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Catheter Misplacement Following Subclavian Vein Catheterization Under Ultrasound Guidance: An Infrequent and Unusual Malposition for CME Credit December 2023 超声引导下锁骨下静脉导管插入术后导管错位:不常见且不寻常的错位,可获继续医学教育学分 2023 年 12 月
Q4 Medicine Pub Date : 2023-12-01 DOI: 10.1177/15443167231210442
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引用次数: 0
Screening for Subclavian Artery Stenosis for CME Credit December 2023 筛查锁骨下动脉狭窄可获继续医学教育学分 2023 年 12 月
Q4 Medicine Pub Date : 2023-12-01 DOI: 10.1177/15443167231210435
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引用次数: 0
The Influence of Aging – Related Decrease in Endothelial Function on the Stiffness of Peripheral Conducting Arteries for CME Credit December 2023 衰老相关的内皮功能下降对外周传导动脉僵硬度的影响,可获继续医学教育学分 2023 年 12 月
Q4 Medicine Pub Date : 2023-12-01 DOI: 10.1177/15443167231210434
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引用次数: 0
Society for Vascular Ultrasound Leadership Update – December 2023 血管超声协会领导更新- 2023年12月
Q4 Medicine Pub Date : 2023-11-14 DOI: 10.1177/15443167231210444
Anita Harrington
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引用次数: 0
Society for Vascular Ultrasound Guidelines for Cross-Training in Vascular Ultrasound and Technology 血管超声学会血管超声与技术交叉训练指南
Q4 Medicine Pub Date : 2023-11-10 DOI: 10.1177/15443167231210624
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引用次数: 0
Cerebral Vasomotor Reactivity Testing in the Middle Cerebral Artery Using Transcranial Doppler to Assess Brain Dysregulation in Long-haul COVID Patients 经颅多普勒检测大脑中动脉血管舒动反应性评估长途COVID - 19患者脑功能失调
Q4 Medicine Pub Date : 2023-11-07 DOI: 10.1177/15443167231202560
Musharaf Mohiuddin, Thomas H. Alexander, Amanda Holcomb, Kaitlyn Alexander, George Plotkin, Alan Cook
Introduction: COVID-19 has wide-ranging physiological effects, with many patients complaining of persistent asthenia following recovery from the acute phase of the infection. The frequent term for this is “Long-Haul COVID.” While we have tools to measure effects on general physiology in human subjects, a metric for cerebral dysregulation is lacking. Cerebral blood flow is closely regulated in a healthy young person. Cerebral vasomotor reactivity (CVR) was used as a tool to assess this dysregulation. Methods: A transcranial Doppler (TCD) study for CVR was performed under the influence of Carbogen gas. A questionnaire collected prior to the procedure provided additional details on subjects’ demographics and COVID history. Cases and controls were recruited using the self-reported questionnaire. Statistics involved assessing the reproducibility of the test, as well as discovering differences between cases and control groups. Results: Cerebral vasomotor reactivity was assessed in 26 subjects (10 cases and 16 controls). Mean flow velocity in the left middle cerebral artery was analyzed at baseline, at peak Carbogen gas exposure, and in the hypercapnic phase. The reproducibility of the test was established within the longitudinal repeated measures data. The case and control groups were insignificant in difference at the base level but significant when controlled for confounders. Cerebral vasomotor reactivity was found to increase by 3.8 units in cases compared to controls. Confounders like body mass index, gender, and age were found significantly different between cases and controls. The number of COVID episodes and symptom severity was significant for CVR. Conclusion: This simple TCD bedside test was found to be effective in assessing CVR among all the subjects and was homogenous in its effect irrespective of baseline subject differences. As a preliminary test, the test showed differences among cases and control groups. The sample for the test lacked sufficient power and observations. A bigger sample size and a subsequent longitudinal follow-up may help better understand the use of CVR to screen high-risk populations for cerebrovascular anomalies.
