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Wang SH, Shyu VBH, Chiu WK, Huang RW, Lai BR, Tsai CH. An Overview of Clinical Examinations in the Evaluation and Assessment of Arterial and Venous Insufficiency Wounds. Diagnostics (Basel) 2023; 13:2494. [PMID: 37568858 PMCID: PMC10417660 DOI: 10.3390/diagnostics13152494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
Arterial and venous insufficiency are two major causes of chronic wounds with different etiology, pathophysiology, and clinical manifestations. With recent advancements in clinical examination, clinicians are able to obtain an accurate diagnosis of the underlying disease, which plays an important role in the treatment planning and management of patients. Arterial ulcers are mainly caused by peripheral artery diseases (PADs), which are traditionally examined by physical examination and non-invasive arterial Doppler studies. However, advanced imaging modalities, such as computed tomography angiography (CTA) and indocyanine green (ICG) angiography, have become important studies as part of a comprehensive diagnostic process. On the other hand, chronic wounds caused by venous insufficiency are mainly evaluated by duplex ultrasonography and venography. Several scoring systems, including Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification, the Venous Clinical Severity Score (VCSS), the Venous Disability Score, and the Venous Segmental Disease Score (VSDS) are useful in defining disease progression. In this review, we provide a comprehensive overlook of the most widely used and available clinical examinations for arterial and venous insufficiency wounds.
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Affiliation(s)
- Szu-Han Wang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei 110, Taiwan
| | - Victor Bong-Hang Shyu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Ren-Wen Huang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Bo-Ru Lai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chia-Hsuan Tsai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
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Li MF, Liang HL, Chiang CL, Wu TH. Pulsatility index-adjusted doppler flow measurement of pedal arteries in peripheral artery disease patients. J Chin Med Assoc 2023; 86:98-104. [PMID: 36599144 DOI: 10.1097/jcma.0000000000000843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To examine the feasibility of using pulsatility index-adjusted (PI) flow equations to accurately characterize blood volume flow changes using Doppler technique in patients with peripheral artery disease (PAD) before and after percutaneous transluminal angioplasty (PTA). METHODS PTA was performed on 17 PAD patients (23 target vessels treated, 16 anterior tibial arteries, and 7 posterior tibial arteries). Arterial diameter, peak systolic velocity, PI, time-averaged mean velocity, and measured volume flow (MVF) of dorsalis pedis artery (DPA) and common plantar artery (CPA) were measured with duplex Doppler ultrasound before and after PTA. PI-adjusted volume flows (PIVF) were calculated as part of the MVF/PIVF relative percentage metric. RESULTS Significant changes (p < 0.001) of the MVF (mean: 33.0 mL/min, range: -20.9-102.2 mL/min) and MVF/PIVF relative percentages (mean: 51.8, range: 5.1-127.2%) in the DPA existed between before and after PTA, whereas no significant changes could be found in the CPA (mean:10.9 mL/min, p = 0.148 and mean: 21.3%, p = 0.146, respectively). Of the 7 treated posterior tibial arteries, the increments of the MVF/PIVF (mean: 60.4%, p = 0.033) was significant but not in the MVF (mean: 26.5 mL/min, p = 0.125). The ankle-brachial index also showed non-significant changes (p = 0.081). All PI-adjusted results matched clinical observations after blood flow restoration. CONCLUSION No conclusions can be drawn from the comparison of actual measured volume flow between before and after PTA. However, using the MVF/PIVF relative percentage allows for a more objective framework upon which to base clinical observations and provides clarity in situations where direct measurement provides a counter-intuitive or contradictory picture.
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Affiliation(s)
- Ming-Feng Li
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Tung-Ho Wu
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Optometry, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
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Mateus S, Paulo R, Coelho P, Rodrigues F, Marques V, Neiva HP, Duarte-Mendes P. Evaluation of Lower Limb Arteriovenous Diameters in Indoor Soccer Athletes: Arterial Doppler Ultrasound Study. Front Physiol 2021; 12:687613. [PMID: 34262477 PMCID: PMC8273383 DOI: 10.3389/fphys.2021.687613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to analyze the arterial and venous diameters of lower limbs in indoor soccer athletes and non-athletes using Doppler ultrasound to identify the differences in the variation of arterial and venous diameters between groups. Additionally, we intended to verify the differences of arterial and venous diameters between the skilled member (right member) and the not skilled member in each group. 74 male volunteers, aged between 19 and 30 years old, were divided in a group of athletes (n = 37, 24 ± 2.7 years, soccer players from national championship), and a group of non-athletes (n = 37, 26 ± 2.83 years). Vascular lower limb was assessed using Doppler ultrasound (Philips HD7 echograph with linear transducer 7–12 MHz). The athletes showed higher diameters of right common femoral artery (p = 0.009; moderate), left common femoral artery (p = 0.005; moderate), right deep femoral artery (p = 0.013; moderate), right popliteal artery (p = 0.003; moderate), and left popliteal artery (p = 0.017; small) than non-athletes. Veins’ diameters were also higher in athletes, specifically the right deep femoral vein (p ≤ 0.001; large), left deep femoral vein (p ≤ 0.001; large), right popliteal vein (p ≤ 0.001; large), and left popliteal vein (p ≤ 0.001; large). Differences were found between the skilled and non-skilled leg in athletes in the popliteal vein (7.68 ± 1.44 mm vs. 7.22 ± 1.09 mm, respectively, p < 0.003). It seems that futsal athletes have superior mean diameters of lower limbs arteries and veins of the deep venous system to non-athletes. Moreover, the veins presented greater dilation, namely of the leg of the skilled lower limb.
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Affiliation(s)
- Sónia Mateus
- EPE-Neurovascular and Cardíac Ultrasound Lab, Espiríto Santo of Évora Hospital, Évora, Portugal.,Sport, Health and Exercise Research Unit, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Department of Clinical Physiology, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
| | - Rui Paulo
- Sport, Health and Exercise Research Unit, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Research Unit in Education and Community Intervention, Viseu, Portugal
| | - Patrícia Coelho
- Sport, Health and Exercise Research Unit, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Department of Clinical Physiology, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Quality of Life in the Rural World, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
| | - Francisco Rodrigues
- Sport, Health and Exercise Research Unit, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Quality of Life in the Rural World, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Department Biomedical Sciences Laboratory, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
| | - Vasco Marques
- Vascular Ultrasound Laboratory, Angiology and Vascular Surgery Service, Northern Lisbon University Hospital Centre, Lisbon, Portugal
| | - Henrique P Neiva
- Department of Sport Sciences, University of Beira Interior, Covilhã, Portugal.,Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, Covilhã, Portugal
| | - Pedro Duarte-Mendes
- Sport, Health and Exercise Research Unit, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,Research Unit in Education and Community Intervention, Viseu, Portugal
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Hardy TA, Paula-Ribeiro M, Silva BM, Lyall GK, Birch KM, Ferguson C, Taylor BJ. The cardiovascular consequences of fatiguing expiratory muscle work in otherwise resting healthy humans. J Appl Physiol (1985) 2021; 130:421-434. [PMID: 33356985 DOI: 10.1152/japplphysiol.00116.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In 11 healthy adults (25 ± 4 yr; 2 female, 9 male subjects), we investigated the effect of expiratory resistive loaded breathing [65% maximal expiratory mouth pressure (MEP), 15 breaths·min-1, duty cycle 0.5; ERLPm] on mean arterial pressure (MAP), leg vascular resistance (LVR), and leg blood flow ([Formula: see text]). On a separate day, a subset of five male subjects performed ERL targeting 65% of maximal expiratory gastric pressure (ERLPga). ERL-induced expiratory muscle fatigue was confirmed by a 17 ± 5% reduction in MEP (P < 0.05) and a 16 ± 12% reduction in the gastric twitch pressure response to magnetic nerve stimulation (P = 0.09) from before to after ERLPm and ERLPga, respectively. From rest to task failure in ERLPm and ERLPga, MAP increased (ERLPm = 31 ± 10 mmHg, ERLPga = 18 ± 9 mmHg, both P < 0.05), but group mean LVR and [Formula: see text] were unchanged (ERLPm: LVR = 0.78 ± 0.21 vs. 0.97 ± 0.36 mmHg·mL-1·min, [Formula: see text] = 133 ± 34 vs. 152 ± 74 mL·min-1; ERLPga: LVR = 0.70 ± 0.21 vs. 0.84 ± 0.33 mmHg·mL-1·min, [Formula: see text] = 160 ± 48 vs. 179 ± 110 mL·min-1) (all P ≥ 0.05). Interestingly, [Formula: see text] during ERLPga oscillated within each breath, increasing (∼66%) and decreasing (∼50%) relative to resting values during resisted expirations and unresisted inspirations, respectively. In conclusion, fatiguing expiratory muscle work did not affect group mean LVR or [Formula: see text] in otherwise resting humans. We speculate that any sympathetically mediated peripheral vasoconstriction was counteracted by transient mechanical effects of high intra-abdominal pressures during ERL.NEW & NOTEWORTHY Fatiguing expiratory muscle work in otherwise resting humans elicits an increase in sympathetic motor outflow; whether limb blood flow ([Formula: see text]) and leg vascular resistance (LVR) are affected remains unknown. We found that fatiguing expiratory resistive loaded breathing (ERL) did not affect group mean [Formula: see text] or LVR. However, within-breath oscillations in [Formula: see text] may reflect a sympathetically mediated vasoconstriction that was counteracted by transient increases in [Formula: see text] due to the mechanical effects of high intra-abdominal pressure during ERL.
