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1.
J Vasc Access ; 21(1): 98-102, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31232170

RESUMO

We are reporting a case of venous thoracic outlet syndrome with recurrent subclavian vein thrombosis in the setting of an ipsilateral brachiocephalic arteriovenous fistula for hemodialysis that was malfunctioning due to the central vein obstruction. The patient also had a concomitant external jugular vein origin stenosis. Given her body habitus and aversion to recovery after traditional first rib resection, we elected for an alternative treatment with an external jugular vein to internal jugular vein transposition with balloon angioplasty of the stenosed external jugular origin segment. The goal of this was to provide simultaneous relief of her outlet obstruction symptoms and salvage her dialysis access with a less invasive technique.


Assuntos
Angioplastia com Balão , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Veias Jugulares/cirurgia , Falência Renal Crônica/terapia , Diálise Renal , Veia Subclávia , Síndrome do Desfiladeiro Torácico/terapia , Extremidade Superior/irrigação sanguínea , Enxerto Vascular/métodos , Adulto , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/fisiopatologia , Veia Subclávia/diagnóstico por imagem , Veia Subclávia/fisiopatologia , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/etiologia , Síndrome do Desfiladeiro Torácico/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/fisiopatologia
2.
Med Hypotheses ; 131: 109255, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31443762

RESUMO

Stenotic immobile valves and other malformations obstruct normal cerebrospinal venous outflow, resulting in reflux flow which combines with the normal outflow to produce standing pressure waves in the internal jugular and other cerebrospinal veins. It is hypothesized that, if the cerebrospinal venous structure between the obstruction and the deep cerebral veins is sufficiently non-compliant, the standing wave will result in bidirectional flow in the fine cerebral veins. Bidirectional flow in the fine veins, over extended periods of time, will cause disorder in the veins' endothelial morphology, and ultimately, result in the disruption of the blood-brain barrier as observed in multiple sclerosis. This physics-based analysis demonstrates a positive correlation between clinically observed MS attributes with the predicted flow patterns and venous malformations that are based on fluid dynamics principles that include venous compliance influences. The physics-based approach used in this analysis provides new insights into MS pathologies based on predicted pressure and flow patterns.


Assuntos
Sistema Nervoso Central/irrigação sanguínea , Veias Cerebrais/fisiopatologia , Hemorreologia , Hidrodinâmica , Veias Jugulares/fisiopatologia , Modelos Cardiovasculares , Esclerose Múltipla/fisiopatologia , Válvulas Venosas/fisiopatologia , Pressão Sanguínea , Barreira Hematoencefálica , Causalidade , Veias Cerebrais/patologia , Complacência (Medida de Distensibilidade) , Endotélio Vascular/patologia , Humanos , Veias Jugulares/patologia , Válvulas Venosas/patologia
3.
PLoS One ; 14(5): e0217641, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150465

RESUMO

We evaluated the safety and feasibility of ultrasound-guided peripherally-inserted central venous catheters (PICC) by a neurointensivist at the bedside compared to fluoroscopy-guided PICC and conventional central venous catheter (CCVC). This was a retrospective study of adult patients who underwent central line placement and were admitted to the neurosurgical intensive care unit (ICU) between January 2014 and March 2018. In this study, the primary endpoint was central line-induced complications. The secondary endpoint was initial success of central line placement. Placements of ultrasound-guided PICC and CCVC performed at the bedside if intra-hospital transport was inappropriate. Other patients underwent PICC placement at the interventional radiology suite under fluoroscopic guidance. A total of 191 patients underwent central line placement in the neurosurgery ICU during the study period. Requirement for central line infusion (56.0%) and difficult venous access (28.8%) were the most common reasons for central line placement. The basilic vein (39.3%) and the subclavian vein (35.1%) were the most common target veins among patients who underwent central line placement. The placements of ultrasound-guided PICC and CCVC at the bedside were more frequently performed in patients on mechanical ventilation (p = 0.001) and with hemodynamic instability (p <0.001) compared to the fluoroscopy-guided PICC placement. The initial success rate of central line placement was better in the fluoroscopy-guided PICC placement than in the placements of ultrasound-guided PICC and CCVC at the bedside (p = 0.004). However, all re-inserted central lines were successful. There was no significant difference in procedure time between the three groups. However, incidence of insertional injuries was higher in CCVC group compared to PICC groups (p = 0.038). Ultrasound-guided PICC placement by a neurointensivist may be safe and feasible compared to fluoroscopy-guided PICC placement by interventional radiologists and CCVC placement for neurocritically ill patients.


