Background-Stent implantation for obstructive femoropopliteal artery disease has been associated with poor long-term outcomes. This study evaluated the effectiveness of shape memory alloy recoverable technology (SMART) nitinol self-expanding stents coated with a polymer impregnated with sirolimus (rapamycin) versus uncoated SMART stents in superficial femoral artery obstructions. Methods and Results-Thirty-six patients were recruited for this double-blind, randomized, prospective trial. All patients had chronic limb ischemia and femoral artery occlusions (57%) or stenoses (average lesion length, 85Ϯ57 mm). Patients were eligible for randomization after successful guidewire passage across the lesion. Eighteen patients received sirolimus-eluting SMART stents and 18 patients received uncoated SMART stents. The primary end point of the study was the in-stent mean percent diameter stenosis, as measured by quantitative angiography at 6 months. The in-stent mean percent diameter stenosis was 22.6% in the sirolimus-eluting stent group versus 30.9% in the uncoated stent group (Pϭ0.294). The in-stent mean lumen diameter was significantly larger in the sirolimus-eluting stent group (4.95 mm versus 4.31 mm in the uncoated stent group; Pϭ0.047). No serious adverse events (death or prolonged hospitalization) were reported. Conclusions-The use of sirolimus-eluting SMART stents for superficial femoral artery occlusion is feasible, with a trend toward reducing late loss compared with uncoated stents. The coated stent also proved to be safe and was not associated with any serious adverse events.

Conversion from CNI-based immunosuppression to MMF and Sir in HTx patients with chronic renal failure was safe, preserved graft function, and improved renal function.

Activated layered double hydroxides (LDHs) with high crystallinity, obtained by calcination/rehydration of LDH precursors synthesized by urea decomposition, have higher catalytic activity in acetone self‐condensation and Knoevenagel reactions than less crystalline materials obtained from LDH precursors synthesized by titration co‐precipitation. The activated LDHs possess both basic and acidic sites. High resolution transmission electron microscopy (HRTEM) confirms that the highly crystalline activated LDHs retain the lattice structure of the LDH precursors with lattice parameters a = b = 0.31 ± 0.01 nm and α = 60 ± 2°. An acid‐base catalytic mechanism has been proposed to interpret the catalytic behavior based on the fact that acid‐base hydroxyl group pairs on the activated LDH surface have a separation of 0.31 nm. It is proposed that the active sites are mainly located on the ordered array of hydroxyl sites on the basal surfaces rather than on the edges, as has been previously suggested. © 2007 American Institute of Chemical Engineers AIChE J, 2007

At the selected doses and target levels for TAC and CsA used in this study, trough level adjusted MMF was more efficacious in combination with TAC for prevention of ARE. Furthermore, CsA patients need significantly more MMF to achieve similar MPA levels.

The impact of sirolimus on hormone levels involved in the hypothalamus-pituitary-gonad axis in male heart transplant recipients was investigated.A pair-matched analysis with 132 male heart transplant recipients on either sirolimus based-or calcineurin inhibitor-based immunosuppression was performed. Matching criteria were age, years after transplantation and creatinine levels. Measured parameters were testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH), sexual hormone-binding globulin (SHBG) and free androgen index (FAI).Mean testosterone was 3.86 ± 1.41 ng/mL in the sirolimus group and 4.55 ± 1.94 ng/mL in the controls (p = = 0.025). Serum LH was 12.82 ± 11.19 mlU/mL in the sirolimus patients and 6.2 ± 5.25 mlU/mL in the controls (p = = 0.015). Follicle stimulating hormone levels were 13.31 ± 18.4 mlU/mL vs. 7.32 ± 5.53 mlU/mL, respectively (p = = 0.015). The analysis revealed a significant decrease in testosterone and a significant increase in FSH and LH in the sirolimus group. The duration of sirolimus treatment correlated positively with SHBG (p < 0.01), LH (p < 0.05) and FSH (p < 0.05) and negative with the FAI (p < 0.05). Sirolimus trough levels correlated with LH and FSH levels (p < 0.01).Heart transplant recipients treated with sirolimus revealed significantly lower testosterone levels and a significant increase in gonadotropic hormones. These effects were trough-level dependent. All candidates awaiting organ transplantation should be informed about these adverse effects.

The purpose of this review is to describe recent advances in non-invasive vascular imaging techniques and to discuss their current clinical applications for imaging of peripheral vessels. Principles for applying ultrasound, CT angiography (CTA), and magnetic resonance angiography (MRA) for non-invasive imaging of peripheral arteries and veins are presented. Clinical applications are reviewed for different vascular diseases, therapy planning, and follow-up studies. Conventional Doppler and color duplex sonography are the most cost-effective procedures to detect or rule out peripheral arterial occlusive disease (PAOD) and to provide specific recommendations for therapy. In the near future, contrast-enhanced MRA (CE MRA) with additional axial two-dimensional time-of-flight studies to search for non-anatomic runoff will replace diagnostic intra-arterial digital subtraction angiography (DSA) for planning of reconstructive surgery with acquisition slabs displaying projections similar to intra-arterial DSA. Color duplex sonography should also be the first non-invasive technique applied for the detection of peripheral aneurysms. Preoperative or preinterventional therapy planning of aneurysms may be performed by CTA or CE MRA. Compression ultrasound is the imaging procedure of choice in deep venous thrombosis (DVT). In the preoperative assessment of venous incompetence, color duplex sonography is the imaging technique which is sufficient in most cases.

Three-dimensional MRA follow-up after stent placement may be applicable for stent patency evaluation in all instances. However, grading of stenoses seems to be unrealistic in steel stents and in most nitinol stents.

Ultrasound is the most widespread diagnostic procedure in obstructive disease of the arteries supplying the brain. The combined non-invasive information on morphology and function makes duplex ultrasound the procedure of choice in screening and follow-up of carotid artery disease. This review deals with all relevant aspects of color duplex ultrasound of the carotids and the vertebral arteries. After a short introduction into the clinical background, the paper focuses on aspects of examination technique. In the main part of the review the relevant ultrasound findings in carotid artery disease are discussed. The different methods for grading stenoses of the internal carotid artery are explained in detail. Other relevant pathologies, such as vertebral artery disease, dissection and aneurysms, are briefly mentioned. The clinical value of ultrasound in the work-up of carotid and vertebral artery disease is briefly discussed in comparison with other imaging procedures.