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Wu Y, Li X, Wang Z, Zhang S, Feng Y, Sun L. Real-time Elastography and Contrast-Enhanced Ultrasound for Evaluating Adventitia in the Early Diagnosis of Vulnerable Plaques: an Exploratory Study Based on Histopathology. Transl Stroke Res 2024; 15:545-555. [PMID: 36807280 DOI: 10.1007/s12975-023-01141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/23/2023]
Abstract
Vulnerable plaque is closely related to the occurrence of ischemic stroke. Therefore, early accurate identification of plaque vulnerability is crucial in risk stratification. In the development of vulnerable plaques, the change of the adventitia is earlier than that of the intima. Currently, researchers focused on the ultrasound detection of intraplaque and intima, but adventitia was often ignored in the examination. Real-time elastography technology (RTE) provides an estimation of adventitia stiffness, and contrast-enhanced ultrasound (CEUS) provides the quantification of adventitial VV. Therefore, we aimed to evaluate the value of adventitia in the early diagnosis of plaque vulnerability by combining CEUS and RTE based on histopathology. Rabbit carotid atherosclerosis models were established, and CEUS and RTE were performed. Normalized maximal video-intensity enhancement (MVE) was calculated to quantify adventitial VV density, and strain values were acquired to evaluate the adventitial elasticity. After removal of the lesion lumen, histological analysis of each excised plaque and adventitia was performed, and vulnerable plaques (n = 32) and stable group (n = 13) were distinguished. Normalized MVE of the adventitial VV and adventitial strain values in the vulnerable group was significantly higher than those in the stable group. Normalized MVE and strain values had a positive linear correlation with histological findings. Normalized MVE of the adventitial VV combined with adventitial strain values could identify plaque vulnerability with the area under the curve of 0.913 (sensitivity 90% and specificity 97%). Accordingly, the multimodal ultrasound detection strategy of adventitia has a high diagnostic value for early plaque vulnerability.
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Affiliation(s)
- Yingnan Wu
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiaoying Li
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zhenzhen Wang
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Shuang Zhang
- Department of Ultrasound, the 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yanan Feng
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Litao Sun
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Abstract
A propeller flap is an islanded flap that reaches the recipient site through an axial rotation around its vascular axis. The degree of rotation varies from 90 degrees to 180 degrees. It is a highly reliable local reconstructive option. These flaps are simple, single-stage, easy to harvest, and not constrained by routine length-to-width ratios. Since their introduction, the technique has continued to evolve and more applications for the use of propeller flaps are being explored. In spite of their growing use in clinical practice in recent years, many reconstructive surgeons are unaware of their versatility, unsure of their safety, and apprehensive about using propeller flaps confidently. This article aims at understanding the nomenclature, key principles, biogeometry and planning, operative technical details, applications, and complications of propeller flaps.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic & Reconstructive Surgery, B. J. Government Medical, College and Sassoon Hospital, Pune, Maharashtra, India,Address for correspondence Nikhil Panse, MCh, DNB Department of Plastic and Reconstructive Surgery, B.J.G.M.C. and Sassoon General HospitalPune, Maharashtra 411001India
| | - Ankur Karanjkar
- Department of Plastic & Reconstructive Surgery, B. J. Government Medical, College and Sassoon Hospital, Pune, Maharashtra, India
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Engel C, Meade R, Harroun N, Penrose A, Shafqat M, Jin X, DeSilva G, Semenkovich C, Zayed M. Altered Peroxisome Proliferator-Activated Receptor Alpha Signaling in Variably Diseased Peripheral Arterial Segments. Front Cardiovasc Med 2022; 9:834199. [PMID: 35783870 PMCID: PMC9248745 DOI: 10.3389/fcvm.2022.834199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/04/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Peripheral atherosclerosis that accumulates in the extracranial carotid and lower extremity arteries can lead to significant morbidity and mortality. However, atherosclerotic disease progression is often not homogenous and is accelerated by diabetes. We previously observed increased phospholipid content in minimally (Min)-diseased arterial segments compared to maximally (Max)-diseased segments. Since Peroxisome Proliferator-Activated Receptor alpha (PPARα) is a key regulator of lipid metabolism, we hypothesized that it may have differential expression and signaling in Min vs. Max-diseased peripheral arterial segments. Methods Eighteen patients who underwent carotid endarterectomy (CEA), and 34 patients who underwent major lower extremity amputation were prospectively enrolled into a vascular tissue biobank. Min and Max-diseased segments were obtained in real-time from CEA plaque and amputated lower extremity arterial segments. mRNA and protein were isolated from specimens and the relative expression of ppara, and its downstream genes Acyl-CoA Oxidase 1 (acox1) and Carnitine Palmitoyltransferase 1A (cpt1a) were also evaluated. We evaluated gene expression and protein content relative to atherosclerotic disease severity and clinical diabetes status. Gene expression was also evaluated relative to Hemoglobin A1c and serum lipid profiles. Results In CEA segments of patients with diabetes, we observed significantly higher ppara and acox1 gene expression (p < 0.01 and p < 0.001 respectively), and higher PPARα protein content (p < 0.05). Hemoglobin A1c significantly correlated with expression of ppara (R2 = 0.66, p < 0.001), acox1 (R2 = 0.31, p < 0.05), and cpt1a (R2 = 0.4, p < 0.05). There was no significant difference in gene expression between Min vs. Max-diseased CEA plaque segments. Conversely, in lower extremity arterial segments of patients with diabetes, we observed significantly lower ppara, acox1, and cpt1a expression (p < 0.05, p < 0.001, and p < 0.0001 respectively). Interestingly, CPT1A content was lower in arterial segments of patients with diabetes (p < 0.05). Hemoglobin A1c and HDL-cholesterol had negative correlations with ppara (R2 = 0.44, p < 0.05; R2 = 0.42, p < 0.05; respectively). Conclusion This study demonstrates the significant differential expression of ppara and its immediate downstream genes in human carotid and lower extremity arteries relative to disease severity and diabetes. These findings highlight that mechanisms that influence atheroprogression in the carotid and lower extremities peripheral arteries are not homogenous and can be impacted by patient diabetes status and serum cholesterol profiles. Further elucidating these differential molecular mechanisms can help improve targeted therapy of atherosclerosis in different peripheral arterial beds.
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Affiliation(s)
- Connor Engel
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Rodrigo Meade
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Nikolai Harroun
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Amanda Penrose
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Mehreen Shafqat
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Xiaohua Jin
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Gayan DeSilva
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Clay Semenkovich
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Mohamed Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States,Division of Molecular Cell Biology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States,Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO, United States,Veterans Affairs St. Louis Health Care System, St. Louis, MO, United States,*Correspondence: Mohamed Zayed,
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Dai J, Zhou Y, Mei S, Chen H. Application of the distally based sural neurocutaneous flaps in the management of foot and ankle defects in patients with diabetic foot. Front Endocrinol (Lausanne) 2022; 13:1009714. [PMID: 36213287 PMCID: PMC9537483 DOI: 10.3389/fendo.2022.1009714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We report our experience on the use of a distally based sural flap for soft tissue reconstruction of foot and ankle defects in patients with diabetic foot. METHODS The actual study is a retrospective, open, non-controlled, and clinical study of 25 patients treated with diabetic foot on whom reconstruction with distally based sural neurocutaneous flaps was performed from May 2019 to December 2021. RESULTS The mean age was 64.9 years, and there were 15 male and 10 female patients. The mean follow-up was 9.8 months, which ranged from 6 to 12 months. The size of the flaps ranged from 6 × 5 to 15 × 9 cm2. Twenty-two of the 25 flaps survived intact with sufficient blood supply. Two cases had a small superficial necrosis, which was resolved after a change of daily dressing and was heeled eventually. In one case, partial necrosis was observed that was managed with minor revision and the use of split-thickness skin graft. CONCLUSIONS The distally based sural flap is considered to be useful for reconstruction of foot and ankle defects in patients with diabetic foot.
