scholarly journals Assessment of Intraoperative Flow Measurement as a Quality Control During Carotid Endarterectomy: A Single-Center Analysis

2020 ◽  
pp. 145749692097113
Author(s):  
A. E. Cyrek ◽  
P. Husen ◽  
S. Radünz ◽  
A. Pacha ◽  
C. Weimar ◽  
...  
Keyword(s):  
Quality Control ◽  
Carotid Endarterectomy ◽  
Flow Measurement ◽  
Intraoperative Imaging ◽  
Intraoperative Ultrasound ◽  
Flow Measurements ◽  
Technical Errors ◽  
Significant Difference ◽  
Artery Disease ◽  
Associated Risk Factors

Background: To evaluate the technical results of the arterial repair, a variety of intraoperative imaging and assessment techniques can be used during carotid endarterectomy. The aim of the study was to evaluate the usefulness of intraoperative ultrasound flow measurement as a quality control after primary carotid endarterectomy in the setting of a teaching hospital. Methods: One hundred and seven consecutive carotid endarterectomies were performed over 24 months at our institution. Retrospectively acquired demographics, intraoperative flow measurements, duplex results, revisions, and surgical outcomes were reviewed. Postoperative 30-day transient ischemic attack, stroke, and death rates were analyzed. Results were compared with ultrasound flow measurement and duplex ultrasonography. Results: From March 2013 to March 2015, 107 primary consecutive carotid endarterectomies were performed in 107 patients (71% male, 29% female). The age ranged from 51 to 81 years with a mean age of 68 ± 4 years. Associated risk factors included diabetes 89 (83%), smoking 92 (86%), hypertension 94 (87.8%), chronic renal insufficiency 71 (66%), and coronary artery disease 57 (53%). Early postoperative duplex scans in all 107 patients showed no significant changes from intraoperative findings. The ipsilateral stroke and death rate in this study was 0 (0/107) and 30-day death and stroke rate was also 0 (0/107), with no significant difference between trainees and senior surgeons. Three patients (2.8 %) had flow <100 mL/min and two of them were revised after completion contrast angiography. Conclusion: The findings of this study indicate that the intraoperative flow measurement is an alternative method for detecting technical errors and a tool for quality control imaging. Especially for the trainees, it makes sense to ensure effectiveness of the procedure upon its completion and to assess the technical adequacy of carotid endarterectomy.

Enhancement of flow measurement for graft verification

2019 ◽  
Vol 27 (8) ◽  
pp. 646-651
Author(s):  
Yury Y Vechersky ◽  
Vasily V Zatolokin ◽  
Boris N Kozlov ◽  
Aleksandra A Nenakhova ◽  
Vladimir M Shipulin
Keyword(s):  
Coronary Artery ◽  
Transit Time ◽  
Flow Measurement ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Flow Measurements ◽  
Technical Problems ◽  
Technical Errors ◽  
Time Flow ◽  
Coronary Bypass Grafts

Background We aimed to evaluate multiple transit-time flow measurements during coronary artery bypass grafting. Methods Transit-time flow measurements were performed first on the arrested heart both with and without a proximal snare on the target coronary artery, second, after weaning from cardiopulmonary bypass, and third, before chest closure. Results Among the 214 grafts considered, 9 (4.2%) were patent and 6 (2.8%) were failing. In the failed grafts, an abnormal transit-time flow was found during the first measurement, in 5 (2.3%) cases with a proximal snare and in one (0.47%) without a snare. In these cases, technical errors with the distal anastomoses were found and immediately corrected. A problem with the proximal anastomosis was found in one graft during the second measurement and corrected right away. Bending due to excessive length was found in 2 (0.93%) grafts during the third measurement, and graft repositioning was performed. The first transit-time flow measurement showed that mean graft flow was significantly decreased with a proximal snare compared to without a proximal snare, throughout the entire coronary territory. Pulsatility index during the first transit-time flow measurement was higher with a proximal snare than without one. Conclusions The 3-time transit-time flow measurement strategy makes it possible to verify and immediately correct technical problems with coronary bypass grafts.

