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Objective.In patients with suspected thoracic outlet syndrome (TOS), diagnosing inter-scalene compression could lead to minimally invasive treatments. During photo-plethysmography, completing a 30 s 90° abduction, external rotation ('surrender' position) by addition of a 15 s 90° antepulsion 'prayer' position, allows quantitative bilateral analysis of both arterial (A-PPG) and venous (V-PPG) results. We aimed at determining the proportion of isolated arterial compression with photo-plethysmography in TOS-suspected patients.Approach.We studied 116 subjects recruited over 4 months (43.3 ± 11.8 years old, 69% females). Fingertip A-PPG and forearm V-PPG were recorded on both sides at 125 Hz and 4 Hz respectively. A-PPG was converted to PPG amplitude and expressed as percentage of resting amplitude (% rest). V-PPG was expressed as percentage of the maximal value (% max) observed during the 'Surrender-Prayer' maneuver. Impairment of arterial inflow during the surrender (As+) or prayer (Ap+) phases were defined as a pulse-amplitude either <5% rest, or <25% rest. Incomplete venous emptying during the surrender (Vs+) or prayer (Vp+) phases were defined as V-PPG values either <70% max, or <87% max.Main results.Of the 16 possible associations of encodings, As - Vs - Ap - Vp- was the most frequent observation assumed to be a normal response. Isolated arterial inflow without venous outflow (As + Vs-) impairment in the surrender position was observed in 10.3% (95%CI: 6.7%-15.0%) to 15.1% (95%CI: 10.7%-20.4%) of limbs.Significance.Simultaneous A-PPG and V-PPG can discriminate arterial from venous compression and then potentially inter-scalene from other levels of compressions. As such, it opens new perspectives in evaluation and treatment of TOS.
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Arterias , Fotopletismografía , Síndrome del Desfiladero Torácico , Venas , Humanos , Femenino , Masculino , Síndrome del Desfiladero Torácico/fisiopatología , Adulto , Venas/fisiopatología , Arterias/fisiopatología , Persona de Mediana Edad , PrevalenciaRESUMEN
BACKGROUND: Unlike conventional microsecond pulsed electrical fields that primarily target the cell membranes, nanosecond pulses are thought to primarily electroporate intracellular organelles. We conducted a comprehensive preclinical assessment of catheter-based endocardial nanosecond pulsed field ablation in swine. METHODS: A novel endocardial nanosecond pulsed field ablation system was evaluated in a total of 25 swine. Using either a low-dose (5-second duration) or high-dose (15-second duration) strategy, thoracic veins and discrete atrial and ventricular sites were ablated. Predetermined survival periods were <1 (n=1), ≈2 (n=7), ≈7 (n=6), 14 (n=2), or ≈28 (n=9) days, and venous isolation was assessed before euthanasia. Safety assessments included evaluation of esophageal effects, phrenic nerve function, and changes in venous caliber. All tissues were subject to careful gross pathological and histopathologic examination. RESULTS: All (100%) veins (13 low-dose, 34 high-dose) were acutely isolated, and all reassessed veins (6 low-dose, 15 high-dose) were durably isolated. All examined vein lesions (10 low-dose, 22 high-dose) were transmural. Vein diameters (n=15) were not significantly changed. Of the animals assessed for phrenic palsy (n=9), 3 (33%) demonstrated only transient palsy. There were no differences between dosing strategies. Thirteen mitral isthmus lesions were analyzed, and all 13 (100%) were transmural (depth, 6.4±0.4 mm). Ventricular lesions were 14.7±4.5 mm wide and 7.1±1.3 mm deep, with high-dose lesions deeper than low-dose (7.9±1.2 versus 6.2±0.8 mm; P=0.007). The esophagus revealed nontransmural adventitial surface lesions in 5 of 5 (100%) animals euthanized early (2 days) post-ablation. In the 10 animals euthanized later (14-28 days), all animals demonstrated significant esophageal healing-8 with complete resolution, and 2 with only trace fibrosis. CONCLUSIONS: A novel, endocardial nanosecond pulsed field ablation system provides acute and durable venous isolation and linear lesions. Transient phrenic injury and nontransmural esophageal lesions can occur with worst-case assessments suggesting limits to pulsed field ablation tissue selectivity and the need for dedicated assessments during clinical studies.