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Affiliation(s)
- Tim A Hardy
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Marcelle Paula-Ribeiro
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom.,Department of Physiology, Federal University of São Paulo, São Paulo, Brazil
| | - Bruno M Silva
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil
| | - Gemma K Lyall
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Karen M Birch
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Carrie Ferguson
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Bryan J Taylor
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom.,Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida
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Duarte-Mendes P, Paulo R, Coelho P, Rodrigues F, Marques V, Mateus S. Variability of Lower Limb Artery Systolic-Diastolic Velocities in Futsal Athletes and Non-Athletes: Evaluation by Arterial Doppler Ultrasound. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020570. [PMID: 31963123 PMCID: PMC7013457 DOI: 10.3390/ijerph17020570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 12/15/2022]
Abstract
Background: Sports athletes, namely high-intensity practitioners, suffer from vascular remodeling overtime. The purpose of this study was to analyze the systolic and diastolic velocities’ variation between non-athletes and futsal athletes by means of arterial lower limb doppler ultrasound. Additionally, we intended to verify if the velocity variations occur primarily at the systolic or the diastolic level and in which arteries. Methods: Seventy-six young males (mean ± SD: 24.9 ± 2.8 years old) volunteered to participate in this cross-sectional study and were divided into two groups: a futsal athletes group (n = 38; 24 ± 2.78 years) in the central region of Portugal playing on the 2nd national league with the same level of practice (16 ± 2.4 years of practice) and a non-athletes group (n = 38: 26 ± 1.8 years) who did not practice sports regularly and were not federated in any sport. All the subjects agreed to participate in the study with the aim of assessing the arterial lower limb through doppler ultrasound (Philips HD7 echograph with linear transducer 7–12 MHz). Results: Differences between groups (p ≤ 0.05) in the systolic velocity of the left deep femoral artery (p = 0.022; d = 0.546, small) and in the right superficial femoral artery (p = 0.028; d = −0.515, small) were found. We also found differences in the diastolic velocity: in the left common femoral artery (p = 0.002; d = −0.748, moderate), in the right deep femoral artery (p = 0.028; d = −0.521, small), in the right superficial femoral artery (p = 0.026; d = −0.522, small), in the right popliteal artery (p = 0.002; d = −0.763, moderate), and in the left popliteal artery (p = 0.007; d = −0.655, moderate). Moreover, the athletes’ group presented the highest mean values, with the exception of the systolic velocity of the left deep femoral artery. In intragroup analysis of variance referring to systolic and diastolic velocities in arterial levels in the right and left arteries, differences were found in all analyses (p ≤ 0.05). Conclusions: We conclude that futsal athletes of our sample go through a process of changes such as increased blood flow velocity in systolic and diastolic cardiac phase in all studied lower limb arteries, showing that the remodeling occurs regardless of vessel radius. Our results reinforce the existence of vascular remodeling that may vary with the sport and its intensity.
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Affiliation(s)
- Pedro Duarte-Mendes
- Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal;
- Sport, Health & Exercise Research Unit (SHERU), Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal; (P.C.); (F.R.)
- Research Unit in Education and Community Intervention (RECI), 3515-776 Viseu, Portugal
- Correspondence: (P.D.-M.); (S.M.)
| | - Rui Paulo
- Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal;
- Sport, Health & Exercise Research Unit (SHERU), Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal; (P.C.); (F.R.)
- Research Unit in Education and Community Intervention (RECI), 3515-776 Viseu, Portugal
| | - Patrícia Coelho
- Sport, Health & Exercise Research Unit (SHERU), Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal; (P.C.); (F.R.)
- Department of Clinical Physiology, Polytechnic Institute of Castelo Branco, 6000-767 Castelo Branco, Portugal
- Quality of Life in the Rural World (Q-Rural), Polytechnic Institute of Castelo Branco, 6000-767 Castelo Branco, Portugal
| | - Francisco Rodrigues
- Sport, Health & Exercise Research Unit (SHERU), Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal; (P.C.); (F.R.)
- Quality of Life in the Rural World (Q-Rural), Polytechnic Institute of Castelo Branco, 6000-767 Castelo Branco, Portugal
- Department Biomedical Sciences Laboratory, Polytechnic Institute of Castelo Branco, 6000-767 Castelo Branco, Portugal
| | - Vasco Marques
- Vascular Ultrasound Laboratory, Angiology and Vascular Surgery Service, University Hospital Centre of Lisbon University Hospital Centre of Lisbon, 1169-024 Lisboa, Portugal;
| | - Sónia Mateus
- Sport, Health & Exercise Research Unit (SHERU), Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal; (P.C.); (F.R.)
- Department of Clinical Physiology, Polytechnic Institute of Castelo Branco, 6000-767 Castelo Branco, Portugal
- EPE–Neurovascular and Cardíac Ultrasound Lab, Espiríto Santo of Évora Hospital, 7000-811 Évora, Portugal
- Correspondence: (P.D.-M.); (S.M.)
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Doppler Flow Measurement of Lower Extremity Arteries Adjusted by Pulsatility Index. AJR Am J Roentgenol 2019; 214:10-17. [PMID: 31670583 DOI: 10.2214/ajr.19.21280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purposes of this study were to estimate the blood volume flow of the lower extremities by means of Doppler technique; to establish a quantitative relationship between volume flow and pulsatility index (PI) in both healthy subjects and patients with peripheral artery disease (PAD); and to derive arterial blood flow equations in the lower extremities for more accurate volume flow estimations. SUBJECTS AND METHODS. Sixty healthy subjects were recruited. Arterial diameter, peak systolic velocity, PI, time-averaged mean velocity, and volume flow of right lower extremity arteries were measured with duplex Doppler ultrasound. Linear regression analysis was used to evaluate the relationship between volume flow and the reciprocal of PI. This quantitative relationship was also used to assess flow changes in 10 patients with PAD before, after, or both before and after percutaneous angioplasty. RESULTS. Volume flow in the common femoral artery was 434.4 mL/min; superficial femoral artery, 172.5 mL/min; popliteal artery, 92.1 mL/min; dorsalis pedis artery, 11.8 mL/min; and common plantar artery, 12.0 mL/min. Linear relationships between the reciprocal of PI and volume flow were found and expressed as linear blood flow equations. For the patients with PAD, no statistical increase in measured flow in the downstream artery after percutaneous angioplasty was found (p = 0.1), although four arteries had decreased flow. After normalization of flow measurements with PI values, however, statistical increases were observed between percentage increment (p < 0.001) calculations. CONCLUSION. When real-time PI values are factored into blood volume flow calculations in the evaluation of lower extremity arteries, discrepancies in flow measurements can be resolved, resulting in more accurate and stable measurements of clinical and diagnostic significance.
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Chayen D, Lorber J, Malic Z, Heldenberg E, Itzhakov Z, Zaretsky M, Rabin I. A New Modified Surgical Technique of In Situ Reverse Arterialization: Leaving the Distal Saphenous Side Branches Open of Nonreconstructable Ischemic Leg Leads to Full Recovery. Ann Vasc Surg 2019; 61:472.e15-472.e21. [PMID: 31401299 DOI: 10.1016/j.avsg.2019.05.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/26/2019] [Accepted: 05/29/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Arterialization of the foot veins in patients with ischemic foot usually result in excessive foot edema, wound infection, venous gangrene, long hospitalization duration, and a high rate of amputation. We herein present an improved method of foot revascularization via the superficial venous system by in situ reverse arterialization (ISRA) of the foot venous bed, leaving the distal saphenous side branches open. METHODS A 69-year-old patient with toe wet gangrene and end-stage peripheral vascular disease with absence of foot target arteries underwent ISRA procedure, using the great saphenous vein, which was anastomosed end-to-side to the proximal superficial femoral artery. Only proximal saphenous tributaries were ligated until arterial flow reached the pedal superficial veins. RESULTS Postoperatively, the foot regained normal pulsation over the superficial venous system. The patient did not experience foot edema. On-table subtraction angiography demonstrated arterial flow through the long saphenous and dorsal foot veins, with returned venous flow through the anterior and posterior tibial veins. Methoxyisobutylisonitrile scan conducted 4 weeks postoperatively demonstrated positive oxygen uptake of the pedal muscles, which was absent before surgery. Electron microscopy of the muscles at the level of the transmetatarsal amputation demonstrated regeneration of muscle tissue with mitosis 6 weeks postoperatively. During 1,000 days of follow-up postsurgery, the flow was reduced and the transcutaneous pO2 level of the foot increased up to 76 mm Hg. CONCLUSIONS This new modified surgical technique of ISRA, in which only proximal saphenous tributaries were ligated in order to prevent high systemic pressure in the foot venous low pressure system, resulted in increased levels of transcutaneous pO2 and reduced flow, leading to full recovery of the ischemic foot.
