scholarly journals Transposição da veia braquial como acesso para hemodiálise: uma alternativa ao uso de prótese sintética

2019 ◽  
Vol 18 ◽  
Author(s):  
Guilherme de Castro-Santos ◽  
Alberto Gualter Salles ◽  
Giuliano Silva dos Anjos ◽  
Ricardo Jayme Procópio ◽  
Túlio Pinho Navarro
Keyword(s):  
Duplex Scan

Resumo Contexto Atualmente, observa-se um esforço mundial para aumento do número de acessos autógenos para hemodiálise. Objetivos Avaliar a perviedade e as complicações da transposição da veia braquial em comparação aos outros acessos autógenos para hemodiálise. Métodos Avaliação retrospectiva de 43 pacientes, com 45 procedimentos. Os pacientes que não apresentaram veias do sistema venoso superficial adequadas ao Duplex Scan pré-operatório foram submetidos à transposição da veia braquial. Esses procedimentos foram divididos em dois grupos: A: uso da veia braquial, n = 10. B: demais acessos, n = 35. Resultados Não houve diferença estatística entre os grupos no que se refere à idade, diabetes, hipertensão arterial sistêmica, dislipidemias, arteriopatias, neoplasias, estágio da doença renal, diâmetro da artéria doadora e da veia receptora, pressão arterial sistólica no membro operado, isquemia pós-operatória, formação de hematoma e infecção. Não houve diferença quanto à perviedade aos 7 dias A: 80% vs. B: 90%, p = 0,6; aos 30 dias A: 80% vs. B: 86%, p = 0,6; e aos 60 dias A: 60% vs. B: 80%, p = 0,22. Houve diferença entre os grupos quanto ao número de fístulas prévias A: 1,0 ± 0,44 vs. B: 0,6 ± 0,3, p = 0,04; e quanto ao edema em membro superior A: 20% vs. B: 0%, p = 0,04. A veia doadora menor que 3 mm esteve associada ao maior risco de oclusão precoce (RR = 8, p = 0,0125). Nesse período, não houve nenhum procedimento com o uso de prótese sintética. Conclusões A veia braquial transposta é uma alternativa à prótese sintética.

Ultraschalluntersuchungen der hirnversorgenden Arterien Bedeutung für Diagnostik und Therapie

1986 ◽  
Vol 06 (06) ◽  
pp. 216-224 ◽  
Author(s):  
B. Widder
Keyword(s):  
Duplex Scan ◽  
Transkranielle Dopplersonographie ◽  
Diagnostik Und Therapie

ZusammenfassungDie Dopplersonographie der extrakraniellen hirnversorgenden Arterien hat sich in den vergangenen Jahren als zuverlässige Methode zur Erkennung höhergradiger Stenosen und Verschlüsse bewährt. In Kombination mit der Schnittbild-Untersuchung (Duplex-Scan) können auch geringgradige Stenosen erfaßt werden, und die transkranielle Dopplersonographie erweitert das Untersuchungsspektrum auf die großen Hirnbasisarterien. In jüngster Zeit kommt den Ultraschallmethoden zunehmende Bedeutung bei der Therapieplanung zu: Die Bestimmung der Autoregulationsreserve mit dem Doppler-C02-Test eignet sich zur Erfassung hämodynamisch kritischer Verschlußprozesse der A. carotis, und die Einführung echomorphologischer Parameter bei der DuplexUntersuchung ermöglicht Aussagen über subintimale Blutungen bei Karotisstenosen mit dadurch erhöhtem embolischen Risiko. Weiterhin gibt die transkranielle Dopplersonographie Auskunft über die Funktionsfähigkeit intrakranieller Kollateralen, gibt Hinweise auf das Clamping-Risiko in der Karotischirurgie, und trägt bei Subarachnoidalblutungen durch Verlaufskontrollen des Vasospasmus zu einer individuell angepaßten operativen und konservativen Therapie bei.

The (Absence of a) Role of Venous Duplex Scan in the Diagnosis of Pulmonary Embolism after Severe Trauma

2006 ◽  
Vol 72 (1) ◽  
pp. 7-10
Author(s):  
George C. Velmahos ◽  
Carlos V. Brown ◽  
Demetrios Demetriades
Keyword(s):  
Intensive Care Unit ◽  
Pulmonary Embolism ◽  
Intensive Care ◽  
Sensitivity And Specificity ◽  
Clinical Suspicion ◽  
Severely Injured ◽  
Duplex Scan ◽  
Severely Injured Patients ◽  
High Level ◽  
Injured Patients

