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Background Endovascular repair of aortic aneurysms involving the visceral segment of the aorta often requires placement of a covered bridging stent in the celiac axis (CA). The median arcuate ligament (MAL) is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. The ligament may compress and distort the celiac artery and result in difficult cannulation, or stenosis and occlusion of the vessel. This study evaluated the influence of the MAL compression on the technical success and the patency of the celiac artery after branched and fenestrated endovascular aortic repair. Methods We retrospectively analyzed a cohort of consecutive patients treated electively for complex aneurysms with branched and fenestrated endovascular aortic repair between January 2007 and April 2014. All data were collected prospectively. Analysis of preoperative computed tomography angiography on a three-dimensional workstation determined the presence of MAL compression. Patency of the CA bridging stent was assessed during follow-up by computed tomography angiography and duplex ultrasound evaluation. Statistical analysis was performed to compare the outcomes of patients with MAL (MAL+) and without MAL (MAL-) compression. Results Of 315 patients treated for aortic disease involving the visceral segment during the study period, 113 had endografts designed with a branch (n = 57) or fenestration (n = 56) for the CA. In 45 patients (39.8%), asymptomatic compression of the CA by the MAL was depicted (MAL+). Complex endovascular techniques were required in this group to access the CA in 16 (14.2%) patients (vs none in the MAL- group; P = .003), which lead to a failed bridging stent implantation in seven patients (6.2%). Increased operative time and dose area product were observed in the MAL+ group, but this did not reach statistical significance. In the MAL+ group, no thrombosis of the CA bridging stents were observed during follow-up; an external compression of the CA bridging stent was depicted in six patients but without hemodynamic effect on duplex ultrasound imaging. In the MAL- group, one CA bridging stent occlusion occurred owing to an embolus from a cardiac source. Conclusions MAL compression is associated with good celiac trunk bridging stent patency during follow-up, but with a higher rate of technical difficulties and failed bridging stent implantation during the procedure. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the impact of preemptive inferior mesenteric artery (IMA) embolization on outcomes of endovascular abdominal aortic aneurysm (AAA) repair (EVAR).Materials and Methods: From January 2015 to July 2017, all patients undergoing elective EVAR or fenestrated EVAR (F-EVAR) for asymptomatic AAA in a single tertiary hospital were retrospectively included. Three groups of patients were defined: patients with a patent IMA who underwent embolization during EVAR/F-EVAR (group 1), those with a patent IMA who did not undergo embolization during EVAR/F-EVAR (group 2), and those with a chronically occluded IMA (group 3). Preoperative aortic morphology, demographics, and procedural details were recorded. Aneurysmal growth (≥5 mm), reintervention, and overall mortality rates were analyzed using multivariate proportional hazard multivariate modeling. Propensity scores were constructed, and inverse probability weighting was applied to a new set of multivariate analyses to perform a sensitivity analysis.Results: A total of 266 patients (male, 95% [n = 249]) with a median age of 70 (65-77) years were included, with F-EVAR procedures comprising 87 (32.7%) of the interventions. There were 52, 142, and 72 patients in groups 1, 2, and 3, respectively. Changes in aneurysmal sac size did not differ between groups, nor did overall survival or reintervention rates at 24 months. IMA embolization was not identified as an independently protective factor for aneurysmal growth during follow-up (relative risk [RR] = 2.82/mm [0.96-8.28], P = .060), whereas accessory renal arteries (RR = 5.07/mm [1.72-14.96], P = .003) and a larger preoperative aneurysmal diameter (RR = 1.09/mm [1.03-1.15], P = .004) were independent risk factors for sac enlargement.Conclusions: Preventive embolization of the IMA during EVAR or F-EVAR did not promote aneurysmal sac shrinking or decrease the reintervention rate at 2-year follow-up. [ABSTRACT FROM AUTHOR]

This study compares and contrasts the travertine depositional facies of two of the largest sites of travertine formation, located in very different geological contexts, i.e. the modern Mammoth Hot Spring (MHS) system in the active volcanic complex of Yellowstone National Park (USA) and the Pleistocene Cakmak quarry, a well-exposed example of the Ballık travertines in the extensional Denizli Basin (Turkey). New, 2D to 3D facies maps of both travertine systems, combined with microscopy, assist in proposing an integrated spring depositional model, based on the existing MHS facies model, understanding general controls on meter to kilometer scale travertine deposit architecture and its preservation, and provide quantitative estimates of facies spatial coverage and slope using GIS. The comparison resulted in the distinction of eight facies, grouped in five downstream facies zones from Vent to Distal Slope. Notwithstanding the different geological context of both travertine systems, observations show that several of the facies are strikingly comparable (draping Apron and Channel Facies, top-slope Pond Facies, crystalline Proximal Slope Facies and Distal Slope Facies), whereas other facies do not have a precise, exposed equivalent (Vent Facies, pavement Apron and Channel Facies, extended Pond facies and phyto Proximal Slope Facies). Combining observations of active springs at MHS with the Cakmak vertical travertine quarry exposures demonstrates that lateral and vertical facies transitions are a sensitive record of changes in the spring dynamics (flow intensity and paths) that become well-preserved in the geological record, and can be recognized as prograding, aggrading, retrograding trends or erosive surfaces, traceable over tens to hundreds of meters. Quantification of facies specific coverage at MHS shows that Proximal and Distal Slope Facies deposits cover as much as ∼90% of the total mapped surface area. In addition, only ∼7% of the surface is found to be marked by a waterfilm related to an active flowing spring. Slope statistics reveal that strong slope breaks can often be related to transgressive Apron and Channel Facies belts and that variable, but steep slopes (up to 40°) are dominated by Proximal Slope Facies, in agreement with the Cakmak exposures. Integrating travertine facies and architecture of deposits formed in distinct geological contexts can improve the prediction of general spring facies distributions and controls in other, modern and ancient, subsurface travertine systems. [ABSTRACT FROM AUTHOR]

