Clinical Hemorheology and Microcirculation - Volume 73, issue 1

Authors: Wiggermann, P. | Krüger-Genge, A. | Jung, F.

Article Type: Editorial

DOI: 10.3233/CH-199200

Citation: Clinical Hemorheology and Microcirculation, vol. 73, no. 1, pp. 1-1, 2019

Authors: Grambow, Eberhard | Dau, Michael | Sandkühler, Niels Arne | Leuchter, Matthias | Holmer, Amadeus | Klar, Ernst | Weinrich, Malte

Article Type: Research Article

Abstract: BACKGROUND: Objective, reliable and easy screening for peripheral artery disease (PAD) is essential to confirm the diagnosis and initiate the respective treatment. Therefore, a new non-invasive hyperspectral camera (TIVITA® Tissue) was tested in patients with and without PAD. OBJECTIVE: It was hypothesized that the oxygenation parameters of the TIVITA® Tissue correlate to established modalities for detection of PAD and allow differentiation between individuals with and without PAD. METHODS: Evaluation of tissue oxygenation was performed in the angiosome of the medial plantar artery in 25 healthy young people and in 24 patients with and 25 …patients without PAD in comparable age. Thereby, superficial oxygenation (StO2 ) and near-infrared (NIR) perfusion index were measured with the TIVITA® Tissue. Additionally, the ankle-brachial-index (ABI), the complaint free walking distance and the vascular quality of life were assessed and demographic data were obtained from all participants. RESULTS: TIVITA® Tissue analysis revealed significantly reduced StO2 and NIR perfusion index in PAD compared to healthy young participants and patients without PAD. StO2 and NIR perfusion index positively correlated with ABI, the complaint free walking distance and the vascular quality of life score. CONCLUSIONS: In summary, this new hyperspectral imaging camera bears great potential for PAD screening as well as for follow up. Show more

Keywords: Hyperspectral imaging, vascular surgery, screening, perfusion imaging, skin microcirculation

DOI: 10.3233/CH-199215

Citation: Clinical Hemorheology and Microcirculation, vol. 73, no. 1, pp. 3-17, 2019

Authors: Park, J.W. | Matschke, K. | Mrowietz, C. | Krüger-Genge, A. | Jung, F.

Article Type: Research Article

Abstract: Hyperlipidemic heart transplant patients who develop cardiac allograft vasculopathy (CAV) benefit from HELP-apheresis (H eparin-induced E xtracorporeal L DL P recipitation) which enables drastic lowering of plasma low-density lipoprotein, lipoprotein (a), and fibrinogen. There is evidence that HELP-apheresis also improves microcirculation by an immediate improvement of impaired endothelial-dependent vasodilatation and additive hemorheological effects. Therefore, cutaneous microcirculation was examined before, during, and after the first HELP-apheresis in eight hyperlipidemic cardiac transplant recipients with CAV. To study the long-term effect the intravital microscopy was repeated after three and 12 months of weekly apheresis treatment. In CAV patients the baseline mean …erythrocyte velocity was pathologically reduced with 0.13±0.07 mm/s. During the first HELP-apheresis the erythrocyte velocity increased significantly (p  = 0.0001) and remained increased until the end of the HELP procedure (p  < 0.05). After three months of weekly apheresis treatment a decrease of temporary flow stops in the capillaries with a progressive homogenization (concordance) of the cutaneous microcirculation was observed. After one year of weekly treatment a markedly increase in mean erythrocyte velocity under resting conditions occurred. In addition, a reactive post-ischemic hyperemia could be established for the first time. Even the first single HELP-apheresis resulted in a significant improvement of the cutaneous microcirculation. The long-term treatment of these patients resulted in a marked improvement of the cutaneous microcirculation with the tendency to a normalization of the regulation of the capillary perfusion. Show more

DOI: 10.3233/CH-199216

Citation: Clinical Hemorheology and Microcirculation, vol. 73, no. 1, pp. 19-27, 2019

Authors: Ullrich, Helen | Gori, Tommaso

Article Type: Research Article

Abstract: Percutaneous coronary intervention is the most often used method for coronary revascularization. Stenting restores blood perfusion to ischemic areas, but it also causes mechanical disruption of the atheromatous plaque and the nearby endothelium, stimulating the activation of platelets. In a similar way, platelets are activated by thrombin exposure in the setting of plaque rupture. The interaction between platelets, oxidative stress and inflammation is an important factor determining the extent and severity of vascular dysfunction observed in these settings. Platelets activated by the vessel trauma release inflammatory and mitogenic mediators into the vascular microenvironment, activating leukocyte chemotaxis and switching the endothelial …phenotypefrom a quiescent to an activate one. The increased bioavailability of reactive oxygen species from the vessel wall, from leukocytes and from platelets, and the subsequent decreased bioavailability of nitric oxide, further stimulates platelets, which are otherwise inhibited by this endothelial mediator. Thus, inflammation, oxidative stress and platelet activation cooperate in a feed-forward mechanism leading to vascular dysfunction and possibly compromising the effect of stenting. Inhibitors of platelet function have thus important ancillary effects beyond their antithrombotic ones, which will be discussed in the present short review. Show more

Keywords: Endothelium, thrombosis, acute coronary syndromes, stent

DOI: 10.3233/CH-199214

Citation: Clinical Hemorheology and Microcirculation, vol. 73, no. 1, pp. 29-34, 2019

Authors: Gerk, U. | Franke, R.P. | Jung, E.M. | Scheller, B. | Krüger-Genge, A. | Jung, F.