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Affiliation(s)
- David Chayen
- Department of Vascular Surgery, Assaf Harofe Medical Center, Sackler Faculty of Medicine, Zerifin, Israel.
| | - Jonathan Lorber
- Department of Vascular Surgery, Assaf Harofe Medical Center, Sackler Faculty of Medicine, Zerifin, Israel
| | - Zvi Malic
- Faculty of Life Science, Cancer Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Eitan Heldenberg
- Department of Vascular Surgery, Assaf Harofe Medical Center, Sackler Faculty of Medicine, Zerifin, Israel
| | - Zalman Itzhakov
- Department of Vascular Surgery, Assaf Harofe Medical Center, Sackler Faculty of Medicine, Zerifin, Israel
| | - Michael Zaretsky
- Department of Vascular Surgery, Assaf Harofe Medical Center, Sackler Faculty of Medicine, Zerifin, Israel
| | - Igor Rabin
- Department of Vascular Surgery, Assaf Harofe Medical Center, Sackler Faculty of Medicine, Zerifin, Israel
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Doherty CJ, King TJ, Incognito AV, Lee JB, Shepherd AD, Cacoilo JA, Slysz JT, Burr JF, Millar PJ. Effects of dynamic arm and leg exercise on muscle sympathetic nerve activity and vascular conductance in the inactive leg. J Appl Physiol (1985) 2019; 127:464-472. [PMID: 31246555 DOI: 10.1152/japplphysiol.00997.2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The influence of muscle sympathetic nerve activity (MSNA) responses on local vascular conductance during exercise are not well established. Variations in exercise mode and active muscle mass can produce divergent MSNA responses. Therefore, we sought to examine the effects of small- versus large-muscle mass dynamic exercise on vascular conductance and MSNA responses in the inactive limb. Thirty-five participants completed two study visits in a randomized order. During visit 1, superficial femoral artery (SFA) blood flow (Doppler ultrasound) was assessed at rest and during steady-state rhythmic handgrip (RHG; 1:1 duty cycle, 40% maximal voluntary contraction), one-leg cycling (17 ± 3% peak power output), and concurrent exercise at the same intensities. During visit 2, MSNA (contralateral fibular nerve microneurography) was acquired successfully in 12/35 participants during the same exercise modes. SFA blood flow increased during RHG (P < 0.0001) and concurrent exercise (P = 0.03) but not cycling (P = 0.91). SFA vascular conductance was unchanged during RHG (P = 0.88) but reduced similarly during concurrent and cycling exercise (both P < 0.003). RHG increased MSNA burst frequency (P = 0.04) without altering burst amplitude (P = 0.69) or total MSNA (P = 0.26). In contrast, cycling and concurrent exercise had no effects on MSNA burst frequency (both P ≥ 0.10) but increased burst amplitude (both P ≤ 0.001) and total MSNA (both P ≤ 0.007). Across all exercise modes, the changes in MSNA burst amplitude and SFA vascular conductance were correlated negatively (r = -0.43, P = 0.02). In summary, the functional vascular consequences of alterations in sympathetic outflow to skeletal muscle are most closely associated with changes in MSNA burst amplitude, but not frequency, during low-intensity dynamic exercise.NEW & NOTEWORTHY Low-intensity small- versus large-muscle mass exercise can elicit divergent effects on muscle sympathetic nerve activity (MSNA). We examined the relationships between changes in MSNA (burst frequency and amplitude) and superficial femoral artery (SFA) vascular conductance during rhythmic handgrip, one-leg cycling, and concurrent exercise in the inactive leg. Only changes in MSNA burst amplitude were inversely associated with SFA vascular conductance responses. This result highlights the functional importance of measuring MSNA burst amplitude during exercise.
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Affiliation(s)
- Connor J Doherty
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Trevor J King
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Anthony V Incognito
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jordan B Lee
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Andrew D Shepherd
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Joseph A Cacoilo
- Department of Kinesiology, University of Guelph-Humber, Toronto, Ontario, Canada
| | - Joshua T Slysz
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jamie F Burr
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Philip J Millar
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada.,Toronto General Research Institute, Toronto General Hospital, Toronto, Ontario, Canada
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Gornati VC, Utsunomia K, de Lima TB, de Freitas Barão FT, Faccioli Lopes D, da Silva ES. Development of a Puncture Technique for Implanting Temporary Vascular Shunts in a Porcine Model. Ann Vasc Surg 2019; 60:455-462. [PMID: 31200035 DOI: 10.1016/j.avsg.2019.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/12/2019] [Accepted: 03/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Temporary vascular shunts (TVSs) are an effective tool for rapidly restoring blood flow to a limb or organ that has experienced vascular injury and ischemia and for which revascularization is not an immediate option. Usually, through an opening in the skin, the TVS is positioned within the proximal and distal stumps of the injured vessel, restoring perfusion and stopping the ischemia. The aim of this study is to compare standard TVS technique and a developed puncture technique for implanting TVS and to evaluate the utility and feasibility of this protocol after arterial lesions, in pigs. METHODS Vascular injuries were inflicted in both hind limbs of 30 pigs, and vascular interventions were performed, using standard and puncture TVS. Because each pig was implanted with both types of TVSs, it was possible to simultaneously monitor, analyze, and compare parameters such as, the mean arterial pressure (MAP, in mm Hg), blood flow (mL/min), and insertion times, in the same animal. RESULTS It was observed that the MAP in the limbs recovered and approached systemic MAP, in 100% of the experiments, in both groups. Analysis of the blood flow data showed that this parameter was significantly reduced in the puncture TVS group (110.36 ± 9.99 mL/min vs. 153.20 ± 18.57 mL/min, P = 0.001). On the other hand, the insertion time for the standard TVS was significantly greater than that of the puncture shunt (15.32 ± 3.08 min vs. 10.37 ± 1.7 min, P = 0.001). Furthermore, it was found that the primary and secondary patency and complication rates were similar for both TVS types. CONCLUSION Thus, given the adequate MAP recovery and reduction in implantation time observed in this experimental and in an animal model study, the use of the puncture TVS technique is effective and feasible.
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Affiliation(s)
- Vitor Cervantes Gornati
- Division of Vascular and Endovascular Surgery, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Karen Utsunomia
- Division of Vascular and Endovascular Surgery, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thaíssio Britto de Lima
- Division of Vascular and Endovascular Surgery, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Daniel Faccioli Lopes
- Division of Vascular and Endovascular Surgery, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Erasmo Simão da Silva
- Division of Vascular and Endovascular Surgery, Universidade de São Paulo, São Paulo, SP, Brazil
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Breeding J, Hamp T, Grealy R, Nair P, Iyer A, Kawanishi Y. Effects of extracorporeal membrane oxygenation pump flow, backflow cannulae, mean arterial blood pressure, and pulse pressure on Doppler-derived flow velocities of the lower limbs in patients on peripheral veno-arterial extracorporeal membrane oxygenation: A pilot study. Aust Crit Care 2018; 32:206-212. [PMID: 29858038 DOI: 10.1016/j.aucc.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/19/2018] [Accepted: 04/14/2018] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND Reported rates of limb ischaemia on peripheral veno-arterial extracorporeal membrane oxygenation (pVA ECMO) vary from 1-52%. OBJECTIVES Primary: To explore (i) the feasibility for appropriately trained intensive care unit staff to measure Doppler derived flow velocities of the lower limbs for patients on pVA ECMO; and (ii) whether these measurements are clinically useful. Secondary: explore the relationship between ECMO pump flow, backflow cannulae (BFC) properties, mean arterial blood pressure (MAP), and pulse pressure on flow velocities. METHOD Inclusion criteria: age>18 years, on pVA ECMO >24 hours. EXCLUSION CRITERIA any guardianship limitations and patients without a BFC. Serial patients receiving pVA-ECMO over a 10 month period had Doppler derived flow velocities of the lower limbs sampled. Simultaneously, other pertinent parameters were recorded. 80% inclusion was considered clinically feasible. Study personnel were asked for feedback regarding the ease and usefulness of studies. RESULTS 15 of 17 patients were included: 88% inclusion. Mean peak systolic velocity (PSV) in the cannulated limb was 31 ± 29 cm/s in the dorsalis pedis (DP) and 27 ± 18 cm/s posterior tibial (PT). Similar flows were recorded in the non-cannulated limbs (DP 34 ± 29 cm/s, PT 44 ± 36 cm/s; P > 0.05). PSV was positively correlated with pulse pressure in cannulated and non-cannulated limbs respectively (r=0.63, P < 0.05; r=0.67 and P < 0.05). There was no significant correlation between PSV and MAP. ECMO pump flow and BFC were negatively correlated with PSV (r=-0.51, P < 0.05; r=-0.43, P < 0.05). CONCLUSION It is generally feasible for ICU staff to measure flow velocities of the lower limbs for patients on pVA ECMO. It remains unclear how clinically useful these measurements are. Doppler derived flow velocities of arteries of the lower limbs of patients on pVA ECMO appear different to non-ECMO patients. PSV in the lower limbs of patients on pVA ECMO seems to be more related to pulse pressure than to other haemodynamic parameters.
