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1.
Ultrasonics ; 104: 106093, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32151876

RESUMEN

Color Doppler (CD) ultrasound has been commonly employed in biomedical field to get hemodynamic information. However, reliable diagnostic evaluation and criteria for vascular diseases may not be provided due to technical limitations of CD, including single-directional measurement, aliasing, and limited imaging conditions. In this study, adaptive hybrid (AH) scheme is proposed to enhance measurement accuracy of conventional CD. It can improve the accuracy of velocity field measurement by replacing erroneous vectors in the measured CD results with the correct vectors obtained from a speckle image velocimetry (SIV) technique. The performance of the proposed AH technique was validated through in vitro experiments for various flow rates and insonation angle conditions, comparing conventional velocimetry techniques. The in vitro experiments demonstrated that the AH technique could measure flow velocity with better accuracy than the CD with bias errors of below 0.7 mm/s. The clinical applicability of the AH was also validated by measuring venous flows at human lower extremity, checking constant volumetric flow rates. Flow rates measured by the AH were maintained along the vein, while the CD and SIV results varied. As a result, the AH can provide improved measurement accuracy without installing a new supplementary equipment. It would be effectively utilized for analyzing flow dynamics and diagnosing valve-related disease.


Asunto(s)
Velocidad del Flujo Sanguíneo/fisiología , Extremidad Inferior/irrigación sanguínea , Ultrasonografía Doppler en Color/métodos , Enfermedades Vasculares/diagnóstico por imagen , Adulto , Algoritmos , Femenino , Humanos , Aumento de la Imagen , Masculino , Fantasmas de Imagen , Transductores
2.
Am Surg ; 86(2): 104-109, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167051

RESUMEN

Deep vein thrombosis (DVT) is linked to reimbursements and publicly reported metrics. Some hospitals discourage venous duplex ultrasound (VDUS) screening in asymptomatic trauma patients because they often find higher rates of DVT. We aim to evaluate the association between lower extremity (LE) VDUS screening and pulmonary embolism (PE) in trauma patients. Trauma patients admitted to an urban Level-1 trauma center between 2010 and 2015 were retrospectively analyzed. We characterized the association of asymptomatic LE VDUSs with PE, upper extremity DVT, proximal LE DVT, and distal LE DVT by univariate and multivariable logistic regression controlling for confounders. Of the 3959 trauma patients included in our study-after adjusting for covariates related to patient demographics, injury, and procedures-there was a significantly lower likelihood of PE in screened patients (odds ratio (OR) = 0.02, P < 0.001) and a higher rate of distal LE DVT (OR 11.1, P = 0.004). Screening was not associated with higher rates of proximal LE DVT after adjustment for covariates (OR = 1.8, P = 0.193). PE was associated with patient transfer status, pelvis fracture, and spinal procedures in unscreened patients. After adjusting for covariates, we have shown that LE VDUS asymptomatic screening is associated with lower rates of PE in trauma patients and not associated with higher rates of proximal LE DVT. Our detailed institutional review of a large cohort of trauma patients over five years provides support for ongoing asymptomatic screening and better characterizes venous thromboembolism outcomes than similarly sized purely administrative data reviews. As a retrospective cohort study with a large sample size, no loss to follow-up, and a population with low heterogeneity, this study should be considered as level III evidence for care management.


Asunto(s)
Enfermedades Asintomáticas , Embolia Pulmonar/diagnóstico por imagen , Tromboembolia Venosa/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagen , Heridas y Traumatismos/complicaciones , Femenino , Humanos , Tiempo de Internación , Modelos Logísticos , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/diagnóstico por imagen , Masculino , Oportunidad Relativa , Embolia Pulmonar/complicaciones , Embolia Pulmonar/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Ultrasonografía Doppler Dúplex/estadística & datos numéricos , Tromboembolia Venosa/complicaciones , Trombosis de la Vena/complicaciones
3.
Medicine (Baltimore) ; 99(11): e19501, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176092

