Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.240
Filtrar
1.
J Comput Assist Tomogr ; 44(1): 20-25, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939877

RESUMO

OBJECTIVES: The purpose of this study was to evaluate whether quantitative analysis of lower leg muscle enhancement measured from dynamic computed tomographic angiography (dyn-CTA) could be used for diagnosis of peripheral arterial occlusive disease. METHODS: Patients (N = 35) with known peripheral arterial occlusive disease underwent the dyn-CTA of calves first. Five minutes later, standard CTA of the peripheral runoff from the diaphragm to the toes was performed. A runoff score was assigned by radiologists as a reference standard for each of 4 lower leg artery segments. The lower leg muscle enhancement measured from the dyn-CTA was analyzed by using quantitative kinetic parameters, including initial enhancement (E1), peak enhancement (Epeak), and enhancement ratio (ER) calculated from average time attenuation curves. In addition, histogram of lower leg muscle enhancement was evaluated by using the first enhanced phase images. RESULTS: Lower extremities were diagnosed as a normal group (n = 22) with each vessel segment score equals to 1 or lower and runoff score, 7 or lower, and otherwise as an ischemia group (n = 48). Average ± SD E1 is 91.4% ± 8.5% and 82.3% ± 10.7%, Epeak is 122.7% ± 10.4% and 115.6% ± 11.1%, and ER is 0.75 ± 0.05 and 0.72 ± 0.09 for normal and ischemia group, respectively. Statistical analysis showed that average E1 and Epeak for the ischemia group were significantly lower (P < 0.05) than the normal group. The histogram analysis demonstrated that mean and median of muscle enhancement in the ischemia group were significantly smaller (P < 0.05), and coefficient of variation (CV) was significantly larger (P < 0.05) than the normal group. There were weak negative correlations (r = -0.42, P < 0.05) between runoff scores and E1 and Epeak, and weak positive correlation (r = 0.40, P < 0.05) between runoff scores and CV. The receiver operating characteristics analysis between the 2 groups had area under the curve of 0.77 and 0.76 for E1 and CV, respectively. CONCLUSIONS: Lower leg muscle enhancement measured from the dyn-CTA could be assessed quantitatively to assist diagnosis of ischemia in clinical practice.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Extremidade Inferior/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação
2.
Medicine (Baltimore) ; 99(4): e18760, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977867

RESUMO

RATIONALE: Peripheral arterial diseases (PADs) is defined as a systemic arterial disorders involving the lower extremity arteries, iliac, and carotid, which is developed more common in patients with chronic kidney disease (CKD) than individual with normal renal function. Concurrence of mesenteric artery disease and lower extremity artery disease (LEAD) is rare. The presence of PADs in patients receiving hemodialysis leads to a dramatic increase in risk of cardiovascular mortality. However, the early diagnosis of PADs in patient with CKD remains a challenge to nephrologists, which adds an adverse effect on prognosis. PATIENT CONCERNS: A 48-year-old man received regular hemodialysis due to end-stage renal failure caused by type 2 diabetes mellitus (T2DM) for 7 years, who was admitted into hospital for acute, severe rest pain of the right lower extremity at the first time. The computed tomography angiography showed severe, diffuse stenosis of the distal third of femoral artery. After discharged, he was readmitted into hospital for abdominal pain and the recurred right lower limb pain. A diagnostic angiography confirmed the initial occlusion of superior mesenteric artery, severe obstruction of the distal segment of femoral artery and diffuse, irregular stenosis of arteria peronea and arteria tibialis posterior. DIAGNOSIS: The patient was diagnosed as PADs including LEAD and mesenteric artery disease. INTERVENTIONS: The percutaneous transulminal angioplasty (PTA) combined with antiplatelet therapy and beraprost were performed. Moreover, the cinacalcet and lanthanum carbonate were prescribed to control calcium-phosphorus- parathyroid hormone metabolism. OUTCOMES: The patient was free of abdominal pain and partly relieved from the ache of lower limb after PTA. However, he finally succumbed to acute myocardial infarction. LESSONS: The incidence of PADs is higher in dialysis patients due to a unique set of biochemical and endocrine abnormalities. As there is a high uremic status and PADs burden in patients with hemodialysis, the short term risk of cardiovascular disesase mortality markedly increases. There is a need for nephrologists and cardiovascular physicians to identify these patients and then provide early and proper treatment.


