Intima-media thickness: correlation between carotids, vertebral artery, aorta and femoral arteries.

AIM: Compare the intima-media thickness (IMT) of the internal carotid artery with the IMT of the common and external carotid, vertebral and femoral arteries and the abdominal aorta to assess the possibility of using these arteries as markers of atherosclerotic disease. METHODS: Fifty patients with atherosclerosic risk factors were examined and the IMT was determined in the carotid arteries and compared with the values of IMT of the vertebral and femoral arteries and the abdominal aorta. The Spearman correlation coefficient and Kappa index were used for statistical analysis. RESULTS: Considering IMT equal or greater than 0,8mm, there was positive and significant correlation between the values obtained for the examined arteries. The best agreement was found between the external and common carotid artery as compared to the internal carotid. (accuracy of 73.5% and 79.2%, respectively). For all arteries the was a positive correlation of the values of the EMI. CONCLUSION: There is positive and significant correlation between the IMT of the internal carotid artery and the vertebral and femoral arteries and abdominal aorta. Routine examinations of either one of these arteries can ad important findings regarding early diagnosis for higher risk patients concerning atherosclerotic disease.

Prevalence of lower limb occlusive vascular disease in outclinic diabetic patients.

AIM: The aim of this study was to determine the prevalence and risk factors for peripheral occlusive vascular disease (POVD) in subjects with diabetes mellitus (DM) in Brazil. METHODS: We evaluated 236 diabetic individuals, in spontaneous demand, representing 471 legs. POVD was assessed by the ankle brachial index (ABI). RESULTS: The mean age was 62.1 years (range 22-89 years), 52% were male, 93.2% type II DM and the mean time to diagnosis was 7.9 years (range 0-37 years). Sixty percent were hypertensives. In 61% at least one pulse was diminished or absent. The prevalence of ischemia was 18% (ABI<0.9) while 22% had an ABI compatible with high grade arterial calcification (ABI>1.3). Overall less than 1/3 of the cases had the vascular exam that could be considered normal. The ABI was lower in subjects with pulse deficit (p<0.001), and a normal pulse had a negative predictive value for ischemia of more than 90%. Subjects with normal pulses were younger and had a decreased diabetes duration (p<0.001 and p<0.05, respectively). An increase in the duration of the diabetes was associated with a progressive decrease in the ABI (p<0.01). Female gender and hypertension were associated with a reduced ABI (p<0.01 and p<0.05, respectively). CONCLUSION: There is a high prevalence of POVD in diabetic individuals. The disease is associated with hypertension and female gender and gets worse with increasing duration of the diabetes.

Bridge graft to a small distal artery after fistula ligation for angioaccess-induced ischemia: report of two cases.

Angioaccess-induced ischemia is an infrequent but cumbersome problem, because both limb ischemia correction and access salvage should be undertaken during the same procedure. This paper reports two cases that we successfully managed with a bridge graft to a small distal artery after fistula ligation.

Major amputations of the lower leg. The patients two years later.

UNLABELLED: The most devastating consequence of vascular disease of the lower extremity is amputation. Although considered as the end of the efforts of the vascular procedures, it should not be considered the end of medical treatment of the patient. The purpose of this study was to determine the situation of patients who suffered a major amputation of the lower leg due to ischemic vascular disease, at least two years after this event. PATIENTS AND METHODS: Forty-eight patients who had major amputation had their chart reviewed and were contacted to inform about the current conditions of rehabilitation. In case of death, the causes of dismissal were obtained. The degree of rehabilitation was compared to the preoperative level of selfishness. RESULTS: Before amputation, 15 patients had an independent life, 21 could walk up to 500 meters, seven were confined to a wheel-chair or used crutches and five were bedridden. At least two years later, 54.2% of the patients died and only nine were fully rehabilitated (18.8% of all the patients and 40.9% of the living patients). CONCLUSIONS: Patients who suffer amputation due to vascular disease do have a low survival rate after two years. Among the survivors, only few patients do have clinical conditions to regain a regular situation of autonomy.

