Mitochondrial function and oxygen supply in normal and in chronically ischemic muscle: A combined 31P magnetic resonance spectroscopy and near infrared spectroscopy study in vivo

AbstractPurpose: We used 31P magnetic resonance spectroscopy (MRS) and near-infrared spectroscopy (NIRS) as a means of quantifying abnormalities in calf muscle oxygenation and adenosine triphosphate (ATP) turnover in peripheral vascular disease (PVD). Methods: Eleven male patients with PVD (mean age, 65 years; range, 55-76 years) and nine male control subjects of similar age were observed in a case-control study in vascular outpatients. Inclusion criteria were more than 6 months' calf claudication (median, 1.5 years; range, 0.6-18 years); proven femoropopliteal or iliofemoral occlusive or stenotic disease; maximum treadmill walking distance (2 km/h, 10° gradient) of 50 to 230 m (mean, 112 m); ankle-brachial pressure index of 0.8 or less during exercise (mean, 0.47; range, 0.29-0.60). Exclusion criteria included diabetes mellitus, anemia, and magnet contraindications. Simultaneous 31P MRS and NIRS of lateral gastrocnemius was conducted during 2 to 4 minutes of voluntary 0.5 Hz isometric plantarflexion at 50% and 75% maximum voluntary contraction force (MVC), followed by 5 minutes recovery. Each subject was studied three times, and the results were combined. Results: Compared with control subjects, patients with PVD showed (1) normal muscle cross-sectional area, MVC, ATP turnover, and contractile efficiency (ATP turnover per force/area); (2) larger phosphocreatine (PCr) changes during exercise (ie, increased shortfall of oxidative ATP synthesis) and slower PCr recovery (47% ± 7% [mean ± SEM] decrease in functional capacity for oxidative ATP synthesis, P =.001); (3) faster deoxygenation during exercise and slower postexercise reoxygenation (59% ± 7% decrease in rate constant, P =.0009), despite reduced oxidative ATP synthesis; (4) correlation between PCr and NIRS recovery rate constants (P <.02); and (5) correlations between smaller walking distance, slower PCr recovery, and reduced MVC (P <.001). The precision of the key measurements (rate constants and contractile efficiency) was 12% to 18% interstudy and 30% to 40% intersubject. Conclusion: The primary lesion in oxygen supply dominates muscle metabolism. Reduced force-generation in patients who are affected more may protect muscle from metabolic stress. (J Vasc Surg 2001;34:1103-10.

A prototype simulator for endovascular repair of abdominal aortic aneurysms

A prototype simulator for training in endovascular repair of abdominal aortic aneurysms (AAA) has been developed. Employing transparent models of human AAA complete with renal, iliac and femoral arteries, this system allows accurate simulation of aortography, road-mapping, catheter guidewire manipulation and stent-graft deployment while obviating the need for ionising radiation

Erratum to “The Distaflo Graft: a Valid Alternative to Interposition Vein?” [European Journal of Vascular and Endovascular Surgery 25 (2003) 235-239]*

AbstractEur J Vasc Endovasc Surg 26, 111-112 (2003