Publications by authors named "Ludomir Stefańczyk"

141 Publications

Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms.

J Clin Med 2021 Mar 24;10(7). Epub 2021 Mar 24.

Department of Neurosurgery and Neurooncology, Medical University of Lodz, Barlicki University Hospital, Kopcińskiego 22, 90-153 Lodz, Poland.

Background: The objective of our project was to identify a late recanalization predictor in ruptured intracranial aneurysms treated with coil embolization. This goal was achieved by means of a statistical analysis followed by a computational fluid dynamics (CFD) with porous media modelling approach. Porous media CFD simulated the hemodynamics within the aneurysmal dome after coiling.

Methods: Firstly, a retrospective single center analysis of 66 aneurysmal subarachnoid hemorrhage patients was conducted. The authors assessed morphometric parameters, packing density, first coil volume packing density (1st VPD) and recanalization rate on digital subtraction angiograms (DSA). The effectiveness of initial endovascular treatment was visually determined using the modified Raymond-Roy classification directly after the embolization and in a 6- and 12-month follow-up DSA. In the next step, a comparison between porous media CFD analyses and our statistical results was performed. A geometry used during numerical simulations based on a patient-specific anatomy, where the aneurysm dome was modelled as a separate, porous domain. To evaluate hemodynamic changes, CFD was utilized for a control case (without any porosity) and for a wide range of porosities that resembled 1-30% of VPD. Numerical analyses were performed in Ansys CFX solver.

Results: A multivariate analysis showed that 1st VPD affected the late recanalization rate ( < 0.001). Its value was significantly greater in all patients without recanalization ( < 0.001). Receiver operating characteristic curves governed by the univariate analysis showed that the model for late recanalization prediction based on 1st VPD (AUC 0.94 (95%CI: 0.86-1.00) is the most important predictor of late recanalization ( < 0.001). A cut-off point of 10.56% (sensitivity-0.722; specificity-0.979) was confirmed as optimal in a computational fluid dynamics analysis. The CFD results indicate that pressure at the aneurysm wall and residual flow volume (blood volume with mean fluid velocity > 0.01 m/s) within the aneurysmal dome tended to asymptotically decrease when VPD exceeded 10%.

Conclusions: High 1st VPD decreases the late recanalization rate in ruptured intracranial aneurysms treated with coil embolization (according to our statistical results > 10.56%). We present an easy intraoperatively calculable predictor which has the potential to be used in clinical practice as a tip to improve clinical outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm10071348DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037793PMC
March 2021

The Role of Urine F2-ISOPROSTANE CONcentration in Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Haemorrhage-A Poor Prognostic Factor.

Diagnostics (Basel) 2020 Dec 22;11(1). Epub 2020 Dec 22.

Department of Neurosurgery and Neurooncology, Barlicki University Hospital, Medical University of Lodz, Kopcińskiego 22, 90-153 Lodz, Poland.

The pathophysiology of delayed cerebral ischemia (DCI) remains unclear. One of the hypotheses suggests that reactive oxygen species play a role in its onset. Thus, we studied F2-isoprostanes (F2-IsoPs)-oxidative stress biomarkers. Our goal was to improve the early diagnosis of DCI in a non-invasive way. We conducted a prospective single center analysis of 38 aneurysmal subarachnoid hemorrhage patients. We assessed urine F2-IsoP concentration using immunoenzymatic arrays between the first and fifth day after bleeding. A correlation between urine F2-IsoP concentration and DCI occurrence was examined regarding clinical conditions and outcomes. The urine F2-IsoP concentrations were greater than those in the control groups ( < 0.001). The 3rd day urine F2-IsoPs concentrations were correlated with DCI occurrence ( < 0.001) and long term outcomes after 12 months ( < 0.001). High levels of urine F2-IsoPs on day 3 can herald DCI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/diagnostics11010005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822020PMC
December 2020

Spatial Configuration of Abdominal Aortic Aneurysm Analysis as a Useful Tool for the Estimation of Stent-Graft Migration.

Diagnostics (Basel) 2020 Sep 23;10(10). Epub 2020 Sep 23.

Institute of Electronics, Lodz University of Technology, 93-005 Lodz, Poland.

The aim of this study was to prepare a self-made mathematical algorithm for the estimation of risk of stent-graft migration with the use of data on abdominal aortic aneurysm (AAA) size and geometry of blood flow through aneurysm sac before or after stent-graft implantation. AngioCT data from 20 patients aged 50-60 years, before and after stent-graft placement in the AAA was analyzed. In order to estimate the risk of stent-graft migration for each patient we prepared an opposite spatial configuration of virtually reconstructed stent-graft with long body or short body. Thus, three groups of 3D geometries were analyzed: 20 geometries representing 3D models of aneurysm, 20 geometries representing 3D models of long body stent-grafts, and 20 geometries representing 3D models of short body stent-graft. The proposed self-made algorithm demonstrated its efficiency and usefulness in estimating wall shear stress (WSS) values. Comparison of the long or short type of stent-graft with AAA geometries allowed to analyze the implants' spatial configuration. Our study indicated that short stent-graft, after placement in the AAA sac, generated lower drug forces compare to the long stent-graft. Each time shape factor was higher for short stent-graft compare to long stent-graft.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/diagnostics10100737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598279PMC
September 2020

Shape and Enhancement Analysis as a Useful Tool for the Presentation of Blood Hemodynamic Properties in the Area of Aortic Dissection.

J Clin Med 2020 May 2;9(5). Epub 2020 May 2.

Institute of Electronics, Lodz University of Technology, 93-005 Lodz, Poland.

