Papers by S. Salles-Cunha
International angiology : a journal of the International Union of Angiology, 2013
The aim of the current study was to evaluate fluid mobilization during the intensive treatment of... more The aim of the current study was to evaluate fluid mobilization during the intensive treatment of leg lymphedema. The mobilization of intracellular and extracellular fluids in the lower and upper extremities and trunk was evaluated with the intensive treatment of leg lymphedema in a prospective study. Mobilization of fluids was assessed by bioelectrical impedance using the InBody S10 device in ten patients with leg lymphedema, regardless of the cause. Treatment consisted of six to eight hours per day of Manual Lymphatic Therapy (Godoy & Godoy technique), Mechanical Lymphatic Therapy (RAGodoy device®) and a non-elastic cotton-polyester stocking. A significant reduction in total water was observed for the lymphedematous limb, but with an increase in intracellular water of from 59% to 61%. Additionally, total water increases were observed in the limbs without lymphedema and in the trunk. There was an increase in total intracellular water of the extremities and trunk, but without any ch...
Journal of Endovascular Surgery, 1996
The advent of endovascular grafting has created detailed imaging requirements for which intravasc... more The advent of endovascular grafting has created detailed imaging requirements for which intravascular ultrasound (IVUS) may be useful. Since intra-arterial IVUS imaging uses space within endovascular graft delivery systems and risks embolism, we investigated the use of intravenous IVUS imaging of arterial vasculature and endovascular grafts, a technique that appears not to have been previously described. IVUS catheters with 12.5- and 20-MHz transducers were inserted through the common femoral artery and vein of mature sheep. Transcutaneous images were also obtained with a 5-MHz linear transducer. B-mode images of the aortoiliac arterial segments and diameter measurements were recorded from both access vessels using anatomic landmarks for site localization. To assess device visualization from the intravenous image source, studies were done in vessels containing previously placed endovascular stent-grafts. In this feasibility study, comparison among intravenous IVUS, arterial IVUS, and external ultrasound indicated equal diameter precision and ability to recognize arterial structures. Comparison of arterial diameter, whether obtained from an arterial, venous, or transcutaneous source, showed similar values. We conclude that it is probable for such techniques to be usefully applied to human aortoiliac arterial segments and that further investigation of arterial visualization from adjacent venous structures is warranted.
Journal of Endovascular Surgery, 1998
To describe a feasibility study in a sheep model using an intravascular ultrasound (IVUS) instrum... more To describe a feasibility study in a sheep model using an intravascular ultrasound (IVUS) instrument in an intravenous position to produce color flow, B-mode images of arterial segments along with Doppler blood flow velocities. Four healthy adult male sheep were anesthetized for surgical exposure of the right external jugular vein. A 9.0F sheath was also introduced in the common femoral artery for arteriography and device insertion. A 7.5-MHz ultrasound probe with 1-cm graduation markers was passed into the jugular vein. B-mode and color flow pictures were captured at aortic branches in cross and longitudinal sections. Length measurements between aortic branches and Doppler spectral velocities were obtained. Guidewire, balloon, and stent maneuvers were monitored by the stationary intravenous IVUS probe. High-quality visualization of the entire abdominal aorta and its branches was achieved in all animals. With the probe stationary in the vena cava, a 1.5-cm linear segment of the aorta could be continuously observed in both B-mode and color flow ultrasound scans. Insertion and implantation of a Palmaz balloon-expandable stent was guided by intravenous IVUS alone. Selective catheterization of the right renal artery was followed visually by moving the intravenous IVUS probe sequentially. Intravenous IVUS appears feasible as a guidance and monitoring tool for endovascular interventions. While conventional IVUS provides only cross-sectional images in B-mode, intravenous IVUS captures color flow and Doppler velocity data as well. These added ultrasound modalities may offer potential advantages for guidance of endovascular procedures and endoleak detection.
Journal of Microwave Power, 1983
Objectives. To determine peri-procedural incidence of side effects following treatment of lower ... more Objectives. To determine peri-procedural incidence of side effects following treatment of lower extremity superficial veins with carbon dioxide-oxygen (CO2-O2) foam sclerotherapy, and to compare results with historical controls using CO2- or air-based foams.
