Transcatheter arterial embolization for hemoperitoneum: unusual manifestation of iatrogenic injury to abdominal muscular arteries

Purpose  

To evaluate the etiology of unusual manifestation of hemoperitoneum and the efficacy of transcatheter arterial embolization (TAE).     

Effect of percutaneous adenovirus-mediated Gax gene delivery to the arterial wall in double-injured atheromatous stented rabbit iliac arteries

Though the efficacy of intravascular gene transfer has been demonstrated in native vessels following acute injury, this methodology has not been validated in complex models of vascular injury that more closely mimic clinical angioplasty procedures. Previous studies have shown that Gax gene overexpression modulates the injury-induced remodeling of the vessel in rat carotid and normal rabbit iliac arteries. Here, we evaluated the effect of the Gax gene delivery in atheromatous stented vessels. Rabbits were fed 120 g daily of 1% cholesterol diet for 3 weeks. At 1 week they underwent initial injury on the external iliac artery, then balloon angioplasty was performed at 3 weeks at the same site with a 2.5 mm diameter channel balloon catheter (three times 1 min at 6 atm). Either saline (n = 4) or the control viral construct Ad-CMVluc (5 x 109 p.f.u.) (n = 5) or Ad-CMVGax (5 x 10(9) p.f.u.) (n = 4) was delivered with a poloxamer mixture via a channel balloon (6 atm, 30 min), and a 15 mm long Palmaz-Schatz stent (PS154) was then deployed at the site (1 min, 8 atm). Arteries were analyzed 1 month later. At 1 month, the Ad-CMVGax treated arteries exhibited a lower maximal intimal area (1. 15+/-0.1 mm2) than saline (1.87+/-0.15 mm2, P = 0.007) or Ad-CMVluc-treated vessels (1.98+/-0.31 mm2, P = 0.04). Likewise Ad-CMVGax-treated vessels displayed a lower maximal percentage cross-sectional area narrowing (35.1+/-3.5%) than saline (65.3+/-9.4%, P = 0.01) or Ad-CMVluc-treated vessels (62.7+/-6.7%, P = 0.02). Angiographic analysis revealed larger minimal lumen diameter in Ad-CMVGax treated arteries (2.0+/-0.1 mm) than saline (1.14+/-0.36 mm, P = 0.06) or Ad-CMVluc-treated vessels (1.23+/-0.25 mm, P = 0.02). Overexpression of the Gax gene inhibits neointimal hyperplasia and lumen loss in atheromatous stented rabbit iliac arteries.     

Female gender increases stiffness of elastic but not of muscular arteries in type I diabetic patients

The reason for the particularly increased risk for cardiovascular complications in diabetic women is still unclear. We have previously found decreased distensibility of elastic arteries in type I diabetic women, indicating increased cardiac load, not seen in type I diabetic men, which might be one contributing factor. Whether the effect of gender is different in muscular arteries in type I diabetic patients has not been assessed. As estimates of arterial distensibility we measured stiffness (beta) and pressure strain elastic modulus (Ep) in the muscular common femoral artery using echo-tracking sonography in 30 women (mean age 34 years, range 20-61) and 26 men (mean age 38 years, range 22-56) with type I diabetes. The results were compared with those of 89 healthy individuals of corresponding age and gender and with previously published results from elastic arteries in these patients obtained at the same occasion. The internal common femoral diameter was significantly decreased in both diabetic men and women. In sharp contrast to the highly significant decreased distensibility of the elastic abdominal aorta and common carotid artery in the type I diabetic women, the distensibility of the common femoral artery did not clearly differ between patients and controls, neither for women nor for men. Thus, the gender difference in changes of arterial distensibility found in elastic arteries was absent or far less obvious in the femoral artery. In conclusion, female gender seems to affect the mechanical properties of elastic, but not of large muscular arteries in type I diabetic patients. Thus, putative gender differences in arterial changes in type I diabetes are to be sought in elastic rather than muscular arteries.     

