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Sample records for innominate artery occlusive

  1. Double steal phenomenon secondary to innominate artery occlusion.

    PubMed

    Esen, Kaan; Yilmaz, Cengiz; Kaya, Omer; Soker, Gokhan; Gulek, Bozkurt; Sahin, Durmus Yildiray

    2016-07-01

    Innominate artery steno-occlusive disease is a relatively rare clinical entity and may cause cerebrovascular symptoms. Herein, we report a 50-year-old male patient who presented with recurrent syncopal episodes and cerebrovascular ischemia. Color Doppler sonography revealed a distinctive flow pattern with partial and total flow reversal in the right internal carotid artery and vertebral artery, respectively. Further angiographic evaluation revealed complete occlusion of the innominate artery. Endovascular stenting was successful and enabled normal antegrade flow in the right common carotid and vertebral artery. PMID:27107766

  2. Primary Stenting of Subclavian and Innominate Artery Occlusive Disease: A Single Center's Experience

    SciTech Connect

    Brountzos, E. N. Petersen, B.; Binkert, C.; Panagiotou, I.; Kaufman, J. A.

    2004-11-15

    Purpose: To review immediate and midterm results of primary stenting for innominate and subclavian artery occlusive lesions. Methods: Retrospective data were collected from 48 consecutive symptomatic patients (27 men and 21 women, median age 64 years) having 49 subclavian and innominate artery lesions treated with stenting. Of the patients 52% had concomitant ischemic heart disease, and 30% had carotid and/or vertebral artery disease. Indication for treatment was vertebrobasilar insufficiency (VBI) in 16.6% of the patients; upper limb ischemia (ULI) in 31.3%; VBI and ULI in 12.5%; transient ischemic attack in 16.7%; angina in 12.5% before or after left internal mammary artery-to-coronary artery bypass grafting; and leg claudication in 10.4% before or after axillofemoral bypass grafting. Balloon-expandable stents were used in 44 lesions and self-expandable stents in 5 lesions. In total, 53 stents were placed in 48 patients. Results: Technical success was 96%, and clinical success 94%. We encountered four complications (two puncture site hematomas, one distal hand embolization and one transient cerebral ischemia). Two patients died within 30 days from other causes, and seven patients were lost to follow-up. Mean follow-up time was 16.7 months (range 0.3 to 68.2). Five patients had recurrent lesions treated by surgical (n = 2) or endovascular (n = 3) means. Cumulative primary patency rate was 91.7% and 77% at 12 and 24 months, respectively. Cumulative secondary patency rate was 96.5% and 91.7% at 12 and 24 months, respectively. Conclusion: Stenting of subclavian and innominate artery lesions resulted in immediate resolution of patients' symptoms with durable midterm effect and few complications in a larger patient group with serious comorbid conditions.

  3. Spontaneous Early Recanalization after Acute Innominate Artery Thromboembolic Occlusion Secondary to Abrupt Aspirin and Statin Discontinuation A Case Report

    PubMed Central

    Tsai, C-K; Lee, J-T; Wu, Y-C; Peng, G-S

    2014-01-01

    ABSTRACT Statin and antiplatelet drugs are widely used for prevention of ischaemic stroke and other cardiovascular diseases in high-risk patients. We report a rare case of a 49-year old man with a history of myocardial infarction and hyperlipidaemia who suffered an acute occlusion of his innominate artery (IA) accompanied by subclavian steal syndrome and cerebral infarction, on day seven after abrupt cessation of aspirin and statin, as confirmed by magnetic resonance and computed tomographic angiography of head and neck, and colour-coded Duplex ultrasonography (CCDU). Aspirin and atorvastatin were immediately re-started on admission. Spontaneous recanalization of IA was shown on repeat CCDU and digital subtraction angiography on day 10 after stroke onset. This case serves as a reminder that abrupt discontinuation of both aspirin and statin in patients with previous history of cardiovascular disease may increase the risk of ischaemic stroke. PMID:25781297

  4. A case with tracheo-innominate artery fistula. Successful management of endovascular embolization of innominate artery.

    PubMed

    Takasaki, Kenji; Enatsu, Kaori; Nakayama, Masahiko; Uchida, Takatoshi; Takahashi, Haruo

    2005-06-01

    Tracheo-innominate artery fistula (TIF) is known as a fatal complication after tracheostomy. We report a 9-year-old girl with early hypoxic encephalopathy who had a tracheo-innominate artery fistula with exsanguinating hemorrhage from her tracheostoma 10 months after tracheostomy. After temporary control of bleeding, embolization of the innominate artery was performed. The patient has remained well 1 year after the procedure. We reviewed the aetiology, diagnosis and management of the tracheo-innominate fistula, and findings suggest that endovascular embolization of the innominate artery may be an appropriate treatment for patients with tracheo-innominate artery fistula. PMID:15917179

  5. Management of trachea--innominate artery fistula.

    PubMed

    Ramesh, M; Gazzaniga, A B

    1978-01-01

    The case histories of three patients with trachea-innominate artery fistula are presented. Low tracheostomy was the etiologic factor producing the fistula in two patients. In both cases, the neck was hyperextended by placing a large roll behind the patient's shoulders and thereby elevating the trachea out of the mediastinum. In one patient a balloon cuff eroded the innominate artery. Management of these patients includes control of hemorrhage by cuff overinflation and/or by endotracheal intubation and packing of the tracheostomy site. The best surgical approach is via a right anterior thoracotomy and a separate neck incision to isolate the blood vessels involved. Median sternotomy should be avoided to prevent mediastinal infection and sternal dehiscence. Carotid stump pressures are a useful guide to determine the efficacy of innominate artery ligation. One patient was saved and is a long-term survivor. PMID:339003

  6. Damage control management of innominate artery injury with tracheostomy.

    PubMed

    Okada, Yohei; Narumiya, Hiromichi; Ishii, Wataru; Ryoji, Iiduka

    2016-12-01

    Innominate artery injury is a rare, but catastrophic complication of tracheostomy. We present a case of severe hemorrhagic shock in a 79-year-old male with innominate artery injury that occurred during tracheostomy. Despite temporary innominate artery isolation, the regional forehead saturation was 60 % without laterality. Because adequate cerebral blood flow was apparently maintained through collateral flow, we ligated the innominate, right carotid, and subclavian arteries. We confirmed adequate blood flow to the brain and the right subclavian artery through collateral circulation after ligation using computed tomographic angiography. A damage control management, which involves ligating the injured innominate artery to arrest hemorrhage and monitoring regional forehead saturation for brain ischemia, can be a considerable procedure for the treatment of severe hemorrhagic shock due to innominate artery injury. PMID:26943693

  7. Suprasternal approach for impending tracheo-innominate artery fistula.

    PubMed

    Fujimoto, Yoshifumi; Hirose, Keiichi; Ota, Noritaka; Murata, Masaya; Ide, Yujiro; Tosaka, Yuko; Tachi, Maiko; Sakamoto, Kisaburo

    2010-09-01

    We report preventive innominate artery division or ligation through a suprasternal approach for impending tracheo-innominate artery fistula (TIF) with recurrent airway oozing in patients with severe neuromuscular disease. Our approach is less invasive and a favorable procedure as preventive surgery for impending TIF. PMID:20859729

  8. Trachea--innominate artery fistula following tracheostomy. Successful repair using an innominate vein graft.

    PubMed

    Nunn, D B; Sanchez-Salazar, A A; McCullagh, J M; Renard, A

    1975-12-01

    This report discusses the first recorded patient in whom a trachea--innominate artery fistula after tracheostomy was treated successfully by resection of the eroded segment of artery followed by graft replacement using the patient's left innominate vein. The mechanism of vessel erosion and its prevention are discussed. Also, suitable methods are presented for obtaining temporary control of the severe hemorrhage associated with a tracheoarterial fistula while simultaneously maintaining an adequate airway. PMID:1108817

  9. Tracheo-innominate artery fistula in children with high-lying innominate artery.

    PubMed

    Chittithavorn, Voravit; Rergkliang, Chareonkiat; Chetpaophan, Apirak; Vasinanukorn, Prasert

    2006-12-01

    Tracheo-innominate artery fistula (TIF) is an uncommon but frequently fatal complication of tracheostomy. Significant airway hemorrhage usually occurs after premonitory bleeding. When massive bleeding occurs, immediate control of arterial bleeding, control of the airway and subsequent definite treatment are the principles for saving lives. Without prompt surgical intervention, the outcome of this complication is grave. Physicians should maintain a high index of suspicion of TIF in any patient with a recent tracheostomy and subsequent tracheal hemorrhage. PMID:17130330

  10. [Patient with innominate artery steal accompanied with cerebral infarction].

    PubMed

    Yasuda, Takashi; Kobayashi, Kenji; Takahashi, Wakoh; Takizawa, Shunya; Kanabuchi, Kazuo; Takagi, Shigeharu

    2007-10-01

    A 49-year-old man suddenly suffered left hemiplegia, and was brought to our hospital by ambulance at the beginning of August, 2006. He had a history of hypertension, and had received replacement of a synthetic graft in the ascending aorta and aortic arch with innominate artery for dissecting aneurysm in the aorta 2 years before. On diffusion-weighted magnetic resonance images obtained after admission, cerebral infarction was detected at the right corona radiata, and MR angiography (MRA) showed obstruction of the right middle cerebral artery. He was given intravenous tissue-plasminogen activator (t-PA) a few hours after arrival, and his hemiplegia was improved on the following day. At 11 days after onset, recanalization of the right middle cerebral artery was seen by MRA. On Doppler ultrasonographic examination, obstruction and thrombus in the innominate artery were observed. Retrograde flow of the right vertebral artery was demonstrated by both pulse-Doppler ultrasonography and velocity-coded color MRA. This patient is a rare example of innominate artery steal and ischemic cerebrovascular disease with obstruction of the innominate artery. Cerebral infarction in this patient might have developed via artery-to-artery embolism, with the thrombus in the innominate artery, rather than through a hemodynamic mechanism with innominate artery steal. PMID:18095497

  11. Endovascular repair of tracheo-innominate artery fistula.

    PubMed

    Wang, Po-Kai; Yen, Pao-Sheng; Shyr, Ming-Hwang; Chen, Tsung-Ying; Chen, Albert; Liu, Hsu-Tang

    2009-03-01

    Innominate arterial wall rupture with pseudoaneurysm formation was found during angiography in a 39-year-old woman 2 days after she had undergone percutaneous dilatational tracheostomy. Endovascular stent surgery and balloon angioplasty were performed but these procedures failed to control the massive bleeding resulting from an endoleak. We report the clinical presentations and describe the treatment of a tracheo-innominate artery fistula in our patient. We also reviewed the algorithms of management and the rescue options for treating a tracheo-innominate artery fistula. PMID:19318299

  12. Trachea-innominate artery fistula: retrospective comparison of treatment methods.

    PubMed

    Yang, F Y; Criado, E; Schwartz, J A; Keagy, B A; Wilcox, B R

    1988-06-01

    A fistula between the trachea and the innominate artery, a potentially fatal complication of tracheostomy, can be managed successfully. We have derived several guidelines from our experience with one such case and from a review of the 36 cases reported in the literature over the last decade. Diagnosis must be established before exsanguination occurs. Bronchoscopy and angiography are often nondiagnostic. Control of hemorrhage and a patent airway are the initial goals of treatment. Interruption of the innominate artery is the definitive treatment, with a low rebleeding rate (7%, 1/14 cases) and good long-term survival (64%, 9/14 cases). Maintenance of continuity of the innominate artery is contraindicated, because of a high rebleeding rate (60%, 6/10 cases) and poor long-term survival (10%, 1/10 cases). There is no convincing evidence that interruption of the innominate artery causes significant neurologic or vascular compromise. PMID:3287639

  13. Operative technique for tracheo-innominate artery fistula repair.

    PubMed

    Furukawa, Kojiro; Kamohara, Keiji; Itoh, Manabu; Morokuma, Hiroyuki; Morita, Shigeki

    2014-04-01

    Tracheo-innominate artery fistula is fatal unless treated surgically. We describe our surgical approach and results in seven patients. The average patient age was 15.7 years; all patients had prior severe neurological deficits. Three of seven patients were in hemorrhagic shock; control of preoperative bleeding was achieved with tracheostomy tube cuff overinflation. The innominate artery and the trachea were exposed through a collar incision and partial upper sternotomy. The innominate artery was divided at the aortic arch and at the bifurcation, with one exception. Cerebral blood flow was monitored by the blood pressure difference in the bilateral upper extremities and by near-infrared spectroscopy. The tracheal fistula was left adherent to the innominate artery in all but one patient. All patients were discharged without new neurologic deficits or severe morbidity. Overall survival was 84% at 37 months, without any vascular, tracheal, or neurological events. PMID:24239114

  14. Late cataclysmic hemorrhage from the innominate artery after tracheostomy.

    PubMed

    Hafez, A; Couraud, L; Velly, J F; Bruneteau, A

    1984-10-01

    We report on 12 patients sustaining late cataclysmic hemorrhage as a complication of tracheostomy or endotracheal intubation, resulting from erosion of the innominate artery. Four long-term survivors are reported. A number of surgical techniques was used and up-to-date management is briefly described. Our technique mainly consists of transecting and suturing the innominate artery without prior debridement. Innominate artery blood flow was not reestablished in all patients, thereby avoiding local wound infection and recurrence of hemorrhage. Initial temporary control of bleeding was achieved either by hyperinflation of the cuff of the tracheostomy tube, or finger compression of the innominate artery against the sternal notch. Definite surgical repair of this lesion and reestablishment of innominate artery flow is carried out through complete sternotomy in combination with right cervical extension which is considered the incision of choice by the authors. To prevent this unusual and lethal complication, tracheostomy should not be used without proper indication and technical errors of its performance, such as placing it lower than the level of third tracheal ring, must be avoided. PMID:6083623

  15. Acute arterial occlusion - kidney

    MedlinePlus

    ... arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury ...

  16. A surgical procedure to prevent tracheo-innominate artery erosion.

    PubMed

    Dellon, A L; Wells, J H; Cowley, R A

    1978-07-01

    The innominate artery of a patient requiring prolonged mechanical ventilation was palpated in the inferior portion of his tracheostomy wound. Life-threatening hemorrhage was prevented by rotation of a local muscle flap the protect the artery and rotation of pedicled skin flaps to create a permanent tracheostomy. PMID:353296

  17. Acute arterial occlusion - kidney

    MedlinePlus

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidneys need a good blood supply. The main artery to the kidney is called the renal artery. ...

  18. Anomalous origin of the left innominate (brachiocephalic) artery in the right aortic arch: How can it be anomalous when the left innominate artery is absent?

    PubMed Central

    Raimondi, Francesca; Bonnet, Damien; Geva, Tal; Sanders, Stephen P

    2016-01-01

    An unusual case of a rare vascular ring, which has been called right aortic arch with aberrant left innominate artery, is presented. The appearance of this case led to the realization that there is really no innominate artery present in this anomaly but only the left dorsal aorta. We present a clarification of the nature and likely development of the vessels present. PMID:27212855

  19. Successful management of tracheo-innominate artery fistula with endovascular stent graft repair.

    PubMed

    Deguchi, J; Furuya, T; Tanaka, N; Nobori, M; Seki, Y; Nomura, Y; Umehara, I; Saito, H; Miyata, T

    2001-06-01

    Tracheo-innominate artery fistula is a highly lethal complication after tracheostomy. A 37-year-old man who had undergone a tracheostomy 14 years earlier because of dysphagia after brain surgery had a tracheo-innominate artery fistula with exsanguinating hemorrhage from his tracheostomy site. After temporary control of the bleeding, a stent graft was implanted in the innominate artery through the brachial artery. The patient recovered uneventfully and remained well 14 months after the procedure, with no sign of infection. Endovascular stent grafting may be the treatment of choice for patients with tracheo-innominate artery fistula. PMID:11389430

  20. Endovascular Treatment of a Ruptured Innominate Artery Aneurysm in Behcet Disease.

    PubMed

    Tsuda, Kazumasa; Ohkura, Kazuhiro; Shintani, Tsunehiro; Saito, Takaaki; Shiiya, Norihiko

    2016-05-01

    In Behcet disease (BD), vascular complication such as false aneurysm formation is common after surgical treatment in the arterial lesion, and the optimal treatment method remains controversial. Concerning the innominate artery aneurysm, lack of experience due to its rarity in vasculo BD makes decision making even more difficult. We report a ruptured innominate artery aneurysm in a 70-year-old man with BD, which was successfully treated by innominate artery stent grafting through the right common carotid artery, axillo-axillary artery bypass grafting, and right subclavian artery coil embolization. The patient is doing well without any vascular complications at eighth postoperative month. PMID:26907373

  1. Surgical repair for tracheo-innominate artery fistula with a muscle flap.

    PubMed

    Sawamura, Yoshihiro; Takase, Kei; Higuchi, Norio; Kikuchi, Sekinori; Ito, Takashi; Tabayashi, Koichi

    2003-11-01

    A 70-year-old woman was quickly diagnosed as having tracheo-innominate artery fistula by three-dimensional computed tomography. Immediate surgical exploration was performed to control the bleeding using a temporary shunt. After the damaged artery was excised, vascular reconstruction was performed to preserve the connection between the proximal and distal ends of the innominate artery with the interposition of a saphenous vein graft. A pedicled sternocleidomastoid muscle flap was successfully used for the tracheal reconstruction. PMID:14650597

  2. Vertebrobasilar Artery Occlusion

    PubMed Central

    Schoen, Jessica C.; Boysen, Megan M.; Warren, Chase R.; Chakravarthy, Bharath; Lotfipour, Shahram

    2011-01-01

    The presentation of vertebrobasilar artery occlusion varies with the cause of occlusion and location of ischemia. This often results in delay in diagnosis. Areas of the brain supplied by the posterior circulation are difficult to visualize and usually require angiography or magnetic resonance imaging. Intravenous thrombolysis and local-intra arterial thrombolysis are the most common treatment approaches used. Recanalization of the occluded vessel significantly improves morbidity and mortality. Here we present a review of the literature and a case of a patient with altered mental status caused by vertebrobasilar artery occlusion. PMID:21691534

  3. Tracheo-innominate artery fistula successfully treated by endovascular stent-graft repair.

    PubMed

    Nakai, Motoki; Sato, Hirotatsu; Sato, Morio; Ikoma, Akira; Sanda, Hiroki; Nakata, Kohei; Minamiguchi, Hiroki; Kawai, Nobuyuki; Sonomura, Tetsuo; Nishimura, Yoshiharu; Okamura, Yoshitaka

    2013-01-01

    We report two patients who developed a tracheo-innominate artery fistula (TIF) after tracheostomy. Contrast-enhanced computed tomography revealed a pseudoaneurysm of the innominate artery protruding into the trachea. Stent grafts were deployed for the innominate artery via two different access routes: the transfemoral approach and the right carotid artery approach. Endovascular stent-graft repair resulted in complete exclusion of the TIF and control of the bleeding from the tracheal stoma. At 12- and 16-month follow-ups, neither patient had clinical signs of graft infection, recurrent fistulization, or ischemic complications. It is feasible and useful to employ the carotid artery approach for stent-graft implantation in patients who have vascular anatomical limitations for the transfemoral approach. Endovascular repair of TIF by stent grafting is a minimally invasive treatment that can be tolerated by patients in poor clinical condition, and is a feasible alternative to surgical treatment. PMID:23065488

  4. [Endotracheal hemorrhage caused by fissuration of the innominate artery during prolonged intubation. Surgical treatment].

    PubMed

    Couraud, L; Hafez, A; Velly, J F

    1984-11-24

    We present our surgical procedure for the control of tracheal haemorrhages due to fissuration of the innominate artery in patients with prolonged tracheal intubation or tracheostomy. Temporary haemostasis and protection of the airways against flooding are ensured by downward advancement of the tube, overinflation of the cuffs and digital pressure if required. The fistula is then located and surgical haemostasis is obtained by resection of the innominate artery away from the infected area. The arterial stumps are covered up for protection against secondary infection. Re-establishment of blood flow is not systematic. Cervicosternotomy is regarded as the incision of choice. No complication was encountered in patients treated by this method. PMID:6239257

  5. Delayed sternal closure after vacuum-assisted closure therapy for tracheo-innominate artery fistula repair.

    PubMed

    Suzuki, Ryo; Mikamo, Akihito; Kurazumi, Hiroshi; Hamano, Kimikazu

    2011-08-01

    We report a case of successful innominate artery resection with delayed sternal closure after vacuum-assisted closure (VAC) therapy for a tracheo-innominate artery fistula (TIF). A 42-year-old woman with cerebral palsy underwent tracheostomy for respiratory assistance. On postoperative day 14, she was transferred to our hospital after an episode of massive hemoptysis. TIF was diagnosed based on the findings of multidetector computed tomography. Thus, we resected the innominate artery and started VAC therapy to control the postoperative local infection. The patient recovered uneventfully, without any infectious sequelae. Our strategy, which includes VAC therapy, for TIF repair may eliminate postoperative infective problems that could induce sequential bleeding and sternal compromise. To our knowledge, this is the first report of using VAC therapy for TIF. PMID:21628318

  6. Endovascular treatment of an innominate artery iatrogenic pseudoaneurysm following subclavian vein catheterization.

    PubMed

    de Troia, Alessandro; Tecchio, Tiziano; Azzarone, Matteo; Biasi, Lukla; Piazza, Paolo; Franco Salcuni, Pier

    2011-01-01

    Central venous catheterization is routinely required in a wide range of clinical situations such as hemodynamic monitoring, delivery of blood products and drugs, hemodialysis, total parental nutrition, and management of perioperative fluids. Pseudoaneurysms account for 4% of all innominate artery aneurysms. Clinical presentation may include airway and neurological compression, chest pain, mediastinal syndrome, upper limb ischemia, and hemodynamic instability. We report what we believe is the first documented case of a successful endovascular stent-graft repair of an innominate artery iatrogenic pseudoaneurysm. PMID:21193466

  7. [Management of tracheo-innominate artery erosions following tracheal resection (author's transl)].

    PubMed

    Moritz, E

    1978-06-01

    The most important points in preventing innominate artery erosions following tracheostomy are proper placement of the stoma and selection of flexible tubes with appropriate low pressure cuffs. In tracheal resections the risk of a tracheo-innominate artery fistula can be reduced by avoiding damage to the adventitia of the artery fibrosed to the stenotic tracheal segment and by interposing tissue between artery and anastomosis. If haemorrhage occurs this can be controlled by hyperinflation of a cuffed endotracheal tube in most cases. Permanent control of this complication can be achieved by resection of the artery without interposing a vascular graft. No cerebral damage will result. A great number of patients can be saved by the timely institution of proper measures. PMID:351971

  8. Tracheo-innominate artery erosion: Successful surgical management of a devastating complication.

    PubMed Central

    Jones, J W; Reynolds, M; Hewitt, R L; Drapanas, T

    1976-01-01

    Successful management of a patient with tracheo-innominate artery erosion requires the rapid institution of specific resuscitative and operative measures. Ten patients seen at the Charity Hospital of Louisiana in New Orleans and 127 documented cases from the world literature were analyzed regarding predisposing factors, diagnostic features, resuscitative measures and operative treatment. Diagnoses associated with abnormal neck positioning were seen in 48% of patients with tracheo-innominate erosions. In 69% of 96 instances, the site of erosion was located at the cannula end and implicates excessive anterior pressure. Caution is recommended in those patients with abnormal neck positions, low placed tracheostomy stomas and individuals with asthenic habitus. Resuscitative measures were highly successful when the tracheal ballon was inflated or when the method of retrosternal finger pressure was used. All personnel providing care for patients with tracheostomies should be aware of the initial measure of ballon inflation. Operative measures which permanently interrupted the innominate artery in the area of possible future erosion were the most successful. Of the 22 cases in which the innominate artery was sacrificed, only one had evidence of cerebral ischemia. Timely institution of proper measures can result in salvage of an unexpected number of these otherwise dramatic fatalities. Images Fig. 2. Fig. 3. Fig. 8. Fig. 9. Fig. 10. PMID:782389

  9. Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review.

    PubMed

    Grant, C A; Dempsey, G; Harrison, J; Jones, T

    2006-01-01

    Tracheo-innominate artery fistula (TIF) is an uncommon yet life threatening complication after a tracheostomy. Rates of 0.1-1% after surgical tracheostomy have been reported, with a peak incidence at 7-14 days post procedure. It is usually fatal unless treatment is instituted immediately. Initial case reports of TIF resulted from surgically performed tracheostomies. We present three fatalities attributable to TIF, confirmed by histopathology, after percutaneous dilatational tracheostomy (PDT). The use of PDT has resulted in tracheostomies being performed by specialists from different backgrounds and the incidence of this complication may be increasing. Pressure necrosis from high cuff pressure, mucosal trauma from malpositioned cannula tip, low tracheal incision, radiotherapy and prolonged intubation are all implicated in TIF formation. Massive haemorrhage occurring 3 days to 6 weeks after tracheostomy is a result of TIF until proven otherwise. We present a simple algorithm for management of this situation. The manoeuvres outlined will control bleeding in more than 80% of patients by a direct tamponade effect. Surgical stasis is obtained by debriding the innominate artery proximally, then transecting and closing the lumen. Neurological sequelae are few. Post-mortem diagnosis of TIF may be difficult, but specific pathology request should be made to assess innominate artery abnormalities. PMID:16299043

  10. Treatment of Tracheoinnominate Fistula with Ligation of the Innominate Artery: A Case Report

    PubMed Central

    Menen, Rhiana S; Pak, Jimmy J; Dowell, Matthew A; Patel, Ashish R; Ashiku, Simon K; Velotta, Jeffrey B

    2016-01-01

    Introduction: Tracheoinnominate fistula, a rare complication of tracheostomy, carries high mortality regardless of treatment; therefore prevention and quick diagnosis is pertinent to survival. Case Presentation: A 76-year-old man who underwent emergent tracheostomy placement presented on postoperative day 10 with massive hemorrhage concerning for tracheoinnominate fistula and was treated with median sternotomy and ligation of the innominate artery. Discussion: This presentation describes a concise diagnosis and treatment plan for a rare event. The key to good outcomes is quick diagnosis and urgent surgical intervention. PMID:27352412

  11. Occlusive Peripheral Arterial Disease

    MedlinePlus

    ... artery. Such people should seek medical care immediately. Did You Know... When people suddenly develop a painful, ... In This Article Animation 1 Peripheral Arterial Disease Did You Know 1 Did You Know... Figure 1 ...

  12. Retinal artery occlusion

    MedlinePlus

    ... These blockages are more likely if there is hardening of the arteries ( atherosclerosis ) in the eye. Clots ... Blindness and vision loss Blood clots Diabetes Glaucoma Hardening of the arteries High blood cholesterol levels High ...

  13. [Experience of 3 successfully treated cases of tracheo-innominate artery fistula and significance of preventive surgery].

    PubMed

    Kawahito, Tomohisa; Takano, Shinji; Egawa, Yoshiyasu; Yoshida, Homare

    2012-12-01

    Tracheo-innominate artery fistula (TIF) is a rare but fatal complication after tracheostomy. Necessary lifesaving measures include proper ventilation, temporary hemostasis, and surgery. Recently, we successfully managed 3 cases of TIF. Ventilation and temporary hemostasis were secured by a long endotracheal tube and overinflated cuff. Division of the innominate artery, restoration of the tracheal fistula with an autologous pericardial patch or direct closure, and aorto-innominate bypass grafting or extra-anatomical bypass grafting with a polytetrafluoroethylene (PTFE) graft were performed through an emergency median sternotomy. All 3 patients recovered with no problems. After TIF occurs, the patient's condition rapidly worsens, and the risk of bacterial contamination in the operative field may increase. Surgical intervention should be performed for patients with tracheal stenosis who are judged to be at high risk for TIF. This preventive surgery includes bypass grafting to divide the innominate artery and partial resection of the anterior bony thorax(upper sternum, medial part of clavicles, and anterior part of upper ribs if necessary). We believe that this procedure will improve tracheal stenosis and minimize the risk of TIF. Thus far, 10 patients have undergone this operation, and their mid-term results are satisfactory. PMID:23202704

  14. Concurrence of the tortuosity of bilateral common and left internal carotid arteries in a case with common origin of the innominate trunk and left common carotid artery.

    PubMed

    Yildiz, Sema; Cece, Hasan; Karayol, Sibel; Ziylan, Zeki

    2010-10-01

    Anatomical variations of carotid arterial system, which are not infrequently encountered, have great impact on the surgical approaches of the neck. Although few reports on common carotid artery tortuosity have been published, no case of symptomatic concurrent common carotid and internal carotid artery tortuosity has been reported. Herein, we report the first case with concurrent common origin of the innominate trunk and left common carotid artery and common and internal carotid artery tortuosity presenting with an oropharyngeal mass. PMID:20407773

  15. ACUTE RETINAL ARTERIAL OCCLUSIVE DISORDERS

    PubMed Central

    Hayreh, Sohan Singh

    2011-01-01

    The initial section deals with basic sciences; among the various topics briefly discussed are the anatomical features of ophthalmic, central retinal and cilioretinal arteries which may play a role in acute retinal arterial ischemic disorders. Crucial information required in the management of central retinal artery occlusion (CRAO) is the length of time the retina can survive following that. An experimental study shows that CRAO for 97 minutes produces no detectable permanent retinal damage but there is a progressive ischemic damage thereafter, and by 4 hours the retina has suffered irreversible damage. In the clinical section, I discuss at length various controversies on acute retinal arterial ischemic disorders. Classification of acute retinal arterial ischemic disorders These are of 4 types: CRAO, branch retinal artery occlusion (BRAO), cotton wools spots and amaurosis fugax. Both CRAO and BRAO further comprise multiple clinical entities. Contrary to the universal belief, pathogenetically, clinically and for management, CRAO is not one clinical entity but 4 distinct clinical entities – non-arteritic CRAO, non-arteritic CRAO with cilioretinal artery sparing, arteritic CRAO associated with giant cell arteritis (GCA) and transient non-arteritic CRAO. Similarly, BRAO comprises permanent BRAO, transient BRAO and cilioretinal artery occlusion (CLRAO), and the latter further consists of 3 distinct clinical entities - non-arteritic CLRAO alone, non-arteritic CLRAO associated with central retinal vein occlusion and arteritic CLRAO associated with GCA. Understanding these classifications is essential to comprehend fully various aspects of these disorders. Central retinal artery occlusion The pathogeneses, clinical features and management of the various types of CRAO are discussed in detail. Contrary to the prevalent belief, spontaneous improvement in both visual acuity and visual fields does occur, mainly during the first 7 days. The incidence of spontaneous visual

  16. Genetic network identifies novel pathways contributing to atherosclerosis susceptibility in the innominate artery

    PubMed Central

    2014-01-01

    Background Atherosclerosis, the underlying cause of cardiovascular disease, results from both genetic and environmental factors. Methods In the current study we take a systems-based approach using weighted gene co-expression analysis to identify a candidate pathway of genes related to atherosclerosis. Bioinformatic analyses are performed to identify candidate genes and interactions and several novel genes are characterized using in-vitro studies. Results We identify 1 coexpression module associated with innominate artery atherosclerosis that is also enriched for inflammatory and macrophage gene signatures. Using a series of bioinformatics analysis, we further prioritize the genes in this pathway and identify Cd44 as a critical mediator of the atherosclerosis. We validate our predictions generated by the network analysis using Cd44 knockout mice. Conclusion These results indicate that alterations in Cd44 expression mediate inflammation through a complex transcriptional network involving a number of previously uncharacterized genes. PMID:25115202

  17. Right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle and ventricular septal defect.

    PubMed

    Mangukia, Chirantan; Sethi, Sonali; Agarwal, Saket; Mishra, Smita; Satsangi, Deepak Kumar

    2014-05-01

    Herein, we report an unusual case of right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle with ventricular septal defect. The blood supply to the innominate artery was by a collateral arising from the descending aorta. The embryological development of this anomaly can be explained by the hypothetical double aortic arch model proposed by Edwards with interruption of the arch at two levels. PMID:24987265

  18. Vertebral artery occlusion and oral contraceptives.

    PubMed Central

    Ask-Upmark, E; Bickerstaff, E R

    1976-01-01

    If vertebral artery occlusion occurs in degenerative arterial disease it is almost invariably left-sided, but in vertebral artery deficiency syndromes associated with oral contraceptives a striking preponderance of right-sided involvement has been shown. This observation adds support to the view that causes other than changes in the wall of the vessel at the site of occlusion must be sought as an explanation of the occlusion. PMID:1252812

  19. Innominate artery injury: a catastrophic complication of tracheostomy, operative procedure revisited

    PubMed Central

    Maruti Pol, Manjunath; Gupta, Amit; Kumar, Subodh; Mishra, Biplab

    2014-01-01

    A patient presented with profuse bleeding from the oronasal cavity following orofaciomaxillary trauma associated with tracheolaryngeal injury and suspected cervical-spine injury due to collapse of a wall on the face, neck and upper chest. The patient was gasping, coughing blood and was unable to speak. Threatened airway was diagnosed. Inability to maintain oxygenation on cricothyroidotomy, forced emergency department surgeons to shift the patient to the operating room for definitive airway. During tracheostomy a major vessel was injured. Application of vascular clamp in the event of achieving haemostasis resulted in disappearance of saturation and pulse in the right upper limb, thus we suspected innominate artery (IA) injury. High tracheostomy performed and endotracheal tube passed into the trachea after removing clot and overcoming compromised narrow tracheal lumen. The injured IA was repaired and the patient survived for 14 days. On postoperative day 14 he died following profound bleeding into the tracheobronchial tree and asphyxia/apnoea. Tracheoinnominate artery fistula was detected at autopsy. PMID:24700033

  20. Bilateral mechanical rotational vertebral artery occlusion.

    PubMed

    Dargon, Phong T; Liang, Conrad W; Kohal, Anmol; Dogan, Aclan; Barnwell, Stanley L; Landry, Gregory J

    2013-10-01

    Rotational vertebral artery occlusion, or bow hunter's stroke, is reversible, positional symptomatic vertebrobasilar ischemia. The typical mechanism of action is obstruction of a dominant vertebral artery with contralateral head rotation in the setting of baseline ipsilateral vertebral artery stenosis or occlusion. Here we present a rare case of mechanical occlusion of bilateral patent vertebral arteries manifesting as near syncope with rightward head rotation. Diagnostic cerebral angiography showed dynamic right C5 vertebral occlusion and left C2 vertebral occlusion. The patient underwent right C4/5 transverse process decompression. Postoperative angiogram showed patent flow through the right vertebral artery in neutral position and with head turn with resultant resolution of symptoms. PMID:23465174

  1. Hybrid Interventional Treatment of Iatrogenic Innominate Artery Aneurysm in a Child.

    PubMed

    Paczkowski, Konrad; Haponiuk, Ireneusz; Chojnicki, Maciej; Brzezińska-Rajszys, Grażyna

    2016-01-01

    An iatrogenic aneurysm of an innominate artery is an extremely rare complication, especially in children. Nevertheless, this pathology was diagnosed in a child given palliative care with chronic respiratory insufficiency and a history of encephalitis requiring permanent ventilation at home via a tracheal tube.A nine-year-old girl with colitis ulcerosa and a history of hemorrhagic encephalitis, with chronic home ventilation therapy, was admitted in an emergency setting because of massive bleeding from the upper respiratory tract and the area surrounding the tracheotomy. Repeated tamponade with topically applied thrombin, and administration of tranexamid acid and cyclonamine appeared ineffective Because of a life-threatening condition and unknown origin of massive bleeding, the child was referred for cardiac catheterization with aortography before qualifying for surgery, with the option of alternative interventional treatment. An alternative option with PTFE-coated stent direct implantation into the brachiocephalic trunk from a peripheral vascular approach was performed. The girl was discharged home after a short recovery. Her chronic home ventilation was continued without additional problems.Stenting of a brachiocephalic trunk aneurysm with a PTFE-coated stent appeared to be a safe and effective treatment of massive bleeding from the respiratory tract, with its main advantage of avoiding the risk of a classic surgical approach in a palliatively treated patient. PMID:27585203

  2. Stenting in Acute Lower Limb Arterial Occlusions

    SciTech Connect

    Raja, Jowad; Munneke, Graham; Morgan, Robert; Belli, Anna-Maria

    2008-07-15

    Management of critical limb ischemia of acute onset includes surgical embolectomy, bypass grafting, aspiration thrombectomy, thrombolysis, and mechanical thrombectomy followed by treatment of the underlying cause. We present our experience with the use of stents to treat acute embolic/thrombotic occlusions in one iliac and three femoropopliteal arteries. Although this is a small case series, excellent immediate and midterm results suggest that stenting of acute occlusions of the iliac, superficial femoral, and popliteal arteries is a safe and effective treatment option.

