Repeated Intravenous Administration of hiPSC-MSCs Enhance The Efficacy of Cell-Based Therapy In Tissue Regeneration

We sought to demonstrate whether therapeutic efficacy can be improved by combination of repeated intravenous administration and local transplantation of human induced pluripotential stem cell derived MSCs (hiPSC-MSCs). In this study, mice model of hind-limb ischemia was established by ligation of left femoral artery. hiPSC-MSCs (5x105) was intravenously administrated immediately after induction of hind limb ischemia with or without following intravenous administration of hiPSC-MSCs every week or every 3 days. Intramuscular transplantation of hiPSC-MSCs (3x106) was performed one week after induction of hind-limb ischemia. We compared the therapeutic efficacy and cell survival of intramuscular transplantation of hiPSC-MSCs with or without a single or repeated intravenous administration of hiPSC-MSCs. Repeated intravenous administration of hiPSC-MSCs could increase splenic regulatory T cells (Tregs) activation, decrease splenic natural killer (NK) cells expression, promote the polarization of M2 macrophages in the ischemic area and improved blood perfusion in the ischemic limbs. The improved therapeutic efficacy of MSC-based therapy was due to both increased engraftment of intramuscular transplanted hiPSC-MSCs and intravenous infused hiPSC-MSCs. In conclusion, our study supported a combination of repeated systemic infusion and local transplantation of hiPSC-MSCs for cardiovascular disease.

A Magic Bullet: Bullet Embolism From the Heart to the Femoral Artery

A case study a patient who was emergently evaluated with an intraoperative transesophageal echocardiography after suffering a gunshot wound to the back is provided. This diagnostic examination revealed a left atrium to aorta fistula, due to the path of the bullet through the body. Immediate postoperative imaging with computed tomography revealed that the bullet had embolized to the left femoral artery from which it was later surgically removed. This rare clinical phenomenon of bullet embolization, involving the heart and associated vasculature, is reviewed.

Single access in complex angioplasty using the ventricular support system Impella CP™

The volume of complex coronary interventions has grown in Brazil and worldwide. Since they are performed in patients at increasingly higher risks, new techniques have been developed when interventional cardiologists are faced with uncommon situations, such as no safe arterial access for the procedure. We report a case of a patient with severe peripheral artery disease and occluded right femoral artery, in whom a single access (left femoral artery) was used for positioning the Impella™ and the guidewire for angioplasty.

SUPPURATION OF IATROGENIC FEMORAL ARTERY ANEURYSM

The article describes the application of methods and methods of reconstructive surgery of iatrogenic false aneurysms of the left femoral artery. Experience shows the optimality of the choice and method of surgical treatment of iatrogenic aneurysms of the femoral artery by restoring prosthetic arteries. The article presents a clinical case of surgical treatment of iatrogenic aneurysm of the left femoral artery resulting from a puncture of the left femoral artery. The elimination of the aneurysm was accompanied by plastic surgery of the defect (5–6 cm) of the left femoral artery by applying prosthetics to the vessels. The rationale for the choice of surgical intervention is given.

Case study successful use of stent graft in post-catherization massive pseudoaneurysm of femoral artery with wide neck

Pseudoaneurysms are not rare and can occur due to varied reasons including percutaneous vascular access. If left untreated, pseudoaneurysms can be fatal. Here, we have presented a classic case study where a large pseudoaneurysm of left femoral artery with very wide neck was closed using stent graft. A 55 years old male was presented with severe painful large mass in left groin. The mass was soft tissue swelling with severe tenderness and pulsatile in nature. The doppler suggested it to be filled with blood and communicating with femoral artery hence diagnosed as pseudoaneurysm. Attempt was made to compress the neck which was large not clearly defined, hence failed. Multiple interventional and surgical options of closure of pseudoaneurysm was discussed. Patient was taken for stent graft deployment in cath lab. Check angiogram showed nicely flowing femoral artery with no signs of pseudoaneurysm. The patient immediately improved with decrease in pain and swelling.

