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1.
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
2.
Eur J Vasc Endovasc Surg ; 59(4): 625-634, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32008931

RESUMEN

OBJECTIVE: The subcutaneous venous network (SVN) is difficult to see with the naked eye. Near infrared illumination (NIr-I) claims to improve this. The aims of this observational study were to investigate whether there are differences between the different methods; to quantify the length and diameter of SVNs; and to confirm if they differ between C0A and C1 CEAP limbs. METHODS: In total, 4 796 images, half of them from the visible spectrum (VS) and the other half from the nearninfrared spectrum (NIrS), belonging to 109 females (C0A: n = 50; C1 CEAP: n = 59) were used to establish the morphological characteristics of the SVN by visual analysis. With Photoshop CS4, SVN diameters and lengths were obtained by digital analysis of 3 052 images, once the images of whole extremities were excluded. RESULTS: On NIr-I, the diameters, trajectories, and colouration of SVNs of C1 limbs appeared more irregular than SVNs of C0A limbs. Compared with the VS images, NIr-I allowed visualisation of a greater length of the SVN in both groups (p < .010). This capacity varied from 2.6 ± 0.9 times (C1) to 16.2 ± 11.9 (C0A). While the SVN length seen in the VS images from C1 limbs was greater than observed in C0A limbs (p < .001), differences between NIr-I images only existed in the lateral part of the lower leg (p = .016). With NIr-I, the median diameter of the C1 CEAP SVN veins was 5.8 mm (interquartile range [IQR] 4.3-7.5 mm), while the median diameter in C0A SVN limbs was 2.6 mm (IQR 2.0-3.6 mm) (p < .001). CONCLUSION: The NIr-I reveals the characteristics of the SVN better than the naked eye. Further studies are required to determine the significance of the changes in the SVN in C0A and C1 limbs, and the factors causing them.


Asunto(s)
Extremidades/irrigación sanguínea , Várices/diagnóstico por imagen , Venas/diagnóstico por imagen , Insuficiencia Venosa/cirugía , Adulto , Velocidad del Flujo Sanguíneo/fisiología , Extremidades/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Flujo Sanguíneo Regional/fisiología , Ultrasonografía Doppler Dúplex/métodos , Várices/cirugía , Insuficiencia Venosa/diagnóstico por imagen
3.
AJR Am J Roentgenol ; 214(4): 786-791, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31939698

RESUMEN

OBJECTIVE. The purpose of this study was to assess the accuracy of portal vein pulsatility for noninvasive diagnosis of high-risk nonalcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS. This retrospective study included patients with biopsy-proven diagnosis of NAFLD who underwent duplex Doppler ultrasound assessment of the main portal vein within 1 year of liver biopsy (January 2014 to February 2018). Doppler ultrasound images were reviewed. The spectral waveform was used to measure the maximum (Vmax) and minimum (Vmin) velocity of blood in the portal veins. Venous pulsatility index (VPI) defined as (Vmax - Vmin) / Vmax was calculated. ROC curve analysis was used to calculate AUC as a measure of accuracy to determine the value of this index for diagnosis of high-risk NAFLD and compared with that of the following four clinical decision aids: NAFLD fibrosis score (FS), fibrosis-4 index (FIB-4), BARD score (body mass index, aspartate aminotransferase [AST]-to-alanine aminotransferase ratio, diabetes mellitus), and AST-to-platelet ratio index (APRI). The value of adding VPI to these indexes was also investigated. RESULTS. Of 123 study subjects, 33 (26.8%) had high-risk NAFLD and were found to have a lower VPI than the other 90 subjects (0.19 vs 0.32; p < 0.001). VPI, NAFLD FS, FIB-4, and APRI had statistically significant diagnostic values for high-risk NAFLD. VPI had the highest optimism-corrected AUC (VPI, 0.84 [95% CI, 0.77-0.91]; NAFLD FS, 0.74 [95% CI, 0.63-0.83]; FIB-4, 0.81 [95% CI, 0.72-0.89]; APRI, 0.73 [95% CI, 0.61-0.82]). Addition of VPI to any of the four scoring systems significantly improved the diagnostic value of the score for high-risk NAFLD. CONCLUSION. VPI may be an accurate noninvasive biomarker for diagnosis of high-risk NAFLD.


