111 Indium and seeded into 5 cm, 4 mm PTFE grafts coated with fibronectin, using similar uncoated PTFE grafts as controls. Platelet accumulation and distribution on six similar coated and uncoated grafts placed in canine carotid, external jugular arterial venous shunts for 2 hr were also determined using autogenous 111 Indium-labeled platelets. Significant differences between group means were determined using the paired Student's t test. Results reveal that seeding efficiency is significantly better in all groups of coated grafts compared to uncoated grafts (P less than 0.01). Cells derived from cell culture also had significantly higher seeding efficiencies than freshly harvested cells when seeded into coated grafts (P less than 0.05) and tended to have higher seeding efficiencies than harvested cells when seeded into uncoated grafts (P = 0.53). Fibronectin coating increased mean platelet accumulation on the entire graft luminal surface, but not to a statistically significant degree (P greater than 0.1). Whether this increased seeding efficiency will improve graft endothelialization remains to be investigated

  18. Angiographic findings of demineralised bone matrix grafts in femoral fracture repair in canines*

    International Nuclear Information System (INIS)

    Kumar, R.V.S.; Ramakrishna, O.

    2000-01-01

    Demineralised bone matrix implants and autogenous cancellous bone grafts were evaluated in femoral fracture repair with bone loss in canines, and compared to untreated animals. Angiograms were taken at 3,6,9 and 12 weeks post- operatively using conrary-420 as contrast medium. Early angiograms showed leakage of contrast medium into soft tissue. Grafted groups showed slight hypervascularity and enhanced capillary network. At 12 Weeks the same groups observed nearly normal persistent vascular supply. Early establishment of cortices continuity and draining of contrast medium via extraosseous veins was observed in demineralized bone matrix implanted groups

  19. Models and Analysis of Atherosclerosis, Restenosis, and Aneurysm Formation in the Mouse

    NARCIS (Netherlands)

    de Waard, Vivian; Gijbels, Marion J. J.; Lutgens, Esther; de Winther, Menno P. J.; de Vries, Carlie J. M.

    2012-01-01

    Atherosclerosis is considered a chronic inflammatory condition of the vessel wall and involves a high chronic concentration of low-density lipoprotein (LDL) in blood. In humans, restenosis develops after intravascular interventions such as angioplasty and stent placement to treat atherosclerosis,

  20. Percutaneous Endoluminal Stent-Graft Repair of an Old Traumatic Femoral Arteriovenous Fistula

    International Nuclear Information System (INIS)

    Uflacker, Renan; Elliott, Bruce M.

    1996-01-01

    A stent-graft was custom made to close a high-flow traumatic arteriovenous fistula of the left superficial femoral artery, present for 30 years, in a 60-year-old man with congestive heart failure and ischemic ulceration in the left foot. A balloon expandable Palmaz stent (P394; 2.5 mm x 3.9 cm) was covered with a polytetrafluoroethylene (PTFE) graft and was inserted percutaneously through an 11 Fr vascular sheath. Follow-up Doppler ultrasound at 6 months demonstrated occlusion of the arteriovenous fistula, patency of the artery, and luminal integrity of the artery and vein

  1. Pelvic Vein Embolisation in the Management of Varicose Veins

    International Nuclear Information System (INIS)

    Ratnam, Lakshmi A.; Marsh, Petra; Holdstock, Judy M.; Harrison, Charmaine S.; Hussain, Fuad F.; Whiteley, Mark S.; Lopez, Anthony

    2008-01-01

    Pelvic vein incompetence is common in patients with atypical varicose veins, contributing to their recurrence after surgery. Therefore, refluxing pelvic veins should be identified and treated. We present our experience with pelvic vein embolisation in patients presenting with varicose veins. Patients presenting with varicose veins with a duplex-proven contribution from perivulval veins undergo transvaginal duplex sonography (TVUS) to identify refluxing pelvic veins. Those with positive scans undergo embolisation before surgical treatment of their lower limb varicose veins. A total of 218 women (mean age of 46.3 years) were treated. Parity was documented in the first 60 patients, of whom 47 (78.3%) were multiparous, 11 (18.3%) had had one previous pregnancy, and 2 (3.3%) were nulliparous. The left ovarian vein was embolised in 78%, the right internal iliac in 64.7%, the left internal iliac in 56.4%, and the right ovarian vein in 42.2% of patients. At follow-up TVUS, mild reflux only was seen in 16, marked persistent reflux in 6, and new reflux in 3 patients. These 9 women underwent successful repeat embolisation. Two patients experienced pulmonary embolisation of the coils, of whom 1 was asymptomatic and 1 was successfully retrieved; 1 patient had a misplaced coil protruding into the common femoral vein; and 1 patient had perineal thrombophlebitis. The results of our study showed that pelvic venous embolisation by way of a transjugular approach is a safe and effective technique in the treatment of pelvic vein reflux.

  2. Diagnostic accuracy of 64 multislice CT angiography in the assessment of coronary in-stent restenosis: A meta-analysis

    International Nuclear Information System (INIS)

    Sun Zhonghua; Almutairi, Abdulrahman Marzouq D.

    2010-01-01

    Purpose: The aim of this study was to perform a meta-analysis of the diagnostic accuracy of 64-slice CT angiography for the detection of coronary in-stent restenosis in patients treated with coronary stents when compared to conventional coronary angiography. Materials and methods: A search of PUBMED/MEDLINE, ProQuest and Cochrane library databases for English literature was performed. Only studies comparing 64-slice CT angiography with conventional coronary angiography for the detection of coronary in-stent restenosis (more than 50% stenosis) were included for analysis. Sensitivity and specificity estimates pooled across studies were tested using a fixed effects model. Results: Fourteen studies met selection criteria for inclusion in the analysis. The mean value of assessable stents was 89%. Prevalence of in-stent restenosis following coronary stenting was 20% among these studies. Pooled estimates of the sensitivity and specificity of overall 64-slice CT angiography for the detection of coronary in-stent restenosis was 90% (95% CI: 86%, 94%) and 91% (95% CI: 90%, 93%), respectively, based on the evaluation of assessable stents. Diagnostic value of 64-slice CT angiography was found to decrease significantly when the analysis was performed with inclusion of nonassessable segments in five studies, with pooled sensitivity and specificity being 79% (95% CI: 68%, 88%) and 81% (95% CI: 77%, 84%). Stent diameter is the main factor affecting the diagnostic value of 64-slice CT angiography. Conclusion: Our results showed that 64-slice CT angiography has high diagnostic value (both sensitivity and specificity) for detection of coronary in-stent restenosis based on assessable segments when compared to conventional coronary angiography.

  3. Surveillance Duplex Ultrasonography of Stent Grafts for Popliteal Aneurysms.

    Science.gov (United States)

    Pineda, Danielle M; Troutman, Douglas A; Dougherty, Matthew J; Calligaro, Keith D

    2016-05-01

    Stent grafts, also known as covered stents, have become an increasingly acceptable treatment for popliteal artery aneurysms. However, endovascular exclusion confers lower primary patency compared to traditional open bypass and exclusion. The purpose of this study was to evaluate whether duplex ultrasonography (DU) can reliably diagnose failing stent grafts placed for popliteal artery aneurysms prior to occlusion. Between June 5, 2007, and March 11, 2014, 21 stent grafts (Viabahn; Gore, Flagstaff, Arizona) were placed in 19 patients for popliteal artery aneurysms. All patients had at least 1 follow-up duplex scan postoperatively. Mean follow-up was 28.9 months (9-93 months). Postoperative DU surveillance was performed in our Intersocietal Accreditation Commission noninvasive vascular laboratory at 1 week postprocedure and every 6 months thereafter. Duplex ultrasonography measured peak systolic velocities (PSVs) and ratio of adjacent PSVs (Vr) every 5 cm within the stent graft and adjacent arteries. We retrospectively classified the following factors as "abnormal DU findings": focal PSV > 300 cm/s, uniform PSVs 3.0. These DU criteria were derived from laboratory-specific data that we previously published on failing stent grafts placed for lower extremity occlusive disease. Four of the 21 stent grafts presented with symptomatic graft thrombosis within 6 months of a normal DU. Three of these 4 patients presented with rest pain and underwent thrombectomy (2) or vein bypass (1), and 1 elected for nonintervention for claudication. Our results suggest that surveillance DU using criteria established for grafts placed for occlusive disease may not be useful for predicting stent graft failure in popliteal artery aneurysms. © The Author(s) 2016.

  4. Safety and efficacy of everolimus-eluting stents for bare-metal in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ota, Hideaki [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Mahmoudi, Michael [University of Surrey, Guildford Road, Surrey, GU2-7XH (United Kingdom); Torguson, Rebecca; Satler, Lowell F.; Suddath, William O.; Pichard, Augusto D. [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Waksman, Ron, E-mail: ron.waksman@medstar.net [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States)

    2015-04-15

    Objective: The aim of this study was to compare the safety and efficacy of the everolimus-eluting stents (EES) with the paclitaxel-eluting stent (PES) and sirolimus-eluting stent (SES) for the treatment of bare-metal in-stent restenosis. Background: The optimal treatment for bare-metal in-stent restenosis remains controversial. Methods: The study cohort comprised 322 consecutive patients (543 lesions) who presented with bare-metal in-stent restenosis to our institution and underwent coronary artery stent implantation with EES (114 patients; 181 lesions), PES (65 patients; 116 lesions) and SES (143 patients; 246 lesions). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac events (MACE) defined as the composite of death, MI, or TLR at 1-year. Results: The three groups were well matched for the conventional risk factors except for age and chronic kidney disease. The 1-year analyzed clinical parameters were similar in the three groups: death (EES = 3.5%, PES = 4.6%, SES = 4.2%; p = 0.94), MI (EES = 3.5%, PES = 6.3%, SES = 2.1%; p = 0.31), TLR (EES = 9.8%, PES = 9.5%, SES = 5.7%; p = 0.42), TVR (EES = 14.3%, PES = 11.1%, SES = 11.3%; p = 0.74), definite ST (EES = 0.9%, PES = 3.1%, SES = 3.5%; p = 0.38) and MACE (EES = 14.0%, PES = 15.4%, SES = 10.5%; p = 0.54). Male gender (hazard ratio = 0.47; 95% confidence interval = 0.25–0.88) and number of treated lesions (hazard ratio = 1.47; 95% confidence interval = 1.06–2.05) were found to be independent predictors of MACE. Conclusion: The results of the present study indicate that EES may provide similar safety and efficacy as first generation DES for the treatment of patients presenting with bare-metal in-stent restenosis.

  5. Aorto-right atrial fistula secondary to rupture of an occluded old saphenous venous graft to right coronary artery.

    Science.gov (United States)

    Balestrini, Carlos Sebastian; Saaibi, José Federico; Ortiz, Santiago Navas

    2014-09-01

    We report a case of an acquired aorta-right atrial fistula, secondary to a ruptured proximal anastomosis of an old saphenous vein graft 12 years after a coronary artery bypass surgery, in a 57 year old patient with multiple cardiovascular risk factors. On admission, he presented with congestive heart failure and on examination a continuous murmur was detected on the right parasternal border. Catheterization showed a fistula from the proximal anastomosis of an occluded right coronary artery saphenous vein graft draining to the right atrium with a large left to right shunt. The fistula was successfully occluded by a percutaneous approach with a Life Tech duct occluder with complete resolution of heart failure. The patient was discharged one week afterwards. After a two-year follow-up, the fistula remained occluded. © 2013 Wiley Periodicals, Inc.

  6. Living Donor Liver Transplantation for Unresectable Liver Adenomatosis Associated with Congenital Absence of Portal Vein: A Case Report and Literature Review.

    Science.gov (United States)

    Brasoveanu, Vladislav; Ionescu, Mihnea Ioan; Grigorie, Razvan; Mihaila, Mariana; Bacalbasa, Nicolae; Dumitru, Radu; Herlea, Vlad; Iorgescu, Andreea; Tomescu, Dana; Popescu, Irinel

    2015-09-19

    Abernethy malformation (AM), or congenital absence of portal vein (CAPV), is a very rare disease which tends to be associated with the development of benign or malignant tumors, usually in children or young adults. We report the case of a 21-year-old woman diagnosed with type Ib AM (portal vein draining directly into the inferior vena cava) and unresectable liver adenomatosis. The patient presented mild liver dysfunction and was largely asymptomatic. Living donor liver transplantation was performed using a left hemiliver graft from her mother. Postoperatively, the patient attained optimal liver function and at 9-month follow-up has returned to normal life. We consider that living donor liver transplantation is the best therapeutic solution for AM associated with unresectable liver adenomatosis, especially because compared to receiving a whole liver graft, the waiting time on the liver transplantation list is much shorter.

  7. Noninvasive detection of coronary artery bypass graft patency by intravenous electron beam computed tomographic angiography.

    Science.gov (United States)

    Yamakami, Shoji; Toyama, Junji; Okamoto, Mitsuhiro; Matsushita, Toyoaki; Murakami, Yoshimasa; Ogata, Masaki; Ito, Shigenori; Fukutomi, Tatsuya; Okayama, Naotsuka; Itoh, Makoto

    2003-11-01

    This study evaluates the usefullness of intravenous electron beam computed tomographic angiography (EBA) for the detection of coronary artery bypass graft patency in 43 patients (33 men and 10 women, mean age, 65 years) who had coronary artery bypass graft surgery. EBA was performed a few days before selective bypass graft angiography (SGA). Forty axial cross-sections of angiographic images of the heart were acquired consecutively by an electrocardiographic trigger signal at 40% of the RR interval, which corresponds to the end-systolic phase. EBA data were reconstructed as a three-dimensional shaded surface display of the heart and bypass grafts. Detectability of the patency of bypass gratis was evaluated, taking selective angiographic images of the bypass grafts as a gold standard. One hundred and nine grafts (96%) out of 114 grafts were subjected to evaluation: 37 grafts were left internal mammary artery grafts (LIMA), 7 were right internal mammary artery grafts (RIMA), 6 were gastroepiploic artery grafts (GEA), 7 were free gastroepiploic artery grafts with venous drainage (free-GEA), 7 were radial artery grafts (RAG), and 45 were saphenous vein gratis (SVG). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EBA were 98%, 100%, 100%, 91%, and 98%, respectively. EBA sampled at the end-systolic period was determined to be useful for the detection of coronary artery bypass graft patency and occlusion.

  8. Mitral restenosis in the early postoperative period of a patient with systemic lupus erythematosus.

    Science.gov (United States)

    Pomerantzeff, P M; Corrêa, J D; Brandão, C M; de Assis, R V; Jatene, A D

    1999-04-01

    A forty-eight year old woman, who had undergone mitral comissurotomy and subsequently developed early restenosis, presented with major comissural fusion and verrucous lesions on the cuspid edges of the mitral valve, with normal subvalvar apparatus. Patient did well for the first six months after surgery when she began to present dyspnea on light exertion. A clinical diagnosis of restenosis was made, which was confirmed by an echocardiogram and cardiac catheterization. She underwent surgery, and a stenotic mitral valve with verrucous lesions suggesting Libman-Sacks' endocarditis was found. Because the diagnosis of systemic lupus erythematosus (SLE) had not been confirmed at that time, a bovine pericardium bioprosthesis (FISICS-INCOR) was implanted. The patient did well in the late follow-up and is now in NYHA Class I.

  9. Intracoronary irradiation: dose response for the prevention of restenosis in swine

    International Nuclear Information System (INIS)

    Weinberger, Judah; Amols, Howard; Ennis, Ronald D.; Schwartz, Allan; Wiedermann, Joseph G.; Marboe, Charles

    1996-01-01

    Purpose: Restenosis after percutaneous transluminal coronary angioplasty represents, in part, a proliferative response of vascular smooth muscle at the site of injury. We have previously shown that high-dose radiation (20 Gy), delivered via an intracoronary 192 Ir source, causes focal medial fibrosis and markedly impairs the restenosis process after balloon angioplasty in swine. This study sought to delineate the dose-response characteristics of this effect. Methods and Materials: Forty juvenile swine underwent coronary angiography; a segment of the left coronary artery was chosen as a target for balloon injury. In 30 swine, a 2 cm ribbon of 192 Ir was positioned at the target segment and 20, 15, or 10 Gy were delivered to the vessel wall (10 animals/dose). Subsequently, overdilatation balloon angioplasty was performed at the irradiated segment. In 10 control swine, overdilatation balloon angioplasty was performed without previous irradiation. Thirty-eight animals survived until sacrifice at 30 ± 3 days. Histopathological analysis was performed by a pathologist in a blinded manner. The area of maximal luminal compromise within the target segment was analyzed via computer-assisted planimetry. Results: Neointimal area was decreased by 71.4% at 20 Gy and by 58.3% at 15 Gy compared with control animals (p < 0.05 for both). A stimulatory effect on smooth muscle cell proliferation was noted at 10 Gy, with a 123% increase in neointimal area compared with controls (p < 0.05). Mean percent area stenosis was also reduced by 63% at 20 Gy and by 74.8% at 15 Gy compared with controls (p < 0.05 for both). Conclusions: Intracoronary irradiation prior to overstretch balloon angioplasty markedly reduces neointima formation; this effect is dose dependent, with evidence of a significant stimulatory effect at 10 Gy. The effective therapeutic dose range for the prevention of restenosis in this model begins at approximately 15 Gy delivered to the vessel wall

  10. CYP2C19⁎2 Polymorphism in Chilean Patients with In-Stent Restenosis Development and Controls

    Directory of Open Access Journals (Sweden)

    Jenny Ruedlinger

    2017-01-01

    Full Text Available Clopidogrel is an antiplatelet drug especially used in patients undergoing percutaneous coronary interventions (PCI. Polymorphisms within CYP2C19 can result in important interindividual variations regarding therapeutic efficacy. Therefore, we aimed to evaluate the impact of the CYP2C19⁎2 variant (rs4244285 on in-stent restenosis occurrence in Chilean patients who underwent PCI and received clopidogrel. A total of 77 cases with stenosis >50% in the angioplasty site (62.75 ± 9.8 years, 80.5% males and 86 controls (65.45 ± 9.8 years, 72.1% males were studied. The polymorphism was genotyped using TaqMan® Drug Metabolism Genotyping Assays. Overall, CYP2C19⁎2 allele frequency was 8.3%. Diabetes, chronic lesions, and bare metal stents (BMS were observed more often in cases than in controls (p = 0.05, p = 0.04, and p = 0.02, resp.. Genotypic frequencies did not differ significantly between the groups (p = 0.15. Nonetheless, the mutated allele was observed in a greater proportion in patients without in-stent restenosis (p = 0.055. There was no significant association between the rs4244285 variant and the occurrence of in-stent restenosis after PCI (OR = 0.44; 95% CI: 0.19 to 1.04; p = 0.06. In summary, no association was identified between the CYP2C19⁎2 variant and the development of coronary in-stent restenosis.

  11. Exclusion of Atherosclerotic Plaque from the Circulation Using Stent-Grafts: Alternative to Carotid Stenting with a Protection Device?

    International Nuclear Information System (INIS)

    Peynircioglu, Bora; Geyik, Serdar; Yavuz, Kivilcim; Cil, Barbaros E.; Saatci, Isil; Cekirge, Saruhan

    2007-01-01

    Purpose. To retrospectively assess the feasibility, safety, and clinical mid-term outcome of patients undergoing carotid artery stenting with stent-grafts. Methods. Over a 4 year period stent-grafts were used in the endovascular treatment of symptomatic internal carotid artery stenosis in 12 patients (2 women, 10 men, aged 47-83 (mean 64) years). Protection devices were not used. Possible microembolic complications were evaluated by magnetic resonance imaging (MRI) examinations of the brain before and the day after the procedure in all patients. Mean follow-up was 22 months (range 1-42 months), by Doppler ultrasonography and conventional angiography as well as clinical examination .Results. The technical success rate was 100%. A total of 13 coronary stent-grafts were used. The mean stenosis rate (in terms of diameter) was 85% and the mean length of stent-grafts used was 20.9 mm. The mean diameter to which the stent-grafts were dilated was 4.66 mm. In-hospital complications occurred in 1 patient who suffered a minor femoral access hematoma that did not require transfusion or surgical decompression. Post-stenting diffusion-weighted MRI revealed several ipsilateral silent microemboli in only 1 case, which was completely asymptomatic. Two patients had a major stroke after 2 years of follow-up. Restenosis was found in 2 patients who underwent successful balloon dilatation followed by placement of a self-expandable bare stent within the stent-grafts. Conclusions. Stent-grafts may prevent microembolic complications during stenting of atherosclerotic carotid lesions in selected cases, offering immediate exclusion of the atherosclerotic lesion from the circulation by pressing the plaque against the vessel wall. Comparative, randomized studies in larger series of patients are needed with carotid-dedicated stent-graft designs

  12. Influence of a pressure gradient distal to implanted bare-metal stent on in-stent restenosis after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Thayssen, Per; Thuesen, Leif

    2007-01-01

    pullback recording in the entire length of the artery. METHODS AND RESULTS: In 98 patients with angina pectoris, 1 de novo coronary lesion was treated with a bare-metal stent. After stent implantation, pressure wire measurements (P(d)=mean hyperemic coronary pressure and P(a)=mean aortic pressure) were......-stent restenosis after 9 months. CONCLUSIONS: A residual abnormal P(d)/P(a) distal to a bare-metal stent was an independent predictor of in-stent restenosis after implantation of a coronary bare-metal stent. Udgivelsesdato: 2007-Dec-11......BACKGROUND: Fractional flow reserve predicts cardiac events after coronary stent implantation. The aim of the present study was to assess the 9-month angiographic in-stent restenosis rate in the setting of optimal stenting and a persisting gradient distal to the stent as assessed by a pressure wire...

  13. Higher plasma level of STIM1, OPG are correlated with stent restenosis after PCI.

    Science.gov (United States)

    Li, Haibin; Jiang, Zhian; Liu, Xiangdong; Yang, Zhihui

    2015-01-01

    Percutaneous Coronary Intervention (PCI) is one of the most effective treatments for Coronary Heart Disease (CHD), but the high rate of In Stent Restenosis (ISR) has plagued clinicians after PCI. We aim to investigate the correlation of plasma Stromal Interaction Molecular 1 (STIM1) and Osteoprotegerin (OPG) level with stent restenosis after PCI. A total of 100 consecutive patients with Coronary Heart Disease (CHD) received PCI procedure were recruited. Coronary angiography was performed 8 months after their PCI. Then patients were divided into 2 groups: observation group was composed by patients who existing postoperative stenosis after intervention; Control group was composed by patients with no postoperative stenosis. The plasma levels of STIM, OPG in all patients were tested before and after intervention. Pearson correlation and multiple linear regression analysis were performed to analysis the correlation between STIM, OPG level and postoperative stenosis. 35 cases were divided into observation group and other 65 were divided into control group. The plasma levels of STIM, OPG have no statistical difference before their PCI procedure, but we observed higher level of High-sensitivity C-reactive protein (Hs-CRP) existed in observation group. We observed higher level of plasma STIM, OPG in observation group when compared with control group after PCI procedure (P PCI, which could provide useful information for the restenosis control after PCI.

  14. [In situ aortofemoral reconstructions in surgical treatment of infected aortofemoral grafts].

    Science.gov (United States)

    Badretdinov, I A; Pokrovsky, A V

    2015-01-01

    The article presents a review of literature sources covering possibilities of peiforming in situ aortofemoral reconstructions in surgical treatment of infected aortofemoral grafts. This methodology makes it possible to improve the outcomes of treatment for paraprosthetic infection at the expense of decreasing lethality and morbidity, increasing parameters of patency of grafts and lower limb salvage in the remote postoperative period. Mention should be made that in situ secondary aortofemoral reconstructions are fraught with danger of relapsing paraprosthetic infection, therefore many publications are dedicated to search for prostheses most resistant to infection. The article also presents the results of works devoted to the use of various types of prostheses for in situ secondary aortofemoral reconstructions: prostheses made of polytetrafluoroethylene (PTFE), synthetic grafts saturated with various antibacterial drugs and gelatine, cadaveric allografts, synthetic prostheses treated with silver ions, autovenous conduits based on the femoral and popliteal veins.

  15. Detection of restenosis after successful coronary angioplasty: Improved clinical decision making with use of a logistic model combining procedural and follow-up variables

    International Nuclear Information System (INIS)

    Renkin, J.; Melin, J.; Robert, A.; Richelle, F.; Bachy, J.L.; Col, J.; Detry, J.M.; Wijns, W.

    1990-01-01

    A prospective study of 111 patients who underwent repeat coronary angiography and exercise thallium-201 scintigraphy 6 +/- 2 months after complete revascularization by percutaneous transluminal coronary angioplasty was performed to assess whether clinical, procedure-related and postangioplasty exercise variables yield independent information for the prediction of angiographic restenosis after angioplasty. Complete revascularization was defined as successful angioplasty of one or more vessels that resulted in no residual coronary lesion with greater than 50% diameter stenosis. Restenosis was defined as a residual stenosis at the time of repeat angiography of greater than 50% of luminal diameter. Restenosis occurred in 40% of the patients. The 111 patients were randomly subdivided into a learning group (n = 84) and a testing group (n = 27). A logistic discriminant analysis was performed in the learning group and the logistic model was used to estimate a logistic probability of restenosis. This probability of restenosis was validated in the testing group. In the learning group of 84 patients univariate analysis of 39 factors revealed 8 factors related to restenosis: recurrence of angina (p less than 0.0001), postangioplasty abnormal finding on exercise thallium-201 scintigram (p less than 0.0001), exercise thallium-201 scintigram score (p less than 0.0001), difference between exercise and rest ST segment depression (p less than 0.001), postangioplasty exercise ST segment depression (p less than 0.001), absolute postangioplasty stenosis diameter (p less than 0.003), postangioplasty exercise work load (p less than 0.03) and postangioplasty exercise heart rate (p less than 0.05)

  16. Postoperative Outcomes of Mitral Valve Repair for Mitral Restenosis after Percutaneous Balloon Mitral Valvotomy

    Directory of Open Access Journals (Sweden)

    Seong Lee

    2015-10-01

    Full Text Available Background: There have been a number of studies on mitral valve replacement and repeated percutaneous mitral balloon valvotomy for mitral valve restenosis after percutaneous mitral balloon valvotomy. However, studies on mitral valve repair for these patients are rare. In this study, we analyzed postoperative outcomes of mitral valve repair for mitral valve restenosis after percutaneous mitral balloon valvotomy. Methods: In this study, we assessed 15 patients (mean age, 47.7±9.7 years; 11 female and 4 male who underwent mitral valve repair between August 2008 and March 2013 for symptomatic mitral valve restenosis after percutaneous mitral balloon valvotomy. The mean interval between the initial percutaneous mitral balloon valvotomy and the mitral valve repair was 13.5±7 years. The mean preoperative Wilkins score was 9.4±2.6. Results: The mean mitral valve area obtained using planimetry increased from 1.16±0.16 cm2 to 1.62±0.34 cm2 (p=0.0001. The mean pressure half time obtained using Doppler ultrasound decreased from 202.4±58.6 ms to 152±50.2 ms (p=0.0001. The mean pressure gradient obtained using Doppler ultrasound decreased from 9.4±4.0 mmHg to 5.8±1.5 mmHg (p=0.0021. There were no early or late deaths. Thromboembolic events or infective endocarditis did not occur. Reoperations such as mitral valve repair or mitral valve replacement were not performed during the follow-up period (39±16 months. The 5-year event-free survival was 56.16% (95% confidence interval, 47.467–64.866. Conclusion: On the basis of these results, we could not conclude that mitral valve repair could be an alternative for patients with mitral valve restenosis after percutaneous balloon mitral valvotomy. However, some patients presented with results similar to those of mitral valve replacement. Further studies including more patients with long-term follow-up are necessary to determine the possibility of this application of mitral valve repair.

  17. The study of drug eluting biodegradable intravascular stent with antiproliferation agent-paclitaxel in preventing vascular restenosis

    International Nuclear Information System (INIS)

    Xiao Yueyong; Zhang Jinshan; Cui Fuzhai; Meng Bo

    2004-01-01

    Objective: To define the effect of drug eluting BIS with antiproliferation agent-paclitaxel in preventing vascular restenosis. Methods: Bare BIS and drug BIS with 60 μg paclitaxel were prepared. Both types of the BIS were implanted into the infrarenal restenosis aortas in canine models, and the animals were euthanized 6 weeks after implantation for histopathological, morphometric and immunohistochemical assessment. Results: The mean lumen area of bare BIS group was (77 586.5 ± 66.0) μm 2 , and lumen of paclitaxel eluting BIS group was (113 435.9 ±71.0) μm 2 . The mean neointima area of bare BIS group was (24 803 ± 56) μm 2 , and paclitaxel eluting BIS group was (12 931 ± 63) μm 2 . The PCNA-positive ratio was (38 ± 15)% in bare BIS group and (11 ± 0.31)% in paclitaxel eluting BIS group. The statistically significant difference between the two groups were noted (P<0.01). Conclusion: BIS as a vehicle of loading and releasing drugs could significantly inhibit the VSMC and neointimal hyperplasia with antiproliferation agent-paclitaxel. BIS is a promising and new strategy in preventing the restenosis

  18. A combined strategy to reduce restenosis for vascular tissue engineering applications.

    Science.gov (United States)

    Patel, Hemang J; Su, Shih-Horng; Patterson, Cam; Nguyen, Kytai T

    2006-01-01

    Biodegradable polymers including poly(l-lactic acid) (PLLA) have been used to develop cardiovascular prostheses such as vascular grafts and stents. However, implant-associated thrombosis, inflammation, and restenosis are still major obstacles for the utility of these devices. The lack of an endothelial cell (EC) lining (endothelialization) on the implants and the responses of the immune systems toward the implants have been associated with these complications. In our research strategy, we have combined the drug delivery principle with the strategies of tissue engineering, the controlled release of anti-inflammation drugs and enhanced endothelialization, to reduce the implant-associated adverse responses. We first integrated curcumin, an anti-inflammatory drug and anti-smooth muscle cell (SMC) proliferative drug, with PLLA. This curcumin-loaded PLLA material was then modified using adsorptive coating of adhesive proteins such as fibronectin, collagen-I, vitronectin, laminin, and matrigel to improve the endothelial cell (EC) adhesion and proliferation, and ECs were seeded on top of these modified surfaces. Our results showed steady drug release kinetics over the period of 50 days from curcumin-loaded PLLA materials. Additionally, integration of curcumin in PLLA increased the roughness of the scaffold at the nanometric scale using an atomic force microscopic analysis. Moreover, coating with fibronectin on curcumin-loaded PLLA surfaces gave the highest EC adhesion and proliferation compared to other adhesive proteins using PicoGreen DNA assays. The ability of our strategy to release the curcumin for producing anti-inflammation and anti-proliferation responses and to improve EC adhesion and growth after EC seeding suggests this strategy may reduce implant-associated adverse responses and be a better approach for vascular tissue engineering applications.

  19. Mitral restenosis in the early postoperative period of a patient with systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Pomerantzeff Pablo Maria Alberto

    1999-01-01

    Full Text Available A forty eight year old woman, who had undergone mitral comissurotomy and subsequently developed early restenosis, presented with major comissural fusion and verrucous lesions on the cuspid edges of the mitral valve, with normal subvalvar apparatus. Patient did well for the first six months after surgery when she began to present dyspnea on light exertion. A clinical diagnosis of restenosis was made, which was confirmed by an echocardiogram and cardiac catheterization. She underwent surgery, and a stenotic mitral valve with verrucous lesions suggesting Libman-Sacks' endocarditis was found. Because the diagnosis of systemic lupus erythematosus (SLE had not been confirmed at that time, a bovine pericardium bioprosthesis (FISICS-INCOR was implanted. The patient did well in the late follow-up and is now in NYHA Class I .

  20. Treatment of carotid siphon aneurysms by use of the Willis stent graft: an angiographic and histopathological study

    International Nuclear Information System (INIS)

    Zhu, Yue-Qi; Li, Ming-Hua; Xie, Jian; Tan, Hua-Qiao; Wang, Jian-Bo; Cheng, Ying-Sheng

    2010-01-01

    We designed a carotid siphon (CS) aneurysm model in dogs to test a new stent graft (the Willis covered stent) and compared tissue reaction over 12-month follow-up versus a comparison group with stents implanted in straight vessels. Twenty-four saccular sidewall aneurysms (group A) and 12 CS aneurysms (group B) were created surgically. A Willis stent graft was implanted in each aneurysm. Angiography was performed immediately and at 1-, 3-, 6- and 12-month post-implantation to investigate aneurysm isolation, endoleak, stent angulation, parent artery (PA) patency and restenosis. Light and scanning electron microscopy were used to identify aneurysmal sac thrombi, intima hyperplasia and endothelial progress. Immediate angiography demonstrated mild endoleak in two aneurysms and three stent angulations in group B. Follow-up at 12 months revealed resolved endoleaks, occlusion in one PA and mild stenosis in three in group B. In group A, occlusion occurred in one PA and mild stenosis in two. Light microscopy revealed new intima, and all aneurysm sacs were filled with thrombi. In group B, endothelial progress was complete at 12 months, and closely correlated with haemodynamic changes. Application of a Willis stent graft is a feasible method of treating CS aneurysms, and it exhibits a prolonged endothelial progress compared with that in straight vessels. (orig.)

  1. Diagnostic value of microRNA-143 in predicting in-stent restenosis for patients with lower extremity arterial occlusive disease

    OpenAIRE

    Yu, Zhi-Hai; Wang, Hai-Tao; Tu, Can

    2017-01-01

    Purpose This study was conducted to explore the diagnostic value of microRNA-143 (miRNA-143) in predicting in-stent restenosis (ISR) of lower extremity arterial occlusive disease (LEAOD). Methods From February 2012 to March 2015, 165 patients (112 males and 53 females) with LEAOD undergoing interventional treatment were enrolled in this study. Serum miRNA-143 expression was detected using quantitative real-time polymerase chain reaction (qRT-PCR). Patients were assigned into the restenosis an...

  2. Results of a Seven-Year, Single-Centre Experience of the Long-Term Outcomes of Bovine Ureter Grafts Used as Novel Conduits for Haemodialysis Fistulas

    International Nuclear Information System (INIS)

    Das, Neelan; Bratby, Mark J.; Shrivastava, Vivek; Cornall, Alison J.; Darby, Christopher R.; Boardman, Philip; Anthony, Susan; Uberoi, Raman

    2011-01-01

    Purpose: To report the long-term outcomes of bovine ureter grafts as novel conduits for haemodialysis fistulas. Materials and Methods: Thirty-five patients underwent placement of a total of 40 SynerGraft 100 (SG100; CryoLife Europa ® , Guildford, UK) bovine ureter grafts between April 2002 and February 2009. Prospective data were collected on all patients, including active surveillance with blood flow studies and 6-monthly duplex ultrasound studies. Main outcome measures were primary and secondary patency rates. Results: Mean follow-up time was 97 weeks (range 4–270). Thirteen patients died from unrelated causes during the study period; 12 of these patients had a functioning graft at the time of death. Five patients underwent transplantation, and all had a functioning graft at transplantation. Twelve patients had a functioning graft at the end of the study period. One hundred and ten stenoses were detected, and 97 venoplasty procedures were performed. Of the stenoses, 41.8% were located at the venous anastomosis, 12.7% within the graft, 17.3% in the outflow veins, and 28.1% in central veins. No arterial stenoses were detected. Primary patency rates were 53% at 6 months and 14% at 1 year. Secondary patency rates were 81% at 6 months, 75% at 1 year, and 56% at 2 years. Conclusions: Active surveillance and intervention was able to achieve satisfactory long-term secondary patency for these novel conduits compared with those made of PTFE seen in other studies.

  3. Transcriptional Control of Vascular Smooth Muscle Cell Proliferation by Peroxisome Proliferator-Activated Receptor-γ: Therapeutic Implications for Cardiovascular Diseases

    Directory of Open Access Journals (Sweden)

    Florence Gizard

    2008-01-01

    Full Text Available Proliferation of vascular smooth muscle cells (SMCs is a critical process for the development of atherosclerosis and complications of procedures used to treat atherosclerotic diseases, including postangioplasty restenosis, vein graft failure, and transplant vasculopathy. Peroxisome proliferator-activated receptor (PPAR γ is a member of the nuclear hormone receptor superfamily and the molecular target for the thiazolidinediones (TZD, used clinically to treat insulin resistance in patients with type 2 diabetes. In addition to their efficacy to improve insulin sensitivity, TZD exert a broad spectrum of pleiotropic beneficial effects on vascular gene expression programs. In SMCs, PPARγ is prominently upregulated during neointima formation and suppresses the proliferative response to injury of the arterial wall. Among the molecular target genes regulated by PPARγ in SMCs are genes encoding proteins involved in the regulation of cell-cycle progression, cellular senescence, and apoptosis. This inhibition of SMC proliferation is likely to contribute to the prevention of atherosclerosis and postangioplasty restenosis observed in animal models and proof-of-concept clinical studies. This review will summarize the transcriptional target genes regulated by PPARγ in SMCs and outline the therapeutic implications of PPARγ activation for the treatment and prevention of atherosclerosis and its complications.

  4. Peripheral nerve regeneration with conduits: use of vein tubes.

    Science.gov (United States)

    Sabongi, Rodrigo Guerra; Fernandes, Marcela; Dos Santos, João Baptista Gomes

    2015-04-01

    Treatment of peripheral nerve injuries remains a challenge to modern medicine due to the complexity of the neurobiological nerve regenerating process. There is a greater challenge when the transected nerve ends are not amenable to primary end-to-end tensionless neurorraphy. When facing a segmental nerve defect, great effort has been made to develop an alternative to the autologous nerve graft in order to circumvent morbidity at donor site, such as neuroma formation, scarring and permanent loss of function. Tubolization techniques have been developed to bridge nerve gaps and have been extensively studied in numerous experimental and clinical trials. The use of a conduit intends to act as a vehicle for moderation and modulation of the cellular and molecular ambience for nerve regeneration. Among several conduits, vein tubes were validated for clinical application with improving outcomes over the years. This article aims to address the investigation and treatment of segmental nerve injury and draw the current panorama on the use of vein tubes as an autogenous nerve conduit.

  5. Peripheral nerve regeneration with conduits: use of vein tubes

    Directory of Open Access Journals (Sweden)

    Rodrigo Guerra Sabongi

    2015-01-01

    Full Text Available Treatment of peripheral nerve injuries remains a challenge to modern medicine due to the complexity of the neurobiological nerve regenerating process. There is a greater challenge when the transected nerve ends are not amenable to primary end-to-end tensionless neurorraphy. When facing a segmental nerve defect, great effort has been made to develop an alternative to the autologous nerve graft in order to circumvent morbidity at donor site, such as neuroma formation, scarring and permanent loss of function. Tubolization techniques have been developed to bridge nerve gaps and have been extensively studied in numerous experimental and clinical trials. The use of a conduit intends to act as a vehicle for moderation and modulation of the cellular and molecular ambience for nerve regeneration. Among several conduits, vein tubes were validated for clinical application with improving outcomes over the years. This article aims to address the investigation and treatment of segmental nerve injury and draw the current panorama on the use of vein tubes as an autogenous nerve conduit.

  6. Does grafting coronary arteries with only moderate stenosis affect long-term mortality?

    Science.gov (United States)

    Sabik, Joseph F.; Olivares, Gabriel; Raza, Sajjad; Lytle, Bruce W.; Houghtaling, Penny L.; Blackstone, Eugene H.

    2016-01-01

    Objective Stenting coronary arteries with non–ischemia-producing moderate stenosis leads to worse outcomes than leaving them unstented. We sought to determine whether grafting coronary arteries with angiographically moderate stenosis is associated with worse long-term survival than leaving them ungrafted. Methods From 1972 to 2011, 55,567 patients underwent primary isolated coronary artery bypass grafting (CABG); 8531 had a single coronary artery with moderate (50%-69%) stenosis, bypassed in 6598 (77%) and not bypassed in 1933 (23%). These arteries were grafted with internal thoracic arteries (ITAs) in 1806 patients (27%) and with saphenous veins (SVs) in 4625 (70%). Mean follow-up for all-cause mortality was 13.0 ± 9.7 years. Results Survival was similar for patients with and without a graft to the moderately stenosed coronary artery (P = .3): 97%, 76%, 43%, and 18% at 1, 10, 20, and 30 years among patients receiving no graft; 97%, 74%, 41%, and 18% among those receiving an SV graft; and 98%, 82%, 51%, and 23% among those receiving an ITA graft. After adjusting for patient characteristics, SV grafting versus nongrafting of moderately stenosed coronary arteries was associated with similar long-term mortality (P = .2), whereas ITA grafting was associated with 22% lower long-term mortality (hazard ratio 0.78; 68% confidence interval 0.75–0.82; P<.0001). Conclusions Grafting coronary arteries with angiographically moderate stenosis is not harmful. Instead, ITA grafting of such coronary arteries is associated with lower long-term mortality. Thus, after placing the first ITA to the left anterior descending, the second ITA should be placed to the second most important coronary artery, even if it is moderately stenosed. PMID:26611750

  7. Stent-in-Stent Technique for the Treatment of Proximal Bronchial Restenosis after Insertion of Metallic Stents: A Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Benjamin Bondue

    2016-01-01

    Full Text Available Endoscopic treatment of a bronchial restenosis previously treated by insertion of a partially covered self-expandable metallic stent (SEMS can be difficult. Classically, after recanalization of the bronchus, the stent is removed and replaced by a more adapted one. We report on two cases of proximal bronchial restenosis treated by insertion of an additional stent inside the lumen of the previously inserted stent using the stent-in-stent (SIS technique. The indications for the initial stent were malignancy in Patient 1 and posttransplant bronchial stenosis in Patient 2. Restenosis occurred at the proximal end of the stent within months in both cases. Stent removal and insertion of a new stent were considered, but this option was discarded because of an excessive risk of bronchial perforation and preference towards an alternative approach. In both cases, a second customized SEMS was placed using the SIS technique after ablation of the proximal end stenosis of the stent by argon plasma coagulation and/or dilation with a balloon. Recanalization of the bronchus was achieved in both cases without complications. The SIS technique is a valuable alternative to removal of SEMS in case of proximal bronchial restenosis.

  8. Increased Plasma Cathepsin S at the Time of Percutaneous Transluminal Angioplasty is Associated with 6-Months’ Restenosis of the Femoropopliteal Artery

    Directory of Open Access Journals (Sweden)

    Mijovski Mojca Bozic

    2018-01-01

    Full Text Available Background: We tested the hypothesis that increased levels of cathepsin S and decreased levels of cystatin C in plasma at the time of percutaneous transluminal angioplasty (PTA are associated with the occurrence of 6-months’ restenosis of the femoropopliteal artery (FPA. Methods: 20 patients with restenosis and 24 matched patients with patent FPA after a 6-months follow-up were in - cluded in this study. They all exhibited disabling claudication or critical limb ischemia and had undergone technically successful PTA. They were all receiving statins and ACE in hi - bitors (or angiotensin II receptor antagonist before the PTA and the therapy did not change throughout the observational period. Plasma concentrations of C-reactive protein were < 10 mg/L and of creatinine within the reference range at the time of the PTA. Plasma concentration and activity of cathepsin S, together with its potent inhibitor cystatin C, were measured the day before and the day after the PTA. Results: The increased plasma concentration and activity of cathepsin S at the time of PTA was associated with the occurrence of 6-months’ restenosis of FPA, independently of established risk factors (lesion complexity, infrapopliteal run-off vessels, type of PTA, age, gender, smoking, diabetes, lipids and of cystatin C. Plasma cystatin C concentration was not associated with restenosis and did not correlate with cathepsin S activity and concentration in the plasma. Conclusion: Increased level of plasma cathepsin S at the time of PTA is associated with 6-months’ restenosis of PTA, independently of established risk factors.

  9. Varicose vein stripping

    Science.gov (United States)

    ... stripping; Venous reflux - vein stripping; Venous ulcer - veins Patient Instructions Surgical wound care - open Varicose veins - what to ask your doctor Images Circulatory system References American Family Physician. Management of varicose veins. www.aafp.org/afp/2008/ ...

  10. Directional atherectomy for treatment of restenosis within coronary stents: clinical, angiographic and histologic results

    NARCIS (Netherlands)

    B.H. Strauss (Bradley); V.A.W.M. Umans (Victor); R-J. van Suylen (Robert-Jan); P.J. de Feyter (Pim); J. Marco (Jean); G. Robertson; J. Renkin; G.R. Heyndrickx (Guy); V.D. Vuzevski (Vojislav); F.T.B. Bosman (Fré); P.W.J.C. Serruys (Patrick)

    1992-01-01

    textabstractAbstract OBJECTIVES: The safety and long-term results of directional coronary atherectomy in stented coronary arteries were determined. In addition, tissue studies were performed to characterize the development of restenosis. METHODS: Directional coronary atherectomy was performed in

  11. Evaluation of batroxobin in preventing vascular restenosis in diabetic patients after infrapopliteal arterial angioplasty: a randomized comparative study

    International Nuclear Information System (INIS)

    Xue Bo; Zhang Peilei; Wang Jue; Li Minghua; Zhao Jungong; Zhu Yueqi; Tan Huaqiao; Wang Jianbo

    2011-01-01

    Objective: To evaluate batroxobin in preventing vascular restenosis in diabetic patients after infrapopliteal arterial angioplasty through comparing the clinical results of the combination use of batroxobin and aspirin with that of simple use of aspirin. Methods: After a successful angioplasty, fifty-two diabetic patients with symptomatic infrapopliteal obstructions were randomly divided into the study group (n=26) and the control group (n=26). Patients in both groups received 100 aspirin everyday, but the patients in study group additionally received 5 IU batroxobin intravenous drip every day for six times. At the end of the follow-up period lasting for 12 months, magnetic resonance angiography (MRA) or Doppler ultrasonic angiography was performed to check the vessels to see if there was any restenosis or reocclusion. The relief degree of clinical symptoms were observed, and both preoperative and postoperative ankle-brachial index (ABI) were regularly determined and compared. Kaplan-Meier curves were constructed to evaluate restenosis/reocclusion-free rate, limb salvage rate and amputation-free rate. Results: During the follow-up period the occurrence of restenosis/reocclusion in study group and control group was 22.0% and 34.5% respectively (P=0.0307). Statistically significant difference in ABI existed between two groups both after the procedure (P<0.05) and at 12 months after the treatment (P=0.0094). Clinical improvement and tissue healing in study group and control group were observed in 23 and 19 patients respectively (P=0.0544). Twelve months after angioplasty, Kaplan-Meier analysis showed that the restenosis/reocclusion-free rate, the limb salvage rate and the amputation-free rate for study group were 74.0%, 96.2% and 84.6% respectively, while they was 54.8%, 92.3% and 84.6% respectively for control group. Conclusion: The results of this study indicate that the use of the clinical therapeutic efficacy and markedly relieve the symptoms, although this

  12. Hemodynamic effects of closure of residual arteriovenous fistulae during in situ graft procedures

    DEFF Research Database (Denmark)

    Laustsen, Jesper; Nielsen, Henriette Svarre; Pedersen, Erik Morre

    2011-01-01

    lower limb ischemia were obtained. Direct measurements of proximal and distal blood pressures in the graft were taken and simultaneous determinations of volume blood flow proximally and distally in the graft with ultrasound transit time technique before and after closure of residual fistulae were made......The objective was to study the intraoperative hemodynamic effects of closure of residual arteriovenous fistulae during in situ saphenous vein graft procedures. Data on 60 residual arteriovenous fistulae in nine patients (five men) with a median age of 74 years (range 64-83 years) with critical....... Closure of a fistula with blood flow around or below 100 mL/min did not increase distal outflow, whereas closure of fistulae with higher blood flow resulted in unpredictable changes in distal outflow. Only fistulae with a blood flow above approximately 100 mL/min may be of hemodynamic significance....

