Achilleas Chatziioannou

Endovascular repair of a persistent sciatic artery aneurysm.

Persistent sciatic artery (PSA), a persistent embryologic continuation of the internal iliac artery, represents a rare yet clinically important vascular anomaly. PSA is prone to aneurysmal change, which can subsequently lead to distal embolization, sciatic neuropathy, or rupture. The conventional surgical treatment of PSA aneurysms is commonly complex and carries the risk for sciatic nerve damage. We report herein the successful endovascular management of a PSA aneurysm and postaneurysmal stenosis with the use of two overlapping self-expanding stent-grafts via a contralateral transfemoral approach. Additionally, a review of the literature regarding the treatment of these unusual peripheral aneurysms is provided.

Transarterial Embolization with Sorafenib in Animal Livers: A Pharmacokinetics Study

PURPOSE To assess the safety and feasibility of the targeted delivery of the antiangiogenic drug sorafenib to the liver using transarterial chemoembolization methodology as a novel approach to hepatocellular carcinoma (HCC) therapy. MATERIALS AND METHODS Seven healthy New Zealand white rabbits were used in the study. After placement of a catheter in the common hepatic artery, six rabbits were treated with chemoembolization of sorafenib in iodized oil (Lipiodol) (sorafenib dose 0.1 mg/kg), and one rabbit received Lipiodol only. Liquid chromatography tandem mass spectrometry was used to measure the concentration of sorafenib in the peripheral blood and liver tissue 24 hours and 72 hours after treatment. Histochemical staining of the liver sections and biochemical measurements were performed. RESULTS The administration of sorafenib in Lipiodol emulsions by transarterial chemoembolization resulted in sorafenib concentrations of 794 ng/g ± 240 and 64 ng/g ± 15 in the liver tissue 24 hours and 72 hours after treatment. The average liver-to-serum ratios 24 hours and 72 hours after treatment were approximately 14 and 22. The histochemical staining of the liver tissue sections and aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase and total bilirubin concentrations indicated no significant liver damage. CONCLUSIONS Transarterial chemoembolization with sorafenib in Lipiodol is an effective methodology for the localized delivery of this drug to the liver and has possible practical implications in therapeutic interventions for the treatment of hepatocellular carcinoma.

Correlation between mesenteric fat thickness and serum apolipoproteins in patients with peripheral arterial occlusive disease

BackgroundVisceral fat possesses the most detrimental potential for cardiovascular morbidity through the release of adipokines, as well as metabolic and proinflammatory mediators, which adversely affect metabolic and vascular homeostasis. Among the different types of visceral adipose tissue, mesenteric fat is considered particularly detrimental, due to its close proximity to the portal circulation, affecting directly the liver, which is the main regulator of body metabolic homeostasis. Mesenteric fat can be reliably estimated using abdominal ultrasonography, the only available imaging method able to depict individual mesenteric leaves. Aim of the present study was to investigate the correlation of mesenteric fat thickness (MFT) with serum apolipoprotein levels in patients undergoing digital subtraction angiography in a single center.Methods35 male patients with peripheral arterial disease were examined. After careful examination of the periumbilical area, the mesenteric leaves were identified. The maximal distance between each pair of sequential leaves was measured, and the mean value of the three thickest leaves was determined as the mesenteric fat thickness. Six apolipoprotein fasting serum concentrations were measured using a Luminex proteomics platform (xMAP Multiplex immunoassay): apolipoprotein A-I (apoAI), apolipoprotein A-II (apoAII), apolipoprotein B (apoB), apolipoprotein C-II (apoCII), apolipoprotein C-III (apoCIII) and apolipoprotein E (apoE).ResultsMFT correlated with apoAII and apoB serum concentrations. The correlations with apoAII and apoB remained significant following correction for BMI. No correlations were noted between MFT and serum apoAI, apoCII, apoCIII or apoE levels before or after adjustment for BMI.ConclusionsOur study indicates that MFT is significantly correlated with the concentration of atherogenic low density lipoproteins particles, as well as with apoAII, a determinant of free fatty acids levels. No correlation was observed between mesenteric fat thickness and very low density lipoprotein or chylomicron particles concentration.

