Dr. Fukaya practices Vascular Medicine at the Stanford Vascular Clinics and Advanced Wound Care Center. She received her medical education in Tokyo and completed her medical training both in the US and Japan. She joined Stanford in 2015.
Vascular Medicine covers a wide range of vascular disorders including chronic venous insufficiency, varicose veins, deep vein thrombosis, post thrombotic syndrome, peripheral artery disease, carotid artery disease, cardiovascular risk evaluation, fibromuscular dysplasia, rare vascular disease, lymphedema, arterial/venous/diabetic ulcers, and wound care.
Dr. Fukaya has a special interest in venous disease and started the Stanford Vascular and Vein Clinic in 2016.
Board Certified in Vascular Medicine
Board Certified in Internal Medicine
Board Certified in Internal Medicine (Japan)
Board Certified in Plastic and Reconstructive Surgery (Japan)
- Vascular Medicine
- Venous Disease
- Varicose Veins
- Wound Healing
- Peripheral Artery Disease
- Deep Vein Thrombosis
- Fibromuscular Dysplasia
- Internal Medicine
Internship: Beth Israel Medical Center (2010) NY
MD, Tokyo Women's Medical University
PhD, Tokyo Women's Medical University
Fellowship, University of Pennsylvania, Vascular Medicine
Residency, Beth Israel Medical Center, Lankenau Medical Center, Internal Medicine
Residency, Tokyo Women's Medical University, Plastic and Reconstructive Surgery
Genetics of Peripheral Vascular Disease
Study on the genetic underpinnings of peripheral vascular disease. GWAS meta-analysis. Principal Investigator.
Bioimpedance in Venous Leg Ulcers
The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society Clinical Practice Guidelines for the Management of Varicose Veins of the Lower Extremities. Part II.
Journal of vascular surgery. Venous and lymphatic disorders
The Society for Vascular Surgery (SVS), the American Venous Forum (AVF), and the American Vein and Lymphatic Society (AVLS) recently published Part I of the 2022 clinical practice guidelines on varicose veins. Recommendations were based on the latest scientific evidence researched following an independent systematic review and meta-analysis of five critical issues affecting the management of patients with lower extremity varicose veins, using the PICO (patients, interventions, comparators, and outcome) system to answer critical questions. Part I discussed the role of duplex ultrasound scanning (DUS) in the evaluation of varicose veins and treatment of superficial truncal reflux. Part II focuses on evidence supporting the prevention and management of varicose vein patients with compression, on treatment with drugs and nutritional supplements, on evaluation and treatment of varicose tributaries, on superficial venous aneurysms, and on the management of complications of varicose veins and their treatment. All Guidelines were based on systematic reviews, and they were graded according to the level of evidence and the strength of recommendations, using the GRADE method. All ungraded Consensus Statements were supported by an extensive literature review and the unanimous agreement of an expert, multidisciplinary panel. Ungraded Good Practice Statements are recommendations that are supported only by indirect evidence. The topic, however, is usually non-controversial and agreed upon by most stakeholders. The Implementation Remarks contain technical information that supports the implementation of specific recommendations. This comprehensive document includes a list of all recommendations (Part I-II), ungraded consensus statements, implementation remarks, and best practice statements to aid practitioners with appropriate, up-to-date management of patients with lower extremity varicose veins.
View details for DOI 10.1016/j.jvsv.2023.08.011
View details for PubMedID 37652254
Cyanoacrylate Glue Reactions: A Systematic Review, Cases, and Proposed Mechanisms.
Journal of vascular surgery. Venous and lymphatic disorders
OBJECTIVE: Cyanoacrylate Glue Closure (CAC) was first used in humans ten years ago to treat venous reflux of the axial veins. Studies have since shown its clinical efficacy in vein closure. However, there is much need to elucidate further, the types of specific adverse reactions that cyanoacrylate glue can cause, and to perform patient selection better and minimize these events. In this study, we systematically reviewed the literature to identify the types of reported reactions. In addition, we explored the pathophysiology contributing to these and proposed the mechanistic pathway with a showcase of actual cases.METHODS: We searched the literature for reports of reactions following cyanoacrylate glue use in patients with venous diseases between 2012 and 2022. The search was performed using Medical Subject Headings (MeSH) terms. The terms included cyanoacrylate, venous insufficiency, chronic venous disorder, varicose veins, vein varicosities, venous ulcer, venous wound, CEAP, vein, adverse events, phlebitis, hypersensitivity, foreign body granuloma, giant cell, endovenous glue induced thrombosis (EGIT), and allergy. The search was limited to the literature published in English. These studies were evaluated for the type of product used, and the reactions noted. A systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, was performed. The COVIDENCE software was used for full-text screening and data extraction. Two reviewers reviewed the data, and the content expert served as the tiebreaker.RESULTS: One hundred and two records were identified, of which, thirty-seven records reported on cyanoacrylate use other than in the context of chronic venous diseases and were excluded. Fifty-five reports were determined appropriate for data extraction. The adverse reactions to cyanoacrylate glue were phlebitis, hypersensitivity, foreign body granuloma, and endovenous glue induced thrombosis (EGIT).CONCLUSIONS: Although cyanoacrylate glue closure for venous reflux is generally a safe and clinically effective treatment choice for symptomatic chronic venous disease patients with axial reflux, some adverse events may be specific to the properties of the cyanoacrylate product. We proposed mechanisms for how such reactions can occur based on histological changes, published reports, and case examples; however, further exploration is necessary to confirm these theories.
View details for DOI 10.1016/j.jvsv.2023.03.018
View details for PubMedID 37054883
- An Alternate Explanation. The New England journal of medicine 2023; 388 (14): 1318-1324
Characteristics of Venous Leg Ulcer Patients at a Tertiary Wound Care Center.
