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Busch V, Streis J, Müller S, Mueller N, Seibert FS, Felderhoff T, Westhoff TH. Oscillometric pulse wave analysis for detecting low flow arteriovenous fistula. BMC Nephrol 2023; 24:186. [PMID: 37355570 PMCID: PMC10290325 DOI: 10.1186/s12882-023-03243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/08/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Pulse wave analysis may be useful to assess fistula function. We aimed to prospectively evaluate if convenient oscillometric devices are applicable to detect flow below 500 ml/min in a real life clinical setting. METHODS Pulse waves were recorded ambilaterally with the vicorder® device at the brachial artery in 53 patients on haemodialysis with native fistula. Primary variables consisted of the mean slope between the systolic maximum and the diacrotic notch (Slope2), the sum of the mean slopes in the four characteristic sections of pulse waves (Slope∑) and the amplitude of relative volumetric change in the measuring cuff at the upper arm (AMP). Fistula flow was measured with the use of duplex sonography using a standardized approach. RESULTS Parameter values above or below the median indicated measurement at the non-fistula side, with sensitivities/specificities of 0.79/0.79 (p < 0.001) for Slope 2, 0.64/0.64 (p = 0.003) for Slope∑ and 0.81/0.81 (p < 0.001) for AMP if measurements at the fistula and non-fistula arm were considered. ROC-analyses of parameter values measured at the fistula to detect low flow demonstrated AUCs (with CI) of 0.652 (0.437-0.866, p = 0.167) for Slope2, 0.732 (0.566-0.899, p = 0.006) for Slope∑ and 0.775 (0.56-0.991, p = 0.012) for AMP. The point with maximal youden's index was regarded as optimal cut-off, which corresponded to sensitivities and specificities of 0.8/0.56 for slope2, 0.86/ 0.56 for Slope∑ and 0.93/0.78 for AMP. CONCLUSION Functional surveillance with oscillometry is a promising clinical application to detect a low fistula flow. Among all investigated pulse wave parameters AMP revealed the highest diagnostic accuracy.
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Affiliation(s)
- Veit Busch
- Nephrovital, Kamen, Germany.
- Fachhochschule Dortmund, Dortmund, Nordrhein-Westfalen, Germany.
| | - Joachim Streis
- Fachhochschule Dortmund, Dortmund, Nordrhein-Westfalen, Germany
- Pleiger Maschinenbau GmbH & Co KG, Witten, Germany
| | - Sandra Müller
- Technische Universität Wien Institut für Diskrete Mathematik und Geometrie, Vienna, Vienna, Austria
| | - Niklas Mueller
- Klinikum der Universität München, Medizinische Klinik und Poliklinik III, Munich, Bavaria, Germany
| | - Felix S Seibert
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany
| | | | - Timm H Westhoff
- Department of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany
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Riebe H, Jünger M, Hecko S, Konschake W. [Diagnosis of chronic venous insufficiency]. Dermatologie (Heidelb) 2023; 74:145-57. [PMID: 36820847 DOI: 10.1007/s00105-023-05110-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/24/2023]
Abstract
For the treatment of chronic venous insufficiency (CVI), various therapeutic options are available. In addition to conservative compression therapy, classical vein surgery, sclerotherapy and endoluminal therapies are increasingly being used to treat varicose veins. For a differentiated indication and correct treatment planning, a stepwise diagnosis with clinical examination and documentation of typical symptoms, dynamic vein function measurement to assess the global venous status as well as a qualitative assessment of the exact insufficient vein segments by means of color-coded duplex sonography is required. Due to the non-invasiveness of the examination and the good assessability of therapeutically relevant parameters such as anatomic conditions, diameter, and reflux of insufficient veins, color-coded duplex sonography is considered the gold standard for imaging diagnostics.
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3
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Giusca S, Lichtenberg M, Schueler M, Heinrich U, Eisenbach C, Andrassy M, Korosoglou G. Safety, effectiveness and mid-term follow-up in 136 consecutive patients with moderate to severely calcified lesions undergoing phoenix atherectomy. Heart Vessels 2020; 36:366-375. [PMID: 32914347 DOI: 10.1007/s00380-020-01695-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/28/2020] [Indexed: 12/24/2022]
Abstract
To investigate the safety and effectiveness of the Phoenix atherectomy device for the treatment of complex and calcified lesions in patients with peripheral artery disease (PAD). 136 consecutive all-comer patients with chronic PAD underwent Phoenix atherectomy. Safety in terms of vessel injury and embolism, efficacy and clinical success in terms of ≥ 1Rutherford class (RF) improvement during follow-up were systematically analyzed. Lesion calcification was categorized by the Peripheral Arterial Calcium Scoring System (PACSS), whereas lesion complexity was classified by the Transatlantic Inter-Society Consensus (TASC). 151 lesions were treated in 136 consecutive patients. Clinical follow-up was available at 10.3 ± 4.2 months in 132 (97%) patients. 55 patients (40%) had intermittent claudication, 16 (12%) rest pain and 65 (48%) had ischemic ulcerations (mean RF class = 4.2 ± 1.1). 15 (11%) patients had TASC B lesions, whereas the majority 72 (53%) and 49 (36%) exhibited TASC C and D lesions, respectively. Mean PACSS score was 3.3 ± 0.9. Mean lesion length was 106 ± 92 mm. Atherectomy was combined with drug-coated balloon (DCB) in 129 (95%) patients. Nine (6.6%) patients with infra-inguinal lesions received stents. Technical and procedural success were recorded in 102 (75%) and 135 (99%), respectively. Perforation was noticed in 2 (1%), whereas asymptomatic embolism occurred in 6 (4%) patients. Clinical success was present in 54 (100%) patients with claudication and in 65 of 78 (83%) patients with critical limb ischemia (CLI). Atherectomy in combination with DCB angioplasty can be safely performed in patients with complex, calcified peripheral lesions with a relatively low rate of bail-out stenting and promising clinical mid-term results.German Clinical Trials Register: DRKS00016708.
