Search Results (35)

Background/Objectives: May–Thurner syndrome (MTS) is a common cause of iliofemoral deep vein thrombosis (DVT). Venous bleeding associated with MTS is extremely rare and has been reported mainly as spontaneous iliac vein rupture (SIVR) with retroperitoneal or iliac hematoma. Additionally, standardized treatment strategies have not yet been established. Herein, we report a case of an iliac hematoma associated with MTS that was successfully treated with endovascular mechanical thrombectomy and bare-metal stenting. Case Presentation: A 69-year-old man presented with acute swelling and pain in the left lower extremity. Computed tomography angiography demonstrated extensive iliofemoral DVT and an iliac hematoma adjacent to the left common iliac vessels, without definite evidence of iliac vein rupture. Initial conservative management with anticoagulation therapy was selected as the patient was hemodynamically stable and showed no active bleeding. However, follow-up imaging one week later revealed persistent DVT with interval enlargement of the hematoma. Pelvic arteriography excluded an arterial bleeding source. Endovascular treatment was performed, including mechanical thrombectomy using the AngioJet system and bare-metal stent placement to restore venous outflow. Follow-up imaging revealed complete thrombus resolution, hematoma regression, and sustained stent patency. Conclusions: Iliac hematomas associated with MTS may occur without definite radiological evidence of iliac vein rupture. In selected hemodynamically stable patients, an individualized endovascular strategy focused on venous outflow restoration using the AngioJet system and bare metal stents may be a feasible treatment option. Full article

Background/Objectives: Early detection of hepatocellular carcinoma (HCC), particularly small lesions (<2 cm), which is crucial for curative treatment, remains challenging with conventional liver dynamic computed tomography (LDCT). We aimed to develop a deep learning algorithm to generate synthetic CT during hepatic arteriography (CTHA) from non-invasive LDCT and evaluate its lesion detection performance. Methods: A cycle-consistent generative adversarial network with an attention module [Unsupervised Generative Attentional Networks with Adaptive Layer-Instance Normalization (U-GAT-IT)] was trained using paired LDCT and CTHA images from 277 patients. The model was validated using internal (68 patients, 139 lesions) and external sets from two independent centers (87 patients, 117 lesions). Two radiologists assessed detection performance using a 5-point scale and the detection rate. Results: Synthetic CTHA significantly improved the detection of sub-centimeter (<1 cm) HCCs compared with LDCT in the internal set (69.6% vs. 47.8%, p < 0.05). This improvement was robust in the external set; synthetic CTHA detected a greater number of small lesions than LDCT. Quantitative metrics (structural similarity index measure and peak signal-to-noise ratio) indicated high structural fidelity. Conclusions: Deep-learning–based synthetic CTHA significantly enhanced the detection of small HCCs compared with standard LDCT, offering a non-invasive alternative with high detection sensitivity, which was validated across multicentric data. Full article

Background and Objectives: Despite huge reductions in the incidence and mortality of cardiovascular disease (CVD) during the last decades, ischemic heart disease (IHD) is globally still a leading cause of death. Although females experience higher mortality, the clinical IHD guidelines do not distinguish between sexes, and despite added diagnostic procedures after introduction of computed coronary arteriography (CTA) the differences remain. This study aimed to describe and evaluate the effect, outcomes and sex disparities of the large number of diagnostic procedures not leading to invasive treatments. Materials and Methods: The study included 274,617 first-entry patients submitted to invasive coronary arteriography (ICA) or CTA 2000–2020, from the mandatory Western Denmark Heart Registry. Mortality was evaluated with Kaplan–Meier curves and further compared to background population. Results: Females constituted 34.1% of all first-entry diagnostic procedures but only 25.5% of those who subsequently underwent invasive treatment, demonstrating a substantially lower treatment rate compared to males. All-cause 10-year mortality was higher in females after treatment 1.26 (1.23–1.30) but lower in the non-treated patients 0.71 (0.67–0.72) at all time points. Comparing to the background population, all non-treated patients revealed lower mortality in all indications, except valves. Conclusions: Despite being referred for coronary diagnostication according to their CVD prevalence, females received less invasive treatments than males and presented with substantially higher mortality after invasive treatments. In variance, non-invasive treated females demonstrated significantly better survival than men both in intra-study comparisons and in assessment with background population mortality. Full article