RESUMEN

BACKGROUND: Clinical and basic research supports that blood glucose fluctuation is an important predictor of diabetic vascular disease and an etiology of lower extremity atherosclerosis, which is an important pathological basis for lower extremity vascular diseases. Previous Chinese National Natural Science Foundation trials (No. 81503566) have reported that the traditional Chinese medicine Shenqi compound can reduce blood glucose fluctuation and low-grade inflammation, and protect blood vessels; however, there are no high-quality clinical evidences available to support the same. This multicenter randomized controlled trial aims to obtain more clinical evidence to confirm the efficacy and safety of Shenqi compound in type 2 diabetes with lower extremity atherosclerosis. METHODS: A multicenter RCT will be implemented in this study for a 32-week study period (8 weeks for intervention and 24 weeks for follow-up). Participants will be recruited from the Teaching Hospital of Chengdu University of TCM, Mianyang Hospital of TCM, and Shuangliu Hospital of TCM. Sixty participants will be randomly divided into a treatment group (basic treatment combined with traditional Chinese medicine Shenqi Compound) or a control group (basic treatment combined with Chinese medicine placebo) with 30 participants in each group. Patients will be selected considering the following inclusion criteria: age between 35 and 65 years, and a positive diagnosis for type 2 diabetes with lower extremity atherosclerosis and TCM syndromes. Primary outcome indicator is an arterial color Doppler ultrasound. Secondary outcome indicators include: blood glucose fluctuation indicators (MBG, SDBG, LAGE), islet ß-cell function evaluation indicators (Homa-IR, Homa-islet, SG, SCP), inflammation indicators (NLR, CRP, IL-6), blood lipids, and HbA1c. Safety index includes vital signs (T, P, R, BP), blood, urine, stool routine, liver and renal function, electrocardiogram, and adverse event records. The endpoint event is defined as the presence of gangrene in the lower limbs. DISCUSSION: Explore the clinical effect of traditional Chinese medicine "Shenqi Compound" to reduce blood glucose fluctuation and use HOMA-IR, the area under the glucose curve, and the area under the C-peptide curve to evaluate the effect of protecting islet ß cell function. TRIAL REGISTRATION: Chinese clinical trial registry (ChiCTR-1900027693). Registered on November 23, 2019. http://www.chictr.org.cn.


Asunto(s)
Aterosclerosis/tratamiento farmacológico , Diabetes Mellitus Tipo 2 , Angiopatías Diabéticas/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Hipoglucemiantes/uso terapéutico , Extremidad Inferior/irrigación sanguínea , Medicina China Tradicional , Aterosclerosis/sangre , Aterosclerosis/fisiopatología , Glucemia , China , Angiopatías Diabéticas/sangre , Angiopatías Diabéticas/fisiopatología , Medicamentos Herbarios Chinos/administración & dosificación , Humanos , Hipoglucemiantes/administración & dosificación , Fitoterapia , Flujo Pulsátil , Ensayos Clínicos Controlados Aleatorios como Asunto , Flujo Sanguíneo Regional , Proyectos de Investigación
5.
J Trauma Acute Care Surg ; 88(2): 197-206, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31804418

RESUMEN

BACKGROUND: Traumatic popliteal arterial injury (TPAI) is associated with a risk of both limb loss and long-term morbidity due to prolonged ischemia and the often-associated musculoskeletal injuries. Long-term functional outcome following this injury has not been adequately studied. We evaluated patients with TPAI to determine if there was an improvement in functional outcome over time. We hypothesized that both the initial severity of ischemia and the associated injuries limited the ability of patients to improve functional outcome. METHODS: Patients with TPAI for 20 years were identified. All patients had at least a 2-year follow-up. Functional outcomes were measured using the Boston University Activity Measure for Post-Acute Care to assess basic mobility (BM) and daily activity (DA). Multiple linear regression, adjusted for age, severity of injury and shock, operative complexity, associated injuries, ischemic time, and length of follow-up were used to identify predictors of functional outcome after TPAI. RESULTS: A total of 214 patients were identified: 123 penetrating (57%) and 91 blunt (43%). Overall mortality was 1.9% (all in-hospital), and amputation occurred in 10%. Of the 210 survivors, follow-up was obtained in 145 patients (69%). Median follow-up was 9.2 years (interquartile range, 5.7-15.7 years). Mean Activity Measure for Post-Acute Care scores for BM and DA were 78 and 75, respectively, both signifying mild impairment (normal, >84). Multiple linear regression failed to identify increasing length of follow-up as a predictor of improved functional outcomes. Only age, lower extremity fracture, and ischemic time were identified as predictors of decreased BM and DA. CONCLUSION: Increasing age, lower extremity fracture, and prolonged ischemic time worsened long-term functional outcomes. Functional outcome did not improve over time, suggesting that maximal recovery may be achieved within the first 2 years postinjury. Thus, early and effective revascularization remains the only potentially modifiable risk factor for improving functional outcomes following TPAI. LEVEL OF EVIDENCE: Prognostic, level III.