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Affiliation(s)
- Sorin Giusca
- Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | | | - Melanie Schueler
- Practice for Cardiology and Vascular Medicine, Hirschberg, Germany
| | - Ulrike Heinrich
- Practice for Vascular Medicine and Gastroenterology, Weinheim, Germany
| | | | - Martin Andrassy
- Fuerst-Stirum Hospital, Cardiology and Vascular Medicine, Bruchsal, Germany
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Mueller N, Streis J, Müller S, Pavenstädt H, Felderhoff T, Reuter S, Busch V. Pulse Wave Analysis and Pulse Wave Velocity for Fistula Assessment. Kidney Blood Press Res 2020; 45:576-588. [PMID: 32575106 DOI: 10.1159/000506741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 02/19/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Pulse wave analysis (PWA) and pulse wave velocity (PWV) provide information about arterial stiffness and elasticity, which is mainly used for cardiovascular risk stratification. In the presented prospective observational pilot study, we examined the hypothesis that radiocephalic fistula (RCF)-related changes of haemodynamics and blood vessel morphology including high as well as low flow can be seen in specific changes of pulse wave (PW) morphology. METHODS Fifty-six patients with RCF underwent local ambilateral peripheral PWA and PWV measurement with the SphygmoCor® device. Given that the output parameters of the SphygmoCor® are not relevant for the study objectives, we defined new suitable parameters for PWA in direct proximity to fistulas and established an appropriate analysing algorithm. Duplex sonography served as reference method. RESULTS Marked changes of peripheral PW morphology when considering interarm differences of slope and areas between the fistula and non-fistula arms were observed in the Arteria radialis, A. brachialis and arterialized Vena cephalica. The sum of the slope differences was found to correlate with an increased flow, while in patients with fistula failure no changes in PW morphology were seen. Moreover, PWV was significantly reduced in the fistula arm. CONCLUSION Beside duplex sonography, ambilateral peripheral PWA and PWV measurements are potential new clinical applications to characterize and monitor RCF function, especially in terms of high and low flow.
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Affiliation(s)
- Niklas Mueller
- Department of Internal Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany.,Department of Internal Medicine III, Division of Haematology and Oncology, Hospital of the Ludwig-Maximilians University Munich, Munich, Germany
| | - Joachim Streis
- Research Center for BioMedical Technology, University of Applied Sciences and Arts, Dortmund, Germany
| | - Sandra Müller
- Kurt Gödel Research Center, Faculty of Mathematics, University of Vienna, Vienna, Austria
| | - Hermann Pavenstädt
- Department of Internal Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
| | - Thomas Felderhoff
- Research Center for BioMedical Technology, University of Applied Sciences and Arts, Dortmund, Germany
| | - Stefan Reuter
- Department of Internal Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany,
| | - Veit Busch
- Department of Internal Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany.,Research Center for BioMedical Technology, University of Applied Sciences and Arts, Dortmund, Germany.,Nephrovital, Kamen, Germany
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von Bieberstein L, van Niftrik CHB, Sebök M, El Amki M, Piccirelli M, Stippich C, Regli L, Luft AR, Fierstra J, Wegener S. Crossed Cerebellar Diaschisis Indicates Hemodynamic Compromise in Ischemic Stroke Patients. Transl Stroke Res 2020; 12:39-48. [PMID: 32506367 PMCID: PMC7803723 DOI: 10.1007/s12975-020-00821-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/21/2020] [Accepted: 05/11/2020] [Indexed: 12/02/2022]
Abstract
Crossed cerebellar diaschisis (CCD) in internal carotid artery (ICA) stroke refers to attenuated blood flow and energy metabolism in the contralateral cerebellar hemisphere. CCD is associated with an interruption of cerebro-cerebellar tracts, but the precise mechanism is unknown. We hypothesized that in patients with ICA occlusions, CCD might indicate severe hemodynamic impairment in addition to tissue damage. Duplex sonography and clinical data from stroke patients with unilateral ICAO who underwent blood oxygen-level-dependent MRI cerebrovascular reserve (BOLD-CVR) assessment were analysed. The presence of CCD (either CCD+ or CCD−) was inferred from BOLD-CVR. We considered regions with negative BOLD-CVR signal as areas suffering from hemodynamic steal. Twenty-five patients were included (11 CCD+ and 14 CCD−). Stroke deficits on admission and at 3 months were more severe in the CCD+ group. While infarct volumes were similar, CCD+ patients had markedly larger BOLD steal volumes than CCD− patients (median [IQR] 122.2 [111] vs. 11.6 [50.6] ml; p < 0.001). Furthermore, duplex revealed higher peak-systolic flow velocities in the intracranial collateral pathways. Strikingly, posterior cerebral artery (PCA)-P2 velocities strongly correlated with the National Institute of Health Stroke Scale on admission and BOLD-CVR steal volume. In patients with strokes due to ICAO, the presence of CCD indicated hemodynamic impairment with larger BOLD-defined steal volume and higher flow in the ACA/PCA collateral system. Our data support the concept of a vascular component of CCD as an indicator of hemodynamic failure in patients with ICAO.
