Magnetic resonance imaging of popliteal artery pathologies

International Nuclear Information System (INIS)

Holden, Andrew; Merrilees, Stephen; Mitchell, Nicola; Hill, Andrew

2008-01-01

This paper illustrates examples of popliteal artery pathologies imaged with contrast enhanced magnetic resonance angiography (CE-MRA) and magnetic resonance imaging (MRI) at a single tertiary referral centre. Popliteal artery pathologies were identified in 1710 patients referred over a 6-year period with symptoms suggesting lower limb arterial occlusive disease. Common pathologies such as atherosclerotic occlusive disease, thromboemboli and aneurysm disease are discussed as well as unusual pathologies such as cystic adventitial disease, mycotic aneurysm and arterial entrapment. The combination of CE-MRA and the excellent soft tissue resolution of MRI allow detailed evaluation of arterial and peri-arterial pathologies, and facilitate appropriate management decisions

Magnetic resonance imaging of popliteal artery pathologies

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Holden, Andrew [Department of Radiology, Auckland City Hospital, Park Road, Grafton, Auckland 9 (New Zealand)], E-mail: andrewh@adhb.govt.nz; Merrilees, Stephen [Department of Radiology, Auckland City Hospital, Park Road, Grafton, Auckland 9 (New Zealand)], E-mail: smerrilees@adhb.govt.nz; Mitchell, Nicola [Department of Radiology, Auckland City Hospital, Park Road, Grafton, Auckland 9 (New Zealand)], E-mail: nmit010@ec.auckland.ac.nz; Hill, Andrew [Department of Vascular Surgery, Auckland City Hospital, Park Road, Grafton, Auckland 9 (New Zealand)], E-mail: ahill@adhb.govt.nz

2008-07-15

This paper illustrates examples of popliteal artery pathologies imaged with contrast enhanced magnetic resonance angiography (CE-MRA) and magnetic resonance imaging (MRI) at a single tertiary referral centre. Popliteal artery pathologies were identified in 1710 patients referred over a 6-year period with symptoms suggesting lower limb arterial occlusive disease. Common pathologies such as atherosclerotic occlusive disease, thromboemboli and aneurysm disease are discussed as well as unusual pathologies such as cystic adventitial disease, mycotic aneurysm and arterial entrapment. The combination of CE-MRA and the excellent soft tissue resolution of MRI allow detailed evaluation of arterial and peri-arterial pathologies, and facilitate appropriate management decisions.

Atypical presentation of popliteal artery entrapment syndrome: involvement of the anterior tibial artery.

Science.gov (United States)

Bou, Steven; Day, Carly

2014-11-01

Popliteal artery entrapment syndrome (PAES) is a rare condition that should be suspected in a young patient with exertional lower extremity pain. We report the case of an 18-year-old female volleyball player with bilateral exertional lower extremity pain who had been previously diagnosed with tendinitis and periostitis. Diagnostic studies showed entrapment of the left popliteal artery and the left anterior tibial artery. To our knowledge, there has only been 1 previous report of anterior tibial artery involvement in PAES. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Direct stent puncture technique for intraluminal stent recanalization in the superficial femoral and popliteal arteries in-stent occlusion: Outcomes from a prospective clinical analysis of diabetics with critical limb ischemia

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Palena, Luis Mariano, E-mail: marianopalena@hotmail.com; Manzi, Marco

2013-07-15

Purpose: To evaluate the efficacy and safety of “Direct Stent Puncture” technique for intraluminal stent recanalization in the femoro-popliteal segments. Methods and Materials: A cohort of diabetics who had symptomatic in-stent occlusion of the superficial femoral or popliteal arteries underwent endovascular recanalization. After antegrade failure, direct stent puncture technique was performed. The primary end-point was to efficacy assessment, intended as technical success and clinical improvement. The secondary end-point was safety assessment, intended as free of complication rate. Results: Fifty-four patients (37 men; 73.6 ± 8.5 years) underwent direct stent puncture technique, after several unsuccessful antegrade attempts to cross the occluded stent. Technical success for intraluminal stent recanalization was achieved in 53/54 (98.2%) of cases and failed in 1/54 (1.8%). Clinical improvement was obtained in 51/54 (94.4%) of cases, with regression of the clinical symptoms and improvement of the TcPO{sub 2}, from 3 ± 18 mmHg to 43 ± 11 mmHg after 15 days (p < 0.001). Free of complications rate was 92.5%. In 2/54 (3.7%) of cases distal embolization occurred, in 1/54 (1.9%) case a sudden vessel thrombosis was diagnosed after 12 hours and in 1/54 (1.9%) case hematoma at the stent puncture site was observed. Conclusions: Direct Stent Puncture technique is an efficacy and safety option for intraluminal stent recanalization in the femoro-popliteal segment in-stent occlusion.

Thrombosed Popliteal Artery Pseudoaneurysm as Herald of Tibial Osteochondroma

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A.M. Ruales Romero

Full Text Available Background: Osteochondroma is the most common non-malignant tumour of bone, accounting for approximately one third of benign lesions in the skeleton. They often develop around the knee in the distal femur and in the proximal tibia and fibula. They present as a painless slow growing mass during adolescence and have been reported to cause damage to adjacent structures such as blood vessels; arterial damage is more common than venous injury and is usually a result of compression, stretching, and rubbing of the arterial wall. Such lesions include stenosis, thrombosis, and pseudoaneurysm formation possibly causing lower limb claudication or acute limb ischemia. Methods: An 18 year old male patient with a 4 week history of pain, hematoma, and oedema of the left calf without previous trauma is reported. A computed tomography scan (CT revealed a large popliteal artery pseudoaneurysm and its close relationship to a protrusion of the proximal tibia. Results: The popliteal artery was repaired by an external saphenous patch and the exostosis was removed. The patient had palpable popliteal and distal pulses after surgery and during the first year follow-up. Conclusions: Tibial osteochondroma should be considered in the differential diagnosis in young patients, among the potential causes of pseudoaneurysm of the femoral or popliteal artery. Surgical repair should be performed to restore normal blood flow with resection of the exostosis to prevent recurrence. Keywords: Popliteal artery, Pseudoaneurysm, Tibial exostosis, Osteochondroma

Popliteal artery entrapment syndrome in a young girl

International Nuclear Information System (INIS)

Haidar, Salwa; Thomas, Karen; Miller, Stephen

2005-01-01

Popliteal artery entrapment syndrome (PAES) is well-described in adults, but is an uncommon cause of lower-limb pain in children. We present an 11.5-year-old girl with thrombosed aneurysm of the right popliteal artery, subsequently diagnosed with bilateral type I PAES. Multimodality illustration of the radiological findings is presented. (orig.)

Anatomical study of the popliteal artery perforator-based propeller flap and its clinical application.

Science.gov (United States)

Onishi, Tadanobu; Shimizu, Takamasa; Omokawa, Shohei; Sananpanich, Kanit; Kido, Akira; Mahakkanukrauh, Pasuk; Tanaka, Yasuhito

2018-05-30

There is lack of anatomical information regarding cutaneous perforator of the popliteal artery and its connections with the descending branch of the inferior gluteal and profunda femoris arteries. We aimed to evaluate the anatomical basis of popliteal artery perforator-based propeller flap from the posterior thigh region and to demonstrate our experience utilizing this flap. Ten fresh cadaveric lower extremities were dissected following injection of a silicone compound into the femoral artery. We investigated the number, location, length, and diameter of cutaneous perforators of the popliteal artery. Based on the results, we treated three cases with a large soft tissue defect around the knee using popliteal artery perforator-based propeller flap. We found a mean of 1.9 cutaneous perforators arising from the popliteal artery with a mean pedicle length of 6 cm and a mean arterial internal diameter of 0.9 mm, which were located at an average of 4 cm proximal to the bicondylar line. The most distal perforator consistently arose along the small saphenous vein and connected proximally with concomitant artery of the posterior femoral cutaneous nerve, forming a connection with perforating arteries of the profunda femoris artery. A mean of 4.5 cutaneous perforators branched from the arterial connection sites. All clinical cases healed without any complications. The popliteal artery perforator-based propeller flap is reliable for reconstruction of soft tissue defects around the knee. The flap should include the deep fascia and concomitant artery along with the posterior femoral cutaneous nerve for maintaining the blood supply.

Endovascular Management of the Popliteal Artery: Comparison of Atherectomy and Angioplasty

Science.gov (United States)

Semaan, Elie; Hamburg, Naomi; Nasr, Wael; Shaw, Palma; Eberhardt, Robert; Woodson, Jonathan; Doros, Gheorghe; Rybin, Denis; Farber, Alik

2013-01-01

Purpose Symptomatic atherosclerotic disease of the popliteal artery presents challenges for endovascular therapy. We evaluated the technical success, complications and midterm outcomes of atherectomy and angioplasty involving the popliteal segment. Methods We conducted a retrospective review of outcomes of popliteal artery intervention using atherectomy or angioplasty performed between 2003 and 2008. Results A total of 56 patients (36% women, age 72.8±12.2 years, 77% critical limb ischemia) underwent popliteal atherectomy (n=18) or angioplasty (n=38). These patients had similar clinical characteristics, TASC/TASC II classification, mean lesion length, and run-off scores. We observed a trend toward higher rates of technical success defined as atherectomy compared to angioplasty (94% vs. 71%, p=0.08). While angioplasty was associated with a higher frequency of arterial dissection (23% vs. 0%, p=0.003), atherectomy was associated with a higher rate of thromboembolic events (22% vs 0%, p=0.01). Adjunctive stenting was used more frequently following angioplasty compared to atherectomy (45% vs. 6%, p=0.005). Thrombolysis was used to treat embolization in 4 patients in the atherectomy group. The improvement in the ankle-brachial index was similar between the two treatment groups. Primary patency of the popliteal artery at 3, 6, and 12 months was 94%, 88%, and 75% in the atherectomy group and 89%, 82%, and 73% in the angioplasty group (p=NS). There were no significant differences in limb salvage and freedom from reintervention at 1 year between the atherectomy and angioplasty groups. Conclusions Our experience with popliteal artery endovascular therapy indicates a distinct pattern of procedural complications with atherectomy compared to angioplasty but similar midterm patency, limb salvage and freedom from intervention. PMID:19942598

Imaging popliteal artery disease in young adults with claudication: self-assessment module.

Science.gov (United States)

Chew, Felix S; Bui-Mansfield, Liem T

2007-09-01

The educational objectives of this self-assessment module on imaging popliteal artery disease in young adults with intermittent claudication are for the participant to exercise, self-assess, and improve his or her knowledge of the imaging and clinical features of popliteal artery entrapment syndrome, cystic adventitial disease,and masses associated with popliteal artery obstruction.

RARE PRESENTATION OF SYMPTOMATIC BILATERAL PROXIMAL POPLITEAL ARTERY ANEURYSM

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Thulasikumar Ganapathy

2016-07-01

Full Text Available True Popliteal artery aneurysm is the most common of all the peripheral artery aneurysms. We present a case of proximal popliteal artery aneurysm involvement both lower limb presented with gangrene in one lower limb and incapacitating claudication pain on the other lower limb. We have successfully repaired both sides aneurysm in the same sitting with Poly Tetra Fluro Ethylene (PTFE graft, as the patient also had multiple venous perforators’ involvement on both sides, which left us only with synthetic graft repair option rather than venous graft repair.

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

International Nuclear Information System (INIS)

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

2001-01-01

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

Alternativa técnica no tratamento endovascular dos aneurismas da artéria poplítea A technical alternative for the endovascular treatment of popliteal artery aneurysms

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Marcelo Ferreira

2008-03-01

Full Text Available O aneurisma de artéria poplítea é relativamente raro, porém representa cerca de 85% de todos os aneurismas arteriais periféricos. Apresenta-se geralmente com um quadro de complicação isquêmica e elevado risco de perda do membro acometido. Em função disso, preconiza-se seu tratamento eletivo, atualmente realizado com resultados satisfatórios pela técnica endovascular. Relatamos nossa experiência com a utilização do stent de nitinol auto-expansível revestido com PTFEe - Fluency (Bard, Alemanha, reforçado internamente com o stent de nitinol auto-expansível Zilver (Cook, EUA no tratamento de um aneurisma de artéria poplítea.Popliteal artery aneurysm is relatively rare, but represents around 85% of all peripheral arterial aneurysms. It is usually presented with ischemic complication and high risk of limb loss. For that reason, its elective treatment is indicated and currently carried through with satisfactory results using endovascular techniques. We describe our experience with the use of an ePTFE-covered nitinol self-expandable stent graft - Fluency (Bard, Germany, reinforced internally with the nitinol self-expandable Zilver stent (Cook, USA for the treatment of a popliteal artery aneurism.

Possible impact of iridium-192 source centering on restenosis rate after femoro-popliteal angioplasty and endovascular brachytherapy in Vienna-2 study

International Nuclear Information System (INIS)

Pokrajac, Boris; Schmid, Rainer; Kirisits, Christian; Mock, Ulrike; Fellner, Claudia; Wambersie, Andre; Poetter, Richard; Minar, Erich

2002-01-01

Purpose: Endovascular brachytherapy (EVBT) has been proven to significantly reduce restenosis after percutaneous transluminal angioplasty (PTA). The object of this analysis was to assess the possible correlation between iridium-192 source non-centering and angiographic-determined restenosis. Materials and methods: A total of 113 patients with long-segment lesions of the superficial femoro-popliteal artery (SFA) were randomized to receive either PTA alone or PTA followed by EVBT in the Vienna-2 study. This analysis was performed on a subgroup of 34 out of 57 patients, who received PTA+EVBT. Angiographic restenosis was defined as lumen reduction of more than 50%. Angiograms taken immediately after PTA (34 patients) and at follow-up (25 patients) were analyzed. The distance between the vessel wall and the actual position of the source at the time of EVBT was measured (in mm) and correlated with the follow-up vessel lumen diameter. Measurements were performed at points at a distance of 10 mm from each other. The dose was determined at the luminal surface and at the reference depth of 2 mm into the vessel wall for different distances from the source. Results: Among the 622 measured points, 62 (10.0%) were within restenotic areas; 560 (90.0%) were in arterial segments without proven angiographic restenosis. As far as source centering is concerned, 7.9% of restenotic points were observed when the maximum distance to the arterial wall was 5 mm. Conclusions: The proportion of restenotic points significantly increased with source non-centering. This observation was interpreted as being related to a decrease in dose at the target. When the maximum distance between the source and the vessel surface was >5 mm, the dose at the reference depth (2 mm into the vessel wall) decreased to values lower than 5 Gy

Popliteal artery puncture in the assessment of patients with severe leg ischemia

DEFF Research Database (Denmark)

Agerskov, K; Faris, I; Tønnesen, K H

1983-01-01

Two-plane angiography and direct segmental pressure measurements in the femoral and popliteal arteries and indirectly on the arm and ankle were performed in 101 limbs seeking to establish a relationship between angiographic assessment of the patency of the popliteal artery and the trifurcation...... vessels and the popliteal ankle pressure difference. When the tiberoperoneal trunk or the trifurcation vessels were occluded or more than 50% of the lumen was stenosed, the pressure difference exceeded 10 mmHg in 30/40 limbs (75%). When three, two, or only one of the tibial vessels were patent......, the pressure difference exceeded 10 mmHg in 2/58 limbs (3%). One month following above knee femoropopliteal bypass (48 limbs), patients with a popliteal-ankle difference less than 10 mmHg obtained a significantly higher ankle pressure index (PI 0.86, range 0.56-1.20) (p less than 0.01) than those...

Initial clinical experience with a new percutaneous peripheral atherectomy device for the treatment of femoro-popliteal stenoses

International Nuclear Information System (INIS)

Zeller, T.; Frank, U.; Buergelin, K.; Schwarzwaelder, U.; Neumann, F.J.; Reimers, B.

2004-01-01

Background: Evaluation of the efficacy and safety of a new 7F-atherectomy device (30-day endpoint) for the treatment of short and mid-length arterial lesions with a reference diameter of 2.5-7 mm. Material and Methods: Fifty-eight femoto-popliteal stenoses in 46 patients (67% male, mean age 66± 9 years) with chronic peripheral occlusive disease of the lower limbs [Rutherford stage 2: n = 13 (28%); stage 3: n = 29 (63%); stage 4: 2 (4%), stage 5: n = 2 (4%]), were treated with directional atherectomy. Target lesion characteristics: Common femoral artery: n = 1 (2%), superficial femoral artery: n = 47 (81%); popliteal artery, n = 10 (17%); instent n = 3 (5%). Thirty (65%) of the interventions were performed using an antegrade approach, 16 (35%) interventions in cross-over technique. Mean degree of stenosis was 83 ± 11 mm, mean length of lesion was 37 ± 37 mm. Results: 6.5 ± 2 (4-10) passes of the lesion were performed with the catheter. Three lesions were treated after predilatation, 55 (95%) interventions as primary atherectomy. In 31/58 lesions (53%) additional balloon angioplasty was performed, in 1 lesion (2%) additional stent placement was needed. The mean degree of stenosis after atherectomy was reduced to 29 ± 20% (0-60%) after additional balloon angioplasty, it was 11 ± 10% (0-30%). A residual stenosis of [de

Popliteal artery entrapment syndrome

International Nuclear Information System (INIS)

Klooster, N.J.J.; Janevski, B.K.; Kitslaar, P.

1988-01-01

Two patients with unilateral popliteal artery entrapment syndrome (PAES) are reported. The importance of diligence in angiographic diagnosis and recognition of the so-called 'functional' PAES group as a separate entity are stressed. It is inferred from our material that a surgical approach for PAES is to be advocated since surgical release of the entrapment can lead to complete resolution of symptoms regardless of aetiology. (orig.) [de

Correlations between aorto-popliteal bolus transit speed and aortic and popliteal bolus transit time during CT angiography of aortoiliac and lower extremity arteries

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Nakaya, Yasuhiro, E-mail: y-nakaya@radiol.med.osaka-u.ac.jp [Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka 565-0871 (Japan); Kim, Tonsok; Hori, Masatoshi; Onishi, Hiromitsu; Nakamoto, Atsushi; Tsuboyama, Takahiro; Maeda, Noboru; Higashihara, Hiroki; Tomoda, Kaname; Nakamura, Hironobu [Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka 565-0871 (Japan)

2011-08-15

Purpose: The purpose of this study was to investigate correlations between the aorto-popliteal bolus transit speed and aortic and popliteal bolus transit time in order to evaluate the possibility for prediction of bolus transit speed by single test injection technique. Materials and methods: Approval was obtained from our institutional review board for this study, which included 42 patients, from all of whom written informed consent was obtained. Low-dose serial CT scanning after injection of 12 ml contrast material (300 mg/ml) at a rate of 3 ml/s followed by saline flush was performed twice, first at the level of the upper abdomen and second at the level of the knee joint. The times needed to reach peak enhancement of the upper abdominal aorta (T-aorta) and bilateral popliteal arteries (T-popliteal) were obtained, and aorto-popliteal bolus transit speeds between the abdominal aorta and popliteal arteries were calculated. ABI was recorded for the bilateral feet. The Pearson's product-moment correlation coefficient was used to investigate the correlation between the bolus transit speed and T-aorta, T-popliteal, ABI, and patient age. Result: The respective correlation coefficients for bolus transit speed on the one hand and T-aorta, T-popliteal, ABI, patient age on the other were -0.50, -0.84, 0.36, and -0.52. Conclusion: The time to peak enhancement for popliteal arteries showed the strongest correlation with aorto-popliteal bolus transit speeds, and was considered to be the most accurate predictor for aorto-popliteal bolus transit speeds.

Percutaneous transluminal angioplasty of the superficial femoral artery by retrograde catheterization via the popliteal artery

DEFF Research Database (Denmark)

Tønnesen, K H; Sager, P; Karle, A

1988-01-01

We report the results of 50 angioplasty procedures via the popliteal artery. A 3-year follow-up including control of blood pressures at ankle and toe levels show results comparable to reports in the literature. This new approach for angioplasty of the superficial femoral artery and eventually of ...

Initial clinical experience with a new percutaneous peripheral atherectomy device for the treatment of femoro-popliteal stenoses; Erste klinische Erfahrungen mit einem neuen Atherektomiekatheter zur Behandlung femoro-poplitealer Stenosen

Energy Technology Data Exchange (ETDEWEB)

Zeller, T.; Frank, U.; Buergelin, K.; Schwarzwaelder, U.; Neumann, F.J. [Herz-Zentrum Bad Krozingen (Germany). Abt. Angiologie; Krankenberg, H. [Kardiologische Gemeinschaftspraxis Mathey, Schofer u. Partner, Hamburg (Germany); Reimers, B. [Centro Civile Mirano (Italy)

2004-01-01

Background: Evaluation of the efficacy and safety of a new 7F-atherectomy device (30-day endpoint) for the treatment of short and mid-length arterial lesions with a reference diameter of 2.5-7 mm. Material and Methods: Fifty-eight femoto-popliteal stenoses in 46 patients (67% male, mean age 66{+-} 9 years) with chronic peripheral occlusive disease of the lower limbs [Rutherford stage 2: n = 13 (28%); stage 3: n = 29 (63%); stage 4: 2 (4%), stage 5: n = 2 (4%]), were treated with directional atherectomy. Target lesion characteristics: Common femoral artery: n = 1 (2%), superficial femoral artery: n = 47 (81%); popliteal artery, n = 10 (17%); instent n = 3 (5%). Thirty (65%) of the interventions were performed using an antegrade approach, 16 (35%) interventions in cross-over technique. Mean degree of stenosis was 83 {+-} 11 mm, mean length of lesion was 37 {+-} 37 mm. Results: 6.5 {+-} 2 (4-10) passes of the lesion were performed with the catheter. Three lesions were treated after predilatation, 55 (95%) interventions as primary atherectomy. In 31/58 lesions (53%) additional balloon angioplasty was performed, in 1 lesion (2%) additional stent placement was needed. The mean degree of stenosis after atherectomy was reduced to 29 {+-} 20% (0-60%) after additional balloon angioplasty, it was 11 {+-} 10% (0-30%). A residual stenosis of < 50% after plain atherectomy was achieved in 55 (95%) lesions, of < 30% in 49 (84%). Complications: 3 (6,5%) cases of embolism of debris were detected and treated successfully by aspiration. The mean ankle-brachial index increased from 0.62 {+-} 0.12 to 0.92 {+-} 0.36 before discharge, and to 0.86 {+-} 0.17 after 30 days. Rutherford stage after 30 days: stage 0: n = 038 (83%); Stage 1: n = 4 (8%); Stage 2: n = 3 (6%); Stage 5: n = 1 (2%). (orig.) [German] Ziel der Arbeit: Multizentrische Anwendungs- und Sicherheits-Studie (30 Tage Follow-up) eines neuen 7F-Atherektomiekatheters zur Behandlung peripherer kurzer und mittellanger Stenosen mit

Straight configuration saphenous vein transposition to popliteal artery for vascular access.

Science.gov (United States)

Caco, Gentian; Golemi, Dhurata; Likaj, Eriola

2017-03-21

The saphenous vein is commonly used as a vascular graft in peripheral artery surgery but rarely used for vascular access. The literature on straight configuration saphenous vein transposition to the popliteal artery is scarce. Here we present two cases of straight configuration saphenous vein transposition to the popliteal artery for vascular access, the surgical technique and respective follow-up. Two young men, aged 29 and 36 years, were chosen for lower-limb vascular access for hemodialysis. The first patient was paraplegic since birth. He used his arms to move so upper extremity vascular access was avoided. The second patient presented with an infected upper extremity arteriovenous graft (AVG) and after multiple closed AVFs he had no more available arm veins. Both patients received autologous lower extremity straight configuration saphenous vein transpositions to the popliteal artery under spinal anesthesia in May and October 2012, respectively. Cannulation of the fistula was allowed after one month. There were no early complications. Slight swelling on the leg appeared in one of the patients. Both fistulas were still functional after 36 and 32 months, respectively. The straight configuration saphenous vein transposition to popliteal artery is simple to perform, offers a long and straight segment for cannulation and may be a suitable autologous vascular access in selected patients.

Computer tomographic demonstration of the popliteal artery entrapment syndrome

International Nuclear Information System (INIS)

Alder, W.; Zwicker, H.

1979-01-01

The popliteal artery entrapment syndrome can be diagnosed by computer tomography with a greater degree of certainty than by angiography. The advantage of computer tomography depends on the simultaneous demonstration of the position of the vessel and of the surrounding muscles and their abnormal situation. (orig.) [de

MR imaging and MR angiography in popliteal artery entrapment syndrome

International Nuclear Information System (INIS)

Atilla, S.; Akpek, S.; Yuecel, C.; Tali, E.T.; Isik, S.; Ilgit, E.T.

1998-01-01

Popliteal artery entrapment (PAE) syndrome is an uncommon congenital anomaly seen in young adults causing ischemic symptoms in the lower extremities. It is the result of various types of anomalous relationships between the popliteal artery and the neighboring muscular structures. The purpose of this study was to define the role of MR imaging combined with MR angiography in the diagnosis of PAE cases. Four cases with segmental occlusion and medial displacement of popliteal artery in digital subtraction angiography (DSA) examinations were diagnosed as PAE syndrome by MR imaging and MR angiography. The DSA and MRA images are compared. All of the cases showed various degrees of abnormal intercondylar insertion of the medial head of the gastrocnemius muscle. The MR images showed detailed anatomy of the region revealing the cause of the arterial entrapment. Subclassification of the cases were done and fat tissue filling the normal localization of the muscle was evaluated. The DSA and MRA images demonstrated the length and localization of the occluded segment and collateral vascular developments equally. It is concluded that angiographic evaluation alone in PAE syndrome might result in overlooking the underlying cause of the arterial occlusion, which in turn leads to unsuccessful therapy procedures such as balloon angioplasty. Magnetic resonance imaging combined with MR angiography demonstrates both the vascular anatomy and the variations in the muscular structures in the popliteal fossa successfully, and this combination seems to be the most effective way of evaluating young adults with ischemic symptoms suggesting PAE syndrome. (orig.)

The clinical importance and prediction of steal following femoro-femoral cross-over bypass: study of the donor iliac artery by intravascular ultrasound, arteriography, duplex scanning and pressure measurements

DEFF Research Database (Denmark)

Vogt, K C; Rasmussen, J G; Schroeder, T V

2000-01-01

to evaluate the clinical significance of the steal phenomenon following femoro-femoral bypass, and whether the addition of intravascular ultrasound (IVUS) to the established examinations of the donor iliac artery can improve the prediction of patients who will develop steal.......to evaluate the clinical significance of the steal phenomenon following femoro-femoral bypass, and whether the addition of intravascular ultrasound (IVUS) to the established examinations of the donor iliac artery can improve the prediction of patients who will develop steal....

Magnetic resonance study on the anatomical relationship between the posterior proximal region of the tibia and the popliteal artery ☆

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Rogério Franco de Araujo Goes

2015-08-01

Full Text Available ABSTRACTOBJECTIVE: To analyze and describe the distance from the popliteal artery to three specific areas of the proximal region of the tibia, with the knee extended, by means of magnetic resonance. METHODS: Images of 100 knees of patients who underwent magnetic resonance examinations were analyzed. The location of the popliteal artery was measured in three different areas of the posterior proximal region of the tibia. The first measurement was made at the level of the knee joint (tibial plateau. The second was 9 mm distally to the tibial plateau. The third was at the level of the anterior tuberosity of the tibia (ATT. RESULTS: The distances between the popliteal artery and the tibial plateau and ATT region were significantly greater in males than in females. The distances between the popliteal artery and the regions 9 mm distally to the tibial plateau and the ATT were significantly greater in the age group over 36 years than in the group ≤36 years. CONCLUSION: Knowledge of the anatomical position of the popliteal artery, as demonstrated through magnetic resonance studies, is of great relevance in planning surgical procedures that involve the knee joint. In this manner, devastating iatrogenic injuries can be avoided, particularly in regions that are proximal to the tibial plateau and in young patients.

Popliteal artery aneurysms. Clinical relevance of dynamics and vulnerability

NARCIS (Netherlands)

Kropman, R.H.J.

2013-01-01

Knowledge of anatomic variations of the popliteal artery is essential for the management of peripheral vascular disease. It influences the success of femoropopliteal and crural reconstructions and may also be important in orthopedic surgery. Variations may increase the risk of bleeding, dissections,

Popliteal artery injury during posterior cruciate ligament reconstruction

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Marcos Henrique Frauendorf Cenni

2015-06-01

Full Text Available This study reports a case of popliteal artery injury during arthroscopic reconstruction of the posterior cruciate ligament. The evolution of the injury is described and comments are made regarding the anatomy of this artery and potential risks of this surgical technique. This study had the aims of alerting the medical community, especially knee surgeons, regarding a severe surgical complication and discussing the ways of preventing it.

Angiographic imaging of the branching of the popliteal artery into the arteries of the lower leg

International Nuclear Information System (INIS)

Prayer, L.; Karnel, F.; Schurawitzki, H.

