Increased Circulating Copeptin Levels Are Associated with Vaso-Occlusive Crisis and Right Ventricular Dysfunction in Sickle Cell Anemia

OBJECTIVE

Vaso-occlusive crisis (VOC) is a common clinical manifestation of sickle cell anemia (SCA) and is associated with increased proinflammatory mediators. Copeptin is the C-terminal part of the prohormone for provasopressin and seems clinically relevant in various clinical conditions. Right ventricular (RV) dysfunction significantly appears in SCA patients due to pulmonary hypertension. This study aimed to investigate the association of copeptin levels in VOC patients and evaluate RV dysfunction.

MATERIALS AND METHODS

A total of 108 patients were enrolled in the study. Twenty-eight SCA patients in steady state (30.2 ± 0.9 years), 25 SCA patients in VOC (36.8 ± 11.8 years), and 55 healthy individuals (31.9 ± 9.4 years) with HbAA genotype were included. Clinical, echocardiographic, and laboratory data were recorded. ELISA was used for the determination of serum levels of copeptin.

RESULTS

VOC patients had significantly higher copeptin level compared both with controls and SCA subjects in steady state (22.6 ± 13.0 vs. 11.3 ± 5.7 pmol/L, 22.6 ± 13.0 vs. 12.4 ± 5.8 pmol/L, p = 0.009 for both). Additionally, the copeptin level was significantly higher in SCA patients with RV dysfunction than those without RV dysfunction (23.2 ± 12.2 vs. 15.3 ± 9.5 pmol/L, p = 0.024). Multiple logistic regression analysis revealed that high-sensitivity C-reactive protein and copeptin levels were found to be associated with VOC.

CONCLUSION

This study showed that copeptin and hs-CRP levels were increased in patients with VOC, and it was found that RV dysfunction was more common in SCA patients with VOC than in the control group. Copeptin can be considered for use as a potential biomarker in predicting VOC crisis in SCA patients and in the early detection of patients with SCA who have the potential to develop RV dysfunction.

Super-selective balloon test occlusion with electrophysiological monitoring to occlude angiographically invisible posterior communicating artery perforators with unruptured aneurysm

Balloon test occlusion (BTO) can predict the ischemic complication risk associated with arterial occlusion. We present a case of an unruptured, broad-necked internal carotid artery-posterior communicating artery (PcomA) aneurysm that was successfully embolized after super-selective BTO of fetal PcomA with electrophysiological monitoring. The proximal portion of the PcomA was internally occluded without causing major neurological deficits, although we observed a small new infarction in the ipsilateral anterior thalamus postoperatively. We recognized small perforators arising from the proximal PcomA during a previous clipping surgery. Super-selective BTO with electrophysiological monitoring could be useful for functional preservation after infarction from angiographically invisible perforators.

Transcranial color Doppler sonography as an alternative tool for evaluation of terminal internal carotid artery steno-occlusion in moyamoya disease

OBJECTIVE

To investigate color Doppler ultrasonography criteria and its value in assessing the steno-occlusion of the terminal internal carotid artery in moyamoya disease.

METHODS

According to the digital subtraction angiography findings, patients were divided into three groups: occlusion of the terminal internal carotid artery, >50% stenosis, and ≤50% stenosis. We measured the terminal and proximal internal carotid artery parameters of each group using transcranial and cervical color Doppler sonography.

RESULTS

Blood flow signals in 12 terminal internal carotid arteries were absent, which were verified as occlusion by digital subtraction angiography. Parameters were obtained in the remaining 159 terminal/proximal internal carotid arteries to predict cutoffs for >50% stenosis and occlusion. For >50% stenosis, mean flow velocity >88.50 cm/s in the terminal internal carotid artery could achieved the highest receiver operating characteristic curve area of 0.776 with 62.50% sensitivity, 88.15% specificity, 48.39% positive predictive values, 92.97% negative predictive value, and 84.27% overall accuracy. For the occlusion, mean flow velocity <49.50 cm/s in the terminal internal carotid artery achieve the highest receiver operating characteristic curve area of 0.734 with 55.56% sensitivity, 83.81% specificity, 63.83% positive predictive values, 78.57% negative predictive value, and 74.21% overall accuracy. The area under receiver operating characteristic curve cutoffs for other parameters were less than 0.7.

