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Biomedical subjects

A M Belli

Publications and source records attributed to A M Belli.

At least 37 records · Page 2Linked to original sources
PubMed1999

The use of the angio-seal haemostatic puncture closure device in high risk patients.

The use of the Angio-Seal haemostatic puncture closure device in 45 patients considered to be at increased risk of puncture site complications is described. Successful device deployment occurred in 44 of 50 arteries (88%). Two major complications were associated with, but not necessarily caused by, the Angio-Seal device. Four minor complications were observed. In a subset of 23 patients well enough to mobilize early after their procedure, 17 did so at an average of 2.6 h as opposed to the routine 12-18 h for patients after a procedure involving a 6-8F sheath. Once the initial learning curve has been overcome, the Angio-Seal device is a simple and successful method of achieving arterial haemostasis following catheterization and is associated with a low risk of complications. At present we would recommend its use for high risk patients only, as manual compression is effective in the majority of routine cases.

Aged↗
PubMed1999

The endovascular management of blue finger syndrome.

OBJECTIVES: To review our experience of the endovascular management of upper limb embolisation secondary to an ipsilateral proximal arterial lesion. DESIGN: A retrospective study. MATERIALS AND METHODS: Over 3 years, 17 patients presented with blue fingers secondary to an ipsilateral proximal vascular lesion. These have been managed using transluminal angioplasty (14) and arterial stenting (five), combined with embolectomy (two) and anticoagulation (three)/anti-platelet therapy (14). RESULTS: All the patients were treated successfully. There have been no further symptomatic embolic episodes originating from any of the treated lesions, and no surgical amputations. Complications were associated with the use of brachial arteriotomy for vascular access. CONCLUSIONS: Endovascular techniques are safe and effective in the management of upper limb embolic phenomena associated with an ipsilateral proximal focal vascular lesion.

Adult↗
PubMed1999

The association between laser Doppler reactive hyperaemia curves and the distribution of peripheral arterial disease.

OBJECTIVES: To determine whether postocclusive laser Doppler fluxmetry (LDF) curves can be related to the arteriographic distribution of disease. DESIGN: Prospective study. MATERIALS: Sixty-nine patients with symptomatic peripheral ischaemia and 15 healthy subjects. METHODS: Laser Doppler fluxmetry (LDF) was monitored on the dorsum of the symptomatic foot following 2 min of arterial occlusion at the ankle. During reperfusion three patterns of LDF were identified (types I-III). All patients subsequently underwent arteriography which was reported independent of LDF results. The distribution of disease, particularly patency of below-knee vessels, was related to the type of LDF curve observed during reactive hyperaemia. RESULTS: Type I curves were observed in all healthy subjects and 75% of patients with a single arterial lesion. Type II curves were found in 78% of patients with multiple lesions above the knee. The presence of either a type I or II curve was associated with a continuous vessel from knee to ankle (positive predictive value 83%, p < 0.01), whilst type III curve was associated with discontinuous infrapopliteal run-off (positive predictive value 86%, p < 0.01). CONCLUSIONS: This pilot study suggests that post-occlusive LDF curves may identify the distribution of arterial disease and may be useful in the non-invasive management of peripheral ischaemia.

Chi-Square Distribution↗
PubMed1999

Superior mesenteric artery stenting for mesenteric ischaemia in Sneddon's syndrome.

Mesenteric ischaemia is a rare but serious cause of abdominal pain. We present the case of a man with Sneddon's syndrome, who had symptomatic mesenteric ischaemia secondary to a superior mesenteric artery stenosis in conjunction with a hepatic artery stenosis. As far as the authors are aware, this has not previously been described in Sneddon's syndrome, which is a vascular systemic disease characterized by an association between cerebrovascular accidents and a livedo reticularis skin rash. He was treated with balloon angioplasty and stent insertion, with good symptomatic improvement. This has implications for other stenoses in this condition should they become symptomatic.

Adult↗
PubMed1999

Using CO2-enhanced arteriography to investigate acute gastrointestinal hemorrhage.

OBJECTIVE: The objective of the study was to compare the efficacy of CO2-enhanced arteriography with that of arteriography enhanced with standard iodinated contrast material in the detection of gastrointestinal hemorrhage. CONCLUSION: For acute gastrointestinal hemorrhage, we did not find an advantage to using CO2 to show active bleeding. In fact, CO2 was inferior to iodinated contrast material in revealing nonbleeding vascular anomalies.

Acute Disease↗
PubMed1999

A review of alternative approaches in the management of iatrogenic femoral pseudoaneurysms.

