Intentional coverage of the left subclavian artery during endovascular repair of traumatic descending thoracic aortic transection

ObjectiveThis single-center, prospective study aimed to investigate the technical success and outcome of intentional coverage of the left subclavian artery (LSA) in patients undergoing thoracic endovascular aortic repair (TEVAR) for traumatic rupture of the aortic isthmus at a tertiary care medical center.MethodsFrom January 2005 to June 2011, patients who presented with traumatic aortic transection underwent TEVAR with coverage of the LSA when the distance between the artery and the rupture was <2 cm. At 12, 24, and 72 hours postoperatively, clinical and neurologic evaluation including transcranial Doppler insonation of the brachial artery was performed. A decrease in peak systolic velocity (PSV) >60% with respect to the contralateral one was considered relevant. Functional status of the left arm was evaluated using a provocative test. Thoracoabdominal computerized tomographic angiography was performed postoperatively at 3-, 6-, and 12-month follow-up.ResultsThirty-one patients (mean age 35 years) underwent emergency TEVAR for traumatic aortic transection with intentional LSA coverage during the study period. In four cases (12.9%) coverage was partial. Two patients (6.4%) died during the postoperative period due to associated lesions. No signs of vertebrobasilar insufficiency, stroke, or paraplegia were observed in any of the patients. Nine patients (36%) had severe arm claudication (ischemic pain within 60 seconds of beginning arm exercise and decrease of PSV between 50% and 60%). Risk factors for the condition were left vertebral artery diameter <3 mm (P < .0001). A significant correlation was found between the degree of PSV reduction and left arm symptoms (P < .0001). There was an improvement in ischemic arm symptoms (P < .0001) during mean follow-up of 36 months (range, 6-65 months), with only one patient (4.2%) presenting with severe claudication. Freedom from reintervention at 48 months was 93.5%. No signs of endoleaks or graft migrations were detected on computerized tomographic angiography control scans.ConclusionsCoverage of the LSA during TEVAR for traumatic aortic injuries appears to be a feasible, safe method for extending the endograft landing zone without increasing the risk of paraplegia, stroke, or left arm ischemia. Left vertebral artery diameter can be used to identify patients at risk for postoperative left arm ischemia

Elderly patient: which vascular access? Choice and management of vascular access in the elderly patient:

The optimal vascular access for elderly patients remains a challenge due to the difficult balance between risks and benefits in a population with increased comorbidity and decreased survival. Long dependence to central vein catheter, patient comorbidities, life expectancy, and complication rates are important influencing the indications for arteriovenous fistula or an arteriovenous graft. Although central vein catheters are simpler way to start a hemodialysis treatment, elderly patients are also at higher risk of death from infection or other complications associated with them more than for younger patients. The discussion revolves around the following key questions: What are the limiting factors for a vascular access in the elderly patients? Central venous catheter—is it still an option for elderly patients? Is still the autologous arteriovenous fistula playing a pivotal role as hemodialysis access in the elderly patients? Are there any real surgical contraindication to perform a vascular access in elderly patients? Is the old age a limiting factor for the vascular access management

Exploring the mass and redshift dependence of the cluster pressure profile with stacks on thermal SZ maps

We provide novel constraints on the parameters defining the universal pressure profile (UPP) within clusters of galaxies, and explore their dependence on the cluster mass and redshift, from measurements of Sunyaev-Zel'dovich Compton-$y$ profiles. We employ both the $\textit{Planck}$ 2015 MILCA and the ACT-DR4 $y$ maps over the common $\sim 2,100\,\text{deg}^2$ footprint. We combine existing cluster catalogs based on KiDS, SDSS and DESI observations, for a total of 23,820 clusters spanning the mass range $10^{14.0}\,\text{M}_{\odot}<M_{500}<10^{15.1}\,\text{M}_{\odot}$ and the redshift range $0.02<z<0.98$. We split the clusters into three independent bins in mass and redshift; for each combination we detect the stacked SZ cluster signal and extract the mean $y$ angular profile. The latter is predicted theoretically adopting a halo model framework, and MCMCs are employed to estimate the UPP parameters, the hydrostatic mass bias $b_{\rm h}$ and possible cluster miscentering effects. We constrain $[P_0,c_{500},\alpha,\beta]$ to $[5.9,2.0,1.8,4.9]$ with $\textit{Planck}$ and to $[3.8,1.3,1.0,4.4]$ with ACT using the full cluster sample, in agreement with previous findings. We do not find any compelling evidence for a residual mass or redshift dependence, thus expanding the validity of the cluster pressure profile over much larger $M_{500}$ and $z$ ranges; this is the first time the model has been tested on such a large (complete and representative) cluster sample. Finally, we obtain loose constraints on the hydrostatic mass bias in the range 0.2-0.3, again in broad agreement with previous works.Comment: 39 pages, 22 figures. Accepted for publication in Apj

Vascular Complications Caused by Tibial Osteochondroma: Focus on the Literature and Presentation of a Popliteal Artery Thrombosis with Acute Lower Limb Ischemia

Osteochondromas are common benign bone tumors, frequently found in adolescents or young adults. Most often asymptomatic and discovered by accidental findings, they may be diagnosed because of compression or dislocation. Vascular complications are an atypical presentation of osteochondromas, and include vessel perforation and thrombosis, arterial thromboembolic events and pseudoaneurysm formation. Popliteal artery thrombosis and acute lower limb ischemia caused by a tibial osteochondroma are rarely observed. Starting from a case of temporary lower extremity ischaemia caused by thrombosis of the subarticular popliteal artery due to an osteochondroma of the proximal tibial protruding in popliteal fossa, we focused a literature analysis on diagnostic and management aspects. A combined vascular-orthopedic approach was performed with intra-arterial locoregional thrombolytic therapy and then a surgical tangential resection of the tibial osteochondroma. The adequate approach for these patients includes clinical evaluation, plain radiographs, CT scan and MRI. The purpose of the present review article is to underline the importance of a combined vascular-orthopedic approach to correct diagnosis and prompt surgical management of vascular complications caused by tibial osteochondromas

Preliminary experience with new generation balloon expandable stent-graft in the treatment of innominate artery obstructive disease

To describe a single center preliminary experience with the use of a specific balloon expandable stent-graft for the treatment of innominate artery (IA) obstructive lesions

Transapical Deployment of Thoracic Stent Graft for Ascending Aorta Coronary Bypass Pseudoaneurysm in a Patient with Prosthetic Aortic Valve

The authors describe the transapical deployment of a thoracic endograft to exclude a saphenous vein graft proximal anastomotic pseudoaneurysm following coronary artery bypass grafting (CABG) in a 63-year-old male with a prosthetic aortic valve. A standard thoracic endograft has been deployed via transapical access after percutaneous transluminal coronary angioplasty of the native vessel perfused by the patent CABG. The procedure was uneventful; an 8-month computed tomography scan showed complete exclusion of the pseudoaneurysm with patency of supra-aortic trunks