Regarding "Prevention of renal failure in patients undergoing thoracoabdominal aortic aneurysm repair".
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Biomedical subjects
Geert Willem Schurink
Publications and source records attributed to Geert Willem Schurink.
Cerebral hyperperfusion syndrome.
Cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy is characterised by ipsilateral headache, hypertension, seizures, and focal neurological deficits. If not treated properly it can result in severe brain oedema, intracerebral or subarachnoid haemorrhage, and death. Knowledge of CHS among physicians is limited. Most studies report incidences of CHS of 0-3% after carotid endarterectomy. CHS is most common in patients with increases of more than 100% in perfusion compared with baseline after carotid endarterectomy and is rare in patients with increases in perfusion less than 100% compared with baseline. The most important risk factors in CHS are diminished cerebrovascular reserve, postoperative hypertension, and hyperperfusion lasting more than several hours after carotid endarterectomy. Impaired autoregulation as a result of endothelial dysfunction mediated by generation of free oxygen radicals is implicated in the pathogenesis of CHS. Treatment strategies are directed towards regulation of blood pressure and limitation of rises in cerebral perfusion. Complete recovery happens in mild cases, but disability and death can occur in more severe cases. More information about CHS and early institution of adequate treatment are of paramount importance in order to prevent these potentially severe complications.
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Comparison of contrast-enhanced magnetic resonance angiography and digital subtraction angiography in patients with chronic critical ischemia and tissue loss.
RATIONALE AND OBJECTIVES: To compare the ability of intra-arterial digital subtraction angiography (IA-DSA) and total runoff contrast-enhanced magnetic resonance angiography (CE-MRA) to demonstrate peripheral arterial anatomy, specifically in patients with chronic critical ischemia and tissue loss. MATERIALS AND METHODS: Twenty-three consecutive patients with chronic critical ischemia and tissue loss underwent CE-MRA and IA-DSA within 2 days. Two teams, consisting of an interventional radiologist and vascular surgeon who were blinded to each other's results, determined the number of named arteries (21 segments) and the presence of >/=50% stenosis or occlusion. RESULTS: Compared with IA-DSA, both teams detected significantly more arterial segments with CE-MRA, both above and below the knee (team 1: above knee 7.0 versus 5.2, P = 0.002, and below knee 8.5 versus 5.4, P < 0.001; team 2: above knee 7.1 versus 5.4, P = 0.004, and below knee 8.3 versus 5.9, P < 0.001). Interobserver agreement between the 2 teams with regard to presence of arteries and the presence of stenoses and/or occlusions yielded kappa values of 0.76 (95% confidence interval 0.71-0.81) for IA-DSA and 0.73 (95% confidence interval 0.66-0.80) for CE-MRA. Treatment was changed based on the CE-MRA findings in 8/23 (35%) patients. CONCLUSIONS: In the present study CE-MRA detected more patent arteries than IA-DSA in patients with chronic critical ischemia and tissue loss. CE-MRA can modify the choice of therapeutic strategy in these patients.
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Comparison of treatment plans for peripheral arterial disease made with multi-station contrast medium-enhanced magnetic resonance angiography and duplex ultrasound scanning.
OBJECTIVE: This study was undertaken to investigate the effects of substituting multi-station total outflow contrast medium-enhanced magnetic resonance angiography (CE-MRA) for color duplex ultrasound (US) scanning on treatment planning in the diagnostic workup of patients with suspected or known peripheral arterial occlusive disease. Patients and methods One hundred consecutive patients referred because of suspected or proved peripheral arterial occlusive disease to a University Hospital underwent both aortoiliac duplex US scanning and multi-station total outflow CE-MRA. For 73 of these patients (57% men; mean age, 62 years) treatment or treatment plans could be retraced. Eighteen patients also underwent femoro-popliteal duplex US scanning. Three experienced vascular surgeons retrospectively formulated two sets of treatment plans based on standardized clinical parameters and either duplex US scanning or CE-MRA. The main outcome measure was proportion of patients for whom the treatment plan matched actual treatment without additional use of intra-arterial digital subtraction angiography. Actual treatment, based on all available information, including results of duplex US scanning, CE-MRA, and any other diagnostic tests, served as the standard of reference. RESULTS: Duplex US scanning provided enough information for treatment planning in 46, 45, and 53 patients versus 67, 68, and 66 patients when CE-MRA was used (surgeons 1, 2, and 3, respectively; surgeons 1 and 2, P <.001; surgeon 3, P =.007). Treatment plans based on duplex US scanning exactly matched actual treatment in 37 of 73 patients (51%; surgeon 1), 36 of 73 patients (49%; surgeon 2), and 46 of 73 patients (63%; surgeon 3). Treatment plans based on CE-MRA exactly matched actual treatment in 56 of 73 patients (77%; surgeon 1), 55 of 73 patients (75%; surgeon 2), and 51 of 73 patients (70%; surgeon 3). Positive predictive value and negative predictive value of duplex US scanning as measures of ability to discriminate between surgical and nonsurgical treatment were 0 of 0 (undefined) and 43 of 46 (93%), 1 of 2 (50%) and 40 of 43 (93%), and 5 of 5 (100%) and 44 of 48 (92%) for surgeons 1, 2, and 3, respectively. For CE-MRA, positive and negative predictive values were 11 of 13 (85%) and 50 of 54 (93%), 10 of 12 (83%) and 51 of 56 (91%), and 8 of 13 (62%) and 48 of 53 (91%), respectively, for surgeons 1, 2, and 3. CONCLUSION: Compared with aorto-iliac and femoro-popliteal duplex US scanning, multi-station total outflow CE-MRA is more effective for treatment planning in most patients with known or suspected peripheral arterial occlusive disease.
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