  13. The importance of the time of digitalization for the incidence of spasms evoked by ouabain in strips of human saphenous vein.

    Science.gov (United States)

    Zerkowski, H R; Wagner, J

    1982-10-01

    The extent of contracture induced by ouabain on preparations of the greater saphenous vein obtained from patients undergoing elective coronary bypass surgery was investigated. The medical pretreatment of the various donor patients was similar but differed with regard to the duration of preoperative digitalization ranging from several days to months. Whereas the maximal contraction induced by noradrenaline was not influenced by prior digitalization, the contracture evoked by ouabain showed a strong dependency on the duration of preoperative digitalization. In patients without or with only short-term preoperative digitalization the spasm exerted by ouabain amounted to 48.8% and 49.2%, respectively, of the maximal contraction induced by noradrenaline, and decreased to zero in patients with long-term digitalization. From this result it is concluded that, in patients after coronary artery bypass grafting who did not receive cardiac glycosides for long-term treatment, the acute administration of glycosides may be a mechanism responsible for the early occlusion of saphenous vein bypass grafts.

  14. In vitro degradation and cell attachment studies of a new electrospun polymeric tubular graft.

    Science.gov (United States)

    Patel, Harsh N; Thai, Kevin N; Chowdhury, Sami; Singh, Raj; Vohra, Yogesh K; Thomas, Vinoy

    Electrospinning technique was utilized to engineer a small-diameter (id = 4 mm) tubular graft. The tubular graft was made from biocompatible and biodegradable polymers polycaprolactone (PCL) and poliglecaprone with 3:1 (PCL:PGC) ratio. Enzymatic degradation effect on the mechanical properties and fiber morphology in the presence of lipase enzyme were observed. Significant changes in tensile strength (1.86-1.49 MPa) and strain (245-205 %) were noticed after 1 month in vitro degradation. The fiber breakage was clearly evident through scanning electron microscopy (SEM) after 4 weeks in vitro degradation. Then, the graft was coated with a collagenous protein matrix to impart bioactivity. Human umbilical vein endothelial cells (HUVECs) and aortic artery smooth muscle cells (AoSMCs) attachment on the coated graft were observed in static condition. Further, HUVECs were seeded on the lumen surface of the grafts and exposed to laminar shear stress for 12 h to understand the cell attachment. The coated graft was aged in PBS solution (pH 7.3) at 37 °C for 1 month to understand the coating stability. Differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (FTIR) suggested the erosion of the protein matrix from the coated graft under in vitro condition.

  15. Drug-eluting stents studies in mice: Do we need atherosclerosis to study restenosis?

    NARCIS (Netherlands)

    Pires, N.M.M.; Jukema, J.W.; Daemen, M.J.A.P.; Quax, P.H.A.

    2006-01-01

    In 2001, the first human study with drug-eluting stents (DES) was published showing a nearly complete abolition of restenosis by using a sirolimus-eluting stent. This success was very encouraging to test new compounds in combination with the DES platform. Nevertheless, several other anti-restenotic

  16. Compliant electrospun silk fibroin tubes for small vessel bypass grafting.

    Science.gov (United States)

    Marelli, Benedetto; Alessandrino, Antonio; Farè, Silvia; Freddi, Giuliano; Mantovani, Diego; Tanzi, Maria Cristina

    2010-10-01

    Processing silk fibroin (SF) by electrospinning offers a very attractive opportunity for producing three-dimensional nanofibrillar matrices in tubular form, which may be useful for a biomimetic approach to small calibre vessel regeneration. Bypass grafting of small calibre vessels, with a diameter less than 6mm, is performed mainly using autografts, like the saphenous vein or internal mammary artery. At present no polymeric grafts made of SF are commercially available, mainly due to inadequate properties (low compliance and lack of endothelium cells). The aim of this work was to electrospin SF into tubular structures (Ø=6mm) for small calibre vessel grafting, characterize the morphological, chemico-physical and mechanical properties of the electrospun SF structures and to validate their potential to interact with cells. The morphological properties of electrospun SF nanofibres were investigated by scanning electron microscopy. Chemico-physical analyses revealed an increase in the crystallinity of the structure of SF nanofibres on methanol treatment. Mechanical tests, i.e. compliance and burst pressure measurements, of the electrospun SF tubes showed that the inner pressure to radial deformation ratio was linear for elongation up to 15% and pressure up to 400 mm Hg. The mean compliance value between 80 and 120 mm Hg was higher than the values reported for both Goretex(R) and Dacron(R) grafts and for bovine heterografts, but still slightly lower than those of saphenous and umbilical vein, which nowadays represent the gold standard for the replacement of small calibre arteries. The electrospun tubes resisted up to 575+/-17 mmHg, which is more than four times the upper physiological pressure of 120 mmHg and more than twice the pathological upper pressures (range 180-220 mmHg). The in vitro tests showed a good cytocompatibility of the electrospun SF tubes. Therefore, the electrospun SF tubes developed within this work represent a suitable candidate for small calibre

  17. The effects of fenoldopam on coronary conduit blood flow after coronary artery bypass graft surgery.

    LENUS (Irish Health Repository)

    Halpenny, M

    2012-02-03

    OBJECTIVE: To quantify the effects of fenoldopam, 0.1 microg\\/kg\\/min, on left internal mammary artery (LIMA) and saphenous vein blood flow after coronary anastomosis. DESIGN: Prospective, randomized, double-blind, placebo-controlled trial. SETTING: University teaching hospital, single institution. PARTICIPANTS: Thirty-one American Society of Anesthesiologists III patients undergoing elective coronary revascularization. INTERVENTIONS: A perivascular ultrasonic flow probe (Linton Instrumentation, Norfolk, UK) was placed around the LIMA and saphenous vein graft after coronary anastomosis. MEASUREMENTS AND MAIN RESULTS: Immediately before and at 5-minute intervals for 15 minutes after starting the infusion, blood flow was measured in the LIMA and one saphenous vein graft using a transit time ultrasonic flow probe. Heart rate, blood pressure, and central venous pressure were documented at these time points. Administration of fenoldopam, 0.1 microg\\/kg\\/min, did not alter heart rate or blood pressure. A small, nonsignificant increase in LIMA blood flow occurred during the 15-minute study period (30 +\\/- 12 to 35 +\\/- 10 mL\\/min) in patients who received fenoldopam. No significant changes occurred in the placebo group. CONCLUSIONS: The findings indicate that fenoldopam, 0.1 microg\\/kg\\/min, did not influence coronary conduit blood flow to a clinically significant extent. The small increase in LIMA blood flow may be of greater importance in high-risk patients or in the prevention of coronary arterial spasm.

  18. Brachytherapy using holmium-166 liquid balloon system for in-stent restenosis: 6 months clinical and angiographic follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Kim, M. H.; Kim, S. K.; Cha, K. S.; Kim, Y. D.; Lee, H. S.; Kang, D. Y. [Donga University College of Medicine, Busan (Korea, Republic of)

    2002-07-01

    In western country, 3 systems of brachytherapy using commercial radioactive source has been established. However, brachytherapy using holmium-166 liquid balloon system (HLBS) for the patient with stent restenosis has not been studied enough. 30 patients (male 23, mean age 58.9 7.7) were enrolled. Target dose was 15 Gy at 1 mm distance from the intimal surface. Clinical diagnoses of the study patients included stable angina 10 and unstable angina 20 patients. Target lesion included LAD 19, LCx 5 and RCA 6 arteries. Pre-brachytherapy treatment included cutting balloon angioplasty in 25, rotational atherectomy in 5 patients. Fractionation and stepping was done in 6 patients each. Follow-up angiography was done in 19 patients. Of them, 4 cases developed angiographic restenosis (21%) including 3 cases of total occlusion. 6 month MACE (major adverse cardiac event) occurred in 5 patients including one sudden cardiac death in a patient with 80 year-old, triple-vessel diseased patient. Vascular brachytherapy using HLBS is a safe and effective treatment modality for in-stent restenosis showing acceptable angiographic and clinical result.

  19. Vacuum-assisted closure therapy for vascular graft infection (Szilagyi grade III) in the groin-a 10-year multi-center experience.

    Science.gov (United States)

    Verma, Himanshu; Ktenidis, Kiriakos; George, Robbie K; Tripathi, Ramesh

    2015-06-01

    The aim of the study was to evaluate the benefit of vacuum-assisted closure (VAC) therapy in the management of deep, alloplastic graft infections (Szilagyi grade III) in the groin. From 2000 to 2009, we identified and included in our study 72 deep inguinal infections in 68 patients, involving native as well as synthetic graft or patch material. There were 29 early graft infections (infections (≥30 days after implantation). Among these, 17 cases involved native grafts/patches (12 grafts and 5 patches), while 55 cases involved non-native grafts/patches [26 polytetrafluorethylene (PTFE) grafts and 24 Dacron grafts (Haemashield, Meadox Medical, Boston Scientific Corporation, Natick, NY; Gelsoft graft, Vascutek, Inchinnan, Renfrewshire, Scotland, UK; Intervascular, Mahwah, NJ); INVISTA, and 5 Vascu-Guard(™) bovine pericardial patches; Synovis Surgical Innovation]. All patients were treated with multiple wound debridements, graft salvage, sartorius myoplasty, intravenous antibiotics and VAC therapy until thorough surface healing was achieved. Exclusion criteria were an alloplastic graft infection with proximal expansion above the inguinal ligament, blood culture positive for septicaemia or septic anastomotic herald or overt bleeding. Nine months after initiation of therapy, overall, graft/patch salvage was achieved in 61 of 72 (84·7%) cases. Of the native graft/patch group, infected graft material was replaced with an autogenous great saphenous vein graft or patch in four patients (23·5%). In the non-native group, vein or synthetic graft preservation without revision was achieved in 48 of 55 (87·3%) patients. The mean duration of VAC therapy was 16 ± 7·7 days, and postoperative mean hospital stay was 25·3 ± 8·5 days. In 23 of 72 (31·9%) cases, a secondary closure of the wound was achieved; in the other 49 cases, wound healing was achieved by meshed split-thickness skin grafting. Mean wound healing time for all wounds was 24·3 ± 12·5 days. Specific

  20. Lower limb gigantism, lymphedema, and painful varicosities following a thigh vascular access graft.

    Science.gov (United States)

    Thompson, Michael; Mathuram Thiyagarajan, Umasankar; Akoh, Jacob A

    2014-07-01

    Prosthetic arteriovenous grafts (AVGs) are associated with greater morbidity than autogenous arteriovenous fistulas (AVFs), but their use is indicated when AVF formation is not possible. This report adds to the literature a case of lower limb gigantism, painful varicosities, and lymphedema following long-term use of AVG in the upper thigh. The patient's past medical history included renal transplantation on the same side well before the AVG was inserted and right leg deep vein thrombosis. Suspicion of AVG thrombosis was excluded by Doppler ultrasound, which demonstrated an access flow of 1700 mL/min. A computed tomography (CT) scan of the abdomen and pelvis did not identify the cause of her symptoms. Whereas functional incompetence of the iliac vein valve might be responsible for the varicosities, the extent of hypertrophy in this case raises the suspicion of lymphatic blockage possibly secondary to groin dissection undertaken at the time of graft insertion, in addition to the previous dissection at the time of transplantation. This case highlights the need for minimal groin dissection during AVG insertion, particularly in patients with a history of previous abdominopelvic surgery. © 2014 International Society for Hemodialysis.

  1. Portal Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Hakan Demirci

    2016-01-01

    Full Text Available Portal vein thrombosis is an important cause of presinusoidal portal hypertension. Portal vein thrombosis commonly occurs in patient with cirrhosis, malignancy and prothrombotic states. Patients with acute portal vein thrombosis have immediate onset. Patients with chronic portal vein thrombosis have developed portal hypertension and cavernous portal transformation. Portal vein thrombosis is diagnosed with doppler ultrasound, computed tomography and magnetic resonance imaging. Therapy with low molecular weight heparin achieves recanalization in more than half of acute cases.

  2. Collateral veins in left renal vein stenosis demonstrated via CT

    Energy Technology Data Exchange (ETDEWEB)

    Lien, H.H.; Lund, G.; Talle, K.

    1983-02-01

    Twelve patients with left renal vein stenosis from tumor compression were studied with CT. All had distended collateral veins in the perirenal space which either formed a radiating or a cobweb pattern or appeared as marked longitudinal veins. Inferior phrenic vein branches were seen in seven patients and were considerably enlarged in two. Other major veins possibly taking part in collateral circulation could not be recognized due to obliteration of fat planes. The renal fascia was thickened in eleven patients, probably due to edema. A close study of the perirenal space with CT may give valuable information about collateral development.

  3. Collateral veins in left renal vein stenosis demonstrated via CT

    International Nuclear Information System (INIS)

    Lien, H.H.; Lund, G.; Talle, K.

    1983-01-01

    Twelve patients with left renal vein stenosis from tumor compression were studied with CT. All had distended collateral veins in the perirenal space which either formed a radiating or a cobweb pattern or appeared as marked longitudinal veins. Inferior phrenic vein branches were seen in seven patients and were considerably enlarged in two. Other major veins possibly taking part in collateral circulation could not be recognized due to obliteration of fat planes. The renal fascia was thickened in eleven patients, probably due to edema. A close study of the perirenal space with CT may give valuable information about collateral development. (orig.)

  4. Prefabrication of a vascularized nerve graft by vessel implantation: preliminary report of an experimental model.

    Science.gov (United States)

    Cavadas, P C; Vera-Sempere, F J

    1994-01-01

    Regeneration through vascularized nerve grafts (VNG) seems to be better than nonvascularized nerve grafts (NVNG), especially in hostile beds. We report on an experimental technique of prefabrication of VNG by direct vessel implantation. An arteriovenous fistula was created in the groin region with autologous vein grafts in the Wistar rat model, and implanted into the sciatic nerve. Five weeks later the sciatic VNG was elevated on the prefabricated pedicle. The flap was free-transferred orthotopically over a silicone sheet to impede plasmatic imbibition. Flap viability at 3 days was complete. India ink injection of the AV fistula resulted in capillary ink filling within the nerve and surrounding tissues. Histologic sections of the flap were examined, revealing its neovascularity. In an ongoing study, the regeneration through this prefabricated VNG is being compared to native VNG.

  5. The value of primary vascular stents in management of early portal vein stenosis after liver transplantation

    Directory of Open Access Journals (Sweden)

    Wen-Tsan Chang

    2016-03-01

    Full Text Available If portal vein stenosis (PVS occurs within 1 month after liver transplantation (LT, especially within 1 week, it can be catastrophic and result in rapid loss of the grafts and mortality. Although surgical treatments have been considered standard treatment for PVS, patients are usually unable to receive operations or re-transplantations, because of their critical conditions and a shortage of grafts. Recently, primary percutaneous transhepatic portal vein stents (PTPS were suggested as alternative and less-invasive treatments of PVS. However, because lethal complications may follow these primary stent placements for patients in early stages after LT, primary PTPS placements for patients suffering PVS 1 month after LT has been suggested. From November 2009 to July 2015, 38 consecutive adult patients underwent LT at our institution. Among them, six recipients suffered PVS within 1 month after LT. Technical success was achieved in all six patients. Clinical success was obtained in two of the four patients suffering PVS within 1 week after LT, and in the other two patients suffering PVS>1 week after LT. All surviving patients and their grafts were in good condition, and their stents remained patent. Our experience showed that primary PTPS placements can be used to effectively treat patients with PVS encountered within 1 month, and even within 1 week, after LT with acceptable short-term results. However, possible fatal complications should be kept in mind. Long-term results of these procedures need further follow-up.

  6. Blood compatibility assessment of graft copolymer (NR-g-DMAA) tubes

    International Nuclear Information System (INIS)

    Razzak, M.T.; Otsuhata, Kazushige; Tabata, Yoneho; Ohashi, Fumio; Takeuchi, Atsuki

    1992-01-01

    Graft copolymer (NR-g-DMAA) tubes have been prepared using simultaneous radiation induced grafting of N,N-dimethyl-acrylamide, (DMAA) onto natural rubber (NR) tubes. The blood compatibility of the NR-g-DMAA tubes was assessed with three methods, namely in vitro test, ex vivo once through test and ex vivo loops test. In the case of the in vitro test, a simple whole blood contacting procedure has been employed. The ex vivo once through test involves the exposing of NR-g-DMAA tubes with once through flow of fresh canine blood and then it was inspected for any evidence of clot. In the case of ex vivo loops test, the NR-g-DMAA tube was implanted at external jugular vein of a mongrel canine and the blood flow in the NR-g-DMAA tube was detected with an ultrasonic flow meter. It was found that the blood compatibility of NR-g-DMAA tubes is improved significantly with the increasing degree of grafting. All the NR-g-DMAA tubes having a degree of grafting of about 30 wt% or more exhibit good blood compatibility. It was found that the blood compatibility of the NR-g-DMAA tube is better than that of a medical grade silicon rubber (SiR) tube. (Author)

  7. Evaluation of the restenosis of coronary artery after percutaneous transluminal coronary angioplasty by three-dimensional coronary magnetic resonance angiography

    International Nuclear Information System (INIS)

    Arisaka, Hiraku

    2000-01-01

    Coronary magnetic resonance angiography (MRA) has been recently brought into clinical use, however, there has not been reports on the comparison with MRA and conventional contrast coronary angiography (CAG) in the detection of the localization and characteristics of coronary restenosis after percutaneous transluminal coronary angioplasty (PTCA). To assess the restenosis of coronary artery after PTCA, this study compared three-dimensional (3D) coronary MRA and CAG. One hundred three patients (76 males and 27 females, average age of 64.6±9.3 years old) were performed coronary MRA at 3-6 months after PTCA. The right coronary artery (RCA) group consist of 21 patients, the left anterior descending branch (LAD) 63 patients and the left circumflex branch (LCX) 19 patients. Coronary MRA was performed with the patients in supine position on a 1.5 T whole body scanner (MAGNETOM VISION, Siemens AG, Germany) using body array coil. The imaging technique used a 3-D gradient echo sequence with respiratory gating and fat suppression. The slice thickness was 2 mm, slab thickness 32 mm, a field of view of 300 mm and a matrix of 128 x 256. Other parameters were an echo time of 2.7 ms and a repetition time of 600 to 1100 msec. The measurement time of 1 imaging slab took 15 to 20 minutes depending on the patient's heart rate. The coronary arteries were reconstructed from the 3-D data set using a multiplanar reconstruction (MPR) technique. According to previous coronary MRA studies, a significant stenosis with a luminal reduction of ≥50% was assumed if a marked signal reduction or signal loss of a vessel segment was visible. In CAG, 57 of 103 patients showed restenosis. In coronary MRA, 37 of 103 patients demonstrated restenosis. The sensitivity, specificity, positive and negative predictive values were 64.9%, 100%, 100% and 69.6%, respectively. Predictive accuracy was 79.6%. Three-dimensional coronary MRA is useful in a noninvasive diagnostic method to evaluate the coronary

  8. Combined Rex-bypass shunt with pericardial devascularization alleviated prehepatic portal hypertension caused by cavernomatous transformation of portal vein.

    Science.gov (United States)

    Wang, Ruo-Yi; Wang, Jun-Feng; Liu, Qian; Ma, Nan; Chen, Wei-Xiu; Li, Jin-Liang

    2017-09-01

    To evaluate the effects of combined Rex-bypass shunt and pericardial devascularization on prehepatic portal hypertension secondary to cavernomatous transformation of portal vein (CTPV). Forty-two patients aged from 3 years to 49 years (divided into 3 groups), 26 cases male and 16 female, with prehepatic vascular hepertention were treated with Rex-bypass shunt combined with pericardial devascularization. In each patient, preoperative assessment included ultrasound and computed tomographic angiography of the portal vein and blood analysis. The procedure was Rex-bypass shunt (with or without graft), and patients with moderate or severe gastroesophageal varices required additional paraesophagogastric devascularization. Splenectomy or subtotal splenectomy was performed if combined hypersplenism co-existed. All data were analyzed retrospectively. No intraoperative death occurred, blood routine analysis improved (P portal vein (LPV) significantly increased, the esophageal and gastric varices significantly relieved in 34 patients (P portal hypertension caused by CTPV.

  9. Focus on Varicose Veins

    Science.gov (United States)

    ... because the valves of the veins no longer work. Under the pressure of gravity these veins can continue to expand and, in ... and to determine whether the vein valves are work- ing properly or have ... painless. How are varicose veins treated? Varicose veins are always ...

  10. Exercise radionuclide ventriculography to detect restenosis following coronary angioplasty

    International Nuclear Information System (INIS)

    De Puey, E.G.; Leatherman, L.L.; Dear, W.E.; Leachman, R.D.; Massin, E.K.; Mathur, V.S.; Burdine, J.A.

    1984-01-01

    Forty one patients (pts) underwent semiupright exercise gated radionuclide ventriculography (EGRNV) before, within 3 d after single vessel transluminal coronary angioplasty (TCA), and 4 to 12 mos later, at which time follow-up cardiac catheterization was also performed. Prior to TCA 76% of pts had abnormal EGRNV, as defined by a failure to increase ejection fraction (EF) by 5 points or the development of a new regional wall motion abnormality. Stenosis was reduced from 90 +- 7% to 18 +- 17%. Early after TCA, exercise duration and maximum double product increased (p's 20% but <50%; Group III (n=8): ≥ 50%] Pts with abnormal EGRNV early after TCA were demonstrated to have a greater percent increase in stenosis at late follow-up than pts with normal EGRNV (41 +- 30% vs 19 +- 25%, p<.001). Early after TCA EGRNV was abnormal in 5% of Group I pts vs 75% in Group III (p<.01), and EF increased to a greater degree during exercise in Group I pts (+11.3 +- 7.5 vs +3.5 +- 6.5 points, p<.01). At 4-12 mos EGRNV was abnormal in 27% of Group I vs 88% of Group III (p<.01), and during exercise EF increased in Group I pts (+11.8 +- 7.8 points) but decreased in Group III (-1.9 +- 8.7 points) (p<.0005). The accuracy of abnormal EGRNV in predicting ≥ 50% restenosis was 73% early post-TCA and 77% at 4-12 mos. The authors conclude that EGRNV is a valuable test to verify the success of TCA and to detect subsequent restenosis

  11. Early detection of restenosis after successful percutaneous transluminal coronary angioplasty by exercise-redistribution Thallium scintigraphy

    NARCIS (Netherlands)

    W. Wijns (William); P.W.J.C. Serruys (Patrick); J.H.C. Reiber (Johan); P.J. de Feyter (Pim); M.J.B.M. van den Brand (Marcel); M.L. Simoons (Maarten); P.G. Hugenholtz (Paul)

    1985-01-01

    textabstractThe value of exercise testing and thallium scintigraphy in predicting recurrence of angina pectoris and restenosis after a primary successful transluminal coronary angioplasty (PTCA) was prospectively evaluated. In 89 patients, a symptom-limited exercise electrocardiogram (ECG) and

  12. A new venous conduit utilizing the recipient portal vein branches for segment V in adult partial liver transplantation.

    Science.gov (United States)

    Moon, I S; Kim, D G; Lee, M D; Hong, S K; Park, S C; Oh, D Y; Ahn, S T; Lee, Y J

    2005-03-01

    Right anterior-medial lobe congestion due to temporary clamping of segment V and/or VIII is common in the operative theater during adult donor right lobe liver transplantation, the most common procedure in our institute. We have used an autogenous saphenous vein conduit to recipient portal vein tributaries in 15 cases, as a "Y-to-I venoplasty" since January 2004. The recipient portal vein is transected 5 mm proximal to its bifurcation and extended to both sides with partial hepatic dissection. The "Y-to-I venoplasty" is made by suture closure of the portal vein transversely to form a tube. The average length is 7.5 cm with a 1.3 cm width. One end of "Y-to-I venoplasty" conduit is anastomosed to the donor segment V branch on the back table. And the other end is anastomosed directly to the IVC via a new window or the middle hepatic vein stump in recipient. The phase distension of the conduit with respiration is noted in the operative field. A 6/15 (40%) patency rate, was observed by CT angiography at the second postoperative week. All-patient conduits showed good flow on serial examinations at the 60th postoperative day. This new venous graft, made of recipient portal vein is a good conduit for segment V decongestion in adult right lobe partial liver transplantation.

  13. Impact of obstructive sleep apnea on the occurrence of restenosis after elective percutaneous coronary intervention in ischemic heart disease

    Directory of Open Access Journals (Sweden)

    Behrendt Dominik

    2008-06-01

    Full Text Available Abstract Rationale There is growing evidence that obstructive sleep apnea is associated with coronary artery disease. However, there are no data on the course of coronary stenosis after percutaneous coronary intervention in patients with obstructive sleep apnea. Objectives To determine whether sleep apnea is associated with increased late lumen loss and restenosis after percutaneous coronary intervention. Methods 78 patients with coronary artery disease who underwent elective percutaneous coronary intervention were divided in 2 groups: 43 patients with an apnea hypopnea – Index 10/h (group II. Late lumen loss, a marker of restenosis, was determined using quantitative coronary angiography after 6.9 ± 3.1 months. Main results Angiographic restenosis (>50% luminal diameter, was present in 6 (14% of group I and in 9 (25% of group II (p = 0.11. Late lumen loss was significant higher in pt. with an AHI > 10/h (0.7 ± 0.69 mm vs. 0.38 ± 0.37 mm, p = 0.01. Among these 35 patients, 21(60% used their CPAP devices regularly. There was a marginally lower late lumen loss in treated patients, nevertheless, this difference did not reach statistical significance (0.57 ± 0.47 mm vs. 0.99 ± 0.86 mm, p = 0.08. There was no difference in late lumen loss between treated patients and the group I (p = 0.206. Conclusion In summary, patients with OSA and coronary artery disease have a higher degree of late lumen loss, which is a marker of restenosis and vessel remodeling after elective percutaneous intervention.

  14. Spider Vein Removal

    Science.gov (United States)

    Spider veins: How are they removed? I have spider veins on my legs. What options are available ... M.D. Several options are available to remove spider veins — thin red lines or weblike networks of ...

  15. Ultrastructural investigations for reducing endothelial cell damage of vein grafts during CABG-operation and practical consequences.

    Science.gov (United States)

    Hickethier, T; Dämmrich, J; Silber, R E; Finster, S; Elert, O

    1999-02-01

    In the present study the influence of different storage solutions on endothelial integrity or damage was investigated with direct methods particularly with transmission electron microscopy (TEM), scanning electron microscopy (SEM) and immunohistochemistry. Saphenous vein segments of 10 cm in length were taken surgically from 6 male CABG-patients (aged 60-70) under standardized conditions. Each vein segment was cut into rings, which were incubated at room temperature for 45 minutes in different storage solutions, particularly in 0.9% sodium chloride solution and in buffered solution (M 199) with 5% human serum albumin respectively. Then, the vein segments were fixed in 3.5% glutaraldehyde and prepared for scanning and transmission electron microscopy to evaluate the endothelial damage. In addition, immunohistochemical staining (CD34, PECAM and Factor VIII) was performed. When using 0.9% sodium chloride solution, the SEM-examination revealed that 55% of the cell population was destroyed. In comparison to these findings only 26% of the endothelial cell population was damaged when the venous segment was stored in buffered solution with 5% albumin (p<0.01). In immunohistochemistry (CD34, PECAM, Factor VIII) these findings were supported. This study demonstrates the importance of storage solutions in regard to endothelial integrity. For best preservation of endothelium it is necessary to modify conventional storage methods. So, storage in buffered solution with albumin has shown much better endothelial cell preservation compared with physiological saline which might reduce the obliteration rate of CABG in future.

  16. [A reduction in the invasiveness during surgical revascularization: the harvesting of the great saphenous vein by a video endoscopic technic].

    Science.gov (United States)

    Terrini, A; Graffigna, A; Martinelli, L

    2000-05-01

    The authors report their preliminary experience of endoscopic saphenous vein harvesting as part of a program devoted to reducing the invasivity of surgical myocardial revascularization. This method allows us to minimize the cutaneous incisions in the inferior limbs necessary to harvest the saphenous vein, thus reducing the incidence of complications. The study includes 41 patients who underwent endoscopic saphenous vein harvesting from October 1998 to September 1999 and, as a control group, 20 patients with similar characteristics operated on with the traditional technique during the same period. The variables considered were: the time necessary to harvest the saphenous vein, the incidence of complications, and the postoperative mobilization. All the endoscopically harvested grafts were adequate for the scheduled procedure. The only complication occurred in a patient operated on with the traditional technique. The time of harvesting and the day of mobilization were similar in the two groups. The reduction of surgical trauma allowed a fast deambulation recovery and better esthetic results. When complete arterial revascularization is not feasible, the endoscopic harvesting of the required saphenous vein segment allows for a significant reduction in the invasivity of the procedure.

  17. Surgical Repair of a Post-traumatic Arteriovenous Fistula Complicated by Stent-Graft Misplacement

    International Nuclear Information System (INIS)

    Sahin, Sinan; Ciinar, Bayer; Bilgin, Sule N.; Celik, Levent; Eren, Ergin E.

    2005-01-01

    An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein which may result from a traumatic injury or occur as a congenital abnormality. It may be asymptomatic or may present with a variety of symptoms. Surgical or endovascular treatment can be preferred. We present a case of unsuccessful percutaneous treatment of a femoral AVF due to misplacement of the stent-grafts, necessitating surgical correction

  18. Association between portal vein pressure drop gradient after transjugular intrahepatic portosystemic shunt and clinical prognosis

    Directory of Open Access Journals (Sweden)

    XU Zhengguo

    2016-12-01

    Full Text Available ObjectiveTo investigate the association between portal vein pressure drop gradient in patients with cirrhotic portal hypertension treated by transjugular intrahepatic portosystemic shunt (TIPS and clinical prognosis, as well as the ideal range of portal vein pressure drop. MethodsA total of 58 patients who underwent TIPS in Xinqiao Hospital of Third Military Medical University from November 2013 to December 2015 were enrolled. All the patients underwent TIPS and embolization of the gastric coronary vein and the short gastric veins, and the change intervals of portal vein pressure gradient were monitored. The follow-up time ranged from 3 days to 2 years, and the association of portal vein pressure drop gradient with postoperative liver function, splenic function, rebleeding rate, hepatic encephalopathy, and portal hypertensive gastrointestinal diseases was analyzed. The paired t-test was used for comparison of parameters before and after treatment. ResultsThe patients had a significant reduction in liver function on day 3 after surgery. At 2 month after surgery, the levels of TBil was rised and had significant changes[(49.81±27.82μmol/L vs (31.64±17.67 μmol/L,t=5.372,P<0.001]. At 6 months after surgery, red blood cell count and platelet count had no significant changes,but,white blood cell count was reduced[(3.79±1.37)×109/L vs (4.57±2.24×109/L,t=2.835,P=0.006]. There was a 23% reduction in portal vein pressure after surgery (from 30.62±3.56 mmHg before surgery to 21.21±2.90 mmHg after surgery, t=23.318,P<0.001. All the patients had varying degrees of relief of gastrointestinal symptoms associated with portal vein hypertension, such as abdominal distension, poor appetite, and diarrhea. Of all patients, none experienced in-stent restenosis or occlusion and 13 experienced hepatic encephalopathy after surgery, which tended to occur at the time when postoperative portal vein pressure was reduced to 14.7-25.7 mmHg, i

  19. Hybrid Repair of Complex Thoracic Aortic Arch Pathology: Long-Term Outcomes of Extra-anatomic Bypass Grafting of the Supra-aortic Trunk

    Energy Technology Data Exchange (ETDEWEB)

    Lotfi, S., E-mail: shamim.lotfi@kcl.ac.uk; Clough, R. E.; Ali, T. [Guy' s and St. Thomas' NHS Trust, Vascular Surgery (United Kingdom); Salter, R. [Guy' s and St. Thomas' NHS Trust, Interventional Radiology (United Kingdom); Young, C. P. [Guy' s and St. Thomas' NHS Trust, Cardiac Surgery (United Kingdom); Bell, R.; Modarai, B.; Taylor, P., E-mail: peter.taylor@gstt.nhs.uk [Guy' s and St. Thomas' NHS Trust, Vascular Surgery (United Kingdom)

    2013-02-15

    Hybrid repair constitutes supra-aortic debranching before thoracic endovascular aortic repair (TEVAR). It offers improved short-term outcome compared with open surgery; however, longer-term studies are required to assess patient outcomes and patency of the extra-anatomic bypass grafts. A prospectively maintained database of 380 elective and urgent patients who had undergone TEVAR (1997-2011) was analyzed retrospectively. Fifty-one patients (34 males; 17 females) underwent hybrid repair. Median age was 71 (range, 18-90) years with mean follow-up of 15 (range, 0-61) months. Perioperative complications included death: 10 % (5/51), stroke: 12 % (6/51), paraplegia: 6 % (3/51), endoleak: 16 % (8/51), rupture: 4 % (2/51), upper-limb ischemia: 2 % (1/51), bypass graft occlusion: 4 % (2/51), and cardiopulmonary complications in 14 % (7/51). Three patients (6 %) required emergency intervention for retrograde dissection: (2 aortic root repairs; 2 innominate stents). Early reintervention was performed for type 1 endoleak in two patients (2 proximal cuff extensions). One patient underwent innominate stenting and revision of their bypass for symptomatic restenosis. At 48 months, survival was 73 %. Endoleak was detected in three (6 %) patients (type 1 = 2; type 2 = 1) requiring debranching with proximal stent graft (n = 2) and proximal extension cuff (n = 1). One patient had a fatal rupture of a mycotic aneurysm and two arch aneurysms expanded. No bypass graft occluded after the perioperative period. Hybrid operations to treat aortic arch disease can be performed with results comparable to open surgery. The longer-term outcomes demonstrate low rates of reintervention and high rates of graft patency.

  20. Hybrid Repair of Complex Thoracic Aortic Arch Pathology: Long-Term Outcomes of Extra-anatomic Bypass Grafting of the Supra-aortic Trunk

    International Nuclear Information System (INIS)

    Lotfi, S.; Clough, R. E.; Ali, T.; Salter, R.; Young, C. P.; Bell, R.; Modarai, B.; Taylor, P.

    2013-01-01

    Hybrid repair constitutes supra-aortic debranching before thoracic endovascular aortic repair (TEVAR). It offers improved short-term outcome compared with open surgery; however, longer-term studies are required to assess patient outcomes and patency of the extra-anatomic bypass grafts. A prospectively maintained database of 380 elective and urgent patients who had undergone TEVAR (1997–2011) was analyzed retrospectively. Fifty-one patients (34 males; 17 females) underwent hybrid repair. Median age was 71 (range, 18–90) years with mean follow-up of 15 (range, 0–61) months. Perioperative complications included death: 10 % (5/51), stroke: 12 % (6/51), paraplegia: 6 % (3/51), endoleak: 16 % (8/51), rupture: 4 % (2/51), upper-limb ischemia: 2 % (1/51), bypass graft occlusion: 4 % (2/51), and cardiopulmonary complications in 14 % (7/51). Three patients (6 %) required emergency intervention for retrograde dissection: (2 aortic root repairs; 2 innominate stents). Early reintervention was performed for type 1 endoleak in two patients (2 proximal cuff extensions). One patient underwent innominate stenting and revision of their bypass for symptomatic restenosis. At 48 months, survival was 73 %. Endoleak was detected in three (6 %) patients (type 1 = 2; type 2 = 1) requiring debranching with proximal stent graft (n = 2) and proximal extension cuff (n = 1). One patient had a fatal rupture of a mycotic aneurysm and two arch aneurysms expanded. No bypass graft occluded after the perioperative period. Hybrid operations to treat aortic arch disease can be performed with results comparable to open surgery. The longer-term outcomes demonstrate low rates of reintervention and high rates of graft patency.

  1. What Are Varicose Veins?

    Science.gov (United States)

    ... Leer en español What Is Varicose (VAR-i-kos) veins are swollen, twisted veins that you can ... TA-ze-uhs), spider veins, varicoceles (VAR-i-ko-seals), and other vein problems. Telangiectasias Telangiectasias are ...

  2. Current Strategies for the Manufacture of Small Size Tissue Engineering Vascular Grafts

    Directory of Open Access Journals (Sweden)

    Michele Carrabba

    2018-04-01

    Full Text Available Occlusive arterial disease, including coronary heart disease (CHD and peripheral arterial disease (PAD, is the main cause of death, with an annual mortality incidence predicted to rise to 23.3 million worldwide by 2030. Current revascularization techniques consist of angioplasty, placement of a stent, or surgical bypass grafting. Autologous vessels, such as the saphenous vein and internal thoracic artery, represent the gold standard grafts for small-diameter vessels. However, they require invasive harvesting and are often unavailable. Synthetic vascular grafts represent an alternative to autologous vessels. These grafts have shown satisfactory long-term results for replacement of large- and medium-diameter arteries, such as the carotid or common femoral artery, but have poor patency rates when applied to small-diameter vessels, such as coronary arteries and arteries below the knee. Considering the limitations of current vascular bypass conduits, a tissue-engineered vascular graft (TEVG with the ability to grow, remodel, and repair in vivo presents a potential solution for the future of vascular surgery. Here, we review the different methods that research groups have been investigating to create TEVGs in the last decades. We focus on the techniques employed in the manufacturing process of the grafts and categorize the approaches as scaffold-based (synthetic, natural, or hybrid or self-assembled (cell-sheet, microtissue aggregation and bioprinting. Moreover, we highlight the attempts made so far to translate this new strategy from the bench to the bedside.

  3. Meniscal allograft transplantation. Part 1: systematic review of graft biology, graft shrinkage, graft extrusion, graft sizing, and graft fixation.

    Science.gov (United States)

    Samitier, Gonzalo; Alentorn-Geli, Eduard; Taylor, Dean C; Rill, Brian; Lock, Terrence; Moutzouros, Vasilius; Kolowich, Patricia

    2015-01-01

    To provide a systematic review of the literature regarding five topics in meniscal allograft transplantation: graft biology, shrinkage, extrusion, sizing, and fixation. A systematic literature search was conducted using the PubMed (MEDLINE), ScienceDirect, and EBSCO-CINAHL databases. Articles were classified only in one topic, but information contained could be reported into other topics. Information was classified according to type of study (animal, in vitro human, and in vivo human) and level of evidence (for in vivo human studies). Sixty-two studies were finally included: 30 biology, 3 graft shrinkage, 11 graft extrusion, 17 graft size, and 6 graft fixation (some studies were categorized in more than one topic). These studies corresponded to 22 animal studies, 22 in vitro human studies, and 23 in vivo human studies (7 level II, 10 level III, and 6 level IV). The principal conclusions were as follows: (a) Donor cells decrease after MAT and grafts are repopulated with host cells form synovium; (b) graft preservation alters collagen network (deep freezing) and causes cell apoptosis with loss of viable cells (cryopreservation); (c) graft shrinkage occurs mainly in lyophilized and gamma-irradiated grafts (less with cryopreservation); (d) graft extrusion is common but has no clinical/functional implications; (e) overall, MRI is not superior to plain radiograph for graft sizing; (f) graft width size matching is more important than length size matching; (g) height appears to be the most important factor influencing meniscal size; (h) bone fixation better restores contact mechanics than suture fixation, but there are no differences for pullout strength or functional results; and (i) suture fixation has more risk of graft extrusion compared to bone fixation. Systematic review of level II-IV studies, Level IV.

  4. Dialysis catheter-related superior vena cava syndrome with patent vena cava: Long term efficacy of unilateral viatorr stent-graft avoiding catheter manipulation

    Energy Technology Data Exchange (ETDEWEB)

    Quaretti, Pietro; Galli, Franco; Maramarco, Lorenzo Paplo; Corti, Riccardo; Leati, Giovanni; Fiorina, Ilaria; Maestri, Marcello [IRCCS Policlinico San Matteo Foundation, Pavia (Italy)

    2014-06-15

    Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome with patent SVC. The clinically driven endovascular therapy was conducted to treat the venous syndrome with a unilateral left brachiocephalic stent-graft without manipulation of the well-functioning catheter. The follow-up was uneventful until death 94 months later.

  5. Dialysis catheter-related superior vena cava syndrome with patent vena cava: Long term efficacy of unilateral viatorr stent-graft avoiding catheter manipulation

    International Nuclear Information System (INIS)

    Quaretti, Pietro; Galli, Franco; Maramarco, Lorenzo Paplo; Corti, Riccardo; Leati, Giovanni; Fiorina, Ilaria; Maestri, Marcello

    2014-01-01

    Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome with patent SVC. The clinically driven endovascular therapy was conducted to treat the venous syndrome with a unilateral left brachiocephalic stent-graft without manipulation of the well-functioning catheter. The follow-up was uneventful until death 94 months later.

  6. Management of carotid Dacron patch infection: a case report using median sternotomy for proximal common carotid artery control and in situ polytetrafluoroethylene grafting.

    Science.gov (United States)

    Illuminati, Giulio; Calio', Francesco G; D'Urso, Antonio; Ceccanei, Gianluca; Pacilè, Maria Antonietta

    2009-01-01

    We report on a 58-year-old male who presented with an enlarging cervical hematoma 3 months following carotid endarterectomy with Dacron patch repair, due to septic disruption of the Dacron patch secondary to presumed infection. The essential features of this case are the control of the proximal common carotid artery gained through a median sternotomy, because the patient was markedly obese with minimal thyromental distance, and the treatment consisting of in situ polytetrafluoroethylene bypass grafting, due to the absence of a suitable autogenous saphenous vein. Median sternotomy is rarely required in case of reintervention for septic false aneurysms and hematomas following carotid endarterectomy but should be considered whenever difficult control of the common carotid artery, when entering the previous cervicotomy, is anticipated. In situ polytetrafluoroethylene grafting can be considered if autogenous vein material is lacking.

  7. Pure 3D laparoscopic living donor right hemihepatectomy in a donor with separate right posterior and right anterior hepatic ducts and portal veins.

    Science.gov (United States)

    Hong, Suk Kyun; Suh, Kyung-Suk; Kim, Hyo-Sin; Yoon, Kyung Chul; Ahn, Sung-Woo; Oh, Dongkyu; Kim, Hyeyoung; Yi, Nam-Joon; Lee, Kwang-Woong

    2017-11-01

    Despite increases in the performance of pure laparoscopic living donor hepatectomy, variations in the bile duct or portal vein have been regarded as relative contraindications to this technique [1-3]. This report describes a donor with separate right posterior and right anterior hepatic ducts and portal veins who underwent pure laparoscopic living donor right hemihepatectomy, integrated with 3D laparoscopy and indocyanine green (ICG) near-infrared fluorescence cholangiography [1, 4, 5]. A 50-year-old man offered to donate part of his liver to his older brother, who required a transplant for hepatitis B-associated liver cirrhosis and hepatocellular carcinoma. Donor height was 178.0 cm, body weight was 82.7 kg, and body mass index was 26.1 kg/m 2 . Preoperative computed tomography and magnetic resonance cholangiopancreatography showed that the donor had separate right posterior and right anterior hepatic ducts and portal veins. The entire procedure was performed under 3D laparoscopic view. Following intravenous injections of 0.05 mg/kg ICG, ICG near-infrared fluorescence camera was used to demarcate the exact transection line and determine the optimal bile duct division point. The total operation time was 443 min; the donor required no transfusions and experienced no intraoperative complications. The graft weighed 1146 g with a graft-to-recipient weight ratio of 1.88%. The optimal bile duct division point was identified using ICG fluorescence cholangiography, and the bile duct was divided with good patency without any stricture. The right anterior and posterior portal veins were transected with endostaplers without any torsion. The patient was discharged on postoperative day 8, with no complications. Using a 3D view and ICG fluorescence cholangiography, pure 3D laparoscopic living donor right hemihepatectomy is feasible in a donor with separate right posterior and right anterior hepatic ducts and portal veins.

  8. Two-Stage Liver Transplantation with Temporary Porto-Middle Hepatic Vein Shunt

    Directory of Open Access Journals (Sweden)

    Giovanni Varotti

    2010-01-01

    Full Text Available Two-stage liver transplantation (LT has been reported for cases of fulminant liver failure that can lead to toxic hepatic syndrome, or massive hemorrhages resulting in uncontrollable bleeding. Technically, the first stage of the procedure consists of a total hepatectomy with preservation of the recipient's inferior vena cava (IVC, followed by the creation of a temporary end-to-side porto-caval shunt (TPCS. The second stage consists of removing the TPCS and implanting a liver graft when one becomes available. We report a case of a two-stage total hepatectomy and LT in which a temporary end-to-end anastomosis between the portal vein and the middle hepatic vein (TPMHV was performed as an alternative to the classic end-to-end TPCS. The creation of a TPMHV proved technically feasible and showed some advantages compared to the standard TPCS. In cases in which a two-stage LT with side-to-side caval reconstruction is utilized, TPMHV can be considered as a safe and effective alternative to standard TPCS.

  9. Varicose vein - noninvasive treatment

    Science.gov (United States)

    ... spider veins. These are small varicose veins. Salt water (saline) or a chemical solution is injected into the varicose vein. The vein will harden and then disappear. Laser treatment can be used on the surface of the skin. Small bursts ...

  10. [Reconstruction of the hypopharynx and cervical esophagus using a free jejunal graft].