Journal of vascular surgery. Venous and lymphatic disorders
OBJECTIVE: The objective of this study was to assess patient, wound, care, and reflux characteristics of venous leg ulcers (VLUs) to update and improve knowledge on disease etiology, identify barriers to healing, and improve treatment.METHODS: Patients diagnosed with venous leg ulcers treated at the Stanford Advanced Wound Care Center between 2018 to 2019 were identified from the Healogics iHeal database. We identified 327 VLU entries, of which 133 were patients that had multiple or recurring wounds. An additional 27 patients were labeled as misdiagnosis, resulting in a final patient sample of 167. Patient demographics, wound, care, and ultrasound data for these patients was extracted from the Stanford electronic medical records regarding characteristics. The initial data analysis suggested possible differences in VLU characteristics depending on patient age and BMI, which was then further analyzed.RESULTS: Of the 167 VLU patients assessed, 53.9% were male, and 46.1% were female. The mean age was 74.7 years, and the average body mass index (BMI) was 30.2 kg/m2, including 41.1% of patients with a BMI over 30 kg/m2. About 50% of wounds were presented in multiples, had cellulitis, or were recurring, and 39.5% were caused by trauma. Most common venous reflux patterns on duplex ultrasound examination were below knee great saphenous vein (GSV) reflux and calf perforator reflux, which was identified in 37.7% and 29.3% of the patients, respectively. Axial GSV reflux was detected in 14.4% of patients. When looking at the patient sample under 60 years of age, 67.7% were male, 61.3% presented with venous skin changes, and 51.6% had diabetes. In the patients older than 60, only 51.9% were male, 37.6% presented with venous skin changes, and 31.6% had diabetes. BMI was greater in the patients under age 60, with an average of 39.2 kg/m2, compared to 28.2 kg/m2 in those above 60. Of the patients with a BMI ≥ 30 kg/m2, 64.3% had multiple wounds, 61.4% had recurring wounds, and 56.5% had venous skin changes. In contrast, in patients with BMI < 30 kg/m2, 47.4% had multiple wounds, 39.2% had recurring wounds, and 32.0% had venous skin changes.CONCLUSION: VLU pathology appears to differ depending on patient demographics and characteristics. Different drivers may influence disease cause, progression, and prognosis, making a standard approach to VLUs difficult. Our findings suggest that identifying different subtypes of VLUs and adapting an algorithm of care with a personalized treatment may help optimize management of these patients.
View details for DOI 10.1016/j.jvsv.2022.09.018
View details for PubMedID 36410701
The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society Clinical Practice Guidelines for the Management of Varicose Veins of the Lower Extremities.: Part I. Duplex Scanning and Treatment of Superficial Truncal Reflux.
Journal of vascular surgery. Venous and lymphatic disorders
The Society for Vascular Surgery (SVS), the American Venous Forum (AVF) and the American Vein and Lymphatic Society (AVLS) collaborated to update the 2011 SVS/AVF clinical practice guidelines and provide new evidence-based recommendations on critical issues affecting the care of patients with varicose veins. Each recommendation is based on a recent, independent systematic review and meta-analysis of the diagnostic tests and treatments options for patients with lower extremity varicose veins. Part I. of the guidelines includes evidence-based recommendations on the evaluation of CEAP (Clinical Class, Etiology, Anatomy, Pathology) Class 2 varicose vein patients with duplex scanning and other diagnostic tests, on open surgical treatment (ligation and stripping) versus endovenous ablation techniques, on thermal versus non-thermal ablations of the superficial truncal veins and on the management of incompetent perforating veins in CEAP Class 2 disease. We also made recommendations on the concomitant vs staged treatment of varicose tributaries using phlebectomy, liquid or foam sclerotherapy (with physician compounded foam or commercially prepared polidocanol endovenous microfoam) in patients who undergo ablation of incompetent superficial truncal veins.
View details for DOI 10.1016/j.jvsv.2022.09.004
View details for PubMedID 36326210
A Comparison of Below-Knee versus Above-Knee Endovenous Ablation of Varicose Veins.
Journal of vascular surgery. Venous and lymphatic disorders
OBJECTIVE: Varicose veins have a significant impact on quality of life and can commonly occur in the thigh and calves. However, there has been no large-scale investigation examining the relationship between anatomic distribution and outcomes after varicose vein treatment. This study sought to compare below-the-knee versus (BTK) and above-the-knee (ATK) varicose vein treatment outcomes.METHODS: Employing the Vascular Quality Initiative Varicose Vein Registry, 13,731 patients undergoing varicose vein ablation for either BTK or ATK lesions were identified. Outcomes were assessed using patient-reported outcomes (PROs) and the Venous Clinical Severity Score (VCSS). Continuous variables were compared using t-test and categorical variables were analyzed using chi2. Multivariable logistic regression was used to estimate the odds of improvement after intervention. The multivariable model controlled for age, gender, race, preoperative VCSS composite score, and history of DVT.RESULTS: Patients who received below-knee treatment had a lower preoperative VCSS composite (7.0±3.3 vs. 7.7±3.3; P<0.001) and lower PROs composite scores (11.1±6.4 vs. 13.0±6.6; P<0.001) compared to those of patients receiving above-knee treatment. However, on follow-up, patients receiving below-knee intervention had a higher postoperative VCSS composite score (4.4±3.3 vs. 3.9±3.5; P<0.001) and PROs composite score (6.1±4.4 vs. 5.8±4.5; P=0.007), the latter approaching statistical significance. Patients receiving above-knee interventions also demonstrated more improvement in both composite VCSS (3.8±4.0 vs. 2.9±3.7; P<0.001) and PROs (7.1±6.8 vs. 4.8±6.6; P<0.001). Multivariable logistic regression analysis similarly revealed that patients receiving above-knee treatment had significantly higher odds of improvement in VCSS composite in both the unadjusted (odds ratio [OR] = 1.45; 95% confidence interval [CI] = [1.28-1.65]; P<0.001 and adjusted (OR = 1.31; 95% CI = [1.14-1.50]; P<0.001) models. Patients receiving above-knee treatment also had a significantly higher odds of reporting improvement in PROs composite in both the unadjusted (OR = 1.85; 95% CI = [1.64-2.11]; P<0.001] and adjusted (OR = 1.65; 95% CI = [1.45-1.88]; P<0.001) models.CONCLUSIONS: Treatment region has a significant association with patient-reported outcomes and VCSS composite scores after varicose vein interventions. Preoperatively, there were significant differences in the composite scores of VCSS and PROs with patients receiving BTK treatment exhibiting less severe symptoms. Yet, the association appeared to reverse postoperatively with those receiving BTK treatments exhibiting worse PROs, worse VCSS composites scores, and less improvement in VCSS composite scores. Therefore, BTK interventions pose a unique challenge compared with ATK interventions in ensuring commensurate clinical improvement after treatment.
