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Medicine May 2016The association between psoriasis and carotid intima-media thickness (CIMT) or impaired flow-mediated dilation (FMD) remains controversial. We aimed to evaluate the... (Meta-Analysis)
Meta-Analysis Review
The association between psoriasis and carotid intima-media thickness (CIMT) or impaired flow-mediated dilation (FMD) remains controversial. We aimed to evaluate the extent of subclinical atherosclerosis as measured by CIMT and FMD in patients with psoriasis by conducting a meta-analysis.A systematic literature search was performed using PubMed, Embase, Cochrane databases, China National Knowledge Infrastructure, and VIP databases up to February 2015. Observational studies investigating CIMT or FMD in patients with psoriasis and controls were eligible. Psoriatic patients and controls were at least age- and sex-matched. Random-effects analysis was used to estimate the weighted mean difference (WMD) and 95% confidence interval (CI) between psoriatic patients and controls.A total of 20 studies were identified and analyzed. Meta-analysis showed that psoriatic patients had a significantly thicker CIMT (WMD 0.11 mm; 95% CI 0.08-0.15) and lower FMD (WMD -2.79%; -4.14% to -1.43%) than those in controls. Subgroup analysis indicated that psoriatic arthritis appeared to have less impaired FMD (WMD -2.45%) and thinner CIMT (WMD 0.10 mm). Psoriatic patients with mean age >45 years had much thicker CIMT (WMD 0.13 mm). The impaired FMD (WMD -3.99%) seemed more pronounced in psoriatic patients with mean age <45 years.This meta-analysis suggests that patients with psoriasis are associated with excessive risk of subclinical atherosclerosis. Screening and monitoring CIMT and brachial artery FMD may be recommended to identify a subgroup of psoriatic patients at higher risk for cardiovascular events.
Topics: Atherosclerosis; Brachial Artery; Carotid Intima-Media Thickness; Dilatation, Pathologic; Humans; Psoriasis; Regional Blood Flow
PubMed: 27196459
DOI: 10.1097/MD.0000000000003576 -
International Wound Journal May 2023Hidradenitis suppurativa (HS) is a chronic and recurrent inflammatory disease often requiring surgical intervention in extensive lesions. Total of seven axillary lesion...
Hidradenitis suppurativa (HS) is a chronic and recurrent inflammatory disease often requiring surgical intervention in extensive lesions. Total of seven axillary lesion with HS was treated with free-style perforator based propeller flaps (innominate perforator originating from the brachial artery) after complete excision. The flap design mimicked the axis and design of the brachioplasty surgery. The flaps were elevated and after obliterating the defect, the remnant flap was discarded and donor site was primarily closed. All flaps were performed successfully and HS did not recur in any of the patients. In addition, the operated limb also showed a reduction of arm circumference of more than 5 cm. This is the first report using the free-style perforator based propeller flap to reconstruct the axillary HS. It is a simple and a reliable approach yielding good functional and aesthetic outcome with additional advantages of providing a brachioplasty.
Topics: Humans; Brachial Artery; Hidradenitis Suppurativa; Perforator Flap; Plastic Surgery Procedures; Skin Transplantation
PubMed: 36398456
DOI: 10.1111/iwj.14010 -
The American Journal of Case Reports Feb 2022BACKGROUND Use of the distal transradial artery (dTRA) for coronary angiography and PCI has been shown to be feasible and potentially has multiple advantages over...
BACKGROUND Use of the distal transradial artery (dTRA) for coronary angiography and PCI has been shown to be feasible and potentially has multiple advantages over proximal TRA regarding vascular complications, but when larger introducer sheaths (>6 Fr) are used, severe spasm and pain can be induced. However, in comparison with the more proximal part of the radial artery, the distal part is on average 0.5 mm smaller. As a consequence, when using dTRA, the use of slender techniques and miniaturization should be preferred to avoid a large sheath-to-artery mismatch, which has unfavorable consequences. A new approach named RailTracking, using a conventional 6 Fr or 7 Fr guiding catheter and a vascular dilator (the Railway Sheathless Access System [RS] from Cordis Company), allows use of distal arterial access without need for a sheet introducer. CASE REPORT We present 2 clinical cases with a difficult arterial access that were successfully managed using the RailTracking technique by dTRA access. In the first one, the conventional methods of arterial crossing failed because of the tortuosity and severe calcifications in the forearm and brachial artery. In the second case, the proximal TRA was occluded. Having arterial access on the dTRA and using the RailTracking allowed us to safely perform the interventions without need for vascular access site conversion. CONCLUSIONS A new approach, RailTracking, which includes sheathless distal radial access and use of the RSS system could potentially decrease the vascular complications and facilitate the crossing, even in cases of complex vessels anatomy.