    Science.gov (United States)

    Pesko, P; Bumbasirević, M; Knezević, J; Dunjić, M; Djukić, V; Simić, A; Stojakov, D; Sabljak, P; Bjelović, M; Janković, Z; Micev, M; Saranović, D

    2000-01-01

    Extensive malignant tumors of the hypopharynx and cervical esophagus continue to challenge surgeons in respect to both type and extent of resection as well as type of reconstruction. In the period between November 1st, 1996 and November 1st, 1998, at our Department, five patients have been operated due to squamocellular carcinoma of the hypopharynx using a free jejunal graft reconstruction method. The first free jejunal graft operation due to hypopharyngeal carcinoma, at the same time the first operation of this kind ever done in our Country, was performed on November 13th, 1998. There were 4 female and one male patient, average age 47.75 years. Disfagia for solid foods was a leading symptom in all patients (mean duration of 3.5 months) and was always accompanied with weight loss (average of 8 kg for two months). In all patients barium swallow, endoscopy, CT as well as intraoperative endoscopy was performed. Radical surgical procedure was always accompanied with the bilateral modified lympf node neck dissection. As a arterial donor vessel superior thyroid artery was used in all patients. As a venous drainage in three patients a external jugular vein was used and in two facial vein. Reconstruction using a free jejunal graft of approximately 25 cm long was performed in all patients creating upper, oropharingeal, anastomosis end to side and distal, esophageal, end to end (in only one patients side to end) using 3/0 apsorbable sutures. Mean duration of the operation was six hours. The postoperative course in all patients was uneventful. On the 9th postoperative day gastrografin and three days later barium swallow radiography was performed as a standard control study. Regular check ups were done on three, six, nine months, year and two years. On all controls all patients were symptom free and feeling well. It is our opinion that in the patients with isolated carcinoma of the hypopharynx due to low morbidity and mortality rate, free jejunal graft method is the surgical

  11. Optimization of cardiovascular stent against restenosis: factorial design-based statistical analysis of polymer coating conditions.

    Directory of Open Access Journals (Sweden)

    Gayathri Acharya

    Full Text Available The objective of this study was to optimize the physicodynamic conditions of polymeric system as a coating substrate for drug eluting stents against restenosis. As Nitric Oxide (NO has multifunctional activities, such as regulating blood flow and pressure, and influencing thrombus formation, a continuous and spatiotemporal delivery of NO loaded in the polymer based nanoparticles could be a viable option to reduce and prevent restenosis. To identify the most suitable carrier for S-Nitrosoglutathione (GSNO, a NO prodrug, stents were coated with various polymers, such as poly (lactic-co-glycolic acid (PLGA, polyethylene glycol (PEG and polycaprolactone (PCL, using solvent evaporation technique. Full factorial design was used to evaluate the effects of the formulation variables in polymer-based stent coatings on the GSNO release rate and weight loss rate. The least square regression model was used for data analysis in the optimization process. The polymer-coated stents were further assessed with Differential scanning calorimetry (DSC, Fourier transform infrared spectroscopy analysis (FTIR, Scanning electron microscopy (SEM images and platelet adhesion studies. Stents coated with PCL matrix displayed more sustained and controlled drug release profiles than those coated with PLGA and PEG. Stents coated with PCL matrix showed the least platelet adhesion rate. Subsequently, stents coated with PCL matrix were subjected to the further optimization processes for improvement of surface morphology and enhancement of the drug release duration. The results of this study demonstrated that PCL matrix containing GSNO is a promising system for stent surface coating against restenosis.

  12. Predictive value study of serum STIM1 and Adropin contents in cardiovascular events and restenosis after PCI operation

    Directory of Open Access Journals (Sweden)

    Qiu-Wei Lin

    2016-02-01

    Full Text Available Objective: To study the predictive value of serum STIM1 and Adropin contents in cardiovascular events and restenosis after PCI operation. Methods: Single coronary artery lesion patients receiving percutaneous coronary intervention in our hospital from May 2014 to January 2015 were selected for study, 45 cases of patients with in-stent restenosis 6 months after PCI operation more than 50% were enrolled in ISR group, 85 cases of patients with instent restenosis no more than 50% were enrolled in NISR group, and then serum STIM1, Adropin and NO contents as well as endothelial progenitor cell content and endothelial microparticle number in peripheral blood of two groups were detected. Results: Serum STIM1 content of ISR group was significantly higher than that of NISR group and STIM1 content was positively correlated with lumen stenosis degree, and serum Adropin content of ISR group was significantly lower than that of NISR group and Adropin content was negatively correlated with lumen stenosis degree; endothelial progenitor cell content in peripheral blood and serum NO content of ISR group were less than those of NISR group, and endothelial microparticle number in peripheral blood was more than that of NISR group; serum STIM1 content was positively correlated with endothelial microparticle number in peripheral blood and negatively correlated with endothelial progenitor cell content in peripheral blood, and serum Adropin content was negatively correlated with endothelial microparticle number in peripheral blood and positively correlated with serum NO content. Conclusion: Serum STIM1 content increase and Adropin content decrease are related to the occurrence of cardiovascular events and restenosis after PCI operation, and the two molecules mainly affect endothelial cell function and endothelial progenitor cell homing.

  13. Results of a randomized clinical trial of external beam radiation to prevent restenosis after superficial femoral artery stenting.

    Science.gov (United States)

    Therasse, Eric; Donath, David; Elkouri, Stéphane; Lespérance, Jacques; Giroux, Marie-France; Oliva, Vincent L; Guertin, Marie-Claude; Bouchard, Louis; Perreault, Pierre; Gilbert, Patrick; Soulez, Gilles

    2016-06-01

    The objective of this study was to evaluate the safety and efficacy of external beam radiation (EBR) in preventing restenosis after superficial femoral artery (SFA) stenting in comparison with a control group treated with SFA stenting only. In this Institutional Review Board-approved study, patients who provided written informed consent were randomly assigned to 0 Gy or 14 Gy of EBR to the stent site 24 hours after SFA stenting. The primary end point was the angiographic binary restenosis rate 2 years after stenting. Categorical and continuous end points were respectively analyzed using logistic regression models and Wilcoxon tests. End points expressed as time to event were analyzed using a log-rank test. The study included 155 patients, 46 women and 109 men (mean age, 66 years; range, 45-85 years). In the 0 and 14 Gy groups, binary restenosis was present, respectively, in 44% (34/77) and 68% (52/76; P = .003) 2 years after stenting. Stent thrombosis occurred in 13% (10/78) of the 0 Gy group and in 33% (25/77) of the 14 Gy group (P = .003). Target lesion revascularization at 2 years was 26% (25/78) in the 0 Gy group and 30% (23/77) in the 14 Gy group (P = .56). There were no significant differences in total walking distances change from baseline to 2 years (46 ± 100 and 26 ± 79 m, respectively, in the 0 Gy and 14 Gy group; P = .25). There were no procedure-related deaths and no major amputations. A single 14 Gy dose of EBR to the SFA stenting site did not prevent in-stent restenosis. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  14. Intravascular ultrasound assessment of minimumlumen area and intimal hyperplasia in in-stent restenosis after drug-eluting or bare-metal stent implantation. The Nordic Intravascular Ultrasound Study (NIVUS)

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Vikman, Saila; Antonsen, Lisbeth

    2017-01-01

    presenting with a DES or bare-metal stent (BMS) in-stent restenosis. Methods: The ``Nordic Intravascular Ultrasound Study (NIVUS)'' study was conducted in Nordic and Baltic countries as a prospective multicenter registry. Two hundred nine patients (DES n = 121 and BMS n = 88) with instent restenosis were...

  15. Platlet Rich Plasma (PRP) Improves Fat Grafting Outcomes.

    Science.gov (United States)

    Modarressi, Ali

    2013-01-01

    Autologous fat transfer offers many qualities of a ideal soft tissue filler. Main advantages of fat grafting ensue from the fact that the lipoaspirate tissue is an abundant source of regenerative pluripotential cells. However, the reported rates of fat cell survival vary greatly in the medical literature (10-90%). Different techniques of harvesting, processing, and reinjecting the fat cells are so claimed to be responsible for these differences, without any agreement concerning the best way to process. To address this important disadvantage, we propose the addition of autologous platelet rich plasma (PRP) which is known as a natural reservoir of growth factors stimulating tissue repair and regeneration. This approach is completely autologous and immediately employed without any type of preconditioning. Platelets rich plasma (PRP) preparation included bleeding of 8 ml of blood from patient's peripheral vein in Regen Lab© tubes containing sodium citrate anticoagulant. The whole blood was centrifugated at 1500 g during 3 min. As Regen-tubes contained a special gel separator, 99 % of red blood cells were discarded from the plasma at the bottom of the gel, and >90% of platelets were harvested in 4 ml of plasma on the top of the gel, called the platelet-rich plasma (PRP). The purified fat prepared by Coleman technique was mixed with different amount of PRP for in vitro, in vivo (mice) and clinical experiments: >50% of PRP for skin rejuvenation, superficial scars correction, infraorbital region, ..., and for 20% of PRP with 80% of purified fat for deep filler indication (nasolabial folds, lips, or soft tissue defect). In vitro studies demonstrated that PRP increased fat cells survival rate and stem cells differentiation. Animal models showed that fat graft survival rate was significantly increased by addition of PRP. Several clinical cases confirmed the improvement of wound healing and fat grafting survival in facial reconstruction and aesthetic cases by association of

  16. Microwave Spectrometry for the Assessment of the Structural Integrity and Restenosis Degree of Coronary Stents

    Science.gov (United States)

    Arauz-Garofalo, Gianluca; Lopez-Dominguez, Victor; Garcia-Santiago, Antoni; Tejada, Javier; O'Callaghan, Joan; Rodriguez-Leor, Oriol; Bayes-Genis, Antoni; Gmag Team; Hugtp Team; Upc Team

    2013-03-01

    Cardiovascular disease is the main cause of death worldwide. Coronary stents are one of the most important improvements to reduce deaths from cardiovascular disorders. Stents are prosthetic tube-shaped devices which are used to rehabilitate obstructed arteries. Despite their obvious advantages, reocclusion occurs in some cases arising from restenosis or structural distortions, so stented patients require chronic monitoring (involving invasive or ionizing procedures). We study microwave scattering spectra (between 2.0 - 18.0 GHz) of metallic stents in open air, showing that they behave like dipole antennas in terms of microwave scattering. They exhibit characteristic resonant frequencies in their microwave absorbance spectra that are univocally related to their length and diameter. This fact allows one to detect stent fractures or collapses. We also investigate the ``dielectric shift'' in the frequency of the resonances mentioned above due to the presence of different fluids along the stent lumen. This shift could give us information about the restenosis degree of implanted stents.

  17. [Effect of compound Danshen dripping pills combined with atorvastatin on restenosis after angioplasty in rabbits].

    Science.gov (United States)

    Song, Jieli; Zeng, Jinpei; Zhang, Yongxia; Li, Pengfei; Zhang, Lihong; Chen, Cibin

    2014-08-01

    To study the effect of compound Danshen dripping pills and atorvastatin on restenosis after abdominal aorta angioplasty in rabbits. Rabbit models of abdominal aorta restenosis after angioplasty were established and treated with saline (group A), compound Danshen dripping pills (group B), atorvastatin (group C), or compound Danshen dripping pills plus atorvastatin (group D). HE staining was used to determine the thickness of arterial intimal hyperplasia and assess the morphological changes of the narrowed artery. Immunohistochemistry was employed to detect the expression of nuclear factor-κB (NF-κB) and monocyte chemoattractant protein-1 (MCP-1). Compared with group A, the 3 treatment groups showed significant increased vascular cavity area and reduced intimal area and percentage of intimal hyperplasia (Ppills combined with atorvastatin produces better effects than the drugs used alone in inhibiting vascular smooth muscle cell proliferation in rabbits after abdominal aorta angioplasty possibly due to a decreased expression of MCP-1 as a result of NF-κB inhibition.

  18. A new method of prefabricated vascularized allogenic bone grafts for maxillo-mandibular reconstruction

    International Nuclear Information System (INIS)

    Pill-Hoon Choung

    1999-01-01

    Although there are various applications of allogenic bone grafts, a new technique of prevascularized lyophilized allogenic bone grafting for maxillo-mandibular reconstruction will be presented. Allogenic bone has been made by author's protocol for jaw defects as a powder, chip or block bone type. The author used lyophilized allogenic bone grafts for discontinuity defects as a block bone. In those cases, neovascularization and resorption of the allogenic bone were important factors for success of grafting. To overcome the problems, the author designed the technique of prefabricated vascularization of allogenic bone, which was lyophilized cranium, with an application of bovine BMP or not. Lyophilized cranial bone was designed for the defects and was put into the scalp. After confirming a hot spot via scintigram several months later, vascularized allogenic bone was harvested pedicled on the parietotemporal fascia based on the superficial temporal artery and vein. Vascularized allogenic cranial bone was rotated into the defect and fixed rigidly. Postoperatively, there was no severe resorption and functional disturbance of the mandible. In this technique, BMP seems to be an important role to help osteogenesis and neovascularization. Eight patients underwent prefabricated vascularization of allogenic bone grafts. Among them, four cases of reconstruction in mandibular discontinuity defects and one case of reconstruction in maxillectomy defect underwent this method, which will be presented with good results. This method may be an alternative technique of microvascular free bone graft

  19. Intraarterial 192Ir high-dose-rate brachytherapy for prophylaxis of restenosis after femoropopliteal percutaneous transluminal angioplasty: the prospective randomized Vienna-2-trial radiotherapy parameters and risk factors analysis

    International Nuclear Information System (INIS)

    Pokrajac, Boris; Poetter, Richard; Maca, Thomas; Fellner, Claudia; Mittlboeck, Martina; Ahmadi, Ramazanali; Seitz, Wolfgang; Minar, Erich

    2000-01-01

    Purpose: The aim of the Vienna-2-trial was to compare the restenosis rate of femoropopliteal arteries after percutaneous transluminal angioplasty (PTA) with or without intraarterial high-dose-rate (HDR) brachytherapy (BT) using an 192 Ir source. Materials and Methods: A prospective, randomized trial was conducted from 11/96 to 8/98. A total of 113 patients (63 men, 50 women), with a mean age of 71 years (range, 43-89 years) were included. Inclusion criteria were (1) claudication or critical limb ischemia, (2) de-novo stenosis of 5 cm or more, (3) restenosis after former PTA of any length, and (4) no stent implantation. Patients were randomized after successful PTA for BT vs. no further treatment. A well-balanced patient distribution was achieved for the criteria used for stratification, as there were 'de-novo stenosis vs. restenosis after former PTA', 'stenosis vs. occlusion', 'claudication vs. critical limb ischemia' and above these for 'diabetes vs. nondiabetes'. PTA length was not well balanced between the treatment arms: a PTA length of 4-10 cm was seen in 19 patients in the PTA alone group and in 11 patients in the PTA+BT group, whereas a PTA length of greater than10 cm was seen in 35 patients and 42 patients, respectively. A dose of 12 Gy was prescribed in 3-mm distance from the source axis. According to AAPM recommendations, the dose was 6.8 Gy in 5-mm distance (vessel radius + 2 mm). Primary endpoint of the study was femoropopliteal patency after 6 months. Results: PTA and additional BT were feasible and well tolerated by all 57 pts in this treatment arm. No acute, subacute, and late adverse side effects related to BT were seen after a mean follow up of 12 months (6-24 months) in 107 patients (PTA n = 54; PTA+ BT n = 53). Crude restenosis rate at 6 months was in the PTA arm 54% vs. 28% in the PTA + BT arm (χ 2 test; p 10 cm) showed significant decrease of the restenosis rate, if BT was added. Significant reduction was not achieved in diabetes patients

  20. The usefulness of contrast material injection at the dorsal vein of the hand in 64-detecter row helical CT coronary angiography

    International Nuclear Information System (INIS)

    Kawano, Youji; Yakabe, Kazuaki; Urata, Jungo; Eto, Miyuki; Yamaguchi, Hiroichiro

    2011-01-01

    In 315 cases of multi detector row CT (MDCT) coronary angiography contrast material were injected at the dorsal vein of the hand. Early 168 cases were used 80 ml of 370 mgI/ml contrast material and later 147 cases were used 350-480 mgI/kg contrast material. In all cases contrast material was injected by 4 ml/sec with post injection of 30-40 ml physiologic saline. The attenuation of RCA No.3 and other coronary arteries or coronary artery bypass graft (CABG) graft was measured. In later cases the usefulness of above 300 HU was 95.2%. In all cases the usefulness was 92.6%. (author)

  1. Worldwide Trends in Multi-arterial Coronary Artery Bypass Grafting Surgery 2004-2014: A Tale of 2 Continents.

    Science.gov (United States)

    Schwann, Thomas A; Tatoulis, James; Puskas, John; Bonnell, Mark; Taggart, David; Kurlansky, Paul; Jacobs, Jeffery P; Thourani, Vinod H; O'Brien, Sean; Wallace, Amelia; Engoren, Milo C; Tranbaugh, Robert F; Habib, Robert H

    2017-01-01

    Recent evidence shows that multi-arterial coronary artery bypass grafting (MABG) based on bilateral internal thoracic (BITA) or left internal thoracic (LITA) and radial artery (RA) improves long-term outcomes compared with single arterial coronary artery bypass grafting (SABG) (LITA + saphenous vein graft). How this evidence affected the worldwide use of MABG, if at all, is not well defined. Accordingly, we report 10-year temporal trends of MABG utilization from 2 continents. A study population of 1,683,434 non-emergent, primary, isolated LITA-based coronary artery bypass grafting (CABG) (≥2 grafts) patients was derived from the Society of Thoracic Surgeons (STS) (1,307,528 (79.5%) of 1,644,388 isolated CABG; total 1179 centers) and the Australia New Zealand Cardiothoracic (ANZ) Databases (34,213 (87%) of 39,046 isolated CABG; 24 centers) between 2004 and 2014. Patients were excluded based on the following: (1) no LITA, (2) if arterial grafts were other than RA or ITA, or (3) if grafting data were missing. The 3 MABG groups were LITA + RA, BITA, and BITA + RA, each with or without supplemental vein grafts. Grafting trends and their associated patient demographics were analyzed. SABG (89.3% STS, 51.4% ANZ) was the most common grafting strategy. MABG was most frequently accomplished by LITA + RA: (STS: 6.1%; ANZ: 42.6%), followed by BITA: (STS: 4.1%; ANZ: 4.3%), while ≥3 (BITA + RA) was rare in the STS (0.5%), but more common in ANZ (5.9%). In the STS, between 2004 and 2014, SABG rates systematically increased from 85.2% to 91.7%, BITA grafting was essentially unchanged from 3.6% to 4.3%, while RA use decreased systematically from 10.5% to 3.7%. In the ANZ, SABG rates increased from 17.3% to 51.4%, BITA grafting decreased from 6.3% to 3.6%, while RA grafting decreased from 65.8% to 39.0%. Compared with SABG patients, BITA patients were younger (STS: median age 59 vs 66, P 30 kg/m 2 ) in STS (37% vs 42%, P < 0.001), more obese in ANZ

  2. Accessory hepatic vein: MR imaging

    International Nuclear Information System (INIS)

    Lee, Chang Hee; Rho, Tack Soo; Cha, Sang Hoon; Park, Cheol Min; Cha, In Ho

    1995-01-01

    To evaluate the MR appearance of the accessory hepatic veins. The study included 87 consecutive patients for whom abdominal MR images were obtained. The subjects who had liver lesion or hepatic vascular abnormalities were excluded. Couinaud classified accessory hepatic veins into inferior and middle right hepatic veins. Our major interests were evaluation of the incidence, morphology, and location of the accessory hepatic vein. Inferior right hepatic vein was demonstrated in 43 out of 87 patients (49%). The morphology was linear in 35 patients (80.5%), and V-shaped in 8 patients (19.5%). In 40 patients (93%), the inferior right hepatic vein was located in the posteroinferior aspect of the right lobe. Middle right hepatic vein was demonstrated in 7 out of 87 patients (8%). All were single linear in morphology, combined with the inferior right hepatic vein, and located between the right hepatic vein and inferior right hepatic vein. The accessory hepatic vein was demonstrated in 49% among the Korean adult population, and was located in posteroinferior portion of the liver, in 93%

  3. Procedural and clinical outcomes after use of the glycoprotein IIb/IIIa inhibitor abciximab for saphenous vein graft interventions

    Energy Technology Data Exchange (ETDEWEB)

    Harskamp, Ralf E., E-mail: r.e.harskamp@gmail.com [Academic Medical Center–University of Amsterdam, Amsterdam (Netherlands); VU University Medical Center, Amsterdam (Netherlands); Duke Clinical Research Institute, Durham, NC (United States); Hoedemaker, Niels [Academic Medical Center–University of Amsterdam, Amsterdam (Netherlands); Newby, L. Kristin [Duke Clinical Research Institute, Durham, NC (United States); Woudstra, Pier; Grundeken, Maik J.; Beijk, Marcel A.; Piek, Jan J.; Tijssen, Jan G. [Academic Medical Center–University of Amsterdam, Amsterdam (Netherlands); Mehta, Rajendra H. [Duke Clinical Research Institute, Durham, NC (United States); Winter, Robbert J. de [Academic Medical Center–University of Amsterdam, Amsterdam (Netherlands)

    2016-01-15

    Background: Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) poses a high-risk for distal coronary thromboembolic events. Glycoprotein IIb/IIIa inhibitors are frequently used in hope of reducing the impact of this, although the safety and efficacy of these drugs to improve outcomes in this setting are understudied. Methods: Patients were included if they had prior coronary artery bypass surgery and subsequently underwent PCI of ≥ 1 SVG graft at a Dutch academic center between 1997 and 2008. These patients were matched 1:1 based on peri-procedural use of abciximab using a propensity-score matching algorithm based on 17 variables. Conditional logistic regression and Cox regression stratified on matched pairs were performed to evaluate the association between abciximab use and MACCE (the composite measure of mortality, myocardial infarction, stroke and repeat revascularization) at 30 days and up to 1 year. Results: The composite of 30-day MACCE occurred in 18 patients (15.3%) in the abciximab group and 16 patients (13.6%) in the propensity matched control group (OR: 1.13, 95% CI: 0.57–2.21, p = 0.73). At 1-year follow-up, MACCE rates were also similar (32.5% vs. 33.9%, HR: 0.97, 95% CI: 0.59–1.59). Major bleeding (BARC types 3a–c) was higher in the abciximab group (11.9% vs. 4.2%, OR: 2.80, 95% CI: 1.01–7.77). Ischemic outcomes did not differ among patients with acute coronary syndromes. Conclusion: The use of intravenous abciximab was not associated with improved clinical outcomes up to 1-year among patients undergoing SVG PCI, but was related to more bleeding. - Highlights: • PCI of SVG poses a high-risk for distal coronary thromboembolic events. • Glycoprotein IIb/IIIa inhibitors are frequently used in an attempt to reduce this risk. • We evaluated the safety and efficacy of abciximab (a glycoprotein IIb/IIIa inhibitor) using a propensity-score matched analysis of 236 patients at a large academic medical center. • Thirty

  4. Endovascular brachytherapy prevents restenosis after femoropopliteal angioplasty: results of the Vienna-3 randomised multicenter study

    International Nuclear Information System (INIS)

    Pokrajac, Boris; Poetter, Richard; Wolfram, Roswitha M.; Budinsky, Alexandra C.; Kirisits, Christian; Lileg, Brigitte; Mendel, Helmuth; Sabeti, Schila; Schmid, Rainer; Minar, Erich

    2005-01-01

    Background and purpose: The aim of the trial was to investigate the effect of Iridium-192 gamma endovascular brachytherapy on reduction of restenosis after femoropopliteal angioplasty. Patients and methods: Between Oct, 1998 and Jul, 2001 a total of 134 patients have been randomized after successful angioplasty to brachytherapy or sham irradiation in a prospective, randomized, multicenter, double blind controlled trial. Patients with de novo lesion of at least 5 cm or recurrent lesion of any length after prior angioplasty have been enrolled. Brachytherapy was performed with 7 F centering catheter. Mean lesion length was 9.1 cm (1.5-25 cm) and mean intervention length 13.6 cm (4-27.5 cm) in brachytherapy cohort. Results: In placebo cohort mean lesion length was 10.3 cm (2-25 cm) and mean intervention length 14.1 cm (2-29 cm). A dose of 18 Gy was prescribed 2 mm from the surface of centering balloons. Analyzed (based on angiography) on intention to treat basis the binary restenosis rate at 12 months was 41.7% (28/67) in brachytherapy cohort and 67.1% (45/67) in placebo cohort (χ 2 test, P 30% residual stenosis after angioplasty) have been 23.4% in the brachytherapy and 53.3% in the placebo group (P<0.05), respectively. The cumulative patency rates after 24 months on intention to treat analysis were 54% in the brachytherapy and 27% in the placebo group (P<0.005). Corresponding data for as treated analysis were 77% in the brachytherapy and 39% in the placebo group (P<0.001). Late thrombosis was not seen. Conclusions: Significant reduction of restenosis rate was obtained with endovascular gamma brachytherapy after femoropopliteal angioplasty

  5. Air Pump-Assisted Graft Centration, Graft Edge Unfolding, and Graft Uncreasing in Young Donor Graft Pre-Descemet Endothelial Keratoplasty.

    Science.gov (United States)

    Jacob, Soosan; Narasimhan, Smita; Agarwal, Amar; Agarwal, Athiya; A I, Saijimol

    2017-08-01

    To assess an air pump-assisted technique for graft centration, graft edge unfolding, and graft uncreasing while performing pre-Descemet endothelial keratoplasty (PDEK) using young donor grafts. Continuous pressurized air infusion was used for graft centration, graft edge unfolding, and graft unwrinkling. Ten eyes of 10 patients underwent PDEK with donors aged below 40 years. In all eyes, the donor scrolled into tight scrolls. In all cases, the air pump-assisted technique was effective in positioning and centering the graft accurately and in straightening infolded graft edges and smoothing out graft creases and wrinkles. Endothelial cell loss was 38.6%. Postoperative best-corrected visual acuity at 6 months was 0.66 ± 0.25 in decimal equivalent. Continuous pressurized air infusion acted as a third hand providing a continuous pressure head that supported the graft and prevented graft dislocation as well as anterior chamber collapse during intraocular maneuvering. Adequate maneuvering space was available in all cases, and bleeding, if any, was tamponaded successfully in all cases. Although very young donor grafts may be used for PDEK, they are difficult to center and unroll completely before floating against host stroma. An air pump-assisted technique using continuous pressurized air infusion allows successful final graft positioning even with very young donor corneas. It thus makes surgery easier as several key steps are made easier to handle. It additionally helps in tamponading hemorrhage during peripheral iridectomy, increasing surgical space, preventing fluctuations in the anterior chamber depth, and promoting graft adherence.

  6. Six-year clinical follow-up after treatment of diffuse in-stent restenosis with cutting balloon angioplasty followed by intracoronary brachytherapy with liquid rhenium-188-filled balloon via transradial approach

    International Nuclear Information System (INIS)

    Hang Chiling; Wu Chiungjen; Hsieh Bortsung

    2010-01-01

    Long-term follow-up studies revealed a significant decline in the benefits of intracoronary radiation for in-stent restenosis. A total of 25 study and 25 contemporaneous control patients with diffuse in-stent restenosis who underwent cutting balloon angioplasty (CBA) transradially, followed by subsequent intracoronary irradiation with a liquid β-emitter Rhenium-188 ( 188 Re)-filled balloon were enrolled in the study. The mean clinical follow-up durations were 64.9±13.0 and 66.3±13.8 months for the irradiated and control patients, respectively. Six-month angiographic restenosis was observed in 16% (4 of 25) of the patients in the irradiated group and 48% (12 of 25) of the patients in the control groups (P=0.03). The 6-month major adverse cardiac events (MACE) rate was 12% and 44%, respectively (P=0.025). The 3-year follow-up angiography was performed in 16 of 21 (76%) irradiated patients and in 4 of 13 (31%) control patients who had no significant restenosis at the 6-month angiographic follow-up. Restenosis occurred in 1 of 16 (7%) irradiated patients and 2 of 4 (50%) control patients. Late target lesion revascularization was performed in 1 irradiated and 2 control patients. The MACE rate within 6 years was significantly reduced in the irradiated group (20% vs. 56%, P=0.019). Brachytherapy using 188 Re-filled balloon following CBA for diffuse in-stent restenotic native coronary arteries is effective in reducing target lesion restenosis and improving long-term outcomes. (author)

  7. Histopathological Evidence of Adventitial or Medial Injury Is a Strong Predictor of Restenosis During Directional Atherectomy for Peripheral Artery Disease.

    Science.gov (United States)

    Tarricone, Arthur; Ali, Ziad; Rajamanickam, Anitha; Gujja, Karthik; Kapur, Vishal; Purushothaman, K-Raman; Purushothaman, Meerarani; Vasquez, Miguel; Zalewski, Adrian; Parides, Micheal; Overbey, Jessica; Wiley, Jose; Krishnan, Prakash

    2015-10-01

    To investigate the impact on restenosis rates of deep injury to the adventitial layer during directional atherectomy. Between 2007 and 2010, 116 consecutive patients (mean age 69.6 years; 56 men) with symptomatic femoropopliteal stenoses were treated with directional atherectomy at a single center. All patients had claudication and TASC A/B lesions in the superficial femoral or popliteal arteries. Histopathology analysis of atherectomy specimens was performed to identify adventitial injury. Clinical follow-up included physical examination and duplex ultrasound scans at 3, 6, and 12 months in all patients. The primary endpoint was the duplex-documented 1-year rate of restenosis, which was determined by a peak systolic velocity ratio 0.05), lesion length (58.7±12.8 vs 56.2±13.6 mm, p=0.40), or vessel runoff (1.9±0.6 vs 2.0±0.6, p=0.37) between patients with and without adventitial injury, respectively. The overall 1-year incidence of restenosis was 57%, but the rate was significantly higher (patherectomy for femoropopliteal stenosis is strongly related to patency at 1 year. © The Author(s) 2015.

  8. Randomized comparison of the clinical outcome of single versus multiple arterial grafts: the ROMA trial-rationale and study protocol.

    Science.gov (United States)

    Gaudino, Mario; Alexander, John H; Bakaeen, Faisal G; Ballman, Karla; Barili, Fabio; Calafiore, Antonio Maria; Davierwala, Piroze; Goldman, Steven; Kappetein, Peter; Lorusso, Roberto; Mylotte, Darren; Pagano, Domenico; Ruel, Marc; Schwann, Thomas; Suma, Hisayoshi; Taggart, David P; Tranbaugh, Robert F; Fremes, Stephen

    2017-12-01

    The primary hypothesis of the ROMA trial is that in patients undergoing primary isolated non-emergent coronary artery bypass grafting, the use of 2 or more arterial grafts compared with a single arterial graft (SAG) is associated with a reduction in the composite outcome of death from any cause, any stroke, post-discharge myocardial infarction and/or repeat revascularization. The secondary hypothesis is that in these patients, the use of 2 or more arterial grafts compared with a SAG is associated with improved survival. The ROMA trial is a prospective, unblinded, randomized event-driven multicentre trial comprising at least 4300 subjects. Patients younger than 70 years with left main and/or multivessel disease will be randomized to a SAG or multiple arterial grafts to the left coronary system in a 1:1 fashion. Permuted block randomization stratified by the centre and the type of second arterial graft will be used. The primary outcome will be a composite of death from any cause, any stroke, post-discharge myocardial infarction and/or repeat revascularization. The secondary outcome will be all-cause mortality. The primary safety outcome will be a composite of death from any cause, any stroke and any myocardial infarction. In all patients, 1 internal thoracic artery will be anastomosed to the left anterior descending coronary artery. For patients randomized to the SAG group, saphenous vein grafts will be used for all non-left anterior descending target vessels. For patients randomized to the multiple arterial graft group, the main target vessel of the lateral wall will be grafted with either a radial artery or a second internal thoracic artery. Additional grafts for the multiple arterial graft group can be saphenous veins or supplemental arterial conduits. To detect a 20% relative reduction in the primary outcome, with 90% power at 5% alpha and assuming a time-to-event analysis, the sample size must include 845 events (and 3650 patients). To detect a 20% relative

  9. Preliminary application of 320-detector spiral CT with ECG editing for assessing coronary artery in-stent restenosis

    International Nuclear Information System (INIS)

    Li Zhiming; Tan Lilian; Li Shuxin; Fu Xi; He Weihong; Liu Ke; Huang Yong; Yu Lin

    2011-01-01

    Objective: To determine the value of 320-detector spiral CT with retrospective ECG gating and editing software for detecting coronary artery in-stent restenosis. Methods: CT scans of 14 patients with coronary artery stnets were retrospectively analyzed. The examinations were performed using a 320-detector spiral CT scanner and retrospective ECG gating combined with ECG editing software. The image quality of reconstructed coronary artery in-stents was compared before and after the editing of synchronously recorded ECG. The paired-sample t test was used for statistical analysis. Results: Before ECG editing, arrhythmia and in-stent artifact resulted in image blurring, missing arterial segments, significant stepladder artifacts or non-visualization of the interior of stents. Of 14 cases before ECG editing, in-stent restenosis was detected in 10 and patency in 3. The coronary artery stent and distal bifurcation were delineated in one patient. After ECG editing, the image quality of coronary artery stents was improved with detection of in-stent restenosis (4 cases) including the one case that not evaluable before ECG editing. The average image quality score before ECG editing (2.14±0.86) was significantly (P<0.001) lower than that after ECG editing (3.07±0.73). Conclusion: Retrospective ECG gating combined with ECG editing of 320-detector spiral CT can reduce the artifacts produced by arrhythmia or in-stent swings and improve the imaging quality of coronary artery stents. (authors)

  10. Experimental study of the preventive effect of 1'03Pd stent on in-stent restenosis in rabbit iliac artery

    International Nuclear Information System (INIS)

    Luo Quanyong; Chen Libo; Yuan Zhibin; Lu Hankui; Zhu Ruisen

    2003-01-01

    Objective: To investigate the ability of γ-emitting 103 Pd radioactive stent implantation for preventing in-stent restenosis in iliac artery of rabbits. Methods: Twenty New Zealand white rabbits were divided into six groups on the basis of radioactivity loading [2.22 (n=3), 5.55 (n=4), 9.25 (n=4), 14.8 (n=3), 22.2 (n=3), 33.3 MBq (n=3)]. 103 Pd stent was implanted in one of the two iliac arteries of each rabbit and nonradioactive stent in the contralateral artery. The rabbits were fed with high fat diet. Treatment efficiency was assessed by angiography and quantitative histomorphometry of the stented iliac segments 28 d after the implantation. Results: Quantitative histomorphometry analysis indicated that 103 Pd stents induced a significant reduction in neointimal area and the percentage of stenosis within radioactive stents was lower compared with that in the control stents. Nevertheless, the suppression of neointima formation by 103 Pd stent implantation was not in a dose-dependent manner. Conclusions: Low-dose intravascular brachytherapy via a γ-particle-emitting 103 Pd radioactive stent potently inhibits neointimal hyperplasia and prevents the in-stent restenosis in rabbit iliac artery. 103 Pd stent implantation probably can be employed as a novel means to prevent in-stent restenosis

  11. New parameter of the right gastroepiploic arterial graft using the power spectral analysis device named MemCalc soft.

    Science.gov (United States)

    Uehara, Mayuko; Takagi, Nobuyuki; Muraki, Satoshi; Yanase, Yosuke; Tabuchi, Masaki; Tachibana, Kazutoshi; Miyaki, Yasuko; Ito, Toshiro; Higami, Tetsuya

    2015-12-01

    Transit-time flow measurement (TTFM) parameters such as mean graft flow (MGF, ml/min), pulsatility index (PI) and diastolic filling (DF, %) have been extensively researched for internal mammary arterial or saphenous vein grafts. In our experience of using the right gastroepiploic arterial (GEA) graft for right coronary artery (RCA) grafting, we observed unique GEA graft flow waveforms. We analysed the GEA graft flow waveforms for their effectiveness in determining GEA graft patency by power spectral analysis. Forty-five patients underwent off-pump coronary artery bypass using the GEA graft for RCA grafting individually. The means of intraoperative MGF, PI and DF were compared between patent and non-patent grafts, postoperatively. Furthermore, the GEA flow data were output and analysed using power spectral analysis. Forty grafts were 'patent' and five were 'non-patent'. There were no significant differences in the mean TTFM parameters between the patent and non-patent grafts (MGF: 22 vs 8 ml/min, respectively, P = 0.068; PI: 3.5 vs 6.5, respectively, P = 0.155; DF: 63 vs 53%, respectively, P = 0.237). Results of the power spectral analysis presented clear differences; the power spectral density (PSD) of patent grafts presented high peaks at frequency levels of 1, 2 and 3 Hz, and the non-patent graft PSD presented high peaks that were not limited to these frequencies. The PSD had a sensitivity and specificity of 80 and 87.5%, respectively. Power spectral analysis of the GEA graft flow is useful to distinguish between non-patent and patent grafts intraoperatively. This should be used as a fourth parameter along with MGF, PI and DF. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  12. Varicose Veins - Multiple Languages

    Science.gov (United States)

    ... Concerns and Discomforts of Pregnancy: Varicose Veins - English MP3 Concerns and Discomforts of Pregnancy: Varicose Veins - 简体中文 (Chinese, Simplified (Mandarin dialect)) MP3 Concerns and Discomforts of Pregnancy: Varicose Veins - English ...

  13. Neoatherosclerosis causing occlusive in-stent restenosis: Impact of intracoronary imaging in the intensity of lipid-lowering therapy

    Energy Technology Data Exchange (ETDEWEB)

    Martí, David, E-mail: docalcala@hotmail.com [Department of Cardiology, Hospital Central de la Defensa, Madrid (Spain); López, Edurne; Álvarez, Salvador; Palazuelos, Jorge; Rada, Ignacio [Department of Cardiology, Hospital Central de la Defensa, Madrid (Spain); Alfonso, Fernando [Department of Cardiology, Hospital Universitario de La Princesa, Madrid (Spain)

    2016-12-15

    The unique physical properties of optical coherence tomography (OCT) make it a useful technique in the study of restenosis mechanisms. In fact, OCT is able to differentiate between neointimal proliferation and neoatherosclerosis within the stent. We report a rare case of occlusive neoatherosclerosis presenting beyond one year after a successful drug-eluting stent implantation. The impact of OCT findings in the clinical decision making process is emphasized. - Highlights: • Optical coherence tomography (OCT) has the unique ability to detect lipid accumulation within the stent margins (i.e. neoatherosclerosis). • Lipid-rich tissues produce light absorption and therefore they typically attenuate backward signals. • Occlusive neoatherosclerosis may appear even in optimally implanted drug eluting stents. • OCT identification of restenosis mechanisms may have implications not only in the interventional strategy, but also in the long-term medical treatment.

  14. Neoatherosclerosis causing occlusive in-stent restenosis: Impact of intracoronary imaging in the intensity of lipid-lowering therapy

    International Nuclear Information System (INIS)

    Martí, David; López, Edurne; Álvarez, Salvador; Palazuelos, Jorge; Rada, Ignacio; Alfonso, Fernando

    2016-01-01

    The unique physical properties of optical coherence tomography (OCT) make it a useful technique in the study of restenosis mechanisms. In fact, OCT is able to differentiate between neointimal proliferation and neoatherosclerosis within the stent. We report a rare case of occlusive neoatherosclerosis presenting beyond one year after a successful drug-eluting stent implantation. The impact of OCT findings in the clinical decision making process is emphasized. - Highlights: • Optical coherence tomography (OCT) has the unique ability to detect lipid accumulation within the stent margins (i.e. neoatherosclerosis). • Lipid-rich tissues produce light absorption and therefore they typically attenuate backward signals. • Occlusive neoatherosclerosis may appear even in optimally implanted drug eluting stents. • OCT identification of restenosis mechanisms may have implications not only in the interventional strategy, but also in the long-term medical treatment.

  15. Custom-made raster method for fistula and graft.

    Science.gov (United States)

    Blokker, C

    2005-01-01

    Unfamiliarity with fistula and graft characteristics can lead to failed punctures, haematomas and sometimes access occlusion. The Custom-made Raster Method provides detailed shunt visualisation and angiographic images by using photo-editing software. Access veins of an individual shunt and an adapted raster are projected on a digital picture of the arm. During angiography the shunt arm is fixated and a digital picture is taken from a fixed vertical angle and distance. Reference points are marked on the shunt arm, which serves as a fixation to draw a raster with coordination points. In this way a picture is created similar to a roadmap with veins. There is complete integration of digital and radiological images by using software programmes Adobe Photoshop + Illustrator or Agfa Web 1000 under Windows XP. All illustrations fit 1:1 by scaling up or down without distortion. Editing with Photoshop gives a precise projection of shunt veins on the real coloured background of the digital photograph. In this projection the grey angiography background is made completely transparent. The system can contain more detailed information in combination with echo (duplex) images of depth and diameter. This visualisation method is a useful tool for multi disciplinary access meetings with intervention radiologists, access surgeons and nephrologists. Access malfunction, aneurysms and stenosis can be projected at the exact location. The system leads to clear and concrete puncture advice. Transfer of access information and communication to other dialysis centres is facilitated.

  16. Valsalva and gravitational variability of the internal jugular vein and common femoral vein: Ultrasound assessment

    Energy Technology Data Exchange (ETDEWEB)

    Beddy, P. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland)]. E-mail: pbeddy@eircom.net; Geoghegan, T. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Ramesh, N. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Buckley, O. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); O' Brien, J. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Colville, J. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Torreggiani, W.C. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland)

    2006-05-15

    Purpose: Central venous cannulation via the common femoral vein is an important starting point for many interventions. The purpose of this study was to determine the optimum conditions for cannulation of the femoral vein and to compare these with the relative changes in the internal jugular vein. Methods: High-resolution 2D ultrasound was utilised to determine variability of the calibre of the femoral and internal jugular veins in 10 healthy subjects. Venous diameter was assessed during the Valsalva manoeuvre and in different degrees of the Trendelenburg position. Results: The Valsalva manoeuvre significantly increased the size of the femoral and internal jugular veins. There was a relatively greater increase in femoral vein diameter when compared with the internal jugular vein of 40 and 29%, respectively. Changes in body inclination (Trendelenburg position) did not significantly alter the luminal diameter of the femoral vein. However, it significantly increased internal jugular vein diameter. Conclusions: Femoral vein cannulation is augmented by the Valsalva manoeuvre but not significantly altered by the gravitational position of the subject.

  17. Potential etiopathogenesis of seventh day syndrome following living donor liver transplantation: ischemia of the graft?

    Science.gov (United States)

    Lan, Xiang; Li, Bo; Wang, Xiao-Fei; Wei, Yong-Gang; Yan, Lu-Nan; Zhao, Ji-Chun

    2010-02-01

    Seventh-day syndrome (7DS) is an early serious complication following liver transplantation with a high mortality because of its unknown etiopathogenesis. This study aimed to analyze the potential etiopathogenesis of 7DS. A retrospective analysis of 98 consecutive living donor liver transplants performed from 2001 to 2007 at our center revealed that 5 patients had suffered from 7DS; their age, MELD score, portal vein inflow and other parameters were compared with those of the other recipients. The 5 patients showed common features: (a) initial uneventful recovery, and a dramatic rise of serum liver enzyme levels 1 to 2 weeks later; (b) decreased inflow in the portal vein accompanied by augmentation of serum creatinine and urea nitrogen level; and (c) serial liver biopsy findings of apoptosis and ischemic necrosis of hepatocytes. Four of the 5 patients died. Age, waiting time to transplantation, MELD score, operation time, cold ischemic time, portal interceptive time and diameter of the portal vein were not significantly different between the 2 groups, but a difference was found in the flow rate of the portal vein (t=3.234, P<0.001). The 5 patients suffered from a decreased portal vein inflow, ischemic liver necrosis, and renal failure. Hence, hypoperfusion of the liver graft was considered to be the etiopathogenesis of 7DS, for which, however sufficient evidence is lacking. More studies of 7DS are needed.

  18. Optimal temporal windows and dose-reducing strategy for coronary artery bypass graft imaging with 256-slice CT

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Kun-Mu [Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Shih Lin District, Taipei 111, Taiwan. (China); Lee, Yi-Wei [Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan (China); Guan, Yu-Xiang [Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan (China); Chen, Liang-Kuang [Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Shih Lin District, Taipei 111, Taiwan. (China); School of Medicine, Fu Jen Catholic University, Taipei, Taiwan (China); Law, Wei-Yip, E-mail: m002325@ms.skh.org.tw [Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Shih Lin District, Taipei 111, Taiwan. (China); Su, Chen-Tau, E-mail: m005531@ms.skh.org.tw [Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Shih Lin District, Taipei 111, Taiwan. (China); School of Medicine, Fu Jen Catholic University, Taipei, Taiwan (China)

    2013-12-11

    Objective: To determine the optimal image reconstruction windows in the assessment of coronary artery bypass grafts (CABGs) with 256-slice computed tomography (CT), and to assess their associated optimal pulsing windows for electrocardiogram-triggered tube current modulation (ETCM). Methods: We recruited 18 patients (three female; mean age 68.9 years) having mean heart rate (HR) of 66.3 beats per minute (bpm) and a heart rate variability of 1.3 bpm for this study. A total of 36 CABGs with 168 segments were evaluated, including 12 internal mammary artery (33.3%) and 24 saphenous vein grafts (66.7%). We reconstructed 20 data sets in 5%-step through 0–95% of the R–R interval. The image quality of CABGs was assessed by a 5-point scale (1=excellent to 5=non-diagnostic) for each segment (proximal anastomosis, proximal, middle, distal course of graft body, and distal anastomosis). Two reviewers discriminated optimal reconstruction intervals for each CABG segment in each temporal window. Optimal windows for ETCM were also evaluated. Results: The determined optimal systolic and diastolic reconstruction intervals could be divided into 2 groups with threshold HR=68. The determined best reconstruction intervals for low heart rate (HR<68) and high heart rate (HR>68) were 76.0±2.5% and 45.0±0% respectively. Average image quality scores were 1.7±0.6 with good inter-observer agreement (Kappa=0.79). Image quality was significantly better for saphenous vein grafts versus arterial grafts (P<0.001). The recommended windows of ETCM for low HR, high HR and all HR groups were 40–50%, 71–81% and 40–96% of R-R interval, respectively. The corresponding dose savings were about 60.8%, 58.7% and 22.7% in that order. Conclusions: We determined optimal reconstruction intervals and ETCM windows representing a good compromise between radiation and image quality for following bypass surgery using a 256-slice CT.

