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Reconstructive procedures in the management of occlusive arterial disease. 动脉闭塞性疾病的重建手术治疗。
Pub Date : 1977-09-01 DOI: 10.1177/153857447701100506
D R Jackson
newer graft conduits and techniques are constantly being advanced by researchers. This paper discusses standard approaches to occlusive peripheral arterial disease distal to the aorto-coronary bypass area. I will not discuss the etiology of the disease processes involved nor the subjects of embolectomies, acute traumatic lesions, or aneurysms (except for the thoracoabdominal aneurysm which is often involved with occlusions in the visceral vessels as
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引用次数: 0
Diagnostic considerations in occlusive arterial disease. 闭塞性动脉疾病的诊断考虑。
Pub Date : 1977-09-01 DOI: 10.1177/153857447701100501
D E Strandness

The diagnostic approaches to the problem of occlusive arterial disease have been reviewed. The history and physical examination are most useful in establishing the diagnosis, localizing the most proximal level of the arterial involvement, and categorizing the patient's stage of disease. Functional evaluation of limb blood pressures and flow velocity at rest and after exercise provide useful data for estimating the degree of the arterial involvement, and this information can be used as the baseline for evaluating the effects of therapy.

本文综述了动脉闭塞性疾病的诊断方法。病史和体格检查在确定诊断、定位动脉累及的最近水平和分类患者的疾病阶段方面是最有用的。静止和运动后肢体血压和血流速度的功能评估为估计动脉受累程度提供了有用的数据,这些信息可作为评估治疗效果的基线。
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引用次数: 3
Radiolabelled fibrinogen and impedance plethysmography in the diagnosis of deep venous thrombosis. 放射标记纤维蛋白原和阻抗容积描记术在深静脉血栓诊断中的应用。
Pub Date : 1977-07-01 DOI: 10.1177/153857447701100404
J R Lemoine, K M Moser
From the Pulmonary Division, Department of Medicine, University of California, San Diego, School of Medicine. Pulmonary embolism continues to be an important cause of death particularly for the in-hospital patient.’ Most thrombi responsible for such events originate in the lower limbs. The clinical diagnosis of such deep-venous thrombosis (DVT) remains notoriously unreliable. Early recognition would permit prompt, appropriate therapy with heparin and hopefully prevent embolization of large clots to the lungs. Recently, two diagnostic aids have become available which offer promise in the early detection of DVT-the radiolabelled p25 fibrinogen test (RLF) 2-4 and impedance plethysmography (IPG).&dquo;7 The theory, methodology and results of these procedures are reviewed briefly in this paper.
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引用次数: 0
The advantages and limitations of radionuclide techniques in the patient with vascular disease an overview. 放射性核素技术在血管疾病患者中的优点和局限性综述。
Pub Date : 1977-07-01 DOI: 10.1177/153857447701100408
F S Mishkin
Radionuclides have been used to objectively assess the circulation for a half century (1). Techniques employing radioactivity were developed to provide true tracers which do not affect the process being measured. Radionuclides provide a unique sensitivity with the ability to detect and quantitate several thousand molecules. Ultimately, this inherently quantitative ability may prove most useful. Relative distribution of activity and hence relative blood flow can be readily determined using particles which are completely trapped by the capillary bed during a single circulatory transit (2). Actual quantitative measurements of flow per unit weight can also be determined either by measuring clearance of intraarterial injection of a diffusible indicator such as
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引用次数: 0
Radionuclide assessment of peripheral arterial disease. 外周动脉疾病的放射性核素评估。
Pub Date : 1977-07-01 DOI: 10.1177/153857447701100407
M E Siegel
The use of radioactive tracers in the diagnostic and prognostic evaluation of the patient with peripheral arterial disease has produced clinically useful information. Their application has provided a means by which: (1) The regional distribution of perfusion at the level of the microcirculation, under various stresses, has provided objective evidence of diffuse small vessel disease; (2) The determination of graft patency can be simply and repeatedly performed; (3) The relative perfusion of &dquo;ischemic&dquo; ulcers can be determined and utilized to prognosticate their healing potential; (4) The presence of arteriovenous shunts can be verified and quantified; and (5) The skin perfusion pressure can be determined and utilized to assess the healing potential of surgical amputations.
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引用次数: 2
Standard management of venous thrombosis. 静脉血栓形成的标准处理。
Pub Date : 1977-07-01 DOI: 10.1177/153857447701100401
M Hume
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引用次数: 0
Noninvasive vascular testing in clinical practice. 无创血管检测在临床实践中的应用。
Pub Date : 1977-07-01 DOI: 10.1177/153857447701100402
R M Carroll, H B Rose, J Vydon
Presented at the American College of Angiology, January 7, 1976, Palm Springs, Calif. Department of Radiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, California 90048. Noninvasive vascular testing has proven to be an important addition to the evaluation of the patient with suspected or documented vascular disease. The ability to determine the hemodynamic significance of stenotic or obstructive lesions in the arterial system has been aptly demonstrated through the efforts of Strandess and others. 1-3 The noninvasive nature of the testing and the reproducibility of the results allows for periodic evaluation to determine the progression of arterial disease. Angiography has been and continues to be the definitive test prior to the performance of arterial surgery. However, the morbidity and cost associated with angiography does not allow it to be a method of screening or repetitive evaluation of patients with vascular disease. In addition, angiography does not provide significant information regarding the dynamics of blood flow in obstructive disease.
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引用次数: 0
Invasive and noninvasive techniques in the detection and evaluation of acute venous thrombosis. 有创与无创技术在急性静脉血栓检测与评估中的应用。
Pub Date : 1977-07-01 DOI: 10.1177/153857447701100403
D E Strandness

