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1.
Rev. baiana saúde pública ; 45(Supl. Especial 2): 39-47, 2021/12/28.
Article in English | LILACS | ID: biblio-1352323

ABSTRACT

Hyperbaric Oxygen Therapy (HBOT) assumes that high pressure hyperoxygenation causes faster tissue recovery and wound healing. Lower extremity flow rates are affected by leg ulcers that change vasodilation, microcirculation resistance, and local tissue demands; how blood hyper oxygenation influences these factors is still unclear. Peripheral arterial occlusive disease (PAOD) has been mostly associated with HBOT results in the femoral artery than in other arteries. Common femoral artery (CFA) peak systolic velocities (PSV), measured pre and post HBOT, were analyzed to research HBOT hemodynamics. Sixteen patients with leg ulcers who were 65 ± 11 (SD) (38-87) years-old, had HBOT of 90 minutes at 2.6 ATA. Bilateral CFA Doppler velocity waveforms were recorded immediately pre and post HBOT. Ulcerated vs non-ulcerated peak systolic velocity (PSV) data were compared using paired t-test. CFA PSV were significantly equal in the ulcerated and non-ulcerated extremities before HBOT: 114 ± 35 (SD) cm/s vs 116 ± 41 cm/s (p = 0.87 by paired t-test). CFA PSV in the ulcerated extremity increased to 122 ± 35 cm/s after HBOT but were statistically insignificant (p =.19 by one-tailed paired t-test). On the other hand, CFA PSV decreased to 103 ± 28 cm/s (p =.049 by one-tailed paired t-test) in the non-ulcerated extremity and were significantly lower after HBOT, with 103 ± 28 cm/s vs 122 ± 35 cm/s for the ulcerated limb (p =.02 by paired t-test). Blood velocity responses post HBOT showed differences between ulcerated vs non-ulcerated extremities. The non-ulcerated extremity apparently responded to oxygenation more than the ulcerated extremity. Such observation suggests further research on hemodynamic reactions caused by HBOT.


A oxigenoterapia hiperbárica (HbOT) assume que a oxigenação de alta pressão resulta em mais celeridade na recuperação do tecido e na cicatrização de feridas. As taxas de fluxo nas extremidades inferiores são afetadas por úlceras nas pernas que alteram a vasodilatação, a resistência da microcirculação e as demandas locais de tecido; esses fatores podem ser influenciados pela hiperoxigenação sanguínea de maneiras ainda não claramente compreendidas. A doença arterial oclusiva periférica femoral (DAOP) tem sido associada a melhores resultados de HBOT quando comparada a outras artérias. As velocidades sistólicas de pico (PSV) da artéria femoral comum (CFA) medidas antes e depois da HBOT foram analisadas como parte de um projeto de pesquisa da hemodinâmica da HBOT. Dezesseis pacientes com úlceras de perna, com idade 65 ± 11 (DP), 38-87 anos, realizaram HBOT com duração de 90 minutos a 2,6 ATA. As formas de onda de velocidade do Doppler CFA bilateral foram registradas imediatamente antes e depois da HBOT. Os dados de PSV ulcerado vs. não ulcerado foram comparados usando o teste t pareado. Pre HBOT CFA PSV não foi significativamente diferente nas extremidades ulceradas e não ulceradas: 114 ± 35 (DP) cm/s vs 116 ± 41 cm/s (p = 0,87 pelo teste t pareado). O PSV pós HbOT CFA na extremidade ulcerada aumentou para 122 ± 35 cm/s, mas não atingiu significância estatística (p = 0,19 pelo teste t pareado unicaudal). Em contraste, CFA PSV na extremidade não ulcerada diminuiu para 103 ± 28 cm/s (p = 0,049 pelo teste t pareado unicaudal). O pós-HbOT CFA PSV foi significativamente menor no membro não ulcerado, 103 ± 28 cm/s vs 122 ± 35 cm/s para o membro ulcerado (p = 0,02 pelo teste t pareado). As respostas da velocidade do sangue após HbOT mostraram diferenças entre as extremidades ulceradas e não ulceradas. Aparentemente, a extremidade não ulcerada respondeu mais significativamente à oxigenação do que a extremidade ulcerada. Tal observação sugere pesquisas adicionais sobre as reações hemodinâmicas decorrentes da HbOT.