Topics: Brachial Artery; Coronary Angiography; Humans; Percutaneous Coronary Intervention; Radial Artery; Treatment Outcome
PubMed: 35188945
DOI: 10.12659/AJCR.934760 -
American Journal of Physiology. Heart... Mar 2021Aging causes deleterious changes in resting conduit artery shear patterns and reduced blood flow during exercise partially attributable to reduced nitric oxide (NO).... (Randomized Controlled Trial)
Randomized Controlled Trial
Aging causes deleterious changes in resting conduit artery shear patterns and reduced blood flow during exercise partially attributable to reduced nitric oxide (NO). Inorganic nitrate increases circulating NO bioavailability and may, therefore, improve age-associated changes in shear rate as well as exercise hyperemia. Ten older adults (age: 67 ± 3 yr) consumed 4.03 mmol nitrate and 0.29 mmol nitrite (active) or devoid of both (placebo) daily for 4 wk in a randomized, double-blinded, crossover fashion. Brachial artery diameter (D) and blood velocity (V) were measured via Doppler ultrasound at rest for the characterization of shear profile as well as during two handgrip exercise trials (4 and 8 kg) for calculation of forearm blood flow (V × cross-sectional area, FBF) and conductance [FBF/mean arterial pressure, forearm vascular conductance (FVC)]. Plasma [nitrate] and [nitrite] increased following active ( < 0.05 for both) but not placebo ( = 0.68 and 0.40, respectively) supplementation. Neither mean nor antegrade shear rate changed following either supplement (beverage-by-time = 0.14 and 0.21, respectively). Retrograde (-13.4 ± 7.0 to -9.7 ± 6.8·s) and oscillatory (0.20 ± 0.08 to 0.15 ± 0.09 A.U., < 0.05 for both) shear decreased following active, but not placebo ( = 0.81 and 0.70, respectively), supplementation. The FBF response (Δ from rest) to neither 4-kg nor 8-kg trials changed following either supplement (beverage-by-time = 0.53 and 0.11, respectively). Similarly, no changes were observed in FVC responses to 4-kg or 8-kg trials (beverage-by-time = 0.23 and 0.07, respectively). These data indicate that inorganic nitrate supplementation improves conduit artery shear profiles, but not exercise hyperemia, in older adults. We report for the first time, to our knowledge, that 4 wk of inorganic nitrate supplementation attenuates retrograde and oscillatory shear in the brachial artery of older adults. However, this was not associated with greater hyperemic or vasodilatory responses to exercise. In sum, these data highlight favorable changes in shear patterns with aging, which may reduce the risk of atherosclerotic cardiovascular disease.
Topics: Age Factors; Aged; Beta vulgaris; Blood Flow Velocity; Brachial Artery; Cross-Over Studies; Dietary Supplements; Double-Blind Method; Female; Forearm; Fruit and Vegetable Juices; Hemodynamics; Humans; Male; Middle Aged; Nitrates; Regional Blood Flow; Time Factors; Treatment Outcome
PubMed: 33449848
DOI: 10.1152/ajpheart.00843.2020 -
Journal of Vascular Surgery Jan 2020Previous investigations have suggested that a minimum venous outflow diameter (MVOD) and perianastomotic arterial diameter are associated with successful autogenous...
OBJECTIVE
Previous investigations have suggested that a minimum venous outflow diameter (MVOD) and perianastomotic arterial diameter are associated with successful autogenous arteriovenous maturation and patency. The goal of this study was to determine anatomic and clinical variables that may influence access patency to guide optimal autogenous access configuration selection.
