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Background: Juxta-anastomotic stenosis is a common issue of arteriovenous fistulas. We aimed to evaluate the results of percutaneous transluminal angioplasty with drug-coated balloon versus plain balloon for the treatment of juxta-anastomotic stenoses of mature but failing distal radiocephalic arteriovenous fistulas. Methods: A total of 80 patients with a juxta-anastomotic stenosis of distal radiocephalic arteriovenous fistula in our clinic between January 2016 and September 2017 were retrospectively analyzed. Patients were divided into two groups according to the type of treatment as drug-coated balloon – percutaneous transluminal angioplasty (n = 44) and plain balloon – percutaneous transluminal angioplasty (n = 43). Intra- and post-procedural data were recorded. Target lesion primary patency rate was evaluated at 6 and 12 months. Of all patients, 48 were females and 39 were males with a mean age of 56.3 ± 10.4 (range, 24–75) years. Both groups had mature fistulas, and the mean age of fistula was 11.3 ± 9.1 months in the drug-coated balloon – percutaneous transluminal angioplasty group and 10.3 ± 8.8 months in the plain balloon – percutaneous transluminal angioplasty group (p = 0.24). Results: There was no significant difference in the target lesion stenosis rate and the median lesion length between the groups. Technical and clinical success were achieved in both groups. Target lesion primary patency was similar at 6 months between the two groups (93.1% vs 81.3%, respectively; p = 0.14) but significantly higher for the drug-coated balloon – percutaneous transluminal angioplasty group at 12 months (81.8% vs 51.1%, respectively; p = 0.01). Conclusion: Our study results suggest that the use of drug-coated balloon combined with percutaneous transluminal angioplasty is an effective treatment for juxta-anastomotic stenoses of mature but failing distal radiocephalic arteriovenous fistulas with significantly improved target lesion primary patency rates and reduced need for juxta-anastomotic reinterventions.

IntroductionThe aim of this study was to determine the outcomes of patients developing ischemic stroke after coronary artery bypass grafting (CABG).MethodsFrom March 2012 to January 2017, 5380 consecutive patients undergoing elective coronary surgery were analyzed. Ninety-five patients who developed ischemic strokes after on-pump coronary surgery were included in the study, retrospectively. The cohort was divided into four subgroups [total anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), posterior circulation infarction (POCI), and lacunar infarction (LACI)] according to the Oxfordshire Community Stroke Project (OCSP) classification. The primary endpoints were in-hospital mortality, total mortality, and survival analysis over an average of 30 months of follow-up. The secondary endpoints were the extent of disability and dependency according to modified Rankin Scale (mRS).ResultsThe incidence of stroke was 1.76% (n=95). The median age was 62.03±10.06 years and 68 (71.6%) patients were male. The groups were as follows: TACI (n=17, 17.9%), PACI (n=47, 49.5%), POCI (n=20, 21.1%), and LACI (n=11, 11.6%). Twenty-eight (29.5%) patients died in hospital and 34 (35.8%) deaths occurred. The overall mortality rate of the TACI group was significantly higher than that of the LACI group (64.7% vs. 27.3%, P=0.041). The mean mRS score of the TACI group was significantly higher than that of the other groups (P=0.003).ConclusionPatients in the TACI group had higher in-hospital and cumulative mortality rates and higher mRS scores. We believe that use of the OCSP classification and the mRS may render it possible to predict the outcomes of stroke after coronary surgery.

Unmanned Aircraft Systems (UAS), the new frontier in civil aviation, add another dimension to the ever-increasing complexity of the current National Airspace System (NAS) in the United States. The future inclusion of private and commercial operations of the UAS into the NAS, unavoidably, raises safety concerns. As the NAS becomes increasingly more complex and constrained, the associated hazard and safety risk modeling must also mature in sophistication. Thus, there is a need for advanced studies focusing on risk-based system safety analysis of emergent UAS operations. This paper presents a regulatory-based integrated approach to system safety and risk analysis of the UAS operations and their interaction with the current NAS and the future Next Generation (NextGen) Airspace.

Exact localization of the bifurcation of the common carotid artery using skin surface landmarks is important for various diagnostic and therapeutic purposes, including emergency cases. Traditional methods have confirmed their accuracy in only a certain percentage of cases and there are inconsistencies among various publications. The cervical computed tomography-angiographic examinations for any diagnostic purpose between June 2017 and December, 2017 in the authors’ hospital were examined. Measurements were performed for (MT-CB) and (MT-SE) distances and the results were recorded [MT = The tip of the mastoid process; CB = common carotid artery bifurcation; SE = sternal extremity of the clavicle]. Cervical computed tomography angiography was found in the records of 91 patients in the 6-month period between June 2017 and December 2017. After exclusion criteria were applied, a total of 116 carotid bifurcation levels on the right and left sides were measured in 58 patients. The mean MT-CB distance was 6.29 ± 0.9 cm (range: 2.9–8.4 cm). The mean distance between MT and SE was 15.3 ± 1.7 cm (range: 9.9–19.0 cm). The (MT-CB): (MT-SE) ratios ranged from 29% to 51% with a mean of 41 ± 4.2% (95% CI: 39.88%–42.10%) and a median of 41.1% (P < 0.05) (Kolmogorov–Smirnov test). The distance ratio values did not change significantly according to age and gender (respectively P = 0.341, P = 0.093). These results show that the CB is usually located at two-fifths of the distance from the mastoid tip to the sternal extremity of the clavicle and closer to the mastoid tip.

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