Iliofemoral Aneurysm in Patients with Type 1 Neurofibromatosis: A Case Report and a Literature Review.

Vascular involvement, especially in the iliofemoral segment, is rare in type 1 neurofibromatosis. We herein report a case involving a 49-year-old male diagnosed with type 1 neurofibromatosis who presented with right inguinal pain and swelling. CT angiography revealed a 50-mm aneurysm extending from the right external artery to the common femoral artery. Although surgical reconstruction was performed successfully, the patient required an additional operation 6 years later for aneurysm enlargement in the deep femoral artery. Histopathological examination confirmed the proliferation of neurofibromatosis cells in the aneurysm wall.

Cystic Adventitial Disease of the (ilio) Femoral Artery with a Connection to the Hip Joint: Case Report and a Review of the Literature.

Objective: Cystic adventitial disease (CAD) is an uncommon non-atherosclerotic peripheral vessel disease, most often seen in the popliteal artery. Only a small number of cases involving the (ilio) femoral artery have been reported. The case of a 48 year old female with CAD of the left femoral artery with a connection of the disease to the hip joint on pre-operative imaging confirmed during surgery is described. A literature review of CAD of the (ilio) femoral artery with patient demographic data, symptoms, management, presence of a joint connection, and long term outcomes was performed. Methods: Multiple databases (Medline, CINAHL, EMBASE) were searched and each article was cross referenced to collect the literature on CAD of the (ilio) femoral artery. Case studies or series of CAD of the (ilio) femoral artery in English between 1995 and 2021 were included. Results: Sixteen case reports with 17 patients were included; 71% were male. CAD was unilateral in all case reports, with 53% on the right side. Patients presented with vascular symptoms including claudication (88%), a palpable pulsating mass (18%), acute limb ischaemia (6%) or limb swelling (8%). Computed tomography angiography (CTA) (76%) and duplex ultrasonography (47%) were the most commonly used imaging modalities. The common femoral artery was the most affected site (88%). Reported treatments were cyst resection and autologous vein reconstruction (six, one recurrence), cyst resection and patch repair (five, one recurrence), cyst resection with synthetic graft reconstruction (three, no recurrence), cyst resection (two, one recurrence), and cyst incision and decompression (one, one recurrence). In 18% of the cases, a connection between the CAD and hip joint was seen. Conclusion: Cyst resection and ligation with interposition of an autologous vein graft, synthetic graft or patch repair (in only locally affected arteries) seems to be the preferred treatment, with a low reported recurrence rate. CTA and magnetic resonance imaging are the imaging modalities of choice when suspecting CAD to determine an appropriate pre-operative plan and identify joint connections.

Incidence, predictors, impact, and treatment of vascular complications after transcatheter aortic valve implantation in a modern prospective cohort under real conditions.

OBJECTIVE: Vascular complications (VCs) occurring in transcatheter aortic valve implantation (TAVI) procedures have frequently been reported in the past. Considering significant technical improvements in delivery systems and vascular closure devices, the goal of this study was to determine the incidence, impact, and prognostic factors of VCs in a recent real-world cohort. METHODS: We report a bicentric prospective analysis of 479 consecutive patients who underwent TAVI between January 2017 and December 2017. VCs were defined according to criteria set out by the Valve Academic Research Consortium (VARC)-2. RESULTS: The incidence of VCs was 26.1% (n = 125 patients), of which 2.9% were major (n = 14) and 23.2% were minor (n = 111). VCs were related to the primary puncture point in 69% of cases compared with 31% at the secondary puncture site. Treatments implemented were medical in 76% of cases and surgical in 24% of cases. The risk factors for VCs were as follows: iliac morphology score, sheath to iliofemoral artery ratio (SIFAR), and moderate-severe iliofemoral calcifications or tortuosity. In the case of major VCs, only sheath to iliofemoral artery ratio was a risk factor. Major VCs significantly increased intrahospital mortality (30.7% vs 1.1% for minor VCs and 1.3% for no VCs; log-rank, P < .0001) and 1-year mortality (40.6% vs 5.6% for minor VCs and 5.6% for no VCs; log-rank, P < .0001). CONCLUSIONS: Using strictly VARC-2 end point definitions, more than one-quarter of TAVI procedures were associated with VCs, primarily minor ones. Secondary puncture points were responsible for one-third of VCs and should therefore also be actively monitored. Major VCs have a significant impact on short-term and midterm survival.

