Quantitative hemodynamic assessment of stenotic below-the-knee arteries using spatio-temporal bolus tracking on 4D-CT angiography.

Background: Peripheral arterial disease (PAD) is a chronic occlusive disease that restricts blood flow in the lower limbs, causing partial or complete blockages of the blood flow. While digital subtraction angiography (DSA) has traditionally been the preferred method for assessing blood flow in the lower limbs, advancements in wide beam Computed Tomography (CT), allowing successive acquisition at high frame rate, might enable hemodynamic measurements.

Purpose: To quantify the arterial blood flow in stenotic below-the-knee (BTK) arteries.

Combined evaluation of blood flow and tissue perfusion in diabetic feet by intra-arterial dynamic 4DCT imaging.

Critical limb ischemia is associated with high mortality and major amputations. Intra-arterial digital subtraction angiography (IADSA) has been the reference standard but has some shortcomings including the two-dimensional projection and the lack of tissue perfusion information. The aim of this exploratory study is to examine four-dimensional computed tomography (4DCT) angiography and perfusion imaging using low-volume intra-arterial contrast injections for an improved anatomic and hemodynamic assessment in patients with foot ulcers.

Stentgraft Limb Occlusion After Endovascular Aneurysm Repair: Incidence and Risk Factors.

Introduction: Stentgraft limb occlusion (SLO) is a potential complication of endovascular aneurysm repair (EVAR). The purposes of this single centre study are to report the incidence of SLO after EVAR and to detect possible risk factors.

Methods: All patients who underwent EVAR between June 2001 and February 2020 were included in this retrospective study.

Use of Intravascular Lithotripsy in Heavily Calcified Renal Artery Stenosis: A Case Report.

Heavily calcified arterial lesions are difficult to treat in an endovascular manner with conventional techniques due to limited arterial compliance. Intravascular lithotripsy offers a novel minimally invasive therapeutic option through endovascular emission of acoustic waves, fracturing calcium deposits and facilitating lesion dilation. We present the case of a successful application of the Shockwave intravascular lithotripsy system (IVL®, Shockwave Medical Inc) in a heavily calcified stenosis of the right renal artery in a patient with a coral reef aorta.

Results of carotid artery stenting. Lessons learned in a Belgian 'real world' practice.

Objective/background: Carotid artery stenting (CAS) is a valuable solution for the treatment of carotid artery stenosis in a high-risk patient population for carotid endarterectomy (CEA). In literature however, there are concerns about the death and stroke rates of CAS in the 'real world' practice. Since Belgium is a small country with a broad offer of medical care, and there is no reimbursement for CAS, only small numbers of patients can be treated per vascular department.

Assessing Diabetic Foot Infections With the ThermoScale: A Comparative Thermometry Device Designed as a Patient Self-Screening Tool.

Diabetic foot infection (DFI) is an important risk factor for amputation, and late diagnosis or referral is often incriminated for poor outcome. To enable an earlier diagnosis of DFI, comparative foot thermometry has been suggested as a self-screening method for patients in a home setting. We validated the efficacy of the ThermoScale, a weighing scale outfitted with temperature sensors that allows accurate temperature measurement in both feet.

Multiple Simple Renal Cysts and Sequential, Rapid Progressive, Aneurysmatic Aortoiliac and Femoral Artery Disease: Case Report and Review of the Literature.

Multiple simple renal cysts have been linked to aortic aneurysm and connective tissue disease by different authors. We present a case of a 64-year-old male patient with multilevel, rapid progressive aneurysmatic disease. Over a period of 11 years, he sequentially developed a symptomatic infrarenal aortic aneurysm of 100 mm, a juxtarenal progression of the aneurysm up to 61 mm, an aneurysm on the descending thoracic aorta of 73 mm, and a common iliac aneurysm of 53 mm.

Improving the diagnosis of peripheral arterial disease in below-the-knee arteries by adding time-resolved CT scan series to conventional run-off CT angiography. First experience with a 256-slice CT scanner.

