Plasma cholesterol-induced lesion networks activated before regression of early, mature, and advanced atherosclerosis.

Plasma cholesterol lowering (PCL) slows and sometimes prevents progression of atherosclerosis and may even lead to regression. Little is known about how molecular processes in the atherosclerotic arterial wall respond to PCL and modify responses to atherosclerosis regression. We studied atherosclerosis regression and global gene expression responses to PCL (≥80%) and to atherosclerosis regression itself in early, mature, and advanced lesions.

Carotid plaque age is a feature of plaque stability inversely related to levels of plasma insulin.

Background: The stability of atherosclerotic plaques determines the risk for rupture, which may lead to thrombus formation and potentially severe clinical complications such as myocardial infarction and stroke. Although the rate of plaque formation may be important for plaque stability, this process is not well understood. We took advantage of the atmospheric (14)C-declination curve (a result of the atomic bomb tests in the 1950s and 1960s) to determine the average biological age of carotid plaques.

Multi-organ expression profiling uncovers a gene module in coronary artery disease involving transendothelial migration of leukocytes and LIM domain binding 2: the Stockholm Atherosclerosis Gene Expression (STAGE) study.

Environmental exposures filtered through the genetic make-up of each individual alter the transcriptional repertoire in organs central to metabolic homeostasis, thereby affecting arterial lipid accumulation, inflammation, and the development of coronary artery disease (CAD). The primary aim of the Stockholm Atherosclerosis Gene Expression (STAGE) study was to determine whether there are functionally associated genes (rather than individual genes) important for CAD development. To this end, two-way clustering was used on 278 transcriptional profiles of liver, skeletal muscle, and visceral fat (n = 66/tissue) and atherosclerotic and unaffected arterial wall (n = 40/tissue) isolated from CAD patients during coronary artery bypass surgery.

A randomized prospective study of valvulotome efficacy in in situ reconstructions.

Objectives: To compare the efficacy of valvulotomes during in situ bypass surgery.

Design: A randomized prospective blinded study.

Materials And Methods: Thirty PAD patients scheduled for infrainguinal greater saphenous vein bypass were randomized to use of adjustable or fixed valvulotomes for valve destruction.

Long-term outcome of infrainguinal percutaneous transluminal angioplasty.

Purpose: To evaluate the long-term outcome of infrainguinal percutaneous transluminal angioplasty (PTA).

Methods: Between 1991 and 1994, 77 patients (45 men; mean age 70 years, range 41-85) underwent infrainguinal PTA for occlusive disease. Patient records and angiographic examinations were reviewed to extract data to a patient register.

Totally implantable subcutaneous port system versus central venous catheter placed before induction chemotherapy in patients with acute leukaemia-a randomized study.

A group of 43 adult patients with acute leukaemia (AL) were randomized to receive a double-lumen totally implantable subcutaneous port system (PORT, n=19) or a double-lumen central venous catheter (CVC, n=24) before induction chemotherapy. Six patients were excluded due to protocol violation ( n=4, CVC) and technical difficulties ( n=2, PORT). A standardized catheter record form was used for recording of catheter function, local infection and bleeding.

The European experience with vascular injuries.

The rich and diverse heritage of the management of vascular injuries in the 45 independent European countries prevents the authors from revealing a uniform picture of the European experience, but some trends are clearly emerging. In countries with a low incidence of penetrating trauma and increasing use of interventional vascular procedures, the proportion of iatrogenic vascular trauma exceeds 40% of all vascular injuries, whereas on other parts of the continent, armed conflicts are still a major cause of vascular trauma. National vascular registries, mostly in the Scandinavian countries, produce useful, nationwide data about vascular trauma and its management but suffer still from inadequate data collection.

Sexual function in women suffering from aortoiliac occlusive disease.

Objective: To describe the sexual function in women suffering aortoiliac occlusive disease (AIOD) and in an age-matched reference group.

Patients And Methods: Thirty-six women suffering from AIOD were included. Twenty were investigated before vascular intervention (untreated) and 16 different women after treatment (treated).

Complications in carotid endarterectomy are predicted by qualifying symptoms and preoperative CT findings.

Objectives: To relate the 30-day perioperative rate of stroke or death in carotid endarterectomy (CEA) to preoperative qualifying symptoms and to the presence of cerebral infarction (CI) demonstrated on computed tomography (CT).

Design: Retrospective clinical study.

Material And Methods: Two hundred and seventy-two consecutive CEAs for symptomatic stenosis in 262 patients were analysed.

Conservative treatment, stent grafting or open repair of abdominal aortic aneurysms.

