Predicting future occlusion or stenosis of lower extremity bypass grafts using artificial intelligence to simultaneously analyze all flow velocities collected in current and previous ultrasound examinations.

Objective: Routine surveillance with duplex ultrasound (DUS) examination is recommended after femoral-popliteal and femoral-tibial-pedal vein bypass grafts with various intervals postoperatively. The presently used methodology to analyze bypass graft DUS examination does not use all the available data and has been shown to have a significant rate for missing impending bypass graft failure. The objective of this research is to investigate recurrent neural networks (RNNs) to predict future bypass graft occlusion or stenosis.

An Interesting Case of a Patient With Disabling Bilateral Lower Extremity Claudication and a Persistent Sciatic Artery.

A persistent sciatic artery is a rare congenital anomaly. This case report highlights the treatment for a patient with a persistent sciatic artery no longer in continuity with the internal iliac artery and atherosclerotic peripheral vascular disease resulting in disabling bilateral lower extremity claudication. It highlights the types and anatomic locations of the sciatic artery and discusses an effective way to treat a patient with arterial insufficiency and this variant anatomy as well as other treatment options.

Endovascular Repair of an Intrathoracic Subclavian Artery Aneurysm in a Patient With Dextrocardia.

This manuscript describes an endovascular repair of a symptomatic, large proximal left subclavian artery aneurysm in a patient with dextrocardia and right-sided aortic arch and absent bilateral internal carotid arteries. The patient had surgical reconstruction as an infant for congenital heart disease with Ventricular Septal Defect, bifid sternum . Given her previous surgical history, we declined an open operation and performed an endovascular repair with stent grafts to successfully repair the subclavian artery aneurysm.

A new noninvasive and patient-specific hemodynamic index for the severity of renal stenosis and outcome of interventional treatment.

Renal arterial stenosis (RAS) often causes renovascular hypertension, which may result in kidney failure and life-threatening consequences. Direct assessment of the hemodynamic severity of RAS has yet to be addressed. In this work, we present a computational concept to derive a new, noninvasive, and patient-specific index to assess the hemodynamic severity of RAS and predict the potential benefit to the patient from a stenting therapy.

The Predictive Ability of the Renal Resistive Index and Its Relationship to Duplex Ultrasound Waveform Propagation in the Aorta and Renal Arteries.

Background: The objective is to investigate whether calculating the PPI (Pulse Pressure Index) and the RRI (Renal Resistive Index) using routinely collected Duplex ultrasound waveforms data obtained from the aorta and renal artery correlates and predicts renal function, and determine whether RRI is affected by the presence of a renal artery stenosis.

Methods: The records of 965 patients were evaluated. The RRI or pulsatility index of the aorta, renal artery, hilum, cortex, and medulla were measured with concurrent glomerular filtration rate GFR, Cr, PPI, and HR measurements, among which 75 patients had a 24-hour urine measured for CrCl, and 32 patients had aortic pulse pressure index (API) calculated from the central aortic pressure measured with applanation tonometry.

Computational methods to automate the initial interpretation of lower extremity arterial Doppler and duplex carotid ultrasound studies.

Background: Lower extremity arterial Doppler (LEAD) and duplex carotid ultrasound studies are used for the initial evaluation of peripheral arterial disease and carotid stenosis. However, intra- and inter-laboratory variability exists between interpreters, and other interpreter responsibilities can delay the timeliness of the report. To address these deficits, we examined whether machine learning algorithms could be used to classify these Doppler ultrasound studies.

Urgent Endovascular Repair of an Anterior Tibial Artery Aneurysm: Case Report and Literature Review.

True aneurysms of the anterior tibial artery are rare with less than 20 published reports in the literature. We report an urgent endovascular repair of a true anterior tibial artery aneurysm in a patient with Ehlers-Danlos type IV, vascular type. This approach resulted in an uneventful recovery without the elevated risks associated with open vascular repair in the setting of connective tissue disorder.

Treatment of a traumatic aortic bifurcation injury with an iliac branch endoprosthesis.

We present the case of a 62-year-old man who sustained a traumatic distal aortic injury associated with an adjacent lumbar vertebral body fracture resulting from a 20-ft fall. Given the site of injury, an iliac artery branched endograft was deployed off-label to preserve the aortic bifurcation and cover a limited amount of healthy aorta to preserve the collaterals. The procedure was successful, with no intraoperative complications or evidence of an endoleak.