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Estudios de Factibilidad , Nervio Frénico , Animales , Porcinos , Factores de Tiempo , Miocardio/patología , Ablación por Catéter/métodos , Ablación por Catéter/efectos adversos , Venas/fisiopatología , Modelos Animales , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/patología , Esófago , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/patologíaRESUMEN
BACKGROUND: Endovascular deep vein arteriaization (DVA) is a novel technique aimed at salvaging peripheral arterial disease unamenable to conventional surgical intervention. This study aims to review contemporary literature on the efficacy, safety, and durability of DVA on patients with no-option critical limb ischemia (NO-CLI). METHODS: The study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, using predefined search terms of "percutaneous deep vein arterialization" or "percutaneous deep venous arterialization" in PubMed, Web of Sciences, OvidSP, and Embase. Only studies with 5 or more patients were included, and studies involving open or hybrid DVA were excluded. The primary outcomes included technical success and primary amputation rates. Secondary outcomes included rates of wound healing, complication, reintervention, and all-cause mortality. RESULTS: Ten studies encompassing a total of 233 patients were included. Patients were primarily those deemed to have NO-CLI. The median follow-up period was 12 months (range 1-63 months). The technical success rate was 97% (95% confidence interval [CI] 96.2%-97.9%) and the major amputation rate was 21.8% (95% 21.1%-22.4%). The wound healing rate was 69.5% (95% CI 67.9-71.0%), complication rate was 13.8% (95% CI 11.7%-15.9%), reintervention rate was 37.4% (95% CI 34.9%-39.9%), and all-cause mortality rate was 15.7% (95% CI 14.1%-17.2%). CONCLUSIONS: Our study showed that endovascular DVA is safe for patients with NO-CLI. Nonetheless, studies were small with follow-up period of less than 1 year. There is currently lack of level 1 evidence to recommend routine use in patients with NO-CLI.
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Amputación Quirúrgica , Procedimientos Endovasculares , Recuperación del Miembro , Enfermedad Arterial Periférica , Humanos , Resultado del Tratamiento , Factores de Riesgo , Factores de Tiempo , Enfermedad Arterial Periférica/cirugía , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/mortalidad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Anciano , Femenino , Masculino , Venas/cirugía , Venas/fisiopatología , Persona de Mediana Edad , Cicatrización de Heridas , Enfermedad Crítica , Anciano de 80 o más Años , Isquemia/cirugía , Isquemia/fisiopatología , Isquemia/mortalidad , Isquemia/diagnóstico por imagenRESUMEN
BACKGROUND: This review article provides an updated review of a relatively common pathology with various manifestations. Superficial venous diseases (SVDs) are a broad spectrum of venous vascular disease that predominantly affects the body's lower extremities. The most serious manifestation of this disease includes varicose veins, chronic venous insufficiency, stasis dermatitis, venous ulcers, superficial venous thrombosis, reticular veins, and spider telangiectasias. METHODS: The anatomy, pathophysiology, and risk factors of SVD were discussed during this review. The risk factors for developing SVD were related to race, age, sex, lifestyle, and certain genetic conditions as well as comorbid deep vein thrombosis. Various classification systems were listed, focusing on the most common one-the revised Clinical-Etiology-Anatomy-Pathophysiology classification. The clinical features including history and physical examination findings elicited in SVD were outlined. RESULTS: Imaging modalities utilized in SVD were highlighted. Duplex ultrasound is the first line in evaluating SVD but magnetic resonance imaging and computed tomography venography, plethysmography, and conventional venography are feasible options in the event of an ambiguous venous duplex ultrasound study. Treatment options highlighted in this review ranged from conservative treatment with compression stockings, which could be primary or adjunctive to pharmacologic topical and systemic agents such as azelaic acid, diuretics, plant extracts, medical foods, nonsteroidal anti-inflammatory drugs, anticoagulants and skin substitutes for different stages of SVD. Interventional treatment modalities include thermal ablative techniques like radiofrequency ablationss, endovenous laser ablation, endovenous steam ablation, and endovenous microwave ablation as well as nonthermal strategies such as the Varithena (polidocanol microfoam) sclerotherapy, VenaSeal (cyanoacrylate) ablation, and Endovenous mechanochemical ablation. Surgical treatments are also available and include debridement, vein ligation, stripping, and skin grafting. CONCLUSIONS: SVDs are prevalent and have varied manifestations predominantly in the lower extremities. Several studies highlight the growing clinical and financial burden of these diseases. This review provides an update on the pathophysiology, classification, clinical features, and imaging findings as well as the conservative, pharmacological, and interventional treatment options indicated for different SVD pathologies. It aims to expedite the timely deployment of therapies geared toward reducing the significant morbidity associated with SVD especially varicose veins, venous ulcers, and venous insufficiency, to improve the quality of life of these patients and prevent complications.