Assuntos
Falência Renal Crônica/terapia , Doença Arterial Periférica/etiologia , Diálise Renal/efeitos adversos , Angioplastia , Diabetes Mellitus Tipo 2/complicações , Evolução Fatal , Artéria Femoral/diagnóstico por imagem , Humanos , Falência Renal Crônica/etiologia , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem
3.
Vasc Endovascular Surg ; 54(2): 141-146, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31749415

RESUMO

OBJECTIVES: To compare outcomes in patients randomized to infrapopliteal (IP) plain balloon angioplasty (PBA) for chronic limb-threatening ischemia within the Bypass versus Angioplasty in Severe Ischemia of the Leg (BASIL)-1 trial between 1999 and 2004 with outcomes in consecutive patients undergoing IP PBA at an academic vascular unit a decade later (2009-2013, Contemporary series [CS]). METHODS: Individual patient data were obtained from prospective BASIL-1 (48 patients) and CS databases (73 patients). All had a minimum of 3-years of follow-up. Outcomes studied were amputation-free survival (AFS), overall survival (OS), major (above ankle) limb amputation, arterial reintervention, immediate technical success, and length of hospital stay for the index procedure and during the following 12-month period. Statistical analysis was performed using SAS version 9.4. RESULTS: The BASIL and CS cohorts were well matched for gender, age, diabetes, previous stroke, myocardial infarction and arterial intervention, and presence of tissue loss. More patients in BASIL-1 underwent concomitant treatment of the superficial femoral (60% vs 37%, P = .01) and above knee popliteal (60% vs 34%, P = .005) arteries. Immediate technical success increased from 73% in BASIL-1 to 90% in the CS (P = .01). Between the two cohorts, there were no differences in AFS (hazard ratio [HR] = 1.00, 95% confidence interval [CI]: 0.65-1.54, P = 1.0), OS (HR = 1.04, 95% CI: 0.66-1.62, P = .9), major amputation (HR = 0.86, 95% CI: 0.37-1.97, P = .7), or reintervention (HR = 0.61, 95% CI: 0.29-1.27, P = .2). Contemporary series patients spent significantly fewer days in hospital following the index procedure (P = .02) and also over the following 12 months (P = .002). CONCLUSIONS: Despite improvements in the immediate technical angiographic success of IP PBA between BASIL and the CS, there were no significant improvements in survival outcomes. Results from BASIL-2 and BEST-CLI are required in order to properly define the clinical and cost-effectiveness of endovascular treatment in such patients.


Assuntos
Angioplastia com Balão , Isquemia/terapia , Doença Arterial Periférica/terapia , Artéria Poplítea , Idoso , Idoso de 80 Anos ou mais , Amputação , Angioplastia com Balão/efeitos adversos , Doença Crônica , Bases de Dados Factuais , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Tempo de Internação , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Intervalo Livre de Progressão , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores de Tempo , Grau de Desobstrução Vascular
4.
Vasc Endovascular Surg ; 54(2): 97-101, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31746279

RESUMO

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.


Assuntos
Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Extremidade Inferior/irrigação sanguínea , Angiografia por Ressonância Magnética , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Padrões de Prática Médica/tendências , Idoso , Tomada de Decisão Clínica , Angiografia por Tomografia Computadorizada/tendências , Bases de Dados Factuais , Procedimentos Endovasculares/tendências , Feminino , Humanos , Angiografia por Ressonância Magnética/tendências , Masculino , Variações Dependentes do Observador , Seleção de Pacientes , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
5.
Vasc Endovascular Surg ; 54(2): 126-134, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31709914

