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Sample records for human femoral arteries

  1. Flows In Model Human Femoral Arteries

    NASA Technical Reports Server (NTRS)

    Back, Lloyd H.; Kwack, Eug Y.; Crawford, Donald W.

    1990-01-01

    Flow is visualized with dye traces, and pressure measurements made. Report describes experimental study of flow in models of human femoral artery. Conducted to examine effect of slight curvature of artery on flow paths and distribution of pressure.

  2. Distinct Differences on Neointima Formation in Immunodeficient and Humanized Mice after Carotid or Femoral Arterial Injury

    PubMed Central

    Moser, Jill; van Ark, Joris; van Dijk, Marcory C.; Greiner, Dale L.; Shultz, Leonard D.; van Goor, Harry; Hillebrands, Jan-Luuk

    2016-01-01

    Percutaneous coronary intervention is widely adopted to treat patients with coronary artery disease. However, restenosis remains an unsolved clinical problem after vascular interventions. The role of the systemic and local immune response in the development of restenosis is not fully understood. Hence, the aim of the current study was to investigate the role of the human immune system on subsequent neointima formation elicited by vascular injury in a humanized mouse model. Immunodeficient NOD.Cg-PrkdcscidIL2rgtm1Wjl(NSG) mice were reconstituted with human (h)PBMCs immediately after both carotid wire and femoral cuff injury were induced in order to identify how differences in the severity of injury influenced endothelial regeneration, neointima formation, and homing of human inflammatory and progenitor cells. In contrast to non-reconstituted mice, hPBMC reconstitution reduced neointima formation after femoral cuff injury whereas hPBMCs promoted neointima formation after carotid wire injury 4 weeks after induction of injury. Neointimal endothelium and smooth muscle cells in the injured arteries were of mouse origin. Our results indicate that the immune system may differentially respond to arterial injury depending on the severity of injury, which may also be influenced by the intrinsic properties of the arteries themselves, resulting in either minimal or aggravated neointima formation. PMID:27759053

  3. Differential mechanical response and microstructural organization between non-human primate femoral and carotid arteries

    PubMed Central

    Raykin, Julia; Li, Haiyan; Gleason, Rudolph L.

    2014-01-01

    Unique anatomic locations and physiologic functions predispose different arteries to varying mechanical responses and pathologies. However, the underlying causes of these mechanical differences are not well understood. The objective of this study was to first identify structural differences in the arterial matrix that would account for the mechanical differences between healthy femoral and carotid arteries and second to utilize these structural observations to perform a microstructurally motivated constitutive analysis. Femoral and carotid arteries were subjected to cylindrical biaxial loading and their microstructure was quantified using two-photon microscopy. The femoral arteries were found to be less compliant than the carotid arteries at physiologic loads, consistent with previous studies, despite similar extracellular compositions of collagen and elastin (P > 0.05). The femoral arteries exhibited significantly less circumferential dispersion of collagen fibers (P < 0.05), despite a similar mean fiber alignment direction as the carotid arteries. Elastin transmural distribution, in vivo axial stretch, and opening angles were also found to be distinctly different between the arteries. Lastly, we modeled the arteries’ mechanical behaviors using a microstructural-based, distributed collagen fiber constitutive model. With this approach, the material parameters of the model were solved using the experimental microstructural observations. The findings of this study support an important role for microstructural organization in arterial stiffness. PMID:24532266

  4. In vitro quantitation of human femoral artery atherosclerosis using near-infrared Raman spectroscopy

    NASA Astrophysics Data System (ADS)

    Dykes, Ava C.; Anastasiadis, Pavlos; Allen, John S., III; Sharma, Shiv K.

    2012-06-01

    Near-infrared Raman spectroscopy has been used in vitro to identify calcified atherosclerotic plaques in human femoral arteries. Raman techniques allow for the identification of these plaques in a nondestructive manner, which may allow for the diagnosis of coronary artery disease in cardiac patients in the future. As Raman spectroscopy also reveals chemical information about the composition of the arteries, it can also be used as a prognostic tool. The in vivo detection of atherosclerotic plaques at risk for rupture in cardiac patients will enhance treatment methods while improving clinical outcomes for these procedures. Raman spectra were excited by an Invictus 785-nm NIR laser and measured with a fiber-coupled micro-Raman RXN system (Kaiser Optical Systems, Inc., Ann Arbor, MI) equipped with a 785 nm CW laser and CCD detector. Chemical mapping of arteries obtained post mortem allowed for the discrete location of atherosclerotic plaques. Raman peaks at 961 and 1073 cm-1 reveal the presence of calcium hydroxyapatite and carbonate apatite, which are known to be present in calcified plaques. By mapping the locations of these peaks the boundaries of the plaques can be precisely determined. Areas of varying degrees of calcification were also identified. Because this can be useful in determining the degree of plaque calcification and vessel stenosis, this may have a significant impact on the clinical treatment of atherosclerotic plaques in the future.

  5. Continuous blood gas monitoring in femoral arteries

    NASA Astrophysics Data System (ADS)

    Schlain, Les A.; Spar, Steven M.; Dellinger, Bart

    1995-05-01

    Continuous intra-arterial blood gas monitoring is a potentially valuable tool in the surgical and intensive care arenas. Patient oxygenation and acid base status can change rapidly and without warning. The ability to monitor pHa, PaCO2 and PaO2 in arterial blood will be a major medical advance for the anesthesiologist and intensivist. Intra-arterial blood gas sensors are typically placed in radial arteries. In certain patient populations accurate monitoring is not possible in radial arteries due to arterial environmental factors such as hypotension, vasoconstriction and atherosclerotic disease. These same factors can make radial cannulation difficult resulting in traumatic catheter insertion, thereby further compromising flow conditions. In situations where radial artery flow is expected to be compromised, selecting a large vessel for sensor placement is desirable. We report an initial feasibility study of our blood gas monitoring system using the femoral artery as the sensing site. Clinical results are presented as well as potential advantages and disadvantages associated with monitoring in the femoral artery.

  6. Alterations in the rheological flow profile in conduit femoral artery during rhythmic thigh muscle contractions in humans.

    PubMed

    Osada, Takuya; Rådegran, Göran

    2005-02-01

    The present study examined the rheological blood velocity profile in the conduit femoral artery during rhythmic muscle contractions at different muscle forces. Eight healthy volunteers performed one-legged, dynamic knee-extensor exercise at work rates of 5, 10, 20, 30, and 40 W at 60 contractions per minute. The time and space-averaged, amplitude-weighted mean (V(mean)) and maximum (V(max)) blood flow velocities in the common femoral artery were measured during the cardiosystolic phase (CSP) and cardiodiastolic phase (CDP) by the Doppler ultrasound technique. The V(max)/V(mean) ratio was used as a flow profile index, in which a ratio of approximately 1 indicates a "flat velocity flow profile" and a ratio significantly >1 indicates a "parabolic velocity flow profile." At rest, the V(max)/V(mean) ratio was approximately 1.3 and approximately 1.8 during the CSP and CDP, respectively. The V(max)/V(mean) ratio was higher (p < 0.01) during the CDP than during the CSP, both at rest and at all work rates. The V(max)/V(mean) ratio during the CSP was higher (p < 0.01) at 30 and 40 W compared to at rest. The V(max)/V(mean) ratio during the CDP was lower (p < 0.05) at 5 and 10 W compared to at rest. There was a positive linear correlation between blood flow and incremental work rates during both the CSP and CDP, respectively. Thus under resting conditions, the findings indicate a "steeper" parabolic velocity profile during the CDP than during the CSP. The velocity profile during the CDP furthermore shifts to being less "steep" during rhythmic muscle contractions at lower intensities, but to being reelevated and normalized as at rest during higher intensities. The "steepness" of the parabolic velocity profile observed during the CSP at rest increased during muscle contraction at higher intensities. In conclusion, the blood velocity in the common femoral artery is parabolic both at rest and during exercise for both the CSP and CDP, indicating the persistence of laminar flow. The

  7. Three-dimensional T2-weighted MRI of the Human Femoral Arterial Vessel Wall at 3.0Tesla

    PubMed Central

    Zhang, Zhuoli; Fan, Zhaoyang; Carroll, Timothy J.; Chung, YiuCho; Weale, Peter; Jerecic, Renate; Li, Debiao

    2010-01-01

    OBJECTIVES To evaluate the potential use of a novel 3D turbo spin-echo (TSE) T2-weighted (T2w) technique for assessing the vessel wall in the superficial femoral artery at 3.0T. BACKGROUND Magnetic resonance imaging (MRI) can be used for the noninvasive assessment of atherosclerotic plaque burden in the peripheral circulation. While black-blood 2D TSE techniques have been used for femoral arterial wall imaging, these techniques require prolonged imaging time to cover a large field of view required to cover the leg. Recently, variable-flip-angle 3D TSE T2w (SPACE) has been introduced as a fast vessel wall imaging technique with submillimeter spatial resolution. A systematic investigation of the application of this technique to femoral arterial wall imaging has yet to be performed. METHODS Fifteen healthy volunteers and 3 patients with peripheral arterial disease (PAD) underwent 3D SPACE imaging of the superficial femoral artery at 3.0T, with the conventional 2D TSE T2w imaging as a reference. Muscle-lumen contrast to noise ratio (CNR) and wall/lumen volumes (WV, LV) were measured at the matched locations on the 3D and 2D image sets. Statistical comparison on a per-subject basis was conducted to determine the difference and agreement between 3D SPACE and the 2D TSE techniques. RESULTS The 3D SPACE data sets enabled vessel visualization from arbitrary orientation through multi-planar reformation (MPR) technique. Muscle-lumen CNR was significantly higher with 3D SPACE than with the 2D TSE (3.12 ± 0.84 vs. 2.17 ± 0.34, p < 0.01). This trend was confirmed when CNR efficiency (CNReff) values were further compared. A similar trend was observed in PAD patients (SPACE vs. 2D TSE T2w: CNR 2.35 ± 0.13 vs. 1.77 ± 0.25; CNReff 15.35 ± 0.61 vs. 3.59 ± 2.62. all p < 0.05). Measurements of WV and LV from the 3D and 2D techniques were highly correlated in volunteers and PAD patients (volunteers, WV: linear regression r2 = 0.98, LV: r2 = 0.98, p < 0.001 for both; patients, WV

  8. A method to quantify and visualize femoral head intraosseous arteries by micro-CT.

    PubMed

    Qiu, Xing; Shi, Xiaotian; Ouyang, Jun; Xu, Dachuan; Zhao, Dewei

    2016-08-01

    We describe a technique for perfusing a barium sulphate suspension into the intraosseous artery. Following the perfusion of abarium sulphate suspension into 14 fresh lower limbs of Chinese cadavers, micro-CT scanning was applied to digitize, quantify and visualize the intraosseous arteries in the human femoral heads. Then, the femoral heads were removed and subjected to micro-CT scanning. The data were imported into the amira and mimics programs to reconstruct and quantify the intraosseous arteries. The femoral head intraosseous artery lengths, areas, volumes, and femoral head bone volumes were quantified. The artery densities and artery ratios were calculated and analysed with independent-samples t-tests. The intraosseous vasculature volume renderings were displayed as screenshots and videos made with amira. Many intraosseous artery study technologies were compared. The barium sulphate suspension was milky white in colour. The perfusion of the barium sulphate suspension followed by micro-CT scanning provided a good representation of the intraosseous artery. The femoral head intraosseous artery lengths, areas and volumes, and the femoral head bone volumes were displayed as the X¯±S . No differences were observed between the left and right femoral head intraosseous arteries in terms of the artery densities or artery ratios. The volume renderings and 3-D orthogonal projections displayed the overall distributions of the intraosseous arteries. The videos clearly demonstrated the entry sites of the nutrition-carrying arteries, their courses and branches, and the intraosseous arterial anastomoses. Our technique is the simplest and least time-consuming method of producing accurate vascular three-dimensional reconstructions. The perfusion of a barium sulphate suspension into intraosseous arteries combined with micro-CT scanning can deliver high-resolution 3-D digitized data and images of intraosseous arteries. This technique does not require bone decalcification or bone

  9. The terminal branches of the medial femoral circumflex artery: the arterial supply of the femoral head.

    PubMed

    Lazaro, L E; Klinger, C E; Sculco, P K; Helfet, D L; Lorich, D G

    2015-09-01

    This study investigates and defines the topographic anatomy of the medial femoral circumflex artery (MFCA) terminal branches supplying the femoral head (FH). Gross dissection of 14 fresh-frozen cadaveric hips was undertaken to determine the extra and intracapsular course of the MFCA's terminal branches. A constant branch arising from the transverse MFCA (inferior retinacular artery; IRA) penetrates the capsule at the level of the anteroinferior neck, then courses obliquely within the fibrous prolongation of the capsule wall (inferior retinacula of Weitbrecht), elevated from the neck, to the posteroinferior femoral head-neck junction. This vessel has a mean of five (three to nine) terminal branches, of which the majority penetrate posteriorly. Branches from the ascending MFCA entered the femoral capsular attachment posteriorly, running deep to the synovium, through the neck, and terminating in two branches. The deep MFCA penetrates the posterosuperior femoral capsular. Once intracapsular, it divides into a mean of six (four to nine) terminal branches running deep to the synovium, within the superior retinacula of Weitbrecht of which 80% are posterior. Our study defines the exact anatomical location of the vessels, arising from the MFCA and supplying the FH. The IRA is in an elevated position from the femoral neck and may be protected from injury during fracture of the femoral neck. We present vascular 'danger zones' that may help avoid iatrogenic vascular injury during surgical interventions about the hip.

  10. [Isolated true aneurysm of the deep femoral artery].

    PubMed

    Salomon du Mont, L; Holzer, T; Kazandjian, C; Saucy, F; Corpataux, J M; Rinckenbach, S; Déglise, S

    2016-07-01

    Aneurysms of the deep femoral artery, accounting for 5% of all femoral aneurysms, are uncommon. There is a serious risk of rupture. We report the case of an 83-year-old patient with a painless pulsatile mass in the right groin due to an aneurysm of the deep femoral artery. History taking revealed no cardiovascular risk factors and no other aneurysms at other localizations. The etiology remained unclear because no recent history of local trauma or puncture was found. ACT angiography was performed, revealing a true isolated aneurysm of the deep femoral artery with a diameter of 90mm, beginning 1cm after its origin. There were no signs of rupture or distal emboli. Due to unsuitable anatomy for an endovascular approach, the patient underwent open surgery, with exclusion of the aneurysm and interposition of an 8-mm Dacron graft to preserve deep femoral artery flow. Due to their localization, the diagnosis and the management of aneurysms of the deep femoral artery can be difficult. Options are surgical exclusion or an endovascular approach in the absence of symptoms or as a bridging therapy. If possible, blood flow to the distal deep femoral artery should be maintained, the decision depending also on the patency of the superficial femoral artery. In case of large size, aneurysms of the deep femoral artery should be treated without any delay.

  11. Incomplete transposition of the common femoral artery and vein.

    PubMed

    Leite, J O; Carvalho Ventura, I; Botelho, F E; Costa Galvao, W

    2010-02-01

    Anatomical variations of the great saphenous vein, femoral artery and femoral vein at the inguinal level are rare. Modifications in the anatomical relationships among theses vessel can cause technical difficulties. There are two reports in the literature of the complete transposition of the femoral artery and vein. Both patients had large varicose veins only in the limb that presented the variation, which suggested an extrinsic compression. In the present paper, we report a case study of a patient with an incomplete transposition of the femoral artery and vein. Specifically, the common femoral vein and the saphenofemoral junction were completely overlapped by the common femoral artery. Although this anatomical variation did not present any clinical signs, it required a more complex surgical procedure.

  12. Anatomy of the medial femoral circumflex artery with respect to the vascularity of the femoral head.

    PubMed

    Zlotorowicz, M; Szczodry, M; Czubak, J; Ciszek, B

    2011-11-01

    We performed a series of 16 anatomical dissections on Caucasian cadaver material to determine the surgical anatomy of the medial femoral circumflex artery (MFCA) and its anastomoses. These confirmed that the femoral head receives its blood supply primarily from the MFCA via a group of posterior superior nutrient arteries and the posterior inferior nutrient artery. In terms of anastomoses that may also contribute to the blood supply, the anastomosis with the inferior gluteal artery, via the piriformis branch, is the most important. These dissections provide a base of knowledge for further radiological studies on the vascularity of the normal femoral head and its vascularity after dislocation of the hip.

  13. Endovascular Treatment of a Ruptured Profunda Femoral Artery Branch After Fogarty Thrombectomy of a Femoro-Femoral Crossover Arterial Graft: A Case Report and Review of the Literature

    SciTech Connect

    Manousaki, Eirini; Tsetis, Dimitrios; Kostas, Theodoros; Katsamouris, Asterios

    2010-02-15

    We present a very rare case of a life-threatening rupture of a profunda femoral artery distal branch after a Fogarty thrombectomy of a thrombosed crossover synthetic graft between the ipsilateral common femoral artery and a contralateral iliac-popliteal graft; the bleeding profunda femoral artery branch was successfully embolized with metallic coils through the axillary artery approach.

  14. Defining the common femoral artery: Insights from the femoral arterial access with ultrasound trial.

    PubMed

    Seto, Arnold H; Tyler, Jeffrey; Suh, William M; Harrison, Alexander T; Vera, Jesus A; Zacharias, Soni J; Daly, Timothy S; Sparling, Jeffrey M; Patel, Pranav M; Kern, Morton J; Abu-Fadel, Mazen

    2017-06-01

    We sought to establish the typical location of the common femoral artery (CFA) bifurcation, the origin and most inferior reflection of the inferior epigastric artery (IEA) relative to the femoral head (FH) and whether patient demographics predicted anatomical variations. In the absence of ultrasound guidance or prior imaging, the precise location of the CFA bifurcation and IEA can only be determined following access site angiography. Fluoroscopic landmarks are commonly used to estimate the location of the CFA bifurcation, but the position of the IEA is less well characterized. Prospectively collected data on 989 patients with femoral angiography in the FAUST trial were analyzed. The level of CFA bifurcation and the origin and most inferior reflection of the IEA were classified by angiography. Logistic regression was used to explore whether baseline demographics were associated with anatomic variations. The CFA bifurcation occurs below the middle 1/3(rd) of the femoral head in 95% of patients, and no patient factors are predictive of a high bifurcation. The IEA origin has a more variable anatomically pattern, with high BSA, male gender, and white race associated with a low IEA origin. Operators should attempt to access the CFA at the level of the middle 1/3(rd) of the FH to maximize the chance of CFA cannulation. However, this location carries an 11% risk of being at or above the IEA origin. Baseline demographics were of limited utility for predicting anatomic variants of the CFA bifurcation and the course of the IEA. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  15. Intimal sarcoma of the superficial femoral artery with osteosarcomatous differentiation.

    PubMed

    Ebaugh, James L; Yuan, Minsheng; Hu, Jeffery; Chen, Ahchean; Raffetto, Joseph D

    2011-05-01

    Sarcomas of the large vessels usually present centrally in the aorta, pulmonary artery, and inferior vena cava. Peripheral arterial sarcomas are exceptionally rare. They have been reported in the iliac and common or profunda femoral arteries, and are frequently undifferentiated. In this study, we describe a differentiated intimal sarcoma of the superficial femoral artery with abundant osteosarcoma within the specimen. Before knowing the diagnosis, treatment was for a presumed pseudoaneurysm using excision and bypass. Postoperatively, the patient received palliative radiation therapy. The tumor's location and histopathology are unique. A differentiated intimal sarcoma has never been reported in the superficial femoral artery, and it represents the second peripheral arterial intimal sarcoma reported with osteosarcomatous differentiation.

  16. Hemodynamic analysis of a compliant femoral artery bifurcation model using a fluid structure interaction framework.

    PubMed

    Kim, Young-Ho; Kim, Jong-Eun; Ito, Yasushi; Shih, Alan M; Brott, Brigitta; Anayiotos, Andreas

    2008-11-01

    The influence of wall motion on the hemodynamic characteristics of the human femoral bifurcation and its effects on the development of peripheral artery disease has not been previously investigated. This study aimed in investigating the hemodynamics of a compliant patient-specific femoral artery bifurcation model by a fluid structure interaction (FSI) scheme. The complex physiological geometry of the femoral artery bifurcation was reproduced from sequentially obtained transverse CT scan images. Velocity waveforms derived from phase contrast MR images were extracted and mapped to define boundary conditions. Equations governing blood flow and wall motion were solved using an FSI framework that utilizes commercial codes: FLUENT for computational fluid dynamics and ANSYS for computational structural dynamics. The results showed that wall compliance decreased flow velocities at the relatively high curvature geometries including common and superficial femoral artery (SFA), and it created strong recirculation in the profunda femoris artery close to the bifurcation. In the SFA region near the apex, time averaged wall shear stress (TAWSS) differences up to 25% between compliant and rigid models were observed. The compliant model also exhibited lower TAWSS and oscillatory shear at the superior section of the common femoral artery close to the bifurcation. The presence of wall motion, however, created minor differences in the general flow-field characteristics. We conclude that wall motion does not have significant influence on the global fluid dynamic characteristics of the femoral artery bifurcation. Longer arterial segments need to be simulated to see the effect of wall motion on tortuousity which was previously cited as an important factor in the development of atherosclerosis at the femoral artery.

  17. Nitinol Self-Expanding Stents for the Superficial Femoral Artery.

    PubMed

    Nathan, Ashwin; Kobayashi, Taisei; Giri, Jay

    2017-04-01

    The superficial femoral artery is a complex artery subject to a unique set of biomechanical loading conditions in its course through the leg. Plain balloon angioplasty and balloon-expandable stents had unacceptably high rates of restenosis, necessitating target vessel revascularization. Nitinol alloy is well suited to provide the strength and flexibility needed of stents to withstand the external forces posed by the environment of the superficial femoral artery. Advances in stent technology with the addition of a slow-releasing antiproliferative agent and changes in scaffold design have shown promise in reducing the rates of stent fracture and in-stent restenosis. Published by Elsevier Inc.

  18. In vitro angioplasty of atherosclerotic human femoral arteries: analysis of the geometrical changes in the individual tissues using MRI and image processing.

    PubMed

    Auer, Martin; Stollberger, Rudolf; Regitnig, Peter; Ebner, Franz; Holzapfel, Gerhard A

    2010-04-01

    Existing atherosclerotic plaque imaging techniques such as intravascular ultrasound, multidetector computed tomography, optical coherence tomography, and high-resolution magnetic resonance imaging (hrMRI) require computerized methods to separate and analyze the plaque morphology. In this work, we perform in vitro balloon angioplasty experiments with 10 human femoral arteries using hrMRI and image processing. The vessel segments contain low-grade to high-grade lesions with very different plaque compositions. The experiments are designed to mimic the in vivo situation. We use a semi-automatic image processing tool to extract the three-dimensional (3D) geometries of the tissue components at four characteristic stages of the angioplasty procedure. The obtained geometries are then used to determine geometrical and mechanical indices in order to characterize, classify, and analyze the atherosclerotic plaques by their specific geometrical changes. During inflation, three vessels ruptured via helical crack propagation. The adventitia, media, and intima did not preserve their area/volume during inflation; the area changes of the lipid pool during inflation were significant. The characterization of changes in individual 3D tissue geometries, together with tissue-specific mechanical properties, may serve as a basis for refined finite element (FE) modeling, which is key to better understand stress evolution in various atherosclerotic plaque configurations.

  19. Percutaneous femoral arterial and venous catheterisation during neonatal intensive care.

    PubMed

    Wardle, S P; Kelsall, A W; Yoxall, C W; Subhedar, N V

    2001-09-01

    Femoral vessel catheterisation is generally avoided in the neonatal period because of technical difficulties and the fear of complications. To review the use of femoral arterial and venous catheters inserted percutaneously on the neonatal intensive care unit. Infants admitted to one of two regional neonatal intensive care units who underwent femoral vessel catheterisation were identified. Information collected included basic details, indication for insertion of catheter, type of catheter and insertion technique, duration of use, and any catheter related complications. Sixty five femoral catheters were inserted into 53 infants. The median gestational age was 29 weeks (range 23-40). Twenty three femoral arterial catheters (FACs) were inserted into 21 infants and remained in situ for a median of three days (range one to eight). Twelve (52%) FACs remained in place until no longer required, and four (17%) infants developed transient ischaemia of the distal limb. Forty two femoral venous catheters (FVCs) were inserted into 40 infants and remained in situ for a median of seven days (range 1-29). Twenty seven (64%) FVCs remained in place until no longer required, and eight (19%) catheters were removed because of catheter related bloodstream infection. FACs and FVCs are useful routes of vascular access in neonates when other sites are unavailable. Complications from femoral vessel catheterisation include transient lower limb ischaemia with FACs and catheter related bloodstream infection.

  20. Percutaneous femoral arterial and venous catheterisation during neonatal intensive care

    PubMed Central

    Wardle, S; Kelsall, A; Yoxall, C; Subhedar, N

    2001-01-01

    BACKGROUND—Femoral vessel catheterisation is generally avoided in the neonatal period because of technical difficulties and the fear of complications.
AIM—To review the use of femoral arterial and venous catheters inserted percutaneously on the neonatal intensive care unit.
METHODS—Infants admitted to one of two regional neonatal intensive care units who underwent femoral vessel catheterisation were identified. Information collected included basic details, indication for insertion of catheter, type of catheter and insertion technique, duration of use, and any catheter related complications.
RESULTS—Sixty five femoral catheters were inserted into 53 infants. The median gestational age was 29 weeks (range 23-40). Twenty three femoral arterial catheters (FACs) were inserted into 21infants and remained in situ for a median of three days (range one to eight). Twelve (52%) FACs remained in place until no longer required, and four (17%) infants developed transient ischaemia of the distal limb. Forty two femoral venous catheters (FVCs) were inserted into 40 infants and remained in situ for a median of seven days (range 1-29). Twenty seven (64%) FVCs remained in place until no longer required, and eight (19%) catheters were removed because of catheter related bloodstream infection.
CONCLUSIONS—FACs and FVCs are useful routes of vascular access in neonates when other sites are unavailable. Complications from femoral vessel catheterisation include transient lower limb ischaemia with FACs and catheter related bloodstream infection.

 PMID:11517206

  1. [Femoral artery pseudoaneurysms encountered in orthopedics and traumatology].

    PubMed

    Raherinantenaina, F; Rajaonanahary, T M A; Rakoto Ratsimba, H N

    2015-12-01

    Most published articles regarding orthopedic- and trauma-related femoral artery pseudoaneurysms (FAPs) are case reports in English. Reported cases are often associated with a literature review but actually provide little robust data. We wanted to summarize the current knowledge on diagnostic and therapeutic features of these FAPs. A new case of superficial FAP is described followed by a review of the literature. A bibliographic search was performed online (PubMed, ScinceDirect) from 1964 to 2015 using the descriptors "traumatic femoral pseudoaneurysm, orthopedic surgery, osteochondroma". A total of 64 cases of FAPs was analyzed. There were 50 men with an average age of 40.72±26.45 years old. The most common clinical presentation was painful swelling (34%). Arteriography was the commonest radiological investigation used (63%). The main etiologies were orthopedic injuries (47%), surgery of the upper thigh (30%) and femoral osteochondromas (23%). Arterial injuries included superficial femoral (47%) and profunda femoris artery (50%). The treatment was open surgery (56%) or endovascular repair (36%). Deep femoral artery and its branches were embolized (47%) or ligated (38%). Endovascular stenting was performed in 30% of posttraumatic FAPs. All FAPs relating to osteochondromas were repaired surgically. Postoperative courses were uneventful in 95% of patients. Endovascular embolization is preferred in management of postsurgical FAPs which have usually involved the deep femoral artery. Endovascular stenting graft may be proposed for posttraumatic FAPs, for which the superficial femoral trunk is the most often involved vessel. Surgical repair should be performed when endovascular stenting graft is not feasible. Surgical repair is mandatory for all FAPs secondary to traumatic exostoses. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  2. Iatrogenic brachial and femoral artery complications following venipuncture in children.

    PubMed

    Dogan, Omer Faruk; Demircin, Metin; Ucar, Ibrahim; Duman, Umit; Yilmaz, Mustafa; Boke, Erkmen

    2006-01-01

    Catheter- or noncatheter-related peripheral arterial complications such as arterial pseudoaneurysm, embolus, or arteriovenous fistula may be seen in the pediatric age group. The most common etiologies defined for arterial complications are peripheral arterial puncture performed for a routine arterial blood gas analysis, arterial catheters placed for invasive monitorization of children, or catheterization performed for diagnostic purposes through the peripheral arterial system, most commonly the femoral artery. Nine children with peripheral arterial complications, whose ages varied between 2 months and 2.5 years, were enrolled in this study. All patients were treated surgically. Following physical examination, Doppler ultrasonography, computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography were used as diagnostic tools. We studied thrombophilic panels preoperatively. Six patients had brachial artery pseudoaneurysms that developed accidentally during venipuncture, I had a brachial arteriovenous fistula that developed after an accidental brachial artery puncture during routine peripheral blood analysis. In the remaining 2 patients, peripheral arterial embolic events were detected. One had a left brachial arterial embolus and the other had a sudden onset right femoral artery embolus that was detected via diagnostic interventions. No morbidity such as amputation, extremity loss, or mortality occurred due to the arterial events or surgery. All patients were discharged from the hospital in good clinical condition. In all patients, follow-up at 3 or 6 months revealed palpable peripheral artery pulsations of the ulnar and radial arteries at wrist level. Because the incidence of peripheral arterial complications is relatively low in children compared to adults, the diagnostic and therapeutic approaches are extrapolated from the adult guidelines. We proposed that early diagnosis and surgical approach prevented the complications from

  3. Medial circumflex femoral artery flap for ischial pressure sore

    PubMed Central

    Palanivelu, S.

    2009-01-01

    A new axial pattern flap based on the terminal branches of the medial circumflex femoral artery is described for coverage of ischial pressure sore. Based on the terminal branches of the transverse branch of medial circumflex femoral artery, which exit through the gap between the quadratus femoris muscle above and the upper border of adductor magnus muscle below, this fascio cutaneous flap is much smaller than the posterior thigh flap but extremely useful to cover ischeal pressure sores. The skin redundancy below the gluteal fold allows a primary closure of the donor defect. It can also be used in combination with biceps femoris muscle flap. PMID:19881020

  4. Dissociation between the time courses of femoral artery blood flow and pulmonary VO2 during repeated bouts of heavy knee extension exercise in humans.

    PubMed

    Fukuba, Yoshiyuki; Ohe, Yukie; Miura, Akira; Kitano, Asami; Endo, Masako; Sato, Hironori; Miyachi, Motohiko; Koga, Shunsaku; Fukuda, Osamu

    2004-05-01

    It has frequently been demonstrated that prior heavy cycling exercise facilitates pulmonary O(2) kinetics at the onset of subsequent heavy exercise. This might be due to improved muscle perfusion via acidosis-induced vasodilating effects. However, it is difficult to measure the blood flow (BF) to the working muscles (via the femoral artery) during cycling exercise. We therefore selected supine knee extension (KE) exercise as an alternative, and investigated whether the faster O(2) kinetics in the 2nd bout was matched by proportionally faster BF kinetics to the exercising muscle. Nine healthy subjects (aged 21-44 years) volunteered to participate in this study. The protocol consisted of two consecutive 6-min KE exercise bouts in a supine position (work rate: 70-75% of peak power) separated by a 6-min baseline rest (EX1 to EX2). During the protocol, a pulsed Doppler ultrasound technique was utilized to continuously measure the BF in the right femoral artery. The protocol was repeated at least 6 times to characterize the precise kinetics. In agreement with previous studies using cycling exercise, the O(2) kinetics in the 2nd bout were facilitated compared with that in the 1st bout [mean +/-s.d. of the 'effective' time constant (tau): EX1, 68.6 +/- 15.9, versus EX2, 58.0 +/- 14.4 s. Phase II-tau: EX1, 48.7 +/- 9.0, versus EX2, 41.2 +/- 13.3 s. Empirical index of the slow component (Delta O(2(6-3))): EX1, 78 +/- 44, versus EX2, 57 +/- 36 ml min(-1) (P < 0.05)]. However, no substantial difference was observed for the facilitation of the femoral artery BF response to the 1st and 2nd exercise bouts [i.e. the 'effective'tau of the femoral artery BF: EX1, 40.8 +/- 16.9, versus EX2, 39.0 +/- 17.1 s (P > 0.05)]. It was concluded that the faster pulmonary O(2) kinetics during heavy KE exercise following prior heavy exercise was not associated with a similar modulation in the BF to the working muscles.

  5. Using simulation for teaching femoral arterial access: A multicentric collaboration.

    PubMed

    Gurm, Hitinder S; Sanz-Guerrero, Jorge; Johnson, Daniel D; Jensen, Andrea; Seth, Milan; Chetcuti, Stanley J; Lalonde, Thomas; Greenbaum, Adam; Dixon, Simon R; Shih, Albert

    2016-02-15

    To assess the impact of simulation training on complications associated with femoral arterial access obtained by first year cardiology fellows. Prior studies demonstrate a higher incidence of arterial access related complications among patients undergoing invasive cardiac procedures. First year cardiology fellows at four teaching hospitals in Michigan tracked their femoral access experience and any associated complications between July 2011 and June 2013. Fellows starting their academic training in July 2012 were first trained on a specially developed simulator before starting their rotation in the catheterization laboratory. The primary outcome was access proficiency, defined as five successful femoral access attempts without any complication or need to seek help from a more experienced team member. A total of 1,278 femoral access attempts were made by 21 fellows in 2011-2012 compared with 869 femoral access attempts made by 21 fellows in 2012-2013. There was a lower rate of access related complications in patients undergoing access attempts by first year fellows in year 2 compared with year 1 (2.1% versus 4.5%, P = 0.003). The number of procedures to achieve procedural proficiency was significantly higher in year 1 compared with year 2 (median 20 versus 10, P = 0.007). Incorporation of simulation in the training of first year fellows was associated with an improvement in proficiency and a clinically meaningful reduction in vascular complications. © 2015 Wiley Periodicals, Inc.

  6. The True Deep Femoral Artery Aneurysm: A Case Report

    PubMed Central

    Jang, Lee Chan; Park, Sung Su

    2017-01-01

    A 55-year-old man with a palpable pulsatile mass and pain in his left thigh was presented to us. He had no history of trauma in his left leg, interventions, operation, or medical diseases, including cardiac valve disease, endocarditis, and systemic infection. The size of the aneurysm was 10 cm×7 cm with a mural thrombus in ultrasonography and multidetector computer tomography. There was no evidence of other aneurysms or occlusive lesions in the other arteries. The aneurysm was resected without a vascular reconstruction of the deep femoral artery. The patient’s symptom improved rapidly. The patient had an uneventful postoperative recovery without complications. We report a case of true deep femoral artery aneurysm, which was successfully treated with resection of an aneurysm without a vascular reconstruction. PMID:28377912

  7. Sphingosine-1-phosphate receptor 3 promotes neointimal hyperplasia in mouse iliac-femoral arteries

    PubMed Central

    Shimizu, Takuya; De Wispelaere, Allison; Winkler, Martin; D’Souza, Travis; Caylor, Jacob; Chen, Lihua; Dastvan, Frank; Deou, Jessie; Cho, Aesim; Larena-Avellaneda, Axel; Reidy, Michael; Daum, Guenter

    2012-01-01

    Objective The objective of this study is to define a role for S1PR3 in intimal hyperplasia. Methods and Results A denudation model of the iliac-femoral artery in wild-type and S1PR3-null mice was used to define a role for S1PR3 in the arterial injury response because we found in humans and mice that expression of S1PR3 is higher in these arteries when compared to carotid arteries. At 28 days after surgery, wild-type arteries form significantly larger lesions than S1PR3-null arteries. BrdU labeling experiments demonstrate that upon injury, wild-type arteries exhibit higher medial as well as intimal proliferation than S1PR3-null arteries. Because S1PR3 expression in vitro is low, we expressed S1PR3 in S1PR3-null SMCs using retroviral-mediated gene transfer to study S1PR3 effects on cell functions and signaling. SMCs expressing S1PR3, but not vector-transfected controls, respond to S1P stimulation with activation of Rac, Erk and Akt. SMCs expressing S1PR3 also grow migrate more. Conclusion In humans and mice, S1PR3 expression is higher in iliac-femoral arteries compared to carotid arteries. S1PR3 promotes neointimal hyperplasia upon denudation of iliac-femoral arteries in mice, likely by stimulating cell migration and proliferation through activation of signaling pathways involving Erk, Akt and Rac. PMID:22308044

  8. Simulation of human atherosclerotic femoral plaque tissue: the influence of plaque material model on numerical results

    PubMed Central

    2015-01-01

    Background Due to the limited number of experimental studies that mechanically characterise human atherosclerotic plaque tissue from the femoral arteries, a recent trend has emerged in current literature whereby one set of material data based on aortic plaque tissue is employed to numerically represent diseased femoral artery tissue. This study aims to generate novel vessel-appropriate material models for femoral plaque tissue and assess the influence of using material models based on experimental data generated from aortic plaque testing to represent diseased femoral arterial tissue. Methods Novel material models based on experimental data generated from testing of atherosclerotic femoral artery tissue are developed and a computational analysis of the revascularisation of a quarter model idealised diseased femoral artery from a 90% diameter stenosis to a 10% diameter stenosis is performed using these novel material models. The simulation is also performed using material models based on experimental data obtained from aortic plaque testing in order to examine the effect of employing vessel appropriate material models versus those currently employed in literature to represent femoral plaque tissue. Results Simulations that employ material models based on atherosclerotic aortic tissue exhibit much higher maximum principal stresses within the plaque than simulations that employ material models based on atherosclerotic femoral tissue. Specifically, employing a material model based on calcified aortic tissue, instead of one based on heavily calcified femoral tissue, to represent diseased femoral arterial vessels results in a 487 fold increase in maximum principal stress within the plaque at a depth of 0.8 mm from the lumen. Conclusions Large differences are induced on numerical results as a consequence of employing material models based on aortic plaque, in place of material models based on femoral plaque, to represent a diseased femoral vessel. Due to these large

  9. Numerical simulation of blood flow in femoral perfusion: comparison between side-armed femoral artery perfusion and direct femoral artery perfusion.

    PubMed

    Kitamura, Shingo; Shirota, Minori; Fukuda, Wakako; Inamura, Takao; Fukuda, Ikuo

    2016-12-01

    Computational numerical analysis was performed to elucidate the flow dynamics of femoral artery perfusion. Numerical simulation of blood flow was performed from the right femoral artery in an aortic model. An incompressible Navier-Stokes equation and continuity equation were solved using computed flow dynamics software. Three different perfusion models were analyzed: a 4.0-mm cannula (outer diameter 15 French size), a 5.2-mm cannula (18 French size) and an 8-mm prosthetic graft. The cannula was inserted parallel to the femoral artery, while the graft was anastomosed perpendicular to the femoral artery. Shear stress was highest with the 4-mm cannula (172 Pa) followed by the graft (127 Pa) and the 5.2-mm cannula (99 Pa). The cannula exit velocity was high, even when the 5.2-mm cannula was used. Although side-armed perfusion with an 8-mm graft generated a high shear stress area near the point of anastomosis, flow velocity at the external iliac artery was decreased. The jet speed decreased due to the Coanda effect caused by the recirculation behind sudden expansion of diameter, and the flow velocity maintains a constant speed after the reattachment length of the flow. This study showed that iliac artery shear stress was lower with the 5.2-mm cannula than with the 4-mm cannula when used for femoral perfusion. Side-armed graft perfusion generates a high shear stress area around the anastomotic site, but flow velocity in the iliac artery is slower in the graft model than in the 5.2-mm cannula model.

  10. Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals

    PubMed Central

    Godoi, Emmanuelle Tenório Albuquerque Madruga; Brandt, Carlos Teixeira; Lacerda, Heloisa Ramos; Godoi, Jocelene Tenório Albuquerque Madruga; de Oliveira, Dinaldo Cavalcanti; Costa, Gabriela Farias Araujo Sousa; dos Santos Junior, Gerson Gomes; Leite, Kaliene Maria Estevão; Godoi, Juannicelle Tenório Albuquerque Madruga; de Vasconcelos, Adriana Ferraz

    2017-01-01

    Background The prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population. Objectives To assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls. Methods Eighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant. Results An IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]). Conclusion In HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects. PMID:28146208

  11. Early atherosclerotic lesions spiraling through the femoral artery.

    PubMed

    Wensing, P J; Meiss, L; Mali, W P; Hillen, B

    1998-10-01

    Atherosclerosis is common in the adductor hiatus region. The aim of this study was to evaluate atherosclerosis in relation to themorphological structure of the femoropopliteal region. Two anatomic features are thought to play an important role in the origin of these lesions: (1) curvature of the vessel, which may lead to unfavorable local hemodynamic factors that change during leg flexion; and (2) abrupt changes in stiffness of surrounding tissues of the vessel. The distal part of 23 postmortem femoral arteries were investigated. Cross sections were obtained every 1 mm over a length of 100 mm. For each cross section, lesion thickness was measured at 12 points along the circumference of the vessel. No apparent relation was found between surrounding structures of the femoral artery and location of atherosclerotic lesions. Three-dimensional reconstructions showed that atherosclerotic lesions were spiraling through the artery in 18 of 23 cases. Spiraling atherosclerotic lesions may be consistent with expected flow patterns in this part of the femoral artery.

  12. Septic arthritis of the hip after percutaneous femoral artery catheterization.

    PubMed

    Backstein, David; Hutchison, Carol; Gross, Allan

    2002-12-01

    Infection of the hip joint can cause severe articular damage. Standard treatment of septic arthritis includes surgical débridement and intravenous antibiotics. Options for definitive management in the presence of joint destruction include excision arthroplasty, arthrodesis, and total hip arthroplasty. Two cases of septic arthritis of the hip as a complication of femoral artery cannulation are presented. These cases highlight a potential complication that may not be readily appreciated by clinicians who routinely perform femoral vascular cannulation. After all evidence of ongoing infection had disappeared, both cases ultimately were treated with total hip arthroplasty. Both patients have improved function and pain at 2.5 and 5 years of follow-up. Given the frequency with which femoral intravascular catheters are used in numerous procedures, methods of avoiding infection of the hip joint must be implemented. These 2 cases emphasize the potential risks of these procedures and show management with total hip arthroplasty. Copyright 2002, Elsevier Science (USA). All rights reserved.

  13. High-Permittivity Thin Dielectric Padding Improves Fresh Blood Imaging of Femoral Arteries at 3T

    PubMed Central

    Lindley, Marc D; Kim, Daniel; Morrell, Glen; Heilbrun, Marta E; Storey, Pippa; Hanrahan, Christopher J; Lee, Vivian S

    2014-01-01

    Objectives Fresh blood imaging (FBI) is a useful non-contrast magnetic resonance angiography (NC-MRA) method for assessment of peripheral arterial disease (PAD), particularly in patients with poor renal function. Compared with 1.5T, 3T enables higher signal to noise ratio (SNR) and/or spatio-temporal resolution in FBI, as demonstrated successfully for the calf station. However, FBI of the thigh station at 3T has been reported to suffer from signal void in the common femoral artery of one thigh only due to the radial symmetry in transmit radio-frequency field (B1+) variation. We sought to increase the femoral arterial signal attenuated by B1+ variation in FBI at 3T using high permittivity dielectric padding. Materials and Methods We performed FBI of the thigh station in 13 human subjects at 3T to compare the following 3 settings: no padding, commercially available thick (~ 5 cm) dielectric padding, and high-permittivity thin (~2 cm) dielectric padding. B1+ mapping was also performed in the common femoral arteries to characterize the radial symmetry in B1+ variation and quantify the improvement in B1+ excitation. We characterized the impact of radial symmetry in B1+ variation on the FBI signal and FBI MRA of the right common femoral artery using quantitative (i.e., contrast-to-noise ratio (CNR)) and qualitative (i.e., conspicuity) analyses. Results The radial symmetry in B1+ variation attenuates signal in the right common femoral artery, which can be partially improved with commercial padding and improved further with high permittivity padding. Averaging the results over 13 subjects, the B1+, CNR and conspicuity scores in the right common femoral artery were significantly better with high-permittivity padding than with commercial padding and baseline (p<0.001). Conclusions Our study shows that high-permittivity dielectric padding can be used to increase the femoral arterial signal attenuated by B1+ variation in FBI at 3T. PMID:25329606

  14. Endovascular Treatment of Complications of Femoral Arterial Access

    SciTech Connect

    Tsetis, Dimitrios

    2010-06-15

    Endovascular repair of femoral arterial access complications is nowadays the treatment of choice in a group of patients who cannot tolerate vascular reconstruction and bleeding due to advanced cardiovascular disease. Endovascular procedures can be performed under local anesthesia, are well tolerated by the patient, and are associated with a short hospitalization time. Ninitinol stent technology allows for safe stent and stent-graft extension at the common femoral artery (CFA) level, due to increased resistance to external compression and bending stress. Active pelvic bleeding can be insidious, and prompt placement of a stent-graft at the site of leakage is a lifesaving procedure. Percutaneous thrombin injection under US guidance is the treatment of choice for femoral pseudoaneurysms (PAs); this can theoretically be safer with simultaneous balloon occlusion across the entry site of a PA without a neck or with a short and wide neck. In a few cases with thrombin failure due to a large arterial defect or accompanying arteriovenous fistula (AVF), a stent-graft can be deployed. The vast majority of catheter-induced AVFs can be treated effectively with stent-graft implantation even if they are located very close to the femoral bifurcation. Obstructive dissection flaps localized in the CFA are usually treated with prolonged balloon inflation; however, in more extensive dissections involving iliac arteries, self-expanding stents should be deployed. Iliofemoral thrombosis can be treated effectively with catheter-directed thrombolysis (CDT) followed by prolonged balloon inflation or stent placement. Balloon angioplasty and CDT can occasionally be used to treat stenoses and occlusions complicating the use of percutaneous closure devices.

  15. Drug-eluting technologies in femoral artery lesions.

    PubMed

    Deloose, K; Lauwers, K; Callaert, J; Maene, L; Keirse, K; Verbist, J; Peeters, P; Bosiers, M

    2013-04-01

    The treatment of femoropopliteal lesions has known an important evolution in the last years. An important limitation of current endovascular therapy remains the occurrence of restenosis. In order to minimize restenosis rates, drug eluting technologies are evolving. The use of drug-eluting stents (DES) in coronary arteries shows beneficial results, leading to investigation of DES in femoropopliteal arteries. In this article, we give an overview of current available data on treatment with drug eluting technologies in the superficial femoral artery (SFA). This paper summarizes also the current available data of the use of drug-coated balloons (DCB) in the femoropopliteal tract. Currently, no data are available on the use of DCB in long lesions. A drug eluting bioresorbable scaffold seems to be very promising in coronary arteries. The transfer to the peripheral area is nowadays ongoing. Which technique and device for which lesion and patient requires further investigation to build up a real evidence based SFA treatment strategy.

  16. Femoral Artery Stenosis Following Percutaneous Closure Using a Starclose Closure Device

    SciTech Connect

    Bent, Clare Louise; Kyriakides, Constantinos; Matson, Matthew

    2008-07-15

    Starclose (Abbott Vascular Devices, Redwood City, CA) is a new arterial closure device that seals a femoral puncture site with an extravascular star-shaped nitinol clip. The clip projects small tines into the arterial wall which fold inward, causing the arterial wall to pucker, producing a purse-string-like seal closing the puncture site. The case history is that of a 76-year-old female patient who underwent day-case percutaneous diagnostic coronary angiography. A Starclose femoral artery closure device was used to achieve hemostasis with subsequent femoral artery stenosis.

  17. Rupture of the Deep Femoral Artery during Proximal Femoral Nailing Following an Intertrochanteric Fracture: A Case Report

    PubMed Central

    Yoon, Han Kook; Park, Junyoung; Oyunbat, Choidog; Kim, Taehwan

    2016-01-01

    Recently, we experienced a case where the diagnosis and management of a deep femoral artery rupture was delayed. This vascular complication occurred during the insertion of a distal interlocking screw of a proximal femoral nail for the fixation of an intertrochanteric femur fracture. A 79-year-old male patient was diagnosed with a right intertrochanteric fracture after a fall. We fixed the fracture with a proximal femoral nail (Zimmer® Natural Nail™ System). One day after the procedure, the patient complained of pain and swelling on the anteromedial side of his middle thigh followed by hypotension, anemia and prolonged thigh swelling. Computed tomography angiography was performed 7 days after the procedure. We found a pseudoaneurysm of the perforating artery caused by injury to the deep femoral artery and an intramuscular hematoma in the anterior thigh muscle. We successfully treated the pseudoaneurysm using coil embolization. Throughout the management of intertrochanteric femoral fractures, it is important to be aware and monitor signs and symptoms related to the possibility of blood vessel damage. When a patient presents with swelling and pain on the middle thigh and/or unexplained anemia postoperatively, the possibility that these symptoms are caused by an injury to the femoral artery must be considered. PMID:27536645

  18. Applied anatomy of the fasciocutaneous branch of the third perforator artery of the deep femoral artery

    PubMed Central

    de Araujo Netto, Belmino Corrêa; Ferreira, Lydia Masako; de Oliveira Santos, Ivan Dunshee Abranches

    2003-01-01

    A study of the anatomy of the fasciocutaneous branch of the third perforator artery of the deep femoral artery was performed to help the elaboration of a fasciocutaneous flap for the reconstruction of skin and subcutaneous and deep fascia of the knee and popliteal region. Forty thighs in 27 fresh cadavers were dissected. In all of the thighs, the third perforator artery was found to arise from the deep femoral artery and reach the posterior aspect of the thigh after perforating the adductor magnus muscle. At that point it was also found that the third perforator artery gives off a branch that emerges through the intermuscular septum between the vast lateral muscle and the long head of the biceps femoral muscle, then crosses the posterior cutaneous nerve and moves directly on to perforate the deep fascia and then to bifurcate into two other branches: one ascending and one descending. The cutaneous area of the flap of the thigh’s posterior region, nourished by the fasciocutaneous branch, was evaluated through the injection of dye. Dying of the upper medial, middle medial, lower medial and lower lateral areas of the flap was not successful in all of the dissected thighs. Nevertheless, the upper lateral and the middle lateral areas were dyed successfully in all 40 dissected thighs of the 27 cadavers. PMID:24115846

  19. A study of femoral artery by twin drivers in magnetic resonance interference elastography.

    PubMed

    Zheng, Y; Chan, Q C C; Li, G; Lam, E Y; Yang, E S

    2007-01-01

    Magnetic Resonance Elastography (MRE) is a phase-contrast technique using conventional Magnetic Resonance Imaging system to visualize propagating shear waves and study the stiffness of tissues. Usually, shear vibrations are applied to the surface of tissues by means of mechanical driver at one point. But in femoral artery study, the shear wave generated by the single driver on the surface of thigh cannot reach the femoral artery behind vein because of the blockage from the vein. In this study, the twin drivers set developed in our laboratory is used to overcome the problem. By using twin drivers driven simultaneously, interference shear wave pattern is generated. MR Interference Elastography is using interference shear wave image to study the stiffness of tissues. And, a finite element modeling was used to simulate single and twin driver datasets. The method was applied to in vivo human's femoral artery. And the result demonstrates the feasibility of this method. Further study will be conducted with the twin drivers in more in-vivo studies.

  20. Successful Angioplasty of a Superficial Femoral Artery Stenosis Caused by a Suture-Mediated Closure Device

    SciTech Connect

    Gemmete, Joseph J. Dasika, Narasimham; Forauer, Andrew R.; Cho, Kyung; Williams, David M.

    2003-08-15

    We report the successful angioplasty of an acute arterial narrowing after suture-mediated closure (SMC) of a femoral arterial puncture. A 75-year-old woman underwent a cerebral arteriogramvia a right common femoral artery puncture. The arteriotomy site was closed with a SMC device. Four days after placement the patient complained of pain in her right calf after walking. An arteriogram 7 days after SMC showed a severe focal stenosis at the origin of the superficial femoral artery involving the presumed puncture site. The lesion was successfully treated with balloon angioplasty. The patient at 6 months was asymptomatic.

  1. Simultaneous bilateral magnetic resonance imaging of the femoral arteries in peripheral arterial disease patients.

    PubMed

    Brown, Ryan; Karmonik, Christof; Brunner, Gerd; Lumsden, Alan; Ballantyne, Christie; Johnson, Shawna; Wang, Yi; Morrisett, Joel

    2011-07-01

    To image the femoral arteries in peripheral arterial disease (PAD) patients using a bilateral receive coil. An eight-channel surface coil array for bilateral MRI of the femoral arteries at 3T was constructed and evaluated. The bilateral array enabled imaging of a 25-cm segment of the superficial femoral arteries (SFA) from the profunda to the popliteal. The array provided improved the signal-to-noise ratio (SNR) at the periphery and similar SNR in the middle of a phantom compared to three other commercially available coils (4-channel torso, quadrature head, whole body). Multicontrast bilateral images of the in vivo SFA with 1 mm in-plane resolution made it possible to directly compare lesions in the index SFA to the corresponding anatomical site in the contralateral vessel without repositioning the patient or coil. A set of bilateral time-of-flight, T1-weighted, T2-weighted, and proton density-weighted images was acquired in a clinically acceptable exam time of ≈45 minutes. The developed bilateral coil is well suited for monitoring dimensional changes in atherosclerotic lesions of the SFA. Copyright © 2011 Wiley-Liss, Inc.

  2. Management of a Complicated Ruptured Infected Pseudoaneurysm of the Femoral Artery in a Drug Addict

    PubMed Central

    Psathas, Emmanouil; Lioudaki, Stella; Karantonis, Fotios-Filippos; Charalampoudis, Petros; Papadopoulos, Othon; Klonaris, Chris

    2012-01-01

    Infected pseudoaneurysm of the femoral artery represents a devastating complication of intravenous drug abuse, especially in the event of rupture. Operative strategy depends upon the extent of arterial injury and the coexistence of infection or sepsis. Options range from simple common femoral artery (CFA) ligation to complex arterial reconstruction with autologous grafts (arterial, venous, or homografts). We report herein the management of a 29-year-old male patient who was urgently admitted with a ruptured pseudoaneurysm of the right CFA, extending well above the inguinal ligament. Multidisciplinary approach with multiple arterial reconstructions and subsequent coverage of the tissue defect with a rectus abdominis musculocutaneous flap transposition was performed. PMID:23227421

  3. Surgical management of infected pseudoaneurysms of femoral artery caused by narcotics injection.

    PubMed

    Li, Quanming; Shu, Chang; Jiang, Xiaohua; Li, Ming; Li, Xin; He, Hao

    2009-06-01

    To investigate the surgical management of infected pseudoaneurysms of femoral artery caused by narcotics injection. The clinical data of 63 cases of infected pseudoaneurysms of femoral artery caused by narcotics injection were reviewed retrospectively. The tumors in 52 cases ruptured. Rupture hemorrhoea first occurred in 45 patients before admission and in 7 during hospitalization. Twenty-six patients suffered from recurrent or multiple hemorrhoea while in hospital. Forty-nine patients received external iliac artery-superficial femoral artery extra-anatomic bypass reconstruction with banded vascular grafts and the other 14 received ligation operations of the external iliac artery or the femoral artery. No one died in the perioperative period. One patient with vascular graft reconstruction developed graft infection during hospitalization and 5 developed graft infection during the follow-up. No ischemic necrosis occurred in the affected limbs after the infected vascular grafts were removed. One patient developed necrosis in the affected limb after the femoral artery was ligated and then above-knee amputation was performed. The others recovered well. Unobstructed blood circulation in the vascular graft was exhibited by color Doppler ultrasonography in 36 cases during the follow-up. Operation as early as possible is the only way to rescue patients' lives threatened by infected pseudoaneurysms of femoral artery caused by narcotics injection. Thorough debridement and drainage, revascularization between external iliac artery and superficial femoral artery using band artificial blood vessel, and controlling infection are therapeutic modus operandi. Ligation of external iliac artery or femoral artery is also a feasible measure to rescue patients' lives when pseudoaneurysms are infected severely.

  4. [Ultrastructural features of femoral artery myocytes during experimental leg lengthening].

    PubMed

    Ir'ianov, Iu M; Migalkin, N S; Kniazeva, L M

    1984-11-01

    Femoral arteries in mature dogs have been studied electron microscopically at various stages of the shin lengthening performed after G. A. Ilizarov method. Certain ultrastructural signs demonstrating biosynthetic and secretory activation of myocytes directed to intensification of elastogenetic processes have been revealed. Immature elastic fibers are forming around myocytes as aggregations of microfibrils, later accumulations of amorphous material appear in them. On the 28th, 42d days of distraction, hyperproduction of intra- and extracellular vesicles is noted, as well as that of intracellular matrix. Cytoplasmic islets of myocytes and intercellular connections increase in number. In the subintimal layer, of the tunica media and at its border with adventitium, longitudinally situating fasciculi of smooth muscle cells are forming. The myocytic ultrastructural peculiarities noted, the new formations of elastic elements depend, at early stages of the experiment, on changes of regional hemodynamics, and at advanced stages - also on the effect of longitudinally acting tension stress.

  5. Comparison of femoral and auricular arterial blood pressure monitoring in pigs.

    PubMed

    Bass, Louise M E; Yu, Dao-Yi; Cullen, Len K

    2009-09-01

    To compare arterial blood pressure measurements obtained from the femoral and auricular arteries in anaesthetized pigs. Prospective experimental study. Fifteen female Large White pigs were used weighing 21.3 +/- 2.3 kg. The pigs were anaesthetized with tiletamine/zolazepam and xylazine administered intramuscularly, and anaesthesia maintained with isoflurane delivered in oxygen/nitrogen. Arterial oxygen partial pressures were maintained between 11.3 and 13.3 kPa and PaCO(2) between 4.6 and 6.0 kPa. Monitoring included electrocardiogram, capnography and invasive blood pressure. The auricular and femoral arteries were catheterized for continuous systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP) measurements. Measurements were recorded every 15 minutes. Statistical analysis involved a Bland-Altman plot analysis. The mean difference +/- confidence intervals between the femoral and the auricular arterial diastolic, systolic and mean blood pressure measurements during hypotension were 2 +/- 7, 2 +/- 5 and 2 +/- 5 mmHg respectively. In conditions of normotension mean difference +/- confidence intervals, of femoral and auricular arterial blood pressure measurements of diastolic, systolic and mean blood pressure were 4 +/- 5, 3 +/- 7 and 4 +/- 4 mmHg respectively. In conditions of increased arterial blood pressure, mean difference +/- confidence intervals, of femoral and auricular arterial blood pressure measurements of diastolic, systolic and mean blood pressure were 4 +/- 5, 3 +/- 8 and 4 +/- 4 mmHg respectively. Auricular artery catheterization is easier and quicker to perform. Pressure measurements from the auricular artery compared well with the femoral artery. We found that auricular arterial blood pressures were similar to femoral arterial values under the conditions of this experiment. We did not test extremes of blood pressure or significant alterations in body temperature.

  6. Recanalization of thrombosed superficial femoral arteries with a hydraulic thrombectomy catheter in a canine model.

    PubMed

    Qian, Z; Wholey, M; Ferral, H; Maynar, M; Postoak, D; Hamide, J; Newman, W P; Moncada, R; Gonzalez-Roman, A; Gimenez, C; Castañeda, W R

    1999-12-01

    This experiment was conducted to evaluate efficacy and safety of the Oasis thrombectomy catheter on arterial thrombosis in dogs. Thrombosis was induced in 18 femoral arteries of nine mongrel dogs. Recanalization of the thrombosed femoral artery was performed using a thrombectomy catheter 7-10 days after thrombus induction. Pre- and postprocedural arterial status was documented by angiography. After mechanical thrombectomy, the animals were sacrificed and the femoral arteries were harvested and examined macro- and microscopically. Additionally, in vitro fragmentation was carried out to determine particle size and distribution from the recovered effluent. Subacute thrombosis was successfully created in 15 femoral arteries. Full recanalization was achieved in 80% (12/15) of the thrombosed femoral arteries without any residual thrombus. No significant downstream embolization was documented angiographically. Endothelial denudation was observed in all the treated arteries along with occasional disruption of the internal elastic lamina. No medial injury was seen. Ninety-eight percent of thrombus was liquefied, defined as particles smaller than 15 microm, by the catheter. Particles larger than 400 microm represented 0.27% of the original clot weight. Occluded femoral arteries with 7- to 10-day-old thrombus can be efficiently recanalized with the Oasis catheter in dogs without any significant complication. This thrombectomy catheter appears to be highly effective and safe and requires no sophisticated equipment. Blood loss was our major concern regarding use of this catheter but can be minimized by strictly controlling activation time and restricting the inflow into the vascular segment being treated.

  7. Flow measurements in a model of the mildly curved femoral artery of man

    NASA Technical Reports Server (NTRS)

    Back, L. H.; Kwack, E. Y.; Crawford, D. W.

    1990-01-01

    The effects of curvature on the flow rate near the wall in the vicinity of the mildly curved femoral artery of man, and on the pressure distributions along the curved segment, were investigated using glass and tygon flow models constructed to conform to the shape of the femoral angiogram of a human subject. The test fluid was 33 percent aqueous sucrose. Steady flow observations, made using a dye flow visualization system, revealed a flow pattern like that observed in coiled pipes. A double helical type flow was found to develop, with converging streamlines in the wall vicinity from the upper and lower plane of curvature merging asymptotically along the inner curvature in a stable manner. Pressure measurements for steady flow revealed progressively larger pressure drops with distance along the entrance region of the curved segment, relative to that for a straight lumen.

  8. [The role of the V-Y plastics in vascular reconstructions directed to the deep femoral artery].

    PubMed

    Gyurkovics, E; Nagy, Z; Jámbor, G; Kaliszky, P

    2001-12-01

    Because of the arteriosclerotic involvement of the superficial femoral artery, considerable part of the aorto-femoral reconstructions is performed with an anastomosis on the deep femoral artery. Stenosis of the deep femoral artery is usually limited to the bifurcation or to the first part of the artery; therefore the choice of treatment is desobliteration, or bypass below the bifurcation. This article describes a form of reconstruction which is suitable for direct endarterectomy of the deep femoral artery, without vein or plastic patch. The experience and advantages of this method are analysed.

  9. Agreement between radial and femoral arterial blood pressure measurements during orthotopic liver transplantation.

    PubMed

    Lee, Matthew; Weinberg, Laurence; Pearce, Brett; Scurrah, Nicholas; Story, David A; Pillai, Param; McCall, Peter R; McNicol, Larry P; Peyton, Philip J

    2015-06-01

    To study agreement between radial and femoral arterial pressure measurements in orthotopic liver transplantation (OLTx) surgery to determine whether arterial cannulation sites are interchangeable. Prospective observational study of 25 patients undergoing OLTx surgery. Radial and femoral arteries were cannulated with standardised arterial line kits. Radial and femoral mean arterial pressure (MAP), systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and pulse pressure (PP) were measured at four time points (30 minutes after induction of anaesthesia, 30 minutes after the start of the anhepatic phase, 30 minutes after liver graft reperfusion and 30 minutes after the start of bile duct anastomosis). The bias, precision and limits of agreement between radial and femoral arterial pressures were calculated in accordance with Bland-Altman statistics. Radial-femoral differences in MAP (mean difference, 4.8 mmHg [SD, 4.5 mmHg]), limits of agreement (- 13.6 and 8.8, P < 0.001) and DAP showed clinically acceptable agreement between measurement sites across all time points. However, clinically significant differences between radial and femoral SAPs (mean difference, - 14.9 mmHg [SD, 24.8 mmHg]) and limits of agreement (- 63.5 and 33.7, P < 0.001) occurred overall. This difference started after portal vein clamping and remained significant throughout the remainder of the operation. Radial artery SAP underestimates femoral artery measurements significantly but unpredictably. As femoral measurement is more likely to reflect central arterial pressure, radial SAP measurement is not reliable in adults undergoing OLTx.

  10. Decreased femoral arterial flow during simulated microgravity in the rat

    NASA Technical Reports Server (NTRS)

    Roer, Robert D.; Dillaman, Richard M.

    1994-01-01

    To determine whether the blood supply to the hindlimbs of rats is altered by the tail-suspension model of weightlessness, rats were chronically instrumented for the measurement of femoral artery flow. Ultrasonic transit-time flow probes were implanted into 8-wk-old Wistar-Furth rats under ketamine-xylazine anesthesia, and, after 24 h of recovery, flow was measured in the normal ambulatory posture. Next, rats were suspended and flow was measured immediately and then daily over the next 4-7 days. Rats were subsequently returned to normal posture, and flow was monitored daily for 1-3 days. Mean arterial flow decreased immediately on the rats being suspensed and continued to decrease until a new steady state of approximately 60% of control values was attained at 5 days. On the rats returning to normal posture, flow increased to levels observed before suspension. Quantile-quantile plots of blood flow data revealed a decrease in flow during both systole and diastole. The observed decrease in hindlimb blood flow during suspension suggests a possible role in the etiology of muscular atrophy and bone loss in microgravity.

  11. Decreased femoral arterial flow during simulated microgravity in the rat

    NASA Technical Reports Server (NTRS)

    Roer, Robert D.; Dillaman, Richard M.

    1994-01-01

    To determine whether the blood supply to the hindlimbs of rats is altered by the tail-suspension model of weightlessness, rats were chronically instrumented for the measurement of femoral artery flow. Ultrasonic transit-time flow probes were implanted into 8-wk-old Wistar-Furth rats under ketamine-xylazine anesthesia, and, after 24 h of recovery, flow was measured in the normal ambulatory posture. Next, rats were suspended and flow was measured immediately and then daily over the next 4-7 days. Rats were subsequently returned to normal posture, and flow was monitored daily for 1-3 days. Mean arterial flow decreased immediately on the rats being suspensed and continued to decrease until a new steady state of approximately 60% of control values was attained at 5 days. On the rats returning to normal posture, flow increased to levels observed before suspension. Quantile-quantile plots of blood flow data revealed a decrease in flow during both systole and diastole. The observed decrease in hindlimb blood flow during suspension suggests a possible role in the etiology of muscular atrophy and bone loss in microgravity.

  12. Stent-Graft Placement for Femoral Artery Pseudoaneurysm in a Patient with Idiopathic Multiple Arterial Aneurysmal Disease

    SciTech Connect

    Koo, Bon Kwon; Choi, Donghoon; Kwon, Kihwan; Jang, Yangsoo; Shim, Won-Heum; Cho, Seung-Yun; Lee, Do Yun

    2002-12-15

    A 34-year-old man presenting with a left inguinal mass was diagnosed as having idiopathic multiple aneurysmal disease and pseudoaneurysm of a left superficial femoral artery. A stent-graft was successfully deployed percutaneously at the left superficial femoral artery pseudoaneurysm. Less invasive treatment should be used to avoid vascular complications in patients with idiopathic multiple aneurysmal disease, especially in those who have a progressive course or a history of prior complications after surgical repair.

  13. Computation of blood flow through collateral circulation of the superficial femoral artery.

    PubMed

    Kruse, R R; Vinke, E J; Poelmann, F B; Rohof, D; Holewijn, S; Slump, C H; Reijnen, Mmpj

    2016-04-01

    Obliteration of collaterals during (endo)vascular treatment of peripheral arterial occlusive disease is considered detrimental. We use a model to calculate maximum collateral bed flow of the superficial femoral artery in order to provide insight in their hemodynamic relevance. A computational model was developed using digital subtraction angiographies in combination with Poiseuille's equation and Ohm's law. Lesions were divided into short and long (<15 cm and ≥15 cm, respectively) and into stenosis and occlusions. Data are presented in relation to the calculated maximum healthy superficial femoral artery flow. Stenotic lesions are longer than occlusive lesions (P < 0.05) and occlusions had more and larger collaterals (P < 0.05). In all four study groups the collateral flow significantly increased the total flow (P < 0.05). The maximum collateral system flow in the stenosis and occlusion groups was 5.1% and 20.8% of healthy superficial femoral artery flow, respectively (P < 0.05), and there were no significant differences between short and long lesions (11.2% and 6.7% of healthy superficial femoral artery flow, respectively). The maximum collateral system flow of the superficial femoral artery is only a fraction, with a maximum of one fifth, of healthy superficial femoral artery flow. Effects of collateral vessel occlusion during (endo)vascular treatment may therefore be without detrimental consequences. © The Author(s) 2015.

  14. Vascular reactivity of rabbit isolated renal and femoral resistance arteries in renal wrap hypertension.

    PubMed

    Khammy, Makhala M; Angus, James A; Wright, Christine E

    2016-02-15

    In rabbits with cellophane renal wrap hypertension, hindquarter and total vascular resistance changes to pressor and depressor agents are amplified compared to those of normotensive rabbits. The aim of the present study was to evaluate the in vitro pharmacodynamics of hypertensive and normotensive rabbit small artery segments isolated from the renal and hindquarter vascular beds. Using wire myography, the full range (Emax) and sensitivity (EC50) to a range of agonists of segments of renal interlobar (≈ 600 µm i.d.), renal arcuate (≈ 250 µm i.d.) and deep femoral branch (≈ 250 µm i.d.) arteries were assessed under normalised conditions of passive tension. Interlobar arteries from hypertensive rabbits were more sensitive (EC50) than those from normotensive rabbits to noradrenaline (6-fold), methoxamine (3-fold) and angiotensin II (3-fold). Arcuate artery reactivity was largely unaffected by hypertension. Deep femoral arteries from hypertensive rabbits had enhanced sensitivity only to noradrenaline (2-fold) and methoxamine (4-fold). Sensitivity to relaxation by acetylcholine was unaffected by hypertension in all arteries. Deep femoral arteries from hypertensive rabbits were more sensitive to sodium nitroprusside than normotensive counterparts. Adenosine caused little relaxation in renal arteries, but full relaxation in deep femoral arteries, unaltered by hypertension. This study found substantial heterogeneity in the pharmacodynamic profile of vessels isolated from different vascular beds and between arterial segments within the kidney. These profiles were differentially affected by hypertension suggesting that hypertension per se is not a resultant of general vascular dysfunction.

  15. Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap.

    PubMed

    Karsidag, Semra; Akcal, Arzu; Sirvan, Selami Serhat; Guney, Soner; Ugurlu, Kemal

    2011-02-01

    Major scrotal defects may result from infection due to Fournier's gangrene, excision of scrotal skin diseases, traumatic avulsion of scrotal and penile skin, and genital burns. The wide spectrum of bacterial flora of the perineum, difficulty in providing immobilisation, and obtaining a natural contour of the testes make testicular cover very difficult. Various methods have been reported to cover the penoscrotal area, including skin grafting, transposing them to medial thigh skin, and use of local fasciocutaneous or musculocutaneous flaps. In this report, reconstruction using six local medial circumflex femoral artery perforator (MCFAP) flaps was undertaken in five male patients (mean age, 47 years) with complex penoscrotal or perineal wounds. The cause of the wounds in four patients was Fournier's gangrene, and was a wide papillomateous lesion in the other patient. Flap width was 6-10 cm and flap length was 10-18 cm. The results showed that a MCFAP flap provided the testes with a pliable local flap without being bulky and also protected the testicle without increasing the temperature. The other advantage of the MCFAP flap was that the donor-site scar could be concealed in the gluteal crease. Our results demonstrated that the MCFAP flap is an ideal local flap for covering penoscrotal defects.

  16. Location of femoral artery puncture site and the risk of postcatheterization pseudoaneurysm formation.

    PubMed

    Gabriel, Marcin; Pawlaczyk, Katarzyna; Waliszewski, Krzysztof; Krasiński, Zbigniew; Majewski, Wacław

    2007-08-21

    Iatrogenic causes constitute increasingly frequent sources of pseudoaneurysms due to endovascular interventions. However, till now, all analyses focused on evaluating different risk factors contributing to the development of pseudoaneurysm, overlooking the issue of localization of femoral puncture. The aim of this study was to assess the influence of position of femoral artery puncture on the risk of pseudoaneurysm formation. 116 patients were evaluated for the site of catheter insertion into femoral arteries. Another group of 273 patients, suspected of vascular complications after endovascular procedures, were diagnosed with pseudoaneurysms which were analyzed for the location of arterial wall disruption. Puncture sites of groin arteries, i.e. EIA (2.7%), CFA (77.5%), SFA and DFA (19.8%), correlated with pseudoaneurysm location reaching 7.6% (EIA), 54.3% (CFA) and 38.1% (SFA, DFA). Type of procedure influenced these values. Duplex ultrasound mapping of CFA before the endovascular intervention eliminated discrepancies between the incidence of pseudoaneurysm formation and the frequency of arterial puncture in the selected vascular segments. Pseudoaneurysms formed in 4.5% of patients undergoing traditional palpation-guided vessel cannulation and in 2.6% of patients after ultrasound-guided puncture of the femoral artery. Upon further analysis, we concluded that the likelihood of the development of pseudoaneurysm depends on the artery punctured in the groin. This risk increases dramatically for external iliac artery, superficial and deep femoral arteries. A simple means of prevention of this dangerous complication of femoral artery puncture is duplex ultrasound mapping of the groin arteries.

  17. Acute arterial occlusion in the midpiece of femoral artery following total knee arthroplasty: Report of one case.

    PubMed

    He, Rui; Yang, Liu

    2016-04-01

    Acute arterial occlusion is a rare complication following total knee arthroplasty (TKA). The incidence as reported previously is from 0.03% to 0.17%; however, the sequelae can be disastrous because of its potential threat to limb loss.We report a case of acute arterial occlusion in the midpiece of femoral artery following TKA occurred 40 min postoperatively. The occlusion site existed at the midpiece of femoral artery is uncommon. Arterial circulation of the lower limb could not be restored by the thrombolysis and thrombectomy treatments performed within 11 h after TKA. In the end, amputation had to be carried out. In the treatment of acute arterial occlusion following TKA with a tourniquet, it is important to fully consider that arteriosclerosis may induce atheromatous plaque disruption, which might be the reason for acute arterial occlusion.

  18. [A ruptured mycotic aneurysm of the femoral artery due to Salmonella typhimurium].

    PubMed

    Calvo Cascallo, J; Mundi Salvadó, N; Cardona Fontanet, M

    1993-01-01

    Mycotic aneurysms of the femoral artery is rare. We report a new case with a mycotic aneurysm of the femoral artery by "Salmonella typhimurium". The surgical operation was performed as surgical emergence for ruptured aneurysm. We did not know the aneurysm infection origin. The treatment of lesions was resection and femoro-femoral bypass with PTFE. The microbiological examination discovered infection material. A posterior bypass infection required a exeresis bypass and new revascularization with iliofemoral saphenous vein bypass by obturator foramen, and antibiotic treatment prolonged.

  19. Revascularization for iliac-femoral artery pseudoaneurysm with greater saphenous vein.

    PubMed

    Wu, Ji-Dong; Zheng, Yue-Hong; Choi, Nim; Rui, Furtado

    2010-03-01

    To investigate the role of revascularization procedures with autologous greater saphenous vein in surgical management of iliac-femoral artery pseudoaneurysm in parenteral drug abusers. Twenty-one patients with iliac-femoral artery pseudoaneurysm caused by parenteral drug abuse from 2004 to 2007 were enrolled. Among them, 15 patients were male and 6 were female; their average age was 31.3 years. The size of pseudoaneurysms ranged from 3.0 cm to 7.5 cm. Common femoral artery and distal external iliac artery were often involved. We performed arterial reconstruction on these patients with autologous greater saphenous vein as a graft after excising iliac-femoral artery pseudoaneurysm through a single curved inguinal incision. All patients were followed up, and the complications were recorded. The surgical procedures were finished without intraoperative mortality or perioperative complications. All patients were free of claudication symptoms after the surgery except one case with preoperative popliteal artery stenosis. One case of infection and wound tissue fistula was found later. One case had inguinal incisional hematoma and another complained of numbness in thigh skin. The use of autologous greater saphenous venous grafts for arterial reconstruction after pseudoaneurysm excision in drug abusers is safe and effective. This technique offers more advantages than arterial ligation alone without revascularization. An optimal greater saphenous venous graft is a prerequisite for revascularization.

  20. Similarities of arterial collagen pressure-diameter relationship in ovine femoral arteries and PLLA vascular grafts.

    PubMed

    Armentano, Ricardo L; Cymberknop, Leandro J; Suarez Bagnasco, Diego; Montini Ballarin, Florencia; Balay, Guillermo; Negreira, Carlos A; Abraham, Gustavo A

    2014-01-01

    In-vivo implanted vascular grafts fail due to the mechanical mismatch between the native vessel and the implant. The biomechanical characterization of native vessels provides valuable information towards the development of synthetic grafts. Five samples of electrospun nanofibrous poly(L-lactic acid)(PLLA) tubular structures were subjected to physiological pulsating pressure using an experimental setup. Four ovine femoral arteries were also tested in the experimental setup under the same conditions. Instantaneous diameter and pressure signals were obtained using gold standard techniques, in order to estimate the dynamic pressure-strain elastic modulus (E(Pε)) of both native vessels and grafts. Synthetic grafts showed a significant increase of E(Pε) (10.57±0.97 to 17.63±2.61 10(6) dyn/cm(2)) when pressure was increased from a range of 50-90 mmHg (elastin-response range) to a range of 100-130 mmHg (collagen-response range). Furthermore, femoral arteries also exhibited a significant increase of EPε (1.66±0.30 to 15.76±4.78 10(6) dyn/cm(2)) with the same pressure variation, showing that both native vessels and synthetic grafts have a similar behavior in the collagen-acting range. The mechanical behavior of PLLA vascular grafts was characterized In vitro. However, the procedure can be easily extrapolated to In vivo experiences in conscious and chronically instrumented animals.

  1. Mean wall shear stress in the femoral arterial bifurcation is low and independent of age at rest.

    PubMed

    Kornet, L; Hoeks, A P; Lambregts, J; Reneman, R S

    2000-01-01

    In elastic arteries, mean wall shear stress appears to be close to 1. 5 Pa, the value predicted by the theory of minimal energy loss. This finding in elastic arteries does not necessarily represent the situation in muscular arteries. Elastic arteries have to store potential energy, while muscular arteries have mainly a conductive function. Therefore, we determined wall shear stress and its age dependency in the common and superficial femoral arteries, 2-3 cm from the flow divider in 54 presumed healthy volunteers between 21 and 74 years of age, using a non-invasive ultrasound system. Prior to the study, the reliability of this system was determined in terms of intrasubject variation. Mean wall shear stress was significantly lower in the common femoral artery (0.35 +/- 0.18 Pa) than in the superficial femoral artery (0.49 +/- 0.15 Pa). In all age categories, peak systolic wall shear stress and the maximal cyclic change in wall shear stress were not significantly different in the common and the superficial femoral arteries. Peak systolic wall shear stress in the common and the superficial femoral arteries was not significantly different from the value previously determined in the common carotid artery, but mean wall shear stress was lower in the common and superficial femoral arteries than in the common carotid artery by a factor of 2-4. In both the common and the superficial femoral arteries, mean, peak systolic and maximal cyclic change in wall shear stress did not change significantly with age, nor did diameter. We conclude that, as compared to elastic arteries, mean wall shear stress is low in the conductive arteries of a resting leg, due to backflow during the first part of the diastolic phase of the cardiac cycle and the absence of flow during the rest of the diastolic phase. Mean wall shear stress is lower in the common than in the superficial femoral artery due to additional reflections from the deep femoral artery.

