34 research outputs found
Evaluation of early and late results and predetermining factors after carotid artery angioplasty and stenting.
No full textThe aim - to assess the carotid artery angioplasty and stenting early and late results and influencing factors. Methods. The study assessed CAS procedures performed in 2006-2013. A total of 227 procedures performed in 211 patients, of which 156 (75.3%) males and 55 (24.7%) females. Results. The study revealed that CAS procedure duration among patient with 3 aortic arch type was significantly longer and the microemboli protection systems were used more frequently. Protection systems were used more frequently when the CAS procedure lasted longer. Protection systems in CAS procedure was used in 70.9% patients. In men and younger patients protection system has been used more frequently. Microemboli in the protection systems have been identified by 17.6% patients and were more determined using the EZ FilterWire and Emboshield-NAV protection system. Increased right ICA stenosis was more common in patients who smoke, and left ICA with a history of myocardial infarction and smoking. Protection system was often used in patients who have had severe left ICA stenosis. The lethality rate in the early post procedural period among men and women was 1.2% and 1.8%, and in 2-year period was 18.7% and 28.6%, respectively. The lethality rate during 2-year period, which have been used for protective systems have been lower. The possibility to experience complications (stroke or TIA) increased 3 aortic arch type and the right common carotid artery stenosis, reduced protection systems using. Focal, linear, Ipsi- and bilateral ischemic cerebral injury was diagnosed less frequently in patients who have undergone Emboshield-NAV type of protection. During 1 year after the CAS cognitive and motor functions worsening, but no significant improvement was obtained. Before CAS poorer cognitive function compared with the control group, was established in symptomatic patients. Both symptomatic and asymptomatic patients before the CAS significantly lower by motor tasks as compared with the control subjects
Miego arterijų angioplastikos ir stentavimo ankstyvųjų bei vėlyvųjų rezultatų ir jiems poveikį darančių veiksnių tyrimas.
No full textThe aim - to assess the carotid artery angioplasty and stenting early and late results and influencing factors. Methods. The study assessed CAS procedures performed in 2006-2013. A total of 227 procedures performed in 211 patients, of which 156 (75.3%) males and 55 (24.7%) females. Results. The study revealed that CAS procedure duration among patient with 3 aortic arch type was significantly longer and the microemboli protection systems were used more frequently. Protection systems were used more frequently when the CAS procedure lasted longer. Protection systems in CAS procedure was used in 70.9% patients. In men and younger patients protection system has been used more frequently. Microemboli in the protection systems have been identified by 17.6% patients and were more determined using the EZ FilterWire and Emboshield-NAV protection system. Increased right ICA stenosis was more common in patients who smoke, and left ICA with a history of myocardial infarction and smoking. Protection system was often used in patients who have had severe left ICA stenosis. The lethality rate in the early post procedural period among men and women was 1.2% and 1.8%, and in 2-year period was 18.7% and 28.6%, respectively. The lethality rate during 2-year period, which have been used for protective systems have been lower. The possibility to experience complications (stroke or TIA) increased 3 aortic arch type and the right common carotid artery stenosis, reduced protection systems using. Focal, linear, Ipsi- and bilateral ischemic cerebral injury was diagnosed less frequently in patients who have undergone Emboshield-NAV type of protection. During 1 year after the CAS cognitive and motor functions worsening, but no significant improvement was obtained. Before CAS poorer cognitive function compared with the control group, was established in symptomatic patients. Both symptomatic and asymptomatic patients before the CAS significantly lower by motor tasks as compared with the control subjects
Perkutaninio šlaunies arterijos kateterizavimo vietinių komplikacijų gydymo taktika
No full textDarbo tikslas
Nustatyti po intervencinių kardiologinių procedūrų per šlaunies arteriją susidariusių vietinių komplikacijų dažnį, pažeidimo vietos tipą ir optimalų gydymo metodą.
Tyrimo medžiaga ir metodai
Atlikta 166 pacientų, 2007–2011 metais patyrusių vietinių komplikacijų po kateterizavimo dėl įtariamos vainikinių arterijų patologijos, ligos istorijų duomenų retrospektyvi analizė. Vietinės kraujagyslių komplikacijos diagnozuotos ir gydytos kraujagyslių chirurgų.
Rezultatai
Tiriamąją grupę sudarė 96 (57,8 %) moterys ir 70 (42,2 %) vyrų. Vidutinis pacientų amžius buvo 69,1 metų (±11,4 metai). 63 pacientams (38 %) nustatyta sutrikusi kojų arterinė kraujotaka. Po kateterizavimo, atlikto dėl širdies kraujagyslių sistemos patologijos, šlaunies arterijos pseudoaneurizma išsivystė 162 (97,6%), arterioveninė fistulė – 3 (1,8 %), didelė hematoma – 1 pacientui. 111 (66,9 %) pacientų gydyta konservatyviai. Chirurginio gydymo prireikė 55 (33,1 %) pacientams. Operuotos 37 moterys (67,3 %) ir 18 vyrų (32,7 %). Vidutinis operuotų pacientų amžius buvo 69,9 (±10) metai. Pseudoaneurizmos pašalinimas ir arterijos plastika venos lopu atlikta 33 (60 %) pacientams, pašalinti krešuliai ir užsiūti arterijos defektai 22 (40 %) pacientams.
