Επιπλοκές της χρήσης του ενδοαορτικού ασκού σε κλινικές και πειραματικές εφαρμογές

Normal Diameter and Growth Rate of Infrarenal Aorta and Common Iliac Artery in Chinese Population Measured by Contrast-Enhanced Computed Tomography

Erectile Dysfunction Due to Atherosclerotic Vascular Disease: The Development of an Animal Model

The purpose of this work is to present a patient-specific (PS) modeling approach for simulating percutaneous transluminal angioplasty (PTA) endovascular treatment and assessing the balloon sizing influence on short-term outcomes in peripheral arteries, i.e. without stent implantation. Two 3D PS stenosed femoral artery models, one with a dominant calcified atherosclerosis while the other with a lipidic plaque, were generated from pre-operative computed tomography angiography images. Elastoplastic constitutive laws were implemented within the plaque and artery models. Implicit finite element method (FEM) was used to simulate the balloon inflation and deflation for different sizings. Besides vessel strains, results were mainly evaluated in terms of the elastic recoil ratio (ERR) and lumen gain ratio (LGR) attained immediately after PTA. Higher LGR values were shown within the stenosed region of the lipidic patient. Simulated results also showed a direct and quantified correlation between balloon sizing and LGR and ERR for both patients after PTA, with a more significant influence on the lumen gain. The max principal strain values in the outer arterial wall increased at higher balloon sizes during inflation as well, with higher rates of increase when the plaque was calcified. Results show that our model could serve in finding a compromise for each stenosis type: maximizing the achieved lumen gain after PTA, but at the same time without damaging the arterial tissue. The proposed methodology can serve as a step toward a clinical decision support system to improve angioplasty balloon sizing selection prior to the surgery.

A novel approach to the balloon angioplasty of a native discrete severe coarctation of the aorta in the management of hypertension.

Microsurgical Bypass Training Rat Model: Part 2-Anastomosis Configurations.

Background/Objectives: The abdominal aorta (AA) bifurcates at the level of the L4 vertebra, giving origin to the right and left common iliac arteries (CIA). The CIA then bifurcates into external iliac arteries (EIA) and internal iliac arteries (IIA). The present radiological study aimed to (i) measure the diameter of the right and left CIA, (ii) measure the distance between the AA bifurcation and the point where the ureter crossed the ipsilateral iliac vessels, (iii) examine the angle of AA bifurcation, and (iv) observe the vertebral level at which the AA bifurcated. Methods: The retrospective cross-sectional study included contrast-enhanced CT angiograms of 200 patients (n = 144 males and 56 females) who attended the radiology department from 1 January 2022 to 31 December 2023. Two independent radiologists interpreted the angiograms. The results were interpreted using parametric and non-parametric statistical tests. Results: The mean angle of the AA bifurcation was 40.46° and 44.68° in males and females, respectively (p = 0.013). The mean diameter of the right and left CIA was wider in males than in females, but no statistical significance was found. The average distance between the AA bifurcation and the point where the right and left ureter crossed the ipsilateral iliac arteries was longer in females (60.99 and 60.29 mm, respectively) than in males (59.05 and 59.95 mm, respectively), but no statistical difference was found (p > 0.05). The most common vertebral level for AA bifurcation was the L4 vertebra, which was found in 137 (68.50%) patients. The AA bifurcated at the level of L3 and L5 in 52 (26.00%) and 11 (5.50%) patients, respectively. Conclusions: Understanding the radiological anatomy of the CIA and AA bifurcation and its relation to the ureter is crucial for surgeons performing aortic and pelvic surgeries.