Angle-dependent backscatter from the arterial wall

The anisotropic nature of intra-arterial echographic images is reported, and the source of this anisotropy is investigated using postmortem human iliac arteries. A 27 MHz transducer, mounted on an ultrasonic microscope, is used to quantify the angular dependence of the backscatter power versus the angle of incidence, and these results are correlated with histological findings. Besides the observed differences in the acoustic response of morphologically different tissues, significant variations in backscatter power are found in both media and internal elastic lamina due to variations in the angle of incidence. This angle dependence is caused by the dominant orientation of fibers in tissue layers and by the shape and size various scattering particles. The results indicate that long microscopic structures with one main orientation are responsible for the backscattered signal and that the angular-dependent response is related to the histologically determined orientation of these fibers. These results may have an impact on the assessment of intra-arterial echographic images.     

Noninvasive simultaneous assessment of wall shear rate and wall distension in carotid arteries

A novel technique has been developed for the noninvasive real-time simultaneous assessment of both blood velocity profile and wall displacements in human arteries. The novel technique is based on the use of two ultrasound beams, one set at optimal angle for wall motion measurements and the other for blood velocity profile measurements. The technique was implemented on a linear array probe divided into two subapertures. A modified commercial ultrasound machine and a custom PC board based on a high-speed digital signal processor was used to process the quadrature demodulated echo signals and display results in realtime. Flow phantom experiments demonstrated the validity of the technique, providing wall shear rate (WSR) estimates within 10% of the theoretical values. The system was also tested in the common carotid arteries of 16 healthy volunteers (age 30 to 53 y). Results of simultaneous diameter distension and WSR measurements were in agreement with published data.     

Ultrasonic imaging of arterial wall echoes

Ultrasonography of carotid arteries was attempted in healthy volunteers. As results had often been unsatisfactory in the past, an improved recording technique was used. Besides successful registrations, some unusual pulsation curves were recorded. Studies with a “pulsating” vessel model clarified the influence of angular and lateral transducer displacement. This influence could be reduced by using proper sensitivity adjustments.     

Rupture of the aortic wall with compression of bronchial arteries

A case of closed traumatic rupture of the aortic wall with compression of the bronchial arteries is described. No comparable case has been reported in the literature so far. The effect on pulmonary perfusion and gas exchange is demonstrated. The compression, displacement and transposition of the bronchial arteries (vasa privata) is shown in postmortem angiography.     

The arterial switch procedure for transposition of the great arteries

TRANSPOSITION OF THE GREAT ARTERIES is the most common congenital heart defect among the birth defects that present with cyanosis during the early neonatal period.INFANTS WITH THIS CARDIAC BIRTH DEFECT, in which the aorta originates from the right ventricle and the pulmonary artery originates from the left ventricle, usually do not survive without surgical intervention in the first few days of life.THE ARTERIAL SWITCH PROCEDURE, performed via a median sternotomy incision during cardiopulmonary bypass, restores the aorta and pulmonary artery to their normal anatomic positions. AORN J 86 (August 2007) 211-226. © AORN, Inc, 2007.     

An arterial wall motion test phantom for the evaluation of wall motion software

Increasing cardiovascular disease has led to new ultrasound methods of assessing artery disease such as arterial wall motion measurement. To validate arterial wall motion software, we developed a mechanically-controlled wall motion test phantom with straight upper and lower agar tissue mimicking material layers that resemble an artery cross section. The wall separation, displacements and wall velocities and accelerations can be controlled within physiologically realistic levels. A user-definable displacement or one of several pre-defined displacement waveforms can be created by the user with custom-written software. The test phantom is then controlled using the defined waveform with a stepper motor controller. Accuracy assessment of the test phantom with a laser vibrometer yielded a positional accuracy of 36+/-2 microm. A typical application of the test phantom is demonstrated by assessing a tissue Doppler imaging (TDI) method for estimating the distension waveform. The TDI-based method was found to have a minimum resolvable displacement of 22.5 microm, and a measurement accuracy of +/-8% using a physiological wall motion movement with a peak displacement of 689 microm. The accuracy of the TDI method was found to decrease with decreasing wall displacement and increasing wall velocity.     

Increased arterial wall stiffness limits flow volume in the lower extremities in type 2 diabetic patients.

