1/47. Marked increase in flow velocities during deep expiration: A duplex Doppler sign of celiac artery compression syndrome.Symptoms of chronic mesenteric ischemia develop when the celiac artery is constricted by the median arcuate ligament of the diaphragm. Lateral aortography is the primary modality for diagnosing ligamentous compression of the celiac artery. However, duplex Doppler sonography performed during deep expiration can cause a marked increase in flow velocities at the compressed region of the celiac artery and suggest the diagnosis of celiac arterial constriction due to the diaphragmatic ligament.- - - - - - - - - - ranking = 1keywords = median (Clic here for more details about this article) |
2/47. Malpositioned or dislocated aortic endoprostheses: repositioning using percutaneous pull-down maneuvers.PURPOSE: To present the capabilities and potential complications of 2 percutaneous techniques for repositioning malpositioned or dislodged aortic endografts. methods: Seven male patients (median age 67.9 years, range 59 to 78) required correction of misplaced or dislocated endografts in the thoracic (n = 1) or infrarenal abdominal aorta (n = 6). In 1 patient, an infrarenal bifurcated stent-graft was mistakenly deployed across a renal artery; repositioning was accomplished by tugging caudally on a guidewire placed across the endograft bifurcation and exteriorized from both femoral arteries. An inflated balloon catheter was used to reposition 3 dislocated aortic devices (1 thoracic, 2 infrarenal) and 3 iliac graft limbs that had disconnected from the main graft body 6 to 12 months after implantation. RESULTS: Repositioning maneuvers were successful in all cases, with the devices being moved from 5 to 27 mm (median 7.8 mm). There were no procedure-related complications. CONCLUSIONS: Nonsurgical repositioning of misplaced aortic prostheses is technically feasible in individual cases. The risk associated with the procedure, however, cannot yet be evaluated.- - - - - - - - - - ranking = 2keywords = median (Clic here for more details about this article) |
3/47. Intermittent vertebral artery compression caused by C1-root schwannoma: case report.Extradural schwannomas of the C1-root are extremely rare. As the tumor grows in size, it may compress surrounding neurovascular structures and cause symptoms. In the present case report, the left vertebral artery (VA) was severely compressed by the tumor, eliciting severe vertigo on turning the head to the right side and with neck extension. We report a 52-year-old man who presented with a history of intermittent episodes of severe vertigo on head movement that was caused by a C1-root schwannoma. The lesion was exposed through an extreme lateral transcondylar approach. At exposure the lesion was yellowish in color and was extradural in location lying between the markedly eroded C1-posterior arch and the compressed vertebral artery (V3) on the left side. The medial portion of the tumor was attached to the C1-nerve root. The tumor was excised enbloc with decompression of the VA. The patient's symptoms completely resolved immediately following surgery, with no recurrence of the symptoms at one year follow up. The vertebral artery may frequently be compressed by osteophytes in cervical spondylosis or due to other causes in the cervical spinal canal, but compression of the artery by C1 extradural schwannoma with vascular insufficiency is rare. Removel of the tumor and the resultant decompression of the artery can be facilitated by the extreme lateral approach as demonstrated by this case.- - - - - - - - - - ranking = 0.44280640550092keywords = nerve (Clic here for more details about this article) |
4/47. Transvenous pacemaker insertion ipsilateral to chronic subclavian vein obstruction: an operative technique for children and adults.subclavian vein occlusion limits insertion of pacing electrodes in children and adults. The concern is greatest in children with a long-term need for pacing systems necessitating use of the contralateral vein and potential bilateral loss of access in the future. We describe an operative technique to provide ipsilateral access in chronic subclavian vein occlusion in five consecutive pediatric (n = 4, mean age 6.5 years) and adult (n = 1, age 70 with bilateral subclavian vein occlusion) patients in whom this condition was noted at the time of pacemaker or ICD implant. Occlusion was documented by venography. Pediatric cardiac diagnoses included complete heart block in all patients, tetralogy of fallot in three, and L-transposition of the great vessels in one. Percutaneous brachiocephalic (innominate) or deep subclavian venous access was achieved by a supraclavicular approach using an 18-gauge Deseret angiocath, a Terumo Glidewire, and dilation to permit one or two 9-11 Fr sheaths. Electrode(s) were positioned in the heart and tunneled (pre- or retroclavicularly) to a pre- or retropectoral pocket. Pacemaker and ICD implants were successful in all without any complication of pneumothorax, arterial or nerve injury, or need for transfusion. Inadvertent arterial access did not occur as compared with prior infraclavicular attempts. One preclavicularly tunneled electrode dislodged with extreme exertion and was revised. Ipsilateral transvenous access for pacemaker or ICD is possible via a deep supraclavicular percutaneous approach when the subclavian venous obstruction is discovered at the time of implant. In children, it avoids the use of the contralateral vein that may be needed for future pacing systems in adulthood. This venous approach provides access large enough to allow even dual chamber pacing in children and can be accomplished safely.- - - - - - - - - - ranking = 0.44280640550092keywords = nerve (Clic here for more details about this article) |
