Late prognostic value of flow-mediated dilation in the brachial artery of patients with chest pain.
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Adult↗
Biomedical subjects
R Katzenschlager
Publications and source records attributed to R Katzenschlager.
Vasospasmus: a rare manifestation of homocystinuria.
We report about a patient suffering from multiple spastic stenoses of varying degree of both iliac arteries and from occlusion of the left tibiofibular trunc. Laboratory investigations revealed increased levels of homocysteine and the diagnosis of homocystinuria was confirmed by fibroblast cell culture. The spasms responded well to vasodilative therapy with nitroglycerine, molsidomine (cGMP mediated) and prostaglandine E1 but not with nifedipine (Ca influx blocker). Our review of literature demonstrated that this arterial spastic abnormality is a very rare complication in patients suffering from homocystinuria.
Adult↗
Effects of successful parathyroidectomy on altered arterial reactivity in patients with hypercalcaemia: results of a 3-year follow-up study.
OBJECTIVE: Serum calcium was found to be an independent, prospective risk factor for myocardial infarction. We have previously shown that altered arterial reactivity in the course of primary hyperparathyroidism, a disease characterized by hypercalcaemia, may predominantly involve the arterial media and not the endothelium as observed in patients with various stages of atherosclerosis. The present study was performed to test whether successful parathyroidectomy can improve vascular reactivity in patients with primary hyperparathyroidism. SUBJECTS AND DESIGN: Endothelium-dependent, flow-mediated and endothelium-independent, nitroglycerin-induced dilatation were assessed by brachial artery ultrasound (7 MHz) in 18 patients with primary hyperparathyroidism (mean +/- SD; age, 55.1 +/- 12.6) prior to and 3 years after successful parathyroidectomy. RESULTS: Parathyroidectomy resulted in significant decreases of PTH (242 +/- 186 vs. 34 +/- 24 ng/l, P = 0. 0001) and serum calcium levels (2.8 +/- 0.3 vs. 2.4 +/- 0.1 mm/l, P = 0.00001) and in an increase of serum phosphate levels (0.78 +/- 0. 23 vs. 1.17 +/- 0.18 mm/l, P = 0.00001). However, normalization of hormone and electrolyte levels did not lead to an improvement of flow-mediated dilatation (12.1 +/- 3.1 vs. 11.0 +/- 5.4&, P = 0.49) or nitroglycerin-induced dilatation (12.5 +/- 3.1 vs. 13.2 +/- 6.8%, P = 0.68) within the follow-up period. No changes were observed with respect to the risk factor profile, vessel size and blood flow. CONCLUSION: These data suggest that restoration of normocalcaemia by parathyroidectomy cannot improve vascular reactivity in patients with primary hyperparathyroidism but may prevent further progression of vascular disease within this period of time.
Aged↗
Colour duplex sonography-guided local lysis of occlusions in the femoro-popliteal region.
BACKGROUND: To evaluate colour duplex sonographic guidance of local lysis of occlusions in the femoropopliteal region. METHODS: Thirteen consecutive patients (8 female, mean age 67) with peripheral artery disease with acute and subacute occlusions in the superficial femoral or popliteal artery were included in this study. The lesions were identified by colour duplex ultrasound (Acuson 128 XP/10) After anterograde puncture the guidewire was advanced through the arterial lesions under B-mode image control. The Mewissen Infusion Catheter and a Katzen infusion wire were then accurately positioned within the lesion under B-mode image control. The fibrinolytic drugs were then inserted into the occlusions, initially 2.5 mg rt-PA as a bolus followed by Urokinase (50,000 IU/h) for 24 hours. After control duplex sonography (over 24 hours) the additional angioplasty was performed either under fluoroscopic or exclusively under ultrasound guidance. RESULTS: Eleven of 13 patients with occlusions in the femoro-popliteal region were partially recanalised after ultrasound guided local lysis and after the additional angioplasties (nine under fluoroscopic and three under ultrasound guidance) the arteries were completely recanalised. CONCLUSIONS: Our data show that not only is the positioning of the catheter and the guidewire for local lysis exclusively under colour duplex guidance possible, but also the surveillance of the local lysis and the additional angioplasty. In the case of any complications, however, easy access to angiography should be possible.
Adult↗
Thromboembolism and resistance to activated protein C in patients with inflammatory bowel disease.
