Meta-analysis of the accuracy of contrast-enhanced ultrasound for the detection of endoleak after endovascular aneurysm repair

Objective

The purpose of this systematic review and meta-analysis was to investigate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) for detection of endoleak after endovascular aneurysm repair (EVAR).

Occult aorto-iliac disease in patients with symptomatic coronary artery disease.

BACKGROUND: Atherosclerosis may affect the entire cardiovascular system despite absence of symptoms. Early changes in the wall of the carotid artery have been related to a higher morbidity and mortality from coronary artery disease (CAD). This study was conducted to investigate the relationship between the presence of occult aorto-iliac disease (OAID) and certain risk factors with the severity of CAD. METHODS: Two hundred and eighty-four consecutive patients subjected to coronary angiography (CA) were studied. Additional images of the aorto-iliac arterial segment were taken. Patients with negative CA or symptomatic lower limb arterial disease (LLAD) were excluded from further analysis. In the remaining patients, the risk factors (age, smoking, diabetes mellitus, hypertension, hyperlipidemia and positive family history for atherosclerosis) and the severity of coronary artery disease (CAD) were analyzed in relation to the presence or absence of OAID. RESULTS: Twelve patients with impaired renal function were excluded from the study. Negative CA was found in 12% (32/272) and symptomatic LLAD was present in 14% (37/272). Eligible for further analysis were 203 patients with positive CA and no LLAD. A hundred and ten of them had a positive CA and the presence of OAID whereas the remaining 93 patients had only a positive CA. The patients with OAID had more severe CAD on CA (p=0.003). There was no difference between the two groups concerning age and gender. The most common risk factors in both groups were hypercholesterolemia and a positive family history but with a significantly higher prevalence in the patients with OAID (p=0.008 and p<0.001, respectively). CONCLUSIONS: The presence of OAID in coronary patients was associated with more severe CAD and with a significantly higher prevalence of hypercholesterolemia and positive family history for atherosclerosis. This subset of patients may represent those with more aggressive atherosclerosis.     

The role of hemodynamic measurements in the management of venous and ischemic ulcers

There is a need for quantitative investigations in the vascular laboratory to manage lower extremity ulcers. The majority of leg ulcers are of venous (45%-60%) or arterial origin (10%-20%). Despite the increasing complexity of new devices used in vascular surgical practice, the anklebrachial pressure index (ABPI) remains the cornerstone for the differential diagnosis of ischemic ulcers. The toe-brachial pressure index and the pole test represent attractive alternative tests especially in patients with diabetes. Color flow Doppler imaging (CFDI) is advantageous over ABPI in cases in which wounds and ulcers prevent the use of a cuff by virtue of their size or location; additionally CFDI technology can detect nonflow limiting lesions, lesions to nonaxial arteries such as the deep femoral artery, or lesions limited to a single tibial artery. Continued improvements in the accuracy of CFDI have prompted some vascular surgeons to replace contrast arteriography in distal bypass procedures. Transcutaneous partial oxygen tension measurement (TcPO(2)) is another noninvasive method that is reliable to select the level of amputation and recommended to determine tissue viability in critically ischemic limbs and in the management of the diabetic foot. CFDI has revolutionized the diagnostic approach to venous disorders and it is considered the gold standard for the assessment of the venous system of the lower limb, causes minimal inconvenience to patients, and is easily repeatable, but it is considered highly operator dependent. Various plethysmography techniques are of limited application in ulcer investigations, because of their difficulty to calibrate signal, unless time measurements such as the postexercise refilling time are used.     

Short- and long-term evaluation of arteriovenous fistulas for chronic hemodialysis.

One hundred ninety-three internal arteriovenous (A-V) fistulas were performed on patients with renal failure in the last eleven years. The A-V fistulas were divided on the basis of the following: side-to-side between the radial artery and cephalic vein (157 cases); end-to-side between the cephalic vein and radial artery (11 cases); end-to-end between the radial artery and cephalic vein (5 cases); A-V fistulas between the brachial artery and the cephalic, basilic or medial cubital vein (20 cases). The side-to-side A-V fistulas achieved an immediate patency in 88% of cases, lower than each of the other groups. However, the subsequent long-term failure rate was less than the other groups. In addition, satisfactory function was maintained at a high level (93%) during the follow-up period. The end-to-side and end-to-end A-V fistulas showed higher percentages of immediate patency (90% and 100%, respectively), although they were used more often on patients with vascular problems. Diabetic nephropathy was the main factor associated with thrombosis of A-V fistulas.