Hasil Pencarian  ::  Simpan CSV :: Kembali

"Introduction: Peripheral arterial disease (PAD) is the most common macroangiopathic complication in type II diabetes mellitus, arising from inadequate blood sugar control. In the presence of PAD, the risk of limb loss will also increase, and arterial bypass is one method to reduce the risk of amputation. In Indonesia, the level of patency for the arterial bypass has not yet been published. On bypass with venous grafts, the patency rates at the location of infrapopliteal reach at 70-80%, while the prosthetic graft is 30-50%. Method: From 2009 to 2012, patients with arterial bypasses were analyzed. The level of patency was described by ultrasound examination and pulsation on clinical examination in the distal anastomosis, reduced pain, and other examinations that support adequate revascularization. Identification of risk factors that affect patency, particularly protective risk factors, were also taken into account. Results: From 2009 to 2012, 29 patients with infra-inguinal arterial bypass were collected. The ratio of men to women was 5:1, with a one-year patency rate of 88% in men, and 75% in women, for an overall of 86.2%. The irreversible risk factor affecting patency was male (p = 0.117). Modifiable risk factors that decreasing patency level were smoking (p = 0.042) and more advanced stage of PAD (p = 0.067). Smoking cessation (p = 0.041) and the use of drugs after bypass procedure (p = 0.072) were known to increase the level of patency. Conclusion: The one-year patency rate for infra-inguinal artery bypass was 37-89%. Smoking cessation was known to increase the level of patency."

"LATAR BELAKANG: Penyakit Arteri Perifer (PAP) merupakan sumbatan aliran darah arteri selain koroner dan intrakranial. PAP dihasilkan dari proses atherosklerosis, emboli, trombus, dan inflamasi yang mengarah ke stenosis arteri. PAP asimptomatik menempati 3-10% populasi dunia, dan meningkat hingga 15-20% pada 70 tahun ke atas. Divisi kami mencatat 18,1-24,7% pasien kaki diabetik dengan PAP mengalami amputasi pada kurun waktu 3 tahun terakhir. Evaluasi ultrasonografi Doppler pada arteri utama ekstremitas bawah diharapkan mampu mendeteksi secara dini apakah pasien akan diamputasi atau tidak baik mayor maupun minor. METODE: Metode yang diambil adalah analitik komparatif kategorik independen dengan disain penelitian kohort retrospektif. Selama Januari 2010 hingga Desember 2011 didapatkan 24 pasien yang masuk kriteria inklusi. Arteri yang diperiksa a.femoralis, a.poplitea, a.tibialis posterior, dan a.dorsalis pedis dengan tampilan spektral mulai dari monofasik, bifasik, atau trifasik terutama dengan pelebaran spektral. Ultrasonografi salah satu modalitas ”operator dependent”, untuk mengurangi bias, peneliti menggunakan operator ultrasonografi adalah peneliti sendiri, trainee atau konsultan divisi kami. HASIL: Hasil didapatkan spektral bifasik hingga monofasik pada a.femoralis 25,0%, a.poplitea 58,3%, a.tibialis posterior 41,6%, a.dorsalis pedis 45,8%, angka amputasi mayor dan minor masing-masing 4%. Perhitungan statistik didapatkan untuk a.femoralis p=0,054 (95% CI), a.poplitea p=0,006 (95% CI), a.tibialis posterior p=0,010 (95% CI), dan a.dorsalis pedis p=0,021 (95% CI). Secara statistik, prediksi amputasi dapat bermakna pada ultrasonografi Doppler pada a.poplitea, a.tibialis posterior, dan a.dorsalis pedis. KESIMPULAN: Dapat ditarik kesimpulan pemeriksaan ultrasonografi Doppler penting dilakukan pada setiap pasien PAP untuk mengevaluasi secara khusus keadaan empat arteri utama ekstremitas bawah pasien dan untuk prediktor amputasi.

---

BACKGROUND: Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation.

METHODS: Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division.

RESULTS: Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI).

CONCLUSION: Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss."