Assuntos
Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Procedimentos Neurocirúrgicos/métodos , Trombose/terapia , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Feminino , Humanos , Unidades de Terapia Intensiva , Veias Jugulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Radiologistas , Trombose/fisiopatologia , Resultado do Tratamento , Ultrassonografia/métodos , Ultrassonografia de Intervenção/efeitos adversos
4.
Rev Assoc Med Bras (1992) ; 65(5): 592-595, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31166432

RESUMO

Hypertension may occur with left ventricular (LV) diastolic dysfunction, and the consequence may be symptoms and signs of heart failure (HF). Hepatojugular reflux (HJR), described as a sign of regurgitation of the tricuspid valve, may reflect structural and functional changes of the LV in the hypertensive patient. The signal may be present in the presence of HF. Case: male, 49 years old with uncontrolled blood pressure. Physical examination showed jugular turgescence, HJR, and elevated blood pressure. Complementary exams showed signs of atrial and left ventricular overload in the electrocardiogram and, the echocardiogram showed left atrium volume increase, concentric LV hypertrophy and signs of grade I diastolic dysfunction. DISCUSSIO: The HJR present correlates with pulmonary artery pressure and probably reflect the increase in central blood volume.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Veias Jugulares/fisiopatologia , Volume Sistólico/fisiologia , Insuficiência da Valva Tricúspide/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Ecocardiografia , Eletrocardiografia , Insuficiência Cardíaca/patologia , Humanos , Hipertensão/fisiopatologia , Veias Jugulares/patologia , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Tricúspide/patologia
6.
Arq Neuropsiquiatr ; 77(1): 3-9, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30758436

RESUMO

OBJECTIVE: The risk of recurrence of new amnesia events in patients having previously experienced transient global amnesia (TGA) ranges between 2.9-23.8%. Our objective was to search for recurrence predictors in TGA patients. METHODS: Retrospective analysis to identify recurrence predictors in a cohort of 203 TGA patients from a single center in Buenos Aires, Argentina, diagnosed between January 2011 and March 2017 Clinical features and complementary studies (laboratory results, jugular vein Doppler ultrasound and brain MRI) were analyzed. Comparison between patients with recurrent versus single episode TGA was performed, applying a multivariate logistic regression model. RESULTS: Mean age at presentation was 65 years (20-84); 52% were female. Median time elapsed between symptom onset and ER visit was two hours, with the average episode duration lasting four hours. Mean follow-up was 22 months. Sixty-six percent of patients referred to an identifiable trigger. Jugular reflux was present in 66% of patients; and 22% showed images with hippocampus restriction on diffusion-weighted MRI. Eight percent of patients had TGA recurrence. Patients with recurrent TGA had a more frequent history of migraine than patients without recurrence (37.5% vs. 14%; p = 0.03). None of the other clinical characteristics and complementary studies were predictors of increased risk of recurrence. CONCLUSIONS: Patients with migraine may have a higher risk of recurrent TGA. None of the other clinical characteristics evaluated allowed us to predict an increased risk of recurrence. Although the complementary studies allowed us to guide the diagnosis, they did not appear to have a significant impact on the prediction of recurrence risk.


Assuntos
Amnésia Global Transitória/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Amnésia Global Transitória/diagnóstico por imagem , Amnésia Global Transitória/fisiopatologia , Feminino , Humanos , Veias Jugulares/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/fisiopatologia , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco
7.
PLoS One ; 14(2): e0207832, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30794544