Background/Objectives: Patients with peripheral arterial disease (PAD) or carotid stenosis (CS) who do not exhibit symptoms suggesting the coexistence of CAD are often not evaluated for CAD. The aim of this study was to assess the prevalence of asymptomatic CAD identified by coronary angiography in patients with PAD or CS, undergoing peripheral arteriography, and without prior diagnosis of CAD. Methods: A total of 350 PAD patients undergoing peripheral angiography, without a history or symptoms of CAD were prospectively enrolled in this study. These patients underwent simultaneous coronary angiography during scheduled peripheral arteriography. The severity of CAD was assessed using the Jeopardy Score Scale (JSC) and by evaluating the number of major coronary vessels involved. Results: Significant coronary artery stenosis was detected in 52.86%, with 50.00% in the PAD group and 51.43% in the CS group. One-, two-, and three-vessel disease was present in 29.14%, 14.28%, and 10.01% of the study population, respectively. The JSC median for the entire cohort was 2 (0–4) and 4 (2–8) when CAD was diagnosed. The combination of CS and PAD was associated with the highest risk for CAD (73%), with a median JSC of 2 (0–8). Conclusions: The risk of co-occurrence of CAD in patients with PAD, regardless of the presence of CAD symptoms, is high, exceeding 50%. Consequently, (in accordance with the guidelines for the management of chronic coronary syndromes), in all patients with PAD, regardless of CAD symptoms, advanced cardiological diagnostics, including coronary CT angiography or functional imaging, should be considered. Full article

We examined whether synchronizing and analyzing three data sources, active personal dosimeter (APD) information, in-room monitoring camera footage, and the operator’s main angiography panel video, could identify opportunities to reduce occupational radiation exposure during cerebral angiography without therapeutic intervention. We analyzed the behavior of eight physicians and radiation doses measured outside the lead apron during 12 diagnostic cerebral angiography procedures performed between January and April 2024. Appropriate use of a ceiling-suspended radiation protective shield (CSRPS) was associated with approximately 70% exposure reduction. In addition, exposure during femoral arteriography (catheter advancement from femoral artery puncture to the aortic arch) accounted for approximately 50% of the total exposure, identifying both as effective intervention points. This approach identified operators’ incorrect use of radiation protection equipment and enabled clear feedback to operators on areas for improvements in radiation protection practices. Full article

Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder associated with premature atherosclerosis and vascular impairment. However, the role of endocan, a biomarker of glycocalyx injury, is not completely clarified in the detection of vascular damage. Therefore, our aim was to investigate serum endocan in comparison with conventional inflammatory markers, arterial stiffness parameters, and carotid ultrasound findings in a cohort of young patients with SLE. Methods: We enrolled 47 clinically active young SLE patients (40 females and 7 males) in the study. Arterial stiffness indicated by augmentation index and pulse wave velocity (PWV) was measured by arteriography. Brachial artery flow-mediated dilatation and common carotid intima-media thickness were detected by ultrasonography. The serum concentrations of endocan, IL-6, MPO, MCP-1, MMP-3, -7, and -9, as well as TNFα, were measured by an enzyme-linked immunosorbent assay (ELISA). Results: We found significant negative correlations between serum endocan and both CH50 and C3. Serum endocan was higher in active SLE patients compared to inactive patients, however, the difference was not statistically significant (241.4 (183–295) vs. 200.3 (167–278) pg/mL; p = 0.313). Serum TNFα and hsCRP significantly correlated with PWV. However, we did not detect significant correlations between vascular diagnostic tests and serum endocan levels. Conclusions: Based on our results, serum endocan is associated with disease activity; however, further studies are needed to clarify the value of serum endocan in the cardiovascular risk estimation of SLE patients. Measurement of serum endocan, as well as the routine assessment of arterial stiffness parameters, should be integrated into the comprehensive management plans of young patients with SLE. Full article

