Acute presentation of Chiari malformation type I in adulthood with arm swelling, a case report and literature review.

Introduction: Chiari malformation type I (CM-I) with cervicothoracic syringomyelia can progress slowly this condition which is very common in clinical practice, particularly in children.

Case Presentation: Patients typically present with chronic complaints, including headache, dizziness, and numbness, although are few reports in the literature describing pediatric patients who developed acute neurological deficits caused by CM-I. Here, we report an unusual presentation of this condition; the patient presented with sudden onset arm swelling with no precipitating factors that could explain the diagnosis.

Predictors of recurrence after paclitaxel drug-coated balloon use for treating femoropopliteal in-stent restenosis.

Objective: Paclitaxel drug-coated balloon (PDCB) angioplasty has been shown to be an effective treatment of in-stent restenosis (ISR) at the femoropopliteal (FP) arteries. Long-term studies, however, have shown a progressive decrease in the patency rates following PDCB. The aim of this study was to determine the predictors of stenosis recurrence after PDCB treatment of FP-ISR, and its immediate and mid-term outcomes.

Duplex-Guided Ipsilateral Antegrade Approach for Flush Superficial Femoral Artery Occlusion.

Objective: Recanalization of flush ostial superficial femoral artery (SFA) occlusion is a very challenging procedure. Using the ipsilateral antegrade approach in such lesions has some difficulties. This study aimed to assess the feasibility, efficacy, and outcomes of duplex-guided ipsilateral antegrade access for endovascular treatment of atherosclerotic flush occlusion of the SFA.

The Relationship Between the Global Limb Anatomic Staging System (GLASS) and Midterm Outcomes of Retrograde Tibiopedal Access After Failure of Antegrade Recanalisation for Chronic Limb Threatening Ischaemia.

Objective: To examine the relationship between the Global Limb Anatomic Staging System (GLASS) and midterm limb and survival related outcomes of retrograde tibiopedal access, after failed recanalisation of infrainguinal chronic total occlusions (CTOs) using the antegrade approach, in patients with chronic limb threatening ischaemia (CLTI).

Methods: This prospective, observational study was conducted between January 2017 and April 2019, and included 213 patients (29 GLASS I, 53 GLASS II, and 131 GLASS III lesions) with infrainguinal CTO in whom a percutaneous tibiopedal access was attempted following failed recanalisation using an antegrade approach. Multivariable Cox proportional hazard regression was performed to assess possible predictors of midterm clinical outcomes.

Unusual presentation of a giant thoracic spinal cord lipoma.

Introduction: Non-dysraphic intradural spinal cord lipomas are rare, and true intramedullary cervical-thoracic lipomas are extremely rare. Spinal lipomas usually present with chronic, progressive myelopathic features. Unlike dysraphic lipomas, which are usually located in the lumbo-sacral region, non-dysraphic lipomas are usually located in the cervical or thoracic spine.

Safety and Efficacy of Hybrid Angiography in Chronic Lower Extremity Ischemia Patients at Risk of Contrast-Induced Acute Kidney Injury.

Aim: The aim of the study was to assess the feasibility and safety of hybrid angiography consisting of carbon dioxide (CO) angiography supplemented by small doses of iodinated contrast medium (ICM) in the endovascular treatment of chronic limb threatening ischemia (CLTI) patients with pre-existing chronic kidney disease (CKD).

Patients And Methods: This prospective study comprised all non-dialysis-dependent CKD patients presenting for endovascular management of CLTI. All endovascular interventions were done using CO as a contrast medium whether alone or supplemented by ICM (hybrid angiography) to treat unilateral arterial steno-occlusive lesions of iliac, femoropopliteal, or BTK arteries.

Predictors of Carotid Artery Stenting-Induced Hemodynamic Instability.

Background: To address the predictors of hemodynamic instability (HI) related to carotid artery stenting (CAS) and evaluate the association between HI and periprocedural adverse outcomes.

Methods: This study comprised all consecutive patients who underwent CAS for atherosclerotic carotid artery stenosis from March 2014 to May 2018. A standardized dose of atropine (0.

Concussion Office Based Rehabilitation Assessment: A Novel Clinical Tool for Concussion Assessment and Management.

The Concussion Office Based Rehabilitation Assessment (COBRA) is a novel tool constructed to ensure a comprehensive assessment of patients who may have sustained a concussion. The SCAT-5 (Sport Concussion Assessment Tool) has long been the gold standard for concussion assessment, however, it was designed as a sideline tool and its utility can be seen to decrease after a few days post-concussion. It also does not prompt evaluation of all the phenotypes of concussion.

Midterm Outcomes of Common Femoral Endarterectomy Combined with Inflow and Outflow Endovascular Treatment for Chronic Limb Threatening Ischaemia.

Objective: To assess mid term outcomes of common femoral endarterectomy combined with an inflow and outflow endovascular revascularisation procedure in patients with chronic limb threatening ischaemia (CLTI).

