The Relationship between Microalbuminuria and Atherosclerosis in Patients with Type II Diabetes and Evaluate the Parameters of Internal Carotid Artery Duplex Sonographic Scanning

We aimed to determine the relationship between microalbuminuria and atherosclerosis in patients with Type II diabetes and evaluate the parameters of extracranial internal carotid artery (ICA) duplex ultrasonographic scanning; pulsatile index (PI) and resistive

The Effect of Saphenous Vein Ablation on Combined Segmental Popliteal Vein Reflux

BACKGROUND: This study examined the role of superficial vein surgery in patients with combined superficial venous reflux and segmental popliteal vein reflux. METHODS: We retrospectively reviewed 42 limbs in 38 patients with combined superficial venous reflux and segmental popliteal vein reflux who underwent saphenous vein ablation between January 2014 and February 2017. Patients underwent outpatient follow-up duplex ultrasonography at 3, 6, and 12 months postoperatively. Resolution of deep vein reflux was defined as reversed blood flow in a popliteal segment for less than 1.0 second and a decrease in the reflux time of more than 20% of the preoperative reflux time. RESULTS: The mean follow-up period was 9 months (range, 3–23 months). Saphenous vein ablations were performed by stripping in 24 limbs and radiofrequency ablation in 18 limbs. Preoperative segmental popliteal vein reflux resolved in 21 of the 42 limbs (50%). CONCLUSION: This study demonstrated that superficial venous surgery corrected segmental popliteal vein reflux in 50% of limbs with combined superficial venous reflux and segmental popliteal vein reflux. Other prospective studies are necessary to elucidate the etiology of the non-reversible cases.

Prevalence of deep vein thrombosis in acute stroke in Government Dharmapuri Medical College Hospital

Introduction: Venous thrombo embolism (VTE) is a frequent cause of preventable illness and death in hospitalized patients. 25% of all cases of venous thrombo embolism are associated with hospitalization and 50 to 75% of cases of VTE in hospitalized patients occur on those in medical wards. Aim of the Study: Prevalence of Deep vein thrombosis in patients admitted with acute stroke. The need for routine anticoagulation for prophylaxis against DVT in acute stroke patients. Materials and methods: Out of 145 patients enrolled for the study after applying the exclusion criteria 50 patients were selected for duplex ultrasonography of lower limb venous system. Results: In our study the prevalence of DVT in acute stroke was analyzed by ultrasound venous Doppler of lower limbs. The analysis of co morbid conditions like diabetes, systemic hypertension, ischemic heart disease, smoking and alcoholism were analyzed to find out if there was any association between their presence and occurrence of DVT. In all these parameters compared within the group of DVT positive patients the p value was more than 0.05 which is statistically insignificant. Conclusion: The prevalence of DVT in acute stroke patients in our hospital group was 6% which is significantly less than that observed in western population. Duplex USG is a useful tool which can be used as a screening tool for early diagnosis of DVT. DVT occurs more commonly in paralyzed limb than non paralyzed limb.

Resistive index as a predictor of renal progression in patients with moderate renal dysfunction regardless of angiotensin converting enzyme inhibitor or angiotensin receptor antagonist medication

BACKGROUND: Previous studies have shown that a higher resistive index (RI) on renal duplex ultrasonography was related with renal progression and acute kidney injury, especially in patients with chronic kidney disease (CKD) using an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist (ARB). We evaluated whether a RI value is a predictive factor for renal progression regardless of ACEI or ARB medication in patients with moderate renal dysfunction. METHODS: We retrospectively analyzed 119 patients with moderate renal dysfunction that had been evaluated with renal duplex ultrasonography from February 2011 to April 2015. Moderate renal dysfunction was defined as a stage 3 to 4 CKD. Renal progression was defined as a doubling of the baseline serum creatinine (sCr), a decrease of baseline glomerular filtration rate by > 50%, or initiation of renal replacement therapy. RESULTS: The mean age was 64.7 ± 11.0 years and sCr level was 2.1 ± 1.2 mg/dL. The RI ≥ 0.79 group showed a higher incidence of renal progression (P = 0.004, log-rank test) compared with the RI < 0.79 group, irrespective of ACEI or ARB usage. In the Cox proportional hazard model, RI ≥ 0.79 was an independent prognostic factor after adjusting for age, sex, diabetes mellitus, sCr, proteinuria, and use of ACEI or ARB (hazard ratio, 4.88; 95% confidence interval, 1.06–22.53; P = 0.043). CONCLUSION: RI ≥ 0.79 on the renal duplex ultrasonography can be a helpful predictor for renal progression in patients with moderate renal dysfunction, regardless of their ACEI or ARB usage.