Backgrounds/Objective: The impact of metabolic disturbances induced by an unbalanced diet on cognitive decline in mid-life is now widely observed, although the mechanisms are not well identified. Here we report that glutamatergic vasoactive pathways are a key feature of high-fat-diet (HFD)-induced neurogliovascular uncoupling in mice. Methods: C57Bl6/J mice are fed either with normal diet (ND) or high-fat diet (HFD) during 6 or 12 months and characterized for metabolic status. Cerebral vascular tree from pial to intraparenchymal arteries, is investigated with Halpern’s arteriography and with differential interference contrast infrared imaging of brain slices. Results: A 70% alteration in the myogenic tone of the basilar artery is observed as early as 6 months (M6) after the HFD. Infrared imaging revealed a 77% reduction in the glutamate-induced vasodilation of intraparenchymal arterioles appearing after 12 months (M12) of the HFD. The respective contributions of enzymes involved in glutamatergic pathways were altered as a function of HFD and time. The decrease in astrocytic COX I observed at M6 was followed by a loss of neuronal COX II and a compensatory action of NOS at M12. Conclusions: This HFD-induced neurogliovascular uncoupling pathway offers therapeutic targets to consider for improving cerebral vasoactive functions while preventing peripheral metabolic disturbances. Full article

The HepACAGA (Hepatic Arteriography and C-arm CT-Guided Ablation) technique, which integrates C-arm CT guidance with transcatheter C-arm CT hepatic arteriography (C-arm CTHA), significantly improves liver tumor ablation outcomes by enhancing tumor visualization, navigation, and the intraprocedural assessment of ablation margins. The two key advantages of using C-arm CT over conventional CT for image guidance are firstly that the entire procedure can be performed in the angiography suite, eliminating the need for patient transfer between the angiography suite (catheterization) and CT-room (ablation), and secondly, that integrated C-arm needle guidance software can greatly reduce the difficulty of needle placement. Beyond these advantages, the HepACAGA technique offers additional benefits across four domains: (1) the direct conversion of ablation to intra-arterial liver-directed therapies (e.g., radioembolization or chemoembolization) upon the intraprocedural detection of disease progression; (2) the direct combination of ablation with intra-arterial treatments or portal vein embolization in one session; (3) the enhanced ablation effect through heat sink effect reduction with adjunct bland embolization or balloon occlusion; and (4) the immediate hemorrhage control through direct embolization. This pictorial essay demonstrates the advantages of combining C-arm CT guidance with real-time C-arm CTHA in the percutaneous thermal ablation of liver tumors, with clinical cases illustrating each of the aforementioned four key domains. Full article

In 2023, the VAS international working group on Buerger’s Disease (BD) recommended two diagnostic criteria based on a prior Delphi study: “definitive” and “suspected”. The “definitive” criteria are history of smoking, typical angiography, and typical histopathological features. All three features are mandatory to confirm a “definitive” diagnosis of BD. The conundrum is—what features should be considered typical of BD angiography? According to this review, segmental occlusion of infrapopliteal arteries, corkscrew collaterals that appear to continue the occluded arterial segment (Martorell’s sign) or bypass the segmental occlusion, absence of atherosclerotic plaque or aneurysm could differentiate BD from ASO. Hence, for “typical” BD angiography, these manifestations should certainly be considered. However, data for differentiating angiography patterns of BD from the small- and medium-sized vasculitis including Behcet’s disease, scleroderma, hepatitis associated vasculitis, and anti-phospholipid syndrome are limited. Further studies for investigating the angiography pattern in BD patients in early and late presentation of BD, particularly in the patients with long-term follow up, are highly recommended. Full article

