Search Results (354)

Peripheral arterial disease (PAD) is a complex, multifactorial atherosclerotic disease that primarily affects the arteries supplying the lower extremities, causing significant occlusion and reduced blood flow. Several studies have found an association between PAD and both genetic and environmental factors, which play a key role in the disease’s pathophysiology. Therefore, in this review, we describe the main genetic variants associated with plaque initiation, progression, and rupture in PAD. Furthermore, we identify different KEGG pathways involved in the pathological processes of these genes. We also describe gene expressions or transcriptomic studies, particularly in biopsies from patients with PAD. These findings could help identify the functional impact of genetic variants on the disease phenotype and, consequently, allow for the development of appropriate interventions that improve patient prognoses. Full article

Background and Objectives: Pulmonary sequestration (PS) is a rare congenital lung malformation. In adults, intralobar disease with recurrent infection or hemoptysis predominates. Cross-sectional imaging (CTA/MRA) is central to mapping the aberrant systemic supply; catheter angiography is used when noninvasive imaging is inconclusive or when an endovascular procedure is planned. We aimed to synthesize adult PS cases treated with endovascular or hybrid approaches and to summarize case selection, techniques, and outcomes. Methods: We conducted a PRISMA-2020-informed systematic review. We searched PubMed and Scopus from 1 January 2000 to 31 May 2025. Two reviewers extracted data independently; due to heterogeneity, we performed a narrative synthesis and a JBI-adapted qualitative risk-of-bias appraisal. Eligible studies enrolled adults (≥18 years) with imaging-confirmed PS treated with embolization, stent-graft exclusion, or hybrid therapy; prespecified outcomes included technical and clinical success, complications, recurrence, and re-intervention. The review was not registered. Results: Of 93 records screened, 41 publications reporting 48 adults were included. Twenty-five patients were managed endovascularly and 23 with hybrid therapy. Intralobar sequestration predominated (36/48); feeding arteries most often arose from the descending thoracic aorta (28/48). Complications were reported in 10 cases, mostly minor; three embolization cases required re-intervention. Conclusions: Endovascular therapy is useful for selected anatomies and urgent bleeding control, while hybrid strategies may benefit large, complex, or aneurysmal feeding arteries. The evidence base is limited to small case reports/series with heterogeneous outcome definitions and follow-up, precluding quantitative synthesis. Standardized outcome definitions, structured follow-up, and prospective registries are needed. Full article

Background: As an extremely sensitive organ, particularly during in utero development, the brain has intrinsic systems to reduce the risk of cerebral damage in cases of insult, such as energy deprivation, due to a mechanism of positive balance in cerebral oxygen–energy substrate demand and supply. This mechanism is called cerebral autoregulation and is present in both the fetal and adult brain. The inaccessibility of the fetal brain to currently available measurement techniques limits its knowledge. Physiological and pathological alterations of fetal cerebral blood flow (CBF) can be assessed during the latter half of pregnancy using sonographic Doppler studies. The limited studies on this subject suggest a potential role for Doppler assessment of the fetal internal carotid artery. Objective: This article reviews the concept of CBF autoregulation and the role of fetal Doppler studies in various brain vascular territories in clinical practice. Methods: A PubMed search was performed, and 156 English articles were used as references in this bibliographic review, published between January 1996 and December 2021. Results: The study of fetal CBF involves indirect observation; the fetal brain constantly changes its characteristics towards complete maturation, which will be fully accomplished only after birth, and the maternal environment influences this process. Conclusions: Doppler study of the internal cerebral artery might be useful in clinical practice. However, technical issues for its study are not established, there are no reference curves, and studies on its clinical value have limited applicability. Full article