CONCLUSION

Mean flow velocity of terminal internal carotid artery provides useful diagnostic information for detecting steno-occlusion in moyamoya disease. It may be used as an alternative tool to evaluate steno-occlusion of the terminal internal carotid artery in moyamoya disease.

Physical and psychological functioning of patients with chronic limb ischemia during a 1-year period after endovascular revascularization

OBJECTIVE

Symptoms of peripheral artery disease (PAD) and patients' physical and psychological status are related in a vicious circle. The aim of this study was to determine the relationships between improvement in parameters of PAD after endovascular procedures and changes in patients' physical and psychological status.

METHODS

We studied 140 consecutive PAD patients: 50 patients with chronic limb-threatening ischemia (CLTI), 50 patients with intermittent claudication (IC) undergoing an endovascular procedure, and 40 IC patients who were not qualified for leg revascularization. All participating patients were assessed at the beginning of the study and at 3 and 12 months of follow-up; scores taken included: ankle-brachial index, 6-minute walking test distance, Barthel index, activities of daily living (ADL) index, instrumental activities of daily living (IADL) index, Mini-Mental State Examination (MMSE), and Hospital Anxiety and Depression Scale (HADS).

RESULTS

After 12 months of follow-up, an improvement in PAD-related symptoms following leg revascularization had been maintained in 56% of the patients with CLTI and in 68% of those with IC. Twelve months after endovascular leg revascularization, the scores in respect of ADL, IADL, and MMSE had increased, and scores for HADS had decreased in both CLTI and IC patients. A higher baseline score in the IADL index was associated with a reduction in the 1-year cardiovascular event risk (OR; 95% CI: 0.70; 0.54-0.91; P < .01).

CONCLUSIONS

In PAD patients, endovascular procedures not only improved PAD-related symptoms, but also ameliorated patients' physical state, improved cognitive function, and reduced depression.

[Radial artery occlusion after a radial access procedure: pilot study comparing eco Doppler and Inverse Barbeau Test assessments]

. Radial artery occlusion after a radial access procedure: pilot study comparing eco Doppler and Inverse Barbeau Test assessments.

INTRODUCTION

Radial artery occlusion (RAO) after a radial access procedure can compromise the distal flow and hamper any possible reuse of the radial artery. Ultrasound examination is the gold standard for identifying RAO, but requires special equipment and expertise. An indirect test to estimate radial flow is the Inverse Barbeau Test (IBT), which evaluates the radial oximetry waveform during ulnar artery compression.

AIM

To determine the incidence of RAO and to compare the results obtained with the ultrasound and IBT tests.

METHODS

Between November 2017 and February 2018, 50 patients undergoing radial access angiography were enrolled. Radial flow was assessed using both ultrasound and IBT, at three times: before the procedure (T0), at 24 hours (T1) and at 30 days (T2).

RESULTS

The incidence of RAO obtained by ultrasound was no cases at T0, 3 (6%) at T1 and 1 (2.4%) at T2. IBT identified 14 (28%), 33 (66%) and 10 (23.8%) cases respectively. Some cases with no occlusion with the ultrasounds, 14 (28%), 30 (60%) and 9 (21.4%) respectively, resulted occluded by IBT.

CONCLUSIONS

The incidence of RAO is comparable to that reported in the literature (<10%). The IBT correctly identifies the presence of flow, but overestimates radial occlusion.

[A periarteritisnodosa presenting as bilateral sub-acute limb ischemia of the legs]

STUDY'S GOAL

As there are no guidelines. This short report shows our experience in management of sub-acute limb ischemia with polyarteritisnodosa.

INTRODUCTION

Acute limb ischemia is rarely seen in periarteritisnodosa.

