Introduction: Endomyocardial fibrosis (EMF) is a form of restrictive cardiomyopathy of unknown etiology, characterized by endocardial fibrosis of the apices and inflow tracts of the right ventricle, left ventricle or both.The majority of people who suffer high morbidity and mortality are children and young females of the poor and deprived communities of tropical Africa.EMF has been reported from other subtropical countries; Egypt, Nigeria, Brazil, Kerala in India, and Sudan.It is exceedingly rare in Europe and North America; however few cases have been reported from China and Japan.In Uganda, it accounted for 25% of cases who reported for echocardiography and 20% in a random population sample in Mozambique.Although ethnicity, diet, poverty, eosinophilia, infection, and malaria have been shown to be associated with EMF, the etiology of the disease still remains undetermined.Diagnosis: Echocardiography is now the gold standard tool for the diagnosis of EMF.There are five prime diagnostic echocardiographic features of EMF; apical fibrosis, ventricular wall fibrosis, huge atrium, atrioventricular valve regurgitation and obliteration of ventricular cavity.The presence of pericardial effusion, endocardium fibrous shelf, and layering of the posterior wall lend further diagnostic support.Treatment: Most patients are seen at a late stage of the disease with heart failure, consequently, medical care is directed accordingly and includes diuretics, angiotensin enzyme inhibitors, and beta-blockers.Surgical care includes pericardectomy, a relatively safe procedure that leads to some improvement in heart failure symptoms.However, endocardial decortication seems to be more definitive and beneficial for many patients with advanced disease.Successful surgery has a clear benefit in terms of symptoms and seems to affect survival favorably.The prognosis is poor and the duration of illness from the time of presentation to death was less than one year in 43.5% of patients, three years in 39.1% of patients, and three to twelve years in 17.4% of patients.Conclusion: EMF is a mysterious disease whose etiology is still unraveling.The afflicted individuals are mostly young females and children who succumb to high rates of morbidity, and mortality from heart failure.Medical and surgical treatment are both practiced with results varying from temporary relief of symptoms to surgery with high mortality rates.
The American Venous Forum and the National Institute for Health and Care Excellence recommend endothermal ablation (ETA) techniques as the first line treatment for superficial venous incompetence. However, these techniques require the use of tumescent anaesthesia prior to energy delivery, which may be a source of discomfort for the patient and can prolong procedure time. Recently, nonthermal, nontumescent (NTNTs) techniques such as mechanochemical ablation (MOCA) have been developed to address some of the negative aspects associated with ETA. This article reviews this technique from a patient selection and perspective point view. Keywords: endovenous ablation, varicose veins, venous disease, mechanochemical ablation
php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Journal of Vascular Diagnostics and Interventions 2018:6 1–5 Journal of Vascular Diagnostics and Interventions Dovepress
Effusive-constrictive pericarditis (ECP) is defined by concurrent pericardial effusion and pericardial constriction. Whereas the pericardial cavity is typically obliterated in patients with constrictive pericarditis without any effusion, in patients with ECP the scarred pericardium not only constricts the cardiac volume but can also put pericardial fluid under increased pressure, leading to signs suggestive of cardiac tamponade. These hemodynamic features can persist even after the pericardial effusion is removed. The underlying pathogenetic process predominantly involves the visceral pericardium or epicardium. It combines visceral pericardial constriction with pericardial inflammation. Its etiology may be as variable as the causes of effusive or constrictive pericardial disease, which may be infective (e.g., bacterial or viral), malignant or autoreactive. The label idiopathic ECP should be avoided and restricted to only those cases in whom, after thorough clinical and pathological workup including PCR for microbial agents in pericardial fluid and cardiac tissue from peri- and epicardial or endomyocardial biopsies and the assessment of autoimmune processes, no definite diagnosis can be made. Since a considerable number of ECP patients have an inflammatory and reversible pericardial reaction, they can improve under causal and/or anti-inflammatory treatment. The treatment should therefore be based first on eradicating the underlying etiological factors. If such a treatment course remains ineffective, pericardiectomy including the removal of the visceral pericardium is the remaining therapeutic option. Keywords: pericarditis, etiology, constriction, hemodynamics of ECP, treatment