The management of iatrogenic pseudoaneurysms (IPAs) demands close co-operation between radiologist, vascular surgeon and plastic surgeon. Ideally, each patient should be reviewed employing a team approach. Many IPAs require only observation; those with a volume greater than 6 cm3 will require treatment as spontaneous thrombosis is uncommon. Radiological treatment options include ultrasound guided compression repair (UGCR), embolisation, and covered stenting. Occasionally, these are unsuccessful or contra-indicated, and the vascular surgical approach is discussed in detail. Finally, the role of the plastic surgeon in dealing with skin ischaemia is detailed.

Aneurysm, False↗
PubMed1998

High prevalence of carotid artery disease in patients with atheromatous renal artery stenosis.

BACKGROUND: Renovascular disease is the most frequently encountered secondary cause of hypertension and is one of the few potentially reversible causes of chronic renal failure. These patients are at increased risk of having cerebrovascular events following operative management for atheromatous renal-artery stenosis. We studied the prevalence of carotid-artery disease in patients with atheromatous renal-artery stenosis. METHODS: A cross-sectional study was carried out on 38 consecutive patients with atheromatous renal-artery stenosis who underwent renal-artery balloon angioplasty. Extracranial carotid atherosclerosis was assessed using a commercially available colour Doppler scanner, depending on the velocity of the peak systolic waveform in the internal carotid artery, and the internal carotid-artery/common carotid-artery ratio. RESULTS: Twenty-one patients (55.3%) had normal or mild carotid-artery disease, 10 (26.3%) had moderate, and 7 (18.4%) had severe carotid-artery disease. Nine patients had previously suffered a stroke (eight infarction, one haemorrhage) and one had multiple transient ischaemic attacks. CONCLUSIONS: Our results suggest that, in patients with atheromatous renal-artery disease severe enough to require angioplasty, 4 out of 10 appear to have moderate to severe carotid-artery disease. This may explain the increased prevalence of atherothrombotic cerebrovascular events in these patients, and also previous observations that, following operative management for atheromatous renal-artery stenosis, some patients had developed an acute or late cerebrovascular event. We suggest therefore that such patients should always be regarded as having generalized vascular disease not confined to one system, and need to be assessed for carotid-artery disease prior to operative management for atheromatous renal-artery stenosis.

Aged↗
PubMed1998

Update on endovascular management of arterial occlusive disease.

Although balloon angioplasty is the most widely used technique for treating peripheral vascular disease, developments in endovascular therapies have extended methods of percutaneous vascular intervention. Lasers have been used to recanalize occluded arteries. Mechanical devices can remove obstructions and metallic stents can be placed to keep a vessel open with good long-term patency.

Angiography, Digital Subtraction↗
PubMed1997

The predictive value of laser Doppler fluxmetry and transcutaneous oximetry for clinical outcome in patients undergoing revascularisation for severe leg ischaemia.

OBJECTIVES: To investigate the predictive value of laser Doppler fluxmetry and transcutaneous oximetry in 41 patients undergoing technically successful revascularisation for severe leg ischaemia. DESIGN: Toe and ankle systolic arterial pressures, transcutaneous oxygen tension (tcpO2), and stressed laser Doppler fluxmetry at the foot (time to peak laser Doppler flux following 2 min arterial occlusion, tp LDF, and the response of LDF to raising the leg 40 cm, the elevated:supine LDF ratio) were measured before revascularisation. Six months later these measurements were compared in those patients who were clinically improved, and those who still had symptoms of severe ischaemia or had lost their limb. SETTING: Vascular Laboratory, St. George's Hospital, London SW17, U.K. RESULTS: Six months following revascularisation 30 (73%) of the 41 patients had partial or complete symptomatic relief. Six (15%) had undergone major amputation and five (12%) still had symptoms of severe ischaemia. Before intervention toe and ankle systolic pressures were similar in the 30 who were improved and the 11 who had lost, or were still at risk of losing, their leg. Pre-revascularisation tcpO2 was significantly lower (18.3 mm Hg vs 33.5 mm Hg; p < 0.05) and tp LDF significantly longer (140 s vs 92 s; P < 0.05) in the 11 patients who were not clinically improved at 6 months. Whilst pre-revascularisation toe and ankle pressures below 30 mm Hg and 50 mm Hg respectively identified only 55% of those patients who were not improved 6 months later, a tp LDF in excess of 100 s identified 82% (p < 0.05) and was noted in five of the six amputees. CONCLUSION: Microcirculatory assessments performed in patients with limb-threatening ischaemia are likely to be more deranged in those patients who suffer clinical failure or amputation despite an apparently successful revascularisation procedure.

Amputation, Surgical↗
PubMed1997

The relationship between the delayed improvement in ankle-brachial pressure index and changes in limb volume following balloon angioplasty for leg ischaemia.

