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Introduction: Median arcuate ligament syndrome (MALS) is an uncommon cause of chronic abdominal pain resulting from the compression of the celiac artery. It shares symptoms with chronic functional abdominal pain, a more common cause of pediatric chronic abdominal pain. Typically found in middle-aged females, MALS is a diagnosis of exclusion.Case Report: A 17-year-old male who presented to the emergency department with periumbilical pain for two months was subsequently diagnosed with MALS through computed tomography angiography. Further vascular and gastroenterology evaluations confirmed the diagnosis, ruling out other common causes of chronic abdominal pain. The patient received non-operative treatment in the form of endoscopic ultrasound celiac plexus block, with the possibility of surgical management if necessary.Conclusion: Median arcuate ligament syndrome is an uncommon cause of chronic abdominal pain that is difficult to differentiate from other causes, especially in pediatric patients. It should be considered in the patient whose previous workup was not conclusive and symptom management had failed. Management is multidisciplinary with non-operative management preferred initially. If there is no improvement, surgical management should be considered.

Background: Knowledge of the anatomy of pulmonary arteries is essential in many invasive procedures concerning pulmonary circulation. In the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (CTEPH), two-dimensional (2D) pulmonary angiography is used. Recognizing the topographic course of the pulmonary arteries and understanding the status in three dimensions (3D) is paramount. This study aimed to evaluate and describe the branching variant of pulmonary arteries in a single case, as well as morphological parameters of the segmental arteries, like length, diameter and branching angles. Methods: One pair of embalmed human cadaver lungs was dissected by a scalpel and surgical forceps and was measured up to the subsegmental arteries. Results: The diameters (ranging from 3.04 to 9.29 mm) and lengths (ranging from 9.09 to 53.91 mm) of the pulmonary segmental arteries varied. The proximal branching angles were wide and close to perpendicular, while distally, the angles between the segmental and subsegmental arteries were narrower (30–45°). Upon evaluating the branching, rare variations were identified and delineated, notably in the lower lobes of both lungs. Conclusions: Utilizing knowledge and data in clinical settings is instrumental for effectively diagnosing and treating CTEPH. Further research is required to explore the complications in invasive procedures related to various anatomical variations. [ABSTRACT FROM AUTHOR]

Arteriovenous malformations (AVMs) are significant vascular lesions that can appear in infancy and are rather uncommon in the craniofacial region. AVM is a vascular anatomical anomaly that can be deadly or incapacitating since it occurs where the venous and artery systems join. The main causes of AVMs are infections, trauma, secondary thrombosis, puberty, and pregnancy. The skeletal muscles are rarely affected by intramuscular vascular malformations (IMVMs), which account for less than 1% of all head and neck tumors. The most often affected muscle is the masseter, which accounts for around 5% of the IMVM in the head and neck. About 40% of the venous anomalies in the head and neck region are associated with phleboliths. Advanced diagnostic aids like Ultrasonography with dopplers, Computed Tomography, and Cone Beam Computed Tomography give us a 3-Dimensional perspective that is more helpful in diagnosing such rare presentations. In this case report, many cutting-edge digital modalities that have helped to diagnose a venous malformation associated with multiple phleboliths in the masseter region of a 16 year old female are highlighted. • Venous malformation (VM) is a type of vascular anomaly. • This report is on a rare case presentation of VM with multiple phleboliths. • Highlights the significance various imaging modalities. [ABSTRACT FROM AUTHOR]

Background and purpose: An essential step during endovascular thrombectomy is identifying the occluded arterial vessel on a cerebral digital subtraction angiogram (DSA). We developed an algorithm that can detect and localize the position of occlusions in cerebral DSA. Methods: We retrospectively collected cerebral DSAs from a single institution between 2018 and 2020 from 188 patients, 86 of whom suffered occlusions of the M1 and proximal M2 segments. We trained an ensemble of deep‐learning models on fewer than 60 large‐vessel occlusion (LVO)‐positive patients. We evaluated the model on an independent test set and evaluated the truth of its predicted localizations using Intersection over Union and expert review. Results: On an independent test set of 166 cerebral DSA frames with an LVO prevalence of 0.19, the model achieved a specificity of 0.95 (95% confidence interval [CI]: 0.90, 0.99), a precision of 0.7450 (95% CI: 0.64, 0.88), and a sensitivity of 0.76 (95% CI: 0.66, 0.91). The model correctly localized the LVO in at least one frame in 13 of the 14 LVO‐positive patients in the test set. The model achieved a precision of 0.67 (95% CI: 0.52, 0.79), recall of 0.69 (95% CI: 0.46, 0.81), and a mean average precision of 0.75 (95% CI: 0.56, 0.91). Conclusion: This work demonstrates that a deep learning strategy using a limited dataset can generate effective representations used to identify LVOs. Generating an expanded and more complete dataset of LVOs with obstructed LVOs is likely the best way to improve the model's ability to localize LVOs. [ABSTRACT FROM AUTHOR]