  19. Experimental study of 103Pd stents for preventing the restenosis of biliary duct

    International Nuclear Information System (INIS)

    Gao Qinyi; Shu Qiang; Lu Xiangdong; Li Yaming; He Guijin; Pei Zhuguo; Xu Shuhe

    2004-01-01

    Objective: To explore the feasibility of preventing biliary duct restenosis with the stent treated with 103 Pd and to elucidate the mechanisms of the inhibition of the smooth muscle cell proliferation and the increase of apoptosis. Methods: The experimental dogs were randomly divided into common-stent group and 103 Pd stent group, each of 6 animals. Pathohistology, cell apoptosis, immunohistochemistry for proliferating cell nuclear antigen (PCNA), the expression of gene p53 by in situs hybridization, the test of the peripheral blood and measurement of radiation of tissue around the stent were studied. Results: The utmost intimal thickness of biliary duct in the 103 Pd stent group was found to be obviously less compared to that in common-stent group after 30 d, the percentages of the stenosis of the biliary duct were (54.73 ± 21.64)% and (17.61 ± 14.52)%, respectively, there was a significant difference between two groups (P 103 Pd stent group, and decreased in the common-stent group; the expression of PCNA of biliary smooth muscle cells of 103 Pd group was weaker compared with that in the common-group. Conclusion: 103 Pd stent may inhibit the proliferation of smooth muscle cells and prevent the restenosis of biliary duct. (authors)

  20. CT findings of portal vein aneurysm

    International Nuclear Information System (INIS)

    Yang, Dal Mo; Chang, Mi Son; Yoon, Myung Hwan; Kim, Hak Soo; Kim, Hyung Sik; Chung, Hyo Sun; Chung, Jin Woo

    1999-01-01

    To describe the CT findings of portal vein aneurysm in eight patients. All patients included in this study (two men and six women) underwent CT examinations between October 1996 and June1998. Of these eight, three were suffering from hepatic disease and portal hypertension. We determined the location, shape, size, and characteristics of the lesions, and the presence or absence of portal vein anomaly. Seven patients had intrahepatic portal vein aneurysm (at the umbilical portion of the left portal vein in five patients, between the transverse and umbilical portion of the left portal vein in one, and at the bifurcation of the anterior and posterior branch of the right portal vein in one), while extrahepatic portal vein aneurysm, at the confluence of the superior mesenteric and splenic vein was found in only one. Lesions were cyst-shaped in seven cases and saccular in one, and showed well-circumscribed, markedly enhanced mass, which communicated with the portal vein and/or gives off major branches. Portal vein anomaly, in which the right anterior segmental portal vein originated from the umbilical portion of the left portal vein, was seen in three patients. In all three, intrahepatic portal vein aneurysm was present at the umbilical portion of the left portal vein, and in one, the umbilical protion of the left portal vein was located to the right of the Cantlic line. CT examination can help reveal portal vein aneurysm by detecting a well-circumscribed, markedly enhanced mass which communicates with the portal vein and/or gives off major branches

  1. Experimental study of the mechanism in esophageal restenosis after balloon dilation of benign stricture

    International Nuclear Information System (INIS)

    Cheng Yingsheng; Yang Renjie; Shang Kezhong; Zhang Huizhen; Li Minghua; Zhuang Qixin; Jiang Zhiming; Ding Zaixian

    2002-01-01

    Objective: Experimental study of the mechanism in esophageal restenosis after balloon dilation of benign stricture. Methods: Esophageal stenosis model of the rats was created by 5 ml of 50% NaOH solution burn with double balloon method, and esophageal restenosis (RS) model was developed by esophageal stenosis with dilation of PTCA balloon catheter. Quantitative and quantitative analysis of esophageal stenosis and RS formation in the rats were observed and recorded by analytic measurements imaging and immuno-histologic chemistry respectively. Results: Esophageal benign stricture and RS model of 49 rats were developed. Cross section area and perimeter of esophageal mucosa layer, muscular layer and the whole layer had increased in experimental group. Comparing to control group, it had remarkable significance in statistics (P < 0.05). PCNA was expressed in 5th day after dilation, and persisted to 1st month. FN was expressed in the 1st day after dilation, still positive on 21st days, partly strong on 30th day. Conclusions: The continued over secretion at all stage of PCNA and FN plays an important role in the RS after balloon dilation of esophageal benign stenosis

  2. Quantitative evaluation of endothelial cell attachment to vascular graft materials using In-111 Oxine label

    Energy Technology Data Exchange (ETDEWEB)

    Park, H.M.; Kesler, K.A.; Stinson, J.; Mock, B.; Arnold, M.

    1985-05-01

    Human umbilical vein endothelial cells were harvested, cultured and labeled with In-111 oxine using a modification of the technique described by Sharefkin et al. Average cell labeling efficiency was 42%. Two graft materials, polytetrafluoroethylene (Gortex) and polyester elastomer (Hytrel), with and without pretreatment with human fibronectin (FN) were incubated with the labeled cells. Quantitation of In-111 activity was done 3 times: at inoculation, after incubation (attachment) and after 1 hr of in vitro perfusion (retention). The average attachment ranged from 53% to 99.5%. The In-111 activity attached ranged from 10 to 20 ..mu..Ci per graft. A gamma camera with medium energy collimator and two pulse height analyzers for 173 and 247 keV photons with 20% window and an on-line computer was used. Images were obtained in 1.5 zoom mode. The count rate response to a In-111 point source up to 150 ..mu..Ci was linear. The results indicate Hytrel permits better endothelial cell attachment than Gortex and FN coating enhances the strength of attachment to both graft materials. The authors conclude that In-111 Oxine labeling is a reliable method for quantitatively evaluating endothelial cell attachment to vascular graft materials.

  3. Effect of force-induced mechanical stress at the coronary artery bifurcation stenting: Relation to in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Cheng-Hung [Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (China); Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan (China); Jhong, Guan-Heng [Graduate Institute of Medical Mechatronics, Chang Gung University, Tao-Yuan, Taiwan (China); Hsu, Ming-Yi; Wang, Chao-Jan [Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan (China); Liu, Shih-Jung, E-mail: shihjung@mail.cgu.edu.tw [Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan (China); Hung, Kuo-Chun [Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (China)

    2014-05-28

    The deployment of metallic stents during percutaneous coronary intervention has become common in the treatment of coronary bifurcation lesions. However, restenosis occurs mostly at the bifurcation area even in present era of drug-eluting stents. To achieve adequate deployment, physicians may unintentionally apply force to the strut of the stents through balloon, guiding catheters, or other devices. This force may deform the struts and impose excessive mechanical stresses on the arterial vessels, resulting in detrimental outcomes. This study investigated the relationship between the distribution of stress in a stent and bifurcation angle using finite element analysis. The unintentionally applied force following stent implantation was measured using a force sensor that was made in the laboratory. Geometrical information on the coronary arteries of 11 subjects was extracted from contrast-enhanced computed tomography scan data. The numerical results reveal that the application of force by physicians generated significantly higher mechanical stresses in the arterial bifurcation than in the proximal and distal parts of the stent (post hoc P < 0.01). The maximal stress on the vessels was significantly higher at bifurcation angle <70° than at angle ≧70° (P < 0.05). The maximal stress on the vessels was negatively correlated with bifurcation angle (P < 0.01). Stresses at the bifurcation ostium may cause arterial wall injury and restenosis, especially at small bifurcation angles. These finding highlight the effect of force-induced mechanical stress at coronary artery bifurcation stenting, and potential mechanisms of in-stent restenosis, along with their relationship with bifurcation angle.

  4. Effect of force-induced mechanical stress at the coronary artery bifurcation stenting: Relation to in-stent restenosis

    International Nuclear Information System (INIS)

    Lee, Cheng-Hung; Jhong, Guan-Heng; Hsu, Ming-Yi; Wang, Chao-Jan; Liu, Shih-Jung; Hung, Kuo-Chun

    2014-01-01

    The deployment of metallic stents during percutaneous coronary intervention has become common in the treatment of coronary bifurcation lesions. However, restenosis occurs mostly at the bifurcation area even in present era of drug-eluting stents. To achieve adequate deployment, physicians may unintentionally apply force to the strut of the stents through balloon, guiding catheters, or other devices. This force may deform the struts and impose excessive mechanical stresses on the arterial vessels, resulting in detrimental outcomes. This study investigated the relationship between the distribution of stress in a stent and bifurcation angle using finite element analysis. The unintentionally applied force following stent implantation was measured using a force sensor that was made in the laboratory. Geometrical information on the coronary arteries of 11 subjects was extracted from contrast-enhanced computed tomography scan data. The numerical results reveal that the application of force by physicians generated significantly higher mechanical stresses in the arterial bifurcation than in the proximal and distal parts of the stent (post hoc P < 0.01). The maximal stress on the vessels was significantly higher at bifurcation angle <70° than at angle ≧70° (P < 0.05). The maximal stress on the vessels was negatively correlated with bifurcation angle (P < 0.01). Stresses at the bifurcation ostium may cause arterial wall injury and restenosis, especially at small bifurcation angles. These finding highlight the effect of force-induced mechanical stress at coronary artery bifurcation stenting, and potential mechanisms of in-stent restenosis, along with their relationship with bifurcation angle.

  5. Long-Term Type 1 Diabetes Enhances In-Stent Restenosis after Aortic Stenting in Diabetes-Prone BB Rats

    NARCIS (Netherlands)

    Onuta, Geanina; Groenewegen, Hendrik C.; Klatter, Flip A.; Boer, Mark Walther; Goris, Maaike; van Goor, Harry; Roks, Anton J. M.; Rozing, Jan; de Smet, Bart J. G. L.; Hillebrands, Jan-Luuk

    2011-01-01

    Type 1 diabetic patients have increased risk of developing in-stent restenosis following endovascular stenting. Underlying pathogenetic mechanisms are not fully understood partly due to the lack of a relevant animal model to study the effect(s) of long-term autoimmune diabetes on development of

  6. Long-term type 1 diabetes enhances in-stent restenosis after aortic stenting in diabetes-prone BB rats

    NARCIS (Netherlands)

    J.-L. Hillebrands (Jan-Luuk); G. Onuta (Geanina); H.C. Groenewegen (Hendrik); F.A. Klatter (Flip); M. Walther Boer (Mark); M. Goris (Maaike); H. van Goor (Harry); A.J.M. Roks (Anton); J. Rozing (Jan); B.J.G.L. de Smet (Bart)

    2011-01-01

    textabstractType 1 diabetic patients have increased risk of developing in-stent restenosis following endovascular stenting. Underlying pathogenetic mechanisms are not fully understood partly due to the lack of a relevant animal model to study the effect(s) of long-term autoimmune diabetes on

  7. Are TIPS Stent-Grafts a Contraindication for Future Liver Transplantation?

    International Nuclear Information System (INIS)

    Maleux, Geert; Pirenne, Jacques; Vaninbroukx, Johan; Aerts, Raymond; Nevens, Frederik

    2004-01-01

    Our purpose was to assess the feasibility of orthotopic liver transplantation (OLT) in patients priorly having undergone transjugular intrahepatic portosystemic shunt (TIPS) with an expanded tetrafluoroethylene (e-PTFE)-covered endoprosthesis. In 48 patients an e- PTFE-covered endoprosthesis was inserted to treat severe complications of portal hypertension. In 36 patients the endoprosthesis was inserted during TIPS creation (de novo TIPS); in the other 12 patients the endoprosthesis was placed to repermeabilize the previously created, but occluded bare stent (revision TIPS). Eight of them (5 de novo and 3 revision cases) later underwent an OLT. The hospital records of these patients were reviewed from initial admission, through TIPS, the pre-OLT period, and OLT to current postoperative status. Five de novo and 3 revision cases underwent OLT 4-279 days (mean delay: 80.8 days) after TIPS procedure. All OLT's were performed under veno-venous bypass surgery. De visu surgical inspection confirmed correct positioning of the fully patent stent graft, starting in the portal vein and ending at the junction of the hepatic vein to the inferior caval vein. No surgical difficulty was observed during proximal or distal clamping or during resection of the diseased liver. Correctly positioned e-PTFE-covered nitinol endoprostheses do not interfere with a later OLT and may not be considered as a contraindication in patients who need a TIPS as a bridge to OLT

  8. Anterior versus posterior approach in reconstruction of infected nonunion of the tibia using the vascularized fibular graft: potentialities and limitations.

    Science.gov (United States)

    Amr, Sherif M; El-Mofty, Aly O; Amin, Sherif N

    2002-01-01

    The potentialities, limitations, and technical pitfalls of the vascularized fibular grafting in infected nonunions of the tibia are outlined on the basis of 14 patients approached anteriorly or posteriorly. An infected nonunion of the tibia together with a large exposed area over the shin of the tibia is better approached anteriorly. The anastomosis is placed in an end-to-end or end-to-side fashion onto the anterior tibial vessels. To locate the site of the nonunion, the tibialis anterior muscle should be retracted laterally and the proximal and distal ends of the site of the nonunion debrided up to healthy bleeding bone. All the scarred skin over the anterior tibia should be excised, because it becomes devitalized as a result of the exposure. To cover the exposed area, the fibula has to be harvested with a large skin paddle, incorporating the first septocutaneous branch originating from the peroneal vessels before they gain the upper end of the flexor hallucis longus muscle. A disadvantage of harvesting the free fibula together with a skin paddle is that its pedicle is short. The skin paddle lies at the antimesenteric border of the graft, the site of incising and stripping the periosteum. In addition, it has to be sutured to the skin at the recipient site, so the soft tissues (together with the peroneal vessels), cannot be stripped off the graft to prolong its pedicle. Vein grafts should be resorted to, if the pedicle does not reach a healthy segment of the anterior tibial vessels. Defects with limited exposed areas of skin, especially in questionable patency of the vessels of the leg, require primarily a fibula with a long pedicle that could easily reach the popliteal vessels and are thus better approached posteriorly. In this approach, the site of the nonunion is exposed medial to the flexor digitorum muscle and the proximal and distal ends of the site of the nonunion debrided up to healthy bleeding bone. No attempt should be made to strip the scarred skin off

  9. Intravascular brachytherapy in prevention of the secondary restenosis angioplasty transluminal coronaries

    International Nuclear Information System (INIS)

    Mejia, S.

    2001-01-01

    The radiotherapy coronary intravascular has demonstrated in a convincing way in clinical and experimental studies that produces a favorable decrease of the restenosis process. There is enough evidence to define this technique as the main current therapeutic option in the handling of the reestenosis intra stent. Accumulated experience exists of up to 3 years in patient's treaties with radiation gamma and multiple studies in several centers that demonstrate similar benefits with issuing beta. The present articulates it revises a series of radiotherapy systems and makes a setting a day on the employment of the brachytherapy intravascular in cardiologic patient

  10. Autologous alternative veins may not provide better outcomes than prosthetic conduits for below-knee bypass when great saphenous vein is unavailable.

    Science.gov (United States)

    Avgerinos, Efthymios D; Sachdev, Ulka; Naddaf, Abdallah; Doucet, Dannielle R; Mohapatra, Abhisekh; Leers, Steven A; Chaer, Rabih A; Makaroun, Michel S

    2015-08-01

    There is a need to better define the role of alternative autologous vein (AAV) segments over contemporary prosthetic conduits in patients with critical limb ischemia when great saphenous vein (GSV) is not available for use as the bypass conduit. Consecutive patients who underwent bypass to infrageniculate targets between 2007 and 2011 were categorized in three groups: GSV, AAV, and prosthetic. The primary outcome was graft patency. The secondary outcome was limb salvage. Cox proportional hazards regression was used to adjust for baseline confounding variables. A total of 407 infrainguinal bypasses to below-knee targets were analyzed; 255 patients (63%) received a single-segment GSV, 106 patients (26%) received an AAV, and 46 patients (11%) received a prosthetic conduit. Baseline characteristics were similar among groups, with the exception of popliteal targets and anticoagulation use being more frequent in the prosthetic group. Primary patency at 2 and 5 years was estimated at 47% and 32%, respectively, for the GSV group; 24% and 23% for the AAV group; and 43% and 38% for the prosthetic group. Primary assisted patency at 2 and 5 years was estimated at 71% and 55%, respectively, for the GSV group; 53% and 51% for the AAV group; and 45% and 40% for the prosthetic group. Secondary patency at 2 and 5 years was estimated at 75% and 60%, respectively, for the GSV group; 57% and 55% for the AAV group; and 46% and 41% for the prosthetic group. In Cox analysis, primary patency (hazard ratio [HR], 0.55; P < .001; 95% confidence interval [CI], 0.404-0.758), primary assisted patency (HR, 0.57; P = .004; 95% CI, 0.388-0.831), and secondary patency (HR, 0.56; P = .005; 95% CI, 0.372-0.840) were predicted by GSV compared with AAV, but there was no difference between AAV and prosthetic grafts except for the primary patency, for which prosthetic was protective (HR, 0.38; P < .001; 95% CI, 0.224-0.629). Limb salvage was similar among groups. AAV conduits may not offer a significant

  11. Graft-Sparing Strategy for Thoracic Prosthetic Graft Infection.

    Science.gov (United States)

    Uchino, Gaku; Yoshida, Takeshi; Kakii, Bunpachi; Furui, Masato

    2018-04-01

     Thoracic prosthetic graft infection is a rare but serious complication with no standard management. We reported our surgical experience on graft-sparing strategy for thoracic prosthetic graft infection.  This study included patients who underwent graft-sparing surgery for thoracic prosthetic graft infection at Matsubara Tokushukai Hospital in Japan from January 2000 to October 2017.  There were 17 patients included in the analyses, with a mean age at surgery of 71.0 ± 10.5 years; 11 were men. In-hospital mortality was observed in five patients (29.4%).  Graft-sparing surgery for thoracic prosthetic graft infection is an alternative option particularly for early graft infection after hemiarch replacement. Georg Thieme Verlag KG Stuttgart · New York.

  12. Vein matching using artificial neural network in vein authentication systems

    Science.gov (United States)

    Noori Hoshyar, Azadeh; Sulaiman, Riza

    2011-10-01

    Personal identification technology as security systems is developing rapidly. Traditional authentication modes like key; password; card are not safe enough because they could be stolen or easily forgotten. Biometric as developed technology has been applied to a wide range of systems. According to different researchers, vein biometric is a good candidate among other biometric traits such as fingerprint, hand geometry, voice, DNA and etc for authentication systems. Vein authentication systems can be designed by different methodologies. All the methodologies consist of matching stage which is too important for final verification of the system. Neural Network is an effective methodology for matching and recognizing individuals in authentication systems. Therefore, this paper explains and implements the Neural Network methodology for finger vein authentication system. Neural Network is trained in Matlab to match the vein features of authentication system. The Network simulation shows the quality of matching as 95% which is a good performance for authentication system matching.

  13. Possible impact of iridium-192 source centering on restenosis rate after femoro-popliteal angioplasty and endovascular brachytherapy in Vienna-2 study

    International Nuclear Information System (INIS)

    Pokrajac, Boris; Schmid, Rainer; Kirisits, Christian; Mock, Ulrike; Fellner, Claudia; Wambersie, Andre; Poetter, Richard; Minar, Erich

    2002-01-01

    Purpose: Endovascular brachytherapy (EVBT) has been proven to significantly reduce restenosis after percutaneous transluminal angioplasty (PTA). The object of this analysis was to assess the possible correlation between iridium-192 source non-centering and angiographic-determined restenosis. Materials and methods: A total of 113 patients with long-segment lesions of the superficial femoro-popliteal artery (SFA) were randomized to receive either PTA alone or PTA followed by EVBT in the Vienna-2 study. This analysis was performed on a subgroup of 34 out of 57 patients, who received PTA+EVBT. Angiographic restenosis was defined as lumen reduction of more than 50%. Angiograms taken immediately after PTA (34 patients) and at follow-up (25 patients) were analyzed. The distance between the vessel wall and the actual position of the source at the time of EVBT was measured (in mm) and correlated with the follow-up vessel lumen diameter. Measurements were performed at points at a distance of 10 mm from each other. The dose was determined at the luminal surface and at the reference depth of 2 mm into the vessel wall for different distances from the source. Results: Among the 622 measured points, 62 (10.0%) were within restenotic areas; 560 (90.0%) were in arterial segments without proven angiographic restenosis. As far as source centering is concerned, 7.9% of restenotic points were observed when the maximum distance to the arterial wall was 5 mm. Conclusions: The proportion of restenotic points significantly increased with source non-centering. This observation was interpreted as being related to a decrease in dose at the target. When the maximum distance between the source and the vessel surface was >5 mm, the dose at the reference depth (2 mm into the vessel wall) decreased to values lower than 5 Gy

  14. Cause of the Scion Death in Green Pepper Grafting System by a Tobamovirus

    Directory of Open Access Journals (Sweden)

    Gug-Seoun Choi

    2011-08-01

    Full Text Available This experiment was attempted to investigate a cause of the scion death in green pepper grafting system. A tobamovirus particle examined in the rootstock of the sample but not in the scion showing necrosis. The virus isolated from the rootstock was identified as Pepper mild mottle virus (PMMoV, pepper tobamovirus pathotype P1.2. (PMMoV-2, by nucleotide sequence analysis and host plant reaction. The virus isolate infected systematically in 6 commercial rootstock varieties using for green pepper grafting seedling production. Green pepper varieties ``Long green mart`` and ``Daechan`` represented resistance to the virus showing local lesions only on the inoculated leaves and ``Manitda`` was systematically infected. In the experiment with grafting ``Long green mart`` or ``Daechan`` onto the those rootstocks, the upper leaves of the scions first showed vein necrosis and wilt symptoms 7 days after inoculation with PMMoV-2 on the cotyledon of the rootstock, following to the scion stem necrosis and then only the scion death. The virus was detected in the rootstock but not in the scion. However, ``Manitda`` of susceptible variety in the grafting system showed mottle symptom on the leaves of the scion but not necrosis on the plant. PMMoV-3 isolate, pepper tobamovirus pathotype P1.2.3, did not cause the scion death in the grafting system. All of the varieties were susceptible to PMMoV-3. These results suggest that the scion death is caused by infecting with pepper tobamovirus pathotype P1.2. in the green pepper grafting system combined with the susceptible rootstock and the resistance scion to the virus pathotype.

  15. Safety and efficacy of limus-eluting stents and balloon angioplasty for sirolimus-eluting in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ota, Hideaki [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Mahmoudi, Michael [University of Surrey, Guildford Road, Surrey, GU2-7XH (United Kingdom); Kitabata, Hironori; Torguson, Rebecca; Chen, Fang; Satler, Lowell F.; Suddath, William O.; Pichard, Augusto D. [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Waksman, Ron, E-mail: ron.waksman@medstar.net [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States)

    2015-03-15

    Objectives: The aim of this study was to compare the safety and efficacy of everolimus-eluting stent (EES), sirolimus-eluting stent (SES), and plain old balloon angioplasty (POBA) for the treatment of SES in-stent restenosis (S-ISR). Background: The optimal treatment for drug-eluting in-stent restenosis remains controversial. Methods: The study cohort comprised 310 consecutive patients (444 lesions) who presented with S-ISR to our institution and underwent treatment with EES (43 patients), SES (102), or POBA (165). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac event (MACE) defined as the composite of death, MI, or TLR at 1-year. Results: The three groups were well matched for the conventional risk factors for coronary artery disease except for smoking. The 1-year analyzed clinical parameters were similar in the three groups: MACE (EES = 14%, SES = 18%, POBA = 20%; p = 0.65), death (EES = 2.3%, SES = 6.2%, POBA = 6.1%; p = 0.61), MI (EES = 4.8%, SES = 2.1%, POBA = 2.5%; p = 0.69), TLR (EES = 11.9%, SES = 12.1%, POBA = 24%; p = 0.78), and TVR (EES = 11.9%, SES = 24.8%, POBA = 22.2%; p = 0.23). There were no cases of definite ST. MACE-free rate was significantly lower in patients with recurrent in-stent restenosis (log-rank p = 0.006). Presentation with acute MI, number of treated lesions and a previous history of MI were found to be independent predictors of MACE. Conclusions: In patients presenting with S-ISR, treatment with implantation of an EES, SES, or POBA is associated with similar clinical outcomes. Patients presenting with recurrent ISR may have a poorer clinical outcome.

  16. Restenosis in coronary bare metal stents. Importance of time to follow-up: a comparison of coronary angiograms 6 months and 4 years after implantation

    DEFF Research Database (Denmark)

    Jørgensen, Erik; Helqvist, Steffen; Kløvgaard, Lene

    2008-01-01

    Objectives. Angiographic late lumen loss measured 6 to 9 month after bare metal stent implantation in the coronary arteries is a validated restenosis parameter. Design. We performed a second angiographic follow-up after 4 years in event free survivors from the DANSTENT trial cohort. Results......-sectional vessel area and a 39% reduction of the binary restenosis rate over time. Conclusions. Instent late lumen loss in bare metal stents decreases spontaneously over time. Maturation of early hyperplastic tissue reaction after stent implantation with subsequent thinning of fibrotic tissue might explain...

  17. Endovascular brachytherapy to prevent restenosis after angioplasty; Endovaskulaere Brachytherapie in der Restenoseprophylaxe nach Angioplastie und Stentimplantation: Eine Uebersicht

    Energy Technology Data Exchange (ETDEWEB)

    Wohlgemuth, W.A.; Bohndorf, K. [Klinikum Augsburg (Germany). Klinik fuer Diagnostische Radiologie und Neuroradiologie

    2003-02-01

    Endovascular radiotherapy is the first effective prophylaxis of restenosis after percutaneous transluminal angioplasty (PTA) and stenting. The FDA recently approved two devices for the delivery of intracoronary radiation following coronary artery stenting. Published multicenter, double-blind, randomized trials of intracoronary radiation therapy report good results for preventing in-stent restenosis, while the data for the peripheral circulation are still inconclusive. Beta-emitters are easier applicable and probably also safer, whereas gamma-emitters have been more extensively evaluated clinically so far. Primary indication for endovascular brachytherapy are patients at high risk for restenosis, such as previous restenoses, in-stent hyperplasia, long stented segment, long PTA lesion, narrow residual vascular lumen and diabetes. Data from coronary circulation suggest a safety margin of at least 4 to 10 mm at both ends of the angioplastic segment to avoid edge restenosis. To prevent late thrombosis of the treated coronary segment, antiplatelet therapy with clopidogrel and aspirin are recommended for at least 6 months after PTA and for 12 months after a newly implanted stent. An established medication regimen after radiotherapy of peripheral arteries is still lacking. (orig.) [German] Die endovaskulaere Radiotherapie stellt das erste erfolgreiche Therapiekonzept in der Restenoseprophylaxe nach PTA und Stentimplantation dar. Am 3.11.2000 hat die amerikanische Food and Drug Administration erstmalig zwei Brachytherapiegeraete zur Restenoseprophylaxe nach Koronararterien-Stenting zugelassen. Grosse multizentrische, kontrollierte Studien wurden fuer das koronare Stromgebiet mit positiven Ergebnissen publiziert, die Datenlage im peripheren Stromgebiet ist noch ungenuegend. Beta-Strahler bieten Vorteile in der Anwendung, moeglicherweise auch in der Sicherheit, Gamma-Strahler dagegen sind besser klinisch evaluiert. Die primaere Indikation zur endovaskulaeren Brachytherapie

  18. Absence of Middle Hepatic Vein Combined with Retro-Aortic Left Renal Vein: a Very Rare Case Report

    Directory of Open Access Journals (Sweden)

    Sezer Akçer

    2012-06-01

    Full Text Available The hepatic and renal veins drain into the inferior vena cava. The upper group of hepatic veins consists of three veins which extend to the posterior face of the liver to join the inferior cava. The left renal vein passes anterior to the aorta just below the origin of the superior mesenteric artery. We detected a variation in the hepatic and renal veins in a multislice CT angiogram of a nine-year-old male patient in the Radiology Department of Afyon Kocatepe University Medical School. The upper group hepatic veins normally drains into the inferior vena cava as three separate trunks, namely the right, left and middle. In our case, we found that only the right and left hepatic veins existed and the middle hepatic vein was absent. Furthermore, the left renal vein, which normally passes anterior to the abdominal aorta, was retro-aortic. Left renal vein variations are of great importance in planning retroperitoneal surgery and vascular interventions. Knowledge of a patient’s hepatic vein and renovascular anatomy and determining their variations and anomalies are of critical importance to abdominal operations, transplantations and preoperative evaluation of endovascular interventions.

  19. Long-term results after carotid artery stenting. Restenosis after carotid artery stenting using self-expandable stent

    International Nuclear Information System (INIS)

    Matsumoto, Yasushi; Furui, Eisuke; Tsuboi, Ken; Takahashi, Akira; Ezura, Masayuki

    2008-01-01

    Carotid artery stenting has emerged as an acceptable treatment alternative in patients with carotid artery stenosis. Although early clinical results of carotid artery stenting have shown promise, long, term clinical results remain less certain. We report the frequency, management, and clinical results of in-stent restenosis after carotid artery stenting using a self-expandable stent. Between August 1998 and September 2004, 80 carotid artery stenting procedures in 78 patients were performed. We evaluated 76 of the 80 procedures in 75 of the 78 patients treated during this period who had a minimum 6-month clinical and imaging (ultrasound and/or magnetic resonance angiography) follow-up. Recurrent stenosis (≥50%) after carotid artery stenting occurred in 3 (3.9%) patients. The recurrent stenosis occurred within one year after the procedure in all cases. The low rate of in-stent restenosis using self-expandable stent suggested that carotid artery stenting may be an effective alternative treatment for carotid artery stenosis, but more data of long-term follow-up are required. (author)

  20. Impact of top end anastomosis design on patency and flow stability in coronary artery bypass grafting.

    Science.gov (United States)

    Koyama, Sachi; Kitamura, Tadashi; Itatani, Keiichi; Yamamoto, Tadashi; Miyazaki, Shohei; Oka, Norihiko; Nakashima, Kouki; Horai, Tetsuya; Ono, Minoru; Miyaji, Kagami

    2016-05-01

    For coronary artery bypass grafting (CABG), free grafts such as a saphenous vein or radial artery are often used for grafts to the lateral and posterior walls. However, the relationship between top-end anastomosis design and long-term patency remains unknown. Because coronary artery blood flow is dominant during diastole, top-end anastomosis may work better if the graft is directed towards the apex, whereas the shortest graft pathway appears to be most efficient. Using computational fluid dynamic models, we evaluated the hemodynamic variables that were affected by the angle of the top-end anastomosis. We created three-dimensional geometries of the aortic root with coronary arteries that involved 75 % stenosis in the obtuse marginal and postero-lateral branches. Two bypass models under vasodilator administration were created: in a"Model A", the top-end anastomosis is parallel to the long axis of the ascending aorta and the graft passed over the conus directed towards the apex; in a "Model B", the top-end anastomosis is directed toward the shortest pathway, and form near the right angles to the long axis of the ascending aorta. Wall shear stress (WSS) and its fluctuation, an oscillatory shear index (OSI) were evaluated to predict fibrosis progression at the anastomosis site and graft flow. Graft flow was 197.3 ml/min and 207.3 ml/min in the "Model A" and "Model B", respectively. The minimal WSS value inside the graft with the "Model A" and "Model B" was 0.53 Pa and 4.09 Pa, respectively, and the OSI value was 0.46 and 0.04, respectively. The top-end anastomosis of a free graft should be directed vertically towards the aorta to achieve the shortest graft pathway to maintain a high graft flow rate and to avoid the risks of endothelial fibrosis and plaque progression over the long-term after CABG.

  1. Genetic variants in CCNB1 associated with differential gene transcription and risk of coronary in-stent restenosis

    NARCIS (Netherlands)

    Silvestre-Roig, Carlos; Fernández, Patricia; Mansego, María L.; van Tiel, Claudia M.; Viana, Rosa; Anselmi, Chiara Viviani; Condorelli, Gianluigi; de Winter, Robbert J.; Martín-Fuentes, Paula; Solanas-Barca, María; Civeira, Fernando; Focaccio, Amelia; de Vries, Carlie J. M.; Chaves, Felipe Javier; Andrés, Vicente

    2014-01-01

    The development of diagnostic tools to assess restenosis risk after stent deployment may enable the intervention to be tailored to the individual patient, for example, by targeting the use of drug-eluting stent to high-risk patients, with the goal of improving safety and reducing costs. The CCNB1

  2. Right atrium positioning for exposure of right pulmonary veins during off-pump atrial fibrillation ablation.

    Science.gov (United States)

    Suwalski, Grzegorz; Emery, Robert; Mróz, Jakub; Kaczejko, Kamil; Gryszko, Leszek; Cwetsch, Andrzej; Skrobowski, Andrzej

    2017-06-01

    Concomitant surgical ablation of atrial fibrillation (AF) is recommended for patients undergoing off-pump coronary revascularization in the presence of this arrhythmia. Achievement of optimal visualization of pulmonary veins while maintaining stable haemodynamic conditions is crucial for proper completion of the ablation procedure. This study evaluates the safety and feasibility of right atrial positioning using a suction-based cardiac positioner as opposed to compressive manoeuvres for exposure during off-pump surgical ablation for AF. Thirty-four consecutive patients underwent pulmonary vein isolation, ganglionated plexi ablation and left atrial appendage occlusion during off-pump coronary artery bypass grafting. Right atrial suction positioning was used to visualize right pulmonary veins. Safety and feasibility end points were analysed intraoperatively and in the early postoperative course. In all patients, right atrial positioning created optimal conditions to complete transverse and oblique sinus blunt dissection, correct placement of a bipolar ablation probe, detection and ablation of ganglionated plexi and conduction block assessment. In all patients, this entire right-sided ablation procedure was completed with a single exposure manoeuvre. Feasibility end points were achieved in all study patients. This report documents the safety and feasibility of right atrial exposure using a suction-based cardiac positioner to complete ablation for AF concomitant with off-pump coronary revascularization. This technique may be widely adopted to create stable haemodynamic conditions and optimal visualization of the right pulmonary veins. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  3. Cine CT in the evaluation of coronary bypass graft patency

    International Nuclear Information System (INIS)

    Stanford, W.; Rooholamini, M.; Rumberger, J.; Marcus, M.; Hiratzka, L.

    1986-01-01

    Cine CT produces axial images over an 8-cm section of the aorta in 50 msec. This characteristic makes the technique useful for evaluating coronary bypass graft (CBG) patency. With the use of 40 ml of 67% iothalamate sodium injected via an antecubital vein, 28 patients with 68 CBGs underwent cine CT. Ten patients with 21 CBGs also underwent cardiac catheterization. In the latter group the overall accuracy of cine CT compared to cardiac catheterization was 95.2% (20/21). The sensitivity was 94.1% (16/17), and the specificity was 100% (4/4). This figure compares favorably with the 92% sensitivity achieved with conventional CT

  4. Endovascular repair of arterial iliac vessel wall lesions with a self-expandable nitinol stent graft system.

    Directory of Open Access Journals (Sweden)

    Birger Mensel

    Full Text Available To assess the therapeutic outcome after endovascular repair of iliac arterial lesions (IALs using a self-expandable Nitinol stent graft system.Between July 2006 and March 2013, 16 patients (13 males, mean age: 68 years with a self-expandable Nitinol stent graft. A total of 19 lesions were treated: nine true aneurysms, two anastomotic aneurysms, two dissections, one arteriovenous fistula, two type 1B endoleaks after endovascular aneurysm repair, one pseudoaneurysm, and two perforations after angioplasty. Pre-, intra-, and postinterventional imaging studies and the medical records were analyzed for technical and clinical success and postinterventional complications.The primary technical and clinical success rate was 81.3% (13/16 patients and 75.0% (12/16, respectively. Two patients had technical failure due to persistent type 1A endoleak and another patient due to acute stent graft thrombosis. One patient showed severe stent graft kinking on the first postinterventional day. In two patients, a second intervention was performed. The secondary technical and clinical success rate was 87.5% (14/16 and 93.8% (15/16. The minor complication rate was 6.3% (patient with painful hematoma at the access site. The major complication rate was 6.3% (patient with ipsilateral deep vein thrombosis. During median follow-up of 22.4 months, an infection of the aneurysm sac in one patient and a stent graft thrombosis in another patient were observed.Endovascular repair of various IALs with a self-expandable Nitinol stent graft is safe and effective.

  5. Implante de stent dentro de stent recém-implantado em ponte de veia safena para otimização do resultado angiográfico Stenting a stent in saphenous vein graft to optimize the angiographic result

    Directory of Open Access Journals (Sweden)

    Antonio Esteves Fº

    1998-03-01

    Full Text Available Mulher de 60 anos, com angina progressiva e revascularização do miocárdio, há oito anos, com ponte de veia safena para coronária direita e anastomose de artéria mamaria esquerda para artéria descendente anterior. Submetida a implante de stent Gianturco-Roubin II em terço proximal da ponte de veia safena para artéria coronária direita, com resultado insatisfatório pela persistência de lesão residual, provavelmente, decorrente de prolapso para dentro da luz de material aterosclerótico através dos coils. Foi implantado outro stent (Palmaz-Schatz biliar dentro do stent GRII com sucesso e ótimo resultado angiográfico. Um 2º stent Palmaz-Schatz biliar foi implantado em lesão distal no corpo da ponte, ultrapassando os dois stents, anteriormente implantados, com sucesso. Em algumas situações, implante de stent dentro de outro stent é recurso útil para otimização de resultado angiográfico do implante de um stent.A 60 year-old woman with progressive angina who had been submitted to saphenous bypass-graft to right coronary artery and a left mammary artery graft to anterior descending artery eight years previously, underwent implantation of a Gianturco Roubin II stent in the proximal third of the saphenous vein graft. The result was suboptimal by persistence of a residual stenosis probably due to prolapse of atherosclerotic material through the coil spaces. Another stent (Palmaz-Schatz biliar stent was implanted at the previously stented site with no residual stenosis. Another Palmaz-Schatz biliar stent was successfully implanted in the distal body of the graft to treat another lesion (passing through the previously stents without difficulty. Stenting a stent, in selected situations, is a useful tool to optimize the angiographic result of stent implantation.

  6. The economics of vein disease.

    Science.gov (United States)

    Sales, Clifford M; Podnos, Joan; Levison, Jonathan

    2007-09-01

    The management of cosmetic vein problems requires a very different approach than that for the majority of most other vascular disorders that occur in a vascular surgery practice. This article focuses on the business aspects of a cosmetic vein practice, with particular attention to the uniqueness of these issues. Managing patient expectations is critical to the success of a cosmetic vein practice. Maneuvering within the insurance can be difficult and frustrating for both the patient and the practice. Practices should use cost accounting principles to evaluate the success of their vein work. Vein surgery--especially if performed within the office--can undergo an accurate break-even analysis to determine its profitability.

  7. Skin graft

    Science.gov (United States)

    Skin transplant; Skin autografting; FTSG; STSG; Split thickness skin graft; Full thickness skin graft ... donor site. Most people who are having a skin graft have a split-thickness skin graft. This takes ...

  8. Evolution of skin grafting for treatment of burns: Reverdin pinch grafting to Tanner mesh grafting and beyond.

    Science.gov (United States)

    Singh, Mansher; Nuutila, Kristo; Collins, K C; Huang, Anne

    2017-09-01

    Skin grafting is the current standard care in the treatment of full thickness burns. It was first described around 1500 BC but the vast majority of advancements have been achieved over the past 200 years. An extensive literature review was conducted on Pubmed, Medline and Google Scholar researching the evolution of skin grafting techniques. The authors concentrated on the major landmarks of skin grafting and also provide an overview of ongoing research efforts in this field. The major innovations of skin grafting include Reverdin pinch grafting, Ollier grafting, Thiersch grafting, Wolfe grafting, Padgett dermatome and modifications, Meek-wall microdermatome and Tanner mesh grafting. A brief description of the usage, advantages and limitations of each technique is included in the manuscript. Skin grafting technique have evolved significantly over past 200 years from Reverdin pinch grafting to modern day meshed skin grafts using powered dermatome. Increasing the expansion ratio and improving the cosmetic and functional outcome are the main focus of ongoing skin grafting research and emerging techniques (such as Integra ® , Recell ® , Xpansion ® ) are showing promise. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  9. Deep Vein Thrombosis

    African Journals Online (AJOL)

    OWNER

    Deep Vein Thrombosis: Risk Factors and Prevention in Surgical Patients. Deep Vein ... preventable morbidity and mortality in hospitalized surgical patients. ... the elderly.3,4 It is very rare before the age ... depends on the risk level; therefore an .... but also in the post-operative period. ... is continuing uncertainty regarding.

  10. Electrospinning thermoplastic polyurethane/graphene oxide scaffolds for small diameter vascular graft applications

    Energy Technology Data Exchange (ETDEWEB)

    Jing, Xin [National Engineering Research Center of Novel Equipment for Polymer Processing, The Key Laboratory of Polymer Processing Engineering of Ministry of Education, South China University of Technology, Guangzhou (China); Department of Mechanical Engineering, University of Wisconsin–Madison, WI (United States); Wisconsin Institute for Discovery, University of Wisconsin–Madison, WI (United States); Mi, Hao-Yang [National Engineering Research Center of Novel Equipment for Polymer Processing, The Key Laboratory of Polymer Processing Engineering of Ministry of Education, South China University of Technology, Guangzhou (China); Salick, Max R. [Wisconsin Institute for Discovery, University of Wisconsin–Madison, WI (United States); Department of Engineering Physics, University of Wisconsin–Madison, WI (United States); Cordie, Travis M. [Wisconsin Institute for Discovery, University of Wisconsin–Madison, WI (United States); Department of Biomedical Engineering, University of Wisconsin–Madison, WI (United States); Peng, Xiang-Fang, E-mail: pmxfpeng@scut.edu.cn [National Engineering Research Center of Novel Equipment for Polymer Processing, The Key Laboratory of Polymer Processing Engineering of Ministry of Education, South China University of Technology, Guangzhou (China); Turng, Lih-Sheng, E-mail: turng@engr.wisc.edu [Department of Mechanical Engineering, University of Wisconsin–Madison, WI (United States); Wisconsin Institute for Discovery, University of Wisconsin–Madison, WI (United States)

    2015-04-01

    Fabrication of small diameter vascular grafts plays an important role in vascular tissue engineering. In this study, thermoplastic polyurethane (TPU)/graphene oxide (GO) scaffolds were fabricated via electrospinning at different GO contents as potential candidates for small diameter vascular grafts. In terms of mechanical and surface properties, the tensile strength, Young's modulus, and hydrophilicity of the scaffolds increased with an increase of GO content while plasma treatment dramatically improved the scaffold hydrophilicity. Mouse fibroblast (3T3) and human umbilical vein endothelial cells (HUVECs) were cultured on the scaffolds separately to study their biocompatibility and potential to be used as vascular grafts. It was found that cell viability for both types of cells, fibroblast proliferation, and HUVEC attachment were the highest at a 0.5 wt.% GO loading whereas oxygen plasma treatment also enhanced HUVEC viability and attachment significantly. In addition, the suture retention strength and burst pressure of tubular TPU/GO scaffolds containing 0.5 wt.% GO were found to meet the requirements of human blood vessels, and endothelial cells were able to attach to the inner surface of the tubular scaffolds. Platelet adhesion tests using mice blood indicated that vascular scaffolds containing 0.5% GO had low platelet adhesion and activation. Therefore, the electrospun TPU/GO tubular scaffolds have the potential to be used in vascular tissue engineering. - Highlights: • TPU/GO vascular scaffolds were prepared via electrospinning. • The addition of GO improved the modulus and hydrophilicity of the scaffolds. • Fibroblast cell culture verified the scaffolds' biocompatibility. • Endothelial cell culture verified the scaffolds' vascular graft affinity. • The mechanical properties fulfilled the requirements of vascular grafts.

  11. Factors Associated with In-stent Restenosis in Patients Following Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Dedi Wihanda

    2015-07-01

    Full Text Available Aim: to determine factors associated with In-Stent Restenosis (ISR in patients following Percutaneous Coronary Intervention (PCI. Methods: a retrospective cross-sectional study was conducted using secondary information from medical records of post-PCI patients who underwent follow-up of angiography PCI between January 2009 and March 2014 at The Integrated Cardiovascular Service Unit, Cipto Mangunkusumo Hospital, Jakarta. Angiographic ISR was defined when the diameter of stenosis ≥50% at follow-up angiography including the diameter inside the stent and diameter with five-mm protrusion out of the proximal and distal ends of the stent. Results: there were 289 subjects including 133 subjects with and 156 subjects without ISR. The incidence of ISR in patients using of bare-metal stent (BMS and drug-eluting stent (DES were 61.3% and 40.7%, respectively. Factors associated with ISR are stent-type (OR=4.83, 95% CI 2.51-9.30, stent length (OR=3.71, 95% CI 1.99-6.90, bifurcation lesions (OR=2.43, 95% CI 1.16-5.10, smoking (OR=2.30, 95% CI 1.33-3.99, vascular diameter (OR=2.18, 95% CI 1.2-3.73, hypertension (OR=2.16, 95% CI 1.16-4.04 and diabetes mellitus (OR=2.14, 95% CI 1.23-3.70. Conclusion: stent type, stent length, bifurcation lesions, smoking, vascular diameter, hypertension and DM are factors associated with ISR in patients following PCI. Key words: bare-metal stent; drug-eluting stent; in-stent restenosis.

  12. Metallic stent placement in hemodialysis graft patients after insufficient balloon dilation

    International Nuclear Information System (INIS)

    Liang, Huei-Lung; Pan, Huay-Ben; Lin, Yih-Huie; Chen, Chiung-Yu; Lai, Pin-Hong; Yang, Chien-Fang; Chung, Hsiao-Min; Wu, Tung-Ho; Chou, Kang-Ju

    2006-01-01

    We wanted to report our experience of metallic stent placement after insufficient balloon dilation in graft hemodialysis patients. Twenty-three patients (13 loop grafts in the forearm and 10 straight grafts in the upper arm) underwent metallic stent placement due to insufficient flow after urokinase thrombolysis and balloon dilation. The indications for metallic stent deployment included 1) recoil and/or kinked venous stenosis in 21 patents (venous anastomosis: 17 patients, peripheral outflow vein: four patients); and 2) major vascular rupture in two patients. Metallic stents 8-10mm in diameter and 40-80 mm in length were used. Of them, eight stents were deployed across the elbow crease. Access patency was determined by clinical follow-up and the overall rates were calculated by Kaplan-Meier survival analysis. No procedure-related complications (stent fracture or central migration) were encountered except for a delayed Wallstent shortening/migration at the venous anastomosis, which resulted in early access failure. The overall primary and secondary patency rates (±standard error) of all the vascular accesses in our 23 patients at 3, 6, 12 and 24 months were 69%±9 and 88%±6,41% ±10 and 88%±6, 30%±10 and 77%±10, and 12%±8 and 61%±13, respectively. For the forearm and upper-arm grafts, the primary and secondary patency rates were 51%±16 and 86%±13 vs 45%±15 and 73%±13 at 6 months, and 25%±15 and 71%±17 vs 23%±17 and 73%±13 at 12 months (ρ = .436 and .224), respectively. Metallic stent placement is a safe and effective means for treating peripheral venous lesions in dialysis graft patients after insufficient balloon dilation. No statistically difference in the patency rates between the forearm and upper-arm patient groups was seen

  13. Evaluation of a xenogeneic acellular collagen matrix as a small-diameter vascular graft in dogs--preliminary observations.

