Femoral Artery Diameter Research Articles

Effects of physical activity breaks during prolonged sitting on vascular and executive function—A randomised cross-over trial

ObjectivesHigh sedentary behaviour is associated with adverse effects on central vascular function and cognitive function. Although interventions to mitigate the adverse effects of workplace sitting are intriguing, evidence of the efficacy of such interventions remains lacking. This randomised cross-over trial was aimed at exploring the effectiveness of prolonged sitting, with or without physical activity breaks, on central, peripheral vascular and cognitive function in adults. MethodsTwenty one healthy adults completed 4 h of simulated work conditions in three experimental visits: (1) uninterrupted sitting (SIT); (2) sitting interrupted by 3 min of walking every hour (LIT); and (3) sitting interrupted by 3 min of stair climbing every hour (MIT). Carotid (CA) and superficial femoral artery (SFA) diameter, velocity, shear rate and blood flow were measured with Duplex ultrasound at 50 MHz at three time points (hours 0, 2 and 4), and executive function was assessed with the computer based Eriksen Flanker task every hour. ResultsThe decreases in reaction time (−30.59%) and accuracy (−10.56%) during SIT conditions were statistically significant, and less of a decrease was observed under LIT and MIT conditions. No significant differences in CA and SFA function were observed with LIT and MIT interventions. ConclusionPhysical activity breaks of varying intensity during prolonged sitting improve reaction time. However, the vascular benefits of physical activity breaks should be confirmed in the future through long term studies in natural environment.

Risk Factors for Access-Related Adverse Events Related to the Preclose Technique in Thoracic Endovascular Aortic Repair

PurposeTo analyze the risk factors for access-related adverse events (AEs) of the preclose technique in thoracic endovascular aortic repair (TEVAR). Materials and MethodsNinety-one patients with Stanford type B aortic dissection who underwent the preclose technique in TEVAR between January 2013 and December 2021 were included. According to the occurrence of access-related AEs, the patients were divided into 2 groups: those with AE and those without AE. Age, sex, combined diseases, body mass index, skin depth, femoral artery diameter, access calcification, iliofemoral artery tortuosity, and sheath size were recorded for risk factor analysis. The sheath–to–femoral artery ratio (SFAR), the ratio of the femoral artery inner diameter (in millimeters) to the sheath’s outer diameter (in millimeters), was also included in the analysis. ResultsSFAR was identified as an independent risk factor for AEs using multivariable logistic analysis (odds ratio, 251.748; 95% CI, 7.004–9,048.534; P = .002). The cutoff value of SFAR was 0.85 and was related to a higher incidence of access-related AEs (5.2% vs 33.3%, P = .001), especially to a higher stenosis rate (0.0% vs 21.2%, P = .001). ConclusionsSFAR is an independent risk factor for access-related AEs of preclose in TEVAR with a cutoff value of 0.85. SFAR could be a new criterion for preoperative access evaluation in high-risk patients that may allow the detection and treatment of access-related AEs at the early stage.

ARTERIAL DIAMETER VARIATIONS AS A NEW INDEX FOR STROKE VOLUME ASSESSMENT: AN EXPERIMENTAL STUDY ON A CONTROLLED HEMORRHAGIC SHOCK MODEL IN PIGLETS.

Background: The assessment of cardiac output (CO) is a major challenge during shock. The criterion standard for CO evaluation is transpulmonary thermodilution, which is an invasive technique. Speckle tracking is an automatized method of analyzing tissue motion using echography. This tool can be used to monitor pulsed arterial diameter variations with low interobserver variability. An experimental model of controlled hemorrhagic shock allows for multiple CO variations. The main aim of this study is to show the correlation between the femoral arterial diameter variations (fADVs) and the stroke volume (SV) measured by thermodilution during hemorrhagic shock management and the resuscitation of anesthetized piglets. The secondary objective is to explore the respective correlations between SV and subaortic time-velocity index, abdominal aorta ADV, carotid ADV, and subclavian ADV. Methods : Piglets were bled until mean arterial pressure reached 40 mm Hg. Controlled hemorrhage was maintained for 30 minutes before randomizing the piglets to three resuscitation groups-the fluid-filling group (reanimated with saline solution only), NEph group (norepinephrine + saline solution), and Eph group (epinephrin + saline solution). Speckle tracking, echocardiographic, and hemodynamic measures were performed at different stages of the protocol. Results : Thirteen piglets were recruited and included for statistical analysis. Of all the piglets, 164 fADV measures were attempted and 160 were successful (98%). The correlation coefficient between fADV and SV was 0.71 (95% confidence interval [CI], 0.62 to 0.78; P < 0.01). The correlation coefficient between SV and abdominal aorta ADV, subclavian ADV, and carotid ADV was 0.30 (95% CI, 0.13 to 0.46; P < 0.01), 0.56 (95% CI, 0.45 to 0.66, P < 0.01), and 0.15 (95% CI, -0.01 to 0.30, P = 0.06), respectively. Conclusions : In this hemorrhagic shock model using piglets, fADV was strongly correlated with SV.

