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US-guided percutaneous thrombin injection enables successful, safe management of postcatheterization pseudoaneurysms.

The degree of stenosis was significantly reduced 6, 12, and 24 months after angioplasty of de novo femoropopliteal stenoses in the patients who underwent endovascular irradiation.

A simple echocardiographic estimate of right ventricular-arterial coupling to assess severity and outcome in pulmonary hypertension on chronic lung diseaseTo the Editor:The adaptation of right ventricular (RV) systolic function to afterload is a major determinant of outcome in pulmonary hypertension [1]. The gold standard measurement of RV-pulmonary arterial (PA) coupling is the ratio of end-systolic to arterial elastances (E es /E a ) which is optimal for RV flow output at minimal energy cost at values between 1.5 and 2 [2]. Progressive RV-PA uncoupling is associated with maintained RV dimensions down to E es /E a values of around 0.8 [3]. Thus, the evaluation of RV-PA coupling would theoretically allow monitoring of the transition from compensated to decompensated RV function in pulmonary hypertension. However, measuring RV-PA coupling at the bedside is technically demanding and invasive. Therefore, simpler imaging surrogates are being evaluated. One of those is the ratio of tricuspid annular plane systolic excursion (TAPSE) as a surrogate of contractility and systolic pulmonary artery pressure (PASP) as a surrogate of afterload, both measured using echocardiography (M-mode for TAPSE and Doppler assessment of the maximum velocity of tricuspid regurgitation for PASP) [4]. The TAPSE/PASP ratio has emerged as a potent predictor of outcome in heart failure [5] as well as in pulmonary arterial hypertension (PAH) [6].Pulmonary hypertension secondary to chronic lung diseases (PH-LD) is most often mild to moderate, with many patients having a mean pulmonary artery pressure (PAP) <35 mmHg. A small percentage of patients referred for evaluation in dedicated centres may have severe pulmonary hypertension with mean PAP in the range reported in PAH [7]. However, RV function is often altered even in mild-to-moderate PH-LD, and is an important determinant of survival and functional status in PH-LD [7,8]. We therefore explored the functional significance and prognostic relevance of the TAPSE/PASP ratio in PH-LD.We analysed patients with PH-LD and idiopathic PAH (iPAH) enrolled in the prospectively recruiting Giessen PH Registry [9]. The diagnosis of PH-LD was established by a multidisciplinary board before enrolment in the Giessen PH registry [9] between December 2004 and March 2012. Follow-up data were retrieved from the Giessen PH Registry up to February 2018. The analysis included consecutive patients with complete echocardiographic (day 1) and invasive haemodynamic data (day 2) and complete follow-up. The patients with iPAH (n=193) were a subset of a previously reported cohort of 290 patients with PAH [6]. The investigation was approved by the ethics committee of the Faculty of Medicine at the University of Giessen (Approval No. 186/16, 266/11). All participating patients gave written informed consent.As recently updated [7], PH-LD was defined by a mean PAP of ⩾21 mmHg (21-24 mmHg with pulmonary vascular resistance (PVR) ⩾3 Wood Units, or ⩾25 mmHg alone), with mean PAP ⩾35 mmHg alone or mean PAP ⩾25 mmHg with low cardiac ...

BACKGROUND AND PURPOSE PCMR is used to evaluate the Chiari I malformation. We compared quantitative PCMR in symptomatic and asymptomatic patients with Chiari I. MATERIALS AND METHODS PCMR image data in an axial section near the foramen magnum in a consecutive series of patients with Chiari I malformations were evaluated. Patients were classified as symptomatic for a Chiari I if they had apnea spells and/or exertional headaches and as asymptomatic if they had symptoms not considered specific for a Chiari I malformation. The PCMR CSF flow study was obtained with the same protocol for all patients and with the neck in neutral, flexed, and extended positions. Images were inspected for CSF flow jets and synchronous bidirectional flow. Peak CSF flow velocities were calculated with commercial software. Differences between the 2 groups were tested with mixed-effects ANOVA and Wilcoxon rank sum or Fisher exact probability tests with significance set at the .05 level. RESULTS Twenty-six patients with Chiari I were classified as symptomatic, and 24, as asymptomatic. Abnormal flow jets tended to occur more often in the symptomatic than in the asymptomatic patients (P = .054). Peak CSF velocities ranged from 2 to 20 cm/s in the symptomatic and the asymptomatic groups and did not differ significantly between the 2 groups or with neck position. CONCLUSIONS Peak CSF flow velocities near the foramen magnum did not differentiate symptomatic and asymptomatic patients with Chiari I.