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Affiliation(s)
- Jiezhi Dai
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yu Zhou
- Department of Orthopedic Surgery, Civil Aviation Hospital of Shanghai, Shanghai, China
| | - Shasha Mei
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Hua Chen, ; Shasha Mei,
| | - Hua Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Hua Chen, ; Shasha Mei,
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Shih YJ, Wang YC, Lin CT, Chang SC, Tzeng YS, Dai NT, Chen TM, Wang CH, Chen SG. Clinical Application of the Peroneal Artery Perforator Flap for Reconstruction of Lateral Malleolus Defects. INT J LOW EXTR WOUND 2021; 22:378-384. [PMID: 33949231 DOI: 10.1177/15347346211015828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The reconstruction of defects of the lateral malleolus involving the exposed fibular bone or tendon is challenging. This study aimed to evaluate the clinical application of the peroneal artery perforator flap with or without split-thickness skin grafting for soft tissue reconstruction of the bony defect of the lateral malleolus of the ankle joints. Reconstruction using a peroneal artery perforator flap with or without split-thickness skin grafting was performed for 15 patients (10 men, 5 women) between January 2007 and December 2018. The mean age was 53.7 years, and the mean size of the flaps was 40 cm2. The flaps were elevated in the form of a perforator flap, and split-thickness skin grafting was performed over the flaps and adjoining raw areas. The flaps survived in all cases; however, partial necrosis was observed in 3 cases. In cases of small-sized defects of the lateral malleolus of the ankle joints where a flap is required for the exposed bone or tendon, reconstruction using the peroneal artery perforator flap is advantageous, since the morbidity rate of the donor site is low and soft tissue is reconstructed.
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Affiliation(s)
- Yu-Jen Shih
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Yen-Chun Wang
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Chin-Ta Lin
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Shun-Cheng Chang
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Yuan-Sheng Tzeng
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Niann-Tzyy Dai
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Tim-Mo Chen
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Chih-Hsin Wang
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Shyi-Gen Chen
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
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Demiri E, Tsimponis A, Pavlidis L, Spyropoulou GA, Foroglou P, Dionyssiou D. Reverse neurocutaneous vs propeller perforator flaps in diabetic foot reconstruction. Injury 2020; 51 Suppl 4:S16-S21. [PMID: 32184012 DOI: 10.1016/j.injury.2020.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/23/2020] [Accepted: 03/07/2020] [Indexed: 02/02/2023]
Abstract
Introduction Reverse neurocutaneous and propeller perforator flaps are both used to reconstruct diabetic distal lower limb defects. Our study aims to compare outcomes between these two groups of flaps with an emphasis on indications and complication rates. Method A retrospective analysis was conducted, reviewing data from 54 diabetic patients who underwent reconstruction of acute or chronic wounds of the foot and ankle between 2005-2018. Thirty-four patients (Group A) had a reverse neurocutaneous flap (NCF): nineteen sural and fifteen lateral supramalleolar flaps. Twenty patients (Group B) had a propeller flap (PF) based on peroneal (n = 13) or posterior tibial artery perforators (n = 7). All patients had a preoperative Doppler examination to identify the nutrient artery of the flap. In both groups, we recorded patients' demographics, characteristics of the defect, postoperative complications and time to heal. Follow-up ranged from 6 to 59 months. Student's t-test and chi-squared test were used for statistical analysis. Results Mean patients' age was 59.1 and 50.8 years for Group A and B, respectively. Defects were located at the Achilles zone (n = 16), posterior heel (n = 14), foot dorsum (n = 9), lateral and medial malleolar areas (n = 8), anterior ankle (n = 5) and lateral foot (n = 2). Mean size of the defect was 42.8 cm2 in Group A and 23 cm2 in Group B. Uneventful healing was recorded in 20/34 neurocutaneous flaps and in 12/20 propeller flaps; complications included two complete flap losses (one NCF, one PF), seventeen distal flap necroses (10 NCFs, 7 PFs), fifteen delayed wound healing events over the donor or recipient site (12 NCFs, 3 PFs). Secondary surgeries were required in 15 NCF and 8 PF patients. Mean healing time was 48.1 and 40.7 days for Group A and B, respectively. All patients, except one NCF case, which resulted in leg amputation, returned to previous levels of ambulation. Conclusion Reverse neurocutaneous and propeller flaps may provide stable reconstruction of diabetic lower limb defects; neurocutaneous flaps are specially indicated for larger and more distally located defects, although they might be associated with longer healing time and additional revision surgeries. Propeller flaps were more frequently used in younger patients for smaller and more proximally located defects.
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Affiliation(s)
- Efterpi Demiri
- Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, Papageorgiou Hospital, Thessaloniki, Greece.
| | - Antonios Tsimponis
- Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, Papageorgiou Hospital, Thessaloniki, Greece
| | - Leonidas Pavlidis
- Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, Papageorgiou Hospital, Thessaloniki, Greece
| | - Georgia-Alexandra Spyropoulou
- Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, Papageorgiou Hospital, Thessaloniki, Greece
| | - Periclis Foroglou
- Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, Papageorgiou Hospital, Thessaloniki, Greece
| | - Dimitrios Dionyssiou
- Department of Plastic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, Papageorgiou Hospital, Thessaloniki, Greece
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Jakubietz RG, Schmidt K, Holzapfel BM, Meffert RH, Jakubietz MG. Pedicled perforator flaps for mid-tibial soft tissue reconstruction in medically compromised patients. JPRAS Open 2020; 24:47-55. [PMID: 32346592 PMCID: PMC7182687 DOI: 10.1016/j.jpra.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/05/2020] [Indexed: 11/17/2022] Open
Abstract
Background The soft tissue of the central pretibial area is difficult to reconstruct often requiring free tissue transfer. Especially medically compromised patients are not ideal candidates for free tissue transfer and may benefit from expeditiously harvested local flaps with limited donor site morbidity. As muscle flaps are rare, pedicled flaps based on lateral perforators represent an alternative as the arc of rotation can often be limited to 90°. Material and Methods A retrospective analysis of patient data was conducted to identify patients over the age of 60 years with comorbidities that underwent pretibial soft tissue reconstruction with a single-pedicle perforator flap. Patient demographics, size and cause of the defect, flap dimension, arc of rotation and complications were recorded. Results Five patients with an average age of 71.4 years were included. The arc of rotation was 69°, all flaps healed. There were two recurrences of osteomyelitis. Conclusion Lateral perforators originating from the anterior tibial artery or peroneal artery are adequate source vessels for single pedicled perforator flaps even in medically compromised patients. A perforator located proximal to the defect allows limiting the arc of rotation to less than 90°, which increases the safety of the flap. Patients benefit from a simple procedure without a microvascular anastomosis and a donor site confined to one extremity.
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Affiliation(s)
- Rafael G. Jakubietz
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Oberduerrbacherstr. 6, DE-97080 Wuerzburg, Germany
- Corresponding author.
| | - Karsten Schmidt
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Oberduerrbacherstr. 6, DE-97080 Wuerzburg, Germany
| | - Boris M. Holzapfel
- Department of Orthopaedic Surgery, KLH Julius Maximilian University Wuerzburg, Germany
| | - Rainer H. Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Oberduerrbacherstr. 6, DE-97080 Wuerzburg, Germany
| | - Michael G. Jakubietz
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Oberduerrbacherstr. 6, DE-97080 Wuerzburg, Germany
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Low OW, Sebastin SJ, Cheah AEJ. A Review of Pedicled Perforator Flaps for Reconstruction of the Soft Tissue Defects of the Leg and Foot. Indian J Plast Surg 2019; 52:26-36. [PMID: 31456610 PMCID: PMC6664841 DOI: 10.1055/s-0039-1688103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Lower extremity soft tissue defects frequently result from high-energy trauma or oncological resection. The lack of suitable muscle flap options for the distal leg and foot makes defects in these locations especially challenging to reconstruct and free tissue transfer is commonly used. Another option that has become more popular in the past two decades are pedicled perforator flaps. Based on a thorough literature review and the authors’ experience on leg perforator flaps for over a decade, this article presents a historical review, the anatomical basis of common perforator flaps of the leg and foot, patient selection, wound selection, perforator selection, flap design, surgical techniques, refinements, and postoperative care. A review of the clinical outcomes and complications of these flaps was also performed and was noted to be comparable to the outcomes of free tissue transfer with significantly lower total flap failure rate. It is hoped that this review will assist surgeons in the formulation of a comprehensive step-by-step guide in performing pedicled perforator flap reconstruction of the lower extremity.