1990-01-01

For the anatomic analysis of the branching of the popliteal artery into the lower leg arteries, 414 intra-arterial DSA images of the lower extremity (obtained in 223 patients) were available. In 90.1% of the material examined, a 'normal' branching was found. If one leg of a patient showed 'normal' branching, there was a probability of 6.9% to find a different branching of the artery in the other leg. In 9.9% of the examined legs deviations from standard branching were observed. If there was a deviation from standard observed in one leg, the probability of finding a variant of branching in the other leg as well was 4.4%. (orig./MG) [de

Intravascular ultrasound as a novel tool for the diagnosis and targeted treatment of functional popliteal artery entrapment syndrome

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Anna E. Boniakowski, MD

2017-06-01

Full Text Available Functional popliteal artery entrapment syndrome can be difficult to diagnose, as the imaging modalities presently employed are designed to detect anatomic entrapment. We describe a novel imaging technique to aid in diagnosis in this cohort. A 22-year-old cyclist presented with exercise-limiting claudication. Magnetic resonance angiography with provocative maneuvers was nondiagnostic. Digital subtraction angiography revealed long-segment occlusion of the popliteal artery with plantar flexion; however, the specific site of compression remained unclear. Intravascular ultrasound allowed specific localization of compression and further confirmed the diagnosis. Thus, we report this as an adjunctive imaging modality to definitively diagnose functional popliteal artery entrapment syndrome and to assist in operative planning.

Popliteal artery injury following traumatic knee joint dislocation in a 14-year-old boy: A case report and review of the literature

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Cvetković Slobodan

2014-01-01

Full Text Available Introduction. Posterior knee joint dislocation associated with injury of the popliteal artery in children is an extremely rare condition. Rapid diagnosis and treatment are essential for limb salvage and function. Case report. We reported a 14-year-old boy who suffered traumatic displacement of the right knee and contusion of the popliteal artery during motorcycle accident. The diagnosis was confirmed using Doppler and duplex ultrasonography and digital substraction transfemoral arteriography. The urgent surgical procedure was performed using posterior approach to the popliteal artery. During the surgical exploration, rupture of the posterior cruciate ligament associated with thrombosed popliteal artery have been found. The damaged popliteal artery was resected and replaced with autologous saphenous vein graft. The last stage of the procedure was a transosseous femoral fixation of posterior circuate ligament. A 3-year-follow-up after the surgery demonstrated intact arterial perfusion and very good function of the knee with a minimal difference as compared with the contralateral knee. Conclusion. Combined orthopedic and vascular injuries are very rare in children. They require combined treatment. [Projekat Ministarstva nauke Republike Srbije, br. 175008

A new diagnostic approach to popliteal artery entrapment syndrome

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Williams, Charles; Kennedy, Dominic; Bastian-Jordan, Matthew; Hislop, Matthew; Cramp, Brendan; Dhupelia, Sanjay [Queensland X-Ray, Sunnybank, Queensland, 4109 (Australia)

2015-09-15

A new method of diagnosing and defining functional popliteal artery entrapment syndrome is described. By combining ultrasonography and magnetic resonance imaging techniques with dynamic plantarflexion of the ankle against resistance, functional entrapment can be demonstrated and the location of the arterial occlusion identified. This combination of imaging modalities will also define muscular anatomy for guiding intervention such as surgery or Botox injection.

A new diagnostic approach to popliteal artery entrapment syndrome

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Williams, Charles; Kennedy, Dominic; Bastian-Jordan, Matthew; Hislop, Matthew; Cramp, Brendan; Dhupelia, Sanjay

2015-01-01

A new method of diagnosing and defining functional popliteal artery entrapment syndrome is described. By combining ultrasonography and magnetic resonance imaging techniques with dynamic plantarflexion of the ankle against resistance, functional entrapment can be demonstrated and the location of the arterial occlusion identified. This combination of imaging modalities will also define muscular anatomy for guiding intervention such as surgery or Botox injection

Diagnosis and surgical approach of popliteal artery entrapment syndrome: a retrospective study

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Stavros Gourgiotis

2008-02-01

Full Text Available Stavros Gourgiotis1, John Aggelakas1, Nikolaos Salemis1, Charalabos Elias2, Charalabos Georgiou11Second Surgical Department, 401 General Army Hospital of Athens, Greece; 2Second Surgical Department, 417 NIMTS Veterans General Hospital of Athens, GreeceBackground: Popliteal artery entrapment syndrome (PAES is a rare but potentially limb threatening peripheral vascular disease occurring predominantly in young adults. This study is a retrospective review of 49 limbs in 38 patients with PAES treated surgically over an 8-year period.Patients and methods: From 1995 to 2002, 38 patients with a mean age of 21 years (range, 18–29 years underwent surgery for PAES at a single institution. The patients’ demographic data and clinical features are recorded. The preoperative diagnosis of PAES was made based on various combinations of investigations including positional stress test, duplex ultrasonography, computed tomography, computed tomographic angiography, and angiography. Results: Nine, 33, and 7 patients had Delaney’s type I, II, and III PAES respectively. The surgical procedures consisted of simple release of the popliteal artery in 33 limbs (67.3%, autogenous saphenous vein (ASV patch angioplasty with or without thromboendarterectomy (TEA in 5 limbs (10.2% and ASV graft interposition or bypass in 11 limbs (22.5%. At a median follow up of 34 months (range, 8–42 months, there were no postoperative complications and all the patients were cured of their symptoms.Conclusions: PAES is an unusual but important cause of peripheral vascular insufficiency especially in young patients. Early diagnosis through a combined approach is necessary for exact diagnosis. Popliteal artery release alone or with vein bypass is the treatment of choice when intervention is indicated for good operative outcome and to prevent limb loss.Keywords: popliteal artery, entrapment syndrome, diagnosis, surgery, treatment

The modified pulse-spray method using Urokinase in subacute and chronic thrombotic arterial occlusion

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Kim, Youn Kil; Hahn, Seong Tae; Baek, Jee Hee; Kim, Choon Yul; Shinn, Kyung Sub

1996-01-01

To evaluate the effectiveness and safety of the modified pulse-spray method using Urokinase(UK) in subacute and chronic thrombotic arterial occlusion. Modified pulse-spray methods using UK were performed in seven patients with subacute (1 week-1month) to chronic (1month-5years) occlusive symptoms such as limb pain, claudication and impotence. Angiographic examination revealed thrombotic occlusion of the aorta, common iliac arteries, brachial arterio-venous hemodialysis graft and femoro-popliteal bypass graft. The patients underwent thrombolysis using modified pulse-spray and additional constant infusion of UK. In the presence of underlying stenosis or organized clots, balloon angioplasty or stent placement was performed. Complete lysis was obtained in five of seven patients. For initial lysis, the mean dose of UK was 420,000 units, and the mean modified pulse-spray time was 50 minutes. Mean total dose of UK and mean total time for complete lysis were 800,000 units and 161 minutes, respectively. Thrombolysis of the femoro-popliteal bypass graft failed due to severe occlusion of the distal anastomosis. Partial lysis was achieved in one patient with aorto-illac occlusion, but further thrombolysis was stopped due to bleeding at the puncture site. The modified pulse-spray method using UK is effective in treating subacute and chronic arterial thrombotic occlusion. It augments the speed, safety and efficacy of thrombolysis. When underlying stenosis or organized clots remain after thrombolysis, ballon angioplasty or stent placement would be helpful

Under X-ray guidance stent implantation through retrograde popliteal artery puncturing for the treatment of superficial femoral artery occlusion: the initial results in nine cases

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He Xu; Gu Jianping; Lou Wensheng; Chen Liang; Chen Guoping; Su Haobo; Song Jinhua; Wang Tao; Xu Ke

2011-01-01

Objective: To discuss the application of retrograde popliteal artery puncturing under X-ray guidance in the interventional therapy for superficial femoral artery occlusion. Methods: Retrograde popliteal artery puncturing under X-ray guidance was carried out in nine patients with long-segment occlusion of superficial femoral artery as antegrade recanalization via femoral artery approach had failed in them. After retrograde route was successfully established, the balloon dilation and subsequent stent placement for occluded vessel were performed. Results: The technical success was obtained in all patients. The occluded superficial femoral arteries were reopened and the symptoms of intermittent claudication disappeared. No serious complications such as injuries of adjacent nerves or vessels occurred. The ankle-brachial index (ABI) increased from preoperative (0.38±0.13) to postoperative (0.92±0.11) with the difference being statistically significant (P<0.01). A follow-up period lasting for 2-16 months was conducted. Eleven months after the treatment, intermittent claudication recurred in one case, and CT angiography showed that the distal part of the stent was narrowed. The symptoms were improved after percutaneous transcatheter angioplasty was performed again. Conclusion: Retrograde popliteal artery puncturing under X-ray guidance is an effective and safe technique for the treatment of superficial femoral artery long-segment occlusion with stent placement, especially for patients in whom antegrade recanalization via femoral artery approach fails. (authors)

Embolização da reperfusão do aneurisma da artéria poplítea com Onyx® Treatment of recurrent popliteal artery aneurysm with Onyx® embolization

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Ligia Jackeline Iorio Pires

2011-09-01

Full Text Available O aneurisma da artéria poplítea é o mais frequente dos aneurismas periféricos verdadeiros. Embora seja assintomático, apresenta complicações isquêmicas por embolia ou trombose. A correção deste aneurisma pode ser cirúrgica convencional, com técnica e prognóstico bem estabelecidos, ou endovascular, técnica inovadora e menos invasiva. A reperfusão do saco aneurismático excluído, apesar de rara, está relacionada à intensa circulação colateral. Relatamos um caso de aneurisma de poplítea, que após dois anos de exclusão apresentou fluxo no saco aneurismático com sintomatologia, sendo tratado por técnica endovacular alternativa.The popliteal artery aneurysm is the most frequent of the peripheral aneurysms. Although asymptomatic, it can complicate with severe limb ischemia due to embolization or thrombosis. The surgical correction presents well-established techniques and results, while the less invasive endovascular therapy is still evolving. The recurrence is very rare and can be related to collateral artery refilling. We report a recurrent popliteal artery aneurysm after two years of conventional ligation and bypass surgery, in which an alternative endovascular strategy was successfully applied.

[Intraoperative lysis and neurostimulation as added therapy in surgery of popliteal artery aneurysm].

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Peiper, C; Heye, K; Ktenidis, K; Horsch, S

1997-01-01

Additional therapy of symptomatic popliteal artery aneurysm includes intraoperative lysis for the treatment of the descending thrombosis and spinal cord stimulation for cases of chronic deterioration of the peripheral perfusion state. Between 1989 and 1996, we treated 50 patients with 55 symptomatic aneurysms using this concept, 18 of them as emergency cases. We reached a postoperative amputation rate of 12.7% and good long-term functional results in 34 of 37 patients.

Surgical treatment of chronic occlusive in peripheral arteries (Review of 100 cases

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H. AHRARI

1977-01-01

slight deterioration during follow up, after femoro-popliteal operations the rate of early success rapidly declined. Aotrto-iliac stenosis is a more promising situation for reconstruction. Either grafting or endarterectomy is available. We abondon endarterectomy in small arteres below the popliteal arteries to avoid reobstruction due to thrombosis. We agree that sympathectomy should be performed at the time of trophic changes in the skin of the foot, and for early gangrene, we remove the third and fourth lumbar ganglia. This operation should increase the circulation to the skin below the knee. We do not recommend sympathectomy as the treatment for claudication. 3- Apart from the data derived from our group, patients gave us the following information. a - many patients come from the northern part of Iran which has a Medite ranean climate . . b - None of them had a hight cholesterol level. c - Only one patient had high blood pressure. d - Half of the patients had occlusion below the popliteal arteries Cmostely Buerger type in character and femoro popliteal obstruction which were segmental occlusion or iliac arteries.

Directional Atherectomy With Antirestenotic Therapy vs Drug-Coated Balloon Angioplasty Alone for Isolated Popliteal Artery Lesions.

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Stavroulakis, Konstantinos; Schwindt, Arne; Torsello, Giovanni; Stachmann, Arne; Hericks, Christiane; Bosiers, Michel J; Beropoulis, Efthymios; Stahlhoff, Stefan; Bisdas, Theodosios

2017-04-01

To report a single-center study comparing drug-coated balloon (DCB) angioplasty vs directional atherectomy with antirestenotic therapy (DAART) for isolated lesions of the popliteal artery. Seventy-two patients were treated with either DCB angioplasty alone (n=31) or with DAART (n=41) for isolated popliteal artery stenotic disease between October 2009 and December 2015. The majority of patients presented with lifestyle-limiting claudication (74% vs 86%, respectively). Vessel calcification (29% vs 29%, respectively), mean lesion length (47 vs 42 mm, respectively), and number of runoff vessels were comparable between the groups. The primary outcome measure was primary patency; secondary outcomes were technical success (<30% residual stenosis or bailout stenting), secondary patency, and freedom from clinically driven target lesion revascularization (TLR). The technical success rate following DCB was 84% vs 93% (p=0.24) after DAART. The 12-month primary patency rate was significantly higher in the DAART group (65% vs 82%; hazard ratio 2.64, 95% confidence interval 1.09 to 6.37, p=0.021), while freedom from TLR did not differ between the 2 treatment strategies (82% vs 94%, p=0.072). Secondary patency at 12 months was identical for both groups (96% vs 96%). Although not statistically significant, bailout stenting was more common after DCB angioplasty (16% vs 5% for DAART, p=0.13) and aneurysmal degeneration of the popliteal artery was seen more often after DAART (7% vs 0% for DCB alone, p=0.25). Popliteal artery injury was observed in 2 patients treated using DAART (5% vs 0% for DCB alone, p=0.5), whereas distal embolization rates were comparable between the groups (3% for DCB alone vs 5% for DAART, p=0.99). In this study, the use of DAART was associated with a higher primary patency rate compared with DCB angioplasty for isolated popliteal lesions. Nonetheless, both treatment options were associated with excellent 12-month secondary patency. Aneurysmal degeneration of

Popliteal versus tibial retrograde access for subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) technique.

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Hua, W R; Yi, M Q; Min, T L; Feng, S N; Xuan, L Z; Xing, J

2013-08-01

This study aimed to ascertain differences in benefit and effectiveness of popliteal versus tibial retrograde access in subintimal arterial flossing with the antegrade-retrograde intervention (SAFARI) technique. This was a retrospective study of SAFARI-assisted stenting for long chronic total occlusion (CTO) of TASC C and D superficial femoral lesions. 38 cases had superficial femoral artery lesions (23 TASC C and 15 TASC D). All 38 cases underwent SAFARI-assisted stenting. The ipsilateral popliteal artery was retrogradely punctured in 17 patients. A distal posterior tibial (PT) or dorsalis pedis (DP) artery was retrogradely punctured in 21 patients, and 16 of them were punctured after open surgical exposure. SAFARI technical success was achieved in all cases. There was no significant difference in 1-year primary patency (75% vs. 78.9%, p = .86), secondary patency (81.2% vs. 84.2%, p = .91) and access complications (p = 1.00) between popliteal and tibial retrograde access. There was statistical difference in operation time between popliteal (140.1 ± 28.4 min) and tibial retrograde access with PT/DP punctures after surgical vessel exposure (120.4 ± 23.0 min, p = .04). The SAFARI technique is a safe and feasible option for patients with infrainguinal CTO (TASC II C and D). The PT or DP as the retrograde access after surgical vessel exposure is a good choice when using the SAFARI technique. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Percutaneous angioplasty of carotid artery stenoses

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Freitag, G.; Freitag, J.; Koch, R.D.; Wagemann, W.

1986-03-01

Percutaneous transluminal angioplasty (PTA) is a well-established method to remedy stenoses and short occlusions in the femoro-popliteal region and has also proved worthwhile in dilating stenoses of pelvic, renal and coronary arteries. Following successful experiments in animals, Mathias et al. employed angioplasty to treat carotid artery stenoses in the same way. To date, successful treatment of carotid artery stenoses has been described only in isolated recent reports. For fear of embolism, angioplasty has not yet become standard practice in this region. Because of the limited number of carotid artery stenoses treated so far, the risk involved cannot be reliably assessed. It is remarkable that no embolism has been reported for the greater number of dilated stenoses of the subclavian artery. Moreover, the report by Mathias et al. indicated that for 350 angioplasties of pelvifemoral arteries 1.1% embolisms occured after artery occlusions only, while no embolism was observed after stenoses. Having gained experience of applying PTA to the treatment of vascular obstructions of extremities, we have adopted this technique in the carotid area as well.

Combined Directional Atherectomy and Drug-Eluting Balloon Angioplasty for Isolated Popliteal Artery Lesions in Patients With Peripheral Artery Disease.

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Stavroulakis, Konstantinos; Bisdas, Theodosios; Torsello, Giovanni; Stachmann, Arne; Schwindt, Arne

2015-12-01

To evaluate the midterm results of combined directional atherectomy (DA) and drug-eluting balloon (DEB) angioplasty for atherosclerotic lesions of the popliteal artery. In a single-arm, prospective study, 21 patients (mean age 63±16 years; 16 men) with isolated popliteal artery lesions were enrolled and underwent treatment with combined DA and DEB angioplasty under filter protection between October 2009 and February 2014. The majority (18, 86%) presented with lifestyle-limiting intermittent claudication and 3 with critical limb ischemia. Fifteen (71%) target sites were de novo lesions; 4 were occlusions. The main outcome was primary patency; secondary outcomes were technical success, secondary patency, and early and midterm morbidity and mortality. The TurboHawk atherectomy device was used in 15 (71%) patients and the SilverHawk peripheral plaque excision system in the remaining 6 patients. The In.Pact Admiral/Pacific DEB was used in the majority of cases (15, 71%). The technical success rate was 90% (n=19). One flow-limiting dissection was treated with bailout stenting. Complications included a perforation of the popliteal artery and 2 puncture site hematomas; there was no distal embolic event. The mean follow-up was 18±12 months. Two restenoses were retreated successfully. Kaplan-Meier estimates of primary patency at 12 and 18 months were 95% and 90%, respectively; the secondary patency was 100%. One (5%) patient died in follow-up. None of the patients had an amputation. In this prospective single-arm study, the combined therapy of DA and DEB angioplasty for popliteal artery lesions showed promising midterm performance. The combination of DA and DEB may, in highly selected patients, overcome the challenges presented by the mobility of the knee joint. © The Author(s) 2015.

Delayed presentation of popliteal artery transection following undisplaced lateral condyle fracture of tibia

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Mohit Gupta

2016-01-01

Full Text Available Literature suggests that vascular damage occurring with orthopedic injury of the lower extremity is rare and uncommon. We present a case of a young adult male who presented to the emergency room with a history of road traffic accident with complaints of pain in the right ankle diagnosed as medial malleolus fracture and pain in the left knee diagnosed as undisplaced lateral tibial condyle fracture. At the time of presentation, the left leg appeared normal and was stabilized with a knee brace, which on the next day developed severe swelling with absence of distal pulses. Doppler revealed no blood flow distal to popliteal artery with severe soft tissue edema. The patient was posted for emergency basis vascular exploration where popliteal artery was surprisingly found transected and was repaired followed by timely fasciotomy. This case report has also been prepared to stress the importance of secondary survey in patients after high energy trauma as it can prevent the important injuries from being missed.

Emergency and elective implantation of covered stent systems in iatrogenic arterial injuries

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Goltz, J.P.; Kickuth, R.; Bastuerk, P.; Hoppe, H.; Triller, J.

2011-01-01

Purpose: To evaluate the effectiveness and safety of covered stents for the management of iatrogenic arterial injury. Materials and Methods: Between 03/1998 and 12/2009, 31 patients underwent selective covered stent implantation after iatrogenic arterial injury. 12/31 of these patients (38.7 %) were hemodynamically unstable. Six different endovascular covered stent types were utilized. The primary endpoints of this study were technical and clinical success and rates of minor and major complications. Results: Initial angiograms demonstrated active extravasation in 19 (61.3 %) patients and pseudoaneurysms in 12 (38.7 %) patients. The following sites of bleeding origin were detected: axillary artery, subclavian artery, common iliac artery, external iliac artery, internal iliac artery, common femoral artery, superficial femoral artery, popliteal and fibular artery, femoro-popliteal and popliteo-crural bypasses, common hepatic artery, aberrant hepatic artery, cystic and gastroduodenal artery. In all patients bleeding was effectively controlled by covered stent implantation resulting in an immediate technical success of 100 %. Clinical success attributed to covered stent implantation was documented in 30 of the 31 patients (96.8 %). Major complications included death in four patients (11.1 %), acute thrombosis with arm ischemia in one patient (2.8 %) and stent fracture with associated pseudoaneurysm in another patient (2.8 %). In 2/31 patients (6.5 %) covered stent failure was detected and successfully treated by implantation of a second covered stent. Conclusion: Emergency and elective implantation of covered stents may be used for minimally invasive and effective management of iatrogenic arterial injury. (orig.)

Early experience with the multilayer aneurysm repair stent in the endovascular treatment of trans/infragenicular popliteal artery aneurysms: a mixed bag.

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Thakar, Tejal; Chaudhuri, Arindam

2013-06-01

To present a preliminary experience using a multilayer flow-modulating stent for trans/infragenicular popliteal endovascular aneurysm repair. Five men (mean age 76 years, range 62-86) with 6 popliteal artery aneurysms (PAAs) measuring 22 to 39 mm in diameter (mean 30) underwent endovascular repair using the Cardiatis Multilayer Aneurysm Repair System (MARS) between June and August 2011. Radiological assessments post procedure using duplex ultrasonography and biplanar knee radiographs (additional contrast studies as necessary) sought evidence of aneurysm exclusion, graft patency, and preservation of branches and runoff vessels. Technical success was achieved in each case. There was one symptomatic stent occlusion requiring thrombectomy at 4 days, with reocclusion, and one leak via the stent struts into the sac with no branch outflow identified. Two further symptomatic stent occlusions were identified within a 6-week follow-up period, totaling 3 occlusions among the 6 devices deployed. No firm conclusion can be reached on the efficacy of the MARS in PAAs due to the inherent limitations of this small series, although a 50% thrombosis rate is a poor outcome. The risk of early thrombosis in flow-modulating stents deployed in the popliteal artery exists, as it does with earlier generation stent-grafts. Larger prospective trials and the influence of more aggressive antithrombotic/anticoagulant therapy should be considered to enable accurate evaluation of this device in popliteal artery aneurysms.

Reliability of Ultrasound Diameter Measurements in Patients with a Small Asymptomatic Popliteal Artery Aneurysm: An Intra- and Inter-observer Agreement Study.

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Zwiers, I; Hoogland, C M T; Mackaay, A J C

2016-03-01

In this study the intra- and inter-observer variability of ultrasound measurements of the diameter of the popliteal artery were tested in a group of patients under surveillance for a small (diameter 10-20 mm), asymptomatic popliteal artery aneurysm (PAA). From a group of patients under ultrasound surveillance for bilateral, asymptomatic PAAs, 13 consecutive patients agreed to participate in the study and provided informed consent. The maximum diameter of the popliteal arteries was assessed by a vascular technologist. The same assessment was repeated by a second vascular technologist, unaware of the results of the first measurement. After a week, this protocol was repeated. The intra- and inter-observer reliability of this measurement was calculated using intra-class correlation coefficients (ICCs) and Bland and Altman plots. Of the 10 patients with bilateral and three patients with unilateral PAA, 12 completed the 2 week protocol. A total of 86 measurements were analyzed. The mean diameter of the popliteal arteries was 13.5 ± 3.4 mm. The ICC for the intra-observer reliability of observer 1 was 0.96 (95% CI 0.92-0.99), p .47. The absolute magnitude of the systematic error of both observers was less than 0.135 mm (median 0.00). Ultrasound measurement of the maximum diameter of the popliteal artery is reproducible; hence, it is suitable for making a clinical treatment decision. Its use for surveillance of small, asymptomatic PAAs is justified. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

The diabetic foot - modern possibilities of vascular reconstruction

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Arlart, I.P.

1992-01-01

Arterial vascular disease in diabetic patients includes both microangiopathy and macroangiopathy. Macroangiopathy, i.e. stenoses of occlusions of the ilio-femoro-popliteal arteries and crural arteries, can be treated by surgical vascular reconstructions and radiological procedures such as recanalisation via catheter and CT-guided lumbar sympathetic trunk, neurolysis. In this paper the different therapeutic techniques are presented in respect of indications and results particularly in the diabetic patients. (orig.) [de

A Matched Case-Control Study on Open and Endovascular Treatment of Popliteal Artery Aneurysms.

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Dorigo, W; Fargion, A; Masciello, F; Piffaretti, G; Pratesi, G; Giacomelli, E; Pratesi, C

2018-01-01

To compare early and late results of open and endovascular management of popliteal artery aneurysm in a retrospective single-center matched case-control study Methods: From 1981 to 2015, 309 consecutive interventions for popliteal artery aneurysm were performed in our institution, in 59 cases with endovascular repair and in 250 cases with open repair. Endovascular repair was preferred in older asymptomatic patients, while open repair was offered more frequently to patients with a thrombosed popliteal artery aneurysm and a poor run-off status. A one-to-one coarsened exact matching on the basis of the baseline demographic, clinical, and anatomical covariates significantly different between the two treatment options was performed and two equivalent groups of 56 endovascular repairs and open repairs were generated. The two groups were compared in terms of perioperative results with χ 2 test and of follow-up outcomes with the Kaplan-Meier curves and log-rank test. There were no differences between the two groups in terms of perioperative outcomes. Median duration of follow-up was 38 months. Five-year survival rates were 94% in endovascular repair group and 89.5% in open repair group (p = 0.4, log-rank 0.6). Primary patency rates at 1, 3, and 5 years were 81%, 78%, and 72% in endovascular repair group and 82.5%, 80%, and 64% in open repair group (p = 0.8, log-rank 0.01). Freedom from reintervention at 5 years was 65.5% in endovascular repair group and 76% in open repair group (p = 0.2, log-rank 1.2). Secondary patency at 1, 3, and 5 years was 94%, 86%, and 74% in endovascular repair group, and 94%, 89%, and 71% in open repair group, respectively (p = 0.9, log-rank 0.01). The rates of limb preservation at 5 years were 94% in endovascular repair group and 86.4% in open repair group (p = 0.3, log-rank 0.8). Open repair and endovascular repair of popliteal artery aneurysms provided in this retrospective single-center experience similar perioperative and follow-up results in

One-Year Outcomes Following Directional Atherectomy of Popliteal Artery Lesions: Subgroup Analysis of the Prospective, Multicenter DEFINITIVE LE Trial

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Rastan, Aljoscha; McKinsey, James F.; Garcia, Lawrence A.; Rocha-Singh, Krishna J.; Jaff, Michael R.; Harlin, Stuart; Kamat, Suraj; Janzer, Sean; Zeller, Thomas

2017-01-01

Purpose: To report the effectiveness of directional atherectomy for the treatment of popliteal artery occlusive disease. Methods: This subset of the prospective, multicenter, single-arm DEFINITIVE LE trial included 158 patients (mean age 72.0±10.9 years; 82 men) who underwent directional atherectomy in 162 popliteal artery lesions between 2009 and 2011. Forty-eight (30.4%) patients were suffering from critical limb ischemia (CLI). The mean lesion length was 5.8±3.9 cm; 38 (23.5%) arteries were occluded. The primary outcome measure for patients with intermittent claudication (IC) was duplex ultrasound–defined primary patency at 1 year; the outcome for subjects with CLI was freedom from major amputation of the target limb at 1 year. Outcomes and adverse events were independently assessed. Results: Procedure success (≤30% residual stenosis) was achieved in 84.4% of treated lesions; adjunctive stenting was required in 6 (3.7%) of the 162 lesions. The 1-year primary patency rate was 75.0% (IC patients 78.2% and CLI patients 67.5%, p=0.118). The freedom from major amputation in both cohorts was 100%. In both IC and CLI patients, significant improvements were demonstrated at 1 year in the Rutherford category, walking distance, and quality of life in comparison to baseline. Conclusion: This study indicates that directional atherectomy in popliteal arteries leads to favorable technical and clinical results at 1 year for claudicant as well as CLI patients. PMID:29117818

Iatrogenic popliteal artery injury in non arthroplasty knee surgery.

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Bernhoff, K; Björck, M

2015-02-01

We have investigated iatrogenic popliteal artery injuries (PAI) during non arthroplasty knee surgery regarding mechanism of injury, treatment and outcomes, and to identify successful strategies when injury occurs. In all, 21 iatrogenic popliteal artery injuries in 21 patients during knee surgery other than knee arthroplasty were identified from the Swedish Vascular Registry (Swedvasc) between 1987 and 2011. Prospective registry data were supplemented with case-records, including long-term follow-up. In total, 13 patients suffered PAI during elective surgery and eight during urgent surgery such as fracture fixation or tumour resection. Nine injuries were detected intra-operatively, five within 12 to 48 hours and seven > 48 hours post-operatively (two days to 23 years). There were 19 open vascular and two endovascular surgical repairs. Two patients died within six months of surgery. One patient required amputation. Only six patients had a complete recovery of whom had the vascular injury detected at time of injury and repaired by a vascular surgeon. Patients sustaining vascular injury during elective procedures are more likely to litigate (p = 0.029). We conclude that outcomes are poorer when there is a delay of diagnosis and treatment, and that orthopaedic surgeons should develop strategies to detect PAI early and ensure rapid access to vascular surgical support. ©2015 The British Editorial Society of Bone & Joint Surgery.

