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Background: Repeat volumetric analysis of abdominal aortic aneurysm (AAA) after endovascular AAA repair (EVAR) is time-consuming and requires advanced processing, dedicated equipment, and skilled operators. Purpose: To clarify the validity of measuring the maximal short-axis diameter (Dmax) of AAA in follow-up non-enhanced axial CT as a means of detecting substantial endoleaks after EVAR. Material and Methods: CT images were retrospectively reviewed in 47 patients (7 women, 40 men; mean age, 76.2 years) who had no endoleak on initial contrast-enhanced CT after EVAR. Regular follow-up CT studies were performed every 6 months. At each CT study, the Dmax on the CT axial image was measured and compared with that on the last CT (115 data-sets). Contrast-enhanced CT was regarded as the standard of reference to decide the presence or absence of endoleaks. The appearance of endoleak was defined as the end point of this study. Results: Endoleaks were detected in 17 patients during the follow-up period. Mean Dmax changes for 6 months were significant between positive and negative endoleak cases (1.8 ± 1.9 vs. -1.1 ± 3.0 mm, P < 0.0001). When the Dmax change ≤ 0 mm for 6 months was used as the threshold for negative endoleak, the sensitivity, specificity, positive predictive value, and negative predictive value were 74.5, 82.4, 96.1, and 35.9%, respectively. When Dmax change ≤-1 mm was used as the threshold, the sensitivity, specificity, PPV, and NPV were 38.8, 100, 100, and 22.1%, respectively. Conclusion: Contrast-enhanced CT is not required for the evaluation of endoleaks when the Dmax decreases by at least 1 mm over 6 months after EVAR. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to report a new computed tomography (CT) finding in acute cardiac tamponade: a contrast-fluid level in the hepatic inferior vena cava (IVC) during an arterial dominant phase CT study (IVC niveau sign) in patients with acute type A aortic dissection.Materials and Methods: We retrospectively reviewed CT studies with the diagnosis of proximal aortic dissection (Stanford type A) with acute cardiac tamponade. There were 12 patients enrolled in the study (6 women, 6 men; mean age 66 years). A total of 62 patients were selected as a control chronic pericardial effusion group to compare with the acute cardiac tamponade group.Results: Among the 12 patients with acute cardiac tamponade, the IVC niveau sign was seen in 7 (58%). In the control chronic pericardial effusion group (n = 62), we identified the IVC niveau sign in only one patient (1.6%). There was a significant difference in the presence of the IVC niveau sign between the acute cardiac tamponade and chronic pericardial effusion groups (P < 0.0001).Conclusion: The presence of the IVC niveau sign suggests acute cardiac tamponade in patients with acute type A aortic dissection. [ABSTRACT FROM AUTHOR]

The purpose was to evaluate CT findings of hemorrhage extending along the pulmonary artery (PA) due to ruptured aortic dissection (AD) and its prognostic factors. In 232 patients with Stanford type A AD, 21 patients (9.1%; 11 women; mean 70.3 years) were diagnosed. Twelve patients had double-barreled (classic) AD, and nine patients had intramural hematoma (IMH; closed false lumen) of the aorta. Based on CT findings, hemorrhage was classified into three categories as follows: category 1 (IMH of the PA or blood localized around the PA), category 2 (extending into the interlobular septa), and category 3 (extending into the alveoli). The factors influencing prognosis, including CT features and patient characteristics, were evaluated. Fourteen (66.7%) of the 21 patients underwent emergency surgery, and 8 (38.1%) patients died within 72 h of onset. Twelve cases (57.1%) were classified into category 1, 2 cases (9.5%) into category 2, and 7 cases (33.3%) into category 3. Double-barreled AD and category 3 hemorrhage were significant risk factors for death in univariate analyses. In multivariate analyses, the presence of category 3 hemorrhage was the only significant risk factor for death. CT findings indicative of a poor prognosis include double-barreled type AD and category 3 hemorrhage. [ABSTRACT FROM AUTHOR]

Objective Myocardial crypts are congenital abnormalities associated with hypertrophic cardiomyopathy (HCM) and other conditions. This study assessed the prevalence of myocardial crypts in Japanese patients. Methods Myocardial crypts were evaluated in a consecutive series of 300 patients (13-92 years old) who underwent computed tomography angiography (CTA) because of clinical suspicion of ischemic heart disease. Results We found a myocardial crypt incidence of 9.7% (29 patients) in our study population, with multiple crypts observed in 2.3% (7 patients). Among these, myocardial crypts were found in 2 out of 8 (25%) patients with hypertrophic cardiomyopathy (HCM), 1 of which was apical-type HCM. In patients with a single crypt (22 patients), the most common location of the crypt was at the left ventricular apex (16/22 patients, 72.7%), followed by the inferior wall (5/22 patients, 22.7%) and the interventricular septum (1/22 patients, 4.6%). Conclusion The incidence of myocardial crypts observed in our study aligns with that reported in previous studies, although the most common location among the Japanese population was the left ventricular apex.

