Impact of Transcatheter Pulmonary Artery Intervention Following Superior Cavopulmonary Connection on Pulmonary Artery Growth

Introduction: Balloon and stent angioplasty of the pulmonary arteries (PAs) are frequently performed following superior cavopulmonary connection (SCPC), not only to normalize the caliber of the affected PA but also in hopes of maximizing downstream growth over time. There are limited data on the impact on subsequent PA growth prior to total cavopulmonary connection (TCPC). Methods: A single-center, retrospective cohort study was performed on children who underwent transcatheter (TC) PA intervention following SCPC between January 1, 2010, and December 31, 2018. Growth of treated and contralateral PAs was measured at the lobar bifurcation (distal branch PA [DBPA]) and in the proximal lower lobe (lower lobe branch [LLB]) on serial angiograms. Growth rate was evaluated using a mixed-effect model clustered by individual patient with an interaction term for treated PA and time to evaluate for differential growth rates between treated and contralateral PAs. Results: Thirty-five patients underwent TC PA intervention following SCPC, at a median of 70 days (interquartile range: 19-297 days) postoperatively. Significant growth was seen at both DBPA and LLB for raw (0.8 mm/year, 95% CI: 0.6-1.0, P < .001 for both) and body surface area (BSA) adjusted measures (8.4mm/m2/year, 95% CI: 5.6-11.2, P < .001; 7.9 mm/m2/year, 95% CI: 5.5-10.2, P < .001). The growth rate of the treated vessel was not significantly different from that of the contralateral vessel at the DBPA or LLB positions for raw ( P = .71, .70) or BSA-adjusted measurements ( P = .86, .64). Conclusion: Transcatheter PA intervention was associated with normal distal PA growth rate relative to the untreated side.

Microsurgical Treatment Strategy of Vertebral Artery Fusiform Aneurysm—From the Standpoint of Hemodynamic Integrity and Perforator Preservation

During treatment of vertebral artery (VA) fusiform aneurysms, it is critical to preserve peripheral perforators and anterograde blood flow of the VA and to reduce hemodynamic load to the contralateral VA. Even in the era of endovascular treatment, there are still many benefits to using microsurgical treatments with appropriate clip application and preservation of the perforators around the aneurysm, in conjunction with various bypass techniques. The ideal microsurgical technique involves reconstructive clipping that obliterates the aneurysm but preserves anterograde blood flow of the VA, followed by isolation of the aneurysm and VA reconstruction. If these two methods are unavailable, proximal clipping of the aneurysm combined with flow-augmentation bypass to the distal branch can be considered as an alternative surgical management. We discuss the microsurgical treatment of unruptured VA fusiform aneurysms in our surgical cases on the basis of a review of the current literature.

Posterior Internal Frontal Artery Vascularization of the Precentral Gyrus Responsible for Proximal Arm Movement: Insight from a Case of Coil Migration

Our knowledge of the vascularization of the precentral gyrus by branches of the anterior cerebral artery (ACA) relies mainly on anatomical cadaveric dissection. A distal branch of the ACA known as the posterior internal frontal artery (PIFA) is thought to vascularize the precentral gyrus responsible for proximal arm movement; however, no clinical correlation has yet been reported to confirm this relation. In this manuscript, we report a case of coil migration in the PIFA, causing proximal arm weakness in a 58-year-old woman treated for aneurysmal subarachnoid hemorrhage. The occurrence of clinical signs immediately following coil migration into the PIFA, combined with evidence of stroke in the cortical territory related to arm movement as seen on imaging, indicates that the PIFA indeed can vascularize this lateral portion of the precentral gyrus. This case confirms our current understanding of the vascularization of the precentral gyrus by distal ACA branches, in particular the PIFA.

Modifying the “Eye of the Tiger” Technique: Preserving Gluteal Artery Perfusion in the Treatment of an Aneurysm of the Hypogastric Artery

Purpose: In endovascular aneurysm repair, parallel stent graft deployment is sometimes utilized to preserve the distal branch perfusion. However, there will be some gutter space around 2 stent grafts, which may cause endoleak. The “eye of the tiger” technique was invented to minimize this leak when deploying a small side-branch stent graft in conjunction with a large aortic endograft. The purpose of this case report is to describe our modified technique for 2 small endografts deployed in double D-shape in order to prevent gutter leak, which we applied in endovascular treatment for a hypogastric artery aneurysm. Case Report: A 79-year-old male patient presented with a right hypogastric artery aneurysm measuring 44 mm. The patient refused the open surgical repair option and hoped for an endovascular treatment. Therefore, endovascular treatment to exclude the hypogastric artery aneurysm as well as preserve the gluteal arteries was planned. An Internal Iliac Component (IIC)(W. L. Gore & Associates, Flagstaff, AZ, USA) was utilized for the proximal sealing and 2 Viabahn stent grafts (W. L. Gore & Associates) were deployed in the superior and inferior gluteal arteries for distal sealing. Then, 2 VBX stent grafts (W. L. Gore & Associates) were added in the IIC as bridging stents to connect the IIC and both Viabahn stent grafts. Next, over-dilatation of VBX stent grafts was performed alternately with an 8 mm balloon catheter and subsequent kissing balloon dilation with 5 mm balloon catheters, which allowed the VBX stents to be set in double D-shape. A follow-up CT scan performed 1 week after the procedure revealed no endoleak and a favorable shape to the VBX stent grafts. Conclusion: The modified method of dilating the VBX stent grafts allowed the double D-shape deployment, minimizing the risk of gutter leak and preserving distal branch perfusion.

