The impact of ankle brachial index and pulse wave velocity on cardiovascular risk according to SCORE and Framingham scales and sex differences.

The aim of the study was to evaluate the usefulness of ankle brachial index (ABI) and pulse wave velocity (PWV) in patients with or without coronary artery disease (CAD) and hypertension (HT) in cardiovascular risk prediction. We studied 200 patients randomized to one of four groups: CAD+HT+; CAD+HT-; CAD-HT+; CAD-HT- (Department of Hypertensiology, Angiology and Internal Diseases, Poznan, Poland: 2009-2012). We evaluated: patient age, lipids profile, ABI and PWV. The cardiovascular risks according to SCORE and Framingham scales were assessed. Statistical calculations were performed in StatSoft Statistica 10. The most interesting aspects of this study were: logistic regression model evaluated the simultaneously influence of ABI and PWV on cardiovascular risk by the SCORE scale and logistic regression model evaluated the influence of ABI and PWV on cardiovascular risk according to the Framingham scale. They showed the possibility (SCORE) of more accurate estimation of cardiovascular risk in an individual patient and graduation of this risk in the exemplary patients. Analysis of the assessment of both: ABI and PWV in predicting of cardiovascular risk according to SCORE and Framingham scales using a logistic regression model indicates that the Framingham scale is less precise than the SCORE scale because it underestimates the real high cardiovascular risk.

Rare variations of hepatic arteries in association with variable origin of gastroduodenal artery found in multidetector computed tomography angiography.

Three rare anatomical variations were found during study on hepatic arterial vascularisation in multidetector computed tomography angiography. In the first described variation the common hepatic artery (CHA) arises from the celiac trunk (CTr) and supplies right hepatic lobe. The left lobe of the liver is supplied by aberrant left hepatic artery originating as a common trunk with the left gastric artery and the splenic artery. This variation may correspond to the type 2 in Michels' classification coexisting with one of three possible patterns of the CTr division (when the CHA is the first branch of the CTr and the gastrosplenic trunk is the second one). The second variation corresponds to the very early bifurcation of the CHA arising from the CTr. Both, the right and left hepatic arteries originate separately from the CTr. The gastroduodenal artery (GDA) originates from the left hepatic artery. It may be regarded as the variation of most common type 1 according to Michels. In the third case the CHA gives raise to the GDA and terminates as the right hepatic artery supplying the right lobe of the liver only. The proper hepatic artery is missing and the left hepatic artery arises from the GDA. This variation does not correspond to any types of Michels' classification.

Monte Carlo simulations for assessment of organ radiation doses and cancer risk in patients undergoing abdominal stent-graft implantation.

OBJECTIVES AND DESIGN: The aim of this work was to assess absorbed radiation doses in selected organs and to estimate cancer and mortality risks in patients undergoing abdominal stent-graft implantation, as a function of age, gender, and anatomical parameters of patients' aneurysms and arteries. MATERIALS AND METHODS: 297 patients (266 males and 31 females) underwent endovascular aortic aneurysm repair (EVAR) with abdominal stent-graft implantation. Kerma-area products Gy-cm(2) for all implanted patients were collected retrospectively. Entrance surface air kerma (ESAK), doses absorbed by selected organs, and cancer/mortality risks were estimated using Monte Carlo simulation methods (CALDose_X software). RESULTS: The highest radiation doses were deposited in the skin, gallbladder wall, and colon wall. The highest average cancer risk was found for the youngest group of patients (<60 years old; 1:275) and the lowest for the oldest (>70 years old, 1:735). The radiation-induced risk of cancer mortality (mortality risk) was about 40% lower than radiation-induced cancer occurrence risk. Aneurysm neck angulations >45° had a significant impact on ESAK, as well as increasing cancer and mortality risks. CONCLUSIONS: The main factors increasing cancer risk are young age and aneurysm neck angulations >45°, which determines the difficulty of proper stent-graft placement. However, the radiation risk associated with the stent-graft implantation procedure is relatively low, and EVAR should not be avoided.

Patients' radiation doses during the implantation of stents in carotid, renal, iliac, femoral and popliteal arteries.