Prediction of the infrainguinal revascularizing surgery outcomes in patients with diseases of the lower limb arteries

The progressive course of lower extremity arterial disease (LEAD) inevitably leads to the development of intermittent claudication, critical ischemia, and gangrene. If a patient shows signs of critical ischemia and trophic disorders, he should undergo revascularization surgery. The development of reocclusion may be observed in the early period following the surgery. The aim of the work was to develop and validate a prognostic model of the results of revascularizing surgeries below the inguinal ligament. The study involved 133 patients with chronic arterial insufficiency of stages II B, III and IV according to Fontaine-Pokrovsky classification. 92 patients underwent open surgeries and 41 underwent endovascular surgeries. To build a prognostic model, 244 criteria were analyzed. The final model was built on the basis of such criteria as surgery type, levels of total cholesterol, homocysteine, cysteinylglycine, ankle brachial index increase, and diameter of the common femoral artery. This prognostic model has the following characteristics: Se = 85.71%, Sp = 82.56%, Acc = 83.33%

Femoral artery collapse ratio as an indicator of chest compression quality during cardiopulmonary resuscitation in a porcine cardiac arrest model

Cardiopulmonary resuscitation (CPR) quality is crucial for improving patient survival rates after cardiac arrest. This study aimed to investigate the usefulness of femoral artery collapse ratio (systolic diameter/diastolic diameter ratio) measurement using M-mode ultrasound versus end-tidal carbon dioxide (ETCO2) for the assessment of high-quality CPR in a porcine cardiac arrest model. A total of 10 male mongrel pigs (age range, 16–20 weeks; weight, 45–50 kg) were used. After anesthesia, the carotid artery was dissected and exposed. The animals were instrumented with an arterial catheter in the exposed carotid artery to monitor arterial blood pressure. Cardiac arrest was induced by injecting potassium chloride (KCl, 40 equivalents of weight). The animals underwent chest compression using a mechanical device, and the chest compression depth and ETCO2 were measured using a defibrillator. To obtain hemodynamic information, two investigators performed an ultrasound examination on both femoral arteries. One examiner measured the femoral peak systolic velocity (PSV), while the other measured the diameters of the femoral artery (systolic diameter and diastolic diameter) in a transverse or longitudinal position using the M-mode of the linear ultrasound probe. As the compression depth increased, ETCO2, femoral artery diameter, collapse ratio (systolic diameter/diastolic diameter), and blood flow increased; however, PSV decreased. The ETCO2 and collapse ratio were positively correlated. The femoral artery collapse ratio, measured using the M-mode ultrasound, could be an alternative and simple method to evaluate high-quality CPR.

Utilization of the Rat's Tail as a Novel Model for Arterialized Venous Flap.

Arterialized tissues provide longevity and coverage of critically exposed tissue, and in pliable areas of the body, thin flaps are needed. Arterialized venous flaps provide all the aforementioned qualities, yet unpredictability in flap perfusion requires further investigation in experimental studies. Existing animal models are thicker in nature and rarely mimic commonly used venous flaps in clinical practice. A novel design of the rat's tail provides an ideal model for arterialized venous flaps. Eleven venous flaps were harvested from the rats' tail, all presenting with two parallel veins in configuration. Arterialization of veins using the femoral artery was done in either along-valve or against-valve fashion, with the purpose of testing the flap's response to different clinical configurations. The vessel diameter and flap thickness were measured. Flap viability was monitored for 7 days after surgery to ensure stable flap viability. Thickness of the tail flap ranged from 1.0 to 1.2 mm, while the abdomen skin thickness ranged from 1.4 to 1.5 mm. The mean diameter of the lateral veins was 0.85 ± 0.08 mm, which was in between the average femoral artery diameter (mean 0.76 ± 0.1 mm) and the average femoral vein diameter (1.28 ± 0.2 mm). Four of the nine against-valve flaps achieved more than 50% flap survival, while all along-valve flaps achieved flap viability of more than 75%, as evident by indocyanine green imaging. This flap demonstrates similar properties to thin venous flaps used in clinical situations. Standardization of this model can push forth better understanding of the arterialization phenomenon in venous flaps for future studies.

