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1.
Vasc Health Risk Manag ; 16: 57-66, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32103970

RESUMO

Background: High-risk patients with advanced peripheral artery disease (PAD), including critical limb ischemia (CLI), are often excluded from peripheral endovascular device intervention clinical trials, leading to difficulty in translating trial results into real-world practice. There is a need for prospectively assessed studies to evaluate peripheral endovascular device intervention outcomes in CLI patients. Methods: LIBERTY 360 is a prospective, observational, multi-center study designed to evaluate the procedural and long-term clinical outcomes of peripheral endovascular device intervention in real-world patients with symptomatic lower-extremity PAD. One thousand two hundred and four patients were enrolled and stratified based on Rutherford Classification (RC): RC2-3 (N=501), RC4-5 (N=603), and RC6 (N=100). For this sub-analysis, RC5 and RC6 patients (RC5-6; N=404) were pooled and 1-year outcomes were assessed. Results: Procedural complications rarely (1.7%) resulted in post-procedural hospitalization and 89.1% of RC5-6 patients were discharged to home. Considering the advanced disease state in RC5-6 patients, there was a high freedom from 1-year major adverse event rate of 65.5% (defined as target vessel revascularization, death to 30 days, and major target limb amputation). At 1 year, freedom from major amputation was 89.6%. Wounds identified at baseline on the target limb had completely healed in 172/243 (70.8%) of the RC5-6 subjects by 1 year. Additionally, the overall quality of life, as measured by VascuQoL, improved from baseline to 1 year. Conclusion: LIBERTY investigated real-world PAD patients with independent oversight of outcomes. This analysis of LIBERTY RC5-6 patients demonstrates that peripheral endovascular device intervention can be successful in CLI patients, with low rates of major amputation and improvement in wound healing and quality of life through 1-year follow-up.LIBERTY 360, https://clinicaltrials.gov/ct2/show/NCT01855412, ClinicalTrials.gov Identifier: NCT01855412.


Assuntos
Procedimentos Endovasculares/instrumentação , Isquemia/terapia , Doença Arterial Periférica/terapia , Idoso , Amputação , Estado Terminal , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Isquemia/diagnóstico , Isquemia/fisiopatologia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Intervalo Livre de Progressão , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Tempo , Estados Unidos , Cicatrização
3.
J Surg Res ; 245: 537-543, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470334

RESUMO

BACKGROUND: After an esophageal resection, continuity is commonly restored by a gastric tube reconstruction and an intrathoracic anastomosis to the remaining proximal esophagus. Ischemia of the anastomotic region is considered to play a pivotal role in anastomotic leakage. Microdialysis (µD) is an excellent method to measure local biochemical substances and parameters in a specific organ or compartment aiming at early detection of ischemia. This animal study evaluates ischemia of the gastric tube reconstruction using a novel method-µD on organ surfaces. This promising method may have the potential to detect an anastomotic leakage before clinical symptoms develop. METHODS: Anesthetized normoventilated pigs were used. Surface microdialysis (S-µD) catheters and an intraparenchymal oxygen tension catheter were placed on the stomach. A gastric tube was made and the gastroepiploic artery was divided halfway along the greater curvature to produce severe ischemia at the top of the gastric tube. µD data from four locations (gastric tube, ileum and peritoneal cavity) were recorded every 20 min during the experiment. Tissue samples from all catheter sites underwent histopathological analysis. Intraparenchymal oxygen partial pressure, systemic blood tests, and hemodynamic parameters were recorded. RESULTS: S-µD data showed values indicating severe ischemia at the top of the gastric tube and intermediate ischemia at the level of transection of the gastroepiploic artery. Ischemia was verified by histopathological analysis of tissue samples and intraparenchymal oxygen tension data. CONCLUSIONS: S-µD can detect and grade severity of local ischemia in real time, in an animal model.


