Search Results (40)

Background/Objectives: Hybrid Angio-CT suites have emerged in response to the growing demands for innovation and procedural complexity in minimally invasive therapies. It is hypothesized that enhanced image guidance capabilities enabled by multimodality imaging can improve procedural safety, accuracy, and efficacy. However, due to the current lack of sufficient data to support a systematic review, the objective of this article is to present a comprehensive synthesis of the existing literature through a narrative review. Methods: This narrative review is based on purposefully identified research reports, their critical evaluation, and synthesis by a group of experienced users. The analysis covers three key areas: (1) current state of available technologies and functionalities, (2) novel perspectives through ‘Direct Intravascular Contrast media Injection CT’ (DICI-CT), and (3) the role of Angio-CT in established and emerging image-guided procedures. Results: The review presents typical configurations and room layouts for Angio-CT systems and discusses further technological improvement potential. Selected literature is complemented by expert experience to report on the current state of the art and demonstrate its use and efficiency. Based on our expert experience, it is demonstrated how DICI-CT can be used to reduce contrast dose and improve lesion visualization, targeting, and endpoint determination. Furthermore, in this review the advantages, including survival benefit (i.e., in trans-arterial chemoembolization and in blunt trauma) and cost-effectiveness (i.e., in emergency care), are reviewed with reference to oncologic and non-oncologic applications in both elective and emergency medicine. Conclusions: Hybrid Angio-CT suites can provide significant additional imaging information with the potential to improve image-guided procedures. This perspective is increasingly supported by retrospective data in interventional oncology and beyond. Provided that further technological advancements are achieved and prospective clinical data substantiates the anticipated clinical and economical benefits, hybrid Angio-CT suites are anticipated to play a key role in the multimodality interventional suite of the future. Full article

Introduction: Patch aortoplasty for aortic coarctation may have a high rate of late aneurysm and pseudoaneurysm formation, with an elevated risk of rupture and subsequent mortality when it occurs. Case: A 55-year-old male with irregular follow-up after patch aortoplasty for aortic coarctation 15 years ago, presented with a late post-coarctectomy aortic arch pseudoaneurysm and re-coarctation. Through a redo thoracotomy and under left heart bypass, the pseudoaneurysm and previous patch were partially excised, and reconstruction with interposition of a “Y” shaped Dacron graft was performed, in order to preserve the patency of the left subclavian artery. The postoperative course was uneventful, and at 6 months, the CT-angio control showed adequate graft patency. Comprehensive Literature Review: A comprehensive literature review with the primary focus on the different late complications after CoA repair (post-aortic coarctation aneurysms and recoarctation), and outcomes of open and endovascular approaches was performed. Conclusions: Open surgical repair for post-coarctectomy pseudoaneurysm is feasible with excellent results. However, due to the technical challenges, it may be performed with better results in high-volume aortic centers. Full article

Background: Right anterior mini-thoracotomy has gained increasing popularity as a preferred approach for mitral valve surgery due to its numerous advantages. This study aims to evaluate the safety and efficacy of this technique in elderly patients. Methods: Between January 2010 and November 2024, a total of 4092 adult patients underwent mitral valve repair or replacement at our institution. Of these, 1687 patients were treated using a minimally invasive approach. This analysis focuses on elderly patients aged 75 years and older (n = 402), further subdivided into two groups: 75–79 years (n = 253) and 80 years and older (n = 149). Results: The study population comprised 49.8% male patients. A small percentage (1.7%) had a history of endocarditis, and 6.5% had undergone prior cardiac surgery. The median logistic EuroSCORE was 7.68 (IQR 5.83–11.00), and the median EuroSCORE II was 2.75 (1.71, 4.40). Alternative cannulation strategies, guided by AngioCT scans, can expand the applicability of this technique to patients unsuitable for femoral cannulation. Median durations for cardiopulmonary bypass (CPB) and aortic cross-clamping were 99.5 and 80.0 min, respectively. Median ventilation time was 7 h, and the median ICU stay was 2 days. Atrial fibrillation was the most common postoperative complication (20.9%). A significant proportion of patients (47.8%) required blood transfusions, and 3.0% needed re-exploration for bleeding. The in-hospital mortality rate was 3.7%, with 7 (1.7%) patients requiring postoperative dialysis and 5 (1.2%) experiencing sepsis and multiple organ failure. Patients aged 80 years and older exhibited worse renal function and higher EuroSCOREs compared to the younger group (p < 0.001). However, they had shorter CPB (p = 0.004) and cross-clamp times (p = 0.001) and underwent a higher proportion of valve replacements (p = 0.003). Rates of major complications and in-hospital mortality were comparable between the two age groups. Logistic regression analysis identified the logistic EuroSCORE as the only significant preoperative risk factor (p = 0.001). Conclusions: Right anterior minithoracotomy is a safe and reproducible surgical approach, even in elderly patients, promoting faster recovery with a lower risk of complications. Among patients aged >80 years, despite higher comorbidities and elevated EuroSCORE II, in-hospital outcomes are comparable to those aged 75–79 years. Full article

