Central aortic pressure waveforms can be calculated from the radial artery pressure waveform using a generalized transfer function to correct for pressure wave distortion in the upper limb. Although validated to standards conventionally applied, reservations are still expressed on use of this process, because of the relatively small number of patients from whom appropriate invasive data were obtained. The study described here supplemented such data with noninvasive data obtained from carotid and radial artery tonometry in 439 patients and normal subjects. The carotid-radial artery transfer function was similar to the aortic-radial when allowance was made for wave travel from aorta to carotid artery. The carotid-radial transfer function was identical in male and female individuals, was similar at different arterial pressures and in mature adults. Differences are relatively small, are seen at frequencies where central pressure wave components are small and are similar to those seen with vasodilator agents in invasive studies. Findings provide further support for use of a generalized transfer function to calculate aortic from upper limb pressure and conform with previously established views on vascular impedance.
The influence of the large arteries and the peripheral load on pressure wave propagation in the human upper limb was investigated in an anatomically realistic multibranched model based on linear transmission theory. To mimic vascular changes seen in life, the viscoelastic properties of large arteries and the peripheral load properties (represented as modified windkessels) were altered as follows: Young's modulus (from 10.9 x 10(6) to 15.3 x 10(6) dyn/cm2) and phase (from 0 to 15 degrees) of the complex elastance, windkessel time constant (from 0 to 0.6 s), and peripheral reflection coefficient (from 0 to 0.95). The relationship between the central aortic and peripheral radial pressure waveforms was analyzed in the time and the frequency domain. Results indicate that the large arterial properties have less influence (peak systolic pressure changed by 3% and peak of transfer function changed by 29%) than the properties of the peripheral load (systolic pressure changed by 14% and peak of transfer function changed by 74%) on the pressure wave propagation in the upper limb.
The effects of wave travel and wave reflection were simulated in a mathematical model of the whole arterial tree consisting of 142 uniform transmission line segments. The arterial model was partitioned into three separate segments: upper limbs, trunk, and lower limbs. Aging was simulated by increasing average pulse wave velocities of these segments (10.9-12.9, 8.0-11.7, and 9.0-11.3 m/s for upper limbs, trunk, and lower limbs, respectively). Reflection coefficients at the terminal elements were altered to simulate vasodilation (0.0) and vasoconstriction (0.95). The impedance patterns and spatial distribution of pressure waveforms generated by the model simulating aging and vasoconstriction were similar to in vivo measurements by other investigators. Reflected pressure waves from each segment reached the ascending aorta and contributed differently to the late systolic peak on the aortic pressure wave. Aging does not alter the origin of these reflected pressure waves in the trunk. Aortic impedance and pressure wave changes induced by simulation of dilation of splanchnic bed were similar to those observed experimentally with nitroglycerin.
Maximal torsional load to failure for the unlocked group is within the functional range of rotational loads experienced at the hip for an average adult. The results show that distal locking significantly increases rotational load to failure. The authors highly recommend routine use of distal interlocking screws during cephalomedullary nail placement in unstable intertrochanteric fractures.
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