Assuntos
Fístula Anastomótica/diagnóstico , Esofagectomia/efeitos adversos , Esôfago/irrigação sanguínea , Isquemia/diagnóstico , Microdiálise/métodos , Anastomose Cirúrgica/efeitos adversos , Animais , Modelos Animais de Doenças , Esôfago/patologia , Esôfago/cirurgia , Humanos , Isquemia/etiologia , Isquemia/patologia , Oxigênio/análise , Índice de Gravidade de Doença , Sus scrofa
4.
Ann Vasc Surg ; 62: 8-14, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31207400

RESUMO

OBJECTIVE: The aim of this study was to evaluate the performance of paclitaxel-eluting stents (PESs) and paclitaxel-coated balloons (PCBs) on amputation-free survival in patients with critical limb ischemia (CLI). METHODS: A retrospective review of all patients with Rutherford stage 5 and 6 limb ischemia undergoing endovascular revascularization with paclitaxel-related technology, both PES and PCB, was carried out over a 4-year period. Clinical grading was determined by Rutherford classification and the Society for Vascular Surgery's Wound, Ischemia, and foot Infection (WIfI) scoring system. Clinical and angiographic follow-up was reviewed based on intention-to-treat analysis. The primary endpoint of this study was amputation-free survival at 12 months. Secondary endpoints included wound healing, freedom from target lesion revascularization, and patency of target vessels at 12 months. Follow-up occurred at 3, 6, and 12 months postoperatively. Target lesion patency was defined as <50% stenosis, based on a duplex velocity ratio of less than or equal to 2. Postoperative ankle-brachial index (ABI) and duplex ultrasound were performed to verify successful treatment. Outcomes were evaluated using Kaplan-Meier and Cox proportional-hazards models. RESULTS: A total of 88 limbs were revascularized in 88 patients. Drug-eluting stent (DES) was used as the sole drug technology in 56 patients (60.7% men, median age 70.5 years) and drug-coated balloon (DCB) was used as the sole drug technology in 32 patients (46.9% men, median age 66 years). Baseline demographics were well matched except for a higher prevalence of occluded target lesions in the DES group (41.1% vs. 12.5%; P = 0.004). Limbs were treated for Rutherford stage 5 CLI in 71.6% and stage 6 CLI in 28.4%. Univariate analysis identified no dependent factors affecting limb salvage, except for the use of DCBs. After 12 months of follow-up, amputation-free survival was significantly higher in the DES group than in the DCB group (88.5% vs. 71.1%; P = 0.0443). Wound healing rates after 1 year were also higher in the DES group (83.9% vs. 59.4%; P = 0.0198). Freedom from target lesion revascularization was no different between patients treated with DESs and patients treated with DCBs (90.6% vs. 85.7%; P = 0.518). Primary patency at 12 months in patients treated with DESs was significantly higher than in patients treated with PCBs (80.4% vs. 58.1%; P = 0.0255). CONCLUSIONS: Overall, drug technology represents a viable option for patients with CLI; a cohort not represented in major randomized trials. In our experience, femoropopliteal lesions treated with DESs have higher primary patency rates than those treated with DCBs. This was found to support higher amputation-free survival rates in patients treated with paclitaxel DESs than those treated with paclitaxel DCB. The use of paclitaxel DESs for CLI was also associated with significantly improved wound healing compared with DCBs. Our data suggest improved outcomes with DESs compared with DCBs; however, these patients represent a nonrandomized, heterogenous group that were treated with the operator's best judgment.


Assuntos
Amputação , Angioplastia com Balão/instrumentação , Fármacos Cardiovasculares/administração & dosagem , Materiais Revestidos Biocompatíveis , Stents Farmacológicos , Isquemia/terapia , Paclitaxel/administração & dosagem , Doença Arterial Periférica/terapia , Dispositivos de Acesso Vascular , Idoso , Amputação/efeitos adversos , Amputação/mortalidade , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/mortalidade , Fármacos Cardiovasculares/efeitos adversos , Tomada de Decisão Clínica , Estado Terminal , Feminino , Humanos , Isquemia/diagnóstico , Isquemia/mortalidade , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Paclitaxel/efeitos adversos , Seleção de Pacientes , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Intervalo Livre de Progressão , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Grau de Desobstrução Vascular
6.
Plast Reconstr Surg ; 144(4): 907-910, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568302

