13 research outputs found
The value of near-infrared spectroscopy for the assessment of calf muscle function in venous patients
Objective: Near-infrared spectroscopy (NIRS) is a noninvasive technique
with the potential to determine the degree of tissue oxygenation. The
aim of the current study was to investigate the use of NIRS as a
reliable method of detecting calf muscle pump dysfunction in groups of
patients with venous disease.
Methods: Patients with superficial venous insufficiency (SW) or history
of deep venous thrombosis (DVT) were classified according to the
comprehensive classification system for chronic venous disorders
(clinical class, etiology, anatomy, and pathophysiology) and compared
with controls (GROUP variable). A 10-stage evaluation of ambulatory
venous function was performed, and corresponding values of calf regional
oxygen saturation (crSaO(2), %) at each phase were recorded (TIME
variable). Thereafter, the percentage changes of crSaO(2) values (A
scores, %) between a given phase and the reference phase were
estimated. Differences among groups and phases were evaluated using
analysis of variance. Subgroup analysis between C0-C2 and C3-C6 patients
was performed. The receiver operating characteristic curve analysis was
used to detect the best predictive capability for SW and DVT.
Results: A total of 30 patients with SW, 31 patients with DVT, and 34
controls were included in the study. A statistically significant effect
of TIME (F = 382.4; P < .001) and TIME x GROUP interaction (F = 6.3; P <
.001) was recorded. Concerning prediction, we found a statistically
significant area under the curve (AUC) for SW (AUC = 0.72; 95%
confidence interval, 0.58-0.83; P = .003) and for DVT (AUC = 0.83; 95%
confidence interval, 0.71-0.92; P < .0001) patients.
Conclusions: The measurement of crSaO(2) using NIBS detected alterations
in calf muscle pump oxygenation during exercise and differences in
tissue oxygenation among SW patients, DVT patients, and controls. NIBS
may represent a reliable noninvasive tool for the study of calf muscle
dysfunction in venous disease and a useful vehicle for generating
testable hypotheses in the laboratory setting
Stress Management in Patients Undergoing Carotid Endarterectomy for Carotid Artery Stenosis: A Pilot Randomized Controlled Trial
Background: Psychological stress is common to patients submitted to
cardiovascular operations. The purpose of this pilot, single-center,
open-label, randomized controlled trial was to investigate the effects
of a stress management program (SMP) on patients undergoing carotid
endarterectomy (CEA).
Methods: A sample of 24 patients with significant (> 70%) carotid
stenosis was finally randomized to SMP (intervention group; n = 12) or
no-stress management intervention (control group; n = 12) before CEA.
SMP consisted of 2 relaxation techniques (relaxation-breathing and
guided imagery) before and 8 weeks after CEA. Measurements included
Perceived Stress Scale (PSS), Hospital Anxiety and Depression Scale
(HADS), Health Locus of Control Scale (HLC), and blood pressure and
heart rate.
Results: The 2 groups did not differ in terms of demographic
characteristics, vascular risk factors, and baseline psychometric
measurements. No delay on the time of surgery was caused by the practice
of the relaxation techniques. Both perceived stress and anxiety improved
within the intervention group at the end of the program (P = 0.005 and P
= 0.007, respectively). No improvement in PSS-14, HLC, and HADS scores
were documented in control group at the end of the 8-week follow-up
period. The intervention group had lower PSS-14 scores at 8 weeks after
CEA (median PSS-14 score, 20 points; range, 10-28) compared with control
group (median PSS, 25 points; range, 11-47; P = 0.026). No significant
effect of SMP was found for blood pressure and heart rate measurements.