Asunto(s)
Enfermedad del Hígado Graso no Alcohólico/diagnóstico por imagen , Vena Porta/fisiopatología , Flujo Pulsátil , Ultrasonografía Doppler Dúplex , Adulto , Anciano , Biomarcadores/análisis , Biopsia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
4.
Eur J Vasc Endovasc Surg ; 59(2): 277-287, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31911136

RESUMEN

OBJECTIVE: The aim of the study was to observe the natural haemodynamic changes after arteriovenous fistula (AVF) creation in haemodialysis patients with and without a previous ipsilateral vascular access. METHODS: This was a retrospective, single centre cohort study. Patient demographics were registered and pre- and post-operative vessel ultrasound examinations were performed at regular follow up intervals. Arteriovenous fistula outcomes in terms of vessel diameter and access flow enhancement were determined for radiocephalic, brachiocephalic, and brachiobasilic AVFs. RESULTS: In total, 331 patients (median age 66 years, 60% male) with 366 new autologous AVFs were studied, of whom 112 patients had a previous ipsilateral vascular access (VA). Patients with a previous ipsilateral VA had a statistically significantly greater pre-operative brachial artery diameter (4.4 mm) and flow (106 mL/min), and basilic vein diameter (4.9 mm), compared with patients without a previous ipsilateral VA (4.0 mm, 54 mL/min, and 4.3 mm, respectively). For all AVF configurations these differences gradually disappeared over three months after AVF creation. The haemodynamic changes reached a plateau at three months, and were statistically significantly accelerated in patients with a previous ipsilateral VA. There were no differences in primary failure or high flow complications between both groups. CONCLUSION: Arteriovenous fistulae show haemodynamic and remodelling changes up to three months post-operatively. Previous ipsilateral VAs may initiate vessel preconditioning, and accelerate the observed haemodynamic changes after AVF creation. However, this preconditioning does not result in a beneficial or detrimental effect on VA function.


Asunto(s)
Derivación Arteriovenosa Quirúrgica/efectos adversos , Fallo Renal Crónico/terapia , Flujo Sanguíneo Regional/fisiología , Diálisis Renal/efectos adversos , Remodelación Vascular/fisiología , Anciano , Arteria Braquial/diagnóstico por imagen , Arteria Braquial/fisiopatología , Arteria Braquial/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Diálisis Renal/métodos , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex , Extremidad Superior/irrigación sanguínea , Grado de Desobstrucción Vascular/fisiología , Venas/diagnóstico por imagen , Venas/fisiopatología , Venas/cirugía
5.
Plast Reconstr Surg ; 145(1): 164e-171e, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31881626

RESUMEN

BACKGROUND: Although venous thrombosis is a leading cause of flap failure, the majority of lower extremity free flap planning is centered on arterial system evaluation. Preoperative identification of relevant abnormality in lower extremity venous systems by means of duplex ultrasound may aid in the diagnosis of clinically important abnormality that could affect lower extremity flap outcomes. METHODS: Between November of 2014 and August of 2017, 57 patients underwent preoperative lower extremity venous duplex imaging and free tissue transfer for lower extremity wounds. A retrospective review was performed to describe lower extremity venous pathologic findings, relevant patient demographic data, comorbid conditions, and outcomes. Discovery of venous abnormality helped guide recipient vein selection. RESULTS: Fifty-seven consecutive patients underwent 59 free flap operations to treat chronic lower extremity wounds. Venous duplex ultrasonography detected venous insufficiency (defined as >0.5 second of reflux) in 23 patients (39.0 percent), including 16 (27.2 percent) with deep thigh reflux, six (10.2 percent) with superficial calf reflux, and four (6.78 percent) with deep calf reflux. Deep venous thrombosis was found in four patients (6.78 percent) and treated with anticoagulation. The flap success rate was 98.3 percent. Five patients (8.47 percent) progressed to amputation. At a mean follow-up time of 15.1 ± 9.51 months (range, 1.67 to 35.2 months), 53 patients (89.8 percent) were able to continue community ambulation. CONCLUSIONS: Lower extremity venous duplex testing before free tissue transfer may be useful for optimizing flap recipient vessel selection and for detecting potentially unknown venous abnormality. Development of free flap planning protocols incorporating preoperative vascular imaging is important to achieving good functional outcomes in this comorbid patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.


Asunto(s)
Rechazo de Injerto/prevención & control , Traumatismos de la Pierna/cirugía , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios/métodos , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Insuficiencia Venosa/diagnóstico , Trombosis de la Vena/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Colgajos Tisulares Libres/irrigación sanguínea , Colgajos Tisulares Libres/trasplante , Rechazo de Injerto/epidemiología , Rechazo de Injerto/etiología , Humanos , Incidencia , Pierna/irrigación sanguínea , Pierna/diagnóstico por imagen , Pierna/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Procedimientos Quirúrgicos Reconstructivos/métodos , Estudios Retrospectivos , Ultrasonografía Doppler Dúplex , Venas/diagnóstico por imagen , Insuficiencia Venosa/complicaciones , Insuficiencia Venosa/epidemiología , Trombosis de la Vena/complicaciones , Trombosis de la Vena/epidemiología , Adulto Joven
6.
Plast Reconstr Surg ; 145(1): 85-96, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31881608