OBJECTIVES AND DESIGN: The aim of the study was to document the radiation doses to patients during the implantation of stents in various arteries and to discuss potential reasons for prolongation of radiological procedures. MATERIALS AND METHODS: Measurements of air kerma (Gy) and dose-area product (Gy cm²) (DAP) were carried out simultaneously on a sample of 345 patients, who underwent different interventional radiological procedures involving angioplasty with stenting of 73 carotid (21.5%), 22 renal (6.5%), 160 iliac (45%), 63 femoral (18.6%) and 27 popliteal (7.9%) arteries. RESULTS: The highest mean air kerma values for fluoroscopy and exposure were found for renal angioplasty (340 and 420 mGy, respectively). With regard to total DAP values, the highest were obtained for renal (148 Gy cm²) and iliac/The Inter-Society Consensus for Management of Peripheral Arterial Disease (TASC) II C (199 Gy cm²) stent implantation. The lowest values were for carotid (53 Gy cm²), iliac/TASC II A (6.3 Gy cm²) and femoral/TASC II A (53 Gy cm²) arteries. For 3.5% of the patients, the air kerma was between 1 and 1.5 Gy and for 1.5%, it was between 1.5 and 2 Gy. CONCLUSIONS: In procedures performed on the arteries of the lower limbs, a significantly higher dose was received by patients with TASC II C lesions. With regard to the number of stents implanted, the total DAP value was 50% higher for simultaneous three-stent implantation than for one or two stents.

Endovascular treatment of intramural hematoma of internal carotid artery after blunt trauma of neck inflicted with the seatbelt.

Blunt trauma of the neck caused by a seatbelt may cause dissection with intramural hematoma of the internal carotid artery. The following case report discusses the differential diagnosis and the potential of endovascular treatment of symptomatic intramural hematoma of the internal carotid artery.

Dose-area product to patients during stent-graft treatment of thoracic and abdominal aortic aneurysms.

This article is the first investigation that studies patient doses (air kerma and DAP) during digital subtraction angiography (DSA) for stent-graft treatment of both thoracic (TAAs) and abdominal (AAAs) aortic aneurysms. Fluoroscopy and exposure time, air kerma and dose-area product (DAP) were analyzed from 100 patients. In 41% of the analyzed patients total air kerma was between 1-2 Gy and for 7% exceeded 2 Gy. Median DAP values for fluoroscopy were 87.6 (TAAs) and 142.2 (AAAs) (Gy cm2) and for exposure 364.7 and 238.7 (Gy cm2), respectively. A 10-min prolongation of treatment causes about 83 Gy cm increase of DAP for fluoroscopy and 390 Gy cm for each 1 s of exposure. A good correlation between DAP and examination times was found for both exposure (r = 0.78) and fluoroscopy (r = 0.7). Moreover, sex was found to be a differential factor for DAP: DAP values for females were about 25% lower for both clinical procedures. For this kind of treatment the radiation doses were obtained for patients. Total air kerma in this kind of treatment for TAAs might be high and can even reach 4 Gy.

Dose-area product of patients undergoing digital subtraction angiography (DSA): abdominal aorta and lower limb examinations.

Complex analysis of the fluoroscopy time, exposure time, air kerma values and dose-area product (DAP) has been carried out for a very large group of patients (655) undergoing digital subtraction angiography (DSA) for abdominal aorta and lower limb examinations. Measurements have been performed for 206 patients with intravenous (IV DSA) and 449 patients with intra-arterial (IA DSA) contrast administration. The results obtained by the two variations of the DSA technique have been compared. Median DAP values for fluoroscopy are 5.4 (IA DSA) and 3.2 (IV DSA) Gy cm and for exposure are 51.7 and 66.3 Gy cm2, respectively. A good correlation between the exposure time and DAP has been found for the two types of examinations: IA DSA (r = 0.78) and IV DSA (r = 0.8). However, the correlation of fluoroscopy time and DAP has been insignificant, and the correlation coefficient is 0.39 for IA DSA and 0.63 for IV DSA. The DAP and the time exposure ratio have been significant factors differentiating these two methods. In fluoroscopy patients obtained higher doses in IA DSA, while in exposure doses were higher in IV DSA. Measurements of DAP can be a simple and accurate method for estimation of the stochastic radiation risk to the patients.

Endovascular treatment of basilar artery aneurysms associated with distal fenestration. A case report.

SUMMARY: Segmental non-fusion of the basilar artery results from failed fusion of the neural arteries and from regression of the bridging arteries that connect the longitudinal arteries. This condition is associated with aneurysm formation in 7% of cases. Distally unfused arteries with associated aneurysms are very rare. We report on a case of successful endovascular treatment of an aneurysm of the distally unfused basilar trunk.

Combined endovascular intervention and percutaneous thrombin injection in the treatment of iatrogenic pseudoaneurysm. Case report.

One of the basic techniques of treatment of iatrogenic pseudoaneurysms is percutaneous thrombin injection. Unfortunately, success rate of this treatment can be limited in cases associated with extensive damage to arterial wall. Our paper presents one case of combined treatment involving endovascular occlusion of the entry to the false aneurysm and percutaneous thrombin injection into the pseudoaneurysm chamber. In our opinion this technique can be successfully applied in patients with contraindications for compression therapy, surgical intervention or failure of traditional injection due to large entry, multiple arterial wall damage or accompanying arteriovenous fistula.

