41/58. Noninvasive assessment of arteriovenous fistula.Noninvasive diagnostic techniques permit objective assessment of the presence, location, and hemodynamic alterations associated with congenital or acquired arteriovenous fistulas. Doppler ultrasound may be used to assess abnormal velocity signals and directional blood flow in afferent and efferent limbs of the fistula, as well as abnormal pressure gradients in the involved extremity. plethysmography permits graphic qualitative assessment of pulse wave form alterations before and after compression of the fistula. In addition, venous occlusion plethysmography permits quantitation of limb or digit blood flow before and after fistula. In addition, venous occlusion plethysmography permits quantitation of limb or digit blood flow before and after fistula compression. Illustrative cases of congenital and acquired arteriovenous fistulas demonstrate the utility of these noninvasive techniques in the objective assessment of patients.- - - - - - - - - - ranking = 1keywords = extremity, limb (Clic here for more details about this article) |
42/58. Sciatic artery aneurysms: report of three cases and review of the literature.Sciatic artery aneurysms (SAAs) develop in a persistent sciatic artery, which is a congenital anomalous continuation of the internal iliac artery and may be the major blood supply to the lower extremity. SAAs may appear clinically with rupture, thrombosis, distal embolization, or compression of the sciatic nerve. We have reviewed our three cases and the literature to delineate those factors that permit correct preoperative diagnosis and appropriate surgical intervention. Our three patients (aged 54 to 82 years) appeared with severe ischemia that resulted in above-knee amputations. The literature reveals 21 patients ranging in age from 35 to 84 years (58% were women). Twenty of those patients had operations, one of which resulted in death, and five in above-knee amputations. Unexplained sciatic or buttock pain, or a palpable "pulsating" buttock mass, suggests an SAA. The diagnosis is confirmed by angiography. The recommended treatment is femoropopliteal bypass grafting followed by ligature or percutaneous endovascular thrombosis of the aneurysm. early diagnosis and correct surgical therapy are the keys to successful management of SAA.- - - - - - - - - - ranking = 0.77640203033505keywords = extremity (Clic here for more details about this article) |
43/58. "Malignant" brachial arteriovenous fistula in a newborn child: a case report.From the time of birth, a patient a rapidly expanding pulsatile mass in the left upper extremity. The findings are those of multiple AV fistulae: thrill, continuous murmur, cutaneous angioma, and rapidly appearing trophic changes. cyanosis and irreversible heart failure ensued, and the patient died after 20 hours of life. An aortogram revealed numerous AV fistulas within an angiomatous network vascularized by a huge subclavian artery and drained by a large subclavian vein.- - - - - - - - - - ranking = 0.77640203033505keywords = extremity (Clic here for more details about this article) |
44/58. Embolization of extensive peripheral angiodysplasias. The alternative to radical surgery.We describe two patients with extensive pelvic and lower limb angiodysplasias, in whom hemodynamic complications subsequently developed. These have been treated by selective angiography and multiple percutaneous transcatheter embolizations with satisfactory results (1 1/2 to four years of follow-up). One patient had had three previous operations with no improvement; amputation was the only surgical alternative. In the other patient, hip disarticulation and hemipelvectomy was seriously considered because of cardiac failure not responding to medical therapy. We review the literature and use our cases to illustrate points of technique and reemphasize the essential role of therapeutic embolization in the management of extensive angiodysplasia.- - - - - - - - - - ranking = 0.074532656554982keywords = limb (Clic here for more details about this article) |
45/58. Congenital arteriovenous malformations of the upper extremity.The embryology and the clinical management of congenital AV fistulas of the upper extremity are discussed. Early excisional surgery of asymptomatic lesions should be confined to ones of a very limited extent. Excisional surgery on extensive lesions should be limited to those which are symptomatic and have decreasing hand function. Possibly of limited effectiveness in some lesions may be the selective occlusion of vascular feeders by injecting cyanoacrylate glue through a catheter.- - - - - - - - - - ranking = 3.8820101516753keywords = extremity (Clic here for more details about this article) |
46/58. Congenital arteriovenous malformations. The role of transcatheter arterial embolization.We treated 11 patients with congenital arteriovenous malformations (AVMs) with staged transcatheter arterial embolization of their lesions. In nine patients, the AVM involved an extremity. One patient had multiple pulmonary AVMs, another an AVM of the pancreas. Embolization was performed using polyvinyl alcohol sponge (Ivalon) particles and Gianturco-Wallace colls. Nine patients had a systemic response to embolization, characterized by pain, fever, leukocytosis, and elevated enzyme levels. Complications (three major, two minor) developed in five patients. A total of 28 staged embolizations were performed, with follow-up to 36 months. We found transcatheter embolization a useful palliative therapy in treating congenital AVMs. It should be considered as a therapeutic alternative for patients with unresectable AVMs, those for whom amputation would be required, and those who are otherwise poor surgical candidates.- - - - - - - - - - ranking = 0.77640203033505keywords = extremity (Clic here for more details about this article) |