Perioperative and Long-term Results of Zenith Fenestrated Aortic Repair in Women.

Background: Inferior perioperative outcomes for women receiving major vascular surgery are well established in the literature in multiple arterial distributions. Therefore, this study was completed to determine the perioperative and durability results associated with women undergoing complex aortic reconstruction using the Zenith Fenestrated platform (ZFEN; Cook Medical, Bloomington, IN).

Methods: A retrospective review of a fenestrated endovascular aortic repair (FEVAR) database capturing all ZFENs performed at our institution between October 2012 and March 2019 was completed.

Perioperative and 1-year transcarotid revascularization outcomes in symptomatic patients.

Objective: Previously published results of carotid revascularization with both transfemoral stenting and endarterectomy have demonstrated inferior perioperative stroke and death outcomes in neurologically symptomatic patients compared with those without symptoms. This study was completed to establish the real-world, symptom-based perioperative and follow-up outcomes for transcarotid artery revascularization (TCAR).

Methods: An institutional retrospective review of all TCARs performed outside of clinical trial regulations from 2016 to 2019 was completed.

An unusual arteriovenous malformation involving the cervical vessels treated with endovascular repair.

We present an unusual and complex arteriovenous malformation involving the vertebral artery, subclavian artery, and internal jugular vein in a 31-year-old man with no history of trauma or catheterization. The repair was done using endovascular techniques to minimize complications from nerve or vascular injury. The massively dilated jugular vein has remained diminished in size and the patient has remained asymptomatic at 8 months.

Aggressive Surveillance Is Needed to Detect Endoleaks and Junctional Separation between Device Components after Zenith Fenestrated Aortic Reconstruction.

Background: Junctional separation and resulting type IIIa endoleak is a well-known problem after EVAR (endovascular aneurysm repair). This complication results in sac pressurization, enlargement, and eventual rupture. In this manuscript, we review the incidence of this late finding in our experience with the Cook Zenith fenestrated endoprosthesis (ZFEN, Bloomington, IN).

Fenestrated endovascular aneurysm repair-induced acute kidney injury does not result in chronic renal dysfunction.

Objective: Acute kidney injury (AKI) is a common physiologic complication after fenestrated endovascular aneurysm repair (FEVAR). This investigation was initiated to determine the unknown impact of post-FEVAR AKI on long-term renal function after index hospital discharge.

Methods: A retrospective review was performed of an institutional FEVAR database capturing preoperative, intraoperative, and postoperative variables related to the implantation of consecutive Zenith Fenestrated endografts (ZFEN; Cook Medical, Bloomington, Ind) between October 2012 and April 2018.

Outcomes associated with a transcarotid artery revascularization-centered protocol in high-risk carotid revascularizations using the ENROUTE neuroprotection system.

Objective: This investigation describes the perioperative and early follow-up results associated with transcarotid artery revascularization (TCAR) in patients not participating in the Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure II (ROADSTER-2) registry using the ENROUTE neuroprotection system (ENPS; Silk Road Medical, Sunnyvale, Calif).

Methods: A retrospective review was performed capturing all TCAR/ENPS procedures in patients deemed to be at high risk for complications after traditional carotid endarterectomy. All patients enrolled in the ROADSTER-2 registry were excluded, leaving only those treated outside trial regulations for analysis.

Adjunctive visceral artery chimney in patients undergoing Zenith Fenestrated aortic repair.

Objective: Visceral artery chimneys have been employed as an adjunct to endovascular aneurysm repair (EVAR) to treat short-neck infrarenal and juxtarenal aortic aneurysms for more than two decades. With the widespread introduction of fenestrated endovascular aneurysm repair by the Food and Drug Administration-approved Zenith Fenestrated endograft (ZFEN; Cook Medical, Bloomington, Ind) to the United States in 2012, clinicians gained the ability to apply the chimney technique to these custom devices for difficult anatomy. The purpose of this report was to demonstrate feasibility and to provide evidence on the performance of chimneys for the treatment of complex juxtarenal aneurysms that could not be adequately treated with ZFEN alone.

Use of the Zenith Fenestrated platform to rescue failing endovascular and open aortic reconstructions is safe and technically feasible.

Objective: Proximal neck dilation is a serious long-term complication directly causing the failure of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) of abdominal aortic aneurysms. However, the implantation of a fenestrated device presents the opportunity for proximal extension of the aortic reconstruction into a healthy segment while maintaining patency of the visceral vessels. The objective of this investigation was to report perioperative and follow-up outcomes using the Zenith Fenestrated (ZFEN; Cook Medical, Bloomington, Ind) aortic stent system in salvaging previous aortic repairs undergoing type IA endoleak or aneurysmal degeneration of the proximal neck.

