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Assesses the effect of glyceryl trinitrate (GTN) on the smooth muscle of the sphincter of Oddi, in terms of ease of cannulation at endoscopic retrograde cholangiopancreatography. Side effects of GTN; Effect of GTN among the experienced endoscopists and trainees; Difference in the average time taken to achieve cannulation of the desired duct.

Targeting receptor-interacting protein kinase 1 (RIPK1) has emerged as a promising therapeutic stratagem for neurodegenerative disorders, particularly Alzheimer's disease (AD). A positron emission tomography (PET) probe enabling brain RIPK1 imaging can provide a powerful tool to unveil the neuropathology associated with RIPK1. Herein, the development of a new PET radioligand, [ 11 C]CNY-10 is reported, which may enable brain RIPK1 imaging. [ 11 C]CNY-10 is radiosynthesized with a high radiochemical yield (41.8%) and molar activity (305 GBq/µmol). [ 11 C]CNY-10 is characterized by PET imaging in rodents and a non-human primate, demonstrating good brain penetration, binding specificity, and a suitable clearance kinetic profile. It is performed autoradiography of [ 11 C]CNY-10 in human AD and healthy control postmortem brain tissues, which shows strong radiosignal in AD brains higher than healthy controls. Subsequently, it is conducted further characterization of RIPK1 in AD using [ 11 C]CNY-10-based PET studies in combination with immunohistochemistry leveraging the 5xFAD mouse model. It is found that AD mice revealed RIPK1 brain signal significantly higher than WT control mice and that RIPK1 is closely related to amyloid plaques in the brain. The studies enable further translational studies of [ 11 C]CNY-10 for AD and potentially other RIPK1-related human studies., (© 2024 The Author(s). Advanced Science published by Wiley‐VCH GmbH.)

Background: Vascular endothelial growth factor is associated with reduced immune response and impaired anti-tumor activity. Combining antiangiogenic agents with immune checkpoint inhibition can overcome this immune suppression and enhance treatment efficacy., Methods: This study investigated the combination of ziv-aflibercept anti-angiogenic therapy with pembrolizumab in patients with advanced melanoma resistant to anti-PD-1 treatment. Baseline and on-treatment plasma and PBMC samples were analyzed by multiplex protein assay and mass cytometry, respectively., Results: In this Phase 1B study (NCT02298959), ten patients with advanced PD-1-resistant melanoma were treated with a combination of ziv-aflibercept (at 2-4 mg/kg) plus pembrolizumab (at 2 mg/kg), administered intravenously every 2 weeks. Two patients (20%) achieved a partial response, and two patients (20%) experienced stable disease (SD) as the best response. The two responders had mucosal melanoma, while both patients with SD had ocular melanoma. The combination therapy demonstrated clinical activity and acceptable safety, despite the occurrence of adverse events. Changes in plasma analytes such as platelet-derived growth factor and PD-L1 were explored, indicating potential alterations in myeloid cell function. Higher levels of circulating CXCL10 in non-responding patients may reflect pro-tumor activity. Specific subsets of γδ T cells were associated with poor clinical outcomes, suggesting impaired γδ T-cell function in non-responding patients., Conclusions: Although limited by sample size and follow-up, these findings highlight the potential of the combination of ziv-aflibercept antiangiogenic therapy with pembrolizumab in patients with advanced melanoma resistant to anti-PD-1 treatment and the need for further research to improve outcomes in anti-PD-1-resistant melanoma., Trial Registration Number: NCT02298959., (© 2024. The Author(s).)