  2. An inexpensive, simple technique to improve the safety of femoral arterial puncture

    PubMed Central

    Mehan, Vivek K.; Patil, Sachinkumar; Patel, Mehul

    2015-01-01

    We describe a safe and inexpensive technique of avoiding femoral access site complications. Initial fluoroscopic screening of a fully inserted local anesthetic needle helps localize the anticipated arterial puncture site. Repeating fluoroscopy after guide wire insertion through the puncture needle confirms the exact puncture site in the artery. PMID:26702683

  3. Fluoroscopically-guided micropuncture femoral artery access for large-caliber sheath insertion.

    PubMed

    Cilingiroglu, Mehmet; Feldman, Ted; Salinger, Michael H; Levisay, Justin; Turi, Zoltan G

    2011-04-01

    Over the last decade, significant developments have been made in the treatment of structural heart disease. Some of these techniques require placement of large arterial sheaths for device delivery. Optimal vascular access is essential for successful large-vessel sheath insertion as well as to avoid vascular complications. The critical step for ideal percutaneous vessel entry is single anterior wall-only puncture of the common femoral artery in a location above the femoral bifurcation and below the inguinal ligament. We describe a fluoroscopically-guided micropuncture technique for accurate placement of large-caliber arterial sheaths.

  4. Treatment of Infected Pseudoaneurysm of Femoral Artery after Vascular Closure Device Deployment: A Practical Solution

    PubMed Central

    Matic, Predrag; Babic, Srdjan; Tanaskovic, Slobodan; Jocic, Dario; Radak, Djordje

    2012-01-01

    Like other invasive procedures, percutaneous coronary interventions are associated with complications. Most common access site for these procedures is common femoral artery. Complications such as groin and retroperitoneal hematoma can be encountered as well as pseudoaneurysms, arteriovenous fistulas, acute arterial occlusion, and infection. When infected pseudoaneurysm occurs, surgical treatment can be extremely difficult. We present a case of the patient in whom infected pseudoaneurysm of common femoral artery developed after percutaneous coronary intervention and was successfully treated by surgical excision and autoarterial graft insertion. PMID:23119221

  5. Carotid-Femoral Pulse Wave Velocity: Impact of Different Arterial Path Length Measurements

    PubMed Central

    Sugawara, Jun; Hayashi, Koichiro; Yokoi, Takashi; Tanaka, Hirofumi

    2009-01-01

    Background Carotid-femoral pulse wave velocity (PWV) is the most established index of arterial stiffness. Yet there is no consensus on the methodology in regard to the arterial path length measurements conducted on the body surface. Currently, it is not known to what extent the differences in the arterial path length measurements affect absolute PWV values. Methods Two hundred fifty apparently healthy adults (127 men and 123 women, 19-79 years) were studied. Carotid-femoral PWV was calculated using (1) the straight distance between carotid and femoral sites (PWVcar–fem), (2) the straight distance between suprasternal notch and femoral site minus carotid arterial length (PWV(ssn–fem)-(ssn–car)), (3) the straight distance between carotid and femoral sites minus carotid arterial length (PWV(car–fem)-(ssn–car)), and (4) the combined distance from carotid site to the umbilicus and from the umbilicus to femoral site minus carotid arterial length (PWV(ssn–umb–fem)-(ssn–car)). Results All the calculated PWV were significantly correlated with each other (r=0.966-0.995). PWV accounting for carotid arterial length were 16-31% lower than PWVcar–fem. PWVcar–fem value of 12 m/sec corresponded to 8.3 m/sec for PWV(ssn–fem)-(ssn–car), 10.0 m/sec for PWV(car–fem)-(ssn–car), and 8.9 m/sec for PWV(ssn–umb–fem)-(ssn–car). Conclusion Different body surface measurements used to estimate arterial path length would produce substantial variations in absolute PWV values. PMID:20396400

  6. The surgical anatomy of the blood supply to the femoral head: description of the anastomosis between the medial femoral circumflex and inferior gluteal arteries at the hip.

    PubMed

    Grose, A W; Gardner, M J; Sussmann, P S; Helfet, D L; Lorich, D G

    2008-10-01

    The inferior gluteal artery is described in standard anatomy textbooks as contributing to the blood supply of the hip through an anastomosis with the medial femoral circumflex artery. The site(s) of the anastomosis has not been described previously. We undertook an injection study to define the anastomotic connections between these two arteries and to determine whether the inferior gluteal artery could supply the lateral epiphyseal arteries alone. From eight fresh-frozen cadaver pelvic specimens we were able to inject the vessels in 14 hips with latex moulding compound through either the medial femoral circumflex artery or the inferior gluteal artery. Injected vessels around the hip were then carefully exposed and documented photographically. In seven of the eight specimens a clear anastomosis was shown between the two arteries adjacent to the tendon of obturator externus. The terminal vessel arising from this anastomosis was noted to pass directly beneath the posterior capsule of the hip before ascending the superior aspect of the femoral neck and terminating in the lateral epiphyseal vessels. At no point was the terminal vessel found between the capsule and the conjoined tendon. The medial femoral circumflex artery receives a direct supply from the inferior gluteal artery immediately before passing beneath the capsule of the hip. Detailed knowledge of this anatomy may help to explain the development of avascular necrosis after hip trauma, as well as to allow additional safe surgical exposure of the femoral neck and head.

  7. A femoral arteriovenous shunt facilitates arterial whole blood sampling in animals.

    PubMed

    Weber, Bruno; Burger, Cyrill; Biro, Peter; Buck, Alfred

    2002-03-01

    In this study we evaluated on-line continuous blood sampling in a femoral arteriovenous (a-v) shunt for use in quantitative tracer studies using gamma-emitting radionuclides in animals. The shunt consisted of 40 cm polyethylene tubing (PE-50) guided through a coincidence probe. Two three-way valves allowed blood pressure measurements and tracer injection. Blood flow in the shunt and the impulse response function (IRF) were assessed using heparinized human blood mixed with fluorine-18 fluorodeoxyglucose (FDG). In vivo experiments were performed in eight male rats (300-350 g) anaesthetized with halothane. In three rats, manual blood sampling was performed in parallel with on-line sampling. In another five animals, the arterial whole blood activity was recorded on-line for 40 min. For the experiments 150-180 MBq FDG was injected over 35 s. Blood flow in the shunt was 23.6, 29.2 and 42.8 ml/h at 100, 120 and 160 mmHg, respectively. The IRF was characterized by minimal dispersion (1-2 s FWHM). Deconvolution of the measured arterial input curves with the IRF changed the measured curve only minimally. Whole blood radioactivity concentration derived from manual and on-line sampling were in excellent agreement. The curves derived from on-line sampling were of high statistical quality. In conclusion, a femoral a-v shunt allows multiple manipulations such as measurement of the arterial whole blood activity, continuous blood pressure monitoring, injection of the tracer and collection of blood samples if necessary. It is not associated with blood loss if the collection of blood samples is not required. It is more convenient to use than manual sampling, the peak of the input curve is never missed and the input curves are of high statistical quality.

  8. Suitability of Exoseal Vascular Closure Device for Antegrade Femoral Artery Puncture Site Closure

    SciTech Connect

    Schmelter, Christopher Liebl, Andrea; Poullos, Nektarios; Ruppert, Volker; Vorwerk, Dierk

    2013-06-15

    Purpose. To assess the efficacy and safety of the Exoseal vascular closure device for antegrade puncture of the femoral artery. Methods. In a prospective study from February 2011 to January 2012, a total of 93 consecutive patients received a total of 100 interventional procedures via an antegrade puncture of the femoral artery. An Exoseal vascular closure device (6F) was used for closure in all cases. Puncture technique, duration of manual compression, and use of compression bandages were documented. All patients were monitored by vascular ultrasound and color-coded duplex sonography of their respective femoral artery puncture site within 12 to 36 h after angiography to check for vascular complications. Results. In 100 antegrade interventional procedures, the Exoseal vascular closure device was applied successfully for closure of the femoral artery puncture site in 96 cases (96 of 100, 96.0 %). The vascular closure device could not be deployed in one case as a result of kinking of the vascular sheath introducer and in three cases because the bioabsorbable plug was not properly delivered to the extravascular space adjacent to the arterial puncture site, but instead fully removed with the delivery system (4.0 %). Twelve to 36 h after the procedure, vascular ultrasound revealed no complications at the femoral artery puncture site in 93 cases (93.0 %). Minor vascular complications were found in seven cases (7.0 %), with four cases (4.0 %) of pseudoaneurysm and three cases (3.0 %) of significant late bleeding, none of which required surgery. Conclusion. The Exoseal vascular closure device was safely used for antegrade puncture of the femoral artery, with a high rate of procedural success (96.0 %), a low rate of minor vascular complications (7.0 %), and no major adverse events.

  9. In vivo noninvasive method for measuring local wave velocity in femoral arteries of pig

    NASA Astrophysics Data System (ADS)

    Zhang, Xiaoming; Kinnick, Randall; Pislaru, Cristina; Fatemi, Mostafa; Greenleaf, James

    2005-09-01

    We have proposed generating a bending wave in the arterial wall using ultrasound radiation force and measuring the wave velocity along the arterial wall [Zhang et al., IEEE Trans. Ultrason. Ferroelectr. Freq. Control 52, 642-652 (2005)]. Here, we report the results of in vivo studies on pigs. The pig was anesthetized, and a micromanometer tip catheter was inserted into the femoral artery to measure luminal pressure. A water bath was created on the animal's groin to allow unimpeded access of the ultrasound beams to the femoral artery. The femoral artery was first located using a 13-MHz linear-array transducer. Then, a vibro-acoustography image was obtained to ensure precise positioning of the excitation force relative to the artery. The artery was excited by the force transducer and the resulting vibration of the arterial wall was measured by a sensing Doppler transceiver. Measured wave velocity was 3.1 m/s at 300 Hz. With this new method wave velocity over a distance of 5 mm, and therefore stiffness of arteries, can be measured locally and non-invasively. Measurement time is short in a few tens of milliseconds, which allows pressure dependence and pharmacological effect on the wall properties to be measured at different cardiac times.

  10. Chitosan hemostatic dressing for control of hemorrhage from femoral arterial puncture site in dogs.

    PubMed

    Szatmári, Viktor

    2015-01-01

    Removal of an introducer-sheath from a femoral artery after completing transarterial embolization of a patent ductus arteriosus can cause life-threatening hemorrhage in dogs. In the present study, the effectiveness of chitosan acetate dressing in 10 experimental dogs was tested. Under general anesthesia, an introducer-sheath was placed into the femoral artery with percutaneous puncture using Seldinger's technique. The outer diameter of the introducer-sheaths varied from 3.0 to 4.0 mm with an introducer/artery ratio of 80 to 123%. The artery's diameter was measured using ultrasonography. Following removal of the introducer-sheath, a chitosan acetate dressing was applied to the wound and held in place with manual compression for 10 min. Successful hemostasis was reached on 12 arteries. However, on two arteries, hemorrhage was uncontrollable and led to a hypovolemic shock during 10 min of manual compression. Possible causes of the negative outcome in two dogs were their old age and an introducer-sheath with a too large diameter. The chitosan acetate dressing was easy to use and the artery remained patent. Dogs could walk directly after recovery from anesthesia and their femoral arteries were saved. In conclusion, the outer diameter of the introducer-sheath should not exceed 3 mm or the inner diameter of the artery.

  11. Chitosan hemostatic dressing for control of hemorrhage from femoral arterial puncture site in dogs

    PubMed Central

    2015-01-01

    Removal of an introducer-sheath from a femoral artery after completing transarterial embolization of a patent ductus arteriosus can cause life-threatening hemorrhage in dogs. In the present study, the effectiveness of chitosan acetate dressing in 10 experimental dogs was tested. Under general anesthesia, an introducer-sheath was placed into the femoral artery with percutaneous puncture using Seldinger's technique. The outer diameter of the introducer-sheaths varied from 3.0 to 4.0 mm with an introducer/artery ratio of 80 to 123%. The artery's diameter was measured using ultrasonography. Following removal of the introducer-sheath, a chitosan acetate dressing was applied to the wound and held in place with manual compression for 10 min. Successful hemostasis was reached on 12 arteries. However, on two arteries, hemorrhage was uncontrollable and led to a hypovolemic shock during 10 min of manual compression. Possible causes of the negative outcome in two dogs were their old age and an introducer-sheath with a too large diameter. The chitosan acetate dressing was easy to use and the artery remained patent. Dogs could walk directly after recovery from anesthesia and their femoral arteries were saved. In conclusion, the outer diameter of the introducer-sheath should not exceed 3 mm or the inner diameter of the artery. PMID:26119165

  12. Iliac Artery Stent Placement Relieves Claudication in Patients with Iliac and Superficial Femoral Artery Lesions

    SciTech Connect

    Ichihashi, Shigeo Higashiura, Wataru; Itoh, Hirofumi; Sakaguchi, Shoji; Kichikawa, Kimihiko

    2013-06-15

    Purpose. To evaluate the efficacy of iliac artery stent placement for relief of claudication in patients with both iliac and superficial femoral artery (SFA) lesions. Methods. Stent placement for only iliac artery occlusive disease was performed in 94 limbs (74 patients) with both iliac and SFA occlusive disease on the same limb. All procedures were performed because intermittent claudication did not improve after continuation of antiplatelet medication therapy and home-based exercise for 3 months. Rutherford classification was 2 in 20 limbs and 3 in 74 limbs. Patients with critical limb ischemia were excluded. Median duration of follow-up was 40 months. Primary patency rates of the iliac stent, clinical improvement rates, and risk factors for requiring additional SFA procedures were evaluated. Results. Primary patency rates of the iliac stent at 1, 3, 5, and 7 years were 97, 93, 79, and 79 %, respectively. The initial clinical improvement rate was 87 %. Continued clinical improvement rates at 1, 3, 5, and 7 years were 87, 81, 69, and 66 %, respectively. SFA Trans-Atlantic Inter-Society Consensus (TASC) II C/D lesion was a significant risk factor for requiring additional SFA procedures. Conclusion. Intermittent claudication was relieved by iliac stent placement in most patients with both iliac and SFA lesions. Thus, the indications for treatment of the SFA intended for claudicants should be evaluated after treatment of the iliac lesion.

  13. Large eddy simulation of a stenosed artery using a femoral artery pulsatile flow profile.

    PubMed

    Barber, Tracie J; Simmons, Anne

    2011-07-01

    Computational fluid dynamics simulation of stenosed arteries allows the analysis of quantities including wall shear stress, velocity, and pressure; detailed in vivo measurement is difficult yet the analysis of the fluid dynamics related to stenosis is important in understanding the likely causes and ongoing effects on the integrity of the vessel. In this study, a three-dimensional Large Eddy Simulation is conducted of a 50% occluded vessel, with a typical femoral artery profile used as the transient inlet conditions. The fluid is assumed to be homogenous, Newtonian and incompressible and the walls are assumed rigid. The stenosis is axisymmetric, however the three-dimensional study allows for a flow field that is not axisymmetric and results show significant three-dimensionality. High values of wall shear stress and oscillatory values of wall shear stress (varying in both space time) are observed. The results of the study give insight into the time-varying flow structures for a mildly stenosed artery and indicate that three-dimensional simulations may be important to gain a complete understanding of the flow field.

  14. Profunda Anchor Technique for Ipsilateral Antegrade Approach in Endovascular Treatment of Superficial Femoral Artery Ostial Occlusion

    SciTech Connect

    Pua, Uei

    2015-04-15

    Endovascular treatment of the superficial femoral artery (SFA) is challenging in the presence of flush ostial occlusion. One of the main challenges is the availability of access sites for intervention. Contralateral retrograde femoral access followed by cross-over and antegrade intervention while commonly used, may not be feasible in cases of altered iliac anatomy (e.g. kissing iliac stents). Ipsilateral antegrade intervention using common femoral artery (CFA) access in these instances while possible is typically challenging due to inadequate working length of the CFA for interrogation of the SFA ostium, compounded by the lack of sheath stability. The “profunda anchor” technique uses a buddy wire in the profunda femoris artery (PFA) to stabilize the sheath and allow catheter manipulation for antegrade intervention at the level of the SFA ostium. The PFA is further used as a conduit for deployment of closure device to avoid interference with the treated SFA.

  15. Effect of alterations in femoral artery flow on abdominal vessel hemodynamics in swine.

    PubMed

    Henderson, J M; Aukerman, J A; Clingan, P A; Friedman, M H

    1999-01-01

    In support of an in vivo investigation in swine of the influence of changes in fluid dynamic wall shear on arterial macromolecular permeability, a procedure has been developed to alter the flows in the porcine posterior arterial vasculature by opening and closing a reversible arteriovenous shunt placed on one of the femoral arteries. Laparoscopic techniques were used to place appropriately modified Transonic Systems ultrasonic flow probes on both external and circumflex iliac arteries, and on the terminal aorta. Flow measurements were made prior to shunt placement, and with the shunt open and closed, to measure the influence of altered external iliac artery flow on the distribution to the infrarenal abdominal vessels. Similar experiments were carried out to relate the flow rates in the external iliac arteries to those in the femoral arteries, which are more accessible. Based on the relationships among the measured flow rates, rules have been developed to estimate the major infrarenal flows in the pig, at baseline and with the shunt opened and closed, from only the flow rates measured at the two femoral arteries.

  16. Evaluations of the Combat Ready Clamp to Control Bleeding in Human Cadavers, Manikins, Swine Femoral Artery Hemorrhage Model and Swine Carcasses

    DTIC Science & Technology

    2012-06-01

    Fayetteville, NC) received FDA 510(k) clearance for prehospital hemorrhage control of pelvic , groin or buttock bleeding in warfare. Although 500 units... pelvic , groin or buttock bleeding in warfare. Although 500 units have been sold and 125-200 deployed, there is but one anecdotal report of its...Clamp (CRC), a device developed by Combat Medical Systems for controlling abdominal or pelvic hemorrhage. METHODS: The Wake Forest University human

  17. Porphyromonas gingivalis is the most abundant species detected in coronary and femoral arteries

    PubMed Central

    Mougeot, J-L. C.; Stevens, C. B.; Paster, B. J.; Brennan, M. T.; Lockhart, P. B.; Mougeot, F. K. B

    2017-01-01

    ABSTRACT An association between oral bacteria and atherosclerosis has been postulated. A limited number of studies have used 16S RNA gene sequencing-based metagenomics approaches to identify bacteria at the species level from atherosclerotic plaques in arterial walls. The objective of this study was to establish detailed oral microbiome profiles, at both genus and species level, of clinically healthy coronary and femoral artery tissues from patients with atherosclerosis. Tissue specimens were taken from clinically non-atherosclerotic areas of coronary or femoral arteries used for attachment of bypass grafts in 42 patients with atherosclerotic cardiovascular disease. Bacterial DNA was sequenced using the MiSeq platform, and sequence reads were screened in silico for nearly 600 oral species using the HOMINGS ProbeSeq species identification program. The number of sequence reads matched to species or genera were used for statistical analyses. A total of 230 and 118 species were detected in coronary and femoral arteries, respectively. Unidentified species detected by genus-specific probes consisted of 45 and 30 genera in coronary and in femoral artery tissues, respectively. Overall, 245 species belonging to 95 genera were detected in coronary and femoral arteries combined. The most abundant species were Porphyromonas gingivalis, Enterococcus faecalis, and Finegoldia magna based on species probes. Porphyromonas, Escherichia, Staphylococcus, Pseudomonas, and Streptococcus genera represented 88.5% mean relative abundance based on combined species and genus probe detections. Porphyromonas was significantly more abundant than Escherichia (i.e. 46.8% vs. 19.3%; p = 0.0005). This study provides insight into the presence and types of oral microbiome bacterial species found in clinically non-atherosclerotic arteries. PMID:28326156

  18. [Management of peripheral vascular disease based on current guidelines. Peripheral artery occlusive disease of the iliac and femoral arteries and carotid artery stenosis].

    PubMed

    Grebe, M T; Sternitzky, R

    2013-12-01

    The article summarizes the recommendations of current European and American guidelines concerning the diagnosis and treatment of peripheral arterial occlusive disease and carotid artery stenosis. In comparison to older recommendations, current guidelines concerning endovascular treatment and concomitant medical therapy have been changed in recent years. With the exception of very complex and long lesions, endovascular methods are seen as the therapy of choice for revascularization of the iliac and femoral arteries. For cardiovascular risk reduction, patients with symptomatic peripheral arterial disease and stenosis of the carotid arteries should receive antiplatelet as well as statin therapy and should not be treated different from patients with coronary artery disease.

  19. Correlation of femoral artery flow velocity waveform with ipsilateral iliac artery stenoses assessed with magnetic resonance imaging.

    PubMed

    Wikström, J; Johansson, L; Karacagil, S; Ahlström, H

    2007-05-01

    Magnetic resonance (MR) permits quantitative flow velocity measurements that could be used to detect changes in the curve profile downstream of a high-grade stenosis. To assess whether MR flow measurements can be used to detect iliac artery stenoses. Contrast-enhanced magnetic resonance angiography (MRA) and quantitative flow measurements in the lower aorta and proximal femoral arteries were performed in 29 patients with suspected iliac artery stenoses. Stenoses were graded into five degrees: 0%, 1-49%, 50-74%, 75-99%, and 100% diameter reduction. The femoral artery waveforms were evaluated qualitatively by two independent reviewers regarding peak systolic velocity (PSV), aortofemoral difference in time-to-peak (DeltaTTP), systolic acceleration (SA), curve-shape index (CSI), and the presence of an early diastolic flow reversal. The correlation between these parameters and the degree of stenosis was assessed. A significant correlation with degree of stenosis was observed for the qualitative flow waveform evaluations, with a high degree of interobserver agreement (kappa = 0.84). A significant correlation was also found between degree of stenosis and PSV, DeltaTTP, SA, CSI, and presence of diastolic flow reversal. The flow velocity pattern, however, remained unchanged, both qualitatively and quantitatively, up to a stenosis degree of at least 75%. Iliac artery stenoses cause femoral artery flow waveform changes that can be detected with MRI, but only at high-grade levels.

  20. Dopplersonographic analysis of the flow field in femoral arteries with stent implants

    NASA Astrophysics Data System (ADS)

    Verius, Michael; Huttary, Ralf; Recheis, Wolfgang; zur Nedden, Dieter

    2004-04-01

    This study investigates the instationary flow field in human femoarl arteries. The flow fiel is measured before and after the implantaion of five different metal stent implants in elastic and scaled silicone models of femoral arteries. The pulsating flow field is investigated under physiological conditions within the silicone vessel. For the simulation of the physilogical hemodynamics a computer controlled pump for the reproducible generation of flow patterns and a fluid with flow properties similar to human blood is used. At significant positions distal, proximal and inside the stent dopplersonographic measurements are performed with stationary and pulsatile flow. Via fast fourier analysis the sampled doppler audio signal, gained from the ultrasound stereo output, is converted into velocity profiles and displayed as color coded 3D spectrograms. By subtracting the spectra of the unstented model of the stented models differential spectra are obtained and compared. These differential spectra are used for a semiquantitative analysis of the flow field change caused by stents and are easy to interpret for the examining physician.

  1. Mechanisms of noradrenaline-induced vasorelaxation in isolated femoral arteries of the neonatal rat.

    PubMed

    Nishina, H; Ozaki, T; Hanson, M A; Poston, L

    1999-06-01

    Isolated arteries from the femoral circulation of Wistar rats mounted on a small vessel myograph demonstrated age related tension development to noradrenaline (NA, 1 x 10(-8) - 5 x 10(-5) M) day 20 greater than day 10 (P<0.005); day 100 greater than day 20 (P<0.001) and depolarizing potassium (125 mM) buffer day 20 greater than day 10 (P<0.001). NA evoked dilatation in femoral arteries from neonatal rats (10 days) when added to unstimulated vessels or to those preconstricted with the thromboxane mimetic, U46619. Relaxation to NA was inhibited by L-NAME (0.1 mM) (P<0.001), endothelial removal (P<0.001) and the alpha2-adrenoceptor antagonist, yohimbine (0.1 microM) (P<0.001). Alpha1- or beta-adrenoceptor antagonism was without effect. Relaxation was evoked in femoral arteries of the 10-day-old rats by the alpha2-adrenoceptor agonist UK14304 (1 x 10(-8) - 5 x 10(-5) M). This relaxation was also abolished by L-NAME (0.1 mM) (P<0.001) or endothelial removal (P<0.001). Alpha2-adrenoceptor-mediated vasorelaxation was the predominant response to NA stimulation in femoral arteries of the neonatal rat. These responses were endothelium-dependent and were NO-mediated.

  2. Axillary Versus Femoral Arterial Cannulation During Repair of Type A Aortic Dissection?

    PubMed Central

    Stamou, Sotiris C.; Gartner, Derek; Kouchoukos, Nicholas T.; Lobdell, Kevin W.; Khabbaz, Kamal; Murphy, Edward; Hagberg, Robert C.

    2016-01-01

    Background The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute Type A aortic dissection with axillary or femoral artery cannulation. Methods A total of 305 patients from five academic medical centers underwent acute Type A aortic dissection repair via axillary (n = 107) or femoral (n = 198) artery cannulation between January 2000 and December 2010. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality, and Cox regression hazard ratios were calculated to determine predictors of long-term mortality. Results Operative mortality was not influenced by cannulation site (16% for axillary cannulation vs. 19% for femoral cannulation, p = 0.64). In multivariate logistic regression analysis, hemodynamic instability (p < 0.001) and prolonged cardiopulmonary bypass time (>200 min; p = 0.05) emerged as independent predictors of operative mortality. Stroke rates were comparable between the two techniques (14% for axillary and 17% for femoral cannulation, p = 0.52). Five-year actuarial survival was comparable between the groups (55.1% for axillary and 65.7% for femoral cannulation, p = 0.36). In Cox regression analysis, predictors of long-term mortality were: age (p < 0.001), stroke (p < 0.001), prolonged cardiopulmonary bypass time (p = 0.001), hemodynamic instability (p = 0.002), and renal failure (p = 0.001). Conclusions The outcomes of femoral versus axillary arterial cannulation in patients with acute Type A aortic dissection are comparable. The choice of arterial cannulation site should be individualized based on different patient risk profiles. PMID:28097193

  3. Vascular closure devices for femoral arterial puncture site haemostasis.

    PubMed

    Robertson, Lindsay; Andras, Alina; Colgan, Frances; Jackson, Ralph

    2016-03-07

    Vascular closure devices (VCDs) are widely used to achieve haemostasis after procedures requiring percutaneous common femoral artery (CFA) puncture. There is no consensus regarding the benefits of VCDs, including potential reduction in procedure time, length of hospital stay or time to patient ambulation. No robust evidence exists that VCDs reduce the incidence of puncture site complications compared with haemostasis achieved through extrinsic (manual or mechanical) compression. To determine the efficacy and safety of VCDs versus traditional methods of extrinsic compression in achieving haemostasis after retrograde and antegrade percutaneous arterial puncture of the CFA. The Cochrane Vascular Trials Search Co-ordinator searched the Specialised Register (April 2015) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 3). Clinical trials databases were searched for details of ongoing or unpublished studies. References of articles retrieved by electronic searches were searched for additional citations. We included randomised and quasi-randomised controlled trials in which people undergoing a diagnostic or interventional procedure via percutaneous CFA puncture were randomised to one type of VCD versus extrinsic compression or another type of VCD. Two authors independently extracted data and assessed the methodological quality of trials. We resolved disagreements by discussion with the third author. We performed meta-analyses when heterogeneity (I(2)) was < 90%. The primary efficacy outcomes were time to haemostasis and time to mobilisation (mean difference (MD) and 95% confidence interval (CI)). The primary safety outcome was a major adverse event (mortality and vascular injury requiring repair) (odds ratio (OR) and 95% CI). Secondary outcomes included adverse events. We included 52 studies (19,192 participants) in the review. We found studies comparing VCDs with extrinsic compression (sheath size ≤ 9 Fr), different VCDs with each other

  4. S-nitrosothiols dilate the mesenteric artery more potently than the femoral artery by a cGMP and L-type calcium channel-dependent mechanism.

    PubMed

    Liu, Taiming; Schroeder, Hobe J; Zhang, Meijuan; Wilson, Sean M; Terry, Michael H; Longo, Lawrence D; Power, Gordon G; Blood, Arlin B

    2016-08-31

    S-nitrosothiols (SNOs) are metabolites of NO with potent vasodilatory activity. Our previous studies in sheep indicated that intra-arterially infused SNOs dilate the mesenteric vasculature more than the femoral vasculature. We hypothesized that the mesenteric artery is more responsive to SNO-mediated vasodilation, and investigated various steps along the NO/cGMP pathway to determine the mechanism for this difference. In anesthetized adult sheep, we monitored the conductance of mesenteric and femoral arteries during infusion of S-nitroso-l-cysteine (L-cysNO), and found mesenteric vascular conductance increased (137 ± 3%) significantly more than femoral conductance (26 ± 25%). Similar results were found in wire myography studies of isolated sheep mesenteric and femoral arteries. Vasodilation by SNOs was attenuated in both vessel types by the presence of ODQ (sGC inhibitor), and both YC-1 (sGC agonist) and 8-Br-cGMP (cGMP analog) mediated more potent relaxation in mesenteric arteries than femoral arteries. The vasodilatory difference between mesenteric and femoral arteries was eliminated by antagonists of either protein kinase G or L-type Ca(2+) channels. Western immunoblots showed a larger L-type Ca(2+)/sGC abundance ratio in mesenteric arteries than in femoral arteries. Fetal sheep mesenteric arteries were more responsive to SNOs than adult mesenteric arteries, and had a greater L-Ca(2+)/sGC ratio (p = 0.047 and r = -0.906 for correlation between Emax and L-Ca(2+)/sGC). These results suggest that mesenteric arteries, especially those in fetus, are more responsive to SNO-mediated vasodilation than femoral arteries due to a greater role of the L-type calcium channel in the NO/cGMP pathway.

  5. Femoral artery plaque characteristics, lower extremity collaterals, and mobility loss in peripheral artery disease.

    PubMed

    McDermott, Mary M; Carroll, Timothy; Carr, James; Yuan, Chun; Ferrucci, Luigi; Guralnik, Jack M; Kibbe, Melina; Criqui, Michael H; Tian, Lu; Polonsky, Tamar; Zhao, Lihui; Gao, Ying; Hippe, Daniel S; Xu, Dongxiang; McCarthy, Walter; Kramer, Christopher M

    2017-09-01

    Little is known about the prognostic significance of specific characteristics of magnetic resonance imaging (MRI) measured plaque in the superficial femoral artery (SFA). Associations of MRI-measured plaque quantity, lumen area, and plaque composition in the SFA with subsequent mobility loss were studied in people with lower extremity peripheral artery disease (PAD). Participants with an ankle-brachial index (ABI) < 1.00 were identified from Chicago medical centers and underwent direct visualization of atherosclerotic plaque in the SFA using MRI. Participants were followed annually for up to 4 years. Mobility loss was defined as becoming unable to walk up and down a flight of stairs or walk one-quarter of a mile without assistance among participants without mobility impairment at baseline. Analyses adjusted for age, sex, race, comorbidities, ABI, physical activity, and other confounders. Of 308 PAD participants without baseline mobility impairment, 100 (32.5%) developed mobility loss during follow-up. Compared to the lowest mean plaque area tertile at baseline, participants in the highest (worst) plaque area tertile had a higher rate of mobility loss (hazard ratio (HR) = 2.08, 95% confidence interval (CI) = 1.14-3.79, p = 0.018). Compared to the highest mean lumen area tertile, the smallest (worst) mean lumen area tertile was associated with greater mobility loss (HR = 2.18, 95% CI = 1.20-3.96, p = 0.011). Neither lipid rich necrotic core nor calcium in the SFA were associated with mobility loss. In conclusion, greater plaque quantity and smaller lumen area in the proximal SFA, but not lipid rich necrotic core or calcium, were associated with higher mobility loss in people with PAD.

  6. Relative risk of aortic and femoral insertion of intraaortic balloon pump after coronary artery bypass grafting procedures.

    PubMed

    Pinkard, J; Utley, J R; Leyland, S A; Morgan, M; Johnson, H

    1993-04-01

    We compared the preoperative, operative, and postoperative characteristics of patients who required balloon pumps after coronary artery bypass graft procedures to determine the relative risks of femoral and aortic insertion. The balloon pump was inserted into the ascending aorta when femoral insertion was not possible because of occlusive disease or small femoral arteries. Femoral insertion was performed in 81 patients and aortic insertion in 42 patients. Patients with aortic insertion were more likely to be small and female (p < 0.05) and were more likely to have carotid bruits and a history of strokes or transient ischemic attacks (p < 0.05). Death was more common in the patients with aortic insertion (18/42, 42.9%) than in those with femoral insertion (19/81, 23.4%) (p < 0.05), as calculated with single regression analysis. Route of insertion was not a predictor of operative death, according to multiple regression analysis. Leg complications were more common in patients with femoral artery insertion (23/81, 28.4%) than in those with aortic insertion (0/42, 0.0%) (p < 0.05). No sternal complications occurred in either group. New neurologic abnormalities were not significantly different between the patients with aortic and femoral insertion. Aortic insertion is a safe alternative to femoral insertion of intraaortic balloon pumps and is associated with fewer leg complications in small or diseased iliac and femoral arteries. The greater mortality rate with aortic insertion is related to greater comorbidity rate in these patients.

  7. Pseudoaneurysm of the Superficial Femoral Artery in Behcet's Disease with Spontaneous Thrombosis Followed by CT Angiography

    SciTech Connect

    Yoshida, Satoru; Akiba, Hidenari; Tamakawa, Mituharu; Takeda, Miki; Yama, Naoya; Hareyama, Masato; Morita, Kazuo; Masuda, Atsushi; Shimamoto, Kazuaki

    1998-07-15

    A 25-year-old man developed sudden pain and a pulsating mass in the left thigh. A diagnosis of Behcet's disease was made because of four major symptoms. Laboratory data indicated active inflammation. Emergency spiral computed tomographic angiography (CTA) showed an aneurysm of the left superficial femoral artery (SFA). Under steroid therapy, follow-up spiral CTA showed spontaneous occlusion of the aneurysm. In the active phase of arteritis, spiral CTA is useful for the diagnosis of arterial lesions to avoid the arterial puncture of conventional arteriography.

  8. Chronic hypoxia alters vasoconstrictive responses of femoral artery in the fetal sheep.

    PubMed

    Kim, Yoon Ha; Veille, Jean-Claude; Cho, Moon Kyoung; Kang, Myoung Seon; Kim, Cheol Hong; Song, Tae-Bok; Figueroa, Jorge P

    2005-02-01

    The purpose of this study was to determine if mild hypoxia alters the responsiveness to vasoactive agents in the renal and the femoral arteries in the fetal sheep. Ten pregnant sheep were operated under halothane anesthesia at 116 to 124 days' gestation. A maternal tracheal catheter was placed for infusing compressed air (control group, n=5) or nitrogen (hypoxia group, n=5) starting on post operative day 6 and maintained for 5 days. Femoral and renal arteries were harvested from the fetus to study the constriction response to phenylephrine (PE 10(-9) to 10(-5)mol/L). To determine the involvement of nitric oxide as a modulator of vessel constriction, N-nitro-L-arginine methyl ester (L-NAME) was used at a concentration of 10 -4 mol/L in parallel chambers. In the hypoxia group, maternal PaO2 significantly decreased from a base-line of 110.4+/-1.4 to 80.5+/-1.6 (mmHg, p<0.01), fetal PaO2 significantly decreased from a baseline of 20.9+/-0.3 to 15.5+/-0.1 (mmHg, p<0.01). Hypoxia was associated with a significant increase in PE maximal response in the absence (184.5+/-6.6 vs. 146.2+/-4.3) and presence (166.9+/-6.3 vs. 145.0+/-4.5) of L-NAME, and a decrease in EC50 in the absence (6.0+/-1.1 vs. 27.0+/-4.1) of L-NAME of femoral arteries. However, there were no significant differences in PE maximal response and EC50 in the absence and presence of L-NAME of renal arteries. We concluded that mild chronic hypoxia seems to increase the fetal femoral artery response to PE, but not in the fetal renal artery. This observation is consistent with a redistribution of cardiac output away from the carcass.

  9. Novel femoral artery terminology: integrating anatomy and clinical procedures leading to standardized intuitive nomenclature.

    PubMed

    Benninger, Brion

    2014-10-01

    The objective of this study is to investigate the terminology of the femoral artery and recommended alternative terminology that satisfies both anatomy and clinical arenas.The femoral artery (FA) is often defined as the continuation of the external iliac artery. Specifically, when the external iliac artery reaches directly beneath the inguinal ligament, it becomes the FA. Currently, Terminologia Anatomica (TA) records the profunda femoris or deep femoral as a terminal branch. Clinicians often use superficial femoral artery (SFA) rather than FA and profunda or deep FA. SFA is actually very deep and well protected for most of its journey. On observation, the terminology in current use is not intuitive. The objective of this study was to investigate the terminology associated with the anatomical and clinical anatomical interpretations of the FA and its terminal branches and to suggest a more appropriate terminology that addresses the points of view of the macro anatomist, as well as that of the clinician. Literature search was conducted regarding the nomenclature of the FA and its terminal branches. Dissection of 89 embalmed cadavers (49F, 40M, ages 47-89) was conducted to analyze the morphology of the FA and its branches. Perusal of the literature revealed a difference in terminology between anatomical and clinical textbooks/atlases/journals regarding the FA and its terminal branch. Our dissections suggested that the FA may be better defined vis-à-vis its relationship to the anterior and posterior compartments of the thigh. A difference in terminology exists between the anatomical and clinical arenas. A need for a standardized terminology is necessary because clinicians and their publishers have not adopted TA. This study suggests that the current FA be considered the common FA and the continuation of the FA, the SFA be renamed the anterior FA and the current profunda (the deep FA) be renamed the posterior FA, respectively. The proposed terminology mirrors the lower

  10. Effects of Crimping on Mechanical Performance of Nitinol Stent Designed for Femoral Artery: Finite Element Analysis

    NASA Astrophysics Data System (ADS)

    Nematzadeh, F.; Sadrnezhaad, S. K.

    2013-11-01

    Nitinol stents are used to minimize improper dynamic behavior, low twistability, and inadequate radial mechanical strength of femoral artery stents. In this study, finite element method is used to investigate the effect of crimping and Austenite finish temperature ( A f) of Nitinol on mechanical performance of Z-shaped open-cell femoral stent under crimping conditions. Results show that low A f Nitinol has better mechanical and clinical performance due to small chronic outward force, large radial resistive force, and appropriate superelastic behavior.

  11. A new method to catheterize a femoral artery in mice using a nylon suture as a 'guide wire'.

    PubMed

    Fukui, S; Nawshiro, H; Wada, K; Shima, K; Hallenbeck, J M

    2001-09-01

    Mice are commonly used in laboratory experiments. Their femoral arteries are so tiny that catheterization is quite difficult. We describe a new method to catheterize the femoral artery in mice. The key feature of this new method is the use of a nylon suture as a 'guide wire'. The full catheterization system consists of two sizes of polyethylene tubes (PE-10, PE-50) and a 4-0 nylon suture. We have been able to repeatedly catheterize mouse femoral arteries (n = 57) successfully and easily with this new system. We believe that this new method can facilitate vascular catheterization in small animals such as mice.

  12. Signature of subclinical femoral artery atherosclerosis in peripheral blood mononuclear cells.

    PubMed

    Llorente-Cortés, Vicenta; de Gonzalo-Calvo, David; Orbe, Josune; Páramo, Jose Antonio; Badimon, Lina

    2014-06-01

    Peripheral arterial disease is a relevant public health problem associated with increased risk of morbimortality. Most of the patients with this condition are asymptomatic. Therefore, the development of accessible biochemical markers seems to be necessary to anticipate diagnosis. Our hypothesis is that asymptomatic subjects with objectively confirmed femoral artery atherosclerosis could be distinguished from control subjects by gene expression analysis in peripheral blood mononuclear cells (PBMC). A total of 37 asymptomatic males over 50 years old were recruited at the University Clinic of Navarra (Spain). Nineteen participants were free from atherosclerotic vascular disease and 18 participants presented subclinical femoral artery atherosclerosis defined by means of Doppler ultrasound. PBMC were isolated from blood and the RNA extracted. A panel of atherosclerotic-related genes were evaluated by Taqman low-density array. In univariate logistic regression models, we found a direct relationship between IL4, ITGAM and TLR2 expression levels in PBMC and femoral atherosclerosis, even when the models were adjusted for age and hypertension prevalence. Multivariate logistic regression models showed that elevated IL4 expression levels were intimately associated with subclinical femoral atherosclerosis after adjusting for the same potential confounders. Current data suggest that gene expression in PBMC, in particular IL4 expression, could be a useful tool in the diagnosis of femoral artery atherosclerosis in asymptomatic patients. Furthermore, in patients with no differences in cardiovascular risk factors except for hypertension, the results point to the immune and inflammatory deregulation as a feature of subclinical peripheral atherosclerosis. © 2014 Stichting European Society for Clinical Investigation Journal Foundation.

  13. Pocket-size imaging devices allow for reliable bedside screening for femoral artery access site complications.

    PubMed

    Filipiak-Strzecka, Dominika; Michalski, Błażej; Kasprzak, Jarosław D; Lipiec, Piotr

    2014-12-01

    The aim of this study was to validate pocket-size imaging devices (PSIDs) as a fast screening tool for detecting complications after femoral artery puncture. Forty patients undergoing femoral artery puncture for arterial access related to percutaneous coronary intervention were enrolled. Twenty-four hours after percutaneous coronary intervention, the involved inguinal region was assessed with PSIDs enabling 2-D gray-scale and color Doppler imaging. Subsequently, examination with a stationary high-end ultrasound system was performed to verify the findings of bedside examination in all patients. In 37 patients, PSID imaging had good diagnostic quality. False aneurysms (one asymptomatic) occurred in four patients, and all were recognized during bedside screening with PSID. One case of femoral artery thrombosis was confirmed with PSID and during standard ultrasonographic examination. Physical examination augmented with the quick bedside PSID examination had a sensitivity of 100% and specificity of 91%. PSID facilitated rapid bedside detection of serious access site complications in the vast majority of patients, including asymptomatic cases.

  14. Amputation risk factors in concomitant superficial femoral artery and vein injuries.

    PubMed Central

    Phifer, T J; Gerlock, A J; Vekovius, W A; Rich, N M; McDonald, J C

    1984-01-01

    Only a small subset of patients with combined superficial femoral artery and vein injuries results in amputation. The importance of the venous component as a risk factor for amputation is uncertain. Ligation vs. reconstruction of venous injuries is controversial. For clarification of these issues, we analyzed retrospectively multiple risk factors for amputation in combined superficial femoral artery and vein injuries in a civilian population. There were 25 patients treated in a 20-year period. Sixteen injuries were caused by small caliber missiles, six by shotgun blasts, and three by knife wounds. Three patients (12%) ultimately underwent amputation. The major risk factor for amputation was method of vascular reconstruction. All three amputations underwent ligation of the superficial femoral vein with arterial reconstruction by placement of a reversed interposition saphenous vein graft (p = 0.0009). None of the remaining 22 patients with salvaged limbs underwent reconstruction by this combination of techniques. Consequently, the authors emphasize the importance of venous reconstruction, particularly in combined injuries with major arterial involvement requiring interposed grafts. PMID:6696539

  15. Superficial femoral artery plaque and functional performance in peripheral arterial disease: walking and leg circulation study (WALCS III).

    PubMed

    McDermott, Mary M; Liu, Kiang; Carroll, Timothy J; Tian, Lu; Ferrucci, Luigi; Li, Debiao; Carr, James; Guralnik, Jack M; Kibbe, Melina; Pearce, William H; Yuan, Chun; McCarthy, Walter; Kramer, Christopher M; Tao, Huimin; Liao, Yihua; Clark, Elizabeth Talley; Xu, Dongxiang; Berry, Jarett; Orozco, Jennifer; Sharma, Leena; Criqui, Michael H

    2011-07-01

    We studied associations of magnetic resonance imaging measurements of plaque area and relative percent lumen reduction in the proximal superficial femoral artery with functional performance among participants with peripheral arterial disease. The clinical significance of directly imaged plaque characteristics in lower extremity arteries is not well established. A total of 454 participants with an ankle brachial index <1.00 underwent magnetic resonance cross-sectional imaging of the proximal superficial femoral artery and completed a 6-min walk test, measurement of 4-m walking velocity at usual and fastest pace, and measurement of physical activity with a vertical accelerometer. Adjusting for age, sex, race, body mass index, smoking, statin use, comorbidities, and other covariates, higher mean plaque area (1st quintile [least plaque]: 394 m, 2nd quintile: 360 m, 3rd quintile: 359 m, 4th quintile: 329 m, 5th quintile [greatest plaque]: 311 m; p trend <0.001) and smaller mean percent lumen area (1st quintile [greatest plaque]: 319 m, 2nd quintile: 330 m, 3rd quintile: 364 m, 4th quintile: 350 m, 5th quintile: 390 m; p trend <0.001) were associated with shorter distance achieved in the 6-min walk test. Greater mean plaque area was also associated with slower usual-paced walking velocity (p trend = 0.006) and slower fastest-paced 4-m walking velocity (p trend = 0.003). Associations of mean plaque area and mean lumen area with 6-min walk distance remained statistically significant even after additional adjustment for the ankle brachial index and leg symptoms. Among participants with peripheral arterial disease, greater plaque burden and smaller lumen area in the proximal superficial femoral artery are associated independently with poorer functional performance, even after adjusting for the ankle brachial index and leg symptoms. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. Location of civilian ballistic femoral fracture indicates likelihood of arterial injury.

    PubMed

    Gitajn, Leah; Perdue, Paul; Hardcastle, John; O'Toole, Robert V

    2014-10-01

    We evaluated whether the location of a ballistic femoral fracture helps predict the presence of arterial injury. We hypothesized that fractures located in the distal third of the femur are associated with a higher rate of arterial injury. We conducted a retrospective review of electronic medical records at our level I trauma centre and found 133 consecutive patients with femoral fractures from civilian gunshots from 2002 to 2007, 14 of whom sustained arterial injury. Fracture extent was measured with computerized viewing software and recorded with a standard technique, calculating proximal, distal, and central locations of the fracture as a function of overall length of the bone. Analyses were conducted with Student's t, Chi-squared, and Fisher's exact tests. The location of any fracture line in the distal third of the femur was associated with increased risk of arterial injury (P<0.05). The odds ratio for the presence of arterial injury when the proximal fracture line was in the distal third of the femur was 5.63 (95% confidence interval, 1.7-18.6; P<0.05) and when the distal fracture line was in the distal third of the femur was 6.72 (95% confidence interval, 1.78-25.44; P<0.05). A fracture line in the distal third of the femur after ballistic injury is six times more likely to be associated with arterial injury and warrants careful evaluation. Our data show that fracture location can help alert clinicians to possible arterial injury after ballistic femoral fracture. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Carotid and femoral artery stiffness in relation to three candidate genes in a white population.

    PubMed

    Balkestein, E J; Staessen, J A; Wang, J G; van Der Heijden-Spek, J J; Van Bortel, L M; Barlassina, C; Bianchi, G; Brand, E; Herrmann, S M; Struijker-Boudier, H A

    2001-11-01

    Different genetic polymorphisms influence cardiovascular disease. We recently discovered a relationship between the intima-media thickness of the muscular femoral artery, but not the elastic common carotid artery, and the combined ACE (ACE, I/D), alpha-adducin (Gly460Trp),and aldosterone synthase (AS, C-344T) gene polymorphisms. To investigate the relationship between these polymorphisms and functional properties of the carotid artery and femoral artery, a sample of 756 subjects enrolled in a population study were genotyped for the presence of the ACE D, alpha-adducin 460Trp, and aldosterone synthase -344T alleles. Vessel wall properties were assessed using a vessel wall movement detector system in combination with applanation tonometry. Statistical analysis allowed for confounders and interaction among genes. Cross-sectional compliance of the common carotid artery was negatively associated with the ACE D allele. ACE II versus ACE DD homozygotes differed, expressed as a percentage of the population mean (7.0%; 95% confidence interval [CI], 1.6% to 12.4%; P=0.02). In multigene analysis, ACE DD subjects also deviated significantly from the population mean for the distensibility coefficient of the common carotid artery when carrying the AS/T allele (-5.5%; 95% CI, -9.3% to -1.7%; P<0.01), without a change in cross-sectional compliance. ACE DD subjects, when homozygote for alpha-adducin Gly460, had a lower femoral cross-sectional compliance (-10.4%; 95% CI, -1.9% to -18.9%; P<0.03) and a lower distensibility (-9.7%; 95% CI, -2.1% to -17.3%; P<0.02) compared with the population mean. These data show that functional large artery properties are influenced by the ACE I/D polymorphism. Cross-sectional compliance and distensibility coefficients are influenced by the ACE I/D genotype, but this influence depends on the vascular territory and genetic background.

  18. Routine Use of Distal Arterial Perfusion in Pediatric Femoral Venoarterial Extracorporeal Membrane Oxygenation.

    PubMed

    Schad, Christine A; Fallon, Brian P; Monteagudo, Julie; Okochi, Shunpei; Cheung, Eva W; Morrissey, Nicholas J; Kadenhe-Chiweshe, Angela V; Aspelund, Gudrun; Stylianos, Steven; Middlesworth, William

    2017-01-01

    Lower-extremity ischemia is a significant complication in children on femoral venoarterial extracorporeal membrane oxygenation (VA ECMO). Our institution currently routinely uses distal perfusion catheters (DPCs) in all femoral arterial cannulations in attempts to reduce ischemia. We performed a single-center, retrospective review of pediatric patients supported with femoral VA ECMO from January 2005 to November 2015. The outcomes of patients with prophylactic DPC placement at cannulation (prophylactic DPC) were compared to a historical group with DPCs placed in response only to clinically evident ischemic changes (reactive DPC). Ischemic complication requiring invasive intervention (fasciotomy or amputation) was the primary outcome. Twenty-nine patients underwent a total of 31 femoral arterial cannulations, 17 with prophylactic DPC and 14 with reactive DPC. Ischemic complications requiring invasive intervention developed in 2 of 17 (12%) prophylactic DPC patients versus 4 of 14 (29%) reactive DPC. In the reactive DPC group, 7 of 14 (50%) had ischemic changes postcannulation, six underwent DPC placement, and three out of six of these patients still required invasive intervention. One of the seven patients had ischemic changes, did not undergo DPC, and required amputation. While a greater percentage of patients in the prophylactic group was cannulated during extracorporeal cardiopulmonary resuscitation (ECPR), statistical significance was not otherwise demonstrated. We demonstrate feasibility of superficial femoral artery (SFA) access in pediatric patients. We note fewer ischemic complications with prophylactic DPC placement, and observe that salvaging a limb with a reactive DPC was only successful 50% of the time. Although there was no statistical difference in the primary outcome between the two groups, limitations and confounding factors include small sample size and a greater percentage of patients in the prophylactic DPC group cannulated with ECPR in progress.

  19. Effect of Arterial Deprivation on Growing Femoral Epiphysis: Quantitative Magnetic Resonance Imaging Using a Piglet Model

    PubMed Central

    Cheon, Jung-Eun; Kim, In-One; Kim, Woo Sun; Choi, Young Hun

    2015-01-01

    Objective To investigate the usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion MRI for the evaluation of femoral head ischemia. Materials and Methods Unilateral femoral head ischemia was induced by selective embolization of the medial circumflex femoral artery in 10 piglets. All MRIs were performed immediately (1 hour) and after embolization (1, 2, and 4 weeks). Apparent diffusion coefficients (ADCs) were calculated for the femoral head. The estimated pharmacokinetic parameters (Kep and Ve from two-compartment model) and semi-quantitative parameters including peak enhancement, time-to-peak (TTP), and contrast washout were evaluated. Results The epiphyseal ADC values of the ischemic hip decreased immediately (1 hour) after embolization. However, they increased rapidly at 1 week after embolization and remained elevated until 4 weeks after embolization. Perfusion MRI of ischemic hips showed decreased epiphyseal perfusion with decreased Kep immediately after embolization. Signal intensity-time curves showed delayed TTP with limited contrast washout immediately post-embolization. At 1-2 weeks after embolization, spontaneous reperfusion was observed in ischemic epiphyses. The change of ADC (p = 0.043) and Kep (p = 0.043) were significantly different between immediate (1 hour) after embolization and 1 week post-embolization. Conclusion Diffusion MRI and pharmacokinetic model obtained from the DCE-MRI are useful in depicting early changes of perfusion and tissue damage using the model of femoral head ischemia in skeletally immature piglets. PMID:25995692

  20. Safety of early ambulation in patients undergoing ultrasound-guided femoral low angle arterial access technique (FLAT).

    PubMed

    Shukla, P A; Kolber, M K; Kumar, A; Patel, R I

    2017-06-01

    To evaluate the safety of early ambulation in patients undergoing transfemoral arterial interventions via ultrasound-guided femoral low angle arterial access technique (FLAT). A total of 58 patients undergoing 72 transfemoral arterial procedures that underwent an attempt at FLAT for femoral artery cannulation at our institution from November 2014 to July 2015 were retrospectively identified. Technical success was defined as obtaining less than a 35-degree angle of entry through the anterior wall of the common femoral artery. Patients for which a low angle was achieved were ambulated after 2hours after hemostasis was achieved with manual compression. All patients received out-patient clinic follow-up which included ultrasound examination of the femoral artery. Chart review provided demographic data, pertinent past medical history, procedural information (type of procedure, size of femoral access sheath, time to ambulation), complications related to arterial access and follow up. Twelve patients were excluded from the study due to inability to analyze ultrasound images. A low angle was achieved in 37 patients (17 men, 20 women; mean age: 58.5 years±13.1 [SD]) undergoing 45 procedures who met inclusion criteria for the study, yielding technical success rate of 75%. There was a moderate positive correlation between the access angle and depth of the common femoral artery at the site of puncture (r=0.45; P<0.01). All patients were followed up within 2 weeks of the initial procedure in the outpatient clinic. No arterial access-related complications occurred. Femoral artery cannulation using FLAT followed by manual compression and ambulation after 2 hours appears to be a safe approach. Copyright © 2016 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  1. Drug coated balloons in the superficial femoral artery.

    PubMed

    Schlager, Oliver; Gschwandtner, Michael E; Willfort-Ehringer, Andrea; Wolf, Florian; Loewe, Christian; Koppensteiner, Renate; Lichtenberg, Michael

    2017-09-20

    Despite the progress in endovascular treatment of patients with peripheral arterial disease, restenosis remains the major drawback, especially in patients with femoropopliteal lesions. To reduce neointimal proliferation and subsequent restenosis the use of antiproliferative drug eluting devices was implemented in the endovascular treatment of femoropopliteal disease. Aiming to use the favorable effects of these antiproliferative agents and to reduce foreign body exposure in affected arteries, drug coated balloons (DCB) have been developed. Up to now, several randomized controlled trials have consistently demonstrated the superiority of DCB over uncoated balloon angioplasty in the treatment of femoropopliteal lesions. Similarly, DCB appear to have favorable effects on vessel patency in the treatment of femoropopliteal instent restenosis. However, there still is a need for further studies, especially addressing different lesion characteristics as well as the combinations of particular treatment modalities.

  2. Intracardiac Penetrating Injury with Right Femoral Artery Embolism due to Blast Injury

    PubMed Central

    Abuzaid, Ahmed Abdulaziz; Al-Abbasi, Thamer; Arekat, Zaid

    2016-01-01

    Embolization due to blast injury with projectiles entering the bloodstream from the heart is a rare event that is unlikely to be suspected during the initial assessment of trauma patients. We report a case in which a missile penetrating the heart chambers managed to embolize and occlude the right common femoral artery. This was successfully managed by means of a multidisciplinary approach that included exploration, cardiorrhaphy, and embolectomy. PMID:28400939

  3. Is there already a place for endovascular treatment of the common femoral artery?

    PubMed

    Geiger, M; Deloose, K; Callaert, J; Bosiers, M

    2015-02-01

    Surgical endarterectomy has been considered the prefered technique for treating the common femoral artery (CFA). Although favorable endovascular treatment results of the CFA have recently become available, losing the groin area as an important acess site is still the major concern for this technique to become the golden standart. Nevertheless, the endovascular approach has shown, through several studies, including our experience, the capacity to establish itself as a complementery treatment for the modern vascular surgeon.

  4. Duplication of the superficial femoral artery: comprehensive review of imaging literature and insight into embryology

    PubMed Central

    Hapugoda, Sachintha; Kwan, Gigi Nga Chi; Watkins, Trevor William; Rophael, John A

    2016-01-01

    An extremely rare case of duplicated superficial femoral artery (SFA) was incidentally observed on computed tomography angiogram (CTA) of the lower limbs for presurgical planning for an osteomyocutaneous fibula flap in a patient with T4a oropharyngeal squamous cell carcinoma (SCC). To our knowledge, this is the sixth reported case in the imaging literature. We performed a comprehensive review of the English literature and discuss the underlying embryological origin underpinning this rare anatomical variant. PMID:27504194

  5. Experimental investigations of the steady flow through an idealized model of a femoral artery bypass

    NASA Astrophysics Data System (ADS)

    Giurgea, Corina; Bode, Florin; Ioan Budiu, Octavian; Nascutiu, Lucian; Banyai, Daniel; Damian, Mihai

    2014-03-01

    The present paper presents the steps taken by the authors in the first stage of an experimental program within a larger national research project whose objective is to characterize the flow through a femoral artery bypass with a view to finding solutions for its optimization. The objective of the stage is to investigate by means of the PIV method the stationary flow through a bypass model with an idealized geometry. A bypass assembly which reunites the idealized geometry models of the proximal and distal anastomoses, and which respects the lengths of a femoral artery bypass was constructed on the basis of data for a real patient provided by medical investigations. With the aim of testing the model and the established experimental set-up with regard to their suitability for the assessment of the velocity field associated to the steady flow through the bypass, three zones that can restore the whole distal anastomosis were PIV investigated. The measurements were taken in the conditions of maintained inflow at the bypass entry of 0.9 l / min (Re = 600). The article presents comparatively the flow spectra and the velocity fields for each zone obtained in two situations: with the femoral artery completely occluded and completely open.

  6. [A mathematical analysis of the flow-velocity curves in the femoral arteries].

    PubMed

    Ley Pozo, J; Vega Gómez, M E; Aldama Figueroa, A; Ochoa Bizet, M

    1993-01-01

    In order to improve the early diagnosis of the aortoiliac injuries, 98 arteries from several supposedly health patients (different ages) and 41 femoral arteries from patients with occlusion at this level (demonstrated by arteriography) were studied. The analysis from the Fourier's series showed highly significant differences between both groups, and so did the comparison of some indexes automatically measured by the Vasoscan VL equip. By multivariant statistics methods was selected the main group of parameters that allows the differentiation between the ill patients and the healthy ones. This procedure can be useful for the physiopathological study and it may be used as a non-invasive method of diagnosis.

  7. Entrapment of the StarClose Vascular Closure System After Attempted Common Femoral Artery Deployment

    SciTech Connect

    Durack, Jeremy C. Thor Johnson, D.; Fidelman, Nicholas; Kerlan, Robert K.; LaBerge, Jeanne M.

    2012-08-15

    A complication of the StarClose Vascular Closure System (Abbott, Des Plaines, IL) after a transarterial hepatic chemoembolization is described. After attempted clip deployment, the entire device became lodged in the tissues overlying the common femoral artery and could not be removed percutaneously. Successful removal of the device required surgical cutdown for removal and arterial repair. Entrapment of the StarClose vascular closure deployment system is a potentially serious complication that has been reported in the Manufacturer and User Facility Device Experience database, but has not been recognized in the literature.

  8. Current Approach to the Diagnosis and Treatment of Femoral-Popliteal Arterial Disease. A Systematic Review

    PubMed Central

    Kasapis, Christos; Gurm, Hitinder S

    2009-01-01

    Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis affecting 5 million adults in the United States, with an age-adjusted prevalence of 4% to 15% and increasing up to 30% with age and the presence of cardiovascular risk factors. In this article we focus on lower extremity PAD and specifically on the superficial femoral and proximal popliteal artery (SFPA), which are the most common anatomic locations of lower extremity atherosclerosis. We summarize current evidence and perform a systematic review on the diagnostic evaluation as well as the medical, endovascular and surgical management of SFPA disease. PMID:21037847

  9. In vivo imaging of superficial femoral artery (SFA) stents for deformation analysis

    NASA Astrophysics Data System (ADS)

    Ganguly, A.; Schneider, A.; Keck, B.; Bennett, N. R.; Fahrig, R.

    2008-03-01

    A high-resolution (198 μm) C-arm CT imaging system (Axiom Artis dTA, Siemens Medical Solutions, Forchheim, Germany) was optimized for imaging superficial femoral artery (SFA) stents in humans. The SFA is susceptible to the development of atherosclerotic lesions. These are typically treated with angioplasty and stent deployment. However, these stents can have a fracture rate as high as 35%. Fracture is usually accompanied by restenosis and reocclusion. The exact cause of breakage is unknown and is hypothesized to result from deforming forces due to hip and knee flexion. Imaging was performed with the leg placed in both straight and bent positions. Projection images obtained during 20 s scans with ~200° of rotation of the C-arm were back-projected to obtain 3D volumes. Using a semi-automatic software algorithm developed in-house, the stent centerlines were found and ellipses were fitted to the slice normals. Image quality was adequate for calculations in 11/13 subjects. Bending the leg was found to shorten the stents in 10/11 cases with the maximum change being 9% (12 mm in a 133 mm stent), and extend the stent in one case by 1.6%. The maximum eccentricity change was 36% with a bend angle of 72° in a case where the stent extended behind the knee.

  10. Effects of indapamide on endothelium-dependent relaxations in isolated canine femoral arteries.

    PubMed

    Schini, V B; Dewey, J; Vanhoutte, P M

    1990-05-02

    Indapamide is an effective antihypertensive agent in humans and in experimental hypertensive animals. The aim of the present study was to investigate whether indapamide affects endothelium-dependent and independent relaxations in canine femoral arteries. Rings (with or without endothelium) were contracted with prostaglandin F2 alpha (2 X 10(-6) mol/liter) before the addition, in a cumulative fashion, of relaxing agents. Indapamide (10(-7) to 10(-4) mol/liter) had no direct effect on unstimulated or prostaglandin-stimulated preparations; it did not alter relaxations of preparations with endothelium induced by acetylcholine, bradykinin, adenosine diphosphate or the calcium ionophore A23187. Similarly, it did not affect relaxations induced by sodium nitroprusside, prostacyclin or forskolin in preparations with or without endothelium. Indomethacin shifted the concentration-response curve to bradykinin to the right and did not alter that to the other relaxing drugs. The reduced relaxation to bradykinin was reversed in a concentration-dependent manner by indapamide (10(-7) to 10(-5) mol/liter). In the presence of indomethacin, indapamide shifted the concentration response curve to prostacyclin (in rings with endothelium) and to forskolin (in rings with and without endothelium) to the left. Thus, indapamide does not directly affect endothelium-dependent and independent relaxations. However, when prostanoid production is impaired, indapamide facilitates the release of endothelium-derived relaxing factor(s), and to a lesser extent, the direct action on vascular smooth muscle of prostanoids (prostacyclin) released from the endothelium.

  11. Evolution and current use of technology for superficial femoral and popliteal artery interventions for claudication.

    PubMed

    Schneider, Peter A

    2017-09-01

    An important facet in caring for patients with claudication is the development of a plan for managing the technology available for superficial femoral artery (SFA) and popliteal artery interventions. Although this is a field in evolution, clinical experience and data are emerging that assist the clinician in making informed choices as to the best method of endovascular treatment. Algorithms for SFA and popliteal artery interventions are developing. Methods for assessing a wide range of technologies are discussed. This article reviews the evolution of technology for SFA and popliteal artery interventions, describes the recent developments in data and clinical experiences, and discusses some potential methods of device assessment and incorporation into clinical practice. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  12. Fast segmentation of the femoral arteries from 3D MR images: A tool for rapid assessment of peripheral arterial disease.

    PubMed

    Chen, Weifu; Xu, Jianrong; Chiu, Bernard

    2015-05-01

    The peripheral arterial disease is a powerful indicator of coexistent generalized atherosclerosis. As plaques in femoral arteries are diffused and can span a length of 30 cm, a large coverage of the arteries is required to assess the full extent of atherosclerosis. Recent development of 3D black-blood magnetic resonance imaging sequences has allowed fast acquisition of images with an extended longitudinal coverage. Vessel wall volume quantification requires the segmentation of the lumen and outer wall boundaries, and conventional manual planimetry would be too time-consuming to be feasible for analyzing images with such a large coverage. To address this challenge in image analysis, this work introduces an efficient 3D algorithm to segment the lumen and outer wall boundaries for plaque and vessel wall quantification in the femoral artery. To generate the initial lumen surface, a user identified the location of the lumen centers manually on a set of transverse images with a user-specified interslice distance (ISD). A number of geometric operators were introduced to automatically adjust the initial lumen surface based on pixel intensity and gradient along the boundary and at the center of each transverse slice. The adjusted surface was optimized by a 3D deformable model driven by the local stiffness force and external force based on image gradient. The optimized lumen surface was expanded to obtain the initial outer wall surface, which was subsequently optimized by the 3D deformable model. The algorithm was executed with and without adjustment of the initial lumen surface and for three different selections of ISD: 10, 20, and 30 mm. The segmentation accuracy was improved in a statistically significant way with the introduction of initial lumen surface adjustment, but was insensitive to the ISD setting. When compared with the manual segmentation, the settings with adjustment have, on average, mean absolute differences (MADs) of 0.28 and 0.36 mm, respectively, for lumen

  13. Percutaneous Thrombin Injection of a Femoral Artery Pseudoaneurysm with Simultaneous Venous Balloon Occlusion of a Communicating Arteriovenous Fistula

    SciTech Connect

    Mittleider, Derek Cicuto, Kenneth; Dykes, Thomas

    2008-07-15

    An 82-year-old woman developed acute occlusion of her right coronary artery. She underwent percutaneous coronary stent placement and aortic balloon pump installation. In the postprocedural period, she developed a common femoral artery pseudoaneurysm (PSA) that communicated with the common femoral vein via an arteriovenous fistula (AVF). After unsuccessful ultrasound-guided compression, ultrasound-guided thrombin injection of the PSA was performed, with simultaneous balloon occlusion of the common femoral vein at the level of the AVF. There was complete thrombosis of the PSA and AVF.

  14. Angioplasty of the pelvic and femoral arteries in PAOD: results and review of the literature.

    PubMed

    Balzer, Jörn O; Thalhammer, Axel; Khan, Verena; Zangos, Stefan; Vogl, Thomas J; Lehnert, Thomas

    2010-07-01

    Evaluation of percutaneous recanalization of obstructed iliac as well as superficial femoral arteries (SFAs) in patients with peripheral arterial obstructive disease (PAOD). The data of 195 consecutive patients with 285 obstructions of the common and or external iliac artery as well as the data of 452 consecutive patients with 602 long occlusions (length>5 cm) of the SFA were retrospectively analyzed. The lesions were either treated with percutaneous transluminal angioplasty (PTA) or Excimer laser assisted percutaneous transluminal angioplasty (LPTA). Overall 316 stents were implanted (Nitinol stents: 136; stainless steel stents: 180) in the iliac artery and 669 stents were implanted (Nitinol stents: 311; Easy Wallstents: 358) in the SFA. The follow-up period was 36-65 months (mean 46.98+/-7.11 months) postinterventionally using clinical examination, ABI calculation, and color-coded duplex sonography. Patency rates were calculated on the basis of the Kaplan-Meier analysis. The overall primary technical success rate was 97.89% for the iliac arteries and 92.35% for the SFA. Minor complications (hematoma, distal emboli and vessel dissection) were documented in 11.79% for the iliac arteries and 7.97% for the SFA. The primary patency rate was 90.3% for the iliac and 52.8% for the SFA after 4 years. The secondary patency rate was 96.84% for the iliac and 77.8% for the SFA after 4 years. Percutaneous recanalization of iliac and superficial femoral artery obstructions is a safe and effective technique for the treatment of patients with PAOD. By consequent clinical monitoring high secondary patency rates can be achieved. The use of a stents seems to result in higher patency rate especially in the SFA when compared to the literature in long-term follow-up. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  15. Implantation of completely biological engineered grafts following decellularization into the sheep femoral artery.

    PubMed

    Syedain, Zeeshan H; Meier, Lee A; Lahti, Mathew T; Johnson, Sandra L; Tranquillo, Robert T

    2014-06-01

    The performance of completely biological, decellularized engineered allografts in a sheep model was evaluated to establish clinical potential of these unique arterial allografts. The 4-mm-diameter, 2-3-cm-long grafts were fabricated from fibrin gel remodeled into an aligned tissue tube in vitro by ovine dermal fibroblasts. Decellularization and subsequent storage had little effect on graft properties, with burst pressure exceeding 4000 mmHg and the same compliance as the ovine femoral artery. Grafts were implanted interpositionally in the femoral artery of six sheep (n=9), with contralateral sham controls (n=3). At 8 weeks (n=5) and 24 weeks (n=4), all grafts were patent and showed no evidence of dilatation or mineralization. Mid-graft lumen diameter was unchanged. Extensive recellularization occurred, with most cells expressing αSMA. Endothelialization was complete by 24 weeks with elastin deposition evident. These completely biological grafts possessed circumferential alignment/mechanical anisotropy characteristic of native arteries and were cultured only 5 weeks prior to decellularization and storage as "off-the-shelf" grafts.

  16. An impedance matching of femoral-popliteal arterial grafts: a theoretical study.

    PubMed

    Hirayama, H; Nishimura, T; Fukuyama, Y

    1997-05-01

    We have proposed a mathematical method to investigate the matching conditions for an arterial graft in the femoral-popliteal region from a mechanical stand-point. Pulsatory blood flow, arterial wall motions, and conservation law are expressed by linear dynamical equations based on strict mechanical and constitutional considerations. To express the physiological blood flow in an actual arterial system, the tethering effects from the surrounding tissue and wall tensions were incorporated. The physiological parameters of arterial wall and tethering were utilized from reported experimental data. By complex analysis, mathematical expressions for the local impedance and reflection coefficient were obtained. They include not only blood properties such as viscosity and density, but also arterial properties including elastic modulus, radius, Poisson ratio, wall thickness, wall tension, frequency, and tethering effects from surrounding tissue. A matching condition was defined for minimizing the local impedance and reflection coefficient. The biophysical background was to reduce any mechanical mismatches, thus minimizing the disturbance of the flow velocity profile and shear stress distribution within the artery. Impedance matching in turn diminishes the negative factors for graft substitution represented by intimal hyperplasia and thrombosis. The calculated impedance and reflection coefficient inversed parabolically to functions of the resistance of the host artery, and there was one host arterial resistance that minimized the impedance and reflection coefficient. The present analysis revealed that for matching host artery with an elevated resistance, the dynamic elastic modulus of the wall of the graft that minimizes the impedance and reflection coefficient was increased. This indicates that for a host artery with a high resistance, an impedance matched stiff wall graft is preferable. For a large radius and a compliant host artery on the other hand, a large compliant graft

  17. Chronic Hypoxia Alters Vasoconstrictive Responses of Femoral Artery in the Fetal Sheep

    PubMed Central

    Veille, Jean-Claude; Cho, Moon Kyoung; Kang, Myoung Seon; Kim, Cheol Hong; Song, Tae-Bok; Figueroa, Jorge P.

    2005-01-01

    The purpose of this study was to determine if mild hypoxia alters the responsiveness to vasoactive agents in the renal and the femoral arteries in the fetal sheep. Ten pregnant sheep were operated under halothane anesthesia at 116 to 124 days' gestation. A maternal tracheal catheter was placed for infusing compressed air (control group, n=5) or nitrogen (hypoxia group, n=5) starting on post operative day 6 and maintained for 5 days. Femoral and renal arteries were harvested from the fetus to study the constriction response to phenylephrine (PE 10-9 to 10-5 mol/L). To determine the involvement of nitric oxide as a modulator of vessel constriction, N-nitro-L-arginine methyl ester (L-NAME) was used at a concentration of 10-4 mol/L in parallel chambers. In the hypoxia group, maternal Pao2 significantly decreased from a baseline of 110.4±1.4 to 80.5±1.6 (mmHg, p<0.01), fetal Pao2 significantly decreased from a baseline of 20.9±0.3 to 15.5±0.1 (mmHg, p<0.01). Hypoxia was associated with a significant increase in PE maximal response in the absence (184.5±6.6 vs. 146.2±4.3) and presence (166.9±6.3 vs. 145.0±4.5) of L-NAME, and a decrease in EC50 in the absence (6.0±1.1 vs. 27.0±4.1) of L-NAME of femoral arteries. However, there were no significant differences in PE maximal response and EC50 in the absence and presence of L-NAME of renal arteries. We concluded that mild chronic hypoxia seems to increase the fetal femoral artery response to PE, but not in the fetal renal artery. This observation is consistent with a redistribution of cardiac output away from the carcass. PMID:15716595

  18. Flow measurements in a model of the mildly curved femoral artery of man.

    PubMed

    Back, L H; Kwack, E Y; Crawford, D W

    1990-01-01

    Steady flow observations in a smooth curved femoral artery model with a gradual bend revealed a flow pattern like that observed in coiled pipes. A double helical type flow was found to develop, with converging streamlines in the wall vicinity from the upper and lower plane of curvature merging asymptotically along the inner curvature in a stable manner. The helical or swirl angle of the labeled fluid particle paths increased with flow rate and thus Dean number. Flow in the wall vicinity was altered by centrifugal effects almost immediately downstream of the transition from the straight to curved segment for steady flow, although the propagation of this effect was observed farther downstream along the inner curvature side. This observed distance along the inner curvature became shorter with increasing Dean number. Pressure measurements for steady flow revealed progressively larger pressure drops with distance along the entrance region of the curved segment relative to that for a straight lumen. The overall pressure drop or flow resistance increased in a nonlinear way with increasing flow rate and thus Dean number. Time average pressure drop measurements across another similar smooth curved femoral model were found to be about the same for simulation of femoral artery pulsatile flow as for steady flow.

  19. TRPA1 Function in Skeletal Muscle Sensory Neurons Following Femoral Artery Occlusion.

    PubMed

    Xing, Jihong; Li, Jianhua

    2017-08-17

    Transient receptor potential channel A1 (TRPA1) is engaged in amplified autonomic responses evoked by stimulation of muscle afferent nerves in rats with experimental peripheral arterial disease. The purposes of this study were to characterize current responses induced by activation of TRPA1 in dorsal root ganglion (DRG) neurons of control limbs and limbs with femoral artery occlusion. DRG neurons from rats were labeled by injecting the fluorescence tracer DiI into the hindlimb muscles and whole-cell patch clamp experiments were performed to determine TRPA1 currents. Data show that AITC (a TRPA1 agonist) from the concentrations of 50 µM to 200 µM produces a dose-dependent increase of amplitudes of inward current responses. Notably, the peak current amplitude induced by AITC is significantly larger in DRG neurons of ligated limbs than that in control limbs. AITC-induced current responses are observed in small and medium size DRG neurons, and there is no difference in size distribution of DRG neurons between control limbs and ligated limbs. However, femoral occlusion increases the percentage of the AITC-sensitive DRG neurons as compared to control. AITC-induced currents in DRG neurons are significantly attenuated by exposure to 10 µM of HC-030031, a potent and selective inhibitor of TRPA1, in both control and femoral occlusion groups. In addition, capsaicin (a TRPV1 agonist) evokes a greater increase in the amplitude of AITC-currents in DRG neurons of ligated limbs than that in control limbs. A greater current response with activation of TRPA1 is developed in muscle afferent nerves when hindlimb arterial blood supply is deficient under ischemic conditions; and TRPV1 is partly responsible for augmented TRPA1 responses induced by arterial occlusion. © 2017 The Author(s). Published by S. Karger AG, Basel.

  20. Posterior Wall Capture and Femoral Artery Stenosis Following Use of StarClose Closing Device: Diagnosis and Therapy

    SciTech Connect

    Stefanczyk, Ludomir; Elgalal, Marcin T.; Szubert, Wojciech; Grzelak, Piotr; Szopinski, Piotr; Majos, Agata

    2013-10-15

    A case of femoral artery obstruction following application of a StarClose type arterial puncture closing device (APCD) is presented. Ultrasonographic and angiographic imaging of this complication was obtained. The posterior wall of the vessel was accidentally caught in the anchoring element of the nitinol clip. This complication was successfully resolved by endovascular treatment and the implantation of a stent.

  1. Iatrogenic injuries of the common femoral artery (CFA) and external iliac artery (EIA) during endograft placement: an underdiagnosed entity.

    PubMed

    Hingorani, Anil P; Ascher, Enrico; Marks, Natalie; Shiferson, Alexander; Patel, Nirav; Gopal, Kapil; Jacob, Theresa

    2009-09-01

    Early limb occlusions following endovascular treatment of aorto-iliac aneurysmal disease is not uncommon (4%-13%). To assess whether the femoral artery entry site could potentially cause this complication, we prospectively evaluated the ipsilateral common femoral artery (CFA) and distal external iliac artery (EIA) with intraoperative duplex scans (IDS). There were 134 patients with infrarenal nonruptured abdominal aorto-iliac aneurysms treated with endografts since 2002 at our institution. Age ranged from 65 to 89 years (mean: 77 +/- 7 years). Aneuryx (n = 41), Zenith (n = 50), and Excluder (n = 43) endografts were used for repair. All procedures were performed via open exposure of the CFA. Introducer diameter varied from 12 mm to 22 mm. All patients underwent IDS of the CFA and distal EIA after repair of the arteriotomies. In 34 patients (25%), we documented intimal dissections causing severe (>70%) stenoses. Of the 271 arteries that were examined, 38 (14%) had abnormal findings that demanded intervention. These were repaired with flap excision, tacking sutures revision, or patch angioplasty (n = 36). Repeat IDS confirmed the adequacy of the repair. No statistical difference was noted if the site of larger introducer sheath and the incidence of flap formation. In addition, 10 small flaps or plaques were visualized but did not create significant stenosis. No differences were noted in the incidence of positive duplex exams between each type graft (P = .4). No early or late iliac limb occlusions were noted. Follow-up of 94% was obtained. Completion arterial duplex scans are helpful in detecting a substantial number of clinically unsuspected technical defects caused by introducer sheaths. Timely diagnosis and repair of these defects may decrease the incidence of early limb occlusion following endograft placement.

