Varizes pulsáteis simulando aneurisma de artéria femoral: relato de caso / Pulsatile varicose veins simulating femoral artery aneurysm: case report

Resumo A regurgitação tricúspide severa é citada como fator associado ao desenvolvimento ou à recidiva de varizes em membros inferiores as quais podem, retrogradamente, apresentar um fluxo pulsátil. O diagnóstico etiológico diferencial desse achado ultrassonográfico deve ser feito com a pesquisa de fístulas arteriovenosas, tendo em vista as diferentes formas de tratamento. Dada a complexidade do estado geral dos pacientes com regurgitação tricúspide, a escolha do tratamento das varizes pulsáteis deve ser individualizada, fruto de uma avaliação multidisciplinar. Fazem parte do arsenal terapêutico todas as técnicas habitualmente empregadas no tratamento de varizes, bem como a associações entre elas a serem escolhidas levando-se em conta a gravidade das manifestações clínicas e o risco cardiovascular envolvido. Relatamos um caso de varizes pulsáteis secundárias a regurgitação tricúspide, diagnosticado durante a suspeita primária de aneurisma de artéria femoral em paciente de 73 anos, com a classificação clínica da doença venosa (CEAP) 4a, oligossintomática, tratada com medidas posturais e elastocompressão.

Abstract Severe tricuspid regurgitation is mentioned as a factor associated with development or recurrence of varicose veins in the lower limbs and may present with retrograde pulsatile flow. Differential etiological diagnosis of this ultrasound finding must include investigation of arteriovenous fistulas, since the treatment methods are different. Given the complexity of the general condition of patients with tricuspid regurgitation, treatment for pulsatile varices should be chosen on a case-by-case basis after multidisciplinary evaluation. All of the techniques commonly used to treat varicose veins are part of the therapeutic arsenal, as well as combinations of them, taking into account the severity of clinical manifestations and the cardiovascular risk involved. We report a case of pulsatile varices secondary to tricuspid regurgitation diagnosed when investigating a primary suspicion of femoral artery aneurysm in a 73-year-old patient, CEAP 4a, oligosymptomatic, who was treated with postural measures and elastic compression.

Clinical Value of Neck Vascular Ultrasound and Homocysteine Level in Patients With Cerebral Infarction and Carotid Stenosis / 中国循环杂志

Objective:To investigate the clinical value of neck vascular ultrasound and homocysteine (Hcy) level in patients with cerebral infarction and carotid stenosis. Methods: Our research included 2 groups. Cerebral infarction group, n=115 patient who were treated in our hospital from 2012-01 to 2013-12, and Control group, n=110 healthy subjects from physical check-up. Neck vascular ultrasound was conducted to classify the degree of carotid stenosis as ①no stenosis, ②mild degree, the stenosis rate≤29%, ③moderate degree, the stenosis rate at 30%~69%,③severe degree, the stenosis rate at 70%~99%,④complete occlusion. Carotid plaque formation and vascular intima-media thickness (IMT) were examined by neck ultrasound. Blood levels of Hcy and triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) were measured in clinical laboratory. Results: Compared with Control group, Cerebral infarction group had the higher rate of carotid stenosis 89.56%vs 10.91%, more plaque formation 73.91%vs 6.08%and increased IMT (1.85 ± 0.42) mm vs (0.75 ± 0.21) mm;higher blood levels of Hcy (42.32 ± 12.02) μmol/L vs (6.32 ± 2.45) μmol/L and higher rate of high blood Hcy syndrome 71.30%vs 3.63%;higher levels of TC (4.25 ± 1.12) mmol/L vs (1.63 ± 0.74) mmol/L and LDL-C (5.96 ± 1.36) mmol/L vs (2.32 ± 0.82) mmol/L, P Conclusion: The patients with cerebral infarction and carotid stenosis have obviously increased blood level of Hcy. Hcy may predict various degree of carotid stenosis in relevant patients.