Anomalies of coronary artery origins are rare but significant conditions that can range from benign to life-threatening. Early detection through imaging is crucial in preventing adverse outcomes. The treatment strategy varies depending on the type and severity of the anomaly, ranging from pharmacological treatment to surgery. A 22-year-old male patient, after syncope, after excluding other causes, had an exercise drill test, which was clinically negative and ECG-positive. Angio-CT revealed an undeveloped left main coronary artery (LMCA), and the circulation was supplied through the right coronary artery (RCA). The RCA provides the left anterior descending artery (LAD), and the LAD retrogradely supplies the left circumflex artery (LCX). The myocardial perfusion scintigraphy showed a slight lack of perfusion in the anterior wall (6% of total perfusion). The patient was qualified for further observation. A 77-year-old female underwent cardiac CT due to stenocardia. CT showed a lack of LMCA. The initial segment of the RCA gave rise to the left coronary artery (LCA), which encircled the aortic bulb posteriorly and bifurcated into branches resembling the LCX and LAD. After the Heart Team consultation, the patient was deemed eligible for conservative treatment. Angio-CT is a valuable tool for detecting coronary artery anomalies. Full article

Background: The femoral artery is a continuation of the external iliac artery. Knowledge of the topography and morphological variability of the thigh vessels informs various fields of medicine, such as hip replacement, hip fracture and femoral trochanter fracture, embolectomy, and angiography. The main aim of this study was to calculate the δ index from morphological measurements. We introduce the δ index to quantify the relative dominance of the DFA in supplying the thigh, aiming to improve clinical assessment and procedural planning. Methods: The study comprised two parts: anatomical dissection and radiological examination. During the anatomical study, 80 lower limbs (34 female and 46 male) fixed in 10% formalin were dissected. For the radiological study, angio-CT scans of the lower limbs of 100 patients (200 lower limbs) were analyzed. In both studies, the δ index was determined. This is the ratio of the diameter of the deep femoral artery at its point of origin to the diameter of the femoral artery after that origin. The morphometric measurements were analyzed statistically using Statistica 12.0 software. Results: The average values of the δ index for the right side were 0.95 (±0.23) and 0.89 (±0.21), respectively, in the anatomical and radiological studies, while for the left side they were 0.94 (±0.23) and 0.89 (±0.27), respectively. The average values for males were 0.88 (±0.18) and 0.80 (±0.17), respectively, while for females they were 1.04 (±0.26) and 1.12 (±0.23), respectively. Conclusions: The δ index, elaborated and calculated in anatomical and radiological studies, showed no statistically significant body side difference. However, it showed a statistically significant sex difference; there was a greater distribution of blood through the deep femoral artery in women than in men. Full article

Background and Objectives: The superior thyroid artery (STA) typically has its origin inferiorly to the greater hyoid horn (GHHB) either from the external carotid artery (ECA) or from the carotid bifurcation (CB) or the common carotid artery (CCA). We aimed to determine the topographic variants of the STA related to the GHHB and the artery of origin and to check their bilateral symmetry. Materials and Methods: Determinations were performed in a sample of 85 archived angio CT adult cases, comprising 53 men and 32 women. The origins of the STAs from the CCA/CB/ECA were classified as types A–C. We defined the vertical topographies of the STA as follows in relation to the GHHB: type 1 (infrahyoid), type 2 (hyoid), and type 3 (suprahyoid). Subtypes of the STA course were added: “a”, lateral to the GHHB; “b”, medial; and “c”, posterior to it. Unilateral combinations of types and bilateral associations of these were established. Results: In 170 carotid axes, we detected STA type A in 8.82%, type B in 28.82%, and type C in 60% of cases. It was absent in 2.35% of the cases. The infrahyoid type 1 of STA was found in 47.06% of cases. The hyoid type 2 was found in 20.59% (2a), 0.59% (2b), and 4.71% (2c). The suprahyoid type 3 was found in 21.18% (3a), 0% (3b), and 3.53% (3c). Thirteen unilateral combinations of types were found. The most prevalent ones were C1 (27.71%), C3a (17.47%), and B1 (15.66%). We established thirty-seven bilateral associations of unilateral combinations of types. The cases with asymmetrical bilateral associations of unilateral combinations of types prevailed. A lowered hyoid bone overlapping the thyroid cartilage was found in one of these cases. The prevailing associations were C1-C1 (bilateral infrahyoid origin of the STA from the ECA, 13/85, 15.29%), C3a-C3a (suprahyoid origins of the STAs from the ECAs and lateral courses over the GHHB, 9/85, 10.58%) and C1-B1 (infrahyoid origins from the ECA and CB, 8/85, 9.41%). Conclusions: The vertical topography of the STA is highly variable and hardly predictable but can be examined in imaging studies. The GHHB may be of use to identify and manage the artery. The STA is rarely absent. Full article

