Endovascular repair of infrarenal abdominal aortic aneurysm combined with aneurysmectomy and interposition bypass for left common femoral artery aneurysm.

Femoral artery aneurysms (FAAs) can occur in some patients with abdominal aortic aneurysms. There is a lack of natural history studies in the published literature. Guidelines recommend FAA repair when symptomatic or larger than 2.

Society for Vascular Surgery duplex ultrasound surveillance guidelines are safe and cost effective for transcarotid artery revascularization.

Background: Carotid duplex ultrasound (CDUS) examination is used in the long-term surveillance after transcarotid artery revascularization (TCAR). The objective of this study was to evaluate the usefulness and cost effectiveness of post-TCAR CDUS surveillance regimens in monitoring for in-stent restenosis (ISR) and associated stroke risk at a single-center community institution.

Methods: CDUS data were collected retrospectively from patients who had undergone TCAR between January 2017 and January 2023.

Symptomatic spontaneous superior mesenteric artery dissection treated with endovascular stent repair.

Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare condition in which patients develop an isolated dissection of the superior mesenteric artery without traumatic or iatrogenic causes. We present the case of a 52-year-old woman who presented with SISMAD and underwent endovascular stenting as her symptoms failed to respond to medical management. We also spend the bulk of the report discussing the current literature on management of SISMAD.

Duplex Ultrasound Surveillance after Transcarotid Artery Revascularization (TCAR) in Clinical Practice.

Background: To propose a protocol for the routine clinical use of duplex ultrasound (DUS) assessment after transcarotid artery revascularization (TCAR) procedures, with its specific point of vascular access, based on DUS data from routine clinical practice.

Methods: DUS data were retrospectively collected at 2 centers from a total of 97 patients who underwent a TCAR procedure with at least 30-day and up to 12-month follow-up. Peak systolic velocity (PSV), end diastolic velocity (EDV), and the internal carotid artery (ICA)/common carotid artery (CCA) PSV ratio were collected at baseline (≤30 days after the procedure) and compared with subsequent measurements.

Carotid body tumor as a potential cause of paroxysmal hemicrania.

A 70-year-old woman presented to our emergency department with a severe left-sided headache. The headache's location and accompanying symptoms are consistent with paroxysmal hemicrania. On workup, a cervical computed tomography scan incidentally revealed a left carotid body tumor, and the patient was referred to vascular surgery.

Uncertainty analysis of response functions and -backgrounds on T and t measurements from Cherenkov neutron detectors at the National Ignition Facility (NIF).

Cherenkov radiators deployed to measure the neutron time-of-flight spectrum have response times associated with the neutron transit across the detector and are free from long time response tails characteristic of scintillation detectors. The Cherenkov radiation results from simple physical processes which makes them amenable to high fidelity Monte Carlo simulation. The instrument response function of neutron time-of-flight systems is a major contributor to both the systematic and statistical uncertainties of the parameters used to describe these spectra; in particular, the first and second moments of these distributions are associated with arrival time, t, and ion temperature, T.

A fused silica Cherenkov radiator for high precision time-of-flight measurement of DT and neutron spectra (invited).

A fused silica Cherenkov radiator has been implemented at the National Ignition Facility to provide a new high precision measurement of the time-of-flight spectrum of 14.1 MeV DT fusion neutrons. This detector enables a high precision (<30 ps) co-registered measurement of both a thresholded -ray and a neutron spectrum on a single record.

response functions for Cherenkov-based neutron detectors.

Neutron time-of-flight diagnostics at the NIF were recently outfitted with Cherenkov detectors. A fused silica radiator delivers sub-nanosecond response time and is optically coupled to a microchannel plate photomultiplier tube with gain from ∼1 to 10. Capitalizing on fast time response and gamma-ray sensitivity, these systems can provide better than 30 ps precision for measuring first moments of neutron distributions.

Uncertainty analysis of signal deconvolution using a measured instrument response function.

A common analysis procedure minimizes the ln-likelihood that a set of experimental observables matches a parameterized model of the observation. The model includes a description of the underlying physical process as well as the instrument response function (IRF). In the case investigated here, the National Ignition Facility (NIF) neutron time-of-flight (nTOF) spectrometers, the IRF is constructed from measurements and models.

Delayed presentation and management of a common carotid pseudoaneurysm following penetrating trauma with a retrograde open carotid stent graft.