CASE REPORT

Here, we present a case with peripheral vascular disease of both lower limbs leading to foot claudication and then a subacute limb ischemia with large necrotic plaques on the lower limb. Angioscan showed occlusion of both superficial femoral arteries. Angiographic imaging showed abnormalities in medium-sized arteries. Pathological study of biopsy from the artery, vein, nerve and skin of the amputated leg confirm the diagnosis of periarteritisnodosa. She benefited from femoral popliteal bypass in both legs, anticoagulant drug and steroids. The non-amelioration of the left leg led to his amputation. The right leg was healed.

Lower-Limb Ischemia at Birth Because of Spontaneous Arterial Thrombosis: A Case Report

CASE

A full-term neonate presented with right lower extremity ischemia at birth because of spontaneous thrombosis of the right common iliac artery. He was initially managed with supportive treatment, anticoagulation, and dressings; however, advanced gangrenous changes precluded salvage of the ischemic limb. A guillotine amputation was performed at day 15 of life, and the stump went on to heal well by secondary intention.

CONCLUSION

Thromboembolic events occurring in infancy are well-recognized phenomena; however, it is far rarer to encounter a neonate born with "congenital gangrene". We discuss the etiology, approach to diagnosis, and treatment of this rare but devastating condition.

Digit Survival After Prolonged Digital Tourniquet Application Associated with Severe Venous Congestion: A Case Report

CASE

A 22-year-old roofer presented to the emergency department with partial amputation of the left middle finger. He was treated with revision amputation using a glove tourniquet. He followed up 14 days later demonstrating a retained tourniquet with severe ischemic changes. The patient was managed conservatively with aspirin, smoking cessation, and observation.

CONCLUSION

At 2-year follow-up, he had normal sensation and function and returned to work. A finger with severe, but incomplete arterial occlusion and profound venous congestion can be salvaged with conservative management of observation and anticoagulation with aspirin therapy after prolonged ischemia of 14 days.

Patent Hemostasis Impact in Clinical Routine: Large Monocentric Echo-Doppler Study of Radial Artery Patency After Coronary Catheterization

BACKGROUND

Radial access is currently the first line of access in interventional cardiology. Nevertheless, this technique carries a 1%-10% risk of radial artery occlusion (RAO) based on series.

METHODS

We conducted a large-scale echo-Doppler evaluation of radial patency including prospectively all patients who underwent coronary angiography and/or angioplasty with radial catheterization at our center in 2018.

RESULTS

A total of 1106 patients were enrolled in the cohort. Average patient age was 70 years, 24.5% were females and 75.5% were males, and 28.3% were diabetics. Five Fr and 6 Fr devices were used in 527 procedures and 565 procedures, respectively. Our study highlighted a very low RAO rate (0.99%). These results are mainly due to the high attention given to patent hemostasis, which was achieved in 1091 patients (98.6%). According to the literature, female gender is a multivariate predictive factor of RAO (P<.01). Furthermore, we confirm the protective nature of heparin (P=.04) with an average heparin dose of 69.73 IU/kg.

CONCLUSIONS

Our study focused on a large population with 1106 patients who underwent radial catheterization shows that a very low rate of RAO (0.99%) can be achieved. These results are correlated with a high attention to patent hemostasis and a close collaboration between the medical and paramedical staff.

[Severe cerebral haemodynamic impairment treated with bypass surgery]

Cerebral hypoperfusion due to steno-occlusive large artery disease poses a diagnostic challenge. This is a case report of a 72-year-old woman, presenting with recurring paroxysmal right-sided hemiparesis, dysphasia and occasionally limb-shaking transient ischaemic attacks, especially during orthostatic challenge. The condition was initially misdiagnosed as focal epilepsy. A workup revealed a left-sided carotid artery occlusion and a haemodynamic failure in the carotid distribution, seen on a 15O-H2O PET acetazolamid scan. The patient was successfully treated with an extracranial-intracranial bypass surgery.

