ABSTRACT
Sports-related vascular insufficiency affecting the lower limbs is uncommon, and early signs and symptoms can be confused with musculoskeletal injuries. This is also the case among professional cyclists, who are always at the threshold between endurance and excess training. The aim of this review was to analyze the occurrence of vascular disorders in the lower limbs of cyclists and to discuss possible etiologies. Eighty-five texts, including papers and books, published from 1950 to 2012, were used. According to the literature reviewed, some cyclists receive a late diagnosis of vascular dysfunction due to a lack of familiarity of the medical team with this type of dysfunction. Data revealed that a reduced blood flow in the external iliac artery, especially on the left, is much more common than in the femoral and popliteal arteries, and that vascular impairment is responsible for the occurrence of early fatigue and reduced performance in cycling.
O desenvolvimento de insuficiência vascular em membros inferiores relacionada à prática esportiva é incomum e no início do surgimento dos sinais e sintomas frequentemente pode ser confundida com lesão musculoesquelética, a exemplo de casos relatados em ciclistas profissionais, por estarem sempre no limiar entre o treinamento em nível máximo e o excesso de treinamento. O objetivo desta revisão de literatura foi analisar a ocorrência de disfunções vasculares em membros inferiores em ciclistas e as possíveis etiologias. Oitenta e cinco textos, entre artigos e livros publicados de 1950 a 2012 foram utilizados. Segundo a literatura, alguns ciclistas têm o diagnóstico de disfunção vascular realizado tardiamente devido à falta da familiaridade da equipe médica com esta modalidade de disfunção. Os resultados da pesquisa revelaram que a redução do fluxo sanguíneo na artéria ilíaca externa, em especial a esquerda, é bem mais comum que a da artéria femoral e poplítea, e que o comprometimento vascular é responsável pela ocorrência de fadiga precoce e redução do desempenho no ciclismo.
Subject(s)
Humans , Male , Female , Femoral Artery/physiopathology , Iliac Artery/physiopathology , Popliteal Artery/physiopathology , Peripheral Vascular Diseases/history , Bicycling , Lower Extremity/physiopathology , Intermittent Claudication , Muscle Fatigue , PainABSTRACT
INTRODUÇÃO: A injeção de trombina guiada por ultrassom (IT) é uma opção para o tratamento de pseudoaneurisma da artéria femoral. No entanto, o resultado dessa técnica em pacientes com síndrome coronária aguda (SCA) pode ser comprometido pelo uso de medicações antitrombóticas. Também, o extravasamento de trombina para a circulação sistêmica pode causar aumento de eventos tromboembólicos. MÉTODOS: Foram selecionados todos os pacientes admitidos com SCA que apresentaram pseudoaneurisma da artéria femoral após procedimento percutâneo, tratados com IT, entre janeiro de 2007 e julho de 2011. Características clínicas e laboratoriais, resultado do tratamento e complicações foram avaliados. RESULTADOS: Analisamos 23 pacientes, com idade de 67,1 ± 14,2 anos, 60,9% eram do sexo feminino, com índice de massa corporal de 28,4 ± 4,7 kg/m², e 52,2% eram diabéticos. À apresentação, 87% tinham SCA sem supradesnivelamento do segmento ST e o restante, infarto do miocárdio com supradesnivelamento do segmento ST. Entre os pacientes avaliados, 70% foram submetidos a intervenção coronária percutânea. Todos os pacientes estavam em uso de ácido acetilsalicílico, 78,3% utilizaram inibidores da P2Y12 e 39,1%, inibidores da glicoproteína IIb/IIIa. A IT foi eficaz em ocluir o pseudoaneurisma em 100% dos casos (96,7% após a primeira injeção), sem embolia distal, infecção local ou necessidade de correção cirúrgica em nenhum caso. Não houve infarto, acidente vascular cerebral ou revascularização não-programada. Houve um óbito por choque cardiogênico, 22 dias após a IT, no segundo dia após cirurgia eletiva de revascularização miocárdica. CONCLUSÕES: O tratamento de pseudoaneurisma da artéria femoral com IT é um método seguro e eficaz em pacientes com SCA.
