Long-term Results of Inframalleolar Bypass for Critical Limb Ischaemia

Peer reviewe

Quality Control of the Foot Revascularization Using Indocyanine Green Fluorescence Imaging

Objectives Critical limb ischemia (CLI) is a clinical diagnosis, confirmed by objective tests, usually ankle-brachial index (ABI), toe pressure (TP) and TcPO2. Furthermore, the anatomical lesions in patients affected by CLI were visualized by ultrasound, angiography, CTA, or MRA. Indocyanine green fluorescence imaging (ICG-FI) is a diagnostic modality for assessing foot perfusion. We aimed to study the usefulness of ICG-FI in the quality control of revascularization. Materials and methods One hundred and four CLI limbs in 101 patients were studied with ICG-FI using SPY Elite before and after open or endovascular revascularization. ABI and TP were also measured. After ICG-FI, assessment of circulation was done using time-intensity curve derived from the two regions of interest the one being in the plantar side of the foot and the other in the dorsal side of the foot. Three parameters were derived from the curves: maximum intensity (the absolute value of the maximum intensity); intensity rate (the value from the time-intensity curve describing the increase in maximum intensity/s) and SPY10 (the intensity achieved during the first 10 s after the foot starts to gain intensity). Results Sixty-two limbs presented category 3 of Rutherford classification, 12 limbs category 4, and 30 limbs category 5. Ninety-five technically successful procedures were achieved, 63 (66.3%) endovascular and 32 (33.7%) surgical revascularizations. In 9 (9.5%) patients, an in-line flow from the aorta to the foot was not achieved due to a failure to recanalize the occlusion (n = 7) or due to distal embolization (n = 2). ABI was not reliable in 58 patients (57.4%) mostly due to pseudohypertension and TPs in 49 (48.5%) patients mostly due to previous minor amputations. ICG-FI was successful in all patients. The mean intensity values before and after the procedure in patients who underwent successful revascularization were 81 +/- 47 units and 120 +/- 5 units of intensity (p <001) and intensity rates 4.2 +/- 4 and 8.0 +/- 6.2 units/s (p =.001), respectively. In the PTA patients in whom the revascularization was unsuccessful, no changes were seen in the hemodynamic parameters. In 6 (8.8%) patients who underwent technically successful revascularization, the SPY values were worse after the revascularization than at the baseline. Conclusions ICG-FI with SPY Elite provides reliable information on the increase in perfusion after revascularization, in addition to implicating possible failure if there is no improvement in the ICG-FI variables. Unlike ABI and TP, it can be performed in all patients. It gives valuable information to complement traditional assessment methods.Peer reviewe

Antitrombotisk medicinering inom kirurgin

English summary

Toe pressure should be part of a vascular surgeon's first-line investigation in the assessment of lower extremity artery disease and cardiovascular risk of a patient

Objective: Toe pressure (TP) is an accurate indicator of the peripheral vascular status of a patient and thus cardiovascular risk, with less susceptibility to errors than ankle-brachial index (ABI). This study aimed to analyze how ABI and TP measurements associate with overall survival and cardiovascular death and to analyze the TP of patients with ABI of 0.9 to 1.3. Methods: The first ABI and TP measurements of a consecutive 6784 patients treated at the Helsinki University Hospital vascular surgery clinic between 1990 and 2009 were analyzed. Helsinki University Vascular Registry and the national Cause of Death Registry provided the data. Results: The poorest survival was in patients with ABI >1.3 (10-year survival, 15.3%; hazard ratio, 2.2; 95% confidence interval, 1.9-2.6; P = 80 mm Hg (43.9%). Of the 642 patients with normal ABI (0.9-1.3), 18.7% had a TP 50 mm Hg. Conclusions: Low TP is associated significantly with survival and cardiovascular mortality. Patients with a normal ABI may have lower extremity artery disease (LEAD) and a considerable risk for a cardiovascular event. If only the ABI is measured in addition to clinical examination, a substantial proportion of patients may be left without LEAD diagnosis or adequate treatment of cardiovascular risk factors. Thus, especially if ABI is normal, LEAD is excluded only if TPs are also measured and are normal.Peer reviewe

