Changes In Peak Systolic Velocity Research Articles

Renal ultrasonography predicts worsening renal function in patients with heart failure under tolvaptan administration.

Renal dysfunction in patients with chronic heart failure predicts a poor prognosis. Tolvaptan has a diuretic effect in patients with chronic kidney disease and heart failure without adverse effects on renal function. We aimed to determine the effects of tolvaptan and predictors of worsening renal function in patients with heart failure. This post hoc analysis was a sub-analysis of a single-centre prospectively randomized trial on the early and short-term tolvaptan administration. We enrolled 201 participants with decompensated heart failure between January 2014 and March 2019 (early group, n=104; age: 79.0±12.8years; late group, n=97; age: 80.3±10.8years). Renal ultrasonography was performed before and after the administration of tolvaptan. Urine output and oral water intake significantly increased during tolvaptan administration. The difference between water intake and urine volume increased during tolvaptan administration. Changes in body weight, blood pressure, heart rate, and estimated glomerular filtration rate (eGFR) in both groups were comparable. The changes in peak-systolic velocity (PSV), acceleration time (AT) of the renal arteries, and resistance index were comparable. The changes in PSV and end-diastolic velocity (EDV) of the interlobar arteries increased following tolvaptan administration (Δmax PSV: 0.0±14.8cm/s before tolvaptan vs. 5.6±15.7cm/s after tolvaptan, P=0.002; Δmean PSV: 0.4±12.3 vs. 4.9±12.7cm/s, P=0.002; Δmax EDV: -0.2±3.5 vs. 1.4±4.0cm/s, P=0.001; Δmean EDV: -0.0±3.1 vs. 1.1±3.4cm/s, P=0.003). The renal artery AT was negatively correlated with the eGFR (Δmax AT: beta=-0.2354, P=0.044; Δmean AT: beta=-0.2477, P=0.035). Tolvaptan increased the PSV and EDV of the interlobar artery, which may mean tolvaptan increased renal blood flow. The renal artery AT may be a surrogate for worsening renal function.

Pelvic Ectopic Kidney Prevalence and Pressure Changes During Cloacal Exstrophy (Omphalocele-Exstrophy-Imperforate Anus-Spinal Defects Syndrome) Closure

To assess the prevalence of pelvic ectopic kidneys (PEK) and compare renal parameters of the PEK to the orthotopic kidney following pubic bone approximation. In four Omphalocele-Exstrophy-Imperforate Anus-Spinal Defects Syndrome (OEIS) patients undergoing second-stage repair with known pelvic and orthotopic kidneys, changes in the renal pelvis pressure (RPP), peak systolic velocity (PSV), and resistive index (RI) were measured in the pelvic and orthotopic kidneys following pubic bone approximation. A paired t-test was performed for analysis. Prevalence was tabulated using a multi-institutional retrospective review. Mean rise in RPP was +26.0 mmHg in the PEK and +10.3 mmHg in the orthotopic kidney (P = .55). One patient had immediate increase in RPP of 66mmHg in the PEK (7mmHg in the orthotopic kidney) which decreased to +17 mmHg in the PEK upon release of the pubic approximation stitch. Mean change in PSV was +67.7 cm/s in the PEK compared to - 25.7 cm/s in the orthotopic kidney (P = .09). Mean change in renal RI was +0.06 in PEK compared to -0.01 in the orthotopic kidney (P = .29). Among 80 OEIS patients, 24 (30%) had a PEK. 3 (4%) had a solitary PEK. During second-stage OEIS closure, we witnessed patterns of higher change in RPP, PSV, and RI of the PEK compared to the orthotopic kidney. Furthermore, PEKs were found in nearly a third of our OEIS patients. Real-time RPP monitoring, especially those with solitary PEK, may aid in the management of OEIS patients during the perioperative period.

Changes in renal-mesenteric duplex ultrasound velocities after fenestrated and branched endovascular aortic aneurysm repair

