A pilot study to evaluate a novel localized treatment to stabilize small- to medium-sized infrarenal abdominal aortic aneurysms.

OBJECTIVE: There is no proven therapy to reduce growth rates of small- to medium-sized abdominal aortic aneurysms (AAAs). Ex vivo and animal studies have demonstrated that a novel stabilizing agent, 1,2,3,4,6-pentagalloyl glucose (PGG), delivered locally to the aneurysm sac, can bind to elastin and collagen to re-establish strength and resist enzymatic degradation. We aimed to demonstrate that a one-time administration of PGG solution to the aneurysm wall is safe and potentially effective to slow the growth of small- to medium-sized AAAs. METHODS: Patients with small- to medium-sized infrarenal AAAs (maximum diameter <5.5 cm) were recruited. Via transfemoral access, a 14F or 16F dual-balloon delivery catheter was introduced into the aneurysm sac. A single, 3-minute, localized endoluminal infusion of PGG was delivered via a 'weeping' balloon to the aneurysm wall. Independent core laboratory measurements of maximum aneurysm sac diameter and sac volume measurements based on computed tomography angiography (CTA) were used for assessments at 1, 6, 12, 24, and 36 months. The primary endpoints were technical success and safety (major adverse events at 30 days). The secondary endpoint was growth stabilization, defined as freedom from aneurysm sac enlargement (diameter increase >5 mm per year or volume increase of >10% per year). RESULTS: Twenty patients (19 male) were enrolled at five centers from May 2019 to June 2022 (mean age, 67.8 years; range, 50-87 years). All procedures were technically successful. The safety profile was consistent with standard interventional procedures. Four patients demonstrated transient elevations of liver enzymes levels that returned to normal by 30 days with no clinical symptoms. Through November 2022, follow-up CTA data is available on the first 11 patients. The average changes in maximum aneurysm diameter from baseline to 6, 12, 24, and 36 months were 0.2 mm, 1.1 mm, 1.2 mm, and 0.8 mm, respectively, and the average changes in volume were 2.0%, 9.6%, 18.1%, and 11.6%, respectively. At 12 months, none of the aneurysms showed growth >5.0 mm, and three had volume growth >10%. CONCLUSIONS: The early results of this first-in-human, small cohort study demonstrated that a single, localized PGG administration to patients with small- to medium-sized infrarenal AAAs is safe. Longer term follow-up on all 20 treated patients is needed to better assess the potential impact on aneurysm growth.

Manejo endovascular de desconexión tras reparación endovascular de aorta fenestrada / Endovascular management of a disconnected bridging stent during fenestrated endovascular aortic repair

Descripción de una complicación en una reparación de AAA con dispositivo anaconda fenestrada (Vascutek, Teru­mo(R)) por desconexión de stent renal en la que se plantearon estrategias de manejo para su corrección con un adecuado desenlace angiográfico y clínico

Description of complication in repair of AAA with fenestrated anaconda device (Vascutek Ltd./Terumo(R)), due to disconnection of renal stent where management strategies were proposed for its correction with an adequate angiographic and clinical outcome

Revascularización de arteria poplítea con arteria ciática persistente bilateral: presentación de un caso / Popliteal Revascularization in Bilateral Persistent Sciatic Artery: Case Report

La arteria ciática persistente (ACP) es una anomalía vascular congénita, poco frecuente, secundaria a una alteración en el desarrollo embriológico. La mayoría de los casos son asintomáticos y se detectan cuando se asocian con aneurismas o embolias. Se presenta el caso de una mujer de 81 años con factores de riesgo cardiovascular quien consulta por isquemia del miembro inferior

The persistent sciatic artery is a rare congenital vascular anomaly secondary to an alteration in embryological development. Most cases are asymptomatic and they are detected when they are associated with the presence of aneurysms or embolisms. We present the case of an 81-year-old woman with cardiovascular risk factors who consulted for ischemia of the lower limb.