Subclavian steal syndrome (SSS) is a rare vascular condition characterized by retrograde blood flow in the vertebral artery, often discovered incidentally in asymptomatic patients. We present a 65-year-old male with recurrent transient ischemic attacks (TIAs) attributed to 99% stenosis at the origin of the left subclavian artery, leading to SSS. Diagnostic modalities included duplex ultrasound, confirming inverted left vertebral artery flow, and multi-slice computed tomography angiography, confirming the diagnosis. Despite an unsuccessful attempt at balloon angioplasty, successful vascular surgery was performed, establishing a left carotid-vertebral artery bypass. The patient recovered well without complications. This case underscores the importance of considering SSS in TIA cases, utilizing non-invasive diagnostic tools, and highlighting the successful management of symptomatic SSS through surgical intervention. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Symmetrical peripheral gangrene (SPG) is very rare condition associated with symmetrical ischemia and gangrene affecting two or more distal extremities. It is almost always associated with septicemia and has a high mortality rate. The rarity of this condition and lack of prospective trials makes its recognition and management difficult. Care providers should maintain a high index of suspicion for SPG in patients with sepsis who develop cyanosis and ischemia of extremities. Doing early culture and sensitivity studies is key in guiding apropriate antibiotic treatment. Symmetrical peripheral gangrene (SPG) is very rare condition associated with symmetrical ischemia and gangrene affecting two or more distal extremities. It can occur at any age and may affect either sex. It is almost always associated with septicemia and has a high mortality rate (up to 35%). The rarity of this condition and lack of prospective trials makes its recognition and management difficulty. Only a few case reports have been in literature since its discovery in 1981. A 14 year old boy was referred to our tertiary facility due to postoperative wound sepsis. He had undergone right scrotal exploration and orchidectomy due to right testicular torsion. His initial symptoms were abrupt onset of scrotal pain and swelling which he developed while playing. Physical examination findings on admission were severe pallor of mucous membranes, fever and diaphoresis and mild respiratory distress. He also had a gangrenous perineal area involving the penis and cyanosed tips of fingers and toes bilaterally. He had a normal ankle branchial index of 0.9. His preliminary laboratory investigations revealed a marked neutrophilia, anemia, thrombocytopenia, and elevated D‐Dimers. Initial resuscitative interventions included oxygen therapy, blood transfusion with whole blood and platelets, empirical antibiotics, analgesics, and surgical debridement of the perineal in theater. A diagnosis of severe sepsis complicated with disseminated intravascular coagulation (DIC) was made. The cyanosis on extremities spread proximally during the patient's course of treatment to full blown gangrene. At the time when clinical and biochemical remission of the infection was attained, the gangrene had demarcated at below elbow in both upper limbs and below knees in both lower limbs. An arterial angiogram was done and revealed normal flow in all proximal and distal branches of the aorta with no occlusion. A multidisciplinary agreement to conduct quadrilateral amputations plus penile amputation was made between urologists, vascular and orthopedic surgeons. The exact pathogenesis of how SPG occurs is not well understood. The underlying mechanism includes a low flow state with DIC. Ischemic changes usually begin in the peripheries and extend proximally. Ischemic changes are not preceded by peripheral vascular occlusive disease. SPG should be suspected when a patient present with marked coldness, pain in the distal extremities, cyanosis, and pallor. Early recognition helps to arrest the progression of ischemic changes before overt gangrene occur and improves the qaulity of life. [ABSTRACT FROM AUTHOR]

Background In reduction mammoplasty, preserving an appropriate skin flap is crucial to achieve a favorable postoperative appearance and prevent blood supply disorders in the nipple-areolar complex (NAC). Previous studies have indicated that a thinner or narrower flap is more favorable for breast shaping, but also increases the risk of blood supply disorders. Accessing the blood perfusion of the NAC and determining the critical threshold for NAC viability are essential aspects of reduction mammoplasty. Objectives The aim of this study was to utilize indocyanine green (ICG) angiography to assess NAC perfusion during reduction mammoplasty. It also sought to identify critical thresholds of various indicators affecting NAC survival and provide guidance for skin flap trimming. Methods Thirty-eight patients who underwent reduction mammoplasty were included. Each patient received ICG angiography before and after skin flap trimming. Data on NAC perfusion, skin flap length, width, thickness, and other relevant indicators were collected. Results Among the patients, 5 experienced NAC blood supply disorders. Multiple linear regression analysis demonstrated that the NAC blood supply had a significant correlation with the tissue thickness at the pedicle base (P <.001) and with the length-to-width ratio across the nipple (P <.05). To optimize NAC survival and achieve favorable breast shaping, cutoff points for the thickness at the pedicle base and the length-to-width ratio across the nipple of 1.15 cm and 1.71, respectively, were established. Conclusions ICG angiography provides an effective means to assess NAC blood supply and postoperative survival. The cutoff points established in this study help to predict the survival of the NAC and guide flap trimming. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Renal arteriovenous malformations (AVMs) are abnormal connections between the renal arteries and venous system. Arteriovenous fistulas account for 70%–80% of renal arteriovenous abnormalities, often resulting from iatrogenic injuries. While most renal AVMs are asymptomatic, hematuria is a common symptom caused by AVM rupture into the renal calyces. Angiography is the gold standard for diagnosis, but noninvasive imaging techniques like ultrasound, computed tomography, or magnetic resonance imaging are commonly used for initial evaluation. Most renal AVMs are managed conservatively. Symptomatic patients typically undergo endovascular embolization, the preferred treatment, while surgery is reserved for unstable patients or those with complex vascular anatomy. We present a case of a 32-year-old man with renal AVMs following a motor vehicle accident. The patient initially received unsuccessful endovascular embolization but achieved successful treatment through open fistula ligation. This case highlights the challenges in managing renal AVMs and the importance of considering alternative interventions when initial treatments prove ineffective. [ABSTRACT FROM AUTHOR]