Background/Objectives: During retroperitoneal surgery, awareness of the anatomic variants of renal arteries (RAs) is essential. We aimed to determine the prevalence of early-branched (short) Ras, the bilateral morphologies of RAs in such cases, and to check for significant correlations regarding gender or side. Short RAs may be regarded as false multiple RAs and should be distinguished from true RAs. Methods: For the study, 185 archived angioCT files were randomly selected and evaluated for <1.5 cm RAs (106 male and 79 female cases). Simple regression and multiple regression tests, alongside ANOVA, were used for the statistical analysis. Results: Short RAs were found in 15/185 cases, 12 males and 3 females (8.1%), with short RAs found on the right side (2.7%), left side (4.86), and bilaterally (one case, 0.54%). The mean length was 9.46 mm. Short RAs were bifurcated in most cases and trifurcated in one case. In four other cases, peculiar RA anatomical patterns were found. They included a right RA origin of the right inferior phrenic artery, variable polar RAs, malrotated and ptotic kidneys, anteriorly dehiscent renal sinuses, and multiple RAs, including five right RAs, with the three inferior ones having precaval courses. Short RAs were not significantly related to gender (p > 0.05). There was a significant correlation between gender and right short RAs (p < 0.05). Conclusions: During renal transplant surgery, distinguishing between true and false multiple RAs is essential. While true multiple RAs may cause surgical discomfort, short RAs may be used as single RAs, but they should be carefully documented before donor nephrectomies. Full article

Objective: The totally endoscopic approach is on the rise to become the new standard in mitral valve surgery. The aim of this study was to develop a morphometric measurement tool for educational purposes to predict operability with low conversion and high repair rates. Methods: From January 2020 to March 2023, 64 patients underwent totally endoscopic mitral valve repair (TE-MVR). Of these, 15 patients were deemed to be unsuitable for TE-MVR due to narrow space and/or anticipated complex repair techniques and underwent repair through sternotomy (MVR-open). Angio-CT scanning was performed for preoperative planning and measurements of the following: the distance between the sternum and the spine (DSS), the distance between the skin incision and the anterior anulus of the mitral valve (DNM) and the intercostal space at the level of the skin incision (ICS). Results: The repair rate for all patients was 98.7%. In the TE-MVR group, the conversion rate to sternotomy was 3.1%. The 30-day survival was 100%. The DSS was 130.4 ± 18.8 mm and 108.1 ± 17.3 mm, and the DSM 70.7 ± 12.1 mm and 58.5 ± 13.6 mm in the TE-MVR and MVR-open, respectively (p < 0.001). Twenty-one TE-MVR patients were found to be technically demanding due to friction and less freedom to move the instruments. The composite morphometric parameter DSS plus 4xICS minus DNM was 53.3, 39.8 and 25.6 for TE-TMReasy, TE-TMRdemanding and MVR-open, respectively (p < 0.05 and p < 0.01). Conclusions: Surgical skills and a long history of expertise are mandatory to achieve excellent results with a low conversion and high repair rate. The composite morphometric parameter may be an easy tool for educational demands to predict the ease and feasibility of TE-MVR. Full article

Objectives: Explore the effect of the introduction of a hybrid CT angio suite on the in-hospital workflow time of patients with acute ischemic stroke. Methods: This was a retrospective observational case-control study. All consecutive patients admitted to our emergency department with suspected ischemic stroke who underwent stroke imaging and mechanical thrombectomy (MT) in the new hybrid CT angio suite from October 2023 to March 2024 were included in the study. The primary outcome was the evaluation of in-hospital workflow times by the assessment of both the time from hospital admission to the beginning of the endovascular treatment (door-to-groin time, DTG) and the time from the interpretation of imaging to arterial puncture (CT-to-groin time, CTTG). The secondary aim was the evaluation of the clinical outcome through the evaluation of the mRS at 3 months. These data were compared to the control group. Results: Between October 2023 and March 2024, 50 consecutive patients with suspected ischemic stroke underwent neuroimaging and MT in the hybrid CT angio suite. We observed a significant reduction of the median DTG time from 71 min to 36 min (p < 0.001) and the median CT-to-groin time from 44 min to 12 min (p < 0.001) compared to the control group. Conclusions: The introduction of the hybrid CT angio suite dedicated to acute ischemic stroke has definitely reduced in-hospital delays, allowing better management of these patients. Full article