RESUMO

INTRODUCTION: Revascularization is the cornerstone of the treatment of critical limb ischemia (CLI), but the number of elderly frail patients increase. Revascularization is not always possible in these patients and conservative therapy seems to be an option. The goals of this study are to analyze the 1-year quality of life (QoL) results and mortality rates of elderly patients with CLI and to investigate if conservative treatment could be an acceptable treatment option. METHODS: Patients with CLI ≥70 years old were included in a prospective observational cohort study in 2 hospitals in the Netherlands between 2012 and 2016 and were divided over 3 treatment modalities: endovascular therapy, surgical revascularization, and conservative treatment. The World Health Organization Quality of Life (WHOQoL-Bref) instrument, a generic QoL assessment tool that includes components of physical, psychological, social relationships and environment, was used to evaluate QoL at baseline, 6 months, and 1 year. RESULTS: In total, 195 patients (56% male, 33% Rutherford 4, mean age of 80) were included. Physical QoL significantly increased after surgical (10.4 vs 14.9, P < .001), endovascular (10.9 vs 13.7, P < .001), and conservative therapy (11.6 vs 13.2, P = .01) at 1 year. One-year mortality was relatively low after surgery (10%) compared to endovascular (40%) and conservative therapy (37%). CONCLUSION: The results of this study could not be used to designate the superior treatment used in elderly patients with CLI. Conservative treatment could be an acceptable treatment option in selected patients with CLI unfit for revascularization. Treatment of choice in elderly patients with CLI is based on multiple factors and should be individualized in a shared decision-making process.


Assuntos
Tratamento Conservador , Procedimentos Endovasculares , Isquemia/terapia , Doença Arterial Periférica/terapia , Qualidade de Vida , Procedimentos Cirúrgicos Vasculares , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Tratamento Conservador/efeitos adversos , Tratamento Conservador/mortalidade , Estado Terminal , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/mortalidade , Isquemia/fisiopatologia , Masculino , Países Baixos , Seleção de Pacientes , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
6.
Vasc Endovascular Surg ; 54(1): 17-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526118

RESUMO

INTRODUCTION: The aim of this study is to describe our experience in the treatment of femoropopliteal occlusive disease with percutaneous transluminal angioplasty (PTA) followed by stenting with S.M.A.R.T. Flex vascular stent system. MATERIALS AND METHODS: From June 2014 to October 2018, 80 patients were treated at our Institution for intermittent claudication, critical, or acute limb ischemia due to total occlusion or long diffused lesions of the femoropopliteal segment. Main study end points are primary patency, target lesion revascularization, and stent fractures; secondary end points are major amputation rate, procedure-related bleeding, incidence of intrastent restenosis, and primary assisted patency after reintervention. RESULTS: Mean follow-up time was 21 months (range 2-48 months). Primary patency rate was 80% (64 patients of 80), with mean covered lesion length of 8.2 cm. The deployment of a single stent was obtained for 57 (89%) patients, with a mean stent length of 9.86 cm. Of 80 patients, 2 (2.5%) had early stent occlusion within first 48 hours after the procedure, while 4 (5%) of 80 patients experienced stent occlusion within first 6 months. Of 80 patients, 6 (7.5%) had an intrastent restenosis detected at duplex ultrasound with a primary-assisted patency after simple re-PTA procedures of 83.3% at 12 months. DISCUSSION: In the literature, primary patency after PTA and stenting of the femoropopliteal trunk seems to be related to several variables, such as number of stents used, specific stent length, diameters, type and length of lesions, type of pathology (if acute or chronic), and number of preoperatory patent below-the-knee vessels. In this study, we try to analyze each single factor in order to understand their role in predisposing specific stent restenosis. CONCLUSIONS: S.M.A.R.T. Flex vascular stent system has shown good results in terms of primary patency in the treatment of calcified lesions both at SFA and at popliteal level. However, in our experience, stent patency seems to be significantly poorer in patients presenting with acute limb ischemia associated with chronic atherosclerotic disease as well as for lesions located in the mid-distal part of the popliteal artery and both when number of stents increases or number of runoff vessel decreases.


Assuntos
Angioplastia/instrumentação , Artéria Femoral , Claudicação Intermitente/terapia , Isquemia/terapia , Doença Arterial Periférica/terapia , Artéria Poplítea , Stents , Idoso , Idoso de 80 Anos ou mais , Angioplastia/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/fisiopatologia , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Itália , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Recidiva , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
7.
Vasc Endovascular Surg ; 54(1): 85-88, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31547785

RESUMO

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.


Assuntos
Artéria Ilíaca/cirurgia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Enxerto Vascular/métodos , Doença Crônica , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular
8.
J Cardiovasc Surg (Torino) ; 60(5): 567-571, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31778065

RESUMO

Chronic total occlusion (CTO) is a common finding during endovascular treatment of peripheral arterial disease. The treatment of CTOs is a challenging task, which requires good knowledge of the devices and their specific characteristics and skills to different techniques for crossing. As a matter of fact, any dedicated center treating patients with peripheral arterial disease requires an adequate consignment stock regarding wires, catheters, balloons and some specific devices for challenging anatomic scenarios. Herein, the most important steps of a successful recanalization of a femoropopliteal CTO are summarized together with a number of tips regarding utilization of different techniques and specific devices.