OBJECTIVE: Thromboembolic events are serious complications in patients with inflammatory bowel disease (IBD). Resistance of factor V to degradation by activated protein C (APC) is a major cause for venous thrombosis and is found in approximately 30% of patients with thromboembolism. The aim of the present study was to assess the prevalence of APC resistance and clinical risk factors in patients with IBD. METHODS: One-hundred-two patients with IBD (64 women and 38 men; median age, 35 yr; range, 17-77 yr; 77 with Crohn's disease, 25 with ulcerative colitis) and 102 gender- and age-matched healthy control subjects were investigated prospectively for the presence of APC resistance. None of the healthy controls but 16 patients with IBD had a history of thromboembolism. RESULTS: Patients with IBD and thromboembolism were young, with a median age of 37 yr (range, 17-61 yr). Five (31.3%) of them had APC resistance, which was more common than in patients with IBD without thromboembolism (7%) and in controls (5.9%) (p < 0.01). Three patients had two thromboembolic events, the other 13 each had one. Deep vein thrombosis of the leg and pulmonary emboli were the most common thromboembolic complications (84.2%). Active disease, fistula, or bowel stenosis were found in 10 (52.6%) of 19 thromboembolic events; in three (15.8%) cases thromboembolism happened postoperatively. CONCLUSIONS: APC resistance is not associated with IBD but, when present, increases the risk of thromboembolism. Patients with IBD and thromboembolism are mostly young and clinical risk factors can be found in one-half of cases.
Activated Protein C Resistance↗
Impairment of endothelium-independent vasodilation in patients with hypercalcemia.
OBJECTIVE: Patients with primary hyperparathyroidism (PHPT) and/or hypercalcemia are at increased risk for myocardial ischemia. Whether PHPT is associated with altered endothelium-dependent dilation, vascular smooth muscle cell function, or both is unknown. This study was performed to test the hypothesis that endothelium-dependent, flow-mediated dilation (FMD) and/or endothelium-independent, nitroglycerin-induced dilation (NMD) is impaired in the preclinical phase of vascular disease in patients with PHPT. METHODS: Twenty-six PHPT patients (mean +/- SD; age 55 +/- 15 y, serum calcium 3.00 +/- 0.37 mmol/l, serum phosphate 0.79 +/- 0.21 mmol/l, iPTH 249 +/- 262 pg/ml) with no evidence of coronary artery disease (CAD) as well as 26 normocalcemic control subjects (CTL; age 51 +/- 12 y) were studied. FMD following reactive hyperemia and NMD after 0.8 mg nitroglycerin (NTG) were assessed in the brachial artery by using high resolution ultrasound (7 MHz). RESULTS: NMD was impaired in PHPT patients compared to CTL (11.9 +/- 3.9% vs. 15.6 +/- 5.7%; p = 0.012). FMD was similar in both study groups (11.6 +/- 4.6% vs. 12.6 +/- 4.9; NS). The ratio of FMD to NMD was significantly different between PHPT patients and CTL (0.98 +/- 0.19 vs 0.81 +/- 0.25, p = 0.0009). On multiple stepwise regression analysis serum calcium was independently associated with the FMD/NMD ratio (r = 0.34, p = 0.017). CONCLUSIONS: Endothelium-independent vasodilation is impaired in PHPT patients without clinical evidence of coronary artery disease compared to normocalcemic CTL, while endothelium-dependent dilation was similar in both study groups. Thus, altered arterial reactivity in the course of PHPT may predominantly involve the arterial media and not the endothelium as observed previously in patients with various stages of atherosclerosis.
Adult↗
Additional benefit of vitamin E supplementation to simvastatin therapy on vasoreactivity of the brachial artery of hypercholesterolemic men.
