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Indian Journal of Ophthalmology Dec 2018The pathogeneses, clinical features, and management of central retinal artery occlusion (CRAO) are discussed. CRAO consists of the following four distinct clinical... (Review)
Review
The pathogeneses, clinical features, and management of central retinal artery occlusion (CRAO) are discussed. CRAO consists of the following four distinct clinical entities: non-arteritic CRAO (NA-CRAO), transient NA-CRAO, NA-CRAO with cilioretinal artery sparing, and arteritic CRAO. Clinical characteristics, visual outcome, and management very much depend upon the type of CRAO. Contrary to the prevalent belief, spontaneous improvement in both visual acuity and visual fields does occur, mainly during the first 7 days. The incidence of spontaneous visual acuity improvement during the first 7 days differs significantly (P < 0.001) among the four types of CRAO; among them, in eyes with initial visual acuity of counting finger or worse, visual acuity improved, remained stable, or deteriorated in NA-CRAO in 22%, 66%, and 12%, respectively; in NA-CRAO with cilioretinal artery sparing in 67%, 33%, and none, respectively; and in transient NA-CRAO in 82%, 18%, and none, respectively. Arteritic CRAO shows no change. Recent studies have shown that administration of local intra-arterial thrombolytic agent not only has no beneficial effect but also can be harmful. Investigations to find the cause and to prevent or reduce the risk of any further visual problems are discussed. Prevalent multiple misconceptions on CRAO are discussed.
Topics: Fluorescein Angiography; Fundus Oculi; Humans; Retinal Artery; Retinal Artery Occlusion; Visual Acuity
PubMed: 30451166
DOI: 10.4103/ijo.IJO_1446_18 -
Journal of Cosmetic Dermatology Feb 2021As the face is known for its extreme variation in vascular anatomy and the number of filler-associated complications due to intra-arterial injection is increasing, we... (Review)
Review
BACKGROUND
As the face is known for its extreme variation in vascular anatomy and the number of filler-associated complications due to intra-arterial injection is increasing, we are in need of a method to visualize anyone's individual arterial anatomy of the face in a completely harmless way.
AIMS
The different medical imaging methods and a recently developed MRA protocol are reviewed.
METHODS
The literature of the last twenty years-with special attention for the last five years-concerning the different medical imaging modalities of the facial arteries was reviewed.
RESULTS
A harmless visualisation of the facial arteries is currently only possible with US or MRA. US may identify single vessels but never the complete arterial network. A combination of IR "heat enhancement" and a MRA 3D-TOF sequence might make it feasible to visualize a large number of facial arteries in a risk-free, radiation-free, contrast-free and non-invasive way.
CONCLUSION
Currently, a new combination of IR "heat enhancement" and a MRA 3D-TOF sequence might be the only method to visualize a large number of facial arteries.
Topics: Arteries; Face; Humans; Magnetic Resonance Angiography
PubMed: 32459040
DOI: 10.1111/jocd.13477 -
JACC. Cardiovascular Interventions May 2022
Topics: Arterial Occlusive Diseases; Cardiac Catheterization; Catheterization, Peripheral; Humans; Radial Artery; Treatment Outcome
PubMed: 35331685
DOI: 10.1016/j.jcin.2022.03.008 -
British Journal of Clinical Pharmacology Nov 2000Arterial endothelial dysfunction is one of the key early events in atherogenesis, preceding structural atherosclerotic changes. It is also important in the late stages... (Review)
Review
Arterial endothelial dysfunction is one of the key early events in atherogenesis, preceding structural atherosclerotic changes. It is also important in the late stages of obstructive atherosclerosis, predisposing to constriction and/or thrombosis. Endothelial function can be measured in coronary arteries and in the periphery by measuring vasomotor function after intra-arterial infusion of pharmacologic substances which enhance the release of endothelial nitric oxide. The disadvantage of these methods is their invasive nature, which generally makes them unsuitable for studies involving asymptomatic subjects. For this reason, noninvasive tests of endothelial function have been developed. In the most widely used of these, an ultrasound-based method, arterial diameter is measured in response to an increase in shear stress, which causes endothelium-dependent dilatation. Endothelial function assessed by this method correlates with invasive testing of coronary endothelial function, as well as with the severity and extent of coronary atherosclerosis. This noninvasive endothelial function testing has provided valuable insights into early atherogenesis, as well as into the potential reversibility of endothelial dysfunction by various strategies, including pharmacological agents (lipid lowering, ACE inhibition), L-arginine, antioxidants and hormones.
Topics: Arteries; Arteriosclerosis; Endothelium, Vascular; Humans; Regional Blood Flow; Ultrasonography; Vasodilation; Vasomotor System
PubMed: 11069434
DOI: 10.1046/j.1365-2125.2000.00277.x -
Radiologia 2020To present our results and describe the technique used for the endovascular treatment of hemorrhoids. (Observational Study)
Observational Study
OBJECTIVE
To present our results and describe the technique used for the endovascular treatment of hemorrhoids.