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Affiliation(s)
- O-Wern Low
- Department of Hand and Reconstructive Microsurgery, University Orthopaedic and Hand Reconstructive Microsurgery Cluster, National University Health System, Singapore, Singapore
| | - Sandeep J Sebastin
- Department of Hand and Reconstructive Microsurgery, University Orthopaedic and Hand Reconstructive Microsurgery Cluster, National University Health System, Singapore, Singapore
| | - Andre E J Cheah
- Department of Hand and Reconstructive Microsurgery, University Orthopaedic and Hand Reconstructive Microsurgery Cluster, National University Health System, Singapore, Singapore
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Weir-McCall J, Bonnici-Mallia M, Ramkumar P, Nath A, Houston J. Whole-body magnetic resonance angiography. Clin Radiol 2019; 74:3-12. [DOI: 10.1016/j.crad.2018.05.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 04/10/2018] [Accepted: 05/29/2018] [Indexed: 01/01/2023]
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Pedicled Peroneal Artery Perforator Flap for Knee Defect Reconstruction: Case Presentation and Literature Discussion. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e2034. [PMID: 30881814 PMCID: PMC6414094 DOI: 10.1097/gox.0000000000002034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/24/2018] [Indexed: 11/25/2022]
Abstract
There have been very limited data on the use of pedicled peroneal artery perforator flaps in knee soft-tissue reconstruction, especially for anterior and medial defects. Here, we present a case of proximally based peroneal artery perforator flap for knee soft-tissue reconstruction in a defect that included lateral, anterior, and medial surfaces of the knee presenting the technical challenges associated with this flap. A 15-year-old girl presented with extruded knee implant after osteosarcoma resection of femur. The defect involved the whole knee with the anterior and mostly the lateral knee surfaces. Her medical condition precluded the use of free tissue transfer. During her previous surgery, gastrocnemius muscles were detached with injured vascular pedicled and posterior tibial artery. Successful single-stage coverage was achieved using a large proximally based pedicled peroneal artery perforator flap. There are only few reports that described the use of peroneal artery flaps for knee soft-tissue coverage. The reach of a proximally based flap can be increased when it is raised on a distal perforator or when peroneal artery has a proximal takeoff. Furthermore, removing the fibula can facilitate the dissection and the reach of the flap till the most medial aspect of the knee. Pedicled peroneal artery perforator flap provides superior soft-tissue coverage with limited morbidity for knee soft-tissue reconstruction; however, flap reach is usually affected by anatomic variation. Preoperative planning can help to determine the reach of the flap and ease the dissection.
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El-Sabbagh AH. Non-microsurgical skin flaps for reconstruction of difficult wounds in distal leg and foot. Chin J Traumatol 2018; 21:197-205. [PMID: 30007533 PMCID: PMC6085275 DOI: 10.1016/j.cjtee.2017.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 11/11/2017] [Accepted: 12/01/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To express the versatility of a variety of non-microsurgical skin flaps used for coverage of difficult wounds in the lower third of the leg and the foot over 4 years period. Five kinds of flaps were used. Each flap was presented with detailed information regarding indication, blood supply, skin territory and technique. METHODS Altogether 26 patients underwent lower leg reconstruction were included in this study. The reconstructive procedures applied five flaps, respectively distally based posterior tibial artery perforator flap (n = 8), distally based peroneal artery perforator flap (n = 4), distally based sural flap (n = 6), medial planter artery flap (n = 2) and cross leg flaps (n = 6). RESULTS In all cases, there were no signs of osteomyelitis of underlying bones or discharge from the undersurface of the flaps. Fat necrosis occurred at the distal end of posterior tibial artery perforator flap in one female patient. The two cases of medial planter artery flap showed excellent healing with closure of donor site primarily. One cross leg flap had distal necrosis. CONCLUSION Would at lower third of leg can be efficiently covered by posterior tibial, peroneal artery and sural flaps. Heel can be best covered by nearby tissues such as medial planter flap. In presence of vascular compromise of the affected limb or exposure of dorsum of foot, cross leg flap can be used.
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Medial temporal lobe atrophy ratings in a large 75-year-old population-based cohort: gender-corrected and education-corrected normative data. Eur Radiol 2017; 28:1739-1747. [PMID: 29124383 PMCID: PMC5834557 DOI: 10.1007/s00330-017-5103-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/24/2017] [Accepted: 09/27/2017] [Indexed: 12/21/2022]
Abstract
Objectives To find cut-off values for different medial temporal lobe atrophy (MTA) measures (right, left, average, and highest), accounting for gender and education, investigate the association with cognitive performance, and to compare with decline of cognitive function over 5 years in a large population-based cohort. Methods Three hundred and ninety 75-year-old individuals were examined with magnetic resonance imaging of the brain and cognitive testing. The Scheltens’s scale was used to assess visually MTA scores (0–4) in all subjects. Cognitive tests were repeated in 278 of them after 5 years. Normal MTA cut-off values were calculated based on the 10th percentile. Results Most 75-year-old individuals had MTA score ≤2. Men had significantly higher MTA scores than women. Scores for left and average MTA were significantly higher in highly educated individuals. Abnormal MTA was associated with worse results in cognitive test and individuals with abnormal right MTA had faster cognitive decline. Conclusion At age 75, gender and education are confounders for MTA grading. A score of ≥2 is abnormal for low-educated women and a score of ≥2.5 is abnormal for men and high-educated women. Subjects with abnormal right MTA, but normal MMSE scores had developed worse MMSE scores 5 years later. Key Points • Gender and education are confounders for MTA grading. • We suggest cut-off values for 75-year-olds, taking gender and education into account. • Males have higher MTA scores than women. • Higher MTA scores are associated with worse cognitive performance.
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Contrast-Enhanced Ultrasound Imaging Quantification of Adventitial Vasa Vasorum in a Rabbit Model of Varying Degrees of Atherosclerosis. Sci Rep 2017; 7:7032. [PMID: 28765521 PMCID: PMC5539241 DOI: 10.1038/s41598-017-06127-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 06/08/2017] [Indexed: 12/16/2022] Open
Abstract
This study used an atherosclerotic rabbit model to investigate the feasibility of quantifying adventitial vasa vasorum (VV) via contrast-enhanced ultrasound (CEUS) imaging to identify early atherosclerosis. Recent evidence has linked adventitial VV with atherosclerotic plaque progression and vulnerability. A growth in VV density has been detected preceding intimal thickening and even endothelial dysfunction. In our study, carotid atherosclerosis rabbit models were used, and animals underwent CEUS imaging at the end of the atherosclerotic induction period. Normalized maximal video-intensity enhancement (MVE) was calculated to quantify VV density. After CEUS imaging, animals were euthanized, and their carotids were processed for histopathological analysis following staining for CD31 and VEGF. Adventitial normalized MVE increased as atherosclerosis progressed (p < 0.001), and normalized MVE also progressed, demonstrating a linear correlation with histological findings (r = 0.634, p < 0.001 for VEGF-positive; r = 0.538, p < 0.001 for CD31-positive). Thus, we histologically validated that CEUS imaging can be used to quantify the development of adventitial VV associated with atherosclerosis progression. This method can be used for monitoring the VV to detect early atherosclerosis.
