Objective This study aims to compare the efficacy, safety, and long-term outcomes of two flow diverters, i.e., pipeline embolization device and flow re-direction endoluminal device, in the treatment of distal carotid aneurysms. Methods A total of 138 patients with 175 aneurysms were included from February 2012 to September 2019. Ninety-nine aneurysms were treated with flow re-direction endoluminal device and 76 with pipeline embolization device. Angiographic follow-ups were at the 6th, 12th, 24th, 36th, and 60th months; the O’Kelly-Marotta grading scale was used to assess aneurysms occlusion. Outcomes of two devices were compared; possible associations regarding patient characteristics, aneurysm properties, treatment details, and adverse events were evaluated. Results The mean follow-up period was 33 months, with 10 patients lost to follow-up. Occlusion rates at the 6th and 12th months and during the last follow-up were similar for flow re-direction endoluminal device (81%, 84%, and 90%) and pipeline embolization device (82%, 85%, and 93%). Occlusion rates were also similar after stand-alone use without coiling. There was no significant difference regarding adverse event rates with a 10.9% overall complication rate, 3.6% mortality, and 0.7% permanent morbidity. All the mortality and morbidity were related to hemorrhagic complications. Device deployment failure was observed with five flow re-direction endoluminal devices and two pipeline embolization devices, whereas two severe in-stent stenoses occurred with each device. Conclusions Both flow re-direction endoluminal device and pipeline embolization device are feasible and effective in flow diversion of distal internal carotid artery aneurysms, with similar adverse events rates and aneurysm occlusion success. Aneurysm occlusion rates increase with time, while the presence of an integrated branch significantly decreases treatment success.

This study aims to evaluate the safety and efficacy of flow diverters (FDs) in the treatment of middle cerebral artery (MCA) aneurysms and share the follow-up (F/U) results. METHODSThe treatment and F/U results of 76 MCA aneurysms treated with the flow re-direction endoluminal device (FRED), FRED Jr., and pipeline embolization device (PED) FD stents were evaluated retrospectively. The aneurysm occlusion rates were compared between FDs, and the integrated and jailed branches were evaluated through follow-ups. The oversizing of the stent was compared between occluded/non-occluded aneurysms and integrated branches. RESULTSThe mean F/U duration was 32 ± 6.3 months, and the mean aneurysm diameter was 4.45 mm. A total of 61 (80.3%) aneurysms were wide-necked; 73 (96.1%) were saccular; 52 (68.4%) were located at the M1 segment; and 36 (45.6%) FREDs, 23 (29.1%) FRED Jr.s, and 19 (24.1%) PEDs were used for treatment. The overall occlusion rates for the 6-, 12-, 24-, 36-, and 60-month digital subtraction angiographies were 43.8%, 63.5%, 73.3%, 85.7%, and 87.5% respectively. The last F/U occlusion rates were 67.6% for FRED, 66.7% for PED, and 60.6% for FRED Jr. (P = 0.863). An integrated branch was covered with an FD during the treatment of 63 (82.8%) aneurysms. A total of six (10%) of the integrated branches were occluded without any symptoms at the last F/U appointment. The median oversizing was 0.45 (0-1.30) for occluded aneurysms, and 0.50 (0-1.40) for non-occluded aneurysms (P = 0.323). The median oversizing was 0.70 (0.45-1.10) in occluded integrated branches and 0.50 (0-1.40) in non-occluded branches (P = 0.131). In-stent stenosis was seen in 22 (30.1%) of the stents at the 6-month F/U and in only 2 (4.7%) at the 24-month F/U. Thus, none of the patients had any neurological deficits because of the in-stent stenosis. Severe in-stent stenosis was seen in two stents. CONCLUSIONMCA aneurysms tend to be complex, with integrated branches and potentially wide necks. FD stents are safe and effective in the treatment of MCA aneurysms, and the patency of the side and jailed branches is preserved in most cases. Higher occlusion and lower in-stent stenosis rates are seen with longer F/U durations.