View details for DOI 10.1016/j.jvsv.2023.08.018
View details for PubMedID 37708939
The Variations and Inconsistencies in Venous Ablation Coverage Policies between Single State and Multistate Carriers in the United States.
Journal of vascular surgery. Venous and lymphatic disorders
Vein ablation is a common and effective treatment for patients with chronic venous insufficiency. The overuse of vein ablations despite the existence of evidence-based guidelines has driven insurance companies to develop restrictive policies for coverage that create barriers to appropriate care. This study compares the insurance coverage by single-state carriers (SSC) to multistate carriers (MSC), highlighting the variations and inconsistencies of the various policies.The American Venous Forum policy navigator was reviewed for the various policies available in the United States. The policies were divided into SSC and MSC. The characteristics of the policies, including anatomic and hemodynamic criteria for specific veins, duration of conservative treatment, disease severity, symptoms, and types of procedures covered, were compared between the two groups. SAS 9.4 was used for statistical analysis.A total of 122 policies were analyzed and divided between SSC (n = 85, 69.7%) and MSC (n = 37, 30.3%). There was a significant variation in the size requirement for great saphenous vein ablation. While 48% of the policies did not specify a size criterion, the remaining policies indicated a minimal size ranging between 3-5.5mm. However, there was no significant difference between SSC and MSC. Similar findings were encountered with the small and anterior accessory saphenous veins. MSC were more likely to define saphenous reflux time > 500ms compared to SSC (81.1% vs. 58.8%, P=0.04). Interestingly, there was a significant difference between SSC and MSC in the criteria for perforator ablation in terms of size and reflux time. MSC were significantly more likely to provide coverage for mechanochemical ablation than SSC (24.3% vs. 8.2%, P=0.03). SSC were more likely to require ≥12 weeks of compression stockings therapy than MSC (76.5% vs. 48.7%, p = 0.01). There were no significant differences in the clinical indications between the two groups, but MSC were more likely to mention major hemorrhage compared to SSC.This study highlights the variations in policies for venous ablation and striking inconsistencies in size criteria particularly. MSC were more likely to cover mechanochemical ablation and require a shorter duration of conservative therapy prior to intervention compared to SSC. Evidence-based guidance is needed to develop more coherent policies for venous ablation coverage.
View details for DOI 10.1016/j.jvsv.2023.07.012
View details for PubMedID 37703944
A Systematic Review on Ablation Techniques for Larger Saphenous Veins in Patients with Symptomatic Superficial Venous Disease.
Journal of vascular surgery. Venous and lymphatic disorders
To summarize the existing evidence for the treatment of saphenous veins >10 mm in diameter, determine whether there were vein size limits for treatment modalities and if there are specific technical considerations for treatment of large veins.We searched the literature for reports of treatment methods and outcomes for patients with large-diameter saphenous veins treated with various ablation methods between 1993 and 2023. These studies were evaluated for the size of the vein determined as "large diameter," type of ablation method, study type, outcomes, adverse events, and any technical considerations noted. A systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The COVIDENCE software was used for full-text screening and data extraction. Three reviewers reviewed the data, and the content expert served as the tiebreaker.Seventy-one records were identified, of which, twenty-four studies were deemed appropriate for extraction. Most of the studies identified reported outcomes of endovenous thermal ablation (EVTA) modalities. There were fewer studies on non-thermal non-tumescent techniques (NTNT) and these studies reported an overall lower occlusion rate compared to EVTA techniques.Large head-to-head trials or randomized controlled that compare all the modalities over a long follow-up duration are yet to be performed. In the existing literature, there is considerable heterogeneity in terms of the study size, design, definition of large veins, site of vein measurement and follow-up periods making it challenging to make fair comparisons and draw firm conclusions. Currently available evidence supports the use of endothermal ablation techniques for the treatment of veins > 10 mm in diameter as they have a more favorable efficacy and safety profile and have a larger body of evidence available compared to NTNT techniques or surgery.
View details for DOI 10.1016/j.jvsv.2023.08.020
View details for PubMedID 37703943
- SVM Communications: Venous Taskforce update and Society announcements. Vascular medicine (London, England) 2023: 1358863X231195630
- Varicose Veins: Approach, Assessment, and Management to the Patient with Chronic Venous Disease. The Medical clinics of North America 2023; 107 (5): 895-909
A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study.
JMIR formative research
2023; 7: e43258
Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth.This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients.Patients and part-time or per-diem, wound care-certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys.This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care-specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2).This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients' technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care.
View details for DOI 10.2196/43258
View details for PubMedID 37610798
The potential of chatbots in chronic venous disease patient management.
Health care providers and recipients have been using artificial intelligence and its subfields, such as natural language processing and machine learning technologies, in the form of search engines to obtain medical information for some time now. Although a search engine returns a ranked list of webpages in response to a query and allows the user to obtain information from those links directly, ChatGPT has elevated the interface between humans with artificial intelligence by attempting to provide relevant information in a human-like textual conversation. This technology is being adopted rapidly and has enormous potential to impact various aspects of health care, including patient education, research, scientific writing, pre-visit/post-visit queries, documentation assistance, and more. The objective of this study is to assess whether chatbots could assist with answering patient questions and electronic health record inbox management.We devised two questionnaires: (1) administrative and non-complex medical questions (based on actual inbox questions); and (2) complex medical questions on the topic of chronic venous disease. We graded the performance of publicly available chatbots regarding their potential to assist with electronic health record inbox management. The study was graded by an internist and a vascular medicine specialist independently.On administrative and non-complex medical questions, ChatGPT 4.0 performed better than ChatGPT 3.5. ChatGPT 4.0 received a grade of 1 on all the questions: 20 of 20 (100%). ChatGPT 3.5 received a grade of 1 on 14 of 20 questions (70%), grade 2 on 4 of 16 questions (20%), grade 3 on 0 questions (0%), and grade 4 on 2/20 questions (10%). On complex medical questions, ChatGPT 4.0 performed the best. ChatGPT 4.0 received a grade of 1 on 15 of 20 questions (75%), grade 2 on 2 of 20 questions (10%), grade 3 on 2 of 20 questions (10%), and grade 4 on 1 of 20 questions (5%). ChatGPT 3.5 received a grade of 1 on 9 of 20 questions (45%), grade 2 on 4 of 20 questions (20%), grade 3 on 4 of 20 questions (20%), and grade 4 on 3 of 20 questions (15%). Clinical Camel received a grade of 1 on 0 of 20 questions (0%), grade 2 on 5 of 20 questions (25%), grade 3 on 5 of 20 questions (25%), and grade 4 on 10 of 20 questions (50%).Based on our interactions with ChatGPT regarding the topic of chronic venous disease, it is plausible that in the future, this technology may be used to assist with electronic health record inbox management and offload medical staff. However, for this technology to receive regulatory approval to be used for that purpose, it will require extensive supervised training by subject experts, have guardrails to prevent "hallucinations" and maintain confidentiality, and prove that it can perform at a level comparable to (if not better than) humans. (JVS-Vascular Insights 2023;1:100019.).