Asunto(s)
Amputación/estadística & datos numéricos , Procedimientos Endovasculares , Isquemia/cirugía , Traumatismos de la Pierna/cirugía , Extremidad Inferior/irrigación sanguínea , Actividades Cotidianas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Isquemia/etiología , Isquemia/mortalidad , Traumatismos de la Pierna/complicaciones , Traumatismos de la Pierna/mortalidad , Masculino , Persona de Mediana Edad , Arteria Poplítea/lesiones , Arteria Poplítea/cirugía , Pronóstico , Sobrevivientes/estadística & datos numéricos , Resultado del Tratamiento , Adulto Joven
6.
Int J Sports Med ; 41(1): 3-11, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31791089

RESUMEN

This study evaluated the morphological changes of the lower limb and associated hemodynamic responses to different lower-body compression pressures (COMPs) in physically active, healthy individuals at rest. Each of the 32 participants underwent three trials with three different degrees of lower-body compression applied: "Low" (2.2±1.4 mmHg), "Medium" (12.9±3.9 mmHg), and "High" (28.8±8.3 mmHg). In each COMP, a cross-sectional area of leg muscles (CSAmuscle), subcutaneous fat (CSAfat), superficial vessels (SupV), deep arteries (DA), and deep veins (DV) at the calf, knee, and thigh levels were measured using magnetic resonance imaging (MRI). Additionally, blood pressure (BP), heart rate (HR), cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR) were measured using Doppler ultrasound (USCOM®). With High COMP, calf CSAmuscle and SupV were smaller (p<0.01), whereas DA and DV were larger (p<0.05). Calf CSAfat, however, was similar among all COMPs. There were no major changes in CSAmuscle and CSAfat at knee and thigh levels. CO (3.2±0.9 L/min) and SV (51.9±16.4 mL) were higher (p<0.05) only with High COMP, but other hemodynamic variables showed no significant changes across different COMPs. The High COMP at the lower limb induces leg morphological changes and increases associated hemodynamic responses of physically active healthy individuals at rest.


Asunto(s)
Hemodinámica/fisiología , Extremidad Inferior/fisiología , Medias de Compresión , Arterias/diagnóstico por imagen , Arterias/fisiología , Presión Sanguínea/fisiología , Estudios Cruzados , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Músculo Esquelético/irrigación sanguínea , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/fisiología , Volumen Sistólico/fisiología , Grasa Subcutánea/irrigación sanguínea , Grasa Subcutánea/diagnóstico por imagen , Grasa Subcutánea/fisiología , Ultrasonografía Doppler , Resistencia Vascular/fisiología , Venas/diagnóstico por imagen , Venas/fisiología , Adulto Joven
7.
Vasa ; 49(1): 72-76, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31414968

RESUMEN

Chronic total occlusion remains one of the most challenging lesions to treat despite continuing developments in medical devices and increasing operator experience. Guidewire perforation complications are being increasingly observed. Early recognition and timely institution of appropriate treatment are essential to prevent potentially devastating sequelae.


