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Biomedical subjects

W E Faught

Publications and source records attributed to W E Faught.

11 recordsLinked to original sources
PubMed1995

The natural history of moderate (50% to 79%) internal carotid artery stenosis in symptomatic, nonhemispheric, and asymptomatic patients.

PURPOSE: This study was undertaken to determine the incidence of disease progression of moderate (50% to 79%) internal carotid artery stenosis in patients with symptoms, patients with nonhemispheric symptoms, and symptom-free patients and to define the risk of development of new neurologic events in each group. METHODS: Over a 6-year period, 272 patients with moderate internal carotid artery stenoses were monitored for a mean of 44 months with color-flow duplex scanning (CFS). At the time of the initial scan, 142 patients were symptom free, 87 had experienced transient ischemic attacks, amaurosis fugax, or mild strokes, and 43 had ill-defined nonhemispheric symptoms. The average number of follow-up scans was 2.4 per patient (range 1 to 11). RESULTS: During follow-up, 23 (26%) of the patients with symptoms, 17 (40%) of the patients with nonhemispheric symptoms, and 30 (21%) of the symptom-free patients had development of additional neurologic symptoms. Life-table comparison of ipsilateral ischemic events showed a significantly (p = 0.03) higher cumulative rate in the symptomatic group (20%) than in the asymptomatic group (7%) at 2 years. Mean annual stroke rates were 6% and 2% in patients in the symptomatic and asymptomatic groups, respectively. None of the patients in the nonhemispheric group had a stroke within 4 years of the initial study. Disease progression occurred in 16% of the patients. In the asymptomatic group, ipsilateral stroke occurred more frequently (p = 0.0001) in patients with disease progression (25%) than in patients with stable lesions (1%). CFS detected disease progression in 19 (79%) of 24 patients before the artery occluded or stroke occurred. In patients with symptoms, stroke was more frequent (p = 0.02) in patients with six or more risk factors (29%) than in those with five or fewer risk factors (7%). CONCLUSION: Although the risk of stroke is less in patients with moderate stenosis than it is in patients with severely stenotic lesions, symptom-free patients with advancing disease and patients with symptoms and multiple risk factors are at increased risk for development of neurologic events. These findings support the use of CFS to monitor patients with carotid artery disease and suggest that a more aggressive surgical approach may be indicated in selected patients with moderate carotid artery stenosis.

Aged↗
PubMed1994

Color-flow duplex scanning of carotid arteries: new velocity criteria based on receiver operator characteristic analysis for threshold stenoses used in the symptomatic and asymptomatic carotid trials.

PURPOSE: Duplex scanning has become the standard for noninvasive evaluation of carotid arteries. However, current ultrasound criteria for internal carotid artery (ICA) stenosis (16% to 49%, 50% to 79%, 80% to 99%) may not be applicable to the categories (30% to 49%, 50% to 69%, 70% to 99%) used in ongoing symptomatic and asymptomatic carotid endarterectomy trials. This study was undertaken to determine new velocity criteria consistent with these categories. METHODS: From January 1, 1989 through October 30, 1992, 5871 color-flow duplex scans were obtained in our laboratories. After inadequate arteriograms and patients with a contralateral ICA occlusion were excluded, 770 peak systolic velocity (PSV) and 229 end-diastolic velocity (EDV) measurements were available for comparison with arteriography. ICA PSV and EDV were subjected to receiver operator characteristic curve analysis to determine optimum criteria for identifying stenoses of 30%, 50%, and 70%. RESULTS: For 70% to 99% carotid artery stenosis, PSV greater than 130 plus EDV greater than 100 provided the best sensitivity (81%), specificity (98%), positive predictive value (89%), negative predictive value (96%), and overall accuracy (95%). For 50% to 69% stenosis, a PSV greater than 130 and EDV of 100 or less cm/sec proved to be the best combination: sensitivity (92%), specificity (97%), positive predictive value (93%), negative predictive value (99%), and accuracy (97%). Stenoses in the 30% to 49% range were less accurately identified. CONCLUSION: These redefined criteria may prove useful for analyzing duplex ultrasound velocity data in reference to the classification of ICA stenosis used in recent clinical trials of the safety and efficacy of carotid endarterectomy.

Blood Flow Velocity↗
PubMed1994

Augmentation of blood flow in limbs with occlusive arterial disease by intermittent calf compression.

PURPOSE: This study was designed to investigate the effect of intermittent calf compression on popliteal arterial blood flow and to see how flow is influenced by position of the subject and by arterial blood pressure at the ankle. METHODS: Volume flow in the popliteal artery of subjects in the sitting and prone positions was measured with duplex ultrasonography before inflation and immediately after deflation of a pneumatic cuff placed around the calf. Eleven legs of control subjects and 41 legs of patients with symptoms (32% patients with diabetes) with decreased ankle pressure were studied. Cuffs were inflated for 2 seconds at pressures ranging from 20 to 120 mm Hg. RESULTS: An increase in arterial blood flow of two to eight times (mean 4.4 +/- 2.0) was found on deflation of the cuff in seated control subjects. Little change in flow was observed when the subjects were in the prone position. In seated patients with arterial obstruction, the mean increase in arterial flow was 3.2 +/- 1.6 times the resting flow. Little correlation was found between the maximum increase in flow and the ankle/brachial index. CONCLUSIONS: An increased arteriovenous pressure gradient accounts for some but not all of the flow increase, much of which must be attributable to transient vasodilatation. Because the increase in flow does not depend on an increased inflow pressure and was not adversely affected by a low resting ankle-brachial pressure index or a low toe-pressure, intermittent external limb compression may deserve investigation as a possible adjunct to the nonoperative treatment of patients with severe arterial insufficiency.

