Sandra Radak

Images in vascular medicine Jugular vein aneurysm - ultrasonographic evaluation

mass in the base of the left side of the neck. His left thyroid lobe had been resected for goiter 16 years ago. Ultrasonography revealed an aneurysm in the shape of a triangle in the transverse plane and ovoid shape in the saggital plane, 42 34 21 mm in size, closely attached to the lateral aspect of the internal jugular vein (IJV) (Panels A and B). At the junction of the middle and the distal third of this aneurysm, a communication with the IJV was seen, 6–7 mm in diameter. High-velocity blood flow was registered within the central part of the aneurysm, and much slower flow near the aneurysmal wall, causing a ‘pseudothrombosis’ effect. The flow through the aneurysmal neck was bidirectional and respiratory phase-dependent (Panel B). Surgery was performed with resection of the aneurysm and lateral suture of the jugular vein. No thrombus was found within the aneurysm, and there was no reaction in the surrounding tissue to connect the previous neck surgery with the aneurysm formation. Pathologic examination showed all layers of a normal vein, with endothelial continuity and fibroblastic proliferation and some mixed muscle layers. Jugular vein aneurysms are rarely seen,1,2 and most frequently have been described in children. They appear to have a benign natural history, and should be excised only if symptomatic, enlarging or disfiguring.3 Duplex 3D ultrasonography was a reliable technique for diagnosis and sufficient for surgical treatment of the problem.

Eversion Carotid Endarterectomy Versus Best Medical Treatment in Symptomatic Patients with Near Total Internal Carotid Occlusion: A Prospective Nonrandomized Trial

BACKGROUND We sought to prospectively evaluate clinical effects of eversion carotid endarterectomy (ECEA) versus best medical treatment of symptomatic patients with near total internal carotid artery (ICA) occlusion. METHODS From January 2003 to December 2006, a total of 309 recently (within 12 months) symptomatic patients with near total ICA occlusion who were eligible for surgery were identified in our institution. Patients were nonrandomly divided into group A (259 patients), who underwent ECEA surgery, and group B (50 patients), who refused surgery. Patients in group B received the best medical treatment based on the opinion of the attending vascular surgeon and/or angiologist. Patients were followed for ipsilateral stroke, transient ischemic accident, and neurologic mortality for 12 months. RESULTS There were no intraoperative and perioperative deaths and strokes in patients who were subjected to surgery. TIA was noted in 4 (1.5%) of these patients. There were no differences between the groups with respect to medications on discharge. Cumulative 12 month incidence of TIA, ipsilateral stroke and neurologic mortality was lower in patients who underwent ECEA than in patients on medical therapy (13 [5%] versus 12 [24%], p < 0.001; 4 [1.5%] versus 7 [14%], p < 0.001; and 4 [1.5%] versus 4 [8%], p = 0.034, respectively). Restenosis of the operated ICA was noted in 7 (3%) patients, and progression of near to total occlusion was seen in 15 (37%) patients in group B. CONCLUSION Our data indicate that recently (within 12 months) symptomatic patients with near total ICA occlusion who underwent ECEA have lower incidence of TIA, ipsilateral stroke, and neurologic death during follow-up than medically treated patients. It appears that, at least in high-volume centers, ECEA should be favored over medical treatment for the management of these patients.

Association of MMP-3 5A/6A gene polymorphism with susceptibility to carotid atherosclerosis

OBJECTIVES Stromelysin-1 (MMP-3) as a key member of metalloproteinase family could have an important role in atherogenesis. The 5A/6A polymorphism in the promoter of MMP-3 gene affects the level of MMP-3 gene expression. We assessed whether the MMP-3 promoter low- and high-activity genotypes are related to susceptibility for carotid atherosclerosis (CA) in Serbian population. DESIGN AND METHODS The study group of case-control design consisted of 515 participants. The 265 patients with ultrasonographic evidence of carotid plaque presence were recruited for the study. The 5A/6A polymorphism was typed by RFLP-PCR. RESULTS There was significantly higher prevalence of genotypes containing 6A allele in the patients with CA compared to controls (p<0.05). The model of inheritance with the dominant effect of 6A allele gave elevated and significant OR for carotid atherosclerosis (adjusted OR 2.35, CI=1.0-5.5, p=0.048). CONCLUSIONS Subjects carrying genotypes with 6A allele had significantly higher susceptibility to carotid atherosclerosis.

Percutaneous angioplasty of internal jugular and azygous veins in patients with chronic cerebrospinal venous insufficiency and multiple sclerosis: early and mid-term results

Purpose: To assess the safety of endovascular treatment of chronic cerebrospinal venous insufficiency (CCSVI) in patients with multiple sclerosis (MS). Materials and Methods: A total of 72 patients with CCSVI and MS (44 with relapsing remitting – RR, 4 with primary progressive, 20 with secondary progressive and 4 with benign MS) underwent percutaneous angioplasty. Outcome measures were colour Doppler ultrasonography parameters, gradient pressure at the vein abnormality level, postoperative complications, re-stenosis, disease severity scored by means of Expanded Disability Status Scale (EDSS) and patients’ assumption of disease status. Controls were done after one month on 72 patients, six months on 69 patients and one year on 61 patients, respectively (the average follow-up was 11 months). Results: There were no postoperative complications. Colour Doppler ultrasonography showed significant improvement in cross-sectional area parameters (P < 0.05) and significant decrease in confluence velocity values (P < 0.05). Postoperative gradient pressure decreased, in internal jugular vein (IJV) significantly (P < 0.05). Re-stenosis appeared in 5.3% of patients. EDSS score was significantly improved (P < 0.01) and about half of patients reported significant or mild improvement in disease status and none of them worsening of symptoms. Conclusion: Endovascular treatment of the IJV and azygous veins in patients with CCSVI and MS is a safe procedure with no post-procedural complications followed by significant improvement of IJV flow haemodynamic parameters and decrease in the EDSS score. Whether CCSVI percutaneous treatment might affect clinical improvement in patients suffering from MS is yet to be seen after completion of major multicentric clinical trials, still it seems like that this procedure is not negligible.