The Impact of Hemodialysis and Arteriovenous Access Flow on Extracranial Hemodynamic Changes in End-Stage Renal Disease Patients

In this study, we characterized cerebral blood flow changes by assessment of blood flow parameters in neck arteries using carotid duplex ultrasonography and predictive factors for these hemodynamic changes. Hemodynamic variables were measured before and during hemodialysis in 81 patients with an arteriovenous access in their arm. Hemodialysis produced significant lowering in peak systolic velocity and flow volume of neck arteries and calculated total cerebral blood flow (1,221.9 ± 344.9 [before hemodialysis] vs. 1,085.8 ± 319.2 [during hemodialysis], P < 0.001). Effects were greater in vessels on the same side as the arteriovenous access and these changes were influenced by arteriovenous access flow during hemodialysis, both in the CCA (r = -0.277, P = 0.015) and the VA (r = -0.239, P = 0.034). The change of total cerebral blood flow during hemodialysis was independently related with age, presence of diabetes, and systemic blood pressure.

The Impact of Hemodialysis and Arteriovenous Access Flow on Extracranial Hemodynamic Changes in End-Stage Renal Disease Patients

In this study, we characterized cerebral blood flow changes by assessment of blood flow parameters in neck arteries using carotid duplex ultrasonography and predictive factors for these hemodynamic changes. Hemodynamic variables were measured before and during hemodialysis in 81 patients with an arteriovenous access in their arm. Hemodialysis produced significant lowering in peak systolic velocity and flow volume of neck arteries and calculated total cerebral blood flow (1,221.9 ± 344.9 [before hemodialysis] vs. 1,085.8 ± 319.2 [during hemodialysis], P < 0.001). Effects were greater in vessels on the same side as the arteriovenous access and these changes were influenced by arteriovenous access flow during hemodialysis, both in the CCA (r = -0.277, P = 0.015) and the VA (r = -0.239, P = 0.034). The change of total cerebral blood flow during hemodialysis was independently related with age, presence of diabetes, and systemic blood pressure.

Prevalence of Asymptomatic Critical Carotid Artery Stenosis in Korean Patients with Chronic Atherosclerotic Lower Extremity Ischemia: Is a Screening Carotid Duplex Ultrasonography Worthwhile?

This study aimed to investigate prevalence of asymptomatic carotid artery stenosis (ACAS) in Korean patients with peripheral arterial disease (PAD) and identify predictive factors of ACAS in patients with PAD. Between 1994 and 2008, 546 patients who underwent bypass surgery due to PAD were identified in a single tertiary teaching hospital. Of those, 409 patients underwent preoperative screening carotid duplex ultrasonography (CDUS). Patients who had an episode of cerebrovascular event or previous carotid artery intervention were excluded and then a retrospective analysis was made of 340 patients. The degree of internal carotid artery (ICA) stenosis was determined by the criteria of Society of Radiologists in Ultrasound Consensus Conference. To determine the risk factors of ACAS, demographic, coexisting medical condition and lesion characteristics were tested with binary logistic regression model. The prevalence of > or =70% ICA stenosis was 14%. ICA occlusion was detected in 7.1%. Multivariate analysis revealed age >65 yr (OR: 2.610, 95% CI: 1.197-5.691) and coronary artery disease (CAD, OR: 2.333, 95% CI: 1.169-4.657) are predictive factors of > or =70% stenosis. A PAD patient who needs revascularization, particularly, >65 yr or has a concomitant CAD, can be a good candidate of screening CDUS.