La terapia de oxígeno hiperbárico (HbOT) asume que la hiperoxigenación a alta presión da como resultado una recuperación más rápida de los tejidos y una cicatrización de heridas. Las tasas de flujo de las extremidades inferiores se ven afectadas por úlceras en las piernas que alteran la vasodilatación, la resistencia de la microcirculación y las demandas de los tejidos locales; estos factores pueden verse influenciados por la hiperoxigenación de la sangre, de formas que aún no se han entendido con claridad. La enfermedad oclusiva arterial periférica femoral (PAOD) se ha relacionado con los mejores resultados de HbOT que otras arterias. Las velocidades sistólicas máximas (PSV) de la arteria femoral común (CFA) medidas antes y después de la HbOT se analizaron como parte de un proyecto para investigar la hemodinámica de la HbOT. Dieciséis pacientes con úlceras en pierna, 65 ± 11 (DE) (38-87) años, 12 hombres, 11 diabéticos, tenían HbOT de 90 minutos a 2,6 ATA. Se registraron formas de onda de velocidad de CFA Doppler bilaterales inmediatamente antes y después de la HbOT. Se compararon los datos de la velocidad sistólica máxima (PSV) ulcerada frente a la no ulcerada mediante la prueba t pareada. Pre HbOT CFA PSV no fue significativamente diferente en las extremidades ulceradas y no ulceradas: 114 ± 35 (DE) cm/s vs 116 ± 41 cm/s (p = 0,87 por prueba t pareada). Post HbOT CFA PSV en la extremidad ulcerada aumentó a 122 ± 35 cm/s pero no alcanzó significación estadística (p =.19 por prueba t unilateral pareada). En contraste, CFA PSV en la extremidad no ulcerada disminuyó a 103 ± 28 cm/s (p =.049 por prueba t unilateral pareada). El PSV después de la HbOT CFA fue significativamente menor en la extremidad no ulcerada, 103 ± 28 cm/s frente a 122 ± 35 cm/s para la extremidad ulcerada (p = 0,02 según la prueba t pareada). Las respuestas de velocidad sanguínea post HbOT mostraron diferencias entre las extremidades ulceradas y no ulceradas. Aparentemente, la extremidad no ulcerada respondió más significativamente a la oxigenación que la extremidad ulcerada. Tal observación sugiere una mayor investigación sobre las reacciones hemodinámicas debidas a la HbOT.


Subject(s)
Femoral Artery , Hyperbaric Oxygenation , Leg , Leg Ulcer
2.
Article in Chinese | WPRIM | ID: wpr-879278

ABSTRACT

Lower extremity movement is a complex and large range of limb movement. Arterial stents implanted in lower extremity are prone to complex mechanical deformation, so the stent is required to have high comprehensive mechanical properties. In order to evaluate the mechanical property of different stents, in this paper, finite element method was used to simulate and compare the mechanical properties of six nitinol stents (Absolute Pro, Complete SE, Lifestent, Protégé EverFlex, Pulsar-35 and New) under different deformation modes, such as radial compression, axial compression/tension, bending and torsion, and the radial support performance of the stents was verified by experiments. The results showed that the comprehensive performance of New stent was better than other stents. Among which the radial support performance was higher than Absolute Pro and Pulsar-35 stent, the axial support performance was better than Complete SE, Lifestent and Protégé EverFlex stent, the flexibility was superior to Protégé Everflex stent, and the torsion performance was better than Complete SE, Lifestent and Protégé Everflex stent. The TTR2 type radial support force tester was used to test the radial support performance of 6 types, and the finite element analysis results were verified. The mechanical properties of the stent are closely related to the structural size. The result provides a reference for choosing a suitable stent according to the needs of the diseased location in clinical applications.


Subject(s)
Alloys , Femoral Artery , Finite Element Analysis , Lower Extremity , Mechanical Phenomena , Prosthesis Design , Stents , Stress, Mechanical
3.
Arch. argent. pediatr ; 118(4): e396-e399, agosto 2020. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1118587

ABSTRACT

El pseudoaneurisma arterial es la dilatación de un vaso, producto de la lesión de la pared. Es generado, principalmente, por traumatismos y, en menor medida, por patologías inflamatorias del endotelio. Se presenta como un hematoma pulsátil y doloroso. Su diagnóstico suele realizarse debido a que, ante una ecografía Doppler, se observa una imagen hipoecoica adyacente a un vaso con flujo en su interior. Su baja prevalencia, asociada a su presentación clínica variable, puede generar confusión con infecciones de piel y partes blandas o trombosis. El manejo puede ser desde la compresión extrínseca hasta la cirugía abierta, y no existen algoritmos terapéuticos en la actualidad. Se describeel caso de un paciente de 13 años con un pseudoaneurisma en una rama muscular de la arteria femoral superficial, secundario a un traumatismo cortante en el que se realizó exitosamente el abordaje endovascular con colocación de microcoils para la exclusión del saco pseudoaneurismático.


Pseudoaneurysm or 'false aneurysm' is defined as an abnormal arterial dilatation produced by an injury to its wall that does not affect the three parietal layers like in 'true' aneurysms. In general, false aneurysms are related to traumatisms and, less frequently, to inflammatory disease of vascular endothelium. Clinically, it shows a pulsatile, painful hematoma in the affected region. The initial diagnosis is usually achieved by Doppler ultrasound showing a hypoechoic image in relation to a blood vessel or its wall. Due to the low prevalence of false aneurysm, it is commonly confused with skin and soft tissue's infections or with thrombosis. There are different options of treatment, from extrinsic compression to open surgery. We describe the case of a 13-year-old patient with traumatic false aneurysm of a muscular branch of femoral artery, successfully managed with endovascular exclusion of the lesion with microcoil


Subject(s)
Humans , Male , Adolescent , Aneurysm, False/diagnostic imaging , Femoral Artery , Wounds and Injuries , Ultrasonography, Doppler , Embolization, Therapeutic , Endovascular Procedures
4.
Rev. colomb. anestesiol ; 48(2): 78-84, Jan.-June 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1115560

