Endovascular Recanalization of the Chronically Occluded Native Superficial Artery After Failed Bypass Graft: Midterm Results.

PURPOSE: To evaluate the safety, effectiveness, and outcomes of endovascular recanalization of chronic total occlusion (CTO) of the superficial femoral artery (SFA) in patients with critical limb ischemia (CLI) after failed surgical bypass graft. METHODS: Endovascular recanalization of SFA CTO was performed for 26 consecutive CLI patients with failed bypass grafts from 2016 to 2020. Patient demographics, bypass and lesion characteristics, procedural data, technical, and clinical outcomes were evaluated. RESULTS: The technical success rate was 96.2% (25/26). Retrograde arterial access was used in 16 (61.6%) patients. Additional tibial and iliac angioplasty was performed in 15 and 2 patients, respectively. Fifteen complications occurred in 10 patients, including thrombosis, embolism, vessel rupture, dissection, arteriovenous fistula, and pseudoaneurysm. Pain relief and wound healing were achieved in 22 patients. The primary, assisted primary, and secondary patency rates were 95.5%, 100%, and 100% at 6 months, 81.8%, 95.5%, and 100% at 12 months, and 76.7%, 82.7%, and 87.5% at 24 months, respectively. By univariate analysis, hyperlipidemia (hazard ratio = 7.82; 95% CI: 1.27-48.04, P = .026) was found to be the only significant risk factor related to primary patency loss. Amputation-free survival and limb salvage rates were 100% and 100% at 6 months, 100% and 100% at 12 months, and 87.1% and 93.8% at 24 months, respectively. CONCLUSIONS: Endovascular recanalization of SFA CTO in CLI patients with graft failures is effective with high technical success rates. Acceptable limb salvage and amputation-free survival rates make this technique a reasonable alternative to repeat surgery for high-risk patients.

The Feasibility of Low-dose Chest CT Acquisition Protocol for the Imaging of COVID-19 Pneumonia.

OBJECTIVE: This study aimed to investigate the feasibility of low-dose chest CT acquisition protocol for the imaging of COVID 19 disease or suspects of this disease in adults. METHODS: In this retrospective case-control study, the study group consisted of 141 patients who were imaged with low dose chest CT acquisition protocol. The control group consisted of 92 patients who were imaged with standard protocol. Anteroposterior and lateral diameters of chest, effective diameter and scan length, qualitative and quantitative noise levels, volumetric CT dose index (CTDIvol), dose length product (DLP), and size-specific dose estimations were compared between groups. RESULTS: Radiation dose reduction by nearly 90% (CTDIvol and DLP values 1.06 mGy and 40.3 mGy.cm vs. 8.07 mGy and 330 mGy.cm, respectively; p < 0.001) was achieved with the use of low-dose acquisition chest CT protocol. Despite higher image noise with low-dose acquisition protocol, no significant effect on diagnostic confidence was encountered. Cardiac and diaphragm movement-related artifacts were similar in both groups (p=0.275). Interobserver agreement was very good in terms of diagnostic confidence assessment. CONCLUSION: For the imaging of COVID-19 pneumonia or suspects of this disease in adults, lowdose chest CT acquisition protocol provides remarkable radiation dose reduction without adversely affecting image quality and diagnostic confidence.

Transhepatic Pharmacomechanical Thrombectomy of Symptomatic Acute Noncirrhotic, Nonmalignant Portomesenteric Venous Thrombosis: Midterm Results.

OBJECTIVE. The purpose of this study was to evaluate the safety and efficacy of transhepatic pharmacomechanical thrombectomy of symptomatic acute portomesenteric venous thrombosis. MATERIALS AND METHODS. Transhepatic pharmacomechanical thrombectomy (catheter-directed thrombolysis with mechanical thrombectomy) was performed in the treatment of nine patients with symptomatic acute noncirrhotic, nonmalignant porto-mesenteric venous thrombosis. The medical records, imaging examinations, technique of transhepatic pharmacomechanical thrombectomy, and clinical outcomes were reviewed. RESULTS. The mean follow-up period was 23.1 months (range, 8-34) months. Successful recanalization of the portomesenteric venous thrombosis, restoration of hepatopetal portal flow, clinically significant improvement in the signs and symptoms of acute mesenteric ischemia, and prevention of bowel resection were achieved in all patients. The most frequent minor complication (in three patients) was minor hemorrhage through the transhepatic access track. No procedure-related major complications occurred during hospitalization. No patient had rethrombosis or complications related to portal hypertension due to portomesenteric venous thrombosis. One patient died of massive pulmonary embolism on the 7th day after treatment. Cavernous transformation of the right portal vein occurred in one patient. CONCLUSION. Transhepatic pharmacomechanical thrombectomy is a safe and effective method of treatment of symptomatic acute portomesenteric venous thrombosis and prevention of bowel infarction.

The Prevalence of Open and Closed Posterior Superior Iliac Spine.

AIM: To determine the prevalence of open and closed posterior superior iliac spine (PSIS) using lower abdominal computed tomography (CT) examinations. MATERIAL AND METHODS: Eight hundred and fifty (M/F:464/386) adult patients who underwent lower abdominal CT between January 2018 and December 2018 were evaluated retrospectively. One radiologist reviewed CT images of patient pelvises to assess the presence of open and closed PSIS. RESULTS: The mean age of all patients was 52.7 ± 18 years. Of the 850 patients, 522 (61.5%) had open PSIS, while 328 (38.5%) had closed PSIS. The distribution of open and closed PSIS by gender was 57.5% and 42.5% in males and 66% and 34% in females, respectively. CONCLUSION: Overall, open PSIS is more common than closed PSIS. The closed PSIS is seen more often in males than in females. If an anteromedial sacral (S)-1 screw direction is chosen for posterior fusion with rod-screw fixation, it is essential to obtain CT images for evaluation of PSIS.