RESUMEN

BACKGROUND: Current guidelines recommend individual risk stratification, chemoprophylaxis, and risk mitigation to prevent venous thromboembolism. However, the evidence for efficacy is lacking in plastic surgery outpatients. Anticoagulation can cause bleeding. Ultrasound technology offers a highly accurate screening method. METHODS: A prospective study was undertaken among 1000 consecutive cosmetic surgery outpatients who were scanned at three times: before surgery, the day after surgery, and 1 week after surgery (inclusion rate, 93 percent). Intravenous sedation was used, with no muscle relaxation. Compression, Doppler color flow, and waveform analysis were performed on the deep veins of the lower extremities, including the calves. Affected patients were followed with weekly scans. No chemoprophylaxis was ordered. Sequential compression devices were used during the first half of the study. RESULTS: Nine deep venous thromboses were detected (0.9 percent). Two thromboses were found on scans performed the day after surgery. Six thromboses were detected on the scan approximately 1 week after surgery. One deep venous thrombosis was detected 35 days after surgery. Eight of the nine patients were prescribed oral anticoagulants. All affected patients recovered fully. The mean time to thrombosis resolution was 4.8 weeks. A logistic regression found no deep venous thrombosis risk reduction from sequential compression devices. Patient age was significantly associated with deep venous thromboses (p < 0.05). CONCLUSIONS: Ultrasound surveillance offers an effective method for early detection and treatment of postoperative deep venous thromboses. This technology offers an alternative to risk stratification and chemoprophylaxis, which causes iatrogenic bleeding. Sequential compression devices are unnecessary for plastic surgery outpatients undergoing total intravenous anesthesia. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.


Asunto(s)
Cirugía Plástica/métodos , Ultrasonografía Doppler Dúplex/métodos , Tromboembolia Venosa/prevención & control , Trombosis de la Vena/diagnóstico por imagen , Adulto , Anciano , Anticoagulantes/uso terapéutico , Femenino , Humanos , Extremidad Inferior/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Trombosis de la Vena/prevención & control
7.
Medicine (Baltimore) ; 98(50): e18234, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852087

RESUMEN

The aim of this prospective observational single-centre pilot study was to evaluate the association between alterations in carotid artery blood flow velocities during cardiac surgery and postoperative delirium.Carotid artery blood flow velocity was determined perioperatively at 5 different timepoints by duplex sonography in 36 adult cardiac surgical patients. Delirium was assessed using the Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist. Additionally, blood flow velocities in the middle cerebral arteries, differences in regional cerebral tissue oxygenation and quantity and quality of microemboli were measured.Delirium was detected in 7 of 36 patients. After cardiopulmonary bypass carotid artery blood flow velocities increased by +23 cm/second (95% confidence interval (CI) 9-36 cm/second) in non-delirious patients compared to preoperative values (P = .002), but not in delirious patients (+3 cm/second [95% CI -25 to 32 cm/second], P = .5781). Middle cerebral artery blood flow velocities were higher at aortic de-cannulation in non-delirious patients (29 cm/second [inter-quartile range (IQR), 24-36 cm/second] vs 12 cm/second [IQR, 10-19 cm/second]; P = .017). Furthermore, brain tissue oxygenation was higher in non-delirious patients during surgery.Our results suggest that higher cerebral blood flow velocities after aortic de-clamping and probably also improved brain oxygenation might be beneficial to prevent postoperative delirium.


Asunto(s)
Velocidad del Flujo Sanguíneo/fisiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Arteria Carótida Común/fisiopatología , Delirio/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Ultrasonografía Doppler Dúplex/métodos , Anciano , Procedimientos Quirúrgicos Cardíacos/métodos , Arteria Carótida Común/diagnóstico por imagen , Delirio/etiología , Delirio/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Proyectos Piloto , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Valor Predictivo de las Pruebas , Estudios Prospectivos
8.
Georgian Med News ; (294): 7-10, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31687940