ABSTRACT

Abstract Introduction: Pain control in total knee arthroplasty (TKA) is a determining factor in the patient's rehabilitation process. With conventional peripheral blocking techniques for the posterior compartment, foot drop, and distal motor deficit have been reported. The infiltration between popliteal artery and capsule of the knee (IPACK) block is a promising emerging analgesic technique. Objective: To describe analgesic control, opioid consumption, and mobility of patients scheduled for TKA using IPACK block as adjunct analgesic to the femoral block. Methods: We conducted a prospective observational cohort study over a 6-month period in adults taken to TKA. Sociodemographic and anthropometric characteristics, laterality, postoperative pain, and opioid consumption, patient and surgeon satisfaction (Likert), postoperative nausea and vomiting, and walk in the first 24hours, were evaluated and reported with a descriptive analysis. Results: Twenty-seven patients taken to TKA received an IPACK block. The pain score remained in a mild level during the 48 hours of evaluation. In 73% of the cases, an opioid rescue dose was not required; 81% of the patients managed to walk in the first 24 hours. Conclusion: The IPACK block, combined with femoral block and neuraxial anesthesia, turn out to be an excellent analgesic strategy for TKA, achieving adequate pain management, prompt rehabilitation, and early ambulation of the patient.


Resumen Introducción: El control del dolor en artroplastia total de rodilla (ATR) es determinante en el proceso de rehabilitación del paciente. Con las técnicas convencionales de bloqueo periférico para el compartimiento posterior se ha reportado pie caído y déficit motor distal. Por lo anterior, se decidió evaluar en una cohorte las cualidades analgésicas del bloqueo IPACK como una técnica emergente prometedora. Objetivo: Describir el control analgésico, consumo de opioides y movilidad de pacientes programados para ATR usando bloqueo IPACK como adyuvante analgésico al bloqueo femoral. Métodos: Se realizó un estudio de cohorte prospectivo, en adultos llevados a ATR, durante 6 meses. Se evaluaron las características sociodemográficas, antropométricas, lateralidad, dolor postopera torio y consumo de opioides, satisfacción del paciente y del cirujano, náuseas y vómito postoperatorio, caminata en las primeras 48 h. Se informar los resultados de forma descriptiva. Resultados: En total, 27 pacientes a quienes se les realizó ATR obtuvieron bloqueo IPACK. La puntuación del dolor se mantuvo en una escala leve en un rango de 1-3 durante las 48 horas de seguimiento. En el 73% de los casos no se requirió una dosis de opioide de rescate. El 81% de los pacientes logró caminar en las primeras 24 horas. Conclusión: El IPACK, combinado con el bloqueo femoral y la anestesia neuroaxial, resultan ser una excelente estrategia analgésica para logar un adecuado control del dolor en ATR, pronta rehabilitación y deambulación temprana del paciente.


Subject(s)
Humans , Female , Aged , Femoral Artery , Knee , Nerve Block , Arthroplasty , Orthopedic Procedures/rehabilitation , Analgesia
5.
Rev. cuba. angiol. cir. vasc ; 21(1): e87, ene.-abr. 2020. fig
Article in Spanish | LILACS, CUMED | ID: biblio-1126373

ABSTRACT

Introducción: La indicación más clara de revascularización en las extremidades inferiores lo constituye la presencia de lesiones isquémicas y el tratamiento de elección, siempre que sea posible, es el endovascular debido a su buena permeabilidad, baja morbilidad y mortalidad. Objetivo: Presentar un caso en el que se utilizó la angioplastia transluminal percutánea del sector fémoro-poplíteo. Presentación del caso: Se presenta un caso con diagnóstico de enfermedad arterial periférica en la extremidad inferior derecha. La angioplastia transluminal percutánea se utilizó para cicatrizar lesiones isquémicas aún en presencia de oclusiones no revascularizables de las arterias infra-poplíteas. El paciente presentaba al examen físico lesión isquémica en el primer dedo y patrón esteno-oclusivo fémoro-poplíteo. Se detectó disminución de los índices de presiones en poplítea y distales. En la arteriografía se apreciaron lesiones esteno-oclusivas en la femoral superficial y oclusión de las arterias infra-poplíteas. Se realizó angioplastia transluminal percutánea de la femoral superficial y el paciente recuperó pulso poplíteo con mejoría hemodinámica. Evolucionó satisfactoriamente y egresó con tratamiento médico. A los cinco meses de operado mantiene su pulso poplíteo presente y la lesión cicatrizada. Conclusión: La angioplastia del sector fémoro-poplíteo es beneficiosa para la cicatrización de la lesión isquémica aún en presencia de oclusiones infra-poplíteas no revascularizables(AU)


Introduction: The clearest indication for revascularization in lower limbs is the presence of ischemic lesions. The treatment of choice, whenever possible, is the endovascular one, due to its good permeability, as well as low morbidity and mortality. Objective: To present a case in which percutaneous transluminal angioplasty of the femoro-popliteal sector. Case presentation: A case is presented with a diagnosis of peripheral arterial disease in the right lower limb. The percutaneous transluminal angioplastywas used to heal ischemic lesions even in the presence of nonrevascularizable occlusions of the infra-popliteal arteries. On physical examination, the patient presented an ischemic lesion on the first finger and a femoro-popliteal steno-occlusive pattern. Decrease in pressure indices was detected in the popliteal and the distal ones. Arteriography showed steno-occlusive lesions in the superficial femoral and occlusion of the infra-popliteal arteries. Percutaneous transluminal angioplasty of the superficial femoral artery was performed and the patient recovered the popliteal pulse with hemodynamic improvement. The patient evolved satisfactorily and was discharged with medical treatment. Five months after surgery, the patient maintains popliteal pulse and the lesion has cicatrized. Conclusion: Angioplasty of the femoro-popliteal sector prove beneficial for the healing of the ischemic lesion even in the presence of nonrevascularizable infra-popliteal occlusions(AU)


