Keunikan anatomi small vessel of the brain dan neurovascular unit, kontroversi peran stganasi vena dalam patofisiologi, klasifikasi small vessel disease, variasi kriteria diagnostik, pitfall dalam neuroimaging, pilihan antiplatelet untuk prevensi sekundar, dampaknya bagi outcome pasien, hubungannya dengan gangguan fungsi kognitif.
Hmm, apa lagi nih yang baru?
Keunikan anatomi small vessel of the brain dan neurovascular unit, kontroversi peran stganasi vena dalam patofisiologi, klasifikasi small vessel disease, variasi kriteria diagnostik, pitfall dalam neuroimaging, pilihan antiplatelet untuk prevensi sekundar, dampaknya bagi outcome pasien, hubungannya dengan gangguan fungsi kognitif.
Hmm, apa lagi nih yang baru?
Carotid Endarterectomy in Stroke Prevention UpdateDenise Crute
Neurocritical Care lecture on the role of carotid artery surgery in stroke prevention, reviewing the latest studies and evidence-based updates, along with neurosurgical techniques.
A Review of Atherectomy in Peripheral Arterial Diseaseasclepiuspdfs
Atherectomy involves exciting technology and offers expanded treatment options for PAD. Data are scant so far in most lower extremity territories to support its use over other interventions, but newer results are promising. There is still a financial benefit to choosing atherectomy in the outpatient setting that likely drives much of its popularity among interventionalists. Atherectomy is an exciting technology for peripheral vascular intervention. Its use has greatly increased over the last decade. Data on its superiority to angioplasty or angioplasty with stenting are scant. Here, we review atherectomy techniques and principles along with results and controversy surrounding its use.
Vertebral artery pseudo-aneurysms and dissections are known to occur as a result of mechanical
manipulations of the cervical region, traumatic injury, spontaneously and iatrogenic injury because of central
venous catheterization. Central venous lines have become an integral part of patient care, but they are
not without complications. Vertebral artery injury (leading to pseudo-aneurysm and dissection) is one of
the rarer complications of central venous catheter placement. We report a case of inadvertent vertebral
artery catheterization during a dialysis catheter placement which subsequently demonstrated arterial
blood. Duplex ultrasound and computed tomographic (CT) scan confirmed vertebral artery catheterization.
It was successfully treated with open surgical technique by the vascular surgeon because of the size of
catheter and subsequent requirement of artery repair. There were no neurological sequelae. Open surgical
repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudo-aneurysms
has been described with promising outcomes, but long-term results are lacking. This case report describes
the rare iatrogenic event of vertebral artery injury and reviews its etiology, diagnosis, complications, and management.
An Overview of Filter-Protected Carotid Artery Stentinggailms
These slides give an overview of cerebral protection devices used today in carotid artery stenting, with special emphasis on distal protection filters. Previous work in the field, results from our laboratory, and future directions of device development are covered.
Introduction: There is growing evidence that Obstructive Sleep Apnea (OSA) is a risk factor for Pulmonary Embolism (PE). This
association represents a major public health burden.Aims and Objectives: To investigate Computed Tomography Obstruction Index (CTOI) and the Right Ventricular (RV) to Left Ventricular (LV) diameter ratio with OSA severity. Materials and Methods: 46 Patients with (PE) were evaluated for OSA. Pulmonary Artery Obstruction Index (PAOI) and RV/ LV diameter ratio was measured by pulmonary angiography. Pulmonary Embolism Severity Index (PESI) was determined. Epworth Sleepiness Scale (ESS) and Polysomnography (PSG) was performed for all patients. Based on the PAOI, patients divided into (< 15%, 15-50%, > 50%).
Carotid Endarterectomy in Stroke Prevention UpdateDenise Crute
Neurocritical Care lecture on the role of carotid artery surgery in stroke prevention, reviewing the latest studies and evidence-based updates, along with neurosurgical techniques.