RESUMEN

Today, the issues of surgical tactics remain unresolved, namely, the choice of volume and area of ​​primary reconstruction with occlusion-stenotic lesions of extracranial arteries and aorto-iliac-femoral segment in conditions of high risk of reperfusion-reoxygenative syndrome. The aim of the study - To improve the results of surgical treatment of combined occlusion-stenotic lesions of extracranial arteries and the aorto-iliac-femoral segment in conditions of high risk of development of reperfusion-reoxygenative complications. The study included 58 patients with combined atherosclerotic lesions of extracranial arteries and aorto-iliac-femoral zone. To diagnose the nature of the lesion of the arterial bed and the features of hemodynamic disorders, ultrasound dopplerography, duplex scanning, X-ray contrast digital angiography were used. The proposed set of measures to prevent the development of reperfusion-reoxygenative complications was introduced to the system of preoperative preparation. The decision of the order of restorative operations on the brachiocephalic arteries and the aorto-iliac-femoral segment was based on the analysis of the localization of the occlusive process in both arterial basins, their hemodynamic characteristics, the degree of ischemia and the tolerance of the brain to ischemia. Due to the spread occlusion-stenotic lesion of extracranial arteries in combination with the stenotic process of the contralateral ICA in the stage of relative compensation of cerebral bloodflow in 7 patients, primarily the surgical intervention on the vessels of the neck was performed. Four to six days after the first surgical intervention, the revascularization of aorta/iliac-femoral segment was performed. In 51 patients, one-time surgical intervention was performed on extracranial arteries and aorto-iliac-femoral basin. Analyzing the results of revascularization operations, it can be argued that a differentiated approach to choosing the tactics of surgical treatment of multifocal atherosclerotic lesions of arterial basins should be used. The revascularization of both arterial basins should be carried out in stages: a reconstructive operation on the extracranial arteries is performed initially, and 4 to 6 days after the first surgical intervention, the aorta/iliac-femoral arterial zone revascularization or revascularization of both arterial basins simultaneously.


Asunto(s)
Aorta Abdominal/diagnóstico por imagen , Arteriopatías Oclusivas/cirugía , Arterias/diagnóstico por imagen , Ultrasonografía Doppler Dúplex/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Anciano , Angiografía de Substracción Digital , Aorta Abdominal/patología , Femenino , Arteria Femoral/diagnóstico por imagen , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/cirugía , Masculino , Persona de Mediana Edad , Daño por Reperfusión/prevención & control
9.
Braz J Cardiovasc Surg ; 34(5): 581-587, 2019 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-31719009

RESUMEN

OBJECTIVE: The aim of this study was to determine the prevalence and risk factors of carotid artery stenosis (CAS) using carotid duplex ultrasound in patients undergoing coronary artery bypass grafting (CABG). METHODS: This retrospective study was conducted between January 2017 and January 2018 and included 166 consecutive patients [130 males (78.31%), 36 females (21.69%); mean age: 64.25±9.78 years] who underwent elective and isolated CABG. Patients who had significant CAS (≥50% stenosis) were compared with patients who had non-significant CAS (<50% stenosis). Logistic regression analysis was applied across the selected parameters to identify risk factors for significant CAS. RESULTS: Of all patients, 36 (21.68%) had CAS ≥50% and 8 (4.81%) had unilateral carotid stenosis ≥70%. Carotid endarterectomy/CABG was performed simultaneously in five (3.01%) patients. None of these patients had cardiac and neurological problems during the postoperative period. The overall incidence of cerebrovascular accident (CVA) after CABG was 1.20% (n=2). Age (P=0.011) and history of CVA (P=0.035) were significantly higher in the CAS ≥50 group than in the CAS <50 group. Significant CAS was identified as a risk factor for postoperative CVA (P=0.013). CONCLUSION: Age and history of CVA were identified as risk factors for significant CAS. Furthermore, significant CAS was identified as a risk factor for postoperative CVA. For this reason, carotid screening is recommended for patients undergoing CABG even in the absence of associated risk factors.


Asunto(s)
Estenosis Carotídea/diagnóstico por imagen , Puente de Arteria Coronaria/métodos , Ultrasonografía Doppler Dúplex/métodos , Anciano , Estenosis Carotídea/etiología , Puente de Arteria Coronaria/efectos adversos , Endarterectomía Carotidea/efectos adversos , Endarterectomía Carotidea/métodos , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Periodo Preoperatorio , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/etiología , Factores de Tiempo , Resultado del Tratamiento
10.
Am J Case Rep ; 20: 1509-1514, 2019 Oct 14.
Artículo en Inglés | MEDLINE | ID: mdl-31607743

RESUMEN

BACKGROUND Subclavian stenosis is an uncommon clinical condition associated with severe cardiovascular complications, usually presenting with claudication and subclavian steal syndrome. Here we describe the rare case of bilateral subclavian artery stenosis in an asymptomatic patient. CASE REPORT Our patient was a 63-year-old chronic smoker with no prior medical history whose chief complaint was dyspnea from an exacerbation of his chronic obstructive pulmonary disease (COPD). He was hypotensive with blood pressure 74/56 mmHg at admission, which raised suspicion for sepsis, adrenal insufficiency but the workup (renal panel, full blood count and synacthen tests) were normal. He quickly recovered after we treated his COPD exacerbation, but his hypotension persisted despite repeated fluid challenges. To evaluate for structural causes of his hypotension, we performed a full cardiovascular examination with 4 limb blood pressure measurements and found upper limb hypotension and lower limb hypertension. Subsequent imaging with ultrasound and computed tomography confirmed the presence of bilateral subclavian artery stenosis. Our diagnosis was thus bilateral subclavian artery stenosis secondary to atherosclerosis from chronic smoking. The patient was subsequently referred to vascular surgery for consideration of surgical revascularization. CONCLUSIONS Bilateral subclavian stenosis is extremely rare and requires a high index of clinical suspicion. Early diagnosis is important in the primary prevention of associated cardiovascular diseases.


