Carotid-Vertebral Artery Bypass for Symptomatic Vertebral Artery Pseudoaneurysm

We report a case of an embolizing proximal vertebral artery aneurysm repaired successfully with reversed saphenous vein graft in the presence of a hypoplastic contralateral vertebral artery. This case illustrates surgical and anaesthetic issues faced with vertebral artery aneurysm repair in order to exclude the aneurysm while maintaining adequate cerebral perfusion.     

Surrogates of Large Artery versus Small Artery Stiffness and Ankle-Brachial Index

Peripheral artery tonometry (PAT) is a novel method for assessing arterial stiffness of small digital arteries. Pulse pressure can be regarded as a surrogate of large artery stiffness. When ankle-brachial index (ABI) is calculated using the higher of the two ankle systolic pressures as denominator (ABI-higher), leg perfusion can be reliably estimated. However, using the lower of the ankle pressures to calculate ABI (ABI-lower) identifies more patients with isolated peripheral arterial disease (PAD) in ankle arteries. We aimed to compare the ability of PAT, pulse pressure, and different calculations of ABI to detect atherosclerotic disease in lower extremities. We examined PAT, pulse pressure, and ABI in 66 cardiovascular risk subjects in whom borderline PAD (ABI 0.91 to 1.00) was diagnosed 4 years earlier. Using ABI-lower to diagnose PAD yielded 2-fold higher prevalence of PAD than using ABI-higher. Endothelial dysfunction was diagnosed in 15/66 subjects (23%). In a bivariate correlation analysis, pulse pressure was negatively correlated with ABI-higher (r = −0.347, p = 0.004) and with ABI-lower (r = −0.424, p < 0.001). PAT hyperemic response was not significantly correlated with either ABI-higher (r = −0.148, p = 0.24) or with ABI-lower (r = −0.208, p = 0.095). Measurement of ABI using the lower of the two ankle pressures is an efficient method to identify patients with clinical or subclinical atherosclerosis and worth performing on subjects with pulse pressure above 65 mm Hg. The usefulness of PAT measurement in detecting PAD is vague.     

高血压病人肱动脉脉压与颈动脉重构关系的探讨

目的观察高血压病人颈动脉结构及功能的变化,并进一步探讨肱动脉脉压与颈动脉结构及功能改变是否相关.方法选取原发性高血压病人54例(EH组),健康自愿者47例(NC组)作为观察对象.应用二维超声测定颈动脉结构与功能.结果 EH组与NC组间年龄、体重指数、性别构成无差异(P>0.05).EH组的收缩压、舒张压、脉压、平均动脉压、颈动脉内膜-中层厚度(IMT)、僵硬度较NC组显著升高(P均<0.05),EH组的颈动脉扩张性较NC组显著降低(P<0.05).直线相关分析显示,年龄、收缩压、脉压与高血压病人颈动脉IMT、内径密切相关,年龄、收缩压、舒张压、脉压与高血压病人颈动脉扩张性、僵硬度密切相关,而且高血压病人颈动脉内膜-中层厚度、内径、扩张性、僵硬度各参数间也密切相关.结论高血压病人颈动脉内膜-中层厚度增厚、扩张性降低、僵硬度增加,扩张性与僵硬度与肱动脉脉压密切相关.     

椎动脉夹层分离

椎动脉夹层分离可能与血管壁结构异常或环境因素有关。症状通常由夹层分离造成管腔狭窄或血凝块形成所致，包括颈后或乳突区疼痛伴随局部神经功能障碍。椎动脉夹层分离的诊断方法包括数字减影血管造影、MRI、CT血管造影以及彩色多普勒超声等。治疗以抗凝为主。     