  3. Avoidance of a potential tracheoinnominate fistula by innominate artery re-implantation in a four year old girl with tracheostomy dependence and Pfeiffer syndrome.

    PubMed

    Olson, Michael D; Boesch, R Paul; Duncan, Audra A; Cofer, Shelagh A

    2016-02-01

    A 4 year old tracheostomy dependent girl with Pfeiffer syndrome was noted on bronchoscopy to have a pulsatile tracheostomal mass. CT chest angiography was consistent with the innominate artery crossing anterior to the trachea and superior to the sternal notch. The patient underwent reimplantation of the innominate artery via a median sternotomy approach. Tracheoinnominate fistula is a potentially devastating complication of tracheostomy. We report discovery of a near tracheoinnominate fistula in order to highlight the importance of regular interval surveillance endoscopy in tracheostomy dependent children and to discuss a preventative surgical intervention employed in prevention of this potentially devastating complication. PMID:26810298

  4. Endovascular stenting of symptomatic innominate artery stenosis under distal balloon protection of the internal carotid and vertebral artery for cerebral protection: a technical case report.

    PubMed

    Sakamoto, Shigeyuki; Kiura, Yoshihiro; Kajihara, Yosuke; Mukada, Kazutoshi; Kurisu, Kaoru

    2013-02-01

    The use of cerebral protection devices in endovascular treatment for innominate artery (IA) stenosis is not well established. We describe a novel technique for cerebral protection during endovascular stenting of symptomatic IA stenosis. An 82-year-old man presented with acutely scattered brain infarction by artery-to-artery embolism due to IA stenosis. Endovascular treatment for symptomatic IA stenosis was planned to prevent recurrent attacks. Endovascular stenting for IA stenosis via the right femoral artery approach was performed under simultaneous distal balloon protection of the right internal carotid artery (ICA) and vertebral artery (VA) via the right brachial artery approach. Successful treatment of symptomatic IA stenosis was achieved with no complications. The technique with simultaneous distal balloon protection of the ICA and VA provided excellent cerebral protection in stenting of IA stenosis. PMID:23263481

  5. Surgical closure of the larynx for intractable aspiration pneumonia: cannula-free care and minimizing the risk of developing trachea-innominate artery fistula.

    PubMed

    Ise, Kazuya; Kano, Makoto; Yamashita, Michitoshi; Ishii, Show; Shimizu, Hirofumi; Nakayama, Kei; Gotoh, Mitsukazu

    2015-10-01

    There is a risk of developing a fatal trachea-innominate artery fistula following laryngotracheal separation for the prevention of intractable aspiration pneumonia. We developed a novel technique of surgical closure of the larynx to avoid this complication and provide long-term cannula-free care. PMID:26276429

  6. Arterial gas occlusions in operating heat pipes

    NASA Technical Reports Server (NTRS)

    Saaski, E. W.

    1975-01-01

    The effect of noncondensable gases on high performance arterial heat pipes has been investigated both analytically and experimentally. Models have been generated which characterize the dissolution of gases in condensate and the diffusional loss of dissolved gases from condensate in arterial flow. These processes, and others, have been used to postulate stability criteria for arterial heat pipes. Experimental observations of gas occlusions were made using a stainless steel heat pipe equipped with viewing ports, and the working fluids methanol and ammonia with the gas additives helium, argon, and xenon. Observations were related to gas transport models.

  7. Left Subclavian Artery Occlusion: Femoro-Axillary Artery Retrograde Bypass

    PubMed Central

    Nakashima, Masaya; Kobayashi, Hideaki; Kobayashi, Masayoshi

    2016-01-01

    The treatment tactics for subclavian artery occlusion include the more commonly used endovascular therapy rather than surgical intervention. We present a case of a 61-year-old woman with dialysis-dependent chronic renal failure who experienced left finger necrosis in the left upper extremity. To salvage the limb, we performed femoro-axillary (fem-ax) artery bypass using an autologous saphenous vein graft. However, 10 months later, she experienced coldness in the left forearm. Angiography revealed chronic total occlusion of the venous bypass. Despite emergent thrombectomy, redo fem-ax artery bypass operation was performed using a prosthetic graft. Upper limb salvage can be achieved by fem-ax artery retrograde bypass. PMID:27386454

  8. [Two Cases of Emergency Extracorporeal Membrane Oxygenation Support in Children Suffering from Tracheo-innominate Artery Fistula].

    PubMed

    Ideno, Satoshi; Shinto, Atsushi; Matsuoka, Taku; Miyazawa, Noriko; Yamamoto, Shinichi

    2016-02-01

    Tracheoinnominate artery fistula (TIF) is a relatively rare life-threating complication of long-term tracheostomy. Two patients with TIF were successfully resuscitated by extracorporeal membrane oxygenation (ECMO) support along with advanced cardiovascular life support. The first patient was a 16-year-old boy undergoing long-term tracheostomy because of cerebral palsy, and the other patient was a previously healthy 11-year-old girl who had undergone primary tracheal tumor resection. In both cases, the onset of TIF was sudden, and the patients were immediately transferred to the operating room for emergency thoracotomy under ongoing cardiopulmonary resuscitation. Innominate artery division was performed under ECMO support. Adequate fluid replacement and hemorrhage control are primary treatment options for resuscitating a patient with TIF. However, hemorrhagic shock in patients with TIF is different from that in other patients, because bleeding into the trachea causes severe respiratory failure and poor oxygenation, which may worsen the resuscitation rate. Thus, ECMO can be used as an option for maintaining oxygenation during cardiopulmonary resuscitation in TIF. Anesthesiologists should pay attention to the increased risk of bleeding due to anticoagulation during ECMO initiation. In conclusion, the results of these cases demonstrate the effectiveness of extracorporeal cardiopulmonary resuscitation in TIF patients. PMID:27017768

  9. Right-sided aorta with complete isolation of the left innominate artery.

    PubMed

    Joseph, Arthur; Core, Jacob; Becerra, Jose L; Kaushal, Ritesh D

    2016-03-01

    A right-sided aorta with an isolated left subclavian and left common carotid artery is a rare arch defect. We are presenting the case of a 56-year-old woman who had initially presented with headache and 3 episodes of right-sided facial and extremity numbness. A presumptive diagnosis of transient ischemic attack prompted imaging studies where a computer tomography angiogram showed aberrant vessels. PMID:26973723

  10. Right-sided aorta with complete isolation of the left innominate artery

    PubMed Central

    Joseph, Arthur; Core, Jacob; Becerra, Jose L.; Kaushal, Ritesh D.

    2015-01-01

    A right-sided aorta with an isolated left subclavian and left common carotid artery is a rare arch defect. We are presenting the case of a 56-year-old woman who had initially presented with headache and 3 episodes of right-sided facial and extremity numbness. A presumptive diagnosis of transient ischemic attack prompted imaging studies where a computer tomography angiogram showed aberrant vessels. PMID:26973723

  11. Retinal arterial occlusive disease in systemic lupus erythematosus.

    PubMed

    Gold, D; Feiner, L; Henkind, P

    1977-09-01

    Four patients with systemic lupus erythematosus (SLE) developed an unusual form of occlusive retinal arterial disease. The most prominent clinical features of this disorder were deposition of yellow-white material in retinal arterial walls and evidence of multifocal retinal arterial occlusion. Fluorescein angiographic findings included nonperfusion of the obstructed arteries and the retinal capillary beds fed by them, and fluorescein leakage at the sites of involvement of the retinal arteries. This ocular complication of SLE is presumably a manifestation of the widespread systemic vascular problems seen in this disorder. It may be more common in patients with lupus involving the CNS. PMID:901267

  12. Ocular neovascularization in eyes with a central retinal artery occlusion or a branch retinal artery occlusion

    PubMed Central

    Mason, John O; Patel, Shyam A; Feist, Richard M; Albert, Michael A; Huisingh, Carrie; McGwin, Gerald; Thomley, Martin L

    2015-01-01

    Purpose To investigate the ocular neovascularization (ONV) rate in eyes with a branch retinal artery occlusion (BRAO) or a central retinal artery occlusion (CRAO), and to study factors that may influence the ONV rate secondary to CRAO. Methods This was a retrospective case series of consecutive patients (286 total eyes: 83 CRAOs and 203 BRAOs) who were diagnosed with a retinal artery occlusion from 1998 to 2013 at the Retina Consultants of Alabama and University of Alabama at Birmingham, Birmingham, AL, USA. Generalized estimating equations were used to evaluate the association between hypothesized risk factors and ONV development. Results Twelve (14.5%) of the 83 eyes with a CRAO developed ONV. Eleven of 12 eyes (91.7%) had iris neovascularization, ten of 12 eyes (83.3%) had neovascular glaucoma, and two of 12 eyes (16.7%) had neovascularization of the optic disc. The average time for ONV development secondary to CRAO was 30.7 days, ranging from the date of presentation to 137 days. Only two (<1.0%) of the 203 eyes with a BRAO developed iris neovascularization. Diabetes mellitus type 2 was a risk factor for ONV development following a CRAO with an adjusted odds ratio of 5.2 (95% confidence interval: 1.4–19.8) (P=0.02). Conclusion ONV is an important complication of CRAO and is a less-frequent complication of BRAO. Patients with a CRAO, especially those with diabetes mellitus type 2, should be closely monitored for the first 6 months for ONV. PMID:26089631

  13. Leptospirosis and Peripheral Artery Occlusive Disease

    PubMed Central

    Chiu, Chun-Hsiang; Lin, Cheng-Li; Lee, Feng-You; Wang, Ying-Chuan; Kao, Chia-Hung

    2016-01-01

    Abstract Data on the association between peripheral artery occlusive disease (PAOD) and leptospirosis are limited. We conducted a retrospective cohort study for determining whether leptospirosis is one of the possible risk factors for PAOD. Patients diagnosed with leptospirosis by using 2000 to 2010 data from the Taiwan National Health Insurance Research Database. Patients with leptospirosis without a history of PAOD were selected. For each leptospirosis patient, 4 controls without a history of leptospirosis and PAOD were randomly selected and frequency-matched for sex, age, the year of the index date, and comorbidity diseases. The follow-up period was from the time of the initial diagnosis of leptospirosis to the diagnosis date of PAOD, or December 31, 2011. The Cox proportional hazard regression models were used for analyzing the risk of PAOD. During the follow-up period, the cumulative incidence of PAOD was higher among the patients from the leptospirosis cohort than among the nonleptospirosis cohort (log-rank test, P < 0.001). In total, 29 patients with PAOD from the leptospirosis cohort and 81 from the nonleptospirosis cohort were observed with the incidence rates of 2.1 and 1.3 per 1000 person-years, respectively, yielding a crude hazards ratio (HR) of 1.62 (95% confidence interval [CI] = 1.44–1.81) and adjusted HR (aHR) of 1.75 (95% CI = 1.58–1.95). The risk of PAOD was 1.75-fold higher in the patients with leptospirosis than in the general population. PMID:26986166

  14. Delayed Axillary Artery Occlusion after Reverse Total Shoulder Arthroplasty

    PubMed Central

    Heitmiller, Richard F.

    2016-01-01

    Axillary artery injury has been associated with shoulder dislocation and surgery. We describe a case of delayed axillary artery occlusion after reverse total shoulder arthroplasty. The injury was confirmed by Doppler and angiography and was treated with angioplasty and stenting. Early recognition and treatment of this injury are mandatory for patients' recovery. PMID:27555975

  15. Spontaneous Recanalization of Superior Mesenteric Artery Occlusion Following Angioplasty and Stenting of Inferior Mesenteric Artery

    SciTech Connect

    Akpinar, Erhan Cil, Barbaros E.; Arat, Anil; Baykal, Atac; Karaman, Kerem; Balkanci, Ferhun

    2006-02-15

    An 84-year-old woman with a history of hypertension and coronary artery disease was admitted with a progressively worsening diffuse abdominal pain. Computed tomography scan of the abdomen and angiography revealed occlusion of the origin and proximal portion of superior mesenteric artery. Aortography also showed severe origin stenosis of inferior mesenteric artery and that the distal part of the superior mesenteric artery was supplied by a prominent marginal artery of Drummond. Patient was effectively treated with percutaneous transluminal angioplasty and stenting of the inferior mesenteric artery. Follow-up imaging studies demonstrated patency of the stent and spontaneous recanalization of superior mesenteric artery occlusion.

  16. Chronic Total Artery Occlusions in Noninfarct-Related Coronary Arteries

    PubMed Central

    Ozeke, Ozcan; Gungor, Mutlu; Topaloglu, Serkan; Aras, Dursun; Ozer, Can

    2014-01-01

    It has been rarely encountered some patients in clinical practice with coronary artery chronic total occlusion (CTO) on angiography but no any clinical history or electrocardiographic, echocardiographic, or left ventriculographic evidence of previous myocardial infarction. These noninfarct-related artery CTO (non-IRA CTO) lesions may be used as a clinical role model of endogenous cardioprotective mechanisms in addition to continuing the process of atherosclerosis. The objective of this study was to characterize the clinical characteristics of patients with non-IRA CTO patients and compared them to those with infarct-related CTO (IRA-CTO). We reviewed our invasive cardiology database searching for the CTO of any major coronary arteries, and assessed whether or not they have the clinical history or electrocardiographic, echocardiographic, and left ventriculographic evidence of previous myocardial infarction. Interestingly, we detected that all these patients with non-IRA CTO had diabetes mellitus, and the clinical and demographic features of these non-IRA CTO patients were compared with age- and sex-matched diabetic IRA-CTO patients with regard to conventional coronary risk factors and the angiographic collateral grading system. There were total 99 CTO patients (49 patients with non-IRA CTO and 50 patients with IRA-CTO).All patients with non-IRA CTO had better collateral circulation (96 vs. 40% p < 0.001) compared with those having IRA-CTO. The only significant difference between the groups was the status of current smoking (4 vs. 88%; p < 0.001). The present study showed that the non-IRA CTOs were associated with diabetes mellitus and better collateral development compared with IRA-CTO. In diabetic patients, the concomitant smoking use may be harmful by preventing endogenous cardioprotective mechanisms. PMID:24627613

  17. Endovascular parent artery occlusion of proximal posterior cerebral artery aneurysms: a report of two cases.

    PubMed

    Oishi, Hidenori; Tanoue, Shunsuke; Teranishi, Kosuke; Hasegawa, Hiroshi; Nonaka, Senshu; Magami, Shunsuke; Yamamoto, Munetaka; Arai, Hajime

    2016-06-01

    We report two cases of proximal posterior cerebral artery (PCA) aneurysms treated with endovascular parent artery occlusion (PAO) with coils. In both cases, selective injection from the 4 F distal access catheter clearly showed the perforating arteries arising from the PCA. Case No 1, a 49-year-old woman, was successfully treated with preservation of a paramedian artery. Case No 2, a 54-year-old woman, was treated in the same manner. The patient underwent extensive thalamic infarction after the procedure because of paramedian artery occlusion. Endovascular PAO with coils is feasible for proximal PCA aneurysms; however, preservation of perforating arteries arising from the PCA is mandatory. PMID:25969452

  18. Missed Total Occlusion Due to the Occipital Artery Arising from the Internal Carotid Artery

    SciTech Connect

    Ustunsoz, Bahri Gumus, Burcak; Koksal, Ali; Koroglu, Mert; Akhan, Okan

    2007-02-15

    A 56-year-old man was referred for digital subtraction angiography (DSA) with an ultrasound diagnosis of right proximal internal carotid artery (ICA) stenosis for possible carotid artery stenting. DSA revealed total occlusion of the ICA and an occipital artery arising from the stump and simulating continuation of the ICA. An ascending pharyngeal artery also arose from the same occipital artery. This case is of interest because this is a rare variation besides being a cause of misdiagnosis at carotid ultrasound.

  19. Monofilament intraluminal middle cerebral artery occlusion in the mouse.

    PubMed

    Clark, W M; Lessov, N S; Dixon, M P; Eckenstein, F

    1997-12-01

    The rat middle cerebral artery (MCA) occlusion model with an intraluminal filament is well characterized with a two hour period of occlusion in widespread use. The recent availability of transgenic animals has led to an interest in adapting the MCA model in the mouse. To date the model has not been well characterized in the mouse. We performed the present study to compare different durations of MCA occlusion and to validate new functional assessments in this model. The MCA occlusion model (5-0 filament) was used. Swiss-Webster mice, 24-44 g, were randomly assigned to four groups: one hour of occlusion; two hours of occlusion; three hours of occlusion; or permanent occlusion. At 48 hours post-ischemia, the animals were rated on three neurologic function scales, and then the brains were removed for lesion size determination. Overall, there was a significant difference in lesion volume (p < 0.001) between the groups. In the permanent group of mice, the average lesion volume was 78.41 +/- 17.47 mm (n = 12); two and three hours of ischemia produced 51.29 +/- 29.82 mm3 (n = 11) and 54.85 mm3 (n = 13), respectively, significantly different than the one hour group 14.84 +/- 31.34 mm3 (n = 11). All three functional scoring systems found significant overall differences between the four groups with our detailed General and Focal scores producing more robust between group treatment differences and showing correlation coefficients of r = 0.766 and r = 0.788, respectively to infarct volume. The MCA filament occlusion model can be successfully adapted in the mouse with either two or three hour occlusions producing reliable infarcts. New functional scoring systems unique to the mouse appear to add additional information. PMID:9427967

  20. Image-Guided Thromboembolectomy of Acute Arterial Occlusion in Children.

    PubMed

    Kim, Song-Yi; Han, Ahram; Choi, Chanjoong; Min, Sang-Il; Kim, Hyo-Cheol; Ha, Jongwon; Min, Seung-Kee

    2016-07-01

    Acute arterial thromboembolism (ATE) is rare in childhood, but this medical emergency requires immediate treatment. Described herein are separate instances of lower extremity ATE in 2 children, both of whom were successfully managed through image-guided thromboembolectomy (IGT). One patient, a 34-month-old female child with nephrotic syndrome, developed bilateral iliac and popliteal thromboembolic arterial occlusions after high-dose steroid therapy. Another 9-year-old girl suffered an embolism of left popliteal artery due to infectious endocarditis. Both patients underwent IGT using over-the-wire Fogarty catheters. During follow-up, presenting symptoms resolved without significant complications. PMID:27177711

  1. How I do it – sole innominate cannulation for acute type A aortic dissection

    PubMed Central

    2012-01-01

    We describe sole direct innominate cannulation for arterial return for establishing both cardiopulmonary bypass and selective antegrade cerebral perfusion in the repair of acute type A dissection and compare it with femoral, axillary, direct aortic and apical cannulations. We believe innominate cannulation has all the advantages of right axillary cannulation and none of its disadvantages. It can be used in all patients in whom innominate artery is not dissected, obstructed, calcified or otherwise diseased. PMID:23167966

  2. Suppression of ischemia in arterial occlusive disease by JNK-promoted native collateral artery development

    PubMed Central

    Ramo, Kasmir; Sugamura, Koichi; Craige, Siobhan; Keaney, John F; Davis, Roger J

    2016-01-01

    Arterial occlusive diseases are major causes of morbidity and mortality. Blood flow to the affected tissue must be restored quickly if viability and function are to be preserved. We report that disruption of the mixed-lineage protein kinase (MLK) - cJun NH2-terminal kinase (JNK) signaling pathway in endothelial cells causes severe blockade of blood flow and failure to recover in the murine femoral artery ligation model of hindlimb ischemia. We show that the MLK-JNK pathway is required for the formation of native collateral arteries that can restore circulation following arterial occlusion. Disruption of the MLK-JNK pathway causes decreased Dll4/Notch signaling, excessive sprouting angiogenesis, and defects in developmental vascular morphogenesis. Our analysis demonstrates that the MLK-JNK signaling pathway is a key regulatory mechanism that protects against ischemia in arterial occlusive disease. DOI: http://dx.doi.org/10.7554/eLife.18414.001 PMID:27504807

  3. Subclavian Steal Syndrome with or without Arterial Stenosis: A Review.

    PubMed

    Kargiotis, Odysseas; Siahos, Simos; Safouris, Apostolos; Feleskouras, Agisilaos; Magoufis, Georgios; Tsivgoulis, Georgios

    2016-09-01

    The subclavian-vertebral artery steal syndrome (SSS) is the hemodynamic phenomenon of blood flow reversal in the vertebral artery due to significant stenosis or occlusion of the proximal subclavian artery or the innominate artery. Occasionally, SSS is diagnosed in patients not harboring arterial stenosis. With the exception of arterial congenital malformations, the limited case reports of SSS with intact subclavian artery are attributed to dialysis arteriovenous fistulas (AVFs). Interestingly, these cases are more frequently symptomatic than those with the classical atherosclerotic SSS forms. On the other hand, the disclosure of SSS due to subclavian/innominate artery atherosclerotic stenosis, even in the absence of accompanying symptoms, should prompt a thorough cardiovascular work-up for the early detection of coexisting coronary, carotid, or peripheral artery disease. Herein, we review the incidence, clinical presentation, sonographic findings, and therapeutic interventions related to SSS with and without subclavian/innominate artery stenosis. We also review the currently available data in the literature regarding the association of SSS and dialysis AVF. In addition, we present a patient with bilateral symptomatic SSS as the result of an arteriovenous graft (AVG) that was introduced after the preexisting AVF in the contralateral arm became nonfunctional. SSS due to subclavian or innominate artery stenosis/occlusion is rarely symptomatic warranting interventional treatment. In contrast, when it is attributed to AVF, surgical correction is frequently necessary. PMID:27301069

  4. Pancreaticoduodenal artery aneurysm associated with coeliac artery occlusion from an aortic intramural hematoma

    PubMed Central

    Sakatani, Akihiko; Doi, Yoshinori; Kitayama, Toshiaki; Matsuda, Takaaki; Sasai, Yasutaka; Nishida, Naohiro; Sakamoto, Megumi; Uenoyama, Naoto; Kinoshita, Kazuo

    2016-01-01

    Pancreaticoduodenal artery aneurysms are a rare type of visceral artery aneurysm, whose rupture is associated with high mortality. These aneurysms are of particular interest because local haemodynamic change caused by coeliac artery obstruction plays an important role in their development. However, the pathophysiological mechanism of coeliac artery obstruction is not completely understood. Pressure from the median arcuate ligament is most frequently reported cause. Although it is well-known that stenosis or occlusion of the visceral vessels may be caused by aortic syndrome, reports of pancreaticoduodenal artery aneurysm associated with coeliac artery occlusion due to aortic syndrome are extremely rare. Our case indicates a new aetiology for a pancreaticoduodenal artery aneurysm and demonstrates the rapid deterioration of the patient affected. PMID:27122676

  5. Deaths from Occlusive Arterial Disease in Renal Allograft Recipients

    PubMed Central

    Ibels, L. S.; Stewart, J. H.; Mahony, J. F.; Sheil, A. G. R.

    1974-01-01

    In a series of 325 recipients of cadaveric renal transplants sudden occlusive arterial disease was found to be responsible for 12% of deaths. Acute myocardial infarction (9%) occurred 25 times more than expected in the normal population and cerebral thrombosis (3%) 300 times more. The greatest loss was in the initial three-month period after transplantation. Patients with renal failure due to essential hypertension were especially at risk, accounting for six of the 12 deaths. PMID:4606408

  6. Left main coronary artery occlusion after percutaneous aortic valve implantation.

    PubMed

    Bartorelli, Antonio L; Andreini, Daniele; Sisillo, Erminio; Tamborini, Gloria; Fusari, Melissa; Biglioli, Paolo

    2010-03-01

    Left main coronary artery occlusion occurred immediately after transfemoral aortic valve implantation in an 87-year-old woman, which resulted in ventricular fibrillation and hemodynamic collapse. This life-threatening complication was promptly diagnosed with transesophageal echocardiography, which showed the disappearance of diastolic left main coronary artery jet flow and was confirmed with aortic root angiography. After prompt defibrillation, hemodynamic support was obtained with intra-aortic balloon pump and inotropic drugs. Functional recovery and survival were achieved with coronary stenting. This report highlights the importance of an integrated team approach of highly skilled specialists for these novel interventions. PMID:20172163

  7. Strategies to prevent radial artery occlusion after transradial PCI.

    PubMed

    Pancholy, Samir B

    2014-07-01

    Radial artery occlusion (RAO) is the most common structural consequence of transradial access (TRA) with an estimated incidence ranging from 2-10 %. Its occurrence is free of any major clinical consequences, especially at rest, with most if not all cases of digital ischemia occurring as a result of embolization, rather than RAO. The incidence of RAO is unacceptably high if "best practices" are not followed. Strategies to prevent RAO need to be implemented to preserve radial artery patency in order to exploit other benefits of TRA. PMID:24890765

  8. Laparoscopic uterine artery occlusion combined with myomectomy for uterine myomas.

    PubMed

    Cheng, Zhongping; Yang, Weihong; Dai, Hong; Hu, Liping; Qu, Xiaoyan; Kang, Le

    2008-01-01

    We sought to evaluate the clinical feasibility and mid- to long-term effects of laparoscopic uterine artery occlusion before myomectomy in the treatment of uterine myomas. A total of 566 patients with uterine myoma were treated by laparoscopic uterine artery occlusion before myomectomy from October 2001 through July 2007. Mean blood loss was 88.2 +/- 52.7 mL (95% CI 82.7-93.8). The highest postoperative temperature was 37.8 +/- 0.3 degrees C, and the postoperative morbidity was 5.7% (32/566). Number of days to the return of bowel movement was 1.9 +/- 0.5d and in hospital stay after surgery was 7.7 +/- 2.5d. Complications included 2 instances of subcutaneous emphysema, 1 of vaginal bleeding, and 3 of mild intestinal obstruction. At a median of 26.3 months (range 6-69 months) of follow-up, the rate of myoma recurrence was 3.0% (15/517), uterus volume reduction was 48.9%, and correction of menstruation abnormality was 97.1% (502/517). Laparoscopic uterine artery occlusion before myomectomy can expand myomectomy indications with better results. PMID:18439509

  9. A Novel Canine Model of Acute Vertebral Artery Occlusion

    PubMed Central

    Zhang, Yunfeng; Jin, Min; Du, Bin; Lin, Hao; Xu, Chengyong; Jiang, Weijian; Jia, Jianping

    2015-01-01

    Background The extended time window and theoretic reduction in hemorrhage make mechanical strategies an attractive approach for the treatment of patients with ischemic stroke. However, a limited availability of suitable animal models of cerebrovascular thrombosis has hampered the study of novel endovascular interventions. The aim of the present study was to develop a new technique for site-specific placement of a thrombus in a canine model that would allow for the evaluation of mechanical thrombectomy and clot retrieval methods and the visualization of thrombus dislocation or fragmentation during angiographic manipulation. Methods Angiography and embolization with a preformed thrombus were performed in 12 canines. Under fluoroscopic guidance, an embolism protection device (EPD) was anchored to the middle segment of the left vertebral artery (VA) via the left femoral arterial sheath. A preformed radiopaque clot was injected through the guide catheter into the left VA, via the contralateral femoral artery, proximal to the EPD. After 15 min of occlusion, the EPD was removed and persistent occlusion of the VA was documented angiographically. Results Angiography performed during the observation period confirmed the persistence of VA occlusion in each case, and displacement of the radiopaque clots did not occur during the 3-hour observation period. The technique allowed selective embolization of targeted vessels without thrombus fragmentation. Conclusion This study demonstrates, for the first time, a canine model of post-circulation embolism induced by autologous blood clot placement. This model can be rapidly formed and easily operated, and the site of thrombosis can be readily controlled. PMID:26545253

  10. Intra-arterial thrombolysis of embolic proximal middle cerebral artery occlusion from presumed atrial myxoma.

    PubMed

    Bekavac, I; Hanna, J P; Wallace, R C; Powers, J; Ratliff, N B; Furlan, A J

    1997-08-01

    The role of thrombolysis in brain ischemia in patients with atrial myxoma is unknown. A patient with acute brain ischemia and previously undiagnosed atrial myxoma recanalized an occluded middle cerebral artery with intra-arterial thrombolysis. Arterial occlusion from presumed myxoma may be amenable to fibrinolysis. Angiography before treatment in patients with atrial myxoma excludes a myxomatous pseudoaneurysm and permits site-specific thrombolytic instillment. PMID:9270611

  11. Coronary artery occlusion extends perfusion territory boundaries through microvascular collaterals.

    PubMed

    Cicutti, N; Rakusan, K; Downey, H F

    1994-01-01

    Simultaneous in vivo infusions of two different colored 10 microns microsphere suspensions into the left anterior descending (LAD; red spheres) and left circumflex (LCx; blue spheres) coronary arteries of nine anesthetized dogs identified a specific region of canine myocardium perfused by both arterial branches. Subsequently, the LAD was ligated and a third (green) set of micropheres was infused into the patent LCx artery. Analysis of 40 microns serial sections of tissue revealed interface zones with capillaries perfused by both arteries. The first zone, defined as the Interface Transistion Zone (ITZ) was formed by an intermingling of microvessels supplied by the parent arteries of the adjacent perfusion territories; it separated tissue containing only one or the other colored microspheres. Another zone, defined as the Boundary Watershed Zone was located within the ITZ and had capillaries containing both red and blue microspheres. The width of ITZ was 53377 +/- 817 microns (mean +/- SD), and the width of the BWZ was 3358 +/- 618 microns. Green microspheres, infused into the LCx following coronary occlusion were also found in the ITZ and BWZ. Furthermore, capillaries perfused exclusively by the LAD before occlusion (tissue with red but not blue microspheres) adjacent to the perfusion interface contained green microspheres as well as red/green aggregates, indicating lateral extension of the LCx perfusion territory. This extension of the LCx territory was quantitated by comparing the location at which densities of green microspheres or green/red aggregates decreased abruptly compared to the location of the original ITZ and BWZ boundaries, respectively. Results showed that LAD occlusion caused a 24% expansion of the ITZ and a 48% expansion of the BWZ. In addition, all expansions were significantly greater in subepicardial compared to subendocardial regions (p < 0.001). These results clearly demonstrate the capability of microvascular anastomoses in providing blood flow

  12. Subintimal Angioplasty for Peripheral Arterial Occlusive Disease: A Systematic Review

    SciTech Connect

    Met, Rosemarie Lienden, Krijn P. Van; Koelemay, Mark J. W.; Bipat, Shandra; Legemate, Dink A.; Reekers, Jim A.

    2008-07-15

    The objective of this study was to summarize outcomes of subintimal angioplasty (SA) for peripheral arterial occlusive disease. The Cochrane Library, Medline and Embase databases were searched to perform a systematic review of the literature from 1966 through May 2007 on outcomes of SA for peripheral arterial occlusive disease of the infrainguinal vessels. The keywords 'percutaneous intentional extraluminal revascularization,' 'subintimal angioplasty,' 'peripheral arterial disease,' 'femoral artery,' 'popliteal artery,' and 'tibial artery' were used. Assessment of study quality was done using a form based on a checklist of the Dutch Cochrane Centre. The recorded outcomes were technical and clinical success, primary (assisted) patency, limb salvage, complications, and survival, in relation to the clinical grade of disease (intermittent claudication or critical limb ischemia [CLI] or mixed) and location of lesion (femoropopliteal, crural, or mixed). Twenty-three cohort studies including a total of 1549 patients (range, 27 to 148) were included in this review. Methodological and reporting quality were moderate, e.g., there was selection bias and reporting was not done according to the reporting standards. These and significant clinical heterogeneity obstructed a meta-analysis. Reports about length of the lesion and TASC classification were too various to summarize or were not mentioned at all. The technical success rates varied between 80% and 90%, with lower rates for crural lesions compared with femoral lesions. Complication rates ranged between 8% and 17% and most complications were minor. After 1 year, clinical success was between 50% and 70%, primary patency was around 50% and limb salvage varied from 80% to 90%. In conclusion, taking into account the methodological shortcomings of the included studies, SA can play an important role in the treatment of peripheral arterial disease, especially in the case of critical limb ischemia. Despite the moderate patency

  13. Acute arterial occlusion in the midpiece of femoral artery following total knee arthroplasty: Report of one case.

    PubMed

    He, Rui; Yang, Liu

    2016-04-01

    Acute arterial occlusion is a rare complication following total knee arthroplasty (TKA). The incidence as reported previously is from 0.03% to 0.17%; however, the sequelae can be disastrous because of its potential threat to limb loss.We report a case of acute arterial occlusion in the midpiece of femoral artery following TKA occurred 40 min postoperatively. The occlusion site existed at the midpiece of femoral artery is uncommon. Arterial circulation of the lower limb could not be restored by the thrombolysis and thrombectomy treatments performed within 11 h after TKA. In the end, amputation had to be carried out. In the treatment of acute arterial occlusion following TKA with a tourniquet, it is important to fully consider that arteriosclerosis may induce atheromatous plaque disruption, which might be the reason for acute arterial occlusion. PMID:27140221

  14. Sinus bradycardia as a predictor of right coronary artery occlusion in patients with inferior myocardial infarction.

    PubMed

    Serrano, C V; Bortolotto, L A; César, L A; Solimene, M C; Mansur, A P; Nicolau, J C; Ramires, J A

    1999-01-01

    Differentiation of right coronary artery (RCA) from left circumflex artery (LCxA) occlusion may be difficult since both can present an electrocardiographic pattern of inferior myocardial infarction (IMI). We studied 133 patients with IMI, 92 patients with RCA occlusion and 41 patients with LCxA occlusion. Risk factors such as previous MI, arterial hypertension, diabetes, smoking, and dislipemia, were similar for RCA and LCxA occlusions. Patients with RCA occlusion had a higher incidence of isolated IMI than patients with LCxA occlusion, 50% vs. 17%, respectively (P<0.001). Arterial hypotension was more prevalent (P<0.05) among patients with RCA (18%) rather than those with LCxA occlusion (2%). RCA occlusion presented an association with sinus bradycardia, an association not observed with LCxA occlusion (15% vs. 0%, respectively; P<0.01). Total atrioventricular block was only present among patients with RCA (18%). Proximal occlusions of the RCA presented lower heart rates (sinus bradycardia) than medial and distal occlusions (13% vs. 1% and 1%, respectively; P<0.0001 and P<0.001). Therefore, regarding patients with IMI: (1) sinus bradycardia is more frequent when the infarct-related artery is the RCA; (2) proximal occlusions of the right coronary predispose low heart rates; and (3) occlusion of the LCxA rarely induces sinus bradycardia. PMID:10077404

  15. Percutaneous Endovascular Treatment of Chronic Iliac Artery Occlusion

    SciTech Connect

    Carnevale, F. C. De Blas, Mariano; Merino, Santiago; Egana, Jose M.; Caldas, Jose G.M.P.

    2004-09-15

    Purpose: To evaluate the clinical and radiological long-term results of recanalization of chronic occluded iliac arteries with balloon angioplasty and stent placement.Methods: Sixty-nine occluded iliac arteries (mean length 8.1 cm; range 4-16 cm) in 67 patients were treated by percutaneous transluminal angioplasty and stent placement. Evaluations included clinical assesment according to Fontaine stages, Doppler examinations with ankle-brachial index (ABI) and bilateral lower extremity arteriograms. Wallstent and Cragg vascular stents were inserted for iliac artery recanalization under local anesthesia. Follow-up lasted 1-83 months (mean 29.5 months).Results: Technical success rate was 97.1% (67 of 69). The mean ABI increased from 0.46 to 0.85 within 30 days after treatment and was 0.83 at the most recent follow-up. Mean hospitalization time was 2 days and major complications included arterial thrombosis (3%), arterial rupture (3%) and distal embolization (1%). During follow-up 6% stenosis and 9% thrombosis of the stents were observed. Clinical improvement occurred in 92% of patients. Primary and secondary patency rates were 75% and 95%, respectively.Conclusion: The long-term patency rates and clinical benefits suggest that percutaneous endovascular revascularization with metallic stents is a safe and effective treatment for patients with chronic iliac artery occlusion.

