1/16. Spontaneous rupture of the inferior vena cava: case report and literature review.Spontaneous rupture of the inferior vena cava is a rare clinical entity. diagnosis of this condition, in the absence of any relevant history, is usually made at laparotomy. Only one such case has previously been reported in the literature. We report a case of spontaneous rupture of the inferior vena cava which was diagnosed following laparotomy for hypovolaemia and acute abdominal pain. This case highlights the fact that spontaneous rupture of the inferior vena cava may be a cause of massive intra-abdominal bleeding not associated with trauma or rupture of the abdominal aorta.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
2/16. Beyond peripheral arteries in Buerger's disease: angiographic considerations in thromboangiitis obliterans.thromboangiitis obliterans is an inflammatory peripheral vascular disease that is strongly associated with smoking. It predominantly affects distal small- and medium-sized blood vessels of both the upper and lower extremities. We present histological evidence of this disease process affecting the internal mammary arteries. This can be of paramount clinical significance for patients with Buerger's disease who present with obstructive coronary artery disease and require coronary artery bypass grafting surgery (CABG). Internal mammary arteries involved with thromboangiitis obliterans cannot be utilized as arterial conduits during CABG and other alternatives have to be used. Therefore, we recommend preoperative angiography of both internal mammary arteries in patients with Buerger's disease requiring CABG to prevent extensive intraoperative dissection of diseased internal mammary arteries.- - - - - - - - - - ranking = 0.17099667472282keywords = upper (Clic here for more details about this article) |
3/16. Azygous vein to right atrium bypass graft in a patient with idiopathic fibrosing mediastinitis and symptomatic superior and inferior vena cava obstructions.We report an unusual case of a patient with diminished cardiac output caused by systemic venous occlusions of unclear etiology with a history of idiopathic fibrosing mediastinitis and retroperitoneal fibrosis. On thoracic, abdominal, and pelvic venograms, the patient was previously known to have superior vena caval and infrarenal inferior vena caval occlusions. Subsequent studies revealed retrograde flow through the azygous and hemiazygous veins and numerous caval-portal anastomoses providing venous return from the upper and lower extremities. After an extensive hypercoagulable state work-up, no abnormalities were found. To relieve the symptoms, the patient underwent an elective right thoracotomy with azygous vein to right atrial bypass graft. The patient has had complete amelioration of the disabling symptoms and participates in many activities that he could not tolerate previously. Because this condition and procedure are unreported, we present a novel surgical treatment option to palliate symptoms caused by concurrent superior and inferior caval obstructions by improving venous return to the heart.- - - - - - - - - - ranking = 0.17099667472282keywords = upper (Clic here for more details about this article) |
4/16. Symmetrical peripheral gangrene and dopamine.We describe a case of a 55-year-old man with hypovolemic shock who developed a symmetrical peripheral gangrene (SPG) on hands and feet. The SPG syndrome consists of sudden onset of symmetrical gangrene of the fingers, toes and rarely, the nose, upper lip, ear lobes or genitals without large vessel obstruction or vasculitis. Vasopressors have been implicated directly or as a contributory cause in many cases. In this case, dopamine was used with high dose (> 20 microg/kg/min) which is inappropriate in hypovolemic shock states. SPG might be a severe and rare complication of dopamine. Care should be taken with the use of dopamine in patients with shock.- - - - - - - - - - ranking = 0.17099667472282keywords = upper (Clic here for more details about this article) |
5/16. Acrogeria (Gottron type): a vascular disorder?We report a 27-year-old Japanese man with the peculiar clinical features of acrogeria. He had had perniosis since early childhood. Prominent atrophic skin changes over the hands, hallux valgus, shortened distal phalanges and atrophic scars on his auricles were noted. X-ray of the hands revealed acro-osteolytic changes of the distal phalanges, and arteriography demonstrated multiple occluded branches of the digital arteries. There were no histological changes of systemic sclerosis in his forearm skin, nor antinuclear antibodies or coagulation disorders. Western immunoblotting demonstrated decreased production of type III collagen by dermal fibroblasts both from an affected finger and from the unaffected upper arm. Although the pathogenesis of acrogeria is unknown, the present case suggests that peripheral circulatory disturbance, as well as a congenital abnormality in type III collagen synthesis, may partly account for the pathogenesis of Gottron-type acrogeria.- - - - - - - - - - ranking = 0.17099667472282keywords = upper (Clic here for more details about this article) |