OBJECTIVES: The aim of this study was to determine whether the combination of lipid-lowering therapy and vitamin E supplementation improves peripheral endothelial function and whether it is more effective than lipid-lowering therapy alone. BACKGROUND: Endothelium-dependent vasodilation is impaired in coronary and peripheral arteries of patients with hypercholesterolemia. Coronary endothelial function has been shown to improve under lipid-lowering and antioxidant therapy, but the effect of additive vitamin E supplementation in the brachial artery is unknown. METHODS: Seven patients with hypercholesterolemia (mean+/-SD; age 51+/-10 yr) were studied. Endothelium-dependent, flow-mediated dilation (FMD) and endothelium-independent nitroglycerin-induced dilation (NMD) were assessed in the brachial artery using high resolution ultrasound 1) at baseline (BL I), 2) after 8 weeks of simvastatin (20 mg) and vitamin E (300 IU) therapy (Comb I), 3) after withdrawal of vitamin E for 4 weeks (Statin), 4) after therapy as in #2 for 4 weeks (Comb II) and 5) after withdrawal of both drugs for 4 weeks (BL II). RESULTS: Combined simvastatin and vitamin E therapy reduced total cholesterol (Comb I vs. BL I: 276+/-22 vs. 190+/-14 mg/dl, p < 0.0001) and low-density lipoprotein (LDL)-C (197+/-22 vs. 106+/-22 mg/dl, p < 0.00001), augmented alpha tocopherol levels normalized to LDL (12.2+/-4.1 vs. 4.9+/-0.9 microg alpha-T/100 mg% LDL-C, p < 0.01) and resulted in significant improvements in FMD (16.4+/-4.7 vs. 4.9+/-2.5%, p < 0.001) as well as NMD (17.9+/-4.3 vs. 11.2+/-2.8%, p < 0.01). The ratio of FMD to NMD (0.92+/-0.17 vs. 0.46+/-0.24%, p < 0.05) also increased under combination therapy, indicating a greater improvement of FMD than that of NMD. After withdrawal of vitamin E, both FMD (Comb I vs. Statin: 16.4+/-4.7 vs. 7.9+/-4.7%, p < 0.01) and NMD (17.9+/-4.3 vs. 10.9+/-4.5%, p < 0.05) decreased significantly such that simvastatin alone only tended to improve FMD and did not change NMD. Results under combination therapy (Comb II vs. BL II) were reproducible. CONCLUSIONS: Combined vitamin E and simvastatin therapy leads to an improvement of FMD and NMD in the brachial artery of patients with hypercholesterolemia. The improvement of FMD is more pronounced after combination therapy than after lipid-lowering therapy alone, similar to previous findings in the coronary circulation.
Adult↗
Color duplex sonography guided stent placement in a stenosis of the superficial femoral artery. A case report.
We report the first case of a successful stent placement under color coded ultrasound guidance alone in the superficial femoral artery of a 73-year-old woman suffering from intermittent calf claudication following restenosis after an uncomplicated angioplasty five months previously. Because of a hemodynamically residual stenosis after three attempts at dilatation, a percutaneous transluminal angioplasty and stent insertion were performed under the sole guidance of color coded ultrasound. The intervention was performed without complication and at the six-month follow-up examination, the patient was symptom-free and the stent was morphologically intact and hemodynamically functional. This case shows that successful stent placement under ultrasonic guidance alone, without fluoroscopic control is possible, provided that there is adequate sonographic visualization.
Aged↗
Systemic endothelial dysfunction is related to the extent and severity of coronary artery disease.
Flow-mediated vasodilation (FMD) of systemic arteries, a non-invasive parameter of endothelial function, is correlated with cardiovascular risk factors. The relationship between FMD and morphologically and clinically evident coronary artery disease has not been described. This study was performed to test the hypothesis that an impairment of FMD in the brachial artery is related to the presence and/or extent and severity of coronary artery disease (CAD). We examined 74 patients with angina pectoris and 14 control subjects (age 17 36 years). Angiography revealed coronary artery disease (> or = 30% diameter stenosis) in 44 patients (CAD, age 32 67 years) and smooth coronary arteries in 30 patients (non-CAD, age 22-73 years). Vasodilation following reactive hyperemia and after sublingual nitroglycerin (NTG) was assessed in the brachial artery using B-mode high resolution ultrasound. CAD patients showed markedly impaired FMD compared to the non-CAD group (5.7 +/- 4.8 versus 12.6 +/- 6.7%, P < 0.0001) and to controls (5.7 +/- 4.8 versus 15.7 +/- 3.9%, P < 0.00001). NTG induced similar degrees of vasodilation in the CAD and non-CAD groups but less vasodilation in the CAD patients compared to controls (12.2 +/- 6.3 versus 20.4 +/- 6.9%, P < 0.01). On univariate analysis, impaired FMD in CAD patients and non-CAD patients was related to the extent of coronary disease (1-, 2- or 3-vessel disease; r = -0.67, P < 0.0001), to the maximum percent diameter stenosis in one of the major coronary vessels (r = -0.52, P < 0.0001), brachial artery diameter (r = -0.46, P < 0.0001) and plasma cholesterol level (r = -0.34, P < 0.001). On multiple stepwise regression analysis the extent of coronary disease (r = -0.51, P < 0.0001) and the baseline brachial artery diameter (r = -0.37, P < 0.0001) were independently associated with FMD in CAD and non-CAD patients. The present findings suggest that the impairment of FMD in the brachial artery, a marker of systemic endothelial function, is closely related to the angiographic extent of CAD.
Adolescent↗
Use of a collagen plug versus manual compression for sealing arterial puncture site after cardiac catheterization.