The role of muscle mass in vascular remodeling: insights from a single-leg amputee model

PurposeBoth muscle mass and physical activity are independent mechanisms that play a role in vascular remodeling, however, the direct impact of muscle mass on the structure and function of the vessels is not clear. The aim of the study was to determine the impact of muscle mass alteration on lower limbs arterial diameter, blood flow, shear rate and arterial stiffness.MethodsNine (33 ± 13 yrs) male individuals with a single-leg amputation were recruited. Vascular size (femoral artery diameter), hemodynamics (femoral artery blood flow and shear rate were measured at the level of the common femoral artery in both amputated (AL) and whole limbs (WL). Muscle mass of both limbs, including thigh for AL and thigh and leg for WL, was measured with a DXA system.ResultsAL muscle mass was reduced compared to the WL (3.2 ± 1.2 kg vs. 9.4 ± 2.1 kg; p = 0.001). Diameter of the femoral artery was reduced in the AL (0.5 ± 0.1 cm) in comparison to the WL (0.9 ± 0.2 cm, p = 0.001). However, femoral artery blood flow normalized for the muscle mass (AL = 81.5 ± 78.7ml min−1 kg−1,WL = 32.4 ± 18.3; p = 0.11), and blood shear rate (AL = 709.9 ± 371.4 s−1, WL = 526,9 ± 295,6; p = 0.374) were non different between limbs. A correlation was found only between muscle mass and femoral artery diameter (p = 0.003, R = 0.6561).ConclusionThe results of this study revealed that the massive muscle mass reduction caused by a leg amputation, but independent from the level of physical activity, is coupled by a dramatic arterial diameter decrease. Interestingly, hemodynamics and arterial stiffness do not seem to be impacted by these structural changes.

Post-Transcatheter Aortic Valve Replacement (TAVR) Vascular Complications: Femoral Artery Minimal Surgical Access Versus Percutaneous Approach.

Percutaneous transfemoral access approach for the transcatheter aortic valve implantation (TAVI) is still associated with significant vascular complications. Hence, evaluation of best techniques for the reduction of vascular injury via the femoral access remains a key subject of research. We report on a single centre's experience with TAVI performed via the Femoral Artery Minimal Surgical Access (MSA) and percutaneous approach (PC). The primary endpoints were to evaluate the incidents of vascular complications by comparing the MSA versus the PC approach according to the VARC-2 criteria. The secondary endpoint included the impact of vascular complications on the in-hospital 30-day mortality and morbidity. Between June 2010 and September 2020, two hundred and thirty-seven consecutive patients who underwent TAVI for severe symptomatic aortic stenosis in our department were divided into two groups: patients treated using the femoral artery minimal surgical access (n = 173), and patients treated using the percutaneous approach (n = 64). Overall rate of access site complications according the VARC-2 were significantly more frequent in the percutaneous cohort (n = 12/64, 18.8% vs n = 2/173, 1.1%, p = 0.0012). The minor access complications including haematoma, bleeding, aneurysm, dissection, stenosis, seroma and infection were more frequent in the PC group (n = 8/64, 12.5% vs n = 2/173, 1.1%, p < 0.001). There were no major access site complications and hospital deaths in the MSA group, which was statistically significant (p < 0.001). Major access complications (n = 4, 6.3%, p < 0.001) and hospital death (n = 2, 3.1%, p < 0.001) were found in the PC cohort. The minimal surgical access approach provided direct and controlled access and significantly reduced the incidence of access site vascular complications in our TAVI patients. It also significantly reduced the in-hospital vascular-related mortality and morbidity. Though both approaches are complementary to each other, minimal surgical access approach would be a better choice for a calcified or tortuous femoral artery, and for a relatively small femoral artery diameter.

Femoral tripod arteries: Surgical anatomic variants.

To describe the surgical anatomy of the femoral tripod arteries and their anatomical variants. Patients who underwent vascular surgery by external arciform approach of the Scarpa between May 2022 and July 2022 were selected. The surgical anatomy was assessed by direct observation. The origin and the course of major branches of the femoral artery (FA) were studied. Diameters and the distance of the origin of the femoral profunda artery (FPA) from the midpoint of the inguinal ligament was measured in millimeters and recorded. The observed anatomical variations were photographed and compared to those in the literature. A total of 40 patients (34 men, 85%) were included. The median diameter of the common femoral artery (CFA) was 9mm (IQR: 7-12mm). The Modal bifurcation was noted in 95% of cases. The collateral branches of the CFA were found to be distributed as follows: the superficial circumflex iliac artery (SCIA) in 34 cases (85%), the superficial epigastric artery (SEA) in 22 cases (55%), the deep external pudic artery in 16 cases (40%), and the superficial external pudic artery in 18 cases (45%). The median diameter of the FPA was 5mm (IQR: 4-6mm). The FPA originated from the posterolateral side of the CFA in 90% of cases, from the posterior side in 5% of cases and from the medial side in 5% of cases. The median diameter of the SFA was 6mm (IQR: 4-9mm). The anatomic variants of the femoral tripod arteries are extremely frequent. Therefore, it is important to recognize the anatomy in order to avoid possible diagnostic errors and to minimize the risk of per and post procedural complications.