    Science.gov (United States)

    Nemcova, S; Noel, A A; Jost, C J; Gloviczki, P; Miller, V M; Brockbank, K G

    2001-01-01

    Autogenous veins are the materials of choice for arterial reconstruction. In the absence of autogenous material, prosthetic materials are used. However, vascular prostheses of less than 0.4 cm in diameter have low long-term patency. This study was designed to determine if cells would infiltrate an engineered xenogeneic biomaterial used as a small diameter arterial graft in dogs and, if so, to determine the phenotype of the infiltrating cells. Nine acellular xenogeneic grafts (0.4 cm in diameter, 5 cm long), composed of porcine collagen derived from the submucosa of the small intestine and type I bovine collagen, were implanted as end to-end interposition grafts in femoral arteries of five male mongrel dogs (total of nine grafts). All dogs received daily aspirin (325 mg). Patency of implanted grafts was monitored weekly by Duplex ultrasonography. After 9 weeks, or earlier in case of blood flow reduction by at least 75%, grafts were explanted and prepared for light or electron microscopy to evaluate cellularization. Eight of nine grafts remained patent up to 9 weeks. At explant, diameters were 0.31 +/- 0.02 cm at the midgraft, and 0.14 +/- 0.01 and 0.19 +/- 0.01 cm at the proximal and distal anastomoses. At explant, cells of mesenchymal origin (endothelial cells, smooth muscle cells, myofibroblasts) were embedded in the extracellular matrix of the graft scaffold. Minimal evidence of cellular inflammatory reaction and no aneurysmal dilatation or thrombus formation was detected. Variable degrees of hyperplasia were present at proximal and distal anastomoses. This preliminary study demonstrates that a collagen-based xenogeneic biomaterial provides a scaffold for cellularization when used for arterial reconstruction in dogs.

  14. Arabidopsis thaliana Ei-5: Minor Vein Architecture Adjustment Compensates for Low Vein Density in Support of Photosynthesis.

    Science.gov (United States)

    Stewart, Jared J; Polutchko, Stephanie K; Demmig-Adams, Barbara; Adams, William W

    2018-01-01

    An Arabidopsis thaliana accession with naturally low vein density, Eifel-5 (Ei-5), was compared to Columbia-0 (Col-0) with respect to rosette growth, foliar vein architecture, photosynthesis, and transpiration. In addition to having to a lower vein density, Ei-5 grew more slowly, with significantly lower rates of rosette expansion, but had similar capacities for photosynthetic oxygen evolution on a leaf area basis compared to Col-0. The individual foliar minor veins were larger in Ei-5, with a greater number of vascular cells per vein, compared to Col-0. This compensation for low vein density resulted in similar values for the product of vein density × phloem cell number per minor vein in Ei-5 and Col-0, which suggests a similar capacity for foliar sugar export to support similar photosynthetic capacities per unit leaf area. In contrast, the product of vein density × xylem cell number per minor vein was significantly greater in Ei-5 compared to Col-0, and was associated not only with a higher ratio of water-transporting tracheary elements versus sugar-transporting sieve elements but also significantly higher foliar transpiration rates per leaf area in Ei-5. In contrast, previous studies in other systems had reported higher ratios of tracheary to sieve elements and higher transpiration rate to be associated with higher - rather than lower - vein densities. The Ei-5 accession thus further underscores the plasticity of the foliar vasculature by illustrating an example where a higher ratio of tracheary to sieve elements is associated with a lower vein density. Establishment of the Ei-5 accession, with a low vein density but an apparent overcapacity for water flux through the foliar xylem network, may have been facilitated by a higher level of precipitation in its habitat of origin compared to that of the Col-0 accession.

  15. Graft intolerance syndrome requiring graft nephrectomy after late kidney graft failure: can it be predicted? A retrospective cohort study.

    Science.gov (United States)

    Bunthof, Kim L W; Verhoeks, Carmen M; van den Brand, Jan A J G; Hilbrands, Luuk B

    2018-02-01

    Graft nephrectomy is recommended in case of early graft failure. When the graft fails more than 3-6 months after transplantation, it is current practice to follow a wait-and-see policy. A common indication for graft removal is the graft intolerance syndrome. We aimed to create a risk prediction model for the occurrence of graft intolerance resulting in graft nephrectomy. We collected data of kidney transplantations performed in our center between 1980 and 2010 that failed at least 6 months after transplantation. We evaluated the association between baseline characteristics and the occurrence of graft nephrectomy because of graft intolerance using a competing risk regression model. Prognostic factors were included in a multivariate prediction model. In- and exclusion criteria were met in 288 cases. In 48 patients, the graft was removed because of graft intolerance. Donor age, the number of rejections, and shorter graft survival were predictive factors for graft nephrectomy because of the graft intolerance syndrome. These factors were included in a prediction rule. Using donor age, graft survival, and the number of rejections, clinicians can predict the need for graft nephrectomy with a reasonable accuracy. © 2017 Steunstichting ESOT.

  16. Construction of tissue-engineered small-diameter vascular grafts in fibrin scaffolds in 30 days.

    Science.gov (United States)

    Gui, Liqiong; Boyle, Michael J; Kamin, Yishai M; Huang, Angela H; Starcher, Barry C; Miller, Cheryl A; Vishnevetsky, Michael J; Niklason, Laura E

    2014-05-01

    Tissue-engineered small-diameter vascular grafts have been developed as a promising alternative to native veins or arteries for replacement therapy. However, there is still a crucial need to improve the current approaches to render the tissue-engineered blood vessels more favorable for clinical applications. A completely biological blood vessel (3-mm inner diameter) was constructed by culturing a 50:50 mixture of bovine smooth muscle cells (SMCs) with neonatal human dermal fibroblasts in fibrin gels. After 30 days of culture under pulsatile stretching, the engineered blood vessels demonstrated an average burst pressure of 913.3±150.1 mmHg (n=6), a suture retention (53.3±15.4 g) that is suitable for implantation, and a compliance (3.1%±2.5% per 100 mmHg) that is comparable to native vessels. These engineered grafts contained circumferentially aligned collagen fibers, microfibrils and elastic fibers, and differentiated SMCs, mimicking a native artery. These promising mechanical and biochemical properties were achieved in a very short culture time of 30 days, suggesting the potential of co-culturing SMCs with fibroblasts in fibrin gels to generate functional small-diameter vascular grafts for vascular reconstruction surgery.

  17. Exclusive use of arterial grafts in coronary artery bypass operations for three-vessel disease : Use of both thoracic arteries and the gastroepiploic artery in 256 consecutive patients

    NARCIS (Netherlands)

    Grandjean, JG; Voors, AA; Boonstra, PW; denHeyer, P; Ebels, T

    1996-01-01

    Methods: From September 1989 to September 1994 we operated on a consecutive group of 256 patients with three-vessel disease in whom we used the right gastroepiploic artery together with both internal thoracic arteries, Vein grafts were not used in these patients, This population consisted of 233 men

  18. Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition.

    Science.gov (United States)

    Blank, Jacqueline J; Rothstein, Abby E; Lee, Cheong Jun; Malinowski, Michael J; Lewis, Brian D; Ridolfi, Timothy J; Otterson, Mary F

    2018-01-01

    Aortic graft infections are a rare but devastating complication of aortic revascularization. Often infections occur due to contamination at the time of surgery. Iatrogenic misplacement of the limbs of an aortobifemoral graft is exceedingly rare, and principles of evaluation and treatment are not well defined. We report 2 cases of aortobifemoral bypass graft malposition through the colon. Case 1 is a 54-year-old male who underwent aortobifemoral bypass grafting for acute limb ischemia. He had previously undergone a partial sigmoid colectomy for diverticulitis. Approximately 6 months after vascular surgery, he presented with an occult graft infection. Preoperative imaging and intraoperative findings were consistent with graft placement through the sigmoid colon. Case 2 is a 60-year-old male who underwent aortobifemoral bypass grafting due to a nonhealing wound after toe amputation. His postoperative course was complicated by pneumonia, bacteremia thought to be secondary to the pneumonia, general malaise, and persistent fevers. Approximately 10 weeks after the vascular surgery, he presented with imaging and intraoperative findings of graft malposition through the cecum. Aortic graft infection is usually caused by surgical contamination and presents as an indolent infection. Case 1 presented as such; Case 2 presented more acutely. Both grafts were iatrogenically misplaced through the colon at the index operation. The patients underwent extra-anatomic bypass and graft explantation and subsequently recovered.

  19. Mid-term results of off-pump coronary artery bypass grafting assessed by multi-slice computed tomography

    International Nuclear Information System (INIS)

    Yoshida, Seijiro; Nitta, Yoshio; Oda, Katsuhiko

    2004-01-01

    Off-pump coronary artery bypass (OPCAB) has recently increased in popularity, but the long-term results are still unknown. We evaluated the mid-term results of OPCAB surgery using multi-slice computed tomography (MSCT), which is a non-invasive postoperative evaluation method. Thirty-one consecutive patients who underwent OPCAB surgery at least 2 years prior to the study were selected. The age was 50 to 79 years (66.9±6.5) and the ratio of men to women was 26:5. Coronary angiography was performed in all patients at 2 weeks postoperatively. The follow-up was complete, and mean follow-up was 30.9 months. There were no hospital deaths and 1 non-cardiac late death. The graft patency rate in coronary angiography was left internal thoracic artery (LITA) 30/30 (100%), right internal thoracic artery (RITA) 2/2 (100%), radial artery (RA) 14/15 (93%), saphenous vein graft (SVG) 15/17 (88%). No graft became occluded on MSCT study and all patients have been angina-free during the follow-up period. We suggest that OPCAB is feasible in most patients with good patency and low mortality. MSCT is an effective follow up method for the morphological findings and noninvasive quantitative evaluation of the bypass grafts. (author)

  20. Vein visualization: patient characteristic factors and efficacy of a new infrared vein finder technology.

    Science.gov (United States)

    Chiao, F B; Resta-Flarer, F; Lesser, J; Ng, J; Ganz, A; Pino-Luey, D; Bennett, H; Perkins, C; Witek, B

    2013-06-01

    We investigated the patient characteristic factors that correlate with identification of i.v. cannulation sites with normal eyesight. We evaluated a new infrared vein finding (VF) technology device in identifying i.v. cannulation sites. Each subject underwent two observations: one using the conventional method (CM) of normal, unassisted eyesight and the other with the infrared VF device, VueTek's Veinsite™ (VF). A power analysis for moderate effect size (β=0.95) required 54 samples for within-subject differences. Patient characteristic profiles were obtained from 384 subjects (768 observations). Our sample population exhibited an overall average of 5.8 [95% confidence interval (CI) 5.4-6.2] veins using CM. As a whole, CM vein visualization were less effective among obese [4.5 (95% CI 3.8-5.3)], African-American [4.6 (95% CI 3.6-5.5 veins)], and Asian [5.1 (95% CI 4.1-6.0)] subjects. Next, the VF technology identified an average of 9.1 (95% CI 8.6-9.5) possible cannulation sites compared with CM [average of 5.8 (95% CI 5.4-6.2)]. Seventy-six obese subjects had an average of 4.5 (95% CI 3.8-5.3) and 8.2 (95% CI 7.4-9.1) veins viewable by CM and VF, respectively. In dark skin subjects, 9.1 (95% CI 8.3-9.9) veins were visible by VF compared with 5.4 (95% CI 4.8-6.0) with CM. African-American or Asian ethnicity, and obesity were associated with decreased vein visibility. The visibility of veins eligible for cannulation increased for all subgroups using a new infrared device.

  1. Palliative treatment of TIPS to portal vein tumor thrombosis complicated with portal vein hypertension

    International Nuclear Information System (INIS)

    Jiang Zaibo; Shan Hong; Guan Shouhai; Zhu Kangshun; Huang Mingsheng; Li Zhengran; Guo Tiansheng; Liu Lang

    2002-01-01

    Objective: To evaluate the palliative therapeutic effects of transjugular intrahepatic portosystemic shunt (TIPS) in portal vein tumor thrombosis (PVTT) complicated with portal vein hypertension, and to discuss the technical skills. Methods: There were 14 cases of end-stage hepatocellular carcinoma complicated with PVTT and portal vein hypertension, the average age was 53.6 yr. There were 8 cases with complete occlusion of main portal vein, 6 eases with incomplete thrombosis, and 5 cases combined with portal vein cavernous transformation. One case had simple hemorrhage, 3 eases had intractable ascites, and 10 cases had hemorrhage accompanied by intractable ascites. Results: The procedure of TIPS was successful in 10 cases, the successful rate was about 71%. The mean portal vein pressure was reduced from 37.2 mm Hg to 18.2 mm Hg, with an average reduction of 19.0 mm Hg. After the procedure of TIPS, the ascites decreased, hemorrhage stopped and the clinical symptoms disappeared. The average survival period was 132.3 days. The procedure were failing in 4 cases. Conclusion: TIPS was an effective palliative therapeutic methods to control the hemorrhage and ascites aroused by hepatic carcinoma complicated with PVTT

  2. [Effect of nattokinase on restenosis after percutaneous transluminal angioplasty of the abdominal artery in rabbits].

    Science.gov (United States)

    Gong, Min; Lin, Huan-bing; Wang, Qian; Xu, Jiang-ping

    2008-08-01

    To investigate the effect of nattokinase on intimal hyperplasia in rabbit abdominal artery after balloon injury and explore a novel strategy for the preventing restenosis after percutaneous transluminal angioplasty. Fifty-six New Zealand rabbits were randomly divided into 7 groups, namely the solvent control group, model group, natto extract lavage group, refined nattokinse lavage group, intravenous refined nattokinse injection group, clopidogrel group and clopidogrel-aspirin group. Balloon injury was induced by inserting the catheter through the femoral artery into the thoracic aorta of the rabbits. The platelet counts were notad and platelet aggregation was observed, and the abdominal artery was taken for pathological analysis. The expressions of MMP-2 and -9 in the abdominal artery were detected immunohistochemically. There was no significant difference in the platelet counts, platelet aggregation rate or MMP-2 and -9 expression between the model group and the nattokinse-treated groups (P>0.05). The stenosis index in each nattokinse-treated group was significantly greater and the neointimal proliferation index smaller than that of the model group (P<0.01 or 0.05). Nattokinse can inhibit restenosis of rabbit abdominal artery after percutaneous transluminal angioplasty, which is independent of its actions on the platelet or MMP-2 and -9 expressions.

  3. Grafting

    Energy Technology Data Exchange (ETDEWEB)

    Garnett, J L [New South Wales Univ., Kensington (Australia). School of Chemistry

    1979-01-01

    The unique value of ionizing radiation for the initiation of grafting to backbone polymers is discussed. The principles of the technique are briefly reviewed. The conditions under which free radicals and ions participate in these reactions are examined. Examples of representative grafting processes are considered to illustrate where the technique can be of potential commercial value to a wide range of industries. The general principles of these grafting reactions are shown to be applicable to radiation induced rapid cure technology such as is provided by electron beam processing facilities. Grafting reactions initiated by UV are also treated and shown to be of importance because of the many similarities in properties of the ionizing radiation and UV systems, also the rapid industrial exploitation of EB and sensitized UV processing technology. Possible future trends in radiation grafting are outlined.

  4. Incremental Value of Increasing Number of Arterial Grafts: The Effect of Diabetes Mellitus.

    Science.gov (United States)

    Schwann, Thomas A; El Hage Sleiman, Abdul Karim M; Yammine, Maroun B; Tranbaugh, Robert F; Engoren, Milo; Bonnell, Mark R; Habib, Robert H

    2018-06-01

    Multiarterial coronary grafting with two arterial grafts leads to improved survival compared with conventional single artery based on left internal thoracic artery to left anterior descending artery and saphenous vein grafts. We investigated whether extending arterial grafting to three or more arterial grafts further improves survival, and whether such a benefit is modified by diabetes mellitus. We analyzed 15-year coronary artery bypass graft surgery mortality data in 11,931 patients (age 64.3 ± 10.5 years; 3,484 women [29.2%]; 4,377 [36.7%] with diabetes mellitus) derived from three US institutions (1994 to 2011). All underwent primary isolated left internal thoracic artery to left anterior descending artery grafting with at least two grafts: one artery (n = 6,782; 56.9%); two arteries (n = 3,678; 30.8%); or three or more arteries (n = 1,471; 12.3%). Long-term survival was estimated by Kaplan-Meier methods. Propensity score matching and comprehensive covariate adjustment (Cox regression) were used to derive long-term risk-adjusted hazard ratio (HR) with 95% confidence interval (CI) for increasing number of arterial grafts in the overall cohort and for diabetes and no-diabetes cohorts. Radial artery (94%) and right internal thoracic artery (6%) were used as additional arterial grafts. Multivariate analysis in all patients showed that diabetes was associated with decreased survival (HR 1.43, 95% CI: 1.34 to 53), whereas increasing number of arterial grafts was associated with decreased mortality (one artery HR 1.0 [reference]; two arteries HR 0.87, 95% CI: 0.80 to 0.95; and three arteries HR 0.83, 95% CI: 0.72 to 0.95). Pairwise comparisons also showed an incremental benefit of additional arterial grafts: two arteries versus one artery, HR 0.89 (95% CI: 0.80 to 0.98); and three arteries versus one artery, HR 0.80 (95% CI: 0.68 to 0.94). A three-artery versus two-artery survival advantage trend was also noted, but was not significant in either the overall study

  5. Drug-eluting stents to prevent stent thrombosis and restenosis.

    Science.gov (United States)

    Im, Eui; Hong, Myeong-Ki

    2016-01-01

    Although first-generation drug-eluting stents (DES) have significantly reduced the risk of in-stent restenosis, they have also increased the long-term risk of stent thrombosis. This safety concern directly triggered the development of new generation DES, with innovations in stent platforms, polymers, and anti-proliferative drugs. Stent platform materials have evolved from stainless steel to cobalt or platinum-chromium alloys with an improved strut design. Drug-carrying polymers have become biocompatible or biodegradable and even polymer-free DES were introduced. New limus-family drugs (such as everolimus, zotarolimus or biolimus) were adopted to enhance stent performances. As a result, these new DES demonstrated superior vascular healing responses on intracoronary imaging studies and lower stent thrombotic events in actual patients. Recently, fully-bioresorbable stents (scaffolds) have been introduced, and expanding their applications. In this article, the important concepts and clinical results of new generation DES and bioresorbable scaffolds are described.

  6. Concerns and Discomforts of Pregnancy - Varicose Veins

    Science.gov (United States)

    Concerns and Discomforts of Pregnancy - Varicose Veins Varicose veins are enlarged veins you may see on your ... Healthy Roads Media project www. healthyroadsmedia. org English - Concerns and Discomforts of Pregnancy (Varicose Veins) Last reviewed ...

  7. The effect of stent structure changes on the hemodynamics and the formation of in-stent restenosis

    International Nuclear Information System (INIS)

    Wu Xia; Xu Ke; Xiao Liang; Zhang Xitong; Su Hongying; Feng Bo

    2009-01-01

    Objective: To investigate the effect of stent structure changes on the formation of in-stent restenosis by studying the influence of these changes on the shear force to the vascular wall, on the velocity of flow and on the flow pattern. Methods: Five stent models were established by using Pro/engineer wildfire 3.0. Model A was regarded as control structure. On the base structure of model A, transverse link component was added to form model B, and vertical link component was added to form model C. The thickness of model D was twice than that of model A, and the meshes density of model E was twice than that of model A. Fluid models were built up by importing these stent models into computational fluid dynamics (CFD) software ansys11.0-CFX, then, CFD analysis was proceeded to study the effect of stent structure on hemodynamics. Results: After the stents were implanted, the percentage of low wall shear stress on the surface of model A, B, C, D and E was 7.78%, 6.65%, 1.48%, 16.52% and 12.12%, respectively. The percentage of D and E was obviously larger than that of A, while the percentage of B was markedly smaller than that of A. The velocity vector on the cross-sectional planes showed that the low velocity and eddy areas in D and E were much larger than that in A, while this area in C was smaller than that in A. Conclusion: The stent structure changes can cause obvious changes in hemodynamics in the implanted vessels. The increase in the thickness and meshes density of the stent is the main factor that induces the formation of low wall shear stress, which will precipitate the development of in-stent restenosis. The added vertical link component will reduce the area of low wall shear stress as well as the occurrence of in-stent restenosis. (authors)

  8. The effects of doxycycline and micronized purified flavonoid fraction on human vein wall remodeling are not hypoxia-inducible factor pathway-dependent.

    Science.gov (United States)

    Lim, Chung Sim; Kiriakidis, Serafim; Paleolog, Ewa M; Davies, Alun H

    2012-10-01

    Doxycycline and micronized purified flavonoid fraction (MPFF) modulate vein wall remodeling that may be associated with hypoxia in varicose veins (VVs), vein graft stenosis, and deep venous thrombosis. We recently reported that in vitro exposure of non-VV (NVVs) and VVs to hypoxic conditions activates the hypoxia-inducible factor (HIF) pathway. This study investigated the in vitro effects of doxycycline and MPFF on the HIF pathway in hypoxic NVVs and VVs. Six NVVs and six VVs obtained from surgery were used to prepare vein organ cultures, which were exposed to hypoxia (1% O(2)), with and without MPFF (10(-5) mol/L) or doxycycline (5 μg/mL) for 16 hours. The veins were analyzed for HIF-1α, HIF-2α, and their target gene expression, with real-time polymerase chain reaction and Western blot. The differences between gene expressions were tested with one-way analysis of variance with repeated measures, followed by the Dunnett test for multiple comparisons. P factor, B-cell lymphoma 2/adenovirus E1B 19-kDa protein-interacting protein 3, prolyl hydroxylase domain-2, and prolyl hydroxylase domain-3, was not significantly altered in NVVs and VVs exposed to hypoxia and treated with doxycycline or MPFF compared with those untreated. Doxycycline and MPFF at a concentration corresponding to a therapeutic dose do not alter the activation of the HIF pathway in NVV and VV organ cultures exposed to hypoxia. Our findings suggest vein wall remodeling actions in NVVs and VVs are likely not HIF-dependent. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  9. Corrosion cast study of the canine hepatic veins.

    Science.gov (United States)

    Uršič, M; Vrecl, M; Fazarinc, G

    2014-11-01

    This study presents a detailed description of the distribution, diameters and drainage patterns of hepatic veins on the basis of the corrosion cast analysis in 18 dogs. We classified the hepatic veins in three main groups: the right hepatic veins of the caudate process and right lateral liver lobe, the middle hepatic veins of the right medial and quadrate lobes and the left hepatic veins of both left liver lobes and the papillary process. The corrosion cast study showed that the number of the veins in the Nomina Anatomica Veterinaria and most anatomical textbooks is underestimated. The number of various-sized hepatic veins of the right liver division ranged from 3 to 5 and included 1 to 4 veins from the caudate process and 2 to 4 veins from the right lateral liver lobe. Generally, in all corrosion casts, one middle-sized vein from the right part of the right medial lobe, which emptied separately in the caudal vena cava, was established. The other vein was a large-sized vein from the remainder of the central division, which frequently joined the common left hepatic vein from the left liver lobes. The common left hepatic vein was the largest of all the aforementioned hepatic veins.

  10. Image Quality Enhancement Using the Direction and Thickness of Vein Lines for Finger-Vein Recognition

    Directory of Open Access Journals (Sweden)

    Young Ho Park

    2012-10-01

    Full Text Available On the basis of the increased emphasis placed on the protection of privacy, biometric recognition systems using physical or behavioural characteristics such as fingerprints, facial characteristics, iris and finger-vein patterns or the voice have been introduced in applications including door access control, personal certification, Internet banking and ATM machines. Among these, finger-vein recognition is advantageous in that it involves the use of inexpensive and small devices that are difficult to counterfeit. In general, finger-vein recognition systems capture images by using near infrared (NIR illumination in conjunction with a camera. However, such systems can face operational difficulties, since the scattering of light from the skin can make capturing a clear image difficult. To solve this problem, we proposed new image quality enhancement method that measures the direction and thickness of vein lines. This effort represents novel research in four respects. First, since vein lines are detected in input images based on eight directional profiles of a grey image instead of binarized images, the detection error owing to the non-uniform illumination of the finger area can be reduced. Second, our method adaptively determines a Gabor filter for the optimal direction and width on the basis of the estimated direction and thickness of a detected vein line. Third, by applying this optimized Gabor filter, a clear vein image can be obtained. Finally, the further processing of the morphological operation is applied in the Gabor filtered image and the resulting image is combined with the original one, through which finger-vein image of a higher quality is obtained. Experimental results from application of our proposed image enhancement method show that the equal error rate (EER of finger-vein recognition decreases to approximately 0.4% in the case of a local binary pattern-based recognition and to approximately 0.3% in the case of a wavelet transform

  11. Covalent immobilization of lysozyme onto woven and knitted crimped polyethylene terephthalate grafts to minimize the adhesion of broad spectrum pathogens

    International Nuclear Information System (INIS)

    Al Meslmani, Bassam M.; Mahmoud, Gihan F.; Leichtweiß, Thomas; Strehlow, Boris; Sommer, Frank O.; Lohoff, Michael D.; Bakowsky, Udo

    2016-01-01

    Graft-associated infections entirely determine the short-term patency of polyethylene terephthalate PET cardiovascular graft. We attempted to enzymatically inhibit the initial bacterial adhesion to PET grafts using lysozyme. Lysozyme was covalently immobilized onto woven and knitted forms of crimped PET grafts by the end-point method. Our figures of merit revealed lysozyme immobilization yield of 15.7 μg/cm"2, as determined by the Bradford assay. The activity of immobilized lysozyme on woven and knitted PET manifested 58.4% and 55.87% using Micrococcus lysodeikticus cells, respectively. Noteworthy, the adhesion of vein catheter-isolated Staphylococcus epidermidis decreased by 6- to 8-folds and of Staphylococcus aureus by 11- to 12-folds, while the Gram-negative Escherichia coli showed only a decrease by 3- to 4-folds. The anti-adhesion efficiency was specific for bacterial cells and no significant effect was observed on adhesion and growth of L929 cells. In conclusion, immobilization of lysozyme onto PET grafts can inhibit the graft-associated infection. - Highlights: • Lysozyme was covalently immobilized on crimped polyethylene terephthalate (PET). • The activity of immobilized lysozyme was meaningfully reduced. • The maintained activity significantly declined the adhesion of Gram-positive stains. • The enzymatic anti-adhesion efficiency reported lesser extent against Gram-negative. • The anti-bacterial activity displayed no significant effect on cells compatibility.

  12. Covalent immobilization of lysozyme onto woven and knitted crimped polyethylene terephthalate grafts to minimize the adhesion of broad spectrum pathogens

    Energy Technology Data Exchange (ETDEWEB)

    Al Meslmani, Bassam M., E-mail: almeslmanib@yahoo.com [Department of Pharmaceutical Technology and Biopharmaceutics, Marburg University, Ketzerbach 63, 35037 Marburg (Germany); Mahmoud, Gihan F., E-mail: mahmoudg@staff.uni-marburg.de [Department of Pharmaceutical Technology and Biopharmaceutics, Marburg University, Ketzerbach 63, 35037 Marburg (Germany); Department of Pharmaceutics and Industrial Pharmacy, Helwan University, Ain Helwan, 11795 Cairo (Egypt); Leichtweiß, Thomas, E-mail: Thomas.Leichtweiss@phys.Chemie.uni-giessen.de [Institute of Physical Chemistry, Justus-Liebig-University Giessen, Heinrich-Buff-Ring 58, 35392 Giessen (Germany); Strehlow, Boris, E-mail: strehlo4@staff.uni-marburg.de [Department of Pharmaceutical Technology and Biopharmaceutics, Marburg University, Ketzerbach 63, 35037 Marburg (Germany); Sommer, Frank O., E-mail: sommerf@med.uni-marburg.de [Institute for Medical Microbiology and Hospital Hygiene, Marburg University, Hans Meerwein Str 2, 35032 Marburg (Germany); Lohoff, Michael D., E-mail: lohoff@med.uni-marburg.de [Institute for Medical Microbiology and Hospital Hygiene, Marburg University, Hans Meerwein Str 2, 35032 Marburg (Germany); Bakowsky, Udo, E-mail: ubakowsky@aol.com [Department of Pharmaceutical Technology and Biopharmaceutics, Marburg University, Ketzerbach 63, 35037 Marburg (Germany)

    2016-01-01

    Graft-associated infections entirely determine the short-term patency of polyethylene terephthalate PET cardiovascular graft. We attempted to enzymatically inhibit the initial bacterial adhesion to PET grafts using lysozyme. Lysozyme was covalently immobilized onto woven and knitted forms of crimped PET grafts by the end-point method. Our figures of merit revealed lysozyme immobilization yield of 15.7 μg/cm{sup 2}, as determined by the Bradford assay. The activity of immobilized lysozyme on woven and knitted PET manifested 58.4% and 55.87% using Micrococcus lysodeikticus cells, respectively. Noteworthy, the adhesion of vein catheter-isolated Staphylococcus epidermidis decreased by 6- to 8-folds and of Staphylococcus aureus by 11- to 12-folds, while the Gram-negative Escherichia coli showed only a decrease by 3- to 4-folds. The anti-adhesion efficiency was specific for bacterial cells and no significant effect was observed on adhesion and growth of L929 cells. In conclusion, immobilization of lysozyme onto PET grafts can inhibit the graft-associated infection. - Highlights: • Lysozyme was covalently immobilized on crimped polyethylene terephthalate (PET). • The activity of immobilized lysozyme was meaningfully reduced. • The maintained activity significantly declined the adhesion of Gram-positive stains. • The enzymatic anti-adhesion efficiency reported lesser extent against Gram-negative. • The anti-bacterial activity displayed no significant effect on cells compatibility.

  13. Normal hepatic vein patterns on ultrasound

    International Nuclear Information System (INIS)

    Kim, Hae Jin; Chae, Yoo Soon; Park, Hea Yeoung; Park, Bok Hwan; Kim, Yang Sook

    1987-01-01

    Understanding of the anatomy of the hepatic vein is important in manipulation for transplantation of the liver, hepatectomy and the treatment of hepatic trauma with avulsion of the hepatic vein. Demonstrated of the inferior right hepatic vein (IRHV) is also important; in some cases of hepatocellular carcinoma, thrombus can be seen in the IRHV; in primary Budd-Chiari syndrome, the IRHV is main draining vein; during hepatectomy, the postero-inferior segment of the right lobe and draining IRHV can be preserved. For some 10 months ultrasound examination was done in a total of 124 patients with normal liver function with special emphasis on the hepatic vein, their branches, and the IRHV, and analysed in terms of branching pattern and relative size of the hepatic vein and the detection rate of the IRHV.

  14. Non-Immunogenic Structurally and Biologically Intact Tissue Matrix Grafts for the Immediate Repair of Ballistic-Induced Vascular and Nerve Tissue Injury in Combat

    Science.gov (United States)

    2004-12-01

    the absence of dilatation, aneurysm formation or neointimal hyperplasia . The 2003 report described the failure to provide appropriate carotid grafts...growth of fibrovascular tissue, sometimes accompanied by inflammatory cells and pigment-laden macrophages. Fragmentation of the umbilical vein...were also present within the device interstices. A fibrovascular stroma (all animals, mild to marked) was also noted within the lumen of the ePTFE

  15. Efficacy and Safety of Endovascular Intervention for the Management of Primary Entire-Inferior Vena Cava Occlusion

    International Nuclear Information System (INIS)

    Zhang, Qingqiao; Huang, Qianxin; Shen, Bin; Sun, Jingmin; Wang, Xiaolong; Liu, Hongtao

    2015-01-01

    PurposeThis study was designed to investigate the safety and efficacy of endovascular intervention for the treatment of primary entire-inferior vena cava (IVC) occlusion.MethodsEndovascular interventions were performed in six patients for the treatment of primary entire-IVC occlusion. IVC and hepatic venography were performed via the jugular and femoral veins. Balloon angioplasty was used to revascularize the hepatic vein and IVC and a stent was placed in the IVC to maintain patency. Postoperative color Doppler ultrasonography was performed at 1, 3, 6, and 12 months, and then annually, to monitor the patency of the hepatic vein and IVC.ResultsThe IVC and one or two hepatic veins were successfully revascularized in five patients. Revascularization was successful in the right and left hepatic veins in one patient; however, IVC patency could not be established in this patient. Eleven Z-type, self-expanding stents were placed into the IVCs of five patients (three stents in two patients, two stents in two patients, and one stent in one patient). There were no instances of postoperative bleeding or mortality. Follow-up was conducted for 18–90 months (42.8 ± 26.5 months). None of the five patients suffered restenosis of the IVC or hepatic veins. However, there was one of the six cases of right hepatic vein restenosis at 18 months postprocedure that was revascularized after a second balloon dilatation.ConclusionsEndovascular intervention is safe and efficacious for the treatment of primary entire-IVC occlusion

  16. The umbilical and paraumbilical veins of man.

    Science.gov (United States)

    Martin, B F; Tudor, R G

    1980-03-01

    During its transit through the umbilicus structural changes occur in the thick wall of the extra-abdominal segment of the umbilical vein whereby the components of the intra-abdominal segment acquire an essentially longitudinal direction and become arranged in fibro-elastic and fibro-muscular zones. The vein lumen becomes largely obliterated by asymmetrical proliferation of loose subendothelial conective tissue. The latter forms a new inner zone within which a small segment of the lumen persists in an eccentric position. This residual lumen transmits blood to the portal system from paraumbilical and systemic sources, and is retained in the upper part of the vein, even in old age. A similar process of lumen closure is observed in the ductus venosus. In early childhood the lower third of the vein undergoes breakdown, with fatty infiltration, resulting in its complete division into vascular fibro-elastic strands, and in old age some breakdown occurs in the outermost part of the wall of the upper two thirds. The paraumbilical veins are thick-walled and of similar structure to the umbilical vein. Together they constitute an accessory portal system which is confined between the layers of the falciform ligament and is in communication with the veins of the ventral abdominal wall. The constituents form an ascending series, namely, Burow's veins, the umbilical vein, and Sappey's inferior and superior veins. The main channel of Sappey's inferior veins may be the remnant of the right umbilical vein since it communicates with the right rectus sheath and often communicates directly with the portal system within the right lobe of the liver. The results are of significance in relation to clinical usage of the umbilical vein.

  17. Idiopathic Bilateral External Jugular Vein Thrombosis.

    Science.gov (United States)

    Hindi, Zakaria; Fadhel, Ehab

    2015-08-20

    Vein thrombosis is mainly determined by 3 factors, which constitute a triad called Virchow's triad: hypercoagulability, stasis, and endothelial injury. Venous thrombosis commonly occurs in the lower extremities since most of the blood resides there and flows against gravity. The veins of the lower extremities are dependent on intact valves and fully functional leg muscles. However, in case of valvular incompetency or muscular weakness, thrombosis and blood stasis will occur as a result. In contrast, the veins of the neck, specially the jugulars, have distensible walls which allow flexibility during respiration. In addition, the blood directly flows downward towards the heart. Nevertheless, many case reports mentioned the thrombosis of internal jugular veins and external jugular veins with identified risk factors. Jugular vein thrombosis has previously been associated in the literature with a variety of medical conditions, including malignancy. This report is of a case of idiopathic bilateral external jugular vein thrombosis in a 21 year-old male construction worker of Southeast Asian origin with no previous medical history who presented with bilateral facial puffiness of gradual onset over 1 month. Doppler ultrasound and computed tomography were used in the diagnosis. Further work-up showed no evidence of infection or neoplasia. The patient was eventually discharged on warfarin. The patient was assessed after 6 months and his symptoms had resolved completely. Bilateral idiopathic external jugular veins thrombosis is extremely rare and can be an indicator of early malignancy or hidden infection. While previous reports in the literature have associated jugular vein thrombosis with malignancy, the present case shows that external jugular vein thrombosis can also be found in persons without malignancy.

  18. Diagnostic value of color doppler ultrasonography in detecting stenosis and occlusion of central veins in patients with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Masoud Pezeshki Rad

    2015-01-01

    Full Text Available Venography is an invasive diagnostic test that uses contrast material that provides a picture of the condition of the veins. But, complications, including adverse effects on the kidney, do occur. On the other hand, with the current technological development, application of ultrasound in the diagnosis of obstructive diseases of the veins is gaining popularity, being non-invasive, easy to perform and cost-effective. The aim of this study was to evaluate the diagnostic value of Doppler sonography in the diagnosis of central vein stenosis. In this descriptive-analytical study, 41 hemodialysis patients who had been referred for 50 upper limb venographies to the radiology department of Imam Reza (AS were included. Patients with chronic kidney disease with a history of catheterization of the vein, jugular or subclavian, and who had established fistulas or synthetic vascular grafts were targeted. Central venous ultrasound was performed on both sides to evaluate stenosis or occlusion. Venography was performed by the radiologist the next day or the day before hemodialysis. Data on demographic characteristics, findings of clinical examination and findings of ultrasound as well as venography were recorded by using the SPSS software, Chi-square test and Spearman correlation, and Kappa agreement was calculated for sensitivity, specificity and predictive values. Twenty-three (56% patients were male subjects and 18 patients (44% were female. Twenty-three (56% patients of the study population were aged 60 years. The overall sensitivity, specificity and positive predictive value and negative predictive value of Doppler sonography in the proximal veins in hemodialysis patients compared with venography were, respectively, 80.9%, 79.3%, 73.9% and 85.1%. Color Doppler sonography, as a non-invasive method, could be a good alternative for venography in the assessment of the upper limb with central vein stenosis and occlusion.

  19. Diagnostic value of color doppler ultrasonography in detecting stenosis and occlusion of central veins in patients with chronic kidney disease.

    Science.gov (United States)

    Rad, Masoud Pezeshki; Kazemzadeh, Gholam Hosain; Ziaee, Masood; Azarkar, Ghodsieh

    2015-03-01

    Venography is an invasive diagnostic test that uses contrast material that provides a picture of the condition of the veins. But, complications, including adverse effects on the kidney, do occur. On the other hand, with the current technological development, application of ultrasound in the diagnosis of obstructive diseases of the veins is gaining popularity, being non-invasive, easy to perform and cost-effective. The aim of this study was to evaluate the diagnostic value of Doppler sonography in the diagnosis of central vein stenosis. In this descriptive-analytical study, 41 hemodialysis patients who had been referred for 50 upper limb venographies to the radiology department of Imam Reza (AS) were included. Patients with chronic kidney disease with a history of catheterization of the vein, jugular or subclavian, and who had established fistulas or synthetic vascular grafts were targeted. Central venous ultrasound was performed on both sides to evaluate stenosis or occlusion. Venography was performed by the radiologist the next day or the day before hemodialysis. Data on demographic characteristics, findings of clinical examination and findings of ultrasound as well as venography were recorded by using the SPSS software, Chi-square test and Spearman correlation, and Kappa agreement was calculated for sensitivity, specificity and predictive values. Twenty-three (56%) patients were male subjects and 18 patients (44%) were female. Twenty-three (56%) patients of the study population were aged 60 years. The overall sensitivity, specificity and positive predictive value and negative predictive value of Doppler sonography in the proximal veins in hemodialysis patients compared with venography were, respectively, 80.9%, 79.3%, 73.9% and 85.1%. Color Doppler sonography, as a non-invasive method, could be a good alternative for venography in the assessment of the upper limb with central vein stenosis and occlusion.

  20. Blood sampling from adrenal gland vein

    International Nuclear Information System (INIS)

    Sun Yong; Ni Caifang

    2009-01-01

    Adrenal gland vein sampling is an interventional method to get the blood samples from the adrenal gland vein. The blood is obtained via a catheter which is selectively inserted in the adrenal gland vein. This technique is mainly used to be diagnostic for primary hyperaldosteronism. A full knowledge of the anatomy and variations of the adrenal gland vein, serious preoperative preparation and skilled catheterization manipulation are necessary for obtaining sufficient blood sample and for reducing the occurrence of complications. Providing the physicians with definite diagnostic evidence and being technically feasible, adrenal gland vein sampling should become one of the routine examinations for clarifying the cause of primary hyperaldosteronism. (authors)

  1. Isolated inferior mesenteric portal hypertension with giant inferior mesenteric vein and anomalous inferior mesenteric vein insertion

    Directory of Open Access Journals (Sweden)

    G Raghavendra Prasad

    2013-01-01

    Full Text Available Extrahepatic portal hypertension is not an uncommon disease in childhood, but isolated inferior mesenteric portal varices and lower gastrointestinal (GI bleed have not been reported till date. A 4-year-old girl presented with lower GI bleed. Surgical exploration revealed extrahepatic portal vein obstruction with giant inferior mesenteric vein and colonic varices. Inferior mesenteric vein was joining the superior mesenteric vein. The child was treated successfully with inferior mesenteric - inferior vena caval anastomosis. The child was relieved of GI bleed during the follow-up.

  2. Multimodal ultrasonographic assessment of leiomyosarcoma of the femoral vein in a patient misdiagnosed as having deep vein thrombosis

    Science.gov (United States)

    Zhang, Mei; Yan, Feng; Huang, Bin; Wu, Zhoupeng; Wen, Xiaorong

    2017-01-01

    Abstract Rationale: Primary leiomyosarcoma (LMS) of the vein is a rare tumor that arises from the smooth muscle cells of the vessel wall and has an extremely poor prognosis. This tumor can occur in vessels such as the inferior vena cava, great saphenous vein, femoral vein, iliac vein, popliteal vein, and renal vein; the inferior vena cava is the most common site. LMS of the femoral vein can result in edema and pain in the lower extremity; therefore, it is not easy to be differentiated from deep vein thrombosis (DVT). Moreover, virtually no studies have described the ultrasonographic features of LMS of the vein in detail. Patient concerns: We present a case of a 55-year-old woman with LMS of the left femoral vein that was misdiagnosed as having deep vein thrombosis (DVT) on initial ultrasonographic examination. The patient began to experience edema and pain in her left leg seven months previously. She was diagnosed as having DVT on initial ultrasonographic examination, but the DVT treatment that she had received for 7 months failed to improve the status of her left lower limb. Diagnoses: She subsequently underwent re-examination by means of a multimodal ultrasonographic imaging approach (regular B-mode imaging, color Doppler imaging, pulsed-wave Doppler imaging, contrast-enhanced ultrasonography), which confirmed a diagnosis of LMS. Interventions: This patient was treated successfully with surgery. Outcomes: This case demonstrates that use of multiple ultrasonographic imaging techniques can be helpful to diagnose LMS accurately. Detection of vasculature in a dilated vein filled with a heterogeneous hypoechoic substance on ultrasonography is a sign of a tumor. Lessons: The pitfall of misdiagnosing this tumor as DVT is a useful reminder. PMID:29145269

  3. Duplex sonography of the near-surface leg veins

    International Nuclear Information System (INIS)

    Mendoza, E.

    2007-01-01

    The book contains the following contributions: The ultrasonograph, selection of the ultrasonic transducer, anatomy of the near-surface vein system, physiology of the near-surface vein system, varicose status classification, systematics of the duplex sonography of near-surface leg veins, provocational maneuver for the duplex sonographic varicose diagnostics, exploration of vena saphena parva, perforans veins, side branches, phlebitis, sonography for varicose therapy, postsurgical sonography, deep leg veins, examination of near-surface leg veins for the pathology of the deep vein system, differential diagnostic clarification of leg oedema from the phlebologic-lymphological view, diagnostic side features along the near-surface leg veins

  4. Drug: D03949 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available ... Treatment of autogenous vein grafts to prevent graft failure (oligonucleotide used with a pressure me...diated device for ex vivo delivery to vein grafts) ... CAS: 328538-04-1 PubChem: 47205936 ...

  5. Self-taught axillary vein access without venography for pacemaker implantation: prospective randomized comparison with the cephalic vein access.

    Science.gov (United States)

    Squara, Fabien; Tomi, Julien; Scarlatti, Didier; Theodore, Guillaume; Moceri, Pamela; Ferrari, Emile

    2017-12-01

    Axillary vein access for pacemaker implantation is uncommon in many centres because of the lack of training in this technique. We assessed whether the introduction of the axillary vein technique was safe and efficient as compared with cephalic vein access, in a centre where no operators had any previous experience in axillary vein puncture. Patients undergoing pacemaker implantation were randomized to axillary or cephalic vein access. All three operators had no experience nor training in axillary vein puncture, and self-learned the technique by reading a published review. Axillary vein puncture was fluoroscopy-guided without contrast venography. Cephalic access was performed by dissection of delto-pectoral groove. Venous access success, venous access duration (from skin incision to guidewire or lead in superior vena cava), procedure duration, X-ray exposure, and peri-procedural (1 month) complications were recorded. results We randomized 74 consecutive patients to axillary (n = 37) or cephalic vein access (n = 37). Axillary vein was successfully accessed in 30/37 (81.1%) patients vs. 28/37 (75.7%) of cephalic veins (P = 0.57). Venous access time was shorter in axillary group than in cephalic group [5.7 (4.4-8.3) vs. 12.2 (10.5-14.8) min, P < 0.001], as well as procedure duration [34.8 (30.6-38.4) vs. 42.0 (39.1-46.6) min, P = 0.043]. X-ray exposure and peri-procedural overall complications were comparable in both groups. Axillary puncture was safe and faster than cephalic access even for the five first procedures performed by each operator. Self-taught axillary vein puncture for pacemaker implantation seems immediately safe and faster than cephalic vein access, when performed by electrophysiologists trained to pacemaker implantation but not to axillary vein puncture. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For Permissions, please email: journals.permissions@oup.com.