Background: Knowledge of the anatomy of pulmonary arteries is essential in many invasive procedures concerning pulmonary circulation. In the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (CTEPH), two-dimensional (2D) pulmonary angiography is used. Recognizing the topographic course of the pulmonary arteries and understanding the status in three dimensions (3D) is paramount. This study aimed to evaluate and describe the branching variant of pulmonary arteries in a single case, as well as morphological parameters of the segmental arteries, like length, diameter and branching angles. Methods: One pair of embalmed human cadaver lungs was dissected by a scalpel and surgical forceps and was measured up to the subsegmental arteries. Results: The diameters (ranging from 3.04 to 9.29 mm) and lengths (ranging from 9.09 to 53.91 mm) of the pulmonary segmental arteries varied. The proximal branching angles were wide and close to perpendicular, while distally, the angles between the segmental and subsegmental arteries were narrower (30–45°). Upon evaluating the branching, rare variations were identified and delineated, notably in the lower lobes of both lungs. Conclusions: Utilizing knowledge and data in clinical settings is instrumental for effectively diagnosing and treating CTEPH. Further research is required to explore the complications in invasive procedures related to various anatomical variations.

This study reported two cases of acute life-threatening hemorrhage after Le Fort I osteotomy. In both cases, computed tomography and angiography revealed damage to the descending palatine artery, which was successfully treated by angiographic embolization. Although massive hemorrhage after Le Fort I osteotomy is rare, acute hemorrhage from the postoperative area may occur. Angiographic embolization is useful in cases of such hemorrhage from the posterior nasal cavity where endoscopic hemostasis is not possible. [ABSTRACT FROM AUTHOR]

Key Clinical Message Symmetrical peripheral gangrene (SPG) is very rare condition associated with symmetrical ischemia and gangrene affecting two or more distal extremities. It is almost always associated with septicemia and has a high mortality rate. The rarity of this condition and lack of prospective trials makes its recognition and management difficult. Care providers should maintain a high index of suspicion for SPG in patients with sepsis who develop cyanosis and ischemia of extremities. Doing early culture and sensitivity studies is key in guiding apropriate antibiotic treatment. Abstract Symmetrical peripheral gangrene (SPG) is very rare condition associated with symmetrical ischemia and gangrene affecting two or more distal extremities. It can occur at any age and may affect either sex. It is almost always associated with septicemia and has a high mortality rate (up to 35%). The rarity of this condition and lack of prospective trials makes its recognition and management difficulty. Only a few case reports have been in literature since its discovery in 1981. A 14 year old boy was referred to our tertiary facility due to postoperative wound sepsis. He had undergone right scrotal exploration and orchidectomy due to right testicular torsion. His initial symptoms were abrupt onset of scrotal pain and swelling which he developed while playing. Physical examination findings on admission were severe pallor of mucous membranes, fever and diaphoresis and mild respiratory distress. He also had a gangrenous perineal area involving the penis and cyanosed tips of fingers and toes bilaterally. He had a normal ankle branchial index of 0.9. His preliminary laboratory investigations revealed a marked neutrophilia, anemia, thrombocytopenia, and elevated D‐Dimers. Initial resuscitative interventions included oxygen therapy, blood transfusion with whole blood and platelets, empirical antibiotics, analgesics, and surgical debridement of the perineal in theater. A diagnosis of severe sepsis complicated with disseminated intravascular coagulation (DIC) was made. The cyanosis on extremities spread proximally during the patient's course of treatment to full blown gangrene. At the time when clinical and biochemical remission of the infection was attained, the gangrene had demarcated at below elbow in both upper limbs and below knees in both lower limbs. An arterial angiogram was done and revealed normal flow in all proximal and distal branches of the aorta with no occlusion. A multidisciplinary agreement to conduct quadrilateral amputations plus penile amputation was made between urologists, vascular and orthopedic surgeons. The exact pathogenesis of how SPG occurs is not well understood. The underlying mechanism includes a low flow state with DIC. Ischemic changes usually begin in the peripheries and extend proximally. Ischemic changes are not preceded by peripheral vascular occlusive disease. SPG should be suspected when a patient present with marked coldness, pain in the distal extremities, cyanosis, and pallor. Early recognition helps to arrest the progression of ischemic changes before overt gangrene occur and improves the qaulity of life.

Pseudoaneurysm of the lingual artery is an extremely rare condition, and the most common causes are trauma, inflammation, neoplasm, or iatrogenic factors. An aneurysm refers to a weakening of an artery wall that creates a bulge or distention of the artery. Aneurysms of the external carotid artery and its branches are rare, comprising only 2.2% of cervical carotid aneurysms, with an even rarer occurrence of mycotic pseudoaneurysm. The superficial temporal artery and facial artery are the most commonly involved branches. Pseudoaneurysms of the lingual artery are an extremely rare entity and are often a consequence of neck surgery, trauma, inflammation, chemoradiotherapy, or odontogenic infection. They may cause life-threatening bleeding. Hereby, the authors present the case of a 47- year-old male patient with biopsy-proven Squamous Cell Carcinoma (SCC) of the hypopharynx who underwent total laryngectomy with Pectoralis Major Myocutaneous Flap (PMMC) reconstruction. The patient presented with a chief complaint of massive bleeding from the oral cavity three weeks post-procedure. The patient was immediately managed conservatively and started on inotropes. Computed Tomography (CT) angiogram of the neck showed a well-defined rounded enhancing structure in relation to the right lingual artery, with enhancement comparable to a vascular structure suggestive of a pseudoaneurysm. The patient underwent lingual artery embolisation, resulting in complete occlusion of the pseudoaneurysm. It is difficult to diagnose and manage lingual artery pseudoaneurysms, and they can cause severe distress to patients when bleeding occurs. To prevent morbidity and mortality associated with lingual artery aneurysms, they must be diagnosed and treated as early as possible.