Traumatic injuries of the head and neck present a difficult diagnostic and therapeutic challenge when identified in a delayed manner. Pseudoaneurysm formation has been reported in the literature typically with regard to blunt mechanisms; however, a delayed presentation following penetrating injury is a rare finding, much less described. In this case report, we describe a pseudoaneurysm of the common carotid artery as a result of penetrating trauma to the thorax.

A single-shot, multiwavelength electro-optic data-acquisition system for inertial confinement fusion applications (invited).

Electro-optic data-acquisition systems encode the output from voltage-history diagnostics onto optical signals. The optical signals can propagate long distances over fiber-optic links without degrading the bandwidth of the encoded signal while protecting the recording electronics from overvoltage damage. The sinusoidal response and tolerance to high-input voltages of the Mach-Zehnder modulator used for the encoding leads to the additional advantage of a high dynamic range and a reduced need for manually swapping attenuators.

Mach-Zehnder recording systems for pulsed power diagnostics.

Fiber-optic transmission and recording systems, based on Mach-Zehnder modulators, have been developed and installed at the National Ignition Facility (NIF), and are being developed for other pulsed-power facilities such as the Z accelerator at Sandia, with different requirements. We present the design and performance characteristics for the mature analog links, based on the system developed for the Gamma Reaction History diagnostic at the OMEGA laser and at NIF. For a single detector channel, two Mach-Zehnders are used to provide high dynamic range at the full recording bandwidth with no gaps in the coverage.

Duplex ultrasound imaging to detect limb stenosis or kinking of endovascular device.

Objective: We attempted to correlate duplex ultrasound (DU) findings with the clinical outcome of graft limb stenosis or kinking after endovascular aneurysm repair (EVAR).

Methods: Between 1998 and 2010, 248 patients underwent EVAR and postoperative DU surveillance of 496 graft limbs in our accredited noninvasive vascular laboratory by one of three experienced technologists. Routine DU surveillance was performed 1 week, 6 months, and annually after EVAR.

Demonstration of ignition radiation temperatures in indirect-drive inertial confinement fusion hohlraums.

We demonstrate the hohlraum radiation temperature and symmetry required for ignition-scale inertial confinement fusion capsule implosions. Cryogenic gas-filled hohlraums with 2.2 mm-diameter capsules are heated with unprecedented laser energies of 1.

Duplex ultrasound factors predicting persistent type II endoleak and increasing AAA sac diameter after EVAR.

Objective: While the significance of type II endoleaks (T2ELs) on the long-term outcome of endovascular abdominal aneurysm repair (EVAR) to repair abdominal aortic aneurysms (AAAs) is debatable, duplex ultrasonography (DU) parameters have been suggested to be predictive of their closure or persistence. The purpose of this study was to determine which, if any, of these variables was associated with persistent T2EL or increased AAA sac diameter.

Methods: Between 1998 and 2009, 278 patients underwent EVAR and post-operative DU surveillance during long-term follow-up (1-11 years) in our accredited non-invasive vascular laboratory by one of three experienced technologists.

Duplex ultrasound imaging alone is sufficient for midterm endovascular aneurysm repair surveillance: a cost analysis study and prospective comparison with computed tomography scan.

Objective: Early in our experience with endovascular aortic aneurysm repair (EVAR) we performed both serial computed tomography scans and duplex ultrasound (DU) imaging in our post-EVAR surveillance regimen. Later we conducted a prospective study with DU imaging as the sole surveillance study and determined cost savings and outcome using this strategy.

Methods: From September 21, 1998, to May 30, 2008, 250 patients underwent EVAR at our hospital.

Relative adrenal insufficiency among trauma patients in a community hospital.

Background: The integrity of the hypothalamic-pituitary-adrenal (HPA) axis is a major determinant of the host response to stress. Recent studies have proven that low doses of hydrocortisone and fludrocortisone can significantly reduce mortality in patients with relative adrenal insufficiency (RAI) without increasing adverse events.

Study Design: This study was a retrospective chart review of patients in a community hospital who carried the diagnosis of both adrenal insufficiency and trauma.

Los Angeles airport noise and mortality--faulty analysis and public policy.

A well-publicized investigation in Los Angeles showed a higher mortality rate in 1970-1971 among residents in a high-noise area near Los Angeles International Airport than in a low-noise control area. The authors of this report attributed the difference to the effects of jet aircraft noise. A reanalysis of the data did not confirm the original results.