[Carotid-subclavian Bypass for Radiation-induced Subclavian Artery Occlusion;Report of a Case]

A male patient underwent radiation therapy for hypopharyngeal cancer and esophageal cancer at the age of 58 years without recurrence. At the age of 63 years, he started to experience fatigue, numbness of the left upper limb and dizziness. The symptom gradually worsened and he was admitted to our hospital for further investigation. By computed tomography scan and angiography, the subclavian artery (SCA) occlusion and a patent left vertebral artery with retrograde flow were revealed( subclavian steal syndrome). Subclavian artery occlusion could not be recanalized by percutaneous transluminal angioplasty. He underwent carotid-subclavian bypass. His symptoms clearly improved. Postopertive course was uneventful and no further symptoms developed after surgery.

Outcomes of endovascular treatment for infrapopliteal peripheral artery disease based on the updated TASC II classification

We retrospectively analyzed all endovascular procedures of infrapopliteal arterial lesions (n = 383) performed in 270 patients at our institution between December 2008 and January 2018. The overall technical success rate was 97% and yielded 98% for stenoses (n = 214) and 95% for occlusions (n = 169). Trans-Atlantic Inter-Society Consensus (TASC II) classification had no impact on success rates (TASC A + B vs C + D; 96.5% vs 96.9%, p = 0.837). Freedom from clinically driven target lesion revascularization (TLR) after 6 and 12 months was 88.3% and 77.2%. TLR was comparable for TASC A to C lesions and no difference was observed comparing groups of moderately complex TASC A/B lesions and more complex TASC C/D lesions (TASC A + B vs C + D; 78.5% vs 74.2%, p = 0.457). Freedom from TLR was significantly lower in very complex TASC D lesions (TASC A + B + C vs D; 79.7% vs 42.5%, p < 0.001). Multivariate analysis identified TASC D lesions (hazard ratio D/A: 1.5; overall p = 0.002), Fontaine class III and IV (hazard ratio III or IV/IIa or IIb: 2.4; p = 0.041), and occlusive lesions (hazard ratio occlusion/stenosis: 2.4; p = 0.026) as predictors for TLR. In conclusion, endovascular therapy for infrapopliteal artery disease was safe and accompanied with a promising long-term outcome.

"Modern Endovascular Therapy"

INTRODUCTION

The past 25 years have been witness to a revolution in how vascular care is delivered. The majority of arterial and venous interventions have converted from open surgery to minimally invasive percutaneous endovascular procedures.

METHODS

This surgical innovations symposium article reviews current endovascular therapy in multiple vascular beds with a primary focus on carotid artery occlusive disease, aortic pathologies, and lower extremity arterial occlusive disease. Mesenteric arterial occlusive disease and lower extremity venous endovascular therapies are also briefly discussed. Indications for intervention, treatment examples and outcomes analysis are presented. While not reviewed in this article, endovascular therapy has also become first line in the treatment of coronary artery disease, chronic mesenteric arterial occlusive disease, superficial venous reflux, central vein occlusion, and acute venous thrombus intervention when indicated.

CONCLUSION

Endovascular therapies are used in all vascular beds to treat the full spectrum of vascular pathologies. Aneurysm disease, atherosclerotic arterial occlusive disease, acute arterial and venous thrombosis, ongoing hemorrhage, and venous reflux are among the issues which can be addressed by endovascular means. The minimally invasive nature of endovascular treatments in what is largely a very co-morbid patient cohort is an attractive method of avoiding major procedural related morbidity and mortality.

[Medication-based secondary prevention in patients with peripheral arterial occlusive disease : An analysis based on secondary data]

BACKGROUND

Peripheral arterial occlusive disease (PAOD) is an atherosclerotic vascular disease with high morbidity and mortality. A consistent medication-based secondary prevention is part of the essential and evidence-based treatment of PAOD. The aim of this study was to ascertain the status quo of medicinal secondary prevention based on submitted prescriptions.

METHODS

In the time period from 2014 to 2017 patients with a confirmed PAOD coding (I70.2-/I73.9-) were identified based on secondary data of the Association of Statutory Health Insurance Physicians Westphalia-Lippe (KVWL). The prescriptions submitted with respect to platelet inhibitors, oral anticoagulants, lipid lowering therapy (LLT) and angiotensin-converting enzyme (ACE) inhibitors in the fourth quarter year after diagnosis coding were collated.