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Várices , Humanos , Factores de Riesgo , Resultado del Tratamiento , Várices/terapia , Várices/fisiopatología , Várices/epidemiología , Insuficiencia Venosa/terapia , Insuficiencia Venosa/fisiopatología , Insuficiencia Venosa/epidemiología , Insuficiencia Venosa/diagnóstico por imagen , Venas/fisiopatología , Venas/diagnóstico por imagen , Valor Predictivo de las PruebasAsunto(s)
Anastomosis Quirúrgica , Vasos Linfáticos , Venas , Humanos , Venas/cirugía , Venas/diagnóstico por imagen , Venas/fisiopatología , Vasos Linfáticos/cirugía , Vasos Linfáticos/diagnóstico por imagen , Resultado del Tratamiento , Linfedema/cirugía , Linfedema/fisiopatología , Procedimientos Quirúrgicos VascularesRESUMEN
OBJECTIVE: Some studies suggest that regional anesthesia provides better patency for arteriovenous fistula (AVF) for hemodialysis access as compared to local and general anesthesia. This study evaluates the impact of anesthetic modality on long term fistula function at 12 months. METHODS: A retrospective review of patients undergoing cephalic vein-based hemodialysis access in consecutive cases between 2014 and 2019 was conducted from five safety net hospitals. The primary endpoint was functional patency at 12 months. Subset analysis individually evaluated cephalic-based lower forearm and wrist vs upper arm AVFs. Bivariate and multivariate logistic regression models evaluated the relationship between anesthetic modality and fistula function at 12 months. RESULTS: There were 818 cephalic-based fistulas created during the study period. The overall 12-month functional patency rate was 78.7%, including an 81.3% patency for upper arm AVF and 73.3% for wrist AVF (P = .009). There was no statistically significant difference among patients with functional and nonfunctional AVFs at 12 months with respect to anesthetic modality when comparing regional, local, and general anesthesia (P = .343). Multivariate regression analysis identified that history of AVF/arteriovenous graft (odds ratio [OR], 0.24; P = .007), receiving intraoperative systemic anticoagulation (OR, 2.49; P < .001), and vein diameter (OR, 1.85; P = .039) as independently associated with AVF functional patency at 12 months. CONCLUSIONS: There was no association between anesthetic modality and functional patency of cephalic-based AVFs at 12 months. Further studies are needed to better define which patients may benefit from regional anesthesia.
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Anestesia General , Derivación Arteriovenosa Quirúrgica , Diálisis Renal , Grado de Desobstrucción Vascular , Humanos , Derivación Arteriovenosa Quirúrgica/efectos adversos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Factores de Tiempo , Resultado del Tratamiento , Factores de Riesgo , Anestesia General/efectos adversos , Anestesia de Conducción , Anestesia Local , Extremidad Superior/irrigación sanguínea , Oclusión de Injerto Vascular/fisiopatología , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/terapia , Medición de Riesgo , Venas/fisiopatología , Venas/cirugía , Venas/diagnóstico por imagenRESUMEN
BACKGROUND: To evaluate the efficacy of rejoining mainstream and accessory veins for forced maturation of autogenous arteriovenous fistula (AVF). METHODS: Twenty-three patients who underwent forced maturation through vein rejoining between January 2018 and September 2022 were included. In cases where AVF maturation failure due to the presence of accessory veins, rejoining was primarily considered when distinguishing the main branch becomes challenging. This difficulty typically occurs when the sizes of the 2 vessels are nearly equal and the combined diameters of these veins exceed 6 mm. RESULTS: The mean age and follow-up duration were 57.39 ± 16.22 years and 965.65 ± 573.42 days, respectively. Rejoining of both arterial and venous cannulation sites was performed in 11 patients (47.8%), and rejoining of only the venous cannulation site or only the arterial cannulation site was performed in 11 patients (47.8%) and 1 patient (4.3%), respectively. The mean vein size was 0.35 ± 0.06 cm before rejoining and 0.69 ± 0.07 cm after surgery, indicating a significant increase in size (P < 0.01), whereas the flow did not change significantly following rejoining surgery. Maturation and cannulation success was 100%. The 1-year primary patency rate after surgery was 82.0%. During the follow-up period, 34.8% of the patients required additional percutaneous transluminal angioplasty to maintain patency, and 2 patients (11.8%) had stenosis in the rejoined section. CONCLUSIONS: Rejoining surgery is an effective method for achieving AVF maturation in patients with accessory veins when identification of the mainstream vein is difficult, and this method may be considered when achieving maturation by sacrificing 1 vein is expected to be challenging.