RESUMO

The authors' purpose was to determine whether there are reliable noninvasive methods of assessing upper extremity ischemia regardless of skin pigmentation. The authors conducted a study of healthy subjects classified based on skin pigmentation using the Fitzpatrick scale, the von Luschan color scale, and self-described race (two Hispanics, three Caucasians, and four African Americans). A surface temperature probe and a near-infrared spectroscopy monitor were placed on the posterior interosseous artery skin territory. Temporary upper limb ischemia was induced by tourniquet insufflation. Readings from both devices were taken at baseline and every 15 seconds for a total of 10 minutes of ischemia. During tourniquet insufflation, the authors found a reliable decrease in tissue oxygenation measured by near-infrared spectroscopy in all subjects and no significant change in temperature readings for any subjects. There was an average decrease of 19 percent in tissue oxygenation using near-infrared spectroscopy, with measurements on average starting at 77 percent and ending at 57 percent. There was no significant difference in the change in near-infrared spectroscopy oxygenation between participants with Fitzpatrick skin types 3, 4, and 5 or when participants were grouped into Fitzpatrick skin type less than or equal to 3 versus greater than 3, or when grouped into Fitzpatrick skin type less than or equal to 4 versus greater than 4. There was also no significant difference in participants grouped into von Luschan scores less than or equal to 20 versus greater than 20. In this healthy subjects study, near-infrared spectroscopy rapidly identified ischemia in all cases, whereas skin surface temperature did not. Near-infrared spectroscopy may be a reliable way of noninvasively monitoring for ischemia regardless of skin pigmentation degree. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Diagnostic, IV.


Assuntos
Temperatura Corporal , Isquemia/diagnóstico , Isquemia/metabolismo , Oxigênio/metabolismo , Pele/irrigação sanguínea , Diagnóstico Precoce , Humanos , Pigmentação da Pele , Espectroscopia de Luz Próxima ao Infravermelho , Fatores de Tempo , Extremidade Superior
7.
Nepal J Ophthalmol ; 11(21): 86-90, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31523073

RESUMO

BACKGROUND: Ocular ischemic syndrome is not a common condition so most of these cases are often misdiagnosed or treated as a different entity. Therefore, it is very important for the ophthalmologists to have this condition in mind as a differential so that the patients can be diagnosed and treated as early as possible. A 42 years female presented with painless, progressive diminution of vision in right eye over the period of 1 month. She doesn't give any history of redness of eyes, fever or trauma. There is no history of diabetes mellitus or hypertension as well. On examination, vision in right and left eyes was 1.78 and 0.30 Log Mar Units respectively. On anterior segment examination, revascularization of iris (1o 4 'o'clock hrs) in right eye was noted. On dilated fund us copy, revascularization of disc (1/3rd) was present in right eye. Cotton wool spots blot hemorrhages and micro aneurysms were also noted in right eye. Likewise, attenuation of arteries were noted on both sides. Fund us fluorescent angiography revealed delayed artery covetous and venous phase. Carotid Doppler was done which showed complete occlusion of right common carotid and bilateral internal carotid artery. These findings lead to the diagnosis as ocular ischemic syndrome so she was then referred to the cardiologist who further confirmed that no active intervention was required at present. The patient was planned for right eye pan retinal photocoagulation (PRP) and was completed in 2 sittings and was asked to follow up regularly. CONCLUSION: Early diagnosis and management is very important for uncommon conditions such as ocular ischemic syndrome to prevent further complications.