RESULTS

In the diagnosis period 2014/2015 a total of 238,397 patients had PAOD in the catchment area of the KVWL. The proportion of submitted prescriptions in the fourth quarter year after diagnosis was 25.9% for LLT, 13.6% for acetylsalicylic acid, 4.5% for clopidogrel, 5.5% for vitamin K antagonists (VKA), 3.5% for non-vitamin K‑dependent oral anticoagulants (NOAC) and 26.8% for ACE inhibitors. Over the course of the 3 years (n = 241,375 patients with PAOD 2016/2017) the proportion of submitted prescriptions for all substances except VKA increased (p < 0.001), whereby the largest relative increase was noted for NOAC (relative increase of 81.7%).

CONCLUSION

The guideline-conform medicinal secondary prevention in patients with PAOD in Germany is still in need of improvement. A consistent implementation of evidence-based medicinal secondary prevention harbors a great potential for improvement of the overall prognosis in patients with PAOD.

[EFFICIENCY OF RADIOLOGICAL METHODS FOR DIAGNOSING THE ARTERIES OF THE FEMORO-POPKLITE-TIBAL SEGMENT]

Objective - to determine the effectiveness of modern methods of radiological diagnostics for improving the results of treatment of patients with distal occlusive-stenotic diseases of the femoral-popliteal-tibial segment of atherosclerotic genesis. The analysis of examinations and treatment of 150 patients with distal atherosclerosis, who were in the Department of Vascular Surgery of the Regional Clinical Hospita A. Novaka. On ultrasound examination of the arteries of the femoral-popliteal-tibial segment, false negative and false positive results were observed in 11 and 3 patients, respectively. On duplex scanning, a false negative was observed in 5 patients, a false positive in two patients. On X-ray contrast angiography, respectively, in 14 and 5 patients, with MDCT - in 3 and 2 patients. To study of the deep femoral artery, the largest number of false positive and false negative results were observed during ultrasound examination of 12 and 5 patients and X-ray contrast angiography in 18 and 12 patients, respectively. Have compared the radiological methods for diagnosing the arteries of the femoral-popliteal-tibial segment and the deep femoral artery, the most effective were MDCT (89.1% and 90%, respectively) and ultrasound duplex scanning (88.7% 82%, respectively). The predictability of the research method for diagnosing the arteries of the femoral-popliteal-tibial segment for ultrasound was 97.7%, for ultrasound - 97.1%, for RCAH - 91.1%, for MSCT - 98% with an accuracy of 90.7%, 95 , 3%, 78.2%, 95.5%. For the deep femoral artery, the predictability of ultrasound was 95.9%, ultrasound - 96.9%, RCAH - 58.6%, MSCT - 99% with an accuracy of 88.7%, 93.3%, 66.5%, 97.3%, respectively.

Distal Transradial Access (dTRA) for Coronary Angiography and Interventions: A Quality Improvement Step Forward?

Distal TRA is a novel access site in the interventional cardiology field, with current data demonstrating high success and infrequent complication rates - global procedural metrics that are comparable with historical proximal TRA. Distal TRA may conversely provide important advantages over proximal TRA, including patient comfort, shorter hemostasis time, and lower radial artery occlusion rates.

An Online Training Intervention on Prehospital Stroke Codes in Catalonia to Improve the Knowledge, Pre-Notification Compliance and Time Performance of Emergency Medical Services Professionals