Pododermatitis (bumblefoot) occurs commonly in birds of prey and owls and shows species-specific differences in its prevalence, especially between falcons and hawks. The development of the disease is particularly associated with circulatory disorders of the feet. To compare the blood vessel supply of the foot sole, especially the metatarsal foot pad, macroscopic dissections including intravascular injection of latex, contrast µCT scans with barium sulphate, corrosion casts (epoxy resin), and histological examinations of the skin were performed in eight avian species. The main supplying artery of the metatarsal pad, the pulvinar artery, originated from the medial digital artery of the first toe. This main pulvinar artery showed a rather vertical course towards the sole surface, subsequently encircling the metatarsal pad like a basket in falcons and owls, whereas a rather horizontal straight course was observed in northern goshawks and common buzzards. Organized fat tissue was present in the subcutis as the basis for the metatarsal pad only in falcons and owls. The dermis of the metatarsal pad showed a well-developed papillary layer and prominent dermal and subdermal vascular networks in all species examined. The observed differences were discussed regarding both the species-specific prevalence and the etiology of bumblefoot. Full article

Objectives: Exercise-induced premature ventricular contractions (EIPVC) have been associated with higher mortality, but the association with coronary artery disease (CAD) has not been precisely established. Our objective was to assess in a group of subjects with EIPVC and cardiovascular risk factors the association with underlying significant coronary artery disease (CAD), in comparison with a control group of patients with cardiovascular risk factors and exercise test (ET) showing ischaemia. Methods: All the patients (above 35 years old) referred for ET at our institution were prospectively included. Patients with at least one cardiovascular risk factor and without known CAD were divided into 2 groups: group A if EIPVC were present (either during exercise or during recovery), at least more than 10% over 30 s of recording; group B if ET was showing ischaemia. The presence of CAD was then confirmed in both groups by coronary arteriography, and/or thallium scintigraphy, and/or cardiac MRI and/or coronary CT angiography performed within 2 months after ET realization. Results: From November 2020 to December 2022, 4098 ETs were performed. After exclusion (normal ETs = 2194; known CAD = 1109; age < 35 years old = 487; congenital heart disease = 59; mitral valve prolapse = 4), 46 patients with EIPVC were finally identified (male 65%, mean age 61.5 ± 11 years), and 71 in group B. CAD was confirmed using additional tests in 5/46 (11%) patients in group A versus 38/71 (54%) in group B (p < 0.0001). Conclusions: Amongst patients without known CAD, the presence of EIPVC was less frequently associated with an underlying CAD, compared to the presence of exercise-induced “electrical” ischaemia. Full article

Purpose: Liver metastases presenting as small hyperintense foci on diffusion-weighted imaging (DWI) pose a therapeutic challenge. Ablation is generally not possible since these lesions are often occult on ultrasound and CT. The purpose of this prospective study was to assess if small liver metastases (≤10 mm) detected on DWI can be successfully localized and ablated with the Hepatic Arteriography and C-Arm CT-Guided Ablation technique (HepACAGA). Materials and Methods: All consecutive patients with small liver metastases (≤10 mm), as measured on DWI, referred for ablation with HepACAGA between 1 January 2021, and 31 October 2023, were included. Re-ablations and ablations concomitant with another local treatment were excluded. The primary outcome was the technical success rate, defined as the intraprocedural detection and subsequent successful ablation of small liver metastases using HepACAGA. Secondary outcomes included the primary and secondary local tumor progression (LTP) rates and the complication rate. Results: A total of 15 patients (26 tumors) were included, with liver metastases from colorectal cancer (73%), neuro-endocrine tumors (15%), breast cancer (8%) and esophageal cancer (4%). All 26 tumors were successfully identified, punctured and ablated (a technical success rate of 100%). After a median follow-up of 9 months, primary and secondary LTP were 4% and 0%, respectively. No complications occurred. Conclusion: In this proof-of-concept study, the HepACAGA technique was successfully used to detect and ablate 100% of small liver metastases identified on DWI with a low recurrence rate and no complications. This technique enables the ablation of subcentimeter liver metastases detected on MRI. Full article