导语:COVID-19具有广泛的生理影响,许多患者在感染急性期恢复后出现持续虚弱。这种情况的常见术语是“长途COVID”。虽然我们有工具来衡量对人类一般生理的影响,但缺乏大脑失调的衡量标准。一个健康的年轻人的脑血流量受到严密的调节。脑血管舒缩反应性(CVR)被用作评估这种失调的工具。方法:采用经颅多普勒(TCD)技术对CVR患者在二氧化碳作用下进行检测。手术前收集的问卷提供了有关受试者人口统计学和COVID病史的更多详细信息。病例和对照组采用自我报告问卷进行招募。统计包括评估测试的可重复性,以及发现病例和对照组之间的差异。结果:26例患者(10例,16例对照组)进行了脑血管舒缩反应性评估。在基线、峰值碳气体暴露和高碳酸期分析左大脑中动脉的平均流速。在纵向重复测量数据中建立了试验的再现性。病例组和对照组在基础水平上差异不显著,但在混杂因素控制下差异显著。与对照组相比,这些病例的脑血管舒缩反应性增加了3.8个单位。混杂因素如体重指数、性别和年龄在病例和对照组之间存在显著差异。COVID发作次数和症状严重程度对CVR有显著性意义。结论:这项简单的TCD床边试验可有效评估所有受试者的CVR,且无论受试者基线差异如何,其效果都是均匀的。作为初步测试,该测试显示了病例和对照组之间的差异。用于测试的样本缺乏足够的功率和观察值。更大的样本量和随后的纵向随访可能有助于更好地了解CVR在筛查脑血管异常高危人群中的应用。
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引用次数: 0
Arteriovenous Fistula Stenosis: Correlating Degree of Neointimal Hyperplasia With Reduction in Volume Flow Measured on Ultrasound and Ultrasound Characterization Based on Stenosis Morphology 动静脉瘘狭窄:超声测量的新生内膜增生程度与容积流量减少的相关性以及基于狭窄形态学的超声表征
Q4 Medicine Pub Date : 2023-10-31 DOI: 10.1177/15443167231201404
Thomas Clifford, Sivaramakrishnan Ramanarayanan, Rhami Nanou, Kate Steiner
Introduction: Duplex ultrasound (DUS) is commonly used to diagnose and grade arteriovenous fistula (AVF) stenosis. Duplex ultrasound may also be used to examine stenosis type based on measurement of intimal-medial thickness (IMT). There are, as yet, no criteria in use to define the different stenosis types based on measurement of percentage IMT (%IMT). In this study, we have examined stenosis morphology using ultrasound. We have examined consecutive DUS examinations to assess the incidence and degree of IMT and correlated %IMT with volume flow as an indicator of AVF dysfunction. Methods: Duplex ultrasound was performed as per standard of care. Volume flow was measured within the ipsilateral brachial artery. Measurements of luminal diameter and vessel wall diameter were used to calculate %IMT. Results: The study group included 156 consecutive DUS examinations demonstrating a greater than 50% AVF stenosis. Mean %IMT was 45%. There were 17 (11%) lesions where there was no measurable IMT; the remainder had measurable IMT. On receiver-operating characteristic (ROC) analysis, a %IMT of 54% predicted low flow with 62.5% sensitivity and 62.7% specificity. Conclusion: Intimal-medial thickness has a moderate predictive value in predicting volume flow. Based on our results, there are 4 lesion types: (1) lesions with no measurable intimal hyperplasia, (2) a predominantly intimal hyperplastic lesion, (3) those with nonpredominant intimal hyperplasia, and (4) those with a valve type stenosis. A value based on correlation with volume flow could be considered based on our results at 54%IMT or based on morphology at 45%IMT to distinguish between predominant and nonpredominant intimal hyperplasia groups. Including measurements of %IMT in clinical trials could further our knowledge of how lesions with no measurable IMT and those with different degrees of intimal hyperplasia respond to different percutaneous interventions. This could potentially improve outcomes for patients and target more costly treatment options where there is most benefit.
双工超声(DUS)常用于动静脉瘘(AVF)狭窄的诊断和分级。双工超声也可用于检查狭窄类型基于测量内膜-内侧厚度(IMT)。到目前为止,还没有基于测量IMT百分比(%IMT)来定义不同狭窄类型的标准。在本研究中,我们使用超声检查狭窄形态。我们检查了连续的DUS检查,以评估IMT的发生率和程度,并将IMT百分比与容积流量的相关性作为AVF功能障碍的指标。方法:双超声检查按护理标准进行。测量同侧肱动脉内的容积流量。测量管腔直径和血管壁直径来计算%IMT。结果:研究组包括156例连续DUS检查,显示AVF狭窄大于50%。平均%IMT为45%。17例(11%)病变没有可测量的IMT;其余患者的IMT可测量。在受试者工作特征(ROC)分析中,54%的%IMT预测低血流,敏感性为62.5%,特异性为62.7%。结论:内内侧厚度对预测容积流量有中等预测价值。根据我们的研究结果,有4种病变类型:(1)没有可测量的内膜增生病变,(2)主要的内膜增生病变,(3)非主要的内膜增生病变,(4)瓣膜型狭窄病变。根据我们在54%IMT时的结果或45%IMT时的形态学来区分显性和非显性内膜增生组,可以考虑基于容积流量相关性的值。在临床试验中纳入%IMT的测量可以进一步了解没有可测量IMT的病变和不同程度内膜增生的病变对不同经皮干预的反应。这可能会潜在地改善患者的预后,并针对更昂贵的治疗方案,在那里有最大的好处。