Asunto(s)
Angioplastia , Síndromes Compartimentales , Extremidad Inferior/cirugía , Cateterismo , Diseño de Equipo , Humanos , Extremidad Inferior/irrigación sanguínea , Resultado del Tratamiento
10.
Vasc Endovascular Surg ; 54(2): 97-101, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31746279

RESUMEN

Preprocedural cross-sectional imaging (PCSI) for peripheral artery disease (PAD) may vary due to patient complexity, anatomical disease burden, and physician preference. The objective of this study was to determine the utility of PCSI prior to percutaneous vascular interventions (PVIs) for PAD. Patients receiving first time lower extremity angiograms from 2013 to 2015 at a single institution were evaluated for PCSI performed within 180 days, defined as computed tomography angiography (CTA) or magnetic resonance angiography (MRA) evaluating abdominal to pedal vasculature. The primary outcome was technical success defined as improving the target outflow vessels to <30% stenosis. Of the 346 patients who underwent lower extremity angiograms, 158 (45.7%) patients had PCSI, including 150 patients had CTA and 8 patients had MRA. Of these, 48% were ordered by the referring provider (84% at an outside institution). Preprocedural cross-sectional imaging was performed at a median of 26 days (interquartile range: 9-53) prior to the procedure. The analysis of the institution's 5 vascular surgeons identified PCSI rates ranging from 31% to 70%. On multivariate analysis, chronic kidney disease (odds ratio [OR] = 0.35; 95% confidence interval [CI]: 0.17-0.73) was associated with less PSCI usage, and inpatient/emergency department evaluation (OR = 3.20; 95% CI: 1.58-6.50) and aortoiliac disease (OR = 2.78; 95% CI: 1.46-5.29) were associated with higher usage. After excluding 31 diagnostic procedures, technical success was not statistically significant with PSCI (91.3%) compared to without PCSI (85.6%), P = .11. When analyzing 89 femoral-popliteal occlusions, technical success was higher with PCSI (88%) compared to procedures without (69%) P = .026. Our analysis demonstrates that routine ordering of PCSI may not be warranted when considering technical success of PVI; however, PCSI may be helpful in treatment planning. Further studies are needed to confirm these findings in another practice setting, with more prescriptive use of PCSI to improve procedural success, and thereby improve the value of PCSI.


Asunto(s)
Angiografía por Tomografía Computarizada , Procedimientos Endovasculares , Extremidad Inferior/irrigación sanguínea , Angiografía por Resonancia Magnética , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/terapia , Pautas de la Práctica en Medicina/tendencias , Anciano , Toma de Decisiones Clínicas , Angiografía por Tomografía Computarizada/tendencias , Bases de Datos Factuales , Procedimientos Endovasculares/tendencias , Femenino , Humanos , Angiografía por Resonancia Magnética/tendencias , Masculino , Variaciones Dependientes del Observador , Selección de Paciente , Enfermedad Arterial Periférica/fisiopatología , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del Tratamiento
11.
Ann Vasc Surg ; 62: 45-50.e2, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31201974

RESUMEN

BACKGROUND: The rates of thromboembolic complications such as deep vein thrombosis (DVT) after venous ablation procedures for symptomatic superficial venous insufficiency are controversial. We sought to describe the risk factors for and incidence of DVT after radiofrequency ablation (RFA) and laser ablation (LA). METHODS: We queried the Truven Health Marketscan Database from 2007-16 for patients who underwent RFA or LA and had a follow-up duplex ultrasound within 30 days of the ablation procedure. The primary outcome was DVT at 7 and 30 days identified by International Classification of Diseases-9 and International Classification of Diseases-10 codes. Multivariable regression was used to evaluate the patient and procedural variables associated with a DVT at 30 days, expressed as odds ratios (ORs) with a 95% confidence interval (95% CI). Patients and procedures with a previous DVT diagnosis were excluded. RESULTS: A total of 256,999 patients underwent 433,286 ablation procedures: 192,195 (44.4%) RFA and 241,091 LA. Of these, 8,203 (1.9%) had a newly diagnosed DVT within 7 days and 13,347 (3.1%) within 30 days of the procedure. The incidence of DVT decreased over the study period. LA (2.8%) demonstrated a lower incidence of DVT at 30 days compared with RFA (3.4%), P < 0.001. On multivariable regression, LA (OR, 0.82; 95% CI 0.80-0.85) was again associated with a decreased risk for 30-day DVT, as was female gender (OR, 0.74; 95% CI, 0.71-0.77), and sclerotherapy performed on the same day (OR, 0.91; 95% CI, 0.85-0.98). A diagnosis of peripheral artery disease (OR, 1.23; 95% CI, 1.16-1.31) and concomitant stab phlebectomy (OR, 1.43; 95% CI, 1.37-1.49) was associated with an increased risk of DVT within 30 days. CONCLUSIONS: The incidence of newly diagnosed DVT within 30 days of an ablation procedure was 3.2%. The risk for DVT decreased in recent years, and LA was associated with an 18% decreased risk compared with RFA.