ObjectiveStenting of renal and mesenteric vessels may result in changes in velocity measurements due to arterial compliance, potentially giving rise to confusion about the presence of stenosis during follow-up. The aim of our study was to compare preoperative and postoperative changes in peak systolic velocity (PSV, cm/s) after placement of the celiac axis (CA), superior mesenteric artery (SMA) and renal artery (RAs) bridging stent grafts during fenestrated-branched endovascular aortic repair (FB-EVAR) for treatment of complex abdominal aortic aneurysms (AAA) and thoracoabdominal aortic aneurysms. MethodsPatients were enrolled in a prospective, nonrandomized single-center study to evaluate FB-EVAR for treatment of complex AAA and thoracoabdominal aortic aneurysms between 2013 and 2020. Duplex ultrasound examination of renal-mesenteric vessels were obtained prospectively preoperatively and at 6 to 8 weeks after the procedure. Duplex ultrasound examination was performed by a single vascular laboratory team using a predefined protocol including PSV measurements obtained with <60° angles. All renal-mesenteric vessels incorporated by bridging stent grafts using fenestrations or directional branches were analyzed. Target vessels with significant stenosis in the preoperative exam were excluded from the analysis. The end point was variations in PSV poststent placement at the origin, proximal, and mid segments of the target vessels for fenestrations and branches. ResultsThere were 419 patients (292 male; mean age, 74 ± 8 years) treated by FB-EVAR with 1411 renal-mesenteric targeted vessels, including 260 CAs, 409 SMAs, and 742 RAs. No significant variances in the mean PSVs of all segments of the CA, SMA, and RAs at 6 to 8 weeks after surgery were found as compared with the preoperative values (CA, 135 cm/s vs 141 cm/s [P = .06]; SMA, 128 cm/s vs 125 cm/s [P = .62]; RAs, 90 cm/s vs 83 cm/s [P = .65]). Compared with baseline preoperative values, the PSV of the targeted vessels showed no significant differences in the origin and proximal segment of all vessels. However, the PSV increased significantly in the mid segment of all target vessels after stent placement. ConclusionsStent placement in nonstenotic renal and mesenteric vessels during FB-EVAR is not associated with a significant increase in PSVs at the origin and proximal segments of the target vessels. Although there is a modest but significant increase in velocity measurements in the mid segment of the stented vessel, this difference is not clinically significant. Furthermore, PSVs in stented renal and mesenteric arteries were well below the threshold for significant stenosis in native vessels. These values provide a baseline or benchmark for expected PSVs after renal-mesenteric stenting during FB-EVAR.

Severe pulmonary regurgitation does not influence exercise capacity in patients with repaired Tetralogy of Fallot

Abstract Funding Acknowledgements Type of funding sources: None. Background Identifying exercise determinants in patients with repaired Tetralogy of Fallot (rTOF) is complex. We sought to investigate exercise performance and to identify the best exercise predictors. Methods We prospectively recruited 100 patients with rTOF, 60 patients with severe PR (SPR), and 40 patients with no PR (control). All patients underwent cardiopulmonary exercise testing with echocardiography. Right ventricle (RV) contractile reserve (CR) was defined by the change in peak systolic velocity (ΔRVS’), and change in fractional area change (ΔFAC). Left ventricle (LV) CR was defined by the change in systolic function (ΔLVS’), and change in global longitudinal strain (ΔLVGLS). Results There was no significant difference in the reduced exercise performance between the SPR and control groups by peak absolute oxygen consumption VO2(1695±627 vs 1744±521, ml/min, p&amp;gt;0.05). During exercise, lower RV CR was observed in the SPR group by ΔRVS’ (41±28 vs 48±20%, p&amp;lt;0.05); and ΔFAC (20±15 vs 23±16, %, p&amp;lt;0.05), while it was greater for LV CR by ΔLVS’ (67±34 vs 61±28%, p&amp;lt;0.05). Change in ΔLVGLS was the same (15±17 vs 16±15, %, p&amp;gt;0.05). There were no associations between exercise measures with the degree of PR and RV volume at rest and during exercise. Augmentation of LVGLS and FAC demonstrated independent associations with peak VO2(r=.55, r=.45, p&amp;lt;0.05). Conclusions There was an overall marked reduction in exercise capacity, but no difference between those with and without PR. The degree of exercise limitation is more dependent upon the ability of RV and LV to augment longitudinal function rather than severity of PR.

Effects of Acupuncture upon cerebral hemodynamics in cerebral small vessel disease: A pilot study.

Recent preclinical studies and meta-analysis of clinical trials suggested that acupuncture may improve cognition in cerebral small vessel disease (CSVD). We investigated the cerebral hemodynamics of acupuncture in subjects with CSVD and compared its impact upon the cerebral hemodynamics in normal elderly subjects. 10 subjects with CSVD (CSVD group) and 10 aged-matched control subjects who had no or insignificant CSVD (control group) were recruited. A single session of acupuncture was applied for 30min in both groups. We assessed the effect of our acupuncture intervention on cerebral hemodynamics by transcranial Doppler ultrasound (TCD). Peak systolic velocity (PSV) and pulsatility index (PI) of the middle cerebral artery (MCA) were assessed. We observed that PSV increased by a maximum of 39% at 20min (p<0.05), while there was no significant change in PI in the CSVD group during the acupuncture session. In the control group, although we observed no significant change in PSV during the acupuncture session, there was a significant decrease in PI by a maximum of 22% at 20min (p<0.05). No adverse events were reported during or after the procedure. This study suggested that our acupuncture prescription was associated with an increase in cerebral blood flow in subjects with established moderate to severe CSVD yet without apparent impact on distal vascular resistance. While, in subjects with no or insignificant CSVD, it may reduce cerebral small vessel distal vascular resistance. A larger study is needed to confirm our findings.