  2. [Percutaneous treatment of a superficial femoral artery aneurysm using an intravascular stent-prosthesis].

    PubMed

    Michel, C; Laffy, P Y; Leblanc, G; Riou, J Y; Chaloum, S; Maklouf, M; Le Guen, O

    1999-05-01

    One case of superficial femoral aneurysm treated percutaneously by endovascular stent graft (Passager Boston) is reported. The initial radiographic evaluation included arteriography and color doppler sonography which enable analysis of the flow path, the extent of the wall thrombus, the choice of stended graft size. The procedure of implantation was technically trouble free. The post-procedure 3D CT and arteriography demonstrated occlusion of the aneurysm and resaturation of normal flow path. The six and twelve month check confirmed the stability of the results locally and the integrity of run off vessels. In weakened and specially elderly patient percutaneous treatment of superficial femoral artery aneurysm can be carried out easily. The contribution of 3D CT is essential in follow up to ensure an optimal result and to detect any complication.

  3. French multicenter experience with the GORE TIGRIS Vascular Stent in superficial femoral and popliteal arteries.

    PubMed

    Sibé, Maxime; Kaladji, Adrien; Boirat, Claire; Cardon, Alain; Chaufour, Xavier; Bossavy, Jean-Pierre; Saint-Lebes, Bertrand

    2017-05-01

    Preliminary results in small single-center studies after stenting with the GORE TIGRIS Vascular Stent (W. L. Gore & Associates, Flagstaff, Ariz) show promising short-term primary patency rates, but larger, multicenter studies are needed. This study therefore investigated the performance of the GORE TIGRIS Vascular Stent at three different centers in France in patients with symptomatic peripheral artery disease. This retrospective, single-arm, multicenter cohort study included 215 patients with peripheral artery disease (Rutherford-Becker category 2-6) who were treated with the GORE TIGRIS Vascular Stent, a dual-component stent consisting of a nitinol wire frame combined with a fluoropolymer-interconnecting structure. The efficacy end point was primary patency defined by freedom from binary restenosis as derived by duplex ultrasound imaging until 2 years after the intervention. Primary, secondary, and primary assisted patency rates at 3, 6, 12, 18, and 24 months were estimated by Kaplan-Meier analysis. The GORE TIGRIS Vascular Stent was used to successfully treat 239 lesions, of which 141 lesions were located in the superficial femoral artery and 98 in the popliteal artery. Patients were a mean age of 74 ± 12 years. Mean lesion length was 86.8 ± 44.7 mm. After 12 and 24 months, the overall primary patency rates were 81.5% and 67.2%, respectively, and primary assisted patency was 94.9% and 84.8%. Secondary patency was achieved in 99.1% at 24 months. Our multicenter experience with the GORE TIGRIS Vascular Stent demonstrates continued good results at 2 years for endovascular treatment of challenging obstructive superficial femoral artery and popliteal artery disease. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  4. Ovine femoral artery bypass grafting using saphenous vein: a new model.

    PubMed

    El-Kurdi, Mohammed S; Soletti, Lorenzo; Nieponice, Alejandro; Abuin, Gustavo; Gross, Christina; Rousselle, Serge; Greisler, Howard; McGrath, Jonathan

    2015-01-01

    Saphenous vein grafts (SVGs) are frequently used for multi-vessel coronary artery bypass grafting and peripheral arterial bypasses; however, the estimated 40% failure rate within the first 5 y due to intimal hyperplasia (IH) and the subsequent failure rate of 2%-4% per year pose a significant clinical problem. Here, we report a surgical model in sheep intended to study IH development in SVGs, which can also be used for the evaluation of potential alternative treatments. Autologous bilateral SVGs were implanted as femoral artery interposition grafts using end-to-side anastomoses in adult sheep (n = 23), which were survived for 30 (n = 6), 90 (n = 7), 180 (n = 7), or 365 (n = 3) days. Post-implant, mid-term, and pretermination angiograms were quantified, and harvested SVGs were evaluated using quantitative histomorphometry. We describe a peripheral arterial surgical technique that models the progression of SVG pathology. Angiographic analysis showed a progressive dilation of SVGs leading to worsening diametrical matching to the target artery and reduced blood flow; and histomorphometry data showed an increase in IH over time. Multivariable regression analysis suggested that statistically significant (P < 0.05) time-dependent relationships exist between SVG dilation and both reduction in blood flow and IH development. Bilateral SVGs implanted onto the femoral arteries of sheep produced, controlled and consistent angiographic and histomorphometric results for which direct correlations could be made. This preclinical investigation model can be used as a robust tool to evaluate therapies intended for cardiovascular pathologies such as occlusive IH in SVGs. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Skeletal muscle perfusion and stem cell delivery in muscle disorders using intra-femoral artery canulation in mice.

    PubMed

    Matthias, Nadine; Hunt, Samuel D; Wu, Jianbo; Darabi, Radbod

    2015-11-15

    Muscular dystrophies are among major inherited muscle disorders characterized by progressive muscle damage and fibrosis with no definitive cure. Recently, gene or cell based therapies have been developed to restore the missing gene expression or replace the damaged tissues. In order to test the efficiency of these therapies in mice models of muscular dystrophies, the arterial route of delivery is very advantageous as it provides uniform muscle exposure to the therapeutic agents or cells. Although there are few reports of arterial delivery of the therapeutic agents or cells in mice, there is no in-depth description and evaluation of its efficacy in perfusion of downstream muscles. This study is aimed to develop a practical method for intra-femoral artery perfusion in mice and to evaluate perfusion efficiency using near-infrared-fluorescence (NIRF) imaging as well as histology following stem cell delivery. Our results provide a practical guide to perform this delicate method in mice. By using a sensitive fluorescent dye, different muscle groups of the hindlimb have been evaluated for proper perfusion. As the final step, we have validated the efficiency of arterial cell delivery into muscles using human iPS-derived myogenic cells in an immunodeficient mouse model for Duchenne muscular dystrophy (NSG-mdx(4cv)).

  6. Emergency Percutaneous Coronary Intervention Through the Left Radial Artery is Associated with Less Vascular Complications than Emergency Percutaneous Coronary Intervention Through the Femoral Artery.

    PubMed

    Qi, Guoqing; Sun, Qi; Xia, Yue; Wei, Liye

    2017-01-01

    To compare the advantages and disadvantages of emergency percutaneous coronary intervention through the left radial artery with those of emergency percutaneous coronary intervention through the femoral artery. A total of 206 patients with acute myocardial infarction who required emergency percutaneous coronary intervention and were admitted to our hospital between January 2011 and August 2013 were divided into the following two groups: a group that underwent percutaneous coronary intervention through the left radial artery and a group that underwent percutaneous coronary intervention through the femoral artery. The times required for angiographic catheter and guiding catheter placement, the success rate of the procedure and the incidence of vascular complications in the two groups were observed. There was no significant difference in catheter placement time or the ultimate success rate of the procedure between the two groups. However, the left radial artery group showed a significantly lower incidence of vascular complications than the femoral artery group (p<0.05). Emergency percutaneous coronary intervention through the left radial artery is associated with less vascular complications than emergency percutaneous coronary intervention through the femoral artery and is thus potentially advantageous for patients.

  7. Emergency Percutaneous Coronary Intervention Through the Left Radial Artery is Associated with Less Vascular Complications than Emergency Percutaneous Coronary Intervention Through the Femoral Artery

    PubMed Central

    Qi, Guoqing; Sun, Qi; Xia, Yue; Wei, Liye

    2017-01-01

    OBJECTIVE: To compare the advantages and disadvantages of emergency percutaneous coronary intervention through the left radial artery with those of emergency percutaneous coronary intervention through the femoral artery. METHODS: A total of 206 patients with acute myocardial infarction who required emergency percutaneous coronary intervention and were admitted to our hospital between January 2011 and August 2013 were divided into the following two groups: a group that underwent percutaneous coronary intervention through the left radial artery and a group that underwent percutaneous coronary intervention through the femoral artery. The times required for angiographic catheter and guiding catheter placement, the success rate of the procedure and the incidence of vascular complications in the two groups were observed. RESULTS: There was no significant difference in catheter placement time or the ultimate success rate of the procedure between the two groups. However, the left radial artery group showed a significantly lower incidence of vascular complications than the femoral artery group (p<0.05). CONCLUSION: Emergency percutaneous coronary intervention through the left radial artery is associated with less vascular complications than emergency percutaneous coronary intervention through the femoral artery and is thus potentially advantageous for patients. PMID:28226025

  8. Superficial femoral artery perforator flap: anatomical study of a new flap and clinical cases.

    PubMed

    Mojallal, Ali; Boucher, Fabien; Shipkov, Hristo; Saint-Cyr, Michel; Braye, Fabienne

    2014-04-01

    The medial thigh has been infrequently studied as a donor site for pedicled or free flaps. In their previous studies, the authors observed a direct cutaneous branch from the superficial femoral artery. This study aimed to investigate the anatomy and potential possibility for flap elevation (the midmedial thigh flap) on this direct branch of the superficial femoral vessels. Circumferential adipocutaneous thigh flaps were harvested from 14 fresh adult cadaver legs. The direct cutaneous branch from the superficial femoral vessels was located between the sartorius and gracilis muscles. Pedicle location, diameter, and length and position of the great saphenous vein and saphenous nerve were recorded. A flap based on this vessel was designed. Height, width, and surface of the skin paddle were recorded. Three-dimensional computed tomographic angiography was used to analyze the area of cutaneous territory supplied by the studied perforator. The pedicle was located at an average distance of 22.79 ± 1.55 cm below the pubic tubercle on the medial axis of the thigh, and it was found in 100 percent of dissections. It was always located between the sartorius and gracilis muscles, with a mean diameter of 2.82 ± 0.69 mm and mean length of 4.79 ± 0.52 cm. The average area of skin perfused was 182.24 cm, located preferentially distal and posterior to the perforator pedicle. Two clinical cases illustrate the feasibility of the midmedial thigh perforator flap. The superficial femoral artery perforator flap appears to be reliable and has a constant vascular anatomy. Donor-site morbidity is low, resulting in only a vertical scar on the medial thigh. Therapeutic, V.

  9. Bradykinin B2 receptor contributes to the exaggerated muscle mechanoreflex in rats with femoral artery occlusion

    PubMed Central

    Lu, Jian; Xing, Jihong

    2013-01-01

    Static muscle contraction activates the exercise pressor reflex, which in turn increases sympathetic nerve activity (SNA) and blood pressure (BP). Bradykinin (BK) is considered as a muscle metabolite responsible for modulation of the sympathetic and cardiovascular responses to muscle contraction. Prior studies have suggested that kinin B2 receptor mediates the effects of BK on the reflex SNA and BP responses during stimulation of skeletal muscle afferents. In patients with peripheral artery disease and a rat model with femoral artery ligation, amplified SNA and BP responses to static exercise were observed. This dysfunction of the exercise pressor reflex has previously been shown to be mediated, in part, by muscle mechanoreflex overactivity. Thus, in this report, we determined whether kinin B2 receptor contributes to the augmented mechanoreflex activity in rats with 24 h of femoral artery occlusion. First, Western blot analysis was used to examine protein expression of B2 receptors in dorsal root ganglion tissues of control limbs and ligated limbs. Our data show that B2 receptor displays significant overexpression in ligated limbs as compared with control limbs (optical density: 0.94 ± 0.02 in control and 1.87 ± 0.08 after ligation, P < 0.05 vs. control; n = 6 in each group). Second, mechanoreflex was evoked by muscle stretch and the reflex renal SNA (RSNA) and mean arterial pressure (MAP) responses to muscle stretch were examined after HOE-140, a B2 receptors blocker, was injected into the arterial blood supply of the hindlimb muscles. The results demonstrate that the stretch-evoked reflex responses were attenuated by administration of HOE-140 in control rats and ligated rats; however, the attenuating effects of HOE-140 were significantly greater in ligated rats, i.e., after 5 μg/kg of HOE-140 RSNA and MAP responses evoked by 0.5 kg of muscle tension were attenuated by 43% and 25% in control vs. 54% and 34% in ligation (P < 0.05 vs. control group; n = 11 in

  10. Thrombus Formation After Percutaneous Catheterization and Manual Compression of the Femoral Artery in Heparinized Sheep

    SciTech Connect

    Kim, Young Hwan; Pavcnik, Dusan Kakizawa, Hideyaki; Uchida, Barry T.; Burke, Allen; Loriaux, Marc; Keller, Frederick S.; Rosch, Josef

    2010-04-15

    The purpose of this study was to evaluate the angiographic and histopathologic changes in the superficial femoral artery (SFA) in heparinized sheep shortly after catheterization with an 8-Fr sheath and manual compression hemostasis either with standard manual compression (SMC) or with the use of a procoagulant chitosan-based HemCon Bandage. The evaluation was done in 38 SFAs of 19 heparinized (100 mg/kg) sheep. After a 5-min catheterization with an 8-Fr sheath, a 5-min compression was applied. Follow-up angiograms to evaluate hemostasis were done immediately after release of compression and then at 2.5-min intervals until no extravasation was present. Compression was reapplied between angiograms. Final angiograms were performed approximately 30 min after hemostasis and after 3 min of passive flexion and extension of sheep hind limbs. Sheep were then euthanized and SFA specimens with surrounding tissues excised for histopathologic evaluation. Both types of compression caused similar changes in the catheterized SFAs. Follow-up angiograms showed mild arterial narrowing in 14 SFAs and intraluminal clots in 9 SFAs. Histology revealed periarterial hematoma in all 38 specimens. Intraluminal thrombi consisting predominantly of platelets and fibrin were present in 32 SFAs. Their size varied from superficial elevations (8 arteries) to medium-sized, 1- to 2-mm, polypoid protrusions (15 arteries) to large polypoid clots, 3-4 mm long (9 arteries). In six SFAs, the arterial access sites were not included in the obtained specimens. In conclusion, hemostasis with manual compression is achieved in the acute phase by formation of a predominantly platelet-fibrin thrombus occluding the arterial wall access site and often extending significantly into the arterial lumen. The healing process of arterial access sites should be explored several days after catheterization.

  11. Laceration of the Common Femoral Artery Following Deployment of the StarClose{sup TM} Vascular Closure System

    SciTech Connect

    Gonsalves, Michael Walkden, Miles Belli, Anna Maria

    2008-07-15

    StarClose is a novel arterial closure device which achieves hemostasis, following arteriotomy, via a nitinol clip deployed on the outer arterial wall. Since its introduction to the market, several studies have shown StarClose to be both safe and effective, with few major complications encountered. We report a case of common femoral artery laceration following deployment of the StarClose vascular closure system. We conclude that the injury occurred secondary to intravascular misplacement of the nitinol clip.

  12. Endogenous endothelin-1and femoral artery shear rate: impact of age and implications for atherosclerosis

    PubMed Central

    Trinity, Joel D.; Barrett-O’Keefe, Zachary; Ives, Stephen J.; Morgan, Garrett; Rossman, Matthew J.; Donato, Anthony J.; Runnels, Sean; Morgan, David E.; Gmelch, Benjamin S.; Bledsoe, Amber D.; Richardson, Russell S.; Wray, D. Walter

    2017-01-01

    Background Both altered shear rate and endothelin-1 (ET-1) are associated with the age-related development of atherosclerosis. However, the role of ET-1, a potent endogenous vasoconstrictor, in altering shear rate in humans, especially in the atherosclerotic-prone vasculature of the leg, is unknown. Therefore, this study examined the contribution of ET-1 to the age-related alterations in common femoral artery (CFA) shear rate. Method BQ-123, a specific endothelin type A (ETA) receptor antagonist, was infused into the CFA, and diameter and blood velocity were measured by Doppler ultrasound in young (n = 8, 24 ± 2 years) and old (n = 9, 70 ± 2 years) study participants. Results and conclusion The old had greater intima–media thickening in the CFA, indicative of a preatherogenic phenotype. Prior to infusion, the old study participants exhibited reduced mean shear rate (27 ± 3/s) compared with the young study participants (62 ± 9/s). This difference was likely driven by attenuated antegrade shear rate in the old as retrograde shear rate was similar in the young and old. Inhibition of ETA receptors, by BQ-123, increased leg blood flow in the old, but not in the young, abolishing age-related differences. Older study participants had a larger CFA (young: 0.82 ± 0.03 cm, old: 0.99 ± 0.03 cm) in which BQ-123 induced significant vasodilation (5.1 ± 1.0%), but had no such effect in the young (−0.8 ± 0.8%). Interestingly, despite the age-specific, BQ-123-induced increase in leg blood flow and CFA diameter, shear rate patterns remained largely unchanged. Therefore, ET-1, acting through the ETA receptors, exerts a powerful age-specific vasoconstriction. However, removal of this vasoconstrictor stimulus does not augment mean shear rate in the old. PMID:26599223

  13. Subintimal Double-Barrel Restenting of an Occluded Primary Stented Superficial Femoral Artery

    SciTech Connect

    Duterloo, Dirk Lohle, Paul N.M.; Lampmann, Leo E.H.

    2007-06-15

    In-stent re-stenosis is a frequent complication of endovascular stents, especially in the superficial femoral artery (SFA). Endovascular re-intervention of in- or peri-stent occlusive disease consists of recanilization through the occluded stent. In our case report, we describe the endovascular treatment of a previously placed stent in the SFA. We unintentionally passed the affected stent subintimally, in a double barrel fashion next to the first stent. The procedure was without any complications and with a successful angiographic result. At one year follow-up the patient still has no complaints and the stent is still patent.

  14. [Use of autologous superficial femoral artery in surgery for aortic prosthesis infection].

    PubMed

    da Gama, A Dinis; Rosa, António; Soares, Mário; Moura, Carlos

    2003-01-01

    The surgical management of the aortic prosthesis infection still remains an enormous challenge for the vascular surgeon and a critical issue for the patient's integrity and life. Several techniques for its management have been devised and employed, along the years, but none of them revealed itself as totally satisfactory. This stimulates the creation of new alternatives. We present the clinical case of an infected aortic prosthesis in a 41 year old man, complicated by duodenal and ureteral erosion, in whom the autologous superficial femoral artery was employed successfully in the treatment of this most demanding situation.

  15. Combined open surgical and endovascular management of ruptured femoral artery from recurrent vulvar cancer.

    PubMed

    Trompetas, Vasileios; Sandison, Andrew Jp; Anderson, Hugh J

    2010-12-30

    We report on the case of a 50-year-old woman with exsanguinating haemorrhage from the common femoral artery as a complication of recurrent vulvar cancer in the groin which was managed successfully with combined open surgical and endovascular intervention. She survived another three months and died from progressive disease without further episodes of bleeding. This complication is rare, presents dramatically, and is usually a terminal event. For those cases where intervention is considered appropriate, the option of combined open surgical and endovascular repair should be kept in mind.

  16. Combined open surgical and endovascular management of ruptured femoral artery from recurrent vulvar cancer

    PubMed Central

    Sandison, Andrew JP; Anderson, Hugh J

    2010-01-01

    We report on the case of a 50-year-old woman with exsanguinating haemorrhage from the common femoral artery as a complication of recurrent vulvar cancer in the groin which was managed successfully with combined open surgical and endovascular intervention. She survived another three months and died from progressive disease without further episodes of bleeding. This complication is rare, presents dramatically, and is usually a terminal event. For those cases where intervention is considered appropriate, the option of combined open surgical and endovascular repair should be kept in mind. PMID:21278892

  17. Superficial femoral artery nitinol stent in a patient with nickel allergy.

    PubMed

    Jetty, Prasad; Jayaram, Srinidhi; Veinot, John; Pratt, Melanie

    2013-11-01

    We present a case of a patient who developed a systemic allergic reaction following placement of a nitnol stent in the superficial femoral artery for claudication symptoms. Shortly after, he was tested for contact dermatitis and found to have a severe reaction to nickel. His symptoms of severe itch and generalized rash resolved within days following stent explantation and reconstruction with a vein graft. The epidemiology and clinical significance of nickel allergy and the concomitant use of nickel-alloy stents are discussed. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  18. Subintimal Double-Barrel Restenting of an Occluded Primary Stented Superficial Femoral Artery

    PubMed Central

    Lohle, Paul N.M.; Lampmann, Leo E.H.

    2007-01-01

    In-stent re-stenosis is a frequent complication of endovascular stents, especially in the superficial femoral artery (SFA). Endovascular re-intervention of in- or peri-stent occlusive disease consists of recanilization through the occluded stent. In our case report, we describe the endovascular treatment of a previously placed stent in the SFA. We unintentionally passed the affected stent subintimally, in a double barrel fashion next to the first stent. The procedure was without any complications and with a successfull angiographic result. At one year follow-up the patient still has no complaints and the stent is still patent. PMID:17410397

  19. Role played by interleukin-6 in evoking the exercise pressor reflex in decerebrate rats: effect of femoral artery ligation

    PubMed Central

    Stone, Audrey J.; Li, Jianhua; Kaufman, Marc P.

    2015-01-01

    IL-6 signaling via the soluble IL-6 receptor (sIL-6r) has been shown to increase primary afferent responsiveness to noxious stimuli. This finding prompted us to test the hypothesis that IL-6 and sIL-6r would increase the exercise pressor reflex in decerebrate rats with freely perfused femoral arteries. We also tested the hypothesis that soluble glycoprotein (sgp)130, an inhibitor of IL-6/sIL-6r signaling, would decrease the exaggerated exercise pressor reflex that is found in decerebrate rats with ligated femoral arteries. In rats with freely perfused femoral arteries, coinjection of 50 ng of IL-6 and sIL-6r into the arterial supply of the hindlimb significantly increased the peak pressor response to static (control: 14 ± 3 mmHg and IL-6/sIL-6r: 17 ± 2 mmHg, P = 0.03) and intermittent isometric (control: 10 ± 2 mmHg and IL-6/sIL-6r: 15 ± 4 mmHg, P = 0.03) hindlimb muscle contraction. In rats with ligated femoral arteries, injection of 50 ng of sgp130 into the arterial supply of the hindlimb reduced the peak pressor response to static (control: 24 ± 2 mmHg and sgp130: 16 ± 3 mmHg, P = 0.01) and intermittent isometric (control: 16 ± 2 mmHg and sgp130: 13 ± 2 mmHg, P = 0.04) hindlimb muscle contraction, whereas there was no effect of sgp130 on the exercise pressor reflex in rats with freely perfused femoral arteries. We conclude that coinjection of exogenous IL-6 and sIL-6r increased the exercise pressor reflex in rats with freely perfused femoral arteries. More importantly, we also conclude that IL-6 and sIL-6r play an endogenous role in evoking the exercise pressor reflex in rats with ligated femoral arteries but not in rats with freely perfused femoral arteries. PMID:25910806

  20. Role played by interleukin-6 in evoking the exercise pressor reflex in decerebrate rats: effect of femoral artery ligation.

    PubMed

    Copp, Steven W; Stone, Audrey J; Li, Jianhua; Kaufman, Marc P

    2015-07-01

    IL-6 signaling via the soluble IL-6 receptor (sIL-6r) has been shown to increase primary afferent responsiveness to noxious stimuli. This finding prompted us to test the hypothesis that IL-6 and sIL-6r would increase the exercise pressor reflex in decerebrate rats with freely perfused femoral arteries. We also tested the hypothesis that soluble glycoprotein (sgp)130, an inhibitor of IL-6/sIL-6r signaling, would decrease the exaggerated exercise pressor reflex that is found in decerebrate rats with ligated femoral arteries. In rats with freely perfused femoral arteries, coinjection of 50 ng of IL-6 and sIL-6r into the arterial supply of the hindlimb significantly increased the peak pressor response to static (control: 14 ± 3 mmHg and IL-6/sIL-6r: 17 ± 2 mmHg, P = 0.03) and intermittent isometric (control: 10 ± 2 mmHg and IL-6/sIL-6r: 15 ± 4 mmHg, P = 0.03) hindlimb muscle contraction. In rats with ligated femoral arteries, injection of 50 ng of sgp130 into the arterial supply of the hindlimb reduced the peak pressor response to static (control: 24 ± 2 mmHg and sgp130: 16 ± 3 mmHg, P = 0.01) and intermittent isometric (control: 16 ± 2 mmHg and sgp130: 13 ± 2 mmHg, P = 0.04) hindlimb muscle contraction, whereas there was no effect of sgp130 on the exercise pressor reflex in rats with freely perfused femoral arteries. We conclude that coinjection of exogenous IL-6 and sIL-6r increased the exercise pressor reflex in rats with freely perfused femoral arteries. More importantly, we also conclude that IL-6 and sIL-6r play an endogenous role in evoking the exercise pressor reflex in rats with ligated femoral arteries but not in rats with freely perfused femoral arteries.

  1. Effects of factor Xa on the expression of proteins in femoral arteries from type 2 diabetic patients.

    PubMed

    López-Farré, Antonio J; Rodriguez-Sierra, Pablo; Modrego, Javier; Segura, Antonio; Martín-Palacios, Naiara; Saiz, Ana M; Zamorano-León, José J; Duarte, Juan; Serrano, Javier; Moñux, Guillermo

    2014-12-01

    Further to its pivotal role in haemostasis, factor Xa (FXa) promotes effects on the vascular wall. The purpose of the study was to evaluate if FXa modifies the expression level of energy metabolism and oxidative stress-related proteins in femoral arteries obtained from type 2 diabetic patients with end-stage vasculopathy. Femoral arteries were obtained from 12 type 2 diabetic patients who underwent leg amputation. Segments from the femoral arteries were incubated in vitro alone and in the presence of 25 nmol l(-1) FXa and 25 nmol l(-1) FXa + 50 nmol l(-1) rivaroxaban. In the femoral arteries, FXa increased triosephosphate isomerase and glyceraldehyde-3-phosphate dehydrogenase isotype 1 expression but decreased pyruvate dehydrogenase expression. These facts were accompanied by an increased content of acetyl-CoA. Aconitase activity was reduced in FXa-incubated femoral arteries as compared with control. Moreover, FXa increased the protein expression level of oxidative stress-related proteins which was accompanied by an increased malonyldialdehyde arterial content. The FXa inhibitor, rivaroxaban, failed to prevent the reduced expression of pyruvate dehydrogenase induced by FXa but reduced acetyl-CoA content and reverted the decreased aconitase activity observed with FXa alone. Rivaroxaban + FXa but not FXa alone increased the expression level of carnitine palmitoyltransferase I and II, two mitochondrial long chain fatty acid transporters. Rivaroxaban also prevented the increased expression of oxidative stress-related proteins induced by FXa alone. In femoral isolated arteries from type 2 diabetic patients with end-stage vasculopathy, FXa promoted disruption of the aerobic mitochondrial metabolism. Rivaroxaban prevented such effects and even seemed to favour long chain fatty acid transport into mitochondria. © 2014 The British Pharmacological Society.

  2. Effects of factor Xa on the expression of proteins in femoral arteries from type 2 diabetic patients

    PubMed Central

    López-Farré, Antonio J; Rodriguez-Sierra, Pablo; Modrego, Javier; Segura, Antonio; Martín-Palacios, Naiara; Saiz, Ana M; Zamorano-León, José J; Duarte, Juan; Serrano, Javier; Moñux, Guillermo

    2014-01-01

    Aim Further to its pivotal role in haemostasis, factor Xa (FXa) promotes effects on the vascular wall. The purpose of the study was to evaluate if FXa modifies the expression level of energy metabolism and oxidative stress-related proteins in femoral arteries obtained from type 2 diabetic patients with end-stage vasculopathy. Methods Femoral arteries were obtained from 12 type 2 diabetic patients who underwent leg amputation. Segments from the femoral arteries were incubated in vitro alone and in the presence of 25 nmol l−1 FXa and 25 nmol l−1 FXa + 50 nmol l−1 rivaroxaban. Results In the femoral arteries, FXa increased triosephosphate isomerase and glyceraldehyde-3-phosphate dehydrogenase isotype 1 expression but decreased pyruvate dehydrogenase expression. These facts were accompanied by an increased content of acetyl-CoA. Aconitase activity was reduced in FXa-incubated femoral arteries as compared with control. Moreover, FXa increased the protein expression level of oxidative stress-related proteins which was accompanied by an increased malonyldialdehyde arterial content. The FXa inhibitor, rivaroxaban, failed to prevent the reduced expression of pyruvate dehydrogenase induced by FXa but reduced acetyl-CoA content and reverted the decreased aconitase activity observed with FXa alone. Rivaroxaban + FXa but not FXa alone increased the expression level of carnitine palmitoyltransferase I and II, two mitochondrial long chain fatty acid transporters. Rivaroxaban also prevented the increased expression of oxidative stress-related proteins induced by FXa alone. Conclusions In femoral isolated arteries from type 2 diabetic patients with end-stage vasculopathy, FXa promoted disruption of the aerobic mitochondrial metabolism. Rivaroxaban prevented such effects and even seemed to favour long chain fatty acid transport into mitochondria. PMID:25041869

  3. Subintimal Recanalization of Long Superficial Femoral Artery Occlusions Through the Retrograde Popliteal Approach

    SciTech Connect

    Yilmaz, Saim; Sindel, Timur; Ceken, Kagan; Alimoglu, Emel; Lueleci, Ersin

    2001-05-15

    Purpose: To investigate the value of the retrograde popliteal artery approach for the percutaneous intentional extraluminal recanalization (PIER) of long superficial femoral artery (SFA) occlusions.Methods: During a period of 17 months, PIER through ultrasound-guided retrograde popliteal artery puncture was performed for 39 long SFA occlusions in 37 patients. In six patients, six additional iliac artery stenoses were also treated via the popliteal approach.Results: The procedure was technically successful in 32 (82%) of 39 SFA occlusions; in 29, lesions were treated with balloon angioplasty alone, and in three, stents were also used. Cumulative patency rate was 66% at 6 months, 62% at 1 year, and 59% at 18 months. Additional iliac artery stenoses were successfully treated in the same session. Complications included two minor hematomas and two SFA ruptures, which required no treatment.Conclusion: PIER through retrograde popliteal puncture is a safe and effective method in the treatment of long femoropopliteal occlusions, with a high technical success, low complication rate and a reasonable short-term patency rate. The technique offers an alternative in cases where standard PIER is unsuccessful or contraindicated.

  4. Alterations in Vasoreactivity of Femoral Artery Induced by Hindlimb Unweighting are Related to the Changes of Contractile Protein in Rats

    NASA Technical Reports Server (NTRS)

    Ma, Jin; Ren, Xinling; Meng, Qinjun; Zhang, Lifan; Purdy, Ralph E.

    2005-01-01

    Responses of endothelium removed femoral arterial rings to vasoactive compounds were examined in vitro, and the expression of Myosin and Actin of femoral artery were observed by Western Blotting and Immunohistochemistry in hndlimb unweighting rats and control rats. The results showed that contractile responses of femoral arterial rings evoked by Phenylephrine, Endothelin-1, Vasopressin, KCl, Ca(2+) and Ca(2+) ionophore A23187 were decreased in hindlimb unweighting rats as compared with that of controls. But vasoddatory responses induced by SNPand cGMP were not different between groups. No significant differences have been found in expressions of Calponin, Myosin, Actin, and the ratio of MHC SM1/SM2 between the two groups, but expression of alpha-SM-Actin decreased in hindlimb unweighting rats. The data indicated that the diminished contractile responsiveness probably result from altered contractile apparatus, especially the contractile proteins.

  5. Alterations in Vasoreactivity of Femoral Artery Induced by Hindlimb Unweighting are Related to the Changes of Contractile Protein in Rats

    NASA Technical Reports Server (NTRS)

    Ma, Jin; Ren, Xinling; Meng, Qinjun; Zhang, Lifan; Purdy, Ralph E.

    2005-01-01

    Responses of endothelium removed femoral arterial rings to vasoactive compounds were examined in vitro, and the expression of Myosin and Actin of femoral artery were observed by Western Blotting and Immunohistochemistry in hndlimb unweighting rats and control rats. The results showed that contractile responses of femoral arterial rings evoked by Phenylephrine, Endothelin-1, Vasopressin, KCl, Ca(2+) and Ca(2+) ionophore A23187 were decreased in hindlimb unweighting rats as compared with that of controls. But vasoddatory responses induced by SNPand cGMP were not different between groups. No significant differences have been found in expressions of Calponin, Myosin, Actin, and the ratio of MHC SM1/SM2 between the two groups, but expression of alpha-SM-Actin decreased in hindlimb unweighting rats. The data indicated that the diminished contractile responsiveness probably result from altered contractile apparatus, especially the contractile proteins.

  6. Fluid particle motion and Lagrangian velocities for pulsatile flow through a femoral artery branch model

    NASA Technical Reports Server (NTRS)

    Cho, Y. I.; Crawford, D. W.; Back, L. H.; Back, M. R.

    1987-01-01

    A flow visualization study using selective dye injection and frame by frame analysis of a movie provided qualitative and quantitative data on the motion of marked fluid particles in a 60 degree artery branch model for simulation of physiological femoral artery flow. Physical flow features observed included jetting of the branch flow into the main lumen during the brief reverse flow period, flow separation along the main lumen wall during the near zero flow phase of diastole when the core flow was in the downstream direction, and inference of flow separation conditions along the wall opposite the branch later in systole at higher branch flow ratios. There were many similarities between dye particle motions in pulsatile flow and the comparative steady flow observations.

  7. Elasticity assessment of electrospun nanofibrous vascular grafts: a comparison with femoral ovine arteries.

    PubMed

    Bagnasco, D Suarez; Ballarin, F Montini; Cymberknop, L J; Balay, G; Negreira, C; Abraham, G A; Armentano, R L

    2014-12-01

    Development of successful small-diameter vascular grafts constitutes a real challenge to biomaterial engineering. In most cases these grafts fail in-vivo due to the presence of a mechanical mismatch between the native vessel and the vascular graft. Biomechanical characterization of real native vessels provides significant information for synthetic graft development. Electrospun nanofibrous vascular grafts emerge as a potential tailor made solution to this problem. PLLA-electrospun nanofibrous tubular structures were prepared and selected as model bioresorbable grafts. An experimental setup, using gold standard and high resolution ultrasound techniques, was adapted to characterize in vitro the poly(L-lactic acid) (PLLA) electrospun structures. The grafts were subjected to near physiologic pulsated pressure conditions, following the pressure-diameter loop approach and the criteria stated in the international standard for cardiovascular implants-tubular vascular prostheses. Additionally, ovine femoral arteries were subjected to a similar evaluation. Measurements of pressure and diameter variations allowed the estimation of dynamical compliance (%C, 10(-2) mmHg) and the pressure-strain elastic modulus (E(Pε), 10(6) dyn cm(-2)) of the abovementioned vessels (grafts and arteries). Nanofibrous PLLA showed a decrease in %C (1.38±0.21, 0.93±0.13 and 0.76±0.15) concomitant to an increase in EPε (10.57±0.97, 14.31±1.47 and 17.63±2.61) corresponding to pressure ranges of 50 to 90 mmHg, 80 to 120 mmHg and 100 to 150 mmHg, respectively. Furthermore, femoral arteries exhibited a decrease in %C (8.52±1.15 and 0.79±0.20) and an increase in E(Pε) (1.66±0.30 and 15.76±4.78) corresponding to pressure ranges of 50-90 mmHg (elastin zone) and 100-130 mmHg (collagen zone). Arterial mechanics framework, extensively applied in our previous works, was successfully used to characterize PLLA vascular grafts in vitro, although its application can be directly extended to in vivo

  8. F 15845, a new blocker of the persistent sodium current prevents consequences of hypoxia in rat femoral artery

    PubMed Central

    Bocquet, A; Sablayrolles, S; Vacher, B; Le Grand, B

    2010-01-01

    BACKGROUND AND PURPOSE The persistent sodium current is involved in myocardial ischaemia and is selectively inhibited by the newly described 3-(R)-[3-(2-methoxyphenylthio-2-(S)-methylpropyl]amino-3,4-dihydro-2H-1,5-benzoxathiepine bromhydrate (F 15845). Here, we describe the pharmacological profile of F 15845 against the effects of hypoxia in femoral arteries in vitro. EXPERIMENTAL APPROACH Isometric tension measurement of rat isolated femoral arteries was used to characterize the protective effect of F 15845 against contraction of the vessels induced by veratrine (100 µg·mL−1) or hypoxia. KEY RESULTS Rat femoral artery expressed the Nav1.5 channel isoform. When exposed to veratrine (100 µg·mL−1), vessels developed a rapid and strong contraction that was abolished by both absence of sodium and blockade of the Na+/Ca++ exchanger by KB-R7943 (10 and 32 µmol·L−1) or treatment with F 15845. When used before veratrine exposure, the potency of F 15845 depended on the extracellular K+ concentration (IC50 = 11 and 0.77 µmol·L−1 for 5 and 20 mmol·L−1 KCl, respectively), whereas its potency was unaffected by extracellular K+ concentration when given after veratrine. F 15845 did not affect either KCl (80 mmol·L−1) or phenylephrine-induced femoral artery contraction. Moreover, endothelium disruption did not affect the protective effect of F 15845 against veratrine-induced femoral artery contraction, suggesting a mechanism of action dependent on smooth muscle cells. Finally, F 15845 prevented in a concentration-dependent manner rat femoral artery contraction induced by hypoxia. CONCLUSION AND IMPLICATIONS F 15845, a selective blocker of the persistent sodium current prevented vascular contraction induced by hypoxic conditions. PMID:20735424

  9. Sympathetic vasomotor control does not explain the change in femoral artery shear rate pattern during arm-crank exercise.

    PubMed

    Thijssen, Dick H J; Green, Daniel J; Steendijk, Sjoerd; Hopman, Maria T E

    2009-01-01

    During lower limb exercise, blood flow through the resting upper limbs exhibits a change characterized by increased anterograde flow during systole, but also large increases in retrograde diastolic flow. One explanation for the retrograde flow is that increased sympathetic nervous system (SNS) tone and concomitant increased peripheral resistance generate a rebound during diastole. To examine whether the SNS contributes to retrograde flow patterns, we measured femoral artery blood flow during arm-crank exercise in 10 healthy men (31 +/- 4 yr) and 10 spinal cord-injured (SCI) subjects who lack sympathetic innervation in the legs (33 +/- 5 yr). Before, and every 5 min during 25-min arm-crank exercise at 50% maximal capacity, femoral artery blood flow and peak anterograde and retrograde shear rate were assessed using echo Doppler sonography. Femoral artery baseline blood flow was significantly lower in SCI compared with controls. Exercise increased femoral artery blood flow in both groups (ANOVA, P < 0.05), whereas leg vascular conductance did not change during exercise in either group. Mean shear rate was lower in SCI than in controls (P < 0.05). Peak anterograde shear rate was higher in SCI than in controls (P < 0.05), whereas peak retrograde shear rate did not differ between groups. Arm-crank exercise induced an increase in peak anterograde and retrograde shear rate in the femoral artery in controls and SCI subjects (P < 0.05). This suggests that the SNS is not obligatory to change the flow pattern in inactive regions during exercise. Local mechanisms may play a role in the arm-crank exercise-induced changes in flow pattern in the femoral artery.

  10. Common Femoral Artery Access on YouTube: What Practices are Being Shown and Who is Delivering the Message?

    PubMed

    Pitcher, Grayson S; Newton, Daniel H; Amendola, Michael F

    Novice learners are increasingly turning to YouTube as a learning resource for surgical procedures. One example of such a procedure is common femoral artery puncture and sheath placement. Practitioners in several specialties perform this procedure to access the arterial system for angiography and intervention. We set forth to compare the techniques demonstrated on YouTube by the various specialists, as well as compare each specialty׳s prevalence on this website. YouTube (www.youtube.com) was accessed in December 2015 at multiple time points with a cleared-cache web browser for the keyword search categories: "femoral artery access," "femoral access," and "angiography access." The top 500 videos from each of these keyword searches were analyzed. Videos were categorized by practitioner specialty, technique, duration of video, age of video, and total views. Videos with clear demonstration of femoral artery access were included in the analysis. All industry videos were excluded from the analysis. Categorical variables were compared using Fisher׳s exact test, and continuous variables were compared with the Student׳s t-test. A total of 2460, 4680 and 1800 videos were found for each keyword search, respectively. Of these, 33 videos clearly demonstrated femoral artery access technique. Vascular specialists, compared to interventional cardiology and radiology, had fewer videos (n = 4 vs. 14) and older videos (3.5 ± 2.1y vs. 2.25 ± 0.5y, p < 0.05). The vascular specialists demonstrated ultrasound-guided access, while interventional cardiology predominantly demonstrated landmark-guided access (p < 0.05). Although YouTube and other online resources are being used by novice learners, vascular specialists are underrepresented for femoral artery access, a foundational vascular procedure. Other practitioners demonstrate videos with landmark-guided access and rarely demonstrate ultrasound use. As recognized vascular experts, vascular surgeons should improve their visibility in

  11. The Role of Common Femoral Artery Endarterectomy in the Endovascular Era.

    PubMed

    Nishibe, Toshiya; Maruno, Keita; Iwahori, Akinari; Fujiyoshi, Toshiki; Suzuki, Shun; Takahashi, Satoshi; Ogino, Hitoshi; Nishibe, Masayasu

    2015-11-01

    The purpose of this study was to review our experiences treating peripheral artery disease (PAD) by common femoral artery endarterectomy (CFE) with and without endovascular therapy (EVT), and to describe the role of CFE in the endovascular era. We retrospectively reviewed a contemporary series of 38 limbs from January 2010 to September 2014. Clinical outcomes of primary patency, assisted primary patency, limb salvage, and survival were analyzed with the Kaplan-Meier method. Multivariable perioperative predictors of primary patency were identified using the stepwise Cox proportional hazards regression model. Hemodynamic success was achieved in 36 of the 38 limbs (95%). The mean ankle brachial pressure index improved significantly, rising from 0.56 ± 0.04 preoperatively to 0.89 ± 0.04 postoperatively (P = 0.0001). Overall primary and assisted primary patency rates, respectively, were 90% and 100% at 12 months and 85% and 94% at 24 months. There was no significant difference in primary patency rate between isolated CFE and hybrid CFE plus EVT. Both limb salvage and survival rates were 97% at 12 months and 97% at 24 months. Multivariate Cox regression analysis revealed that no clinical or perioperative risk factors were predictive of decreased primary patency. CFE is a safe, effective, and durable procedure for common femoral artery disease, and hybrid CFE plus EVT can be a valid alternative to open surgical bypass for multilevel occlusive artery disease. These observations stress that CFE plays a vital role in the management of PAD even in the endovascular era. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Comparison of ultrasound-guided and fluoroscopy-assisted antegrade common femoral artery puncture techniques.

    PubMed

    Slattery, Michael M; Goh, Gerard S; Power, Sarah; Given, Mark F; McGrath, Frank P; Lee, Michael J

    2015-06-01

    To prospectively compare the procedural time and complication rates of ultrasound-guided and fluoroscopy-assisted antegrade common femoral artery (CFA) puncture techniques. Hundred consecutive patients, undergoing a vascular procedure for which an antegrade approach was deemed necessary/desirable, were randomly assigned to undergo either ultrasound-guided or fluoroscopy-assisted CFA puncture. Time taken from administration of local anaesthetic to vascular sheath insertion in the superficial femoral artery (SFA), patients' age, body mass index (BMI), fluoroscopy radiation dose, haemostasis method and immediate complications were recorded. Mean and median values were calculated and statistically analysed with unpaired t tests. Sixty-nine male and 31 female patients underwent antegrade puncture (mean age 66.7 years). The mean BMI was 25.7 for the ultrasound-guided (n = 53) and 25.3 for the fluoroscopy-assisted (n = 47) groups. The mean time taken for the ultrasound-guided puncture was 7 min 46 s and for the fluoroscopy-assisted technique was 9 min 41 s (p = 0.021). Mean fluoroscopy dose area product in the fluoroscopy group was 199 cGy cm(2). Complications included two groin haematomas in the ultrasound-guided group and two retroperitoneal haematomas and one direct SFA puncture in the fluoroscopy-assisted group. Ultrasound-guided technique is faster and safer for antegrade CFA puncture when compared to the fluoroscopic-assisted technique alone.

  13. Clinical Outcome of Surgical Endarterectomy for Common Femoral Artery Occlusive Disease.

    PubMed

    Kuma, Sosei; Tanaka, Kiyoshi; Ohmine, Takahiro; Morisaki, Koichi; Kodama, Akio; Guntani, Atsushi; Ishida, Masaru; Okazaki, Jin; Mii, Shinsuke

    2016-01-01

    Although common femoral artery endarterectomy (CFE) is the standard treatment for occlusive disease of the common femoral artery (CFA), several studies have noted encouraging results for endovascular therapy in this anatomical area.  A retrospective multi-center study of 118 consecutive limbs from 111 symptomatic patients undergoing CFE between April 1998 and December 2014 was performed. Seventy-five CFE were performed on limbs for intermittent claudication and 43 CFE were performed for critical limb ischemia (CLI). The prevalence of perioperative complications was higher in patients with CLI than in the claudication patients. The technical success rate was 99% in all cases. The 1- and 5-year primary patency rates were 100% and 100% for claudication and 95% and 95% for CLI, respectively. The assisted-primary patency rates were 100% at both time points in both groups. Freedom from major amputation at 1 and 5 years was 100% and 100% in the claudication patients and 93% and 82% in the CLI patients, respectively. The 1- and 5-year overall survival rates were 97% and 89% in the claudication patients and 69% and 33% in the CLI patients, respectively. CFE is a safe, effective and durable procedure for occlusive disease of the CFA. This procedure should remain the standard treatment for this anatomical region.

  14. False aneurysm of the common femoral artery after total hip arthroplasty. A case report.

    PubMed

    Mallory, T H; Jaffe, S L; Eberle, R W

    1997-05-01

    A 59-year-old healthy man presented with osteoarthritis of his left hip that was recalcitrant to nonoperative treatment. He subsequently elected to have arthroplasty of the hip performed. At 3 months after arthroplasty, he returned reporting progressive groin pain: most remarkable was a palpable mass in the groin region. An arteriogram showed a radiodense mass adjacent to the acetabulum, and a computed tomography scan with contrast confirmed a large false aneurysm originating from the common femoral artery. In this particular case, a pointed Hohmann retractor punctured the common femoral artery, creating the dynamics of the development of a false aneurysm. Primary suture repair of the vascular defect was performed, followed by a complete and uncomplicated recovery of the patient to full activity. Since this case, the authors have discontinued the use of pointed. Hohmann retractors and now use a blunt, rounded Hohmann retractor during total hip arthroplasty without compromising acetabular exposure. However, care must be taken in blunt retractor placement to avoid retractor slippage during the procedure. This case shows the need for awareness of potential mechanisms for vascular injury related to total hip arthroplasty.

  15. Recent advances in self-expanding stents for use in the superficial femoral and popliteal arteries.

    PubMed

    Aghel, Arash; Armstrong, Ehrin J

    2014-07-01

    Significant advances have been made in femoropopliteal stent design and clinical outcomes during the past decade. Initial randomized studies demonstrated superiority of nitinol self-expanding stents to balloon angioplasty for treatment of moderate-length superficial femoral artery stenoses. During longer-term follow-up, first generation nitinol stents were hampered by high rates of stent fracture. A number of newer nitinol stent designs have been developed with improved conformability, greater radial strength and lower rates of long-term stent fracture. These newer stent designs have demonstrated superior primary patency and decreased restenosis for the treatment of moderate-length femoropopliteal lesions relative to historical benchmarks. Recent advances in drug-eluting nitinol stents have also offered treatment options for challenging lesion subsets including very long femoropopliteal lesions and for the treatment of in-stent restenosis. This article reviews recent advances and upcoming research in nitinol self-expanding stent technology for the treatment of superficial femoral and popliteal artery stenosis.

  16. In vivo oxygen transport in the normal rabbit femoral arterial wall.

    PubMed Central

    Crawford, D W; Back, L H; Cole, M A

    1980-01-01

    In vivo measurements of tissue oxygen tension were made at 10-micrometer intervals through functioning in situ rabbit femoral arterial walls, using inhalation anesthesia and recessed microcathodes with approximately 4-micrometer external diameters. External environment was controlled with a superfusion well at 30 torr PO2, 35 torr PCO2. Blood pressure, gas tension levels, and blood pH were held within the normal range. Radial PO2 measurements closely fit a mathematical model for unidimensional diffusion into a thick-walled artery with uniform oxygen consumption, and the distances traversed fit measured dimensions of quick-frozen in vivo sections. Using standard values of diffusion and solubility coefficients, mean calculated medial oxygen consumption was 99 nl0/ml-s. Mural oxygen consumption appeared to be related linearly to mean tangential wall stress. Differences in experimental design and technique were compared with previous in vivo and in vitro measurements of wall oxygenation, and largely account for the varying results obtained. Control of environment external to the artery, and maintenance of normally flowing blood in the lumen in vivo appeared critical to an understanding of mural oxygenation in life. If the conditions of this experiment prevailed in arteries with thicker avascular layers, PO2 could have been 20 torr at approximately 156 micrometer and 10 torr at 168 micrometer from blood (average values). Images PMID:7410554

  17. Manipulation of arterial stiffness, wave reflections, and retrograde shear rate in the femoral artery using lower limb external compression.

    PubMed

    Heffernan, Kevin S; Lefferts, Wesley K; Kasprowicz, Ari G; Tarzia, Brendan J; Thijssen, Dick H; Brutsaert, Tom D

    2013-07-01

    Exposure of the arterial wall to retrograde shear acutely leads to endothelial dysfunction and chronically contributes to a proatherogenic vascular phenotype. Arterial stiffness and increased pressure from wave reflections are known arbiters of blood flow in the systemic circulation and each related to atherosclerosis. Using distal external compression of the calf to increase upstream retrograde shear in the superficial femoral artery (SFA), we examined the hypothesis that changes in retrograde shear are correlated with changes in SFA stiffness and pressure from wave reflections. For this purpose, a pneumatic cuff was applied to the calf and inflated to 0, 35, and 70 mmHg (5 min compression, randomized order, separated by 5 min) in 16 healthy young men (23 ± 1 years of age). Doppler ultrasound and wave intensity analysis was used to measure SFA retrograde shear rate, reflected pressure wave intensity (negative area [NA]), elastic modulus (Ep), and a single-point pulse wave velocity (PWV) during acute cuff inflation. Cuff inflation resulted in stepwise increases in retrograde shear rate (P < 0.05 for main effect). There were also significant cuff pressure-dependent increases in NA, Ep, and PWV across conditions (P < 0.05 for main effects). Change in NA, but not Ep or PWV, was associated with change in retrograde shear rate across conditions (P < 0.05). In conclusion, external compression of the calf increases retrograde shear, arterial stiffness, and pressure from wave reflection in the upstream SFA in a dose-dependent manner. Wave reflection intensity, but not arterial stiffness, is correlated with changes in peripheral retrograde shear with this hemodynamic manipulation.

  18. Effects of long-term feeding of α-glucosylhesperidin on the mechanical properties of rabbit femoral arteries.

    PubMed

    Naiki, Takeru; Kurose, Yuki; Hayashi, Kozaburo; Takumi, Hiroko; Kometani, Takashi

    2012-01-01

    Many people are sensitive to cold, resulting in poor blood circulation. There is evidence that hesperidin results in increased peripheral circulation and skin temperature. A transglycosylated hesperidin, α-glucosylhesperidin, is more bioabsorbable than hesperidin. In the present study, biomechanical studies were performed on the effects of long-term feeding of α-glucosylhesperidin on the contractile response (diameter response) and stiffness of femoral arteries excised from rabbits. Animals in the normal (non-treated), low, and high groups were fed 0, 150 and 4500 mg/day, respectively, of α-glucosylhesperidin for about 24 weeks. The feeding of α-glucosylhesperidin did not change arterial stiffness nor mean blood flow rate in the femoral artery; however, it increased mean aortic blood pressure and decreased arterial diameter at 100 mmHg in the high group. The diameter responses developed by 10-5 M of norepinephrine were significantly lower in the high and low groups than in non-treated group. This result indicates that, due to the long-term feeding of α-glucosylhesperidin, arterial contraction induced by the neurotransmitter of sympathetic nerves decreases. It was estimated that blood flow in such muscular arteries as the femoral artery is maintained at normal by α-glucosylhesperidin even under the conditions of autonomic imbalance and cold intolerance.

  19. Starclose SE® hemostasis after 6F direct antegrade superficial femoral artery access distal to the femoral head for peripheral endovascular procedures in obese patients

    PubMed Central

    Spiliopoulos, Stavros; Kitrou, Panagiotis; Christeas, Nikolaos; Karnabatidis, Dimitris

    2016-01-01

    PURPOSE Direct superficial femoral artery (SFA) antegrade puncture is a valid alternative to common femoral artery (CFA) access for peripheral vascular interventions. Data investigating vascular closure device (VCD) hemostasis of distant SFA 6F access are limited. We aimed to investigate the safety and effectiveness of the Starclose SE® VCD for hemostasis, following direct 6F antegrade SFA access distal to the femoral head. METHODS This prospective, single-center study included patients who were not suitable for CFA puncture and were scheduled to undergo peripheral endovascular interventions using direct antegrade SFA 6F access, at least 2 cm below the inferior edge of femoral head. Hemostasis was obtained with the Starclose SE® VCD (Abbott Laboratories). Primary endpoints were successful hemostasis rate and periprocedural (30-day) major complication rate. Secondary endpoint was the rate of minor complications. Clinical and Doppler ultrasound follow-up was performed at discharge and at one month. RESULTS Between September 2014 and August 2015, a total of 30 patients (21 male; 70.0%) with a mean body mass index of 41.2 kg/m2 were enrolled. Mean age was 72±9 years (range, 67–88 years). Most patients suffered from critical limb ischemia (87.1%) and diabetes (61.3%). Calcifications were present in eight cases (26.6%). Reason for direct SFA puncture was obesity (100%). Successful hemostasis was achieved in 100% of the cases. No major complications were noted after one-month follow-up. Minor complications included two <5 cm hematomas (6.6%) not necessitating treatment. CONCLUSION In this prospective study, Starclose SE® VCD was safe and effective for hemostasis of antegrade direct SFA puncture. Uncomplicated hemostasis was achieved even in cases of puncturing 2 to 7 cm below the inferior edge of the femoral head. PMID:27641942

  20. Starclose SE® hemostasis after 6F direct antegrade superficial femoral artery access distal to the femoral head for peripheral endovascular procedures in obese patients.

    PubMed

    Spiliopoulos, Stavros; Kitrou, Panagiotis; Christeas, Nikolaos; Karnabatidis, Dimitris

    2016-01-01

    Direct superficial femoral artery (SFA) antegrade puncture is a valid alternative to common femoral artery (CFA) access for peripheral vascular interventions. Data investigating vascular closure device (VCD) hemostasis of distant SFA 6F access are limited. We aimed to investigate the safety and effectiveness of the Starclose SE® VCD for hemostasis, following direct 6F antegrade SFA access distal to the femoral head. This prospective, single-center study included patients who were not suitable for CFA puncture and were scheduled to undergo peripheral endovascular interventions using direct antegrade SFA 6F access, at least 2 cm below the inferior edge of femoral head. Hemostasis was obtained with the Starclose SE® VCD (Abbott Laboratories). Primary endpoints were successful hemostasis rate and periprocedural (30-day) major complication rate. Secondary endpoint was the rate of minor complications. Clinical and Doppler ultrasound follow-up was performed at discharge and at one month. Between September 2014 and August 2015, a total of 30 patients (21 male; 70.0%) with a mean body mass index of 41.2 kg/m2 were enrolled. Mean age was 72±9 years (range, 67-88 years). Most patients suffered from critical limb ischemia (87.1%) and diabetes (61.3%). Calcifications were present in eight cases (26.6%). Reason for direct SFA puncture was obesity (100%). Successful hemostasis was achieved in 100% of the cases. No major complications were noted after one-month follow-up. Minor complications included two <5 cm hematomas (6.6%) not necessitating treatment. In this prospective study, Starclose SE® VCD was safe and effective for hemostasis of antegrade direct SFA puncture. Uncomplicated hemostasis was achieved even in cases of puncturing 2 to 7 cm below the inferior edge of the femoral head.

  1. Access to the Superficial Femoral Artery in the Presence of a 'Hostile Groin': A Prospective Study

    SciTech Connect

    Marcus, Adrian J.; Lotzof, Kevin; Howard, Adam

    2007-06-15

    Purpose. Lower limb angioplasty is commonly performed via antegrade common femoral artery (CFA) puncture, followed by selective superficial femoral artery (SFA) catheterization. Arterial access can be complicated by a 'hostile groin' (scarring, obesity, or previous failed CFA puncture). We prospectively investigated color duplex ultrasound (CDU)-guided SFA access for radiological interventions. Methods. Antegrade CDU-guided CFA and SFA puncture were compared in 30 patients requiring intervention for severe leg ischemia who had hostile groins. Demographics, screen time, radiation dose, intervention, and complications were prospectively recorded. Results. Treatment in 30 patients involved 44 angioplasties (40 transluminal, 4 subintimal) and 2 diagnostic angiograms. Fifteen of these patients had CDU-guided CFA punctures; in 8 of these patients CDU-guided CFA puncture 'failed' (i.e., there was failure to pass a guidewire or catheter into the CFA or SFA), necessitating immediate direct CDU-guided SFA puncture. Overall, the mean screen time and radiation dosage, via direct CDU-guided SFA puncture in 30 patients, was 4.8 min and 464 Gy cm{sup 2} respectively. With CDU-guided CFA puncture, mean screen time (10 min), radiation dose (2023 Gy cm{sup 2}), and complications (13%) were greater when compared with the SFA puncture results overall and in the same patients at subsequent similar procedures (2.7 min, 379 Gy cm{sup 2} (p < 0.05), no complications in this subgroup). Five complications occurred: 2 each at CFA and SFA entry sites, and 1 angioplasty embolus. Conclusions. The CDU-guided SFA puncture technique was both more effective than CDU-guided CFA access in patients with scarred groins, obesity, or failed CFA punctures and safer, with reduced screen times, radiation doses, and complications.

  2. [Stenting in superficial femoral artery and usCRP: Multicentric study SAFE in 255 patients].

    PubMed

    Beregi, Jean-Paul; Lehalle, Bertrand; Cardon, Jean-Marie; Pillet, Jean-Christophe; Chabanier, Alain; Sibé, Maxime; Aubry, Pascal; de Cassin, Patrice; Raffin, Jean-Bernard; Lecointre, Bruno; Vernhet, Hélène

    2010-12-01

    To evaluate mid-term primary patency of the femoral artery stenting in correlation with usCRP level and characteristics of the population, morphological aspect of the lesions and interventional techniques. Patients were prospectively included in a multicenter study (18 centers in France) after stenting (SMART, Cordis Johnson & Johnson, Issy-les-Moulineaux, France) of the superficial femoral artery (SFA). Inclusion and exclusion criteria were based on recommendations and every day practice of the centers. Thus 255 patients (183 men; mean age: 69 years; range 44-92) were included. Technical success of the SFA stenting was 100% without any complications and primary angiographic success 97%. usCRP level increased significantly (p < 0.05) between before and 24h after SFA stenting. In the subgroup of patients without initial inflammation (n = 157), usCRP increased significantly (p < 0.05) in the group of patient with initial thrombosis and additional intervention (graft, amputation, angioplasty on other arterial bed) in the same procedure compared to the remaining patients. Restenosis rate was 12.4% (26/209 patients) at 7 ± 2 months. Before stenting, usCRP level was not predictive of a restenosis, whereas after stenting, an increase of the 24h usCRP level was significantly higher in the subgroup of patient with an occlusion at mid-term (8 patients; p < 0.05). This study demonstrated good patency at 7 months of SFA stenting with nitinol SMART with an increase of the usCRP level 24h after stenting in favour of the presence of an occlusion at mid-term follow-up. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  3. Femoral Artery Occlusion Increases Muscle Pressor Reflex and Expression of Hypoxia-Inducible Factor-1α in Sensory Neurons

    PubMed Central

    Gao, Wei; Li, Jianhua

    2013-01-01

    Hypoxia inducible factor-1 (HIF-1) has an important contribution to pathophysiological changes of homeostasis under conditions of oxygen deprivation as well as ischemia. We examined the effects of femoral artery occlusion on HIF-1α expression in sensory dorsal root ganglion (DRG) neurons of rats. Also, we examined cardiovascular responses to static muscle contraction following femoral occlusion. We hypothesized that hindlimb vascular insufficiency increases the levels of sensory nerves’ HIF-1α and augments autonomic responses induced by activation of muscle afferent nerves. In addition, we examined if the reflex cardiovascular responses were altered as HIF-1α was increased in the DRG neurons. Our data show that HIF-1α was significantly increased in the lumbar DRG neurons 6, 24 and 72 hours after femoral artery ligation as compared with sham control. Administration of dimethyloxalylglycine (DMOG), a stabilizer of HIF-α, significantly increased HIF-1α in the lumbar DRG neurons. Furthermore, femoral occlusion enhanced the reflex pressor response to muscle contraction; however, the response was not altered by injection of DMOG. Overall, our results indicate that 1) femoral artery occlusion increases HIF-1α levels of in DRG neurons and contraction-induced pressor response; and 2) an increase in HIF-1α of DRG neurons per se may not alter the muscle pressor reflex. PMID:25346936

  4. Association of subclinical wall changes of carotid, femoral, and popliteal arteries with obstructive coronary artery disease in patients undergoing coronary angiography.

    PubMed

    Kafetzakis, Alexandros; Kochiadakis, George; Laliotis, Aggelos; Peteinarakis, Ioannis; Touloupakis, Emmanouel; Igoumenidis, Nikos; Katsamouris, Asterios

    2005-10-01

    To examine the association of occult atherosclerosis of carotid, femoral, and popliteal arteries with the presence and severity of obstructive coronary artery disease (CAD) in patients without a history or presence of cerebrovascular or peripheral arterial disease using ultrasound examination of peripheral arteries. One hundred eighty-four such individuals underwent routine coronary angiography. Obstructive CAD was found in 103 cases, which comprised the patient group. The remaining 81 individuals comprised the control group. All were blindly examined by duplex ultrasonography in order to assess occult atherosclerosis, as indicated by the estimation of intima-media thickness of the carotid artery (IMTC), intima-media thickness of the femoral artery (IMTF), intima-media thickness of the popliteal artery (IMTP), and ultrasonic biopsy (UB) of the carotid and femoral arteries. For the individuals with positive coronary angiography findings, the severity of CAD was estimated by the number of the diseased vessels. IMTC, IMTF, IMTP, and UB showed significant correlation with the presence of obstructive CAD, but only IMTC and IMTF were independent predictive factors, with specificity of 74% and 60% and sensitivity of 76% and 70%, respectively. Additionally, our analysis yielded a regression model that, for a given value of IMTC and IMTF, may estimate the probability of CAD: p (CAD) = e((- 4.765 + 3.36 IMTC + 1.91 IMTF))/1 + e((- 4.765 + 13.36 IMTC + 1.91 IMTF)). Patients with one-vessel disease had significantly lower IMTC (p < 0.001) and UB (p = 0.011) and lower IMTF (p = 0.057) than those with three-vessel disease. The assessment of occult atherosclerosis by duplex ultrasonography in both the carotid and the femoral arteries is significantly associated with the presence and severity of CAD.

  5. RISKS AND CONSEQUENCES OF USING THE TRANSPORTAL TECHNIQUE IN RECONSTRUCTING THE ANTERIOR CRUCIATE LIGAMENT: RELATIONSHIPS BETWEEN THE FEMORAL TUNNEL, LATERAL SUPERIOR GENICULAR ARTERY AND LATERAL EPICONDYLE OF THE FEMORAL CONDYLE

    PubMed Central

    Astur, Diego Costa; Aleluia, Vinicius; Santos, Ciro Veronese; Arliani, Gustavo Gonçalves; Badra, Ricardo; Oliveira, Saulo Gomes; Kaleka, Camila Cohen; Cohen, Moisés

    2015-01-01

    Objective: Define a security zone to avoid possibles vascular and ligamentar complications during anterior cruciate ligament reconstruction. Methods: Arthroscopic reconstruction using the transtibial and transportal technique in cadaver knees was performed followed by dissection and measurement of the distance between the femoral tunnel and the proximal attachment of the lateral collateral ligament and the femoral tunnel and the lateral superior genicular artery. Results: The measure of the analysed distances show us an aproximation between the major branch of the lateral superior genicular artery and the femoral insertion of the colateral lateral ligament and the femoral tunnel during the transportal technique. Conclusion: We realize that the use of technical ship it to arthroscopic ACL reconstruction has a higher probability of injury to the lateral geniculate artery and insertion of the lateral collateral ligament, promoting post-surgical complications such as instability of the knee, osteonecrosis of the femoral condyle and ligamentização graft. PMID:27047873

  6. Effects of 8 hemodynamic conditions on direct blood pressure values obtained simultaneously from the carotid, femoral and dorsal pedal arteries in dogs.

    PubMed

    Monteiro, Eduardo R; Campagnol, Daniela; Bajotto, Gustavo C; Simões, Clarissa R; Rassele, Alice C

    2013-12-01

    This study aimed to evaluate the effect of 8 hemodynamic conditions on blood pressure measurements taken from the carotid, femoral and dorsal pedal arteries of dogs. Six healthy dogs. During isoflurane anesthesia, catheters were introduced into the carotid, femoral and dorsal pedal arteries of dogs to allow simultaneous monitoring of direct blood pressure in each artery. The dogs were submitted to 8 hemodynamic conditions induced by combining changes in heart rate (bradycardia, normocardia, tachycardia) with changes in blood pressure (hypotension, normotension, hypertension). Values obtained from each arterial catheter were compared and agreement between central (carotid) and peripheral (femoral and dorsal pedal) values were analyzed by the Bland-Altman method. During hypotensive conditions, systolic arterial pressure (SAP) was lower in the femoral and dorsal pedal arteries compared to the carotid artery whereas during normotensive and hypertensive conditions, SAP was higher in peripheral arteries. During hypotensive states, increases in heart rate resulted in greater bias between central and peripheral SAP whereas during normotensive states, the bias decreased as heart rate increased. Mean and diastolic arterial pressures were lower in the femoral and dorsal pedal arteries than in the carotid artery during most hemodynamic conditions. In healthy anesthetized dogs, invasive blood pressure measurements in peripheral arteries may differ significantly from measurements in a central artery. The greatest differences were observed in SAP and the magnitude of differences between central and peripheral blood pressure measurements varied according to the dog's hemodynamic condition. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. Evaluation of Nitinol Stents Using a 3-Dimensional Printed Superficial Femoral Artery Model: A Preliminary Study.

    PubMed

    Girsowicz, Elie; Georg, Yannick; Seiller, Hélène; Lejay, Anne; Thaveau, Fabien; Heim, Frédéric; Chakfe, Nabil

    2016-05-01

    Mechanical tests assessing Nitinol stents used for the superficial femoral artery (SFA) are designed without taking into account their deployment environments. The objectives of this study were (1) to create normal and pathologic femoral artery models, (2) to run mechanical tests reproducing the stresses of the SFA, and (3) to study and compare Nitinol stents in those conditions. Femoral artery models with identical mechanical properties to the SFA were created using the 3-dimensional printing technology. Those models were designed with and without an asymmetric focal 50% stenosis. Three mechanical tests (bending-compression, bending-compression-torsion, and multiple bending tests) were created and 1 flexible stent was tested, of 6 and 7-mm diameter. Three samples of the stent, LifeStent (Bard(®)), were deployed and tested in the models. Stents alone were evaluated in the same conditions. The analysis focused on the comparison of rheologic curves, level of kink, and the energy deployed for each stent to kink. In the 3 tests, all stents deployed in the models presented a kink during their evaluation. When tested alone, during the compression-bending and bending-compression-torsion tests, no plicature was observed. During the multiple bending test, the energy deployed to plicature for the stent tested alone was of 1.4 ± 0.10 and 2.84 ± 0.1 J compared with 9.7 ± 0.6 and 8.25 ± 0.6 J when deployed in the model for the Lifestent 6 × 80 and 7 × 80 mm, respectively. For all of these 3 tests, 6-mm diameter stents exhibited a level of kink and energy of kink higher than 7 mm stents. The behavior of the stents changed in the stenosed model whatever diameter is taken into account. Analysis of the rheologic curves showed a decrease in the inflection of the curve related to the plication. In the bending-compression test, the presence of a stenosis lead to an early plication of the model, with less deployed kinking energy whereas in the bending

  8. Acute Ischemia due to Superficial Femoral Artery Thrombosis: Results of In Situ Fibrinolysis.

    PubMed

    Arsicot, Matthieu; Della Schiava, Nellie; Boudjelit, Tarek; Rouvière, Olivier; Feugier, Patrick; Lermusiaux, Patrick; Millon, Antoine

    2016-05-01

    The management of acute ischemia due to the thrombosis superficial femoral artery (SFA) stents is complex. In situ arterial fibrinolysis, still not evaluated in this indication, would allow, by lifting the ischemia and uncovering its cause, to avoid thrombectomy, endovascular recanalization, or arterial bypass. The purpose of the study was to evaluate the effectiveness, the complications, and the assisted secondary patency of in situ fibrinolysis for thrombosis of SFA stents. We conducted a retrospective monocentric study with prospective collection of the data. Between October 2011 and December 2014, 86 in situ fibrinolysis procedures were carried out for acute lower limb ischemia. Twelve procedures were carried out for acute ischemia due to the thrombosis of SFA stents. Clinical success was defined by the lifting of acute ischemia. The causes of thromboses, the complications related to the fibrinolysis, and the secondary assisted patency were analyzed. The mean age of the patients was 66.3 (55-90) years. The average length of the stents was 119.3 (18-270) mm. In 10 patients, the thrombosis extended in the full length of the artery. The average time between the implantation of the stent and the initiation of the fibrinolysis was 180 (11-369) days. The average time between the beginning of the symptoms and fibrinolysis was 5 (0-12) days. The average duration of treatment was 46 (24-72) hr. Clinical success was obtained in all the patients. Diagnosed isolated or associated lesions were a progression of the atheromatous disease upstream or downstream of the stent in 6 cases, and an isolated intrastent restenosis in 3 cases. In 2 cases, no obvious cause was found. One or more additional endovascular procedures were carried out in 9 cases at the end of the fibrinolysis, and consisted of a transluminal intrastent angioplasty with an active balloon in 5 cases, an additional stenting in 3 cases, and the stenting of upstream or downstream arteries in 5 cases. Secondary

  9. Left Radial Versus Femoral Access for Coronary Angiography in Post-Coronary Artery Bypass Graft Surgery Patients.

    PubMed

    Pasley, Thomas F; Khan, Ali; Yen, Lu-Yin; Newcombe, Ruth; Humphreys, Hayley; El-Jack, Seif

    2016-03-01

    It has been recently demonstrated that coronary angiography of native coronary arteries via the radial artery results in reduced morbidity and mortality, when compared with a femoral approach. However, the efficacy and safety of the transradial approach in patients with coronary grafts is relatively unknown. We performed a retrospective audit of all patients with a history of previous coronary artery bypass graft (CABG) surgery who underwent diagnostic angiography at our institution from 2008-2012. The primary efficacy endpoint was procedure time (minutes), while the secondary efficacy measure was patient radiation exposure (μGy/m²). There were 326 post-CABG patients studied during the defined period, with 254 via femoral approach and 72 via left radial artery. There was no significant difference between the two approaches in procedure time (37 minutes in radial group vs 35 minutes in femoral group; t-test, P=.43). There was also no difference in radiation exposure (7855 μGy/m² in femoral group vs 6825 μGy/m² in radial group; Satterthwaite t-test, P=.08). This study shows the validity of a left radial approach in patients who have undergone angiography post CABG. It suggests that transradial angiography can be safely performed in these patients, without significant increase in procedural time or radiation exposure.

  10. Joint segmentation of lumen and outer wall from femoral artery MR images: Towards 3D imaging measurements of peripheral arterial disease.

    PubMed

    Ukwatta, Eranga; Yuan, Jing; Qiu, Wu; Rajchl, Martin; Chiu, Bernard; Fenster, Aaron

    2015-12-01

    Three-dimensional (3D) measurements of peripheral arterial disease (PAD) plaque burden extracted from fast black-blood magnetic resonance (MR) images have shown to be more predictive of clinical outcomes than PAD stenosis measurements. To this end, accurate segmentation of the femoral artery lumen and outer wall is required for generating volumetric measurements of PAD plaque burden. Here, we propose a semi-automated algorithm to jointly segment the femoral artery lumen and outer wall surfaces from 3D black-blood MR images, which are reoriented and reconstructed along the medial axis of the femoral artery to obtain improved spatial coherence between slices of the long, thin femoral artery and to reduce computation time. The developed segmentation algorithm enforces two priors in a global optimization manner: the spatial consistency between the adjacent 2D slices and the anatomical region order between the femoral artery lumen and outer wall surfaces. The formulated combinatorial optimization problem for segmentation is solved globally and exactly by means of convex relaxation using a coupled continuous max-flow (CCMF) model, which is a dual formulation to the convex relaxed optimization problem. In addition, the CCMF model directly derives an efficient duality-based algorithm based on the modern multiplier augmented optimization scheme, which has been implemented on a GPU for fast computation. The computed segmentations from the developed algorithm were compared to manual delineations from experts using 20 black-blood MR images. The developed algorithm yielded both high accuracy (Dice similarity coefficients ≥ 87% for both the lumen and outer wall surfaces) and high reproducibility (intra-class correlation coefficient of 0.95 for generating vessel wall area), while outperforming the state-of-the-art method in terms of computational time by a factor of ≈ 20. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Intervention on Surgical Systemic-to-Pulmonary Artery Shunts: Carotid Versus Femoral Access.

    PubMed

    Ligon, R Allen; Ooi, Yinn K; Kim, Dennis W; Vincent, Robert N; Petit, Christopher J

    2017-09-11

    The purpose of this study was to compare results between the femoral arterial (FA) and carotid arterial (CA) approaches in catheter-based interventions on Blalock-Taussig shunts (BTS). Transcatheter intervention on BTS is often performed in shunt-dependent, hypoxemic infants. The approach to BTS intervention likely has an impact on timeliness and overall success. The authors reviewed all cases of catheter intervention for BTS obstruction between 2012 and 2017 for their institution. They sought to compare procedural success rates and time, sheath time, time to arterial access, and time from access to stent implantation between FA and CA approaches. There were 42 BTS interventions between 34 patients. BTS intervention was more successful from the CA approach (p = 0.035). Among the FA cohort, BTS intervention was unsuccessful in 8 cases (25%), 5 of which were converted to CA with subsequent success. The CA cohort had lower procedure time (62 min vs. 104 min; p = 0.01) and anesthesia time (119 min vs. 151 min; p = 0.01). Additionally, CA access was associated with shorter time to arterial access (4.0 min vs. 9.3 min; p < 0.01), time to placement of the guidewire through the BTS (6.5 min vs. 13 min; p < 0.01), and time from the final sheath to BTS stent implantation (9 min vs. 20 min; p < 0.01). Operators should consider the route of access to the BTS deliberately. The authors' approach has been the carotid artery as an alternative access site-associated with greater procedural success, shorter procedural time, and shorter time to stent implantation. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  12. Retrograde access via the popliteal artery to facilitate the re-entry technique for recalcitrant superficial femoral artery chronic total occlusions.

    PubMed

    Pappy, Reji; Hennebry, Thomas A; Abu-Fadel, Mazen S

    2011-10-01

    Subintimal recanalization is beneficial in selected patients with peripheral chronic total occlusions (CTO). However, in complex cases, re-entry into the true arterial lumen may prove to be unsuccessful with a conventional guidewire or a re-entry catheter when using standard femoral artery access. Our case series describes these technical dilemmas along with strategies that can be utilized to overcome these challenges. Copyright © 2011 Wiley-Liss, Inc.

  13. Femoral artery pseudoaneurysm as a complication of angioplasty. How can it be prevented?

    PubMed Central

    Gupta, Prabha Nini; Salam Basheer, Abdul; Sukumaran, Gireesh Gomaty; Padmajan, Sabin; Praveen, Satheesan; Velappan, Praveen; Nair, Bigesh Unnikrishnan; Nair, Sandeep Govindan; Kunjuraman, Usha Kumari; Madthipat, Unnikrishnan; R, Jayadevan

    2013-01-01

    Femoral pseudoaneurysm is a common complication of repeated femoral puncture during cardiac catheterisation. We describe here the development of femoral pseudoaneurysms in a patient with Takayasu's arteritis, which healed in response to conservative treatment, and review the literature on the prevention and treatment of femoral pseudoaneurysm. PMID:27326111

  14. Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin

    SciTech Connect

    Pecoraro, Felice Sabatino, Ermanno R.; Dinoto, Ettore; Rosa, Giuliana La; Corte, Giuseppe; Bajardi, Guido

    2015-10-15

    A 78-year-old man presented with a 7-cm aneurysm in the left superficial femoral artery, which was considered unfit and anatomically unsuitable for conventional open surgery for multiple comorbidities. The patient was treated with stent-graft [Viabhan stent-graft (WL Gore and Associates, Flagstaff, AZ)]. Two years from stent-graft implantation, the patient presented a purulent secretion and a spontaneous external expulsion through a fistulous channel. No claudication symptoms or hemorrhagic signs were present. The pus and device cultures were positive for Staphylococcus aureus sensitive to piperacillin/tazobactam. Patient management consisted of fistula drainage, systemic antibiotic therapy, and daily wound dressing. At 1-month follow-up, the wound was closed. To our knowledge, this is the first case of this type of stent-graft complication presenting with external expulsion.

  15. Differences in perioperative femoral and radial arterial blood pressure in neonates and infants undergoing pediatric cardiac surgery requiring cardiopulmonary bypass.

    PubMed

    Cho, Hwa Jin; Lee, Sang Hoon; Jeong, In Seok; Yoon, Nam Sik; Ma, Jae Sook; Ahn, Byoung Hee

    2017-08-30

    Several reports claim that blood pressure (BP) in the radial artery may underestimate the accurate BP in critically ill patients. Here, the authors evaluated differences in mean blood pressure (MBP) between the radial and femoral artery during pediatric cardiac surgery to determine the effectiveness of femoral arterial BP monitoring. The medical records of children under 1 year of age who underwent open-heart surgery between 2007 and 2013 were retrospectively reviewed. Radial and femoral BP were measured simultaneously, and the differences between these values were analyzed at various times: after catheter insertion, after the initiation of cardiopulmonary bypass (CPB-on), after aortic cross clamping (ACC), after the release of ACC, after weaning from CPB, at arrival in the intensive care unit (ICU), and every 6h during the first day in the ICU. A total of 121 patients who underwent open-heart surgery met the inclusion criteria. During the intraoperative period, from the beginning to the end of CPB, radial MBPs were significantly lower than femoral MBPs at each time-point measured (p<0.05). Multivariate analysis showed that longer CPB time (>60min, odds ratio: 7.47) was a risk factor for lower radial pressure. However, discrepancies between these two values disappeared after arrival in the ICU. There was no incidence of ischemic complications associated with the catheterization of both arteries. The authors suggest that femoral arterial pressure monitoring can be safely performed, even in neonates, and provides more accurate BP values during CPB-on periods, and immediately after weaning from CPB, especially when CPB time was greater than 60min. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  16. Fluoroscopy-guided femoral artery puncture reduces the risk of PCI-related vascular complications.