Asunto(s)
Hipotensión/etiología , Síndrome del Robo de la Subclavia/diagnóstico por imagen , Enfermedades Asintomáticas , Aterosclerosis/complicaciones , Angiografía por Tomografía Computarizada , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Fumadores , Arteria Subclavia/diagnóstico por imagen , Ultrasonografía Doppler Dúplex , Arteria Vertebral/diagnóstico por imagen
11.
Artículo en Inglés, Ruso | MEDLINE | ID: mdl-31626173

RESUMEN

AIM: To assess the dynamics of blood flow in patients with hemodynamically significant pathological kinked internal carotid arteries (PK ICA) with their orthostatic and rotational positions. MATERIAL AND METHODS: Eighty-six patients, including 35 with PK ICA due to fibromuscular dysplasia (FMD) and 51 with PK ICA due to hypertensive heart disease, and 20 healthy people were examined. All patients underwent Doppler ultrasound scanning. All indicators were evaluated in the position of the patient lying on his back and functional stress tests (orthostatic, rotational). RESULTS: The peak systolic velocity, end diastolic velocity, peripheral resistance index did not differ significantly in patients with PK ICA due to FMD and hypertensive heart disease. The increase of blood flow in bends was significantly higher with S-shaped kinking, regardless of the reason for their formation (p<0.05). In orthostatic position, significant changes of hemodynamic parameters in ICA in healthy people did not occur. Moreover, more frequent formation of turbulent blood flows in the group with hypertensive heart disease (78%) and a decrease in LBFV in the standing position were found in patients with PK ICA due to FMD. Rotational position did not alter the hemodynamics in ICA in healthy people and significantly influenced the values of LBFV in patients with PK ICA. CONCLUSION: Changes in hemodynamic parameters in the area of kinking with orthostatic and rotational positions of ICA demonstrate more significant impairments in patients with PK ICA due to hypertensive heart disease compared to patients with FMD. The rotational position of PK ICA is the most informative for identifying turbulent blood flow and an increase in peak systolic velocity in the area of kinking.


Asunto(s)
Arteria Carótida Interna , Estenosis Carotídea , Velocidad del Flujo Sanguíneo , Arterias Carótidas , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/fisiopatología , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/fisiopatología , Diástole , Hemodinámica , Humanos , Flujo Sanguíneo Regional , Ultrasonografía Doppler , Ultrasonografía Doppler Dúplex
12.
J Med Case Rep ; 13(1): 282, 2019 Sep 08.
Artículo en Inglés | MEDLINE | ID: mdl-31493785

RESUMEN

BACKGROUND: A pseudoaneurysm is a rare but serious complication after transradial coronary catheterization. Although different treatment modalities have been proposed to treat post-catheterization pseudoaneurysm, only limited data are available to guide the treatment approach. CASE PRESENTATION: We report a rare case of two distinct pseudoaneurysms complicating transradial percutaneous coronary intervention in a 75-year-old Hispanic woman being treated with dual antiplatelet agents for myocardial infarction and warfarin for atrial fibrillation. The pseudoaneurysms were diagnosed with ultrasound and were successfully treated with a series of Terumo Corporation (TR) band compressions. CONCLUSIONS: This case demonstrates the efficacy of compression therapy in managing post-catheterization radial artery pseudoaneurysm in patients with high bleeding risk.


Asunto(s)
Aneurisma Falso/diagnóstico por imagen , Cateterismo Cardíaco/efectos adversos , Arteria Radial/diagnóstico por imagen , Anciano , Fibrilación Atrial/tratamiento farmacológico , Femenino , Humanos , Infarto del Miocardio/tratamiento farmacológico , Intervención Coronaria Percutánea , Ultrasonografía Doppler Dúplex
13.
Gac Med Mex ; 155(4): 350-356, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31486781

