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2.
Int J Sports Med ; 41(1): 3-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31791089

RESUMO

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


Assuntos
Hemodinâmica/fisiologia , Extremidade Inferior/fisiologia , Meias de Compressão , Artérias/diagnóstico por imagem , Artérias/fisiologia , Pressão Sanguínea/fisiologia , Estudos Cross-Over , Feminino , Frequência Cardíaca/fisiologia , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiologia , Volume Sistólico/fisiologia , Gordura Subcutânea/irrigação sanguínea , Gordura Subcutânea/diagnóstico por imagem , Gordura Subcutânea/fisiologia , Ultrassonografia Doppler , Resistência Vascular/fisiologia , Veias/diagnóstico por imagem , Veias/fisiologia , Adulto Jovem
3.
Vasa ; 49(1): 72-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31414968

RESUMO

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


Assuntos
Angioplastia , Síndromes Compartimentais , Extremidade Inferior/cirurgia , Cateterismo , Desenho de Equipamento , Humanos , Extremidade Inferior/irrigação sanguínea , Resultado do Tratamento
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(1): 69-74, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31500525

RESUMO

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


Assuntos
Embolectomia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Trombectomia , Tromboembolia/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Masculino , Tromboembolia/diagnóstico por imagem , Tromboembolia/fisiopatologia , Resultado do Tratamento
6.
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
7.
Khirurgiia (Mosk) ; (12): 54-59, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825343

RESUMO

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


Assuntos
Celulite (Flegmão)/cirurgia , Supuração/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Celulite (Flegmão)/etiologia , Desbridamento , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Supuração/etiologia , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento , Veias/cirurgia
8.
Rev Med Suisse ; 15(674): 2236-2240, 2019 Dec 04.
Artigo em Francês | MEDLINE | ID: mdl-31804035

RESUMO

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


Assuntos
Diabetes Mellitus Tipo 2/complicações , Extremidade Inferior/irrigação sanguínea , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Amputação , Artérias/patologia , Diabetes Mellitus Tipo 2/patologia , Diabetes Mellitus Tipo 2/terapia , Humanos , Fatores de Risco , Doenças Vasculares/patologia , Doenças Vasculares/terapia
9.
Rev Med Suisse ; 15(674): 2242-2246, 2019 Dec 04.
Artigo em Francês | MEDLINE | ID: mdl-31804036

RESUMO

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


Assuntos
Artérias/patologia , Extremidade Inferior/irrigação sanguínea , Doenças Vasculares/terapia , Humanos , Fatores de Risco , Resultado do Tratamento , Doenças Vasculares/patologia
10.
Rev Med Suisse ; 15(674): 2247-2250, 2019 Dec 04.
Artigo em Francês | MEDLINE | ID: mdl-31804037

RESUMO

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


Assuntos
Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/complicações , Doença Arterial Periférica/terapia , Estilo de Vida Saudável , Humanos , Fatores de Risco , Resultado do Tratamento
11.
Rev Med Suisse ; 15(674): 2252-2255, 2019 Dec 04.
Artigo em Francês | MEDLINE | ID: mdl-31804038

RESUMO

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


Assuntos
Terapia por Exercício , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/terapia , Exercício/fisiologia , Humanos , Caminhada
12.
Angiol Sosud Khir ; 25(4): 35-39, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855199

RESUMO

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


Assuntos
Anticoagulantes/uso terapêutico , Rivaroxabana/uso terapêutico , Doenças Vasculares/tratamento farmacológico , Doenças Vasculares/cirurgia , Grau de Desobstrução Vascular/efeitos dos fármacos , Varfarina/uso terapêutico , Anticoagulantes/farmacologia , Artérias/efeitos dos fármacos , Artérias/cirurgia , Implante de Prótese Vascular , Artéria Femoral/efeitos dos fármacos , Artéria Femoral/cirurgia , Humanos , Extremidade Inferior/irrigação sanguínea , Artéria Poplítea/efeitos dos fármacos , Artéria Poplítea/cirurgia , Estudos Retrospectivos , Rivaroxabana/farmacologia , Artérias da Tíbia/efeitos dos fármacos , Artérias da Tíbia/cirurgia , Resultado do Tratamento , Varfarina/farmacologia
13.
Internist (Berl) ; 60(12): 1235-1239, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31667527

