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Objectives: Stroke or cerebrovascular accident is associated with defects in the circle of Willis; the vascular network that supplies the brain. There is currently lack of literature on the involvement of the circle of Willis in patients with stroke or its association with impending stroke. The objective of the study was to evaluate luminal diameter of arteries that constitute the circle of Willis in patients with stroke using computed tomography angiography (CTA) and magnetic resonance imaging (MRI) scans. Material and Methods: Angiograms of 340 male and female patients aged 15–>75 (40.18 ± 1.1 and 43.68 ± 1.18) years with suspected stroke, referred for either brain CTA or MRI in selected hospitals/diagnostic centers in Nigeria were evaluated using RadiAnt and the MicroDicom viewer software applications. A retrospective descriptive research design was adopted with approval from the federal health research ethics committee. Direct measurement of luminal diameter of major arteries of the circle of Willis was done using SPSS version 25 at P < 0.05. Results: From the 340 images assessed, 256 (75.29%) patients had ischemic stroke with luminal diameter of arteries of the circle of Willis ranged from 1 mm to >3 mm while 84 (24.71%) patients were without stroke with luminal diameter ranged from 1 mm to 2.11 mm (P < 0.05). Conclusion: Patients with stroke have larger luminal diameter of arteries that form the circle of Willis when compared to patients without stroke. The study has established for the 1st time, luminal diameter of circle of Willis that may be an index in the sampled Nigerian population.

We attempted to improve the accuracy of coronary CT angiography (CCTA)-derived fractional flow reserve (FFR) (FFRCT) by expanding the coronary tree in the computational fluid dynamics (CFD) domain. An observational study was performed to evaluate the effects of extending the coronary tree analysis for FFRCT from a minimal diameter of 1.2 to 0.8 mm. Patients who underwent CCTA and interventional FFR were enrolled retrospectively. Seventy-six patients qualified based on the inclusion criteria. The three-dimensional (3D) coronary artery tree was reconstructed to generate a finite element mesh for each subject with different lower limits of luminal diameter (1.2 mm and 0.8 mm). Outlet boundary conditions were defined according to Murray’s law. The Newton–Krylov–Schwarz (NKS) method was applied to solve the governing equations of CFD to derive FFRCT. At the individual patient level, extending the minimal diameter of the coronary tree from 1.2 to 0.8 mm improved the sensitivity of FFRCT by 16.7% (p = 0.022). This led to the conversion of four false-negative cases into true-positive cases. The AUC value of the ROC curve increased from 0.74 to 0.83. Moreover, the NKS method can solve the computational problem of extending the coronary tree to an 0.8-mm luminal diameter in 10.5 min with 2160 processor cores. Extending the reconstructed coronary tree to a smaller luminal diameter can considerably improve the sensitivity of FFRCT. The NKS method can achieve favorable computational times for future clinical applications. • Extending the reconstructed coronary tree to a smaller luminal diameter can considerably improve the sensitivity of FFR CT . • The NKS method applied in our study can effectively reduce the computational time of this process for future clinical applications.

Although the adverse events of pathologic Vieussens' arterial ring (VAR) have been reported, it is difficult to determine optimal clinical management. Thus, we hypothesized that the luminal diameter ratio of VAR obtained from coronary computed tomography angiography (CCTA) could be used as a clinical tool to inform appropriate patient management.A total of 29 patients with pathologic VAR were retrospectively recruited for this study. The VAR luminal diameter ratio was defined as a quotient of VAR fistula divided by the orifice of RCA or LAD, based on which, patients were divided into small fistula group and large fistula group. The AUC, sensitivity, specificity, positive and negative predictive values were obtained from ROC curve. The cutoff value of the VAR luminal diameter ratio was calculated and assessed during the follow-up.The VAR luminal diameter ratio of fistula/RCA orifice was 0.505 ± 0.098 in small fistula group and 1.020 ± 0.150 in large fistula group. The VAR luminal diameter ratio of fistula/LAD orifice was 0.507 ± 0.123 in small fistula group and 1.039 ± 0.151 in large group. The value was correlated with the choice of the treatment (r = 0.643 p 0.01, r = 0.627 p 0.01). The AUC, sensitivity, specificity, positive and negative predictive values were 0.803, 54.5%, 100%, 100% and 78.3% of the fistula/RCA orifice ratio and 0.833, 63.64%, 94.44%, 87.5% and 81.0% of the fistula/LAD orifice ratio, respectively. The cutoff values of both fistula/RCA orifice and fistula/LAD orifice ratios were 0.676.The VAR luminal diameter ratio may be a valuable index to determine appropriate treatment for patients with pathologic VAR.

Objective: The objective of the study was to develop a reference luminal diameter (LD) of the abdominal aorta (AA) in Abuja, Nigeria. Methods: The LD of the AA of 422 male and female healthy subjects was measured sonographically using standard protocol. The relationship between age, body mass index (BMI), gender, and the LD of the AA was determined in the subjects. Statistical analysis was performed by the Student’s t-test and Pearson’s correlation coefficient at p < 0.05 level of significance. Results: The values of the LD of the AA in the healthy subjects were 15.16 ± 0.55 mm in males and 15.15 ± 0.55 mm in females. The 5th and 95th percentile normal reference limits of the AA were 14.20–16.10 mm, respectively. There were no significant differences in the LD measurements in male and female subjects. Age correlated strongly positively with LD (ɼ=0.90) of the AA in both genders. BMI showed weak positive correlation with LD (ɼ=0.136) of the AA in female healthy subjects only. Conclusion: The reference LD of the AA in the study population was 15.16 ± 0.55 mm in males and 15.15 ± 0.55 mm in females. The LD of the AA increased proportionately with age.

This study evaluated the calcium blooming-reducing effect and the differences of luminal diameter among various-energy virtual monochromatic images (VMIs) using rapid kilovolt-switching dual-energy computed tomography (DECT). Forty-five calcified segments in 31 patients were analyzed. For the analysis, 40- to 140-keV VMIs on both non-contrast CT and coronary CT angiography were generated at 10-keV steps, and calcification size and luminal diameter were measured using CT number profile curve and full-width at half-maximum method. We compared calcification size and luminal diameter on each keV VMIs with those on 70-keV VMI. There was no significant differences among the 40- to 140-keV VMIs regarding calcification size or luminal diameter. The 40- to 140-keV VMIs produced by single-source DECT had no effect on the calcification size or luminal diameter in the coronary artery.