View details for DOI 10.1016/j.jvsvi.2023.100019
View details for PubMedID 37701430
View details for PubMedCentralID PMC10497234
- Images in Vascular Medicine: Vascular complications in a young patient with vascular Ehlers-Danlos syndrome. Vascular medicine (London, England) 2023: 1358863X231170652
- Sticking to the same thromboprophylaxis for surgical sickle cell disease patients. Journal of vascular surgery. Venous and lymphatic disorders 2023; 11 (3): 553-554
VIEW-VLU Observational Study of the Effect of Varithena on Wound Healing in the Treatment of Venous Leg Ulcers.
Journal of vascular surgery. Venous and lymphatic disorders
Chronic venous hypertension, triggered by venous reflux and/or obstruction, leads to skin changes and venous leg ulcers. Compression therapy is standard of care, but many wounds remain unhealed. The objectives of this study were to observe the effects of endovenous chemical ablation with commercially available 1% polidocanol injectable microfoam on venous leg ulcer healing and recurrence rates.The VIEW VLU study was a multicenter, open-label, Phase 4 registry of patients with active venous leg ulcers resulting from venous insufficiency of the great saphenous vein and/or anterior accessory saphenous vein systems who underwent ablation with 1% polidocanol microfoam. Primary outcomes included wound healing rate (change in wound perimeter), wound closure at 12 weeks post-treatment, and time to wound closure. Secondary outcomes included venous leg ulcer recurrence, numeric pain score at the ulcer location, EuroQol five-dimension five-level questionnaire quality-of-life index, and the Venous Clinical Severity Score. Patients were followed for 12 months.76 patients (80 ulcers) from 14 sites across the USA and Canada were enrolled (mean age 63.6±13.7 years, 39.5% female sex, mean body mass index 36.3). 96.3% presented with great saphenous vein incompetence. Mean baseline wound perimeter was 117.2±107.4 mm and 26.3% (21/80) of wounds were circumferential. Mean ulcer age was 34.8 ± 51.8 weeks at first presentation and mean compression therapy duration was 26.4±35.9 weeks. Median wound perimeter decreased 16.3% from baseline in the first two weeks post-procedure, and 27% at 12 weeks. By 12 weeks, 53.8% (43/80) of wounds were healed. Median time to ulcer closure by Kaplan Meier analysis was 89 days (95%CI 62.0, 117.0). In Kaplan-Meier analysis of initially healed wounds, 88.9% (95%CI; 76.9, 94.8) remained closed 12 weeks post-closure. Mean numeric pain scores (ulcer site) improved by 41.0% and 64.1% at 12 weeks and 12 months post-procedure, respectively. The health-related quality-of-life index (scale of 0-1) improved from 0.65±0.27 at baseline to 0.72±0.28 at 12 weeks and 0.73±0.30 at 12 months. By 12 weeks post-treatment, the mean target leg Venous Clinical Severity Score had significantly decreased by 5.8 points, and by 12 months had decreased by 10.0 points.Treatment with 1% polidocanol microfoam was associated with promising wound healing rates and low recurrence rates for venous leg ulcers, despite a challenging patient population with recalcitrant ulcers, a large percentage of which were circumferential, in patients with high body mass indexes.
View details for DOI 10.1016/j.jvsv.2023.01.011
View details for PubMedID 36972751
- Developing ways to compare and contrast for deep venous interventions. Journal of vascular surgery. Venous and lymphatic disorders 2023; 11 (2): 432
Complications of vascular Ehlers-Danlos syndrome
SAGE PUBLICATIONS LTD. 2022: NP3
View details for Web of Science ID 000923957000022
Increasing access, quality, and convenience of care through a specialty-matched telenursing platform for vascular and wound patients - a pilot study
SAGE PUBLICATIONS LTD. 2022: 656
View details for Web of Science ID 000923957000099
Rare adverse event following cyanoacrylate closure of greater saphenous vein
SAGE PUBLICATIONS LTD. 2022: NP7-NP8
View details for Web of Science ID 000923957000029
Approach to venous leg ulcers- should we determine subtypes?
SAGE PUBLICATIONS LTD. 2022: 649
View details for Web of Science ID 000923957000088
Guideline medication adherence patterns and physical activity in people with peripheral artery disease: a multiethnic study of atherosclerosis study
SAGE PUBLICATIONS LTD. 2022: 647-648
View details for Web of Science ID 000923957000085
- Vascular Disease Patient Information Page: Venous leg ulcers. Vascular medicine (London, England) 2022: 1358863X221118120
Varicose Veins and Chronic Venous Disease.
2021; 39 (4): 567-581
Chronic venous disease is a worldwide problem associated with significant morbidity and is expected to increase in prevalence as the current population ages. This is a comprehensive review of the anatomy, pathophysiology, genomics, clinical classification, and treatment modalities of chronic venous disease.
View details for DOI 10.1016/j.ccl.2021.06.009
View details for PubMedID 34686268
Epidemiology and Genetics of Venous Thromboembolism and Chronic Venous Disease.
