shu-508 and Peripheral-Vascular-Diseases

Ultrasound contrast agents are not only effective in ultrasonic imaging but are also important tools for drug or gene delivery. Ultrasound beams can disrupt microbubbles and cell membranes, offering the opportunity to locally deliver drugs or genes. Liposome-shelled microbubbles have many advantages and are widely used in many applications, while Lipofectamine (Invitrogen, Life Technologies, Carlsbad, CA, USA), as a material of microbubble membranes, has been used to enhance the effects of gene delivery. Ultrasound contrast agents that have therapeutic effects can be used for treating peripheral vascular diseases, particularly in thrombotic and angiogenic diseases. A combination of targeted contrast agent and drug-carrying contrast agent may be safer and more effective in treating thrombosis. Vascular endothelial growth factor-loaded microbubbles are expected to treat a variety of neovascular diseases such as severe limb ischemia and other diseases. Although there are several limitations in the application of therapeutic ultrasound microbubble contrast agents, it will offer a new hope for the treatment of peripheral vascular disease.

Topics: Albumins; Chemistry, Pharmaceutical; Contrast Media; Drug Delivery Systems; Fluorocarbons; Gene Transfer Techniques; Humans; Indicators and Reagents; Lipids; Microbubbles; Peripheral Vascular Diseases; Phospholipids; Polysaccharides; Safety; Sulfur Hexafluoride; Ultrasonic Therapy; Ultrasonography; Vascular Endothelial Growth Factor A

To estimate the dosage needed for continuous infusion and to investigate whether continuous infusion of the ultrasound contrast-enhancing agent Levovist (SH U 508A) can improve duplex scanning of crural arteries in patients with peripheral arterial obstructive disease (PAOD) eligible for distal bypass graft surgery.. The study design consisted of two parts. Part 1 investigated the color and spectral Doppler scan enhancement of three different Levovist dosages (200, 300, and 400 mg/mL) in one arterial segment of a patent lumen of a crural artery in seven patients with PAOD. Part 2 investigated the value of the optimum Levovist dosage in the assessment of 10 crural arteries in 10 consecutive patients with PAOD. Angiography was the reference standard.. Part 1: Levovist significantly enhanced color and spectral Doppler scan as compared with baseline ultrasound scan, but no differences were found between the Levovist dosages. Thus, the lowest Levovist dosage sufficed for application in part 2, because of its infusion volume and prolonged enhancement time. Part 2: The agreement between contrast-enhanced duplex scanning and angiography was moderate (kappa = 0.50; 95% confidence interval [CI], 0.03-0.97). Five (50%) of 10 crural arteries that could not adequately be visualized with routine duplex scanning could be visualized with contrast-enhanced duplex scanning.. Contrast-enhanced duplex scanning by means of continuous infusion of Levovist in patients with PAOD improves the ultrasound scan investigation of crural arteries in case routine duplex scanning is inconclusive and might reduce the need for angiography.

Topics: Aged; Aged, 80 and over; Angiography; Arterial Occlusive Diseases; Arteries; Blood Vessel Prosthesis Implantation; Contrast Media; Dose-Response Relationship, Drug; Female; Humans; Infusions, Intravenous; Leg; Male; Middle Aged; Peripheral Vascular Diseases; Polysaccharides; Ultrasonography, Doppler, Duplex; Vascular Patency

To determine the magnitude and duration of peripheral vascular and cardiac Doppler signal enhancement after intravenous administration of contrast agent SH U 508A.. Suboptimal cardiac or peripheral vascular Doppler examinations were evaluated. A total of 75 intravenous bolus injections were made in 30 patients. Spectral audio Doppler intensity was measured throughout the duration of contrast effect.. No clinically relevant adverse effects were noted, and Doppler enhancement was apparent in all cases. The diagnostic confidence of the investigators when scored before and after Doppler enhancement improved from 35% to 91% (P < .05). Doppler intensity increased more than 16 dB in all vascular regions investigated (P < .05). The contrast effect lasted for more than 120 seconds in the peripheral vascular and cardiac groups at equivalent doses.. Intravenously administered SH U 508A is effective in markedly increasing cardiac, femoral arterial, and transcranial (cerebral arterial) Doppler signal intensity. The effect improves the clinical diagnostic confidence in cases of suboptimal unenhanced Doppler examinations.