Assuntos
Procedimentos Endovasculares/métodos , Artéria Femoral , Doença Arterial Periférica/terapia , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
9.
J Cardiovasc Surg (Torino) ; 60(6): 652-661, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31603292

RESUMO

INTRODUCTION: Hyperspectral imaging (HSI) is a noninvasive technique for transcutaneous measurements of tissue perfusion. This study (1) provides a review of the current literature on HSI for tissue perfusion measurements of the lower leg and (2) introduces a standardized measurement protocol for HSI measurements with a portable system. EVIDENCE ACQUISITION: A literature search was performed for studies on tissue perfusion measurements with HSI in the lower extremity. A standardized protocol was developed to perform HSI measurements in 43 healthy volunteers at the plantar side of the foot and at the lateral side of the calf, with 3 consecutive hyperspectral images at each location. EVIDENCE SYNTHESIS: The literature review identified 9 studies, including 2 of healthy volunteers, 4 of patients with diabetes mellitus, and 3 of patients with peripheral arterial disease. In 5 of 7 patient studies, HSI values were associated with severity of disease or wound healing. In our study, the healthy volunteers' HSI values for oxyhemoglobin, deoxyhemoglobin, and oxygen saturation were (mean±SD) 82.8±24, 55.7±15.7, and 59.2±11.7, respectively, at the plantar surface of the foot, and 40.8±11, 38.0±7.8, and 51.7±10.5, respectively, at the lateral side of the calf. HSI values differed significantly between the calf and plantar locations. Intraoperator reliability between the 3 consecutive images ranged from 81% to 89%. CONCLUSIONS: Limited evidence indicates that HSI is associated with severity of peripheral arterial disease and diabetes mellitus, and with wound healing. Hyperspectral images with a portable system can be taken with high precision when a standardized measurement protocol is used. However, differences exist at several locations at the lower extremity, so each measurement location should be used as its own reference when consecutive measurements are performed during follow-up. More studies with larger patient cohorts should be performed before HSI can be incorporated as standard tool in the diagnostic armamentarium of the vascular specialist.


Assuntos
Extremidade Inferior/irrigação sanguínea , Imagem de Perfusão/métodos , Doença Arterial Periférica/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Microcirculação , Imagem de Perfusão/normas , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Fluxo Sanguíneo Regional , Índice de Gravidade de Doença , Análise Espectral , Cicatrização
10.
J Cardiovasc Surg (Torino) ; 60(6): 672-678, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31603293

RESUMO

BACKGROUND: Sarcopenia, commonly determined by measuring skeletal muscle mass index (SMI) at the third lumbar level, has been identified as a predictor of clinical outcome in a variety of diseases. For patients with peripheral arterial occlusive disease (PAOD), we hypothesized that lower extremity SMI (LESMI) might be a more precise predictor of outcome and the extent of chronic ischemia than the systemic muscle mass at the L3 level. We investigated the association between complete muscle volume and muscle area derived with single-slice 2-dimensional measurements in the legs to identify at which level cross-sectional single-slice measurements are most representative of the muscle volume and investigated whether LESMI is associated with systemic sarcopenia and PAOD severity. METHODS: Muscle volumes and areas were semiautomatically segmented from computed tomography (CT) scans of the affected and contralateral legs of 50 PAOD patients with Fontaine stage IIb and 50 PAOD patients with Fontaine stage IV. The muscle mass was determined for the complete volumes of the upper and lower legs and for cross-sectional slices at 40%, 50%, and 60% of the length of the femur and tibia. Patients were determined as sarcopenic based on sex-specific cut-off values at the L3 spinal segment. Two observers segmented 20 randomly selected patients to determine the interobserver reliability with the intraclass correlation coefficient. RESULTS: The correlation between the LESMI of the complete muscle volume and the three cross-sectional slices in all 200 upper and 200 lower legs was moderately strong to strong. Interobserver reliability of cross-sectional slice segmentation was excellent. The LESMI, both measured volumetrically and cross-sectionally, were significantly lower in patients with sarcopenia compared to patients without sarcopenia. The LESMI was lower in patients with Fontaine stage IV compared to patients with Fontaine stage IIb for both volumetric and cross-sectional measurements. CONCLUSIONS: Segmentation of skeletal muscle mass from cross-sectional single-slice CT in the upper and lower leg can accurately and precisely substitute complete volume segmentations. These findings warrant the use of measurements based on cross-sectional single-slice CT for assessing the LESMI. Patients with systemic sarcopenia are also at increased risk for muscle mass loss in the lower extremities. In the current study, LESMI was lower in patients with Fontaine class IV PAOD compared to patients with Fontaine class IIb PAOD. Future studies should assess the predictive value of the LESMI on clinical outcomes in PAOD patients.