  6. Portal vein thrombosis is a potentially preventable complication in clinical islet transplantation

    Science.gov (United States)

    Kawahara, Toshiyasu; Kin, Tatsuya; Kashkoush, Samy; Gala-Lopez, Boris; Bigam, David L.; Kneteman, Norman M.; Koh, Angela; Senior, Peter A.; Shapiro, A.M. James

    2011-01-01

    Percutaneous transhepatic portal access avoids surgery, but is rarely associated with bleeding or portal venous thrombosis. We herein report our large, single-center experience of percutaneous islet implantation, and evaluate risk factors of portal vein thrombosis and graft function. Prospective data was collected on 268 intraportal islet transplants (122 subjects). A portal venous Doppler ultrasound was obtained on Days 1 and 7 days posttransplant. Therapeutic heparinization, complete ablation of the portal catheter tract with Avitene paste, and limiting packed cell volume to islet transplant procedures over the past 5 years. In the previous cumulative experience, partial thrombosis did not affect islet function. Standard liver volume correlated negatively (r=−0.257, Pislet transplantation, provided therapeutic anticoagulation is maintained, and packed cell volume is limited to <5 ml. PMID:21883914

  7. Grafting and curing

    International Nuclear Information System (INIS)

    Garnett, J.L.; Loo-Teck Ng; Visay Viengkhou

    1998-01-01

    Progress in radiation grafting and curing is briefly reviewed. The two processes are shown to be mechanistically related. The parameters influencing yields are examined particularly for grafting. For ionising radiation grafting systems (EB and gamma ray) these include solvents, substrate and monomer structure, dose and dose-rate, temperature and more recently role of additives. In addition, for UV grafting, the significance of photoinitiators is discussed. Current applications of radiation grafting and curing are outlined. The recent development of photoinitiator free grafting and curing is examined as well as the potential for the new excimer laser sources. The future application of both grafting and curing is considered, especially the significance of the occurrence of concurrent grafting during cure and its relevance in environmental considerations

  8. Relationship of serum S1P and HC-II levels with vasoactive substances and cytokines in patients with cerebral vascular restenosis after stent implantation

    Directory of Open Access Journals (Sweden)

    Yong Liu

    2017-04-01

    Full Text Available Objective: To study the relationship of serum sphingosine 1-phosphate (S1P and heparin cofactor II (HCII levels with vasoactive substances and cytokines in patients with cerebral vascular restenosis after stent implantation. Methods: 52 patients who received cerebrovascular stent implantation and developed restenosis in our hospital between May 2012 and December 2015 were collected as observation group, and 40 healthy patients with cerebrovascular stent implantation who had re-examination in our hospital during the same period were selected as control group. ELISA method was used to detect serum S1P and HC-II levels as well as vasoactive substance and inflammatory factor contents. Spearman correlation analysis was used to evaluate the relationship of serum S1P and HC-II levels with vasoactive substances and inflammatory factors. Results: Serum S1P and HC-II levels of observation group were lower than those of control group (P<0.05; serum vasoactive substances endothelin (ET, angiotensin II (AngII and thromboxane B2 (TXB2 contents of observation group were higher than those of control group while nitric oxide (NO content was lower than that of control group (P<0.05; serum inflammatory factors hypersensitive C-reactive protein (hs-CRP, interleukin-1 (IL-1, IL-6, IL-8 and IL-11 contents of observation group were higher than those of control group (P<0.05. Serum S1P and HC-II levels in patients with cerebral vascular restenosis after stent implantation were directly correlated with vasoactive substance and inflammatory factor contents. Conclusion: Serum S1P and HC-II levels decrease in patients with cerebral vascular restenosis after stent implantation, and it is an important cause of cerebral vascular dysfunction and systemic inflammatory response.

  9. Clinical implications of portal hemodynamics after small-diameter portacaval H graft

    International Nuclear Information System (INIS)

    Sarfeh, I.J.; Rypins, E.B.; Fardi, M.; Conroy, R.M.; Mason, G.R.; Lyons, K.P.

    1984-01-01

    To assess the role of portal hemodynamics in the development of postshunt encephalopathy, we studied 19 patients after small-diameter portacaval H grafting (SD-PCHG). We used contrast studies as well as technetium-labeled macroaggregated albumin injected into the portal vein to assess direction of portal flow. We then quantitated the mesenteric fraction of flow perfusing the liver by injecting macroaggregated albumin into a peripheral mesenteric vein tributary. We found that none of seven patients with prograde flow by both scintigraphy and angiography developed postoperative encephalopathy, but the incidence was 58% in the remaining patients (p . 0.02). The fraction of mesenteric flow perfusing the liver after SD-PCHG was 12% +/- 4%, but this did not significantly correlate with encephalopathy rates. We conclude that after SD-PCHG, prograde portal flow minimizes encephalopathy rates. Although encephalopathy occurs in patients with predominantly reversed flow, a subgroup of patients with reversed flow remain without symptoms. The absolute fraction of mesenteric flow perfusing the liver has less influence on encephalopathy rates than has direction of portal flow. This study identifies a complex relationship between portal hemodynamics and encephalopathy

  10. Vascular Reconstruction Technique Using a Tubular Graft for Leiomyosarcoma of the Inferior Vena Cava: A Case Report

    Directory of Open Access Journals (Sweden)

    C. Higutchi

    Full Text Available Objective/background: This study is a case report that addresses the key aspects of vascular reconstruction, as well as the intraoperative complications, postoperative morbidity, and possibility of adjunctive therapy. Methods: This article reports the case of a 46 year old female patient with a leiomyosarcoma located in the middle segment of the inferior vena cava (between the renal and hepatic veins who underwent surgical resection with vena cava reconstruction and insertion of a tubular graft made of a synthetic material. Results: This case report reveals that surgical resection of the tumor with the insertion of a smaller-caliber tubular graft provide better patency of the vena cava reconstruction, which was maintained for a year after surgery. In addition, the patient was asymptomatic for lower limb edema, despite having a local recurrence after one year. Surgical resection is the treatment of choice for leiomyosarcoma of the inferior vena cava (LIVC and is the only therapy that offers a chance of cure. Several surgical techniques are used for this condition, especially, reconstruction with a vascular graft using natural or synthetic materials. Conclusion: Due to the aggressiveness of the disease, this study suggests that surgical intervention used may have no influence on a patient's survival outcome. However, vascular reconstruction with a smaller-caliber tubular graft may yield a better prognosis for patients in terms of postoperative symptoms, such as edema and thrombosis. Keywords: Inferior vena cava, Leiomyosarcoma, Synthetic vascular grafting

  11. Portal vein thrombosis.

    Science.gov (United States)

    Chawla, Yogesh K; Bodh, Vijay

    2015-03-01

    Portal vein thrombosis is an important cause of portal hypertension. PVT occurs in association with cirrhosis or as a result of malignant invasion by hepatocellular carcinoma or even in the absence of associated liver disease. With the current research into its genesis, majority now have an underlying prothrombotic state detectable. Endothelial activation and stagnant portal blood flow also contribute to formation of the thrombus. Acute non-cirrhotic PVT, chronic PVT (EHPVO), and portal vein thrombosis in cirrhosis are the three main variants of portal vein thrombosis with varying etiological factors and variability in presentation and management. Procoagulant state should be actively investigated. Anticoagulation is the mainstay of therapy for acute non-cirrhotic PVT, with supporting evidence for its use in cirrhotic population as well. Chronic PVT (EHPVO) on the other hand requires the management of portal hypertension as such and with role for anticoagulation in the setting of underlying prothrombotic state, however data is awaited in those with no underlying prothrombotic states. TIPS and liver transplant may be feasible even in the setting of PVT however proper selection of candidates and type of surgery is warranted. Thrombolysis and thrombectomy have some role. TARE is a new modality for management of HCC with portal vein invasion.

  12. Treatment of carotid-siphon aneurysms by using willis stent-graft: an angiographic and histopathologic study in dogs

    International Nuclear Information System (INIS)

    Zhu Yueqi; Li Minghua; Xie Jian; Tan Huaqiao; Cheng Yingsheng; Wang Jianbo

    2010-01-01

    Objective: To establish a carotid siphon aneurysm model in dogs in order to test the mechanical features of a newly-designed Willis covered stent-graft and to investigate the histological reaction of the stent-implanted vessel during a follow-up period of 12 months. Methods: Twenty-four saccular sidewall aneurysms were surgically created in twelve dogs (group A) and 12 carotid siphon aneurysms in another twelve dogs (group B). A Willis stent-graft was implanted in each aneurysm. Angiography was performed immediately after the procedure and 1, 3, 6 and 12 months after the implantation to investigate the aneurysm isolation, endoleak, stent angulation, and the patency or restenosis of the parent artery. Light and scanning electronic microscopy were used to identify aneurysmal sac thrombi, intima hyperplasia and endothelial progress of the stent-loaded arterial segment. Results: In group B, postoperative immediate angiography demonstrated that two aneurysms had mild endoleak and three stents became angulated. Follow-up exam 12 months after the procedure revealed that all previous endoleaks disappeared, one parent artery became occluded and three parent arteries developed mild stenosis (< 50%). In group A, occlusion of parent artery was seen in one and mild stenosis (< 50%) in 2 cases. Electronic microscopy revealed new intima formation in all stents, and all aneurysmal sacs were filled with thrombi. In group B, the endothelialization process was not completed until 12 months after the stent implantation, and a marked correlation existed between endothelial cell arrangement and the hemodynamic orientation. Conclusion: It is feasible to treat carotid-siphon aneurysm in dog with a Willis stent-graft. The complete endothelialization of the covered stent in tortuous vessel takes longer time than that in rather straight vessel. (authors)

  13. Case report: Varicosity of the communicating vein between the left renal vein and the left ascending lumbar vein mimicking a renal artery aneurysm: Report of an unusual site of varicose veins and a novel hypothesis to explain its association with abdominal pain

    Directory of Open Access Journals (Sweden)

    Sandeep G Jakhere

    2011-01-01

    Full Text Available A communicating vein between the left renal vein and the left ascending lumbar vein has only rarely been reported in the imaging literature. There are very few reports of varicosity of this communicating vein. Nonetheless, awareness about this communicating vein is of utmost importance for surgeons performing aortoiliac surgeries and nephrectomies as it may pose technical difficulties during surgery or cause life-threatening retroperitoneal hemorrhage. Varicosity of this venous channel may be mistaken for paraaortic lymphadenopathy, adrenal pseudo-mass, or renal artery aneurysm. We report a case of a patient with varicosity of this communicating vein, which mimicked a left renal artery aneurysm. A novel hypothesis is also proposed to explain the relationship with abdominal pain.

  14. Interventional treatment of iliac vein compression syndrome

    International Nuclear Information System (INIS)

    Li Xiaoqiang; Zhou Weiming; Nie Zhonglin; Yu Chaowen

    2002-01-01

    Objective: To explore the clinical significance of interventional treatment of iliac vein compression syndrome (IVCS). Methods: Percutaneous transluminal angioplasty (PTA) was performed in 40 cases. Thirty-three cases underwent endovascular stent implantation and 27 cases underwent second-stage left saphenous vein ligation and stripping and the valves of left femoral veins narrowing. Thirty-one cases were followed-up postoperatively and the duration was 6-66 months (mean 28 months). Results: The dilation of iliac veins was successful in 36 cases and there were god efficacy in all patients when they discharged from hospital. Followed-up during post-operation, all the limbs ulcers were cured and varicose veins disappeared. The skin pigmentation disappeared in 17 of 19 cases and markedly relieved in 2 cases. Left lower limb swelling disappeared in 15 of 17 cases and relieved in 2 cases. Conclusion: There is good efficacy in the interventional treatment of left iliac vein lesions, but second-stage procedures should be performed in secondary lesions of saphenous veins and valves of femoral veins

  15. Grafting the alar rim: application as anatomical graft.

    Science.gov (United States)

    Gruber, Ronald P; Fox, Paige; Peled, Anne; Belek, Kyle A

    2014-12-01

    Alar rim contour and alar rim grafts have become essential components of rhinoplasty. Ideally, grafts of the nose should be anatomical in shape. So doing might make grafts of the alar rim more robust. The authors considered doing that by applying the graft as a continuous extension of the lateral crus. Twelve patients (two men and 10 women) constituted the study group (seven primary and five secondary cases). Of those, there were five concave rims, two concave rims with rim retraction, two boxy tips, and three cephalically oriented lateral crura. Surgical technique included the following: (1) an open approach was used; (2) a marginal incision that ignored the caudal margin of the lateral crus (the incision went straight posteriorly to a point 5 to 6 mm from the rim margin) was used; (3) a triangular graft was made to cover the exposed vestibular skin; (4) it was secured end to end to the caudal border of the lateral crus; and (5) the poster end was allowed to sit in a small subcutaneous pocket. Follow-up was 11 to 19 months. All 12 patients exhibited good rims as judged by a blinded panel. Rim retraction was not fully corrected in one patient, but no further treatment was required. One patient did require a secondary small rim graft for residual rim concavity. The concept of grafting the alar rim is strongly supported by the authors' results. The modifications the authors applied by designing the graft to be anatomical in shape has been a technical help.

  16. Matrix Metalloproteinases 2 and 3 Gene Polymorphisms and the Risk of Target Vessel Revascularization after Percutaneous Coronary Intervention: Is There Still Room for Determining Genetic Variation of MMPs for Assessment of an Increased Risk of Restenosis?

    Directory of Open Access Journals (Sweden)

    J.J.W. Verschuren

    2010-01-01

    Full Text Available Objective: Mixed results have been reported of matrix metalloproteinases (MMP and their association with restenosis after percutaneous coronary intervention (PCI. The current study examines whether multiple single nucleotide polymorphisms (SNPs, covering the full genomic region of MMP2 and MMP3, were associated with restenosis in the GENDER study population.

  17. Randomized controlled study of excimer laser atherectomy for treatment of femoropopliteal in-stent restenosis: initial results from the EXCITE ISR trial (EXCImer Laser Randomized Controlled Study for Treatment of FemoropopliTEal In-Stent Restenosis).

    Science.gov (United States)

    Dippel, Eric J; Makam, Prakash; Kovach, Richard; George, Jon C; Patlola, Raghotham; Metzger, D Christopher; Mena-Hurtado, Carlos; Beasley, Robert; Soukas, Peter; Colon-Hernandez, Pedro J; Stark, Matthew A; Walker, Craig

    2015-01-01

    The purpose of this study was to evaluate the safety and efficacy of excimer laser atherectomy (ELA) with adjunctive percutaneous transluminal angioplasty (PTA) versus PTA alone for treating patients with chronic peripheral artery disease with femoropopliteal bare nitinol in-stent restenosis (ISR). Femoropopliteal stenting has shown superiority to PTA for lifestyle-limiting claudication and critical limb ischemia, although treating post-stenting artery reobstruction, or ISR, remains challenging. The multicenter, prospective, randomized, controlled EXCITE ISR (EXCImer Laser Randomized Controlled Study for Treatment of FemoropopliTEal In-Stent Restenosis) trial was conducted across 40 U.S. centers. Patients with Rutherford Class 1 to 4 and lesions of target lesion length ≥4 cm, vessel diameter 5 to 7 mm were enrolled and randomly divided into ELA + PTA and PTA groups by a 2:1 ratio. The primary efficacy endpoint was target lesion revascularization (TLR) at 6-month follow up. The primary safety endpoint was major adverse event (death, amputation, or TLR) at 30 days post-procedure. Study enrollment was stopped at 250 patients due to early efficacy demonstrated at a prospectively-specified interim analysis. A total of 169 ELA + PTA subjects (62.7% male; mean age 68.5 ± 9.8 years) and 81 PTA patients (61.7% male; mean age 67.8 ± 10.3 years) were enrolled. Mean lesion length was 19.6 ± 12.0 cm versus 19.3 ± 11.9 cm, and 30.5% versus 36.8% of patients exhibited total occlusion. ELA + PTA subjects demonstrated superior procedural success (93.5% vs. 82.7%; p = 0.01) with significantly fewer procedural complications. ELA + PTA and PTA subject 6-month freedom from TLR was 73.5% versus 51.8% (p < 0.005), and 30-day major adverse event rates were 5.8% versus 20.5% (p < 0.001), respectively. ELA + PTA was associated with a 52% reduction in TLR (hazard ratio: 0.48; 95% confidence interval: 0.31 to 0.74). The EXCITE ISR trial is the first large, prospective, randomized study

  18. The angiographic demonstration of hepatic vein obstruction

    International Nuclear Information System (INIS)

    Zu Maoheng; Xu Hao; Li Guojun; Gu Yuming; Wei Ning; Wang Cheng; Xu Wei

    2004-01-01

    Objective: To evaluate the angiographic feature of hepatic vein obstruction. Methods Forty-five patients (male 23, female 22, age 9-54 years) suffered from hepatic vein obstruction. The inferior vena cavography and the hepatic venography were performed in all cases. Results: IVC was free in 37 patients with hepatic vein obstruction, both IVC and HV were obstructed in 8 patients. The local or long stenosis of IVC was found in 31 inferior vena cavography. The diameter of IVC was normal in 12 patients. The sign of membranous dome was found in hepatic vein orifice in 5 cases and in accessory hepatic vein orifice in 4 cases. Intrahepatic venous collaterals were found in 45 cases. Conclusion: Hepatic vein obstruction can be reproached primarily in inferior vena cavography, the membranous dome is a direct sign of membranous obstruction of HV and AHV in inferior vena cavography. The selected hepatic venography can provide reliable evidence to diagnose hepatic vein obstruction

  19. Effects of 32P radioactive stents on in-stent restenosis in a double stent injury model of the porcine coronary arteries

    International Nuclear Information System (INIS)

    Kim, Han-Soo; Chan, Rosanna C.; Kollum, Marc; Au, Arthur; Tio, Fermin O.; Yazdi, Hamid A.; Ajani, Andrew E.; Waksman, Ron

    2001-01-01

    Background: The major limitation of coronary stenting remains in-stent restenosis, due to the development of neointimal proliferation. Radioactive stents have demonstrated the ability to reduce this proliferation in the healthy nonatherosclerotic porcine animal model. However, inhibition of tissue proliferation in the in-stent restenotic lesion in a porcine model is not well characterized. The objective of this study was to examine the efficacy and safety of the 32 P radioactive stent for the treatment of in-stent restenosis in a double stent injury model of the porcine coronaries. Methods and Materials: Eighteen coronary arteries in 9 pigs underwent nonradioactive stent (8 mm in length) implantation. Thirty days after the initial stent implantation, a 32 P radioactive stent (18 mm in length) with an activity of 0 and 18 μCi was implanted to cover the initial stent. The swine were killed 30 days after the second stent implantation. Histomorphometric analysis was performed for vessel area (VA), stent strut area (SSA), intimal area (IA), and lumen area (LA). Results: Injury scores, VA, SSA, and LA were similar among the control and radiated groups. Neointimal formation was significantly reduced after placement of radioactive stents as compared to control in both the overlapped (0.93±0.12 vs. 1.31±0.51 mm 2 , p 2 , p 32 P radioactive stents may be safe and effective in reducing neointimal formation leading to in-stent restenosis. Longer follow-up will be required to examine whether these positive findings can be maintained

  20. Randomized comparison between intracoronary β-radiation brachytherapy and implantation of paclitaxel-eluting stents for the treatment of diffuse in-stent restenosis

    International Nuclear Information System (INIS)

    Schukro, Christoph; Syeda, Bonni; Kirisits, Christian; Schmid, Rainer; Pichler, Philipp; Pokrajac, Boris; Lang, Irene; Poetter, Richard; Glogar, Dietmar

    2007-01-01

    Background and purpose: Intracoronary brachytherapy was the primary therapeutic option for the treatment of in-stent restenosis (ISR) during the last years. Especially for the treatment of diffuse ISR (lesions >10 mm), β-source brachytherapy was significantly superior to singular balloon angioplasty. Despite lacking clinical database, the implantation of drug eluting stents recently became a common procedure for the treatment of ISR. This randomized trial aimed to compare the efficacy of β-brachytherapy with β-radioisotopes 90 Sr/ 90 Y and paclitaxel-eluting stent implantation for the treatment of diffuse ISR. Material and methods: Thirty-seven patients with diffuse ISR were randomly assigned to β-brachytherapy after balloon angioplasty (Beta-Cath TM in 17 patients) or paclitaxel-eluting stent implantation (Taxus-Express2 TM in 20 patients). Six-month clinical follow-up was obtained for all patients, while angiographic follow-up was available for 30 patients. Results: Binary ISR (restenosis >50%) within target segment was observed in three patients treated with Beta-Cath TM , of which one needed target segment revascularisation for recurrent ISR, whereas no significant restenosis occurred in the patients treated with Taxus-Express2 TM (P = 0.037). No further major adverse cardiac (target segment revascularisation, myocardial infarction, death) was found in either group (P = NS). Stent implantation was the more time-saving (31 ± 11 min versus 60 ± 23 min, P TM arm, we found no difference in clinical outcome after implantation of paclitaxel-eluting stents for the treatment of diffuse ISR when compared to β-brachytherapy

  1. A Vein Map Biometric System

    Directory of Open Access Journals (Sweden)

    Felix Fuentes

    2013-08-01

    Full Text Available There is increasing demand world-wide, from government agencies and the private sector for cutting-edge biometric security technology that is difficult to breach but userfriendly at the same time. Some of the older tools, such as fingerprint, retina and iris scanning, and facial recognition software have all been found to have flaws and often viewed negatively because of many cultural and hygienic issues associated with them. Comparatively, mapping veins as a human barcode, a new technology, has many advantages over older technologies. Specifically, reproducing a three-dimensional model of a human vein system is impossible to replicate. Vein map technology is distinctive because of its state-of-the-art sensors are only able to recognize vein patterns if hemoglobin is actively flowing through the person

  2. No association between metal allergy and cardiac in-stent restenosis in patients with dermatitis-results from a linkage study

    DEFF Research Database (Denmark)

    Thyssen, Jacob P; Engkilde, Kåre; Menné, Torkil

    2011-01-01

    Background. Percutaneous coronary intervention (PCI) with implantation of a metal stent is a common procedure performed in patients with symptomatic ischaemic heart disease. Intracoronary stents typically have a backbone of stainless steel, which contains nickel, chromium, and molybdenum, and it ......Background. Percutaneous coronary intervention (PCI) with implantation of a metal stent is a common procedure performed in patients with symptomatic ischaemic heart disease. Intracoronary stents typically have a backbone of stainless steel, which contains nickel, chromium, and molybdenum......, and it remains unclear whether individuals who are allergic to these metals have an increased risk of restenosis after PCI with stent implantation. Objectives. To further evaluate whether dermatitis patients with nickel and/or chromium allergy had an increased risk of developing cardiac in-stent restenosis...... with stainless steel stents. Methods. An individual-level linkage study was performed to identify dermatitis patients who had been patch tested with the European baseline series between 1979 and 2007 at Gentofte University Hospital (N = 18794) and who had also undergone PCI at some point in a Danish hospital...

  3. Deep vein thrombosis of the leg

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Hee; Rhee, Kwang Woo; Jeon, Suk Chul; Joo, Kyung Bin; Lee, Seung Ro; Seo, Heung Suk; Hahm, Chang Kok [College of Medicine, Hanyang University, Seoul (Korea, Republic of)

    1987-04-15

    Ascending contrast venography is the definitive standard method for the diagnosis of deep vein thrombosis (DVT) of the lower extremities. Authors analysed 22 cases of DVT clinically and radiographically. 1.The patients ranged in age from 15 to 70 yrs and the most prevalent age group was 7th decade (31%). There was an equal distribution of males and females. 2.In 11 cases of 22 cases, variable etiologic factors were recognized, such as abdominal surgery, chronic bedridden state, local trauma on the leg, pregnancy, postpartum, Behcet's syndrome, iliac artery aneurysm, and chronic medication of estrogen. 3.Nineteen cases out of 22 cases showed primary venographic signs of DVT, such as well-defined filling defect in opacified veins and narrowed, irregularly filled venous lumen. In only 3 cases, the diagnosis of DVT was base upon the segmental nonvisualization of deep veins with good opacification of proximal and distal veins and presence of collaterals. 4.Extent of thrombosis: 3 cases were confined to calf vein, 4 cases extended to femoral vein, and 15 cases had involvement above iliac vein. 5.In 17 cases involving relatively long segment of deep veins, propagation pattern of thrombus was evaluated by its radiologic morphology according to the age of thrombus: 9 cases suggested central or antegrade propagation pattern and 8 cases, peripheral or retrograde pattern. 6.None of 22 cases showed clinical evidence of pulmonary embolism. The cause of the rarity of pulmonary embolism in Korean in presumed to be related to the difference in major involving site and propagation pattern of DVT in the leg.

  4. Deep vein thrombosis of the leg

    International Nuclear Information System (INIS)

    Lee, Eun Hee; Rhee, Kwang Woo; Jeon, Suk Chul; Joo, Kyung Bin; Lee, Seung Ro; Seo, Heung Suk; Hahm, Chang Kok

    1987-01-01

    Ascending contrast venography is the definitive standard method for the diagnosis of deep vein thrombosis (DVT) of the lower extremities. Authors analysed 22 cases of DVT clinically and radiographically. 1.The patients ranged in age from 15 to 70 yrs and the most prevalent age group was 7th decade (31%). There was an equal distribution of males and females. 2.In 11 cases of 22 cases, variable etiologic factors were recognized, such as abdominal surgery, chronic bedridden state, local trauma on the leg, pregnancy, postpartum, Behcet's syndrome, iliac artery aneurysm, and chronic medication of estrogen. 3.Nineteen cases out of 22 cases showed primary venographic signs of DVT, such as well-defined filling defect in opacified veins and narrowed, irregularly filled venous lumen. In only 3 cases, the diagnosis of DVT was base upon the segmental nonvisualization of deep veins with good opacification of proximal and distal veins and presence of collaterals. 4.Extent of thrombosis: 3 cases were confined to calf vein, 4 cases extended to femoral vein, and 15 cases had involvement above iliac vein. 5.In 17 cases involving relatively long segment of deep veins, propagation pattern of thrombus was evaluated by its radiologic morphology according to the age of thrombus: 9 cases suggested central or antegrade propagation pattern and 8 cases, peripheral or retrograde pattern. 6.None of 22 cases showed clinical evidence of pulmonary embolism. The cause of the rarity of pulmonary embolism in Korean in presumed to be related to the difference in major involving site and propagation pattern of DVT in the leg

  5. Bilateral meandering pulmonary veins

    Energy Technology Data Exchange (ETDEWEB)

    Thupili, Chakradhar R.; Udayasankar, Unni [Pediatric Imaging, Imaging Institute Cleveland Clinic, Cleveland, OH (United States); Renapurkar, Rahul [Imaging Institute Cleveland Clinic, Thoracic Imaging, L10, Cleveland, OH (United States)

    2015-06-15

    Meandering pulmonary veins is a rare clinical entity that can be mistaken for more complex congenital syndromes such as hypogenetic lung syndrome. We report imaging findings in a rare incidentally detected case of bilateral meandering pulmonary veins. We briefly discuss the role of imaging in diagnosing this condition, with particular emphasis on contrast-enhanced CT. (orig.)

  6. Nanofat grafting under a split-thickness skin graft for problematic wound management.

    Science.gov (United States)

    Kemaloğlu, Cemal Alper

    2016-01-01

    Obesity and certain medical disorders make the reconstruction of skin defects challenging. Different kind of procedure can be used for these defect, besides, skin grafting is one of the most common and simplest procedure. Fat grafting and stem cells which are located in the adipose tissue have been commonly used in plastic surgery for regeneration and rejuvenation purposes. To decrease graft failure rate we performed nanofat grafting under an autologous split-thickness skin graft in our patient who had a problematic wound. The case of a 35-year-old female patient with a traumatic skin defect on her left anterior crural region is described herein. After subsequent flap reconstruction, the result was disappointing and the defect size was widened. The defect was treated with combined grafting (nanofat grafting under an autologous split-thickness skin graft). At the 6 months follow-up assessment after combined grafting, the integrity of the skin graft was good with excellent pliability. Combined grafting for problematic wounds seems to be a useful technique for cases requiring reconstruction. The potential existence of stem cells may be responsible for the successful result in our patient.

  7. Resveratrol combined with total flavones of hawthorn alleviate the endothelial cells injury after coronary bypass graft surgery.

    Science.gov (United States)

    Zhu, Ying; Feng, Bing; He, Songmin; Su, Zuqing; Zheng, Guangjuan

    2018-02-01

    To explore the preventive and therapeutic effects of Resveratrol combined with total flavones of hawthorn, compatibility of traditional Chinese medicines, on the endothelial cells injury after artery bypass graft surgery. The animal model of coronary artery bypass grafting (CABG) was prepared by transplanting a segment of autologous jugular vein onto the transected common carotid artery in rabbits. After CABG surgery, the rabbits were administrated with saline (model group), aspirin (Aspirin group), resveratrol (Res group), total flavones of hawthorn (Haw group) and resveratrol combined with total flavones of hawthorn (Res+Haw group) once a day for eight weeks, respectively. Eight weeks later, the grafting arteries from all group were obtained for the pathomorphism observation, peripheral blood was collected to detect circulating endothelial cells (CECs) by flow cytometry. And the concentration of albumen and mRNA of ICAM-1 in the serum were measured by western blot and quantitative real-time polymerase chain reaction, respectively. Compared with the model group, the level of CECs density and the expressions of albumen and mRNA of ICAM-1 were significantly decreased in the aspirin,resveratrol,total flavones of hawthorn and resveratrol combined with total flavones of hawthorn groups (P Resveratrol combined with total flavones of hawthorn could protect the endothelial cells after coronary artery bypass graft. Copyright © 2018 Elsevier GmbH. All rights reserved.

  8. The veining phenomenon in unalloyed plutonium

    International Nuclear Information System (INIS)

    White, J.S.

    1976-01-01

    An investigation has been made of the veining phenomenon in unalloyed plutonium. The surface markings, or veins, which are sometimes seen on α-phase plutonium samples, arise as a result of the β→α transformation. As far as is known, this veining is unrivalled in its scale and form as compared with the solid state surface transformation effects shown by any other metal. The phenomenon has been explained by the application of the Le Chatelier principle to the phase change. In this instance, the large (10%) volume contraction associated with the β→α reaction and the anisotropy of the nonoclinic α-phase structure, account for the fact that the veins are so prominent in plutonium. On the basis of the proposed model, the veins can only form at temperatures where the transformation mechanism is non-martensitic. (Auth.)

  9. Effect of bidispersity in grafted chain length on grafted chain conformations and potential of mean force between polymer grafted nanoparticles in a homopolymer matrix.

    Science.gov (United States)

    Nair, Nitish; Wentzel, Nathaniel; Jayaraman, Arthi

    2011-05-21

    In efforts to produce polymeric materials with tailored physical properties, significant interest has grown around the ability to control the spatial organization of nanoparticles in polymer nanocomposites. One way to achieve controlled particle arrangement is by grafting the nanoparticle surface with polymers that are compatible with the matrix, thus manipulating the interfacial interactions between the nanoparticles and the polymer matrix. Previous work has shown that the molecular weight of the grafted polymer, both at high grafting density and low grafting density, plays a key role in dictating the effective inter-particle interactions in a polymer matrix. At high grafting density nanoparticles disperse (aggregate) if the graft molecular weight is higher (lower) than the matrix molecular weight. At low grafting density the longer grafts can better shield the nanoparticle surface from direct particle-particle contacts than the shorter grafts and lead to the dispersion of the grafted particles in the matrix. Despite the importance of graft molecular weight, and evidence of non-trivial effects of polydispersity of chains grafted on flat surfaces, most theoretical work on polymer grafted nanoparticles has only focused on monodisperse grafted chains. In this paper, we focus on how bidispersity in grafted chain lengths affects the grafted chain conformations and inter-particle interactions in an implicit solvent and in a dense homopolymer polymer matrix. We first present the effects of bidispersity on grafted chain conformations in a single polymer grafted particle using purely Monte Carlo (MC) simulations. This is followed by calculations of the potential of mean force (PMF) between two grafted particles in a polymer matrix using a self-consistent Polymer Reference Interaction Site Model theory-Monte Carlo simulation approach. Monte Carlo simulations of a single polymer grafted particle in an implicit solvent show that in the bidisperse polymer grafted particles

  10. Unusual termination of the right testicular vein | Woldeyes | Anatomy ...

    African Journals Online (AJOL)

    The testicular veins are formed by the veins emerging from the testis and epididymis forming the pampiniform venous plexus. The right testicular vein drains into inferior vena cava and the left testicular vein to the left renal vein. Testicular veins display a great variability with regard to their number, course and sites of ...

  11. Bone grafting: An overview

    Directory of Open Access Journals (Sweden)

    D. O. Joshi

    2010-08-01

    Full Text Available Bone grafting is the process by which bone is transferred from a source (donor to site (recipient. Due to trauma from accidents by speedy vehicles, falling down from height or gunshot injury particularly in human being, acquired or developmental diseases like rickets, congenital defects like abnormal bone development, wearing out because of age and overuse; lead to bone loss and to replace the loss we need the bone grafting. Osteogenesis, osteoinduction, osteoconduction, mechanical supports are the four basic mechanisms of bone graft. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. An ideal bone graft material is biologically inert, source of osteogenic, act as a mechanical support, readily available, easily adaptable in terms of size, shape, length and replaced by the host bone. Except blood, bone is grafted with greater frequency. Bone graft indicated for variety of orthopedic abnormalities, comminuted fractures, delayed unions, non-unions, arthrodesis and osteomyelitis. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. By adopting different procedure of graft preservation its antigenicity can be minimized. The concept of bone banking for obtaining bone grafts and implants is very useful for clinical application. Absolute stability require for successful incorporation. Ideal bone graft must possess osteogenic, osteoinductive and osteocon-ductive properties. Cancellous bone graft is superior to cortical bone graft. Usually autologous cancellous bone graft are used as fresh grafts where as allografts are employed as an alloimplant. None of the available type of bone grafts possesses all these properties therefore, a single type of graft cannot be recomm-ended for all types of orthopedic abnormalities. Bone grafts and implants can be selected as per clinical problems, the equipments available and preference of

  12. An unusual case: right proximal ureteral compression by the ovarian vein and distal ureteral compression by the external iliac vein

    Directory of Open Access Journals (Sweden)

    Halil Ibrahim Serin

    2015-12-01

    Full Text Available A 32-years old woman presented to the emergency room of Bozok University Research Hospital with right renal colic. Multidetector computed tomography (MDCT showed compression of the proximal ureter by the right ovarian vein and compression of the right distal ureter by the right external iliac vein. To the best of our knowledge, right proximal ureteral compression by the ovarian vein together with distal ureteral compression by the external iliac vein have not been reported in the literature. Ovarian vein and external iliac vein compression should be considered in patients presenting to the emergency room with renal colic or low back pain and a dilated collecting system.

  13. Saphenous vein graft near-infrared spectroscopy imaging insights from the lipid core plaque association with clinical events near-infrared spectroscopy (ORACLE-NIRS) registry.

    Science.gov (United States)

    Danek, Barbara A; Karatasakis, Aris; Alame, Aya J; Nguyen-Trong, Phuong-Khanh J; Karacsonyi, Judit; Rangan, Bavana; Roesle, Michele; Atwell, Amy; Resendes, Erica; Martinez-Parachini, Jose Roberto; Iwnetu, Rahel; Kalsaria, Pratik; Siddiqui, Furqan; Muller, James E; Banerjee, Subhash; Brilakis, Emmanouil

    2017-05-01

    We sought to examine near-infrared spectroscopy (NIRS) imaging findings of aortocoronary saphenous vein grafts (SVGs). SVGs are prone to develop atherosclerosis similar to native coronary arteries. They have received little study using NIRS. We examined the clinical characteristics and imaging findings from 43 patients who underwent NIRS imaging of 45 SVGs at our institution between 2009 and 2016. The mean patient age was 67 ± 7 years and 98% were men, with high prevalence of diabetes mellitus (56%), hypertension (95%), and dyslipidemia (95%). Mean SVG age was 7 ± 7 years, mean SVG lipid core burden index (LCBI) was 53 ± 60 and mean maxLCBI 4 mm was 194 ± 234. Twelve SVGs (27%) had lipid core plaques (2 yellow blocks on the block chemogram), with a higher prevalence in SVGs older than 5 years (46% vs. 5%, P = 0.002). Older SVG age was associated with higher LCBI (r = 0.480, P < 0.001) and higher maxLCBI 4 mm (r = 0.567, P < 0.001). On univariate analysis, greater annual total cholesterol exposure was associated with higher SVG LCBI (r = 0.30, P = 0.042) and annual LDL-cholesterol and triglyceride exposure were associated with higher SVG maxLCBI 4 mm (LDL-C: r = 0.41, P = 0.020; triglycerides: r = 0.36, P = 0.043). On multivariate analysis, the only independent predictor of SVG LCBI and maxLCBI 4mm was SVG age. SVG percutaneous coronary intervention was performed in 63% of the patients. An embolic protection device was used in 96% of SVG PCIs. Periprocedural myocardial infarction occurred in one patient. Older SVG age and greater lipid exposure are associated with higher SVG lipid burden. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  14. Investigation of adverse events associated with an off-label use of arterial stents and CE-marked iliac vein stents in the iliac vein: insights into developing a better iliac vein stent.

    Science.gov (United States)

    Shida, Takuya; Umezu, Mitsuo; Iwasaki, Kiyotaka

    2018-06-01

    We analyzed the adverse events associated with an off-label use of arterial stents and CE-marked iliac vein stents for the treatment of iliac venous thromboembolism and investigated their relationships with the anatomical features of the iliac vein, to gain insights into the development of a better iliac vein stent. Reports of adverse events following the use of stents in the iliac vein were retrieved from the Manufacturer and User Facility Device Experience (MAUDE) database that contain suspected device-associated complications reported to the Food and Drug Administration. Data from 2006 to 2016 were investigated. The literature analysis was also conducted using PubMed, Cochrane Library, EMBASE, and Web of Science focusing on English articles published up to 4 October 2016. The analysis of 88 adverse events from the MAUDE database and 182 articles from the literature revealed that a higher number of adverse events had been reported following the use of arterial stents in the iliac vein compared to CE-marked iliac vein stents. While stent migration and shortening were reported only for the arterial stents, stent fracture and compression occurred regardless of the stent type, even though a vein does not pulsate. A study of the anatomical features of the iliac vein implies that bending, compression, and kink loads are applied to the iliac vein stents in vivo. For designing, developing, and pre-clinical testing of stents intended for use in the iliac vein, the above mechanical load environments induced by the anatomical features should be considered.

  15. Preoperative mapping of the saphenous vein

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Sillesen, H; Nielsen, Tina G

    1995-01-01

    A consecutive series of 92 patients had their greater saphenous vein assessed with duplex ultrasound scanning prior to planned infrainguinal bypass procedures. A naturally occurring optimal vein diameter was discovered. It was significantly correlated with higher postoperative ankle-brachial pres......-brachial pressure index (ABI) and lesser early postoperative thrombosis. A significant linear regression was found between the pre and postoperative vein diameter....

  16. The CT appearance of the superior intercostal veins

    International Nuclear Information System (INIS)

    Lund, G.

    1982-01-01

    The CT appearance of the superior intercostal veins is described. The veins are more frequently seen on the right side. The right superior intercostal vein should not be misinterpreted as a paraspinal mass when it is large or bulges into the contour of the right lung. A case of stenosis of the left brachiocephalic vein is shown, where the left superior intercostal vein serves as a collateral. (orig.)

  17. Aggravated restenosis and atherogenesis in ApoCIII transgenic mice but lack of protection in ApoCIII knockouts: the effect of authentic triglyceride-rich lipoproteins with and without ApoCIII.

    Science.gov (United States)

    Li, Haibo; Han, Yingchun; Qi, Rong; Wang, Yuhui; Zhang, Xiaohong; Yu, Maomao; Tang, Yin; Wang, Mengyu; Shu, Ya-Nan; Huang, Wei; Liu, Xinfeng; Rodrigues, Brian; Han, Mei; Liu, George

    2015-09-01

    Previously, our group and others have demonstrated a causative relationship between severe hypertriglyceridaemia and atherogenesis in mice. Furthermore, clinical investigations have shown high levels of plasma Apolipoprotein C-III (ApoCIII) associated with hypertriglyceridaemia and even cardiovascular disease. However, it remains unclear whether ApoCIII affects restenosis in vivo, and whether such an effect is mediated by ApoCIII alone, or in combination with hypertriglyceridaemia. We sought to investigate ApoCIII in restenosis and clarify how smooth muscle cells (SMCs) respond to authentic triglyceride-rich lipoproteins (TRLs) with or without ApoCIII (TRLs ± ApoCIII). ApoCIII transgenic (ApoCIIItg) and knockout (ApoCIII-/-) mice underwent endothelial denudation to model restenosis. Here, ApoCIIItg mice displayed severe hypertriglyceridaemia and increased neointimal formation compared with wild-type (WT) or ApoCIII-/- mice. Furthermore, increased proliferating cell nuclear antigen (PCNA)-positive cells, Mac-3, and vascular cell adhesion protein-1 (VCAM-1) expression, and 4-hydroxynonenal (4HNE) production were found in lesion sites. ApoCIIItg and ApoCIII-/- mice were then crossed to low-density lipoprotein receptor-deficient (Ldlr-/-) mice and fed an atherogenic diet. ApoCIIItg/Ldlr-/- mice had significantly increased atherosclerotic lesions. However, there was no statistical difference in restenosis between ApoCIII-/- and WT mice, and in atherosclerosis between ApoCIII/Ldlr double knockout and Ldlr-/- mice. SMCs were then incubated in vitro with authentic TRLs ± ApoCIII isolated from extreme hypertriglyceridaemia glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1-deficient (GPIHBP1-/-) mice crossed with ApoCIIItg or ApoCIII-/- mice. It was shown that TRLs + ApoCIII promoted SMC proliferation, VCAM-1 expression, and reactive oxygen species (ROS) production, and activated the Akt pathway. Scavenging ROS significantly reduced SMC

  18. Balloon-occluded retrograde transvenous obliteration of gastric varix draining via the left inferior phrenic vein into the left hepatic vein

    International Nuclear Information System (INIS)

    Ibukuro, Kenji; Mori, Koichi; Tsukiyama, Toshitaka; Inoue, Yoshihiro; Iwamoto, Yukako; Tagawa, Kazumi

    1999-01-01

    We encountered a patient with gastric varix draining not via the usual left suprarenal vein but via the left inferior phrenic vein joining the left hepatic vein. Transfemoral balloon-occluded retrograde transvenous obliteration (BRTO) of the varix was performed under balloon occlusion of the left inferior phrenic vein via the left hepatic vein and retrograde injection of the sclerosing agent (5% of ethanolamine oleate) into the gastric varix. Disappearance of the gastric varix was confirmed on endoscopic examination 2 months later.

  19. Leiomyosarcoma of the inferior vena cava level II involvement: curative resection and reconstruction of renal veins

    Directory of Open Access Journals (Sweden)

    Wang Quan

    2012-06-01

    Full Text Available Abstract Leiomyosarcoma of the inferior vena cava (IVCL is a rare retroperitoneal tumor. We report two cases of level II (middle level, renal veins to hepatic veins IVCL, who underwent en bloc resection with reconstruction of bilateral or left renal venous return using prosthetic grafts. In our cases, IVCL is documented to be occluded preoperatively, therefore, radical resection of tumor and/or right kidney was performed and the distal end of inferior vena cava was resected and without caval reconstruction. None of the patients developed edema or acute renal failure postoperatively. After surgical resection, adjuvant radiation therapy was administrated. The patients have been free of recurrence 2 years and 3 months, 9 months after surgery, respectively, indicating the complete surgical resection and radiotherapy contribute to the better survival. The reconstruction of inferior vena cava was not considered mandatory in level II IVCL, if the retroperitoneal venous collateral pathways have been established. In addition to the curative resection of IVCL, the renal vascular reconstruction minimized the risks of procedure-related acute renal failure, and was more physiologically preferable. This concept was reflected in the treatment of the two patients reported on.

  20. Vein Patch Closure Using Below the Knee Greater Saphenous Vein for Femoral Endarterectomy Procedures is Not Always a Safe Choice

    Directory of Open Access Journals (Sweden)

    M. Berner

    Full Text Available : Background: The complication of vein patch rupture is well described after carotid patch angioplasty; however, there is a paucity of data about the safety of vein patch closure in the setting of femoral endarterectomy. Methods/results: From May 2012 to May 2015, 115 femoral endarterectomies with patch closure were performed. A patch rupture occurred in three cases (2.6% with a mortality rate of 66% (2/3. In all cases the greater saphenous vein below the knee was used as patch material. Discussion/conclusion: Vein patches, particularly from small calibre veins, should be excluded in femoral endarterectomy procedures as they pose a substantial risk of rupture. Keywords: Angioplasty, Patch rupture, Femoral artery, Patch, Great saphenous vein

  1. Varicose Veins: Role of Mechanotransduction of Venous Hypertension

    Science.gov (United States)

    Atta, Hussein M.

    2012-01-01

    Varicose veins affect approximately one-third of the adult population and result in significant psychological, physical, and financial burden. Nevertheless, the molecular pathogenesis of varicose vein formation remains unidentified. Venous hypertension exerted on veins of the lower extremity is considered the principal factor in varicose vein formation. The role of mechanotransduction of the high venous pressure in the pathogenesis of varicose vein formation has not been adequately investigated despite a good progress in understanding the mechanomolecular mechanisms involved in transduction of high blood pressure in the arterial wall. Understanding the nature of the mechanical forces, the mechanosensors and mechanotransducers in the vein wall, and the downstream signaling pathways will provide new molecular targets for the prevention and treatment of varicose veins. This paper summarized the current understanding of mechano-molecular pathways involved in transduction of hemodynamic forces induced by blood pressure and tries to relate this information to setting of venous hypertension in varicose veins. PMID:22489273

  2. Arteriovenous shunt graft ulceration with sinus and graft epithelialization

    Directory of Open Access Journals (Sweden)

    Pooja Singhal

    2015-03-01

    Full Text Available Arteriovenous fistula and grafts are used as access sites for patients with chronic kidney disease and are prone for complications. Stent grafts are used to treat access site complications. We report a rare and unusual finding of epithelialization of the sinus tract and the lumen of a polytetrafluoroethylene graft, following ulceration of the overlying skin.

  3. [Deep vein thrombosis prophylaxis.

    Science.gov (United States)

    Sandoval-Chagoya, Gloria Alejandra; Laniado-Laborín, Rafael

    2013-01-01

    Background: despite the proven effectiveness of preventive therapy for deep vein thrombosis, a significant proportion of patients at risk for thromboembolism do not receive prophylaxis during hospitalization. Our objective was to determine the adherence to thrombosis prophylaxis guidelines in a general hospital as a quality control strategy. Methods: a random audit of clinical charts was conducted at the Tijuana General Hospital, Baja California, Mexico, to determine the degree of adherence to deep vein thrombosis prophylaxis guidelines. The instrument used was the Caprini's checklist for thrombosis risk assessment in adult patients. Results: the sample included 300 patient charts; 182 (60.7 %) were surgical patients and 118 were medical patients. Forty six patients (15.3 %) received deep vein thrombosis pharmacologic prophylaxis; 27.1 % of medical patients received deep vein thrombosis prophylaxis versus 8.3 % of surgical patients (p < 0.0001). Conclusions: our results show that adherence to DVT prophylaxis at our hospital is extremely low. Only 15.3 % of our patients at risk received treatment, and even patients with very high risk received treatment in less than 25 % of the cases. We have implemented strategies to increase compliance with clinical guidelines.