Adult↗
PubMed1994

Carotid endarterectomy without angiography: is color-flow duplex scanning sufficient?

BACKGROUND: This study was designed to determine whether clinical evaluation and color-flow duplex scanning (CFS) alone provide enough information for patients to undergo carotid endarterectomy (CEA) safely without preoperative cerebral angiography and to assess the appropriate role of CFS in the evaluation of extracranial carotid artery disease. METHODS: During a 31-month period 167 patients (114 symptomatic and 53 asymptomatic) underwent CFS and angiography during evaluation for CEA. One hundred fifty-three patients were studied retrospectively, and 14 were studied prospectively. Data were reviewed to determine whether cerebral angiography added information not provided by duplex findings and, if so, did the results alter clinical management. RESULTS: Of the 167 patients studied, 149 underwent CEA and 18 were treated medically. Results of the two diagnostic modalities agreed perfectly in 82% of the patients, with 99% of the stenoses estimated by CFS being classified within one category of those measured with angiography. The sensitivity of CFS for detecting greater than 50% diameter-reducing stenoses of the internal carotid artery was 98%, and the positive predictive value was 99%. For detecting greater than 80% stenoses, CFS had a sensitivity of 84% and a positive predictive value of 95%. Clinical management was altered by angiographic findings in only seven patients (4%). False-positive results (n = 5) were due to poor scanning technique or interpreter error (n = 2), anatomic variations (n = 2), and unknown cause (n = 1). All false-negative results (n = 2) were due to poor scanning technique. CONCLUSIONS: Ninety-six percent of the patients in this study would have received appropriate clinical management based on neurologic history and the results of CFS alone. Our results indicate that CFS is sufficient for determining the need for surgery in patients being considered for CEA and can supplant cerebral angiography in nearly all clinical circumstances.

Aged↗
PubMed1993

Does air plethysmography correlate with duplex scanning in patients with chronic venous insufficiency?

PURPOSE: Duplex ultrasonography with distal cuff deflation was used to determine the presence and size of incompetent veins and compare the results with those of air plethysmography in patients with chronic venous insufficiency. METHODS: Thirty-two legs underwent a detailed study with both modalities. Sixteen legs had venous ulceration, six had stasis dermatitis, and ten had symptomatic varicose veins without skin changes. RESULTS: Although the venous filling index (VFI) in limbs with ulcers (5.4 +/- 3.8 ml/sec) and dermatitis (7.7 +/- 4.6 ml/sec) was significantly higher (p < 0.05) than it was in limbs with varicose veins (2.6 +/- 1.7 ml/sec), there was a large amount of overlap. Only 13% of ulcerated legs had VFI greater than 10 ml/sec. Sixty-three percent of legs with ulcers, 33% of legs with dermatitis, and 90% of legs with varicose veins had VFIs less than 5 ml/sec. Mean ejection fractions (EFs) in the three groups were similar, ranging from 45% to 52%. Combining VFI and EF did not lessen the overlap between groups. Forty-one percent of limbs with ulcers or dermatitis had air plethysmography parameters in the normal or intermediate area (VFI < 5 ml/sec; EF > 40%), which in previous studies corresponded to an incidence of ulceration of only 2%. VFI had a significant but weak correlation (r = 0.39) with the diameter of incompetent veins at the knee and a somewhat stronger relationship (r = 0.55) with the diameter of lower leg veins. Total venous volume correlated moderately well with calf vein diameter (r = 0.75). The clinical status of the leg did not correlate with the diameters of incompetent veins at the knee or calf levels. All limbs with an obstructed outflow had EFs less than 60% and ulcers or dermatitis. CONCLUSIONS: We conclude that plethysmographic measurements of functional venous parameters (VFI,EF) do not discriminate well between limbs with uncomplicated varicose veins and limbs with ulcers or stasis dermatitis and that VFI correlates poorly with the presence of incompetent veins and their diameters. Both duplex scanning and plethysmography seem to be necessary for a complete evaluation of limbs with chronic venous insufficiency.

Chronic Disease↗
PubMed1993

Presentation and natural history of internal carotid artery occlusion.