Venous duplex scan (VDS) has been used for interim bedside diagnosis of pulmonary embolism (PE) in severely injured patients deemed to be at risk if transported out of the intensive care unit. In combination with the level of clinical suspicion for PE, VDS helps select patients for temporary treatment until definitive diagnosis is made. We evaluate the sensitivity and specificity of VDS in critically injured patients with a high level of clinical suspicion for PE. We performed a prospective observational cohort study at the surgical intensive care unit of an academic level 1 trauma center. Patients were 59 critically injured patients suspected to have PE over a 30-month period. The level of clinical suspicion for PE was classified as low or high according to preset criteria. Interventions were VDS and a PE outcome test (conventional or computed tomographic pulmonary angiography). The sensitivity and specificity of VDS to detect PE in all patients and in patients with high level of clinical suspicion was calculated against the results of the outcome test. PE was diagnosed in 21 patients (35.5%). The sensitivity and specificity of VDS was 33 per cent and 89 per cent, respectively. Among the 28 patients who had a high level of clinical suspicion for PE, the sensitivity of VDS was 23 per cent and the specificity 93 per cent. In this latter population, 1 of the 4 (25%) positive VDS was of a patient without PE and 10 of the 24 (42%) negative VDS were of patients who had PE. VDS does not accurately predict PE in severely injured patients, even in the presence of a high level of clinical suspicion.

scholarly journals Carotid Plaque Characterization Using Digital Image Processing and its Potential in Future Studies of Carotid Endarterectomy and Angioplasty

1998 ◽  
Vol 5 (3) ◽  
pp. 240-246 ◽  
Author(s):  
Giorgio M. Biasi ◽  
Paolo M. Mingazzini ◽  
Lucia Baronio ◽  
Maria Rosa Piglionica ◽  
Stefano A. Ferrari ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Carotid Endarterectomy ◽  
Carotid Plaque ◽  
Screening Tool ◽  
Brain Infarction ◽  
Carotid Stent ◽  
Plaque Characterization ◽  
Duplex Scan ◽  
Future Studies ◽  
The Mean

Purpose: To corroborate the validity of a computerized methodology for evaluating carotid lesions at risk for stroke based on plaque echogenicity. Methods: The records of 96 carotid endarterectomy patients (59 men; median age 69.5 years, range 52 to 83) with stenoses > 50% were studied retrospectively. Forty-one patients (43%) had been symptomatic preoperatively. All patients had undergone computed tomography (CT) to detect infarction in the carotid territory and a duplex scan to measure carotid stenosis. Plaque echogenicity was analyzed by computer, expressing the echodensity in terms of the gray scale median (GSM). The incidence of CT-documented cerebral infarction was analyzed in relation to symptomatology, percent stenosis, and echodensity. Results: Symptoms correlated well with CT evidence of brain infarction: 32% of symptomatic patients had a positive CT scan versus 16% for asymptomatic plaques (p = 0.076). The mean GSM value was 56 ± 14 for plaques associated with negative CT scans and 38 ± 13 for plaques from patients with positive scans (p < 0.0001). However, there was no difference in the GSM value between plaques with > or < 70% stenosis. Furthermore, the incidence of CT infarction was 40% in the cerebral territory of carotid plaques with a GSM value < 50 and only 9% in those with a GSM > 50 (p < 0.001). Conclusions: Computerized analysis of plaque echogenicity appears to provide clinically useful data that correlates with the incidence of cerebral infarction and symptoms. This method of analyzing plaque echolucency could be used as a screening tool for carotid stent studies to identify high-risk lesions better suited to conventional surgical treatment.

TP5.2.2 Office based endovascular radiofrequency ablation (OBEVRFA) as a standalone procedure for varicose veins

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ashok Balasubramanian ◽  
Raghvinder Gambhir ◽  
Hisham Rashid
Keyword(s):  
Varicose Veins ◽  
Symptomatic Relief ◽  
Electronic Patient Records ◽  
First Line ◽  
Duplex Scan ◽  
Secondary Procedure ◽  
Long Saphenous Vein ◽  
Number Of Patients ◽  
Secondary Procedures ◽  
Endovascular Radiofrequency Ablation

Abstract Aims The aim of this study was to identify the number of patients that required a secondary procedure for persistence/ recurrence of symptoms within 3 years of the index (OBEVRFA) procedure. Method Retrospective analysis of data collected prospectively for patients booked to have OBEVRFA in the period January 2017- January 2018 was accessed from electronic patient records. Their clinic follow letters, scans and any secondary procedures done were documented on an excel sheet. Results A total of 303 patients, were booked for an OBEVRFA of which 17 (5.6%) patients did not attend the procedure. 39 (12.8%) patients were cancelled on the day of the procedure. 247 patients (M:F 1:1.5), underwent OBEVRFA. 53 patients (21.8%), had residual veins or were symptomatic & were followed up beyond their 3 month period. 24 patients had a duplex scan which showed complete recanalization in 4, a reflux in non-treated secondary vein (Like Anterior thigh vein or duplicated Long saphenous vein) and a new perforator incompetence in others. 40 (16.1%) patients eventually underwent secondary procedures, 8 underwent classical High flush ligation and stripping with multiple stab avulsions (MSA) , 7 had a redo OBEVRFA, 3 had a redo RFA with MSA under GA, others had MSA alone and 1 had successful sclerotherapy. 3 patients were not keen for a secondary procedure. Conclusion OBEVRFA alone provides complete symptomatic relief in over 80% of patients with only 16% needing a secondary procedure. For symptomatic varicose veins from truncal reflux OBEVRFA should be the first line treatment on NHS.