OBJECTIVE: To document an association between arterial wall stiffness and reduced flow volume in the lower-extremity arteries of diabetic patients. RESEARCH DESIGN AND METHODS: We recruited 60 consecutive type 2 diabetic patients who had no history or symptoms of peripheral arterial disease (PAD) in the lower extremities and normal ankle/brachial systolic blood pressure index at the time of the study (non-PAD group) and 20 age-matched nondiabetic subjects (control group). We used an automatic device to measure pulse wave velocity (PWV) in the lower extremities as an index of arterial wall stiffness. At the popliteal artery, we evaluated flow volume and the resistive index as an index of arterial resistance to blood flow using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. RESULTS: Consistent with previous reports, we confirmed that the non-PAD group had an abnormally higher PWV compared with that of the control group (P < 0.001). To further demonstrate decreased flow volume and abnormal flow pattern at the popliteal artery in patients with a higher degree of arterial wall stiffness, we assigned the 60 non-PAD patients to tertiles based on their levels of PWV. In the highest group, magnetic resonance angiograms of the calf and foot arteries showed decreased intravascular signal intensity, indicating the decreased arterial inflow in those arteries. The highest group was also characterized by the lowest late diastolic and total flow volumes as well as the highest resistive index among the groups. From stepwise multiple regression analysis, PWV and autonomic function were identified as independent determinants for late diastolic flow volume (r(2) = 0.300; P < 0.001). CONCLUSIONS: Arterial wall stiffness was associated with reduced arterial flow volume in the lower extremities of diabetic patients.     

Thromboresistance of the arterial wall: the role of heparin and glycosaminoglycans

Thromboresistance of the arterial wall is the result of many factors which dynamically interact with each other. Glycosaminoglycans (GAG), among which heparin, synthesized by endothelial cells, smooth muscle cells, and fibroblasts, play an important role in determining vessel wall non-thrombogenicity. We are describing morphological-morphometrical characterization (increase in endothelial cell density and nucleus/cytoplasm ratio) of bovine aortic endothelial cells grown in the presence of heparin and other GAGs.     

The influence of the wall tension on the contractile responses of arteries

The present study aimed at determining the influence of tension on the responses of arterial smooth muscle to noradrenaline, phenylephrine and angiotensin II. Concentration-response curves to these agonists were obtained in the rat aorta, at two levels of tension: 3 g (29.4 mN) and 0.5 g (4.9 mN). The results obtained show that the maximal responses to the agonists used (in percent of the maximal response to noradrenaline) were significantly larger (P < 0.05) at 3 g than at 0.5 g: 113% versus 66%, respectively, for noradrenaline; 95% versus 59%, respectively, for phenylephrine; 60% versus 24%, respectively, for angiotensin II. In the presence of gadolinium (100 mumol/L)--a mechanogated ion channel blocker--the responses to noradrenaline at 3 g were still significantly larger than responses at 0.5 g: 103% versus 67%, respectively. The compound H-7 (20 mumol/L)--a protein kinase C inhibitor--caused a marked decrease in the maximal responses to noradrenaline at both levels of tension, the responses being reduced to 44% at 3 g and to 20% at 0.5 g. Isradipine (1 mumol/L)--a calcium channel blocker--caused a slight decrease in the responses to noradrenaline at both levels of tension, the responses being reduced to 86% (3 g) and to 50% (0.5 g). In endothelium-free arterial rings, the responses to noradrenaline at 3 g and 0.5 g were also significantly different: 118% versus 80%, respectively. It is concluded that the tension of the arterial wall is a major factor influencing the effects of vasoconstrictor agents; however the mechanisms underlying this supersensitivity at higher tension remain unknown.     

Calcium distribution in the vessel wall and intima-media thickness of the human carotid arteries

Increased common carotid artery (CCA) intima-media thickness (IMT) measured by B-mode ultrasound is an early marker of the atherosclerotic process. Arterial calcification is not clearly understood. Using the particle-induced X-ray emission (PIXE) method, we have looked for the location in the artery wall where calcium accumulated in the early phase of atherosclerosis. Twelve segments of CCAs of deceased stroke patients were investigated. In-vivo, carotid duplex ultrasound was performed with bilateral CCA IMT measurement at plaque-free sections. During autopsy, segments of carotid arteries were collected and filled under pressure with a stained histologic embedding material. The frozen arteries were cut into 60-microm-thick slices. Calcium distribution maps from the segments of arteries were determined by PIXE method. IMT measured by ultrasound and calcium distribution maps measured by PIXE were compared. In our cross-sectional study, using the PIXE analysis and ultrasound images, we could demonstrate early calcium accumulation in the media layer. Our results have also shown a significant relationship between calcium content of distributional maps measured by PIXE analysis and corresponding IMT on B-mode ultrasound images of human CCAs.