Hepatocellular carcinoma (HCC) is a hypervascular malignancy commonly treated with transarterial chemoembolization (TACE), in which success relies on the accurate identification and embolization of tumor feeding arteries while sparing the nontumorous liver parenchyma. This review introduces the concept of selective angiographic roadmap analysis (SARA), a systematic and stepwise approach to evaluating hepatic arterial supply in HCC, with the aim of standardizing angiographic planning and improving TACE outcomes. SARA emphasizes recognition of typical and variant hepatic arterial anatomy, systematic identification of accessory and extrahepatic feeders, and integration with intraprocedural cone-beam computed tomography (CBCT) to enhance feeder detection and reduce nontarget embolization. Although primarily applied in TACE, the principles of SARA are equally relevant to transarterial radioembolization (TARE) where precise arterial mapping is critical. Embolization strategies are discussed across different levels of selectivity, from lobar to superselective techniques. The complementary role of advanced imaging modalities, such as CT angiography (CTA), MR angiography (MRA), and artificial intelligence-assisted vessel tracking, is also explored. Adopting the SARA framework in conjunction with these technologies may improve technical success and tumor control and preserve liver function in patients undergoing intra-arterial therapies. Full article

Background/Objectives: This study presents a case of chronic internal carotid artery [ICA] occlusion initially misinterpreted as ICA agenesis on magnetic resonance angiography (MRA). The report underscores the importance of retrospective review of prior imaging, particularly computed tomography angiography [CTA], in establishing the correct diagnosis. Case Report: A 70-year-old man presented with persistent headache, pulsatile tinnitus, and intermittent dizziness. Neurological examination and laboratory results were unremarkable. Initial cranial MRA demonstrated absence of flow in the left ICA, raising suspicion of congenital agenesis. However, retrospective evaluation of a CTA performed nine years earlier revealed a well-formed left carotid canal without ICA opacification, confirming the diagnosis of chronic ICA occlusion. Results: Current imaging again showed lack of enhancement in the left ICA, with adequate cerebral perfusion supplied via the contralateral ICA and vertebrobasilar system. Recognition of the preserved carotid canal on earlier CTA clarified the diagnosis as chronic occlusion rather than agenesis. Although surgical or endovascular revascularization was recommended, the patient opted for conservative management. At three months of follow-up, symptoms had improved and clinical monitoring continues. Conclusions: This case underscores the importance of distinguishing ICA agenesis from chronic occlusion, particularly by evaluating the carotid canal on CT. The presence of a carotid canal strongly indicates prior patency of the ICA and supports a diagnosis of occlusion. Careful differentiation is critical to avoid misinterpretation and to guide appropriate clinical management. In addition, reviewing prior imaging can be valuable when current findings are inconclusive or potentially misleading. Since this is a single case report, these observations should be regarded as hypothesis-generating rather than definitive, and further studies are needed to validate their broader applicability. Full article

The common iliac artery supplies blood to the lower extremities, and stenosis in this region severely impacts hemodynamics. This study investigates the effects of 25%, 50%, and 75% iliac artery stenosis on key hemodynamic parameters using a fluid–structure interaction (FSI) approach. Semi-idealized geometries reconstructed from patient-specific data modeled realistic arterial behavior. Parameters such as wall displacement, time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), high oscillatory low shear magnitude (HOLMES) index, and endothelial cell activation potential (ECAP) were evaluated. Results showed peak wall displacement of 2.85 mm in the bifurcation zone under 75% stenosis. TAWSS increased with stenosis severity, peaking in stenotic regions and decreasing significantly downstream. OSI was highest in non-stenosed right branches and bifurcation areas, indicating multidirectional shear forces. HOLMES values were lowest downstream of stenoses, indicating disturbed flow. ECAP exceeded the thrombosis risk threshold (1.4 Pa⁻¹) in post-stenotic zones under 75% stenosis, suggesting a higher risk of clot formation. These results demonstrate that stenosis disrupts local flow and causes hemodynamic changes downstream, emphasizing the need for comprehensive clinical assessment beyond the stenotic site. Regions with elevated ECAP and low HOLMES downstream may be prone to thrombosis, highlighting the importance of careful hemodynamic monitoring for treatment strategies. Full article

