Quantitative assessment of rehabilitation results in peripheral arterial disease

Peripheral arterial disease [PAD] patients are commonly classified on the basis of subjective evaluations of pain and fatigue. It could he important to have, at least, an objective measurement ofJƒtigue for better evaluation of muscle performance and exercise tolerance in such patients as well as for serial quantitative assessment of different vascular rehabilitation programs designed for claudications. Median frequency [MDF] analysis has been recently used to monitor electromyo graphic [EMG] power spectrum shift toward lower frequencies due to muscle fati gue. Twenty-five PAD patients and ten control subjects matched for age and sex were studied. Surface EMO was recorded over the medial gastrocnemius muscle along 40 seconds at maximal voluntaty contraction. The median frequency of the electromyoraphic power spectrum was calculated in the first 10 seconds [TO] and the last 10 seconds [T1]. Change from TO to T1 was statistically calculated and considered as the fatigue index [FI]. EMG reassessment was done for the patients' group after completing a physical training program. Significantly lower initial Ti values, compared with initial TO, were found in both the PAD and the control groups. A highly significant difference was documented regarding all the initial MDF parameters between the patient and control groups. Moreover, a highly significant difference was recorded between the initial and the post-rehabilitation FI in the patients' group. EMG frequency analysis can be considered an easy, painless, practical and reproducible method which has a high degree of precision and accuracy in providing objective information on the muscle performance and fatigue in PAD patients

Brachio-infraclavicular axillary interposition graft as a successful tertiary vascular access procedure for hemodialysis

This study describes experience with brachio-axillary interposition graft for hemodialysis as a successful tertiary vascular access procedure. The purpose of the study is to assess the role of this procedure in the dialysis access algorithm. Between May [1995] and March [2000], fourteen grafts were placed in 14 patients, with exhausted venous arm sites. No significant post-operative complications occurred, the secondary patency rate after 1 and 2 years was 85.7% and 77% respectively, which were much better than conventional arm bridge fistula 50-70% after one year, Really, this procedure opened the closed doors infront of those miserable patients with chronic renal failure and exhausted all venous arm sites and good enough that the proposed two main problems with this procedure which were heart failure and steal phenomena did not occur with a significant importance. No single case of heart failure occurred in this series also, steal phenomena occurred only in one case with mild degree that there was no need for intervention, So, it might prove reasonable to use this graft earlier in an effort to eliminate the painful, costly and inconvenient multiple revisions frequently required with more conventional grafts