RESUMO

BACKGROUND: Peripheral artery disease (PAD) is often diagnosed in an advanced stage. Accordingly, revascularization is also performed late. OBJECTIVES: In this paper, the authors describe the progression to critical limb ischemia and cardiovascular risk. Revascularization for secondary prevention is explained. Revascularization strategies according to lesion location and complexity of the stenosis or occlusion are discussed. MATERIALS AND METHODS: The current guidelines and randomized controlled studies and meta-analyses are analyzed. RESULTS: PAD is associated with a considerable level of suffering and a high cardiovascular risk. Up to 20% of patients with claudicants will progress to critical limb ischemia. Progression and risk of mortality increase during the course of the disease. Improvement of walking ability by revascularization is a major goal of secondary prevention. In the femoropopliteal segment, drug-coated balloon (DCB) angioplasty and bare-metal stent (BMS) implantation are the methods of choice. In long lesions, spot-stenting should be preferred. For treatment of in-stent restenosis, DCB have proven their effectiveness. In severely calcified or dissected lesions, BMS are well suited. Infrapopliteal lesions should be revascularized to provide in-line flow to the foot through the target arterial path. According to current evidence, DCB or drug-eluting stents are more effective than plain old balloon angioplasty or BMS.


Assuntos
Angioplastia com Balão/métodos , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/terapia , Guias de Prática Clínica como Assunto , Fármacos Cardiovasculares , Stents Farmacológicos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
14.
Artigo em Russo | MEDLINE | ID: mdl-31626157

RESUMO

AIM: To study the possibility and feasibility of using terahertz-modulated infrared radiation in the treatment of patients with gonarthrosis, including those with concomitant chronic lower limb venous insufficiency and to develop a specific treatment procedure. SUBJECTS AND METHODS: A total of 92 patients were examined and treated. The patients matched for age, gender, and main clinical manifestations were divided into a study group and a control one. All the patients received disease-modifying anti-rheumatic drugs, therapeutic exercises, including those in a swimming pool. In addition to the basic treatment, the patients in the study group had terahertz-modulated infrared radiotherapy. Before and after treatment, all the patients underwent a physical examination; their complaints were studied; pain severity was assessed by a visual analog scale (VAS) for pain; lower limb temperature was measured by infrared beam thermography; and microcirculation in the affected knee joint area was analyzed by laser Doppler flowmetry. RESULTS: Analysis of posttreatment changes in clinical manifestations in the study group revealed a significant reversion of clinical manifestations, such as knee joint pain occurring at the end of the day or in the first half of the night (from 42.6 to 15.3%), as well as pain occurring after mechanical load and reducing at rest (from 72.3 to 25.5%). The changes in mean VAS scores in the study group (from 6.1±0.7 to 2.1±0.6) were significantly pronounced (p<0.01) compared with those in the controls (from 6.6±0.7 to 4.3±0.4). Infrared beam thermography established that the study group had a decrease in the thermal asymmetry value between varicose veins and adjacent tissues, indicating a hemodynamic improvement in the lower extremity vessels (by 1.57±0.07 °C in the study group (p<0.05) versus 0.91±0.04 °C in the control group (p<0.05). The ongoing package of rehabilitation measures assisted in reducing the temperature difference between the affected vein area and adjacent tissues. CONCLUSION: The incorporation of terahertz-modulated infrared radiation into a therapeutic complex was found to have a positive impact on the clinical symptoms of the disease, the state of local hemodynamics and microcirculation, which substantially enhances the efficiency of therapy.