Subject(s)
Humans , Male , Middle Aged , Popliteal Artery , General Surgery , Angiography , Angioplasty , Femoral Artery
6.
Rev. bras. cir. cardiovasc ; 35(1): 28-33, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1092467

ABSTRACT

Abstract Introduction: One of the most important points of the acute type A aortic dissection surgery is how to perform cannulation regarding cerebral protection concerns and the conditions of arterial structures as a pathophysiological consequence of the disease. Objective: In this study, femoral and axillary cannulation methods were compared in acute type A aortic dissection operations. Methods: The study retrospectively evaluated 52 patients who underwent emergency surgery for acute type A aortic dissection. Patients without malperfusion according to Penn Aa classification were chosen for preoperative standardization of the study groups. The femoral arterial cannulation group was group 1 (n=22) and the axillary arterial cannulation group was group 2 (n=30). The groups were compared in terms of perioperative and postoperative results. Results: There was no statistically significant difference in terms of preoperative data. In terms of postoperative parameters, especially early mortality and new-onset cerebrovascular event, there was no statistically significant difference. Mortality rates in group 1 and group 2 were 13.6% (n=3) and 10% (n=3), respectively (P=0.685). Postoperative new-onset cerebral events ratio was found in 5 (22.7%) in the femoral cannulation group and 6 (20%) in the axillary cannulation group (P=0.812). Conclusion: Both femoral and axillary arterial cannulation methods can be safely performed in patients with acute type A aortic dissection, provided that cerebral protection strategies should be considered in the first place. The method to be performed may vary depending on the patient's current medical condition or the surgeon's preference.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Axillary Artery/surgery , Femoral Artery , Femur/surgery , Aneurysm, Dissecting , Vascular Surgical Procedures , Catheterization , Retrospective Studies , Treatment Outcome
7.
Rev. cuba. angiol. cir. vasc ; 20(2): e391, jul.-dic. 2019. graf
Article in Spanish | LILACS | ID: biblio-1003861

ABSTRACT

Introducción: Los aneurismas arteriales son poco frecuentes en edad pediátrica, sin embargo; se observa un incremento en la incidencia de pseudoaneurismas a partir de traumatismos vasculares, sobre todo, por la aplicación de procederes invasivos. También se observan en procesos infecciosos y tumorales adyacentes, que acaban por lesionar la pared arterial. La mayoría suelen ser asintomáticos, o se presentan como una masa pulsátil que se asientan sobre la zona de la arteria afectada. Objetivo: Demostrar la importancia del diagnóstico temprano de los pseudoaneurismas para el tratamiento quirúrgico oportuno y evitar complicaciones posteriores. Presentación del caso: se discute un caso de una paciente de dos años de edad con un trauma vascular iatrogénico en la extremidad inferior derecha, que se manifestó como una tumoración pulsátil. Se realizó eco-doppler y angiografía, con lo que se diagnosticó un aneurisma de la arteria femoral derecha. Se realizó una exéresis y reconstrucción vascular con buena evolución. Conclusiones: El diagnóstico rápido de estas entidades vasculares evita que se presenten complicaciones posteriores y aseguran una evolución rápida y satisfactoria de los pacientes que las padecen(AU)


Introduction: Arterial aneurysms are rare in the pediatric ages. However, it is observed an increasement of the incidence of pseudoaneurysms caused by vascular traumas, mainly due to the use of invasive procedures. It is also present in infectious and tumour processes that end up injuring the arterial wall. Most of them are asymptomatic or are presented as a pulsatile mass that sets up over the affected artery's zone. Objective: To show the importance of early diagnosis of pseudo-aneurysms. Case presentation: It is presented the case of a two years old patient with a iatrogenic vascular trauma in the right lower limb that manifested in the way of a pulsatile tumor. Through an eco-Doppler and an angiography, an aneurysm of the right femoral artery was diagnosed, which led to an excision and a vascular reconstruction with good evolution. Conclusions: Early diagnosis of these vascular entities allows its timely surgical treatment, avoids the appearance of further complications and assures a prompt and satisfactorily evolution of the patients(AU)


Subject(s)
Humans , Female , Child, Preschool , Aneurysm, False/surgery , Aneurysm, False/diagnosis , Femoral Artery , Computed Tomography Angiography/methods
8.
Rev. chil. cardiol ; 38(3): 204-209, dic. 2019. graf, ilus
Article in Spanish | LILACS | ID: biblio-1058064

ABSTRACT

RESUMEN:TAVI transfemoral en una paciente con obesidad extrema y estenosis aórtica severa. Una mujer extremadamente obesa (IMC 62.5 Kg/M2) con estenosis aórtica severa fue descartada para cirugía bariátrica y reemplazo valvular aórtico. Se efectuó una TAVI por vía transfemoral, sin anestesia general. Se describen cuidadosas técnicas para efectuar la punción femoral y su sellado posterior. La paciente se recuperó sin incidentes, la gradiente transvalvular aórtica se redujo significativamente y hubo mínima insuficiencia valvular.