Effect of Baduanjin exercise on cerebral blood flow and cognitive frailty in the community older adults with cognitive frailty: A randomized controlled trial

Background/ObjectivesRegular Baduanjin exercise training has been shown to be beneficial to the physical and cognitive health of older adults, but the underlying mechanisms remain to be investigated. This study examined the influence of Baduanjin on cerebral hemodynamics in community-dwelling older adults with cognitive frailty. DesignRandomized controlled trial. MethodsA total of 102 eligible participants were randomly allocated into the Baduanjin exercise intervention group (BEG) or usual physical activity control group (CG) for 24 weeks. Cerebral hemodynamic parameters of bilateral middle/anterior cerebral artery and basilar artery, cognitive ability and physical frailty were assessed using Transcranial Doppler (TCD), Montreal Cognitive Assessment (MoCA) and Edmonton Frailty Scale (EFS) at baseline and 24 weeks post-intervention. ResultsAfter 24 weeks intervention, the changes in peak systolic velocity (PSV), mean blood flow velocity (MBFV), and end diastolic velocity (EDV) in the right middle cerebral artery and basilar artery were better in the BEG than in the CG; the increase in MoCA scores and the decrease in EFS scores were significantly higher in the BEG than in the CG. Moreover, the interaction of exercise and time on those variables showed obvious significance. ConclusionsThe 24 weeks Baduanjin exercise training had a positive beneficial effect on cerebral blood flow in community-dwelling older adults with cognitive frailty. This may be a potential mechanism by which Baduanjin exercise improves the cognitive frailty in older adults. Trial registrationChinese Clinical Trial Registry, ChiCTR1800020341. Date of registrationDecember 25, 2018, http://www.chictr.org.cn/showproj.aspx?proj=29846.

Comparison of Middle Cerebral Artery Doppler and Cord Blood Hemoglobin in the Diagnosis of Fetal Anemia among Rh-negative Pregnant Women

Background: Most prevalent cause of fetal anemia is Rh incompatibility between the mother's and the fetus's blood types, where antibodies from the mother damage the fetus's red blood cells causing fetal hemolytic anemia. Objective: To compare the Doppler of the middle cerebral artery of the fetus and cord blood hemoglobin to diagnose fetal anemia among Rh-negative women in the last trimester of pregnancy. Methodology: This was a cross-sectional study conducted at the Gynecology &amp; Obstetrics Department, Mercy Teaching Hospital Peshawar, from February 2020 to May 2021. A total of 126 Rh-negative blood group women were included who were in the last trimester of the pregnancy. Ethical approval was obtained from Ethics Committee and informed written consent was taken from the study participants. Middle cerebral artery Doppler peak systolic velocity was checked at 28th, 32nd, and 34th week of gestation. If middle cerebral artery Doppler peak systolic velocity changes were present, then patients were closely monitored and managed appropriately for post-delivery assessment of cord blood fetal anemia. A pre-designed structured proforma was used to collect patient details. Results: Mean age of 126 pregnant mothers was 28±7 years, and the mean parity was 4.57±2. The overall frequency of fetal anemia among Rh-negative women predicted by middle cerebral artery Doppler peak systolic velocity was 59 (46.8%), while anemia on cord blood sampling after delivery was found in 43 (34.1%) of babies. No anemia was found in 83 (65.8%) study participants. The sensitivity and specificity of middle cerebral artery Doppler were 100% and 84% respectively. Conclusion: Middle cerebral artery Doppler can be a simple noninvasive method to detect fetal anemia before the development of hydrops fetalis with high sensitivity and specificity.

Cerebrovascular Risk in Restless Legs Syndrome: Intima-Media Thickness and Cerebral Vasomotor Reactivity: A Case-Control Study.