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Affiliation(s)
- Lita von Bieberstein
- Dept. of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | | | - Martina Sebök
- Dept. of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zürich, Switzerland
| | - Mohamad El Amki
- Dept. of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Marco Piccirelli
- Dept. of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Zürich, Switzerland
| | - Christoph Stippich
- Dept. of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Zürich, Switzerland
| | - Luca Regli
- Dept. of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zürich, Switzerland
| | - Andreas R Luft
- Dept. of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Jorn Fierstra
- Dept. of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zürich, Switzerland
| | - Susanne Wegener
- Dept. of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
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Zanow J, Settmacher U, Schüle S. [Intraoperative completion diagnostics in open vascular surgery]. Chirurg 2020; 91:461-465. [PMID: 32185427 DOI: 10.1007/s00104-020-01155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Intraoperative imaging diagnostics during open vascular surgical procedures aim to enhance diagnostic certainty during the operation, ensure quality control documentation and reduce avoidable complications; however, the evidence for the various diagnostic imaging procedures with respect to improvement of perioperative outcome is not confirmed for carotid endarterectomy or for infrainguinal bypass surgery. Nevertheless, an intraoperative diagnostic control is principally recommended. The advantage of intraoperative imaging is confirmed and essential for the surgical reconstruction of bypass occlusions and acute thromboembolic occlusions.
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Affiliation(s)
- J Zanow
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - U Settmacher
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - S Schüle
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
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Kehrer A, Sachanadani NS, da Silva NPB, Lonic D, Heidekrueger P, Taeger CD, Klein S, Jung EM, Prantl L, Hong JP. Step-by-step guide to ultrasound-based design of alt flaps by the microsurgeon - Basic and advanced applications and device settings. J Plast Reconstr Aesthet Surg 2020; 73:1081-90. [PMID: 32249187 DOI: 10.1016/j.bjps.2019.11.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/02/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The anterolateral thigh (ALT) perforator flap is a popular reconstructive tissue transfer. Consistent with the "hot/cold zone" concept for rapid dissection and thin flap harvest, reliable preoperative perforator mapping is mandatory. Color-coded duplex sonography (CCDS) has been shown to have the highest pooled sensitivity and positive predictive value to identify ALT perforating vessels. By reviewing this guide, the reader should learn: 1. Probe selection and basic/advanced device settings 2. Interpreting tissue morphology 3. Structured mapping approach 4. Pedicle position planning 5. Safe flap design 6. Assess subcutaneous course and flap's thickness for subfascial/epifascial/suprafascial harvest 7. Implement perforators identified into a tailor-made flap design including chimeric flaps. METHODS Experiences with ultrasound-guided flap design gained from 125 ALT perforator flap free tissue transfers performed in two reconstructive centers was the basis of our guide. Our structured method comprises standardized markings, patient positioning, and simple ergonomics. Basic and advanced CCDS settings, selection, and conventional probe guidance are outlined for the microsurgeon. RESULTS Linear multifrequency probes (6-15 MHz) were used. Best preset programs were breast, thyroid, and vascular. Favorable device properties were depth focused to 2-5 cm, pulse repetition frequency (PRF/Scale) set low to 0.5-1.5 kHz/3-10 cm/s, color gain high, and wall filter (WF) low/off (< 50 Hz). Additional parameters were discussed. A 100% concordance rate was seen comparing preoperative perforator visualization with CCDS and intraoperative findings. Detailed picture and video material were demonstrated. CONCLUSION CCDS is a powerful tool for preoperative perforator mapping in perforator flaps such as the ALT.
