We investigated the relationship between the Doppler blood velocity pattern in peroneal and posterior tibial arteries (PER and PTA) and the skin perfusion pressure (SPP) in the dorsal region in 27 patients with peripheral arterial disease in whom the Doppler signal in anterior tibial artery (ATA) was not detected at the ankle level. SPP in the dorsal region was significantly lower in patients representing waveform type C than those with type A and B in PER and PTA. SPP in the dorsal region significantly correlated with resistance index (R.I.) in PER and PTA. Subgroup analysis revealed that Doppler waveform and R.I. in PER more precisely reflect the SPP in the dorsal region than those in PTA in patients with anterograde perfusion in the dorsal artery. In patients with retrograde perfusion in the dorsal artery, Doppler waveform and R.I. in PER and PTA similarly reflect the dorsal SPP. These results suggest that analysis of Doppler blood velocity pattern in PER and PTA may be useful to estimate the SPP in the dorsal region in patients with ATA occlusion. In the case of anterograde perfusion in the dorsal artery, PER may be more suitable to evaluate the dorsal ischemia compared with PTA.
A 37-year-old woman was aware of her right neck pain and tiredness of her right arm when she arose in the morning. Muscle weakness was detected in the right deltoid and bicep brachii muscles. Cervical magnetic resonance angiography showed that the cervical cord was normal, but that the right vertebral artery was occluded. The vascular cavity was found dissected in computed tomography angiography and vertebral artery ultrasonography, and showed string sign in vertebral angiography. We concluded that right C5 nerve compression by vertebral artery dissection caused her right upper extremity muscle weakness.
From April 2005, we started a hospital-based complex decongestive physiotherapy (CDP) education program for lymph edema patients and 139 patients had undergone this program until March 2009. In 6 cases, our CDP education program was abandoned. In the other 133 cases, the CDP education program was completed, and the circumferences of the affected extremities were significantly decreased. These effects of decrease in circumference have been kept in maintenance phases, but the follow up rate was 53.2% in cases more than two years after discharge. It is obvious of the effectiveness of this education program, because the decrease in circumference of the affected limbs has been kept up in the follow up period. It is important to establish a system for continuing the support therapy, and also it is urgent to establish the safety network for the patients who need help.
We studied the treatment provided in 12 patients of ruptured abdominal visceral artery aneurysm with concomitant hemorrhagic shock. Ruptured aneurysm sites were located in the pancreaticoduodenal (6 patients), colic (2 patients), splenic (2 patients), renal (1 patient), and gastroduodenal (1 patient) arteries. Initial emergency treatment including fluid administration and blood transfusion was provided, and contrast-enhanced computed tomography and angiography were performed for all patients. Ten patients were treated by interventional radiology (IVR) with coil embolization, and two patients underwent urgent laparotomy. All 12 patients survived and were discharged without major complications. IVR is an effective and less invasive for treating ruptured visceral artery aneurysms with concomitant hemorrhagic shock. However, it is necessary to consider emergent surgical treatment in cases to difficult to treat with IVR.
The cardio-ankle vascular index (CAVI) assesses newly developed arterial stiffness. The purpose of this study was to investigate the relationship between CAVI and cardiac function and structure. The subjects were 543 consecutive patients who had undergone CAVI measurement and transthoracic Doppler echocardiography in the same day. Patients were divided into 3 groups using CAVI curves to exclude the influence of sex and physiological age; higher than mean+SD (group H), within mean±SD (group M), lower than mean-SD (group L). We measured left ventricular (LV) ejection fraction, transmitral flow velocity and the mitral annular velocity. High CAVI levels were noted as an increased risk factor for atherosclerosis. There was no relationship between CAVI and ejection fraction. In contrast, LV diastolic function was related with the CAVI. The e’ wave, E/A and e’/a’ of group H were significantly lower than group M and group L. Concerning the cardiac structural parameters, CAVI was enhanced in patients with LA dilatation and LV hypertrophy compared with patients without them. From results of the multivariate regression analysis it was confirmed that the CAVI was influenced by age, atherosclerotic risk factors, related e’ wave and LV wall thickness. The study revealed that an increased CAVI was related with LV diastolic dysfunction and remodeling of cardiac structure. Arterial stiffness assessed by CAVI may be a useful parameter to evaluate ventriculo-arterial coupling.
