4.2. Screening from a Vascular Point of View Both CT angiography selleck chemicals llc selleck kinase inhibitor and conventional angiography were used to evaluate vascular integrity and anatomy within the residual limb. Patients screened in 2008 typically underwent CT angiography while the later patients were screened using conventional angiography. This change was multifactorial, influenced in part by the increasing sensitivity to radiation exposure and awareness of renal drug sensitivity. In addition, technological advances facilitated the transition as the two modalities became fairly comparable in quality, but with the advantage that conventional imaging could be acquired using less contrast when performed by an experienced interventionalist [8�C10].

At our institution, vascular mapping whether by CT or conventional angiography focused on identifying vessels adequate to serve as the vascular pedicle for the transplant. Features that defined acceptability were those proven in other transplant populations to decrease the degree of turbulence and thus complication, such as large vessel caliber, relative lack of branching, and maximum vessel length [8, 11�C13]. Thus, a preference was placed on using the radial and ulnar arteries, rather than collaterals, and attention was directed to the length of the preserved vessels and their approximation to the distal-most aspect of the residual limb. 4.3.

Musculoskeletal Postsurgical Surveillance Since extremity composite tissue transplantation entails the transfer of multiple tissue types which each heal and reject independently, radiological surveillance attempted to monitor for signs of both processes [2, 3].

Postsurgical radiologic imaging focused on documenting transplant healing and the exclusion of postsurgical complication. These concerns were largely answerable by conventional radiography using serial radiographs, with CT and MRI being secondary modalities to further evaluate any irregularity detected on the initial radiograph or on physical examination. The Anacetrapib structural concerns dictating imaging within the postsurgical period were akin to conventional orthopedic procedures with attention given to osseous alignment, progressive signs of healing, and surveillance for hardware failure.

It can be argued whether the radiologist should comment on the subjective bone density observed on follow-up radiographic studies given these patients’ ongoing immunosuppressive therapy. Although little exists in the literature concerning the long-term effects of Tacrolimus (FK506) on bone Drug_discovery healing in humans, FK506 has been shown to decrease trabecular bone density in rat models secondary to increased osseous resorption [14].