A Review of Atherectomy in Peripheral Arterial Diseaseasclepiuspdfs
Atherectomy involves exciting technology and offers expanded treatment options for PAD. Data are scant so far in most lower extremity territories to support its use over other interventions, but newer results are promising. There is still a financial benefit to choosing atherectomy in the outpatient setting that likely drives much of its popularity among interventionalists. Atherectomy is an exciting technology for peripheral vascular intervention. Its use has greatly increased over the last decade. Data on its superiority to angioplasty or angioplasty with stenting are scant. Here, we review atherectomy techniques and principles along with results and controversy surrounding its use.
Vertebral artery pseudo-aneurysms and dissections are known to occur as a result of mechanical
manipulations of the cervical region, traumatic injury, spontaneously and iatrogenic injury because of central
venous catheterization. Central venous lines have become an integral part of patient care, but they are
not without complications. Vertebral artery injury (leading to pseudo-aneurysm and dissection) is one of
the rarer complications of central venous catheter placement. We report a case of inadvertent vertebral
artery catheterization during a dialysis catheter placement which subsequently demonstrated arterial
blood. Duplex ultrasound and computed tomographic (CT) scan confirmed vertebral artery catheterization.
It was successfully treated with open surgical technique by the vascular surgeon because of the size of
catheter and subsequent requirement of artery repair. There were no neurological sequelae. Open surgical
repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudo-aneurysms
has been described with promising outcomes, but long-term results are lacking. This case report describes
the rare iatrogenic event of vertebral artery injury and reviews its etiology, diagnosis, complications, and management.
An Overview of Filter-Protected Carotid Artery Stentinggailms
These slides give an overview of cerebral protection devices used today in carotid artery stenting, with special emphasis on distal protection filters. Previous work in the field, results from our laboratory, and future directions of device development are covered.
Introduction: There is growing evidence that Obstructive Sleep Apnea (OSA) is a risk factor for Pulmonary Embolism (PE). This
association represents a major public health burden.Aims and Objectives: To investigate Computed Tomography Obstruction Index (CTOI) and the Right Ventricular (RV) to Left Ventricular (LV) diameter ratio with OSA severity. Materials and Methods: 46 Patients with (PE) were evaluated for OSA. Pulmonary Artery Obstruction Index (PAOI) and RV/ LV diameter ratio was measured by pulmonary angiography. Pulmonary Embolism Severity Index (PESI) was determined. Epworth Sleepiness Scale (ESS) and Polysomnography (PSG) was performed for all patients. Based on the PAOI, patients divided into (< 15%, 15-50%, > 50%).
PAD can be diagnosed in asymptomatic individuals by a combination of physical examination and simple, noninvasive Doppler ultrasonography to measure the ankle–brachial index
Our project, our experience and our results at December 31 st 2013
Il nostro progetto, la nostra esperienza ed i nostri risultati aggiornati al 31.12.2013
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
IMAGES OF A COMPLEX CASE OF MULTIPLE ANEURYSMAL DISEASE IN A 58 YEAR OLD MAN
IMMAGINI DI UN CASO COMPLESSO DI MALATTIA POLINEURISMATICA
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Thermal Imaging for the Diagnosis of Early Vascular Dysfunctions: A Case Reportasclepiuspdfs
Diseases of blood vessels (referred in this article as vascular dysfunction) cause more morbidity and mortality, than combined impact of any other major non-communicable disease including cancer. We strongly feel that the development of a therapy system based on the management of disease of the vessel than management of the risk factors will yield better results and provide greater opportunity for individualized therapy. Detection of early vascular changes before clinical manifestations of endothelial dysfunction, hardening of the arteries, increased intima-media thickness, is of great importance for early identification of individuals with increased risk of accelerated atherosclerosis.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
1. 155 Vol.-3, No.-2, January 2011 Cardiovas Journal
Introduction
The peripheral arterial disease (PAD) generally