The aim of the study was to investigate (1) the safety and efficacy of the application of a collagen plug (Vasoseal) at arterial puncture sites, (2) the hemostasis time, and (3) the comfort for the patient of a collagen plug (Vasoseal) when compared with manual compression. Sixty-two patients were randomized either for application of a collagen plug (Vasoseal, group A, n = 33) or manual compression (group B, n = 29) after cardiac catheterization. All patients were evaluated for subjective pain score ranging from 1 to 5 (1 = no pain up to 5 = very strong pain). In addition the authors measured the time until hemostasis could be achieved. The patients were evaluated by duplex sonography for complications at days 1 and 7 after the procedure. The pain score demonstrated a significantly lower score in group A when compared with group B (P = 0.01). The mean time for hemostasis was significantly lower in group A (mean 9.6 minutes) when compared with group B (mean 23.6 minutes) (P = 0.0001). Regarding the complication rate there was no significant difference between the groups (group A vs group B, P = 0.82). The authors conclude that the application of a collagen plug at the arterial puncture site is a safe and time-saving method. In addition it is less painful and therefore better tolerated than manual compression.
Aged↗
Ultrasound guided compression therapy in 134 patients with iatrogenic pseudo-aneurysms: advantage of routine duplex ultrasound control of the puncture site following transfemoral catheterization.
BACKGROUND: The following study was designed to evaluate the effectiveness and safety of ultrasound guided compression therapy (UGCT) of iatrogenic postcatheterization pseudo-aneurysms (PA) on the one hand and to justify the usefulness of the routine colour duplex control of the puncture site following transfemoral catheterization, on the other hand. MATERIAL AND METHODS: During the study period 142 patients with (PA) following transfemoral catheterization were identified by means of colour duplex examination Eighty of these 142 patients were identified during a routine colour duplex control of the puncture site the day after PTA/angiography because of peripheral arterial occlusive disease (PAOD) [group A]; the remaining 62 patients with symptomatic groins were referred from other departments [group B]. RESULTS: In 8 patients of group B UGCT was considered to be contra-indicated, they were primarily treated by surgical repair of the PA. A total of 134 patients (group A 80 patients, group B 54 patients) underwent an UGCT. In total the success rate of UGCT was in group A 100% and in group B 78%. 12/54 patients (all group B) with failure of UGCT underwent a secondary surgical repair of the PA. Within group B there was a negative correlation between delay of diagnosis/UGCT and success (p < 0.04), whereas the size of the sheath did not influence the outcome of the UGCT (p = 0.3). CONCLUSION: Our study confirms the effectiveness and safety of UGCT. Routine colour duplex control of the puncture site the day following the removal of the sheath after percutaneous catheterization and UGCT of PAs without delay can increase the success rate of UGCT and minimize the need for surgical repair of PAs.
Adult↗
Demonstration of cystic adventitial disease by intravascular ultrasound imaging.
In a 34-year-old woman with intermittent calf claudication, cystic adventitial disease of the popliteal artery was demonstrated by intravascular ultrasound imaging. Multiple intramural cystic masses were seen to be compressing the arterial lumen. The diagnoses of cystic adventitial disease was confirmed by surgery. Intravascular ultrasound imaging reliably identifies cystic adventitial disease; its application can be recommended as an alternative to established diagnostic procedures (computed tomography, magnetic resonance imaging) in patients undergoing angiography.
Adult↗
Femoropopliteal artery: initial and 6-month results of color duplex US-guided percutaneous transluminal angioplasty.
PURPOSE: To evaluate color duplex ultrasonographic (US) guidance of percutaneous transluminal angioplasty (PTA) of femoropopliteal artery stenoses and occlusions. MATERIALS AND METHODS: Twenty-four patients (11 women, 13 men; mean age, 65.0 years) with severe claudication, abnormal ankle-arm pressure indexes, and lesions in the superficial femoral or popliteal artery depicted at US underwent balloon PTA with US guidance. US findings were confirmed before and after PTA by means of intravenous digital subtraction angiography. RESULTS: All of 22 segmental stenoses and three of four superficial femoral artery occlusions were successfully treated (in 23 patients). In three cases, a residual stenosis was detected after initial PTA, and PTA was repeated with a larger balloon catheter. Of the 21 patients followed up for 6 months, one had reocclusion and three had hemodynamically significant restenosis. CONCLUSION: Results of PTA with US guidance in short stenoses or occlusions of the femoral or popliteal artery are similar to those of PTA with fluoroscopic control.