MATERIAL AND METHODS
We used right femoral artery or radial artery access to catheterize the inferior mesenteric artery, proceeding to the superior rectal artery with a 2.7F microcatheter to catheterize and embolize each distal branch distally with PVA particles (300-500μm) and proximally with coils (2-3mm). Patients were discharged 24hours after the procedure and clinically followed up at one month by anoscopy.
RESULTS
We included 20 patients (4 women and 16 men; mean age, 61.85 years (27-81 years); mean follow-up, 10.6 months (28-2 months). Technical success was achieved in 18 (90%) patients and clinical success in 15 (83.4%); one patient required a second embolization of the medial rectal artery and two required surgery. Recovery was practically painless. At the one-month follow-up, all patients were very satisfied and anoscopy demonstrated marked improvement of the hemorrhoids. There were no complications secondary to embolization.
CONCLUSIONS
Our initial results suggest that selective intra-arterial embolization is a safe and painless procedure that is well tolerated because it avoids rectal trauma and patients recover immediately.
Topics: Adult; Aged; Aged, 80 and over; Catheterization; Embolization, Therapeutic; Female; Femoral Artery; Hemorrhoids; Humans; Male; Mesenteric Artery, Inferior; Middle Aged; Radial Artery; Retrospective Studies
PubMed: 32029240
DOI: 10.1016/j.rx.2019.12.004 -
BMC Surgery Oct 2019The outcomes in patients with pancreatic or ampulla tumors remain unsatisfactory, especially with invasion into the hepatic artery (HA) or the superior mesenteric artery...
BACKGROUND
The outcomes in patients with pancreatic or ampulla tumors remain unsatisfactory, especially with invasion into the hepatic artery (HA) or the superior mesenteric artery (SMA). In this setting, pancreatectomy combined with arterial resection and reconstruction may offer the possibility of an en-block resection with negative margins and acceptable morbidity and mortality.
METHODS
A six year retrospective review of pancreatectomies performed at our institution, included 21 patients that underwent a pancreatectomy combined with arterial resection and reconstruction. Arterial reconstruction was performed under an operating microscope. The types of arterial reconstruction included direct anastomosis, arterial transposition, and arterial bypass with a vascular graft.
RESULTS
The surgical procedures consisted of 19 pancreaticoduodenectomies and 2 total pancreatectomies. The tumors were located at the pancreatic head (n = 10), whole pancreas (n = 2), distal common bile duct (n = 5), ampulla (n = 2) and retroperitoneum with pancreatic head involvement (n = 2). All operations achieved R0 resection successfully, with no intraoperative complication. Eighteen patients recovered without complications while three patients died from intra-abdominal hemorrhage due to a pancreatic fistula, though notably the bleeding was not at the arterial anastomosis site. All reconstructed arteries showed adequate patency at follow-up. The median postoperative survival was 11.6 months in all the 11 patients with pancreatic adenocarcinoma.
CONCLUSION
Pancreatectomy combined with arterial resection and reconstruction is a feasible treatment option. The microsurgical technique is critically important to achieving a successful and patent arterial anastomosis.
Topics: Adenocarcinoma; Adult; Aged; Ampulla of Vater; Female; Hepatic Artery; Humans; Male; Mesenteric Artery, Superior; Middle Aged; Pancreatectomy; Pancreatic Neoplasms; Pancreaticoduodenectomy; Plastic Surgery Procedures; Retrospective Studies; Vascular Surgical Procedures; Young Adult
PubMed: 31601220
DOI: 10.1186/s12893-019-0560-2 -
Journal of Cerebral Blood Flow and... Apr 2018Metabolic regulation of cerebrovascular tone directs blood flow to areas of increased neuronal activity and during disease states partially compensates for insufficient... (Review)
Review
Metabolic regulation of cerebrovascular tone directs blood flow to areas of increased neuronal activity and during disease states partially compensates for insufficient perfusion by enhancing blood flow in collateral blood vessels. Acid-base disturbances frequently occur as result of enhanced metabolism or insufficient blood supply, but despite definitive evidence that acid-base disturbances alter arterial tone, effects of individual acid-base equivalents and the underlying signaling mechanisms are still being debated. H is an important intra- and extracellular messenger that modifies cerebrovascular tone. In addition, low extracellular [HCO] promotes cerebrovascular contraction through an endothelium-dependent mechanism. CO alters arterial tone development via changes in intra- and extracellular pH but it is still controversial whether CO also has direct vasomotor effects. Vasocontractile responses to low extracellular [HCO] and acute CO-induced decreases in intracellular pH can counteract H-mediated vasorelaxation during metabolic and respiratory acidosis, respectively, and may thereby reduce the risk of capillary damage and cerebral edema that could be consequences of unopposed vasodilation. In this review, the signaling mechanisms for acid-base equivalents in cerebral arteries and the mechanisms of intracellular pH control in the arterial wall are discussed in the context of metabolic regulation of cerebrovascular tone and local perfusion.