El bazo: un órgano olvidado / The spleen: a forgotten organ

Tradicionalmente, el bazo ha sido un órgano “huérfano”. Su desarrollo embriológico se ha descrito con el sistema digestivo, pero no es parte de éste. Su principal función, de producción de glóbulos rojos y blancos, la cumple en el período fetal temprano, y luego su importancia es limitada. Por no ser el bazo un órgano necesario para la preservación de funciones vitales, tiene una atención limitada tanto de los clínicos como de los radiólogos. Sin embargo, éste puede ser afectado por múltiples patologías y es importante conocer las características imaginológicas de cada una de éstas para permitir al clínico hacer un enfoque terapéutico adecuado. Este artículo proporciona un enfoque multimodal por tomografía computarizada y resonancia magnética para el diagnóstico de las diferentes patologías esplénicas.

The spleen has traditionally been regarded as an “orphan” organ. Its embryological development is described together with the digestive system, although it is not part of the gastrointestinal tract. Its main function is during the early fetal development when it produces both red and white blood cells, losing this function during the late fetal life. Nevertheless, the spleen continues to work as a filter for blood cells and also has importantimmune functions. As it is not necessary for the preservation of vital life functions, the spleen receives limited attention by both radiologists and clinicians. It is, however, an organ with multiple pathological conditions that have representation in the differentdiagnostic imaging modalities; radiologists, therefore, must be aware of these conditions and their radiological characteristics. This article provides a diagnostic approach to themost common diseases affecting the spleen using tomography and magnetic resonance.

Embolización de angiomiolipomas renales: reporte de caso / Embolization of renal angiomyolipomas: case report

Los angiomiolipomas son tumores benignos de origen mesenquimal que afectan frecuentemente los riñones y presentan un alto riesgo de sangrado espontáneo. Este artículo describe el caso de un paciente con angiomiolipomas renales bilaterales y hematuria asociada, a quien se le realizó una embolización selectiva con micropartículas de polivinil alcohol (PVA). De ahí se concluye que la embolización selectiva de estos tumores muestra buenos resultados en la prevención del sangrado y en la preservación de la función renal.

Angiomyolipomas are bening tumors of mesenchymal origin that frecuently affect the kidney and present a hihg risk of spontaneus bleeding. This article describes the case of a patient with bilateral renal angiomyolipomas and asocciated hematuria, who experiencedselective embolization whit microparticles of PVA. From this it was concluded that the selectvie embolization of these tumours shows good results in the prevention of bleeding and in the preservation of renal function.

Functional hallux limitus or rigidus caused by a tenodesis effect at the retrotalar pulley: description of the functional stretch test and the simple hoover cord maneuver that releases this tenodesis.

Functional hallux limitus is a loss of metatarsophalangeal joint extension during the second half of the single-support phase, when the weightbearing foot is in maximal dorsiflexion. Functionally, it constitutes a sagittal plane blockade during gait. As a result, the mechanical support and stability mechanisms of the foot are disrupted, with important consequences during gait. Functional hallux limitus is a frequent, though relatively unknown condition that clinicians may overlook when examining patients with complaints that are not limited to their feet, for they can also present other symptoms such as hip, knee and lower-back pain. The purpose of this article is to present a critical review of the literature on functional hallux limitus and to explain a previously described and simple diagnostic test (flexor hallucis longus stretch test) and a physiotherapeutic manipulation (the Hoover cord maneuver) that recovers the dorsiflexion of the hallux releasing the tenodesis effect at the retrotalar pulley, which according to our clinical experience is the main cause of functional hallux limitus. The latter, to the best of our knowledge, has never been described before.

Reliable acetabular cup orientation with a new gravity-assisted guidance system.

Acetabular cup orientation is a key factor determining hip stability, and standard mechanical guides have shown little help in improving alignment. An in vitro study was carried out to compare the accuracy and precision of a new gravity-assisted guidance system with a standard mechanical guide. Three hundred ten cups were impacted by 5 surgeons, and the final cup orientation was measured. With the new guide, the average error in anteversion was 0.4 degrees , compared with 10.4 degrees with the standard guide and 0.3 degrees and -4.7 degrees , respectively, for abduction angles. The average time required for orienting the cups was similar for both guides. The accuracy and reproducibility obtained with the new guide were better (P < .0001). These good results would require a clinical validation.

Association of two respiratory congenital anomalies: tracheal diverticulum and cystic adenomatoid malformation of the lung.

Many associations of congenital anomalies of the respiratory system have been reported, but the combination of tracheal diverticulum and cystic adenomatoid malformation (CCAM) is unique. We present a patient with these two anomalies and analyze their embryological correlation.