Results of Surgical Treatment of Patients with Critical Limb Ischemia and Stenotic Lesions of the Brachiocephalic Arteries

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Alexei L. Charyshkin

2017-06-01

Full Text Available The aim of our study was to evaluate the results of the surgical treatment for patients with critical limb ischemia (CLI and stenotic lesions of the brachiocephalic arteries. Methods and Results: We examined 72 patients (68/87.2% men and 4/7.3% women aged from 46 to 78 years (mean age, 62.2±4.3 years with CLI and stenotic lesions of the brachiocephalic arteries. Conservative treatment was performed in 17(23.6% patients and surgical treatment in 55(76.4%. It has been carried out 73 surgical operations: femoral popliteal bypass (5/6.8%, lumbar sympathectomy (4/5.5%, thrombectomy of occluded aortofemoral graft (2/2.7%, limb amputation (4/5.5%, iliofemoral bypass (4/5.5%, aortofemoral bifurcation bypass (10/13.1%, endovascular surgery (1/1.6%, limb amputation at thigh level - 4(5.5%, thrombectomy of occluded distal arteries (4/5.5%, femoro-femoral cross-over bypass (1/1.6%, resection of popliteal artery aneurysm and prosthesis of the popliteal artery (1/1.6%, semi-closed loop endarterectomy of occluded arteries of the lower limbs (8/10.9%, carotid endarterectomy (23/31.5%, and carotid-subclavian bypass (2/2.7%. After the surgical intervention, we observed the disappearance or reduction of pain, restoration of sensitivity and motor activity, and healing of trophic ulcers in 75% of patients. In the late postoperative period, we detected the progression of limb ischemia in 4(5.5% patients; in connection with that, we performed limb amputation at thigh level. Ischemic stroke with a lethal outcome developed in one patient (1.4%. Conclusion: In patients with multifocal atherosclerosis, multilevel reconstructive surgical interventions must be performed in stages, due to the high operational risk, and risk of complications, secondary amputations and lethality in the postoperative period.

Popliteal Artery Aneurysm in Women

DEFF Research Database (Denmark)

Ravn, Hans; Pansell-Fawcett, Karin; Björck, Martin

2017-01-01

OBJECTIVES: Ninety-five per cent of those operated on for popliteal artery aneurysm (PA) are men. Thus, PAs in women are difficult to investigate. The aim was to study the disease in women. METHODS: Women treated for PA in 1987-2012, prospectively registered in the Swedish vascular registry......, Swedvasc, supplemented by case records, were compared with the larger male cohort. Survival was determined through cross linkage with the National Population Registry. RESULTS: 1509 patients (men and women), 1872 legs, were identified; of these 74 patients (4.9%) were women, 81 legs (4.3%). The median age...... was 70 years in women versus 69 in men. Twenty-nine centres operated on women (range 1-7 women/centre). There were no time trends in the proportion of women operated on (p=.5). Bilateral PA occurred in 9.5% of women and 27.0% of men (p=.002). For symptomatic aneurysms, there was a larger proportion...

The diabetic foot - modern possibilities of vascular reconstruction. Der diabetische Fuss - moderne Moeglichkeiten der Gefaessrekonstruktion

Energy Technology Data Exchange (ETDEWEB)

Arlart, I.P. (Katharinenhospital, Stuttgart (Germany). Radiologisches Inst.)

1992-05-01

Arterial vascular disease in diabetic patients includes both microangiopathy and macroangiopathy. Macroangiopathy, i.e. stenoses of occlusions of the ilio-femoro-popliteal arteries and crural arteries, can be treated by surgical vascular reconstructions and radiological procedures such as recanalisation via catheter and CT-guided lumbar sympathetic trunk, neurolysis. In this paper the different therapeutic techniques are presented in respect of indications and results particularly in the diabetic patients. (orig.).

[Trampoline accident with anterior knee dislocation caused popliteal artery disruption].

Science.gov (United States)

Pedersen, Peter Heide; Høgh, Annette Langager

2011-10-17

Only a few reports describe the risk of neurovascular damage following knee dislocation while trampolining. A 16 year-old male in a trampoline accident, sustained multi-ligament damage and occlusion of the popliteal artery. The occlusion did not show clinically until 24 hours after the trauma. He underwent vascular surgery (short saphenous bypass). We recommend implementing algorithms, for the management of suspected knee dislocation and possible accompanying neurovascular injuries in all trauma centers.

Popliteal vascular entrapment syndrome caused by a rare anomalous slip of the lateral head of the gastrocnemius muscle

International Nuclear Information System (INIS)

Liu, Patrick T.; Moyer, Adrian C.; Huettl, Eric A.; Fowl, Richard J.; Stone, William M.

2005-01-01

Popliteal vascular entrapment syndrome can result in calf claudication, aneurysm formation, distal arterial emboli, or popliteal vessel thrombosis. The most commonly reported causes of this syndrome have been anomalies of the medial head of the gastrocnemius muscle as it relates to the course of the popliteal artery. We report two cases of rare anomalous slips of the lateral head of the gastrocnemius muscle causing popliteal vascular entrapment syndrome. (orig.)

Mycotic aneurysm of the popliteal artery secondary to Streptococus pneumoniae: a case report and review of the literature.

LENUS (Irish Health Repository)

Killeen, Shane D

2009-01-01

Cases of true mycotic popliteal artery aneurysm are rare. Presentation is variable but invasive and non-invasive investigations collectively facilitate diagnosis and guide operative procedures. Definitive treatment generally utilizes surgical intervention with excision and reconstruction using autologous vein graft. Prolonged targeted antibiotic therapy is an important adjuvant.

Popliteal artery repair in massively transfused military trauma casualties: a pursuit to save life and limb.

Science.gov (United States)

Fox, Charles J; Perkins, Jeremy G; Kragh, John F; Singh, Niten N; Patel, Bhavin; Ficke, James R

2010-07-01

Popliteal artery war wounds can bleed severely and historically have high rates of amputation associated with ligation (72%) and repair (32%). More than before, casualties are now surviving the initial medical evacuation and presenting with severely injured limbs that prompt immediate limb salvage decisions in the midst of life-saving maneuvers. A modern analysis of current results may show important changes because previous limb salvage strategies were limited by the resuscitation and surgical techniques of their eras. Because exact comparisons between wars are difficult, the objective of this study was to calculate a worst-case (a pulseless, fractured limb with massive hemorrhage from popliteal artery injury) amputation-free survival rate for the most severely wounded soldiers undergoing immediate reconstruction to save both life and limb. We performed a retrospective study of trauma casualties admitted to the combat support hospital at Ibn Sina Hospital in Baghdad, Iraq, between 2003 and 2007. US military casualties requiring a massive transfusion (> or = 10 blood units transfused within 24 hours of injury) were identified. We extracted data on the subset of casualties with a penetrating supra or infrageniculate popliteal arterial vascular injury. Demographics, injury mechanism, Injury Severity Score, tourniquet use, physiologic parameters, damage control adjuncts, surgical repair techniques, operative time, and outcomes (all-cause 30-day mortality, amputation rates, limb salvage failure, and graft patency) were investigated. Forty-six massively transfused male casualties, median age 24 years (range, 19-54 years; mean Injury Severity Score, 19 +/- 8.0), underwent immediate orthopedic stabilization and vascular reconstruction. There was one early death. The median operative time for the vascular repairs was 217 minutes (range, 94-630 minutes) and included all damage control procedures. Combined arterial and venous injuries occurred in 17 (37%). Ligation was

Positive association between increased popliteal artery vessel wall thickness and generalized osteoarthritis: is OA also part of the metabolic syndrome?

International Nuclear Information System (INIS)

Kornaat, Peter R.; Sharma, Ruby; Geest, Rob J. van der; Lamb, Hildo J.; Bloem, Johan L.; Watt, Iain; Kloppenburg, Margreet; Hellio le Graverand, Marie-Pierre

2009-01-01

The purpose of the study was to determine if a positive association exists between arterial vessel wall thickness and generalized osteoarthritis (OA). Our hypothesis is that generalized OA is another facet of the metabolic syndrome. The medical ethical review board of our institution approved the study. Written informed consent was obtained from each patient prior to the study. Magnetic resonance (MR) images of the knee were obtained in 42 patients who had been diagnosed with generalized OA at multiple joint sites. Another 27 MR images of the knee were obtained from a matched normal (non-OA) reference population. Vessel wall thickness of the popliteal artery was quantitatively measured by dedicated software. Linear regression models were used to investigate the association between vessel wall thickness and generalized OA. Adjustments were made for age, sex, and body mass index (BMI). Confidence intervals (CI) were computed at the 95% level and a significance level of α = 0.05 was used. Patients in the generalized OA population had a significant higher average vessel wall thickness than persons from the normal reference population (p ≤ α), even when correction was made for sex, age, and BMI. The average vessel wall thickness of the popliteal artery was 1.09 mm in patients with generalized OA, and 0.96 mm in the matched normal reference population. The association found between increased popliteal artery vessel wall thickness and generalized osteoarthritis suggests that generalized OA might be another facet of the metabolic syndrome. (orig.)

Positive association between increased popliteal artery vessel wall thickness and generalized osteoarthritis: is OA also part of the metabolic syndrome?

Energy Technology Data Exchange (ETDEWEB)

Kornaat, Peter R.; Sharma, Ruby; Geest, Rob J. van der; Lamb, Hildo J.; Bloem, Johan L.; Watt, Iain [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Kloppenburg, Margreet [Leiden University Medical Center, Department of Rheumatology, Leiden (Netherlands); Hellio le Graverand, Marie-Pierre [Pfizer Global Research and Development, New London, CT (United States)

2009-12-15

The purpose of the study was to determine if a positive association exists between arterial vessel wall thickness and generalized osteoarthritis (OA). Our hypothesis is that generalized OA is another facet of the metabolic syndrome. The medical ethical review board of our institution approved the study. Written informed consent was obtained from each patient prior to the study. Magnetic resonance (MR) images of the knee were obtained in 42 patients who had been diagnosed with generalized OA at multiple joint sites. Another 27 MR images of the knee were obtained from a matched normal (non-OA) reference population. Vessel wall thickness of the popliteal artery was quantitatively measured by dedicated software. Linear regression models were used to investigate the association between vessel wall thickness and generalized OA. Adjustments were made for age, sex, and body mass index (BMI). Confidence intervals (CI) were computed at the 95% level and a significance level of {alpha} = 0.05 was used. Patients in the generalized OA population had a significant higher average vessel wall thickness than persons from the normal reference population (p {<=} {alpha}), even when correction was made for sex, age, and BMI. The average vessel wall thickness of the popliteal artery was 1.09 mm in patients with generalized OA, and 0.96 mm in the matched normal reference population. The association found between increased popliteal artery vessel wall thickness and generalized osteoarthritis suggests that generalized OA might be another facet of the metabolic syndrome. (orig.)

Normal pedal pulses in a popliteal artery thrombosis after a trampoline-associated knee dislocation: a case report.

Science.gov (United States)

Harb, Z; Harb, A; Kammoona, Ishan; Huber, C

2011-04-01

In lower extremity trauma, it is routine to check the neurovascular status of the affected limb. Failure to recognise a vascular injury can have catastrophic consequences for the patient. The frequent observation of the distal pulses at regular intervals after a traumatic knee dislocation is absolutely mandatory for the early recognition and management of popliteal artery thrombosis. A limb-threatening complication of popliteal artery thrombosis occurring in association with a palpable dorsalis pedis pulse after a trampoline-related knee dislocation is reported here to emphasise some important teaching points. These lessons are a learning tool to help in the early recognition of the potential complications associated with such injuries and thus minimise their occurrence.

Concomitant posterior hip dislocation, ipsilateral intertrochanteric- and proximal tibial- fractures with popliteal artery injury: a challenging trauma mélange

Directory of Open Access Journals (Sweden)

Pranit N. Chotai

2015-12-01

Full Text Available Constellation of ipsilateral posterior hip dislocation, intertrochanteric- and proximal tibial fracture with popliteal artery injury is rare. Management of this presentation is challenging. A motor vehicle accident victim presented with these injuries, but without any initial signs of vascular compromise. Popliteal artery injury was diagnosed intra-operatively and repaired. This was followed by external fixation of tibial fracture, open reduction of dislocated hip and internal fixation of intertrochanteric fracture. Patient regained bilateral complete weight bearing and returned to pre-accident activity level. Apt surgical management including early repair of vascular injury in such a trauma mélange allows for a positive postoperative outcome.

Incidence, risk factors, treatment and prognosis of popliteal artery embolization in the superficial femoral artery interventions.

Directory of Open Access Journals (Sweden)

Weiwei Wu

Full Text Available OBJECTIVE: Percutaneous transluminal angioplasty and stenting (PTA + stent has gained acceptance as a primary treatment modality for the superficial femoral artery (SFA diseases. Popliteal artery embolization (PAE is a severe complication in SFA interventions. The purpose of this study was to evaluate the incidence, risk factors, treatment and prognosis of PAE in primary SFA PTA + stent. METHODS: Chronic SFA arteriosclerosis cases that underwent primary PTA + stent were reviewed from a retrospectively maintained database. Runoff vessels were evaluated in all cases before and after the interventions for PAE detection. The primary patency, secondary patency and limb salvage rates were calculated using Kaplan-Meier analysis and compared using log-rank analysis. Cox multivariate regression was performed to evaluate predictors of patency and limb salvage rates. RESULTS: There were 436 lesions treated in 388 patients with 10 PAE events (2.3% in total. PAE rate was significantly higher in Transatlantic Inter-Society Consensus (TASC C/D group compared with TASC A/B group (OR = 8.91, P = .002, in chronic total occlusion (CTO lesions compared with stenotic lesions (P<.0001, and in group with history of cerebral ischemic stroke (OR = 6.11, P = .007. PAE rates were not significantly affected by age, sex, smoking, hypertension, diabetes, hyperlipidemia and runoff status. The binary logistic regression showed that only the TASC C/D was an independent predictor of PAE (P = .031. The 12-month and 24-month primary patency, secondary patency and limb salvage rates in PAE group showed no significant differences comparing with non-PAE group. CONCLUSIONS: PAE is a rare event in primary SFA PTA + stent. TASC C/D lesion, CTO and cerebral ischemic stroke history are risk factors for PAE. PAE is typically reversible by comprehensive techniques. If the popliteal flow is restored in time, PAE has no significant effect on long-term patency and limb

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Arteriotomy revealed an area of fractured intima with overlying thrombus. The area was debrided and ... the ankle (and not the posterior tibial artery). On exploration five lateral tears to the femoro-popliteal ... transverse intimal fracture with overlying thrombus (Fig. 3). Passage of a Fogarty embolectomy catheter returned a ...

Surveillance Duplex Ultrasonography of Stent Grafts for Popliteal Aneurysms.

Science.gov (United States)

Pineda, Danielle M; Troutman, Douglas A; Dougherty, Matthew J; Calligaro, Keith D

2016-05-01

Stent grafts, also known as covered stents, have become an increasingly acceptable treatment for popliteal artery aneurysms. However, endovascular exclusion confers lower primary patency compared to traditional open bypass and exclusion. The purpose of this study was to evaluate whether duplex ultrasonography (DU) can reliably diagnose failing stent grafts placed for popliteal artery aneurysms prior to occlusion. Between June 5, 2007, and March 11, 2014, 21 stent grafts (Viabahn; Gore, Flagstaff, Arizona) were placed in 19 patients for popliteal artery aneurysms. All patients had at least 1 follow-up duplex scan postoperatively. Mean follow-up was 28.9 months (9-93 months). Postoperative DU surveillance was performed in our Intersocietal Accreditation Commission noninvasive vascular laboratory at 1 week postprocedure and every 6 months thereafter. Duplex ultrasonography measured peak systolic velocities (PSVs) and ratio of adjacent PSVs (Vr) every 5 cm within the stent graft and adjacent arteries. We retrospectively classified the following factors as "abnormal DU findings": focal PSV > 300 cm/s, uniform PSVs 3.0. These DU criteria were derived from laboratory-specific data that we previously published on failing stent grafts placed for lower extremity occlusive disease. Four of the 21 stent grafts presented with symptomatic graft thrombosis within 6 months of a normal DU. Three of these 4 patients presented with rest pain and underwent thrombectomy (2) or vein bypass (1), and 1 elected for nonintervention for claudication. Our results suggest that surveillance DU using criteria established for grafts placed for occlusive disease may not be useful for predicting stent graft failure in popliteal artery aneurysms. © The Author(s) 2016.

The current role of vascular stents.

Science.gov (United States)

Busquet, J

1993-09-01

The limitations of percutaneous balloon angioplasty have favoured the development and the use of vascular endoprostheses or stents. These thin-walled metal devices maintain after expansion, an optimal and constant diameter for the vascular lumen. Restenosis, dissection, abrupt closure, residual stenosis or re-opened total occlusion represent appropriate indications for stenting. A large experience with non-coronary application of stents is currently available in iliac, femoro-popliteal and renal arteries, aorta, large veins.

Popliteal amyloidoma presenting with leg ischemia in a chronic dialysis patient

International Nuclear Information System (INIS)

Aoki, Y.; Kaneda, Kiyoshi; Miyagi, Noboru; Itoh, Manabu; Ohmoto, Hirofumi

2000-01-01

The authors report a case of bilateral popliteal amyloidoma causing stenosis of the popliteal artery and vein. This patient had been treated with hemodialysis for 26 years. The diagnosis was made with MR angiography. A popliteal tumor of the right knee was resected surgically and the histologic examination showed deposition of amyloid. After resecting the popliteal tumor, the severe leg pain and intermittent claudication improved. This report suggests that popliteal amyloid tumors should be considered in a patient undergoing long-term hemodialysis who complains of leg pain and intermittent claudication. (orig.)

Use of a New Hybrid Heparin-Bonded Nitinol Ring Stent in the Popliteal Artery: Procedural and Mid-term Clinical and Anatomical Outcomes

International Nuclear Information System (INIS)

Parthipun, Aneeta; Diamantopoulos, Athanasios; Kitrou, Panagiotis; Padayachee, Soundrie; Karunanithy, Narayan; Ahmed, Irfan; Zayed, Hany; Katsanos, Konstantinos

2015-01-01

PurposeTo report the immediate and mid-term clinical and anatomical outcomes of a novel, hybrid, heparin-bonded, nitinol ring stent (TIGRIS; Gore Medical) when used for the treatment of lesions located in the popliteal artery.Materials and MethodsThis was a prospective single-centre registry. Patients eligible for inclusion were individuals suffering from symptomatic popliteal arterial occlusive disease (Rutherford–Becker stage 3–6; P1–P3 segments) and treated with placement of the TIGRIS stent(s). Patients were prospectively scheduled for clinical review and duplex ultrasound follow-up after 6 and 12 months. Outcome measures included immediate technical success, primary vessel patency, in-stent binary restenosis (evaluable by Duplex at 50 % threshold; PSVR > 2.0), freedom from target lesion revascularization (TLR) and amputation-free survival (AFS) estimated by Kaplan–Meier (K–M) survival analysis. Cox proportional-hazards regression analysis was also performed to adjust for confounders and search for independent predictors of outcomes.ResultsFrom August 2012 to March 2014, a total of 54 popliteal TIGRIS stents were implanted in 50 limbs of 48 patients (27 men and 21 women; mean age 76.0 ± 1.7 years). Median Rutherford–Becker stage was five at baseline and 37/50 (74.0 %) were chronic total occlusions. Technical success was achieved in all cases (100 %). Stented lesion length was 114.2 ± 36.9 mm (range 6–20 cm). Median follow-up was 11.8 ± 0.8 months. After 12 months, primary patency of the TIGRIS stent was 69.5 ± 10.2 % with an 86.1 ± 5.9 % freedom from TLR and 87 ± 5.0 % AFS (K–M estimates).ConclusionThe TIGRIS hybrid heparin-bonded nitinol ring stent is a safe and effective endovascular option for complex occlusive disease of the popliteal artery

Use of a New Hybrid Heparin-Bonded Nitinol Ring Stent in the Popliteal Artery: Procedural and Mid-term Clinical and Anatomical Outcomes

Energy Technology Data Exchange (ETDEWEB)

Parthipun, Aneeta; Diamantopoulos, Athanasios; Kitrou, Panagiotis [King’s Health Partners, Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Padayachee, Soundrie [King’s Health Partners, Department of Ultrasonic Angiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Karunanithy, Narayan; Ahmed, Irfan [King’s Health Partners, Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Zayed, Hany [King’s Health Partners, Department of Vascular Surgery, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Katsanos, Konstantinos, E-mail: konstantinos.katsanos@gstt.nhs.uk, E-mail: katsanos@med.upatras.gr [King’s Health Partners, Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom)

2015-08-15

PurposeTo report the immediate and mid-term clinical and anatomical outcomes of a novel, hybrid, heparin-bonded, nitinol ring stent (TIGRIS; Gore Medical) when used for the treatment of lesions located in the popliteal artery.Materials and MethodsThis was a prospective single-centre registry. Patients eligible for inclusion were individuals suffering from symptomatic popliteal arterial occlusive disease (Rutherford–Becker stage 3–6; P1–P3 segments) and treated with placement of the TIGRIS stent(s). Patients were prospectively scheduled for clinical review and duplex ultrasound follow-up after 6 and 12 months. Outcome measures included immediate technical success, primary vessel patency, in-stent binary restenosis (evaluable by Duplex at 50 % threshold; PSVR > 2.0), freedom from target lesion revascularization (TLR) and amputation-free survival (AFS) estimated by Kaplan–Meier (K–M) survival analysis. Cox proportional-hazards regression analysis was also performed to adjust for confounders and search for independent predictors of outcomes.ResultsFrom August 2012 to March 2014, a total of 54 popliteal TIGRIS stents were implanted in 50 limbs of 48 patients (27 men and 21 women; mean age 76.0 ± 1.7 years). Median Rutherford–Becker stage was five at baseline and 37/50 (74.0 %) were chronic total occlusions. Technical success was achieved in all cases (100 %). Stented lesion length was 114.2 ± 36.9 mm (range 6–20 cm). Median follow-up was 11.8 ± 0.8 months. After 12 months, primary patency of the TIGRIS stent was 69.5 ± 10.2 % with an 86.1 ± 5.9 % freedom from TLR and 87 ± 5.0 % AFS (K–M estimates).ConclusionThe TIGRIS hybrid heparin-bonded nitinol ring stent is a safe and effective endovascular option for complex occlusive disease of the popliteal artery.

Vascugraft polyurethane arterial prosthesis as femoro-popliteal and femoro-peroneal bypasses in humans: pathological, structural and chemical analyses of four excised grafts.

Science.gov (United States)

Zhang, Z; Marois, Y; Guidoin, R G; Bull, P; Marois, M; How, T; Laroche, G; King, M W

1997-01-01

Following positive results obtained in in vitro studies and in vivo implantations in animals, a clinical trial using the Vascugraft polyurethane arterial prosthesis as a below-knee substitute was undertaken in 15 patients. Eight grafts became occluded during the first year, and segments from four of them were explanted and made available for pathological, structural and chemical investigations. The implantation periods ranged from 21 to 358 days. Failures were associated with kinking (one case), possible anastomotic mismatch between the graft and the artery (one case), and poor run-off (two cases). No organized collagenous internal encapsulation was noted; however, endothelial-like cells were observed at the anastomotic site of one graft. No significant structural degradation of the prostheses was observed in those grafts implanted for 21, 38 and 46 days. Some deteriorations in the fibrous structure were observed on the external surface of the prosthesis implanted for 358 days. High-resolution carbon C1s analysis by ESCA demonstrated a 60 to 80% decrease in carbonate content on the surface of all explanted prostheses. Chemical analyses of each polyurethane graft by IR, SEC and DSC revealed no significant chemical changes. The clinical performance of the Vascugraft prosthesis for below-knee implantation proved to be no more impressive than that of expanded polytetrafluorethylene, the currently accepted reference. The decision by B. Braun Melsungen AG to end this program is therefore to be regarded as highly professional.

Early and mid-term results in the endovascular treatment of popliteal aneurysms with the multilayer flow modulator.

Science.gov (United States)

Ucci, Alessandro; Curci, Ruggiero; Azzarone, Matteo; Bianchini Massoni, Claudio; Bozzani, Antonio; Marcato, Carla; Marone, Enrico Maria; Perini, Paolo; Tecchio, Tiziano; Freyrie, Antonio; Argenteri, Angelo

2018-01-01

Background The endovascular approach became an alternative to open surgical treatment of popliteal artery aneurysm over the last few years. Heparin-bonded stent-grafts have been employed for endovascular popliteal artery aneurysm repair, showing good and stable results. Only few reports about the use of multilayer flow modulator are available in literature, providing small patient series and short follow-up. The aim of this study is to report the outcomes of patients with popliteal artery aneurysm treated with the multilayer flow modulator in three Italian centres. Methods We retrospectively analysed a series of both symptomatic and asymptomatic patients with popliteal artery aneurysm treated with the multilayer flow modulator from 2009 to 2015. Follow-up was undertaken with clinical and contrast-enhanced ultrasound examinations at 1, 6 and 12 months, and yearly thereafter. Computed tomography angiography was performed in selected cases. Primary endpoints were aneurysm sac thrombosis; freedom from sac enlargement and primary, primary-assisted and secondary patency during follow-up. Secondary endpoints were technical success, collateral vessels patency, limb salvage and aneurysm-related complications. Results Twenty-three consecutive patients (19 males, age 72 ± 11) with 25 popliteal artery aneurysms (mean diameter 23 mm ± 1, 3 symptomatic patients) were treated with 40 multilayer flow modulators during the period of the study. Median follow-up was 22.6 ± 16.7 months. Complete aneurysm thrombosis occurred in 92.9% of cases (23/25 cases) at 18 months. Freedom from sac enlargement was 100% (25/25 cases) with 17 cases of aneurysm sac shrinkage (68%). At 1, 6, 12 and 24 months, estimated primary patency was 95.7%, 87.3%, 77% and 70.1%, respectively. At the same intervals, primary-assisted patency was 95.7%, 91.3%, 86% and 86%, respectively, and secondary patency was 100%, 95.7%, 90.3% and 90.3%, respectively. Technical success was 100%. The collateral

Chronic Expanding Hematoma in the Popliteal Fossa after Pseudoaneurysm Surgery because of Nail Puncture

Directory of Open Access Journals (Sweden)

Serdar Yilmaz

2014-01-01

Full Text Available Hematomas caused by surgery or trauma that persist and expand slowly for more than a month are defined as chronic expanding hematomas (CEH. Magnetic resonance imaging (MRI is useful for the diagnosis. Total excision with the pseudocapsule is the treatment method. Pseudoaneurysms result from arterial wall disruptions and can be mistaken for CEH. We present a rare case report of a 45-year-old man with a large, painful swelling in his left popliteal fossa. He had a puncture wound by a nail 11 years ago and a gradually expanding mass occurred in his popliteal fossa. A pseudoaneurysm was detected and operated a year later. After surgery, a gradually expanding mass recurred in his popliteal fossa. On the arteriography, the popliteal artery was occluded and the blood flow was maintained with collateral vessels. On MRI, an enormous swelling of 115 × 107 × 196 cm in diameter was seen. It was diagnosed as CEH and was excised completely protecting the collateral vessels and there was no recurrence after a year from the surgery.