The Qinghai–Tibet Plateau (QTP), a globally significant tourist destination and critical ecological barrier, faces an intrinsic conflict between development and conservation. The scientific identification of suitable tourism zones is therefore crucial for formulating sustainable development policies. Conventional suitability assessments, however, which typically rely on subjective, expert-based weighting and static, supply-side data, often fail to capture the complex, non-linear dynamics of actual tourist–environment interactions. To overcome these limitations, an innovative analytical framework is presented, integrating massive tourist trajectory big data (66.7 million GPS points) as an objective, demand-driven suitability proxy, a Geo-detector model to identify key drivers and their interactions, and a Random Forest algorithm for spatial prediction. The framework achieves high predictive accuracy (AUC = 0.827). The results reveal significant spatial heterogeneity: over 85% of the QTP is unsuitable for tourism, while suitable zones are intensely concentrated in southeastern river valleys, forming distinct agglomerations around core cities and along primary transport arteries. Analysis demonstrates that supporting conditions—particularly transport accessibility and service facility density—are the dominant drivers, their influence substantially surpassing that of natural resource endowment. Furthermore, the formation of high-suitability zones is not attributable to any single factor but rather to the synergistic coupling of multiple conditions. This research establishes a replicable, data-driven paradigm for tourism planning in environmentally sensitive regions, offering a robust scientific basis to guide the sustainable development of the QTP. Full article

The renal vessels are known to exhibit variations in different populations. The present retrospective cross-sectional study aimed to evaluate the radiological anatomy of renal arteries and veins in the Omani population. Computed tomography angiography scans were used to assess diameter, laterality, and vascular branching patterns in adults (aged ≥ 18 years) who underwent contrast-enhanced CT angiography of the abdomen and pelvis between 1 January 2023, and 31 December 2024. Normal CT angiograms of cases performed for vascular pathology screening, renal transplant workup, or trauma evaluation with normal findings were included. Measurements included diameters, anatomical course, and vascular variations in the renal arteries and veins. Accessory renal arteries were defined as any additional arteries arising from the aorta supplying the kidney, regardless of the entry point. The mean diameters of the right and left renal arteries were significantly higher in males (p = 0.020 and 0.026, respectively). The right renal vein was significantly larger in females (p = 0.020). Accessory renal arteries were identified in 24.22% (n = 31 patients), including two cases with unilateral double accessory arteries. The right and left RA diameters were 4.51 ± 0.91 mm and 4.95 ± 0.98 mm, respectively, both significantly larger in males (p = 0.020 and 0.026). Supernumerary renal veins were observed in 21 patients; retroaortic and circumaortic left RVs were found in seven and one case(s), respectively. Venous variations were present in 17.2% of the Omani subjects. The findings may enhance preoperative planning, especially in renal transplantation and urologic surgery, by increasing awareness of anatomical variants. This region-specific dataset supports the development of optimized imaging protocols and surgical strategies for better patient care. Full article

With the impact of fossil energy on the climate environment and the development of energy technologies, new energy vehicles, represented by electric cars, have begun to receive increasing attention and emphasis. The rapid proliferation of public charging infrastructure for NEVs has concurrently influenced traditional petrol station networks, creating measurable disparities in their spatial distributions that warrant systematic investigation. This research examines Wenzhou City, China, as a representative case area, employing multi-source Point of Interest (POI) data and spatial analysis models to analyse differential characteristics in spatial layout accessibility, service equity, and underlying driving mechanisms between public electric vehicle charging stations (EV) and traditional gas stations (GS). The findings reveal that public electric vehicle charging stations exhibit a pronounced “single-centre concentration with weak multi-centre linkage” spatial configuration, heavily reliant on dual-core drivers of population density and economic activity. This results in marked service accessibility declines in peripheral areas, resembling a cliff-like drop, and a relatively low spatial equity index. In contrast, traditional gas stations demonstrate a “core-axis linkage” diffusion pattern with strong coupling to urban road networks, showing gradient attenuation in service coverage efficiency along transportation arteries, fewer suburban service gaps, and more gradual accessibility reductions. Location entropy analysis further indicates that charging station deployment shows significant capital-oriented tendencies, with certain areas exhibiting paradoxical “excess facilities” phenomena, while gas station distribution aligns more closely with road network topology and transportation demand dynamics. Furthermore, the layout characteristics of public charging stations feature a more complex and diverse range of land use types, while traditional gas stations have a strong dependence on industrial land. This research elucidates the spatial distribution patterns of emerging and legacy energy infrastructure in the survey regions, providing critical empirical evidence for optimising energy infrastructure allocation and facilitating coordinated transportation system transitions. The findings also offer practical insights for the construction of energy supply facilities in urban development frameworks, holding substantial reference value for achieving sustainable urban spatial governance. Full article