refers to a disorder that obstructs the blood supply
to upper and lower extremities, most commonly
caused by atherosclerosis but may also result
from thrombosis, embolism, vasculities,
fibromascular dysplasia or entrapment. Where as
the peripheral vascular disease includes PAD and
other atherosclerotic conditions such as renal
artery disease and carotid artery disease as well
as vasculities, vasospasm, venous thrombosis,
venous insufficiency and lymphatic disorder.1
Atherosclerosis is the leading cause of occlusive
arterial disease of the extremities in patients over
40 years old, the highest incidence occurs in sixth
and seventh decades of life.2 The pathology of PAD
is similar to coronary artery disease. The most
important risk factors are smoking, diabetes
mellitus, hyperlipidaemia and hypertension.3
Tobacco increases the relative risk 2-4 times,
Diabetes also increase relative risk for PAD like
smoking. Among patients with PAD diabetic
patients are more likely to have amputation than
non diabetic patients.4 Distal disease affecting the
tibial and peroneal arteries occurs more frequently
in diabetes. Risk of PAD increase if total
cholesterol and LDL are elevated. In Framingham
study it is seen that probability of claudication in
70 years male smoker is 2.5% per 4 year, Which
increases to 24% per 4 year when smoking is
Study of 89 Cases of Peripheral Vascular
Disease by CT Angiography
M Faruque1, AEMM Islam1, S Haque1, MT Islam2, MG Kibria1, M Hossain3, MA Salam1,
F Rahman4, MA Hasnat1, HIL Rahman Khan1
1Department of Cardiology, Dhaka Medical college Hospital, 2 Department Radiology & Imaging, Holy
Family Red Crescent Hospital, Dhaka 3 Department of Vascular surgery, NICVD, Dhaka
4 Department of Cardiology, BSMMU, Dhaka
Abstract:
Objective: The purpose of this study was to observe the morphological pattern by CT angiography
and risk factors for development of peripheral vascular disease in Bangladeshi patient suffering
from peripheral vascular disease using a multidetector scanner in the evaluation of patients with
peripheral vascular disease.
Subject and Method: Eighty nine patients with peripheral vascular disease who were referred for
evaluation of peripheral vascular disease underwent CT angiography. We scanned patients from the
level of the cerebral arteries to the pedal arteries in a single helical scan. CT angiograms were
produced using maximum-intensity-projection, multiplanous reformation and reconstructions.
Findings were graded according to nine categories: 1, normal (0% stenosis); 2, mild (1-49% stenosis);
3, moderate (50-74% stenosis); 4, severe (>75% stenosis); 5, tortuosity; 6, aneurysm, 7, calcification,
8, Arteriovenous malformation (AVM), and 9, haematoma.
Results: We found Most of the patients in our study were male (69 out of 89 patients). The mean age
was 54.49 ±18.36 in male and 49.45 ±17.89 for female. Commonest risk factor in our study was
hypertension 46.1%, followed by diabetes 30.3%, family history 27% smoking 23.6%,
dyslipidaemia13.5%. Stenosis (5.61%) was the predominate lesion followed by haematoma (4.49%),
Arterio –venous malformation (4.49%). Abdominal aorta was mostly affected in the studied population
(58.43%) followed by Lower limb (37.08%), Carotid (22.47%), Renal (7.87%) and Upper limb arteries
(4.49%).
Conclusion: CT angiography is a noninvasive technique for the imaging of peripheral vascular
disease. Since no data is available from a well designed study in PVD in our country, till then the
data obtained from this study can be used in Bangladesh.
(Cardiovasc. j. 2011; 3(2): 155-162)
Key words:
CT angiogram,
Peripheral
vascular disease
(PVD).
Address of Correspondence: Prof. M Faruque, Department of Cardiology, NICVD, Dhaka. Bangladesh.
2. 156 Vol.-3, No.-2, January 2011 Cardiovas Journal
associated with hypertension, hypercholes
trolaemia and diabetes mellitus.5 PAD affects large
number of people world wide but more common in
USA. It is estimated that 10 million people with
symptomatic disease another 20-30 million people
are asymptomatic. It is estimated that 10% of
people over 60 years of age are affected and
prevalence continues to increase with age. The
cardinal symptoms of PAD include intermittent
claudication and rest pain .The location of the
symptom often relates to the site of the most
proximal stenosis. Buttock, hip or thigh
claudication typically occurs in patients with
obstruction of aorta and iliac arteries. Calf
claudication characterizes femoral or popliteal
artery stenosis.Ankle and pedal claudication occurs
in patients with tibial and peroneal artery disease.