Strokes are a time-dependent medical emergency. The training of emergency medical service (EMS) professionals is essential to ensure the activation of stroke codes with pre-notification, as well as a rapid transfer to achieve early therapy. New assessment scales for the detection of patients with suspected large vessel occlusion ensures earlier access to endovascular therapy. The aim of this study was to evaluate the impact on an online training intervention focused on the Rapid Arterial oCclusion Evaluation (RACE) scoring of EMS professionals based on the prehospital stroke code in Catalonia from 2014 to 2018 in a pre–post intervention study. All Catalonian EMS professionals and the clinical records from primary stroke patients were included. The Kirkpatrick model guided the evaluation of the intervention. Data were collected on the knowledge on stroke recognition and management, pre-notification compliance, activated stroke codes and time performance of EMS professionals. Knowledge improved significatively in most items and across all categories, reaching a global achievement of 82%. Pre-notification compliance also improved significantly and remained high in the long-term. Increasingly higher notification of RACE scores were recorded from 60% at baseline to 96.3% in 2018, and increased on-site clinical care time and global time were also observed. Therefore, the online training intervention was effective for increasing EMS professionals’ knowledge and pre-notification compliance upon stroke code activation, and the wide adoption of a new prehospital scale for the assessment of stroke severity (i.e., the RACE scale) was achieved.

Perioperative acute internal carotid thrombosis after general surgery

INTRODUCTION

The average incidence of perioperative stroke during major non-cardiac surgery is less than 1%, suggesting that it is rarely a major problem for the vast majority of patients.

METHODS

In our paper we present a 46-year-old patient undergoing acute right hemicolectomy who developed right-sided hemiparesis in the perioperative setting. Immediate CTAg examination showed an ischemic stroke in the left hemisphere as a result of left internal carotid thrombosis. A surgical procedure to recanalize the left carotid artery was performed 14 hours from the onset of neurological symptomatology and the neurological deficit gradually recovered fully.

CONCLUSION

Our case report supports studies showing that a thorough diagnostic assessment allows the selection of patients who may benefit from urgent revascularization of acute internal carotid occlusion during the phase of acute brain ischemia.

Hand Hematoma After Cardiac Catheterization Via Distal Radial Artery

This is the first reported case of severe hand hematoma after cardiac catheterization through the distal radial artery, with the hematoma extending distally to the sheath insertion site. The distribution of the hematoma in our case is completely different compared to the hematomas observed after traditional radial catheterization, which used to extend to the forearm. Therefore, the traditional EASY classification may not apply to hematomas after catheterization through the distal radial artery.

Preventive Effects of Resveratrol on Endocannabinoid System and Synaptic Protein Modifications in Rat Cerebral Cortex Challenged by Bilateral Common Carotid Artery Occlusion and Reperfusion

This study aims to evaluate the putative roles of a single acute dose of resveratrol (RVT) in preventing cerebral oxidative stress induced by bilateral common carotid artery occlusion, followed by reperfusion (BCCAO/R) and to investigate RVT’s ability to preserve the neuronal structural integrity. Frontal and temporal-occipital cortices were examined in two groups of adult Wistar rats, sham-operated and submitted to BCCAO/R. In both groups, 6 h before surgery, half the rats were gavage-fed with a single dose of RVT (40 mg/per rat in 300 µL of sunflower oil as the vehicle), while the second half received the vehicle alone. In the frontal cortex, RVT pre-treatment prevented the BCCAO/R-induced increase of lipoperoxides, augmented concentrations of palmitoylethanolamide and docosahexaenoic acid, increased relative levels of the cannabinoid receptors type 1 (CB1) and 2 (CB2), and peroxisome-proliferator-activated-receptor (PPAR)-α proteins. Increased expression of CB1/CB2 receptors mirrored that of synaptophysin and post-synaptic density-95 protein. No BCCAO/R-induced changes occurred in the temporal-occipital cortex. Collectively, our results demonstrate that, in the frontal cortex, RVT pre-treatment prevents the BCCAO/R-induced oxidative stress and modulates the endocannabinoid and PPAR-α systems. The increased expression of synaptic structural proteins further suggests the possible efficacy of RVT as a dietary supplement to preserve the nervous tissue metabolism and control the physiological response to the hypoperfusion/reperfusion challenge.