A Study of Transcutaneous Oxygen Saturation by Pulse Oximetry in Symptomatic Ischaemic Lower Limb – A Cross Sectional Analytical Study in a Tertiary Care Hospital in Tirupathi

2021 ◽  
Vol 8 (32) ◽  
pp. 3018-3022
Author(s):  
Sadhu Nagamuneiah ◽  
Gandikota Venkata Prakash ◽  
Sabitha P ◽  
Jandla Bhulaxmi ◽  
Dintyala Venkata S.S.Dintyala Venkata S.S. Mythri ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Pulse Oximetry ◽  
Analytical Study ◽  
Lower Extremities ◽  
Care Hospital ◽  
Colour Doppler ◽  
Duplex Scan ◽  
Cross Sectional ◽  
Transcutaneous Oxygen ◽  
Arterial Insufficiency

BACKGROUND Chronic arterial insufficiency (CAI) results in stenotic-occlusive disease of vascularized arterial disorders of tissues and organs. CAI of the lower extremities represents a significant medical and socio-economic problem due to a high incidence of morbidity, invalidity and mortality. METHODS A cross sectional analytical study was conducted in a group of 100 patients, admitted at the Vascular Department of the Sri Venkateshwara Ramnaraian Ruia Government General Hospital, Tirupati during the period from September 2018 to August 2019, with evident symptoms and signs of different stages of lower extremities CAI verified by ultrasonography. In patients with lower extremity disorder of tissue arterial capillaries, SpO2 was determined by pulse oximetry. CAI of the lower extremity was determined on the basis of clinical findings and colour Doppler duplex scan echo sonography results. Using the conventional method (single-gate) and colour Doppler duplex scan (multi-gate), the presence and localization of stenosis, the segmental predominance (with multisegmental forms) and the degree of progression of stenotic-occlusive lesions were verified. RESULTS Results Using pulse oximetry, depending on the of stage of lower extremities CAI, we revealed a considerable difference in the stages of functional ischemia Mean SpO2: Fontaine I – 95.50 %, Fontaine II – 92.90; in stage critical ischemia SpO2: Fontaine III – 65.00 % and Fontaine IV – 49.87 %. In 29 patients with gangrenous foot and fingers SpO2 was immeasurable and progressive decrease in SpO2 of arterial capillaries (p<0.01 between stages). CONCLUSIONS Due to the reliability and simplicity of pulse oximetry it can be a routinely used diagnostic device for patients with early determined stage of lower extremities CAI. KEYWORDS Chronic Arterial Insufficiency, SPO2, Pulse Oximetry, Ischemia

scholarly journals Abordagem de pacientes com úlcera da perna de etiologia venosa

2006 ◽  
Vol 81 (6) ◽  
pp. 509-522 ◽  
Author(s):  
Luciana Patrícia Fernandes Abbade ◽  
Sidnei Lastória
Keyword(s):  
Duplex Scan ◽  
Para Determinar

Úlceras venosas são comuns na população adulta, causando significante impacto social e econômico devido a sua natureza recorrente e ao longo tempo decorrido entre sua abertura e cicatrização. Quando não manejadas adequadamente, as úlceras venosas têm altas taxas de falha de cicatrização e recorrência. Apesar da elevada prevalência e da importância da úlcera venosa, ela é freqüentemente negligenciada e abordada de maneira inadequada. Esta revisão discute abordagem diagnóstica e terapêutica das úlceras venosas. O diagnóstico clínico baseia-se em história e exame físico, com ênfase nos sinais e sintomas associados e palpação dos pulsos dos membros inferiores. A ultra-sonografia Doppler deve ser utilizada para determinar o índice pressórico entre o tornozelo e o braço, e exames não invasivos, como o duplex scan, devem ser realizados para avaliar o sistema venoso superficial, profundo e perfurante. Para abordagem terapêutica são fundamentais os diagnósticos clínico e laboratorial corretos, além do diagnóstico e tratamento adequados das complicações das úlceras crônicas. Os esforços devem ser direcionados para a cicatrização da úlcera e, posteriormente, para evitar as recidivas. O grande avanço no conhecimento da fisiopatogenia das úlceras venosas tem permitido o desenvolvimento de novas modalidades de tratamento clínico e cirúrgico.

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