Similarly stenosis of the subclavian, axillary or
brachial arteries may cause shoulder, biceps or
forearm claudication respectively. Symptoms
should resolve several minutes after cessation of
effort. There may be impotence in male. Rest pain
in legs worse at night relieved by hanging the leg
over the edge of the bed. Extremities may be cold.
It may be cyanosed; there may be pain, ulceration
and gangrene in 50-100 % patients. On
examination the limb is cold with dry skin and
lack of hair. Pulse is diminished or absent. There
may be ulceration; gangrene or dark discoloration
usually starts at the toes. Death due to PAD is
rare. Death occurs usually secondary to CAD or
CVD. Relative risk of all cause of death is 2-6 fold
higher than general people. Death rate increases
with decrease of ABI. Five years mortality with
ABI < 0.85 is 10% where as mortality approaches
> 50% when ABI is < 0.40. Patients may be
diagnosed by duplex ultrasonography, CT
angiogram, MR angiogram. Conventional
angiogram is gold standard for diagnosis.4
Methods:
Study Population
Peripheral C-T Angiogram was performed in 89
patients from 2006-2007 patients were referred
for vascular insufficiency, severe back pain, neck
swelling, uncontrolled hypertension and vertigo
from outdoor patient department. This non
invasive new Technology of C-T Angiogram
procedure was done on 89 patients who are
suffering from peripheral vascular disease. All the
procedures were done in Modern diagnostic Centre,
Dhanmondi – 8, Dhaka.
We scanned patients fromthe level of the cerebral
arteries to the pedal arteries in a single helical
scan. CT angiograms were produced using
maximum-intensity-projection reconstructions.
Findings weregraded according to nine categories:
1, normal (0% stenosis); 2, mild (1-49% stenosis);
3, moderate (50-74% stenosis); 4, severe (>75%
stenosis); 5, tortuosity; 6, aneurysm, 7, calcification,
8, Arteriovenous malformation (AVM), and 9,
haematoma.6
Inclusion criteria:
(1) Clinically suspected peripheral vascular
disease.
(2) Secondary Hypertension.
(3) Neck swelling of vascular origin.
(4) Vascular injury of Road Traffic Accident.
Exclusion criteria:
(1) Chronic renal failure.
(2) Acute pulmonary oedema (LVF).
(3) Congestive Cardiac Failure.
(4) Valvular Heart disease.
(5) Hypersensitivity to dye.
(6) Non co-operative patient ( Psychosomatic
disease)
(7) Unconscious patient
Procedure
Patient preparation typically involved placing the
patient supine of the CT table without a pillow or
foam wedge under the knees. The rationale for
not putting any support under the knees is that
the field of view should be enlarged to reconstruct
the arteries of interest as they move anteriorly
under the pillow. Any unnecessary increase in the
field-of-view was avoided as this diminishes in-plane
resolution. It may additionally be advantageous to
place tape around the patient‘s knee and ankles.
The rationale for taping is at the necessity to
increase the field-of-view. Taping the feet helped
to remind the patient to keep them immobile.
Somatom Sensation 64 slice (Simens) CT
angiogram machine was used. As soon as the
primary CTA was completed, the reconstruction
Study of 89 Cases of Peripheral Vascular Disease by CT Angiography M Faruque et al.
156
3. 157 Vol.-3, No.-2, January 2011 Cardiovas Journal
of images below the knee should be prioritized and
a quick assessment as the adequacy of these images
made. If insufficient arterial opacification was
present, then the second acquisition could be
triggered at that time. This approach assures that
the pedal vessels will be adequately assessed even
in the setting of substantially prolonged circulation
times. When assessing the peripheral arteries,
contrast medium flow rates of at least 4 ml per
second and preferably 5 ml per second were
desirable. When imaging atherosclerotic occlusive
disease, the scan range was extended from the
supra-renal aorta through the toes in the setting
of limb threatening ischaemia or to the ankles
in the setting of claudication. The presence of
stenosis (considered hemodynamically significant
when greater than fifty percent), occlusions, and
the lengths of these abnormalities are the most
important clinical observations to be made. The
product of scan times and the injection rate
determined total volume of contrast
administered. There were no complication
related to C-T angio and all studies are
technically adequate.