We herein report a case of a renal arteriovenous fistula arising due to blunt trauma. A 61-year-old female was suspected of having a renal artery aneurysm based on a computed tomography (CT) scan performed at the referring hospital. She had hit the right side of her back after slipping from a stage as a child. An abdominal bruit was heard on the right umbilical point, and mild urinary occult blood was observed. Right renal arteriography revealed two consecutive aneurysms from the upper branch, and the inferior vena cava was early enhanced. A renal arteriovenous fistula (AVF) with aneurysmal formation was diagnosed. Coil embolization with balloon occlusion for the AVF was successfully performed without any complications, including fever and renal dysfunction. Coil embolization is therefore considered to be a safe and effective method for treating a renal arteriovenous fistula with aneurysmal formation.
In men, testosterone plays a key role in health. In addition, some research points out the relationship between low testosterone levels and arteriosclerosis. On the other hand, Cardio-Ankle Vascular Index (CAVI) is known to reflect systemic arteriosclerosis independent of blood pressure. Our goal is to clarify the clinical significance of blood testosterone concentration as a cardiovascular risk factor using CAVI. The 252 middle or high aged male subjects without histories of cardiovascular events were enrolled and we examined the relationship of blood free testosterone concentration (F-T) and cardiovascular risk factors including CAVI. There were significant negative correlations between F-T and CAVI. Multiple regression analysis indicated that F-T was selected as the independent variable for CAVI as a subordinate factor. On the other hand, multiple logistic regression analysis indicated that subjects with low F-T (≤7.0 ng/ml) showed 3.0 times higher odds ratio for high value of CAVI (≥9.0) than those with high F-T (≥10.0 ng/ml). Data indicates the close association between F-T and CAVI, suggesting that low blood testosterone concentration is an important factor in the progression of systemic arteriosclerosis.
Accuracy of one minute walking on treadmill exercise test (WT) using automatic measurements of ankle-brachial pressure index (ABI) is not known. Results of 5 and 1 minute WTs were compared with computed tomographic angiography findings in 57 patients who had suspected peripheral arterial occlusive disease (PAD). The sensitivity was 78.8% in both WTs. The specificity was 100% in 5 minute WT, and was 93.8% in 1 minute WT. Since the accuracy of 1 minute WT is almost equal with 5 minute WT, it is useful for a diagnosis of PAD.
Small aorta syndrome (SAS), which express the same meaning “Hypoplastic aortoiliac syndrome,” is an atherosclerotic occlusive disease. SAS has presented a wide range of hypoplasia from abdominal aorta to common iliac artery, particularly in young woman. Myotonic dystrophy is autosomal dominant multisystem disorder with several symptoms, presenting progressive muscular weakness. A 48-year-old woman, complicating with myotonic dystrophy, had complained of right leg pain at rest. MRA revealed severe stenosis in both the right common iliac, the superficial femoral artery and the left superficial femoral artery. We selected EVT for this lesion. At first, PTA ballooning was performed in right superficial femoral artery, and a stent was placed to the right common iliac artery. We experienced the rare case of SAS with myotonic dystrophy.
The purpose of this study was to examine the usefulness of near-infrared spectroscopy (NIRS) for evaluating peripheral vasodilation during reactive hyperemia. Thirty female patients (younger women with mean age of 22 yrs, n=10; middle age women with a men age of 41 yrs, n=10; older women with a mean age of 62 yrs, n=10.) participated in this study. All older women were postmenopausal. Blood pressure (BP) and cardio ankle vascular index (CAVI) were measured at rest and NIRS signals were measured in the forearm during reactive hyperemia after 5 min arterial occlusion. CAVI and recovery time of oxygenated hemoglobin (HbO2) in older women were impaired compared to younger women. Moreover, initial increase in total Hb after cuff deflation indicated total blood volume changes in younger women were significantly greater than older women. There was a significant relationship between HbO2 recovery time and systolic BP. These results indicate that older women exhibit a delayed HbO2 response during reactive hyperemia. We suggest that these alterations in HbO2 kinetics are indicative of microvasculature dysfunction in these subjects and NIRS might be a potential tool to evaluate peripheral vasodilation.