Correlation of internal jugular vein, common carotid artery, femoral artery and femoral vein diameters with central venous pressure.

This study aimed to detect the correlation of central venous pressure (CVP) with the internal jugular vein (IJV), common carotid artery (CCA), femoral vein (FV), and femoral artery (FA) diameters measured with ultrasound (USG) in patients under mechanical ventilation to evaluate whether they are suitable to be used as an alternative low-cost and noninvasive method for the detection of CVP. A total of 40 patients aged from 18 to 90 who had been receiving therapy in the intensive care unit (ICU) were included in the study. Central venous catheter was placed into the patients through right IJV or subclavian vein in their first 24-hour of hospitalization and the right atrium pressure (RAP) was measured from the catheter, the tip of which was confirmed to reach right atrium. In the same session, CCA, IJV, FA, and FV diameters were measured with USG and their correlations with CVP were calculated. In addition, correlations of the measured venous and artery diameters between each other were detected as well. There was a significantly high correlation between CVP and CCA diameter (R = 0.603, P < .000). There was a significantly low correlation between CVP and IJV diameter (R = 0.352, P = .026), a significantly low correlation between FA and FV diameters (R = 0.317, P = .047), a significantly low correlation between FA and CCA diameters (R = 0.330, P = .038), and a significantly low correlation between IJV and CCA diameters (R = 0.364, P = .020). CVP and CCA diameters exhibited a high correlation. For detection of CVP, the ultrasonographic CCA diameter measurement can be used as an alternative noninvasive method which is easy to use and minimally affected by measurement errors of individuals and which has low learning curve compared with the other measurement methods.

Influence of Local Muscle Cooling on Mitochondrial-Related Gene Expression at Rest.

The purpose of this study was to determine the impact of localized cooling of the skeletal muscle during rest on mitochondrial related gene expression. Thermal wraps were applied to the vastus lateralis of each limb of 12 participants. One limb received a cold application (randomized) (COLD), while the other did not (RT). Wraps were removed at the 4 h time point and measurements of skin temperature, blood flow, and intramuscular temperature were taken prior to a muscle biopsy. RT-qPCR was used to measure expression of genes associated with mitochondrial development. Skin and muscle temperatures were lower in COLD than RT (p < 0.05). Femoral artery diameter was lower in COLD after 4 h (0.62 ± 0.05 cm, to 0.60 ± 0.05 cm, p = 0.018). Blood flow was not different in COLD compared to RT (259 ± 69 mL·min–1 vs. 275 ± 54 mL·min–1, p = 0.20). PGC-1α B and GABPA expression was higher in COLD relative to RT (1.57-fold, p = 0.037 and 1.34-fold, p = 0.006, respectively). There was no difference (p > 0.05) in the expression of PGC-1α, NT-PGC-1α, PGC-1α A, TFAM, ESRRα, NRF1, GABPA, VEGF, PINK1, PARK 2, or BNIP3-L. The impact of this small magnitude of difference in gene expression of PGC-1α B and GABPA without alterations in other genes are unknown. There appears to be only limited impact of local muscle cooling on the transcriptional response related to mitochondrial development.

Vascular And Skeletal Muscle Remodeling: Beyond Physical Inactivity.