Behçet’s disease is a relapsing–remitting vasculitis that affects both arterial and venous vessels of various sizes. A 48-year-old man with Behçet’s disease was seen at the outpatient clinic of our hospital for painful lesions on his left leg. Physical examination showed two tender erythematous linear indurations on the medial side of the left thigh and calf, of about 3 cm and 10 cm in length, respectively. Duplex ultrasonography revealed echogenic material in the lumen of collateral superficial veins, with no extension to the deep venous system. The patient was started on once-daily subcutaneous low-molecular-weight heparin in combination with elastic compression stockings, with spectacular improvement. Superficial venous thrombosis is a common manifestation of Behçet’s disease, and the diagnosis is based on clinical features. Superficial venous thrombosis has a dual prognostic value: on one hand, it should raise the suspicion of concomitant deep venous and/or arterial involvement, and on the other hand, it may predict the development of future severe visceral manifestations. Keywords: Behçet’s disease, vasculitis, vascular involvement, venous thrombosis, superficial vein thrombosis
Introduction: Cerebral cross-perfusion is essential for ipsilateral brain viability during unilateral insult. Aortic arch and great vessel procedures depend on its function for safe practice, unless adjuncts like shunts are used. This paper assesses the contribution of cerebrovascular anatomy against physiology in determining requisite hemispheric perfusion during carotid endarterectomy (CEA). Materials and methods: A review of shunting requirements for CEAs under locoregional anesthesia (LA) at the John Radcliffe Hospital during 1999–2013 was performed. A PubMed search for “Circle of Willis” was screened for all original articles defining cerebrovascular anatomy by postmortem or angiography. Results: Over 14 years, 1137 CEAs were performed under cervical plexus block; during this period, the departmental standard of practice evolved from exclusively general anesthesia to predominantly LA. CEAs performed under LA during the early phase (1999–2003) had a shunt rate of 15.1%, compared to 20% as predicted by stump pressures alone. However, shunting decreased as higher perioperative systolic pressures were routinely practiced; shunt rates were 8.0% during the intermediate (2004–2007) and 6.4% during the later (2008–2013) phase. By comparison, 25 articles characterizing 6414 brains report an intact circle of Willis in 33–35% of people, with a complete hemi-circle anteriorly (77%) seen more commonly than posteriorly (42%), and 11–16% deficient in both hemi-circles with no cross-flow. Conclusion: Cerebral cross-perfusion is fundamental for safe CEA. Anatomy of the circle of Willis alone does not itself determine adequacy. Physiological mechanisms are important in overriding apparent deficiencies, and these can be manipulated perioperatively. Consequently, only 1 out of 15 patients requires shunting during CEA. Keywords: Circle of Willis, cerebral, cross-perfusion, carotid, shunt, anatomical variation
php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Journal of Vascular Diagnostics and Interventions 2017:5 21–34 Journal of Vascular Diagnostics and Interventions Dovepress
Purpose: To evaluate the efficacy and safety of ethylene vinyl alcohol copolymer (Onyx) with or without coils in treatment of type II endoleaks associated with abdominal aortic endografts. Materials and methods: The medical records of 14 patients (12 men and 2 women, mean age 73 years) with type II endoleaks associated with abdominal aortic endografts, and treated with Onyx, with or without coils, were reviewed. These patients underwent 19 type II endoleak embolization procedures. Time to follow up computed tomography angiogram (CTA), initial and follow-up aneurysm sac characteristics, embolization access technique, use of coils, volume and type of Onyx used, and complications were recorded. Results: Mean procedure time was 124 minutes (range, 51–237 minutes), and mean volume of Onyx used per procedure was 2.1 cc (range, 1.5–3). Mean follow-up time between initial and final CTA was 19.9 months (range, 0.5–64.4). After one or more treatments, follow-up imaging documented complete occlusion of the endoleaks in 10 of 14 patients. Mean sac size decreased by an average of 0.3 cm in those with successful embolization and increased by an average of 0.4 cm in those with failed embolization. One major complication (infection, 5.2%) occurred before adding prophylactic antibiotics to our protocol. No significant inadvertent embolization occurred. Conclusion: This study contributes to the growing body of data regarding safety and efficacy of treating type II endoleaks using Onyx. Potential benefits are both technical and economic. As we found advantages with the use of Onyx, additional studies are warranted. Keywords: endoleak, onyx, embolization