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Affiliation(s)
- Jeff Breeding
- St Vincent's Hospital Sydney, 390 Victoria St, Darlinghurst, NSW, 2010, Australia.
| | - Thomas Hamp
- St Vincent's Hospital Sydney, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Robert Grealy
- St Vincent's Hospital Sydney, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Priya Nair
- St Vincent's Hospital Sydney, 390 Victoria St, Darlinghurst, NSW, 2010, Australia; Garvin Institute for Medical Research, 384 Victoria St, Darlinghurst, NSW, 2010, Australia; University of New South Wales, High St, Kensington, NSW, 2052, Australia
| | - Arjun Iyer
- St Vincent's Hospital Sydney, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Yujiro Kawanishi
- St Vincent's Hospital Sydney, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
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11
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Normahani P, Powezka K, Aslam M, Standfield NJ, Jaffer U. Podiatry Ankle Duplex Scan: Readily Learned and Accurate in Diabetes. Angiology 2017; 69:220-227. [PMID: 29214861 DOI: 10.1177/0003319717695994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to train podiatrists to perform a focused duplex ultrasound scan (DUS) of the tibial vessels at the ankle in diabetic patients; podiatry ankle (PodAnk) duplex scan. Thirteen podiatrists underwent an intensive 3-hour long simulation training session. Participants were then assessed performing bilateral PodAnk duplex scans of 3 diabetic patients with peripheral arterial disease. Participants were assessed using the duplex ultrasound objective structured assessment of technical skills (DUOSATS) tool and an "Imaging Score". A total of 156 vessel assessments were performed. All patients had abnormal waveforms with a loss of triphasic flow. Loss of triphasic flow was accurately detected in 145 (92.9%) vessels; the correct waveform was identified in 139 (89.1%) cases. Participants achieved excellent DUOSATS scores (median 24 [interquartile range: 23-25], max attainable score of 26) as well as "Imaging Scores" (8 [8-8], max attainable score of 8) indicating proficiency in technical skills. The mean time taken for each bilateral ankle assessment was 20.4 minutes (standard deviation ±6.7). We have demonstrated that a focused DUS for the purpose of vascular assessment of the diabetic foot is readily learned using intensive simulation training.
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Affiliation(s)
- Pasha Normahani
- 1 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Katarzyna Powezka
- 1 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mohammed Aslam
- 1 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nigel J Standfield
- 1 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Usman Jaffer
- 1 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
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12
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Frey S, Haine A, Kammer R, von Tengg-Kobligk H, Obrist D, Baumgartner I. Hemodynamic Characterization of Peripheral Arterio-venous Malformations. Ann Biomed Eng 2017; 45:1449-1461. [PMID: 28324193 DOI: 10.1007/s10439-017-1821-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/15/2017] [Indexed: 01/06/2023]
Abstract
Peripheral arterio-venous malformations (pAVMs) are congenital vascular anomalies that require treatment, due to their severe clinical consequences. The complexity of lesions often leads to misdiagnosis and ill-planned treatments. To improve disease management, we developed a computational model to quantify the hemodynamic effects of key angioarchitectural features of pAVMs. Hemodynamic results were used to predict the transport of contrast agent (CA), which allowed us to compare our findings to digital subtraction angiography (DSA) recordings of patients. The model is based on typical pAVM morphologies and a generic vessel network that represents realistic vascular feeding and draining components related to lesions. A lumped-parameter description of the vessel network was employed to compute blood pressure and flow rates. CA-transport was determined by coupling the model to a 1D advection-diffusion equation. Results show that the extent of hemodynamic effects of pAVMs, such as arterial steal and venous hypertension, strongly depends on the lesion type and its vascular architecture. Dimensions of shunting vessels strongly influence hemodynamic parameters. Our results underline the importance of the dynamics of CA-transport in diagnostic DSA images. In this context, we identified a set of temporal CA-transport parameters, which are indicative of the presence and specific morphology of pAVMs.
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Affiliation(s)
- Sabrina Frey
- ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland.
| | - A Haine
- Division of Angiology, Swiss Cardiovascular Center, University of Bern, Bern University Hospital, Bern, Switzerland
| | - R Kammer
- Division of Angiology, Swiss Cardiovascular Center, University of Bern, Bern University Hospital, Bern, Switzerland
| | - H von Tengg-Kobligk
- Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Bern University Hospital, Bern, Switzerland
| | - D Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - I Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, University of Bern, Bern University Hospital, Bern, Switzerland
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13
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Hwang JY. Doppler ultrasonography of the lower extremity arteries: anatomy and scanning guidelines. Ultrasonography 2017; 36:111-119. [PMID: 28219004 PMCID: PMC5381852 DOI: 10.14366/usg.16054] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/18/2022] Open
Abstract
Doppler ultrasonography of the lower extremity arteries is a valuable technique, although it is less frequently indicated for peripheral arterial disease than for deep vein thrombosis or varicose veins. Ultrasonography can diagnose stenosis through the direct visualization of plaques and through the analysis of the Doppler waveforms in stenotic and poststenotic arteries. To perform Doppler ultrasonography of the lower extremity arteries, the operator should be familiar with the arterial anatomy of the lower extremities, basic scanning techniques, and the parameters used in color and pulsed-wave Doppler ultrasonography.
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Affiliation(s)
- Ji Young Hwang
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea
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14
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Jaffer U, Normahani P, Matyushev N, Aslam M, Standfield NJ. Intensive Simulation Training in Lower Limb Arterial Duplex Scanning Leads to Skills Transfer in Real-World Scenario. JOURNAL OF SURGICAL EDUCATION 2016; 73:453-460. [PMID: 26861581 DOI: 10.1016/j.jsurg.2015.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 10/18/2015] [Accepted: 11/15/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To train novices to perform an abbreviated duplex lower limb ultrasound scan using simulation training and assess real-world skills transference. METHODS Novices undertook 3 days of simulation training. Their progress was assessed using the Duplex Ultrasound Objective Structured Assessment of Technical Skills (DUOSATS) for simulation and Cumulative Imaging Score (CIS). A final assessment day was held to assess DUOSATS for simulation and real patient scanning, CIS, cumulative diagnostic accuracy, and sections A and B of the Society of Vascular Technology examination. MSc students in vascular ultrasound were also assessed for comparison. RESULTS A total of 17 novices and 7 MSc students with 3-month training participated. Novices improved DUOSATS for simulation scores between days 1, 3, and 4: 18 (17-19) vs 27 (25-28) vs 30 (28-32), (median [interquartile range], p < 0.001). Novices improved in CIS between days 1 and 3: 10 (10-13) vs 21 (19-21), p < 0.001, with a decline on day 4: 15.3 (11.3-18.3), p < 0.001. On the final assessment day, there were no significant differences between novices and MSc students in: DUOSATS for simulation scores (30 [28-32] vs 31 [6-31.5], p = 0.85); DUOSATS for patient assessment (31 [28.7-33.7] vs 26.7 [24.5-35.7], p = 0.41); CIS (15.3 [11.3-18.7] vs 20.7 [12.3-22.2], p = 0.2), respectively. However, novices performed better in section B of the Society of Vascular Technology examination compared with MSc students (72.9% vs 54.3%, p < 0.001). Novices also demonstrated a higher diagnostic accuracy when compared with MSc students (65.7% of arterial segments correctly assessed vs 47.6%, respectively [p = 0.044]). CONCLUSIONS Intensive simulation of 3-day training achieved real patient-based assessments that were comparable to MSc students who were 3 months into their traditional training program.
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Affiliation(s)
- Usman Jaffer
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom; London Postgraduate School of Surgery, London, United Kingdom.
| | - Pasha Normahani
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
| | - Nikolay Matyushev
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom; London Postgraduate School of Surgery, London, United Kingdom
| | - Mohammed Aslam
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
| | - Nigel J Standfield
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom; London Postgraduate School of Surgery, London, United Kingdom
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15
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Normahani P, Aslam M, Martin G, Standfield NJ, Jaffer U. Variation in duplex peak systolic velocity measurement in a multi-site vascular service. Perfusion 2015; 30:636-42. [DOI: 10.1177/0267659115573280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Duplex US (DUS) is increasingly utilised as a first-line investigation for the assessment of carotid disease. For clinical decision-making, DUS assessment must be accurate and reproducible to ensure reliability. We aimed to investigate the variability in peak systolic velocity (PSV) measurement in a multi-site vascular network. Methods: DUS measurements of PSV were taken from continuous and pulsatile flow, generated by a high fidelity phantom, by 12 experienced vascular scientists across four hospitals. Participants were blinded to the actual PSV value (50 cm/s). Results: We observed an average error of 13.2% (± 8.3) and 11.6% (± 7.5) in PSV measurements taken from pulsatile and continuous waveforms, respectively. Measurements of PSV using the pulsatile waveform demonstrated statistically significant variation across all hospitals; ((hospital/mean) A 43.9 cm/s, B 61.7 cm/s, C 57.4 cm/s, D 47.7 cm/s, p=0.001). Further analysis demonstrated statistically significant variation in 4 instrumentation-related factors when measuring from a pulsatile waveform (Doppler angle, angle of insonation, velocity range, scale range). Conclusion: We observed a significant level of error and variation in PSV measurements across four sites within our vascular network. Variation in instrumentation-related factors may be accountable for this. In light of the centralisation of vascular services, it is increasingly important to unify and implement scanning protocols in order to reduce error and inter-site variability.
