The role of interventional radiology in the treatment of lower limb vascular injuries after orthopaedic surgery

Purpose: This paper focuses on the role of interventional radiology embolisations in a series of patients presenting with iatrogenic vascular injuries of the lower limbs following orthopaedic interventions. Material and methods: Fourteen patients (mean age: 64 years, range 23-90 years) were retrospectively analysed. Clinical presentation consisted of palpable pulsatile mass, pain, reduced lower limb motion, or visible haematoma; 11 patients had also anaemia (haemoglobin < 7 g/dl). Results: The time between orthopaedic surgery and embolisation ranged between 0 and 67 days (mean: 15 days). Injured arterial vessels were as follows: inferior gluteal artery (2), superficial external pudendal artery (2), deep femoral artery (1), lateral circumflex femoral artery (3), medial circumflex femoral artery (2), articular branch of descending genicular artery (1), perforating femoral arteries (3), posterior tibial recurrent artery (1), and anterior tibial artery (1). The typologies of vascular lesion were: pseudoaneurysm 57%, bleeding with extraluminal contrast agent blush of the terminal arterial segment 36%, and laceration and bleeding with extraluminal contrast agent blush of the arterial main trunk 7%. Embolising agents adopted were microcoils 57%, glue 14%, microplug 7%, particles 14%, and covered stent 7%. In all cases clinical and procedural technical successes were obtained (100%). Conclusions: For the management of vascular injuries occurring after different orthopaedic interventions of the lower limbs, endovascular embolisations have proven to be safe and effective; orthopaedic surgeons should be aware of the support that interventional radiology could provide in the case of iatrogenic vascular complications

Successful endovascular embolization of a giant splenic artery pseudoaneurysm secondary to a huge pancreatic pseudocyst with concomitant spleen invasion

Pseudoaneurysms of the pancreatic and peripancreatic arteries is a well-known complication of chronic or necrotizing pancreatitis due to proteolytic enzymatic digestion of the arterial wall. A major part of peripancreatic pseudoaneurysms involve the splenic artery, but any peripancreatic artery may be involved and bleed. They are potentially life threatening for patients, due to spontaneous intraperitoneal rupture, rupture and fistulization into the surrounding organs, or fistulization into the pancreatic duct. Small ones are usually asymptomatic and are often diagnosed incidentally, while giant (> 5 cm) aneurysms and pseudoaneurysms are symptomatic and may be detected as a pulsatile mass in the upper-left quadrant or epigastrium. Imaging plays a key role in the identification of splenic artery aneurysms and pseudoaneurysms, while angiography still represents the gold standard for the diagnosis, although nowadays it plays a prominent role in treatment. Treatment of splenic artery pseudoaneurysms is mandatory because of the high probability of rupture, with a mortality rate of up to 90%. The gold standard treatment is represented by surgery, with a mortality rate between 16% and 50%. In recent years the endovascular approach has proven to be an effective alternative treatment for splenic artery pseudoaneurysms, and it is currently the method of choice. In this article, we present the case of a ant pseudoaneurysm of the splenic artery due to huge pseudocysts in a young alcoholic patient with recurrent and chronic pancreatitis, complicated by fistulization and invasion of spleen parenchyma and arteriovenous fistula

A singular case of massive urethrorrhagia solved by transarterial embolization

Abstract Background Urethrorrhagia is frequent in pelvic trauma, rarely due to traumatic injuries of internal pudendal artery branches. Case presentation Our aim is to underline the role of transarterial embolization in selected patients, as in this case in which a young man manifested urethral hemorrhage after high-energy motorcycle crash not associated with injuries of the inferior urinary tract. Multi-detector computed tomography (MDCT) showed pubic symphysis diastasis and perineal hematoma with pseudoaneurysm into the penis bulb. The first approach was conservative with perineal external compression and intravenous injection of tranexamic acid. Afterward, due to the decline of clinical conditions, we decided to perform a selective angiography, confirming the vascular injury of distal branches of both internal pudendal arteries with contrast agent extravasation into urethral bulb; endovascular embolization was performed with detachable micro-coils. The principal results were seen quickly, indeed urethrorrhagia arrested and hemoglobin values normalized. Erectile function was preserved at 6-months follow-up. Conclusions Endovascular embolization proved to be a minimally invasive therapeutic approach, clinically effective, with a low rate of complications and high probability to preserve erectile function

Thermodynamic simulation of atmospheric DLI-CVD processes for the growth of chromium-based hard coatings using bis(benzene)chromium as molecular source

Direct liquid injection (DLI) is a new technology particularly convenient for feeding CVD reactors with low volatility molecular precursors. Thus DLI-CVD can operate under atmospheric pressure and is a promising process for industrial applications requiring high precursor flow rates such as continuous deposition. In order to help the experimenter, a thermodynamic approach is particularly suitable for determining the chemistry of the process, i.e. the influence of the main growth parameters such as temperature, total pressure and initial gas phase composition on the nature of the deposited phases. A choice of the most explicit representations of the thermodynamic modelling describing the great trends resulting from the variation of experimental parameters is presented. Thermodynamic calculations in the Cr–C–H, Cr–N–C–H and Cr–C–Cl–H chemical systems were made to predict the atmospheric CVD growth of carbides, nitrides andmetal chromium coatings, respectively. Bis(benzene)chromium (BBC) was used as metalorganic precursor and the calculations simulated respectively the reactive gas phase mixtures BBC/solvent, BBC/NH3/solvent and BBC/C6Cl6/solvent. Even if a satisfactory agreement was found between experimental and theoretical tendencies, the deposition of metastable phases reveals that kinetics can play amajor role in such processes. Based on these results, chromium carbides, nitrides and metal coatings have been successfully deposited by DLI-CVD under atmospheric pressure either as single phased or nanostructured multilayer hard coatings

