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Biomedical subjects

Gregory M Soares

Publications and source records attributed to Gregory M Soares.

10 recordsLinked to original sources
PubMed2006

Renal artery duplex ultrasonography as a screening and surveillance tool to detect renal artery stenosis: a comparison with current reference standard imaging.

OBJECTIVE: Digital subtraction angiography quantitative vessel analysis (QVA) to assess percent renal arterial stenosis (RAS) is the reference standard. Quantitative vessel analysis is not ideal for screening purposes. Renal artery duplex ultrasonography (RADUS) is a noninvasive method to screen for RAS using well-known parameters. We investigated the direct correlation between several RADUS parameters and QVA to evaluate the acceptability of RADUS as a RAS screening and surveillance tool. METHODS: We performed a multicenter retrospective study. Stenoses were evaluated in all patients with arteriograms and RADUS examinations within 30 days of each other in the span of 1 year. Percent stenosis of each stenotic renal artery segment was calculated digitally with QVA and correlated with the corresponding peak systolic velocity (PSV) and renal-aortic ratio (RAR) obtained with RADUS. Descriptive statistics and receiver operating characteristic curves were calculated. Correlation of percent stenosis, PSV, and RAR was performed. Sensitivity, specificity, and accuracy of diagnostic cut points for each RADUS parameter were calculated. RESULTS: Sixty-seven renal arteries were included. Thirty-three arteries had less than 60% stenosis; 34 had stenosis of 60% or greater. The mean values were PSV, 272.791 cm/s; RAR, 3.716; and angiographic percent stenosis, 51.731%. Receiver operating characteristic curves showed higher accuracy for RAR with stenoses of 60% or greater versus PSV. CONCLUSIONS: Renal artery duplex ultrasonographic parameters for 60% or greater RAS correlate well with QVA. For detecting stenosis of 60% or greater, RAR is the most accurate parameter at a threshold of 2.5. Renal-aortic ratio is more accurate than PSV. Peak systolic velocity may be a useful RADUS alternative parameter for hemodynamically important stenoses in the setting of aortic disease when aortic velocities are less than 40 or greater than 100 cm/s.

Angiography, Digital Subtraction↗
PubMed2005

Quality of life and exercise performance after aortoiliac stent placement for claudication.

PURPOSE: To determine the effect of aortoiliac stent placement on walking ability and health-related quality of life (QOL) for elderly individuals with moderate to severe intermittent claudication. MATERIALS AND METHODS: A prospective single-center study was performed in 35 consecutive patients (46 symptomatic limbs) with intermittent claudication and aortoiliac insufficiency (mean age+/-SD, 61.1 years+/-9.5). Baseline and follow-up data to 12 months included clinical status, ankle-brachial index (ABI), exercise performance according to a standardized treadmill exercise protocol, and self-reported health-related QOL according to the Walking Impairment Questionnaire (WIQ) and the Short Form 36 (SF-36). RESULTS: Comparing baseline with 12-month data, mean ABI significantly improved from 0.64+/-0.15 to 0.89+/-0.19 (P<.01). Similarly, mean initial claudication duration improved from 1.7 minutes+/-1.0 to 4.7 minutes+/-3.3 and maximum walking duration on the treadmill test improved from a mean of 3.3 minutes+/-1.8 to 8.7 minutes+/-4.4. All WIQ subscales showed significant improvement, and the SF-36 physical component scale as well as subscales of physical functioning, bodily pain, role physical, and vitality showed significant improvement. There was no 30-day mortality. Complications in the perioperative period that required treatment were observed in three patients (9%), but surgery was not required for any complications. Importantly, urgent or emergent surgery was not required for any complication and no permanent disability related to complications occurred. CONCLUSIONS: A high technical success rate (97%) and low complication rate were observed. Exercise performance and health-related QOL results improved significantly after stent placement. Revascularization with stent placement should be strongly considered in addition to conservative management for moderate to severe claudication with aortoiliac obstruction. A randomized clinical trial would be needed to gauge the relative effectiveness of stent implantation and conservative therapy.

Adult↗
PubMed2005

Clinical services provided by interventional radiologists to Medicare beneficiaries in the United States, 2000-2003.

To identify trends in Evaluation and Management (E&M) and non-E&M services of interventional radiologists (physician specialty type 94) from 2000 to 2003 for Medicare patients, Medicare Part B physician annual allowed services data from the Centers of Medicare and Medicaid Services (CMS) were analyzed for all interventional radiologists from 2000 to 2003. Because the number of interventional radiologists in the United States according to the Society of Interventional Radiology is, on average, 4.2 times the number of interventional radiologists who use physician specialty type 94, we extrapolated the E&M services for each year. During the period examined, the total number of E&M services by interventional radiologists increased 309%, from 9,698 in 2000 to 29,914 in 2003. The most commonly performed services were Office or Other Outpatient Visit (Current Procedural Terminology [CPT] codes 99211-99215) for established patients, followed by Subsequent Hospital Care (CPT 99231-99233) and Office or Other Outpatient Consultations (CPT 99241-99245). The extrapolated number of E&M services by interventional radiologists for Medicare patients in 2003 is approximately 107,853. The number of Office and Outpatient Visits for New Patients (CPT 99201-99205) increased 142%, whereas the number of Consultations for New Patients (CPT 99241-99245) increased 208%. The total number of codes reimbursed by CMS to interventional radiologists (type 94) increased from 2.8 million in 2000 to 3.8 million in 2003.