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Affiliation(s)
- P Normahani
- Department of Vascular Surgery, Imperial College School of Medicine, UK
| | - M Aslam
- Department of Vascular Surgery, Imperial College School of Medicine, UK
| | - G Martin
- Department of Vascular Surgery, Imperial College School of Medicine, UK
| | - NJ Standfield
- Department of Vascular Surgery, Imperial College School of Medicine, UK
| | - U Jaffer
- Department of Vascular Surgery, Imperial College School of Medicine, UK
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16
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Choi HW, Jansen B, Birrer D, Kassab GS. Effect of saline injection mixing on accuracy of conductance lumen sizing of peripheral vessels. PLoS One 2013; 8:e74622. [PMID: 24058606 PMCID: PMC3772889 DOI: 10.1371/journal.pone.0074622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/05/2013] [Indexed: 12/03/2022] Open
Abstract
Transient displacement of blood in vessel lumen with saline injection is necessary in the conductance method for measurement of arterial cross-sectional area (CSA). The displacement of blood is dictated by the interactions between arterial flow hemodynamics and saline injection dynamics. The objective of the present study is to understand how the accuracy of conductance measurements is affected by the saline injection. Computational simulations were performed to assess the error in predictions of arterial CSA using conductance measurements over a range of peripheral artery diameters (i.e., 4, 7, and 10 mm) with an introducing catheter (6 Fr.) for various blood flow and saline injection rates. The simulation results were validated using the conductance measurements of the phantoms with known diameters (i.e., 7 and 10 mm). The results demonstrated that a minimum ratio of saline injection rate to blood flow rate of 3 is needed to fully displace the blood and result in accurate measurement of CSA for the peripheral artery sizes considered. Furthermore, the error was shown to be minimized as the detection electrodes are positioned between the distal to the mixing zone induced by saline injection and far downstream (4–8 cm from the injection catheter tip). The present study shows that even for the large peripheral arteries (7–10 mm) where mixing can occur, an appropriate injection rate and detection position can produce accurate measurement of lumen size.
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Affiliation(s)
- Hyo Won Choi
- Department of Biomedical Engineering, Indiana University Purdue University, Indianapolis, Indiana, United States of America
| | - Benjamin Jansen
- Department of Biomedical Engineering, Indiana University Purdue University, Indianapolis, Indiana, United States of America
| | - David Birrer
- Department of Biomedical Engineering, Indiana University Purdue University, Indianapolis, Indiana, United States of America
| | - Ghassan S. Kassab
- Department of Biomedical Engineering, Indiana University Purdue University, Indianapolis, Indiana, United States of America
- Department of Surgery, Indiana University Purdue University, Indianapolis, Indiana, United States of America
- Department of Cellular and Integrative Physiology, Indiana University Purdue University, Indianapolis, Indiana, United States of America
- * E-mail:
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17
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Duplex ultrasound volumetric flow analysis before and after hemodialysis in patients with brachio-cephalic fistulae. J Vasc Access 2013; 14:342-7. [PMID: 23661143 DOI: 10.5301/jva.5000150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2013] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The United Kingdom Renal Association recommends duplex ultrasound to monitor arteriovenous fistula (AVF) flow rates during surveillance. Significant flow rate changes should prompt further investigation or treatment to avoid a failing fistula. Hemodialysis is known to alter the hemorrheologic and physiologic factors with a potential impact on measured flow rates. The aim of this study was to determine the difference in flow rate measured with duplex ultrasound before and after a single hemodialysis session in patients with brachial-cephalic fistulae. METHODS Patients with brachial-cephalic AVFs in our dialysis populations who were undergoing regular hemodialysis without recent intervention (less than six weeks) were invited to participate. Flow measurements were made pre-and post-hemodialysis using a Zonare ultrasound machine. The vascular scientist was always blinded to the pre-hemodialysis flow. RESULTS A total of 157 patients were identified with brachial-cephalic fistulae. Following exclusions, 119 patients were eligible. However, a further 58 were excluded because they declined or did not attend leaving 61 patients in the study. Paired t test showed a statistically significant reduction in flow rate of 105 mL/min (P=0.026) post-hemodialysis which equates to a -6.9% change in flow (95% C.I. -12.7 to -0.8%). Bland-Altman analysis showed limits of flow rate agreement between -599 mL/min and +810 mL/min (+/-1.96 s.d.). CONCLUSIONS Whilst we have shown a statistically significant change in flow rate post-hemodialysis, this is small and should be taken in the context of previously accepted interobserver variability. Therefore, the practical and financial considerations of implementing an AVF surveillance programme are likely to outweigh the minimal benefit of consistency that would be enabled by strict protocol of pre-hemodialysis flow measurements.
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18
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Osada T. Physiological aspects of the determination of comprehensive arterial inflows in the lower abdomen assessed by Doppler ultrasound. Cardiovasc Ultrasound 2012; 10:13. [PMID: 22443486 PMCID: PMC3366871 DOI: 10.1186/1476-7120-10-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 03/26/2012] [Indexed: 11/30/2022] Open
Abstract
Non-invasive measurement of splanchnic hemodynamics has been utilized in the clinical setting for diagnosis of gastro-intestinal disease, and for determining reserve blood flow (BF) distribution. However, previous studies that measured BF in a "single vessel with small size volume", such as the superior mesenteric and coeliac arteries, were concerned solely with the target organ in the gastrointestinal area, and therefore evaluation of alterations in these single arterial BFs under various states was sometimes limited to "small blood volumes", even though there was a relatively large change in flow. BF in the lower abdomen (BF(Ab)) is potentially a useful indicator of the influence of comprehensive BF redistribution in cardiovascular and hepato-gastrointestinal disease, in the postprandial period, and in relation to physical exercise. BF(Ab) can be determined theoretically using Doppler ultrasound by subtracting BF in the bilateral proximal femoral arteries (FAs) from BF in the upper abdominal aorta (Ao) above the coeliac trunk. Prior to acceptance of this method of determining a true BF(Ab) value, it is necessary to obtain validated normal physiological data that represent the hemodynamic relationship between the three arteries. In determining BF(Ab), relative reliability was acceptably high (range in intra-class correlation coefficient: 0.85-0.97) for three arterial hemodynamic parameters (blood velocity, vessel diameter, and BF) in three repeated measurements obtained over three different days. Bland-Altman analysis of the three repeated measurements revealed that day-to-day physiological variation (potentially including measurement error) was within the acceptable minimum range (95% of confidence interval), calculated as the difference in hemodynamics between two measurements. Mean BF (ml/min) was 2951 ± 767 in Ao, 316 ± 97 in left FA, 313 ± 83 in right FA, and 2323 ± 703 in BF(Ab), which is in agreement with a previous study that measured the sum of BF in the major part of the coeliac, mesenteric, and renal arteries. This review presents the methodological concept that underlies BF(Ab), and aspects of its day-to-day relative reliability in terms of the hemodynamics of the three target arteries, relationship with body surface area, respiratory effects, and potential clinical usefulness and application, in relation to data previously reported in original dedicated research.
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Affiliation(s)
- Takuya Osada
- Department of Sports Medicine for Health Promotion, Tokyo Medical University, Tokyo, Japan.
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Furtado de Medeiros CA, Ferreira Silveira SA, Hüsemann Menezes F. Femoral/Axillary Volume Flow Ratio as a New Index for the Assessment of Iliac Atherosclerosis. Angiology 2010; 61:690-7. [DOI: 10.1177/0003319710366125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To measure the arterial volume flow (VF) with duplex scan, calculate femoral/axillary VF ratio, and discuss its applicability as a new index for the hemodynamic significance of an aorto-iliac occlusive lesion. Methods: Several measures of VF were obtained consecutively with duplex scan in both common femoral and axillary arteries of healthy volunteers with no signs of atherosclerosis and patients with documented evidence of occlusive aorto-iliac disease with segmental pressure measurement. Then the patient group was sent to complimentary evaluation for a second confirmatory examination. Results: There were a total of 635 measures of VF performed in 10 healthy volunteers and 8 patients with severe iliac stenoses or occlusion, 2 of then with bilateral disease. When comparing normal participants and patients with severe iliac stenoses or occlusion, there was statistical significant difference between these 2 groups (P < .01 Mann-Whitney). Similar result was found when comparing patient with diseased limbs with their own contralateral normal side (P < .05 Wilcoxon). And measuring the VF only during the systolic phase was a much more sensitive parameter for differentiating the normal from the diseased. Besides that a good correlation between proximal thigh pressure index and femoral/axillary systolic flow ratio was found in the patient group (P < .01 Spearman correlation). Conclusion: The femoral/axillary VF ratio is useful in assessing the hemodynamic significance of aorto-iliac disease, and the systolic femoral-axillary ratio may also be useful as a follow-up tool.