Assuntos
Artéria Carótida Primitiva , Estenose das Carótidas/complicações , Oftalmopatias/diagnóstico , Olho/irrigação sanguínea , Isquemia/diagnóstico , Retina/diagnóstico por imagem , Adulto , Estenose das Carótidas/diagnóstico , Oftalmopatias/etiologia , Oftalmopatias/cirurgia , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Fotocoagulação/métodos , Retina/cirurgia , Síndrome , Ultrassonografia Doppler
8.
BMJ Case Rep ; 12(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31519720

RESUMO

A 56-year-old truck driver with a history of tobacco use presented with acute onset digital ischaemia in the ulnar distribution of his dominant hand, associated with severe pain. Occupational exposures included extensive manual labour and prolonged vibratory stimuli. Workup with Doppler and angiography confirmed the diagnosis of hypothenar hammer syndrome (HHS). After the failure of medical management, he underwent ulnar artery thrombectomy with reconstruction and arterial bypass grafting. His pain improved significantly postsurgically, and he was able to return to a normal routine. This case illustrates the classic presentation, examination, imaging findings and management options of HHS. HHS should be considered in patients with digital ischaemia and associated occupational exposures. Diagnosing the condition appropriately allows for optimal management, aiming at minimising symptoms and maximising quality of life.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Dedos/irrigação sanguínea , Síndrome da Vibração do Segmento Mão-Braço/diagnóstico por imagem , Artéria Ulnar/lesões , Angiografia/métodos , Arteriopatias Oclusivas/etiologia , Diagnóstico Diferencial , Dedos/patologia , Síndrome da Vibração do Segmento Mão-Braço/etiologia , Humanos , Isquemia/diagnóstico , Isquemia/fisiopatologia , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Síndrome , Trombectomia/métodos , Resultado do Tratamento , Artéria Ulnar/patologia , Artéria Ulnar/cirurgia , Ultrassonografia Doppler/métodos , Enxerto Vascular/métodos
9.
J Vasc Surg ; 70(3): 996-1006.e7, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31445653

RESUMO

OBJECTIVE: Readmission to the hospital after revascularization for peripheral artery disease (PAD) is frequently reported. No consensus exists as to the exact frequency and risk factors for readmission. This review aimed to determine the incidence of and risk factors for 30-day readmission after revascularization for PAD. METHODS: PubMed/Medline (Ovid), Scopus, Web of Science, the Cochrane Library, and CINAHL were searched systematically from inception until May 20, 2018. Studies were eligible for inclusion if they included patients with diagnosed PAD undergoing revascularization and reported the readmission rate and a statistical evaluation of the association of at least one risk factor with readmission. Studies were excluded if data for other procedures could not be distinguished from revascularization. Two authors undertook study selection independently with the final inclusion decision resolved through consensus. The PRISMA and Meta-analyses of Observational Studies in Epidemiology guidelines were followed regarding data extraction and quality assessment, which was performed by two authors independently. Data were pooled using a random effects model. RESULTS: The primary outcome was readmission within 30 days of revascularization. Fourteen publications reporting the outcomes of 526,008 patients were included. Reported readmission rates ranged from 10.9% to 30.0% with a mean of 16.4% (95% confidence interval [CI], 15.1%-17.9%). Meta-analyses suggested the following risk factors had a significant association with readmission: female sex (odds ratio [OR], 1.13; 95% CI, 1.05-1.21), black race (OR, 1.36; 95% CI, 1.28-1.46), dependent functional status (OR, 1.72; 95% CI, 1.43-2.06), critical limb ischemia (OR, 2.12; 95% CI, 1.72-2.62), emergency admission (OR, 1.75; 95% CI, 1.43-2.15), hypertension (OR, 1.39; 95% CI, 1.26-1.54), heart failure (OR, 1.82; 95% CI, 1.50-2.20), chronic pulmonary disease (OR, 1.19; 95% CI, 1.08-1.32), diabetes (OR, 1.47; 95% CI, 1.32-1.63), chronic kidney disease (OR, 1.93; 95% CI, 1.62-2.31), dialysis dependence (OR, 2.08; 95% CI, 1.75-2.48), smoking (OR, 0.83; 95% CI, 0.78-0.89), postoperative bleeding (OR, 1.70; 95% CI, 1.23-2.35), and postoperative sepsis (OR, 4.13; 95% CI, 2.02-8.47). CONCLUSIONS: Approximately one in six patients undergoing revascularization for PAD are readmitted within 30 days of their procedure. This review identified multiple risk factors predisposing to readmission, which could potentially serve as a way to target interventions to reduce readmissions.