PurposeAlthough some studies have suggested an association between cardiovascular disease and restless legs syndrome (RLS), the mechanisms underlying this relationship remain unclear. The intima-media thickness (IMT) and vasomotor reactivity are two simple, non-invasive tools to investigate preclinical atherosclerosis and microangiopathy, respectively. The aims of this study were to evaluate carotid IMT and to explore vasomotor reactivity in idiopathic RLS (iRLS) patients.Patients and MethodsWe enrolled 44 iRLS after exclusion of patients with secondary causes of RLS, history of vascular events, known uncontrolled vascular risk factors and other neurological disorders. Forty-four age and sex matched controls were therefore recruited. No significant differences in demographic data and vascular risk factors were found between the two groups. Carotid IMT was measured with a high-resolution B-mode ultrasound on the far-wall of common carotid artery, 10 mm and 30 mm to the carotid bulb. Vasomotor reactivity to hypo- and hypercapnia was assessed, by right middle cerebral artery transcranial Doppler, accordingly to the changes in peak systolic velocity, peak diastolic velocity and mean blood flow velocity.ResultsMean IMT was significantly increased in patients with iRLS when measured immediately proximally to carotid bifurcation (0.73; sd=0.17), versus controls (0.65; sd=0.13); p=0.035. Patients showed higher cerebrovascular flow velocities (CBFVs) compared to controls. After multivariate analysis, age, hypertension and iRLS proved to be independent IMT predictors.ConclusionIncreased IMT and higher CBFVs in iRLS support the association of iRLS with vascular damage, possibly through enhanced atherogenesis and sympathetic hyperactivity. However, to clarify a causal relationship, further longitudinal assessment of these parameters is needed, trying to control all their physiological modifying factors.

Early Effects of Laparoscopic Sleeve Gastrectomy and Laparoscopic One-Anastomosis Gastric Bypass on Portal Venous Flow: a Prospective Cohort Study.

Portal vein thrombosis (PVT) is an infrequent, yet potentially lethal, complication of bariatric surgery. The aim of this prospective, non-randomized, cohort study is to compare between laparoscopic sleeve gastrectomy (LSG) and laparoscopic one-anastomosis gastric bypass (LOAGB) in terms of their early postoperative effects on portal venous flow and patency. Forty-nine morbidly obese patients were allocated to one of 2 groups (A or B). Group A patients underwent LSG, whereas group B patients underwent LOAGB. Portal venous Doppler ultrasound scanning was performed preoperatively and 2 weeks postoperatively in all cases, in order to assess the portal venous flow (PVF) in terms of flow direction and peak systolic velocity (PSV); as well as to assess the portal venous patency and exclude PVT. The mean change in PSV (ΔPSV) and the mean percentage change in PSV (%ΔPSV) were determined in both groups. In all cases (group A (n = 26); group B (n = 23)), the direction of PVF was "hepatopetal" both preoperatively and 2 weeks postoperatively. The mean ΔPSV and the mean %ΔPSV were higher in LSG patients "group A" (- 0.84 cm/s and 3.25% respectively) compared with LOAGB patients "group B"(- 0.06 cm/s and 0.27% respectively); P = 0.038 and 0.039 respectively. The mean change in PSV was in the negative direction in both groups, i.e., "deceleration." No cases of PVT were reported in the study. Laparoscopic sleeve gastrectomy is associated with greater reduction in portal venous peak systolic flow velocity in the early postoperative period, compared with laparoscopic one-anastomosis gastric bypass.

Effect of occipitoatlantal decompression on cerebral blood flow dynamics as evaluated by Doppler ultrasonography.

Osteopathic manipulative treatment reduces symptoms in patients with headache disorders, but the underlying mechanisms are unclear. To evaluate blood flow in the intracranial and extracranial vasculature before and after occipitoatlantal decompression (OAD) using Doppler ultrasonography. Healthy, first-year osteopathic medical students from A.T. Still University's Kirksville College of Osteopathic Medicine participated in a randomized, single-blinded, two-period, two-treatment crossover study. The participants were randomly assigned to 1 of 2 treatment interventions: OAD or sham touch. After one week, participants returned to have the other intervention performed. Blood flow parameters-peak systolic velocity (PSV) and end-diastolic velocity (EDV)-in the middle cerebral artery (MCA), internal carotid artery (ICA), and vertebral artery (VA) were evaluated before, immediately after, 5minutes after, and 10minutes after treatment. Differences in PSV, EDV, heart rate (HR), and blood pressure (BP) for both interventions were analyzed for the four time points using mixed-effects models. Thirty healthy medical students (11 men, 19 women; mean age, 24years) participated in this study. EDV increased after OAD in the MCA, ICA, and VA (all p<0.001); no change occurred after sham touch (all p>0.05). EDV was greater for all post-treatment timepoints after OAD in the MCA, ICA, and VA than after sham touch (all p<0.001). Although baseline PSV in the MCA measured before treatment was different between treatment interventions (p=0.01), no difference was found between interventions at any post-treatment time point (all p>0.59). Changes in PSV in the ICA and VA and for HR and BP did not depend on treatment intervention (p>0.06). Increases in EDV occurred in major cranial arteries after OAD but not after sham touch, indicating that OAD improves blood flow to the brain. The exact mechanism of this increase is unknown; however, it can be explained by either parasympathetic stimulation through the secretion of vasodilating neurotransmitters or by a decrease in external tissue pressure on ICA and VA, with the resulting flow causing further dilation in the MCA.