Asunto(s)
Terapia por Láser/efectos adversos , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/cirugía , Ablación por Radiofrecuencia/efectos adversos , Trombosis de la Vena/etiología , Adulto , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/epidemiología , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos/epidemiología , Trombosis de la Vena/diagnóstico por imagen
12.
Ann Vasc Surg ; 62: 106-113, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31394233

RESUMEN

BACKGROUND: Current algorithms for the management of blunt lower extremity trauma recommend additional imaging in patients presenting with soft signs of vascular injury and an ankle-brachial index (ABI) less than 0.9. The aim of this study is to analyze lower extremity computed tomography angiographies (CTAs) to determine the incidence and characteristics of patients sustaining vascular injury from blunt lower extremity trauma. We hypothesized that a lower ABI threshold can avoid unnecessary imaging without missing clinically significant vascular injury. METHODS: A single-center, retrospective review of all consecutive patients who presented to a level 1 trauma center with blunt lower extremity trauma and underwent a CTA from January 2015 to December 2017 was conducted. Baseline demographics, clinical features, and outcomes were recorded. Patients without documented ABIs were excluded. A receiver operating characteristic curve was used to define the ABI threshold. RESULTS: One hundred twenty-five patients (133 injured limbs) met inclusion criteria. The mean age was 44 years (range 9-96), and 74% of the patients were male. A vascular abnormality was identified on CTA in 65 limbs (48.9%), of which only 8 (12%) required intervention. The ABIs in these 8 injured limbs were between 0 and 0.6. An ABI threshold of 0.6 maximized the balance between sensitivity (100%) and specificity (87%) and missed no injuries requiring revascularization. CONCLUSIONS: The ABI remains useful in evaluating blunt lower extremity trauma. A lower ABI threshold in patients presenting with soft signs of vascular injury after blunt trauma may avoid unnecessary imaging without missing vascular injuries requiring intervention. Further prospective studies are needed to validate the safety and effectiveness of a lower ABI threshold.


Asunto(s)
Índice Tobillo Braquial , Arterias/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Extremidad Inferior/irrigación sanguínea , Procedimientos Innecesarios , Lesiones del Sistema Vascular/diagnóstico , Heridas no Penetrantes/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Arterias/fisiopatología , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/fisiopatología , Lesiones del Sistema Vascular/terapia , Washingtón , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/fisiopatología , Heridas no Penetrantes/terapia , Adulto Joven
13.
Vasc Endovascular Surg ; 54(1): 69-74, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31500525

RESUMEN

Acute limb ischemia (ALI) is an abrupt decrease of blood flow to a limb, resulting in a potential threat to that body part. In ALI, which is commonly caused by embolism or traumatic occlusion, symptoms appear quickly due to a lack of collateral blood flow and extension of the thrombus to arterial outflow. In cases with ALI presentation, urgent evaluation and management are necessary. Here, we report 3 cases with ALI due to thromboembolism. Conventional open thromboembolectomy was performed with a femoral artery cutdown and antegrade passage of the embolectomy catheter. Further, distal access was created in the dorsalis pedis artery and/or posterior tibial artery at the ankle level. After the retrograde passage of the guidewire and antegrade insertion of the embolectomy catheter, the embolus was completely removed.


Asunto(s)
Embolectomía , Isquemia/cirugía , Extremidad Inferior/irrigación sanguínea , Trombectomía , Tromboembolia/cirugía , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Humanos , Isquemia/diagnóstico por imagen , Isquemia/fisiopatología , Masculino , Tromboembolia/diagnóstico por imagen , Tromboembolia/fisiopatología , Resultado del Tratamiento
14.
Vasc Endovascular Surg ; 54(1): 85-88, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31547785