Design. Prospective data collection, quality-assurance program, private clinical setting.
Materials. The clinical population consisted of one hundred patients, 95% women, 52±13 (SD) years-old, CEAP class C2EpAsPr.
Methods. Patients underwent ultrasound-guided foam sclerotherapy following thermal ablation; 1-3 % polidocanol and 70% CO2-30%O2 gas were mixed in a 1:4 proportion. Volume injected averaged 22±11 (range: 2-48) ml. Vital signs were monitored for 1 hour; side effects were recorded up to 24 hours post procedure. Incidence of side effects was compared to CO2- and air-based foam data.
Results. Heart rated decreased from 73±11 at the start to 68±9 bpm (p<.001 by paired t-test) following the procedure. Systolic and diastolic pressures, 127/75 ±18/14 mmHg, respiratory rate, 15±4 rpm, and pO2, 98±2 %, did not change significantly. Itching (n=7) or localized leg pain (n=24) reporting was similar to that for air-based foam (P>.05). No reporting of dry cough or nausea was superior to the air foam experience (P<.05). Reporting of chest tightness (n=1) or dizziness (n=1) was less than that for air-based foam (P=.002). Incidence of visual disturbance (n=2), although less than that for CO2 (3%) or air (8%), was not significantly different (P>.05).
Conclusions. Lower or similar incidence of side effects was documented following CO2-O2 when compared to CO2 or air-based foam sclerotherapy.
Phlebology: The Journal of Venous Disease, 2008
Phlebology: The Journal of Venous Disease, 2008
Journal of Vascular Technology
Purpose: Several trials have clarified the value of endarterectomy as the primary treatment for s... more Purpose: Several trials have clarified the value of endarterectomy as the primary treatment for severe internal carotid artery (lCA) stenosis. In contrast, confusion has increased as to how to quantitate severe ICA disease. Diminishing use of arteriography and increased dependence on ultrasound (US) have also raised new arguments. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) has popularized percentage diameter reduction referenced to the normal ICA diameter distal to the bulb. This criterion, however, is insensitive to mild or even moderate stenoses and, unacceptably, may provide negative measurements in the presence of disease. We investigated if. in practice, the interpretation of arteriograms only followed the NASCET measurement criterion or if local percentage diameter stenosis was still being considered.
Phlebology / Venous Forum of the Royal Society of Medicine, 2012
Venous ultrasonography identifies reflux patterns of the great and small saphenous veins (GSV, SS... more Venous ultrasonography identifies reflux patterns of the great and small saphenous veins (GSV, SSV), allowing evaluation of lower extremities for treatment planning and patient follow-up. To determine progression of saphenous vein reflux patterns in women with primary venous valvular insufficiency. Venous ultrasonography was performed in the extremities of 92 women, 43 ± 12 (23-77) years old, CEAP (clinical, aetiological, anatomical and pathological elements) clinical classes C1-C2. Two examinations were performed 33 ± 19 (8-89) months apart in patients without saphenous vein treatment. GSV and SSV reflux patterns were classified as segmental, multisegmental, distal, proximal, diffuse and normal. Prevalence was determined for each examination, separately for right and left extremities, and jointly. Prevalence was compared using χ2 statistics. Reflux prevalence was higher for the GSV, 89% (164/184) and 88% (n = 162), than for the SSV, 24% (n = 45) and 30% (n = 56), respectively for f...
International angiology : a journal of the International Union of Angiology, 2011
To determine if gray-scale median (GSM) analysis could differentiate acute and recent deep venous... more To determine if gray-scale median (GSM) analysis could differentiate acute and recent deep venous thrombosis (DVT). Patients submitted to vascular ultrasound examination of lower extremities due to suspected DVT were evaluated. Patients with acute or recent femoropopliteal DVT were included, whereas those without DVT, with chronic or isolated calf DVT were excluded. Time of onset of DVT symptoms was recorded. A transverse image of the thrombosed vein and adjacent artery was obtained. Two sonographers determined a subjective impression of thrombus time of progression and classified it as acute or recent. Thrombus GSM was calculated with a software. ROC curve was used to determine GSM cut-off points. Fischer's exact and Student´s t tests were also used. P<0.05 indicated statistical significance. 128 veins of 63 extremities were studied. Thrombus GSM correlated with time of onset of DVT symptoms (P=0.005) and with subjective evaluation of thrombus time of progression (P<0.001...