We developed a comprehensive method for functional assessment of the changes in immune populations and killing activity of peripheral blood mononuclear cells after cocultures with cancer cells using mass cytometry. In this study, a 43-marker mass cytometry panel was applied to a coculture of immune cells from healthy donors' peripheral blood mononuclear cells with diverse cancer cell lines. DNA content combined with classical CD45 surface staining was used as gating parameters for cocultures of immune cells (CD45 high /DNA low ) with hematological (CD45 low /DNA high ) and solid cancer cell lines (CD45 neg /DNA high ). This strategy allows for universal discrimination of cancer cells from immune populations without the need for a specific cancer cell marker and simultaneous assessment of phenotypical changes in both populations. The use of mass cytometry allows for simultaneous detection of changes in natural killer, natural killer T cell, and T cell phenotypes and degranulation of immune populations upon target recognition, analysis of target cells for cytotoxic protein granzyme B content, and cancer cell death. These findings have broad applicability in research and clinical settings with the aim to phenotype and assess functional changes following not only NK-cancer cell interactions but also the effect of those interactions on other immune populations., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Patients with smoldering multiple myeloma (SMM) are observed until progression, but early treatment may improve outcomes. We conducted a phase II trial of elotuzumab, lenalidomide, and dexamethasone (EloLenDex) in patients with high-risk SMM and performed single-cell RNA and T cell receptor (TCR) sequencing on 149 bone marrow (BM) and peripheral blood (PB) samples from patients and healthy donors (HDs). We find that early treatment with EloLenDex is safe and effective and provide a comprehensive characterization of alterations in immune cell composition and TCR repertoire diversity in patients. We show that the similarity of a patient's immune cell composition to that of HDs may have prognostic relevance at diagnosis and after treatment and that the abundance of granzyme K (GZMK) + CD8 + effector memory T (TEM) cells may be associated with treatment response. Last, we uncover similarities between immune alterations observed in the BM and PB, suggesting that PB-based immune profiling may have diagnostic and prognostic utility., Competing Interests: Declaration of interests N.J.H. is a consultant for Constellation Pharmaceuticals. F.A. is an employee of Illumina Inc. O.Z. is an employee of Ikena Oncology and a stockholder in Ikena Oncology and Morphosys AG. G.G. receives research funds from IBM and Pharmacyclics and is an inventor on patent applications filed by the Broad Institute related to MSMuTect, MSMutSig, POLYSOLVER, SignatureAnalyzer-GPU, and MSIDetect. He is also a founder and consultant of and holds privately held equity in Scorpion Therapeutics. I.M.G. has a consulting or advisory role with AbbVie, Adaptive, Amgen, Aptitude Health, Bristol Myers Squibb, GlaxoSmithKline, Huron Consulting, Janssen, Menarini Silicon Biosystems, Oncopeptides, Pfizer, Sanofi, Sognef, Takeda, The Binding Site, and Window Therapeutics and has received speaker fees from Vor Biopharma and Veeva Systems, Inc., and her spouse is the CMO and equity holder of Disc Medicine. S.M. has a consulting role with Abbvie, Adaptive Biotechnology, Amgen, Celgene/BMS, GlaxoSmithKline, Janssen, Novartis, Oncopeptides, Regeneron, Roche, and Takeda and has received research funding from Abbvie, Adaptive Biotechnology, Amgen, Celgene/BMS, GlaxoSmithKline, Janssen, Novartis, Oncopeptides, Regeneron, Roche, and Takeda. A.J.Y. has a consulting role with Adaptive Biotechnologies, Amgen, BMS, Celgene, GSK, Janssen, Karyopharm, Oncopeptides, Sanofi, and Takeda and has received research funding from Amgen, Janssen, and Takeda. M.B. is a consultant for Sanofi, Genzyme, and Janssen and has received research funding from MedImmune, Janssen, Legend Biotech, Amgen, Celularity, Bristol Myers Squibb, Celgene, Bluebird bio, Millennium, Takeda, Cerecor (currently Avalo Therapeutics), and C4 Therapeutics. M.B has an advisory role and received honoraria from Bristol Myers Squibb, Takeda, Janssen, and Menarini. T.H.M. received advisory board fees from Legend Biotech. R.S.-P., G.G., and I.M.G. are co-inventors on a patent application related to this work (PCT/US22/74839)., (Copyright © 2022 Elsevier Inc. All rights reserved.)

