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1.
Vasc Endovascular Surg ; 54(1): 75-79, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31506016

RESUMO

Brachial artery aneurysms and arteriovenous malformations (AVM) are limb-threatening vascular anomalies. This patient presented with a bilobed brachial artery aneurysm in the antecubital fossa proximally to an AVM arising from the dorsal interosseous and ulnar arteries that had been treated with endovascular embolization, leaving the hand solely supplied by the radial artery. The aneurysm continued to increase in size and imaging revealed concomitant thrombus. A femoral vein interposition graft was used to repair the aneurysm, and postoperatively, the patient retained full left arm function.


Assuntos
Aneurisma/cirurgia , Malformações Arteriovenosas/complicações , Artéria Braquial/cirurgia , Veia Femoral/transplante , Artéria Ulnar/anormalidades , Adolescente , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Embolização Terapêutica , Feminino , Humanos , Resultado do Tratamento , Artéria Ulnar/diagnóstico por imagem , Grau de Desobstrução Vascular
2.
Vasc Endovascular Surg ; 54(1): 5-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31506033

RESUMO

INTRODUCTION: High flow rates may develop in arteriovenous fistula (AVF), resulting in clinical syndromes of steal, aneurysmal fistula, or high-output cardiac failure. Various techniques with varying success have been advocated to treat this difficult problem. We present a hemodynamically validated novel banding technique. METHODS: We designed a computational fluid dynamic (CFD) model of the native high-flow AVF and tested various juxta-anastomotic venous diameters to determine the effect on AVF blood flow and pressure. We translated this principle in our banding technique, wherein adjustable banding was performed in conjunction with ultrasound-guided brachial artery flow measurement to determine the optimal band diameter. Polyurethane patch was used to fashion the adjustable band. Patient demographics, AVF flow parameters pre- and postintervention, operative intervention, and ultrasound follow-up data were collected prospectively. RESULTS: Our CFD testing demonstrated that the band diameter needed to achieve optimal distal blood pressure and preserve AVF flow depending on blood pressure, end capillary pressure, venous pressure, and vascular diameters. Five patients subsequently underwent dynamic banding of symptomatic high-flow AVF. Mean brachial artery blood flow rates pre- and postbanding were 2964 mL/min (confidence interval [CI]: 1487-4440 mL/min) and 1099 mL/min (CI: 571.7-1627 mL/min), respectively (P = .01). All patients had symptomatic improvement, and at a mean follow-up of 1 year, this benefit was sustained with no AVF thrombosis or loss. CONCLUSION: Adjustable dynamic band using ultrasound-guided brachial artery flow shows promising results in producing accurate AVF blood flow reduction with sustained efficacy in the short term for patients with symptomatic high-flow AVF.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Artéria Braquial/fisiopatologia , Hemodinâmica , Complicações Pós-Operatórias/cirurgia , Diálise Renal , Adolescente , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Artéria Braquial/diagnóstico por imagem , Simulação por Computador , Humanos , Ligadura , Pessoa de Meia-Idade , Modelos Cardiovasculares , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Fluxo Sanguíneo Regional , Reoperação , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção
3.
Vasc Endovascular Surg ; 54(1): 80-84, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31533547

RESUMO

Brachial artery pseudoaneurysms (BAPs) are rare but could lead to complications of high morbidity. We report a case of a BAP presenting with hand ischemia and median nerve neuropathy nearly a decade after the inciting iatrogenic trauma, successfully treated with excision and direct repair. This report highlights that untreated pseudoaneurysms can be indolent and present late with both symptoms of embolization and local compression.


Assuntos
Falso Aneurisma/etiologia , Artéria Braquial/lesões , Doença Iatrogênica , Isquemia/etiologia , Flebotomia/efeitos adversos , Extremidade Superior/irrigação sanguínea , Lesões do Sistema Vascular/etiologia , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/fisiopatologia , Falso Aneurisma/cirurgia , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Artéria Braquial/cirurgia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Isquemia/cirurgia , Masculino , Neuropatia Mediana/etiologia , Fluxo Sanguíneo Regional , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/fisiopatologia , Lesões do Sistema Vascular/cirurgia
4.
Hypertension ; 74(4): 921-928, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31446803