The scan direction was craniocaudal for Lower
Limb CTA, with the range from the level of
infrarenal aorta to the pedal arch; while for Upper
Limb CTA; the scan direction was caudocranial
from the level of aortic arch to the palmer arch.
The patients were instructed to continue quiet
breathing for the duration of scan. The success of
any CTA depends on the calculation of an accurate
delay to start the acquisition of images after the
injection of contrast, to get optimum arterial
enhancement, not contaminated by the venous
phase. The delay was calculated by using the test
bolus technique.
Data Collection & Analysis
The demographic profile of all patients including
age, sex was taken. The major risk factors of
peripheral arterial disease i.e. diabetes,
hypertension, smoking, dyslipidaemia and family
history were taken in each patient. The peripheral
arteries were studied- Carotid arteries, Abdominal
Aorta, Upper limb arteries, Lower limb arteries
and renal arteries. Morphological pattern of lesions
were described in each involved artery. Data
analysis was done in SPSS programme.
Results:
In all of our initial 89 patients, there has been no
technical failure. The procedure has been well
tolerated and in no study was there image
degradation due to motion artifacts. Patients of
peripheral vascular disease, with symptoms of
deceased or absent pulses, claudicaton or rest pain
also underwent CTA.
Table-I
Age distribution of ct angiography patients (n=89)
Age group Sex Total Percentage P value
Male Female 0.61NS
Upto 30 9 4 13 14.6
31-40 7 4 11 12.4
41-50 9 1 10 11.2
51-60 18 4 22 24.7
61-70 14 5 19 21.3
71 & above 12 2 14 15.7
Total 69 20 89 100.0
Table-II
Mean age by sex (Male=69, Female=20)
Sex Mean SD P Value
Male 54.49 18.36 NS
Female 49.45 17.89
Cardiovascular Journal Volume 3, No. 2, 2011
157
4. 158 Vol.-3, No.-2, January 2011 Cardiovas Journal
Table I shows age and sex distribution of the study
population. It shows most of the patients were
above 50yrs of age. Age and sex differences were
not statistically significant.
Table II shows Mean age in male and female were
54.49±18.36 and 49.45±17.89 which was not
significant statistically.
Table III shows distribution of risk factors in both
sexes. Most of the patients were hypertensive
(46.1%) followed by diabetes (30.3%) and smoking
(23.6%). Except smoking other risk factors did not
vary significantly in two sexes.
Table-IVshowsinvolvementoftheperipheralarteries
and their sex distribution. It shows abdominal aorta
was the most affected artery 58.43%, followed by
lower limb arteries 37.08%, carotid arteries 22.47%,
renal arteries 7.87% and upper limb arteries 4.49%.
Involvement of the peripheral arteries did not vary
significantly in both sexes.
Table V shows morphological pattern of involved
carotid arteries and their distribution in both
sexes. Most commonly found lesion was stenosis
(5.61%), followed by haematoma (4.49%), Arterio
–venous malformation (4.49%).
Table-III
Distribution of risk factors of the patients
Risk factors Positive Total Percentage P Value
Male Female
Diabetes 21 6 27 30.3 NS
Hypertension 34 7 41 46.1 NS
Smoking 21 0 21 23.6 S
Dyslipidaemia 9 3 12 13.5 NS
Family history 21 3 24 27 NS
Table-IV
Distribution of the involved peripheral artery diseases by sex
Arteries involved Normal Total Percentage Abnormal Total Percentage
Male Female Male Female
Carotid 56 13 69 77.53 13 7 20 22.47
Abdominal aorta 23 14 37 41.57 46 6 52 58.43
Upper limb 68 17 85 95.51 1 3 4 4.49
Lower limb 37 19 56 62.92 32 1 33 37.08
Renal 64 18 82 92.13 5 2 7 7.87
Table-V
Morphology Pattern of Carotid Artery by sex (n=89)
Carotid Artery Male Female Total Percentage
Mild Stenosis 1 3 4 4.49
Moderate Stenosis 1 0 1 1.12
Tortuous 1 1 2 2.25
Aneurysm 2 1 3 3.37
Calcification 1 1 2 2.25
AVM 3 1 4 4.49
Haematoma 4 0 4 4.49
Normal 56 13 69 77.53
Total 69 20 89 100.00
Study of 89 Cases of Peripheral Vascular Disease by CT Angiography M Faruque et al.
