On the basis of the USI data alone, a prediction of arteriographic findings was possible at the 95% level for occlusion and severe stenosis and for ruling out hemodynamically significant stenosis. The addition of velocity data improved prediction in borderline degrees of stenosis. USI was effective for quantifying clinically significant degrees of stenosis.
Historically, patients with mild to moderate neurologic deficits lasting longer than 24 hours were believed to have sustained a completed stroke. They were followed up for 4 to 6 weeks and cerebral angiography was performed if indicated. CT scanning has identified a subset of these patients who have sustained a reversible ischemic neurologic deficit (RIND) rather than a completed stroke. The timing for angiography and surgery for this group has not been established. In an earlier study we found that 21% (4 of 19 patients) suffered a second stroke during the 4- to 6-week waiting period. To avoid this high rate of recurrence, we instituted an aggressive program of CT scan evaluation and surgical therapy for all "stroke patients" with negative CT scans. Two hundred forty-five patients were seen with a persistent neurologic deficit between July 1980 and December 1983. These patients underwent CT scans 1 and 5 days after the initial event. Of these 245 patients, 171 patients (70%) were found to have negative CT scans. Appropriate carotid lesions were found by arteriography in 110 (64%) of the negative CT scan group. There were 61 (55%) men and 49 (45%) women in this group. Eighty-five patients (77%) had previous neurologic symptoms or a cerebrovascular accident. Hypertension was present in 52% and diabetes mellitus in 30%. All 110 patients underwent carotid endarterectomy within 14 days (mean 10 days) of the initial onset of their neurologic deficit; these were all done with shunt protection. No patient suffered another neurologic deficit in the same territory within 30 days after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
Small vessel networks were detected adjacent to or in connection with most of the radiofrequency ablation-treated GSVs. SFJ ligation was associated with fewer small vessel networks and proximal GSV recanalization. Most below-knee untreated GSV segments remained patent, and most exhibited reflux.
Gender bias exists in use of ultrasonography for diagnosis of DVT. The greater incidence of women undergoing venous ultrasonography is not explained by higher prevalence of DVT risk factors or of higher occurrence of positive ultrasound examination results. Further investigation is needed to determine whether these differences indicate underuse of ultrasonography in men or overuse in women.
ABIs significantly improved Doppler waveform accuracy at all levels. Compared with ABI, the addition of segmental pressure to waveform data failed to improve accuracy. Pressure measurements above the ankle may lack cost effectiveness and clinical utility.
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