2021; 128 (12): 1988-2002
Venous disease is a term that broadly covers both venous thromboembolic disease and chronic venous disease. The basic pathophysiology of venous thromboembolism and chronic venous disease differ as venous thromboembolism results from an imbalance of hemostasis and thrombosis while chronic venous disease occurs in the setting of tissue damage because of prolonged venous hypertension. Both diseases are common and account for significant mortality and morbidity, respectively, and collectively make up a large health care burden. Despite both diseases having well-characterized environmental components, it has been known for decades that family history is an important risk factor, implicating a genetic element to a patient's risk. Our understanding of the pathogenesis of these diseases has greatly benefited from an expansion of population genetic studies from pioneering familial studies to large genome-wide association studies; we now have multiple risk loci for each venous disease. In this review, we will highlight the current state of knowledge on the epidemiology and genetics of venous thromboembolism and chronic venous disease and directions for future research.
View details for DOI 10.1161/CIRCRESAHA.121.318322
View details for PubMedID 34110897
- US National Trends in Vascular Surgical Practice During the COVID-19 Pandemic. JAMA surgery 2021
Incentivizing physical activity through activity monitoring interventions in PAD - a pilot study.
VASA. Zeitschrift fur Gefasskrankheiten
Background: There is ample evidence to show that supervised exercise is efficacious and cost effective for improving claudication symptoms in patients with peripheral artery disease (PAD). Home based exercise therapy can be an effective alternative to supervised exercise however, the results of this is variable depending on the level of motivation and engagement of the patient. Patients and methods: We performed a pilot study in 41 patients to determine whether a home based exercise program with the use of an activity tracking device with personalized feedback and financial incentives can increase daily activity, improve walking and sustain engagement in the exercise regimen in patients with PAD. In this randomized pilot study, the patients in the study group were fitted with an activity monitoring device and given behavioral monitoring, motivational updates and feedback regarding their exercise program. This study group was further divided in to two groups. One half of these patients in the study group were also given financial incentives if they reached their set targets. The control group wore the device with no feedback or ability to see their number of steps walked. Results: Results showed that at the end of the 12 week period, patients in the study groups walked more compared to the controls and the financial incentive structure resulted in an additional 38-63% increase in average daily steps. Conclusions: This pilot study revealed that a home-based exercise program with activity monitoring, feedback and financial incentives resulted increased daily steps, 6-minute walking distance and overall compliance with the program in PAD patients with claudication.
View details for DOI 10.1024/0301-1526/a000924
View details for PubMedID 33150850
Identifying dietary and nutritional risk factors for symptomatic peripheral arterial disease using the UK biobank cohort study
SAGE PUBLICATIONS LTD. 2020: NP5
View details for Web of Science ID 000542416200027
- The impact of low-dose anticoagulation therapy on peripheral artery disease: insights from the VOYAGER trial. Cardiovascular research 2020; 116 (12): e156–e158
Er:YAG Laser versus Sharp Debridement in Management of Chronic Wounds: Effects on Pain and Bacterial Load.
Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society
Chronic wounds affect roughly 6.5 million patients in the United States annually. Current standard of therapy entails weekly sharp debridement. However, the sharp technique is associated with significant pain, while having minimal impact on the bioburden. Our study proposes the Er:YAG laser as an alternative method of debridement that may decrease procedural pain, reduce bioburden, and potentially improve overall healing. This pilot study was performed as a prospective, randomized, controlled, crossover clinical trial, containing two groups: 1) one group underwent single laser debridement session first, followed by single sharp debridement session one week later; 2) the other group underwent single sharp debridement session first, followed by single laser debridement session one week later. Variables analyzed included pain during debridement, pre- and post-debridement wound sizes, pre- and post-debridement bacterial loads and patient preference. Twenty-two patients were enrolled (12 patients in Group 1, plus 10 patients in Group 2). The mean pain score for patients undergoing laser debridement was 3.0 ±1.7 versus 4.8 ±2.6 for those undergoing sharp debridement (p=0.003). The mean percent change in wound size one-week post-laser debridement was -20.8% ±80.1%, as compared with -36.7% ±54.3% one-week post-sharp debridement (p=0.6). The percentage of patients who had a bacterial load in the Low/Negative category increased from 27.3% to 59.1% immediately after laser debridement (p=0.04), versus 54.5% to 68.2% immediately after sharp debridement (p=0.38). Moreover, there was a sustained decrease in bacterial load one-week post-laser debridement, as compared with no sustained decrease one-week post-sharp debridement (p <0.02). Overall, 52.9% of patients preferred laser debridement versus 35.3% for sharp debridement. We believe that Er:YAG laser serves as a promising technology in chronic wounds, functioning as a potentially superior alternative to sharp debridement, the current standard of therapy. This article is protected by copyright. All rights reserved.
View details for DOI 10.1111/wrr.12764
View details for PubMedID 31587431
Clinical and Genetic Determinants of Varicose Veins.
2018; 138 (25): 2869–80
BACKGROUND: Varicose veins are a common problem with no approved medical therapies. Although it is believed that varicose vein pathogenesis is multifactorial, there is limited understanding of the genetic and environmental factors that contribute to their formation. Large-scale studies of risk factors for varicose veins may highlight important aspects of pathophysiology and identify groups at increased risk for disease.METHODS: We applied machine learning to agnostically search for risk factors of varicose veins in 493519 individuals in the UK Biobank. Predictors were further studied with univariable and multivariable Cox regression analyses (2441 incident events). A genome-wide association study of varicose veins was also performed among 337536 unrelated individuals (9577 cases) of white British descent, followed by expression quantitative loci and pathway analyses. Because height emerged as a new candidate risk factor, we performed mendelian randomization analyses to assess a potential causal role for height in varicose vein development.RESULTS: Machine learning confirmed several known (age, sex, obesity, pregnancy, history of deep vein thrombosis) and identified several new risk factors for varicose vein disease, including height. After adjustment for traditional risk factors in Cox regression, greater height remained independently associated with varicose veins (hazard ratio for upper versus lower quartile, 1.74; 95% CI, 1.51-2.01; P<0.0001). A genome-wide association study identified 30 new genome-wide significant loci, identifying pathways involved in vascular development and skeletal/limb biology. Mendelian randomization analysis provided evidence that increased height is causally related to varicose veins (inverse-variance weighted: odds ratio, 1.26; P=2.07*10-16).CONCLUSIONS: Using data from nearly a half-million individuals, we present a comprehensive genetic and epidemiological study of varicose veins. We identified novel clinical and genetic risk factors that provide pathophysiological insights and could help future improvements of treatment of varicose vein disease.