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Hansen T, Kilander L, Ahlström H, Lind L. Total atherosclerotic burden measured by magnetic resonance imaging is related to five-year decline in cognitive function. Clin Physiol Funct Imaging 2017; 38:373-377. [PMID: 28402078 DOI: 10.1111/cpf.12423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/16/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to explore whether total atherosclerotic burden is related to future decline in performance on cognitive tests. METHODS The total atherosclerotic burden (TAS) was assessed by whole-body magnetic resonance angiography (WBMRA) in 305 subjects at age 70 in the study Prospective Investigation of Vasculature in Uppsala Seniors (PIVUS). The mini-mental state examination (MMSE) and trail making tests (TMT) A and B were evaluated at ages 75 and 80 in 190 of those subjects. No subject with a diagnosis of dementia was included in the sample. RESULTS MMSE did not change during the 5 years of follow-up, while TMT A and B increased by 4 and 7 s, respectively. TAS at age 70 was significantly related to the individual change in TMT B (P<0·0001) between age 75 and 80, when adjusted for sex, education level, TMT B at age 75 and Framingham score at age 70. No such relationship was seen for the change in TMT A (P = 0·10). The relationship between TAS and the change in MMSE was of borderline significance (P = 0·025). CONCLUSION A relationship was found between the total atherosclerotic burden and future decline in performance on TMT B, highlighting a role of global atherosclerosis in the cognitive decline seen during ageing.
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Affiliation(s)
- Tomas Hansen
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Håkan Ahlström
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
| | - Lars Lind
- Institution of Medical Sciences, Uppsala University, Uppsala, Sweden
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Weir-McCall JR, White RD, Ramkumar PG, Gandy SJ, Khan F, Belch JJF, Struthers AD, Houston JG. Follow-up of atheroma burden with sequential whole body contrast enhanced MR angiography: a feasibility study. Int J Cardiovasc Imaging 2016; 32:825-32. [PMID: 26809611 PMCID: PMC4853465 DOI: 10.1007/s10554-016-0842-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/13/2016] [Indexed: 11/26/2022]
Abstract
Assess the feasibility of whole body magnetic resonance angiography (WB-MRA) for monitoring global atheroma burden in a population with peripheral arterial disease (PAD). 50 consecutive patients with symptomatic PAD referred for clinically indicated MRA were recruited. Whole body MRA (WB-MRA) was performed at baseline, 6 months and 3 years. The vasculature was split into 31 anatomical arterial segments. Each segment was scored according to degree of luminal narrowing: 0 = normal, 1 = <50 %, 2 = 50–70 %, 3 = 71–99 %, 4 = vessel occlusion. The score from all assessable segments was summed, and then normalised to the number of assessable vessels. This normalised score was divided by four (the maximum vessel score) and multiplied by 100 to give a final standardised atheroma score (SAS) with a score of 0–100. Progression was assessed with repeat measure ANOVA. 36 patients were scanned at 0 and 6 months, with 26 patients scanned at the 3 years follow up. Only those who completed all three visits were included in the final analysis. Baseline atherosclerotic burden was high with a mean SAS of 15.7 ± 10.3. No significant progression was present at 6 months (mean SAS 16.4 ± 10.5, p = 0.67), however there was significant disease progression at 3 years (mean SAS 17.7 ± 11.5, p = 0.01). Those with atheroma progression at follow-up were less likely to be on statin therapy (79 vs 100 %, p = 0.04), and had significantly higher baseline SAS (17.6 ± 11.2 vs 10.7 ± 5.1, p = 0.043). Follow up of atheroma burden is possible with WB-MRA, which can successfully quantify and monitor atherosclerosis progression at 3 years follow-up.
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Affiliation(s)
- Jonathan R. Weir-McCall
- />Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, DD1 9SY UK
| | - Richard D. White
- />Department of Clinical Radiology, University Hospital of Wales, Cardiff, CF14 4XW UK
| | - Prasad G. Ramkumar
- />NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY UK
| | - Stephen J. Gandy
- />NHS Tayside Medical Physics, Ninewells Hospital, Dundee, DD1 9SY UK
| | - Faisel Khan
- />Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, DD1 9SY UK
| | - Jill J. F. Belch
- />Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, DD1 9SY UK
| | - Allan D. Struthers
- />Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, DD1 9SY UK
| | - J. Graeme Houston
- />Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, DD1 9SY UK
- />NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY UK
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16
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Automated extraction and labelling of the arterial tree from whole-body MRA data. Med Image Anal 2015; 24:28-40. [DOI: 10.1016/j.media.2015.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 05/09/2015] [Accepted: 05/13/2015] [Indexed: 11/18/2022]
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Tarnoki DL, Tarnoki AD, Richter A, Karlinger K, Berczi V, Pickuth D. Clinical value of whole-body magnetic resonance imaging in health screening of general adult population. Radiol Oncol 2015; 49:10-6. [PMID: 25810696 PMCID: PMC4362601 DOI: 10.2478/raon-2014-0031] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 06/18/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Whole-body magnetic resonance imaging (WB-MRI) and angiography (WB-MRA) has become increasingly popular in population-based research. We evaluated retrospectively the frequency of potentially relevant incidental findings throughout the body. MATERIALS AND METHODS 22 highly health-conscious managers (18 men, mean age 47±9 years) underwent WB-MRI and WB-MRA between March 2012 and September 2013 on a Discovery MR750w wide bore 3 Tesla device (GE Healthcare) using T1 weighted, short tau inversion recovery (STIR) and diffusion weighted imaging (DWI) acquisitions according to a standardized protocol. RESULTS A suspicious (pararectal) malignancy was detected in one patient which was confirmed by an endorectal sonography. Incidental findings were described in 20 subjects, including hydrocele (11 patients), benign bony lesion (7 patients) and non-specific lymph nodes (5 patients). Further investigations were recommended in 68% (ultrasound: 36%, computed tomography: 28%, mammography: 9%, additional MRI: 9%). WB-MRA were negative in 16 subjects. Vascular normal variations were reported in 23%, and a 40% left proximal common carotid artery stenosis were described in one subject. CONCLUSIONS WB-MRI and MRA lead to the detection of clinically relevant diseases and unexpected findings in a cohort of healthy adults that require further imaging or surveillance in 68%. WB-MR imaging may play a paramount role in health screening, especially in the future generation of (epi)genetic based screening of malignant and atherosclerotic disorders. Our study is the first which involved a highly selected patient group using a high field 3-T wide bore magnet system with T1, STIR, MRA and whole-body DWI acquisitions as well.
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Affiliation(s)
- David Laszlo Tarnoki
- Department of Diagnostic and Interventional Radiology, Caritasklinikum Saarbrücken St. Theresia, Academic Teaching Hospital of Saarland University, Saarbrücken, Germany
- Department of Radiology and Oncotherapy, Semmelweis University School of Medicine, Budapest, Hungary
| | - Adam Domonkos Tarnoki
- Department of Diagnostic and Interventional Radiology, Caritasklinikum Saarbrücken St. Theresia, Academic Teaching Hospital of Saarland University, Saarbrücken, Germany
- Department of Radiology and Oncotherapy, Semmelweis University School of Medicine, Budapest, Hungary
| | - Antje Richter
- Department of Diagnostic and Interventional Radiology, Caritasklinikum Saarbrücken St. Theresia, Academic Teaching Hospital of Saarland University, Saarbrücken, Germany
| | - Kinga Karlinger
- Department of Radiology and Oncotherapy, Semmelweis University School of Medicine, Budapest, Hungary
| | - Viktor Berczi
- Department of Radiology and Oncotherapy, Semmelweis University School of Medicine, Budapest, Hungary
| | - Dirk Pickuth
- Department of Diagnostic and Interventional Radiology, Caritasklinikum Saarbrücken St. Theresia, Academic Teaching Hospital of Saarland University, Saarbrücken, Germany
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van der Zee CW, Moerman E, Haverlag R, Schepers T. Coverage of Exposed Bone of the Lateral Malleolus With a Proximally Based Lateral Malleolar Perforator Flap. J Foot Ankle Surg 2014; 54:730-3. [PMID: 25154652 DOI: 10.1053/j.jfas.2014.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Indexed: 02/03/2023]
Abstract
The treatment of soft tissue defects of the ankle, combined with an implant-related infection, remains a challenge. The present case report illustrates the use of a pedicled perforator flap for soft tissue reconstruction to cover a postoperative defect at the lateral malleolus after an ankle fracture.