Topics: Acid-Base Equilibrium; Acid-Base Imbalance; Animals; Cerebral Arteries; Cerebrovascular Circulation; Humans; Signal Transduction; Vasodilation
PubMed: 28984162
DOI: 10.1177/0271678X17733868 -
Brazilian Journal of Anesthesiology... 2016Intra-arterial injection of medications may cause acute and severe ischemia and result in morbidity and mortality. There is no information in the literature evaluating...
BACKGROUND
Intra-arterial injection of medications may cause acute and severe ischemia and result in morbidity and mortality. There is no information in the literature evaluating the arterial endothelial effects of sugammadex and dexmedetomidine. The hypothesis of our study is that sugammadex and dexmedetomidine will cause histological changes in arterial endothelial structure when administered intra-arterially.
METHODS
Rabbits were randomly divided into 4 groups. Group Control (n=7); no intervention performed. Group Catheter (n=7); a cannula inserted in the central artery of the ear, no medication was administered. Group Sugammadex (n=7); rabbits were given 4mg/kg sugammadex into the central artery of the ear, and Group Dexmedetomidine (n=7); rabbits were given 1μg/kg dexmedetomidine into the central artery of the ear. After 72h, the ears were amputated and histologically investigated.
RESULTS
There was no significant difference found between the control and catheter groups in histological scores. The endothelial damage, elastic membrane and elastic fiber damage, smooth muscle hypertrophy and connective tissue increase scores in the dexmedetomidine and sugammadex groups were significantly higher than both the control and the catheter groups (p<0.05). There was no significant difference found between the dexmedetomidine and sugammadex groups in histological scores.
CONCLUSION
Administration of sugammadex and dexmedetomidine to rabbits by intra-arterial routes caused histological arterial damage. To understand the histological changes caused by sugammadex and dexmedetomidine more clearly, more experimental research is needed.
Topics: Animals; Arteries; Dexmedetomidine; Ear, External; Endothelium, Vascular; Hypnotics and Sedatives; Injections, Intra-Arterial; Male; Muscle, Smooth, Vascular; Rabbits; Sugammadex; gamma-Cyclodextrins
PubMed: 27591458
DOI: 10.1016/j.bjane.2015.01.003 -
Diagnostic and Interventional Imaging Jun 2015The availability of intra-arterial hepatic therapies (radio and/or chemo-embolisation, intra-arterial hepatic chemotherapy) has convinced radiologists to perfect their... (Review)
Review
The availability of intra-arterial hepatic therapies (radio and/or chemo-embolisation, intra-arterial hepatic chemotherapy) has convinced radiologists to perfect their knowledge of the anatomy of the liver arteries. These sometimes, complex procedures most often require selective arterial catheterization. Knowledge of the different arteries in the liver and the peripheral organs is therefore essential to optimize the procedure and avoid eventual complications. This paper aims to describe the anatomy of the liver arteries and the variants, applying it to angiography images, and to understand the implications of such variations in interventional radiological procedures.
Topics: Celiac Artery; Hepatic Artery; Humans; Liver; Radiography; Radiology, Interventional
PubMed: 24534562
DOI: 10.1016/j.diii.2013.12.001 -
European Journal of Vascular and... Mar 2018Vascular calcification is related to vascular diseases, for example, atherosclerosis, and its comorbidities, such as diabetes and chronic kidney disease. In each... (Review)
Review
Vascular calcification is related to vascular diseases, for example, atherosclerosis, and its comorbidities, such as diabetes and chronic kidney disease. In each condition, a distinctive histological pattern can be recognised that may influence technical choices, possible intra-operative complications, and procedure outcomes, no matter if the intervention is performed by open or endovascular means. This review considers the classification and initiating mechanisms of vascular calcification. Dystrophic and metastatic calcifications, Monckeberg's calcification, and genetic forms are firstly outlined, followed by their alleged initiation mechanisms; these include (a) ineffective macrophage efferocytosis; (b) ectopic osteogenesis driven by modified resident or circulating osteoprogenitors. As in physiological bio-mineralisation, active calcification starts with the deposition of cell derived matrix vesicles into the extracellular matrix. To substantiate this belief, an in depth ultra-structural documentation of hydroxyapatite crystal deposition on such vesicles is provided in an ex-vivo human vascular cell model. Revealing the vesicle composition and phenotype in normal and pathological vascular conditions will be essential for the development of new therapeutic strategies, in order to prevent and treat vascular calcification.
Topics: Animals; Arteries; Calcium Phosphates; Cell Differentiation; Crystallization; Durapatite; Extracellular Matrix; Extracellular Vesicles; Fibrosis; Humans; Monckeberg Medial Calcific Sclerosis; Peripheral Arterial Disease; Phenotype; Vascular Calcification
PubMed: 29371036
DOI: 10.1016/j.ejvs.2017.12.009