RESUMO

Clustering of arterial blood pressure (BP) waveform parameters could summarize complex information into distinct elements, which could be used to investigate cumulative (nonredundant) associations. We investigated this hypothesis in a large, adult population-based study (ViDA trial [Vitamin D Assessment] trial). To interpret the clusters and evaluate their usefulness, we examined their predictors and associations with cardiovascular events. In 4253 adults (mean age 65 years; 55% male) without a prior cardiovascular event, suprasystolic oscillometry was performed, yielding aortic pressure waveforms and several hemodynamic parameters. Participants were followed up for 4.6 years (median), accruing 300 cardiovascular events. Principal component analysis reduced 14 arterial waveform parameters to 3 uncorrelated factors that together explained 90% of the variability of the original data. Factors 1, 2, and 3 appeared to represent BP pulsatility, mean BP, and wave reflection, respectively. Across 6 antihypertensive drug classes, there were no differences in brachial systolic (P=0.23) and diastolic (P=0.13) BP; but there were significant variations in factor 3 (P<0.0001), especially for ß-blocker use. The first and third factors were positively associated with cardiovascular events (multivariable-adjusted standardized hazard ratio [95% CI]=1.33 [1.18-1.50] and 1.15 [1.02-1.30], respectively), whereas the second factor had a J-shaped relationship, with a nadir corresponding to a brachial diastolic BP of ≈75 mm Hg. In conclusion, BP pulsatility, mean BP, and wave reflection are prognostically meaningful, distinct aspects of arterial function that can be used to summarize physiological variations in multiple arterial waveform parameters and identify truly cumulative associations when used as cardiovascular risk outcomes.


Assuntos
Pressão Arterial/fisiologia , Artéria Braquial/fisiopatologia , Hipertensão/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Pressão Arterial/efeitos dos fármacos , Feminino , Hemodinâmica , Humanos , Hipertensão/tratamento farmacológico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso
5.
Diabetes Metab Syndr ; 13(2): 1387-1391, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336497

RESUMO

BACKGROUND: Type 2 diabetes has a high spread and growing process. Using appropriate food diets is among therapeutic approaches has been applied for diabetic patients. Soya utilization has shown effective results in controlling metabolic abnormalities of these patients. The aim of this study is to investigate the effects of soy nut on glycemic conditions, blood pressure, lipid profile, antioxidant effects and vascular endothelial function of these patients. METHODS: 70 patients with type 2 diabetes were randomly divided into two groups of the test (35 people) and control (35 people). The patients in the intervention group were subjected to 60 g soy nut diet as a part of daily protein for 8 weeks and the control group under the usual diet of diabetes. The fasting glucose, blood pressure, lipid profile, brachial blood flow, the level of serum E-Selectin and total antioxidant capacity in control and test group were assessed before and after diet. RESULTS: Consuming 60 g soy nut for 8 weeks significantly decreased the fasting blood glucose (P = 0.03), total serum cholesterol (P < 0.01), LDL-c (P = 0.01), and E-Selectin (P < 0.01) and increased the capacity of serum total antioxidants (P < 0.01), brachial blood flow (P < 0.01) but didn't have any significant effect on systolic/diastolic blood pressure, HDL-c, and TG. CONCLUSION: Soy nut utilization in the patients with type-2 diabetes can significantly improve the glycemic condition, increase brachial blood flow, decrease E-selectin (improvement of endothelial function), increase serum total antioxidants and lipid profile but has no significant effect on blood pressure and HDL-c.


Assuntos
Antioxidantes/metabolismo , Biomarcadores/análise , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/sangue , Endotélio Vascular/fisiopatologia , Nozes , Soja/química , Velocidade do Fluxo Sanguíneo , Artéria Braquial/fisiopatologia , Doenças Cardiovasculares/sangue , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/patologia , Selectina E/metabolismo , Endotélio Vascular/efeitos dos fármacos , Feminino , Seguimentos , Índice Glicêmico , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
6.
Eur J Appl Physiol ; 119(8): 1855-1863, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31187279

RESUMO

INTRODUCTION: Postprandial hyperglycemia (PPH) impairs vascular endothelial function (VEF). A single bout of aerobic exercise (AE) attenuates PPH-induced decreases in brachial artery flow-mediated dilation (FMD), a non-invasive measure of VEF, in healthy adults for up to 17 h post-exercise. Studies examining the effects of resistance exercise (RE) on postprandial FMD responses are lacking. PURPOSE: We hypothesized that a single bout of exercise performed the prior evening would attenuate PPH-induced decreases in FMD, independent of exercise modality. METHODS: In a randomized, cross-over design, overweight/obese adults [n = 11 (8 women); 22 ± 4 years; 32.3 ± 5.8 kg m-2] completed 3 separate trials: control (seated rest), AE (30 min at ~ 60% VO2max), or whole-body RE (30 min, 6 exercises, 3 × 10-repetition maximum). Each trial occurred 14-17 h prior to an oral glucose tolerance test (OGTT). Brachial artery FMD and plasma glucose and insulin were measured prior to and at 30-min intervals for 2 h following the OGTT. Repeated-measures ANOVA and Bonferroni post hoc tests were used to evaluate differences within and between trials. RESULTS: Trials occurred 15.3 ± 1.0 h prior to the OGTT. Relative to baseline, FMD transiently decreased (P < 0.05) at 30-60 min post-ingestion, plasma glucose increased (P < 0.01) at 30-90 min post-ingestion, and plasma insulin increased (P < 0.01) at 30-120 min post-ingestion. No between trial differences were observed for FMD, glucose, or insulin. CONCLUSIONS: Aerobic or resistance exercise performed the evening prior to an OGTT does not attenuate postprandial decreases in brachial artery FMD in overweight/obese adults.


