Volume 2 Isssue 1

Research Article: Use of High-Pass and Low-Pass Electrocardiographic Filters in an International Cardiological Community and Possible Clinical Effects

Franco Parola and Javier Garcia-Niebla*

Background: High-pass and low-pass filters applied to 12-lead Electrocardiograms (ECG) are fundamental to avoid artifacts, but an inappropriate use may lead to misdiagnosis. Our goal is to evaluate cutoff points for these filters used as routine by cardiology professionals from different countries, and to determine to what extent they adjust to the established guidelines.
Methods: We designed a descriptive study where 12-lead ECGs were included, both from adults and teenagers, distributed between August 2016 and February 2017 within the Ibero-American Forum on Arrhythmias on the Internet (FIAI) through the instant messaging apps WhatsApp and Telegram.
Results: 48% of ECGs had at least one of the two filter cutoff points printed. The bandwidth recommended by different scientific societies (= 0.05 Hz and = 150 Hz) was present in 2%. The most frequent low frequency cutoff value was 0.5 Hz (47%) and the high frequency one was between 25 Hz and 40 Hz (74%). As to the last consensus guidelines, we registered that 32% of ECGs met the low frequency cutoff point and just 5% the high frequency cutoff point.
Conclusions: There is a high ratio of tracings lacking printed information on the filter used, and those that do have it, use inappropriate cutoff points in a high percentage, which may have significant diagnostic consequences.

Cite this Article: Parola F, Garcia-Niebla J. Use of High-Pass and Low-Pass Electrocardiographic Filters in an International Cardiological Community and Possible Clinical Effects. Adv J Vasc Med. 2017;2(1): 034-038.

Published: 01 December 2017

Research Article: Experiences with Large-Bore Catheters as Vascular Access for Extracorporeal Detoxification Methods

Rolf Bambauer, Daniel Burgard, Reinhard Latza and Ralf Schiel

After the introduction of large-bore catheters with the Seldinger technique into the vena cava superior via internal jugular veins in 1979, the advantages of this puncturing technique versus the puncture of the femoral and subclavian veins were observed. But complications and side effects of this puncturing technique were found, too. Besides the complications such as faulty puncture, bleeding, hematothorax, thrombosis and faults in catheter material the infections and septicaemia are the most severe.
Background: catheter-related infections, thrombosis and stenosis are among the most frequent complications associated with catheters which are inserted in vessels as vascular access. These complications are usually related to the handling of the staff, the catheter materials, and the surface properties of the catheter. To reduce such complications especially Catheter-Related Infections (CRI), catheters with surface treatments of the outer surface, such as ion beam assisted deposition were investigated in a retrospective study, to prove if the surface treatment of the catheters is sufficient to reduce the high infection rate.
Methods: The study from 1992 - 2007 evaluated silver coated and non-coated as a control implanted large-bore catheters for hemodialysis or apheresis methods. The catheters were inserted under sterile conditions into the internal jugular or subclavian veins. After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays. Pieces of these catheters were also examined using a Scanning Electron Microscope (SEM).
Results: The coated catheters with argent only on the outer surface showed a tendency towards longer in situ time. The microbiologic examinations of the catheter tips were in both catheter types high positive, but not significant.
Conclusion: The coated catheters with argent, only on the outer surface, showed no significant reduction in infection rate by evaluation of all collected data in this retrospective study. There was no association between the surface treated and the untreated catheters in significantly reducing patient discomfort. Other technologies which include the outer and inner surface are necessary. To reduce the tremendous high costs of the catheter-related infections new materials and new technologies must be developed, which should have a better biocompatibility. These requirements show perhaps the new material such as the microdomain structured inner and outer surface, as an example, are considered more biocompatible because they mimic the structure of natural biological surface.

Cite this Article: Bambauer R, Burgard D, Latza R, Schiel R. Experiences with Large-Bore Catheters as Vascular Access for Extracorporeal Detoxification Methods. Adv J Vasc Med. 2017;2(1): 026-034.