Popliteal artery thrombosis in a patient with Cogan syndrome: Treatment with thrombolysis and percutaneous transluminal angioplasty

International Nuclear Information System (INIS)

Bastug, Demir E.; Dominic, Anthony; Ortiz, Orlando; DiBartolomeo, Anthony G.; Kotzan, Jeffrey M.; Abraham, F. Matthew

1997-01-01

A 31-year-old woman with Cogan syndrome (a rare form of systemic vasculitis) was evaluated for a cold, painful left foot with diminished pulses. Arteriography demonstrated thrombosis of the left popliteal artery with evidence of vasculitis. Thrombolytic therapy was begun with initial success but eventual rethrombosis. After reinitiating thrombolytic therapy combined with intraarterial vasodilator therapy, successful angioplasty was performed with sustained results, at 6-month follow-up

The Primary Patency and Fracture Rates of Self-Expandable Nitinol Stents Placed in the Popliteal Arteries, Especially in the P2 and P3 Segments, in Korean Patients

Energy Technology Data Exchange (ETDEWEB)

Chang, Il Soo; Chee, Hyun Keun; Park, Sang Woo; Yun, Ik Jin; Hwang, Jae Joon; Lee, Song Am; Kim, Jun Seok; Chang, Seong Hwan; Jung, Hong Geun [Konkuk University Hospital, Seoul (Korea, Republic of)

2011-04-15

We wanted to evaluate the status of self-expandable nitinol stents implanted in the P2 and P3 segments of the popliteal artery in Korean patients. We retrospectively analyzed 189 consecutive patients who underwent endovascular treatment for steno occlusive lesions in the femoropopliteal artery from July 2003 to March 2009, and 18 patients who underwent stent placement in popliteal arterial P2 and P3 segments were finally enrolled. Lesion patency was evaluated by ultrasound or CT angiography, and stent fracture was assessed by plain X-rays at 1, 3, 6 and 12 months and annually thereafter. At the 1-month follow-up, stent fracture (Type 2) was seen in one limb (up to P3, 1 of 18, 6%) and it was identified in seven limbs at the 3-month follow-up (Type 2, Type 3, Type 4) (n = 1: up to P2: n = 6: P3). At the 6-month follow-up, one more fracture (Type 1) (up to P3) was noted. At the 1-year follow-up, there were no additional stent fractures. Just four limbs (up to P2) at the 2-year follow-up did not have stent fracture. The primary patency was 94%, 61% and 44% at 1, 3 and 6 months, respectively, and the group with stent implantation up to P3 had a higher fracture rate than that of the group that underwent stenting up to P2 (p < 0.05). We suggest that stent placement up to the popliteal arterial P3 segment and over P2 in an Asian population can worsen the stent patency owing to stent fracture. It may be necessary to develop a stent design and structure for the Asian population that can resist the bending force in the knee joint

[Studies and clinical experiences in the use of domestic blood vessel prostheses with increased thromboresistance].

Science.gov (United States)

Spiridonov, A A; Satmari, V V; Zaporozhan, A A; Grozovskiĭ, Iu A; Il'ina, M B; Novikova, S P; Shekhter, A B; Dobrova, N B

1989-01-01

The experimental and clinical data on the use of new native grafts with increased thromboresistance--the Vitlan and heparinized ones are presented. In all the acute and chronic experiments, the increased thromboresistance of both types of the grafts versus the common Fluorlon-Lavsan ones, and well-formed neointima with sufficient vascularization by the year 1 and 5 of follow-up were revealed. Complete organization of the external and internal capsules of the grafts was noted 5 mos later, no tissue reaction to Vitlan and heparinized grafts was revealed. The Vitlan grafts were used in 19 patients. Good immediate and long-term results were obtained in reconstruction of the aorto-femoral, aorto-pulmonary and femoro-popliteal segments with the grafts of 10 and 8 mm in diameter. All the Vitlan shunts of the femoro-popliteal segment with 6 mm diameter were thrombosed 1-6 mos after the operation. The heparinized grafts with 8 mm diameter at the femoro-popliteal position were used in 28 patients, good long-term results were noted in 27.

A successful retrieval of stripped outer coating of J-tip diagnostic guidewire from the left popliteal artery during elective coronary angiography

Directory of Open Access Journals (Sweden)

Damjanović Miodrag

2014-01-01

Full Text Available Introduction. Entrapment and fracture of diagnostic or therapeutic devices within the coronary circulatory system are a rare, but increasing problem. Case report. A 70-yearold man was admitted in our clinic for coronary angiography before the planned aortic valve replacement. An arterial sheath was inserted in the right common femoral artery. After introducing a J-tip diagnostic coronary guidewire into the aorta and advancing a left Judkins diagnostic catheter over it, suddenly occured peeling off of the wire´s hydrophilic coating at the aortic arch level. Very soon, this outer coating of guidewire carried by the blood stream was entered into the left femoral artery, then into the left popliteal artery. This stripped part of guidewire was successfully caught and extracted out by using a goose-neck snare catheter. Conclusion. A sudden stripping of outer coating of a J-tip diagnostic hydrophilic coronary guidewire during coronary angiography is possible to manage quickly and successfully by the use of a simple cathether.

Trombose aguda de aneurisma de artéria femoral isolado: relato de caso Acute thrombosis of isolated femoral artery aneurysm: case report

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André Hideo Motoki

2008-12-01

Full Text Available Aneurismas de artéria femoral são raros, porém são o segundo tipo mais freqüente de aneurismas periféricos, sendo o aneurisma de artéria poplítea o mais comum. Normalmente, são de etiologia aterosclerótica. As complicações deste aneurisma são representadas por embolia, trombose e, mais raramente, a rotura. O objetivo deste trabalho é relatar um caso de um paciente com 59 anos, masculino, com queixa de dor súbita em membro inferior esquerdo associado à frialdade, palidez e ausência de pulsos. O ecocolordoppler evidenciou a presença de aneurisma trombosado da artéria femoral comum. O paciente foi submetido, com sucesso, à ressecção do aneurisma, com reconstrução do leito arterial.Common femoral artery aneurysms are rare; however, they are the second most frequent type of peripheral aneurysm, popliteal artery aneurysms being the most common. They usually have atherosclerotic ethiology. The complications of this aneurysm are thromboembolism and, more rarely, rupture. This article aimed at reporting the case of a 59-year-old male patient with complaint of sudden pain in his left leg associated with coldness, paleness and absence of pulses. Color Doppler ultrasound showed a thrombosed aneurysm of the common femoral artery. The patient was successfully submitted to aneurysm resection with reconstruction of the arterial bed.

Dual-energy CT angiography in peripheral arterial occlusive disease - accuracy of maximum intensity projections in clinical routine and subgroup analysis

International Nuclear Information System (INIS)

Kau, Thomas; Eicher, Wolfgang; Reiterer, Christian; Niedermayer, Martin; Rabitsch, Egon; Hausegger, Klaus A.; Senft, Birgit

2011-01-01

To evaluate the accuracy of dual-energy CT angiography (DE-CTA) maximum intensity projections (MIPs) in symptomatic peripheral arterial occlusive disease (PAOD). In 58 patients, DE-CTA of the lower extremities was performed on dual-source CT. In a maximum of 35 arterial segments, severity of the most stenotic lesion was graded (<10%, 10-49% and 50-99% luminal narrowing or occlusion) independently by two radiologists, with DSA serving as the reference standard. In DSA, 52.3% of segments were significantly stenosed or occluded. Agreement of DE-CTA MIPs with DSA was good in the aorto-iliac and femoro-popliteal regions (κ = 0.72; κ = 0.66), moderate in the crural region (κ = 0.55), slight in pedal arteries (κ = 0.10) and very good in bypass segments (κ = 0.81). Accuracy was 88%, 78%, 74%, 55% and 82% for the respective territories and moderate (75%) overall, with good sensitivity (84%) and moderate specificity (67%). Sensitivity and specificity was 82% and 76% in claudicants and 84% and 61% in patients with critical limb ischaemia. While correlating well with DSA above the knee, accuracy of DE-CTA MIPs appeared to be moderate in the calf and largely insufficient in calcified pedal arteries, especially in patients with critical limb ischaemia. (orig.)

Bacteria of leg atheromatous arteries responsible for inflammation.

Science.gov (United States)

Olszewski, Waldemar Lech; Rutkowska, Joanna; Moscicka-Wesolowska, Maria; Swoboda-Kopec, Ewa; Stelmach, Ewa; Zaleska, Marzanna; Zagozda, Malgorzata

2016-09-01

Ischaemia of the lower limbs is frequently followed by inflammation and, in advanced cases, necrosis of peripheral tissues. Whether this is caused by arterial hypoperfusion only or by the presence of bacteria in the arterial walI as well remains unclear. The aim of the study was to prove the presence and source of bacteria in arterial specimens and evaluate their chemotactic properties resulting in the formation of periarterial cellular infiltrates. Bacterial culture and testing for 16sRNA were performed in fragments of popliteal artery harvested from amputated limbs. Carotid artery plaques served as controls. Fragments of arteries were transplanted into scid mice to evaluate their chemotactic activity for macrophages. a) higher prevalence of isolates and 16sRNA in atherosclerotic popliteal than carotid arteries, b) high density of plaque and periarterial infiltrates and mRNA level for pro-inflammatory cytokines in popliteal arteries, c) prevalent microbes were Staphylococcus aureus, S. epidermidis and Enterococci, d) foot skin and arterial bacterial phenotypes and DNA revealed evident similarities, and e) more intensive mouse macrophage accumulation in popliteal than carotid implants into scid mice. The presence of bacteria in the lower limb arterial wall was documented. They may predispose to inflammation secondary to ischaemic changes.

Rupture of popliteal arterial aneurysm due to salmonella infection

International Nuclear Information System (INIS)

Kim, Dong Hun; Oh, Hyung Woo; Kim, Dong Hyun; Byun, Joo Nam

2006-01-01

We report here on a case of popliteal aneurysm and rupture that occurred over a 10-day period and this was all secondary to salmonella infection. Computed tomography (CT) angiography of the extremity that was performed before and after aneurysmal rupture showed the aneurysm's rapid evolution to rupture over a short period of time. We also review the pathogenesis, clinical presentation, diagnostic approach and management of salmonella aneurysms

Constriction of collateral arteries induced by "head-up tilt" in patients with occlusive arterial disease of the legs

DEFF Research Database (Denmark)

Agerskov, K; Henriksen, O; Tønnesen, K H

1981-01-01

The effect of head-up tilt on leg blood flow and segmental arterial blood pressures was studied in 21 patients with occlusion or severe stenosis of the common or superficial femoral artery. Arterial pressure was measured directly in the brachial artery, common femoral artery and popliteal artery....... Relative change in blood flow in the leg during tilt was estimated by changes in arterio-venous oxygen differences and by the indicator dilution technique in nine patients. Head-up tilt caused a decrease in leg blood flow of 36% corresponding to an increase in total vascular resistance of 57%. Tilt did...... not change the pressure gradient from femoral to popliteal artery in the patients with occlusion of the superficial femoral artery, indicating that the flow resistance offered by the collateral arteries had increased. In a bilateral sympathectomised patient the increase in collateral resistance was almost...

Stent fractures in the Hemobahn/Viabahn stent graft after endovascular popliteal aneurysm repair

NARCIS (Netherlands)

Tielliu, Ignace F. J.; Zeebregts, Clark J.; Vourliotakis, George; Bekkema, Foppe; van den Dungen, Jan J. A. M.; Prins, Ted R.; Verhoeven, Eric L. G.

Objective: During the last decade, endovascular repair of popliteal artery aneurysms (PAAs) has become a valid alternative to open repair. This study analyzes the incidence and origin of stein graft fractures after endovascular repair, its impact on patency, and strategies to prevent fractures.

Balloon angioplasty of popliteal and crural arteries in elderly with critical chronic limb ischemia

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Atar, Eli; Siegel, Yoel; Avrahami, Ram; Bartal, Gabriel; Bachar, Gil N.; Belenky, Alexander

2005-02-01

Objective: Elderly patients with extensive infrainguinal peripheral vascular disease and critical chronic limb ischemia (CCLI) are poor surgical candidates. Our purpose was to evaluate angiographic and clinical results of popliteal, infrapopliteal, and multi-level disease percutaneous transluminal angioplasty (PTA) in such patients. Design: Retrospective study of angiographic and clinical files in selected group. Materials and methods: Between 1996 and 2002, 38 elderly patients aged 80-94 years old (mean age 83.3) with critical leg ischemia were treated with PTA. All patients were at high surgical risk. 31/38 (81.5%) patients had chronic non-healing wounds, and 14/38 (37%) had multi-level disease of superficial femoral, popliteal and crural arteries. One hundred and two lesions were treated by angioplasty. Immediate angiographic and 1 year clinical results were retrospectively analyzed. Results: The overall procedural success rate was 32/38 (84.2%). There were three major complications (7.9%), but no deaths, and three technical failures, all were of infrapopliteal lesions. After 1 year, 27 patients could be followed, five patients died during the first year of unrelated causes. Twenty-three patients (85.2%), were clinically re-occluded within 1 year, but complete and partial wound healing was achieved in 80% (16/20) and rest pain improvement in 57% (4/7), so that overall limb salvage was 74% (20/27). Conclusions: Elderly patients with multi-level CCLI have a short patency term following angioplasty of 14.8% after 1 year. Nevertheless, this temporary vascular patency enables wound healing or improvement in 74% of these patients, thus such endovascular interventions are recommended in this age group.

Balloon angioplasty of popliteal and crural arteries in elderly with critical chronic limb ischemia

International Nuclear Information System (INIS)

Atar, Eli; Siegel, Yoel; Avrahami, Ram; Bartal, Gabriel; Bachar, Gil N.; Belenky, Alexander

2005-01-01

Objective: Elderly patients with extensive infrainguinal peripheral vascular disease and critical chronic limb ischemia (CCLI) are poor surgical candidates. Our purpose was to evaluate angiographic and clinical results of popliteal, infrapopliteal, and multi-level disease percutaneous transluminal angioplasty (PTA) in such patients. Design: Retrospective study of angiographic and clinical files in selected group. Materials and methods: Between 1996 and 2002, 38 elderly patients aged 80-94 years old (mean age 83.3) with critical leg ischemia were treated with PTA. All patients were at high surgical risk. 31/38 (81.5%) patients had chronic non-healing wounds, and 14/38 (37%) had multi-level disease of superficial femoral, popliteal and crural arteries. One hundred and two lesions were treated by angioplasty. Immediate angiographic and 1 year clinical results were retrospectively analyzed. Results: The overall procedural success rate was 32/38 (84.2%). There were three major complications (7.9%), but no deaths, and three technical failures, all were of infrapopliteal lesions. After 1 year, 27 patients could be followed, five patients died during the first year of unrelated causes. Twenty-three patients (85.2%), were clinically re-occluded within 1 year, but complete and partial wound healing was achieved in 80% (16/20) and rest pain improvement in 57% (4/7), so that overall limb salvage was 74% (20/27). Conclusions: Elderly patients with multi-level CCLI have a short patency term following angioplasty of 14.8% after 1 year. Nevertheless, this temporary vascular patency enables wound healing or improvement in 74% of these patients, thus such endovascular interventions are recommended in this age group

Derivação com veias de membro superior após trombólise de aneurisma de artéria poplítea: alternativa para salvamento de membro Arm vein bypass after popliteal artery aneurysm thrombolysis: an alternative for limb salvage

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João Antonio Corrêa

2007-06-01

Full Text Available Os autores relatam um caso de aneurisma de artéria poplítea trombosado em que se realizou fibrinólise com sucesso na fase aguda. Foram utilizadas veias de braço para realização do enxerto e exclusão do aneurisma, pois o paciente havia sido previamente submetido à safenectomia bilateral e revascularização do miocárdio com as veias do outro braço. Apesar das dificuldades, o salvamento do membro foi alcançado.The authors report a case of a thrombosed popliteal artery aneurysm successfully treated by fibrinolysis in its acute stage. Arm veins were used to perform a bypass and aneurysm exclusion, since the patient had previously been submitted to bilateral saphenous vein stripping and myocardial revascularization using the veins of the other arm. Despite the difficulties, limb salvage was achieved.

Pseudoaneurysms of large arteries associated with AIDS

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Carlos Eli Piccinato

Full Text Available BACKGROUND: Several vascular complications are known to occur in association with the acquired immunodeficiency syndrome (AIDS and recent publications have called attention to the development of pseudoaneurysms of large arteries in patients with AIDS. CASE REPORT: We report on 2 patients with AIDS aged 23 and 31 years with pseudoaneurysms of the abdominal aorta and common iliac arteries. After clinical and radiological evaluation by arteriography and computed tomography, the patients were submitted to aneurysmectomy, with the placement of a patch of dacron in the first case and the interposition of a right aorto-iliac and left femoral prosthesis in the second. The second patient developed new aneurysms of the right subclavian and left popliteal arteries 2 months after surgery. Proximal ligation of the right subclavian artery was performed to treat the first aneurysm and resection and interposition of a reversed saphenous vein was carried out to treat the pseudoaneurysm of the popliteal artery. Histopathological examination of the popliteal artery revealed necrotizing arteritis.

The edema of the lower limb: investigations by dynamic and static lymphoscintigraphy

International Nuclear Information System (INIS)

Fritz, P.; Wildeshaus, K.H.; Winkel, K. zum.

1986-01-01

24 patients with edema of the lower limb after femoro-popliteal or femoro-crural bypass surgery were investigated by dynamic and static lymphoscintigraphy. In 20 patients contrast phlebography was also done. Venous drainage disturbences were not demonstrable. Legs with edema had a statistically significant lower drainage capacity for sup(99m)Tc sulfur microcolloid than contralateral legs. Velocity of prefascial lymphatic transport of radioactivity showed no significant differences between edematous and contralateral legs. Static lymphoscintigraphy demonstrated typical lymphedema associated-soft tissue findings in 83%. Diffuse retention of radiocolloid in the region of the edema and iatrogenic lesions of lymph vessels (dermal back flow) in the region of the surgical scar were found in 45% and 41% of cases, respectively. Based on the criteria of dynamic and static lymphoscintigraphy and the pathogenetic classification of lymphedema according to FOELDI, a dynamic insufficiency of lymph drainage must be assumed to be the cause of lymphedema after arterial reconstructions. Iatrogenic lymph vessel lesions also play a causative role. Dynamic and static lymphoscintigraphy gives valuable information for the differentiation between postreconstructive lymphedema of mechanical and functional origin. (Author)

Femoropopliteal laser recanalization - a multicenterstudy

International Nuclear Information System (INIS)

Lammer, J.; Pilger, E.; Karnel, F.; Schurawitzki, H.; Horvath, W.; Oertl, M.; Riedl, M.; Umek, H.; Klein, G.E.; Schreyer, H.; Neumayer, K.; Einspieler, R.; Olbert, F.; Polterauer, P.; Haidinger, D.; Partsch, H.; Graz Univ.; Vienna Univ.; Vienna Univ.; Krankenhaus der Barmherzigen Brueder, Linz; Wilhelminenspital, Vienna

1990-01-01

Laser-assisted angioplasty was performed in four different hospitalcenters, following the same treatment protocol and using a Nd-YAG laser with a sapphire-probe catheter. The initial recanalization rate of 259 femoro-popliteal occlusions with a mean length of 7.5 cm was 84%. Dissections or perforations were observed in 10%. An emergency surgical intervention was required in 1.1%. The long-term patency rate of the successfully recanalized arteries was 74% after 2 years. The cumulative cure rate of all 259 patients was 62%. (orig.) [de

Popliteal Arterial Aneurysms

African Journals Online (AJOL)

plication was acute arterial occlusion caused by thrombo- embolism. The reasons for ... Total. 43. 55. TABLE 11. CONCOMITANT DISEASE IN 38 PATIENTS .... Dacron prosthesis in 4. .... genous saphenous vein and the type of anastomosis.

Endovascular repair of posttraumatic multiple femoral-femoral and popliteal-popliteal arteriovenous fistula with Viabahn and excluder stent graft

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Šarac Momir

2011-01-01

Full Text Available Background. Traumatic arteriovenous (AV fistula is considered to be a pathologic communication between the arterial and venous systems following injury caused mostly by firearms, sharp objects or blasting agents. Almost 50% of all traumatic AV fistulas are localized in the extremities. In making diagnosis, besides injury anamnesis data, clinical image is dominated by palpable thrill and auscultator continual sounds at the site of fistula, extremities edemas, ischemia distally of fistula, pronounced varicose syndrome, and any signs of the right heart load in high-flow fistulas. Case report. We presented a male 32-year-old patient self-injured the region of the right lower and upper leg by shotgun during hunting in 2005. The same day the patient was operated on in a tertiary traumatology health care institution under the diagnosis of vulnus sclopetarium femoris et cruris dex; AV fistula reg popliteae dex; fractura cruris dex. The performed surgery was ligatura AV fistulae; reconstructio a. popliteae cum T-T anastomosis; fasciotomia cruris dex. Postoperatively, in the patient developed a multiple AV fistula of the femoral and popliteal artery and neighboring veins. The patient was two more times operated on for closing the fistula but with no success. Three years later the patient was referred to the Clinic for Vascular Surgery, Military Medical Academy, Belgrade, Serbia. A physical examination on admission showed the right upper leg edema, pronounced varicosities and high thrill, signs of the skin induration and initial ischemia with ulceration in the right lower leg, as well as numerous scars in the inner side of the leg from the previously performed operations. Due to the right heart load there were also present easy getting tired, tachypnoea and tachycardia. CT and contrast angiography verified the presence of multiple traumatic AV fistulas in the surface femoral and popliteal artery and neighboring veins of the highest diameter being 1 cm

The Infrapopliteal Arterial Occlusions Similar to Buerger Disease: Report of Two Cases

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Kimihiro Igari

2014-01-01

Full Text Available We herein present two cases that required the differential diagnosis of Buerger disease. Case 1 involved a 55-year-old male with a smoking habit who was admitted with ulcers and coldness in his fingers and toes. Angiography showed blockage in both the radial and posterior tibial arteries, which led to an initial diagnosis of Buerger disease. However, a biopsy of the right posterior tibial artery showed pathological findings of fibromuscular dysplasia (FMD. Case 2 involved a 28-year-old male with intermittent claudication who was examined at another hospital. Angiography showed occlusion of both popliteal and crural arteries, and the patient was suspected to have Buerger disease. However, computed tomography disclosed an abnormal slip on both sides of the popliteal fossa, and we diagnosed him with bilateral popliteal artery entrapment syndrome (PAES. These cases illustrate that other occlusive diseases, such as FMD and PAES, may sometimes be misdiagnosed as Buerger disease.

Duplex scanning in the diagnosis of acute deep vein thrombosis of the lower extremity

NARCIS (Netherlands)

van Ramshorst, B.; Legemate, D. A.; Verzijlbergen, J. F.; Hoeneveld, H.; Eikelboom, B. C.; de Valois, J. C.; Meuwissen, O. J.

1991-01-01

In a prospective study the value of duplex scanning in the diagnosis of acute femoro-popliteal thrombosis was compared to conventional contrast venography (CV) as a gold standard. A total of 126 legs in 117 patients suspected of having deep vein thrombosis (DVT) or pulmonary embolism (PE) were

Diagnosis of Popliteal Venous Entrapment Syndrome by Magnetic Resonance Imaging Using Blood-Pool Contrast Agents

International Nuclear Information System (INIS)

Beitzke, Dietrich; Wolf, Florian; Juelg, Gregor; Lammer, Johannes; Loewe, Christian

2011-01-01

Popliteal vascular entrapment syndrome is caused by aberrations or hypertrophy of the gastrocnemius muscles, which compress the neurovascular structures of the popliteal fossa, leading to symptoms of vascular and degeneration as well as aneurysm formation. Imaging of popliteal vascular entrapment may be performed with ultrasound, magnetic resonance imaging (MRI), computed tomography angiography, and conventional angiography. The use of blood-pool contrast agents in MRI when popliteal vascular entrapment is suspected offers the possibility to perform vascular imaging with first-pass magnetic resonance angiographic, high-resolution, steady-state imaging and allows functional tests all within one examination with a single dose of contrast agent. We present imaging findings in a case of symptomatic popliteal vein entrapment diagnosed by the use of blood pool contrast-enhanced MRI.

[Traumatic knee dislocation with popliteal vascular disruption: retrospective study of 14 cases].

Science.gov (United States)

Bonnevialle, P; Chaufour, X; Loustau, O; Mansat, P; Pidhorz, L; Mansat, M

2006-12-01

Complex femorotibial dislocation of the knee joint generally results from high-energy trauma caused by a traffic or a contact sport accident. Besides disruption of the cruciate ligaments, in 10-25% of patients present concomitant palsy of the common peroneal nerve and more rarely disruption of the popliteal artery. The purpose of this work was to assess outcome in a monocentric consecutive series of knee dislocations with ischemia due to disruption of the popliteal artery and to focus on specific aspects of management. This retrospective series included eleven men and three women, aged 18 to 74 years (mean 47 years). The right knee was injured in five and the left knee in six. Trauma resulted from a farm accident in six patients, fall from a high level in two, a traffic accident in three and a skiing accident (fall) in one. Two other patients with morbid obesity were fall victims. Nine patients had a single injury, two presented an associated serious head injury, one a severe chest injury, and one multiple trauma with coma, chest contusion, and abdominal lesions. One patient had a fracture of the distal femur with associated ischemia. Five knee dislocations were open with a popliteal wound for three and a posteromedial wound for two. Four patients presented total sciatic nerve palsy and nine palsy of the common peroneal nerve. The dislocation was documented in ten cases: lateral (n=1), anterior (n=4), posterior (n=5). For four patients, the dislocation had been reduced during pre-hospital care. Preoperative arteriography was available for eight patients and confirmed the disruption of the popliteal artery; the diagnosis was obvious in six other patients who were directed immediately to the operative theatre without pre-operative imaging. Revascularization was achieved with a upper popliteal-lower popliteal bypass using an inverted saphenous graft. The graft was harvested from the homolateral greater saphenous vein in eight patients and the contralateral vein in six

Lower extremity computed tomography angiography can help predict technical success of endovascular revascularization in the superficial femoral and popliteal artery.

Science.gov (United States)

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 technical failure (P = .014). Longer lengths of occlusion were also associated with technical failure (P = .042). Multiple occlusions (P = .55), negative remodeling (P = .69), vessel runoff (P = .56), and percentage of vessel calcification (P = .059) were not associated with failure. On multivariable analysis, 100% calcification remained the only significant predictor of technical failure (odds ratio, 9.0; 95% confidence interval, 1.8-45.8; P = .008). Analysis of preoperative CTA shows 100% calcification as the best predictor of technical failure of endovascular revascularization of occlusions in the SFA-pop region. Further studies are needed to determine the cost-effectiveness of obtaining preoperative CTA for lower extremity PAD. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Civilian popliteal artery injuries

African Journals Online (AJOL)

with reversed vein grafting in 68 patients, primary anastomosis in 33, prosthetic graft insertion in 11, ... patients underwent delayed amputation, giving an overall amputation rate of 37.5%. .... injury, level of arterial injury and type of repair had no significant ... patients, graft occlusion, and diseased crural vessels with poor run-.

Superficial femoral artery TASC D Registry: twelve-month effectiveness analysis of the Pulsar-18 SE nitinol stent in patients with critical limb ischemia.

Science.gov (United States)

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 (PSVRPulsar-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 SFA occlusions using subintimal or intraluminal recanalization technique with implantation of the Pulsar-18 SE nitinol stent in CLI patients is safe and clinically effective with a primary patency rate after 12 months of 77% and a freedom from target lesion revascularization rate of 86%.

A Successful Treatment of Thromboembolic Ischemia in Persistent Sciatic Artery Through Surgical and Endovascular Intervention

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İsa Coşkun

2012-12-01

Full Text Available A 50-year-old man, presented with sudden onset of right leg coldness, numbness and pain for 1.5 months. It was found that the right superficial femoral artery was thrombosed, which ended at the mid-thigh level and a continued as the popliteal artery in magnetic resonance angiography. Persistence of the sciatic artery is extremely rare vascular anomaly. It is prone to undergo early atherosclerotic changes, occlusive embolism, and aneurysm formation. In this article we report a patient with acute artery occlusion developed in popliteal and crural arteries in a patient with persistent sciatic artery which was successfully treated through surgical and endovascular intervention.

Efficacy of double inversion recovery magnetic resonance imaging for the evaluation of the synovium in the femoro-patellar joint without contrast enhancement

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Son, Ye Na; Jin, Wook; Jahng, Geon-Ho; Park, Yong Sung; Park, So Young [Kyung Hee University School of Medicine, Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul (Korea, Republic of); Cha, Jang Gyu [Soonchunhyang University Bucheon Hospital, Department of Radiology, Bucheon-si, Gyeonggi-do (Korea, Republic of); Yun, Seong Jong [Kyung Hee University School of Medicine, Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul (Korea, Republic of); Department of Radiology, Aerospace Medical Center, Republic of Korea Air Force, Cheongwon-gun, Chungcheongbuk-do (Korea, Republic of); Park, Ji Seon; Ryu, Kyung Nam [Kyung Hee University Hospital, Department of Radiology, Seoul (Korea, Republic of)

2018-02-15

To investigate the efficacy of double inversion recovery (DIR) sequence for evaluating the synovium of the femoro-patellar joint without contrast enhancement (CE). Two radiologists independently evaluated the axial DIR and CE T1-weighted fat-saturated (CET1FS) images of 33 knees for agreement; the visualisation and distribution of the synovium were evaluated using a four-point visual scaling system at each of the five levels of the femoro-patellar joint and the location of the thickest synovium. The maximal synovial thickness at each sequence was measured by consensus. The interobserver agreement was good (κ = 0.736) for the four-point scale, and was excellent for the location of the thickest synovium on DIR and CET1FS (κ = 0.955 and 0.954). The intersequential agreement for the area with the thickest synovium was also excellent (κ = 0.845 and κ = 0.828). The synovial thickness on each sequence showed excellent correlation (r = 0.872). The DIR showed as good a correlation as CET1FS for the evaluation of the synovium at the femoro-patellar joint. DIR may be a useful MR technique for evaluating the synovium without CE. (orig.)