Assuntos
Glicemia/metabolismo , Endotélio Vascular/fisiopatologia , Obesidade/fisiopatologia , Treinamento de Resistência/métodos , Vasodilatação , Adulto , Artéria Braquial/fisiopatologia , Humanos , Insulina/sangue , Masculino , Período Pós-Prandial , Treinamento de Resistência/efeitos adversos
7.
Croat Med J ; 60(3): 265-272, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31187955

RESUMO

AIM: To assess the effect of air, gas mixture composed of 50% nitrogen and 50% oxygen (nitrox 50), or gas mixture composed of 1% nitrogen and 99% oxygen (nitrox 99) on bubble formation and vascular/endothelial function during decompression after self-contained underwater breathing apparatus diving. METHODS: This randomized controlled study, conducted in 2014, involved ten divers. Each diver performed three dives in a randomized protocol using three gases: air, nitrox 50, or nitrox 99 during ascent. The dives were performed on three different days limited to 45 m sea water (msw) depth with 20 min bottom time. Nitrogen bubbles formation was assessed by ultrasound detection after dive. Arterial/endothelial function was evaluated by brachial artery flow mediated dilatation (FMD) before and after dive. RESULTS: Nitrox 99 significantly reduced bubble formation after cough compared with air and nitrox 50 (grade 1 vs 3 and vs 3, respectively, P=0.026). Nitrox 50 significantly decreased post-dive FMD compared with pre-dive FMD (3.62 ± 5.57% vs 12.11 ± 6.82% P=0.010), while nitrox 99 did not cause any significant change. CONCLUSION: Nitrox 99 reduced bubble formation, did not change post-dive FMD, and decreased total dive duration, indicating that it might better preserve endothelial function compared with air and nitrox 50 dive protocols.


Assuntos
Doença da Descompressão/prevenção & controle , Descompressão/métodos , Mergulho/fisiologia , Endotélio Vascular/fisiopatologia , Nitrogênio/uso terapêutico , Oxigênio/uso terapêutico , Adulto , Ar , Artéria Braquial/fisiopatologia , Doença da Descompressão/diagnóstico por imagem , Doença da Descompressão/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nitrogênio/química , Oxigênio/química , Ultrassonografia , Vasodilatação
8.
Hypertension ; 74(1): 208-215, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31055952

RESUMO

Early detection of coronary artery dysfunction is of paramount cardiovascular clinical importance, but a noninvasive assessment is lacking. Indeed, the brachial artery flow-mediated dilation test only weakly correlated with acetylcholine-induced coronary artery function ( r=0.36). However, brachial artery flow-mediated dilation methodologies have, over time, substantially improved. This study sought to determine if updates to this technique have improved the relationship with coronary artery function and the noninvasive indication of coronary artery dysfunction. Coronary artery and brachial artery function were assessed in 28 patients referred for cardiac catheterization (61±11 years). Coronary artery function was determined by the change in artery diameter with a 1.82 µg/min intracoronary acetylcholine infusion. Based on the change in vessel diameter, patients were characterized as having dysfunctional coronary arteries (>5% vasoconstriction) or relatively functional coronary arteries (<5% vasoconstriction). Brachial artery function was determined by flow-mediated dilation, adhering to current guidelines. The acetylcholine-induced change in vessel diameter was smaller in patients with dysfunctional compared with relatively functional coronary arteries (-11.8±4.6% versus 5.8±9.8%, P<0.001). Consistent with this, brachial artery flow-mediated dilation was attenuated in patients with dysfunctional compared with relatively functional coronaries (2.9±1.9% versus 6.2±4.2%, P=0.007). Brachial artery flow-mediated dilation was strongly correlated with the acetylcholine-induced change in coronary artery diameter ( r=0.77, P<0.0001) and was a strong indicator of coronary artery dysfunction (receiver operator characteristic=78%). The current data support that updates to the brachial artery flow-mediated dilation technique have strengthened the relationship with coronary artery function, which may now provide a clinically meaningful indication of coronary artery dysfunction.


Assuntos
Acetilcolina/administração & dosagem , Artéria Braquial/efeitos dos fármacos , Cateterismo Cardíaco/métodos , Doença da Artéria Coronariana/diagnóstico , Circulação Coronária/efeitos dos fármacos , Vasos Coronários/efeitos dos fármacos , Idoso , Artéria Braquial/fisiopatologia , Estudos de Coortes , Circulação Coronária/fisiologia , Vasos Coronários/fisiopatologia , Feminino , Humanos , Infusões Intralesionais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Medição de Risco , Vasoconstrição/efeitos dos fármacos , Vasoconstrição/fisiologia , Vasodilatação/efeitos dos fármacos , Vasodilatação/fisiologia
9.
Monaldi Arch Chest Dis ; 89(2)2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31107040