Assuntos
Composição Corporal , Isquemia/diagnóstico por imagem , Extremidade Inferior/irrigação sanguínea , Músculo Esquelético/diagnóstico por imagem , Atrofia Muscular/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Sarcopenia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Feminino , Humanos , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Atrofia Muscular/fisiopatologia , Variações Dependentes do Observador , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sarcopenia/fisiopatologia , Índice de Gravidade de Doença
11.
J Cardiovasc Surg (Torino) ; 60(6): 642-651, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31603294

RESUMO

INTRODUCTION: The aim of this article is to systematically review the literature on medical adjunctive therapy for patients with chronic limb-threatening ischemia (CLTI). EVIDENCE ACQUISITION: MEDLINE, Embase, and Cochrane Database of Systematic Reviews were searched for studies published between January 1st, 2009, and June 1st, 2019. Articles that studied medical treatment of CLTI patients and reported clinical outcomes were eligible. Main exclusion criteria were case reports <20 patients, incorrect publication type, and CLTI caused by Buerger disease. The primary end point was major amputation (above the ankle) in studies with a follow-up of ≥6 months. Secondary end points were other clinical end points such as death and wound healing. Study quality was assessed according to the Downs and Black checklist. EVIDENCE SYNTHESIS: Included were 42 articles: four focused on antiplatelet therapy, five on antihypertensive medication, 6 on lipid-lowering therapy, 16 on stem cell therapy, three on growth factors, five on prostanoids, and one study each on cilostazol, glucose-lowering therapy, spinal cord stimulation, sulodexide, and hemodilution. Calcium channel blockers, iloprost, cilostazol, and hemodilution showed significant improvement of limb salvage, but data are limited. Stem cell therapy showed no significant improvement of limb salvage but could potentially improve wound healing. Antiplatelets, antihypertensives, and statins showed significantly lower cardiovascular events rates but not evident lower major amputation rates. The quality of the studies was fair to good. CONCLUSIONS: Certain medical therapies serve to improve limb salvage next to revascularization in CLTI patients, whereas others are important in secondary prevention. Because high quality evidence is limited, further research is needed.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Isquemia/tratamento farmacológico , Doença Arterial Periférica/tratamento farmacológico , Amputação , Fármacos Cardiovasculares/efeitos adversos , Estado Terminal , Humanos , Isquemia/diagnóstico por imagem , Isquemia/mortalidade , Isquemia/fisiopatologia , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Fatores de Risco , Resultado do Tratamento
12.
J Cardiovasc Surg (Torino) ; 60(6): 679-685, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31603295

RESUMO

BACKGROUND: Endovascular treatment of occlusive disease of the superficial femoral artery (SFA) has evolved from plain old balloon angioplasty (POBA) through primary stenting strategy to drug eluting technology-based approach. The RAPID Trial investigates the added value of drug coated balloons (DCB, Legflow) in a primary stenting strategy (Supera stent) for intermediate (5-15 cm) and long segment (>15 cm) SFA lesions. METHODS: In this multicenter, patient-blinded trial, 160 patients with intermittent claudication, ischemic rest pain, or tissue loss due to intermediate or long SFA lesions were randomized (1:1) between Supera + DCB and Supera. Primary endpoint was primary patency at 2 years, defined as freedom from restenosis on duplex ultrasound (peak systolic velocity ratio <2.4). RESULTS: At 2 years, primary patency was 55.1% (95% CI: 43.1-67.1%) in the Supera + DCB group versus 48.3% (95% CI: 35.6-61.0%) in the Supera group (P=0.957). Per protocol analysis showed a primary patency rate of 60.9% (95% CI: 48.6-73.2%) in the Supera + DCB group versus 49.8% (95% CI: 36.9-62.7%) in the Supera group (P=0.469). The overall mortality rate was 5% in both groups (P=0.975). Sustained functional improvement was similar in both groups. CONCLUSIONS: The 2-year results in the current trial of a primary Supera stenting strategy are consistent with other trials reporting on treatment of intermediate and long SFA lesions. A DCB supported Supera stent strategy did not improve patency rate compared to a Supera stent only strategy.