The aim of this study was to create a mathematical approach for blood hemodynamic description with the use of brightness analysis. Medical data was collected from three male patients aged from 45 to 65 years with acute type IIIb aortic dissection that started proximal to the left subclavian artery and involved the renal arteries. For the recognition of wall dissection areas Digital Imaging and Communications in Medicine (DICOM) data were applied. The distance from descending aorta to the diaphragm was analyzed. Each time Feret (D) and Hydraulic (D) diameter were calculated. Moreover, an average brightness (B) was analyzed. Finally, to describe blood hemodynamic in the area of aortic wall dissection, mathematical function combining difference in brightness value and diameter for each computed tomography (CT) scan was calculated. The results indicated that D described common duct more accurately compare to D. While, D described more accurately true and false ducts. Each time when connection of true and false duct appeared, true duct had lower brightness compare to common duct and false duct. Moreover, false duct characterized with higher brightness compare to common duct. In summary, the proposed algorithm mimics changes in brightness value for patients with acute type IIIb aortic dissection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9051330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290319PMC
May 2020

Systematic and Multidisciplinary Evaluation of Fibromuscular Dysplasia Patients Reveals High Prevalence of Previously Undetected Fibromuscular Dysplasia Lesions and Affects Clinical Decisions: The ARCADIA-POL Study.

Hypertension 2020 04 9;75(4):1102-1109. Epub 2020 Mar 9.

From the Departments of Hypertension (E.W.-C., A.P., P.D., E.F., K.J.-P., M.K., M.P., K.H., P.T., M.S., K.K., A.J.), Institute of Cardiology, Warsaw, Poland.

Fibromuscular dysplasia (FMD), regarded as a generalized vascular disease, may affect all vascular beds and may result in arterial stenosis, occlusion, aneurysm, or dissection. It has been proposed to systematically evaluate all vascular beds in patients with FMD, regardless of initial FMD involvement. However, the impact of this approach on clinical decisions and on management is unknown. Within the prospective ARCADIA-POL study (Assessment of Renal and Cervical Artery Dysplasia-Poland), we evaluated 232 patients with FMD lesions confirmed in at least one vascular bed, out of 343 patients included in the registry. All patients underwent a detailed clinical evaluation including computed tomography angiography of intracranial and cervical arteries, as well as computed tomography angiography of the abdominal aorta, its branches, and upper and lower extremity arteries. In the study group, FMD lesions were most frequently found in renal arteries (87.5%). FMD was also found in cerebrovascular (24.6%), mesenteric (13.8%), and upper (3.0%) and lower extremity (9.9 %) arteries. Newly diagnosed FMD lesions were found in 34.1% of the patients, and previously undetected vascular complications were found in 25% of the patients. Among all FMD patients included in the study, one out of every 4 evaluated patients qualified for interventional treatment due to newly diagnosed FMD lesions or vascular complications. The ARCADIA-POL study shows for the first time that the systematic and multidisciplinary evaluation of patients with FMD based on a whole-body computed tomography angiography scan has an impact on their clinical management. This proved the necessity of the systematic evaluation of all vascular beds in patients with FMD, regardless of initial FMD involvement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/HYPERTENSIONAHA.119.13239DOI Listing
April 2020

Unusual coexistence of double inferior vena cava with nutcracker syndrome-a case report and review of the literature.

J Int Med Res 2020 Feb;48(2):300060520904520

Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Łódź, Łódź, Poland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0300060520904520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7110912PMC
February 2020

Arterial vessel reactivity in patients in the long term after kidney transplantation - preliminary study.

Arch Med Sci 2019 Sep 20;15(5):1240-1246. Epub 2019 Aug 20.

Department of Clinical Pharmacology, 1 Chair of Internal Medicine, Medical University of Lodz, Lodz, Poland.

Introduction: The aim of this study was to evaluate the endothelial-dependent and -independent arterial vessels' reactivity in patients in the long term after kidney transplantation (KTx).

Material And Methods: The study included 36 (15 females; 21 males) patients after KTx with good, stable graft function and 94 healthy individuals (51 males, 43 females). The endothelial-dependent dilatory capacity of the brachial artery was estimated by an ischemic test (flow-mediated dilation - FMD), and independent by nitroglycerin-mediated vasodilation (NMD). The results were shown for age-related groups and compared with age-related healthy people.

Results: KTx patients were mean 5.1 ±2.3 years after transplantation with the mean estimated glomerular filtration rate (eGFR) 50.3 ±17.1 ml/min/1.73 m. The mean vessel diameter before tests was significantly larger in healthy people than in KTx patients. The FMD test showed vasodilation becoming weaker along with age in both groups, but in KTx patients this relationship was clearly enhanced. The NMD was delayed in relation to age, and in KTx patients was preserved, being only slightly weaker than in healthy people.

Conclusions: Both endothelium-dependent and -independent arterial wall reactions decrease with age. The endothelial-dependent vascular response is more attenuated in KTx patients than the independent one. The endothelium-independent vasodilation in KTx patients is comparable with that in healthy people.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aoms.2019.87240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764299PMC
September 2019

Predicting Outcome and Conservative Treatment Failure in Patients with Skull Fracture after Traumatic Brain Injury: A Retrospective Cohort Study.

J Neurol Surg A Cent Eur Neurosurg 2019 Nov 29;80(6):460-469. Epub 2019 Aug 29.

Department of Neurosurgery and Neuro-oncology, Medical University of Lodz, Barlicki Memorial Teaching Hospital, Kopcinskiego, Lodz, Poland.

Objective:  Traumatic brain injury (TBI) remains a major cause of morbidity and mortality worldwide. The prognostic value of skull fracture (SF) remains to be clearly defined. To evaluate the need for neurosurgical intervention and determine the risk factors of conservative treatment failure (CTF), we retrieved from the hospital database the records of patients with SF after TBI.

Methods:  We analyzed 146 consecutive patients (mean age: 49.8 ± 17.5 years) treated at the department of neurosurgery in a 5-year period. Clinical data, radiologic reports, and laboratory results were evaluated retrospectively.

Results:  A total of 63% of patients were treated conservatively, 21.9% were operated on immediately, and 15.1% experienced CTF. Overall, 73.3% had a favorable outcome; the mortality rate was 13%. Intracranial bleeding occurred in 96.6% of cases, basilar SF in 61%, and cerebrospinal fluid (CSF) leak in 2.8%. The independent risk factors for outcome were Glasgow Coma Scale (GCS) score, age, and platelet count (PCT). The independent risk factors for CTF were epidural hematoma, subdural hematoma, mass effect, edema, international normalized ratio, PCT, mean platelet volume, and CSF leakage. The consensus decision tree algorithm used at the accident and emergency department indicated patients with no need for neurosurgical intervention with an accuracy of 91.7%, sensitivity of 88.9%, and featured the importance of mass effect, GCS, and epidural hematoma.

