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Purpose: To measure common femoral artery (CFA) diameters in infants and children referred for cardiac catheterization and investigate if CFA diameters can be predicted upon the basis of age, body mass index (BMI), and height., Methods: CFA diameters were measured in 84 infants and children (50 boys; age range 1- 220 months) referred for diagnostic or therapeutic cardiac interventions. Sonographic measurements were made in a supine position utilizing a 7.5-MHz linear transducer; diameters were defined as the intima to intima distance. Age was described in months and height in centimeters. The Spearman correlation coefficient (rho) was used to test the similarity of diameters between sides; the Pearson correlation coefficient (r) was used to analyze the influence of age, height, and BMI on CFA diameter., Results: Diameters of the right and left CFA were similar (rho=0.951). Age and height were highly correlated (rho=0.956), but not BMI and height (rho=0.279). The best model was CFA diameter = -0.838 + 0.031 height + 0.046 BMI. Height was the most relevant determinant for CFA diameter (p<0.0001, 90% CI 0.027 to 0.036; BMI: p=0.093, 90% CI 0.001 to 0.090, and the intercept: p=0.032, 90% CI-1.475 to-0.200)., Conclusions: Common femoral artery diameter can be sufficiently predicted from height and BMI of infants and children prior to femoral catheterization or surgical reconstruction.

Purpose: To explore if the diameter of an occluded superficial femoral artery (SFA) can predict the technical success of percutaneous recanalization., Methods: Two hundred patients (151 men; mean age 57 +/- 16 years) suffering from peripheral arterial occlusive disease were evaluated with duplex ultrasonography to measure arterial diameters and percent diameter reduction. Seventy-nine (39.5%) patients had segmental or complete SFA occlusions that ranged in age from 2 to 26 months (median 11). The majority of occlusions (45, 57.0%) were < or =10 cm long (range 10-35). Percutaneous recanalization was performed in 71 patients using either conventional angioplasty or local low-dose thrombolysis with rtPA., Results: Diameters of 79 unilaterally occluded SFAs at the level of occlusion were 4.5 +/- 1.4 mm versus 5.7 +/- 1.3 mm for the patent contralateral artery (p=0.055). None of the 121 patent SFAs had diameters < or =3.5 mm, but 12 (15%) of the 79 occluded SFAs did, and none of these could be recanalized. The sensitivity of the 3.5-mm cut point to predict recanalization failure was 44% (specificity 100%). CONCLUSIONS; Our data suggest that occluded SFAs with a diameter reduction to < or =3.5 mm are not suitable for percutaneous recanalization, as the original arterial lumen cannot be reconstructed.

Purpose: We measured changes in peak systolic velocity ratio and sonogaphic vascular diameter during different hemodynamic conditions in patients with femoral or iliac artery stenosis., Methods: In 35 patients with isolated femoral or iliac artery stenosis, prestenotic and intrastenotic peak systolic velocity and inner vascular diameter were calculated using color Doppler sonography and gray-scale sonography, respectively. The measurements were performed with the patient at rest (baseline), after leg exercise, and again after oral administration of 10 mg of the vasodilator nifedipine., Results: The mean prestenotic and intrastenotic peak systolic velocity and the peak systolic velocity ratio (intrastenotic/prestenotic peak systolic velocity) were 70 +/- 31 cm/second, 360 +/- 130 cm/second, and 6.5 +/- 3.6 at baseline; 78 +/- 37 cm/second, 404 +/- 171 cm/second, and 6.6 +/- 4.2 after leg exercise; and 71 +/- 30 cm/second, 353 +/- 109 cm/second, and 5.9 +/- 3.2 after nifedipine administration. The mean prestenotic and intrastenotic diameter and percentage of diameter reduction were 5.9 +/- 3.2 mm, 2.3 +/- 1.1 mm, and 59 +/- 13% at baseline; 4.8 +/- 2.4 mm, 2.0 +/- 1.3 mm, and 62 +/- 13% after leg exercise; and 5.9 +/- 2.9 mm, 2.5 +/- 1.0 mm, and 54 +/- 14% after nifedipine administration. Only the difference in intrastenotic diameter after leg exercise was significantly different from baseline., Conclusions: The peak systolic velocity ratio in peripheral arterial stenosis seems to be relatively independent of the hemodynamic conditions and cannot be used for investigations of vasomotion of stenotic arterial segments during different hemodynamic conditions., (Copyright 2000 John Wiley & Sons, Inc.)