Background: Pulmonary artery periadventitial hematoma (PAPH) with aortic dissection (AD) is a rare condition but has been reported to correlate with prognosis. However, there are few cases of PAPH, and the relationship with computed tomography (CT) findings of AD are unknown. This study aimed to evaluate CT findings and early prognosis in patients with PAPH in AD., Methods: This was a retrospective analysis of data from patients with Stanford type A AD diagnosed with contrast-enhanced CT in our institution from April 2008 to February 2023; 316 patients were included in the analyses. Patients comprised a PAPH group (n=78) and a non-PAPH group (n=238). The PAPH group was further divided into a group that died within 1 week of onset (death group; n=15) and a group that survived (alive group; n=63). PAPH was classified into three grades on the basis of the CT findings, as follows: Grade 1: PAPH only in the mediastinum; Grade 2: PAPH that extended into the lung field, with/without interlobular septa; and Grade 3: PAPH with pulmonary hemorrhage., Results: Compared with the non-PAPH group, the PAPH group had higher rates of early death (P=0.001), pericardial (P<0.001) and mediastinal hemorrhage (P<0.001). When comparing the death and alive groups, there was a significant difference in the rates of inoperable case (P<0.001), Grade 3 PAPH (PAPH with pulmonary hemorrhage) (P<0.001), and hemothorax (P=0.02). Multivariable analysis showed a significant association between Grade 3 PAPH (PAPH with pulmonary hemorrhage) and early death (P=0.004)., Conclusions: Standard type A AD with PAPH is not rare. Mortality was higher in the PAPH group vs . the non-PAPH group, and Grade 3 PAPH (PAPH with pulmonary hemorrhage) was a significant risk factor for early death., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-1914/coif). The authors have no conflicts of interest to declare., (2024 Journal of Thoracic Disease. All rights reserved.)

A 24-year-old man was admitted to our hospital because of severe heart failure. Although he was treated with diuretics and positive inotropic agents, his heart failure progressed. An endomyocardial biopsy revealed iron deposition in his myocytes. Finally, he was diagnosed with hereditary hemochromatosis. After starting administration of an iron-chelating agent in addition to conventional treatment for heart failure, his condition improved. We should consider hemochromatosis in heart failure patients with severe right ventricular dysfunction in addition to left ventricular dysfunction.

Present study quantitatively analyzed adrenal venous flow using four-dimensional computed tomography (4D CT). We reviewed 4D CT images of 55 patients [mean age, 52 years ± 11 (standard deviation); 23 females] who underwent adrenal venous sampling between August 2017 and February 2021. Time-density curves were referred for the adrenal venous enhancement. The clinical factors affecting hemodynamics were assessed using uni- and multivariate linear regression analyses. The right and left adrenal veins (RAV and LAV, respectively) were visualized in all cases. Mean peak enhancement values in RAV and LAV were 247 ± 67 and 292 ± 70 Hounsfield units (P < 0.01), and were reached at 44.43 ± 6.86 and 45.39 ± 7.53 s (P < 0.01), respectively. The body mass index (BMI), plasma renin activity and potassium were significant factors influencing the peak enhancement of RAV blood flow [standardized regression coefficients, - 0.327 (P = 0.017), - 0.346 (P = 0.013), 0.426 (P = 0.016), respectively]. A linear relationship between sex and the time-to-peak was observed for RAV [standardized regression coefficient, 0.348 (P = 0.046)]. RAV had a lower contrast effect than LAV and reached its peak faster. BMI, plasma renin activity, and potassium were associated with flow density in RAV. Sex independently influenced the time-to-peak., (© 2023. Springer Nature Limited.)