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Derivación Arteriovenosa Quirúrgica , Oclusión de Injerto Vascular , Diálisis Renal , Grado de Desobstrucción Vascular , Venas , Humanos , Derivación Arteriovenosa Quirúrgica/efectos adversos , Femenino , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Factores de Tiempo , Adulto , Anciano , Estudios Retrospectivos , Venas/cirugía , Venas/diagnóstico por imagen , Venas/fisiopatología , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/fisiopatología , Oclusión de Injerto Vascular/terapia , Extremidad Superior/irrigación sanguínea , Factores de Riesgo , Flujo Sanguíneo RegionalRESUMEN
STUDY OBJECTIVES: Venous blood gases (VBGs) are not consistently considered suitable surrogates for arterial blood gases (ABGs) in assessing acute respiratory failure due to variable measurement error. The physiological stability of patients with chronic ventilatory failure may lead to improved agreement in this setting. METHODS: Adults requiring ABGs for sleep or ventilation titration studies had VBGs drawn before or after each ABG, in a randomized order. Veno-arterial correlation and agreement were examined for carbon dioxide tension (PCO2), pH, oxygen tension (PO2), and oxygen saturation (SO2). RESULTS: We analyzed 115 VBG-ABG pairs from 61 patients. Arterial and venous measures were correlated (P < .05) for PCO2 (r = .84) and pH (r = .72), but not for PO2 or SO2. Adjusted mean veno-arterial differences (95% limits of agreement) were +5.0 mmHg (-4.4 to +14.4) for PCO2; -0.02 (-0.09 to +0.04) for pH; -34.3 mmHg (-78.5 to +10.0) for PO2; and -23.9% (-61.3 to +13.5) for SO2. VBGs obtained from the dorsal hand demonstrated a lower mean PCO2 veno-arterial difference (P < .01). A venous PCO2 threshold of ≥ 45.8 mmHg was > 95% sensitive for arterial hypercapnia, so measurements below this can exclude the diagnosis without an ABG. A venous PCO2 threshold of ≥ 53.7 mmHg was > 95% specific for arterial hypercapnia, so such readings can be assumed diagnostic. The area under the receiver operating characteristic curve of 0.91 indicated high discriminatory capacity. CONCLUSIONS: A venous PCO2 < 45.8 mmHg or ≥ 53.7 mmHg would exclude or diagnose hypercapnia, respectively, in patients referred for sleep studies, but VBGs are poor surrogates for ABGs where precision is important. CLINICAL TRIAL REGISTRATION: Registry: Australian New Zealand Clinical Trials Register; Name: A comparison of arterial and blood gas analyses in sleep studies; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372717; Identifier: ACTRN12617000562370. CITATION: Lindstrom SJ, McDonald CF, Howard ME, et al. Venous blood gases in the assessment of respiratory failure in patients undergoing sleep studies: a randomized study. J Clin Sleep Med. 2024;20(8):1259-1266.
