Whey protein supplementation (WPS) has been shown to improve functional outcomes in populations that are able to participate in high-intensity resistance training. The purpose of the study was to evaluate the efficacy of WPS on rehabilitation outcomes in a frail, hospitalized elderly population. Men and women (n = 47) were randomly assigned to either a control group or WPS group for the length of their hospital stay. Several functional and serum measures were determined pre- and post-intervention. WPS significantly increased average daily protein intake and was well tolerated. The WPS group exhibited significant improvements in grip strength and knee extensor force over the control group, and a significant positive correlation was found between change in prealbumin and percent-increase knee extensor force. These findings support the use of WPS to improve protein nutritional status and rehabilitation outcomes in a clinical setting involving a frail, elderly population.

OBJECTIVES Pre-procedural CT angiography (CTA) assists in evaluating vascular morphology, disease distribution and treatment planning in patients with lower extremity peripheral artery disease (PAD). The aim of the study was to determine the predictive value of radiographic findings on CTA and technical success of endovascular revascularization of occlusions in the superficial femoral-popliteal (SFA-pop) region. METHODS Medical records and available imaging studies were reviewed for patients undergoing endovascular intervention for PAD between January 2013 and December 2015 at a single academic institution. Radiologists reviewed pre-operative CTAs of patients with occlusions in the SFA-pop region. Radiographic criteria previously used to evaluate chronic occlusions in the coronary arteries were used. Technical success, defined as restoration of inline flow through the SFA-pop region with < 30% stenosis at the end of the procedure, and intra-operative details were evaluated. RESULTS From 2013–2015, 407 patients underwent 540 endovascular procedures for PAD. Pre-procedural CTAs were performed in 217 patients (53.3%), and 84 occlusions in the SFA-pop region were diagnosed. Ten occlusions were excluded as no endovascular attempt to cross the lesion was made due to extensive disease or concomitant iliac intervention. Of the remaining 74 occlusions in the SFA-pop region, 59 were successfully treated (80%), 15 unsuccessfully crossed (20%). The indications for revascularization were claudication in 57% of patients with the remaining for critical limb ischemia. Tasc A, B and C occlusions were treated with 87% success while Tasc D occlusions were treated with 68% success, P=.047. There were 9 occlusions with 100% vessel calcification which was associated with technical failure (P=.014). Longer lengths of occlusion were also associated with technical failure (P=.042). Multiple occlusions (P=.55), negative remodeling (P=.69), vessel runoff (P=.56), and percentage of vessel calcification (P=.059) were not associated with failure. On multivariable analysis 100% calcification remained the only significant predictor of technical failure (OR 9.0, 95% CI 1.8–45.8, P=.008). CONCLUSIONS Analysis of pre-operative CTAs shows 100% of calcification as the best predictor of technical failure of endovascular revascularization of occlusions in the SFA-pop region. Further studies are needed to determine the cost effectiveness of obtaining pre-operative CTA for lower extremity PAD.

Popliteal artery aneurysms (PAAs) are the most common peripheral artery aneurysms. They are frequently symptomatic and are associated with high rates of morbidity and limb loss. PAA can be treated by open or endovascular means, although there are no specified recommendations guiding treatment choice. This article delineates many of the differences between open and endovascular repair of asymptomatic PAA, and highlights several key articles comparing open and endovascular repair to guide decision making. Proper diagnosis and choice of repair can lead to good outcomes in the treatment of asymptomatic PAA.

As the number of patients afflicted by chronic limb-threatening ischemia (CLTI) continues to grow, new solutions are necessary to provide effective, durable treatment options that will lead to improved outcomes. The diagnosis of CLTI remains mostly clinical, and endovascular revascularization remains mostly balloon-based. Multiple innovative techniques and technologies are in development or in early usage that may provide new solutions. This review categorizes areas of advancement, highlights recent developments in the management of CLTI and looks forward to novel devices that are currently under investigation.

A genetically encodable caspase-3 sensing system has been created using self-assembling split-GFP, in which a C-terminal fragment is "covalently" cyclized via a caspase-3 substrate sequence mediated by split-intein. The specific cleavage of the cyclic C-terminal fragment by caspase-3 induces the GFP reassembly and fluorescence recovery.