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Gornik HL. Spotlight on the vascular zebras. Vasc Med 2024:1358863X241250325. [PMID: 38715328 DOI: 10.1177/1358863x241250325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Affiliation(s)
- Heather L Gornik
- University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH, USA
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2
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Martinez A, Steinberg RS, Okoh A, Ko YA, Wells B. Racial differences in fibromuscular dysplasia. Vasc Med 2024:1358863X241239869. [PMID: 38689448 DOI: 10.1177/1358863x241239869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Andrea Martinez
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Alexis Okoh
- Emory Department of Medicine, Division of Cardiology, Atlanta, GA, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bryan Wells
- Emory Department of Medicine, Division of Cardiology, Atlanta, GA, USA
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Trihan JE, Croquette M, Hersant J, Prigent R, Fontaine C, Henni S, Lanéelle D. Accuracy of maximal acceleration time of pedal arteries to diagnose critical limb-threatening ischemia. Vasc Med 2024; 29:153-162. [PMID: 38469710 DOI: 10.1177/1358863x231226216] [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: 03/13/2024]
Abstract
INTRODUCTION Maximal acceleration time of distal arteries of the foot (ATmax) is correlated to ankle-brachial index (ABI) and toe-brachial index (TBI), and seems very promising in diagnosing severe peripheral artery disease (PAD) and especially critical limb-threatening ischemia (CLTI). Our goal was to confirm the cut-off value of 215 ms to predict a toe pressure (TP) ⩽ 30 mmHg. METHODS A 4-month retrospective study was conducted on patients addressed for suspicion of PAD. Demographic data, ABI, TBI, and Doppler ultrasound scanning parameters of the dorsal pedis and lateral plantar arteries (DPA and LPA) were recorded. RESULTS A total of 137 patients with 258 lower limbs were included. ATmax was highly correlated to TBI (r = -0.89, p < 0.001). With the cut-off value of 215 ms, ATmax was effective to diagnose TP ⩽ 30 mmHg with a sensitivity of 93% [95% CI 77-99], a specificity of 96% [95% CI 92-98], a positive predictive value of 73% [95% CI 56-86], a negative predictive value of 99% [95% CI 97-100], and an area under the receiver operating characteristics curve of 0.99 [95% CI 0.98-1.00]. ATmax also showed promising results to rule out PAD in healthy patients. CONCLUSION ATmax is a reliable diagnostic tool to diagnose low TP and could be a new easily performed hemodynamic criterion for diagnosis of CLTI.
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Affiliation(s)
- Jean-Eudes Trihan
- Vascular Medicine Unit, Hospital of Cholet, Cholet, Pays de la Loire, France
- Vascular Medicine Department, University Hospital Angers, Angers, Pays de la Loire, France
| | - Magali Croquette
- Vascular Medicine Unit, University Hospital Centre Poitiers, Poitiers, Nouvelle-Aquitaine, France
| | - Jeanne Hersant
- Vascular Medicine Department, University Hospital Angers, Angers, Pays de la Loire, France
- UMR CNRS 1083, INSERM 6015, LUNAM University, Angers, France
| | - Romain Prigent
- Vascular Medicine Unit, Hospital of Cholet, Cholet, Pays de la Loire, France
| | - Cedric Fontaine
- Vascular Medicine Unit, Hospital of Cholet, Cholet, Pays de la Loire, France
| | - Samir Henni
- Vascular Medicine Department, University Hospital Angers, Angers, Pays de la Loire, France
- UMR CNRS 1083, INSERM 6015, LUNAM University, Angers, France
| | - Damien Lanéelle
- Vascular Medicine Unit, University Hospital Côte de Nacre, Caen, Normandie, France
- UNICAEN, INSERM 1075, COMETE, Caen, Normandie, France
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Wong A, Sharma A, Ramcharitar R. Cardiovascular manifestations of Erdheim-Chester disease: A narrative review with two cases. Vasc Med 2024:1358863X241228271. [PMID: 38469821 DOI: 10.1177/1358863x241228271] [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: 03/13/2024]
Abstract
Erdheim-Chester disease (ECD) is a rare 'L' (Langerhans) group histiocytic neoplasm that affects a multitude of organ systems, causing osteosclerotic bone lesions, periaortic encasement ('coated' aorta), retroperitoneal fibrosis involving kidneys and ureters ('hairy kidney'), and infiltration of the central nervous system. Cardiovascular involvement can occur in up to 70% of patients and is usually found during computed tomography/magnetic resonance imaging evaluation. When present, cardiovascular symptoms can have wide variability in presentation from asymptomatic to pericarditis, fatal cardiac tamponade, myocardial infarction, conduction abnormalities, heart failure, renal artery stenosis, and claudication. Cardiac involvement found on imaging includes right atrial pseudotumor, right atrioventricular groove infiltration, and pericardial effusions. ECD can involve the large- and medium-sized arteries, often seen as periarterial thickening (commonly coating the aorta) with stenosis/occlusion. Although more cardiovascular ECD cases have begun to be published in the literature, more data are needed on the outcomes of these patients, as well as how cardiovascular manifestations respond to treatment of ECD.
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Affiliation(s)
- Alan Wong
- Department of Vascular Medicine, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Aditya Sharma
- Department of Vascular Medicine, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Randy Ramcharitar
- Department of Vascular Medicine, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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Kupinski AM. Mesenteric and renal arterial duplex ultrasound: A review. Vasc Med 2023; 28:463-475. [PMID: 37259501 DOI: 10.1177/1358863x231172247] [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: 06/02/2023]
Abstract
Duplex ultrasound examinations of the mesenteric and renal circulations are commonly used to detect disease as well as to follow up patients after open surgery or endovascular intervention. The aims of this review were to present essential elements of these duplex ultrasound examinations as well as conduct a literature review of diagnostic criteria. Documentation of appropriate images and data will aid in an accurate interpretation. Spectral Doppler waveforms from various segments of these arterial systems can contribute both direct and indirect evidence of the presence of disease. Various studies have validated the duplex ultrasound diagnostic criteria which more recently have expanded to include specific criteria for stented vessels. This review presents a summary of the fundamental exam components and diagnostic criteria utilized for mesenteric and renal duplex ultrasound.
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Affiliation(s)
- Ann Marie Kupinski
- North Country Vascular Diagnostics, Inc., Altamont, NY, USA
- Albany Medical College, Albany, NY, USA
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6
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de Castro-Santos G, Gonçalves PEO, Procópio RJ, Dardik A, Navarro TP. Accuracy of the pedal acceleration time to diagnose limb ischemia in patients with and without diabetes using the WIfI classification. Vasc Med 2023; 28:36-44. [PMID: 36759936 DOI: 10.1177/1358863x221150453] [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: 02/11/2023]
Abstract
INTRODUCTION Evaluation of limb hemodynamics using the ankle-brachial index (ABI) may be difficult due to skin lesions, extensive necrosis, and obesity, such as commonly present in patients with diabetes with chronic limb-threatening ischemia (CLTI). We hypothesized that the pedal acceleration time (PAT) correlates with ABI and Wound, Ischemia, and foot Infection (WIfI) scores in patients with diabetes to serve as a new modality to accurately stage CLTI. METHODS A single-center, cross-sectional study included patients with and without diabetes > 18 years with CLTI. Limbs were categorized in three grades of ischemia based on the ABI (ABI < 0.8, < 0.6, and < 0.4) and in two classes based on WIfI stages of amputation risk. Receiver operator characteristic (ROC) curves were used to determine PAT sensitivity, specificity, and accuracy to predict lower-limb ischemia. RESULTS A total of 141 patients (67 nondiabetic and 74 diabetic) and 198 lower limbs (94 nondiabetic and 104 diabetic) met the inclusion criteria. In patients without diabetes, the accuracy of PAT for detecting an ABI < 0.8 was 85%; for detecting an ABI < 0.6 was 85%; and for detecting an ABI < 0.4 was 87%. In patients with diabetes, the accuracy of PAT in detecting an ABI < 0.8 was 91%; for detecting an ABI < 0.6 was 79%; and for detecting an ABI < 0.4 was 88%. In patients without diabetes, the accuracy for detecting WIfI stages of moderate and high amputation risk was 77% and for patients with diabetes was also 77%. CONCLUSIONS PAT shows high correlation with the ABI as well as with the WIfI stages of amputation risk and the grades of ischemia, with high accuracy.
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Affiliation(s)
- Guilherme de Castro-Santos
- Department of Surgery, Vascular Surgery Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Ricardo Jayme Procópio
- Department of Surgery, Vascular Surgery Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Túlio Pinho Navarro
- Department of Surgery, Vascular Surgery Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Choi JCB, Miranda J, Greenleaf E, Conte MS, Gerhard-Herman MD, Mills JL, Barshes NR. Lower-extremity pressure, staging, and grading thresholds to identify chronic limb-threatening ischemia. Vasc Med 2023; 28:45-53. [PMID: 36759932 DOI: 10.1177/1358863x221147945] [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: 02/11/2023]
Abstract
INTRODUCTION The Society for Vascular Surgery Threatened Limb Classification System ('WIfI') is used to predict risk of limb loss and identify peripheral artery disease in patients with foot ulcers or gangrene. We estimated the diagnostic sensitivity of multiple clinical and noninvasive arterial parameters to identify chronic limb-threatening ischemia (CLTI). METHODS We performed a single-center review of 100 consecutive patients who underwent angiography for foot gangrene or ulcers. WIfI stages and grades were determined for each patient. Toe, ankle, and brachial pressure measurements were performed by registered vascular technologists. CLTI severity was characterized using Global Limb Anatomic Staging System (GLASS stages) and angiosomes. Medial artery calcification in the foot was quantified on foot radiographs. RESULTS GLASS NA (not applicable), I, II, and III angiographic findings were seen in 21, 21, 23, and 35 patients, respectively. A toe-brachial index < 0.7 and minimum ipsilateral ankle-brachial index < 0.9 performed well in identifying GLASS II and III angiographic findings, with sensitivity rates 97.8% and 91.5%, respectively. The diagnostic accuracy rates of noninvasive measures peaked at 74.7% and 89.3% for identifying GLASS II/III and GLASS I+ angiographic findings, respectively. The presence of medial artery calcification significantly diminished the sensitivity of most noninvasive parameters. CONCLUSIONS The use of alternative noninvasive arterial testing parameters improves sensitivity for detecting PAD. Abnormal noninvasive results should suggest the need for diagnostic angiography to further characterize arterial anatomy of the affected limb. Testing strategies with better accuracy are needed.
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Affiliation(s)
- Justin Chin-Bong Choi
- Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Jorge Miranda
- Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Erin Greenleaf
- Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Michael S Conte
- Division of Vascular & Endovascular Surgery, University of California at San Francisco, San Francisco, CA, USA
| | | | - Joseph L Mills
- Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA.,Baylor-St Luke's Medical Center, Houston, TX, USA
| | - Neal R Barshes
- Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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Artyszuk Ł, Symonides B, Gaciong Z, Cienszkowska K, Ludwiczak M, Wrzaszczyk M, Szmigielski CA. A new threshold for kidney asymmetry improves association with abnormal renal-aortic ratio for diagnosis of renal artery stenosis. Vasc Med 2022; 27:551-556. [PMID: 36190768 DOI: 10.1177/1358863x221118604] [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: 01/24/2023]
Abstract
BACKGROUND Renal artery stenosis (RAS) reflects more widespread atherosclerosis deposition and is associated with high morbidity and mortality. According to the guidelines, a discrepancy in the size of the kidneys of over 15 mm found in an ultrasound should initiate the RAS diagnostic algorithm. This study aims to find the optimal threshold for renal asymmetry that better reflects the frequency of a significantly abnormal renal-aortic ratio (RAR), justifying further RAS diagnostic workup, than the currently used cut-off of 15 mm difference in renal diameters. METHODS The analysis included 1175 patients (mean age: 52 years, IQR: 38-66, men/women: 597/578) who underwent Doppler ultrasonography screening of renal arteries with recorded kidney size and RAR calculation. Ultrasound features of RAS were defined as a RAR greater than 3.5 or signs of renal artery occlusion. Receiver operating characteristic (ROC) curves were created and analyzed for absolute differences in kidney size and abnormal RAR. We calculated the area under the curve (AUC) and optimal cut-off values for sensitivity and specificity analysis. RESULTS The final analysis included 169 patients with a significant difference in renal dimension. RAS features were met in 61 patients. According to ROC curve analysis, the optimal index of renal asymmetry was 12 mm. The sensitivity and specificity for this method were 82.0% and 83.3%, respectively, and AUC was 86.3%. CONCLUSION Changing the definition of a significant difference in kidney size from 15 mm to 12 mm increases sensitivity and specificity for abnormal RAR and this finding may accelerate the diagnosis of RAS.
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Affiliation(s)
- Łukasz Artyszuk
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Symonides
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Zbigniew Gaciong
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Cienszkowska
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Marta Ludwiczak
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Wrzaszczyk
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Cezary A Szmigielski
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
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9
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Pamulapati V, Guitart JR, Helenowski IB, Resnick S, Ho KJ. Use of computed tomographic and digital subtraction angiography to determine optimal duplex ultrasound criteria for predicting superior mesenteric artery in-stent restenosis. Vasc Med 2021; 26:566-568. [PMID: 34269145 DOI: 10.1177/1358863x211025615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vivek Pamulapati
- Division of Vascular Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joan R Guitart
- Division of Vascular Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Irene B Helenowski
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Scott Resnick
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karen J Ho
- Division of Vascular Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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10
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Gornik HL, Rundek T, Gardener H, Benenati JF, Dahiya N, Hamburg NM, Kupinski AM, Leers SA, Lilly MP, Lohr JM, Pellerito JS, Rholl KS, Vickery MA, Hutchisson MS, Needleman L. Optimization of duplex velocity criteria for diagnosis of internal carotid artery (ICA) stenosis: A report of the Intersocietal Accreditation Commission (IAC) Vascular Testing Division Carotid Diagnostic Criteria Committee. Vasc Med 2021; 26:515-525. [PMID: 34009060 PMCID: PMC8493430 DOI: 10.1177/1358863x211011253] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diagnostic criteria to classify severity of internal carotid artery (ICA) stenosis vary across vascular laboratories. Consensus-based criteria, proposed by the Society of Radiologists in Ultrasound in 2003 (SRUCC), have been broadly implemented but have not been adequately validated. We conducted a multicentered, retrospective correlative imaging study of duplex ultrasound versus catheter angiography for evaluation of severity of ICA stenosis. Velocity data were abstracted from bilateral duplex studies performed between 1/1/2009 and 12/31/2015 and studies were interpreted using SRUCC. Percentage ICA stenosis was determined using North American Symptomatic Carotid Endarterectomy Trial (NASCET) methodology. Receiver operating characteristic analysis evaluated the performance of SRUCC parameters compared with angiography. Of 448 ICA sides (from 224 patients), 299 ICA sides (from 167 patients) were included. Agreement between duplex ultrasound and angiography was moderate (κ = 0.42), with overestimation of degree of stenosis for both moderate (50–69%) and severe (⩾ 70%) ICA lesions. The primary SRUCC parameter for ⩾ 50% ICA stenosis of peak-systolic velocity (PSV) of ⩾ 125 cm/sec did not meet prespecified thresholds for adequate sensitivity, specificity, and accuracy (sensitivity 97.8%, specificity 64.2%, accuracy 74.5%). Test performance was improved by raising the PSV threshold to ⩾ 180 cm/sec (sensitivity 93.3%, specificity 81.6%, accuracy 85.2%) or by adding the additional parameter of ICA/common carotid artery (CCA) PSV ratio ⩾ 2.0 (sensitivity 94.3%, specificity 84.3%, accuracy 87.4%). For ⩾ 70% ICA stenosis, analysis was limited by a low number of cases with angiographically severe disease. Interpretation of carotid duplex examinations using SRUCC resulted in significant overestimation of severity of ICA stenosis when compared with angiography; raising the PSV threshold for ⩾ 50% ICA stenosis to ⩾ 180 cm/sec as a single parameter or requiring the ICA/CCA PSV ratio ⩾ 2.0 in addition to PSV of ⩾ 125 cm/sec for laboratories using the SRUCC is recommended to improve the accuracy of carotid duplex examinations.
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Affiliation(s)
- Heather L Gornik
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hannah Gardener
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James F Benenati
- Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
| | | | - Naomi M Hamburg
- Whitaker Cardiovascular Institute, Boston University, Boston, MA, USA
| | - Ann Marie Kupinski
- Albany Medical College, Albany, NY, USA.,North Country Vascular Diagnostics, Inc., Altamont, NY, USA
| | - Steven A Leers
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael P Lilly
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MA, USA
| | - Joann M Lohr
- Department of Surgery, Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA
| | - John S Pellerito
- Department of Radiology, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Kenneth S Rholl
- Department of Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, George Washington University, Alexandria, VA, USA
| | | | - Marge S Hutchisson
- Intersocietal Accreditation Commission (IAC), Vascular Testing Division, Ellicott City, MD, USA
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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11
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Mitchell CC, Wilbrand SM, Cook TD, Meshram NH, Steffel CN, Nye R, Varghese T, Hermann BP, Dempsey RJ. Carotid Plaque Strain Indices Were Correlated With Cognitive Performance in a Cohort With Advanced Atherosclerosis, and Traditional Doppler Measures Showed no Association. J Ultrasound Med 2020; 39:2033-2042. [PMID: 32395885 PMCID: PMC7531894 DOI: 10.1002/jum.15311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/20/2020] [Accepted: 04/06/2020] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Traditional Doppler measures have been used to predict cognitive performance in patients with carotid atherosclerosis. Novel measures, such as carotid plaque strain indices (CPSIs), have shown associations with cognitive performance. We hypothesized that lower mean middle cerebral artery (MCA) velocities, higher bulb-internal carotid artery (ICA) velocities, the MCA pulsatility index (PI), and CPSIs would be associated with poorer cognitive performance in individuals with advanced atherosclerosis. METHODS Neurocognitive testing, carotid ultrasound imaging, transcranial Doppler imaging, and carotid strain imaging were performed on 40 patients scheduled for carotid endarterectomy. Kendall tau correlations were used to examine relationships between cognitive tests and the surgical-side maximum peak systolic velocity (PSV; from the bulb, proximal, mid, or distal ICA), mean MCA velocity and PI, and maximum CPSIs (axial, lateral, and shear strain indices used to characterize plaque deformations with arterial pulsation). Cognitive measures included age-adjusted indices of verbal fluency, verbal and visual learning/memory, psychomotor speed, auditory attention/working memory, visuospatial construction, and mental flexibility. RESULTS Participants had a median age of 71.0 (interquartile range, 9.75) years; 26 were male (65%), and 14 were female (35%). Traditional Doppler parameters, PSV, mean MCA velocity, and MCA PI did not predict cognitive performance (all P > .05). Maximum CPSIs were significantly associated with cognitive performance (P < .05). CONCLUSIONS Traditional velocity measurements of the maximum bulb-ICA PSV, mean MCA velocity, and PI were not associated with cognitive performance in patients with advanced atherosclerotic disease; however, maximum CPSIs were associated with cognitive performance. These findings suggest that cognition may be associated with unstable plaque rather than blood flow.
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Affiliation(s)
- Carol C. Mitchell
- Department of Medicine, Division of Cardiovascular
Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland
Avenue, Madison, WI, USA 53792
| | - Stephanie M. Wilbrand
- Department of Neurological Surgery, University of Wisconsin
School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, USA
53792
| | - Thomas D. Cook
- Department of Biostatistics and Medical Informatics,
University of Wisconsin School of Medicine and Public Health, 610 Walnut Street,
Madison WI, USA 53726
| | - Nirvedh H. Meshram
- Department of Medical Physics, University of Wisconsin
School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland
Avenue, Madison, WI, USA 53705
- Department of Electrical and Computer Engineering,
University of Wisconsin-Madison, University of Wisconsin-Madison, 1415 Engineering
Drive, Madison, WI, USA 53706
- Corresponding Author: Carol C. Mitchell,
PhD, 600 Highland Avenue, Madison, WI, USA 53792, 608-262-0680,
| | - Catherine N. Steffel
- Department of Medical Physics, University of Wisconsin
School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland
Avenue, Madison, WI, USA 53705
| | - Rebecca Nye
- Department of Medicine, Division of Cardiovascular
Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland
Avenue, Madison, WI, USA 53792
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin
School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland
Avenue, Madison, WI, USA 53705
- Department of Electrical and Computer Engineering,
University of Wisconsin-Madison, University of Wisconsin-Madison, 1415 Engineering
Drive, Madison, WI, USA 53706
| | - Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of
Medicine and Public Health, 600 Highland Avenue, Madison, WI USA 53792
| | - Robert J. Dempsey
- Department of Neurological Surgery, University of Wisconsin
School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, USA
53792
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12
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Pintea Bentea G, Wauters A, Wautrecht JC, Cogan E. Laser Doppler imaging evaluation of nitroglycerin patch application in systemic sclerosis patients. Vasc Med 2020; 25:559-568. [PMID: 32990196 DOI: 10.1177/1358863x20953901] [Citation(s) in RCA: 4] [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] [Indexed: 12/13/2022]
Abstract
Recent studies suggest the use of topical nitroglycerin (NTG) application in systemic sclerosis (SSc)-associated Raynaud phenomenon (RP). With the current study, we aimed to characterize for the first time the microvascular response to a NTG patch (Trinipatch® 5 mg/24 h) applied to the hand dorsum in patients with SSc using Laser Doppler imaging (LDI) at baseline and following a cold challenge. The study included 21 patients with SSc and 13 controls. Blood flow was evaluated by LDI at the level of the fingertips and metacarpus. Microvascular morphology was evaluated by nailfold capillaroscopy (NC). LDI revealed decreased fingertip baseline perfusion and a stronger vasoconstrictor response to a cold challenge in patients with SSc versus control. Metacarpal application of a NTG patch led to an increase in blood flow and hand temperature in patients with SSc. Furthermore, NTG administration led to a faster reperfusion after cold challenge. Correlation analyses revealed that the magnitude of the vasodilatory response was inversely related to baseline fingertip perfusion and hand temperature, but unrelated to the number of capillaries/mm assessed using NC. In conclusion, we provide evidence of a vasodilatory reaction following NTG patch application in patients with SSc using LDI and a protective effect against cold challenge. The magnitude of the response to NTG was related to functional, but not structural features. Our results support a further evaluation of the NTG patch as a possible therapeutic agent in SSc-associated RP.
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Affiliation(s)
| | - Aurélien Wauters
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Claude Wautrecht
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Elie Cogan
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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13
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Rogers RK, Montero-Baker M, Biswas M, Morrison J, Braun J. Assessment of foot perfusion: Overview of modalities, review of evidence, and identification of evidence gaps. Vasc Med 2020; 25:235-245. [PMID: 32362209 DOI: 10.1177/1358863x20909433] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Patients with critical limb ischemia have nonhealing wounds and/or ischemic rest pain and are at high risk for amputation and mortality. Accurate evaluation of foot perfusion should help avoid unnecessary amputation, guide revascularization strategies, and offer efficient surveillance for patency. Our aim is to review current modalities of assessing foot perfusion in the context of the practical clinical management of patients with critical limb ischemia.
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Affiliation(s)
- R Kevin Rogers
- Section of Vascular Medicine, Division of Cardiology, University of Colorado, Aurora, CO, USA
| | - Miguel Montero-Baker
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Minakshi Biswas
- Section of Vascular Medicine, Division of Cardiology, University of Colorado, Aurora, CO, USA
| | - Justin Morrison
- Section of Vascular Medicine, Division of Cardiology, University of Colorado, Aurora, CO, USA
| | - Jonathan Braun
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA
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14
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Wen C, Gao M, Fu Y, Zhao R, Tong Y, Scissons R, Lanéelle D, Mahé G. A high variability of arterial Doppler waveform descriptions exists in China. Vasc Med 2020; 25:221-222. [PMID: 32202484 DOI: 10.1177/1358863x20903808] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chaoyang Wen
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Meiying Gao
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Yuwei Fu
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Rui Zhao
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Yisha Tong
- Department of Vascular Surgery, Austin Hospital, Melbourne, VIC, Australia
| | | | - Damien Lanéelle
- Université de Caen, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Service de Médecine Vasculaire, INSERM 1075, Caen, France
| | - Guillaume Mahé
- Université de Rennes 1, INSERM CIC 1414, Rennes, France.,Department of Vascular Medicine, CHU Rennes, Rennes, France
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15
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Pokeerbux MR, Delmaire C, Morell-Dubois S, Demondion X, Lambert M. Styloidogenic compression of the internal jugular vein, a new venous entrapment syndrome? Vasc Med 2020; 25:378-380. [PMID: 32186245 DOI: 10.1177/1358863x20902842] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Internal jugular vein (IJV) thrombosis is mainly related to central venous catheter, malignancy, and ovarian hyperstimulation syndrome. We report a case of IJV thrombosis possibly related to IJV compression between the styloid process and the first cervical vertebra (C1) transverse process. To support this hypothesis, we perform radiological assessment of the IJV and examine its relationship with the styloid process and C1 transverse process in 34 controls. Our results showed a strong correlation between IJV diameter and styloid process-C1 transverse process distance. Compared to control subjects, our patient had a short styloid process-C1 transverse process distance, which suggests its involvement in IJV thrombosis.
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Affiliation(s)
| | - Christine Delmaire
- University of Lille, Lille, France.,Department of Neuroradiology, CHU Lille, Lille, France
| | - Sandrine Morell-Dubois
- Department of Internal Medicine, CHU Lille, Lille, France.,University of Lille, Lille, France
| | - Xavier Demondion
- University of Lille, Lille, France.,Department of Musculoskeletal Radiology, CHU Lille, Lille, France
| | - Marc Lambert
- Department of Internal Medicine, CHU Lille, Lille, France.,University of Lille, Lille, France
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16
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Abstract
Although the resting ankle-brachial index (ABI) is commonly used as a tool to diagnose peripheral artery disease (PAD), several additional indices measured after exercise may have increased sensitivity for identifying PAD. The aim of this study was to determine the utility of resting ABI and three post-exercise physiological parameters for diagnosing PAD confirmed by arterial imaging studies. For each qualifying study, we assessed the performance measures for identifying PAD for resting ABI < 0.90, exercise ABI < 0.90, a decrease in ABI > 20% with exercise, and a decrease in ankle pressure > 30 mmHg with exercise. Of the 199 exams that met our inclusion criteria, imaging showed a > 75% stenotic lesion in at least one limb in 138 (69%) of patients. For stenoses > 75%, resting ABI < 0.90 had a sensitivity of 64% (95% CI: 56-72%) and exercise ABI < 0.90 had a sensitivity of 88% (95% CI: 82-93%). The sensitivity for a post-exercise ABI decrease > 20% was 67% (95% CI: 59-75%) and the sensitivity for a decrease in ankle pressure > 30 mmHg was 4% (95% CI: 2-9%). For individuals with a normal resting ABI but stenotic lesions > 75% confirmed by imaging (n=49), the addition of exercise ABI testing correctly identified an additional 25% of this population. Overall, exercise ABI < 0.90 exhibits a greater sensitivity for detecting PAD compared to resting ABI. Furthermore, exercise ABI < 0.90 had added clinical utility in patients with normal resting ABIs and was superior to other commonly used exercise indices.
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Affiliation(s)
- Aaron W Aday
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Scott Kinlay
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Cardiovascular Division, VA Boston Healthcare System, Boston, MA, USA
| | - Marie D Gerhard-Herman
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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