    PubMed

    Fitts, James; Ver Lee, Peter; Hofmaster, Patricia; Malenka, David

    2008-06-01

    In previous work by the Northern New England Cardiovascular Study Group, risk factors for vascular access site complications in percutaneous coronary intervention (PCI) were identified and a regional effort to reduce these complications was initiated. As part of this effort we considered making a regional recommendation that location of the femoral head as seen on fluoroscopy (fluoro) be used to help determine the site of femoral artery puncture. Therefore, we assessed the use of fluoro to determine whether it actually reduced the rate of vascular complications and shortened length of stay. Data were collected prospectively on 2,651 consecutive PCIs at Eastern Maine Medical Center from 2000 to 2003 including use of fluoro, vascular access site complications (bleeding, pseudoaneurysm formation, hematoma, embolic event or thrombus, A-V fistula), and length of stay. Use of fluoro among eight interventionists was variable: 3 < 20%, 3 35-50%, 2 > 70%. Among all interventions, 48% were performed with fluoro to guide vascular access. The use of fluoro was associated with a significantly lower incidence of pseudoaneurysms (0.3% vs. 1.1%, P = 0.017) and any arterial injury (0.7% vs. 1.9%, P < 0.01). There was no significant difference in bleeding (1.6% vs. 1.8%, P = 0.69). For each physician, there were fewer vascular injuries when fluoro was used. Average length of stay was significantly lower among patients in the fluoro group (2.1 days vs. 2.4, P < 0.01). We conclude that using fluoro to guide vascular access leads to lower complication rates and a shorter length of stay. This approach may become our regional standard of care.

  17. Comparison of Ultrasound-Guided and Fluoroscopy-Assisted Antegrade Common Femoral Artery Puncture Techniques

    SciTech Connect

    Slattery, Michael M.; Goh, Gerard S.; Power, Sarah; Given, Mark F.; McGrath, Frank P.; Lee, Michael J.

    2015-06-15

    PurposeTo prospectively compare the procedural time and complication rates of ultrasound-guided and fluoroscopy-assisted antegrade common femoral artery (CFA) puncture techniques.Materials and MethodsHundred consecutive patients, undergoing a vascular procedure for which an antegrade approach was deemed necessary/desirable, were randomly assigned to undergo either ultrasound-guided or fluoroscopy-assisted CFA puncture. Time taken from administration of local anaesthetic to vascular sheath insertion in the superficial femoral artery (SFA), patients’ age, body mass index (BMI), fluoroscopy radiation dose, haemostasis method and immediate complications were recorded. Mean and median values were calculated and statistically analysed with unpaired t tests.ResultsSixty-nine male and 31 female patients underwent antegrade puncture (mean age 66.7 years). The mean BMI was 25.7 for the ultrasound-guided (n = 53) and 25.3 for the fluoroscopy-assisted (n = 47) groups. The mean time taken for the ultrasound-guided puncture was 7 min 46 s and for the fluoroscopy-assisted technique was 9 min 41 s (p = 0.021). Mean fluoroscopy dose area product in the fluoroscopy group was 199 cGy cm{sup 2}. Complications included two groin haematomas in the ultrasound-guided group and two retroperitoneal haematomas and one direct SFA puncture in the fluoroscopy-assisted group.ConclusionUltrasound-guided technique is faster and safer for antegrade CFA puncture when compared to the fluoroscopic-assisted technique alone.

  18. The role of ERK in phasic and tonic contractile responses in rat femoral arteries after hindlimb unloading.

    PubMed

    Yuan, Ming; Li, Zhili; Wang, Desheng; Jiang, Shizhong

    2005-01-01

    The present study tested the hypothesis that the role of ERK in phasic and tonic contractile responses is declined by hindlimb unloading (HU) in rat femoral arteries. Male Wistar rats were randomised into HU and Control group (n=7). After 14d, the femoral arteries were isolated and cut into 3-mm ring segments. In the absence or presence of PD98059(MEK inhibitor), contractile response to NE(10μM) was measured in Krebs solution in a tissue bath at 37°C, isometric tension were recorded with Powerlab system. The area under curve (AUC), phasic and tonic contractile responses between two groups were compared. After 14d-HU, the AUC, phasic and tonic NE-induced contractile responses were declined compared with controls. PD98059 did not affect the AUC in arteries from HU, but significantly decreased the AUC in arteries from control (100±7.1% vs. 61.18±11.3%, P<0.05). In contrast to control, the inhibitory ratio of PD98059 was significantly lower in phasic (7.42±3.24% vs. 33.59± 9.19%, P=0.0198) and tonic (26.93±3.78% vs. 46.75±5.67%, P=0.0131) contractile responses of HU group. Moreover, the inhibitory ratio of PD98059 wasn't significantly different between the phasic and tonic contractile responses in control group (P=0.2464). But for HU group, the difference was statistically significant (P=0.002). We demonstrated that the role of ERK was declined in both phasic and tonic contractile responses in rat femoral arteries after hindlimb unloading. Simulated microgravity induced by HU may attenuate the contractile responses of femoral arteries by inhibiting the role of ERK in thick and thin filament regulatory pathways.

  19. A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures

    PubMed Central

    2013-01-01

    Background and purpose The micro-architecture of bone has been increasingly recognized as an important determinant of bone strength. Successful operative stabilization of fractures depends on bone strength. We evaluated the osseous micro-architecture and strength of the osteoporotic human femoral head. Material and methods 6 femoral heads, obtained during arthroplasty surgery for femoral neck fracture, underwent micro-computed tomography (microCT) scanning at 30 μm, and bone volume ratio (BV/TV), trabecular thickness, structural model index, connection density, and degree of anisotropy for volumes of interest throughout the head were derived. A further 15 femoral heads underwent mechanical testing of compressive failure stress of cubes of trabecular bone from different regions of the head. Results The greatest density and trabecular thickness was found in the central core that extended from the medial calcar to the physeal scar. This region also correlated with the greatest degree of anisotropy and proportion of plate-like trabeculae. In the epiphyseal region, the trabeculae were organized radially from the physeal scar. The weakest area was found at the apex and peripheral areas of the head. The strongest region was at the center of the head. Interpretation The center of the femoral head contained the strongest trabecular bone, with the thickest, most dense trabeculae. The apical region was weaker. From an anatomical and mechanical point of view, implants that achieve fixation in or below this central core may achieve the most stable fixation during fracture healing. PMID:24032522

  20. High femoral artery bifurcation predicts contralateral high bifurcation: implications for complex percutaneous cardiovascular procedures requiring large caliber and/or dual access.

    PubMed

    Gupta, Vipul; Feng, Kent; Cheruvu, Pavan; Boyer, Nathan; Yeghiazarians, Yerem; Ports, Thomas A; Zimmet, Jeffrey; Shunk, Kendrick; Boyle, Andrew J

    2014-09-01

    Recent advances in technology have led to an increase in the use of bilateral femoral artery access and the requirement for large-bore access. Optimal access is in the common femoral artery (CFA), rather than higher (in the external iliac artery) or lower (in one of the branches of the CFA). However, there is a paucity of data in the literature about the relationship between bifurcation level of one CFA and the contralateral CFA. To define the prevalence of high bifurcation of the CFA and the relationship between bifurcation level on both sides, we performed a retrospective analysis of all patients with bilateral femoral angiography. From 4880 femoral angiograms performed at UCSF cardiac catheterization laboratory between 2005-2013, a total of 273 patients had bilateral femoral angiograms. The prevalence of low/normal, high, and very-high femoral bifurcations was 70%, 26%, and 4%, respectively, with no difference between sides. A high or very-high bifurcation significantly increased the likelihood of a high bifurcation on the contralateral side (odds ratio >3.0). Multivariable logistic regression analysis revealed age, gender, self-reported race, height, weight, and body mass index were not predictive of high or very-high bifurcations on either side. In conclusion, high femoral artery bifurcations are common and increase the likelihood of a high bifurcation of the contralateral femoral artery.

  1. A comparison of continuous non-invasive arterial pressure with invasive radial and femoral pressure in patients undergoing cardiac surgery.

    PubMed

    Broch, O; Bein, B; Gruenewald, M; Carstens, A; Illies, C; Schöneich, F; Steinfath, M; Renner, J

    2013-03-01

    Non-invasive continous monitoring of finger arterial pressure has gained increasing interest. The aim of the present study was to compare the accuracy of non-invasive reconstructed brachial artery pressure by the Nexfin™ device (NFAP) with invasive femoral (IFAP) and radial (IRAP) artery pressure before and after cardiopulmonary bypass (CPB). Fifty patients scheduled for elective coronary surgery were studied before and after CPB, respectively. Each patient was monitored with the non-invasive system, and both an indwelling femoral and radial arterial catheter. A passive leg raising maneuver was also performed before and after CPB. Measurements included mean (MAP), systolic (SAP) and diastolic (DAP) arterial pressure by NFAP (MAP,SAP,DAP(NFAP)), IFAP (MAP,SAP,DAP(IFAP)) and IRAP (MAP,SAP,DAP(IRAP)). Percentage changes of MAP for all measurement sites were also calculated. There was a moderate correlation between MAP(NFAP) and MAP(IFAP) both before (r=0.64, P<0.0001) and after (r=0.57, P<0.0001) CPB, with a percentage error (PE) of 29% and 27%, respectively. Correlation coefficients between MAP(NFAP) and MAP(IRAP) were r=0.53, P<0.0001 (PE 34%) before and r=0.54, P<0.0001 (PE 29%) after CPB. There was a significant correlation in percentage changes between ∆MAP(NFAP) and ∆MAP(IFAP) before (r=0.70, P<0.0001) and after (r=0.71, P<0.0001) CPB and for ∆MAP(NFAP) and ∆MAP(IRAP) (r=0.67, P<0.0001; r=0.74, P<0.0001), respectively. Non-invasive, reconstructed brachial artery pressure showed moderate correlation compared with both invasive femoral and radial artery pressure. Furthermore, the non-invasive monitoring system was able to reflect percentage changes in mean arterial pressure in a moderate fashion.

  2. Clinical and pathological assessment of different suture techniques for microvascular anastomosis in rat femoral artery

    PubMed Central

    El-Shazly, Mohamed

    2007-01-01

    This study examined the clinical and pathological features after a microvascular anastomosis of a rat femoral artery using four different suture techniques. Sixty Sprage-Dawely rats were divided randomly into 4 groups. Fifteen bisected arteries (one from each animal) in Group I, II, III and IV were sutured with the simple interrupted suture, continuous suture, sleeve suture and cuff suture, respectively. The anastomosis times in Group I, II, III and IV were 28.67, 14.67, 15.47 and 15.93 min, respectively. Immediate bleeding that stopped without intervention (grade I) was observed in 67%, 73% and 60% of the anastomosed vessels in Groups II, III and IV, respectively, while 60% of the vessels in Group I showed light bleeding that was inhibited by gentile pressure (grade II). All vessels examined appeared to be patent at 5 and 15 min after the anastomosis. On the 7th day postoperatively, the vessels of Group I showed the highest patency rate (93%) compared with Groups II (67%), III (73%) and IV (87%). Moreover, there were more pronounced pathological changes in Group I than in the other groups. These changes included endothelial loss, endothelial proliferation, degeneration and necrosis of the tunica media. Suture materials surrounded by an inflammatory reaction were also observed. In conclusion, the simple interrupted suture is preferable for microvascular anastomosis due to its highest patency rate. The other techniques investigated can be good alternatives because of their short anastomotic time and moderate pathological changes. PMID:17679774

  3. Laser scoop desobliteration: a method for minimally invasive remote recanalization of chronically occluded superficial femoral arteries

    NASA Astrophysics Data System (ADS)

    Heneweer, Carola; Siggelkow, Markus; Helle, Michael; Petzina, Rainer; Wulff, Asmus; Schaefer, Joost P.; Berndt, Rouven; Rusch, Rene; Wedel, Thilo; Klaws, Guenther; Müller-Gerbl, Magdalena; Röcken, Christoph; Jansen, Olav; Lutter, Georg; Cremer, Joachim; Groß, Justus

    2015-02-01

    Stenosis and occlusion of the superficial femoral artery (SFA) are most common in arterial occlusive disease. There are numerous interventional, surgical, and combined approaches to reconstitute maximum blood supply to the lower limb; however, despite intense clinical research, the long-term success rates are still poor. We present the first results with a catheter prototype for laser-based minimal invasive endarterectomy, called laser scoop desobliteration (LSD). The tip of a glass fiber containing a catheter was modified with a spatula head design and connected to an ultraviolet laser. It was tested in cadavers fixed with the Thiel embalming technique preserving tissue consistency, flexibility, and plasticity. After longitudinal arteriotomy of the SFA, a circular dissection between media and adventitia was performed. Then the LSD catheter was inserted and propagated with a progress of 1 mm/s. Afterward, the atheroma core, which showed a plain surface without substantial attaching tissue debris, was removed. Histological examination of the vessel wall showed that the dissection was performed at the media/adventitia interface. In summary, the constructed LSD catheter allowed a rapid and easy way to perform an endarterectomy, thereby offering an innovative approach in the treatment of chronic occluded SFA.

  4. Laser scoop desobliteration: a method for minimally invasive remote recanalization of chronically occluded superficial femoral arteries.

    PubMed

    Heneweer, Carola; Siggelkow, Markus; Helle, Michael; Petzina, Rainer; Wulff, Asmus; Schaefer, Joost P; Berndt, Rouven; Rusch, Rene; Wedel, Thilo; Klaws, Guenther; Müller-Gerbl, Magdalena; Röcken, Christoph; Jansen, Olav; Lutter, Georg; Cremer, Joachim; Groß, Justus

    2015-02-01

    Stenosis and occlusion of the superficial femoral artery (SFA) are most common in arterial occlusive disease. There are numerous interventional, surgical, and combined approaches to reconstitute maximum blood supply to the lower limb; however, despite intense clinical research, the long-term success rates are still poor. We present the first results with a catheter prototype for laser-based minimal invasive endarterectomy, called laser scoop desobliteration (LSD). The tip of a glass fiber containing a catheter was modified with a spatula head design and connected to an ultraviolet laser. It was tested in cadavers fixed with the Thiel embalming technique preserving tissue consistency, flexibility, and plasticity. After longitudinal arteriotomy of the SFA, a circular dissection between media and adventitia was performed. Then the LSD catheter was inserted and propagated with a progress of 1 mm∕s. Afterward, the atheroma core, which showed a plain surface without substantial attaching tissue debris, was removed. Histological examination of the vessel wall showed that the dissection was performed at the media/adventitia interface. In summary, the constructed LSD catheter allowed a rapid and easy way to perform an endarterectomy, thereby offering an innovative approach in the treatment of chronic occluded SFA.

  5. Acoustic hemostasis of porcine superficial femoral artery: Simulation and in-vivo experimental studies

    NASA Astrophysics Data System (ADS)

    Zeng, Xiaozheng; Mitchell, Stuart; Miller, Matthew; Barnes, Stephen; Hopple, Jerry; Kook, John; Moreau-Gobard, Romain; Hsu, Stephen; Ahiekpor-Dravi, Alexis; Crum, Lawrence A.; Eaton, John; Wong, Keith; Sekins, K. Michael

    2012-10-01

    In-vivo focused ultrasound studies were computationally simulated and conducted experimentally with the aim of occluding porcine superficial femoral arteries (SFA) via thermal coagulation. A multi-array HIFU applicator was used which electronically scanned multiple beam foci around the target point. The spatio-temporally averaged acoustic and temperature fields were simulated in a fluid dynamics and acousto-thermal finite element model with representative tissue fields, including muscle, vessel and blood. Simulations showed that with an acoustic power of 200W and a dose time of 60s, perivascular tissue reached 91°C; and yet blood reached a maximum 59°C, below the coagulation objective for this dose regime (75°C). Per simulations, acoustic-streaming induced velocity in blood reached 6.1cm/s. In in-vivo experiments, several arteries were treated. As simulated, thermal lesions were observed in muscle surrounding SFA in all cases. In dosing limited to 30 to 60 seconds, it required 257W to provide occlusion (one complete and one partial occlusion). Angiography and histology showed evidence of thrombogenesis and collagen shrinkage-based vessel constriction at these doses.

  6. Safety and efficacy of combined micropuncture and shallow angle femoral artery access for neurovascular angiography.

    PubMed

    Bourgeois, Austin C; Kolze, Chris T; Guimaraes, Marcelo S; Pasciak, Alexander S; Ferrell, Andrew S; Bradley, Yong; Kvamme, Peter

    2017-05-15

    The AXERA 2 low-angle vascular access device utilizes a dual arteriotomy mechanism in which the standard access tract is compressed by a vascular sheath inserted over the second, low-angle tract. It is unknown whether this device could be effectively used with 21-gauge micropuncture access, as the micropuncture introducer makes a larger arteriotomy than the 19-gauge needle provided with the AXERA 2 system. A retrospective review was performed on 189 patients who underwent common femoral artery access for diagnostic cerebrovascular angiography using either combined micropuncture and AXERA 2 access or standard access with manual pressure hemostasis. Demographic and procedural data were reviewed along with complications related to vascular access and times to bed elevation, ambulation and discharge. Combined micropuncture and AXERA 2 access was performed on 110 patients and 79 patients had standard access. The AXERA device was successfully used in 91.8% of the cases. Demographic data, anticoagulant use and sheath sizes were similar between both subsets. Use of the AXERA 2 was associated with two bleeding complications (1.8%) compared with 10 (12.7%) with manual pressure hemostasis alone. Institution-specific protocol allowed shorter mean manual compression time, as well as shorter times to ambulation and discharge with the AXERA 2. Use of the AXERA 2 device with micropuncture access did not infer increased bleeding risk than standard arterial access in this patient series. The considerable incidence of device use failures suggests a learning curve associated with its use.

  7. Actions of vanadate on vascular tension and sodium pump activity in cat isolated cerebral and femoral arteries.

    PubMed Central

    Sánchez-Ferrer, C. F.; Marín, J.; Lluch, M.; Valverde, A.; Salaices, M.

    1988-01-01

    1. The mechanisms involved in the responses induced by sodium vanadate (Va3 VO4) on cat cerebral and femoral arteries were studied. The possibility that these responses were due to Na+, K+-ATPase inhibition was investigated by measuring the effect of vanadate on [3H]-ouabain binding to arterial membrane fractions, K+-induced vasodilatation and ouabain-sensitive 86Rb+ uptake. 2. The vanadium compounds (Na3VO4, VOSO4, VCl3 and O5V3) induced similar, concentration-dependent contractions in each kind of artery, the cerebral vessels being the most sensitive to these compounds. 3. Exposure of the arteries to a low-Na+ (25 mM) solution suppressed the contraction caused by vanadate in femoral but not in cerebral arteries. 4. Vanadate-induced contractions were reduced in Ca2+-free medium but remained unaffected by 3 x 10(-6) M phentolamine, reserpine pretreatment or 3 x 10(-6) M verapamil in both kinds of artery. 5. The addition of 7.5 mM K+ to the arteries immersed in a K+-free solution induced vasodilatation, which was not modified by 10(-3) M vanadate. 6. The consecutive administration of ouabain (10(-4) M) and vanadate (10(-3) M) (or vice versa), or the simultaneous administration of both agents (10(-8) to 10(-3) M) appeared to produce an additive contraction in both types of artery. 7. Vanadate (10(-7) to 10(-3) M) did not displace the [3H]-ouabain binding to arterial membrane fractions of these arteries, whereas 10(-4) M ouabain did. 8. In both kinds of artery, total 86Rb+ uptake was reduced by ouabain (10(-8) to 10(-3) M), in a concentration-dependent manner, whereas it was not modified by vanadate (10(-8)-10(-3) M).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3349233

  8. Retrograde Popliteal Access to Percutaneous Peripheral Intervention for Chronic Total Occlusion of Superficial Femoral Arteries.

    PubMed

    Dumantepe, Mert

    2017-07-01

    The aim of this study is to present our initial experience with the use of the retrograde popliteal artery access in patients with chronic total occlusions of superficial femoral artery (SFA). From July 2012 to May 2014, a total of 28 patients (20 men, mean age 61.2 ± 11.5 years) with total occlusion of the SFA and good distal runoff were treated with percutaneous atherectomy, balloon angioplasty, and stenting (mean length 165.3 ± 57.5 mm, range 72-336 mm). All patients had severe claudication or critical limb ischemia, and most of the lesions were TransAtlantic Inter-Society Consensus classification type D (n = 21). Technical success was achieved in all cases. In majority (26, 92.8%) of the patients, endoluminal recanalization was possible from the popliteal access; SFA recanalization in the other 2 cases was obtained through the subintimal space. During a mean follow-up of 12.9 ± 2.5 months, claudication, severity, rest pain, and toe ulcers improved significantly. Ankle-brachial index changed from 0.54 ± 0.11 to 0.91 ± 0.2 at 1 year after intervention ( P < .001), and patency rates at 1, 6, and 12 months after interventions were 100%, 92.8%, and 85.7%, respectively. One pseudoaneurysm and 1 arteriovenous fistula were found in the popliteal region on duplex examinations. There were 2 in-stent restenosis and 3 occlusions during the 12-month follow-up. These occlusions were treated with reendovascular procedures. Our secondary patency rate was 96.4%. No stent fracture was observed. The retrograde popliteal artery approach under duplex guidance can be considered as safe, efficient, and the primary SFA recanalization strategy in carefully selected patients, with competitive immediate and mid-term results.

  9. Differential responses to CO2 and sympathetic stimulation in the cerebral and femoral circulations in humans

    PubMed Central

    Ainslie, Philip N; Ashmead, Jon C; Ide, Kojiro; Morgan, Barbara J; Poulin, Marc J

    2005-01-01

    The relative importance of CO2 and sympathetic stimulation in the regulation of cerebral and peripheral vasculatures has not been previously studied in humans. We investigated the effect of sympathetic activation, produced by isometric handgrip (HG) exercise, on cerebral and femoral vasculatures during periods of isocapnia and hypercapnia. In 14 healthy males (28.1 ± 3.7 (mean ± s.d.) years), we measured flow velocity (; transcranial Doppler ultrasound) in the middle cerebral artery during euoxic isocapnia (ISO, +1 mmHg above rest) and two levels of euoxic hypercapnia (HC5, end-tidal PCO2, PET,CO2, = +5 mmHg above ISO; HC10, PET,CO2= +10 above ISO). Each PET,CO2 level was maintained for 10 min using the dynamic end-tidal forcing technique, during which increases in sympathetic activity were elicited by a 2-min HG at 30% of maximal voluntary contraction. Femoral blood flow (FBF; Doppler ultrasound), muscle sympathetic nerve activity (MSNA; microneurography) and mean arterial pressure (MAP; Portapres) were also measured. Hypercapnia increased and FBF by 5.0 and 0.6% mmHg−1, respectively, and MSNA by 20–220%. Isometric HG increased MSNA by 50% and MAP by 20%, with no differences between ISO, HC5 and HC10. During the ISO HG there was an increase in cerebral vascular resistance (CVR; 20 ± 11%), while remained unchanged. During HC5 and HC10 HG, increased (13% and 14%, respectively), but CVR was unchanged. In contrast, HG-induced sympathetic stimulation increased femoral vascular resistance (FVR) during ISO, HC5 and HC10 (17–41%), while there was a general decrease in FBF below ISO. The HG-induced increases in MSNA were associated with increases in FVR in all conditions (r = 0.76–0.87), whereas increases in MSNA were associated with increases in CVR only during ISO (r = 0.91). In summary, in the absence of hypercapnia, HG exercise caused cerebral vasoconstriction, myogenically and/or neurally, which was reflected by increases in CVR and a maintained . In

  10. Management of Isolated Atherosclerotic Stenosis of the Common Femoral Artery: A Review of the Literature.

    PubMed

    Halpin, David; Erben, Young; Jayasuriya, Sasanka; Cua, Bennett; Jhamnani, Sunny; Mena-Hurtado, Carlos

    2017-05-01

    Common femoral endarterectomy (CFE) remains the standard of care for treatment of atherosclerotic stenosis of the common femoral artery (CFA). Endovascular interventions have become the first-line therapy for atherosclerotic disease of the aortoiliac and femoropopliteal systems. Recent reports have documented high rates of technical success and low rates of complications with endovascular management of CFA stenosis. This study is a contemporary review of the surgical and endovascular literature on the management CFA stenosis and compares the results of these methods. A search of OVID Medline identified all published reports of revascularization of isolated atherosclerotic CFA stenosis. For each study selected for review, the number of patients, number of limbs treated, percentage of patients with critical limb ischemia, and mean length of follow-up was recorded. Study end points included survival, primary patency, freedom from target lesion revascularization (TLR), freedom from amputation, and complications. The review included 7 CFE studies and 4 endovascular studies. Survival was similar between the groups. Primary patency was consistently higher with CFE compared to endovascular therapy. Freedom from TLR was lower with CFE compared to endovascular therapy. Morbidity and mortality was also higher with CFE compared to endovascular therapy. Freedom from amputation was not consistently reported in the endovascular studies. There is limited data to support endovascular treatment of isolated CFA atherosclerosis. CFE has durable results, but there is significant morbidity and mortality resulting from this procedure. Endovascular interventions have low rates of complications, high rates of technical success, good short-term patency but increased need for repeat interventions when compared to surgery. Further trial data comparing CFE with endovascular therapy is needed to guide the management of CFA stenosis.

  11. Abnormal origin of right coronary artery and use of Tiger catheter through femoral route.

    PubMed

    Datta, Goutam; Rai, Durga Prasad

    2016-01-01

    Abnormal origin of right coronary artery (RCA) is not uncommon. The incidence is .25-.92%. Right Judkin catheter is used universally for engaging right coronary ostium from femoral route. We have tried Tiger catheter from femoral route in abnormal origin of RCA patients. We were successful in cannulating RCA ostium in most of the cases. We have studied about 5120 patients over 4 years. We have selected patients from November 2010 to November 2014. Our patients are from two institutions-I.P.G.M.E.R., Kolkata and Burdwan Medical College, West Bengal. Right Judkin 3.5 and 4 were used universally. We have used AL-1,2,3, AR1,2, multipurpose, different guide catheters for cannulating RCA ostium in those cases where we failed to engage by right Judkin catheter. We have used Tiger catheter as a last resort when all endeavor failed. Among 40 cases of left sinus origin Type A-9, Type B-14, Type C-6, Type D-3, and Type E-8 patients were observed. But 668 cases abnormal origin of RCA were from right coronary sinus only. High take-off origin were 422 cases (8%), low take-off were 132 cases (2.5%), and posterior origin were 114 cases (2%). We could engage right coronary ostium by Tiger catheter in 690 cases (97%). We failed in 23 cases (3%). Tiger catheter can be used successfully in abnormal RCA origin cases. It is more effective but less risky in comparison to other catheters. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  12. Abnormal origin of right coronary artery and use of Tiger catheter through femoral route

    PubMed Central

    Datta, Goutam; Rai, Durga Prasad

    2016-01-01

    Background Abnormal origin of right coronary artery (RCA) is not uncommon. The incidence is .25–.92%. Right Judkin catheter is used universally for engaging right coronary ostium from femoral route. We have tried Tiger catheter from femoral route in abnormal origin of RCA patients. We were successful in cannulating RCA ostium in most of the cases. Materials and methods We have studied about 5120 patients over 4 years. We have selected patients from November 2010 to November 2014. Our patients are from two institutions—I.P.G.M.E.R., Kolkata and Burdwan Medical College, West Bengal. Right Judkin 3.5 and 4 were used universally. We have used AL-1,2,3, AR1,2, multipurpose, different guide catheters for cannulating RCA ostium in those cases where we failed to engage by right Judkin catheter. We have used Tiger catheter as a last resort when all endeavor failed. Results and analysis Among 40 cases of left sinus origin Type A—9, Type B—14, Type C—6, Type D—3, and Type E—8 patients were observed. But 668 cases abnormal origin of RCA were from right coronary sinus only. High take-off origin were 422 cases (8%), low take-off were 132 cases (2.5%), and posterior origin were 114 cases (2%). We could engage right coronary ostium by Tiger catheter in 690 cases (97%). We failed in 23 cases (3%). Conclusion Tiger catheter can be used successfully in abnormal RCA origin cases. It is more effective but less risky in comparison to other catheters. PMID:26896276

  13. Children and Adolescent Obesity Associates with Pressure-Dependent and Age-Related Increase in Carotid and Femoral Arteries' Stiffness and Not in Brachial Artery, Indicative of Nonintrinsic Arterial Wall Alteration

    PubMed Central

    García-Espinosa, Victoria; Curcio, Santiago; Castro, Juan Manuel; Arana, Maite; Giachetto, Gustavo; Chiesa, Pedro; Zócalo, Yanina

    2016-01-01

    Aim. To analyze if childhood obesity associates with changes in elastic, transitional, and/or muscular arteries' stiffness. Methods. 221 subjects (4–15 years, 92 females) were assigned to normal weight (NW, n = 137) or obesity (OB, n = 84) groups, considering their body mass index z-score. Age groups were defined: 4–8; 8–12; 12–15 years old. Carotid, femoral, and brachial artery local stiffness was determined through systodiastolic pressure-diameter and stress-strain relationships. To this end, arterial diameter and peripheral and aortic blood pressure (BP) levels and waveforms were recorded. Carotid-femoral, femoropedal, and carotid-radial pulse wave velocities were determined to evaluate aortic, lower-limb, and upper-limb regional arterial stiffness, respectively. Correlation analysis between stiffness parameters and BP was done. Results. Compared to NW, OB subjects showed higher peripheral and central BP and carotid and femoral stiffness, reaching statistical significance in subjects aged 12 and older. Arterial stiffness differences disappeared when levels were normalized for BP. There were no differences in intrinsic arterial wall stiffness (elastic modulus), BP stiffness relationships, and regional stiffness parameters. Conclusion. OB associates with BP-dependent and age-related increase in carotid and femoral (but not brachial) stiffness. Stiffness changes would not be explained by intrinsic arterial wall alterations but could be associated with the higher BP levels observed in obese children. PMID:27066273

  14. Quantitative Impact of Cardiovascular Risk Factors and Vascular Closure Devices on the Femoral Artery after Repeat Cardiac Catheterization

    PubMed Central

    Tiroch, Klaus A.; Matheny, Michael E.; Resnic, Frederic S.

    2010-01-01

    Background We evaluated the exact quantitative long-term impact of repeated catheterizations, vascular closure devices (VCDs) and cardiovascular risk factors on the femoral artery after cardiac catheterization. Methods A total of 2,102 available femoral angiograms from 827 consecutive patients were analyzed using caliper-based quantitative vascular analysis (QVA). These patients underwent coronary interventions between 01/2005-04/2007, and had at least one additional catheterization procedure through the ipsilateral femoral access site from 12/2001 until 01/2008. Multivariate analysis was performed to control for confounding variables. The primary outcome was change in artery size. Results The average punctured artery diameter was 6.5mm±2.1mm. The average time between first case and last follow-up was 349 days. There was no significant change of the punctured artery size over time after the index procedure (P=0.15) and no change associated with the use of VCDs (P=0.25) after multivariate analysis. Smaller arteries were associated with female gender (−1.22mm, P<0.0001), presence of angiographic peripheral vascular disease (PVD, −1.19mm, P<0.0001), and current (−0.48mm, P=0.001) or former (−0.23mm, P=0.01) smoking status, while previous statin therapy was associated with an increase in artery size (+0.47mm, P<0.0001). VCDs were used less often compared to manual compression in cases preceding the first detection of angiographic PVD (P<0.001). Conclusion VCDs are not associated with a change in the artery size or progression of PVD. Overall, there is no change in vessel size over time after repeat catheterizations, with a decrease in vessel size associated with current and former smoking, and an increase with previous statin therapy. PMID:20102878

  15. Human Arterial Ring Angiogenesis Assay.

    PubMed

    Seano, Giorgio; Primo, Luca

    2016-01-01

    In this chapter we describe a model of human angiogenesis where artery explants from umbilical cords are embedded in gel matrices and subsequently produce capillary-like structures. The human arterial ring (hAR) assay is an innovative system that enables three-dimensional (3D) and live studies of human angiogenesis. This ex vivo model has the advantage of recapitulating several steps of angiogenesis, including endothelial sprouting, migration, and differentiation into capillaries. Furthermore, it can be exploited for (1) identification of new genes regulating sprouting angiogenesis, (2) screening for pro- or anti-angiogenic drugs, (3) identification of biomarkers to monitor the efficacy of anti-angiogenic regimens, and (4) dynamic analysis of tumor microenvironmental effects on vessel formation.

  16. Transvenous Embolization of a Spontaneous Femoral AVF 5 Years After an Incomplete Treatment with Arterial Stent-Grafts

    SciTech Connect

    Peynircioglu, Bora Ozkan, Murat; Dogan, Omer Faruk; Cil, Barbaros E.; Dogan, Riza

    2008-03-15

    A 66-year-old man with complex left femoral arterio-venous fistula (AVF) was first diagnosed after a deep venous thrombosis incident approximately 5 years ago. Partial treatment was performed by means of endografts along the superficial femoral artery, which remained patent for 5 years. The patient had been doing well until a couple of months ago when he developed severe venous stasis and ulcers of the left cruris, due to a high-flow nonhealing complex AVF with additional iliac vein occlusion. Therefore; the definitive treatment was performed by a unique endovascular technique combined with surgical venous bypass (femoro-femoral crossover saphenous bypass, the Palma operation). A novel percutaneous transvenous technique for occlusion of a complex high-flow AVF is reported with a review of the literature. The case is unique with spontaneous AVF, transvenous embolization with detachable coils and ONYX, and the hybrid treatment technique as well as the long-term patency of superficial femoral artery stent-grafts.

  17. Bioabsorbable stent implantation vs. common femoral artery endarterectomy: early results of a randomized trial.

    PubMed

    Linni, Klaus; Ugurluoglu, Ara; Hitzl, Wolfgang; Aspalter, Manuela; Hölzenbein, Thomas

    2014-08-01

    To compare clinical and hemodynamic outcome in patients undergoing treatment of common femoral artery (CFA) atherosclerotic lesions by bioabsorbable stent implantation (BASI group) or by common femoral artery endarterectomy (CFE group). A randomized, controlled, single-center, open-label trial was initiated to compare outcomes of BASI or CFE in patients with chronic atherosclerotic occlusive lesions in the CFA. From May 2011 to April 2013, 116 consecutive patients were recruited; after excluding 36 patients, 80 patients (52 men; mean age 72.2±9.6 years) were enrolled 1:1 and are the subject of this intention-to-treat interim analysis (40 patients in each group). The primary endpoint was surgical site infections; secondary outcome measures were technical success, hemodynamic improvement, clinical improvement, patency, limb salvage, and survival. There was no statistically significant difference between both groups regarding demographic data, cardiovascular risk factors, or CFA occlusions. The CFE patients presented with 7 surgical site infections (all minor) vs. none in the BASI group (p=0.002) and a longer mean postoperative hospital stay of 7 vs. 2 days for BASI patients (p<0.001). Technical success rates were 97.5% and 100% for the BASI and CFE groups, respectively. Postoperative ankle-brachial index means were comparable (p=0.38). The 30-day primary patency rates were 92.5% and 100% for the BASI and CFE groups, respectively (p=0.038). There were 6 reconstruction failures in CFE patients vs. none in the BASI group (p=0.02); 5 failures involved initial CFA occlusions. At 1 year, the primary and secondary patency rates were 80% vs. 100% (p=0.007) and 84% vs. 100% (p=0.01) for BASI and CFE patients, respectively. Limb salvage was equivalent, and survival rates were 88% and 90% for BASI vs. CFE patients (p=0.51) at 1 year. This interim analysis suggests that BASI is not an option for CFA occlusion and is only a limited option for CFA stenosis. Clinical and

  18. Ten Year Experience with Prosthetic Graft Infections Involving the Femoral Artery

    PubMed Central

    Siracuse, Jeffrey J; Nandivada, Prathima; Giles, Kristina A; Hamdan, Allen D; Wyers, Mark C; Chaikof, Elliot L; Pomposelli, Frank B; Schermerhorn, Marc L

    2013-01-01

    Background Prosthetic graft infection is a major complication of peripheral vascular surgery. We investigated our institution’s experience over ten years with bypass grafts involving the femoral artery to determine the incidence and risk factors for prosthetic graft infection. Methods A retrospective cohort single institution review of prosthetic bypass grafts involving the femoral artery from 2001–2010 evaluated patient demographics, body mass index, comorbidities, indications, location of bypass, type of prosthetic material, case urgency, previous ipsilateral bypass or percutaneous interventions; and evaluated the incidence of graft infections, amputations, and mortality. Results There were 496 prosthetic grafts identified with a graft infection rate of 3.8% (n=19) at a mean follow-up of 27 months. Multivariable analysis shows that redo bypass (HR 5.8, 95% CI 2.2–15.0), active infection at time of bypass (HR 5.2, 95% CI 1.9–14.2), female gender (HR 4.5, 95% CI 1.6–12.7), and diabetes mellitus (HR 4.6, 95% CI 1.5–14.3) were significant predictors of graft infection. Graft infection was predictive of major lower extremity amputation (HR 9.8, 95% CI 3.5–27.1) as was preoperative tissue loss (HR 4.7, 95% CI 1.8–11.9). Graft infection did not predict long term mortality, however chronic renal insufficiency (HR 2.3, 95% CI 1.6–3.4), tissue loss (HR 1.4, 95% CI 1.0–1.9), and active infection (HR 2.3, 95% CI 1.6–3.4) did. Infected grafts were removed 79% of the time. Staphylococcus epidermidis (37%) and Methicillin-sensitive Staphylococcus aureus (26%) were the most common pathogens isolated. Conclusions Redo-bypass, female gender, diabetes, and active infection at time of bypass are associated with a higher risk for prosthetic graft infection and major extremity amputation, but do not confer an increased risk of mortality. Autologous vein for lower extremity bypass and endovascular interventions should be considered when feasible in high

  19. Ruptured Mycotic Common Femoral Artery Pseudoaneurysm: Fatal Pulmonary Embolism after Emergency Stent-Grafting in a Drug Abuser

    PubMed Central

    Kalogirou, Thomas E.; Giagtzidis, Ioakeim T.; Papazoglou, Konstantinos O.

    2014-01-01

    The rupture of a mycotic femoral artery pseudoaneurysm in an intravenous drug abuser is a limb- and life-threatening condition that necessitates emergency intervention. Emergency stent-grafting appears to be a viable, minimally invasive alternative, or a bridge, to subsequent open surgery. Caution is required in cases of suspected concomitant deep vein thrombosis in order to minimize the possibility of massive pulmonary embolism during stent-grafting, perhaps by omitting stent-graft postdilation or by inserting an inferior vena cava filter first. We describe the emergency endovascular management, in a 60-year-old male intravenous drug abuser, of a ruptured mycotic femoral artery pseudoaneurysm, which was complicated by a fatal pulmonary embolism. PMID:25593530

  20. Pressure difference-flow rate variation in a femoral artery branch casting of man for steady flow

    NASA Technical Reports Server (NTRS)

    Cho, Y. I.; Back, L. H.; Crawford, D. W.

    1983-01-01

    In-vitro, steady flow in a casting of the profunda femoris branch of the femoral artery of man was studied by measuring pressure differences in the main lumen and also in the branch over a large Reynolds number range from 200 to 1600. Effects of viscous and inviscid flows in this femoral artery branch were demonstrated quantitatively. The critical ratio of the flow rate in the branch to the upstream main lumen in this casting was found to be 0.4, above which the inviscid flow analysis indicated a pressure rise and below which it yielded a pressure drop in the main lumen across the branch junction. Pressure rises were experimentally found to occur both in the main lumen and in the branch for certain ranges of the aforementioned ratio.

  1. Pressure difference-flow rate variation in a femoral artery branch casting of man for steady flow

    NASA Technical Reports Server (NTRS)

    Cho, Y. I.; Back, L. H.; Crawford, D. W.

    1983-01-01

    In-vitro, steady flow in a casting of the profunda femoris branch of the femoral artery of man was studied by measuring pressure differences in the main lumen and also in the branch over a large Reynolds number range from 200 to 1600. Effects of viscous and inviscid flows in this femoral artery branch were demonstrated quantitatively. The critical ratio of the flow rate in the branch to the upstream main lumen in this casting was found to be 0.4, above which the inviscid flow analysis indicated a pressure rise and below which it yielded a pressure drop in the main lumen across the branch junction. Pressure rises were experimentally found to occur both in the main lumen and in the branch for certain ranges of the aforementioned ratio.

  2. Combined Low-Frequency Ultrasound and Urokinase-Containing Microbubbles in Treatment of Femoral Artery Thrombosis in a Rabbit Model

    PubMed Central

    Mu, Yuming

    2016-01-01

    This paper aims to study the thrombolytic effect of low-frequency ultrasound combined with targeted urokinase-containing microbubble contrast agents on treatment of thrombosis in rabbit femoral artery; and to determine the optimal combination of parameters for achieving thrombolysis in this model. A biotinylated-avidin method was used to prepare microbubble contrast agents carrying urokinase and Arg-Gly-Asp-Ser (RGDS) peptides. Following femoral artery thrombosis in New Zealand white rabbits, microbubble contrast agents were injected intravenously, and ultrasonic exposure was applied. A 3 × 2 × 2 factorial table was applied to categorize the experimental animals based on different levels of combination of ultrasonic frequencies (Factor A: 1.6 MHz, 2.2 MHz, 2.8 MHz), doses of urokinase (Factor B: 90,000 IU/Kg, 180,000 IU/Kg) and ultrasound exposure time (Factor C: 30 min, 60 min). A total of 72 experimental animals were randomly divided into 12 groups (n = 6/group). Doppler techniques were used to assess blood flow in the distal end of the thrombotic femoral artery during the 120 minutes thrombolysis experiment. The rate of recanalization following thrombolysis was calculated, and thrombolytic efficacy was evaluated and compared. The thrombolytic recanalization rate for all experimental subjects after thrombolytic therapy was 68.1%. The optimal parameters for thrombolysis were determined to be 1) an ultrasound frequency of 2.2 MHz and 2) a 90,000 IU/kg dose of urokinase. Ultrasound exposure time (30 min vs. 60 min) had no significant effect on the thrombolytic effects. The combination of local low-frequency ultrasound radiation, targeted microbubbles, and thrombolytic urokinase induced thrombolysis of femoral artery thrombosis in a rabbit model. The ultrasonic frequency of 2.2 MHz and urokinase dose of 90,000 IU/kg induced optimal thrombolytic effects, while the application of either 30 min or 60 min of ultrasound exposure had similar effects. PMID:28033371

  3. Combined Low-Frequency Ultrasound and Urokinase-Containing Microbubbles in Treatment of Femoral Artery Thrombosis in a Rabbit Model.

    PubMed

    Zhu, Yanping; Guan, Lina; Mu, Yuming

    2016-01-01

    This paper aims to study the thrombolytic effect of low-frequency ultrasound combined with targeted urokinase-containing microbubble contrast agents on treatment of thrombosis in rabbit femoral artery; and to determine the optimal combination of parameters for achieving thrombolysis in this model. A biotinylated-avidin method was used to prepare microbubble contrast agents carrying urokinase and Arg-Gly-Asp-Ser (RGDS) peptides. Following femoral artery thrombosis in New Zealand white rabbits, microbubble contrast agents were injected intravenously, and ultrasonic exposure was applied. A 3 × 2 × 2 factorial table was applied to categorize the experimental animals based on different levels of combination of ultrasonic frequencies (Factor A: 1.6 MHz, 2.2 MHz, 2.8 MHz), doses of urokinase (Factor B: 90,000 IU/Kg, 180,000 IU/Kg) and ultrasound exposure time (Factor C: 30 min, 60 min). A total of 72 experimental animals were randomly divided into 12 groups (n = 6/group). Doppler techniques were used to assess blood flow in the distal end of the thrombotic femoral artery during the 120 minutes thrombolysis experiment. The rate of recanalization following thrombolysis was calculated, and thrombolytic efficacy was evaluated and compared. The thrombolytic recanalization rate for all experimental subjects after thrombolytic therapy was 68.1%. The optimal parameters for thrombolysis were determined to be 1) an ultrasound frequency of 2.2 MHz and 2) a 90,000 IU/kg dose of urokinase. Ultrasound exposure time (30 min vs. 60 min) had no significant effect on the thrombolytic effects. The combination of local low-frequency ultrasound radiation, targeted microbubbles, and thrombolytic urokinase induced thrombolysis of femoral artery thrombosis in a rabbit model. The ultrasonic frequency of 2.2 MHz and urokinase dose of 90,000 IU/kg induced optimal thrombolytic effects, while the application of either 30 min or 60 min of ultrasound exposure had similar effects.

  4. Randomized Trial of the SMART Stent versus Balloon Angioplasty in Long Superficial Femoral Artery Lesions: The SUPER Study

    SciTech Connect

    Chalmers, Nicholas; Walker, Paul T.; Belli, Anna-Maria; Thorpe, Anthony P.; Sidhu, Paul S.; Robinson, Graham; Ransbeeck, Mariella van

    2013-04-15

    To determine whether primary stenting reduces the rate of restenosis compared with balloon angioplasty alone in the endovascular treatment of long superficial femoral artery lesions; and to assess the effect of treatment on quality of life. A total of 150 patients with superior femoral artery occlusion or severe stenosis of 5-22 cm length from 17 UK centers were randomized to either primary stenting with the SMART stent or balloon angioplasty (i.e., percutaneous transluminal angioplasty, PTA). Bailout stent placement was permitted in case of inadequate result from PTA. The primary end point was restenosis measured by duplex ultrasound at 1 year. Quality-of-life assessments were performed by the EuroQol (EQ)-5D questionnaire. Mean lesion length was 123.0 mm in the stent group and 116.8 mm in the PTA group. A total of 140 (93.3 %) of 150 had total occlusions. At 12 months' follow-up, restenosis measured by Duplex ultrasound was not significantly different between the stent and PTA groups by intention-to-treat or as-treated analyses: 47.2 versus 43.5 % (p = 0.84) and 40.8 versus 46.7 % (p = 0.68), respectively. There were fewer target lesion revascularizations in patients randomized to stenting, but this did not reach statistical significance (12.5 vs. 20.8 %, p = 0.26). There was no difference in the rate of amputation. Patients in both groups reported improved quality of life. Primary stenting of long lesions in predominantly occluded superficial femoral arteries does not reduce the rate of binary restenosis compared with balloon angioplasty and bailout stenting. Both treatment strategies conferred a meaningful and sustained improvement to the quality of life of patients with severe superficial femoral artery disease.

  5. Nitric oxide-dependent vasodilatation of rabbit femoral artery by beta(2)-adrenergic stimulation or cyclic AMP elevation in vivo.

    PubMed

    Xu, B; Li, J; Gao, L; Ferro, A

    2000-03-01

    Some studies suggest that beta-adrenoceptor-mediated vasorelaxation is in part mediated through nitric oxide (NO) release. We wished to determine the contribution of the L-arginine / NO system to vasodilatation in response to beta-adrenoceptor stimulation with isoprenaline or cyclic adenosine-3',5'-monophosphate (cyclic AMP) elevation with forskolin and dibutyryl cyclic AMP in vivo, using a rabbit femoral artery constant perfusion model. Baseline femoral artery pressure was similar in rabbits receiving isoprenaline, forskolin or dibutyryl cyclic AMP. Isoprenaline, forskolin and dibutyryl cyclic AMP each decreased femoral artery pressure in a dose-dependent manner. The doses (mol kg(-1)) of isoprenaline, forskolin and dibutyryl cyclic AMP which decreased pressure by 10% from baseline, expressed as a negative logarithm (-log ED(10)) were: 10.0+/-0.2, 9.5+/-0.1 and 4.9+/-0.1 respectively (P<0.0001 for each). Use of beta-adrenoceptor subtype-selective antagonists showed that the vascular response to isoprenaline was purely due to stimulation of the beta(2)-adrenoceptor subtype. Injection of 1 micromol kg(-1) N(G)-nitro-L-arginine methyl ester (L-NAME) did not alter baseline pressure. However, it abolished the pressure response to isoprenaline (P<0.0001), and significantly attenuated the pressure responses to forskolin and dibutyryl cyclic AMP: -log ED(10) values for forskolin and dibutyryl cyclic AMP, in the presence of L-NAME, were 7.9+/-0.1 and 3.5+/-0.3 respectively (P<0.0001 for each, as compared with values in the absence of L-NAME). These results indicate that beta(2)-adrenergic stimulation and cylic AMP elevation activate the L-arginine/NO system in rabbit femoral artery in vivo, and that NO generation contributes importantly to the changes in vascular tone induced by agents which modulate beta-adrenoceptors or cyclic AMP.

  6. Diminished Neurogenic Femoral Artery Vasoconstrictor Response in a Zucker Obese Rat Model: Differential Regulation of NOS and COX Derivatives

    PubMed Central

    Martínez, Ana Cristina; Hernández, Medardo; Novella, Susana; Martínez, María Pilar; Pagán, Rosa María; Hermenegildo, Carlos; García-Sacristán, Albino; Prieto, Dolores; Benedito, Sara

    2014-01-01

    Objective Peripheral arterial disease is one of the macrovascular complications of type 2 diabetes mellitus. This study addresses femoral artery regulation in a prediabetic model of obese Zucker rats (OZR) by examining cross-talk between endothelial and neural factors. Methods and Results Arterial preparations from lean (LZR) and OZR were subjected to electrical field stimulation (EFS) on basal tone. Nitric oxide synthase (NOS) and cyclooxygenase (COX) isoform expression patterns were determined by immunohistochemical labelling and Western blotting. Results indicate significantly reduced noradrenergic contractions in preparations from OZR compared with those of LZR. Functional inhibition of endothelial NOS (eNOS) indicated a predominant role of this isoform in LZR and its modified activity in OZR. Neural (nNOS) and inducible NOS (iNOS) were activated and their expression was higher in femoral arteries from OZR. Neurotransmission modulated by large-conductance Ca2+-activated (BKCa) or voltage-dependent (KV) K+ channels did not seem compromised in the obese animals. Endothelial COX-1 and COX-2 were expressed in LZR and an additional adventitial location of COX-2 was also observed in OZR, explaining the higher COX-2 protein levels detected in this group. Prostanoids derived from both isoforms helped maintain vasoconstriction in LZR while in OZR only COX-2 was active. Superoxide anion inhibition reduced contractions in endothelium-intact arteries from OZR. Conclusions Endothelial dysfunction led to reduced neurogenic vasoconstriction in femoral arteries from OZR. In a setting of obesity, NO-dependent nNOS and iNOS dilation activity could be an alternative mechanism to offset COX-2- and reactive oxygen species-mediated vasoconstriction, along with impaired endothelial NO relaxation. PMID:25216050

  7. Efficacy and safety of percutaneous treatment of iatrogenic femoral artery pseudoaneurysm by biodegradable collagen injection.

    PubMed

    Hamraoui, Karim; Ernst, Sjef M P G; van Dessel, Pascal F H M; Kelder, Johannes C; ten Berg, Jurriën M; Suttorp, Maarten Jan; Jaarsma, Wybren; Plokker, Thijs H W

    2002-04-17

    OBJECTIVES; The goal of this study was to assess the safety and efficacy of femoral artery pseudoaneurysm (FAP) closure by collagen injection. BACKGROUND; The FAP is an infrequent but troublesome complication after percutaneous transfemoral catheter procedures. If ultrasound-guided compression repair (UGCR) fails, vascular surgery is indicated. We have developed a less invasive method to close FAPs percutaneously by injecting collagen and, thus, inducing clotting within the aneurysm. Via a 9F needle or 11F sheath, a biodegradable adhesive bovine collagen is injected percutaneously into the FAP, guided by angiography from the contralateral site. From 1993 to 2000, compression and UGCR had failed to obliterate 110 FAPs. These patients have been treated by collagen injection. Mean age of the patients was 65.6 +/- 10.2 years (range: 32 to 85 years), and 50% were women. Immediate closure of the FAP was achieved in 107/110 patients (97.3%) without any complication or adverse effect. In one patient the collagen could not be applied due to unfavorable anatomy. One patient needed a second session of collagen injection. In one patient too much collagen was inserted, which resulted in external compression of the artery, and surgical intervention was required. The overall success rate was 108/110 (98%, 95% confidence interval: 93.5% to 99.8%). Among the patients with successful procedures, there were no recurrences during six months follow-up. The percutaneous treatment of iatrogenic FAP, by injection with collagen, is an effective and safe strategy. This method provides an excellent therapeutic alternative to the traditional surgical management.

  8. A prospective evaluation of using IVUS during percutaneous superficial femoral artery interventions.

    PubMed

    Hitchner, Elizabeth; Zayed, Mohamed; Varu, Vinit; Lee, George; Aalami, Oliver; Zhou, Wei

    2015-01-01

    The outcomes of endovascular interventions of the superficial femoral artery (SFA) are variable. Completion angiography is typically performed to confirm satisfactory outcomes after SFA angioplasty and/or stenting. However, two-dimensional angiography may not accurately reflect the extent of residual stenosis. We sought to determine whether intravascular ultrasound (IVUS) can help with residual disease assessment and procedure outcome. Patients with anticipated SFA disease were prospectively recruited to the study. Patients with primary SFA disease on diagnostic angiography were included. After SFA endovascular intervention with angioplasty and/or stenting, a completion angiogram was performed to confirm satisfactory results before IVUS evaluation. IVUS-detected maximal residual stenosis, maximal residual lesion volume, and number of nonconsecutive posttreatment SFA segments with >50% residual stenosis were evaluated. Periprocedural ankle-brachial indexes (ABIs), Short Form 36 (SF-36) surveys, and Walking Impairment Questionnaires were also collected. Fifty-nine patients were prospectively enrolled. Thirty-three received angioplasty only, and 26 received angioplasty and stenting. All patients were men, mean age was 67 years, and major comorbidities included coronary artery disease (53%), active smoking (56%), hypertension (88%), and diabetes (68%). The angioplasty-only cohort had more nonconsecutive areas of >50% residual stenosis (P = 0.004), greater residual stenosis (P = 0.03), and smaller minimal lumen diameters after treatment (P = 0.01) than the angioplasty and stenting cohort. However, there was no significant difference in ABI between the 2 groups and no difference in ABI improvement after intervention. Sixty-four percent of all patients demonstrated a >0.2 increase in postintervention ABI. Improvement in ABI at 1 month after procedure significantly correlated with postintervention SF-36 survey physical scores (r = 0.435, P = 0.007). IVUS evaluation

  9. Does ultrasound-guided lidocaine injection improve local anaesthesia before femoral artery catheterization?

    PubMed

    Spiliopoulos, S; Katsanos, K; Diamantopoulos, A; Karnabatidis, D; Siablis, D

    2011-05-01

    To present the results of a prospective, randomized, single-centre study investigating local anaesthesia before percutaneous common femoral artery (CFA) puncture and catheterization with the use of ultrasound-guided injection of lidocaine versus standard infiltration by manual palpation. Patients scheduled to undergo diagnostic or therapeutic transfemoral catheter-based procedures gave informed consent and were randomized in two groups. In the first arm local anaesthesia with lidocaine hydrochloride 1% was performed under ultrasound guidance (group U/S), while in the second arm the standard method of manual artery palpation was applied (group M). In both groups, subsequent CFA catheterization was achieved under ultrasound guidance. The primary study endpoint was peri-procedural pain level evaluated with a visual-analogue scale (VAS score 0-10). Between January 2009 and 2010, 200 patients (161 men, mean age 63±12 years) were equally assigned to each group without any significant differences in baseline demographics. Patients in group U/S experienced significantly less pain during CFA catheterization in comparison with group M with a difference of three points in mean VAS score reported (1.6±1.6 versus 4.6±1.9, p<0.0001). In addition, significantly less volume of lidocaine was used in group U/S compared to group M (16±2.7 versus 19±0.8ml, p<0.001).Total vascular access time was similar in both groups (4.4±1.3 versus 4.5±1.3min). Overall complications included two small groin haematomas in each group. Ultrasound-guided local anaesthesia of the CFA prior to percutaneous transcatheter procedures is safe and achieves superior levels of analgesia with minimal patient pain and discomfort compared to the standard method of manual palpation. Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  10. Twelve months follow-up after retrograde recanalization of superficial femoral artery chronic total occlusion

    PubMed Central

    Wojtasik-Bakalarz, Joanna; Arif, Salech; Chyrchel, Michał; Rakowski, Tomasz; Bartuś, Krzysztof; Dudek, Dariusz

    2017-01-01

    Introduction Fifty percent of cases of peripheral artery disease are caused by chronic total occlusion (CTO) of the superficial femoral artery (SFA). Ten–fifteen percent of percutaneous SFA recanalization procedures are unsuccessful. In those cases the retrograde technique can increase the success rate of the procedure, but the long-term follow-up of such procedures is still unknown. Aim To assess the efficacy and clinical outcomes during long-term follow-up after retrograde recanalization of the SFA. Material and methods We included patients after at least one unsuccessful percutaneous antegrade recanalization of the SFA. Patients were evaluated for the procedural and clinical follow-up of mean time 13.9 months. Results The study included 17 patients (7 females, 10 males) who underwent percutaneous retrograde recanalization of the SFA from June 2011 to June 2015. The mean age of patients was 63 ±7 years. Retrograde puncture of the distal SFA was successful in all cases. A retrograde procedure was performed immediately after antegrade failure in 4 (23.5%) patients and after a previously failed attempt in 13 (76.5%) patients. The procedure was successful in 15 (88.2%) patients, and unsuccessful in 2 (11.8%) patients. Periprocedural complications included 1 peripheral distal embolization (successfully treated with aspiration thrombectomy), 1 bleeding event from the puncture site and 7 puncture site hematomas. During follow-up the all-cause mortality rate was 5.8% (1 patient, non-cardiac death). The primary patency rate at 12 months was 88.2% and secondary patency 100%. Conclusions The retrograde SFA puncture seems to be a safe and successful technique for CTO recanalization and is associated with a low rate of perioperative and long-term follow-up complications. PMID:28344617

  11. The influence of composition and location on the toughness of human atherosclerotic femoral plaque tissue.

    PubMed

    Cunnane, E M; Barrett, H E; Kavanagh, E G; Mongrain, R; Walsh, M T

    2016-02-01

    The toughness of femoral atherosclerotic tissue is of pivotal importance to understanding the mechanism of luminal expansion during cutting balloon angioplasty (CBA) in the peripheral vessels. Furthermore, the ability to relate this parameter to plaque composition, pathological inclusions and location within the femoral vessels would allow for the improvement of existing CBA technology and for the stratification of patient treatment based on the predicted fracture response of the plaque tissue to CBA. Such information may lead to a reduction in clinically observed complications, an improvement in trial results and an increased adoption of the CBA technique to reduce vessel trauma and further endovascular treatment uptake. This study characterises the toughness of atherosclerotic plaque extracted from the femoral arteries of ten patients using a lubricated guillotine cutting test to determine the critical energy release rate. This information is related to the location that the plaque section was removed from within the femoral vessels and the composition of the plaque tissue, determined using Fourier Transform InfraRed spectroscopy, to establish the influence of location and composition on the toughness of the plaque tissue. Scanning electron microscopy (SEM) is employed to examine the fracture surfaces of the sections to determine the contribution of tissue morphology to toughness. Toughness results exhibit large inter and intra patient and location variance with values ranging far above and below the toughness of healthy porcine arterial tissue (Range: 1330-3035 for location and 140-4560J/m(2) for patients). No significant difference in mean toughness is observed between patients or location. However, the composition parameter representing the calcified tissue content of the plaque correlates significantly with sample toughness (r=0.949, p<0.001). SEM reveals the presence of large calcified regions in the toughest sections that are absent from the least tough

  12. Emergency Stent Grafting After Unsuccessful Surgical Repair of a Mycotic Common Femoral Artery Pseudoaneurysm in a Drug Abuser

    SciTech Connect

    Lupattelli, Tommaso; Garaci, Francesco Giuseppe; Basile, Antonio; Minnella, Daniela Paola; Casini, Andrea; Clerissi, Jacques

    2009-03-15

    Mycotic false aneurysm caused by local arterial injury from attempted intravenous injections in drug addicts remains a challenging clinical problem. The continued increase in drug abuse has resulted in an increased incidence of this problem, particularly in high-volume urban centres. In the drug-abusing population, mycotic arterial pseudoaneurysms most often occur because of missed venous injection and are typically seen in the groin, axilla, and antecubital fossa. Mycotic aneurysms may lead to life-threatening haemorrhage, limb loss, sepsis, and even death. Any soft-tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management. We report a case of rupturing mycotic pseudoaneurysm of the left common femoral artery treated by surgical resection followed by vessel reconstruction with autologous material. Unfortunately, at the time of discharge a sudden leakage from the vein graft anastomosis occurred, with subsequent massive bleeding, and required emergent endovascular covered stenting. To the best of our knowledge, this is the first reported case of femoral artery bleeding in a drug abuser treated by stent graft placement.

  13. Popliteal Retrograde Approach is Effective and Safe for Superficial Femoral Artery Chronic Total Occlusion

    PubMed Central

    Ashikaga, Takashi; Shimura, Tsukasa; Hatano, Yu; Sasaoka, Taro; Kurihara, Ken; Yoshikawa, Shunji; Maejima, Yasuhiro; Isobe, Mitsuaki

    2015-01-01

    Objective: Endovascular treatment (EVT) using a popliteal approach is effective for superficial femoral artery (SFA) chronic total occlusion (CTO); however, its effectiveness, safety, and consequent complications are unclear. Materials and Methods: We studied 324 consecutive EVTs (in 187 patients) performed at three centers between April 2008 and March 2013, and selected all EVTs that included SFA CTO regions. A total of 91 EVTs (in 65 patients) were included and divided into two groups; “with popliteal approach” (WPA) and “without popliteal approach” (WOPA). Results: Despite higher rates of hypertension (WPA, 88.9% vs. WOPA, 69.1%; p = 0.04) and CTO length >200 mm (55.6% vs. 28.3%, respectively; p <0.01), the primary success rate was better in the WPA group (97.2% vs. 78.2%, respectively; p <0.01); however, both total complication rate and major complication rate were not significantly different. We compared popliteal puncture using a sheath and using a microcatheter alone. There were no significant differences between sheath and microcatheter use in terms of primary success rates (95.5% vs. 100%, respectively; p = 0.61) and puncture site complications (22.7% vs. 14.2%, respectively; p = 0.53). Conclusion: A popliteal approach improved the primary success rate of EVT for SFA CTO. PMID:26421071

  14. Drug-coated balloons are replacing the need for nitinol stents in the superficial femoral artery.

    PubMed

    Kitrou, Panagiotis; Karnabatidis, Dimitrios; Katsanos, Konstantinos

    2016-08-01

    Amassed evidence from several randomized controlled trials and high quality meta-analyses clearly support the primary use of paclitaxel-coated balloons (PCB) in the superficial femoral artery over traditional plain balloon angioplasty or primary bare nitinol stenting with significantly lower vascular restenosis, less need for repeat procedures, improved quality of life and potential cost savings for the healthcare system. Stents may be reserved for bail-out in case of a suboptimal dilatation result, and for selected more complex lesions, or in case of critical limb ischemia in order to eliminate vessel recoil and maximize immediate hemodynamic gain. Debulking atherectomy remains unproven, but holds a lot of promise in particular in combination with PCBs, in order to improve compliance of the vessel wall by plaque removal, allow for a better angioplasty result and optimize drug transfer and bioavailability. The present overview summarizes and discusses current evidence about femoropopliteal PCB angioplasty compared to the historical standard of plain old balloon angioplasty and bare nitinol stents. Available evidence is appraised in the context of clinically meaningful results, relevant unresolved issues are highlighted, and future trends are discussed.

  15. Short- and midterm results of the fascia suture technique for closure of femoral artery access sites after endovascular aneurysm repair.

    PubMed

    Montán, Carl; Lehti, Leena; Holst, Jan; Björses, Katarina; Resch, Timothy A

    2011-12-01

    To evaluate the midterm outcomes and potential risk factors associated with the fascia suture technique (FST) for closure of femoral artery access sites after percutaneous endovascular aneurysm repair (EVAR). Between April 2007 and April 2008, 100 consecutive EVAR cases were evaluated retrospectively. A third of the procedures were emergent (16 ruptured aneurysms). Of the 187 femoral access sites, 160 (85.5%) were closed by the FST as a first choice. Pre- and postoperative chart and imaging data were collected from computerized medical records for analysis of demographics and the rate of complications (bleeding, infection, thrombosis, pseudoaneurysms, and stenosis). Preoperative risk factors for FST failure were analyzed with regard to obesity (based on the subcutaneous fat layer), plaque at the femoral access site, and stenosis based on the pre- and 1-year postoperative computed tomography scans. Of the 160 FST closures, 146 (91.3%) were technically successful. The 14 (8.8%) technical failures were converted to open cutdown intraoperatively because of bleeding (11, 6.8%), inadequate limb perfusion (2, 1.2%), and a broken guidewire (1, 0.6%). Two (1.2%) pseudoaneurysms required surgical repair after 2 weeks. Data from the 1-year follow-up showed no signs of increased stenosis, thrombosis, or formation of plaque. Nine small (<1 cm(3)) pseudoaneurysms were detected and managed conservatively. No preoperative risk factors were associated with FST failure. The fascia suture technique seems to be safe, effective, and simple to use for closing percutaneous access sites after EVAR. Complications are rare, and the outcome is not affected by obesity, femoral calcification, or femoral artery stenosis.

  16. Angioplasty and stent placement - peripheral arteries

    MedlinePlus

    Percutaneous transluminal angioplasty - peripheral artery; PTA - peripheral artery; Angioplasty - peripheral arteries; Iliac artery -angioplasty; Femoral artery - angioplasty; Popliteal artery - angioplasty; Tibial artery - angioplasty; Peroneal artery - ...

  17. The mechano-gated channel inhibitor GsMTx4 reduces the exercise pressor reflex in rats with ligated femoral arteries

    PubMed Central

    Copp, Steven W.; Kim, Joyce S.; Ruiz-Velasco, Victor

    2016-01-01

    Mechanical and metabolic stimuli arising from contracting muscles evoke the exercise pressor reflex. This reflex is greater in a rat model of simulated peripheral arterial disease in which a femoral artery is chronically ligated than it is in rats with freely perfused femoral arteries. The role played by the mechanically sensitive component of the exaggerated exercise pressor reflex in ligated rats is unknown. We tested the hypothesis that the mechano-gated channel inhibitor GsMTx4, a relatively selective inhibitor of mechano-gated Piezo channels, reduces the exercise pressor reflex in decerebrate rats with ligated femoral arteries. Injection of 10 μg of GsMTx4 into the arterial supply of the hindlimb reduced the pressor response to Achilles tendon stretch (a purely mechanical stimulus) but had no effect on the pressor responses to intra-arterial injection of α,β-methylene ATP or lactic acid (purely metabolic stimuli). Moreover, injection of 10 μg of GsMTx4 into the arterial supply of the hindlimb reduced both the integrated pressor area (control 535 ± 21, GsMTx4 218 ± 24 mmHg·s; P < 0.01), peak pressor (control 29 ± 2, GsMTx4 14 ± 3 mmHg; P < 0.01), and renal sympathetic nerve responses to electrically induced intermittent hindlimb muscle contraction (a mixed mechanical and metabolic stimulus). The reduction of the integrated pressor area during contraction caused by GsMTx4 was greater in rats with ligated femoral arteries than it was in rats with freely perfused femoral arteries. We conclude that the mechanically sensitive component of the reflex contributes to the exaggerated exercise pressor reflex during intermittent hindlimb muscle contractions in rats with ligated femoral arteries. PMID:26921442

  18. Efficacy of treatment of edge stenosis of endografts inserted for superficial femoral artery stenotic disease.

    PubMed

    Golchehr, Bahar; Holewijn, Suzanne; Kruse, Rombout R; van Walraven, Laurens A; Zeebregts, Clark J; Reijnen, Michel M P J

    2015-09-01

    The role of endografts in the treatment of extensive superficial femoral artery (SFA) occlusive disease is enlarging. Results are limited by the occurrence of edge stenosis. The aim of the study was to retrospectively evaluate the efficacy of treatment of edge stenosis of endografts inserted for SFA occlusive disease. All patients, treated between November 2001 and December 2011, with a self-expandable polytetrafluoroethylene-endograft were gathered in a prospective database in three hospitals. The incidence of primary edge stenosis and the incidence of re-edge stenosis after treatment were retrospectively noted and a comparison was made between the results of percutaneous transluminal angioplasty (PTA) and extension of the endograft. A total of 88 patients presented with 115 edge stenoses, of which the majority presented within 1 year after insertion of the endograft (mean time to edge stenosis 10.7 ± 8.2 months). Seventy-three stenoses (63%) manifested at the proximal and 42 at the distal edge (37%). The 1-year incidence of restenosis and/or occlusion was 45% after PTA and 43% after endograft extension, with 1-year patency rates of 81% and 92%, respectively. The incidence of restenosis/occlusion after treatment with PTA was 12% higher at two years compared to extension of the endograft (55% vs. 43%, respectively). Edge stenosis may well be treated with either PTA or extension of the endograft. The incidence of restenosis and/or occlusion after both PTA and extension is high, but patency rates are acceptable. Aggressive surveillance is needed during the first year after insertion. © 2015 Wiley Periodicals, Inc.

  19. CryoPlasty therapy of the superficial femoral and popliteal arteries: a single center experience.

    PubMed

    Samson, Russell H; Showalter, David P; Lepore, Michael R; Ames, Scott

    Long-term patency remains a significant hurdle in the minimally invasive treatment of arteriosclerosis in the superficial femoral and popliteal arteries. New technologies designed to address the sources of restenosis have recently been introduced. CryoPlasty therapy (Boston Scientific, Natick, Mass) is a new approach designed to significantly reduce injury, elastic recoil, stent implantation, neointimal hyperplasia, and constrictive remodeling. The technique combines the dilatation forces of percutaneous transluminal angioplasty with cold thermal energy applied to the plaque and vessel wall. The cumulative effect of limiting the sources of restenosis with CryoPlasty therapy was shown to demonstrate longer term patency in a prospective, multicenter, Investigational Device Exemption study of the PolarCath Peripheral Dilatation System. The CryoPlasty therapy experience of 1 center is reported, in which 47 lesions in 32 consecutive patients (34 procedures, 33 limbs) were treated. The technical success rate was 96%. There were no type 3 flow-limiting dissections, and only 4 (8.5%) lesions were stented. There were no unanticipated adverse events, specifically no thrombus, acute occlusions, distal embolizations, aneurysms, or groin complications. With an average follow-up of 12 months, only 5 lesions have recurred, 4 requiring re-intervention. The 12-month freedom from restenosis for lesions and limbs treated was 82.2% and 84.4%, respectively. These results are similar to the findings of the Investigational Device Exemption study and are encouraging. CryoPlasty therapy appears to be a viable endovascular therapeutic option to achieve longer term patency without compromising options for future interventions. The lack of early occlusions may be due to a low rate of spiral dissection that may be a particular benefit of this form of angioplasty.

  20. Sufficient penetration of peracetic acid into drilled human femoral heads.

    PubMed

    Brosig, H; Jacker, H-J; Borchert, H-H; Kalus, U; Dörner, T; von Versen, R; Pruss, A

    2005-01-01

    Chemical sterilisation methods for musculoskeletal transplants have the problem of penetration into all tissue strata. The present study examined if a peracetic acid/ethanol solution penetrated to a sufficient extent into specifically prepared femoral heads. To this effect, 10 femoral heads have been provided with drillings (diameter 2 mm, depth 10 mm) at a distance of 15 mm (series B) and placed in a diffusion chamber with sterilisation solution. From an additional central drilling at the femoral neck junction, the sample drawing was made after 30 min each over a period of 4 h for the iodometric determination of peracetic acid (PAA) concentration. Ten femoral heads, which did contain only the central drilling, served as controls (series A). In 9 of the examined femoral heads of series A the defined minimum concentration of PAA of 0.2% (inactivation of bacteria, spores, fungi) has been clearly exceeded over the complete period of measurement. About 0.8% PAA (inactivation of viruses) was achieved within 4 h only with six femoral heads. Nine out of the 10 examined femoral heads in series B show a clearly improved penetration behaviour which was expressed in smaller standard deviations, a faster increase in concentration, as well as in higher starting and final concentrations (approx. 0.9%) of PAA. Previous drying in air leads to a faster penetration into the centre of the bone. Standardised drilling of de-cartilaged femoral heads creates favourable conditions for the penetration of the PAA sterilisation solution into the whole tissue and guarantees a sufficient inactivation of microorganisms.

  1. Identification by ultrasound evaluation of the carotid and femoral arteries of high-risk subjects missed by three validated cardiovascular disease risk algorithms.

    PubMed

    Postley, John E; Luo, Yanting; Wong, Nathan D; Gardin, Julius M

    2015-11-15

    Atherosclerotic cardiovascular disease (ASCVD) events are the leading cause of death in the United States and globally. Traditional global risk algorithms may miss 50% of patients who experience ASCVD events. Noninvasive ultrasound evaluation of the carotid and femoral arteries can identify subjects at high risk for ASCVD events. We examined the ability of different global risk algorithms to identify subjects with femoral and/or carotid plaques found by ultrasound. The study population consisted of 1,464 asymptomatic adults (39.8% women) aged 23 to 87 years without previous evidence of ASCVD who had ultrasound evaluation of the carotid and femoral arteries. Three ASCVD risk algorithms (10-year Framingham Risk Score [FRS], 30-year FRS, and lifetime risk) were compared for the 939 subjects who met the algorithm age criteria. The frequency of femoral plaque as the only plaque was 18.3% in the total group and 14.8% in the risk algorithm groups (n = 939) without a significant difference between genders in frequency of femoral plaque as the only plaque. Those identified as high risk by the lifetime risk algorithm included the most men and women who had plaques either femoral or carotid (59% and 55%) but had lower specificity because the proportion of subjects who actually had plaques in the high-risk group was lower (50% and 35%) than in those at high risk defined by the FRS algorithms. In conclusion, ultrasound evaluation of the carotid and femoral arteries can identify subjects at risk of ASCVD events missed by traditional risk-predicting algorithms. The large proportion of subjects with femoral plaque only supports the use of including both femoral and carotid arteries in ultrasound evaluation. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Pseudoaneurysm of a branch of the femoral circumflex artery as a complication of revision arthroscopic release of the iliopsoas tendon

    PubMed Central

    Nakano, Naoki; Lisenda, Laughter; Khanduja, Vikas

    2017-01-01

    Treatment of painful internal snapping hip via arthroscopic release of the iliopsoas tendon is becoming the preferred option over open techniques because of the benefits of minimal dissection and fewer complications. However, complications do occur with arthroscopic techniques as well. We present the case of a 33-year-old woman who presented with painful internal snapping of her right hip and underwent arthroscopic release of the iliopsoas tendon. Following the procedure she continued to complain of pain in her groin and was therefore investigated further with a magnetic resonance imaging (MRI) which revealed a swelling near the femoral circumflex vessels. A computed tomography (CT) angiogram revealed a 15 mm pseudoaneurysm of the femoral circumflex artery, which was successfully treated by selective catheterisation and embolisation. Hip arthroscopists should be sufficiently familiar with the vascular anatomy around the hip and keep this complication in mind when releasing the iliopsoas tendon arthroscopically especially in revision cases with adhesions. PMID:28322718

  3. Effect of Atherosclerosis on the Lateral Circumflex Femoral Artery and Its Descending Branch: Comparative Study to Nonatherosclerotic Risk

    PubMed Central

    Nanasilp, Tirapat; Kunaphensaeng, Paiboon; Ruamthanthong, Anuchit

    2016-01-01

    Background: The anterolateral thigh (ALT) flap has been widely used for reconstructions. Nevertheless, the atherosclerotic risk factors that affect the lateral circumflex femoral artery (LCFA) are still inconclusive. The aim was to study the effect of atherosclerosis on the LCFA and descending branch (dLCFA) visualized by computer tomographic angiography (CTA) between nonatherosclerosis and atherosclerosis. Methods: Retrospective studies of CTA of lower extremity were reviewed. The patients were divided into 2 groups: nonatherosclerotic and atherosclerotic risk factors. The angiographic study of LCFA and dLCFA was analyzed, and atherosclerotic and nonatherosclerotic risk factors were compared. Results: Ninety-seven patients with 194 lower extremities were enrolled. Atherosclerotic risks comprised 76 patients. A total of 14, 16, and 46 patients had 1, 2, and 3 risk factors, respectively. Musculocutaneous perforator was 79.38%. The LCFA originated from deep femoral, common femoral, and superficial femoral artery was 97.42%, 2.06%, and 0.52%, respectively. The dLCFA was classified into 5 types depending on its origin. Diameters of LCFA in nonatherosclerotic and atherosclerotic patients were 4.03 ± 0.71 and 4.07 ± 0.97 mm, respectively. No statistical significance was found between both groups in diameters of LCFA. Diameters of dLCFA in nonatherosclerotic patients were 2.28 ± 0.28 mm and in atherosclerotic patients were 2.11 ± 0.28 mm. Statistical significance of diameters of dLCFA was found in patients having 3 risk factors and smoker groups (p < 0.05). Conclusions: LCFA is not atherosclerosis resistant. Stenosis of the LCFA and dLCFA occurred in varying degrees in atherosclerosis-risk patients. Preoperative CTA should be considered to evaluate the patency in multiple risk factors patients. PMID:27757321

  4. Long-term outcome of femoral above-knee popliteal artery bypass using autologous saphenous vein versus expanded polytetrafluoroethylene grafts.