Purpose: Hepatic Arteriography and C-Arm CT-Guided Ablation of liver tumors (HepACAGA) is a novel technique, combining hepatic–arterial contrast injection with C-arm CT-guided navigation. This study compared the outcomes of the HepACAGA technique with patients treated with conventional ultrasound (US) and/or CT-guided ablation. Materials and Methods: In this retrospective cohort study, all consecutive patients with hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLM) treated with conventional US-/CT-guided ablation between 1 January 2015, and 31 December 2020, and patients treated with HepACAGA between 1 January 2021, and 31 October 2023, were included. The primary outcome was local tumor recurrence-free survival (LTRFS). Secondary outcomes included the local tumor recurrence (LTR) rate and complication rate. Results: 68 patients (120 tumors) were included in the HepACAGA cohort and 53 patients (78 tumors) were included in the conventional cohort. In both cohorts, HCC was the predominant tumor type (63% and 73%, respectively). In the HepACAGA cohort, all patients received microwave ablation. Radiofrequency ablation was the main ablation technique in the conventional group (78%). LTRFS was significantly longer for patients treated with the HepACAGA technique (p = 0.015). Both LTR and the complication rate were significantly lower in the HepACAGA cohort compared to the conventional cohort (LTR 5% vs. 26%, respectively; p < 0.001) (complication rate 4% vs. 15%, respectively; p = 0.041). Conclusions: In this study, the HepACAGA technique was safer and more effective than conventional ablation for HCC and CRLM, resulting in lower rates of local tumor recurrence, longer local tumor recurrence-free survival and fewer procedure-related complications. Full article

With the rapidly evolving field of image-guided tumor ablation, there is an increasing demand and need for tools to optimize treatment success. Known factors affecting the success of (non-)thermal liver ablation procedures are the ability to optimize tumor and surrounding critical structure visualization, ablation applicator targeting, and ablation zone confirmation. A recent study showed superior local tumor progression-free survival and local control outcomes when using transcatheter computed tomography hepatic angiography (CTHA) guidance in percutaneous liver ablation procedures. This pictorial review provides eight clinical cases from three institutions, MD Anderson (Houston, TX, USA), Gustave Roussy (Paris, France), and Amsterdam UMC (Amsterdam, The Netherlands), with the intent to demonstrate the added value of real-time CTHA guided tumor ablation for primary liver tumors and liver-only metastatic disease. The clinical illustrations highlight the ability to improve the detectability of the initial target liver tumor(s) and identify surrounding critical vascular structures, detect ‘vanished’ and/or additional tumors intraprocedurally, differentiate local tumor progression from non-enhancing scar tissue, and promptly detect and respond to iatrogenic hemorrhagic events. Although at the cost of adding a minor but safe intervention, CTHA-guided liver tumor ablation minimizes complications of the actual ablation procedure, reduces the number of repeat ablations, and improves the oncological outcome of patients with liver malignancies. Therefore, we recommend adopting CTHA as a potential quality-improving guiding method within the (inter)national standards of practice. Full article

The spontaneous rupture of a subcostal (12th intercostal) artery is exceptionally rare and could be fatal, requiring early diagnosis and treatment. Only one case of intercostal artery (ICA) bleeding in a patient undergoing hemodialysis (HD) has been reported. We additionally describe a 41-year-old man undergoing HD who presented with a spontaneous hemoperitoneum and shock resulting from a subcostal artery rupture. He initially complained of diffuse abdominal pain and dizziness at the emergency room. His abdomen was bloated, and there was tenderness in the right upper quadrant area. Enhanced computed tomography and arteriography revealed a rupture of the right subcostal artery. After the super-selection of the bleeding artery by a microcatheter, embolization was performed using a detachable coil and gelfoam. In a subsequent arteriogram, additional contrast leakage was no longer detected, and his blood pressure was restored to normal. The patient was discharged without any sequelae. He was followed up at our HD center without recurrence of ICA bleeding. To the best of our knowledge, this is the second case in the English literature documenting a spontaneous ICA rupture in a patient undergoing HD. This case indicates that injury to ICA should be suspected when patients undergoing HD complain of abdominal or chest pain and dizziness, although it is very rare. Full article