Assuntos
Procedimentos Endovasculares/efeitos adversos , Claudicação Intermitente/cirurgia , Isquemia/cirurgia , Readmissão do Paciente , Doença Arterial Periférica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estado Terminal , Feminino , Nível de Saúde , Humanos , Incidência , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/epidemiologia , Isquemia/diagnóstico , Isquemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
10.
J Hand Surg Asian Pac Vol ; 24(3): 359-370, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438795

RESUMO

Background: Chronic hand ischemia refers to progressive, non-acute ischemic symptoms such as cold intolerance, rest pain, ulceration, tissue necrosis, and digit loss and poses a significant challenge in management. Conservative treatment begins with medical optimization and pharmacologic therapy, but when symptoms persist, surgical intervention may be required. Various operations exist to improve circulation including sympathectomy, arterial bypass, or venous arterialization. The purpose of this study is to systematically review published outcomes and present our experience with each surgical technique. Methods: A systematic review of literature regarding surgical treatment of chronic hand ischemia published between 1990 and 2016 was conducted using PRISMA guidelines. A retrospective-review of surgical interventions for chronic hand ischemia from 2010 to 2016 was then conducted. Primary outcomes included improvement in pain, wound-healing, and development of new ulcerations. Results: The review included 38 eight studies, showing all three techniques were effective in treating chronic hand ischemia. Sympathectomy had the lowest rate of new ulcerations (0.8%); bypass had the highest rate of healing existing ulcerations (89%). Arterialization was associated with consistent pain improvement pain (100%) but more complications (30.8%). Our series included 18 patients with 21 affected hands, 18 sympathectomies, 6 ulnar artery bypasses, and 1 arterialization. Most hands had improvement of wounds (89.5%) and pain (78.9%). No patients developed new ulcerations, but one required secondary amputation. Conclusions: When conservative measures fail to improve chronic hand ischemia, surgical intervention is an effective last line treatment. An algorithmic approach can determine the best operation for patients with chronic hand ischemia.


Assuntos
Mãos/irrigação sanguínea , Isquemia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Estudos Retrospectivos , Simpatectomia , Resultado do Tratamento , Artéria Ulnar/cirurgia , Veias/cirurgia , Adulto Jovem
11.
Am J Case Rep ; 20: 1268-1272, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455756

RESUMO

BACKGROUND Myonecrosis is an uncommon complication of poorly controlled diabetes, predominantly involving the lower limbs. It is an atypical presentation in the upper limbs. Here, we report a rare case with atypical involvement of the upper limbs. CASE REPORT A 53-year-old diabetic woman presented with left arm pain for the past week. She was not compliant with her medications. The patient denied any history of trauma or injection. Physical examination revealed a warm, tender, and erythematous swelling on the medial side of the left arm and was otherwise unremarkable. Her glycemic control was poor, with Hb A1C of 9.6%. Duplex ultrasonography demonstrated no evidence of fluid collection or thrombosis. An initial MRI (without contrast) report was misleadingly suggestive of polymyositis. Orthopedic consultant urged the patient to transfer to the operating room for aspiration of a probable infectious nidus, which resulted in a dry tap. Despite confusing radiological clues, ischemic myonecrosis was suspected, and second MRI studies (with contrast) reported necrosis. Tissue biopsy (the criterion standard) was withheld to avoid the risk of delayed healing or superimposed infection. Meanwhile, the patient received supportive treatment and achieved full recovery within 1 month. CONCLUSIONS Diabetic myonecrosis should be suspected in any poorly controlled diabetic patient presenting with otherwise unexplained muscle pain without any evidence of infection. Diagnosis can be made by MRI, leaving very few indications for invasive procedures. Analgesics and glycemic control are the mainstays of treatment.