OBJECTIVES: To investigate the association between changes in the ankle-brachial pressure index (ABPI) and simultaneous changes in calf volume following percutaneous transluminal angioplasty (PTA) for chronic leg ischaemia. MATERIALS: A total of 37 consecutive patients undergoing PTA for chronic leg ischaemia. METHODS: Bilateral calf volume, as calculated from girth measurements, and ABPI were determined before PTA, and repeated 24 h and 1 week following the procedure. Changes in the calf volume of the treated leg, both absolute and relative to changes of the non-treated leg, were then related to simultaneous changes in ABPI. RESULTS: Twenty-four hours following PTA, the calf volumes of both legs were decreased, although the ratio of the treated: untreated leg had increased by 2.4% (CI + 1.1-3.7, p < 0.01). After 1 week there was no difference in calf volume. These patterns were observed both in the 21 patients who had ABPI improvement of 0.15 or more 1 week following PTA, and in the 16 whose ABPI was unchanged. In the former group ABPI improved by a further 0.13 between 24 h and 1 week following PTA (p < 0.05), but there was no relationship between this delayed ABPI increase and simultaneous changes in calf volume. CONCLUSIONS: We did not detect any significant calf swelling following PTA. Furthermore, changes in ABPI were not related to changes in calf volume.

Angioplasty, Balloon↗
PubMed1997

The nature and importance of changes in toe-brachial pressure indices following percutaneous transluminal angioplasty for leg ischaemia.

OBJECTIVES: To document changes in toe-brachial pressure indices (TBPI) during the 6 months following percutaneous transluminal angioplasty (PTA) and relate these changes to restenosis. Furthermore, to ascertain the effect of administering a vasodilator, glyceryl trinitrate (GTN), immediately following PTA. DESIGN: Eighty-three technically successful PTA procedures were studied. Fifty-six were for intermittent claudication, 14 for ischaemic rest pain, and 13 for non-healing ulcers. Immediately following balloon dilatation an intra-arterial bolus of either 150 micrograms GTN, with or without a 10 mg GTN patch for 24 h, or a saline placebo was administered. TBPI were measured before and for 6 h after PTA and then at 24 h, 1 week, 1 month and 6 months. At this time, patency at the PTA site was determined by arteriography. RESULTS: There was continuing TBPI improvement over 1 month in patients given saline following PTA. In patients given GTN, peak TBPI was achieved by 1 week, and corresponded with the TBPI observed immediately following GTN administration. Restenosis occurred in 27 (33%) patients, and was significantly more frequent following the procedures for rest pain or ulceration, or where a TBPI increase of more than 0.15 by 1 week was observed. CONCLUSIONS: Haemodynamic changes following PTA continue for at least 1 month, can be modified by GTN administration, and are predictive of subsequent restenosis. Measuring the TBPI increase during the first week following PTA underestimates total improvement, and may give false reassurance with respect to recurrent disease.

Aged↗
PubMed1997

The future of arteriography and vascular interventional radiology.

Non-invasive vascular imaging techniques threaten to diminish the catheter skills which radiology trainees currently acquire during diagnostic angiography. This, coupled with the desire of some vascular surgeons to perform minimally invasive "endovascular surgery", may threaten the future of this radiological subspecialty, or perhaps it will help to create a new discipline incorporating surgical, medical and radiological skills.

Angiography↗
PubMed1996

Transbrachial arteriography: indications and complications.

PURPOSE: to retrospectively evaluate brachial artery puncture at the antecubital fossa with regard to the indications for and complications arising from the procedure. PATIENTS AND METHODS: Sixty-two cumulative brachial artery punctures in fifty-three patients over a 5-year-period were retrospectively studies. RESULTS: In the majority of cases the brachial approach was utilised in order to avoid groin puncture in patients with absent femoral pulses or recent graft surgery. Occasionally it was performed as a more direct method of assessing upper limb arterial anatomy. Catheter sizes ranged from 3F to 8F. Fifty-one (82%) of the procedures were diagnostic and 11 (18%) were interventional. Glyceryl trinitrate was routinely administered. The overall incidence of complications was low (8%) and included haematoma and arterial spasm. None required surgical intervention and all resolved without permanent sequelae. CONCLUSION: Brachial artery puncture at the antecubital fossa is a suitable site of access for both diagnostic and interventional procedures. Potential limitations are the long distance from puncture site to that of intervention and damage to the brachial artery can result in upper limb ischaemia. Percutaneous brachial artery puncture at the antecubital fossa is, however, a low-risk alternative to either intravenous digital subtraction angiography or axillary artery puncture in patients in whom the femoral approach is contraindicated.

Aged↗