Background: Many researches and studies were performed to investigate many aspects of the vermiform appendix. Many variations were observed at the different regions, among that, the focus was made on the lymphoid number and diameter, wall thickness, and luminal diameter. Objective: The aim of this work was to a finding of histomorphometery features of the adult vermiform appendix for different sex and age groups. Materials & methods: Fifty cadavers were included and divided into five age groups; A(20-29), B(30-39), C(40-49), D(50-59), and E(60-70)years. Ten cadavers were included for each age group. The inclusion criteria of the cadavers were brain stroke, built injuries, sudden death, car accident, and angina pectorals. The exclusion was with gangrenous, grossly inflammation and perforated appendices cadavers. Total length was measured from the base to the tip, as well as the diameter using a digital vernier caliper. Histological slides were made using HE Number and diameter of lymphoid follicles. Male and females have shown clear differences with increasing age groups.

Background We sought to compare quantitative coronary CT angiography (CTA) assessment versus standard clinical reading to identify heart transplanted (HTX) patients with progressive coronary wall thickening. Methods 35 patients (23 males, age 58 [IQR: 50;61] years) underwent 256-slice coronary CTA at one year and two years after HTX to rule out cardiac allograft vasculopathy (CAV). In addition to the standard clinical read, we quantified total vessel wall volume in all coronaries up to 2-mm luminal diameter. Fixed threshold settings were used to assess calcified (>350 HU) and non-calcified vessel wall components with high- (131–350 HU), intermediate- (75–130 HU) and low-attenuation ( Results Total lumen volume did not change between baseline and follow-up studies (p = 0.59). Total vessel wall volume showed significant increase (464 [IQR: 338; 570] vs. 563 [IQR: 345; 717] mm3, p Conclusion Quantitative coronary wall assessment is feasible with coronary CTA in HTX patients. Coronary wall thickening within the first two years after HTX is mainly attributable to non-calcified lesion components and might be an early sign of CAV.

Here we describe the use of a VBX balloon expandable stent-graft (WL Gore, Flagstaff, AZ, USA) to treat a right brachiocephalic vein stenosis in a haemodialysis patient prior to ipsilateral upper limb arterio-venous (AV) fistula formation. Balloon expandable stent-grafts are unsuitable for treating peripheral fistula stenoses due to their susceptibility of being crushed. The right brachiocephalic vein is both relatively short in comparison to the left and is less susceptible to extrinsic compression and the use of such a device to treat stenosis here allows for very accurate placement and restoration of luminal diameter. The advantages and disadvantages of using these devices in haemodialysis access circuits are also discussed herein, in what we believe to be the first report of the application of a dedicated commercially available balloon expandable stent graft in a haemodialysis patient.

Introduction This cross-sectional study sought to survey the current practice of computed tomography prior to transcatheter aortic valve implantation (CT-TAVI) in the United Kingdom. Methods All members of the British Society of Cardiovascular Imaging (BSCI) were invited to complete a 27-item online CT-TAVI survey. Results 47 responses were received from 40 cardiac centres, 23 (58%) of which performed TAVI on-site (TAVI centres). Only 6 respondents (13%) performed high volume activity (>200 scans per year) compared with 13 (28%) performing moderate (100–200 scans per year) and 27 (59%) performing low (0–99 scans per year) volume activity. Acquisition protocols varied (41% retrospective, 12% prospective with wide padding, 47% prospective with narrow padding), as did the phase of reporting (45% systolic, 37% diastolic, 11% both, 6% unreported) and use of beta blockade (22%). Median dose length product (DLP) was 675 mGy.cm (interquartile range 477 - 954 mGy.cm). Compared with non-TAVI centres, TAVI centres were more likely to report minimum ilio-femoral luminal diameter (n=25, 96% versus n=7, 58%, p=0.003) and optimal tube angulation for intervention (n=12, 46% versus n=1, 8%, p=0.02). TAVI centres trended towards using lower contrast volume than non-TAVI centres (98±27 vs. 118±42 ml, p=0.06); radiation doses did not differ (766±502 vs 801±461mGy.cm, p=0.66). Conclusion This national survey formally describes current CT-TAVI practice in the United Kingdom. High volume activity was only present at 1 in 7 cardiac CT centres. There is wide variation in scan acquisition, scan reporting and radiation dose exposure.

AimsOptical coherence tomography (OCT)-guided external elastic lamina (EEL)-based stent sizing is safe and as effective as intravascular ultrasound in achieving post-procedural lumen dimensions. However, when compared with automated lumen diameter (LD) measurements, this approach is time-consuming. We aimed to compare vessel diameter measurements and stent diameter selection using either of these approaches and examined whether applying a correction factor to automated LD measurements could result in selecting similar stent diameters to the EEL-based approach.Methods and resultsWe retrospectively compared EEL-based measurements vs. automated LD in reference segments in 154 OCT acquisitions and derived a correction factor for stent sizing using the ratio of EEL to LD measurements. We then prospectively applied the correction factor in 119 OCT acquisitions. EEL could be adequately identified in 100 acquisitions (84%) at the distal reference to allow vessel diameter measurement. Vessel diameters were larger with EEL-based vs. LD measurements at both proximal (4.12 ± 0.74 vs. 3.14 ± 0.67 mm, P 0.25 mm in 63% and potentially hazardous stent oversizing in 41% of cases.ConclusionEEL-based stent downsizing led to selection of larger stent diameters vs. LD upsizing. While applying a correction factor to automated LD measurements resulted in similar mean diameters to EEL-based measurements, this approach cannot be used clinically due to frequent and potentially hazardous stent over-sizing.

To select animals of appropriate size for preclinical studies of cardiovascular devices, reference knowledge of the cardiovascularanatomy relative to body weight is crucial. We measured the luminal diameters of the arteries (carotid, femoral, and iliac arteries) that are the common access vessels for endovascular and vascular procedures in Yorkshire×Landrace swine. Measurements were performed by using both ultrasound and angiographic methods and were correlated with body weight. Results showed no statistically significant difference between the left and right vessels in the diameters of the carotid,femoral, and iliac arteries. The diameters of the measured arteries showed high correlation with animal weight in pigs thatweighed less than 70 kg.

Background:Giant coronary aneurysms are the most severe complications of Kawasaki disease. There are few reports of outcomes from China. Most previous studies were based only on absolute aneurysmal dimensions. The aim of the present study was to catalog the outcomes of Kawasaki disease with giant coronary aneurysms in southwest China based on absolute dimensions and the z-score adjusted for body surface area.Methods and results:All patients diagnosed with giant coronary aneurysms (z-score ≥ 10 or absolute dimension ≥ 8 mm) between December, 2002 and December, 2018 were included. We retrospectively analysed patient characteristics and clinical data from 38 patients with giant coronary aneurysms. Over a median follow-up period of 30.5 months (range from 1.7 months to 22.3 years), including patients in chronic phase who had been diagnosed prior to 2002, eight patients had myocardial infarction, including two deaths and one patient with coronary artery bypass grafting. The 1-, 2-, and 5-year event-free rates were 0.63, 0.63, and 0.53 for thrombosis, respectively, and 0.86, 0.81, and 0.81 for major adverse cardiac events, respectively. The 1-, 2-, and 5-year regression-free rates were 0.94, 0.85, and 0.67, respectively. A total of 73.7% of patients remained active.Conclusion:In the early stages of Kawasaki disease, patients with giant coronary aneurysms often experience major cardiovascular events; however, they are also likely to have normalisation of the coronary internal luminal diameter. With long-term anticoagulation, close cardiologic monitoring, and prompt thrombolytic therapy, most patients can achieve disease-free periods.