  16. Incidence and Predictors of Radial Artery Occlusion Associated Transradial Catheterization

    PubMed Central

    Tuncez, Abdullah; Kaya, Zeynettin; Aras, Dursun; Yıldız, Abdulkadir; Gül, Enes Elvin; Tekinalp, Mehmet; Karakaş, Mehmet Fatih; Kısacık, Halil Lütfü

    2013-01-01

    In this study, we sought to assess the incidence and predictors of radial artery occlusion (RAO), which is a significant complication of transradial cardiac catheterization. We prospectively evaluated the results of 106 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) via the transradial approach (TRA). At the 3rd h of intervention, the radial artery was checked by palpation; color doppler ultrasonography was performed at the 24th h. Fluoroscopy duration, procedure success, and complications of the radial artery were recorded. The procedure was successfully completed in all patients. RAO was detected in eight female and two male patients. In terms of RAO, there was a statistically significant difference between males and females (p=0.019). Other parameters did not show a significant correlation with RAO. Altough did not have any effect on procedural success, eight patients developed transient radial artery spasm. Gender was not associated with radial arterial spasms (p=0.19). TRA in the diagnosis and treatment of coronary artery disease has shown high procedural success and low complication rates; it addition, it presents a low economic burden. It should be used widely and be involved in the routine cardiology residency program. PMID:24151442

  17. Coronary artery occlusion after arterial switch operation in an asymptomatic 15-year-old boy.

    PubMed

    Saini, Ashish P; Cyran, Stephen E; Ettinger, Steven M; Pauliks, Linda B

    2016-08-16

    A 15-year-old boy with transposition of the great arteries (TGA) and neonatal arterial switch operation (ASO) presented with complete occlusion of the left main coronary artery (LMCA). Intra-operatively, an intramural left coronary artery was identified. Therefore, since age 7 years he had a series of screening exercise stress tests. At 13 years old, he had 3 to 4 mm ST segment depression in the infero-lateral leads without symptoms. This progressed to 4.2 mm inferior ST segment depression at 15 years old with normal stress echocardiogram. Sestamibi myocardial perfusion scan and cardiac magnetic resonance imaging was inconclusive. Therefore, a coronary angiogram was obtained which showed complete occlusion of the LMCA with ample collateralization from the right coronary artery system. This was later confirmed on a computed tomogram (CT) angiogram, obtained in preparation of coronary artery bypass grafting. The case illustrates the difficulty of detecting coronary artery stenosis and occlusion in young patients with rich collateralization. Coronary CT angiogram and conventional angiography were the best imaging modalities to detect coronary anomalies in this adolescent with surgically corrected TGA. Screening CT angiography may be warranted for TGA patients, particularly for those with known coronary anomalies. PMID:27574609

  18. Coronary artery occlusion after arterial switch operation in an asymptomatic 15-year-old boy

    PubMed Central

    Saini, Ashish P; Cyran, Stephen E; Ettinger, Steven M; Pauliks, Linda B

    2016-01-01

    A 15-year-old boy with transposition of the great arteries (TGA) and neonatal arterial switch operation (ASO) presented with complete occlusion of the left main coronary artery (LMCA). Intra-operatively, an intramural left coronary artery was identified. Therefore, since age 7 years he had a series of screening exercise stress tests. At 13 years old, he had 3 to 4 mm ST segment depression in the infero-lateral leads without symptoms. This progressed to 4.2 mm inferior ST segment depression at 15 years old with normal stress echocardiogram. Sestamibi myocardial perfusion scan and cardiac magnetic resonance imaging was inconclusive. Therefore, a coronary angiogram was obtained which showed complete occlusion of the LMCA with ample collateralization from the right coronary artery system. This was later confirmed on a computed tomogram (CT) angiogram, obtained in preparation of coronary artery bypass grafting. The case illustrates the difficulty of detecting coronary artery stenosis and occlusion in young patients with rich collateralization. Coronary CT angiogram and conventional angiography were the best imaging modalities to detect coronary anomalies in this adolescent with surgically corrected TGA. Screening CT angiography may be warranted for TGA patients, particularly for those with known coronary anomalies. PMID:27574609

  19. Subclavian steal and rest pain in a case of brachiocephalic artery occlusion.

    PubMed

    Kapa, Suraj; Adams, Jonathon

    2008-01-01

    A patient with multiple vessel disease presented with symptoms of significant bilateral upper extremity pain and weakness that was more significant on the right side. On carotid duplex scanning, brachiocephalic artery occlusion with retrograde flow was noted through the right common carotid and right vertebral arteries at rest. Furthermore, 50% to 90% occlusion of the left internal carotid was noted. Filling of the right subclavian artery was noted to be through the right vertebral and right common carotid arteries. Unlike isolated subclavian steal syndrome, brachiocephalic artery occlusion induces significant hemodynamic alterations in extracranial arterial flow, which normally produces no symptoms at rest, but may produce symptoms with exercise. The occurrence of subclavian steal phenomenon in the presence of brachiocephalic occlusion is extremely rare. The present case is the first to report a patient presenting with bilateral upper extremity rest pain in the presence of brachiocephalic artery occlusive disease. PMID:22477423

  20. Plasmacytic Aortitis with Occlusion of the Right Coronary Artery.

    PubMed

    Zambetti, Benjamin R; Garrett, Edward

    2016-01-01

    BACKGROUND Inflammation of the aortic wall, known as aortitis, is a rare clinical entity which is frequently asymptomatic, or identified when the patient presents with an aortic aneurysm or dissection. It is most often caused by infection or autoimmune vasculitides such as giant cell or Takayasu's arteritis. CASE REPORT The case presented is that of a 55-year-old man with symptomatic occlusion of the right coronary artery caused by a plasmacytic aortitis suggestive of IgG4 disease, which was successfully treated with coronary artery bypass grafting and an ascending aortic graft. CONCLUSIONS A review of the current literature emphasizes how poorly the etiology and natural history of plasmacytic aortitis is understood. PMID:27471062

  1. Plasmacytic Aortitis with Occlusion of the Right Coronary Artery

    PubMed Central

    Zambetti, Benjamin R.; Garrett, Edward

    2016-01-01

    Patient: Male, 55 Final Diagnosis: Plasmacytic aortitis Symptoms: Dizziness • nausea Medication: — Clinical Procedure: — Specialty: Surgery Objective: Unusual clinical course Background: Inflammation of the aortic wall, known as aortitis, is a rare clinical entity which is frequently asymptomatic, or identified when the patient presents with an aortic aneurysm or dissection. It is most often caused by infection or autoimmune vasculitides such as giant cell or Takayasu’s arteritis. Case Report: The case presented is that of a 55-year-old man with symptomatic occlusion of the right coronary artery caused by a plasmacytic aortitis suggestive of IgG4 disease, which was successfully treated with coronary artery bypass grafting and an ascending aortic graft. Conclusions: A review of the current literature emphasizes how poorly the etiology and natural history of plasmacytic aortitis is understood. PMID:27471062

  2. [Ruptured Internal Carotid Artery Aneurysm Coiling in a Patient with Ipsilateral Internal Carotid Artery Occlusion via the Posterior Communicating Artery].

    PubMed

    Ashida, Noriaki; Saitoh, Minoru; Fujita, Atsushi; Kohmura, Eiji

    2016-09-01

    Background:De novo aneurysms after internal carotid artery(ICA)occlusion occur in the contralateral ICA or anterior communicating artery. Hemodynamic changes with increased blood flow to the contralateral carotid circulation were considered the main factor for the formation of these aneurysms. We report a rare case of ruptured ICA aneurysm associated with ipsilateral ICA occlusion treated with coil embolization via the vertebrobasilar and posterior communicating arteries. Case Presentation:An 82-year-old woman presented with sudden-onset disturbance of consciousness at our outpatient clinic and went into cardiopulmonary arrest. Computed tomography(CT)performed after cardiopulmonary resuscitation revealed diffuse subarachnoid hemorrhage. Three-dimensional CT angiography revealed a right ICA aneurysm associated with the ipsilateral ICA occlusion. Considering that the patient showed clinical improvement with the critical care for neurogenic pulmonary edema, the aneurysm was treated with endovascular coil embolization via the posterior communicating artery. With this technique, complete obliteration was attained without perioperative complication. Conclusion:Endovascular coil embolization via the posterior communicating artery was proven effective as a treatment method for ruptured ICA aneurysms with ipsilateral ICA occlusion. Hemodynamic stress due to increased blood flow in the posterior communicating artery may play an important role in the growth and rupture of ICA aneurysms. PMID:27605482

  3. Endovascular Therapeutic Approaches for Acute Superior Mesenteric Artery Occlusion

    SciTech Connect

    Acosta, S. Sonesson, B.; Resch, T.

    2009-09-15

    The purpose of this study was to characterize the outcome of attempted endovascular intervention in patients with acute embolic or thrombotic superior mesenteric artery (SMA) occlusion. The records of 21 patients during a 3-year period between 2005 and 2008 were retrieved from the in-hospital registry. The first group included 10 patients (6 women and 4 men; median age 78 years) with acute embolic occlusion of the SMA. The median duration of symptoms from symptom onset to angiography was 30 hours (range 6 to 120). Synchronous emboli (n = 12) occurred in 6 patients. Embolus aspiration was performed in 9 patients, and 7 of these had satisfactory results. Complementary local thrombolysis was successful in 2 of 3 patients. Residual emboli were present at completion angiography in all 7 patients who underwent successful aspiration embolectomy, and bowel resection was necessary in only 1 of these patients. One serious complication occurred because of a long SMA dissection. The in-hospital survival rate was 90% (9 of 10 patients). The second group included 11 patients (10 women and 1 man; median age 68 years) with atherosclerotic acute SMA occlusions. The median time of symptom duration before intervention was 97 hours (range 17 to 384). The brachial, femoral, and SMA routes were used in 6, 7, and 5 patients, respectively. SMA stenting was performed through an antegrade (n = 7) or retrograde (n = 3) approach. Bowel resection was necessary in 4 patients. No major complications occurred. The in-hospital survival rate was 82% (9 of 11 patients). Endovascular therapy of acute SMA occlusion provides a good alternative to open surgery.

  4. A vertebral artery dissection with basilar artery occlusion in a child.

    PubMed

    Devue, Katleen; Van Ingelgem, Annemie; De Keukeleire, Katrien; De Leeuw, Marc

    2014-01-01

    This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services. PMID:25587466

  5. Giant vertebral artery aneurysm in a child treated with endovascular parent artery occlusion and coil embolization

    PubMed Central

    Park, Hun-Soo; Nakagawa, Ichiro; Wada, Takeshi; Nakagawa, Hiroyuki; Hironaka, Yasuo; Kichikawa, Kimihiko; Nakase, Hiroyuki

    2014-01-01

    Background: Intracranial giant vertebral artery aneurysms are extremely rare in the pediatric population and are associated with significant morbidity and mortality. The present report describes a case of a pediatric patient with giant vertebral artery aneurysm who presented with intracranial mass effect. This patient was successfully treated with endovascular parent artery occlusion and coil embolization. Case Description: A 7-year-old girl presented with tetraparesis, ataxia, dysphagia, and dysphonia. Cerebral angiography revealed intracranial giant aneurysm arising from the right vertebral artery. The patient underwent endovascular parent artery occlusion alone to facilitate aneurysmal thrombosis as an initial treatment. This was done to avoid a coil mass effect to the brainstem. However, incomplete thrombosis occurred in the vicinity of the vertebral artery union. Therefore, additional coil embolization for residual aneurysm was performed. Two additional coil embolization procedures were performed in response to recurrence. Mass effect and clinical symptoms gradually improved, and the patient had no associated morbidity or recurrence at 2 years after the last fourth coil embolization. Conclusion: Intracranial giant vertebral artery aneurysms are rare and challenging in pediatric patients. Staged endovascular strategy can be a safe and effective treatment option. PMID:25071937

  6. Short series of upper limb acute arterial occlusions in 4 different etiologies and review of literature.

    PubMed

    Coskun, Selcuk; Soylu, Lutfi; Coskun, Pınar Koksal; Bayazıt, Murat

    2013-12-01

    Upper limb acute arterial occlusions are uncommon, and when compared with lower limb occlusions, only a few cases have been reported. Although atrial fibrillation is the most common cause, many conditions may lead to ischemia. In this article, 8 cases of upper limb arterial ischemia due to 4 different etiologies were reported (7 brachial, 1 axillary), and the literature was reviewed. PMID:24055482

  7. Emergency endovascular revascularization of tandem occlusions: Internal carotid artery dissection and intracranial large artery embolism.

    PubMed

    Cohen, José E; Leker, Ronen R; Eichel, Roni; Gomori, Moshe; Itshayek, Eyal

    2016-06-01

    Internal carotid artery dissection (ICAD) with concomitant occlusive intracranial large artery emboli is an infrequent cause of acute stroke, with poor response to intravenous thrombolysis. Reports on the management of this entity are limited. We present our recent experience in the endovascular management of occlusive ICAD and major intracranial occlusion. Consecutive anterior circulation acute stroke patients meeting Medical Center criteria for endovascular management of ICAD from June 2011 to June 2015 were included. Clinical, imaging, and procedure data were collected retrospectively under Institutional Review Board approval. The endovascular procedure for carotid artery revascularization and intracranial stent thrombectomy is described. Six patients met inclusion criteria (National Institutes of Health Stroke Scale score 12-24, time from symptom onset 2-8hours). Revascularization of the extracranial carotid dissection and stent thrombectomy were achieved in 5/6 patients, resulting in complete recanalization (Thrombolysis in Myocardial Infarction flow grade 3 in a mean 2.7hours), and modified Rankin Scale score 0-2 at 90 day follow-up. In one patient, attempts to microcatheterize the true arterial lumen failed and thrombectomy was therefore not feasible. No arterial dissection, arterial rupture or accidental stent detachment occurred, and there was no intracerebral hemorrhage or hemorrhagic transformation. Our preliminary data on this selected subgroup of patients suggest the presented approach is safe, feasible in a significant proportion of patients, and efficacious in achieving arterial recanalization and improving patient outcome. Crossing the dissected segment remains the most important limiting factor in achieving successful ICA recanalization. Further evaluation in larger series is warranted. PMID:26924182

  8. Coiling occlusion of the vertebral artery for a patient with recurrent posterior circulation TIAs.

    PubMed

    Chembala, J; Jadun, C; Natarajan, I; Roffe, C

    2013-02-01

    Recurrent posterior circulation infarcts frequently involve multiple vascular territories, suggesting an embolic source. We describe a patient with left vertebral artery occlusion who had recurrent transient ischaemic attacks due to cerebral embolization originating from the occluded vertebral artery in spite of optimal anticoagulant and antithrombotic treatment. This was successfully managed by coiling occlusion of the vertebral artery with no recurrence of symptoms over one year of follow-up. To our knowledge, this is the first report of coiling occlusion in the treatment of recurrent vertebral artery embolization. PMID:23859172

  9. Pregnancy management for a patient with graft occlusion after right iliac artery bypass surgery.

    PubMed

    Nakae, Ruriko; Matsuzaki, Shinya; Egawa-Takata, Tomomi; Mimura, Kazuya; Kanagawa, Takeshi; Kimura, Tadashi

    2015-06-01

    We describe an extremely rare case of a pregnant woman who had a successful delivery despite developing bypass graft occlusion after right external iliac bypass surgery. External and common iliac artery bypass surgery is often performed when arteriosclerosis obliterans or thromboangiitis obliterans result in iliac artery occlusion or when revascularization is required because of iliac artery injury. Because arteriosclerosis obliterans and thromboangiitis obliterans rarely develop in young women or girls, most physicians have little experience with graft occlusion after iliac artery bypass surgery. Here we describe and discuss the published work pertaining to this extremely rare case. PMID:25511914

  10. Myocardial viability in coronary artery chronic total occlusion.

    PubMed

    Vefali, Huseng; Manda, Yugandhar; Shirani, Jamshid

    2015-01-01

    Coronary artery chronic total occlusion (CTO) has rapidly become a popular target of percutaneous coronary intervention (PCI). Technical and technological advances required for approaching these anatomically complex and challenging lesions have progressed at an extraordinary pace and have led to amazing success rates. Patient selection, however, has primarily focused on patient symptoms, lesion characteristics, as well as the state of collateral circulation. Multiple national and international registries have been established to follow the progress of percutaneous CTO recanalization and have provided valuable information. Concern, however, exists that this challenging procedure will become the "standard of care" before its effectiveness and appropriateness is tested in prospective controlled trials. This manuscript reviews the current state of patient selection and the need for careful assessment of the presence and extent of myocardial viability prior to lengthy, resource-intensive, and potentially high-risk procedures. PMID:25413581

  11. Combined branch retinal vein and artery occlusion in toxoplasmosis.

    PubMed

    Aggio, Fabio Bom; Novelli, Fernando José de; Rosa, Evandro Luis; Nobrega, Mário Junqueira

    2016-01-01

    A 22-year-old man complained of low visual acuity and pain in his left eye for five days. His ophthalmological examination revealed 2+ anterior chamber reaction and a white, poorly defined retinal lesion at the proximal portion of the inferotemporal vascular arcade. There were retinal hemorrhages in the inferotemporal region extending to the retinal periphery. In addition, venous dilation, increased tortuosity, and ischemic retinal whitening along the inferotemporal vascular arcade were also observed. A proper systemic work-up was performed, and the patient was diagnosed with ocular toxoplasmosis. He was treated with an anti-toxoplasma medication, and his condition slowly improved. Inferior macular inner and middle retinal atrophy could be observed on optical coherence tomography as a sequela of ischemic injury. To our knowledge, this is the first report of combined retinal branch vein and artery occlusion in toxoplasmosis resulting in a striking and unusual macular appearance. PMID:27463632

  12. Different Imaging Strategies in Patients With Possible Basilar Artery Occlusion

    PubMed Central

    Beyer, Sebastian E.; Hunink, Myriam G.; Schöberl, Florian; von Baumgarten, Louisa; Petersen, Steffen E.; Dichgans, Martin; Janssen, Hendrik; Ertl-Wagner, Birgit; Reiser, Maximilian F.

    2015-01-01

    Background and Purpose— This study evaluated the cost-effectiveness of different noninvasive imaging strategies in patients with possible basilar artery occlusion. Methods— A Markov decision analytic model was used to evaluate long-term outcomes resulting from strategies using computed tomographic angiography (CTA), magnetic resonance imaging, nonenhanced CT, or duplex ultrasound with intravenous (IV) thrombolysis being administered after positive findings. The analysis was performed from the societal perspective based on US recommendations. Input parameters were derived from the literature. Costs were obtained from United States costing sources and published literature. Outcomes were lifetime costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and net monetary benefits, with a willingness-to-pay threshold of $80 000 per QALY. The strategy with the highest net monetary benefit was considered the most cost-effective. Extensive deterministic and probabilistic sensitivity analyses were performed to explore the effect of varying parameter values. Results— In the reference case analysis, CTA dominated all other imaging strategies. CTA yielded 0.02 QALYs more than magnetic resonance imaging and 0.04 QALYs more than duplex ultrasound followed by CTA. At a willingness-to-pay threshold of $80 000 per QALY, CTA yielded the highest net monetary benefits. The probability that CTA is cost-effective was 96% at a willingness-to-pay threshold of $80 000/QALY. Sensitivity analyses showed that duplex ultrasound was cost-effective only for a prior probability of ≤0.02 and that these results were only minimally influenced by duplex ultrasound sensitivity and specificity. Nonenhanced CT and magnetic resonance imaging never became the most cost-effective strategy. Conclusions— Our results suggest that CTA in patients with possible basilar artery occlusion is cost-effective. PMID:26022634

  13. Intra-arterial thrombolysis of central retinal artery occlusion following percutaneous atrial septal defect closure.

    PubMed

    Jeon, Jin Pyeong; Cho, Young Dae; Han, Moon Hee

    2016-07-01

    Use of percutaneous devices for atrial septal defect (ASD) closure is growing, given the minimally invasive nature and the long-term durability of this approach. The reported rate of thrombus formation after catheter closure is 1.2%. Thrombotic risk varies according to closure device and Dacron-covered nitinol Amplatzer devices carry a 0-0.3% rate of thrombus formation; but central retinal artery occlusion (CRAO) is rarely implicated as an adverse event. Herein, we report the first successful intra-arterial thrombolytic treatment of CRAO developing after ASD closure via Amplatzer device. © 2015 Wiley Periodicals, Inc. PMID:26153142

  14. The association of central retinal artery occlusion and extracranial carotid artery disease.

    PubMed Central

    Douglas, D J; Schuler, J J; Buchbinder, D; Dillon, B C; Flanigan, D P

    1988-01-01

    To determine the incidence of associated carotid artery disease and the effect of carotid endarterectomy on subsequent neurologic sequelae, a retrospective study of 66 patients with central retinal artery occlusion (CRAO) was undertaken. Ipsilateral extracranial carotid artery disease was present in 23 of 33 patients (70%) who had carotid arteriography. Sixteen patients had carotid endarterectomy following their CRAO (Group I) and 50 did not (Group II). Seven of the 40 patients available for follow-up in Group II had a subsequent stroke (mean follow-up: 54 months). Of the seven Group II patients shown to have associated carotid disease (Group IIs), three (43%) had a subsequent stroke during follow-up (mean: 28.3 months) compared to zero in Group I (p = 0.033; mean follow-up: 18.7 months). Because of the strong association between CRAO and ipsilateral carotid artery disease and because of the significantly higher incidence of subsequent ipsilateral stroke in CRAO patients with carotid disease who did not undergo endarterectomy, thorough evaluation of the carotid arteries followed by carotid endarterectomy, if indicated, is warranted in CRAO patients who have no other obvious etiology for the occlusion. PMID:3389947

  15. Transcatheter Splenic Artery Occlusion for Treatment of Splenic Artery Steal Syndrome After Orthotopic Liver Transplantation

    SciTech Connect

    Uflacker, Renan; Selby, J. Bayne; Chavin, Kenneth; Rogers, Jeffrey; Baliga, Prabhakar

    2002-08-15

    Purpose: To review some aspects of the problem of splenic artery steal syndrome as cause of ischemia in transplanted livers and treatment by selective splenic artery occlusion. Materials and Methods: Eleven liver transplant patients from a group of 350 patients, nine men and two women,ranging in age from 40 years to 61 years (mean 52 years), presented with biochemical evidences of liver ischemia and failure, ranging from one to 60 days following orthotopic liver transplantation. Diagnosis of splenic artery steal syndrome was suspected by elevated enzymes, Doppler ultrasound and confirmed by celiac angiogram. Patients with confirmed hepatic artery thrombosis before angiography were excluded from the study. Embolization with Gianturco coils was performed. Results: All patients were treated by splenic artery embolization with Gianturco coils. The 11 patients improved clinically within 24 hours of the procedure with significant change in the biochemical and clinical parameters. Followup ranged from one month to two years. One of the 11 patient initially improved, but developed hepatic artery thrombosis within 24 hours of the embolic treatment,requiring surgical repair. Conclusion: Splenicartery steal syndrome following liver transplantation surgery can be diagnosed by celiac angiography, and effectively treated by splenic artery embolization with coils. Embolization is one of the treatments available, it is minimally invasive, and leads to immediate clinical improvement. Hepatic artery thrombosis is a possible complication of the procedure.

  16. A novel method to determine perineal artery occlusion among male bicyclists.

    PubMed

    Parthiban, Sujeeth; Hotaling, James M; Kathrins, Martin; Baftiri, Amit P; Freels, Sally; Niederberger, Craig S

    2015-01-01

    Background. Perineal pressure due to bicycle riding has been associated with erectile dysfunction. We developed a novel method to measure the occlusive force exerted over the perineal arteries and determined perineal artery occlusion by a variety of seat designs. Methods. Doppler ultrasonography facilitated perineal artery localization and determination of the force required for perineal artery occlusion in 20 healthy men. Flexiforce(®) sensors were affixed over the proximal and distal aspects of the perineal arteries bilaterally. Individuals completed bicycle rides in the road- and stationary-settings with six distinct seat designs, including those with and without an anterior "nose." Results. The occlusion time proportion of the total ride time was calculated for each trial. The overall occlusion time proportion was 0.59 (95% CI [0.45-0.73]) across all seats and settings. The "no-nose" bicycle seat and the stationary-setting demonstrated significantly lower occlusion proportion times than the traditional nose bicycle seat and road-setting, respectively. However, all bicycle seats yielded an occlusion time proportion of 0.41 or greater. Discussion. Our method of real-time, non-invasive force measurement localized to the perineal arteries may be used to validate future bicycle seat design. It also underscores the significant risk of perineal artery insufficiency in men who are avid bicyclists. This risk may be minimized by using newer "no-nose" bicycle seats. PMID:26713236

  17. A novel method to determine perineal artery occlusion among male bicyclists

    PubMed Central

    Hotaling, James M.; Kathrins, Martin; Baftiri, Amit P.; Freels, Sally; Niederberger, Craig S.

    2015-01-01

    Background. Perineal pressure due to bicycle riding has been associated with erectile dysfunction. We developed a novel method to measure the occlusive force exerted over the perineal arteries and determined perineal artery occlusion by a variety of seat designs. Methods. Doppler ultrasonography facilitated perineal artery localization and determination of the force required for perineal artery occlusion in 20 healthy men. Flexiforce® sensors were affixed over the proximal and distal aspects of the perineal arteries bilaterally. Individuals completed bicycle rides in the road- and stationary-settings with six distinct seat designs, including those with and without an anterior “nose.” Results. The occlusion time proportion of the total ride time was calculated for each trial. The overall occlusion time proportion was 0.59 (95% CI [0.45–0.73]) across all seats and settings. The “no-nose” bicycle seat and the stationary-setting demonstrated significantly lower occlusion proportion times than the traditional nose bicycle seat and road-setting, respectively. However, all bicycle seats yielded an occlusion time proportion of 0.41 or greater. Discussion. Our method of real-time, non-invasive force measurement localized to the perineal arteries may be used to validate future bicycle seat design. It also underscores the significant risk of perineal artery insufficiency in men who are avid bicyclists. This risk may be minimized by using newer “no-nose” bicycle seats. PMID:26713236

  18. Percutaneous Treatment in Iliac Artery Occlusion: Long-Term Results

    SciTech Connect

    Gandini, Roberto; Fabiano, Sebastiano; Chiocchi, Marcello; Chiappa, Roberto Simonetti, Giovanni

    2008-11-15

    We evaluated the long-term results of recanalization with primary stenting for patients with long and complex iliac artery occlusions. This was a retrospective nonrandomised study. Between 1995 and 1999, 138 patients underwent recanalization of an occluded iliac artery with subsequent stenting. Patency results were calculated using Kaplan-Meier analysis. The mean length of follow-up was 108 months. Variables affecting primary stent patency such as patient age; stent type and diameter; lesion site, shape, and length; Society of Cardiovascular and Interventional Radiology classification; total runoff score; Fontaine classification; and cardiovascular risk factors were analysed using Breslow test. These variables were then evaluated for their relation to stent patency using Cox proportional hazards test. Technical success was 99%. Primary patency rates were 90% (SE .024), 85% (SE .029), 80% (SE .034), and 68% (SE .052) at 3, 5, 7, and 10 years, respectively. Lesion site (p = 0.022) and stent diameter (p = 0.028) were shown to have a statistically significant influence on primary stent patency. Long-term results of iliac recanalization and stent placement were excellent, without major complications, even in highly complex vascular obstructions. A primary endovascular approach appears to be justified in the majority of patients as a less invasive alternative treatment to surgery. In any case, a first-line interventional approach should be considered in elderly patients or in patients with severe comorbidities.

  19. Successful percutaneous coronary intervention for chronic total occlusion of right coronary artery in patient with dextrocardia.

    PubMed

    Munawar, Muhammad; Hartono, Beny; Iskandarsyah, Kurniawan; Nguyen, Thach N

    2013-07-01

    Situs inversus with dextrocardia is rare congenital anomaly. Coronary artery disease in such patients is quite rare. We reported a 52-year-old man with dextrocardia and chronic total occlusion at the proximal right coronary artery just after conus branch and severe stenosis at the proximal left anterior descending artery. He underwent successful percutaneous coronary intervention with stenting of total occluded right coronary artery and simultaneously stenting of the proximal left anterior descending artery. PMID:23456428

  20. Comprehensive analysis of myocardial infarction due to left circumflex artery occlusion: comparison with infarction due to right coronary artery and left anterior descending artery occlusion

    SciTech Connect

    Huey, B.L.; Beller, G.A.; Kaiser, D.L.; Gibson, R.S.

    1988-11-01

    Forty consecutive patients with creatine kinase-MB confirmed myocardial infarction due to circumflex artery occlusion (Group 1) were prospectively evaluated and compared with 107 patients with infarction due to right coronary artery occlusion (Group 2) and 94 with left anterior descending artery occlusion (Group 3). All 241 patients underwent exercise thallium-201 scintigraphy, radionuclide ventriculography, 24 h Holter electrocardiographic (ECG) monitoring and coronary arteriography before hospital discharge and were followed up for 39 +/- 18 months. There were no significant differences among the three infarct groups in age, gender, number of risk factors, prevalence and type of prior infarction, Norris index, Killip class and frequency of in-hospital complications. Acute ST segment elevation was present in only 48% of patients in Group 1 versus 71 and 72% in Groups 2 and 3, respectively (p = 0.012), and 38% of patients with a circumflex artery-related infarct had no significant ST changes (that is, elevation or depression) on admission (versus 21 and 20% for patients in Groups 2 and 3, respectively) (p = 0.001). Abnormal R waves in lead V1 were more common in Group 1 than in Group 2 (p less than 0.003) as was ST elevation in leads I, aVL and V4 to V6 (p less than or equal to 0.048). These differences in ECG findings between Group 1 and 2 patients correlated with a significantly higher prevalence of posterior and lateral wall asynergy in the group with a circumflex artery-related infarct. Infarct size based on peak creatine kinase levels and multiple radionuclide variables was intermediate in Group 1 compared with that in Group 2 (smallest) and Group 3 (largest). During long-term follow-up, the probability of recurrent cardiac events was similar in the three infarct groups.

  1. Suprarenal fixation barbs can induce renal artery occlusion in endovascular aortic aneurysm repair.

    PubMed

    Subedi, Shree K; Lee, Andy M; Landis, Gregg S

    2010-01-01

    Renal artery occlusion following endovascular abdominal aortic aneurysm repair with suprarenal fixation is uncommon. We report one patient who was found to develop renal artery occlusion and parenchymal infarction 6 months after repair using an endovascular graft with suprarenal fixation. Our patient underwent emergent endovascular repair of a symptomatic 6 cm abdominal aortic aneurysm. The covered portion of the endograft was inadvertently deployed well below the renal artery orifices. At the completion of the procedure both renal arteries were confirmed to be patent. One month postoperatively, a computed tomographic (CT) scan showed exclusion of the aortic sac and normal enhancement of both kidneys. At 6 months, the patient was found to have elevated serum creatinine levels despite having no clinical symptoms. CT scanning revealed a nonenhancing left kidney, and angiography demonstrated an occlusion of the left renal artery. A barb welded to the bare metal stent appeared to be impinging on the renal artery. We believe that renal artery occlusion after endovascular repair can occur due to repetitive injury to the renal artery orifice from barbs welded to the bare metal stent. To our knowledge, this is the first reported case of renal artery occlusion caused by repetitive injury from transrenal fixation systems. PMID:19540715

  2. A Large Posttraumatic Subclavian Artery Aneurysm Complicated by Artery Occlusion and Arteriobronchial Fistula Successfully Treated Using a Covered Stent

    SciTech Connect

    Stefanczyk, Ludomir; Czeczotka, Jaroslaw; Elgalal, Marcin; Sapieha, Michal; Rowinski, Olgierd

    2011-02-15

    The treatment of posttraumatic aneurysms of peripheral arteries using covered stents is increasingly commonplace. We present the case of a 10-year-old girl with a pseudoaneurysm of the subclavian artery complicated by an arteriobronchial fistula with hemorrhaging into the bronchial tree and distal subclavian artery occlusion. Despite the lack of artery patency, endovascular stent graft implantation was successful. Pseudoaneurysm exclusion and involution was achieved, together with a patent implant and maintained collateral circulation patency.

  3. Endovascular treatments for posterior cerebral artery aneurysms and vascular insufficiency of fetal-type circulation after parent artery occlusion.

    PubMed

    Matsumura, Hideaki; Kato, Noriyuki; Fujiwara, Yusuke; Hosoo, Hisayuki; Yamazaki, Tomosato; Yasuda, Susumu; Matsumura, Akira

    2016-10-01

    We present a retrospective analysis of endovascular treatments for posterior cerebral artery (PCA) aneurysms and discuss the susceptibility of a fetal-type PCA to vascular insufficiency after parent artery occlusion. Among 1207 aneurysms treated with endovascular therapy between March 1997 and March 2013 in our institution, 10 patients (0.8%) presented PCA aneurysms. The principal strategy was to employ selective coil embolization for the aneurysm. However, in certain cases of fusiform or dissecting aneurysms, we performed parent artery occlusion with coils. Clinical and radiological data were collected from hospital charts and evaluated retrospectively. The mean age was 52.7±15.6years (range, 12-65years). Five patients (50%) were admitted with a subarachnoid hemorrhage, and one patient presented with slowly developing paralysis. The remaining four patients were diagnosed incidentally. Five patients underwent selective coil embolization, and five patients underwent parent artery occlusion. All endovascular therapies were successfully performed. However, two patients in the parent artery occlusion group suffered cerebral infarction, and both patients exhibited a fetal-type PCA. The remaining three patients in the parent artery occlusion group exhibited an adult-type PCA and did not suffer a cerebral infarction. Endovascular treatment with either selective coil embolization or parent artery occlusion is safe and effective as the long as the anatomical type of the PCA is considered. Patients with a fetal-type PCA may develop vascular insufficiency upon parent artery occlusion. Neurosurgeons should attempt to preserve the parent artery using a flow-diverting stent or stent-assisted technique for a fetal-type PCA aneurysm. PMID:27523585

  4. Preservation of retinal structure and function after cilioretinal artery occlusion: a case report.

    PubMed

    Brown, Craig J

    2016-01-01

    Cilioretinal artery occlusion is a cause of sudden, often catastrophic loss of central vision. There are no established effective treatments. Recently, a patient presented 24 hours after a cilioretinal artery occlusion, following a cardiac catheterization prior to which her blood thinners had been discontinued. Lacking an effective way to address the severe retinal ischemic oxidative stress, she was offered, under compassionate use, a multivitamin complex designed to address retinal ischemia and oxidative stress. Significant components of this product are L-methylfolate and n-acetyl cysteine. The patient experienced a rapid unexpected improvement in vision and preservation of retinal structure, suggesting that marked improvement in retinal artery occlusions outcomes may be possible as late as 24 hours postocclusion. This is the third reported case of cilioretinal artery occlusion associated with cardiac catheterization. PMID:26929671

  5. Preservation of retinal structure and function after cilioretinal artery occlusion: a case report

    PubMed Central

    Brown, Craig J

    2016-01-01

    Cilioretinal artery occlusion is a cause of sudden, often catastrophic loss of central vision. There are no established effective treatments. Recently, a patient presented 24 hours after a cilioretinal artery occlusion, following a cardiac catheterization prior to which her blood thinners had been discontinued. Lacking an effective way to address the severe retinal ischemic oxidative stress, she was offered, under compassionate use, a multivitamin complex designed to address retinal ischemia and oxidative stress. Significant components of this product are L-methylfolate and n-acetyl cysteine. The patient experienced a rapid unexpected improvement in vision and preservation of retinal structure, suggesting that marked improvement in retinal artery occlusions outcomes may be possible as late as 24 hours postocclusion. This is the third reported case of cilioretinal artery occlusion associated with cardiac catheterization. PMID:26929671

  6. Pulmonary veno-occlusive disease presenting with thrombosis of pulmonary arteries.

    PubMed Central

    Katz, D. S.; Scalzetti, E. M.; Katzenstein, A. L.; Kohman, L. J.