With the increasing use of mass cytometry in clinical research, a simplified and standardized protocol for immunophenotyping human peripheral blood mononuclear cells (PBMCs) in clinical trials is needed. We present a simplified in-plate staining protocol for up to 80 samples, for laboratories of all mass cytometry expertise levels, aimed to generate reproducible datasets for large clinical cohorts. In this protocol, we provide details on the requirements to obtain meaningful results, spanning from sample quality, barcoding, and batch-freezing of stained samples., Competing Interests: Dr. Hodi reports grants and/or personal fees from Bristol-Myers Squibb, Merck, EMD Serono, Novartis, Surface, Compass Therapeutics, Apricity, Sanofi, Pionyr, 7 Hills Pharma, Torque, Bicara, Pieris Pharmaceutical, Checkpoint Therapeutics, Genentech/Roche, Bioentre, Gossamer, Iovance, Trillium, Catalym, Immunocore, Amgen, and Zumutor outside the submitted work. In addition, Dr. Hodi has a patent (#20100111973) with royalties paid and patents (#7250291, #9402905, #10279021, #10106611, #20170248603, #20160046716, #20140004112, #20170022275, #20170008962, and #20170343552) pending., (© 2022 The Author(s).)

This protocol details a staining technique optimized for immunophenotyping of human bone marrow immune populations using mass cytometry. The protocol accounts for the limitations of working with human bone marrow, such as reduced viability, low cell counts, and fragile cell pellets, to successfully acquire single viable cells ready for downstream analysis. This assay can be used to characterize the activation, exhaustion, and cytotoxicity of immune populations and ensure comprehensive immunophenotyping of human bone marrow clinical samples., Competing Interests: Hodi FS: Dr. Hodi reports grants and/or personal fees from Bristol-Myers Squibb, Merck, EMD Serono, grants and Novartis, Surface, Compass Therapeutics, Apricity, Sanofi, Pionyr, 7 Hills Pharma, Torque, Bicara, Pieris Pharmaceuticals, Checkpoint Therapeutics, Genentech/Roche, Bioentre, Gossamer, Iovance, Trillium, Catalym, Immunocore, Amgen, Zumutor, outside the submitted work; in addition, Dr. Hodi has a patent (#20100111973) with royalties paid, patents (#7250291) (#9402905) (# 10279021) (#10106611) (#20170248603) (#20160046716) (#20140004112) (#20170022275) (#20170008962) and (#20170343552) pending. Ghobrial IM : Dr Ghobrial has the following potential conflicts of interest to disclose: Honoraria: Celgene, Bristol-Myers Squibb, Takeda, Amgen, Janssen; Consulting or Advisory Role: Bristol-Myers Squibb, Novartis, Amgen, Takeda, Celgene, Cellectar, Sanofi, Janssen, Pfizer, Menarini Silicon Biosystems Oncopeptides, The Binding Site, GlazoSmithKlein, AbbVi Adaptive; Travel, Accommodations, Expenses: Bristol-Myers Squibb, Novartis, Celgene, Takeda, and Janssen Oncology., (© 2022 The Authors.)

Introduction and Objectives: Endograft repair of abdominal aortic aneurysms (AAA) has become a viable alternative to open surgical repair in the last decade. We report here our experience and analysis of the surgical outcomes associated with endograft AAA repair., Methods: Patients suffering from significant abdominal aortic aneurysms (> 5cm in diameter) underwent endovascular repair. We report our experience with 342 consecutive patients from June 1998 to December 2004. Outcomes such as perioperative mortality, length of admission, length of ICU admission, operative blood loss, rates of transfusion postoperatively, rates of postoperative myocardial infarction (MI), rates of lower extremity ischemia, rates of conversion to open surgery, and the incidence of postoperative endoleaks were reviewed and analyzed. These results were compared to our patients undergoing open AAA repair during the same time period. Differences in the rates of perioperative mortality (2.0% vs 5.3%, NS) were not significant. However, the length of admission (4.8 vs 11.6 days, P=<0.001), length of ICU admission (0.6 vs 3.8 days, P=<0.001), blood transfusion (0.27 vs 1.83 units, P=<0.001), rates of postoperative MI (0.9% vs 5.0%, P=<0.001), and the incidence of postoperative renal insufficiency (4.1% vs 22.2%, P=<0.001) were superior in our endovascular group as compared to our open subset. In addition, most of our results were comparable to those results reported in recent major trials of endograft AAA repair., Conclusions: Endograft repair of AAA demonstrated superior outcomes when compared to our patients undergoing open AAA repair. However, these results must be weighed against the risk of endoleaks, secondary interventions, and routine radiographic surveillance required for the endovascular approach.