RESUMEN

The common femoral artery (CFA) is the most widely used inflow in all types of surgical revascularization in patients with peripheral artery disease. However, the CFA cannot always be used because of calcification, obstruction, or previous dissection. Here, we report a rare case of selecting the deep circumflex iliac artery (DCIA) as a source of inflow to perform a surgical revascularization in a patient with chronic limb-threatening ischemia. A 62-year-old man was admitted to our hospital due to necrotized third and fifth toes with pain at rest. Computed tomography showed severe stenosis of the CFA, superficial femoral artery, and deep femoral artery, and an entirely stented external iliac artery. The DCIA was identified as the only patent artery. Considering the condition of the other arteries, we selected the DCIA as a source of inflow. Deep circumflex iliac-popliteal bypass was performed with a saphenous vein. The bypass graft was patent 9 months after surgery and limb salvage had been achieved.


Asunto(s)
Arteria Ilíaca/cirugía , Isquemia/cirugía , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/cirugía , Injerto Vascular/métodos , Enfermedad Crónica , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/fisiopatología , Isquemia/diagnóstico por imagen , Isquemia/fisiopatología , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Resultado del Tratamiento , Grado de Desobstrucción Vascular
15.
Rev Med Suisse ; 15(674): 2236-2240, 2019 Dec 04.
Artículo en Francés | MEDLINE | ID: mdl-31804035

RESUMEN

Lower extremity arterial disease (LEAD) is a serious and invalidating disease with a relatively high prevalence in the diabetic population. Patients suffering from both conditions have a less favourable prognosis of affected limbs compared to non-diabetic patients, with more frequent adverse limb events such as amputations. Nevertheless, awareness of LEAD remains sub-optimal in the diabetic population. Regular and appropriate screening for this condition is therefore recommended. Affected individuals should receive optimal medical treatment, including intensive management of the various cardiovascular risk factors and strict blood glucose control.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Extremidad Inferior/irrigación sanguínea , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/diagnóstico , Amputación , Arterias/patología , Diabetes Mellitus Tipo 2/patología , Diabetes Mellitus Tipo 2/terapia , Humanos , Factores de Riesgo , Enfermedades Vasculares/patología , Enfermedades Vasculares/terapia
16.
Rev Med Suisse ; 15(674): 2242-2246, 2019 Dec 04.
Artículo en Francés | MEDLINE | ID: mdl-31804036

RESUMEN

Prevalence of lower extremity artery disease (LEAD) is increasing with age, and there is a trend over the last decade towards an increase of LEAD patients. These patients are at increased risk of lower limb adverse event (MALE), but also at very high risk of major cardiovascular events (MACE). The best medical treatment, including medications, enable a reduction of this risk. Nevertheless, some patients will continue to develop MACE. New therapeutic molecules have been developed with randomized controlled trials, and showed a reduction of the -cardiovascular risk among these selected patients.


Asunto(s)
Arterias/patología , Extremidad Inferior/irrigación sanguínea , Enfermedades Vasculares/terapia , Humanos , Factores de Riesgo , Resultado del Tratamiento , Enfermedades Vasculares/patología
17.
Rev Med Suisse ; 15(674): 2247-2250, 2019 Dec 04.
Artículo en Francés | MEDLINE | ID: mdl-31804037

RESUMEN

Lower extremity peripheral artery disease can lead to local complications but also to complications in other vascular areas, stressing the systemic impact of the atheromatous disease. The current concepts of MALE (Major Adverse Limb Events) and MACE (Major Adverse Cardiac Events) encompass these risks. The systemic vascular complications, as well as the ones at lower extremities, are associated with significant morbidity and mortality. An optimal therapeutic management and healthy lifestyle, such as regular exercise, are crucial to limit the risk of unfavorable progression of the arterial disease. A close collaboration between the general practitioner and the angiologist is a key to adequate initial management and follow-up of the patients.


Asunto(s)
Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/terapia , Estilo de Vida Saludable , Humanos , Factores de Riesgo , Resultado del Tratamiento
18.
Rev Med Suisse ; 15(674): 2252-2255, 2019 Dec 04.
Artículo en Francés | MEDLINE | ID: mdl-31804038

RESUMEN

Patients with lower extremity peripheral artery disease (PAD) have decreased functional capacities leading to decreased quality of life and increased cardiovascular morbidity and mortality. Exercise therapy is recommended among first-choice therapeutic options and improves overall physical function and quality of life in symptomatic patients with PAD. Exercise therapy is also effective in patients with PAD following revascularization. Other than walking, different training modalities are safe, feasible and effective to induce clinical benefits for these patients. We present here the role of exercise therapy and its specificities in the management of PAD.