Conclusions:  Tests included in the complete blood count appeared useful for predicting the course in patients with SF, although the most important factors were age and neurologic status, as well as radiologic findings. Our decision tree requires further validation before it can be used in everyday practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-1692672DOI Listing
November 2019

Renal-aortic ratio as an objective measure of renal artery diameter a computed tomography angiography study.

BMC Cardiovasc Disord 2019 07 30;19(1):181. Epub 2019 Jul 30.

Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Lodz, Łódź, ul. Pomorska 251, 92-213, Lodz, Poland.

Background: Considering vital role of renal arteries in many surgical procedures, diameter of renal arteries seems to be an important measure of kidney perfusion. In this study, we analyzed a new parameter, renal-aortic ratio (R-Ar) as an objective measure of the renal artery diameter.

Method: The study included CT angiographic images from 254 patients (129 women and 125 men). R-Ar was calculated by dividing the diameter of the main renal artery for each kidney by the aortic diameter.

Results: R-Ar values for the whole study group ranged between 0.0863 and 0.5083; the ranges of R-Ar values for women and men patients were 0.1150-0.5083 and 0.0863-0.4449, respectively. In 412 cases (81.10%), the kidney was supplied by a single renal artery (RA variant) and in 96 (18.90%) by more than one artery (sRA variant). A significant difference was found in R-Ar values for RA and sRA variants (p = 0.0008). When the anatomical variant of renal perfusion was not considered on statistical analysis, a significant difference was found between the R-Ar values for women and men (p = 0.0259). No statistically significant difference was observed in R-Ar values for the right and left kidneys (p = 0.3123). Spearman's coefficient of rank correlation between patient age and renal-aortic ratio values for the whole study group equaled - 0.36.

Conclusion: The analysis of the renal-aortic ratio values demonstrated that the diameter of renal arteries depended primarily on their number, and the relative diameter of renal arteries in women was larger than in men.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12872-019-1163-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668124PMC
July 2019

Predictors for ophthalmic segment aneurysms recanalization after coiling and flow diverter embolization in 6- and 12-month follow-up.

J Clin Neurosci 2019 Oct 12;68:151-157. Epub 2019 Jul 12.

Department of Neurosurgery and Neurooncology, Medical University of Lodz, Barlicki University Hospital, Kopcińskiego 22, 90-153 Lodz, Poland.

Carotid-ophthalmic aneurysms are indication for endovascular treatment. Coil embolization is associated with a high recanalization rate and thus usage of flow diverter (FD) could constitute the treatment of choice. Although implementation of FD is very effective, it carries a significant risk of complications. The goal of our study was to find a radiological recanalization marker in order to facilitate decision process which would result in fewer treatment-related complications and in this way, to personalize endovascular therapy. We made a retrospective analysis of seventy-five patients with saccular carotid-ophthalmic aneurysms treated endovascularly. Morphometric measurements were performed in CTA 3D aneurysm models. The aneurysm size and volume were measured on the base of digital subtraction angiography (DSA) images. The treatment effectiveness was determined visually using the modified Raymond Roy classification after embolization and on the 6- and 12-month follow-up DSA. Statistica 13.1 software was used. Multivariate analyses showed that the aneurysm neck size (OR 2.51; 95%CI: 1.20-5.26), aspect ratio (OR 2.60; 95%CI: 1.27-5.21) and neck to parent artery ratio (OR 2.68; 95%CI: 1.26-5.70) were risk factors for carotid-ophthalmic aneurysms recanalization after 6 months. Of those factors, aneurysm neck size remained the only significant risk factor for carotid-ophthalmic aneurysms recanalization after 12 months (OR 5.23, 95%CI: 1.71-15.93). Various factors seem to influence recanalization. Preoperatively, if the above-mentioned predictors of recanalization are present, coiling is burdened with a high recanalization rate. In those cases, FD embolization should be considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2019.07.007DOI Listing
October 2019

Variation in the morphology of spinous processes in the cervical spine - An objective and parametric assessment based on CT study.

PLoS One 2019 27;14(6):e0218885. Epub 2019 Jun 27.

Department of Angiology, Interfaculty Department of Anatomy and Histology, Medical University of Lodz, Lodz, Poland.

Background: Typically, cervical vertebrae display bifid spinous processes. Nevertheless, this feature may vary both between subjects and even within the vertebrae of the same individual. Although such variation can be important in archaeological research, anthropological studies and forensic medicine, it has not so far been the subject of any detailed studies.

Material And Methods: An analysis of 200 cervical spine CT examinations was performed. The morphology of the spinous process was evaluated, and new anthropometric parameters were selected to allow a more precise quantitative analysis of the degree of bifidity.

Results: The spinous process base (i.e. the part of the spinous process which was not bifid) was significantly longer in CII and CVII than in the other vertebrae. The spinous process branches (bifid elements) were significantly longer in CVI and CVII than in the other vertebrae. The angle between the branches was significantly sharper in CII and CVII than in CIII-CVI, on the right side, and CIII-CV, on the left side. On the right side, the branching coefficient (degree of branch development) was significantly higher for CII and significantly lower for CVI-CVII than for the other vertebrae. On the left side, the coefficient was significantly higher for CII and CIV, and significantly lower for CVI-CVII, compared to the other vertebrae.

Conclusion: Our findings highlight new objective parameters of morphological variability in the spinous processes of the cervical spine. They can form the basis of a new detailed differentiation of vertebrae and can represent an independent determinant of anatomical variability in the cervical spine.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0218885PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597074PMC
February 2020

A novel vision-based system for quantitative analysis of abdominal aortic aneurysm deformation.

Biomed Eng Online 2019 May 14;18(1):56. Epub 2019 May 14.

Institute of Electronics, Lodz University of Technology, Łódź, Poland.