Assuntos
Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/radioterapia , Insuficiência Venosa/complicações , Estudos de Viabilidade , Feminino , Humanos , Raios Infravermelhos/uso terapêutico , Extremidade Inferior/irrigação sanguínea , Masculino , Osteoartrite do Joelho/fisiopatologia , Resultado do Tratamento , Insuficiência Venosa/fisiopatologia
15.
Khirurgiia (Mosk) ; (10): 43-49, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626238

RESUMO

OBJECTIVE: To analyze the effectiveness of complex therapy of necrotizing infection using the original method of stimulation of angiogenesis in patients with chronic arterial insufficiency of the lower extremities. MATERIAL AND METHODS: In 53 patients, operations were performed using the proposed technologies for stimulation of angiogenesis. A control group consisting of 56 patients was formed to compare the results of treatment. They had standard vascular therapy for the correction of ischemia. Morphological studies of the muscles of the lower extremities included assessment of capillary bed density and spatial orientation of the capillaries before and after treatment. Computed angiography of the lower extremities followed by calculation of perfusion index was performed to assess changes in the microvasculature. Clinical evaluation of the results was carried out using R. Rutherford scale. RESULTS: Revascularization resulted significant augmentation of capillary bed density and the number of functioning capillaries in muscular tissue. This was accompanied by increased perfusion index and TcPO2 values. The effect of treatment is observed in 12-14 days after surgery and persists for a long time. The best outcomes are found in patients with ischemia grade IIb-III. Incidence of lower limb amputations was more than 2 times lower in the main group compared with the control group. CONCLUSION: Combined stimulation of angiogenesis including mechanical tunneling of the muscles of the affected limb and administration of platelet rich plasma is effective procedure. This method does not require complex equipment and may be used in the treatment of patients with complications of chronic lower limb ischemia and contraindicated direct arterial reconstruction.


Assuntos
Arteriopatias Oclusivas/cirurgia , Capilares/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Necrose/cirurgia , Neovascularização Fisiológica , Arteriopatias Oclusivas/fisiopatologia , Capilares/fisiopatologia , Humanos , /terapia , Isquemia/fisiopatologia , Isquemia/cirurgia , Extremidade Inferior/fisiopatologia , Microvasos/fisiopatologia , Microvasos/cirurgia , Músculo Esquelético/fisiopatologia , Músculo Esquelético/cirurgia , Necrose/etiologia , Necrose/fisiopatologia , Plasma Rico em Plaquetas/fisiologia , Resultado do Tratamento
16.
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
17.
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
18.
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
19.
Vasc Health Risk Manag ; 15: 409-418, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31571892

RESUMO

Introduction: Previous studies have shown that veterans with lower limb amputation have a higher risk for cardiovascular disease (CVD) compared with population-based controls. American veterans who have served in Iraq and Afghanistan with lower limb amputation may be at a similarly higher risk. Patients and methods: The Navel Health Research Center (NHRC) maintains the Expeditionary Medical Encounter Database (EMED) of military personnel who have sustained combat limb amputation or serious limb injury during the conflicts in Iraq and Afghanistan. Department of Veterans Affairs data from 2003 to April 2015 was used to analyze CVD risk factors in this cohort. Veterans with either unilateral (n=442) or bilateral (n=146) lower limb amputation were compared to those with serious lower limb trauma without amputation (n=184). Multivariate regression was used to measure associations between lower limb amputation and CVD risk factors over an average of 8 years of follow-up. Outcomes included mean arterial pressure (MAP), low-density lipoprotein, high-density lipoprotein (HDL), and serum triglycerides (TG). Results: Compared with the limb injury group, those with unilateral lower limb amputation had significantly lower HDL (p<0.05) and higher TG (p<0.05). Those with bilateral lower limb amputation had significantly higher MAP (p<0.05), lower HDL (p<0.01), and higher TG (p<0.001). The prevalence of metabolic syndrome, defined as type 2 diabetes or a constellation of blood pressure and lipid changes consistent with metabolic syndrome, was 8.7%, 14.9%, and 21.9% for limb injury, unilateral amputation, and bilateral amputation groups, respectively. Veterans with bilateral lower limb amputation had a 2.25-increased odds ratio (95% confidence interval 1.19-5.05) of type 2 diabetes or blood pressure and lipid changes consistent with metabolic syndrome compared to those with limb injury. Conclusions: Results suggest that veterans with lower limb amputation have a higher risk for metabolic syndrome. Primary care interventions to manage weight, blood pressure, and lipid levels are fundamental in order to reduce cardiac risk in this relatively young cohort.


