Increased pregnancy loss in young women with aortoiliac disease

BACKGROUND: During clinical evaluation of young women with peripheral arterial occlusive disease, we were surprised by the high prevalence of pregnancy loss in women with segmental stenosis confined to the aortoiliac segment. We wondered if increased occurrence of miscarriage is the result of high expression of vascular and obstetrical risk factors in these patients, or if it is related to localization of disease. In a case-control study designed to investigate risk factors for peripheral arterial occlusive disease in young women, we assessed the risk of miscarriage in these patients according to level of obstruction. METHODS: A total of 202 female patients, aged 18-49 years and 466 healthy control women from a population based case-control study, donated venous blood samples and filled out a structured questionnaire concerning classical cardiovascular risk factors and obstetrical history. In all patients, diagnosis of peripheral arterial occlusive disease was confirmed by intra-arterial angiography. Patients were classified into two groups: those with and those without stenosis of the aortoiliac segment (aortoiliac disease). RESULTS: In 77 of the 202 patients (38%) with peripheral arterial occlusive disease, the obstruction was confined to the aortoiliac segment. The occurrence of miscarriage was high (42%) in young women with aortoiliac disease. Compared to healthy controls, the risk of miscarriage increased 3-fold (OR 3.1; 95% CI 1.8-5.6) in these patients. Adjustment for obstetrical and vascular risk factors did not affect the risk estimate. CONCLUSION: This is the first study that identifies aortoiliac disease as a risk factor for pregnancy loss in young women. The risk of miscarriage is increased 3-fold in women with aortoiliac disease. The presence of vascular and obstetrical risk factors did not affect the strength of the association. Pregnancy loss could be the first sign of insufficient aortic circulation in these patients.     

Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: review of the literature

OBJECTIVE: To determine the effectiveness and safety of percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures as published in the scientific literature. DESIGN: Literature review. METHOD: Medline and the Cochrane library were searched with the terms 'percutaneous vertebroplasty', 'vertebral compression fractures', 'osteoporotic' and 'osteoporosis'. Criteria for inclusion were: (a) the studies had to have been published in the period January 1985-August 2002, (b) the study population had to include at least 10 patients, (c) the patients had to have been treated with percutaneous vertebroplasty, and (d) the diagnosis had to have been 'osteoporotic vertebral compression fracture'. RESULTS: Twelve studies met the inclusion criteria. Pain relief was seen in 60%-100% of the patients within the first 24 hours and this result improved to 78-100% in the long term (maximum 4 years). The complications immediately after the procedure were related to cement leakages and were mostly of no clinical consequence. Serious complications such as pulmonary embolism were rare. In the long term, percutaneous vertebroplasty was associated with an increased risk of fractures in the adjacent vertebrae. CONCLUSION: Percutaneous vertebroplasty seems to be effective and safe in the treatment of osteoporotic vertebral compression fractures. A prospective randomised intervention study has, however, not yet been performed. For the time being, percutaneous vertebroplasty should be reserved for carefully selected patients in whom conservative therapy has not produced results.     

Ultrasound measurements of intraabdominal fat estimate the metabolic syndrome better than do measurements of waist circumference

BACKGROUND: We recently developed an ultrasound technique to estimate intraabdominal fat (IAF). This method is more accurate than measurement of waist and hip circumferences and is simpler and less expensive than computed tomography or magnetic resonance imaging. OBJECTIVE: We compared the associations of ultrasound and waist-circumference (WC) measurements of IAF with other components of the metabolic syndrome. DESIGN: IAF was determined in 600 consecutive participants in the Secondary Manifestations of Arterial Disease (SMART) study. The mean (+/- SD) age was 56.1 +/- 12.6 y, 30.0% of participants were women, and the mean body mass index (BMI; in kg/m2) was 26.6+/- 4.1. RESULTS: IAF increased with age (ultrasound: r = 0.28; WC: r = 0.25; P < 0.001 for both). Higher IAF, as measured by ultrasound but not by WC, was independently associated with higher metabolic risk factors. The correlation coefficients between IAF measured by ultrasound and plasma glucose, total cholesterol, HDL cholesterol, and triacylglycerol were 0.13, 0.16, -0.13, and 0.25, respectively (all P < 0.001; adjusted for age, sex, and BMI). The corresponding coefficients for IAF measured by WC were 0.17 (P < 0.001) and 0.01, -0.06, and 0.05 (all NS). CONCLUSIONS: These results confirm the findings of computed tomography and magnetic resonance imaging investigations. When IAF is measured by ultrasound, the associations are more pronounced than when WC measurements are used and are independent of BMI. This suggests that IAF can be more reliably assessed by ultrasound measurements than by WC measurements.     