Purpose: Run-off Computed Tomography Angiography (run-off CTA) of the lower extremities has become the method of choice for the diagnostic imaging of patients suffering from peripheral arterial disease (PAD). However, it remains a challenging radiological examination with a considerable risk of non-diagnostic image quality for the assessment of below-the-knee arteries. In this study, we investigate the diagnostic benefit of adding time-resolved CT scan series to the standard run-off CTA by performing repeated axial acquisitions over the calves of the patient during a second bolus of iodinated contrast injection.

Efficacy of urokinase lock to treat thrombotic dysfunction of tunneled hemodialysis catheters: A retrospective cohort study.

Background:: There are few data to inform decisions about the optimal management of occluded tunneled cuffed hemodialysis catheters with thrombolytic locking solutions. The effect of dose, dwell-time, and number of administrations remains controversial.

Methods:: In this retrospective single-center review of tunneled cuffed catheters used between 2010 and 2014, restoration of blood flow as well as pre- and post-pump pressures after either short (30 min) or prolonged (48-72 h) administration of 100,000 IU of urokinase locking solution was evaluated in all thrombotic dysfunctions.

Paclitaxel-coated versus plain old balloon angioplasty for the treatment of infrainguinal arterial disease in diabetic patients: the Belgian diabetic IN.PACT Trial.

Background: Several trials have shown that drug coated balloon (DCB) angioplasty reduce the rates of restenosis in the femoropopliteal artery. This controlled, prospective, multicenter study was designed to demonstrate the efficacy of DCB to inhibit restenosis of the infrainguinal arteries in an exclusive diabetic population.

Methods: Between 2012 and 2014, 106 diabetic patients with symptomatic peripheral arterial disease (PAD) were enrolled at 11 sites in Belgium, 54 treated with DCB angioplasty and 52 treated with plain old balloon angioplasty (POBA).

Gastrocnemius fascia release under local anaesthesia as a treatment for neuropathic foot ulcers in diabetic patients: a short series.

Background: Diabetic foot ulceration is the leading cause of major amputation in the developed world. Plantar neuropathic ulcers at the forefoot can be managed conservatively with off-loading, but treatment is not invariably successful. Achilles tendon lengthening procedures aim at increasing dorsiflexion and decreasing forefoot pressure but can be associated with complications and require prolonged postoperative immobilization to prevent tendon rupture.

Fighting human error : what surgeons can learn from aviators.

Background: The rigorous implementation of safety policies have made air travel one of the safest modes of transport. Health institutions and hospital managing bodies increasingly adopt cues from aviation safety protocols and policies in an attempt to reduce medical errors and patient harm. Among hospital staff, surgeons are most likely to be confronted with these aviation-derived safety concepts.

Gas gangrene in the diabetic foot: lessons learned from a salvaged limb.

A 55 year old man was seen in the emergency department with an infected right foot and sepsis. Examination of the right foot revealed subcutaneous crepitus from the metatarsal head up to the tarsus; interstitial and intramedullary gas was confirmed on x-rays and computed tomographic scans. During 44 days of hospitalization, the patient was treated with multiple courses of antibiotic therapy, various wound care modalities (including negative wound pressure therapy) and several surgical interventions (debridements, amputations, revascularizations and reconstructive plastic surgery).

Stenting complex aorta aneurysms with the Cardiatis multilayer flow modulator: first impressions.

Objectives: Our aim was to assess the feasibility and efficacy of the Cardiatis multilayer flow modulator in the treatment of complex aorta aneurysms.

Methods: This is a single-center prospective registry. Six patients (4 males and 2 females; mean age 74 years) with complex aorta aneurysms (unsuitable for endovascular repair with standard, fenestrated, or branched stent grafts) were treated with the Cardiatis multilayer flow modulator.

Wound morphology and topography in the diabetic foot: hurdles in implementing angiosome-guided revascularization.

Purpose. Angiosome-guided revascularization is an approach that improves wound healing but requires a surgeon to determine which angiosomes are ischemic. This process can be more difficult than anticipated because diabetic foot (DF) wounds vary greatly in quantity, morphology, and topography.

Discharge on the first postoperative day after elective carotid endarterectomy.

Background: Medical complications may prolong the hospital stay after elective carotid endarterectomy (CEA). We prospectively assessed the social and medical feasibility and safety of patient discharge on the first postoperative day after elective CEA and unplanned readmissions.

