Relationship of age, gender, race, and body size to infrarenal aortic diameter

AbstractPurpose: To assess the effects of age, gender, race, and body size on infrarenal aortic diameter (IAD) and to determine expected values for IAD on the basis of these factors.Methods: Veterans aged 50 to 79 years at 15 Department of Veterans Affairs medical centers were invited to undergo ultrasound measurement of IAD and complete a prescreening questionnaire. We report here on 69,905 subjects who had no previous history of abdominal aortic aneurysm (AAA) and no ultrasound evidence of AAA (defined as IAD ≥ 3.0 cm).Results: Although age, gender, black race, height, weight, body mass index, and body surface area were associated with IAD by multivariate linear regression (all p < 0.001), the effects were small. Female sex was associated with a 0.14 cm reduction in IAD and black race with a 0.01 cm increase in IAD. A 0.1 cm change in IAD was associated with large changes in the independent variables: 29 years in age, 19 cm or 40 cm in height, 35 kg in weight, 11 kg/m2 in body mass index, and 0.35 m2 in body surface area. Nearly all height-weight groups were within 0.1 cm of the gender means, and the unadjusted gender means differed by only 0.23 cm. The variation among medical centers had more influence on IAD than did the combination of age, gender, race, and body size.Conclusions: Age, gender, race, and body size have statistically significant but small effects on IAD. Use of these parameters to define AAA may not offer sufficient advantage over simpler definitions (such as an IAD ≥3.0 cm) to be warranted. (J Vasc Surg 1997;26:595-601.

Intracerebral Hemorrhage After Carotid Endarterectomy

Intracerebral hemorrhage (ICH) is a rare complication of carotid endarterectomy (CE). In our multicenter series of 1,180 CE (Baker-Littooy), three ICH occurred, of which two were fatal. One patient was receiving anticoagulants because ofa prosthetic aortic valve; another had rupture of a known ipsilateral intracranial aneurysm. Both occurred more than six weeks postoperatively. The third patient, who was hypertensive, had a nonfatal ipsilateral thalamic hemorrhage on the third postoperative day. Though these three patients represent only 0.25% of our series, they constitute 12% of our total strokes. ICH constitutes the largest percentage of nontechnically-related strokes and noncardiac deaths after CE

Carotid endarterectomy for recurrent stenosis

AbstractPurpose: The purpose of this study was to report our results in the surgical management of recurrent carotid stenosis (RCS) after carotid endarterectomy (CEA).Methods: In a 20-year period, we performed 1209 CEAs; 82 operations (6.8%) were for RCS. There were 33 men and 36 women, with an average age of 66.3 years. Nine patients underwent two redo CEAs and two patients underwent three redo CEAs for either bilateral recurrence or a second recurrence on the same side. Overall, 10 patients were identified with a second recurrence.Results: The average time to presentation with RCS was 65 months (range, 3 to 361 months). The majority of patients (66%) were symptomatic, 34% had transient ischemic attacks, 17% had amaurosis fugax, 9% had strokes, and 6% had nonhemispheric symptoms. Before repair, angiograms were obtained. Patch repair was performed in 61 procedures (74%), 41 with vein, 11 with Dacron, and nine with polytetrafluoroethylene. Autogenous or synthetic bypass grafts were used in 20 procedures (24%), vein in eight, Dacron in two, and polytetrafluoroethylene in 10. In one patient, an occluded internal carotid artery was ligated and an endarterectomy of the external carotid artery was performed without a patch. The operative stroke rate was 4.8%. Minor complications included transient or permanent cranial nerve deficits in 7.3% and wound hematomas in 2.4%.Conclusion: Although repeat endarterectomy to treat RCS is technically more demanding, it can be performed safely. Long-term follow-up examination shows that a second recurrence may develop, and we recommend serial noninvasive testing. (J Vasc Surg 1997;25:877-83.

Polestriding exercise and vitamin E for management of peripheral vascular disease

Etude de l'utisation du Polestriding (sorte de marche solicitant les muscles des membres inférieurs et supérieurs dans un mouvement de ski de fond) et de la vitamine E pour améliorer les capacités de locomotion et la qualité de vie, des personnes atteintes d'artérite oblitérante