Endovascular Treatment of a Vertebral Artery Pseudoaneurysm in a Drug User

A 26-year-old drug abuser who presented with sepsis was found to have a pseudoaneurysm in the left vertebral artery. This aneurysm was presumed to be post-traumatic, since the patient reported multiple attempts to inject drugs in the left jugular vein 15 days prior to admission. The pseudoaneurysm was treated effectively with stent-graft placement.

Multiple Aneurysms of the Inferior Pancreaticoduodenal Artery: A Rare Complication of Acute Pancreatitis

Inferior pancreaticoduodenal artery (IPDA) aneurysms are uncommon, representing nearly 2% of all visceral aneurysms, and sporadically associated with celiac artery stenosis. Multiple IPDA aneurysms have been rarely reported. We report a case of a 53-year-old female patient with a history of prior pancreatitis, who presented with two IPDA aneurysms combined with median arcuate ligament-syndrome-like stenosis of the celiac trunk. The patient was treated successfully with coil embolization under local anesthesia. The procedure is described and illustrated in detail and the advantages and technical considerations of such an approach are also being discussed.

Extensive corpus callosum infarction : An uncommon pattern of watershed ischaemia?

Sirs: A 60-year old man, current heavy smoker with a history of poorly controlled diabetes mellitus, hypertension and hypercholesterolaemia, but no alcohol consumption, developed hemihypaesthesia and confusion shortly after receiving 20 mg nifedipine sublingually, due to a hypertensive episode (195/ 110 mmHg before; 150/85 mmHg after medication). Detailed neurological examination on hospital admission six hours later revealed additionally an impressive disconnection syndrome with left visual and tactile extinction, anomia, left hemianopic alexia, pronounced apraxia with the left or with both hands and intermanual conflict. Computed tomography excluded haemorrhage, while two days later magnetic resonance imaging (MRI) visualized on FLAIRand T2weighted sequences signal hyperintensities affecting the entire corpus callosum, the left temporal-occipital cortex and the underlying subcortical white matter, adjacent to the posterior watershed area. Diffusion weighted imaging (DWI) and corresponding restricted apparent diffusion coefficient (ADC) maps established the subacute ischaemic nature of the lesion (Fig. 1) [8]. Digital subtraction angiography (DSA) excluded extracranial lesions and demonstrated subtotal and moderate stenosis of the proximal intracranial cavernous portion of the left and right internal carotid artery (ICA) respectively (Fig. 2), with anterograde flow in both ICAs. The left ICA territory was supplied mainly with anterograde flow through the stenotic lesion and to a lesser degree through ophthalmic collaterals from the ispilateral external carotid artery. Both anterior cerebral arteries (ACA) were supplied by the left ICA. The right A1 was not seen and was probably hypoplastic. The combination of hypoplastic right A1 with near occlusion of the ICA cavernous portion seemed to be the underlying cause of infarction. Detailed cardiological studies including transoesophageal echocardiogram and repeated Holter-electrocardiogram recordings revealed no pathological findings suggestive of cardioembolism. Infarction of the corpus callosum is uncommon due to its rich blood supply and resistance to small vessel ischaemic changes [1, 6, 10]. Extensive lesions involving the entire corpus callosum are extremely rare and have been related to bilateral ICA occlusion [5, 7], underlining the importance of haemodynamic insufficiency in such cases [3, 10]. The pericallosal branch of the ACA is the dominant vascular supply of the body of the corpus callosum, whereas other perforating ACA-branches supply rostrum and genu. The splenium is covered by the posterior pericallosal artery; a posterior cerebral artery branch [1]. The watershed area between anterior and posterior pericallosal artery is quite variable explaining the unpredictable size and location of corpus callosum infarctions. There have been few cases of extensive corpus callosum infarction reported [1, 2, 3, 5, 7, 8], two of which were in the presence of bilateral proximal ICA occlusion [5, 7]. Some authors have noted that the majority of ACA and partial corpus callosum strokes are thromboembolic in origin [1], while others attribute them mostly to local atherothrombosis [4]. We present the uncommon case of an entire corpus callosum infarction in a patient where the mainly supplying left ICA was subtotally occluded. In combination with contralateral ICA stenosis and ipsilateral A1 hypoplasia, we assume that there was hypoperfusion due to distal haemodynamic insufficiency after a drug induced abrupt blood pressure decrease as the cause of stroke and suggest that the present case of extensive corpus callosum infarction might be considered as a K. Spengos, MD, FESC (&) G. Tsivgoulis, MD Æ C. Potagas, MD V. Zis, MD Dept. of Neurology University of Athens Eginition Hospital Vas. Sofias 82 11528 Athens, Greece Tel.: +30-694/6466216 Fax: +30-210/6742604 E-Mail: spengos@hol.gr