Low grade appendiceal mucinous neoplasm (LAMN) is the primary source of pseudomyxoma peritonei (PMP). PMP may develop after seemingly complete resection of primary tumor by appendectomy, which is unpredictable due to lack of reliable prognostic indicators. We retrospectively reviewed 154 surgically resected LAMNs to explore if any of the macroscopic and microscopic characteristics may be associated with increasing risk of PMP development. Our major findings include: (1) As compared to those without PMP, the cases that developed PMP were more frequent to have (a) smaller luminal diameter (1 cm) and thicker wall, separate mucin aggregations, and microscopic perforation/rupture, all suggestive of luminal mucin leakage; (b) microscopic acellular mucin presenting on serosal surface and not being confined to mucosa; and (c) neoplastic epithelium dissecting outward beyond mucosa, however, with similar frequency of neoplastic cells being present in muscularis propria. (2) Involvement of neoplastic cells or/and acellular mucin at surgical margin did not necessarily lead to tumor recurrence or subsequent PMP, and clear margin did not absolutely prevent PMP development. (3) Coexisting diverticulum, resulted from neoplastic or non-neoplastic mucosa being herniated through muscle-lacking vascular hiatus of appendiceal wall, was seen in a quarter of LAMN cases, regardless of PMP. The diverticular portion of tumor involvement was often the weakest point where rupture occurred. In conclusion, proper evaluation of surgical specimens with search for mucin and neoplastic cells on serosa and for microscopic perforation, which are of prognostic significance, should be emphasized.

Background: Growth of the intracranial arteries facilitates the rapid increase in cerebral growth in the first 2 decades of life. In the age of cerebral endovascular treatment, many questions arise in the pediatric cohort regarding the safety and efficacy of these therapeutic approaches. Small arterial diameter may influence treatment selection in the very young, but to date little normative data is available to define vascular growth in infants and children. Methods: Subjects in this single-institution, retrospective cohort study were identified by MRI brain imaging keyword query as “normal” with age 0-18 years old at the time of the study. Medical records were reviewed to capture weight, length, and head circumference and exclude cerebrovascular or connective tissue disease risk factors. MRI T2-weighted images were measured to calculate the head circumference and arterial diameter in axial and coronal planes. A growth curve was created from the head circumferences and intracranial artery diameters to compare luminal caliber to age, sex and recorded growth parameters. Results: 317 subjects (170 female, 147 male) are included in the analysis. Luminal diameter was observed to increase rapidly in all arterial segments over the first 3 years of life. Compared to weight and length, head circumference most closely correlated with arterial size. Head circumference growth is most rapid during the first 3 years, tracking closely with the rate of luminal growth. An example relationship between arterial diameter and head circumference is shown in Figure 1. Conclusions: This is the largest cohort of cerebral arterial luminal growth in childhood. We show that arterial diameter can be measured non-invasively on MRI brain and correlated to routinely measured growth parameters. A better understanding of normal arterial growth is essential to our treatment of cerebrovascular disease in children.

Objective To examine whether no anisodamine injection before CTE was feasible without impairing image quality and diagnostic performance. Materials The change of mural thickness and luminal diameter were compared between using and no using anisodamine. The diagnostic performance of small-bowel disease was analyzed and compared. Results No motion artifact was detected in two groups. There was no significant difference regarding the change of luminal diameter and mural thickness (all P > 0.05). The diagnostic accuracy of small-bowel disease was no significant difference (P = 0.63). Conclusion Lack of anisodamine injection before CTE did not impair image quality and diagnostic performance compared with CTEs performed with anisodamine injection.

Background: The tracheobronchial tree is a branched distribution system that carries air from the trachea down to the acini which are the gas exchange units of the lung. In the trachea air speed is high and the airway is particularly vulnerable to obstruction by foreign bodies and tumors. The study of the morphological variations of luminal diameter of the trachea is of profound clinical importance as it may help the clinicians for smooth conduction of some maneuvers like endotracheal intubation and bronchoscopic procedure. It also helps the surgeons to deal with resection and reconstruction of the trachea.Objective: The present study was carried out to establish a Bangladeshi standard regarding the luminal diameter of the trachea and to minimize the dependency on foreign standards.Materials and Methods: This cross sectional descriptive study was performed on 70 post mortem human trachea (44 male and 26 female) to find out the difference in luminal diameter of the trachea of Bangledeshi people in relation to age and sex. The specimens were collected from the morgue in the department of Forensic Medicine, Mymensingh Medical College, Mymensingh by purposive sampling technique. All specimens were grouped into three groups according to age ? Group A, B and C. Dissection was performed according to standard autopsy techniques. The trachea was cut horizontally through the upper border of the 5th tracheal ring and the luminal diameter was measured. The average diameter was expressed in centimeter. All data were recorded in the predesigned data sheet and statistical analysis was done using computer based statistical package, SPSS to evaluate the significance of variance between the different findings.Results: In the present study the maximum luminal diameter of the trachea was 1.65 in Group A, 2.05 in Group B and 1.85 cm in Group C. The minimum luminal diameter of the trachea was 0.7 cm in Group A, 0.85 cm in Group B and in Group C 0.85 cm. The mean (±SD) luminal diameter of the trachea was 1.24 ± 0.3, 1.39 ± 0.3 and 1.29 ± 0.23 cm in Group A, B and C respectively. The maximum mean luminal diameter of the trachea was in Group B (1.39 cm) and minimum was in Group A (1.24 cm). The mean difference of luminal diameter of the trachea between groups was statistically non significant at p>0.5 level. The maximum mean (±SD) luminal diameter of the trachea was 1.50 ± 0.3 cm in male in Group B and minimum mean (±SD) luminal diameter of the trachea was 1.17 ± 0.26 cm in female in Group C. The mean luminal diameter of the male trachea was found to be greater than that of the female trachea among the age group. Mean difference between sexes in Group B was statistically highly significant at p

Small-bowel capsule endoscopy (CE) has recently been used in children. During the past few years, an intense research activity has defined the advantages and limitations of CE. Its uses have been established in several small-bowel pathologies such as obvious or obscure digestive bleeding, Crohn disease, and hereditary polyposis. Although the absence of biopsy reduces the specificity of CE findings, small-bowel exploration using CE achieves better accuracy in detecting lesions than most radiological examinations. In children, swallowing problems and the risk of retention due to stenosis are the main concerns when using CE: these problems can be solved using endoscopic delivery of the capsule and luminal diameter calibration, respectively. This review focuses on the evidence making CE indispensable to small-bowel exploration.