RESUMO

Increasing survival from cystic fibrosis show untypical systems involvement, such as cardiocirculatory. In particular, the presence of CFTR in smooth muscle and endothelial cells, systemic inflammation and oxidative stress could explain vascular alterations in these patients. We aimed at noninvasely evaluating macro- and microvascular dysfunction in cystic fibrosis adults without cardiovascular risk factors. Twenty-twoadults affected by cystic fibrosis and 24 healthy volunteers matched for age and sex were enrolled. None had known cardiovascular risk factors. All people underwent blood pressure measurement, microvascular function assessment by EndoPAT-2000 device (calculating RH-PAT index) and macrovascular evaluation by pulse wave velocity (PWV). RH-PAT index was significantly lower in patients than in controls (1.74±0.59 vs 2.33±0.34; p<0.001). Thirteen patients of 22 had a value inferior to the threshold of 1.67 (59.1%), while no controls had (p<0.001). Carotid-femoral PWV did not differ between the two groups (5.2±1.5 m/s vs 5.4±1.1; p=0.9), while brachial-ankle one did (11.0±2.2 m/s vs 10.1±0.8 m/s; p=0.04).Adults patients affected by cystic fibrosis show peripheral endothelial dysfunction, which is the first alteration in atherosclerotic phenomenon. Moreover, arterial stiffness measured by PWV unclearly seems to differ respect of healthy people, perhaps because PWV alterations are typical of above 50 years old people. It is unclear what prognostic role of future developing of atherosclerotic disease these findings could be, but it seems evident that cystic fibrosis directly affects cardiovascular system itself.


Assuntos
Artérias/fisiopatologia , Fibrose Cística/fisiopatologia , Endotélio/fisiopatologia , Microvasos/fisiopatologia , Adulto , Índice Tornozelo-Braço , Pressão Sanguínea , Artéria Braquial/fisiopatologia , Artérias Carótidas/fisiopatologia , Estudos de Casos e Controles , Feminino , Artéria Femoral/fisiopatologia , Humanos , Masculino , Análise de Onda de Pulso , Fatores de Risco , Artérias da Tíbia/fisiopatologia , Rigidez Vascular , Adulto Jovem
11.
PLoS One ; 14(4): e0211726, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30969969

RESUMO

BACKGROUND: Brachial artery reactivity (BAR) is usually determined as the maximum brachial artery diameter (BAD) following release of an occluding pressure cuff compared to a BAD before cuff inflation. BAD early after cuff deflation can also serve as baseline for estimating total brachial artery reactivity (TBAR). We investigate whether TBAR is associated with first time coronary heart disease events. METHODS: Participants of the Multi-Ethnic Study of Atherosclerosis (n = 5499) consisting of whites, African-Americans, Chinese and Hispanics were followed longitudinally for a mean of 12.5 years. Brachial artery ultrasound was performed following five minutes of cuff occlusion at the forearm. TBAR was estimated from BAD following cuff release as the difference between maximum and minimum brachial artery diameters divided by the minimum diameter multiplied by 100%. TBAR was added to multivariable Cox proportional hazards models with Framingham risk factors as predictors and time to first coronary heart disease event as outcome. RESULTS: Average TBAR was 9.7% (9.7 SD). Mean age was 61.7 years, 50.9% women. Increased TBAR was associated with lower risk of CHD events with a hazard rate of 0.78 per SD increase (95% C.I. 0.67, 0.91; p = 0.001). A TBAR below the median of 7.87% (Inter Quartile Range: 4.16%, 13.0%) was associated with a 31% lower risk of coronary heart disease event (Hazard Ratio: 0.69; 95% C.I.: 0.55, 0.87). CONCLUSION: TBAR is an independent predictor of first time coronary heart disease events and is exclusively measured after release of a blood pressure occlusion cuff.


Assuntos
Aterosclerose/epidemiologia , Artéria Braquial/fisiopatologia , Doença das Coronárias/epidemiologia , Afro-Americanos , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Aterosclerose/etnologia , Aterosclerose/fisiopatologia , Estudos de Coortes , Doença das Coronárias/etnologia , Doença das Coronárias/fisiopatologia , Grupo com Ancestrais do Continente Europeu , Feminino , Hispano-Americanos , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais
12.
Hypertension ; 73(6): 1327-1335, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31006327