The incidence of abdominal aortic aneurysm (AAA) is increasing in most parts of the world and the natural history is death from rupture unless the patient dies from another cause prior to rupture. The treatment of the aneurysm involves insertion of a vascular prosthesis sutured proximally to the non-dilated segment of the aorta and distally either to the neck below the aneurysm or on a convenient place in the iliac or femoral arteries. The endovascular technique has brought the possibility of inserting and securing this prosthesis in the aorta by use of stents which replace surgical suture and act as friction seals.

Postocclusive reactive hyperemia estimating peripheral vascular resistance: a noninvasive method to predict outcome of infrainguinal vascular reconstructions?

Objective: The peripheral vascular resistance is an important factor determining the outcome of infrainguinal revascularizations. When measured intraoperatively, it correlates to graft patency, but to select patients to surgery a preoperative, preferably noninvasive, method is necessary. The aim of the present study is to test if parameters recorded during postocclusive reactive hyperemia can be used for that purpose.

The "ad hoc" estimation of outflow does not predict patency of infrainguinal reconstructions.

Objectives: This prospective study was performed to evaluate the clinical implication of the adhoc estimation (also called SVS score) of outflow on patency of infrainguinal in situ femoropopliteal or -distal bypasses.

Methods: The bypasses were followed with Duplex scanning at 1, 3, 6, and 12 months after surgery. Fifty-three bypasses were recruited for the study, 20 of which were performed in 17 diabetics.

The effect of erythropoietin treatment on arteriovenous haemodialysis fistula/graft: a prospective study with colour flow Doppler ultrasonography.

To determine the effect of erythropoietin (EPO) on patency the haemodynamics and morphology in haemodialysis fistula/graft were prospectively assessed using ultrasonographic two-dimensional imaging and colour flow Doppler together with pulsed Doppler, prior to and during partial correction of anaemia with EPO. Nineteen radiocephalic fistula and 11 loop grafts in 30 patients on routine maintenance haemodialysis were investigated prior to EPO treatment. A significant stenosis defined as a localised 100% increase in flow velocity was found in the arterial inflow in seven (23%) patients, in the loop graft in seven (64% of loop grafts) patients, and in the venous segments in 23 (77%) patients.

Calcitonin gene-related peptide attenuates experimental ischemic renal failure in a rat model of reversible renal ischemic insult.

Calcitonin gene-related peptide (CGRP) has been shown to decrease vascular resistance and increase renal blood flow. To study the effects of CGRP in acute renal failure (ARF) of moderate degree, we used a rat model of bilateral temporary renal artery occlusion (RAO) inducing ARF with spontaneous recovery within 1 week, resembling a clinical situation. Three groups were studied: CGRP 10 (CGRP10) and 25 (CGRP25) pmol.

Venous shunting as a complication to penile revascularization--a case report.

As a serious complication to arterial penile revascularisation arterio-venous shunting was observed in a 60 years old male. The patient suffered bilateral obstruction of his pudendal arteries. Following revascularization using the left inferior epigastric artery he obtained good pulsation in the penis but no return of sexual function.

Does low-dose acetylsalicylic acid prevent stroke after carotid surgery? A double-blind, placebo-controlled randomized trial.

Background And Purpose: The aim of this randomized double-blind, placebo-controlled trial was to evaluate whether neurological deficits could be prevented with low-dose acetylsalicylic acid (ASA) as an adjunct to carotid endarterectomy.

Methods: A total of 232 patients were randomized to two groups, 75 mg/d ASA starting preoperatively and continued for 6 months (n = 117) or placebo (identical tablets) (n = 115). The patients were followed up regularly for 1 year.

Natural history of patients with unoperated atherosclerotic carotid artery disease--results from a retrospective study.

The natural history of carotid artery disease was studied in a retrospective study of 609 angiograms performed during 1969-1979 on patients who had subsequently not been operated on. The indication for angiography differed, but was aimed at clarifying suspected cerebrovascular events. 578 patients could be followed-up after a median time of 10.

Changes in middle cerebral artery flow velocity and pulsatility index after carotid endarterectomy.

Transcranial Doppler sonography (TCD) was used in 33 patients undergoing carotid endarterectomy (CEA). Mean flow velocity (MCA MV) and the pulsatility index in the middle cerebral artery (MCA PI) were measured pre- and on six occasions postoperatively. The MCA MV was reduced by anaesthesia but was increased postoperatively (+43%, p less than 0.

Edema after lower limb arterial reconstruction. Influence of background factors, surgical technique and potentially prophylactic methods.

The pathogenesis of lower leg edema regularly following a distal arterial reconstruction is unclear and generally no treatment is used. In 85 patients background factors such as diabetes, age, sex and side of operation were analysed and found not to influence the degree of edema. A significantly less pronounced edema was found when a prosthetic graft was used as compared to a vein graft as well as if the distal anastomosis was located above as compared to below the knee.