  4. Anomalous adrenal vein anatomy complicating the evaluation of primary hyperaldosteronism

    Directory of Open Access Journals (Sweden)

    Kaitlin M. Ford, BS

    2018-02-01

    Full Text Available Adrenal vein development in utero occurs concurrently with the development of the inferior vena cava, the renal veins, and the gonadal veins. The embryologic formation of these veins involves communication of various venous systems. Although the left adrenal-renal vein complex is most commonly described as a shared emptying of the left adrenal vein and the left inferior phrenic vein into the left renal vein, there have been reports of numerous anatomic variations of this complex. In this report, we present a case of a rare variant of the left adrenal vein, in which the left adrenal vein empties into the left gonadal vein, which takes an atypical course superolateral to the left kidney.

  5. On dynamics of uranium vein mineralization

    International Nuclear Information System (INIS)

    Petrosyan, R.V.

    1981-01-01

    The formation of urnaium vein deposits and the essence of consanguinity of the mineralization and wall metasomatites are considered. The formation of uranium mineralization is analysed from the positions of Korzhinsky D. S. : the formation of metasomatite aureole and associated vein ores take place as a result of the development of one solution flow while the formation of mineral vein associations occurs on the background of contineous filtration of the solution during metasomato is due to a repeated (pulse) half-opening of fractures and their filling with a part of filtrating solution. The analysis of the available information on the example of two different uranium manifestations permits to reveal certain relations both in the character of wall rock alterations and between the metasomatosis and the formation of ore minerals in veins. The conclusion is made that spatial-time correlations of vein formations with wall metasomatites attest that the pulse formation of ores in veinlets occurs on the background and in interrelation with a consecutive precipitation of components in the aureole volume. The analysis of element migration dynamics in wall aureole carried out from the positions of the Korzhinsky hypothesis of the advance wave of acid components that takes into account the interaction of continuous and pulse mechanisms of solution movement permits to avoid contradictions when interpreting the processes of wall rock alterations and vein ore-forming, and permits to make a common scheme of vein ore-genesis [ru

  6. Role of graft oversizing in the fixation strength of barbed endovascular grafts.

    Science.gov (United States)

    Kratzberg, Jarin A; Golzarian, Jafar; Raghavan, Madhavan L

    2009-06-01

    The role of endovascular graft oversizing on risk of distal graft migration following endovascular aneurysm repair for abdominal aortic aneurysm is poorly understood. A controlled in vitro investigation of the role of oversizing in graft-aorta attachment strength for endovascular grafts (EVGs) with barbs was performed. Barbed stent grafts (N = 20) with controlled graft oversizing varying from 4-45% were fabricated while maintaining other design variables unchanged. A flow loop with physiological flow characteristics and a biosynthetic aortic aneurysm phantom (synthetic aneurysm model with a bovine aortic neck) were developed. The stent grafts were deployed into the aortic neck of the bio-synthetic aortic aneurysm phantom under realistic flow conditions. Computed tomography imaging of the graft-aorta complex was used to document attachment characteristics such as graft apposition, number of barbs penetrated, and penetration depth and angle. The strength of graft attachment to the aortic neck was assessed using mechanical pullout testing. Stent grafts were categorized into four groups based on oversizing: 4-10%; 11-20%; 21-30%; and greater than 30% oversizing. Pullout force, a measure of post-deployment fixation strength was not different between 4-10% (6.23 +/- 1.90 N), 11-20% (6.25 +/- 1.84 N) and 20-30% (5.85 +/- 1.89 N) groups, but significantly lower for the group with greater than 30% oversizing (3.67 +/- 1.41 N). Increasing oversizing caused a proportional decrease in the number of barbs penetrating the aortic wall (correlation = -0.83). Of the 14 barbs available in the stent graft, 89% of the barbs (12.5 of 14 on average) penetrated the aortic wall in the 4-10% oversizing group while only 38% (5.25 of 14) did for the greater than 30% group (P barb penetration were found to be positively correlated to pullout force. Greater than 30% graft oversizing affects both barb penetration and graft apposition adversely resulting in a low pullout force in this in vitro

  7. A Morphological Insight of the Femoral Vein

    Directory of Open Access Journals (Sweden)

    Ferreira AH

    2015-10-01

    Full Text Available A total of 13 cadavers (12 men and 1 women of different age group were used for the study with the purpose to determine the prevalence of femoral vein duplication. Lower limb regions (26 sides were carefully dissected as per the standard dissection procedure. Femoral vein (unitruncular was found in 96.15% of specimen. Bitruncular configurations (total bifidity was found in a male cadaver of 75 years of age (3.85%. In the right lower limb, 6.5 cms below the inguinal ligament the femoral vein - lateral ramus received the lateral circumflex femoral vein, and the medial circumflex femoral vein, and the lateral and medial ramii formed a common venous trunk. Knowledge of the truncular venous variations is important to recognize and avoid potential errors in diagnosis of deep venous thrombosis of the femoral vein, in the case of an occluded duplicated trunk.

  8. Cavernous transformation of the portal vein

    International Nuclear Information System (INIS)

    Lehotska, V.; Dostalova, K.; Durkovsky, A.; Samal, V.

    1995-01-01

    In this contribution, the authors give an account of a rare case of a cavernous transformation of the portal vein that may have originated secondarily in a proliferative hematogenous disease with a polyglobulia and thrombosis in the periferal blood count as well as development of portal hypertension of a prehepatal type. The state of hyper-coagulation in a myeloproliferative disease may have lead to a chronic thrombosis of the portal vein with a subsequent malformation of the portal vein in terms of a cavernous transformation of the portal vein. The case is an interesting one because of the discrepancy between the gravity of the thrombotic complication and slightness of the symptoms in the clinical picture. The authors point out the importance of ultrasonography and computed tomography examination following the intravenous application of a water solution of a contrast medium in a morphologic diagnosing of a rare complication of a chronic thrombotic clot of the portal vein - the cavernous transformation. (authors)

  9. Varicose Vein Treatment (Endovenous Ablation of Varicose Veins)

    Science.gov (United States)

    ... associated veins. top of page What are the benefits vs. risks? Benefits No surgical incision is needed—only a small ... risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in ...

  10. Preduodenal portal vein: its surgical significance.

    Science.gov (United States)

    Makey, D A; Bowen, J C

    1978-11-01

    Preduodenal portal vein is a rare anatomical variant which may be one of many anomalies in the neonate with duodenal "atresia." Preduodenal portal vein also may be an occasional finding in an adult undergoing biliary, gastric, or pancreatic surgery. Awareness and recognition of the anomaly are essential for the avoidance of injury during such operations. We report here a symptomless patient whose preduodenal portal vein was discovered at cholecystectomy.

  11. Multimodal ultrasonographic assessment of leiomyosarcoma of the femoral vein in a patient misdiagnosed as having deep vein thrombosis: A case report.

    Science.gov (United States)

    Zhang, Mei; Yan, Feng; Huang, Bin; Wu, Zhoupeng; Wen, Xiaorong

    2017-11-01

    Primary leiomyosarcoma (LMS) of the vein is a rare tumor that arises from the smooth muscle cells of the vessel wall and has an extremely poor prognosis. This tumor can occur in vessels such as the inferior vena cava, great saphenous vein, femoral vein, iliac vein, popliteal vein, and renal vein; the inferior vena cava is the most common site. LMS of the femoral vein can result in edema and pain in the lower extremity; therefore, it is not easy to be differentiated from deep vein thrombosis (DVT). Moreover, virtually no studies have described the ultrasonographic features of LMS of the vein in detail. We present a case of a 55-year-old woman with LMS of the left femoral vein that was misdiagnosed as having deep vein thrombosis (DVT) on initial ultrasonographic examination. The patient began to experience edema and pain in her left leg seven months previously. She was diagnosed as having DVT on initial ultrasonographic examination, but the DVT treatment that she had received for 7 months failed to improve the status of her left lower limb. She subsequently underwent re-examination by means of a multimodal ultrasonographic imaging approach (regular B-mode imaging, color Doppler imaging, pulsed-wave Doppler imaging, contrast-enhanced ultrasonography), which confirmed a diagnosis of LMS. This patient was treated successfully with surgery. This case demonstrates that use of multiple ultrasonographic imaging techniques can be helpful to diagnose LMS accurately. Detection of vasculature in a dilated vein filled with a heterogeneous hypoechoic substance on ultrasonography is a sign of a tumor. The pitfall of misdiagnosing this tumor as DVT is a useful reminder.

  12. Bone Graft Alternatives

    Science.gov (United States)

    ... Spine Treatment Spondylolisthesis BLOG FIND A SPECIALIST Treatments Bone Graft Alternatives Patient Education Committee Patient Education Committee ... procedure such as spinal fusion. What Types of Bone Grafts are There? Bone grafts that are transplanted ...

  13. Duplication of the Portal Vein: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Won; Shin, Hyeong Cheol; Jou, Sung Shick; Han, Jong Kyu; Kim, Il Young [Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of)

    2009-12-15

    The duplication of the portal vein is an uncommon congenital anomaly. To date, only four cases have been reported in the medical literature. This anomaly can cause portal hypertension in pediatric patients. In addition, duplication of the portal vein has various patterns of connection with a splenic vein or mesenteric veins, and it can lie anterior or posterior to the duodenum. We report the MDCT findings of an adult patient with duplication of the portal vein that was found incidentally

  14. Management of Post-Traumatic Phlegmasia Cerulea Dolens via Right-to-Left Femoral Vein to Femoral Vein Bypass (Palma Procedure).

    Science.gov (United States)

    Dua, Anahita; Heller, Jennifer; Lee, Cheong

    2017-11-01

    Phlegmasia cerulea dolens (PCD) is a rare condition resulting from venous occlusion that impairs arterial flow. We report a rare case of post-traumatic PCD after ligation of the iliac vein with successful treatment by right-to-left femoral vein to femoral vein bypass using left great saphenous vein (Palma procedure). The clinical presentation, diagnostic process, and approach to management along with a literature review on the operative management of PCD are presented in this case report.

  15. Absent right superior caval vein in situs solitus

    DEFF Research Database (Denmark)

    Lytzen, Rebekka; Sundberg, Karin; Vejlstrup, Niels

    2015-01-01

    Introduction In up to 0.07% of the general population, the right anterior cardinal vein obliterates and the left remains open, creating an absent right superior caval vein and a persistent left superior caval vein. Absent right superior caval vein is associated with additional congenital heart...... disease in about half the patients. We wished to study the consequences of absent right superior caval vein as an incidental finding on prenatal ultrasonic malformation screening. Material and methods This is a retrospective case series study of all foetuses diagnosed with absent right superior caval vein...... no postnatal complications. All children were found to have healthy hearts at follow-up. CONCLUSIONS: In all cases, the findings proved to be a benign condition with no clinical manifestations or complications. Although isolated absent right superior caval vein does not seem to affect the outcome, associated...

  16. Discovery of an imidazopyridine-containing 1,4-benzodiazepine nonpeptide vitronectin receptor (alpha v beta 3) antagonist with efficacy in a restenosis model.

    Science.gov (United States)

    Keenan, R M; Lago, M A; Miller, W H; Ali, F E; Cousins, R D; Hall, L B; Hwang, S M; Jakas, D R; Kwon, C; Louden, C; Nguyen, T T; Ohlstein, E H; Rieman, D J; Ross, S T; Samanen, J M; Smith, B R; Stadel, J; Takata, D T; Vickery, L; Yuan, C C; Yue, T L

    1998-11-17

    In the 3-oxo-1,4-benzodiazepine-2-acetic acid series of vitronectin receptor (alpha v beta 3) antagonists, a compound containing an imidazopyridine arginine mimetic was discovered which had sufficient potency and i.v. pharmacokinetics for demonstration of efficacy in a rat restenosis model.

  17. Graft irradiation abrogates graft-versus-host disease in combined pancreas-spleen transplantation

    International Nuclear Information System (INIS)

    Schulak, J.A.; Sharp, W.J.

    1986-01-01

    A model of combined pancreas-spleen transplantation (PST) was studied in LBN F1 recipients of Lewis grafts in order to evaluate the efficacy of pretransplant graft irradiation in preventing lethal graft-versus-host disease (GVHD). Recipients of unmodified PST uniformly developed severe GVHD and died (MST = 16.7 +/- 3.8 days). Whole body donor irradiation with either 500 or 250 rad prevented lethal GVHD. Similarly, ex vivo graft irradiation with either 1000 or 500 rad also resulted in normal weight gain, graft function, and host survival for the 6-week study period. Conversely, delay of graft irradiation until 3 days after transplantation failed to prevent this complication (MST = 15.8 +/- 3.7 days). Recipients of irradiated grafts displayed glucose tolerance tests that were identical to those in the control group indicating that the doses of radiation employed in these experiments were not deleterious to islet function. Irradiated spleen grafts appeared histologically normal at 6 weeks after transplantation. Cells derived from these grafts failed to stimulate lymph node enlargement in a popliteal lymph node assay for GVHD, suggesting that these spleens may have become repopulated with host cells. These experiments confirm that PST has the potential to cause lethal GVHD and suggest that pretransplant graft irradiation may be used to prevent its occurrence

  18. Finger vein extraction using gradient normalization and principal curvature

    Science.gov (United States)

    Choi, Joon Hwan; Song, Wonseok; Kim, Taejeong; Lee, Seung-Rae; Kim, Hee Chan

    2009-02-01

    Finger vein authentication is a personal identification technology using finger vein images acquired by infrared imaging. It is one of the newest technologies in biometrics. Its main advantage over other biometrics is the low risk of forgery or theft, due to the fact that finger veins are not normally visible to others. Extracting finger vein patterns from infrared images is the most difficult part in finger vein authentication. Uneven illumination, varying tissues and bones, and changes in the physical conditions and the blood flow make the thickness and brightness of the same vein different in each acquisition. Accordingly, extracting finger veins at their accurate positions regardless of their thickness and brightness is necessary for accurate personal identification. For this purpose, we propose a new finger vein extraction method which is composed of gradient normalization, principal curvature calculation, and binarization. As local brightness variation has little effect on the curvature and as gradient normalization makes the curvature fairly uniform at vein pixels, our method effectively extracts finger vein patterns regardless of the vein thickness or brightness. In our experiment, the proposed method showed notable improvement as compared with the existing methods.

  19. Effect of Grafting Method, Graft Cover and Foliar Spray of some Mineral Elements on Persian Walnut Graft-take and Winter Survival Rate

    Directory of Open Access Journals (Sweden)

    Reza Rezaee

    2017-09-01

    Full Text Available Introduction: Persian walnut (Juglans regia L. is an important nut crop in Iran and many parts of the world. One of the major challenges of growing walnut is planting of non-grafted walnut trees in orchards, which leads to the reduction of yield, quality and productivity of walnut orchards. Compared to the other fruit trees, walnut grafting is difficult and even newly grafted walnut seedlings are vulnerable to fall or winter frost chilling, so that most of the seedlings are lost after subjecting to the cold winter. There are a few studies reporting successful grafting in outdoor conditions, however, final grafting take after winter has been usually ignored. Hence, increased walnut grafting success and improved tree growth after grafting through foliar nutrient application may lead to increased tolerance of chilling. Therefore, main goals of this research were to investigate the effect of some graft covers and role of foliar spray of calcium, boron and zinc on the reduction of frost damage in newly grafted seedlings under outdoor conditions. Materials and methods: This research was conducted at agricultural research station, Khoy city, west Azerbaijan province, during 2012-2014. In the first experiment, three methods of grafting including cleft, bark and V-shaped, and two kinds of graft covers including moist sawdust and superabsorbent plus cotton wool were investigated in terms of grafting success and quality of seedlings. In the second experiment, effect of the three above-mentioned grafting methods and two levels of foliar spray including sequential spray of Ca (4 ppm, B and Zn (2% (3 times during growth season and control (no spray were studied in terms of frost damage. The experiments conducted in factorial based on randomized complete block design with 10 trees in each plot. Data were collected 45 days after grafting take, final grafting take after one winter, subsequent scion growth length and diameter and concentration of Ca, B and Zn in

  20. Adventitial cystic disease of the common femoral vein presenting as deep vein thrombosis

    Directory of Open Access Journals (Sweden)

    Young-Kyun Kim

    2016-07-01

    Full Text Available Adventitial cystic disease of the common femoral vein is a rare condition. We herein report the case of a 50-year-old woman who presented with painless swelling in her left lower leg that resembled deep vein thrombosis. She underwent femoral exploration and excision of the cystic wall. The presentation, investigation, treatment, and pathology of this condition are discussed with a literature review.

  1. Suction blister grafting - Modifications for easy harvesting and grafting

    Directory of Open Access Journals (Sweden)

    2012-01-01

    Full Text Available Suction blister grafting is a simple modality of treatment of patients with resistant and stable vitiligo. But raising the blisters may be time consuming and transferring to the recipient site may be difficult as the graft is ultrathin. By doing some modifications we can make the technique simpler and easier. We can decrease the blister induction time by intradermal injection of saline, exposure to Wood′s lamp, intrablister injection of saline. By these methods we can decrease the blister induction time from 2-3 hrs to 45-90 minutes. After harvesting the graft, it can be transferred to the recipient area by taking the graft on a sterile glass slide, on the gloved finger, rolling the graft over a sterile syringe and then spreading on the recipient area, or taking on the sterile wrapper of paraffin dressing and then placing over the recipient area.

  2. Evaluation of synthetic vascular grafts in a mouse carotid grafting model.

    Science.gov (United States)

    Chan, Alex H P; Tan, Richard P; Michael, Praveesuda L; Lee, Bob S L; Vanags, Laura Z; Ng, Martin K C; Bursill, Christina A; Wise, Steven G

    2017-01-01

    Current animal models for the evaluation of synthetic grafts are lacking many of the molecular tools and transgenic studies available to other branches of biology. A mouse model of vascular grafting would allow for the study of molecular mechanisms of graft failure, including in the context of clinically relevant disease states. In this study, we comprehensively characterise a sutureless grafting model which facilitates the evaluation of synthetic grafts in the mouse carotid artery. Using conduits electrospun from polycaprolactone (PCL) we show the gradual development of a significant neointima within 28 days, found to be greatest at the anastomoses. Histological analysis showed temporal increases in smooth muscle cell and collagen content within the neointima, demonstrating its maturation. Endothelialisation of the PCL grafts, assessed by scanning electron microscopy (SEM) analysis and CD31 staining, was near complete within 28 days, together replicating two critical aspects of graft performance. To further demonstrate the potential of this mouse model, we used longitudinal non-invasive tracking of bone-marrow mononuclear cells from a transgenic mouse strain with a dual reporter construct encoding both luciferase and green fluorescent protein (GFP). This enabled characterisation of mononuclear cell homing and engraftment to PCL using bioluminescence imaging and histological staining over time (7, 14 and 28 days). We observed peak luminescence at 7 days post-graft implantation that persisted until sacrifice at 28 days. Collectively, we have established and characterised a high-throughput model of grafting that allows for the evaluation of key clinical drivers of graft performance.

  3. Evaluation of synthetic vascular grafts in a mouse carotid grafting model.

    Directory of Open Access Journals (Sweden)

    Alex H P Chan

    Full Text Available Current animal models for the evaluation of synthetic grafts are lacking many of the molecular tools and transgenic studies available to other branches of biology. A mouse model of vascular grafting would allow for the study of molecular mechanisms of graft failure, including in the context of clinically relevant disease states. In this study, we comprehensively characterise a sutureless grafting model which facilitates the evaluation of synthetic grafts in the mouse carotid artery. Using conduits electrospun from polycaprolactone (PCL we show the gradual development of a significant neointima within 28 days, found to be greatest at the anastomoses. Histological analysis showed temporal increases in smooth muscle cell and collagen content within the neointima, demonstrating its maturation. Endothelialisation of the PCL grafts, assessed by scanning electron microscopy (SEM analysis and CD31 staining, was near complete within 28 days, together replicating two critical aspects of graft performance. To further demonstrate the potential of this mouse model, we used longitudinal non-invasive tracking of bone-marrow mononuclear cells from a transgenic mouse strain with a dual reporter construct encoding both luciferase and green fluorescent protein (GFP. This enabled characterisation of mononuclear cell homing and engraftment to PCL using bioluminescence imaging and histological staining over time (7, 14 and 28 days. We observed peak luminescence at 7 days post-graft implantation that persisted until sacrifice at 28 days. Collectively, we have established and characterised a high-throughput model of grafting that allows for the evaluation of key clinical drivers of graft performance.

  4. Delayed grafting for banked skin graft in lymph node flap transfer.

    Science.gov (United States)

    Ciudad, Pedro; Date, Shivprasad; Orfaniotis, Georgios; Dower, Rory; Nicoli, Fabio; Maruccia, Michele; Lin, Shu-Ping; Chuang, Chu-Yi; Chuang, Tsan-Yu; Wang, Gou-Jen; Chen, Hung-Chi

    2017-02-01

    Over the last decade, lymph node flap (LNF) transfer has turned out to be an effective method in the management of lymphoedema of extremities. Most of the time, the pockets created for LNF cannot be closed primarily and need to be resurfaced with split thickness skin grafts. Partial graft loss was frequently noted in these cases. The need to prevent graft loss on these iatrogenic wounds made us explore the possibility of attempting delayed skin grafting. We have herein reported our experience with delayed grafting with autologous banked split skin grafts in cases of LNF transfer for lymphoedema of the extremities. Ten patients with International Society of Lymphology stage II-III lymphoedema of upper or lower extremity were included in this study over an 8-month period. All patients were thoroughly evaluated and subjected to lymph node flap transfer. The split skin graft was harvested and banked at the donor site, avoiding immediate resurfacing over the flap. The same was carried out in an aseptic manner as a bedside procedure after confirming flap viability and allowing flap swelling to subside. Patients were followed up to evaluate long-term outcomes. Flap survival was 100%. Successful delayed skin grafting was done between the 4th and 6th post-operative day as a bedside procedure under local anaesthesia. The split thickness skin grafts (STSG) takes more than 97%. One patient needed additional medications during the bedside procedure. All patients had minimal post-operative pain and skin graft requirement. The patients were also reported to be satisfied with the final aesthetic results. There were no complications related to either the skin grafts or donor sites during the entire period of follow-up. Delayed split skin grafting is a reliable method of resurfacing lymph node flaps and has been shown to reduce the possibility of flap complications as well as the operative time and costs. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  5. Evolution of shear stress, protein expression, and vessel area in an animal model of arterial dilatation in hemodialysis grafts

    Science.gov (United States)

    Misra, Sanjay; Fu, Alex A.; Misra, Khamal D.; Glockner, James F.; Mukhopadyay, Debabrata

    2010-01-01

    Purpose To evaluate the wall shear stress, protein expression of matrix metalloproteinases-2 (MMP-2), -9 (MMP-9), and the inhibitors (tissue inhibitor of matrix metalloproteinases-1 (TIMP-1), and -2 (TIMP-2)), and vessel area over time in a porcine model for hemodialysis polytetrafluoroethylene (PTFE) grafts. Materials and methods In 21 pigs, subtotal renal infarction was performed and 28 days later, a PTFE graft was placed to connect the carotid artery to the ipsilateral jugular vein. Phase contrast MR was used to measure blood flow and vessel area at 1, 3, 7, and 14 days after graft placement. Wall shear stress was estimated from Poiseuille’s law. Animals were sacrificed at day 3 (N=7), day 7 (N=7), and day 14 (N=7) and expression of MMP-2, MMP-9, TIMP-1, and TIMP-2 were determined at the grafted and control arteries. Results The mean wall shear stress of the grafted artery was higher than the control artery at all time points (P<0.05). It peaked by day 3 and decreased by days 7–14 as the vessel area nearly doubled. By days 7–14, there was a significant increase in active MMP-2 followed by a significant increase in pro and active MMP-9 by day 14 (P<0.05, grafted artery versus control). TIMP-1 expression peaked by day 7 and then decreased while TIMP-2 expression was decreased at days 7–14. Conclusions The wall shear stress of the grafted artery peaks by day 3 with increased MMP-2 activity by days 7–14 followed by pro and active MMP-9 by day 14 and the vessel area nearly doubled. PMID:20123196

  6. Skin Graft

    OpenAIRE

    Shimizu, Ruka; Kishi, Kazuo

    2012-01-01

    Skin graft is one of the most indispensable techniques in plastic surgery and dermatology. Skin grafts are used in a variety of clinical situations, such as traumatic wounds, defects after oncologic resection, burn reconstruction, scar contracture release, congenital skin deficiencies, hair restoration, vitiligo, and nipple-areola reconstruction. Skin grafts are generally avoided in the management of more complex wounds. Conditions with deep spaces and exposed bones normally require the use o...

  7. The role of interventional radiology in management of patients with end-stage renal disease

    International Nuclear Information System (INIS)

    Surlan, M.; Popovic, P.

    2003-01-01

    percutaneous drainage. Doppler US, magnetic resonance angiography and digital subtraction angiography have a principle role in the evaluation of vascular complications of renal transplantation and management of the endovascular therapy. Stenosis, the most common vascular complication, occurs in 1-12% of transplanted renal arteries and represents a potentially curable cause of hypertension following transplantation and/or renal dysfunction. Treatment with percutaneous transluminal renal angioplasty (PTRA) or PTRA with stent has been technically successful in 82-92% of the cases, and graft salvage rate has ranged from 80 to 100%. Restenosis occurs in up to 20% of cases, but are usually amenable to repeated PTRA. Complications such as arterial and vein thrombosis are uncommon. Intrarenal A/V fistulas and pseudoaneurysms are occasionally seen after biopsy, the treatment requires superselective embolisation. Urologic complications are relatively uncommon, predominantly they consist of the urinary leaks and urethral obstruction. Interventional treatment consists of percutaneous nephrostomy, balloon dilation, insertion of the double J stents, metallic stent placement and external drainage of the extrarenal collections

  8. Evaluation of Replacement Grafts and Punch Grafts in the Treatment of Vitiligo

    Directory of Open Access Journals (Sweden)

    Singh Ajit Kumar

    1980-01-01

    Full Text Available Thirtycasesof vitiligo eachwithminimum of two lesions undent replacement graft and multiple punch grafts in one lesion each. Complications observed at the recipient site like infection and raised nigosed surface were significantly more in replacement grafts. Hypopigmentation of the graft was significantly more when the disease was progressive.

  9. A noise-optimized virtual monochromatic reconstruction algorithm improves stent visualization and diagnostic accuracy for detection of in-stent re-stenosis in lower extremity run-off CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Mangold, Stefanie [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Eberhard-Karls University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); De Cecco, Carlo N.; Yamada, Ricardo T.; Varga-Szemes, Akos; Stubenrauch, Andrew C.; Fuller, Stephen R. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Caruso, Damiano [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Rome ' ' Sapienza' ' , Department of Radiological Sciences, Oncology and Pathology, Rome (Italy); Vogl, Thomas J.; Wichmann, Julian L. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Nikolaou, Konstantin [Eberhard-Karls University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Todoran, Thomas M. [Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States)

    2016-12-15

    To evaluate the impact of noise-optimized virtual monochromatic imaging (VMI+) on stent visualization and accuracy for in-stent re-stenosis at lower extremity dual-energy CT angiography (DE-CTA). We evaluated third-generation dual-source DE-CTA studies in 31 patients with prior stent placement. Images were reconstructed with linear blending (F{sub 0}.5) and VMI+ at 40-150 keV. In-stent luminal diameter was measured and contrast-to-noise ratio (CNR) calculated. Diagnostic confidence was determined using a five-point scale. In 21 patients with invasive catheter angiography, accuracy for significant re-stenosis (≥50 %) was assessed at F{sub 0}.5 and 80 keV-VMI+ chosen as the optimal energy level based on image-quality analysis. At CTA, 45 stents were present. DSA was available for 28 stents whereas 12 stents showed significant re-stenosis. CNR was significantly higher with ≤80 keV-VMI+ (17.9 ± 6.4-33.7 ± 12.3) compared to F{sub 0}.5 (16.9 ± 4.8; all p < 0.0463); luminal stent diameters were increased at ≥70 keV (5.41 ± 1.8-5.92 ± 1.7 vs. 5.27 ± 1.8, all p < 0.001) and diagnostic confidence was highest at 70-80 keV-VMI+ (4.90 ± 0.48-4.88 ± 0.63 vs. 4.60 ± 0.66, p = 0.001, 0.0042). Sensitivity, negative predictive value and accuracy for re-stenosis were higher with 80 keV-VMI+ (100, 100, 96.4 %) than F{sub 0}.5 (90.9, 94.1, 89.3 %). 80 keV-VMI+ improves image quality, diagnostic confidence and accuracy for stent evaluation at lower extremity DE-CTA. (orig.)

  10. Augmented reality based real-time subcutaneous vein imaging system.

    Science.gov (United States)

    Ai, Danni; Yang, Jian; Fan, Jingfan; Zhao, Yitian; Song, Xianzheng; Shen, Jianbing; Shao, Ling; Wang, Yongtian

    2016-07-01

    A novel 3D reconstruction and fast imaging system for subcutaneous veins by augmented reality is presented. The study was performed to reduce the failure rate and time required in intravenous injection by providing augmented vein structures that back-project superimposed veins on the skin surface of the hand. Images of the subcutaneous vein are captured by two industrial cameras with extra reflective near-infrared lights. The veins are then segmented by a multiple-feature clustering method. Vein structures captured by the two cameras are matched and reconstructed based on the epipolar constraint and homographic property. The skin surface is reconstructed by active structured light with spatial encoding values and fusion displayed with the reconstructed vein. The vein and skin surface are both reconstructed in the 3D space. Results show that the structures can be precisely back-projected to the back of the hand for further augmented display and visualization. The overall system performance is evaluated in terms of vein segmentation, accuracy of vein matching, feature points distance error, duration times, accuracy of skin reconstruction, and augmented display. All experiments are validated with sets of real vein data. The imaging and augmented system produces good imaging and augmented reality results with high speed.

  11. A new kind of 32P stent used for prevention of the restenosis after PTCA in rabbit iliac arteries

    International Nuclear Information System (INIS)

    Gao Dongsheng; Chen Runfen; Mao Jialiang; Huang Dingjiu

    2003-01-01

    Objective: To evaluate the effect and the mechanism of a new kind of 32 P stents used for prevention of the restenosis after percutaneous transluminal coronary angioplasty (PTCA); to observe the 'edge effect' caused by radioactive stents. Methods: Six 32 P-β-emitting stents made by compound plating, paired with 6 31 P nonradioactive(control) stents, were placed separately, one in one iliac artery in 6 rabbits, respectively. Animals were sacrificed after 30 d. Angiography, morphometry and immunohistochemistry work-up were performed. Results: There were no aneurysm or thrombosis in the arteries with stents placed. Morphometric measurements demonstrated that the mean minimum lumen diameter (MLD) was greater in 32 P stents than that in control stents (P 32 P stents was greater than that in control stents, but the later had marked neointimal area than the former (P 32 P-β-emitting stents made by compound plating could prevent in-stent restenosis significantly by inhibiting the neointimal growth even with low radioactivity; and it is safe, cheap and easy to make. But an unexpected increase in neointimal response, the so-called 'edge effect', was observed in the study

  12. A Phase II study of external-beam radiotherapy and endovascular brachytherapy with PTA and stenting for femoropopliteal artery restenosis

    International Nuclear Information System (INIS)

    Narayan, Kailash; Denton, Michael; Das, Ram; Bernshaw, David; Rolfo, Aldo; Dyk, Sylvia van; Mirakian, Alex

    2006-01-01

    Purpose: To assess the safety and seek evidence of efficacy of combined external-beam radiotherapy (EBRT) and endovascular brachytherapy in the treatment of stenotic vascular lesions. Methods and Materials: Seventeen patients with high risk for restenosis of femoropopliteal arteries were enrolled in this study from February 2000 to August 2002. The external beam radiotherapy regimen consisted of 10 Gy in 5 fractions of 2 Gy, starting on Day 0. This was followed on Day 6 by angiography, stent placement, and intraluminal brachytherapy to a dose of 10 Gy at 1.2 mm from stent surface. The EBRT was continued from the same day to another 10 Gy in 2 Gy daily fractions for 5 days. Results: The follow up ranged from 33 months to 60 months. At the time of analysis 15 of 17 patients were alive with patent stents. Of these, 10 were symptom-free. Two patients died of unrelated causes. Conclusions: The combination of EBRT and endovascular brachytherapy provided adequate dose distribution without any geographical miss or 'candy wrapper' restenosis. No incidence of aneurysmal dilation of radiated vascular segment was observed. The treatment was feasible, well tolerated, and achieved 88% stenosis free survival

  13. Influence of using a single facial vein as outflow in full-face transplantation: A three-dimensional computed tomographic study.

    Science.gov (United States)

    Rodriguez-Lorenzo, Andres; Audolfsson, Thorir; Wong, Corrine; Cheng, Angela; Arbique, Gary; Nowinski, Daniel; Rozen, Shai

    2015-10-01

    The aim of this study was to evaluate the contribution of a single unilateral facial vein in the venous outflow of total-face allograft using three-dimensional computed tomographic imaging techniques to further elucidate the mechanisms of venous complications following total-face transplant. Full-face soft-tissue flaps were harvested from fresh adult human cadavers. A single facial vein was identified and injected distally to the submandibular gland with a radiopaque contrast (barium sulfate/gelatin mixture) in every specimen. Following vascular injections, three-dimensional computed tomographic venographies of the faces were performed. Images were viewed using TeraRecon Software (Teracon, Inc., San Mateo, CA, USA) allowing analysis of the venous anatomy and perfusion in different facial subunits by observing radiopaque filling venous patterns. Three-dimensional computed tomographic venographies demonstrated a venous network with different degrees of perfusion in subunits of the face in relation to the facial vein injection side: 100% of ipsilateral and contralateral forehead units, 100% of ipsilateral and 75% of contralateral periorbital units, 100% of ipsilateral and 25% of contralateral cheek units, 100% of ipsilateral and 75% of contralateral nose units, 100% of ipsilateral and 75% of contralateral upper lip units, 100% of ipsilateral and 25% of contralateral lower lip units, and 50% of ipsilateral and 25% of contralateral chin units. Venographies of the full-face grafts revealed better perfusion in the ipsilateral hemifaces from the facial vein in comparison with the contralateral hemifaces. Reduced perfusion was observed mostly in the contralateral cheek unit and contralateral lower face including the lower lip and chin units. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  14. Personal authentication through dorsal hand vein patterns

    Science.gov (United States)

    Hsu, Chih-Bin; Hao, Shu-Sheng; Lee, Jen-Chun

    2011-08-01

    Biometric identification is an emerging technology that can solve security problems in our networked society. A reliable and robust personal verification approach using dorsal hand vein patterns is proposed in this paper. The characteristic of the approach needs less computational and memory requirements and has a higher recognition accuracy. In our work, the near-infrared charge-coupled device (CCD) camera is adopted as an input device for capturing dorsal hand vein images, it has the advantages of the low-cost and noncontact imaging. In the proposed approach, two finger-peaks are automatically selected as the datum points to define the region of interest (ROI) in the dorsal hand vein images. The modified two-directional two-dimensional principal component analysis, which performs an alternate two-dimensional PCA (2DPCA) in the column direction of images in the 2DPCA subspace, is proposed to exploit the correlation of vein features inside the ROI between images. The major advantage of the proposed method is that it requires fewer coefficients for efficient dorsal hand vein image representation and recognition. The experimental results on our large dorsal hand vein database show that the presented schema achieves promising performance (false reject rate: 0.97% and false acceptance rate: 0.05%) and is feasible for dorsal hand vein recognition.

  15. Thrombosis of right ovarian vein

    International Nuclear Information System (INIS)

    Forner, J.; Talens, A.; Flores, M.; Mendez, M.

    2001-01-01

    Ovarian vein thrombosis is a rare postpartum complication (0.1%). It can be fatal, since it can lead to sepsis, pulmonary thromboembolisms and inferior vena cava or renal vein thrombosis. Computed tomography and magnetic resonance imaging are the techniques of choice for its diagnosis, while the value of ultrasound is limited due to its low sensitivity and specificity. We report the case of a woman who, during puerperium, developed thrombosis of right ovarian vein that presented clinical, ultrasonographic and computed tomographic features of appendicitis. We describe the radiological sings and stress the fact that this diagnosis should be suspected in puerperal women. (Author) 9 refs

  16. Edema de membro inferior secundário a exérese de veia safena magna para utilização como enxerto na revascularização do miocárdio Lower limb edema after great saphenous vein harvesting to be used as graft in myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Cleusa Ema Quilici Belczak

    2009-03-01

    Full Text Available CONTEXTO: A revascularização do miocárdio utilizando-se a veia safena magna ainda é procedimento cirúrgico bastante realizado na atualidade. O edema que surge no membro inferior operado causa grande desconforto e necessita ser melhor estudado. OBJETIVOS: Caracterizar o edema de membro inferior secundário a exérese da veia safena magna pela técnica de incisões escalonadas para sua utilização como enxerto venoso na revascularização do miocárdio. MÉTODOS: Foram selecionados aleatoriamente 44 indivíduos submetidos a exérese de veia safena magna para revascularização miocárdica há mais de 3 meses. Excluíram-se fatores que pudessem interferir na formação de edema dos membros inferiores. Foram avaliados por volumetria e perimetria maleolares ambos os membros inferiores. Considerou-se como presença de edema significativo a diferença de volume maior que 50 mL e maior de 2 cm em relação ao membro não-operado. Para a análise estatística foram empregados o teste do qui-quadrado, teste exato de Fisher, teste t de Student e o teste de McNemar. O nível de significância adotado foi de 5% (a = 0,05. RESULTADOS: Encontraram-se diferenças estatisticamente significativas (p BACKGROUND: Myocardial revascularization using the great saphenous vein is still a very common surgical procedure. The edema that occurs in the operated leg causes much discomfort and requires further studies. OBJECTIVES: To describe lower limb edema secondary to great saphenous vein harvesting using the bridge technique for use as venous graft in myocardial revascularization. METHODS: Forty-four individuals previously submitted to great saphenous vein harvesting for myocardial revascularization more than 3 months before were randomly selected. Patients with factors that might interfere with formation of lower limb edema were excluded. Both operated and non-operated legs were evaluated by volumetry and perimetry of the malleolar region. Differences greater than

  17. Fabrication and preliminary study of a biomimetic tri-layer tubular graft based on fibers and fiber yarns for vascular tissue engineering.

    Science.gov (United States)

    Wu, Tong; Zhang, Jialing; Wang, Yuanfei; Li, Dandan; Sun, Binbin; El-Hamshary, Hany; Yin, Meng; Mo, Xiumei

    2018-01-01

    Designing a biomimetic and functional tissue-engineered vascular graft has been urgently needed for repairing and regenerating defected vascular tissues. Utilizing a multi-layered vascular scaffold is commonly considered an effective way, because multi-layered scaffolds can easily simulate the structure and function of natural blood vessels. Herein, we developed a novel tri-layer tubular graft consisted of Poly(L-lactide-co-caprolactone)/collagen (PLCL/COL) fibers and Poly(lactide-co-glycolide)/silk fibroin (PLGA/SF) yarns via a three-step electrospinning method. The tri-layer vascular graft consisted of PLCL/COL aligned fibers in inner layer, PLGA/SF yarns in middle layer, and PLCL/COL random fibers in outer layer. Each layer possessed tensile mechanical strength and elongation, and the entire tubular structure provided tensile and compressive supports. Furthermore, the human umbilical vein endothelial cells (HUVECs) and smooth muscle cells (SMCs) proliferated well on the materials. Fluorescence staining images demonstrated that the axially aligned PLCL/COL fibers prearranged endothelium morphology in lumen and the circumferential oriented PLGA/SF yarns regulated SMCs organization along the single yarns. The outside PLCL/COL random fibers performed as the fixed layer to hold the entire tubular structure. The in vivo results showed that the tri-layer vascular graft supported cell infiltration, scaffold biodegradation and abundant collagen production after subcutaneous implantation for 10weeks, revealing the optimal biocompatibility and tissue regenerative capability of the tri-layer graft. Therefore, the specially designed tri-layer vascular graft will be beneficial to vascular reconstruction. Copyright © 2017. Published by Elsevier B.V.

  18. Assessment and management of patients with varicose veins.

    Science.gov (United States)

    Allen, Louise

    Varicose veins are enlarged superficial veins found in the legs. This article explores the anatomy and physiology of the venous system to assist nurses to assess, manage and treat patients with varicose veins.

  19. Clinical effectiveness of secondary interventions for restenosis after renal artery stenting

    Science.gov (United States)

    Simone, Thomas A.; Brooke, Benjamin S.; Goodney, Philip P.; Walsh, Daniel B.; Stone, David H.; Powell, Richard J.; Cronenwett, Jack L.; Nolan, Brian W.

    2013-01-01

    Objective Secondary interventions for renal artery restenosis (RAS) after renal artery stenting are common, despite limited data about their effectiveness. This study was designed to evaluate the outcomes of endovascular treatment of recurrent RAS. Methods We conducted a retrospective review of patients who underwent renal artery stenting between 2001 and 2011 at Dartmouth-Hitchcock Medical Center. Patients who required secondary interventions were compared with control patients who underwent only primary interventions for RAS. Multivariate regression models were used to identify factors associated with successful outcomes, as measured by changes in blood pressure, estimated glomerular filtration rate, and number of antihypertensive medications required. Results Sixty-five secondary (57 patients) renal interventions were undertaken for recurrent RAS associated with progressive hypertension or renal dysfunction and compared with outcomes after 216 primary (180 patients) renal artery stenting procedures. Patients undergoing primary vs secondary interventions did not differ significantly in the number of preoperative antihypertensive medications used, comorbid conditions, or blood pressure. All primary and secondary interventions were performed with stents and showed no difference in procedural complications. At a mean follow-up of 23 months (range, 1–128 months), similar improvements in renal function and blood pressure were found between patients undergoing primary and secondary interventions, and there was no difference in rates of restenosis or survival between cohorts. Regression models showed that the use of embolic protection devices was associated with improved renal function after primary (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1–3.8; P < .05) and secondary (OR, 4.7; 95% CI, 1.7–12.5; P < .05) interventions, whereas statin therapy was associated with improved renal (OR, 2.0; 95% CI, 1.3–3.2; P < .05) and blood pressure response (OR, 4

  20. Deep vein thrombosis: a clinical review

    Directory of Open Access Journals (Sweden)

    Kesieme EB

    2011-04-01

    Full Text Available Emeka Kesieme1, Chinenye Kesieme2, Nze Jebbin3, Eshiobo Irekpita1, Andrew Dongo11Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Nigeria; 2Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Nigeria; 3Department of Surgery, University of Port Harcourt Teaching Hospital, Port-Harcourt, NigeriaBackground: Deep vein thrombosis (DVT is the formation of blood clots (thrombi in the deep veins. It commonly affects the deep leg veins (such as the calf veins, femoral vein, or popliteal vein or the deep veins of the pelvis. It is a potentially dangerous condition that can lead to preventable morbidity and mortality.Aim: To present an update on the causes and management of DVT.Methods: A review of publications obtained from Medline search, medical libraries, and Google.Results: DVT affects 0.1% of persons per year. It is predominantly a disease of the elderly and has a slight male preponderance. The approach to making a diagnosis currently involves an algorithm combining pretest probability, D-dimer testing, and compression ultrasonography. This will guide further investigations if necessary. Prophylaxis is both mechanical and pharmacological. The goals of treatment are to prevent extension of thrombi, pulmonary embolism, recurrence of thrombi, and the development of complications such as pulmonary hypertension and post-thrombotic syndrome.Conclusion: DVT is a potentially dangerous condition with a myriad of risk factors. Prophylaxis is very important and can be mechanical and pharmacological. The mainstay of treatment is anticoagulant therapy. Low-molecular-weight heparin, unfractionated heparin, and vitamin K antagonists have been the treatment of choice. Currently anticoagulants specifically targeting components of the common pathway have been recommended for prophylaxis. These include fondaparinux, a selective indirect factor Xa inhibitor and the new oral selective direct thrombin inhibitors (dabigatran and selective

  1. Dual Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varix Draining into the Left Adrenal Vein and Left Inferior Phrenic Vein

    International Nuclear Information System (INIS)

    Nishida, Norifumi; Ninoi, Teruhisa; Kitayama, Toshiaki; Yamamoto, Akira; Sakai, Yukimasa; Sato, Kimihiko; Hamuro, Masao; Nakamura, Kenji; Inoue, Yuichi; Yamada, Ryusaku

    2004-01-01

    A 66-year-old woman with a gastric varix, draining into a dilated left adrenal vein and a left inferior phrenic vein, was treated with dual balloon-occluded retrograde transvenous obliteration (B-RTO). Under balloon occlusion of the left adrenal vein and the left inferior phrenic vein, retrograde injection of a sclerosant (5% ethanolamine oleate) into the gastric varix was performed. Two weeks later, disappearance of flow in the gastric varix was confirmed on endoscopic ultrasound examination

  2. Impact of Angioscopic Evaluation for Femoropopliteal In-Stent Restenosis Before and After Excimer Laser Atherectomy.

    Science.gov (United States)

    Idemoto, Akiko; Okamoto, Naotaka; Tanaka, Akihiro; Mori, Naoki; Nakamura, Daisuke; Yano, Masamichi; Makino, Nobuhiko; Egami, Yasuyuki; Shutta, Ryu; Tanouchi, Jun; Nishino, Masami

    2017-07-01

    In-stent restenosis (ISR) is a prevalent problem following stenting of femoropopliteal lesions. A potential novel treatment modality for ISR including excimer laser atherectomy (ELA) has become available. We performed ELA for in-stent chronic total occlusion (CTO) of femoropopliteal lesions and evaluated lesion morphology before and after ELA by angioscopy in 2 patients. The angioscopic findings clearly showed removal of in-stent thrombi after ELA. Thus, ELA may be effective for in-stent CTO of femoropopliteal lesions. This is the first report describing the direct visualization of ELA effect for vaporization of thrombi in femoropopliteal in-stent lesions by angioscopy.

  3. Coarctation Long-term Assessment (COALA): significance of arterial hypertension in a cohort of 404 patients up to 27 years after surgical repair of isolated coarctation of the aorta, even in the absence of restenosis and prosthetic material.