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Croteau E, Lavallée É, Labbe SM, Hubert L, Pifferi F, Rousseau JA, Cunnane SC, Carpentier AC, Lecomte R, Bénard F. Image-derived input function in dynamic human PET/CT: methodology and validation with 11C-acetate and 18F-fluorothioheptadecanoic acid in muscle and 18F-fluorodeoxyglucose in brain. Eur J Nucl Med Mol Imaging 2010; 37:1539-50. [PMID: 20437239 PMCID: PMC2914861 DOI: 10.1007/s00259-010-1443-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 03/08/2010] [Indexed: 01/05/2023]
Abstract
Purpose Despite current advances in PET/CT systems, blood sampling still remains the standard method to obtain the radiotracer input function for tracer kinetic modelling. The purpose of this study was to validate the use of image-derived input functions (IDIF) of the carotid and femoral arteries to measure the arterial input function (AIF) in PET imaging. The data were obtained from two different research studies, one using 18F-FDG for brain imaging and the other using 11C-acetate and 18F-fluoro-6-thioheptadecanoic acid (18F-FTHA) in femoral muscles. Methods The method was validated with two phantom systems. First, a static phantom consisting of syringes of different diameters containing radioactivity was used to determine the recovery coefficient (RC) and spill-in factors. Second, a dynamic phantom built to model bolus injection and clearance of tracers was used to establish the correlation between blood sampling, AIF and IDIF. The RC was then applied to the femoral artery data from PET imaging studies with 11C-acetate and 18F-FTHA and to carotid artery data from brain imaging with 18F-FDG. These IDIF data were then compared to actual AIFs from patients. Results With 11C-acetate, the perfusion index in the femoral muscle was 0.34±0.18 min−1 when estimated from the actual time–activity blood curve, 0.29±0.15 min−1 when estimated from the corrected IDIF, and 0.66±0.41 min−1 when the IDIF data were not corrected for RC. A one-way repeated measures (ANOVA) and Tukey’s test showed a statistically significant difference for the IDIF not corrected for RC (p<0.0001). With 18F-FTHA there was a strong correlation between Patlak slopes, the plasma to tissue transfer rate calculated using the true plasma radioactivity content and the corrected IDIF for the femoral muscles (vastus lateralis r=0.86, p=0.027; biceps femoris r=0.90, p=0.017). On the other hand, there was no correlation between the values derived using the AIF and those derived using the uncorrected IDIF. Finally, in the brain imaging study with 18F-FDG, the cerebral metabolic rate of glucose (CMRglc) measured using the uncorrected IDIF was consistently overestimated. The CMRglc obtained using blood sampling was 13.1±3.9 mg/100 g per minute and 14.0±5.7 mg/100 g per minute using the corrected IDIF (r2=0.90). Conclusion Correctly obtained, carotid and femoral artery IDIFs can be used as a substitute for AIFs to perform tracer kinetic modelling in skeletal femoral muscles and brain analyses.
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Affiliation(s)
- Etienne Croteau
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC Canada
- Sherbrooke Molecular Imaging Center, Centre de recherche clinique Étienne-LeBel, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC Canada
| | - Éric Lavallée
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC Canada
- Sherbrooke Molecular Imaging Center, Centre de recherche clinique Étienne-LeBel, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC Canada
| | - Sébastien M. Labbe
- Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC Canada
| | - Laurent Hubert
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC Canada
- Sherbrooke Molecular Imaging Center, Centre de recherche clinique Étienne-LeBel, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC Canada
| | - Fabien Pifferi
- Research Center on Aging, Université de Sherbrooke, Sherbrooke, QC Canada
- Mécanismes Adaptatifs et Évolution, MNHN-CNRS, Brunoy, France
| | - Jacques A. Rousseau
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC Canada
- Sherbrooke Molecular Imaging Center, Centre de recherche clinique Étienne-LeBel, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC Canada
| | - Stephen C. Cunnane
- Research Center on Aging, Université de Sherbrooke, Sherbrooke, QC Canada
- Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC Canada
| | - André C. Carpentier
- Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC Canada
| | - Roger Lecomte
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC Canada
- Sherbrooke Molecular Imaging Center, Centre de recherche clinique Étienne-LeBel, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC Canada
| | - François Bénard
- Division of Nuclear Medicine, Department of Radiology, University of British Columbia, Vancouver, BC Canada
- BC Cancer Agency, 675 West 10th Avenue, Vancouver, BC V5Z 1L3 Canada
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Byrom MJ, Bannon PG, White GH, Ng MKC. Animal models for the assessment of novel vascular conduits. J Vasc Surg 2010; 52:176-95. [PMID: 20299181 DOI: 10.1016/j.jvs.2009.10.080] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 09/25/2009] [Accepted: 10/04/2010] [Indexed: 11/19/2022]
Abstract
The development of an ideal small-diameter conduit for use in vascular bypass surgery has yet to be achieved. The ongoing innovation in biomaterial design generates novel conduits that require preclinical assessment in vivo, and a number of animal models have been used for this purpose. This article examines the rationale behind animal models used in the assessment of small-diameter vascular conduits encompassing the commonly used species: baboons, sheep, pigs, dogs, rabbits, and rodents. Studies on the comparative hematology for these species relative to humans are summarized, and the hydrodynamic values for common implant locations are also compared. The large- and small-animal models are then explored, highlighting the characteristics of each that determine their relative utility in the assessment of vascular conduits. Where possible, the performance of expanded polytetrafluoroethylene is given in each animal and in each location to allow direct comparisons between species. New challenges in animal modeling are outlined for the assessment of tissue-engineered graft designs. Finally, recommendations are given for the selection of animal models for the assessment of future vascular conduits.
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Hoyt K, Hester FA, Bell RL, Lockhart ME, Robbin ML. Accuracy of volumetric flow rate measurements: an in vitro study using modern ultrasound scanners. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1511-8. [PMID: 19854966 PMCID: PMC3415042 DOI: 10.7863/jum.2009.28.11.1511] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Volumetric flow measurement with Doppler ultrasound is useful in assessing blood flow as part of an evaluation of arteriovenous fistula maturity in patients undergoing hemodialysis. In this study, we assessed both accuracy and variability in volumetric flow measurements obtained using modern and commercially available ultrasound systems and an in vitro experimental setup. METHODS Volumetric flow measurements using duplex ultrasound were obtained by 3 users operating 5 different systems for randomized flow in the range of 100 to 1000 mL/min. Users performed 3 consecutive measurements at a given flow rate. Data were analyzed using statistical techniques to assess measurement accuracy and variability. RESULTS Over the span of flow rates studied, the root mean square error (RMSE) for the 5 ultrasound systems ranged from 38.8 to 79.7, 36.8 to 52.0, 73.0 to 85.3, 26.7 to 44.6, and 43.9 to 93.5 mL/min. Corresponding average RMSE values were 60.3, 42.7, 81.1, 37.2, and 64.4 mL/min, respectively. A linear regression analysis of mean interobserver measurements revealed an excellent correlation for all ultrasound systems (r(2) > 99.1%). Assessment of intraobserver measurements revealed no statistically significant differences for any ultrasound system evaluated (P > .94). Comparison of interobserver measurements indicates no statistically significant differences between any of the 5 systems (P > .14). CONCLUSIONS Modern ultrasound systems are reasonably accurate in blood flow measurement in an experimental setup mimicking clinically relevant blood flow ranges in a hemodialysis fistula. Users need adequate training and experience to perform multiple measurements and use appropriate techniques to minimize errors in flow measurement.
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Affiliation(s)
- Kenneth Hoyt
- Department of Radiology, University of Alabama at Birmingham, Volker Hall G082, 1670 University Boulevard, Birmingham, AL 35294, USA.
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23
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Diagnostic accuracy of intraarterial and i.v. MR angiography for the detection of stenoses of the infrainguinal arteries. AJR Am J Roentgenol 2009; 192:117-21. [PMID: 19098189 DOI: 10.2214/ajr.08.1230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to prospectively evaluate the diagnostic accuracy of intraarterial (i.a.) and i.v. MR angiography (MRA) of the infrainguinal arteries in comparison with the reference standard selective digital subtraction angiography (DSA). SUBJECTS AND METHODS Twenty consecutive patients with symptomatic peripheral arterial occlusive disease (PAOD) underwent i.v. MRA and i.a. MRA of the infrainguinal arteries and DSA, which served as the reference standard. For i.v. MRA, 27 mL of gadodiamide was injected through a peripheral arm vein; for i.a. MRA, 30 mL of diluted contrast agent (5 mL of gadodiamide in 55 mL of 0.9% saline solution) was twice injected in the superficial femoral artery with a flow rate of 2.5 mL/s through a 5-French sheath that was placed on the occasion of DSA before vascular intervention. A 3D gradient-echo sequence was performed using a dedicated coil system on a 1.5-T MR scanner. Three independent blinded observers localized and quantitatively graded stenoses on i.v. MRA and i.a. MRA. The overall impression of image quality of i.v. MRA and i.a. MRA was documented using a 4-point scale (1, excellent; 4, poor). Interobserver agreement was calculated. RESULTS The mean sensitivity and mean specificity for the detection of stenoses >or= 50% of the upper leg arteries (i.e., superficial femoral artery and popliteal artery) were 85.5% and 83.3% for i.a. MRA and 82.2% and 86.7% for i.v. MRA, respectively. The mean sensitivity and mean specificity for the detection of stenoses >or= 50% of the lower leg arteries (i.e., proximal anterior tibial artery, tibiofibular trunk, proximal posterior tibial artery, and proximal peroneal artery) were 91.7% and 75.0% for i.a. MRA, respectively, and 87.5% each for i.v. MRA. the diagnostic quality of i.a. MRA images and i.v. MRA images was assessed as excellent or good. CONCLUSION i.a. MRA provides sensitivity and specificity for the detection of hemodynamically significant stenoses of the infrainguinal arteries comparable to i.v. MRA and therefore is a good diagnostic tool especially for MR-guided vascular interventions.