Iliofemoral artery lumen volume assessment with three dimensional multi-detector computed tomography and vascular complication risk in transfemoral transcatheter aortic valve replacement.

BACKGROUND: Transfemoral Transcatheter Aortic Valve Replacement (TAVR) carries a risk of Vascular Complications (VCs) at the access site. The currently used measures for assessing the risk for VCs are not accurate enough, and sometimes fail to predict them. We therefore aimed to examine whether Iliofemoral artery lumen volume (IFV) assessment with 3-dimensional computed tomography (CT) predicts VCs after transfemoral TAVR. METHODS: We identified 45/560 trans-femoral TAVR patients with VC, then performed nearest neighbor 1:1 matching for patients with no VC, matching for age, sex, TAVR year, valve size and type, closure-device, sheath size and peripheral vascular disease. IFV, minimal diameter, tortuosity, and calcification were measured, and their diagnostic performance assessed. RESULTS: The final analysis included 45 patients with and 45 patients without VCs. The two groups were well balanced. For all patients, median IFV was 8.65 ml (IQR 6.5-11.95). IFV was lower in patients with VC compared to patients without VC: 7.10 ml (IQR 5.4-9.0) vs. 10.10 ml (IQR 8.3-13.3), p < 0.001. VC risk had marginal association with iliofemoral artery minimal diameter (p = 0.06) and no association with tortuosity or calcification. Compared with other measurements, IFV had the most favorable receiver operating curve for the prediction of VC, with an area under the curve (AUC) of 0.78. CONCLUSION: IFV measurement using 3-dimensional CT is significantly associated with VCs in transfemoral TAVR patients and might be superior to currently accepted parameters. IFV should be further studied among extended cohorts of TAVR treated patients as a novel tool for VC risk assessment prior to transfemoral TAVR.

Safety of Zilver PTX Drug-Eluting Stent Implantation Following Drug-Coated Balloon Dilation in a Healthy Swine Model.

PURPOSE: To compare the safety of Zilver PTX drug-eluting stents (DES) following drug-coated balloon (DCB) angioplasty or conventional balloon angioplasty (BA) in a healthy porcine iliofemoral artery model. METHODS: DES implantation following DCB (DCB+DES) or BA (BA+DES) was assessed by angiography and histology in the nondiseased iliofemoral arteries of 20 animals, with sacrifice at 1, 3, and 6 months. Safety assessment compared quantitative measures of vessel integrity (eg, preservation of artery geometry, structure, and lumen dimensions; absence of aneurysm; malapposition) and histological parameters (eg, excessive inflammation). The percentage of uncovered struts could not be >30% per section and the endothelial cell loss had to be <50%. The vascular and skeletal muscle changes in the downstream regions were also assessed histologically for evidence of emboli. RESULTS: No significant differences in safety parameters, including inflammation and endothelial cell loss, were observed between the 2 groups at all time points. Percentage of fibrin was significantly higher in DCB+DES at 3 months [20.0% (IQR 11.6, 28.4) vs BA+DES 4.2% (IQR 1.4, 9.6), respectively; p=0.04], with consistent trends between groups at all time points. Medial smooth muscle cell loss peaked at 1 month and was not statistically different between groups at any time point, although the loss was greater in the DCB+DES group. Sections with arterioles exhibiting paclitaxel-associated fibrinoid necrosis in downstream tissues were observed exclusively in the DCB group at 1 month (14.3% of sections) and 3 months (11.5%). CONCLUSION: This preclinical study suggests that Zilver PTX stent implantation is a safe strategy after DCB angioplasty and might be considered for patients who require stenting after DCB treatment.

How to define the hemodynamic significance of an equivocal iliofemoral artery stenosis: Review of literature and outcomes of an international questionnaire.

