An In-Vitro Comparison of Steady State Leakage Rates through Introducer Sheaths Used for Fenestrated Endovascular Aortic Aneurysm Repair.

Background: Fenestrated Endovascular Aneurysm Repair (fEVAR) involves deploying a covered stent into the aorta followed by multiple visceral stents through fenestrations in the main body of graft. The most commonly used large sheaths for cannulation of visceral vessels are the Gore DrySeal Flex, Cook Performer Check-Flo, and Medtronic Sentrant. None of these sheaths were designed for the insertion of multiple sheaths, and so a slow but steady leakage of blood occurs during the procedure.

Novel Glycomimetics Protect against Glycated Low-Density Lipoprotein-Induced Vascular Calcification In Vitro via Attenuation of the RAGE/ERK/CREB Pathway.

Heparan sulphate (HS) can act as a co-receptor on the cell surface and alterations in this process underpin many pathological conditions. We have previously described the usefulness of mimics of HS (glycomimetics) in protection against β-glycerophosphate-induced vascular calcification and in the restoration of the functional capacity of diabetic endothelial colony-forming cells in vitro. This study aims to investigate whether our novel glycomimetic compounds can attenuate glycated low-density lipoprotein (g-LDL)-induced calcification by inhibiting RAGE signalling within the context of critical limb ischemia (CLI).

Staphylococcus aureus surgical site infection rates in 5 European countries.

Objective: To determine the overall and procedure-specific incidence of surgical site infections (SSI) caused by Staphylococcus aureus (S. aureus) as well as risk factors for such across all surgical disciplines in Europe.

Methods: This is a retrospective cohort of patients with surgical procedures performed at 14 European centres in 2016, with a nested case-control analysis.

Personalised nitinol stent for focal plaques: Design and evaluation.

Unlabelled: The purpose of this study is to develop personalised nitinol stents for arteries with one and two opposite focal plaques. Novel designs are evaluated through comparison with a commercial stent design, in terms of lumen gain and shape as well as stress levels in the media layer after stenting.

Methods: Personalised stents are developed for arteries with one and two opposite focal plaques, based on medical imaging of patients and computer simulations.

Numerical simulations of patient-specific models with multiple plaques in human peripheral artery: a fluid-structure interaction analysis.

Atherosclerotic plaque in the femoral is the leading cause of peripheral artery disease (PAD), the worse consequence of which may lead to ulceration and gangrene of the feet. Numerical studies on fluid-structure interactions (FSI) of atherosclerotic femoral arteries enable quantitative analysis of biomechanical features in arteries. This study aims to investigate the hemodynamic performance and its interaction with femoral arterial wall based on the patient-specific model with multiple plaques (calcified and lipid plaques).

Loss of SIRT1 in diabetes accelerates DNA damage-induced vascular calcification.

Aims: Vascular calcification is a recognized predictor of cardiovascular risk in the diabetic patient, with DNA damage and accelerated senescence linked to oxidative stress-associated pathological calcification. Having previously shown that systemic SIRT1 is reduced in diabetes, the aim was to establish whether SIRT1 is protective against a DNA damage-induced senescent and calcified phenotype in diabetic vascular smooth muscle cells (vSMCs).

Methods And Results: Immunohistochemistry revealed decreased SIRT1 and increased DNA damage marker expression in diabetic calcified arteries compared to non-diabetic and non-calcified controls, strengthened by findings that vSMCs isolated from diabetic patients show elevated DNA damage and senescence, assessed by the Comet assay and telomere length.

A Literature Review and Case Series of DVT Patients with Absent IVC Treated with Thrombolysis.

Background: Congenital absence of the inferior vena cava is related to deep venous thrombosis (DVT) in 5% of cases with no other risk factors. DVT is normally diagnosed by Duplex, whereas computerized tomography or magnetic resonance imaging is required to visualize this absence, and so, it is often missed but ought to be considered in young patients. There are many existing cases in the literature illustrating this link, but these patients were often managed conservatively with anticoagulation.

Generation of Human-Induced Pluripotent Stem Cells From Anterior Cruciate Ligament.

Human-induced pluripotent stem cells (hiPSCs) are reprogrammed somatic cells and are an excellent cell source for tissue engineering applications, disease modeling, and for understanding human development. HiPSC lines have now been generated from a diverse range of somatic cell types and have been reported to retain an epigenetic memory of their somatic origin. To date, the reprogramming of a true ligament has not been reported.

Stratification of knee osteoarthritis: two major patient subgroups identified by genome-wide expression analysis of articular cartilage.

Introduction: Osteoarthritis (OA) is a heterogeneous and complex disease. We have used a network biology approach based on genome-wide analysis of gene expression in OA knee cartilage to seek evidence for pathogenic mechanisms that may distinguish different patient subgroups.

Methods: Results from RNA-Sequencing (RNA-Seq) were collected from intact knee cartilage at total knee replacement from 44 patients with OA, from 16 additional patients with OA and 10 control patients with non-OA.

Giant Hepatic Aneurysm Presenting With Hematemesis Successfully Treated With an Endovascular Technique.

Hepatic artery aneurysms are uncommon visceral aneurysms that are usually found incidentally on imaging. We present a case of large common hepatic aneurysm presenting with life-threatening hematemesis due to duodenal erosion, in a 66-year-old man, treated by embolization with Onyx and coils while preserving hepatic perfusion.

Elevated levels of endothelial-derived microparticles, and serum CXCL9 and SCGF-β are associated with unstable asymptomatic carotid plaques.

Endothelial microparticles (EMPs) are released from dysfunctional endothelial cells. We hypothesised that patients with unstable carotid plaque have higher levels of circulating microparticles compared to patients with stable plaques, and may correlate with serum markers of plaque instability and inflammation. Circulating EMPs, platelet MPs (PMPs) and inflammatory markers were measured in healthy controls and patients undergoing carotid endarterectomy.