• Les anticorps spécifiques des myosites (ASM) et anticorps associés aux myosites (AAM) dans la sclérodermie systémique (ScS). • La prévalence des ASM/AAM, des ASM et des AAM était respectivement de 17 %, 8,0 % et 9,7 %. • La prévalence isolée de chaque anticorps était faible (inférieure à 5 %). • La positivité des AAM était associée à la pneumopathie intesticielle et à la myosite. • Aucune association clinique n'a été mise en évidence avec les ASM. Dans la sclérodermie systémique (ScS) et les myopathies inflammatoires idiopathiques (MII), les auto-anticorps sont utilisés dans la pratique quotidienne comme biomarqueurs des phénotypes cliniques. Cette étude vise à estimer la prévalence des anticorps spécifiques des myosites (ASM) et des anticorps associés aux myosites (AAM) en utilisant deux tests immunoblots différents dans une cohorte de patients atteints de ScS bien caractérisés, puis à étudier leurs associations cliniques. Dans cette étude transversale, les sérums de 300 patients ont été testés de façon consécutive, avec réalisation simultanée des tests immunoblots « myosites » Euroimmun® et D-tek®. La prévalence des ASM/AAM, ASM et AAM était respectivement de 17,0 %, 8,0 % et 9,7 %. En combinant les résultats des deux tests, des anticorps anti-PM/Scl 100 étaient présents chez 5,0 % (intervalle de confiance à 95 % : 2,8 ; 8,1) ; anti-PM/Scl 75 et anti-TIF1γ chez 3,7 % (1,8 ; 6,5) ; anti-Ku chez 3,0 % (1,4 ; 5,6) ; anti-MDA5 chez 1,3 % (0,4 ; 3,4) ; anti-Mi-2 β, anti-NXP2, anti-PL-7 et anti-SRP chez 0,7 % (0,08 ; 2,4) ; anti-EJ et anti-PL-12 chez 0,3 % (0,01 ; 1,8) des patients. Aucune réactivité anti-SAE1, Jo-1 ou OJ n'a été observée. Les anticorps anti-PM/Scl 75 étaient associés à la pneumopathie interstitielle (80 % contre 42 %) et la myosite (27 % contre 3 %) ; les anticorps anti-Ku étaient associés avec la myosite (33 % contre 3 %). Dans cette étude transversale portant sur 300 patients atteints de ScS, la prévalence des ASM/AAM, des ASM et des AAM, testés à partir de deux immunoblots différents, était respectivement de 17,0 %, 8,0 % et 9,7 %. La positivité des AAM était associée à la pneumopathie interstitielle et à la myosite, mais cette étude n'a pas mis en évidence d'association clinique avec les ASM. [ABSTRACT FROM AUTHOR]

Objective: In systemic sclerosis (SSc) and idiopathic inflammatory myopathies (IIM), auto-antibodies are used in daily practice as potent biomarkers of clinical phenotypes. This study aimed at estimating the prevalence of myositis-specific (MSA) and myositis-associated (MAA) auto-antibodies in a well-characterised SSc patients cohort using two different immunoblot assays, and studying their clinical associations.Methods: In this cross-sectional study, the sera of 300 consecutive patients were tested at the same time with myositis antibodies Euroimmun® and D-tek® immunoblot assays.Results: Prevalence of MSA/MAA, MSA and MAA were 17.0%, 8.0% and 9.7%, respectively. When combining results of both tests, anti-PM/Scl 100 were found in 5.0% (95% confidence interval 2.8; 8.1); anti-PM/Scl 75 and anti-TIF1γ in 3.7% (1.8; 6.5); anti-Ku 3.0% (1.4; 5.6); anti-MDA5 in 1.3% (0.4; 3.4); anti-Mi-2 β, anti-NXP2, anti-PL-7 and anti-SRP in 0.7% (0.08; 2.4); anti-EJ and anti-PL-12 in 0.3% (0.01; 1.8) of patients. No reactivity against SAE1, Jo-1 or OJ was observed. Anti-PM/Scl 75 antibodies were associated with interstitial lung disease (80% vs. 42%) and myositis (27% vs. 3%); anti-Ku antibodies were associated with myositis (33% vs. 3%).Conclusion: In this cross-sectional study of 300 SSc patients, the prevalence of MSA/MAA, MSA and MAA using immunoblot assays were 17.0%, 8.0% and 9.7%, respectively. MAA positivity was associated with ILD and myositis, but this study did not highlight any clinical associations with MSA positivity. [ABSTRACT FROM AUTHOR]