[A case of cerebral reversible vasoconstriction syndrome triggered by repetition transcranial magnetic stimulation]

A 75-year-old man was admitted for combined low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy. Five days after the initiation of rTMS, he developed hypotension and temporary exacerbation of the right hemiplegia with thunderclap headache. MRA showed segmental stenosis of the left middle cerebral artery, which findings were improved at 9 days after the onset of the headache. He was diagnosed as having the reversible cerebral vasoconstriction syndrome (RCVS). The rTMS was recognized as safe rehabilitation treatment. However, it is necessary to recognize that RCVS can become one of the precipitants. This is the first report of RCVS triggered by rTMS.

The Increase of Blood Anticardiolipin Antibody Depends on the Underlying Etiology in Cerebral Ischemia

Although anticardiolipin antibody (aCL) has been suggested to be a potent risk factor for thrombosis and atherosclerosis in multiple arterial beds, conflicting results exist between aCL and cerebral ischemia in the general stroke population. To elucidate if this discrepancy relates to the heterogeneity of underlying etiologies, the blood beta2-glycoprotein I dependent-aCL in 432 Taiwanese adults was examined. The associated cerebral ischemia in these patients was classified into five subtypes according to the cause of cerebral ischemia. The results were compared with those in 100 healthy controls. A definite increase of aCL-IgG isotype was found in 41 patients (9.35%) and four controls (4.0%). The relative risk was 2.52. The frequency of increased aCL-IgG was 12.2%, 12.8%, 8.8%, 3.9%, and 3.5% in patients with large-artery atherosclerotic disease, stroke of unknown etiology, small-artery occlusive disease, cardioembolism, and stroke of other known etiology, respectively. Only patients with large-artery atherosclerotic disease (p<0.025) and stroke of unknown etiology (p<0.05) had higher frequencies of increased aCL than those in control subjects. The frequencies of abnormal results of activated partial thromboplastin time, antinuclear factor, Coombs’ test, and venereal disease research laboratory were 2.84%, 1.22%, 1.02%, and 1.34% in these 41 patients, respectively. Accordingly, aCL-IgG selectively increases in patients with large-artery atherosclerosis and stroke of unknown etiology, reflecting selective activation of humoral immunity for aCL in the pathogenesis of cerebral ischemia.

[Risk factors for primary patency of occlusive femoral artery after subintimal angioplasty in diabetics]

OBJECTIVE

To retrospectively explore the status of primary patency after subintimal angioplasty (SIA) and identify the risk factors affecting for primary patency of occlusive lesions in femoral arteries after SIA in patients with diabeticses mellitus.

METHODS

From January 2009 to May 2011, 43 diabetics patients with 43 occlusive femoral arteries were successfully underwent subintimal angioplasty successfully with or without stenting.Recurrent stenosis was defined as an arterial diameter reduction of over 50%. And arterial occlusion was confirmed by an absence of color or power signal in the arterial lumen measured on color Doppler. The Kaplan-Meier method was employed to determine the primary patency. A multivariate analysis was performed with Cox's proportional hazard regression model to determine the independent factors for effects on primary patency.

RESULTS

A total of 17 morphologic abnormalities occurred during a median follow-up period of 21 (14-32) months. The median follow time of the successful 43 patients was 21 months (from 14 to 32 month). Minor complications occurred in 4 patents. There was no early mortality. A total of 17 morphologic abnormalities occurred during follow-up. The cumulative primary patency at 6, 12, 12 and 24 months were (86 ± 5)%, (75% ± 7)% and (43 ± 12)% respectively. Primary patency was affected negatively by the number of occlusive run-off vessels (B = -4.417, SX- = 1.627, P = 0.007) and the severity degree according to the Inter-society consensus for the management of peripheral arterial disease (TASC II) classification (B = -2.502, SX- = 0.955, P = 0.009), and positively by the a history of smoking (B = 3.115, SX- = 1.523, P = 0.041).

CONCLUSIONS

Subintimal angioplasty is a less invasive procedure with a lower rate of morbidity and adequate cceptable patency. And the number of occlusive run-off vessels, lesion typing degree of severity according to the TASC II classification negatively and smoking positively have significant influence effects on the primary patency in diabetics patients.

