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K Massalha

Publications and source records attributed to K Massalha.

13 recordsLinked to original sources
PubMed2000

["Panorama images" with ultrasound. A computer program joins individual images to make a continuous image].

SieScape is a novel method that enables the investigator to obtain continuous ultrasonographic images of extensive structures. Its ease of use and rapidity of deployment make SieScape the method of choice for the documentation and monitoring of large superficial lesions, for example hematomas following arterial puncture. With the aid of Color Sie Scape, not only views can be obtained in any desired plane, but also the relationship of the hematoma to the vascular structures can be documented.

Abdominal Muscles↗
PubMed2000

Effect of hemodynamic conditions on sonographic measurements of peak systolic velocity and arterial diameter in patients with peripheral arterial stenosis.

PURPOSE: We measured changes in peak systolic velocity ratio and sonogaphic vascular diameter during different hemodynamic conditions in patients with femoral or iliac artery stenosis. METHODS: In 35 patients with isolated femoral or iliac artery stenosis, prestenotic and intrastenotic peak systolic velocity and inner vascular diameter were calculated using color Doppler sonography and gray-scale sonography, respectively. The measurements were performed with the patient at rest (baseline), after leg exercise, and again after oral administration of 10 mg of the vasodilator nifedipine. RESULTS: The mean prestenotic and intrastenotic peak systolic velocity and the peak systolic velocity ratio (intrastenotic/prestenotic peak systolic velocity) were 70 +/- 31 cm/second, 360 +/- 130 cm/second, and 6.5 +/- 3.6 at baseline; 78 +/- 37 cm/second, 404 +/- 171 cm/second, and 6.6 +/- 4.2 after leg exercise; and 71 +/- 30 cm/second, 353 +/- 109 cm/second, and 5.9 +/- 3.2 after nifedipine administration. The mean prestenotic and intrastenotic diameter and percentage of diameter reduction were 5.9 +/- 3.2 mm, 2.3 +/- 1.1 mm, and 59 +/- 13% at baseline; 4.8 +/- 2.4 mm, 2.0 +/- 1.3 mm, and 62 +/- 13% after leg exercise; and 5.9 +/- 2.9 mm, 2.5 +/- 1.0 mm, and 54 +/- 14% after nifedipine administration. Only the difference in intrastenotic diameter after leg exercise was significantly different from baseline. CONCLUSIONS: The peak systolic velocity ratio in peripheral arterial stenosis seems to be relatively independent of the hemodynamic conditions and cannot be used for investigations of vasomotion of stenotic arterial segments during different hemodynamic conditions.

Administration, Oral↗
PubMed2000

Interventional therapy of vascular complications caused by the hemostatic puncture closure device angio-seal.

The hemostatic puncture closure device Angio-Seal is a quick, safe, and easy-to-use system, allowing rapid sealing of the vascular access site following coronary angiography and interventional procedures. It is advantageous for patients in whom early mobilization is desired and may therefore decrease hospital costs. Despite the documented low complication rate, there are some specific problems. Reporting on five cases, we describe problems in diagnosis and possible interventional therapy of Angio-Seal-associated complications such as stenosis, occlusion, or peripheral embolism. Our experience led to the concept of precise diagnosis in any patient with leg symptoms and early interventional treatment with the aim of complete removal of the intra-arterial parts of the Angio-Seal device. Any delay in diagnosis and treatment increases the risk of additional thrombotic occlusion. Spontaneous dissolution of the Angio-Seal sponge limits interventional possibilities of complete removal. Cathet. Cardiovasc. Intervent. 49:142-147, 2000.

Adult↗
PubMed2000

[Carotid stenting with the new slotted tube stent--prospective multicenter study. Essen experiences]].

UNLABELLED: The indication for therapy of high degree carotid stenoses is discussed controversely in regard to new publications. Only symptomatic carotid stenoses are accepted as indication for operative therapy (arterectomy). The new method of carotid stenting was investigated in several studies and needs to be proved in controlled prospective randomized trials. The use of the self-expanding wall-stent has been established in most working groups; nevertheless some disadvantages should be considered (uncontrolled long segment stenting, covering the origin of ext. carotid artery, insufficient adaptation of struts in carotid communis). After development of a new flexible multicellular balloon-expanding stent (Jo-Carotisstent) with sufficient flexibility and compressibility and different stent lengths, the use of this stent in high degree carotid stenoses was investigated. The aim of this study was to analyze the acute and long-term quantitative stent results (angiography and duplex sonography) and clinical results periinterventionally and during follow-up (0.5-1 year). METHODS: Selective approach from femoral, 8 Fr.-guiding catheter, canalization of stenosis with coronary guide wire (0.014 inch), primary PTA with coronary balloon. RESULTS: In 47 of 48 patients with 49 carotid stenoses, successful stent implantation was achieved (97.9%). In 2 patients TIA of short duration (4.2%) and in 1 patient (2.1%) a minor stroke occurred. All stents could be implanted with optimal reference diameter. During follow up after 0.5 year no significant proliferative restenosis was observed. The quantitative analysis showed excellent stent-diameter after 0.5 year with only minimal recoil (< 5%) and no clinical event. CONCLUSION: Using a new flexible and non-deforming multicellular balloon-expanded stent, selective stenting of high degree carotid artery stenoses can be realized with an excellent procedural success rate and a complication rate comparable with the results of other publicated studies. The results after 0.5 year follow-up seem to be promising.