Popliteal artery pseudoaneurysm treated with covered stent placement and thrombolysis: a case report.

Pseudoaneurysms of the popliteal artery are a rare clinical entity, accounting for <4% of all popliteal aneurysms. Accurate diagnosis and effective intervention is required to prevent potentially limb-threatening complications. We present the case of a 37-year-old man with acute limb ischaemia due to distal calf vessel thrombosis secondary to a popliteal pseudoaneurysm that was managed with covered stent placement and thrombolysis.

Novel methods for accurate identification, isolation, and genomic analysis of symptomatic microenvironments in atherosclerotic arteries.

A challenge facing surgeons is identification and selection of patients for carotid endarterectomy or coronary artery bypass/surgical intervention. While some patients with atherosclerosis develop unstable plaques liable to undergo thrombosis, others form more stable plaques and are asymptomatic. Identification of the cellular signaling mechanisms associated with production of the inflammatory, hemorrhagic lesions of mature heterogenic plaques will help significantly in our understanding of the differences in microenvironment associated with development of regions susceptible to rupture and thrombosis and may help to predict the risk of plaque rupture and guide surgical intervention to patients who will most benefit.

Treatment of aortoiliac aneurysms with the iliac bifurcated device for preservation of internal iliac artery flow.

Introduction: The iliac bifurcated device (IBD) is an innovative endovascular device for aortoiliac aneurysm repair. The objective of this study is to provide further evidence on the efficacy and safety of the device.

Study Design: Case series study with retrospective analysis of prospectively collected nonrandomized data.

Endovascular aortic repair with the chimney technique using the ultra low-profile Ovation stent-graft for juxtarenal aneurysms having small iliac access vessels.

Purpose: To report the first experience using the chimney technique in combination with the latest-generation low-profile stent-graft to seal abdominal aortic aneurysms having a very short neck (proximal sealing zone) and difficult access due to very small iliac vessels.

Materials And Methods: Use of an ultra low-profile 14F delivery aortic stent-graft system (Ovation; Trivascular, Santa Rosa, CA) with chimneys to the lowermost renal arteries in two patients who were not anatomically suitable for endovascular aortic aneurysm repair (EVAR) and too frail for open surgery.

Results: Implantation of stent-grafts and chimneys was technically successful without endoleak or other postinterventional complications.

Endovascular repair of aortic arch false aneurysm with branched endograft.

This case report describes the use of a customized branched device for the treatment of a distal anastomotic false aneurysm in an ascending to descending interposition graft in a 34-year-old Jehovah's Witness with congenital aortic arch interruption. A single branched customized stent graft device was used to successfully exclude the false aneurysm. The procedure was challenging due to the abnormal congenital anatomy.

Meta-analysis of outcomes of endovascular treatment of infrapopliteal occlusive disease with drug-eluting stents.

Purpose: To review emerging evidence regarding the use of bare metal (BMS) vs. drug-eluting stents (DES) in the treatment of infrapopliteal occlusive disease.

Methods: A systematic review of the literature was undertaken to identify all studies comparing stent treatments of infragenicular vessels in patients with chronic lower limb ischemia.

The chimney technique in endovascular aortic aneurysm repair: late ruptures after successful single renal chimney stent grafts.

Background: The chimney graft technique has been proposed as an alternative endovascular treatment of juxtarenal aortic aneurysms, extending the landing zone and enabling successful exclusion of the aneurysm with standard endograft devices.

Methods: A prospective observational study assigning patients with juxtarenal aortic aneurysm treated with single renal chimney grafts in a tertiary vascular center in the United Kingdom was conducted. Primary outcome endpoints were defined as technical success, perioperative morbidity and mortality, and freedom from any type of endoleak, reintervention, and aneurysm-related death.

Contralateral occlusion of the internal carotid artery increases the risk of patients undergoing carotid endarterectomy.

Background: Controversy exists about whether occlusion of the contralateral internal carotid artery in patients undergoing carotid endarterectomy (CEA) is associated with a worse perioperative prognosis and outcome.

Methods: A systematic review of electronic information sources was undertaken to identify studies comparing perioperative and early outcomes of CEA in patients with occluded and patent contralateral carotid arteries. The methodologic quality of selected studies was independently appraised by two reviewers.

Outcomes of endovascular aneurysm repair with 2 different endograft systems with suprarenal fixation in patients with hostile infrarenal aortic anatomy.

Objective: To evaluate 2 different aortic endograft systems with suprarenal fixation in patients with unfavorable neck morphology.

Methods: A prospective observational study assigning patients with abdominal aortic aneurysm with unfriendly neck anatomy treated with 2 different endograft systems (Endurant and Zenith) was conducted. The log-rank test was applied to investigate the differences in cumulative outcome parameters.

A meta-analysis of endovascular versus surgical reconstruction of femoropopliteal arterial disease.

Background: Controversy exists as to the relative merits of surgical and endovascular treatment of femoropoliteal arterial disease.

Methods: A systematic review of the literature was undertaken to identify studies comparing open surgical and percutaneous transluminal methods for the treatment of femoropopliteal arterial disease. Outcome data were pooled and combined overall effect sizes were calculated using fixed or random effects models.

Chimney technique in the endovascular management of complex aortic disease.

The objective of this study was to systematically review the literature reporting on the chimney technique and perform an analysis of the outcomes. A search of electronic databases was undertaken to identify all studies reporting on the outcome of the chimney technique. The selected articles were divided into those reporting on the treatment of aortic pathology involving the visceral and those involving the supra-aortic branches.