A pitfall in the measurement of arterial blood pressure in the ischaemic limb during elevation

DEFF Research Database (Denmark)

Bülow, J; Jelnes, Rolf

1987-01-01

In order to evaluate if elevation of the ischaemic limb above heart level is an alternative to the conventionally applied method with external counterpressure for estimation of skin perfusion pressure, femoral and popliteal artery pressures were measured directly in eight patients with occlusion...... of the superficial femoral artery. The measurements were done in the horizontal position and during elevation of the calf above heart level. During elevation relative blood flow, measured by arterio-venous oxygen saturation differences, decreased compared with the horizontal position. In contrast the popliteal...... arterial pressure decreased only by 20% of the value expected from the degree of elevation of the calf above the level of the heart. Thus, it could be calculated that calf vascular resistance increased two- to three-fold on average during elevation. Four patients were reexamined with the venous pressure...

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

Energy Technology Data Exchange (ETDEWEB)

Fanelli, Fabrizio, E-mail: fabrizio.fanelli@uniroma1.it [Sapienza University of Rome, Vascular and Interventional Radiology Unit, Department of Radiological Sciences (Italy); Primo, Massimiliano Di [Hopital Europeen Georges Pompidou, University Paris Descartes (France); Boatta, Emanuele [Sapienza University of Rome, Vascular and Interventional Radiology Unit, Department of Radiological Sciences (Italy); Johnston, Krystal, E-mail: kjohnston@medinst.com [MED Institute, Inc (United States); Sapoval, Marc, E-mail: marc.sapoval2@egp.aphp.fr [Hopital Europeen Georges Pompidou, University Paris Descartes (France)

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.

Functional angiography of arteries near the knee joint: Consequences for stent implantation. Funktionsangiographie der kniegelenknahen Arterien: Konsequenzen fuer die Stentimplantation

Energy Technology Data Exchange (ETDEWEB)

Zocholl, G; Zapf, S; Schild, H; Thelen, M [Mainz Univ. (Germany, F.R.). Inst. fuer Klinische Strahlenkunde

1990-12-01

Angiographic studies of the arteries adjoining the knee in 25 patients show extensive kinking and stenoses of the popliteal artery and less frequently of the distal femoral artery during flexion of the knee joint. This is due to the loss of elasticity with increasing age forcing the vessel into a tortuous course during shortening of the pathway of the popliteal artery with knee flexion. Independent of the principle of the different stents available they probably will not increase the contractility of the stented vessel in the longitudinal axis. It is to expect that after implantation of stents into the original artery kinking will occur predominantly in the original segments of the vessel and at the transitions to the stented segments leading to intimal damage by shear forces thus propagating local progress of atherosclerosis. (orig.).

Three-layered architecture of the popliteal fascia that acts as a kinetic retinaculum for the hamstring muscles.

Science.gov (United States)

Satoh, Masahiro; Yoshino, Hiroyuki; Fujimura, Akira; Hitomi, Jiro; Isogai, Sumio

2016-09-01

When patients report pain in the popliteal fossa upon knee extension, the pain is usually localized in the lower region of the popliteal fossa. However, some patients complain of pain in the upper region of the popliteal fossa as the knee is flexed, which motivated us to examine the role of the popliteal fascia as the retinaculum of the hamstring muscles. Thirty-four thighs from 19 Japanese cadavers were dissected. The popliteal fascia was defined as the single aponeurotic sheet covering the popliteal fossa. We found that the fascia acted as a three-layered retinaculum for the flexor muscles of the thigh and provided a secure route for neurovascular structures to the lower leg in any kinetic position of the knee joint. The superficial layer of the popliteal fascia covering the thigh was strongly interwoven with the epimysium of biceps femoris along its lateral aspect and with that of the semimembranosus along its medial aspect, ensuring that the flexor muscles remained in their correct positions. The intermediate layer arose from the medial side of biceps femoris and merged medially with the superficial layer. The profound layer stretched transversely between the biceps femoris and the semimembranosus. Moreover, we investigated the nerve distribution in the popliteal fascia using Sihler's staining and whole-mount immunostaining for neurofilaments. The three-layered fascia was constantly innervated by branches from the posterior femoral cutaneous or saphenous nerve. The nerves were closely related and distributed to densely packed collagen fibers in the superficial layer as free or encapsulated nerve endings, suggesting that the fascia is involved in pain in the upper region of the popliteal fossa.

Stenting for peripheral artery disease of the lower extremities: an evidence-based analysis.

Science.gov (United States)

2010-01-01

In January 2010, the Medical Advisory Secretariat received an application from University Health Network to provide an evidentiary platform on stenting as a treatment management for peripheral artery disease. The purpose of this health technology assessment is to examine the effectiveness of primary stenting as a treatment management for peripheral artery disease of the lower extremities. CONDITION AND TARGET POPULATION Peripheral artery disease (PAD) is a progressive disease occurring as a result of plaque accumulation (atherosclerosis) in the arterial system that carries blood to the extremities (arms and legs) as well as vital organs. The vessels that are most affected by PAD are the arteries of the lower extremities, the aorta, the visceral arterial branches, the carotid arteries and the arteries of the upper limbs. In the lower extremities, PAD affects three major arterial segments i) aortic-iliac, ii) femoro-popliteal (FP) and iii) infra-popliteal (primarily tibial) arteries. The disease is commonly classified clinically as asymptomatic claudication, rest pain and critical ischemia. Although the prevalence of PAD in Canada is not known, it is estimated that 800,000 Canadians have PAD. The 2007 Trans Atlantic Intersociety Consensus (TASC) II Working Group for the Management of Peripheral Disease estimated that the prevalence of PAD in Europe and North America to be 27 million, of whom 88,000 are hospitalizations involving lower extremities. A higher prevalence of PAD among elderly individuals has been reported to range from 12% to 29%. The National Health and Nutrition Examination Survey (NHANES) estimated that the prevalence of PAD is 14.5% among individuals 70 years of age and over. Modifiable and non-modifiable risk factors associated with PAD include advanced age, male gender, family history, smoking, diabetes, hypertension and hyperlipidemia. PAD is a strong predictor of myocardial infarction (MI), stroke and cardiovascular death. Annually, approximately

Application of the Polytron 1000 VR for functional diagnosis and interventional examination of arteries of the lower extremity: First clinical results

Energy Technology Data Exchange (ETDEWEB)

Kueffer, G.; Ziegler, L.; Hahn, D.

1989-01-01

The article reports the clinical experience gained with the POLYTRON-1000 VR system which has been used for all functional diagnostic tasks for detection of compression syndrome of the popliteal artery, and for diagnostic preparation and execution of atherectomy of pelvic and leg arteries with the Simpson catheter.

Ruptured popliteal cyst diagnosed by ultrasound before evaluation for deep vein thrombosis.

Science.gov (United States)

Kim, Joon Sung; Lim, Seong Hoon; Hong, Bo Young; Park, So Young

2014-12-01

Most popliteal cysts are asymptomatic. However, cysts may rupture, resulting in pain and swelling of the leg that could also arise from other diseases, including deep vein thrombosis, lymphedema, cellulitis, and tear of a muscle or tendon. Therefore, it is difficult to diagnose a ruptured popliteal cyst based on only a patient's history and physical examination. Musculoskeletal ultrasound has been regarded as a diagnostic tool for ruptured popliteal cyst. Here, we describe a patient who was rapidly diagnosed as ruptured popliteal cyst by ultrasonography. Therefore, ultrasound could be used to distinguish a ruptured popliteal cyst from other diseases in patients with painful swollen legs before evaluation for deep vein thrombosis.

Absence of the genicular arterial anastomosis as generally depicted in textbooks.

Science.gov (United States)

Sabalbal, M; Johnson, M; McAlister, V

2013-09-01

Textbook representations of the genicular arterial anastomosis show a large direct communication between the descending branch of the lateral circumflex femoral artery (DBLCFA) and a genicular branch of the popliteal artery but this is not compatible with clinical experience. The aim of this study was to determine whether the arterial anastomosis at the knee is sufficient, in the event of traumatic disruption of the superficial femoral artery, to infuse protective agents or to place a stent to restore flow to the lower leg. Dissection of ten cadaveric lower limbs was performed to photograph the arterial anatomy from the inguinal ligament to the tibial tubercle. Anastomosis with branches of the popliteal artery was classified as: 'direct communication', 'approaching communication' or 'no evident communication'. A constant descending artery in the lateral thigh (LDAT) was found to have five types of origin: Type 1 (2/10 limbs) involved the lateral circumflex femoral branch of the femoral artery, Type 2 (3/10 limbs) the lateral circumflex femoral branch of the profunda femoris artery, Type 3 (1/10 limbs) the femoral artery, Type 4 (3/10 limbs) the superficial femoral artery and Type 5 (2/10 limbs) the profunda femoris artery. In one limb, there were two descending arteries (Types 4 and 5). Collateral circulation at the knee was also variable: direct communicating vessels (3/10 limbs); approaching vessels with possible communication via capillaries (5/10 limbs); no evident communication (2/10 limbs). Communicating vessels, if present, are too small to provide immediate collateral circulation. Modern representations of the genicular arterial anastomosis are inaccurate, derived commonly from an idealised image that first appeared Gray's Anatomy in 1910. The afferent vessel is not the DBLCFA. The majority of subjects have the potential to recruit collateral circulation via the LDAT following gradual obstruction to normal arterial flow, which may be important if the LDAT

Martial arts training attenuates arterial stiffness in middle aged adults.

Science.gov (United States)

Douris, Peter C; Ingenito, Teresa; Piccirillo, Barbara; Herbst, Meredith; Petrizzo, John; Cherian, Vincen; McCutchan, Christopher; Burke, Caitlin; Stamatinos, George; Jung, Min-Kyung

2013-09-01

Arterial stiffness increases with age and is related to an increased risk of coronary artery disease. Poor trunk flexibility has been shown to be associated with arterial stiffness in middle-aged subjects. The purpose of our research study was to measure arterial stiffness and flexibility in healthy middle-aged martial artists compared to age and gender matched healthy sedentary controls. Ten martial artists (54.0 ± 2.0 years), who practice Soo Bahk Do (SBD), a Korean martial art, and ten sedentary subjects (54.7 ± 1.8 years) for a total of twenty subjects took part in this cross-sectional study. Arterial stiffness was assessed in all subjects using pulse wave velocity (PWV), a recognized index of arterial stiffness. Flexibility of the trunk and hamstring were also measured. The independent variables were the martial artists and matched sedentary controls. The dependent variables were PWV and flexibility. There were significant differences, between the SBD practitioners and sedentary controls, in PWV (P = 0.004), in trunk flexibility (P= 0.002), and in hamstring length (P= 0.003). The middle-aged martial artists were more flexible in their trunk and hamstrings and had less arterial stiffness compared to the healthy sedentary controls. The flexibility component of martial art training or flexibility exercises in general may be considered as a possible intervention to reduce the effects of aging on arterial stiffness.

Mycotic aneurysm of the superior mesenteric artery after septic embolism

International Nuclear Information System (INIS)

Schmidt, F.; Dinkel, H.P.

2002-01-01

Mycotic aneurysms of the aorta and the visceral arteries are life-threatening diseases, due to potential rupture and organ or limb ischemia. They occur in endocarditis, immunodeficiency, bacteremia and fungemia, and have a poor prognosis.We report on a case of a 54-year-old male patient suffering from abdominal angina after mitral valve replacement for septic mycotic endocarditis. In presence of a mycotic-embolic occlusion of the left popliteal artery and multiple septic organ infarctions a mycotic aneurysm of the superior mesenteric artery was found in abdominal spiral-CT.Based on sequential spiral-CT examinations, this case demonstrates the development of a septic aneurysm of the superior mesenteric artery. (orig.) [de

Diagnosing a popliteal venous aneurysm in a primary care setting: A case report

Directory of Open Access Journals (Sweden)

Symvoulakis Emmanouil K

2008-09-01

Full Text Available Abstract Introduction Popliteal venous aneurysms are uncommon but potentially fatal vascular disorders. They can be symptomatic or asymptomatic, mimicking different conditions. Popliteal venous aneurysms are possible sources of embolism. Case presentation A 68-year-old woman presented at a rural primary health care unit in Crete, Greece, reporting local symptoms of discomfort in the right popliteal fossa with pain during palpation. Colour Doppler ultrasonography revealed local widening and saccular dilatation in the right distal popliteal vein. The diagnosis of a popliteal venous aneurysm was formulated. Conclusion Popliteal venous aneurysms are rare conditions, but are potentially more common than usually thought in daily practice. Physician awareness and access to ultrasound examination may allow for early diagnosis, before the occurrence of any thromboembolic or other major complication.

Origem anômala da artéria circunflexa da artéria pulmonar direita Anomalous origin of circunflex artery from the right pulmonary artery

Directory of Open Access Journals (Sweden)

José Carlos R Iglézias

1989-08-01

Full Text Available É relatado, pela primeira vez na literatura, o caso de paciente adulto de 35 anos, com queixa de dor precordial aos esforços desde há 17 anos e que, após ter sido submetido a correção de coarctação de aorta, foi investigado e teve como diagnóstico: origem anômala da artéria circunflexa. No intra-operatório, constatou-se que a mesma tinha origem na artéria pulmonar direita. Foi realizada a sutura do óstio anômalo e um enxerto livre da artéria torácica interna direita para a coronária circunflexa. Além da raridade da lesão, são possíveis considerações fisiopatológicas relacionadas com a coarctação da aorta, neste caso específico.A case never described in adults before is here reported. A 35-year-old patient who had referred precordial pain in effort for seventeen years was investigated after having been submitted to correction of coarctation of the aorta, and had the following diagnosis: anomalous origin of the circunflex artery. In the intraoperatory, the latter was found to proceeed from the right pulmonary artery. The anomalous ostio was sutured and a free graft was made, from the right internal thoracic artery to the circunflex coronary. In addition to the unusualness of such pathology, some physiopatologic considerations related to the coarctation of the aorta may be made, in this particular case.

State of the States, 2012: Arts Education State Policy Summary

Science.gov (United States)

Arts Education Partnership (NJ1), 2012

2012-01-01

The "State of the States 2012" summarizes state policies for arts education identified in statute or code for all 50 states and the District of Columbia. Information is based primarily on results from the AEP Arts Education State Policy Survey conducted in 2010-11, and updated in April 2012.

Bilateral Persistent Sciatic Arteries Complicated with Acute Left Lower Limb Ischemia

Directory of Open Access Journals (Sweden)

Hsuan-Yin Wu

2007-12-01

Full Text Available Persistent sciatic artery (PSA is a rare congenital malformation. In the early embryonic stage, the sciatic artery is the major blood supply for the lower limb bulb and is later replaced by the iliofemoral artery as the limb develops. Its failure to regress, sometimes associated with femoral arterial hypoplasia, and therefore becoming the dominant inflow to the lower extremity is called PSA. This anomaly is often associated with a higher rate of aneurysm formation or thromboembolic complications causing lower extremity ischemia. Here, we describe a 79-year-old male patient who presented with acute left lower extremity ischemia. He was treated initially with conventional embolectomy through inguinal and popliteal incisions. The bilateral PSA with thrombosed aneurysms was not identified at first on computed tomographic angiography. It was later diagnosed intraoperatively due to the discontinuity of the superficial femoral artery and popliteal artery found with embolectomy catheter, and was managed successfully with ePTFE graft bypass. Careful interpretation of the imaging study may be helpful in preoperative diagnosis.

Popliteal Artery Entrapment Syndrome in Children: Experience With Four Cases of Acute Ischaemia and Review of the Literature.

Science.gov (United States)

Settembre, N; Bouziane, Z; Bartoli, M A; Nabokov, V; Venermo, M; Feugier, P; Malikov, S

2017-04-01

Popliteal artery entrapment syndrome (PAES) is an uncommon anatomical anomaly, frequently described in adults. The most common symptom is claudication. Acute limb ischaemia (ALI) in children is rare, but it may evolve and lead to limb loss or lifelong complications. Clinical and surgical experience of PAES in children is reported. Data from the literature are analysed in order to assess the severity of this disease and to identify the factors characterising the diagnosis and the outcome of treatment in paediatric patients. Four children (aged 7-16 years) were referred with ALI due to PAES. Among the 439 articles reporting cases of PAES, 55 patients under 18 years of age were the focus. The PAES cases were classified according to the Love and Whelan classification modified by Rich. Data from 79 children (106 limbs, 27 bilateral PAES) were collected and analysed. Type I PAES was present in 41 (39%), Type II in 23 (22%), Type III in 24 (23%), Type IV in 12 (11%), and Type V in two (2%) limbs. A functional PAES was present in one patient bilaterally. In two cases, the type of PAES was not reported. Claudication occurred in 68 cases (64%), and ALI in 19 (18%). In 60 cases (57%), revascularisation with or without myotomy was required; myotomy alone was performed in 41 cases (39%). Symptomatic PAES in children should be considered a severe condition requiring urgent investigation in order to avoid any delays in the treatment. Early diagnosis and treatment are essential to prevent serious complications. The long-term outcomes of surgical treatment with the correction of the anatomical anomaly and vascular reconstruction are satisfactory with a low complication rate. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Repeatability of popliteal blood flow and lower limb vascular conductance at rest and exercise during body tilt using Doppler ultrasound

International Nuclear Information System (INIS)

Villar, R; Hughson, R L

2013-01-01

We tested the data repeatability for popliteal blood flow velocity (PBV), popliteal arterial diameter (AD pop ), popliteal blood flow (PBF) and lower limb vascular conductance (VC) at rest and exercise in three body positions, two work rates and two inspired oxygen fractions. Fifteen, eleven and ten healthy volunteers participated in the three phases of the studies. Resting protocols were performed in horizontal (HOR), 35° head-down tilt (HDT) and 45° head-up tilt (HUT) for 5 min in each body position. Participants also exercised at lower and higher power outputs (repeated plantar flexion contractions at 20% and 30% maximal voluntary contraction, respectively) in HOR, HDT and HUT and in normoxia (21%O 2 ) and hypoxia (14%O 2 ) with the same work rates and body positions. PBV and AD pop were measured by ultrasound to determine PBF, and VC was estimated by dividing PBF by muscle perfusion pressure (MPP). PBV, AD pop , PBF and VC were not different, demonstrated good agreement and consistency between the two days of testing during both rest and exercise conditions regardless of body position. Therefore, these data support the utilization of Doppler and echo Doppler ultrasound as a reproducible method to measure PBV and AD pop and consequently estimate PBF and VC responses in such conditions. (paper)

Sympathetic reflex control of resistance in collateral arteries in the lower extremities in patients with diabetes mellitus

DEFF Research Database (Denmark)

Agerskov, K; Tønnesen, K H

1982-01-01

The vascular response in the lower extremities to 40 degrees head-up tilt was studied in 5 patients with occlusion of the superficial femoral artery and maturity onset diabetes mellitus with symptoms suggesting autonomic neuropathy. The pressure measurements were performed via catheters placed...... in the brachial artery, femoral artery and vein and popliteal artery and vein. Relative blood flow was calculated as the relative change in arterio-venous oxygen saturation. Absolute blood flow in the common femoral artery was measured by an indicator dilution technique. Resistance of the collateral arteries...

Ruptured peroneal aneurysm after infrapopliteal prosthetic bypass with Taylor patch

Directory of Open Access Journals (Sweden)

Florian Enzmann

Full Text Available Introduction: A 45-year-old mailman underwent an implantation of a femoro-peroneal polytetrafluoroethylene (PTFE bypass with a distal Taylor patch six years prior to admission after two failed autologous reconstructions and extensive fasciotomy. The initial pathology was an acute ischemia due to popliteal entrapment with subsequent popliteal thrombectomy. Report: The patient was examined because of pain, reduction of walking distance and development of a palpable mass at the medial fasciotomy site. A 6-cm pseudoaneurysm with complete disruption of the suture line of the vein patch was discovered and resected. Arterial continuity with a vein interposition graft was established using non-reversed cephalic vein. Conclusion: The etiology of the aneurysm is not entirely clear. One may argue that the fourth revascularization could have been performed with an arm vein instead of a prosthetic graft with the probability of a better long term patency in a young patient. 15 months after the procedure the bypass is patent and the patient is without any symptoms. This complication of a Taylor patch has not been reported before. Keywords: Taylor patch, Pseudoaneurysm, Infrapopliteal bypass

Unusual Presentation of Popliteal Cyst on Magnetic Resonance Imaging

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Tsuyoshi Ohishi

2016-01-01

Full Text Available Popliteal cyst commonly presents as an ellipsoid mass with uniform low signal intensity on T1-weighted magnetic resonance images and high signal intensity on T2-weighted images. Here, we describe a popliteal cyst with unusual appearance on magnetic resonance imaging, including heterogeneous intermediate signal intensity on T2-weighted images. Arthroscopic cyst decompression revealed that the cyst was filled with necrotic synovial villi, indicative of rheumatoid arthritis. Arthroscopic enlargement of unidirectional valvular slits with synovectomy was useful for the final diagnosis and treatment.

Popliteal Venous Aneurysm: A Rare Cause of Recurrent Pulmonary Emboli and Limb Swelling

International Nuclear Information System (INIS)

Russell, David A.; Robinson, Graham J.; Johnson, Brian F.

2008-01-01

Popliteal venous aneurysm is a rare cause of recurrent pulmonary embolism, although the true incidence of aneurysm is probably underestimated. One-third of patients suffer further embolic events despite therapeutic anticoagulation. We report the case of a 59-year-old male who presented with recurrent PEs over a period of 12 years despite anticoagulation therapy. A thrombophilia screen and abdominal ultrasound were normal at that time. He reattended with recurrent pulmonary emboli, left calf swelling, and a mass in his left popliteal fossa causing limitation of knee movement. Venous duplex and MRI of his popliteal fossa demonstrated a thrombosed true popliteal venous aneurysm with popliteal and superficial femoral vein occlusion. In view of the mass effect we proceeded to surgical excision of his aneurysm after prophylactic placement of an IVC filter. The patient regained normal knee function with intensive inpatient physiotherapy. He has been recommenced on lifelong anticoagulant. The presentation, investigation, and management of the condition are briefly discussed. We suggest that a bilateral lower limb duplex is performed to exclude venous aneurysm in all patients presenting with pulmonary embolism in which an underlying source cannot otherwise be identified and no thrombophilic tendency is detected.

Design considerations for studies of the biomechanical environment of the femoropopliteal arteries.

Science.gov (United States)

Ansari, Farzana; Pack, Lindsay K; Brooks, Steven S; Morrison, Tina M

2013-09-01

The purpose of this study was to review the available literature regarding the biomechanics of the superficial femoral artery (SFA) and popliteal artery (PA) in patients with peripheral arterial disease (PAD). Stents are one of many available therapies used to treat patients with PAD. Because stents are permanent implants, they undergo a variety of deformations as patients go about their daily activities such as walking, sitting in a chair, or climbing stairs. As a part of the marketing application for United States Food and Drug Administration approval, stents need to be evaluated for long-term durability under a variety of loading modes. The information available in the literature provides direction for such evaluation. We performed a literature search of the PubMed database looking for "key vessel" and "mechanics" (all fields) or "deformation" (all fields) or "flexion" (all fields) or "mechanical environment" (all fields) or "tortuosity" (all fields) or "dynamics" (all fields) or "forces" (all fields), where the "key vessel" was "Femoral Artery," "Superficial Femoral Artery," "Popliteal Artery," and "Femoropopliteal." Using a decision tree, we found 12 relevant articles that focused solely on the nonradial cyclic deformations associated with musculoskeletal motion. Despite the many limitations associated with combining these studies, we learned that under walking conditions, the proximal and mid-SFA deforms, on average, by shortening in the axial direction 4.0%, by twisting 2.1°/cm, and by bending 72.1 mm; the distal SFA and proximal PA deform by shortening in the axial direction 13.9%, by twisting 3.5°/cm, and by being pinched such that the aspect ratio of the lumen changes 4.6%. The distal PA deforms by shortening in the axial direction 12.3%, by twisting 3.5°/cm, by bending 22.1 mm, and by being pinched such that the aspect ratio of the lumen changes 12.5%. A review of the current literature reveals heterogeneous study designs that confound interpretation

The “SAFARI” Technique Using Retrograde Access Via Peroneal Artery Access

International Nuclear Information System (INIS)

Zhuang, Kun Da; Tan, Seck Guan; Tay, Kiang Hiong

2012-01-01

The “SAFARI” technique or subintimal arterial flossing with antegrade–retrograde intervention is a method for recanalisation of chronic total occlusions (CTOs) when subintimal angioplasty fails. Retrograde access is usually obtained via the popliteal, distal anterior tibial artery (ATA)/dorsalis pedis (DP), or distal posterior tibial artery (PTA). Distal access via the peroneal artery has not been described and has a risk of continued bleeding, leading to compartment syndrome due to its deep location. We describe our experience in two patients with retrograde access via the peroneal artery and the use of balloon-assisted hemostasis for these retrograde punctures. This approach may potentially give more options for endovascular interventions in lower limb CTOs.

State-of-the-art

DEFF Research Database (Denmark)

Pecher, Arthur; Kofoed, Jens Peter

This report presents a short overview on the state-of-the-art of wave tank testing of wave energy converters (WEC). Here for, it focuses mainly on the Phase 1 and 2 development phases of wave energy converters, as these are done in the wave tank (WEC), while the other development phases are perfo......This report presents a short overview on the state-of-the-art of wave tank testing of wave energy converters (WEC). Here for, it focuses mainly on the Phase 1 and 2 development phases of wave energy converters, as these are done in the wave tank (WEC), while the other development phases...

Safety of Perioperative Aprotinin Administration During Isolated Coronary Artery Bypass Graft Surgery: Insights From the ART (Arterial Revascularization Trial).

Science.gov (United States)

Benedetto, Umberto; Altman, Douglas G; Gerry, Stephen; Gray, Alastair; Lees, Belinda; Angelini, Gianni D; Flather, Marcus; Taggart, David P

2018-03-03

There is still uncertainty about the safety of aprotinin for coronary artery bypass graft surgery. The ART (Arterial Revascularization Trial) was designed to compare survival after bilateral versus single internal thoracic artery grafting. Many of the ART patients (≈30%) received perioperative aprotinin. We investigated the association between perioperative aprotinin administration and short-term (in-hospital) and long-term outcomes by performing a post hoc analysis of the ART. Among patients enrolled in the ART (n=3102) from 2004 to 2007, we excluded those who did not undergo surgery (n=18) and those with no information about use of perioperative aprotinin (n=9). Finally, 836 of 3076 patients (27%) received aprotinin. Propensity matching was used to select 536 pairs for final comparison. Aprotinin was also associated with an increased risk of hospital mortality (9 [1.7%] versus 1 [0.2%]; odds ratio, 9.12; 95% confidence interval [CI], 1.15-72.2; P =0.03), intra-aortic balloon pump insertion (37 [6.9%] versus 17 [3.2%]; odds ratio, 2.26; 95% CI, 1.26-4.07; P =0.006), and acute kidney injury (102 [19.0%] versus 76 [14.2%]; odds ratio, 1.42; 95% CI, 1.03-1.97; P =0.03). Aprotinin was not associated with a lower incidence of transfusion (37 [6.9%] versus 28 [5.2%]; odds ratio, 1.34; 95% CI, 0.81-2.23; P =0.25) and reexploration (26 [4.9%] versus 19 [3.5%]; hazard ratio, 1.39; 95% CI, 0.76-2.53; P =0.28). At 5 years, all-cause mortality was significantly increased in the aprotinin group (56 [10.6%] versus 38 [7.3%]; hazard ratio, 1.51; 95% CI, 1.0-2.28; P =0.045). In the present post hoc ART analysis, aprotinin was associated with a significantly increased risk of early and late mortality. URL: http://www.isrctn.com. Unique identifier: ISRCTN46552265. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

The 'SAFARI' Technique Using Retrograde Access Via Peroneal Artery Access

Energy Technology Data Exchange (ETDEWEB)

Zhuang, Kun Da, E-mail: zkunda@gmail.com [Singapore General Hospital, Interventional Radiology Centre (Singapore); Tan, Seck Guan [Singapore General Hospital, Department of General Surgery (Singapore); Tay, Kiang Hiong [Singapore General Hospital, Interventional Radiology Centre (Singapore)

2012-08-15

The 'SAFARI' technique or subintimal arterial flossing with antegrade-retrograde intervention is a method for recanalisation of chronic total occlusions (CTOs) when subintimal angioplasty fails. Retrograde access is usually obtained via the popliteal, distal anterior tibial artery (ATA)/dorsalis pedis (DP), or distal posterior tibial artery (PTA). Distal access via the peroneal artery has not been described and has a risk of continued bleeding, leading to compartment syndrome due to its deep location. We describe our experience in two patients with retrograde access via the peroneal artery and the use of balloon-assisted hemostasis for these retrograde punctures. This approach may potentially give more options for endovascular interventions in lower limb CTOs.