The predictive model of carotid angiopathy set from randomly sampled community data / 中华急诊医学杂志

Objective To establish a practical and effective predictive model for predicting carotid plaque/thickened intima,and to provide a novel perspective for stroke screening.Methods A retrospective analysis of the community screening data collected from September 2012 to March 2013 was performed.The data of blood pressure,serum lipid profile and fasting blood glucose and ultrasonographic checks of carotid artery were documented.One thousand subjects were randomly sampled from totally 14 226 individuals and divided into 2 groups according to the presence of carotid plaque/thickened intima.Analysis of relevant data of subjects with Logistic regression were performed.Predictive model was established according to the odds ratio for each risk factor and evaluated by C statistics.Results In the randomly sampled 1000 subjects,164 ones were found to be with carotid plaque/thickened intima.The mean age was (60.23 ± 10.09) years old,110 (67.1％) were male.Smoker,hypertension,angina pectoris,diabetes and hyperlipidemia were seen more often in the subjects with carotid plaque/thickened intima.Logistic regression analysis showed the independent risk factors for carotid plaque/thickened intima included advanced age (OR =1.15,95％ CI:1.12-1.84,P＜0.01),male (OR=3.97,95％CI:2.49-6.33,P＜0.01),smoking (OR=1.80,95％CI:1.24-2.56,P =0.002),diabetes (OR =1.80,95％ CI:1.15-2.98,P =0.012),hypertension (OR =2.82,95％ CI:1.15-2.98,P ＜ 0.01),high total cholesterol level (OR =1.63,95％ CI:1.31-2.02,P ＜ 0.01) and high LDL-C (low density lipoprotein-cholesterol) level (OR =1.70,95 ％ CI:1.35-2.14,P ＜ 0.01).The advanced age was found to be the strongest predictive factor in this model.The C statistics of this model is 0.804,which overweighs other models previously reported.The optimal cutoff point for prediction was 3.5,with a sensitivity of 0.713 and a specificity of 0.757.Conclusion An practical and effective model for predicting carotid plaque/thickened intima established from sampling data of community residents is favorable for both stroke screening and primary stroke prevention.

Vascular ultrasound combined with Seldinger technology improves the success rate of peripherally inserted central catheter and reduces potential complications / 中华临床营养杂志

ObjectiveTo investigate the applicability and superiority of modified Seldinger technique (MST).MethodsTotally 108 patients receiving peripherally inserted central catheter (PICC) through vascular ultrasound combined with MST technology were enrolled as MST group and another 108 patients receiving PICC using traditional direct vision method as control group.The first puncture success rate,PICC succesa rate,catheterization time required,and early complication rate were compared between these two groups.ResultsThe first puncture success rate was 88.89％ in MST group and 72.22％ in control group (P=0.002) ; the catheterization success rate was 82.41％ in MST group and 57.41％ in control group ( P =0.000).In the MST group,there were two cases where the catheter within neck was ectopic ( P =0.003 ),two cases experienced bleeding at the puncture sites (P =0.017),three cases had phlebitis (P =0.001 ),and one case suffered from catheter blockage (P=0.010).In the eontrol group,the corresponding numbers were 13,10,18,and 9.However,the time required for PICC showed no significant difference between these two groups (P=0.685).In the MST group,15 cases were catheterized in less than 15 minutes,72 cases between 15 and 25 minutes,and 21 cases for more than 25 minutes.In the control group,12 cases were catheterized in less than 15 minutes,70 cases between 15 and 25 minutes,and 26 cases for more than 25 minutes.ConclusionPICC through MST can be more effective in positioning the targeting blood vessels,increasing the success rate of catheter insertion,reducing various tissue damages,and lowering potential complications.

Comparison of placement of peripherally inserted central catheters using vascular ultrasound guidance system and traditional method in 938 tumor patients / 中华临床营养杂志

Objective To compare the placement of peripherally inserted central catheters(PICC)by using vascular ultrasound guidance system and traditional method.Methods Totally 938 patients undergoing PICC were divided into the traditional method group and the vascular ultrasound system and microintroducer techniques group according to the puncture time.The differences in the one-attempt success rate and the overall success rate of the placement and the incidences of complications were compared between the two groups.Results The one-attempt success rate was 93.01％ in the traditional method group and 98.76％ in the vascular ultrasound system and microintroducer techniques group(P =0.005).The successful rate of PICC placement was 100％.The incidence of complication was 11.29％ in the traditional method group and 2.47％ in the vascular ultrasound system and microintroducer technique group(P =0.000).Conclusion The PICC placement using vascular ultrasound guidance system and microintroducer techniques can increase one-attempt success rate and decrease complications.