Non-invasive, continuous monitoring of carotid artery hemodynamics may provide valuable insights on cerebral blood perfusion (CBP). Near-infrared spectroscopy (NIRS) is a non-invasive modality that may be a good candidate for real-time carotid artery monitoring. We designed a wearable NIRS system to monitor the left and right radial and carotid arteries in 20 healthy subjects. The changes in total hemoglobin concentration (HbT) and tissue oxygen saturation (StO₂) in all 80 arteries were continuously monitored in response to changes in oxygen supply. Wilcoxon non-parametric equivalence testing was used to compare changes in the radial (reference) and carotid arteries. The system-derived HbT and StO₂ trends matched the expected physiological responses over time in the radial and carotid arteries. The mean peak-to-peak amplitude [uM] of HbT during sustained deep breathing was practically equivalent between the left radial (0.9 ± 0.8) and left carotid (1.6 ± 1.1) arteries (p = 0.01). The mean peak-to-peak amplitude [%] of StO₂ was practically equivalent between the left radial (0.3 ± 0.2) and left carotid (0.3 ± 0.2) arteries (p < 0.001) and the right radial (0.4 ± 0.5) and right carotid (0.5 ± 0.4) arteries (p = 0.001). These findings indicate that NIRS may be a good option for monitoring the carotid arteries to track changes in CBP. Full article

The Ile River is the main water artery of the Lake Balkhash basin and the main fresh water resource supplying the south-eastern part of Kazakhstan. Increasing human economic activity makes it necessary to assess the anthropogenic load of the river on various ecosystems, including possible harmful effects. The assessment of anthropogenic load on the Ile River ecosystem was realized by the anthropogenic load fraction indicator and by the values of the chemical substance inflow modulus. For this purpose, the Ile River was divided into 3 sections: section I—from the border post HP Dobyn to 164 km above Kapshagai hydroelectric power plant (HPP); section II—between the points 164 km above and 37 km below Kapshagai HPP; and section III —from 37 km below HPP to Ushzharma village. The anthropogenic load strongly depends on the share of anthropogenic impact contributed by pollutants. Characteristic pollution components are copper, and in some cases zinc, ammonium, and nitrite nitrogen. The assessment of anthropogenic load also considers organic and biogenic substances in the chemical composition of river water. The variability in the volume of dissolved chemical inflows in different sections of the river made it possible to assess the transformation of anthropogenic load along the length of the Ile River. Full article