Change in Peak Systolic Velocity of Cavernous Artery in Response to Low Intensity Shock Waves Therapy in Diabetic Polyneuropathy Patients with Erectile Dysfunction: A Randomized Controlled Trial

Although several reports have documented the subjective improvement of erectile function after low-intensity extracorporeal shockwave therapy (LI-ESWT) in patients with vasculogenic erectile dysfunction (ED), objective assessment data of penile hemodynamics are lacking. The aim of this research is to detect the Change in peak systolic velocity of cavernous artery in response to low intensity shock waves therapy in diabetic patients with erectile dysfunction. This study is a randomized controlled trial. Overall forty male individuals with mean age (48.6±5.52 years)who have erectile dysfunction after diabetes were equally divided into two separate groups. 1st Group received low intensity extracorporeal shock wave therapy (ESWT). 2nd Group received shame therapy by put head of shock wave while machine is turned off. 1st Group received low intensity extracorporeal shock wave with the following parameters: - 3000 SWs (energy intensity of 0.09mJ/mm2) to each of five different sites of application: three areas along the penile shaft and two areas at the crural level for six weeks as a total period of treatment. Measurements of peak systolic velocity by penile duplex were performed before the treatment and after 3months. There were change in peak systolic velocity of the right and left cavernous arteries were low at baseline, indicating arterial insufficiency. After treatment, PSV significantly in the two groups; however, the post-treatment PSV was significantly higher in the SW group compared to the PFE group (p &lt; 0.001, for both arteries).LIESWT is lead to significant changes in patients suffering from erectile dysfunction after diabetes as evidenced by increase in the peak systolic volume of the both right and left cavernous arteries of the shock wave group.

Respiratory Fluctuation of Peak Systolic Velocities in the Carotid Doppler Waveforms of Patients With Obstructive Airway Disease: Evidence of Pulsus Paradoxus With Experimental Validation.

To characterize fluctuations in peak systolic velocities (PSVs) in Doppler waveforms of the carotid artery in patients with and without obstructive airway disease and in volunteers subjected to incremental levels of airway resistance in an experimental model. The PSV variation in common carotid waveforms was measured in 100 patients who had had a carotid ultrasound examination and no respiratory or carotid disease. This was compared to that of patients who had this study during an admission for acute exacerbation of chronic obstructive pulmonary disease (COPD). The PSV variation was correlated with pulmonary function testing. In addition, 14 healthy volunteers were asked to breathe through 5 resistors. Simultaneous recordings were made of Doppler waveforms in the common carotid artery, cardiac activity, and respiration. Peak systolic velocity changes from inspiration to expiration were calculated. Of the 100 patients without respiratory disease, the magnitude of the PSV variation averaged 6.3 cm/s. Of the 33 patients with COPD, the PSV variation averaged 16.5 cm/s. Nineteen of the 33 patients with COPD had concurrent pulmonary function testing; there was a statistically significant correlation between the PSV variation and forced vital capacity and forced expiratory volume indices. For the volunteers, mean velocity changes were 7.1, 6.6, 8.3, 15.1, and 16.1 cm/s for 0.00-, 2.15-, 3.27-, 3.58-, and 5.77-cm H2 O/L/s levels of breathing resistance, respectively. There was a statistically significant relationship between an increasing airway load and the decline in PSV during inspiration (P = .02). The PSV variation is greater in patients with increased airway resistance. Similar changes are evident in volunteers breathing into resistors. These findings likely reflect pulsus paradoxus.

Resistive Index is an Early Indicator for Flow Deterioration in Comparison with Intima Media Thickness for Patients with Hypertension and Diabetes in Relation to Age

Background: Atherosclerosis is well known related to age and certain cardiovascular diseases. Aging is one reason of arteries function deterioration which can cause loss of compliance and plaque accumulation, this effect increases by the presence of certain diseases such as hypertension and diabetes disease. Aim: To investigate the reduction of blood supply to the brain in patients with diabetes and hypertension with age and the role of resistive index in the diagnosis of reduced blood flow. Method: Patients with both diseases diabetic and hypertension were classified according to their age to identify the progression of the disease and factors influencing the carotid artery blood flow. By using ultrasound and standard Doppler techniques, the following parameters were measured, lumen Diameter (D), Intima – media thickness (IMT), peak systolic velocity (PSV), end diastolic velocity (EDV), Pulsatility Index (PI), Resistive Index (RI), velocity gradient, and the flow rate. Results: Results show that a small insignificant increase in the lumen diameter (3.49%), (p value > 0.05) between the old age group and the younger group (35- 55) and (56-75) year old. A significant increase in the intima-media (IMT) thickness, end diastolic velocity (EDV) and RI between both age groups was (33.78%), (-31.76%) and (10%) respectively with significant (p value 0.05) but all were statistically close to significance. Conclusion: The increased thickness in IMT did not influence the lumen diameter significantly. RI has the prime effect in the reduction of the blood flow which influenced blood supply to the brain and can indicate the effectiveness of intima media thickness on flow impairment. The changes in PSV, EDV, RI, and PI are also related with reduced compliance.