We compared the symmetry of carotid arteries in youth with high-resolution ultrasound. Participants (n=230 (121 females),13.8 ± 2.9 years old) were assessed for: intima media thickness (cIMT), lumen diameter (cLD), incremental elastic modulus (cIEM), diameter compliance (cDC), cross-sectional compliance (cCSC), diameter distensibility (cDD), and cross-sectional distensibility (cCSD). No significant differences (P >0.05 all) were found for cIMT (0.49 ± 0.09 mm vs. 0.49 ± 0.08 mm), cIEM (1095 ± 382 mmHg vs. 1116 ± 346mmHg), cDC (0.01 ± 0.0 mm/mmHg vs. 0.01 ± 0.0 mm/mmHg), cCSC (0.01 ± 0.001/mmHg vs. 0.01 ± 0.001/mmHg), cDD (14.0 ± 3.16% vs. 13.7 ± 3.18%), and cCSD (30.1 ± 7.37% vs. 29.4 ± 7.36%). Significant differences were found for cLD (6.06 ± 0.62 mm vs. 6.33 ± 0.64 mm, P <0.001). These data suggest that these values may be used interchangeably if one side is inaccessible.
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Overview of common errors and pitfalls to avoid in the acquisition and interpretation of ultrasound imaging of the abdominal aorta Penelope C Lema, Janice H Kim, Erika St James Department of Emergency Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA Abstract: Abdominal aortic aneurysms (AAAs) occur when the aorta diameter is >3 cm (30 mm). Ruptured AAA has a high mortality rate. Ultrasound is the imaging modality of choice to screen for this vascular disease. There are many common errors and pitfalls in the acquisition and interpretation of ultrasound imaging of the abdominal aorta, such as measurement errors and variations in technique, misdiagnosis errors, difficulty with visualization of the aorta and a wide range of sonographer experience. We review the common errors and pitfalls to recognize and avoid in ultrasound imaging of the abdominal aorta. Keywords: ultrasound, abdominal aortic aneurysm, AAA, pitfalls and errors, imaging technique
Sequential contraction compression therapy has been found to have a positive effect on numerous vascular conditions. The authors report the results of a pilot study looking at the effect of a sequential contraction compression device (SCCD) on patients with peripheral arterial disease (PAD). The authors evaluated ten patients with moderate PAD and treated them with one session of sequential contraction compression therapy. The primary outcome measure was a change in temperature of the foot. The authors found that there was a significant change in the foot temperatures during the treatment, which was somewhat maintained after the treatment. The results of the study indicate that there may be a place for SCCD in the treatment of PAD and that further research must be performed to validate this treatment. Keywords: peripheral arterial disease, treatment, compression therapy
terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Journal of Vascular Diagnostics and Interventions 2016:4 23–37 Journal of Vascular Diagnostics and Interventions Dovepress
and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Journal of Vascular Diagnostics and Interventions 2016:4 9–22 Journal of Vascular Diagnostics and Interventions Dovepress
Coronary computed tomography angiography (CTA) has been increasingly used to detect coronary artery disease. The diagnostic performance of coronary CTA is well established with a high sensitivity and negative predictive value. Nevertheless, the diagnostic value of coronary CTA is offset by a high false positive rate, partly due to the technique lacking physiological lesion assessment when performed in the conventional way. This has raised concerns regarding unnecessary invasive coronary angiography referrals and inappropriate revascularization procedures. Recent advances in computational fluid dynamics and image-based modeling have enabled the calculation of coronary artery blood flow and pressure under various modeled physiologic conditions from coronary CTA without the need for hyperemia-inducing medications, modification of acquisition protocol or further radiation. Coronary flow and pressure can be derived both at rest and during simulated maximum hyperemia allowing for the calculation of fractional flow reserve from coronary CTA (FFR CTA ) across stenotic lesions in a fashion similar to invasive FFR. This novel non-invasive technology offers concurrent anatomical and functional assessment of major epicardial coronary arteries. The diagnostic performance of FFR CTA has been tested in three major trials where it resulted in accurate identification of ischemia-related lesions. Similar to an invasive FFR-guided management strategy, the use of FFR CTA has been shown to improve patients' outcomes and reduce health care costs. FFR CTA is emerging as an attractive alternative to invasive FFR. There are, however, several challenges that need to be overcome before FFR CTA can be incorporated into routine clinical practice. Keywords: computational Fluid Dynamics, CFD, coronary CTA, FFR, coronary artery disease, CAD
