PubMed Health⌕ Search

Biomedical subjects

C V Ruckley

Publications and source records attributed to C V Ruckley.

At least 127 records · Page 7Linked to original sources
PubMed1994

Duplex ultrasound surveillance of infrainguinal bypass grafts: auditing the process.

The effectiveness of an infrainguinal bypass graft surveillance programme using duplex scanning was assessed over a 2-year period. Of 220 infrainguinal bypass grafts (123 vein and 97 PTFE grafts; 114 to the above knee level, 94 below knee and 12 distal to popliteal artery) in 203 patients, 208 (94.5%) were available for follow-up surveillance. The protocol called for duplex scans at 6 weeks, 3, 6, 9 and 12 months. Fifty-seven grafts (27%) were found to have a V1/V2 ratio equal to or greater than 1.5 and in this group 25 grafts occluded. The median time between primary operation and positive duplex finding was 4 months. Thirty-nine grafts failed during follow-up (at time of analysis median follow-up was 12 months [range 2-83 months]). There were 18 interventions resulting from surveillance-detected stenoses. The median time between positive duplex finding and further investigation was 2 months. Further, there were significant differences in the site of abnormal findings between ePTFE and vein grafts. The value of a surveillance programme may be reduced if there are low rates of intervention and/or excessive delays in intervention following the demonstration of graft-related stenoses. Surveillance programmes and subsequent interventions need to be audited.

Adult↗
PubMed1993

Comparison of long-term survival after successful repair of ruptured and non-ruptured abdominal aortic aneurysm.

Long-term survival was assessed after the repair of non-ruptured (n = 311) and ruptured (n = 227) abdominal aortic aneurysm. Follow-up was 94.2 per cent complete, and the overall survival rate at 8 years was 43.6 per cent. There was no significant difference in 8-year survival rates between patients with non-ruptured (45.2 per cent) and ruptured (40.5 per cent) aneurysms. The survival curves were also compared with that for an age- and sex-matched population derived from Scottish Home and Health Department data.

Aged↗
PubMed1993

Foot volumetry and duplex ultrasonography after saphenous and subfascial perforating vein ligation for recurrent venous ulceration.

Forty-three patients undergoing superficial and perforating vein ligation for recurrent venous ulceration underwent preoperative and postoperative foot volumetry and postoperative duplex ultrasonography. Patients were followed for a median of 66 (range 18-144) months. Of nine patients who developed recurrent ulceration, six had femoral vein incompetence and all had popliteal vein incompetence demonstrated by duplex ultrasonography. Of the 34 patients who remained ulcer-free, five had femoral vein incompetence and a single patient had popliteal vein incompetence on duplex scanning, giving positive predictive values for recurrent ulceration of 55 per cent (femoral vein incompetence) and 90 per cent (popliteal vein incompetence). Patients with saphenofemoral incompetence on late follow-up were also more likely to suffer recurrence. Preoperative foot volumetry with tourniquet occlusion of superficial veins showed that the median expulsion fraction of patients who developed recurrent ulcer during follow-up was 0.8 (range 0.6-2.3) per cent compared with 1.5 (range 0.4-2.9) per cent for those who remained ulcer-free (P = 0.025); the median half-refilling time of patients with recurrent ulcer was 1.5 (range 0.5-5.5) s compared with 5.0 (range 0.5-23.0) s for those without recurrence (P < 0.01). Postoperative foot volumetry showed similar differences. Deep venous incompetence, particularly of the popliteal segment, as demonstrated by duplex ultrasonography and foot volumetry, is a useful predictor of recurrent ulceration after subfascial perforator and superficial venous ligation.

Adult↗
PubMed1993

Recurrent varicose veins: correlation between preoperative clinical and hand-held Doppler ultrasonographic examination, and anatomical findings at surgery.

A consecutive series of 118 patients (148 legs) presenting with recurrent varicose veins underwent preoperative clinical and hand-held Doppler ultrasonographic examination by a single observer. The presence of saphenofemoral, mid-thigh perforator and saphenopopliteal reflux was noted. Ultrasonography markedly improved the accuracy of clinical assessment at all three potential sites of reflux compared with operative findings. Of 71 patients undergoing repeat groin dissection, only 20 (28 per cent) had a tied saphenofemoral junction, 31 (44 per cent) had intact major tributaries and 52 (73 per cent) had an intact long saphenous vein (LSV) in the thigh. There was a positive association between mid-thigh perforator reflux giving rise to recurrent varices and the presence of an intact LSV in the thigh. Of 45 legs with saphenopopliteal reflux, only four had previously undergone saphenopopliteal ligation, suggesting that most short saphenous varicosities had either appeared after or had not been recognized at the time of primary surgery. This study indicates that even an experienced vascular surgeon can have difficulty in assessing the presence or absence of recurrent deep to superficial reflux by means of clinical examination alone and that Doppler ultrasonographic examination is mandatory. Recurrence continues to be associated with persistent or recurrent incompetence at the site of previous inadequate surgery.

Adult↗
PubMed1993

Preoperative coagulopathy in ruptured abdominal aortic aneurysm predicts poor outcome.

