Our objective is to determine if there is correlation between serum thyroglobulin and SUVmax of the main lesion detected in F18-FDG-PET/CT scan, in differentiated thyroid cancer (DTC) patients with suspected recurrence.

AbstractBackground: Atrial septal communications account for approximately 6-10% of congenital heart defects, with an incidence of 1 in 1,500 live births. The atrial septal defect (ASD) is among the most common acyanotic congenital cardiac lesions, occurring in 0.1% of births and accounting for 30-40% of clinically important intracardiac shunts.Transcatheter device closure is advised for all symptomatic patients and also for asymptomatic patients with a Qp: Qs ratio of at least 2:1 or those with right ventricular enlargement. The timing for elective closure is usually after the 1st yr and before entry into school. Closure carried out at open heart surgery is associated with a mortality rate of <1%. Repair is preferred during early childhood because surgical mortality and morbidity are significantly greater in adulthood.

Aim of Study

Is to evaluate 2.5 years experience in transcatheter device closure of secundum atrial septal defect at the Pediatric Cardiology Unit, Assiut University Children Hospital.

Patients and Methods

The study was conducted on 62 patients [56 (90.4%) children and 6 (9.6%) adults] who underwent transcatheter secundum ASD device closure, at Pediatric Cardiology Unit of Assiut University Children Hospital from March 2014 till September 2016.

Results

Transcatheter closure of secundum ASD in chil-dren adolescents and adults has a high success rate (98.3%) regarding the efficacy (successful closure of the defect without residual shunt) and safety (no death or major complications as cerebral embolism, cardiac tamponade, device embolization or dislodgement requiring open cardiac surgery and infectious endocarditis) during procedure …

Abstract
Background: To address the predictors of hemodynamic instability (HI) related to carotid artery stenting (CAS) and evaluate the
association between HI and periprocedural adverse outcomes. Methods: This study comprised all consecutive patients who
underwent CAS for atherosclerotic carotid artery stenosis from March 2014 to May 2018. A standardized dose of atropine (0.4 mg)
was given prior to stent deployment. Changes in heart rate, blood pressure, and neurological status were monitored and recorded.
Potential predictors of HI were tested in multivariate analysis using binary logistic regression model. Results: A total of 728 patients
were enrolled. Two hundred twenty seven patients (31.2%) developed periprocedural HI. The presence of hypertension (OR, 2.037;
95% CI, 1.292-3.211; P ¼ 0.0022), symptomatic carotid lesions (OR, 1.704; 95% CI, 1.057-2.747; P ¼ 0.0287), right sided lesions
(OR, 3.090; 95%CI, 1.934-4.935; P0.0001), hyperechoic/calcified plaques (OR, 2.195; 95%CI, 1.458-3.304; p P¼0.0002), and longer
lesions (OR, 1.043; 95% CI, 1.012-1.076; P¼0.0072) were significant predictable factors for the occurrence of HI. On the other hand,
smoking was significantly associated with a 48.1% decrease in risk of development of HI (OR, 0.519; 95% CI, 0.358-0.754; P¼ 0.0006).
There were no statistically significant differences in periprocedural morbidity or mortality between patients with and without HI.
Conclusion: HI occurs in a considerable percentage of patients undergoing CAS. Hypertension, right sided, symptomatic carotid
lesions, calcified plaques, and longer lesions were shown to be independent risk factors for the development of periprocedural HI.
Conversely, smoking demonstrated a protective effect. HI did not appear to predispose to periprocedural adverse events.
Keywords
carotid stenting, hemodynamic instability, complications, atropine

Background
Percutaneous transluminal angioplasty (PTA) is the mainstay of treatment in
stenosed hemodialysis access. Being less invasive and outpatient procedure,
PTA is a safe and useful intervention to maintain access patency in patients
with failing hemodialysis arteriovenous fistulas (AVFs). The aim of this study
was to evaluate the efficacy of balloon angioplasty in treatment of patients with
failing upper extremity hemodialysis access.
Methods
This is a prospective study of all adult patients who underwent balloon angioplasty
for the treatment of patients with symptoms of a failing dialysis access due to
presence of significant stenosis in dialysis access circuit. The study conducted at
the Department of Vascular and Endovascular Surgery, Assiut University Hospital
(a tertiary referral hospital), between January 2017 and December 2018. Both the
primary and assisted primary patency rates were analyzed by the Kaplan-Meier plot
method.
Results
149 patients underwent PTA for treatment of failing dialysis access symptoms. The
most common site of stenosis in our study was the juxta-anastomotic site (49 %).
The overall success rate was 96.6%. Balloon angioplasty was performed in all
patients without stent placement. Sixteen (10.7%) complications were encountered
in the study. At 1 year, the primary patency and the assisted primary patency rates
was 60.5% and 80%, respectively. Age of the fistula (P=0.017), presence of
multiple lesions (P=0.016), total lesion length >5cm (P=0.030), and diabetes
mellitus (P=0.012) were significant independent predictors of loss of primary
patency.
Conclusions
Balloon angioplasty is safe and effective treatment modality for treatment of
stenosis in failing hemodialysis access patients with good technical success and
acceptable short-term primary patency rates. Repeated interventions are required
to maintain patency.
Keywords:
failing hemodialysis access, percutaneous transluminal angioplasty, stenosis

Abstract
Objective: Recanalization of flush ostial superficial femoral artery (SFA) occlusion is a very challenging procedure. Using the
ipsilateral antegrade approach in such lesions has some difficulties. This study aimed to assess the feasibility, efficacy, and
outcomes of duplex-guided ipsilateral antegrade access for endovascular treatment of atherosclerotic flush occlusion of the
SFA. Methods: This is a prospective two-center study that included chronic lower extremity ischemia patients with flush
occlusion of SFA who underwent duplex-guided ipsilateral antegrade endovascular revascularization due to unfeasible contralateral
femoral approach. Flush occlusions were preoperatively documented by duplex ultrasound and computed tomography
angiography in all patients. The outcome measures were technical success, patency rates, perioperative morbidity
and mortality, limb salvage, and amputation free survival rates. Results: Between April 2019 and March 2021, 49 patients were
enrolled in the current study with a mean age of 63.7 ± 5.7 years. Diabetes was the most common risk factor and was found in 40
(81.6%) patients. Associated popliteal lesions were found in seven (14.3%) patients, while 10 (20.4%) patients had combined
tibial disease. Selective stenting was done in nine (18.4%) patients. Technical success was achieved in 43 (87.8%) patients. All
failures were due to inability to cross the lesion rather than failure to access the common femoral artery. All complications were
minor and occurred in seven (14.3%) patients. Primary, assisted primary, and secondary patency rates were 63.9% ± 7.1%,
82.8% ± 5.6%, and 93.5% ± 3.7% at 12 months, respectively. The overall 12-month limb salvage and amputation free survival
rates were 91.8% and 83.3% ± 5.4%, respectively. Conclusion: Duplex-guided ipsilateral antegrade femoral access is a feasible,
safe, and effective endovascular treatment option for flush SFA occlusion when contralateral femoral access is not possible.
Keywords
duplex ultrasound, chronic limb ischemia, flush occlusion, ipsilateral femoral access, superficial femoral artery, endovascular
treatment

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.