Quantifying dynamic contrast-enhanced MRI of the knee in children with juvenile rheumatoid arthritis using an arterial input function (AIF) extracted from popliteal artery enhancement, and the effect of the choice of the AIF on the kinetic parameters.

Science.gov (United States)

Workie, Dagnachew W; Dardzinski, Bernard J

2005-09-01

Quantification of dynamic contrast-enhanced (DCE) MRI based on pharmacokinetic modeling requires specification of the arterial input function (AIF). A full representation of the plasma concentration data, including the initial rise and decay parts, considering the delay and dispersion of the bolus contrast is important. This work deals with modeling of DCE-MRI data from the knees of children with a history of juvenile rheumatoid arthritis (JRA) by using an AIF extracted from the signal enhancement data from the nearby popliteal artery. Three models for the AIFs were considered: a triexponential (AIF1), a gamma-variate plus a biexponential (AIF2), and a biexponential (AIF3). The pharmacokinetic parameters obtained from the model were Ktrans', kep, and V'p. The results from AIF1 and AIF2 showed no statistically significant difference. However, some statistically significant differences were seen with AIF3, particularly for parameters Ktrans' and V'p in the synovium (SNVM). These results suggest the importance of obtaining an appropriate AIF representation in pharmacokinetic modeling of JRA. Specifically, the initial rising part of the AIF should be incorporated for optimal pharmacokinetic modeling results. The pharmacokinetic parameters (mean+/-SD) derived from AIF1, using the average plasma concentration data, were as follows: SNVM Ktrans'(min-1)=0.52+/-0.34, kep(min-1)=0.71+/-0.39, and V'p=0.33+/-0.16, and for the distal femoral physis (DFP) Ktrans'(min-1)=1.83+/-1.78, kep(min-1)=2.65+/-1.80, and V'p=0.46+/-0.31. The pharmacokinetic parameters in the SNVM may be useful for investigating activity and therapeutic efficacy in studies of JRA. Longitudinal studies are necessary to find or demonstrate the parameter that is more sensitive to disease activity. Copyright (c) 2005 Wiley-Liss, Inc.

Antiphospholipid Syndrome during pregnancy: the state of the art

Science.gov (United States)

Di Prima, Fosca A. F.; Valenti, Oriana; Hyseni, Entela; Giorgio, Elsa; Faraci, Marianna; Renda, Eliana; De Domenico, Roberta; Monte, Santo

2011-01-01

Obstetric complications are the hallmark of antiphospholipid syndrome. Recurrent miscarriage, early delivery, oligohydramnios, prematurity, intrauterine growth restriction, fetal distress, fetal or neonatal thrombosis, pre-eclampsia/eclampsia, HELLP syndrome, arterial or venous thrombosis and placental insufficiency are the most severe APS-related complication for pregnant women. Antiphospholipid antibodies promote activation of endothelial cells, monocytes and platelets, causing an overproduction of tissue factor and thromboxane A2. Complement activation might have a central pathogenetic role. These factors, associated with the typical changes in the hemostatic system during normal pregnancy, result in a hypercoagulable state. This is responsible of thrombosis that is presumed to provoke many of the pregnancy complications associated with APS. Obstetric care is based on combined medical-obstetric high-risk management and treatment with the association between aspirin and heparin. This review aims to deter- mine the current state of the art of APS by investigating the knowledge achievements of recent years, to provide the most appropriate diagnostic and therapeutic management for pregnant women suffering from this syndrome. PMID:22439075

Cultivating Demand for the Arts: Arts Learning, Arts Engagement, and State Arts Policy. Summary

Science.gov (United States)

Zakaras, Laura; Lowell, Julia F.

2008-01-01

The findings summarized in this report are intended to shed light on what it means to cultivate demand for the arts, why it is necessary and important to cultivate this demand, and what state arts agencies (SAAs) and other arts and education policymakers can do to help. The research considered only the benchmark arts central to public policy:…

Popliteal lymphadenectomy for treating metastatic melanoma: case report

Directory of Open Access Journals (Sweden)

Sergio Renato Pais Costa

Full Text Available CONTEXT: Regional lymph node involvement in patients with malignant melanomas has been associated with poor prognosis. In-transit metastases also lead to poor long-term survival. Whereas for nodal disease only regional lymphadenectomy offers adequate locoregional control, for in-transit metastasis both local excision and isolated limb perfusion with chemotherapy plus tumor necrosis factor-alpha can be used for disease control. In cases of tumors located in the distal region of the legs, the lymphatic dissemination most commonly observed is to the inguinal chain. Consequently, therapeutic inguinal lymphadenectomy or even selective lymphadenectomy (sentinel lymph node biopsy have been recommended. On the other hand, involvement of the popliteal chain is very rare. When this occurs, popliteal lymphadenectomy should be indicated. Local excision may be the logical approach for a few small in-transit metastases because of the low morbidity in this procedure, when compared with isolated limb perfusion. CASE REPORT: A case of melanoma of the heel with popliteal chain involvement and in-transit metastases is presented. This was treated by means of regional lymphadenectomy plus in-transit metastases excision, with a good postoperative course.

Support for Arts Education. State Arts Agency Fact Sheet

Science.gov (United States)

National Assembly of State Arts Agencies, 2011

2011-01-01

Supporting lifelong learning in the arts is a top priority for state arts agencies. By supporting arts education in the schools, state arts agencies foster young imaginations, address core academic standards, and promote the critical thinking and creativity skills essential to a 21st century work force. State arts agencies also support…

Emergency interventional therapy of peripheral arterial stenosis and thrombosis

International Nuclear Information System (INIS)

Cai Fengquan; Yu Xixiang

2004-01-01

Objective: To evaluate the clinical value of emergency interventional therapy of stenosis and thrombosis of peripheral arteries. Methods: 26 patients suffered from stenosis and thrombosis of peripheral arteries including, 3 subclavical arteries, 5 iliac arteries, 7 femoral arteries, 4 popliteal arteries, 4 posterior or anterior tibial arteries, 2 graft vessels and 1 instent restenosis were undertaken interventional ATD or urokinase infusion thrombolysis, percutanous transluminal angioplasty (PTA) and stent placement. Results: The stenotic arteries were recanalized after PTA or stent placement and the thrombosis vanished after thrombolysis with distal flowes improved or resumed. Clinical symptom was ameliorated. No more complication occurred except one patient with alimentary hemorrhage after thrombolysis. The patients were followed up from 1 to 20 months with all the involved arteries keeping in constant patency without any amputation. Conclusions: Emergency thrombolysis by machine or drug along with PTA or stent placement can effectively cure the stenosis or thrombosis of peripheral artery with recanalization and no amputation. (authors)

State Arts Agency Fact Sheet: Support for Arts Education

Science.gov (United States)

Online Submission, 2015

2015-01-01

This national overview of state arts agency grants and services for arts education includes summary statistics and geographic distribution. The fact sheet uses data from Final Descriptive Reports of state arts agency grant-making activities submitted annually to the National Assembly of State Arts Agencies (NASAA) and the National Endowment for…

The sural artery and vein as recipient vessels in free flap reconstruction about the knee.

Science.gov (United States)

Johnson, P E; Harris, G D; Nagle, D J; Lewis, V L

1987-04-01

The sural artery and vein were used successfully as recipient vessels in nine patients who required free flap reconstruction about the knee. The anatomy of the sural vessels and the potential advantages of their use as free flap recipients are reviewed and discussed. Indications include popliteal vessels that are absent or severely damaged, as determined by preoperative angiography. No anastomotic complications were encountered in this series, indicating that the sural artery and vein can be used successfully as recipient vessels.

Sonographic and MRI appearance of tensor fasciae suralis muscle, an uncommon cause of popliteal swelling

International Nuclear Information System (INIS)

Montet, Xavier; Mauget, Denis; Sandoz, Alain; Martinoli, Carlo; Bianchi, Stefano

2002-01-01

A 20-year-old white man presented with a localized unilateral swelling in the popliteal fossa. Ultrasound (US) showed the presence of an accessory muscle, the tensor fasciae suralis. The muscle was located in the proximal portion of the popliteal fossa, superficial to the medial head of the gastrocnemius. Its long tendon extended inferiorly to join the Achilles tendon. Magnetic resonance images correlated well with the US findings, confirming the diagnosis. Tensor fasciae suralis muscle is a rare cause of popliteal swelling and must be differentiated from other masses. Both US and magnetic resonance imaging can diagnose it but we suggest US as the first-line technique in its evaluation. (orig.)

The superficial ulnar artery: development and clinical significance Artéria ulnar superficial: desenvolvimento e relevância clínica

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Srinivasulu Reddy

2007-09-01

Full Text Available The principal arteries of the upper limb show a wide range of variation that is of considerable interest to orthopedic surgeons, plastic surgeons, radiologists and anatomists. We present here a case of superficial ulnar artery found during the routine dissection of right upper limb of a 50-year-old male cadaver. The superficial ulnar artery originated from the brachial artery, crossed the median nerve anteriorly and ran lateral to this nerve and the brachial artery. The superficial ulnar artery in the arm gave rise to a narrow muscular branch to the biceps brachii. At the elbow level the artery ran superficial to the bicipital aponeurosis where it was crossed by the median cubital vein. It then ran downward and medially superficial to the forearm flexor muscles, and then downward to enter the hand. At the palm, it formed the superficial and deep palmar arches together with the branches of the radial artery. The presence of a superficial ulnar artery is clinically important when raising forearm flaps in reconstructive surgery. The embryology and clinical significance of the variation are discussed.As principais artérias do membro superior apresentam uma ampla variação, que é relativamente importante a cirurgiões ortopédicos e plásticos, radiologistas e anatomistas.Apresentamosumcaso de artéria ulnar superficial encontrada durante dissecção de rotina de membro superior direito de um cadáver masculino de 50 anos de idade.Aartéria ulnar superficial originava-se da artéria braquial, cruzava o nervo mediano anteriormente e percorria lateralmente esse nervo e a artéria braquial. A artéria ulnar superficial no braço deu origem a um ramo muscular estreito do músculo bíceps braquial. Ao nível do cotovelo, a artéria percorria superficialmente a aponeurose bicipital, onde era cruzada pela veia cubital mediana. Percorria, então, em sentido descendente e medialmente superficial aos músculos flexores do antebraço, e então descendia para

Mammary-type myofibroblastoma of popliteal fossa

International Nuclear Information System (INIS)

Scotti, C.; Camnasio, F.; Fontana, F.; Fraschini, G.; Rizzo, N.; De Cobelli, F.; Peretti, G.M.

2008-01-01

Mammary-type myofibroblastoma is a very rare, benign, spindle cell lesion, arising mainly in the inguinal region. This clinical entity strictly duplicates the features of its breast counterpart. To our knowledge, this is the first report of this particular lesion occurring in the popliteal fossa. We discuss the clinical, radiological and histopathological features of this case, emphasizing the role of incisional biopsy in such an unusual neoplasia. (orig.)

State of the States 2016: Arts Education State Policy Summary

Science.gov (United States)

Aragon, Stephanie

2016-01-01

The "State of the States 2016" summarizes state policies for arts education identified in statute or administrative code for all 50 states and the District of Columbia. Information is based on a comprehensive search of state education statute and codes on each state's relevant websites. Complete results from this review are available in…

The Hindlimb Arterial Vessels in Lowland paca (Cuniculus paca, Linnaeus 1766).

Science.gov (United States)

Leal, L M; de Freitas, H M G; Sasahara, T H C; Machado, M R F

2016-04-01

This study aims to describe the origin and distribution of the hindlimb arterial vessels. Five adult lowland pacas (Cuniculus paca) were used. Stained and diluted latex was injected, caudally to the aorta. After fixation in 10% paraformaldehyde for 72 h, we dissected to visualize and identify the vessels. It was found out that the vascularization of the hindlimb in lowland paca derives from the terminal branch of the abdominal aorta. The common iliac artery divides into external iliac and internal iliac. The external iliac artery emits the deep iliac circumflex artery, the pudendal epigastric trunk, the deep femoral artery; the femoral artery originates the saphenous artery, it bifurcates into cranial and caudal saphenous arteries. Immediately after the knee joint, the femoral artery is called popliteal artery, which divides into tibial cranial and tibial caudal arteries at the level of the crural inter-osseous space. The origin and distribution of arteries in the hindlimb of lowland paca resembles that in other wild rodents, as well as in the domestic mammals. © 2014 Blackwell Verlag GmbH.

[The use of vascular prothesis Gore Viabahn in the managment of the lower limbs ischemia].

Science.gov (United States)

Pupka, Artur; Szyber, Przemysław Piotr; Skóra, Jan; Pawłowski, Stanisław

2011-01-01

The chronic lower limbs ischaemia is caused mainly by arteriosclerosis. After insufficient conservative treatment only the surgical intervention can salvage the limb. The revascularisation surgery can be performed by open surgery with implantation of the prosthetic bypass or by endovascular angioplasty with stent. This second method seems to be the best alternative for the patients with several concomitant systemic diseases. Nevertheless it is limited by presence of the long-distance arteriosclerotic lesions. The resolve of that problem is use of new generation of long endovascular covered stents. They can be succesfuly used in aorto-femoral and femoro-popliteal segment. Their efficiacy is simmilar to traditional prosthetic grafts.

EXERCISE-INDUCED ARTERIAL ADAPTATIONS IN ELITE JUDO ATHLETES

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Panagiotis Karagounis

2009-09-01

Full Text Available The purpose of this study was to examine exercise-induced arterial adaptations in elite Judo male and female athletes. 27 male Judo athletes (age 24.06 ± 2 years, 11 female Judoka (age 24.27 ± 1 years, 27 sedentary healthy men (age 24.01 ± 2 years and 11 women (age 24.21 ± 1 years participated in the current study. The examined vessels included brachial, radial, ulnar, popliteal, anterior and posterior tibial arteries. The experimental parameters were recorded with the use of Duplex ultrasound at rest. Diastolic diameter and blood mean flow velocity of the examined arteries in Judo athletes were found to be both significantly increased (p < 0.05 compared to the findings of the control groups. In male Judo athletes the brachial (p < 0.001, radial (p < 0.001, and anterior tibial artery (p < 0.001 presented the highest difference on the diastolic diameter, compared with the control male group. In female Judo athletes, ulnar (p < 0.001, radial (p < 0.001, and brachial (p < 0.001 arteries illustrated the highest diastolic diameter. The highest blood mean flow velocity was recorded in ulnar (p < 0.001 and popliteal arteries (p < 0.001 of the Judo athletes groups. Recording differences between the two genders, male participants presented larger arteries than females. Conclusively, Judo has been found to be a highly demanding physical sport, involving upper and lower limbs leading to significant arterial adaptations. Obtaining vascular parameters provide a useful tool to the medical team, not only in the direction of enhancement of the efficacy of physical training, but in unknown so far parameters that may influence athletic performance of both male and female elite Judokas

Acupuncture-induced Popliteal Arteriovenous Fistula Successfully Treated With Percutaneous Endovascular Intervention

Directory of Open Access Journals (Sweden)

Hsuan-Fu Kuo

2010-03-01

Full Text Available A 39-year-old female visited our cardiovascular outpatient department with paresthesia and soreness around the right popliteal fossa, where thrill was palpable. There was no history of trauma, apart from her having undergone acupuncture several years previously. An arteriovenous fistula (AVF was diagnosed by vascular ultrasonography and magnetic resonance imaging. Angiography confirmed the presence of an AVF fed by the medial geniculate artery. Transarterial embolization was performed to close the AVF using coils and tissue adhesive. To the best of our knowledge, acupuncture-induced AVF has not been previously reported. We present a case demonstrating the merits of percutaneous endovascular intervention for treating this rare complication. The additional administration of a tissue adhesive can achieve complete closure of the AVF in the event of an unsatisfactory result following coil embolization. Doctors should be aware of the potential vascular complications of acupuncture, and of the management options.

State-of-the-art MRI techniques in neuroradiology: principles, pitfalls, and clinical applications

Energy Technology Data Exchange (ETDEWEB)

Viallon, Magalie [Universite de Lyon, CREATIS, UMR CNRS 5220 - INSERM U1044, INSA de Lyon, Lyon (France); Universite de Lyon-Saint-Etienne, Department of Radiology, Centre Hospitalier Universitaire de Saint-Etienne, Saint Etienne (France); Cuvinciuc, Victor; Barnaure-Nachbar, Isabelle; Lovblad, Karl-Olof; Haller, Sven [University Hospital of Geneva, Department of Neuroradiology, Geneva (Switzerland); Delattre, Benedicte; Toso-Patel, Seema; Becker, Minerva [University Hospital of Geneva, Department of Radiology, Geneva (Switzerland); Merlini, Laura [University Hospital of Geneva, Department of Pediatric Radiology, Geneva (Switzerland)

2015-05-01

This article reviews the most relevant state-of-the-art magnetic resonance (MR) techniques, which are clinically available to investigate brain diseases. MR acquisition techniques addressed include notably diffusion imaging (diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), and diffusion kurtosis imaging (DKI)) as well as perfusion imaging (dynamic susceptibility contrast (DSC), arterial spin labeling (ASL), and dynamic contrast enhanced (DCE)). The underlying models used to process these images are described, as well as the theoretic underpinnings of quantitative diffusion and perfusion MR imaging-based methods. The technical requirements and how they may help to understand, classify, or follow-up neurological pathologies are briefly summarized. Techniques, principles, advantages but also intrinsic limitations, typical artifacts, and alternative solutions developed to overcome them are discussed. In this article, we also review routinely available three-dimensional (3D) techniques in neuro MRI, including state-of-the-art and emerging angiography sequences, and briefly introduce more recently proposed 3D quantitative neuro-anatomy sequences, and new technology, such as multi-slice and multi-transmit imaging. (orig.)

State-of-the-art MRI techniques in neuroradiology: principles, pitfalls, and clinical applications

International Nuclear Information System (INIS)

Viallon, Magalie; Cuvinciuc, Victor; Barnaure-Nachbar, Isabelle; Lovblad, Karl-Olof; Haller, Sven; Delattre, Benedicte; Toso-Patel, Seema; Becker, Minerva; Merlini, Laura

2015-01-01

This article reviews the most relevant state-of-the-art magnetic resonance (MR) techniques, which are clinically available to investigate brain diseases. MR acquisition techniques addressed include notably diffusion imaging (diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), and diffusion kurtosis imaging (DKI)) as well as perfusion imaging (dynamic susceptibility contrast (DSC), arterial spin labeling (ASL), and dynamic contrast enhanced (DCE)). The underlying models used to process these images are described, as well as the theoretic underpinnings of quantitative diffusion and perfusion MR imaging-based methods. The technical requirements and how they may help to understand, classify, or follow-up neurological pathologies are briefly summarized. Techniques, principles, advantages but also intrinsic limitations, typical artifacts, and alternative solutions developed to overcome them are discussed. In this article, we also review routinely available three-dimensional (3D) techniques in neuro MRI, including state-of-the-art and emerging angiography sequences, and briefly introduce more recently proposed 3D quantitative neuro-anatomy sequences, and new technology, such as multi-slice and multi-transmit imaging. (orig.)

[The physiopathology of critical ischemia of the lower limbs].

Science.gov (United States)

Novo, S; Abrignani, M G; Liquori, M; Sangiorgi, G B; Strano, A

1993-10-01

Peripheral obstructive arterial disease (POAD) of the lower limbs is the third main complication of atherosclerosis, after coronary artery disease and cerebrovascular disease. In 15-20% of cases POAD have an unfavourable evolution toward critical leg ischemia (CLI). This clinical condition is characterized by the onset of rest pain and/or trophic cutaneous lesions until gangrene appears. In some cases amputation is needed. The pathophysiological, clinical and therapeutic aspects of CLI were recently discussed in two Consensus Conferences held in Berlin in 1989 and in Rudesheim in 1991, with the elaboration of a final draft published on circulation. CLI appears when peripheral perfusion critically decreases due to macro and microcirculatory alterations. Atherosclerotic plaque is the primum movens, but often there are more plaques in sequence along the ilio-femoro-popliteal axis. The pathophysiological and clinical consequences are more severe if the stenosis is haemodynamically important, after a rapid progression of plaque growth or when thrombotic complications develop. The reduction in distal perfusion induces troubles in the microcirculation and an embalancement between the microvascular defense system (MDS) and the microvascular flow regulating system (MFRS) with endothelial dysfunction, platelet and leucocytes activation, worsening of blood viscosity due to the increase in fibrinogen levels and to the red cells deformability changes, activation of coagulation and impairment of fibrinolysis. So, a vicious circle appears with further worsening of distal perfusion and onset of trophic lesions. A further worsening of CLI can derive from local recurrent infections particularly frequent in diabetic patients.

State of the art

International Nuclear Information System (INIS)

Lederman, L.M.

1983-01-01

There is a large body of experience in high luminosity data taking in fixed target research. We try to consider a wide variety of high rate experiments which were limited by the detector (not by available beam) to a preset number of collisions per second. We then attempt to translate these state-of-the-art experiments to effective collider experiments. To this end, we extend the chosen detector to a comparison 4π collider detector operating near 1 TeV. There are several issues: (1) effective solid angle must be translated to approx. = 4π, (2) environments may be quite different, e.g., beam dump near fixed target or beam halo muons vs. collider backgrounds, (3) the multiplicity varies over the experiments selected and (4) we have to treat open vs closed geometries. The large variety of experiments selected is designed to average over the causes for detector limitation. Finally we chose detectors which have produced physics in order to gauge the state of the art

Variability of the morphology of gastrocnemius muscle in an African ...

African Journals Online (AJOL)

... palpation of popliteal arterial pulse, popliteal nerve block and the assessment of gastrocnemius muscle for autografting. The additional variant heads also bear evolutionary importance. Keywords: Gastrocnemius; Multi-Pinnate; Popliteal Entrapment Syndrome; Variations; Four-Headed, Third Head Of Gastrocnemius ...

Pseudoaneurisma de artéria poplítea secundário a osteocondroma femoral: relato de caso

Directory of Open Access Journals (Sweden)

Fabricio Mascarenhas de Oliveira

Full Text Available Osteochondromas are the most common benign tumor of the bone. They are sometimes responsible for vascular complications involving either veins or arteries, principally around the knee. Pseudoaneurysms are considered a rare condition. The authors describe the occurrence of a pseudoaneurysm of the popliteal artery in association with a femoral osteochondroma in a 30-years-old man.

Pressure Sore at an Unusual Site- the Bilateral Popliteal Fossa: A Case report

Directory of Open Access Journals (Sweden)

Kamal Kataria

2012-05-01

Full Text Available Pressure sore is tissue ulceration due to unrelieved pressure, altered sensory perception, and exposure to moisture. Geriatric patients with organic problems and patients with spinal cord injuries are the high-risk groups. Soft tissues over bony prominences are the common sites for ulcer development. About 95% of pressure ulcers occur in the lower part of the body. Ischial tuberosity, greater trochanter, sacrum and heel are common sites. In addition to these, pressure sores at unusual sites like nasal alae, malar eminences, cervical region and medial side of knee have also been described. Only 1.6% of the patients present with sores in areas outside the pelvis and lower extremity. In a paraplegic patient, pressure sores are usually over extensor surface of knee and heel but pressure ulcer over popliteal fossa are extremely rare. We herein report a case of a 36-years-old diabetic and paraplegic male, who presented with multiple bed sores involving the sacral area, heels and bilateral popliteal fossa. Popliteal fossa is an unusual site for pressure sores. Only one similar case has been previously reported in the literature.

Pressure Sore at an Unusual Site- the Bilateral Popliteal Fossa: A Case report

Science.gov (United States)

Kataria, Kamal; Sagar, Sushma; Singhal, Manish; Yadav, Rajni

2012-01-01

Pressure sore is tissue ulceration due to unrelieved pressure, altered sensory perception, and exposure to moisture. Geriatric patients with organic problems and patients with spinal cord injuries are the high-risk groups. Soft tissues over bony prominences are the common sites for ulcer development. About 95% of pressure ulcers occur in the lower part of the body. Ischial tuberosity, greater trochanter, sacrum and heel are common sites. In addition to these, pressure sores at unusual sites like nasal alae, malar eminences, cervical region and medial side of knee have also been described. Only 1.6% of the patients present with sores in areas outside the pelvis and lower extremity. In a paraplegic patient, pressure sores are usually over extensor surface of knee and heel but pressure ulcer over popliteal fossa are extremely rare. We herein report a case of a 36-years-old diabetic and paraplegic male, who presented with multiple bed sores involving the sacral area, heels and bilateral popliteal fossa. Popliteal fossa is an unusual site for pressure sores. Only one similar case has been previously reported in the literature. PMID:29181131

The Art of the Renaissance Capitalist State

Directory of Open Access Journals (Sweden)

Rebeka Vidrih

2007-12-01

This article also highlights the fact that the concept of art developed in Florence – a city-state that played an important role in the early-capitalist world of the Renaissance, but never assumed a leading role like Venice and Genoa. »Art« was thus created through Florence’s efforts to demonstrate its equality and importance and, although it failed to achieve this in the field of the (capitalist economy, it at least succeeded in the field of the (absolutist state that was subordinate to this economy.

Kinesio taping & Síndrome femoro-patelar: una revisión sistemática

OpenAIRE

López-Aguilar, Beatriz; Merino-Marban, Rafael

2014-01-01

INTRODUCCIÓN: El síndrome femoro-patelar (SFP), también conocido como condromalacia rotuliana, aparece cuando existe una degeneración del cartílago rotuliano entre las superficies óseas del fémur y de la rótula. Su sintomatología característica es un dolor anterior de la rodilla que se agudiza al mover dicha articulación. OBJETIVOS: Actualizar los datos sobre la efectividad del Kinesiotaping (KT) en el tratamiento del SFP y aportar posibles pautas de aplicación del KT en el SFP. PALABR...

Acute pulmonary edema following inflation of arterial tourniquet.

Science.gov (United States)

Santhosh, M C B; Pai, R B; Rao, R P

2014-10-01

Arterial tourniquets are used as one of the methods for reducing blood loss and for allowing blood free surgical field. A 20-year-old, 45 kg healthy female with a sphere shaped pendunculated hemangioma in the popliteal fossa of her left lower limb was applied with arterial tourniquet after exsanguination. The procedure was performed under general anesthesia. Soon after exsanguination and tourniquet inflation, the patient developed pulmonary edema which subsided after deflating the tourniquet. The clinical evolution, treatment and pathophysiology of this complication are described. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Diagnostic accuracy of color Doppler flow imaging and Duplex US in peripheral arterial disease

International Nuclear Information System (INIS)

Karmel, M.I.; Polak, J.F.; Whittemore, A.D.; Mannick, J.A.; Donaldson, M.C.; O'Leary, D.H.

1988-01-01

Color Doppler flow imaging (5 MHz) and Duplex US were used in a prospective examination of 154 arterial segments in the lower extremities of 11 symptomatic patients. Each extremity was divided into seven arterial segments (common femoral, profunda femoral, proximal, middle, and distal superficial femoral, and proximal and distal popliteal arteries). Arterial maps were drawn for each patient and compared with the arteriograms. Seventeen significant stenoses and 18 complete occlusions were predicted and confirmed by means of arteriography. Four significant stenoses and four occlusions were predicted and not confirmed. One hundred nine normal arterial segments were correctly predicted. No significant stenoses or occlusions were missed. Prospective identification of the severity and location of disease can help to optimize both the angiographic approach and hospital services utilization

Bilateral giant femoropopliteal artery aneurysms: a case report

Directory of Open Access Journals (Sweden)

Perdikides Theodossios P

2008-04-01

Full Text Available Abstract Introduction Popliteal artery aneurysms are the most common peripheral arterial aneurysms, and are frequently bilateral. Acute limb ischemia, rupture and compression phenomena can complicate these aneurysms when the diameter exceeds 2 cm. Case Presentation We report an 82-year-old male patient with two giant femoropopliteal aneurysms, 10.5 and 8.5 cm diameters, managed in our institution. Both aneurysms were resected and a polytetrafluoroethylene (PTFE femoropopliteal interposition graft was placed successfully. Management and literature review are discussed. Conclusion We believe this is the first report in the medical literature of bilateral giant femoropopliteal aneurysms.

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African Journals Online (AJOL)

muscular blastema and grows from the calcaneous cephalad to implant ... muscle regresses. The superficial popliteal artery unites with the remainder of the deep popliteal artery to form the definitive popliteal artery at the knee. Anatomical variations arise when ... dorsiflexion against resistance. An athlete or physically active ...

State-of-the-art inventory

NARCIS (Netherlands)

Verhagen, H.J.; Van Gerven, K.A.J.; Akkerman, G.J.

2005-01-01

The present report provides a state-of-the-art inventory of relevant information and technical concepts for the ComCoast project, being the first phase of the research stages of Work Package 3 (WP3). This project was assigned to Royal Haskoning by CUR. The information scan was set-up in a systematic

Multimodal Dialogue Management - State of the art

NARCIS (Netherlands)

Bui Huu Trung, B.H.T.

