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Annual Meeting Abstracts: From the Western Vascular Society
ANNUAL MEETING ABSTRACTS From the Western Vascular Society The Seventh Annual Meeting of the Western Vascular Society will be held in Maui, Hawaii, on Jan. 12-15, 1992. Selected abstracts from that meeting are published here.
CHAT analysis ofthe influence ofspecific risk factors on late results following carotid endarterectomy Eugene F. Bernstein, MD, PhD, Jeffrey Kaplan, MD, Terese E. Scala, RN, and Ralph B. Dilley, MD, Scripps
Clinic and Research Foundation, La lolla,
catif'.
The CHAT classification separates various current and historical presentations of cerebrovascular disease in an effort to determine important prognostic clues for management and prognosis. To evaluate known risk factors for late stroke, we followed 633 patients who had undergone 714 carotid operations (CEA) over an average of 44 months. We analyzed the indication for surgery (by CHAT) and the effect of preoperative risk factors (age, hypertension, cardiac disease, tobacco use, diabetes, hyperlipidemia, renal, pulmonary, and a total risk factor score: TOT) on the end points oflate stroke and death. Stroke was uncommon after CEA: at 5 years, 6% of all CEA.patients had sustained a late stroke. of 127 patients with ~aurosis fugax, both the late stroke and late mortality incidence was least (a combined total of 1%/year), and the 17 patients who had permanent blindness fared equally well. The 28 patients with vertebrobasilar symptoms and treated by CEA also fared particularly well, with no late strokes or de~ths within the fi~st ~ years. Logistic regression analyses indicated ~at each ~ndl cation for carotid endarterectomy was assocIated WIth a differing risk factor prognos~s fQr late stroke. For patients with asymptomatic lesions, oilly diabetes W!lS an important risk factor for late stroke (p = 0.05), whereas renal dise,ase was the only marker,f~r early death. ~hose factors'did not adversely affect patients with amaurosis fugax, ~here ~o bacco, gender and TOT were important. For patients. ~th cortical TIA, diabetes, smoking, and TOT were predictive of late stroke and of death. For patients with prior stroke, age, smoking, and TOT were predictive. In contrast to patients without surgical treatment for stroke and TIA (Framingham, etc), age was less predictive of late stroke or death, and several other specific risk factors appeared to play relatively minor roles. We conclude that stroke <1fter CEA is uncommon, least common after ocular symp~oms, and most likely after permanent cortical stroke. Specific risk factors are less important after CEA than for the medically treated stroke patient.
Color Doppler imaging of lower extremity arterial occlusive disease: A prospective validation study Thomas S. Hatsukami, MD, Jean F. Primozich, BS, RVT, R. Eugene Zierler, MD, John Harley, MD, and D. Eugene Strandness Jr., MD, University ofWashington, Seattle, Wash. Few reports exist in the literature validating the use of calor Doppler imaging (COl) for evaluation of lower
232
extremity arterial occlusive disease, particularly in the tibial and peroneal arteries. This prospective, blinded study attempts to address the following questions: (1) how does CDI compare with arteriography? (2) can CDI accurately assess the tibial and peroneal arteries? and (3) how well does color image data alone, without spectral waveform information, identify and classify hemodynamically significant arterial lesions in the lower extremities? Twenty-nine men undergoing arteriography before a lower extremity arterial reconstructive procedure were studied with a color ultrasound scanner from the level of the infrarenal aorta to the distal peroneal and tibial arteries. Both color imaging data and spectral waveforms were obtained in 10 patients, whereas only color data were collected in 19 patients. Color images were. examined for the presence o~ absence of triphasic flow, wall irregularities, poststenotic flow p~t· terns, calor bruits, and collaterals. A total of 785 arterIal segments were available for comparison. . Color Doppler imaging is comparable to arterIography in the evaluation of arteries proximal to the knee. Below this level, CDI accurately categorizes hemodynamically significant disease. However, larger numbers are required for a better estimate of sensitivity. Results obtained with color imaging alone compare favorably to those acquired th~ough the interpretation of color images and spec~al waveforms. However, the quality of data collected Wlth CDI is highly dependent on the operator and instrument. Whether "these results can be reproduced with different examiners using different color scanners is unknown. Validation ofeach laboratory's results and continued use of spectral waveform information is recommended.
Accuracy of duplex scanning for the measurement of arterial volume flow Brenda K. Zierler, RN, BSN, RVT, Thomas R. Kirkman, BA, Larry W. Kraiss, MD, William G. Reiss, PharmD, John R. Horn, PharmD, Larry A. Bauer, PharmD, Alexander W. Clowes, MD, and Ted R. Kohler, MD,
Veterans Administration Medical Center, Seattle, Wash. Duplex ultrasonography can accurately classify t?e degree ofarterial stenosis based on velocity changes, but 1~ ability to measure volume flow has not been validated. Thls study examined the accuracy of duplex ultrasound measurement ofvolume flow in a baboon model. Volume flow (V ) was calculated from Doppler measurements ofaverage f • cl blood velocity over several cardiac cycles (nme average velocity, TAV) and vessel cross-sectional area [Vr = TAV x A]. Fourteen anesthetized male baboons (-10 kg) served as subjects. B-mode ultrasound measurements of external iliac artery diameters (mean, 2.5 mm)
CHAT analysis ofthe influence ofspecific risk factors on late results following carotid endarterectomy Eugene F. Bernstein, MD, PhD, Jeffrey Kaplan, MD, Terese E. Scala, RN, and Ralph B. Dilley, MD, Scripps
Clinic and Research Foundation, La lolla,
catif'.