    1995-01-01

    Pulmonary veno-occlusive disease is a rare cause of pulmonary hypertension. An unusual case presenting with thrombosis of the right pulmonary artery and serological evidence of autoimmunity is reported. Images PMID:7638821

  7. External iliac artery occlusion in a paediatric patient following handlebar trauma

    PubMed Central

    Singla, Animesh A.; McPherson, Danielle; Singla, Apresh A; Cross, Jane; Leslie, Anthony

    2015-01-01

    Arterial occlusion following blunt trauma is an uncommon occurrence. We report an unusual case of delayed external iliac artery occlusion in a young male following blunt abdominal injury. He was successfully treated with thromboendarterectomy and saphenous vein patch repair. There have only been a handful of documented cases occurring in the paediatric population. All patients presenting with groin injury from this mechanism should be carefully investigated and monitored for risk of vascular injury. PMID:25733671

  8. External iliac artery occlusion in a paediatric patient following handlebar trauma.

    PubMed

    Singla, Animesh A; McPherson, Danielle; Singla, Apresh A; Cross, Jane; Leslie, Anthony

    2015-01-01

    Arterial occlusion following blunt trauma is an uncommon occurrence. We report an unusual case of delayed external iliac artery occlusion in a young male following blunt abdominal injury. He was successfully treated with thromboendarterectomy and saphenous vein patch repair. There have only been a handful of documented cases occurring in the paediatric population. All patients presenting with groin injury from this mechanism should be carefully investigated and monitored for risk of vascular injury. PMID:25733671

  9. Aseptic cavernous sinus thrombosis after internal carotid arterial occlusion in polycythaemia vera.

    PubMed Central

    Melamed, E; Rachmilewitz, E A; Reches, A; Lavy, S

    1976-01-01

    Two patients with untreated polycythaemia vera developed intracranial internal carotid arterial occlusion followed by monocular blindness and the characteristic features of ipsilateral cavernous sinus thrombosis. Primary septic source and signs of systemic infection were absent. It is suggested that the predisposing factors in this unusual syndrome were hyperviscosity and venous sludging induced by the basic haematological disorder and progression of the thrombotic process within the internal carotid artery towards its intracavernous portion with occlusion of the ophthalmic artery and of the arterial branches which supply the walls of the sinus. Images PMID:932749

  10. Functional Development of the Coronary Collateral Circulation During Coronary Artery Occlusion in the Conscious Dog

    PubMed Central

    Bloor, Colin M.; White, Francis C.

    1972-01-01

    We studied changes in the coronary collateral circulation during coronary artery occlusion in 14 conscious dogs by: a) determining simultaneous changes in peripheral coronary pressure (PCP) and retrograde flow (RF) after abrupt coronary artery occlusion; b) correlating these functional indices with quantitative anatomic indices (AI) of coronary collateral development (Menick et al: Am Heart J 82:503-510, 1971); and c) observing changes in these indices after repeated reocclusions of a coronary artery. These dogs were subjected to left circumflex coronary artery (LCCA) occlusions for 2 hours to 8 days; pressure tubes were implanted in the aorta and LCCA, the latter tube placed distal to an occlusive cuff for PCP and RF measurements. Afterwards the animals were sacrificed, their hearts injected with a modified Schlesinger's gelatin mass, and AI determined. During 2 to 24 hour LCCA occlusions (11 dogs) mean PCP rose to levels 50 to 80% of prevailing aortic pressure. During repreated 2- to 24-hour occlusions (2 dogs) in the same dog, the rate at which PCP rose increased. Retrograde flow was unchanged during 2- to 24-hour occlusions. Anatomic indices of these dogs were in the same range as those observed in unoccluded controls. When LCCA occlusion was maintained for more than 4 days (3 dogs), mean PCP rose during the first 24 hours and then remained stable; RF did not change until 4 days into occlusion and then increased. Anatomic indices of dogs occluded for more than 4 days were significantly greater (P < 0.001) than those of the 2- to 24-hour occlusion groups. Our study shows that: a) the early PCP rise after occlusion is not associated with an increase in RF, b) RF is a better index of collateral function and c) RF correlated well with the anatomic development of the collateral bed. ImagesFig 2Fig 1 PMID:5033259

  11. [Intra-arterial administration of prostaglandin E1 in occlusive arterial diseases].

    PubMed

    Davidović, L; Vranes, M; Cernak, I; Kostić, D; Lovrić, A; Sagić, D; Lotina, S

    1992-01-01

    The authors present their result of a two-year follow-up of 106 patients to whom an intra-arterial perfusion of prostaglandin E1 was administered, as limb salvage procedure. The patients were in the IIIrd and IVth stage of occlusive diseases by Fountain, and surgical reconstructions were not possible. All patients were divided into five groups: A--diabetic angiopathy (5), B--distal form of atherosclerosis (40), C--diabetic angiopathy and atherosclerosis (45), D--Burger disease (10) and E--adjuvant therapy in reconstruction with poor run-off (6). The Doppler sonographic and angiographic measurements were performed. After transcutaneous (16 cases), or intraoperative (90 cases) introduction of the catheter into superficial of profunda femoral artery, a continuous intraarterial administration of prostaglandin E1 was carried out in a dose of 10 nanograms/kg body weight/minute (total dosage 3000 nanograms). The patients were controlled immediately after the treatment, as well as 1, 3, 6, 12, 24 and 36 months after the treatment. In efficiency of the treatment was estimated on the following basis: elimination of rest pain, healing of trophic ulceration and demarcation of gangrenous processes. Our late results of intra-arterial administration of prostaglandin E1 proved to be a very successful limb salvage procedure. The treatment was more successful in a connections between the upper knee arterial net and pedal arterial arches were preserved. PMID:1641706

  12. Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion

    PubMed Central

    2015-01-01

    Cosmetic facial filler-related ophthalmic artery occlusion is rare but is a devastating complication, while the exact pathophysiology is still elusive. Cerebral angiography provides more detailed information on blood flow of ophthalmic artery as well as surrounding orbital area which cannot be covered by fundus fluorescein angiography. This study aimed to evaluate cerebral angiographic features of cosmetic facial filler-related ophthalmic artery occlusion patients. We retrospectively reviewed cerebral angiography of 7 patients (4 hyaluronic acid [HA] and 3 autologous fat-injected cases) showing ophthalmic artery and its branches occlusion after cosmetic facial filler injections, and underwent intra-arterial thrombolysis. On selective ophthalmic artery angiograms, all fat-injected patients showed a large filling defect on the proximal ophthalmic artery, whereas the HA-injected patients showed occlusion of the distal branches of the ophthalmic artery. Three HA-injected patients revealed diminished distal runoff of the internal maxillary and facial arteries, which clinically corresponded with skin necrosis. However, all fat-injected patients and one HA-injected patient who were immediately treated with subcutaneous hyaluronidase injection showed preserved distal runoff of the internal maxillary and facial arteries and mild skin problems. The size difference between injected materials seems to be associated with different angiographic findings. Autologous fat is more prone to obstruct proximal part of ophthalmic artery, whereas HA obstructs distal branches. In addition, hydrophilic and volume-expansion property of HA might exacerbate blood flow on injected area, which is also related to skin necrosis. Intra-arterial thrombolysis has a limited role in reconstituting blood flow or regaining vision in cosmetic facial filler-associated ophthalmic artery occlusions. PMID:26713062

  13. De Winter Electrocardiographic Pattern Related with a Non-Left Anterior Descending Coronary Artery Occlusion.

    PubMed

    Montero Cabezas, José M; Karalis, Ioannis; Schalij, Martin J

    2016-09-01

    The electrocardiographic pattern consisting of ST-segment depression and hyperacute T waves in patients with acute chest pain, known as "De Winter pattern," has been related with the occlusion of the proximal left anterior descending artery (LAD). The association of these findings with the involvement of a different coronary artery has not been described. We present a 53-year-old patient with an occlusion of the first diagonal branch and an electrocardiogram showing a "De Winter pattern." The reported case demonstrates that "De Winter pattern" is not exclusively associated with the occlusion of the proximal segment of the LAD. PMID:27592618

  14. Safety of coil occlusion of the parent artery for endovascular treatment of anterior communicating artery aneurysm.

    PubMed

    Kim, Sanghyeon; Kang, Myongjin; Choi, Jae-Hyung; Kim, Dong Won

    2016-06-01

    Many studies lay emphasis on the clinical importance of perforating branches of the anterior communicating artery (ACoA) and report that vascular damage of the perforators from ACoA aneurysm during surgery cause subsequent postoperative amnesia. The purpose of our study was to analyze the safety of parent artery occlusion for ACoA aneurysm coiling based on the anatomical features of the ACoA complex in 13 patients with 13 ACoA aneurysms. All patients underwent coiling of the aneurysm sac and ACoA. Aneurysm characteristics including size, dome-to-neck ratio, anterior/posterior orientation of the aneurysm dome with respect to the axis of the pericallosal artery, location of the aneurysm neck with respect to the A1-A2 segment of the anterior cerebral artery (ACA) or the ACoA, and the presence of hypoplasia/aplasia of A1 segment were assessed. The aneurysm neck was located directly on the ACoA in five aneurysms (38%), whereas eight (62%) had the neck located at the A1-A2 junction. Of the five patients whose aneurysm neck was located in the ACoA, four patients had infarcts in the basal forebrain. Three of the patients complained of amnesia. None of the aneurysms with the neck located at the A1-A2 junction were associated with infarction. There has been little evidence thus far that parent vessel occlusion of ACoA aneurysms is a safe method for the treatment of aneurysms. Patients with the aneurysm neck located at the A1-A2 junction and without A1 aplasia, who were treated with aneurysm sac and ACoA embolism, were potentially safe. PMID:26988084

  15. Transient Aortic Occlusion Augments Collateral Blood Flow and Reduces Mortality During Severe Ischemia due to Proximal Middle Cerebral Artery Occlusion.

    PubMed

    Ramakrishnan, Gomathi; Dong, Bin; Todd, Kathryn G; Shuaib, Ashfaq; Winship, Ian R

    2016-04-01

    Cerebral collateral circulation provides alternative vascular routes for blood to reach ischemic tissues during stroke. Collateral therapeutics attempt to augment flow through these collateral channels to reduce ischemia and brain damage during acute ischemic stroke. Transient aortic occlusion (TAO) has pre-clinical data suggesting that it can augment collateral blood flow and clinical data suggesting a benefit for patients with moderate cortical strokes. By diverting blood from the periphery towards the cerebral circulation, TAO has the potential to augment primary collateral flow at the circle of Willis and thereby improve outcome even during large, hemispheric strokes. Using proximal middle and anterior cerebral artery occlusion in rats, we demonstrate that TAO reduces mortality and improves collateral blood flow in severely ischemic animals. As such, TAO may be an effective therapy to reduce early mortality during severe ischemia associated with proximal occlusions. PMID:26706246

  16. Leptospirosis and Peripheral Artery Occlusive Disease: A Nationwide Cohort Analysis.

    PubMed

    Chiu, Chun-Hsiang; Lin, Cheng-Li; Lee, Feng-You; Wang, Ying-Chuan; Kao, Chia-Hung

    2016-03-01

    Data on the association between peripheral artery occlusive disease (PAOD) and leptospirosis are limited. We conducted a retrospective cohort study for determining whether leptospirosis is one of the possible risk factors for PAOD. Patients diagnosed with leptospirosis by using 2000 to 2010 data from the Taiwan National Health Insurance Research Database. Patients with leptospirosis without a history of PAOD were selected. For each leptospirosis patient, 4 controls without a history of leptospirosis and PAOD were randomly selected and frequency-matched for sex, age, the year of the index date, and comorbidity diseases. The follow-up period was from the time of the initial diagnosis of leptospirosis to the diagnosis date of PAOD, or December 31, 2011. The Cox proportional hazard regression models were used for analyzing the risk of PAOD. During the follow-up period, the cumulative incidence of PAOD was higher among the patients from the leptospirosis cohort than among the nonleptospirosis cohort (log-rank test, P < 0.001). In total, 29 patients with PAOD from the leptospirosis cohort and 81 from the nonleptospirosis cohort were observed with the incidence rates of 2.1 and 1.3 per 1000 person-years, respectively, yielding a crude hazards ratio (HR) of 1.62 (95% confidence interval [CI] = 1.44-1.81) and adjusted HR (aHR) of 1.75 (95% CI = 1.58-1.95).The risk of PAOD was 1.75-fold higher in the patients with leptospirosis than in the general population. PMID:26986166

  17. Static contrast technique for creating transpedal arterial access in patients with tibioperoneal occlusions.

    PubMed

    Chang, John Chien-Hwa; Lin, Lau-Shen; Chiu, Chih-Hung

    2013-10-01

    Transpedal arterial access is a useful but challenging technique for patients with tibioperoneal occlusions. It is associated with a long learning curve, requires the administration of a large amount of contrast media, and exposes patients and interventionists to additional radiation. Here we present a new technique by which it is easier and faster to create a transpedal arterial access. PMID:23769939

  18. Obstruction of the Aorta and Left Pulmonary Artery After Gianturco Coil Occlusion of Patent Ductus Arteriosus

    SciTech Connect

    Kuo, H.-Cg; Ko, Sheung-Fat; Wu, Yu-Tsun; Huang, Chien-Fu; Chien, Shao-Ju; Tiao, Mao-Meng; Liang, Chi-Di

    2005-01-15

    We report an unusual case of simultaneous obstruction of the left pulmonary artery and descending thoracic aorta after Gianturco coil occlusion in a 15-month-old boy. The diagnosis was made by echocardiography and cardiac angiography. At surgery, thrombi coating on the protruded parts of the Gianturco coil in the pulmonary artery and aorta were found.

  19. Cerebral arterial occlusion and intracranial venous thrombosis in a woman taking oral contraceptives.

    PubMed Central

    Montón, F.; Rebollo, M.; Quintana, F.; Berciano, J.

    1984-01-01

    Occlusion of the middle cerebral artery and thrombosis of the superior sagittal sinus are reported in a 30-year-old woman taking oral contraceptives (OC). The coexistence of arterial and venous cerebral pathology as a complication of OC use has only been previously reported in one case. The pathogenesis of this rare association is briefly discussed. Images Fig. 1 Fig. 2 PMID:6462985

  20. Temporary Arterial Balloon Occlusion as an Adjunct to Yttrium-90 Radioembolization

    SciTech Connect

    Hagspiel, Klaus D.; Nambiar, Ashwin; Hagspiel, Lauren M.; Ahmad, Ehab Ali; Bozlar, Ugur

    2013-06-15

    Purpose. This study was designed to describe the technique of arterial occlusion using a temporary occlusion balloon system as an alternative to coil occlusion during Yttrium-90 radioembolization of hepatic tumors. Methods. Review of charts, angiography, and follow-up imaging studies of consecutive patients undergoing oncological embolization procedures in which a HyperForm system (ev3 Neurovascular, Irvine, CA) was used. Intraprocedural target vessel occlusion and patency of the target vessel on follow-up were recorded. Clinical data and Bremsstrahlung scans were reviewed for evidence of nontarget embolization. Results. Four radioembolization procedures were performed in three patients (all female, age 48-54 (mean 52) years). Five arteries were temporarily occluded (three gastroduodenal arteries, one right gastric artery, and one cystic artery). All radioembolization procedures were successfully completed. Follow-up imaging (either digital subtraction angiography (DSA) or computed tomography angiography (CTA)) was available for all patients between 28-454 (mean 183) days following the procedure, demonstrating all five vessels to be patent. No clinical or imaging evidence for nontarget embolization was found. Conclusions. Temporary balloon occlusion of small and medium-sized arteries during radioembolization allows safe therapy with preserved postprocedural vessel patency on early and midterm follow-up.

  1. Mechanical Recanalization of Subacute Vessel Occlusion in Peripheral Arterial Disease with a Directional Atherectomy Catheter

    SciTech Connect

    Massmann, Alexander Katoh, Marcus; Shayesteh-Kheslat, Roushanak; Buecker, Arno

    2012-10-15

    Purpose: To retrospectively examine the technical feasibility and safety of directional atherectomy for treatment of subacute infrainguinal arterial vessel occlusions. Methods: Five patients (one woman, four men, age range 51-81 years) with peripheral arterial disease who experienced sudden worsening of their peripheral arterial disease-related symptoms during the last 2-6 weeks underwent digital subtraction angiography, which revealed vessel occlusion in native popliteal artery (n = 4) and in-stent occlusion of the superficial femoral artery (n = 1). Subsequently, all patients were treated by atherectomy with the SilverHawk (ev3 Endovascular, USA) device. Results: The mean diameter of treated vessels was 5.1 {+-} 1.0 mm. The length of the occlusion ranged 2-14 cm. The primary technical success rate was 100%. One patient experienced a reocclusion during hospitalization due to heparin-induced thrombocytopenia. There were no further periprocedural complications, in particular no peripheral embolizations, until hospital discharge or during the follow-up period of 1 year. Conclusion: The recanalization of infrainguinal arterial vessel occlusions by atherectomy with the SilverHawk device is technically feasible and safe. In our limited retrospective study, it was associated with a high technical success rate and a low procedure-related complication rate.

  2. Bilateral vertebral artery occlusion with retrograde basilary flow in three cases of giant cell arteritis

    PubMed Central

    Boettinger, Markus Robert; Sebastian, Schreglmann Robert; Gamulescu, Maria-Andreea Robert; Grauer, Oliver; Ritzka, Markus; Schuierer, Gerhard Robert; Bogdahn, Ulrich Robert; Steinbrecher, Andreas; Schlachetzki, Felix

    2009-01-01

    Vertebrobasilar ischaemia is a rare life-threatening complication in giant cell arteritis (GCA). We report three patients with bilateral vertebral artery occlusion. Neurovascular imaging, including CT-angiography, MR-angiography and colour-coded duplex sonography revealed flow reversal in the basilar artery as well as inflammation of the vertebral vessel wall. The first patient died from massive brainstem infarction, the other two patients survived the initial inflammatory phase of GCA. No stroke recurrence at 12 months’ follow-up on warfarin and steroid treatment was observed. Bilateral distal vertebral artery occlusion and retrograde basilar artery flow persisted. Outcome in these patients is dependant on potent immunosuppression, concurrent atherosclerotic steno-occlusive disease and presence and/or rapid development of sufficient collateral pathways into the vertebrobasilar circulation. The identification of patients with high risk of ischaemia due to compromised vertebrobasilar flow may be important to select adjunct treatment to immunosuppression, such as anticoagulation in GCA. PMID:21691390

  3. Evolution of Internal Carotid Artery Occlusion in Non-Traumatic Carotid Dissection

    PubMed Central

    RUSU, Octavia; VASILE, Mihai; BAJENARU, Ovidiu; ANTOCHI, Florina

    2014-01-01

    Cervical artery dissection is becoming a more frequently identified cause of ischemic stroke among the young and middleaged patients. The pathogenesis of non-traumatic dissection has not been yet entirely elucidated, but certain risk factors have been reported. We present the case of a young patient with ischemic stroke in the middle cerebral artery territory secondary to internal carotid artery dissection and occlusion, in whom we identified two rarely incriminated risk factors: migraine and recent infection (pneumonia). PMID:25705278

  4. A Rare Cause of Retinal Artery Occlusion in Severe Hypernatremic Dehydration in Newborns.

    PubMed

    Ozer, Pinar Altiaylik; Kabatas, Emrah Utku; Kurtul, Bengi Ece; Dilli, Dilek; Zenciroglu, Aysegul; Okumus, Nurullah

    2016-05-01

    Neonatal hypernatremia is an important electrolyte disorder that may have serious complications. It may be a rare and underdiagnosed cause of venous and arterial thrombosis, leading to severe brain damage by cerebral edema and intracranial hemorrhage. Here, the authors present a case of bilateral central retinal artery occlusion in a newborn with severe hypernatremic dehydration who is found to be normal in terms of other causes of retinal arterial thromboembolization. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:482-485.]. PMID:27183555

  5. A simple technique to rule out occlusion of right coronary artery after aortic valve surgery.

    PubMed

    Fernández, Angel L; El-Diasty, Mohammad M; Martínez, Amparo; Alvarez, Julian; García-Bengochea, José B

    2011-12-01

    Mechanical occlusion of the right coronary artery during aortic valve surgery is an infrequent but serious complication. Early recognition and expeditious management are important to reduce mortality. We developed a safe, quick, and easy technique to assess right coronary artery flow after aortic valve surgery. Direct intraoperative right coronary artery flow was measured by placing a transit-time flowmeter probe around the right coronary artery. We were able to promptly detect severe right coronary artery insufficiency in patients with acute unexpected right ventricular failure after aortic valve replacement. PMID:22115253

  6. Cerebral blood flow response pattern during balloon test occlusion of the internal carotid artery

    SciTech Connect

    Witt, J.P.; Yonas, H.; Jungreis, C.

    1994-05-01

    To evaluate the risk of temporary or permanent internal carotid artery occlusion. In 156 patients intraarterial balloon test occlusion in combination with a stable xenon-enhanced CT cerebral blood flow study was performed before radiologic or surgical treatment. All 156 patients passed the clinical balloon test occlusion and underwent a xenon study in combination with a second balloon test. Quantitative flow data were analyzed for absolute changes as well as changes in symmetry. Fourteen patients exhibited reduced flow values between 20 and 30 mL/100 g per minute, an absolute decrease in flow, and significant asymmetry in the middle cerebral artery territory during balloon test occlusion. These patients would be considered at high risk for cerebral infarction if internal carotid artery occlusion were to be performed. With one exception they belonged to a group (class I) of 61 patients who showed bilateral or ipsilateral flow decrease and significant asymmetry with lower flow on the side of occlusion. The other 95 patients, who showed a variety of cerebral blood flow response patterns including ipsilateral or bilateral flow increase, were at moderate (class II) or low (class III) stroke risk. In contrast to these findings, exclusively qualitative flow analysis failed to identify the patients at high risk: a threshold with an asymmetry index of 10% revealed only 16% specificity whereas an asymmetry index of 45% showed only 61% sensitivity for detection of low flow areas (<30 mL/100 g per minute). For achieving a minimal hemodynamic related-stroke rate associated with permanent clinical internal carotid artery occlusion we suggest integration of a thorough analysis of quantitative cerebral blood flow data before and during balloon test occlusion. 68 refs., 5 figs., 2 tabs.

  7. Uterine Artery Embolization Versus Laparoscopic Uterine Artery Occlusion: The Outcomes of a Prospective, Nonrandomized Clinical Trial

    SciTech Connect

    Mara, Michal; Kubinova, Kristyna; Maskova, Jana; Horak, Petr; Belsan, Tomas; Kuzel, David

    2012-10-15

    Purpose: To compare outcomes of two different types of occlusive therapy of uterine fibroids. Methods: Women with fibroid(s) unsuitable for laparoscopic myomectomy (LM) were treated with uterine artery embolization (UAE) or laparoscopic uterine artery occlusion (LUAO). Results: Before the procedure, patients treated with UAE (n = 100) had a dominant fibroid greater in size (68 vs. 48 mm) and a mean age lower (33.1 vs. 34.9 years) than surgically treated patients (n = 100). After 6 months, mean shrinkage of fibroid volume was 53 % after UAE and 39 % after LUAO (p = 0.063); 82 % of women after UAE, but only 23 % after LUAO, had complete myoma infarction (p = 0.001). Women treated with UAE had more complications (31 vs. 11 cases, p = 0.006) and greater incidence of hysteroscopically verified intrauterine necrosis (31 vs. 3 %, p = 0.001). Both groups were comparable in markers of ovarian functions and number of nonelective reinterventions. The groups did not differ in pregnancy (69 % after UAE vs. 67 % after LUAO), delivery (50 vs. 46 %), or abortion (34 vs. 33 %) rates. The mean birth weight of neonates was greater (3270 vs. 2768 g, p = 0.013) and the incidence of intrauterine growth restriction lower (13 vs. 38 %, p = 0.046) in post-UAE patients. Conclusion: Both methods are effective in the treatment of women with future reproductive plans and fibroids not suitable for LM. UAE is more effective in causing complete ischemia of fibroids, but it is associated with greater risk of intrauterine necrosis. Both methods have low rate of serious complications (except for a high abortion rate).

  8. Subclavian Artery Occlusion and Pseudoaneurysm Caused by Lung Apex Mucormycosis: Successful Treatment with Transcatheter Embolization

    SciTech Connect

    Economopoulos, Nikolaos; Kelekis, Dimitris; Papadopoulos, Antonios; Kontopoulou, Christina; Brountzos, Elias N.

    2007-02-15

    Subclavian artery pseudoaneurysm and occlusion in young patients are usually post-traumatic. We report the case of a 33-year-old diabetic woman with subclavian artery occlusion and pseudoaneurysm formation caused by pulmonary mucormycosis infection. The patient presented with diabetic ketoacidosis, Horner's syndrome, and absent left arm pulses. A cystic lesion of the left lung apex was found by imaging, was surgically resected, and was histologically diagnosed as mucormycosis infection. Magnetic resonance angiography depicted a left subclavian artery pseudoaneurysm and occlusion adjacent to the mucormycosis lesion. To protect against thromboembolic complications and rupture, the pseudoaneurysm was embolized with coils. The patient is clinically well 1 year after the intervention with no perfusion of the pseudoaneurysm.

  9. Nd YAG Laser Embolysis in a Young Woman with Hemiretinal Artery Occlusion.

    PubMed

    Mukhtar, Ahsan; Malik, Sidra; Khan, Muhammad Saim; Ishaq, Mazhar

    2016-07-01

    Retinal artery occlusion is an uncommon condition but can lead to grave consequences if not managed in time. Elderly population with other comorbid conditions like hypertension, ischemic heart disease, hyperlipidemia and stroke are commonly affected. However, this condition may affect younger population with entirely different systemic associations. Thromboembolism, which usually takes place secondary to cardiac emboli or hypercoagulable states cause retinal artery occlusion in young population. A24-year lady presented with a short history of unilateral altitudinal visual loss. On examination, she was found to have hemiretinal artery occlusion. Ocular massage, anterior chamber paracentesis was performed initially, followed by Nd YAG laser embolysis, which led to successful restoration of retinal circulation and significant improvement in visual field loss. Detailed evaluation and systemic investigations were carried out to identify the underlying cause, but no systemic association could be found. PMID:27504560

  10. Subclavian artery occlusion and pseudoaneurysm caused by lung apex mucormycosis: successful treatment with transcatheter embolization.

    PubMed

    Economopoulos, Nikolaos; Kelekis, Dimitris; Papadopoulos, Antonios; Kontopoulou, Christina; Brountzos, Elias N

    2007-01-01

    Subclavian artery pseudoaneurysm and occlusion in young patients are usually post-traumatic. We report the case of a 33-year-old diabetic woman with subclavian artery occlusion and pseudoaneurysm formation caused by pulmonary mucormycosis infection. The patient presented with diabetic ketoacidosis, Horner's syndrome, and absent left arm pulses. A cystic lesion of the left lung apex was found by imaging, was surgically resected, and was histologically diagnosed as mucormycosis infection. Magnetic resonance angiography depicted a left subclavian artery pseudoaneurysm and occlusion adjacent to the mucormycosis lesion. To protect against thromboembolic complications and rupture, the pseudoaneurysm was embolized with coils. The patient is clinically well 1 year after the intervention with no perfusion of the pseudoaneurysm. PMID:16832593

  11. Successful Recanalization of a Longstanding Right Common Iliac Artery Occlusion with a Radiofrequency Guidewire

    SciTech Connect

    Tapping, C. R.; Uri, I. F.; Dixon, S.; Bratby, M. J.; Anthony, S.; Uberoi, R.

    2012-10-15

    We describe a case of successful recanalization of a longstanding right common iliac occlusion with a radiofrequency (RF) guidewire. The patient had been symptomatic with claudication for 3 years, and a preliminary attempt to cross the lesion using conventional techniques proved unsuccessful. Using low and medium intensity RF pulses and a PowerWire, a tract through the occlusion was established, which allowed subsequent stenting with an excellent angiographic result and a good immediate clinical response. We propose this as a useful technique in the peripheral arterial system for occlusive lesions not amenable to traditional recanalization techniques.

  12. Technique, Complication, and Long-Term Outcome for Endovascular Treatment of Iliac Artery Occlusion

    SciTech Connect

    Ozkan, Ugur Oguzkurt, Levent; Tercan, Fahri

    2010-02-15

    The aim of this study was to report technical details, procedure-related complications, and results of endovascular treatment in chronic iliac artery occlusion. Between 2001 and 2008, endovascular treatments of 127 chronic iliac artery occlusions in 118 patients (8 women and 110 men; mean age, 59 years) were retrospectively reviewed. The study was based on Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery Standards). All occlusions were treated with stent placement with or without preliminary balloon angioplasty. Kaplan-Meier estimators were used to determine patency rates. Univariate and multivariate analyses were performed to determine variables affecting successful recanalization, major complications, early stent thrombosis ({<=}30 days), and primary and secondary patency rates. Initial technical success was achieved in 117 (92%) procedures. Successful recanalization was obtained by antegrade approach in 69 of 77 (90%) procedures and by retrograde approach in 52 of 105 (50%) procedures (p < 0.001). Complications were encountered in 28 (24%) patients [minor in 7 patients (6%) and major in 22 patients (19%)]. One death occurred in the operative period secondary to iliac artery rupture. Early stent thrombosis was seen in eight (7%) patients. Presence of critical limb ischemia (p = 0.03), subintimal recanalization (p = 0.03), and major complication (p = 0.02) were the independent predictors of early stent thrombosis on multivariate analysis. Primary and secondary patency rates at 5 years were 63 and 93%, respectively. Presence of critical limb ischemia, TASC type C iliac lesions, combined occlusions of both common and external iliac arteries, and major complications were associated with decreased patency rates on univariate analysis, whereas these factors were not independent predictors of stent patency on multivariate analysis. In conclusion, endovascular treatment of iliac artery occlusion has a

  13. Unilateral sequential papillophlebitis and central retinal artery occlusion in a young healthy patient

    PubMed Central

    Demirok, Gülizar; Kocamaz, Mehmet Fatih; Topalak, Yasemin; Şengün, Ahmet; Hasanreisoğlu, Berati

    2015-01-01

    A 23-year-old girl presented to the clinic with metamorphopsia and photopsia in her left eye. After detailed ophthalmic examination, central retinal vein occlusion with optic disc edema was detected in that eye. Three days after diagnosis, the patient returned to our clinic with visual acuity decrease. Central retinal artery occlusion sparing cilioretinal artery was detected. All the laboratory tests were normal except for heterozygous methylenetetrahydrofolate reductase mutation (A1298C genotypes) and an indefinite Lyme disease seropositivity. Symptoms and visual disturbance recovered without any further treatment other than acetylsalicylic acid for prophylaxis. PMID:26862099

  14. A case of an occlusive right coronary artery dissection after stent implantation: dilemmas and challenges.

    PubMed

    Panoulas, Vasileios F; Figini, Filippo; Giustino, Gennaro; Carlino, Mauro; Chieffo, Alaide; Latib, Azeem; Colombo, Antonio

    2015-01-01

    A 53-year-old man with stable angina had a staged percutaneous coronary intervention to a critical focal stenosis of the mid-segment of the right coronary artery (RCA). Two hours after successful RCA stent implantation, the patient re-presented with inferior ST elevation secondary to acute dissection originating at the distal edge of the stent, causing subtotal occlusion of the distal RCA. The patient had TIMI-2 flow in the posterolateral branch and occlusion of the posterior descending artery. This case describes the procedural challenges the operators were faced with and successful use of the "rescue STAR" technique as a last resort. PMID:25589705

  15. Retrograde Proximal Anterior Tibial Artery Access for Treating Femoropopliteal Segment Occlusion: A Novel Approach.

    PubMed

    Affonso, Breno Boueri; Golghetto Domingos, Fernanda Uchiyama; da Motta Leal Filho, Joaquim Maurício; Maciel, Macello José Sampaio; Cavalcante, Rafael Noronha; Bortolini, Edgar; Carnevale, Francisco Cesar

    2016-05-01

    Some challenges have been detected when there are long and complex lesions of femoropopliteal arterial occlusive disease, even with descriptions of the retrograde pedal approaches. The aim of this article is to describe the retrograde proximal anterior tibial artery access for treatment of femoropopliteal segment occlusion when antegrade recanalization failed (retrograde recanalization and rearranging the system into an antegrade position). Technical and clinical success was achieved in 100% of 4 cases, with an improvement of at least 2 Rutherford classes. Minor complication, small hematoma in an anterior compartment of the limb, occurred in 1 patient. No sign of compartmental syndrome was observed. PMID:26902943

  16. Left lateral free wall pathway ablation complicated by plaque rupture and acute occlusion of the left anterior descending coronary artery.

    PubMed

    Yildiz, Bekir Serhat; Alihanoglu, Yusuf Izzettin; Kilic, Ismail Dogu; Evrengul, Harun

    2014-06-01

    Radiofrequency (RF) ablation of accessory bypass tracts associated with the Wolff-Parkinson-White (WPW) syndrome has become the treatment of choice for many arrhythmias. Complications are unusual and acute coronary artery occlusion is very rare. We here present a 38-year-old male patient with an acute occlusion of proximal left anterior descending (LAD) coronary artery after RF ablation of a left free wall accessory pathway. An interesting feature is the site of the coronary artery occlusion which is remote from the RF application site. The occlusion was successfully treated with the placement of an intracoronary stent. PMID:25029886

  17. The Infrapopliteal Arterial Occlusions Similar to Buerger Disease: Report of Two Cases

    PubMed Central

    Igari, Kimihiro; Toyofuku, Takahiro; Inoue, Yoshinori; Iwai, Takehisa

    2014-01-01

    We herein present two cases that required the differential diagnosis of Buerger disease. Case 1 involved a 55-year-old male with a smoking habit who was admitted with ulcers and coldness in his fingers and toes. Angiography showed blockage in both the radial and posterior tibial arteries, which led to an initial diagnosis of Buerger disease. However, a biopsy of the right posterior tibial artery showed pathological findings of fibromuscular dysplasia (FMD). Case 2 involved a 28-year-old male with intermittent claudication who was examined at another hospital. Angiography showed occlusion of both popliteal and crural arteries, and the patient was suspected to have Buerger disease. However, computed tomography disclosed an abnormal slip on both sides of the popliteal fossa, and we diagnosed him with bilateral popliteal artery entrapment syndrome (PAES). These cases illustrate that other occlusive diseases, such as FMD and PAES, may sometimes be misdiagnosed as Buerger disease. PMID:25431737

  18. Influence of the chronic abdominal aortic occlusion on the femoral artery disease pattern.

    PubMed

    Ilic, Nikola S; Koncar, Igor; Dragas, Marko; Golubovic, Milka; Bozic, Vesna; Ilijas, Cinara; Zivan, Maksimovic; Davidovic, Lazar

    2014-02-01

    We design a study to evaluate whether patients with chronic aortic occlusion have a different pattern of femoral artery atherosclerosis than patients with other forms of aortoiliac disease as well as to discuss potential causal mechanisms. From January 2008 to January 2010, 467 patients with aortoiliac occlusive disease were enrolled at Clinic of Vascular and Endovascular Surgery in Belgrade, Serbia. Among them 60 patients were divided into two groups, patients with chronic aortic occlusion (COA) and diffuse aortoiliac occlusive disease (AIOD, Leriche type II). Each group consisted of 30 patients. Those two groups were compared according to symptomatology, ABI values, femoral artery pressure gradient, atherosclerosis level in the femoral region and predictors of atherosclerosis.Patients with AIOD had severe atherosclerosis unlike patients with COA. Also, high elevation of postoperative ABIs in patients with an early atherosclerosis (0, I, II and III) was noted suggesting patent distal arterial tree. FAP gradient was significantly higher in COA group comparing with AIOD group (left: t=-10.963, P<0.01;right: t=-8.962, P<0.01). In conclusion, our data demonstrate that older patients have had more time to develop multilevel disease (AOID) and those with CAO have more isolated aortic disease chronic aortic occlusion. PMID:23550207

  19. Fiberoptic study on the effects of transluminal angioplasty in experimental occlusive arterial thrombosis.

    PubMed

    Tomaru, T; Uchida, Y; Sugimoto, T

    1988-02-01

    Percutaneous transluminal coronary angioplasty has been proposed as definitive therapy for coronary recanalization of occluded coronary arteries in patients with acute myocardial infarction (AMI). The effects of transluminal angioplasty (TA) on experimental occlusive canine arterial thrombi that closely simulated the clinical condition was examined by a fiberoptic method. Experimental arterial thrombosis was produced by endothelial denudation and induction of luminal stenosis. Eighteen dogs that showed total occlusion of the iliac artery with thrombi were evaluated. Seven dogs (group A) with 6-hour-old thrombi received 20,000 IU/kg intravenous urokinase (UK) but did not show recanalization. TA was performed with a Gruentzig or Simpson-Robert balloon catheter and its effect was evaluated by a vascular fibroscope. Eight dogs (group B) with 6-hour-old thrombi underwent primary TA. After TA, less than 50% luminal obstruction with residual thrombi was visualized in five dogs (71%) of group A and four dogs (50%) of group B. Residual thrombi showed a doughnut-like or globular type shape and consisted of dense fibrin networks and compact platelet aggregates. All dogs in group B received 20,000 IU/kg intravenous UK after TA, but most of them showed progression of thrombus size despite UK infusion. In conclusion, the results suggest (1) that TA is effective in recanalization of an occluded artery with aged thrombus that is resistant to thrombolytic therapy and (2) that vascular fiberscope is a useful method for evaluation of the effects of TA on occlusive arterial thrombus. PMID:2963513

  20. Marvels, Mysteries, and Misconceptions of Vascular Compensation to Peripheral Artery Occlusion

    PubMed Central

    ZIEGLER, MATTHEW A.; DISTASI, MATTHEW R.; BILLS, RANDALL G.; MILLER, STEVEN J.; ALLOOSH, MOUHAMAD; MURPHY, MICHAEL P.; AKINGBA, A. GEORGE; STUREK, MICHAEL; DALSING, MICHAEL C.; UNTHANK, JOSEPH L.