Article Type: Research Article

DOI: 10.3233/CH-199217

Citation: Clinical Hemorheology and Microcirculation, vol. 73, no. 1, pp. 35-42, 2019

Authors: Reinders, Yvonne | Pohl, Fabian | Ahrens, Norbert | Prantl, Lukas | Kuehlmann, Britta | Haubner, Frank

Article Type: Research Article

Abstract: BACKGROUND: To overcome the compromised wound healing in radiation induced chronic wounds platelet-rich plasma (PRP), as therapeutic agent, is current subject of studies. PRP is associated with pro-angiogenic effects. Nevertheless, effects of platelet-rich plasma in cutaneous wound healing processes are poorly understood so far. Methods: In this study, the migration of endothelial cells, fibroblasts and keratinocytes in conjunction with platelet-rich plasma treatment is investigated in the context of radiation effects. Additionally, cell proliferation and viability after external radiation was analyzed regarding treatment by platelet-rich plasma. RESULTS: All cell cultures showed a trend towards decreasing proliferation and …viability after irradiation irrespective of PRP. Upon PRP treatment, irradiated fibroblasts as well as endothelial cells showed an enhanced proliferation whereas proliferation and viability of keratinocytes was reduced after PRP treatment. Scratch assays support the positive effect of PRP on fibroblast and endothelial cell migration, whereas a negative effect on keratinocytes was observed after PRP treatment. CONCLUSIONS: The present study documents both deleterious effects of external radiation as well as the protective effect of PRP. In summary, increased viability, proliferation and migration are indeed a consequence of the pro-proliferative effect exerted by PRP. Therefore, treatment with PRP products might be useful in the management of chronic radiogenic wounds. Show more

Keywords: Wound healing, irradiation, platelet-rich plasma, scratch assay, viability, proliferation

DOI: 10.3233/CH-199218

Citation: Clinical Hemorheology and Microcirculation, vol. 73, no. 1, pp. 43-51, 2019

Authors: Klingelhoefer, Eric | Hesse, Karl | Taeger, Christian D. | Prantl, Lukas | Stepniewski, Adam | Felmerer, Gunther

Article Type: Research Article

Abstract: BACKGROUND: The optimal surgical treatment for lymphedema is still subject of intensive research. Therefore, it is vital to investigate what significance lymphovenous anastomosis (LVA) has in this context. OBJECTIVE: This study aims to determine the short- and long-term results as well as the most important factors that can improve outcomes after LVA. METHODS: This study includes a complete data set of 26 patients who received LVA for a therapy-resistant lymphedema. Patients were followed up for an average of 23 months. RESULTS: 50% of the patients reported a subjective improvement. Without conservative treatment after the …operation the patients showed significant better results (100% vs. 40.9%, p  = 0.030). The localization of lymphedema as well as the region of LVA had a significant influence. In patients with lymphedema affecting the entire leg, symptom improvement was significantly lower (35.3% vs. 77.8%, p  = 0.039). Patients who received LVA in an upper limb show a significantly higher improvement in symptoms than patients who received LVA in a lower limb (100% vs. 30%, p  = 0.021). CONCLUSIONS: We identified factors with a significant influence on the outcome of patients after receiving LVA. Patients with early-stage upper extremity lymphedema seem to benefit most from this procedure. Show more

Keywords: Lymphedema surgery, lymphovenous anastomosis, microsurgery, results, postoperative care

DOI: 10.3233/CH-199213

Citation: Clinical Hemorheology and Microcirculation, vol. 73, no. 1, pp. 53-63, 2019

Authors: Schwarze, V. | Lindner, F. | Marschner, C. | Negrão de Figueiredo, G. | Rübenthaler, J. | Clevert, D.-A.