Assuntos
Complicações do Diabetes , Isquemia/diagnóstico , Músculo Esquelético/patologia , Necrose/diagnóstico por imagem , Diabetes Mellitus/tratamento farmacológico , Feminino , Humanos , Imagem por Ressonância Magnética , Adesão à Medicação , Pessoa de Meia-Idade , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/diagnóstico por imagem , Mialgia/etiologia
13.
Int J Mol Sci ; 20(15)2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31362356

RESUMO

Mouse hind limb ischemia is the most common used preclinical model for peripheral arterial disease and critical limb ischemia. This model is used to investigate the mechanisms of neovascularization and to develop new therapeutic agents. The literature shows many variations in the model, including the method of occlusion, the number of occlusions, and the position at which the occlusions are made to induce hind limb ischemia. Furthermore, predefined end points and the histopathological and radiological analysis vary. These differences hamper the correlation of results between different studies. In this review, variations in surgical methods of inducing hind limb ischemia in mice are described, and the consequences of these variations on perfusion restoration and vascular remodeling are discussed. This study aims at providing the reader with a comprehensive overview of the methods so far described, and proposing uniformity in research of hind limb ischemia in a mouse model.


Assuntos
Membro Posterior/irrigação sanguínea , Isquemia/diagnóstico , Isquemia/etiologia , Neovascularização Fisiológica , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Operatórios , Animais , Modelos Animais de Doenças , Membro Posterior/anatomia & histologia , Membro Posterior/patologia , Membro Posterior/cirurgia , Camundongos , Imagem de Perfusão , Fluxo Sanguíneo Regional , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Ultrassonografia Doppler
14.
Analyst ; 144(15): 4677-4686, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31268052

RESUMO

We have investigated the development of murine hindlimb ischemia from day 1 to day 55 after femoral artery ligation (FAL) using blood flow analysis, functional tests, histopathological staining, and in vivo Raman spectroscopy. FAL resulted in hindlimb blood deprivation and the loss of functionality as attested by the blood flow analysis and functional tests, respectively. The limbs recovered a normal circulation progressively without recovering complete functionality. Histological analysis showed changes in the morphology of muscle fibers with intense inflammation. From day 22 to day 55 post-ischemia, regeneration of the myofibers was observed. Raman spectroscopic results related to subcutaneous analysis made the identification of modification in the biochemical constituents of hindlimb muscles possible during disease progression. Ischemia was characterized by a quantitative increase in the lipid content and a decrease in the protein content. The lipid to protein ratio can be used as a spectroscopic marker to score the severity of ischemia. Multivariate statistical analysis PC-LDA (Principal Component-Linear Discriminant Analysis) was used to classify all the data measured for the normal and ischemic tissues. This classification illustrated an excellent separation between the control and ischemic tissues at any time during the course of ischemic development. In vivo Raman spectroscopy was then applied to assess the potential of this technique as a screening tool to explore an ischemic disease non-invasively (transcutaneously). For this purpose, the influence of skin on the diagnostic accuracy was evaluated; transcutaneous analysis revealed the accuracy of this technique, indicating its potential in the in situ monitoring of muscle structural changes during ischemia.


Assuntos
Membro Posterior/metabolismo , Isquemia/diagnóstico , Isquemia/metabolismo , Fibras Musculares Esqueléticas/metabolismo , Pele/metabolismo , Animais , Circulação Sanguínea/fisiologia , Análise Discriminante , Membro Posterior/irrigação sanguínea , Masculino , Camundongos Endogâmicos BALB C , Análise Multivariada , Fibras Musculares Esqueléticas/patologia , Análise Espectral Raman/métodos
15.
Graefes Arch Clin Exp Ophthalmol ; 257(10): 2095-2101, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31273510