    2010-01-01

    Peripheral arterial disease is a major health problem and there is a significant need to develop therapies to prevent its progression to claudication and critical limb ischemia. Promising results in rodent models of arterial occlusion have generally failed to predict clinical success and led to questions of their relevance. While sub-optimal models may have contributed to the lack of progress, we suggest that advancement has also been hindered by misconceptions of the human capacity for compensation and the specific vessels which are of primary importance. We present and summarize new and existing data from humans, Ossabaw miniature pigs, and rodents which provide compelling evidence that natural compensation to occlusion of a major artery (i) may completely restore perfusion, (ii) occurs in specific pre-existing small arteries, rather than the distal vasculature, via mechanisms involving flow-mediated dilation and remodeling (iii) is impaired by cardiovascular risk factors which suppress the flow-mediated mechanisms and (iv) can be restored by reversal of endothelial dysfunction. We propose that restoration of the capacity for flow-mediated dilation and remodeling in small arteries represents a largely unexplored potential therapeutic opportunity to enhance compensation for major arterial occlusion and prevent the progression to critical limb ischemia in the peripheral circulation. PMID:20141596

  1. Carotid artery stenting using the proximal or dual protection method for near occlusion of the cervical internal carotid artery.

    PubMed

    Sakamoto, Shigeyuki; Kiura, Yoshihiro; Kajihara, Yosuke; Shibukawa, Masaaki; Okazaki, Takahito; Matsushige, Toshinori; Shinagawa, Katsuhiro; Mukada, Kazutoshi; Kurisu, Kaoru

    2013-10-01

    The treatment for patients with near occlusion of the cervical internal carotid artery (ICA) is controversial. The aim of this study was to examine the results of carotid artery stenting (CAS) as a surgical treatment for ICA near occlusion. Between April 2008 and September 2012, 14 patients (all men; mean age, 75.4 years) with ICA near occlusion were treated with CAS. This represents 5.2% of a total of 267 patients treated with CAS during the study period. All patients were treated with CAS using an embolic protection device. The proximal balloon protection method was performed in five patients, and the dual protection method using a proximal balloon and distal filter protection was used in nine patients. We examined the change of stenotic lesion, hyperintensity spot in diffusion-weighted imaging (DWI), and perioperative complications after CAS. All near occlusions were successfully dilated. Among 2 of 14 patients, DWI showed 1 and 4 hyperintensity spots. Transient and persistent complications, including neurological deficits, did not occur in any patients. In this small number of cases, CAS using the proximal or dual embolic protection method seems to be a safe and beneficial treatment for ICA near occlusion. PMID:23793616

  2. Antegrade transcatheter closure of coronary artery fistulae using vascular occlusion devices.

    PubMed

    Pedra, C A; Pihkala, J; Nykanen, D G; Benson, L N

    2000-01-01

    Two children (a 9 year old boy and a 2.5 year old girl) with coronary artery fistulae communicating with the right ventricle underwent successful transcatheter occlusion using an antegrade technique. A Rashkind double umbrella device was used in one case and an Amplatzer duct occluder in the other. PMID:10618344

  3. Memory Dysfunction in Caudate Infarction Caused by Heubner's Recurring Artery Occlusion

    ERIC Educational Resources Information Center

    Mizuta, Hideko; Motomura, Naoyasu

    2006-01-01

    We report five cases with caudate infarction due to Heubner's recurring artery occlusion, in which we conducted detailed memory examinations in terms of explicit memory and implicit memory. We performed the auditory verbal learning test as explicit memory tasks, and motor and cognitive procedural memory tasks, developed by Komori, as implicit…

  4. Stent-assisted mechanical recanalization for symptomatic subacute or chronic middle cerebral artery occlusion

    PubMed Central

    Guo, Dong; Ma, Ji; Li, Teng-Fei; Zhu, Ming; Han, Xin-Wei; Shui, Shao-Feng

    2015-01-01

    To assess the feasibility and short-term effects of treating patients with subacute or chronic middle cerebral artery (M1) occlusion by stent-assisted mechanical recanalization. Six patients with cerebral arteries occlusion underwent surgery. Six cerebral arteries occlusion in 5 patients were successfully recanalized. On postoperative day 1, four patients’ symptoms were relieved and two patients’ symptoms were exacerbated, of which one was significantly improved after 3 days, the other one’s symptoms were recovered to preoperative levels in 2 weeks. No patients died after surgery. No stroke or transient ischemic attack occurred. The average follow-up of was 4.2 months, no worsening of condition, recurrence or death occurred. The results indicate that for patients with subacute or chronic middle cerebral artery (M1) occlusion, mechanical recanalization was technically feasible under the premise of strict case screening. Mechanical recanalization is able to improve ischemic symptoms and promote dysfunction restoration. But its long-term effect remains to be evaluated by further large samples, long-term follow-up studies. PMID:26885148

  5. Stenting of the Brachiocephalic Vein Following Occlusion After Coronary Artery Bypass Surgery.

    PubMed

    Sandler, Nicola; Sharpin, Claire; Bhagwat, Krishna; Ma, Robert; Yii, Ming; Almeida, Aubrey

    2016-07-01

    We describe a case of left arm swelling over nine months post coronary artery bypass grafting (CABG), due to occlusion of the left brachiocephalic vein. The patient's perioperative course, diagnosis, and management of this complication are presented. doi: 10.1111/jocs.12765 (J Card Surg 2016;31:432-434). PMID:27282334

  6. Emergency revascularization of acute internal carotid artery occlusion: Follow the spike, it guides you.

    PubMed

    Cohen, José E; Gomori, John M; Leker, Ronen R; Eichel, Roni; Itshayek, Eyal

    2016-07-01

    The present study sought to examine the incidence of the angiographic "spike sign" and to assess its predictive significance for achieving carotid revascularization in 54 patients with acute internal carotid artery (ICA) occlusions that required urgent endovascular revascularization. Clinical and imaging files of consecutive patients with ICA occlusion who were treated in a tertiary care academic medical center from 2011-2015 were retrospectively examined under Institutional Review Board approval with a waiver of the requirement for informed consent. All proximal ICA occlusions were treated by stent-assisted carotid angioplasty, and all distal embolic occlusions were managed with stent-assisted mechanical thrombectomy. The study included 24 patients with acute ICA occlusion (group 1) and 30 patients with tandem ICA-intracranial occlusions (group 2). The spike sign was seen in 16/24 patients in group 1 (67%), and successful ICA revascularization was achieved in 14/16 (88%). The sign was seen in 26/30 patients in group 2 (87%), and ICA revascularization was successful in all 26 (100%). The remaining 12 patients had no spike sign, and ICA revascularization was successful in only 7/12 (58%). The spike sign is a transient finding that represents the proximal patent remnant of the stenotic corridor in fresh clot. Acute ICA occlusion frequently leaves the spike sign as a marker of the recent thrombotic event. The spike vertex points to the "path of least resistance" for the guidewire to cross the occlusion and engage the true arterial lumen, a critical step during ICA endovascular revascularization. PMID:26935747

  7. Sympathetic neuroeffector transmission to pulmonary vascular smooth muscle in porcine superior mesenteric arterial occlusion (SMAO) shock.

    PubMed

    Greenberg, S; Glenn, T M; Eddy, L J; Rebert, R R

    1980-01-01

    Splanchnic arterial occlusion shock results in pulmonary endothelial damage and depression of porcine intralobar pulmonary artery and vein contractility. This study evaluates the functional integrity of the adrenergic nerves innervating intralobar pulmonary arteries and veins and the changes in neurotransmission following 1) superior mesenteric artery occlusion (SMAO) shock in swine; 2) sequential inhibition of prostacyclin, thromboxane, and prostaglandin synthesis; and 3) mechanical stripping of the endothelium. Rings of porcine intralobar pulmonary arteries and veins were obtained from sham and SMAO shocked swine. They were suspended in muscle baths and stimulated transmurally at 1-32 Hz, 2 msec duration, 2 msec delay at 7.5-10V. Some experiments were performed on rings of intralobular pulmonary arteries and veins in which the endothelium was stripped with a razor blade. Appropriate inverted-reverted controls were used to account for any deleterious effects of the preparatory techniques involved in stripping. Intralobar pulmonary arteries and veins from sham swine contracted in response to 1 Hz, with maximum responses at 32 Hz. The responses to nerve stimulation were enhanced by cocaine and inhibited by phentolamine, an alpha-receptor antagonist. Inhibition of endothelial prostacyclin synthesis, as well as endothelial stripping, diminished by 30-40% the responses to nerve stimulation. The responses to nerve stimulation were depressed in both intralobar pulmonary arteries and veins in SMAO shocked swine. The data demonstrate physiologic regulation of neural control in porcine pulmonary blood vessels. Furthermore, the data suggest that prostaglandin, the vascular endothelium, and shock, may modify this process. PMID:7315616

  8. Transient presyncope secondary to posterior descending artery occlusion.

    PubMed

    Moffat, Andrew D; Al-Khatib, Jamal T; Michael, Jennifer; Nguyen, Vien X

    2011-01-01

    We describe the case of a 64-year-old male initially presenting with presyncope and bradycardia, without any anginal symptoms or objective evidence of myocardial ischemia. A stress test induced no physical symptoms but revealed a left bundle branch block with multiple preventricular contractions on electrocardiogram. Subsequent catheterization revealed severe obstructive disease throughout the coronary arteries. He was treated percutaneously on two separate heart catheterizations. The presyncope and bradycardia resolved after reperfusion of the posterior descending artery. PMID:24826229

  9. Early detection and differentiation of venous and arterial occlusion in skin flaps using visible diffuse reflectance spectroscopy and autofluorescence spectroscopy

    PubMed Central

    Zhu, Caigang; Chen, Shuo; Chui, Christopher Hoe-Kong; Tan, Bien-Keem; Liu, Quan

    2016-01-01

    Our previous preclinical study demonstrated that both visible diffuse reflectance and autofluorescence spectroscopy, each of which yields a different set of physiological information, can predict skin flap viability with high accuracy in a MacFarlane rat dorsal skin flap model. In this report, we further evaluated our technique for the early detection and differentiation of venous occlusion and arterial occlusion in a rat groin flap model. We performed both diffuse reflectance and autofluorescence measurements on the skin flap model and statistically differentiated between flaps with and without occlusions as well as between flaps with venous occlusion and those with arterial occlusion based on these non-invasive optical measurements. Our preliminary results suggested that visible diffuse reflectance and autofluorescence spectroscopy can be potentially used clinically to detect both venous and arterial occlusion and differentiate one from the other accurately at an early time point. PMID:26977363

  10. Early detection and differentiation of venous and arterial occlusion in skin flaps using visible diffuse reflectance spectroscopy and autofluorescence spectroscopy.

    PubMed

    Zhu, Caigang; Chen, Shuo; Chui, Christopher Hoe-Kong; Tan, Bien-Keem; Liu, Quan

    2016-02-01

    Our previous preclinical study demonstrated that both visible diffuse reflectance and autofluorescence spectroscopy, each of which yields a different set of physiological information, can predict skin flap viability with high accuracy in a MacFarlane rat dorsal skin flap model. In this report, we further evaluated our technique for the early detection and differentiation of venous occlusion and arterial occlusion in a rat groin flap model. We performed both diffuse reflectance and autofluorescence measurements on the skin flap model and statistically differentiated between flaps with and without occlusions as well as between flaps with venous occlusion and those with arterial occlusion based on these non-invasive optical measurements. Our preliminary results suggested that visible diffuse reflectance and autofluorescence spectroscopy can be potentially used clinically to detect both venous and arterial occlusion and differentiate one from the other accurately at an early time point. PMID:26977363

  11. Suction Thrombectomy of Thrombotic Occlusion of the Subclavian Artery in a Case of Takayasu's Arteritis

    SciTech Connect

    Purkayastha, Sukalyan; Jayadevan, E.R.; Kapilamoorthy, T.R.; Gupta, A.K. E-mail: gupta@sctimst.ac.in

    2006-04-15

    Takayasu's arteritis, also known as pulseless disease, is a chronic inflammatory arteritis affecting large vessels, predominantly the aorta and its main branches. Vessel inflammation leads to wall thickening, fibrosis, stenosis, and thrombus formation. Percutaneous removal of arterial thrombus with the use of several devices has been reported, with mixed results. We present a case of Takayasu's arteritis with thrombotic occlusion of the subclavian artery in which pulsed urokinase injection and suction thrombectomy were used to revascularize a threatened limb and to establish the sole arterial supply to the brain.

  12. Superior Mesenteric Artery Pseudoaneurysm Associated with Celiac Axis Occlusion Treated Using Endovascular Techniques

    SciTech Connect

    Ray, Biswajit; Kuhan, Ganesh; Johnson, Brian; Nicholson, Anthony A.; Ettles, Duncan F.

    2006-10-15

    The case of a 30-year-old woman with a post-traumatic pseudoaneurysm of the superior mesenteric artery and associated celiac axis occlusion is presented. The patient was successfully treated with celiac artery recanalization and placement of a covered stent within the superior mesenteric artery. Follow-up at 3, 6, and 12 months and 3 years demonstrated patency of the covered stent and continued exclusion of the aneurysm. Although the long-term success of this procedure is unknown this management option should be considered where facilities are available, to reduce the increased morbidity associated with open surgical procedure.

  13. Complete occlusion of the right middle cerebral artery associated with Mycoplasma pneumoniae pneumonia

    PubMed Central

    Kang, Ben; Kim, Dong Hyun; Hong, Young Jin; Son, Byong Kwan; Lim, Myung Kwan; Choe, Yon Ho

    2016-01-01

    We report a case of a 5-year-old girl who developed left hemiparesis and left facial palsy, 6 days after the initiation of fever and respiratory symptoms due to pneumonia. Chest radiography, conducted upon admission, showed pneumonic infiltration and pleural effusion in the left lung field. Brain magnetic resonance imaging showed acute ischemic infarction in the right middle cerebral artery territory. Brain magnetic resonance angiography and transfemoral cerebral angiography revealed complete occlusion of the right middle cerebral artery. Mycoplasma pneumoniae infection was identified by a 4-fold increase in IgG antibodies to M. pneumoniae between acute and convalescent sera by enzyme-linked immunosorbent assay. Fibrinogen and D-dimer levels were elevated, while laboratory exams in order to identify other predisposing factors of pediatric stroke were all negative. This is the first reported pediatric case in English literature of a M. pneumoniae-associated cerebral infarction involving complete occlusion of the right middle cerebral artery. PMID:27186223

  14. Complete occlusion of the proximal subclavian artery post-CABG: Presentation and treatment

    PubMed Central

    Sadek, Mouhannad M; Ravindran, Aravindhan; Marcuzzi, Daniel W; Chisholm, Robert J

    2008-01-01

    Atherosclerotic disease of the proximal left subclavian artery is an uncommon cause of angina in the post-coronary artery bypass graft patient, and is termed coronary-subclavian steal syndrome. Typical manifestations include cardiac symptoms of angina and noncardiac symptoms of lightheadedness, left arm numbness or weakness, and a difference in blood pressure of more than 20 mmHg between both arms. A case of complete proximal occlusion of the subclavian artery is reported. The clinical picture, investigations and treatment are described. Historical treatments of occlusive disease include surgical bypass graft and, more recently, percutaneous transluminal angioplasty. The patient underwent percutaneous transluminal angioplasty with stenting by a retrograde approach, with an excellent short-term response, but ultimately required a carotid subclavian bypass due to restenosis. PMID:18612504

  15. [Sudden left-sided vision loss. Occlusion of the left central retinal artery].

    PubMed

    Stebler, J; Oechslin, E; Bernasconi, P; Greminger, P

    2001-05-23

    A 77 year old female patient was admitted to our hospital because of a rapid onset left-sided visual loss. Occlusion of the left central retinal artery was confirmed by the consultant ophthalmologist. The patient was further evaluated to exclude a thromboembolic event. Chest x-ray was consistent with pulmonary hypertension. Doppler echocardiography revealed a secundum atrial septal defect with a bi-directional shunt. In this 77 year old patient, arterio-arterial embolism from atherosclerotic plaques is the most probable cause of her central retinal artery occlusion. Yet, paradoxical embolism might be another reason for acute visual loss in this setting, which, however, is difficult to confirm definitively. PMID:11441708

  16. A Lumped Parameter Method to Calculate the Effect of Internal Carotid Artery Occlusion on Anterior Cerebral Artery Pressure Waveform

    PubMed Central

    Abdi, M.; Navidbakhsh, M.; Razmkon, A.

    2016-01-01

    Background and Objective Numerical modeling of biological structures would be very helpful tool to analyze hundreds of human body phenomena and also diseases diagnosis. One physiologic phenomenon is blood circulatory system and heart hemodynamic performance that can be simulated by utilizing lumped method. In this study, we can predict hemodynamic behavior of one artery of circulatory system (anterior cerebral artery) when disease such as internal carotid artery occlusion is occurred. Method Pressure-flow simulation is one the leading common approaches for modeling of circulatory system behavior and forecasts of hemodynamic in numerous physiological conditions. In this paper, by using lumped model (electrical analogy), CV system is simulated in MATLAB software (SIMULINK environment). Results The performance of healthy blood circulation and heart is modeled and the obtained results used for further analyses. The stenosis of internal carotid artery at different rates was, then, induced in the circuit and the effects are studied. In stenosis cases, the effects of internal carotid artery occlusion on  left anterior cerebral artery pressure waveform are investigated. Conclusion The findings of this study may have implications not only for understanding the behavior of human biological system at healthy condition but also for diagnosis of diseases in circulatory and cardiovascular system of human body. PMID:27026953

  17. Symptomatic Very Delayed Parent Artery Occlusion After Flow Diversion Stent Embolization

    PubMed Central

    OISHI, Hidenori; TERANISHI, Kosuke; NONAKA, Senshu; YAMAMOTO, Munetaka; ARAI, Hajime

    2016-01-01

    Flow diversion stents (FDSs) are constructed from high-density braided mesh, which alters intra-aneurysmal hemodynamics and leads to aneurysm occlusion by inducing thrombus formation. Although there are potential complications associated with FDS embolization, one of the serious complications is the parent artery occlusion due to the in-stent thrombosis. A 72-year-old woman with a symptomatic giant fusiform aneurysm in the cavernous segment of ICA underwent single-layer pipeline embolization device (PED) embolization. Six-month and 1-year follow-up conventional angiographies showed the residual blood flow in the aneurysm. Two-year follow-up MRI showed the aneurysm sac shrinkage and the antiplatelet therapy was discontinued. The patient suffered from symptomatic parent artery occlusion due to the in-stent thrombosis, 4 months after antiplatelet therapy discontinuation. The patient with the incompletely occluded aneurysm after PED embolization should be given long-term antiplatelet therapy because of the risk of delayed parent artery occlusion. PMID:27169622

  18. Symptomatic Very Delayed Parent Artery Occlusion After Flow Diversion Stent Embolization.

    PubMed

    Oishi, Hidenori; Teranishi, Kosuke; Nonaka, Senshu; Yamamoto, Munetaka; Arai, Hajime

    2016-06-15

    Flow diversion stents (FDSs) are constructed from high-density braided mesh, which alters intra-aneurysmal hemodynamics and leads to aneurysm occlusion by inducing thrombus formation. Although there are potential complications associated with FDS embolization, one of the serious complications is the parent artery occlusion due to the in-stent thrombosis. A 72-year-old woman with a symptomatic giant fusiform aneurysm in the cavernous segment of ICA underwent single-layer pipeline embolization device (PED) embolization. Six-month and 1-year follow-up conventional angiographies showed the residual blood flow in the aneurysm. Two-year follow-up MRI showed the aneurysm sac shrinkage and the antiplatelet therapy was discontinued. The patient suffered from symptomatic parent artery occlusion due to the in-stent thrombosis, 4 months after antiplatelet therapy discontinuation. The patient with the incompletely occluded aneurysm after PED embolization should be given long-term antiplatelet therapy because of the risk of delayed parent artery occlusion. PMID:27169622

  19. Posterior Ciliary Artery Occlusion Caused by Hyaluronic Acid Injections Into the Forehead: A Case Report.

    PubMed

    Hu, Xiu Zhuo; Hu, Jun Yan; Wu, Peng Sen; Yu, Sheng Bo; Kikkawa, Don O; Lu, Wei

    2016-03-01

    Although cosmetic facial soft tissue fillers are generally safe and effective, improper injections can lead to devastating and irreversible consequences. We represent the first known case of posterior ciliary artery occlusion caused by hyaluronic acid. A 41-year-old female presented with right visual loss 7 hours after receiving cosmetic hyaluronic acid injections into her forehead. Examination revealed no light perception in the right eye and multiple dark ischemic area of injection over the forehead and nose. The right fundus revealed a pink retina with optic nerve edema. Fluorescein angiogram showed several filling defects in the choroidal circulation and late hyperfluorescence in the choroid. A right posterior ciliary artery occlusion and embolic occlusion of facial artery braches was diagnosed. With hyaluronidase injection, hyperbaric oxygen therapy, oral aspirin, oral acetazolamide and dexamethasone venotransfuse treatment, the patient's forehead and nasal skin improved and vision recovered to hand movements. With proper technique, vascular occlusion is rare following facial filler injection. Vision consequences can be severe if filler emboli enter the ocular circulation. Physicians should be aware of this potential side effect, recognize its presentation, and be knowledgeable of effective management. PMID:26986163

  20. Partial Aortic Occlusion and Cerebral Venous Steal: Venous Effects of Arterial Manipulation in Acute Stroke

    PubMed Central

    Pranevicius, Osvaldas; Pranevicius, Mindaugas; Liebeskind, David S.

    2011-01-01

    Acute ischemic stroke therapy emphasizes early arterial clot lysis or removal. Partial aortic occlusion has recently emerged as an alternative hemodynamic approach to augment cerebral perfusion in acute ischemic stroke. The exact mechanism of cerebral flow augmentation with partial aortic occlusion remains unclear and may involve more than simple diversion of arterial blood flow from the lower body to cerebral collateral circulation. The cerebral venous steal hypothesis suggests that even a small increase in tissue pressure in the ischemic area will divert blood flow to surrounding regions with lesser tissue pressures. This may cause no-reflow (absence of flow after restoration of arterial patency) in the ischemic core and “luxury perfusion” in the surrounding regions. Such maldistribution may be reversed with increased venous pressure titrated to avoid changes in intracranial pressure. We propose that partial aortic occlusion enhances perfusion in the brain by offsetting cerebral venous steal. Partial aortic occlusion redistributes blood volume into the upper part of the body, manifest by an increase in central venous pressure. Increased venous pressure recruits the collapsed vascular network and, by eliminating cerebral venous steal, corrects perifocal perfusion maldistribution, analogous to positive end expiratory pressure recruitment of collapsed airways to decrease ventilation/perfusion mismatch in the lungs. PMID:21441149

  1. Influence of Puncture Site on Radial Artery Occlusion After Transradial Coronary Intervention

    PubMed Central

    Bi, Xi-Le; Fu, Xiang-Hua; Gu, Xin-Shun; Wang, Yan-Bo; Li, Wei; Wei, Li-Ye; Fan, Yan-Ming; Bai, Shi-Ru

    2016-01-01

    Background: The risk of radial artery occlusion (RAO) needs particular attention in transradial intervention (TRI). Therefore, reducing vascular occlusion has an important clinical significance. The aim of this study was to determine the appropriate puncture site during TRI through comparing the occurrence of RAO between the different puncture sites to reduce the occurrence of RAO after TRI. Methods: We prospectively assessed the occurrence of RAO in 606 consecutive patients undergoing TRI. Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention. Risk factors for RAO were evaluated using a multivariate model analysis. Results: Of the 606 patients, the RAO occurred in 56 patients. Compared with TRI at 2–5 cm away from the radius styloid process, the odds ratio (OR) for occlusion risk at 0 cm and 1 cm were 9.65 (P = 0.033) and 8.90 (P = 0.040), respectively. The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤1 (OR = 2.45, P = 0.004). Conclusion: Distal puncture sites (0–1 cm away from the radius styloid process) can lead to a higher rate of RAO. Trial Registration: ClinicalTrials.gov, NCT01979627; https://clinicaltrials.gov/ct2/show/NCT01979627?term = NCT01979627 and rank = 1. PMID:27064032

  2. Posterior Ciliary Artery Occlusion Caused by Hyaluronic Acid Injections Into the Forehead

    PubMed Central

    Hu, Xiu Zhuo; Hu, Jun Yan; Wu, Peng Sen; Yu, Sheng Bo; Kikkawa, Don O.; Lu, Wei

    2016-01-01

    Abstract Although cosmetic facial soft tissue fillers are generally safe and effective, improper injections can lead to devastating and irreversible consequences. We represent the first known case of posterior ciliary artery occlusion caused by hyaluronic acid. A 41-year-old female presented with right visual loss 7 hours after receiving cosmetic hyaluronic acid injections into her forehead. Examination revealed no light perception in the right eye and multiple dark ischemic area of injection over the forehead and nose. The right fundus revealed a pink retina with optic nerve edema. Fluorescein angiogram showed several filling defects in the choroidal circulation and late hyperfluorescence in the choroid. A right posterior ciliary artery occlusion and embolic occlusion of facial artery braches was diagnosed. With hyaluronidase injection, hyperbaric oxygen therapy, oral aspirin, oral acetazolamide and dexamethasone venotransfuse treatment, the patient's forehead and nasal skin improved and vision recovered to hand movements. With proper technique, vascular occlusion is rare following facial filler injection. Vision consequences can be severe if filler emboli enter the ocular circulation. Physicians should be aware of this potential side effect, recognize its presentation, and be knowledgeable of effective management. PMID:26986163

  3. Acute middle cerebral artery occlusion: reappraisal of the role of endovascular revascularization.

    PubMed

    Cohen, José E

    2013-02-01

    Intravenous tissue plasminogen activator was the first successful stroke therapy in acute ischaemic stroke, after innumerable failed attempts at neuroprotection and neurorestoration. However, intravenous tissue type plasminogen activator has been shown to be effective in recanalizing middle cerebral artery occlusions in only about one-third of cases. The natural history of untreated acute middle cerebral artery occlusion is poor, leading to long-term disability in >70% and mortality in 20%. Recanalization alone is not the name of the game. Only timely, very rapid recanalization, achieved within minutes or at most a few hours after stroke has occurred, before irreversible brain damage develops, is effective. Is intravenous tissue type plasminogen activator the best available option we have for these patients? With recently introduced stent-based thrombectomy devices, neurointerventionalists have achieved complete recanalization rates of more than 90% in middle cerebral artery and 'T' occlusions, with a mean procedural recanalization time of less than one-hour and negligible complication rates. More than 80% of patients less than 80 years of age who were treated within eight-hours after stroke onset in our centre achieved a modified Rankin score of 0-2 at three-month follow-up. The site of arterial occlusion is a factor driving the choice between a standard intravenous tissue type plasminogen activator protocol and an alternative intervention such as intravenous and/or mechanical thrombolysis to achieve early recanalization. The role of intravenous tissue type plasminogen activator must be redefined in major occlusions, and the indications for endovascular therapy must also be reappraised. PMID:23336262

  4. De novo giant A2 aneurysm following anterior communicating artery occlusion

    PubMed Central

    Ibrahim, Tarik F.; Hafez, Ahmad; Andrade-Barazarte, Hugo; Raj, Rahul; Niemela, Mika; Lehto, Hanna; Numminen, Jussi; Jarvelainen, Juha; Hernesniemi, Juha

    2015-01-01

    Background: De novo intracranial aneurysms are reported to occur with varying incidence after intracranial aneurysm treatment. They are purported to be observed, however, with increased incidence after Hunterian ligation; particularly in cases of carotid artery occlusion for giant or complex aneurysms deemed unclippable. Case Description: We report a case of right-sided de novo giant A2 aneurysm 6 years after an anterior communicating artery (ACoA) aneurysm clipping. We believe this de novo aneurysm developed in part due to patient-specific risk factors but also a significant change in cerebral hemodynamics. The ACoA became occluded after surgery that likely altered the cerebral hemodynamics and contributed to the de novo aneurysm. We believe this to be the first reported case of a giant de novo aneurysm in this location. Following parent vessel occlusion (mostly of the carotid artery), there are no reports of any de novo aneurysms in the pericallosal arteries let alone a giant one. The patient had a dominant right A1 and the sudden increase in A2 blood flow likely resulted in increased wall shear stress, particularly in the medial wall of the A2 where the aneurysm occurred 2 mm distal to the A1-2 junction. Conclusion: ACoA preservation is a key element of aneurysm surgery in this location. Suspected occlusion of this vessel may warrant closer radiographic follow-up in patients with other risk factors for aneurysm development. PMID:26664872

  5. Delayed Transcranial Echo-Contrast Bolus Arrival in Unilateral Internal Carotid Artery Stenosis and Occlusion.

    PubMed

    Gómez-Choco, Manuel; Schreiber, Stephan J; Weih, Markus; Doepp, Florian; Valdueza, José M

    2015-07-01

    Some patients with internal carotid artery (ICA) occlusion or stenosis are at risk of developing a hemodynamic stroke. Transcranial ultrasonography using an echo-contrast bolus technique might be able to assess the extent of hemodynamic compromise. We describe a transcranial Doppler sonographic method that analyzes the differences in echo-contrast bolus arrival between both middle cerebral arteries after intravenous echo-contrast application. Ten patients with 50%-79% ICA stenosis, 10 patients with 80%-99% ICA stenosis and 22 patients with ICA occlusion were studied and compared with 15 age-matched controls. There were significant increases in delayed filling of the middle cerebral artery in both 80%-99% stenoses and occlusions compared with controls. The extent of the observed delays did not correlate with vasomotor reactivity. Echo-contrast bolus arrival time can be used to gain additional information on the intracranial hemodynamic effects of extracranial carotid artery disease that seems to be independent of the established ultrasound indices. PMID:25890887

  6. Central Retinal and Posterior Ciliary Artery Occlusion After Intralesional Injection of Sclerosant to Glabellar Subcutaneous Hemangioma

    SciTech Connect

    Matsuo, Toshihiko; Fujiwara, Hiroyasu; Gobara, Hideo; Mimura, Hidefumi; Kanazawa, Susumu

    2009-03-15

    The aim of this study is to describe vision loss caused by central retinal artery and posterior ciliary artery occlusion as a consequence of sclerotherapy with a polidocanol injection to a glabellar hemangioma. An 18-year-old man underwent direct injection with a 23-gauge needle of 1 mL of a polidocanol-carbon dioxide emulsion into the glabellar subcutaneous hemangioma under ultrasound visualization of the needle tip by radiologists. He developed lid swelling the next day, and 3 days later at referral, the visual acuity in the left eye was no light perception. Funduscopy revealed central retinal artery occlusion and fluorescein angiography disclosed no perfusion at all in the left fundus, indicating concurrent posterior ciliary artery occlusion. The patient also showed mydriasis, blepharoptosis, and total external ophthalmoplegia on the left side. Magnetic resonance imaging demonstrated the swollen medial rectus muscle. In a month, blepharoptosis and ophthalmoplegia resolved but the visual acuity remained no light perception. Sclerosing therapy for facial hemangioma may develop a severe complication such as permanent visual loss.

  7. Relation of haemostatic, fibrinolytic, and rheological variables to the angiographic extent of peripheral arterial occlusive disease.

    PubMed

    Woodburn, K R; Lowe, G D; Rumley, A; Love, J; Pollock, J G

    1995-12-01

    We investigated the relationships between the angiographic severity of peripheral arterial occlusive disease (PAOD) and haemostasis, fibrinolytic, and rheological variables in 219 patients with symptomatic peripheral arterial occlusive disease (PAOD). White cell count, fibrinogen, cross-linked fibrin degradation products (FDP), von Willebrand factor, and plasminogen activator inhibitor levels were all elevated in comparison with age-matched population controls (all p < 0.0001, Mann-Whitney U test), while fibrinogen (Spearman r = 0.30), von Willebrand factor (r = 0.40), and log (FDP) (r = 0.56), (all p < 0.0001) showed a strong correlation with the angiographic extent of PAOD. Multivariate analysis indicated that log (FDP) was a strong independent predictor of the angiographic severity of PAOD (p < 0.0001), in addition to increasing age (p < 0.0001), presence of tissue sepsis (p < 0.02), prior vascular surgery (p = 0.007), and other vascular pathology (p = 0.007). These results confirm that increase in fibrinogen, von Willebrand factor, plasminogen activator inhibitor and fibrin turnover, are strongly associated with the presence of symptomatic peripheral arterial disease, and suggest that there may be a causal link between fibrin turnover, as determined by FDP levels, and the extent of peripheral arterial occlusive disease. PMID:8708425

  8. Relation of haemostatic, fibrinolytic, and rheological variables to the angiographic extent of peripheral arterial occlusive disease.

    PubMed

    Woodburn, K R; Lowe, G D; Rumley, A; Love, J; Pollock, J G

    1995-09-01

    We investigated the relationships between the angiographic severity of peripheral arterial occlusive disease (PAOD) and haemostasis, fibrinolytic, and rheological variables in 219 patients with symptomatic peripheral arterial occlusive disease (PAOD). White cell count, fibrinogen, cross-linked fibrin degradation products (FDP), von Willebrand factor, and plasminogen activator inhibitor levels were all elevated in comparison with age-matched population controls (all p < 0.0001, Mann-Whitney U test), while fibrinogen (Spearman r = 0.30), von Willebrand factor (r = 0.40), and log (FDP) (r = 0.56), (all p < 0.0001) showed a strong correlation with the angiographic extent of PAOD. Multivariate analysis indicated that log (FDP) was a strong independent predictor of the angiographic severity of PAOD (p < 0.0001), in addition to increasing age (p < 0.0001), presence of tissue sepsis (p < 0.02), prior vascular surgery (p = 0.007), and other vascular pathology (p = 0.007). These results confirm that increases in fibrinogen, von Willebrand factor, plasminogen activator inhibitor and fibrin turnover, are strongly associated with the presence of symptomatic peripheral arterial disease, and suggest that there may be causal link between fibrin turnover, as determined by FDP levels, and the extent of peripheral arterial occlusive disease. PMID:8919237

  9. [Accidental occlusion of the common femoral artery after Angio-Seal-application].

    PubMed

    Silber, S; Schön, N; Seidel, N; Heiss-Bogner, J

    1998-01-01

    Removal of the arterial sheath immediately after PTCA is desirable for patients, reduces the medical staff's workload, and may decrease hospital costs due to a shortened length of stay. Although the safety and efficacy of the hemostatic systems used especially for the above purpose have been sufficiently documented, inadvertent intraluminal vascular occlusion is theoretically possible. While partial or complete arterial occlusion in conjunction with the VasoSeal collagen prototype device has been previously reported, similar complications occurring with the Angio-Seal device were not published. In this report, we describe a 54-year old female patient (height: 150 cm, weight: 42.5 kg) who was transferred for PTCA following an acute anterior wall myocardial infarction. Immediately after PTCA, the Angio-Seal device was deployed utilizing standard technique. No difficulties were encountered during device deployment, however, immediately following device placement active arterial bleeding occurred. Due to the inadequacy of hemostasis, heparin was reversed with protamine to avoid further hemorrhagic complications. Following this, the desired hemostasis quickly occurred, but the patient soon complained about symptoms suggestive of an acute occlusion of the right femoral artery. Unsatisfactory attempts at lysis resulted in the patient being transferred to vascular surgery. The complete Angio-Seal system (anchor including collagen) was located intravascularly, and removed during surgery. This case report demonstrates that even an experienced examiner can inadvertently deploy the Angio-Seal completely intraarterially. In addition to the known contraindication, "peripheral arterial occlusive disease", we recommend that the Angio-Seal device not be utilized in patients of small physical size. PMID:9531701

  10. Laser angioplasty with lensed fibers and a holmium:YAG laser in iliac artery occlusions

    NASA Astrophysics Data System (ADS)

    White, Christopher J.; Ramee, Stephen R.; Mesa, Juan E.; Collins, Tyrone J.; Kotmel, Robert; Godfrey, Maureen A.

    1991-05-01

    Holmium-YAG (2.1 (mu) ) laser recanalization was attempted in 10 totally occluded miniature swine iliac arteries using a lensed fiber delivery system. The iliac artery occlusions were created in a Yucatan miniature swine model of atherosclerosis by means of a high cholesterol diet and balloon endothelial denudation. In order to increase the spot size, a spherical silica lens was attached to the distal end of a 300 micrometers core diameter silica optical fiber. The holmium-YAG laser was operated in the free-running mode with 250 microsecond(s) ec pulses at 4 Hz. The energy delivered was 225 mJ per pulse for the 1.0 mm lensed fiber and 200 mJ per pulse for the 1.3 mm lensed fiber. Laser energy was delivered in 2 to 5 second bursts. Successful recanalization was achieved in all 10 arteries attempted without perforation of the arterial wall. The average length of the occlusions was 5.0 +/- 1.8 cm. Following successful laser recanalization significant stenoses (>50%) remained in all of the arteries as judged by angiography. In conclusion, the lensed fibers coupled to the pulsed holmium-YAG laser were safe and effective in recanalizing these difficult lesions in relatively straight iliac arteries. There is potential clinical utility for this system as an adjunct to balloon angioplasty in patients with lesions which are unable to be crossed with guidewires.

  11. Hyperbaric oxygen for the treatment of the rare combination of central retinal vein occlusion and cilioretinal artery occlusion.

    PubMed

    Celebi, Ali Riza Cenk; Kilavuzoglu, Ayse Ebru; Altiparmak, Ugur Emrah; Cosar, C Banu; Ozkiris, Abdullah

    2016-03-01

    A 43-year-old male presented with sudden onset of painless, blurred vision in his left eye. Dilated fundoscopic examination showed signs consistent with the diagnosis of a combination of central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CLRAO). He received daily 2-h sessions of hyperbaric oxygen treatment (HBOT), 253 kPa for 14 days. At the end of the HBOT course, the patient's left visual acuity had improved from 20/200 to 20/20. Dilated fundoscopic examination showed that the intra-retinal haemorrhages in the entire retina and the retinal whitening along the course of the CLRA seen at presentation had completely resolved. The combination of CLRAO and CRVO comprises a discrete clinical entity. Even though there are many hypotheses concerning this condition, it is most likely the result of elevated intraluminal pressure in the retinal capillaries due to CRVO that exceeds the pressure in the CLRA. HBOT may be an effective treatment for CRVO-associated CLRAO. PMID:27044464

  12. Effect of selective occlusion of the umbilical arteries and/or veins on uterine blood flow in sheep.

    PubMed

    Hasaart, T H; de Haan, J; Horiguchi, T

    1986-01-01

    Maternal uterine blood flow was depressed during total umbilical cord occlusion, probably based on an increased fetal cotyledonary tissue pressure (Hasaart and de Haan (1985) Eur. J. Obstet. Gynec. Reprod. Biol., 19, 125-131). This supposed mechanism was further analysed by performing selective occlusions of the umbilical arteries and/or veins (mean occlusion time 35 s). An occluding device which allowed separate occlusion of umbilical veins and arteries was applied to the umbilical cord in 7 chronically prepared fetal lambs between 106 and 135 days gestation. Median uterine artery blood flow (UBF) was measured with an electromagnetic flow meter. During occlusion of both umbilical veins (VV, n = 22) in 6 animals a maximal decrease in UBF to 87.5% of control value (P less than 0.001) was found at the end occlusion, followed by a gradual return to control value in the post occlusion period. Occlusion of both umbilical arteries (AA, n = 29) in 5 animals was accompanied by a slight increase in UBF to 103% of control value (P less than 0.01). Total occlusion of the umbilical arteries and veins simultaneously (n = 17) in 4 animals did not result in any change in UBF. The changes in volume and turgor in the fetal cotyledonary tissue associated with the arterial and venous occlusions should lead to respectively a decrease (AA) and increase (VV) in resistance to maternal flow, causing the changes in uterine blood flow. It is concluded that volume changes in the fetal compartment of the sheep placenta affect maternal uterine blood flow. PMID:3956829

  13. [A Case of Acute Arterial Occlusion of the Lower Limb during Chemotherapy for Lung Cancer].

    PubMed

    Tanaka, Kentaro; Takada, Kazuto; Kojima, Eiji; Shimizu, Takahiro; Miyamatsu, Shohko; Nohara, Kango; Sakurai, Tsutomu; Mizuno, Takaaki; Yamashita, Yuuki

    2016-05-01

    A 69-year-old man visited a clinic for left leg weakness. With suspicions of lung cancer and a metastatic brain tumor, he was referred to our hospital and was diagnosed with large cell neuroendocrine carcinoma, cT1bN0M1b (BRA), stage IV. After stereotactic radiosurgery for his brain metastasis, he was treated with chemotherapy containing cisplatin and irinotecan. A week after initiating chemotherapy, he suddenly developed severe right leg pain and adynamia. A computed tomography angiogram revealed occlusion of the right common femoral artery, and percutaneous thrombectomy was performed. The symptoms resolved completely, and he was discharged without any sequelae or recurrence. Acute arterial occlusion of the limbs during chemotherapy is uncommon and requires prompt diagnosis and treatment; hence, caution should be paid when it is clinically suspected. PMID:27210093

  14. Transneuronal Degeneration of Thalamic Nuclei following Middle Cerebral Artery Occlusion in Rats

    PubMed Central

    2016-01-01

    Objective. Postinfarction transneuronal degeneration refers to secondary neuronal death that occurs within a few days to weeks following the disruption of input or output to synapsed neurons sustaining ischemic insults. The thalamus receives its blood supply from the posterior circulation; however, infarctions of the middle cerebral arterial may cause secondary transneuronal degeneration in the thalamus. In this study, we presented the areas of ischemia and associated transneuronal degeneration following MCAo in a rat model. Materials and Methods. Eighteen 12-week-old male Sprague-Dawley rats were randomly assigned to receive middle cerebral artery occlusion surgery for 1, 7, and 14 days. Cerebral atrophy was assessed by 2,3,5-triphenyltetrazolium hydrochloride staining. Postural reflex and open field tests were performed prior to animal sacrifice to assess the effects of occlusion on behavior. Results. Myelin loss was observed at the lesion site following ischemia. Gliosis was also observed in thalamic regions 14 days following occlusion. Differential degrees of increased vascular endothelial growth factor expression were observed at each stage of infarction. Increases in myelin basic protein levels were also observed in the 14-day group. Conclusion. The present rat model of ischemia provides evidence of transneuronal degeneration within the first 14 days of occlusion. The observed changes in protein expression may be associated with self-repair mechanisms in the damaged brain. PMID:27597962

  15. Transneuronal Degeneration of Thalamic Nuclei following Middle Cerebral Artery Occlusion in Rats.

    PubMed

    Chang, Shu-Jen; Cherng, Juin-Hong; Wang, Ding-Han; Yu, Shu-Ping; Liou, Nien-Hsien; Hsu, Ming-Lun

    2016-01-01

    Objective. Postinfarction transneuronal degeneration refers to secondary neuronal death that occurs within a few days to weeks following the disruption of input or output to synapsed neurons sustaining ischemic insults. The thalamus receives its blood supply from the posterior circulation; however, infarctions of the middle cerebral arterial may cause secondary transneuronal degeneration in the thalamus. In this study, we presented the areas of ischemia and associated transneuronal degeneration following MCAo in a rat model. Materials and Methods. Eighteen 12-week-old male Sprague-Dawley rats were randomly assigned to receive middle cerebral artery occlusion surgery for 1, 7, and 14 days. Cerebral atrophy was assessed by 2,3,5-triphenyltetrazolium hydrochloride staining. Postural reflex and open field tests were performed prior to animal sacrifice to assess the effects of occlusion on behavior. Results. Myelin loss was observed at the lesion site following ischemia. Gliosis was also observed in thalamic regions 14 days following occlusion. Differential degrees of increased vascular endothelial growth factor expression were observed at each stage of infarction. Increases in myelin basic protein levels were also observed in the 14-day group. Conclusion. The present rat model of ischemia provides evidence of transneuronal degeneration within the first 14 days of occlusion. The observed changes in protein expression may be associated with self-repair mechanisms in the damaged brain. PMID:27597962

  16. Impact of a bidirectional approach via radial and popliteal arteries for the treatment of chronic total occlusion of lower limb artery: A case report

    PubMed Central

    Sakai, Hidetsugu; Oyama, Naotsugu; Imagawa, Shogo; Kishimoto, Noriaki; Tsutsui, Hiroyuki

    2007-01-01

    A 49-year-old man with poorly controlled diabetes was admitted to Kushiro Rosai Hospital, Hokkaido, Japan after scalding both feet with boiling water. Because of poor healing, he was assessed for peripheral arterial disease. Angiography revealed total occlusion of the right common and external iliac arteries, diffuse stenosis of the right superficial femoral artery, focal stenosis of the left common iliac artery and chronic total occlusion of the left superficial femoral artery. A staged procedure with bidirectional approach via the radial and popliteal arteries was attempted. During the procedures, the patient was in the prone position on the catheterization table, and bidirectional guidewire manipulation was performed. All of the lesions were successfully stented. The patient was not required to change positions during the procedure, which can be performed by a single operator. The bidirectional approach is effective in the setting of transcatheter treatment of chronic total occlusive disease. PMID:22477246

  17. Central Retinal Artery Occlusion: A Literature Review and the Rationale for Hyperbaric Oxygen Therapy.

    PubMed

    Olson, Evan A; Lentz, Kathy

    2016-01-01

    Central retinal artery occlusion is visually devastating and has no proven treatments. The therapeutic interval between symptom onset and potentially sight-saving intervention is narrow. Traditional conservative approaches include digital massage, administration of systemic vasodilators and diuretics, and lowering of intraocular pressure. Systemic and targeted fibrinolytic therapy is under investigation but is associated with significant adverse reactions. We report a case in which hyperbaric oxygen therapy restored retinal perfusion, and the patient's vision was improved. PMID:27039492

  18. Diagnosis of arterial occlusive disease of the lower extremities by laser Doppler flowmetry.

    PubMed

    Van den Brande, P; Welch, W

    1988-01-01

    Laser Doppler Flowmetry offers the possibility of non-invasive and continuous recording of tissue blood flow. Skin blood flux in resting state and during postocclusive reactive hyperemia was measured at the pulpa of the toe in 21 normal lower limbs and in 58 limbs with arterial occlusive disease. Proper assessment of postischemic flux- and time- parameters (beginning of reactive hyperemia, peak flux, time of peak flux and duration of hyperemic flux) permits accurate separation of healthy and diseased limbs. PMID:3058833

  19. Primary Stent Placement for Recanalization of Iliac Artery Occlusions: Using a Self-Expanding Spiral Stent

    SciTech Connect

    Kim, Jae-Kyu; Kim, Yun-Hyeon; Chung, Sang-Yeung; Kang, Heoung-Keun

    1999-07-15

    Purpose: To report the clinical results for recanalizations of an occluded iliac artery by a self-expanding spiral stent. Methods: We attempted to recanalize 36 iliac artery occlusions in 34 patients [33 men, 1 woman, aged 51-75 years (average 61.6 years)]. The average lesion length was 6.92 cm (range 1-14 cm). The patients' chief complaints were intermittent claudication and resting pain. Fontaine classification was assigned before and after the procedure. Technical and clinical success were also analyzed. Results: Forty-five stents were successfully deployed in 34 patients. All 36 lesions (13 in the external iliac artery, 12 in the common iliac artery, and 11 in both) were patently recanalized on angiography. The follow-up period ranged from 6 months to 36 months (mean 11.9 months). Fourteen stents (39%) with incomplete expansion were dilated with a balloon catheter. Good technical (100%) and clinical (94%) results were obtained. The only complication was one hematoma at the puncture site. Reocclusions were noted in two lesions (5%) at 1 week and 15 months, respectively. Conclusion: A self-expanding spiral stent is a safe and effective device for recanalization of an iliac artery occlusion as the primary stent without any previous intervention.

  20. Microballoon Occlusion Test to Predict Colonic Ischemia After Transcatheter Embolization of a Ruptured Aneurysm of the Middle Colic Artery

    SciTech Connect

    Tajima, Tsuyoshi Yoshimitsu, Kengo; Inokuchi, Hiroyuki; Irie, Hiroyuki; Nishie, Akihiro; Hirakawa, Masakazu; Ishigami, Kousei; Ushijima, Yasuhiro; Okamoto, Daisuke; Honda, Hiroshi; Itoh, Hiroyuki; Morita, Masaru; Kakeji, Yoshihiro

    2008-07-15

    A 76-year-old woman presented with sudden massive melena, and superior mesenteric arteriography showed an aneurysm in the middle colic artery (MCA). Because she had a history of right hemicolectomy and ligation of the inferior mesenteric artery (IMA) during open abdominal aortic aneurysm repair, embolization of the MCA aneurysm was considered to pose a risk comparable to that of colonic ischemia. A microballoon occlusion test during occlusion of the MCA confirmed retrograde visualization of the IMA branches through the collateral arteries by way of the left internal iliac artery, and embolization was successfully performed using microcoils. No colonic ischemia or aneurysm rupture occurred after embolization.

  1. Axillary Artery Access for Combined Endoaortic Balloon Occlusion and Perfusion During Robotic Mitral Valve Surgery.

    PubMed

    Ambur, Vishnu V; Kadakia, Sagar S; Taghavi, Sharven; Jayarajan, Senthil N; Kashem, Mohammed Abul; McCarthy, James; Shiose, Akira; Wheatley, Grayson H; Toyoda, Yoshiya; Guy, T Sloane

    2016-01-01

    We aimed to develop a method that provides an alternative cannulation site in robotic mitral valve surgery that allows simultaneous endo-occlusion and antegrade perfusion. A 71-year-old man with severe mitral regurgitation and history of coronary artery bypass grafting underwent totally endoscopic robotic mitral valve repair. A 23-mm endoreturn cannula was placed through a 10-mm graft that was sewn to the left axillary artery. An endoballoon was passed through the Dacron/cannula complex and into the ascending aorta. This complex was used for simultaneous antegrade perfusion, endoballoon occlusion, and antegrade cardioplegia. Completion transesophageal echocardiography showed no evidence of mitral regurgitation. The patient had an uneventful postoperative course and was doing well at his 2-month follow-up appointment. The left axillary artery is a viable option for simultaneous endoballoon occlusion, antegrade perfusion, and antegrade cardioplegia in robotic mitral valve surgery. This has the potential benefit of providing antegrade perfusion, which some studies have shown to be associated with a decreased risk of complications when compared with retrograde perfusion specifically in patients with severe peripheral vascular disease. PMID:27093272

  2. Endovascular surgery for peripheral arterial occlusive disease. A critical review.

    PubMed Central

    Ahn, S S; Eton, D; Moore, W S

    1992-01-01

    Endovascular surgery is a new multidisciplinary field that applies the recently innovated techniques of angioscopy, intraluminal ultrasound, balloon angioplasty, laser, mechanical atherectomy, and stents. This field can be defined as a diagnostic and therapeutic discipline that uses catheter-based systems to treat vascular disease. As such, it integrates the subspecialties of vascular surgery, interventional radiology, interventional cardiology, and biomedical engineering for the common purpose of improving arterial hemodynamics. Endovascular surgery offers many potential benefits: long incisions are replaced with a puncture wound, the need for postoperative intensive care is significantly reduced, major cardiac and pulmonary complications from general anesthesia are side stepped, and the dollar savings could be dramatic as the need for intensive care unit and in-hospital stay diminishes. Despite these technological advancements, endovascular surgery is still in its infancy and currently has limited applications. This review provides an updated summary of endovascular surgery today and addresses some of the obstacles still preventing its widespread use. PMID:1385944

  3. A bypass case due to an acute inferior myocardial infarction caused by vascular occlusion of the left subclavian artery and left anterior descending artery.

    PubMed

    Altas, Yakup; Ulugg, Ali Veysel

    2016-01-01

    ST segment elevation is the most common electrocardiographic finding in acute myocardial infarction. ST elevation in chest leads generally represents left anterior descending artery occlusion, while elevation in DII and III, and aVF represents right coronary and circumflex artery occlusion. A female patient aged 66 years was admitted to our emergency service with ST elevation in leads DIII and aVF. A diagnosis of acute inferior myocardial infarction was made. The patient's history included coronary artery bypass graft involving the left internal mammary artery to the left anterior descending coronary artery and aorta to the right coronary artery. The patient was taken to the cardiac catheterization laboratory for primary percutaneous coronary intervention and a lesion in the left anterior descending artery was identified. Additionally, the left subclavian artery was totally occluded. Following intervention to the lesion, the patient was discharged on day 4 of admission. PMID:27555777

  4. A bypass case due to an acute inferior myocardial infarction caused by vascular occlusion of the left subclavian artery and left anterior descending artery

    PubMed Central

    Altas, Yakup; Ulugg, Ali Veysel

    2016-01-01

    ST segment elevation is the most common electrocardiographic finding in acute myocardial infarction. ST elevation in chest leads generally represents left anterior descending artery occlusion, while elevation in DII and III, and aVF represents right coronary and circumflex artery occlusion. A female patient aged 66 years was admitted to our emergency service with ST elevation in leads DIII and aVF. A diagnosis of acute inferior myocardial infarction was made. The patient’s history included coronary artery bypass graft involving the left internal mammary artery to the left anterior descending coronary artery and aorta to the right coronary artery. The patient was taken to the cardiac catheterization laboratory for primary percutaneous coronary intervention and a lesion in the left anterior descending artery was identified. Additionally, the left subclavian artery was totally occluded. Following intervention to the lesion, the patient was discharged on day 4 of admission. PMID:27555777

  5. The risk of stroke with occlusion of the internal carotid artery.

    PubMed

    Pierce, G E; Keushkerian, S M; Hermreck, A S; Iliopoulos, J I; Thomas, J H

    1989-01-01

    Reports of all cervicocephalic arteriograms (n = 1836) performed at one institution during a 10-year period were reviewed and the patients were classified into three groups according to the indication for arteriography. Group I included all patients with symptoms or findings compatible with occlusive disease of the carotid or vertebral artery (n = 806). Group II included patients with cerebrovascular symptoms unrelated to carotid or vertebral disease (e.g., patients with subarachnoid hemorrhage) (n = 367). Group III consisted of patients with no evidence of cerebrovascular disease (e.g., patients with primary and metastatic brain tumors) (n = 663). One hundred ten atherosclerotic occlusions of the internal carotid artery (ICA) were found in 106 patients in group I. Fifty-one percent of these patients had a history of stroke before arteriography, 24% had transient ischemic attacks (TIAs) or amaurosis fugax (AF), and 12% had nonhemispheric symptoms. Only 13% (1.7% of group I patients) were without symptoms. Ninety-one percent of the strokes and 75% of the TIAs or AF were ipsilateral to the ICA occlusion. Seventy-six percent of patients with stroke and 80% with ipsilateral TIAs or AF vs only 29% of patients without symptoms had contralateral stenosis of 60% diameter reduction or greater (p less than 0.003). No occlusions of the ICA occurred in groups II or III. Three hundred forty-six patients in groups II and III were more than 60 years of age. Assuming either Poisson or binomial distributions, the incidence of silent ICA occlusion in the population at large older than 60 years was estimated at less than 1% (p less than 0.03). PMID:2911144

  6. Blood flow redistribution and ventilation-perfusion mismatch during embolic pulmonary arterial occlusion

    PubMed Central

    Burrowes, K. S.; Clark, A. R.; Tawhai, M. H.

    2011-01-01

    Acute pulmonary embolism causes redistribution of blood in the lung, which impairs ventilation/perfusion matching and gas exchange and can elevate pulmonary arterial pressure (PAP) by increasing pulmonary vascular resistance (PVR). An anatomically-based multi-scale model of the human pulmonary circulation was used to simulate pre- and post-occlusion flow, to study blood flow redistribution in the presence of an embolus, and to evaluate whether reduction in perfused vascular bed is sufficient to increase PAP to hypertensive levels, or whether other vasoconstrictive mechanisms are necessary. A model of oxygen transfer from air to blood was included to assess the impact of vascular occlusion on oxygen exchange. Emboli of 5, 7, and 10 mm radius were introduced to occlude increasing proportions of the vasculature. Blood flow redistribution was calculated after arterial occlusion, giving predictions of PAP, PVR, flow redistribution, and micro-circulatory flow dynamics. Because of the large flow reserve capacity (via both capillary recruitment and distension), approximately 55% of the vasculature was occluded before PAP reached clinically significant levels indicative of hypertension. In contrast, model predictions showed that even relatively low levels of occlusion could cause localized oxygen deficit. Flow preferentially redistributed to gravitationally non-dependent regions regardless of occlusion location, due to the greater potential for capillary recruitment in this region. Red blood cell transit times decreased below the minimum time for oxygen saturation (<0.25 s) and capillary pressures became high enough to initiate cell damage (which may result in edema) only after ~80% of the lung was occluded. PMID:22140626

  7. Modulation of the spontaneous contractions of the initial lymphatics of the bat's wing by arterial and venous occlusion.

    PubMed

    Unthank, J L; Hogan, R D

    1988-01-01

    The spontaneous contractions of the initial lymphatics of the bat's wing were observed to be modulated by changes in local blood flow. Lymphatic pressure and frequency of contraction were measured with the servo-null technique during the occlusion of the ulnar artery or vein. Lymphatic contractile activity was decreased during arterial occlusion but was increased during venous occlusion and postocclusion hyperemia. These changes in lymphatic activity are not consistent with the hypothesis that flow-associated changes in lymphatic contractile activity is mediated primarily by metabolic factors. PMID:3359051

  8. A protocol for characterizing the impact of collateral flow after distal middle cerebral artery occlusion

    PubMed Central

    DeFazio, R. Anthony; Levy, Sean; Morales, Carmen L.; Levy, Rebecca V.; Dave, Kunjan R.; Lin, Hung W.; Abaffy, Tatjana; Watson, Brant D.; Perez-Pinzon, Miguel A.; Ohanna, Victoria

    2010-01-01

    I. SUMMARY In humans and in animal models of stroke, collateral blood flow between territories of the major pial arteries has a profound impact on cortical infarct size. However, there is a gap in our understanding of the genetic determinants of collateral formation and flow, as well as the signaling pathways and neurovascular interactions regulating this flow. Previous studies have demonstrated that collateral flow between branches of the anterior cerebral artery (ACA) and the middle cerebral artery (MCA) can protect mouse cortex from infarction after middle cerebral artery occlusion. Because the number and diameter of collaterals varies among mouse strains and after transgenic manipulations, a combination of methods is required to control for these variations. Here, we report an inexpensive approach to characterizing the cerebrovascular anatomy, and in vivo monitoring of cerebral blood flow as well. Further, we introduce a new, minimally invasive method for the occlusion of distal MCA branches. These methods will permit a new generation of studies on the mechanisms regulating collateral remodeling and cortical blood flow after stroke. PMID:21593993

  9. Transcatheter Thrombolysis with High-Dose Bolus Tissue Plasminogen Activator in Iatrogenic Arterial Occlusion after Femoral Arterial Catheterization

    SciTech Connect

    Tsetis, Dimitrios K.; Kochiadakis, George E.; Hatzidakis, Adam A.; Skalidis, Emannuel I.; Chryssou, Evangelia G.; Tritou, Ioanna N.; Vardas, Panos E.; Gourtsoyiannis, Nicholas C.

    2002-01-15

    Purpose: To assess the efficacy of percutaneous local thrombolysis with high-dose bolus recombinant tissue plasminogen activator (rt-PA) in patients with acute limb ischemia due to arterial thrombosis after cardiac catheterization.Methods: We treated eight patients (7 men; mean age 56 years) with thrombotic occlusion of both the common femoral artery (CFA) and external iliac artery (EIA) in six patients and of the CFA only in two patients. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 Fr end-hole catheter and subsequently two additional boluses of 5 mg rt-PA were given through a catheter with multiple side-holes. In case of a significant amount of residual thrombus, a continuous infusion of 2.5 mg/hr of rt-PA was started.Results: Successful lysis was achieved in all patients. The mean duration of lysis was 2 hr 41 min. The mean total amount of rt-PA delivered was 23.16 mg. In four patients unmasked flow-limited dissections confined to the CFA were managed by prolonged balloon dilatation, while in the remaining four patients with extension of the dissection to the external iliac artery one or two Easy Wallstents were implanted. There was prompt relief of lower limb ischemic symptoms and signs in all patients. Two groin hematomas were conservatively treated.Clinical and color Doppler flow imaging follow-up with a mean duration of 15 months, showed no reappearance of ischemic symptoms or development of restenosis in any of the patients. One patient died 6 months after thrombolysis.Conclusions: Transcatheter thrombolysis with high-dose bolus rt-PA is a safe and effective treatment inpatients with iatrogenic arterial occlusion after femoral catheterization. Underlying dissections should be treated by prolonged balloon dilatation but stent implantation is often required.

  10. Profunda anchor technique for ipsilateral antegrade approach in endovascular treatment of superficial femoral artery ostial occlusion.

    PubMed

    Pua, Uei

    2015-04-01

    Endovascular treatment of the superficial femoral artery (SFA) is challenging in the presence of flush ostial occlusion. One of the main challenges is the availability of access sites for intervention. Contralateral retrograde femoral access followed by cross-over and antegrade intervention while commonly used, may not be feasible in cases of altered iliac anatomy (e.g. kissing iliac stents). Ipsilateral antegrade intervention using common femoral artery (CFA) access in these instances while possible is typically challenging due to inadequate working length of the CFA for interrogation of the SFA ostium, compounded by the lack of sheath stability. The "profunda anchor" technique uses a buddy wire in the profunda femoris artery (PFA) to stabilize the sheath and allow catheter manipulation for antegrade intervention at the level of the SFA ostium. The PFA is further used as a conduit for deployment of closure device to avoid interference with the treated SFA. PMID:25522981

  11. Profunda Anchor Technique for Ipsilateral Antegrade Approach in Endovascular Treatment of Superficial Femoral Artery Ostial Occlusion

    SciTech Connect

    Pua, Uei

    2015-04-15

    Endovascular treatment of the superficial femoral artery (SFA) is challenging in the presence of flush ostial occlusion. One of the main challenges is the availability of access sites for intervention. Contralateral retrograde femoral access followed by cross-over and antegrade intervention while commonly used, may not be feasible in cases of altered iliac anatomy (e.g. kissing iliac stents). Ipsilateral antegrade intervention using common femoral artery (CFA) access in these instances while possible is typically challenging due to inadequate working length of the CFA for interrogation of the SFA ostium, compounded by the lack of sheath stability. The “profunda anchor” technique uses a buddy wire in the profunda femoris artery (PFA) to stabilize the sheath and allow catheter manipulation for antegrade intervention at the level of the SFA ostium. The PFA is further used as a conduit for deployment of closure device to avoid interference with the treated SFA.

  12. Autonomic and myocardial changes in middle cerebral artery occlusion: stroke models in the rat.

    PubMed

    Cechetto, D F; Wilson, J X; Smith, K E; Wolski, D; Silver, M D; Hachinski, V C

    1989-11-20

    Stroke models in larger animals such as the cat, dog and monkey are becoming increasingly more expensive and less readily available. However, the rat is an excellent model for focal cerebral ischemia. Rats are readily available, inexpensive and their neuroanatomy and brain function have been studied extensively. Increases in plasma catecholamines and myocardial damage have been observed in clinical stroke. We examined autonomic and myocardial changes in two rat stroke models. In one model only the middle cerebral artery was occluded (MCAO) while the other model involved occlusion of both the MCA and the common carotid artery (MCAO/CCAO). Arterial blood pressure and heart rate were monitored continuously in 25 male rats (326-430 g) that underwent one of the following procedures: (1) MCAO only; (2) MCAO/CCAO; (3) CCAO only; and (4) sham occlusions (SHAM). Arterial blood samples (0.5 ml) for radioenzymatic assay of norepinephrine (NE) and epinephrine (E) were taken twice before the occlusions and at 90 and 180 min after the occlusions. The animals were perfused at the end of the experiment and the heart removed and examined histologically. Tetrazolium salts were reacted with oxidative enzymes to delineate the region of inadequate perfusion. The mean blood pressure and pulse pressure of the SHAM, MCAO/CCAO and CCAO groups significantly declined from initial values (from an average of 78 to 53 mm Hg) during the course of the experiment. However, the mean blood pressure and pulse pressure of the MCAO rats did not change during the experiment, so that the final mean blood pressure and pulse pressure were significantly higher than in the other 3 groups. The levels of both NE and E increased significantly (NE, 1443 +/- 285.9 to 4095 +/- 929 pg/ml; E, 2402 +/- 623 to 3741 +/- 1166 pg/ml) following occlusion in the MCAO group only while the other 3 groups did not change. Four of 6 hearts in the MCAO group were abnormal, showing evidence of subendocardial hemorrhage, ischemic

  13. The challenge of basilar artery occlusion wake-up stroke: too late for intravenous thrombolysis?

    PubMed

    Caliandro, Pietro; Reale, Giuseppe; Tartaglione, Tommaso; Rossini, Paolo Maria

    2016-07-01

    We describe the case of a patient carried to our emergency department, with the wake-up finding of dysarthria, right hemiplegia and worsening consciousness impairment (NIHSS 12). After performing a CT angiography, which showed complete basilar occlusion, we determined the MR DWI-FLAIR mismatch to estimate the stroke onset time. Because of the favorable mismatch (DWI hyperintensity in the left pons, no FLAIR hyperintensity in the same region), the patient underwent thrombolysis with sudden neurological improvement. In addition, the DWI hyperintensity first observed in the left pons totally regressed after thrombolysis. Wake-up stroke constitutes about 14 % of all strokes, while the percentage of basilar artery occlusion wake-up strokes is still unknown. Although thrombolysis in patients with unknown-onset time is still an off-label therapy, basilar artery occlusion is a potentially fatal event. In our case we used RM DWI-FLAIR mismatch to rapidly estimate the stroke onset time and to treat the patient with an off-label but potentially effective and safe therapy. PMID:26960980

  14. The Effect of Endovascular Revascularization of Common Iliac Artery Occlusions on Erectile Function

    SciTech Connect

    Gur, Serkan; Ozkan, Ugur; Onder, Hakan; Tekbas, Gueven; Oguzkurt, Levent

    2013-02-15

    To determine the incidence of erectile dysfunction in patients with common iliac artery (CIA) occlusive disease and the effect of revascularization on erectile function using the sexual health inventory for males (SHIM) questionnaire. All patients (35 men; mean age 57 {+-} 5 years; range 42-67 years) were asked to recall their sexual function before and 1 month after iliac recanalization. Univariate and multivariate analyses were performed to determine variables effecting improvement of impotence. The incidence of impotence in patients with CIA occlusion was 74% (26 of 35) preoperatively. Overall 16 (46%) of 35 patients reported improved erectile function after iliac recanalization. The rate of improvement of impotence was 61.5% (16 of 26 impotent patients). Sixteen patients (46%), including seven with normal erectile function before the procedure, had no change. Three patients (8%) reported deterioration of their sexual function, two of whom (6%) had normal erectile function before the procedure. The median SHIM score increased from 14 (range 4-25) before the procedure to 20 (range 1-25) after the procedure (P = 0.005). The type of recanalization, the age of the patients, and the length of occlusion were related to erectile function improvement in univariate analysis. However, these factors were not independent factors for improvement of erectile dysfunction in multivariate analysis (P > 0.05). Endovascular recanalization of CIA occlusions clearly improves sexual function. More than half of the patients with erectile dysfunction who underwent endovascular recanalization of the CIA experienced improvement.

  15. Subintimal angioplasty for superficial femoral artery occlusion: poor patency in critical ischaemia.

    PubMed Central

    Smith, B. M.; Stechman, M.; Gibson, M.; Torrie, E. P. H.; Magee, T. R.; Galland, R. B.

    2005-01-01

    INTRODUCTION: Subintimal angioplasty has been proposed for the treatment of long segment occlusive disease and for patients with critical limb ischaemia (CLI) with significant co-morbidity. There is no consensus as to short- and long-term patency. We present our experience with this technique. METHODS: Between 1995 and 2000, 43 consecutive patients (48 limbs) underwent subintimal angioplasty for superficial femoral artery occlusions. Outcome measures were haemodynamic and/or symptomatic patency. RESULTS: Technical success was achieved in 14/17 limbs with CLI (82%) and 30/31 (97%) with intermittent claudication (IC). There were 7 complications (15%), 6 occurring in the claudicant group. The median occlusion length was 10 cm for CLI and 6 cm for IC. Patency at 12 and 36 months, on an intention-to-treat basis, was 69% and 58% for claudicants and 25% and 25% for patients with CLI (P = 0.0005 and P = 0.0044, respectively). Following only technically successful procedures, 12-month patency was 72% (IC) and 31% (CLI) (P = 0.009). Patients with occlusions > or = 10 cm were more likely to re-occlude than those < 10 cm (12-month patency 60% versus 25%;P = 0.037). CONCLUSIONS: In this series, short- and long-term patency in patients with CLI is poor. Subintimal angioplasty in the treatment of CLI should be reserved for those patients not fit for surgical bypass. PMID:16176697

  16. Retrograde Pedal/Tibial Artery Access for Treatment of Infragenicular Arterial Occlusive Disease

    PubMed Central

    El-Sayed, Hosam F.