Asunto(s)
Terapia por Ejercicio , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/terapia , Ejercicio/fisiología , Humanos , Caminata
19.
Khirurgiia (Mosk) ; (12): 54-59, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31825343

RESUMEN

OBJECTIVE: To analyze the causes and develop methods for the treatment of extensive purulent processes after combined phlebectomy in patients with lower limb varicose veins. MATERIAL AND METHODS: The authors reported 3 cases of extensive phlegmon after phlebectomy for the period from 2014 to 2018. It is shown that comprehensive debridement of purulent-inflammatory lesion with application of additional methods including high-energy exposure by the air-plasma flow is essential for effective treatment of this complication. In addition, literature review showed only few observations of severe septic complications after traditional varicose vein surgery. RESULTS: Radical debridement of purulent wounds with wide excision of necrotic subcutaneous tissue and fascia, combination of standard surgical technique and plasma scalpel, as well as subsequent plasmodynamic staged wound repair in a therapeutic mode prevented severe purulent-inflammatory process, stopped systemic inflammatory syndrome and resulted fast wound healing. CONCLUSION: Active surgical approach combined with air-plasma technology was followed by high-quality correction of extensive suppurative process. Minimally invasive management of varicose disease with improvement of surgical techniques will minimize the likelihood of these complications.


Asunto(s)
Celulitis (Flemón)/cirugía , Supuración/cirugía , Infección de la Herida Quirúrgica/cirugía , Várices/cirugía , Procedimientos Quirúrgicos Vasculares/efectos adversos , Celulitis (Flemón)/etiología , Desbridamiento , Humanos , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/cirugía , Supuración/etiología , Infección de la Herida Quirúrgica/etiología , Resultado del Tratamiento , Venas/cirugía
20.
Angiol Sosud Khir ; 25(4): 35-39, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31855199

RESUMEN

The authors analysed oral anticoagulant agents prescribed in the postoperative period to patients after endured reconstructive operative intervention on arteries of the femorotibial segment. The study included a total of 104 patients subjected to femoropopliteal or femorotibial bypass grafting using an autologous vein or a prosthesis. Depending on the prescribed anticoagulation agent, the patients were subdivided into two groups. Group One patients (n=43) in the postoperative period received rivaroxaban, and Group Two patients (n=61) took warfarin. Efficacy of therapy was evaluated by the frequency of haemorrhage and thromboses in the early and remote postoperative periods. The findings of the immediate postoperative period demonstrated comparable rates of haemorrhagic complications, early thromboses and redo interventions in both Groups (p=0.7). The duration of long-term postoperative period varied from 3 months to 5 years. No statistically significant differences in patency of the performed reconstructions were revealed between the groups. The 3-year primary assisted patency rate in the rivaroxaban group and warfarin group amounted to 89 and 80%, respectively. The incidence of haemorrhagic complications in the postoperative period was insignificant in the studied groups. Hence, rivaroxaban may be prescribed in the early and remote postoperative period to patients who underwent open reconstructive operative intervention on arteries of the infrainguinal zone.


Asunto(s)
Anticoagulantes/uso terapéutico , Rivaroxabán/uso terapéutico , Enfermedades Vasculares/tratamiento farmacológico , Enfermedades Vasculares/cirugía , Grado de Desobstrucción Vascular/efectos de los fármacos , Warfarina/uso terapéutico , Anticoagulantes/farmacología , Arterias/efectos de los fármacos , Arterias/cirugía , Implantación de Prótesis Vascular , Arteria Femoral/efectos de los fármacos , Arteria Femoral/cirugía , Humanos , Extremidad Inferior/irrigación sanguínea , Arteria Poplítea/efectos de los fármacos , Arteria Poplítea/cirugía , Estudios Retrospectivos , Rivaroxabán/farmacología , Arterias Tibiales/efectos de los fármacos , Arterias Tibiales/cirugía , Resultado del Tratamiento , Warfarina/farmacología
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