Observing anomalies in the origin of the coronary arteries is a rare but recognized scenario during coronarography. All the major coronary arteries originating from the right sinus of Valsalva is an extremely rare anomaly, its reported incidence being 0.008% in angiographic studies. Most coronary artery variations are benign and are therefore found accidentally or postmortem. However, some anomalies in the origin of the coronary arteries are associated with myocardial ischemia and a higher risk of sudden cardiac death. Herein, we report a sporadic case of anomalous origin of the coronary arteries, in which the right coronary artery, anterior interventricular artery and left circumflex artery arise separately from the right sinus of Valsalva, each originating from a separate ostium. Regardless of their low incidence rate, coronary artery anomalies can cause serious technical challenges during coronary angiography and percutaneous interventions because of the unusual location and course of the artery. Echocardiography, computed tomography, and magnetic resonance imaging can be useful in such cases. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate foveal avascular zone (FAZ) features and macular flow density (FD) in various retinal layers in a cohort of patients with foveal hypoplasia (FH) using optical coherence tomography angiography (OCTA), in order to characterize microvascular abnormalities and explore their potential clinical significance. FAZ parameters and FD, as well as retinal thickness and volume values were analyzed and compared between patients with FH and an age- and gender-matched control cohort. Correlations between disease severity and visual acuity (VA), as well as between disease severity and FAZ features were evaluated. A total of 19 eyes with FH and 19 control eyes were included. The study group showed significantly higher FD values in the foveal sectors of the superficial and deep capillary plexus compared to controls. FAZ area, perimeter, and acircularity index (ACI) were noticeably altered in eyes with FH; however, they did not correlate with disease severity. Visual acuity was negatively correlated with disease severity. The results of this study provide evidence of altered microvasculature architecture specifically in the foveal sectors of patients with FH. The higher FD values in the foveal sectors of FH patients suggest a potential compensatory response of the retinal microvasculature. FAZ parameters and FD values of the foveal sectors could be used as part of an OCTA-based grading system in FH patients. [ABSTRACT FROM AUTHOR]

We present a case of a bronchial artery to pulmonary artery fistula. This occurred in a 77-year-old male of Bangladeshi ethnicity with a new diagnosis of cavitating pulmonary tuberculosis. A 4D CTA protocol was required to elicit the nature of the vascular abnormality. Fistula between bronchial and pulmonary arteries is an uncommon phenomenon, with few published cases. This case demonstrates the difficulty with which these fistulae are imaged. 4D CTA is a technique that is increasingly being shown to be useful in characterizing vascular anomalies such as fistulae, with embolization as the mainstay of treatment.

The article present a case study of a 59-year-old male with seropositive rheumatoid arthritis, hypertension and anticoagulation due to past pulmonary embolism, hospitalized for fever and myalgia. It discusses the diagnostic utility of simultaneous positron emission tomography-computed tomography (PET/CT) and angiography in identifying polyarteritis nodosa (PAN) in a patient with abdominal bleeding and findings of hepatic artery microaneurysms and stenoses.

Iatrogenic coronary artery dissection is a rare complication seen in 0.07% of coronary procedures. Presentations of this condition vary, ranging from signs of myocardial ischemia to rarer presentations of ventricular arrhythmias. We present a rare case of a 55-year-old patient with native aortic valve endocarditis who developed right coronary artery dissection (RCAD) in the immediate post-op period presenting with refractory ventricular fibrillation (VF). Emergency coronary angiogram revealed an extensive RCAD extending from the ostium to the mid-vessel as the cause of VF. A consensus between the cardiologists and the cardiac surgeons led to an emergency right coronary artery bypass graft (CABG) that resolved the VF. This case illustrates a rare presentation of iatrogenic RCAD and the successful management of the same. We highlight the importance of prompt detection via angiography in patients suspected of having coronary artery dissection and showcase the successful implementation of emergency CABG in a patient with unstable haemodynamics. [ABSTRACT FROM AUTHOR]

Pseudoaneurysm of the lingual artery is an extremely rare condition, and the most common causes are trauma, inflammation, neoplasm, or iatrogenic factors. An aneurysm refers to a weakening of an artery wall that creates a bulge or distention of the artery. Aneurysms of the external carotid artery and its branches are rare, comprising only 2.2% of cervical carotid aneurysms, with an even rarer occurrence of mycotic pseudoaneurysm. The superficial temporal artery and facial artery are the most commonly involved branches. Pseudoaneurysms of the lingual artery are an extremely rare entity and are often a consequence of neck surgery, trauma, inflammation, chemoradiotherapy, or odontogenic infection. They may cause life-threatening bleeding. Hereby, the authors present the case of a 47-year-old male patient with biopsy-proven Squamous Cell Carcinoma (SCC) of the hypopharynx who underwent total laryngectomy with Pectoralis Major Myocutaneous Flap (PMMC) reconstruction. The patient presented with a chief complaint of massive bleeding from the oral cavity three weeks post-procedure. The patient was immediately managed conservatively and started on inotropes. Computed Tomography (CT) angiogram of the neck showed a well-defined rounded enhancing structure in relation to the right lingual artery, with enhancement comparable to a vascular structure suggestive of a pseudoaneurysm. The patient underwent lingual artery embolisation, resulting in complete occlusion of the pseudoaneurysm. It is difficult to diagnose and manage lingual artery pseudoaneurysms, and they can cause severe distress to patients when bleeding occurs. To prevent morbidity and mortality associated with lingual artery aneurysms, they must be diagnosed and treated as early as possible. [ABSTRACT FROM AUTHOR]