Aims: Renal sympathetic denervation (RDN) has recently been suggested to be a novel treatment strategy for patients with treatment-resistant hypertension. However, the latest randomized studies have provided conflicting results and the influence of RDN on arterial stiffness remains unclear. Therefore, this study aimed to detect the effects of RDN on arterial stiffness as measured with aortic pulse wave velocity (PWV) and distensibility in addition to cardiac function and T1 mapping at baseline and at 6-month follow-up. Methods: RDN was performed in a total of 16 patients with treatment-resistant hypertension, and the procedures were conducted at two university hospitals using two different RDN devices. All patients and age-matched controls underwent a comprehensive clinical examination and cardiac magnetic resonance protocols both at baseline and at a 6-month follow-up. Results: In the treatment group, the systolic blood pressure (SBP) was found to be decreased at the follow-up visit (office SBP; 173±24 compared to 164±25 mmHg [ P = 0.033]), the 24-hour ambulatory SBP had decreased (163±25 compared to 153±20 mmHg [ P =0.057]), the aortic PWV had decreased from 8.24±3.34 to 6.54±1.31 m/s ( P =0.053), and the aortic distensibility had increased from 2.33±1.34 to 3.96±3.05 10−3 mmHg−1 ( P =0.013). The changes in aortic PWV and distensibility were independent of the observed reductions in SBP. Conclusion: The arterial stiffness, as assessed with aortic PWV, and distensibility were improved at 6 months after RDN. This improvement was independent of the reduction in SBP. Keywords: renal denervation, cardiovascular MR, arterial stiffness
Bilateral inferior petrosal sinus sampling (BIPSS) is a minimally invasive procedure performed in the workup of adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome (CS). Because noninvasive tests in the evaluation of CS patients lack sensitivity, BIPSS is the gold standard in diagnosing Cushing disease (CD), which is a pituitary source of excess ACTH. Here, the pathophysiology of CD and procedural details of BIPSS are reviewed. Keywords: pituitary adenoma, Cushing disease, inferior petrosal sinus, venous sampling
Primary aldosteronism causes 15%–25% of cases of drug-resistant hypertension. Adrenal vein sampling (AVS) is a procedure entailing the measurement of aldosterone from both adrenal veins, to diagnose an adrenal source of excess aldosterone secretion. Because unilateral adrenal etiologies of primary aldosteronism may be surgically resected, identifying these sources by venous sampling is critical. Technical aspects of the procedure are reviewed, with emphasis on strategies to avoid common difficulties during AVS. Keywords: primary aldosteronism, hypertension, venous sampling, adrenal adenoma
Duplex ultrasonography is the ideal modality to assess great saphenous vein insufficiency. Duplex ultrasonography incorporates both gray scale images to delineate anatomy and color-Doppler imaging that visualizes the flow of blood in a structure. Assessment of great saphenous vein requires definition of the anatomy, augmentation of flow, evaluation for both superficial and deep vein thrombosis, and determining the presence of reflux. Currently, evolution in the treatment of reflux also relies on ultrasound for the treatment of the disease. Understanding the utilization of the ultrasound for the diagnosis and treatment of greater saphenous vein reflux is important for practitioners treating reflux disease. Keywords: duplex ultrasonography, small saphenous vein
Magnetic resonance angiography (MRA) is a dynamic and growing field. In most cases, MRA has replaced conventional angiography and computed tomographic angiography in the evaluation of vascular disease. Numerous MRA techniques are available in clinical practice, each with their own strengths and weaknesses. A number of non-contrast techniques are available that do not expose patients to the potentially toxic effects of gadolinium. Dynamic time-resolved imaging is emerging as an important tool in the evaluation of the hemodynamic consequences of vascular disease. In this review, we summarize the state of the art in MRA of the aorta and peripheral arteries. Keywords: magnetic resonance angiography, aorta, renal arteries, mesenteric arteries, peripheral arteries