RESUMEN

Introduction: Atherosclerotic carotid artery disease (CAD) is a major risk factor for cerebrovascular disease. Objective: To analyze the association of major vascular risk factors with atherosclerotic CAD and white matter disease (WMD) in patients without a history of ischemic stroke. Method: Risk factors were assessed with carotid examination using Doppler duplex ultrasound. Cases with a history cerebral infarction or transient ischemic attack were not included. Subjects had brain magnetic resonance imaging scans available and those with large-artery ischemic lesions were excluded. Multivariate models were constructed for the prediction of atherosclerotic CAD, significant carotid stenosis, atheroma burden and WMD. Results: One-hundred and forty-five subjects were assessed (60.7% were females, mean age was 73 years). Atherosclerotic CAD was documented in 54.5%, carotid stenosis ≥ 50% in 9.0%, > 6 atheroma plaques in 7.6%, and periventricular or subcortical WMD in 28.3% (20.6% had atherosclerotic CAD and WMD concurrently). Risk factors independently associated with atherosclerotic CAD were age and hypertension; hypertension was associated with ≥ 50% carotid stenosis; age was associated with > 6 atheroma plaques; and age, diabetes and hypertension were associated with WMD. Obesity was not associated with any of the analyzed independent variables. Conclusions: In asymptomatic subjects without a history of ischemic stroke, age and hypertension were the most important risk factors for macrovascular disease. Diabetes mellitus was associated with microvascular disease. Obesity alone was not a major determinant of CAD or WMD.


Asunto(s)
Enfermedades de las Arterias Carótidas/epidemiología , Estenosis Carotídea/epidemiología , Leucoencefalopatías/epidemiología , Placa Aterosclerótica/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Leucoencefalopatías/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Placa Aterosclerótica/diagnóstico por imagen , Estudios Retrospectivos , Factores de Riesgo , Ultrasonografía Doppler Dúplex
14.
Biomed Res Int ; 2019: 8787010, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31534965

RESUMEN

Uterine radial artery resistance index (URa-RI) by Doppler ultrasound may reflect the changes in the uteroplacental circulation and be associated with adverse events in early pregnancy. Recurrent pregnancy losses (RPL) are associated with thrombophilia, and anticoagulation treatment with low molecular weight heparin improves pregnancy outcome in women with RPL and thrombophilia. A retrospective cohort study was conducted in 139 pregnant women with 3 or more RPL and thrombophilia. The relationship between pregnancy outcome and dynamic changes of URa-RI was analyzed in 116 women who delivered a liveborn infant and 23 who miscarried the index pregnancy. Patients were on preconception low molecular weight heparin, low-dose aspirin (81mg per day), and prednisone treatment. URa-RI was measured during periovulation time, at the time of positive pregnancy test, and then repeated every two weeks until 32-week gestation or the time of miscarriage. The URa-RI at 8-week gestation was significantly higher in women who miscarried the index pregnancy than those who delivered alive born infant (0.51±0.08 vs. 0.42±0.03, P<0.001). Receiver operating characteristic curve analysis demonstrated that URa-RI of 8 wk gestation effectively distinguished women who miscarried from those who had a live birth with an area under the curve of 82.6% (95% CI 69.01-97.17). After adjusting for covariates including age, BMI, and number of miscarriages, multiple logistic regression models showed that each 0.1 unit increase of URa-RI of 8 wk gestation was associated with 18.70-point increase in the risk of miscarriage (OR19.70, 95%CI 4.26-91.1, P<0.001), and women with an URa-RI≥0.45 had an OR of 49.48 (95% CI 8.01-307.95; P<0.001) for miscarriage compared to those who had URa-RI<0.45. In women with RPL and inherited thrombophilia, increased URa-RI at 8-week gestation was associated with spontaneous abortion independent of other risk factors while they were on anticoagulation treatment.


Asunto(s)
Aborto Habitual , Complicaciones Hematológicas del Embarazo , Trombofilia , Ultrasonografía Doppler Dúplex , Arteria Uterina , Resistencia Vascular , Aborto Habitual/sangre , Aborto Habitual/diagnóstico por imagen , Aborto Habitual/tratamiento farmacológico , Aborto Habitual/fisiopatología , Anticoagulantes/administración & dosificación , Aspirina/administración & dosificación , Femenino , Heparina de Bajo-Peso-Molecular/administración & dosificación , Humanos , Nacimiento Vivo , Embarazo , Complicaciones Hematológicas del Embarazo/sangre , Complicaciones Hematológicas del Embarazo/diagnóstico por imagen , Complicaciones Hematológicas del Embarazo/tratamiento farmacológico , Complicaciones Hematológicas del Embarazo/fisiopatología , Estudios Retrospectivos , Trombofilia/sangre , Trombofilia/diagnóstico por imagen , Trombofilia/tratamiento farmacológico , Trombofilia/fisiopatología , Arteria Uterina/diagnóstico por imagen , Arteria Uterina/fisiopatología
15.
Praxis (Bern 1994) ; 108(12): 807-813, 2019 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-31530132