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Análisis de los Gases de la Sangre , Insuficiencia Respiratoria , Humanos , Masculino , Análisis de los Gases de la Sangre/métodos , Femenino , Insuficiencia Respiratoria/sangre , Insuficiencia Respiratoria/diagnóstico , Persona de Mediana Edad , Dióxido de Carbono/sangre , Polisomnografía/métodos , Adulto , Venas/fisiopatología , Oxígeno/sangre , Anciano , Concentración de Iones de HidrógenoRESUMEN
OBJECTIVE: We describe the feasibility and short-term outcome of our surgical technique to repair the lymph vessel disruption directly after axillary lymph node dissection during breast cancer surgery. This procedure is called immediate lymphatic reconstruction to prevent breast cancer treatment-related lymphedema (BCRL), which frequently occurs after axillary lymph node dissection. The surgical technique consisted of lymphaticovenous anastomosis (LVA) or lymphaticolymphatic anastomosis. We named the procedure lymphatic bypass supermicrosurgery (LBS). METHODS: This study used a retrospective cohort design of patients with breast cancer between May 2020 and February 2023. LBS was performed by making an intima-to-intima coaptation between afferent lymph vessels and the recipient's veins (LVA) or efferent lymph vessels lymphaticolymphatic anastomosis. RESULTS: A total of 82 patients underwent lymphatic bypass. The mean age of patients was 50 ± 12 years, and most had stage III breast cancer (n = 59 [72%]). LVA was the most common type of lymphatic bypass (94.6%). The median number of LVA was 1 (range, 1-4) and 1 (range, 1-3) for lymphaticolymphatic anastomosis. The median follow-up time was 12.5 months (range, 1-33 months). The 50 patients who had postoperative indocyanine green lymphography described arm dermal backflow stage 0 in 20 (40%), stage 1 in 19 (38%), stage 2 in 2 (4%), and stage 3 in 9 (18%) cases. The proportion of BCRL was 11 (22%), and subclinical lymphedema was 19 (38%) in this period. Most cases were in stable subclinical lymphedema (10, 58.8%). The 1-year and 2-year BCRL rates were 14% (95% confidence interval, 4%-23.9%) and 22% (95% confidence interval, 10.1%-33.9%), respectively. CONCLUSIONS: Along with the emerging immediate lymphatic reconstruction, LBS is a feasible supermicrosurgery technique that may have a potential role in BCRL prevention. A randomized controlled study would confirm the effectiveness of the technique.
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Anastomosis Quirúrgica , Linfedema del Cáncer de Mama , Neoplasias de la Mama , Estudios de Factibilidad , Escisión del Ganglio Linfático , Vasos Linfáticos , Microcirugia , Humanos , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Vasos Linfáticos/cirugía , Vasos Linfáticos/diagnóstico por imagen , Anastomosis Quirúrgica/efectos adversos , Microcirugia/efectos adversos , Microcirugia/métodos , Adulto , Neoplasias de la Mama/cirugía , Escisión del Ganglio Linfático/efectos adversos , Resultado del Tratamiento , Factores de Tiempo , Linfedema del Cáncer de Mama/cirugía , Linfedema del Cáncer de Mama/etiología , Linfedema del Cáncer de Mama/prevención & control , Linfedema del Cáncer de Mama/diagnóstico , Mastectomía/efectos adversos , Anciano , Linfedema/cirugía , Linfedema/etiología , Linfedema/prevención & control , Linfedema/diagnóstico por imagen , Linfografía , Venas/cirugía , Venas/diagnóstico por imagen , Venas/fisiopatologíaRESUMEN
BACKGROUND: Alternative autologous veins can be used as a conduit when adequate great saphenous vein is unavailable. We analyzed the results of our infrainguinal bypasses after adopting upper extremity veins in our practice. METHODS: This is a single-center observational study involving all patients whose infrainguinal bypass involved the use of upper extremity veins between April 2019, when we began using arm veins, and February 2023. RESULTS: During the study period, 49 bypasses were done in 48 patients; mean age 68.1 ± 9.8; men 32 (66.7%); body mass index 28.0 ± 4.8; indications for surgery: chronic limb threatening ischemia 41 (83.7%); acute limb ischemia 3 (6.1%); complications of previous prosthetic 3 (6.1%), or autologous 2 (4.1%) bypass grafts. Vein splicing was used in 43 (87.8%) bypasses with 3-segment grafts being the most common (26; 53.1%). There were 24 (49.0%) femorotibial, 11 (22.4%) femoropopliteal, 9 (18.4%) femoropedal, and 5 (10.2%) extension jump bypass procedures. Eighteen (36.7%) operations were redo surgeries. Twenty-one (42.9%) bypasses were formed using only arm veins. The median follow-up was 12.9 months (4.5-24.2). Two bypasses occluded during the first 30 postoperative days (2/49; 4.1%). Overall 30-day, 1-year, and 2-year primary patency rates were 93.7% ± 3.5%, 84.8% ± 5.9%, and 80.6% ± 6.9%, and secondary patency (SP) rates were 95.8% ± 2.9%, 89.2% ± 5.3%, and 89.2% ± 5.3%. One-segment grafts had better patencies than 2-, 3-, and 4-segment grafts (1-year SP 100% ± 0% vs 87.6% ± 6.0%). Two-year amputation-free survival was 86.8% ± 6.5%; 2-year overall survival was 88.2% ± 6.6%. CONCLUSIONS: Integration of arm vein grafts in infrainguinal bypass practice can be done safely with low incidences of perioperative graft failure. One-segment grafts had better patencies than spliced vein grafts. The achieved early patency and amputation-free survival rates strongly encourage their use. In the absence of a single-segment great saphenous vein, upper extremity vein grafts should be the preferred conduit choice.