RESUMO

Excessive erythrocytosis (EE; hemoglobin concentration [Hb] ≥21 g/dL in adult males) is associated with increased cardiovascular risk in highlander Andeans. We sought to quantify shear stress and assess endothelial function via flow-mediated dilation (FMD) in male Andeans with and without EE. We hypothesized that FMD would be impaired in Andeans with EE after accounting for shear stress and that FMD would improve after isovolemic hemodilution. Brachial artery shear stress and FMD were assessed in 23 male Andeans without EE (age: 40±15 years [mean±SD]; Hb<21 g/dL) and 19 male Andeans with EE (age: 43±14 years; Hb≥21 g/dL) in Cerro de Pasco, Peru (4330 m). Shear stress was quantified from Duplex ultrasound measures of shear rate and blood viscosity. In a subset of participants (n=8), FMD was performed before and after isovolemic hemodilution with blood volume replaced by an equal volume of human serum albumin. Blood viscosity and Hb were 48% and 23% higher (both P<0.001) and FMD was 28% lower after adjusting for the shear stress stimulus ( P=0.013) in Andeans with EE compared to those without. FMD was inversely correlated with blood viscosity ( r2=0.303; P<0.001) and Hb ( r2=0.230; P=0.001). Isovolemic hemodilution decreased blood viscosity by 30±10% and Hb by 14±5% (both P<0.001) and improved shear stress stimulus-adjusted FMD from 2.7±1.9% to 4.3±1.9% ( P=0.022). Hyperviscosity, high Hb, or both, actively contribute to acutely reversible impairments in FMD in EE, suggesting that this plays a pathogenic role in the increased cardiovascular risk.


Assuntos
Altitude , Viscosidade Sanguínea/fisiologia , Artéria Braquial/fisiopatologia , Hemoglobinas/metabolismo , Policitemia/sangue , Fluxo Sanguíneo Regional/fisiologia , Vasodilatação/fisiologia , Adulto , Artéria Braquial/diagnóstico por imagem , Endotélio Vascular/fisiopatologia , Humanos , Masculino , Policitemia/etiologia , Policitemia/fisiopatologia , Fatores de Risco , Ultrassonografia Doppler
13.
J Vasc Surg ; 70(3): 853-857, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30837176

RESUMO

BACKGROUND: In 2002, Oakes et al described a novel procedure designed to salvage the distal cephalic venous outflow of a Brescia-Cimino fistula by placing a prosthetic graft between the brachial artery in the antecubital space and the cephalic vein at the wrist. In this fashion, the more proximal veins were saved for future procedures. Their approach was reported and found to be successful in the short term, but the long-term durability of the Oakes procedure has not been described. This study aimed to determine the long-term primary, primary-assisted, and secondary patency rates of the brachial to distal cephalic vein Oakes procedure. METHODS: This is a retrospective review of a prospective database in a large, single institution. All patients who underwent the Oakes procedure from 1998 to 2012 were followed up to 2018. We reviewed the time to intervention, type of intervention, patency rates, and mortality of this patient population. RESULTS: Over the 5-year study period, 14 patients were identified who underwent the Oakes procedure, of whom seven (50%) were female. The average age was 55.7 years (range, 38-73 years). All patients had a previously placed Brescia-Cimino that was not suitable for dialysis but was patent. The average number of days to placement of an Oakes brachial to distal cephalic graft was 396 (range, 119-1167) days. A total of 71% (10) of patients underwent an intervention to maintain the graft, of whom 50% (5) underwent an angioplasty and 50% (5) had a thrombectomy/revision procedure. The average number of days to first intervention was 367.3 (range, 21-1048) days from Oakes placement. Of this cohort, 30% (3) of patients had a second intervention, of whom one (33%) underwent an angioplasty and two (66%) had revisions. One patient had a third and a fourth intervention at 39 days and 74 days, respectively, that were both angioplasties. The overall number of days the Oakes procedure remained usable from placement was 843.6 (range, 21-3790) days or 2.3 years. CONCLUSIONS: This study concluded that the Oakes procedure may extend the use of the distal dialysis access site by 2.3 years without increasing infection and is hence a durable solution that should be considered in patients requiring dialysis access.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular , Artéria Braquial/cirurgia , Oclusão de Enxerto Vascular/cirurgia , Artéria Radial/cirurgia , Terapia de Salvação/métodos , Extremidade Superior/irrigação sanguínea , Veias/cirurgia , Adulto , Idoso , Implante de Prótese Vascular/efeitos adversos , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Bases de Dados Factuais , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Diálise Renal , Reoperação , Estudos Retrospectivos , Fatores de Risco , Terapia de Salvação/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
14.
J Vasc Surg ; 70(1): 199-207.e4, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30894304

