99TCm-labeled leucocyte scan for detecting infection of vascular graft involving groin.

The clinical value of Technitium-99TCm leucocyte in detecting early post-operative infection of prosthetic vascular grafts, to and from the femoral artery involving groin dissection is assessed. Twenty-five patients underwent bypass procedure using either Dacron or PTFE grafts. 99TCm labeled leucocyte scans were undertaken between 6-8 days following the bypass procedure. Fourteen patients had normal scans and no subsequent evidence of graft infection. The remaining 11 patients had abnormal scans discharge. These patients underwent serial scanning until the scan normalised or graft infection developed. Of 11 patients, who had abnormal initial scans, 2 developed clinical groin infection and were thus true positive, 7 patients subsequently had normal scans, 2 patients died of other causes. The sensitivity of 99TCm labeled leucocyte scan is 100%, but unlike some previous reports, we found a low specificity. The graft material used did not make any difference as far as the sensitivity or specificity of detection of graft infection was concerned.

Screening for abdominal aortic aneurysm: is opportunistic detection a realistic alternative?

OBJECTIVES: To determine whether abdominal aortic aneurysms (AAA) may be detected during investigation for concurrent disease and to assess whether opportunistic detection is a feasible alternative to a formal screening programme. DESIGN: A prospective review of previous investigations in subjects attending for aortic screening. MATERIALS AND METHODS: 276 men aged 65-80 attended the Chichester AAA screening programme. They were asked whether they had consulted their General Practitioner and whether they had undergone radiological investigation within the preceding 5 years. RESULTS: Two-hundred and sixty-one subjects had consulted their General Practitioner (94.6%) within the past 5 years. Fifty-six patients had been investigated with radiological imaging: in 22 cases (8.0%) the investigation had the potential to detect an AAA. The opportunistic detection rate was 0.4% (one AAA) in comparison to 12.0% for the screening programme (33 AAA). Imaging investigations with the potential to pick up AAA failed to detect five out of six aneurysms in this group. CONCLUSIONS: Opportunistic screening for AAA is not a realistic alternative to a formal screening programme but may improve the detection rate in the community.

Serial investigation of balloon angioplasty induced changes in the superficial femoral artery using colour duplex ultrasonography.

Percutaneous transluminal balloon angioplasty (PTA) of superficial femoral artery lesions is associated with similar initial success rates in coronary and iliac artery angioplasty but its application is limited by a much higher incidence of restenosis. To improve understanding of the trauma caused to the vessel by balloon angioplasty and the mechanisms contributing to the subsequent processes of healing and restenosis requires serial investigations of the treated arteries in vivo. This paper describes a prospective study using colour duplex ultrasonic imaging to assess arterial changes in 51 patients with atherosclerotic disease undergoing PTA of superficial femoral artery stenoses and occlusions. Each patient was scanned prior to angioplasty and at intervals up to 6 months post-angioplasty. On each scan, measurements were made of the overall vessel and lumen diameters at each site of angioplasty. These measurements indicate that angioplasty improves vessel patency mainly by stretching of the vessel wall, with compression and/or redistribution of the atherosclerotic plaque contributing less than 25% to the improvement of lumen diameter. Serial measurements after angioplasty show complex patterns of change at the angioplasty sites indicating that several mechanisms may be contributing to the processes of vessel healing and subsequent restenosis. Possible mechanisms which could explain the measured changes in overall vessel and lumen diameters are discussed.