Phlebology / Venous Forum of the Royal Society of Medicine, 2010
Impact of pregnancies on great saphenous vein (GSV) reflux patterns deserves clarification. Which... more Impact of pregnancies on great saphenous vein (GSV) reflux patterns deserves clarification. Which GSV segment is most affected? Is the saphenofemoral junction (SFJ) involved? Colour-flow duplex ultrasonography was performed in 583 women extremities with primary varicose veins (clinical, aetiological, anatomical and pathological elements [CEAP C2]), without oedema, skin changes or ulcer. Women with previous thrombosis or varicose surgery were excluded. GSV reflux sources and drainage points were located at SFJ, thigh, knee and calf. Prevalence of most proximal reflux source was noted as a function of 0, 1, 2, 3 and 4 or more pregnancies. chi(2) statistics was employed. Prevalence of GSV reflux was not dependent on 0, 1, 2, 3 or >or=4 pregnancies: 75%, 69%, 79%, 70% and 76% for right leg (P = 0.79) and 78%, 81%, 82%, 79% and 73% for left leg (P = 0.87), respectively. Prevalence of SFJ reflux and GSV reflux, starting at the thigh, knee or calf, was similar and showed no tendencies t...
Vascular
Owing to the overall poor medical health of patients with end-stage renal disease, we have sought... more Owing to the overall poor medical health of patients with end-stage renal disease, we have sought alternatives to the use of general anesthesia for access procedures. Furthermore, since local anesthesia (1) does not offer the motor block that is sometimes desired and (2) can be difficult to maintain when a large amount of vein needs to be transposed, we examined whether regional blocks can be useful for the creation of new arteriovenous fistulae (AVF). From August 2002 to January 2005, 41 patients scheduled for AVF placement underwent a regional block with the use of a lidocaine and ropivacaine mixture using a nerve stimulator. Either axillary, interscalene, or infraclavicular blocks or a combination was used. Intraoperative duplex ultrasonography was used to assess the degree of venodilatation of the basilic and cephalic veins before and after the block. The site of each measurement was marked on the skin and selected by a clearly identifiable branch point. Each measurement was rec...
Vascular surgery
Previous research has suggested that arterial aneurysm might result from a systemic tendency to d... more Previous research has suggested that arterial aneurysm might result from a systemic tendency to dilatation. This systemic effect would involve both arterial and venous dilatation. The authors investigated whether venous grafts implanted to bypass popliteal artery aneurysms (PAA) had larger diameters than those implanted to treat peripheral arterial occlusive disease (PAOD). They compared representative diameters of 20 vein grafts implanted for PAA with matched bypass grafts implanted for PAOD. Graft diameters were obtained by means of CVI-Q M-mode ultrasound imaging. Each PAA patient/graft was matched to an equivalent PAOD patient/graft based on the patient's gender and age and the vein graft type and distal anastomosis. Secondarily, graft proximal anastomosis was matched in 60% (12/20) of the cases. Age was matched if the difference was < or = 4 years. Average age at the time of surgery was 68 +/-12 years for PAA and 68 +/-13 for PAOD groups. There were 11 reversed greater s...
Vascular and endovascular surgery
The clinical significance of lower extremity deep vein thrombus (DVT) propagation in the setting ... more The clinical significance of lower extremity deep vein thrombus (DVT) propagation in the setting of anticoagulation therapy remains unclear. The purpose of this study is to compare results of thrombus outcome found with repeat duplex ultrasonography to the incidence of pulmonary embolism and mortality. During a recent 18-month period, 457 patients were diagnosed with lower extremity DVT with duplex ultrasonography and their data were retrospectively analyzed. Repeat examinations were available for review in 118 patients (51 men, 67 women). Results of repeat duplex exams were divided into 4 groups: resolved, improved, unchanged, or extended proximally. All patients received heparin and warfarin therapy. Ventilation-perfusion (V/ Q) scans were obtained only for signs and symptoms of pulmonary embolism (n=30). Mortality, the prevalence of high-probability V/ Q scans, frequency of intracaval filter insertion, gender, mean age, mean prothrombin time (PT), mean partial thromboplastin time...