Purpose We compared the ability of intracranial high-resolution vessel wall imaging (VWI) without gadolinium and 3-D time-of-flight (3D-TOF) MRA techniques to characterize intracranial arterial stenosis and arterial wall plaque consistent with atherosclerotic plaque. Methods Consecutive intracranial VWI examinations performed within 2 months of a 3D-TOF exam with at least 1 noted plaque was included. Examinations assessed 17 vessel segments for plaque and diameters of stenotic and normal segments using double oblique reformatted images. Results were compared with the VWI and 3D-TOF exams considered the reference standard for plaque and luminal stenosis, respectively. Results Assessed segments totaled 286 from 17 patients. Proximal segment sensitivity and specificity for luminal stenosis detection with VWI was 92.5% and 82.1%, respectively, whereas for assessing plaque with 3D-TOF it was 59.4% and 98.3%, respectively. The mean intra-rater difference in luminal diameter measurements between VWI and 3D-TOF at normal segments and at the area of maximal stenosis was 0.02 mm (SD 0.51 mm) and 0.08 mm (SD 0.66 mm), respectively. Conclusions Intracranial VWI demonstrated reasonably high sensitivity and specificity for luminal stenosis assessment using 3D-TOF as a reference standard, while 3D-TOF demonstrated low sensitivity for plaque detection. Our results suggest that VWI can be used for simultaneous assessment of luminal stenosis and plaque in the intracranial arteries.

BACKGROUND AND PURPOSE: High-resolution MR imaging has recently been introduced as a promising diagnostic modality in intracranial artery disease. Our aim was to compare high-resolution MR imaging with digital subtraction angiography for the characterization and diagnosis of various intracranial artery diseases. MATERIALS AND METHODS: Thirty-seven patients who had undergone both high-resolution MR imaging and DSA for intracranial artery disease were enrolled in our study (August 2011 to April 2014). The time interval between the high-resolution MR imaging and DSA was within 1 month. The degree of stenosis and the minimal luminal diameter were independently measured by 2 observers in both DSA and high-resolution MR imaging, and the results were compared. Two observers independently diagnosed intracranial artery diseases on DSA and high-resolution MR imaging. The time interval between the diagnoses on DSA and high-resolution MR imaging was 2 weeks. Interobserver diagnostic agreement for each technique and intermodality diagnostic agreement for each observer were acquired. RESULTS: High-resolution MR imaging showed moderate-to-excellent agreement (interclass correlation coefficient = 0.892–0.949; κ = 0.548–0.614) and significant correlations ( R = 0.766–892) with DSA on the degree of stenosis and minimal luminal diameter. The interobserver diagnostic agreement was good for DSA (κ = 0.643) and excellent for high-resolution MR imaging (κ = 0.818). The intermodality diagnostic agreement was good (κ = 0.704) for observer 1 and moderate (κ = 0.579) for observer 2, respectively. CONCLUSIONS: High-resolution MR imaging may be an imaging method comparable with DSA for the characterization and diagnosis of various intracranial artery diseases.

ObjectiveThis cross-sectional observational study sought to describe variations in CT in the context of transcatheter aortic valve implantation (CT-TAVI) as currently performed in the UK.Methods408 members of the British Society of Cardiovascular Imaging were invited to complete a 27-item online CT-TAVI survey.Results47 responses (12% response rate) were received from 40 cardiac centres, 23 (58%) of which performed TAVI on-site (TAVI centres). Only six respondents (13%) performed high-volume activity (>200 scans per year) compared with 13 (28%) performing moderate (100–200 scans per year) and 27 (59%) performing low (0–99 scans per year) volume activity. Acquisition protocols varied (41% retrospective, 12% prospective with wide padding, 47% prospective with narrow padding), as did the phase of reporting (45% systolic, 37% diastolic, 11% both, 6% unreported). Median dose length product was 675 mGy.cm (IQR 477–954 mGy.cm). Compared with non-TAVI centres, TAVI centres were more likely to report minimum iliofemoral luminal diameter (n=25, 96% vs n=7, 58%, p=0.003) and optimal tube angulation for intervention (n=12, 46% vs n=1, 8%, p=0.02).ConclusionsThis national survey formally describes current CT-TAVI practice in the UK. High-volume activity was only present at one in seven cardiac CT centres. There is wide variation in scan acquisition, scan reporting and radiation dose exposure in cardiac CT centres.

Background The purpose of this study was to evaluate learning curves for an existing microsurgical training model. We compared efficiency and amount of training needed to achieve proficiency between novice microsurgeons without operative experience versus those who had completed a surgical internship. Methods Ten novice microsurgeons anastomosed a silastic tube model. Time to perform each anastomosis, luminal diameter, and number of errors were recorded. Results First year residents improved up to a brief plateau at 10 repetitions, followed by continued improvement. Second year residents improved up to a plateau at 10 repetitions with no further improvement thereafter. There was no significant difference in luminal area or errors between groups. Conclusion Residents with no operative experience can benefit from early exposure to microsurgical training. These interns continue to improve with additional repetitions while second year residents achieve proficiency with fewer repetitions.

Objective: Predicting which abdominal aortic aneurysms (AAA) will require surgery and which may remain stable remains a challenge. We set out to evaluate whether semi-automatic diameter measurements and finite element analysis (FEA) might predict the four-year prognosis of AAAs more precisely than standard diameter measurements. Methods: From a retrospective dataset of 97 patients with aneurysm baseline diameter of 40-50 mm, 39 AAAs remained below 55 mm in diameter for four years whilst 58 expanded beyond 54 mm within four years, or were treated surgically. Standard diameters, measured by radiologists or vascular surgeons, were recorded at baseline and at follow-up. Maximal external and luminal diameters as well as total and luminal volume were semi-automatically re-measured from 3D models based on CT images. FEA, estimating the peak wall rupture index (PWRI), was subsequently performed. Further, in 94 patients from the dataset, standard diameter growth rates between baseline and follow-up were calculated. Results: Aneurysms that would require surgery within four years were identified with 100% specificity by semi-automatic diameter, n=13 (22%), luminal diameter, n=14 (24%), PWRI, n=7 (12%), and luminal volume, n=5 (8.6%). Neither standard diameter nor total volume could reach 100% specificity. AAA diameter growth rate correlated with baseline semi-automatic diameter (r=0.39, p=9.2e-5), luminal diameter (r=0.29, p=0.005) and luminal volume (r=0.23, p=0.027) but not with PWRI (r=0.17, p=0.094), total volume (r=0.16, p=0.13), nor standard diameter (r=0.14, p=0.17). Conclusion: In AAAs with small diameters, precise, semiautomatic measurement of the maximal external and luminal diameter is able to specifically identify aneurysms requiring surgery within four years.