冠状动脉钙化研究进展

冠状动脉钙化(CAC)是导致一般人群和冠状动脉性心脏病患者不良结局的危险因素。CAC的发病机制和骨形成有共同的途径,目前已经确定了一些导致CAC发生和发展的危险因素。用药物治疗控制CAC的努力没有取得成功,而冠状动脉钙化的患者经皮冠脉介入术和冠状动脉搭桥术后的无事件生存率也较低。虽然应用药物洗脱支架和斑块修饰装置对钙化血管的预后有一定改善,但不良事件发生率仍然很高。在未来,仍需创新的药物和器械治疗来改善CAC患者的不良预后。     

Distal Radial Artery Approach to Prevent Radial Artery Occlusion Trial

ObjectivesThe aim of this study was to compare the rate of proximal radial artery occlusion (RAO) with Doppler ultrasound between distal and conventional radial access 24 h and 30 days after a transradial coronary procedure.BackgroundThe use of distal radial access to prevent proximal RAO (PRAO) in the proximal segment at 24 h and 30 days after a procedure, compared with conventional radial access, is unknown.MethodsThis was a prospective, comparative, longitudinal, randomized study. A total of 282 patients were randomized to either proximal radial access (n = 142) or distal radial access (n = 140) to evaluate the superiority of the distal approach in the prevention of PRAO with Doppler ultrasound 24 h and 30 days after a transradial coronary procedure.ResultsIn the per protocol analysis, the rates of PRAO at 24 h and 30 days were 8.4% and 5.6% in the proximal group and 0.7% and 0.7% in the distal group, respectively (24 h: odds ratio [OR]: 12.8; 95% confidence interval [CI]: 1.6 to 100.0; p = 0.002; 30 days: OR: 8.2; 95% CI: 1.0 to 67.2; p = 0.019). In an intention-to-treat analysis, the 24-h and 30-day rates of PRAO were 8.8% and 6.4% for proximal radial access and 1.2% and 0.6% in the distal radial access group (24 h: OR: 7.4; 95% CI: 1.6 to 34.3; p = 0.003; 30 days: OR: 10.6; 95% CI: 1.3 to 86.4; p = 0.007).ConclusionsDistal radial access prevents RAO in the proximal segment at 24 h and 30 days after the procedure compared with conventional radial access.     

Single Coronary Artery

A 54-year-old postmenopausal female, with systemic arterial hypertension and insulin dependent diabetes mellitus, had exertional chest discomfort. At cardiac catheterization, a single coronary artery arising from the right sinus of Valsalva was seen (Fig. 1). This condition is extremely rare, discovered in < 0.05% of the general population. Transesophageal echocardiography using color flow imaging documented that the left anterior descending coronary artery was anterior to the pulmonary artery (Fig. 2).     

冠状动脉钙化研究进展

冠状动脉钙化越来越受到重视,发现钙化即意味着亚临床动脉粥样硬化的存在,而动脉硬化不一定都有钙化。通常钙化越严重,冠脉管腔狭窄程度也就越高。但有时二者却缺乏很好的相关性。现就冠脉钙化的发生机制,冠脉钙化及积分与冠心病及其严重程度的关系,冠脉钙化检测方法及积分,血管重构在严重的冠脉钙化却没有明显的管腔狭窄中的作用等方面做一综述。     

Renal Artery Embolism

Renal artery embolism was first described in 1940, but it is only recently becoming recognized as a clinically significant entity. Although relatively uncommon, it is clearly responsible for considerable morbidity in patients who experience it. The pathogenesis is typically related to cardiac thrombus formation with subsequent embolization, although other etiologies have been described. The authors present a case report followed by a review of the literature to highlight the clinical characteristics of this phenomena. Presentation, diagnostics, and treatment options will be reviewed with the aim of increasing awareness of renal artery embolism. As clinicians become more familiar with this condition, they will be more likely to consider it as a possible diagnosis in patients with a typical presentation. This will hopefully lead to improved care through prompt diagnosis and treatment, particularly as one treatment option may be time sensitive.     

寰前节间动脉

寰前节间动脉是成人较少见的一种永久性颈动脉一椎基底动脉吻合，常与脑血管病的发生、临床表现及治疗相关。文章对已报道的寰前节间动脉病例做了综述。