158
5. 159 Vol.-3, No.-2, January 2011 Cardiovas Journal
Fig.-1: Cerebral Angiogram as shown in CT Fig.-2: Cerebral Angiogram as shown in CT
Table-VI
Morphology Pattern of Abdominal Aorta by sex (n=89)
Abdominal aorta Male Female Total Percentage
Mild Stenosis 4 2 6 6.74
Moderate Stenosis 26 2 28 31.46
Severe Stenosis 7 0 7 7.87
Tortuous 0 1 1 1.12
Thrombus 1 0 1 1.12
Aneurysm 3 0 3 3.37
Calcification 5 1 6 6.74
Normal 23 14 37 41.57
Total 69 20 89 100.00
Fig.-3: Abdominal aneurysm affecting supra and
infra renal region
Fig:-4: Extra vascular mass compressing the lower
part of the abdominal aorta near its bifurcation
Cardiovascular Journal Volume 3, No. 2, 2011
159
6. 160 Vol.-3, No.-2, January 2011 Cardiovas Journal
Table-VII
Morphology Pattern of Upper Limb Artery by sex (n=89)
Upper limb artery Male Female Total Percentage
Mild Stenosis 0 1 1 1.12
Moderate Stenosis 0 0 0 0
Severe Stenosis 0 0 0 0
Tortuous 0 2 2 2.25
Thrombus 0 0 0 0
Aneurysm 1 0 1 1.12
Calcification
Normal 68 17 85 95.51
Total 69 20 89 100.00
Table-VIII
Morphology Pattern of Lower Limb Artery by sex (n=89)
Lower limb artery Male Female Total Percentage
Mild Stenosis 2 0 2 2.25
Moderate Stenosis 13 1 14 15.73
Severe Stenosis 3 0 3 3.37
Tortuous 0 0 0 0
Thombus 0 0 0 0
Aneurysm 0 0 0 0
Calcification 14 0 14 15.73
Normal 37 19 56 62.92
Total 69 20 89 100.00
Fig.-5: PVD affecting right and left common iliac
artery.
Fig.-6: Aneurysm affecting infra renal aorta and
right common iliac artery.
Study of 89 Cases of Peripheral Vascular Disease by CT Angiography M Faruque et al.
160
7. 161 Vol.-3, No.-2, January 2011 Cardiovas Journal
Table VI shows morphological pattern of involved
abdominal aorta and their distribution in both
sexes. Most commonly found lesion was stenosis
(46.07), followed by calcification (6.74%), aneurysm
(3.37%).
Table VII shows morphological pattern of involved
upper limb arteries and their distribution in both
sexes. Most commonly found lesion was tortuosity
(2.25%), followed by stenosis (1.12%), aneurysm
(1.12%).
Table VIII shows morphological pattern of involved
lower limb arteries and their distribution in both
sexes. Most commonly found lesion was stenosis
(5.61%), followed by haematoma(4.49%), Arterio –
venous malformation 4.49%.
Table IX shows morphological pattern of involved
carotid arteries and their distribution in both
sexes. Most commonly found lesion was stenosis
(5.61%), followed by haematoma (4.49%), Arterio
–venous malformation 4.49%.
Discussion:
This retrospective observational study was done
to evaluate the pattern of peripheral vascular
diseases and to evaluate CT angiogram as a
diagnostic tool for peripheral vascular diseases. It
is the first study with CT angiogram in Bangladeshi
patient. We want to show not the efficacy of the
procedure but to show the pattern and severity of
the peripheral vascular disease and its correlation
with risk factors.