Purpose To evaluate an EW-7197-eluting nanofiber-covered stent (NFCS) for suppressing granulation tissue formation after stent placement in a canine urethral model. Materials and methods All experiments were approved by the committee of animal research. A total of 12 NFCSs were placed in the proximal and distal urethras of six dogs. Dogs were divided into two groups with 3 dogs each. The control stent (CS) group received NFCSs and the drug stent (DS) group received EW-7197 (1000 μg)-eluting NFCSs. All dogs were sacrificed 8 weeks after stent placement Histologic findings of the stented urethra were compared using the Mann-Whitney U test. Results Stent placement was technically successful in all dogs without procedure-related complications. On urethrographic analysis, the mean luminal diameter was significantly larger in the DS group than in the CS group at 4 and 8 weeks after stent placement (all p < 0.001). On histological examination, mean thicknesses of the papillary projection, thickness of submucosal fibrosis, number of epithelial layers, and degree of collagen deposition were significantly lower in the DS group than in the CS group (all p < 0.001), whereas the mean degree of inflammatory cell infiltration was not significantly different (p > 0.05). Conclusion The EW-7197-eluting NFCS is effective and safe for suppressing granulation tissue formation after stent placement in a canine urethral model.

BACKGROUND A wider angle between the left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX) has been suggested to induce plaque formation in the arterial system via changes in shear stress. However, the relationship between the left main coronary artery (LM)-LAD angle and LAD stenosis has not been investigated. Therefore, we aimed to evaluate the associations between the LM-LAD and LAD-LCX angles and LAD stenosis. METHODS Coronary computed tomography angiographies (CTAs) of 201 patients with suspected coronary artery disease were analyzed. Angle measurements were performed twice by experts using CTA images, and the values were averaged. The patients were divided into two groups, based on the presence of significant LAD stenosis (luminal diameter narrowing ≥50%) on CTA. RESULTS The mean LM-LAD and LAD-LCX angles were 37.46° and 63.04°, respectively. The LM-LAD and LAD-LCX angles of the group with significant LAD stenosis were significantly wider than that of the group with nonsignificant LAD stenosis (P

Abdominal aortic aneurysm (AAA) is a local expansion of the abdominal aorta wall caused by a complex multifactorial maladaptive vascular remodeling. Despite recent advances in the management of cardiovascular diseases, there currently is no established drug therapy for AAA. Since the probability of death from a ruptured AAA still remains high, preventive elective repair of AAAs larger than 5.5 cm in luminal diameter is considered the best treatment option. However, perioperative complications are problematic as elective AAA repair comes with numerous intrinsic risks. Impelled by the need of improving AAA therapy, significant efforts have been made to identify pharmacological tools that would slow down AAA enlargement and lower the risk of rupture, thereby reducing the necessity of surgical intervention. In this review, we discuss recent findings addressing molecular targets that could potentially treat AAA, particularly addressing: statins, classical renin angiotensin system (RAS) blockers, the protective arm of RAS, renin inhibitors, tetracyclines, interleukin-1 beta inhibition, anti-angiogenic agents and urocortins.

Objectives There is limited data on how well 2D-QCA and OCT agree with each other for measurement of coronary artery lumen dimensions. We aimed to assess the agreement between the two modalities. Methods Patients undergoing OCT for assessment of coronary artery lesions were reviewed. Minimum luminal diameter (MLD), proximal reference diameter and distal reference diameter were measured for each lesion prior to stenting. Results OCT was performed in 64 patients and 40 lesions were suitable for analysis. There was a good correlation for proximal and distal reference diameters (r = 0.86, p

Oesophageal stenting is now standard treatment for managing both benign and malignant stenosis of the oesophagus. There is a wide choice in oesophageal stents currently available on the market, with variations in the stent material, size and design. Most oesophageal stents are made from metal alloy compounds for use in malignant strictures, although there are stents made of durable polymers, and now of biodegradable (BD) material, for use in both benign and malignant strictures. With the development of self-expanding plastic stents, self-expanding metal stents and BD stents, stent placement for oesophageal pathologies can be safe and cost-effective. Oesophageal stenting has several challenges for a therapeutic endoscopist which is determined by the location of stricture or tumour, the anatomy of the stenosis and the nature of stent selected. Strictures that have narrow or tortuous lumens can be particularly difficult to stent as the luminal diameter must allow access of at least a 0.035 inch guide wire. This review covers the indications and outcomes of different stents in clinical situations to help rational decision-making.

The purpose of the study The research is aimed at examining histologic and morphometric aspects of the major duodenal papilla which has opisthorchiasis invasion. Materials and methods The research uses cadaveric material taken in the department of morbid anatomy of Surgut regional clinical hospital. All the cases which were included in the study (98 dead patients) had the direct evidence of infection with opisthorchiasis according to post-mortem examination together with information about the length of opisthorchiasis invasion during the life of the patients. The control group included 30 dead patients without the pathology of hepatobiliary tract. The study showed that the opisthorchiasis invasion brings about successive changes in papilla tissues which can be divided into three stages according to morphological criteria - the adenomatous stage, the adenofibrous stage and the sclerotic stage (the names reflect the nature of changes). The analysis of the material was carried out using statistical approach. Results and their discussion Morphological research with sufficient evidence demonstrated specific changes which take place in the tissues of the major duodenal papilla at different stages of papillitis. It also determined that the luminal diameter of papilla is the indicator of these changes. Conclusion The general tendency of changes in the major duodenal papilla brought about by opesthorchiasis can be described as progressive degradation of morphological structures that constitute the tissue of the major duodenal papilla, which results in functional failure of the given anatomical structure.