RESUMO

OBJECTIVE: The arteriovenous fistula (AVF) is recommended as the preferred hemodialysis access. However, placing an AVF in all patients may result in poor access outcomes and increased central venous catheter (CVC) use because of increased comorbid conditions, age, and suboptimal vessels. In patients with inadequate superficial veins for AVFs, the use of the brachial veins for creation of forearm arteriovenous grafts (AVGs) has received limited attention. This retrospective study aimed to evaluate outcomes of forearm brachial-brachial AVGs (BB-AVGs) placed in patients with poor superficial veins. METHODS: We identified 111 BB-AVGs created in 111 consecutive patients, using standard-walled polytetrafluoroethylene grafts, between January 2010 and December 2015. After excluding 6 patients (non-dialysis initiation, missing information, and death within 1 month), we included 105 patients from 21 dialysis centers. We analyzed primary failures, time to cannulation, patency, complications, and revisions. Patency rates were calculated by the Kaplan-Meier method. The incidence of complications and revisions was expressed as number of events per person-year. RESULTS: A total of 105 patients (median age, 69 years) were followed up for a median time of 21.2 months (interquartile range, 9.2-36.5 months). Of the patients, 72.4% were on chronic hemodialysis and had previously undergone one or more access procedures. At the time of BB-AVG placement, prior accesses were 39 AVFs, 20 tunneled CVCs, and 17 AVGs. BB-AVG rates of primary failure and revision before cannulation were 7.6% and 5.7%, respectively. BB-AVGs were cannulated after a median time of 3.4 weeks (interquartile range, 2.8-4.1 weeks). Primary patency rates at 12, 24, and 36 months were 49.5%, 29.5%, and 19.5%. Secondary patency rates at 12, 24, and 36 months were 76.3%, 62.7%, and 54.6%. After cannulation, the incidence of complications and revisions was 1.054 and 0.649 per person-year, respectively. Most complications and interventions were due to thrombosis (0.527 per person-year) or stenosis (0.381 per person-year) and related interventions (0.490 per person-year). A minority of patients experienced AVG infections (0.052 per person-year), with only two requiring access removal. CONCLUSIONS: In patients with poor superficial veins, the forearm BB-AVG is a reliable access because of low access-related morbidity and considerable long-term access survival. BB-AVG placement has the advantage of preserving proximal vessels. In these patients, such an approach can delay both rapid exhaustion of vascular sites and early recourse to CVC permanent use.


Assuntos
Derivação Arteriovenosa Cirúrgica , Implante de Prótese Vascular , Artéria Braquial/cirurgia , Antebraço/irrigação sanguínea , Diálise Renal , Veias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/instrumentação , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Remoção de Dispositivo , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia , Adulto Jovem
15.
Cardiovasc Diabetol ; 18(1): 34, 2019 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885194

RESUMO

BACKGROUND: Exercise, when performed on a regular basis, is a well-accepted strategy to improve vascular function in patients with type 2 diabetes. However, the exercise intensity that yields maximal adaptations on structural and functional indices in patients with type 2 diabetes remains uncertain. Our objective was to analyze the impact of a 1-year randomized controlled trial of combined high-intensity interval training (HIIT) with resistance training (RT) vs. a combined moderate continuous training (MCT) with RT on structural and functional arterial indices in patients with type 2 diabetes. METHODS: Patients with type 2 diabetes (n = 80) were randomized into an exercise intervention with three groups: control, combined HIIT with RT and combined MCT with RT. The 1-year intervention had 3 weekly exercise sessions. High-resolution ultrasonography of the common carotid artery and central and peripheral applanation tonometry were used to assess the changes in structural and functional arterial indices. Generalized estimating equations were used to model the corresponding outcomes. RESULTS: After adjusting the models for sex, baseline moderate-to-vigorous physical activity, and mean arterial pressure changes, while using the intention-to-treat analysis, a significant interaction was observed on the carotid intima-media thickness (cIMT) for both the MCT (ß = - 4.25, p < 0.01) and HIIT group (ß = - 3.61, p < 0.01). However, only the HIIT observed favorable changes from baseline to 1-year on peripheral arterial stiffness indices such as carotid radial arterial pulse wave velocity (ß = - 0.10, p = 0.044), carotid to distal posterior tibial artery pulse wave velocity (ß = - 0.14, p < 0.01), and on the distensibility coefficient (ß = - 0.00, p < 0.01). No effect was found for hemodynamic variables after the intervention. CONCLUSIONS: Following a 1-year intervention in patients with type 2 diabetes, both the MCT and HIIT group reduced their cIMT, whereas only the HIIT group improved their peripheral arterial stiffness indices and distensibility coefficient. Taken together, HIIT may be a meaningful tool to improve long-term vascular complications in type 2 diabetes. Trial registration clinicaltrials.gov ID: NCT03144505.


Assuntos
Artéria Braquial/fisiopatologia , Artérias Carótidas/fisiopatologia , Diabetes Mellitus Tipo 2/terapia , Angiopatias Diabéticas/terapia , Hemodinâmica , Treinamento Intervalado de Alta Intensidade , Treinamento de Resistência , Anti-Hipertensivos/uso terapêutico , Pressão Arterial , Artéria Braquial/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/diagnóstico por imagem , Angiopatias Diabéticas/fisiopatologia , Humanos , Hipoglicemiantes/uso terapêutico , Manometria , Portugal , Análise de Onda de Pulso , Fatores de Tempo , Resultado do Tratamento , Rigidez Vascular
16.
Hypertension ; 73(5): 1036-1041, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30905194