Course of the post-catheterization pulseless arm.

With the purpose of determining the course of the non-operated post-catheterization brachial artery thrombosis, 45 patients in this condition were followed during a one month period of survey. A gradual increase in Doppler-derived pressure index of the ischemic arm was observed. This index averaged 0.51 on the day of occlusion, increased to an average of 0.66 in the immediate following day and on the 30th day averaged 0.82. All but 10 patients were asymptomatic after 30 days, although a similar increase in pressure index was observed among these patients, being thus indistinguishable from the whole group. Since it was not possible to predict in which patients symptoms of arm ischemia would remain present, it seems advisable to consider surgical restoration of flow in all cases of brachial artery thrombosis after cardiac catheterization.

Hemodinamica do enxerto femoro-femoral cruzado. Estudo experimental. / Hemodynamics of the cross-over femoro-femoral graft.Experimental study

As alteracoes hemodinamicas que ocorrem na arteria iliaca doadora, apos realizacao de derivacao femoro-femoral cruzada, foram, experimentalmente, avaliadas, utilizando-se o efeito Doppler ultrassom. Apesar de empregado como metodo semi-quantitativo, houve consonancia com os achados obtidos em estudos semelhantes, nos quais se usaram metodos quantitativos para determinacao de fluxo sanguineo.Observou-se, em vigencia de arvore arterial distal normal, tendencia para duplicacao do fluxo pela arteria iliaca, doadora, quando ocluida sua homonima contra-lateral apos instalacao de derivacao cruzada. A importancia desta duplicacao de fluxo e notavel por ser responsavel pela alteracao da chamada "estenose critica" da arteria iliaca. Em condicoes hemodinamicas normais, seu valor se situa em torno de 52% de comprometimento da liz arterial, diminuindo para 40% quando ocorre duplicacao de velocidade do sangue. Tal fato exige, alem da apreciacao anatomica de eventuais lesoes arterioscleroticas que possam comprometer a arteria iliaca doadora, avaliacao funcional desse vaso em condicoes de fluxo aumentado

Aneurisma toraco-abdominal.Consideracoes cirurgicas e anestesiologicas. / Thoraco-abdominal aneurysm: surgical and anestesiologic considerations

O aneurisma da aorta toraco-abdominal e apresentado como afeccao grave e de indicacao cirurgica. Os autores explicam sua experiencia inicial a aneurismectomia pela tecnica preconizada por Crawford, fazendo consideracoes a respeito do procedimento cirurgico e ressaltando as implicacoes anestesiologicas, bem como as dos preparo pre-operatorio

Aneurysm of the anterior jugular vein.

Aneurysms of the anterior jugular vein are rare. This case report describes such an abnormality. In this instance, microscopic study showed abnormal distribution of elastic and muscular fibers along the wall of the vessel. These findings and corroboration of these findings in other similar cases suggest a congenital etiology for the abnormality. The existence of venous aneurysms as a true pathologic feature is confirmed.

Lymphatic disruption in varicose vein surgery.

In order to investigate the possibility of lymphatic disruption occurring during varicose vein surgery, lymphangiography performed by a modification of the Kinmonth technique was done in seven patients before and after standard surgical ablation of primary varicose veins. All seven patients demonstrated marked disruption of lymphatics. Extravasation of lymphangiogram contrast medium at the calf level and at the thigh level precluded demonstration of the groin lymphatics. It is concluded that lymphatic disruption attends varicose vein removal and such lymphatic damage contributes to postoperative leg edema.

Forefoot perfusion pressure and minor amputation for gangrene.

In many cases of digital gangrene, limited amputation to preserve the majority of the foot is possible. In the absence of invasive infection, forefoot perfusion pressure is the single most important factor in determining outcome of minor amputation. At ankle pressures of less than 35 mm. Hg, salvage of the foot appears to be futile. The presence or absence of diabetes mellitus has no noticeable effect on the result of amputation. Ankle systolic pressure measurement cannot supplant but should supplement clinical judgement in selecting surgical treatment for gangrene.