Purpose: Colonic bleeding has historically been controlled by the use of localization procedures and surgery. Since our initial experience with superselective embolization of colonic bleeding, it has become our preferred method for the control of lower gastrointestinal hemorrhage. This follow-up study evaluates the Hartford Hospital experience using angiographic methods as the primary modality for the treatment of colonic bleeding., Methods: From March 1993 to September 1999, 27 patients who had angiographically visualized colonic hemorrhage underwent arterial embolization procedures. Diagnostic arteriography was performed in all patients using digital subtraction imaging and selective contrast injections into the superior and inferior mesenteric arteries. Once the bleeding site was identified, superselective arteriogram and embolization was performed. Platinum-fibered coils, Hilal coils, or polyvinyl alcohol particle emboli were then fluoroscopically guided into the bleeding vessel. A repeat arteriogram was performed to confirm occlusion and the absence of any collateral channels., Results: All 27 patients were initially controlled with arterial embolization; 6 patients rebled (22.2 percent), and 5 of these patients required surgery. Two patients demonstrated ischemia (7.4 percent), one of which required surgical intervention. The other patient was followed up by colonoscopy. There was no mortality in this study., Conclusion: Superselective embolization is effective in controlling colonic hemorrhage and is associated with a low rate of postembolization ischemia. Our experience with angiography reinforces the paradigm shift from its use as a diagnostic tool to the primary method for the control of colonic bleeding. Because patients have been followed up for as long as seven years, this approach remains effective for the long-term treatment of colonic bleeding.

Purpose: Iliac artery anatomy is a central factor in endoluminal abdominal aortic aneurysm therapy. It serves as the conduit for graft deployment and as the region of distal graft seal. Thirty-eight percent of iliac vessels in our patients require special treatment because of aneurysms, tortuosity, or small size. Bilateral hypogastric artery exclusion has been avoided because of concerns of colorectal ischemia, hip/buttock claudication, and impotence. We suggest that elective, staged, bilateral hypogastric embolization can be performed safely with reasonably low morbidity and can expand the anatomic boundaries for stent-graft abdominal aortic aneurysm repair., Methods: This study was performed as a retrospective chart review of patients requiring hypogastric artery embolization for endovascular repair of abdominal aortic aneurysms between June 1998 and June 2000. Patients with otherwise appropriate anatomy and common iliac artery aneurysms were informed of the option for stent-graft repair with internal iliac artery embolization with its risks of impotence, hip/buttock claudication, and bowel ischemia. Patients underwent unilateral or staged bilateral coil embolizations of their proximal hypogastric arteries with an approximate 1-week interval between procedures. Hospital and office records were reviewed; phone interviews were performed. Follow-up ranged from 1 to 12 months., Results: During a 24-month period, 65 patients underwent endovascular abdominal aortic aneurysm repair; 18 patients (28%) required hypogastric artery embolization. Seven (39%) of these patients underwent bilateral embolization. There were no episodes of clinically evident bowel ischemia. Lactate levels were normal in all measured patients. Postoperative fevers (> 101.0 degrees F) were documented in 10 (56%) of 18 patients. The average white blood cell count was 12.8 x 10(9)/L (range, 8.5-22.9). There were no positive blood culture results. The return to the full preoperative diet occurred in 1 to 3 days. Hip/buttock claudication occurred in approximately 50% of patients with persistent but improved symptoms at 6 months. Eighty-seven percent of patients had preoperative erectile dysfunction. Only two patients noted worsening of erectile function postoperatively., Conclusions: Preliminary results indicate that bilateral hypogastric artery embolization can be performed, when necessary, with reasonable morbidity in patients undergoing stent-graft abdominal aortic aneurysm repair.

