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PURPOSE: Lower extremity amputation prevention (LEAP) is an ongoing program in our institution aimed at salvaging limbs in patients with critical limb ischemia (CLI). Patients in the LEAP program with reconstructible anatomy on initial Doppler imaging received either bypass surgery or percutaneous transluminal balloon angioplasty (PTA). We present the 3 year limb salvage rate and angiographic disease patterns in 42 consecutive diabetic patients with CLI who received PTA in 2005. METHODS AND MATERIAL: 26 women and 16 men with diabetes between the ages of 45 and 91 years old (mean age, 70.8 years) received PTA in 2005. Presenting symptoms were rest pain (n = 22), pre-existing gangrene (n = 17), non-healing ulcer (n = 16) and cellulitis (n = 2). The aim of the PTA was to achieve straight-line flow from the abdominal aorta down to the patent dorsalis pedis or plantar arch, with limb salvage as the ultimate outcome. Failure of treatment was defined as any amputation above the level of a Syme's amputation or the need for further surgical bypass. Technical success was achieved in 90% (38 out of 42 patients). RESULTS: Limb salvage rates were 93% at 1 month, 87% at 3 months, 82% at 6 months, 78% at 1 year, 69% at 2 years and 66% at 3 years. Mortality was 17% (n = 7) at 3 years. Of the 13 patients with failed therapy, 3 underwent bypass, 9 had amputations and 1 had bypass followed by amputation. Four of the cases required further intervention due to worsening gangrene and infection, while the remaining was due to persistent rest pain. The rest of the 32 patients had no lower limb related issues at the end of 3 years, with improvement of the presenting symptoms. Patterns of treated segments were aortoiliac occlusions (n = 3), pure infrapopliteal disease (n = 3), femoropopliteal with at least 1 good infrapopliteal run-off vessel (n = 14) and combined femoropopliteal and infrapopliteal disease (n = 25). CONCLUSION: Involvement of infrapopliteal vessels that needs to be treated is common in Asian diabetics. While early limb salvage rates up to 1 year are similar, the 3 year limb salvage rates in Asian diabetics are lower than the western population.

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AIM: The purpose of this study was to compare the depth of vascular penetration of non-spherical polyvinyl alcohol (PVA) versus trisacryl gelatin microspheres (MS) in women undergoing uterine artery embolization (UAE) immediately before transabdominal myomectomy. MATERIALS AND METHODS: A total of 17 patients who had been referred for embolization before myomectomy underwent bilateral uterine artery embolization using either 355-500 microm PVA (group A) or 700-900 microm MS (group B). The depth of penetration of the particles was assessed by identifying their presence and location in the resected specimen. RESULTS: Of the 17 women enrolled in this study, 10 were in group A and 6 in group B. One woman underwent embolization using both types of particle and was excluded from the analysis. Embolic particles were significantly (p = 0.048) more frequently located within the fibroid (4/6, 67%) in Group B than Group A (1/10, 10%). Particles were also identified in the perifibroid tissues in 4/6 (67%) in Group B and 4/10 (40%) in Group A, with no statistical difference. There were no procedural complications. CONCLUSION: MS particles (700-900 microm) penetrate significantly deeper into leiomyomata compared with non-spherical PVA (355-500 microm). MS may therefore confer advantages in UAE, as they may more specifically target the fibroid, allowing an earlier end-point to embolization and minimizing ischaemic damage to normal myometrium and ovaries.

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OBJECTIVES: Osmotic myelinolysis is a distinctive clinical syndrome with characteristic CT and MR features. This study was undertaken to determine the MR appearance of these lesions on T1 and T2-weighted, and diffusion-weighted imaging (DWI) sequences with apparent diffusion coefficient (ADC) mapping. MATERIALS AND METHODS: We describe six patients who presented with deranged serum sodium levels and subsequently developed osmotic myelinolysis. CT and MRI scans were retrospectively reviewed, including the advanced functional MR sequence of DWI with ADC mapping. RESULTS: Both cerebral white matter and pontine lesions were typically hypo and hyper-intense on T1 and T2W sequences respectively. Lesions were mildly hyperintense on isotropic DWI images with elevation of the ADC. CONCLUSION: MRI is superior to CT in depicting lesions in osmotic myelinolysis. DWI with ADC mapping suggests that osmotic myelinolysis is not simply a demyelinating disorder but has similarities to multiple sclerosis.

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