Background: The effects of adrenal venous sampling (AVS) may be limited by the anatomical variants of adrenal veins., Purpose: To investigate the benefits of AVS for patients who underwent four-dimensional computed tomography (4D CT) before AVS., Material and Methods: We reviewed the images of contrast-enhanced four phase three-dimensional (3D) and 4D CT in patients who received AVS between February 2010 and February 2021. A total of 112 patients (59 women; mean age = 55.3  ± 11.8 years) were enrolled. Of the entire population, 49.1% (55/112) underwent 4D CT, whereas 50.9% (57/112) underwent 3D CT. The anatomical features of adrenal veins and procedural data were obtained. Simple linear regression analyses were performed to determine the relationship between imaging protocols and AVS., Results: On comparison of the two groups, the 4D cohort had a higher success rate (98.2% vs. 78.9%; P  = 0.001), shorter procedure and fluoroscopy time (73.6 ± 37.3 min vs. 110.5 ± 47.9 min; P  < 0.001 and 28.7 ± 31.2 min vs. 97.4 ± 251.7 min; P  = 0.047, respectively), lower radiation exposure (243.5 ± 315.5 mGycm 2 vs. 613.4 ± 674.6 mGycm 2 ; P  < 0.001) and less contrast volume (46.2 ± 42.7 ml vs. 68.3 ± 47.4 ml vs; P  = 0.014). In simple linear regression analysis, positive and negative identification of right adrenal vein before AVS significantly influenced the success rate (unstandardized coefficients [UC] = 0.304, standardized coefficients [SC] = 0.304; P  = 0.001) and operation duration (UC = -46.124, SC = -0.318; P  = 0.001)., Conclusion: Pre-procedural 4D CT may facilitate successful AVS. Compared with four-phase 3D CT, this protocol is better to shorten the operation and fluoroscopy time, and to reduce the radiation dose and contrast consumption.

Purpose: To evaluate quantified iodine mapping parameters in dual-energy computed tomography in normal patients versus those with chronic thromboembolic pulmonary hypertension (CTEPH) with and without pulmonary thromboembolism., Materials and Methods: Using automatically quantified iodine mapping in dual-energy computed tomography, we evaluated lung relative average enhancement, standard deviation (SD), and the SD/lung relative average enhancement ratio. We compared the values for these parameters in normal patients versus those with CTEPH. We also performed a receiver operating characteristic curve analysis to determine the diagnostic cutoffs for the parameters., Results: Patients constituted 41 patients (10 male [24.4%] and 31 female [75.6%]; mean age [SD]: 70.0 y [13.3]) with CTEPH and 237 (92 male [38.8%] and 145 female [61.2%]; mean age [SD]: 65.9 y [15.9]) normal patients. We found significant differences in lung relative average enhancement (34.9±6.3 vs. 26.9±6.3; P <0.0001), SD (11.6±1.9 vs. 14.7±3.3; P <0.001), and the SD/lung relative average enhancement ratio (33.7±5.0 vs. 55.7±10.4; P <0.001) between the normal and CTEPH groups, respectively. The ROC analyses demonstrated high discriminatory power (area under the curve=0.99) for using the SD/lung relative average enhancement ratio to differentiate between patients in the normal group and CTEPH group. At a threshold for the area under the curve of 44.2, diagnostic sensitivity, specificity, positive predictive value, and negative predictive value for the ratio were 92.7%, 97.5%, 86.5%, and 98.7%, respectively., Conclusions: Patients with CTEPH were well-discriminated from normal patients using the SD/lung relative average enhancement ratio., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To investigate the relationships between indications for thoracic endovascular aortic repair for acute/subacute complicated Stanford type B aortic dissection and clinical outcomes, and complications specific to thoracic endovascular aortic repair., Material and Methods: The J-predictive study retrospectively collected data of patients treated with thoracic endovascular aortic repair for complicated Stanford type B aortic dissection at 20 institutions from January 2012 to March 2017. From the database, those treated for acute/subacute complicated Stanford type B aortic dissection were extracted (n = 118; 96 men; average age, 66.1 years; standard deviation, ± 13) and classified into groups 1, 2, and 3 according to thoracic endovascular aortic repair indications (rupture, superior mesenteric artery malperfusion, and renal or lower extremity malperfusion, respectively). Primary and secondary measures were mortality (overall and aortic-related) and complications related to thoracic endovascular aortic repair, respectively. For each outcome, the risks of being in groups 1 and 2 were statistically compared with that of being in group 3 as