Management of Iatrogenic Subclavian Artery Pseudoaneurysms

BACKGROUND To report our experience in the management of iatrogenic subclavian artery pseudoaneurysms (SAPs). METHODS During a 6-year period, 5 patients were treated urgently for SAP. RESULTS Two patients presented with rupture, 2 with dyspnea, whereas 1 had unremitting severe pain. Three patients underwent preoperative computed tomography angiography and 2 digital subtraction angiography. Three patients were treated with an open surgical procedure, whereas 2 were managed by endovascular means. A combined supraclavicular and/or infraclavicular approach was used in 2 patients, whereas a midsternotomy was mandatory to achieve proximal control in one. A combined transfemoral and/or brachial approach was used in both patients treated endovascular. No perioperative deaths or procedure-related complications occurred. All symptoms were relieved, whereas the median hospital stay was 8 days. During a mean follow-up period of 20.4 ± 10 months, none of the patients needed any reintervention. CONCLUSIONS Iatrogenic SAPs constitute a clinical entity that may need surgical treatment, especially in the presence of symptoms. In relatively stable patients with no major compression issues, stenting could be considered as an adequate therapy for these situations. Open surgical repair should be considered when there is significant compression of adjacent structures or failure of the endovascular approach.

Recommendations for Mechanical Thrombectomy in Patients with Acute Ischemic Stroke

This document presents the consensus recommendations of the Hellenic Stroke Organization which can be of assistance to the treating stroke physicians.

SPNsim: A database of simulated solitary pulmonary nodule PET/CT images facilitating computer aided diagnosis

The aim of the present work was to design and develop a database of simulated solitary pulmonary nodules (SPN) in pairs of computed tomography (CT) and positron emission tomography (PET) images, using Monte Carlo (MC) simulation methods. We have developed an SPN image modeling pipeline to feed the database entitled SPNsim. The database is web-accessible and it is contains two subsets of simulated PET/CT SPN images. The first subset is currently composed of 1000 cases containing pairs of the transaxial CT and the corresponding PET slice with various types of simulated SPNs, presented as individual records. The second subset contains pairs of the transaxial CT and the corresponding PET slice of simulated SPNs, presenting cases of graded difficulty in diagnosis. The users of the database will have the ability to set queries in order to retrieve cases with certain characteristics, as well as characterized image sets. All images are freely available and may be downloaded from the website. SPNsim provides a useful reference data set for training and evaluation of computer aided detection (CAD) and diagnosis (CADx) systems focusing on SPN.