This report is about the state of the art in dialogue management. We first introduce an overview of a multimodal dialogue system and its components. Second, four main approaches to dialogue management are described (finite-state and frame-based, information-state based and probabilistic, plan-based,

Greenhouse mechanization: State of the art and future perspective

NARCIS (Netherlands)

Henten, van E.

2006-01-01

This paper reviews the state of the art and future perspective of greenhouse mechanization. Driving forces for mechanization are identified. Dutch greenhouse crop production is used as an example. Analysis of a generic crop production process combined with a review of the state of the art in

Fuel cells: state of the art

International Nuclear Information System (INIS)

Campanari, S.; Casalegno, A.

2007-01-01

This paper deals with the main features at present state-of-the-art fuel cell and hybrid cycle technologies, discussing their actual performance, possible applications, market entry perspectives and potential development [it

Heteronomy in the arts field: state funding and British arts organizations.

Science.gov (United States)

Alexander, Victoria D

2018-03-01

For Bourdieu, the field of cultural production is comprised of an autonomous and a heteronomous sector. A heteronomous sector is one that is interpenetrated by the commercial field. I discuss an arena that, until recently, was part of the relatively autonomous sector in the field of cultural production - the supported arts sector in the United Kingdom - and argue that it became more heteronomous, due to the penetration by the state. Heteronomy due to the commercial field is present but secondary to, and driven by, the actions of the state. Political parties' attempts to diffuse and legitimate a particular economic ideology have led to state demands that arts institutions adopt neoliberal business practices in exchange for funding. Government giving to the arts, previously at arm's length, proved to be a Faustian bargain that demanded significant repayment in the form of lost autonomy. Coercive pressures from the state, enacted over time, show how the domination of one field over another can occur, even when the domination is resisted. © London School of Economics and Political Science 2017.

Popliteal cysts and subgastrocnemius bursitis are associated with knee symptoms and structural abnormalities in older adults: a cross-sectional study.

Science.gov (United States)

Cao, Yuelong; Jones, Graeme; Han, Weiyu; Antony, Benny; Wang, Xia; Cicuttini, Flavia; Ding, Changhai

2014-03-03

The role of popliteal cysts and subgastrocnemius bursitis in knee joint homeostasis is uncertain. The aim of this study is to describe cross-sectional associations between popliteal cysts, subgastrocnemius bursitis, knee symptoms and structural abnormalities in older adults. A cross-sectional sample of 900 randomly-selected subjects (mean age 63 years, 48% female) were studied. Knee pain, stiffness and dysfunction were assessed by self-administered Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaire. Radiographic knee osteophyte and joint space narrowing (JSN) were recorded. Magnetic resonance imaging (MRI) was utilized to assess popliteal cysts, subgastrocnemius bursitis, cartilage defects and bone marrow lesions (BMLs). Popliteal cysts were present in 11.7% and subgastrocnemius bursitis in 12.7% of subjects. Subgastrocnemius bursitis was more common in those with popliteal cyst (36.2% versus 9.7%, P bursitis was associated with increased osteophytes and JSN in the medial tibiofemoral compartment. Both were significantly associated with cartilage defects in all compartments, and with BMLs in the medial tibiofemoral compartment. Furthermore, both popliteal cysts and subgastrocnemius bursitis were significantly associated with increased weight-bearing knee pain but these associations became non-significant after adjustment for cartilage defects and BMLs. Popliteal cysts and subgastrocnemius bursitis are associated with increased symptoms as well as radiographic and MRI-detected joint structural abnormalities. Longitudinal data will help resolve if they are a consequence or a cause of knee joint abnormalities.

State of the art undersøgelse

DEFF Research Database (Denmark)

Nielsen, Nils

1998-01-01

Dette skrift omhandler nogle af de erfaringer der til dato er opnået i forbindelse med standby projektets udførelse. Hovedtemaet er en “State of the art undersøgelse” der omhandler standby-spændingsforsyninger, samt komponenter der kan anvendes til konstruktion af dem......Dette skrift omhandler nogle af de erfaringer der til dato er opnået i forbindelse med standby projektets udførelse. Hovedtemaet er en “State of the art undersøgelse” der omhandler standby-spændingsforsyninger, samt komponenter der kan anvendes til konstruktion af dem...

Where is your state of the art?

Science.gov (United States)

Ríos Gaona, Manuel

2015-04-01

Beyond the purposes of publishing, questioning and/or hypothesizing, every research has the noble aim to quench the constant human need of pushing farther away the boundaries of knowledge, may such frontier exist. The state of the art is the generic expression coined to limit the whereabouts of any particular knowledge. We use it just like a compass, it tells us how far we are, what has been done and where we should go. Take for instance quantum field theory, the state of the art in particle physics will tell you that everything that exists in this universe is made of bosons, quarks and leptons. What!?. Hold on, I was taught (and luckily maybe you weren't) that the fundamental particles were electrons, neutrons and protons, right?. Indeed, that is the state of the art but from almost one century ago. So, if I may ask... where is your state of the art? This is not about quantum physics; it is not even about hydrology; it is about everything. Today, everybody doing or not a PhD fiercely believes that their research is important, extremely unique, life changing (and help us God if we are wrong); but how can you be so sure that what you do, isn't already done?. We live in a modern world, cool environmental scientists now have tagged this era as the Anthropocene; globalization is everywhere and of course knowledge has not escaped to it. Not only knowledge is now global but is totally diversified, any crazy idea you can think of (or actually you can't) it is very likely that somebody already has his/hers hands on it. Nevertheless, this is a good thing, isn't it?. Well, that is the whole point. Every time I should write my research's state of the art, I always get overwhelmed because it actually is pretty difficult to establish, and later when I think I get it, it seems that I am solving issues that somebody already bothered to solve 30 years ago. Therefore, does it really have some purpose to be swimming in a huge pool of knowledge, not knowing where exactly I am? or

Utilização da artéria radial como segundo enxerto arterial em pacientes acima de 70 anos The use of the radial artery as the second choice for arterial graft in patients over 70 years of age

Directory of Open Access Journals (Sweden)

Joseph Fredric Whitaker

2005-03-01

Full Text Available OBJETIVO: Estudo retrospectivo para avaliar a morbi-mortalidade e a evolução hospitalar em pacientes com idade superior a 70 anos, submetidos à operação de revascularização do miocárdio com utilização da artéria radial como segundo enxerto arterial. MÉTODO: No período de agosto de 1994 a dezembro de 2002, foram realizadas 2487 cirurgias de revascularização do miocárdio no Instituto do Coração de Juiz de Fora. Dentre os pacientes operados, 476 tinham idade superior a 70 anos, sendo que em 36 (Grupo II foi utilizada a artéria radial como 2º enxerto arterial. O mesmo tipo de cirurgia foi realizado em 142 pacientes com idade inferior a 70 anos (Grupo I. Não foram incluídas neste estudo reoperações, cirurgias sem CEC ou com procedimentos associados. RESULTADOS: A média de idade do Grupo II foi 72,5 anos, a mortalidade hospitalar neste grupo de pacientes foi 6,0%, a incidência de complicações também foi baixa, comparável à observada no mesmo tipo de operação realizada em pacientes com idade inferior a 70 anos. CONCLUSÃO: Diante destes resultados, os autores acreditam que a artéria radial possa ser usada com segurança como 2º enxerto arterial em pacientes acima de 70 anos, criteriosamente selecionados, apesar do maior risco de co-morbidades associadas nesta faixa etária.OBJECTIVE: Retrospective study eveluating the morbid-mortality and hospital behaviour in patients over 70-years -od patients submitted to myocardial revascularization involving the radial artery as the second arterial graft. METHOD: During the period of August 1994 to December 2002, 2487 cases of myocardial revascularization were performed by the group of the Juiz de Fora Heart Institute, 476 of whom were 70 years of age or older and 36 (Group II received the radial artery as the second arterial graft. The same type of surgery was performed in 142 patients under 70-year-old (Group I. Reoperations, off-pump operations (OPCAB or associated procedures

State of the Art in the Cramer Classification Scheme and ...

Science.gov (United States)

Slide presentation at the SOT FDA Colloquium on State of the Art in the Cramer Classification Scheme and Threshold of Toxicological Concern in College Park, MD. Slide presentation at the SOT FDA Colloquium on State of the Art in the Cramer Classification Scheme and Threshold of Toxicological Concern in College Park, MD.

Guide to state-of-the-art electron devices

CERN Document Server

2013-01-01

Concise, high quality and comparative overview of state-of-the-art electron device development, manufacturing technologies and applications Guide to State-of-the-Art Electron Devices marks the 60th anniversary of the IEEE Electron Devices Committee and the 35th anniversary of the IEEE Electron Devices Society, as such it defines the state-of-the-art of electron devices, as well as future directions across the entire field. Spans full range of electron device types such as photovoltaic devices, semiconductor manufacturing and VLSI technology and circuits, covered by IEEE Electron and Devices Society Contributed by internationally respected members of the electron devices community A timely desk reference with fully-integrated colour and a unique lay-out with sidebars to highlight the key terms Discusses the historical developments and speculates on future trends to give a more rounded picture of the topics covered A valuable resource R&D managers; engineers in the semiconductor industry; applied scientists...

The state-of-the-art of ART sealants.

Science.gov (United States)

Frencken, Jo E

2014-03-01

Sealing caries-prone pits and fissure systems is an effective caries-preventive measure. There are basically two types of sealant materials: glass-ionomer and resin-based materials. Low- and medium-viscosity glass-ionomers were initially used and showed a low level of retention. With the advent of the ART approach in the mid-nineties, high-viscosity glass-ionomers were introduced as sealant material and the retention rate of ART sealants increased substantially. As the effectiveness of a sealant is measured by its capacity to prevent (dentine) carious lesion development, sealant retention is considered a surrogate endpoint. The ART sealant protocol is described. Systematic reviews and meta-analysis covering low- medium- and high-viscosity glass-ionomer (ART) sealants have concluded that there is no evidence that either glass-ionomer or resin-based sealants prevent dentine carious lesions better. The annual dentine carious lesion development in teeth with high-viscosity glass-ionomer ART sealants over the first three years is 1%. These ART sealants have a high capacity of preventing carious lesion development. Because no electricity and running water is required, ART sealants can be placed both inside and outside the dental surgery. High-viscosity glass-ionomer ART sealants can be used alongside resin-based sealants.41:119-124

State of the art in video system performance

Science.gov (United States)

Lewis, Michael J.

1990-01-01

The closed circuit television (CCTV) system that is onboard the Space Shuttle has the following capabilities: camera, video signal switching and routing unit (VSU); and Space Shuttle video tape recorder. However, this system is inadequate for use with many experiments that require video imaging. In order to assess the state-of-the-art in video technology and data storage systems, a survey was conducted of the High Resolution, High Frame Rate Video Technology (HHVT) products. The performance of the state-of-the-art solid state cameras and image sensors, video recording systems, data transmission devices, and data storage systems versus users' requirements are shown graphically.

The state-of-the-art of ART restorations.

Science.gov (United States)

Frencken, Jo E

2014-04-01

ART is less anxiety- and pain-provoking than traditional restorative treatments; administration of local anaesthesia is rarely required. Systematic reviews have provided evidence of the high level of effectiveness of high-viscosity glass-ionomer ART restoration in restoring single-surface cavities, both in primary and permanent posterior teeth, but its survival rates in restoring multiple-surface cavities in primary posterior teeth needs to be improved. Insufficient information is available regarding the survival rates of multiple-surface ART restorations in permanent teeth. Evidence from these reviews indicates no difference in the survival rates of single-surface high-viscosity glass-ionomer ART restorations and amalgam restorations in primary and permanent posterior teeth. Where indicated, high-viscosity glass-ionomer ART restorations can be used alongside traditional restorations. ART provides a much more acceptable introduction to dental restorative care than the traditional 'injection, drill and fill'.

Intravascular ultrasound evaluation of JETSTREAM atherectomy removal of superficial calcium in peripheral arteries.

Science.gov (United States)

Maehara, Akiko; Mintz, Gary S; Shimshak, Thomas M; Ricotta, Joseph J; Ramaiah, Venkatesh; Foster, Malcolm T; Davis, Thomas P; Gray, William A

2015-05-01

Endovascular treatment of calcified femoral-popliteal disease is challenging. We sought to evaluate the mechanism of lumen gain when using the JETSTREAM Atherectomy System to treat calcified peripheral artery lesions. The JETSTREAM Calcium Study was a prospective, single-arm, multicentre study to evaluate the JETSTREAM Atherectomy System for severely calcified femoral-popliteal artery lesions, i.e., patients with claudication and lesions with superficial calcium >90° and >5 mm in length as determined by intravascular ultrasound (IVUS). The 2.1 mm catheter was used in this study without distal protection. Fifty-five patients underwent angiographic screening: 26 (45%) met IVUS inclusion criteria. Angiographic calcium was moderate in eight cases and severe in 14, with no available data for four cases. Visual diameter stenosis was 86±9% pre-treatment, 37±13% post atherectomy, and 10±6% post adjunctive treatment (adjunctive PTA+stenting in eight and adjunct PTA alone in 16). IVUS showed lumen area increased from 6.6±3.7 mm2 to 10.0±3.6 mm2 (p=0.001): calcium reduction was responsible for 86±23% of the lumen increase. Although the superficial calcium arc did not change (151±70° to 146±71°, p=0.83), the arc of reverberation increased (23±20° to 65±40°, p=0.006), indicating device-related modification of calcium. Adjunctive balloon angioplasty was performed in 62% of the lesions, and stent implantation in 31%. In 11 cases with adjunctive balloon dilation, the MLA increased from 7.1 (6.4, 7.8) mm2 post atherectomy to 11.9 (10.3, 13.5) mm2 post balloon (pAtherectomy System increased lumen dimensions in moderately or severely calcified femoral-popliteal lesions by removing superficial calcium without major complications.

Femoro-acetabular impingement and hip pain with conventionally normal x-rays.

LENUS (Irish Health Repository)

Baker, J F

2010-06-01

There has in recent years been a fundamental change in the understanding of hip pain in the young adult and hip pain without plain radiographic findings of arthritis. Pain in these groups has long represented a diagnostic and therapeutic challenge. With new appreciation of hip biomechanics, pathological processes and the arrival of modern imaging modalities we now have a greater understanding of non-arthritic hip pathology. One of the commonest yet least well recognized \\'new\\' diagnoses around the hip is femoro-acetabular impingement (FAI). FAI is a developmental condition of the hip joint that is associated with abnormal anatomical configuration and thus joint mechanics on either the femoral or acetabular sides or both. It is hypothesized to have a variety of precipitants and may ultimately lead to labral and chondral injury and what has previously been referred to as \\'primary\\' or \\'idiopathic\\' hip osteoarthritis.

Iliac artery reconstruction secondary to incidental injury in open hernia repair: A case report and literature review

Directory of Open Access Journals (Sweden)

R. Doña-Jaimes

2018-04-01

Full Text Available Introduction: Inguinal hernia repair is one of the most common surgeries performed worldwide by general surgeons. More than 750,000 inguinal hernia repairs are performed each year in the United States. Complications of inguinal or femoral hernia are relatively rare, depending on the clinical circumstances in which the patient is admitted to the operating room and the type of hernia. The complications are classified as: intraoperative, short term and long term. Arterial lesions are the rarest but most dangerous. Objective: To describe surgical techniques used to repair injuries to the external iliac artery during an inguinal hernia repair that is reproducible by general surgeons. Materials and methods: A case report of an intraoperative external iliac artery injury is presented in which is a polytetrafluoroethylene (PTFE graft was used over the length of the lesion. Different techniques may be used for revascularisation: autogenous vein graft, synthetic grafts, revascularisation with ipsilateral or contralateral internal iliac artery and femoro-femoral crossover graft. Conclusion: The surgical technique using PTFE grafts is effective for repairing arterial injuries and it results in timely revascularisation that promotes satisfactory progress. Resumen: Introducción: La plastia inguinal es una de las cirugías más frecuente realizadas a nivel mundial por cirujanos generales. En Estados Unidos más de 750,000 hernioplastias inguinales se realizan por año. Las complicaciones de una hernia inguinal o femoral son relativamente infrecuentes, depende de las circunstancias clínicas en las que se ingresa a quirófano y el tipo de la hernia. Las complicaciones se clasifican en: intraoperatoría, a corto plazo y a largo plazo. Las lesiones arteriales son las más raras pero más graves. Objetivo: Describir técnicas quirúrgicas para reparación de lesiones de la arteria iliaca durante una plastia inguinal y reproducible por cirujanos generales

Peripheral arterial angiography and interventional treatment in diabetic foot ulcers

International Nuclear Information System (INIS)

Guo Xiaohua; Cheng Yongde; Hu Suying; He Jianrong; Lin Kaiqin; Jin Honglai; Shi Shijie

2003-01-01

Objective: To assess the changes of peripheral arteries and choice of interventional treatment in diabetic foot ulcers. Methods: Thirty-six diabetic patients with foot ulcers were examined by lower extremity DSA with simultaneous ultrasonic Doppler examination for correlative study and interventional treatment carried out in 17 segmental stenotic cases. Among them, 12 patients were treated by PTA and 5 patients by intravascular stenting. Results: Irregular stenoses and obstruction were observed in all patients with peripheral foot ulcers. DSA examination was more reliable comparing with Doppler examination for demonstration of the arterial injury above the level of popliteal artery. PTA and primary stenting were effective in all of these subjects outcoming with promotion of the lower extremity arterial blood perfusion and foreseen curing efficacy. Conclusions: Peripheral arterial stenoses were common in diabetic patients with foot ulcers. In clinical practice, DSA examination and interventional treatment could give a fertile prognosis and reduce disabling

Compartment syndrome and popliteal vascular injury complicating unicompartmental knee arthroplasty

NARCIS (Netherlands)

Kort, Nanne Pieter; Van Raay, Jos J. J. A. M.; van Horn, Jim R.

Popliteal vascular injury and the compartment syndrome of the leg are rare but important complications of knee arthroplasties. Early diagnosis and treatment are of paramount importance in preventing the devastating complications of these conditions. To our knowledge, these complications have not

One Step Closer to the Marketplace for State-of-the-Art Wind Turbine

Science.gov (United States)

Drivetrain | News | NREL One Step Closer to the Marketplace for State-of-the-Art Wind Turbine Drivetrain One Step Closer to the Marketplace for State-of-the-Art Wind Turbine Drivetrain April 1, 2016 modeling, and testing in state-of-the-art facilities designed to put the drivetrain through its paces

Deep Venous Reflux Associated with a Dilated Popliteal Fossa Vein Reversed with Endovenous Laser Ablation and Sclerotherapy

Directory of Open Access Journals (Sweden)

Daniel P. Link

2013-01-01

Full Text Available Objective. To report an incidence of reflux in the deep venous system reversed by ablation of a popliteal fossa vein (PFV. Method. A 40-year-old man with pain and swelling in the medial upper calf was found to have an incompetent PFV. Results. Reflux in the femoral and popliteal veins was reversed utilizing endovenous laser ablation and foam sclerotherapy, documented on Duplex studies before and after the intervention. There was also resolution of symptoms. Conclusion. A PFV can be associated with deep venous reflux. Correction of this reflux with ablation of the PFV suggests that his type of reflux is secondary to volume effects of the incompetent popliteal vein.

Aneurisma da Artéria Renal: caso clínico Renal Artery Aneurysm

Directory of Open Access Journals (Sweden)

Joana Moreira

2011-12-01

Full Text Available Apresenta-se o caso clínico de um doente com volumoso aneurisma da artéria renal esquerda. Do sexo masculino, de 22 anos de idade, com lombalgia à esquerda com algumas semanas de evolução. Recorreu ao médico assistente que solicitou estudo imagiológico por ecografia abdominal. Detectada imagem sugestiva de aneurisma da aorta abdominal. Este achado motivou a transferência para o nosso Hospital onde foi admitido consciente e orientado, hemodinamicamente estável, apresentando uma massa pulsátil epigástrica, com frémito e sopro sistólico à auscultação. Angio-TC revelou um aneurisma da artéria renal esquerda com 16 cm de diâmetro. Dada a estabilidade clínica e topografia lesional optou-se por tentar embolizar, sem sucesso, o tronco da artéria renal esquerda antes da abordagem cirúrgica. O doente foi então submetido a Nefrectomia total esquerda por via toraco-abdominal. Pós-operatório sem complicações, locais ou sistémicas. Alta ao 8ºdia, mantendo boa função renal e com níveis normais de hemoglobina. Diagnóstico de aneurisma da artéria renal confirmado por estudo anátomo-patológico da peça operatória.One case of a large left renal artery aneurysm in a young patient 22 years old is presented. He appealed to his assistant physician a few weeks after development of left back pain. Abdominal ultrasound imaging study has been requested. Suggestive abdominal aortic aneurysm was detected. This finding led to the transfer to our hospital where he was admitted conscious and hemodynamically stable. A pulsatile epigastric mass with a systolic murmur on auscultation and thrill were detected. Angio-CT scan revealed a left renal artery aneurysm, 16 cm in diameter. Given the clinical stability and lesional topography we decide a previous embolization of left renal artery, unsuccessfully. The patient underwent then left total nephrectomy, through thoraco-abdominal incision. No local or systemic complications in the postoperative

The State of Comic Art Bibliography in North America

Directory of Open Access Journals (Sweden)

Michael Rhode

2010-08-01

Full Text Available Within the past two decades, several American bibliographies of comic art have been published to aid in research on comics and cartooning. Professor John Lent’s ten-volume Comic Art Bibliographies is one of the largest such projects and he began it with a self-published volume in 1986. Librarian Randy Scott published The Comic Art Collection Catalog: An Author, Artist, Title and Subject Catalog Of The Comic Art Collection, Special Collections Division, Michigan State University Libraries, whi...

State of the art in microfabrication

NARCIS (Netherlands)

Schmitz, Jurriaan

2014-01-01

In this review paper the state of the art in microfabrication is presented. The focus is on trends in integrated circuit fabrication by mainstream industrial players. The article starts with Moore’s Law, describing its inception as well as the evolution of Moore’s metric of the number of components

Aneurisma idiopático de artéria radial: relato de caso Idiopathic radial artery aneurysm: case report

Directory of Open Access Journals (Sweden)

Luiz Ernani Meira Jr.

2011-12-01

Full Text Available Os aneurismas da artéria radial são extremamente raros. Em sua maioria, consistem de pseudoaneurismas pós-traumáticos. Os aneurismas da artéria radial verdadeiros podem ser idiopáticos, congênitos, pós-estenóticos ou associados a patologias, tais como vasculites e doenças do tecido conjuntivo. Foi relatado um caso de aneurisma idiopático de artéria radial em uma criança de três anos, que, após completa investigação diagnóstica complementar, foi submetida à ressecção cirúrgica.Radial artery aneurysms are extremely rare. Post-traumatic pseudoaneurysms are the vast majority. True radial artery aneurysms can be idiopathic, congenital, poststenotic, or associated with some pathologies, such as vasculitis and conjunctive tissue diseases. We report a case of an idiopathic aneurysm of the radial artery in a three-year-old child who was submitted to surgical resection after a complete diagnostic approach.

State-of-the-art of home networking

NARCIS (Netherlands)

Koonen, A.M.J.; Popov, M.

2012-01-01

To introduce the Symposium on "Indoor Optical Networks: a Promising Way to a Converged Service Delivery", this presentation will give a brief overview of state-of-the-art home networking architectures, technologies and applications covering both technical and techno-economic aspects.

New simulators from old - achieving state-of-the-art simulation without state-of-the-art costs

International Nuclear Information System (INIS)

Heilmeier, H.J.; Rosser, R.M.; Fyffe, K.L.; Gaerttner, G.F.; Chulick, E.T.

1990-01-01

Achieving a state-of-the-art simulator for operator training requires neither the expensive remodeling of old simulators nor the acquisition of very expensive new machines. In this paper the authors present two distinct cases where older training simulators have been upgraded to meet training requirements with a minimum of inexpensive hardware additions, including plug-in/-out panels, and software changes

14 CFR 1203.403 - State-of-the-art and intelligence.

Science.gov (United States)

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false State-of-the-art and intelligence. 1203.403... PROGRAM Guides for Original Classification § 1203.403 State-of-the-art and intelligence. A logical... available from intelligence sources is known or is available to others. It is also important to consider...

How the United States Funds the Arts. Third Edition

Science.gov (United States)

National Endowment for the Arts, 2012

2012-01-01

The infrastructure for arts and cultural support in the United States is complex and adaptive. Citizens who enjoy the arts can choose from a wide array of drama, visual and media arts, dance, music, and literature available in formal and informal settings--theaters, museums, and concert halls, but also libraries, schools, places of worship,…

Platelet kinetics: the state of the art

International Nuclear Information System (INIS)

Heyns, A. duP

1984-01-01

In this paper an overview of the state of the art of platelet kinetics 1982 is presented. The subjects considered include a discussion of the advantages and disadvantages of some of the many radionuclide platelet labels, viz 51 Cr, 111 In, focussing briefly on models for analysis of platelets survival. (Auth.)

State-of-the-art in Heterogeneous Computing

Directory of Open Access Journals (Sweden)

Andre R. Brodtkorb

2010-01-01

Full Text Available Node level heterogeneous architectures have become attractive during the last decade for several reasons: compared to traditional symmetric CPUs, they offer high peak performance and are energy and/or cost efficient. With the increase of fine-grained parallelism in high-performance computing, as well as the introduction of parallelism in workstations, there is an acute need for a good overview and understanding of these architectures. We give an overview of the state-of-the-art in heterogeneous computing, focusing on three commonly found architectures: the Cell Broadband Engine Architecture, graphics processing units (GPUs, and field programmable gate arrays (FPGAs. We present a review of hardware, available software tools, and an overview of state-of-the-art techniques and algorithms. Furthermore, we present a qualitative and quantitative comparison of the architectures, and give our view on the future of heterogeneous computing.

The Arts and State Governments: At Arm's Length or Arm in Arm?

Science.gov (United States)

Lowell, Julia F.; Ondaatje, Elizabeth Heneghan

2006-01-01

Even though a majority of Americans claim to support public funding of the arts, state government spending on the arts is minimal--and may be losing ground relative to other types of state expenditures. Moreover, most state arts agencies, or SAAs, have not succeeded in convincing state government leaders that the arts should be integral to their…

Fondaparinux for intra and perioperative anticoagulation in patients with heparin-induced thrombocytopenia candidates for peripheral vascular surgery: Report of 4 cases.

Science.gov (United States)

Illuminati, Giulio; Calio', Francesco G; Pizzardi, Giulia; Amatucci, Chiara; Masci, Federica; Palumbo, Piergaspare

2016-01-01

Intra and perioperative anticoagulation in patients with heparin induced thrombocytopenia (HIT), candidates for peripheral vascular surgery remains a challenge, as the best alternative to heparin has not yet been established. We evaluated the off-label use of fondaparinux in four patients with HIT, undergoing peripheral vascular surgery procedures. Four patients of whom 3 men of a mean age of 66 years, with proven heparin induced thrombocytopenia (HIT) underwent two axillo-femoral bypasses, one femoro-popliteal bypass and one resection of a splenic artery aneurysm under fondaparinux. No intra or perioperative bleeding or thrombosis of new onset was observed. In the absence of a valid alternative to heparin for intra and perioperative anticoagulation in HIT, several other anticoagulants can be used in an off-label setting. However, no general consensus exist on which should be the one of choice. In this small series fondaparinux appeared to be both safe and effective. These preliminary results seem to justify the off-label use of fondaparinux for intra and perioperative anticoagulation in patients with HIT, candidates for peripheral vascular surgery interventions. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Utilização da safena magna in situ para arterialização do arco venoso do pé The great saphenous vein in situ for the arterialization of the venous arch of the foot

Directory of Open Access Journals (Sweden)

Cesar Roberto Busato

2010-09-01

Full Text Available CONTEXTO: O tratamento da isquemia crítica de membros inferiores sem leito arterial distal pode ser realizado por meio da inversão do fluxo no arco venoso do pé. OBJETIVO: O objetivo deste trabalho foi apresentar a técnica e os resultados obtidos com a arterialização do arco venoso do pé, mantendo a safena magna in situ. MÉTODOS: Dezoito pacientes, dos quais 11 com aterosclerose (AO, 6 com tromboangeíte obliterante (TO e 1 com trombose de aneurisma de artéria poplítea (TA foram submetidos ao método. A safena magna in situ foi anastomosada à melhor artéria doadora. O fluxo arterial derivado para o sistema venoso progride por meio da veia cujas válvulas são destruídas. As colaterais da veia safena magna são ligadas desde a anastomose até o maléolo medial, a partir do qual são preservadas. RESULTADOS: Dos pacientes, 10 (55,6% mantiveram suas extremidades, 5 com AO e 5 com TO; 7 (38,9% foram amputados, 5 com AO, 1 com TO e 1 com Ta; houve 1 óbito (5,5%. CONCLUSÃO: A inversão do fluxo arterial no sistema venoso do pé deve ser considerada para salvamento de extremidade com isquemia crítica sem leito arterial distal.BACKGROUND: Critical lower limb ischemia in the absence of a distal arterial bed can be treated by arterialization of the venous arch of the foot. OBJETIVE: The objective of this paper was to present the technique and the results of the arterialization of the venous arch of the foot with the in situ great saphenous vein. METHODS: Eighteen patients, 11 with atherosclerosis (AO, 6 with thromboangiitis obliterans (TO and 1 with popliteal artery aneurysm thrombosis were submitted to venous arch arterialization. The in situ great saphenous vein was anastomosed to the best donor artery. Arterial flow derived from the venous system progresses through the vein whose valves were destroyed. The collateral vessels of the great saphenous vein are linked from the anastomosis to the medial malleolus and preserved from this point

77 FR 5281 - State-of-the-Art Reactor Consequence Analyses Reports

Science.gov (United States)

2012-02-02

... NUCLEAR REGULATORY COMMISSION [Docket ID: NRC-2012-0022] State-of-the-Art Reactor Consequence... release of Draft NUREG-1935, ``State-of-the-Art Reactor Consequence Analyses (SOARCA) Report,'' for public... offsite radiological health consequences for potential severe reactor accidents for the Peach Bottom...