Išvados
Vietinių kraujagyslių komplikacijų po intervencinių kardiologinių procedūrų per šlaunies arteriją įvyko 166 pacientams (0,706 %). Dažniausia komplikacija po šlaunies arterijos kateterizavimo – pseudoaneurizma. Pseudoaneurizmos sėkmingai gydytos konservatyviai 111 pacientų (66,9 %). Punkcijos vietos kraujagyslių komplikacijos buvo dažnesnės ligoniams, kuriems buvo periferinių arterijų aterosklerozinis pažeidimas (p<0,01).
Reikšminiai žodžiai: jatrogeninis šlaunies arterijos pažeidimas, pseudoaneurizma
Treatment of local complications that develop after catheterisation through the femoral artery puncture
Ingrida Ašakienė, Andrius Černauskas, Nerijus Misonis, Vaidotas Zabulis, Robertas Breivis, Sigitas Tvarionavičius, Ramūnas Kvietkauskas
Objective
To determine what is the rate, type, and the best treatment of local femoral access complications after interventional cardiology catheterisation procedures through percutaneous femoral artery puncture.
Materials and methods
Retrospective analysis of 166 patient medical records was carried out. All the patients underwent coronarography for the suspected coronary artery disease. All of them from 2007 to 2011 developed local femoral access complications. All complications were diagnosed and treated by vascular surgeons.
Results
The study group consisted of 96 (57.8%) women and 70 (42.2%) men. The average age of the patients was 69.1 years (±11.4 years). Limb ischemia was determined in 63 patients (38%). After catheterisation due to cardiovascular pathology, femoral artery pseudoaneurysm developed in 162 patients (97.6%), arteriovenous fistula in 3 patients (1.8%), and massive hematoma in 1 patient; 111 patients (66.9%) were treated conservatively and 55 (33.1%) surgically. The surgically treated group consisted of 37 women (67.3%) and 18 men (32.7%). The average age of surgically treated patients was 69.9 (±10) years. Pseudoaneurysm removal and venous patch plasty were performed in 33 patients (60%). The removal of blood clots and direct suture of arterial defects were performed in 22 patients (40%).
Conclusions
166 patients (0.706%) developed local vascular complications after cardiovascular interventions through the femoral artery. Pseudoaneurysm was the most common complication after femoral artery catheterisation. Conservative treatment was successful in 111 patients (66.9%). Local vascular complications of the puncture site were more common in patients with a peripheral arterial disease (p < 0.01).
Key words: iatrogenic femoral artery damage, pseudoaneurys
New photoplethysmographic parameter reveals blunted endothelium-dependent response to sulbutamol in coronary and hypertensive patients
No full textBackground. Analysis of photoplethysmographic digital volume pulse (DVP) parameter inflection point (IP) before and after inhaled salbutamol is used for the noninvasive assessment of endothelial function. Our aim was to determine if there are other more informative DVP parameters. Methods. The DVP was recorded in 62 patients with coronary heart disease
(CHD) (n = 20), arterial hypertension (n = 22) and healthy volunteers (n = 20) before and after 400 g salbutamol inhalation. Measerument of IP decrease after salbutamol as well as the new derivative parameter – the ratio of salbutamol induced maximal IP decrease with maximal prolongation of peakto-peak time (PPT) between forward systolic and reflected waves (IP/ PPT)
– were applied for analysis of DVP curves.
Results. Better discrimination between the groups was found when applying the new parameter IP/ PPT compared with the traditional IP parameter. IP/ PPT was significantly higher in patients with arterial hypertension (1.79 2.74 vs. 0.23 0.19, p = 0.01) and with CHD (2.88 3.01 vs. 0.23 0.19, p 0.0013) as compared with the control subjects. No significant
difference between the decrease of IP after salbutamol in patient groups with arterial hypertension and CHD was found when compared them with the control group (10.48 6.88%, 11.14 11.10% and 15.12 16.03% respectively, p = 0.3). The prolongation of PPT was significantly greater in control group compared with arterial hypertension group (93.12 83.79 vs.
37.79 47.50, p = 0.03) but not in CHD patients (93.12 83.79 vs. 60.86 60.26, p = 0.2).
