RESUMEN
Patients with highly angulated neck anatomy may account for up to a fifth of all patients treated by endovascular repair. However there is evidence that these patients have worse early and long-term outcomes, including sac expansion. This review explores the evidence supporting the use of endovascular repair in the setting of severe neck angulation, with particular emphasis on new technology with devices that have expanded the anatomical criteria for endovascular aneurysm repair such as the Lombard Aorfix and Medtronic Endurant endografts.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aortografía/métodos , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Procedimientos Endovasculares/instrumentación , Humanos , Selección de Paciente , Valor Predictivo de las Pruebas , Diseño de Prótesis , Stents , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVES: There is evidence that the improvement following supervised exercise for claudication results from skeletal muscle adaptation. The myosin heavy chain (MHC) determines muscle fibre type and therefore efficiency. Immunohistochemical analysis has failed to take account of hybrid MHC expression within myofibres. This study sought evidence of differential MHC protein expression following supervised exercise for claudication. DESIGN: 38 claudicants were recruited. Subjects undertook a three-month supervised exercise programme. Controls were patients awaiting angioplasty for claudication. MATERIALS AND METHODS: Subjects underwent paired gastrocnemius biopsy. Relative expression of MHC proteins was determined by SDS-PAGE electrophoresis. Non-parametric data is presented as median with the inter-quartile range and parametric as the mean ± standard deviation. RESULTS: Upon completion of the exercise programme there was a 94% increase (124 (106-145) to 241 (193-265) metres, p = 0.002) in maximum walking distance, which was not evident in the control group. An 11.1% (p = 0.02) increase in MHC I expression was observed in the exercise but not the control group (34.3% ± 6.8 to 45.4% ± 4.4). There was a positive correlation between the change in MHC I expression and the improvement in claudication distance (r = 0.69, p < 0.05). CONCLUSIONS: Supervised exercise training for claudication results in an increase in the proportion of MHC type I expression within the symptomatic gastrocnemius muscle.
Asunto(s)
Terapia por Ejercicio , Tolerancia al Ejercicio , Claudicación Intermitente/terapia , Músculo Esquelético/fisiopatología , Adaptación Fisiológica , Anciano , Biopsia , Electroforesis en Gel de Poliacrilamida , Inglaterra , Prueba de Esfuerzo , Femenino , Humanos , Claudicación Intermitente/diagnóstico , Claudicación Intermitente/metabolismo , Claudicación Intermitente/fisiopatología , Masculino , Persona de Mediana Edad , Músculo Esquelético/irrigación sanguínea , Músculo Esquelético/metabolismo , Cadenas Pesadas de Miosina/metabolismo , Isoformas de Proteínas , Recuperación de la Función , Factores de Tiempo , Resultado del Tratamiento , Regulación hacia Arriba , CaminataRESUMEN
OBJECTIVES: We have used ultrasound guided foam sclerotherapy (UGFS) to treat varicose veins in 2029 limbs since 2006. In 2009 we introduced physiological gas (30% O2 and 70% CO2) for making foam with sodium tetradecyl sulphate (Fibrovein, STD Pharmaceutical Products Ltd, Hereford UK) instead of air. The aim of this study was to compare our early experience of UFGS using CO2/O2 with our prior experience using air. METHODS: Data were collected in a prospectively maintained database. In this series 470 limbs were treated with UGFS and followed up at 6 weeks with clinical and duplex ultrasound assessment. The 235 consecutive limbs undergoing UGFS immediately before and the 235 after the introduction of CO2/O2 were selected for comparison. RESULTS: The age, gender and CEAP classifications for the two groups were not significantly different. 73% were primary veins and 70% great saphenous, with no differences between the groups. Transient neurological events are rare in our experience (0.7%) with only one visual disturbance occurring in this series. There was a significant reduction in the incidence of skin staining in the CO2/O2 (7.2% vs 3.3%, p = 0.02, χ² test) as compared to the air treated group, but no difference in the incidence of thrombophlebitis. The total volume of foam injected was similar in both groups but use of CO2/O2 foam was associated with a significant improvement in the truncal occlusion rate, from 86% to 91% (p < 0.05, χ² test). CONCLUSION: UGFS with CO2/O2 instead of air was associated with a slightly increased saphenous truncal occlusion rate and reduced the incidence of skin staining without increasing thrombophlebitis in this clinical series. We observed only one transient neurological event in this series so could not evaluate the effect of CO2/O2 foam in reducing these events.