Vascular remodeling refers to the changes in the structure and function of vessels. This adaptability of the arteries is essential to successfully handle vascular distress and arterial disease. Both, skeletal muscle mass and the level of physical activity are independent mechanisms that plays a role in this physiological phenomenon. However, the direct impact of the skeletal muscle mass remodeling on the structure and function of the vessels is not clear. PURPOSE: To determine the impact of skeletal muscle mass remodeling on lower limbs arterial diameter, blood flow and arterial stiffness. METHODS: Nine young (33±13 yrs) physical active individuals with a single-leg amputation (single transtibial amputation) were recruited for the study. Vascular size (femoral artery diameter), hemodynamics (femoral artery blood flow) and arterial stiffness (carotid-femoral pulse wave velocity) were measure with an ultrasound doppler device at the level of the common femoral artery in both amputee (AL) and whole limbs (WL). Skeletal muscle mass of both limbs was measured with a DEXA system. Both AL and WL were equally utilized by the individuals for ambulation and recreational sports. RESULTS: The skeletal muscle mass of the AL was significantly reduced in comparison to the WL (3.2±1.2 Kg Vs 9.4±2.1 Kg; P=0.0011). Also, the diameter of the femoral artery was significantly reduced in the AL 0.5±0.1 cm in comparison to the WL 0.9±0.2 (p=0.0012). However, femoral artery blood flow normalized for the muscle mass (mean difference 49.07 ml۰min-1۰kg-1; p = 0.11) and carotid-femoral Pulse Wave Velocity (mean difference 0.91 cm۰s-1; p =0.21) were similar between the two legs. Interestingly, linear regression analysis shows a significant correlation between skeletal muscle mass and femoral artery diameter (p=0.0031). CONCLUSION: The results of this study revealed that the massive skeletal muscle reduction caused by a transtibial amputation, but independent form the level of physical activity, is coupled by a dramatic arterial diameter decrease. Interestingly, local circulation and arterial stiffness seems not impacted by these structural changes.

Comparison of blood flow between two mechanical compression devices using ultrasound: Animal trial

BackgroundDuring manual chest compression, maintaining accurate compression depth and consistency is a challenge. Therefore, mechanical chest compression devices(mCCDs) have been increasingly incorporated in clinical practice. Evaluation and comparison of the efficacy of these devices is critical for extensive clinical application. Hence, this study compared the cardiopulmonary resuscitation(CPR) efficiency of two chest compression devices, LUCAS™ 3(Physio-Control, Redmond, USA) and Easy Pulse (Schiller Medizintechnik GMBH, Feldkirchen, Germany), in terms of blood flow using ultrasonography(USG) in a swine model. MethodsA swine model was used to compare two mCCDs, LUCAS™ 3 and Easy Pulse. Cardiac arrest was induced by injecting potassium chloride(KCl) solution in eight male mongrel pigs and the animals were randomly divided into two groups. Mechanical CPR was provided to two groups using LUCAS™ 3(LUCAS™ 3 group) and Easy Pulse(Easy Pulse group). USG was used to measure hemodynamic parameters including femoral peak systolic velocity(PSV) and femoral artery diameters(diameter during systole and diastole). Blood flow rate was calculated by multiplying the PSV and cross-sectional area of the femoral artery during systole. The end-tidal carbon dioxide(EtCo2), chest compression depth was measured. Systolic blood pressure, mean blood pressure, and diastolic blood pressure were also measured using an arterial catheter. ResultsThe chest compression depth was much deeper in LUCAS™ 3 group than Easy Pulse group(LUCAS™ 3: 6.80 cm; Easy Pulse: 3.279 cm, p < 0.001). However, EtCo2 was lower in the LUCAS™ 3 group(LUCAS™ 3: 19.8 mmHg; Easy Pulse: 33.4 mmHg, p < 0.001). The PSV was higher in the LUCAS™ 3 group(LUCAS™ 3: 67.6 cm s−1; Easy Pulse: 55.0 cm s−1, p < 0.001), while the systolic(LUCAS™ 3: 1.5 cm; Easy Pulse: 2.0 cm, p < 0.001) and diastolic diameters were larger in the Easy Pulse group(LUCAS™ 3: 0.4; Easy Pulse: 0.8 cm, p < 0.001). The femoral flood flow rate was also lower in the LUCAS™ 3 group(LUCAS™ 3: 32.55 cm3/s; Easy Pulse: 61.35 cm3/s, p < 0.001). ConclusionThe Easy Pulse had a shallower compression depth and slower PSV but had a wider systolic diameter in the femoral artery as compared to that in LUCAS™ 3. Blood flow and EtCo2 were higher in the easy pulse group probably because of the wider diameter. Therefore, an easy pulse may create and maintain more effective intrathoracic pressure.