Background: In clinical diagnostics, combination of different imaging techniques is applied to assess spatial configuration of the abdominal aortic aneurysm (AAA) and deformation of its wall. As deformation of aneurysm wall is crucial parameter in assessing wall rupture, we aimed to develop and validate a Non-Invasive Vision-Based System (NIVBS) for the analysis of 3D elastic artificial abdominal aortic models. 3D-printed elastic AAA models from four patients were applied for the reconstruction of real hemodynamic. During experiments, the inlet boundary conditions included the injection volume and frequency of pulsation averaged from electrocardiography traces. NIVBS system was equipped with nine cameras placed at a constant distance to record wall movement from 360 angle and a dedicated set of artificial lights providing coherent illumination. Additionally, self-prepared algorithms for image acquisition, processing, segmentation, and contour detection were used to analyze wall deformation. Finally, the shape deformation factor was applied to evaluate aorta's deformation. Experimental results were confronted with medical data from AngioCT and 2D speckle-tracking echocardiography (2DSTE).

Results: Image square analyses indicated that the optimal distance between the camera's lens and the investigated object was in the range of 0.30-0.35 m. There was approximately 1.44% difference observed in aneurysm diameters between NIVBS (86.57 ± 5.86 mm) and AngioCT (87.82 ± 6.04 mm) (p = 0.7764). The accuracy of developed algorithm for the reconstruction of the AAA deformation was equal to 98.56%. Bland-Altman analysis showed that the difference between clinical data (2DSTE) and predicted wall deformation (NIVBS) for all patients was 0.00 mm (confidence interval equal to 0.12 mm) for aneurysm size, 0.01 mm (confidence interval equal to 0.13 mm) and 0.00 mm (confidence interval equal to 0.09 mm) for the anterior and posterior side, as well as 0.01 mm (confidence interval equal to 0.18 mm) and 0.01 mm (confidence interval equal to 0.11 mm) for the left and right side. The optimal range of camera's lens did not affect acquired values.

Conclusions: The NIVBS with proposed algorithm that reconstructs the pressure from surrounding organs is appropriate to analyze the AAAs in water environment. Moreover, NIVBS allowed detailed quantitative analysis of aneurysm sac wall deformation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12938-019-0681-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518716PMC
May 2019

Arterio-bronchial fistula as a complication of post-traumatic subclavian artery pseudoaneurysm - radiological findings and outcome.

Adv Respir Med 2019 ;87(2):110-113

Department of Radiology and Diagnostic Imaging, Medical University of Lodz, USK nr 1, 22 Kopcińskiego Str., 90-153 Lodz, Poland.

Post-traumatic arterio-bronchial fistula is a rare cause of life-threatening hemorrhage. We present a case of a ten-year-old patient with a post-traumatic subclavian artery pseudoaneurysm complicated by an arterio-bronchial fistula and occlusion of the subclavian artery. The patient was treated with a stent-graft. We present radiological images of the fistula and the evolution of the changes in subsequent follow-up examinations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/ARM.2019.0017DOI Listing
December 2019

Association of intrarenal blood flow with renal function and target organ damage in hypertensive patients with fibromuscular dysplasia: the ARCADIA-POL study.

Pol Arch Intern Med 2019 04 7;129(4):234-241. Epub 2019 Mar 7.

Department of Hypertension, Institute of Cardiology, Warsaw, Poland

INTRODUCTION Data on the assessment of intrarenal blood flow parameters in patients with renal fibromuscular dysplasia (FMD) are scarce. OBJECTIVES The aim of the study was to evaluate intrarenal blood flow parameters in patients with FMD and significant or nonsignificant renal artery stenosis (RAS). PATIENTS AND METHODS We evaluated intrarenal blood flow parameters by Doppler ultrasonography in 153 patients with renal FMD enrolled in the ARCADIA‑POL study: 32 and 121 patients with and without significant RAS, respectively, compared with 60 matched patients with essential hypertension and 60 healthy controls. RESULTS Patients with FMD and significant RAS had a lower renal resistive index (RRI) compared with patients with FMD without significant RAS, patients with essential hypertension, and normotensive controls (mean [SD], 0.51 [0.08] vs 0.60 [0.07], 0.62 [0.06], and 0.61 [0.06], respectively; P <0.001). In patients with nonsignificant RAS, RRI correlated significantly with carotid intima-media thickness, 24‑hour diastolic blood pressure, 24‑hour pulse pressure, left ventricular diastolic function, known duration time of hypertension, and age. In patients with significant RAS, there was a significant correlation between RRI and known duration time of hypertension, left ventricular diastolic function, and age. In a separate, "per‑kidney" analysis, renal arteries with FMD and significant RAS were characterized by lower RRI values, higher maximal blood flow velocity, higher renal aortic ratio, and longer acceleration time compared with renal arteries with FMD and nonsignificant RAS as well as renal arteries without FMD. CONCLUSIONS In contrast to atherosclerotic RAS, intrarenal blood flow in patients with FMD and RAS is preserved, confirming that renal vasculature is relatively intact in these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20452/pamw.4479DOI Listing
April 2019

Diameters of Arteries Supplying Horseshoe Kidneys and the Level They Branch off Their Parental Vessels: A CT-Angiographic Study.

J Clin Med 2019 Apr 5;8(4). Epub 2019 Apr 5.

Department of Radiology, Barlicki University Hospital, Medical University of Łódź, Kopcińskiego Str. 22, 90-153 Łódź, Poland.

Background: The most common renal fusion anomaly is horseshoe kidney (HSK), a condition associated with variable arterial blood supply. The aim of this study was to determine whether the height of origin of the renal artery determines its diameter and whether it differs from the mean diameter of the renal arteries of normal kidneys (NK).

Methods: Computer tomography angiography (CTA) studies of 336 patients (88 HSK and 248 NK) were obtained in a search of renal arteries; these were than classified into four groups according to height of its origin: Group I, branching from the aorta superior to the inferior mesenteric artery (IMA); Group II, branching from the aorta below the IMA; Group III, branching from the iliac artery; and Group IV, originating from the internal and external iliac artery.