RESUMO

Cardiac diseases with elevated central venous pressure have higher frequency of jugular venous reflux (JVR), which is associated with decreased cerebral blood flow and white matter hyperintensities. Whether patients with severe mitral-regurgitation (SMR) have poorer cognitive functions and whether JVR is involved were determined in this pilot study. Patients with SMR and age/sex-matched controls were prospectively recruited. Neuropsychological tests such as global cognitive (Mini-Mental State Examination, MMSE), verbal memory, executive, and visuospatial domains were performed. Cardiac parameters by cardiac catheterisation and echocardiography, and the frequency of JVR by colour-coded duplex ultrasonography were obtained. Forty patients with SMR and 40 controls (71.1±12.2, 38-89 years; 75% men) were included. Compared with the controls, patients with SMR had lower scores in all neuropsychological tests but only MMSE and visuospatial test scores were statistically significant after adjusting for age, sex, and educational level. We further adjusted for cardiovascular risk factors; the significance remained in the visuospatial test but diminished in MMSE. Multivariate linear regression analyses adjusted for age, sex, and educational level showed that JVR combined with high right-atrial-pressure (RAP > 50th-percentile, 12 mmHg) was significantly associated with poorer performances in both MMSE [right JVR: B coefficient(95% confidence interval,p) = -2.83(-5.46-0.20, 0.036); left JVR: -2.77(-5.52-0.02, 0.048)] and visuospatial test [right JVR: -4.52(-8.89-0.16, 0.043); left JVR: -4.56(-8.81-0.30, 0.037)], with significances that remained after further adjusting for cardiovascular risk factors. Our pilot results suggest that retrogradely-transmitted venous pressure might be involved in the mechanisms mediating the relationship between cardiac diseases and brain functions.


Assuntos
Circulação Cerebrovascular/fisiologia , Cognição/fisiologia , Disfunção Cognitiva/etiologia , Veias Jugulares/fisiopatologia , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/fisiopatologia , Ecocardiografia Transesofagiana , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico , Testes Neuropsicológicos , Projetos Piloto , Radiografia Torácica , Fatores de Risco , Índice de Gravidade de Doença
8.
J Emerg Med ; 56(3): 323-326, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30638648

RESUMO

BACKGROUND: Internal jugular venous thrombosis (IJVT) is an uncommon condition rarely diagnosed in the outpatient setting. IJVT carries significant morbidity and mortality and must be considered in the differential diagnosis for new-onset neck pain and swelling, especially in the emergency setting. Paget-Schroetter syndrome (PSS), or primary thrombosis secondary to effort, is an uncommon, likely under-recognized etiology of thrombosis. We report a case of PSS extending from the right subclavian vein into the right internal jugular vein, suspected based upon patient history and physical examination and confirmed by point-of-care ultrasound (POCUS). We then review the presentation, causes, and diagnostic standards for PSS. CASE REPORT: We present a case of a 79-year-old man who presented to the Emergency Department with acute right-sided neck pain 1 day after playing the saxophone for 4 h the prior evening. POCUS confirmed Paget-Schroetter syndrome, or primary effort thrombosis of the internal jugular vein. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: To our knowledge, this is the first documented case of PSS resulting from venous stasis with prolonged Valsalva maneuver and vascular trauma with activity of playing the saxophone. The significance of this case is the unusual etiology of a rare presentation and the ability to diagnose this condition quickly and accurately with POCUS.


Assuntos
Música , Trombose Venosa Profunda de Membros Superiores/complicações , Trombose Venosa/etiologia , Idoso , Anticoagulantes/uso terapêutico , Serviço Hospitalar de Emergência/organização & administração , Humanos , Veias Jugulares/fisiopatologia , Masculino , Sistemas Automatizados de Assistência Junto ao Leito/tendências , Ultrassonografia/métodos , Trombose Venosa Profunda de Membros Superiores/fisiopatologia , Trombose Venosa/fisiopatologia
9.
Aerosp Med Hum Perform ; 90(2): 132-134, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30670124

RESUMO

BACKGROUND: Internal jugular phlebectasia (IJP) is an uncommon entity with only about 100 reported cases and with very few available cases in the literature. The current case study is about a male trainee fighter pilot incidentally diagnosed to have IJP. With limited literary evidence, it was a complex task to predict the prognosis of IJP and its implications on fighter flying.CASE REPORT: In order to confirm the diagnosis, a preliminary study was carried out to find out the normal and expanded area of the internal jugular vein (IJV) of 30 volunteers. The expanded area of the right IJV of the trainee pilot fell beyond 1 SD of the study population, confirming the diagnosis of IJP in the trainee pilot.DISCUSSION: Aeromedical concerns were the anti-G straining maneuver, positive pressure breathing for G, negative Gz, modified Valsalva maneuver, and rapid decompression. Considering the potential progression of IJP by repeated exposure to aviation stresses, the trainee pilot was re-assigned to helicopters.Khatua SS, Sannigrahi P, Dahiya M, Rastogi P, Raheem A. Aeromedical decision making in internal jugular phlebectasia. Aerosp Med Hum Perform. 2019; 90(2):132-134.