View details for PubMedID 30566020
- Clinical and Genetic Determinants of Varicose Veins Prospective, Community-Based Study of approximate to 500 000 Individuals CIRCULATION 2018; 138 (25): 2869–80
- Disparities as Predictors of Non-Healing in Lower Extremity Wounds ELSEVIER SCIENCE INC. 2018: E248
Bioimpedance and New-Onset Heart Failure: A Longitudinal Study of >500 000 Individuals From the General Population
JOURNAL OF THE AMERICAN HEART ASSOCIATION
2018; 7 (13)
Heart failure constitutes a high burden on patients and society, but although lifetime risk is high, it is difficult to predict without costly or invasive testing. We aimed to establish new risk factors of heart failure, which potentially could enable early diagnosis and preemptive treatment.We applied machine learning in the UK Biobank in an agnostic search of risk factors for heart failure in 500 451 individuals, excluding individuals with prior heart failure. Novel factors were then subjected to several in-depth analyses, including multivariable Cox models of incident heart failure, and assessment of discrimination and calibration. Machine learning confirmed many known and putative risk factors for heart failure and identified several novel candidates. Mean reticulocyte volume appeared as one novel factor and leg bioimpedance another, the latter appearing as the most important new marker. Leg bioimpedance was lower in those who developed heart failure during an up to 9.8-year follow-up. When adjusting for known heart failure risk factors, leg bioimpedance was inversely related to heart failure (hazard ratio [95% confidence interval], 0.60 [0.48-0.73] and 0.75 [0.59-0.94], in age- and sex-adjusted and fully adjusted models, respectively, comparing the upper versus lower quartile). A model including leg bioimpedance, age, sex, and self-reported history of myocardial infarction showed good discrimination for future heart failure hospitalization (Concordance index [C-index]=0.82) and good calibration.Leg bioimpedance is inversely associated with heart failure incidence in the general population. A simple model of exclusively noninvasive measures, combining leg bioimpedance with history of myocardial infarction, age, and sex provides accurate predictive capacity.
View details for PubMedID 29959136
Clinical and genetic determinants of varicose veins: a prospective, community-based prospective study of similar to 500,000 individuals
SAGE PUBLICATIONS LTD. 2018: 300
View details for Web of Science ID 000433926000017
Incentivizing physical activity through activity monitoring interventions in PAD - a pilot study
SAGE PUBLICATIONS LTD. 2018: 313
View details for Web of Science ID 000433926000035
Impact of Pocket Ultrasound Use by Internal Medicine Housestaff in the Diagnosis of Dyspnea
JOURNAL OF HOSPITAL MEDICINE
2014; 9 (9): 594-597
Recent reports demonstrate high diagnostic accuracy of lung ultrasound for evaluation of dyspnea. We assessed the feasibility of training internal medicine residents in lung ultrasound with a pocket ultrasound device.We performed a prospective, observational trial of residents performing lung ultrasound with a pocket ultrasound. Training consisted of two 90-minute sessions of didactics and supervised bedside performance. Two residents received an additional 2 weeks of training. Residents recorded a clinical diagnosis based on admission data. Following lung ultrasound performance, an ultrasound diagnosis was recorded integrating clinical and sonographic findings. Using receiver operating curve analysis, the area under the curve was calculated for both clinical diagnosis and ultrasound diagnosis using attending physician's final discharge diagnosis as the gold standard.Five residents performed 69 exams. The AUC for ultrasound diagnosis was significantly higher than that for clinical diagnosis (0.87 vs 0.81, P < 0.01). AUCs increased using lung ultrasound for diagnoses as follows: chronic obstructive pulmonary disease (0.73-0.85, P = 0.06), acute pulmonary edema (0.85-0.89, P = 0.49), pneumonia (0.77-0.88, P = 0.01), and pleural effusions (0.76-0.96, P < 0.002).Lung ultrasound performed by residents with a pocket ultrasound improved the diagnostic accuracy of dyspnea. Two residents undergoing extended training showed a total increase in diagnostic accuracy.
View details for DOI 10.1002/jhm.2219
View details for Web of Science ID 000342679100008
View details for PubMedID 24891227
Peripheral arterial disease, prevalence and cumulative risk factor profile analysis
EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY
2014; 21 (6): 704-711
The primary aim of the present study was to determine the cumulative effect of a set of peripheral artery disease (PAD) risk factors among age, gender and race/ethnicity groups in the United States.We examined data from a nationally representative sample of the US population (National Health and Nutrition Examination Survey [NHANES], 1999-2004). A total of 7058 subjects 40 years or older that completed the interview, medical examination and had ankle-brachial index (ABI) measurements were included in this study.The age- and sex-standardized prevalence of PAD was 4.6 % (standard error [SE] 0.3%).The highest prevalence of PAD was observed among elderly, non-Hispanic Blacks and women. In a multivariable age-, gender- and race/ethnicity-adjusted model hypertension, diabetes, chronic kidney disease, and smoking were retained as PAD risk factors (p ≤ 0.05 for each). The odds of PAD increased with each additional risk factor present from a non-significant 1.5-fold increase (O.R 1.5, 95% confidence interval [CI] 0.9-2.6) in the presence of one risk factor, to more than ten-fold (OR 10.2, 95% CI 6.4-16.3) in the presence of three or more risk factors. In stratified analysis, non-Hispanic Blacks (OR 14.7, 95% CI 2.1-104.1) and women (OR 18.6, 95% CI 7.1-48.7) were particularly sensitive to this cumulative effect.In a large nationally representative sample, an aggregate set of risk factors that included diabetes mellitus, chronic kidney disease, hypertension and smoking significantly increase the likelihood of prevalent PAD. A cumulative risk factor analysis highlights important susceptibility differences among different population groups and provides additional evidence to redefine screening strategies in PAD.
