CT angiography for the assessment of EVAR complications: a pictorial review

Endovascular aneurysm repair (EVAR) is a minimally invasive treatment proposed as an alternative to open repair in patients with abdominal aortic aneurysms. EVAR consists in a stent-graft placement within the aorta in order to exclude the aneurysm from arterial circulation and reduce the risk of rupture. Knowledge of the various types of devices is mandatory because some stents/grafts are more frequently associated with complications. CT angiography is the gold standard diagnostic technique for preprocedural planning and postprocedural surveillance. EVAR needs long-term follow-up due to the high rate of complications. Complications can be divided in endograft device-related and systemic complications. The purpose of this article is to review the CT imaging findings of EVAR complications and the key features for the diagnosis.

Multiple Splenic Artery Aneurysms: A Case Report and Review of the Literature

Background: Multiple splenic artery aneurysms (MSAAs) are rare and there are few reports about their treatment. We herein present a rare case of MSAAs treated with splenectomy combined with endovascular embolization.Methods: A 51-year-old female patient was incidentally diagnosed with MSAAs. Splenectomy combined with endovascular embolization was the chosen treatment.Outcomes: The patient recovered uneventfully and was discharged from the hospital 5 days after splenectomy. The patient has been doing well during the 27-months of follow-up.Conclusion: Combined with the experience of the previous literature, we think splenectomy combined with endovascular embolization is a safe, reliable and minimally invasive treatment for some selected multiple SAAs, depending on several patient parameters, such as the age, sex, aneurysm dimension, aneurysm location, complications, and severity of the clinical findings.

Effects of drug abuse and mental disorders on oral health: a case report

Substance use disorders, related to mental health issues can lead to oral pathologies. The purpose of this case report was to identify the oral conditions and manifestations in a 28-year-old male narco-dependent schizophrenic who smoked tobacco and marijuana. In intra-oral clinical exploration, poor oral hygiene, excessive tartar formation and dental plaque were observed, and the diagnosis of severe chronic periodontitis was established. The choice of a treatment plan in such patients is complex because the consequences of an invasive treatment can aggravate the psychological state and emotional stability leading to a negative effect on behaviour and mental health due to edentulism. The effects of excessive drug consumption related to schizophrenia can cause poor oral hygiene habits leading to oral pathologies and the loss of teeth. Keywords: drugs, schizophrenia, oral manifestations, mental health, oral pathologies.

What is the added value of CT-angiography in patients with transient ischemic attack?

Background Transient ischemic attack (TIA) is an important predictor for a pending stroke. Guidelines recommend a workup for TIA-patients similar to that of stroke patients, including an assessment of the extra- and intracranial arteries for vascular pathologies with direct therapeutic implications via computed tomography angiography (CTA). Aim of our study was a systematic analysis of TIA-patients receiving early CTA-imaging and to evaluate the predictive value of TIA-scores and clinical characteristics for ipsilateral vascular pathologies and the need of an invasive treatment. Methods We analysed clinical and imaging data from TIA patients being admitted to a tertiary university hospital between September 2015 and March 2018. Following subgroups were identified: 1) no- or low-grade vascular pathology 2) ipsilateral high-risk vascular pathology and 3) high-risk findings that needed invasive, surgical or interventional treatment. We investigated established TIA-scores (ABCD2-, the ABCD3- and the SPI-II score) and various clinical characteristics as predictive factors for ipsilateral vascular pathologies and the need for invasive treatment. Results Of 812 patients, 531 (65.4%) underwent initial CTA in the emergency department. In 121 (22.8%) patients, ipsilateral vascular pathologies were identified, of which 36 (6.7%) needed invasive treatment. The ABCD2-, ABCD3- and SPI-II-scores were not predictive for ipsilateral vascular pathologies or the need for invasive treatment. We identified male sex (OR 1.579, 95%CI 1.049–2.377, p = 0.029), a short duration of symptoms (OR 0.692, 95% CI 0.542–0.884, p = 0.003), arterial hypertension (OR 1.718, 95%CI 0.951–3.104, p = 0.073) and coronary heart disease (OR 1.916, 95%CI 1.184–3.101, p = 0.008) as predictors for ipsilateral vascular pathologies. As predictors for the need of invasive treatment, a short duration of symptoms (OR 0.565, 95%CI 0.378–0.846, p = 0.006), arterial hypertension (OR 2.612, 95%OR 0.895–7.621, p = 0.079) and hyperlipidaemia (OR 5.681, 95%CI 0.766–42.117, p = 0.089) as well as the absence of atrial fibrillation (OR 0.274, OR 0.082–0.917, p = 0.036) were identified. Conclusion More than every fifth TIA-patient had relevant vascular findings revealed by acute CTA. TIA-scores were not predictive for these findings. Patients with a short duration of symptoms and a vascular risk profile including coronary heart disease, arterial hypertension and hyperlipidaemia most likely might benefit from early CTA to streamline further diagnostics and therapy.