METHODS
Accesses created from 2010 to 2016 were analyzed from data entered into a prospective database. Preprocedure duplex ultrasound mapping data of artery and tourniquet-derived vein diameters and demographic and clinical variables were collected. Survival-based cut point analysis was used to determine anatomic parameters most predictive of access failure. Kaplan-Meier and Cox proportional hazards analyses were used to assess patencies and maturation and to identify independent predictors of access failure.
RESULTS
A total of 356 first-time autogenous accesses were created (median follow-up, 20 months; range, 0-73 months). Of these, 202 (56.7%) were radiocephalic and 154 (43.3%) were brachiocephalic. Maturation failure at end of follow-up for arteriovenous accesses was 26% ± 3% for radiocephalic accesses and 15% ± 3% for brachiocephalic accesses (P < .001). For radiocephalic accesses, MVOD <3.0 mm and radial artery diameter <2.1 mm independently predicted access maturation failure (MVOD <3.0 mm: hazard ratio [HR], 2.62 [95% confidence interval (CI), 1.27-5.39; P = .009]; radial artery diameter <2.1 mm: HR, 2.20 [95% CI, 1.20-4.05; P = .011]) and secondary patency loss (MVOD <3.0 mm: HR, 2.21 [95% CI, 1.24-3.96; P = .007]; radial artery diameter <2.1 mm: HR, 2.11 [95% CI, 1.26-3.63; P = .004]). A combination of radial artery diameter <2.1 mm and MVOD <3.0 mm most strongly predicted maturation failure (HR, 4.24; 95% CI, 1.71-10.49; P = .002) and loss of secondary patency (HR, 4.03; 95% CI, 1.88-8.64; P < .001). Only diabetes mellitus (HR, 2.24; P = .012) predicted secondary patency loss. For brachiocephalic accesses, MVOD <3.4 mm (HR, 2.12; 95% CI, 1.02-4.46; P = .043) was found to independently predict secondary patency loss in addition to previous ipsilateral (HR, 2.37; P = .038) and bilateral (HR, 4.00; P = .015) tunneled hemodialysis catheters. Brachial artery diameter was not associated with either access maturation or patency.
CONCLUSIONS
Artery and tourniquet-derived vein diameters independently predict radiocephalic access patency and functional outcomes. A combination of a radial artery diameter <2.1 mm and MVOD <3.0 mm best predicts maturation failure and patency loss for radiocephalic access. MVOD <3.4 mm was associated with increased loss of brachiocephalic access secondary patency, but MVOD was not associated with maturation.
Topics: Aged; Arteriovenous Shunt, Surgical; Brachial Artery; Databases, Factual; Female; Graft Occlusion, Vascular; Humans; Male; Middle Aged; Radial Artery; Renal Dialysis; Retrospective Studies; Risk Assessment; Risk Factors; Tourniquets; Treatment Outcome; Ultrasonography, Doppler, Duplex; Upper Extremity; Vascular Patency; Veins
PubMed: 31303475
DOI: 10.1016/j.jvs.2019.03.075 -
Vascular Medicine (London, England) Nov 2009Clinic-based, case-control studies linked sleep-disordered breathing (SDB) to markers of endothelial dysfunction. We attempted to validate this association in a large...
Clinic-based, case-control studies linked sleep-disordered breathing (SDB) to markers of endothelial dysfunction. We attempted to validate this association in a large community-based sample, and evaluate the relation of SDB to arterial diameter and peripheral blood flow. This community-based, cross-sectional observational study included 327 men and 355 women, aged 42-83 years, from the Framingham Heart Study site of the Sleep Heart Health Study. The polysomnographically derived apnea-hypopnea index and the hypoxemia index (percent sleep time with oxyhemoglobin saturation below 90%) were used to quantify the severity of SDB. Brachial artery ultrasound measurements included baseline diameter, percent flow-mediated dilation, and baseline and hyperemic flow velocity and volume. The baseline brachial artery diameter was significantly associated with both the apnea-hypopnea index and the hypoxemia index. The association was diminished by adjustment for body mass index, but remained significant for the apnea-hypopnea index. Age-, sex-, race- and body mass index-adjusted mean diameters were 4.32, 4.33, 4.33, 4.56, 4.53 mm for those with apnea-hypopnea index < 1.5, 1.5-4.9, 5-14.9, 15-29.9, >/= 30, respectively; p = 0.03. Baseline flow measures were associated with the apnea-hypopnea index but this association was non-significant after adjusting for body mass index. No significant association was observed between measures of SDB and percent flow-mediated dilation or hyperemic flow in any model. In conclusion, this study supports a moderate association of SDB and larger baseline brachial artery diameter, which may reflect SDB-induced vascular remodeling. This study does not support a link between SDB and endothelial dysfunction as measured by brachial artery flow-mediated dilation.