Coronary arterydisease (CAD)has become a significant causeof heart attack, especially amongthose 40yearsoldor younger. There is a need to develop new technologies andmethods to deal with this disease.Many researchers have proposed image processing-based solutions for CADdiagnosis, but achieving highly accurate results for angiogram segmentation is still a challenge. Several different types of angiograms are adopted for CAD diagnosis. This paper proposes an approach for image segmentation using ConvolutionNeuralNetworks (CNN) for diagnosing coronary artery disease to achieve state-of-the-art results.We have collected the 2D X-ray images from the hospital, and the proposed model has been applied to them. Image augmentation has been performed in this research as it's the most significant task required to be initiated to increase the dataset's size. Also, the images have been enhanced using noise removal techniques before being fed to the CNN model for segmentation to achieve high accuracy. As the output, different settings of the network architecture undoubtedly have achieved different accuracy, among which the highest accuracy of the model is 97.61%. Compared with the other models, these results have proven to be superior to this proposed method in achieving state-of-the-art results. [ABSTRACT FROM AUTHOR]

Sarcomas of the head and neck account for about 2% of all head and neck malignancies in adults. The median age at diagnosis is 50–54 years with a slight male predominance. The rarity of these sarcomas and lack of prospective trials make it difficult to reach valid conclusions. A 36‐year‐old woman was referred to our hospital because of an expanding non‐pulsatile mass in the right supraclavicular fossa with associated numbness and paresthesia of the right forearm. The patient reported that the mass had gradually enlarged for the past 5 months. She had no history of trauma or any chronic illnesses. A physical examination revealed a mass measuring approximately 7 cm × 5 cm above the right clavicle with no palpable thrill or bruit. Ultrasound‐guided biopsy was done and the histology report revealed soft tissue cells, fatty cells, and skeletal muscle cells; no tumor cells were identified. Magnetic resonance angiogram studies were made and revealed a highly vascularized supraclavicular mass. Under a multidisciplinary approach, the mass was resected. Head and neck sarcomas are relatively rare tumors and those of the head and neck account for about 2% of all head and neck malignancies and 4%–10% of all sarcomas in adults. The main histologic subtypes are rhabdomyosarcoma, osteosarcoma, chondrosarcoma, and angiosarcoma. [ABSTRACT FROM AUTHOR]

Intracranial dural arteriovenous fistulas (DAVFs) are rare lesions accounting for 10 to 15% of intracranial arteriovenous malformations. They involve an anomalous shunt between meningeal arteries, intracranial (venous sinuses and/or cortical veins), or medullary veins. The DAVFs are usually acquired, implying previous aggression of the dura mater. Thus, they are associated with dural sinus thrombosis, previous craniotomy, and trauma. However, they are idiopathic in most instances and have no evident cause. Their clinical presentation is variable, with symptoms depending on their location and venous drainage pattern. However, lesions with cortical venous drainage have the highest risk of causing the most significant morbidity and mortality. High clinical suspicion alongside noninvasive cross-sectional imaging techniques such as computed tomography and magnetic resonance imaging help establish the diagnosis. Digital subtraction angiography is the gold standard for diagnosis and accurate classification, permitting the evaluation of the feeding vessels, cortical venous drainage, and venous ectasia. Accordingly, a prompt diagnosis and precise classification of these lesions are essential. Endovascular treatment is nowadays the primary therapeutic modality for DAVFs. The access route can be divided into transarterial, transvenous, and combined approaches based on angioarchitecture, venous drainage model, and location. Surgical resection and stereotactic radiosurgery may be considered in some cases. A personalized case-by-case approach accomplishes a high complete treatment grade with a low complication rate. This review highlights the epidemiology, pathogenesis, clinical presentation, classification, diagnosis, and endovascular treatment of patients with intracranial DAVFs.

Coronary artery intramural hematoma is a rare complication of percutaneous coronary intervention which develops from intimal tear of coronary artery and propagates by blood accumulation along the medial surface of adjacent segment. Fifty-three-year-old male presented with nonexertional chest pain; he was referred after a positive stress test with+ moderate lateral wall ischemia. Coronary angiography showed 80% lesion in mid-left anterior descending artery (mLAD). Angiogram after angioplasty with 2.0 mm × 15 mm balloon and 3.0 mm × 15 mm drug-eluting-stent demonstrated a new stenotic lesion distal to stented mLAD segment. Subsequently, an overlapping 3.0 mm × 30 mm stent was placed with effective restoration of blood flow through LAD. During percutaneous coronary intervention (PCI), balloon predilatation can result in plaque fracture and stent deployment may cause intimal tear forming intramural hematoma which can lead to post-PCI myocardial infarction necessitating prompt detection by intravascular imaging with intravascular ultrasound and optical coherence tomography. Management is based on individual patient's characteristics and includes medical therapy, angiographic surveillance or repeat PCI.

