10 research outputs found
The role of carotid plaque echogenicity in baroreflex sensitivity
ObjectiveThe baroreflex sensitivity is impaired in patients with carotid atherosclerosis. The purpose of our study was to assess the impact of carotid plaque echogenicity on the baroreflex function in patients with significant carotid atherosclerosis, who have not undergone carotid surgery.MethodSpontaneous baroreflex sensitivity (sBRS) was estimated in 45 patients with at least a severe carotid stenosis (70%-99%). sBRS calculation was performed noninvasively, with the spontaneous sequence method, based on indirectly estimated central blood pressures from radial recordings. This method failed in three patients due to poor-quality recordings, and eventually 42 patients were evaluated. After carotid duplex examination, carotid plaque echogenicity was graded from 1 to 4 according to Gray-Weale classification and the patients were divided into two groups: the echolucent group (grades 1 and 2) and the echogenic group (grades 3 and 4).ResultsSixteen patients (38%) and 26 patients (62%) were included in the echolucent and echogenic group, respectively. Diabetes mellitus was observed more frequently among echolucent plaques (χ2 = 8.0; P < .004), while those plaques were also more commonly symptomatic compared with echogenic atheromas (χ2 = 8.5; P < .003). Systolic arterial pressure, diastolic arterial pressure, and heart rate were similar in the two groups. Nevertheless, the mean value of baroreflex sensitivity was found to be significantly lower in the echogenic group (2.96 ms/mm Hg) compared with the echolucent one (5.0 ms/mm Hg), (F [1, 42] = 10.1; P < .003).ConclusionsThese findings suggest that echogenic plaques are associated with reduced baroreflex function compared with echolucent ones. Further investigation is warranted to define whether such an sBRS impairment could be responsible for cardiovascular morbidity associated with echogenic plaques
The effects of endogenous and exogenous androgens on cardiovascular disease risk factors and progression
Cardiovascular disease incidence rates have long been known to significantly differ between the two sexes. Estrogens alone fail to explain this phenomenon, bringing an increasing amount of attention to the role of androgens. Contrary to what was initially hypothesized, androgens seem to have an overall cardioprotective effect, especially in men. Recent studies and published data continue to support this notion displaying a consistent inverse correlation with atherosclerosis progression and cardiovascular disease both in regressive and prospective study models. Clinical studies have also revealed what seems to be a differential androgenic effect on various cardiovascular risk factors between men and women. Further insight indicates that in order to avoid confusion it may be also preferable to separately examine the effects of endogenous androgen levels from exogenous testosterone administration, as well as discern the differential results of low to normal and supraphysiological administration doses. This review summarizes old and recent data according to the above distinctions, in an attempt to further our understanding of the role of androgens in cardiovascular disease
The role of carotid plaque echogenicity in baroreflex sensitivity
Objective: The baroreflex sensitivity is impaired in patients with
carotid atherosclerosis. The purpose of our study was to assess the
impact of carotid plaque echogenicity on the baroreflex function in
patients with significant carotid atherosclerosis, who have not
undergone carotid surgery.
Method: Spontaneous baroreflex sensitivity (sBRS) was estimated in 45
patients with at least a severe carotid stenosis (70%-99%). sBRS
calculation was performed noninvasively, with the spontaneous sequence
method, based on indirectly estimated central blood pressures from
radial recordings. This method failed in three patients due to
poor-quality recordings, and eventually 42 patients were evaluated.
After carotid duplex examination, carotid plaque echogenicity was graded
from 1 to 4 according to Gray-Weale classification and the patients were
divided into two groups: the echolucent group (grades 1 and 2) and the
echogenic group (grades 3 and 4).
Results: Sixteen patients (38%) and 26 patients (62%) were included in
the echolucent and echogenic group, respectively. Diabetes mellitus was
observed more frequently among echolucent plaques (chi(2) = 8.0; P <
.004), while those plaques were also more commonly symptomatic compared
with echogenic atheromas (chi(2) = 8.5; P < .003). Systolic arterial
pressure, diastolic arterial pressure, and heart rate were similar in
the two groups. Nevertheless, the mean value of baroreflex sensitivity
was found to be significantly lower in the echogenic group (2.96 ms/mm
Hg) compared with the echolucent one (5.0 ms/mm Hg), (F[1, 42] = 10.1;
P < .003).
Conclusions:These findings suggest that echogenic plaques are associated
with reduced baroreflex function compared with echolucent ones. Further
investigation is warranted to define whether such an sBRS impairment
could be responsible for cardiovascular morbidity associated with
echogenic plaques. (J Vasc Surg 2011;54:93-99.