Topics: Adult; Aged; Aged, 80 and over; Blood Flow Velocity; Brachial Artery; Cross-Sectional Studies; Female; Humans; Hyperemia; Hypoxia; Laser-Doppler Flowmetry; Male; Middle Aged; Polysomnography; Regional Blood Flow; Severity of Illness Index; Sleep Apnea Syndromes; Ultrasonography; Vasodilation
PubMed: 19808720
DOI: 10.1177/1358863X09105132 -
Internal Medicine Journal Jan 2021Despite multiple studies, it has not been possible to account for the normal changes of blood pressure that occur from infancy to old age. We sought a comprehensive... (Review)
Review
Despite multiple studies, it has not been possible to account for the normal changes of blood pressure that occur from infancy to old age. We sought a comprehensive explanation, by linking brachial pressure with the well documented changes in the arterial pulse waveform, whose peak and nadir determine systolic, diastolic and pulse pressure in brachial arteries. Changes in humans arterial pulse wave contour from birth to old age can be readily explained on (i) growth, with increasing length of the body from birth to adolescence, and adult height maintained thereafter, and (ii) degeneration and dilation of the aorta from elastic fibre fracture throughout life, causing progressive increase in aortic pressure wave amplitude from early return of wave reflection, and summation of incident with reflected waves in systole. These changes throughout life complement arterial pulse waveform analysis and explain brachial cuff pressure values, with optimal pulse wave pattern for cardiac interaction apparent in adolescence.
Topics: Adult; Aorta; Arterial Pressure; Blood Pressure; Brachial Artery; Humans; Longevity; Systole
PubMed: 32175664
DOI: 10.1111/imj.14815 -
American Journal of Physiology. Heart... Aug 2018Sex hormone concentrations differ between men, premenopausal women with natural menstrual cycles (NAT), and premenopausal women using oral contraceptive pills (OCP), as...
Sex hormone concentrations differ between men, premenopausal women with natural menstrual cycles (NAT), and premenopausal women using oral contraceptive pills (OCP), as well as across menstrual or OCP phases. This study sought to investigate how differences in sex hormones, particularly estradiol, between men and women and across cycle phases might influence brachial artery endothelial function. Fifty-three healthy adults (22 ± 3 yr, 20 men, 15 NAT women, and 18 second-, third-, or fourth-generation OCP women) underwent assessments of sex hormones and endothelial [flow-mediated dilation (FMD) test] and smooth muscle [nitroglycerin (NTG) test] function. Men were tested three times at 1-wk intervals, and women were tested three times throughout a single menstrual or OCP cycle (NAT: menstrual, midfollicular, and luteal phases and OCP: placebo/no pill, "early", and "late" active pill phases). Endogenous estradiol concentration was comparable between men and women in their NAT menstrual or OCP placebo phase ( P = 0.36) but increased throughout a NAT cycle ( P < 0.001). Allometrically scaled FMD did not change across a NAT or OCP cycle but was lower in both groups of women than in men ( P = 0.005), whereas scaled NTG was lower only in NAT women ( P = 0.001). Changes in estradiol across a NAT cycle were not associated with changes in relative FMD ( r = 0.01, P = 0.62) or NTG ( r = 0.09, P = 0.13). Duration of OCP use was negatively associated with the average relative FMD for second-generation OCP users only ( r = -0.65, P = 0.04). Our findings suggest that brachial endothelial function is unaffected by cyclic hormonal changes in premenopausal women but may be negatively impacted by longer-term use of second-generation OCPs. NEW & NOTEWORTHY We demonstrate that brachial artery flow-mediated dilation does not change across a menstrual or oral contraceptive pill cycle in premenopausal women but is lower in women than in men. Although unaffected by within-cycle changes in estradiol, brachial flow-mediated dilation is negatively correlated with duration of oral contraceptive pill use for second-generation pills.