BACKGROUND: Ultrasound-guided thrombin injection (TI) is an option for the treatment of femoral artery pseudoaneurysm. Nevertheless, the result of this technique in patients with acute coronary syndrome (ACS) may be compromised by the use of antithrombotic drugs. In addition, thrombin extravasation to systemic circulation could potentially cause an increase in thromboembolic events. METHODS: Patients admitted with ACS who developed femoral artery pseudoaneurysm after a percutaneous procedure and treated by TI between January 2007 and July 2011 were included. Clinical and laboratory characteristics, treatment results and complications were evaluated. RESULTS: We evaluated 23 patients with mean age of 67.1 ± 14.2 years, 60.9% were women, with body mass index of 28.4 ± 4.7 kg/m² and 52.2% were diabetics. At presentation, 87% had non-ST elevation ACS and the remaining had ST elevation myocardial infarction. Of the evaluated patients, 70% were submitted to percutaneous coronary intervention. All patients were receiving aspirin, 78.3% used P2Y12 inhibitors and 39.1% used glycoprotein IIb/IIIa inhibitors. TI was successful in occluding the pseudoaneurysm in 100% of cases (96.7% after the first injection), without distal embolization, local infection or need of surgical correction. There were no cases of myocardial infarction, stroke or unscheduled revascularization. There was one death due to cardiogenic shock 22 days after TI, on the second post-operative day after an elective coronary artery bypass graft surgery. CONCLUSIONS: Treatment of femoral artery pseudoaneurysm by TI is a safe and effective procedure in patients with ACS.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Femoral Artery/physiopathology , Aneurysm, False/physiopathology , Aneurysm, False/therapy , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/physiopathology , Thrombin/administration & dosage , Cardiac Catheterization , Heparin/administration & dosage , Percutaneous Coronary Intervention/methods , Platelet Aggregation Inhibitors , Ultrasonography, Interventional/methodsABSTRACT
Background: Hemodialysis patients (HD) display high rates of cardiac disease and mortality. The cardiovascular morbidity and mortality of HD patients is attributable in a significant proportion to endothelial dysfunction, arterial stiffness, and vascular calcifications. Aim: To measure vascular reactivity in HD subjects and compare them with healthy volunteers. Material and Methods: Forty eight non diabetic patients aged 58 ± 4.6 years (29 males) on hemodialysis for a mean lapse of 4.8 years were studied. Arterial stiffness was measured in the radial artery. Pulse wave velocity was measured by noninvasive peripheral arterial tonometry in carotid and femoral arteries. Endothelial function was assessed, measuring reactive hyperemia response after a 5 min period of ischemia. As a control, all values were also measured in age and gender-matched healthy volunteers. Results: Arterial stiffness was significantly higher in HD patients than controls (23.9 ± 3.3 and 18.4 ± 3.4% respectively, p < 0.05). HD subjects had an increased pulse wave velocity (10.0 ± 0.8 and 7.6 ± 0.9 m/s respectively, p < 0.05). A reduction in the change in pulse amplitude pressure, as a measure of arterial dysfunction, was only observed in male patients (1.7± 0.4 and2.7 ± 0.4 respectively p < 0.01). Conclusions: Noninvasive assessment of peripheral vascular function may be useful for the identification of patients at risk for late cardiac events.
Subject(s)
Female , Humans , Male , Middle Aged , Blood Pressure/physiology , Carotid Arteries/physiopathology , Endothelium, Vascular/physiology , Femoral Artery/physiopathology , Radial Artery/physiopathology , Vascular Stiffness/physiology , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/etiology , Case-Control Studies , Manometry , Predictive Value of Tests , Renal Dialysis , Risk FactorsABSTRACT
The elastic modulus of elastic arteries has been extensively studied, while studies of muscular arteries are sparse. In this study, the elastic modulus of right common femoral artery [RCFA] were estimated with the kinetic pressure changes and compared in healthy and atherosclerotic groups. The relative diameter and kinetic pressure changes of the RCFA were measured and estimated using echo-tracking sonography and Doppler spectrum analysis in 41 men [16 healthy and 25 atherosclerosis diseases]. Then the kinetic elastic modulus in the RCFA was estimated in two groups. The results show that, the arterial strain was significantly high in healthy group relative to atherosclerotic group. The estimated values of kinetic elastic modulus of RCFA in atherosclerotic artery are significantly high compared with healthy group [P-value < 0.05]. It is concluded that in RCFA with large content of smooth muscles, mechanical properties [Kinetic elastic modulus] are affected by progression of atherosclerosis
Subject(s)
Humans , Male , Femoral Artery/physiopathology , Biocompatible Materials , Atherosclerosis , Ultrasonography, Doppler , ElasticityABSTRACT
El presente trabajo estudia el comportamiento del flujo sanguíneo a partir de arterias femorales humanas estenóticas con distintos grados de obstrucción, extraídas de autopsias y de amputaciones quirúrgicas y de simulaciones producidas por un programa computacional simulador original basado en el método de los elementos finitos para líquidos newtonianos, homogéneos e incompresibles. Su empleo produjo numerosas curvas de máxima resumidas en un único gráfico de aplicación sencilla para el profesional. Más allá de la evaluación del origen y del impacto de los remolinos analizando las distintas variables intervinientes (esto es: presión, velocidad y tensiones), los resultados aquí reportados pueden constituir un útil complemento diagnóstico junto a los demás métodos usados actualmente, a los que no contraviene ni invalida.
Subject(s)
Humans , Male , Middle Aged , Computer Simulation , Femoral Artery/pathology , Blood Pressure , Constriction, Pathologic/diagnosis , Constriction, Pathologic/pathology , Constriction, Pathologic/physiopathology , Femoral Artery/physiopathology , Regional Blood FlowABSTRACT
Cardiac output measurement has a significat role in the critical care setting. The standard of measurement currently is via pulmonary arterial catheter but it has some technical difficulties and serious complications. The authors performed a new method of measurement that used a catheter in a femoral artery. The results of both methods performed simultaneously in 10 surgical intensive care patients every 2 hours for 24 hours were compared. There was high correlation between the two methods, r = 0.97. The average difference of the cardiac output values was 0.46 l/min with standard deviation 0.56 l/min.