Purpose: The authors review their experience using transcatheter embolization in the treatment of acute lower gastrointestinal hemorrhage., Materials and Methods: A retrospective review was conducted on 17 patients who underwent superselective transcatheter embolization for an acute lower gastrointestinal hemorrhage. All 17 patients were followed clinically 4 days to 60 months (mean, 18.5 months) after embolization for the presence of ischemia or for recurrent bleeding. In addition, 12 of 17 patients were examined 1 day to 12 months (mean, 38.8 months) after embolization by means of colonoscopy or by pathologic review., Results: Transcatheter embolization achieved immediate hemostasis in 15 of 17 patients (88%) and was the definitive treatment in 76%. The other two patients underwent successful surgical resections after incomplete hemostasis of cecal lesions. Two patients of the 15, with initially successful embolizations, had recurrent hemorrhage within 30 days; both underwent further embolization with one failure. No intestinal infarction or stricture developed in the 15 patients who underwent successful embolization., Conclusions: The authors' experience supports the role of transcatheter embolization as a primary means of therapy for patients with an acute lower gastrointestinal hemorrhage. Their data further supports growing evidence that superselective embolization may be most efficacious in reducing complication rates.

Purpose: To evaluate stent placement in the treatment of mesenteric ischemia., Patients and Methods: Twelve patients (eight women, four men; mean age, 63 years) with chronic mesenteric ischemia underwent stent placement for stenoses or occlusions during a 5.5-year period. Nine patients with 10 stenoses (three celiac arteries, seven superior mesenteric arteries) and three patients with three chronic occlusions (two superior mesenteric arteries, one aortosuperior mesenteric artery bypass graft) were treated., Results: Initial technical success was achieved in 11 of the 12 patients (92%), including all three patients with chronic occlusions. There were no technical complications. There was one postprocedural death (<30 days) due to bowel ischemia and infarction, despite a technically successful procedure. Clinical follow-up was available in all 12 patients, with a mean follow-up of 15.7 months (range, 0-38.5 months). Primary and primary-assisted patency up to 18 months was 74% (standard error [SE], 13%) and 83% (SE, 11%), respectively. Secondary patency was 83% (SE, 11%) at 3 years. All three patients (100%) with chronic occlusions had relief of clinical signs and symptoms at a mean follow-up of 22 months (range, 13-38.5 months)., Conclusions: Stent placement is safe and clinically effective as an adjunctive therapy to angioplasty or as a primary method of treatment for chronic mesenteric ischemia in patients with focal visceral artery stenoses or occlusions.

Purpose: To develop a stable, transluminally created abdominal aortic aneurysm (AAA) within a live animal model., Materials and Methods: Eight mongrel dogs were utilized to evaluate a new, catheter-based technique for the creation of an AAA. With use of a standard angioplasty balloon and a balloon-expandable intravascular metallic stent, the infrarenal abdominal aorta was overdilated to twice its measured diameter into a fusiform shape AAA in eight dogs. At 30 days, aortography was performed, the dogs were killed, and the aorta was resected and evaluated for histopathology., Results: Seven of the eight dogs that underwent transluminal AAA creation survived the initial procedure. A stable, fusiform AAA was successfully created in these seven dogs. At 30 days, repeat angiography and histologic examination confirmed that the seven AAAs were still twice the diameter of the normal aorta (a four-fold increase in luminal area), that the branch arteries remained patent, and that the lumen was endothelialized. One of the eight dogs was killed 9 hours after the procedure because of inability to awaken from anesthesia. Gross and histopathologic results in this one dog also demonstrated an intact aorta containing an AAA., Conclusions: A stable, infrarenal AAA model can be successfully created in the canine species with use of standard catheter-based techniques and equipment. This model can be used to test emerging endovascular treatments of AAA.

Purpose: To evaluate the efficacy of thrombolytic therapy in the treatment of acute axillosubclavian vein thrombosis in patients with Paget-Schroetter syndrome., Materials and Methods: A 4.5-year, retrospective study of all patients with "effort" thrombosis of the axillosubclavian vein was performed., Results: Six men and eight women (age range, 18-56 years; mean, 34 years) presented with acute axillosubclavian vein thrombosis. Twenty thrombotic events occurred in the 14 patients and were treated with urokinase only (14 of 20) or urokinase combined with percutaneous transluminal angioplasty (PTA) (six of 20), Nine of the 14 treatments with urokinase only (64%) resulted in complete lysis of thrombus, whereas four treatments (29%) resulted in restoration of flow with some residual stenosis, yielding an immediate patency rate of 93%. Eight of the 14 patients remained asymptomatic after thrombolytic therapy (urokinase or urokinase and PTA) alone (n = 4), or in combination with a first rib resection (n = 4) at a mean follow-up of 24 months (range, 1-36 months)., Conclusions: Thrombolytic therapy appears to be a safe and efficacious method of establishing immediate patency of the axillosubclavian vein and may be helpful in establishing a symptom-free result in patients with Paget-Schroetter syndrome. Rib resection and repeated thrombolytic therapy are frequently necessary to complete treatment.

