Abstract
Objective: Paclitaxel drug-coated balloon (PDCB) angioplasty has been shown to be an effective treatment of in-stent
restenosis (ISR) at the femoropopliteal (FP) arteries. Long-term studies, however, have shown a progressive decrease in the
patency rates following PDCB. The aim of this study was to determine the predictors of stenosis recurrence after PDCB
treatment of FP-ISR, and its immediate and mid-term outcomes.
Methods: This prospective, non-randomized study included all chronic lower extremity ischemia patients of Rutherford
class 3–6 who underwent PDCB angioplasty to treat >50% FP-ISR between June 2017 and December 2019. The primary
endpoint was primary patency, defined as freedom from binary restenosis and freedom from clinically driven target lesion
revascularization (CD-TLR) at 12 months. Secondary endpoints included 12-months freedom from CD-TLR and major
adverse events (MAEs).
Results: A total of 73 symptomatic chronic limb ischemia patients (73 limbs including 63 with limb threatening ischemia)
underwent PDCB angioplasty of FP-ISR lesions (13.7% Tosaka class I, 54.8% class II, and 31.5% class III). The mean ISR lesion
length was 121.8 ± 52.7 mm. Technical success was achieved in 70 (95.9%) patients. Kaplan–Meier estimate of the 12-
months rates of primary patency and freedom from CD-TLR was 76.1% and 87.4%, respectively. At one year, MAEs
occurred in eight patients (11.0%) including two deaths (2.7%), one major amputation (1.4%), and six (8.2%) surgical
revascularizations. Multivariable analysis showed that Tosaka class III ISR (HR 4.51, CI: 1.31–15.53, p < 0.001) and reference
vessel diameter (HR 0.38, 95% CI: 0.18–080, p = 0.01) were independently associated with recurrent ISR.
Conclusions: PDCB is safe and effective treatment of FP-ISR lesions. Occlusive ISR lesions and reference vessel diameter
were independently associated with recurrent ISR stenosis after PDCB treatment.
Keywords
In-stent restenosis, paclitaxel drug-coated balloon, peripheral arterial disease, drug-eluting balloon, femoropopliteal
arteries

APL) as an alternative permanent vascular access in strictly selected patients with end-stage renal disease.
Methods: This single-center prospective observational study was conducted between January 2014 and June 2017 and
included 89 brachial AAPL procedures. Primary, assisted primary, and secondary patency rates were calculated using
Kaplan-Meier analysis.
Results: Exhausted peripheral veins were the most common indication for brachial AAPL. Patients were followed up for a
mean period of 28.7 6 4.9 months. Nineteen grafts developed thrombosis, 13 grafts developed pseudoaneurysms, 9 grafts
developed hematoma, and 6 grafts were abandoned because of infection. The primary, assisted primary, and secondary
patency rates were 62% 6 5.2%, 71.2% 6 4.9%, and 89.6% 6 3.3% at 24 months, respectively.
Conclusions: Brachial AAPL can offer a simple, safe, and efficient alternative as a permanent hemodialysis access in
a selected subset of end-stage renal disease patients, with acceptable durability and rate of complications. Because
of its unique specifications, cooperation between vascular surgeons and dialysis staff is mandatory. (J Vasc Surg
2020;72:181-7.)
Keywords: Arterio-arterial; Alternative dialysis access; Brachial artery prosthetic loop; Exhausted peripheral veins; Central
venous occlusive disease

N-nitrosodiethylamine (ND) is an extremely toxic unavoidable environmental contaminant. Copper^II-albumin (CuAB) complex, a newly developed Cu complex, showed antioxidant and anti-inflammatory potential. Hereby, we explored the plausible neuroprotective role of CuAB complex toward ND-evoked neurotoxicity in mice. Twenty-four male mice were sorted into 4 groups (6 mice each). Control group, mice were administered oral distilled water; and CuAB group, mice received CuAB complex at a dose of 817 µg/kg orally, three times weekly. In ND group, ND was given intraperitoneally (50 mg/kg body weight, once weekly for 6 w). CuAB+ND group, mice were administered a combination of CuAB and ND. The brain was quickly extracted upon completion of the experimental protocol for the evaluation of the oxidative/antioxidative markers, inflammatory cytokines, and histopathological examination. Oxidative stress was induced after ND exposure indicated by a reduction in GSH and SOD1 level, with increased MDA level. In addition, decreased expression of SOD1 proteins, Nrf2, and 5-HT mRNA expression levels were noticed. An apoptotic cascade has also been elicited, evidenced by overexpression of Cyt c, Cl. Casp 3. In addition, increased regulation of proinflammatory genes (TNF-α, IL-6, iNOS, Casp1, and NF-κB (p65/p50); besides, increment of protein expression of P-IKBα and reduced expression of IKBα. Pretreatment with CuAB complex significantly ameliorated ND neuronal damage. Our results recommend CuAB complex supplementation because it exerts neuroprotective effects against ND-induced toxicity.

Objective To assess the inter-observer variability between readers in the detection of bone metastases
for different modalities [planar bone scintigraphy (BS), single photon emission computed tomography/
computed tomography (SPECT/CT), and fluorine-18 fluorodeoxyglucose positron emission tomography/
computed tomography (PET/CT) (F-18 FDG PET/CT)].

Methods Patients with known primary tumors referred for metastatic workup either by F-18 FDG PET/CT or
conventional planar BS and SPECT/CT were enrolled in this prospective study. The three modalities (BS, SPECT/CT, and PET/CT) were acquired for each patient. Interpretation was done by two independent nuclear medicine physicians separately and blindly; reader 1 (R1) and reader 2 (R2). A three-point subjective scale was used (1 = negative for bone metastases, 2 = equivocal, and 3 = positive). The findings were compared to the final patient status based on clinical and radiological follow-up for at least 6 months. The Kappa test was used to assess the degree of agreement between readers in their interpretation of each modality.

Results A total of 54 patients (39 females and 15 males, ages 26–76; mean: 54.7 ± 12) were eligible for
this study. Fair agreement 0.372 between R1 and R2 in interpretation of BS was noticed that improved to 0.847
after addition of SPECT/CT. Perfect agreement was achieved between R1 and R2 while interpreting PET/CT
images (kappa = 0.964, P < 0.001).

Conclusion F-18 FDG PET/CT significantly improved the inter-observer variability between readers, allowing
for better diagnosis of bone metastases in known cancer patients. Also, it was superior to BS and SPECT/CT in
the detection of bone metastases.