Topics: Adult; Blood Flow Velocity; Brachial Artery; Contraceptives, Oral, Hormonal; Endothelium, Vascular; Female; Gonadal Hormones; Humans; Male; Menstrual Cycle; Random Allocation
PubMed: 29727219
DOI: 10.1152/ajpheart.00102.2018 -
Obesity (Silver Spring, Md.) Nov 2009Endothelial dysfunction may link obesity to cardiovascular disease (CVD). We tested the hypothesis that visceral abdominal tissue (VAT) as compared with subcutaneous...
Endothelial dysfunction may link obesity to cardiovascular disease (CVD). We tested the hypothesis that visceral abdominal tissue (VAT) as compared with subcutaneous adipose tissue (SAT) is more related to endothelium-dependent vasodilation. Among Framingham Offspring and Third Generation cohorts (n = 3,020, mean age 50 years, 47% women), we used multivariable linear regression adjusted for CVD and its risk factors to relate computed tomography (CT)-assessed VAT and SAT, BMI, and waist circumference (WC), with brachial artery measures. In multivariable-adjusted models, BMI, WC, VAT, and SAT were positively related to baseline artery diameter and baseline mean flow velocity (all P < 0.001), but not hyperemic mean flow velocity. In multivariable-adjusted models, BMI (P = 0.002), WC (P = 0.001), and VAT (P = 0.01), but not SAT (P = 0.24) were inversely associated with percentage of flow-mediated dilation (FMD%). However, there was little incremental increase in the proportion of variability explained by VAT (R(2) = 0.266) as compared to SAT (R(2) = 0.265), above and beyond traditional risk factors. VAT, but not SAT was associated with FMD% after adjusting for clinical covariates. Nevertheless, the differential association with VAT as compared to SAT was minimal.
Topics: Abdominal Fat; Adiposity; Body Mass Index; Brachial Artery; Cardiovascular Diseases; Endothelium, Vascular; Female; Hemodynamics; Humans; Male; Middle Aged; Models, Statistical; Risk Factors; Stress, Mechanical; Subcutaneous Fat; Tomography, X-Ray Computed; Vasodilation; Waist Circumference
PubMed: 19282819
DOI: 10.1038/oby.2009.60 -
Folia Morphologica 2023The aim of the following study was to present and comprehensively describe a case of a bilateral absence of the deep brachial artery (DBA). Furthermore, its embryology... (Meta-Analysis)
Meta-Analysis
The aim of the following study was to present and comprehensively describe a case of a bilateral absence of the deep brachial artery (DBA). Furthermore, its embryology and clinical significance will also be discussed. During routine dissection, a 71-year-old male cadaver with a bilateral abnormality in the DBA and its branches was found. The first branch of the brachial artery (BA) was found to be the radial collateral artery, which passed behind the radial nerve. Furthermore, the middle collateral artery originated distal to the radial collateral artery and gave off first a singular, minor muscular branch and then the superior ulnar collateral artery. Later, the preceding nutrient arteries of the humerus and the deltoid branch consecutively branched off from the middle collateral artery. Subsequently, the middle ulnar collateral artery, the inferior ulnar collateral artery, the deltoid artery, the radial artery, and the ulnar artery branched off from the BA, as adapted in the current knowledge regarding the anatomy of the upper extremity. Furthermore, detailed measurements of the distances between the mentioned arteries were carried out. In the present study, a bilateral absence of the DBA was demonstrated. Meta-analysis focusing on the anatomy of this artery has shown how variable its characteristics are. However, our case report is the first in the literature to present this extremely rare variation. Having adequate knowledge regarding the anatomy of the arteries of the proximal arm is of immense importance when performing orthopaedic and reconstructive surgeries in this area.
Topics: Male; Humans; Aged; Brachial Artery; Arm; Ulnar Artery; Radial Artery; Humerus; Cadaver
PubMed: 37016782
DOI: 10.5603/FM.a2023.0026