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Affiliation(s)
| | - Esther Moerman
- Department of Plastic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Robert Haverlag
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Tim Schepers
- Department of Surgery, Trauma Surgery Trauma Unit, Academic Medical Centre, Amsterdam, The Netherlands
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Hagström E, Michaëlsson K, Melhus H, Hansen T, Ahlström H, Johansson L, Ingelsson E, Sundström J, Lind L, Ärnlöv J. Plasma–Parathyroid Hormone Is Associated With Subclinical and Clinical Atherosclerotic Disease in 2 Community-Based Cohorts. Arterioscler Thromb Vasc Biol 2014; 34:1567-73. [DOI: 10.1161/atvbaha.113.303062] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Cardiovascular risk factors have different impact on different arterial territories. Diseases with elevated circulating parathyroid hormone (PTH) such as primary hyperparathyroidism and chronic renal failure have been shown to be associated with an increased risk of cardiovascular disease, predominantly heart or cerebrovascular diseases. However, data on the associations between circulating PTH and peripheral atherosclerosis are limited.
Approach and Results—
Two prospective, community-based studies were used. In 306 men and women, who were 70 years old, from the Prospective investigation of the vasculature in Uppsala seniors (PIVUS) study, cross-sectional relations between PTH and atherosclerotic burden assessed by whole-body magnetic resonance angiography were investigated. In 998 men, who were 71 years old, from the Uppsala longitudinal study of adult men (ULSAM) study, the association between PTH concentration and risk of subsequent nonfatal atherosclerotic disease (excluding coronary or cerebrovascular disease) was investigated. Adjusting for established vascular risk factors, PTH was associated with burden of atherosclerosis (increase in total atherosclerotic score per SD PTH increase: 0.04, 0.003–0.08;
P
=0.03) in the PIVUS study. During follow-up in the ULSAM study (median 16.7 years), 89 men were diagnosed with nonfatal atherosclerotic disease. In Cox-regression analyses adjusting for established vascular risk factors and mineral metabolism, higher PTH was associated with an increased risk of nonfatal atherosclerotic disease (hazard ratio for 1 SD increase of PTH: 1.55, 1.33–1.88;
P
<0.0001). Results were similar when including fatal atherosclerotic disease in the outcome.
Conclusions—
In 2 independent community-based cohorts, PTH was associated to the degree of atherosclerosis and risk of clinically overt atherosclerotic disease, respectively. Our data confirm and extend previous studies supporting a role for PTH in the development of atherosclerotic disease.
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Affiliation(s)
- Emil Hagström
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Karl Michaëlsson
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Håkan Melhus
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Thomas Hansen
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Håkan Ahlström
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Lars Johansson
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Erik Ingelsson
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Johan Sundström
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Lars Lind
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
| | - Johan Ärnlöv
- From the Uppsala Clinical Research Center (E.H., E.I., J.S., J.Ä.), Departments of Radiology (T.H., H.A., L.J.) and Medical Sciences (E.H., J.Ä., E.I., J.S., L.L.), Uppsala University, Uppsala, Sweden; and the School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.)
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20
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Lundberg C, Hansen T, Ahlström H, Lind L, Wikström J, Johansson L. The relationship between carotid intima-media thickness and global atherosclerosis. Clin Physiol Funct Imaging 2014; 34:457-62. [PMID: 24405735 PMCID: PMC4237190 DOI: 10.1111/cpf.12116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 11/15/2013] [Indexed: 11/28/2022]
Abstract
Background The aim of this study was to investigate the relationship between (i) carotid intima–media thickness (CIMT) at baseline as well as (ii) change in CIMT over 5 years (ΔCIMT) and atherosclerotically induced luminal narrowing in non-coronary arterial territories assessed by whole-body magnetic resonance angiography (WBMRA). Methods and results In subgroups of the Prospective Investigation of Vasculature in Uppsala Seniors (PIVUS) study, US measurements of CIMT in the common carotid arteries were analysed at 70 and 75 years and ΔCIMT was calculated (n = 272). WBMRA, assessing arterial stenosis in five different territories by which also a total atherosclerotic score (TAS) was calculated, was performed at 70 years (n = 306). Results Carotid intima–media thickness in the carotid artery at baseline was correlated with TAS (P = 0·0001) when adjusted to a set of traditional risk factors for atherosclerosis, as well as to stenosis in two of the different investigated territories (aorta and lower leg, P = 0·013 and P = 0·004), but there was no significant correlation between ΔCIMT and TAS (P = 0·41). Conclusions In the present study, CIMT, but not ΔCIMT over 5 years, in the carotid artery was related to overall stenoses in the body, as assessed by WBMRA. These findings support CIMT as a general marker for atherosclerosis.
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Affiliation(s)
- C Lundberg
- Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden
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21
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Lundberg C, Johansson L, Barbier CE, Lind L, Ahlström H, Hansen T. Total atherosclerotic burden by whole body magnetic resonance angiography predicts major adverse cardiovascular events. Atherosclerosis 2013; 228:148-52. [PMID: 23474127 DOI: 10.1016/j.atherosclerosis.2013.02.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 01/25/2013] [Accepted: 02/13/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of the present study was to investigate the relationship between the Total Atherosclerotic Score (TAS), a measurement of the overall atherosclerotic burden of the arterial tree by whole body magnetic resonance angiography (WBMRA), and the risk of major adverse cardiovascular events (MACE), defined as cardiac death, myocardial infarction, stroke and/or coronary revascularization, assuming that TAS predicts MACE. METHODS AND RESULTS 305 randomly selected 70 year-old subjects (47% women) underwent WBMRA. Their atherosclerotic burden was evaluated and TAS > 0, that is atherosclerotic changes, were found in 68% of subjects. During follow-up (mean 4.8 years), MACE occurred in 25 subjects (8.2%). Adjusting for multiple risk factors, TAS was associated with MACE (OR 8.86 for any degree of vessel lumen abnormality, 95%CI 1.14-69.11, p = 0.037). In addition, TAS improved discrimination and reclassification when added to the Framingham risk score (FRS), and ROC (Receiver Operator Curve) increased from 0.681 to 0.750 (p = 0.0421). CONCLUSION In a population-based sample of 70 year old men and women WBMRA, with TAS, predicted MACE independently of major cardiovascular risk factors.
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Affiliation(s)
- Christina Lundberg
- Department of Radiology, Uppsala University hospital, 75185 Uppsala, Sweden.
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Georgescu AV, Matei IR, Capota IM. The use of propeller perforator flaps for diabetic limb salvage: a retrospective review of 25 cases. Diabet Foot Ankle 2012; 3:18978. [PMID: 23050066 PMCID: PMC3464067 DOI: 10.3402/dfa.v3i0.18978] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 07/30/2012] [Accepted: 08/13/2012] [Indexed: 11/24/2022]
Abstract
Background Peripheral vascular disease and/or diabetic neuropathy represent one of the main etiologies for the development of lower leg and/or diabetic foot ulcerations, and especially after acute trauma or chronic mechanical stress. The reconstruction of such wounds is challenging due to the paucity of soft tissue resources in this region. Various procedures including orthobiologics, skin grafting (SG) with or without negative pressure wound therapy and local random flaps have been used with varying degrees of success to cover diabetic lower leg or foot ulcerations. Other methods include: local or regional muscle and fasciocutaneous flaps, free muscle and fasciocutaneous, or perforator flaps, which also have varying degrees of success. Patients and methods This article reviews 25 propeller perforator flaps (PPF) which were performed in 24 diabetic patients with acute and chronic wounds involving the foot and/or lower leg. These patients were admitted beween 2008 and 2011. Fifteen PPF were based on perforators from the peroneal artery, nine from the posterior tibial artery, and one from the anterior tibial artery. Results A primary healing rate (96%) was obtained in 18 (72%) cases. Revisional surgery and SG for skin necrosis was performed in six (24%) cases with one complete loss of the flap (4%) which led to a lower extremity amputation. Conclusions The purpose of this article is to review the use of PPF as an effective method for soft tissue coverage of the diabetic lower extremity and/or foot. In well-controlled diabetic patients that present with at least one permeable artery in the affected lower leg, the use of PPF may provide an alternative option for soft tissue reconstruction of acute and chronic diabetic wounds.