a control using Fisher's exact test., Results: Mortality rate (odds ratio, 5.22; 95% confidence interval [CI], 1.33-20.53) and prevalence of paraparesis/paraplegia (odds ratio, 30.46; confidence interval, 1.71-541.77) were higher in group 1 than in group 3. Compared to group 3, group 2 showed no statistically significant differences in mortality or complications related to thoracic endovascular aortic repair., Conclusions: Rupture as an indication for thoracic endovascular aortic repair for type B aortic dissection was more likely to result in worse mortality and high prevalence of spinal cord ischemia., Level of Evidence: Level 4, Case series., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Abstract: The differences between the pathologies of cases of type A acute aortic dissection (AAD) that did and did not result in prehospital death (PHD) have not been fully elucidated.This study aimed to compare the CT findings and clarify the differences between the pathologies of such cases.Ninety four consecutive type A AAD patients between 2010 and 2020 were enrolled in this study. There were 47 males and 47 females (mean age: 69.0 ± 14.4 years). The patients were divided into those that did (n = 25, 27%) and did not (n = 69, 73%) suffer PHD. We retrospectively evaluated the CT or postmortem CT findings of each case and analyzed the relationships between clinical factors (CT findings and clinical characteristics) and PHD using logistic regression analysis.Bloody pericardial effusion (96% vs 35%, P < .0001), bloody pleural effusion (40% vs 1%, P < .0001), and mediastinal hematomas (88% vs 14%, P < .0001) were significantly more common in the PHD group than in the no PHD group.In the multivariate logistic regression analysis, bloody pericardial effusion and lung consolidation were found to be significant risk factors for PHD (odds ratio: 21.29 [95% confidence intervals {CI}: 1.19-248.29] and 13.72 [95% CI: 1.79-105.06], respectively; P = .014 and P  = .012, respectively). AD affecting the abdominal aorta was identified as a significant negative risk factor for PHD (odds ratio: 0.02 [95% CI: 0.01-0.65]; P = .0042).Most PHD due to type A AAD are associated with hemorrhaging. Bleeding into the pericardium and type A AAD confined to the thoracic aorta are significant risk factors for PHD. Secondary respiratory failure might contribute to PHD in such cases., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: The purpose of this study was to investigate whether there were significant differences in the intensity distributions of thoracic aorta hemodynamic parameters between groups with different ejection fractions (EF) using four-dimensional flow magnetic resonance imaging and to investigate the relationships between each parameter.A total of 26 patients, 13 each with EF of >60% and <30%, underwent cardiac four-dimensional flow magnetic resonance imaging (EF >60%: mean age: 54 ± 11.6 years, EF <30%: mean age: 49.2 ± 17.2 years). The thoracic aorta was divided into the proximal and distal ascending aorta (AAo), aortic arch, and the proximal and distal descending aorta, and each section was further divided into the anterior wall, posterior wall, lesser curvature, and greater curvature. The intensity distributions of wall shear stress (WSS), energy loss (EL), and vorticity (Vort) (hemodynamic parameters) and the concordance rates between these distributions were analyzed.The concordance rate between the intensity distributions of EL and Vort was high. Only the intensity distributions of EL and Vort in the distal AAo differed significantly between the groups (P < .001). In the EF >60% group, these intensity distributions showed higher values in the greater curvature of the AAo, whereas in the EF <30% group higher values were seen in the lesser curvature of the AAo.Although there was no significant intergroup difference in the WSS intensity distribution, in the EF <30% group the WSS intensity distribution tended to exhibit higher values in the lesser curvature of the distal AAo, and the WSS intensity distribution values for the greater curvature tended to gradually increase from the arch to the proximal descending aorta.The only significant differences between the EF groups were found in the intensity distributions of EL and Vort in the distal AAo. This suggests that the distributions of atherosclerosis may be EF-dependent., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Rationale: Acute type A aortic dissection and chronic type B aortic dissection (TBAD) occurs simultaneously in rare cases. Although the development of ulcer-like projection (ULP) is associated with an increase in adverse aorta-related events, the false-lumen