Anatomical study of dorsalis pedis artery

Background: The dorsalis pedis artery is the dorsal artery of the foot. The knowledge of any variation in the course and distribution of the artery is clinically important and it is used to record peripheral pulsation. The aim of this study was to study origin, course, relation and branches of the artery. The length and diameter of surgically important branch were recorded. Methods: An observational cross-sectional study was conducted at dissection hall of anatomy department at Chitwan medical college. Thirty lower limbs from fifteen cadavers were dissected for the study. Photographs were taken at different site of dissection and on finding anomalies. Newborn specimens and Conical enlargements if present were excluded. Results: The diameter of the artery ranged from 3.0 to 4.6mm and its length ranged between 5.6cm to 8.4cm.The length of deep plantar artery was between 5.6cm to 8.4cm. Double lateral tarsal artery was found in (24)80% of the studied specimen and (6)20% were with single lateral tarsal artery. In 90% of the specimen medial tarsal artery originated as proximal and distal branch form medial aspect of dorsalis pedis. The arcuate artery emerged directly from dorsalis pedis artery in (100%) all studied specimen. The 2nd ,3rd and 4th metatarsal artery were placed on their corresponding intermetatarsal space. Conclusions: Awareness of anatomical variation of vasculature of foot is important for the vascular surgeons, angiographers and reconstruction surgeons. Dorsalis pedis artery is excellent for the revascularization since it is the largest artery below the ankle joint.

Multivessel spontaneous coronary artery dissection in a patient after mild COVID-19: A case report

Coronavirus disease 2019 (COVID-19) is characterized by heterogeneity of possible cardiovascular manifestations. Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, the development of which in patients with COVID-19 has been described and studied insufficiently. A 35-year-old male patient presented to our hospital with an acute coronary syndrome a few weeks after mild COVID-19. According to coronary angiography, a dissection of ramus intermedius was detected. Successful stenting was performed. Subsequently, the patient had relapses of chest pain, which led to two repeated coronary angiographies. The patient had been diagnosed with consecutive dissections of right coronary artery and distal branch of ramus intermedius. Repeated stenting of dissected segments of right coronary artery and ramus intermedius was not performed. Afterward, the patient’s condition remained stable and he was successfully discharged. One of the main pathophysiological mechanisms of cardiovascular complications in COVID-19 is probably the virus-triggered hyperinflammation and massive release of cytokines. A systemic inflammatory response may initiate inflammation of the vascular wall and other target tissues. The results of histological studies confirm the direct infection of endothelial cells 2019-nCoV with the development of diffuse endothelial inflammation (endotheliitis). It is possible that in patients with a genetic predisposition to artery dissection, COVID-19 may be a trigger of spontaneous coronary artery dissection.

Assessment of the Flexion Force of TMA and Elgiloy Intrusion Arches to Different Lengths of Activation. An In Vitro Study

The present study analyzed the utilitary arch of Ricketts made with TMA and Elgiloy alloys, evaluating the forces that each one presented at different activation lengths. METHODS: A total of 30 arches (15 per alloy) 17x25 caliber were assessed. An acrylic model that simulated the jaw was used with tubes welded to the bands located on the first molars where the arches were attached and brackets were bonded to the lower incisors. The Ricketts arches had a total length of 100 mm and were activated in their distal branch, obtaining the lengths of 5, 10 and 15 mm measured from the slot of the anterior brackets in the midline. A Digital Universal Testing Machine CMT-5L was used to measure the bending force and the statistical analysis was carried out with the Student's T and Mann-Whitney U test. RESULTS: The TMA alloys had a significantly lower strength in each of the activations 5, 10, 15 mm (13,53; 31,61 and 42,01grams respectively) compared to Elgiloy (31.41; 62,61 y 93,00 grams respectively). While increasing the activation length, the flexural forces increased significantly for both alloys. CONCLUSION: The suggested forces for the intrusion of lower incisors were reached by the Elgiloy arches.

Neotype designation and re-description of Prolachlanius resinatus (Hagen) (Neuroptera, Hemerobiidae) from Baltic amber, with the first record of the species from Rovno amber

Prolachlanius resinatus (Hagen) is re-described, based on five specimens from late Eocene Baltic amber (including the neotype designated herein) and the first recorded specimen from contemporaneous Rovno amber (Klesov locality). This is the most common species of Hemerobiidae in Baltic amber. The forewing venation of Prolachlanius is most similar to that of Sympherobius, and, therefore, its assignment to Sympherobiinae is confirmed. The genus differs from other Sympherobiinae by the distal branch of RP being not deeply forked, and the presence of crossvein 4r-m in the forewing. The male genitalia of Prolachlanius are sufficiently dissimilar from those of other Sympherobiinae to distinguish it as a separate genus, particularly by the structure of the ectoprocts, and the 8th and 9th sternites. The extremely short eighth sternite of Prolachlanius is especially noteworthy.