Objectives: Narrowed right ventricular (RV) outflow conduits and pulmonary arteries (PA) increase RV pressures and warrant interventions. Stent angioplasty is an alternative to more morbid redo-surgery in developing countries. We evaluate the efficacy and safety of stenting and assess need for redo-surgical reinterventions on midterm follow-up after stent angioplasty. Methods: Patients who underwent conduit, main PA and bilateral branch PA stenting for elevated RV pressures were analyzed retrospectively. Success was defined as 20% reduction in RV pressures or RV-aortic pressure ratio; 50% reduction in gradients or 50% increase of luminal diameter. Procedural results, complications and need for redo surgeries on follow-up were assessed. Results: Among 60 patients aged 1–46 years, 57 were post-operative patients, who needed stenting at a median period of 48 months after surgery. Stenting succeeded in 98% and reduced RV pressures from 105.42 ± 28.39 mmHg to 54.46 ± 16.89 mmHg. Direct major procedural complications in five (8%) patients included procedural failure in one, stent migration in three and lung hemorrhage in one. None of the stented conduits needed a surgical change on a follow-up ranging 3–120 months. Following bilateral PA stenting in twenty-four patients, only two needed a repeat open-heart surgery during follow-up ranging 3–108 months. Catheter reinterventions on follow-up included elective percutaneous pulmonary valve implantation in nine patients and stent redilation in seven patients. Conclusions: Stent angioplasty was safe and effective. Surgery was postponed in all stenosed conduits. Elective redilation of stents after bilateral PA stenting may be needed for somatic growth; but open-heart repeat surgeries can be avoided in a majority. Keywords: Stent angioplasty, Conduit stenting, Pulmonary artery stents, Bifurcation stenting

Sizing and planning is the single most important step towards successful endovascular repair of thoracoabdominal and pararenal aortic aneurysms using fenestrated and/or branched stent grafts. Current techniques of sizing are largely based on analysis of aortic morphology using computed tomography imaging datasets and centerline of flow technique. The specific stent design or approach is dependent upon the extent of aneurysm, luminal diameter of the aorta, vessel orientation, presence of atherosclerotic debris and quality of access vessels. Newer adjuncts such as preloaded catheters and guide-wire systems help reduce some of the steps of the procedure and can be incorporated into planning. Lower profile fabric also has helped reduce the need for conduits, especially in women and patients with smaller vessels. This chapter summarizes the key steps for sizing and planning fenestrated and branched endovascular aortic repair.

Although combined supine and prone acquisitions improve the detection of inferolateral obstructive coronary artery disease (CAD), the predictors of inaccurate detection of inferolateral ischemia have not been reported by using cadmium zinc telluride (CZT) myocardial perfusion imaging (MPI).Vasodilator stress (99m)Tc tetrofosmin MPI using CZT camera and coronary angiography was performed in 322 patients within an interval of 2 months. Prone MPI was performed immediately after supine MPI. Narrowing of the luminal diameter ≥ 75% was considered significant. The presence of an abnormality on both supine and prone images was considered significant. Combined supine and prone imaging, compared with supine-only quantification, was more specific (93% vs. 72%, respectively, p0.0001) and accurate (88% vs. 74%, p0.0001) without compromising sensitivity (82% vs. 68%, p=0.10). The area under the curve for detecting inferolateral ischemia was 0.769 (95% CI 0.705-0.833) for supine imaging and 0.802 (95% CI 0.730-0.875) for combined supine and prone imaging (p0.05). Multivariable analysis revealed that previous inferolateral myocardial infarction was an independent predictor of a false diagnosis (odds ratio=3.45, 95% confidence interval [CI] 1.62-7.37, p0.001).Combined supine and prone quantitative CZT MPI enhances the detection of inferolateral CAD without adversely affecting its sensitivity. However, we recommend inferolateral ischemia be monitored in patients with a history of previous inferolateral MI because previous inferolateral MI is a predictor of inaccurate diagnosis.

Objective To compare bursting strength, construction time, and anastomotic dimensions of 4 jejunoileal anastomotic techniques. Study Design Experimental ex vivo study. Animals Adult horses (n = 12). Methods Jejunoileal anastomoses were constructed from harvested ileal and distal jejunal segments using a single-layer Lembert technique (1HS), double-layer simple continuous/Cushing technique (2HS), stapled side-to-side technique (SS), or stapled functional end-to-end technique (FEE). Anastomotic construction time was recorded. Bursting pressures (BP), bursting wall tension (BWT), percentage of mean anastomotic luminal diameter reduction, percentage of luminal diameter reduction relative to adjacent ileal and jejunal diameters and stomal length, were calculated. Results FEE had the shortest construction time. BP of 1HS and 2HS was significantly higher than FEE and SS (P

⁎ Corresponding author at: EMO-GVM Centro Cuore Co E-mail address: info@emocolumbus.it (A. Colombo). Fig. 1. Coronary angiogramand intracoronary image of initia Two bioresorbable scaffoldswere implanted on the proxima luminal diameter, VD: vessel diameter. B. Angiogram at 16 midportion of the LCx and the ectatic lesion (yellow asteris enlargement of the vessel with the maximum scaffold lum figure, the reader is referred to the web version of this artic

BACKGROUND The objective of this study was to assess the regional geometry of the Heineke-Mikulicz (HM) strictureplasty. The HM intestinal strictureplasty is commonly performed for the treatment of stricturing Crohn's disease of the small intestine. This procedure shifts relatively normal proximal and distal tissue to the point of narrowing and thus increases the luminal diameter. The overall effect on the regional geometry of the HM strictureplasty, however, has not been previously described in detail. METHODS HM strictureplasties were created in latex tubing and cast with an epoxy resin. The resultant casts of the lumens were then imaged using computed tomography. Using 3-dimensional vascular reconstruction software, the cross-sectional areas were determined and the surface geometry was examined. RESULTS The HM strictureplasty, while increasing the lumen at the point of the stricture, also results in a counterproductive luminal narrowing proximal and distal to the strictureplasty. Within the model used, cross-sectional area was diminished 25% to 50% below baseline. This effect is enhanced when 2 strictureplasties are placed in close proximity to each other. CONCLUSIONS The HM strictureplasty results in alterations in the regional geometry that may result in a compromise of the lumen proximal and distal to the location of the strictureplasty. When 2 HM strictureplasties are created in close proximity to each other, care should be undertaken to assure that the lumen of the intervening segment is adequate.

Objective. To examine conjunctival lymphatic vessels and to analyze the relationship between lymphangiogenesis and aggressive recurrent pterygia.Methods. Tissues from 60 excised recurrent (including 19 of Grade 1, 28 of Grade 2, and 13 of Grade 3) pterygia were used in the study. Tissues from 9 nasal epibulbar conjunctivae segments were used as controls. Pterygium slices from each patient were immunostained with LYVE-1 monoclonal antibodies to identify lymphatic microvessels in order to calculate the lymphovascular area (LVA), the lymphatic microvessel density (LMD), and the lymphovascular luminal diameter (LVL). The relationship between lymphangiogenesis (LVA, LMD, and LVL) and pterygium aggression (width, extension, and area) was clarified.Results. Few LYVE-1 positive lymphatic vessels were found in the normal epibulbar conjunctiva segments. Lymphatic vessels were slightly increased in Grades 1 and 2 and were dramatically increased in Grade 3 recurrent pterygia. The LMD was correlated with the pterygium area in Grade 1 and 2 pterygia. In Grade 3, both LVA and LMD were significantly correlated with the pterygium area.Conclusions. Lymphangiogenesis was associated with the degree of aggression in recurrent pterygia, particularly in substantial Grade 3 recurrent pterygia.

