Background/Objectives: Virtual non-contrast (VNC) images derived from dual-energy CTA (DE-CTA) could potentially replace true non-contrast (TNC) scans while reducing radiation exposure. This study evaluated the image quality of VNC compared to TNC for assessing native arteries and bypass grafts in patients with peripheral arterial disease (PAD). Methods: We retrospectively analyzed 175 patients (111 men, 64 women, mean age: 69.3 ± 9.5 years) with PAD who underwent lower extremity DE-CTA. Mean attenuation and image noise values of TNC and VNC images were measured in native arteries and bypass grafts at six arterial levels, from the aorta to the popliteal arteries, using circular regions of interest (ROI). Signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) were calculated. Three independent radiologists evaluated the subjective image quality of VNC images compared to baseline TNC scans for overall quality (4-point Likert scale), and for residual contrast medium (CM), calcium subtractions, and bypass graft visualization (3-point Likert scales). Radiation dose parameters (DLP, CTDIvol) were recorded to estimate effective dose values (ED) and the potential radiation dose reduction. Differences between TNC and VNC measurements and radiation dose parameters were compared using a paired t-test. Interobserver agreement was assessed with Gwet’s AC2. Results: VNC attenuation and noise values were significantly lower across all native arterial levels (p < 0.05, mean difference: 4.7 HU–10.8 HU) and generally lower at all bypass regions (mean difference: 2.2 HU–13.8 HU). Mean image quality scores were 3.03 (overall quality), 2.99 (residual contrast), 2.04 (subtracted calcifications), and 3.0 (graft visualization). Inter-reader agreement was excellent for each assessment (AC2 ≥ 0.81). The estimated radiation dose reduction was 36.8% (p < 0.0001). Conclusions: VNC reconstructions demonstrated comparable image quality to TNC in a PAD assessment and offer substantial radiation dose reduction, supporting their potential as a promising alternative in clinical practice. Further prospective studies and optimization of reconstruction algorithms remain essential to confirm diagnostic accuracy and address remaining technical limitations.

Pseudoaneurysms resulting from Fogarty balloon catheterization for thromboembolism (termed post-thromboembolectomy pseudoaneurysms [PTPAs]) are rare but pose significant clinical challenges, particularly when they affect below-the-knee arteries. The underlying pathophysiology of PTPAs involves arterial wall injury, leading to blood extravasation and the formation of a pseudoaneurysm sac. The presentation of PTPAs varies but is often characterized by localized pain, swelling, and a palpable pulsatile mass, which may appear immediately or be delayed. Diagnostic modalities such as duplex ultrasound, computed tomography angiography, and digital subtraction angiography are essential for accurate detection and characterization. Management strategies for PTPAs range from conservative observation to radiological interventions and open surgical reconstruction. The choice of treatment depends on factors such as the size and anatomical location of the pseudoaneurysm, as well as the patient’s overall health status. This review synthesizes case reports and highlights the critical importance of prompt diagnosis and individualized treatment strategies. Additionally, it underscores the need for ongoing research, particularly in complex cases requiring a combination of approaches, to refine treatment protocols and improve patient outcomes.

Background/Objectives: We sought to demonstrate the versatility and economy of physician-modified endograft (PMEG) fenestrated endovascular aortic repair (FEVAR) based on the Treo (Terumo Aortic) platform for patients referred for custom-made device (CMD) FEVAR due to a complex abdominal aortic aneurysm (CAAA). Endovascular planning was performed utilizing a standardized design incorporating all visceral arteries with a low supra-celiac landing zone. The pure cost of the aortic components was compared between the PMEG and CMD designs. Methods: A total of 39 consecutive patients treated with CMD FEVAR due to a CAAA between September 2018 and December 2023 were recruited at a tertiary vascular center for a retrospective evaluation. Endovascular planning was performed on readily available computed tomography angiography (CTA) datasets using 3Mensio Vascular (Pie Medical Imaging) software. The actual cost of the major components was compared between the implanted CMD platform produced by Cook and the planned Treo-based PMEG repair. Results: A total of 155 fenestrations were planned on 3 triple-, 34 quadruple-, and two quintuple-fenestrated devices. The 90 mm distance between the proximal edge and the flow divider of the 120 mm long main body of the Treo graft allowed for the placement of all necessary fenestrations of the target arteries without the need to reduce the 3 cm supra-celiac landing zone while also preserving a safety distance of >1 cm to the flow divider. The costs of the components were EUR 33896 for CMD and EUR 8878 for a PMEG. Conclusions: This retrospective study suggests that a quadruple-fenestrated PMEG based on the Treo bifurcation is a highly versatile alternative with a significant price advantage over custom-made devices for the treatment of complex abdominal aortic aneurysms.

Knee osteoarthritis (KOA) is a leading cause of late-life pain, mobility loss, and disability, and is increasingly recognized as a phenotype-dependent manifestation of joint aging rather than a purely mechanical disorder. Cellular senescence, inflammaging, mitochondrial dysfunction, synovial inflammation, vascular remodeling, and impaired repair capacity converge to shape KOA symptoms and progression. This narrative review synthesizes evidence on conservative and minimally invasive KOA therapies within a geroscience-guided, phenotype-informed framework. A structured search of PubMed/MEDLINE and Embase from January 2010 to May 2026 identified randomized trials, meta-analyses, guidelines, position statements, and high-quality observational studies evaluating lifestyle interventions, pharmacologic and nutritional strategies, intra-articular therapies, genicular nerve ablation, and genicular artery embolization (GAE). Weight reduction, exercise, and education remain core joint healthspan interventions, with consistent evidence for pain reduction, functional benefit, and favorable systemic effects on inflammation and metabolism. Pharmacologic analgesia, intra-articular corticosteroids, and hyaluronic acid are best interpreted as symptom modulators, while platelet-rich plasma, autologous conditioned serum, and mesenchymal stromal/stem cell-based approaches remain limited by heterogeneity and insufficient long-term structural data. Genicular nerve ablation may support functional longevity through pain control without structural modification. GAE is biologically plausible for synovitis/hypervascularity-dominant KOA, but sham-controlled evidence remains inconsistent. Future trials should distinguish symptomatic relief from true modification of joint aging biology. Graphical abstract

Digital subtraction angiography (DSA) remains an important reference modality for evaluating chronic limb-threatening ischemia (CLTI), with left transradial access (TRA) increasingly favored for its lower complication rates and patient comfort. Radiation safety for operators is paramount, yet the impact of patient positioning on scatter radiation during lower limb diagnostic catheter angiography (CA) is understudied. This single-center randomized controlled trial evaluated whether head-first (HF) vs. feet-first (FF) supine patient orientation affects operator radiation exposure during lower extremity CA from left TRA. Between February and August 2024, 24 patients with CLTI were enrolled and randomized to HF or FF positions. Operator radiation exposure was measured using thermoluminescent dosimeters (TLDs) at the eye, chest, and left ring finger. Background radiation was subtracted. Procedures were standardized and performed by a single experienced interventional radiologist. Fluoroscopy time, dose area product (DAP), and contrast usage were recorded. No statistically significant differences were found between groups in patient BMI and procedural parameters. Patient positioning (HF vs. FF) did not significantly impact operator radiation exposure. A trend toward higher finger exposure in FF position suggests the need for optimized hand protection. These findings support flexible patient positioning without compromising operator safety, reinforcing adherence to ALARA principles.