Variations in the origin of the right coronary artery have an incidence between 0.09 % and 0.92 %. Herein, we report a rare case of a coronary artery anomaly in which the right coronary artery originates from the left main coronary artery. This variant was found during routine coronarography, combined with an artificial aortic valve. Despite their rare occurrence, some variations in the origins of the coronary arteries can be life threatening and are associated with a higher risk of sudden cardiac death. They can also pose serious technical challenges and predispose to complications during coronary angiographic procedures. Thus, knowledge of such anomalies is paramount for managing the patients correctly. [ABSTRACT FROM AUTHOR]

BackgroundRight ventricle dilatation (RVD) is a common complication of non-intubated COVID-19 pneumonia caused by pro-thrombotic pneumonitis, intra-pulmonary shunting, and pulmonary vascular dysfunction. In several pulmonary diseases, RVD is routinely measured on computed tomography pulmonary angiogram (CTPA) by the right ventricle-to-left ventricle (LV) diameter ratio > 1 for predicting adverse events.ObjectiveThe aim of the study was to evaluate the association between RVD and the occurrence of adverse events in a cohort of critically ill non-intubated COVID-19 patients.MethodsBetween February 2020 and February 2022, non-intubated patients admitted to the Amiens University Hospital intensive care unit for COVID-19 pneumonia with CTPA performed within 48 h of admission were included. RVD was defined by an RV/LV diameter ratio greater than one measured on CTPA. The primary outcome was the occurrence of an adverse event (renal replacement therapy, extracorporeal membrane oxygenation, 30-day mortality after ICU admission).ResultsAmong 181 patients, 62% (n = 112/181) presented RVD. The RV/LV ratio was 1.10 [1.05–1.18] in the RVD group and 0.88 [0.84–0.96] in the non-RVD group (p = 0.001). Adverse clinical events were 30% and identical in the two groups (p = 0.73). In Receiving operative curves (ROC) analysis, the RV/LV ratio measurement failed to identify patients with adverse events. On multivariable Cox analysis, RVD was not associated with adverse events to the contrary to chest tomography severity score > 10 (hazards ratio = 1.70, 95% CI [1.03–2.94]; p = 0.04) and cardiovascular component (> 2) of the SOFA score (HR = 2.93, 95% CI [1.44–5.95], p = 0.003).ConclusionRight ventricle (RV) dilatation assessed by RV/LV ratio was a common CTPA finding in non-intubated critical patients with COVID-19 pneumonia and was not associated with the occurrence of clinical adverse events.

Abstract Sarcomas of the head and neck account for about 2% of all head and neck malignancies in adults. The median age at diagnosis is 50–54 years with a slight male predominance. The rarity of these sarcomas and lack of prospective trials make it difficult to reach valid conclusions. A 36‐year‐old woman was referred to our hospital because of an expanding non‐pulsatile mass in the right supraclavicular fossa with associated numbness and paresthesia of the right forearm. The patient reported that the mass had gradually enlarged for the past 5 months. She had no history of trauma or any chronic illnesses. A physical examination revealed a mass measuring approximately 7 cm × 5 cm above the right clavicle with no palpable thrill or bruit. Ultrasound‐guided biopsy was done and the histology report revealed soft tissue cells, fatty cells, and skeletal muscle cells; no tumor cells were identified. Magnetic resonance angiogram studies were made and revealed a highly vascularized supraclavicular mass. Under a multidisciplinary approach, the mass was resected. Head and neck sarcomas are relatively rare tumors and those of the head and neck account for about 2% of all head and neck malignancies and 4%–10% of all sarcomas in adults. The main histologic subtypes are rhabdomyosarcoma, osteosarcoma, chondrosarcoma, and angiosarcoma.

We describe a 28-year-old man who sustained an open IIIB left ankle fracture dislocation with heel pad avulsion. The patient underwent formal angiography of the left lower extremity, followed by free tissue transfer of a rectus abdominis flap several days later. Intraoperatively, a thrombus was identified in the deep inferior epigastric artery above the femoral artery access site requiring thrombectomy. Histologic analysis estimated the thrombus age at 12 to 72 hours, raising concern that the thrombus was induced during angiogram instrumentation. Donor and recipient site-specific risks of arterial instrumentation (including invasive diagnostics) should be considered when planning free tissue transfer.

A diagnosis of an intracranial aneurysm depends on the angiographic configuration and should be cautiously differentiated from aneurysm mimics. In cases of duplicate anterior choroidal arteries (AChAs), infundibular widening of the distal minor AChA can be an aneurysm mimic. If the minor AChA with a smaller diameter is obscured angiographically due to poor contrast filling, an associated infundibular widening beside the proximal large AChA can misinterpreted as a typical AChA aneurysm in angiograms. The authors report on two such cases of duplicate AChAs with infundibular widening presenting like a typical AChA aneurysm in angiograms. Surgical exploration revealed a perforating artery emitting from the dome of the saccular lesion, confirming infundibular widening of a duplicate AChA. No reparative procedure was applied to the infundibular widening in a 48-year-old man, while two vascular outpouchings from the infundibular widening were clipped preserving the duplicate AChA in a 55-year-old woman. [ABSTRACT FROM AUTHOR]

Intracranial dural arteriovenous fistulas (DAVFs) are rare lesions accounting for 10 to 15% of intracranial arteriovenous malformations. They involve an anomalous shunt between meningeal arteries, intracranial (venous sinuses and/or cortical veins), or medullary veins. The DAVFs are usually acquired, implying previous aggression of the dura mater. Thus, they are associated with dural sinus thrombosis, previous craniotomy, and trauma. However, they are idiopathic in most instances and have no evident cause. Their clinical presentation is variable, with symptoms depending on their location and venous drainage pattern. However, lesions with cortical venous drainage have the highest risk of causing the most significant morbidity and mortality. High clinical suspicion alongside noninvasive cross-sectional imaging techniques such as computed tomography and magnetic resonance imaging help establish the diagnosis. Digital subtraction angiography is the gold standard for diagnosis and accurate classification, permitting the evaluation of the feeding vessels, cortical venous drainage, and venous ectasia. Accordingly, a prompt diagnosis and precise classification of these lesions are essential. Endovascular treatment is nowadays the primary therapeutic modality for DAVFs. The access route can be divided into transarterial, transvenous, and combined approaches based on angioarchitecture, venous drainage model, and location. Surgical resection and stereotactic radiosurgery may be considered in some cases. A personalized case-by-case approach accomplishes a high complete treatment grade with a low complication rate. This review highlights the epidemiology, pathogenesis, clinical presentation, classification, diagnosis, and endovascular treatment of patients with intracranial DAVFs. [ABSTRACT FROM AUTHOR]