Objective To evaluate long-term patterns of luminal changes after implantation of different types of drug-eluting stents (DES), we analyzed the serial angiographic outcomes of patients implanted with zotarolimus-eluting stents (ZES), sirolimus-eluting stents (SES), or paclitaxel-eluting stents (PES). Background Little is known regarding long-term luminal changes after DES implantation. Methods As a subgroup analysis of the ZEST trial, we performed complete angiographic evaluation immediately after the procedure and at 9 months and 2 years in 111 patients with 165 lesions (36 patients with ZES, 40 with SES, and 35 with PES). Results Baseline clinical, angiographic, and procedural characteristics were similar among the three groups. Quantitative angiographic analysis revealed significant decreases in minimal luminal diameter 9 months after stent implantation in the ZES (from 2.71 ± 0.49 to 2.21 ± 0.42 mm, P < 0.001), SES (from 2.79 ± 0.49 to 2.58 ± 0.57 mm, P < 0.001), and PES (from 2.66 ± 0.45 to 2.19 ± 0.52 mm, P < 0.001) groups. However, significant late improvements with different degree in luminal diameter were observed between 9 months and 2 years in the ZES (from 2.21 ± 0.42 to 2.39 ± 0.58 mm, P = 0.001), SES (from 2.58 ± 0.57 to 2.66 ± 0.60 mm, P = 0.039), and PES (from 2.19 ± 0.52 to 2.43 ± 0.52 mm, P < 0.001) groups. Conclusion Serial angiographic follow-up study revealed a biphasic luminal response after DES implantation, characterized by an early progression phase for the first 9 months and a late regression phase from 9 months to 2 years. © 2012 Wiley Periodicals, Inc.

ZusammenfassungHintergrund: Obwohl das Lymphsystem der Haut bei den primären Lymphödemen einbezo-gen ist, werden die Morphologie und die An-ordnung der Lymphgefäße in der betroffenen Hautregion der unteren Extremität bei dieser Krankheit wenig beschrieben und verstanden. Unser Ziel war es, die strukturellen und räumlichen Eigenschaften der Lymphgefäße in der be-troffenen Hautregion der unteren Extremität bei Patienten mit primären Lymphödemen zu charakterisieren und ihre Rolle bei dieser Krankheit herauszuarbeiten.Methoden: Es wurden Hautbiopsien der unteren Extremität von 14 Patienten mit primärem Lymphödem sowie von 10 altersmäßig ent-sprechenden Kontrollen entnommen und immunhistochemisch sowie mikroskopischeuntersucht unter Verwendung von podoplanin-Antikörpern (einem lymphatischen Marker). Die Lymphgefäße jedes Abschnittes wur-den gezählt und der innere luminale Durchmesser bestimmt.Ergebnisse: Die Gesamtdichte und der innere luminale Durchmesser der Lymphgefäße in der betroffenen Haut der untereren Extremität der Patienten mit primärem Lymph-ödem waren verglichen mit Kontrollen größer (p=0,004 bzw. p=0,014 ). Im oberen Bereich der Lederhaut bis 300 μm war die Dichte der Lymphgefäße der Lymphödem-Patienten niedriger im Vergleich zu den Kontrollen (p=0,00). Demgegenüber war die Dichte der Lymphgefäße in der tiefen Lederhaut (>300 μm) bei primärem Lymphödem höher als bei den Kontrollen (p=0,00).Zusammenfassung: Die betroffene Haut der unteren Extremität der Primärlymphödem-Pa-tienten wird gekennzeichnet durch die Hyper-plasie und Dilatation von Lymphvasculaturen hauptsächlich in der tiefen Lederhaut, was auf eine pathogene Rolle bei der Entstehung und der klinischen Manifestation der Krankheit hindeuten könnte.

Bioresorbable vascular scaffolds (BVS) present different mechanical properties as compared to metallic platform stents. Therefore, the standard procedural technique to achieve appropriate deployment may differ.Fifty-two lesions treated with a 3 x 18 mm BVS were imaged with optical coherence tomography (OCT) post-implantation and screened for parameters suggesting non-optimal deployment. These included minimal scaffold area (minSA)5 mm², residual area stenosis (RAS)20%, edge dissections, incomplete scaffold/strut apposition (ISA)5% and scaffold pattern irregularities. The angiographic proximal and distal maximal lumen diameters (DMAX) were measured by quantitative coronary angiography. Based on the DMAX values, the population was divided into three groups: DMAX2.5 mm (n=13), DMAX between 2.5-3.3 mm (n=30) and DMAX3.3 mm (n=9). All three groups presented with similar pre-implantation angiographic characteristics except for the vessel size and were treated with similar balloon/artery ratios. The group with a DMAX2.5 mm presented with a higher percentage of lesions with minSA5 mm² (30.8% vs. 10.0% vs. 0%; p=0.08) and edge dissections (61.5% vs. 33.3% vs. 11.1%; p=0.05). Lesions with5% of ISA were significantly higher in the group with DMAX3.3 mm (7.7% vs. 36.7% vs. 66.7%; p=0.02). RAS20% was similar between all groups (46.2 vs. 53.3 vs. 77.8%; p=0.47) and scaffold pattern irregularities were only documented in three cases.BVS implantation guided with quantitative angiography may improve the OCT findings of optimal deployment. The clinical significance of these angiographic and OCT findings warranted long term follow-up of larger cohort of patients.

This study aims to highlight the peculiar presentation and management of children's corrosive ingestions in developing countries associated with malnutrition, delay in management, lack of technology, and sporadic follow-up.An observational study was carried out since 2005 on all children (15 years old) admitted for caustic soda ingestion to the "Emergency" Surgical Center in Sierra Leone, either in the acute postinjury phase or for dilatation of esophageal strictures. Complications, mortality, stricture recurrence, and ability to swallow were the main outcome measures. Improvement in nutritional status (ie, gaining weight) and sustained esophageal patency were both considered reference points to successful treatment.In 4 years (2005-2009), 175 children were admitted, 53.7% at more than 1 month after ingestion. Dilatations were carried out in 77.7%, and a gastrostomy was placed in 64%. Perforations and death rate were 4.5% and 2.8%, respectively. Sixty-two patients (35.4%) required more than 7 dilatations, whereas 15 (8.5%) were unable to maintain a satisfactory luminal diameter. Follow-up (range, 1-36 months; median, 7 months) was possible in 52.7%. Long-term success according to the aforementioned criteria was observed in only 16%.Delayed presentations and complex strictures with repeated postdilatation recurrence are characteristics of children's corrosive ingestion in developing countries. Malnutrition is common, and gastrostomy is frequently compulsory. Esophageal patency with improvement in nutritional state is achieved only in a small percentage of patients.