Subclavian Steal Syndrome Treated by Axilloaxillary Bypass Surgery : The Role of Duplex Sonography

We report herein a case of subclavian steal syndrome due to occlusive disease in multiple branches of the aortic arch, which was successfully treated by axilloaxillary bypass and subclavian stent insertion. The hemodynamic changes were evaluated using duplex sonography and transcranial Doppler before and after each procedure. The waveform and parameters of blood flow revealed an objective improvement in cerebral perfusion. These findings correlated well with clinical outcome. Neurosonologic evaluation can provide objective evidence for improved hemodynamic status after treatment.

The Frequency of Occurrence and Clinical Significance of the Giacomini Vein

PURPOSE: The Giacomini vein (GV) is one of branches that arising from the short saphenous vein (SSV) which extends cephalad along the posterior thigh communicating to the great saphenous vein (GSV), GSV branch or deep venous system. Despite of its common occurrence, the clinical significance of this venous structure isunknown yet. We investigated the frequency and the anatomical feature of the GV and the frequency of superficial or deep venous reflux associated GV to clarify its clinical significance. METHOD: We conductednon-invasive vascular evaluations on both legs using duplex ultrasonography in 50 patients having leg varicosity or telangiectasis. RESULT: 16 patients (32%) of 50 patients[28 limbs (28%) of 100 limbs]revealed the GV in their lower extremities. Among the patient with GV, venous refluxes of GSV, SSV or perforating vein (PV) were noted in frequencies of 16 limbs (76%), 8 limbs (38%) and 9 limbs (42%) respectively. The SSV and PV reflux were more common in the legs with GV than the legs without GV (P<0.001 respectively, McNemar test) regardless the existence of GV reflux. CONCLUSION: The SSV or PV reflux was more commonly associated with GV.

The Frequency of Occurrence and Clinical Significance of the Giacomini Vein

PURPOSE: The Giacomini vein (GV) is one of branches that arising from the short saphenous vein (SSV) which extends cephalad along the posterior thigh communicating to the great saphenous vein (GSV), GSV branch or deep venous system. Despite of its common occurrence, the clinical significance of this venous structure isunknown yet. We investigated the frequency and the anatomical feature of the GV and the frequency of superficial or deep venous reflux associated GV to clarify its clinical significance. METHOD: We conductednon-invasive vascular evaluations on both legs using duplex ultrasonography in 50 patients having leg varicosity or telangiectasis. RESULT: 16 patients (32%) of 50 patients[28 limbs (28%) of 100 limbs]revealed the GV in their lower extremities. Among the patient with GV, venous refluxes of GSV, SSV or perforating vein (PV) were noted in frequencies of 16 limbs (76%), 8 limbs (38%) and 9 limbs (42%) respectively. The SSV and PV reflux were more common in the legs with GV than the legs without GV (P<0.001 respectively, McNemar test) regardless the existence of GV reflux. CONCLUSION: The SSV or PV reflux was more commonly associated with GV.

Evaluation of cerebral vessels of the elder with essential hypertension complicated silent cerebral infarction / 医学研究生学报

Objective:To analyze the correlation between intra-extracranial arterial stenosis and silent cerebral infarction(SCI) in the elder with essential hypertension(EH). Methods:The results of color duplex ultrasonography(Duplex) and digital subtraction angiography(DSA) examination of 86 patients with essential hypertension complicated silent cerebral infarction were analyzed.The incidence of intra-and extracranial arterial stenosis and arthrosclerosis plaque were calculated.The comparative value of Duplex and DSA for evaluating atherosclerosis of extracranial carotid artery was analyzed using statistic methods. Results:The incidence of arthrosclerosis plaque was higher in SCI group than that in normal control group(62.79%,24%,P

Iatrogenic Pseudoaneurysm of Iliac-femoral Artery; the Efficacy of Ultrasound-guided Thrombin Injection Therapy