Topics: Cerebral Arterial Diseases; Contrast Media; Echocardiography, Doppler; Female; Femoral Artery; Humans; Injections, Intravenous; Male; Middle Aged; Mitral Valve Insufficiency; Peripheral Vascular Diseases; Polysaccharides; Ultrasonography, Doppler, Transcranial

to evaluate if ultrasound contrast-agent infusion could improve duplex-ultrasound imaging of peripheral arterial disease (PAD) and increase the agreement with digital subtraction arteriography (DSA).. prospective and consecutive study.. of 60 consecutive PAD patients, 15 were found to have an inconclusive duplex-ultrasound scan of the trifurcation and were included in the study. All 15 patients (53% male) were scheduled for DSA, all being candidates for vascular surgery due to claudication (n = 3, 20%), rest pain (n = 5, 33%) and tissue loss (n = 7, 47%).. on the day before DSA, a duplex-ultrasound scan of the trifurcation was performed. If the duplex-ultrasound scan was found inconclusive, it was repeated during continuous ultrasound contrast-agent infusion. DSA was performed unaware of the duplex-ultrasound results and served as the gold standard.. after contrast-agent administration, the number of inconclusively diagnosed segments was significantly reduced by 26 (70%), from 37 to 11(p < 0.001). In 19 segments (73%) contrast-agent infusion changed the diagnosis in accordance with the DSA (p < 0.05). Values of sensitivity and positive predictive value were improved from 0.20 (0.04-0.62) to 0.47 (0.26-0.69) and 0.50 (0.10-0.91) to 0.80 (0.49-0.93), respectively. Specificity and negative predictive value were unchanged. Agreement between duplex-ultrasound and DSA were improved from poor (kappa = 0.18 (95% CI: 0-0.82)) to moderate (kappa = 0.45 (0.17-0.74)) (p = 0.44).. ultrasound contrast-agents improve the diagnostic ability of duplex-ultrasound when scanning difficult arterial segments in patients suffering from PAD.

Topics: Adult; Aged; Aged, 80 and over; Angiography, Digital Subtraction; Arterial Occlusive Diseases; Contrast Media; Female; Humans; Lower Extremity; Male; Middle Aged; Peripheral Vascular Diseases; Polysaccharides; Predictive Value of Tests; Prospective Studies; Tibial Arteries; Ultrasonography, Doppler, Color

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Female; Humans; Male; Middle Aged; Peripheral Vascular Diseases; Polysaccharides; Ultrasonography

To evaluate whether echo-enhancement with Levovist improves the diagnostic confidence of duplex scanning of the iliac arteries.. Sixteen patients admitted for either PTA (n=7) or femoro-femoral cross-over bypass (n=9) were examined with duplex scanning before and after Levovist injection. The diagnostic confidence was noted before and after the echo-enhancement on a visual analog scale. The following day, intraoperatively, an IVUS examination of the iliac artery was performed. The agreement between duplex scanning before and after enhancement compared to IVUS was evaluated by kappa statistics, and sensitivity-specificity calculations.. The diagnostic confidence improved in 50% of the patients, remained unchanged in 44%, and deteriorated in one (6%) patient. The agreement with IVUS was moderate before enhancement (kappa=0.48) and good after the enhancement (kappa=0.63). Sensitivity rose from 64% (before) to 73% (after) Levovist while the specificity was unchanged (100%). These values are not as good as reported by others after fasting of the patients and comparing the results with arteriography.. Levovist improves the diagnostic confidence of duplex scanning, but marginally. In inconclusive duplex scannings echo-enhancement can supply decisive informations.

Topics: Aged; Angioplasty, Balloon; Contrast Media; Female; Humans; Iliac Artery; Male; Peripheral Vascular Diseases; Pilot Projects; Polysaccharides; Sensitivity and Specificity; Ultrasonography, Doppler, Duplex; Ultrasonography, Interventional

Topics: Animals; Contrast Media; Femoral Artery; Humans; Iliac Artery; Leg; Peripheral Vascular Diseases; Polysaccharides; Popliteal Vein; Ultrasonography, Doppler, Color