Vascular and Skeletal Muscle Remodeling: Beyond Physical Inactivity

Vascular remodeling refers to the changes in the structure and function of vessels. This adaptability of the arteries is essential to successfully handle vascular distress and arterial disease. Both, skeletal muscle mass and the level of physical activity are independent mechanisms that plays a role in this physiological phenomenon. However, the direct impact of the skeletal muscle mass remodeling on the structure and function of the vessels is not clear.PURPOSETo determine the impact of skeletal muscle mass remodeling on lower limbs arterial diameter, blood flow and arterial stiffness.METHODSNine young (33±13 yrs) physical active individuals with a single‐leg amputation (transtibial amputation) were recruited for the study. Vascular size (femoral artery diameter), hemodynamics (femoral artery blood flow) and arterial stiffness (carotid‐femoral pulse wave velocity) were measure with an ultrasound doppler device at the level of the common femoral artery in both amputee (AL) and whole limbs (WL). Skeletal muscle mass of both limbs was measured with a DEXA system. Both AL and WL were equally utilized by the individuals for ambulation and recreational sports.RESULTSThe skeletal muscle mass of the AL was significantly reduced in comparison to the WL (3.2±1.2 Kg Vs 9.4±2.1 Kg; P=0.0011). Also, the diameter of the femoral artery was significantly reduced in the AL 0.5±0.1 cm in comparison to the WL 0.9±0.2 (p=0.0012). However, femoral artery blood flow normalized for the muscle mass (mean difference 49.07 ml۰min‐1۰kg‐1; p = 0.11) and carotid‐femoral Pulse Wave Velocity (mean difference 0.91 cm۰s‐1; p =0.21) were similar between the two legs. Interestingly, linear regression analysis shows a significant correlation between skeletal muscle mass and femoral artery diameter (p=0.0031).CONCLUSIONThe results of this study revealed that the massive skeletal muscle reduction caused by a transtibial amputation, but independent form the level of physical activity, is coupled by a dramatic arterial diameter decrease. Interestingly, local circulation and arterial stiffness seems not impacted by these structural changes.

Targeting Endogenous Antioxidant Capacity to Prevent Vascular Dysfunction Induced by Limb Immobilization

BackgroundBrief periods of limb disuse that accompany orthopedic injuries can impair vascular function and increase cardiovascular disease risk. Specifically, limb immobilization elicits a decrease in vascular shear stress which leads to an increase in oxidative stress and impaired vasodilation. We hypothesized that increasing the activation of nuclear factor‐erythroid factor 2‐related factor 2 (Nrf2), a critical transcription factor that regulates expression of endogenous antioxidants, using a novel, naturally occurring, supplement (PB125), would preserve vascular function during 14 days of limb immobilization.MethodsTen young, healthy individuals were randomized to receive either PB125 (100mg, N=6, 3M/3F, 28±5 y, BMI= 25±6 kg/m2) or placebo (N=4, 1M/3F, 23±4 y, BMI=24±3 kg/m2). Utilizing Doppler ultrasound, before and after 14 days of leg immobilization, leg blood flow (LBF) and vascular conductance (LVC) were measured in the common femoral artery at rest and during passive leg movement (PLM), and during knee‐extensor (KE) exercise at 3 relative intensities (40, 60, 80% of max; KE max = 35±10W). Additionally, flow mediated dilation (FMD) and post‐occlusive reactive hyperemia were assessed in the popliteal and brachial arteries.ResultsLower limb immobilization reduced daily step count by 53 ± 19% in both groups (PB125 vs. placebo p &gt; 0.05). Femoral, popliteal, and brachial artery diameters were not significantly different following immobilization. Resting LBF and LVC were lower following immobilization in the placebo group (pre vs. post; LBF: 485±124 vs. 357±106 ml/min, p = 0.001; LVC: 5.2±1.1 vs. 3.7±0.9 ml/min/mmHg, p = 0.001), but were preserved in the PB125 group (LBF: 239±63 vs. 237±78 ml/min, p &gt; 0.05; LVC: 2.6±0.6 vs. 2.6±0.7 ml/min/mmHg, p &gt; 0.05). However, LBF and LVC during KE exercise were not impacted by limb immobilization. Microvascular function, as assessed by the hyperemic response to PLM, was diminished in the placebo group (LVC Δpeak: 6.8±2.8 vs. 3.7±1.4 ml/min/mmHg, p = 0.049), but preserved in the PB125 group (LVC Δpeak: 3.0±0.6 vs. 3.0±1.8 ml/min/mmHg p &gt; 0.05). Conversely, microvascular function, assessed by reactive hyperemia, was unchanged in both the popliteal and brachial arteries. Macrovascular function changes due to immobilization were limb‐specific, with a decrease in popliteal artery FMD with placebo (6.5±4.1 vs. 1.9±1.6 %, p = 0.046) and preservation with PB125 (4.4±3.6 vs. 2.8±1.9 %, p &gt; 0.05), while brachial artery FMD was unchanged in both groups (p &gt; 0.05).ConclusionsLimb immobilization induced both microvascular and macrovascular changes in the leg which may contribute to the attenuated LBF and LVC at rest. Administration of PB125 preserved vascular function during disuse, presumably by mitigating the deleterious impact of oxidative stress. Hence, PB125 supplementation, and, therefore, augmented endogenous antioxidant capacity, appears to mitigate the negative vascular effects of limb disuse.