Primary angiitis of central nervous system (PACNS) is a rare idiopathic disorder affecting blood vessels of brain, spinal cord, and meninges, consequently leading to infarct and less frequently hemorrhage. CNS vasculitis can also occur as part of systemic vasculitis or secondary to autoimmune diseases or infections. The clinical manifestations of PACNS are non specific and no single laboratory investigation or neuroimaging finding can reliably diagnose this condition. Histopathological evidence of transmural inflammation of blood vessels of CNS is the gold standard, but is generally pursued subsequent to conventional angiogram (CA) because of its invasive nature. The differentials of PACNS are exhaustive and include systemic vasculitis, secondary vasculitis, non inflammatory intracranial vasculopathies, demyelination, and neoplasm. These alternative conditions can often be distinguished by history, examination, immunological testing, cerebrospinal fluid analysis, and neuroimaging. CA can detect vasculitic changes in the large to medium cerebral arteries but the specificity is low. Recent advancements in vessel wall imaging techniques have further enabled the distinction of various intracranial vasculopathies from CNS vasculitis. The disease has considerable morbidity and fatality unless timely treatment with immunosuppressive agents is initiated. Induction therapy with glucocorticoids and cyclophosphamide followed by azathioprine, mycophenolate mofetil, or methotrexate as maintenance therapy is the cornerstone of management. Biological agents such as rituximab and anti tumour necrosis factor alpha inhibitors (infliximab and etanercept) may be used in refractory cases. This review discusses the approach to the diagnosis, determinants of outcome, and management. [ABSTRACT FROM AUTHOR]

Coronary artery calcium scores are derived from cardiac-gated noncontrast computed tomography scans that are used in cardiac risk stratification. However, an elevated calcium score does not always translate to coronary artery luminal obstruction. Our case demonstrates an extremely high coronary artery calcium score despite nonobstructive coronaries on angiogram.

Objective: Calcified coronaries still remain a major challenge for interventional cardiologist. This study aims to evaluate safety and efficacy of intravascular lithotripsy (IVL) in management of coronary artery calcification. Methods: This was a retrospective single centre study regarding the utility of IVL in management of calcified coronaries. Patients with hemodynamically stable acute coronary syndrome or symptomatic chronic coronary syndrome (CCS) and calcified coronaries on angiography and who underwent IVL were enrolled. Intravascular imaging was performed wherever feasible. The primary endpoint was procedural success. In addition, data regarding procedural complications were collected. Results: A total of 29 patients underwent IVL with a majority being males and having comorbidities such as hypertension and diabetes. A procedural success rate of 93.1% was achieved with no patient having >50% residual stenosis. IVL catheter was successfully delivered in all patients. The mean catheter diameter was 3.3 ± 0.4 mm and mean number of delivered pulses was 70.3 ± 16.4. The arteries most commonly intervened were the left main coronary and the left anterior descending artery. Intracoronary imaging revealed a significant increase in minimum luminal cross-sectional area (MLA) post IVL (pre-MLA: 5.1 ± 2.5 mm2; post-MLA: 10.7 ± 2.9 mm2; P

Background: Every year, across the globe about 1,800,000 people suffers with heart attack and India has the highest rate in the world with almost 25% families having a member who suffered heart attack at least once. One of the solutions to reduce the heart attacks in patients is placing a stent. Once the blockage is identified, it is suggested that a stent with the required size is inserted into the coronary artery. The invasive device and its associated cost automatically leads to a dilemma for both the doctors as well as patients. The young practitioners of cardiology may face a dilemma sometimes whether to go for stent or not. The patients undergoing treatment for cardiac issues would be in a two state mind whether to go for stent or not. The above two dilemmas can be mitigated and confidence of both doctors and patients in decision making can be enhanced with the help of a technology driven application that suggests requirement of stent with a degree of confidence. Methods: The chatbot in our project shall help in taking textual and image based inputs of the information of the heart and coronary artery of a patient and predicts the requirement of stent being placed. The real time data of 50 patients was used in training the model with a data set consisting of 349 scanned images of angiogram. The model developed consists of sequential CNN model with 5 convolutional 2D layers and 5 Maxpool layers. Results: The model could achieve an accuracy of 81%. Conclusions: The authors have successfully developed and tested a machine learning based chatbot model to predict the need of a stent in cardiac treatment.

Primary angiitis of central nervous system (PACNS) is a rare idiopathic disorder affecting blood vessels of brain, spinal cord, and meninges, consequently leading to infarct and less frequently hemorrhage. CNS vasculitis can also occur as part of systemic vasculitis or secondary to autoimmune diseases or infections. The clinical manifestations of PACNS are non-specific and no single laboratory investigation or neuroimaging finding can reliably diagnose this condition. Histopathological evidence of transmural inflammation of blood vessels of CNS is the gold standard, but is generally pursued subsequent to conventional angiogram (CA) because of its invasive nature. The differentials of PACNS are exhaustive and include systemic vasculitis, secondary vasculitis, non-inflammatory intracranial vasculopathies, demyelination, and neoplasm. These alternative conditions can often be distinguished by history, examination, immunological testing, cerebrospinal fluid analysis, and neuroimaging. CA can detect vasculitic changes in the large to medium cerebral arteries but the specificity is low. Recent advancements in vessel wall imaging techniques have further enabled the distinction of various intracranial vasculopathies from CNS vasculitis. The disease has considerable morbidity and fatality unless timely treatment with immunosuppressive agents is initiated. Induction therapy with glucocorticoids and cyclophosphamide followed by azathioprine, mycophenolate mofetil, or methotrexate as maintenance therapy is the cornerstone of management. Biological agents such as rituximab and anti-tumour necrosis factor alpha inhibitors (infliximab and etanercept) may be used in refractory cases. This review discusses the approach to the diagnosis, determinants of outcome, and management.