PURPOSE: As a consequence of the widespread application of coronary and peripheral interventional procedures, the incidence of a femoral pseudoaneurysm is increasing. Along with the traditional surgical approach, ultrasound-guided compression or thrombin injection therapy has recently been developed and is widely used to reduce surgical morbidity. The efficacy of these therapies was compared to define the guidelines for treating an iatrogenic femoral pseudoaneurysm in Korean patients. METHODS: Ultrasound-guided therapies were performed prospectively since October 2000. The results of the surgical repair from July 1996 were reviewed retrospectively. A total 22 patients with an iliofemoral pseudoaneurysm were enrolled in this study. RESULTS: Surgical repair was performed in 12 cases, ultrasound-guided compression therapy in 1 case, and ultrasound-guided thrombin injection in 9 cases. A primary closure of the puncture site (11 cases) and an iliac artery interposition graft (1 case) were performed. Postoperative complications developed in 4 cases; wound hematoma, wound infection and ureter injury. Compression therapy was successfully performed in 1 case. A thrombin injection was performed in 9 cases. Immediate thrombotic obliteration of the pseudoaneurysm occurred in all cases. Partial recannalization was detected during follow-up duplex sonography in 1 case, who was successfully treated by an additional thrombin injection. There were no complications associated with the thrombin injection and no recurrence had occurred during the 4 weeks follow-up. CONCLUSION: Thrombin injection therapy is highly efficient, safe, and comfortable. Ultrasound-guided thrombin injection could be the initial treatment of choice for treating iatrogenic femoral pseudoaneurysm.

Minimally invasive surgery for low extremity varicosis complicated with chronic ulcers / 中国微创外科杂志

Objective To study the minimally invasive surgical treatment for lower extremity varicosis complicated with chronic ulcers. Methods The authors reviewed 58 patients with low extremity varicosis complicated with chronic ulcers characterized by the CEAP (clinical, etiologic, anatomic, pathophysiologic) classification by using duplex ultrasonography. After the location of the perforating veins producing ulcers was marked, minimally invasive operations under local anesthesia were performed. Results Postoperatively, the ulcers healed in 1 month in 49 patients whose lesion surfaces were smaller than 3 cm ? 3 cm and completely cleared up in 2 months in the rest of 9 patients who had relatively larger ulcers. Follow-up observations for 0.5~1.5 years found remarkable improvement of skin color and elasticity in patients with severe cutaneous hyperpigmentation and lipodermatosclerosis. No recurrence was seen. Conclusions Both valvular insufficiency of the great or less saphenous vein and the perforating venous incompetence should be treated simultaneously in patients with lower extremity varicosis complicated with chronic ulcers.

Deep Vein Thrombosis After Major Spinal Surgery: Incidence in a Korean Population / 대한정형외과학회잡지

PURPOSE: To determine the incidence of deep vein thrombosis (DVT) after major spinal surgery in a Korean population without antithrombic prophylaxis. MATERIALS AND METHODS: Three hundred and thirteen patients who underwent major spinal surgery were evaluated prospectively. All patients were examined with duplex ultrasonography assessments of both lower extremities. No specific antithrombotic prophylaxes were used in any patient before or after surgery. RESULTS: There were 4 patients with positive findings of DVT on duplex ultrasonography and only 1 patient with clinically symptomatic DVT. The overall incidence of thrombotic complications was 1.3% and incidence of symptomatic DVT was 0.3%. CONCLUSION: Considering the low rate of DVT, routine screening and prophylaxis for DVT appears unwarranted in Koreans before or after major spinal surgery.

The Usefulness of RigiScan(R) as Screening Test for Duplex Ultrasonography after Intracorporeal Injection / 대한비뇨기과학회지

PURPOSE: To investigate whether the result of RigiScan after intracorporeal injection could predict the result of duplex ultrasonography, and determine the necessity of duplex ultrasonography. MATERIALS AND METHODS: We performed both RigiScan and duplex ultrasonography after intracorporeal injection in 18 men with erectile dysfunction. All of the patients were evaluated by history taking, physical examination, laboratory test, hormonal tests, and neurologic examination before RigiScan and duplex ultrasonography. We measured maximal arterial diameter, peak systolic velocity, end-diastolic velocity using a 7 MHz. color Doppler unit and these results of duplex ultrasonography were compared with penile rigidity and tumescence measured by RigiScan. RESULTS: The positive and negative predictive value of RigiScan were 81.8% and 85.7%, respectively. The result of RigiScan was comparable with that of duplex ultrasonography and the accuracy of RigiScan was resonable. CONCLUSIONS: According to this results, duplex ultrasonography was needed if the response of RigiScan is abnormal after intracorporeal injection. However, duplex ultrasonography can be ommitted if the response of RigiScan is normal after intracorporeal injection.