In vivo Evidence of Arterial Dynamic Properties Alteration in Atherosclerotic Rabbit

Objectives: Atherosclerosis severely damages the arterial wall. The aim of this study was to assess in vivo, for the first time, arterial dynamic properties, reactivity, and stiffness in atherosclerotic (ATH) rabbits. Methods: The rabbits were fed with 0.3% cholesterol diet. Femoral artery (FA) or abdominal aorta (AA) diameter was recorded by echotracking, together with blood pressure. Arterial reactivity after local administration of agents and stiffness were measured as diameter or pulsatile diameter changes. Results: FA dilation induced by acetylcholine was reduced in the function of diet duration (9–65 weeks). With mid-term diet duration (35–45 weeks), the dilation to nitroprusside was greatly reduced; the constriction to norepinephrine was reduced but not that to serotonin, thromboxane agonist, or angiotensin II. After 17- and 28-week diet AA and FA stiffness were increased while distensibility was reduced. Arterial stiffness measured by regional pulse wave velocity was unaltered. We observed that after 28-week diet, FA exhibited a stiffened wall at the plaque level and higher distensibility at the upstream site. Discussion/Conclusion: Arterial reactivity and compliance were greatly modified by atherosclerosis, at various degrees dependent on diet duration. ATH rabbit is therefore a suitable model for in vivo investigations of treatments targeting dynamic properties of arterial wall.

A Novel Basic Training Laboratory Model on Live Subjects for Supermicrosurgery: Mouse Femoral Artery, Vein and Nerve

BACKGROUNDIncreasing success rates of supermicrosurgery operations have increased the importance of developing the ideal training model for super-microsurgery. Working on the model is very important for increasing and continuing microsurgery and supermicrosurgery skills. We aimed to present a standardized, simple and easy to access live training model for supermicrosurgery.METHODSThe experiment was performed in the University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, IDEA, Istanbul, Turkey in 2020. Twelve BALB/c male albino mice weighing 20-45 gr were used in the study. Unilateral femoral artery, vein and nerve diameters of mice were measured. Anastomosis was performed on the bilateral femoral vessels. The surgical procedure times were also recorded.RESULTSThe mean weight of the mice was 36.6 ± 6.09 gr, the length was 15.10 ± 1.10 cm. The mean external diameter of the femoral artery, vein and nerves were 0.31 ± 0.34 mm, 0.48 ± 0.70 mm, 0.38 ± 0.43 mm, respectively. The mean preparation time of neurovascular structures for anastomosis was 15.75 ± 1.54 min, mean femoral artery and vein anastomosis time was 24.91±1.72 and 33.16±1.74 min, respectively. Vascular patency was detected as 100% after all vascular anastomosis procedures.CONCLUSIONMice femoral neurovascular structures are similar to rats in terms of basic morphology, and they are small enough for super-microsurgery education model. Dissection of mice femoral bundles are easy to perform. In terms of training models, anesthetic requirement and laboratory costs are less for mice, and handling them is much easier compared to rats; thus, making them especially suitable for basic supermicrosurgery training courses.

Real-World Experience With a Large Bore Vascular Closure Device During TAVI Procedure: Features and Predictors of Access-Site Vascular Complications.

BackgroundsAmong vascular closure devices (VCDs), the novel collagen plug-based MANTA VCD is the first designed for large bore percutaneous access. We aimed to assess the features and predictors of access-site vascular complications in an unselected trans-femoral transcatheter aortic valve replacement (TF-TAVR) population.MethodsPatients undergoing large bore arteriotomy closure with 18F MANTA VCD following TF-TAVR at a large tertiary care center from September 2019 to January 2021 were prospectively analyzed. Primary Outcome was the MANTA VCD access-site-related complications according to Valve Academic Research Consortium-3 (VARC) definitions. Its incidence and predictors were evaluated.ResultsEighty-eight patients (median age 82 years, 48% male, 3.3 median Society of Thoracic Surgeons score) undergoing TF-TAVR were included, mostly (63%) treated with a self-expandable device and with outer diameter sizes varied from 18F to 24-F. MANTA VCD technical success rate was 98%, while 10 patients (11%) experienced MANTA VCD access-site vascular complications which included 8% of minor complications and only to 2% of major events resulting in VARC type ≥2 bleeding. Vessel occlusion/stenosis (60%), perforation (20%), and pseudoaneurysm/dissection/hematoma (20%) occurred, but all were managed without surgical treatment. Independent predictors of failure were age (p = 0.04), minimum common femoral artery diameter (CFA) (p < 0.01), sheath-to-femoral-artery ratio (SFAR) (p < 0.01), and a lower puncture height (p = 0.03). A CFA diameter <7.1 mm with a SFAR threshold of 1.01 were associated with VCD failure.ConclusionsIn a more comers TF-TAVR population, MANTA VCD was associated with reassuring rates of technical success and major access-site vascular complications. Avoiding lower vessel size and less puncture site distance to CFA bifurcation might further improve outcomes.