Article Type: Research Article

Abstract: BACKGROUND: Frequently focal splenic lesions (FSL) - cysts, hemangioma, hamartoma, metastases or infarction amongst others – are incidentally found within the scope of the sonographic examination of the abdomen. By using native B-mode and Color Doppler the underlying entity often is not elucidated. Thus, more elaborate imaging modalities like CT and MRI scans with their associated risks are used to clarify the entity of FSL. PURPOSE: The aim of the present retrospective single-center study is to evaluate the diagnostic performance of CEUS examination for assessing splenic focal lesions by comparison with findings from CT and MRI scans. …MATERIALS AND METHODS: Between 2010–2018 46 patients were included in the study. All patients underwent native B-mode, Color Doppler and CEUS after given informed consent. The applied contrast agent was a second-generation blood pool agent (SonoVue ® , Bracco, Milan, Italy). CEUS examinations were performed and interpreted by a single experienced radiologist (EFSUMB Level 3). RESULTS: All patients were examined without occurrence of any side effects. In total, 53 FSL were investigated (9% traumatic vs. 91% non-traumatic). Compared to CT, CEUS showed a sensitivity, specificity, PPV, NPV of 100% for assessing infarction, hematoma, hamartoma, cystic and malignant lesions. In comparison with MRI, CEUS presented a sensitivity, specificity, PPV, NPV of 100% for evaluating pseudolesions, hemangioma, hamartoma, cystic and malignant lesions. CONCLUSION: With an excellent safety profile CEUS shows an equipollent diagnostic performance for differentiating FSL compared to CT and MRI scans. Show more

Keywords: Spleen, tumor, focal splenic lesion, contrast-enhanced ultrasound, CEUS

DOI: 10.3233/CH-199204

Citation: Clinical Hemorheology and Microcirculation, vol. 73, no. 1, pp. 65-71, 2019

Authors: Rennert, Janine | Wiesinger, Isabel | Beyer, Lukas Philipp | Schicho, Andreas | Stroszczynski, Christian | Wiggermann, Philipp | Jung, Ernst Michael

Article Type: Research Article

Abstract: AIM: Evaluation of the post-interventional success following ablative techniques (radiofrequency and microwave) using a new color coded perfusion quantification software with CEUS in patients with primary and secondary liver malignancies. MATERIAL AND METHODS: 75 patients (60 males, 15 females, age 24–84 years, mean 62.7 years) with 128 malignant liver lesions were included in this study. Between 01/2013 and 06/2018, the therapeutic interventional procedure in 88 lesions was MWA, in 40 lesions RFA. All patients underwent CEUS using a convex multifrequency probe (1–6 MHz) following application of 1–2.4 ml sulphur hexaflouride microbubbles, before and within 24 hours following RFA and MWA …to detect residual tumor tissue. Postprocessing of the stored DICOM loops from 15 sec up to 1 min using a perfusion quantification software regarding peak enhancement (pE), time to peak (TTP), mean transit time (MTT), rise time (Ri) and Wash-in area under the curve (WiAUC) in the center of the lesion, the border area and periphery was performed. RESULTS: In patients treated with RFA, pE differences between center of the lesion vs. surrounding liver were found to be statistically extremely significant (p  < 0.001), differences between center of the lesion and margin were also statistically significant (p  < 0.01). mTT, TTP, WiAuC and Ri showed no significant difference between center, margin or surrounding liver. In patients treated with MWA, statistically significant differences (p  < 0.05) were found for pE, Ri and mTT regarding the differences between center of lesion and surrounding tissue. WiAuC and TTP showed no significant differences between center, margin or surrounding liver. CONCLUSION: CEUS with perfusion imaging is a valuable supporting tool for post-interventional success control following RFA and MWA of primary and secondary liver maligancies. Focus should be placed upon pE following MWA and pE, Ri and mTT following RFA. Show more

Keywords: Microwave ablation (MWA), radiofrequency ablation (RFA), contrast enhanced ultrasound (CEUS), perfusion analysis, primary and secondary liver malignancies

DOI: 10.3233/CH-199224

Citation: Clinical Hemorheology and Microcirculation, vol. 73, no. 1, pp. 73-83, 2019

Authors: Negrão de Figueiredo, G. | Mueller-Peltzer, K. | Schwarze, V. | Zhang, L. | Rübenthaler, J. | Clevert, D.A.

Article Type: Research Article

Abstract: BACKGROUND: Conventional ultrasound and MRI are very important techniques for the detection of gallbladder alterations. In the past years, studies showed that the additional use of contrast media to the conventional ultrasound allows the early depiction of pathological microvessels and their flow elucidating suspect findings stipulating the prompt therapy approach. OBJECTIVE: The study aims to evaluate the performance of CEUS in gallbladder diseases and compare it to MR imaging using histopathological findings as a gold standard. MATERIAL AND METHODS: The retrospective mono-center study analysed 18 patients with gallbladder alterations between 2009 and 2017. All patients underwent …CEUS and MRI examinations and all results were confirmed in the pathology. CEUS images were performed and interpreted by a single experienced physician. RESULTS: CEUS imaging results compared to MR imaging of the gallbladder demonstrated a sensitivity of 100%, specificity of 93%, a positive predictive value of 67% and a negative predictive value of 100%. CONCLUSION: CEUS enables the depiction and characterization of important vascularization’s patterns facilitating the early differentiation between malignant and benign findings. In this study, CEUS displayed a better diagnostic accuracy than MRI proving to be a valuable additional tool to the established imaging modalities. Show more

Keywords: CEUS, gallbladder alterations, MRI, histopathological findings, adenocarcinoma

DOI: 10.3233/CH-199202

Citation: Clinical Hemorheology and Microcirculation, vol. 73, no. 1, pp. 85-93, 2019