Aged↗
[Leriche syndrome: treatment with local lysis and subsequent percutaneous transluminal angioplasty].
Two cases of Leriche's syndrome treated by local thrombolysis and subsequent percutaneous transluminal angioplasty with or without additional stent implantation are described. The fibrinolytic drugs were applied locally into the occlusions through a Mewissen Infusion Catheter and a Katzen Infusion Wire (initial 2.5 mg rt-PA as bolus followed by Urokinase (50000 IU/h) during 24 and 48 hours respectively. Residual stenotic lesions and occlusions were successfully treated with PTA alone in case 1 and with PTA in combination with a stent implantation in case 2. In accordance with Bean et al. (1985) and Goffette et al. (1989) we recommend local lysis in combination with PTA with or without additional stent implantation as an alternative treatment to surgery or systemic lysis for the treatment of Leriche's syndrome.
Adult↗
Incidence of pseudoaneurysm after diagnostic and therapeutic angiography.
PURPOSE: To investigate prospectively with color flow duplex (CFD) sonography the incidence of pseudoaneurysm or arteriovenous fistula (AVF) after transfemoral arterial catheterization with angiography, percutaneous transluminal angioplasty (PTA), or local lysis (LL). MATERIALS AND METHODS: CFD sonography was used to examine the puncture site in 565 consecutive patients who had undergone PTA, LL, or angiography (581 procedures). RESULTS: The incidence of pseudoaneurysm in the first 300 procedures in which standard compression was used was 14.0% overall, 27.0% after LL with antegrade-puncture PTA, 18.5% after antegrade-puncture PTA, 9.3% after retrograde-puncture PTA, and 1.2% after angiography. To decrease the high incidence, in the next 281 procedures manual compression was continued for at least 5 minutes after local bleeding had stopped. This significantly reduced the incidence to 1.1% overall, 8.0% after LL in combination with PTA, 0.9% after antegrade PTA alone, 0.9% after retrograde PTA, and 0% after angiography (P < .01). CONCLUSION: The incidence of pseudoaneurysm after transfemoral arterial catheterization depends on the type of intervention. The main risk factor is too brief a period of manual compression.
Adult↗
Detection of symptomless postoperative deep vein thrombosis.
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Double-Blind Method↗
[Gender-specific differences of risk factors of atherosclerosis. A study of 3,850 Vienna employees].
Atherosclerosis is the most frequent cause of death in Austria as well as in the other western industrialized countries. Sex specific differences in the various age groups concerning relative myocardial infarction-mortality stimulated us to investigate the risk factors for atherosclerosis in 3850 employees. An extensive lipid status, liver and kidney function parameters were determined, the blood-pressure was measured, and a cardiovascular centered case history was examined. The mean cholesterol level and the LDL-cholesterol level in males were significantly higher than in females (cholesterol: males 223.8 +/- 56.8 mg/dl, females 208.2 +/- 43.3 mg/dl, LDL-cholesterol: male 151.9 +/- 55.1 mg/dl, female 132.2 +/- 40.1 mg/dl, p < 0.001). The mean HDL-cholesterol level in males were significantly lower than in females (males: 45.0 +/- 11.6 mg/dl, females 56.2 +/- 13.3 mg/dl, p < 0.001). No significant difference concerning smoking-behaviour could be determined between female and male participants in this cohort (33.0% of the males resp. 33.6% of the females stated that they smoked cigarettes). Hypercholesterolaemia and cigarette-smoking are the main risk factors for both sexes, however the situation of women-except for the 6th decade-is much better than that of men. Remarkable is the increasing number of female-smokers, especially at younger age.
Adult↗
[Macroembolism as a complication of ultra-high dose urokinase lysis of occlusion of a bifurcation prosthesis].
The case of a 70-year-old woman suffering from a long occlusion of the right branch of an aortobifemoral dacron-graft implanted six years ago is reported. Patency could be achieved by a systemic application of an ultrahigh dose of urokinase (UHUK = 9,000,000 I.U/6 h, intermittent daily application, two cycles). As a major complication macro-embolism to the popliteal artery and to the superficial femoral artery occurred, however. A further cycle of UHUK, local thrombolytic therapy (12 mg rtPA) and surgical thrombectomy failed to achieve persistent recanalization. So the patient finally had to be provided with a femoro-crural composite bypass. In conclusion, in a systemic thrombolytic therapy of occlusions of dacron grafts in the aorto-iliacal area a standard dose of urokinase (initial dose 600,000 I.U., maintenance dose 150,000 I.U./h, infusion pump) is recommended.
Aged↗