Assuntos
Amputação/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Extremidade Inferior/irrigação sanguínea , Síndrome Metabólica/epidemiologia , Lesões do Sistema Vascular/cirurgia , Saúde dos Veteranos , Adulto , Campanha Afegã de 2001- , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Bases de Dados Factuais , Feminino , Hemodinâmica , Humanos , Guerra do Iraque 2003-2011 , Lipídeos/sangue , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia , United States Department of Veterans Affairs , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/fisiopatologia
20.
Medicine (Baltimore) ; 98(37): e17103, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517841

RESUMO

BACKGROUND: To assess whether the ultrasound (US) is a reliable approach in detecting lower-limb deep-vein thrombosis (DVT) in patients without symptoms of DVT. METHODS: The research team performed a systematic search in PubMed, Ovid, Cochrane, and Web of Science without language or date restrictions. Full-text reports on prospective diagnostic studies involve the detection of lower-limb proximal and distal DVT in patients without symptoms of DVT using US and venography. A meta-analysis was performed using Meta-DiSc (version 1.4), providing the pooled sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios of the detection accuracy of US. There were 4 different classes of subgroup analysis-the class of patients stratified by location of US exam (proximal, distal, whole leg), the class stratified by technique (color/doppler, compression, both modalities), the class stratified by kind of surgery (orthopedic, otherwise hospitalized) and the class stratified by era of publishing (1980s, 1990s, 2000s). The study quality and the risk of bias were evaluated using QUADAS-2, with heterogeneity was assessed and quantified by the Q score and I statistics, respectively. RESULTS: The meta-analysis included 26 articles containing 41 individual studies with a total of 3951 patients without symptoms of DVT. Using venography as the gold standard, US for proximal DVT had a pooled sensitivity of 59% (95% confidence interval (CI) = 51%-66%) and a pooled specificity of 98% (95% CI = 97%-98%), US for distal DVT had a poor sensitivity of 43% (95% CI = 38%-48%) and a pooled specificity of 95% (95% CI = 94%-96%), US for whole-leg DVT had a pooled sensitivity of 59% (95% CI = 54%-64%) and a pooled specificity of 95% (95% CI = 94%-96%), US for post-major orthopedic surgery patients had a pooled sensitivity of 52% (95% CI = 49%-55%), and US for other types of patients had a pooled sensitivity of 58% (95% CI = 43%-72%). Pure compression technique for DVT had a poor sensitivity of 43% (95% CI = 39%-48%), pure color/doppler technique for DVT had a pooled sensitivity of 58% (95% CI = 53%-63%), compression and color/doppler technique for DVT had a pooled sensitivity of 61% (95% CI = 48%-74%). CONCLUSION: US could be a useful tool for diagnosing DVT, but it has a lower positive rate and a higher false negative rate. The rate of missed diagnosis of lower-limb DVT by US amounts to 50% or so in the patients without symptoms of DVT. The negative results do not preclude the possibility of DVT and if appropriate heightened surveillance and continued monitoring or try a more accurate inspection method is warranted. The whole leg evaluation and color/doppler technique should be the preferred approach.


Assuntos
Diagnóstico Tardio , Extremidade Inferior/irrigação sanguínea , Ultrassonografia/normas , Trombose Venosa/diagnóstico , Humanos , Extremidade Inferior/fisiopatologia , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos , Trombose Venosa/epidemiologia
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