Vascular and endovascular surgery
Venography is rarely available for comparison with ultrasonography (US) as a means for quality as... more Venography is rarely available for comparison with ultrasonography (US) as a means for quality assurance (QA) in the detection of lower extremity venous thrombosis. New QA methods must be implemented. We compared results of multiple serial studies performed in the same extremity as a QA indicator. From a 3-year sample of close to 9,000 venous tests, we obtained a subset of 44 patients who had 331 tests in 71 lower extremities throughout the years. A positive or negative study preceded or followed by another positive or negative study was considered as a confirmed study. A negative or positive study not preceded or followed by a negative or positive study was considered as unconfirmed. Explanations were then sought to explain unconfirmed results. There were 169 (51%) and 124 (37%) confirmed positive and negative studies, respectively, and 13 (4%) and 25 (8%) unconfirmed positive and negative studies, respectively. Of the 13 unconfirmed positive tests, 2 were preceded by negative test...
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 1982
Noninvasive ankle systolic, mean and diastolic pressures were obtained with an oscillometric inst... more Noninvasive ankle systolic, mean and diastolic pressures were obtained with an oscillometric instrument available commercially. Systolic pressures were also measured at either the posterior tibial or dorsal pedal artery by using the Doppler technique with the ultrasound probe. Ankle pressures were obtained in normal subjects and in patients with peripheral vascular disease, particularly patients with calcified or incompressible vessels or with different posterior tibial and dorsal pedal Doppler pressures. Systolic pressures by oscillometry and by Doppler were equal in normal subjects and in functionally normal limbs of patients. In the presence of mild vascular disease, systolic pressure was decreased and mean and diastolic pressures were within normal limits. Measurements by Doppler and by oscillometry were similar. In patients with moderate disease, the systolic pressure by oscillometry, although decreased, was consistently higher than Doppler pressures, and the mean ankle pressur...
Vascular and endovascular surgery
In the past decade, expected in-hospital length of stay (LOS) after carotid endarterectomy (CEA) ... more In the past decade, expected in-hospital length of stay (LOS) after carotid endarterectomy (CEA) has decreased from 4 days to 1. Long LOS is associated with known complications and factors affecting severity of the patient's condition. Factors affecting an intermediate stay of 2 to 4 days need further clarification. The vascular registry at Jobst Vascular Center includes data on manifestation of disease; cardiovascular history; operation and discharge dates; surgeon; surgical details such as patching, shunting, and completion arteriography; and complications. Univariate chi-square and ANOVA and multivariate logistic regression were applied to analyze 635 CEAs performed in 1998, 1999, and 2000. Statistical significance was at a p value less than 0.05 (two-sided). Overall morbidity rate was 8.2% with three (0.5%) in-hospital neurologic complications and one death for a 0.16% mortality rate. Fifty-eight percent of the patients were discharged in 1 day. Patients staying 1 day were 3...
The Journal of cardiovascular surgery
Toe and ankle systolic blood pressures were measured noninvasively in asymptomatic volunteers and... more Toe and ankle systolic blood pressures were measured noninvasively in asymptomatic volunteers and in patients with peripheral arterial obstructive disease. The measurement of ankle pressure was falsely elevated in 23% (51/219) of the diseased limbs studied, as a consequence of partial or total vessel incompressibility caused by arterial calcification and rigidity. Eighty percent (41/51) of limbs with erroneous ankle pressure readings were from patients with diabetes mellitus. Toe pressure was the most reliable indicator of occlusive disease, and was able to assess disease distal to the ankle. Five groups were separated using the ankle-brachial and the toe-ankle systolic pressure ratios: normal, claudication, limb salvage, claudication/incompressible arteries, and limb salvage/incompressible arteries. Insulin dependent and orally-medicated diabetics predominated in the two groups with incompressible arteries. The toe-brachial systolic pressure ratio was an accurate hemodynamic indica...