Background: This study aims to identify specific segmental distribution patterns of lower extremity chronic venous disease based on latent class analysis of Doppler mapping results. Methods: A total of 1,871 lower extremities of 1,218 treatment-naïve patients (536 males, 682 females; mean age 45.4 years; range, 21 to 87 years) with chronic venous disease referred for Doppler examination between September 2009 and August 2018 were included. Refluxing superficial venous segments of the lower extremities were mapped and recorded in database in 10 distinct anatomic locations as follows: saphenofemoral junction and proximal greater saphenous vein, mid and distal thigh greater saphenous vein, anterior and posterior accessory saphenous veins, proximal and distal calf greater saphenous vein, saphenopopliteal junction and proximal lesser saphenous vein, distal lesser saphenous vein, and intersaphenous veins including Giacomini’s vein. Repeated examinations were excluded. The latent class analysis was applied to identify any possible anatomic distribution patterns of chronic venous disease. Results: Bayesian information criteria revealed three latent class models fit for refluxing segment distribution as follows: 58.2% (n=1,089) were above-the-knee greater saphenous vein segments including saphenofemoral junction (pattern 1); 29.3% (n=548) were below-the-knee greater saphenous vein segments (pattern 2); and 12.5% (n=234) were lesser saphenous vein segments and intersaphenous veins including Giacomini’s vein (pattern 3). There was no age- or sex-specific differences in the chronic venous disease distribution patterns. Conclusion: The latent class analysis, by identifying previously unseen subgroups within the sampled population, provides a new approach to classification of reflux patterns in chronic venous disease. Identification of latent classes may provide understanding of different pathophysiological bases of venous reflux and more optimal planning for interventions.

Objective: Stiffness of breast lesions helps distinguish malignant from benign solid masses. Stiffness can be quantitatively measured by magnetic resonance and ultrasound imaging using apparent diffusion coefficient (ADC) and shear-wave elastography (SWE) techniques, respectively. This study aims to analyze correlations between SWE and ADC in biopsy-proven small fibroadenomas. Patients and Methods: Shear-wave elastography and ADC measurements of 50 fibroadenomas were evaluated retrospectively. Mean patient age was 41±13 years (range 27-63). All lesions had maximum diameters of ≤20 millimeters. Correlations between intralesional ADC, lesion-parenchyma ADC ratio, intralesional SWE, SWE heterogeneity index and lesion volume were analyzed. Results: Mean values of lesions were as follows: ADC=1.71±0.22 x10-3mm2/s, ADC ratio=1.04±0.09, maximum SWE=73.4±28.8 kPa, minimum SWE=43.9±21.8 kPa and SWE heterogeneity index =29.4±12.7 kPa. There was a strong inverse correlation between fibroadenoma ADC and SWE values (rho = -0.746, p <0.01). Significant correlations were also found between fibroadenoma volume and ADC (rho = -0.525, p <0.05) and SWE (rho = 0.840, p <0.01). Conclusion: Apparent diffusion coefficient and SWE values show strong inverse correlation in small fibroadenomas. If proven threshold values for lesion characterization are revealed, ultrasonographic SWE and diffusion-weighted MRI have potential to be used interchangeably.

Background: Greater saphenous vein (GSV) courses within saphenous compartment, an adipose-filled space bound by fasciae provides structural support. Ultrasound shear-wave elastography (SWE) provides objective and quantitative data on tissue shear elasticity modulus. Objective: This study aims to analyze possible associations between early stage GSV insufficiency and saphenous intracompartmental SWE measurements. Methods: Two-hundred consecutive patients, ages 22 to 81 (mean=44.3) years, with venous insufficiency symptoms underwent Doppler and SWE examinations. Patients had no visible or palpable sign of venous disease or had telangiectasia and reticular veins only. Analyses regarding patient age, gender, presence of venous insufficiency of GSV proper and intracompartmental connective tissue elasticity were performed. Results: Ninety-six patients had Doppler evidence for either bilateral or unilateral insufficiency of GSV proper at mid-thigh level. Intracompartmental elasticity of patients with venous insufficiency (mean=4.36±2.24 kilopascals; range 1.55 to 10.44 kPa) did not differ significantly from those with normal veins (mean=4.82±2.61 kPa; range 2.20 to 12.65 kPa) (p=0.231). No threshold for predicting the presence of venous insufficiency could be determined. Neither were there any correlations between age, gender and intracompartmental elasticity. In patients with unilateral insufficiency, however, elastography values around insufficient veins were significantly lower compared to contralateral normal GSV (p<0.001). Conclusion: Many intrinsic and patient factors affect intracompartmental connective tissue elastography measurements; thus, cut-off values obtained from specific populations have limited generalizability. Nevertheless, statistically significant intrapatient differences of intracompartmental elasticity among diseased and normal saphenous veins indicate that lack of elastic support from surrounding connective tissues contributes to venous insufficiency in early stages.