Assuntos
Angioplastia com Balão/instrumentação , Fármacos Cardiovasculares/administração & dosagem , Materiais Revestidos Biocompatíveis , Artéria Femoral , Doença Arterial Periférica/terapia , Stents , Dispositivos de Acesso Vascular , Angioplastia com Balão/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Estudos Prospectivos , Desenho de Prótese , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
13.
J Cardiovasc Surg (Torino) ; 60(6): 686-692, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31603296

RESUMO

BACKGROUND: In patients requiring infrageniculate surgical revascularization a single-segment great saphenous vein (SS-GSV) is the optimal conduit. In the absence of a SS-GSV, the small saphenous vein and arm veins can also be used to obtain an all-autologous bypass. The aim of this study was to compare the long-term results of infrageniculate SS-GSV bypasses and spliced vein bypasses in patients with chronic limb-threatening ischemia (CLTI). METHODS: A total of 308 consecutive CLTI patients who underwent a primary infragenicular, autologous bypass between January 2000 and December 2016 were included. The definition of a spliced vein bypass was a graft consisting of at least two venous segments. RESULTS: A SS-GSV graft was used in 235 patients, and a spliced vein graft was used in 73 patients. Significantly more infrapopliteal bypasses were performed in the spliced vein group (P=0.024), and in this group the mean operation time was almost 60 minutes longer (P<0.001). The overall morbidity rate was 44%. The overall 30-day mortality was 3.2%, and overall in-hospital mortality was 4.9%. No significant differences were observed between the groups in mortality, overall morbidity or any specific complication. Comparing the SS-GSV group with the spliced vein group, no significant differences were observed between overall survival (53.2% vs. 45.7%), primary patency (55.5% vs. 53.2%), assisted primary patency (78.5% vs. 76.5%), secondary patency (87.9% vs. 90.6%) and limb salvage (83.3% vs. 82.0%). CONCLUSIONS: The use of infrageniculate spliced vein bypasses for the treatment of CLTI patients results in similar results compared with infrageniculate SS-GSV bypass grafts. A strict surveillance protocol in the first 2 years and a liberal reintervention strategy may result in excellent long-term patency rates.


Assuntos
Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Veia Safena/transplante , Enxerto Vascular/métodos , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Mortalidade Hospitalar , Humanos , Isquemia/diagnóstico por imagem , Isquemia/mortalidade , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Países Baixos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Enxerto Vascular/mortalidade , Grau de Desobstrução Vascular
15.
J Stroke Cerebrovasc Dis ; 28(11): 104370, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31522885

RESUMO

BACKGROUND: Peripheral arterial disease (PAD) is an advanced form of atherosclerosis defined by an abnormal ankle-brachial index (ABI). However, the ABI provides no information about the location of atherosclerosis. We investigated the clinical implication of PAD confirmed using lower-extremity ultrasonography (LEUS), with consideration of the atherosclerosis location. METHODS: Patients with acute ischemic stroke who underwent LEUS were enrolled. Patients with PAD were further divided into those with PAD at the proximal (above-popliteal artery, PADP) and distal (below-tibialis artery, PADD) segments. The clinical outcome was compared between patients with and without PAD, and between PADP and PADD. The atherosclerosis location in the cerebral artery was also compared between groups. RESULTS: Among 289 patients, PAD was observed in 108 (37.4%) patients (43 had PADP and 65 had PADD). Patients with PAD were slightly older (P < .001) and had more significant carotid artery stenosis (30.6% versus 12.7%, P < .001) than those without. Patients with PAD had poor 3-month functional outcome than those without (modified-Rankin Scale score: 3 [interquartile range, 1-4] versus 2 [1-3], respectively, P = .003). Diabetes, high-stroke severity, and the presence of PADP (odds ratio, 3.893; 95% confidence interval, 1.454-10.425; P = .007) were independently associated with poor functional outcome at 3 months. Patients with PADP showed higher prevalence of extracranial stenosis than those with PADD (41.9% versus 23.1%; P = .038). CONCLUSIONS: Our study suggests that subclinical PAD, especially PADP, is associated with poor functional outcome at 3 months after stroke onset. Interestingly, the location of cerebral atherosclerosis differed according to the location of PAD.