Abstract No. 649 Endovascular management of transplant renal artery stenosis

Transplant renal artery stenosis (TRAS) occurs in up to 23% of renal transplant recipients, with consequences including refractory hypertension and graft failure. Endovascular treatment options for TRAS include percutaneous transluminal angioplasty (PTA) and stenting. In this study, we compare clinical outcomes of TRAS treated by PTA alone vs. PTA with stenting at a large tertiary referral center performing over 400 renal transplants per year. Thirty adult patients referred for treatment of TRAS between November 2011 and May 2019 were retrospectively reviewed. Indications for angiogram included elevated creatinine, refractory hypertension, graft dysfunction, or elevated renal artery peak systolic velocity. Primary outcomes were reduction in blood pressure (systolic/diastolic) and serum creatinine following intervention. Secondary outcomes included change in peak systolic velocity and intra-arterial pressure gradient. Sixteen patients underwent PTA alone; 14 underwent PTA with stenting (5 drug-eluting, 9 bare-metal). PTA with stenting resulted in statistically significant, sustained drop in systolic blood pressure immediately (11.5%, P = 0.0023), 1 month (7.45%, P = 0.006), and 3 months (12.0%, P = 0.0028) postintervention, but had no significant effect on creatinine at any time point. PTA alone had no significant effect on blood pressure but did result in significant creatinine reduction at 1 month (6.01%, P = 0.005) and 3 months (8.2%, P = 0.014). Baseline creatinine was higher in patients who received PTA alone (2.82 ± 1.33) vs. stenting (1.95 ± 0.68), although the difference was non-significant. No complications were noted in the PTA group; one access complication of common femoral artery pseudoaneurysm occurred in the PTA with stenting group and was treated with thrombin injection. Endovascular treatment of TRAS is safe and effective, with significant, sustained improvement in systolic blood pressure in patients treated with stent placement as compared to PTA alone.

349 Penile Duplex Ultrasonography Supplements Goniometry in Formal Assessment of Efficacy of Intralesional Collagenase Clostridium Histolyticum for Peyronie's Disease

The evaluation of effectiveness of Collagenase Clostridium histolyticum (CCh) in treating men with Peyronie’s disease is largely limited to goniometry, symptoms assessment, and standardized questionnaires. These assessments do not determine objective changes in erectile function or vascular flow. Additionally, goniometry typically does not capture improvement in hourglass deformities or hinge defects. Doppler ultrasound measurement of peak systolic velocities has been investigated as a possible adjunctive assessment tool. While initial studies did not demonstrate improvement in velocities, these studies did not take into consideration velocities both proximal and distal to the penile plaque. This study evaluated the changes in peak systolic velocities of the cavernosal arteries of men with PD before and after 8 injections of CCh. An institutional review board approved database of 152 patients treated with CCh at an academic men’s health practice from January 2016 through April 2019 was reviewed. Doppler ultrasonography was performed after a chemically induced erection by a single examiner both before and after 8 CCh injections. Peak systolic velocities (PSV) were measured both proximal and distal to the palpable plaque bilaterally. Patient demographic information and goniometry data were also extracted. Univariate statistical analysis compared PSV data before and after CCh therapy.

Thromboangiitis obliterans: Aggressive angioplasty provides a potential solution (randomized pilot study).

Background:Thromboangiitis obliterans is an inflammatory disease affecting both medium- and small-sized vessels. Vasodilators, antiplatelets were proposed for treatment but the effect was minimal.Objective:This study was conducted to investigate the effect of balloon angioplasty on patients with Buerger’s disease compared to medical treatment.Methods:Between January 2006 and December 2016, 82 patients with Buerger’s disease were enrolled in the study, of whom 52 were randomized to the aggressive endovascular intervention and 30 were randomized medically by cilostazol and aspirin as a control group. In all, 23% of the patients presented with severe claudication, 50% with ischemic rest pain and 27% with ischemic ulcers. Randomization was done using the opaque envelope method. Allocation concealment was maintained to ensure no selection bias. Patient groups were compared for the duration of ulcer healing, ankle–brachial index, peak systolic velocity changes and transcutaneous oximetry (TcPO2) level for 30 months.Results:No major procedural complications occurred in the endovascular group. Angiographic success was achieved in 100% of supragenicular lesions but in 90% of infrapopliteal lesions. The endovascular group showed a statistically significant improvement in the ulcer healing size and duration at 6 months after the procedure with a mean time of 3 ± 0.9 months compared to 5.8 ± 1.69 months for the medical treatment group (p < 0.001), the mean TcPO2 from 27.23 ± 16.75 mm Hg (range: 0–56 mm Hg) before the procedure to 71.32 ± 12.94 mm Hg (range: 52–92 mm Hg) following revascularization (p < 0.01). The mean ankle–brachial index significantly improved from 0.54 ± 0.14 preoperatively to 0.82 ± 0.08 at final follow-up (p < 0.01).Conclusion:The endovascular therapy should be considered as an effective, safe, minimally invasive method in the light of the promising results after a modification of the standard technique.

Anti-atherosclerotic effects between a combined treatment with simvastatin plus hirudin and single simvastatin therapy in patients with early type 2 diabetes mellitus

This study aimed to investigate the efficacy and safety of simvastatin plus hirudin in preventing atherosclerosis in the patients with early type 2 diabetes mellitus (T2DM). This was a 24-week, randomized, open-label and controlled study in which 150 outpatients initially diagnosed with T2DM were randomly assigned into either simvastatin (40 mg daily at night) plus hirudin (3 g thrice daily) group [combined group (CG) n=75] or simvastatin (40 mg once daily) group [monotherapy group (MG) n=75]. The therapeutic efficacy was evaluated by the score of carotid artery atherosclerosis, plaque size, peak systolic velocity (PSV) and end-diastolic velocity (EDV) on carotid ultrasonography at three and six months after treatment. Logistic regression analysis was used to investigate the correlation between treatment and carotid atherosclerosis. One hundred and thirty-one patients completed this study, and there were no significant differences in the dropout rate in the CG (14.67%) and the MG (10.67%). Significant difference was found in the incidence of adverse events in the CG compared with the MG (37.50% vs. 17.91%, P<0.05) due to the higher risk of hemorrhage (12.50% vs. 1.49%, P<0.05), which did not affect the treatment compliance. The efficacy of combined treatment was better than monotherapy in the enhancement of carotid artery atherosclerosis scores (P<0.01), the plaque thickness (P<0.05) and the change of PSV (P<0.05) and EDV (P<0.05) since three months after treatment, which maintained to the end of observation. In addition, hirudin treatment was able to independently predict the carotid artery atherosclerosis scores (β=2.37, P<0.05), the plaque thickening (β=3.51, P<0.01) and the change of PSV (β=1.69, P<0.05) and EDV (β=1.79, P<0.05). Combined use of simvastatin and hirudin is well tolerated and possesses better anti-atherosclerotic effects than simvastatin alone in patients with early T2DM.

FUNCTIONAL POPLITEAL ARTERY ENTRAPMENT SYNDROME: INVESTIGATION WITH DYNAMIC AND DOPPLER ULTRASOUND

A. Background Functional popliteal artery entrapment syndrome (fPAES), a cause of exertional leg pain, has a clinical presentation and clinical findings that are often indistinguishable from those of other leg pain causes (1). This condition may also coexist and overlap in symptomatology with other leg pain causes, further complicating the diagnosis (2). Although fPAES is usually considered a rare cause of leg pain (3), the true incidence of this condition is unknown, and fPAES is likely underdiagnosed and underreported (4). A missed diagnosis may result in disease progression and the use of unnecessary invasive procedures (3), and untreated fPAES may lead to popliteal artery damage, embolization, and limb ischemia (5). Although a diagnostic method using a combination of dynamic ultrasound and MR imaging/MR angiography has been described for fPAES (5), to our knowledge, no investigational studies have been performed to assess the dynamic ultrasound findings in this entity. This study sought to evaluate the usefulness of dynamic plantar flexion and dorsiflexion of the calf and the effect on the popliteal artery Doppler waveform in patients with clinically suspected fPAES and no structural abnormality. B. Methods We performed a retrospective review of ultrasound studies in patients who presented with clinically suspected PAES over a 3-year period. The ultrasound studies consisted of an anatomic survey of the popliteal. Dynamic nonresistant dorsiflexion and plantar flexion evaluations of the popliteal artery plus spectral Doppler evaluations of the popliteal artery obtained in neutral, plantar flexion, and dorsiflexion positions were performed before and after patients exercised. Patients with anatomic abnormalities were excluded. The following parameters were assessed: The proportion of symptomatic knees versus asymptomatic knees in which plantar flexion and/or dorsiflexion of the foot resulted in popliteal artery compression. The peak systolic velocity (PSV) of the popliteal artery in all positions for knees with and knees without dynamic popliteal artery compression. The absolute value change in PSV of the popliteal artery from neutral to plantar flexion and from neutral to dorsiflexion in the pre- and postexercise state for knees with and knees without dynamic popliteal artery compression. ROC analysis for clustered data was used to assess the ability of PSV to distinguish between knees with and knees without arterial compression. C. Results A total of 88 knees (77 symptomatic, 11 asymptomatic) in 45 patients were included in the study. Dynamic arterial compression was observed in 38% (29/77) of symptomatic knees. No compression seen in asymptomatic knees. Both pre-exercise and postexercise knees with arterial compression had significantly higher absolute changes in PSV from neutral to plantar flexion versus knees without arterial compression (Table). There was a smaller significant change in PSV from neutral to dorsiflexion in the pre-exercise state. There was no significant change in PSV in the postexercise state from neutral to dorsiflexion or with respect to PSV values at any position between knees with and knees without arterial compression. D. Conclusions/Significance In patients with clinically suspected PAES without anatomic abnormality, dynamic ultrasound demonstrated compression of the popliteal artery in 38% of knees. No dynamic arterial compression was seen in asymptomatic knees. There was a significant elevation in PSV from neutral to plantar flexion in pre- and postexercise states and from pre-exercise neutral to dorsiflexion positions in knees with arterial compression versus knees without arterial compression. Tables [Table: see text] References Joy SM, Raudales R. Popliteal artery entrapment syndrome. Curr Sports Med Rep. 2015;14(5):364-367. Hislop M, Kennedy D, Cramp B, Dhupelia S. Functional popliteal artery entrapment syndrome: poorly understood and frequently missed? A review of clinical features, appropriate investigations, and treatment options. J Sports Med (Hindawi Publ Corp). 2014;2014:105953. Gaunder C, McKinney B, Rivera J. Popliteal artery entrapment or chronic exertional compartment syndrome? Case Rep Med. 2017;2017:6981047 Hislop M, Brideaux A, Dhupelia S. Functional popliteal artery entrapment syndrome: use of ultrasound guided Botox injection as a non-surgical treatment option. Skeletal Radiol. 2017;46(9):1241-1248. Williams C, Kennedy D, Bastian-Jordan M, Hislop M, Cramp B, Dhupelia S. A new diagnostic approach to popliteal artery entrapment syndrome. J Med Radiat Sci. 2015;62(3):226-229.