Multidetector-row computed tomographic angiography (angio-CT) aims to achieve optimal opacification of the vascular compartment of interest. The distribution and quality of vascular opacification are influenced by patient-related factors, contrast medium (CM)-related factors, and scanner-related factors. This systematic review evaluates these factors and their effects on contrast enhancement. A comprehensive literature search was made in February 2024 across four online bibliographic databases (Web of Science, PubMed, Scopus, and CAB Abstract) in adherence with the PRISMA 2020 guidelines. After screening the 5990 unique published articles initially identified, 20 full-text original studies met the inclusion criteria for the final review. The amount of abdominal adipose tissue was found to significantly affect enhancement, which suggests the possibility of reducing the CM dose to minimize adverse effects or toxicity. The injection rate of the CM, rather than the injection duration, was identified as the most critical factor, with important clinical implications. For scanners with slower acquisition speeds or longer scan durations, maintaining a fixed CM injection duration may optimize vascular phase acquisition. In contrast, faster scanners benefit from bolus tracking, which allows for improved differentiation between vascular phases. Additionally, administering a saline flush post-CM injection enhances arterial opacification while reducing the necessary CM dose. This systematic review highlights essential factors influencing contrast enhancement in angio-CT for dogs and provides a foundation for future research aimed at optimizing imaging protocols in veterinary medicine. Full article

Background: Chest pain is one of the most common causes of emergency room visits and also accounts for numerous visits to the family physician’s office or Outpatient Clinics of cardiology or internal medicine. Case Report: Here we present a case of a 48-year-old female patient who presented to our hospital emergency unit but refused hospital admission. She presented in our Outpatient Clinic with a complaint of typical chest pain indicating it to be of coronary origin. A computed tomography (CT) coronary angiography for the evaluation of this chest pain was indicated. While ruling out the coronary origin of this chest pain, we were surprised to have incidentally identified the presence of an esophageal tumor mass that had intimate contact with carina of the trachea. After the diagnosis of esophageal leiomyoma was made and its surgical treatment was performed, the patient was asymptomatic. Approximately one year after the surgical intervention was performed, following the cessation of antiplatelet therapy and statin, the patient returned to our Outpatient Clinic complaining of chest pain again with the same characteristics as previously presented, being terrified by the possibility of the recurrence of the esophageal leiomyoma. Upon resuming investigations, it was proven through coronary angio-CT evaluation that the etiology of the chest pain was indeed coronary this time. However, the patient still refused hospital admission and the performance of percutaneous coronary angiography with the potential implantation of a coronary stent. Conclusions: Chest pain can be due to various underlying pathologies and should not be neglected. A thorough investigation and timely management are key to treating this possible fatal symptom. In our case, the patient presented twice with the complaint of typical chest pain indicating a possible coronary event, but at the first presentation, it was due to esophageal leiomyoma, while a year later, the patient had similar pain, which was indeed this time due to coronary blockage. Hence, it is of utmost importance to think of all possible scenarios and to investigate accordingly, leaving no stone unturned. Full article

Diabetic foot ulceration is one of the most common complications in patients treated for diabetes mellitus. The presented pilot study describes the successful treatment of diabetic ulceration of the heel with ongoing osteomyelitis in a 39-year-old patient after using a combination of modified chitosan-based biomaterial in combination with autologous mesenchymal stem cells isolated from bone marrow and dermal fibroblasts. The isolated population of bone marrow mesenchymal stem cells fulfilled all of the attributes given by the International Society for Stem Cell Research, such as fibroblast-like morphology, the high expression of positive surface markers (CD29: 99.1 ± 0.4%; CD44: 99.8 ± 0.2% and CD90: 98.0 ± 0.6%) and the ability to undergo multilineage differentiation. Likewise, the population of dermal fibroblasts showed high positivity for the widely accepted markers collagen I, collagen III and vimentin, which was confirmed by immunocytochemical staining. Moreover, we were able to describe newly formed blood vessels shown by angio CT and almost complete closure of the skin defect after 8 months of the treatment. Full article