Aged↗
PubMed2000

Color Doppler sonography of arteries associated with perforating veins.

BACKGROUND: It has been known for some time that perforating veins had associated perforating arteries. There has been no way to investigate these arteries preoperatively. The newer high resolution ultrasonic devices enable us to investigate these arteries. We are able to localize, determine the frequency, and measure the size of the arteries associated with perforating veins of the lower extremities. METHODS: All patients were studied in our clinical vascular laboratory. PATIENTS: 55 patients with different degrees of varicosities were studied. MEASURES: Each patient had their perforating veins and arteries investigated with a 7.5 MHz linear array transducer (Siemens, Type Elegra). RESULTS: 73% of the 233 perforating veins identified had an associated perforating artery. No preferred localization of the perforating veins was noted. The number of location did not correlate with the presence or absence of incompetence of the veins. The perforating arteries were located in close proximity to the perforating veins but did not go far into the subcutaneous fat. The maximum systolic velocity was 12+/-8 cm/sec. CONCLUSIONS: The preoperative detection of perforating arteries associated with perforating veins is possible using a color Doppler scanner. Their pathophysiological function and its relation to bleeding complications, wound healing and ulcer healing can be studied using this tool.

Adult↗
PubMed1999

[Difficulties in the detection of heparin-induced thrombocytopenia type II].

We report about a 29 year old female who developed right-sided leg vein thrombosis over three levels. Thrombectomy was attempted followed by intravenous anticoagulation with heparin. The platelet count dropped acutely from 176,000/microliter to 11,000/microliter after the sixth day. A lung perfusion-ventilation-scintigraphy suggested recent pulmonary embolism by lateral, predominantly right-sided perfusion deficits. ACT scan of the pelvic region showed rethrombosis of the right common iliac vein. The clinical suspicion of heparin-induced thrombocytopenia (HIT) type II was confirmed by a positive heparin-induced platelet aggregation test and the detection of antibodies by heparin-platelet factor 4-ELISA. The patient was treated with lepirudin at body-weight-adapted dose. After recovery of the platelet count to 102,000/microliter within seven days the treatment was changed to Orgaran after exclusion of immunologic cross reactivity. An overlapping oral anticoagulation with Marcoumar was initiated. Although HIT type II usually develops over a few days, acute thrombopenia can also occur. There is therefore no safe diagnostic interval permitting a timely detection.

Adult↗
PubMed1999

Ergotamine-induced intermittent claudication.

We report about a female patient with intermittent claudication caused by ergotamine. She used ergotamine as a treatment for migraine headaches for more than 4 years. The claudication began 7 month before admission. Colour Doppler sonography and angiography showed severe stenosis of the left external iliac and superficial femoral artery. The patient was treated with phenprocoumon for one year after withdrawal of ergotamine. After that the superficial femoral stenosis disappeared completely, but the external iliac stenosis was still present and was consequently successfully treated by atherectomy. The histology showed a fibrosis of the intima and a hypertrophy of the media.

Adult↗
PubMed1999

Stenosis-jet can cause a dissection of the superficial femoral artery.

A dissection of the superficial femoral artery mainly occurs due to trauma or manipulation of the artery by means of interventional procedures. In contrast to dissections of the carotid arteries which are known to occur spontaneously we present the case of a stenosis of the superficial femoral artery that led to a dissection caused by the stenosis-jet. The dissection on the other hand caused an appositional thrombus which led to the embolic occlusion of the pedal-arteries. In case of peripheral embolisms in patients with or without history of peripheral arterial occlusion disease it is important to look for a causing arterial pathology preferably by duplex sonography.

Adult↗
PubMed1999

[Therapeutic ultrasound for the recanalization of peripheral vascular occlusions].

Since the development of percutaneous transluminal angioplasty several techniques such as laser or atherectomy devices have been developed for recanalization of peripheral arterial occlusions. In a first clinical study we investigated if also the application of intravascular ultrasound can be useful for recanalization of occluded peripheral arteries. We applied an ultrasound angioplasty device (ACOLYSIS, ANGIOSONICS, USA) in a percutaneous approach in 8 patients with peripheral arterial occlusions (7 femoro-popliteal segments, 1 external iliac artery-occlusion). All patients suffered from severe leg ischemia due to subacute thrombotic occlusions. The ultrasound transmitter was introduced and advanced under fluoroscopic guidance to the site of the lesion. After activation the ultrasound transmitter was slowly advanced into the occlusion easily creating a channel within the occlusive material. Depending on the length of the occlusion (5-16 cm) treatment times ranged from 120-480 s. To further reduce the mass of the occlusive material an aspiration thrombectomy was performed in all cases leading to a complete recanalization in 6 cases. In 2 cases a remaining stenosis was successfully dilated. Intra-vascular ultrasonic devices can be useful for recanalization of occluded peripheral arteries. With the use of high-energy ultrasound a selective injury of the occlusive material can be induced without damaging the surrounding arterial wall. This selectivity is based on the differences in elasticity between the atherosclerotic plaque and the media layers. Especially if thrombolytic therapy of longer peripheral arterial occlusions fails or is contraindicated ultrasound angioplasty may be a new approach for recanalization.