RESUMO

PURPOSE: Remote ischemic conditioning (RIC) implies that transient ischemia in one organ can affect blood flow and protect from ischemia in another remote organ such as the retina. The purpose of the present study was to investigate the effect of RIC on the diameter of retinal arterioles in patients with diabetic retinopathy and whether this effect differs among peripheral and macular vessels. METHODS: In twenty type 1 diabetes patients aged 20-31 years, the Dynamic Vessel Analyzer (DVA) was used to measure diameters of peripheral and macular arterioles during rest, isometric exercise, and flicker stimulation. Measurements were obtained before, immediately after, and 1 h after RIC, and were compared to responses obtained from normal persons. RESULTS: The reduced baseline diameter (p < 0.009) and contraction of peripheral retinal arterioles during isometric exercise (p = 0.025) observed immediately after RIC in normal persons were absent in the studied diabetic patients. CONCLUSIONS: RIC affects the diameter of peripheral but not macular arterioles in normal persons, but the response is abolished in diabetic patients. TRIAL REGISTRATION: NCT03906383.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Retinopatia Diabética/diagnóstico , Isquemia/diagnóstico , Fluxo Sanguíneo Regional/fisiologia , Artéria Retiniana/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Vasodilatação/fisiologia , Adulto , Arteríolas/patologia , Arteríolas/fisiopatologia , Retinopatia Diabética/complicações , Retinopatia Diabética/fisiopatologia , Feminino , Humanos , Isquemia/etiologia , Isquemia/fisiopatologia , Precondicionamento Isquêmico/métodos , Masculino , Artéria Retiniana/fisiopatologia , Adulto Jovem
16.
J Pediatr Ophthalmol Strabismus ; 56: e53-e56, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31282962

RESUMO

A 53-year-old woman presented with diplopia and deviation of the left eye for the past 3 years. She had non-resolving isolated left lateral rectus palsy. She underwent a medial rectus recession and Hummelsheim (Wright's modification) procedure in her left eye. Postoperatively, the anterior segment ischemia resolved with steroids. [J Pediatr Ophthalmol Strabismus. 2019;56:e53-e56.].


Assuntos
Doenças do Nervo Abducente/cirurgia , Segmento Anterior do Olho/irrigação sanguínea , Isquemia/etiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Complicações Pós-Operatórias , Visão Binocular , Doenças do Nervo Abducente/fisiopatologia , Angiografia , Segmento Anterior do Olho/diagnóstico por imagem , Movimentos Oculares/fisiologia , Feminino , Humanos , Isquemia/diagnóstico , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Doenças Raras
17.
Vasc Health Risk Manag ; 15: 187-208, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31308682

RESUMO

Peripheral arterial disease is a chronic vascular disease characterized by impaired circulation to the lower extremities. Its most severe stage, known as critical limb ischemia (CLI), puts patients at an increased risk of cardiovascular events, amputation, and death. The objective of this literature review is to describe the burden of disease across a comprehensive set of domains-epidemiologic, clinical, humanistic, and economic-focusing on key studies published in the last decade. CLI prevalence in the United States is estimated to be approximately 2 million and is likely to rise in the coming years given trends in important risk factors such as age, diabetes, and smoking. Hospitalization for CLI patients is common and up to 60% are readmitted within 6 months. Amputation rates are unacceptably high with a disproportionate risk for certain demographic and socioeconomic groups. In addition to limb loss, CLI patients also have reduced life expectancy with mortality typically exceeding 50% by 5 years. Given the poor clinical prognosis, it is unsurprising that the quality of life burden associated with CLI is significant. Studies assessing quality of life in CLI patients have used a variety of generic and disease-specific measures and all document a substantial impact of the disease on the patient's physical, social, and emotional health status compared to population norms. Finally, the poor clinical outcomes and increased medical resource use lead to a considerable economic burden for national health care systems. However, published cost studies are not comprehensive and, therefore, likely underestimate the true economic impact of CLI. Our summary documents a sobering assessment of CLI burden-a poor clinical prognosis translating into diminished quality of life and high costs for millions of patients. Continued prevention efforts and improved treatment strategies are the key to ameliorating the substantial morbidity and mortality associated with this disease.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Isquemia/economia , Isquemia/terapia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/economia , Doença Arterial Periférica/terapia , Amputação/economia , Estado Terminal , Humanos , Incidência , Isquemia/diagnóstico , Isquemia/epidemiologia , Salvamento de Membro , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Prevalência , Qualidade de Vida , Fatores de Risco , Resultado do Tratamento , Estados Unidos/epidemiologia
18.
Vasc Med ; 24(5): 422-430, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31339474