Energy Hub Model for the Massive Adoption of Hydrogen in Power Systems

A&nbsp;promising&nbsp;energy&nbsp;carrier&nbsp;and&nbsp;storage&nbsp;solution&nbsp;for&nbsp;integrating&nbsp;renewable&nbsp;energies&nbsp;into&nbsp; the&nbsp;power&nbsp;grid&nbsp;currently&nbsp;being&nbsp;investigated&nbsp;is&nbsp;hydrogen&nbsp;produced&nbsp;via&nbsp;electrolysis.&nbsp;It&nbsp;already&nbsp;serves&nbsp; various&nbsp;purposes,&nbsp;but&nbsp;it&nbsp;might&nbsp;also&nbsp;enable&nbsp;the&nbsp;development&nbsp;of&nbsp;hydrogen-based&nbsp;electricity&nbsp;storage&nbsp; systems&nbsp;made&nbsp;up&nbsp;of&nbsp;electrolyzers,&nbsp;hydrogen&nbsp;storage&nbsp;systems,&nbsp;and&nbsp;generators&nbsp;(fuel&nbsp;cells&nbsp;or&nbsp;engines).&nbsp; The&nbsp;adoption&nbsp;of&nbsp;hydrogen-based&nbsp;technologies&nbsp;is&nbsp;strictly&nbsp;linked&nbsp;to&nbsp;the&nbsp;electrification&nbsp;of&nbsp;end&nbsp;uses&nbsp;and&nbsp; to&nbsp;multicarrier&nbsp;energy&nbsp;grids.&nbsp;This&nbsp;study&nbsp;introduces&nbsp;a&nbsp;generic&nbsp;method&nbsp;to&nbsp;integrate&nbsp;and&nbsp;optimize&nbsp;the&nbsp; sizing&nbsp;and&nbsp;operation&nbsp;phases&nbsp;of&nbsp;hydrogen-based&nbsp;power&nbsp;systems&nbsp;using&nbsp;an&nbsp;energy&nbsp;hub&nbsp;optimization&nbsp; model,&nbsp;which&nbsp;can&nbsp;manage&nbsp;and&nbsp;coordinate&nbsp;multiple&nbsp;energy&nbsp;carriers&nbsp;and&nbsp;equipment.&nbsp;Furthermore,&nbsp; the&nbsp;uncertainty&nbsp;related&nbsp;to&nbsp;renewables&nbsp;and&nbsp;final&nbsp;demands&nbsp;was&nbsp;carefully&nbsp;assessed.&nbsp;A&nbsp;case&nbsp;study&nbsp;on&nbsp;an&nbsp; urban&nbsp;microgrid&nbsp;with&nbsp;high&nbsp;hydrogen&nbsp;demand&nbsp;for&nbsp;mobility&nbsp;demonstrates&nbsp;the&nbsp;method’s&nbsp;applicability,&nbsp; showing&nbsp;how&nbsp;the&nbsp;multi-objective&nbsp;optimization&nbsp;of&nbsp;hydrogen-based&nbsp;power&nbsp;systems&nbsp;can&nbsp;reduce&nbsp;total&nbsp; costs,&nbsp;primary&nbsp;energy&nbsp;demand,&nbsp;and&nbsp;carbon&nbsp;equivalent&nbsp;emissions&nbsp;for&nbsp;both&nbsp;power&nbsp;grids&nbsp;and&nbsp;mobility&nbsp; down&nbsp;to&nbsp;−145%.&nbsp;Furthermore,&nbsp;the&nbsp;adoption&nbsp;of&nbsp;the&nbsp;uncertainty&nbsp;assessment&nbsp;can&nbsp;give&nbsp;additional&nbsp; benefits,&nbsp;allowing&nbsp;a&nbsp;downsizing&nbsp;of&nbsp;the&nbsp;equipment.&nbsp

Genetic differentiation of the Capparis spinosa group in the Mediterranean area

The Capparis spinosa group is represented in the Mediterranean by a complex of taxa widespread in North Africa, the Middle East, and southern Europe. The taxonomy of this group used to be based on morphological characters with little work on the genetics of the group, and there is still much to be learned about its evolutionary history and diversification. We sampled 431 individuals of two subspecies and five varieties of C. spinosa and analysed them using highly informative EST-SSR markers to evaluate the population genetic diversity, structure and differentiation of the species in the Mediterranean. In addition, comparisons with the genetic profiles of C. spinosa subsp. cartilaginea, the putative ancestral taxon were made to investigate the phylogeographic history and possible gene flow across taxa. Integrated Bayesian approaches showed: i) a high divergence among C. spinosa subsp. spinosa var. canescens, C. spinosa subsp. spinosa var. aegyptia and the three varieties belonging to C. spinosa subsp. rupestris (var. rupestris, var. ovata and var. myrtifolia), with a clear separation between var. aegyptia and var. canescens which allows to consider var. aegyptia as a subspecies of C. spinosa; ii) a significant correlation between genetic divergence and geographic distance between the five varieties studied; iii) that the different varieties in the Mediterranean may have been derived from C. spinosa subsp. cartilaginea. Further genomic investigations are required to confirm our results. However, the findings presented allows us to suggest the genus Capparis can be considered a model for the study of the gene flow and differentiation in species occurring in a wide range of habitats