ABSTRACT: An extremely obese woman (BMI 62.5 Kg/M2) with severe symptomatic aortic stenosis was discarded for bariatric surgery or aortic valve replacement. A transfemoral TAVI was performed, without general anesthesia. Careful techniques to perform and seal the transfemoral puncture are described. The patient recovered uneventfully with a significant decrease in aortic valve gradient and minimal aortic insufficiency.


Subject(s)
Humans , Female , Middle Aged , Aortic Valve/diagnostic imaging , Transcatheter Aortic Valve Replacement , Aortic Valve Stenosis , Angiography , Ultrasonography , Femoral Artery/surgery , Femoral Artery/diagnostic imaging , Obesity
9.
Rev. bras. cir. cardiovasc ; 34(1): 48-56, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985235

ABSTRACT

Abstract Objective: Over the past 10 years, the rate of patients who have undergone coronary artery bypass graft (CABG) surgery has increased twofold in cases of coronary angiography. Today, transradial access is the first choice for coronary angiography. We aimed to compare the efficacy and reliability of radial versus femoral access for coronary angiography in post-CABG surgery in this study. Methods: Data from 442 patients who underwent post-CABG surgery between 2012-2017 were retrospectively compared. The right radial route was used in 120 cases, the left radial route in 148, and femoral route in 174. These three pathways were compared in terms of procedure time and fluoroscopy time, efficacy, and complication development. Comparisons among the three groups were performed with Bonferroni test for continuous variables and chi-square or Fisher's exact test for nominal variables as a binary. Results: Comparison results indicate that femoral access was better than left radial access and the left radial access was better than right radial access in terms of fluoroscopy time (10.71±1.65, 10.94±1.25, 16.12±5.28 min, P<0.001) and total procedure time (17.28±1.68, 17.68±2.34, 23.04±5.84 min, P<0.001). The left radial pathway was the most effective way of viewing left internal mammary artery (LIMA). No statistically significant differences were found among the three groups in other graft visualizations, all minor complications, total procedure and fluoroscopy time "Except LIMA imaging". Mortality due to processing was not observed in all three groups. Conclusion: The left radial route is preferred over right radial access for post-CABG angiography because the left radial pathway is close to the LIMA and is similar to the femoral pathway. In LIMA graft imaging, right radial access is a reliable route, even though it is not as effective as other pathways. We hope that the right radial pathway will improve with physician experience and innovations.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Bypass/methods , Coronary Angiography/methods , Radial Artery/surgery , Femoral Artery/surgery , Mammary Arteries/surgery , Aorta/diagnostic imaging , Time Factors , Fluoroscopy/methods , Cardiac Catheterization/methods , Reproducibility of Results , Retrospective Studies , Analysis of Variance , Treatment Outcome , Radial Artery/diagnostic imaging , Femoral Artery/diagnostic imaging , Operative Time , Mammary Arteries/diagnostic imaging
10.
Article in English | WPRIM | ID: wpr-762830

ABSTRACT

BACKGROUND: Microvascular anastomosis patency is adversely affected by local and systemic factors. Impaired intimal recovery and endothelial mechanisms promoting thrombus formation at the anastomotic site are common etiological factors of reduced anastomosis patency. Epigallocatechin gallate (EGCG) is a catechin derivative belonging to the flavonoid subgroup and is present in green tea (Camellia sinensis). This study investigated the effects of EGCG on the structure of vessel tips used in microvascular anastomoses and evaluated its effects on thrombus formation at an anastomotic site. METHODS: Thirty-six adult male Wistar albino rats were used in the study. The right femoral artery was cut and reanastomosed. The rats were divided into two groups (18 per group) and were systemically administered either EGCG or saline. Each group were then subdivided into three groups, each with six rats. Axial histological sections were taken from segments 1 cm proximal and 1 cm distal to the microvascular anastomosis site on days 5, 10, and 14. RESULTS: Thrombus formation was significantly different between the EGCG and control groups on day 5 (P=0.015) but not on days 10 or 14. The mean luminal diameter was significantly greater in the EGCG group on days 5 (P=0.002), 10 (P=0.026), and 14 (P=0.002). Intimal thickening was significantly higher on days 5 (P=0.041) and 10 (P=0.02). CONCLUSIONS: EGCG showed vasodilatory effects and led to reduced early thrombus formation after microvascular repair. Similar studies on venous anastomoses and random or axial pedunculated skin flaps would also contribute valuable findings relevant to this topic.