Spontaneous arterial recanalization with magnetic resonance angiography evidence: Report of a case
A 27-year-old man was admitted to our hospital for investigation of
severe claudication in his right foot. Based on the findings of magnetic
resonance imaging (MRI) and magnetic resonance angiography (MRA), we
diagnosed anatomic popliteal artery entrapment syndrome, which was
causing a short popliteal artery occlusion. Moreover, a long posterior
tibial artery occlusion and a peroneal artery lesion had developed as
distal thromboembolic complications of the entrapment. Thus, we planned
to perform in situ vein bypass graft for the popliteal occlusion and
start thrombolytic treatment for the posterior tibial and peroneal
lesions. While contemplating the operation, the patient showed a gradual
clinical improvement over the next 2 months. A second MRA showed total
arterial recanalization of the right posterior tibial and peroneal
arteries, although the popliteal artery was still occluded. Spontaneous
lower limb arterial recanalization is a rare phenomenon. To our
knowledge, this is the first case of spontaneous arterial recanalization
after a distal thromboembolic event caused by popliteal entrapment
syndrome
Fungal infection of aortoiliac endograft: A case report and review of the literature
Infection of aortoiliac endografts is, to date, a rare complication of
endovascular surgery. Staphylococcus species are the most common
responsible pathogens, just as in cases with infected grafts after open
aortic surgery. We report a case of a 65-year-old man with a history of
diabetes mellitus and bladder cancer who developed stent-graft infection
3 years after endovascular treatment for a 5.6 cm abdominal aortic
aneurysm. The diagnosis of endograft infection was established
radiologically by computed tomographic scans. After intravenous
administration of antibiotics and fluids to improve his clinical
condition, the patient underwent surgical excision of the infected
prosthesis and a bifurcated rifampicin-impregnated Dacron graft was
placed in situ. Cultures from the purulent fluid around the aorta and
from the endograft revealed development of Candida albicans. To our
knowledge, this is the first case of an infected endograft due to a
fungus. The patient died from septic shock 3 days postoperatively in the
intensive care unit
Minilaparotomy abdominal aortic aneurysm repair in the era of minimally invasive vascular surgery: preliminary results
Background:
This study aimed to evaluate the early post-operative clinical impact of
minimal incision aortic surgery (MIAS) for infrarenal abdominal aortic
aneurysm (AAA) repair in comparison with the standard open repair.
Methods:
A case-control study was conducted. Patients of groups A (19 patients)
and B (18 patients) were treated with the MIAS technique and the
standard open method, respectively.
Results:
There were significant differences between the two groups in fluid
resuscitation during the operation. Post-operatively, there were
significant differences between groups A and B in the time until
starting liquid diet (2 +/- 0.74 versus 3.55 +/- 0.85 post-operative
days (PD), respectively; P < 0.05), the time until starting the solid
diet (3.05 +/- 0.77 versus 5.11 +/- 0.75 PD, respectively; P < 0.05),
the time of ambulation (2 +/- 0.74 versus 3.4 +/- 0.98 PD, respectively;
P < 0.05) and in the hospital length of stay (4 +/- 0.81 versus 9.7 +/-
2.66 days, respectively; P < 0.05).
Conclusions:
The MIAS technique, for repair of infrarenal aortic aneurysms, is a safe
and feasible procedure that combines the early advantages of
endovascular repair with the long-term advantages of the traditional
open repair
Surgical management of extracranial internal carotid aneurysms by cervical approach
Background: Extracranial internal carotid artery aneurysms (EICAA) are
rare vascular problems with a great potential for lethal thromboembolic
episodes.
Methods: From 1994 to 2004, nine patients with EICAA, seven men and two
women, were surgically treated for 10 aneurysms in our department.
Aneurysm led to hemispheric symptoms in six cases (two hemispheric
strokes and four hemispheric transient ischaemic attacks). The cause was
fibrodysplasia in two cases, atherosclerosis in four cases, trauma in
two cases and spontaneous dissection in two cases. All aneurysms were
treated surgically by the cervical approach using shunting. Extended
cervical approach was necessary in four patients with high-lying
aneurysms. Nine aneurysms were totally resected and successful
revascularization was carried out. Open aneurysmorrhaphy with vein patch
angioplasty was carried out in one case of a saccular aneurysm.
Results: There were no perioperative deaths or transient ischaemic
attacks or strokes. Four patients developed cranial nerve deficits: one
had hoarsness, two had partial facial paralysis (patients with extended
cervical approach) and one had tongue deviation. These neurological
symptoms were observed in large aneurysms (> 4.5 cm) and disappeared
within 14 months. No neurological complication was observed in a follow
up that ranged from 6 months to 10 years.
Conclusions: Surgical repair of EICAA, especially with total resection
and arterial reconstruction, is strongly recommended. Extended cervical
approach has many technical difficulties but can allow treatment of
high-lying aneurysms