078 Amniotic fluid allograft for the treatment of erectile dysfunction: a pilot series

Amniotic fluid allograft has been used by orthopedic surgeons in joint replacement procedures to expedite recovery. Although it consists of a host of elements that may be beneficial in the treatment of erectile dysfunction (ED), it has never been tested for this disease process. Proflo® (Urostem Biologics; Coral Springs, FL) is a human allograft derived from amniotic fluid that does not contain stem cells. We present our pilot series using AmnioFactor® amniotic fluid allograft injections for the treatment of ED. After IRB approval, patients undergoing amniotic fluid allograft injections for the treatment of ED were prospectively identified. A baseline Sexual Health Inventory for Men (SHIM) score and a penile Doppler ultrasound were obtained on each patient prior to treatment. Each cycle was performed four to six weeks apart and consisted of 1.5 cc of amniotic fluid allograft injected into each corpora cavernosum for a total of 3 cc. All patients underwent at least two cycles, with a maximum of four cycles being offered. A post-treatment SHIM score and a post-treatment penile Doppler ultrasound were obtained for comparison. The primary endpoint was the development of post-treatment complications. Secondary endpoints looked to evaluate subjective improvement in erectile function (SHIM scores) and objective changes in peak systolic velocity (PSV) and end-diastolic velocity (EDV) on penile Doppler ultrasound.

Effect of collagenase Clostridium histolyticum on penile vascular and morphological parameters in patients with Peyronie's disease.

BackgroundTo examine the changes in penile vascular parameters after the administration of collagenase Clostridium histolyticum (CCH) in patients with Peyronie’s disease (PD).MethodsWe retrospectively reviewed the records for all patients treated with CCH for PD between 04/2014 and 05/2017 who underwent penile duplex Doppler ultrasound (PDDU) after pharmacologically induced erection both before and after four cycles of CCH treatment. The primary outcomes measured were changes in peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) after CCH treatment. Paired t-tests, chi-squared tests, and correlation coefficients were performed between functional and vascular parameters before and after four rounds of CCH to determine statistical significance (P<0.05).ResultsA total of 51 patients were included in the study. After four cycles of CCH therapy, there was no statistically significant change in PSV, EDV, RI, or International Index of Erectile Function score when compared to baseline. Similarly, there was no correlation between vascular parameters and change in curvature. There was a statistically significant change in penile curvature (60˚±16.9˚ to 40.8˚±14.9˚, P<0.001) and erect penile circumference (11.6±1.0 to 11.9±1.0 cm, P<0.05) after treatment.ConclusionsIn spite of a significant change in penile curvature, this change did not correlate with changing penile vascular or morphological parameters. Overall, CCH therapy seems to have a negligible impact on penile vasculature, furthering evidence of its favorable safety profile.