RESUMO

Radial intra-arterial blood pressure (BP) is sometimes used as the reference standard for validation of brachial cuff BP devices. Moreover, there is an emerging wearables market seeking to measure BP at the wrist. However, radial systolic BP may differ when compared with brachial; yet some authors have labeled these differences as a fictional Popeye phenomenon. Indeed, differences between brachial and radial systolic BP have never been accurately quantified, and this was the aim of this study. Intra-arterial BP was measured consecutively at the brachial and radial artery in 180 participants undergoing coronary angiography (aged 61±10 years; 69% men). On average, radial systolic BP was 5.5 mm Hg higher than brachial systolic BP. Only 43% of participants had radial systolic BP within ±5 mm Hg of brachial. Additionally, 46%, 19%, and 13% of participants had radial systolic BP >5, between 5 and 10, and between 10 and 15 mm Hg higher than brachial respectively. A further 14% of participants had radial systolic BP >15 mm Hg higher than brachial, representing the so-called Popeye phenomenon. Finally, 11% of participants had radial systolic BP >5 mm Hg lower than brachial. In conclusion, radial systolic BP is not representative of brachial systolic BP, with most participants having a radial systolic BP >5 mm Hg higher than brachial and many with differences >15 mm Hg. Therefore, validation testing of BP devices utilizing intra-arterial BP as the reference standard should use intra-arterial BP measured at the same site as the brachial cuff or wearable device.


Assuntos
Pressão Sanguínea/fisiologia , Artéria Braquial/fisiopatologia , Hipertensão/fisiopatologia , Artéria Radial/fisiopatologia , Determinação da Pressão Arterial , Feminino , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade
17.
PLoS One ; 14(3): e0213239, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30856206

RESUMO

BACKGROUND AND AIM: Sepsis is associated with marked alterations in hemodynamic responses, autonomic dysfunction and impaired vascular function. However, to our knowledge, analysis of noninvasive markers to identify greater risk of death has not yet been investigated. Thus, our aim was to explore the prognostic utility of cardiac output (CO), stroke volume (SV), indices of vagal modulation (RMSSD and SD1), total heart rate variability (HRV) indices and FMD of brachial artery (%FMD), all measured noninvasively, in the first 24 hours of the diagnosis of sepsis. METHODS: 60 patients were recruited at ICU between 2015 and 2017 and followed by 28 days. CO, SV, RR intervals were measurement. Doppler ultrasound was used to assess brachial artery FMD and the hyperemic response were obtained (%FMD). Patients were divided by survivors (SG) and nonsurvivors groups (NSG). RESULTS: A total of 60 patients were analysed (SG = 21 and NSG = 39). Survivors were younger (41±15 years vs. 55±11 years) and used less vasoactive drugs. As expected, APACHE and SOFA scores were lower in NSG compared to SG. In addition, higher SD1, triangular index, % FMD, velocity baseline and hyperemia flow velocity as well as lower HR values were observed in the SG, compared to NSG (P<0.05). Interestingly, RMSSD and SD1 indices were independent predictors of %FMD, ΔFMD and FMDpeak. RMSSD threshold of 10.8ms and %FMD threshold of -1 were optimal at discriminatomg survivors and nonsurvivors. CONCLUSION: Noninvasive measurements of autonomic and endotelial function may be important markers of sepsis mortality, which can be easily obtained in the early stages of sepsis at the bedside.


Assuntos
Hemodinâmica/fisiologia , Sepse/mortalidade , Adulto , Fatores Etários , Idoso , Artéria Braquial/fisiopatologia , Estudos de Casos e Controles , Eletrocardiografia , Feminino , Frequência Cardíaca , Humanos , Unidades de Terapia Intensiva , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Sepse/patologia , Índice de Gravidade de Doença , Volume Sistólico
18.
Blood Press Monit ; 24(2): 93-98, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30741746

RESUMO

OBJECTIVES: Although applanation tonometry is the most widely used method for evaluating arterial stiffness, oscillometric ambulatory blood pressure monitoring devices using specific algorithms for pulse wave analyses have been validated more recently. Currently, it is not clear how to interpret 24-h mean values of arterial stiffness parameters. The objective of this study was to compare 24-h mean values of arterial stiffness parameters obtained using 24-h ambulatory blood pressure monitoring device (Mobil-O-Graph) against a validated single-measure tonometric system (SphygmoCor). MATERIALS AND METHODS: We measured brachial and central arterial pressure, augmentation index (AIx), and carotid-to-femoral pulse wave velocity (cfPWV) using SphygmoCor device in 82 high and very high cardiovascular risk patients. The Mobil-O-Graph device for the 24-h blood pressure and arterial stiffness parameter monitoring was used on the same day and started within 2 h after measurements using SphygmoCor were done. RESULTS: Mean AIx values were 26.38±9.95 for SphygmoCor office measurement and 26.69±8.45 for Mobil-O-Graph 24-h mean values. The mean difference was -0.31±9.78 (P=0.775). CfPWV values were 10.56±2.59 m/s for SphygmoCor office measurement and 8.72±1.29 m/s for Mobil-O-Graph 24-h mean values. The difference of 1.84±2.15 m/s was statistically significant (P<0.001). Correlation coefficients for AIx and cfPWV between two methods were 0.444 and 0.468, respectively (P<0.001). CONCLUSION: The agreement between SphygmoCor single measurement and Mobil-O-Graph 24-h mean values of arterial stiffness parameters is moderate. The 24-h mean values of cfPWV obtained by Mobil-O-Graph are significantly lower than SphygmoCor values obtained in the office, whereas 24-h AIx mean values do not have a significant bias.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/instrumentação , Monitorização Ambulatorial da Pressão Arterial/métodos , Artéria Braquial/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Rigidez Vascular , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Ann Vasc Surg ; 58: 331-337, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30769062