    PubMed

    Sala, Florent; Hassen-Khodja, Reda; Lecis, Alexandre; Bouillanne, Pierre-Jean; Declemy, Serge; Batt, Michel

    2003-07-01

    Despite a recent flurry of publications on preferred techniques for femoral above-knee popliteal artery bypass, controversy persists over the use of autologous saphenous vein and expanded polytetrafluoroethylene (ePTFE) grafts. The purpose of this study was to compare our long-term results using these two bypass materials. In a series of 474 infrainguinal bypasses performed between January 1993 and December 1998, we performed a total of 75 femoral above-knee popliteal artery bypass using an autologous saphenous vein graft in 48 cases (64%) and an ePTFE graft in 27 cases (36%). Prosthetic grafts were used by choice in 17 cases and by necessity due to the absence of useable vein in 10 cases. There were 55 men and 18 women with a mean age of 70 years. The indication for bypass was lower extremity arterial occlusive disease at stage II in 17 cases (22.7%), stage III in 9 cases (12%), and stage IV in 36 cases (48%); subacute ischemia in 8 cases (10.7%); and femoropopliteal aneurysm in 5 cases (6.7%). Preoperative arteriography demonstrated three patent leg arteries in 15.5% of cases, two patent leg arteries in 43.5%, and one patent leg artery in 41%. There was no significance difference between the vein graft and ePTFE graft groups with regard to indications and arteriographic findings. No patient died during the immediate postoperative period. The mean duration of follow-up was 25.5 months (range, 3 to 108 months). The primary patency rate at 4 years was 82.2 +/- 8% for venous bypass vs. 80.6 +/- 11.8% for ePTFE bypass (p = 0.42). The secondary patency rate at 4 years was 84.7 +/- 7.4% for vein bypasses and 79.5 +/- 12% for ePTFE bypasses (p = 0.26). In our experience, there was no statistically significant difference in long-term outcome of femoral above-knee popliteal artery bypass using autologous vein grafts or prosthetic ePTFE grafts.

  5. Association of Serum HMGB2 Levels With In-Stent Restenosis: HMGB2 Promotes Neointimal Hyperplasia in Mice With Femoral Artery Injury and Proliferation and Migration of VSMCs.

    PubMed

    He, Yu Hu; Wang, Xiao Qun; Zhang, Jian; Liu, Zhu Hui; Pan, Wen Qi; Shen, Ying; Zhu, Zheng Bin; Wang, Ling Jie; Yan, Xiao Xiang; Yang, Ke; Zhang, Rui Yan; Shen, Wei Feng; Ding, Feng Hua; Lu, Lin

    2017-04-01

    In a previous study, we established diabetic and nondiabetic minipig models with coronary artery in-stent restenosis (ISR). Mass spectrometry showed that high-mobility group box (HMGB) 2 level was higher in ISR than in non-ISR tissue from diabetic minipigs. We here investigated whether serum HMGB2 levels were related to ISR in coronary artery disease patients. The effect of HMGB2 was evaluated in mice with femoral artery wire injury and in human aortic smooth muscle cells. From 2513 patients undergoing coronary artery intervention and follow-up angiography at ≈1 year, 262 patients were diagnosed with ISR, and 298 patients with no ISR were randomly included as controls. Serum HMGB2 levels were significantly higher in patients with ISR than in those without ISR and were associated with ISR severity. Multivariable logistic regression analysis showed that HMGB2 level was independently associated with ISR. In experiments, HMGB2 expression was increased in vascular tissue after injury. Perivascular HMGB2 administration promoted injury-induced neointimal hyperplasia in C57Bl/6 mice compared with in the control, whereas such pathophysiological features were attenuated in Hmgb2(-/-) mice. Mechanistically, HMGB2 enhanced neointimal hyperplasia in mice and proliferation and migration in human aortic smooth muscle cells by inducing reactive oxygen species through increased p47phox phosphorylation. Knocking down p47phox, however, inhibited HMGB2-induced effects in human aortic smooth muscle cells. Finally, HMGB2-induced effects were significantly declined in receptor of advanced glycation end products knockdown or deficient cells, but not in Toll-like receptor 4 knockdown or deficient cells. Serum HMGB2 levels were associated with ISR in patients. HMGB2 promoted neointimal hyperplasia in mice with arterial wire injury through reactive oxygen species activation. © 2017 American Heart Association, Inc.

  6. TRPA1 mediates amplified sympathetic responsiveness to activation of metabolically sensitive muscle afferents in rats with femoral artery occlusion

    PubMed Central

    Xing, Jihong; Lu, Jian; Li, Jianhua

    2015-01-01

    Autonomic responses to activation of mechanically and metabolically sensitive muscle afferent nerves during static contraction are augmented in rats with femoral artery occlusion. Moreover, metabolically sensitive transient receptor potential cation channel subfamily A, member 1 (TRPA1) has been reported to contribute to sympathetic nerve activity (SNA) and arterial blood pressure (BP) responses evoked by static muscle contraction. Thus, in the present study, we examined the mechanisms by which afferent nerves' TRPA1 plays a role in regulating amplified sympathetic responsiveness due to a restriction of blood flow directed to the hindlimb muscles. Our data show that 24–72 h of femoral artery occlusion (1) upregulates the protein levels of TRPA1 in dorsal root ganglion (DRG) tissues; (2) selectively increases expression of TRPA1 in DRG neurons supplying metabolically sensitive afferent nerves of C-fiber (group IV); and (3) enhances renal SNA and BP responses to AITC (a TRPA1 agonist) injected into the hindlimb muscles. In addition, our data demonstrate that blocking TRPA1 attenuates SNA and BP responses during muscle contraction to a greater degree in ligated rats than those responses in control rats. In contrast, blocking TRPA1 fails to attenuate SNA and BP responses during passive tendon stretch in both groups. Overall, results of this study indicate that alternations in muscle afferent nerves' TRPA1 likely contribute to enhanced sympathetically mediated autonomic responses via the metabolic component of the muscle reflex under circumstances of chronic muscle ischemia. PMID:26441669

  7. The Inflammatory Response to Femoral Arterial Closure Devices: A Randomized Comparison Among FemoStop, AngioSeal, and Perclose

    SciTech Connect

    Jensen, Jens Saleh, Nawzad; Jensen, Ulf; Svane, Bertil; Joensson, Anders; Tornvall, Per

    2008-07-15

    The objectives of this study were to investigate whether the systemic inflammatory response differs, in patients undergoing coronary angiography, among the arterial closure devices FemoStop, AngioSeal, and Perclose. The study is a prospective and randomized study. We measured pre- and postprocedural C-reactive protein (CRP), fibrinogen, and interleukin-6 (IL-6) plasma levels and collected clinical and procedural data on 77 patients who underwent coronary angiography because of stable angina pectoris. Patients were randomized to the following device: FemoStop (mechanical compression), AngioSeal (anchor and collagen sponge), or Perclose (nonabsorbable suture). No patient group experienced an increased incidence of vascular complications. There were no differences among the three groups regarding CRP, fibrinogen, or IL-6 values before or after coronary angiography. IL-6 levels increased 6 h after the procedure in all groups (p < 0.01), however, the increase did not differ among the groups. After 30 days there were no increased values of CRP or fibrinogen. We conclude that the femoral arterial closure devices AngioSeal and Perclose do not enhance an inflammatory response after a diagnostic coronary angiography, measured by CRP, fibrinogen, and IL-6, compared to femoral arterial closure using a mechanical compression device.

  8. TRPA1 mediates amplified sympathetic responsiveness to activation of metabolically sensitive muscle afferents in rats with femoral artery occlusion.

    PubMed

    Xing, Jihong; Lu, Jian; Li, Jianhua

    2015-01-01

    Autonomic responses to activation of mechanically and metabolically sensitive muscle afferent nerves during static contraction are augmented in rats with femoral artery occlusion. Moreover, metabolically sensitive transient receptor potential cation channel subfamily A, member 1 (TRPA1) has been reported to contribute to sympathetic nerve activity (SNA) and arterial blood pressure (BP) responses evoked by static muscle contraction. Thus, in the present study, we examined the mechanisms by which afferent nerves' TRPA1 plays a role in regulating amplified sympathetic responsiveness due to a restriction of blood flow directed to the hindlimb muscles. Our data show that 24-72 h of femoral artery occlusion (1) upregulates the protein levels of TRPA1 in dorsal root ganglion (DRG) tissues; (2) selectively increases expression of TRPA1 in DRG neurons supplying metabolically sensitive afferent nerves of C-fiber (group IV); and (3) enhances renal SNA and BP responses to AITC (a TRPA1 agonist) injected into the hindlimb muscles. In addition, our data demonstrate that blocking TRPA1 attenuates SNA and BP responses during muscle contraction to a greater degree in ligated rats than those responses in control rats. In contrast, blocking TRPA1 fails to attenuate SNA and BP responses during passive tendon stretch in both groups. Overall, results of this study indicate that alternations in muscle afferent nerves' TRPA1 likely contribute to enhanced sympathetically mediated autonomic responses via the metabolic component of the muscle reflex under circumstances of chronic muscle ischemia.

  9. Brain GLP-1 Signaling Regulates Femoral Artery Blood Flow and Insulin Sensitivity Through Hypothalamic PKC-δ

    PubMed Central

    Cabou, Cendrine; Vachoux, Christelle; Campistron, Gérard; Drucker, Daniel J.; Burcelin, Rémy

    2011-01-01

    OBJECTIVE Glucagon-like peptide 1 (GLP-1) is a gut-brain hormone that regulates food intake, energy metabolism, and cardiovascular functions. In the brain, through a currently unknown molecular mechanism, it simultaneously reduces femoral artery blood flow and muscle glucose uptake. By analogy to pancreatic β-cells where GLP-1 activates protein kinase C (PKC) to stimulate insulin secretion, we postulated that PKC enzymes would be molecular targets of brain GLP-1 signaling that regulate metabolic and vascular function. RESEARCH DESIGN AND METHODS We used both genetic and pharmacological approaches to investigate the role of PKC isoforms in brain GLP-1 signaling in the conscious, free-moving mouse simultaneous with metabolic and vascular measurements. RESULTS In normal wild-type (WT) mouse brain, the GLP-1 receptor (GLP-1R) agonist exendin-4 selectively promotes translocation of PKC-δ (but not -βII, -α, or -ε) to the plasma membrane. This translocation is blocked in Glp1r−/− mice and in WT mice infused in the brain with exendin-9, an antagonist of the GLP-1R. This mechanism coordinates both blood flow in the femoral artery and whole-body insulin sensitivity. Consequently, in hyperglycemic, high-fat diet–fed diabetic mice, hypothalamic PKC-δ activity was increased and its pharmacological inhibition improved both insulin-sensitive metabolic and vascular phenotypes. CONCLUSIONS Our studies show that brain GLP-1 signaling activates hypothalamic glucose-dependent PKC-δ to regulate femoral artery blood flow and insulin sensitivity. This mechanism is attenuated during the development of experimental hyperglycemia and may contribute to the pathophysiology of type 2 diabetes. PMID:21810595

  10. Ischemic-reperfusion of unilateral external iliac artery in rat: A new model for vasculitic femoral neuropathy.

    PubMed

    Muthuraman, Arunachalam; Ramesh, Muthusamy

    2016-08-15

    Clinically, ischemic environment during gynecological surgery at lithotomy position is most common causative factor for the development of vasculitic femoral neuropathy (VFN). The present study was designed to induce the clinically relevant rat model of VFN by ischemic-reperfusion (I/R) injury of unilateral external iliac artery (uEIA). The VFN was induced by 3, 4 and 5h occlusion of uEIA followed by reperfusion. The I/R of uEIA induced VFN was evaluated by (i) behavioral parameters i.e., hind limb temperature; weight bearing capacity; (ii) kinematic analysis i.e., paw posture, splay angle, static sciatic index (SSI), and ankle-angle tests; (iii) evaluation of pain perception i.e., plantar and pin prick; (iv) serum biochemical estimation i.e., nitrate, lipid peroxidation, TNF-α and calcium level; (v) evaluation of motor and sensory nerve conduction velocity; and (vi) measurement of nerve fiber density. The 4 and 5h occlusion of uEIA has produced the potential changes in behavioral, functional, electrophysiological, biochemical and histopathological assessment. The 5h occlusion of uEIA has shown to produce the mortality. Whereas, 3h occlusion does not produce the significant changes in the development of VFN. The 4h ischemic occlusion of uEIA has shown potential rat model of VFN due to its close mimicking capacity of VFN in human. Therefore, it can be useful to explore the newer anti-neuralgic medicine and with their pharmacodynamic action in the field of various neurovascular disorders. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Successful carbon dioxide angiography guided endovascular thrombectomy of the superficial femoral artery in a young patient with critical limb ischemia.

    PubMed

    Giusca, Sorin; Eisele, Tom; Raupp, Dorothea; Eisenbach, Christoph; Korosoglou, Grigorios

    2017-03-01

    Currently, the treatment of thromboembolic ischemia of the lower extremities includes percutaneous rotational thrombectomy and aspiration devices. However, the standard approach for endovascular treatment requires the administration of iodine contrast agents, which is problematic in patients with pre-existing renal disease and diabetes. Herein, we describe a case of a CO2 angiography guided endovascular thrombectomy of the superficial femoral artery (SFA) in a young patient with critical limb ischemia. Mechanical thrombectomy using the Rotarex system, catheter aided aspiration and subsequent stent placement in the SFA was entirely guided using CO2 angiography.

  12. Femoral curvature in Neanderthals and modern humans: a 3D geometric morphometric analysis.

    PubMed

    De Groote, Isabelle

    2011-05-01

    Since their discovery, Neanderthals have been described as having a marked degree of anteroposterior curvature of the femoral shaft. Although initially believed to be pathological, subsequent discoveries of Neanderthal remains lead femoral curvature to be considered as a derived Neanderthal feature. A recent study on Neanderthals and middle and early Upper Palaeolithic modern humans found no differences in femoral curvature, but did not consider size-corrected curvature. Therefore, the objectives of this study were to use 3D morphometric landmark and semi-landmark analysis to quantify relative femoral curvature in Neanderthals, Upper Palaeolithic and recent modern humans, and to compare adult bone curvature as part of the overall femoral morphology among these populations. Comparisons among populations were made using geometric morphometrics (3D landmarks) and standard multivariate methods. Comparative material involved all available complete femora from Neanderthal and Upper Palaeolithic modern human, archaeological (Mesolithic, Neolithic, Medieval) and recent human populations representing a wide geographical and lifestyle range. There are significant differences in the anatomy of the femur between Neanderthals and modern humans. Neanderthals have more curved femora than modern humans. Early modern humans are most similar to recent modern humans in their anatomy. Femoral curvature is a good indicator of activity level and habitual loading of the lower limb, indicating higher activity levels in Neanderthals than modern humans. These differences contradict robusticity studies and the archaeological record, and would suggest that femoral morphology, and curvature in particular, in Neanderthals may not be explained by adult behavior alone and could be the result of genetic drift, natural selection or differences in behavior during ontogeny.

  13. Final Results of the Protected Superficial Femoral Artery Trial Using the FilterWire EZ System

    SciTech Connect

    Mueller-Huelsbeck, Stefan; Paulsen, Friedrich; Heller, Martin; Jahnke, Thomas

    2010-12-15

    The purpose of this study was to evaluate the safety and efficacy of debris-capture for distal protection using the FilterWire EZ Embolic Protection System (Boston Scientific, Mountain View, CA) with the additional aim to further define the incidence of distal embolization during superficial femoral artery (SFA) interventions. A prospective, single-centre registry was designed to evaluate the performance of the FilterWire EZ in capturing debris during standard SFA percutaneous intervention. The PRO-RATA study included 30 patients suitable for PTA (Fontaine IIb to III or Rutherford I to II classification). The primary end points were occurrence of distal embolization or decreased runoff, improvement in ankle-brachial index ankle-brachial index (ABI) after the procedure, and number of filters containing emboli. Secondary end points included major adverse events (i.e., procedure- or device-related death and/or clinical target lesion revascularisation), device delivery, deployment success, and incidence of embolic recovery (patients with device success exhibiting embolic protection in the filter). Procedural success was determined as {<=}30% residual stenosis with no worsening of distal runoff as determined on angiography. A total of 29 patients (age 66.2 {+-} 12 years; total no. of limbs = 30; total no. of lesions = 30) suitable for PTA were enrolled in the study between February 2007 and March 2008. There were 26 patients with claudication (Fontaine IIB) and 3 patients with stage IV peripheral vascular disease. In one patient, lesions in both legs were treated. No procedural or device-related complications occured. The average degree of stenosis was 86 {+-} 7%. Stenosis length ranged from 8 to 88 mm. The average degree of residual stenosis was 10 {+-} 10%. ABI improved from 0.56 {+-} 0.16 to 0.92 {+-} 0.19 (P < 0.05). No restenosis or dissection was seen at 1-month ultrasound follow-up. Macroscopic debris was found in 27 of 30 filters of all distal protection devices

  14. An efficient approach to study the pulsatile blood flow in femoral and coronary arteries by Differential Quadrature Method

    NASA Astrophysics Data System (ADS)

    Ghasemi, Seiyed E.; Hatami, M.; Hatami, J.; Sahebi, S. A. R.; Ganji, D. D.

    2016-02-01

    In this paper, flow analysis for a non-Newtonian third grade blood in coronary and femoral arteries is simulated numerically. Blood is considered as the third grade non-Newtonian fluid under periodic body acceleration motion and pulsatile pressure gradient. Differential Quadrature Method (DQM) and Crank Nicholson Method (CNM) are used to solve the Partial Differential Equation (PDE) governing equation by which a good agreement between them was observed in the results. The influences of some physical parameters such as amplitude, lead angle and body acceleration frequency on non-dimensional velocity and profiles are considered. For instance, the results show that increasing the amplitude, Ag, and reducing the lead angle of body acceleration, ϕ, make higher velocity profiles in the center line of both arteries.

  15. Late presenting, contained rupture of the superficial femoral artery following atherectomy and stenting: case report and literature review.

    PubMed

    Clegg, Stacey; Aghel, Arash; Rogers, R Kevin

    2014-08-01

    Excisional atherectomy alone or followed by stenting is considered an appropriate treatment strategy for patients with lifestyle-limiting claudication due to obstructive infra-inguinal peripheral arterial disease (Ramaiah et al., J Endovasc Ther 2006;13:592-6021). We present a case of a 69-year-old man with eccentric severely calcified disease of the superficial femoral artery (SFA) treated with excisional atherectomy followed by stenting with an interwoven nitinol stent. The procedure was complicated by extravascular stent migration associated with a contained rupture presenting 30 days after the intervention. The complication was successfully treated with a stent graft. Although rare, pseudoaneurysms have been reported at the site of prior atherectomy; however, this case is the first description of a contained rupture post atherectomy associated with erosion of a nitinol stent into an extra-luminal position. The mechanism and management of this complication are discussed. © 2014 Wiley Periodicals, Inc.

  16. Acid-sensing ion channel subtype 3 function and immunolabelling increases in skeletal muscle sensory neurons following femoral artery occlusion.

    PubMed

    Xing, Jihong; Lu, Jian; Li, Jianhua

    2012-03-01

    Sympathetic nerve activity and arterial blood pressure responses to static hindlimb muscle contractions are greater in rats with femoral arteries that were previously ligated (24-72 h earlier) than in control rats. Studies further demonstrate that acid-sensing ion channel subtype 3 (ASIC(3)) in thin-fibre muscle afferents contributes to the amplified reflex muscle responses observed in occluded rats, probably due to enhanced ASIC(3) expression in muscle sensory neurons. The purpose of this study was to characterize acid-induced current with activation of ASIC(3) in dorsal root ganglion (DRG) neurons of control rats and rats with 24 h of femoral occlusion using whole-cell patch clamp methods. Also, immunohistochemistry was employed to examine existence of ASIC(3) expression in DRG neurons of thin-fibre afferents. DRG neurons from 4- to 6-week-old rats were labelled by injecting the fluorescence tracer DiI into the hindlimb muscles 4-5 days prior to the recording experiments. The results of this study show that ∼90% of current responses evoked by pH 6.7 in DRG neurons innervating the hindlimb muscles are ASIC(3)-like. The peak current amplitude to pH 6.7 is significantly attenuated with application of rAPETx2, a specific ASIC(3) antagonist. In addition, ASIC(3)-like current responses to pH 6.7 are observed in small, medium and large DRG neurons, and size distribution of DRG neurons is similar in control and occluded animals. However, the peak current amplitude of DRG neuron response induced by ASIC(3) stimulation is larger in occluded rats than that in control rats. Moreover, the percentage of DRG neurons with ASIC(3)-like currents is greater after arterial occlusion compared with control. Furthermore, results from double immunofluorescence experiments show that femoral artery occlusion mainly augments ASIC(3) expression within DRG neurons projecting C-fibre afferents. Taken together, these data suggest that (1) the majority of current responses to pH 6.7 are ASIC

  17. Full metal jacket stenting of the superficial femoral artery: a retrospective review.

    PubMed

    Shah, Parth S; Hingorani, Anil; Ascher, Enrico; Shiferson, Alexander; Gopal, Kapil; Jung, Daniel; Marks, Natalie; Jacob, Theresa

    2011-01-01

    The technique of long segment stenting of the superficial femoral artery (SFA) has been associated with poorer short- and long-term results. The full metal jacket (FMJ) stenting is typically described as long segment continuous stenting of a vessel segment. Initially, this technique was described in percutaneous coronary interventions. However, until recently, FMJ of the SFA has not been studied. We examined our experience with FMJ of the SFA to evaluate the outcomes and the safety of this technique. Retrospective data were gathered for peripheral angioplasties and stenting for the period between January 2005 and December 2008. The cases involving FMJ stenting of the SFA were identified by angiographic findings and the operative dictations providing the stent data. Selective FMJ stenting of the SFA was performed for the residual stenosis after balloon angioplasty of the SFA because of either dissection or significant recoil. The cases with concomitant iliac artery angioplasty and/or stenting were excluded from the data set for analysis. The variables for the evaluation were primary patency rate, mortality rate, and limb salvage rate, which were stratified on the basis of the risk factors. A total of 63 cases involving FMJ stenting of the SFA were identified from the database of 707 patients who had peripheral endovascular interventions between January 2005 and December 2008. Average age of the patients was 70 years (range: 52-104 years, SD: 10.1 years). There were no transatlantic inter-society consensus (TASC) A lesions, 11% (7/63) of the lesions were TASC B, 68% (43/63) were TASC C, and 21% (13/63) were TASC D. The median primary patency rate was 9 months (95% CI: 5.06-12.94). The mortality rate was 4% at 6-month follow-up. The limb salvage rate was 85.7%. In all, 65% (41/63) of the patients were claudicants, whereas 23% (15/63) had intervention for some form of tissue loss (ischemic ulcer, gangrene). Associated infrapopliteal intervention was performed in 15

  18. Drug-Coated Balloon Versus Standard Percutaneous Transluminal Angioplasty for the Treatment of Superficial Femoral and Popliteal Peripheral Artery Disease

    PubMed Central

    Tepe, Gunnar; Schneider, Peter; Brodmann, Marianne; Krishnan, Prakash; Micari, Antonio; Metzger, Christopher; Scheinert, Dierk; Zeller, Thomas; Cohen, David J.; Snead, David B.; Alexander, Beaux; Landini, Mario; Jaff, Michael R.

    2015-01-01

    Background— Drug-coated balloons (DCBs) have shown promise in improving the outcomes for patients with peripheral artery disease. We compared a paclitaxel-coated balloon with percutaneous transluminal angioplasty (PTA) for the treatment of symptomatic superficial femoral and popliteal artery disease. Methods and Results— The IN.PACT SFA Trial is a prospective, multicenter, single-blinded, randomized trial in which 331 patients with intermittent claudication or ischemic rest pain attributable to superficial femoral and popliteal peripheral artery disease were randomly assigned in a 2:1 ratio to treatment with DCB or PTA. The primary efficacy end point was primary patency, defined as freedom from restenosis or clinically driven target lesion revascularization at 12 months. Baseline characteristics were similar between the 2 groups. Mean lesion length and the percentage of total occlusions for the DCB and PTA arms were 8.94±4.89 and 8.81±5.12 cm (P=0.82) and 25.8% and 19.5% (P=0.22), respectively. DCB resulted in higher primary patency versus PTA (82.2% versus 52.4%; P<0.001). The rate of clinically driven target lesion revascularization was 2.4% in the DCB arm in comparison with 20.6% in the PTA arm (P<0.001). There was a low rate of vessel thrombosis in both arms (1.4% after DCB and 3.7% after PTA [P=0.10]). There were no device- or procedure-related deaths and no major amputations. Conclusions— In this prospective, multicenter, randomized trial, DCB was superior to PTA and had a favorable safety profile for the treatment of patients with symptomatic femoropopliteal peripheral artery disease. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique Identifiers: NCT01175850 and NCT01566461. PMID:25472980

  19. Hypotension in the chronically hypoxic chicken embryo is related to the β-adrenergic response of chorioallantoic and femoral arteries and not to bradycardia.

    PubMed

    Lindgren, Isa; Crossley, Dane; Villamor, Eduardo; Altimiras, Jordi

    2011-10-01

    Prolonged fetal hypoxia leads to growth restriction and can cause detrimental prenatal and postnatal alterations. The embryonic chicken is a valuable model to study the effects of prenatal hypoxia, but little is known about its long-term effects on cardiovascular regulation. We hypothesized that chicken embryos incubated under chronic hypoxia would be hypotensive due to bradycardia and βAR-mediated relaxation of the systemic and/or the chorioallantoic (CA) arteries. We investigated heart rate, blood pressure, and plasma catecholamine levels in 19-day chicken embryos (total incubation 21 days) incubated from day 0 in normoxia or hypoxia (14-15% O(2)). Additionally, we studied α-adrenoceptor (αAR)-mediated contraction, relaxation to the β-adrenoceptor (βAR) agonist isoproterenol, and relaxation to the adenylate cyclase activator forskolin in systemic (femoral) and CA arteries (by wire myography). Arterial pressure showed a trend toward hypotension in embryos incubated under chronic hypoxic conditions compared with the controls (mean arterial pressure 3.19 ± 0.18 vs. 2.59 ± 0.13 kPa, normoxia vs. hypoxia, respectively. P = 0.056), without an accompanied bradycardia and elevation in plasma norepinephrine and lactate levels. All vessels relaxed in response to βAR stimulation with isoproterenol, but the CA arteries completely lacked an αAR response. Furthermore, hypoxia increased the sensitivity of femoral arteries (but not CA arteries) to isoproterenol. Hypoxia also increased the responsiveness of femoral arteries to forskolin. In conclusion, we suggest that hypotension in chronic hypoxic chicken embryos is the consequence of elevated levels of circulating catecholamines acting in vascular beds with exclusive (CA arteries) or exacerbated (femoral arteries) βAR-mediated relaxation, and not a consequence of bradycardia.

  20. Spontaneous Rupture of Superficial Femoral Artery Repaired with Endovascular Stent-Grafting with use of Rendez-Vous Technique, Followed by Delayed Infection

    SciTech Connect

    Fanelli, Fabrizio Cannavale, Alessandro; Gazzetti, Marianna; Fantozzi, Cristiano; Taurino, Maurizio; Speziale, Francesco

    2013-02-15

    This is the case of a 72-year-old man with lower limb ischemia due to spontaneous rupture of nonaneurysmal superficial femoral artery that developed into thigh hematoma. After failure of a Fogarty revascularization, an emergency endovascular procedure was performed to restore the arterial continuity. A rendezvous procedure was performed with a double femoral and popliteal approach and two covered stent-grafts were deployed. Patient's clinical conditions immediately improved, but 4 months later the stent-grafts were surgically removed for infection and exteriorization. A femoropopliteal bypass was performed. After 1 year follow-up, the patient is in good clinical condition.

  1. Endovascular Treatment of In-Stent Occlusion: New Technique for Recanalization of Long Superficial Femoral Artery Occlusion (Direct Stent Puncture Technique)

    SciTech Connect

    Palena, Luis Mariano Cester, Giacomo; Manzi, Marco

    2012-04-15

    In-stent reocclusion is a frequent complication of endovascular treatment and stenting, especially in the superficial femoral artery. Neointimal hyperplasia is the main cause of this problem, but in many cases, it occurs as a result of the presence of stent strut fractures. The two treatment options are endovascular and surgical intervention. The effectiveness of endovascular interventions in patients with critical limb ischemia has been well established, but in some cases, crossing the occluded stent is difficult. We describe a new technique to recanalize long in-stent superficial femoral artery occlusions characterized by direct stent puncture, followed by retrograde-antegrade recanalization after antegrade failures.

  2. Endovascular treatment of in-stent occlusion: new technique for recanalization of long superficial femoral artery occlusion (direct stent puncture technique).

    PubMed

    Palena, Luis Mariano; Cester, Giacomo; Manzi, Marco

    2012-04-01

    In-stent reocclusion is a frequent complication of endovascular treatment and stenting, especially in the superficial femoral artery. Neointimal hyperplasia is the main cause of this problem, but in many cases, it occurs as a result of the presence of stent strut fractures. The two treatment options are endovascular and surgical intervention. The effectiveness of endovascular interventions in patients with critical limb ischemia has been well established, but in some cases, crossing the occluded stent is difficult. We describe a new technique to recanalize long in-stent superficial femoral artery occlusions characterized by direct stent puncture, followed by retrograde-antegrade recanalization after antegrade failures.

  3. Ultrasound-guided femoral arterial access in pediatric cardiac catheterizations: A prospective evaluation of the prevalence, risk factors, and mechanism for acute loss of arterial pulse.

    PubMed

    Alexander, John; Yohannan, Thomas; Abutineh, Iman; Agrawal, Vijaykumar; Lloyd, Hannah; Zurakowski, David; Waller, B Rush; Sathanandam, Shyam

    2016-12-01

    The objectives of this study were to describe the prevalence, mechanisms, and identify risk factors for acute loss of arterial pulse (LOP) in children who had ultrasound-guided femoral arterial access (UGFAA) during cardiac catheterization. LOP is a known complication in children following femoral arterial (FA) access for cardiac catheterization. The prevalence of LOP requiring treatment ranges between 4% and 8%. A prospective study was performed including 486 cardiac catheterizations using UGFAA in children ≤18 years over a 3 years period. Ultrasound and Doppler evaluations were performed prior to and at the end of the procedure. LOP was identified in 33 cases (6.8%) with 23 (4.7%) requiring treatment. For children ≤6 months, the prevalence of LOP requiring treatment was 13.6%. FA diameter <3 mm was the only significant independent predictor for LOP (OR: 8.44, 95% CI: 2.07-34.5, P < 0.001). Smaller patient size, number of access attempts, time required for access, operator experience, sheath size, and length of procedure were not found to be significant predictors. Children with LOP had a greater percentage decrease in vessel diameter (median 62% vs 18%, P < 0.001) compared to those without LOP. FA thrombus was diagnosed only in 9 patients (27% of those with LOP). The prevalence of LOP requiring treatment is 4.7% when UGFAA is used during pediatric cardiac catheterizations. Arterial spasm was more common than thrombus as a cause of LOP. FA diameter <3 mm was the only independent predictor for LOP in this carefully designed prospective study. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  4. The effect of short-term and long-term femoral artery ligation on rat calf muscle oxygen tension, blood flow, metabolism and function.

    PubMed

    Angersbach, D; Jukna, J J; Nicholson, C D; Ochlich, P; Wilke, R

    1988-01-01

    The effect of short-term (1 day-1 week) and long-term (6-12 weeks) femoral artery ligation on the oxygen tension (pO2), blood flow, metabolism and function of rat gastrocnemius muscle has been examined. Femoral artery ligation reduced resting blood flow, pO2 and pH. Concomitantly, the concentration of high energy phosphates was reduced and the muscle lactate concentration increased. The fatigue developed by the gastrocnemius/plantaris muscle, during a 10 min period of isometric exercise, was increased and the associated hyperaemia was attenuated. The surgery, performed to ligate the artery, induced an increase in the plasma fibrinogen concentration and whole blood viscosity. As the time interval increased after the femoral artery ligation there was a progressive reduction of the magnitude of the effects. Ten weeks after ligation resting muscle concentrations of high energy phosphates and lactate, whole blood viscosity and muscle pH had normalized. However, resting muscle blood flow, pO2, ability to sustained isometric exercise and the exercise induced hyperaemia were still reduced compared to intact animals. Comparison with literature data reveals that the changes produced by chronic femoral artery ligation in rat calf muscle mimic those seen in man with intermittent claudication.

  5. Sympathetic ganglion transcutaneous electrical nerve stimulation after coronary artery bypass graft surgery improves femoral blood flow and exercise tolerance.

    PubMed

    Cipriano, Gerson; Neder, J Alberto; Umpierre, Daniel; Arena, Ross; Vieira, Paulo J C; Chiappa, Adriana M Güntzel; Ribeiro, Jorge P; Chiappa, Gaspar R

    2014-09-15

    We tested the hypothesis that transcutaneous electrical nerve stimulation (TENS) over the stellate ganglion region would reduce sympathetic overstimulation and improve femoral blood flow (FBF) after coronary artery bypass graft surgery. Thirty-eight patients (20 men, 24 New York Heart Association class III-IV) were randomized to 5-day postoperative TENS (n = 20; 4 times/day; 30 min/session) or sham TENS (n = 18) applied to the posterior cervical region (C7-T4). Sympathetic nervous system was stimulated by the cold pressor test, with FBF being measured by ultrasound Doppler. Femoral vascular conductance (FVC) was calculated as FBF/mean arterial pressure (MAP). Six-min walking distance established patients' functional capacity. Before and after the intervention periods, pain scores, opiate requirements, and circulating β-endorphin levels were determined. As expected, preoperative MAP increased and FBF and FVC decreased during the cold pressor test. Sham TENS had no significant effect on these variables (P > 0.05). In contrast, MAP decreased in the TENS group (125 ± 12 vs. 112 ± 10 mmHg). This finding, in association with a consistent increase in FBF (95 ± 5 vs. 145 ± 14 ml/min), led to significant improvements in FVC (P < 0.01). Moreover, 6-min walking distance improved only with TENS (postsurgery-presurgery = 35 ± 12 vs. 6 ± 10 m; P < 0.01). TENS was associated with lesser postoperative pain and opiate requirements but greater circulating β-endorphin levels (P < 0.05). In conclusion, stellate ganglion TENS after coronary artery bypass graft surgery positively impacted on limb blood flow during a sympathetic stimulation maneuver, a beneficial effect associated with improved clinical and functional outcomes.

  6. Morphometric and ultrastructural analysis of the effect of bromocriptine and cyclosporine on the vasospastic femoral artery of rats

    PubMed Central

    Tokmak, Mehmet; Başocak, Kahan; Canaz, Hüseyin; Canaz, Gökhan; İplikçioğlu, Celal

    2015-01-01

    Vasospasm is the main causes of mortality and morbidity in patiens with subarachnoid hemorrhage (SAH). The arterial narrowing mechanism that develops after SAH is not yet fully understood but many studies showed that hypotension, neurogenic reflexes, clots in the subarachnoidal space, spasmogenic agents, humoral and celluler immunity play a role in the etiology. In this study we investigate the effects of Bromocriptine and Cyclosporine A in vasospasm secondary to SAH on rat femoral artery from ultrastructural and morphometric perspectives. 120 male Sprague-Dawley rats divided into 12 groups: Vasospasm (V), control (K), surgical control (CK) groups, vasospasm+Bromocriptine and/or Cyclosporine-A groups (VCyA, VBr, VBr+CyA), Bromocriptine and/or Cyclosporine-A control groups (CK, BK, Br+CyAK), Bromocriptine and/or Cyclosporine-A surgical control groups (BCK, CyCK, Br+CyACK). In order to create SAH model, 0, 1 cm3 blood injected into silastic sheath wrapped rat femoral artery. Bromocriptine (2 mg/kg/d) and Cyclosporine A (10 mg/kg/d) combinations applied to control, surgical control and vasospastic models. Light microscopy, transmission electron microscopy and scanning electron microscopy used during this study. Statistical evaluation of the morphometric measurement data concerning vascular wall thickness and luminal cross-sectional areas of all groups were performed using Mann-Whitney U, Wilcoxon-signed rank, and Student-t tests. Cyclosporine A, whose effects in the prevention of vasospasm have been demonstrated in previous studies. In this study we discovered that Bromocriptine demonstrated strong effects similar to Cyclosporine-A. Bromocriptine and Cyclosporine A markedly prevent the development of chronic morphologic vasospasm following SAH. The combined use of both drugs does not change this preventive effect. PMID:26770311

  7. Cost-effectiveness analysis of drug-coated therapies in the superficial femoral artery.

    PubMed

    Sridharan, Natalie D; Boitet, Aureline; Smith, Kenneth; Noorbakhsh, Kathy; Avgerinos, Efthymios; Eslami, Mohammad H; Makaroun, Michel; Chaer, Rabih

    2017-09-25

    Drug-coated balloons (DCBs) may increase durability of endovascular treatment of superficial femoral artery (SFA) disease while avoiding stent-related risks. The purpose of this study was to use meta-analytic data of DCB studies to compare the cost-effectiveness of potential SFA treatments: DCB, drug-eluting stent (DES), plain old balloon angioplasty (POBA), or bare-metal stent (BMS). A search for randomized controlled trials comparing DCB with POBA for treatment of SFA disease was performed. Hazard ratios were extracted to account for the time-to-event primary outcome of target lesion revascularization. Odds ratios were calculated for the secondary outcomes of primary patency (PP) and major amputation. Incorporating pooled data from the meta-analysis, cost-effectiveness analysis, assuming a payer perspective, used a decision model to simulate patency at 1 year and 2 years for each index treatment modality: POBA, BMS, DCB, or DES. Costs were based on current Medicare outpatient reimbursement rates. Eight studies (1352 patients) met inclusion criteria for meta-analysis. DCB outperformed POBA with respect to target lesion revascularization over time (pooled hazard ratio, 0.41; P < .001). Risk of major amputation at 12 months was not significantly different between groups. There was significantly improved 1-year PP in the DCB group compared with POBA (pooled odds ratio, 3.30; P < .001). In the decision model, the highest PP at 1 year was seen in the DES index therapy strategy (79%), followed by DCB (74%), BMS (71%), and POBA (64%). With a baseline cost of $9259.39 per patent limb at 1 year in the POBA-first group, the incremental cost per patent limb for each other strategy compared with POBA was calculated: $14,136.10/additional patent limb for DCB, $38,549.80/limb for DES, and $59,748,85/limb for BMS. The primary BMS option is dominated by being more expensive and less effective than DCB. Compared directly with DCB, DES costs $87,377.20 per additional patent

  8. Utilization of femoral head for estimating the skeletal burden of U and Pu in humans

    SciTech Connect

    Singh, N.P.; Lewis, L.L.; Wrenn, M.E.

    1989-03-01

    Uranium and Pu were determined in vertebrae, ribs and femoral head samples obtained from the same population. Vertebrae and rib samples were obtained at autopsy and femoral head samples were obtained from persons undergoing hip surgery. The results indicate that there was no statistically (p less than or equal to 0.05) significant difference between the mean concentration of /sup 239,240/Pu in vertebrae and ribs. Also, there was no significant difference between the mean concentration of /sup 239,240/Pu in ribs and femoral head. Also, statistical tests were performed to see whether the mean concentrations of /sup 238/U and /sup 234/U in three different bones differ from each other. The results suggest that there was no statistically significant difference between vertebrae and ribs, vertebrae and head of the femur nor between ribs and femoral head. These results indicate that femoral head may be an appropriate substitute for vertebrae or ribs, the most commonly used bone for inferring the skeletal burden of U and Pu in human. Femoral head samples can be obtained from living persons undergoing hip surgery, while vertebrae and ribs are obtained only at autopsy.

  9. Dilatation by angiotensin II of the rat femoral arterial bed in vivo via pressure/flow-induced release of nitric oxide and prostaglandins

    PubMed Central

    Heinemann, Akos; Wachter, Christof H; Peskar, Bernhard A; Holzer, Peter

    1997-01-01

    The haemodynamic effects of angiotensin II (AII) and, for comparison, arginine vasopressin (AVP) in the femoral and superior mesenteric artery of urethane-anaesthetized rats were analysed with the ultrasonic transit time shift technique. I.v. bolus injection of AII (0.1–3 nmol kg−1) and AVP (0.03–1 nmol kg−1) increased blood pressure which was accompanied by a decrease in blood flow through the superior mesenteric artery and an increase in femoral blood flow. The femoral hyperaemia was in part due to vasodilatation as indicated by a rise of femoral vascular conductance up to 200% relative to baseline. The femoral vasodilatation caused by AVP, but not AII, was followed by vasoconstriction. Blockade of angiotensin AT1 receptors by telmisartan (0.2–20 μmol kg−1) prevented all haemodynamic responses to AII. The femoral dilator responses to AII and AVP depended on the increase in vascular perfusion pressure since vasodilatation was reversed to vasoconstriction when blood pressure was maintained constant by means of a gravity reservoir. However, the AII-evoked femoral vasodilatation was not due to an autonomic or neuroendocrine reflex because it was not depressed by hexamethonium (75 μmol kg−1), prazosin (0.25 μmol kg−1) or propranolol (3 μmol kg−1). The AII-induced femoral vasodilatation was suppressed by blockade of nitric oxide (NO) synthesis with NG-nitro-L-arginine methyl ester (L-NAME, 40 μmol kg−1) and reversed to vasoconstriction when L-NAME was combined with indomethacin (30 μmol kg−1), but was left unaltered by antagonism of endothelin ETA/B receptors with bosentan (37 μmol kg−1). These results demonstrate that the effect of AII to increase systemic blood pressure and the resulting rise of perfusion pressure in the femoral artery stimulates the formation of NO and prostaglandins and thereby dilates the femoral arterial bed. This local vasodilator mechanism is sufficient to mask the direct

  10. Nitrite and S-Nitrosohemoglobin Exchange Across the Human Cerebral and Femoral Circulation: Relationship to Basal and Exercise Blood Flow Responses to Hypoxia.

    PubMed

    Bailey, Damian M; Rasmussen, Peter; Overgaard, Morten; Evans, Kevin A; Bohm, Aske M; Seifert, Thomas; Brassard, Patrice; Zaar, Morten; Nielsen, Henning B; Raven, Peter B; Secher, Niels H

    2017-01-10

    The mechanisms underlying red blood cell (RBC)-mediated hypoxic vasodilation remain controversial, with separate roles for nitrite () and S-nitrosohemoglobin (SNO-Hb) widely contested given their ability to transduce nitric oxide bioactivity within the microcirculation. To establish their relative contribution in vivo, we quantified arterial-venous concentration gradients across the human cerebral and femoral circulation at rest and during exercise, an ideal model system characterized by physiological extremes of O2 tension and blood flow. Ten healthy participants (5 men, 5 women) aged 24±4 (mean±SD) years old were randomly assigned to a normoxic (21% O2) and hypoxic (10% O2) trial with measurements performed at rest and after 30 minutes of cycling at 70% of maximal power output in hypoxia and equivalent relative and absolute intensities in normoxia. Blood was sampled simultaneously from the brachial artery and internal jugular and femoral veins with plasma and RBC nitric oxide metabolites measured by tri-iodide reductive chemiluminescence. Blood flow was determined by transcranial Doppler ultrasound (cerebral blood flow) and constant infusion thermodilution (femoral blood flow) with net exchange calculated via the Fick principle. Hypoxia was associated with a mild increase in both cerebral blood flow and femoral blood flow (P<0.05 versus normoxia) with further, more pronounced increases observed in femoral blood flow during exercise (P<0.05 versus rest) in proportion to the reduction in RBC oxygenation (r=0.680-0.769, P<0.001). Plasma gradients reflecting consumption (arterial>venous; P<0.05) were accompanied by RBC iron nitrosylhemoglobin formation (venous>arterial; P<0.05) at rest in normoxia, during hypoxia (P<0.05 versus normoxia), and especially during exercise (P<0.05 versus rest), with the most pronounced gradients observed across the bioenergetically more active, hypoxemic, and acidotic femoral circulation (P<0.05 versus cerebral). In contrast, we failed

  11. Pulsed excimer laser angioplasty of human cadaveric arteries.

    PubMed

    Farrell, E M; Higginson, L A; Nip, W S; Walley, V M; Keon, W J

    1986-02-01

    Laser angioplasty has been limited by the lack of precise control of thermal and acoustic vascular injury. Pulsed excimer lasers, by contrast, have a capacity to affect target tissue without heat dispersion or damage to surrounding structures. The ablative properties of three excimer wavelengths, krypton fluoride (249 nm), xenon chloride (308 nm), and xenon fluoride (351 nm), were investigated with the use of fresh human cadaveric normal and atherosclerotic femoral arteries. Light and electron microscopy demonstrated clean cuts with histologically normal edges. There was no evidence of either thermal or acoustic damage with any of the wavelengths studied. The depth of ablation varied directly with the number of pulses and inversely with tissue density while the incision width remained constant. The excimer laser appears to offer significant advantages over its conventional counterparts for the ablation of atherosclerotic plaque.

  12. Is venous blood drawn from femoral access adequate to estimate the central venous oxygen saturation and arterial lactate levels in critically ill patients?

    PubMed Central

    Marti, Yara Nishiyama; de Freitas, Flávio Geraldo Rezende; de Azevedo, Rodrigo Palácio; Leão, Milena; Bafi, Antônio Tonete; Machado, Flavia Ribeiro

    2015-01-01

    Objectives The purpose of this study was to test if venous blood drawn from femoral access can be used to estimate the central venous oxygen saturation and arterial lactate levels in critically ill patients. Methods Bland-Altman analysis and Spearman correlations were used to compare the femoral venous oxygen saturation and central venous oxygen saturation as well as arterial lactate levels and femoral lactate. A pre-specified subgroup analysis was conducted in patients with signs of hypoperfusion. In addition, the clinical agreement was also investigated. Results Blood samples were obtained in 26 patients. In 107 paired samples, there was a moderate correlation (r = 0.686, p < 0.0001) between the central venous oxygen saturation and femoral venous oxygen saturation with a bias of 8.24 ± 10.44 (95% limits of agreement: -12.23 to 28.70). In 102 paired samples, there was a strong correlation between the arterial lactate levels and femoral lactate levels (r = 0.972, p < 0.001) with a bias of -2.71 ± 9.86 (95% limits of agreement: -22.03 to 16.61). The presence of hypoperfusion did not significantly change these results. The clinical agreement for venous saturation was inadequate, with different therapeutic decisions in 22.4% of the situation; for lactate, this was the case only in 5.2% of the situations. Conclusion Femoral venous oxygen saturation should not be used as a surrogate of central venous oxygen saturation. However, femoral lactate levels can be used in clinical practice, albeit with caution. PMID:26761471

  13. Coaxial electrospinning of P(LLA-CL)/heparin biodegradable polymer nanofibers: potential vascular graft for substitution of femoral artery.

    PubMed

    Zhai, Wei; Qiu, Li-Jun; Mo, Xiu-Mei; Wang, Sheng; Xu, Yun-Fei; Peng, Bo; Liu, Min; Huang, Jun-Hua; Wang, Guang-Chun; Zheng, Jun-Hua

    2013-06-07

    Electrospinning is one of the most simple and effective methods to prepare polymer fibers with the diameters ranging from nanometer to several micrometers. Poly(L-lactide)-co-poly (ɛ-caprolactone) (P(LLA-CL)) fibers and P(LLA-CL)/heparin coaxial composite fibers herein were successfully prepared by single electrospinning and coaxial electrospinning, respectively. The prepared endothelialized P(LLA-CL) and P(LLA-CL)/heparin vascular grafts were used in the Beagle dogs experiment to evaluate the feasibility of thus made different scaffolds for substitution of dog femoral artery in early period, medium term, and long term, meanwhile the pure P(LLA-CL) vascular graft was used as the control group during all the experiments. The animal model was established by using the graft materials to anastomose both femoral arteries of dogs. The vascular grafts patency rates (i.e., the unobstructed capacity of blood vessel) were detected by color Doppler flow imaging technology and digital subtraction angiography. To observe the histological morphology at different periods, the vascular grafts were removed after 7, 14, and 30 days, and the corresponding histological changes were evaluated by hematoxylin and eosin staining. The experimental results show that in the early period, the patency rates of pure P(LLA-CL) graft, endothelial P(LLA-CL) graft, and P(LLA-CL)/heparin graft were 75%, 75%, and 100%, respectively; in the medium term, the patency rates of pure P(LLA-CL) graft and endothelial P(LLA-CL) graft were 25%, whereas that of P(LLA-CL)/heparin graft was 50%; the patency rates of pure P(LLA-CL) graft and endothelial P(LLA-CL) graft were down to 0%, whereas the patency rate of P(LLA-CL)/heparin graft was 25% in the long term. This preliminary study has demonstrated that P(LLA-CL)/heparin coaxial composite fiber maybe a reliable artificial graft for the replacement of femoral artery. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2013.

  14. Augmented P2X response and immunolabeling in dorsal root ganglion neurons innervating skeletal muscle following femoral artery occlusion.

    PubMed

    Xing, Jihong; Lu, Jian; Li, Jianhua

    2013-04-01

    The responsiveness of sensory neurons to muscle metabolites is altered under the conditions of insufficient limb blood supply in some diseases, such as peripheral artery disease. The purpose of this study was to examine ATP-induced current with activation of purinergic P2X subtypes P2X₃ and P2X₂/₃ in dorsal root ganglion (DRG) neurons of control limbs and limbs with 24 h of femoral artery occlusion using whole cell patch-clamp methods. Also, dual-labeling immunohistochemistry was employed to determine existence of P2X₃ expression in DRG neurons of thin-fiber afferents. DRG neurons from 4- to 6-wk-old rats were labeled by injecting the fluorescence tracer DiI into the hindlimb muscles 4-5 days before the recording experiments. Transient (P2X₃), mixed (P2X₃ and P2X₂/₃), and sustained (P2X₂/₃) current responses to α,β-methylene ATP (a P2X receptor agonist) are observed in small and medium DRG neurons, and size distribution of DRG neurons is similar in control and occluded limbs. However, the peak current amplitude of DRG neuron induced by stimulation of P2X₃ and/or P2X₂/₃ is larger in occluded limbs than that in control limbs. Moreover, the percentage of DRG neurons with P2X₃ transient currents is greater after arterial occlusion compared with control. In addition, a rapid desensitization was observed in DRG neurons with transient currents, but not with sustained currents in control and occluded groups. Furthermore, results from immunofluorescence experiments show that femoral artery occlusion primarily augments P2X₃ expression within DRG neurons projecting C-fiber afferents. Overall, these findings suggest that 1) greater ATP-induced currents with activation of P2X₃ and P2X₂/₃ are developed when hindlimb arterial blood supply is deficient under ischemic conditions and 2) increased P2X₃ expression is largely observed in C-fibers of DRG neurons after hindlimb vascular insufficiency.

  15. Safety and efficacy of femoral artery closure with the FemoSeal(R) device after coronary angiography using a 7 French sheath.

    PubMed

    Wanitschek, M M; Suessenbacher, A; Dörler, J; Pachinger, O; Moes, N; Alber, H F

    2011-09-01

    Post-cardiac catheterization femoral artery hemostasis can be accomplished with several mechanisms, including the FemoSeal® hemostasis device which has been designed and approved for closure of 6 French (F) arterial puncture sites. The aim of this study was to investigate whether the FemoSeal® vascular closure device can effectively and safely seal 7F arterial puncture sites after diagnostic and interventional cardiac catheterizations. Femoral artery puncture sites of 50 consecutive patients undergoing cardiac catheterization were closed with the FemoSeal® vascular closure device, according to the manufacturer's instructions. Efficacy endpoints were time to hemostasis and successful ambulation. Safety endpoints included bleeding complications, vessel occlusion and pseudoaneurysms. Mean time to hemostasis was 57.8±26.3 seconds (0-125 seconds). Hemostasis was achieved in 100 percent of the 50 patients. One patient suffered minor bleeding the next day, i.e. local hematoma. This clinical study demonstrates that the FemoSeal® vascular closure device, initially approved for closure of 6F arterial puncture sites, shows promising efficacy and safety to seal a larger (7F) femoral arterial puncture sites after diagnostic and interventional cardiac catheterizations.

  16. Role of muscular eNOS in skeletal arteries: Endothelium-independent hypoxic vasoconstriction of the femoral artery is impaired in eNOS-deficient mice.

    PubMed

    Kim, Hae Jin; Yoo, Hae Young; Lin, Hai Yue; Oh, Goo Taeg; Zhang, Yin Hua; Kim, Sung Joon

    2016-09-01

    We previously reported that hypoxia augments α-adrenergic contraction (hypoxic vasoconstriction, HVC) of skeletal arteries in rats. The underlying mechanism may involve hypoxic inhibition of endothelial nitric oxide synthase (eNOS) expressed in skeletal arterial myocytes (16). To further explore the novel role of muscular eNOS in the skeletal artery, we compared HVC in femoral arteries (FAs) from eNOS knockout (KO) mice with that from wild-type (WT) and heterozygous (HZ) mice. Immunohistochemical assays revealed that, in addition to endothelia, eNOS is also expressed in the medial layer of FAs, albeit at a much lower level. However, the medial eNOS signal was not evident in HZ FAs, despite strong expression in the endothelium; similar observations were made in WT carotid arteries (CAs). The amplitude of contraction induced by 1 μM phenylephrine (PhE) was greater in HZ than in WT FAs. Hypoxia (3% Po2) significantly augmented PhE-induced contraction in WT FAs but not in HZ or KO FAs. No HVC was observed in PhE-pretreated WT CAs. The NOS inhibitor nitro-l-arginine methyl ester (0.1 mM) also augmented PhE contraction in endothelium-denuded WT FAs but not in WT CAs. Inhibitors specific to neuronal NOS and inducible NOS did not augment PhE-induced contraction of WT FAs. NADPH oxidase 4 (NOX4) inhibitor (GKT137831, 5 μM), but not NOX2 inhibitor (apocynin, 100 μM), suppressed HVC. Consistent with the role of reactive oxygen species (ROS), HVC was also inhibited by pretreatment with tiron or polyethylene glycol-catalase. Taken together, these data suggest that the eNOS expressed in smooth muscle cells in FAs attenuates α-adrenergic vasoconstriction; this suppression is alleviated under hypoxia, which potentiates vasoconstriction in a NOX4/ROS-dependent mechanism. Copyright © 2016 the American Physiological Society.

  17. Effects of KRN4884, a novel K+ channel opener, on ionic currents in rabbit femoral arterial myocytes.

    PubMed

    Muraki, Katsuhiko; Sasaoka, Akiko; Ohya, Susumu; Watanabe, Minoru; Imaizumi, Yuji

    2003-11-01

    Effects of KRN4884 (5-amino-N-[2-(2-chlorophenyl)ethyl]-N'-cyano-3-pyridinecarboxamidine), a novel K(+) channel opener, on ionic currents were examined in rabbit femoral arterial myocytes (RFAMs). Under whole-cell clamp conditions where cells were superfused with 5.9 mM K(+) bathing solution, KRN4884 elicited an outward current at -30 mV. KRN4884-induced current had a reversal potential of -78 mV and was abolished by application of glibenclamide (glib). KRN4884 was approximately 43 times more potent than levcromakalim in activating an ATP-sensitive K(+) current (I(K-ATP)). On the other hand, KRN4884 affected neither voltage-dependent Ca(2+) nor delayed rectifier K(+) channel currents. In the inside-out patch clamp configuration where cells were superfused with the symmetrical 140 mM K(+) solution, KRN4884 activated 47 pS K(+) channels in the presence of adenosine diphosphate. Similar 47 pS K(+) channels, which were reversibly inhibited by glib, were recorded under outside-out patch conditions. Using RT-PCR analysis, we found that inward rectifier K channel 6.1 (Kir6.1) and sulfonylurea 2B (SUR2B) transcripts were predominantly expressed in rabbit femoral artery. These results indicate that KRN4884 potently activates I(K-ATP) in RFAMs. The KRN4884-sensitive 47 pS K(+) channel activity underlying I(K-ATP) is a vascular type K(ATP) channel consisting of Kir6.1 and SUR2B and has similar characteristics to those of ATP-sensitive K(+) channels activated by K(+) channel openers in other types of smooth muscles.

  18. OUTBACK catheter for treatment of superficial femoral and iliac artery chronic total occlusion: Experience from two centers

    PubMed Central

    Husainy, Mohammad Ali; Suresh, Balla; Fang, Cheng; Ammar, Thoraya; Botchu, Rajesh; Thava, V

    2016-01-01

    Purpose: The OUTBACK® catheter is a reentry device that enables reentry into a vessel lumen from the subintimal space during subintimal angioplasty. It is reserved for cases where reentry has not been possible using conventional wire and catheter techniques. We report a two-center experience in recanalization of the chronic total occlusions of the common iliac (CIA) and the superficial femoral artery (SFA) using the OUTBACK® catheter in cases where other techniques were unsuccessful. Material and Methods: All cases where recanalization was performed using the OUTBACK® reentry catheter between January 2010 to January 2015 were retrospectively identified and included in this study. 21 patients were identified. The indication for intervention in these cases included claudication and critical leg ischemia. In all cases, conventional recanalization could not be successfully achieved. Results: The OUTBACK® catheter was used to recanalize 10 SFA occlusion and 9 CIA occlusions. In 19 patients (90%), reentry into true arterial lumen was successfully achieved. 17 patients had their recanalization through the transfemoral approach whereas 2 patients had a transpopliteal artery approach. In 2 patients, reentry into the true lumen could not be achieved using the OUTBACK® catheter due to patient's intolerability for the procedure and severe atherosclerotic calcified plaques. There was 100% patency of the vessel intervened on Duplex ultrasound at 24 months of follow up. 16 patients (84%) remained asymptomatic and 2 patients (10.5%) reported worsening of their symptoms due to the development of new lesions within the arterial system. Conclusion: The OUTBACK® catheter is an effective and safe technique for reentry into the vessel lumen when conventional techniques fail. PMID:27413275

  19. [Embolism of the humeral artery originating in a thrombosed axillo-femoral bypass].

    PubMed

    Barba, A; Escribano, J V; García-Alfageme, A

    1992-01-01

    A case of a patient, with acute arterial ischemia at the upper limb is reported. On this case, ischemia was caused by humeral arterial embolism. The embolic origin was focused on the proximal end of a thrombosed axillofemoral bypass. After a rude manipulation during surgical procedure, part of the thrombus, following the sanguineous current, occluded the humeral artery. Patient underwent an emergent surgery. Posterior course was good. Histology showed a re-epithelialized, ancient thrombus. Cardiologic studies and angiography showed no others embolic focuses.

  20. Cortical and trabecular load sharing in the human femoral neck.

    PubMed

    Nawathe, Shashank; Nguyen, Bich Phuong; Barzanian, Nasim; Akhlaghpour, Hosna; Bouxsein, Mary L; Keaveny, Tony M

    2015-03-18

    The relative role of the cortical vs trabecular bone in the load-carrying capacity of the proximal femur-a fundamental issue in both basic-science and clinical biomechanics-remains unclear. To gain insight into this issue, we performed micro-CT-based, linear elastic finite element analysis (61.5-micron-sized elements; ~280 million elements per model) on 18 proximal femurs (5M, 13F, ages 61-93 years) to quantify the fraction of frontal-plane bending moment shared by the cortical vs trabecular bone in the femoral neck, as well as the associated spatial distributions of stress. Analyses were performed separately for a sideways fall and stance loading. For both loading modes and across all 18 bones, we found consistent patterns of load-sharing in the neck: most proximally, the trabecular bone took most of the load; moving distally, the cortical bone took increasingly more of the load; and more distally, there was a region of uniform load-sharing, the cortical bone taking the majority of the load. This distal region of uniform load-sharing extended more for fall than stance loading (77 ± 8% vs 51 ± 6% of the neck length for fall vs. stance; mean ± SD) but the fraction of total load taken by the cortical bone in that region was greater for stance loading (88 ± 5% vs. 64 ± 9% for stance vs. fall). Locally, maximum stress levels occurred in the cortical bone distally, but in the trabecular bone proximally. Although the distal cortex showed qualitative stress distributions consistent with the behavior of an Euler-type beam, quantitatively beam theory did not apply. We conclude that consistent and well-delineated regions of uniform load-sharing and load-transfer between the cortical and trabecular bone exist within the femoral neck, the details of which depend on the external loading conditions.

  1. Routine Use of Fluoroscopic-Guided Femoral Arterial Puncture to Minimise Vascular Complication Rates in CTO Intervention: Multi-centre UK Experience.

    PubMed

    Fairley, Sarah L; Lucking, Andrew J; McEntegart, Margaret; Shaukat, Aadil; Smith, David; Chase, Alexander; Hanratty, Colm G; Spratt, James C; Walsh, Simon J

    2016-12-01

    Chronic total occlusion (CTO) revascularisation has a crucial role in contemporary percutaneous coronary intervention (PCI). Procedural success is influenced by disease complexity, calcific burden and patient characteristics but has substantially improved with the implementation of novel hybrid strategies. However, vascular-access related complications remain a cause of morbidity and mortality. This study aimed to assess the effectiveness of fluoroscopic-guided femoral arterial puncture to minimise this risk during CTO PCI. Standardised data were retrospectively collected from four high-volume UK CTO centres between September 2011 and November 2013. Demographic, clinical and procedural data (vascular access site, sheath size, anticoagulation use) was collated. The anatomical location of the femoral puncture in relation to the femoral bifurcation, femoral head position and inferior epigastric artery were recorded. Adverse events related to vascular access were documented. A total of 528 patients were included (676 femoral punctures) with the majority being male (n=432, 81.8%). Large sheaths (8F) were used in 81.2% of cases. Fluoroscopy-enabled punctures were made in the 'safe zone' in over > 93% of cases. Vascular closure devices (VCD) were used in 88.3% of cases. The adverse event rate per puncture was 0.89%. This study demonstrates an extremely low incidence of vascular-access complications in CTO PCI when fluoroscopic guidance is used to obtain femoral arterial access by default radial operators. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  2. Aortoiliac Artery Reconstruction Using Bilateral Reversed Superficial Femoral Veins for an Infected Abdominal Aortic Aneurysm

    PubMed Central

    Hirai, Hanako; Yasuhara, Kiyomitsu; Hatori, Kyohei; Miki, Takao; Obayashi, Tamiyuki

    2016-01-01

    Surgical treatment of an infected abdominal aortic aneurysm (IAAA) is difficult and the ideal graft material is a subject of debate. A 60-year-old man with untreated diabetes mellitus was referred to our hospital presenting with fever and left lower abdominal pain. The patient was diagnosed with an IAAA by blood culture and computed tomography. We treated the patient surgically for the IAAA using bilateral reversed superficial femoral veins which were shaped into a bifurcated graft. No signs of recurrent infection or aneurysmal dilation were observed for 3 years after the procedure. PMID:27087879

  3. Aortoiliac Artery Reconstruction Using Bilateral Reversed Superficial Femoral Veins for an Infected Abdominal Aortic Aneurysm.

    PubMed

    Ohki, Satoshi; Hirai, Hanako; Yasuhara, Kiyomitsu; Hatori, Kyohei; Miki, Takao; Obayashi, Tamiyuki

    2016-01-01

    Surgical treatment of an infected abdominal aortic aneurysm (IAAA) is difficult and the ideal graft material is a subject of debate. A 60-year-old man with untreated diabetes mellitus was referred to our hospital presenting with fever and left lower abdominal pain. The patient was diagnosed with an IAAA by blood culture and computed tomography. We treated the patient surgically for the IAAA using bilateral reversed superficial femoral veins which were shaped into a bifurcated graft. No signs of recurrent infection or aneurysmal dilation were observed for 3 years after the procedure.

  4. Femoral morphology and femoropelvic musculoskeletal anatomy of humans and great apes: a comparative virtopsy study.

    PubMed

    Morimoto, Naoki; Ponce de León, Marcia S; Nishimura, Takeshi; Zollikofer, Christoph P E

    2011-09-01

    The proximal femoral morphology of fossil hominins is routinely interpreted in terms of muscular topography and associated locomotor modes. However, the detailed correspondence between hard and soft tissue structures in the proximal femoral region of extant great apes is relatively unknown, because dissection protocols typically do not comprise in-depth osteological descriptions. Here, we use computed tomography and virtopsy (virtual dissection) for non-invasive examination of the femoropelvic musculoskeletal anatomy in Pan troglodytes, P. paniscus, Gorilla gorilla, Pongo pygmaeus, and Homo sapiens. Specifically, we analyze the topographic relationship between muscle attachment sites and surface structures of the proximal femoral shaft such as the lateral spiral pilaster. Our results show that the origin of the vastus lateralis muscle is anterior to the insertion of gluteus maximus in all examined great ape specimens and humans. In gorillas and orangutans, the insertion of gluteus maximus is on the inferior (anterolateral) side of the lateral spiral pilaster. In chimpanzees, however, the maximus insertion is on its superior (posteromedial) side, similar to the situation in modern humans. These findings support the hypothesis that chimpanzees and humans exhibit a shared-derived musculoskeletal topography of the proximal femoral region, irrespective of their different locomotor modes, whereas gorillas and orangutans represent the primitive condition. Caution is thus warranted when inferring locomotor behavior from the surface topography of the proximal femur of fossil hominins, as the morphology of this region may contain a strong phyletic signal that tends to blur locomotor adaptation.

  5. Delayed iliacus compartment syndrome following femoral artery puncture: case report and literature review

    PubMed Central

    Mwipatayi, Bibombe P.; Daneshmand, Ali; Bangash, Haider K.; Wong, Jackie

    2016-01-01

    Iliacus compartment syndrome is a rare retroperitoneal compartment neuropathy caused by bleeding within the iliacus muscle leading to hematoma formation and compression upon the femoral nerve, causing both sensory and motor deficits. A 75-year-old Caucasian man presented with severe right hip pain associated with motor and sensory deficit in the right lower extremity, 2 weeks post elective balloon aortic valvuloplasty for critical aortic stenosis. A non-contrast computed tomography scan revealed low-attenuation areas in keeping with an iliacus hematoma. An iliacus fasciotomy and hematoma evacuation was performed with retroperitoneal approach. The patient reported marked reduction in his groin pain with clinical improvement of the right hip flexion though the sensory deficit was unchanged. On Day 3, postoperatively the patient died from respiratory and multi-organ failure. Iliac hematomas are rare and can be caused by traumatic and non-traumatic injury, and can be exacerbated by complications of anticoagulant therapy. Delaying surgical evacuation of the hematoma can lead to prolonged or permanent disability. However, there are other reports describing good recovery with non-operative management. Non-surgical intervention is recommended if radiological studies do not explicitly confirm the presence of a discreet hematoma compressing the femoral nerve, unless progression of symptoms increases. PMID:27273684

  6. The Use of ExoSeal Vascular Closure Device for Direct Antegrade Superficial Femoral Artery Puncture Site Hemostasis

    SciTech Connect

    Rimon, Uri Khaitovich, Boris; Yakubovich, Dmitry; Bensaid, Paul Golan, Gil; Silverberg, Daniel

    2015-06-15

    PurposeThis study was designed to assess the efficacy and safety of the ExoSeal vascular closure device (VCD) to achieve hemostasis in antegrade access of the superficial femoral artery (SFA).MethodsWe retrospectively reviewed the outcome of ExoSeal VCD used for hemostasis in 110 accesses to the SFA in 93 patients between July 2011 and July 2013. All patients had patent proximal SFA based on computer tomography angiography or ultrasound duplex. Arterial calcifications at puncture site were graded using fluoroscopy. The SFA was accessed in an antegrade fashion with ultrasound or fluoroscopic guidance. In all patients, 5–7F vascular sheaths were used. The ExoSeal VCD was applied to achieve hemostasis at the end of the procedure. All patients were clinically examined and had ultrasound duplex exam for any puncture site complications during the 24 h postprocedure.ResultsIn all procedures, the ExoSeal was applied successfully. We did not encounter any device-related technical failure. There were four major complications in four patients (3.6 %): three pseudoaneurysms, which were treated with direct thrombin injection, and one hematoma, which necessitated transfusion of two blood units. All patients with complications were treated with anticoagulation preprocedure or received thrombolytic therapy.ConclusionsThe ExoSeal VCD can be safely used for antegrade puncture of the SFA, with a high procedural success rate (100 %) and a low rate of access site complications (3.6 %)

  7. Modified T-Graft for Extracorporeal Membrane Oxygenation in a Patient with Small-Caliber Femoral Arteries.

    PubMed

    Calderon, Daniel; El-Banayosy, Aly; Koerner, Michael M; Reed, Amy B; Aziz, Faisal

    2015-12-01

    Extracorporeal membrane oxygenation (ECMO) is generally used as a last resort to provide cardiopulmonary support in patients whose advanced cardiac or respiratory failure does not respond to less invasive treatments. Lower-limb ischemia secondary to the large diameter of the arterial cannula is one of ECMO's major limitations: in patients who have small-caliber arteries, the cannulas can reduce native blood flow. The creation of a T-graft-a well-described technique to avoid limb ischemia-enables flow into the ECMO cannula without jeopardizing blood flow to the limb. However, leaving the graft exposed through an open groin wound can result in dislodgment, and it increases the risk of infection. We describe our modification of a conventional T-graft in an 18-year-old woman who had systolic heart failure, acute respiratory distress syndrome, and small-caliber femoral vessels. We tunneled a polytetrafluoroethylene graft inside a Dacron graft, then ran the combined graft through a subcutaneous tunnel similar to that created for a peripheral bypass. Thus, the graft was protected from environmental exposure and the risk of infection. Our technique seems safer and more secure than the original T-graft technique, and we recommend its consideration during ECMO cannulation.

  8. Prospective Nonrandomized Trial of Manual Compression and Angio-Seal and Starclose Arterial Closure Devices in Common Femoral Punctures

    SciTech Connect

    Ratnam, Lakshmi A.; Raja, Jowad; Munneke, Graham J.; Morgan, Robert A.; Belli, Anna-Maria

    2007-04-15

    We compared the use of manual compression and Angio-Seal and Starclose arterial closure devices to achieve hemostasis following common femoral artery (CFA) punctures in order to evaluate safety and efficacy. A prospective nonrandomized, single-center study was carried out on all patients undergoing CFA punctures over 1 year. Hemostasis was achieved using manual compression in 108 cases, Angio-Seal in 167 cases, and Starclose in 151 cases. Device-failure rates were low and not significantly different in the two groups (manual compression and closure devices; p = 0.8). There were significantly more Starclose (11.9%) patients compared to Angio-Seal (2.4%), with successful initial deployment subsequently requiring additional manual compression to achieve hemostasis (p < 0.0001). A significant number of very thin patients failed to achieve hemostasis (p = 0.014). Major complications were seen in 2.9% of Angio-Seal, 1.9% of Starclose, and 3.7% of manual compression patients, with no significant difference demonstrated; 4.7% of the major complications were seen in female patients compared to 1.3% in males (p = 0.0415). All three methods showed comparable safety and efficacy. Very thin patients are more likely to have failed hemostasis with the Starclose device, although this did not translate into an increased complication rate. There is a significant increased risk of major puncture-site complications in women with peripheral vascular disease.

  9. The Results of a New Distal Protection Method in Intervention for Chronic Total Occlusion of the Superficial Femoral Artery

    PubMed Central

    Kobayashi, Tomoko; Funatsu, Atsushi; Ejima, Emiko; Muranishi, Hiromi; Utsunomiya, Makoto; Shibata, Kensaku; Mizobuchi, Masahiro; Enjoji, Yoshihisa; Nakamura, Shigeru

    2009-01-01

    Aims. To determine the efficacy of a new distal protection method in SFA CTO interventions. Methods and Results. From June 2003 to February 2009, ninety-two consecutive, chronic total occlusions of superficial femoral arteries were treated with catheter-based intervention using a bidirectional approach. Nine of these cases were managed with our original, distal protection method, based on symptoms, angiographic images, wire resistance, and intravascular ultrasound images. The average age was 73 years; eight patients were male. The mean occlusion length was 17.1 cm. A distal protection balloon was inserted from the retrograde sheath in the popliteal artery and placed distal to the occluded lesion after successful wire crossing. Lesion dilatation with a balloon was performed antegradely and debris was removed by 6Fr. guiding catheter. Debris was retrieved from all lesions, consisting mainly of thrombus. Where we decided not to use the distal protection method, there was no distal thromboembolism. Conclusion. In SFA-CTO intervention, the risk of distal embolization is 10%, which can be anticipated and eliminated by the distal protection method. PMID:19946634

  10. Interaction between Advanced Glycation End Products Formation and Vascular Responses in Femoral and Coronary Arteries from Exercised Diabetic Rats

    PubMed Central

    Delbin, Maria A.; Davel, Ana Paula C.; Couto, Gisele Kruger; de Araújo, Gustavo G.; Rossoni, Luciana Venturini; Antunes, Edson; Zanesco, Angelina

    2012-01-01

    Background The majority of studies have investigated the effect of exercise training (TR) on vascular responses in diabetic animals (DB), but none evaluated nitric oxide (NO) and advanced glycation end products (AGEs) formation associated with oxidant and antioxidant activities in femoral and coronary arteries from trained diabetic rats. Our hypothesis was that 8-week TR would alter AGEs levels in type 1 diabetic rats ameliorating vascular responsiveness. Methodology/Principal Findings Male Wistar rats were divided into control sedentary (C/SD), sedentary diabetic (SD/DB), and trained diabetic (TR/DB). DB was induced by streptozotocin (i.p.: 60 mg/kg). TR was performed for 60 min per day, 5 days/week, during 8 weeks. Concentration-response curves to acetylcholine (ACh), sodium nitroprusside (SNP), phenylephrine (PHE) and tromboxane analog (U46619) were obtained. The protein expressions of eNOS, receptor for AGEs (RAGE), Cu/Zn-SOD and Mn-SOD were analyzed. Tissues NO production and reactive oxygen species (ROS) generation were evaluated. Plasma nitrate/nitrite (NOx−), superoxide dismutase (SOD), catalase (CAT), thiobarbituric acid reactive substances (TBARS) and Nε-(carboxymethyl) lysine (CML, AGE biomarker). A rightward shift in the concentration-response curves to ACh was observed in femoral and coronary arteries from SD/DB that was accompanied by an increase in TBARS and CML levels. Decreased in the eNOS expression, tissues NO production and NOx− levels were associated with increased ROS generation. A positive interaction between the beneficial effect of TR on the relaxing responses to ACh and the reduction in TBARS and CML levels were observed without changing in antioxidant activities. The eNOS protein expression, tissues NO production and ROS generation were fully re-established in TR/DB, but plasma NOx− levels were partially restored. Conclusion Shear stress induced by TR fully restores the eNOS/NO pathway in both preparations from non-treated diabetic

  11. Femoral curvature variability in modern humans using three-dimensional quadric surface fitting.

    PubMed

    Chapman, Tara; Sholukha, Victor; Semal, Patrick; Louryan, Stéphane; Rooze, Marcel; Van Sint Jan, Serge

    2015-12-01

    This study analysed femoral curvature in a population from Belgium in conjunction with other morphological characteristics by the use of three-dimensional (3D) quadric surfaces (QS) modelled from the bone surface. 3D models were created from computed tomography data of 75 femoral modern human bones. Anatomical landmarks (ALs) were palpated in specific bony areas of the femur (shaft, condyles, neck and head). QS were then created from the surface vertices which enclose these ALs. The diaphyseal shaft was divided into five QS shapes to analyse curvature in different parts of the shaft. Femoral bending differs in different parts of the diaphyseal shaft. The greatest degree of curvature was found in the distal shaft (mean 4.5° range 0.2°-10°) followed by the proximal (mean 4.4° range 1.5°-10.2°), proximal intermediate (mean 3.7° range 0.9°-7.9°) and distal intermediate (mean 1.8° range 0.2°-5.6°) shaft sections. The proximal and distal angles were significantly more bowed than the intermediate proximal and the intermediate distal angle. There was no significant difference between the proximal and distal angle. No significant correlations were found between morphological characteristics and femoral curvature. An extremely large variability of femoral curvature with several bones displaying very high or low degrees of femoral curvature was also found. 3D QS fitting enables the creation of accurate models which can discriminate between different patterns in similar curvatures and demonstrates there is a clear difference between curvature in different parts of the shaft.

  12. Invasive evaluation of plaque morphology of symptomatic superficial femoral artery stenoses using combined near-infrared spectroscopy and intravascular ultrasound.

    PubMed

    Zacharias, Sibin K; Safian, Robert D; Madder, Ryan D; Hanson, Ivan D; Pica, Mark C; Smith, James L; Goldstein, James A; Abbas, Amr E

    2016-08-01

    The purpose of this study is to characterize the plaque morphology of severe stenoses in the superficial femoral artery (SFA) employing combined near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS). Atherosclerosis is the most common cause of symptomatic peripheral arterial disease. Plaque composition of SFA stenoses has been characterized as primarily fibrous or fibrocalcific by non-invasive and autopsy studies. NIRS has been validated to detect lipid-core plaque (LCP) in the coronary circulation. We imaged severe SFA stenoses with NIRS-IVUS prior to revascularization in 31 patients (46 stenoses) with Rutherford claudication ⩾ class 3. Angiographic parameters included lesion location and stenosis severity. IVUS parameters included plaque burden and presence of calcium. NIRS images were analyzed for LCP and maximum lipid-core burden index in a 4-mm length of artery (maxLCBI4mm). By angiography, 38 (82.6%) lesions were calcified and 9 (19.6%) were chronic total occlusions. Baseline stenosis severity and lesion length were 86.0 ± 11.0% and 36.5 ± 46.5 mm, respectively. NIRS-IVUS identified calcium in 45 (97.8%) lesions and LCP in 17 (37.0%) lesions. MaxLCBI4mm was 433 ± 244. All lesions with LCP also contained calcium; there were no non-calcified lesions with LCP. In conclusion, this is the first study of combined NIRS-IVUS in patients with PAD. NIRS-IVUS demonstrates that nearly all patients with symptomatic severe SFA disease have fibrocalcific plaque, and one-third of such lesions contain LCP. These findings contrast with those in patients with acute coronary syndromes, and may have implications regarding the pathophysiology of atherosclerosis in different vascular beds. © The Author(s) 2016.

  13. Fluoroscopy vs. traditional guided femoral arterial access and the use of closure devices: a randomized controlled trial.

    PubMed

    Abu-Fadel, Mazen S; Sparling, Jeffrey M; Zacharias, Soni J; Aston, Christopher E; Saucedo, Jorge F; Schechter, Eliot; Hennebry, Thomas A

    2009-10-01

    To compare the effectiveness of accessing the common femoral artery (CFA) using fluoroscopic guidance (FG) versus traditional anatomic landmark guidance (TALG) during cardiac catheterization and to determine the effect of the two modalities on the appropriateness for use of vascular closure devices (VCDs). Previous studies have shown a consistent relationship between the head of the femur and the CFA, yet there is no prospective data validating the superiority of fluoroscopy-assisted CFA access. A total of 972 patients were randomized to either FG or TALG access. The primary endpoint of the study was the angiographic suitability of the puncture site for VCD use. Secondary endpoints included arteriotomy location, time and number of attempts needed to obtain access, and the incidence of vascular complications. Of these, 474 patients were randomized into the FG arm and 498 patients into the TALG arm. A total of 79.5% of patients in the fluoroscopy arm and 80.7% in the traditional arm (P = 0.7) were deemed angiographically suitable for VCD based on the arteriotomy. The fluoroscopy group had significantly less arteriotomies below the inferior border of the head of the femur (P = 0.03). Total time for sheath insertion (105.7 +/- 130.7 vs. 106.5 +/- 152.6 sec) and number of arterial punctures (1.1 +/- 0.4 vs. 1.1 +/- 0.5) did not differ among the FG and TALG, respectively. The rates of vascular complications were not different. The angiographic suitability for VCD was not different between FG and TALG groups. Fluoroscopy decreased the number of low arteriotomies. The time to sheath insertion, number of arterial punctures needed to obtain access, and the incidence of complications were also similar.