Published: 01 December 2017

Research Article: Associated with the Time of Exposure of Peripheral Intravenous Devices Risk of Developing Phlebitis: A Prospective Cohort Study at a Latin American University Hospital

Arenas Villamizar Angel Ricardo*, Velasquez Serna Diana Lorena and Leon Giraldo Hoover

Introduction: The Center for Disease Control CDC recommends the replacement of peripheral intravenous catheter (IV) every 72 up to 96 hours. Routine replacement is thought to reduce the risk of phlebitis and bacteremia; however multiple studies have not shown a significant difference of such practice.
Objective: To evaluate the risk of phlebitis in patients with catheters change every 72 hours Vs changes under indications of phlebitis and determine the factors that contribute to the development of phlebitis.
Methodology: A three-arm (n = 341) prospective cohorts study was proposed, in which patients to this study were randomized into three groups ,for the first group of patients the catheter was routinely taken off every 72 hours, in the second group the catheter was only removed in light of phlebitis signs. The third group kept the current regular conditions of routinely changes used in catheters and dressings.
Results: The study included a total of 261 patients that meet the inclusion criteria, from which 14% presented mechanical phlebitis (n = 28), 80% chemical phlebitis (n = 29). 67% of the cases of phlebitis appeared in the second arm of study (n = 24). Infective phlebitis was not documented in any of the three groups. The patients on whom the device was used for more than 72 hours have a 3 times higher probability to develop chemical phlebitis (RR = 2.92, CI: 1.35 - 6.33). The ratio catheter per patient was superior in the use of catheters made of teflon of 3.2 catheters per patient.
Conclusion: No cases of infectious phlebitis occurred in the study groups related this finding with adequate hand washing and strict supervision during the time of study techniques. The time of removal of catheters every 72 hours did not evidence a reduction of infectious phlebitis higher than expected by proper hand washing techniques.

Cite this Article: Angel Ricardo AV, Diana Lorena VS, Hoover LG. Associated with the Time of Exposure of Peripheral Intravenous Devices Risk of Developing Phlebitis: A Prospective Cohort Study at a Latin American University Hospital. Adv J Vasc Med. 2017;2(1): 020-025.

Published: 20 October 2017

Case Report: OCT Dilemma in Juxtaluminal Cavity: Ruptured Plaque versus Intraplaque Hemorrhage

Ioannis A. Stathopoulos*, Khady Fall and Akiko Maehara

We present the first reported finding, during optical coherence tomography evaluation of a right coronary artery, of a juxtaluminal cavity filled with signal poor tissue without attenuation. We discuss the possible explanations according to previous descriptions of OCT findings.

Cite this Article: Stathopoulos IA, Fall K, Maehara A. OCT Dilemma in Juxtaluminal Cavity: Ruptured Plaque versus Intraplaque Hemorrhage. SRL Vasc Med. 2017;2(1): 017-019.

Published: 21 March 2017

Research Article: In Hereditary Haemorrhagic Telangiectasia Pathological Nailfold Capillaroscopy is Associated with Pulmonary Arteriovenous Malformations

Roberto Zarrabeitia*, Elena Aurrecoechea, Concepcion Farinas-Alvarez, Ana Fontalba, Jesus Zarauza, Luisa Ojeda, Jose A. Parra

Introduction and Aim: Nailfold capillaroscopy is used to assess vascularization in pathologies involving distal blood vessels. This study aims at describing nailfold capillaroscopy findings in a large cohort of Spanish Hereditary Hemorrhagic Telangiectasia (HHT) (Rendu Osler Weber) patients to correlate these findings with the presence of organ involvement.
Materials and Methods: During the period January 1, 2002 December 31, 2013 nailfold capillaroscopy with a digital microscope (100x) was performed on 195 HHT patients. Internal organ involvement was confirmed using Computed Tomography (CT) and altered Contrast Echocardiography (CEC) for Pulmonary Arteriovenous Malformations (MAVp), cranial magnetic resonance angiography for brain arteriovenous malformations, abdominal CT angiography for liver involvement and upper and lower endoscopy including video capsule endoscopy for gastrointestinal involvement.
Results: 107 women and 88 men were studied. Pathological findings were observed in 53.8% of patients. In HHT1 and older (> 50 years) this percentage reached 81.3% and 64.3% respectively; there were no significant differences considering gender. The most frequent observed pattern was the presence of mega capillaries (80%). The association between internal organ involvement and pathological capillaroscopy result was significant only in Pulmonary Arteriovenous Malformations (MAVp). The sensitivity of pathological capillaroscopy to detect MAVp was 85.4%.
Conclusions: Pathological capillaroscopy findings (especially mega-capillaries) are common especially in HHT1 patients and in elderly HHT patients. The association between pulmonary vascular malformations and pathological capillaroscopy result is highly significant. This observation could help to intensify lung screening and endovascular treatment in HHT patients.

Cite this Article: Zarrabeitia R, Aurrecoechea E, Farinas-Alvarez C, Fontalba A, Zarauza J, et al. In Hereditary Haemorrhagic Telangiectasia Pathological Nailfold Capillaroscopy is Associated with Pulmonary Arteriovenous Malformations SRL Vasc Med. 2017;2(1): 006-016.

