Hemodynamic parameters in the central retinal artery in active retinopathy of prematurity and their relationship with the central retinal vein

Purpose. To analyze the main hemodynamic parameters in the central retinal artery, as well as their relationship with hemodynamic indicators in the central retinal vein, depending on the stage and type of active ROP with the use of color duplex scanning. Material and methods. The 63 premature babies with various stages of active ROP and no signs of ROP were included in the study. The 55 children with active ROP included in the study were distributed according to the stages and type of disease course. All children were at the same gestational age at the time of examination – 37–38 weeks of postmenstrual age or at 6–11 weeks of life. For all these children were performed color duplex scanning of the vessels of the eye and orbit in the modes of color Doppler mapping and pulsed Doppler. Results. The study of the hemodynamic features of the central retinal artery in premature infants with active ROP showed that the progression of the disease was accompanied by a significant increase in blood flow velocity (Vsyst and Vdiast) with each subsequent stage of ROP. A higher index of peripheral vascular resistance is recorded in comparison with the non-progressive favorable type for children with an unfavorable course of the disease.The analysis of the ratio of the maximum blood flow velocities in the central retinal artery and central retinal vein made it possible to determine in which of the vessels the hemodynamic changes are most pronounced, depending on the stage and form of active ROP. Conclusion. Thus, there are statistically significant changes in such large vessels of the retinal bed as the central retinal artery and central retinal vein during active ROP. Color duplex scanning, having a significant diagnostic potential in assessing hemodynamic parameters, made it possible to obtain reliable information about the linear blood flow velocity and the state of peripheral resistance in the central retinal artery and their relationship with the central retinal vein. This information opens up prospects for improving the accuracy of predicting the nature of the course of the disease, especially i n the early stages. Keywords: color duplex scanning, active retinopathy of prematurity, hemodynamic parameters, central retinal artery, central retinal vein

Ultrasound in the Diagnosis of Perinatal Ischemic Strokes (Literature Review with Their Own Clinical Observations)

The issues of early diagnosis of perinatal arterial stroke (PAII) continue to be discussed in the domestic and foreign literature. Along with MRI, the ultrasound method allows to identify foci of ischemia of different localization and sizes in newborns. During ultrasound, we identified 29 cases of PAIA of different localization in children of different gestational and postnatal age. Analysis of our own and published data showed that up to 32 weeks of gestational development, AII develops in the lenticular-striar basin, and later in the cortical-subcortical region. Diagnostic capabilities of ultrasound in PAII can be significantly expanded by using ultrasound duplex scanning of brain vessels. Our observations showed that the nature of changes in Doppler parameters depends on the localization of the affected vascular basin and on the duration of cerebrovascular disorders

The potential of duplex scanning in the diagnosis of pathological tortuosity of the vertebral artery

Aim. To assess the capabilities of duplex scanning and study the features of hemodynamics in the vertebral arteries before and after surgical treatment.Material and methods. The results of anatomical and circulatory characteristics of an extracranial segment of the vertebral arteries in 52 patients with various forms of pathological tortuosity were analyzed. Kinking was present in 38 patients, coiling in 8 patients, and Powers anomaly in 6 patients. There were 18 men and 34 women. The mean age of the patients was 45.6±8.7 years.Results and discussion. In all types of PT of VA with ostium stenosis, the diameter of the artery was decreased, and based on tortuosity it contributed both to the reduction and deterioration of arterial blood flow to the vertebrobasilar basin. The decrease or increase in the linear velocity of blood flow, as well as other blood flow parameters, depended on both the type of pathological tortuosity of the PA and on the vessel diameter and the value of angulation. Hypoplasia of the opposite vertebral artery also occurred in 28 patients, which resulted in impaired blood supply to the brain.Vascular examination after reconstructive surgeries resulted in normalization of the parameters of arterial circulation and cerebral perfusion. Primary vascular patency was 96.2%, restenosis was not revealed in any observation.Conclusion. Duplex scanning is a highly informative technique for both diagnosing pathological deformities of the vertebral arteries and assessing the restoration of the hemodynamics of the vertebrobasilar system after reconstructive surgery. This method provides the most accurate information on the anatomical form and localization of pathological deformities of the vertebral artery. It also allows quantitative assessment of cerebral blood flow.

Anatomic-hemodynamical types of recurrence of the lower extremities varicose disease

Objective. To improve the results of treatment in patients with postoperative recurrence of varicose disease of the lower extremities with the help of studying of peculiarities of disorders in regional venous hemodynamics and determination of anatomic-hemodynamic types of the disease. Materials and methods. There were examined 85 patients with postoperative recurrence of varicose disease of the lower extremities. Ultrasonic duplex scanning of veins was performed on apparatus «EnVisor», manufactured by «Philips» (Holland) using a multifrequency linear sensor with the 12 - 5 MHz frequency for subcutaneous veins and a convex sensor with the 5 - 2 MHz frequency - for deep veins. Results. There were delineated 8 anatomic-hemodynamical types of recurrences of varicose disease of the lower extremities. The investigation conducted have permitted to systematize the causes and signs of the disease. Objective criteria for prognostication of the varicose disease of the lower extremities recurrence may be applied for optimization of volume of primary surgical intervention and prophylaxis of its complications. Conclusion. The main causes of the recurrence development in varicose disease of the lower extremities are tactical and technical mistakes of surgeons during performance of primary surgical interventions in patients, suffering varicose disease of the lower extremities. Studying of peculiarities in development of recurrence of varicose disease of the lower extremities permits to elaborate the practical anatomic-hemodynamical classification, which systematizes the main causes of the varicose disease recurrence and constitutes the base for the reoperations tactics elaboration.

Subclavian Vessel Compression Assessed by Duplex Scanning in Patients with Neurogenic Thoracic Outlet Syndrome and No Vascular Signs

Neurogenic thoracic outlet syndrome (NTOS) is the most frequent form of TOS. It may affect both sides, but specific complementary exams are lacking. We aimed to evaluate duplex scanning results in a group of patients with unilateral or bilateral NTOS and no clinical vascular signs, referred for rehabilitation. We performed a retrospective observational study in patients with unilateral or bilateral NTOS and no vascular symptoms. Subclavian vessels were assessed by duplex scanning. Compressions were considered in case of >50% of increased or decreased blood flow. A total of 101 patients met NTOS criteria; mean age was 40 +/− 10.2; 79.2% women. Seventy patients had a unilateral NTOS and 31 a bilateral form. Duplex scanning showed that 56.4% of the patients had vessels compression, 55.7% in the unilateral group and 58.1% in the bilateral (p = 0.81). In unilateral NTOS, 21 (30%) patients had bilateral vascular compression, 17 (24.3%) had ipsilateral compression and 1 (1.4%) had contralateral compression. In bilateral NTOS, 15 (48.4%) had bilateral compression and 3 (9.7%) compression on only one side. We found a significant difference of the rate of vascular compressions between symptomatic and non-symptomatic upper-limbs, 54.5% vs. 32.9%, respectively, (p = 0.002) and a significant association between symptomatic upper-limbs and vascular compression (OR = 2.45 [95%IC: 1.33–4.49]; p = 0.002). The sensitivity and the specificity of the duplex scanning were 54.5% and 67%, respectively. The ROC curve area was of 0.608 [95%IC: 0.527–0.690]. Despite a highly significant association between symptomatic upper-limbs and vascular compression, duplex scanning did not help make the diagnosis of NTOS.