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Enfermedad Arterial Periférica , Trasplante Autólogo , Grado de Desobstrucción Vascular , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Enfermedad Arterial Periférica/cirugía , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/diagnóstico por imagen , Factores de Riesgo , Estudios Retrospectivos , Venas/trasplante , Venas/cirugía , Venas/fisiopatología , Vena Safena/trasplante , Injerto Vascular/efectos adversos , Injerto Vascular/métodos , Anciano de 80 o más Años , Recuperación del Miembro , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/fisiopatología , Oclusión de Injerto Vascular/cirugía , Extremidad Superior/irrigación sanguínea , Amputación Quirúrgica , ReoperaciónRESUMEN
OBJECTIVE: The 2010 Pacific Vascular Symposium 6 (PVS6) brought venous disease content experts together with a goal of addressing critical issues collated together in the next decade with concrete plans to achieve these goals. This mapping review aims to provide a broader representation of how progress in critical issues of chronic venous disease has been made by extrapolating scientific publications related to the PVS6 initiatives. METHODS: We performed a mapping review identifying original or systematic review/meta-analysis articles related to PVS 6 initiatives (aims) that addressed one of the following key objectives: scales to measure chronic venous disease, effectiveness of interventional deep venous thrombus removal, development of a deep venous valve, and biomarkers related to venous disease. Searches were undertaken in PubMed, Ovid Medline, Cochrane Library, Embase (Elsevier), CINAHL (EBSCO), and Scopus. We extracted descriptive information about the studies and predefined variables for each specific aim, showing what and where research exists on the aims included. RESULTS: A total of 2138 articles were screened from 3379 retrieved articles from six electronic databases. We mapped 186 included articles, finding that the total number of publications significantly increased after the 2010 PVS6 meeting. Aim results were visually summarized. The largest body of data addressed catheter-based thrombus removal strategies for acute iliofemoral deep venous thrombosis. Primary research on artificial venous valves and venous biomarkers remained limited. No new post-thrombotic syndrome (PTS) score has been developed. CONCLUSIONS: This mapping review identified and characterized the available evidence and gaps in our knowledge of chronic venous disease that exist visually, which may guide where more significant investments for the future should be targeted.
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Enfermedades Vasculares , Humanos , Enfermedad Crónica , Enfermedades Vasculares/terapia , Enfermedades Vasculares/diagnóstico , Trombosis de la Vena/terapia , Trombosis de la Vena/diagnóstico por imagen , Congresos como Asunto , Venas/fisiopatología , Venas/diagnóstico por imagenRESUMEN
Vasovagal syncope (VVS) has a high prevalence in the general population and is associated with potential complications. There is limited information on the possible association between venous capacitance (VC) and venous return (VR), important determinants of preload and VVS. Since the tilt test was reported to yield a high rate of false positive results, the aim of this study was to evaluate whether abnormal VC and VR at baseline could predispose individuals to VVS.To this end, 88 young, healthy volunteers were recruited and classified to 26 (29.5%) who experienced typical VVS and 62 (70.5%) who did not. VC and VR were evaluated with a commercial device and plethysmography applied to the elevated legs. Maximum venous outflow (MVO), segmental venous capacitance (SVC) and MVO/SVC ratio were calculated and averaged.No significant differences between MVO (5.0±0.5 vs 5.6±0.8, p>0.05), SVC (6.0±0.5 vs 6.3±0.8, p>0.05) or MVO/SVC ratio (0.83±0.02 vs 0.86±0.03, p>0.05) were observed for the non-VVS and VVS volunteers, respectively. There was a significant association between a higher MVO and SVC values and a larger decrease in diastolic blood pressure with standing, although correlations were weak (R2=0.0582 and 0.0681, respectively).In conclusion, at baseline, VC and VR are not impaired in healthy volunteers with a history of VVS. It remains unknown if similar results would be found in patients with cardiovascular comorbidities. Also, the sensitivity of VC and VR evaluations to identify a predisposition for VVS following physiological provocations merits further study.