Subject(s)
Adult , Animals , Catechin , Femoral Artery , Humans , Male , Microsurgery , Oxidants , Phenobarbital , Rats , Skin , Tea , Thrombosis , Vasodilation
11.
Article in English | WPRIM | ID: wpr-762672

ABSTRACT

PURPOSE: Pseudoaneurysms after percutaneous vascular access are common and potentially fatal if left untreated. The aim of this study was to determine the incidence and risk factors associated with access site pseudoaneurysms after endovascular intervention for peripheral arterial disease (PAD) under a routine postintervention ultrasound (US) surveillance protocol. METHODS: A total of 254 PAD interventions were performed in a single center between January 2015 and November 2016, and puncture site duplex US surveillance was routinely performed within 48 hours of the procedure. Clinical, procedural and follow-up US data were analyzed. RESULTS: The overall incidence of pseudoaneurysm was 2.75% (6 cases in the femoral artery and 1 in the brachial artery). There was no difference between retrograde and antegrade approach, but there was a higher rate of pseudoaneurysm formation after manual compression compared to arterial closure device (ACD) use (4.3% vs. 0.87%). Manual compression was more commonly used for antegrade punctures (79.0%) and ACD for retrograde punctures (67.7%). Calcification was more frequently found in antegrade approach cases (46.8% vs. 16.9% for retrograde cases) and manual compression was preferred in its presence. All pseudoaneurysms were treated successfully at the time of diagnosis by US-guided compression repair and there were no cases of rupture. CONCLUSION: Pseudoaneurysm rates after therapeutic endovascular intervention for PAD were comparable to other cardiologic or interventional radiologic procedures despite the higher possibility of having a diseased access vessel. Routine US surveillance of access sites allowed for early diagnosis and noninvasive treatment of pseudoaneurysms, preventing potentially fatal complications.


Subject(s)
Aneurysm, False , Diagnosis , Early Diagnosis , Endovascular Procedures , Femoral Artery , Follow-Up Studies , Incidence , Peripheral Arterial Disease , Punctures , Risk Factors , Rupture , Ultrasonography , Vascular Closure Devices
12.
Article in English | WPRIM | ID: wpr-762023

ABSTRACT

A 58-year-old male patient with severe claudication due to thrombosis of the left ilio-femoro-popliteal artery aneurysm. He also had a venous stasis ulcer with a history of multiple embolotherapy of arteriovenous malformation. Duplex sonography revealed reflux and varicose veins of the left great saphenous vein (GSV). A sequential bypass surgery was performed that consisted of excision of the left external iliac and common femoral artery aneurysm, external iliac to deep femoral interposition with an expanded polytetrafluoroethylene graft, and femoro-posterior tibial artery bypass with the reversed left GSV. Symptoms of claudication were alleviated and the chronic ulcer was healed in time. To our knowledge, this is the first report of successful bypass in a patient with arterial aneurysm, arteriovenous malformation, and venous insufficiency that can be diagnosed as an atypical case of Parkes Weber syndrome. Long-term follow-up is needed to define the fate of aneurysms and varicose vein graft.


Subject(s)
Aneurysm , Arteries , Arteriovenous Fistula , Arteriovenous Malformations , Embolization, Therapeutic , Femoral Artery , Follow-Up Studies , Humans , Male , Middle Aged , Polytetrafluoroethylene , Popliteal Artery , Saphenous Vein , Sturge-Weber Syndrome , Thrombosis , Tibial Arteries , Transplants , Ulcer , Varicose Ulcer , Varicose Veins , Venous Insufficiency
13.
Article in English | WPRIM | ID: wpr-762022

ABSTRACT

The development of post-catheterization arterial pseudoaneurysms is one of the most common vascular access complications following angiographies and endovascular interventions. Different therapeutic options to treat these lesions have been used. We herein report the case of a 79-year-old woman who was referred to our service for evaluation with a post-catheterization superficial femoral artery pseudoaneurysm measuring 4 cm. Owing to the anatomical location of the arterial pseudoaneurysm and the patient’s refusal to undergo open surgery, we treated the lesion using an endovascular approach with a balloon tamponade. The procedure was successful, and the patient recovered well and was discharged from the hospital without complications. At 6-month follow-up she remained symptom-free and without recurrence.


Subject(s)
Aged , Aneurysm, False , Angiography , Balloon Occlusion , Female , Femoral Artery , Follow-Up Studies , Humans , Recurrence
14.
Article in English | WPRIM | ID: wpr-762006

ABSTRACT

PURPOSE: The clinical characteristics and results of femoropopliteal artery injury (FPAI) remain unclear. In this study, we evaluated the outcomes and risk factors of limb loss in patients treated for FPAI. MATERIALS AND METHODS: We retrospectively reviewed data from a database of patients who underwent revascularization for an FPAI at a single institution between January 2013 and December 2017. We reviewed and analyzed the characteristics, postoperative results, and factors that influence amputation rates. RESULTS: Twenty-four femoropopliteal arterial reconstructions in 24 patients were included in this study. Among the patients were 20 (83.3%) male with a first-quartile age of 28 years and a third-quartile age of 45 years (range, 15–68 years). The mean injury severity score (ISS) was 16 (range, 4–55), and 5 patients (20.8%) had ISSs of >20 points. The mean mangled extremity severity score (MESS) was 3.8 (range, 1–11), and 8 patients (33.3%) had MESSs of >5 points. In terms of arterial reconstruction methods, autogenous saphenous vein grafting, vein patching, and primary closure were performed in 9 patients (37.5%), 4 patients (16.7%), and 11 patients (45.8%), respectively. Despite arterial reconstruction, 5 patients (20.8%) underwent above-knee amputation. ISSs of >20, MESSs of >7, and orthopedic fixation were statistically significant factors associated with amputation. CONCLUSION: In cases of FPAI with ISSs of >20, MESSs of >7, and orthopedic fixation, amputations should be considered. We were also careful to attempt limb salvage in such cases.


