Subject(s)
Leg Ulcer/epidemiology , Leg Ulcer/prevention & control , Adult , Aged , Humans , Leg Ulcer/etiology , Leg Ulcer/physiopathology , Microcirculation , Middle Aged , Patient Education as Topic , Prognosis , Recurrence , Risk Factors , Varicose Ulcer/epidemiology , Varicose Ulcer/prevention & controlABSTRACT
Vertebrobasilar ischemic disease cannot be adequately explored by echo-Doppler ultrasonic investigating procedures, since they do not permit the study of the intracranial arteries. The transcranial pulsed Doppler (2 MHZ) velocity detection method developed by R. Aaslid now offers such possibilities, although it has not yet been validated in this field. The authors relate their experience and methodological criteria (patient's position, deepness of access, flow direction, response to compression tests). They conducted 2 studies, one bearing on the detection of 14 cases of 75% stenosis of the superior segment, or of arteriographically-confirmed endocranial vertebral/basilar artery occlusion; the other one was concerned with assessing the basilar hemodynamic consequences of vertebral-subclavian steal syndromes. Out of 17 steal syndrome cases, of which 5 were symptomatic (4 pre-steal cases, 7 permanent, 6 intermittent), basilar flow determined spontaneously or following postischemic hyperemic test of the upper limb, was moderately changed in 30% of cases. Transcranial pulsed Doppler ultrasonic examination could be recommended in addition to the regular echo-Doppler velocity detection test, and thus contribute to exploring and monitoring transient or full-blown ischemic accidents of the vertebrobasilar circulation, in expectation of medical, surgical or angioplastic management.
Subject(s)
Subclavian Steal Syndrome/diagnosis , Ultrasonography , Vertebrobasilar Insufficiency/diagnosis , Angiography , Female , Humans , Male , Subclavian Steal Syndrome/diagnostic imaging , Vertebrobasilar Insufficiency/diagnostic imagingABSTRACT
Since December 1985, we have operated upon seven bicycle racers for endofibrosis of the external iliac artery. In all instances, the athletes had started cycling early in life and were engaged in top level competition by the age of 17. The principal complaint was intermittent claudication of one lower limb at "near-maximal" exercise. Pain could be reproduced by exertional tests on an ergometric bicycle, and in all cases except one, measurement of ankle systolic pressure of that limb compared with the opposite side and brachial pressures showed a marked decrease on the involved side. Arteriography, performed with multiple views and positions, documented a 5 to 6 cm moderately stenotic (less than 40% diameter) segment, associated with arterial lengthening. Surgical treatment consisted of endarterectomy and shortening of the artery. Four patients were able to return to competition. The origin of this pathology is discussed, based on gross and histologic findings. Under certain predisposing anatomic conditions, abnormal hemodynamics, probably due to a high flow arterial state and an aerodynamic position on the bicycle, provoke repeated trauma which eventually produces the lesion. Practically unrecognized until now with only two previous publications on the subject in the literature, this entity is probably not uncommon.
Subject(s)
Bicycling , Iliac Artery/pathology , Sports , Adult , Fibrosis , Humans , Iliac Artery/surgery , MaleABSTRACT
Postoperative follow up examinations were conducted using vascular functional explorations (V.F.E.) including thermometry, Doppler, irrigraphy, digital plethysmography and tread mill. Immediate and long-term effects of lumbar sympathectomy have to be distinguished: the majority of hemodynamic variations noted are not due exclusively to lumbar sympathectomy, except for the iatrogenic development of vasomotor inertia (R.H.T. indifferent or negative) and perhaps values with time of the digital flow curve. Results of V.F.E. after lumbar sympathectomy are discussed in relation to three modalities and taking into account the efficacy and extent of the sympathetic chain resection. The question is raised as to the usefulness of lumbar sympathectomy when the pretreatment V.F.E. findings show hemodynamic elements of the type that would be expected after lumbar sympathectomy.
Subject(s)
Arterial Occlusive Diseases/diagnosis , Leg/blood supply , Sympathectomy , Arterial Occlusive Diseases/therapy , Exercise Test , Hemodynamics , Humans , Hyperemia/diagnosis , Lumbosacral Region , Plethysmography , Plethysmography, Impedance , Postoperative Period , Thermography , Time Factors , UltrasonographyABSTRACT
Results and correlation with arteriographic findings in 25 cases. The methodological criteria essential to the reliability of this examination are described, as well as the special conditions of recording which may influence interpretation. The respective values for systolic and diastolic circulatory rates obtained on ultrasound curves led the authors to classify the results into five groups. There was satisfactory correlation between the latter and the anatomical data provided by arteriography of the vertebral arteries. Such a quantitative approach provides an assessment of the functionally normal or pathological state of the vertebral arteries and of circulatory assymetry.