Conclusion. The new DVP parameter IP/ PPT for photoplethysmographic analysis of salbutamol-induced changes could be suggested for evaluation of endothelial function
Photoplethysmographic assessment of the pulse wave: a blunted response to salbutamol in arterial hypertension and coronary heart disease
No full textObjectives: A systemic vascular effect of beta2-adrenergic agonist salbutamol is partially mediated through the L-arginine–NO pathway. Therefore, the attenuation of photoplethysmographic digital volume pulse parameters under salbutamol inhalation could be used for the evaluation of endothelial function. The aim of the study was to estimate the vascular response to salbutamol in patients with arterial hypertension (AH) and coronary heart disease (CHD). Design and Methods: Totally 71 subjects were studied: 30 patients with AH, 26 patients with CHD and 15 healthy controls (C). All the subjects underwent the detailed clinical assessment and photoplethysmographic evaluation of the pulse wave response to 400 µg salbutamol inhalation. A portable photoplethysmograph Micro MedicalMP2000 ( Gillingham , Kent , United Kingdom ) was used for digital volume pulse analysis..
Hemoroidinių arterijų embolizacija – naujas hemorojaus gydymo metodas: atvejo pristatymas
No full textĮvadas / tikslas
Keturiasdešimt ketverių metų vyrui dėl lėtinio hepatito B išsivysčiusios kepenų cirozės 2011 m. rugsėjo 30 d. atlikta kepenų transplantacija. Progresuojant hepatitui po 4 metų išsivystė kepenų transplantato cirozė, hepatorenalinis sindromas, portinės hipertenzijos sindromas (splenomegalija ir hipersplenizmas, stemplės venų varikozė, tiesiosios žarnos venų varikozė), hiperurikemija. III° hemorojus komplikavosi gausiais kraujavimais. Dėl posthemoraginės anemijos kelis kartus atliktos hemotransfuzijos. Konservatyvus gydymas buvo neveiksmingas. Dėl trombocitopenijos (45x10⁹/l), tiesiosios žarnos venų varikozės, gausaus kraujavimo operacijos metu arba po operacijos didelio pavojaus klasikinės hemoroidektomijos arba mikroinvazinių operacijų (LHP, THD) nebuvo galima atlikti. Situacija buvo aptarta konsiliume dalyvaujant intervenciniams radiologams. Buvo nuspręsta atlikti hemoroidinių arterijų embolizaciją. 2015 m. liepos 30 d. buvo atliktos visceralinė ir selektyvi angiografija. Į apatinę mezenterinę arteriją buvo įvesta kaniulė. Hemoroidinių arterijų embolizacija atlikta „Interblock 18“ mikrospiralėmis. Panaudotos trys 3 mm 6 cm ilgio spiralės. Introdiuseris pašalintas. Punkcijos vieta užsiūta „Angioseal“ prietaisu.
Po embolizacijos praėjus 3 savaitėms atlikta RRS. Kraujavimo iš tiesiosios žarnos požymių neaptikta, hemorojiniai mazgai sumažėjo, apie 70 % sumažėjo tiesiosios žarnos venų varikozė. Per 23 mėn. po procedūros kraujavimų iš tiesiosios žarnos nepastebėta.
Išvados
Hemoroidinių arterijų embolizacija reikalauja įvairių sričių gydytojų specialistų komandos darbo – intervencinio radiologo, proktologo, pilvo chirurgo, transplantologo. Viršutinės tiesiosios žarnos arterijos (retais atvejais ir papildoma apatinės tiesiosios žarnos arterijos) embolizacija yra patikimas, efektyvus, saugus mikroinvazinis kraujuojančio hemorojaus gydymo metodas, taikytinas pacientams, sergantiems kepenų ciroze arba turintiems kraujo krešėjimo sutrikimų
Intravenous r-tPA dose influence on outcome after middle cerebral artery ischemic stroke treatment by mechanical thrombectomy /
No full textBackground and Objectives: Pretreatment with intravenous thrombolysis (IVT) is still recommended in all eligible acute ischemic stroke patients with large-vessel occlusion before mechanical thrombectomy (MTE). However, the added value and safety of bridging therapy versus direct MTE remains controversial. We aimed at evaluating the influence of r-tPA dose level in patients with middle cerebral artery (MCA) occlusion treated with MTE. Materials and Methods: We prospectively compared clinical and radiological outcomes in 38 bridging patients, with 65 receiving direct MTE for MCA stroke admitted to Vilnius University Hospital Santaros Clinics. Following our protocol, r-tPA infusion was stopped just before MTE in the operating room. Therefore, we divided all bridging patients into three groups according to the amount of r-tPA they received: bolus, partial dose or full dose. Functional independence at 90 days was assessed by a modified Rankin Scale score, i.e., from 0–2. The safety outcomes included 90-day mortality and any intracerebral hemorrhage (ICH). Results: Baseline characteristics and functional outcome at 90 days did not di er between the bridging and direct MTE groups. Shorter MTE procedure and hospitalization time (p = 0.025 and p = 0.036, respectively) were observed in the direct MTE group. An IVT treatment subgroup analysis showed higher rates of symptomatic ICH (p < 0.001) and longer intervals between imaging to MTE (p = 0.005) in the full r-tPA dose group. Conclusions: In patients with an MCA stroke, direct MTE seems to be a safe and equally e ective as bridging therapy. The optimal r-tPA dose remains unclear. Randomized trials are needed to accurately evaluate the added value of r-tPA in patients treated with MTE