Reduction of patient motion artifacts in digital subtraction angiography: evaluation of a fast and fully automatic technique

The performance of an automatic technique for the reduction of patient motion artifacts in digital subtraction angiography was evaluated. Four observers assessed the quality of 104 cerebral digital subtraction angiographic images that were processed by means of both the automatic technique and manual pixel shifting. The automatic technique resulted in better image quality and was considerably less time-consuming.     

MR-guided balloon angioplasty: In vitro demonstration of the potential of MRI for guiding,monitoring, and evaluating endovascular interventions

The purpose of this study was to demonstrate the potential of MRI for guiding, monitoring, and evaluating endovascular interventions. This was done by investigating the feasibility of MR-guided balloon angioplasty in a stenosed vessel model. Catheters and guidewires were prepared for susceptibility-based MR visualization by incorporating paramagnetic markers into their walls. Near real-time monitoring (up to 1 image/sec) of the interventional procedure was achieved by using a dynamic two-dimensional gradient-echo technique. Devices were localized by on-the-fly subtraction of a baseline image from consecutive dynamic images and by merging the subtraction images with a previously acquired road map. All steps involved in balloon angioplasty, from the introduction and placement of a guidewire to the positioning of a catheter across the stenosis, inflation of the balloon, and dilatation of the stenosis could adequately be monitored with MR fluoroscopy. The beneficial effect of dilatation could be substantiated by a reduction of stenosis-related hypointensities and hyperintensities in the posttreatment MR angiogram as compared to the pretreatment angiogram and by a posttreatment increase of the volumetric flow rate.     

Intraarterial pressure gradients after randomized angioplasty or stenting of iliac artery lesions

Purpose To determine initial technical results of percutaneous transluminal angioplasty (PTA) and stent procedures in the iliac artery, mean intraarterial pressure gradients were recorded before and after each procedure. Methods We randomly assigned 213 patients with typical intermittent claudication to primary stent placement (n=107) or primary PTA (n=106), with subsequent stenting in the case of a residual mean pressure gradient of >10 mmHg (n=45). Eligibility criteria included angiographic iliac artery stenosis (>50% diameter reduction) and/or a peak systolic velocity ratio >2.5 on duplex examination. Mean intraarterial pressures were simultaneously recorded above and below the lesion, at rest and also durign vasodilatation in the case of a resting gradient ≤10 mmHg. Results Pressure gradients in the primary stent group were 14.9±10.4 mmHg before and 2.9±3.5 mmHg after stenting. Pressure gradients in the primary PTA group were 17.3±11.3 mmHg pre-PTA, 4.2±5.4 mmHg post-PTA, and 2.5±2.8 mmHg after selective stenting. Compared with primary stent placement, PTA plus selective stent placement avoided application of a stent in 63% (86/137) of cases, resulting in a considerable cost saving. Conclusion Technical results of primary stenting and PTA plus selective stenting are similar in terms of residual pressure gradients.     

Outcomes in Dieulafoy’s Lesion: A 10-Year Clinical Review

Digestive Diseases and Sciences - Dieulafoy’s lesion (DL) is a rare, but serious cause of gastrointestinal bleeding, most frequently treated with endoscopic therapy. We examined...