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引用次数: 0
Screening for Subclavian Artery Stenosis 锁骨下动脉狭窄的筛查
Q4 Medicine Pub Date : 2023-10-17 DOI: 10.1177/15443167231201897
Jill Sommerset, Chungeun Lee, Alexis Sigmund, Priyanka Rao, Beejay Feliciano, Yolanda Vea, Desarom Teso, Riyad Karmy-Jones
Introduction: Subclavian artery stenosis of >50% has been linked to an increased risk of cardiovascular morbidity, complications after carotid interventions, and difficulty in managing hypertension. This has led to increased emphasis on screening for these lesions. In addition, these lesions may be associated with upper extremity symptoms including claudication and pain at rest. Methods: A retrospective review of patients who were referred over a 2-year period for arm pain in the setting of suspected or proven subclavian artery stenosis or occlusion was performed. This was compared to an unmatched cohort of patients who underwent carotid artery duplex with subclavian artery duplex for other reasons. Data included measuring the interbrachial systolic pressure difference (>15 and >20 mm Hg), arm-arm index, and hand acceleration time (HAT). Results: Among the172 patients studied, 48 had subclavian artery stenosis or occlusion and 26 of these had corresponding symptoms. Female gender ( P = .012), history of coronary intervention ( P = .007), hypertension ( P = .039), and arm-arm index of <0.9 ( P = .0001) were significantly associated with subclavian artery stenosis or occlusion. A HAT of >100 milliseconds was significantly associated with symptomatic subclavian artery stenosis or occlusion. Conclusions: An arm-arm index of <0.9 is a useful tool for screening for subclavian artery stenosis. In patients with subclavian artery stenosis, HAT may be useful in confirming that the arm symptoms are due to this particular lesion.
锁骨下动脉狭窄50%与心血管疾病风险增加、颈动脉介入术后并发症和高血压管理困难有关。这使得人们更加重视对这些病变的筛查。此外,这些病变可能与上肢症状有关,包括跛行和休息时疼痛。方法:对2年内因怀疑或证实锁骨下动脉狭窄或闭塞而出现手臂疼痛的患者进行回顾性分析。这与一组不匹配的患者进行了比较,这些患者因其他原因接受了颈动脉和锁骨下动脉双重手术。数据包括测量肱间收缩压差(>15和> 20mmhg)、臂-臂指数和手加速时间(HAT)。结果:172例患者中,48例有锁骨下动脉狭窄或闭塞,其中26例有相应症状。女性(P = 0.012)、冠状动脉介入治疗史(P = 0.007)、高血压(P = 0.039)、臂-臂指数<0.9 (P = 0.0001)与锁骨下动脉狭窄或闭塞显著相关。100毫秒的HAT与症状性锁骨下动脉狭窄或闭塞显著相关。结论:臂臂指数<0.9是筛查锁骨下动脉狭窄的有效工具。对于锁骨下动脉狭窄的患者,HAT可能有助于确认上肢症状是由这种特殊病变引起的。
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引用次数: 0
Utilization of Deep Vein Arterialization for Limb Salvage 深静脉动脉化在残肢抢救中的应用
Q4 Medicine Pub Date : 2023-10-06 DOI: 10.1177/15443167231202502
Suzanna Fitzpatrick, Eleanor Dunlap, Khanjan Nagarsheth
The utilization of deep vein arterialization (DVA) is a feasible and successful operative strategy for patients with severe chronic limb-threatening ischemia (CLTI) with no open or endovascular surgical options other than major limb amputation. The DVA technique creates a connection, either percutaneously or surgically, between a source of arterial inflow and venous outflow, allowing distal blood flow to heal chronic wounds that otherwise would have required amputation. In this case report, we describe a single patient with CLTI and nonreconstructable arterial disease and a chronic nonhealing wound who underwent a percutaneous DVA procedure with improvement in their ischemic rest pain and complete healing of their wound.