The pancreas exhibits a uniquely intricate vascular architecture characterized by frequent and clinically significant morphological variations. These variations—impacting both arterial supply and venous drainage—are critical determinants in surgical planning, radiologic interpretation, and interventional outcomes. This comprehensive review examines the full spectrum of pancreatic vascular anatomy, with particular emphasis on embryological development, imaging manifestations, and surgical relevance. Key arterial structures, including the superior and inferior pancreaticoduodenal arteries (SPDAs and IPDAs) and the dorsal pancreatic artery (DPA)—are explored in detail alongside accessory branches. On the venous side, focus is placed on the gastrocolic trunk (GCT) of Henle, the uncinate and centro-inferior pancreatic veins, and the dorsal pancreatic vein (DPV). The review highlights that arterial aberrations, such as a DPA originating from the superior mesenteric artery (SMA), or duplicated patterns of the IPDA, as well as venous anomalies such as variant drainage of the GCT or the centro-inferior pancreatic vein, have substantial implications during pancreaticoduodenectomy, distal pancreatectomy, and transplantation procedures. With advances in multidetector computed tomography (MDCT), magnetic resonance angiography (MRA), and three-dimensional (3D) modeling, high-risk vascular variants can now be accurately mapped preoperatively, facilitating safer and more effective minimally invasive and robotic-assisted surgeries. In conclusion, the recognition and understanding of pancreatic vascular variations are imperative for optimal surgical and interventional management. This review underscores the importance of multidisciplinary collaboration among surgeons, radiologists, and anatomists, which will allow them to integrate detailed anatomical knowledge into clinical workflows, ultimately improving patient outcomes in pancreatic procedures. 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

Objective: Cervical pregnancy (CP) accounts for less than 1% of all ectopic pregnancies. The standard of management for CP is still under detailed investigation; however, among the known treatment methods, super-selective uterine artery embolization (UAE) and the use of methotrexate (MTX) have emerged as effective and minimally invasive options in recent years. Our aim is to present our center’s experience and provide available evidence evaluating the efficacy of UAE in the treatment of CP. Materials and Methods: This single-center and retrospective study evaluated the procedural and clinical outcomes of patients with CP who underwent endovascular uterine embolization with MTX between 2017 and 2024. Both procedural and clinical efficacy and safety, as well as the rate of complications and long-term outcomes, were noted. Results: A total of nine patients were diagnosed with CP (imaging examination included transvaginal ultrasound and/or magnetic resonance imaging) and referred for endovascular treatment. The mean age of the patients was 36.7 years, and the mean gestational age on admission was 9 weeks. In all cases, selective catheterization of supplying vessels and subsequent embolization with a mixture of methotrexate and gel sponge was carried out. The technical success rate was 100% with no complications. Follow-up ultrasound confirmed the disappearance of the flow signal around the intracervical gestational sac in all cases. Conclusions: In conclusion, this retrospective study demonstrated the procedural and clinical safety and efficacy of uterine artery embolization in patients with cervical pregnancy. This is why endovascular therapy should be proposed to these individuals and be included in treatment options discussed during multidisciplinary boards. Full article

Background and Objectives: The causes and clinical outcomes of renal perfusion abnormalities occurring after para-aortic lymphadenectomy (PANDx) for gynecologic malignancies are unknown. We investigated the potential involvement of accessory renal artery (ARA) obstruction in their development by reassessing perioperative contrast-enhanced computed tomography (CECT). Materials and Methods: This retrospective study investigated a clinical database to identify urinary contrast defects using CECT in all patients who had undergone PANDx between January 2020 and December 2024. The perfusion defects in the kidney detected by CECT were extracted by a gynecologic oncologist and evaluated by a radiologist and urologist for suspected obstruction of ARAs. Results: Postoperative renal contrast defects were observed in 3.8% (6/157) of patients. Renal parenchymal fibrosis, cortical atrophy, and parenchymal thinning were observed as universal findings in all patients showing renal contrast defects. In five of the six cases, ARAs supplying the infarcted renal segments were identified on preoperative CECT, and arterial obstruction was confirmed on postoperative imaging. The remaining case was considered to be latent pyelonephritis. All five patients underwent laparotomy, and preoperative CECT failed to detect ARAs. The median resected para-aortic lymph node was 23 nodes (range: 15–33) in five patients, showing no statistically significant difference compared to patients without perfusion abnormalities (p = 0.19). Postoperative serum creatinine levels remained stable. Conclusions: ARA obstruction appears to be a risk factor for segmental renal infarction after para-aortic lymphadenectomy in gynecological malignancies; however, the clinical impact on urinary function may be limited. Awareness of this potential complication is essential for gynecologic oncologists performing PANDx. Full article