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Síncope Vasovagal/diagnóstico , Venas/fisiopatología , Presión Venosa , Adolescente , Adulto , Anciano , Presión Sanguínea , Estudios Transversales , Femenino , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Mesa Inclinada , Adulto JovenRESUMEN
OBJECTIVE: To determine the effects of graduated and progressive elastic compression stockings (ECS) on postural diameter changes and viscoelasticity of leg veins in healthy controls and in limbs with chronic venous disease (CVD). METHODS: In 57 patients whose legs presented with C1s, C3, or C5 CEAP classes of chronic venous disease and were treated primarily with compression, and 54 healthy controls matched for age and body mass index, we recorded interface pressures (IFP) at 9 reference leg levels. Cross-sectional areas of the small saphenous vein (SSV) and a deep calf vein (DCV) were measured with B-mode ultrasound with patients supine and standing, recording the force (PF) applied on the ultrasound probe to collapse each vein with progressive ECS, and with and without graduated 15 to 20 mm Hg and 20 to 36 mm Hg elastic stockings. We chose these veins because they were free of detectable lesion and could be investigated at the same level (mid-height of the calf), and their compression by the ultrasound probe was not hampered by bone structures. RESULTS: IFP decreased from ankle to knee with graduated 15 to 20 and 20 to 36 mm Hg, but increased with progressive ECS, and were 8.4 to 13.8 mm Hg lower for C1s than for control or C3 and C5 limbs. Without ECS, the SSV median [lower-upper quartile] cross-sectional area was 4.9 mm2 [3.6-7.1 mm2] and 7.1 mm2 [3.0-9.9 mm2] in C3 and C5 limbs versus 2.9 mm2 [1.8-5.2 mm2] and 3.8 mm2 [2.1-5.4 mm2] in controls (P < .01), respectively, while supine and standing. It remained greater in C3 and C5 than in C1s and control limbs wearing any ESC. Wearing compression, especially with progressive ECS, decreased the SSV and DCV cross-sectional area only with patients supine, thus decreasing postural changes, which remained highly diverse between individuals. The SSV cross-sectional area versus PF function traced a hysteresis loop of which the area, related to viscosity, was greater in C3 and C5 limbs than controls, even with graduated 15 to 20 or 20 to 36 mm Hg ECS. Progressive ECS decreased vein viscosity in the supine position, whereas 20 to 36 mm Hg and progressive ECS increased distensibility in the standing position. CONCLUSIONS: ECS decrease the cross-sectional area of SSV and DCV with patients supine, but not upright. C1s limbs show distinctive features, especially regarding IFP. Graduated 20 to 36 mm Hg and progressive stockings lower viscosity and increase distensibility of the SSV.