    Science.gov (United States)

    Hager, Alfred; Kanz, Simone; Kaemmerer, Harald; Schreiber, Christian; Hess, John

    2007-09-01

    Recent studies have demonstrated that there is a loss of aortic compliance in patients after coarctation repair. The clinical effect of this and other mechanisms apart from restenosis on the rate of arterial hypertension is unknown. From 1974 through 2000, 404 patients born before January 1, 1985, underwent surgical intervention for isolated aortic coarctation. From those 382 who are still alive, 273 patients aged 16 to 73 years (1-27 years after surgical intervention) underwent a structured clinical investigation according to a prospective protocol, including blood pressure measurement at all limbs, ambulatory blood pressure measurement, and symptom-limited exercise testing. Sixty-seven (25%) patients were already taking antihypertensive drugs, and another 63 (23%) patients had an increased ambulatory blood pressure. Still another 26 (10%) patients had a blood pressure during exercise exceeding 2 standard deviations of reference values. Only 117 (43%) patients had a normal blood pressure reaction. From those 156 patients with hypertension, only 21 (13%) had a systolic brachial-ankle blood pressure difference of greater than 20 mm Hg, suggesting restenosis. In the patient group without restenosis (n = 245), independent risk factors for hypertension were repair with prosthetic material, male sex, a residual brachial-ankle blood pressure difference, and older age at follow-up. The majority of patients were hypertensive at long-term follow-up after coarctation repair. This is caused by restenosis, defined by a gradient of greater than 20 mm Hg, in only a few patients. Even in those without prosthetic material or minimal-grade restenosis, there is a substantial incidence of arterial hypertension.

  4. Feasibility of the Use of RapiGraft and Skin Grafting in Reconstructive Surgery

    Directory of Open Access Journals (Sweden)

    Jung Dug Yang

    2016-09-01

    Full Text Available BackgroundSkin grafting is a relatively simple and thus widely used procedure. However, the elastic and structural quality of grafted skin is poor. Recently, various dermal substitutes have been developed to overcome this disadvantage of split-thickness skin grafts. The present study aims to determine the feasibility of RapiGraft as a new dermal substitute.MethodsThis prospective study included 20 patients with partial- or full-thickness skin defects; the patients were enrolled between January 2013 and March 2014. After skin defect debridement, the wound was divided into two parts by an imaginary line. Split-thickness skin grafting alone was performed on one side (group A, and RapiGraft and split-thickness skin grafting were used on the other side (group B. All patients were evaluated using photographs and self-questionnaires. The Manchester scar scale (MSS, a chromameter, and a durometer were used for the scar evaluation. The average follow-up period was 6 months.ResultsThe skin graft take rates were 93% in group A and 89% in group B, a non-significant difference (P=0.082. Statistically, group B had significantly lower MSS, vascularity, and pigmentation results than group A (P<0.05 for all. However, the groups did not differ significantly in pliability (P=0.155.ConclusionsThe present study indicates that a simultaneous application of RapiGraft and a split-thickness skin graft is safe and yields improved results. Therefore, we conclude that the use of RapiGraft along with skin grafting will be beneficial for patients requiring reconstructive surgery.

  5. Recurrence of superficial vein thrombosis in patients with varicose veins.

    Science.gov (United States)

    Karathanos, Christos; Spanos, Konstantinos; Saleptsis, Vassileios; Tsezou, Aspasia; Kyriakou, Despina; Giannoukas, Athanasios D

    2016-08-01

    To investigate which factors other than history of superficial vein thrombosis (SVT) are associated with recurrent spontaneous SVT episodes in patients with varicose veins (VVs). Patients with a history of spontaneous SVT and VVs were followed up for a mean period of 55 months. Demographics, comorbidities, and thrombophilia screening test were analyzed. Patients were grouped according to the clinical-etiology-anatomy-pathophysiology classification. A multiple logistic regression analysis with the forward likelihood ratio method was undertaken. Thirteen patients out of 97 had a recurrence SVT episode during the follow-up period. All those patients were identified to have a thrombophilia defect. Protein C and S, antithrombin, and plasminogen deficiencies were more frequently present in patients without recurrence. Gene mutations were present in 38% in the nonrecurrence group and 77% in the recurrence group. After logistic regression analysis, patients with dislipidemia and mutation in prothrombin G20210A (FII) had an increased risk for recurrence by 5.4-fold and 4.6-fold, respectively. No deep vein thrombosis or pulmonary embolism occurred. Dislipidemia and gene mutations of F II are associated with SVT recurrence in patients with VVs. A selection of patients may benefit from anticoagulation in the short term and from VVs intervention in the long term. © The Author(s) 2015.

  6. Endovenous mechanochemical ablation of great saphenous vein incompetence using the ClariVein device: a safety study

    NARCIS (Netherlands)

    Eekeren, R. van; Boersma, D.; Elias, S.; Holewijn, S.; Werson, D.A.; Vries, J.P. de; Reijnen, M.M.P.J.

    2011-01-01

    PURPOSE: To evaluate the feasibility and safety of endovenous mechanochemical ablation (MOCA) for the treatment of great saphenous vein (GSV) incompetence. METHODS: The newly developed ClariVein device uses a technique that combines mechanical endothelial damage using a rotating wire with the

  7. THE ROLE OF LIPOTROPIC THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE BEFORE AND AFTER CORONARY REVASCULARIZATION

    Directory of Open Access Journals (Sweden)

    R. N. Adzhiev

    2013-01-01

    Full Text Available Review of large of trials that prove the positive impact of high-dose lipid-lowering therapy on the prognosis in patients with ischemic heart disease (IHD are presented. The data on the efficacy of the lipid profile correction by lipid apheresis in patients with hypercholesterolemia that is refractory to optimal medical therapy are showed. The results of the large trials (LIPS, ARMYDA, NAPLES II, ARMYDA-RECAPTURE, Post-CABG, TNT and meta-analyzes on the role of statins, prescribed before and after coronary artery bypass surgery and stenting, in reducing the risk of early and late cardiac events and the need for repeat myocardial revascularization are analyzed. The issue of therapeutic apheresis should be considered in cases of refractory hypercholesterolemia according to ESC/EAS Guidelines for the management of dyslipidaemias (2011. The tendency to reduction in the risk of stent restenosis and vein graft lesions after lipid apheresis is found in very high risk patients with IHD and refractory hypercholesterolemia that underwent coronary stenting or bypass surgery.

  8. THE ROLE OF LIPOTROPIC THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE BEFORE AND AFTER CORONARY REVASCULARIZATION

    Directory of Open Access Journals (Sweden)

    R. N. Adzhiev

    2015-09-01

    Full Text Available Review of large of trials that prove the positive impact of high-dose lipid-lowering therapy on the prognosis in patients with ischemic heart disease (IHD are presented. The data on the efficacy of the lipid profile correction by lipid apheresis in patients with hypercholesterolemia that is refractory to optimal medical therapy are showed. The results of the large trials (LIPS, ARMYDA, NAPLES II, ARMYDA-RECAPTURE, Post-CABG, TNT and meta-analyzes on the role of statins, prescribed before and after coronary artery bypass surgery and stenting, in reducing the risk of early and late cardiac events and the need for repeat myocardial revascularization are analyzed. The issue of therapeutic apheresis should be considered in cases of refractory hypercholesterolemia according to ESC/EAS Guidelines for the management of dyslipidaemias (2011. The tendency to reduction in the risk of stent restenosis and vein graft lesions after lipid apheresis is found in very high risk patients with IHD and refractory hypercholesterolemia that underwent coronary stenting or bypass surgery.

  9. Chloroanthraquinone as a grafted probe molecule to investigate grafting yield on carbon powder

    International Nuclear Information System (INIS)

    Le Comte, Annaïg; Brousse, Thierry; Bélanger, Daniel

    2016-01-01

    Spontaneous grafting of chloroanthraquinone (ClAQ) groups on Black Pearls carbon by reduction of the corresponding in-situ generated diazonium cations was successfully achieved. The presence of an halogen atom on the quinone molecule allowed the use of different spectroscopic characterization techniques to determine the accurate quinone content of the modified carbon. Electrochemical characterization highlighted that the presence of chlorine atom on the grafted molecule did not affect the electrochemical response or the grafting reaction efficiency. The amount of ClAQ molecules at the carbon surface after grafting was determined by cyclic voltammetry, together with thermogravimetric analysis coupled mass spectroscopy, X-ray photoelectron spectroscopy and elemental analysis. The ClAQ mass loadings estimated from the four techniques are in very good agreement and confirm that the grafted moieties are all electrochemically active and accessible. Finally, the grafting of quinone-type molecule using the reduction of diazonium cations does not affect the electroactivity of the grafted groups and cyclic voltammetry can be considered as a reliable technique to evaluate the mass loading of grafted quinone groups on porous carbon. Thus ClAQ can be used as a grafted probe molecule to investigate grafting yield on carbon powder, and this approach can be extended to functionalized electrodes used in an increasing number of electrochemical energy storage devices.

  10. Gd-DTPA-enhanced MR venography for varicose veins of the calf

    International Nuclear Information System (INIS)

    Kohata, Yoshiko; Naito, Akira; Ito, Katuhide.

    1995-01-01

    2D time-of-flight MR venography (2D TOF MRV) was performed in 16 patients (25 calves) with varicose veins and 2 volunteers (4 calves), and compared with venography. Sequential SPGR (TR/TE/FA=45 ms/7 ms/60deg) transverse images and/or GRASS (TR/TE/FA=100 ms/13 ms/60deg) transverse images were obtained for MRV. Superior presaturation pulse (S-SAT) was placed in 21 calves, and 0.05 mmol/kg Gd-DTPA was used in all calves. Projection MRVs were generated with maximum intensity projection (MIP) reconstruction. Regarding sequence parameter, S-SAT was useful to eliminate signal from artery that would obscure the signal of deep veins. The detectability of deep veins was improved with the use of S-SAT. In the comparison with venography, MRV could more clearly demonstrate varicose veins more than 5 mm in diameter and their drainage veins than venography. But it could not so clearly demonstrate deep veins as venography. It could not detect fine varicose veins less than 5 mm in diameter and connecting veins with valve insufficiency. In the examination of varicose veins, detection of deep veins, large varicose veins and their main drainage veins is clinically important, because diagnosis of patency of deep veins and dilatation of the drainage veins is necessary to choose the treatment, concluding conservative therapy, stripping and sclerotherapy. However, detection of fine varicose veins and connecting veins are not so important because those veins seldom need treatment. MRV was not so suitable for detection of deep veins, but very useful for detection of varicose veins more than 5 mm in diameter and their main drainage veins. In conclusion, MRV is non-invasive and effective method in varicose veins of calf, and it can take the place of venography with the improvement of deep vein detectability. (author)

  11. Cartilage grafting in facial reconstruction with special consideration of irradiated grafts

    International Nuclear Information System (INIS)

    Donald, P.J.

    1986-01-01

    The search for the perfect facial implant for reconstruction of the face continues. Cartilage, once thought to be an undesirable graft material because of its propensity for absorption, has regained popularity in the past decade. Various preparation techniques have been employed to ensure graft sterility and diminished absorption. An improved understanding of cartilage structure and physiology has shed considerable light on the host-graft relationship. Gamma irradiation is a time-honored method of preservation. An experiment was undertaken to investigate the physiology of irradiated cartilage grafts following prolonged implantation on the facial skeleton of sheep and dog. Merthiolate preserved grafts were used as controls. Direct observation, histochemical techniques, autoradiography, and transmission electron micrography were used to determine chondrocyte viability and matrix composition. It was surprising to note that following implantation of 16 to 72 months, complete resorption was seen in 87.7% of the irradiated grafts and in 43.8% of the Merthiolate stored controls. Many of the grafts acquired chondrocytes from the host and produced new proteoglycan matrix as well as undergoing some degree of ossification. A comparison to the clinical situation in humans is made. 98 references

  12. Leiomyosarcoma of the renal vein

    Directory of Open Access Journals (Sweden)

    Lemos Gustavo C.

    2003-01-01

    Full Text Available Leiomyosarcoma of the renal vein is a rare tumor of complex diagnosis. We presented a case of renal vein leiomyosarcoma detected in a routine study. The primary treatment was complete surgical removal of the mass. In cases where surgical removal is not possible the prognosis is poor, with high rates of local recurrence and distant spread.

  13. Ultrasound assessment of great saphenous vein insufficiency

    Directory of Open Access Journals (Sweden)

    Chander RK

    2015-06-01

    Full Text Available Rajiv K Chander,1 Thomas S Monahan1,2 1Section of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, 2Department of Surgery, Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA Abstract: Duplex ultrasonography is the ideal modality to assess great saphenous vein insufficiency. Duplex ultrasonography incorporates both gray scale images to delineate anatomy and color-Doppler imaging that visualizes the flow of blood in a structure. Assessment of great saphenous vein requires definition of the anatomy, augmentation of flow, evaluation for both superficial and deep vein thrombosis, and determining the presence of reflux. Currently, evolution in the treatment of reflux also relies on ultrasound for the treatment of the disease. Understanding the utilization of the ultrasound for the diagnosis and treatment of greater saphenous vein reflux is important for practitioners treating reflux disease. Keywords: duplex ultrasonography, small saphenous vein 

  14. Antiplatelet drug selection in PCI to vein grafts in patients with acute coronary syndrome and adverse clinical outcomes: Insights from the British Cardiovascular Intervention Society database.

    Science.gov (United States)

    Sirker, Alex; Kwok, Chun Shing; Kontopantelis, Evangelos; Johnson, Tom; Freeman, Philip; de Belder, Mark A; Ludman, Peter; Zaman, Azfar; Mamas, Mamas A

    2018-01-22

    This study aims to evaluate outcomes associated with different P2Y12 agents in Saphenous Vein graft (SVG) percutaneous coronary intervention (PCI). SVG PCI is associated with greater risks of ischemic complications, compared with native coronary PCI. Outcomes associated with the use of potent P2Y12 blocking drugs, Prasugrel and Ticagrelor, in SVG PCI are unknown. Patients included in the study underwent SVG PCI in the United Kingdom between 2007 and 2014 for acute coronary syndrome and were grouped by P2Y12 antiplatelet use. In-hospital major adverse cardiac events, major bleeding and 30-day and 1-year mortality were examined. Multiple imputations with chained equations to impute missing data were used. Adjustment for baseline imbalances was performed using (1) multiple logistic regression (MLR) and (separately) (2) propensity score matching (PSM). Data weres analyzed from 8,119 patients and most cases were treated with Clopidogrel (n = 7,401), followed by Ticagrelor (n = 497) and Prasugrel (n = 221). In both MLR and PSM models, there was no significant evidence to suggest that either Prasugrel or Ticagrelor was associated with significantly lower 30-day mortality compared with Clopidogrel. The odds ratios reported from the multivariable analysis were 1.22 (95% CI: 0.60-2.51) for Prasugrel vs. Clopidogrel and 0.48 (95% CI: 0.20-1.16) for Ticagrelor vs. Clopidogrel. No significant differences were seen for in-hospital ischemic or bleeding events. Our real world national study provides no clear evidence to indicate that use of potent P2Y12 blockers in SVG PCI is associated with improved clinical outcomes. © 2018 Wiley Periodicals, Inc.

  15. Evaluation of early coronary graft patency after coronary artery bypass graft surgery using multislice computed tomography angiography

    Directory of Open Access Journals (Sweden)

    Raissi Kamal

    2009-12-01

    Full Text Available Abstract Background Coronary artery bypass graft (CABG surgery is the standard of care in the treatment of advanced coronary artery disease, and its long-term results are affected by the failure of bypass grafts. The aim of the present study was to evaluate the early patency rate in coronary bypass grafts. Methods A total of 107 consecutive patients who underwent CABG were included in this study. Early graft patency was evaluated via computed tomography (CT angiography in the first week after surgery. Results There were a total of 366 grafts, comprised of 250 venous grafts and 116 arterial grafts. Multi-slice CT detected acute graft occlusions in 32 (8.7% of all the grafts, including 26 (10% of the 250 venous grafts and 6 (5% of the 116 arterial grafts. The patency rates obtained were 97.3% for the left internal mammary (IMA grafts, 50% for the radial artery grafts, and 50% for the right IMA grafts. Additionally, 107 (96.4% grafts to the left anterior descending artery (LAD were classified as patent, whereas 1 (30% of the 3 grafts in the left circumflex (LCX region and 1 (50% of the 2 grafts in the right coronary artery (RCA territory were found to be occluded. In the venous category, 8 (13.7% of the 58 grafts to LAD were found to be occluded. In the LCX region, 9 (8.5% of the 106 grafts were classified as occluded, while the remaining 97 (91.5% grafts were patent. The venous grafts to RCA were occluded in 9 (10.4% of the 86 grafts. Amongst the multiple preoperative, intraoperative, and postoperative factors, pump time was significantly longer in the patients with occluded grafts than in those with patent grafts (P = 0.04. Conclusion The IMA grafts had the highest early patency rate amongst the coronary bypass grafts. However, the other arterial grafts were associated with a high rate of acute occlusions.

  16. Gonadal vein tumor thrombosis due to renal cell carcinoma

    Directory of Open Access Journals (Sweden)

    Hamidreza Haghighatkhah

    2015-01-01

    Full Text Available Renal cell carcinoma (RCC had a tendency to extend into the renal vein and inferior vena cava, while extension into the gonadal vein has been rarely reported. Gonadal vein tumor thrombosis appears as an enhancing filling defect within the dilated gonadal vein anterior to the psoas muscle and shows an enhancement pattern identical to that of the original tumor. The possibility of gonadal vein thrombosis should be kept in mind when looking at an imaging study of patients with RCC

  17. Perfusion of veins at arterial pressure increases the expression of KLF5 and cell cycle genes in smooth muscle cells

    International Nuclear Information System (INIS)

    Amirak, Emre; Zakkar, Mustafa; Evans, Paul C.; Kemp, Paul R.

    2010-01-01

    Vascular smooth muscle cell (VSMC) proliferation remains a major cause of veno-arterial graft failure. We hypothesised that exposure of venous SMCs to arterial pressure would increase KLF5 expression and that of cell cycle genes. Porcine jugular veins were perfused at arterial or venous pressure in the absence of growth factors. The KLF5, c-myc, cyclin-D and cyclin-E expression were elevated within 24 h of perfusion at arterial pressure but not at venous pressure. Arterial pressure also reduced the decline in SM-myosin heavy chain expression. These data suggest a role for KLF5 in initiating venous SMCs proliferation in response to arterial pressure.

  18. Identifikasi Pepper vein yellows virus yang Berasosiasi dengan Penyakit Yellow Vein Banding pada Tanaman Mentimun di Bali

    Directory of Open Access Journals (Sweden)

    I Dewa Nyoman Nyana

    2016-11-01

    Full Text Available Yellowing vein banding disease has been reported infecting cucurbit plants in Bali since 2014. Similar vein banding symptom on chilli pepper was observed previously, and early diagnosis indicated infection of Polerovirus. The objective of this research was to confirm the presence of Polerovirus infection on cucumber plant showing yellow vein banding symptom in Bali. Reverse transcription polymerase chain reaction – based detection method was conducted using specific primer pairs PeVYV-CP-F-BamH1/ PeVYV-CP-R-Pst1followed by sequencing and nucleotide sequence analysis.  Specific DNA fragments of ± 650 bp was successfully amplified from field samples.  Nucleotide sequence analysis showed that the sequence has the highest similarity > 95% with Pepper vein yellow virus (PeVYV infecting chili pepper from Indonesia (Bali, and Rembang, Japan, and Greece.

  19. Endovascular management for significant iatrogenic portal vein bleeding.

    Science.gov (United States)

    Kim, Jong Woo; Shin, Ji Hoon; Park, Jonathan K; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu-Bo

    2017-11-01

    Background Despite conservative treatment, hemorrhage from an intrahepatic branch of the portal vein can cause hemodynamic instability requiring urgent intervention. Purpose To retrospectively report the outcomes of hemodynamically significant portal vein bleeding after endovascular management. Material and Methods During a period of 15 years, four patients (2 men, 2 women; median age, 70.5 years) underwent angiography and embolization for iatrogenic portal vein bleeding. Causes of hemorrhage, angiographic findings, endovascular treatment, and complications were reported. Results Portal vein bleeding occurred after percutaneous liver biopsy (n = 2), percutaneous radiofrequency ablation (n = 1), and percutaneous cholecystostomy (n = 1). The median time interval between angiography and percutaneous procedure was 5 h (range, 4-240 h). Common hepatic angiograms including indirect mesenteric portograms showed active portal vein bleeding into the peritoneal cavity with (n = 1) or without (n = 2) an arterioportal (AP) fistula, and portal vein pseudoaneurysm alone with an AP fistula (n = 1). Successful transcatheter arterial embolization (n = 2) or percutaneous transhepatic portal vein embolization (n = 2) was performed. Embolic materials were n-butyl cyanoacrylate alone (n = 2) or in combination with gelatin sponge particles and coils (n = 2). There were no major treatment-related complications or patient mortality within 30 days. Conclusion Patients with symptomatic or life-threatening portal vein bleeding following liver-penetrating procedures can successfully be managed with embolization.

  20. Pancreas grafts

    International Nuclear Information System (INIS)

    Hahn, D.; Buell, U.; Land, W.; Unertl, K.

    1981-01-01

    Perfusion studies with sup(99m)Tc-DTPA, which has hitherto been used routinely to investigate renal grafts, have also proved useful for monitoring the perfusion of pancreas grafts. A total perfusion failure is equally reliably demonstrable as in renal grafts. Quantitatively smaller perfusion alterations can be demonstrated by monitoring the course. It seems possible to differentiate the salivary edema of a rejection reaction, well known from animal experiments, with the help of other paramters (e.g. creatinine). Further clinical studies are however necessary to confirm these results. (orig.) [de

  1. Graft union formation in artichoke grafting onto wild and cultivated cardoon: an anatomical study.

    Science.gov (United States)

    Trinchera, Alessandra; Pandozy, Gianmarco; Rinaldi, Simona; Crinò, Paola; Temperini, Olindo; Rea, Elvira

    2013-12-15

    In order to develop a non-chemical method such as grafting effective against well-known artichoke soil borne diseases, an anatomical study of union formation in artichoke grafted onto selected wild and cultivated cardoon rootstocks, both resistant to Verticillium wilt, was performed. The cardoon accessions Belgio (cultivated cardoon) and Sardo (wild cardoon) were selected as rootstocks for grafting combinations with the artichoke cv. Romolo. Grafting experiments were carried out in the autumn and spring. The anatomical investigation of grafting union formation was conducted by scanning electron microscopy (SEM) on the grafting portions at the 3rd, 6th, 10th, 12th day after grafting. For the autumn experiment only, SEM analysis was also performed at 30 d after grafting. A high affinity between artichoke scion and cardoon rootstocks was observed, with some genotype differences in healing time between the two bionts. SEM images of scion/rootstock longitudinal sections revealed the appearance of many interconnecting structures between the two grafting components just 3d after grafting, followed by a vascular rearrangement and a callus development during graft union formation. De novo formation of many plasmodesmata between scion and rootstock confirmed their high compatibility, particularly in the globe artichoke/wild cardoon combination. Moreover, the duration of the early-stage grafting process could be influenced not only by the scion/rootstock compatibility, but also by the seasonal conditions, being favored by lower temperatures and a reduced light/dark photoperiod. Copyright © 2013 Elsevier GmbH. All rights reserved.

  2. Femoro-Supragenicular Popliteal Bypass with a Bridging Stent Graft in a Diffusely Diseased Distal Target Popliteal Artery: Alternative to Below-Knee Popliteal Polytetrafluoroethylene Bypass

    Directory of Open Access Journals (Sweden)

    Joung Hun Byun

    2017-10-01

    Full Text Available Background: Lesions in distal target arteries hinder surgical bypass procedures in patients with peripheral arterial occlusive disease. Methods: Between April 2012 and October 2015, 16 patients (18 limbs with lifestyle- limiting claudication (n=12 or chronic critical limb ischemia (n=6 underwent femoral–above-knee (AK polytetrafluoroethylene (PTFE bypass grafts with a bridging stent graft placement between the distal target popliteal artery and the PTFE graft. Ring-supported PTFE grafts were used in all patients with no available vein for graft material. Follow-up evaluations assessed clinical symptoms, the ankle-brachial index, ultrasonographic imaging and/or computed tomography angiography, the primary patency rate, and complications. Results: All procedures were successful. The mean follow-up was 12.6 months (range, 11 to 14 months, and there were no major complications. The median baseline ankle-brachial index of 0.4 (range, 0.2 to 0.55 significantly increased to 0.8 (range, 0.5 to 1.0 at 12 months (p<0.01. The primary patency rate at 12 months was 83.3%. The presenting symptoms resolved within 2 weeks. Conclusion: In AK bypasses with a diffusely diseased distal target popliteal artery or when below-knee (BK bypass surgery is impossible, this procedure could be clinically effective and safe when used as an alternative to femoral-BK bypass surgery.

  3. Scintigraphic assessment of focal platelet accumulations following infrainguinal bypass surgery in humans

    DEFF Research Database (Denmark)

    Nielsen, Tina G; Hesse, B; Eiberg, J

    1997-01-01

    . In 28 patients undergoing in situ vein (n = 24), composite vein-polytetrafluoroethylene (PTFE) (n = 1) or PTFE (n = 3) bypass surgery, assumed vascular injuries were recorded intraoperatively. Autologous indium-111-labelled platelets were injected into the inflow artery immediately after restoration...... antiplatelet therapy or vein graft diameter. Only 2 of the 20 intragraft platelet depositions occurred in areas where intra-operative vascular injury was suspected. In the composite graft and the PTFE grafts, diffuse activity was observed throughout the entire bypass. In conclusion, focal activity...

  4. Tidlige erfaringer med duplexovervågning af femoropopliteale og -krurale vene-bypass

    DEFF Research Database (Denmark)

    Nielsen, Tina G; von Jessen, Frants; Schroeder, T V

    1993-01-01

    Identification and correction of graft stenoses in femoropopliteal and -crural vein bypasses can prevent reconstruction failure. Sixty six consecutive vein bypasses entered a postoperative surveillance protocol, which implied clinical assessment, measurement of ankle blood pressure and duplex...... could not be reestablished. Of the 34 bypasses with normal duplex-scans only 2 (6%) thrombosed (p blood pressure measurement could reliably predict graft failure. This study indicates that duplex......-scanning effectively identifies grafts at risk and can be expected to improve long-term patency of infrainguinal vein bypasses....

  5. Conventional tomographic hilar anatomy emphasizing the pulmonary veins

    International Nuclear Information System (INIS)

    Genereux, G.P.

    1983-01-01

    The pulmonary hili are a frequent site of interpretive uncertainty because of thir complex anatomy. The right hilar shadow relates primarily to the ascending and descending pulmonary arteries and the right superior pulmonary vein, whereas the left hilar density accrues from the left pulmonary artery, left descending pulmonary artery, and left superior pulmonary vein. The right and left superoir pulmonary veins are intimately associated with and inseparable from the arteries. Knowledge of the course of these veins facilitates their identification on conventional tomograms. The right and left inferior pulmonary veins lie behind the lower hili and contribute only a small increment to the normal hilar density; the horizontal course of these vessels readily distinguishes them from the vertically oriented lower lobe arteries. Prominence of both the right and left superior and inferior veins may cause hilar pseudotumors. Conventional tomograms are most helpful in understanding plain radiographs. A multiview approach in anteroposterior, 55 0 posterior oblique, and lateral projections is recommended for a complete assessment. Computed tomography in transaxial sections adds further understanding of spatial relations in the hili, including the contributions of the pulmonary veins

  6. Evaluation of the portal veins, hepatic veins and bile ducts using fat-suppressed segmented True FISP

    International Nuclear Information System (INIS)

    Ueda, Takashi; Uchikoshi, Masato; Imaoka, Izumi; Iwaya, Kazuo; Matsuo, Michimasa; Wada, Akihiko

    2005-01-01

    True FISP (fast imaging with steady-state free precession) is a fast imaging technique that provides high SNR (signal to noise ratio) and excellent delineation of parenchymal organs. The contrast of True FISP depends on the mixture of T 2 /T 1 . Vessels with slow flow are usually displayed as high signal intensity on True FISP images. The purpose of this study was to optimize fat-suppressed (FS) segmented True FISP imaging for portal veins, hepatic veins, and bile ducts. FS segmented True FISP images were applied to the phantoms of liver parenchyma, saline, and oil with various flip angles (every 10 degrees from 5-65 degrees) and k-space segmentations (3, 15, 25, 51, 75, 99). Five healthy volunteers were also examined to get optimized flip angle and k-space segmentation. The largest flip angle, 65 degrees, showed the best contrast between the liver parenchyma phantom, saline, and oil. The largest segmentations, 99, provided the best contrast between a liver parenchyma phantom and saline. However, the signal of the oil phantom exceeded that of the liver parenchyma phantom with 99 segmentations. As a result, the flip angle of 65 degrees and 75 segments is recommended to get the best contrast between the liver parenchyma phantom and saline, while suppressing the signal of oil. The volunteer studies also support the phantom studies and showed excellent anatomical delineation of portal veins, hepatic veins, and bile ducts when using these parameters. We conclude that True FISP is potentially suitable for the imaging of portal veins, hepatic veins, and bile ducts. The flip angle of 65 degrees with 75 segments is recommended to optimize FS segmented True FISP images. (author)

  7. Prospective ECG-triggered axial CT at 140-kV tube voltage improves coronary in-stent restenosis visibility at a lower radiation dose compared with conventional retrospective ECG-gated helical CT

    Energy Technology Data Exchange (ETDEWEB)

    Horiguchi, Jun; Fujioka, Chikako; Kiguchi, Masao; Kohno, Shingo [Hiroshima University Hospital, Department of Clinical Radiology, Hiroshima (Japan); Yamamoto, Hideya; Kitagawa, Toshiro [Hiroshima University, Department of Molecular and Internal Medicine, Division of Clinical Medical Science, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima (Japan); Ito, Katsuhide [Hiroshima University, Department of Radiology, Division of Medical Intelligence and Informatics, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima (Japan)

    2009-10-15

    The purpose of this study was to compare coronary 64-slice CT angiography (CTA) protocols, specifically prospective electrocardiograph (ECG)-triggered and retrospective ECG-gated CT acquisition performed using a tube voltage of 140 kV and 120 kV, regarding intracoronary stent imaging. Coronary artery stents (n=12) with artificial in-stent restenosis (50% luminal reduction, 40 HU) on a cardiac phantom were examined by CT at heart rates of 50-75 beats per minute (bpm). The subjective visibility of in-stent restenosis was evaluated with a three-point scale (1 clearly visible, 2 visible, and 3 not visible), and artificial lumen narrowing [(inner stent diameter - measured lumen diameter)/inner stent diameter], lumen attenuation increase ratio [(in-stent attenuation - coronary lumen attenuation)/coronary lumen attenuation], and signal-to-noise ratio of in-stent lumen were determined. The effective dose was estimated. The artificial lumen narrowing (mean 43%), the increase of lumen attenuation (mean 46%), and signal-to-noise ratio (mean 7.8) were not different between CT acquisitions (p=0.12-0.91). However, the visibility scores of in-stent restenosis were different (p<0.05) between ECG-gated CTA techniques: (a) 140-kV prospective (effective dose 4.6 mSv), 1.6; (b) 120-kV prospective (3.3 mSv), 1.8; (c) 140-kV retrospective (16.4-18.8 mSv), 1.9; and (d) 120-kV retrospective (11.0-13.4 mSv), 1.9. Thus, 140-kV prospective ECG-triggered CTA improves coronary in-stent restenosis visibility at a lower radiation dose compared with retrospective ECG-gated CTA. (orig.)

  8. A COMPARATIVE STUDY OF TYMPANOPLASTY USING SLICED CARTILAGE GRAFT VS. TEMPORALIS FASCIA GRAFT

    Directory of Open Access Journals (Sweden)

    Rahul Ashok Telang

    2018-02-01

    Full Text Available BACKGROUND The objective of the study was to compare the hearing improvement after using sliced cartilage graft with that of temporalis fascia and to compare the graft take-up between the two graft materials. MATERIALS AND METHODS A prospective clinical study including 60 patients with chronic mucosal otitis media, who were selected randomly from the outpatient department, after obtaining their consent were divided into 2 groups of 30 each, and evaluated according the study protocol. Their pre-operative audiometry was recorded and both groups of patients underwent surgery with one of the graft materials- temporalis fascia or sliced tragal cartilage with a thickness of 0.5 mm. All patients were regularly followed up and post-operative audiometry was done at 3 months. The hearing improvement in the form of closure of air-bone-gap and graft take-up was analysed statistically. RESULTS The temporalis fascia graft group had a pre-operative ABG of 22.33 ± 6.24 dB and post-operative ABG of 12.33 ± 4.72 dB with hearing improvement of 10.00 dB. The sliced cartilage graft group had a pre-operative ABG of 20.77 ± 5.75 dB and postoperative ABG of 10.50 ± 4.46 dB with hearing improvement of 10.27 dB. In the temporalis fascia group, 28 (93.3% patients had good graft take-up and in the sliced cartilage group 29 (96.7% had good graft take-up. There was statistically significant hearing improvement in both of our study groups but there was no statistically significant difference between the two groups. There was no statistically significant difference in graft take-up also. CONCLUSION Sliced cartilage graft is a good auto-graft material in tympanoplasty, which can give good hearing improvement and has good graft take-up, which is comparable with that of temporalis fascia.

  9. Generating and analyzing synthetic finger vein images

    OpenAIRE

    Hillerström, Fieke; Kumar, Ajay; Veldhuis, Raymond N.J.

    2014-01-01

    Abstract: The finger-vein biometric offers higher degree of security, personal privacy and strong anti-spoofing capabilities than most other biometric modalities employed today. Emerging privacy concerns with the database acquisition and lack of availability of large scale finger-vein database have posed challenges in exploring this technology for large scale applications. This paper details the first such attempt to synthesize finger-vein images and presents analysis of synthesized images fo...

  10. Advances in radiation grafting

    International Nuclear Information System (INIS)

    Hegazy, El-Sayed A.; AbdEl-Rehim, H.A.; Kamal, H.; Kandeel, K.A.

    2001-01-01

    Graft copolymerization is an attractive means for modifying base polymers because grafting frequently results in the superposition of properties relating to the backbone and pendent chains. Among the various methods for initiating the grafting reaction, ionizing radiation is the cleanest and most versatile method of grafting available. Ion-exchange membranes play an important role in modern technology, especially in separation and purification of materials. The search for improved membrane composition has considered almost every available polymeric material because of its great practical importance. Grafting of polymers with a mixture of monomers is important since different types of chains containing different functional groups are included. A great deal is focused on the waste treatment of heavy and toxic metals from wastewater because of the severe problems of environmental pollution. Functionalized polymers suitable for metal adsorption with their reactive functional groups such as carboxylic and pyridine groups suitable for waste treatment were prepared by radiation grafting method. More reactive chelating groups were further introduced to the grafted copolymer through its functional groups by chemical treatments with suitable reagents. The advances of radiation grafting and possible uses are briefly discussed

  11. Endovascular Radiofrequency Ablation for Varicose Veins

    Science.gov (United States)

    2011-01-01

    Executive Summary Objective The objective of the MAS evidence review was to conduct a systematic review of the available evidence on the safety, effectiveness, durability and cost–effectiveness of endovascular radiofrequency ablation (RFA) for the treatment of primary symptomatic varicose veins. Background The Ontario Health Technology Advisory Committee (OHTAC) met on August 26th, 2010 to review the safety, effectiveness, durability, and cost-effectiveness of RFA for the treatment of primary symptomatic varicose veins based on an evidence-based review by the Medical Advisory Secretariat (MAS). Clinical Condition Varicose veins (VV) are tortuous, twisted, or elongated veins. This can be due to existing (inherited) valve dysfunction or decreased vein elasticity (primary venous reflux) or valve damage from prior thrombotic events (secondary venous reflux). The end result is pooling of blood in the veins, increased venous pressure and subsequent vein enlargement. As a result of high venous pressure, branch vessels balloon out leading to varicosities (varicose veins). Symptoms typically affect the lower extremities and include (but are not limited to): aching, swelling, throbbing, night cramps, restless legs, leg fatigue, itching and burning. Left untreated, venous reflux tends to be progressive, often leading to chronic venous insufficiency (CVI). A number of complications are associated with untreated venous reflux: including superficial thrombophlebitis as well as variceal rupture and haemorrhage. CVI often results in chronic skin changes referred to as stasis dermatitis. Stasis dermatitis is comprised of a spectrum of cutaneous abnormalities including edema, hyperpigmentation, eczema, lipodermatosclerosis and stasis ulceration. Ulceration represents the disease end point for severe CVI. CVI is associated with a reduced quality of life particularly in relation to pain, physical function and mobility. In severe cases, VV with ulcers, QOL has been rated to be as bad

  12. Umbilical vein draining into the inferior vena cava via the internal iliac vein, bypassing the liver

    International Nuclear Information System (INIS)

    Currarino, G.; Stannard, M.W.; Texas Univ., Dallas, TX; Kolni, H.

    1991-01-01

    This is the third report of an anomalous umbilical vein draining ectopically in a left pelvic vein, probably the left internal iliac, and through the inferior vena cava into the right atrium. The anomaly was encountered in a newborn infant with nonimmune hydrops fetalis, hypertrophic cardiomyopathy, multiorgan failure and possibly Noonan Syndrome. (orig.)

  13. Umbilical vein draining into the inferior vena cava via the internal iliac vein, bypassing the liver

    Energy Technology Data Exchange (ETDEWEB)

    Currarino, G.; Stannard, M.W. (Children' s Medical Center, Dallas, TX (United States). Dept. of Radiology Texas Univ., Dallas, TX (United States). Southwestern Medical Center); Kolni, H. (Methodist Hospital, Dallas, TX (United States). Dept. of Pediatrics)

    1991-05-01

    This is the third report of an anomalous umbilical vein draining ectopically in a left pelvic vein, probably the left internal iliac, and through the inferior vena cava into the right atrium. The anomaly was encountered in a newborn infant with nonimmune hydrops fetalis, hypertrophic cardiomyopathy, multiorgan failure and possibly Noonan Syndrome. (orig.).

  14. Evaluation of regeneration of liver function in pig model of auxiliary partial liver transplantation

    International Nuclear Information System (INIS)

    Li Jiaxin; Chen Xiaopeng; Rui Ging; Shong Qun; Chen Fangman; Lu Meijing; Chen Yongquan

    2010-01-01

    Objective: To establish a pig model of auxiliary partial liver transplantation and observe the liver function regeneration of host liver and graft. Methods: The portal vein providing for the host liver were gradually contracted; the donor hepatic veins were eng-to-side anastomosed to inferior vena cava in host caudal; graft was transplanted into the space under the host liver, part of receivers relieved portal vein angiography and color Doppler flow imaging was performed 3 days after surgery. Liver function of double livers in relievers was checked up, 3 days and 1 week after surgery respectively. Results: After surgery 10 relievers survived over 1 week, blood enzymology from hepatic vein of grafts 1 week after surgery were not ameliorative significantly compared with those 3 days after surgery (P > 0.05). Blood enzymology indexes from hepatic veins of grafts 1 week after surgery were were improved significantly compared with 3 days after surgery (P < 0.05). The graft did not reveal atrophic and gained favorable function. Conclusion: Favorable regeneration in the auxiliary partial liver transplantation model has achieved. Ideal foundation has been established for simulating and investigating human auxiliary liver transplantation. (authors)

  15. Patterning of leaf vein networks by convergent auxin transport pathways.

    Science.gov (United States)

    Sawchuk, Megan G; Edgar, Alexander; Scarpella, Enrico

    2013-01-01

    The formation of leaf vein patterns has fascinated biologists for centuries. Transport of the plant signal auxin has long been implicated in vein patterning, but molecular details have remained unclear. Varied evidence suggests a central role for the plasma-membrane (PM)-localized PIN-FORMED1 (PIN1) intercellular auxin transporter of Arabidopsis thaliana in auxin-transport-dependent vein patterning. However, in contrast to the severe vein-pattern defects induced by auxin transport inhibitors, pin1 mutant leaves have only mild vein-pattern defects. These defects have been interpreted as evidence of redundancy between PIN1 and the other four PM-localized PIN proteins in vein patterning, redundancy that underlies many developmental processes. By contrast, we show here that vein patterning in the Arabidopsis leaf is controlled by two distinct and convergent auxin-transport pathways: intercellular auxin transport mediated by PM-localized PIN1 and intracellular auxin transport mediated by the evolutionarily older, endoplasmic-reticulum-localized PIN6, PIN8, and PIN5. PIN6 and PIN8 are expressed, as PIN1 and PIN5, at sites of vein formation. pin6 synthetically enhances pin1 vein-pattern defects, and pin8 quantitatively enhances pin1pin6 vein-pattern defects. Function of PIN6 is necessary, redundantly with that of PIN8, and sufficient to control auxin response levels, PIN1 expression, and vein network formation; and the vein pattern defects induced by ectopic PIN6 expression are mimicked by ectopic PIN8 expression. Finally, vein patterning functions of PIN6 and PIN8 are antagonized by PIN5 function. Our data define a new level of control of vein patterning, one with repercussions on other patterning processes in the plant, and suggest a mechanism to select cell files specialized for vascular function that predates evolution of PM-localized PIN proteins.

  16. Patterning of leaf vein networks by convergent auxin transport pathways.

    Directory of Open Access Journals (Sweden)

    Megan G Sawchuk

    Full Text Available The formation of leaf vein patterns has fascinated biologists for centuries. Transport of the plant signal auxin has long been implicated in vein patterning, but molecular details have remained unclear. Varied evidence suggests a central role for the plasma-membrane (PM-localized PIN-FORMED1 (PIN1 intercellular auxin transporter of Arabidopsis thaliana in auxin-transport-dependent vein patterning. However, in contrast to the severe vein-pattern defects induced by auxin transport inhibitors, pin1 mutant leaves have only mild vein-pattern defects. These defects have been interpreted as evidence of redundancy between PIN1 and the other four PM-localized PIN proteins in vein patterning, redundancy that underlies many developmental processes. By contrast, we show here that vein patterning in the Arabidopsis leaf is controlled by two distinct and convergent auxin-transport pathways: intercellular auxin transport mediated by PM-localized PIN1 and intracellular auxin transport mediated by the evolutionarily older, endoplasmic-reticulum-localized PIN6, PIN8, and PIN5. PIN6 and PIN8 are expressed, as PIN1 and PIN5, at sites of vein formation. pin6 synthetically enhances pin1 vein-pattern defects, and pin8 quantitatively enhances pin1pin6 vein-pattern defects. Function of PIN6 is necessary, redundantly with that of PIN8, and sufficient to control auxin response levels, PIN1 expression, and vein network formation; and the vein pattern defects induced by ectopic PIN6 expression are mimicked by ectopic PIN8 expression. Finally, vein patterning functions of PIN6 and PIN8 are antagonized by PIN5 function. Our data define a new level of control of vein patterning, one with repercussions on other patterning processes in the plant, and suggest a mechanism to select cell files specialized for vascular function that predates evolution of PM-localized PIN proteins.

  17. Restenosis of the sigmoid sinus after stenting for treatment of intracranial venous hypertension: case report

    International Nuclear Information System (INIS)

    Tsumoto, T.; Miyamoto, T.; Shimizu, M.; Inui, Y.; Nakakita, K.; Hayashi, S.; Terada, T.

    2003-01-01

    We report what we believe to be the first case of restenosis of the sigmoid sinus after stenting, in a 42-year-old man with an arteriovenous malformation with progressive right hemiparesis secondary to venous hypertension. Angiography revealed severe stenosis of the left sigmoid sinus, which was dilated with a self-expandable stent. Six months after the procedure, however, the sinus was again severely stenosed. Intravascular sonography revealed intimal proliferation in the stented sinus. It was dilated percutaneously, and the venous pressure decreased from 51 to 33 mmHg. On sonography, the intimal tissue decreased in thickness and the diameter of the stent enlarged a little. (orig.)

  18. Restenosis of the sigmoid sinus after stenting for treatment of intracranial venous hypertension: case report

    Energy Technology Data Exchange (ETDEWEB)

    Tsumoto, T.; Miyamoto, T.; Shimizu, M.; Inui, Y.; Nakakita, K.; Hayashi, S. [Department of Neurosurgery, Minami Wakayama National Hospital, Wakayama (Japan); Terada, T. [Department of Neurological Surgery, Wakayama Medical University, Wakayama (Japan)

    2003-12-01

    We report what we believe to be the first case of restenosis of the sigmoid sinus after stenting, in a 42-year-old man with an arteriovenous malformation with progressive right hemiparesis secondary to venous hypertension. Angiography revealed severe stenosis of the left sigmoid sinus, which was dilated with a self-expandable stent. Six months after the procedure, however, the sinus was again severely stenosed. Intravascular sonography revealed intimal proliferation in the stented sinus. It was dilated percutaneously, and the venous pressure decreased from 51 to 33 mmHg. On sonography, the intimal tissue decreased in thickness and the diameter of the stent enlarged a little. (orig.)

  19. Quantification of deep medullary veins at 7 T brain MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kuijf, Hugo J.; Viergever, Max A.; Vincken, Koen L. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands); Bouvy, Willem H.; Razoux Schultz, Tom B.; Biessels, Geert Jan [University Medical Center Utrecht, Department of Neurology, Brain Center Rudolf Magnus, Utrecht (Netherlands); Zwanenburg, Jaco J.M. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands)

    2016-10-15

    Deep medullary veins support the venous drainage of the brain and may display abnormalities in the context of different cerebrovascular diseases. We present and evaluate a method to automatically detect and quantify deep medullary veins at 7 T. Five participants were scanned twice, to assess the robustness and reproducibility of manual and automated vein detection. Additionally, the method was evaluated on 24 participants to demonstrate its application. Deep medullary veins were assessed within an automatically created region-of-interest around the lateral ventricles, defined such that all veins must intersect it. A combination of vesselness, tubular tracking, and hysteresis thresholding located individual veins, which were quantified by counting and computing (3-D) density maps. Visual assessment was time-consuming (2 h/scan), with an intra-/inter-observer agreement on absolute vein count of ICC = 0.76 and 0.60, respectively. The automated vein detection showed excellent inter-scan reproducibility before (ICC = 0.79) and after (ICC = 0.88) visually censoring false positives. It had a positive predictive value of 71.6 %. Imaging at 7 T allows visualization and quantification of deep medullary veins. The presented method offers fast and reliable automated assessment of deep medullary veins. (orig.)

  20. Preoperative mapping of the saphenous vein

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Sillesen, H; Nielsen, Tina G

    1996-01-01

    A series of 124 patients had their greater saphenous vein assessed with duplex ultrasound scanning prior to planned infrainguinal bypass procedures. 33 (27%) bypass procedures thrombosed within the first year. A naturally occurring optimal vein diameter was discovered: 5.0-6.5 mm at mid-thigh lev...