Impact of the Post-Thrombotic Syndrome on the Arterial Wall of the Lower Limbs

ObjectiveDeep vein thrombosis of the lower limbs is a common disease in vascular surgery. Approximately 20–50% of deep vein thrombosis patients develop post-thrombotic syndrome, which can severely affect the patient's quality of life. However, the precise science of the pathophysiology of the progression of the post-thrombotic syndrome remains unclear. Studies have demonstrated that patients with post-thrombotic syndrome of the lower limbs have impaired arterial wall endothelial function. Nevertheless, there is little research on the different impacts of post-thrombotic syndrome on the arterial wall endothelial function between the affected limbs and the healthy limbs. This study aims to assess this difference.MethodsA total of 60 patients treated for the post-thrombotic syndrome of the lower limbs were included. The flow-mediated dilation (FMD%) and nitroglycerin-mediated dilation (NMD%) were measured to assess the different endothelial function alterations of the common femoral arterial wall between the affected limb and the healthy limb.ResultsNo significant differences in the common femoral artery diameter between the affected limbs and the healthy limbs were discovered (8.94 ± 0.92 mm vs 8.75 ± 1.0 mm, P = 0.710). The flow-mediated dilation of the common femoral artery of the affected limbs were significantly lower compared to the healthy limbs (FMD%: 3.21 ± 1.07% vs 5.19 ± 1.35%, P = 0.001). However, there was no significant difference in the nitroglycerin-mediated dilation of the common femoral artery between the affected limbs and the healthy limbs（ NMD%: 13.37 ± 1.78% versus 14.45 ± 2.14%, P = 0.083).ConclusionsOur results demonstrated the association between post-thrombotic syndrome and deteriorated endothelial functional properties of the arterial wall of the lower limbs. Endothelial dysfunction of the arteries wall was more severe in the affected lower limbs with the post-thrombotic syndrome than in the healthy limbs. The mentioned findings may partly explain the pathophysiology of the progression post-thrombotic syndrome of the lower limbs.Highlightstudies have demonstrated that patients with post-thrombotic syndrome of the lower limbs have impaired arterial wall endothelial function. Our results demonstrated the endothelial dysfunction of the arteries wall was more severe in the affected lower limbs with the post-thrombotic syndrome than in the healthy limbs. Our findings may partly explain the pathophysiology of the progression post-thrombotic syndrome of the lower limbs.

Pre-procedural femoral vessel ultrasound in dogs with patent ductus arteriosus: diameter, image quality and relationship with arterial catheterization

IntroductionObjectives: Patent ductus arteriosus (PDA) in dogs is often treated via minimally invasive transvascular occlusion using femoral artery access. This study compared ultrasound-derived diameter and image quality of the right femoral artery (RFA) and vein (RFV) in dogs with PDA using a linear ultrasound probe (L-P) and phased-array transthoracic echocardiography probe (TTE-P). The case outcome was assessed. Animals, materials & methodsForty-five client-owned dogs with PDA were prospectively enrolled. Ultrasound-measured RFA and RFV diameters were obtained on images acquired with both probes pre-operatively and compared using Bland–Altman plots. The image quality of RFA and RFV was scored on L-P and TTE-P images. ResultsComparison of RFA and RFV diameter from L-P versus TTE-P images revealed: [Mean difference (limits of agreement): RFA = 0.009 mm (−0.78–0.79 mm), RFV = 0.523 mm (−1.75–2.79 mm)]. Image quality scores were significantly higher for L-P than TTE-P (P < 0.0001). In six small dogs, measurable images were unattainable with TTE-P. Dogs of similar body weight had variable RFA diameters. Twenty-seven dogs had RFA catheterization. In 21/27 dogs, RFA diameter exceeded the external diameter of the introducer used for catheterization, and in 6/27, it was smaller. ConclusionsPre-procedural ultrasound of the RFA in dogs with PDA is useful given variable RFA diameter relative to body weight. Despite poorer image quality, RFA diameters from TTE-P images were very similar to L-P images on average, suggesting TTE-Ps are suitable for pre-procedural planning in most dogs. Vasospasm, hypotension or differences in the location of ultrasound measurement versus catheterization might produce variation in pre-procedural versus intraoperative RFA size.