Methods: This was a prospective study. All patients who, for the first time, underwent planned one stage hybrid common femoral artery (CFA) endarterectomy combined with an inflow and/or outflow endovascular revascularisation procedure to achieve limb salvage in patients with CLTI due to multilevel disease were included between January 2015 and May 2017.

Phenytoin Seizure Prophylaxis Therapy Resulting in Severe Thrombocytopenia After Brain Tumor Debulking Surgery.

BACKGROUND Phenytoin is an antiepileptic drug that is usually prescribed as a prevention treatment for tonic-clonic seizures or partial seizures, and as a prophylaxis for the neurosurgical related seizures. Phenytoin administration has several drawbacks; one drawback phenytoin-induced thrombocytopenia, which is a rare and significant adverse event. We report a rare adverse event after phenytoin prophylaxis therapy after a brain tumor debulking surgery, which resulted in severe unpredicted thrombocytopenia.

Midterm outcomes of brachial arterio-arterial prosthetic loop as permanent hemodialysis access.

Objective: The objective of this study was to report the midterm outcomes of the brachial arterio-arterial prosthetic loop (AAPL) as an alternative permanent vascular access in strictly selected patients with end-stage renal disease.

Methods: This single-center prospective observational study was conducted between January 2014 and June 2017 and included 89 brachial AAPL procedures. Primary, assisted primary, and secondary patency rates were calculated using Kaplan-Meier analysis.

Hybrid salvage of thrombosed dialysis access grafts.

Background: To report our experience and evaluate the results of a hybrid procedure comprising of surgical thrombectomy and adjuvant high pressure balloon angioplasty for management of thrombosed arteriovenous grafts (AVGs) with underlying venous anastomotic stenosis.

Methods: Between January 2015 and June 2017, 148 patients with first-time thrombosis of AVGs were considered for treatment with surgical thrombectomy followed by high pressure balloon angioplasty of the underlying venous anastomotic lesions. Monitoring and surveillance was subsequently performed using clinical and hemodialysis criteria to detect a failing/failed access.

Spinal arachnoid web-a review article.

The spinal arachnoid web is an abnormal formation of an arachnoid membrane in the subarachnoid space. It is a rare entity with some degree of uncertainty surrounding its etiology. It can result in a displacement of the spinal cord causing pain and neurological symptoms as well as blockage of cerebrospinal fluid (CSF) flow and subsequent syringomyelia.

Editor's Choice - A Prospective Study to Evaluate Complete Wound Healing and Limb Salvage Rates After Angiosome Targeted Infrapopliteal Balloon Angioplasty in Patients with Critical Limb Ischaemia.

Objective/background: To evaluate complete wound healing and limb salvage rates in patients with critical limb ischaemia (CLI) with concurrent foot ulceration/gangrene who underwent angiosome targeted infrapopliteal balloon angioplasty.

Methods: This was a prospective observational study. In total, 212 patients who underwent successful infrapopliteal balloon angioplasty to assist wound healing and achieve limb salvage were included from June 2014 to March 2016.

COACH CV: The Seven Clinical Phenotypes of Concussion.

Our understanding of the diverse physiological manifestations of concussion is changing rapidly. This has an influence on the clinical assessment of patients who have sustained a concussion. The 2017 Consensus Statement on Concussion in Sport states that numerous post-injury clinical findings, such as cognitive deficits, post-traumatic headaches, dizziness, difficulties with oculomotor function, and depression have all been associated with a poorer prognosis in concussed patients.

Balloon angioplasty with selective stenting strategy in treatment of hemodialysis related central vein occlusive lesions.

Background: The aim of this study was to evaluate the safety and efficacy of balloon angioplasty and selective stenting in treatment of symptomatic central vein occlusive lesions (CVOL) in patients with upper extremity hemodialysis access.

Methods: Seventy-four hemodialysis patients with symptomatic CVOL underwent endovascular therapy between March 2014 and November 2015. Both the primary and secondary patency rates were analyzed by the Kaplan-Meier plot method.

Efficacy and safety of Duplex-guided polidocanol foam sclerotherapy for venous malformations.

Background: The aim of our study was to report our experience regarding the safety, efficacy of duplex-guided polidocanol (POL) foam sclerotherapy on the overall status of signs and symptoms in patients with venous malformations (VMs).

Methods: Thirty seven patients with symptomatic extratruncular VMs were treated with duplex-guided POL foam sclerotherapy using Tessari's method. Twenty five patients had limited VMs, while twelve had infiltrating VMs.

Balloon angioplasty for revision of failing lower extremity bypass grafts.

Objective: The aim of this study was to evaluate the efficacy and safety of balloon angioplasty as the primary method of intervention in patients with color duplex ultrasound documented failing bypass grafts and to determine factors that may affect the patency of lower extremity bypass grafts revised by percutaneous transluminal angioplasty (PTA).

Methods: All consecutive patients who underwent lower extremity bypass grafts from January 2009 to December 2013 were enrolled in a graft surveillance program. Patients identified as having failing grafts underwent arteriography to confirm the diagnosis with a view to concomitant treatment of the lesion using balloon angioplasty.