The hemostatic puncture closure device Angio-Seal is a quick, safe, and easy-to-use system, allowing rapid sealing of the vascular access site following coronary angiography and interventional procedures. It is advantageous for patients in whom early mobilization is desired and may therefore decrease hospital costs. Despite the documented low complication rate, there are some specific problems. Reporting on five cases, we describe problems in diagnosis and possible interventional therapy of Angio-Seal-associated complications such as stenosis, occlusion, or peripheral embolism. Our experience led to the concept of precise diagnosis in any patient with leg symptoms and early interventional treatment with the aim of complete removal of the intra-arterial parts of the Angio-Seal device. Any delay in diagnosis and treatment increases the risk of additional thrombotic occlusion. Spontaneous dissolution of the Angio-Seal sponge limits interventional possibilities of complete removal. Cathet. Cardiovasc. Intervent. 49:142-147, 2000., (Copyright 2000 Wiley-Liss, Inc.)

The authors investigated the prevalence of atherosclerotic lesions in carotid and femoral arteries in people with varying risk factors. They searched for differences in the region of manifestation of atherosclerosis due to different risk factors. Over 5 years they investigated 4,200 people (2,600 men, 1,600 women aged 20 to 70 years) who reported feeling healthy. They did a B-mode sonography of the internal, external, and common carotid artery; and the common, the proximal superficial, and profundal femoral artery. They questioned the people regarding hypertension, hypercholesterolemia, diabetes mellitus, and smoking habits. Isolated carotid artery atherosclerosis was found in 2.8% of the men and 1.6% of the women; 10.9% of the men and 4.4% of the women had isolated femoral artery lesions. A combination of atherosclerotic lesions in both arteries was present in 8.3% of the men and 4.0% of the women. When only one risk factor was present atherosclerotic lesions of the femoral arteries were predominant. Diffuse atherosclerosis dominated with increasing number of risk factors. The rate of people with isolated carotid atherosclerosis was highest when no risk factor was present and decreased to a fixed rate of 12% to 17% independent of the number of risk factors. An increasing number of risk factors can be associated with a diffuse manifestation of atherosclerotic lesions. However, there are a certain number of people who demonstrate only carotid artery or femoral artery atherosclerosis independent of the number of risk factors.

A dissection of the superficial femoral artery mainly occurs due to trauma or manipulation of the artery by means of interventional procedures. In contrast to dissections of the carotid arteries which are known to occur spontaneously we present the case of a stenosis of the superficial femoral artery that led to a dissection caused by the stenosis-jet. The dissection on the other hand caused an appositional thrombus which led to the embolic occlusion of the pedal-arteries. In case of peripheral embolisms in patients with or without history of peripheral arterial occlusion disease it is important to look for a causing arterial pathology preferably by duplex sonography.

Levovist, a new echo-enhancing agent, is proclaimed to give more information about blood flow and therefore might be supposed to show the true intravascular lumen. Thus, it has to be shown whether such an echo-enhancing agent influences the sonographic estimation of vascular stenosis. We investigated 32 patients with PAOD and a single stenosis in the iliacal or femoral arteries (mean age 54+/-13 years) using a color Doppler sonographic equipment with a 5.4 or 7.3 MHz linear transducer. Levovist was given in a concentration of 200 mg/ml i.v with a total dose of 4 g. We did two measurements before the application of Levovist. Peak systolic velocity ratio (PSVR) was 6.5+/-3.6 and 6.4+/-3.8 before and 6.3+/-4.2 after application of Levovist. Sonographic diameter reduction was 59+/-15 and 62+/-16% before, and 60+/-16% after application. Diameter reduction in angiography was 65+/-13%. Reduction of the cross section area was 81+/-14 and 83+/-15% before, and 83+/-16% after application. The use of the echo-enhancing agent Levovist does not influence the calculation of the peak systolic velocity ratio, diameter reduction or cross section area reduction. The degree of the stenosis calculated from the sonographic reduction in diameter tended to be smaller than in angiography either with or without Levovist., (Copyright 1998 Elsevier Science Ireland Ltd.)

