Augmented Arterial Sensitivity to Serotonin in Vascular Disease: Implications for Tissue Perfusion

2015 ◽  
pp. 76-82 ◽  
Author(s):  
C. Orlandi
Keyword(s):  
Vascular Disease ◽  
Tissue Perfusion

Improving Outcomes for Lower Extremity Amputations Using Intraoperative Fluorescent Angiography to Predict Flap Viability

2017 ◽  
Vol 52 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Andrew E. Yang ◽  
Charles A. Hartranft ◽  
Alisha Reiss ◽  
Charles R. Holden
Keyword(s):  
Lower Extremity ◽  
Vascular Disease ◽  
Sensitivity And Specificity ◽  
Skin Flap ◽  
Tissue Perfusion ◽  
Wound Complications ◽  
Vascular Surgeon ◽  
Flap Viability ◽  
Breast Reconstructive Surgery ◽  
Vasopressor Use

Objectives: Nearly 25% of vascular surgery patients operated on for peripheral vascular disease are readmitted within 30 days. Development of adjuncts to minimize wound complications remains an area of great interest. Here, we present our experience with intraoperative fluorescent angiography (IFA) as a tool to predict skin flap viability following lower extremity amputations (LEAs). Methods: Experience with IFA using indocyanine green (ICG) dye was reviewed retrospectively at a single institution. Records of patients undergoing LEA with use of IFA by 2 vascular surgeons from 2013 to 2014 were reviewed. Absolute and relative tissue perfusion values were evaluated for sensitivity and specificity in regard to skin flap viability. Results: Thirteen patients with a mean age of 70.5 years (standard deviation [SD] = 12.0, range: 49-93 years) underwent 17 amputations. Indications included rest pain, tissue gangrene, and vascular disease unsuitable for revascularization. Amputation levels included toe (23%), transmetatarsal (18%), below knee (41%), and above knee (18%). Six (35%) amputations required revision with a mean time-to-revision of 26.1 days (SD = 19.9, range: 9-61 days). Of these revisions, 14 (83%) patients proceeded to a proximal-level amputation. Mean follow-up was 235 days (SD = 148, range: 5-448 days), and IFA was used in all cases. Absolute perfusion values (APVs) between 5 and 9 displayed sensitivity and specificity of 50% and 64%, respectively. Additionally, a relative perfusion value (RPV) of ≤31% displayed 100% sensitivity and specificity. Sensitivity and specificity fell to 83% at a relative perfusion of ≤27% and ≤35%, respectively. Conclusion: IFA during LEA is safe and easily performed by the vascular surgeon. The RPVs as a predictor of skin flap viability correlate well with those reported in breast reconstructive surgery. Unfortunately, APVs fail to support any predication for flap failure or success. Patient comorbidities and intraoperative variables such as vasopressor use may contribute to this finding.

Abstract #234 High Prevalence of Systemic Collagen Vascular Disease in Women with T1DM

2018 ◽  
Vol 24 ◽  
pp. 45-46
Author(s):  
Yicheng Bao ◽  
Jing Hughes ◽  
Maamoun Salam ◽  
Janet McGill
Keyword(s):  
Vascular Disease ◽  
Collagen Vascular Disease ◽  
High Prevalence

Initial experience with a new quantitative assessment tool for fluorescent imaging in peripheral artery disease

VASA ◽  
2017 ◽  
Vol 46 (5) ◽  
pp. 383-388 ◽  
Author(s):  
Henrik Christian Rieß ◽  
Anna Duprée ◽  
Christian-Alexander Behrendt ◽  
Tilo Kölbel ◽  
Eike Sebastian Debus ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Quantitative Assessment ◽  
Tissue Perfusion ◽  
Fluorescent Imaging ◽  
Peripheral Artery ◽  
Peripheral Bypass ◽  
Before And After ◽  
Artery Disease ◽  
Green Fluorescent ◽  
Peripheral Bypass Grafting

Abstract. Background: Perioperative evaluation in peripheral artery disease (PAD) by common vascular diagnostic tools is limited by open wounds, medial calcinosis or an altered collateral supply of the foot. Indocyanine green fluorescent imaging (ICG-FI) has recently been introduced as an alternative tool, but so far a standardized quantitative assessment of tissue perfusion in vascular surgery has not been performed for this purpose. The aim of this feasibility study was to investigate a new software for quantitative assessment of tissue perfusion in patients with PAD using indocyanine green fluorescent imaging (ICG-FI) before and after peripheral bypass grafting. Patients and methods: Indocyanine green fluorescent imaging was performed in seven patients using the SPY Elite system before and after peripheral bypass grafting for PAD (Rutherford III-VI). Visual and quantitative evaluation of tissue perfusion was assessed in an area of low perfusion (ALP) and high perfusion (AHP), each by three independent investigators. Data assessment was performed offline using a specially customized software package (Institute for Laser Technology, University Ulm, GmbH). Slope of fluorescent intensity (SFI) was measured as time-intensity curves. Values were compared to ankle-brachial index (ABI), slope of oscillation (SOO), and time to peak (TTP) obtained from photoplethysmography (PPG). Results: All measurements before and after surgery were successfully performed, showing that ABI, TTP, and SOO increased significantly compared to preoperative values, all being statistically significant (P < 0.05), except for TTP (p = 0.061). Further, SFI increased significantly in both ALP and AHP (P < 0.05) and correlated considerably with ABI, TTP, and SOO (P < 0.05). Conclusions: In addition to ABI and slope of oscillation (SOO), the ICG-FI technique allows visual assessment in combination with quantitative assessment of tissue perfusion in patients with PAD. Ratios related to different perfusion patterns and SFI seem to be useful tools to reduce factors disturbing ICG-FI measurements.

Vascular disease in systemic sclerosis

VASA ◽  
2011 ◽  
Vol 40 (1) ◽  
pp. 3-4
Author(s):  
Poredos
Keyword(s):  
Systemic Sclerosis ◽  
Vascular Disease

Albuminuria as early test for vascular disease

The Lancet ◽  
2005 ◽  
Vol 365 (9459) ◽  
pp. 556-557 ◽  
Author(s):  
G REMUZZI ◽  
J WEENING
Keyword(s):  
Vascular Disease
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