Validation of a Standardised Duplex Ultrasound Classification System for the Reporting and Grading of Peripheral Arterial Disease.

OBJECTIVE: Duplex ultrasound (DUS), a non-invasive means of arterial mapping, allows for the reliable diagnosis of peripheral arterial disease (PAD). One of the authors (C.P.O.), developed a standardised DUS based scoring system, devised for rapid detection and reporting of PAD. The purpose of this study was to validate this system, and to determine the diagnostic performance both overall and per disease severity. METHODS: In total, 250 participants were recruited, based on diagnosis of (n = 125) or absence of PAD (n = 125) from general practice registers. Right and left legs per subject were handled as independent readings, determining actual PAD status via ankle brachial pressure index (ABPI) < 0.9, and then further grading disease severity using suggested ABPI ranges. Data were excluded if no corresponding ABPI value was obtained per DUS determination or if the ABPI reading was > 1.4, owing to the risk of false negatives due to incompressible vessels. Diagnostic sensitivity and specificity were obtained overall, and per severity classification. Furthermore, inter-rater agreement between ABPI and DUS determined PAD severity was determined by linear weighted Cohen's kappa. RESULTS: The sensitivity and specificity in the detection of disease overall was 81.0% (95% confidence interval [CI] 73.4 - 87.2) and 86.3% (95% CI 82.3 - 89.8), respectively. From mild to severe PAD, sensitivity increased from 71.1% (95% CI 55.7 - 83.6) to 89.3% (95% CI 71.8 - 97.7). Furthermore, a Cohen's kappa value of 0.63 (95% CI 0.57 - 0.69) was obtained, indicating moderate agreement between the two diagnostic methods. CONCLUSION: The findings of this study validate the diagnostic performance of the standardised DUS scoring system, as well as its capacity to grade severity of disease, offering a potential tool for the identification of PAD in community/research settings following initial screening methods. Confirmatory work could include a comparison of DUS determined disease with gold standard methods of non-invasive angiography, and novel tools such as toe flex near infrared spectroscopy and multisite photoplethysmography.

[Vascular diagnostics before microvascular tissue transfer on the lower extremities : An algorithm]. / Gefäßdiagnostik vor mikrovaskulärem Gewebetransfer an der unteren Extremität : Ein Algorithmus.

Microsurgical free flap transfer plays a key role in soft tissue reconstruction of the lower extremities. Through close cooperation between plastic and orthopedic surgery, great progress and success in limb salvage could be achieved over the last decades. The risk for extremity malperfusion is especially high in older patients and after trauma. To maximize the success rate for free flap transfer there is need for interdisciplinary clinical examination and diagnostics. In addition to clinical methods radiological procedures are necessary to evaluate and optimize lower extremity perfusion before surgery.Vascular ultrasound provides important information about the arterial and venous status; however, DSA, CTA and MRA are well-established and exact methods to evaluate arterial inflow. The use of less invasive methods makes it much more feasible, economic and comfortable to perform preoperative selection of patients requiring interventional procedures.In the case of intraluminal stenosis without any option for PTA, a vascular surgeon can be involved at an early stage to evaluate further surgical options. In some cases, similar surgical revascularization and free flap transfer can be performed in a single surgery. The aim of this study is to implement a standardized algorithm for preoperative examination and radiological diagnostics before reconstructive surgery of the lower extremity.

Digital orbitoplethysmograph: A new device to study the regional cerebral circulation using extraorbital plethysmography.

BACKGROUND: Noninvasive diagnostic methods utilizing pulse wave measurements on the surface of the head are an important tool in diagnosing various types of cerebrovascular disease. The measurement of extraorbital pressure fluctuations reflects intraocular and intracranial pressure changes and can be used to estimate pressure changes in intracranial arteries and the collateral circulation. NEW METHOD: In this paper, we describe our patented (CZ 305757) digital device for noninvasive measuring and monitoring of orbital movements using pressure detection. We conducted preclinical tests (126 measurements on 42 volunteers) to evaluate the practical capabilities of our device. Two human experts visually assessed the quality of the pressure pulsation and discriminability among various test conditions (specifically, subject lying, sitting, and the Matas carotid occlusion test). RESULTS: The results showed that our device provided clinically relevant outcomes with a sufficient level of detail of the pulse wave and a high reliability (not less than 85%) in all clinically relevant situations. It was possible to record the effect of the Matas carotid occlusion test. COMPARISON WITH EXISTING METHOD(S): Our fully noninvasive, lightweight (185 g), portable, and wireless device provides a considerably cheaper alternative to the current diagnostic methods (e.g., transcranial ultrasound, X-ray, or MRI angiography) for specific assessment of cerebral circulation. Within a minute, it can detect the Willis circle integrity and thus eliminate the potential risks associated with the Matas test using standard EEG. CONCLUSIONS: Our device represents an improvement and a valid alternative to the current methods diagnosing regional cerebral circulation.

Good stress, bad stress--the delicate balance in the vasculature.

BACKGROUND: Radicals have important physiological functions, for example, in immune defense and vasoprotection. However, they are also potentially dangerous waste products of cellular metabolism and they can contribute to the development of many different diseases. METHOD: Selective literature review. RESULTS: The scientific understanding of radicals has not yet led to any therapeutic application. For many years, scavenging already formed radicals with antioxidants was considered to be the most promising therapeutic approach, but clinical trials based on this principle have yielded mostly negative results. Thus, entirely new approaches are needed. The goal should be to prevent the formation of harmful radicals, or to treat radical-related damage if it has already occurred. New diagnostic tools have the potential to identify those patients that are most likely to benefit from this form of treatment, as well as to document its success. CONCLUSIONS: A new generation of cardiovascular drugs is being developed for the prevention or the mechanism-based treatment of vascular damage caused by oxidative stress. This new therapy should go hand in hand with new diagnostics, in accordance with the principle of individualized medicine.