Prevalência da estenose aterosclerótica do tronco celíaco e da artéria mesentérica superior na arteriopatia oclusiva dos membros inferiores / Prevalence of atherosclerotic stenosis of celiac trunk and superior mesenteric artery in occlusive arteriopathy of lower limbs

A eventual relação entre a aterosclerose das artérias dos membros inferiores com a aterosclerose das artérias intestinais foi pouco estudada. Objetivo: Avaliar pela ecografia vascular (Doppler) presença de lesões com estenose 70 por cento na artéria mesentérica superior e/ou tronco celíaco em doentes com arteriopatia obstrutiva crônica dos membros inferiores. Método: Foram estudados dois grupos, cada um com 60 doentes (40 homens e 20 mulheres). O grupo-caso foi composto por doentes com arteriopatia obstrutiva crônica dos membros inferiores, claudicação intermitente limitante ou dor de repouso e/ou lesões tróficas de extremidade, sem queixas gastrintestinais...

Pseudo-aneurisma de artéria tibial posterior pós-tratamento de fratura de perna com fixador externo: relato de caso e revisão da literatura / Pseudoaneurysm of the posterior tibial artery after external fixation for leg fracture: case report and review of the literature

Este trabalho descreve um caso de pseudo-aneurisma da artéria tibial posterior devido ao uso de fixador externo para tratamento de fratura dos ossos da perna (técnica de Ilizarov), bem como as técnicas utilizadas para seu tratamento. A compressão guiada por ultra-som e a injeção de trombina guiada por ultra-som foram realizadas, sem sucesso. O tratamento definitivo do pseudo-aneurisma e reconstrução arterial foi conseguido através do tratamento cirúrgico clássico, usando enxerto interposto de veia safena magna homóloga invertida. As indicações, vantagens e desvantagens das técnicas de tratamento não invasivo (compressão guiada por ultra-som e injeção de trombina guiada por ultra-som) e as possíveis causas de sua incapacidade na obliteração do pseudo-aneurisma são discutidas. Também foi realizada a revisão de casos de pseudo-aneurisma da artéria tibial posterior na literatura médica, encontrando-se apenas um caso semelhante, entre 24 publicados.

We describe a case of pseudoaneurysm in the posterior tibial artery following treatment for tibial and fibula fractures using external fixation (Ilizarov technique), as well as the techniques used for its treatment. Ultrasound-guided compression and ultrasound-guided thrombin injection were unsuccessfully performed. Definite treatment of pseudoaneurysm and arterial reconstruction was achieved through the traditional surgical treatment, using interposed graft of inverted homologous great saphenous vein. Indications, advantages and disadvantages of noninvasive treatment techniques (ultrasound-guided compression and ultrasound-guided thrombin injection) and the possible causes of their inability in obliterating the pseudoaneurysm are discussed. A literature review of pseudoaneurysms of the posterior tibial artery was also carried out, resulting in only one similar case out of 24 published cases.

Comparison of the lag time to initiation of flow-mediated vasodilation to endothelium-dependent vasodilation in early diagnosis of endothelial dysfunction

BACKGROUND: Endothelial dysfunction is an early event in atherogenesis. The conventional non-invasive methods, measuring flow mediated vasodilation at 1 minute after hyperemic condition, had some limitation. The purpose of this study is to evaluate the usefulness of initial reaction time(IRT) after hyperemic condtion as a new parameter of endothelial function. METHOD: Flow-mediated, endothelium-dependent vasodilation (FMD), endothelium-independent vasodilation (EID) and IRT were measured in 12 young diabetic patients(6 male and 6 female, mean age 26.3) and 12 age-matched healthy controls (6 male and 6 female, mean age 25.6), For the measurement of brachial arterial diameter, 7.5MHz ultrasound was used and for the continous monitoring of arterial diameter, specially designed fixing device was applied to the all subjects. RESULT: There were no significant difference in BMI (body mass index), mean age and blood pressure between normal control and young diabetic group. The FMD of young diabetic patients was lower than that of age-matched healthy controls (diabetic patients: 6.32.1%, healthy control: 8.92.7%, p<0.05). There was no significant difference in EID between normal control and young diabetic group. The IRT of FMD was significantly shorter in healthy control group than in young diabetic group (healthy control: 20.42.8 sec, diabetic group: 29.55.4 sec, p<0.0001). But IRT of EID showed no significant difference between normal control and young diabetic group. The IRT of FMD showed a significant negative correlation with FMD (r=-0.74, p<0.001) and HDL cholesterol level(r=-0.68, p<0.0001). CONCLUSION: These findings strongly suggest that IRT can also be used for early diagnosis of endothelial dysfunction.