An endovascular repair of an abdominal aortic aneurysm (AAA) is technically less invasive than open surgery, but gives results as effective as open surgery if the anatomy is adequate. Unfortunately, 20-30% of AAA patients are not suitable for endovascular repair because they lack a sufficient proximal landing zone. In an effort to broaden the applicability of endovascular repair, the chimney technique has been introduced. This refers to deployment of a covered or bare-metal stent parallel to the main aortic endograft within the aneurysm, creating a conduit that runs outside the main aortic endograft into the aortic branches. We report the case of a 75-year-old male with a juxtarenal abdominal aortic aneurysm and multiple comorbidities who was treated successfully with an endovascular aneurysm repair using a chimney graft.
Aged ; Aneurysm ; Aortic Aneurysm, Abdominal* ; Comorbidity ; Endovascular Procedures ; Humans ; Male ; Stents ; Transplants*

An endovascular repair of an abdominal aortic aneurysm (AAA) is technically less invasive than open surgery, but gives results as effective as open surgery if the anatomy is adequate. Unfortunately, 20-30% of AAA patients are not suitable for endovascular repair because they lack a sufficient proximal landing zone. In an effort to broaden the applicability of endovascular repair, the chimney technique has been introduced. This refers to deployment of a covered or bare-metal stent parallel to the main aortic endograft within the aneurysm, creating a conduit that runs outside the main aortic endograft into the aortic branches. We report the case of a 75-year-old male with a juxtarenal abdominal aortic aneurysm and multiple comorbidities who was treated successfully with an endovascular aneurysm repair using a chimney graft.
Aged ; Aneurysm ; Aortic Aneurysm, Abdominal* ; Comorbidity ; Endovascular Procedures ; Humans ; Male ; Stents ; Transplants*

No abstract available.
Cardiomyopathy, Hypertrophic ; Mitral Valve Insufficiency ; Mitral Valve

Erdheim-Chester disease (ECD), also known as non-Langerhans cell histiocytosis, is a multi-systemic disease with unclear pathogenesis. Based on a small number of case studies, pegylated interferon-α (PEG-IFN-α) has been used as the front-line treatment option. However, there are limited data regarding administration of ropegylated-interferon α-2b (ROPEG-IFN-α 2b) for ECD patients. Herein, we report two cases of severe ECD treated with two types of PEG-IFN-α. One patient with heart and skeleton involvement and BRAF V600E mutation was treated with weekly PEG-IFN-α 2a. Another patient with bone involvement and no BRAF V600E mutation was administered monthly ROPEG-IFN-α 2b. The two types of PEG-IFN-α showed excellent disease control, excellent survival outcomes, and manageable toxicities in ECD patients. These results suggest that ROPEG-IFN-α 2b could be used equivalently to PEG-IFN-α 2a for management of advanced ECD.

BACKGROUND: Atrial fibrillation (AF) is a well-established risk factor for stroke. Interestingly, ischemic stroke increases risk of incident AF in patients without prior diagnosed AF. For better risk stratification for post-stroke AF, we studied left atrial (LA) size and mechanical function using two-dimensional (2D) speckle tracking imaging in patients with acute ischemic stroke. METHODS: A total of 227 patients (132 males, age 67 ± 12) with acute ischemic stroke without a history of AF underwent 2D transthoracic echocardiography and speckle tracking imaging for the assessment of LA volume index and global LA longitudinal strain (LALS). From clinical variables, the CHA2DS2-VASc score and National Institute of Health Stroke Scale (NIHSS) were calculated in each patient. Post-stroke AF was defined as newly diagnosed AF during the course after ischemic stroke. RESULTS: Post-stroke AF occurred in 25 patients (11%). Patients with post-stroke AF were older and showed a higher tendency of CHA2DS2-VASc score, significantly higher log NIHSS, larger LA volume index and lower global LALS than those without. In multivariate analysis, global LALS was an independent predictor for post-stroke AF (hazard ratio 0.90, 95% confidence interval 0.83.0.97, p < 0.01) after controlling for confounding factors. Furthermore, global LALS provided incremental predictive value for post-stroke AF over the CHA2DS2-VASc score, NIHSS, and LA volume index. The global LALS < 14.5% better distinguished post-stroke AF (area under the curve 0.837, sensitivity 60%, specificity 95%, p < 0.01) than CHA2DS2-VASc score. CONCLUSION: Global LALS as a marker of LA mechanical function has incremental predictive value for post-stroke AF in patients with acute ischemic stroke.
Atrial Fibrillation* ; Echocardiography ; Heart Atria ; Humans ; Male ; Multivariate Analysis ; Risk Factors ; Sensitivity and Specificity ; Stroke*