Objective To describe our experience with very distal placement of the Neuron 6 F 0.053 inch inner luminal diameter guide catheter (Penumbra Inc, San Leandro, California, USA) within the intracranial and extracranial vasculature to allow treatment of various neurovascular pathologies. Previously, this was thought to be only possible with a microcatheter. Methods 12 cases are presented in which traditional guide catheters were unable to successfully navigate tortuous anatomy or provide stable support for intervention. Results The Neuron 6 F 0.053 inch inner luminal diameter delivery catheter (Penumbra) was placed in a very distal location within the internal carotid artery, external carotid artery and venous system enabling successful endovascular treatment of the intracranial pathology with no related neurological complications. Conclusion All lesions were successfully treated through a microcatheter advanced in a coaxial fashion through the distally placed guide catheter. There were no complications related to the distal position of the guide catheter.

Purpose: To evaluate the use of cine-magnetic resonance imaging (MRI) with a steady-state free precession sequence to monitor and assess small bowel motility. Materials and Methods: Sequential MRI, using a balanced steady-state free precession sequence, was performed in eight healthy male volunteers at 0, 15, 30, 45, and 60 minutes after oral administration of 1500 mL of nonabsorbable fluid to monitor small bowel contractions. Using the cine-mode display, small bowel contractions were reviewed and the luminal diameter was measured on each image to obtain frequency and amplitude of bowel contractions. Results: The oral preparation was well tolerated without major complications. Cine-MRI provided high temporal, spatial, and contrast resolution for monitoring bowel contractions. Mean values with standard deviations of frequency and amplitude of bowel contractions were 6.0 ± 2.98/min and 10.4 ± 4.53 mm, respectively, and were 5.1 ± 3.38/min and 9.59 ± 5.57 mm at the jejunal loops and 6.9 ± 2.22/min and 11.2 ± 3.06 mm at the ileal loops. With the passage of luminal fluid, frequency of bowel contractions decreased and the bowels tended to pause their contractions. Conclusion: Cine-MRI provides sufficient dynamic images to observe small bowel contractions. Measurement of bowel caliber permits calculation of amplitude and frequency of the contractions for characterization and quantitative assessment of small bowel motility function. J. Magn. Reson. Imaging 2011;33:1235–1240. © 2011 Wiley-Liss, Inc.

The current definition of a significant stenosis in an autologous arteriovenous fistula (aAVF), the percentage narrowing compared with the adjacent "normal" vessel, is inaccurate. We believe a significant stenosis in the aAVF is an absolute minimal luminal diameter determined by the requirements of the hemodialysis pump. To determine what absolute diameter constitutes a hemodynamically significant stenosis in a radio-cephalic autologous arteriovenous fistula (RC aAVF), the minimal luminal diameter of dysfunctional RC aAVF was compared to that of functional RC aAVF using grayscale and color ultrasound. There were 93 fistulas in study group and 77 in control group. The mean minimum luminal diameter in study group was significantly lower than in control group (2.19 vs. 4.71 mm, p 0.001). With a cutoff value of 2.7 mm, there was 90% sensitivity and 80% specificity in distinguishing functional fistula from dysfunctional fistula. The area under the receiver-operator curve was 90% (CI 84-94%), indicating that a 2.7 mm diameter is accurate in discriminating functional from dysfunctional fistulas. An absolute minimal luminal diameter of 2.7 mm, as determined with grayscale and color ultrasound, is a useful cutoff for defining significant stenosis in a RC aAVF.

Background: Primary percutaneous coronary intervention (PCI) is the preferred method of ST-segment elevation acute myocardial infarction (STEMI) management but no-reflow phenomenon is one of its major complications that affects patient's outcome. Objective: Identification of possible clinical, angiographic and procedural predictors for no-reflow in patients with AMI after primary percutaneous coronary intervention (PCI). Methods: A total of hundred patients with AMI who had been treated by primary PCI at the National heart institute (NHI) and cardiology department, Menoufia University hospital were enrolled in this study, according to thrombolysis in myocardial infarction (TIMI) flow grade, patients were divided into a reflow group (TIMI 3) and a no-reflow group (TIMI ≤ 2). The clinical, angiographic and procedural data were compared between both groups. Discussion: Sixteen patients (16%) developed no-reflow phenomenon after primary PCI. Statistical analysis showed that time from onset to reperfusion, low initial TIMI flow grade, high thrombus burden, long lesion length and large reference luminal diameter were correlated with no-reflow (P < 0.05 for all) and were considered to be independent predictors of no-reflow. Conclusion: The occurrence of no-reflow after primary PCI for acute myocardial infarction can be predicted by certain clinical, angiographic and procedural features.

Coronary artery ectasia and aneurysms (CEA) present an uncommon cause of myocardial ischemia and infarction. Atherosclerosis is the most common etiology of this phenomenon. Ectasia has been characterized as a luminal diameter of 1.5-fold of normal diameter while an aneurysmal coronary artery refers

Background: Multiple techniques have been established for the insertion of totally implantable chemotherapy ports. Cephalic vein cut down technique is considered a safe technique with reasonable success. The surgical team implanting the chemoports and the nursing team handling them have a learning curve. This prospective observational cohort study aimed to document the techniques used for the implantation, the success and failure of cephalic vein cut down technique, the intraoperative and delayed complications of chemoport implantation, and the ease and difficulties of the nursing personnel in subsequent handling of the chemoports. Patients and Methods: All consecutive patients undergoing surgical implantation of chemoports between September 2015 and December 2017 were included in this study. Chemoport implantation was first attempted in the cephalic vein by cut down technique followed by closed Seldinger method in the subclavian or internal jugular vein. Surgical details were recorded and further access of the chemoport by the nursing personnel was monitored. Any difficulty in access or use of the chemoports was noted and help sought. All data were collected prospectively and analysed. Results: Thirty chemoport implantations and 280 chemoport cannulations were performed during the study period. Cephalic vein cut down technique was performed in 28 (96%) patients. Cephalic vein implantation of chemoport was successful in 14 (50%) patients. Obliterated vein, small luminal diameter and adverse anatomy were reasons for failure. Patients who had not previously received chemotherapy had a cephalic vein success rate higher than those who had, with an odds ratio of 2.4. Chemoport access by nursing personnel was easy in 92% patients. No blood return was seen in 7%. Conclusion: Cephalic vein cut down technique was successful in 50% patients. It was less successful in patients who have previously been treated with chemotherapy. No blood return on access was the commonest cause for concern while handling chemoports. An algorithm for the preference of veins to be used and an institutional protocol for chemoport access and use increase safety and efficiency.

This report describes a simple venous reconstructive technique that results in an autogenous vascular graft with sufficient luminal diameter for replacing the vena cava. The majority of vena caval reconstructions are performed using prosthetic grafts; however, graft infection is a concern in clean-contaminated hepatobiliary and retroperitoneal resections.