Superficial temporal artery aneurysms

AbstractObjective: We analyzed the data from our vascular registry to determine the cause, clinical features, and cost-effective management of this uncommon pathologic entity. Design: Patients referred to the vascular surgery outpatient clinic of a tertiary referral center during the past 18 years were evaluated. Subjects: The subjects were six male patients (14 to 32 years) referred for evaluation of a unilateral pulsatile mass over the temporal region of the head. Intervention: Diagnosis of superficial temporal artery aneurysm was verified by loss of the aneurysm's pulse with compression of the ipsilateral proximal superficial temporal artery. All treated aneurysms were electively ligated and excised as an ambulatory procedure. Results: The symptoms were resolved. No recurrences or other complications were seen. Conclusions: Although rare, a superficial temporal artery aneurysm should be considered when a temporal head mass is evaluated. This condition is almost always a result of blunt or penetrating head trauma. Clinical examination is sufficient to confirm the diagnosis. Simple elective ligation and excision of the aneurysm is curative. (J Vasc Surg 1998;27:374-7.

COLLISION WORK PERFORMED BY PATIENTS WITH PERIPHERAL ARTERY DISEASE

The goal of this study was to assess the differences in collision work performed by healthy, aged-matched controls compared to patients with peripheral artery disease (PAD) to provide foundations for an eventual exoskeleton design. Collision work is energy dissipated into the surrounding environment from impact, in this study’s case, upon heel strike. When designing an exoskeleton for patients with PAD, harvesting energy lost to collision work could be a valuable mechanism to improve walking performance. Devices designed to utilize the normally dissipated energy for assisting propulsion to improve walking performance are under-explored [1, 2]. The purpose of this study was to assess the validity of healthy, older individuals as a model for patients with PAD when investigating collision work as a primary exoskeleton design consideration. References [1] Kuo, A., et al. (2005). Exerc. Sport Sci. Rev.,33: 88-97 [2] Li, Q., et al. (2009). J. Neuroeng. Rehabil., 6: 22-22 [3] Donelan, J., et al.(2002). A. D. J. Biomech., 35: 117-12

The effect of pharmacological treatment on gait biomechanics in peripheral arterial disease patients

<p>Abstract</p> <p>Background</p> <p>Pharmacological treatment has been advocated as a first line therapy for Peripheral Arterial Disease (PAD) patients suffering from intermittent claudication. Previous studies document the ability of pharmacological treatment to increase walking distances. However, the effect of pharmacological treatment on gait biomechanics in PAD patients has not been objectively evaluated as is common with other gait abnormalities.</p> <p>Methods</p> <p>Sixteen patients were prescribed an FDA approved drug (Pentoxifylline or Cilostazol) for the treatment of symptomatic PAD. Patients underwent baseline gait testing prior to medication use which consisted of acquisition of ground reaction forces and kinematics while walking in a pain free state. After three months of treatment, patients underwent repeat gait testing.</p> <p>Results</p> <p>Patients with symptomatic PAD had significant gait abnormalities at baseline during pain free walking as compared to healthy controls. However, pharmacological treatment did not produce any identifiable alterations on the biomechanics of gait of the PAD patients as revealed by the statistical comparisons performed between pre and post-treatment and between post-treatment and the healthy controls.</p> <p>Conclusions</p> <p>Pharmacological treatment did not result in statistically significant improvements in the gait biomechanics of patients with symptomatic PAD. Future studies will need to further explore different cohorts of patients that have shown to improve significantly their claudication distances and/or their muscle fiber morphology with the use of pharmacological treatment and determine if this is associated with an improvement in gait biomechanics. Using these methods we may distinguish the patients who benefit from pharmacotherapy and those who do not.</p

The effect of exoskeleton footwear on joint angular motion during walking in patients with peripheral artery disease

Gait, Lower Extremity, Peripheral Artery Disease, Joint Angle, Exoskeleton Footwear, Exoskeleton, Assistive Device, Walking

In vivo three-dimensional blood velocity profile shapes in the human common, internal, and external carotid arteries