6/16. Giant celiac artery aneurysm with associated visceral occlusive disease.celiac artery aneurysms are rarely seen in clinical practice. We report an unusual case of a large celiac artery aneurysm in a patient with associated visceral occlusive disease who presented with vague abdominal pain and underwent uneventful open surgical repair.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
7/16. Postural compression of subclavian vein in droopy shoulder syndrome--a case report.A patient with droopy shoulder syndrome (DSS) presented postural symptoms of venous compression of the left upper limb, in addition to those of traction at the brachial plexus. An antegrade phlebography clearly demonstrated impaired patency of the subclavian vein on neck extension. Recognition and management of the compromised venous drainage in patients with DSS is important in preventing vascular complications of the upper limbs.- - - - - - - - - - ranking = 0.34199334944565keywords = upper (Clic here for more details about this article) |
8/16. Stress testing in the evaluation of upper-extremity perfusion.Stress testing is an important element in the evaluation of upper extremity vascular perfusion. Advances in noninvasive testing provide mechanisms to evaluate the static structural characteristics of the arterial system, to define patient and nonpatient vessels to identify areas of thrombosis or occlusion, to evaluate arterial wall motility and elasticity, and to observe the nutritional capillary bed. To understand upper-extremity vascular function, however, some form of stress testing is crucial. The techniques discussed previously continue to evolve and serve only as examples of the potential of noninvasive tests evaluated before, during, and after stress. Stress testing provides techniques that allow us to understand the functional components of vascular perfusion and to monitor our attempts at interventions.- - - - - - - - - - ranking = 1.0259800483369keywords = upper (Clic here for more details about this article) |
9/16. Endoluminal graft exclusion of a proximal para-anastomotic pseudoaneurysm following aortobifemoral bypass.PURPOSE: To describe a case of endoluminal graft exclusion of a proximal para-anastomotic pseudoaneurysm that occurred 17 years following aortobifemoral bypass for occlusive disease. methods AND RESULTS: The lesion was found on abdominal ultrasound examination as part of a work-up for acute abdominal pain and upper gastrointestinal bleeding in a 67-year-old male. A 5-cm saccular pseudoaneurysm was confirmed by preintervention aortography and spiral computed tomography (CT) scanning. Because of the patient's acute symptoms and high-risk medical condition (cardiomyopathy), he was deemed a candidate for endoluminal bypass. At the time of intervention, intravascular ultrasound (IVUS) interrogation identified a 3.5-cm-long separation of the existing aortic graft from the proximal aortic stump with a large pseudoaneurysm. The lesion was isolated and repaired by placement of an aortic-to-right iliac endoluminal bypass, ligation of the left limb of the aortofemoral graft, and femorofemoral bypass to restore blood flow to the lower extremities. Spiral CT scans at 48 hours and 3 months following the procedure confirmed complete isolation of the lesion. CONCLUSIONS: This case illustrates the feasibility of endografting for repair of aortic para-anastomotic pseudoaneurysms, and it also highlights the potential role of IVUS imaging in endoluminal graft deployment.- - - - - - - - - - ranking = 1.1709966747228keywords = abdominal pain, upper (Clic here for more details about this article) |
10/16. Multiple idiopathic arterial aneurysms in children: a case report and review of the literature.A 6-year-old boy from china presented initially at 2 years of age with a pulsatile mass in his right antecubital fossa. He was not fully evaluated until the age of six years, when pan-angiography and computed axial tomography scan revealed multiple aneurysms of his right brachial artery, right radial artery aneurysms, an infrarenal aortic aneurysm, and a right internal carotid artery aneurysm in the region of the cavernous sinus. The patient underwent uneventful repairs of both the abdominal aortic aneurysm and the multiple aneurysms of the right arm. Pathologic evaluation was significant for medial fibrosis of the arterial wall with decreased and disordered elastin fibers. review of the previously reported cases in children indicate the upper extremity arteries are involved in 92% of patients, the aortoiliac region in 92% of patients, and the renal/mesenteric vessels in 77% of cases. lower extremity and cerebrovascular arteries are involved to a lesser extent. Children with peripheral aneurysms should have pan-angiography performed before treatment is begun. Surgical repair in these cases has been excellent.- - - - - - - - - - ranking = 0.17099667472282keywords = upper (Clic here for more details about this article) |
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