Aged↗
PubMed1998

SieScape: a new sonographic dimension with fictive images.

SieScape is a new data processor that produces continuous sonographic images of large structures. It works without mechanical control of position and can be used with any transducer. Its accuracy and reproducibility is relevant for measurements and has to be investigated. With the ultrasound equipment of Siemens, type Elegra (5- and 7-MHz linear array transducer), we did repetitive measurements of linear superficial distances, curved circumferences and diameters of human legs. Finally, we tried to do continuous investigations of vascular structures to produce SieScape images. The linear superficial distances of 150 mm were underestimated (147.4+/-3.3 mm). Diameter measurements of the calf, with an adjusted depth of 40 mm, tended to give more accurate values than measurements with a depth of 70 mm, which were all overestimated. The circumferences of the calf measured between superficial markers were calculated as too small. SieScape really provides new sonographic documentation. The SieScape images are fictive, because they do not exactly reproduce anatomic dimensions.

Algorithms↗
PubMed1998

The use of the echo-enhancing agent Levovist does not influence the estimation of the degree of vascular stenosis calculated from peak systolic velocity ratio, diameter reduction and cross section area reduction.

Levovist, a new echo-enhancing agent, is proclaimed to give more information about blood flow and therefore might be supposed to show the true intravascular lumen. Thus, it has to be shown whether such an echo-enhancing agent influences the sonographic estimation of vascular stenosis. We investigated 32 patients with PAOD and a single stenosis in the iliacal or femoral arteries (mean age 54+/-13 years) using a color Doppler sonographic equipment with a 5.4 or 7.3 MHz linear transducer. Levovist was given in a concentration of 200 mg/ml i.v with a total dose of 4 g. We did two measurements before the application of Levovist. Peak systolic velocity ratio (PSVR) was 6.5+/-3.6 and 6.4+/-3.8 before and 6.3+/-4.2 after application of Levovist. Sonographic diameter reduction was 59+/-15 and 62+/-16% before, and 60+/-16% after application. Diameter reduction in angiography was 65+/-13%. Reduction of the cross section area was 81+/-14 and 83+/-15% before, and 83+/-16% after application. The use of the echo-enhancing agent Levovist does not influence the calculation of the peak systolic velocity ratio, diameter reduction or cross section area reduction. The degree of the stenosis calculated from the sonographic reduction in diameter tended to be smaller than in angiography either with or without Levovist.

Angiography↗
PubMed1998

Influence of changes in arterial blood pressure and peripheral arterial resistance on peak systolic velocity ratio.

BACKGROUND: Peak systolic velocity ratio has been described as a parameter to determine the degree of arterial stenosis. But there is very little information about the influence of changes in arterial blood pressure or peripheral arterial resistance during exercise on the peak systolic velocity ratio. PATIENTS AND METHODS: Peak systolic velocity was calculated before and in arterial stenosis in 35 patients with only single stenosis in the femoral or iliacal arteries under 4 different conditions: a) twice under resting conditions as a control, b) increased blood pressure by arm activation but unchanged peripheral vascular resistance, c) increased blood pressure by leg activation with a reduced peripheral vascular resistance by metabolic vasodilatation, d) decreased blood pressure associated with pharmacologically reduced peripheral resistance (10 mg nifedipine). RESULTS: Peak systolic velocity ratio was: a) 5.8 +/- 3.7 and 5.7 +/- 3.3, b) 5.6 +/- 3.6 (the increase in systolic arterial blood pressure was 20 +/- 3 mmHg), c) 6.3 +/- 4.4 (increase in systolic arterial blood pressure was 21 +/- 3 mmHg), d) 5.6 +/- 3.4 (decrease in systolic arterial blood pressure was 18 +/- 8 mmHg) without being significantly different from each other. The correlation factors of the peak systolic velocity ratios to the angiographic diameter reduction were between 0.737 and 0.847. Although the mean values suggest that there is no influence from the different exercise tests or nifedipine application on the peak systolic velocity ratio single stenosis demonstrated large reproducible differences. CONCLUSION: The influence of changes in arterial blood pressure and peripheral resistance on peak systolic velocity ratio appeared small. But a single stenosis showed large increases or decreases of peak systolic velocity ratio possibly due to vasomotion of the prestenotic or stenotic arterial segment.

Adult↗