RESUMO

In patients with symptomatic peripheral artery disease (PAD), the impact of chronic kidney disease (CKD) on major adverse cardiovascular events has not been fully evaluated. The Examining Use of Ticagrelor In PAD (EUCLID) trial randomized 13,885 patients with PAD to ticagrelor 90 mg twice daily or clopidogrel 75 mg daily. This post hoc analysis compared the incidence of the primary composite endpoint (cardiovascular death, myocardial infarction (MI), or ischemic stroke) in patients with CKD (eGFR < 60 mL/min/1.73 m2) with those without CKD (eGFR ⩾ 60 mL/min/1.73 m2). The primary safety endpoint was thrombolysis in MI (TIMI) major bleeding. A total of 13,483 patients were included; 3332 (25%) had CKD, of whom 237 had stage 4/5 disease. Median follow-up was approximately 30 months. After statistical adjustment, patients with CKD had a higher rate of the primary endpoint compared with those without CKD (6.75 vs 3.72 events/100 patient-years; adjusted hazard ratio (HR) 1.45, 95% CI 1.30-1.63). CKD was not associated with increased risk of hospitalization for acute limb ischemia (ALI) (adjusted HR 0.96, 95% CI 0.69-1.34) or major amputation (adjusted HR 0.92, 95% CI 0.66-1.28). CKD was not associated with a significantly increased risk of major bleeding (adjusted HR 1.21, 95% CI 0.89-1.64), but minor bleeding was significantly increased (adjusted HR 1.51, 95% CI 1.07-2.15). In conclusion, patients with PAD and CKD had higher rates of cardiovascular death, MI, and ischemic stroke, but similar rates of ALI, major amputation, and TIMI major bleeding when compared with patients without CKD. ClinicalTrials.gov Identifier: NCT01732822.


Assuntos
Clopidogrel/administração & dosagem , Taxa de Filtração Glomerular , Isquemia/tratamento farmacológico , Rim/fisiopatologia , Doença Arterial Periférica/tratamento farmacológico , Inibidores da Agregação de Plaquetas/administração & dosagem , Insuficiência Renal Crônica/fisiopatologia , Ticagrelor/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Amputação , Isquemia Encefálica/mortalidade , Isquemia Encefálica/prevenção & controle , Clopidogrel/efeitos adversos , Feminino , Hemorragia/induzido quimicamente , Hemorragia/mortalidade , Humanos , Incidência , Isquemia/diagnóstico , Isquemia/mortalidade , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/prevenção & controle , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Inibidores da Agregação de Plaquetas/efeitos adversos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/mortalidade , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle , Ticagrelor/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
19.
Tex Heart Inst J ; 46(2): 130-132, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31236079

RESUMO

Acute aortic dissection can be complicated by malperfusion syndromes, including ischemia of the lower limbs. In some cases, delayed correction of leg ischemia leads to reperfusion injury, potentially resulting in renal failure. We describe the case of a 64-year-old woman who presented with acute aortic dissection manifesting itself as lower-limb ischemia. During and after aortic surgery with cardiopulmonary bypass, the patient developed myonephropathic metabolic syndrome. Hyperkalemia was corrected and acute kidney injury was prevented by infusing large volumes of intravenous fluids and administering human atrial natriuretic peptide. Peripheral bypass surgery was unnecessary. This case suggests that restoring blood flow to an ischemic leg by means of adjunctive perfusion during aortic repair with cardiopulmonary bypass is a viable way to overcome the biochemical instability associated with prolonged ischemia, especially hyperkalemia in the early phase of reperfusion.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Ponte Cardiopulmonar/métodos , Isquemia/terapia , Extremidade Inferior/irrigação sanguínea , Perfusão/métodos , Traumatismo por Reperfusão/prevenção & controle , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Isquemia/diagnóstico , Isquemia/etiologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
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