Temporary bite-raising crowns.
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Adolescent↗
Biomedical subjects
Sunita Srivastava
Publications and source records attributed to Sunita Srivastava.
Basic fibroblast growth factor increases collateral blood flow in spontaneously hypertensive rats.
Ischemia-induced angiogenic response is reduced in spontaneously hypertensive rats (SHR). To study whether exogenous basic fibroblast growth factor (bFGF) infusion is effective in expanding collateral circulation in frankly hypertensive SHR, femoral arteries of male SHR (weighing approximately 250 g) were kept intact (nonoccluded control; n = 9) or occluded for 4h(n = 12) or for 16 days with vehicle (n = 14) or bFGF [0.5 (n = 17), 5.0 (n = 13), and 50.0 (n = 14) microg. kg-1. day-1 for 14 days] intraarterially. Maximal collateral-dependent blood flows (BF) to the hindlimbs were determined with 85Sr- and 141Ce-labeled microspheres during running at 20 and 25 m/min (15% grade). Preexercise heart rates (approximately 530 beats/min) and blood pressures (BP; approximately 200 mmHg) were similar across groups except in the high-dose bFGF group, where BP was reduced by approximately 12% (P < 0.05). Femoral artery occlusion for 4 h resulted in approximately 95% reduction of BF in calf muscles [199 +/- 18.7 (nonoccluded group) to 10 +/- 1.0 ml. min-1. 100 g-1; P < 0.001]. BF to calf muscles of the vehicle and low-dose bFGF (0.5 microg. kg-1. day-1) groups increased to 36 +/- 3.2 and 45 +/- 2.0 ml. min-1. 100 g-1, respectively (P < 0.001). bFGF infusion at 5.0 and 50.0 microg. kg-1. day-1 further increased (P < 0.001) BF to calf muscles (62 +/- 4.6 and 62 +/- 2.2 ml. min-1. 100 g-1, respectively). Our results show that bFGF can effectively increase BF in hypertensive rats. The reduced hypertension with high-dose bFGF suggests that a critical signal in arteriogenesis (nitric oxide bioavailability) may be restored. These findings suggest that the dulled endothelial nitric oxide synthase of SHR does not preempt collateral vessel remodeling.
Animals↗
Should patients with challenging anatomy be offered endovascular aneurysm repair?
OBJECTIVES: Treatment of abdominal aortic aneurysm is controversial in patients at high physiologic risk for open repair and high anatomic risk for endovascular repair. We compared outcome in patients at high risk because of anatomy (short or angulated neck), severe occlusive disease, or bilateral iliac aneurysms (group A) with outcome in patients at low risk (group B). MATERIAL AND METHODS: Patients at high anatomic risk who underwent treatment between October 1998 and March 2002 with the Zenith endovascular graft (group A) were compared with patients at low anatomic risk enrolled in a prospective multicenter trial (group B). Variables compared included overall mortality, need for secondary interventions, development of endoleak, and change in aneurysm sac diameter. The chi(2) test, Student t test, and proportions analysis were used to assess the data. RESULTS: Data for 493 patients (group A, 141; group B, 352) were evaluated. Mean follow-up was 9 months (range, 1-24 months). Perioperative mortality was similar for groups A and B (0.7% vs 1%). Frequency of endoleak was higher in patients with high-risk anatomy (25% vs 11%), but not significantly so (P >.06). The rate of aneurysm shrinkage, even in the absence of endoleak, was slower in group A (P <.05). CONCLUSIONS: In physiologically challenged patients at higher anatomic risk for endovascular aneurysm repair, initial mortality rate is similar to that in patients at lower risk. Short-term technical results are acceptable. Decreased long-term survival (largely unrelated to the procedure), slightly higher frequency of endoleak, and a lower rate of sac shrinkage may temper enthusiasm for endovascular repair in this subgroup. Risks of repairing aneurysms in this patient population must be viewed in the context of expected results of intervention or medical observation.
Algorithms↗
Broadening the applicability of endovascular aneurysm repair: the use of iliac conduits.
OBJECTIVE: Suboptimal iliac anatomy has sometimes precluded endovascular repair of abdominal aortic aneurysm (AAA). In an effort to increase the applicability of endovascular repair, a limited retroperitoneal approach and iliac conduit was used in some patients with unsuitable iliac anatomy at high risk for open repair. METHODS: Charts and imaging studies of 312 patients who underwent endovascular (AAA) repair at the Cleveland Clinic Foundation between June 1999 and November 2000 were reviewed. Among these, 22 patients with complex iliac anatomy had an iliac conduit placed. Seventeen of these procedures were planned, but five were unplanned and placed after an iliac artery injury. A group of 17 patients who underwent a standard endovascular repair without conduits was selected and matched to the 17 patients in the planned conduit group by baseline comorbidities. The conduits were 8-mm or 10-mm polyester grafts sewn proximally to the common iliac artery and provided unobstructed access to the aneurysm. After insertion of the endograft device through the conduit, the distal end of the conduit was anastomosed to the external iliac or common femoral vessels. RESULTS: Operative time and estimated blood loss were higher among patients in whom conduits were performed, especially when performed urgently as an unplanned procedure. Although operative time and intensive care unit and hospital stays were longer for the group of patients with iliac conduits, the cardiac pulmonary and renal complication rates were similar for the conduit and the standard endovascular repair group. CONCLUSION: The use of a limited retroperitoneal approach and iliac conduit for patients with difficult iliac anatomy increases the applicability of the endovascular repair of AAA. This technique should be considered when an open surgical approach is inadvisable on the basis of medical comorbidities.
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