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Affiliation(s)
- Alexandru V Georgescu
- Department of Plastic Surgery and Reconstructive Microsurgery, Clinic Hospital of Recovery, University of Medicine "Iuliu Hatieganu", Cluj Napoca, Romania
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Laible M, Schoenberg SO, Weckbach S, Lettau M, Winnik E, Bischof J, Franke R, Reiser M, Kramer H. Whole-body MRI and MRA for evaluation of the prevalence of atherosclerosis in a cohort of subjectively healthy individuals. Insights Imaging 2012; 3:485-93. [PMID: 22836780 PMCID: PMC3443278 DOI: 10.1007/s13244-012-0180-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 05/23/2012] [Accepted: 06/04/2012] [Indexed: 01/07/2023] Open
Abstract
Objectives To assess the prevalence of cardiovascular findings in asymptomatic individuals by means of 1.5-T whole-body magnetic resonance imaging and angiography. Methods A cohort of 138 individuals (118 men, 20 women) with a mean age of 54 years (SD ± 7.55) was referred to whole-body MRI at 1.5-T, including contrast-enhanced whole-body MR angiography (MRA) and cardiac MRI. A total of 2,065/2,070 vessel segments (99.8%) and cardiac function were evaluated. Results Approximately one-fourth of the participating individuals had vascular abnormalities. In 17 subjects (12.3% of all subjects) significant luminal narrowing was observed in at least one vascular segment. Luminal narrowing (mild to severe) was observed in 1 (0.7% of all subjects respectively) of the renal arteries, 7 (5.0%) of the carotid arteries, and 3 (2.2%) of the pelvic and upper leg arteries, and in 17 segments (12.3%) of arteries in the lower leg. In cardiac function and perfusion imaging, wall motion disorders were observed in six patients (4.3%), with additional delayed enhancement and isolated delayed enhancement present in two cases. Functional parameters differed from reference values in 55 cases. Conclusions Even in an asymptomatic cohort of middle-aged predominantly male individuals, atherosclerotic disease is not uncommon and is detectable by whole-body MRI. Main Messages In middle-aged predominantly male individuals, atherosclerotic disease is not uncommon. Even in an asymptomatic collective, approximately one fourth had vascular abnormalities. Using whole-body MR angiography (MRA), 99.8% of 2,070 vessel segments could be evaluated.
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Affiliation(s)
- M Laible
- Department of Clinical Radiology, University Hospital Munich, Grosshadern Campus, Munich, Germany,
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Tharayil J, Patil RK. Reverse peroneal artery flap for large defects of ankle and foot: A reliable reconstructive technique. Indian J Plast Surg 2012; 45:45-52. [PMID: 22754152 PMCID: PMC3385397 DOI: 10.4103/0970-0358.96584] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Large soft tissue defects around the lower third of the leg, ankle and foot always have been challenging to reconstruct. Reverse sural flaps have been used for this problem with variable success. Free tissue transfer has revolutionised management of these problem wounds in selected cases. Materials and Methods: Twenty-two patients with large defects around the lower third of the leg, ankle and foot underwent reconstruction with reverse peroneal artery flap (RPAF) over a period of 7 years. The mean age of these patients was 41.2 years. Results: Of the 22 flaps, 21 showed complete survival without even marginal necrosis. One flap failed, where atherosclerotic occlusion of peroneal artery was evident on the table. Few patients had minor donor site problems that settled with conservative management. Conclusions: RPAF is a very reliable flap for the coverage of large soft tissue defects of the heel, sole and dorsum of foot. This flap adds versatility in planning and execution of this extended reverse sural flap.
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Affiliation(s)
- Jose Tharayil
- Department of Plastic and Reconstructive Surgery, Lakeshore Hospital, Cochin, Kerala, India
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Järhult SJ, Hansen T, Ahlström H, Johansson L, Sundström J, Lind L. Brachial artery hyperaemic blood flow velocity in relation to established indices of vascular function and global atherosclerosis: the Prospective Investigation of the Vasculature in Uppsala Seniors study. Clin Physiol Funct Imaging 2012; 32:227-33. [PMID: 22487158 DOI: 10.1111/j.1475-097x.2011.01117.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Systolic to diastolic blood flow velocity (SDFV) ratio in the brachial artery recently proved to be related to cardiovascular risk and carotid atherosclerosis. We hypothesized that the SDFV ratio was related to established markers of vascular function and global atherosclerosis. METHODS Established markers of endothelial function in forearm resistance vessels, flow-mediated vasodilation and arterial stiffness were assessed in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study including 1016 individuals aged 70. Whole-body magnetic resonance angiography was performed in a random 306 of the participants. Atherosclerotic lesions were summarized in a total atherosclerotic score (TAS). Before and during hyperaemia of the brachial artery, systolic and diastolic blood flow velocities were measured by Doppler. RESULTS The SDFV ratio was positively related to endothelium-independent vasodilatation, while inverse relations were found to flow-mediated dilation, common carotid artery distensibility and the stroke volume to pulse pressure ratio. Endothelium-dependent vasodilatation and total peripheral resistance index were not significantly related to the SDFV ratio. The SDFV ratio (P = 0·015) and the blood flow increase (BFI) during hyperaemia (P = 0·020) were both significantly related to TAS after gender adjustment. When adjusted for the Framingham risk score, both the SDFV ratio (P = 0·057) and BFI (P = 0·078) lost somewhat in significance. CONCLUSION The SDFV ratio was related to established markers of both vasodilation and arterial compliance, and to global atherosclerosis. Future larger studies have to evaluate whether the SDFV ratio is related to global atherosclerosis independently of traditional risk factors.
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Affiliation(s)
- Susann J Järhult
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
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Propeller perforator flaps in distal lower leg: evolution and clinical applications. Arch Plast Surg 2012; 39:94-105. [PMID: 22783507 PMCID: PMC3385316 DOI: 10.5999/aps.2012.39.2.94] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 01/31/2012] [Accepted: 02/01/2012] [Indexed: 12/22/2022] Open
Abstract
Simple or complex defects in the lower leg, and especially in its distal third, continue to be a challenging task for reconstructive surgeons. A variety of flaps were used in the attempt to achieve excellence in form and function. After a long evolution of the reconstructive methods, including random pattern flaps, axial pattern flaps, musculocutaneous flaps and fasciocutaneous flaps, the reappraisal of the works of Manchot and Salmon by Taylor and Palmer opened the era of perforator flaps. This era began in 1989, when Koshima and Soeda, and separately Kroll and Rosenfield described the first applications of such flaps. Perforator flaps, whether free or pedicled, gained a high popularity due to their main advantages: decreasing donor-site morbidity and improving aesthetic outcome. The use as local perforator flaps in lower leg was possible due to a better understanding of the cutaneous circulation, leg vascular anatomy, angiosome and perforasome concepts, as well as innovations in flaps design. This review will describe the evolution, anatomy, flap design, and technique of the main distally pedicled propeller perforator flaps used in the reconstruction of defects in the distal third of the lower leg and foot.