RESUMO

BACKGROUND: The aim of this study is to investigate the effect of preexisting calcification in the inflow artery on maturation and flow volume of an arteriovenous fistula (AVF). METHODS: Patients who underwent AVF creation for hemodialysis were prospectively recruited between March and November 2017. On preoperative duplex ultrasound, calcification in the arterial media within 5 cm of the planned anastomosis area was assessed. Clinical maturation was defined as the successful use of the fistula for ≥75% of the dialysis sessions during a month within 6 months after surgery. Radiological maturation was defined as a venous diameter of ≥0.4 cm and a flow volume of ≥500 mL/min. Flow volumes of the inflow artery and the cephalic vein were measured at 6 and 12 weeks after AVF creation. RESULTS: Eighteen patients with calcification and 29 patients without calcification were enrolled in this study. There was no significant difference in the clinical and radiological maturation between the groups. The flow volume of the inflow artery, measured at 6 weeks postoperatively, was significantly higher in the noncalcification group than in the calcification group (P = 0.042). The flow volume of the inflow artery in the noncalcification group was increased at 12 weeks postoperatively (P = 0.091). Flow volume of the vein was higher in the noncalcification group than in the calcification group, although it did not reach statistical significance. CONCLUSIONS: In conclusions, preexisting arterial calcification did not adversely affect the AVF maturation. However, arterial calcification correlated with the flow volume of the inflow artery of AVF.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Braquial/cirurgia , Artéria Radial/cirurgia , Diálise Renal , Extremidade Superior/irrigação sanguínea , Calcificação Vascular/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Velocidade do Fluxo Sanguíneo , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Fluxo Sanguíneo Regional , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Calcificação Vascular/diagnóstico por imagem , Grau de Desobstrução Vascular
20.
Kidney Blood Press Res ; 44(1): 123-132, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30808839

RESUMO

BACKGROUND/AIMS: Possible predictive value of aortic-brachial arterial stiffness mismatch assessed by pulse wave velocity PWV ratio in peritoneal dialysis patients' outcomes need to be further elucidated. The aim of this study is to investigate the predictor value of PWV ratio on peritoneal dialysis (PD) patients' outcomes in China. METHODS: In this longitudinal cohort study, patients who started PD during September 20, 2005, to February 05, 2008, were included. All the patients were followed until January 31, 2018. Aortic-brachial arterial stiffness mismatch was assessed using carotid-femoral pulse wave velocity divided by carotid-radial pulse wave velocity (PWV ratio). RESULTS: A total of 181 incident PD patients were included. The median survival of patients in PWV ratio above median group (4.03 years, 95% CI 4.64-7.99 years) was shorter than that of PWV ratio below median group (10.43 years, 95% CI 9.74-11.12 years, p< 0.001). The cardiovascular mortality rate in PWV ratio above median group were significantly higher than that of PWV below median group (log rank test, p< 0.001). Univariate Cox regression analysis showed that both PWV ratio (HR 2.42, 95% CI 1.80-3.25, p< 0.001) and CF-PWV (HR 1.27, 95% CI 1.16-1.38, p< 0.001) were associated with high patients' all-cause mortality. Multivariable Cox regression analysis showed that the PWV ratio was a strong and significantly predictor of cardiovascular mortality (HR 2.08 95% CI 1.16-3.71, p=0.014) after adjusting for coronary heart disease history (HR 2.39, 95% CI 1.20-4.76, p=0.013), diabetes mellitus history (HR 2.84, 95% CI 1.51-5.33, p=0.001). However, the CF-PWV was failed to be included as a significant predictor for both all-cause and CVD mortality in the multivariable Cox regression model. CONCLUSION: Aortic-brachial arterial stiffness mismatch as assessed by PWV ratio, a new arteries stiffness risk parameter, is a significant prognostic indicator of CVD mortality in PD patients. We demonstrated that the discriminative power of the PWV ratio for both all-cause and CVD mortality was better than that CF-PWV.


Assuntos
Artéria Braquial/fisiopatologia , Diálise Peritoneal/mortalidade , Análise de Onda de Pulso , Rigidez Vascular , Adulto , Idoso , Doenças Cardiovasculares/mortalidade , China , Estudos de Coortes , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/mortalidade , Falência Renal Crônica/fisiopatologia , Estudos Longitudinais , Pessoa de Meia-Idade , Valor Preditivo dos Testes
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