[Evaluation of Reekrossballoon catheter to treat long-segment occlusion of iliofemoral artery]

OBJECTIVE

The purpose of this study was to examine the safety and efficacy of the Reekross balloon catheter for recanalization of long CTO of iliofemoral arteries.

METHODS

A retrospective analysis of patients with long CTO of iliofemoral arteries who underwent angioplasty with Reekross balloon catheter between January 2011 and May 2013 was performed. All lesions were TASC II C and D. Sixty-eight patients(75 limbs) were enrolled with mean age of (69 ± 12) years, 53 male and 15 female. The limbs of Rutherford III, IV, V and VI were 41, 13, 19 and 2. Technical successrate, ankle brachial index (ABI), complication rate, and cumulative primary patency rate were evaluated.

RESULTS

Technical success ratewas 90.7%. ABI increased from pre-procedure (0.41 ± 0.12) to 3-day post-procedure (0.77 ± 0.20) (t = -7.263, P < 0.01). Follow-up was achieved in 56 cases (61 limbs) from 12 to 40 months, with a mean of (26.3 ± 7.1) months. Primary patency rates at 3 months, 6 months, 12 months and 24 months were (98.4 ± 1.6) %, (86.7 ± 4.4)%, (80.0 ± 5.2) % and ( 69.4 ± 6.3) %.

CONCLUSION

The Reekross balloon catheter is safe and effective for successful recanalization of CTO of iliofemoral artery.

Arterial thrombosis in four patients treated with thalidomide

Thalidomide has been associated with venous thrombotic events, as reported in the post-marketing surveillance reports by Celgene Corporation; as well as case reports in the literature. Seven arterial thrombotic events have been reported in patients receiving thalidomide with 3 cases occurring in patients with other predisposing conditions. We report 4 additional cases of arterial thromboses in 1 lymphoma and 3 myeloma patients treated with thalidomide. The mechanism for these events is unclear; however, it is significant that 2 patients were receiving concomitant anticoagulation with aspirin and warfarin.

[Compartment syndrome in the left lower leg following semiradical hysterectomy under general anesthesia combined with epidural anesthesia]

A 72-year-old woman, ASA physical status II, weighing 47 kg, with uterine cancer was scheduled for semiradical hysterectomy. She had uncontrolled diabetes mellitus with FBS 123 mg x dl(-1) and HbA1c 7.0%. After an epidural catheter had been placed at the L1-2 level, general anesthesia was induced with propofol 100 mg, fentanyl 50 microg and vecuronium 5 mg. The trachea was intubated, and ventilation was controlled. Anesthesia was maintained with 1.5% sevoflurane in 30% oxygen and epidural anesthesia. Systolic blood pressure was maintained between 80-120 mmHg throughout the operation and the total blood loss was 1260 g. Continuous epidural anesthesia was started 1 hour before the end of operation using 0.2% ropivacaine and 3.7 microg x ml(-1) fentanyl at 5 ml x hr(-1). She awoke in the operating room and her trachea was extubated. After awaking from anesthesia, she complained of weakness and numbness in the both lower extremities. We considered these as an influence of epidurally administered 5 ml of 0.5% ropivacaine 30 min before the end of surgery. However, 2 hours later, she complained of right lower leg pain. We removed the epidural catheter, considering the possibility of the epidural catheter tip stimulating nerve root. However, next morning, the frontal part of her right lower leg turned reddish and swollen, and the pain appeared with the pulse of dorsalis pedis artery hardly palpable. Taken together these symptoms and the elevation of creatine kinase to 20000 IU x l(-1), we diagnosed as a compartment syndrome. In the evening of the postoperative one day, emergent fasciotomy was performed under local anesthesia. She was discharged with full recovery of her right leg function, and a well healed fasciotomy scar. Magnetic resonance angiography (MRA) on the 10th postoperative day demonstrated the obstruction of the right superficial femoral artery and anterior tibial artery. Emergent fasciotomy is the recommended treatment for severe compartment syndrome. Early recognition, diagnosis, and surgical intervention averted potential neural and functional impairment in this patient.