Subject(s)
Amputation , Amputation, Traumatic , Arteries , Extremities , Femoral Artery , Humans , Injury Severity Score , Limb Salvage , Lower Extremity , Male , Orthopedics , Popliteal Artery , Retrospective Studies , Risk Factors , Saphenous Vein , Transplants , Vascular System Injuries , Veins
15.
Article in English | WPRIM | ID: wpr-762003

ABSTRACT

Iliac artery aneurysms are usually asymptomatic. Herein, we report a novel strategy for the repair of a pseudoaneurysm involving the external iliac artery using a conventional artificial graft and bare metal stent. A 76-year-old male patient presented with severe resting pain and right foot discoloration. Computed tomography angiography revealed a right distal external iliac artery pseudoaneurysm, with severe calcified occlusion at the right common and superficial femoral arteries. After exposing the right femoral artery, long-segment endarterectomy and patch angioplasty with the ipsilateral greater saphenous vein were performed. Before the completion of patch angioplasty, a surgeon-modified 8-mm expanded polytetrafluoroethylene (ePTFE) graft was inserted for complete pseudoaneurysm repair. If a commercial covered stent is not available, minimally invasive endovascular repair can be safely performed using a surgeon-modified ePTFE graft and bare metal stent.


Subject(s)
Aged , Aneurysm , Aneurysm, False , Angiography , Angioplasty , Endarterectomy , Femoral Artery , Foot , Humans , Iliac Artery , Male , Polytetrafluoroethylene , Prostheses and Implants , Saphenous Vein , Stents , Transplants
16.
Article in English | WPRIM | ID: wpr-761796

ABSTRACT

Free fatty acid (FFA) intake regulates blood pressure and vascular reactivity but its direct effect on contractility of systemic arteries is not well understood. We investigated the effects of saturated fatty acid (SFA, palmitic acid), polyunsaturated fatty acid (PUFA, linoleic acid), and monounsaturated fatty acid (MUFA, oleic acid) on the contractility of isolated mesenteric (MA) and deep femoral arteries (DFA) of Sprague–Dawley rats. Isolated MA and DFA were mounted on a dual wire myograph and phenylephrine (PhE, 1–10 µM) concentration-dependent contraction was obtained with or without FFAs. Incubation with 100 µM of palmitic acid significantly increased PhE-induced contraction in both arteries. In MA, treatment with 100 µM of linoleic acid decreased 1 µM PhE-induced contraction while increasing the response to higher PhE concentrations. In DFA, linoleic acid slightly decreased PhE-induced contraction while 200 µM oleic acid significantly decreased it. In MA, oleic acid reduced contraction at low PhE concentration (1 and 2 µM) while increasing it at 10 µM PhE. Perplexingly, depolarization by 40 mM KCl-induced contraction of MA was commonly enhanced by the three fatty acids. The 40 mM KCl-contraction of DFA was also augmented by linoleic and oleic acids while not affected by palmitic acid. SFA persistently increased alpha-adrenergic contraction of systemic arteries whereas PUFA and MUFA attenuated PhE-induced contraction of skeletal arteries. PUFA and MUFA concentration-dependent dual effects on MA suggest differential mechanisms depending on the types of arteries. Further studies are needed to elucidate underlying mechanisms of the various effects of FFA on systemic arteries.


Subject(s)
Animals , Arteries , Blood Pressure , Fatty Acids , Fatty Acids, Unsaturated , Femoral Artery , Linoleic Acid , Mesenteric Arteries , Oleic Acid , Oleic Acids , Palmitic Acid , Phenylephrine , Rats , Receptors, Adrenergic, alpha , Vasoconstriction
17.
Article in English | WPRIM | ID: wpr-786694

ABSTRACT

PURPOSE: The outcomes of endovascular aneurysmal repair (EVAR) for infrarenal abdominal aortic aneurysms (AAAs) in the Middle East have rarely been reported. We analyzed the outcomes of EVAR in a Jordanian population.MATERIALS AND METHODS: We conducted a retrospective review of the medical records of patients with infrarenal AAA who were treated with elective EVAR between January 2004 and January 2017 at a single center in Jordan. Patient characteristics, anatomical characteristics, procedural details, and early and late postoperative outcomes were analyzed.RESULTS: A total of 288 patients (mean age, 70 years; 77.8% males) underwent EVAR for infrarenal AAA (median aneurysm size, 64 mm). Bifurcated endografts were used in 265 patients, and aorto-uni-iliac devices were used in 22 patients. Successful endograft deployment was achieved in all patients with no open conversion. Early complications included localized groin hematoma in 15, femoral artery dissection in 4, wound infection in 3, and seroma in 3 patients. With a mean follow-up of 60 months, 50 endoleaks were detected, including 9 type I, 38 type II, and 3 type III. Seven patients had unilateral graft limb occlusion. The 30-day mortality was 1.7%, and long-term mortality was 7.0%, mostly due to non-AAA-related causes.CONCLUSION: EVAR was safely performed in Jordanian patients with minimal complications. However, long-term surveillance is important due to the risk of endoleaks and consequent intervention.