Assuntos
Aviação , Dilatação Patológica/diagnóstico , Veias Jugulares/fisiopatologia , Pilotos , Treinamento por Simulação , Doenças Vasculares/diagnóstico , Medicina Aeroespacial , Técnicas de Apoio para a Decisão , Diagnóstico Diferencial , Humanos , Masculino , Manobra de Valsalva , Adulto Jovem
10.
Thromb Haemost ; 119(2): 308-318, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30605919

RESUMO

Recently, internal jugular vein stenosis (IJVS) is gaining increasing attention from clinical researchers due to a series of confounding symptoms that impair the quality of life in affected individuals but cannot be explained by other well-established causes. In this study, we aimed to elucidate the clinical features, neuroimaging characteristics and pathogenesis of IJVS, and explore their possible correlations, in attempt to provide useful clues for clinical diagnosis and treatment. Forty-three eligible patients with unilateral or bilateral IJVS confirmed by contrast-enhanced magnetic resonance venography of the brain and neck were enrolled in this study. Magnetic resonance imaging along with magnetic resonance angiography or computed tomography angiography was applied to identify the radiological pattern of parenchymal or arterial lesions. Cerebral perfusion and metabolism were evaluated by single-photon emission computed tomography (SPECT). Of the 43 patients (46.0 ± 16.0 years old; 30 female), 14 (32.6%) had bilateral and 29 had unilateral IJVS. The common clinical symptoms at admission were tinnitus (60.5%), tinnitus cerebri (67.6%), headache (48.8%), dizziness (32.6%), visual disorders (39.5%), hearing impairment (39.5%), neck discomfort (39.5%), sleep disturbance (60.5%), anxiety or depression (37.5%) and subjective memory decline (30.2%). The presence of bilateral demyelination changes with cloudy-like appearance in the periventricular area and/or centrum semiovale was found in 95.3% (41/43) patients. SPECT findings showed that 92.3% (24/26) patients displayed cerebral perfusion and metabolism mismatch, depicted by bilaterally and symmetrically reduced cerebral perfusion and increased cerebral glucose consumption. IJVS may contribute to alterations in cerebral blood flow and metabolism, as well as white matter lesion formation, all of which may account for its clinical manifestations.


Assuntos
Veias Jugulares/fisiopatologia , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Neuroimagem , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Ansiedade/complicações , Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular , Estudos de Coortes , Constrição Patológica/fisiopatologia , Depressão/complicações , Feminino , Cefaleia/complicações , Perda Auditiva/complicações , Humanos , Masculino , Transtornos da Memória/complicações , Pessoa de Meia-Idade , Flebografia/métodos , Projetos Piloto , Qualidade de Vida , Fatores de Risco , Zumbido/complicações , Transtornos da Visão/complicações
11.
Clin Hemorheol Microcirc ; 71(3): 325-335, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29914014

RESUMO

BACKGROUND: Arteriovenous fistula (AVF) may affect erythrocytes through many pathways (e.g., mechanical, inflammatory). However, these effects haven't been elucidated completely yet. OBJECTIVE: To follow-up the hemorheological and the hematological changes in the presence of artificial carotid-jugular fistula in rats. METHODS: Female Wistar rats were subjected to sham-operated group (SG, n = 6) and to fistula group (FG, n = 10). Under general anesthesia, the right carotid artery and jugular vein were isolated via a neck incision, and in the FG carotid-jugular fistula was performed by microsurgical techniques. Hematological variables, red blood cell (RBC) deformability and membrane (mechanical) stability parameters were determined before operation and on the 1st and 6th postoperative weeks. Density separated samples ('young' and 'old' RBCs) were also tested. RESULTS: In FG group hematocrit, RBC and platelet counts increased gradually to reach highly significant level of increment on the 6th postoperative week. RBC deformability significantly was impaired. The membrane stability test showed lower deformability values after applying mechanical shearing. No significant differences were observed between density separated RBC subpopulations. CONCLUSIONS: The presence of arteriovenous fistula may lead to an increment of RBC mass and impairment of RBC deformability. These changes could be one of the pathways through which the fistula influences the microcirculation.