Timing of Penile Color Flow Duplex Ultrasonography Using a PGE1 / 대한비뇨기과학회지

Duplex ultrasonography (USG) is an accepted method to assess noninvasively arterial inflow to the penis. Optimal pharmacological agents as well as timing of the scan and stimulation during the scan continue to be debated. Between August 1994 and May 1996, 24 normal males (control group) and 45 impotent patients (impotence group) underwent penile doppler sonography, and their records were reviewed. Scans were performed at 1, 3, 5, 10, 15, 20 and 30 minutes after intracavernous injection of PGE1 (10 pg) in all subjects. Any subject not having a full erection at 15 minutes performed private self-stimulation for at least 5 minutes before the 30 minute scan. If we define normal arterial inflow as a peak systolic velocity (PSV) of 30 cm. per second or greater in the best artery, 46% of control group and 55% of impotence group achieved this velocity until 5 minutes. One (4%) of control group and three (6%) of impotence group achieved maximum velocity at 1 or 3 minutes but continually PSV of 30 cm. per second or greater after 5 minutes, so any subject may not have had an incorrect diagnosis. When we calculated maximum velocity in the best artery in relation to percentage tumescence, maximum velocity were recorded most often at 10% tumescence (46% of control group and 51% of impotence group). If we define normal arterial inflow as PSV of 30 cm. per second or greater in best artery, the cumulative percentage of patients who achieved this velocity at 1, 3, 5, 10, 15, 20 and 30 minutes were 4, 34, 46, 88, 96, 96 and 100% in control group and 6, 28, 55, 90, 92, 94 and 96% in impotence group. In conclusion, we support delaying the initial scan until 5 minutes, performing the additional scans until 30 minutes and self-stimulation when necessary. We believe all efforts should be made to have studies performed in the setting of least anxiety to the patient.

Diagnostic Value of Duplex Ultrasound for the Evalution of Corporal Veno-occlusive Function in Penile Erection / 대한비뇨기과학회지

Corporal veno-occlusive function is the essential part in the hemodynamic process of penile erection. Parameters for evaluation of the quality of the veno-occlusive mechanism are end diastolic flow velocity (EDV) and its derivative resistance index (RI) as measured by pharmacopenile duplex ultrasound which is considered as an initial screening test for the patients with vasculogenic impotence. We compared the accuracy of these parameters by investigating the correlation between the result of duplex sonographic study and some other studies, pharmacoerection test and dynamic infusion cavernosometry (DIC) in 45 patients who received all of these studies and were proved to have normal arterial inflow of the penis. EDV and RI values were well correlated with maintenance flow rate values of DIC at various levels of intracavernosal pressures (50, 100 and 150 mmHg) (R=0.418-0.701 and R=0.454-0.620 respectively). Diagnostic result of duplex scanning was identical to cavernosometric result in 80% and pharmacoerection response in 82%. We conclude that EDV and RI appeared to be used as good indices evaluating corporal veno-occlusive function.

Penile Duplex Ultrasonography with Intracavernous Papaverine Injection / 대한비뇨기과학회지

To assess the penile hemodynamic function and penile anatomy, duplex ultrasonography combined with intracavernous papaverine injection was undertaken in psychogenic, neurogenic and vasculogenic impotence patients, and patients with priapism and Peyronie's disease Patients. The results were as follows ; 1. In 7 neurogenic and 7 psychogenic impotence patients, changes of luminal diameter of cavernous artery and peak flow velocity were 0.69 +/- 0.13mm, 8.99 +/- 2.54cm/sec in flaccid phase, and 1.13 +/- 0.12mm, 21.38 +/- 8.43cm/sec in erection phase. 2. In 4 vasculogenic impotence patients, changes of luminal diameter and peak flow velocity were minimal. 3. Penile ultrasound is considered valuable in the evaluation of extent of Peyronie's plaque and determination of the type of priapism. Penile duplex ultrasonography combined with papaverine injection is considered the best screening method of vasculogenic impotence, and valuable in the evaluation of the penile structures.