The Corona Mortis vessel is an anastomosis between the obturator and external iliac or inferior epigastric vasculature. It can be arterial, venous, or both. Its injury is a source of severe hemorrhage during hernia repairs, urological, gynecological, and orthopedic procedures. We present a case of a 53-year-old female patient with a history of peripheral arterial disease that underwent angioplasty for limb salvage that resulted in injury of the Corona Mortis variant and a subsequent persistent pelvic hemorrhage. Hemostasis of extravasation was achieved through coil embolization and patient recovered without any complications. This is the first publication in vascular surgery literature that we are aware of where an injury can result in life-threatening hemorrhage from the Corona Mortis.

Background: Persistent trigeminal artery or persistent primitive trigeminal artery (PTA) is the most common carotid-basilar anastomosis in both cadaveric and live patient studies, followed by persistent hypoglossal and persistent otic arteries. Approximately 0.2% of all angiographies reported this finding. Case report: We present the case of a 21-year-old male who arrived at the emergency department with tonic‒clonic seizures. After performing diagnostic contrast magnetic resonance imaging and digital subtraction angiography, the patient was diagnosed with a right occipital arteriovenous malformations (AVM) fed by the right calcarine artery associated with an ipsilateral PTA. After considering surgical and endovascular treatment options, the patient was selected for watchful waiting. We included a literature review of the PTA, the results of a PubMed search regarding the combined presence of these findings, and a brief discussion providing insight into the implications for treatment. Conclusions: Although several studies have linked PTA to different vascular pathologies, such as cerebral aneurysms, the association between PTA and AVMs remains scarce. This case, along with the literature review, shows that further research is needed to characterize the relationship between these findings. [ABSTRACT FROM AUTHOR]

This article presents the results of the joint work of specialists in the field of image analysis and ophthalmologists on the task of analyzing images obtained by the method of optical coherence tomography angiography. A descriptive algorithmic scheme for analyzing images obtained using optical coherence tomography angiography is built to automate the detection of pathological changes in the morphometric characteristics of the fundus. The algorithmic scheme is based on the methods of image processing, analysis, and recognition. The previously developed feature space is supplemented and modified, based on which it is possible to identify pathological changes in the structure of the choroid plexuses of the human retina. It was possible to improve the accuracy of classifying images of healthy and pathological eyes, as well as significantly increasing the accuracy of classification of borderline cases. Software is created that makes it possible to accurately carry out differential diagnostics of the normal state of vessels from the pathological one in the offline mode, which increases its diagnostic value. It is planned to achieve higher classification accuracy results for all three cases. [ABSTRACT FROM AUTHOR]

The adoption of the transradial approach (TRA) has been increasing in popularity as a primary method to conduct both diagnostic and therapeutic interventions. As this technique gains broader acceptance and use within the neuroendovascular community, comparing its complication profile with a better-established alternative technique, the transfemoral approach (TFA), becomes more important. This study aimed to evaluate the safety of TRA compared with TFA in patients undergoing diagnostic, therapeutic, and combined neuroendovascular procedures. A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of PubMed and other databases was conducted for studies from all available dates. To compare TRA and TFA, we performed an indirect meta-analysis between studies that mentioned the complications of the procedures. Our search yielded 532 studies, of which 108 met full inclusion criteria. A total of 54,083 patients (9137 undergoing TRA and 44,946 undergoing TFA) were included. Access site complication rate was lower in TRA (1.62%) compared with TFA (3.31%) (P < 0.01). Neurological complication rate was lower in TRA (1.64%) compared with TFA (3.82%) (P = 0.02 and P < 0.01, respectively). Vascular spasm rate was higher in TRA (3.65%) compared with TFA (0.88%) (P < 0.01). Wound infection complication rate was higher in TRA (0.32%) compared with TFA (0.2%) (P < 0.01). Patients undergoing TFA are significantly more likely to experience access site complications and neurological complications compared with patients undergoing TRA. Patients undergoing TRA are more likely to experience complications such as wound infections and vascular spasm. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the enhancement of lung parenchyma on dual‐energy (DE) computed tomogram (CT) by comparing attenuation between routine post‐contrast and dual‐energy generated virtual unenhanced (VU) images. Methods: Patients presenting to the Emergency Department who subsequently underwent DE‐CT pulmonary angiogram from the 1st to the 30th of November were enrolled. The DE data set obtained was used to generate VU images. Attenuation in Hounsfield units (HU) was measured at two sites for each patient and compared between VU and routine post‐contrast (PC) reconstructions. Statistical analysis was performed using paired‐samples t‐test. Results: There is a statistical difference between lung parenchymal attenuation value between the CV and PC images, denser in the PC dataset and also towards the bases, with a mean HU of −841 and −817 (difference of 24) respectively. Conclusions: This study confirms increased lung parenchymal density when comparing PC and VU reconstructions. Based on results, the paper recommends utilising dual‐energy capabilities for VU reconstructions in CTPAs to optimise assessment of lung parenchyma. [ABSTRACT FROM AUTHOR]