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Titolo:
ARTERIOVENOUS MALFORMATION DRAINING VEIN PHYSIOLOGY AND DETERMINANTS OF TRANSNIDAL PRESSURE-GRADIENTS
Autore:
YOUNG WL; KADER A; PILESPELLMAN J; ORNSTEIN E; STEIN BM;
Indirizzi:
COLUMBIA PRESBYTERIAN MED CTR,161 FT WASHINGTON AVE,DAP 901 NEW YORK NY 10032 COLUMBIA UNIV,COLL PHYS & SURG,DEPT ANESTHESIOL NEW YORK NY 00000 COLUMBIA UNIV,COLL PHYS & SURG,DEPT NEUROL SURG NEW YORK NY 00000 COLUMBIA UNIV,COLL PHYS & SURG,DEPT RADIOL NEW YORK NY 00000
Titolo Testata:
Neurosurgery
fascicolo: 3, volume: 35, anno: 1994,
pagine: 389 - 395
SICI:
0148-396X(1994)35:3<389:AMDVPA>2.0.ZU;2-X
Fonte:
ISI
Lingua:
ENG
Soggetto:
JUGULAR VENOUS COMPRESSION; HEMORRHAGE; RESECTION; EMBOLIZATION; AVMS;
Keywords:
ARTERIOVENOUS MALFORMATION; INTRACEREBRAL PRESSURE; PERFUSION PRESSURE; VENOUS DRAINAGE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
25
Recensione:
Indirizzi per estratti:
Citazione:
W.L. Young et al., "ARTERIOVENOUS MALFORMATION DRAINING VEIN PHYSIOLOGY AND DETERMINANTS OF TRANSNIDAL PRESSURE-GRADIENTS", Neurosurgery, 35(3), 1994, pp. 389-395

Abstract

ARTERIOVENOUS MALFORMATION (AVM) draining vein pressure (DVP) may have an influence on both the natural history of the disease and treatment outcome. The purposes of this study were to assess the relationship between DVP and other clinical and physiological variables and to characterize the transmission of arterial pressure across the AVM nidus, DVP measurements were carried out during elective AVM resection with isoflurane/nitrous oxide anesthesia with arterial carbon dioxide pressure of approximate to 30 mm tig. The gradient between the right atrium and operative measurement site was noted. Pre-excision feeding mean arterial pressure and DVP were measured with a 26-gauge needle simultaneously with systemic mean arterial pressure and central venous pressure (CVP), DVP was tested with systemic mean arterial pressure increased to approximate to 20 mm Hg with phenylephrine or CVP increased with a Valsalva maneuver. Finally, preresection and postresection DVP values were compared. Relative to the site of measurement, DVP was 7 +/- 5 mm Hg at a CVP of -4 +/- 5 mm Hg (n = 45), There was no influence of presentation, presence of deep venous drainage, size, location, or prior embolization on DVP, In 19 patients, DVP decreased (8 +/- 4 to 5 +/- 3;P < 0.05) whereas CVP increased from pre- to postresection (-4 +/- 5 to -2 +/- 5; P< 0.05). For the phenylephrine challenge (n = 11), therewas no difference (P = 0.84) between the Delta DVP (2 +/- 1 mm Hg) and the Delta CVP (2 +/- 3 mm Hg). For the Valsalva maneuver challenge (n = 7), however, Delta CVP (8 +/- 4 mm Hg) was greater (P < 0.02) thanDelta DVP (3 +/- 2 mm Hg). Feeding mean arterial pressure and DVP were positively correlated (y = 0.2x + 2.4; r = 0.59; n = 14; P < 0.05) without any apparent influence of angiographic venous stenosis. Nevertheless, transnidal pressure drop or net cerebral perfusion pressure gradient (i.e., the lowest possible perfusion pressure to which normal adjacent circulatory beds might be exposed) was inversely correlated with AVM size (y = -6.1x + 52.3; r = 0.68; n = 14; P < 0.01). Clinically relevant changes in systemic mean arterial pressure and CVP affect DVPmore as a venous than as an arterial structure. Most importantly, higher feeding mean arterial pressure is associated with higher DVP, but notwithstanding, a lower transnidal pressure gradient is present in larger AVMs. A lower transnidal pressure gradient, which may be associated with certain postoperative hemodynamic complications when transmitted to adjacent capillary beds, also may protect against spontaneous intranidal vessel rupture.

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Documento generato il 05/12/20 alle ore 04:06:03