Background and Objectives: Typically, the external carotid artery (ECA) sends off separate anterior branches: the superior thyroid, lingual, and facial arteries. These could, however, form common trunks: thyrolinguofacial, linguofacial (LFT), or thyrolingual. Although known, the LFT variant was poorly detailed previously, and most authors just counted the variant. We aimed to demonstrate the individual anatomical possibilities of the LFT on a case-by-case basis. Materials and Methods: 150 archived angioCT files were used. After applying inclusion and exclusion criteria, 147 files of 86 males and 61 females were kept for this study. Results: In 34/147 cases, LFTs were found (23.12%). Bilateral LFTs were found in 13/34 cases (38.24%) and unilateral LFTs in 21/34 (61.76%) cases. Forty-seven LFTs were thus identified and further studied for different variables. Regarding the vertical topography of LFT origin, type 1a (suprahyoid and infragonial) was found in 28 LFTs (59.57%), type 1b (suprahyoid and gonial) was found in eight LFTs (17.02%), type 3 (suprahyoid and supragonial) was found in two LFTs (4.25%), type 2 (hyoid level of origin) in eight LFTs (17.02%), and type 3 (infrahyoid origin) in just one LFT (2.12%). Types of the initial course of the LFT were determined: type I, ascending, was found in 22/47 LFTs; type II, descending, in 12/47 LFTs; and type III, transverse, in 13/47 LFTs. Regarding the orientation of the first loop of the LFT, 23/47 LFTs had no loop, 4/47 had anterior loops, 1/47 had a posterior loop, 5/47 had superior loops, 5/47 had inferior loops, and 9/47 had medial loops. The position of the LFT relative to the ECA was classified as medial, anterior, or antero-medial. An amount of 12/47 LFTs were anterior to the ECA, 22/47 were antero-medial, 10/47 were medial, 2/47 were inferior, and 1/47 was lateral. Regarding their general morphology, 23/47 LFTs had a rectilinear course, 22/47 had loops, and 2/47 were coiled. A case-by-case presentation of results further demonstrated the diversity of the LFT. Conclusions: In conclusion, the morphology and topography of the LFT are individually specific and unpredictable. It can be anticipated case-by-case by surgeons on CT or MR angiograms. Full article

Background: Acute gastrointestinal bleeding (GIB) is a commonly encountered medical emergency. In cases of negative endoscopic evaluations, computed tomography angiography (CTA) is usually the next diagnostic step. To date, data regarding positive CTA examinations are lacking. We aimed to assess the clinical and laboratory parameters that predict a positive CTA examination, as demonstrated by the extravasation of contrast material into the bowel lumen. Methods: We performed a single-center retrospective study, including all patients who were admitted with GIB and who underwent CTA. Analysis was performed to compare patients’ characteristics, and logistic regression was used to explore parameters associated with a positive CTA. Results: We included 154 patients. Of them, 25 patients (16.2%) had active GIB on CTA vs. 129 patients (83.8%) who did not. On univariate analysis, several parameters were positively associated with active GIB, including congestive heart failure (OR 2.47, 95% CI 1.04–5.86, p = 0.04), warfarin use (OR 4.76, 95% CI 1.49–15.21, p = 0.008), higher INR (OR 1.33, 1.04–1.69, p = 0.02), and low albumin level (OR 0.37, 95% CI 0.17–0.79, p = 0.01). On multivariate logistic regression analysis, only high INR (OR 1.34, 95% CI 1.02–1.76, p = 0.03) and low albumin (OR 0.3, 95% CI 0.12–0.7, p = 0.005) kept their positive association with active bleeding, while a high ASA score was negatively associated with an active GIB. Conclusions: We could identify high INR and low albumin as strong predictors of active GIB, as demonstrated by positive CTA. On the other hand, comorbid patients classified by a high ASA score did not experience a higher rate of active GIB. Full article

(1) Background: Stylohyoid syndrome, known as classical Eagle Syndrome (cES), is characterized by calcification of the stylohyoid chain with numerous nonspecific symptoms, mainly pain. This study introduces minimally invasive cervical styloidectomy (MICS). (2) Methods: MICS was performed on sixty-five patients diagnosed with classical Eagle Syndrome. Patients underwent meticulous differential diagnosis. Surgical plans were established based on the findings from neck angioCT. (3) Results: The healing process was uneventful, without significant complications. The overall success rate was 97.0%, with a follow-up of a minimum of six months. In one case, the surgery did not yield the desired improvement. In one case, a partial relapse of symptoms was observed. (4) Conclusions: MICS is a straightforward and efficient surgical treatment technique for stylohyoid syndrome. Full article