Subject(s)
Adult , Aged , Aged, 80 and over , Cardiac Output, High/diagnosis , Cardiac Output, Low/diagnosis , Femoral Artery/physiopathology , Form Perception , Humans , Intensive Care Units , Middle Aged , Pulmonary Artery/physiopathology , Pulse , Reproducibility of Results , Thermodilution/methodsABSTRACT
Reportamos nuestra experiencia de 33 casos de derivaciones extraanatómicas durante un periodo de 2 años en el Hospital de Especialidades del Centro Médico Nacional ®Siglo XXI¼. De los pacientes incluidos, 24 fueron del sexo masculino y 9 del femenino, con un rango de edad de 17 a 75 años y una media de 55.8 años. El 42.4 por ciento de los pacientes incluidos, 24 fueron del sexo masculino y 9 del femenino, con un rango de edad de 17 a 75 años y una media de 55.8 años. El 42.2 por ciento de los pacientes tenían historia de tabaquismo intenso. La principal indicación para la colocación del área quirúrgica vascular. La derivación más utilizada fue: Fémoro-femoral y axilo-femoral. El tipo de injerto más utilizado fue: PTFE y dacrón, obtuvimos una mortalidad de 15 por ciento y una morbilidad de 12.1 por ciento. Se obtuvo revascularización exitosa en 93.9 por ciento. A 3 pacientes se les realizó un procedimiento indirecto tipo simpatectomía quirúrgica lumbar. Conclusión. Un alto número de pacientes tiene contraindicaciones para revascularización directa por la vía antómica. En ellos es de utilidad las derivaciones extraanatómicas las cuales tienen un alto porcentaje de éxito mediano y largo plazo y así evitar un alto porcentaje de pérdida de extremidades
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Smoking/adverse effects , Smoking/pathology , Femoral Artery/anatomy & histology , Femoral Artery/surgery , Femoral Artery/physiopathology , Transplantation, AutologousABSTRACT
Presentacion del caso de una paciente portadora de una miocardiopatia dilatada embolizante hacia la periferia (arteria femoral) y hacia el sistema nervioso central (Cerebro). Por ecocardiografia se confirma la fuente enboligena: el ventriculo izquierdo. Se distucte la anticoagulacion vs factores socioculturales.
Subject(s)
Humans , Male , Female , Middle Aged , Thrombosis/physiopathology , Cardiomyopathies/physiopathology , Thrombosis/physiopathology , Bolivia , Femoral Artery/physiopathology , Phenytoin/therapeutic useABSTRACT
El uso del catéter arterial umbilical continúa siendo de amplia utilización en los recién nacidos críticamente enfermos, con riesgo de complicaciones como sangrado, arritmias cardiacas, onfalitis, trombosis, sepsis, enterocolitis, hemorragia intraventricular, etc. Presentamos el caso de un neonato prematuro de 990g con enfermedad de membrana hialina grave que presentó, trombosis arterial aguda que involucró el miembro inferior izquierdo, Se manejó con estreptoquinasa (trombolítico) y finalmente la lesión se limitó con pérdida de la articulación tarso-metatarsiana y del calcáneo. El diagnóstico de trombosis en la actualidad se realiza por ultrasonido-doppler, el manejo puede ser heparina, trombolíticos y/o quirúrgico. Existe escasa experiencia con el uso de trombolíticos en la etapa neonatal
Subject(s)
Infant, Newborn , Humans , Embolism and Thrombosis , Femoral Artery/physiopathology , Hyaline Membrane Disease/complicationsABSTRACT
A 100 pacientes con insuficiencia arterial periférica de los miembros inferiores por aterosclerosis comprobada mediante cirugía o angiografías fueron tratados con quelación con ácido etilendiaminotetracético. El estudio oscilográfico y el índice doppler tobillo-brazo realizados antes y después del tratamiento mostraron una diferencia estadística significativa con un aumento promedio del índice de 0.319 por lo que los autores lo proponen como una alternativa terapéutica en pacientes con ateroesclerosis severa
Subject(s)
Humans , Male , Female , Middle Aged , Iliac Artery/physiopathology , Popliteal Artery/physiopathology , Arterial Occlusive Diseases , Arterial Occlusive Diseases/therapy , Atherosclerosis/complications , Atherosclerosis/therapy , Chelating Agents/administration & dosage , Chelating Agents/therapeutic use , Extremities/blood supply , Femoral Artery , Femoral Artery/physiopathology , Chelation Therapy/methodsABSTRACT
Fueron estudiados 17 pacientes portadores de arterio-esclerosis-fémoro-poplítea cronica Estado II B de Fontaine. Se les administró 200 mg. de Buflomedil en solución, por vía intra-arterial femoral. Se analizó en el trabajo los resultados obtenidos de acuerdo al método de fotopletismografía digital, que es considerado actualmente un parámetro válido en la medición de las variaciones del flujo arterial capilar. Fueron analizados estadísticamente los resultados mostrando un importante aumento del flujo capilar en la extremidad inferior tratada