Subject(s)
Aneurysm , Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis , Endoleak , Extremities , Femoral Artery , Follow-Up Studies , Groin , Hematoma , Humans , Jordan , Medical Records , Middle East , Mortality , Retrospective Studies , Seroma , Transplants , Wound Infection
19.
J. vasc. bras ; 18: e20180113, 2019. ilus
Article in Portuguese | LILACS | ID: biblio-990119

ABSTRACT

Aneurismas verdadeiros isolados da artéria femoral superficial (AFS) são raros, representando 0,5% dos aneurismas periféricos. Até 2012, existiam relatos na literatura de apenas 103 pacientes com aneurismas verdadeiros isolados da AFS. As principais complicações associadas são: trombose, embolização distal e rotura, sendo a última a mais comum. Os autores relatam o caso de um paciente masculino, de 55 anos, atendido emergencialmente com dor e massa pulsátil em coxa esquerda, condição posteriormente diagnosticada como ruptura de aneurisma da AFS. O paciente foi submetido à correção cirúrgica emergencial com ligadura do aneurisma e revascularização com veia safena magna reversa, com evolução satisfatória


Isolated true aneurysms of the superficial femoral artery (SFA) are rare, accounting for 0.5% of peripheral aneurysms. The literature up to 2012 contains reports of just 103 patients with isolated SFA aneurysms. The main complications are thrombosis, distal embolization, and rupture, which is the most common of the three. The authors report the case of a 55-year-old male patient admitted to the emergency service with pain and a pulsatile mass in the left thigh, subsequently confirmed as rupture of an SFA aneurysm. The patient underwent open aneurysm repair with ligature and revascularization with a reversed saphenous vein bypass


Subject(s)
Humans , Male , Middle Aged , Femoral Artery , Aneurysm , Saphenous Vein , Thigh , Thrombosis , Sex Factors , Ultrasonography/methods , Lower Extremity , Endovascular Procedures/methods
20.
J. vasc. bras ; 18: e20160104, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-984684

ABSTRACT

O stent primário é uma opção de tratamento bem estabelecida para a doença arterial periférica em território femoropoplíteo. Estudos nacionais são escassos. Objetivos Avaliar desfechos clínicos e radiológicos em curto e médio prazo em pacientes classificados como Rutherford 3-6, tratados com o uso de stent em lesões femoropoplíteas. Métodos A análise foi realizada com base em um banco de dados prospectivamente mantido de doentes tratados entre julho de 2012 e julho de 2015. O objetivo primário foi a perviedade. Os objetivos secundários foram melhora na classificação de Rutherford, índice tornozelo/braço, revascularização do vaso-alvo, taxa de salvamento do membro e óbito em até 24 meses. Resultados Foram incluídos 64 pacientes, sendo 61 com lesões TASC II A/B (95%). A taxa de perviedade primária em 6, 12 e 24 meses foi de 95,2%, 79,1% e 57,9%, respectivamente. A análise de regressão de Cox revelou uma menor perviedade em pacientes com doença oclusiva (RR, 6,64, IC 95%, 1,52-28,99, p = 0,02), bem como uma perda de perviedade cerca de seis vezes maior em doentes TASC B do que TASC A (RR, 5,95, IC 95%, 1,67-21,3, p = 0,0061). Em 12 meses, 90,38% dos doentes permaneceram assintomáticos. A taxa de salvamento do membro em 24 meses foi de 94,3% (IC 95%, 87,9-100%). A ausência de revascularização do vaso-alvo em 24 meses foi de 90,5% (IC 95%, 82,8-98,9%). Conclusões Os resultados foram compatíveis com estudos internacionais, apesar do estágio mais avançado da doença vascular observada em nosso grupo. Piores desfechos foram associados a doença oclusiva e lesões complexas


Primary stenting is a well-established treatment option for femoropopliteal arterial obstructive disease. There is a shortage of Brazilian studies of the subject. Objectives To evaluate short and mid-term clinical and radiological outcomes in patients classified as Rutherford 3-6 and treated with stenting of femoropopliteal lesions. Methods Analysis based on a prospectively populated database of patients treated from July 2012 to July 2015. The primary endpoint was primary patency. Secondary endpoints were clinical and ankle/brachial index changes. Target Vessel Revascularization, limb salvage rate and death, within a 24-month follow-up period. Results 64 patients were enrolled, including 61 TASC II A / B lesions (95%). The primary patency rates at 6, 12, and 24 months were 95.2%, 79.1% and 57.9%, respectively. Cox regression analysis revealed lower patency rates in patients with occlusive disease (hazard ratio [HR], 6.64; 95% confidence interval [CI], 1.52-28,99, p = 0.02), as well as patency loss about 6 times higher in TASC B than in TASC A patients ([HR], 5.95, 95% CI, 1.67-21.3, p = 0.0061). At 12 months, 90.38% of the patients remained asymptomatic. The limb salvage rate at 24 months was 94.3% (95% CI, 87.9-100%). Freedom from TVR at 24 months was 90.5% (95% CI 82.8-98.9%). Conclusions Results of primary patency were compatible with international studies, despite the more advanced stage of the vascular disease observed in our group. Occlusive disease and complex lesions were both associated with worse outcomes


Subject(s)
Humans , Male , Female , Stents , Ankle Brachial Index/methods , Femoral Artery , Peripheral Arterial Disease/therapy , Popliteal Artery , Thrombosis/therapy , Vascular Patency , Comorbidity , Retrospective Studies , Lower Extremity , Endovascular Procedures/methods
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