Purpose: To retrospectively review and to report the results of stent placement for focal mid-abdominal aortic stenoses., Materials and Methods: During a 4-year period, 10 focal mid-abdominal aortic stenoses were treated with stent placement in nine patients (six women and three men; mean age, 61 years; range, 49-73 years). All of the stenoses were atherosclerotic in nature except for one at the proximal anastomosis of an aortobi-femoral graft, which may have been from fibrointimal hyperplasia. Seven of the 10 stenoses were treated with primary stent placement, whereas three were treated with stent placement after suboptimal angioplasty., Results: The technical success rate was 100%. Clinical success, defined as complete elimination or improvement of symptoms present before stent placement, was achieved in eight of the nine patients with a mean duration of follow-up of 1.6 years (range, 0.2-3.0 years)., Conclusion: In view of the excellent technical and clinical success, the authors believe that stent placement should be considered as an adjective therapy to angioplasty or as a primary method of treatment in properly selected patients with focal mid-abdominal aortic stenoses.

The purpose of this study was to determine the safety and efficacy of transcatheter embolization in the management of bleeding visceral artery pseudoaneurysms. Eight patients (four women and four men) whose mean age was 61.0 years (range 44 to 77 years) underwent emergency transcatheter embolization for acute hemorrhage from a visceral artery pseudoaneurysm. Arteriographic technique was used to localize and selectively embolize these seven visceral artery pseudoaneurysms (three inferior pancreaticoduodenal, one gastroduodenal, two hepatic, and one splenic) by means of intravascular steel coils. Arteriography demonstrated visceral artery pseudoaneurysms in all eight patients. Acute hemorrhage was documented by endoscopy, falling hematocrit levels, CT scans, and arteriography. Successful embolization of these visceral artery pseudoaneurysms was achieved in seven (88%) of eight patients. In one patient embolization was not attempted because of a worsening clinical status, and this patient subsequently underwent emergency surgical resection. There was no significant morbidity associated with the procedures and seven patients remain asymptomatic with no further bleeding at a mean follow-up of 21.1 months (range 11 to 46 months). Arteriographic embolization of visceral artery pseudoaneurysms is a safe and highly successful technique for the effective identification and treatment of hemorrhage even in critically ill patients.

Esophageal strictures in children may develop as a primary constriction, secondary to a surgically repaired esophageal atresia (with or without tracheoesophageal fistula), as a result of chemical injury after caustic ingestion, or following esophageal surgery. Traditional treatment of esophageal strictures has been limited to dilation (using bougie dilators) with esophagoscopy under general anesthesia. Recent reports have shown success with fluoroscopically guided balloon catheter dilation. Eight children (aged 2 months to 14 years) were treated with balloon catheter dilation for focal strictures of the esophagus. In six of the eight cases, complete resolution of the strictures was achieved after an average of 7.5 dilations (range, 1 to 14). Two of the eight patients moved to another part of the country and did not complete treatment. There has been no morbidity or mortality. In selected centers, balloon catheter dilation under fluoroscopic guidance has become a safe treatment of benign esophageal strictures in children. It should be considered the treatment of choice in the initial management of esophageal narrowing and appears to be safer than the more traditional methods of esophageal dilation.