4D Flow Versus 2D Phase Contrast MRI in Populations With Bi- and Tricuspid Aortic Valves

Aim: To compare 4D flow magnetic resonance imaging (MRI) and 2D phase contrast (PC) MRI when evaluating bicuspid (BAV) and tricuspid (TAV) aortic valves. Materials and Methods: A total of 83 subjects (35 BAV, 48 TAV) were explored with 4D flow and 2D PC MRI. Systolic peak velocity, peak flow and regurgitation fraction were analysed at two pre-defined aortic levels (aortic root, mid-tubular). Furthermore, the two methods of 4D flow analysis (Heart and Artery) were compared. Results: Correlation between the 2D PC MRI and 4D flow MRI derived parameters ranged from moderate (R=0.58) to high (R=0.90). 4D flow MRI yielded significantly higher peak velocities in the tubular aorta in both groups. Regarding the aortic root, peak velocities were significantly higher in the TAV group with 4D flow MRI, but in the BAV group 4D flow MRI yielded non-significantly lower values. Findings on peak flow differences between the two modalities followed the same pattern as the differences in peak velocities. 4D flow MRI derived regurgitation fraction values were lower in both locations in both groups. Interobserver agreement for different 4D flow MRI acquired parameters varied from poor (ICC=0.07) to excellent (ICC=1.0) in the aortic root, and it was excellent in the tubular aorta (ICC=0.8-1.0). Conclusion: 4D flow MRI seems to be accurate in comparison to 2D PC MRI in normal aortic valves and in BAV with mild to moderate stenosis. However, the varying interobserver reproducibility and impaired accuracy at higher flow velocities should be taken into account in clinical practice when using the 4D flow method.publishedVersionPeer reviewe

Kartoitus nuorten sijoitusinnosta ja -tuntemuksesta

Työn tavoitteena oli selvittää miksi nuoret eivät aloita sijoittamista nuorena. Opinnäytetyön aiheen valikoitumiseen vaikutti oma kiinnostus sijoittamista kohtaan. Sijoittamisen suosio on ollut yleisesti kasvussa viime vuosina. Pitkä sijoitusperiodi pienentää riskejä ja mahdollistaa hyötymisen korkoa korolle -ilmiöstä. Näistä hyödyistä pääsee nauttimaan varmemmin, kun pitkäjänteisen sijoittamisen aloittaa mahdollisimman varhain. Opinnäytetyön tietoperustassa käsiteltiin aluksi hieman rahan historiaa, jonka jälkeen siirryttiin tarkastelemaan rahoitusmarkkinoiden tehtäviä sekä suomalaisia sijoittajina. Näiden jälkeen teoriassa perehdyttiin sijoittamisen riskeihin ja mahdollisuuksiin. Lopuksi tutustuttiin eri sijoituskohteiden, kuten osakkeiden, rahastojen, asuntosäästämisen sekä kryptojen ominaispiirteisiin. Osana opinnäytetyötä toteutettiin kvantitatiivinen kyselytutkimus alkuvuodesta 2022. Tutkimuksen kohderyhmänä olivat yli 18-vuotiaat nuoret lukiosta ja ammattikoulusta. Kysely toteutettiin ammattikoululaisille sähköpostin välityksellä ja lukiolaisille heidän ryhmänohjaajiensa tunnilla. Hyväksyttyjä vastauksia saatiin yhteensä 78 kappaletta. Tuloksista selvisi, että nuoret ovat hyvin kiinnostuneita sijoittamisesta. Vastaajista lukiolaiset olivat hieman ammattikoululaisia kiinnostuneempia. Nuoret haluaisivat oppia sijoittamisesta mieluiten koulun kautta, mutta heidän mielestään koulussa ei opeteta tarpeeksi sijoittamisesta. Osalla nuorista oli jo sijoituksia ja suurimman osan on tarkoitus aloittaa sijoittaminen tulevaisuudessa