View details for DOI 10.1177/2047487312452968
View details for Web of Science ID 000337565600004
View details for PubMedID 22739687
View details for PubMedCentralID PMC4436703
- Endothelial progenitor cell mobilization following acute wound injury WOUND REPAIR AND REGENERATION 2013; 21 (6): 907-908
Approach to diagnosing lower extremity ulcers
2013; 26 (3): 181-186
Chronic leg ulcers (as differentiated from wound of the foot) are most often due to venous disease, arterial insufficiency (peripheral arterial disease), or a combination of both. Treatment modalities vary depending on the etiology of the ulcer, so it is important to make an appropriate diagnosis of the wound. Like for most medical illnesses, the determination of the etiology of these wounds is based on history, physical examination, and testing.
View details for DOI 10.1111/dth.12054
View details for Web of Science ID 000320034800001
View details for PubMedID 23742278
- Images in vascular medicine. Spontaneous celiac artery dissection. Vascular medicine 2013; 18 (1): 47-48
Heparin-induced thrombocytopenia: analysis of risk factors in medical inpatients
BRITISH JOURNAL OF HAEMATOLOGY
2011; 154 (3): 373-377
Heparin-induced thrombocytopenia (HIT) is an unpredictable reaction to heparin characterized by thrombocytopenia and increased risk of life-threatening venous and/or arterial thrombosis. Data are lacking regarding additional risk factors that may be associated with the development of HIT. This study aimed to identify the risk factors that may be associated with HIT in medical inpatients receiving heparin. Twenty five thousand six hundred and fifty-three patients admitted to the medicine service who received heparin product were reviewed retrospectively. The diagnosis of HIT was confirmed if the platelet count dropped >50% from baseline and there was a positive laboratory HIT assay. Fifty-five cases of in-hospital HIT were observed. Multivariate analysis identified the administration of full anticoagulation dose with unfractionated heparin or exposure to heparin products for more than 5 d with an increased risk of HIT. Moreover, patients who were on haemodialysis, carried a diagnosis of autoimmune disease, gout or heart failure were also at increased risk. The results suggest that when using heparin products in these patient cohorts, increased surveillance for HIT is necessary.
View details for DOI 10.1111/j.1365-2141.2011.08746.x
View details for Web of Science ID 000292648000011
View details for PubMedID 21615718
Imaging of the superficial inferior epigastric vascular anatomy and preoperative planning for the SIEA flap using MDCTA
JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY
2011; 64 (1): 63-68
The superficial inferior epigastric artery (SIEA) flap consists of skin and subcutaneous fat with limited donor-site morbidity and has the potential to be very versatile - either as a thin flap without excessive fat tissue or as a voluminous flap for breast reconstruction. However, anatomical inter-individual variability often makes the choice of a free SIEA flap difficult. Imaging of small-calibre vessels is possible with the multi-detector-row computed tomography angiography (MDCTA) and to obtain the characteristics of the superficial inferior epigastric vascular anatomy, we investigated the superficial inferior epigastric system using MDCTA.We investigated 17 patients who had abdominal wall MDCTA in preparation for a free flap procedure using either the deep inferior epigastric perforator (DIEP), SIEA or the groin flap. The visibility and anatomical characteristics including the branching pattern, the diameter, course of travel and layers were noted.The SIEA was visible in 64.7% and, of these, 36.4% had a common trunk formation with the superficial circumflex iliac artery (SCIA), while 63.6% arose independently. The measured diameters were SIEA 1.6 ± 0.4mm, SCIA 1.4 ± 0.4mm, deep circumflex iliac artery (DCIA) 2.4 ± 0.4mm, DIEA 2.9 ± 0.4mm and superficial inferior epigastric vein (SIEV) 3.1 ± 0.5mm. The SIEA consistently coursed lateral to and deeper than the SIEV and also lateral to the DIEA.MDCTA provided detailed three-dimensional information of the superficial inferior epigastric vascular system including the course and size of the SIEA. The information on vascular anatomy obtained with the MDCTA is valuable in the preoperative planning of the free SIEA flap and should be performed routinely.
View details for DOI 10.1016/j.bjps.2010.03.012
View details for Web of Science ID 000285408300020
View details for PubMedID 20392682
Granular cell tumor of the suprasternal space
JOURNAL OF DERMATOLOGY
2010; 37 (10): 900-903
A case of granular cell tumor (GCT) was reported. We encountered a 33-year-old woman with a painless, elastic, hard mass in the soft tissue of the suprasternal space. The tumor was excised with several millimeters margin of normal tissue above the deep cervical fascia and the wound was closed primarily. Histological examination on hematoxylin-eosin stain showed a tumor growth in the mid- to deep dermis and eosinophilic small granules that were consistent with granular cell tumors. Immunohistochemical studies showed positive staining for S-100 protein. We experienced a case of a granular cell tumor occurring in the suprasternal space and report the importance of including it in the differential diagnosis of subcutaneous soft tissue tumors.
View details for DOI 10.1111/j.1346-8138.2010.00907.x
View details for Web of Science ID 000282177500007
View details for PubMedID 20860741
Magnetic resonance angiography to evaluate septocutaneous perforators in free fibula flap transfer
JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY
2010; 63 (7): 1099-1104
In harvesting free fibula composite flaps, preoperative knowledge of the lower limb vascular anatomy is essential to prevent ischaemic complications or flap failure. Magnetic resonance angiography (MRA) allows imaging of the septocutaneous perforators (< or = 1-2mm diameter) of the peroneal artery used in the free fibula flap.We investigated seven patients undergoing the free fibula flap preoperatively with high-resolution MRA images to study the following: 1) tibio-peroneal anatomy, 2) peripheral artery disease, 3) the positions of the perforator vessels on the peroneal artery and their course in the posterolateral intermuscular septum and 4) the cutaneous distribution of the perforators, and to compare them to surgical findings.MRA demonstrated tibio-peroneal anatomy in sufficient detail to exclude anatomic variants and significant peripheral vascular disease, detected septocutaneous perforators arising from the peroneal artery coursing in the posterolateral intermuscular septum and determined the skin terminus of the septocutaneous perforators. All septocutaneous perforators found during surgery were detected prospectively on high-resolution MRA.Lower leg vascular anatomy assessment with high-resolution MRA determined the location of the septocutaneous perforators of the peroneal artery preoperatively with accuracy and precision. This anatomical knowledge provides for a safer procedure and the opportunity to plan surgical details preoperatively.