Purpose: To evaluate percutaneous transluminal angioplasty (PTA) in the treatment of visceral ischemia., Patients and Methods: Over a 14-year period, 25 focal visceral artery stenoses were treated with PTA in 16 patients with acute or chronic visceral ischemia. Thirteen patients were women and three were men, with a mean age of 64.7 years (range, 54-79 years). PTA was performed in seven celiac arteries, 17 superior mesenteric arteries, and one inferior mesenteric artery., Results: PTA was technically successful in 14 of 16 patients (88%). Two patients were lost to follow-up. Nine of 12 patients (75%) demonstrated primary patency with relief of clinical symptoms at a mean follow-up of 2.3 years (range, 0.3-5 years). The remaining three patients underwent successful repeat PTA for recurrent symptoms. There was one postprocedural death, and one patient subsequently underwent successful surgical bypass for recurrent visceral ischemia., Conclusions: Angioplasty of the visceral arteries may provide relief for select patients with intestinal ischemia, but redilation may be required in some patients.

Purpose: The coronary-subclavian artery steal (CSS) syndrome is caused by critical stenosis in the subclavian artery proximal to a bypass graft from the internal mammary artery (IMA) to the coronary artery. The stenosis results in retrograde flow in the IMA and steal from the coronary artery., Patients and Methods: Percutaneous transluminal angioplasty (PTA) was performed in eight patients (five men, three women). In four patients (group 1), coronary ischemia had developed 0.5-70 months (mean, 31 months) after IMA-to-coronary artery bypass surgery. These four patients (mean age, 58 years; range, 44-68 years) underwent PTA of a single area of focal subclavian stenosis to treat CSS. In four other patients (group 2), atherosclerotic subclavian stenosis had developed proximal to a donor IMA before planned bypass surgery. These patients (mean age, 53 years; range, 50-57 years) underwent PTA of a single focal subclavian stenosis to prevent CSS., Results: Group 1 patients were free of myocardial ischemia at follow-up (mean follow-up, 39.0 months; range, 14-101 months). Three of four patients in group 2 underwent coronary artery bypass grafting with the ipsilateral IMA following PTA of the subclavian stenosis; they were free of angina at follow-up (mean follow-up, 14 months; range, 10-18 months)., Conclusion: PTA is a safe and efficacious short-term method for prevention and treatment of CSS syndrome.

Purpose: To determine the long-term results of percutaneous transluminal angioplasty (PTA) of focal infrarenal abdominal aortic stenoses., Patients and Methods: Over a 10-year period, 15 focal infrarenal abdominal aortic stenoses were treated with PTA in 14 patients (13 women and one man; mean age, 53.2 years; range, 43-78 years)., Results: The initial technical success rate was 100%. Clinical patency, as defined by continued absence or improvement in symptoms after PTA, was achieved in 14 of the 15 angioplasty procedures (93%) with a mean duration of clinical follow-up of 4.3 years (range, 0.6-9.8 years) in the 14 patients. Long-term noninvasive follow-up demonstrated continued patency of the angioplasty site in 11 of 11 patients available for study. The mean ankle-arm index in these 11 patients was 0.95 (range, 0.9-1.0) at a mean follow-up of 4.8 years (range, 0.6-9.8 years). There was no significant morbidity or mortality associated with the angioplasty procedures., Conclusion: In view of the high degree of technical success and the excellent long-term patency, we believe that PTA should be considered a primary method of treatment in properly selected patients with focal abdominal aortic stenoses.

Purpose: Enteral feeding via gastrostomy or gastrojejunostomy tubes has an established role in patients unable to maintain adequate oral intake. However, creation and maintenance of a site for long-term nutritional support can be significant problems in patients who have undergone previous surgery or in patients with chronic aspiration, abnormal stomach position, or recurrent inadvertent tube dislodgment. Direct percutaneous jejunostomy (DPJ) tube placement performed with fluoroscopic guidance was evaluated in these patients., Patients and Methods: Fourteen DPJ tube placements for enteral feeding were attempted in 13 patients with use of local anesthesia, fluoroscopic guidance, the Seldinger technique, and jejunopexy. There were nine male and four female patients with a mean age of 75.2 years (range, 45-95 years)., Results: DPJ was successful in 11 of 13 patients. A mean follow-up of 58.9 days (range, 3-291 days) was obtained in all 11 patients., Conclusions: DPJ is a safe and viable alternative for the creation and maintenance of long-term enteral tube feeding, particularly in patients with underlying esophagogastric malignancy, recurrent inadvertent tube dislodgement, or previous gastric surgery.