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Abstract
Giant cell arteritis (GCA) and Takayasu's arteritis are both forms of large vessel vasculitis and can be manifested in the eye. While GCA affects patients over the age of 50 years, patients with Takayasu's arteritis are between 15 and 30 years old. The diagnosis is based on a combination of anamnesis, imaging and systemic inflammatory reactions. The diagnosis can be confirmed by biopsy. Typical eye involvement of GCA are anterior ischemic optic neuropathy (AION) and central retinal artery occlusion, while Takayasu's arteritis involves hypertensive retinopathy and Takayasu's retinopathy (capillary dilatation, microaneurysms and arteriovenous anastomoses). The treatment consists of steroids in combination with classical immunosuppressants or biologics.
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Affiliation(s)
- Thomas Neß
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - Wolfgang Schmidt
- Rheumatologie, Klinische Immunologie und Osteologie, Standort Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Deutschland
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Favaretto E, Sartori M, Pacelli A, Conti E, Cosmi B. Coronary artery disease and restenosis after peripheral endovascular intervention are predictors of poor outcome in peripheral arterial disease. Acta Cardiol 2019; 75:649-656. [PMID: 31414620 DOI: 10.1080/00015385.2019.1653565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background: Few data are available on long-term atherothrombotic events after percutaneous transluminal angioplasty (PTA) for peripheral arterial disease (PAD). Restenosis after PTA may be a marker of a more aggressive atherothrombosis. Aim: To ascertain whether restenosis detected by duplex sonography (DUS) after PTA for iliac and femoro-popliteal disease is associated with a higher risk of cardiovascular events. Methods: We conducted a prospective cohort study of patients undergoing iliac or femoro-popliteal PTA for PAD. Patients were seen at one month, six months, one year and every year thereafter after PTA. At each visit, DUS was performed and accordingly restenosis was stratified into two categories (absent/present). The outcome was the composite of major adverse cardiovascular events (MACE). Results: Two hundred and fifty patients (aged 69 ± 11 years, male 59.2%) were enrolled. During a mean follow-up of 1207 ± 904 days, 102 (40.8%) patients developed restenosis. Restenosis was more frequent in patients with diabetes and critical limb ischaemia. MACEs (n = 76) were more frequent in the patients that developed restenosis vs. those that did not (40.2 vs. 23.6%, p = .005). Predictors of MACEs were diabetes (HR 2.02, 95%CI: 1.19-3.41, p = .009), presence of coronary heart disease at enrolment (HR 2.84, 95%CI: 1.78-4.53, p = .001) and restenosis (HR 1.87, 95%CI: 1.16-3.00, p = .010). Conclusion: Restenosis at DUS, diabetes, and coronary heart disease in patients who underwent iliac or femoro-popliteal PTA for PAD are associated with increased risk of arterial thrombotic event. Intervention trials are required to show the benefit of different therapeutic approaches in such patients at high risk of clinical deterioration.
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Affiliation(s)
- Elisabetta Favaretto
- Angiology and Blood Coagulation Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Michelangelo Sartori
- Angiology and Blood Coagulation Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Antonio Pacelli
- UO Medicina Interna Ospedale ICOT di Latina Sapienza Universita’ di Roma
| | - Eleonora Conti
- Angiology and Blood Coagulation Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Benilde Cosmi
- Angiology and Blood Coagulation Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
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Connolly F, Röhl JE, Guthke C, Wengert O, Valdueza JM, Schreiber SJ. Emergency Room Use of "Fast-Track" Ultrasound in Acute Stroke: An Observational Study. Ultrasound Med Biol 2019; 45:1103-1111. [PMID: 30773376 DOI: 10.1016/j.ultrasmedbio.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/01/2019] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
Early information on vascular status in acute stroke is essential. We analyzed whether duplex ultrasound (DUS) using a fast-track protocol provides this information without relevant delay. One hundred forty-six patients were prospectively enrolled. DUS was performed by sonographers with two levels of experience. The carotid and vertebral arteries, as well as all basal cerebral arteries, were bilaterally analyzed. Criteria for vessel analysis were (i) normal or stenosis <50%, (ii) stenosis ≥50% and (iii) occlusion. The mean duration of the ultrasound investigation was 6:07 ± 2:06 min with a significant difference between more and less experienced investigators (p < 0.0001). Insonation times decreased during the study in both groups. The sensitivity, specificity, positive predictive value and negative predictive value of ultrasound findings in comparison with computed tomography angiography were 73%, 99%, 84% and 98%, respectively. Our data suggest that "fast track" DUS is feasible and reliable. The time required for DUS assessment depends on the sonographer´s experience.
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Affiliation(s)
- Florian Connolly
- Department of Neurology, Charité, Universitätsmedizin Berlin, Berlin, Germany.
| | - Jens-Eric Röhl
- Department of Neurology, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Carolin Guthke
- Department of Neurology, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Oliver Wengert
- Department of Neurology, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - José M Valdueza
- Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Stephan J Schreiber
- Department of Neurology, Asklepios Fachklinikum Brandenburg, Brandenburg an der Havel, Germany
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Giusca S, Raupp D, Dreyer D, Eisenbach C, Korosoglou G. Successful endovascular treatment in patients with acute thromboembolic ischemia of the lower limb including the crural arteries. World J Cardiol 2018; 10:145-152. [PMID: 30386492 PMCID: PMC6205845 DOI: 10.4330/wjc.v10.i10.145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/07/2018] [Accepted: 08/11/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To examine the efficacy and safety of the 6 French (6F) Rotarex®S catheter system in patients with acute limb ischemia (ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.
METHODS The files of patients in our department with ALI between 2015 and 2017 were examined. In seven patients, the Rotarex®S catheter was used in the proximal segment of the crural arteries. Data related to the clinical examination, Doppler sonography, angiography and follow-up from these patients were further used for analysis.
RESULTS Two patients (29%) had thrombotic occlusion of the common femoral artery, and the remaining five exhibited thrombosis of the superficial femoral artery and popliteal artery. Mechanical thrombectomy was performed in all cases using a 6F Rotarex®S catheter. Additional Rotarex®S catheter thrombectomy due to remaining thrombus formation with no reflow was performed in the anterior tibial artery in two of seven cases (29%), in the tibiofibular tract and posterior tibial artery in two of seven cases (29%) and in the tibiofibular tract and fibular artery in the remaining three of seven cases (43%). Ischemic symptoms resolved promptly in all, and none of the patients experienced a procedural complication, such as crural vessel dissection, perforation or thrombus embolization.
CONCLUSION Mechanical debulking using the 6F Rotarex®S catheter system may be a safe and effective treatment option in case of thrombotic or thromboembolic occlusion of the proximal and mid-portion of crural arteries.
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Affiliation(s)
- Sorin Giusca
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim 69469, Germany
| | - Dorothea Raupp
- Department of Gastroenterology and Diabetology, GRN Hospital Weinheim, Weinheim 69469, Germany
| | - Dirk Dreyer
- Straub Medical AG, Wangs CH-7323, Switzerland
| | - Christoph Eisenbach
- Department of Gastroenterology and Diabetology, GRN Hospital Weinheim, Weinheim 69469, Germany
| | - Grigorios Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim 69469, Germany
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Kishino T, Harashima K, Hashimoto S, Fukuta N, Seki M, Ohnishi H, Watanabe T, Otaki J. Meal Ingestion and Hemodynamic Interactions Regarding Renal Blood Flow on Duplex Sonography: Potential Diagnostic Implications. Ultrasound Med Biol 2018; 44:2050-2054. [PMID: 30041904 DOI: 10.1016/j.ultrasmedbio.2018.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 05/13/2018] [Accepted: 05/16/2018] [Indexed: 06/08/2023]
Abstract
Splanchnic blood flow changes dramatically after meal ingestion. The present study evaluated physiologic interactions between meal ingestion and hemodynamics with respect to renal blood flow on duplex sonography, assessing the possible influence on Doppler parameters used as diagnostic criteria for renal artery stenosis. Subjects comprised 26 healthy young men (mean age: 22 ± 2 y). Sonographic measurements were made shortly after breakfast and every 1 h thereafter and were compared with values measured before the meal. Peak systolic velocity in the renal artery was elevated post-prandially, peaking at 1 h (90 ± 12 cm/s), compared with pre-prandially (73 ± 10 cm/s, p < 0.01). Similarly, acceleration time at the intra-renal segmental artery shortened to a minimum at 1 h (45 ± 5 ms) compared with baseline (51 ± 6 ms, p < 0.01). The present study indicates that renal blood flow is altered for a few hours after meal ingestion. Attention should be paid to the interpretation of data measured after meals on duplex sonography for diagnosis of renal artery stenosis.
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Affiliation(s)
- Tomonori Kishino
- Faculty of Health Sciences, Kyorin University, Tokyo, Japan; School of Medicine, Kyorin University, Tokyo, Japan.
| | | | | | - Naoya Fukuta
- Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| | - Masayo Seki
- Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| | | | | | - Junichi Otaki
- Faculty of Health Sciences, Kyorin University, Tokyo, Japan
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Maier IL, Hofer S, Joseph AA, Merboldt KD, Tan Z, Schregel K, Knauth M, Bähr M, Psychogios MN, Liman J, Frahm J. Carotid artery flow as determined by real-time phase-contrast flow MRI and neurovascular ultrasound: A comparative study of healthy subjects. Eur J Radiol 2018; 106:38-45. [PMID: 30150049 DOI: 10.1016/j.ejrad.2018.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 04/02/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The assessment of carotid artery flow by neurovascular ultrasound (nvUS) can be complemented by real-time phase-contrast (RT-PC) flow MRI which apart from quantitative flow parameters offers velocity distributions across the entire vessel lumen. MATERIALS AND METHODS The feasibility and diagnostic potential of RT-PC flow MRI was evaluated in 20 healthy volunteers in comparison to conventional nvUS. RT-PC flow MRI at 40 ms temporal resolution and 0.8 mm in-plane resolution resulted in velocity maps with low phase noise and high spatiotemporal accuracy by exploiting respective advances of a recent nonlinear inverse model-based reconstruction. Peak-systolic velocities (PSV), end-diastolic velocities (EDV), flow volumes and comprehensive velocity profiles were determined in the common, internal and external carotid artery on both sides. RESULTS Flow characteristics such as pulsatility and individual abnormalities shown on nvUS could be reproduced and visualized in detail by RT-PC flow MRI. PSV to EDV differences revealed good agreement between both techniques, mean PSV and EDV were significantly lower and flow volumes were higher for MRI. CONCLUSION Our findings suggest that RT-PC flow MRI adds to clinical diagnostics, e.g. by alterations of dynamic velocity distributions in patients with carotid stenosis. Lower PSV and EDV values than for nvUS mainly reflect the longer MRI acquisition time which attenuates short peak velocities, while higher flow volumes benefit from a proper assessment of the true vessel lumen.
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Affiliation(s)
- Ilko L Maier
- Department of Neurology, University Medical Center Göttingen, Germany.
| | - Sabine Hofer
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany.
| | - Arun A Joseph
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany.
| | - K Dietmar Merboldt
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany.
| | - Zhengguo Tan
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany.
| | - Katharina Schregel
- Department of Neuroradiology, University Medical Center Göttingen, Germany; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Michael Knauth
- Department of Neuroradiology, University Medical Center Göttingen, Germany.
| | - Mathias Bähr
- Department of Neurology, University Medical Center Göttingen, Germany.
| | | | - Jan Liman
- Department of Neurology, University Medical Center Göttingen, Germany.
| | - Jens Frahm
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany.
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Nazerian P, Bigiarini S, Pecci R, Taurino L, Moretti M, Pavellini A, Capretti E, Grifoni S, Vanni S. Duplex Sonography of Vertebral Arteries for Evaluation of Patients with Acute Vertigo. Ultrasound Med Biol 2018; 44:584-592. [PMID: 29276136 DOI: 10.1016/j.ultrasmedbio.2017.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/30/2017] [Accepted: 11/04/2017] [Indexed: 06/07/2023]
Abstract
We evaluated the role of vertebral artery extracranial color-coded duplex sonography (VAECCS) in predicting vertebrobasilar stroke in consecutive patients presenting to the emergency department with vertigo of suspected ischemic origin. The final diagnosis was established by a panel of experts consisting of an emergency physician, a neurologist, and an otoneurologist. Vertebrobasilar stroke was diagnosed when an acute brain ischemic lesion congruent with symptoms was detected by neuroimaging during the index visit or a stroke was diagnosed within a 3-mo period after emergency department presentation. Among 126 patients, 28 (22%) were diagnosed with vertebrobasilar stroke. Fifteen (75%) of 20 patients with abnormal VAECCS results and 13 (12%) of 106 with normal VAECCS results had a final diagnosis of vertebrobasilar stroke. The sensitivity and specificity of VAECCS were 53.6% and 94.9%, respectively. Detecting an abnormal flow pattern at VAECCS significantly increased the risk of vertebrobasilar stroke (odds ratio = 21.5). The flow patterns most frequently related to vertebrobasilar stroke were absence of flow and high resistance pattern velocity (odds ratio = 9.3 and 22.7, respectively). VAECCS predicts vertebrobasilar stroke and could be a useful bedside screening tool in patients with vertigo.
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Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.
| | - Sofia Bigiarini
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Rudi Pecci
- Otoneurology Clinic, Careggi University Hospital, Firenze, Italy
| | - Lucia Taurino
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Marco Moretti
- Neuroradiology Unit, Careggi University Hospital, Firenze, Italy
| | - Andrea Pavellini
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Elisa Capretti
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Simone Vanni
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
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15
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Korosoglou G, Eisele T, Raupp D, Eisenbach C, Giusca S. Successful recanalization of long femoro-crural occlusive disease after failed bypass surgery. World J Cardiol 2017; 9:842-847. [PMID: 29317991 PMCID: PMC5746627 DOI: 10.4330/wjc.v9.i12.842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/26/2017] [Accepted: 11/28/2017] [Indexed: 02/06/2023] Open
Abstract
Patients with critical limb ischemia necessitate immediate intervention to restore blood flow to the affected limb. Endovascular procedures are currently preferred for these patients. We describe the case of an 80-year-old female patient who presented to our department with ischemic rest pain and ulceration of the left limb. The patient had history of left femoral popliteal bypass surgery, femoral thromboendarterectomy and patch angioplasty of the same limb 2 years ago. Doppler sonography and magnetic resonance angiography revealed an occlusion of the left superficial femoral artery (SFA) and popliteal artery and of all three infra-popliteal arteries. Due to severe comorbidities, the patient was scheduled for a digital subtraction angiography. An antegrade approach was first attempted, however the occlusion could not be passed. After revision of the angiography acquisition, a stent was identified at the level of the mid SFA, which was subsequently directly punctured, facilitating the retrograde crossing of the occlusion. Thereafter, balloon angioplasty was performed in the SFA, popliteal artery and posterior tibial artery. The result was considered suboptimal, but due to the large amount of contrast agent used, a second angiography was planned in 4 wk. In the second session, drug coated balloons were used to optimize treatment of the SFA, combined with recanalization of the left fibular artery, to optimize outflow. The post-procedural course was uneventful. Ischemic pain resolved completely after the procedure and at 8 wk of follow-up and the foot ulceration completely healed.
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Affiliation(s)
- Grigorios Korosoglou
- Cardiology and Vascular Medicine, GRN Academic Teaching Hospital, Weinheim 69469, Germany
| | - Tom Eisele
- Cardiology and Vascular Medicine, GRN Academic Teaching Hospital, Weinheim 69469, Germany
| | - Dorothea Raupp
- Diabetology and Gastroenterology, GRN Academic Teaching Hospital, Weinheim 69469, Germany
| | - Christoph Eisenbach
- Diabetology and Gastroenterology, GRN Academic Teaching Hospital, Weinheim 69469, Germany
| | - Sorin Giusca
- Cardiology and Vascular Medicine, GRN Academic Teaching Hospital, Weinheim 69469, Germany
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16
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Kamper L, Altenburg A, Das M, Haage P. [Diagnostics and endovascular treatment of venous diseases]. Radiologe 2017; 57:765-778. [PMID: 28808735 DOI: 10.1007/s00117-017-0284-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In venous disease, acute thromboses and chronic venous insufficiency have the highest health economics relevance. Duplex sonography is the first line diagnostic assessment tool, while cross-sectional imaging is employed as a supplementary method. Due to the availability and examination times computed tomography is preferred in the emergency setting and is supplemented by magnetic resonance imaging (MRI) for specific questions. Endovascular treatment procedures are increasingly becoming available in addition to classical conservative treatment methods.
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Affiliation(s)
- L Kamper
- Zentrum für Radiologie, HELIOS-Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Deutschland.
| | - A Altenburg
- Zentrum für Radiologie, HELIOS-Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Deutschland
| | - M Das
- Klinik für Diagnostische und Interventionelle Radiologie, HELIOS St. Johannes Klinik Duisburg, An der Abtei 7-11, 47166, Duisburg, Deutschland
| | - P Haage
- Zentrum für Radiologie, HELIOS-Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Deutschland
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17
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Koh W, Kallenberg K, Karch A, Frank T, Knauth M, Bähr M, Liman J. Transcranial doppler sonography is not a valid diagnostic tool for detection of basilar artery stenosis or in-stent restenosis: a retrospective diagnostic study. BMC Neurol 2017; 17:89. [PMID: 28490351 PMCID: PMC5426050 DOI: 10.1186/s12883-017-0872-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 05/06/2017] [Indexed: 11/26/2022] Open
Abstract
Background There are contradictory reports concerning the validity of transcranial sonography (TCD and TCCS) for examinations of the basilar artery. Here we investigated sensitivity and specificity of transcranial sonography for the detection of basilar artery stenosis and in-stent-restenosis compared to cerebral angiography. Methods We analyzed data of 104 examinations of the basilar artery. The association between sonographic peak systolic velocity (PSV) and degree of stenosis obtained by cerebral angiography was evaluated applying Spearman’s correlation coefficient. Receiver Operating Characteristics (ROC) curves and areas under the curve (AUC) were calculated for the detection of a ≥50% stenosis defined by angiography. Optimal cut-off was derived using the Youden-index. Results A weak but statistically significant correlation between PSV and the degree of stenosis was found (n=104, rho=0.35, p<0.001). ROC analysis for a detection of ≥50% stenosis showed an AUC of 0.70, a sensitivity of 74.0% and a specificity of 65.0% at the optimal cut off of 124 cm/s. Results were consistent when analyzing examinations done in stented and unstented arteries separately (TCD VS DSA/CTA in unstented artery: AUC=0.66, sensitivity 61.0%, specificity 65.0%, TCD/TCCS VS DSA in stented artery: AUC=0.63, sensitivity 71.0%, specificity 82.0%). Comparing TCCS measurements exclusively to angiography, ROC analysis showed an AUC of 1.00 for the detection of an in-stent-restenosis ≥50% with a sensitivity and specificity of 100% when a PSV of 132 cm/s was used as a cut off value. Conclusion Validity of TCD in the assessment of basilar artery stenosis or in-stent restenosis is poor. First results for TCCS are promising, but due to the small samplesize further studies with larger samples sizes are warranted.
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Affiliation(s)
- Woori Koh
- Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Kai Kallenberg
- Department of Neuroradiology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - André Karch
- Epidemiological and Statistical Methods, Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany
| | - Tobias Frank
- Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Michael Knauth
- Department of Neuroradiology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Mathias Bähr
- Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Jan Liman
- Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
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18
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Rudolphi PB, Recke A, Langan EA, Hunold P, Kahle BK. Are Sonographically Measured Vascular Haemodynamic Parameters Reproducible Using Magnetic Resonance Imaging? Eur J Vasc Endovasc Surg 2016; 52:665-672. [PMID: 27687640 DOI: 10.1016/j.ejvs.2016.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/03/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE/BACKGROUND Hemodynamic measurements of blood flow in the common femoral vein and artery can be performed readily using duplex sonography. The ratio of venous to arterial volume flow in these vessels, the venous arterial flow index (VAFI), is increased in patients with varicose veins and/or chronic venous disease. The objective was to determine the reproducibility of sonographically measured hemodynamic flow parameters using phase contrast magnetic resonance imaging (MRI). METHODS Based on hemodynamic volume flow measurements from the common femoral vein and artery the VAFI was calculated in seven patients with varicose veins (C2, Ep, As, Pr) and 32 healthy controls using standard duplex sonography and MRI. RESULTS Based on duplex sonography, the average VAFI (VAFI_d) was 1.05 ± 0.17. The same ratio, using MRI (VAFI_mri) was 1.05 ± 0.19. There was a significant correlation between the VAFI_d and the VAFI_MRI (p = .0021). In patients with venous disease, the average VAFI_d and VAFI_mri were 1.36 ± 0.21 and 1.36 ± 0.20, respectively. In contrast, in the healthy cohort the VAFI_d was 1.00 ± 0.12 and the VAFI_mri measured 1.01 ± 0.15. As expected, there was a significant difference between the VAFI measured in those with venous disease when compared with that of healthy controls (p < .0001). CONCLUSION There is a significant correlation between the VAFI measured using sonography and MRI. The study confirmed the elevation of VAFI in patients with chronic venous disease.
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Affiliation(s)
- P B Rudolphi
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - A Recke
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - E A Langan
- Department of Dermatology and Comprehensive Centre for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - P Hunold
- Clinic for Radiology and Nuclear Medicine, University of Lübeck, Lübeck, Germany
| | - B K Kahle
- Department of Dermatology, University of Lübeck, Lübeck, Germany.
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19
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Gehlen M, Schwarz-Eywill M, Schäfer N, Pfeiffer A, Bösenberg H, Maier A, Hinz C. [Brain stem infarction, temporal headache, and elevated inflammatory parameters in a 74-year-old man]. Internist (Berl) 2016; 57:604-9. [PMID: 27055655 DOI: 10.1007/s00108-016-0045-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We report the case of a 74 year old man with a brain stem infarction, temporal headache and elevated inflammatory parameters. Giant cell arteritis with involvement of the temporal and vertebral arteries was proven by histology, duplex sonography and MRI. Although intensive immunosuppressive therapy was started, the patient developed two brain infarcts within 6 months. Initially, C‑reactive protein and erythrocyte sedimentation rate were significantly elevated, but normalized over time. Involvement of the vertebral artery in giant cell arteritis is thought to be rare; steroid refractory courses are very rare. Brain stem infarction might be the consequence.
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Affiliation(s)
- M Gehlen
- Abteilung für Rheumatologie und Osteologie, Klinik Der Fürstenhof, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland. .,Evangelisches Krankenhaus, Universität Oldenburg, Campus Medizin, Oldenburg, Deutschland.
| | - M Schwarz-Eywill
- Evangelisches Krankenhaus, Universität Oldenburg, Campus Medizin, Oldenburg, Deutschland
| | - N Schäfer
- Evangelisches Krankenhaus, Universität Oldenburg, Campus Medizin, Oldenburg, Deutschland
| | - A Pfeiffer
- Evangelisches Krankenhaus, Universität Oldenburg, Campus Medizin, Oldenburg, Deutschland
| | - H Bösenberg
- Evangelisches Krankenhaus, Universität Oldenburg, Campus Medizin, Oldenburg, Deutschland
| | - A Maier
- Nordwestdeutsches Rheumazentrum, St.-Josef-Stift Sendenhorst, Sendenhorst, Deutschland
| | - C Hinz
- Abteilung für Rheumatologie und Osteologie, Klinik Der Fürstenhof, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland
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Abstract
Vasospasms of the intracranial arteries are a well-known complication of subarachnoid hemorrhage and are also frequently encountered in other disorders such as migraine, cerebral vasculitis or reversible cerebral vasoconstriction syndrome. In contrast, recurrent spontaneous vasospasms of the extracranial circulation appear to be extremely rare and have most often been associated with migraine. We present a patient with recurrent strokes due to spontaneous transient vasospastic occlusions of the internal carotid artery (ICA) without migraine over a time period of at least 13 years. Initially, the patient had presented with a bilateral ICA occlusion and a cerebral infarct on the right side. While the right ICA remained occluded, a reopening of the left ICA could be detected 3 days after this initial event. In subsequent years, both duplex sonography and magnetic resonance angiography revealed recurrent occlusions of the left ICA, which resolved spontaneously within days. This case and other rare previous reports indicate that recurrent non-migrainous vasospasms of the extracranial carotid artery likely reflect a distinct entity which can cause ischemic strokes.
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Affiliation(s)
- Sigrid Wöpking
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
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