Cost-effectiveness of Intraoperative Imaging in Carotid Endarterectomy

Neurosurgery ◽  
2005 ◽  
Vol 57 (3) ◽  
pp. 478-485 ◽  
Author(s):  
Mark G. Burnett ◽  
Sherman C. Stein ◽  
Seema S. Sonnad ◽  
Eric L. Zager
Keyword(s):  
Cost Effectiveness ◽  
Carotid Endarterectomy ◽  
English Language ◽  
Intraoperative Imaging ◽  
Controlled Trial ◽  
Intraoperative Ultrasound ◽  
Decision Analytic Model ◽  
Perioperative Stroke ◽  
The Impact ◽  
Completion Angiography

ABSTRACT OBJECTIVE: There has never been a large, randomized controlled trial to assess the impact of intraoperative imaging on the success of carotid endarterectomy (CEA). This comparison involves cost-effectiveness analysis. METHODS: We constructed a decision-analytic model to compare effectiveness and costs of intraoperative ultrasound (IUS) and completion angiography as adjuncts to CEA. Data on procedural mortality, morbidity, and costs were obtained from the English-language literature. The review included a total of 52 reports, encompassing more than 22,000 patients. The main components of costs were those of the monitoring interventions and the care of perioperative stroke. RESULTS: Mean perioperative outcome without completion imaging is approximately 96.7% of what it would be in the absence of perioperative stroke or death. IUS and completion angiography each result in approximately 2% improvement in expected outcome. Mean perioperative costs are $396.50 for IUS, $721.30 for no monitoring, and $840.90 for completion angiography. Because IUS is significantly more effective at detecting technical errors that would likely result in perioperative stroke than no imaging and is significantly less costly than angiography, this strategy dominates the other two (i.e., it provides greater effectiveness at lower cost). CONCLUSION: Although surgical complications are uncommon, IUS substantially lowers the rate of perioperative stroke and mortality and thus is significantly more cost-effective than either completion angiography or no operative imaging.

Markers of Hemostatic Activation in Affected Coronary Arteries during Angioplasty

1994 ◽  
Vol 72 (05) ◽  
pp. 672-675 ◽  
Author(s):  
Nicolas W Shammas ◽  
Michael J Cunningham ◽  
Richard M Pomearntz ◽  
Charles W Francis
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Venous Blood ◽  
Balloon Inflation ◽  
Blood Samples ◽  
Hemostatic System ◽  
Significant Difference ◽  
Hemostatic Markers ◽  
Artery Disease ◽  
High Doses

SummaryTo characterize the extent of early activation of the hemostatic system following angioplasty, we obtained blood samples from the involved coronary artery of 11 stable angina patients during the procedure and measured sensitive markers of thrombin formation (fibrino-peptide A, prothrombin fragment 1.2, and soluble fibrin) and of platelet activation ((3-thromboglobulin). Levels of hemostatic markers in venous blood obtained from 14 young individuals with low pretest probability for coronary artery disease were not significantly different from levels in venous blood or intracoronary samples obtained prior to angioplasty. Also, there was no translesional (proximal and distal to the lesion) gradient in any of the hemostatic markers before or after angioplasty in samples obtained between 18 and 21 min from the onset of the first balloon inflation. Furthermore, no significant difference was noted between angioplasty and postangioplasty intracoronary concentrations. We conclude that intracoronary hemostatic activation does not occur in the majority of patients during and immediately following coronary angioplasty when high doses of heparin and aspirin are administered.

The Effect of Antiplatelet Drugs on Plasma Betathromboglobulin in Coronary Artery Disease

1979 ◽  
Author(s):  
P Han ◽  
A Turpie ◽  
E Genton ◽  
M Gent
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Crossover Trial ◽  
Specific Protein ◽  
Antiplatelet Drugs ◽  
Significant Difference ◽  
Pre Treatment ◽  
Artery Disease ◽  
Therapeutic Doses ◽  
Granule Release

Platelets play a role in the development and complications of coronary artery disease (CAD) and a number of abnormalities of platelet function which can be corrected by antiplatelet drugs have been described. Betathromboglobulin (BTG), a platelet-specific protein which is released from α-granules during platelet activation is significantly elevated in patients with angiographically demonstrated CAD (51.0 ± 31.0 ng/ml., n = 50) compared to normal (28.0 ± 8.0 ng/ml., n = 70) p < 0.001. The effect of sulphinpyrazone (800 mg.) or aspirin (1200 mg.)/dipyridamole (200 mg.) on plasma BTG in CAD was studied in a blind prospective crossover trial in 25 patients. Mean BTG concentration pre-treatment was 52.3 ng/ml. and after 1 month’s treatment with placebo, sulphinpyrazone or aspirin/dipyridamole mean plasma BTG concentrations were 53.5, 49.6 and 56.7 ng/ml. respectively. Analysis of variance showed no significant difference between the means (p > 0.1) . This study confirms increased plasma BTG concentrations in patients with CAD and indicates that therapeutic doses of these antiplatelet drugs do not significantly effect the BTG level and thus appear not to prevent α-granule release in CAD.