Results: The HSK group included 398 arteries (mean diameter 4.30 mm) and the NK group 598 (5.52 mm) (p < 0.0001). In the HSK group, the mean diameters according to groups were: Group I, 4.54 mm; Group II, 4.28 mm; Group III, 3.41 mm; and Group IV, 3.43 mm. Statistically significant differences were found between arteries originating from the aorta and arteries branching from the iliac arteries (p < 0.0001). In the NK group, the corresponding values were: Group I, 5.53 mm; and Group II, 4.45 mm. The number of arteries supplying the HSK wider than 3.0 mm were: Group I, 83.0%; Group II, 82.4%; Group III, 68.4%; and Group IV, 66.6%.

Conclusions: The renal arteries of the HSK branch from their parental vessels at lower levels and have smaller diameters than those of NK.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm8040464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518850PMC
April 2019

Diagnostic value of lateral ventricle ratio: a retrospective case-control study of 112 acute subdural hematomas after non-severe traumatic brain injury.

Brain Inj 2018 Nov 10:1-7. Epub 2018 Nov 10.

a Department of Neurosurgery and Neuro-oncology , Medical University of Lodz, Norbert Barlicki Memorial Teaching Hospital No. 1 , Lodz , Poland.

Primary Objective: To evaluate correlation between the lateral ventricle ratio (LVR) and the risk of conservative treatment failure (CTF) among patients with acute subdural hematoma (ASDH) after non-severe traumatic brain injury (TBI), we retrieved from the hospital database and performed a retrospective analysis of 1339 cases with TBI treated during the 2008-2016 period.

Methods And Procedures: 112 patients with ASDH, GCS≥ 9 and initial conservative treatment were enrolled. They were divided according to the final treatment method applied (surgical or conservative). Clinical and radiological data was evaluated. We used ROC curve analysis and multivariate logistic regression model to identify risk factors of CTF.

Main Outcomes And Results: LVR higher than 1.48 calculated on admission CT scans was the strongest predictor of CTF, with sensitivity of 78.9% and specificity of 93.5% (AUC: 0.774-0.994). LVR, prolonged prothrombin time and coexisting traumatic subarachnoid hemorrhage were independent risk factors.

Conclusions: Despite limitations, study results support the view that patients after non-severe TBI with ASDH and with lateral ventricle asymmetry, defined as LVR> 1.48, require surgical treatment. LVR seems to be indirect, but still the closest method to quantify intracranial compliance. Thus, in the selected group of patients without clinical symptoms of critically diminished compensatory reserve, LVR could indicate those who need a surgical decompression.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02699052.2018.1539871DOI Listing
November 2018

Computational Fluid Dynamics as an Engineering Tool for the Reconstruction of Hemodynamics after Carotid Artery Stenosis Operation: A Case Study.

Medicina (Kaunas) 2018 Jun 1;54(3). Epub 2018 Jun 1.

Medical Electronics Division, Institute of Electronics, Lodz University of Technology, 90-924 Lodz, Poland.

Brain ischemic stroke is caused by impaired or absolutely blocked blood flow into the brain regions. Despite the large number of possible origins, there is no general strategy for preventive treatment. In this paper, we aimed to predict the hemodynamics in a patient who experienced a critical stenosis operation in the carotid artery. This is a unique study where we used medical data together with the computational fluid (CFD) technique not to plan the surgery, but to predict its outcome. AngioCT data and blood perfusion of brain tissue (CT-perfusion) together with CFD technique were applied for stroke formation reconstruction in different clinical conditions. With the use of self-made semiautomatic algorithm for image processing and 3DDoctror software, 3D-vascular geometries before and after surgical intervention were reconstructed. As the paper is focused on the analysis of stroke appearance, apparent stroke was simulated as higher and lower pressure values in the cranial part due to different outcomes of the surgical intervention. This allowed to investigate the influence of spatial configuration and pressure values on blood perfusion in the analyzed circulatory system. Application of CFD simulations for blood flow reconstruction for clinical conditions in the circulatory system accomplished on average 98.5% and 98.7% accuracy for CFD results compared to US-Doppler before and after surgical intervention, respectively. Meanwhile, CFD results compared to CT-perfusion indicated an average 89.7% and 92.8% accuracy before and after surgical intervention, respectively. Thus, the CFD is a reliable approach for predicting the patient hemodynamics, as it was confirmed by postoperative data. Our study indicated that the application of CFD simulations for blood flow reconstruction for clinical conditions in circulatory system reached 98% and 90% accuracy for US-Doppler and CT-perfusion, respectively. Therefore, the proposed method might be used as a tool for reconstruction of specific patients' hemodynamics after operation of critical stenosis in the carotid artery. However, further studies are necessary to confirm its usefulness in clinical practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/medicina54030042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122108PMC
June 2018

A novel method for describing biomechanical properties of the aortic wall based on the three-dimensional fluid-structure interaction model.

Interact Cardiovasc Thorac Surg 2019 02;28(2):306-315

Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.

Objectives: Our goal was to present a novel non-invasive approach for assessment of aortic wall displacement to describe its biomechanical properties during the cardiac cycle.

Methods: The fluid-structure interaction (FSI) technique was used to reconstruct aortic wall displacement based on computed tomography angiography and 2-dimensional speckle-tracking technique (2DSTT) data collected from 20 patients [10 with healthy aortas (AA) and 10 with abdominal aortic aneurysms (AAAs)]. The mechanical properties of the wall of the aorta were described by the Yeoh hyperelastic materials model with α and β parameters, and wall displacement was determined with 2DSTT. The mechanical parameters of the wall of the aorta in the FSI model were automatically updated in the calculation loop until the calculated and clinically measured wall movements were the same.

Results: Results showed 98% accuracy of FSI compared to 2DSTT for AA and AAA (P > 0.05). The mean wall deformation for AA was 2.45 ± 0.12 mm and 2.49 ± 0.10 mm for FSI and 2DSTT, respectively (P = 0.40), whereas that for AAA was 2.84 ± 0.44 mm and 2.88 ± 0.45 mm, respectively (P = 0.83). The FSI analysis indicated that the α and β parameters for AA were equal to 14.35 ± 1.30 N⋅cm-2 and 9.33 ± 1.08 N⋅cm-2, respectively; and for AAA, α was 11.00 ± 0.49 N⋅cm-2 and β was 79.46 ± 4.32 N⋅cm-2.