Conclusions: Our results indicate that relaxation techniques appear to
be beneficial in terms of stress and anxiety reduction in patients
undergoing CEA. These findings require independent confirmation in the
setting of a larger, double-blind randomized controlled trial
Development of a scoring system for the prediction of early graft failure after peripheral arterial bypass surgery
Common femoral artery injury secondary to tennis ball strike
Tennis is a popular, safe sport that exposes amateur or professional
players to minimal risk of injury. Most of this risk is related to
musculoskeletal injuries, and vascular trauma is extremely rare. We
present a case of a 68-year-old man in whom intermittent claudication
developed after his right groin was struck by a tennis ball. The patient
sought medical evaluation 2 months after the accident, and a subtotal
occlusion of his right common femoral artery was disclosed by
angiography and treated by endarterectomy
Effect of diabetes mellitus on the clinical outcome of lower limb arterial bypass surgery:A propensity score analysis
Objectives Diabetic patients who undergo lower limb arterial bypass surgery are considered to have a worse clinical outcome compared to non-diabetics. The aim of the study was to test this hypothesis after applying propensity score matching analysis. Patients and methods A total of 113 consecutive lower limb bypass procedures (55 diabetic and 58 non-diabetic) were evaluated regarding their clinical outcome. Endpoints of the study included amputation-free survival, limb salvage, patency and patients’ survival up to 36 months post-procedure. After propensity score matching analysis, two new groups, diabetic and non-diabetic, of 31 limbs in each one were created, both equivalent regarding all baseline characteristics. Results Between the propensity score matching groups, the amputation-free survival was 68.8% in the non-diabetic and 37.7% in the diabetic group at 36 months ( p = 0.004). Similarly, the survival was 88.6% and 57.6%, respectively, in the two groups at the same time point ( p = 0.01). On the contrary, no difference was found in patency (58.3% vs. 56%) and in limb salvage rate (74.1% vs. 60.8%). Conclusions Lower limbs arterial bypass surgery has similar results regarding patency and limb salvage rate in diabetic and non-diabetic patients. On the contrary, mortality is worse in diabetic patients, this affecting negatively their amputation-free survival. </jats:sec
A Global Assessment of the Inflammatory Response Elicited Upon Open Abdominal Aortic Aneurysm Repair
Intravenous thrombolysis or endovascular therapy for acute ischemic stroke associated with cervical internal carotid artery occlusion: the ICARO-3 study
The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospective data collected prospectively from 37 centres in 7 countries. Patients treated with endovascular treatment within 6 h from stroke onset (cases) were matched with patients treated with intravenous thrombolysis within 4.5 h from symptom onset (controls). Patients receiving either intravenous or endovascular therapy were included among the cases. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale (mRS), dichotomized as favourable (score of 0-2) or unfavourable (score of 3-6). Safety outcomes were death and any intracranial bleeding. Included in the analysis were 324 cases and 324 controls: 105 cases (32.4 %) had a favourable outcome as compared with 89 controls (27.4 %) [adjusted odds ratio (OR) 1.25, 95 % confidence interval (CI) 0.88-1.79, p = 0.1]. In the adjusted analysis, treatment with intra-arterial procedures was significantly associated with a reduction of mortality (OR 0.61, 95 % CI 0.40-0.93, p = 0.022). The rates of patients with severe disability or death (mRS 5-6) were similar in cases and controls (30.5 versus 32.4 %, p = 0.67). For the ordinal analysis, adjusted for age, sex, NIHSS, presence of diabetes mellitus and atrial fibrillation, the common odds ratio was 1.15 (95 % IC 0.86-1.54), p = 0.33. There were more cases of intracranial bleeding (37.0 versus 17.3 %, p = 0.0001) in the intra-arterial procedure group than in the intravenous group. After the exclusion of the 135 cases treated with the combination of I.V. thrombolysis and I.A. procedures, 67/189 of those treated with I.A. procedures (35.3 %) had a favourable outcome, compared to 89/324 of those treated with I.V. thrombolysis (27.4 %) (adjusted OR 1.75, 95 % CI 1.00-3.03, p = 0.05). Endovascular treatment of patients with acute ICA occlusion did not result in a better functional outcome than treatment with intravenous thrombolysis, but was associated with a higher rate of intracranial bleeding. Overall mortality was significantly reduced in patients treated with endovascular treatment but the rates of patients with severe disability or death were similar. When excluding all patients treated with the combination of I.V. thrombolysis and I.A. procedures, a potential benefit of I.A. treatment alone compared to I.V. thrombolysis was observed