  14. MRI after implantation of a novel femoral closure device following intra-arterial catheterisation: implications for subsequent contrast-enhanced MR angiography.

    PubMed

    Mohrs, Oliver K; Petersen, Steffen E; Nowak, Bernd; Kauczor, Hans-Ulrich; Voigtlaender, Thomas

    2010-05-01

    To assess MRI safety aspects and artefacts of a novel femoral artery closure device during contrast-enhanced MR angiography in patients following intra-arterial catheterisation. Ten consecutive patients underwent MRI within 24 h of coronary angiography and placement of a femoral artery closure device. We used a T2-weighted gradient-echo MRI sequence to measure the device-related artefact size in comparison with a phantom image, phase-contrast flow measurement proximal to, at the level of and distal to the device to quantify potential differences in flow velocity and contrast-enhanced 3D gradient-echo MR angiography to differentiate potential femoral artery stenosis from device-related artefacts. The mean size of the oval-shaped artefact was 8.4 x 6.6 mm (+/-1.0 x 0.8 mm) and was almost identical to the maximum artefact size of the phantom measurement (8.3 x 5.7 mm). Device placement did not result in an increased peak velocity (proximal 69 +/- 23 cm/s, at the level of 64 +/- 11 cm/s and distal to the device 63 +/- 12 cm/s, p = 0.67). The mean artefact penetration into the vessel lumen was 0.5 +/- 0.5 mm (percentage vessel narrowing 7.0 +/- 6%; range 0-16%). The MR conditional StarClose femoral artery closure device was used safely within 24 h of deployment at 1.5 T. Despite clip-related artefacts MR angiography will allow for easy differentiation of clip-related artefacts from high-grade atherosclerotic stenosis.

  15. Rare Case of Multiple Aneurysms with Rupture of the Deep Femoral Artery Aneurysm.

    PubMed

    Dulić, Grgur; Požgain, Zrinka; Pinotić, Krešimir; Šego, Krunoslav; Selthofer, Robert; Rončević, Ivica

    2015-11-01

    Profunda femoris artery aneurysms (PFAA) are very rare and easily overlooked. Currently, around 100 PFAA and 20 ruptured PFAA have been described in the literature. This is a report on a case of ruptured PFAA with thoracoabdominal aortic aneurysm. A ligation of the profunda femoris artery (PFA) and a femoropopliteal supragenicular bypass with vascular prosthesis were performed in the surgical treatment, which showed good results on the further follow-ups. A month after the procedure the patient had a rupture of the thoracoabdominal aortic aneurysm with fatal result. Therefore, it is recommended to perform a search for another aneurysm, especially on the aortoiliac segment, in every diagnosed PFAA case.

  16. Authentication of Radial Versus Femoral Arterial Pressure Waveform-Derived Cardiac Output With Transesophageal Echocardiography-Derived Cardiac Output Measurements in Patients Undergoing On-Pump Coronary Bypass Surgery.

    PubMed

    Maddali, Madan Mohan; Waje, Niranjan Dilip; Sathiya, Panchatcharam Murthi

    2017-08-01

    The aim of this study was to ascertain if arterial waveform-derived cardiac output measurements from radial and femoral cannulation sites were reliable as compared with transesophageal echocardiography (TEE)-derived cardiac output (CO) values, and which of the CO measurements derived from radial and the femoral arterial pressure waveforms closely tracked simultaneously measured TEE-derived CO values. This study also aimed to ascertain if cardiopulmonary bypass (CPB) would impact the accuracy of arterial pressure-derived CO values from either of the 2 sites. A prospective observational study. Tertiary care cardiac center. Cardiac surgical patients undergoing on-pump primary coronary artery bypass surgery. Waveform-derived CO monitoring through radial and femoral artery cannulation using a FloTrac/Vigileo system. Twenty-seven consecutive cardiac surgical patients undergoing on-pump primary coronary artery bypass surgery were included in the study. Cardiac output was measured sequentially by the arterial pressure waveform analysis method from radial and femoral arterial sites and compared with simultaneously measured TEE-derived CO. Cardiac output data were obtained in triplicate at 6 predefined time intervals: before and after sternotomy, 5, 15, and 30 minutes after separation from CPB and prior to shifting the patient out of the operating room. The overall bias of the study was 0.11 and 0.27, the percentage error was 19.31 and 18.45, respectively, for radial and femoral arterial waveform-derived CO values as compared with TEE-derived CO measurements. The overall precision as compared with the TEE-derived CO values was 16.94 and 15.95 for the radial and femoral cannulation sites, respectively. The bias calculated by the Bland-Altman method suggested that CO measurements from the radial arterial site were in closer agreement with TEE-derived CO values at all time periods, and the relation was not affected by CPB. However, percentage error and precision calculations

  17. Endovascular repair of femoral artery pseudoaneurysm after orthopedic surgery with balloon-expandable covered stents.

    PubMed

    Eslami, Mohammad H; Silvia, Brian A

    2008-01-01

    Arterial injury after orthopedic procedures is an uncommon complication that can present clinically in a variety of forms and has conventionally been repaired by open vascular surgery. The case and discussion in this article highlights the usefulness of endovascular repair following a delayed presentation of vascular injury from an orthopedic procedure.

  18. Broad-range TRP channel inhibitors (2-APB, flufenamic acid, SKF-96365) affect differently contraction of resistance and conduit femoral arteries of rat.

    PubMed

    Bencze, Michal; Behuliak, Michal; Vavřínová, Anna; Zicha, Josef

    2015-10-15

    Transient receptor potential (TRP) channels are proposed to contribute to membrane depolarization and Ca2+ influx into vascular smooth muscle (VSM) cells. Our aim was to study the effects of widely used broad-range TRP channel inhibitors--2-aminoethoxydiphenyl borate (2-APB), flufenamic acid (FFA) and SKF-96365--on the contraction of freshly isolated small and large arteries. Endothelium-denuded resistance (≈250 µm) and conduit (≈1000 µm) femoral arteries were isolated from adult Wistar rats and mounted in wire myograph. The effects of the above mentioned TRP channel inhibitors and voltage-dependent calcium channel inhibitor nifedipine were studied on arterial contractions induced by phenylephrine, U-46619 or K+. Phenylephrine-induced contractions were also studied in the absence of extracellular Na+. mRNA expression of particular canonical and melastatin TRP channel subunits in femoral vascular bed was determined. TRP channel inhibitors attenuated K+-induced contraction less than nifedipine. Phenylephrine-induced contraction was more influenced by 2-APB in resistance arteries, while FFA completely prevented U-46619-induced contraction in both sizes of arteries. The absence of extracellular Na+ prevented the inhibitory effects of 2-APB, but not those of FFA. The observed effects of broad-range TRP channel inhibitors, which were dependent on the size of the artery, confirmed the involvement of TRP channels in agonist-induced contractions. The inhibitory effects of 2-APB (but not those of FFA or SKF-96365) were dependent on the presence of extracellular Na+.

  19. Combined radial-tibial access strategy and radial-tibial reverse CART in a patient with aortobifemoral graft and complex superficial femoral artery occlusion.

    PubMed

    Hanna, Elias B; Prout, Davey L

    2017-09-01

    We present the case of a patient with a history of aortobifemoral grafting who presented with left lower extremity ischemic rest pain. Aortofemoral angiography was performed through a left radial access and showed a long, calcified total occlusion of the left superficial femoral artery (SFA) and a subtotal popliteal occlusion. The popliteal artery and SFA were crossed retrogradely through a 4-Fr anterior tibial access; the retrograde devices went subintimally and did not reenter at the common femoral level. Subsequently, the radial access was used for antegrade subintimal crossing and dilatation of the SFA, which allowed reentry of the retrograde devices (radial-tibial reverse controlled antegrade-retrograde tracking [CART]). The SFA was then successfully treated retrogradely with orbital atherectomy and drug-coated balloon angioplasty, through a 4-Fr equivalent tibial sheath. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  20. Chimeric flaps pedicled with the lateral circumflex femoral artery for individualised reconstruction of through-and-through oral and maxillofacial defects.

    PubMed

    Gong, Zhao-jian; Zhang, Sheng; Wang, Kai; Tan, Hong-yu; Zhu, Zhao-fu; Liu, Jin-bing; Ren, Zhen-hu; He, Zhi-jing; Wu, Han-jiang

    2015-02-01

    Reconstruction of through-and-through oral and maxillofacial defects has always been difficult. We have evaluated the feasibility and reconstructive efficacy of chimeric flaps pedicled with the lateral circumflex femoral artery in the reconstruction of 41 through-and-through oral and maxillofacial defects after resections for cancer. There were 29 chimeric anterolateral thigh and anterolateral thigh flaps and 12 chimeric anterolateral thigh and anteromedial thigh flaps, the sizes of which ranged from 5×8 to 9×11 cm. The chimeric flaps provided separate flaps to reconstruct the intraoral mucosa and extraoral skin defects, and 40/41 of them survived. The appearance and function were satisfactory in all patients after the reconstruction. Chimeric flaps pedicled with the lateral circumflex femoral artery are a good choice for the reconstruction of through-and-through oral and maxillofacial defects.

  1. An analysis of factors affecting the mercury content in the human femoral bone.

    PubMed

    Zioła-Frankowska, A; Dąbrowski, M; Kubaszewski, Ł; Rogala, P; Kowalski, A; Frankowski, M

    2017-01-01

    The study was carried out to determine the content of mercury in bone tissue of the proximal femur (head and neck bone) of 95 patients undergoing total hip replacement due to osteoarthritis, using CF-AFS analytical technique. Furthermore, the investigations were aimed at assessing the impact of selected factors, such as age, gender, tobacco smoking, alcohol consumption, exposure to chemical substance at work, type of degenerative changes, clinical evaluation and radiological parameters, type of medications, on the concentration of mercury in the head and neck of the femur, resected in situ. Mercury was obtained in all samples of the head and neck of the femur (n = 190) in patients aged 25-91 years. The mean content of mercury for the whole group of patients was as follows: 37.1 ± 35.0 ng/g for the femoral neck and 24.2 ± 19.5 ng/g for the femoral head. The highest Hg contents were found in femoral neck samples, both in women and men, and they amounted to 169.6 and 176.5 ng/g, respectively. The research showed that the mercury content of bones can be associated with body mass index, differences in body anatomy, and gender. The uses of statistical analysis gave the possibility to define the influence of factors on mercury content in human femoral bones.

  2. Quantitative comparison of the microscopic anatomy of the human ACL femoral and tibial entheses.

    PubMed

    Beaulieu, Mélanie L; Carey, Grace E; Schlecht, Stephen H; Wojtys, Edward M; Ashton-Miller, James A

    2015-12-01

    The femoral enthesis of the human anterior cruciate ligament (ACL) is known to be more susceptible to injury than the tibial enthesis. To determine whether anatomic differences might help explain this difference, we quantified the microscopic appearance of both entheses in 15 unembalmed knee specimens using light microscopy, toluidine blue stain and image analysis. The amount of calcified fibrocartilage and uncalcified fibrocartilage, and the ligament entheseal attachment angle were then compared between the femoral and tibial entheses via linear mixed-effects models. The results showed marked differences in anatomy between the two entheses. The femoral enthesis exhibited a 3.9-fold more acute ligament attachment angle than the tibial enthesis (p<0.001), a 43% greater calcified fibrocartilage tissue area (p<0.001), and a 226% greater uncalcified fibrocartilage depth (p<0.001), with the latter differences being particularly pronounced in the central region. We conclude that the ACL femoral enthesis has more fibrocartilage and a more acute ligament attachment angle than the tibial enthesis, which provides insight into why it is more vulnerable to failure.

  3. Vasculitic peripheral neuropathy induced by ischemia-reperfusion in the rat femoral artery involves activation of proinflammatory signaling pathway in the sciatic nerve.

    PubMed

    Chung, Chih-Yang; Chang, Yi-Wei; Huang, Chun-Jen; Wang, Po-Kai; Wan, Hung-Chieh; Lin, Yi-Ying; Kao, Ming-Chang

    2017-08-24

    Ischemia-reperfusion (IR) in the rat femoral artery has been proposed as an experimental model of vasculitic peripheral neuropathy (VPN) which presents neuropathic pain and peripheral nerve injury patterns observed clinically. This study investigates the involvement of the proinflammatory signaling pathway underlying the peripheral mechanisms of VPN. Male Sprague-Dawley rats were allocated to receive either a sham operation or IR. IR was induced by occluding the right femoral artery for 4h followed by reperfusion periods from 0 to 72h. The behavioral parameters were assessed at baseline as well as at days 1, 2 and 3 after reperfusion. The time-course analyses of proinflammatory mediators in the sciatic nerves were also performed on rats of the sham group or IR groups with reperfusion periods of 0, 2, 4, 24 and 72h, respectively. The behavioral data confirmed that this VPN model induced hindpaw mechano-allodynia and heat hyperalgesia as well as impaired hindpaw grip strength. The molecular data revealed that IR in the femoral artery activated the expression of nuclear factor-κB (NF-κB) in the sciatic nerve indicating a neuroinflammatory response. Moreover, IR in the femoral artery increased the expression of proinflammatory cytokines TNF-α and IL-1β in the sciatic nerve. This study elucidated the novel time-course expression profiles of NF-κB and proinflammatory cytokines in VPN induced by IR which may be involved in the development of neuropathic pain. Since NF-κB is a key element during neuroinflammation, strategies targeting the NF-κB signaling pathway may provide therapeutic potential against VPN induced by IR. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Aortoiliac reconstruction in patients with combined iliac and superficial femoral arterial occlusion.

    PubMed

    Sumner, D S; Strandness, D E

    1978-09-01

    Despite revascularization of the common femoral--profunda femoris system, many patients fail to obtain satisfactory relief from claudication or rest pain. Clinical observations were compared with objective physiological data in 54 technically successful aortoiliofemoral reconstructions for multilevel disease. Nine of 28 operations (32%) for claudication and five of 26 operations (19%) for ischemia at rest had poor results. While the average ankle pressure index (API = ankle blood pressure/arm blood pressure) rose from 0.52 +/- 0.03 (SEM) to 0.81 +/- 0.03 in limbs treated successfully for claudication, it changed insignificantly in those with an unsuccessful result (0.58 +/- 0.04 to 0.61 +/- 0.04). When ischemic symptoms were relieved, API rose from 0.23 +/- 0.04 to 0.55 +/- 0.03 but increased only from 0.22 +/- 0.09 to 0.40 +/- 0.02 in limbs with insufficient improvement. Preoperative thigh pressure index (TPI) in claudicating limbs with poor results (0.96 +/- 0.05) differed little from that in limbs with good results (0.92 +/- 0.05); nor was the TPI of ischemic limbs with poor results (0.83 +/- 0.13) significantly greater than that in limbs with good results (0.60 +/- 0.05). Neither the TPI nor the thigh to ankle pressure gradient was of value in predicting which extremities would respond poorly to aortoiliofemoral reconstruction.

  5. The protective effect of cilostazol on isolated rabbit femoral arteries under conditions of ischemia and reperfusion: the role of the nitric oxide pathway

    PubMed Central

    Santos, Mariana R.G.A.; Celotto, Andréa C; Capellini, Verena K; Evora, Paulo R B; Piccinato, Carlos E; Joviliano, Edwaldo E

    2012-01-01

    OBJECTIVES: The clinical significance of ischemia/reperfusion of the lower extremities demands further investigation to enable the development of more effective therapeutic alternatives. This study investigated the changes in the vascular reactivity of the rabbit femoral artery and nitric oxide metabolites under partial ischemia/reperfusion conditions following cilostazol administration. METHODS: Ischemia was induced using infrarenal aortic clamping. The animals were randomly divided into seven groups: Control 90 minutes, Ischemia/Reperfusion 90/60 minutes, Control 120 minutes, Ischemia/Reperfusion 120/90 minutes, Cilostazol, Cilostazol before Ischemia/Reperfusion 120/90 minutes, and Ischemia 120 minutes/Cilostazol/Reperfusion 90 minutes. Dose-response curves for sodium nitroprusside, acetylcholine, and the calcium ionophore A23187 were obtained in isolated femoral arteries. The levels of nitrites and nitrates in the plasma and skeletal muscle were determined using chemiluminescence. RESULTS: Acetylcholine- and A23187-induced relaxation was reduced in the Ischemia/Reperfusion 120/90 group, and treatment with cilostazol partially prevented this ischemia/reperfusion-induced endothelium impairment. Only cilostazol treatment increased plasma levels of nitrites and nitrates. An elevation in the levels of nitrites and nitrates was observed in muscle tissues in the Ischemia/Reperfusion 120/90, Cilostazol/Ischemia/Reperfusion, and Ischemia/Cilostazol/Reperfusion groups. CONCLUSION: Hind limb ischemia/reperfusion yielded an impaired endothelium-dependent relaxation of the femoral artery. Furthermore, cilostazol administration prior to ischemia exerted a protective effect on endothelium-dependent vascular reactivity under ischemia/reperfusion conditions. PMID:22358243

  6. Successful Endovascular Repair of an Iatrogenic Perforation of the Superficial Femoral Artery Using Self-Expanding Nitinol Supera Stents in a Patient with Acute Thromboembolic Limb Ischemia.

    PubMed

    Eisele, Tom; Muenz, Benedikt M; Korosoglou, Grigorios

    2016-01-01

    The treatment of acute thromboembolic limb ischemia includes well-established surgical thrombectomy procedures and, in recent times, also percutaneous rotational thrombectomy using Straub Rotarex® system. This modality not only enables efficient treatment of such thrombotic occlusion but also in rare cases may imply the risk of perforation of the occluded artery. Herein, we report the case of a perforation of the superficial femoral artery (SFA) in an elderly female patient with thromboembolic limb ischemia. The perforation was successfully treated by implantation of self-expanding nitinol Supera stents and without the need for implantation of a stent graft.

  7. Successful Endovascular Repair of an Iatrogenic Perforation of the Superficial Femoral Artery Using Self-Expanding Nitinol Supera Stents in a Patient with Acute Thromboembolic Limb Ischemia

    PubMed Central

    Eisele, Tom; Muenz, Benedikt M.

    2016-01-01

    The treatment of acute thromboembolic limb ischemia includes well-established surgical thrombectomy procedures and, in recent times, also percutaneous rotational thrombectomy using Straub Rotarex® system. This modality not only enables efficient treatment of such thrombotic occlusion but also in rare cases may imply the risk of perforation of the occluded artery. Herein, we report the case of a perforation of the superficial femoral artery (SFA) in an elderly female patient with thromboembolic limb ischemia. The perforation was successfully treated by implantation of self-expanding nitinol Supera stents and without the need for implantation of a stent graft. PMID:27213074

  8. Vasculo-Behçet's Disease that Began with Femoral Arterial Pseudoaneurysm Followed by Deep Venous Thrombosis: Report of a Case.

    PubMed

    Haruki, Tomohiro; Miyasaka, Shigeto; Maeta, Hiroyuki; Morimoto, Keisuke; Taniguchi, Iwao

    2009-01-01

    Vasculo-Behçet's disease mainly affects the venous system and central or peripheral arteries. It is often difficult to diagnosis this due to the complexity of symptoms and the rarity. A 35-year-old man with refractory inguinal lymphadenitis was admitted to our hospital. He was diagnosed with left femoral arterial pseudoaneurysm by enhanced CT scan of the lower legs, and we performed an emergency operation. Seven months postoperatively, he suddenly developed deep venous thrombosis, and then, symptoms such as aphthous stomatitis and pudendal ulcer started to develop progressively, complicating his uveitis. Finally, he was diagnosed with vasculo-Behçet's disease.

  9. Chronic vascular response after self-expanding nitinol stent implantation in superficial femoral arteries: a serial intravascular ultrasound analysis.

    PubMed

    Nishimura, Machiko; Fujii, Kenichi; Fukunaga, Masashi; Kawasaki, Daizo; Miki, Kojiro; Saita, Ten; Horimatsu, Tetsuo; Tamaru, Hiroto; Imanaka, Takahiro; Naito, Yoshiro; Masuyama, Tohru

    2016-10-01

    The mechanical properties of the self-expanding nitinol stents (SENS) and chronic biological stimulation on the wall from the SENS have not been fully investigated. This study evaluated the mechanical vascular response to SENS implantation in superficial femoral artery (SFA) lesions using serial volumetric intravascular ultrasound (IVUS). Twenty-five symptomatic patients due to de novo SFA lesions scheduled for SENS placement were prospectively enrolled. Serial IVUS studies were performed immediately after crossing with a guidewire, immediately after the procedure, and at a 8-month follow-up. Serial IVUS volumetric analysis was conducted after stent deployment and at follow-up. Mean stent, lumen and neointimal areas were calculated as the volume divided by the stent length, and the calcium arc was measured. At follow-up, SENS had increased 40.6 % in overall volume. The chronic stent expansion tended to be larger, and the mean neointimal area at the 8-month follow-up was significantly larger in less calcified lesions compared to heavily calcified lesions. As a result, the mean late lumen area loss was significantly larger in lesions with calcium arcs of 0° and in the first and second quadrants than in those with calcium arcs in the third and fourth quadrants (2.8 ± 7.2, 1.3 ± 5.6, 0.6 ± 5.9, 1.2 ± 5.4, -0.8 ± 5.2 mm(2), respectively; p < 0.001). SENSs continued to enlarge with intimal proliferation over 8 months in all lesions. Although arterial calcium affected the degree of chronic stent expansion during the follow-up period, neointimal proliferation was smaller in heavily calcified lesion compared to less calcified lesion following SENS implantation.

  10. Cost-effectiveness of superficial femoral artery endovascular interventions in the UK and Germany: a modelling study

    PubMed Central

    Kearns, Benjamin C; Thomas, Steven M

    2017-01-01

    Objectives To assess the lifetime costs and cost-effectiveness of 5 endovascular interventions to treat superficial femoral arterial disease. Design A model-based health economic evaluation. An existing decision analytical model was used, with updated effectiveness data taken from the literature, and updated costs based on purchasing prices. Setting UK and German healthcare perspectives were considered. Participants Patients with intermittent claudication of the femoropopliteal arteries eligible for endovascular treatment. Methods UK and German healthcare perspectives were considered, as were different strategies for re-intervention. Interventions Percutaneous transluminal angioplasty (PTA) with bail-out bare metal stenting (assumed to represent the existing standard of care, and 4 alternatives: primary bare metal stents, drug-eluting stents, drug-eluting balloons (DEBs) and biomimetic stents). Primary outcome measures The incremental cost-effectiveness ratio between 2 treatments, defined as the incremental costs divided by the incremental quality-adjusted life years (QALYs). Results Use of a biomimetic stent, BioMimics 3D, was always estimated to dominate the other interventions, having lower lifetime costs and greater effectiveness, as measured by QALYs. Of the remaining interventions, DEBs were always the most effective, and PTA the least effective. There was uncertainty in the cost-effectiveness results, with key drivers being the costs and effectiveness of the biomimetic stent along with the costs of DEBs. Conclusions All 4 of the alternatives to PTA were more effective, with the biomimetic stent being the most cost-effective. As there was uncertainty in the results, and all of the interventions have different mechanisms of action, all 4 may be considered to be alternatives to PTA. PMID:28087551

  11. Evaluation of electric field distribution in electromagnetic stimulation of human femoral head.

    PubMed

    Su, Yukun; Souffrant, Robert; Kluess, Daniel; Ellenrieder, Martin; Mittelmeier, Wolfram; van Rienen, Ursula; Bader, Rainer

    2014-12-01

    Electromagnetic stimulation is a common therapy used to support bone healing in the case of avascular necrosis of the femoral head. In the present study, we investigated a bipolar induction screw system with an integrated coil. The aim was to analyse the influence of the screw parameters on the electric field distribution in the human femoral head. In addition, three kinds of design parameters (the shape of the screw tip, position of the screw in the femoral head, and size of the screw insulation) were varied. The electric field distribution in the bone was calculated using the finite element software Comsol Multiphysics. Moreover, a validation experiment was set up for an identical bone specimen with an implanted screw. The electric potential of points inside and on the surface of the bone were measured and compared to numerical data. The electric field distribution within the bone was clearly changed by the different implant parameters. Repositioning the screw by a maximum of 10 mm and changing the insulation length by a maximum of 4 mm resulted in electric field volume changes of 16% and 7%, respectively. By comparing the results of numerical simulation with the data of the validation experiment, on average, the electric potential difference of 19% and 24% occurred when the measuring points were at a depth of approximately 5 mm within the femoral bone and directly on the surface of the femoral bone, respectively. The results of the numerical simulations underline that the electro-stimulation treatment of bone in clinical applications can be influenced by the implant parameters.

  12. Comparison of time-frequency distribution techniques for analysis of simulated Doppler ultrasound signals of the femoral artery.

    PubMed

    Guo, Z; Durand, L G; Lee, H C

    1994-04-01

    The time-frequency distribution of the Doppler ultrasound blood flow signal is normally computed by using the short-time Fourier transform or autoregressive modeling. These two techniques require stationarity of the signal during a finite interval. This requirement imposes some limitations on the distribution estimate. In the present study, three new techniques for nonstationary signal analysis (the Choi-Williams distribution, a reduced interference distribution, and the Bessel distribution) were tested to determine their advantages and limitations for analysis of the Doppler blood flow signal of the femoral artery. For the purpose of comparison, a model stimulating the quadrature Doppler signal was developed, and the parameters of each technique were optimized based on the theoretical distribution. Distributions computed using these new techniques were assessed and compared with those computed using the short-time Fourier transform and autoregressive modeling. Three indexes, the correlation coefficient, the integrated squared error, and the normalized root-mean-squared error of the mean frequency waveform, were used to evaluate the performance of each technique. The results showed that the Bessel distribution performed the best, but the Choi-Williams distribution and autoregressive modeling are also techniques which can generate good time-frequency distributions of Doppler signals.

  13. Role of Stent Grafts and Helical-Woven Bare-Metal Stents in the Superficial Femoral and Popliteal Arteries.

    PubMed

    Madassery, Sreekumar; Turba, Ulku C; Arslan, Bulent

    2016-06-01

    Peripheral vascular disease (PVD) is a devastating medical problem that may lead to significant life alterations for patients, from simply limiting their daily activities to potential loss of limbs and eventual demise. Superficial femoral and popliteal arteries are significantly common locations for PVD sequelae to present itself, and owing to their length and mobile nature, treatment of these segments are quite challenging. Indications for PVD treatment include lifestyle-limiting claudication that is not responding to medical management, ischemic rest pain, nonhealing ulcers, and lower extremity gangrene. There is a wide variety of treatment options that include medical management, interventional, and surgical techniques. Interventional techniques include plain old balloon angioplasty, cryoplasty, drug-coated balloon angioplasty, self-expanding bare-nitinol stents, self-expanding covered stents, self-expanding drug-eluding stents, and a number of atherectomy devices (ie, laser, rotational, orbital, and excisional). The scope of this article is to review indications, patient selection, and deployment techniques of Viabahn and Supera self-expanding stents. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Effectiveness of Viabahn in the Treatment of Superficial Femoral Artery Occlusive Disease: A Systematic Review and Meta-analysis.

    PubMed

    Zhang, Lei; Bao, Junmin; Zhao, Zhiqing; Lu, Qingsheng; Zhou, Jian; Jing, Zaiping

    2015-08-01

    To evaluate the effectiveness of the Viabahn stent-graft in the treatment of superficial femoral artery (SFA) occlusive disease. A systematic review and meta-analysis of published studies was performed to evaluate the efficacy of the Viabahn for SFA lesions. Studies were stratified according to controlled vs uncontrolled design and analyzed using random-effects models. Outcomes are reported as the risk ratio (RR) and 95% confidence interval (CI). Four prospective randomized controlled trials, one retrospective controlled study, and 9 uncontrolled studies were identified. In controlled studies, primary patency with the Viabahn was superior to other interventions at 1 year (RR 0.63, 95% CI 0.49 to 0.82, p<0.001) and ankle-brachial index (ABI) improvement was greater at 6 months (mean difference 0.05, 95% CI 0.01 to 0.09, p=0.01) compared with other interventions. Subgroup analysis demonstrated a lower incidence of stent fracture in lesions with >15-cm stented lengths. In uncontrolled studies, ABI improvement was consistently superior at all measurement points during follow-up. Current evidence suggests that the Viabahn stent-graft is a safe and effective option for symptomatic SFA lesions. Prospective multicenter randomized controlled trials with long-term follow-up are needed to confirm the sustained efficacy of the Viabahn device. © The Author(s) 2015.

  15. Lower extremity computed tomography angiography can help predict technical success of endovascular revascularization in the superficial femoral and popliteal artery.

    PubMed

    Itoga, Nathan K; Kim, Tanner; Sailer, Anna M; Fleischmann, Dominik; Mell, Matthew W

    2017-09-01

    Preprocedural computed tomography angiography (CTA) assists in evaluating vascular morphology and disease distribution and in treatment planning for patients with lower extremity peripheral artery disease (PAD). The aim of the study was to determine the predictive value of radiographic findings on CTA and technical success of endovascular revascularization of occlusions in the superficial femoral artery-popliteal (SFA-pop) region. Medical records and available imaging studies were reviewed for patients undergoing endovascular intervention for PAD between January 2013 and December 2015 at a single academic institution. Radiologists reviewed preoperative CTA scans of patients with occlusions in the SFA-pop region. Radiographic criteria previously used to evaluate chronic occlusions in the coronary arteries were used. Technical success, defined as restoration of inline flow through the SFA-pop region with <30% stenosis at the end of the procedure, and intraoperative details were evaluated. From 2013 to 2015, there were 407 patients who underwent 540 endovascular procedures for PAD. Preprocedural CTA scans were performed in 217 patients (53.3%), and 84 occlusions in the SFA-pop region were diagnosed. Ten occlusions were excluded as no endovascular attempt to cross the lesion was made because of extensive disease or concomitant iliac intervention. Of the remaining 74 occlusions in the SFA-pop region, 59 were successfully treated (80%) and 15 were unsuccessfully crossed (20%). The indications for revascularization were claudication in 57% of patients and critical limb ischemia in the remaining patients. TransAtlantic Inter-Society Consensus A, B, and C occlusions were treated with 87% success, whereas D occlusions were treated with 68% success (P = .047). There were nine occlusions with 100% vessel calcification that was associated with technical failure (P = .014). Longer lengths of occlusion were also associated with technical failure (P = .042). Multiple

  16. Drug-eluting stents in superficial femoral artery treatment: could they be the standard of care?

    PubMed

    Bosiers, Marc; Deloose, Koen; Callaert, Joren; Peeters, Patrick; Bosiers, Michel

    2016-12-01

    Endovascular techniques have improved markedly over the past several decades. Plain old balloon angioplasty can only reach patencies around 40% after 1 year. Scaffolding stents have resulted in improved short-term results but encountered limitations for longer-term durability. With the introduction of drug-eluting technologies the process of intimal hyperplasia might be slowed, resulting in improved long-term patency results. At first, limus-eluting technologies were not able to transfer the enthusiasm from the coronaries to the infrainguinal vascular bed. However, the newer generation paclitaxel-eluting technologies perform significantly better in femoropopliteal arteries than their non-eluting or non-coated counterparts. The results of a prospective randomized trial comparing DES versus DCB is eagerly awaited. For the moment there seems, based on the meta-analysis, no difference between the two treatment modalities. Although, we need to keep in mind that DCB perform worse in long calcified lesions.

  17. Passive biaxial mechanical properties and in vivo axial pre-stretch of the diseased human femoropopliteal and tibial arteries.

    PubMed

    Kamenskiy, Alexey V; Pipinos, Iraklis I; Dzenis, Yuris A; Lomneth, Carol S; Kazmi, Syed A Jaffar; Phillips, Nicholas Y; MacTaggart, Jason N

    2014-03-01

    Surgical and interventional therapies for atherosclerotic lesions of the infrainguinal arteries are notorious for high rates of failure. Frequently, this leads to expensive reinterventions, return of disabling symptoms or limb loss. Interaction between the artery and repair material likely plays an important role in reconstruction failure, but data describing the mechanical properties and functional characteristics of human femoropopliteal and tibial arteries are currently not available. Diseased superficial femoral (SFA, n = 10), popliteal (PA, n = 8) and tibial arteries (TA, n = 3) from 10 patients with critical limb ischemia were tested to determine passive mechanical properties using planar biaxial extension. All specimens exhibited large nonlinear deformations and anisotropy. Under equibiaxial loading, all arteries were stiffer in the circumferential direction than in the longitudinal direction. Anisotropy and longitudinal compliance decreased distally, but circumferential compliance increased, possibly to maintain a homeostatic multiaxial stress state. Constitutive parameters for a four-fiber family invariant-based model were determined for all tissues to calculate in vivo axial pre-stretch that allows the artery to function in the most energy efficient manner while also preventing buckling during extremity flexion. Calculated axial pre-stretch was found to decrease with age, disease severity and more distal arterial location. Histological analysis of the femoropopliteal artery demonstrated a distinct sub-adventitial layer of longitudinal elastin fibers that appeared thicker in healthier arteries. The femoropopliteal artery characteristics and properties determined in this study may assist in devising better diagnostic and treatment modalities for patients with peripheral arterial disease.

  18. PASSIVE BIAXIAL MECHANICAL PROPERTIES AND IN VIVO AXIAL PRE-STRETCH OF THE DISEASED HUMAN FEMOROPOPLITEAL AND TIBIAL ARTERIES

    PubMed Central

    Kamenskiy, Alexey V.; Pipinos, Iraklis I.; Dzenis, Yuris A.; Lomneth, Carol S.; Jaffar Kazmi, Syed A.; Phillips, Nicholas Y.; MacTaggart, Jason N.

    2015-01-01

    Surgical and interventional therapies for atherosclerotic lesions of the infrainguinal arteries are notorious for high rates of failure. Frequently, this leads to expensive reinterventions, return of disabling symptoms, or limb loss. Interaction between the artery and repair material likely plays an important role in reconstruction failure, but data describing the mechanical properties and functional characteristics of human femoropopliteal and tibial arteries are currently not available. Diseased superficial femoral (SFA, n=10), popliteal (PA, n=8), and tibial arteries (TA, n=3) from 10 patients with critical limb ischemia were tested to determine passive mechanical properties using planar biaxial extension. All specimens exhibited large non-linear deformations and anisotropy. Under equibiaxial loading, all arteries were stiffer in the circumferential direction than in the longitudinal direction. Anisotropy and longitudinal compliance decreased distally, but circumferential compliance increased, possibly to maintain a homeostatic multiaxial stress state. Constitutive parameters for a 4-fiber family invariant-based model were determined for all tissues to calculate in vivo axial pre-stretch that allows the artery to function in the most energy efficient manner while also preventing buckling during extremity flexion. Calculated axial pre-stretch was found to decrease with age, disease severity, and more distal arterial location. Histological analysis of the femoropopliteal artery demonstrated a distinct sub-adventitial layer of longitudinal elastin fibers that appeared thicker in healthier arteries. The femoropopliteal artery characteristics and properties determined in this study may assist in devising better diagnostic and treatment modalities for patients with peripheral arterial disease. PMID:24370640

  19. Impaired compensation to femoral artery ligation in diet-induced obese mice is primarily mediated via suppression of collateral growth by Nox2 and p47phox

    PubMed Central

    DiStasi, Matthew R.; Mund, Julie A.; Bohlen, H. Glenn; Miller, Steven J.; Ingram, David A.; Dalsing, Michael C.

    2015-01-01

    The present study was undertaken to establish the role of NADPH oxidase (Nox) in impaired vascular compensation to arterial occlusion that occurs in the presence of risk factors associated with oxidative stress. Diet-induced obese (DIO) mice characterized by multiple comorbidities including diabetes and hyperlipidemia were used as a preclinical model. Arterial occlusion was induced by distal femoral artery ligation in lean and DIO mice. Proximal collateral arteries were identified as the site of major (∼70%) vascular resistance to calf perfusion by distal arterial pressures, which decreased from ∼80 to ∼30 mmHg with ligation in both lean and DIO mice. Two weeks after ligation, significant vascular compensation occurred in lean but not DIO mice as evidenced by increased perfusion (147 ± 48% vs. 49 ± 29%) and collateral diameter (151 ± 30% vs. 44 ± 17%). Vascular mRNA expression of p22phox, Nox2, Nox4, and p47phox were all increased in DIO mice. Treatment of DIO mice with either apocynin or Nox2ds-tat or with whole body ablation of either Nox2 or p47phox ameliorated the impairment in both collateral growth and hindlimb perfusion. Multiparametric flow cytometry analysis demonstrated elevated levels of circulating monocytes in DIO mice without impaired mobilization and demargination after femoral artery ligation. These results establish collateral resistance as the major limitation to calf perfusion in this preclinical model, demonstrate than monocyte mobilization and demarginatin is not suppressed, implicate Nox2-p47phox interactions in the impairment of vascular compensation to arterial occlusion in DIO mice, and suggest that selective Nox component suppression/inhibition may be effective as either primary or adjuvant therapy for claudicants. PMID:26297224

  20. Improvement in Claudication After Angioplasty of Distal Ostial Collateral Stenosis in Patients with Long-Segment Occlusion of the Femoral Artery

    SciTech Connect

    Mueller-Buehl, Uwe; Strecker, Ernst-Peter; Goettmann, Dieter; Vetter, Sylvia; Boos, Irene B.L.

    2000-11-15

    Purpose: To evaluate the angiographic and clinical effects of percutaneous transluminal angioplasty (PTA) of distal ostial collateral stenoses in patients with claudication and long-segment occlusion of the superficial femoral artery (SFA).Methods: In ten patients (9 men, 1 woman) with stable intermittent claudication due to chronic long-segment occlusion of the SFA a high-grade stenosis of the distal collateral ostium of the deep femoral artery to the popliteal artery were dilated. PTA was performed using popliteal artery access. Claudication distances on the treadmill and ankle-brachial pressure indices (ABI) at rest were analyzed before, 1 week, and 14 weeks after PTA.Results: Initial technical success was obtained in all patients. There were no significant periprocedural local complications. The initial mean claudication distance on the treadmill increased significantly from 107 {+-} 65 m to 306 {+-} 209 m (p < 0.01), the maximal claudication distance from 203 {+-} 128 m to 392 {+-} 167 m (p < 0.01). The mean ABI changed slightly but significantly (0.61 {+-} 0.08 vs. 0.64 {+-} 0.07; p < 0.05). Early follow-up after 14 weeks revealed no clinical deterioration.Conclusion: This new technique is considered helpful in patients with well-defined claudication and long-segment occlusion of the SFA.

  1. Fluid dynamic study in a femoral artery branch casting of man with upstream main lumen curvature for steady flow.

    PubMed

    Back, M R; Cho, Y I; Back, L H

    1985-08-01

    An in-vitro, steady flow investigation was conducted in a hollow, transparent vascular replica of the profunda femoris branch of man for a range of physiological flow conditions. The replica casting tested was obtained from a human cadaver and indicated some plaque formation along the main lumen and branch. The flow visualization observations and measured pressure distributions indicated the highly three-dimensional flow characteristics with arterial curvature and branching, and the important role of centrifugal effects in fluid transport mechanisms.

  2. Fluid dynamic study in a femoral artery branch casting of man with upstream main lumen curvature for steady flow

    NASA Technical Reports Server (NTRS)

    Cho, Y. I.; Back, L. H.; Back, M. R.

    1985-01-01

    An in-vitro, steady flow investigation was conducted in a hollow, transparent vascular replica of the profunda femoris branch of man for a range of physiological flow conditions. The replica casting tested was obtained from a human cadaver and indicated some plague formation along the main lumen and branch. The flow visualization observations and measured pressure distributions indicated the highly three-dimensional flow characteristics with arterial curvature and branching, and the important role of centrifugal effects in fluid transport mechanisms.

  3. Response of human coronary arteries at different mechanical conditions.

    PubMed

    Atienza, J M

    2010-01-01

    The lack of reliable mechanical data on coronary arteries hampers the application of numerical models to vascular problems, and precludes physicians from knowing in advance the response of coronary arteries to the different interventions. In this work, the mechanical properties of human coronary arteries have been characterized. Whole samples from human right (RC) and left anterior descending (LAD) coronary arteries aged between 23 and 83 years have been studied by means of in-vitro tensile testing up to failure. Knowledge of the mechanical response of human coronary arteries could be applied to optimize the election of vascular grafts or to prevent arterial damage during angioplasty.

  4. Development of cortical bone geometry in the human femoral and tibial diaphysis.

    PubMed

    Gosman, James H; Hubbell, Zachariah R; Shaw, Colin N; Ryan, Timothy M

    2013-05-01

    Ontogenetic growth processes in human long bones are key elements, determining the variability of adult bone structure. This study seeks to identify and describe the interaction between ontogenetic growth periods and changes in femoral and tibial diaphyseal shape. Femora and tibiae (n = 46) ranging developmentally from neonate to skeletally mature were obtained from the Norris Farms No. 36 archeological skeletal series. High-resolution X-ray computed tomography scans were collected. Whole-diaphysis cortical bone drift patterns and relative bone envelope modeling activity across ages were assessed in five cross-sections per bone (total bone length: 20%, 35%, 50%, 65%, and 80%) by measuring the distance from the section centroid to the endosteal and periosteal margins in eight sectors using ImageJ. Pearson correlations were performed to document and interpret the relationship between the cross-sectional shape (Imax /Imin ), total subperiosteal area, cortical area, and medullary cavity area for each slice location and age for both the femur and the tibia. Differences in cross-sectional shape between age groups at each cross-sectional position were assessed using nonparametric Mann-Whitney U tests. The data reveal that the femoral and tibial midshaft shape are relatively conserved throughout growth; yet, conversely, the proximal and distal femoral diaphysis and proximal tibial diaphysis appear more sensitive to developmentally induced changes in mechanical loading. Two time periods of accelerated change are identified: early childhood and prepuberty/adolescence.

  5. Diagnostics of femoral head status in humans using laser spectroscopy - In vitro studies.

    PubMed

    Lin, Huiying; Li, Wansha; Zhang, Hao; Chen, Peng; Chen, Delong; He, Wei; Svanberg, Sune; Svanberg, Katarina

    2016-12-23

    Osteonecrosis of the femoral head (ONFH), a recalcitrant and disabling disease, is caused by inadequate or fully disrupted blood supply to the affected segment of the subchondral bone. Theoretically, there will develop gas-filled pores during the bone decay process due to lacking blood supply. Unfortunately, the relationship between the gas-filled pores and ONFH is still unclear. Here, we have introduced diode laser absorption spectroscopy to detect oxygen and water vapor signals in the femoral heads from hip replacement in 19 patients. Five samples are affected by osteoarthritis (OA) and the others are related to ONFH. Oxygen and water vapor signals could be obtained, demonstrating the presence of gas-filled pores in both the OA and ONFH groups while the measurement results showed no significant difference. A study of gas exchange was also performed on one excised bone sample to study how these gas pores communicate with the ambient air. The results suggested that the obtained oxygen signals inside the bone samples originate from the invasion of ambient air, which is not expected in vivo. In conclusion, the ability to detect the gas signal of laser absorption spectroscopy shows the potential for the medical application of assessing the human femoral head in vivo. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  6. Common femoral artery endarterectomy for lower-extremity ischemia: evaluating the need for additional distal limb revascularization.

    PubMed

    Malgor, Rafael D; Ricotta, Joseph J; Bower, Thomas C; Oderich, Gustavo S; Kalra, Manju; Duncan, Audra A; Gloviczki, Peter

    2012-10-01

    The role of common femoral artery endarterectomy (CFE) and the need for distal revascularization is challenging in certain clinical scenarios. For some patients with claudication or rest pain CFE alone may suffice, however, some surgeons advocated that in-line flow must be re-established in patients with major tissue loss for wound healing purposes. The decision when to perform CFE with or without distal revascularization is sometimes difficult. The objective of this study was to evaluate the outcomes of common femoral artery endarterectomy (CFE) to define predictive factors for additional distal revascularization. Retrospective review of 262 consecutive CFEs in 230 patients with lower-extremity ischemia between 1997 and 2008. Patients were divided into two groups: group A (n = 169; CFE alone) and group B (n = 93; CFE + distal revascularization). Concomitant iliac intervention was included only if performed by endovascular approach. Patients were analyzed by Rutherford category (RC) and TransAtlantic InterSociety Consensus (TASC) II classification. Primary end points were mortality, patency, reintervention, and limb salvage. Demographics, preoperative Society for Vascular Surgery score assessment, and TASC II classification did not differ between groups. Mean follow-up was 75 months (range: 1-128 months). Technical success was obtained in all patients. RC (3 ± 1.2 vs. 5 ± 1.4; P = 0.001), diabetes (33% vs. 52%; P = 0.005), mean operative time (+154 minutes; P < 0.001), and length of hospital stay (+1.7 days; P = 0.03) were higher in group B. Reintervention rates were higher in group B than group A (12% vs. 3%; P = 0.015). For patients with RC 5/TASC D lesions and patients with RC 6 regardless of TASC, initial distal revascularization (group B) was associated with fewer reinterventions or major amputations (29%) than CFE alone (67%) (P = 0.002). The cumulative 5-year primary patencies for groups A and group B were 96% and 92%, respectively. Secondary patency was

  7. Local and systemic effects of leg cycling training on arterial wall thickness in healthy humans.

    PubMed

    Thijssen, Dick H J; Dawson, Ellen A; van den Munckhof, Inge C L; Birk, Gurpreet K; Timothy Cable, N; Green, Daniel J

    2013-08-01

    Exercise training is associated with direct effects on conduit artery function and structure. Cross-sectional studies suggest the presence of systemic changes in wall thickness as a result of exercise in healthy subjects, but no previous study has examined this question in humans undertaking exercise training. To examine the change in superficial femoral (SFA, i.e. local effect) and carotid (CA, i.e. systemic effect) artery wall thickness across 8 weeks of lower limb cycle training in healthy young men. Fourteen healthy young male subjects were assigned to an 8-week training study of cycling exercise (n = 9) or a control period (n = 5). Before, during (2, 4 and 6 weeks) and after training, SFA and CA wall thickness was examined using automated edge-detection of high resolution ultrasound images. We also measured resting diameter and calculated the wall:lumen(W:L)-ratio. Exercise training did not alter CA or SFA baseline diameter (P = 0.14), but was associated with gradual, consistent and significant decreases in wall thickness and W:L-ratio in both the CA and SFA (P < 0.001 and 0.002, respectively). Two-way ANOVA revealed a comparable magnitude of decrease in wall thickness and W:L-ratio in both arteries across the 8-week period (interaction-effect; P = 0.29 and 0.12, respectively). No changes in artery diameter, wall thickness or W:L-ratio were apparent in controls (0.82, 0.38 and 0.52, respectively). We found that cycle exercise training in healthy young individuals is associated with modest, but significant, decreases in wall thickness in the superficial femoral and carotid arteries. These findings suggest that exercise training causes systemic adaptation of the arterial wall in healthy young subjects. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Critical appraisal of paclitaxel balloon angioplasty for femoral-popliteal arterial disease.

    PubMed

    Herten, Monika; Torsello, Giovanni B; Schönefeld, Eva; Stahlhoff, Stefan

    2016-01-01

    Peripheral arterial disease, particularly critical limb ischemia, is an area with urgent need for optimized therapies because, to date, vascular interventions often have limited life spans. In spite of initial encouraging technical success after femoropopliteal percutaneous transluminal angioplasty or stenting, postprocedural restenosis remains the major problem. The challenging idea behind the drug-coated balloon (DCB) concept is the biological modification of the injury response after balloon dilatation. Antiproliferative drugs administered via DCBs or drug-eluting stents are able to suppress neointimal hyperplasia, the main cause of restenosis. This article reviews the results of DCB treatments of femoropopliteal and infrapopliteal lesions in comparison to standard angioplasty with uncoated balloons. A systematic literature search was performed in 1) medical journals (ie, MEDLINE), 2) international registers for clinical studies (ie, www.clinicaltrials.gov), and 3) abstracts of scientific sessions. Several controlled randomized trials with follow-up periods of up to 5 years demonstrated the efficacy of paclitaxel -DCB technology. However, calcified lesions seem to affect the efficacy of DCB. Combinations of preconditioning methods with DCBs showed promising results. Although the mechanical abrasion of calcium via atherectomy or laser ablation showed favorable periprocedural results, the long-term impact on restenosis and clinical outcome has to be demonstrated. Major advantages of the DCBs are the rapid delivery of drug at uniform concentrations with a single dose, their efficacy in areas wherein stents have been contraindicated until now (ie, bifurcation, ostial lesions), and in leaving no stent scaffold behind. Reinterventions are easier to perform because DCBs leave no metal behind. Various combinations of DCBs with other treatment modalities may prove to be viable options in future. The follow-up results of clinical studies will evaluate the long-term impact

  9. Use of Spider Filter Embolic Protection Device During Endovascular Revascularization of Acute Thromboembolic Occlusion of Superficial Femoral Artery.

    PubMed

    Jia, Zhongzhi; Zhao, Jinwei; Tian, Feng; Wang, Kai; Li, Shaoqin; Jiang, Guomin; Wang, Weiping

    2015-12-01

    To retrospectively evaluate the safety and efficacy of the Spider filter embolic protection device (EPD) in protecting patients from distal migration of thromboemboli during revascularization of acute superficial femoral artery (SFA) occlusion secondary to thromboemboli. Data from all patients at our institution who had EPD placement for embolic protection during endovascular revascularization for acute thromboembolic occlusion of the SFA were analyzed. From April 2007 to June 2014, a total of 14 patients had EPD placement during endovascular revascularization for acute SFA occlusion secondary to thromboemboli. All patients presented with acute onset of limb ischemia, and further work-up with imaging studies demonstrated thromboembolic occlusions. The duration from onset of symptoms to revascularization was 7.0 ± 2.7 h (range 2-14 h). An aspiration technique for thrombectomy was used in all 14 cases (aspiration alone, 6 cases; aspiration plus urokinase, 7 cases; additional angioplasty after urokinase, 1 case). Spider filter EPDs were successfully placed at the target in all 14 cases, and the thromboemboli were captured in 13/14 (92.9%) cases. Successful reestablishment of the SFA flow without distal branch embolism occurred in all 14 cases. There were no EPD-related complications. During a mean 32.2 ± 20.2 months of follow-up, 13 patients remained asymptomatic; one patient who underwent PTA during the procedure reported limb coolness and fatigue 6 months later because of recurrent atherosclerotic stenosis. The Spider filter EPD can be safe and effective in protecting patients from distal branch embolism when they undergo an endovascular thrombectomy procedure.

  10. Midterm results of endovascular treatment of superficial femoral artery disease with biodegradable stents: single-center experience.

    PubMed

    Silingardi, Roberto; Lauricella, Antonio; Coppi, Giovanni; Nicolosi, Emanuele; Gennai, Stefano; Coppi, Gioacchino

    2015-03-01

    To assess the midterm efficacy of a biodegradable poly-l-lactic acid (PLLA) stent in the treatment of superficial femoral artery (SFA) occlusive disease. Between June 2009 and April 2011, 35 de novo SFA lesions were treated with 43 biodegradable stents. This nonrandomized, retrospective, single-center study included patients with moderate or severe claudication, lower-limb rest pain, or ischemic ulceration restricted to the toes; symptoms were classified as Rutherford category 2 (48.6%), 3 (37.1%), 4 (8.6%), or 5 (5.7%). The population included 28 men and had a mean age of 71 years (range, 51-81 y). Follow-up included clinical examination and color-flow duplex imaging. Mean follow-up was 38.3 months (range, 30-58 mo). Technical success was reported in all patients (100%). There were no intraoperative or immediate (< 30 d) complications.. During follow-up, one in-stent occlusion and seven in-stent restenoses occurred, all of which were successfully treated with percutaneous transluminal angioplasty. Primary and secondary patency rates were 77.1% and 97.1% at 24 and 36 months, respectively. No stent recoil or stent fracture was encountered. Late follow-up (> 12 mo) by ultrasound confirmed total reabsorption of the stent structures. Clinical improvement (ie, an upward shift of at least two Rutherford categories) was achieved in all 35 patients. Midterm results for biodegradable PLLA stents for atherosclerotic SFA lesions were associated with high technical success and secondary patency rates, without stent recoil and vessel remodeling. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

  11. Twelve-month experience with the GORE® TIGRIS® Vascular Stent in the superficial femoral and popliteal arteries.

    PubMed

    Piorkowski, M; Freitas, B; Steiner, S; Botsios, S; Bausback, Y; Scheinert, D; Schmidt, A

    2015-02-01

    The aim of this paper was to report the continued mid-term follow-up of the first patients world-wide treated with the GORE(®) TIGRIS(®) Vascular Stent, a dual component stent consisting of a nitinol wire frame combined with a fluoropolymer-interconnecting structure. From December 2011 until November 2012, 32 consecutive patients (20 men, mean age 72.8 years) with 40 atherosclerotic femoropopliteal lesions (5% occlusions) underwent angioplasty and implantation of a GORE(®) TIGRIS(®) Vascular Stent. The patients were scheduled for follow-up at 3, 6 and 12 months after stent implantation for duplex ultrasound and assessment of Rutherford-Becker class (RBC) and Ankle-Brachial Index (ABI). Here we report the completed 6-month follow-up and, for the first time, a 12-month follow-up. The median follow-up was 418 days. During the 12-month follow-up 4 patients died. Restenosis or reocclusion of the stent in this time period was observed in 5 lesions (12.5%), resulting in a cumulative primary patency rate of 85.5±6.0%. The ABI increased pre-interventionally from 0.65±0.18 to 0.91±0.18 (P<0.0001) at the 12-month visit. The median RBC improved from 3 to 1 (P<0.0001). No stent thrombosis related to discontinuation of dual antiplatelet therapy 4 weeks after the index procedure was observed. The mid-term follow-up of the dual component GORE(®) TIGRIS(®) Vascular Stent showed promising results with high 12-month primary patency rates after femoropopliteal endovascular interventions. These first clinical data are very promising compared to other stent concepts in the superficial femoral and popliteal artery.

  12. A network meta-analysis of randomized controlled trials comparing treatment modalities for de novo superficial femoral artery occlusive lesions.

    PubMed

    Antonopoulos, Constantine N; Mylonas, Spyridon N; Moulakakis, Konstantinos G; Sergentanis, Theodoros N; Sfyroeras, George S; Lazaris, Andreas M; Kakisis, John D; Vasdekis, Spyros N

    2017-01-01

    Treatment of superficial femoral artery (SFA) lesions remains challenging. We conducted a network meta-analysis of randomized controlled trials aiming to explore the efficacy of treatment modalities for SFA "de novo" lesions. Eleven treatments for SFA occlusive disease were recognized. We used primary patency and binary restenosis at 12-month follow-up as proxies of efficacy for the treatment of SFA lesions. A total of 33 studies (66 study arms; 4659 patients) were deemed eligible. In terms of primary patency, odds ratios (ORs) with 95% confidence intervals (CIs) were statistically significantly higher in drug-eluting stent (DES; OR, 10.05; 95% CI, 3.22-31.39), femoropopliteal bypass surgery (BPS; OR, 7.15; 95% CI, 2.27-22.51), covered stent (CS; OR, 3.56; 95% CI, 1.33-9.53), and nitinol stent (NS; OR, 2.83; 95% CI, 1.42-5.51) compared with balloon angioplasty (BA). The rank order from higher to lower primary patency in the multidimensional scaling was DES, BPS, NS, CS, drug-coated balloon, percutaneous transluminal angioplasty with brachytherapy, stainless steel stent, cryoplasty (CR), and BA. Combination therapy of NS with CR and drug-coated balloon were the two most effective treatments, followed by NS, CS, percutaneous transluminal angioplasty with brachytherapy, cutting balloon, stainless steel stent, BA, and CR in terms of multidimensional scaling values for binary restenosis. DES has shown encouraging results in terms of primary patency for SFA lesions, whereas BPS still maintains its role as a principal intervention. On the contrary, BA and CR appear to be less effective treatment options. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  13. Transient Monoplegia as a Result of Unilateral Femoral Artery Ischemia Detected by Multimodal Intraoperative Neuromonitoring in Posterior Scoliosis Surgery

    PubMed Central

    Pankowski, Rafal; Roclawski, Marek; Dziegiel, Krzysztof; Ceynowa, Marcin; Mikulicz, Marcin; Mazurek, Tomasz; Kloc, Wojciech

    2016-01-01

    Abstract This is to report a case of 16-year-old girl with transient right lower limb monoplegia as a result of femoral artery ischemia detected by multimodal intraoperative spinal cord neuromonitoring (MISNM) during posterior correction surgery of adolescent idiopathic scoliosis. A patient with a marfanoid body habitus and LENKE IA type scoliosis with the right thoracic curve of 48° of Cobb angle was admitted for posterior spinal fusion from Th6 to L2. After selective pedicle screws instrumentation and corrective maneuvers motor evoked potentials (MEP) began to decrease with no concomitant changes in somato-sensory evoked potentials recordings. The instrumentation was released first partially than completely with rod removal but the patient demonstrated constantly increasing serious neurological motor deficit of the whole right lower limb. Every technical cause of the MEP changes was eliminated and during the wake-up test the right foot was found to be pale and cold with no popliteal and dorsalis pedis pulses palpable. The patient was repositioned and the pelvic pad was placed more cranially. Instantly, the pulse and color returned to the patient's foot. Following MEP recordings showed gradual return of motor function up to the baseline at the end of the surgery, whereas somato-sensory evoked potentials were within normal range through the whole procedure. This case emphasizes the importance of the proper pelvic pad positioning during the complex spine surgeries performed in prone position of the patient. A few cases of neurological complications have been described which were the result of vascular occlusion after prolonged pressure in the inguinal area during posterior scoliosis surgery when the patient was in prone position. If incorrectly interpreted, they would have a significant impact on the course of scoliosis surgery. PMID:26871822

  14. Quasi-linear viscoelastic properties of the human medial patello-femoral ligament.

    PubMed

    Criscenti, G; De Maria, C; Sebastiani, E; Tei, M; Placella, G; Speziali, A; Vozzi, G; Cerulli, G

    2015-12-16

    The evaluation of viscoelastic properties of human medial patello-femoral ligament is fundamental to understand its physiological function and contribution as stabilizer for the selection of the methods of repair and reconstruction and for the development of scaffolds with adequate mechanical properties. In this work, 12 human specimens were tested to evaluate the time- and history-dependent non linear viscoelastic properties of human medial patello-femoral ligament using the quasi-linear viscoelastic (QLV) theory formulated by Fung et al. (1972) and modified by Abramowitch and Woo (2004). The five constant of the QLV theory, used to describe the instantaneous elastic response and the reduced relaxation function on stress relaxation experiments, were successfully evaluated. It was found that the constant A was 1.21±0.96MPa and the dimensionless constant B was 26.03±4.16. The magnitude of viscous response, the constant C, was 0.11±0.02 and the initial and late relaxation time constants τ1 and τ2 were 6.32±1.76s and 903.47±504.73s respectively. The total stress relaxation was 32.7±4.7%. To validate our results, the obtained constants were used to evaluate peak stresses from a cyclic stress relaxation test on three different specimens. The theoretically predicted values fit the experimental ones demonstrating that the QLV theory could be used to evaluate the viscoelastic properties of the human medial patello-femoral ligament. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Wire-Interwoven Nitinol Stent Outcome in the Superficial Femoral and Proximal Popliteal Arteries: Twelve-Month Results of the SUPERB Trial.

    PubMed

    Garcia, Lawrence; Jaff, Michael R; Metzger, Christopher; Sedillo, Gino; Pershad, Ashish; Zidar, Frank; Patlola, Raghotham; Wilkins, Robert G; Espinoza, Andrey; Iskander, Ayman; Khammar, George S; Khatib, Yazan; Beasley, Robert; Makam, Satyaprakash; Kovach, Richard; Kamat, Suraj; Leon, Luis R; Eaves, William Britton; Popma, Jeffrey J; Mauri, Laura; Donohoe, Dennis; Base, Carol C; Rosenfield, Kenneth

    2015-05-01

    Stent-based therapy in the superficial femoral and popliteal arteries in patients with peripheral artery disease is compromised by restenosis and risk of stent fracture or distortion. A novel self-expanding nitinol stent was developed that incorporates an interwoven-wire design (Supera stent, IDEV Technologies, Inc, Webster, TX) to confer greater radial strength, flexibility, and fracture resistance. This prospective, multicenter, investigational device exemption, single-arm trial enrolled 264 patients with symptomatic peripheral artery disease undergoing percutaneous treatment of de novo or restenotic lesions of the superficial femoral or proximal popliteal (femoropopliteal) artery. Freedom from death, target lesion revascularization, or any amputation of the index limb at 30 days (+ 7 days) postprocedure was achieved in 99.2% (258/260) of patients (P < 0.001). Primary patency at 12 months (360 ± 30 days) was achieved in 78.9% (180/228) of the population (P < 0.001). Primary patency by Kaplan-Meier analysis at 12 months (360 days) was 86.3%. No stent fracture was observed by independent core laboratory analysis in the 243 stents (228 patients) evaluated at 12 months. Clinical assessment at 12 months demonstrated improvement by at least 1 Rutherford-Becker category in 88.7% of patients. The SUPERB Trial, an investigational device exemption study using an interwoven nitinol wire stent in the femoropopliteal artery, achieved the efficacy and safety performance goals predesignated by the Food and Drug Administration. On the basis of the high primary patency rate, absence of stent fracture, and significant improvements in functional and quality-of-life measures, the Supera stent provides safe and effective treatment of femoropopliteal lesions in symptomatic patients with peripheral artery disease. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00933270. © 2015 American Heart Association, Inc.

  16. Computer measurement of arterial disease

    NASA Technical Reports Server (NTRS)

    Armstrong, J.; Selzer, R. H.; Barndt, R.; Blankenhorn, D. H.; Brooks, S.

    1980-01-01

    Image processing technique quantifies human atherosclerosis by computer analysis of arterial angiograms. X-ray film images are scanned and digitized, arterial shadow is tracked, and several quantitative measures of lumen irregularity are computed. In other tests, excellent agreement was found between computer evaluation of femoral angiograms on living subjects and evaluation by teams of trained angiographers.

  17. Dietary supplementation of fermented soybean, natto, suppresses intimal thickening and modulates the lysis of mural thrombi after endothelial injury in rat femoral artery.

    PubMed

    Suzuki, Yasuhiro; Kondo, Kazunao; Matsumoto, Yuji; Zhao, Bing-Qing; Otsuguro, Kenichi; Maeda, Tetsuya; Tsukamoto, Yoshinori; Urano, Tetsumei; Umemura, Kazuo

    2003-07-25

    We have previously demonstrated that natto-extracts containing nattokinase (NK) inactivates plasminogen activator inhibitor type 1 and then potentiates fibrinolytic activity. In the present study, we investigated the effects of dietary supplementation with natto-extracts on neointima formation and on thrombolysis at the site of endothelial injury. Endothelial damage in the rat femoral artery was induced by intravenous injection of rose bengal followed by focal irradiation by transluminal green light. Dietary natto-extracts supplementation containing NK of 50 or 100 CU/body was started 3 weeks before endothelial injury and then continued for another 3 weeks. Intimal thickening in animals given supplementation was significantly (P<0.01) suppressed compared with controls and the intima/media ratio in animals with 50 and 100 CU/body NK and control group was 0.09 +/- 0.03, 0.09 +/- 0.06 and 0.16 +/- 0.12, respectively. Although femoral arteries were reopened both in control animals and those treated with NK within 8 hours after endothelial injury, mural thrombi were histologically observed at the site of endothelial injury. In the control group, the center of vessel lumen was reopened and mural thrombi were attached on the surface of vessel walls. In contrast, in NK-treated groups, thrombi near the vessel wall showed lysis and most of them detached from the surface of vessel walls. In conclusion, dietary natto-extracts supplementation suppressed intimal thickening produced by endothelial injury in rat femoral artery. These effects may partially be attributable to NK, which showed enhanced thrombolysis near the vessel wall.

  18. Thoracic Stent Graft Implantation for Aortic Coarctation with Patent Ductus Arteriosus via Retroperitoneal Iliac Approach in the Presence of Small Sized Femoral Artery

    PubMed Central

    Korkmaz, Ozge; Beton, Osman; Goksel, Sabahattin; Kaya, Hakkı; Berkan, Ocal

    2016-01-01

    Endovascular stent graft implantation is a favorable method for complex aortic coarctation accompanied by patent ductus arteriosus. Herein, an 18-year-old woman with complex aortic coarctation and patent ductus arteriosus was successfully treated by endovascular thoracic stent graft via retroperitoneal approach. The reason for retroperitoneal iliac approach was small sized common femoral arteries which were not suitable for stent graft passage. This case is the first aortic coarctation plus patent ductus arteriosus case described in the literature which is treated by endovascular thoracic stent graft via retroperitoneal approach. PMID:27242935

  19. Carotid femoral pulse wave velocity in type 2 diabetes and hypertension: capturing arterial health effects of step counts

    PubMed Central

    Dasgupta, Kaberi; Rosenberg, Ellen; Joseph, Lawrence; Trudeau, Luc; Garfield, Natasha; Chan, Deborah; Sherman, Mark; Rabasa-Lhoret, Rémi; Daskalopoulou, Stella S.

    2017-01-01

    Objective: Optimal medication use obscures the impact of physical activity on traditional cardiometabolic risk factors. We evaluated the relationship between step counts and carotid-femoral pulse wave velocity (cfPWV), a summative risk indicator, in patients with type 2 diabetes and/or hypertension. Research design and methods: Three hundred and sixty-nine participants were recruited (outpatient clinics; Montreal, Quebec; 2011–2015). Physical activity (pedometer/accelerometer), cfPWV (applanation tonometry), and risk factors (A1C, Homeostatic Model Assessment–Insulin Resistance, blood pressure, lipid profiles) were evaluated. Linear regression models were constructed to quantify the relationship of steps/day with cfPWV. Results: The study population comprised 191 patients with type 2 diabetes and hypertension, 39 with type 2 diabetes, and 139 with hypertension (mean ± SD: age 59.6 ± 11.2 years; BMI 31.3 ± 4.8 kg/m2; 54.2% women). Blood pressure (125/77 ± 15/9 mmHg), A1C (diabetes: 7.7 ± 1.3%; 61 mmol/mol), and low-density lipoprotein cholesterol (diabetes: 2.19 ± 0.8 mmol/l; without diabetes: 3.13 ± 1.1mmol/l) were close to target. Participants averaged 5125 ± 2722 steps/day. Mean cfPWV was 9.8 ± 2.2 m/s. Steps correlated with cfPWV, but not with other risk factors. A 1000 steps/day increment was associated with a 0.1 m/s cfPWV decrement across adjusted models and in subgroup analysis by diabetes status. In a model adjusted for age, sex, BMI, ethnicity, immigrant status, employment, education, diabetes, hypertension, medication classes, the mean cfPWV decrement was 0.11 m/s (95% confidence interval −0.2, −0.02). Conclusions: cfPWV is responsive to step counts in patients who are well controlled on cardioprotective medications. This ability to capture the ‘added value’ of physical activity supports the emerging role of cfPWV in arterial health monitoring. PMID:28129250

  20. Routine use of ultrasound guidance in femoral arterial access for peripheral vascular intervention decreases groin hematoma rates.

    PubMed

    Kalish, Jeffrey; Eslami, Mohammad; Gillespie, David; Schermerhorn, Marc; Rybin, Denis; Doros, Gheorghe; Farber, Alik

    2015-05-01

    Use of fluoroscopy and bone landmarks to guide percutaneous common femoral artery (CFA) access has decreased access site complications compared with palpation alone. However, only limited case series have examined the benefits of ultrasound to guide CFA access during peripheral vascular intervention (PVI). We evaluated the effect of routine vs selective use of ultrasound guidance (UG) on groin hematoma rates after PVI. The Vascular Study Group of New England database (2010-2014) was queried to identify the complication of postprocedural groin hematoma after 7359 PVIs performed through CFA access. Hematoma (including pseudoaneurysms) was defined as minor (requiring compression or observation), moderate (requiring transfusion or thrombin injection), and major (requiring operation). Both procedure-level and interventionalist-level analyses were performed. Multivariable Poisson regression models were used to compare hematoma rates of interventionalists based on routine (≥80% of PVIs) and selective (<80%) utilization of UG in the adjusted overall sample and in multiple subgroups. The overall postprocedural groin hematoma rate after PVI was 4.5%, and the rate of combined moderate and major hematoma was 0.8%. Among 114 interventionalists with ≥10 PVI procedures, routine and selective UG was used by 31 (27%) and 83 (73%) interventionalists, respectively. Routine UG was protective against hematoma (rate ratio [RR], 0.62; 95% confidence interval [CI], 0.46-0.84; P < .01). Subgroup analysis revealed that routine UG was also protective against hematoma under the following circumstances: age >80 years (RR, 0.47; 95% CI, 0.27-0.85; P = .01), body mass index ≥30 (RR, 0.51; 95% CI, 0.29-0.90; P = .02), and sheath size >6F (RR, 0.43; 95% CI, 0.23-0.79; P < .01). Routine UG may potentially protect against the complication of hematoma for both modifiable and nonmodifiable patient and procedural characteristics. Encouraging routine UG is a feasible quality improvement

  1. Predictors of common femoral artery access site complications in patients on oral anticoagulants and undergoing a coronary procedure

    PubMed Central

    Shammas, Nicolas W; Shammas, Gail A; Jones-Miller, Susan; Gumpert, Mileah Rose; Gumpert, Miranda Jade; Harb, Christine; Chammas, Majid Z; Shammas, W John; Khalafallah, Rommy A; Barzgari, Amy; Bou Dargham, Bassel; Daher, Ghassan E; Rachwan, Rayan Jo; Shammas, Andrew N

    2017-01-01

    Background It is unclear whether patients on oral anticoagulants (OAC) undergoing a procedure using common femoral artery access have higher adverse events when compared to patients who are not anticoagulated at the time of the procedure. Methods We retrospectively reviewed data from consecutive patients who underwent a cardiac procedure at a tertiary medical center. Patients were considered (group A) fully or partially anticoagulated if they had an international normalized ratio (INR) ≥1.6 on the day of the procedure or were on warfarin or new OAC within 48 h and 24 h of the procedure, respectively. The nonanticoagulated group (group B) had an INR <1.6 or had stopped their warfarin and new OAC >48 h and >24 h preprocedure, respectively. The index primary end point of the study was defined as the composite end point of major bleeding, vascular complications, or cardiovascular-related death during index hospitalization. The 30-day primary end point was defined as the occurrence of the index primary end point and up to 30 days postprocedure. Results A total of 779 patients were included in this study. Of these patients, 27 (3.5%) patients were in group A. The index primary end point was met in 11/779 (1.4%) patients. The 30-day primary composite end point was met in 18/779 (2.3%) patients. There was no difference in the primary end point at index between group A (1/27 [3.7%]) and group B (10/752 [1.3%]; P=0.3155) and no difference in the 30-day primary composite end point between group A (2/27 [7.4%]) and group B (16/752 [2.1%]; P=0.1313). Multivariable analysis showed that a low creatinine clearance (odds ratio [OR] =0.56; P=0.0200) and underweight patients (<60 kg; OR =3.94; P=0.0300) were independent predictors of the 30-day primary composite end point but not oral anticoagulation (P=0.1500). Conclusion Patients on OAC did not have higher 30-day major adverse events than those who were not anticoagulated at index procedure. PMID:28408835

  2. Intravascular Ultrasound-Derived Stent Dimensions as Predictors of Angiographic Restenosis Following Nitinol Stent Implantation in the Superficial Femoral Artery.

    PubMed

    Miki, Kojiro; Fujii, Kenichi; Kawasaki, Daizo; Shibuya, Masahiko; Fukunaga, Masashi; Imanaka, Takahiro; Tamaru, Hiroto; Sumiyoshi, Akinori; Nishimura, Machiko; Horimatsu, Tetsuo; Saita, Ten; Okada, Kozo; Kimura, Takumi; Honda, Yasuhiro; Fitzgerald, Peter J; Masuyama, Tohru; Ishihara, Masaharu

    2016-06-01

    To identify intravascular ultrasound (IVUS) measurements that can predict angiographic in-stent restenosis (ISR) following nitinol stent implantation in superficial femoral artery (SFA) lesions. A retrospective review was conducted of 97 patients (mean age 72.9±8.9 years; 63 men) who underwent IVUS examination during endovascular treatment of 112 de novo SFA lesions between July 2012 and December 2014. Self-expanding bare stents were implanted in 46 lesions and paclitaxel-eluting stents in 39 lesions. Six months after stenting, follow-up angiography was conducted to assess stent patency. The primary endpoint was angiographic ISR determined by quantitative vascular angiography analysis at the 6-month follow-up. Variables associated with restenosis were sought in multivariate analysis; the results are presented as the odds ratio (OR) and 95% confidence interval (CI). At follow-up, 27 (31.8%) angiographic ISR lesions were recorded. The lesions treated with uncoated stents were more prevalent in the ISR group compared with the no restenosis group (74.1% vs 44.8%, p=0.02). Lesion length was longer (154.4±79.5 vs 109.0±89.3 mm, p=0.03) and postprocedure minimum stent area (MSA) measured by IVUS was smaller (13.9±2.8 vs 16.3±1.6 mm(2), p<0.001) in the ISR group. Multivariate analysis revealed that bare stent use (OR 7.11, 95% CI 1.70 to 29.80, p<0.01) and longer lesion length (OR 1.08, 95% CI 1.01 to 1.16, p=0.04) were predictors of ISR, while increasing postprocedure MSA (OR 0.58, 95% CI 0.41 to 0.82, p<0.01) was associated with lower risk of ISR. Receiver operating characteristic analysis identified a MSA of 15.5 mm(2) as the optimal cutpoint below which the incidence of restenosis increased (area under the curve 0.769). Postprocedure MSA can predict ISR in SFA lesions, which suggests that adequate stent enlargement during angioplasty might be required for superior patency. © The Author(s) 2016.

  3. Human hip joint cartilage: MRI quantitative thickness and volume measurements discriminating acetabulum and femoral head.

    PubMed

    Li, Wei; Abram, François; Beaudoin, Gilles; Berthiaume, Marie-Josée; Pelletier, Jean-Pierre; Martel-Pelletier, Johanne

    2008-12-01

    This paper aims at developing a quantitative system for measuring human hip cartilage thickness and volume using magnetic resonance imaging (MRI). A new MRI-acquisition technique, named axial rotation, where the acquisition planes are organized around a virtual axis, was used. The MRI protocol consists of a 2-D multiple-echo data image combination (MEDIC) using water excitation. Inner and outer interface contours of acetabulum and femoral head cartilage are obtained using a semiautomated 3-D segmentation method and combined to form 3-D surfaces. A local spherical coordinate system computed from the original contours enables cartilage thickness and volume computation. An anatomical labeling is performed automatically for thickness and volume measurements in predefined subregions: inferior, anterior, superior, and posterior. A registration module is introduced allowing the assessment of cartilage changes over time. Validation of the system was conducted with three protocols each involving data obtained from nine subjects: 1) registration process accuracy; 2) intrareader reproducibility; and 3) intervisit coefficient of variation. Data showed excellent correlation coefficients for either the intrareader (r>or=0.0942, p<0.0001 ) or intervisit (r>or=0.0837, p<0.005) protocols. This noninvasive system, which enables the quantification of cartilage thickness and volume in the human hip joint using MRI, is the first to discriminate the acetabular and femoral head cartilage throughout the entire hip without the use of an external device, and to implement hip registration for follow-up studies on the same subject.

  4. Role for NGF in augmented sympathetic nerve response to activation of mechanically and metabolically sensitive muscle afferents in rats with femoral artery occlusion.

    PubMed

    Lu, Jian; Xing, Jihong; Li, Jianhua

    2012-10-15

    Arterial blood pressure and heart rate responses to static contraction of the hindlimb muscles are greater in rats whose femoral arteries were previously ligated than in control rats. Also, the prior findings demonstrate that nerve growth factor (NGF) is increased in sensory neurons-dorsal root ganglion (DRG) neurons of occluded rats. However, the role for endogenous NGF in engagement of the augmented sympathetic and pressor responses to stimulation of mechanically and/or metabolically sensitive muscle afferent nerves during static contraction after femoral artery ligation has not been specifically determined. In the present study, both afferent nerves and either of them were activated by muscle contraction, passive tendon stretch, and arterial injection of lactic acid into the hindlimb muscles. Data showed that femoral occlusion-augmented blood pressure response to contraction was significantly attenuated by a prior administration of the NGF antibody (NGF-Ab) into the hindlimb muscles. The effects of NGF neutralization were not seen when the sympathetic nerve and pressor responses were evoked by stimulation of mechanically sensitive muscle afferent nerves with tendon stretch in occluded rats. In addition, chemically sensitive muscle afferent nerves were stimulated by lactic acid injected into arterial blood supply of the hindlimb muscles after the prior NGF-Ab, demonstrating that the reflex muscle responses to lactic acid were significantly attenuated. The results of this study further showed that NGF-Ab attenuated an increase in acid-sensing ion channel subtype 3 (ASIC3) of DRG in occluded rats. Moreover, immunohistochemistry was employed to examine the number of C-fiber and A-fiber DRG neurons. The data showed that distribution of DRG neurons with different thin fiber phenotypes was not notably altered when NGF was infused into the hindlimb muscles. However, NGF increased expression of ASIC3 in DRG neurons with C-fiber but not A-fiber. Overall, these data

  5. Cell proliferation in human coronary arteries.

    PubMed Central

    Gordon, D; Reidy, M A; Benditt, E P; Schwartz, S M

    1990-01-01

    Despite the lack of direct evidence for cell multiplication, proliferation of smooth muscle cells in human atherosclerotic lesions has been assumed to play a central role in ontogeny of the plaque. We used antibodies to cell cycle-related proteins on tissue sections of human arteries and coronary atherosclerotic plaques. Specific cell types were identified by immunochemical reagents for smooth muscle, monocyte-macrophages, and other blood cells. Low rates of smooth muscle cell proliferation were observed. Macrophages were also observed with rates of proliferation comparable to that of the smooth muscle. Additional replicating cells could not be defined as belonging to specific cell types with the reagents used in this study. These findings imply that smooth muscle replication in advanced plaques is indolent and raise the possibility of a role for proliferating leukocytes. Images PMID:1972277

  6. Femoral Artery Atherosclerosis Is Associated With Physical Function Across the Spectrum of the Ankle-Brachial Index: The San Diego Population Study.