Assuntos
Isquemia Encefálica/reabilitação , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/diagnóstico por imagem , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Ultrassonografia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
16.
Vasc Health Risk Manag ; 15: 283-290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496717

RESUMO

Angiography remains a widely utilized imaging modality during vascular procedures. Angiography, however, has its limitations by underestimating the true vessel size, plaque morphology, presence of calcium and thrombus, plaque vulnerability, true lesion length, stent expansion and apposition, residual narrowing post intervention and the presence or absence of dissections. Intravascular ultrasound (IVUS) has emerged as an important adjunctive modality to angiography. IVUS offers precise imaging of the vessel size, plaque morphology and the presence of dissections and guides interventional procedures including stent sizing, assessing residual narrowing and stent apposition and expansion. IVUS-guided treatment has shown to yield superior outcomes when compared to angiography-only guided therapy. The cost-effectiveness of the routine use of IVUS during vascular procedures needs to be further studied.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Ultrassonografia de Intervenção , Doença da Artéria Coronariana/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Stents , Resultado do Tratamento
17.
J Med Vasc ; 44(5): 311-317, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31474340

RESUMO

INTRODUCTION: Chronic inflammatory diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), are accompanied by high cardiovascular morbidity and mortality secondary to accelerated and premature atherosclerosis. Atherosclerosis is correlated with chronic systemic inflammation independently of the factors for cardiovascular risk. Vasculitis of large arteries such as Takayasu's disease, are characterized both by chronic systemic inflammation and local parietal vascular inflammation. METHODS: We prospectively analyzed in a case-control study, a group of 64 carriers of Takayasu's arteritis patients with a mean age of 41 years [±11.94], a group of 50 RA female patients aged 45 years [±10.27], and a control group with an average age of 44 years [±12.63]. We recorded classic cardiovascular risk factors and used the Framingham equation to calculate the risk. We measured the intima-media thickness (IMT) in the carotids and noted the presence of carotid, aortic and femoral atheroma. RESULTS: The mean calculated cardiovascular risk was 3.5 % in the Takayasu's group. It was 4.4 % in the RA group, and 4.5 % in controls with no significant difference between the three groups (P=0.153). Subclinical atherosclerosis defined by IMT> 0.70mm and/or the presence of atheroma plaque was found in 87 % of Takayasu's patients versus 76 % of RA patients, (P=0.088) and 48 % of controls (P<0.001). Most atherosclerotic plaques were found in the Takayasu group. Compared to the control group the carotid intima-media thickness was significantly higher in the Takayasu group. The average IMT in the Takayasu group was 0.91mm [±0.368], 0.76mm [±0.151] for the PR group, and 0.71mm [±0.141] for controls. DISCUSSION: Atherosclerosis observed in Takayasu's disease was accelerated and premature, occurring in young patients with a low overall cardiovascular risk. Recent data support the central role of inflammation in all stages of atherogenesis from endothelial dysfunction to plaque rupture. Systemic inflammation associated with local parietal inflammation observed in Takayasu's arteritis, appears to be responsible for accelerated and premature atherosclerosis. The results of our study and the literature review favor an active strategy for cardiovascular prevention in Takayasu's disease.


Assuntos
Doenças da Aorta/epidemiologia , Doenças das Artérias Carótidas/epidemiologia , Doença Arterial Periférica/epidemiologia , Arterite de Takayasu/epidemiologia , Adulto , Idade de Início , Doenças da Aorta/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Placa Aterosclerótica , Prevalência , Estudos Prospectivos , Fatores de Risco , Arterite de Takayasu/diagnóstico , Fatores de Tempo
19.
Vasc Endovascular Surg ; 53(7): 558-562, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31327305