    2013-01-01

    Endovascular intervention has emerged as an accepted modality for treating patients with critical limb ischemia. However, this therapy poses multiple challenges to the interventionalist due to the presence of widespread multilevel disease, long and complex occlusive lesions, and the common involvement of the tibial vessels. Retrograde pedal/tibial access is a relatively new technique that allows the treatment of tibial occlusive lesions when conventional endovascular techniques fail. This article reviews the technical details and published data regarding this technique and evaluates its use in this difficult-to-treat patient population. PMID:23805338

  17. Emergency placement of stent-graft for symptomatic acute carotid artery occlusion after endarterectomy.

    PubMed

    Ko, Jun Kyeung; Choi, Chang Hwa; Lee, Sang Weon; Lee, Tae Hong

    2015-01-01

    A patient underwent a left-sided carotid endarterectomy (CEA) for an asymptomatic 80% carotid artery (CA) stenosis. There were no signs of intolerance during the carotid cross-clamping and an initially uneventful awakening was observed. However, in the third postoperative hour he experienced left amaurosis and dysarthria. An urgent MRI showed an occluded internal CA on the operated site without evidence of acute infarction. To recanalize the occluded internal CA and minimize leakage from the arteriotomy site, a self-expandable stent-graft was placed, covering the dissection and the distal atherosclerotic lesions. Complete recanalization of the left internal CA was achieved and the patient showed a dramatic improvement of his preoperative deficits. To our knowledge, this is the first case of stent-graft implantation for a symptomatic acute CA occlusion following CEA. Stent-graft placement should be considered as an alternative method of treatment for acute CA occlusion or dissection following CEA. PMID:25636626

  18. Emergency placement of stent-graft for symptomatic acute carotid artery occlusion after endarterectomy.

    PubMed

    Ko, Jun Kyeung; Choi, Chang Hwa; Lee, Sang Weon; Lee, Tae Hong

    2016-03-01

    A patient underwent a left-sided carotid endarterectomy (CEA) for an asymptomatic 80% carotid artery (CA) stenosis. There were no signs of intolerance during the carotid cross-clamping and an initially uneventful awakening was observed. However, in the third postoperative hour he experienced left amaurosis and dysarthria. An urgent MRI showed an occluded internal CA on the operated site without evidence of acute infarction. To recanalize the occluded internal CA and minimize leakage from the arteriotomy site, a self-expandable stent-graft was placed, covering the dissection and the distal atherosclerotic lesions. Complete recanalization of the left internal CA was achieved and the patient showed a dramatic improvement of his preoperative deficits. To our knowledge, this is the first case of stent-graft implantation for a symptomatic acute CA occlusion following CEA. Stent-graft placement should be considered as an alternative method of treatment for acute CA occlusion or dissection following CEA. PMID:25653229

  19. Bilateral thalamic stroke due to occlusion of the artery of Percheron in a patient with a patent foramen ovale.

    PubMed

    Jumean, Khalid; Arqoub, Ahmad Abu; Al Hadidi, Moayad Awni; Hawatmeh, Amer; Shaaban, Hamid

    2016-01-01

    The artery of Percheron (AOP) is a rare vascular variant in which a single dominant thalamoperforating artery arises from the P1 segment and bifurcates to supply both paramedian thalami. Occlusion of this uncommon vessel results in a characteristic pattern of bilateral paramedian thalamic infarcts with or without mesencephalic infarctions. We report a case of a 37-year-old man with acute bilateral thalamic infarcts. The scans revealed symmetric bilateral hyperintense paramedian thalamic lesions consistent with an acute ischemic event. The posterior circulation was patent including the tip of the basilar artery and both posterior cerebral arteries, making the case compatible with occlusion of the AOP. This type of infarct is associated with embolic phenomena, and further evaluation revealed a patent foramen ovale as the source of emboli in the cerebrovascular circulation. The occlusion of the AOP is a rare cause of coma in young patients, and early recognition of this rare disease entity may lead to more favorable outcomes. PMID:27003984

  20. Bilateral thalamic stroke due to occlusion of the artery of Percheron in a patient with a patent foramen ovale

    PubMed Central

    Jumean, Khalid; Arqoub, Ahmad Abu; Al Hadidi, Moayad Awni; Hawatmeh, Amer; Shaaban, Hamid

    2016-01-01

    The artery of Percheron (AOP) is a rare vascular variant in which a single dominant thalamoperforating artery arises from the P1 segment and bifurcates to supply both paramedian thalami. Occlusion of this uncommon vessel results in a characteristic pattern of bilateral paramedian thalamic infarcts with or without mesencephalic infarctions. We report a case of a 37-year-old man with acute bilateral thalamic infarcts. The scans revealed symmetric bilateral hyperintense paramedian thalamic lesions consistent with an acute ischemic event. The posterior circulation was patent including the tip of the basilar artery and both posterior cerebral arteries, making the case compatible with occlusion of the AOP. This type of infarct is associated with embolic phenomena, and further evaluation revealed a patent foramen ovale as the source of emboli in the cerebrovascular circulation. The occlusion of the AOP is a rare cause of coma in young patients, and early recognition of this rare disease entity may lead to more favorable outcomes. PMID:27003984

  1. Hoarseness after pulmonary arterial stenting and occlusion of the arterial duct.

    PubMed

    Assaqqat, Mervat; Siblini, Ghassan; Fadley, Fadel Al

    2003-06-01

    We report a 12-year-old girl who had multiple congenital cardiac lesions, specifically an arterial duct, left pulmonary arterial stenosis, an atrial septal defect in the oval fossa, and mild Ebstein's malformation of the tricuspid valve. Therapeutic transcatheter intervention was performed to stent the left pulmonary artery, occlude the arterial duct with a coil, and place a device to close the atrial septal defect. Subsequent to the catheterization, she complained of hoarseness, which was shown to be due to entrapment of the left recurrent laryngeal nerve between the coil used to close the arterial duct and the stent placed in the left pulmonary artery. Laryngoscopy confirmed paralysis of the recurrent laryngeal nerve. PMID:12903881

  2. Central retinal artery occlusion following laser treatment for ocular ischemic aortic arch syndrome

    PubMed Central

    Shah, Payal J.; Ellis, Brian; DiGiovine, Lauren R.; Hogg, Jeffery P.; Leys, Monique J.

    2015-01-01

    Objective: Ocular ischemic syndrome is a rare blinding condition generally caused by disease of the carotid artery. We describe a 69-year-old female with a 50 pack-year smoking history with aortic arch syndrome causing bilateral ocular ischemic syndrome. Methods: The patient presented with progressive visual loss and temple pain. Slit lamp biomicroscopy revealed bilateral iris neovascularization. This finding prompted a cardiovascular work up. Panretinal photocoagulation with retrobulbar block was performed in the right eye. Results: A temporal artery biopsy was negative. The carotid duplex ultrasound showed only a 1–39% stenosis. MRA revealed a more proximal occlusion of the aortic branch for which she underwent subclavian carotid bypass surgery. At the one month follow up, the right eye suffered profound vision loss secondary to a central retinal artery occlusion. Conclusion: Ocular neovascularization may be one of the clinical manifestations of aortic arch syndrome. This case also illustrates the limitations of relying solely on carotid duplex ultrasound testing. We caution against overly aggressive panretinal photocoagulation utilizing retrobulbar anesthesia.

  3. Combined use of intraoperative indocyanine green and dynamic angiography in rotational vertebral artery occlusion.

    PubMed

    Chaudhry, Nauman S; Ambekar, Sudheer; Elhammady, Mohamed Samy; Riley, Jonathan P; Pradilla, Gustavo; Nogueira, Raul G; Ahmad, Faiz U

    2016-08-01

    Rotational vertebral artery occlusion, also known as bow hunter's syndrome, is a well-documented surgically amenable cause of vertebrobasilar insufficiency. Traditionally, patients have been imaged using dynamic rotational angiography. The authors sought to determine whether intraoperative indocyanine green (ICG) angiography could reliably assess the adequacy of surgical decompression of the vertebral artery (VA). The authors report two patients who presented with multiple transient episodes of syncope provoked by turning their head to the right. Rotational dynamic angiography revealed a dominant VA that became occluded with head rotation to the right side. The patients underwent successful surgical decompression of the VA via an anterior cervical approach. Intraoperative ICG angiography demonstrated patency of the VA with head rotation. This was further confirmed by intraoperative dynamic catheter angiography. To our knowledge, we present the first two cases of the use of ICG combined with intraoperative dynamic rotational angiography to document the adequacy of surgical decompression of the VA in a patient with rotational vertebral artery occlusion. Intraoperative ICG angiography is a useful adjunct and may potentially supplant the need for intraoperative catheter angiography. PMID:27041076

  4. Clinical efficiency investigation of laparoscopic uterine artery occlusion combined with myomectomy for uterine fibroids.

    PubMed

    Yin, Xiang-Hua; Gao, Ling-Ling; Gu, Yang; Song, Jing-Zhe; Gao, Jing; Ji, Xiao-Ping

    2014-01-01

    To investigate the effectiveness of laparoscopic uterine artery occlusion combined with myomectomy for uterine fibroids. From August 2008 to August 2009, forty-eight women with uterine fibroids desiring to preserve their uteri underwent laparoscopic myomectomy. Among them, 18 women received laparoscopic uterine artery occlusion before uterine myomectomy while the others received laparoscopic myomectomy only. All of the 48 cases with uterine fibroids underwent laparoscopic myomectomy successfully, and no patient developed Intraoperative or postoperative complications. The average operation time was (105.6±27.6) min, and the average surgical blood loss was (87.52±18.35) ml. Blocking uterine artery before laparoscopic myomectomy is valuable and feasible for the management of women with symptomatic fibroids. Adopting this method can obtain pleasing therapeutic effect. The method can reduce blood loss thus make the surgical field clean and clear, and it can reduce the operating time and recurrence rate. It can also reduce electro-coagulation on the surgical surface and therefore cause less tissue necrosis and lower incidence of complications. PMID:24995096

  5. Clinical efficiency investigation of laparoscopic uterine artery occlusion combined with myomectomy for uterine fibroids

    PubMed Central

    Yin, Xiang-Hua; Gao, Ling-Ling; Gu, Yang; Song, Jing-Zhe; Gao, Jing; Ji, Xiao-Ping

    2014-01-01

    To investigate the effectiveness of laparoscopic uterine artery occlusion combined with myomectomy for uterine fibroids. From August 2008 to August 2009, forty-eight women with uterine fibroids desiring to preserve their uteri underwent laparoscopic myomectomy. Among them, 18 women received laparoscopic uterine artery occlusion before uterine myomectomy while the others received laparoscopic myomectomy only. All of the 48 cases with uterine fibroids underwent laparoscopic myomectomy successfully, and no patient developed Intraoperative or postoperative complications. The average operation time was (105.6±27.6) min, and the average surgical blood loss was (87.52±18.35) ml. Blocking uterine artery before laparoscopic myomectomy is valuable and feasible for the management of women with symptomatic fibroids. Adopting this method can obtain pleasing therapeutic effect. The method can reduce blood loss thus make the surgical field clean and clear, and it can reduce the operating time and recurrence rate. It can also reduce electro-coagulation on the surgical surface and therefore cause less tissue necrosis and lower incidence of complications. PMID:24995096

  6. Limb suction evoked during arterial occlusion causes systemic sympathetic activity in humans.

    PubMed

    Cui, Jian; Blaha, Cheryl; Herr, Michael D; Drew, Rachel C; Muller, Matthew D; Sinoway, Lawrence I

    2015-09-01

    Venous saline infusions in an arterially occluded forearm evokes reflex increases in muscle sympathetic nerve activity (MSNA) and blood pressure (BP). We hypothesized that the application of suction to the human limbs would activate this venous distension reflex and raise sympathetic outflow. We placed airtight pressure tanks and applied 100 mmHg negative pressure to an arterially occluded limb (occlusion and suction, O&S) to induce tissue deformation without fluid translocation. BP, heart rate (HR), and MSNA were assessed in 19 healthy subjects during 2 min of arm or leg O&S. Occlusion without suction served as a control. During a separate visit, saline (5% forearm volume) was infused into veins of the arterially occluded arm (n = 13). The O&S increased limb circumference, MSNA burst rate (arm: Δ6.7 ± 0.7; leg: Δ6.8 ± 0.7 bursts/min), and total activity (arm: Δ199 ± 14; leg: Δ172 ± 22 units/min) and BP (arm: Δ4.3 ± 0.3; leg: Δ9.4 ± 1.4 mmHg) from the baseline. The MSNA and BP responses during arm O&S correlated with those during leg O&S. Occlusion alone had no effect on MSNA and BP. MSNA (r = 0.607) responses during arm O&S correlated with those evoked by the saline infusion into the arm. These correlations suggest that sympathetic activation during limb O&S is likely, at least partially, to be evoked via the venous distension reflex. These data suggest that suction of an occluded limb evokes sympathetic activation and that the limb venous distension reflex exists in arms and legs of normal humans. PMID:26136530

  7. Limb suction evoked during arterial occlusion causes systemic sympathetic activity in humans

    PubMed Central

    Cui, Jian; Blaha, Cheryl; Herr, Michael D.; Drew, Rachel C.; Muller, Matthew D.

    2015-01-01

    Venous saline infusions in an arterially occluded forearm evokes reflex increases in muscle sympathetic nerve activity (MSNA) and blood pressure (BP). We hypothesized that the application of suction to the human limbs would activate this venous distension reflex and raise sympathetic outflow. We placed airtight pressure tanks and applied 100 mmHg negative pressure to an arterially occluded limb (occlusion and suction, O&S) to induce tissue deformation without fluid translocation. BP, heart rate (HR), and MSNA were assessed in 19 healthy subjects during 2 min of arm or leg O&S. Occlusion without suction served as a control. During a separate visit, saline (5% forearm volume) was infused into veins of the arterially occluded arm (n = 13). The O&S increased limb circumference, MSNA burst rate (arm: Δ6.7 ± 0.7; leg: Δ6.8 ± 0.7 bursts/min), and total activity (arm: Δ199 ± 14; leg: Δ172 ± 22 units/min) and BP (arm: Δ4.3 ± 0.3; leg: Δ9.4 ± 1.4 mmHg) from the baseline. The MSNA and BP responses during arm O&S correlated with those during leg O&S. Occlusion alone had no effect on MSNA and BP. MSNA (r = 0.607) responses during arm O&S correlated with those evoked by the saline infusion into the arm. These correlations suggest that sympathetic activation during limb O&S is likely, at least partially, to be evoked via the venous distension reflex. These data suggest that suction of an occluded limb evokes sympathetic activation and that the limb venous distension reflex exists in arms and legs of normal humans. PMID:26136530

  8. Retrospective study of threshold time for the conventional treatment of branch retinal artery occlusion

    PubMed Central

    Muramatsu, Daisuke; Minezaki, Teruumi; Tsubota, Kinya; Wakabayashi, Yoshihiro; Goto, Hiroshi

    2014-01-01

    Purpose To investigate the medical backgrounds of patients and the treatment periods from the onset of branch retinal artery occlusion to obtaining improved final visual acuity. Methods This was a retrospective case series study. A total of 68 consecutive patients (69 eyes) with branch retinal artery occlusion who visited Tokyo Medical University Hospital from 2007 to 2012 were included in this study. All patients underwent ophthalmic examinations and visual acuity tests. We reviewed their medical records for systemic conditions, as well as the periods from onset of symptoms to treatment. Participants were categorized into 2 groups: group A (n=36), which received any treatment within 24 hours from onset, and group B (n=33), which visited our hospital after 24 hours from onset. Best corrected visual acuity (BCVA) changes from the first to final visit and the relationships between systemic condition and visiting time to BCVA were assessed. Results At the first visit, 59% of the patients had BCVA over 20/40; the ratio was increased to 74% at the final visit. BCVA improved more than 2 lines for 35% of the patients and was unchanged for 57% of those receiving conventional treatment. BCVA over 20/40 was significantly lower in hyperlipidemia patients. Hypertension, diabetes mellitus, and significant carotid stenosis were not correlated. The mean BCVA at baseline (0.91±1.03) significantly recovered to 0.35±0.91 after treatment in group A (P<0.001, Student’s t-test). The mean BCVA at baseline (0.30±0.64) was 0.25±0.61 at the final visit in group B (no significant change). Conclusion Conventional treatment within 24 hours from onset was acceptable for branch retinal artery occlusion. PMID:25284974

  9. [Results of endovascular interventions in patients with occlusive stenotic lesions of arteries of the aortoiliac segment].

    PubMed

    Karpenko, A A; Starodubtsev, V B; Ignatenko, P V; Rabtsun, A A; Mitrofanov, V O

    2016-01-01

    Presented herein are the results of endovascular interventions performed in a total of 220 patients with chronic ischaemia of lower limbs and occlusive and stenotic lesions of the aortoiliac arterial segment. Group One patients (n=155) underwent angioplasty with stenting (a total of 186 interventions performed) and Group Two patients (n=65) were subjected to recanalization of the occlusion zone with stenting (65 interventions). The remote results were assessed in all patients within the terms of up to 4 years. In Group One patients, restenosis of the stented segments within the mentioned terms of follow up was revealed in 11 (7.1%) cases, thrombosis - in 5 (3.2%) cases. In Group Two patients restenosis was detected in 3 (4.6%) cases and thrombosis of the stented segment in 6 (9.2%) cases. In the both groups, restenosis >50% or thrombosis of the stented segment developed significantly more often with the length of the stented segment exceeding 100 mm (p=0.01 in Group One and p=0.0077 in Group Two). Primary patency of the stented segments at 12 and 24 months after the intervention in Group One amounted to 97.5±1.5 and 92.3±3.3% and in Group Two 92.7±3.6 and 81.9±6.6%, respectively. A conclusion was made that endovascular interventions may be a method of choice in occlusive and stenotic lesions of the aortoiliac-segment arteries. Extended length of the lesion of iliac-segment arteries (more than 100 mm) deteriorates the rates of primary patency after stenting. PMID:27336338

  10. Experimental occlusion of the central artery of the retina. IV: Retinal tolerance time to acute ischaemia.

    PubMed Central

    Hayreh, S. S.; Weingeist, T. A.

    1980-01-01

    Ophthalmoscopic, fluorescein angiographic, electrophysiological, and morphological studies on 63 eyes of rhesus monkeys with acute transient experimental occlusion of the central artery of the retina (OCAR) showed that the retina suffered irreparable damage after ischaemia of 105 minutes but recovered well after ischaemia of 97-98 minutes. The tolerance time of the brain to acute transient ischaemia is many times shorter than that of the retina. The metabolism of ischaemic neurones (in the retina and brain) is discussed with a view to explaining this difference, and also the various factors possibly responsible for the retina's longer tolerance to ischaemia, as compared to the brain. PMID:7426553

  11. [Iliac artery occlusion balloons for suspected placenta accreta during cesarean section].

    PubMed

    Burgos Frías, N; Gredilla, E; Guasch, E; Gilsanz, F

    2014-02-01

    Massive obstetric hemorrhage still remains a major cause of maternal mortality and morbidity. The risk factors associated with this pathology must be identified in order to schedule the appropriate delivery with the necessary resources. A case is presented of an iliac artery occlusion with intravascular balloons for suspected placenta accreta during cesarean section. The perioperative treatment, as well as an analysis of the treatment options is described, along with their advantages and disadvantages, from the use of postpartum hemorrhage protocols, blood transfusion and procoagulant factors, and other maneuvers to control bleeding, until the hysterectomy. PMID:23276376

  12. Tirofiban combined with urokinase selective intra-arterial thrombolysis for the treatment of middle cerebral artery occlusion

    PubMed Central

    FENG, LEI; LIU, JUN; LIU, YUNZHEN; CHEN, JIAN; SU, CHUNHAI; LV, CHUANFENG; WEI, YUZHEN

    2016-01-01

    The aims of the present study were to establish a model of embolic stroke in rabbits and to evaluate the efficacy and safety of intra-arterially administered tirofiban combined with urokinase thrombolysis. The middle cerebral artery occlusion model (MCAO) of embolic stroke was established in New Zealand rabbits via an autologous clot. The model rabbits were allocated at random into four groups: Tirofiban group (T group), urokinase group (UK group), tirofiban and urokinase group (T + UK group) and the control group (C group). The recanalization rate, relative-apparent diffusion coefficient (rADC) and neurological function deficit score (NFDS) values were compared among the four groups. The recanalization rate, rADC and NFDS values were improved in the T + UK group compared with the other groups. In summary, the intra-arterial administration of tirofiban combined with urokinase thrombolysis was a more effective intervention in an MCAO model compared with intra-arterial urokinase alone, and may promote reperfusion and reduce infarct volume. PMID:26998029

  13. TRANSITION TO COLLATERAL FLOW AFTER ARTERIAL OCCLUSION PREDISPOSES TO CEREBRAL VENOUS STEAL

    PubMed Central

    Pranevicius, Osvaldas; Pranevicius, Mindaugas; Pranevicius, Henrikas; Liebeskind, David S.

    2011-01-01

    Introduction Stroke related tissue pressure increase in the core (Pcore) and penumbra (Ppen) determines regional cerebral perfusion pressure (rCPP) defined as a difference between local inflow pressure (Pi) and venous (Pv) or tissue pressure, whichever is higher. We previously showed that venous pressure reduction below the Pcore causes blood flow diversion - cerebral venous steal. Now we investigated how transition to collateral circulation after complete arterial occlusion affects rCPP distribution. Methods We modified two parallel Starling resistor model to simulate transition to collateral inflow after complete main stem occlusion. We decreased Pv from the arterial pressure (Pa) to zero, and investigated how arterial and venous pressure elevation augments rCPP. Results When core pressure exceeded venous (Pcore>Pv), rCPP=Pi−Pcore. Venous pressure (Pv) decrease from Pa to Pcore caused smaller Pi to drop augmenting rCPP. Further drop of Pv to Ppen decreased rCPP in the core but augmented rCPP in penumbra. After transition to collateral circulation, lowering Pv below Ppen further decreased rCPP and collaterals themselves became pathway for steal. Venous pressure level at which rCPP in the core becomes zero we termed the “point of no reflow” (PONR). Transition from direct to collateral circulation resulted in decreased Pi, decreased rCPP, and a shift of PONR to higher venous loading values. Arterial pressure augmentation increased rCPP, but only after venous pressure exceeded PONR. Conclusion In the presence of tissue pressure gradients, transition to collateral flow predisposes to venous steal (collateral failure) which may be reversed by venous pressure augmentation. PMID:22246692

  14. Perfusion-Weighted MRI Parameters for Prediction of Early Progressive Infarction in Middle Cerebral Artery Occlusion

    PubMed Central

    Kim, Hoon; Kim, Yerim; Kim, Young Woo; Kim, Seong Rim

    2016-01-01

    Objective Early progressive infarction (EPI) is frequently observed and related to poor functional outcome in patients with middle cerebral artery (MCA) infarction caused by MCA occlusion. We evaluated the perfusion parameters of magnetic resonance imaging (MRI) as a predictor of EPI. Methods We retrospectively analyzed patients with acute MCA territory infarction caused by MCA occlusion. EPI was defined as a National Institutes of Health Stroke Scale increment ≥2 points during 24 hours despite receiving standard treatment. Regional parameter ratios, such as cerebral blood flow and volume (rCBV) ratio (ipsilateral value/contralateral value) on perfusion MRI were analyzed to investigate the association with EPI. Results Sixty-four patients were enrolled in total. EPI was present in 18 (28%) subjects and all EPI occurred within 3 days after hospitalization. Diabetes mellitus, rCBV ratio and regional time to peak (rTTP) ratio showed statically significant differences in both groups. Multi-variate analysis indicated that history of diabetes mellitus [odds ratio (OR), 6.13; 95% confidence interval (CI), 1.55–24.24] and a low rCBV ratio (rCBV, <0.85; OR, 6.57; 95% CI, 1.4–30.27) was significantly correlated with EPI. Conclusion The incidence of EPI is considerable in patients with acute MCA territory infarction caused by MCA occlusion. We suggest that rCBV ratio is a useful neuro-imaging parameter to predict EPI. PMID:27446514

  15. Cerebral autoregulation and brain networks in occlusive processes of the internal carotid artery

    PubMed Central

    Avirame, Keren; Lesemann, Anne; List, Jonathan; Witte, Anja Veronica; Schreiber, Stephan Joachim; Flöel, Agnes

    2015-01-01

    Patients with unilateral occlusive processes of the internal carotid artery (ICA) show subtle cognitive deficits. Decline in cerebral autoregulation and in functional and structural integrity of brain networks have previously been reported in the affected hemisphere (AH). However, the association between cerebral autoregulation, brain networks, and cognition remains to be elucidated. Fourteen neurologically asymptomatic patients (65±11 years) with either ICA occlusion or high-grade ICA stenosis and 11 age-matched healthy controls (HC) (67±6 years) received neuropsychologic testing, transcranial Doppler sonography to assess cerebral autoregulation using vasomotor reactivity (VMR), and magnetic resonance imaging to probe white matter microstructure and resting-state functional connectivity (RSFC). Patients performed worse on memory and executive tasks when compared with controls. Vasomotor reactivity, white matter microstructure, and RSFC were lower in the AH of the patients when compared with the unaffected hemisphere and with controls. Lower VMR of the AH was associated with several ipsilateral clusters of lower white matter microstructure and lower bilateral RSFC in patients. No correlations were found between VMR and cognitive scores. In sum, impaired cerebral autoregulation was associated with reduced structural and functional connectivity in cerebral networks, indicating possible mechanisms by which severe unilateral occlusive processes of the ICA lead to cognitive decline. PMID:25388676

  16. The Benefits of Internal Thoracic Artery Catheterization in Patients With Chronic Abdominal Aortic Occlusion

    SciTech Connect

    Ilic, Nikola Davidovic, Lazar; Koncar, Igor; Dragas, Marko; Markovic, Miroslav; Colic, Momcilo; Cinara, Ilijas

    2011-04-15

    Occlusion of the abdominal aorta may be caused by an embolic lesion, but more commonly by thrombotic disease at the aortoiliac area, progressing retrograde. However, the visualization of the distal run-off via internal thoracic-epigastric inferior artery collateral channel may be a very important diagnostic tool, especially in countries with poor technical equipment. This study was designed to show the benefit of the selective internal thoracic angiography in cases with complete aortic occlusion. We present 30 patients with chronic aortic abdominal occlusion who were submitted to the transaxillary aortography and selective ITA angiography with purpose of distal run off evaluation. Angiographic evaluation was performed by two independent radiologists according to previously defined classification. Good angiographic score via internal thoracic angiography by first observer was achieved in 19 (63.3%) patients and in 18 (60%) by a second observer. Transaxillary aortography showed inferior results: good angiographic score by the first observer in six (20%) patients and by the second observer in three (3%) patients. Low extremity run-off is better visualized during internal thoracic angiography than during transaxillary aortography.

  17. Percutaneous transluminal laser guide wire recanalization of chronic subclavian artery occlusion in symptomatic coronary-subclavian steal syndrome.

    PubMed

    Eggebrecht, H; Naber, C K; Oldenburg, O; Herrmann, J; Haude, M; Erbel, R; Baumgart, D

    2000-12-01

    Treatment of subclavian artery stenosis by percutaneous balloon angioplasty and adjunctive stent placement was shown to be safe and efficacious, but it may be limited in tight stenoses and long occlusions. We describe the case of a patient who experienced progressive angina pectoris associated with signs of cerebrovertebral insufficiency 9 yr after bypass surgery, including left internal mammary artery (LIMA) grafting to the left anterior descending coronary artery. Angiography showed reversed flow through the LIMA graft into the subclavian artery and a 4-cm occlusion beginning at the origin of the left subclavian artery, representing a rare coronary-subclavian steal syndrome. After a conventional approach failed, recanalization was performed successfully using laser guide wire angioplasty with adjunctive stent placement in a combined radial and femoral approach. PMID:11108691

  18. Balloon-Assisted Occlusion of the Internal Iliac Arteries in Patients with Placenta Accreta/Percreta

    SciTech Connect

    Bodner, Leonard J.; Nosher, John L. Gribbin, Christopher; Siegel, Randall L.; Beale, Stephanie; Scorza, William

    2006-06-15

    Background. Placenta accreta/percreta is a leading cause of third trimester hemorrhage and postpartum maternal death. The current treatment for third trimester hemorrhage due to placenta accreta/percreta is cesarean hysterectomy, which may be complicated by large volume blood loss. Purpose. To determine what role, if any, prophylactic temporary balloon occlusion and transcatheter embolization of the anterior division of the internal iliac arteries plays in the management of patients with placenta accreta/percreta. Methods. The records of 28 consecutive patients with a diagnosis of placenta accreta/percreta were retrospectively reviewed. Patients were divided into two groups. Six patients underwent prophylactic temporary balloon occlusion, followed by cesarean section, transcatheter embolization of the anterior division of the internal iliac arteries and cesarean hysterectomy (n = 5) or uterine curettage (n = 1). Twenty-two patients underwent cesarean hysterectomy without endovascular intervention. The following parameters were compared in the two groups: patient age, gravidity, parity, gestational age at delivery, days in the intensive care unit after delivery, total hospital days, volume of transfused blood products, volume of fluid replacement intraoperatively, operating room time, estimated blood loss, and postoperative morbidity and mortality. Results. Patients in the embolization group had more frequent episodes of third trimester bleeding requiring admission and bedrest prior to delivery (16.7 days vs. 2.9 days), resulting in significantly more hospitalization time in the embolization group (23 days vs. 8.8 days) and delivery at an earlier gestational age than in those in the surgical group (32.5 weeks). There was no statistical difference in mean estimated blood loss, volume of replaced blood products, fluid replacement needs, operating room time or postoperative recovery time. Conclusion. Our findings do not support the contention that in patients with

  19. Retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes

    PubMed Central

    Kurtz, Will S; Glueck, Charles J; Hutchins, Robert K; Sisk, Robert A; Wang, Ping

    2016-01-01

    Background Ocular vascular occlusion (OVO), first diagnosed during or immediately after giving birth, often reflects superposition of the physiologic thrombophilia of pregnancy on previously undiagnosed underlying familial or acquired thrombophilia associated with spontaneous abortion, eclampsia, or maternal thrombosis. Specific aim We describe OVO, first diagnosed during pregnancy or immediately postpartum, in three young females (ages 32, 35, 40) associated with previously undiagnosed familial thrombophilia. Results Branch retinal artery occlusion (BRAO) occurred at 9 and 13 weeks gestation in two females, aged 32 and 35. Central retinal vein occlusion occurred immediately postpartum in a 40-year-old. One of the two females with BRAO subsequently developed eclampsia, and one had a history of unexplained first trimester spontaneous abortion. All three females were found to have previously unexplained familial thrombophilia. The two females with BRAO had low first trimester free protein S 42 (41%), lower normal limit (50%), and one of these two had high factor VIII (165%, upper normal limit 150%). The woman with central retinal vein occlusion had high factor XI (169%, upper normal limit 150%). Enoxaparin (40–60 mg/day) was started and continued throughout pregnancy in both females with BRAO to prevent maternal–placental thrombosis, and of these two females, one had an uncomplicated pregnancy course and term delivery, and the second was at gestational week 22 without complications at the time of this manuscript. There were no further OVO events in the two females treated with enoxaparin or in the untreated patient with postpartum eclampsia. Conclusion OVO during pregnancy may be a marker for familial or acquired thrombophilia, which confers increased thrombotic risk to the mother and pregnancy, associated with spontaneous abortion or eclampsia. OVO during pregnancy, particularly when coupled with antecedent adverse pregnancy outcomes, should prompt urgent

  20. Strophanthus hispidus attenuates the Ischemia-Reperfusion induced myocardial Infarction and reduces mean arterial pressure in renal artery occlusion

    PubMed Central

    Gundamaraju, Rohit; Vemuri, Ravi Chandra; Singla, Rajeev K; Manikam, Rishya; Rao, A Ranga; Sekaran, Shamala Devi

    2014-01-01

    Background: The myocardium is generally injured in the case of reperfusion injury and arterial damage is caused by hypertension. In reference to these statements, the present study was focused. Cardiac glycosides were said to have protective effects against myocardial infarction and hypertension. Strophanthus hispidus was thus incorporated in the study. Objective: The prime objective of the study was to investigate the protective effects of Strophanthus hispidus against ischemia-reperfusion myocardial Infarction and renal artery occluded hypertension in rats. Materials and Methods: The animal model adopted was surgically-induced myocardial ischemia, performed by means of left anterior descending coronary artery occlusion (LAD) for 30 min followed by reperfusion for another 4 h. Infarct size was assessed by using the staining agent TTC (2,3,5-triphenyl tetrazolium chloride). Hypertension was induced by clamping the renal artery with renal bulldog clamp for 4 h. Results: The study was fruitful by the effect of Strophanthus hispidus on infarction size, which got reduced to 27.2 ± 0.5and 20.0 ± 0.2 by 500 mg/Kg and 1000 mg/Kg ethanolic extracts which was remarkably significant when compared with that of the control group 52.8 ± 4.6. The plant extract did reduce heart rate at various time intervals. There was also a protective effect in the case of mean arterial blood pressure were the 500 mg/Kg and 1000 mg/Kg of the plant extract did reduce the hypertension after 60 minutes was 60.0 ± 4.80 and 50.50 ± 6.80. Conclusion: The results suggest that 500 mg/Kg and 100 mg/Kg ethanolic extract of Strophanthus hispidus was found to possess significant cardiac protective and anti-hypertensive activity. PMID:25298674

  1. Endovascular Treatment of In-Stent Occlusion: New Technique for Recanalization of Long Superficial Femoral Artery Occlusion (Direct Stent Puncture Technique)

    SciTech Connect

    Palena, Luis Mariano Cester, Giacomo; Manzi, Marco

    2012-04-15

    In-stent reocclusion is a frequent complication of endovascular treatment and stenting, especially in the superficial femoral artery. Neointimal hyperplasia is the main cause of this problem, but in many cases, it occurs as a result of the presence of stent strut fractures. The two treatment options are endovascular and surgical intervention. The effectiveness of endovascular interventions in patients with critical limb ischemia has been well established, but in some cases, crossing the occluded stent is difficult. We describe a new technique to recanalize long in-stent superficial femoral artery occlusions characterized by direct stent puncture, followed by retrograde-antegrade recanalization after antegrade failures.

  2. Ulnar Artery Compression: A Feasible and Effective Approach to Prevent the Radial Artery Occlusion after Coronary Intervention

    PubMed Central

    Tian, Jun; Chu, Yu-Shun; Sun, Jing; Jiang, Tie-Min

    2015-01-01

    Background: Radial artery (RA) occlusion (RAO) is not rare in patients undergoing coronary intervention by transradial approach (TRCI). Predictors of and prevention from RAO have not been systematically studied. This study aimed to analyze the risk factors of the weakness of RA pulsation (RAP) and its predictive value for RAO after TRCI, and simultaneously to describe a feasible and effective approach to maintain RA patency. Methods: Between June 2006 and March 2010, all patients who underwent TRCI were classified according to the weakness of RAP after removing compression bandage with confirmation by Doppler ultrasound for the first 30 consecutive patients. Among a total of 2658 patients studied, 187 (7%) patients having a weaker RAP were prospectively monitored. At 1 h after bandage removal, the ulnar artery in puncture side of all patients was blocked with manual compression to favor brachial and collateral artery blood flow through the RA until a good RAP was restored. The primary analysis was the occurrence of RAO. Results: Doppler ultrasound demonstrated the significant reduction of both systolic velocity (61.24 ± 3.95 cm/s vs. 72.31 ± 3.57 cm/s) and diastolic velocity (1.83 ± 0.32 cm/s vs. 17.77 ± 3.97 cm/s) in RA at access side as compared to the contralateral RA (all P < 0.001), but these velocities in ipsilateral ulnar artery (81.2 ± 2.16 cm/s and 13.1 ± 2.86 cm/s, respectively) increased profoundly. The average time of ulnar artery compression was 4.1 ± 1.2 h (ranged 2.5–6.5 h). There were two patients experienced persistent RAO with a success rate of 98.9% and RAO in 0.075% of patients after ulnar artery compression was applied. The pulsation of the ulnar artery after compression was removed had not been influenced by the compression. Conclusions: After intervention using TRCI approach, the presence of a weaker RAP is an indicator of imminent RAO. The continuing compression of ipsilateral ulnar artery is an effective approach to maintain RA

  3. Percutaneous Thrombin Injection of a Femoral Artery Pseudoaneurysm with Simultaneous Venous Balloon Occlusion of a Communicating Arteriovenous Fistula

    SciTech Connect

    Mittleider, Derek Cicuto, Kenneth; Dykes, Thomas

    2008-07-15

    An 82-year-old woman developed acute occlusion of her right coronary artery. She underwent percutaneous coronary stent placement and aortic balloon pump installation. In the postprocedural period, she developed a common femoral artery pseudoaneurysm (PSA) that communicated with the common femoral vein via an arteriovenous fistula (AVF). After unsuccessful ultrasound-guided compression, ultrasound-guided thrombin injection of the PSA was performed, with simultaneous balloon occlusion of the common femoral vein at the level of the AVF. There was complete thrombosis of the PSA and AVF.

  4. Acute three-vessel cervical arterial occlusion due to spontaneous quadruple cervical artery dissection

    PubMed Central

    Aronov, Moisey; Shevchenko, Natalia S; Amosova, Natalia A; Kotenko, Konstantin V

    2014-01-01

    Cervical artery dissection (CAD) is one of the most frequent causes (14.5%) of stroke in young adults. Cases with involvement of more than two arteries are rare. Arnold et al described 11 cases (1.5%) with triple CAD of a reported 740 patients and just a single (0.1%) quadruple case in the same population. Simultaneous dissection of the four principal vessels is extremely rare. According to Papagiannaki et al, the incidence of simultaneous three or four CADs is 1–3/million in the general population. To the best of our knowledge, there are only three published cases of spontaneous quadruple CAD. PMID:24957585

  5. Dichloroacetate attenuates myocardial acidosis and metabolic changes induced by partial occlusion of the coronary artery in dogs.

    PubMed

    Sakai, K; Ichihara, K; Nasa, Y; Kamigaki, M; Abiko, Y

    1990-01-01

    The present study was undertaken to examine whether dichloroacetate, which inhibits pyruvate dehydrogenase kinase and, therefore, increases the activity of pyruvate dehydrogenase, attenuates myocardial acidosis and metabolic changes induced by coronary occlusion. In dogs anesthetized with pentobarbital, the left anterior descending coronary artery was incompletely occluded to reduce the left anterior descending flow to a half to one third of the original flow (partial occlusion) to produce myocardial (regional) ischemia. Partial occlusion was continued for 90 min, and a bolus injection of saline or dichloroacetate was made intravenously 30 min after the onset of occlusion. Partial occlusion decreased myocardial pH significantly. An injection of dichloroacetate (150 mg/kg) increased myocardial pH that had been lowered by partial occlusion. Myocardial metabolites were measured in other dogs. Partial occlusion decreased the myocardial levels of adenosine triphosphate, creatine phosphate and energy charge potential, and increased that of lactate significantly, without affecting the myocardial levels of pyruvate and nonesterified fatty acids. Dichloroacetate attenuated the ischemia-induced changes in the myocardial levels of adenosine triphosphate, creatine phosphate, energy charge potential and lactate. These results indicate that dichloroacetate attenuates the myocardial acidosis and metabolic changes during coronary partial occlusion. PMID:2095718

  6. Bilateral internal carotid artery and vertebral artery dissections with retinal artery occlusion after a roller coaster ride - case report and a review.

    PubMed

    Ozkan Arat, Yonca; Volpi, John; Arat, Anıl; Klucznik, Richard; Diaz, Orlando

    2011-01-01

    We present the first case of a woman with no significant medical history who developed dissections of bilateral carotid and bilateral vertebral arteries, as well as a retinal artery occlusion, after a roller coaster ride. A 35-year-old woman developed right-sided neck pain followed by a frontal headache immediately after a roller coaster ride. Five days after the incident, she developed complete loss of vision in her right eye for two hours. Subsequently, the vision improved but remained significantly decreased. On presentation, her visual acuity was 20/200 in the right and 20/20 in the left eye. Her fundus exam revealed retinal edema in the superotemporal retinal artery distribution without any visible emboli. Her neurological exam was otherwise normal. The cerebral angiogram showed bilateral internal carotid and vertebral artery dissections. The patient remained stable with conservative therapy without further worsening of vision or any new neurological deficits. Outcomes for cervicocephalic arterial dissection are usually favorable, but early diagnosis is critical for initiation of appropriate treatment of possible complications. Physicians must have a high index of suspicion for arterial dissection when patients note any headache, neck pain or vertigo triggered by violent motion after leisure activities such as roller coaster rides. PMID:21341139

  7. Conus artery occlusion causing isolated right ventricular outflow tract infarction: novel application of cardiac magnetic resonance in anterior STEMI

    PubMed Central

    Lyle, Melissa; Tweet, Marysia; Young, Phillip M.; Best, Patricia J. M.

    2016-01-01

    Acute ST elevation in the anterior precordial leads typically suggests an anteroseptal infarction due to left anterior descending coronary artery obstruction, but the differential can be broad. Conus branch artery occlusion is a potentially overlooked cause of anteroseptal ST elevation myocardial infraction. Cardiac magnetic resonance (CMR) imaging is an emerging technology which can differentiate the etiology of anterior ST elevation in patients with no apparent coronary abnormalities on coronary angiography and normal echocardiography. PMID:27280090

  8. Early retinal inflammatory biomarkers in the middle cerebral artery occlusion model of ischemic stroke

    PubMed Central

    Ritzel, Rodney M.; Pan, Sarah J.; Verma, Rajkumar; Wizeman, John; Crapser, Joshua; Patel, Anita R.; Lieberman, Richard; Mohan, Royce

    2016-01-01

    Purpose The transient middle cerebral artery occlusion (MCAO) model of stroke is one of the most commonly used models to study focal cerebral ischemia. This procedure also results in the simultaneous occlusion of the ophthalmic artery that supplies the retina. Retinal cell death is seen days after reperfusion and leads to functional deficits; however, the mechanism responsible for this injury has not been investigated. Given that the eye may have a unique ocular immune response to an ischemic challenge, this study examined the inflammatory response to retinal ischemia in the MCAO model. Methods Young male C57B/6 mice were subjected to 90-min transient MCAO and were euthanized at several time points up to 7 days. Transcription of inflammatory cytokines was measured with quantitative real-time PCR, and immune cell activation (e.g., phagocytosis) and migration were assessed with ophthalmoscopy and flow cytometry. Results Observation of the affected eye revealed symptoms consistent with Horner’s syndrome. Light ophthalmoscopy confirmed the reduced blood flow of the retinal arteries during occlusion. CX3CR1-GFP reporter mice were then employed to evaluate the extent of the ocular microglia and monocyte activation. A significant increase in green fluorescent protein (GFP)-positive macrophages was seen throughout the ischemic area compared to the sham and contralateral control eyes. RT–PCR revealed enhanced expression of the monocyte chemotactic molecule CCL2 early after reperfusion followed by a delayed increase in the proinflammatory cytokine TNF-α. Further analysis of peripheral leukocyte recruitment by flow cytometry determined that monocytes and neutrophils were the predominant immune cells to infiltrate at 72 h. A transient reduction in retinal microglia numbers was also observed, demonstrating the ischemic sensitivity of these cells. Blood–eye barrier permeability to small and large tracer molecules was increased by 72 h. Retinal microglia exhibited enhanced

  9. Estrogen synthesis in the central nucleus of the amygdala following middle cerebral artery occlusion: role in modulating neurotransmission.

    PubMed

    Saleh, T M; Connell, B J; Legge, C; Cribb, A E

    2005-01-01

    Stroke-induced lesions of the insular cortex in the brain have been linked to autonomic dysfunction (sympathoexcitation) leading to arrhythmogenesis and sudden cardiac death. In experimental models, systemic estrogen administration in male rats has been shown to reduce stroke-induced cell death in the insular cortex as well as prevent sympathoexcitation. The central nucleus of the amygdala has been postulated to mediate sympathoexcitatory output from the insular cortex. We therefore set out to determine if endogenous estrogen levels within the central nucleus of the amygdala are altered following stroke and if microinjection of estrogen into the central nucleus of the amygdala modulates autonomic tone. Plasma estrogen concentrations were not altered by middle cerebral artery occlusion (22.86+/-0.14 pg/ml vs. 21.24+/-0.33 pg/ml; P>0.05). In contrast, estrogen concentrations in the central nucleus of the amygdala increased significantly following middle cerebral artery occlusion (from 20.83+/-0.54 pg/ml to 76.67+/-1.59 pg/ml; P<0.05). Local infusion of an aromatase inhibitor, letrozole, into the central nucleus of the amygdala at the time of middle cerebral artery occlusion prevented the increase in estrogen concentration suggesting that this increase was dependent on aromatization from testosterone. Furthermore, bilateral microinjection of estrogen (0.5 microM in 200 nl) directly into the central nucleus of the amygdala significantly decreased arterial pressure and sympathetic tone and increased baroreflex sensitivity, and these effects were enhanced following co-injection with either an N-methyl-D-aspartate or non-N-methyl-D-aspartate receptor antagonist. Taken together, the results suggest that middle cerebral artery occlusion resulted in synthesis of estrogen within the central nucleus of the amygdala and that this enhanced estrogen level may act to attenuate overstimulation of central nucleus of the amygdala neurons to prevent middle cerebral artery occlusion

  10. Ventricular tachycardic storm with a chronic total coronary artery occlusion treated with percutaneous coronary intervention

    PubMed Central

    2015-01-01

    A 66-year-old man with a history of coronary artery disease was evaluated due to ventricular tachycardic (VT) storm. The patient continued to have frequent recurrences of VT despite treatment with amiodarone and lidocaine. Since the ventricular arrhythmia could be related to myocardial ischemia related to a chronic total occlusion (CTO) of the right coronary artery, the patient underwent successful percutaneous coronary intervention of the CTO, followed by implantable cardioverter defibrillator implantation. He had no further episodes of VT during his hospital stay. After 9 months of follow-up, he had no further chest pain or clinically apparent recurrent ischemia. Interrogation of his defibrillator has shown brief nonsustained episodes of ventricular tachycardia, but the patient has not required delivery of a shock. The temporal association between treatment of the CTO and resolution of the VT, as well as the lack of recurrence of sustained VT, suggest a causative link between underlying ischemia produced by a chronically occluded coronary artery and provocation of VT and lend supportive evidence to this treatment approach. PMID:25829653

  11. Transfundal Uterine Incision Performed with Prophylactic Common Iliac Artery Balloon Occlusion for Patient with Placenta Previa Totalis

    PubMed Central

    Nishida, Yoshihiro; Hirakawa, Tomoko; Utsunomiya, Yufuko; Tsusue, Hatsumi; Narahara, Hisashi

    2012-01-01

    A 37-year-old primigravida at 35 weeks of gestation presented with known anterior wall dominant placenta previa totalis and suspected placenta accreta was successfully treated with transfundal uterine (transverse) incision performed with prophylactic common iliac artery balloon occlusion. This new surgical approach could be an alternative procedure for avoiding excessive blood loss during caesarean delivery. PMID:22844198

  12. Endovascular management of porto-mesenteric venous thrombosis developing after trans-arterial occlusion of a superior mesenteric arteriovenous fistula.

    PubMed

    Garg, Deepak; Lopera, Jorge Enrique; Goei, Anthony D

    2013-09-01

    Porto-mesenteric venous thrombosis following a trans-arterial occlusion of a superior mesenteric arteriovenous fistula is a rare occurrence. We present a case of endovascular management of one such case treated pharmacomechanically with catheter-directed mesenteric thrombolysis and transjugular intrahepatic portosystemic shunt creation without long-term successful outcome. PMID:23475546

  13. Plasma homoarginine, arginine, asymmetric dimethylarginine and total homocysteine interrelationships in rheumatoid arthritis, coronary artery disease and peripheral artery occlusion disease.

    PubMed

    Kayacelebi, Arslan Arinc; Willers, Janina; Pham, Vu Vi; Hahn, Andreas; Schneider, Jessica Y; Rothmann, Sabine; Frölich, Jürgen C; Tsikas, Dimitrios

    2015-09-01

    Elevated circulating concentrations of total L-homocysteine (thCys) and free asymmetric dimethylarginine (ADMA) are long-established cardiovascular risk factors. Low circulating L-homoarginine (hArg) concentrations were recently found to be associated with increased cardiovascular morbidity and mortality. The biochemical pathways of these amino acids overlap and share the same cofactor S-adenosylmethionine (SAM). In the present study, we investigated potential associations between hArg, L-arginine (Arg), ADMA and thCys in plasma of patients suffering from rheumatoid arthritis (RA), coronary artery disease (CAD) or peripheral artery occlusive disease (PAOD). In RA, we did not find any correlation between ADMA or hArg and thCys at baseline (n = 100) and after (n = 83) combined add-on supplementation of omega-3 fatty acids, vitamin E, vitamin A, copper, and selenium, or placebo (soy oil). ADMA correlated with Arg at baseline (r = 0.446, P < 0.001) and after treatment (r = 0.246, P = 0.03). hArg did not correlate with ADMA, but correlated with Arg before (r = 0.240, P = 0.02) and after treatment (r = 0.233, P = 0.03). These results suggest that hArg, ADMA and Arg are biochemically familiar with each other, but unrelated to hCys in RA. In PAOD and CAD, ADMA and thCys did not correlate. PMID:25618752

  14. Atrial Fibrillation and Coronary Artery Disease as Risk Factors of Retinal Artery Occlusion: A Nationwide Population-Based Study

    PubMed Central

    Yen, Ju-Chuan; Lin, Hsiu-Li; Hsu, Chia-An; Li, Yu-Chuan (Jack); Hsu, Min-Huei

    2015-01-01

    We use Taiwanese national health insurance research database (NHIRD) to investigate whether thrombolism (carotid artery disease (CAD) as a surrogate) or embolism (atrial fibrillation (AF) as a surrogate) plays roles in later retinal artery occlusion (RAO) development and examine their relative weights. The relative risks of RAO between AF and CAD patients and controls were compared by estimating the crude hazard ratio with logistic regression. Kaplan-Meier analysis was used to calculate the cumulative incidence rates of developing RAO, and a log-rank test was used to analyze the differences between the survival curves. Separate Cox proportional hazard regressions were done to compute the RAO-free rate after adjusting for possible confounding factors such as age and sex. The crude hazard ratios were 7.98 for the AF group and 5.27 for the CAD group, and the adjusted hazard ratios were 8.32 and 5.34 for the AF and CAD groups, respectively. The observation time with RAO-free was shorter for AF compared with CAD group (1490 versus 1819 days). AF and CAD were both risk factors for RAO with different hazard ratios. To tackle both AF and CAD is crucial for curbing RAO. PMID:26558268

  15. Central retinal artery occlusion following orbital tumor resection: Is rapid intervention effective?

    PubMed

    Rajabi, Mohammad Taher; Naderan, Mohammad; Mohammadi, Seyed Ziaeddin Tabatabaei; Rajabi, Mohammad Bagher

    2015-08-01

    A 52-year-old male patient presented at our hospital with unilateral proptosis and vision loss in his left eye. Imaging evaluations showed orbital tumor, so the patient underwent surgery. About an hour later after tumor removal, patient developed sudden vision loss and became no light perception. Fundus evaluation revealed central retinal artery occlusion (CRAO). The patient was treated immediately with ocular massage and anterior chamber paracentesis as well as systemic therapy with mannitol and intravenous administration of acetazolamide. After thirty minutes, he recovered perception to light and then hand motion and 2 h later, it was improved to 1 m counting finger. CRAO following orbital tumor has not been reported before. We recommend ocular examination in all patients that undergo orbital surgery immediately to 2-3 h after surgery. PMID:26576528

  16. Scuba diving, acute left anterior descending artery occlusion and normal ECG

    PubMed Central

    Doll, Sébastien Xavier; Rigamonti, Fabio; Roffi, Marco; Noble, Stéphane

    2013-01-01

    We report the case of an acute proximal occlusion of the left anterior descending coronary (LAD) artery following a scuba diving decompression accident and associated with normal ECG. Following uneventful thromboaspiration and coronary stenting, the patient was discharged on day  4 with secondary preventative therapies. A transthoracic echocardiography performed at this point showed a complete recovery compared with an initial localised akinesia involving the anterior and apical portion of the left ventricle upon admission. This case highlights that significant acute coronary lesions involving the LAD can occur without any ECG anomaly. The presence of acute and persistent angina associated with troponin elevation should prompt physicians to consider coronary angiography without delay, independently of the ECG results. PMID:23376677

  17. Intraoperative laser speckle contrast imaging improves the stability of rodent middle cerebral artery occlusion model

    NASA Astrophysics Data System (ADS)

    Yuan, Lu; Li, Yao; Li, Hangdao; Lu, Hongyang; Tong, Shanbao

    2015-09-01

    Rodent middle cerebral artery occlusion (MCAO) model is commonly used in stroke research. Creating a stable infarct volume has always been challenging for technicians due to the variances of animal anatomy and surgical operations. The depth of filament suture advancement strongly influences the infarct volume as well. We investigated the cerebral blood flow (CBF) changes in the affected cortex using laser speckle contrast imaging when advancing suture during MCAO surgery. The relative CBF drop area (CBF50, i.e., the percentage area with CBF less than 50% of the baseline) showed an increase from 20.9% to 69.1% when the insertion depth increased from 1.6 to 1.8 cm. Using the real-time CBF50 marker to guide suture insertion during the surgery, our animal experiments showed that intraoperative CBF-guided surgery could significantly improve the stability of MCAO with a more consistent infarct volume and less mortality.

  18. Intraoperative bleeding control during cesarean delivery of complete placenta previa with transient occlusion of uterine arteries

    PubMed Central

    Kim, Ju Hyun; Joung, Eun-Ju; Lee, Soo-Jung; Kwack, Jae Young

    2015-01-01

    There are few methods to control heavy intra-operative bleeding during cesarean delivery of placenta previa. Transient occlusion of uterine arteries (TOUA) during operation has previously been reported as a quick and safe method to control intra-operative uterine bleeding. We reported 2 cases of cesarean delivery with complete placenta previa in which TOUA was performed to safely reduce intra-operative complication, especially heavy intra-operative bleeding. In the 2 cases, cesarean deliveries were safe and without any complications under the TOUA method. TOUA can be a good method to control heavy intra-operative bleeding during cesarean delivery of complete placenta previa with risk of heavy bleeding. PMID:26623419

  19. Estimating the Radiation Dose to the Fetus in Prophylactic Internal Iliac Artery Balloon Occlusion: Three Cases

    PubMed Central

    Kai, Kentaro; Hamada, Tomohiro; Yuge, Akitoshi; Kiyosue, Hiro; Nishida, Yoshihiro; Nasu, Kaei; Narahara, Hisashi

    2015-01-01

    Background. Although radiation exposure is of great concern to expecting patients, little information is available on the fetal radiation dose associated with prophylactic internal iliac artery balloon occlusion (IIABO). Here we estimated the fetal radiation dose associated with prophylactic IIABO in Caesarean section (CS). Cases. We report our experience with the IIABO procedure in three consecutive patients with suspected placenta previa/accreta. Fetal radiation dose measurements were conducted prior to each CS by using an anthropomorphic phantom. Based on the simulated value, we calculated the fetal radiation dose as the absorbed dose. We found that the fetal radiation doses ranged from 12.88 to 31.6 mGy. The fetal radiation dose during the prophylactic IIABOs did not exceed 50 mGy. Conclusion. The IIABO procedure could result in a very small increase in the risk of harmful effects to the fetus. PMID:26180648

  20. Systemic Hypoxia and the Depression of Synaptic Transmission in Rat Hippocampus after Carotid Artery Occlusion

    PubMed Central

    Fowler, J C; Gervitz, L M; Hamilton, M E; Walker, J A

    2003-01-01

    The relationship between step reductions in inspired oxygen and the amplitude of evoked field excitatory postsynaptic potentials (fEPSPs) recorded from hippocampal CA1 neurons was examined in anaesthetized rats with a unilateral common carotid artery occlusion. The amplitudes of fEPSPs recorded from the hippocampus ipsilateral to the occlusion were significantly more depressed with hypoxia than were the fEPSPs recorded from the contralateral hippocampus. The adenosine A1-selective antagonist, 8-cyclopentyl-1,3-dimethylxanthine (8-CPT), blunted the hypoxic depression of the fEPSP. Tissue partial pressure of oxygen (Ptiss,O2) was measured in the ipsilateral and contralateral hippocampus using glass Clark-style microelectrodes. Ptiss,O2 fell to similar levels as a function of inspired oxygen in the ipsilateral and contralateral hippocampus, and in the ipsilateral hippocampus after administration of 8-CPT. Hippocampal blood flow (HBF) was measured using laser Doppler flowmetry. A decline in HBF was associated with systemic hypoxia in both hippocampi. HBF, as a function of inspired oxygen, fell significantly more in the ipsilateral than in the contralateral hippocampus. We conclude that endogenous adenosine acting at the neuronal A1 receptor plays a major role in the depression of synaptic transmission during hypoxic ischaemia. The greater susceptibility of the fEPSP in the ipsilateral hippocampus to systemic hypoxia cannot be explained entirely by differences in Ptiss,O2 or HBF between the two hemispheres. PMID:12807994

  1. Screen-imaging guidance using a modified portable video macroscope for middle cerebral artery occlusion.

    PubMed

    Zhu, Xingbao; Luo, Junli; Liu, Yun; Chen, Guolong; Liu, Song; Ruan, Qiangjin; Deng, Xunding; Wang, Dianchun; Fan, Quanshui; Pan, Xinghua

    2012-04-25

    The use of operating microscopes is limited by the focal length. Surgeons using these instruments cannot simultaneously view and access the surgical field and must choose one or the other. The longer focal length (more than 1 000 mm) of an operating telescope permits a position away from the operating field, above the surgeon and out of the field of view. This gives the telescope an advantage over an operating microscope. We developed a telescopic system using screen-imaging guidance and a modified portable video macroscope constructed from a Computar MLH-10 × macro lens, a DFK-21AU04 USB CCD Camera and a Dell laptop computer as monitor screen. This system was used to establish a middle cerebral artery occlusion model in rats. Results showed that magnification of the modified portable video macroscope was appropriate (5-20 ×) even though the Computar MLH-10 × macro lens was placed 800 mm away from the operating field rather than at the specified working distance of 152.4 mm with a zoom of 1-40 ×. The screen-imaging telescopic technique was clear, life-like, stereoscopic and matched the actual operation. Screen-imaging guidance led to an accurate, smooth, minimally invasive and comparatively easy surgical procedure. Success rate of the model establishment evaluated by neurological function using the modified neurological score system was 74.07%. There was no significant difference in model establishment time, sensorimotor deficit and infarct volume percentage. Our findings indicate that the telescopic lens is effective in the screen surgical operation mode referred to as "long distance observation and short distance operation" and that screen-imaging guidance using an modified portable video macroscope can be utilized for the establishment of a middle cerebral artery occlusion model and micro-neurosurgery. PMID:25722675

  2. Self expandable stent application to prevent limb occlusion in external iliac artery during endovascular aneurysm repair

    PubMed Central

    Lee, Jae Hoon

    2016-01-01

    Purpose Iliac extension of stent-graft during endovascular aneurysm repair (EVAR) increases the incidence of limb occlusion (LO). Hypothetically, adjunctive iliac stent (AIS) could offer some additional protection to overcome this anatomic hostility. But still there is no consensus in terms of effective stent characteristics or configuration. We retrospectively reviewed our center's experience to offer a possible answer to this question. Methods Our study included 30 patients (38 limbs) with AIS placed in the external iliac artery (EIA) from January 2010 to December 2013. We classified iliac tortuosity based on anatomic characteristics. AIS's were deployed in EIA with a minimum 5-mm stick-out configuration from the distal edge of the stent-graft. Results According to the iliac artery tortuosity index, grade 0, grade 1, and grade 2 were 5 (13.2%), 30 (78.9%), and 3 (7.9%), respectively. The diameter of all AIS was 12 mm, which was as large as or larger than the diameter of the stent-graft distal limb. SMART stents were preferred in 34 limbs (89.5%) and stents with 60-mm length were usually used (89.5%). During a mean follow-up of 9.13 ± 10.78 months, ischemic limb pain, which could be the sign of LO, was not noticed in any patients. There was no fracture, kinking, migration, in-stent restenosis, or occlusion of AIS. Conclusion The installation of AIS after extension of stent-graft to EIA reduced the risk of LO without any complications. AIS should be considered as a preventive procedure of LO if stent-graft needs to be extended to EIA during EVAR. PMID:27617255

  3. Posterior epistaxis: endonasal exposure and occlusion of the branches of the sphenopalatine artery.

    PubMed

    Holzmann, David; Kaufmann, Thomas; Pedrini, Paula; Valavanis, Anton

    2003-09-01

    Intractable posterior epistaxis (PE) is a frequent emergency for which different treatment modalities are available. While nasal packing causes extreme discomfort and angiography with consecutive selective embolization is not available everywhere, recent studies emphasize the value of sphenopalatine artery (SPA) occlusion by different techniques and indicate success rates of 13-33%. In our institution, previously endoscopic management of PE consisted either of isolated coagulation of an identified bleeding source (group A) or cutting and coagulation of arterial branches running through the sphenopalatine foramen (SPF) (group B). According to our neuroradiological and rhinological experience we developed a modification of SPA transsection and coagulation following identification of the division in conchal and septal branches of the SPA (group C). During a 26-month period the success rates of these three techniques in 95 patients were compared prospectively. The three modalities revealed a re-bleeding rate of 3 out of 21 (21%) in group A, 1 in 6 (16.7%) in group B and 3 in 69 (4.3%) in group C. At the level of the SPF, 36 out of 69 patients had one conchal branch, whereas 30 (43.5%) had two and 3 (4.4%) had three. If SPA transsection and coagulation for intractable PE is adopted the anatomic varieties of the SPA with its division in conchal and septal branches have to be taken into account. According to our experience the septal branch of the SPA plays a major role in PE. Its occlusion significantly improves the success rate of PE treatment. PMID:12720007

  4. Innominate vein repair after iatrogenic perforation with central venous catheter via mini-sternotomy—Case report

    PubMed Central

    Siordia, Juan A.; Ayers, Georganne R.; Garlish, Amanda; Subramanian, Sreekumar

    2015-01-01

    Introduction Iatrogenic damage of the innominate vein is a possible complication with extracorporeal central venous line catheter insertion techniques. When perforation occurs, the catheter is left in place and surgery is required for careful removal and repair of other possible complications, including hemothorax and cardiac tamponade. The traditional approach for innominate vein repair is via a complete median sternotomy. Presentation of case A 75-year-old female patient with hypertension, diabetes mellitus type two and end stage renal failure, coronary artery disease presenting with iatrogenic innominate vein perforation and pulmonary effusion status post placement of a tunneled hemodialysis catheter through the left subclavian vein. Discussion The patient underwent a partial upper sternotomy into the right fourth intercostal space. Ministernotomy and endovascular techniques provide similar outcomes to those of traditional surgical approaches. However, with minimal access and trauma, these new methods provide better post-operative outcomes for patients. Conclusion The case presented in this report suggests a new approach to replace the traditional complete median sternotomy in attempts to repair the innominate vein. The mini-sternotomy approach provides sufficient visualization of the vessel and surrounding structures with minimal post-operative complications and healing time. PMID:25956040

  5. Effect of tromethamine (THAM) on infarct volume following permanent middle cerebral artery occlusion in rats.

    PubMed

    Kiening, K L; Schneider, G H; Unterberg, A W; Lanksch, W R

    1997-01-01

    This study investigates the influence on tromethamine (THAM) on ischemic volume induced by permanent middle cerebral artery occlusion (MCAO) in rats. 14 male Sprague Dawley rats underwent left sided permanent MCAO by electro coagulation. Animals were treated either by 3-M THAM given intravenously in a single dosage of 0.6 mmol/kg body weight (THAM group: n = 7) 10 min following MCAO and again 1, 2, 3, 4 and 5 hours later or by NaCl 0.9% (placebo group: n = 7) in the same mode. Mean arterial blood pressure (MABP) was monitored for 30 min post MCAO and arterial blood gases were taken 10 min after the first injection. The extent of ischemia volume was assessed by planimetry of coronal sections stained with triphenyl-tetrazolium chloride (TTC) and with hematoxilin/eosin (HE). Tests for significance were accomplished by ANOVA on ranks. A difference of p < 0.05 was considered significant. The THAM group showed an insignificant decrease in MABP 1 min after injection (THAM: 75 +/- 11 mmHg, placebo: 86 +/- 10 mmHg). Arterial pH was significantly different (THAM: 7.46 +/- 0.04; placebo: 7.32 +/- 0.03). In TTC staining, the ischemia volume--given in absolute values and percentage of the total left volume--was significantly reduced in the THAM group (THAM: 43.9 +/- 8.3 mm3/7.0 +/- 1.3%; placebo: 95.2 +/- 13.8 mm3/14.2 +/- 2.0%). In HE staining, the reduction of ischemia, volume did not reach statistical significance (THAM: 49.1 +/- 9.9 mm3/9.6 +/- 1.8%; placebo: 66.3 +/- 14.5 mm3/13.1 +/- 2.8%). Based on these results, a moderate neuroprotective effect of THAM in experimental cerebral infarction could be demonstrated. PMID:9416318

  6. A Comparison between Mechanical Thrombectomy and Intra-arterial Fibrinolysis in Acute Basilar Artery Occlusion: Single Center Experiences

    PubMed Central

    Jung, Seunguk; Jung, Cheolkyu; Bae, Yun Jung; Choi, Byung Se; Kim, Jae Hyoung; Lee, Sang-Hwa; Chang, Jun Young; Kim, Beom Joon; Han, Moon-Ku; Bae, Hee-Joon; Kwon, Bae Ju; Cha, Sang-Hoon

    2016-01-01

    Background and Purpose Recent advances in intra-arterial techniques and thrombectomy devices lead to high rate of recanalization. However, little is known regarding the effect of the evolvement of endovascular revascularization therapy (ERT) in acute basilar artery occlusion (BAO). We compared the outcome of endovascular mechanical thrombectomy (EMT) versus intra-arterial fibrinolysis (IAF)-based ERT in patients with acute BAO. Methods After retrospectively reviewed a registry of consecutive patients with acute ischemic stroke who underwent ERT from September 2003 to February 2015, 57 patients with acute BAO within 12 hours from stroke onset were enrolled. They were categorized as an IAF group (n=24) and EMT group (n=33) according to the primary technical option. We compared the procedural and clinical outcomes between the groups. Results The time from groin puncture to recanalization was significantly shorter in the EMT group than in the IAF group (48.5 [25.3 to 87.8] vs. 92 [44 to 179] minutes; P=0.02) The rate of complete recanalization was significantly higher in the EMT group than in the IAF group (87.9% vs 41.7%; P<0.01). The good outcome of the modified Rankin Scale score≤2 at 3 months was more frequent in the EMT group than in the IAF group, but it was not statistically significant (39.4% vs 16.7%; P=0.06). Conclusions EMT-based ERT in patients with acute BAO is superior to IAF-based ERT in terms of the reduction of time from groin puncture to recanalization and the improvement of the rate of complete recanalization. PMID:27283281

  7. Intraoperative Endovascular Stent-graft Repair of a Popliteal Artery Laceration and Occlusion during Total Knee Arthroplasty.

    PubMed

    Kehagias, Elias; Ioannou, Christos V; Kontopodis, Nikolaos; Balalis, Constatinos; Tsetis, Dimitrios

    2015-10-01

    Injury to the popliteal vessels during total knee arthroplasty is a rare but serious complication that can cause permanent loss of function. Its incidence has been reported to be on the rise with an incidence ranging from 0.03% to 0.51%. Although rare, these complications deserve attention as they may have dire consequences, with mortality reaching 7%, amputation in up to 42%, and other morbidities such as ischemic nerve injury (foot drop). We present a case of a 78-year-old female with a pulseless limb after intraoperative injury of the popliteal artery during total knee replacement surgery who was immediately investigated with digital subtraction angiography and found to have a popliteal artery laceration with significant bleeding and a distal occlusion of the artery that was repaired endovascularly. A covered stent graft was used to simultaneously exclude the arterial laceration and to recanalize the localized popliteal occlusion. To our knowledge, this is the first report of an iatrogenic popliteal artery laceration and occlusion treated endovascularly in the intraoperative time. PMID:26133992

  8. Variable ECG signs of ischemia during controlled occlusion of the left and right coronary artery in humans.

    PubMed

    De Marchi, Stefano F; Meier, Pascal; Oswald, Philipp; Seiler, Christian

    2006-07-01

    Infarct size (IS) increases with vascular occlusion time, area at risk for infarction, lack of collateral supply, absence of preconditioning, and myocardial demand for O2 supply. ECG S-T segment elevation is used as a measure of severity of ischemia and a surrogate for IS. This study in 50 patients with coronary artery disease undergoing a first 120-s balloon occlusion of a stenosis sought to determine whether S-T segment elevation, corrected for the above-mentioned variables, in the left coronary artery (LCA group, n = 36) is different from that in the right coronary artery (RCA group, n = 14) territory. After consideration of all known determinants of IS, particularly mass at risk and collateral supply, the LCA territory is more sensitive than the RCA region to a 2-min period of myocardial ischemia. PMID:16428337

  9. Long-term survival in permanent middle cerebral artery occlusion: a model of malignant stroke in rats

    PubMed Central

    Shanbhag, Nagesh C.; Henning, Robert H.; Schilling, Lothar

    2016-01-01

    Occlusion of the middle cerebral artery (MCA) by an intraluminal filament is widely used to study focal brain ischemia in male Sprague-Dawley rats. However, permanent occlusion goes along with a high fatality. To overcome this drawback we designed a new filament carrying a bowling pin-shaped tip (BP-tip) and compared this with three conventionally tipped filaments. Follow-up periods were 24 h (all groups) and 72 and 120 h in BP-tip group. Ischemic damage and swelling were quantified using silver nitrate staining. Collateral flow via the posterior cerebral artery (PCA) was assessed using selective dye perfusion of the internal carotid artery. Despite a comparable decrease of brain perfusion in all groups, ischemic damage was significantly smaller in BP-tips (p < 0.05). Moreover, BP-tip significantly reduced mortality from 60% to 12.5% and widely spared the occipital region and hypothalamus from ischemic damage. Conventional but not BP-tip filaments induced vascular distortion, measured as gross displacement of the MCA origin, which correlated with occipital infarction size. Accordingly, BP-tip occluded rats showed a significantly better collateral filling of the PCA territory. Ischemic volume significantly increased in BP-tip occlusion at 72 h follow-up. BP-tip filaments offer superior survival in permanent MCA occlusion, while mimicking the course of a malignant stroke in patients. PMID:27329690

  10. Penetrating Atherosclerotic Ulcer of the Abdominal Aorta Involving the Celiac Trunk Origin and Superior Mesenteric Artery Occlusion: Endovascular Treatment

    SciTech Connect

    Ferro, Carlo; Rossi, Umberto G. Petrocelli, Francesco; Seitun, Sara; Robaldo, Alessandro; Mazzei, Raffaele

    2011-02-15

    We describe a case of endovascular treatment in a 64-year-old woman affected by a penetrating atherosclerotic ulcer (PAU) of the abdominal aorta with a 26-mm pseudoaneurysm involving the celiac trunk (CT) origin and with superior mesenteric artery (SMA) occlusion in the first 30 mm. The patient underwent stenting to treat the SMA occlusion and subsequent deployment of a custom-designed fenestrated endovascular stent-graft to treat the PAU involving the CT origin. Follow-up at 6 months after device placement demonstrated no complications, and there was complete thrombosis of the PAU and patency of the two branch vessels.