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Samimi M, Maruani A, Bertrand P, Arbeille P, Lorette G. Arterial blood flow in limbs with port-wine stains can predict length discrepancy. Br J Dermatol 2009; 160:219-20. [DOI: 10.1111/j.1365-2133.2008.08939.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Bilodeau K, Couet F, Boccafoschi F, Mantovani D. Design of a Perfusion Bioreactor Specific to the Regeneration of Vascular Tissues Under Mechanical Stresses. Artif Organs 2005; 29:906-12. [PMID: 16266305 DOI: 10.1111/j.1525-1594.2005.00154.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of this work was to design a bioreactor to stimulate the three-dimensional regeneration of arterial tissue on a cylindrical scaffold with a methodological approach. Once seeded, the scaffold is perfused internally and the externally with culture medium with two independent perfusion systems at different flow rates. The horizontal position and the rotation of the construct ensure the uniformity of the arterial growth and of the endothelial cell spreading. During cell culture, the parameters, such as internal flow and stretching of the vessel, can evolve gradually from the fetal stage to the adult stage. The bioreactor will also be useful for investigating the influence of mechanical stresses and strains on the properties of mature arteries (rigidity, burst strength, adhesion of endothelial cells, etc.).
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Affiliation(s)
- Katia Bilodeau
- Laboratory for Biomaterials and Bioengineering, Department of Materials Engineering, Laval University, Quebec City, Canada
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26
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Zorger N, Volk M, Hamer OW, Lenhart M, Seitz J, Butz B, Paetzel C. Intraarterial Gadolinium-Enhanced MR Angiography in Humans for the Detection of Infrainguinal Arterial Stenoses Before and After Percutaneous Angioplasty. AJR Am J Roentgenol 2005; 185:867-72. [PMID: 16177402 DOI: 10.2214/ajr.04.0900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objectives of this study were to show the feasibility of intraarterial MR angiography of the infrainguinal arteries and to compare the accuracy of intraarterial MR angiography with selective intraarterial digital subtraction angiography for the detection of stenoses before and after percutaneous balloon angioplasty. SUBJECTS AND METHODS Fifteen patients underwent digital subtraction angiography and intraarterial MR angiography before and after balloon angioplasty. For intraarterial MR angiography, 30 mL of diluted contrast agent (5 mL of gadodiamide diluted in 55 mL of 0.9% saline solution) was injected through a sheath in the superficial femoral artery using a flow rate of 2.5 mL/sec. A 3D gradient-echo sequence was performed. Four independent blinded observers assessed differences in the quantitative measurement of stenoses and localization of lesions between digital subtraction angiography and intraarterial MR angiography. The overall impression of the intraarterial MR angiography images was documented on a 4-point scale (1 = excellent, 4 = poor). Interobserver variability was calculated. RESULTS Intraarterial MR angiography from the upper leg to the trifurcation was feasible in all 30 examinations with a mean overall impression of all segments of 1.3 (SD, 0.68). For the detection of significant stenoses (> or = 50% stenosis), the overall sensitivity and specificity for the femoropopliteal and crural vessels were 92.4% and 91.7% and 91.9% and 87.8%, respectively. For the complete leg, sensitivity and specificity were 92.2% and 88.6%, respectively. Interobserver variability for intraarterial MR angiography of the crural vessels exceeded that of the femoropopliteal arteries. CONCLUSION Intraarterial MR angiography of the infrainguinal arteries is feasible in humans using injections of diluted contrast agent at concentrations as low as 8%. It has a high sensitivity for detecting stenoses and an acceptable interobserver variability.
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Affiliation(s)
- Niels Zorger
- Department of Radiology, University of Regensburg, Klinikum, Franz Josef Strauss Allee 11, Regensburg 93042, Germany
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27
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Abstract
PURPOSE To evaluate whether muscle contraction-induced variability of limb femoral arterial blood flow (FABF) can be reduced with longer sampling durations. This was assessed in relation to muscle contraction-relaxation cycles (CRcycles) during steady-state, one-legged, dynamic knee-extensor exercise (KEE) at varying "exercise intensities" and "contraction frequencies." METHODS Eleven male subjects performed steady-state KEE at 10-40 W at 30 and 60 contractions per minute (cpm). FABF (Doppler ultrasound) and contraction-relaxation-induced variability in FABF was determined for 1-, 2-, 5-, 10-, 15-, 20-, and 30-CRcycles during approximately 4-min steady-state KEE. Variability was determined as coefficients of variation (CV). RESULTS During KEE at 30 and 60 cpm CVFABF was significantly higher for 1-CRcycles (12.3% and 15.5%) and 2-CRcycles (9.6% and 11.8%) than for 30-CRcycles (4.0% and 5.2%), but similar for 10-CRcycles to 30-CRcycles at all work rates and contraction frequencies. The CVFABF between work rates at 30 and 60 cpm did not statistically differ (P = NS) for any of the CRcycle measurements. However, the single CRcycles-induced CVFABF at 60 cpm was significantly higher (P < 0.05) than that at 30 cpm at the lower exercise intensities of 10 and 20 W, but with no significant difference at 30 and 40W. CONCLUSION Limb blood flow variability was markedly reduced with a longer sampling measurement of at least 10-CRcycles, which had a CVFABF of approximately 5%. Furthermore, the 1-CRcycle-induced FABF variability was similar at each exercise intensity, but significant variations were seen between contraction frequencies at lower exercise intensities. It is speculated the difference between the contraction frequencies at lower exercise intensities may be due to the muscle contraction-relaxation-induced variations in muscle force (intramuscular pressure), along with the superimposed blood pressure waves.
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Affiliation(s)
- Takuya Osada
- The Copenhagen Muscle Research Centre, University of Copenhagen, and Rigshospitalet, Copenhagen, Denmark.
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28
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Klein WM, Bartels LW, Bax L, van der Graaf Y, Mali WPTM. Magnetic resonance imaging measurement of blood volume flow in peripheral arteries in healthy subjects. J Vasc Surg 2003; 38:1060-6. [PMID: 14603218 DOI: 10.1016/s0741-5214(03)00706-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Peripheral arterial disease results in insufficient blood supply to the leg. Assessment of blood flow may provide information about severity of the disease. Magnetic resonance imaging (MRI) has potential use for simple, fast quantitative blood flow measurement. We investigated normal blood flow values for age and sex in the common femoral artery and popliteal artery in 50 healthy volunteers. In addition, we examined reproducibility and determinants of blood flow. METHODS We performed cardiac-triggered phase-contrast quantitative flow measurements in the common femoral artery and popliteal artery, and MRI of the calves in 50 healthy volunteers (age, 26-80 years). Ten persons underwent MRI three times, to analyze reproducibility. RESULTS All measurements were technically successful. Mean blood flow was 353 mL/min in the femoral artery and 61.9 mL/min in the popliteal artery. Coefficient of variation of femoral measurements was 16%, and of popliteal measurements was 19%. Femoral blood flow was significantly related to age and sex. Popliteal blood flow was significantly related to calf muscle volume, adjusted for age and sex. CONCLUSION Normal values for blood flow to the legs are presented. The measurements have reasonable reproducibility. Blood flow to the legs depends on age, sex, and calf muscle volume.
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Affiliation(s)
- Willemijn M Klein
- Department of Radilogy, University Medical Center, Utrecht, The Netherlands
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Huonker M, Schmid A, Schmidt-Trucksass A, Grathwohl D, Keul J. Size and blood flow of central and peripheral arteries in highly trained able-bodied and disabled athletes. J Appl Physiol (1985) 2003; 95:685-91. [PMID: 12433857 DOI: 10.1152/japplphysiol.00710.2001] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In a cross-sectional study, central and peripheral arteries were investigated noninvasively in high-performance athletes and in untrained subjects. The diastolic inner vessel diameter (D) of the thoracic and abdominal aorta, the subclavian artery (Sub), and common femoral artery (Fem) were determined by duplex sonography in 18 able-bodied professional tennis players, 34 able-bodied elite road cyclist athletes, 26 athletes with paraplegia, 17 below-knee amputated athletes, and 30 able-bodied, untrained subjects. The vessel cross-sectional areas (CSA) were set in relation to body surface area (BSA), and the cross-section index (CS-index = CSA/BSA) was calculated. Volumetric blood flow was determined in Sub and Fem via a pulsed-wave Doppler system and was set in relation to heart rate to calculate the stroke flow. A significantly increased D of Sub was found in the racket arm of able-bodied tennis players compared with the opposite arm (19%). Fem of able-bodied road cyclist athletes and of the intact limb in below-knee amputated athletes showed similar increases. D of Fem was lower in athletes with paraplegia (37%) and in below-knee amputated athletes proximal to the lesion (21%) compared with able-bodied, untrained subjects; CS-indexes were reduced 57 and 31%, respectively. Athletes with paraplegia demonstrated a larger D (19%) and a larger CS-index in Sub (54%) than able-bodied, untrained subjects. No significant differences in D and CS-indexes of the thoracic and abdominal aorta were found between any of the groups. The changes measured in Sub and Fem were associated with corresponding alterations in blood flow and stroke flow in all groups. The study suggests that the size and blood flow volume of the proximal limb arteries are adjusted to the metabolic needs of the corresponding extremity musculature and underscore the impact of exercise training or disuse on the structure and the function of the arterial system.
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Affiliation(s)
- M Huonker
- Medical University Hospital, Freiburg, Department of Prevention, Rehabilitation and Sportsmedicine, Freiburg, Germany.