Free-flap cover of complex defects around the knee using the descending genicular artery as the recipient pedicle.

Science.gov (United States)

Venkatramani, H; Sabapathy, S R; Nayak, S

2014-01-01

Selection of ideal recipient vessels is one of the most important factors determining success in free-flap reconstruction of the lower limb. At the knee, the choice of vessels has traditionally been either the common femoral or the popliteal vessels and their branches but these are often difficult to use or cannot be used. A series of 32 free flaps for cover of complex injuries of the knee involving the distal femur, the knee joint and the upper tibia were reconstructed using the descending genicular branch of the femoral artery in the adductor canal and its muscular branches to the vastus medialis as the recipient vessels. All but one flap survived with no major complications. The use of the descending genicular artery as the recipient vessel for reconstruction with free flaps around the knee has various advantages including: (i) it is mostly remote from the zone of trauma, (ii) it is constant in location, (iii) the recipient vessels are an excellent size match for end-to-end anastomosis, (iv) there is no need for changes of position of the patient when using most free flaps commonly used for knee reconstruction, (v) it is easy to harvest these simultaneously, (vi) secondary exposure of the underlying skeleton from all quadrants is unlikely to divide the flap pedicle as it is superior and (vii), perhaps most important of all, it obviates the need for exploration of the popliteal fossa. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

State Arts Policy: Trends and Future Prospects

Science.gov (United States)

Lowell, Julia F.

2008-01-01

State arts agencies (SAAs)--key players within the U.S. system of public support for the arts--face growing economic, political, and demographic challenges to the roles and missions they adopted when founded in the mid-1960s. This report, the fourth and final in a multiyear study, looks at state arts agencies' efforts to rethink their roles and…

Diagnóstico clínico diferencial entre oclusão da artéria carótida interna e da artéria cerebral média A comparative symptomatological study of internal carotid artery occlusion and middle cerebral artery occlusion

Directory of Open Access Journals (Sweden)

Roberto Melaragno

1971-03-01

Full Text Available Foi feito um estudo comparativo entre o quadro clínico inicial de 61 casos de oclusão da artéria carótida interna e o de 23 casos de oclusão da artéria cerebral média, diagnosticados pela angiografia cerebral e/ou pela necropsia em pacientes submetidos ou não à cirurgia vascular. Os autores comparam a idade dos pacientes, o sexo, o modo de início da afecção, a existência ou não de convulsões e/ou cefaléias, a ocorrência do acidente cerebral durante o sono ou em vigília, a existência de ictos prévios, os níveis de pressão arterial, o grau de consciência, a força muscular, os achados eletrencefalográficos, a palpação e ausculta das carótidas em nível cervical. Os resultados são demonstrados em índices percentuais, pelos quais os autores inferem que não há significância estatística nesses elementos com três exceções: a maior ocorrência de convulsões nas oclusões da artéria cerebral média em relação às da carótida, a oftalmodinamometria e a sintomatologia carotídea cervical. A oftalmodinamometria revela valores significantemente menores nas pressões da artéria central da retina, no mesmo lado da trombose da carótida em 70,0% dos casos, enquanto que medidas normais e simétricas verificaram-se em todos os casos de oclusão da artéria cerebral média em que o exame foi realizado. No que concerne a sinais arteriais no pescoço, havia anormalidades palpatórias e auscultatórias em 52,4% dos pacientes com trombose da carótida e em 8,6% dos casos com oclusão da cerebral média. Concluem os autores, portanto, que apenas a angiografia cerebral permite um diagnóstico seguro entre ambas as sedes da oclusão.A comparative study of the early clinical picture in 61 cases of internal carotid artery occlusion and 23 cases of middle cerebral artery occlusion, diagnosed by cerebral angiography and/or necropsy in patients who were either submitted to surgery or not operated upon is reported. The authors had

Ascertaining the international state of the art of PSA methodology

International Nuclear Information System (INIS)

Linden, J. von

1998-01-01

Plant-specific PSAs, to be performed within the framework of the Periodic Safety Review of German Nuclear Power Plants require further development of the methodology. For that purpose foreign PSA-guidelines and PSA-reviewes as well as relevant literature are examined and appropriate insights are adopted within task A.2 of project SR 2096. The main goal of these activities is to achieve a comparison of the state of the art of PSA-methodologies applied abroad and in Germany. The German state of the art refers to the extent as is documented in the German PSA Guide (Leitfaden Probabilistische Sicherheitsanalyse /PSUe97/) which has to be used for the Periodic Safety Review of German Nuclear Power Plants. The structure for the evaluation is based on the working steps of a PSA. In total, according to the objectives of the Periodic Safety Review the German approach for plant-specific PSAs based on the German PSA Guide is conform to the state of the art abroad. Identified deviations in some details are evaluated reflecting the view of GRS. Particular aspects resulting from the evaluation should be considered for further development of the German PSA Guide. (orig.) [de

Complications of operative treatment of injuries of peripheral arteries.

Science.gov (United States)

Velinovic, M M; Davidovic, B L; Lotina, I S; Vranes, R M; Djukic, L P; Arsov, J V; Ristic, V M; Kocica, J M; Petrovic, L P

2000-06-01

In 1991 and 1992, a total of 97 patients with 106 peripherial arterial injuries underwent surgery at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia. Civilian injuries accounted for 53 (54.6%) patients (94.3% males, age range: 16-63 yr, mean: 35.2), and 44 patients had war injuries (93.2% males, age range: 19-61 yr, mean: 34.8). The injuries affected the superfitial femoral artery in 31 (29.24%); the popliteal artery in 28 (26.41%); the brachial artery in 17 (16.04%); the posterior tibial artery in 6 (5.66%); the axillary artery in 5 (4.72%); the anterior tibial artery in 5 (4.72%); the tibioperoneal trunk in 4 (3. 77%); the common femoral artery in 4 (3.77%); the external iliac artery in 2 (1.89%); the profound femoral artery in 2 (1.89%); the radial artery in 1 (0.94%); and ulnar artery in 1 (0.94%).A total of 98 reconstructive procedures were used to treat these patients. Graft interposition carried out in 50 (51.02%); by pass in 25 (25. 51%); end-to-end anastomosis in 9 (9.18%); suture in 8 (8.16%); ligation in 4 (4.08%); and patch-angioplasty in 2 (2.04%). Primary reconstruction of injured arteries was performed in 72.2% and secondary repair in 27.8% cases. Infection developed in 51 (52.57%) patients, and it was significantly (P<0.05) more common in the war injuries (70.45%) and in secondary repairs (88.89%). The presence of associated lesions (69.56%) was also correlated with a greater rate of infection. Amputation was necessary in 21 (21.65%) of our patients, and was significantly (P<0.05) more often performed after secondary (44.44%) than primary operations (12.86%) and in the presence of associated injuries (32.61%).

State of the art magnetic resonance imaging

International Nuclear Information System (INIS)

Weissman, J.D.

1987-01-01

In less than a decade Magnetic Resonance Imaging (MRI) has evolved from a laboratory demonstration to a safe and effective technique for clinical diagnosis. This evolutionary process continues. At this time 2-D and 3-D imaging of the head and body is firmly established in clinical use. Surface coil imaging, two-component chemical shift imaging, in-vivo spectroscopy and flow imaging are currently in various stages of development. The present state of the art of MRI is a function of an array of technologies: magnet, Rf coil, Rf pulse amplifier, gradient coil and driver, pulse programmer, A/D converter, computer system architecture, array processors and mass storage (both magnetic and optical). The overall product design is the result of a complex process which balances the advantages and disadvantages of each component for optimal system performance and flexibility. The author discusses the organization of a state-of-the-art MRI system. Several examples of the kinds of system interactions affecting design choices are given. (Auth.)

Characterizing Resting-State Brain Function Using Arterial Spin Labeling

Science.gov (United States)

Jann, Kay; Wang, Danny J.J.

2015-01-01

Abstract Arterial spin labeling (ASL) is an increasingly established magnetic resonance imaging (MRI) technique that is finding broader applications in studying the healthy and diseased brain. This review addresses the use of ASL to assess brain function in the resting state. Following a brief technical description, we discuss the use of ASL in the following main categories: (1) resting-state functional connectivity (FC) measurement: the use of ASL-based cerebral blood flow (CBF) measurements as an alternative to the blood oxygen level-dependent (BOLD) technique to assess resting-state FC; (2) the link between network CBF and FC measurements: the use of network CBF as a surrogate of the metabolic activity within corresponding networks; and (3) the study of resting-state dynamic CBF-BOLD coupling and cerebral metabolism: the use of dynamic CBF information obtained using ASL to assess dynamic CBF-BOLD coupling and oxidative metabolism in the resting state. In addition, we summarize some future challenges and interesting research directions for ASL, including slice-accelerated (multiband) imaging as well as the effects of motion and other physiological confounds on perfusion-based FC measurement. In summary, this work reviews the state-of-the-art of ASL and establishes it as an increasingly viable MRI technique with high translational value in studying resting-state brain function. PMID:26106930

Origem anômala de uma artéria pulmonar da aorta ascendente: resolução da hipertensão arterial pulmonar com a correção cirúrgica Anomalous origin of one pulmonary artery from the ascending aorta: surgical repair resolving pulmonary arterial hypertension

Directory of Open Access Journals (Sweden)

Marco Aurélio Santos

2004-12-01

Full Text Available OBJETIVO: Enfatizar a possibilidade diagnóstica da origem anômala de uma artéria pulmonar da aorta ascendente, em lactentes com quadro de insuficiência cardíaca clinicamente intratável e sem defeito estrutural intracardíaco. MÉTODOS: Estudo retrospectivo em quatro lactentes com insuficiência cardíaca intratável, submetidos a estudo ecocardiográfico bidimensional com cortes subcostal, supraesternal e paraesternal, e a estudo hemodinâmico e angiocardiográfico na projeção ântero-posterior. RESULTADOS: Três dos quatro lactentes tinham a artéria pulmonar direita originando-se da aorta ascendente, como diagnóstico principal. No quarto paciente a artéria pulmonar esquerda originava-se da aorta ascendente associada à ampla comunicação interventricular. Os lactentes tinham pressão em ambas artérias pulmonares em nível sistêmico. Todos foram submetidos a tratamento cirúrgico que consistiu na translocação da artéria pulmonar anômala da aorta. Não houve óbitos cardíacos imediatos ou tardios. CONCLUSÃO: Uma vez estabelecido o diagnóstico de origem anômala de artéria pulmonar da aorta ascendente, na forma isolada, a correção cirúrgica deverá ser prontamente realizada, não só pelo desenvolvimento de doença vascular pulmonar, como pelos excelentes resultados cirúrgicos atualmente obtidos.OBJECTIVE: To emphasize the diagnostic possibility of the anomalous origin of one pulmonary artery from the ascending aorta in infants with clinically refractory heart failure and no intracardiac structural defect. METHODS: Retrospective study of 4 infants with refractory heart failure undergoing 2-dimensional echocardiographic study with subcostal, suprasternal, and parasternal views, and hemodynamic and angiocardiographic study in the anteroposterior projection. RESULTS: Three of the 4 infants had their right pulmonary artery originating from the ascending aorta as their major diagnosis. In the fourth patient, the left pulmonary

The "State of Art" of Organisational Blogging

Science.gov (United States)

Baxter, Gavin J.; Connolly, Thomas M.

2013-01-01

Purpose: The aim of this paper is to provide an overview of the "state of art" of organisational blogging. It also aims to provide a critical review of the literature on organisational blogging and propose recommendations on how to advance the subject area in terms of academic research. Design/methodology/approach: A systematic literature review…

Contemporary Romanian Art in the United States1

Directory of Open Access Journals (Sweden)

Altman Dana

2014-08-01

Full Text Available The article discusses the recent international interest in contemporary Romanian art and its growth in market share, with a focus on the United States. The theme is followed thorough in numerous museum exhibitions, increased collector following, art fair presence, gallery representation and auction activity initially in Europe and the United States. The phenomenon is discussed both in the context of the larger international movement conducive to the contemporary art price bubble, and in that of the local socio-economic changes. My chief interest lies in the factors leading up to the entry of post 1989 Romanian art in the global arena as a manifestation of market forces in the field. The analysis follows its grass roots local emergence through non-profit institutions, individual artists, small publications, low budget galleries, as well as the lack of contribution (with few notable exceptions of state institutions, while pointing out the national context of increasing deregulation of social support systems resulting in lack of focus on cultural manifestations. The conclusion is that the recent ascent of contemporary Romanian art (and coincidentally, the award winning contemporary Romanian cinematography is a fortuitous convergence of various factors, among which, increased international mobility and sharing. At the same time, it is also the result of the evolution of various individual artists that pursued a form of art rooted in Romanian artistic tradition but with a focus on the symbolic figurative. The result is a personal semiotics of raising the mundane to extraordinary levels that reconfigured the anxiety of entering a new system into an unmistakable and lasting visual language.

Mission Accomplished: Working with State Arts Agencies

Science.gov (United States)

Boyer, Johanna Misey

2005-01-01

Most everyone involved professionally in the non-profit arts comes in contact with a state arts agency. A person may be on the Teaching Artist roster, works for a grantee organization, or has directly received a grant or fellowship. The work that one does in the school is probably funded by the state arts agency. Or, at a more basic level, the…

Subintimal angioplasty for the treatment of long segment occlusion of superficial femoral artery: the midterm results

International Nuclear Information System (INIS)

Lou Wensheng; Gu Jianping; He Xu; Chen Liang; Chen Guoping; Su Haobo; Song Jinhua; Wang Tao; Xu Ke

2011-01-01

Objective: To discuss the clinical value of subintimal angioplasty in treating long segment occlusion of superficial femoral artery and to observe its midterm results. Methods: Subintimal angioplasty was performed in 45 patients with long segment occlusion of superficial femoral artery, whose clinical presentation was intermittent claudication or critical limb ischemia. The primary patency, limb salvage and factors influencing long-term patency were observed, and the clinical data were analyzed. Results: Of the total 45 cases, the subintimal angioplasty was successfully accomplished in 43. The success rate of antegrade approach technique via the superficial femoral artery was 80% (n=36), the occlusion was recanalized by using retrograde approach technique via ipsilateral popliteal artery in 7 case. The total technical success rate was 95.6%. The primary patency in 43 successful cases at 6, 12, 24 and 36 months was 85.7%, 69.0% 57.3% and 50.9%, respectively. No statistically significant difference in primary patency existed between the group of intermittent claudication and the group of critical limb ischemia (P>0.05). Statistically significant prediction factors for primary patency included the number of the run off vessels below the knee and the length of the occlusion (P<0.05). Conclusion: Subintimal angioplasty is an effective procedure for the treatment of long segment occlusions of superficial femoral artery with satisfactory mid-term results. (authors)

111In leukocyte scintigraphy in the diagnosis of vascular graft infection

International Nuclear Information System (INIS)

Royen, E.A. van; Roevekamp, M.H.; Dongen, R.J.A.M. van; Schoot, J.B. van der; Hardeman, M.R.

1982-01-01

Infection at the site of a vascular graft is a serious complication in vascular surgery especially when synthetic materials have been used. Prosthetic grafts are widely employed in aorto-iliac, aorto-femoral and femoro-popliteal bypasses. X-ray investigation, angiography, ultrasound and computer tomography are of limited value in the diagnosis of graft infection. Delay in diagnosis and treatment of this complication results in a high morbidity and mortality. Some reports are available on the use of gallium-67 citrate scintigraphy. However, its accumulation in normal intestinal structures is a serious drawback. The authors investigated the effectiveness of indium-111 leukocytes scintigraphy in the diagnosis of vascular graft infection. The possible accumulation of labelled leukocytes was assessed both subjectively by visual interpretation and quantitatively by computer evaluation. (Auth.)

The Use of Below-Knee Percutaneous Transluminal Angioplasty in Arterial Occlusive Disease Causing Chronic Critical Limb Ischemia

International Nuclear Information System (INIS)

Loefberg, Ann-Marie; Loerelius, Lars-Erik; Karacagil, Sadettin; Westman, Bo; Almgren, Bo; Berqgvist, David

1996-01-01

Purpose: To determine the efficacy, safety and long-term results of crural artery percutaneous transluminal angioplasty (PTA) in limbs with chronic critical limb ischemia (CLI). Methods: Patients undergoing crural artery PTA due to CLI were followed at regular clinic visits with ankle brachial pressure index (ABPI) measurements. PTA of the crural arteries was attempted either alone (n= 39) or in combination with PTA of the superficial and/or popliteal artery (n= 55) in 86 limbs (82 patients and 94 procedures) presenting with CLI. The ages of patients ranged from 37 to 94 years (mean 72 years). The indications for PTA were rest pain in 10 and ulcer/gangrene in 84 limbs.Results: A technically successful PTA with at least one crural level was achieved in 88% of cases (n= 83). Cumulative primary clinical success rates at 6, 12, 24, and 36 months were 55%, 51%, 36%, and 36%, respectively. Cumulative secondary clinical success and limb salvage rates at 36 months were 44% and 72%, respectively. Conclusion: PTA of the crural arteries might be considered the primary choice of treatment in patients with CLI and distal lesions with localized stenosis or segmental short occlusions

For What Purpose the Arts? An Analysis of the Mission Statements of Urban Arts High Schools in Canada and the United States

Science.gov (United States)

Gaztambide-Fernández, Rubén; Nicholls, Rachael; Arráiz-Matute, Alexandra

2016-01-01

While general arts programs have declined in many schools across the United States and Canada, the number of specialized art programs in public secondary schools has swelled since the 1980s. While this increase is often celebrated by arts educators, questions about the justification of specialized arts programs are rarely raised, and their value…

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

International Nuclear Information System (INIS)

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

2013-01-01

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.

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

Energy Technology Data Exchange (ETDEWEB)

Fanelli, Fabrizio, E-mail: fabrizio.fanelli@uniroma1.it; Cannavale, Alessandro [University of Rome ' Sapienza,' , Department of Radiological Sciences, Vascular and Interventional Radiology Unit (Italy); Gazzetti, Marianna [Sapienza University of Rome ' Sapienza,' , Department of Surgery Paride Stefanini, Vascular Surgery Division, Policlinico Umberto I (Italy); Fantozzi, Cristiano; Taurino, Maurizio [University of Rome ' Sapienza,' , Department of Vascular Surgery (Italy); Speziale, Francesco [Sapienza University of Rome ' Sapienza,' , Department of Surgery Paride Stefanini, Vascular Surgery Division, Policlinico Umberto I (Italy)

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.

State of the social responsibility art

OpenAIRE

Varela López, Leidy Viviana; Universidad de San Buenaventura Cali.

2015-01-01

From the eighties, it has been addressing the issue of corporate social responsibility, specifically toward the defense of human rights and climate change. However, although they have applied corporate social responsibility principles in some of the existing institutions, it is still very small the work being done around the specific activity of solid waste management. Some works have been compiled to build a state of the art for understanding in depth the concept of corporate social responsi...

State of the art report on design for X

DEFF Research Database (Denmark)

Papanikolaou, Apostolos; Andersen, Poul; Kristensen, Hans Otto Holmegaard

2009-01-01

The present State of the Art report aims at defining and reviewing the curent state of the ship design process in the frame of a holistic approach, accounting for various objectives and constraints. The report addresses mainly the design of transportation carriers, though some covered aspects...

A State of the Art Overview

DEFF Research Database (Denmark)

Jahangiri, Tohid; Bak, Claus Leth; Silva, Filipe Miguel Faria da

2015-01-01

The first EHV composite cross-arms have been used since late 1990's in Switzerland. It was the first step to the compaction of towers sizes. Since then, significant advances have been made in composite cross-arms technology while the lattice construction technique has not been seriously challenged...... of EHV composite cross-arms and lightning protection methods are reviewed based on the state of the art review and subsequently some solutions are presented to overcome the two main challenges....

Intracranial intrasellar kissing carotid arteries: case report Artérias carótidas intracranianas intra-selares "que se beijam": relato de caso

Directory of Open Access Journals (Sweden)

Arthur de Azambuja Pereira Filho

2007-06-01

Full Text Available Intracranial "kissing" carotid arteries are a rare variant of the carotid arteries, where both internal carotid arteries deviate medially and touch each other near the midline within the sphenoid sinus or the sphenoid bone, including the sella. This anomaly is particularly important since it may cause or mimic pituitary disease and also may complicate transsphenoidal surgery. We report a rare case of intracranial intrasellar kissing carotid arteries in a 57-years-old woman that was submitted to a computed tomography angiography during investigation of a sudden headache, and to discuss the clinical relevance of this radiological finding.Artérias carótidas intracranianas "que se beijam" representam rara variação da anatomia arterial, onde ambas as artérias carótidas internas desviam-se medialmente e tocam-se próximo à linha media dentro do seio esfenoidal ou do osso esfenóide, incluindo a sela túrcica. Essa anomalia é particularmente importante, pois pode causar ou simular doença pituitária e ainda pode complicar uma cirurgia transesfenoidal. Relatamos um raro caso de artérias carótidas intracranianas "que se beijam" em mulher de 57 anos, a qual foi investigada por angiotomografia por quadro de cefaléia súbita. Discutimos a relevância clínica desse achado radiológico.

Meniscal Allograft Transplantation: State of the Art.

Science.gov (United States)

Trentacosta, Natasha; Graham, William C; Gersoff, Wayne K

2016-06-01

Meniscal allograft transplantation has evolved over the years to provide a state-of-the-art technique for the sports medicine surgeon to utilize in preserving contact mechanics and function of the knee in irreparable meniscal pathology. However, this procedure continues to spark considerable debate on proper tissue processing techniques, acceptable indications, methods of implantation, and potential long-term outcomes.

Espessamento médio-intimal na origem da artéria subclávia direita como marcador precoce de risco cardiovascular Intima-media thickness in the origin of right subclavian artery as an early marker of cardiovascular risk

Directory of Open Access Journals (Sweden)

Carlos Alberto Engelhorn

2006-11-01

EMI na origem da artéria subclávia direita pode ser considerado um marcador mais precoce para avaliação de risco cardiovascular.OBJECTIVE: Common carotid artery intima-media thickness (IMT is considered a factor of cardiovascular risk and an early marker of coronary artery disease. This study aimed to investigate the existence of a correlation between IMT in the carotid arteries and at the origin of the right subclavian artery, as well as to evaluate IMT in the subclavian artery as an earlier marker of cardiovascular risk. METHODS: One hundred and six consecutive patients, 52 males and 54 females, average age 51 years, underwent color Doppler ultrasonography to evaluate carotid and right subclavian arteries. The relationship between carotid IMT and right subclavian IMT was assessed using the Pearson's correlation coefficient analysis and a 95% confidence interval. Reliability of right subclavian artery IMT measurement for the diagnosis of early thickening (considering a > 0.8 mm carotid thickness as reference was described as to sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Cut-off values for the right subclavian IMT were indicated by the ROC curve, and p values 0.8 mm. The mean IMT value for the carotid artery was 0.87 mm (SD = 0.23 and for the subclavian artery, 1.17 mm (SD = 0.46, with a 0.31 correlation coefficient (95% CI: 0.12; 0.47. The ROC curve analysis indicated a cut-off value of 0.7 mm for the right subclavian artery IMT, using as reference a 0.8 mm cut-off value for the carotid artery (91% sensitivity, 27% specificity, 66% PPV, 65% NPV, and 66% accuracy. CONCLUSION: Our study showed that carotid artery IMT correlates well with right subclavian artery IMT. With a 0.7 mm cut-off value, it is possible to detect IMT in the right subclavian artery earlier than in the carotid arteries. The IMT at the origin of the right subclavian artery can be considered an earlier marker for the assessment of cardiovascular

Multimodality imaging in the diagnosis of deep vein thrombosis and popliteal pseudoaneurysm complicating a sessile osteochondroma

Energy Technology Data Exchange (ETDEWEB)

Christensen, Jared D.; Monu, Johnny U.V. [University of Rochester School of Medicine and Dentistry, Department of Imaging Sciences, 601 Elmwood Ave., Box 648, Rochester, NY (United States)

2008-08-15

Synergistic use of ultrasonography, radiography, multidetector CT (MDCT) and MRI enabled a prompt and accurate diagnosis of a nonocclusive popliteal vein thrombus (deep venous thrombosis, DVT) and a pseudoaneurysm complicating a sessile osteochondroma in an 11-year-old boy who presented in the emergency department with sudden-onset nontraumatic pain in the posterior aspect of the knee. (orig.)

EMERGENCY STATES IN ARTERIAL HYPERTENSION

Directory of Open Access Journals (Sweden)

M. A. Gurevich

2014-01-01

Full Text Available The article describes in detail potential emergency states in patients with different stages of arterial hypertension with special attention to diagnosis and rational management of hypertensive crisis. Differentiated approach to management of different forms of hypertensive crisis is specified.

Results of Infrageniculate Bypasses Using the Profunda Femoris Artery as Inflow Source.

Science.gov (United States)

Illuminati, Giulio; Calio', Francesco G; Pizzardi, Giulia; Pasqua, Rocco; Masci, Federica; Frezzotti, Francesca; Palumbo, Piergaspare; Vietri, Francesco

2018-02-01

When the common femoral artery is not accessible for infrainguinal bypass grafting, the profunda femoris artery (PFA) can be a valuable alternative inflow source for distal arterial revascularization. The purpose of this retrospective study was to evaluate the results of infrageniculate bypass grafting via the PFA as inflow source for critical limb ischemia. Between 1994 and 2016, 68 patients, 51 men of a mean age of 74 years, underwent an infrageniculate arterial bypass grafting for critical limb ischemia, using the PFA as inflow site. PFA was exposed at the Scarpa's triangle in 38 patients (56%) and at its medio-crural segment in 30 patients (44%). The distal anastomosis was performed on the infragenicular popliteal artery in 33 patients (48%), the peroneal artery in 14 patients (20%), the tibioperoneal trunk in 8 patients (12%), the posterior tibial artery in 8 patients (12%), and the dorsalis pedis artery in 5 patients (8%). The graft material consisted of a reversed great saphenous vein (GSV) in 62 patients (91%) and a 6-mm polytetrafluoroethylene graft in 6 patients (9%). The median duration of follow-up was 51 months (range, 6-72 months). As main results, postoperative mortality and morbidity, overall late patients' survival, primary grafts' patency, and limb salvage rate were considered. Operative mortality and morbidity were 3% and 4%, respectively. Overall patients' survival, primary patency and limb salvage rate, at 36 and 60 months were, respectively, 62% and 53%, 66% and 59%, and 92% and 77%. The PFA, both exposed at the Scarpa's triangle and at mid-thigh, is an excellent inflow source for infrageniculate revascularizations. It should remain an important part of the technical armamentarium of vascular surgeons, even in the endovascular era. Copyright © 2017 Elsevier Inc. All rights reserved.

State of the art of solid state dosimetry

International Nuclear Information System (INIS)

Souza, Susana O.; Yamamoto, Takayoshi; D'Errico, Francesco

2014-01-01

Passive solid-state detectors still dominate the personal dosimetry field. This article provides state of the art in this field and summarizes the most recent works presented on TL, OSL and RPL during the 17th International Conference on Solid State Dosimetry held in Recife in September 2013. The Article contains in particular the techniques Thermoluminescence (TL), Optically Stimulated Luminescence (OSL), radio photoluminescence (RPL). Thermoluminescence has the biggest advantage of the wide availability of commercial materials for dosimetry, and the nature tissue-equivalent of several of these materials. The limitation of the TL dosimetry presents fading luminance signal and the need for high temperatures to obtain the signal. The Optically Stimulated Luminescence has the advantages of high sensitivity, the possibility of multiple reading, while its limit is the need to use response compensating filters in addition to the high cost of equipment and dosimeters still restricted very few options trading . The radio photoluminescence has a reading that is completely non-destructive, but their dosimeters present lack of tissue-equivalent and a high cost. Presents the details of the techniques and the advantages and limitations of each of these will be discussed