Current Procedural Terminology↗
PubMed2004

Aortoiliac insufficiency: long-term experience with stent placement for treatment.

PURPOSE: To establish and report the authors' experience with the long-term outcomes of aortoiliac stent placement for treatment of chronic lower-extremity ischemia. MATERIALS AND METHODS: Stents were placed in 505 arterial segment lesions in 365 patients who presented with symptoms of chronic leg ischemia between February 1992 and March 2001. The 505 treated lesions were 88 occlusions and 417 stenoses. Indications for stent placement were claudication in 312 (62%), rest pain in 107 (21%), ulcer in 67 (13%), and gangrene in 19 (4%) arterial segments. Patients were followed up for up to 105 months (mean, 33 months +/- 27 [SD]). RESULTS: Hemodynamic success was achieved in 484 (98%) of the 496 limbs for which postprocedural translesion pressure gradients were available. Mean ankle-brachial indexes improved from 0.53 +/- 0.25 to 0.79 +/- 0.23 (P <.001). Major complications were seen in 24 (7%) patients. Two patients (0.5%) died within 30 days after stent placement. Twenty (6%) of 355 patients underwent aortic or iliac bypass surgery during the follow-up period. Eight years after stent placement, primary patency was 74%; primary assisted patency, 81%; and secondary patency, 84%. Variables associated with better patency included stenosis (rather than occlusion), shorter lesion length, older age, and limb-threatening ischemia. At the last follow-up examination, 74% of the 466 limbs for which follow-up clinical status data were available were asymptomatic, 22% were associated with claudication, 3% were associated with rest pain, and 1% were associated with ischemic tissue loss. Five patients underwent amputation on the ipsilateral side after stent placement. CONCLUSION: Findings from long-term experience with aortoiliac stent placement for treatment of chronic lower-extremity ischemia confirmed the procedure to be a durable, low-risk revascularization option.

Aged↗
PubMed2003

Osseous change adjacent to soft-tissue hemangiomas of the extremities: correlation with lesion size and proximity to bone.

OBJECTIVE: The purpose of this study was to describe the findings of MR imaging and radiographic changes that occur in osseous structures adjacent to soft-tissue hemangiomas of the extremities and to correlate them with patient symptomatology, the size of the hemangiomas, and their proximity to adjacent bone. MATERIALS AND METHODS: We retrospectively reviewed the radiographs and MR images of 35 patients with soft-tissue hemangiomas of the extremities. The pattern and extent of the osseous change were categorized as periosteal, cortical, or medullary. Symptomatology, size, and proximity of the hemangioma to the adjacent bone were compared with the presence or absence of osseous change. Statistical analysis was performed using the Student's t test. RESULTS: Osseous change was noted on radiographs in 13 (37%) of 35 patients and on MR images in 11 (31%) of 35 patients with a total of 14 patients (40%) showing osseous change on at least one study. Periosteal change was present in eight (23%) of 35 patients; cortical change, in 11 (31%) of 35 patients; and medullary change, in 10 (29%) of 35 patients. Direct contact between the soft-tissue hemangioma and the adjacent bone was seen in 13 of 14 patients with osseous change. In those patients without osseous change, the average distance between the soft-tissue hemangioma and bone was 1.06 cm (range, 0-4 cm). No correlation was found between symptoms and the presence of osseous change. CONCLUSION: Soft-tissue hemangiomas of the extremities frequently result in adjacent osseous change that can be categorized as either periosteal, cortical, or medullary. Only medullary changes correspond with hemangioma size, whereas all three categories of change correlate with the proximity of the hemangioma to the adjacent bone. The presence of osseous change does not correlate with patient symptomatology.

Adolescent↗
PubMedDate not supplied

Percutaneous salvage of crushed bilateral aorto-iliac stents: case report.

There are multiple reports of externally deformed or crimped intravascular stents. Percutaneous salvage has been described in multiple anatomic locations including the carotid artery, coronary artery bypass grafts, and hemodialysis conduits. We report successful percutaneous salvage of severely crushed aortoiliac stents in a patient status post low anterior resection, chemotherapy, and radiation therapy for rectal carcinoma. A review of the literature describing approaches to externally deformed stents in other anatomic regions, the limited experience with crushed iliac stents, and our technique is presented.

Aorta, Abdominal↗