"Latar Belakang: Penyakit AAA sebagian besar berlokasi pada infrarenal. Mortalitas meningkat dengan ruptur. Faktor risiko utama ruptur adalah diameter aneurisma dan hipertensi. Analisis computational fluid dynamic (CFD) pada aliran darah memungkinkan untuk mengetahui predileksi area tempat terjadinya ruptur. Wall shear stress (WSS) dan tekanan dinding merupakan parameter yang bisa dianalisis melalui CFD untuk melihat potensi ruptur pada AAA. Tujuan: Mengetahui morfologi aneurisma AAA infrarenal beserta sebaran nilai WSS dan tekanan dinding aneurisma berdasarkan CFD untuk memprediksi ruptur aneurisma. Metode: Studi cross-sectional dengan analisis CT angiogram pasien AAA infrarenal di Divisi Vaskular dan Endovaskular-Departemen Bedah dan Departemen Radiologi RSUPN Dr. Cipto Mangunkusumo pada bulan Juli–Desember 2022. Data CT angiografi diolah dengan Radiant Viewer untuk dijadikan model 3D. Dari keseluruhan sampel, dikelompokkan menjadi 5 tipe aneurisma. Kemudian masing-masing model dilakukan proses pembuatan solid vessel dengan Meshmixer. Proses selanjutnya adalah geometri, meshing, setup parameter CFD, dan solution untuk menghasilkan kontur WSS dan tekanan dinding pada berbagai kecepatan dan tekanan darah dengan program ANSYS 2022 R2 Academic Student. Hasil visual pada tiap tipe dianalisis dan dibandingkan. Uji statistik non-parametrik WSS dan tekanan dinding pada tiap tipe dan antar grup menggunakan SPSS 25.0 dengan nilai p dianggap bermakna jika p<0,05. Hasil: Dari 93 CT angiogram, setelah eksklusi didapatkan 40 sampel. Median usia 67 (47-76 th), dengan 90% adalah laki-laki. Sebanyak 25% sampel memiliki komponen sakular. Hasil analisis visual, terdapat korelasi area antara WSS terendah dengan tekanan dinding tertinggi. Perubahan kecepatan dan tekanan darah inisial juga mengubah nilai dan luas area pada kontur WSS dan tekanan dinding aorta, meskipun pusat perubahan kontur masih berada pada area yang relatif sama. Terdapat perbedaan bermakna pada WSS dan tekanan dinding (p=0,038 dan p<0,001). Kesimpulan: Area WSS terendah berkaitan dengan lokasi tekanan dinding tertinggi. Berubahnya kecepatan dan tekanan darah, mempengaruhi luas dan nilai dari WSS dan tekanan dinding.

---

Background: AAA disease is mostly located in infrarenal. Mortality increases with rupture. The main risk factors for rupture are diameter sac and hypertension. Computational fluid dynamic (CFD) analysis of blood flow allows for a detection where rupture area will occur. Wall shear stress (WSS) and wall pressure are parameters that can be analyzed through CFD to see the potential location for rupture in AAA. Objective: Knowing the morphology of infrarenal AAA along with the distribution of WSS values ​​and aneurysmal wall pressure based on CFD to predict aneurysm rupture. Method: Cross-sectional study with CT angiogram analysis of infrarenal AAA patients in the Vascular and Endovascular Division-Department of Surgery and the Department of Radiology RSUPN Dr. Cipto Mangunkusumo in July–December 2022. CT angiography data was processed with Radiant Viewer to be used as a 3D model. From the whole sample, grouped into 5 types of aneurysms. Then for each model the process of making a solid vessel is carried out with the Meshmixer. The next process is geometry, meshing, CFD parameter setup, and solutions to produce WSS and wall pressure contours at various speeds and blood pressures with the ANSYS 2022 R2 Academic Student program. Visual results for each type were analyzed and compared. WSS and wall pressure non-parametric statistical test were performed for each type and between groups using SPSS 25.0 with a p-value considered significant if p <0.05. Results: Of the 93 CT angiograms, after exclusion, 40 samples were obtained. Median age 67 (47-76 years), with 90% were men. As much as 25% of the sample had a saccular component. The results of the visual analysis showed that there was an area correlation between the lowest WSS and the highest wall pressure. Changes in velocity and initial blood pressure also changed the value and area of ​​the WSS and the aortic wall pressure contours, although the center of the contour change was still in the relatively same area. There was a significant difference in WSS and wall pressure (p=0.038 and p<0.001). Conclusion: The area of ​​lowest WSS corresponds to the location of the highest wall pressure. Changes in blood velocity and pressure affect the area and value of WSS and wall pressure."