Background: Recanalization of femoral artery occlusions is difficult and different forms of intra-arterial lysis or mechanical procedures have been described. We investigated the effectiveness of a prolonged intra-arterial lysis with rt-pa in combination with PGE1 followed by angioplasty., Patients and Methods: 43 patients (age 60.4 +/- 14.3 years) with peripheral arterial occlusions older than 3 months and longer than 10 cm were treated with intra-arterial rt-pa (3 mg in 3 h) followed by PGE1 (2.1 ml/h for 3 h, concentration: 20 micrograms/50 ml NaCl) in alternating order. Treatment times ranged from 1 to 7 days (2.9 +/- 1.6). Doses of 26.5 +/- 21.9 mg rt-PA and 20.4 +/- 16 micrograms PGE1 were used. If necessary, angioplasty was performed after a wire was passed through the lumen., Results: Recanalization was achieved in 47 out of 85 arterial segments with reocclusion in 9 segments. The arterial perfusion deteriorated once due to peripheral embolism. Other adverse effects included one case of retroperitoneal and one case of intracrural bleeding and one aneurysma spurium., Conclusion: In chronic arterial occlusions which do not respond to conventional angioplasty and/or short term fibrinolysis recanalization may be achieved in about 50% by means of prolonged alternating application of rt-pa and PGE1.

The arteries of the thigh of 126 male marathon runners at the age of 41.6 +/- 11.3 years were examined with B-Scan-ultrasound. 32 (62.1%) persons were found with arteriosclerotical plaques. All of them were older than 35 years, so the number of arteriosclerosis in this group increases to 36.4 percent (n = 88). 38 persons were younger than 35 years. Persons with plaques started training about 10.9 years later than those without plaques. Correlations of plaques and age, age of starting training, years of training and km/year were found. The numbers of riskfactors showed significant differences between both groups but the correlation of "having no risk factor" and arteriosclerotical plaques was higher than the correlations of nicotine, hypertension, hypercholesterolemia and plaques. It seems that marathon running itself is a risk factor of developing arteriosclerotical plaques in the femoral arteries particularly if the age of starting training is higher than 30 years.

With the help of high-resolution real-time sonography, we examined the carotid and femoral arteries in 3,500 asymptomatic persons to assess early states of atherosclerosis an to prove the utility of B-Scan-Sonography in this aim. We found 384 people having plaques, totally 769 pl. 68 p.c. of all plaques we were found in the femoral arteries, 32 p.c. in the carotid arteries, in each case with preference of the bifurcation and the pre-bifurcation-region. This seems to confirm earlier studies on this theme. As regards to the morphology, we found 67 p.c. (of all plaques) being faintly-echogenic ("fatty-streaks" or intermediär type). 73 p.c. of all plaques showed a smooth or faintly irregular surface-character. More than 75% of all plaques had a volume less than 0.3 ccm. Altogether, the results verify the assessment of mostly early states of atherosclerosis with the help of real-time-ultrasound and underline this method being a good and sufficient non-invasive-technique for screening-examinations on an asymptomatic collective.

In a epidemiological study 3840 clerks of state of North Rhein Westfalia were investigated concerning the frequency of atherosklerotic leasions of the carotid and femoral arteries in duplex scanning. 17% of all investigated showed independency to age, sex and risk factors alterations of the vessel walls. Men had twice as much plaques as women and male subjects with multiple risk factors had four times more plaques than those without.

The detection of atherosclerotic lesions in asymptomatic healthy subjects is possible using ultrasound. Populations can be investigated in order to detect differences in early and asymptomatic atherosclerosis due to gender and risk factors. This study investigated 2605 male (21–69 years) and 1601 female (20–70 years) employees and civil servants of the city of Düssel-dorf, Germany. The ultrasound investigations were performed with an ATL device, type Ultra-mark 4 plus, and a 7.5-MHz linear transducer on the carotid and proximal femoral arteries. An atherosclerotic lesion was defined as visibly different from the intima by its echogenicity and by being larger than 1 mm. A thickening of the intima media complex was not considered to be atherosclerosis. The prevalence of atherosclerotic lesions in male subjects was higher than those in female subjects regardless of age. In male subjects it was 5.3% (30–39 years), 19.8% (40–49 years), 36.7% (50–59 years) and 47.7% (60–70 years). The female subjects had a prevalence of 2.1%, 8.4%, 17.5% and 37.7% in the corresponding age groups. Risk factors such as smoking, hyper-tension and hypercholesterolemia were higher in men than in women. The increase of atheros-clerotic lesions from one decade to another was highest in women between 50 and 59 years and 60 and 70 years. This large increase could not be explained by a similar increase in risk factors. It was therefore concluded that male subjects had a higher prevalence of atherosclerosis at earlier ages than females, but female subjects showed a postmenopausal rise in prevalence. [ABSTRACT FROM AUTHOR]