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Therapeutic application of contrast-enhanced ultrasound and low-dose urokinase for thrombolysis in a porcine model of acute peripheral arterial occlusion Harm P. Ebben, BSc, Johanna H. Nederhoed, MD, Jeroen Slikkerveer, MD, Otto Kamp, MD, PhD, Geert W.J.M. Tangelder, MD, PhD, René J.P. Musters, MD, PhD, Willem Wisselink, MD, PhD, Kak K. Yeung, MD, PhD Journal of Vascular Surgery Volume 62, Issue 2, Pages (August 2015) DOI: /j.jvs Copyright © 2015 Society for Vascular Surgery Terms and Conditions
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Fig 1 Overview of the experimental protocol. A, Diagram shows the experimental setting, with the pig lying supine and the site of occlusion highlighted (inset). Location of microcirculation, limb pressure, and flow measurements are shown. B, Experimental protocol over time (minutes) is shown, with each small vertical line on the x-axis representing a measurement point. The arrow corresponds to t = 0 (ie, the moment of initiation of therapy, after which immediate measurement followed). B, Baseline; S, stabilization period (10 minutes). , stenosis is created; , induction of thrombus; , release of the proximal clamp; and , release of the distal clamp. Journal of Vascular Surgery , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions
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Fig 2 Arterial blood flow is shown for individual pigs. The top of the graph shows mean systemic and limb arterial pressures. See Table II for symbols corresponding to pig identifications. The white symbols depict partial occlusion at the moment of initiation of therapy, and the black symbols depict complete occlusion. The arrow corresponds to t = 0 (ie, the moment of initiation of therapy, after which immediate measurement followed). S, Stabilization period; , release of the distal clamp;, administration of 1 vial of microbubbles; baseline flow (flow after creating a stenosis) is not shown here. Journal of Vascular Surgery , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions
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Fig 3 Mean microcirculation curves. The two main groups (ie, based on therapy) are each divided in two subgroups, depending on whether there was total or partial occlusion at the moment of initiation of therapy. The white symbols depict pigs treated with urokinase-only (UK) and the black symbols depict pigs treated with urokinase plus microbubbles (UK+). The large arrow corresponds to the moment of initiation of therapy. The continuous line depicts pigs with total occlusion, and the dashed line depicts pigs with partial occlusion at the moment of initiation of therapy. , Release of the distal clamp;, administration of 1 vial of microbubbles; baseline flow (flow after creating a stenosis) is not shown here. PU, Perfusion units. Journal of Vascular Surgery , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions
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Fig 4 Thrombus weights at necropsy (A) grouped and for (B) individual pigs. A, The horizontal line in the middle of each box indicates the median; the top and bottom borders of the box mark the 75th and 25th percentiles, respectively, and the whiskers mark the 90th and 10th percentiles. B, *Indicates pigs in which only partial occlusion was reached before initiation of therapy. Note the difference in the y-axis between (A) grouped and (B) individual figures. UK, Urokinase-only group, dark columns; UK+, urokinase plus microbubbles group, light columns. Journal of Vascular Surgery , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions
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