PURPOSE: This retrospective study was undertaken to investigate the effect of presenting neurologic symptoms, vascular risk factors, and degree of contralateral internal carotid artery stenosis on subsequent stroke and death rates of patients with internal carotid artery occlusion (ICO). METHODS: One hundred sixty-seven patients with ICO were evaluated over a 5-year period. Mean follow-up was 39 months. Initial symptoms included transient ischemic attack in 29 patients (17%), stroke in 71 patients (43%), nonhemispheric symptoms in 22 patients (13%), and no symptoms in 45 patients (27%). Ninety percent of the presenting strokes occurred ipsilateral to the ICO. RESULTS: During follow-up 54 (32%) patients died, 10 (19%) of stroke and 22 (41%) of heart disease. The 5-year cumulative survival rate was 63%. Subsequent neurologic events occurred in 26% of the patients. Thirty patients (18%) had a stroke during follow-up, of which 20 (67%) occurred ipsilateral to the ICO. The 5-year stroke-free rate was 76%. Patients who had a stroke had a less favorable 4-year stroke-free rate (67%) than those who had transient ischemic attack (92%) or those who originally had no symptoms (89%), p = 0.03 and p = 0.04, respectively. In addition, there was a trend towards a worse 5-year contralateral stroke-free rate in patients with contralateral stenosis of 50% to 99% (77%) compared with patients with less than 50% contralateral stenosis (94%), p = 0.08. Twenty patients underwent carotid endarterectomy on the nonoccluded side. There were no perioperative strokes or deaths. Carotid endarterectomy seemed to reduce the long-term stroke morbidity rate (p = 0.10) on the operated side in patients with 80% to 99% contralateral stenosis but did not perceptibly improve stroke-free rates on the occluded side or in patients with 50% to 79% stenosis. CONCLUSION: Patients with ICO have a variable prognosis. There is a significant incidence of subsequent stroke, which seems to be related to the presenting neurologic event and the degree of stenosis in the contralateral internal carotid artery.

Adult↗
PubMed1992

Superior results of ileoanal pull through (IAPT) in polyposis coli vs ulcerative colitis patients.

Colectomy, mucosal proctectomy, and ileoanal pull through (IAPT) have replaced proctocolectomy as the operation of choice in most patients with the colorectal mucosal diseases ulcerative colitis and polyposis coli. This study was conducted to determine whether there is any difference in postoperative morbidity and long-term functional results when IAPT is performed for polyposis coli than when it is performed for ulcerative colitis patients. Between 1982 and 1989, 277 IAPT procedures were performed at the University of Utah Medical Center, 239 for ulcerative colitis and 38 for polyposis coli syndromes. A prospective study compared polyposis and colitis patients after IAPT with regards to age, family history, preoperative findings, operative findings, postoperative complications, and long-term complications. Functional results were compared including day and night stool frequency, incidence of nighttime incontinence, and incidence of pouchitis. The incidence of postoperative complications was lower in the polyposis group than in the colitis group, but the numbers were low enough in both diseases that significant differences were not detected. However, the incidence of pouchitis (0% vs 19%), day (4.2 vs 6.0) and night (0.4 vs 0.9) stool frequency, and nighttime incontinence (5% vs 25%) was significantly lower in the polyposis group when compared to the colitis group. We conclude that IAPT performed for polyposis conditions is associated with superior results when compared with results from patients who undergo the procedure for ulcerative colitis.

Adenomatous Polyposis Coli↗
PubMed1992

Vascular applications of lasers.

There have been major advances in laser technology and in our understanding of the effects of laser energy on blood vessels. This, in turn, has led to the many clinical applications of lasers in patients with vascular disease. The clinical results of laser endarterectomy, laser angioplasty, laser-assisted balloon angioplasty, laser-assisted vascular anastomoses, and the future of lasers in cardiovascular disease are discussed.

Humans↗
PubMed1990

The effects of laser energy on the arterial wall.

Laser energy has been proposed as a method of resecting atherosclerotic plaque since the mid 1960s. However, only over the past several years have we come to understand some of the unique interactions of the laser with cardiovascular tissue. In laser angioplasty a major challenge has been choosing the optimal laser and duration of laser exposure to achieve adequate resection of plaque, while minimizing such complications as thrombosis, perforation, embolization, aneurysm formation, and accelerated atherosclerosis. Ultimately we must develop a more selective laser that resects plaque while leaving adjacent arterial wall uninjured. This review describes the physics of laser energy, the different lasers available for use in the cardiovascular system, laser-arterial wall interactions, and some of the limitations of laser angioplasty.

Arteriosclerosis↗
PubMed1989

Splenic abscess: presentation, treatment options, and results.

Pyogenic splenic abscess is a rare condition that tends to occur in patients with predisposing factors. The use of splenectomy or computed tomography-guided percutaneous drainage in 10 patients with splenic abscess is presented. In 8 of 10 cases, the diagnosis was based on abdominal computed tomography scan. Seven of 10 patients were treated with splenectomy, and 3 were managed with computed tomography-guided drainage. Abscess cultures included Escherichia coli, Enterobacter, Streptococcus viridans, Staphylococcus aureus, and Bacteroides fragilis. There were two morbidities and one death in the splenectomy group and no complications in those treated with percutaneous drainage. This review suggests a flexible approach in the management of splenic abscess. Although splenectomy remains the traditional treatment for bacterial splenic abscess, CT-guided drainage may be appropriate in carefully selected patients.

Abscess↗