Restenosis after carotid endarterectomy: incidence and endovascular management.

SUMMARY: Surgical procedures designed to restore vascular patency for a recurrent stenosis following carotid endarterectomy (CEA) are burdened with technical difficulties as well as with the possibility of serious neurological complications. An endovascular approach employing transluminal percutaneous angioplasty and stenting (PTAS) is a promising solution to these problems. We aimed to evaluate the incidence of carotid artery restenosis following CEA, and to evaluate the safety and efficacy of treating post-CEA restenosis with an endovascular technique (PTAS). One hundred and two patients who underwent CEA for symptomatic and asymptomatic stenosis were included in the analysis. Clinical and sonographic follow-up examinations identified carotid artery restenosis in 16 patients, who fulfilled our criteria for endovascular treatment. Carotid PTAS was performed on symptomatic patients with a stenosis over 60% of the artery lumen (n=7) and in asymptomatic patients with a stenosis over 80% (n=9). The post-PTAS patients were evaluated by duplex sonography every three months over a 24 month follow-up period for evidence of restenosis. The cumulative incidence of post-CEA carotid restenosis qualifying for PTAS was 9.3% during an average 12-month follow-up interval. The average time from CEA to carotid PTAS was 11 months. All 16 endovascular procedures were technically successful. All of the carotid arteries were widely patent following PTAS. There were no immediate perioperative complications. One patient died two days after carotid PTAS from a cerebral hemorrhage. Thirteen of the 16 patients remained asymptomatic and had no sonographic evidence of significant restenosis during the 24- month post-PTAS follow-up period. One patient developed a symptomatic 80% restenosis proximal to the stent six months after carotid PTAS. Another patient developed an asymptomatic 60% restenosis proximal to the stent at 24 months. One patient was lost to follow-up. Following CEA, there is a significant risk of developing a symptomatic or high-grade carotid artery restenosis requiring correction. Endovascular treatment (PTAS) of a recurrent stenosis after CEA is a safe and effective alternative to repeat carotid surgery.

Leo stent for endovascular treatment of broad-necked and fusiform intracranial aneurysms.

SUMMARY: The advent of intracranial stents has widened the indications for endovascular treatment of broad-necked and fusiform aneurysms. Leo stent is a self-expandable, nitinol, braided stent dedicated to intracranial vessels. The aim of this study is to present our experience in endovascular treatment of broad-necked and fusiform intracranial aneurysms using self-expanding, nitinol Leo stents. Between February 2004 and November 2006, 25 broad-necked and three fusiform aneurysms in 28 patients were treated using Leo stents in our centre. There were 18 patients who experienced acute subarachnoid haemorrhage due to aneurysm rupture, two patients who experienced SAH at least 12 months ago and in eight patients aneurysms were found incidentally. Aneurysms were located as follows: internal carotid artery (15), basilar artery (5), basilar tip (3), posterior inferior cerebral artery (2), M1/M2 segment (1), A2 segment (1) and vertebral artery (1). There were no difficulties with stent deployment and delivery. All patients after acute SAH (n=18) underwent stent implantation and coil embolization in one procedure. The remaining patients underwent coil embolization in a staged procedure. Immediate aneurysm occlusion of more than 95% was achieved in all patients who underwent stent placement and coil embolization in one procedure. There were three thromboembolic complications encountered in patients in an acute setting of SAH, preloaded only on acetylsalicylic acid. Use of abciximab led to patency within the stent and parent vessel. However, one of these patients presented rebleeding from the aneurysm during administration of abciximab and died. Application of Leo stents in cases of broadnecked and fusiform intracranial aneurysms is safe and effective with a low complication rate.

[A case of primary hepatocellular carcinoma with tumor thrombus in the right atrium and massive pulmonary embolism]. / Przypadek pierwotnego raka watroby powiklanego skrzeplina w prawym przedsionku i masywna zatorowoscia plucna.

We present a case report of primary hepatocellular carcinoma with tumor thrombus extending into the right atrium complicated by pulmonary embolism. A 49-year-old man was admitted to our hospital for searching a cause of thrombus in the right atrium. The patient complained of shortness of breath and oedema of the lower extremities. He had a history of hepatitis B. Abdominal sonography and computed tomography revealed a tumor of the liver. A needle biopsy confirmed the diagnosis of hepatocellular carcinoma. Magnetic resonance showed a tumor thrombus also in the inferior vena cava. The diagnosis of pulmonary embolism was confirmed by pulmonary perfusion scintigraphy. This case stresses that clinicians should include hepatocellular carcinoma among the possible causes of intracardiac thrombus and pulmonary embolism.