In a prospective study of 50 consecutive patients undergoing operation for ruptured abdominal aortic aneurysm, a coagulation screen was performed on admission to hospital. Twenty patients with either a platelet count < 100 x 10(9)/l or a prothrombin time > 1.5 times the control value had a mortality rate of 65 per cent (95 per cent confidence interval 45-85 per cent); a further 23 patients with normal screen results had a mortality rate of 9 per cent (95 per cent confidence interval 0-20 per cent) (P < 0.001). Seven patients, of whom three died, did not have an admission coagulation screen performed. Patient age in the study group did not have independent statistical predictive power. This study indicates that coagulopathy at the time of admission predicts poor outcome in patients with ruptured aortic aneurysm. Current management strategies are inadequate for the treatment of these patients, who can be rapidly identified on admission by means of platelet and prothrombin counts.

Aortic Aneurysm, Abdominal↗
PubMed1993

Serial imaging of the carotid bifurcation and cerebrovascular reserve after carotid endarterectomy.

A radioisotopic method of quantifying mean cerebral transit time was used to assess the immediate effects of carotid endarterectomy on cerebrovascular reserve (CVR) in 69 patients. In addition, serial postoperative data were acquired on CVR, clinical status and non-invasive imaging of the internal carotid arteries in 56 patients over a period of 6-48 (median 24) months. Twenty-one patients (30 per cent) had preoperative evidence of impaired CVR in the symptomatic hemisphere. Within 4 days of surgery, however, reserve had returned to normal in 17 of the 21 patients. During follow-up, four of the 56 patients developed recurrent stenosis (> 50 per cent) or occlusion of the artery operated on but only two of these had impairment of CVR and none was symptomatic. Three patients suffered recurrent transient ischaemic attacks (TIAs) but none had recurrent internal carotid artery disease or impaired CVR. One patient suffered a TIA in the territory of the non-operated artery during follow-up in association with disease progression and CVR impairment. However, the TIA preceded recognition of either of these changes. Twelve other patients had (or developed) stenosis (> 50 per cent) in the non-operated artery during follow-up but none was symptomatic or developed impairment of CVR. Although assessment of CVR provided useful information on the frequency of haemodynamic compromise before carotid endarterectomy and on the natural history of disease progression, neither serial assessment of reserve nor non-invasive imaging of the carotid bifurcation influenced clinical practice during follow-up.

Blood Flow Velocity↗
PubMed1993

Role of the leucocyte in the pathogenesis of vascular disease.

The leucocyte plays a key role in the local and systemic tissue injury that results from peripheral arterial disease and chronic venous insufficiency. Despite the apparent dissimilarities between limb ischaemia and chronic venous ulceration, in both diseases macrovascular abnormalities lead to microvascular leucocyte trapping and activation. Activated leucocytes adhere to and damage adjacent endothelium by expressing adhesion molecules and releasing harmful moieties such as proteases and free radicals. Subsequent loss of endothelial integrity and the migration of activated leucocytes outwith the circulation leads to destruction of surrounding tissue. Leucocytes and their products are also involved in the systemic manifestations of ischaemia such as multiple organ failure and coagulopathy. An overview of leucocyte biology as it pertains to peripheral arterial and venous disease is presented. The opportunities for novel therapeutic interventions based on a better understanding of this biology are also discussed.

Blood Platelets↗
PubMed1993

Factors influencing the hyperaemic response after carotid endarterectomy.

Transcranial Doppler ultrasonography was used to evaluate serially the changes in middle cerebral artery blood flow velocity (MCAV) in 37 consecutive patients during the first 72 h after carotid endarterectomy to identify factors that may predispose towards postoperative hyperaemia. Within 6 h of endarterectomy, median MCAV in the operated hemisphere was 48 per cent (95 per cent confidence interval 37-60 per cent) above that on admission and remained 27 per cent (95 per cent confidence interval 19-37 per cent) higher at 72 h. There was a similar, but less marked, increase in MCAV in the contralateral middle cerebral artery during the same time period. There was no association between the postoperative increase in MCAV and clinical presentation, admission MCAV, the presence or absence of a residual neurological deficit or infarction on computed tomography before operation, carotid clamp time, shunt usage, internal carotid artery stump pressure or MCAV during clamping. The greatest increase in MCAV was observed in patients with internal carotid artery stenosis > or = 50 per cent and, more particularly, in those with preoperative evidence of impaired cerebrovascular reserve. In the latter patients, MCAV was 100 per cent above the admission level within 12 h of operation and was still 50 per cent raised at 72 h.

Blood Flow Velocity↗
PubMed1993

Immediate effects of carotid clamp release on middle cerebral artery blood flow velocity during carotid endarterectomy.