enlargement caused by the ULP progression is uncommon., Patient Concerns: A 72-year-old female with chronic TBAD was admitted to our unit with back and chest pain. Computed tomography revealed acute type A aortic dissection and a hematoma caused by rupturing of the descending aorta due to chronic TBAD. After endovascular intervention, the false lumen thrombosed and shrunk., Diagnosis: After 9 months, a developing ULP, which projected into a dilating false lumen, was found. An impending ruptured descending aortic aneurysm was confirmed., Interventions: Emergency Total arch replacement and thoracic endovascular aortic repair (TEVAR) was performed., Outcomes: The procedure was successful. One year later, regular follow-up showed that the false lumen had completely shrunk., Lessons: ULP can arise and cause progressive dilation of false lumen after TEVAR. Careful and regular computed tomography examinations are required for early diagnosis of false lumen becoming thrombosed after TEVAR. Close follow-up and timely intervention, including TEVAR, should be considered in cases of aortic enlargement due to a newly developed ULP., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: Balloon pulmonary angioplasty (BPA) is used to treat patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH); the goal is to improve pulmonary perfusion. We aimed to evaluate lung perfusion blood volume (PBV) with haemodynamic and exercise-capacity parameters to assess the efficacy of BPA in the treatment of CTEPH., Methods: We retrospectively studied 33 patients over a 6-year period. DECT pulmonary angiography was performed before and after BPA. DECT provided iodine distribution maps; whole-lung and regional PBV images and quantification were generated using post-processing software. A mosaic pattern suggesting perfusion inhomogeneity is typical in CTEPH. Hypothetically, BPA treatment would promote homogenization that would be reflected in the calculated standard deviation., Results: Lung perfusion images showed decreased heterogeneity after BPA. There was a significant difference before and after BPA in the whole-lung PBV and in the regional standard deviation for pulmonary arterial pressure (R = 0.37, p = 0.032 and R = 0.57, p = 0.006), pulmonary vascular resistance (R = 0.51, p = 0.023 and R = 0.60, p = 0.002), transtricuspid pressure gradient (R = 0.50, p = 0.0028 and R = 0.61, p = 0.0001), brain natriuretic peptide (R = 0.54, p = 0.0012 and R = 0.46, p = 0.0078), and 6-min walking distance (R = 0.59, p = 0.003 and R = 0.26, p = 0.14). The effects were especially pronounced after the first BPA procedure., Conclusion: Decreased lung heterogeneity may suggest BPA efficacy in treating CTEPH. After BPA treatment, improved lung PBV and improved regional standard deviation showed a strong positive correlation with haemodynamic parameters and exercise capacity, which also suggests that BPA is effective in treating CTEPH., (© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Background: Spontaneous rupture of the iliac vein has rarely been reported. Its associated hypovolemic shock-related symptoms and signs, including syncope and hypotension, have been observed in most of these cases. Successful transcatheter venous embolization for massive bleeding due to spontaneous rupture of the external iliac vein was herein reported., Case Presentation: An 82-year-old female patient developed sudden left lower abdominal and back pain. Immediately, she lost consciousness and went into shock. CT images of her abdomen revealed a huge retroperitoneal hematoma, with leakage of contrast medium in the hematoma in the left flank. These findings suggested left external iliac vein rupture. Open surgery was considered; however, since the patient's condition may have deteriorated further due to the time needed to prepare for surgery, including general anesthesia, transcatheter venous embolization of the left iliac vein was selected. A 5.2-Fr compliant balloon catheter (nominal diameter of 10 mm) was inflated at the distal site of the external iliac vein to reduce extravasation. N-butyl-2-cyanoacrylate (NBCA) was mixed with Lipiodol at a ratio of 1:2. The left Iliac vein was filled and completely embolized with the NBCA/Lipiodol mixture (total injected volume, 5 mL) using a 1.8-Fr microcatheter. After embolization, the patient quickly. An inferior vena cava filter was placed 1 day after embolization., Conclusion: Spontaneous rupture of the iliac vein is a very rare and lethal condition. Transcatheter venous embolization may control potentially life-threatening bleeding. Rapid bleeding control in a critical condition is facilitated by this minimally invasive approach.