In this work we propose a generic modeling approach for simulating percutaneous transluminal angioplasty (PTA) endovascular treatment, and evaluating the influence of balloon design, plaque composition, and balloon sizing on acute post-procedural outcomes right after PTA, without stent implantation. Clinically-used PTA balloons were classified into two categories according to their compliance characteristics, and were modeled correspondingly. Self-defined elastoplastic constitutive laws were implemented within the plaque and artery models, after calibration based on experimental and clinical data. Finite element method (FEM) implicit solver was used to simulate balloon inflation and deflation. Besides balloon profile at max inflation, results are mainly assessed in terms of the elastic recoil ratio (ERR) and lumen gain ratio (LGR) obtained immediately after PTA. No variations in ERR nor LGR values were detected when the balloon design changed, despite the differences observed in their profile at max inflation. Moreover, LGR and ERR inversely varied with the augmentation of calcification level within the plaque (-11% vs. +4% respectively, from fully lipidic to fully calcified plaque). Furthermore, results showed a direct correlation between balloon sizing and LGR and ERR, with noticeably higher rates of change for LGR (+18% and +2% for LGR and ERR respectively for a calcified plaque and a balloon pressure increasing from 10 to 14 atm). However a larger LGR comes with a higher risk of arterial rupture. This proposed methodology opens the way for evaluation of angioplasty balloon selections towards clinical procedure optimization.

When performing high-risk abdominal aortic aneurysm (AAA), aortic cross-clamp time was reduced to a mean of 9 minutes by performing retrograde anastomosis using a ringed Y-graft (RYG). Retrograde anastomosis with RYG was performed in nine patients, (eight men and one woman) with a mean age of 74 years (range: 65–82 years). Three patients had angina pectoris and chronic renal failure, two had angina pectoris, one had thoracoabdominal aortic aneurysm and chronic renal failure, one had renal failure, one had aortic regurgitation, and one had aortic stenosis. First, the right common, external, and internal iliac arteries were clamped, then, the right limb of the graft was anastomosed to the common iliac artery or external iliac artery. Next, the aorta and left common iliac artery were clamped, and a longitudinal incision was made in the aneurysm. The proximal end of the RYG was inserted into the aorta and blood flow was resumed. Finally, the left limb of the graft was anastomosed to the left common iliac artery or external iliac artery. The mean aortic cross-clamp time was 9 minutes (range: 8–18 minutes). There were no cardiac complications during surgery. The mean operating time was 3:34 hours (range: 3:05–4:35 hours), and the blood loss averaged 1156 ml (range: 200–2000 ml). None of the patients developed postoperative complications and all of them have remained well after discharge. Retrograde anastomosis using RYG is one type of surgery that could be used in cases of high-risk patients with AAA.

Distribution of Iliac Artery Calcification on Unenhanced Computed Tomography Scans Performed on Potential Recipients Prior to Renal Transplantation

The Contemporary Role of Extra-anatomical Surgical Renal Revascularization in Patients with Atherosclerotic Renal Aretery Disease

Deep venous thrombosis (DVT) has been noted to occur as much as 60% more frequently in the left lower extremity than in the right extremity [1]. Virchow first suggested this disparity in 1851 when he observed that iliofemoral vein thrombosis was five times more likely to occur in the left leg than in the right leg [2]. In 1957, May and Thurner [3] pathologic changes at the points where the right common iliac artery crosses over the left common iliac artery. They found that the right iliac artery compressed the left iliac vein against the fifth lumbar vertebra in 22% of 430 cadavers. A recent large number of study using computed tomography showed that mean percentage of compression was 36.6%: 29.7% (66/222) of greater than 50% compression and 7.2% (16/222) of greater than 70% compression [4]. They concluded that increasing levels of percentage compression were not associated with left-sided DVT up to 70%; however, greater than 70% compression might be associated with left DVT. The results of this study are consistent with those of previous smaller studies on iliac vein compression [5,6]. However, Kibbe et al. [7] reported that hemodynamically significant left common iliac vein compression is a frequent anatomic variant in asymptomatic individuals. Hence, they concluded that compression of the left iliac vein might represent a normal anatomic pattern that has thus far been thought as a pathologic condition. Several studies have demonstrated that therapeutic roles of lymphadenectomy in endometrial cancer and cervical cancer [8-10]. Moreover, extended systematic lymph node dissection resulted in high regional tumor control and high metastatic lymph node rate in cervical cancer [11,12]. To perform the extended systematic lymphadenectomy, it is important to know the exact anatomy of major retroperitoneal vascular structure. Kose et al. [13] demonstrated that prevalence of major retroperitoneal vascular structure anomalies was 17% and common iliac artery and/or vein anomalies was 1.8%. Presence of these anomalies may lead to devastating complications resulting in organ loss or death. However, a few data on anomalies of common iliac vessels are available. Cancer patients are at increased risk of venous thromboembolism and pulmonary embolism. For prediction of venous thromboembolism, several biomarkers were introduced including blood count analysis (elevated leukocyte and platelet count and decreased hemoglobin), D-dimer, prothrombin fragment, soluble P-selectin, and clotting factor VII [14]. Furthermore, risk assessment models were developed that include clinical and laboratory markers. From a clinical perspective, it would be helpful to have biomarkers that enable early identification of cancer patients at risk of venous thromboembolism and to target anticoagulation for primary prevention of venous thormboembolism based on risk stratification. In summary, severe compression of the common iliac vein may be associated with left-sided DVT. We should be concerned about the degree of compression to the common iliac vein during systematic para-aortic and pelvic lymphadenectomy for the treatment of gynecologic cancer patients. To prevent life threatening bleeding during systematic lymphadenectomy, it is important to know the exact anatomy of major retroperitoneal vascular structure including common iliac vessels [15]. Thromboprophylaxis is considered to reduce venous thromoembolism using several biomarkers and clinical parameters.