Transcranial Doppler ultrasound was employed in 44 patients undergoing carotid endarterectomy in order to identify factors associated with the greatest increases in middle cerebral artery blood flow velocity (MCAV) immediately after carotid clamp release and restoration of flow. Previous reports have suggested that such increases might reflect post-ischemic hyperaemia. Overall, the median increase in MCAV on restoration of flow [58 cm/s (95% Cl 44-68)] was greater than the median decrease in MCAV after initial carotid clamping [36 cm/s (95% Cl 26-43), p < 0.0001]. However, the immediate increase in MCAV tended to be transient and, in one patient, may have represented a hyperaemic response to a haemodynamically induced intraoperative neurological deficit. There was no association between the magnitude of MCAV increase and clinical presentation, degree of carotid stenosis, computed tomography scan findings, type of anaesthesia, nor the presence or absence of impaired cerebral vascular reserve, nor the occurrence of intraoperative air embolisation. The greatest increases in MCAV on clamp release were observed in patients with the greatest decreases in MCAV at clamping and those with the lowest internal carotid artery stump pressures. The most likely explanation for the findings is that they represent a transient hyperaemic response to carotid occlusion. It remains unclear whether this phenomenon is mediated by some degree of ischaemic injury or simply by the effect of a sudden surge of blood through low resistance arterioles that have dilated in order to maintain the collateral circulation during carotid clamping.

Blood Flow Velocity↗
PubMed1993

Acute thrombosis of the non-aneurysmal abdominal aorta.

Fourteen patients admitted over a 9 year period with acute thrombotic occlusion of the non-aneurysmal abdominal aorta have been reviewed. Twelve patients underwent aortic bifurcation graft reconstruction, one thromboendarterectomy alone, and one a re-entry operation for dissection. Two patients (14%) died in the perioperative period. The mean postoperative survival of the remaining patients is to date 55 (range 4-93) months with a mean follow-up period of 69 (range 18-100) months. The results indicate these patients should be treated aggressively by early reconstructive surgery in the expectation that the majority will survive their operation and gain a useful extension to their lives.

Adult↗
PubMed1993

A prospective study of the natural history of femoropopliteal artery stenosis using duplex ultrasound.

A foreknowledge of impending femoral artery occlusion might allow prevention of a deterioration in ischaemia by percutaneous transluminal angioplasty (PTA) in the preocclusive stage. A window of opportunity exists before a femoral stenosis progresses to occlusion and its treatment by PTA becomes more difficult, riskier and associated with lower patency. The size of this window is unknown. This is the first report of a study of the natural history of femoral stenoses using Duplex ultrasound. The aims of the study were to determine in patients with symptomatic peripheral arterial disease: (1) the incidence of progression from stenosis to occlusion; (2) the change in severity of stenosis over time; and (3) the relationship between severity of stenosis and progression to occlusion. The velocity ratio (VR) of 43 femoral artery stenoses in 38 patients was measured by Duplex ultrasound. The examination was repeated after a median of 28 (range 5-76) weeks. Nine/43 (21%) stenoses progressed to occlusion within a median of 13 weeks. Little overall change in VR was demonstrable if occlusion did not occur. Only stenoses with a VR > 3 progressed to occlusion in the study period. The data suggest that severe stenoses progress more rapidly than moderate, with a relatively brief window of opportunity. If PTA is to be undertaken, stenoses with a VR greater than 3 should be treated with minimum delay.

Adult↗
PubMed1993

Quality of life following lower limb amputation for peripheral arterial disease.

Lower limb amputations for peripheral arterial disease are performed predominantly on an elderly population with poor social support and concomitant medical problems. The effect of amputations on the quality of life of this population has not been properly assessed. The quality of life of 149 amputees from one hospital was evaluated using the Nottingham Health Profile and compared to that of a control group matched for age and sex. One hundred and thirty (87%) amputees and 115 (77%) controls responded to the questionnaire. Amputees reported significantly more problems with mobility, social isolation, lethargy, pain, sleep and emotional disturbance than controls (p < 0.001). However, mobility was the only significant independent factor after matched logistic regression analysis (p < 0.001). The differences in social isolation and emotional distress lost their significance after adjustment for mobility. The overall quality of life following lower limb amputation for peripheral arterial disease is poor, but much of this is secondary to restricted mobility. Rehabilitation following amputation should therefore focus on attempts to improve mobility.

Activities of Daily Living↗
PubMed1993

An audit of trends and current practice of carotid endarterectomy in Edinburgh (1975-1990).

Changes in the patient population and trends in management were studied for 260 consecutive carotid endarterectomies performed during the periods 1975-1982 and 1983-1990. A 43% increase was observed in the number of operations (from 107 to 153), an 81% increase taking into account patients randomized to medical treatment in the European Carotid Surgery Trial. There were significant reductions in patients continuing to smoke (79 to 60%, P = 0.001), in those with systolic hypertension (21 to 11%, P = 0.018) and diastolic hypertension (26 to 12%, P = 0.002), and in those with asymptomatic carotid lesions (8 to 2%, P = 0.031). There were significant increases in the proportion of patients with strokes presenting with a residual neurological deficit (40 to 66%, P = 0.024), and in those with ocular symptoms (30 to 50%, P = 0.001) and with stenoses greater than 50% (58 to 71%, P = 0.018). This study suggests a trend for a higher risk population with more severe carotid disease. In the light of results of clinical trials, further evolution of patient selection is likely to occur and should be taken into account when evaluating the risk of carotid endarterectomy.

Adult↗