Purpose The goal of the study was to review current literature regarding the diagnosis of equivocal (50-70%) iliofemoral artery stenosis and compare these findings with the daily practice of an international panel of endovascular experts. Methods The Medline Database was searched for relevant publications, and an electronic survey was sent to experts in the field covering the following topics: definition of an equivocal iliofemoral artery stenosis, angiographic visualization and investigation protocols of an equivocal stenosis, intra-arterial pressure measurements, and definition of hemodynamic significance of an equivocal iliofemoral artery stenosis using a physiologic measure. Results Of the 37 invited endovascular experts, 21 (53.8%) agreed to participate in the survey. Analysis of existing literature shows that the level of evidence for diagnosing equivocal iliofemoral artery stenosis is mediocre and is not being implemented by experts in the field. Conclusion Studies have shown that a stenosis of between 50% and 70% iliofemoral lumen diameter reduction shows a wide range of trans-stenotic pressure gradients. Equivocal iliofemoral artery stenosis can best be identified using three-dimensional quantitative vascular analysis software. Although evidence for a clear hemodynamic cutoff point is weak, performing trans-lesion intra-arterial pressure measurements at rest and during maximal hyperemia is preferred. Diagnosing iliofemoral artery stenosis solely on lumen diameter reduction is inadequate.

The Early Results for Surgical Treatment of Atherosclerotic Arterial Occlusive Disease in the Ilio-femoral Artery

PURPOSE: To review clinical features and operative results for patients, who underwent surgical treatment. METHOD: A retrospective review of 40 patients who underwent ilio-femoral artery bypasses surgery for ilio-femoral arterial occlusive disease. RESULT: Hypertension (60%) and diabetes (42%) were the most common underlying diseases among the patients according to the result of the patient's records; 35 (87.5%) men and 5 (12.5%) women, the mean age is 63. The operation was done for the patients who have the rest pain (57.5%), and this was followed by claudication (22.5%). The median follow-up period was 25.73 months. The most common occluded site was the superficial femoral artery (62.5%). The most common bypass operation was the femoropopliteal bypass (57.5%). In addition to that, the graft infection was the most common postoperative complication (12.5%). The 1st year and 2nd year primary graft patency rates were 60% and 42%. CONCLUSION: Among the various methods of treatment for the atherosclerotic arterial occlusive disease, bypass surgery is known as the most effective method. Although the early primary patency rates of this analysis were inferior to those of previous reports, a simple comparison was not adequate, because the data of this analysis was not sub-divided according to followings; the sites of occlusion, distal run off, operative indications, operative methods, and etc.

Effects of Tongxinluo Capsule on ET,NO,SOD and MDA in atherosclerosis obliterans rabbits / 中成药

AIM:To explore the dynamic changes of ET,NO,SOD and MDA in atherosclerosis obliterans(ASO) rabbits,as well as the effects of Tongxinluo Capsule(Radix et Rhizoma Ginseng,Hirudo,Scorpio,Eupolyphaga seu Steleophaga,etc.)(TXL) and the candidate mechanisms. METHODS: Rabbits were randomly divided into 7 groups: sham,model,TXL(0.8,0.4,0.2 g/kg),Tongsaimai tablet(0.8 g/kg) and Laishike((0.002 g/kg)).The animal model of ASO was established with a combined method of mechanical trauma,immunologic injury and high fat fodder feeding.Rabbits were administrated the drugs for 8 weeks after surgery.The levels of ET,NO,SOD and MDA were determined at the time points below: pre-experiment,pre-drug administration,4 weeks after drug administration,8 weeks after drug administration,12 weeks after drug administration.The histopathological changes in iliofemoral artery were examined after opacification. RESULTS: TXL significantly extenuated the decrease in the caliber of the iliofemoral artery of the injured hind limb and decreased MDA content while increased SOD activity and NO content in serum. CONCLUSION: TXL might show effects on improving endothelial cell dysfunction,clearing free radicals and antagonizing lipid peroxidation,which might be the candidate mechanisms for the prevention and treatment of TXL for ASO.