Published: 10 March 2017

Research Article: Can a Fast Track Referral System Improve the Effectiveness of a Graft Surveillance Programme?

Feras F. Abdallah*, Joanne Fuller, Ganesh Kuhan, John V. Smyth, Nicholas Chalmers and Ferdinand S. Inglott

Purpose: To assess the effectiveness of a fast track referral system from Vascular Laboratory to Interventional Radiology on threatened vein bypass grafts in the lower limbs.
Methods: A Fast Track System (FTS) was set up in February 2011 to minimise the delay from duplex scan to intervention for bypass grafts with identified significant stenoses. 111 scans were performed pre - FTS over one year and compared with 190 scans which were performed post-FTS introduction over two years.
Results: Significant stenoses were identified in 24 scans (22%) before FTS, of which, 6 (25%) had no intervention, 15 (62.5%) had interventions and 3 (12.5%) were occluded by the time of intervention. The median delays from duplex to referral to radiology and from duplex to intervention were 32 and 56 days respectively. After the introduction of FTS, 35 scans were noted to have significant stenoses. Only 23 (66%) of them had interventions. The median delays from duplex scan to referral to radiology and from duplex to intervention were 0 and 20 days respectively. There was one graft (3%) occlusion after the introduction of FTS by the time of the angiogram compared with 3 (12.5%) in the pre-FTS group (p = 0.35).
Conclusions: Approximately 20% of the scans performed over one year for infra-inguinal bypass are at risk of failure. The FTS has reduced the time - delay from Duplex scan to referral to radiology and the number of occluded grafts. Further improvement is needed to reduce the delay between the referral and intervention.
Keywords: Vein graft; Infra - inguinal bypass; Surveillance scan

Cite this Article: Abdallah FF, Fuller J, Kuhan G, Smyth JV, Chalmers N, et al. Can a Fast Track Referral System Improve the Effectiveness of a Graft Surveillance Programme? SRL Vasc Med. 2017;2(1): 006-009.

Published: 10 March 2017

Research Article: Characteristics of Arterial Wall Stiffness in Healthy Adolescents: Preliminary Mechanical Mapping of the Main Upper Body Arterial Branches

Roch L. Maurice*, Katherine YH. Chen, David Burgner, Michael Cheung, Laurence Vaujois, Anne-Monique Nuyt, Jean-Luc Bigras, and Nagib Dahdah

Background: Arterial stiffness is an independent predictor of cardiovascular disease. Independent of aging and other cardiovascular risk factors, arterial stiffness increases from the proximal to the distal arterial compartments. The overall aim of this work is to establish a longitudinal mechanical mapping of the arterial tree in healthy individuals.
Methods: We report preliminary data quantifying stiffness of the abdominal aorta (AAA), common carotid artery (CCA) and brachial artery (BA) in adolescents. In group-1 subjects (from Melbourne, Australia), cine-loops of the AAA and CCA B-mode data were digitally recorded, whereas in group-2 (from Montreal, Canada), cine-loops of the CCA and BA B-mode data were acquired at the same clinical evaluation. Arterial wall elastic moduli (EIBM) were estimated off-line using our proprietary non-invasive imaging-based biomarker algorithm (ImBioMark).
Results: Group-1 (n = 13) was 12.9 ± 2.5 years, with normal body habitus, blood pressure 117 ± 6 / 64 ± 4 mmHg and heart rate 71 ± 12 beats/min. Group-2 (n = 11) was 14.4 ± 1.2 years, also with normal body habitus, blood pressure 112 ± 10 / 64 ± 6 mmHg and heart rate 73 ± 10 beats / min. Arterial stiffness increased from proximal to distal compartments, with EIBM of 31 ± 6 kPa (AAA), 49 ± 16 kPa (CCA) and 130 ± 26 kPa (BA); p < 0.001.
Conclusion: This paper contrasts, for the first time, stiffness between AAA, CCA and BA in the same adolescents. Further investigations will include additional arterial beds (pulmonary, renal and femoral) and will increase sample size to allow age-stratification. The current preliminary findings indicate that longitudinal mechanical mapping of the arterial tree in healthy individuals is feasible.

Cite this Article: Maurice RL, Chen KYH, Burgner D, Cheung M, Vaujois L, et al. Characteristics of Arterial Wall Stiffness in Healthy Adolescents: Preliminary Mechanical Mapping of the Main Upper Body Arterial Branches. SRL Vasc Med. 2017;2(1): 001-005.

Published: 06 February 2017

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