RESUMO

OBJECTIVE: Thrombolytic therapy is widely used in the treatment of arterial occlusions causing acute limb ischemia (ALI); however, knowledge regarding the efficacy of the different catheter systems available is scarce. The objective of this study was to compare the safety and efficacy of 2 catheter-directed infusion systems for intra-arterial thrombolysis in the setting of ALI. METHODS: A retrospective analysis was conducted to study all catheter-directed thrombolysis procedures performed over 32 months in patients diagnosed with ALI. Patients with thrombosis in both native arteries and bypass grafts were included. Patients with contraindications to thrombolysis, or those receiving thrombolysis for deep venous thrombosis, were excluded. The duration of thrombolysis, amount of thrombolytic agent, and technical success rate were recorded. Technical success was defined as complete or near-complete resolution of thrombus burden, allowing for further intervention. Data were stratified to include location of thrombus, procedural complications, mortality, and rates of limb loss. RESULTS: Ninety-one patients met inclusion criteria. Among them, Uni-Fuse and EKOS catheters were used in 69 and 22 patients, respectively. The mean age of the population was 71 (standard deviation [SD]: ±1.5) for patients treated with the EKOS catheter and 70 years (SD: ±2.6) for patients receiving thrombolysis with Uni-Fuse. There was no significant difference in the mean infusion duration (1.65 vs 1.9 days), volume of tissue plasminogen activator (44.6 vs 48.2 mg), or technical success rate (72% vs 86%) between the Uni-Fuse and EKOS cohorts (P > .3). Furthermore, there was no difference in major limb loss or compartment syndrome between each group (P > .4). The overall complication rate was 14% in both groups, with a 30-day mortality rate of 4% when treated with either catheter system. CONCLUSION: This study suggests that a standard multi-hole infusion catheter demonstrates similar clinical safety and efficacy as the ultrasound-accelerated EKOS system in the treatment of ALI.


Assuntos
Cateterismo Periférico , Fibrinolíticos/administração & dosagem , Isquemia/terapia , Doença Arterial Periférica/terapia , Terapia Trombolítica , Trombose/terapia , Terapia por Ultrassom , Doença Aguda , Idoso , Amputação , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Registros Eletrônicos de Saúde , Desenho de Equipamento , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Parenterais , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Salvamento de Membro , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/instrumentação , Trombose/diagnóstico por imagem , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Terapia por Ultrassom/efeitos adversos , Terapia por Ultrassom/instrumentação , Dispositivos de Acesso Vascular
20.
Vasc Endovascular Surg ; 53(6): 464-469, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31213146

RESUMO

INTRODUCTION: During endovascular aneurysm repair, the iliac artery typically serves as a conduit for device delivery. The degree of tortuosity and calcification in the iliac artery ultimately determines whether the device can successfully traverse the vessel. These 2 parameters can be assessed using qualitative approaches or calculated using quantitative methods based on the Society for Vascular Surgery (SVS) reporting standards. The objective of this study was to determine whether qualitative methods are sufficient to accurately assess iliac artery tortuosity and calcification by calculating interobserver variability and comparing them to the SVS Reporting Standards. METHODS: Three vascular surgeons reviewed preoperative computed tomography scans for 50 patients who underwent fenestrated endovascular aneurysm repair and qualitatively assessed left and right iliac artery tortuosity and calcification. Iliac artery geometries were segmented from these image sets. Tortuosity index and calcification length ratio were calculated and categorized based on the SVS Reporting Standards. RESULTS: Interobserver variability was calculated for the qualitative assessments using interclass correlation coefficients. For tortuosity index, among the 3 observers, good agreement was found for the left iliac artery and fair agreement was found for the right. For calcification length ratio, excellent agreement was found for both iliac arteries. When compared to the quantitative assessment, the qualitative assessments underpredicted tortuosity in 2.3% of cases, matched the quantitative values in 16.7% of cases, and overpredicted tortuosity in 81.0% of cases. The qualitative assessments underpredicted calcification in 46.3% of cases, matched the quantitative values in 49.3% of cases, and overpredicted calcification in 4.3% of cases. CONCLUSION: Qualitative assessment of iliac artery tortuosity showed fair-to-good interobserver agreement and poor agreement to SVS Reporting Standards. Qualitative assessment of iliac artery calcification showed excellent interobserver agreement and fair agreement to SVS Reporting Standards. These trends should be considered when qualitative reporting methodologies are used.


Assuntos
Angiografia por Tomografia Computadorizada , Artéria Ilíaca/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA