The Role of Duplex Ultrasound in the Detection of Upper Extremity Artery Pathology, and Post Endovascular Complications

2018 ◽  
Vol 42 (1) ◽  
pp. 26-29
Author(s):  
Jason Roberts ◽  
Vaqar Ali ◽  
Mian Ahmed Hasan
Keyword(s):  
Upper Extremity ◽  
Fibromuscular Dysplasia ◽  
Duplex Ultrasound ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Upper Extremities ◽  
Peripheral Arterial ◽  
The Relationship ◽  
Abnormal Pathology

Upper extremity pathology is uncommon and generally involves the brachial artery in about 12% of the cases. Of chronic upper limb ischemia, trauma, fibromuscular dysplasia, giant cell arteritis, and atherosclerosis are among the most reported cases. After a thorough review of the literature, there is agreement with duplex ultrasound sensitivity and specificity for predicting >70% stenosis in the subclavian arteries with a sensitivity of >82% and specificity of >90%. This article not only correlates the relationship between duplex ultrasound and severe peripheral arterial disease, but it also proves with 100% accuracy the ability to detect latent and abnormal pathology of the upper extremities post endovascular intervention.

scholarly journals Acute Lower Limb Ischemia—Etiology, Pathology, and Management

2020 ◽  
Vol 29 (03) ◽  
pp. 168-174
Author(s):  
Balaji Natarajan ◽  
Prashant Patel ◽  
Ashis Mukherjee
Keyword(s):  
Hybrid Approach ◽  
Duplex Ultrasound ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Neurological Deficits ◽  
Initial Assessment ◽  
Common Source ◽  
Acute Limb Ischemia ◽  
Management Options ◽  
Peripheral Arterial

AbstractAcute limb ischemia (ALI) is a vascular emergency associated with a high risk for limb loss and death. Most cases result from in situ thrombosis in patients with preexisting peripheral arterial disease or those who have undergone vascular procedures including stenting and bypass grafts. The other common source is cardioembolic. The incidence has decreased in recent times due to better anticoagulation strategies. Patients with suspected ALI should be evaluated promptly by a vascular specialist and consideration should be given for transfer to a higher level of care if such expertise is not available locally. Initial assessment should focus on staging severity of ischemic injury and potential for limb salvage. Neurological deficits can occur early and are an important poor prognostic sign. Duplex ultrasound and computed tomography angiography help plan intervention in patients with a still-viable limb and prompt catheter-based angiography is mandated in patients with an immediately threatened limb. Further investigations need to be pursued to differentiate embolic from thrombotic cause for acute occlusion as this can change management. Options include intravascular interventions, surgical bypass, or a hybrid approach. In this article, the authors discuss the common etiologies, clinical evaluation, and management of patients presenting with acute limb ischemia.

scholarly journals In Vivo Matrigel Plug Assay as a Potent Method to Investigate Specific Individual Contribution of Angiogenesis to Blood Flow Recovery in Mice

2021 ◽  
Vol 22 (16) ◽  
pp. 8909
Author(s):  
Zeen Aref ◽  
Paul H. A. Quax
Keyword(s):  
Blood Flow ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Matrigel Plug ◽  
Peripheral Arterial ◽  
The Sacrifice ◽  
Deficient Mice ◽  
Specific Contribution

Neovascularization restores blood flow recovery after ischemia in peripheral arterial disease. The main two components of neovascularization are angiogenesis and arteriogenesis. Both of these processes contribute to functional improvements of blood flow after occlusion. However, discriminating between the specific contribution of each process is difficult. A frequently used model for investigating neovascularization is the murine hind limb ischemia model (HLI). With this model, it is difficult to determine the role of angiogenesis, because usually the timing for the sacrifice of the mice is chosen to be optimal for the analysis of arteriogenesis. More importantly, the occurring angiogenesis in the distal calf muscles is probably affected by the proximally occurring arteriogenesis. Therefore, to understand and subsequently intervene in the process of angiogenesis, a model is needed which investigates angiogenesis without the influence of arteriogenesis. In this study we evaluated the in vivo Matrigel plug assay in genetic deficient mice to investigate angiogenesis. Mice deficient for interferon regulatory factor (IRF)3, IRF7, RadioProtective 105 (RP105), Chemokine CC receptor CCR7, and p300/CBP-associated factor (PCAF) underwent the in vivo Matrigel model. Histological analysis of the Matrigel plugs showed an increased angiogenesis in mice deficient of IRF3, IRF7, and RP105, and a decreased angiogenesis in PCAF deficient mice. Our results also suggest an involvement of CCR7 in angiogenesis. Comparing our results with results of the HLI model found in the literature suggests that the in vivo Matrigel plug assay is superior in evaluating the angiogenic response after ischemia.

Role of Doppler Ultrasound in Comparison With MDCT Angiography in the Assessment of Lower Limb PAD

2021 ◽  
Vol 15 (11) ◽  
pp. 2936-2937
Author(s):  
Mehwish Tahir ◽  
Sadaf Iqbal ◽  
Maimoona Gulshan
Keyword(s):  
Doppler Ultrasound ◽  
Lower Limb ◽  
Multidetector Ct ◽  
Duplex Ultrasound ◽  
Arterial Disease ◽  
Radiology Department ◽  
Atherosclerotic Plaques ◽  
Mdct Angiography ◽  
Peripheral Arterial

Aim: Role of Doppler ultrasound in comparison with MDCT angiography in the assessment of lower limb Peripheral arterial disease. Methodology: This study was conducted in Radiology department of Shalamar Hospital Lahore. A total of 42 patients (31 males and 11 females) diagnosed with PAD by using both Doppler ultrasound and MDCTA were included. The data collected was entered, tabulated and statistically analyzed on IBM-SPSS 25.0 version. Results: A total of 336 arterial segments were assessed on both modalities. Duplex ultrasound detected 278 (83%) positive patent segments, 124(37%) segments showing atherosclerosis and 63(19%) segments with stenosis/thrombus, in comparison to MDCTA which was able to detect 221 (66%) patent vessels,153(46%) segments showing atherosclerosis and 114 (34%) segments showing thrombus/ stenosis. The results showed that the MDCTA was able to detect 15% more arterial segments with stenosis/ thrombus and 9% more segments with atherosclerotic plaques as compared to Doppler. Conclusion: Doppler ultrasound is the modality of choice in detecting grade 0 and 1 PAD while. MDCTA is more accurate in assessing patients with grade 2 and 3 PAD who need surgical intervention. Key Words: PAD, Duplex ultrasound, Multidetector CT Angiography

scholarly journals What Is Currently the Role of TcPO2 in the Choice of the Amputation Level of Lower Limbs? A Comprehensive Review

2021 ◽  
Vol 10 (7) ◽  
pp. 1413
Author(s):  
Judith Catella ◽  
Anne Long ◽  
Lucia Mazzolai
Keyword(s):  
Arterial Disease ◽  
Major Amputation ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Quality Of Data ◽  
Amputation Level ◽  
Increased Risk ◽  
Transcutaneous Oximetry ◽  
Peripheral Arterial

Some patients still require major amputation for lower extremity peripheral arterial disease treatment. The purpose of pre-operative amputation level selection is to determine the most distal amputation site with the highest healing probability without re-amputation. Transcutaneous oximetry (TcPO2) can detect viable tissue with the highest probability of healing. Several factors affect the accuracy of TcPO2; nevertheless, surgeons rely on TcPO2 values to determine the optimal amputation level. Background about the development of TcPO2, methods of measurement, consequences of lower limb amputation level, and the place of TcPO2 in the choice of the amputation level are reviewed herein. Most of the retrospective studies indicated that calf TcPO2 values greater than 40 mmHg were associated with a high percentage of successful wound healing after below-knee-amputation, whereas values lower than 20 mmHg indicated an increased risk of unsuccessful healing. However, a consensus on the precise cut-off value of TcPO2 necessary to assure healing is missing. Ways of improvement for TcPO2 performance applied to the optimization of the amputation-level are reported herein. Further prospective data are needed to better approach a TcPO2 value that will promise an acceptable risk of re-amputation. Standardized TcPO2 measurement is crucial to ensure quality of data.

scholarly journals The Role of Circulating Biomarkers in Peripheral Arterial Disease

2021 ◽  
Vol 22 (7) ◽  
pp. 3601
Author(s):  
Goren Saenz-Pipaon ◽  
Esther Martinez-Aguilar ◽  
Josune Orbe ◽  
Arantxa González Miqueo ◽  
Leopoldo Fernandez-Alonso ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Lower Limb ◽  
Prediction Models ◽  
Arterial Disease ◽  
Cardiac Damage ◽  
Thrombotic Occlusion ◽  
Medical Treatments ◽  
Peripheral Arterial ◽  
Inflammatory Molecules

Peripheral arterial disease (PAD) of the lower extremities is a chronic illness predominantly of atherosclerotic aetiology, associated to traditional cardiovascular (CV) risk factors. It is one of the most prevalent CV conditions worldwide in subjects >65 years, estimated to increase greatly with the aging of the population, becoming a severe socioeconomic problem in the future. The narrowing and thrombotic occlusion of the lower limb arteries impairs the walking function as the disease progresses, increasing the risk of CV events (myocardial infarction and stroke), amputation and death. Despite its poor prognosis, PAD patients are scarcely identified until the disease is advanced, highlighting the need for reliable biomarkers for PAD patient stratification, that might also contribute to define more personalized medical treatments. In this review, we will discuss the usefulness of inflammatory molecules, matrix metalloproteinases (MMPs), and cardiac damage markers, as well as novel components of the liquid biopsy, extracellular vesicles (EVs), and non-coding RNAs for lower limb PAD identification, stratification, and outcome assessment. We will also explore the potential of machine learning methods to build prediction models to refine PAD assessment. In this line, the usefulness of multimarker approaches to evaluate this complex multifactorial disease will be also discussed.

The epidemiology of onychomycosis: possible role of smoking and peripheral arterial disease

2000 ◽  
Vol 14 (6) ◽  
pp. 466-469 ◽  
Author(s):  
Aditya K. Gupta ◽  
Madhulika A. Gupta ◽  
Richard C. Summerbell ◽  
Elizabeth A. Cooper ◽  
Nellie Konnikov ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Peripheral Arterial

scholarly journals Lower-limb hot-water immersion acutely induces beneficial hemodynamic and cardiovascular responses in peripheral arterial disease and healthy, elderly controls

2017 ◽  
Vol 312 (3) ◽  
pp. R281-R291 ◽  
Author(s):  
Kate N. Thomas ◽  
André M. van Rij ◽  
Samuel J. E. Lucas ◽  
James D. Cotter
Keyword(s):  
Blood Pressure ◽  
Lower Limb ◽  
Water Immersion ◽  
Duplex Ultrasound ◽  
Arterial Disease ◽  
Hot Water ◽  
Healthy Elderly ◽  
Limb Perfusion ◽  
Peripheral Arterial ◽  
Hot Water Immersion

Passive heat induces beneficial perfusion profiles, provides substantive cardiovascular strain, and reduces blood pressure, thereby holding potential for healthy and cardiovascular disease populations. The aim of this study was to assess acute responses to passive heat via lower-limb, hot-water immersion in patients with peripheral arterial disease (PAD) and healthy, elderly controls. Eleven patients with PAD (age 71 ± 6 yr, 7 male, 4 female) and 10 controls (age 72 ± 7 yr, 8 male, 2 female) underwent hot-water immersion (30-min waist-level immersion in 42.1 ± 0.6°C water). Before, during, and following immersion, brachial and popliteal artery diameter, blood flow, and shear stress were assessed using duplex ultrasound. Lower-limb perfusion was measured also using venous occlusion plethysmography and near-infrared spectroscopy. During immersion, shear rate increased ( P < 0.0001) comparably between groups in the popliteal artery (controls: +183 ± 26%; PAD: +258 ± 54%) and brachial artery (controls: +117 ± 24%; PAD: +107 ± 32%). Lower-limb blood flow increased significantly in both groups, as measured from duplex ultrasound (>200%), plethysmography (>100%), and spectroscopy, while central and peripheral pulse-wave velocity decreased in both groups. Mean arterial blood pressure was reduced by 22 ± 9 mmHg (main effect P < 0.0001, interaction P = 0.60) during immersion, and remained 7 ± 7 mmHg lower 3 h afterward. In PAD, popliteal shear profiles and claudication both compared favorably with those measured immediately following symptom-limited walking. A 30-min hot-water immersion is a practical means of delivering heat therapy to PAD patients and healthy, elderly individuals to induce appreciable systemic (chronotropic and blood pressure lowering) and hemodynamic (upper and lower-limb perfusion and shear rate increases) responses.

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