Conclusions: The FSI technique may be successfully applied to assess the mechanical parameters of patient-specific aortic walls using computed tomography angiographic and 2DSTT measurements.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/icvts/ivy252DOI Listing
February 2019

The level of origin of renal arteries in horseshoe kidney vs. in separated kidneys: CT-based study.

Surg Radiol Anat 2018 Oct 24;40(10):1185-1191. Epub 2018 Jul 24.

Department of Radiology, Barlicki University Hospital, Medical University of Łódź, Kopcińskiego Str. 22, 90-153, Lodz, Poland.

Purpose: Horseshoe kidney is a rare congenital anomaly with potential clinical implications. The aim of this study was to determine the number of renal arteries and veins and the level at which the arteries branched off their parental vessels in individuals with horseshoe kidney (HSK) and in persons with separated kidneys (SK).

Materials And Methods: The analysis included computed tomography angiography studies of 331 patients (83 HSK and 248 SK). The number of renal vessels and diameters of renal arteries were determined, along with the level at which they branched in relation to other ramifications (four groups of origin were proposed) and their entrance of the vessels to the kidney.

Results: Number of renal arteries in HSK group was 4.57 ± 1.39 per patient and 2.4 ± 0.43 in SK group (p < 0.0001). The distribution of branching level of renal arteries in HSK group was: I group ~ 57%, II group ~ 27%, III group ~ 15% and IV group < 1%, whereas in SK group the distribution was respectively: I group ~ 99%, II group < 1%, III and IV group - 0% (p = 0.0001). In HSK group, diameter of renal arteries branching above the IMA was 4.61 ± 1.58 mm, as compared with 3.96 ± 1.34 mm for the arteries branching below (p = 0.0004). Number of veins was 566 in SK group (87.70% of kidneys were supplied by single vein) and 323 in HSK group (9.64% kidneys were supplied by two veins) (p < 0.0001).

Conclusion: In HSK group, renal arteries significantly more often branch off their parental vessels below the origin of IMA and such vessels are usually smaller.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00276-018-2071-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6153647PMC
October 2018

Iatrogenic Gerbode-type defect after surgical correction of double-outlet right ventricle.

Kardiol Pol 2018 ;76(7):1117

Chair and Department of Cardiology, Medical University of Lodz, Kniaziewicza 1/5, 91-347 Łódź, Poland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/KP.2018.0140DOI Listing
November 2018

Simulation of phase contrast angiography for renal arterial models.

Biomed Eng Online 2018 Apr 16;17(1):41. Epub 2018 Apr 16.

Department of Diagnostic Imaging, Medical University of Lodz, Łódź, ul. Kopcińskiego 22, 90-153, Lodz, Poland.

Background: With the development of versatile magnetic resonance acquisition techniques there arises a need for more advanced imaging simulation tools to enable adequate image appearance prediction, measurement sequence design and testing thereof. Recently, there is a growing interest in phase contrast angiography (PCA) sequence due to the capabilities of blood flow quantification that it offers. Moreover, as it is a non-contrast enhanced protocol, it has become an attractive option in areas, where usage of invasive contrast agents is not indifferent for the imaged tissue. Monitoring of the kidney function is an example of such an application.

Results: We present a computer framework for simulation of the PCA protocol, both conventional and accelerated with echo-planar imaging (EPI) readout, and its application to the numerical models of kidney vasculatures. Eight patient-specific renal arterial trees were reconstructed following vessel segmentation in real computed tomography angiograms. In addition, a synthetic model was designed using a vascular tree growth simulation algorithm. The results embrace a series of synthetic PCA images of the renal arterial trees giving insight into the image formation and quantification of kidney hemodynamics.

Conclusions: The designed simulation framework enables quantification of the PCA measurement error in relation to ground-truth flow velocity data. The mean velocity measurement error for the reconstructed renal arterial trees range from 1.5 to 12.8% of the aliasing velocity value, depending on image resolution and flip angle. No statistically significant difference was observed between measurements obtained using EPI with a number of echos (NETL) = 4 and conventional PCA. In case of higher NETL factors peak velocity values can be underestimated up to 34%.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12938-018-0471-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902949PMC
April 2018

Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries.

Arch Med Sci 2018 Mar 17;14(2):442-453. Epub 2016 Mar 17.

Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland.

Renal vascularization variants vastly differ between individuals due to the very complex embryogenesis of the kidneys. Moreover, each variant may have implications for clinical and surgical interventions. The number of operating procedures continues to grow, and includes renal transplants, aneurysmorrhaphy and other vascular reconstructions. In any surgical technique, unawareness of the presence of multiple renal arteries may result in a fatal outcome, especially if laparoscopic methods are used. The aim of this review is to comprehensively identify the variation within multiple renal arteries and to highlight the connections between the presence of accessory renal arteries and the coexistence of other variants of vascularization. Another aim is to determine the potential clinical implications of the presence of accessory renal arteries. This study is of particular importance for surgeons, intervention radiologists, nephrologists and vascular surgeons.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aoms.2015.55203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5868651PMC
March 2018

The Influence of Suprascapular Notch Shape on the Visualization of Structures in the Suprascapular Notch Region: Studies Based on a New Four-Stage Ultrasonographic Protocol.

Biomed Res Int 2017 20;2017:5323628. Epub 2017 Dec 20.

Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Łódź, Łódź, Poland.

Evaluation of the morphology of the suprascapular notch region is important from a clinical point of view because it is the most common site of suprascapular nerve compression and injury. A group of 120 patients underwent ultrasound examination of the suprascapular notch region according to our original four-stage "step-by-step" protocol. The notches were classified based on their morphology and measurements like maximal depth (MD) and superior transverse diameter (STD) as follows: type I-MD is longer than STD, type II-MD and STD are equal, type III-STD is longer than MD, and in type IV/V-notches only the bony margin was visualized without depression. Both suprascapular notches were fully visualized in 115 of 120 patients. The type III suprascapular notch was the most prevalent (64.2%), followed by type IV/V (18.7%), type I (11.1%), and type II (6.0%). Color Doppler analysis allowed the suprascapular artery to be recognized in all visualized notches. The suprascapular vein was visible in 176 notches and the suprascapular nerve in 150. Notches containing both suprascapular nerve and vein were significantly wider and shallower than average. As the suprascapular artery is the most easily recognised structure in the area, it may serve as a useful landmark of the suprascapular notch.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2017/5323628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750495PMC
August 2018

What Each Clinical Anatomist Has to Know about Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome): A Review of the Most Important Findings.

Biomed Res Int 2017 11;2017:1746570. Epub 2017 Dec 11.

Department of Angiology, Medical University of Łódź, Narutowicza 60, 90-136 Łódź, Poland.

Nutcracker syndrome (NCS) is the most common term for compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. The development of NCS is associated with the formation of the left renal vein (LRV) from the aortic collar during the sixth to eighth week of gestation and abnormal angulation of the superior mesenteric artery from the aorta. Collateralization of venous circulation is the most significant effect of NCS. It includes mainly the left gonadal vein and the communicating lumbar vein. Undiagnosed NCS may affect retroperitoneal surgery and other radiological and vascular procedures. The clinical symptoms of NCS may generally be described as renal presentation when symptoms like haematuria, left flank pain, and proteinuria occur, but urologic presentation is also possible. Radiological methods of confirming NCS include Doppler ultrasonography as a primary test, retrograde venography, which can measure the renocaval pressure gradient, computed tomography angiography, which is faster and less traumatic, intravascular ultrasound, and magnetic resonance angiography. Treatment can be conservative or surgical, depending on the severity of symptoms and degree of LRV occlusion. Nutcracker syndrome is worth considering especially in differential diagnosis of haematuria of unknown origin.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2017/1746570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742442PMC
August 2018

Predictors of recanalization after endovascular treatment of posterior circulation aneurysms.

Pol Przegl Chir 2017 Dec;89(6):7-11

Department of Neurosurgery and Neurooncology, Medical University of Lodz, Barlicki University Hospital, Lodz, Poland.

Introduction: Posterior circulation aneurysms account for approximately 30% of all intracranial aneurysms, and their rupture often causes aneurysmal subarachnoid hemorrhage (aSAH). Because surgical treatment of posterior circulation aneurysms is difficult, endovascular treatment is commonly indicated. However, simple coil embolization is associated with a high rate of recanalization. Our goal was to investigate morphometric aneurysmal features assessed on pre-embolization computed tomography angiography (CTA) as predictors of recanalization in patients with posterior circulation aneurysms.

Material And Methods: We retrospectively analyzed data of 24 patients who underwent coil embolization due to rupture of saccular posterior circulation aneurysms. The morphometric features of aneurysms were measured based on pre-embolization 3D-CTA-aneurysm models, and aneurysmal size and volume were measured on digital subtraction angiography (DSA) images. The effectiveness of initial endovascular treatment was determined visually with the modified Raymond Roy classification directly after embolization and on follow-up DSAs. Recanalization was diagnosed when, compared to the primary embolization aneurysm appearance, compaction and filling of the aneurysm occurred. Statistical analysis was performed with Statistica 13.1 software.

Results: Higher maximal aneurysm height perpendicular to the aneurysmal neck was associated with a greater aneurysm recanalization risk (12.12±5.13mm vs. 7.41±3.97mm, p=0.039), and this relationship remained significant after adjustment for patient's age, sex and aneurysm localization (OR=1.26, 95%CI: 1.01-1.60, p=0.047). Maximal aneurysm height perpendicular to the aneurysmal neck distinguished well between recanalized and non-recanalized aneurysms (AUC=0.755, 95%CI: 0.521- 0.989, p=0.033).

Conclusions: Predictors of aneurysm recanalization can help choose best endovascular treatment strategies, which could reduce complication rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5604/01.3001.0010.6734DOI Listing
December 2017

Arterio-biliary fistulas: What to choose as endovascular treatment?

Vascular 2018 Aug 23;26(4):445-448. Epub 2017 Nov 23.

4 Department of Radiology and Diagnostic Imaging, Medical University of Wroclaw, Wroclaw, Poland.

Objectives Endovascular procedures are the treatment of choice in cases of intrahepatic fistulas. Arterio-biliary fistulas are the rarest and most difficult to treat, due to high risk of infection. Methods Eight cases of persistent hemobilia that developed as a result of arterio-biliary fistulas are presented. Five cases developed as a result of iatrogenic injury, two cases as a result of chronic infection, one case as a consequence of trauma. Results Patients were treated using endovascular embolization or combined endovascular and endoscopic biliary tract revision. The results were monitored after six to seven days and one month after embolization. The embolizations were considered effective in all cases. One patient had four asynchronous fistulas requiring separate treatments sessions. Four patients required a revision of their biliary ducts after embolization and restoration of patency. In one patient, a migration of the coil to biliary ducts occurred. Conclusion Endovascular treatment of arterio-biliary fistulas is safe and effective. The use of embolization with soft and biodegradable materials like histoacrylic glue or thrombin may be the optimal method of treatment in comparison with coils which have a risk of migration or chronic infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1708538117743178DOI Listing
August 2018

Inhaled Corticosteroids in Asthma: Promoting or Protecting Against Atherosclerosis?

Med Sci Monit 2017 Nov 9;23:5337-5344. Epub 2017 Nov 9.

Department of Radiology and Diagnostic Imaging, Barlicki Hospital, Medical University of Łódź, Łódź, Poland.