    PubMed

    Wassel, Christina L; Ellis, Alicia M; Suder, Natalie C; Barinas-Mitchell, Emma; Rifkin, Dena E; Forbang, Nketi I; Denenberg, Julie O; Marasco, Antoinette M; McQuaide, Belinda J; Jenny, Nancy S; Allison, Matthew A; Ix, Joachim H; Criqui, Michael H

    2017-07-20

    The ankle-brachial index (ABI) is inadequate to detect early-stage atherosclerotic disease, when interventions to prevent functional decline may be the most effective. We determined associations of femoral artery atherosclerosis with physical functioning, across the spectrum of the ABI, and within the normal ABI range. In 2007-2011, 1103 multiethnic men and women participated in the San Diego Population Study, and completed all components of the summary performance score. Using Doppler ultrasound, superficial and common femoral intima media thickness and plaques were ascertained. Logistic regression was used to assess associations of femoral atherosclerosis with the summary performance score and its individual components. Models were adjusted for demographics, lifestyle factors, comorbidities, lipids, and kidney function. In adjusted models, among participants with a normal-range ABI (1.00-1.30), the highest tertile of superficial intima media thickness was associated with lower odds of a perfect summary performance score of 12 (odds ratio=0.56 [0.36, 0.87], P=0.009), and lower odds of a 4-m walk score of 4 (0.34 [0.16, 0.73], P=0.006) and chair rise score of 4 (0.56 [0.34, 0.94], P=0.03). Plaque presence (0.53 [0.29, 0.99], P=0.04) and greater total plaque burden (0.61 [0.43, 0.87], P=0.006) were associated with worse 4-m walk performance in the normal-range ABI group. Higher superficial intima media thickness was associated with lower summary performance score in all individuals (P=0.02). Findings suggest that use of femoral artery atherosclerosis measures may be effective in individuals with a normal-range ABI, especially, for example, those with diabetes mellitus or a family history of peripheral artery disease, when detection can lead to earlier intervention to prevent functional declines and improve quality of life. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  7. Early postoperative changes in hematological, erythrocyte aggregation and blood coagulation parameters after unilateral implantation of polytetrafluoroethylene vascular graft in the femoral artery of beagle dogs.

    PubMed

    Toth, Csaba; Klarik, Zoltan; Kiss, Ferenc; Toth, Eniko; Hargitai, Zoltan; Nemeth, Norbert

    2014-05-01

    The failure of small-caliber vascular grafts still means a serious problem. Concerning the early postoperative complications we aimed to investigate the hemostaseological and hemorheological aspects of this issue in a canine model. In the Control group only anesthesia was induced. In the Grafted group under general anesthesia a 3.5-cm segment was resected unilaterally from the femoral artery and replaced with a PTFE graft (diameter: 3 mm). On the 1st-3rd-5th-7th and 14th postoperative days the skin temperature of both hind limbs was measured, and blood sampling occurred for hematological, hemostaseological and hemorheological tests. The skin temperature of the operated versus intact limbs did not differ. In the Grafted group leukocyte count was elevated by the 1st postoperative day, while platelet count increased over the entire follow-up period. Fibrinogen concentration rose on the 1st-5th days, activated partial thromboplastin time increased on the 3rd-7th days. Erythrocyte aggregation was enhanced significantly on the 1st-5th days. In specimens taken on the 14th day, histologically we found matured thrombus narrowing the graft lumen. Small-caliber PTFE graft implantation into the femoral artery caused significant changes in several hemostaseological and hemorheological parameters. However, better clarifying the factors leading to early thrombosis of these grafts needs further studies.

  8. Patterns of sexual, bilateral and interpopulational variation in human femoral neck-shaft angles

    PubMed Central

    ANDERSON, JOHN Y.; TRINKAUS, ERIK

    1998-01-01

    Data on femoral neck-shaft angles were collected for 30 modern, historic and prehistoric human population samples, and analysed with respect to sexual dimorphism, bilateral asymmetry, geographical patterning and general economic level. Although some samples had modest sexual dimorphism in this angle, and some individuals exhibited clear asymmetry, there were no consistent patterns of sexual or side differences across human populations. Similarly, there was no evidence for geographic differences, since broad regional groups lacked significant differences and mean angles were not correlated with latitude. However, there is a significant increase in mean neck-shaft angles across populations with an increasingly sedentary existence and with mechanisation. The last reflects the developmental plasticity of this feature with respect to habitual load levels during ontogeny of the hip region. PMID:9643428

  9. Effects of aging and hypertension on the participation of endothelium-derived constricting factor (EDCF) in norepinephrine-induced contraction of rat femoral artery.

    PubMed

    Líšková, Silvia; Silvia, Líšková; Petrová, Miriam; Miriam, Petrová; Karen, Petr; Petr, Karen; Kuneš, Jaroslav; Jaroslav, Kuneš; Zicha, Josef; Josef, Zicha

    2011-09-30

    Endothelium-dependent contraction elicited by high concentrations of acetylcholine was described in hypertensive as well as in aged normotensive rats. The contribution of endothelium-derived constricting factor (EDCF) to norepinephrine-induced contraction is still unknown. We aimed to compare EDCF participation to norepinephrine-induced arterial contraction in spontaneously hypertensive rats (SHR) and aged normotensive Wistar-Kyoto (WKY) rats. Femoral arteries from either adult (7-months-old) or aged (14-months-old) animals were placed in myograph and norepinephrine-induced concentration-response curves were recorded under control conditions and in the presence of indomethacin (cyclooxygenase inhibitor, 10(-5) mol/l) or L-NNA (NO synthase inhibitor, 10(-4) mol/l) or both. Norepinephrine-induced concentration-response curve was enhanced in SHR compared to WKY rats, but concentration-response curve of aged WKY rats was similar to those of adult SHR. Cyclooxygenase inhibition largely attenuated concentration-response curves in all groups. However, this effect was greater in aged WKY rats and adult SHR compared to adult WKY rats. NO synthase inhibition augmented norepinephrine-induced contraction in arteries of adult WKY rats, but not in arteries from aged WKY rats or adult SHR. The combined administration of L-NNA and indomethacin had no additive effects on concentration-response curves. EDCF contribution to norepinephrine-induced contractions of arteries was considerably greater in adult SHR (80±3%) and aged WKY rats (86±2%) compared to adult WKY rats (35±10%). The inhibition of NO synthase augmented EDCF contribution to norepinephrine-induced contraction only in arteries from adult WKY rats (76±9%). We conclude that EDCF contribution to norepinephrine-induced contraction of conduit arteries is similarly enhanced in adult hypertensive and aged normotensive rats.

  10. In the femoral artery bifurcation, differences in mean wall shear stress within subjects are associated with different intima-media thicknesses.

    PubMed

    Kornet, L; Hoeks, A P; Lambregts, J; Reneman, R S

    1999-12-01

    In elastic arteries, intima-media thickening is more pronounced in areas with low than with high mean and peak wall shear stress. These findings in elastic arteries are not necessarily representative of the situation in muscular arteries. The former arteries have to store volume energy, whereas the latter are mainly conductive vessels. It was the aim of the present study to investigate noninvasively whether differences in wall shear stress within a muscular artery bifurcation, if any, were associated with different intima-media thicknesses (IMTs). The effect of age on the possible differences was assessed as well. We determined IMT and mean, peak systolic, and the maximum cyclic change in shear stress near the posterior wall in the common (FC) and the superficial (FS) femoral artery 20 to 30 mm from the flow divider in 54 presumed healthy subjects between 21 and 74 years of age. Results were considered in terms of intrasubject differences. Before the study, the reliability of the ultrasonic system to assess wall shear rate and IMT was determined in terms of intrasubject variability. IMT at the posterior wall was significantly larger in the FC than in the FS, probably owing to the significantly lower mean wall shear stress at this site in the FC. The relative differences in IMT and mean wall shear stress between FC and FS were independent of age. The difference in wall shear stress between both arteries can likely be explained by a different influence of reflections. In both the FC and FS, mean, peak systolic, and maximum cyclic change in shear stress near the posterior wall did not change significantly with age, whereas IMT did increase significantly with age.

  11. Effects of high glucose with or without other metabolic substrates on alpha-adrenergic contractions in rat mesenteric and femoral arteries

    PubMed Central

    Vorn, Rany

    2017-01-01

    Hyperglycemia is associated with an increased risk of cardiovascular diseases. It has been demonstrated that chronic exposure to high glucose impaired endothelial functions. However, specific effects of short-term exposure to high glucose on vascular reactivity are controversial. Moreover, the combined effects of other metabolic substrates such as free fatty acids (FFA) on vascular reactivity remain poorly understood. Here we investigate the effects of short-term exposure to high glucose with or without other metabolic substrates including FFAs termed “nutrition full” (NF) solution, on mesenteric (MA) and deep femoral arteries (DFA) of rats. Arterial ring segments were mounted in a double-wire myograph. Contraction in response to phenylephrine (PhE) was determined in control (5 mM) and high glucose (23 mM, HG) environments over a 30 min period. In both arteries, PhE-inducedvasocontraction was enhanced by pre-incubation of HG solution. A combined incubation with HG and palmitic acid (100 µM) induced similar sensitization of PhE-contractions in both arteries. In contrast, high K+-induced contractions were not affected by HG. Interestingly, pre-incubation with NF solution decreased PhE-induced contraction in MA but increased the contraction in DFA. In NF solution, the HG-induced facilitation of PhE-contraction was not observed in MA. Furthermore, the PhE-induced contraction of DFA was attenuated by HG in NF solution. Our results demonstrate that the sensitization of PhE-induced arterial contraction by HG is differentially affected by other metabolic substrates. The conversation of skeletal arterial contractility by HG in NF solution requires careful interpretation of the previous in vitro studies where only glucose is included in physiological salt solutions. Further studies are required to elucidate the mechanism underlying the inconsistent effect of NF solution on MA and DFA. PMID:28066145

  12. Self-expanding nitinol stents in recanalisation of long-length superficial femoral artery occlusions in patients with critical limb ischaemia.

    PubMed

    Taneja, M; Tay, K H; Sebastian, M; Pasupathy, S; Lin, S E; Teo, T; Low, R; Irani, F G; Chng, S P; Dewan, A; Tan, B S

    2009-12-01

    This study aims to evaluate our experience with self-expanding nitinol stent- enabled recanalisation of long-length occlusions (30 cm or more) of the superficial femoral artery (SFA). 573 patients underwent 842 lower limb interventions from August 2006 to December 2008. A retrospective review of patients undergoing recanalisation of long-length SFA occlusions with self-expanding nitinol stents and an evaluation of their patency and impact on limb salvage, were done. 22 patients (mean age 62.5 years, male: female ratio 11:11) underwent 22 long-length SFA stenting procedures. The spectrum of critical limb ischaemia included rest pain (five), ulcer (six) and gangrene (11). Length of occlusions varied from 30 cm to 45 cm (average length 36.4 cm). Five patients had stents placed through the ipsilateral popliteal artery approach, and the rest had stents placed through the femoral artery approach. All patients were followed up over an average duration of 12 months. One patient died due to associated medical conditions during this period. Six out of 21 (28.6 percent) of the stents thrombosed completely on one year follow-up. Of these, two patients underwent amputation, one patient had a bypass, and the stent in two patients were recanalised with balloon angioplasty. All remaining patent stents showed varying degrees of stenoses at one year. The overall limb salvage rate at one year following stent placement was 81 percent. Our experience showed the beneficial result of long-length SFA stent placement with good limb salvage outcome. Repeat interventions may be required to maintain the patency of stents in these patients.

  13. Femoral Arterial Haemostasis Using an Anchored Collagen Plug after Percutaneous EVAR with an Ultra-Low Profile Device: Prospective Audit of an Evolving "Post-Close" Technique.

    PubMed

    Chaudhuri, A

    2017-08-01

    To present an audit of a successful "post-close" haemostatic technique using the Angio-Seal VIP vascular closure device (VCD) after percutaneous endovascular aneurysm repair (p-EVAR) using an ultra-low profile (ULP) device. Thirty patients underwent EVAR using the Ovation device, of which 26 procedures were totally percutaneous. Data including patient habitus, procedural details, number of VCDs deployed including use of the double wire approach, and technical success/complications were prospectively recorded. Numerical/statistical analyses were undertaken using Microsoft Excel 2007 and Minitab for Windows. Thirty consecutive patients (27 male, 3 female; age range 70-85 years [mean 76.1, SD 6.5]) underwent EVAR for an infrarenal AAA (mean size 61 mm, SD 9.7) between March 2014 and August 2016 using the Ovation endograft system. In a few patients open ipsilateral femoral access was used (n=4); the remainder underwent p-EVAR (n=26), and these results are presented hereafter. Ipsilateral sheath sizes used varied between 14F (n=22), 15F (n=3), and 16F (n=1), and were closed using a single 8F Angio-Seal (n=7), a combination of 8F/6F Angio-Seal VCDs (n=18), or two 8F Angio-Seal VCDs (n=1) with prior double wire set up. Contralateral punctures were closed mostly with a single 8F Angio-Seal (n=24) or combination of 8F/6F Angio-Seal VCDs (n=2) to seal defects downsized to 12F. The overall immediate haemostasis success rate was 100%. Mean length of stay in the p-EVAR cohort was 2 days (SD 1.5). All patients had a post-EVAR computed tomography angiogram (n=24) or duplex ultrasound (n=2) which did not reveal any stenoses or seromas; two patients developed an ipsilateral femoral pseudoaneurysm successfully treated by thrombin injection. A "post-close" technique can be employed successfully for haemostasis after p-EVAR using an ULP device. An 8F Angio-Seal is usually effective in closing a 12F femoral arterial defect. This represents a viable option for femoral arterial closure

  14. Evaluation of the biodegradable peripheral Igaki-Tamai stent in the treatment of de novo lesions in the superficial femoral artery: the GAIA study.

    PubMed

    Werner, Martin; Micari, Antonio; Cioppa, Angelo; Vadalà, Giuseppe; Schmidt, Andrej; Sievert, Horst; Rubino, Paolo; Angelini, Annalisa; Scheinert, Dierk; Biamino, Giancarlo

    2014-03-01

    This study sought to evaluate the safety and performance of the Igaki-Tamai (Igaki Medical Planning Company, Kyoto, Japan) biodegradable stent in patients with occlusive superficial femoral artery (SFA) disease. Poly-L-lactic acid (PLLA) biodegradable stents have been shown to be effective in the coronaries, but no data are available regarding their efficacy in the femoral artery. A prospective, multicenter, nonrandomized study enrolled 30 patients with symptomatic de novo SFA disease undergoing implantation of Igaki-Tamai bioresorbable stents. Clinical examinations and duplex ultrasound were prospectively performed after 1, 6, 9, and 12 months. The main study endpoints were technical success, restenosis rate, rate of target lesion revascularization (TLR), changes in ankle-brachial index (ABI), and quality of life by evaluating the walking impairment questionnaire (WIQ). Safety was assessed by monitoring the occurrence of major adverse clinical events and serious adverse events. The mean age of the patients was 67.7 years, and 77% were male. The mean lesion length was 5.9 cm. Mean diameter stenosis was reduced from 89.9% to 6.2%, after stent implantation. Technical success was 96.7%. Binary restenosis rate for the 6 and 12 months follow-up was 39.3% and 67.9%, respectively. The TLR rate was 25.0% after 6 months and 57.1% after 12 months. All TLR were successful; the secondary patency rate after 1 year was 89.3%. Between baseline and 12 months, ABI increased in 53.6% of patients. Functional endpoints (WIQ), even if affected by a relatively high reintervention rate, showed improvement in most of the patients. The GAIA (Evaluation of the Biodegradable Peripheral Igaki-Tamai Stent in the Treatment of De Novo Lesions in the Superficial Femoral Artery) study shows that when using biodegradable PLLA stents (Igaki-Tamai), the immediate angiographic results are comparable to the results of metal stents, achieving a high secondary patency rate after 1 year. Modifications

  15. Three-year results of the VIBRANT trial of VIABAHN endoprosthesis versus bare nitinol stent implantation for complex superficial femoral artery occlusive disease.

    PubMed

    Geraghty, Patrick J; Mewissen, Mark W; Jaff, Michael R; Ansel, Gary M

    2013-08-01

    The predominant mode of bare nitinol stent failure is diffuse in-stent restenosis, and failure rates correlate to the length and complexity of the treated lesion. Addition of an expanded polytetrafluoroethylene lining to a nitinol stent frame, as found in the VIABAHN endoprosthesis, mitigates the ingrowth of intimal hyperplasia. We compared the long-term outcomes of complex superficial femoral artery disease intervention using the VIABAHN endoprosthesis to those obtained with bare nitinol stent implantation. One hundred forty-eight patients with symptomatic complex superficial femoral artery disease (TransAtlantic Inter-Society Consensus I class C and D lesions, accompanied by intermittent claudication or ischemic rest pain) were randomized to endovascular intervention using either bare nitinol stent implantation (76 patients) or nonheparin-bonded VIABAHN endoprosthesis deployment (72 patients). Patency, limb hemodynamics, and quality of life were evaluated at 1, 6, 12, 24, and 36 months following intervention. The average treated lesion measured 18 ± 8 cm in length, and 58.8% of lesions displayed segmental or complete occlusion. At 3 years, primary patency rates (defined by peak systolic velocity ratio ≤ 2.0 and no target lesion revascularization) did not significantly differ between patients treated with the VIABAHN stent graft and those who received a bare nitinol stent (24.2% vs 25.9%; P = .392). Stent fractures were significantly more common in bare nitinol stents (50.0%) than in the VIABAHN endoprostheses (2.6%). Primary-assisted patency rates were higher in those receiving bare nitinol stents than the VIABAHN stent graft (88.8% vs 69.8%; P = .04), although secondary patency rates did not differ between bare nitinol stent and stent graft recipients (89.3% vs 79.5%; P = .304). There were no instances of procedure-related mortality or amputation. The hemodynamic improvement and quality measures improved equally in both groups. The long-term outcomes of

  16. Dorsal root tetrodotoxin-resistant sodium channels do not contribute to the augmented exercise pressor reflex in rats with chronic femoral artery occlusion

    PubMed Central

    McCord, Jennifer L.; Leal, Anna K.; Kaufman, Marc P.

    2011-01-01

    We investigated the contribution of tetrodotoxin (TTX)-resistant sodium channels to the augmented exercise pressor reflex observed in decerebrated rats with femoral artery ligation. The pressor responses to static contraction, to tendon stretch, and to electrical stimulation of the tibial nerve were compared before and after blocking TTX-sensitive sodium channels on the L3-L6 dorsal roots of rats whose hindlimbs were freely perfused and rats whose femoral arteries were ligated 72 h before the start of the experiment. In the freely perfused group (n = 9), pressor (Δ22 ± 4 mmHg) and cardioaccelerator (Δ32 ± 6 beats/min) responses to contraction were attenuated by 1 μM TTX (Δ4 ± 1 mmHg, P < 0.05 and Δ17 ± 4 beats/min, P < 0.05, respectively). In the 72 h ligated group (n = 9), the augmented pressor response to contraction (32 ± 4 mmHg) was also attenuated by 1 μM TTX (Δ8 ± 2 mmHg, P < 0.05). The cardioaccelerator response to contraction was not significantly attenuated in these rats. In addition, TTX suppressed the pressor response to tendon stretch in both groups of rats. Electrical stimulation of the tibial nerve evoked similar pressor responses between the two groups (freely perfused: Δ74 ± 9 mmHg and 72 h ligated: Δ78 ± 5 mmHg). TTX attenuated the pressor response to the tibial nerve stimulation by about one-half in both groups. Application of the TTX-resistant sodium channel blocker A-803467 (1 μM) with TTX (1 μM) did not block the pressor response to tibial nerve stimulation to any greater extent than did application of TTX (1 μM) alone. Although the contribution of TTX-resistant sodium channels to the augmented exercise pressor reflex may be slightly increased in rats with chronic femoral artery ligation, TTX-resistant sodium channels on dorsal roots do not play a major role in the augmented exercise pressor reflex. PMID:21076028

  17. Microstructure and mechanics of human resistance arteries.

    PubMed

    Bell, J S; Adio, A O; Pitt, A; Hayman, L; Thorn, C E; Shore, A C; Whatmore, J L; Winlove, C P

    2016-12-01

    Vascular diseases such as diabetes and hypertension cause changes to the vasculature that can lead to vessel stiffening and the loss of vasoactivity. The microstructural bases of these changes are not presently fully understood. We present a new methodology for stain-free visualization, at a microscopic scale, of the morphology of the main passive components of the walls of unfixed resistance arteries and their response to changes in transmural pressure. Human resistance arteries were dissected from subcutaneous fat biopsies, mounted on a perfusion myograph, and imaged at varying transmural pressures using a multimodal nonlinear microscope. High-resolution three-dimensional images of elastic fibers, collagen, and cell nuclei were constructed. The honeycomb structure of the elastic fibers comprising the internal elastic layer became visible at a transmural pressure of 30 mmHg. The adventitia, comprising wavy collagen fibers punctuated by straight elastic fibers, thinned under pressure as the collagen network straightened and pulled taut. Quantitative measurements of fiber orientation were made as a function of pressure. A multilayer analytical model was used to calculate the stiffness and stress in each layer. The adventitia was calculated to be up to 10 times as stiff as the media and experienced up to 8 times the stress, depending on lumen diameter. This work reveals that pressure-induced reorganization of fibrous proteins gives rise to very high local strain fields and highlights the unique mechanical roles of both fibrous networks. It thereby provides a basis for understanding the micromechanical significance of structural changes that occur with age and disease. Copyright © 2016 the American Physiological Society.

  18. Microstructure and mechanics of human resistance arteries

    PubMed Central

    Adio, A. O.; Pitt, A.; Hayman, L.; Thorn, C. E.; Shore, A. C.; Whatmore, J. L.; Winlove, C. P.

    2016-01-01

    Vascular diseases such as diabetes and hypertension cause changes to the vasculature that can lead to vessel stiffening and the loss of vasoactivity. The microstructural bases of these changes are not presently fully understood. We present a new methodology for stain-free visualization, at a microscopic scale, of the morphology of the main passive components of the walls of unfixed resistance arteries and their response to changes in transmural pressure. Human resistance arteries were dissected from subcutaneous fat biopsies, mounted on a perfusion myograph, and imaged at varying transmural pressures using a multimodal nonlinear microscope. High-resolution three-dimensional images of elastic fibers, collagen, and cell nuclei were constructed. The honeycomb structure of the elastic fibers comprising the internal elastic layer became visible at a transmural pressure of 30 mmHg. The adventitia, comprising wavy collagen fibers punctuated by straight elastic fibers, thinned under pressure as the collagen network straightened and pulled taut. Quantitative measurements of fiber orientation were made as a function of pressure. A multilayer analytical model was used to calculate the stiffness and stress in each layer. The adventitia was calculated to be up to 10 times as stiff as the media and experienced up to 8 times the stress, depending on lumen diameter. This work reveals that pressure-induced reorganization of fibrous proteins gives rise to very high local strain fields and highlights the unique mechanical roles of both fibrous networks. It thereby provides a basis for understanding the micromechanical significance of structural changes that occur with age and disease. PMID:27663767

  19. Suitability of a 7-F ExoSeal Vascular Closure Device for Femoral Artery Punctures Made by 8-F or 9-F Introducer Sheaths.

    PubMed

    Goto, Shunsaku; Ohshima, Tomotaka; Ishikawa, Kojiro; Yamamoto, Taiki; Nishizawa, Toshihisa; Shimato, Shinji; Kato, Kyozo

    2017-08-01

    To establish the safety and efficacy of the 7-F ExoSeal device for the closure of femoral puncture sites made by 8-F or 9-F introducer sheaths. Between January 2013 and December 2016, 332 patients (mean age 68.4±12.1 years; 195 men) underwent neurointerventional procedures via percutaneous puncture of the common femoral artery and an 8-F (n=272, 81.9%) or 9-F (n=60, 18.1%) introducer. The access sites were sealed with a 7-F ExoSeal in all cases. Procedure success and closure-related complication rates were evaluated, and risk factors for complications were analyzed by comparing patient characteristics between those who did and did not experience complications. Procedure success rates were 99.3% in the 8-F group and 100% in the 9-F group. The overall complication rate was 6.3% (n=17; all in the 8-F group), of which 13 (4.8%) were minor sequelae, including access-site hematoma (n=8), oozing (n=3), pseudoaneurysm (n=1), and retroperitoneal bleeding (n=1). Among the 4 (1.5%) major complications were 3 instances of bleeding requiring a blood transfusion and 1 surgical vascular repair. No complications were observed in the 9-F group. Patients who experienced complications had significantly longer activated clotting times (262±46 vs 218±55 seconds; p<0.001) compared with patients without complications. A 7-F ExoSeal vascular closure device is safe and effective for the closure of femoral puncture sites made by 8-F or 9-F introducer sheaths.

  20. High Residual Collagen-Induced Platelet Reactivity Predicts Development of Restenosis in the Superficial Femoral Artery After Percutaneous Transluminal Angioplasty in Claudicant Patients

    SciTech Connect

    Gary, Thomas; Prüller, Florian Raggam, Reinhard; Mahla, Elisabeth; Eller, Philipp Hafner, Franz Brodmann, Marianne

    2016-02-15

    PurposeAlthough platelet reactivity is routinely inhibited with aspirin after percutaneous angioplasty (PTA) in peripheral arteries, the restenosis rate in the superficial femoral artery (SFA) is high. Interaction of activated platelets and the endothelium in the region of intervention could be one reason for this as collagen in the subendothelium activates platelets.Materials and MethodsA prospective study evaluating on-site platelet reactivity during PTA and its influence on the development of restenosis with a total of 30 patients scheduled for PTA of the SFA. Arterial blood was taken from the PTA site after SFA; platelet function was evaluated with light transmission aggregometry. After 3, 6, 12, and 24 months, duplex sonography was performed and the restenosis rate evaluated.ResultsEight out of 30 patients developed a hemodynamically relevant restenosis (>50 % lumen narrowing) in the PTA region during the 24-month follow-up period. High residual collagen-induced platelet reactivity defined as AUC >30 was a significant predictor for the development of restenosis [adjusted odds ratio 11.8 (9.4, 14.2); P = .04].ConclusionsHigh residual collagen-induced platelet reactivity at the interventional site predicts development of restenosis after PTA of the SFA. Platelet function testing may be useful for identifying patients at risk.

  1. Distribution of mesoscale elastic properties and mass density in the human femoral shaft.

    PubMed

    Rohrbach, Daniel; Grimal, Quentin; Varga, Peter; Peyrin, Francoise; Langer, Max; Laugier, Pascal; Raum, Kay

    2015-04-01

    Cortical bone properties are determined by tissue composition and structure at several hierarchical length scales. In this study, the spatial distribution of micro- and mesoscale elastic properties within a human femoral shaft has been investigated. Microscale tissue degree of mineralization (DMB), cortical vascular porosity Ct.Po and the average transverse isotropic stiffness tensor C(Micro) of cylindrical-shaped samples (diameter: 4.4 mm, N = 56) were obtained from cortical regions between 20 and 85% of the total femur length and around the periphery (anterior, medial, posterior and lateral quadrants) by means of synchrotron radiation µCT (SRµCT) and 50-MHz scanning acoustic microscopy (SAM). Within each cylinder, the volumetric bone mineral density (vBMD) and the mesoscale stiffness tensor C(Meso) were derived using a numerical homogenization approach. Moreover, microelastic maps of the axial elastic coefficient c33 measured by SAM at distinct cross-sectional locations along the femur were used to construct a 3-D multiscale elastic model of the femoral shaft. Variations of vBMD (6.1%) were much lower than the variations of mesoscale elastic coefficients (11.1-21.3%). The variation of DMB was only a minor predictor for variations of the mesoscale elastic properties (0.05 ≤ R(2) ≤ 0.34). Instead, variations of the mesoscale elastic properties could be explained by variations of cortical porosity and microscale elastic properties. These data were suitable inputs for numerical evaluations and may help to unravel the relations between structure and composition on the elastic function in cortical bone.

  2. Successful Antibiotic Treatment of Severe Staphylococcal Infection of a Long Stent Graft in the Superficial Femoral Artery with Graft Preservation in the Long Term

    SciTech Connect

    Treitl, Marcus; Rademacher, Antje; Becker-Lienau, Johanna; Reiser, Maximilian F.; Hoffmann, Ulrich; Czihal, Michael

    2011-06-15

    Introduction: Bacterial infection of endovascular stent grafts is a serious condition, regularly leading to graft replacement by open bypass surgery.Case ReportWe describe the case of a staphylococcal infection of a 150-mm covered stent graft (Gore Viabahn), placed in the superficial femoral artery. Stent graft infection was successfully treated by oral administration of penicillinase-resistant flucloxacillin and the lipopeptide daptomycin with complete graft preservation, not requiring surgical treatment. During 1-year follow-up, the graft infection did not reappear. However, the patient developed restenosis at the proximal margin of the stent with recurrence of mild claudication, so far treated conservatively. Conclusion: With the increased use of covered stent grafts in the peripheral vasculature, the frequency of graft infection will increase. We demonstrate that with newly developed antibiotics, it is possible to treat this severe complication conservatively, with complete graft preservation and without the need for bypass surgery in selected cases.

  3. Rho-kinase inhibition attenuates calcium-induced contraction in β-escin but not Triton X-100 permeabilized rabbit femoral artery.

    PubMed

    Clelland, Lyndsay J; Browne, Brendan M; Alvarez, Silvina M; Miner, Amy S; Ratz, Paul H

    2011-09-01

    K+-depolarization (KCl) of smooth muscle has long been known to cause Ca2+-dependent contraction, but only recently has this G protein-coupled receptor (GPCR)-independent stimulus been associated with rhoA kinase (ROCK)-dependent myosin light chain (MLC) phosphatase inhibition and Ca2+ sensitization. This study examined effects of ROCK inhibition on the concentration-response curves (CRCs) generated in femoral artery by incrementally adding increasing concentrations of KCl to intact tissues, and Ca2+ to tissues permeabilized with Triton X-100, β-escin and α-toxin. For a comparison, tissue responses were assessed also in the presence of protein kinase C (PKC) and MLC kinase inhibition. The ROCK inhibitor H-1152 induced a strong concentration-dependent inhibition of a KCl CRC. A relatively low GF-109203X concentration (1 μM) sufficient to inhibit conventional PKC isotypes also inhibited the KCl CRC but did not affect the maximum tension. ROCK inhibitors had no effect on the Ca2+ CRC induced in Triton X-100 or α-toxin permeabilized tissues, but depressed the maximum contraction induced in β-escin permeabilized tissue. GF-109203X at 1 μM depressed the maximum Ca2+-dependent contraction induced in α-toxin permeabilized tissue and had no effect on the Ca2+ CRC induced in Triton X-100 permeabilized tissue. The MLC kinase inhibitor wortmannin (1 μM) strongly depression the Ca2+ CRCs in tissues permeabilized with Triton X-100, α-toxin and β-escin. H-1152 inhibited contractions induced by a single exposure to a submaximum [Ca2+] (pCa 6) in both rabbit and mouse femoral arteries. These data indicate that β-escin permeabilized muscle preserves GPCR-independent, Ca2+- and ROCK-dependent, Ca2+ sensitization.

  4. Rho-kinase inhibition attenuates calcium-induced contraction in β-escin but not Triton X-100 permeabilized rabbit femoral artery

    PubMed Central

    Clelland, Lyndsay J.; Browne, Brendan M.; Alvarez, Silvina M.; Miner, Amy S.; Ratz, Paul H.

    2011-01-01

    K+-depolarization (KCl) of smooth muscle has long been known to cause Ca2+-dependent contraction, but only recently has this G protein-coupled receptor (GPCR)-independent stimulus been associated with rhoA kinase (ROCK)-dependent myosin light chain (MLC) phosphatase inhibition and Ca2+ sensitization. This study examined effects of ROCK inhibition on the concentration-response curves (CRCs) generated in femoral artery by incrementally adding increasing concentrations of KCl to intact tissues, and Ca2+ to tissues permeabilized with Triton X-100, β-escin and α-toxin. For a comparison, tissue responses were assessed also in the presence of protein kinase C (PKC) and MLC kinase inhibition. The ROCK inhibitor H-1152 induced a strong concentration-dependent inhibition of a KCl CRC. A relatively low GF-109203X concentration (1 μM) sufficient to inhibit conventional PKC isotypes also inhibited the KCl CRC but did not affect the maximum tension. ROCK inhibitors had no effect on the Ca2+ CRC induced in Triton X-100 or α-toxin permeabilized tissues, but depressed the maximum contraction induced in β-escin permeabilized tissue. GF-109203X at 1 μM depressed the maximum Ca2+-dependent contraction induced in α-toxin permeabilized tissue and had no effect on the Ca2+ CRC induced in Triton X-100 permeabilized tissue. The MLC kinase inhibitor wortmannin (1 μM) strongly depression the Ca2+ CRCs in tissues permeabilized with Triton X-100, α-toxin and β-escin. H-1152 inhibited contractions induced by a single exposure to a submaximum [Ca2+] (pCa 6) in both rabbit and mouse femoral arteries. These data indicate that β-escin permeabilized muscle preserves GPCR-independent, Ca2+- and ROCK-dependent, Ca2+ sensitization. PMID:21706258

  5. Following-up changes in red blood cell deformability and membrane stability in the presence of PTFE graft implanted into the femoral artery in a canine model

    NASA Astrophysics Data System (ADS)

    Toth, Csaba; Kiss, Ferenc; Klarik, Zoltan; Gergely, Eszter; Toth, Eniko; Peto, Katalin; Vanyolos, Erzsebet; Miko, Iren; Nemeth, Norbert

    2014-05-01

    It is known that a moderate mechanical stress can even improve the red blood cells' (RBC) micro-rheological characteristics, however, a more significant stress causes deterioration in the deformability. In this study, we aimed to investigate the effect of the presence of artificial graft on the RBC deformability and membrane stability in beagles. In the Control group only anesthesia was induced and in the postoperative (p.o.) period blood samplings were carried out. In the Grafted group under general anesthesia, the left femoral artery was isolated, from which a 3.5 cm segment was resected and a PTFE graft (O.D.: 3 mm) of equal in length was implanted into the gap. On the 1st, 3rd, 5th, 7th and 14th p.o. days blood was collected the cephalic veins and RBC deformability was determined ektacytometry (LoRRca MaxSis Osmoscan). Membrane stability test consisted of two deformability measurements before and after the cells were being exposed to mechanical stress (60 or 100 Pa for 300 seconds). Compared to the Control group and the baseline values the red blood cell deformability showed significant deterioration on the 3rd, 5th and mainly on the 7th postoperative day after the graft implantation. The membrane stability of erythrocyte revealed marked inter-group difference on the 3rd, 5th and 7th day: in the Grafted group the deformability decreased and during the membrane stability test smaller difference was observed between the states before and after shearing. We concluded that the presence of a PTFE graft in the femoral artery may cause changes in RBC deformability in the first p.o. week. RBC membrane stability investigation shows a lower elongation index profile for the grafted group and a narrowed alteration in the deformability curves due to mechanical stress.

  6. Cutting-Balloon Angioplasty Versus Balloon Angioplasty as Treatment for Short Atherosclerotic Lesions in the Superficial Femoral Artery: Randomized Controlled Trial

    SciTech Connect

    Poncyljusz, Wojciech Falkowski, Aleksander; Safranow, Krzysztof Rac, Monika; Zawierucha, Dariusz

    2013-12-15

    Purpose: To evaluate the treatments of a short-segment atherosclerotic stenosis in the superficial femoral arteries with the cutting balloon angioplasty (CBA) versus conventional balloon angioplasty [percutaneous transluminal angioplasty (PTA)] in a randomized controlled trial. Material and Methods: The study group comprised 60 patients (33 men, 27 women; average age 64 years) with a short ({<=}5 cm) focal SFA de novo atherosclerotic stenosis associated with a history of intermittent claudication or rest pain. The primary end point of this study was the rate of binary restenosis in the treated segment 12 months after the intervention. All patients were evenly randomized to either the PTA or CBA treatment arms. Follow-up angiograms and ankle-brachial index (ABI) measurements were performed after 12 months. The evaluation of the restenosis rates and factors influencing its occurrence were calculated by logistic regression analysis. Results: In the intention-to-treat analysis, restenosis rates after 2-month follow-up were 9 of 30 (30 %) in the PTA group and 4 of 30 (13 %) in the CBA group (p = 0.117). In the actual treatment analysis, after exclusion of patients who required nitinol stent placement for a suboptimal result after angioplasty alone (5 patients in the PTA group and none in the CBA group), restenosis rates were 9 of 25 (36 %) and 4 of 30 (13 %), respectively (p = 0.049). In the intention-to-treat analysis there were also significant differences in ABI values between the PTA and CBA groups at 0.77 {+-} 0.11 versus 0.82 {+-} 0.12, respectively (p = 0.039), at 12 months. Conclusion: Based on the presented results of the trial, CBA seems to be a safer and more effective than PTA for treatment of short atherosclerotic lesions in the superior femoral artery.

  7. Noninvasive assessment of arterial compliance of human cerebral arteries with short inversion time arterial spin labeling

    PubMed Central

    Warnert, Esther AH; Murphy, Kevin; Hall, Judith E; Wise, Richard G

    2015-01-01

    A noninvasive method of assessing cerebral arterial compliance (AC) is introduced in which arterial spin labeling (ASL) is used to measure changes in arterial blood volume (aBV) occurring within the cardiac cycle. Short inversion time pulsed ASL (PASL) was performed in healthy volunteers with inversion times ranging from 250 to 850 ms. A model of the arterial input function was used to obtain the cerebral aBV. Results indicate that aBV depends on the cardiac phase of the arteries in the imaging volume. Cerebral AC, estimated from aBV and brachial blood pressure measured noninvasively in systole and diastole, was assessed in the flow territories of the basal cerebral arteries originating from the circle of Willis: right and left middle cerebral arteries (RMCA and LMCA), right and left posterior cerebral arteries (RPCA and LPCA), and the anterior cerebral artery (ACA). Group average AC values calculated for the RMCA, LMCA, ACA, RPCA, and LPCA were 0.56%±0.2%, 0.50%±0.3%, 0.4%±0.2%, 1.1%±0.5%, and 1.1%±0.3% per mm Hg, respectively. The current experiment has shown the feasibility of measuring AC of cerebral arteries with short inversion time PASL. PMID:25515216

  8. Bare nitinol stent enabled recanalization of long-segment, chronic total occlusion of superficial femoral and adjacent proximal popliteal artery in diabetic patients presenting with critical limb ischemia.

    PubMed

    Taneja, Manish; Tay, Kiang Hiong; Dewan, Atul; Sebastian, Mathew G; Pasupathy, Shanker; Lin, Sheuh En; Teo, Terence; Lo, Richard; Tan, Seck Guan; Irani, Farah G; Tan, Bien Soo

    2010-01-01

    To evaluate our experience of limb salvage with bare nitinol stent enabled recanalization of long length occlusions of superficial femoral artery (SFA) and adjacent proximal popliteal artery (PPA) in diabetic patients. A total of 573 patients underwent 842 lower limb interventions from August 2006 to September 2008 at our institute. A retrospective review was done of diabetic patients undergoing recanalization of long length SFA/adjacent PPA (>10 cm) occlusions with self expanding bare nitinol stents evaluating their impact on limb salvage. Forty-four patients (mean age 65.2 years, M:F 25:19) underwent 49 long-length (>10 cm) SFA/PPA stenting procedures over a period of 26 months. Diabetics comprised 66% of patients (n=29, mean age: 63.7 years, M: F 19:10). The infrapopliteal distal run-off in this diabetic subgroup comprised one vessel (n=14/29, 48%), two vessels (n=12/29, 41%), and three vessels (n=3/29, 10%). The spectrum of critical limb ischemia included rest pain (n=8), ulcer (n=7) and gangrene (n=14). The lengths of occlusions recanalized were 10-39 cm. A total of 58 stents (individual length 10-17 cm, average diameter 6 mm, mean 2 stents per patient) were placed with average length of stented segment being 23.8 cm. Four patients had stents placed through ipsilateral popliteal artery approach with rest placed through femoral artery approach. Significant complications of the procedure included distal embolization (n=3) successfully managed with thrombolysis and popliteal arteriovenous fistula in one patient undergoing recanalization through popliteal approach, managed with covered stent placement. No procedure related mortality occurred during thirty-day follow-up period. All were followed up over an average duration of twelve months post-procedure. Three patients died due to associated medical conditions during this period. The following amputations were done on follow-up (three toe amputations, five forefoot amputations, three below-knee amputations, two

  9. Safety and efficacy of the EPIC™ nitinol vascular stent system for the treatment of lesions located in the superficial femoral artery: prospective and multicentric trial.

    PubMed

    Nasser, Felipe; Kambara, Antonio; Abath, Carlos; Cavalcanti, Douglas; Barros, Ilana; Pires, Norma; Rivera, Marco; Neser, Adnan; Ingrund, Jose; Burihan, Marcelo; Silveira, Pierre; Galego, Gilberto; Bortoluzzi, Cristiano; Franklin, Rafael; Bosiers, Marc; Deloose, Koen; Razuk, Alvaro; Caffaro, Roberto; Karakhanian, Walter K; Park, Jong; Lopes, Caetano; Pinto, Daniel; Bez, Leonardo; Lopes, Rodrigo; Mourão, André; Kleinsorge, Gustavo

    2017-06-01

    The aim of this study was to evaluate the short and mid-term safety and efficacy of the EPIC™ nitinol vascular stent system for the treatment of lesions located in the superficial femoral artery (SFA). From October 2010 to June 2012, 83 subjects were enrolled in a prospective, multicenter, non-randomized study designed to demonstrate that the EPIC nitinol vascular stent system for SFA lesions is non-inferior to the published patency rates found in literature. Inclusion criteria were stenosis or occlusion of the SFA or SFA and proximal popliteal artery, with total length from 4 to 11 cm and amenable for treatment with a single stent, in patients with a score from 2 to 5 on Rutherford classification. The primary endpoint was primary patency rate at 12 months as determined by Duplex ultrasound. The secondary endpoints evaluated were: initial arteriographic success, primary patency rate at 6 months, major adverse event rate at one year and technical success. Follow-up with a complete clinical and physical exam, including ABI and Duplex ultrasound was performed at 6 and 12 months. Most patients (56.6%) were men and the mean age was 68.59 (33.1-99.15) years. 25.3% of the total population had intermittent claudication and 73.5% presented with critical limb ischemia. Most lesions were total occlusions (75.9%) and the mean lesion length was 71.16 mm. Contralateral femoral access was performed in 26.5%cases, and ipsilateral femoral approach was used for the remaining 73.5% patients. Technical and arteriographic success was obtained in all 83 (100.00%) patients. Duplex controlled primary patency rate at 6 and 12 months was 95.8% and 76.1%, respectively. The freedom from target lesion revascularization rate was 98.7% and 92.6% at 6 and 12 months, respectively. No stent fractures were observed in this study. Major adverse event rate at 1 year (clinically driven TLR, major amputation, and all-cause mortality) was 15.7%: two target lesion revascularizations (2.4%), one major

  10. Harmonic skeleton guided evaluation of stenoses in human coronary arteries.

    PubMed

    Yang, Yan; Zhu, Lei; Haker, Steven; Tannenbaum, Allen R; Giddens, Don P

    2005-01-01

    This paper presents a novel approach that three-dimensionally visualizes and evaluates stenoses in human coronary arteries by using harmonic skeletons. A harmonic skeleton is the center line of a multi-branched tubular surface extracted based on a harmonic function, which is the solution of the Laplace equation. This skeletonization method guarantees smoothness and connectivity and provides a fast and straightforward way to calculate local cross-sectional areas of the arteries, and thus provides the possibility to localize and evaluate coronary artery stenosis, which is a commonly seen pathology in coronary artery disease.

  11. Harmonic Skeleton Guided Evaluation of Stenoses in Human Coronary Arteries

    PubMed Central

    Yang, Yan; Zhu, Lei; Haker, Steven; Tannenbaum, Allen R.; Giddens, Don P.

    2013-01-01

    This paper presents a novel approach that three-dimensionally visualizes and evaluates stenoses in human coronary arteries by using harmonic skeletons. A harmonic skeleton is the center line of a multi-branched tubular surface extracted based on a harmonic function, which is the solution of the Laplace equation. This skeletonization method guarantees smoothness and connectivity and provides a fast and straightforward way to calculate local cross-sectional areas of the arteries, and thus provides the possibility to localize and evaluate coronary artery stenosis, which is a commonly seen pathology in coronary artery disease. PMID:16685882

  12. Effect of Stent Implantation on the Deformations of the Superficial Femoral Artery and Popliteal Artery: In Vivo Three-Dimensional Deformational Analysis from Two-Dimensional Radiographs.

    PubMed

    Schumann, Steffen; Gökgöl, Can; Diehm, Nicolas; Büchler, Philippe; Zheng, Guoyan

    2017-01-01

    The objective of this work was to develop a system for three-dimensional (3D) reconstruction of the femoropopliteal artery from two angiographic views and to quantify the in vivo 3D deformations in 18 patients before balloon angioplasty and after primary stent implantation. The procedure had an insignificant effect on the bending behavior of the artery, as the average mean curvature change within the lesion remained constant before (0.04 cm(-1) ± 0.03) and after stent implantation (0.03 cm(-1) ± 0.04). A significant effect of stent implantation was measured in terms of a decrease in arterial shortening during leg flexion.

  13. Is There an Association Between Carotid-Femoral Pulse Wave Velocity and Coronary Heart Disease in Patients with Coronary Artery Disease: A Pilot Study.

    PubMed

    Katsiki, Niki; Kollari, Erietta; Dardas, Sotirios; Dardas, Petros; Haidich, Anna-Bettina; Athyros, Vasilios G; Karagiannis, Asterios

    2016-01-01

    Arterial stiffness has been shown to predict cardiovascular morbidity and mortality. Carotid-femoral pulse wave velocity (cfPWV) is regarded the gold standard marker of arterial stiffness. In previous studies, cfPWV was associated with the presence of coronary heart disease (CHD). However, with regard to CHD severity as assessed by the Syntax Score, only brachial-ankle PWV was reported to correlate with Syntax Score; no data exist for cfPWV. In this pilot study, we evaluated the possible associations between cfPWV, CHD and Syntax Score in 62 consecutive pa-tients (49 males; mean age: 64±12years) with chest pain undergoing scheduled coronary angiography. cfPWV was signifi-cantly higher in CHD patients than in non-CHD individuals (10 vs. 8.4 m/s; p = 0.003). No significant association was found between cfPWV and CHD severity as assessed by Syntax Score. A cut-off point of 12.3 m/s was considered as diagnostic for abnormally increased cfPWV (specificity: 97%; sensitivity: 12%; positive likelihood ratio: 3.558). Further research is needed to establish the relationship between cfPWV and Syntax Score.

  14. Contribution of Ca²⁺-dependent Cl⁻ channels to norepinephrine-induced contraction of femoral artery is replaced by increasing EDCF contribution during ageing.

    PubMed

    Liskova, Silvia; Petrova, Miriam; Karen, Petr; Behuliak, Michal; Zicha, Josef

    2014-01-01

    The activation of Ca(2+)-dependent Cl(-) channels during norepinephrine-induced contraction of vascular smooth muscle was suggested to depolarize cell membrane and to increase Ca(2+) entry. Hypertension and ageing are associated with altered Ca(2+) handling including possible activation of Ca(2+)-dependent Cl(-) channels. Our study was aimed to determine Ca(2+)-dependent Cl(-) channels contribution to norepinephrine-induced contraction during hypertension and ageing. Norepinephrine-induced concentration-response curves of femoral arteries from 6- and 12-month-old spontaneously hypertensive rats (SHR) and Wistar-Kyoto (WKY) rats were recorded using wire myograph. Pretreatment with Ca(2+)-dependent Cl- channel inhibitor indanyloxyacetic acid 94 [R(+)-IAA-94](IAA) attenuated norepinephrine-induced contraction in all groups, but relatively more in WKY than SHR arteries. The attenuation of norepinephrine-induced contraction after Ca(2+)-dependent Cl(-) channels blockade was partially reduced in 12-month-old WKY rats, but substantially diminished in 12-month-old SHR. IAA effect was enhanced after NO synthase inhibition but decreased by ageing. In 20-month-old WKY rats norepinephrine-induced contraction was not affected by IAA but was almost abolished after cyclooxygenase inhibition by indomethacin or niflumic acid. In conclusion, contribution of Ca(2+)-dependent Cl(-) channels to norepinephrine-induced contraction diminished with age, hypertension development, and/or NO synthesis inhibition. Ca(2+)-dependent Cl(-) channels are important for maintenance of normal vascular tone while their inactivation/closing might be a pathological mechanism.

  15. Effect on Intimal Hyperplasia of Dexamethasone Released from Coated Metal Stents Compared with Non-Coated Stents in Canine Femoral Arteries

    SciTech Connect

    Strecker, Ernst-Peter; Gabelmann, Andreas; Boos, Irene; Lucas, Christopher; Xu, Zhongying; Haberstroh, Joerg; Freudenberg, Nicolaus; Stricker, Helmut; Langer, Mathias; Betz, Eberhard

    1998-11-15

    Purpose: Polymer-coated, dexamethasone (DXM)-releasing stents were tested in order to assess the efficacy of DXM released locally for the prevention of stent restenosis due to intimal hyperplasia. Methods: Strecker stents coated with a biodegradable membrane containing DXM were implanted percutaneously into the femoral artery in 14 dogs. The contralateral artery received a conventional non-coated stent serving as control. The drugs are eluted by degradation of the carrier membrane. Follow-up intraarterial digital subtraction angiography (DSA) was obtained at 3, 6, 9, 12, and 24 weeks with subsequent autopsy. Specimens for gross and microscopic pathology were obtained and histomorphometry was performed. Results: Four of 14 DXM-coated stents showed thrombotic occlusion within the first 3 weeks; ten DXM-coated stents remained patent. At follow-up DSA, DXM-coated stents showed a significantly wider lumen than the non-coated stents. At morphometry there was less intimal hyperplasia over DXM-coated stents than over non-coated stents (p < 0.05). Conclusion: DXM-coated stents reduce neointimal hyperplasia in dogs when compared with non-coated stents.

  16. The effect of intermittent intraabdominal pressure elevations and low cardiac output on the femoral to carotid arterial blood pressure difference in piglets.

    PubMed

    Aksakal, Devrim; Hückstädt, Thomas; Richter, Steffen; Klitscher, Daniela; Wowra, Tobias; Schier, Felix; Wessel, Lucas M; Kubiak, Rainer

    2016-11-01

    Our previous work in a laparoscopic setting in piglets revealed that the systolic femoral artery pressure was approximately 5 % higher than its carotid counterpart, whereas the mean and diastolic values showed no significant difference. This remained idem when the intraabdominal pressure (IAP) was gradually increased. In this study, we aimed to investigate the effect of (1) intermittent IAP elevations and (2) a low cardiac output (CO) on the blood pressure (BP) difference cranially (carotid artery) and caudally (femoral artery) of a capnoperitoneum (ΔP = P a fem-P a carot). A total of twenty-two piglets (mean body weight 11.0 kg; range 8.9-13.3 kg) were studied. Of these, 14 underwent intermittent IAP elevations at 8 and 16 mmHg, and ΔP was measured. In another 8 piglets, a model of reduced CO was created by introducing an air embolism (2 ml/kg over 30 s) in the inferior caval vein (VCI) at 12 mmHg IAP to further assess the influence of this variable on ΔP. Systolic ΔP remained at a mean of 5.6 mmHg and was not significantly affected by insufflation or exsufflation up to an IAP of 16 mmHg. Diastolic and mean values showed no differences between P a carot and P a fem. P a fem, systol remained higher than its carotid counterpart as long as the cardiac index (CI) was above 1.5 l/min/m(2), but fell significantly below P a carot, systol at a low CI. There was no CO-dependent effect on diastolic and mean ΔP. Repeated IAP elevations do not significantly influence ΔP. Intermittent IAP elevations do not significantly influence ΔP. Despite of a CO-dependent inversion of systolic ΔP, mean BP measurements at the leg during laparoscopy remain representative even at low CO values.

  17. Topography of the femoral nerve in relation to components of the iliopsoas muscle in human fetuses.

    PubMed

    Jakubowicz, M

    1991-01-01

    Studies were performed on 60 human fetuses of both sexes of 35 to 365 mm C.-R. length (9-40 weeks). The psoas minor muscle was found in 25.8% of cases independently of sex and body side. In 6.45% of cases the muscle continued into psoas major muscle by short, weakly developed tendon. In 97.5% of studied fetuses junctions between tendons of psoas major and iliacus muscles was observed. In 2.5% of cases an independent, short tendon was found in the half of length of the iliacus muscle. In 7.5% of cases connection between the psoas major and iliacus muscles was found. In all cases femoral nerve originated from the lumbar plexus between two layers of the psoas major muscle and it ran in the groove between the psoas major and iliacus muscles towards the muscular lacuna. In 5.0% of cases the nerve divided into crura. In 2.5% of cases the crura embraced anteriorly and posteriorly bundles of the psoas major muscle as well as in 2.5% of cases bundles of the iliacus muscle.

  18. Three Point Bending Test of Human Femoral Tissue: An Essay in Ancient and Modern Bones

    NASA Astrophysics Data System (ADS)

    González-Bárcenas, L. A.; Trejo-Camacho, H.; Suárez-Estrella, I.; Heredia, A.; Magaña, C.; Bucio, L.; Orozco, E.

    2003-09-01

    Some procedures for characterising the mechanical properties of femur diaphysis are reviewed here. We have used the three point bending test to measure the relative rupture modulus of ancient healthy human tissues (1250, 800, 614, and 185 years BP) as well as recent bones. The maximum resistance to fracture was measured applying a force (by a wedge) over the femoral inner surface. The maximum rupture strength was about 150 MPa for recent bone and decreased as the antiquity increased. The typical anisotropy that is observed in this kind of tissues is due to the anisotropical orientation of fibres as well as the textured orientation of the apatite crystals over the collagen fibres. Therefore we found that ancient bones show less fracture strength probably due to an abiotic crystal growth phenomenon during the diagenesis process. By LVSEM analysis we have found that in recent samples the fracture surface is irregular due to the crosslinking interactions between the collagen molecules, in comparison with the ancient samples, where a smooth surface is clearly appreciated as the antiquity of the sample increases. The results reported here strongly suggest that these composites should contain a fibrillar phase as a matrix constituted mainly by a natural polymer (i.e. collagen, cellulose, etc.). Moreover, this composite must have a minimum rupture strength of about 150 MPa.

  19. Serotonin-induced blood flow changes in the rat hindlegs after unilateral ligation of the femoral artery. Inhibition by the S2 receptor antagonist ketanserin.

    PubMed

    Verheyen, A; Vlaminckx, E; Lauwers, F; Van Den Broeck, C; Wouters, L

    1984-08-01

    Collateral arteries can clearly be visualized in corrosion cast material after ligation of the femoral artery in rats. To characterize the influence of serotonin on the blood circulation under the experimental condition of unilateral ligation, we performed intermuscular thermoflow measurements. The data showed that intraperitoneal serotonin (8.7 and 20 mg.kg-1) injection markedly reduced the muscle temperature in both hindlegs. However, the effect was significantly more pronounced on the ligated side, where the blood was supplied through a collateral circulation, than on the non-ligated side with its normal arterial vasculature. Almost identical changes were obtained in rats with an early as well as in animals with a more advanced stage of collateral development (challenge with 8.7 mg.kg-1 serotonin). Evans blue dye experiments and angiographic data further revealed that, after challenge with 20 mg.kg-1 serotonin, the severe temperature decrease at the ligated side probably reflected a nearly complete blockage of blood supply. Pretreatment with the S2 receptor antagonist ketanserin (2.5 mg.kg-1) resulted in a significant reduction in the extent and duration of the serotonin-induced temperature decrease as revealed by the temperature measurements; such a treatment inhibited also the blockage in blood flow as seen with the other techniques. This study shows that serotonin, through its vasoconstrictive properties, can restrict the blood flow to the lower extremities of the rat, particularly when the blood is supplied through collateral circulation. This probably results in moderate to severe skeletal muscle ischaemia. It also suggests that the vasoconstriction is not only important in the inhibition of collateral blood flow in recently established collaterals but also in collateral vessels in a more advanced stage of development. The in vivo vasoconstriction and subsequent reduction of the blood supply caused by serotonin can be effectively counteracted by

  20. Antegrade vs Crossover Femoral Artery Access in the Endovascular Treatment of Isolated Below-the-Knee Lesions in Patients With Critical Limb Ischemia.

    PubMed

    Li, Yukun; Esmail, Ali; Donas, Konstantinos P; Pitoulias, Georgios; Torsello, Giovanni; Bisdas, Theodosios; Michelagnoli, Stefano; Troisi, Nicola

    2017-06-01

    To evaluate the safety and effectiveness of antegrade vs crossover femoral artery access in the endovascular treatment of isolated below-the-knee (BTK) lesions in patients with critical limb ischemia (CLI). Between January 2014 and December 2015, 224 high-risk patients (mean age 75.8±9.8 years; 151 men) with CLI underwent infragenicular interventions on 292 crural vessels in 3 European vascular centers. All patients had isolated TransAtlantic Inter-Society Consensus (TASC) C (n=26) or D (n=198) BTK lesions. Primary endpoints were freedom from access-related complications and technical success comparing the antegrade vs crossover access groups. Balloon angioplasty was the most used treatment modality (169 vessels, 75.4%). The technical success rate was 88.4% in the entire cohort and 88.0% in the antegrade group vs 90.4% in the crossover group (p>0.99). In all patients, the technical success rate was higher for stenotic lesions (100%) vs occlusions (85.5%, p=0.002) and in patients with TASC C BTK lesions (100%) vs TASC D (86.9%, p=0.033). The overall freedom from access-related complications was 97.8%: 99% in the antegrade group and 90.6% in the crossover group (p=0.022). Larger sheath size (5/6-F vs 4-F) was associated with a significantly higher risk for access-related complications (7.1% vs 1.1%, respectively; p=0.047). The present multicenter study showed high technical success and a low incidence of access-related complications in the treatment of isolated BTK lesions using either antegrade or crossover femoral access. The antegrade approach with the use of a 4-F system seems to have a significantly lower rate of access-related complications.

  1. Computational modeling of hypertensive growth in the human carotid artery

    NASA Astrophysics Data System (ADS)

    Sáez, Pablo; Peña, Estefania; Martínez, Miguel Angel; Kuhl, Ellen

    2014-06-01

    Arterial hypertension is a chronic medical condition associated with an elevated blood pressure. Chronic arterial hypertension initiates a series of events, which are known to collectively initiate arterial wall thickening. However, the correlation between macrostructural mechanical loading, microstructural cellular changes, and macrostructural adaptation remains unclear. Here, we present a microstructurally motivated computational model for chronic arterial hypertension through smooth muscle cell growth. To model growth, we adopt a classical concept based on the multiplicative decomposition of the deformation gradient into an elastic part and a growth part. Motivated by clinical observations, we assume that the driving force for growth is the stretch sensed by the smooth muscle cells. We embed our model into a finite element framework, where growth is stored locally as an internal variable. First, to demonstrate the features of our model, we investigate the effects of hypertensive growth in a real human carotid artery. Our results agree nicely with experimental data reported in the literature both qualitatively and quantitatively.

  2. Assessment of flow-mediated dilatation in the superficial femoral artery using a sustained shear stress stimulus via calf plantar-flexion exercise.

    PubMed

    King, T J; Schmitter, S M; Pyke, K E

    2017-06-01

    What is the central question of this study? The aim was to establish the ability of a newly designed leg exercise technique to produce sustained elevations in shear rate that stimulate flow-mediated dilatation (FMD) in the superficial femoral artery and to determine the repeat trial stability of the FMD response. What is the main finding and its importance? Calf plantar-flexion exercise can be used to increase shear stress and stimulate FMD in the superficial femoral artery. However, the magnitude of FMD varied systematically when multiple trials were repeated in short succession. The superficial femoral artery (SFA) is susceptible to vascular disease, and a technique to assess flow-mediated dilatation (FMD) in this vessel in response to a sustained shear stress stimulus could provide important information about endothelial function. The aim of this study was to establish the ability of a newly designed SFA leg exercise-FMD (LEX-FMD) technique to produce sustained elevations in shear rate, which stimulate FMD, and to determine the repeat trial stability of the FMD response. The SFA FMD stimulated by reactive hyperaemia (RH) and calf plantar-flexion exercise (LEX) was assessed via ultrasound in 19 healthy men (n = 10) and women (n = 9). The two experimental visits included either four trials of LEX-FMD or four trials of RH-FMD. The shear stress stimulus was estimated as the shear rate (blood velocity/SFA diameter). Results are expressed as the means ± SD. The LEX steady-state shear rate was consistent between trials (P = 0.176), whereas the RH shear rate area under the curve was higher in trial 1 versus trials 2-4 (P < 0.05). The %RH-FMD (four-trial mean 4.9 ± 2.5%) and absolute RH-FMD were not significantly different between trials (P = 0.465 and P = 0.359, respectively). Both %LEX-FMD and absolute LEX-FMD were higher during trial 3 (4.8 ± 3.4%) than trial 1 (3.6 ± 2.7%; P = 0.026 and P = 0.026, respectively). The magnitude of RH

  3. Retrograde arterial leg blood flow during tilt-back from a head-up posture: importance of capacitive flows when arterial pressure changes.

    PubMed

    Sheriff, Don D; Nådland, Inger Helene; Toska, Karin

    2010-03-01

    The windkessel function of the arterial system converts the intermittent action of the heart into more continuous microcirculatory blood flow during diastole via the return of elastic energy stored in the walls of the arteries during systole. Might the same phenomenon occur regionally within the arterial system during tilting owing to regional differences in local arterial pressure imposed by gravity? We sought to test the hypothesis that during tilt-back from a head-up posture, the return of stored elastic energy in leg arteries would work to slow, or perhaps transiently reverse, the flow of blood in the femoral artery. Femoral artery blood flow and arterial pressure were recorded during tilt back from a 30 degrees head-up posture to supine (approximately 0.5 G) in young, healthy subjects (n = 7 males and 3 females) before and during clonidine infusion. During control (no drug) conditions femoral artery blood flow ceased for an entire heart beat during tilt-back. During clonidine infusion femoral artery blood flow reversed for at least one entire heart beat during tilt-back, i.e., blood flow in the retrograde direction in the femoral artery from the leg into the abdomen. Thus substantial capacitive effects of tilting on leg blood flow occur in humans during mild changes in posture.

  4. An Ex Vivo Model in Human Femoral Heads for Histopathological Study and Resonance Frequency Analysis of Dental Implant Primary Stability

    PubMed Central

    Hernández-Cortés, Pedro; Galindo-Moreno, Pablo; Catena, Andrés; Ortega-Oller, Inmaculada; Salas-Pérez, José; Gómez-Sánchez, Rafael; Aguilar, Mariano; Aguilar, David

    2014-01-01

    Objective. This study was designed to explore relationships of resonance frequency analysis (RFA)—assessed implant stability (ISQ values) with bone morphometric parameters and bone quality in an ex vivo model of dental implants placed in human femoral heads and to evaluate the usefulness of this model for dental implant studies. Material and Methods. This ex vivo study included femoral heads from 17 patients undergoing surgery for femoral neck fracture due to osteoporosis (OP) (n = 7) or for total prosthesis joint replacement due to severe hip osteoarthrosis (OA) (n = 10). Sixty 4.5 × 13 mm Dentsply Astra implants were placed, followed by RFA. CD44 immunohistochemical analysis for osteocytes was also carried out. Results. As expected, the analysis yielded significant effects of femoral head type (OA versus OA) (P < 0.001), but not of the implants (P = 0.455) or of the interaction of the two factors (P = 0.848). Bonferroni post hoc comparisons showed a lower mean ISQ for implants in decalcified (50.33 ± 2.92) heads than in fresh (66.93 ± 1.10) or fixated (70.77 ± 1.32) heads (both P < 0.001). The ISQ score (fresh) was significantly higher for those in OA (73.52 ± 1.92) versus OP (67.13 ± 1.09) heads. However, mixed linear analysis showed no significant association between ISQ scores and morphologic or histomorphometric results (P > 0.5 in all cases), and no significant differences in ISQ values were found as a function of the length or area of the cortical layer (both P > 0.08). Conclusion. Although RFA-determined ISQ values are not correlated with morphometric parameters, they can discriminate bone quality (OP versus OA). This ex vivo model is useful for dental implant studies. PMID:24995307

  5. An ex vivo model in human femoral heads for histopathological study and resonance frequency analysis of dental implant primary stability.

    PubMed

    Hernández-Cortés, Pedro; Monje, Alberto; Galindo-Moreno, Pablo; Catena, Andrés; Ortega-Oller, Inmaculada; Salas-Pérez, José; Mesa, Francisco; Gómez-Sánchez, Rafael; Aguilar, Mariano; Aguilar, David; O'Valle, Francisco

    2014-01-01

    This study was designed to explore relationships of resonance frequency analysis (RFA)-assessed implant stability (ISQ values) with bone morphometric parameters and bone quality in an ex vivo model of dental implants placed in human femoral heads and to evaluate the usefulness of this model for dental implant studies. This ex vivo study included femoral heads from 17 patients undergoing surgery for femoral neck fracture due to osteoporosis (OP) (n = 7) or for total prosthesis joint replacement due to severe hip osteoarthrosis (OA) (n = 10). Sixty 4.5 × 13 mm Dentsply Astra implants were placed, followed by RFA. CD44 immunohistochemical analysis for osteocytes was also carried out. As expected, the analysis yielded significant effects of femoral head type (OA versus OA) (P < 0.001), but not of the implants (P = 0.455) or of the interaction of the two factors (P = 0.848). Bonferroni post hoc comparisons showed a lower mean ISQ for implants in decalcified (50.33 ± 2.92) heads than in fresh (66.93 ± 1.10) or fixated (70.77 ± 1.32) heads (both P < 0.001). The ISQ score (fresh) was significantly higher for those in OA (73.52 ± 1.92) versus OP (67.13 ± 1.09) heads. However, mixed linear analysis showed no significant association between ISQ scores and morphologic or histomorphometric results (P > 0.5 in all cases), and no significant differences in ISQ values were found as a function of the length or area of the cortical layer (both P > 0.08). Although RFA-determined ISQ values are not correlated with morphometric parameters, they can discriminate bone quality (OP versus OA). This ex vivo model is useful for dental implant studies.

  6. One-year outcomes of the U.S. and Japanese regulatory trial of the Misago stent for treatment of superficial femoral artery disease (OSPREY study).

    PubMed

    Ohki, Takao; Angle, John F; Yokoi, Hiroyoshi; Jaff, Michael R; Popma, Jeffrey; Piegari, Guy; Kanaoka, Yuji

    2016-02-01

    The purpose of this study was to assess the safety and efficacy of the Misago stent (Terumo Corp, Tokyo, Japan) in occlusive and stenotic superficial femoral artery (SFA) disease. The safety and efficacy of the Misago SFA stent were evaluated prospectively in this initial collaboration trial between Japan and the United States. Because this trial enrolled patients mainly from Japan and the United States and because there is a question as to whether a race difference exists in SFA stent performance, the race difference on outcome was also analyzed. In addition, results were compared with a prior SFA stent trial. The Misago stent was implanted in 261 subjects with TransAtlantic Inter-Society Consensus (TASC) type A and type B SFA lesions (201 subjects in the United States, 50 in Japan, 9 in Taiwan, 1 in South Korea). The mean age of the patients was 69.3 ± 10.0 years, and the mean lesion length was 83.8 ± 41.3 mm. The overall 12-month primary patency rate and clinically driven target lesion revascularization were 82.9% and 13.0%, respectively. Regional differences within the Occlusive/Stenotic Peripheral Artery Revascularization Study (OSPREY) and outcomes between U.S. and Asian patients were similar, including primary patency (82.9% vs 83.0%; P = .889), clinically driven target lesion revascularization (13.4% vs 11.7%; P = .829), stent fracture rate (1.3% vs 0.0%; P = 1.000), and stent thrombosis rate (0.5% vs 0.0%; P = 1.000). OSPREY 12-month data showed satisfactory outcome of the Misago stent for the treatment of TASC type A and type B SFA lesions and appears to be comparable to recent stent trials. In addition, the lack of difference in outcome among races supports the value of international trials. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  7. Comparison of the results of percutaneous transluminal angioplasty and stenting with medical treatment for claudicants who have superficial femoral artery occlusive disease.

    PubMed

    Wilson, Samuel; Gelfand, Dmitri; Jimenez, Juan; Gordon, Ian

    2006-01-01

    The outcomes of medical management of peripheral vascular disease localized to the superficial femoral artery (SFA) were compared with those obtained by percutaneous transluminal angioplasty (PTA) with or without stenting in a review of selected studies. The natural history of localized SFA disease is favorable, with major amputation rates less than 10% and revascularization in only 18% of patients over a 10-year interval. Conservative treatment of claudicants shows increases (150%) in walking distance if the ankle brachial index (ABI) is over 0.6 and patients stop smoking. Analysis of 10 trials (882 patients) of PTA with or without stenting found that the overall primary patency rates at 12 months were 71.1% for PTA plus stenting and 58.3% for PTA alone. Technical success with PTA with or without stenting is over 90%, and early results at 6 months are superior to those with exercise. In three randomized controlled trials, however, the difference between PTA and medical treatment at 2 years, whether measured by walking distance or ABI, was not significant, nor was the quality of life. For long-term improvement in walking distance (> 1 year) in the claudicant, intervention is not superior to medical treatment and a monitored exercise program. Consideration should be given to including a nonintervention control group and 2-year outcomes in the evaluation of new SFA stents.

  8. Treatment effect with anti-RAGE F(ab')2 antibody improves hind limb angiogenesis and blood flow in Type 1 diabetic mice with left femoral artery ligation.

    PubMed

    Tekabe, Yared; Anthony, Tamykah; Li, Qing; Ray, Rashmi; Rai, Vivek; Zhang, Geping; Schmidt, Ann Marie; Johnson, Lynne L

    2015-06-01

    We investigated treatment with a receptor for advanced glycation endproduct (RAGE) blocking antibody on angiogenic response to hind limb ischemia in diabetic mice. Streptozotocin treated C57BL/6 mice received either murine monoclonal anti-RAGE F(ab')2 intraperitoneally (n=10) or saline (n=9) for 9 weeks. Diabetic plus 10 non-diabetic C57BL/6 mice underwent left femoral artery ligation and 5 days later angiogenesis imaging with (99m)Tc-Arg-Gly-Asp (RGD) nanoSPECT/CT. Twenty-four days later, hind limb blood flow was measured with ultrasound, the mice were euthanized, and tissue was taken for immunohistochemistry. The angiogenic imaging signal in ischemic limbs was higher in RAGE-ab treated versus saline treated mice at day 5 (3.1±1.4 vs 1.68±0.35, p=0.02) and blood flow was higher at day 24 (1.49±0.5 vs 0.61±0.39, p=0.04). Immunohistochemistry of ischemic muscles showed greater capillary density in the RAGE-ab treated group versus the vehicle-treated group (p<0.001) (NS from non-diabetic mice). In conclusion, treatment with anti-RAGE F(ab')2 in diabetic mice improves neovascularization in the ischemic leg. © The Author(s) 2015.

  9. Comparison of Small Intestinal Submucosa-Covered and Noncovered Nitinol Stents with PTFE Endografts in Injured Ovine Femoral Arteries: A Pilot Study

    SciTech Connect

    Nakata, Manabu; Pavcnik, Dusan Uchida, Barry T.; Van Alstine, William; Timmermans, Hans A.; Toyota, Naoyuki; Terada, Masaki; Brountzos, Elias; Kaufman, John A.; Keller, Frederick S.; Rosch, Josef

    2003-09-15

    The purpose of this study was to compare performance of small intestinal submucosa (SIS)-covered endografts (SCEs) to polytetra-fluoroethylene (PTFE)-covered endografts (PCEs) and to bare nitinol stents (BSs) in injured sheep femoral artery (FA). Bare Zilver 6 mm x 40 mm nitinol stents (n = 6), Zilver stents covered with SIS (n = 6), and Palmaz stents 6 mm x 37 mm covered with PTFE (n = 6) were implanted in the balloon-injured FAs of nine female sheep. Follow-up arteriograms were obtained before animal sacrifice at 1, 3 and 6 months, with three animals at each time point. The FAs with the implanted device were explanted for histologic studies and morphologic measurements. Stent implantation was technically successful in all sheep. All BS and SCEs were patent at each time point. Five BSs and five SCEs exhibited formation of progressive eccentric intimal hyperplasia (IH) that was more advanced in SCE at 6 months. Cross-sectional area narrowing averaged 60% for BSs and 67% for SCEs. One BS, one SCE and two patent PCEs exhibited mild-to-moderate formation of concentric IH. Four PCS occluded one at 1 month, two at 3 months and one at 6 months. Performance of the devices placed into sheep FAs depended on their relation to the curving peri-articular portion of the FA during extremity flexion. BSs and SCEs placed in this portion exhibited progressive growth of eccentric IH while PCEs placed in this portion occluded.

  10. A Novel Device for True Lumen Re-Entry After Subintimal Recanalization of Superficial Femoral Arteries: First-in-Man Experience and Technical Description

    SciTech Connect

    Airoldi, Flavio Faglia, Ezio Losa, Sergio Tavano, Davide; Latib, Azeem; Mantero, Manuela Lanza, Gaetano Clerici, Giacomo

    2011-02-15

    Subintimal angioplasty (SAP) is frequently performed for the treatment of critical limb ischemia (CLI) and has been recognized as an effective technique for these patients. Nevertheless, this approach is limited by the lack of controlled re-entry into the true lumen of the target vessel. We describe a novel device for true lumen re-entry after subintimal recanalization of superficial femoral arteries (SFA). We report our experience with six patients treated between April 2009 and January 2010 with a novel system designed to facilitate true lumen re-entry. The device was advanced by ipsilateral antegrade approach through a 6-French sheath. Successful reaccess into the true lumen was obtained in five of six patients without complications. The patient in whom the reaccess to the true lumen was not possible underwent successful bypass surgery. At 30 days follow-up, the SFA was patent in all patients according to echo-Doppler examination. Our preliminary experience indicates that this novel re-entry device increases the success rate of percutaneous revascularization of chronically occluded SFA.

  11. Acute effects of short-term intimal heating by laser-heated thermal balloon angioplasty in canine stenotic femoral arteries in vivo

    NASA Astrophysics Data System (ADS)

    Miyamoto, Akira; Sakurada, Masami; Arai, Tsunenori; Mizuno, Kyoichi; Sugiyabu, Yasunori; Kurita, Akira; Nakamura, Haruo; Kikuchi, Makoto; Watanabe, Tamishige; Utsumi, Atsushi; Akai, Yoshiro; Takeuchi, Kiyoshi

    1993-06-01

    Short-term intimal heating may be effective to improve luminal geometry without deep medial injury which can induce restenosis. We developed a new laser-heated thermal balloon catheter which can quickly raise and lower the balloon temperature. To investigate the acute effect of short-term thermal balloon angioplasty (STBA) for stenotic lesions, we performed STBA following balloon angioplasty (BA) in 8 canine stenotic femoral arteries. Cw Nd:YAG laser delivery (10 W, 15 s) induced the maximum temperature of 83 degree(s)C on average. Angiography and angioscopy were performed at pre-BA, post-BA and post-STBA. The angiographical mean stenotic diameter was 1.8 mm at pre-BA, 2.2 mm* at post-BA, 2.9 mm** at post-STBA (*:p < 0.05 pre-BA vs post-BA, **:p < 0.05 pre- and post-BA vs post-STBA). The angioscopic observation revealed intimal flaps and tears in 7 lesions after BA. The luminal geometry after STBA was symmetrically expanded. However, the intimal injury was still observed although the intimal flaps were partly sealed by STBA. These results suggested that the dilatation mechanism of STBA for stenotic lesions might be attributed to preventing elastic recoil rather than to sealing intimal fragments induced by BA.

  12. Comparison of small intestinal submucosa-covered and noncovered nitinol stents with PTFE endografts in injured ovine femoral arteries: a pilot study.

    PubMed

    Nakata, Manabu; Pavcnik, Dusan; Uchida, Barry T; VanAlstine, William; Timmermans, Hans A; Toyota, Naoyuki; Terada, Masaki; Brountzos, Elias; Kaufman, John A; Keller, Frederick S; Rosch, Josef

    2003-01-01

    The purpose of this study was to compare performance of small intestinal submucosa (SIS)-covered endografts (SCEs) to polytetra-fluoroethylene (PTFE)-covered endografts (PCEs) and to bare nitinol stents (BSs) in injured sheep femoral artery (FA). Bare Zilver 6 mm X 40 mm nitinol stents (n = 6), Zilver stents covered with SIS (n = 6), and Palmaz stents 6 mm x 37 mm covered with PTFE (n = 6) were implanted in the balloon-injured FAs of nine female sheep. Follow-up arteriograms were obtained before animal sacrifice at 1, 3 and 6 months, with three animals at each time point. The FAs with the implanted device were explanted for histologic studies and morphologic measurements. Stent implantation was technically successful in all sheep. All BS and SCEs were patent at each time point. Five BSs and five SCEs exhibited formation of progressive eccentric intimal hyperplasia (IH) that was more advanced in SCE at 6 months. Cross-sectional area narrowing averaged 60% for BSs and 67% for SCEs. One BS, one SCE and two patent PCEs exhibited mild-to-moderate formation of concentric IH. Four PCS occluded one at 1 month, two at 3 months and one at 6 months. Performance of the devices placed into sheep FAs depended on their relation to the curving peri-articular portion of the FA during extremity flexion. BSs and SCEs placed in this portion exhibited progressive growth of eccentric IH while PCEs placed in this portion occluded.

  13. Long-term Treatment with Hesperidin Improves Endothelium-dependent Vasodilation in Femoral Artery of Spontaneously Hypertensive Rats: The Involvement of NO-synthase and Kv Channels.