Objective: True understanding of carotid bifurcation pathophysiology requires a detailed knowledge of the hemodynamic conditions within the arteries. Data on carotid artery hemodynamics are usually based on simplified, computer-based, or in vitro experimental models, most of which assume that the velocity profiles are axially symmetric away from the carotid bulb. Modeling accuracy and, more importantly, our understanding of the pathophysiology of carotid bifurcation disease could be considerably improved by more precise knowledge of the in vivo flow properties within the human carotid artery. The purpose of this work was to determine the three-dimensional pulsatile velocity profiles of human carotid arteries. Methods: Flow velocities were measured over the cardiac cycle using duplex ultrasonography, before and after endarterectomy, in the surgically exposed common (CCA), internal (ICA), and external (ECA) carotid arteries (n = 16) proximal and distal to the stenosis/endarterectomy zone. These measurements were linked to a standardized grid across the flow lumina of the CCA, ICA, and ECA. The individual velocities were then used to build mean three-dimensional pulsatile velocity profiles for each of the carotid artery branches. Results: Pulsatile velocity profiles in all arteries were asymmetric about the arterial centerline. Posterior velocities were higher than anterior velocities in all arteries. In the CCA and ECA, velocities were higher laterally, while in the ICA, velocities were higher medially. Pre- and postendarterectomy velocity profiles were significantly different. After endarterectomy, velocity values increased in the common and internal and decreased in the external carotid artery. Conclusions: The in vivo hemodynamics of the human carotid artery are different from those used in most current computer-based and in vitro models. The new information on three-dimensional blood velocity profiles can be used to design models that more closely replicate the actual hemodynamic conditions within the carotid bifurcation. Such models can be used to further improve our understanding of the pathophysiologic processes leading to stroke and for the rational design of medical and interventional therapies

Changes in ankle muscle force and power during walking in patients with peripheral artery disease

Background: Patients with peripheral artery disease (PAD) have significantly reduced lower extremity muscle strength compared with healthy individuals as measured during isolated, single plane joint motion by isometric and isokinetic strength dynamometers. The objective of this study was to understand the contribution of the ankle muscles during walking in patients with PAD and compared to healthy older individuals. Methods: A total of 12 patients diagnosed with Fontaine stage II PAD and 10 healthy older controls were recruited for the study. Each subject walked across a 10-meter pathway with reflective markers placed on specific anatomical locations on lower limbs while the marker coordinates were recorded using a 12-high speed infrared camera system. Gait simulations were performed in OpenSim software (version 4.0). The muscle force and power for individual muscles at ankle and as a group of ankle plantar flexor muscles were exported from OpenSim. Results: There was a significant reduction in ankle muscle power in patients with PAD during propulsion phase (p \u3c 0.05). There were significant reductions in lateral and medial gastrocnemius muscle forces and power during propulsion in patients with PAD (p \u3c 0.05). However, soleus muscle force and power were not altered during stance phase. Conclusions: Our simulation findings identified important information about PAD gait mechanics, specifically altered ankle muscle force and power contribution during stance phase

Fluid administration rate for uncontrolled intraabdominal hemorrhage in swine

Background We hypothesized that slow crystalloid resuscitation would result in less blood loss and a smaller hemoglobin decrease compared to a rapid resuscitation during uncontrolled hemorrhage. Methods Anesthetized, splenectomized domestic swine underwent hepatic lobar hemitransection. Lactated Ringers was given at 150 or 20 mL/min IV (rapid vs. slow, respectively, N = 12 per group; limit of 100 mL/kg). Primary endpoints were blood loss and serum hemoglobin; secondary endpoints included survival, vital signs, coagulation parameters, and blood gases. Results The slow group had a less blood loss (1.6 vs. 2.7 L, respectively) and a higher final hemoglobin concentration (6.0 vs. 3.4 g/dL). Conclusions Using a fixed volume of crystalloid resuscitation in this porcine model of uncontrolled intraabdominal hemorrhage, a slow IV infusion rate produced less blood loss and a smaller hemoglobin decrease compared to rapid infusion

Machine Learning-Based Peripheral Artery Disease Identification Using Laboratory-Based Gait Data