View details for DOI 10.1016/j.bjps.2009.06.002
View details for Web of Science ID 000278656200005
View details for PubMedID 19577973
Monitoring Partial and Full Venous Outflow Compromise in a Rabbit Skin Flap Model
PLASTIC AND RECONSTRUCTIVE SURGERY
2009; 124 (3): 796-803
Free flap failure often results from venous thrombosis. The authors developed a rabbit flap model of partial venous obstruction and evaluated four monitoring devices in detecting partial and full venous compromise.Nine skin flaps were elevated on their arteriovenous pedicles in rabbits. The flap was assessed with quantitative Doppler of arterial inflow, transcutaneous oxygen and carbon dioxide tension, near-infrared spectroscopy tissue oxygen saturation, and scanning laser Doppler imaging. After a stable baseline was achieved, the outflow vein was subjected to partial and full venous obstruction followed by release.Pedicle arterial flow decreased significantly from baseline (5.9 +/- 3.0 ml/minute) during partial (4.1 +/- 2.4 ml/minute; 30.5 percent; p < 0.01) and full obstruction (0.3 +/- 0.4 ml/minute; 94.9 percent; p < 0.01). All other measures changed significantly with full obstruction: transcutaneous oxygen tension decreased by 79.6 percent; transcutaneous carbon dioxide tension increased by 69.0 percent; near-infrared spectroscopy tissue oxygen saturation decreased by 35.7 percent; and scanning laser Doppler imaging decreased by 78.8 percent. Laser Doppler imaging was the only noninvasive device that decreased significantly (p < 0.01) with partial obstruction, from 222.8 +/- 77.3 units to 186.5 +/- 73.2 units (16.3 percent).The authors established a venous obstruction flap model and evaluated four clinically relevant monitoring devices during partial and full venous occlusion. All devices detected full occlusion, but only scanning laser Doppler imaging and arterial Doppler detected partial occlusion. Scanning laser Doppler imaging monitoring may allow warning of impending venous obstruction. Near-infrared spectroscopy tissue oxygen saturation varied the least between flaps and therefore may be the most easily interpreted device for full venous occlusion. Both characteristics are important for clinical application.
View details for DOI 10.1097/PRS.0b013e3181b03768
View details for Web of Science ID 000269485200013
View details for PubMedID 19730298
Monitoring the changes in intraparenchymatous venous pressure to ascertain flap viability
PLASTIC AND RECONSTRUCTIVE SURGERY
2007; 119 (7): 2111-2117
Disruption of venous outflow can lead to tissue necrosis. Thrombosis of a venous channel at the coaptation site in instances of free tissue transfer could cause death of the transplanted tissues. Although various techniques have been used to monitor the viability of transferred tissues, there has been no technique designed specifically to check the flow within and the patency of the venous channel. The authors have devised an approach with which to monitor the changes in venous pressure in a composite tissue transferred by means of microsurgical technique for bodily reconstruction.The status of the venous system in various composite tissue grafts was monitored at the time of surgery or for 3 days after the completion of surgery by placing a small-caliber catheter in the vein within the transferred tissue. A total of 52 patients participated in the study.The venous pressure noted in grafts with a patent venous channel remained constant within a range between 0 and 35 mmHg. Venous insufficiency was detected in three of the 52 cases, with unmistakable findings of an elevated venous pressure of over 50 mmHg.The technique of measuring the venous pressure by means of an indwelling venous catheter to monitor changes was found to accurately assess the patency of the venous channel and, by inference, the viability of the transferred tissue. No morbidity was associated with the technique.
View details for DOI 10.1097/01.prs.0000260594.94139.4a
View details for Web of Science ID 000246669000021
View details for PubMedID 17519709
Magnetic resonance angiography for free fibula flap transfer
JOURNAL OF RECONSTRUCTIVE MICROSURGERY
2007; 23 (4): 205-211
Recent refinements of magnetic resonance angiography (MRA) allow imaging vessels as small as the septocutaneous perforators (< or = 1 to 2 mm diameter), but a Medline review reveals no report of septocutaneous vessel imaging for free flap surgery. Challenges in fibula free flap preparation include knowledge of: (1) tibioperoneal anatomy, (2) the positions of the perforator vessels on the peroneal artery and their course in the posterolateral intermuscular septum, and (3) the cutaneous distribution of the perforators. Questioning whether high-resolution MRA could image these, we studied the lower extremities of nine healthy volunteers. MRA demonstrated tibioperoneal anatomy in sufficient detail to exclude anatomic variants and significant peripheral vascular disease and showed septocutaneous perforators arising from the peroneal artery and coursing in the posterolateral intermuscular septum to the skin. High-resolution MRA provided anatomic and clinical information that conventionally has been impossible to obtain preoperatively or has required multiple tests, often of an invasive nature.
View details for DOI 10.1055/s-2007-981501
View details for Web of Science ID 000247092000005
View details for PubMedID 17530612
HBO and gas embolism
2007; 29 (2): 142-145
Gas embolism, which occurs with the entry of gas into the circulatory system from the vein, artery or both, is a potentially serious even fatal condition. The two main causes of gas embolism are iatrogenic and diving. The site of entry and the signs and symptoms distinguish between arterial and venous embolism. The entering gas may be air, but may also be CO(2) or other gases, especially in iatrogenic embolism. Supportive care is the primary therapy for venous gas embolism, while hyperbaric oxygen therapy in addition to supportive care is the first line of treatment for arterial gas embolism. In this article, we will review the pathophysiology, etiology, diagnosis and treatment of gas embolism.
View details for DOI 10.1179/016164107X174165
View details for Web of Science ID 000246301000005
View details for PubMedID 17439698
- Divided naevus of the penis: A hypothesis on the embryological mechanism of its development ACTA DERMATO-VENEREOLOGICA 2003; 83 (2): 155-156