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Lu TC, Lin CH, Lin CH, Lin YT, Chen RF, Wei FC. Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects. J Plast Reconstr Aesthet Surg 2011; 64:386-93. [PMID: 20538534 DOI: 10.1016/j.bjps.2010.05.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 05/05/2010] [Accepted: 05/07/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Ting-Chen Lu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, 5, Fu-Hsing St. Kuei-Shan, Taoyuan, Taiwan
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Abizanda P, Atienzar P, Casado L, Romero L, Sánchez-Jurado PM, León M, Martín-Sebastiá E, López-Jiménez E, Paterna G, Martínez-Sánchez E. Cardiovascular risk factors are associated with subclinical atherosclerosis in high functioning older adults. Maturitas 2010; 67:54-9. [DOI: 10.1016/j.maturitas.2010.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 04/08/2010] [Accepted: 04/23/2010] [Indexed: 01/19/2023]
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Moguillansky D, Leng X, Carson A, Lavery L, Schwartz A, Chen X, Villanueva FS. Quantification of plaque neovascularization using contrast ultrasound: a histologic validation. Eur Heart J 2010; 32:646-53. [PMID: 20581005 DOI: 10.1093/eurheartj/ehq197] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The density of vasa vasorum within atherosclerotic plaque correlates with histologic features of plaque vulnerability in post-mortem studies. Imaging methods to non-invasively detect vasa vasorum are limited. We hypothesized that contrast ultrasound (CUS) can quantify vasa vasorum during atherosclerosis progression. METHODS AND RESULTS New Zealand white rabbits received a high-fat diet for 3 weeks, and bilateral femoral artery stenosis was induced by balloon injury. Contrast ultrasound femoral imaging was performed at baseline and 2, 4, and 6 weeks post injury to quantify adventitial videointensity. At each imaging time point 10 vessels were sectioned and stained with haematoxylin and eosin and von-Willebrand factor. Adventitial vasa vasorum density was quantified by counting the number of stained microvessels and their total cross-sectional area. Plaque size (per cent lumen area) progressed over time (P < 0.001), as did adventitial vasa vasorum density (P < 0.001). Plateau peak videointensity also progressed, demonstrating a strong linear correlation with histologic vasa vasorum density (P < 0.001). Receiver operating characteristic analysis indicated that a three-fold increase in median adventitial videointensity had a sensitivity of 100% and specificity of 88% for predicting abnormal neovascularization. CONCLUSION We have histologically validated that CUS quantifies the development of adventitial vasa vasorum associated with atherosclerosis progression. This imaging technique has the potential for characterizing prognostically significant plaque features.
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Affiliation(s)
- Diego Moguillansky
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Cardiovascular Institute, Pittsburgh, PA, USA
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Lehrke S, Egenlauf B, Steen H, Lossnitzer D, Korosoglou G, Merten C, Ivandic BT, Giannitsis E, Katus HA. Prediction of coronary artery disease by a systemic atherosclerosis score index derived from whole-body MR angiography. J Cardiovasc Magn Reson 2009; 11:36. [PMID: 19761595 PMCID: PMC2758875 DOI: 10.1186/1532-429x-11-36] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Accepted: 09/17/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whole-body magnetic resonance angiography (WB-MRA) has shown its potential for the non-invasive assessment of nearly the entire arterial vasculature within one examination. Since the presence of extra-cardiac atherosclerosis is associated with an increased risk of coronary events, our goal was to establish the relationship between WB-MRA findings, including a systemic atherosclerosis score index, and the presence of significant coronary artery disease (CAD). METHODS WB-MRA was performed on a 1.5T scanner in 50 patients scheduled to undergo elective cardiac catheterization for suspected CAD. In each patient, 40 extra-cardiac vessel segments were evaluated and assigned scores according to their luminal narrowing. The atherosclerosis score index (ASI) was generated as the ratio of summed scores to analyzable segments. RESULTS ASI was higher in patients with significant (> 50% stenosis) CAD (n = 27) vs. patients without CAD (n = 22; 1.56 vs. 1.28, p = 0.004). ASI correlated with PROCAM (R = 0.57, p < 0.001) and Framingham (R = 0.36, p = 0.01) risk scores as estimates of the 10-year risk of coronary events. A ROC derived ASI of > 1.54 predicted significant CAD with a sensitivity of 59%, specificity of 86% and a positive predictive value of 84%. Logistic regression revealed ASI > 1.54 as the strongest independent predictor for CAD with a 11-fold increase in likelihood to suffer from significant coronary disease. On the contrary, while 15/27 (55%) of patients with CAD exhibited at least one extra-cardiac stenosis > 50%, only 3/22 (14%) of those patients without CAD did (p = 0.003). The likelihood for an extra-cardiac stenosis when CAD is present differed between vascular territories and ranged from 15% for a carotid stenosis to 44% for a stenosis in the lower extremities. CONCLUSION This study provides important new evidence for the close association of extra-cardiac and coronary atherosclerosis. The novel findings that a WB-MRA derived systemic atherosclerosis score index is not only associated with established cardiovascular risk scores but is also predictive of significant CAD suggest its potential prognostic implications and underline the importance to screen for coronary disease in patients with extra-cardiac manifestations of atherosclerosis.
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Affiliation(s)
- Stephanie Lehrke
- Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Benjamin Egenlauf
- Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Henning Steen
- Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Dirk Lossnitzer
- Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Grigorius Korosoglou
- Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Constanze Merten
- Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Boris T Ivandic
- Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Evangelos Giannitsis
- Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
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Lind L, Andersson J, Hansen T, Johansson L, Ahlström H. Atherosclerosis measured by whole body magnetic resonance angiography and carotid artery ultrasound is related to arterial compliance, but not to endothelium-dependent vasodilation - the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Clin Physiol Funct Imaging 2009; 29:321-9. [DOI: 10.1111/j.1475-097x.2009.00871.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wikström J, Hansen T, Johansson L, Ahlström H, Lind L. Lower extremity artery stenosis distribution in an unselected elderly population and its relation to a reduced ankle-brachial index. J Vasc Surg 2009; 50:330-4. [PMID: 19446989 DOI: 10.1016/j.jvs.2009.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 02/27/2009] [Accepted: 03/10/2009] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study evaluated the distribution and degree of symmetry of lower extremity artery stenoses in an unselected elderly population and its relation to a reduced ankle-brachial index (ABI) measurement. METHODS This was a population-based study set in a university hospital comprising 306 randomly selected 70-year-old individuals participating in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Whole-body magnetic resonance angiography (MRA) and bilateral ABI measurements were performed in each participant. The prevalence of stenosis >or=50% was evaluated in nine different arterial segments in both legs: common iliac artery (CIA), external iliac artery (EIA), common femoral artery (CFA), superficial femoral artery (SFA), popliteal artery (PA), tibioperoneal trunk (TPTr), anterior tibial artery (ATA), posterior tibial artery (PTA), and peroneal artery. The relations between the prevalences of stenosis in different arterial segments in the right and left leg were assessed. An evaluation was made of the relation between a >or=50% stenosis and an ABI <0.9 in the different segments. RESULTS The prevalence of stenosis was 0% to 21%. In all segments, a stenosis was more commonly found in one of the legs only than in both legs. The prevalence of >or=50% stenosis in the right leg only, left leg only, and both legs was 0.3%, 0.7%, and 0% in the CIA; 0.3%, 1.0%, and 0.7% in the EIA; 0%, 0%, and 0% in the CFA; 2.0%, 1.3%, and 0.7% in the SFA; 0.7%, 0.7%, and 0.3% in the PA; 1.0%, 0.7%, and 0% in the TPTr; 5.6%, 6.3%, and 8.6% in the ATA; 0.7%, 1.7%, and 0% in the peroneal artery; and in 2.0%, 2.7%, and 3.4% in the PTA. When the legs were compared, a significant correlation was found for the presence of a >or=50% stenosis in the EIA, SFA, PA, ATA, and PTA. Seventeen participants showed ABI <0.9. In logistic regression analysis with ABI <0.9 as dependent variable, stenosis in SFA, ATA, and PTA were the major independent variables to explain a low ABI in both of the legs. CONCLUSIONS The distribution of stenosis differs substantially when legs are compared. Despite this difference, stenosis in SFA, ATA, and PTA was the major determinant of a low ABI in both of the legs.
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Affiliation(s)
- Johan Wikström
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden.
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Abstract
Diabetes mellitus is a major cardiovascular risk factor and one of the major causes for morbidity and mortality worldwide. Diabetic complications have not only major impact on the quality of life of diabetic patients, but are also potentially life-threatening. Therefore prevention, diagnosis and therapy of these long-term complications are of high importance. However, diagnosis of the variety of complications from diabetes mellitus remains a diagnostic challenge and usually several diagnostic steps are necessary to diagnose or exclude these complications. In the last years whole body magnetic resonance imaging (WB-MRI) including whole body magnetic resonance angiography (WB-MRA) has been introduced for cardiovascular imaging and is now increasingly applied in clinical routine for the workup of patients with cardiovascular disease and for cardiovascular screening. The article summarizes rationales for WB-MRI in diabetes mellitus, technical concepts of disease specific cardiovascular WB-MRI in diabetes mellitus and discusses potential clinical consequences.