Assuntos
Fístula Arteriovenosa/sangue , Deformação Eritrocítica/fisiologia , Hemorreologia , Veias Jugulares/fisiopatologia , Animais , Ratos , Ratos Wistar
12.
J Vasc Access ; 20(3): 250-259, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30141363

RESUMO

INTRODUCTION: Internal jugular vein occlusion often makes necessary the use of less desirable routes as external jugular, subclavian, and femoral vein approaches in addition to inferior vena cava approaches. This a prospective cross-sectional follow-up study of the alternative approaches for placement of cuffed hemodialysis catheters in end-stage renal disease patients with bilateral internal jugular vein occlusion from the interventional nephrology point of view. METHOD: The study was conducted on 134 end-stage renal disease patients who were referred for insertion of a challenging hemodialysis catheter due to bilateral internal jugular vein occlusion. Ultrasound Doppler guided catheter insertion was used as a routine practice in addition to fluoroscopy or post insertion X-ray to localize catheter tip position and exclude complications. Follow-up of patients was conducted until the end of the study or catheter removal. FINDINGS: The most highly prevalent alternative approach is the trans-external iliac vein inferior vena cava approach (43.28%) followed by external jugular vein approach (14.93%), innominate vein approach (10.18%), internal jugular vein collaterals by interventional radiology (7.46%), femoral vein approach (7.46%), transhepatic approach (5.97%), subclavian vein approach (5.22%), and finally the retrograde femoral vein approach (1.49%). DISCUSSION: End-stage renal disease patients maintained on regular hemodialysis who have bilateral internal jugular vein obstruction and non-functioning arteriovenous fistula/graft is a daily scenario in nephrology practice. Our study showed that there is a variety of approaches for the insertion of cuffed hemodialysis catheters other than occluded internal jugular veins. Interventional nephrologists have a major role in solving the problem of poor hemodialysis vascular access. These alternative approaches can conserve the anatomically limited number of percutaneous access sites in each patient.


Assuntos
Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/métodos , Cateteres de Demora , Cateteres Venosos Centrais , Veias Jugulares , Falência Renal Crônica/terapia , Diálise Renal , Doenças Vasculares/complicações , Adulto , Cateterismo Venoso Central/efeitos adversos , Constrição Patológica , Estudos Transversais , Desenho de Equipamento , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/fisiopatologia , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia Intervencionista , Resultado do Tratamento , Ultrassonografia Doppler , Ultrassonografia de Intervenção , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/fisiopatologia
13.
Phlebology ; 34(5): 347-354, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30336758

RESUMO

OBJECTIVES: The purpose of this study is to test venous valve performance and identify differences between native tissue and replacement devices developed with traditional tissue treatment methods using a new in vitro model with synchronized hemodynamic parameters and high-speed valve image acquisition. METHODS: An in vitro model mimicking the venous circulation to test valve performance was developed using hydrostatic pressure driven flow. Fresh and glutaraldehyde-treated vein segments were placed in the setup and opening/closing of the valves was captured by a high-speed camera. Hemodynamic data were obtained using synchronized hardware and virtual instrumentation. RESULTS: Geometric orifice area and opening/closing time of the valves was evaluated at the same hemodynamic conditions. A reduction in geometric orifice area of 27.2 ± 14.8% (p < 0.05) was observed following glutaraldehyde fixation. No significant difference in opening/closing time following chemical fixation was observed. CONCLUSIONS: The developed in vitro model was shown to be an effective method for measuring the performance of venous valves. The observed decrease in geometric orifice area following glutaraldehyde treatment indicates a decrease in flow through the valve, demonstrating the consequences of traditional tissue treatment methods.