47/58. Embolization therapy in the management of congenital arteriovenous malformations.Eight patients with congenital arteriovenous malformations (AVMs) underwent staged transcatheter arterial embolization. Six patients had AVMs involving an extremity, one had multiple pulmonary AVMs, and one had an AVM of the pancreas. Embolization was performed using Ivalon (polyvinyl alcohol) particles and Gianturco coils. Clinical course, fever pattern, and appropriate enzymatic laboratory studies were monitored. leukocytosis occurred in all but one patient following embolization. A febrile course with the temperature reaching 39.6 degrees C without evidence of infection was seen in several patients for 3 to 5 days postembolization. Marked elevation in the creatine phosphokinase level and positive fibrin split products were noted in several instances. Because embolizations were performed in stages, serial arteriography was available. Embolization resulted in a reduction in symptoms in all eight patients and allowed a more limited surgical procedure than would otherwise have been possible in two patients. Complications occurred in three patients and are described. It is concluded that transcatheter arterial embolization is a useful therapeutic alternative in the management of congenital AVMs.- - - - - - - - - - ranking = 0.77640203033505keywords = extremity (Clic here for more details about this article) |
48/58. angiomatosis osteohypotrophica.Based on a clinical and radiological study of seven patients, a syndrome consisting of congenital hemangiomas with arteriovenous fistulae engaging the soft tissues and the bones, and associated with shortening of the involved extremity, for which we suggest the name angiomatosis osteohypotrophica, is reported. Angioma, varicose veins and/or arteriovenous fistulae with resulting increase in limb have been widely known since the beginning of this century as Klippel-Trenaunay syndrome. Although the patients in this series present all other features of Klippel-Trenaunay syndrome, thinning and shortening of the long bones occurred, resulting in an overall reduction in limb length. Intraosseous hemangiomas in the metacarpal, respective metatarsal bones were common characteristic findings. The arteriograms undertaken in this study showed, in addition to hemangiomas, presence of arteriovenous shunts within the area of the tumour. Their influence on skeletal growth is discussed.- - - - - - - - - - ranking = 0.92546734344502keywords = extremity, limb (Clic here for more details about this article) |
49/58. Diagnostic dilemma of an intramedullary vascular malformation. A case report.A young man was seen at a neurologic center for a slowly progressive myelopathy involving the lower limbs in 1983. After examination and investigations, a diagnosis of chronic tuberculous spinal arachnoiditis was made and the patient was administered antituberculous treatment. However, his condition continued to deteriorate. He was reviewed at another center in 1985, where a diagnosis of demyelinating disorder was made, for which he was treated. However, this also did not help, and he was diagnosed as having a nonspecific spinal arachnoiditis at yet another center in 1988. His condition continued to worsen, and after ten years of symptoms, when magnetic resonance imaging (MRI) was done, an intramedullary cystic lesion opposite D-12 vertebrae was seen, which on histopathology was proved to be a vascular malformation. After excision of the lesion his neurologic status has been slowly improving. The conditions that a malformation could mimic, misleading a clinician, and the role of MRI in clinching the diagnosis are highlighted.- - - - - - - - - - ranking = 0.074532656554982keywords = limb (Clic here for more details about this article) |
50/58. delayed diagnosis of spinal vascular malformations presenting as intermittent myelopathy.We report our recent experience of three male patients, whose clinical diagnosis and subsequent surgery was delayed for 9.25 and 15 months respectively. Initially, they all presented with vague, either sensory or motor lower limb disturbances and intermittency of symptoms was followed by bladder dysfunction or impotence. Extensive laboratory work-up was unrevealing and the non-specific diagnosis of myelopathy further delayed the recognition of the underlying vascular lesion. Finally spinal magnetic resonance imaging (MRI), supine myelography and selective spinal arteriography indicated the presence of a tumor in the first patient and vascular malformation in the other two. neurosurgery and histology confirmed one cavernous angioma and two arteriovenous malformations, all thoracic and dural. We believe that both the cryptic nature of these lesions and our technical limitations (spinal arteriography and MRI not readily available), accounted for the delayed diagnosis in our three patients, who nevertheless, when treated by surgery showed a satisfactory outcome in the first case, while further deterioration was prevented in the other two.- - - - - - - - - - ranking = 0.074532656554982keywords = limb (Clic here for more details about this article) |
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