Investigation of the influence of the flow structure on the accuracy of flow measurement before a hydrometric structure in an open channel

2020 ◽  
pp. 41-44
Author(s):  
Anatoly Kusher
Keyword(s):  
Velocity Profile ◽  
Flow Velocity ◽  
Water Flow ◽  
Flow Measurement ◽  
Water Discharge ◽  
Critical Depth ◽  
Flow Measurements ◽  
Study Results ◽  
Flow Velocity Profile ◽  
Upstream Flow

The reliability of water flow measurement in irrigational canals depends on the measurement method and design features of the flow-measuring structure and the upstream flow velocity profile. The flow velocity profile is a function of the channel geometry and wall roughness. The article presents the study results of the influence of the upstream flow velocity profile on the discharge measurement accuracy. For this, the physical and numerical modeling of two structures was carried out: a critical depth flume and a hydrometric overfall in a rectangular channel. According to the data of numerical simulation of the critical depth flume with a uniform and parabolic (1/7) velocity profile in the upstream channel, the values of water discharge differ very little from the experimental values in the laboratory model with a similar geometry (δ < 2 %). In contrast to the critical depth flume, a change in the velocity profile only due to an increase in the height of the bottom roughness by 3 mm causes a decrease of the overfall discharge coefficient by 4…5 %. According to the results of the numerical and physical modeling, it was found that an increase of backwater by hydrometric structure reduces the influence of the upstream flow velocity profile and increases the reliability of water flow measurements.

Regional Cervical Plexus Blockage for Carotid Endarterectomy in Patients with Cardiovascular Risk Factors

2015 ◽  
Vol 18 (4) ◽  
pp. 140 ◽  
Author(s):  
Mehmet Taşar ◽  
Mehmet Kalender ◽  
Okay Güven Karaca ◽  
Ata Niyazi Ecevit ◽  
Salih Salihi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Carotid Artery Disease ◽  
Risk Groups ◽  
Cardiac Risk ◽  
Cervical Plexus ◽  
Cardiac Risk Factors ◽  
Significant Difference

Background: Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. <br />Methods: We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy ± patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared.<br />Results: Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P &gt; .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection.<br />Conclusion: Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed. <br /><br />

Osteoprotegerin and Osteopontin Serum Levels are Associated with Vascular Function and Inflammation in Coronary Artery Disease Patients

2020 ◽  
Vol 18 (5) ◽  
pp. 523-530 ◽  
Author(s):  
Konstantinos Maniatis ◽  
Gerasimos Siasos ◽  
Evangelos Oikonomou ◽  
Manolis Vavuranakis ◽  
Marina Zaromytidou ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Endothelial Function ◽  
Vascular Function ◽  
Serum Levels ◽  
Atherosclerosis Progression ◽  
Control Subjects ◽  
Significant Difference ◽  
Artery Disease ◽  
Stable Cad

Background: Osteoprotegerin and osteopontin have recently emerged as key factors in both vascular remodelling and atherosclerosis progression. Interleukin-6 (IL-6) is an inflammatory cytokine with a key role in atherosclerosis. The relationship of osteoprotegerin, osteopontin, and IL-6 serum levels with endothelial function and arterial stiffness was evaluated in patients with coronary artery disease (CAD). Methods: We enrolled 219 patients with stable CAD and 112 control subjects. Osteoprotegerin, osteopontin and IL-6 serum levels were measured using an ELISA assay. Endothelial function was evaluated by flow-mediated dilation (FMD) in the brachial artery and carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness. Results: There was no significant difference between control subjects and CAD patients according to age and sex. Compared with control subjects, CAD patients had significantly impaired FMD (p<0.001) and increased PWV (p=0.009). CAD patients also had significantly higher levels of osteoprotegerin (p<0.001), osteopontin (p<0.001) and IL-6 (p=0.03), compared with control subjects. Moreover, IL-6 levels were correlated with osteoprotegerin (r=0.17, p=0.01) and osteopontin (r=0.30, p<0.001) levels. FMD was correlated with osteoprotegerin levels independent of possible confounders [b coefficient= - 0.79, 95% CI (-1.54, -0.05), p=0.04]. Conclusion: CAD patients have increased osteoprotegerin, osteopontin and IL-6 levels. Moreover, there is a consistent association between osteoprotegerin and osteopontin serum levels, vascular function and inflammation in CAD patients. These findings suggest another possible mechanism linking osteoprotegerin and osteopontin serum levels with CAD progression through arterial wall stiffening and inflammation.

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