1/3. Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report.BACKGROUND: The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits. CASE REPORT: A 70 year-old mildly hypertensive male without previous or present arteriosclerotic, pulmonary, or urological manifestations was subjected to endovascular treatment after his mass-screening diagnosed abdominal aortic aneurysm had expanded to above 5 cm in diameter, the aneurysm having been found by CT-scanning and arteriography to be endovascularly treatable. A Vanguard bifurcated aortic stent graft was implanted under epidural/spinal anaesthesia and covered by cephalosporine and heparin (8000 IE) protection. Apart from treatment of a groin haematoma and stenosis of the left superficial femoral artery, the postoperative period presented no problems. A few days before the monthly follow-up visit, the patient developed uraemia, gangrene of one foot and dyspnoea. blood glucose and LDH was elevated. Deterioration led to death a month and a half after stent implantation. autopsy showed extraordinary large, extensive soft, brown vegetations in the lower part of the thoracic aorta above the properly infrarenally-placed stent. Microscopic examination revealed multiple microemboli in the liver, spleen, pancreas, intestines, testes, and especially the kidneys. DISCUSSION: Early death from microemboli after aortic stent implantation has been reported. However, the present case developed fatal multiple microemboli so late that they could not have originated from the excluded mural thrombus. The sudden death of an otherwise healthy man of extensive microemboli is difficult to explain. The stent application may have altered the proximal flow and wall movements disposing to microemboli in the case of vegetations.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Accidental embolization of an intravenous cannula in the upper limb: retrieval following computed tomography localization.Embolization of small foreign body particles from peripheral veins to the heart or lungs is an uncommon occurrence and, once released into the circulation, localization and retrieval may be difficult. We present a case of accidental separation and embolization of a 28 mm long distal portion of a polytetrafluoroethylene intravenous cannula that was sited in a superficial right wrist vein. The fragment travelled as far as the antecubital fossa prior to the application of a tourniquet. It was then accurately located in the cephalic vein using contiguous axial computed tomography with reconstructions, and was easily retrieved under local anaesthesia. A management approach to this uncommon but potentially serious problem is suggested.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/3. Cardiovascular collapse after femoral prosthesis surgery for acute hip fracture.PURPOSE: Prosthetic revision of hip fractures may result in embolization of tissue products leading to death. In this report, from cases reported to the Anaesthesia Advisory Committee to the Chief Coroner of ontario, emphasis is placed on the immediate resuscitative procedures which may offset a fatal outcome. CLINICAL FEATURES: Two elderly patients are reported in whom hip fractures necessitated primary prosthetic hip repair. The first patient, with a history of limited cardiac reserve and syncope, suffered a subcapital hip fracture. Under general anaesthesia, a Moore's prosthesis was inserted. The anaesthetic period remained relatively stable until surgical reaming of the femoral canal. bradycardia, hypotension and cyanosis developed and quickly proceeded to a fatal cardiac arrest. autopsy demonstrated diffuse pulmonary embolism of fat and thrombus. The second patient suffered a fracture around the stem of a previously inserted femoral prosthesis. Under general anaesthesia, a new cemented hip prosthesis was inserted, following which hypotension occurred. This was supported with small doses of ephedrine, ventilation was controlled with oxygen and the procedure was quickly terminated. Despite addition of a dopamine infusion, cardiac arrest and death followed. autopsy disclosed massive fat and bone marrow embolization. CONCLUSION: The combination of hip fracture, activated clotting factors and borderline cardiopulmonary function presents a risk of death from embolization of tissue products released during the placement of a cemented hip prosthesis. While the outcome of this catastrophe is generally poor, all practitioners should be prepared to immediately institute resuscitative procedures to manage the accompanying cardiovascular collapse.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |