Purpose: This study aimed to conduct a comprehensive analysis of the global burden and attributable risk factors for lower extremity peripheral arterial disease (LEPAD) among postmenopausal women, and project future trends. Methods: All data were obtained from the Global Burden of Disease Study 2021, stratified by age, sex, and region to evaluate disparities. We performed decomposition analysis to quantify the contributions of population growth, aging, and epidemiological changes, and comparative risk assessment to evaluate attributable risk factors. The Bayesian age-period-cohort (BAPC) model was applied to project future trends by 2035. Results: In 2021, there were 66,392,811 prevalent cases, 33,854 deaths, and 777,299 DALYs of LEPAD among postmenopausal women globally. Due to population growth and aging, these figures increased by 99.84%, 72.93%, and 73.06%, respectively, compared to 1990. High fasting plasma glucose was the leading attributable risk factor. Projections indicate a continued increase in the global burden by 2035. Conclusion: Our findings reveal a substantial and persistently increasing burden of LEPAD among postmenopausal women globally. Targeted strategies are urgently needed to ensure healthier aging among this vulnerable population.

The early development of aortic dissections (AD) is manifested by tear propagation. The direction and extent of tear propagation are important for surgical strategy selection and outcomes, yet the mechanism underlying early tear propagation is largely unknown. Interface damage, leading to in-plane propagation, is modeled using the cohesive zone method. Bulk material damage, causing transmural propagation, is modeled using a strain-energy-based damage criterion. The influences of geometrical parameters are examined with a double-layer finite-element model of a three-dimensional (3D) idealized aorta. With blood pressure in the true lumen fixed at a physiological value, new findings are: Critical pressures for in-plane tear propagation are well within the physiological blood pressure. Initially, in-plane propagation is more likely to propagate as the tear size increases. However, critical pressures increase when reaching geometrical thresholds of the tear. The opening mode (Mode-I) is the leading fracture mode for in-plane propagation. For transmural propagation, three representative locations are identified, and critical pressures drop monotonically with increasing tear size. In-plane propagation is more likely to occur than transmural propagation in the parameter space studied. However, as blood pressure in the true lumen increases, critical pressures for in-plane propagation increase rapidly and transmural propagation prevails. This study successfully integrates interface damage and bulk material damage methods to model tear propagations, identifying possible mechanisms behind dissection progression. The findings can help predict the outcomes of early development of aortic dissections and assist with treatment and management.

Myocardial bridging (MB), a congenital coronary anomaly with systolic luminal narrowing of arteries, may lead to serious cardiovascular events. However, the biomechanical effects of MB remain poorly understood. In this paper, computational and theoretical efforts are combined to investigate the morpho-hemodynamics of MB. A fluid mechanics model, validated by fluid dynamics analysis, is developed to predict the luminal pressure distributions in branched, slender tubular structures with non-uniform curvatures and varying cross-sections. An elastic mechanics model is proposed to predict the stress concentrations in perforated soft tissues with an anisotropic constitutive relation and arbitrarily shaped holes. The results show that increasing the compression ratio, the narrowed arterial length, and the embedded depth leads to a higher relative pressure drop (RPD) across the tunneled segment and a lower major outlet flow rate. The dependence of RPD on the bridge location is indistinct. Due to myocardial contractility, the maximum von Mises stress in the arterial wall increases significantly, which may cause endothelial dysfunction. Further, a risk classification model, supported by clinical results, is proposed. By combining the compression ratio of MB and the length of the narrowed section, this model exhibits excellent discriminant ability in assessing the severity of MB. This work helps understand the biomechanical effects of MB in coronary arteries, and provides a theoretical basis for the prognostic predictions and clinical interventions of MB patients.

OBJECTIVE:Acute type B aortic dissection (ATBD) is a severe cardiovascular event with potential impact on health related quality of life (HRQoL). Evidence on post-operative rehabilitation and exercise guidance remains limited. This study evaluated HRQoL among patients with ATBD after thoracic endovascular aortic repair (TEVAR), focusing on follow up duration, sex, and age. METHODS:This single centre, cross sectional survey study initially screened 625 patients who underwent TEVAR for ATBD between 1 January 2016 and 31 July 2023. HRQoL was assessed using the Chinese versions of the Medical Outcomes Study 36 Item Short Form Health Survey (SF-36v2). Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were compared with sex specific Shanghai normative values, and factors associated with PCS and MCS were analysed. RESULTS:Three hundred and six patients completed interviews. PCS was lower than sex specific Shanghai normative values in both men and women, whereas MCS was not significantly lower than the corresponding normative values. In multivariable analyses, being a woman was associated with lower PCS (β = -2.77, 95% confidence interval [CI] -5.49 - -0.06; p = .045), and increasing age was associated with lower PCS (β = -0.18 per year, 95% CI -0.26 - -0.10; p < .001). For MCS, follow up duration of 13 - 24 months compared with ≤ 12 months was associated with lower scores (β = -3.34, 95% CI -5.61 - -1.08; p = .004). CONCLUSION:Patients with TEVAR treated ATBD had lower PCS than sex specific Shanghai normative values, while MCS was not significantly lower. Increasing age and being a woman were associated with lower PCS, suggesting that physical HRQoL after TEVAR may differ across patient subgroups. These findings support incorporating patient reported outcomes and individualised assessment of physical recovery into post-TEVAR follow up.

OBJECTIVE:The factors influencing patency loss after iliocaval and iliofemoral venous stenting remain incompletely understood. We therefore conducted a systematic review and meta-analysis to synthesize the available evidence. METHODS:PubMed, Embase, and Cochrane Library were searched to December 2025. Studies reporting associations between potential risk factors and stent outcomes were included. Data were synthesized narratively, and random-effects meta-analyses with Hartung-Knapp adjustment were performed when comparable multivariable-adjusted estimates were available. RESULTS:A total of 49 studies were included, predominantly involving retrospective cohorts. The meta-analysis suggested that post-thrombotic disease, stent extension across or below the inguinal ligament, and hyperlipidemia were associated with an increased risk of patency loss, whereas increasing age showed a modest inverse association with patency loss. The narrative evidence suggested that greater anatomical disease extent was associated with poorer stent patency, whereas the evidence regarding impaired venous inflow was heterogeneous and varied according to the disease phenotype, anatomical segment, and inflow definition. Pooled analyses did not identify statistically significant associations of sex, stent length, or number of stents with patency loss. Evidence regarding anticoagulation discontinuation and adjunctive antiplatelet therapy was insufficient and inconsistent. CONCLUSIONS:Patency loss after iliocaval and iliofemoral venous stenting appears to be associated with the disease phenotype, higher anatomical disease burden, and stent landing strategy. Venous inflow impairment may also be associated with poorer stent patency, although the evidence was heterogeneous. The predominantly retrospective evidence precludes causal inference. Prospective studies with standardized definitions and robust adjustment are needed to improve risk stratification and optimize post-stenting management.

Objective: To evaluate the long-term safety and efficacy of endovascular treatment in patients with subclavian artery stenosis or occlusion (SAS/SAO) and the resultant disease prognosis. Methods: This single-center retrospective study analyzed 232 consecutive patients undergoing endovascular treatment for SAS/SAO between June 2017 and June 2024. The end points included technical success, complication rate, and rates of freedom from cardiovascular death (CVD), restenosis, and reintervention. Multivariable analysis was performed to determine the independent predictors. Results: The technical success rate was significantly higher in patients with stenosis than in patients with occlusion (99.4% vs 90.8%, P < .001). The perioperative complication rate was 5.2%. Over the mean follow-up time of 48.2 months, the rates of freedom from CVD, restenosis, and reintervention were 97.1%, 89.1%, and 97.0% at 5 years and 88.7%, 77.7%, and 89.0% at 7 years, respectively. Predictors (hazard ratio, 95% confidence interval; P) of CVD included upper limb ischemia (6.845, 1.108-42.301; P = .038), age (1.148, 1.001-1.316; P = .048), and prior coronary revascularization (8.683, 1.311-57.511; P = .025). Predictors of restenosis included upper limb ischemia (2.408, 1.007-5.757; P = .048) and smaller stent diameter (0.665, 0.461-0.958; P = .029). Predictors of reintervention included transbrachial access (3.494, 1.278-9.551; P = .015) and right-sided lesion (6.080, 1.457-25.376; P = .013). Conclusions: Endovascular treatment is a safe and effective revascularization strategy for SAS/SAO, demonstrating favorable long-term patency and a low complication rate. This study identified the risk factors for CVD, restenosis, and reintervention, which may benefit the management of patients at risk. (JVS-Vascular Insights 2026;4:100420.)

Abnormal morphologies of blood vessels may cause severe clinical complications. The true lumens (TLs) of type B aortic dissection (TBAD) patients exhibit different levels of spiral configurations. It remains unclear how the true lumen chirality (TLC) influences, e.g., vascular remodeling and disease progression. In this paper, we investigate, through a combination of experimental measurements and numerical simulations, the hemodynamics of TBAD with structural chirality. A fluid-structure interaction (FSI) model integrating the support effect of lateral aortic branches is applied to analyze the complex hemodynamic process in spirally curved, flexible luminal structures. The FSI results are supported by the four-dimensional flow magnetic resonance imaging measurements. We find that the entire dissected aortas with more notable TLC are featured by higher time-averaged wall shear stress, larger averaged von Mises stresses, more prominent deformation, and greater time-averaged luminal blood pressure. The TLC shortens the relative residence time of the blood, and accelerates the blood flow in the false lumens (FLs). The postoperative follow-up results demonstrate that the helical TL can be effectively straightened and well remodeled when long stent graft repair is adopted. It is revealed that the TLC in TBAD may promote aortic rupture, progression of the dissection, and FL dilation. It is suggested that the TLC should be accounted for in the surgical planning when the helical angle of TBADs exceeds 180 degrees. This work may help understand the biomechanical and biomedical effects of the structural chirality in TBAD, and holds potential applications in the treatment of TBAD and other aortic diseases.

This study aims to optimize the embolization endpoint to improve therapeutic outcomes in interventional procedures and minimize the risk of ectopic embolism caused by excessive embolic agent injection. Hemodynamic changes during embolization were simulated by modeling the terminal resistance vessels as a porous medium. An in vitro experimental platform has been developed to replicate the embolization process. Based on these simulations and experimental data, a quantitative method was established to evaluate the embolization endpoint using local arterial blood pressure. The method was further validated through renal artery embolization experiments in pigs. The quantitative method effectively predicted changes in local arterial pressure and flow rate, with an average error of approximately 1.65% in simulations and 3.09% in in vitro experiments. In animal studies, the pressure-based endpoint evaluation method closely aligned with imaging results, reducing the required embolic agent by an average of 17.86%. Local arterial blood pressure is considered a reliable criterion for determining the embolization endpoint, offering a relatively standardized and quantitative approach to embolization endpoint assessment. This method has significant clinical value in reducing radiation exposure and facilitating the automation of embolic agent injection procedures in the field of embolization therapy for solid tumors.

Peripheral arterial disease (PAD), a condition caused by atherosclerosis, poses significant cardiovascular risks by disrupting blood flow. Computational fluid dynamics offers insights into vascular remodeling mechanisms, leveraging patient-specific anatomical data from computed tomography angiography (CTA) to enhance the accuracy of blood flow analysis. This study aims to evaluate the capability of an idealized arterial model in simulating hemodynamic parameters and blood flow patterns by comparing it with patient-specific geometries. Additionally, the study investigates the impact of stenosis at different locations within the femoral artery: upstream, downstream, and at the Profunda on flow disturbances and downstream regions. Blood flow was modeled as a Newtonian fluid, assuming a constant viscosity independent of shear rate, which is a reasonable approximation for femoral arteries where shear rates are typically high. Both an idealized PAD geometry and a patient-specific model derived from CTA data were employed for simulations. Results showed elevated blood velocities at bifurcations, notably at the superficial femoral artery (SFA) and profunda femoral artery, with peak velocities exceeding 1.90 m/s. Regions of low wall shear stress (WSS) were identified at key branching points and along arteries such as the popliteal and tibial arteries. The idealized model effectively replicated patient-specific flow patterns. Upstream stenosis caused severe flow disturbances, with velocities up to 3.9 m/s and Reynolds numbers (Re) of 1272 in the mainstream region, disrupting flow recovery. Downstream stenosis caused severe disturbances, with Re of 1835 beyond the bifurcations, whereas profunda stenosis had minimal effect, maintaining Re below 1000. This study emphasizes the importance of patient-specific anatomical factors in predicting stenosis and highlights the utility of idealized models for generating hemodynamic profiles. These findings enhance the pre-treatment planning and management methods for PAD patients.

Stanford type B aortic dissections often exhibit helical morphology. However, the influences of structural helicity on periprocedural and mid-to long-term adverse events after thoracic endovascular aortic repair (TEVAR) remain unclear. In this article, a total of 197 patients who underwent TEVAR between October 2019 and December 2020 were studied. Among them, 93 patients were excluded, and 104 patients were analyzed. The maximum helical angles and the maximum twists were measured using an efficient morphological method based on computed tomography angiography images. The whole dissecting aorta was divided into five zones. The visceral aortic zone exhibited the most pronounced structural helicity compared with other zones. Patients with the maximum helical angle larger or smaller than 200° were categorized into two groups, i.e., the groups of strong helicity and weak helicity. The patients in the strong helicity group exhibited a greater likelihood of experiencing adverse events after TEVAR.

OBJECTIVE:The prevalence of peripheral artery disease (PAD) is on the rise due to an aging population. This study aimed to gain insight into the clinical role of infrared thermography (IRT) as a diagnostic method and prognostic tool for below-the-knee (BTK) PAD patients. MATERIALS AND METHODS:The study prospectively recruited 64 patients who received lower limb revascularization for symptomatic BTK PAD (ChiCTR2400083847). IRT was used to detect lower limb skin temperature. Locations on the lower extremity sampled with IRT were dorsal areas, plantar areas, and medial and lateral areas of the calves. RESULTS:One hundred twenty-eight limbs of 64 patients were divided into normal (n=35), mild (n=22), moderate (n=55), and severe (n=16) groups based on the ankle-brachial index (ABI) testing. Limbs in the moderate and severe groups showed an obvious decrease in surface temperature when compared to the normal baseline measurements, particularly in the dorsal areas (all p values <0.01). Further analysis revealed IRT increased the sensitivity of ABI from 75.8% (69/91) to 96.7% (88/91) in PAD diagnosis. In addition, our results showed maximum temperature variations (ΔTEMP) on treated limbs decreased significantly after endovascular treatment. Further analysis revealed showed a negative correlation between maximum ΔTEMP on treated limbs and walking distance. CONCLUSIONS:Our findings showed the use of IRT increased the diagnostic efficacy of ABI in BTK PAD patients. This noninvasive technique has the potential to be applied in PAD diagnosis, preoperative, and postoperative evaluation.Clinical ImpactAn ankle-brachial index (ABI) is the most commonly used diagnostic method for evaluating vascular disorders in the lower limb. The high prevalence of medial sclerosis, which can render arteries incompressible upon cuff inflation, may lead to falsely elevated ABI values (ABI>1.4) in patients with diabetes mellitus. Infrared thermography (IRT) is a novel potential diagnostic method that does not require physical contact. The use of IRT may increase the diagnostic efficacy of ABI in BTK PAD patients. This non-invasive technique has the potential to be applied in PAD diagnosis, preoperative, and postoperative evaluation.

We read the Long term health related quality of life after acute type B aortic dissection: a cross sectional survey study by Meccanici et al.1 with considerable interest and noted important questions arising from the publication.

Purpose: False lumen (FL) expansion often occurs in type B aortic dissection (TBAD) and has been associated with the presence of re-entry tears. This longitudinal study aims to elucidate the role of re-entry tears in the progression of TBAD using a controlled swine model, by assessing aortic hemodynamics through combined imaging and computational modeling. Materials and Methods: A TBAD swine model with a primary entry tear at 7 cm distal to the left subclavian artery was created in a previous study. In the current study, reintervention was carried out in this swine model to induce 2 additional re-entry tears of approximately 5 mm in diameter. Computed tomography (CT) and 4-dimensional (4D) flow magnetic resonance imaging (MRI) scans were taken at multiple follow-ups before and after reintervention. Changes in aortic volume were measured on CT scans, and hemodynamic parameters were evaluated based on dynamic data acquired with 4D-flow MRI and computational fluid dynamics simulations incorporating all available in vivo data. Results: Morphological analysis showed FL growth of 20% following the initial TBAD-growth stabilized after the creation of additional tears and eventually FL volume reduced by 6%. Increasing the number of re-entry tears from 1 to 2 caused flow redistribution, with the percentage of true lumen (TL) flow increasing from 56% to 78%; altered local velocities; reduced wall shear stress surrounding the tears; and led to a reduction in FL pressure and pressure difference between the 2 lumina. Conclusion: This study combined extensive in vivo imaging data with sophisticated computational methods to show that additional re-entry tears can alter dissection hemodynamics through redistribution of flow between the TL and FL. This helps to reduce FL pressure, which could potentially stabilize aortic growth and lead to reversal of FL expansion. This work provides a starting point for further study into the use of fenestration in controlling undesirable FL expansion. Clinical Impact Aortic growth and false lumen (FL) patency are associated with the presence of re-entry tears in type B aortic dissection (TBAD) patients. Guidelines on how to treat re-entry tears are lacking, especially with regards to the control and prevention of FL expansion. Through a combined imagining and computational hemodynamics study of a controlled swine model, we found that increasing the number of re-entry tears reduced FL pressure and cross lumen pressure difference, potentially stabilising aortic growth and leading to FL reduction. Our findings provide a starting point for further study into the use of fenestration in controlling undesirable FL expansion.

Objective: Management of antithrombotic therapy in patients undergoing venous stents has not yet reached consensus, and there are not any recommendations from published guidelines. We undertook a Delphi consensus from Chinese experts to develop recommendations regarding the preferred antithrombotic therapy in patients following venous stenting. Methods: The phase 1 questionnaire was comprised of three clinical scenarios of venous stenting for non-thrombotic iliac vein lesions (NIVL), acute deep vein thrombosis (DVT), and post-thrombotic syndrome (PTS) and was sent to venous practitioners across China. In phase 2, the results of phase 1 were distributed to a panel of experts for evaluation along with a questionnaire encompassing a series of statements produced during phase 1. A modified Delphi method was used to reach consensus on recommendations through two rounds of surveys. Results: The phase 1 questionnaire was completed by 283 respondents. In phase 2, an expert panel consisting of 28 vascular surgeons and interventional radiologists was assembled and voted 17 statements relating to antithrombotic management after venous stenting for NIVL (4 statements), DVT (6 statements), and PTS (7 statements). The majority of the statements about the antithrombotic agent selection received a high consensus strength. Conclusions: Based on the national Delphi consensus of Chinese experts regarding antithrombotic therapy following iliac venous stenting in three common scenarios, most of the statements could be used to guide antithrombotic management following venous stenting. Further studies are required to clarify controversial issues including the dose and duration of anticoagulants, the role of antiplatelet agents, especially in patients with NIVL. (J Vasc Surg Venous Lymphat Disord 2024;12:101739.)

Computational fluid dynamics (CFD) simulations have shown great potentials in cardiovascular disease diagnosis and postoperative assessment. Patient-specific and well-tuned boundary conditions are key to obtaining accurate and reliable hemodynamic results. However, CFD simulations are usually performed under non-patient-specific flow conditions due to the absence of in vivo flow and pressure measurements. This study proposes a new method to overcome this challenge by tuning inlet boundary conditions using data extracted from electrocardiogram (ECG). Five patient-specific geometric models of type B aortic dissection were reconstructed from computed tomography (CT) images. Other available data included stoke volume (SV), ECG, and 4D-flow magnetic resonance imaging (MRI). ECG waveforms were processed to extract patient-specific systole to diastole ratio (SDR). Inlet boundary conditions were defined based on a generic aortic flow waveform tuned using (1) SV only, and (2) with ECG and SV (ECG + SV). 4D-flow MRI derived inlet boundary conditions were also used in patient-specific simulations to provide the gold standard for comparison and validation. Simulations using inlet flow waveform tuned with ECG + SV not only successfully reproduced flow distributions in the descending aorta but also provided accurate prediction of time-averaged wall shear stress (TAWSS) in the primary entry tear (PET) and abdominal regions, as well as maximum pressure difference, ∆P max , from the aortic root to the distal false lumen. Compared with simulations with inlet waveform tuned with SV alone, using ECG + SV in the tuning method significantly reduced the error in false lumen ejection fraction at the PET (from 149.1% to 6.2%), reduced errors in TAWSS at the PET (from 54.1% to 5.7%) and in the abdominal region (from 61.3% to 11.1%), and improved ∆P max prediction (from 283.1% to 18.8%) However, neither of these inlet waveforms could be used for accurate prediction of TAWSS in the ascending aorta. This study demonstrates the importance of SDR in tailoring inlet flow waveforms for patient-specific hemodynamic simulations. A well-tuned flow waveform is essential for ensuring that the simulation results are patient-specific, thereby enhancing the confidence and fidelity of computational tools in future clinical applications.

Abstract OBJECTIVES Understanding morphology and how this relates to treatment strategy is critical for achieving remodelling in aortic dissection. A controllable and reproducible large animal model is required for investigating new therapeutic devices and interventions. METHODS Our experimental protocol involved the development of surgically created type B aortic dissection (TBAD) and endovascular reintervention-induced TBAD porcine models. The sample was randomly divided into 2 groups: 1 underwent a secondary tear creation (STC) procedure and the other underwent a false lumen extension (FLE) procedure. Anatomical features were observed at 1 and 3 months, and 2 animals in each group were euthanized at 3 months after the procedures. The aorta and main branches were harvested en bloc, cross-sectioned and prepared for histological examination. RESULTS All surgically created TBAD models were successfully generated, and no unintended complications occurred. The endovascular reintervention-induced TBAD model was successfully created in 11 of 12 animals, with 6 in the STC group and 5 in the FLE group. In the STC group, the intraoperative mean diameter of the new secondary tear was 7.23 mm, and a slight increase was observed at first 30 days (P = 0.0026). In the FLE group, the intraoperative new propagation length was (235.80 ± 84.94) mm. The FL propagation length at the 1-month follow-up was significantly longer than that measured intraoperatively (P = 0.0362). Histological evaluation demonstrated that the elastic fibres in the media layer of the aortic wall were disrupted and appeared to be significantly stretched on the adventitial side of the false lumen. CONCLUSIONS Our endovascular reintervention is a reliable, minimally invasive approach for producing specific TBAD models with different morphologies.

Computer modeling and numerical simulation are essential for understanding the progression of aortic dissection. However, tear propagation has not been properly modeled and simulated. The in-plane dissection propagation between concentrically distributed elastic lamellae is modeled using the cohesive zone method with a bilinear traction-separation law. The parameters of cohesive elements are calibrated for the three modes of interfacial damage in the media, enabling quantitative predictions of in-plane tear propagation. An idealized cylindrical tube-shaped bilayer thick-wall model of the aorta is employed to elucidate the influence of geometrical parameters, loading conditions and residual stress on the tear propagation. While the model is capable of replicating that deeper, larger tears are associated with lower critical pressure, new findings include: (i) Larger axial stretch leads to lower critical pressure; (ii) Increased magnitude of residual stress is associated with higher critical pressure; (iii) Pressure difference between true and false lumen alters the critical pressure; (iv) The interfacial damage is mostly opening mode in the axial direction, but shear-dominated in the circumferential direction; (v) Damage due to the opening mode is associated with smaller fracture energy, which makes it easier to propagate than the shear and the mixed modes. (vi) The deformed shape of the tear, which is related to its geometrical features and loading conditions, modulates the critical pressure via two pathways: (a) deformed shapes are associated with specific modes of damage, which influences the critical pressure, and (b) deformed shapes modulate the critical pressure directly via geometrical constraints.

BackgroundEmbolization is a common treatment method for tumor-targeting, anti-organ hyper-function, and hemostasis. However, the injection of embolic agents largely depends on the experiences of doctors, and doctors need to work in an X-ray environment that hurts their health. Even for a well-trained doctor, complications such as ectopic embolism caused by excessive embolic agents are always inevitable.ResultsThis paper established a flow control curve model for embolic injection based on local arterial pressure. The end-vessel network was simplified as a porous media. The hemodynamic changes at different injection velocities and embolization degrees were simulated and analyzed. Sponge, a typical porous medium, was used to simulate the blocking and accumulation of embolic agents by capillary networks in the in vitro experimental platform.ConclusionsThe simulation and experimental results show that the local arterial pressure is closely related to the critical injection velocity of the embolic agent reflux at a certain degree of embolization. The feasibility of this method for an automatic embolic injection system is discussed. It is concluded that the model of the flow control curve of embolic injection can effectively reduce the risk of ectopic embolism and shorten the time of embolic injection. The clinical application of this model is of great value in reducing radiation exposure and improving the success rate of interventional embolization.

HomeRadiologyVol. 307, No. 2 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyHyperrealistic Rendering of Type II EndoleakBaolei Guo , Liying PengBaolei Guo , Liying PengAuthor AffiliationsFrom the Department of Vascular Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Xuhui District, Shanghai 200032, China (B.G.); and Central Research Institute, United Imaging Healthcare, Shanghai, China (L.P.).Address correspondence to B.G. (email: [email protected]).Baolei Guo Liying PengPublished Online:Feb 14 2023https://doi.org/10.1148/radiol.222150MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Supplemental material is available for this article.A 71-year-old man with a history of abdominal aortic aneurysm status after endovascular aortic repair (EVAR) presented for follow-up CT angiography (CTA) at 19 months. Hyperrealistic rendering (HRR) (United Imaging Healthcare) visually demonstrated an enlarged aneurysm sac measuring 7.2 cm in maximum diameter (previously 6.1 cm, before EVAR), with type II endoleaks involving the bilateral L4 lumbar arteries and the inferior mesenteric artery (Figure, Figure S1, Movie). The patient was admitted to the hospital and underwent embolization of the aforementioned feeding vessels. Follow-up CTA at 6 months after the embolization procedure showed complete thrombosis of the aneurysm sac with no residual endoleak.Images in a 71-year-old man diagnosed with type II endoleak 19 months after the endovascular aortic repair for an abdominal aortic aneurysm. The hyperrealistic rendering from CT angiography provides a clear representation of the endoleak (black arrows) and the three major feeding vessels (white arrows) (ie, bilateral lumbar arteries [LA] and the inferior mesenteric artery [IMA]). (A) The hyperrealistic rendering in posterior view demonstrates the feeding lumbar arteries and the associated iliolumbar-lumbar pathway arising from the internal iliac arteries. (B) The hyperrealistic rendering in anterior view reveals a pathway from the superior mesenteric artery to the inferior mesenteric artery by means of the arc of Riolan feeding into the aneurysm sac (shown as a semitransparent cavity).Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie: Hyper-realistic rendering from CT angiography in a 71-year-old man diagnosed with type II endoleak.Download Original Video (97.3 MB)Endoleaks, in particular type II endoleaks defined as aneurysm sac backfilling from aortic branches (1), are the most common complications of EVAR and pose persistent risk of aortic rupture. Visualization of the inflow vessels is crucial for preoperative planning. As an advanced three-dimensional visualization technique with use of physically based volume rendering, HRR can generate photorealistic images with enhanced display of complex spatial relationships and lifelike surface details. By assisting proceduralists in identifying the endoleak feeding vessels, HRR provides value in developing treatment strategies.Disclosures of conflicts of interest: B.G. No relevant relationships. L.P. No relevant relationships.Supported by the National Natural Science Foundation of China (grant 82000436) and the Science and Technology Commission of Shanghai Municipality (grants 201409004800 and 21410710500).Reference1. Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg 2002;35(5):1029–1035. Crossref, Medline, Google ScholarArticle HistoryReceived: Aug 29 2022Revision requested: Oct 10 2022Revision received: Oct 21 2022Accepted: Oct 31 2022Published online: Feb 14 2023 FiguresReferencesRelatedDetailsRecommended Articles Contrast-enhanced US Evaluation of Endoleaks after Endovascular Stent Repair of Abdominal Aortic AneurysmRadioGraphics2022Volume: 42Issue: 6pp. 1758-1775Agenesis of Infrarenal Abdominal Aorta and Iliac ArteriesRadiology2021Volume: 301Issue: 1pp. 46CT Angiography of the Arc of RiolanRadiology2021Volume: 300Issue: 1pp. 36Predictors of Mortality from Spontaneous Soft-Tissue Hematomas in a Large Multicenter Cohort Who Underwent Percutaneous Transarterial EmbolizationRadiology2019Volume: 291Issue: 1pp. 250-258Abdominal Vascular Complications in Neurofibromatosis Type 1Radiology: Cardiothoracic Imaging2020Volume: 2Issue: 5See More RSNA Education Exhibits Radiological Intervention Of Type 2 Endoleak After Endovascular Aortic Aneurysm RepairDigital Posters2021When Everything is NOT under Control: Aortic EndoleaksDigital Posters2019Endoleaks: What the Radiologist Needs to KnowDigital Posters2020 RSNA Case Collection Pancreaticoduodenal artery aneurysms with concurrent SMA stenosisRSNA Case Collection2020Arterioureteral fistulaRSNA Case Collection2021Persistent Sciatic ArteryRSNA Case Collection2022 Vol. 307, No. 2 Supplemental MaterialMetrics Altmetric Score PDF download

A 72 year old female was transferred with acute iatrogenic type B aortic dissection (TBAD) six hours after left subclavian artery (LSA) stenting for subclavian steal syndrome with dizziness. Computed tomography angiography showed TBAD with the primary entry tear at the LSA orifice, possibly due to endovascular treatment of a heavily calcified plaque causing the LSA stenosis (A, arrow). The patient was initially managed medically but underwent thoracic endovascular repair with coverage of the LSA two weeks later (B, arrow). At follow up, the patient no longer experienced dizziness despite the LSA being covered.