Assuntos
Hemodinâmica , Veias Jugulares/fisiopatologia , Modelos Cardiovasculares , Válvulas Venosas/fisiopatologia , Animais , Bovinos
14.
Phlebology ; 34(5): 336-346, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30336762

RESUMO

OBJECTIVE: To investigate the biological effects of a novel endovenous scaffold in a porcine model. METHODS: Petalo is a compliant venous scaffold implanted into the internal jugular veins of 12 healthy pigs. The pigs were sacrificed at one, two, three, and six months, respectively. Microscopic investigations were performed at two blinded laboratories. RESULTS: Neo-intima formation progressively covering up the stent metallic bars was observed. The inflammatory response of the venous wall showed a peak after three months by the implant, followed by marked reduction after six months. The device induced a significant ( p < 0.01) increase of the thickness respect to the control regions, but was comparable in sections obtained after three and six months. CONCLUSIONS: The implant of Petalo compliant venous scaffold in the venous wall of this porcine model is characterized by neointima formation and by an inflammatory reaction which tends to decrease after six months. Our data point against the induction of smooth muscle cells proliferation and migration as confirmed by electronic transmission microscopy analyses.


Assuntos
Veias Jugulares , Neointima , Stents , Doenças Vasculares , Animais , Veias Jugulares/patologia , Veias Jugulares/fisiopatologia , Neointima/patologia , Neointima/fisiopatologia , Suínos , Fatores de Tempo , Doenças Vasculares/patologia , Doenças Vasculares/fisiopatologia , Doenças Vasculares/terapia
15.
J Cardiovasc Pharmacol Ther ; 24(3): 269-277, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30474386

RESUMO

Poly (propylene carbonate, PPC) is a new member of the aliphatic polyester family. An outstanding feature of PPC is that it produces mainly water and carbon dioxide when degraded in vivo, causing minimal side effects. This unique property together with excellent biocompatibility and biodegradability makes PPC a promising material for drug delivery. In this study, we explored the effect of the sirolimus (an inhibitor of cell growth)-eluting PPC mesh on graft stenosis and its possible mechanisms in a rat arteriovenous grafting model. The PPC mesh was prepared by electrospinning. A jugular vein to abdominal aortic autograft transplantation model was established in rats. The graft was then treated by wrapping with the drug mesh or the drug-free mesh or left untreated. Four weeks posttransplantation, neointima was measured with hematoxylin and eosin staining, matrix metalloproteinase-2 (MMP-2), and MMP-9, and proliferating cell nuclear antigen (PCNA) in the grafts were assayed by Western blotting and immunohistochemistry, respectively. In vitro rat aortic adventitial fibroblast cell (RAAFC) migration was assessed using the Boyden chamber assay, and phospho-mammalian target of rapamycin (mTOR) levels in RAAFCs were determined by Western blotting. Animals with the drug mesh had an intimal area index of 4.87% ± 0.98%, significantly lower than that of the blank group (14.21% ± 2.56%) or the PPC group (15.03% ± 2.35%, both P < .05). The sirolimus mesh markedly suppressed MMP-2 and MMP-9 expression, decreased PCNA-positive cell numbers, inhibited RAAFC migration, and reduced phospho-mTOR levels. Our data suggest that the sirolimus-eluting PPC mesh might be potentially applied for the management of grafting stenosis.


Assuntos
Aorta Abdominal/cirurgia , Fármacos Cardiovasculares/administração & dosagem , Materiais Revestidos Biocompatíveis , Oclusão de Enxerto Vascular/prevenção & controle , Veias Jugulares/transplante , Propano/análogos & derivados , Sirolimo/administração & dosagem , Telas Cirúrgicas , Enxerto Vascular/instrumentação , Animais , Autoenxertos , Movimento Celular , Desenho de Equipamento , Fibroblastos/metabolismo , Fibroblastos/patologia , Oclusão de Enxerto Vascular/metabolismo , Oclusão de Enxerto Vascular/patologia , Oclusão de Enxerto Vascular/fisiopatologia , Veias Jugulares/metabolismo , Veias Jugulares/patologia , Veias Jugulares/fisiopatologia , Masculino , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Fosforilação , Antígeno Nuclear de Célula em Proliferação/metabolismo , Ratos Wistar , Serina-Treonina Quinases TOR/metabolismo , Enxerto Vascular/efeitos adversos , Grau de Desobstrução Vascular
18.
J Vasc Interv Radiol ; 29(12): 1717-1724, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30396843