There are a variety of noninvasive testing procedures which can be used to establish the diagnosis of acute venous thrombosis with a high degree of certainty. For prospective screening of patients at risk, only 125I-labelled fibrinogen is of value, but does have a false positive rate of 21%. Its greatest problem is that it must be given prior to the event and, furthermore, it is not accurate in the upper thigh or the region of the iliac veins. Doppler ultrasound, plethysmography and phleborheography are accurate methods of detecting thrombi which involve the major veins of the limb from the level of the tibial veins below the knee to the level of the iliac veins in the abdomen. If properly performed, the sensitivity and specificity should exceed 90% in experienced laboratories. Contrast phlebography remains the best method of demonstrating venous thrombosis but does have limitations with regard to costs, pain to the patient and the production of thrombosis in a small percentage of patients. Furthermore, if the injections are done at the foot level, at least 18% will have inadequate visualization of the iliac veins, a critically important venous segment. It use must be restricted to those situations in which the noninvasive tests are equivocal or the information is absolutely essential for a therapeutic decision.

有各种各样的无创检测程序,可用于建立诊断急性静脉血栓的高度确定性。对于有风险患者的前瞻性筛查,只有125i标记的纤维蛋白原是有价值的,但假阳性率为21%。它最大的问题是必须在事件发生之前给出,而且,它在大腿上部或髂静脉区域是不准确的。多普勒超声、体积脉搏和静脉造影是检测肢体主要静脉血栓的准确方法,从膝盖以下的胫静脉水平到腹部的髂静脉水平。如果操作得当,在经验丰富的实验室中,灵敏度和特异性应超过90%。对比静脉造影术仍然是显示静脉血栓形成的最佳方法,但在费用、患者疼痛和一小部分患者血栓形成方面存在局限性。此外,如果在足部水平进行注射,至少18%的人无法充分显示髂静脉,这是一个至关重要的静脉段。它的使用必须限制在那些情况下,无创测试是模棱两可的或信息是绝对必要的治疗决定。
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引用次数: 3
The choice of test for diagnosis of venous thrombosis. 静脉血栓诊断方法的选择。
Pub Date : 1977-07-01 DOI: 10.1177/153857447701100405
E W Pollak

Doppler ultrasound is the preferred screening test in asymptomatic patients with high risk for venous thrombosis. Radiographic phlebography leads to definitive diagnosis in most instances. Radionuclide angiography using 99mTc MAA with delayed images to detect particle entrapment in venous blood clots can be used when radiographic phlebography is contraindicated or impractical. To detect active thrombosis in patients with past venous disease, the serial fibrinogen uptake test is the method of choice. This method is also used to monitor the efficacy of anticoagulation therapy and to detect propagating thrombosis in patients failing to respond to anticoagulation, hopefully before massive lethal pulmonary embolism occurs. Radionuclide methods are contraindicated in pregnant women and children where non invasive methods are preferred. No completely satisfactory test exists for detection of hypogastric vein thrombosis. Among the methods currently being evaluated in the laboratory the ultrasound B-scan imaging, 99mTc MAA uptake test and 99mTc mAA venous scan offer the best possibilities for successful clinical application.

多普勒超声是静脉血栓形成高危无症状患者的首选筛查方法。在大多数情况下,x线静脉造影可明确诊断。放射性核素血管造影使用99mTc MAA延迟图像来检测静脉血凝块中的颗粒夹持,当x线摄影血管造影禁忌或不切实际时可以使用。在既往静脉疾病患者中检测活动性血栓形成,纤维蛋白原摄取试验是首选方法。该方法也可用于监测抗凝治疗的疗效,并在抗凝治疗无效的患者中检测血栓的扩散,希望在发生大规模致死性肺栓塞之前。放射性核素法在孕妇和儿童中是禁忌的,而非侵入性方法是首选的。目前还没有完全令人满意的检测胃下静脉血栓的方法。目前实验室正在评估的方法中,超声b扫描成像、99mTc MAA摄取试验和99mTc MAA静脉扫描为临床成功应用提供了最好的可能性。
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引用次数: 2
Radionuclide venography and the role of radionuclides in the detection of venous disease. 放射性核素静脉造影和放射性核素在静脉疾病检测中的作用。
Pub Date : 1977-07-01 DOI: 10.1177/153857447701100406
R C Verma, M M Webber, L Ramanna, J I Eisenman, L R Bennett
Until recently, the true incidence of venous thrombosis in the general population was difficult to determine. However, with the availability of noninvasive screening techniques, such data are now being gathered. The incidence of calf vein thrombosis, as measured by the fibrinogen uptake test in inpatient (medical and surgical) population, ranges from 30% to 60%.’ In carefully examined autopsy specimens, the incidence of deep vein thrombosis in the leg varied from 26% to 86%.’-’ 2
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引用次数: 2
期刊
Vascular surgery
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