Calcium score: a new risk factor for colorectal anastomotic leakage

Aortic dissection (AD) is a tear in the intima of the aorta, leading to blood flow into the medial layer and creating a false lumen. It is a true medical emergency with high mortality, particularly for Type A dissections involving the ascending aorta0 Aortic dissection is a rare but catastrophic cardiovascular emergency. This report details the case of a 62-year-old male presenting with an extensive aortic dissection, which spanned the entire length of the aorta—from the aortic root to the common iliac arteries. Remarkably, the dissection flap involved the ostia of several critical branch vessels, namely the left carotid artery, the left renal artery, and the left common iliac artery. The patient, presenting with non-specific chest pain initially treated as gastric distress, was diagnosed rapidly using Point-of-Care Ultrasound (POCUS) and confirmed with computer tomography (CT). This case underscores the challenges in diagnosing extensive aortic dissection and highlights the importance of timely and comprehensive imaging for planning management, which, unfortunately, was refused by the patient against medical advice (AMA).

Isolated abdominal aortic dissection constitutes a relatively small percentage of all aortic dissections. In this paper we present a case of a 59-year-old man who reported to the hospital because of the sudden appearance of intermittent claudication of his left lower limb. After establishing the diagnosis the patient was qualified for endovascular treatment due to dissection involving the final 1 cm of his abdominal aorta and extending to his left common iliac artery with significant true lumen compression. Stent was implanted into the left common iliac artery with almost complete occlusion of the false lumen and expansion of the true lumen of his iliac artery. During the 70-month follow-up we achieved a good result with evidence of stent patency and no signs of expansion of the false lumen. The paper discusses the epidemiology, aetiology, diagnosis and treatment of isolated abdominal dissections.

To describe a case of an anomalous common iliac artery (CIA) arising from the aorta as the fourth lumbar artery (4th LA) and following a retro-psoas course as the continuation of the 4th LA. Contrast-enhanced abdominopelvic computed tomography (CT) findings of an incidentally detected anomalous CIA are described in an 8-year-old girl. CT showed that the right CIA originated from the distal aorta at the L3-L4 level with an acute angle and continued posteriorly in the course of the 4th LA. The right CIA descended into the iliac fossa as a single artery, lying posterior to the psoas muscle. It gave off the internal iliac artery (IIA) low in the iliac fossa and continued as the external iliac artery (EIA). The median sacral artery (MSA) originated from the left proximal CIA and joined the posterior division of the right IIA. Fourth LA continuation of the CIA is a rare vascular anomaly with a few published reports to date. The anomaly occurs far more on the right side than the left and is mostly asymptomatic. An abnormal connection between the umbilical artery and the distal aorta probably results in this anomaly, as well as in another group of CIA anomalies that are characterized by the absence of one or two CIAs with trifurcation or quadrifurcation of the distal aorta. Although the vascular anomaly is mostly asymptomatic, knowledge of it is important in the interventions of the area to prevent complications.