Internal mammary artery aneurysms are rare, but serious, clinical entities. We describe a rare case in which an internal mammary artery aneurysm in a patient with Takayasu arteritis was successfully treated with coil embolization. To the best of our knowledge, this is the first report of an internal mammary artery aneurysm associated with Takayasu arteritis., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objectives: During mitral annuloplasty, we twisted the harvested auto-pericardium to enable adequate ring sizing and implanted it to prevent ring-related complications. Indication for twisted auto-pericardial band (APB) was limited to patients with less than severe annular dilation to ensure high reproducibility and durability. The aim of this study was to investigate the long-term outcomes of twisted APB annuloplasty., Methods: From 1999 to 2009, 107 patients (62 ± 12 years, degenerative 92 and infective endocarditis 15) with isolated posterior mitral leaflet (PML) prolapse with inter-commissural distance of 32 mm or smaller underwent twisted APB annuloplasty. Of these, 104 patients without early leaflet repair failure were studied. Leaflet repairs were predominantly performed by quadrangular resection. Median APB size was 28 mm., Results: Follow-up rate was 98.1% and duration was 10.9 ± 4.8 years. There were two early and 34 late deaths. Survival and freedom from cardiac-related death at 15 years were 61.7% ± 5.6% and 83.8% ± 4.7%, respectively. Age and male sex were independent predictors of mortality. There were four late reoperations for recurrent severe mitral regurgitation (MR), three of which were due to new chordal rupture. Freedom from reoperation and freedom from moderate or severe MR at 15 years were 93.1% ± 3.5% and 81.3% ± 6.2%, respectively. No patients developed hemolysis, ring dehiscence, or infective endocarditis., Conclusions: The long-term outcomes of twisted APB for isolated PML prolapse without severe annular dilation are satisfactory. Twisted APB annuloplasty may be a preferable option to reduce ring-related complications with sufficient durability.

The outcomes of carbon dioxide digital subtraction angiography (CO2-DSA) for performing percutaneous transluminal balloon angioplasty (balloon PTA) in hemodialysis patients has not been fully clarified. The purpose was to compare the outcomes of balloon PTA of hemodialysis shunts in terms of vessel patency between patients treated using CO2-DSA and conventional digital subtraction angiography using iodine contrast medium (C-DSA).We retrospectively evaluated 76 patients (38 males and 38 females, mean age: 65.0 ± 14.0 years). They were under hemodialysis and treated with balloon PTA using CO2-DSA or C-DSA at our institution between 2009 and 2016. Mean duration of the follow-up period was 25.59 ± 21.45 months. We compared the patency rates obtained after CO2-DSA-based balloon PTA with those after C-DSA-based balloon PTA. Secondary patency, which was defined as the duration of patency after all further endovascular interventions until surgical repair, was considered as the endpoint in this study.Overall, 19 and 57 patients underwent CO2-DSA- and C-DSA-based balloon PTA, respectively. CO2-DSA- and C-DSA-based balloon PTA produced clinical success rates of 100% and 96.5%, respectively. Blood vessel injury occurred in one patient who underwent C-DSA-based balloon PTA. No major complications occurred in CO2 group. At 24 months, the post-PTA secondary patency rates of CO2-DSA- and C-DSA-based balloon PTA were 94.1% and 93.9%, respectively (P = .9594).CO2-DSA is safe for hemodialysis patients. Compared with C-DSA, CO2-DSA-based balloon PTA produces have a similar secondary patency rate.