    PubMed

    Dobiaš, Lukáš; Petrová, Miriam; Vojtko, Róbert; Kristová, Viera

    2016-10-01

    Hesperidin is the most common flavonoid found in citrus fruits and is expected to exert vasodilation action relevant to its health benefits. The present study aimed to explore the effect of hesperidin on the vascular responses in normotensive and hypertensive rats and the involvement of NO-synthase and Kv channels. The 15-week-old Wistar and spontaneously hypertensive rats (SHR) were randomized to orally receive either hesperidin (50 mg/kg/day) or a corresponding volume of the water for 4 weeks. Vascular responses of isolated femoral arteries were studied with myograph in control conditions and during inhibition of NO-synthase with l-NNA and Kv channels with 4-AP. Hesperidin had no effect on blood pressure. Endothelium-dependent vasodilation in Wistar and SHR was significantly improved by the treatment with hesperidin. The contraction responses after l-NNA were increased in all groups of rats to similar extent, but relaxatory responses were significantly attenuated only in SHR. The inhibition of Kv channels significantly reduced endothelium-dependent vasodilatory responses in only in SHR administered with hesperidin. The results of our experiment indicate that hesperidin might improve the endothelium-dependent vasodilation during hypertension, possibly through the enhancement of Kv channels function. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  14. Passive heat therapy improves endothelial function, arterial stiffness and blood pressure in sedentary humans.

    PubMed

    Brunt, Vienna E; Howard, Matthew J; Francisco, Michael A; Ely, Brett R; Minson, Christopher T

    2016-09-15

    A recent 30 year prospective study showed that lifelong sauna use reduces cardiovascular-related and all-cause mortality; however, the specific cardiovascular adaptations that cause this chronic protection are currently unknown. We investigated the effects of 8 weeks of repeated hot water immersion ('heat therapy') on various biomarkers of cardiovascular health in young, sedentary humans. We showed that, relative to a sham group which participated in thermoneutral water immersion, heat therapy increased flow-mediated dilatation, reduced arterial stiffness, reduced mean arterial and diastolic blood pressure, and reduced carotid intima media thickness, with changes all on par or greater than what is typically observed in sedentary subjects with exercise training. Our results show for the first time that heat therapy has widespread and robust effects on vascular function, and as such, could be a viable treatment option for improving cardiovascular health in a variety of patient populations, particularly those with limited exercise tolerance and/or capabilities. The majority of cardiovascular diseases are characterized by disorders of the arteries, predominantly caused by endothelial dysfunction and arterial stiffening. Intermittent hot water immersion ('heat therapy') results in elevations in core temperature and changes in cardiovascular haemodynamics, such as cardiac output and vascular shear stress, that are similar to exercise, and thus may provide an alternative means of improving health which could be utilized by patients with low exercise tolerance and/or capabilities. We sought to comprehensively assess the effects of 8 weeks of heat therapy on biomarkers of vascular function in young, sedentary subjects. Twenty young, sedentary subjects were assigned to participate in 8 weeks (4-5 times per week) of heat therapy (n = 10; immersion in a 40.5°C bath sufficient to maintain rectal temperature ≥ 38.5°C for 60 min per session) or thermoneutral water

  15. Determination of human coronary artery composition by Raman spectroscopy.

    PubMed

    Brennan, J F; Römer, T J; Lees, R S; Tercyak, A M; Kramer, J R; Feld, M S

    1997-07-01

    We present a method for in situ chemical analysis of human coronary artery using near-infrared Raman spectroscopy. It is rapid and accurate and does not require tissue removal; small volumes, approximately 1 mm3, can be sampled. This methodology is likely to be useful as a tool for intravascular diagnosis of artery disease. Human coronary artery segments were obtained from nine explanted recipient hearts within 1 hour of heart transplantation. Minces from one or more segments were obtained through grinding in a mortar and pestle containing liquid nitrogen. Artery segments and minces were excited with 830 nm near-infrared light, and Raman spectra were collected with a specially designed spectrometer. A model was developed to analyze the spectra and quantify the amounts of cholesterol, cholesterol esters, triglycerides and phospholipids, and calcium salts present. The model provided excellent fits to spectra from the artery segments, indicating its applicability to intact tissue. In addition, the minces were assayed chemically for lipid and calcium salt content, and the results were compared. The relative weights obtained using the Raman technique agreed with those of the standard assays within a few percentage points. The chemical composition of coronary artery can be quantified accurately with Raman spectroscopy. This opens the possibility of using histochemical analysis to predict acute events such as plaque rupture, to follow the progression of disease, and to select appropriate therapeutic interventions.

  16. Hemorheological abnormalities in human arterial hypertension

    NASA Astrophysics Data System (ADS)

    Lo Presti, Rosalia; Hopps, Eugenia; Caimi, Gregorio

    2014-05-01

    Blood rheology is impaired in hypertensive patients. The alteration involves blood and plasma viscosity, and the erythrocyte behaviour is often abnormal. The hemorheological pattern appears to be related to some pathophysiological mechanisms of hypertension and to organ damage, in particular left ventricular hypertrophy and myocardial ischemia. Abnormalities have been observed in erythrocyte membrane fluidity, explored by fluorescence spectroscopy and electron spin resonance. This may be relevant for red cell flow in microvessels and oxygen delivery to tissues. Although blood viscosity is not a direct target of antihypertensive therapy, the rheological properties of blood play a role in the pathophysiology of arterial hypertension and its vascular complications.

  17. Reliable femoral chronic total occlusion model using a thin biodegradable polymer coated copper stent in a porcine model.

    PubMed

    Kim, Nan Yeol; Lim, Kyung Seob; Jeong, Myung Ho; Bae, In Ho; Park, Jun-Kyu; Nah, Jae-Woon; Park, Dae Sung; Lee, So Youn; Jang, Eun Jae; Kim, Jong Min; Kim, Jung Ha; Kee, Hae Jin; Cho, Soo-Na; Sim, Doo Sun; Park, Keun-Ho; Hong, Young Joon; Oh, Sang-Gi; Kim, Sang-Hyung; Ahn, Youngkeun; Kang, Jung Chaee

    2015-04-01

    Chronic total occlusions (CTOs) are common in patients with peripheral arterial disease (PAD). This study aimed to examine the feasibility and reliability of a CTO induced by a thin biodegradable polymer (polyglycolic acid) coated copper stent in a porcine femoral artery. Novel thin biodegradable polymer coated copper stents (9 mm long) were crimped on an angioplasty balloon (4.5 mm diameter × 12 mm length) and inserted into the femoral artery. Histopathologic analysis was performed 35 days after stenting. In five of six stented femoral arteries, severe in-stent restenosis and total occlusion with collateral circulation were observed without adverse effects such as acute stent thrombosis, leg necrosis, or death at 5 weeks. Fibrous tissue deposition, small vascular channels, calcification, and inflammatory cells were observed in hematoxylin-eosin, Carstair's, and von Kossa tissue stains; these characteristics were similar to pathological findings associated with CTOs in humans. The neointima volume measured by micro-computed tomography was 93.9 ± 4.04 % in the stented femoral arteries. CTOs were reliably induced by novel thin biodegradable polymer coated copper stents in porcine femoral arteries. Successful induction of CTOs may provide a practical understanding of their formation and application of an interventional device for CTO treatment.

  18. Silent cerebral infarct after cardiac catheterization as detected by diffusion weighted Magnetic Resonance Imaging: a randomized comparison of radial and femoral arterial approaches

    PubMed Central

    Hamon, Michèle; Burzotta, Francesco; Oppenheim, Catherine; Morello, Rémy; Viader, Fausto; Hamon, Martial

    2007-01-01

    Background and objective Cerebral microembolism detected by transcranial Doppler (TCD) occurs systematically during cardiac catheterization, but its clinical relevance, remains unknown. Studies suggest that asymptomatic embolic cerebral infarction detectable by diffusion-weighted (DW) MRI might exist after percutaneous cardiac interventions with a frequency as high as 15 to 22% of cases. We have set up, for the first time, a prospective multicenter trial to assess the rate of silent cerebral infarction after cardiac catheterization and to compare the impact of the arterial access site, comparing radial and femoral access, on this phenomenon. Study design This prospective study will be performed in patients with severe aortic valve stenosis. To assess the occurrence of cerebral infarction, all patients will undergo cerebral DW-MRI and neurological assessment within 24 hours before, and 48 hours after cardiac catheterization and retrograde catheterization of the aortic valve. Randomization for the access site will be performed before coronary angiography. A subgroup will be monitored by transcranial power M-mode Doppler during cardiac catheterization to observe cerebral blood flow and track emboli. Neuropsychological tests will also be recorded in a subgroup of patients before and after the interventional procedures to assess the impact of silent brain injury on potential cognitive decline. The primary end-point of the study is a direct comparison of ischemic cerebral lesions as detected by serial cerebral DW-MRI between patients explored by radial access and patients explored by femoral access. Secondary end-points include comparison of neuropsychological test performance and number of microembolism signals observed in the two groups. Implications Using serial DW-MRI, silent cerebral infarction rate will be defined and the potential influence of vascular access site will be evaluated. Silent cerebral infarction might be a major concern during cardiac catheterization

  19. Haemodynamic assessment of human coronary arteries is affected by degree of freedom of artery movement.

    PubMed

    Javadzadegan, Ashkan; Yong, Andy S C; Chang, Michael; Ng, Martin K C; Behnia, Masud; Kritharides, Leonard

    2017-02-01

    Abnormal haemodynamic parameters are associated with atheroma plaque progression and instability in coronary arteries. Flow recirculation, shear stress and pressure gradient are understood to be important pathogenic mediators in coronary disease. The effect of freedom of coronary artery movement on these parameters is still unknown. Fluid-structure interaction (FSI) simulations were carried out in 25 coronary artery models derived from authentic human coronaries in order to investigate the effect of degree of freedom of movement of the coronary arteries on flow recirculation, wall shear stress (WSS) and wall pressure gradient (WPG). Each FSI model had distinctive supports placed upon it. The quantitative and qualitative differences in flow recirculation, maximum wall shear stress (MWSS), areas of low wall shear stress (ALWSS) and maximum wall pressure gradient (MWPG) for each model were determined. The results showed that greater freedom of movement was associated with lower MWSS, smaller ALWSS, smaller flow recirculation zones and lower MWPG. With increasing percentage diameter stenosis (%DS), the effect of degree of freedom on flow recirculation and WSS diminished. Freedom of movement is an important variable to be considered for computational modelling of human coronary arteries, especially in the setting of mild to moderate stenosis. 3D: Three-dimensional; 3DR: Three-dimensional Reconstruction; 3D-QCA: Three-dimensional quantitative coronary angiography; ALWSS: Areas of low wall shear stress; CAD: Coronary artery disease; CFD: Computational fluid dynamics; %DS: Diameter stenosis percentage; EPCS: End point of counter-rotating streamlines; FSI: Fluid-structure interaction; IVUS: Intravascular ultrasound; LAD: Left anterior descending; MWSS: Maximum wall shear stress; SST: Shear stress transport; TAWSS: Time-averaged wall shear stress; WSS: wall shear stress; WPG: Wall pressure gradient; MWPG: Maximum wall pressure gradient; FFR: Fractional flow reserve; i

  20. Deformation pattern and load transfer of an uncemented femoral stem with modular necks. An experimental study in human cadaver femurs.

    PubMed

    Enoksen, Cathrine H; Gjerdet, Nils R; Klaksvik, Jomar; Arthursson, Astvaldur J; Schnell-Husby, Otto; Wik, Tina S

    2016-02-01

    Modular necks in hip arthroplasty allow variations in neck-shaft angles, neck version and neck lengths and have been introduced to improve accuracy when reconstructing the anatomy and hip joint biomechanics. Periprosthetic bone resorption may be a consequence of stress shielding in the proximal femur after implantation of a femoral stem. The purpose of this study was to investigate the deformation pattern and load transfer of an uncemented femoral stem coupled to different modular necks in human cadaver femurs. A cementless femoral stem was implanted in twelve human cadaver femurs and tested in a hip simulator corresponding to single leg stance and stair climbing activity with patient-specific loading. The stems were tested with four different modular necks; long, short, retro and varus. The long neck was used as reference in statistical comparisons, as it can be considered the "standard" neck. The deformation of bone during loading was measured by strain gauge rosettes at three levels of the proximal femur on the medial, lateral and anterior side. The cortical strains were overall reduced on the medial and lateral side of femur, for all implants tested, and in both loading conditions compared to the unoperated femur. Although there were statistical significant differences between the necks, the results did not show a consistent pattern considering which neck retained or lost most strain. In general the differences were small, with the highest significant difference between the necks of 3.23 percentage points. The small differences of strain between the modular necks tested in this study are not expected to influence bone remodeling in the proximal femur. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. [Pulmonary arterial hypertension associated to human immunodeficiency virus].

    PubMed

    Sandoval-Gutiérrez, José Luis; Santos-Martínez, Luis Efren; Rodríguez-Silverio, Juan; Baranda-Tovar, Francisco Martín; Rivera-Rosales, Rosa María; Flores-Murrieta, Francisco Javier

    2015-01-01

    From the advent of the highly effective antiretroviral treatment, the life expectancy of patients with human immunodeficiency virus has increased significantly. At present, the causes of death are non-infectious complications. Between them, the pulmonary arterial hypertension has a special importance. It is important early detection to establish the therapeutic, with the objective of preventing a fatal outcome to future.

  2. Factors affecting the aluminium content of human femoral head and neck.

    PubMed

    Zioła-Frankowska, Anetta; Dąbrowski, Mikołaj; Kubaszewski, Łukasz; Rogala, Piotr; Frankowski, Marcin

    2015-11-01

    Tissues for the study were obtained intraoperatively during hip replacement procedures from 96 patients. In all the cases, the indication for this treatment was primary or secondary degenerative changes in the hip joint. The subject of the study was the head and neck of the femur, resected in situ. Aluminium concentrations measured in femoral head and neck samples from patients aged between 25 and 91 were varied. Statistical methods were applied to determine the variations in relation to the parameters from the background survey. Significant differences in the aluminium content of femoral head samples were observed between patients under and over 60 years of age. Based on the results, it was confirmed that the aluminium accumulates in bones over a lifetime. The study showed that the content of aluminium in the head and neck of the femur depends on the factors such as: type of medicines taken, contact with chemicals at work, differences in body anatomy and sex. The study on the levels of aluminium in bones and the factors affecting its concentration is a valuable source of information for further research on the role of aluminium in bone diseases. Based on the investigations, it was found that the GF-AAS technique is the best analytical tool for routine analysis of aluminium in complex matrix samples. The use of femoral heads in the investigations was approved by the Bioethics Committee of the University of Medical Sciences in Poznań (Poland). Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Investigation of elemental distribution in human femoral head by PIXE and SRXRF microprobe

    NASA Astrophysics Data System (ADS)

    Zhang, Y. X.; Wang, Y. S.; Zhang, Y. P.; Zhang, G. L.; Huang, Y. Y.; He, W.

    2007-07-01

    In order to study the distribution and possible degenerative processes inducing the loss of inorganic substances in bone and to provide a scientific basis for the prevention and therapy of osteoporosis, proton induced X-ray emission (PIXE) method is used for the determination of elemental concentrations in femoral heads from five autopsies and seven patients with femoral neck fractures. Synchrotron radiation X-ray fluorescence (SRXRF) microprobe analysis technique is used to scan a slice of the femoral head from its periphery to its center, via cartilage, compact and spongy zones. The specimen preparation and experiment procedure are described in detail. The results show that the concentrations of P, Ca, Fe, Cu, Sr in the control group are higher than those in the patient group, but the concentrations of S, K, Zn, Mn are not significantly different. The quantitative results of elemental distribution, such as Ca, P, K, Fe, Zn, Sr and Pb in bone slice tissue including cartilage, substantial compact and substantial spongy, are investigated. The data obtained show that the concentrations of Ca, P, K, (the major elements of bone composition), are obviously low in both spongy and cartilage zones in the patient group, but there are no remarkable differences in the compact zone. Combined with the correlations between P, K, Zn, Sr and Ca, the loss mechanism of minerals and the physiological functions of some metal elements in bone are also discussed.

  4. No benefit of a proximal stem centralizer in cementing of a femoral prosthesis in human cadavers

    PubMed Central

    2011-01-01

    Background and purpose A proximal stem centralizer may be beneficial regarding cementing pressures, cement penetration, and stem alignment. We measured these parameters when cementing a mat-surfaced femoral component with and without the use of a proximal stem centralizer. Material and methods 8 femoral prostheses with proximal centralizers and 8 femoral prostheses without proximal centralizers were cemented according to third-generation cementing technique in 8 pairs of embalmed cadaveric femora. We recorded intramedullary pressures (peak levels, the area under the pressure curves and mean pressure) with 6 pressure transducers during stem cementation. Computer tomographic scanning of specimens was performed to evaluate stem alignment after surgery. Thickness of the cement mantle, cement penetration, and stem centralization at the metaphyseal part of the femur were measured on cross sections using stereology. Results There were no statistically significant differences in measured pressure and cement penetration values between the groups. There was similar cement distribution around the stems; however, in using a proximal centralizer, the cement mantle tended to be thinner laterally. Moreover, we found a larger variation in stem alignment on lateral projection in the proximal centralizer group. Interpretation No benefits regarding intramedullary pressures and cement penetration were obtained from cementation of a straight stem with a proximal stem centralizer. However, there was an increased risk of inferior stem positioning in the reamed medullary cavity using the centralizing device. PMID:21434768

  5. Atherosclerotic plaques occur in absence of intima-media thickening in both systemic sclerosis and systemic lupus erythematosus: a duplexsonography study of carotid and femoral arteries and follow-up for cardiovascular events

    PubMed Central

    2014-01-01

    Introduction The objective of this cross-sectional and retrospective cohort study was (1) to determine the usefulness of intima-media thickness (IMT) in contrast to plaque assessment, (2) to examine the value of additive femoral artery sonography and (3) to identify potential risk factors for atherosclerosis and incident cardiovascular events in systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) patients. Methods In this study, 90 SSc and 100 SLE patients were examined by duplexsonography. IMT was measured in common carotid and common femoral arteries, plaques were assessed in common, internal and external carotid and common, proximal superficial and deep femoral arteries. Different definitions of pathological IMT (pIMT) were compared with the presence of plaque. Results were evaluated in relation to traditional and non-traditional risk factors for baseline atherosclerosis (logistic regression) and their predictive value for cardiovascular events during follow-up (cox regression). Results Definite atherosclerosis occurred frequently without signs of subclinical atherosclerosis in both diseases: pIMT >0.9 mm was present in only 17/59 (28.9%) SSc and 13/49 (26.5%) SLE patients with already present atherosclerotic plaques. Using age-adjusted pIMT definitions, this rate was even lower (5.1-10.3% in SSc, 14.3-26.5% in SLE). Plaques were located only at the carotid or only at the femoral arteries in 26 (13.7%) and 24 (12.6%) patients, respectively. Age and nicotine pack-years were independently associated with atherosclerotic plaques in SLE and SSc patients, as well as the cumulative prednisolone dose in SSc subgroup, and ssDNA positive SLE patients had a lower risk for atherosclerotic plaque. During follow-up (available for 129/190 (67.9%) patients, 650 person-years), cardiovascular events occurred more often in patients with coronary heart disease (adjusted-hazards ratio (HR) 10.19, 95% confidence interval (CI) 3.04 to 34.17, P <0.001), male patients

  6. Arterial stiffness identification of the human carotid artery using the stress-strain relationship in vivo

    PubMed Central

    Khamdaeng, T.; Luo, J.; Vappou, J.; Terdtoon, P.; Konofagou, E.E.

    2014-01-01

    Arterial stiffness is well accepted as a reliable indicator of arterial disease. Increase in carotid arterial stiffness has been associated with carotid arterial disease, e.g., atherosclerotic plaque, thrombosis, stenosis, etc. Several methods for carotid arterial stiffness assessments have been proposed. In this study, in-vivo noninvasive assessment using applanation tonometry and an ultrasound-based motion estimation technique was applied in seven healthy volunteers (age 28 ± 3.6 years old) to determine pressure and wall displacement in the left common carotid artery (CCA), respectively. The carotid pressure was obtained using a calibration method by assuming that the mean and diastolic blood pressures remained constant throughout the arterial tree. The regional carotid arterial wall displacement was estimated using a 1D cross-correlation technique on the ultrasound radio frequency (RF) signals acquired at a frame rate of 505–1010 Hz. Young’s moduli were estimated under two different assumptions: (i) a linear elastic two-parallel spring model and (ii) a two-dimensional, nonlinear, hyperelastic model. The circumferential stress (σθ) and strain (εθ) relationship was then established in humans in vivo. A slope change in the circumferential stress-strain curve was observed and defined as a transition point. The Young’s moduli of the elastic lamellae (E1), elastin-collagen fibers (E2) and collagen fibers (E3) and the incremental Young’s moduli before (E0≤εθ<ε0T) and after the transition point (EεθT≤εθ) were determined from the first and second approach, respectively, to describe the contribution of the complex mechanical interaction of the different arterial wall constituents. The average E1, E2 and E3 from seven healthy volunteers were found to be equal to 0.15 ± 0.04, 0.89 ± 0.27 and 0.75 ± 0.29 MPa, respectively. The average E0≤εθ<εθTInt and EεθT≤εθInt of the intact wall (both the tunica adventitia and tunica media layers

  7. Relationship between mechanical properties and bone mineral density of human femoral bone retrieved from patients with osteoarthritis.

    PubMed

    Haba, Yvonne; Lindner, Tobias; Fritsche, Andreas; Schiebenhöfer, Ann-Kristin; Souffrant, Robert; Kluess, Daniel; Skripitz, Ralf; Mittelmeier, Wolfram; Bader, Rainer

    2012-01-01

    The objective of this study was to analyse retrieved human femoral bone samples using three different test methods, to elucidate the relationship between bone mineral density and mechanical properties. Human femoral heads were retrieved from 22 donors undergoing primary total hip replacement due to hip osteoarthritis and stored for a maximum of 24 hours postoperatively at + 6 °C to 8 °C.Analysis revealed an average structural modulus of 232±130 N/mm(2) and ultimate compression strength of 6.1±3.3 N/mm(2) with high standard deviations. Bone mineral densities of 385±133 mg/cm(2) and 353±172 mg/cm(3) were measured using thedual energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT), respectively. Ashing resulted in a bone mineral density of 323±97 mg/cm(3). In particular, significant linear correlations were found between DXA and ashing with r = 0.89 (p < 0.01, n = 22) and between structural modulus and ashing with r = 0.76 (p < 0.01, n = 22).Thus, we demonstrated a significant relationship between mechanical properties and bone density. The correlations found can help to determine the mechanical load capacity of individual patients undergoing surgical treatments by means of noninvasive bone density measurements.

  8. Postcatheterization Femoral Arteriovenous Fistulas: Endovascular Treatment with Stent-Grafts

    SciTech Connect

    Onal, Baran Kosar, Sule; Gumus, Terman; Ilgit, Erhan T.; Akpek, Sergin

    2004-09-15

    Purpose: To report our results of stent-graft implantation for the endovascular treatment of postcatheterization femoral arteriovenous fistulas (AVFs) occurring between the deep femoral artery and the femoral vein.Methods: Endovascular treatment of iatrogenic femoral AVFs as a result of arterial puncture for coronary angiography and/or angioplasty was attempted in 10 cases. Balloon-expandable stent-grafts, one for each lesion, were used to repair the fistulas, which were between the deep femoral artery and the femoral vein in all cases. Stent-graft implantation to the deep femoral artery was performed by a contralateral retrograde approach.Results: All stent-grafts were deployed successfully. Complete closure of the fistulas was accomplished immediately in nine of 10 cases. In one case, complete closure could not be obtained but the fact that the complaint subsided was taken to indicate clinical success. In three cases, side branch occlusion of the deep femoral artery occurred. No complications were observed after implantation. Follow-up for 8-31 months (mean 18.5 months) with color Doppler ultrasonography revealed patency of the stented arterial segments without recurrent arteriovenous shunting in those nine patients who had successful immediate closure of their AVFs.Conclusion: Our results with a mean follow-up 18.5 months suggest that stent-graft implantation for the closure of postcatheterization femoral AVFs originating from the deep femoral artery is an effective, minimally invasive alternative procedure.

  9. Mechanical thrombectomy using Rotarex system and stent-in-stent placement for treatment of distal femoral artery occlusion secondary to stent fracture – a case report and literature review

    PubMed Central

    Dys, Krzysztof; Drelichowska-Durawa, Justyna; Dołega-Kozierowski, Bartosz; Lis, Michał; Sokratous, Kyriakos; Iwanowski, Wojciech; Drelichowski, Stanisław; Witkiewicz, Wojciech

    2013-01-01

    Summary Background: Treatment of peripheral arterial diseases may be distinguished into conservative and interventional management; the latter is divided into surgical and endovascular procedures. Management of peripheral artery stenosis and occlusion with vascular stents is associated with the risk of late complications such as restenosis, stent fracture or dislocation. Case Report: A 62-year-old woman with generalized atherosclerosis, particularly extensive in lower limb arteries, was admitted to the Department of Angiology 11 months after having an endovascular procedure performed due to critical ischemia of left lower limb. Because of stent occlusion, a decision to perform angiographic examination of lower limb arteries was made. Examination revealed occlusion of the superficial femoral artery along its entire length, including previously implanted stents. Distal stent was fractured with slight dislocation of the proximal segment. A decision was made to perform mechanical thrombectomy using a Rotarex system followed by a stent-in-stent placement procedure. Follow-up angiography and ultrasound scan performed 24 hours after the procedure revealed a patent vessel with satisfactory blood flow. Discussion: Nowadays, imaging diagnostics of peripheral artery stenosis involves non-invasive examinations such as ultrasound, minimally invasive examinations such as angio-MRI and MDCT, or invasive examinations such as DSA and IVUS. DSA examinations are used to confirm significant stenosis or occlusion of a vessel, particularly when qualifying a patient for endovascular treatment. Due to their anatomic location, the superficial femoral artery and the popliteal artery are subject to various forces e.g. those exerted by the working muscles. Mechanical thrombectomy and atherectomy are efficient methods of arterial recanalization used in the treatment of acute, subacute or even chronic occlusions or stenosis of peripheral vessels. Conclusions: Frequency of angioplasty and

  10. Five-year outcomes of self-expanding nitinol stent implantation for chronic total occlusion of the superficial femoral and proximal popliteal artery.

    PubMed

    Sakamoto, Yasunari; Hirano, Keisuke; Iida, Osamu; Soga, Yoshimitsu; Suzuki, Kenji; Muramatsu, Toshiya; Tsukahara, Reiko

    2013-09-01

    To investigate the 5-year patency rates and predictors of restenosis after self-expanding nitinol stent implantation for chronic total occlusion (CTO) in superficial femoral and proximal popliteal artery (SFPA) lesions. Outcomes and long-term patency rates after self-expanding nitinol stent for CTO in the SFPA lesions have not been clarified. From January 2004 to December 2009, 861 serial arteriosclerosis obliterans patients, 1,017 limbs, underwent endovascular therapy with implantation of a self-expanding nitinol stent for SFPA lesions at four institutions in Japan. Of the cohort, 352 patients, 383 limbs, had self-expanding nitinol stents implanted for CTOs in the SFPA and were followed for 5 years. We retrospectively investigated patency rate and multivariate predictors associated with restenosis. Mean age was 72 ± 9 years and 31% were female patients. In total, 58% of the patients had diabetes mellitus and 25% were patients with critical limb ischemia. Occluded length was 194 ± 89 mm, mean total stent length was 198 ± 7 mm, and mean stent diameter was 7.1 ± 0.9 mm. Five-year primary and secondary patency rates were 51.8 and 79.5%, respectively, and the rates of freedom from bypass surgery, major or minor amputation, and all-cause death were 96.1, 96.2, and 78.4%, respectively. Female gender (odds ratio, 1.95; P = 0.0051) and mean stent diameter (odds ratio, 0.77; P = 0.0324) were factors strongly associated with restenosis. Women and patients requiring small stents failed to maintain primary patency when treated with self-expanding nitinol stents for CTO lesions in the SFPA. Although primary patency was low, the secondary patency rate was acceptable. Copyright © 2013 Wiley Periodicals, Inc.

  11. Nitinol stenting improves primary patency of the superficial femoral artery after percutaneous transluminal angioplasty in hemodialysis patients: a propensity-matched analysis.

    PubMed

    Kawamura, Yoshihiro; Ishii, Hideki; Aoyama, Toru; Tanaka, Miho; Takahashi, Hiroshi; Kumada, Yoshitaka; Toriyama, Takanobu; Murohara, Toyoaki

    2009-11-01

    Although percutaneous transluminal angioplasty (PTA) has become a common therapeutic standard for peripheral artery disease (PAD), high restenosis rates in the superficial femoral artery (SFA) remain a major problem. Nitinol stent implantation is reported to reduce restenosis in SFA after PTA in the general population; however, little is known about whether the nitinol stent improves primary patency after PTA in hemodialysis patients who are at higher risk of revascularization failure. The aim of this study was to clarify the effects of nitinol stent implantation for primary patency in SFA after PTA in hemodialysis patients with PAD. Eighty consecutive hemodialysis patients (167 SFA lesions) who underwent PTA with nitinol stents from January 2006 to January 2008 were compared with 64 hemodialysis patients (128 SFA lesions) who received stainless steel stents in the preceding 2 years. In the follow-up study to 2 years, incidence of restenosis, amputation, and all-cause mortality were analyzed. End points between the groups were examined with the Kaplan-Meier and log-rank methods. Prognostic values for end points were calculated by a Cox univariate analysis and Cox multivariable regression models. To statistically minimize the differences in each stent group, a propensity-matched analysis was also performed using the model including male gender, age, diabetes, hypertension, hyperlipidemia, smoking, incidence of ulcer/gangrene, and TransAtlantic Inter-Society Consensus (TASC) type C+D. The 2-year primary patency rate was 58% in the nitinol group vs 42% in the stainless steel group (hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.39-0.84; P = .0045), despite a higher prevalence of TASC C+D lesion in the nitinol group (68% vs 49%, P = .0014). In 108 lesions matched after propensity score analysis, the primary patency for 2 years was 64% in the nitinol group vs 42% in the stainless steel group (HR, 0.39; 95% CI, 0.24-0.65; P = .0003). Cox multivariate models

  12. Superficial femoral artery TASC D Registry: twelve-month effectiveness analysis of the Pulsar-18 SE nitinol stent in patients with critical limb ischemia.

    PubMed

    Lichtenberg, M; Stahlhoff, W; Boese, D

    2013-08-01

    Single center observational study analyzing the primary patency rate and freedom from target lesions revascularization rate of the Pulsar-18 nitinol stent after recanalization of long superficial femoral artery (SFA) occlusions (TASC D) in 22 patients with critical limb ischemia (CLI). Between 1/2011 and 7/2011, 22 consecutive patients (9 male, 13 female) with chronic total occlusions (CTO) of the femoro-popliteal arteries presenting with CLI (17 patients with Rutherford 4 score, and 5 patients with Rutherford 5 score) were enrolled and successfully recanalized using the Pulsar-18 self-expanding (SE) nitinol stent (BIOTRONIK AG, Buelach, Switzerland). Primary patency at 12 months was defined as no binary restenosis (>50%) on Duplex ultrasound (PSVR<2.5) and respectively no target lesion revascularization performed within 12 months. The average lesion length of the treated femoro-popliteal segment was 315 mm. Performing spot stenting average stent length in all patients was 245 mm (minimal 215 mm, maximal 315 mm). Technical success, with establishing an antegrade straight line flow to the foot through a reopened SFA, was achieved in all 22 patients. Subintimal and intraluminal recanalization techniques were used. Two patients with Rutherford 5 score had a minor amputation shortly after the recanalization procedure. All other patients had a complete wound healing of their lesions during a 6 month follow-up. After 12 month follow-up the primary patency rate of the Pulsar-18 SE nitinol stent was 77% with a per protocol restenosis in 5 of 22 patients. Seventeen patients showed a walking capacity on treadmill test >300 meters (Rutherford II). Two patients with a documented restenosis were Rutherford, these patients were treated conservatively. Three patients with restenosis and a Rutherford III score were scheduled for an endovascular target lesion revascularization leading to a freedom from target lesion revascularization rate of 86%. Endovascular intervention of long

  13. Passive biaxial mechanical response of aged human iliac arteries.

    PubMed

    Schulze-Bauer, Christian A J; Mörth, Christian; Holzapfel, Gerhard A

    2003-06-01

    Inflation and extension tests of arteries are essential for the understanding of arterial wall mechanics. Data for such tests of human arteries are rare. At autopsy we harvested 10 non-diseased external iliac arteries of aged subjects (52-87 yrs). Structural homogeneity was ensured by means of ultrasound imaging, and anamneses of patients were recorded. We measured the axial in situ stretches, load-free geometries and opening angles. Passive biaxial mechanical responses of preconditioned cylindrical specimens were studied in 37 degrees C calcium-free Tyrode solution under quasistatic loading conditions. Specimens were subjected to pressure cycles varying from 0 to 33.3 kPa (250 mmHg) at nine fixed axial loads, varying from 0 to 9.90N. For the description of the load-deformation behavior we employed five "two-dimensional" orthotropic strain-energy functions frequently used in arterial wall mechanics. The associated constitutive models were compared in regard to their ability of representing the experimental data. Histology showed that the arteries were of the muscular type. In contrast to animal arteries they exhibited intimal layers of considerable thickness. The average ratio of wall thickness to outer diameter was 7.7, which is much less than observed for common animal arteries. We found a clear correlation between age and the axial in situ stretch lambda is (r = -0.72, P = 0.03), and between age and distensibility of specimens, i.e. aged specimens are less distensible. Axial in situ stretches were clearly smaller (1.07 +/- 0.09, mean +/- SD) than in animal arteries. For one specimen lambda is was even smaller than 1.0, i.e. the vessel elongated axially upon excision. The nonlinear and anisotropic load-deformation behavior showed small hystereses. For the majority of specimens we observed axial stretches smaller than 1.3 and circumferential stretches smaller than 1.1 for the investigated loading range. Data from in situ inflation tests showed a significant

  14. Drug-Eluting Nitinol Stent Treatment of the Superficial Femoral Artery and Above-the-Knee Popliteal Artery (The Zilver PTX Single-Arm Clinical Study): A Comparison Between Diabetic and Nondiabetic Patients

    SciTech Connect

    Fanelli, Fabrizio; Primo, Massimiliano Di; Boatta, Emanuele; Johnston, Krystal; Sapoval, Marc

    2013-10-15

    Purpose: To describe the 1-year results of drug-eluting nitinol stent placement in the femoropopliteal artery of diabetic and nondiabetic patients. Materials and Methods: All patients enrolled in this prospective, multicenter study underwent paclitaxel-eluting stent placement for de novo or restenotic lesions of the superficial femoral and/or popliteal artery. Baseline and follow-up walking impairment questionnaire (WIQ) scores, Rutherford classifications, and ankle-brachial index (ABI) measurements were obtained. Follow-up was completed at 1, 6, and 12 months. Results: There were 285 diabetic patients and 502 nondiabetic patients treated. There were no significant differences in mean lesion length or lesion calcification between patient groups. Procedural success in both treatment groups was >97 %. There were no significant differences between diabetic and nondiabetic groups in Kaplan-Meier estimates of patency, event-free survival (EFS), or freedom from target lesion revascularization (TLR) at 6 and 12 months. Both groups experienced a significant increase in ABI and WIQ values after treatment, and these improvements were sustained to 12-month follow-up; however, nondiabetic patients had significantly greater 6- and 12-month WIQ scores compared with diabetic patients. Based on covariate analysis, the only factors shown to be significant and to negatively influence patency were longer lesion length (p = 0.009), higher Rutherford classification (p = 0.02), and lack of hypertension (p = 0.02); diabetic status was not found to be a significant factor. Conclusion: Diabetic and nondiabetic patients had similar estimates of primary patency, EFS, and freedom from TLR; however, diabetic patients showed less improvement in WIQ scores compared with nondiabetic patients.

  15. Relaxant effects of antidepressants on human isolated mesenteric arteries

    PubMed Central

    Vila, José Ma; Medina, Pascual; Segarra, Gloria; Lluch, Paloma; Pallardó, Federico; Flor, Blas; Lluch, Salvador

    1999-01-01

    Aims The therapeutic action of tricyclic agents may be accompanied by unwanted effects on the cardiovascular system. The evidence for the effects on vascular and nonvascular smooth muscle comes from animal studies. Whether these studies can be extrapolated to human vessels remains to be determined. Therefore, the present study was designed to investigate the influence of amitriptyline, nortriptyline and sertraline on the contractile responses of human isolated mesenteric arteries to electrical field stimulation, noradrenaline and potassium chloride. Methods Arterial segments (lumen diameter 0.8–1.2 mm) were obtained from portions of the human omentum during the course of 41 abdominal operations (22 men and 19 women), and rings 3 mm long were mounted in organ baths for isometric recording of tension. In some artery rings the endothelium was removed mechanically. Results In precontracted artery rings amitriptyline, nortriptyline and sertraline (3×10−7–10−4 m) produced concentration-dependent relaxation that was independent of the presence or absence of vascular endothelium. Incubation with indomethacin (3×10−6 m) reduced the pD2 values thus indicating the participation of dilating prostanoid substances in this response. Amitriptyline and nortriptyline inhibited both the neurogenic-and noradrenaline-induced contractions. In contrast, only the highest concentration of sertraline reduced the adrenergic responses. Amitriptyline, nortriptyline and sertraline inhibited contractions elicited by KCl and produced rightward shifts of the concentration-response curve to CaCl2 following incubation in calcium-free solution. Conclusions These results indicate that amitriptyline and nortriptyline could act as adrenoceptor antagonists and direct inhibitors of smooth muscle contraction of human mesenteric arteries, whereas sertraline might principally exert its action only as direct inhibitor of smooth muscle contraction. This relaxant mechanism involves an interference

  16. Arterial stiffness identification of the human carotid artery using the stress-strain relationship in vivo.

    PubMed

    Khamdaeng, T; Luo, J; Vappou, J; Terdtoon, P; Konofagou, E E

    2012-03-01

    Arterial stiffness is well accepted as a reliable indicator of arterial disease. Increase in carotid arterial stiffness has been associated with carotid arterial disease, e.g., atherosclerotic plaque, thrombosis, stenosis, etc. Several methods for carotid arterial stiffness assessment have been proposed. In this study, in vivo noninvasive assessment using applanation tonometry and an ultrasound-based motion estimation technique was applied in seven healthy volunteers (age 28±3.6years old) to determine pressure and wall displacement in the left common carotid artery (CCA), respectively. The carotid pressure was obtained using a calibration method by assuming that the mean and diastolic blood pressures remained constant throughout the arterial tree. The regional carotid arterial wall displacement was estimated using a 1D cross-correlation technique on the ultrasound radio frequency (RF) signals acquired at a frame rate of 505-1010Hz. Young's moduli were estimated under two different assumptions: (i) a linear elastic two-parallel spring model and (ii) a two-dimensional, nonlinear, hyperelastic model. The circumferential stress (σ(θ)) and strain (ɛ(θ)) relationship was then established in humans in vivo. A slope change in the circumferential stress-strain curve was observed and defined as the transition point. The Young's moduli of the elastic lamellae (E(1)), elastin-collagen fibers (E(2)) and collagen fibers (E(3)) and the incremental Young's moduli before ( [Formula: see text] ) and after the transition point ( [Formula: see text] ) were determined from the first and second approach, respectively, to describe the contribution of the complex mechanical interaction of the different arterial wall constituents. The average moduli E(1), E(2) and E(3) from seven healthy volunteers were found to be equal to 0.15±0.04, 0.89±0.27 and 0.75±0.29MPa, respectively. The average moduli [Formula: see text] and [Formula: see text] of the intact wall (both the tunica

  17. Computational modeling of hypertensive growth in the human carotid artery

    PubMed Central

    Sáez, Pablo; Peña, Estefania; Martínez, Miguel Angel; Kuhl, Ellen

    2014-01-01

    Arterial hypertension is a chronic medical condition associated with an elevated blood pressure. Chronic arterial hypertension initiates a series of events, which are known to collectively initiate arterial wall thickening. However, the correlation between macrostructural mechanical loading, microstructural cellular changes, and macrostructural adaptation remains unclear. Here, we present a microstructurally motivated computational model for chronic arterial hypertension through smooth muscle cell growth. To model growth, we adopt a classical concept based on the multiplicative decomposition of the deformation gradient into an elastic part and a growth part. Motivated by clinical observations, we assume that the driving force for growth is the stretch sensed by the smooth muscle cells. We embed our model into a finite element framework, where growth is stored locally as an internal variable. First, to demonstrate the features of our model, we investigate the effects of hypertensive growth in a real human carotid artery. Our results agree nicely with experimental data reported in the literature both qualitatively and quantitatively. PMID:25342868

  18. Thermomechanical behavior of human carotid arteries in the passive state.

    PubMed

    Guinea, G V; Atienza, J M; Elices, M; Aragoncillo, P; Hayashi, K

    2005-06-01

    Localized heating or cooling is expanding the clinical procedures used to treat cardiovascular diseases. Advantageous implementation and development of these methods are linked indissolubly to a deeper understanding of the arterial response to combined mechanical and thermal loads. Despite this, the basic thermomechanical behavior of human blood vessels still remains largely unknown, primarily due to the lack of appropriate experimental data. In this work, the influence of temperature on the passive behavior of human carotid arteries was studied in vitro by means of inflation tests. Eleven carotid segments were tested in the range 0-200 mmHg at four different temperatures of 17, 27, 37, and 42 degrees C. The results show that the combined change of temperature and stress has a dramatic effect on the dilatation coefficient of the arterial wall, which is shifted from negative to positive depending on the stress state, whereas the structural stiffness of the arterial wall does not change appreciably in the range of temperatures tested.

  19. Grating interferometry-based phase microtomography of atherosclerotic human arteries

    NASA Astrophysics Data System (ADS)

    Buscema, Marzia; Holme, Margaret N.; Deyhle, Hans; Schulz, Georg; Schmitz, Rüdiger; Thalmann, Peter; Hieber, Simone E.; Chicherova, Natalia; Cattin, Philippe C.; Beckmann, Felix; Herzen, Julia; Weitkamp, Timm; Saxer, Till; Müller, Bert

    2014-09-01

    Cardiovascular diseases are the number one cause of death and morbidity in the world. Understanding disease development in terms of lumen morphology and tissue composition of constricted arteries is essential to improve treatment and patient outcome. X-ray tomography provides non-destructive three-dimensional data with micrometer-resolution. However, a common problem is simultaneous visualization of soft and hard tissue-containing specimens, such as atherosclerotic human coronary arteries. Unlike absorption based techniques, where X-ray absorption strongly depends on atomic number and tissue density, phase contrast methods such as grating interferometry have significant advantages as the phase shift is only a linear function of the atomic number. We demonstrate that grating interferometry-based phase tomography is a powerful method to three-dimensionally visualize a variety of anatomical features in atherosclerotic human coronary arteries, including plaque, muscle, fat, and connective tissue. Three formalin-fixed, human coronary arteries were measured using advanced laboratory μCT. While this technique gives information about plaque morphology, it is impossible to extract the lumen morphology. Therefore, selected regions were measured using grating based phase tomography, sinograms were treated with a wavelet-Fourier filter to remove ring artifacts, and reconstructed data were processed to allow extraction of vessel lumen morphology. Phase tomography data in combination with conventional laboratory μCT data of the same specimen shows potential, through use of a joint histogram, to identify more tissue types than either technique alone. Such phase tomography data was also rigidly registered to subsequently decalcified arteries that were histologically sectioned, although the quality of registration was insufficient for joint histogram analysis.

  20. Chronic stability and selectivity of four-contact spiral nerve-cuff electrodes in stimulating the human femoral nerve

    NASA Astrophysics Data System (ADS)

    Fisher, L. E.; Tyler, D. J.; Anderson, J. S.; Triolo, R. J.

    2009-08-01

    This study describes the stability and selectivity of four-contact spiral nerve-cuff electrodes implanted bilaterally on distal branches of the femoral nerves of a human volunteer with spinal cord injury as part of a neuroprosthesis for standing and transfers. Stimulation charge threshold, the minimum charge required to elicit a visible muscle contraction, was consistent and low (mean threshold charge at 63 weeks post-implantation: 23.3 ± 8.5 nC) for all nerve-cuff electrode contacts over 63 weeks after implantation, indicating a stable interface with the peripheral nervous system. The ability of individual nerve-cuff electrode contacts to selectively stimulate separate components of the femoral nerve to activate individual heads of the quadriceps was assessed with fine-wire intramuscular electromyography while measuring isometric twitch knee extension moment. Six of eight electrode contacts could selectively activate one head of the quadriceps while selectively excluding others to produce maximum twitch responses of between 3.8 and 8.1 N m. The relationship between isometric twitch and tetanic knee extension moment was quantified, and selective twitch muscle responses scaled to between 15 and 35 N m in tetanic response to pulse trains with similar stimulation parameters. These results suggest that this nerve-cuff electrode can be an effective and chronically stable tool for selectively stimulating distal nerve branches in the lower extremities for neuroprosthetic applications.

  1. Amputated limb by cerclage wire of femoral diaphyseal fracture: a case report.

    PubMed

    Won, Yougun; Yang, Kyu-Hyun; Kim, Kwang-Kyoun; Weaver, M J; Allen, Elizabeth M

    2016-12-01

    An entrapment of the femoral artery by cerclage wiring is a rare complication after spiral diaphyseal femoral fractures. We report the case of an 82-year-old female treated by an antegrade intramedullary nailing and multiple cable augmentation, which was then complicated by injury to the femoral artery that resulted in ipsilateral leg necrosis and amputation. The entrapment was caused by direct belting by the cable and resulted in a total obstruction of the femoral artery.

  2. Functional integrative analysis of the human hip joint: the three-dimensional orientation of the acetabulum and its relation with the orientation of the femoral neck.

    PubMed

    Bonneau, Noémie; Baylac, Michel; Gagey, Olivier; Tardieu, Christine

    2014-04-01

    In humans, the hip joint occupies a central place in the locomotor system, as it plays an important role in body support and the transmission of the forces between the trunk and lower limbs. The study of the three-dimensional biomechanics of this joint has important implications for documenting the morphological changes associated with the acquisition of a habitual bipedal gait in humans. Functional integration at any joint has important implications in joint stability and performance. The aim of the study was to evaluate the functional integration at the human hip joint. Both the level of concordance between the three-dimensional axes of the acetabulum and the femoral neck in a bipedal posture, and patterns of covariation between these two axes were analysed. First, inter-individual variations were quantified and significant differences in the three-dimensional orientations of both the acetabulum and the femoral neck were detected. On a sample of 57 individuals, significant patterns of covariation were identified, however, the level of concordance between the axes of both the acetabulum and the femoral neck in a bipedal posture was lower than could be expected for a key joint such as the hip. Patterns of covariation were explored regarding the complex three-dimensional biomechanics of the full pelvic-femoral complex. Finally, we suggest that the lower degree of concordance observed at the human hip joint in a bipedal posture might be partly due to the phylogenetic history of the human species.

  3. Long-term Results for Primary Bypass vs. Primary Angioplasty/Stent for Intermittent Claudication Due to Superficial Femoral Artery Occlusive Disease

    PubMed Central

    Siracuse, Jeffrey J.; Giles, Kristina A.; Pomposelli, Frank B.; Hamdan, Allen D.; Wyers, Mark C.; Chaikof, Elliot L.; Nedeau, April E.; Schermerhorn, Marc L.

    2012-01-01

    Background Percutaneous transluminal angioplasty +/− stent (PTA/S) and surgical bypass are both accepted treatments for claudication due to superficial femoral artery (SFA) occlusive disease. However, long-term results comparing these modalities for primary intervention in patients who have had no prior intervention has not been reported. We report our results with three year follow-up. Methods We reviewed all lower extremity bypass procedures at Beth Israel Deaconess Medical Center from 2001–2009 and all PTA/S performed from 2005 through 2009 for claudication. We excluded all limb salvage procedures and included only those that were undergoing their first intervention for claudication due to SFA disease. We recorded patient demographics, comorbidities, perioperative medications, TASC classification, and runoff. Outcomes included complications, restenosis, symptom recurrence, reinterventions, major amputation, and mortality. Results We identified 113 bypass grafts and 105 PTA/S of femoral-popliteal lesions without prior interventions. Bypasses were above the knee in 62% (45% vein) and below the knee in 38% (100% vein). Mean age was 63 (bypass) vs. 69 (PTA/S) (P<.01). Mean length of stay (LOS) was 3.9 vs. 1.2 days (P<.01). Bypass grafts were used less for TASC A (17% vs. 40%, P<.01), and more for TASC C (36% vs. 11%, P<.01) and TASC D (13% vs. 3%, P<.01) lesions. There were no differences in perioperative (2% vs. 0%, NS) or 3 year mortality (9 vs. 8%, NS). Wound infection was higher with bypass (16% vs. 0%, P<.01). None involved grafts. Bypass showed improved freedom from restenosis (73% vs. 42% - 3 years, HR 0.4, 95% CI 0.23–0.71), symptom recurrence (70% and 36% at 3 years, HR 0.37, 95% CI 0.2–0.56), and freedom from symptoms at last follow-up (83% vs. 49%, (HR 0.18, 95% CI 0.08–0.40). There was no difference in freedom from reintervention (77% vs. 66% at 3 years, NS). Multivariable analysis of all patients showed that restenosis was predicted by PTA

  4. Vortex generation in pulsatile flow through arterial bifurcation models including the human carotid artery.

    PubMed

    Fukushima, T; Homma, T; Harakawa, K; Sakata, N; Azuma, T

    1988-08-01

    Visualization experiments were performed to elucidate the complicated flow pattern in pulsatile flow through arterial bifurcations. Human common carotid arteries, which were made transparent, and glass-models simulating Y- and T-shaped bifurcations were used. Pulsatile flow with wave forms similar to those of arterial flow was generated with a piston pump, elastic tube, airchamber, and valves controlling the outflow resistance. Helically recirculating flow with a pattern similar to that of the horseshoe vortex produced around wall-based protuberances in circular tubes was observed in pulsatile flow through all the bifurcations used in the present study. This flow type, which we shall refer to as the horseshoe vortex, has also been demonstrated to occur at the human common carotid bifurcation in steady flow with Reynolds numbers above 100. Time-varying flows also produced the horseshoe vortex mostly during the decelerating phase. Fluid particles of dye solution approaching the bifurcation apex diverged, divided into two directions perpendicularly, and then showed helical motion representing the horseshoe vortex formation. While this helical flow was produced, the stagnation points appeared on the wall upstream of the apex. Their position was dependent upon the flow distribution ratio between the branches in the individual arteries. The region affected by the horseshoe vortex was smaller during pulsatile flow than during steady flow. Lowering the Reynolds number together with the Womersley number weakened the intensity of helical flow. A separation bubble, resulting from the divergence or wall roughness, was observed at the outer or inner wall of the branch vessels and made the flow more complicated.

  5. Mycotic femoral aneurysm.

    PubMed

    Wilson, Richard Scott; Bennett, Kenneth R

    2007-05-01

    After several weeks of fever and chills, a 31-year-old logger developed pain in his right thigh. Upon examination a tender, pulsating upper thigh mass was found with a long loud bruit arising from it. Severe aortic insufficiency was present; however, blood cultures were negative. An angiogram, captured blood with contrast spewing from the profunda femoral artery to fill a 5 x 10 cm sac. A false aneurysm was diagnosed and resected; numerous gram positive cocci were present in cut sections, but cultures from the cavity grew the gram negative bacteria Salmonella and Alcaligenes. After one month of intravenous ampicillin the aortic valve was replaced after being destroyed by endocarditis. Ampicillin was continued and recovery was uneventful. Mycotic aneurysms are commonly caused by Salmonella (10%), which was second only to Staphylococcus (30%). The femoral artery accounts for 38% of all mycotic aneurysms. They typically present with a pulsatile mass (52%), bruit (50%), and fever (48%). This diagnosis can be supported by leukocytosis (64-71%), positive blood cultures (50-85%), and a history of arterial trauma (51%) (injection drug use, intravascular procedure, or trauma) or endocarditis (10%).

  6. Biomechanics of Ergometric Stress Test: regional and local effects on elastic, transitional and muscular human arteries

    NASA Astrophysics Data System (ADS)

    Valls, G.; Torrado, J.; Farro, I.; Bia, D.; Zócalo, Y.; Lluberas, S.; Craiem, D.; Armentano, Rl

    2011-09-01

    Ergometric exercise stress tests (EST) give important information about the cardiovascular (CV) response to increased demands. The expected EST-related changes in variables like blood pressure and heart rate are known, but those in the arterial biomechanics are controversial and incompletely characterized. In this context, this work aims were to characterize the regional and local arterial biomechanical behaviour in response to EST; to evaluate its temporal profile in the post-EST recovery phase; and to compare the biomechanical response of different to EST. Methods: In 16 non-trained healthy young subjects the carotid-femoral pulse wave velocity and the carotid, femoral and brachial arterial distensibility were non-invasively evaluated before (Rest) and after EST. Main results: The EST resulted in an early increase in the arterial stiffness, evidenced by both, regional and local parameters (pulse wave velocity increase and distensibility reduction). When analyzing conjunctly the different post-EST recovery stages there were quali-quantitative differences among the arterial local stiffness response to EST. The biomechanical changes could not be explained only by blood pressure variations.

  7. First clinical experience with the Innova versus the Protege EverFlex self-expanding bare metal stents in superficial femoral artery occlusions.

    PubMed

    Gabrielli, Roberto; Rosati, Maria Sofia; Chiappa, Roberto; Millarelli, Massimiliano; Marcuccio, Luigi; Siani, Andrea; Caselli, Giovanni

    2015-03-01

    To evaluate outcomes of superficial femoral artery (SFA) stenting with Boston Scientific Innova stent system (Boston Scientific Corporation Place, Natick, Massachusetts, United States) compared with ev3 Protege stent system (Endovascular, Inc., Plymouth, Minnesota, United States) in terms of safety and effectiveness and to identify factors predictive of restenosis. From March 2012 to January 2013, 71 patients with SFA TASC (Trans Atlantic Inter-Societal Consensus)-II B and C occlusive lesions were treated by percutaneous transluminal angioplasty with stenting (30 patients in the Innova group and 41 cases in the Protege group) and were evaluated by retrospective observational data analysis. Chi-square tests for categorical data and time to event provided two-sided p values with a level of significance at 0.05 and 95% confidence intervals (CIs). Survival curves for primary patency were plotted using the Kaplan-Meier method. Univariate analysis for diabetes, hypercholesterolemia, smoking, hypertension, and critical limb ischemia was performed according to the Cox proportional hazards model. The mean follow-up was 14 months (range 1-18 months). The occlusive lesions treated were ≤15 cm in length. The 12-month primary patency rate was significantly higher in the Protege group (81.5%; 31/38) than the Innova group (43.3%; 13/30; hazard ratio [HR] 3.0; 95% CI: 1.38-6.8; p = 0.005. The secondary patency was similar to the primary comparison data and showed a significant advantage for the Protege stent (HR 2.9; 95% CI: 1.21-6.99; p = 0.01). Univariate analysis demonstrated that diabetes and smoking were significantly related to patency failure in both groups. SFA stenting is generally a safe procedure, but the effectiveness and patency rates are significantly lower for Innova than Protege. Furthermore, preoperative diabetes and smoking continue to be associated with low primary patency rate. These preliminary data suggest that Innova stent is not the treatment of choice

  8. Impact of stent diameter on vascular response after self-expanding paclitaxel-eluting stent implantation in the superficial femoral artery.

    PubMed

    Miki, Kojiro; Fujii, Kenichi; Shibuya, Masahiko; Fukunaga, Masashi; Imanaka, Takahiro; Kawai, Kenji; Tamaru, Hiroto; Sumiyoshi, Akinori; Nishimura, Machiko; Horimatsu, Tetsuo; Saita, Ten; Yoshihara, Nagataka; Kimura, Takumi; Honda, Yasuhiro; Fitzgerald, Peter J; Masuyama, Tohru; Ishihara, Masaharu

    2017-10-01

    The optimal sizing of self-expanding paclitaxel-eluting stents (PES) in the treatment for superficial femoral artery (SFA) lesions is unclear. This study sought to investigate the influence of PES diameter on stent patency in SFA lesions using optical frequency domain imaging (OFDI). A total of 20 de novo SFA lesions were randomized 1:1 to receive either self-expanding PES with a nominal diameter of 6mm or 8mm. Follow-up angiography and OFDI was scheduled six months after stent implantation, and volumetric OFDI analysis was performed to evaluate vascular response to the stents. Volume index (VI) was defined as the volume divided by the stent length. The primary end point was lumen VI at the 6-month follow-up. Secondary end point was minimum lumen diameter (MLD) by quantitative vascular angiography (QVA) at the follow-up. Stent length was 78.0±23.9mm in the 6-mm group and 70.0±23.6mm in the 8-mm group (p=0.46). Baseline QVA data were also similar between the two groups. MLD immediately after stent implantation was similar between the two groups (4.2±0.5mm in the 6-mm group and 3.9±0.5mm in the 8-mm group, p=NS). At the 6-month follow-up, MLD was greater in the 8-mm group compared to the 6-mm group (4.0±1.0mm vs. 3.2±0.4mm, p<0.05). Stent VI was larger in the 8-mm group (28.4±6.7mm(3)/mm vs. 22.2±1.2mm(3)/mm, p=0.01). Neointimal VI was similar between the two groups (5.8±2.9mm(3)/mm vs. 5.2±2.6mm(3)/mm, p=0.68). Lumen VI was greater in the 8-mm group (23.2±7.6mm(3)/mm vs. 17.3±2.6mm(3)/mm, p=0.04). Chronic stent enlargement resulted in greater lumen area after implantation of self-expanding PES with a large diameter at the mid-term follow-up. Stent diameter might be important for stent patency in procedure with PES for SFA lesions. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  9. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from the SIROCCO trial.

    PubMed

    Duda, Stephan H; Bosiers, Marc; Lammer, Johannes; Scheinert, Dierk; Zeller, Thomas; Oliva, Vincent; Tielbeek, Alexander; Anderson, John; Wiesinger, Benjamin; Tepe, Gunnar; Lansky, Alexandra; Jaff, Michael R; Mudde, Catharina; Tielemans, Hans; Beregi, Jean-Paul

    2006-12-01

    To review clinical outcomes of patients with chronic limb ischemia and TASC type C lesions treated with sirolimus-eluting versus bare SMART nitinol self-expanding stents. Data were obtained from a randomized, multicenter, double-blinded study conducted in 2 phases. All 93 patients had chronic limb ischemia and superficial femoral artery (SFA) occlusions or stenoses (average lesion length 8.3 cm). In total, 47 patients (31 men; mean age 66.3+/-9.1 years, range 50-84) received the sirolimus-eluting SMART stent and 46 patients (36 men; mean age 65.9 +/-10.8 years, range 38-83) received a bare SMART nitinol stent. Both groups were followed for a mean 24 months. Both the sirolimus-eluting and the bare SMART stents were effective in revascularizing the diseased SFA and in sustaining freedom from restenosis. For both types of stents, improvements in ankle-brachial indices (ABI) and symptoms of claudication were maintained over 24 months (median 24-month ABI 0.96 for the sirolimus group versus 0.87 for the bare stent group, p>0.05). At 24 months, the restenosis rate in the sirolimus group was 22.9% versus 21.1% in the bare stent group (p>0.05). The cumulative in-stent restenosis rates according to duplex ultrasound were 4.7%, 9.0%, 15.6%, and 21.9%, respectively, at 6, 9, 18, and 24 months; the rates did not differ significantly between the treatment groups. The TLR rate for the sirolimus group was 6% and for the bare stent group 13%; the TVR rates were somewhat higher: 13% and 22%, respectively. Mortality rates did not differ significantly between the groups. These data demonstrate that the sirolimus-eluting and the bare SMART stent are effective, safe, and free from restenosis in a majority of patients for up to 24 months. Because the restenosis rate in the bare stent group is unexpectedly low, no significant difference could be found between the sirolimus-eluting and the bare SMART stents.

  10. The posterior part of the human cerebral arterial circle (CAC): arterial caliber from gestational weeks 13 to 24

    PubMed Central

    Vasović, Ljiljana P; Jovanović, Ivan D; Ugrenović, Sladjana Z; Anđelković, Zlatibor P

    2007-01-01

    Numerous studies have reported that all components of the cerebral arterial circle in the 4-month-old human fetus are more slender than adult vessels, and of equal caliber. After that period, a degree of caliber differentiation is present, especially at the level of the posterior communicating arteries. The aim of this study was to determine arterial diameters in the posterior part of the fetal cerebral arterial circle from the 4th month (IV) to the 6th (VI). One hundred and seventy-two fetal cerebral arterial circles were examined by means of a surgical microscope. It was determined that average diameters of the left (right) pre-communicating parts of the posterior cerebral artery ranged from 0.30 ± 0.03 (0.29 ± 0.02) mm in month IV, to 0.36 ± 0.04 (0.36 ± 0.03) mm during month V and up to 0.55 ± 0.22 (0.50 ± 0.18) mm in month VI. The average diameters of the left (right) posterior communicating artery ranged from 0.24 ± 0.02 mm (0.25 ± 0.02) in month IV, to 0.30 ± 0.03 mm (0.29 ± 0.05) during month V and up to 0.38 ± 0.08 (0.44 ± 0.10) in month VI. Gender differences between posterior cerebral artery and posterior communicating artery diameters were not significant. Average posterior cerebral artery diameters were significantly larger than posterior communicating artery diameters in months IV and V, but not in month VI. It was established that caliber differentiation in the posterior part of the cerebral arterial circle began from gestational month IV, and that gender differences in arterial diameters were not significant until month VI of gestation. PMID:17784935

  11. Drug-coated balloon versus standard percutaneous transluminal angioplasty for the treatment of superficial femoral and popliteal peripheral artery disease: 12-month results from the IN.PACT SFA randomized trial.

    PubMed

    Tepe, Gunnar; Laird, John; Schneider, Peter; Brodmann, Marianne; Krishnan, Prakash; Micari, Antonio; Metzger, Christopher; Scheinert, Dierk; Zeller, Thomas; Cohen, David J; Snead, David B; Alexander, Beaux; Landini, Mario; Jaff, Michael R

    2015-02-03

    Drug-coated balloons (DCBs) have shown promise in improving the outcomes for patients with peripheral artery disease. We compared a paclitaxel-coated balloon with percutaneous transluminal angioplasty (PTA) for the treatment of symptomatic superficial femoral and popliteal artery disease. The IN.PACT SFA Trial is a prospective, multicenter, single-blinded, randomized trial in which 331 patients with intermittent claudication or ischemic rest pain attributable to superficial femoral and popliteal peripheral artery disease were randomly assigned in a 2:1 ratio to treatment with DCB or PTA. The primary efficacy end point was primary patency, defined as freedom from restenosis or clinically driven target lesion revascularization at 12 months. Baseline characteristics were similar between the 2 groups. Mean lesion length and the percentage of total occlusions for the DCB and PTA arms were 8.94 ± 4.89 and 8.81 ± 5.12 cm (P=0.82) and 25.8% and 19.5% (P=0.22), respectively. DCB resulted in higher primary patency versus PTA (82.2% versus 52.4%; P<0.001). The rate of clinically driven target lesion revascularization was 2.4% in the DCB arm in comparison with 20.6% in the PTA arm (P<0.001). There was a low rate of vessel thrombosis in both arms (1.4% after DCB and 3.7% after PTA [P=0.10]). There were no device- or procedure-related deaths and no major amputations. In this prospective, multicenter, randomized trial, DCB was superior to PTA and had a favorable safety profile for the treatment of patients with symptomatic femoropopliteal peripheral artery disease. http://www.clinicaltrials.gov. Unique Identifiers: NCT01175850 and NCT01566461. © 2014 The Authors.

  12. Hybrid approach to limb salvage in the setting of an infected femoral-femoral bypass graft.

    PubMed

    Jones, Douglas W; Meltzer, Andrew J; Schneider, Darren B

    2014-08-01

    Prosthetic vascular graft infection in patients with advanced peripheral arterial disease can lead to multiple additional procedures, including extra-anatomic bypass or even amputation. We report the case of an 88-year-old woman with critical limb ischemia and an infected prosthetic femoral-femoral bypass graft. Using a planned hybrid 2-stage approach, we performed endovascular recanalization of the native left iliac arterial system using remote access via the superficial femoral artery to avoid infected groin wounds. Recanalization of the patient's Trans-Atlantic Inter-Society Consensus II D chronic iliac occlusion allowed for removal of the infected graft and placement of a profunda femoris artery to proximal posterior tibial artery bypass, thereby restoring inflow and avoiding the infected left groin. Newer endovascular techniques coupled with open surgical options may lead to limb salvage in patients with previously unreconstructable peripheral arterial disease.

  13. Characterization of optimal resting tension in human pulmonary arteries

    PubMed Central

    Hussain, Azar; Bennett, Robert T; Chaudhry, Mubarak A; Qadri, Syed S; Cowen, Mike; Morice, Alyn H; Loubani, Mahmoud

    2016-01-01

    AIM To determine the optimum resting tension (ORT) for in vitro human pulmonary artery (PA) ring preparations. METHODS Pulmonary arteries were dissected from disease free sections of the resected lung in the operating theatre and tissue samples were directly sent to the laboratory in Krebs-Henseleit solution (Krebs). The pulmonary arteries were then cut into 2 mm long rings. PA rings were mounted in 25 mL organ baths or 8 mL myograph chambers containing Krebs compound (37 °C, bubbled with 21% O2: 5% CO2) to measure changes in isometric tension. The resting tension was set at 1-gram force (gf) with vessels being left static to equilibrate for duration of one hour. Baseline contractile reactions to 40 mmol/L KCl were obtained from a resting tension of 1 gf. Contractile reactions to 40 mmol/L KCl were then obtained from stepwise increases in resting tension (1.2, 1.4, 1.6, 1.8 and 2.0 gf). RESULTS Twenty PA rings of internal diameter between 2-4 mm were prepared from 4 patients. In human PA rings incrementing the tension during rest stance by 0.6 gf, up to 1.6 gf significantly augmented the 40 mmol/L KCl stimulated tension. Further enhancement of active tension by 0.4 gf, up to 2.0 gf mitigate the 40 mmol/L KCl stimulated reaction. Both Myograph and the organ bath demonstrated identical conclusions, supporting that the radial optimal resting tension for human PA ring was 1.61 g. CONCLUSION The radial optimal resting tension in our experiment is 1.61 gf (15.78 mN) for human PA rings. PMID:27721938

  14. Comparison of Knee Kinematics After Single-Bundle Anterior Cruciate Ligament Reconstruction via the Medial Portal Technique With a Central Femoral Tunnel and an Eccentric Femoral Tunnel and After Anatomic Double-Bundle Reconstruction: A Human Cadaveric Study.

    PubMed

    Herbort, Mirco; Domnick, Christoph; Raschke, Michael Johannes; Lenschow, Simon; Förster, Tim; Petersen, Wolf; Zantop, Thore

    2016-01-01

    Anatomic femoral tunnel placement in anterior cruciate ligament (ACL) reconstruction is considered to be a key to good primary stability of the knee. There is still no consensus on whether a centrally placed single bundle in the anatomical femoral footprint can compare with anatomic double-bundle (DB) reconstruction. The purpose of this study was to determine knee kinematics after single-bundle ACL reconstruction via the medial portal technique using 2 different femoral tunnel positions and to compare results with those of the anatomic DB technique. The hypotheses were that (1) single-bundle reconstruction using the medial portal technique with a centrally placed femoral tunnel relative to the native footprint (SB-central technique) would more closely restore intact knee kinematics compared with the same reconstruction technique with an eccentric femoral tunnel drilled in the anteromedial bundle footprint (SB-AM technique) and (2) DB reconstruction would result in superior kinematics compared with the SB-central technique. Controlled laboratory study. Knee kinematics was examined in 10 fresh-frozen human cadaveric knees using a robotic/universal force-moment sensor system. Kinematics in simulated pivot-shift and 134-N anterior tibial loading tests were determined in different conditions within the same specimen: (1) intact ACL, (2) deficient ACL, (3) SB-AM, (4) SB-central, and (5) DB. All reconstruction techniques significantly reduced anterior tibial translation (ATT) compared with a deficient ACL at 0°, 15°, 30°, 60°, and 90° in the anterior tibial loading test (P < .01, repeated-measures analysis of variance) and at 0°, 15°, and 30° in the simulated pivot-shift test (P < .001). There were no significant differences in the SB-central group and the DB group compared with the intact ACL. Reconstruction in the SB-AM group resulted in significantly increased ATT compared with the intact ACL in near-to-extension angles in both tests (0°, 15°, and 30°; P

  15. Recombinant Human Bone Morphogenetic Protein-2 in Debridement and Impacted Bone Graft for the Treatment of Femoral Head Osteonecrosis

    PubMed Central

    Gao, Fuqiang; Shi, Zhencai; Zhang, Qidong; Guo, Wanshou

    2014-01-01

    The purpose of this study was to compare the clinical outcomes of impacted bone graft with or without recombinant human bone morphogenetic protein-2 (rhBMP-2) for osteonecrosis of the femoral head (ONFH). We examined the effect of bone-grafting through a window at the femoral head-neck junction, known as the “light bulb” approach, for the treatment of ONFH with a combination of artificial bone (Novobone) mixed with or without rhBMP-2. A total of 42 patients (72 hips) were followed-up from 5 to 7.67 years (average of 6.1 years). The patients with and without BMP were the first group (IBG+rhBMP-2) and the second group (IBG), respectively. The clinical effectiveness was evaluated by Harris hip score (HHS). The radiographic follow-up was evaluated by pre-and postoperative X-ray and CT scan. Excellent, good, and fair functions were obtained in 36, 12, and 7 hips, respectively. The survival rate was 81.8% and 71.8% in the first and second group, respectively. However, the survival rate was 90.3% in ARCO stage IIb, c, and only 34.6% in ARCO stage IIIa(P<0.05). It was concluded that good and excellent mid-term follow-up could be achieved in selected patients with ONFH treated with impacted bone graft operation. The rhBMP-2 might improve the clinical efficacy and quality of bone repair. PMID:24956102

  16. Experience With Intravascular Ultrasound Imaging Of Human Atherosclerotic Arteries

    NASA Astrophysics Data System (ADS)

    Mallery, John A.; Gessert, James M.; Maciel, Mario; Tobis, John M.; Griffith, James M.; Berns, Michael W.; Henry, Walter L.

    1989-08-01

    Normal human arteries have a well-defined structure on intravascular images. The intima appears very thin and is most likely represented by a bright reflection arising from the internal elastic lamina. The smooth muscle tunica media is echo-lucent on the ultrasound image and appears as a dark band separating the intima from the adventitia. The adventitia is a brightly reflective layer of variable thickness. The thickness of the intima, and therefore of the atherosclerotic plaque can be accurately measured from the ultrasound images and correlates well with histology. Calcification within the wall of arteries is seen as bright echo reflection with shadowing of the peripheral wall. Fibrotic regions are highly reflective but do not shadow. Necrotic liquid regions within advanced atherosclerotic plaques are seen on ultrasound images as large lucent zones surrounded by echogenic tissue. Imaging can be performed before and after interventional procedures, such as laser angioplasty, balloon angioplasty and atherectomy. Intravascular ultrasound appears to provide an imaging modality for identifying the histologic characteristics of diseased arteries and for quantifying plaque thickness. It might be possible to perform such quantification to evaluate the results of interventional procedures.

  17. Zero-stress states of human pulmonary arteries and veins.

    PubMed

    Huang, W; Yen, R T

    1998-09-01

    The zero-stress states of the pulmonary arteries and veins from order 3 to order 9 were determined in six normal human lungs within 15 h postmortem. The zero-stress state of each vessel was obtained by cutting the vessel transversely into a series of short rings, then cutting each ring radially, which caused the ring to spring open into a sector. Each sector was characterized by its opening angle. The mean opening angle varied between 92 and 163 degrees in the arterial tree and between 89 and 128 degrees in the venous tree. There was a tendency for opening angles to increase as the sizes of the arteries and veins increased. We computed the residual strains based on the experimental measurements and estimated the residual stresses according to Hooke's law. We found that the inner wall of a vessel at the state in which the internal pressure, external pressure, and longitudinal stress are all zero was under compression and the outer wall was in tension, and that the magnitude of compressive stress was greater than the magnitude of tensile stress.

  18. Heparin inhibits human coronary artery smooth muscle cell migration.

    PubMed

    Kohno, M; Yokokawa, K; Yasunari, K; Minami, M; Kano, H; Mandal, A K; Yoshikawa, J

    1998-09-01

    Heparin, an anticoagulant, has been shown to reduce neointimal proliferation and restenosis following vascular injury in experimental studies, but the clinical trials of heparin in coronary balloon angioplasty have been negative. The current study, therefore, examined the effect of heparin on basal or stimulated migration by serum and platelet-derived growth factor (PDGF)-BB in cultured human coronary artery smooth muscle cells (SMCs) by Boyden's chamber method. In addition, the reversibility of the heparin effect on human coronary artery SMC migration was examined. Fetal calf serum (FCS) and PDGF-BB stimulated SMC migration in a concentration-dependent manner. Heparin in moderate to high concentration (10 to 100 U/mL) exhibited concentration-related inhibition of FCS- and PDGF-BB-stimulated SMC migration; however, a low concentration (1 U/mL) of heparin had no inhibitory effects. Heparin also had weak inhibitory effects on nonstimulated SMC migration. The SMCs that were exposed to a high concentration (100 U/mL) of heparin for 6 hours were capable of migrating after a short lag period of removal of heparin from the culture medium. These SMCs also showed recovery of responses to FCS and PDGF-BB by migrating significantly greater than the nonstimulated level. Furthermore, heparin-containing medium did not contain detached cells. These results indicate that heparin inhibits human coronary artery SMC migration, especially when stimulated by FCS or PDGF-BB, and that this inhibitory effect of heparin is reversible and not simply a function of killing cells.

  19. Relaxation of human isolated mesenteric arteries by vasopressin and desmopressin.

    PubMed Central

    Martínez, M C; Vila, J M; Aldasoro, M; Medina, P; Flor, B; Lluch, S

    1994-01-01

    1. The effects of vasopressin and deamino-8-D-arginine vasopressin (DDAVP, desmopressin) were studied in artery rings (0.8-1 mm in external diameter) obtained from portions of human omentum during the course of abdominal operations (27 patients). 2. In arterial rings under resting tension, vasopressin produced concentration-dependent, endothelium-independent contractions with an EC50 of 0.59 +/- 0.12 nM. The V1 antagonist d(CH2)5Tyr(Me)AVP (1 microM) and the mixed V1-V2 antagonist desGly-d(CH2)5D-Tyr(Et)ValAVP (0.01 microM) displaced the control curve to vasopressin to the right in a parallel manner without differences in the maximal responses. In the presence of indomethacin (1 microM) the contractile response to vasopressin was significantly increased (P < 0.01). 3. In precontracted arterial rings, previously treated with the V1 antagonist, d(CH2)5Tyr(Me)AVP (1 microM), vasopressin produced endothelium-dependent relaxation. This relaxation was reduced significantly (P < 0.05) by indomethacin (1 microM) and unaffected by the V1-V2 receptor antagonist desGly-d(CH2)5D-Tyr(Et)ValAVP (1 microM) or by NG-nitro-L-arginine methyl ester (L-NAME, 0.1 mM). 4. The selective V2 receptor agonist, DDAVP, caused endothelium-independent, concentration-dependent relaxations in precontracted arterial rings that were inhibited by the mixed V1-V2 receptor antagonist, but not by the V1 receptor antagonist or by pretreatment with indomethacin or L-NAME. 5. Results from this study suggest that vasopressin is primarily a constrictor of human mesenteric arteries by V1 receptor stimulation; vasopressin causes dilatation only during V1 receptor blockade. The relaxation appears to be mediated by the release of vasodilator prostaglandins from the endothelial cell layer and is independent of V2 receptor stimulation or release of nitric oxide.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7834191

  20. Intermittent hypoxia and arterial blood pressure control in humans: role of the peripheral vasculature and carotid baroreflex.

    PubMed

    Tremblay, Joshua C; Boulet, Lindsey M; Tymko, Michael M; Foster, Glen E

    2016-09-01

    Intermittent hypoxia (IH) occurs in association with obstructive sleep apnea and likely contributes to the pathogenesis of hypertension. The purpose of this study was to examine the putative early adaptations at the level of the peripheral vasculature and carotid baroreflex (CBR) that may promote the development of hypertension. Ten healthy male participants (26 ± 1 yr, BMI = 24 ± 1 kg/m(2)) were exposed to 6 h of IH (1-min cycles of normoxia and hypoxia) and SHAM in a single-blinded, counterbalanced crossover study design. Ambulatory blood pressure was measured during each condition and the following night. Vascular strain of the carotid and femoral artery, a measure of localized arterial stiffness, and hemodynamic shear patterns in the brachial and femoral arteries were measured during each condition. Brachial artery reactive hyperemia flow-mediated vasodilation was assessed before and after each condition as a measure of endothelial function. CBR function and its control over leg vascular conductance (LVC) were measured after each condition with a variable-pressure neck chamber. Intermittent hypoxia 1) increased nighttime pulse pressure by 3.2 ± 1.3 mmHg, 2) altered femoral but not brachial artery hemodynamics, 3) did not affect brachial artery endothelial function, 4) reduced vascular strain in the carotid and possibly femoral artery, and 5) shifted CBR mean arterial pressure (MAP) to higher MAP while blunting LVC responses to CBR loading. These results suggest limb-specific vascular impairments, reduced vascular strain, and CBR resetting combined with blunted LVC responses are factors in the early pathogenesis of IH-induced development of hypertension. Copyright © 2016 the American Physiological Society.

  1. The circumflex branch of the left coronary artery in the human infant.

    PubMed Central

    Reig, J; Loncán, M P; Martin, S; Doménech, J M

    1987-01-01

    Coronary arterial vascularisation in the human infant in the first five weeks of life, was studied by radiological and injection-corrosion techniques. The main differences lay in the characteristics of the circumflex artery and its distribution over the myocardial wall. These differences were age-related. Coronary arterial anastomoses were detected in 61% of the hearts. PMID:3503054

  2. Shared Human-Chimpanzee Pattern of Perinatal Femoral Shaft Morphology and Its Implications for the Evolution of Hominin Locomotor Adaptations

    PubMed Central

    Morimoto, Naoki; Zollikofer, Christoph P. E.; Ponce de León, Marcia S.

    2012-01-01

    Background Acquisition of bipedality is a hallmark of human evolution. How bipedality evolved from great ape-like locomotor behaviors, however, is still highly debated. This is mainly because it is difficult to infer locomotor function, and even more so locomotor kinematics, from fossil hominin long bones. Structure-function relationships are complex, as long bone morphology reflects phyletic history, developmental programs, and loading history during an individual’s lifetime. Here we discriminate between these factors by investigating the morphology of long bones in fetal and neonate great apes and humans, before the onset of locomo