To better understand the use of magnetic resonance angiography (MRA) in evaluating peripheral vascular disease, the authors studied arteries in the foot and ankle. Twenty patients with arterial occlusive disease of the lower extremity were studied with two-dimensional time-of-flight MRA, and the results were compared with those of 10 conventional x-ray arteriograms, four digital subtraction arteriograms, and three intraoperative arteriograms. The studies were reviewed and rated by three radiologists blinded to the patients' clinical history. Also, the first 16 patients were examined with MRA before and after intravenous injection of gadopentetate dimeglumine. The mean confidence levels for the reviewers' interpretations of the MRA studies were significantly higher than those for the conventional arteriograms for the medial plantar, lateral plantar, and plantar arch arteries of the feet (P < or = .005). Postcontrast MRA images were inferior to precontrast images because of overlapping of veins and arteries. Time-of-flight MRA without gadolinium can serve as a useful complementary study for evaluating patients with peripheral vascular disease in the foot and ankle.

Aged↗

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Vascular endoscopy --- an adjunct to carotid surgery.

Technical advances in optical instrumentation have made vascular endoscopy a potential method for intraoperative evaluation of carotid endarterectomy. A prospective protocol was designed to evaluate the efficacy and practicality of this technique using the Hopkins Optical System in 35 carotid endarterectomies. The external carotid artery was examined after completion of the endarterectomy. The distal internal carotid artery was examined after removal of the shunt with all but 1 cm of the arteriotomy closed. Total time required for the procedure was less than 5 minutes in 21 cases and between 5 and 10 minutes in 14. Positive findings were noted in 71% of the external carotid endarterectomies which consisted of intimal flaps in 13 cases and intimal shreds in 25. In 2 patients (6%), internal carotid endoscopy revealed intimal shreds capable of embolizing and probably capable of causing a postoperative neurologic deficit. This technique permits a precise and complete evaluation of the vascular reconstruction.

Carotid Arteries↗

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Proceedings: Topical myocardial coolings: an intensive laboratory investigation.

Explore the source record for details and available documents.

Animals↗

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Correlation of ophthalmic findings with carotid artery stenosis.

Patients presenting with symptoms suggestive of amaurosis fugax, or with findings of Hollenhorst plaques on fundoscopy are frequently referred for duplex evaluation to detect possible carotid artery disease. To better determine the reliability of monocular visual loss and the presence of Hollenhorst plaques for predicting the presence or significance of carotid artery stenosis, we prospectively studied 66 patients with these ocular signs and symptoms. After evaluation, the patients were categorized as follows: 34 of 66 (52%) patients had amaurosis fugax, 23 (35%) had asymptomatic Hollenhorst plaques, 7 (11%) had retinal artery occlusion, and 2 (3%) had venous stasis retinopathy. All patients were evaluated ophthalmologically, with carotid duplex scanning and spectral analysis. A stenosis of greater than 60% was regarded as significant. The presence of risk factors including hypertension, diabetes, a history of CVA or TIA's, tobacco use and hyperlipidemia was recorded. There were no statistically significant differences (p greater than 0.05) in the incidence of atherosclerotic risk factors between the four groups. Patients with amaurosis fugax were more likely to have a significant carotid artery stenosis than those with asymptomatic Hollenhorst plaques or retinal artery occlusion (53% vs 9% vs 0% respectively) (p less than 0.006). We conclude that routine carotid duplex scanning is indicated in all patients with amaurosis fugax in view of the frequent association with significant carotid stenosis (53%). However, the presence of Hollenhorst plaques in the absence of visual symptoms appears not to have a significant association with carotid disease and may not necessarily require routine screening unless other risk factors for carotid stenosis are present.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

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Atherosclerotic aneurysms of the axillary artery. A report of two cases and a review of the literature.

Atherosclerotic axillary artery aneurysms are rare. We report two cases of this entity and review the literature with respect to clinical presentation, diagnosis, operative management, and long-term outcome of these lesions.

Aged↗

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Outcome of intraarterial urokinase for acute vascular occlusion.

Intraarterial urokinase (IAUK) was administered to 33 patients on 40 occasions for the treatment of acute extremity ischemia and long-term patency was assessed. Lysis was successful in 39 of the 40 cases (95%). Occlusive thrombus was cleared in 12 of 13 patients with native artery occlusion (7 complete, 5 partial), 8 of 9 with autologous vein grafts (5 complete, 3 partial), and in all 18 patients with synthetic grafts (17 complete, 1 partial). The primary cumulative patency following successful IAUK was 100% for native arteries and 47% for synthetic grafts at 12 months, and 23% for autologous grafts at 9 months. The difference in rethrombosis rate between autologous vein (67%) and native artery (0%) was significant (p = 0.02) as was the difference between infrainguinal prosthetic grafts (63%) and native artery (p = 0.025). IAUK is most effective for the treatment of native artery occlusion, but is significantly less effective for thrombosed infrainguinal autologous vein or synthetic grafts due to the likelihood of reocclusion, despite the high immediate success rate. For autologous vein grafts, lysis is frequently incomplete and patency rapidly deteriorates regardless of adjunctive therapy to relieve the underlying obstruction.

Blood Vessel Prosthesis↗

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Internal mammary artery subclavian vein fistula following internal jugular vein catheterization. A case report and review of the literature.

We have recently treated a patient with an arteriovenous fistula that developed after a right internal jugular vein catheterization. The patient was found to have a pulsatile hematoma and a bruit five days after removal of a temporary pacemaker catheter. Digital subtraction arteriography documented a fistula between the right internal mammary artery and subclavian vein. The fistula was surgically repaired via the cervical route. To our knowledge, an arteriovenous fistula between the internal mammary artery and subclavian vein has not been previously described as a complication of a percutaneous internal jugular vein catheterization.

Adult↗