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Gerrits HL, de Haan A, Sargeant AJ, van Langen H, Hopman MT. Peripheral vascular changes after electrically stimulated cycle training in people with spinal cord injury. Arch Phys Med Rehabil 2001; 82:832-9. [PMID: 11387591 DOI: 10.1053/apmr.2001.23305] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test whether a short period of training leads to adaptations in the cross-sectional area of large conduit arteries and improved blood flow to the paralyzed legs of individuals with spinal cord injury (SCI). DESIGN Before-after trial. SETTING Rehabilitation center, academic medical center. PARTICIPANTS Nine men with spinal cord lesions. INTERVENTION Six weeks of cycling using a functional electrically stimulated leg cycle ergometer (FES-LCE). MAIN OUTCOME MEASURES Longitudinal images and simultaneous velocity spectra were measured in the common carotid (CA) and femoral (FA) arteries using quantitative duplex Doppler ultrasound examination. Arterial diameters, peak systolic inflow volumes (PSIVs), mean inflow volumes (MIVs), and a velocity index (VI), representing the peripheral resistance, were obtained at rest. PSIVs and VI were obtained during 3 minutes of hyperemia following 20 minutes of FA occlusion. RESULTS Training resulted in significant increases in diameter (p < .01), PSIVs (p < .01), and MIVs (p < .05), and reduced VI (p < .01) of the FA, whereas values in the CA remained unchanged. Postocclusive hyperemic responses were augmented, indicated by significantly higher PSIVs (p <.01) and a trend toward lower VI. CONCLUSION Six weeks of FES-LCE training increased the cross-sectional area of large conduit arteries and improved blood flow to the paralyzed legs of individuals with SCI.
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Affiliation(s)
- H L Gerrits
- Institute for Fundamental and Clinical Human Movement Sciences, Vrije University Amsterdam, Amsterdam, the Netherlands.
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31
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Ubbink DT, Fidler M, Legemate DA. Interobserver variability in aortoiliac and femoropopliteal duplex scanning. J Vasc Surg 2001; 33:540-5. [PMID: 11241125 DOI: 10.1067/mva.2001.111734] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The interobserver variability of aortoiliac and femoropopliteal duplex scanning in peripheral arterial occlusive disease was assessed. METHODS Two experienced, independent vascular technologists investigated in random order 61 consecutive patients sent to the vascular laboratory for investigation of the aortoiliac or femoropopliteal arteries. In each aortoiliac vessel segment, the proximal, mid, and distal peak systolic velocities (PSVs) were measured, and corresponding PSV ratios were calculated. The superficial femoral artery was divided in 10-cm segments with a roll-centimeter taped from the upper patella margin. Interclass correlation coefficients (ICCs) were calculated as a means of appreciating the measurement variability of the PSV ratio values as a continuous variable and the Kappa value for the PSV ratio categories of less than 2.0, 2.0 through 3.0, more than 3.0, and occlusions. RESULTS The overall ICC and Kappa values were 0.72 (95% CI, 0.63-0.79) and 0.53 for the aortoiliac tract and 0.85 (95% CI, 0.79-0.89) and 0.73 for the femoropopliteal tract. Agreement in the PSV ratio categories was 85% in the aortoiliac and 87% in the femoropopliteal tract. Interobserver variation increased markedly with increasing PSV ratio. In the PSV ratio category between 2.0 to 3.0, indicating a borderline stenosis, a substantial disagreement was found (aortoiliac, 1 of 8 agreement; femoropopliteal, 2 of 8 agreement). CONCLUSION A moderate interobserver agreement was found in the duplex investigation of the aortoiliac and femoropopliteal arteries. One should be aware of this in clinical decision making, especially in cases of borderline stenoses. In these cases, repetition of the measurement or additional diagnostics is advocated.
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Affiliation(s)
- D T Ubbink
- Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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32
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Walker RD, Smith RE, Sherriff SB, Wood RF. Time-averaged mean velocity for volumetric blood flow measurements: an in vitro model validation study using physiological femoral artery flow waveforms. ULTRASOUND IN MEDICINE & BIOLOGY 1999; 25:577-582. [PMID: 10386733 DOI: 10.1016/s0301-5629(99)00010-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study assesses the accuracy of the volume flow measurement of the ATL HDI 3000 duplex ultrasound scanner using a model of the femoral arterial circulation. The beam profile of the transducer was measured, and used to identify regions of the beam where there may be poor insonation characteristics. The flow measurement accuracy was not found to be influenced by the vessel depth between 1.0 cm and 8.0 cm in a 0.7 cm diameter vessel. Overall accuracy was 3%+/-9%. Vessels in excess of 0.9 cm produced larger errors. In the model system, pulse rates between 60 bpm and 120 bpm had no significant effect on the measurement accuracy (p > 0.01). The results of this study suggest that accurate measurements of femoral arterial blood flow are possible. Further work will be required to assess the accuracy of the technique in vivo.
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Affiliation(s)
- R D Walker
- Division of Clinical Sciences, Section of Surgery, University of Sheffield, UK.
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Licht PB, Christensen HW, Røder O, Høilund-Carlsen PF. Volume flow estimation by colour duplex. Eur J Vasc Endovasc Surg 1999; 17:219-24. [PMID: 10092894 DOI: 10.1053/ejvs.1998.0741] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the accuracy of volume blood flow using a digitised colour duplex scanner. DESIGN Observer-blinded experimental study. MATERIALS AND METHODS Method comparison was performed with linear regression analysis of 89 paired observations in 11 anaesthetised pigs. A Siemens Sonoline Elegra ultrasound system was used for transcutaneous volume flow estimation using invasive transit time flowmetry by Cardiomed as a reference. RESULTS For the individual measurement we found a standard error of the estimate (SEE) of 22 ml/min. For the regression line, however, the SEE was only 0.2 ml/min. CONCLUSIONS Digitised colour-duplex sonography has a volume flow measurement error that is too high for single measurements in the individual patient for the method to be useful in clinical decision making, but sufficient for examinations of groups and comparison of groups.
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Affiliation(s)
- P B Licht
- Department of Clinical Physiology and Nuclear Medicine, Odense University Hospital, Denmark
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Osada T, Katsumura T, Hamaoka T, Inoue S, Esaki K, Sakamoto A, Murase N, Kajiyama J, Shimomitsu T, Iwane H. Reduced blood flow in abdominal viscera measured by Doppler ultrasound during one-legged knee extension. J Appl Physiol (1985) 1999; 86:709-19. [PMID: 9931212 DOI: 10.1152/jappl.1999.86.2.709] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The redistribution of blood flow (BF) in the abdominal viscera during right-legged knee extension-flexion exercise at very low intensity [peak heart rate (HR), 76 beats/min] was examined by using Doppler ultrasound. While sitting, subjects performed a right-legged knee extension-flexion exercise every 6 s for 20 min. BF was measured in the upper abdominal aorta (Ao), right common femoral artery (RCFA), and left common femoral artery (LCFA). Visceral BF (BFVis) was determined by the equation [BFAo - (BFRCFA + BFLCFA)]. A comparison with the change in BF (DeltaBF) preexercise showed a greater increase in DeltaBFRCFA than in DeltaBFAo during exercise. This resulted in a reduction of BFVis to 56% of its preexercise value or a decrease in flow by 1,147 +/- 293 (+/-SE) ml/min at the peak workload. Oxygen consumption correlated positively with DeltaBFAo, DeltaBFRCFA, and DeltaBFLCFA but inversely with DeltaBFVis during exercise and recovery. Furthermore, BFVis (% of preexercise value) correlated inversely with both an increase in HR (r = -0.89), and percent peak oxygen consumption (r = -0.99). This study demonstrated that, even during very-low-intensity exercise (HR <90 beats/min), there was a significant shift in BF from the viscera to the exercising muscles.
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Affiliation(s)
- T Osada
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo 160-8402, Japan.
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35
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Holland CK, Brown JM, Scoutt LM, Taylor KJ. Lower extremity volumetric arterial blood flow in normal subjects. ULTRASOUND IN MEDICINE & BIOLOGY 1998; 24:1079-1086. [PMID: 9833575 DOI: 10.1016/s0301-5629(98)00103-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The objective of this clinical study was to establish normal values for volumetric blood flow in the leg at rest using Doppler ultrasound, and to determine what biophysical factors influence resting volumetric flow. Arterial blood flow was measured at four sites in the legs of 40 healthy subjects using an ATL Ultramark 9 HDI system. All subjects were nonhypertensive nonsmokers with ankle brachial index values greater than 1 and no history of vascular disease. The subjects, 20 of each gender, in age ranging from 20 to 64 y were examined. Blood flow was calculated from the time-averaged, intensity-weighted mean velocity Doppler waveforms and vessel cross-sectional area at the same site. Thigh and calf circumference measurements were used to estimate muscle masses. The mean flow and standard error measured in four arteries in the leg were: 284+/-21 mL/min in the common femoral (CFA); 152+/-10 mL/min in the superficial femoral (SFA); 72+/-5 mL/min in the popliteal; and 3+/-1 mL/min in the dorsalis pedis. Although women tended to have higher time-averaged mean velocities in the CFA and SFA than men (t-test, p < 0.008), their arterial cross-sectional areas tended to be smaller (t-test, p < 0.004) and no statistically significant difference was found between men and women in volumetric flow at any site. No correlation was found between age, weight, height, muscle mass and volumetric flow at all four sites. These estimates of lower extremity volumetric flow in healthy subjects provide a baseline for future studies of flow rates in patients with vascular disease.
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Affiliation(s)
- C K Holland
- Department of Radiology, University of Cincinnati College of Medicine, OH, USA.
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