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Motion of blood in the venous system—novel findings
Published in Dinker B. Rai, Mechanical Function of the Atrial Diastole, 2022
t1 records the transit time of technetium or the circulation time of blood beginning at the injection site of the femoral artery and ending at the selected site of the ipsilateral iliac vein. Although blood has a different velocity as it traverses to the arterial capillary and venous segment of its passage, t1 represents the average velocity. Among the patients studied there was only one patient with mixed etiology in whom the velocity was decreased by both arterial and venous disease. The remaining patients had normal arterial circulation as documented by the ankle-brachial index. The prolonged t1 was caused by decreased velocity of the blood in the venous segment of its passage.
Current imaging strategies in cardio-oncology
Published in Susan F. Dent, Practical Cardio-Oncology, 2019
Mirela Tuzovic, Melkon Hacobian, Eric H. Yang
Ankle-brachial index (ABI) is a simple test, which provides an accurate and rapid way for detecting the presence and severity of lower extremity arterial disease. The ABI is defined as the ratio of the systolic blood pressure in the upper arm compared to the ankle. Brachial and dorsalis pedis arterial systolic pressures are measured by applying an appropriately sized blood pressure cuff and using a continuous wave Doppler probe to record the arterial signal. Values below 0.9 are indicative of peripheral arterial disease (30). ABI can be performed at baseline and annually in asymptomatic patients at risk for peripheral artery disease such as patients receiving abdominal and/or pelvic radiation. In symptomatic patients, especially treated with high-risk agents such as nilotinib or ponatinib, direct visualization with arterial ultrasonography or CT/MR angiography may be indicated (2).
How to perform revision lumbar decompression
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Jacob Hoffman, Ryan Murphy, Mark L. Prasarn, Shah-Nawaz M. Dodwad
Prior to obtaining advanced imaging or laboratory testing, a history should be taken and a detailed physical exam performed at the initial evaluation. The patient should be questioned regarding the exact nature of the symptoms to identify radiculopathy or neurogenic claudication. A detailed review of the patient's past spinal surgery should be obtained. Inspection of the previous surgical incision may reveal subcutaneous fullness and fluctuance, indicating a postoperative pseudomeningocele. The presence of a draining wound at the previous surgical site indicates an infection that must be addressed with surgical debridement. Sagittal balance may be assessed with the patient standing. Significant stenosis may result in positive sagittal balance or leaning forward to decompress the neural elements. Peripheral pulses should be palpated to rule out vascular claudication. In office, ankle-brachial index may be utilized to evaluate for peripheral vascular disease. Hip joints are ranged to rule out pain from hip arthropathy, primarily with internal/external rotation. The neurologic status of the patient is evaluated and graded with sensory testing, motor strength testing, deep tendon reflexes, and assessment of gait.
Association of a low ankle brachial index with progression to end-stage kidney disease in patients with advanced-stage diabetic kidney disease
Published in Renal Failure, 2023
Ruiying Tang, Yun Liu, Jiexin Chen, Jihong Deng, Yan Liu, Qingdong Xu
The ankle-brachial index (ABI) has recently become a routine screening parameter for vascular complications in patients with DM [5]. A correlation between the ABI and microvascular complications in diabetes has been widely reported [6]. The ABI is calculated as the ankle-to-arm systolic blood pressure (SBP) ratio. It is a simple, noninvasive screening tool used to detect peripheral arterial disease (PAD) [7,8] as it reflects the aging and pathological state of blood vessels. An ABI threshold of 0.90 has been reported to have 90% sensitivity and specificity to detect PAD when compared to angiography methods [9]. A low ABI (<0.9) is a predictor of cardiovascular disease, stroke, and mortality in the general population and in patients with DM and chronic kidney disease (CKD) [10–13]. Atherosclerosis also contributes to the deterioration of kidney function, as a low ABI is predictive of future diminished kidney function and is associated with an increased risk of CKD and decreased eGFR [14–16]. Additionally, a close relationship between low ABI and early-stage CKD was found in patients with diabetes with normal albuminuria [15], suggesting that a low ABI level contributed to diminished kidney function independent of albuminuria. However, U-shape relationships between the ABI and eGFR, CKD, cardiovascular disease, and all-cause mortality have also been reported [9,17].
Life-style counseling program and supervised exercise improves walking distance and quality of life in patients with intermittent claudication
Published in Physiotherapy Theory and Practice, 2022
Asger Jacobsen, Kim Christian Houlind, Amrit Rai
In the period from 1 May 2018 to 1 September 2019, 62 patients with IC and different stages of PAD were referred to the rehabilitation center. A total of 35 participants were included in the treatment program (Figure 2). The participants mean age was 71.5 years (SD 7.7 years), 57.1% were males and had a mean BMI at 27 kg/m2 (SD 5 kg/m2). The majority of the participants were male (57.1%), retired (71.4%), and current or former smokers (97.1%). Only 31.4% of the patients had a history of previous revascularization procedure. The mean ankle brachial index of the included patient, but excluding the patient with diabetes, was 0.57 (SD 0.13). Out of 35 included, 8 (22%) were known patients with diabetes, where the average lowest toe pressure measured was 44 mm Hg (range 26–67 mm Hg). Details of the included patients are presented in Table 2. Adherence to the training session was high, out of 36 session of SET, majority of patients completed over 90% of the exercises training sessions. The average adherence was 90.8% (SD 6.7%) outcome Data.
Impact of systemic lupus erythematosus on in-hospital outcomes of peripheral artery disease—insight from the National Inpatient Sample database
Published in Baylor University Medical Center Proceedings, 2022
Jay Shah, Kritika Luthra, Ghulam Mujtaba Ghumman, Ma’en Al-Dabbas, Muhammad Ahsan, Sindhu Avula, Syed Sohail Ali, Ameer Kabour, Hemindermeet Singh
Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder with a wide range of clinical presentations. The disease has varying prevalence geographically and has high overall morbidity and mortality.1 Cardiovascular diseases are prevalent in SLE patients and are a major cause of morbidity and mortality, mainly related to atherosclerosis.2 The inflammation and circulating autoantibodies associated with SLE make it an independent risk factor for the development of premature atherosclerosis, even in the absence of traditional risk factors of hypertension, hyperlipidemia, or renal disease.3,4 This manifestation of atherosclerosis in the lower limbs’ vasculature leads to a low ankle-brachial index and increased prevalence of peripheral arterial disease (PAD), a coronary artery disease risk equivalent.5 This article compares the in-hospital outcomes among PAD patients with and without SLE.