An arm and a leg: A case of rheumatoid vasculitis and antiphospholipid antibody syndrome

Rheumatoid vasculitis is a rare extra-articular complication of rheumatoid arthritis. The most common manifestation is cutaneous; however, it can manifest in various organ systems and is associated with a high degree of morbidity and mortality. Diagnosis is challenging, and there are no validated diagnostic or classification criteria. Most cases should be confirmed with tissue biopsy when possible given the severity of disease and the extent of immunosuppression required to treat this condition. We report the case of a 54-year-old white woman with long-standing, uncontrolled, and seropositive rheumatoid arthritis with a history of elevated anticardiolipin IgG and IgM antibodies who presented with acute stenosis of her left femoral artery which ultimately required a left above-the-knee amputation. Histopathology revealed findings consistent with vasculitis and thrombosis, and subsequent imaging revealed multifocal arterial and venous thromboses. She was diagnosed with rheumatoid vasculitis and antiphospholipid antibody syndrome, and was treated with high-dose glucocorticoids, cyclophosphamide, and warfarin. Rheumatoid vasculitis is a rare but devastating complication of rheumatoid arthritis, and vigilance for this condition must be maintained, especially in patients with long-standing, seropositive disease.

Common Femoral Artery Diameters Determined by Doppler Ultrasonography

Common femoral arteries diameters (left and right) were studied, on a number of 60 cases (26 women and 34 men) with a General Electric – Voluson 730 Expert ultrasonograph. The diameters of the common femoral arteries, left and right, were measured in three points: proximal, middle and inferior, in 60 cases as it follows: 26 cases on women (43,33%) and 34 cases on men (56,70%). Regarding the proximal third of the right common femoral artery, the diameter range was found between 6,1 and 8,9mm, in women being between 6,2-7,9mm, and in men between 6,1-8,9mm. The diameter of the middle third had values between 5,8-9,7mm, in women ranging from 6,1 to 7,8mm, and in men from 5,8 to 9,7mm. At the level of the inferior third, the femoral artery had a diameter between 6,8-12,7mm, in women ranging from 6,5 to 9,8mm, and in men from 6,3 to 12,7mm. The common left femoral artery, in its proximal third had a diameter with values between 5,7 – 9,9mm, in women from 6,2 to 8,0mm, and in men being between 5,7-9,9mm. In the middle third the values were found between 6,1-9,8mm, in women being from 6,6 to 7,9mm, and in men from 6,1 to 9,8mm. Regarding the inferior third, the diameters had values between 7,0-12,5mm, in women ranging from 7,1 to 10,5mm, and in men, from 6,8 to 12,5mm.

Alterations in Endothelin Receptors Following Hemorrhage and Resuscitation by Centhaquin

Endothelin-1 (ET-1) acts on ETA and ETB receptors and has been implicated in hemorrhagic shock (shock). We determined effect of shock and resuscitation by hypertonic saline (saline) or centhaquin on ETA and ETB receptor expression. Rats were anesthetized, a pressure catheter was placed in the left femoral artery; blood was withdrawn from the right femoral artery to bring mean arterial pressure (MAP) to 35 mm Hg for 30 min, resuscitation was performed and 90 min later sacrificed to collect samples for biochemical estimations. Resuscitation with centhaquin decreased blood lactate and increased MAP. Protein levels of ETA or ETB receptor were unaltered in the brain, heart, lung and liver following shock or resuscitation. In the abdominal aorta, shock produced an increase (140 %) in ETA expression which was attenuated by saline and centhaquin; ETB expression was unaltered following shock but was increased (79 %) by centhaquin. In renal medulla, ETA expression was unaltered following shock, but was decreased (-61 %) by centhaquin; shock produced a decrease (-34 %) in ETB expression which was completely attenuated by centhaquin and not saline. Shock induced changes in ETA and ETB receptors in the aorta and renal medulla are reversed by centhaquin and may be contributing to its efficacy.