Methods: Between June 2011 and January 2012, 57 consecutive patients scheduled for elective CEA were enrolled with the aim of discharge on the first postoperative day if there were no medical contraindications and on the condition that the patient should not be left alone during the first day and night at home.

Skin grafting the contaminated wound bed: reassessing the role of the preoperative swab.

Objective: To investigate use of the preoperative wound swab to predict graft failure compared with establishing the indication for skin grafting on clinical grounds alone.

Method: Patients requiring meshed split-thickness skin grafting were prospectively included; the indication for grafting was established on clinical grounds exclusively. A preoperative swab of the wound bed was taken, but its result was concealed to prevent it influencing clinical decision-making.

Intraluminal crossing of near-impenetrable occlusions by balloon-assisted battering ram technique.

Purpose: Subintimal crossing of total occlusions and acquiring reentry into the true lumen may be hazardous in highly calcified lesions, with or without the use of expensive reentry devices. Even when desirable, intraluminal crossing may not be feasible, because the guidewire tends to follow a path of least resistance between the intimal plaque and the adventitia.

Technique: A standard percutaneous transluminal angioplasty balloon is positioned just above the proximal cap of the occlusion and insufflated to 6 atmosphere.

Treatment of lymphocutaneous fistulas after vascular procedures of the lower limb: accurate wound reclosure and 3 weeks of consistent and continuing drainage.

Background: Lymphocutaneous fistulas occurring after vascular procedures of the lower limb are a rare, but frustrating, complication. Many treatment options exist, but may lead to inconsistent results, with infection, delayed wound healing, and prolonged hospital stay. We present a simple surgical treatment of wound closure and drainage.

Primary closure with a filleted hallux flap after transmetatarsal amputation of the big toe for osteomyelitis in the diabetic foot: a short series of four cases.

In the diabetic foot, osteomyelitis of the first metatarsal head adjacent to a malum perforans may require resection of the metatarsophalangeal joint. This results in a dysfunctional great toe and large tissue defects that take a long time to heal. The authors postulated that transmetatarsal amputation followed by primary closure with a filleted hallux flap would be feasible in selected cases.

The surgical history of the amputated limb according to the indication for revascularization: diabetic foot, acute ischaemia, aneurysmal disease, chronic arterial occlusive disease.

Background: To investigate whether the indication for the first revascularization (diabetic foot, acute ischaemia, aneurysmal disease, chronic occlusive disease) determines the surgical history and survival time in amputated limbs.

Methods: The surgical history of lower extremities amputated between 2002 and 2009 was reviewed for the number of (endo)vascular procedures, minor amputations, wound debridements, complications requiring surgery (acute ischaemia, bleeding, graft infection) and limb survival time (LST).

Results: 100 limbs were included in the study.

Establishing the learning curve for a tunneled dialysis catheter placement.

Purpose: To determine how many procedures a surgical trainee requires before they are able to place a tunneled double-lumen dialysis catheter safely on their own.

Methods: Surgical trainees unfamiliar with the procedure received a pre-operative briefing in which we explained 1) why, how, and in what particular order each operational step should be executed and 2) what the possible pitfalls/complications are. Next, an experienced surgeon demonstrated the procedure with the trainee scrubbed-in as their assistant.

The ankle--brachial index and the diabetic foot: a troublesome marriage.

Background: The ankle--brachial index (ABI) is a simple, noninvasive, widely used test that detects peripheral arterial disease (PAD). In patients with diabetes, the ABI is notoriously unreliable and this is usually attributed to medial calcinosis, which stiffens the arteries and renders them poorly compressible. However, the distribution of atherosclerotic lesions in those with diabetes is different as well: lesions predominantly reside in below-the-knee (BTK) arteries.

Diabetes mellitus is a predictor for early adverse outcome after carotid endarterectomy.

Purpose: The aim of the study was to compare the outcome after carotid endarterectomy (CEA) in patients with and without diabetes mellitus.

Methods: We prospectively recorded the data from patients who underwent CEA. A patient was considered diabetic when he reported the use of antidiabetic medication.