BACKGROUND Bronchial asthma is an inflammatory disease of the respiratory system. However, it may also induce systemic effects. Although reports suggest patients with asthma are at increased risk of cardiovascular events, the association between asthma and atherosclerosis is unclear. The aim of the present study was to compare the progression of atherosclerosis between patients with asthma treated with inhaled corticosteroids and healthy controls. MATERIAL AND METHODS In 102 adult patients with asthma, markers of arterial stiffness (pulse wave velocity and augmentation index) were evaluated by applanation tonometry. Structural atherosclerotic changes (intima-media complex thickness and presence of atherosclerotic plaque) were assessed sonographically. Lipid profile and fasting glucose level were measured. Clinical data concerning the course of asthma, its severity, and management strategy were obtained. A group of 102 healthy, age-matched controls were examined according to the same protocol. RESULTS The majority of patients presented well-controlled asthma of moderate severity. When adjusted for weight, age, and systolic blood pressure, no significant differences were observed in pulse wave velocity, in augmentation index, or in intima-media complex thickness between groups. In controls, atherosclerotic plaque occurred significantly more often than in patients with asthma (p=0.0226). Moreover, in patients with asthma, the intima-media complex thickness of the right common carotid artery was significantly correlated with forced expiratory volume in 1 second (R²=-0.2951, p=0.0083). There was no significant difference in any of the atherosclerosis markers between different types and doses of administered inhaled corticosteroids. CONCLUSIONS Patients with bronchial asthma presented a decreased risk of atherosclerosis in comparison to healthy controls.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5691568PMC
http://dx.doi.org/10.12659/msm.904469DOI Listing
November 2017

Usefulness of Routine Coronary CT Angiography in Patients with Transposition of the Great Arteries After an Arterial Switch Operation.

Pediatr Cardiol 2018 Feb 31;39(2):335-346. Epub 2017 Oct 31.

Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, ul. Rzgowska 281/289, 93-338, Lodz, Poland.

Coronary complications in patients with transposition of the great arteries (TGA) after an arterial switch operation (ASO) are relatively rare, but of all the possible postoperative adverse events, they are potentially the most dangerous. The fate of the coronary arteries, which are transplanted during the neonatal ASO, remains uncertain. There is also no consensus regarding their postoperative evaluation, especially in asymptomatic patients. The aim of this study was to present the early results of routinely performed coronary computed tomography angiography (CCTA) in asymptomatic adolescents and young adults with TGA after an ASO. An initial series of 50 CCTAs performed in asymptomatic patients with TGA after an ASO were evaluated. In each case, a detailed examination of the coronary anatomy, its relationship to the surrounding structures, its exact position in the neoaortic sinus, and the presence of significant coronary abnormalities was performed. The CT scans revealed significant coronary abnormalities in 12 asymptomatic patients: three had acute proximal angulation and stenosis, four had an intra-arterial course, seven had a muscular bridge, one had a left anterior descending artery with an intramuscular course, and one had coronary fistulas to the pulmonary arteries. Additionally, in 25 patients, proximal acute angulation of at least one coronary artery was detected, and four of them had a high ellipticity index. Most of the potentially severe anatomical features were related to the left coronary artery or the left anterior descending artery. CCTA routinely performed on asymptomatic patients with TGA after an ASO provides accurate and useful information for postoperative management. The frequency of coronary anomalies and potentially dangerous anatomical features in this group of patients is high, and their impact on postoperative follow-up remains unknown.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00246-017-1761-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797754PMC
February 2018

Does the type of renal artery anatomic variant determine the diameter of the main vessel supplying a kidney? A study based on CT data with a particular focus on the presence of multiple renal arteries.

Surg Radiol Anat 2018 Apr 5;40(4):381-388. Epub 2017 Oct 5.

Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Łódź, Narutowicza 60, 90-136, Łódź, Poland.

Background: An in-depth knowledge of renal vascular anatomy is essential when planning many surgical procedures; however, a few data exists regarding renal artery diameter. The aim of this study was to assess this morphological feature and to investigate whether a correlation exists between renal artery diameter and the type of arterial supply, with a particular emphasis on variant anatomy and the presence of multiple renal arteries.

Materials And Methods: Computed tomography angiography (CTA) studies of 248 patients, i.e., a total of 496 kidneys, were evaluated. The mean age of the patients was 66.4 ± 15.01 years. Renal artery diameter was measured based on the type of arterial blood supply.

Results: The frequency of occurrence of three anatomic variants of renal arterial supply was established: single renal artery (RA) 43.35%, single artery with prehilar branching (pRA) 37.30%, and multiple renal artery (mRA) 19.35%. The diameter of single renal arteries, with either prehilar or hilar branching, was significantly larger than when multiple arteries were present. A detailed analysis of just the mRA variant demonstrated that the diameter of the renal arteries in men was larger (p = 0.012) than those in women and that there was no difference in diameter with regard to the side of the body (p = 0.219).

Conclusions: The classification described in our study containing a detailed description of renal artery diameter. It may be helpful in clinical practice, especially for transplantologists, surgeons, and vascular surgeons.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00276-017-1930-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880851PMC
April 2018

A new approach for the pre-clinical optimization of a spatial configuration of bifurcated endovascular prosthesis placed in abdominal aortic aneurysms.

PLoS One 2017 9;12(8):e0182717. Epub 2017 Aug 9.

Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Lodz, Poland.

Complexity of the spatial configuration of an aortic implant with bifurcation in the distal part is related to changes in blood hemodynamic in the area of bifurcation which may disturb blood flow and lead to thrombus formation. This study was designed to characterize parameters which define spatial configuration of an aortic implant for which the risk of thrombus formation is the smallest. We used AngioCT data from 74 patients, aged 55 ±10 years, after endovascular procedure to prepare 3D geometries of stent-grafts. Computational Fluid Dynamics (CFD) simulations were used to reconstruct blood hemodynamic and simulate thrombus formation. Next, geometric parameters of stent-grafts included the ratio of volume of upper part to the bifurcations, the relation of inlet and outlet diameters of a stent-graft and deformations in the iliac part of the stent-graft were analyzed. We also analyzed tortuosities (spiral twisting of the flow around the flow direction) and bends (the largest angulation in distal part of a stent-graft). The CFD results were confronted with AngioCT data to verify if computer generated thrombus appeared in particular patient. Additionally, geometric parameters of analyzed stent-grafts were used to propose a mathematical tool for prediction of thrombus appearance. The results showed that tortuosities and bends of a stent-graft had the highest impact on thrombus formation. Formation of thrombi was observed in 22% to 31% of cases (at blood hematocrit Hct = 40%) even for small values of tortuosities and bends indicating that these parameters are dominant in determining blood clotting. Our calculated results overlapped with clinical data in 80% to 91%. Therefore, we conclude that tortuosities and bends have high impact on thrombus formation and should be under special attention during stent-graft recommendation and patients' follow-ups.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0182717PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549977PMC
October 2017