深静脉动脉化(DVA)是严重慢性肢体缺血(CLTI)患者的一种可行且成功的手术策略,除了主要肢体截肢外,没有其他开放或血管内手术选择。DVA技术通过经皮或手术在动脉流入源和静脉流出源之间建立连接,使远端血流治愈慢性伤口,否则就需要截肢。在本病例报告中,我们描述了一位患有CLTI和不可重建动脉疾病和慢性不愈合伤口的患者,他接受了经皮DVA手术,其缺血性休息疼痛得到改善,伤口完全愈合。
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引用次数: 0
Contribution of Doppler Ultrasound of the Supra-Aortic Trunks in the Etiological Evaluation of Ischemic Strokes at the Douala General Hospital 杜阿拉总医院主动脉上干多普勒超声在缺血性卒中病因评价中的作用
Q4 Medicine Pub Date : 2023-09-30 DOI: 10.1177/15443167231201397
Félicité Kamdem, Farol Maka Kamdem, Caroline Kenmegne, Jaff Fenkeu Kweban, Glwadys Ngono Atéba, Daniel Massi Gams, Salomon Mbahe, Sidick Aboubakar Mouliom, Henri Ngoté, Lade Viché, Marie Solange Ndom Ebongue, Siddikatou Djibrilla, Elysée Claude Bika Léle, Anastase Dzudié, Yacouba Mapoure Njankouo
Introduction: The advent of Doppler ultrasound has revolutionized the diagnosis of even subclinical atherosclerosis of the neck vessels. The aim of this study was to evaluate the contribution of Doppler ultrasound of the supra-aortic trunks in the etiological evaluation of ischemic stroke. Methods: Our cross-sectional and analytical study with retrospective and prospective data collection more than 8 years from January 1, 2010, to December 31, 2017, involved patients aged at least 21 years who were hospitalized for ischemic stroke. Doppler ultrasound of the supra-aortic trunks allowed us to group carotid atherosclerotic plaques into 5 grades according to the Gray-Weal classification modified by Geroulakos. Similarly, we assessed the degree of carotid stenosis in these patients. Factors associated with atherosclerotic plaques and stenosis were determined using multivariate logistic regression. Associations with a P < 0.1 in univariate regression were included in the multivariate model. Differences were considered significant for P < .05. Results: We recruited 271 patients with a mean age of 60 ± 12 years. Hypertension, increased low-density lipoprotein, diabetes, smoking, and obesity were present in 76.8%, 74.7%, 36.5%, 9.6%, and 80.1%, respectively. Atherosclerotic carotid plaques were found in 76.0% of the patients. For the left carotid artery, Grade I, II, and III plaques were present in 32.4%, 30.5%, and 21.4% of these patients, respectively, and the results were similar in the right carotid artery. Age ≥60 years, female gender, and increased low-density lipoprotein were significantly associated with carotid atherosclerosis (odds ratio = 12.6, P = .003; odds ratio = 3.23, P = .001; and odds ratio = 4, P = .002, respectively). Carotid stenosis ≥50% was found in 5.9% of patients with plaque, and age >70 years was significantly associated with these stenoses (odds ratio = 4.74, P = .045). Conclusion: Our study showed a high prevalence of atherosclerotic carotid plaques (76.0%) and stenosis (5.9%) among patients with ischemic strokes who had Doppler ultrasound of the neck vessels. Age is a powerful risk factor associated with carotid atherosclerosis and stenosis. Female gender and dyslipidemia are also significantly associated with carotid atherosclerotic plaques.
多普勒超声的出现彻底改变了颈部血管亚临床动脉粥样硬化的诊断。本研究的目的是评价多普勒超声在缺血性脑卒中病因评估中的作用。方法:我们的横断面和分析研究收集了2010年1月1日至2017年12月31日超过8年的回顾性和前瞻性数据,涉及年龄至少21岁的缺血性脑卒中住院患者。多普勒超声检查主动脉上干,根据Geroulakos修改的Gray-Weal分级,我们将颈动脉粥样硬化斑块分为5级。同样,我们评估了这些患者的颈动脉狭窄程度。动脉粥样硬化斑块和狭窄的相关因素采用多元逻辑回归确定。与P <将单因素回归的0.1纳入多因素模型。P <的差异被认为是显著的;. 05。结果:我们招募了271例患者,平均年龄为60±12岁。高血压、低密度脂蛋白升高、糖尿病、吸烟和肥胖分别占76.8%、74.7%、36.5%、9.6%和80.1%。76.0%的患者出现颈动脉粥样硬化斑块。对于左颈动脉,分别有32.4%、30.5%和21.4%的患者出现I级、II级和III级斑块,右颈动脉的结果相似。年龄≥60岁、女性、低密度脂蛋白升高与颈动脉粥样硬化显著相关(优势比= 12.6,P = 0.003;优势比= 3.23,P = 0.001;优势比= 4,P = 0.002)。5.9%斑块患者颈动脉狭窄≥50%,年龄70岁与这些狭窄显著相关(优势比= 4.74,P = 0.045)。结论:我们的研究显示,在接受多普勒超声检查的缺血性卒中患者中,颈动脉粥样硬化斑块(76.0%)和狭窄(5.9%)的发生率很高。年龄是颈动脉粥样硬化和狭窄的重要危险因素。女性和血脂异常也与颈动脉粥样硬化斑块显著相关。
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引用次数: 0
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Journal for Vascular Ultrasound
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