Objectives: Lung perfusion blood volume (PBV) using dual-energy computed tomography has recently become an accepted technique for diagnosing pulmonary thromboembolism. We evaluated the correlation among lung PBV, single-photon emission computed tomography (SPECT) and catheter pulmonary angiography images in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and after balloon pulmonary angioplasty (BPA)., Methods: In total, 17 patients and 57 sessions were evaluated with the three modalities. Segmental lung perfusion and its improvement in lung PBV and SPECT were compared with catheter pulmonary angiography as the reference standard before and after BPA., Results: The sensitivity for detecting segmental perfusion defects using SPECT and lung PBV was 85% and 92%, the specificity was 99% and 99%, the accuracy was 92% and 95%, the positive predictive value was 99% and 99%, and the negative predictive value was 88% and 93%. The sensitivity for detecting segmental perfusion improvement using SPECT and lung PBV was 61% and 69%, the specificity was 75% and 83%, the accuracy was 62% and 70%, the positive predictive value was 97% and 98%, and the negative predictive value was 12% and 16%., Conclusions: Lung PBV is a useful technique for evaluation of segmental lung perfusion and its improvement in patients with CTEPH., Key Points: • BPA is a new treatment for patients with CTEPH. • Lung PBV images may be more sensitive for pulmonary blood flow. • The current work demonstrates that Lung PBV images are useful in evaluating patients with CTEPH. • The current work demonstrates that Lung PBV is useful in gauging the treatment effect of BPA.

Objectives: We evaluated the reperfusion by balloon pulmonary angioplasty (BPA) in lung PBV and SPECT images., Methods: In total, 17 patients and 57 sessions were evaluated. Pre-BPA and post-BPA lung PBV and SPECT/CT images, based on both anatomical segments and physiologic regions (upper/middle/lower) were compared., Results: BPA had a positive effect on most hypoperfused/unperfused segments/regions. There was generally a high rate of agreement between PBV measurements and SPECT/CT., Conclusions: BPA shows promise as a treatment modality for CTEPH patients. SPECT/CT, and, to a lesser extent, PBV, were useful in indicating areas in need of balloon angioplasty., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Massive hemoptysis is a life-threatening condition and can arise as a complication of conditions. Conversely, hemoptysis rarely occurs as a complication of a ruptured thoracic aortic aneurysm (TAA)., Case Presentation: A 76-year-old male had a history of surgical replacement of the whole aortic arch due to a TAA. Three years after the surgery, severe hemoptysis occurred, which resulted in the patient's emergency hospitalization at our hospital. The patient was diagnosed with ruptured pseudoaneurysms of the aortic arch. Emergency thoracic endovascular aortic repair (TEVAR) was performed. .After that, the hemoptysis stopped, and the patient was discharged. Two months later, the hemoptysis reccurred so the patient was re-admitted to our hospital. CT showed a type 2 endoleak from the bronchial artery. The anastomotic pseudoaneurysms remained. As re-rupturing of the anastomotic aneurysms due to a type 2 endoleak was suspected, transcatheter arterial embolization was performed to treat the type 2 endoleak. The patient's hemoptysis stopped, and he was discharged.One year later, CT showed that the anastomotic pseudoaneurysms had disappeared, and the diameter of the aorta had also reduced., Conclusion: We present a case of hemoptysis caused by a type 2 endoleak that occurred after TEVAR for a ruptured TAA. The hemoptysis was secondary to aortobronchial fistulas caused by anastomotic aortic pseudoaneurysms. Transcatheter arterial embolization of the type 2 endoleak was very effective against the hemoptysis, and the pseudoaneurysms also disappeared. No such cases have been reported previously., Competing Interests: Our institutional ethics committee approved this case report and the committee’s reference number is 17121829.Informed consent was obtained from all individual participants included in the study.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.