RESUMEN

Color Doppler ultrasound is the diagnostic cornerstone of vascular assessment. Almost all arteries and veins of the human body are accessible to this diagnostic imaging, which as a result is very often used as first-line diagnostic test. Recent technological developments in high-end ultrasound machines enable us to optimize image quality in color-coded duplex ultrasound of arteries and veins. To obtain an optimal instrument setting, all relevant adjustments of imaging must be considered. In B-Mode ultrasound, the basic vascular imaging method, the most important settings to optimize are ultrasound frequency, gain, dynamic range, and focus, whereas color Doppler depends on angle supersonic sounding and its application in clinical practice. Most mistakes in measuring blood flow velocities, a frequent cause of misinterpretation, result from insufficient angle correction. Cardiac pathologies may result in typical changes of arterial and venous Doppler curves.


Asunto(s)
Cardiopatías , Ultrasonografía Doppler en Color , Ultrasonografía Doppler Dúplex , Arterias , Velocidad del Flujo Sanguíneo , Cardiopatías/diagnóstico por imagen , Humanos , Ultrasonografía
16.
Surgery ; 166(4): 601-606, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31405580

RESUMEN

BACKGROUND: Difficult cephalad exposure during carotid endarterectomy in patients with high plaque (HP) may lead to increased incidence of complications after carotid endarterectomy. We report on our experience of carotid endarterectomy in patients with HP. METHODS: This is a retrospective review of 1,233 consecutive patients who underwent carotid endarterectomy by a single surgeon at 2 teaching hospitals between January 1989 to December 2018. Group A consisted of patients with HP (n = 100) diagnosed by computed tomography angiography of the neck in 90, catheter-based arteriography in 8, and an unexpected finding during carotid endarterectomy in 2 patients. Group B consisted of 1,133 consecutive carotid endarterectomies with plaque ending in Zone 1 non-high plaque (nHP). RESULTS: Both groups were similar in age (70.9 ± 8.7 vs 70.3 ± 9.1, P = .53). There was a preponderance of male patients in the HP group (78.0% vs 66.1%, P = .02). Associated risk factors, including coronary artery disease, hypertension, diabetes, chronic obstructive pulmonary disease, and hyperlipidemia, were similar in both groups. Indications for carotid endarterectomy in HP patients include recent stroke (<8 weeks) in 15 patients (15.0%), transient ischemic attack in 23 patients (23.0%), and asymptomatic in 62 patients (62.0%). Three patients (3.0%) with HP required shunt placement compared with 10.9% in the nHP group (P = .009). Completion carotid arteriogram was performed in 6 patients. Perioperative stroke and mortality were similar in both groups. The incidence of cranial nerve injury was higher in the HP group. CONCLUSION: Most patients with HP can be diagnosed with computed tomography angiography of the neck or catheter-based arteriography. Shunt requirement in patients with HP is significantly lower than in the nHP group. Perioperative stroke and mortality in patients with HP undergoing carotid endarterectomy is similar to the nHP group; however, there is a higher incidence of permanent cranial nerve injury. Carotid artery stenting should be considered in cases in which carotid endarterectomy may be challenging, such as in patients with HP. Overall, our results demonstrate that carotid endarterectomy can be safely performed in patients with HP, however, at an increased risk of permanent cranial nerve injury.


Asunto(s)
Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/cirugía , Angiografía por Tomografía Computarizada/métodos , Endarterectomía Carotidea/métodos , Seguridad del Paciente , Placa Aterosclerótica/cirugía , Factores de Edad , Anciano , Anciano de 80 o más Años , Angiografía/métodos , Estenosis Carotídea/mortalidad , Estudios de Cohortes , Endarterectomía Carotidea/efectos adversos , Femenino , Hospitales de Enseñanza , Humanos , Ataque Isquémico Transitorio/prevención & control , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/diagnóstico por imagen , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Accidente Cerebrovascular/prevención & control , Tasa de Supervivencia , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex/métodos , Estados Unidos
17.
Praxis (Bern 1994) ; 108(10): 679-684, 2019 Aug.
Artículo en Alemán | MEDLINE | ID: mdl-31387491

RESUMEN

Vascular Color-Coded Duplex Ultrasound in Practice: Artifacts Abstract. Ultrasound artifacts are technical phenomena which may cause diagnostic mistakes and do not correlate with the real target organ. These optical and acoustic phenomena of color-coded duplex ultrasound are very common in the real world and may lead to misinterpretations and diagnostic errors. The twinkling artifact, for example, imitates high-flow velocities and turbulences, which may lead to the misdiagnosis of a high-grade stenosis or of vascularization. Mirror image artifacts may irritate the sonographer and cause an impression of an additional - really not existing - vessel. The "seagull cry", whose origin is not well understood, is usually found in the region of a high-grade stenosis.