Denosumab-Induced Medication-Related Osteonecrosis of the Jaw (DRONJ): A 5-Year Retrospective Cohort Study

Denosumab (Dmab) has been suggested as a first-line therapy for osteoporotic patients. However, a standardized protocol for the prevention of Dmab induced medication-related osteonecrosis of the jaw (MRONJ) has not yet been established. Thus, we investigated the factors that can affect Dmab induced MRONJ (DRONJ) to elucidate the relationship between invasive dental treatment and Dmab administration in patients who underwent Dmab and invasive dental treatment (especially tooth extraction) between October 2016 and March 2020. Four of the 98 patients developed MRONJ before and after tooth extraction. Two out of 4 patients developed MRONJ regardless of invasive treatment after Dmab administration and proceeded with extraction, and one patient developed DRONJ after Dmab administration and extraction. The other patient underwent a tooth extraction without osteoporosis treatment, and spontaneous DRONJ developed after Dmab administration. All MRONJ/DRONJ cases reported in this study show that MRONJ/DRONJ can develop as chronic inflammation without invasive dental treatment, therefore, implementing preventive dental treatment before initiating Dmab treatment is necessary to reduce the likelihood of DRONJ.

Eff ect of ursodeoxycholic acid in postcholecystectomy cholestatic hepatopathy verified by ultrasonography

Summary: Cholestasis syndrome is accompanied by a large number of diverse liver and biliary tract diseases. Many cholestatic changes are fully reversible in the fi rst phase. However, with long-term cholestasis, extensive hepatocyte dysfunction occurs, the disease progresses, and many cholestatic syndromes result in irreversible liver damage and failure. Cholestatic liver diseases represent an important group of liver diseases that are an indication for liver transplantation. Postcholecystectomy syndrome is an imprecisely defi ned term, which includes a set of ongoing or recurrent or new diffi culties of patients after gallbladder surgery. We distinguish between early postcholecystectomy syndrome immediately in the postoperative period, or late postcholecystectomy syndrome, which occurs months or even years later. Ultrasonography is the fi rst imaging examination method for diseases of the liver and hepatobiliary system. It is a non-invasive method, available, relatively cheap, easily repeatable, and it does not represent a burden for the patient. Common bile duct dilatation after cholecystectomy is a common accidental fi nding that is inconclusive in the absence of clinical symptomatology and with normal laboratory fi ndings. Ursodeoxycholic acid forms the basis of cholestasis therapy, the only treatment whose effi cacy in cholestatic liver disease has been demonstrated in randomized and long-term studies. A further positive is that many years of ursodeoxycholic acid administration are not accompanied by more serious side eff ects. This case report supports the concept of a prompt and at the same time deepening benefi cial eff ect of ursodeoxycholic acid treatment in patients with cholestatic hepatopathy verified by ultrasonography indicated for conservative treatment or refusing invasive treatment. Key words: cholestasis – postcholecystectomy syndrome – ultrasonography – ursodeoxycholic acid

The feasibility evaluation of transapical saddle-shaped valved stent for transcatheter mitral valve implantation

Background: Transcatheter mitral valve implantation (TMVI) is a promising and minimally invasive treatment for high-risk mitral regurgitation (MR). The purpose of this study was to investigate the feasibility of a novel self-expanding valved stent for transcatheter mitral valve implantation via apical access. Methods: A novel self-expanding mitral valved stent system was designed and fabricated for the in vivo evaluation. It is consists of an atrial flange and a saddle-shaped ventricular body connected by two opposing anchors and two opposing extensions. During the valve deployment, each anchor is controlled by a recurrent string. TMVI was performed in ten pigs using the valve prosthesis through the apical access to verify technical feasibility. Echocardiography and ventricular angiography were used to assess hemodynamic data and valve function. The surviving pigs were sacrificed four weeks later to confirm stent deployment. Results: Ten animals underwent transapical mitral valve implantation with the novel mitral valved stent. Optimal valve deployment and accurate anatomical adjustment were obtained in nine animals. Implantation failed in one case, and the animal died one day later due to stent mismatch. After stent implantation, the hemodynamic parameter of other animals was stable and valve function was normal. The mean pressure across the mitral valve and left ventricular outflow tract (LVOT) were 2.98±0.91mmHg and 3.42±0.66 mmHg, respectively. The macroscopic evaluation confirmed the stable and secure positioning of the stents in the mitral valve. No obvious valve displacement, embolism, and paravalvular leakage were observed four weeks after valve implantation. Conclusions: This study proved that the novel mitral valved valve stent is technically feasible in animals. This device features opposing anchors, opposing recurrent strings, and saddle-like ventricular portions, providing structural design details for reducing TMVI complications. However, the long-term feasibility and durability of this valved stent need to be improved and verified.