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Mirza MAI, Hansen T, Johansson L, Ahlström H, Larsson A, Lind L, Larsson TE. Relationship between circulating FGF23 and total body atherosclerosis in the community. Nephrol Dial Transplant 2009; 24:3125-31. [PMID: 19429932 DOI: 10.1093/ndt/gfp205] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Fibroblast growth factor-23 (FGF23) is a regulator of mineral metabolism and has been suggested to play a role in vascular calcification in chronic kidney disease (CKD). Data on the association between FGF23 and atherosclerosis, both in CKD and in the community, is limited. METHODS The total body atherosclerosis score (AS) was determined by a magnetic resonance imaging-based angiography in 306 elderly men and women, representing a subsample of the community-based PIVUS cohort. Subjects were divided into three categories based on AS: AS = 0, low AS and high AS. Serum FGF23 was measured using a two-site monoclonal antibody ELISA. RESULTS In continuous and multi-category regression models, higher FGF23 was associated with a significant increase in the odds of having a high AS (OR 1.43, CI 1.06-1.92 to OR 3.01, CI 1.52-5.99). This association was stronger in individuals with eGFR <60 mL/min/1.73 m(2) (n = 27), reaching a nearly 6-fold increase in the odds for a high AS in the upper FGF23 tertile (OR 5.64, CI 2.78-11.5). We found weaker support for a relationship between FGF23 and the presence of atherosclerosis as subjects in the highest FGF23 tertile had an increased risk for an AS > 0 in crude models (OR 1.93, CI 1.05-3.55), but this was not statistically significant in adjusted (OR 1.42, CI 0.74-1.72) models. CONCLUSIONS We provide novel evidence supporting an association between serum FGF23 and total body atherosclerosis in the community. Additional studies are warranted to determine the prospective relationship between FGF23 and atherosclerosis, and whether FGF23 is a modifiable cardiovascular risk factor.
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Affiliation(s)
- Majd A I Mirza
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Hansen T, Ahlström H, Söderberg S, Hulthe J, Wikström J, Lind L, Johansson L. Visceral adipose tissue, adiponectin levels and insulin resistance are related to atherosclerosis as assessed by whole-body magnetic resonance angiography in an elderly population. Atherosclerosis 2008; 205:163-7. [PMID: 19118830 DOI: 10.1016/j.atherosclerosis.2008.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Revised: 10/17/2008] [Accepted: 11/11/2008] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The principal aim of this study was to determine whether the amount of visceral adipose tissue (VAT) is more related than subcutaneous adipose tissue (SAT) to atherosclerosis assessed by whole-body MRA (WBMRA). A further objective was to investigate whether traditional risk factors, inflammation, or adipokines could explain the hypothesized relationship between VAT and atherosclerosis. METHODS Men and women aged 70 were recruited from the general population into the Prospective Investigation of The Vasculature in Uppsala Seniors (PIVUS) and 306 of them underwent WBMRA in a clinical 1.5-T scanner. The arterial tree was assessed for degree of stenosis or occlusion and a total atherosclerotic score (TAS) was established. Information on risk factors and BMI and on SAT and VAT, segmented on an axial MR scan was collected. Adiponectin, leptin, and high sensitive C-reactive protein (hsCRP) were measured in serum. HOMA index was used as a marker of insulin resistance. RESULTS VAT was related to TAS independently of gender, total obesity (BMI), amount of SAT, hsCRP and also to the traditional risk factors included in the Framingham risk score (FRS) in an elderly population. Adiponectin or the HOMA insulin resistance, but not leptin or VAT, together with FRS was significantly related to TAS in a multiple censored regression model. CONCLUSION Adiponectin attenuated the relationship between VAT and TAS, suggesting that adiponectin and insulin resistance is an important link between visceral adiposity and atherosclerosis.
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Affiliation(s)
- T Hansen
- Dept of Radiology, Uppsala University Hospital, Sweden.
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Total-body contrast-enhanced MRA on a short, wide-bore 1.5-T system: intra-individual comparison of Gd-BOPTA and Gd-DOTA. Eur Radiol 2008; 18:2265-73. [DOI: 10.1007/s00330-008-0976-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 03/19/2008] [Accepted: 03/21/2008] [Indexed: 10/22/2022]
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Wanhainen A, Themudo R, Ahlström H, Lind L, Johansson L. Thoracic and abdominal aortic dimension in 70-year-old men and women – A population-based whole-body magnetic resonance imaging (MRI) study. J Vasc Surg 2008; 47:504-12. [DOI: 10.1016/j.jvs.2007.10.043] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Revised: 10/17/2007] [Accepted: 10/21/2007] [Indexed: 11/26/2022]
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A total atherosclerotic score for whole-body MRA and its relation to traditional cardiovascular risk factors. Eur Radiol 2008; 18:1174-80. [DOI: 10.1007/s00330-008-0864-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 11/24/2007] [Accepted: 01/08/2008] [Indexed: 10/22/2022]
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Kramer H, Weckbach S, van Kaick G, Reiser MF, Schoenberg SO. [Screening in cardiovascular diseases]. Radiologe 2008; 48:52-62. [PMID: 18210053 DOI: 10.1007/s00117-007-1607-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cardiovascular disease still ranks number one in the mortality statistics in the industrialized world. In Germany the five most common causes of death are all associated with arteriosclerotic changes of the arterial vasculature. As the treatment often extends over long periods and it can be impossible for patients to work, peripheral arterial occlusive disease (PAOD) constitutes a not inconsiderable economic factor. Thus, screening for arteriosclerotic disease seems to be reasonable, because the potential for influencing arteriosclerotic changes is known to be higher in an early stage of the disease even before symptoms become apparent. Not every case can be cured, but progression can frequently be slowed down. The need for invasive procedures, some of them associated with ionizing radiation, limited the use of imaging of the arterial vasculature for a long time. Noninvasive clinical examinations such as the "ankle brachial index" (ABI) can indicate the presence of PAOD, though exact localization of the pathologic changes is not possible except with imaging methods. In contrast to these, MRI is a noninvasive imaging modality that does not involve ionizing radiation but offers high spatial resolution arterial imaging.
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Affiliation(s)
- H Kramer
- Institut für Klinische Radiologie, Klinikum Grosshadern der Ludwig-Maximilians-Universität München, München, Deutschland.
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Hansen T, Ahlström H, Johansson L. Whole-body screening of atherosclerosis with magnetic resonance angiography. Top Magn Reson Imaging 2007; 18:329-337. [PMID: 18025987 DOI: 10.1097/rmr.0b013e318159aaa2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
With whole-body magnetic resonance angiography (WBMRA), it is possible to examine the whole arterial tree except intracranial and coronary vessels in a single examination without the risks involved in ionizing radiation or arterial cannulation. Whole-body magnetic resonance angiography is well suited for repeated clinical examinations in patients with systemic diseases such as vasculitis or atherosclerosis and can also be used for scientific purposes. On the basis of the WBMRA overview, a possible further development of the WBMRA concept can be to perform further acquisitions at sites with atherosclerotic plaques with higher-resolution scans to determine the degree of stenosis more accurately or to achieve plaque characterization. A total validation of WBMRA compared with digital subtraction angiography (DSA) is not possible owing to the hazards of ionizing radiation. Studies have shown a high sensitivity and specificity for the pelvic and lower limb arteries in comparison with DSA. No systematic validation against DSA has been performed for the renal, aortic, and carotid arteries. Various methods have been used, however, for confirmation of vascular abnormalities found on WBMRA such as ultrasonography, dedicated MRA, or DSA, with reasonably high agreement. The WBMRA method has not been studied with regard to prediction of future cardiovascular (CV) events, as have intima media thickness, coronary artery calcium scoring, and the ankle-brachial index. The full usefulness of WBMRA in an epidemiological setting and as a complementary screening tool for assessing CV risk still needs to be validated against future CV events.
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Affiliation(s)
- Tomas Hansen
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden.
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