Asunto(s)
Artefactos , Ultrasonografía Doppler en Color , Errores Diagnósticos , Humanos , Ultrasonografía Doppler Dúplex
18.
Cardiol Young ; 29(10): 1294-1296, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31466537

RESUMEN

We report the case of a 10-year-old girl with Takayasu arteritis who developed acute onset wrist drop diagnosed with a large right axillary artery aneurysm compressing the surrounding structures. Our case is unique because it describes a rare presentation of Takayasu arteritis (axillary aneurysm) in a child that was treated successfully in an unconventional manner by transcutaneous embolisation following failure of trans-arterial approach.


Asunto(s)
Aneurisma/terapia , Arteria Axilar , Embolización Terapéutica/métodos , Arteritis de Takayasu/complicaciones , Aneurisma/diagnóstico , Aneurisma/etiología , Angiografía , Niño , Femenino , Humanos , Arteritis de Takayasu/diagnóstico , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler Dúplex
19.
Surgery ; 166(6): 1076-1083, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31277885

RESUMEN

BACKGROUND: In this article, we report the outcomes of patients with deep venous thrombosis in the lower limbs treated with the oral anticoagulant rivaroxaban or warfarin, focusing on the recanalization rate (measured with duplex ultrasound) and the incidence of postthrombotic syndrome. METHODS: This was a prospective, consecutive, randomized, blind cohort study of patients admitted with deep venous thrombosis to the Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual, São Paulo, Brazil, between March 2016 and July 2018. The patients were randomized into 2 groups and treated with oral anticoagulation for 6 months: either rivaroxaban (group 1) or warfarin (group 2). The study was registered at clinicaltrials.gov under NCT 02704598. RESULTS: Eighty-eight patients with deep venous thrombosis were admitted to the Vascular Surgery Department and randomized into the 2 groups. The follow-up time was 360 days. Analyses were performed at 180 and 360 days. Four patients were excluded from the study during follow-up because of a diagnosis of ovarian cancer (1 patient), head and neck cancer (1 patient), lung cancer (1 patient), and stomach cancer (1 patient). Therefore, 84 patients were evaluated: 46 patients in group 1 and 38 in group 2. The incidence of postthrombotic syndrome was 17.9% (15 cases) in the total cohort, but was significantly higher in group 2 (11 cases, 28.9%) than in group 1 (4 cases, 8.7%; P < .001; odds ratio, 4.278). The rate of total venous recanalization at 360 days was 40.5% (34 patients) in the total cohort, but was significantly higher in group 1 (35 patients, 76.1%) than in group 2 (5 patients, 13.2%; P < .001). The incidence of partial venous recanalization was 46.4% and was significantly higher in group 2 (28 patients, 73.7%) than in group 1 (11 patients, 23.9%; P = .016). Five patients in the total cohort (6%) showed no venous recanalization, all of them in group 2 (P = .016). CONCLUSION: In this study, patients who received oral rivaroxaban displayed a lower incidence of postthrombotic syndrome and a better total vein recanalization rate after 6 and 12 months than patients who received warfarin.


Asunto(s)
Anticoagulantes/administración & dosificación , Síndrome Postrombótico/epidemiología , Rivaroxabán/administración & dosificación , Grado de Desobstrucción Vascular/efectos de los fármacos , Trombosis de la Vena/tratamiento farmacológico , Warfarina/administración & dosificación , Administración Oral , Brasil/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Extremidad Inferior , Masculino , Persona de Mediana Edad , Síndrome Postrombótico/diagnóstico por imagen , Síndrome Postrombótico/etiología , Estudios Prospectivos , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico por imagen
20.
Clin Lab ; 65(7)2019 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-31307155

RESUMEN

BACKGROUND: Inherited thrombophilia represents a prothrombotic disorder that predisposes to thrombosis. METHODS: We present a case of a 67-year-old female with a personal and family history of iterative thrombotic events. She was admitted in the Surgical Clinic at the age of 59, presenting the classical symptoms and signs for left lower limb deep vein thrombosis, confirmed by a venous Duplex Ultrasonography. This was the third episode of a venous thrombosis. Under anticoagulant treatment the evolution was good. The patient was advised to test for inherited thrombophilia mutations. RESULTS: Four years later, she experienced another episode of thrombosis. The patient tested positive for five of the most frequent mutations found in inherited thrombophilia. CONCLUSIONS: Patients with recurrent venous thrombosis and positive family history for thrombotic events must be checked for thrombophilic conditions, inherited or acquired.


Asunto(s)
Mutación , Trombofilia/genética , Trombosis de la Vena/genética , Anciano , Femenino , Humanos , Recurrencia , Trombofilia/complicaciones , Trombofilia/diagnóstico , Ultrasonografía Doppler Dúplex , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiología
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