RESUMO

PURPOSE: To demonstrate the feasibility of detecting patency, stenosis, or occlusion of transjugular intrahepatic portosystemic shunt (TIPS) with four-dimensional (4D) flow MR imaging. MATERIALS AND METHODS: Sequential adult patients with TIPS were eligible for enrollment. Volumetric phase-contrast sequence was used to image TIPS. Particle tracing cine images were used for qualitative assessment of stenosis. TIPS was segmented to generate quantitative data sets of peak velocity. Segmentation and quantitative measurement of flow throughout an entire TIPS defined technical success. Doppler US was used for comparison. Venography, when available, and 6-month clinical follow-up were used as reference standards. RESULTS: 4D flow MR imaging was performed in 23 patient encounters and was technically successful in 16/23 (69.6%) encounters. Three cases demonstrated both focal turbulence and abnormal velocities (> 190 cm/s or < 90 cm/s) on 4D flow and had venography-confirmed stenosis (true-positive cases). Seven cases had normal velocities and no turbulence on 4D flow, and all were confirmed negative with clinical follow-up or venography (true-negative cases). Six cases had discordant 4D flow results, with abnormal velocities but no turbulence or focal turbulence but normal velocities. All 6 discordant cases had no evidence of dysfunction during 6-month follow-up. CONCLUSION: 4D flow MR imaging can detect TIPS patency and stenosis, but further investigation is required before it can be used to assess for TIPS dysfunction.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Veias Jugulares/cirurgia , Angiografia por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/métodos , Imagem de Perfusão/métodos , Veia Porta/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Angiografia Digital , Velocidade do Fluxo Sanguíneo , Estudos de Viabilidade , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/fisiopatologia , Circulação Hepática , Flebografia/métodos , Veia Porta/diagnóstico por imagem , Veia Porta/fisiopatologia , Derivação Portossistêmica Transjugular Intra-Hepática/instrumentação , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Falha de Prótese , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Stents , Resultado do Tratamento , Ultrassonografia Doppler , Grau de Desobstrução Vascular
20.
J Am Heart Assoc ; 7(15): e008184, 2018 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-30371245

RESUMO

Background Heart failure is one of the most costly diagnosis-related groups, largely because of hospital readmissions. Objective assessment of volume status to ensure optimization before hospital discharge could significantly reduce readmissions. We previously demonstrated an ultrasound method of quantifying percentage of cross-sectional area ( CSA ) change of the right internal jugular vein with Valsalva that reliably estimates central venous pressure. Methods and Results Patients admitted with acute decompensated heart failure ( ADHF ) underwent ultrasound measurements of the right internal jugular vein at end-expiration and during the strain phase of Valsalva to determine a percentage of CSA change. An initial subgroup of patients with right heart catheterization and accompanying ultrasound measurements of the right internal jugular vein identified a percentage of CSA change predictive of right atrial pressure ( RAP ) ≥12 mm Hg. Images of admitted ADHF patients were obtained at admission and discharge for final analysis. Simultaneous right heart catheterization and right internal jugular vein ultrasound measurements demonstrated that a <66% CSA change predicted RAP ≥12 mm Hg (positive predictive value: 87%; P<0.05, receiver operating characteristic curve). Elevated admission RAP by percentage of CSA change normalized by discharge ( P<0.05), indicating that this test is significantly responsive to therapeutic interventions. Using the cutoff value of 66% CSA change, normal RAP at discharge had 91% predictive value for patients avoiding 30-day readmission ( P<0.05). Conclusions This bedside ultrasound technique strongly correlates to invasive RAP measurement in ADHF patients, identifies restoration of euvolemia, and is predictive of 30-day ADHF readmission. This tool could help guide inpatient ADHF treatment and may lead to reduced readmissions.


Assuntos
Insuficiência Cardíaca/diagnóstico por imagem , Veias Jugulares/diagnóstico por imagem , Readmissão do Paciente/estatística & dados numéricos , Doença Aguda , Idoso , Complacência (Medida de Distensibilidade) , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Veias Jugulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito , Prognóstico , Ultrassonografia
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