Peripheral artery disease (PAD) manifests from atherosclerosis, which limits blood flow to the legs and causes changes in muscle structure and function, and in gait performance. PAD is underdiagnosed, which delays treatment and worsens clinical outcomes. To overcome this challenge, the purpose of this study is to develop machine learning (ML) models that distinguish individuals with and without PAD. This is the first step to using ML to identify those with PAD risk early. We built ML models based on previously acquired overground walking biomechanics data from patients with PAD and healthy controls. Gait signatures were characterized using ankle, knee, and hip joint angles, torques, and powers, as well as ground reaction forces (GRF). ML was able to classify those with and without PAD using Neural Networks or Random Forest algorithms with 89% accuracy (0.64 Matthew’s Correlation Coefficient) using all laboratory-based gait variables. Moreover, models using only GRF variables provided up to 87% accuracy (0.64 Matthew’s Correlation Coefficient). These results indicate that ML models can classify those with and without PAD using gait signatures with acceptable performance. Results also show that an ML gait signature model that uses GRF features delivers the most informative data for PAD classification

Considerations for Implementation of an Ankle-Foot Orthosis to Improve Mobility in Peripheral Artery Disease

Objective To explore the perceptions of wearing an ankle-foot orthosis (AFO) in patients with peripheral artery disease (PAD) who did and did not adopt the AFO intervention. This follows a clinical trial of the effectiveness of an AFO in improving walking distances for patients with PAD-related claudication. Design A randomized crossover trial of standard of care and an AFO for 3 months. Semistructured interviews were conducted 1.5 months into the AFO intervention to understand acceptability, demand, implementation, and practicality. Data were analyzed using a summative content analysis approach. Setting Vascular surgery clinic and biomechanics research laboratory. Participants Patients (N=15; male, 100%; age, 71.9±.6.7y; body mass index [calculated as weight in kilograms divided by height in meters squared], 29.0±.5.5; ankle brachial index: AFO intervention withdrawal, 0.543; AFO intervention completion, 0.740) with claudication completed the study, and 6 withdrew prior to intervention completion. Interventions A certified orthotist fit participants with an AFO that was worn for 3 months. Main Outcome Measures Qualitative analysis of the semistructured interviews. Results Key differences were reported between AFO intervention completion and AFO intervention withdrawal. Six of 14 of AFO intervention completion participants described their initial reactions to the AFO as negative vs 3 of 6 AFO intervention withdrawal participants. Only 5 of 15 AFO intervention completion participants reported minimal use of the AFO compared with 5 of 6 AFO intervention withdrawal participants. The AFO intervention withdrawal group reported higher levels of physical discomfort with the use of the AFO (4/6 vs 7/15) and preexisting health issues becoming a barrier to the use of the AFO (3/6 vs 5/15). Positive aspects reported included ease in standing and walking for AFO intervention withdrawal (4/6) and AFO intervention completion groups (13/15) as well as walking straighter and longer with less pain for AFO intervention withdrawal (3/6) and AFO intervention completion groups (9/15). Conclusions Patients withdrawing prior to completion of AFO intervention tended to have more negative perceptions, more comorbidities, and more physical discomfort than those completing the intervention. Both groups reported positive aspects of the AFO. Implementation studies are needed to address barriers to AFO adoption

Spatiotemporal Changes Posttreatment in Peripheral Arterial Disease

Accumulating evidence suggests revascularization of peripheral arterial disease (PAD) limbs results in limited improvement in functional gait parameters, suggesting underlying locomotor system pathology. Spatial and temporal (ST) gait parameters are well studied in patients with PAD at baseline and are abnormal when compared to controls. The purpose of this study was to systematically review and critically analyze the available data on ST gait parameters before and after interventions. A full review of literature was conducted and articles were included which examined ST gait parameters before and after intervention (revascularization and exercise). Thirty-three intervention articles were identified based on 154 articles that evaluated ST gait parameters in PAD. Four articles fully assessed ST gait parameters before and after intervention and were included in our analysis. The systematic review of the literature revealed a limited number of studies assessing ST gait parameters. Of those found, results demonstrated the absence of improvement in gait parameters due to either exercise or surgical intervention.Our study demonstrates significant lack of research examining the effectiveness of treatments on ST gait parameters in patients with PAD. Based on the four published articles, ST gait parameters failed to significantly improve in patients with PAD following intervention