Institutional experience with the Zenith Fenestrated aortic stent graft.

Objective: The Zenith Fenestrated (ZFEN; Cook Medical, Bloomington, Ind) aortic stent graft system was approved for commercial use by the Food and Drug Administration in April 2012. We report our single-center experience of 100 consecutive patients treated with the ZFEN platform from October 2012 to March 2017.

Methods: A retrospective review of our prospectively maintained fenestrated endovascular aneurysm repair (FEVAR) database at a tertiary care academic institution located in the Midwest United States was performed for descriptive analysis.

All-optical tunable multilevel amplitude regeneration based on coherent wave mixing using a polarizer.

We describe and demonstrate an all-optical tunable phase- preserving scheme for multilevel amplitude regeneration based on coherent optical wave mixing using a polarizer for optical star 8-quadrature-amplitude modulation (star-8QAM) and star-16QAM signals with a power ratio of 1:5. Amplitude noise can be efficiently suppressed on both amplitude levels. A regeneration factor of nearly 5 for the higher-amplitude level of star-8QAM and 3 for lower-amplitude level are achieved.

Human daily activity recognition with sparse representation using wearable sensors.

Human daily activity recognition using mobile personal sensing technology plays a central role in the field of pervasive healthcare. One major challenge lies in the inherent complexity of human body movements and the variety of styles when people perform a certain activity. To tackle this problem, in this paper, we present a novel human activity recognition framework based on recently developed compressed sensing and sparse representation theory using wearable inertial sensors.

Prospective, multicenter experience with the Ventana Fenestrated System for juxtarenal and pararenal aortic aneurysm endovascular repair.

Objective: This study assessed preliminary results of the Ventana Fenestrated System (Endologix, Irvine, Calif) as an off-the-shelf integrated device for juxtarenal aortic aneurysm (JAA) or pararenal aortic aneurysm (PAA) endovascular repair.

Methods: From November 2010 to April 2012, seven centers enrolled 31 patients with JAAs or PAAs in an international clinical trial of the Ventana Fenestrated System. Clinical and laboratory evaluations were done predischarge and at 1 month, with continuing follow-up through 5 years.

A vascular laboratory protocol for improving and managing after-hours suspected acute deep venous thrombosis.

This study reviews the clinical and workforce impact of a suggested protocol designed for the management of suspected acute deep venous thrombosis (DVT) in patients seen after standard vascular laboratory business hours. The protocol included the use of Wells score, D-dimer and a single dose of therapeutic anticoagulant to defer venous duplex ultrasound (VDU) testing until routine business hours unless contraindicated. Information was collected on medical history, physical exam and the timing of any diagnostic studies and treatment provided.

Beyond the standard clinical rating scales: fine-grained assessment of post-stroke motor functionality using wearable inertial sensors.

Accurate motor function assessment of post-stroke patients plays a critical role in their rehabilitation interventions. In this paper, we propose an approach to use wearable inertial sensing technology to quantitatively evaluate the patients' motor behavior. Different from existing wearable motor function assessment techniques that focus on building mapping functions that correlate sensed movement signals to the standard clinical rating scales, our approach provides a fine-grained assessment by capturing detailed patterns contained in the patients' movements.

Robust human activity and sensor location corecognition via sparse signal representation.

Human activity recognition with wearable body sensors receives lots of attentions in both research and industrial communities due to the significant role in ubiquitous and mobile health monitoring. One of the most concerned issues related to this wearable technology is that the sensor signals significantly depends on where the sensors are worn on the human body. Existing research work either extracts location information from the activity signals or takes advantage of the sensor location information as a priori information to achieve better activity recognition performance.

Femoral arterial access management for endovascular aortic aneurysm repair: evolution and outcome.

Endovascular repair of abdominal and thoracic aortic aneurysms (AAAs and TAAs, respectively) has become the standard of care for anatomically appropriate patients. All the devices developed to date for endograft repair of AAAs and TAAs are deployed through relatively large (12F to 24F) sheaths. Traditionally, this access has required arterial exposure with open cut down, but with the development of suture-mediated arterial closure devices and decreasing profile of delivery sheaths of endografts, there is an increasing trend toward percutaneous endovascular repair of aortic aneurysms.