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Pierna/irrigación sanguínea , Medias de Compresión , Enfermedades Vasculares/fisiopatología , Enfermedades Vasculares/terapia , Venas/fisiopatología , Adulto , Anciano , Estudios de Casos y Controles , Enfermedad Crónica , Elasticidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Postura , Presión , ViscosidadAsunto(s)
Branquioma/patología , Neoplasias de la Mama/patología , Neoplasias de Cabeza y Cuello/patología , Síndromes Paraneoplásicos Oculares/diagnóstico , Esclerótica/irrigación sanguínea , Trastornos de la Visión/diagnóstico , Branquioma/cirugía , Neoplasias de la Mama/cirugía , Angiografía por Tomografía Computarizada , Femenino , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Escisión del Ganglio Linfático , Mastectomía Segmentaria , Persona de Mediana Edad , Órbita/irrigación sanguínea , Venas/fisiopatología , Agudeza Visual/fisiologíaRESUMEN
OBJECTIVES: The treatment of a refluxing perforator is indicated in the setting of severe chronic venous insufficiency, but there are limited data on the presence of multilevel disease in these patients. This study sought to evaluate whether the presence of a pathologic perforator is predictive of the presence of central venous pathology. METHODS: This study was a retrospective review of the institutional Vascular Quality Initiative database. Consecutive patient limbs were identified that underwent intervention of refluxing perforators. The patients who underwent imaging, including magnetic resonance imaging or computed tomography (group A), were compared with those who did not undergo imaging (group B). The treated limbs in group A were also compared with the contralateral limbs as an internal control. Anatomical findings on imaging were analyzed by two independent investigators. The primary outcome was the presence and degree of central venous stenosis as measured by an orthogonal diameter reduction of >50% by axial imaging. Secondary outcomes included demographic and clinical differences between the two groups, frequency of central venous intervention, and duration of ulcer healing. Standard statistical analysis was performed. RESULTS: Ninety-three patient limbs underwent treatment of a pathologic perforator, with 30 in group A and 63 in group B. The following demographic and clinical variables were higher in group A compared with group B: male sex, body mass index, deep venous thrombosis history, recent or active anticoagulation use, perforator diameter, Clinical Etiology Anatomy Pathophysiology class 4, 5, or 6, and Venous Clinical Severity Score. Radiographic analysis of group A revealed concordance of a treated pathologic perforator with an ipsilateral central venous stenosis in 53.3% of patients, and a higher frequency of common iliac vein stenosis (50% vs 21.4%, P = .024) and external iliac vein stenosis (20% vs 0%, P = .012) compared with the contralateral limbs. When separated by the left or right limb, the left limbs exhibited a greater degree of common iliac vein stenosis as compared with the contralateral limbs (50.7% ± 20.9% vs 16.3% ± 16.5%, P < .001) as well as a greater frequency of >50% common iliac vein stenosis (46.7% vs 13.3%, P = .046). The right limbs exhibited a greater frequency of >50% external iliac vein stenosis as compared with the contralateral limbs (33.3% vs 0%, P = .022). CONCLUSIONS: This study suggests that patients with severe chronic venous insufficiency who undergo treatment for a pathologic perforator may have additional ipsilateral central venous pathology, supporting the presence of multilevel disease. Additional axial imaging might unmask central venous pathology and provide another option for treatment.
Asunto(s)
Angiografía por Tomografía Computarizada , Angiografía por Resonancia Magnética , Flebografía , Várices/diagnóstico por imagen , Venas/diagnóstico por imagen , Insuficiencia Venosa/diagnóstico por imagen , Adulto , Anciano , Enfermedad Crónica , Toma de Decisiones Clínicas , Bases de Datos Factuales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Várices/patología , Várices/fisiopatología , Várices/terapia , Venas/patología , Venas/fisiopatología , Insuficiencia Venosa/patología , Insuficiencia Venosa/fisiopatología , Insuficiencia Venosa/terapia , Cicatrización de HeridasRESUMEN
BACKGROUND: The purpose of the present study was to evaluate the technical feasibility and safety of sharp recanalization for central venous occlusive disease (CVOD) in patients requiring hemodialysis. METHODS: Patients with CVOD requiring hemodialysis who had undergone endovascular recanalization using sharp devices, including the stiff end of a guidewire, Chiba needle, or RUS-100 to cross occluded segments after conventional techniques had failed were included. The needle was guided toward a target placed at the opposite end of the occlusion. Although the guidewire was passed though the occlusion, subsequent procedures such as percutaneous transluminal angioplasty could be performed. RESULTS: A total of 27 sharp recanalization procedures in 25 patients were performed. Two attempts failed, 1 patient had undergone two separate successful procedures, and 23 procedures in 23 patients were successful. The overall technique success was 92.6%. The stiff end of a guidewire was the first choice for all the procedures, and recanalization was achieved in 18 patients (66.7%). A Chiba biopsy needle was used in six procedures (22.2%), with 100% technical success. A RUPS-100 set was used in two procedures (7.4%), with one aborted because of concern for complications. The occlusion was subsequently crossed using a Chiba needle. Four minor adverse events (two of mediastinal hematoma and two of chest pain) had occurred, and two major adverse events (pericardial tamponade and acute pleural effusion in one patient [4%], treated with the guidewire stiff-end technique, who recovered after drainage) had occurred. CONCLUSIONS: Sharp recanalization is safe and feasible with high technical success for CVOD in patients requiring hemodialysis who cannot be recanalized using conventional techniques.