We evaluated 89 patients with clinical suspicion of
PVD by CT angiogram. Most of the patients in our
study were male (69 out of 89 patients). The mean
age was 54.49 ±18.36 in male and 49.45 ±17.89 for
female. This difference is not significant. Most of
the patients in our series were more than 50yrs of
age (61.7%). This also correlates with the study of
Norgren et al. 7
The commonest risk factor in our study was
hypertension 46.1%, followed by diabetes 30.3%,
family history of atherosclerotic coronary and
peripheral vascular diseases 27% smoking 23.6%,
dyslipidaemia 13.5%. In a prospective study Price
at el have shown that the combined effect of
smoking on the cardiovascular risk factor has
influence on peripheral arterial disease.8
Explanation for the effect of cigarette smoking
on the development of peripheral arterial disease
have been described.9,10 which may reflect the
gender difference in this series as none of the
female subject in this study had history of
smoking. Such mechanisms could include a direct
toxic effect of whole smoke, nicotine and/or
carbon monoxide on endothelial cells, increased
platelet reactivity and agreeability, and/or a
detrimental effect of the elevated white blood cell
count found consistently in smokers.11Diabetes
mellitus was also shown as a major risk factor
for atherosclerotic peripheral arterial disease.
Other risk] factors associated with PVD in this
study also correlates with other studies. 12
Abdominal aorta was mostly affected in the studied
population (58.43%). Lower limb (37.08%), Carotid
(22.47%), Renal (7.87%) and Upper limb arteries
were affected according to decreasing frequency.
Involvements of the peripheral arteries do not vary
Table-IX
Morphology Pattern of Renal Artery by sex (n=89)
Renal artery Male Female Total Percentage
Mild Stenosis 1 0 1 1.12
Moderate Stenosis 1 0 1 1.12
Severe Stenosis 1 0 1 1.12
Tortuous 0 0 0 0
Thrombus 0 0 0 0
Aneurysm 2 2 4 4.49
Calcification 0 0 0 0
Normal 64 18 82 92.13
Total 69 20 89 100.00
Cardiovascular Journal Volume 3, No. 2, 2011
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8. 162 Vol.-3, No.-2, January 2011 Cardiovas Journal
significantly in both sexes. Stenosis (5.61%) was
the predominate lesion followed by haematoma
(4.49%), Arterio-venous malformation (4.49%) As
atherosclerosis is the main pathogenesis of the
peripheral vascular disease, according to the
observation, morphological prevalence of lesions
can be done from different arterial segments.
Limitation
The major drawback of CTA is large amount of
intravenous contrast and the ionizing radiation
involved. Also, no information is obtained regarding
the flow direction and velocity. In addition, CTA
may fail to demonstrate short segment stenosis,
apart from the fact that horizontally oriented
branches are poorly visualized, thus significant
lesions may be missed in certain instances. Total
number of patients in this study was also small.
Despite these limitations, the vast majority of
examinations we performed were considered
sufficiently diagnostic to avoid more invasive
imaging.
Conclusion:
Our initial experience of CT angiography with
MSCT has shown that it is a promising new, fast
and non-invasive imaging modality that can be
utilized effectively in the evaluation of peripheral
vasculature. Some of the inherent limitations of
the technique and the time consumed in post-
processing can be overcome with future
workstation and technology advances. Thus it
would be appropriate to conclude that CTA is
clearly emerging as a screening tool in patients of
peripheral vascular disease. CT angiography is a
noninvasive techniquefor the imaging of peripheral
vascular disease.Since no data is available from a
well designed study in PVD in our country, till
then the data obtained from this study can be used
in Bangladesh. As the software of CT angiogram
is developing day by day, in near future at least in
some cases it will replace the invasive angiogram.
Acknowledgement :Mr. Mostafizur Rahman, Mr.
Nurul Islam, Mr. Monir Ahmed, Mst. Nasima
Yesmin.
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