The Journal of microwave power, 1983
Static and alternating magnetic fields are employed in blood flowmeters using nuclear magnetic re... more Static and alternating magnetic fields are employed in blood flowmeters using nuclear magnetic resonance (NMR) principles and electromagnetic induction by a moving conductor (TEM). Both techniques require high steady magnetic fields, obtained either from permanent magnets or from electromagnets. A relatively homogeneous magnetic field is needed for NMR, but, though important for calibration, homogeneity is not critical for TEM. NMR is more complex than TEM since it requires radio-frequency and audio-frequency magnetic fields. However, the TEM method requires surface electrodes in contact with the skin, or needle electrodes placed subcutaneously, whereas NMR is contactless. The NMR flowmeter can be calibrated directly, but appropriate and approximate models must be assumed and then solved by computer to quantify blood flow by the TEM flowmeter. Flow in individual vessels is measured a priori in the TEM flowmeter by virtue of the assumed models. To measure flow in individual vessels b...
Medical instrumentation
A cylindrical crossed-coil nuclear magnetic resonance flowmeter has been developed to measure art... more A cylindrical crossed-coil nuclear magnetic resonance flowmeter has been developed to measure arterial blood flow through the human forearm. This paper describes the in vivo studies to evaluate the performance of the instrument. Flow rates were comparable to values reported in the literature. The NMR flowmeter is a noninvasive, contactless-type flowmeter and has the advantage of accurate measurement unimpaired by clothing, bandages, or casts. One measurement can be taken in less than 2 min.
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Papers by S. Salles-Cunha
Design. Prospective data collection, quality-assurance program, private clinical setting.
Materials. The clinical population consisted of one hundred patients, 95% women, 52±13 (SD) years-old, CEAP class C2EpAsPr.
Methods. Patients underwent ultrasound-guided foam sclerotherapy following thermal ablation; 1-3 % polidocanol and 70% CO2-30%O2 gas were mixed in a 1:4 proportion. Volume injected averaged 22±11 (range: 2-48) ml. Vital signs were monitored for 1 hour; side effects were recorded up to 24 hours post procedure. Incidence of side effects was compared to CO2- and air-based foam data.
Results. Heart rated decreased from 73±11 at the start to 68±9 bpm (p<.001 by paired t-test) following the procedure. Systolic and diastolic pressures, 127/75 ±18/14 mmHg, respiratory rate, 15±4 rpm, and pO2, 98±2 %, did not change significantly. Itching (n=7) or localized leg pain (n=24) reporting was similar to that for air-based foam (P>.05). No reporting of dry cough or nausea was superior to the air foam experience (P<.05). Reporting of chest tightness (n=1) or dizziness (n=1) was less than that for air-based foam (P=.002). Incidence of visual disturbance (n=2), although less than that for CO2 (3%) or air (8%), was not significantly different (P>.05).
Conclusions. Lower or similar incidence of side effects was documented following CO2-O2 when compared to CO2 or air-based foam sclerotherapy.
Design. Prospective data collection, quality-assurance program, private clinical setting.
Materials. The clinical population consisted of one hundred patients, 95% women, 52±13 (SD) years-old, CEAP class C2EpAsPr.
Methods. Patients underwent ultrasound-guided foam sclerotherapy following thermal ablation; 1-3 % polidocanol and 70% CO2-30%O2 gas were mixed in a 1:4 proportion. Volume injected averaged 22±11 (range: 2-48) ml. Vital signs were monitored for 1 hour; side effects were recorded up to 24 hours post procedure. Incidence of side effects was compared to CO2- and air-based foam data.
Results. Heart rated decreased from 73±11 at the start to 68±9 bpm (p<.001 by paired t-test) following the procedure. Systolic and diastolic pressures, 127/75 ±18/14 mmHg, respiratory rate, 15±4 rpm, and pO2, 98±2 %, did not change significantly. Itching (n=7) or localized leg pain (n=24) reporting was similar to that for air-based foam (P>.05). No reporting of dry cough or nausea was superior to the air foam experience (P<.05). Reporting of chest tightness (n=1) or dizziness (n=1) was less than that for air-based foam (P=.002). Incidence of visual disturbance (n=2), although less than that for CO2 (3%) or air (8%), was not significantly different (P>.05).
Conclusions. Lower or similar incidence of side effects was documented following CO2-O2 when compared to CO2 or air-based foam sclerotherapy.