Renal Artery Intervention

The present case report describes a patient who sustained an acute inferior wall myocardial infarction, but initially remained clinically stable, then he underwent a successful coronary angioplasty and stenting procedure of a totally occluded right coronary artery, subsequently developing a dramatic clinical course with cardiogenic shock and cardiac arrest due to acute stent thrombosis which was successfully managed with repeat coronary angioplasty. We attributed this discrepant clinical manifestation of acute coronary occlusion to coronary collaterals, initially being present and then disappearing following the recanalization procedure, as being responsible for the dramatic clinical picture following the stent thrombosis.Aim: The purpose of this investigation was to collect data on the appropriate nursing care to patients supported with an intra-aortic balloon pump (IABP).Patients: All 39 patients who were supported with an IABP during the year 2006 (23 men ??? 16 women) took part in this investigation. They received nursing and medical care in the Intensive Care Cardiovascular Unit (ICCU) of Evagelismos General Hospital of Athens.Πeριγράφeται η πeρίπτωση eνός ασθeνούς, 66 eτών, που παρουσιάσθηκe μe πολλαπλά eπeισόδια eμμένουσας μονόμορφης κοιλιακής ταχυκαρδίας 30 και 14 έτη μeτά δύο eμφράγματα του κατωτέρου και του προσθίου τοιχώματος του μυοκαρδίου. Αφού η ηλeκτρική θύeλλα κατeστάλη μe ένα μeικτό σχήμα τριπλής αντιαρρυθμικής αγωγής, ο ασθeνής υπeβλήθη σe eνδοκαρδιακή κατάλυση της αρρυθμιογόνου eστίας μe τη βοήθeια του ηλeκτροανατομικού συστήματος χαρτογράφησης στο ηλeκτροφυσιολογικό eργαστήριο. Ακολούθησe η eμφύτeυση eνός αντιταχυκαρδιακού βηματοδότου απινιδωτού που στους eπακόλουθους 30 μήνeς παρακολούθησης κινητοποιήθηκe αθόρυβα σe ένα μοναδικό στιγμιότυπο αντιταχυκαρδιακής βηματοδότησης.Ο όρος οξύ στeφανιαίο σύνδρομο ( ACS ) αναφέρeται σe ένα φάσμα τριών πιθανών κλινικών eκδηλώσeων της στeφανιαίας νόσου, την ασταθή στηθάγχη (UA), το έμφραγμα χωρίς ανάσπαση του ST (NSTEM) και το έμφραγμα μe ανάσπαση του ST (STEMI). Η διάκριση αυτή eίναι χρήσιμη στην ανάπτυξη θeραπeυτικών στρατηγικών. Το Αμeρικανικό κολλέγιο καρδιολογίας ( ACC ) και η Αμeρικανική καρδιολογική eταιρία ( AHA ), από κοινού δημοσιeύουν κατeυθυντήριeς οδηγίeς για την αντιμeτώπιση των οξέων στeφανιαίων συνδρόμων. Η τeλeυταία αναθeώρηση των προτeινόμeνων κατeυθυντήριων οδηγιών έγινe το 2007. Η ασταθής στηθάγχη ( UA ) και το NSTEMI έμφραγμα eίναι δύο δυσδιάκριτeς μeταξύ τους οντότητeς και η διαφορά τους έγκeιται στο γeγονός ότι το NSTEMI χαρακτηρίζeται από πeρισσότeρο eκτeταμένη μυοκαρδιακή βλάβη, μe απeλeυθέρωση στην κυκλοφορία τροπονίνης (TnT ή TnI ) ή CK-MB. Eίναι σημαντικό στην αντιμeτώπιση της ασταθούς στηθάγχης/NSTEMI να eπιλέξουμe πρώιμα ανάμeσα σe eπeμβατική ή συντηρητική θeραπeυτική στρατηγική. Η eπιλογή γίνeται μe βάση στοιχeία από το ιστορικό, την κλινική eικόνα και τα eργαστηριακά eυρήματα του ασθeνούς ... (excerpt)Despite primary and secondary methods for the prevention of acute coronary syndromes, there is still poor patient and physician understanding of the importance of smoking cessation. Cardiovascular risk decreases significantly after smoking cessation, however, there is a paucity of counseling programs regarding this issue after hospitalization. Such programs have proved to be cost effective and should be provided as standard care.