The CHAT classification separates various current and historical presentations of cerebrovascular disease in an effort to determine important prognostic clues for management and prognosis. To evaluate known risk factors for late stroke, we followed 633 patients who had undergone 714 carotid operations (CEA) over an average of 44 months. We analyzed the indication for surgery (by CHAT) and the effect of preoperative risk factors (age, hypertension, cardiac disease, tobacco use, diabetes, hyperlipidemia, renal, pulmonary, and a total risk factor score: TOT) on the end points oflate stroke and death. Stroke was uncommon after CEA: at 5 years, 6% of all CEA.patients had sustained a late stroke. of 127 patients with ~aurosis fugax, both the late stroke and late mortality incidence was least (a combined total of 1%/year), and the 17 patients who had permanent blindness fared equally well. The 28 patients with vertebrobasilar symptoms and treated by CEA also fared particularly well, with no late strokes or de~ths within the fi~st ~ years. Logistic regression analyses indicated ~at each ~ndl cation for carotid endarterectomy was assocIated WIth a differing risk factor prognos~s fQr late stroke. For patients with asymptomatic lesions, oilly diabetes W!lS an important risk factor for late stroke (p = 0.05), whereas renal dise,ase was the only marker,f~r early death. ~hose factors'did not adversely affect patients with amaurosis fugax, ~here ~o bacco, gender and TOT were important. For patients. ~th cortical TIA, diabetes, smoking, and TOT were predictive of late stroke and of death. For patients with prior stroke, age, smoking, and TOT were predictive. In contrast to patients without surgical treatment for stroke and TIA (Framingham, etc), age was less predictive of late stroke or death, and several other specific risk factors appeared to play relatively minor roles. We conclude that stroke <1fter CEA is uncommon, least common after ocular symp~oms, and most likely after permanent cortical stroke. Specific risk factors are less important after CEA than for the medically treated stroke patient.
Color Doppler imaging of lower extremity arterial occlusive disease: A prospective validation study Thomas S. Hatsukami, MD, Jean F. Primozich, BS, RVT, R. Eugene Zierler, MD, John Harley, MD, and D. Eugene Strandness Jr., MD, University ofWashington, Seattle, Wash. Few reports exist in the literature validating the use of calor Doppler imaging (COl) for evaluation of lower
232
extremity arterial occlusive disease, particularly in the tibial and peroneal arteries. This prospective, blinded study attempts to address the following questions: (1) how does CDI compare with arteriography? (2) can CDI accurately assess the tibial and peroneal arteries? and (3) how well does color image data alone, without spectral waveform information, identify and classify hemodynamically significant arterial lesions in the lower extremities? Twenty-nine men undergoing arteriography before a lower extremity arterial reconstructive procedure were studied with a color ultrasound scanner from the level of the infrarenal aorta to the distal peroneal and tibial arteries. Both color imaging data and spectral waveforms were obtained in 10 patients, whereas only color data were collected in 19 patients. Color images were. examined for the presence o~ absence of triphasic flow, wall irregularities, poststenotic flow p~t· terns, calor bruits, and collaterals. A total of 785 arterIal segments were available for comparison. . Color Doppler imaging is comparable to arterIography in the evaluation of arteries proximal to the knee. Below this level, CDI accurately categorizes hemodynamically significant disease. However, larger numbers are required for a better estimate of sensitivity. Results obtained with color imaging alone compare favorably to those acquired th~ough the interpretation of color images and spec~al waveforms. However, the quality of data collected Wlth CDI is highly dependent on the operator and instrument. Whether "these results can be reproduced with different examiners using different color scanners is unknown. Validation ofeach laboratory's results and continued use of spectral waveform information is recommended.
Accuracy of duplex scanning for the measurement of arterial volume flow Brenda K. Zierler, RN, BSN, RVT, Thomas R. Kirkman, BA, Larry W. Kraiss, MD, William G. Reiss, PharmD, John R. Horn, PharmD, Larry A. Bauer, PharmD, Alexander W. Clowes, MD, and Ted R. Kohler, MD,
Veterans Administration Medical Center, Seattle, Wash. Duplex ultrasonography can accurately classify t?e degree ofarterial stenosis based on velocity changes, but 1~ ability to measure volume flow has not been validated. Thls study examined the accuracy of duplex ultrasound measurement ofvolume flow in a baboon model. Volume flow (V ) was calculated from Doppler measurements ofaverage f • cl blood velocity over several cardiac cycles (nme average velocity, TAV) and vessel cross-sectional area [Vr = TAV x A]. Fourteen anesthetized male baboons (-10 kg) served as subjects. B-mode ultrasound measurements of external iliac artery diameters (mean, 2.5 mm)