Color Doppler sonographic evaluation of flow volume of the internal carotid and vertebral arteries after carotid endarterectomy

To measure by Doppler sonography the blood flow volume (BFV) of the ipsilateral and contralateral extracranial internal carotid arteries (ICAs) and both vertebral arteries (VAs) before and after a carotid endarterectomy (CEA) of the ICA. We correlated the result with the degree of stenosis of the ICA.

Recanalization of chronic carotid occlusion: case report and review of the literature.

Recanalization of an occluded extracranial internal carotid artery is a rare event. The mechanism remains unclear. We report a case of recanalized internal carotid artery in its extracranial portion. The patient underwent successful carotid endarterectomy.

Jugular vein aneurysm.

Jugular vein aneurysm is a rare morphologic entity. This report describes a case of an asymptomatic internal jugular vein aneurysm that presented as an enlarging mass in the neck. Diagnosis was established with duplex ultrasonography and venography. No thrombus was diagnosed in the aneurysm, but since the patient was uncomfortable with having a tumor in his neck, surgery was performed with resection of the aneurysm and lateral venorrhaphy of the jugular vein.

Color duplex sonography in the detection of internal carotid artery restenosis after carotid endarterectomy: comparison with computed tomographic angiography.

Internal carotid artery restenosis after carotid endarterectomy is a major postoperative event, but the clinically best suited means for diagnosis of restenosis are still debated. The objective of this study was to evaluate the sensitivity and specificity of color duplex sonography for detection of substantial internal carotid artery restenosis, verified by computed tomographic (CT) angiography.

Radial Artery Harvesting for Coronary Artery Bypass Grafting: A Stepwise-Made Decision

BACKGROUND The purpose of this study was to propose a safe, stepwise, testing system to select radial arteries that are suitable for conduits on the basis of their morphologies and characteristics of the collateral circulation. METHODS Before operation, 113 patients underwent the modified Allen test, Doppler ultrasonography, and pulse oximetry testing. Morphologic criteria used for radial artery exclusion were small size of radial or ulnar artery (< 2 mm in inner diameter), diffuse calcifications, and congenital anomalies of forearm arteries. Collateral circulation was interpreted as insufficient if the reverse flow in the anatomic snuffbox was absent or if the increase of the ulnar peak systolic flow velocity was less than 20%. RESULTS A positive modified Allen test was found in 10.6% of patients. As assessed by Doppler ultrasonography, 27 patients (23.9%) were not candidates for radial artery harvesting according to morphologic and functional abnormalities of forearm and hand circulation. Pulse oximetry test results were abnormal in 6.2%. After a follow-up period of 8.9 +/- 1.8 months, 23 patients (29.1% of operated patients) were controlled for Doppler ultrasonographic changes in the ulnar artery. The mean peak systolic flow velocity was significantly higher than the preoperative value measured at rest (p < 0 .001). CONCLUSIONS After preoperative tests, including the modified Allen test, Doppler ultrasonography, and pulse oximetry, 30.1% of patients were not considered candidates for radial artery harvesting. This method provides preoperative radial artery selection according to its morphologies, compensatory capacity of collateral circulation, and anatomic properties of ulnar artery.

The Impact of Facial Lipofilling on Patient-Perceived Improvement in Facial Appearance and Quality of Life.

An investigation of the effect of facial lipofilling on patients satisfaction is a challenging and ongoing research area. Therefore, the aim of this study was to investigate the impact of aesthetic intervention on self-perceived improvement in facial appearance and quality of life (QoL) after 1- and 6-month follow-ups. In the period from October 1, 2014, to March 1, 2015, a total of 63 consecutive subjects who underwent a facial lipofilling were included in the study. The satisfaction with facial appearance was estimated by using the Satisfaction with Facial Appearance Overall scale. QoL was assessed by using the 36-Item Short Form Health Survey (SF-36). Severity of depressive and anxiety symptoms was quantified by using the Hamilton depression and anxiety rating scales. The self-esteem was assessed by Rosenberg self-esteem scale. The average Satisfaction with Facial Appearance Overall scale score at baseline was 45.5 ± 13.0, while this score reached values of 84.5 ± 16.2 after 1 month (Z = -6.744, p < 0.001) and 82.7 ± 12.6 after 6 months (Z = -6.545, p < 0.001) of follow-up. The mean change of Satisfaction with Facial Appearance Overall scale score from baseline to 1-month follow-up was 38.9 ± 21.2 and from baseline to 6-month follow-up was 37.1 ± 18.9. Statistically significant improvement in QoL at each subsequent time point, compared with those at baseline, was detected for all domains of the SF-36 except for subscales of physical functioning and pain. It has been highlighted that advanced social life was strongly associated with improvement in satisfaction with facial appearance, better self-esteem, and lower level of anxiety and depression during the period of follow-up after facial lipofilling. The results of this study supported the hypothesis that the level of self-confidence and mental health-related QoL could be significantly improved following facial lipofilling treatment.