5/47. Vascular reconstruction of a vertebral artery loop causing cervical radiculopathy and vertebrobasilar insufficiency. Case report.The authors present the case of a 62-year-old man with a 4-month history of progressive left-sided C-5 radiculopathy and dizziness. neuroimaging studies revealed a looped vertebral artery (VA) that had migrated into the widened left C4-5 intervertebral foramen. The patient underwent vascular reconstruction of the VA loop, in which there was minimal manipulation of the C-5 nerve root, via a left-sided anterolateral approach after a balloon occlusion test. Postoperatively the patient's symptoms improved immediately, and there were no signs of recurrence within the 2-year follow-up period. This excellent outcome supports the belief that a proper surgical reconstruction of the compressive, tortuous VA should be the therapeutic option of choice, which carries a lower risk of the nerve root injury and improves the hemodynamics in the posterior circulation.- - - - - - - - - - ranking = 0.88561281100184keywords = nerve (Clic here for more details about this article) |
6/47. MR imaging of popliteal pterygium syndrome in pediatric patients.OBJECTIVE: Our purpose was to describe the use of MR imaging in the evaluation of the positions of the popliteal artery and peroneal nerve in children with popliteal pterygium syndrome for preoperative planning and to describe the typical appearance of popliteal pterygium on MR imaging. CONCLUSION: By depicting the popliteal artery and peroneal nerve either in normal positions or abnormally located immediately adjacent to the pterygium, MR imaging provides useful information for preoperative planning in children with popliteal pterygium syndrome. The MR appearance of a popliteal pterygium is that of a band of abnormal tissue extending from the ischium to the os calcis that has signal characteristics of fibrous tissue often attached to a belly of anomalous muscle.- - - - - - - - - - ranking = 0.88561281100184keywords = nerve (Clic here for more details about this article) |
7/47. Embolization in a patient with ruptured anterior inferior pancreaticoduodenal arterial aneurysm with median arcuate ligament syndrome.In median arcuate ligament syndrome, the root of the celiac artery is compressed and narrowed by the median arcuate ligament of the diaphragm during expiration, causing abdominal angina. aneurysm may be formed in arteries of the pancreas and duodenum due to a chronic increase in blood flow from the superior mesenteric artery into the celiac arterial region. We report a patient saved by embolization with coils of ruptured aneurysm that developed with markedly dilated anterior inferior pancreaticoduodenal artery due to median arcuate ligament syndrome.- - - - - - - - - - ranking = 7keywords = median (Clic here for more details about this article) |
8/47. Paraneoplastic acral vascular syndrome: epidemiologic features, clinical manifestations, and disease sequelae.BACKGROUND: Acral vascular syndromes associated with malignancy have rarely been reported. OBJECTIVE: Our purpose was to assess the clinical and evolving features of paraneoplastic acral vascular syndromes. patients and methods: Two cases of paraneoplastic gangrene are described and analyzed together with previously reported cases identified by a medline search. RESULTS: Among the 68 patients identified, 40 had gangrene, 16 had acrocyanosis, and 12 had Raynaud's phenomenon. The male to female ratio was 0.89; median age was 59 years. fingers were affected in 94%. Adenocarcinomas were the predominant associated malignancies (41%), and metastases were observed in 41%. The acral vascular syndromes in 48% of the patients definitively regressed after tumor treatment. Forty-four percent of the patients died within 2 years. A favorable cutaneous outcome was obtained with prostacyclin infusions in 6 patients. CONCLUSION: A neoplastic origin of acral vascular syndrome should be considered in elderly patients, especially men, in the absence of usual causative conditions.- - - - - - - - - - ranking = 1keywords = median (Clic here for more details about this article) |
9/47. Complex regional pain syndrome after thromboendarterectomy: which type is it?The authors describe a complex regional pain syndrome (CRPS) and discuss its type according to the presence or absence of nerve injury. A patient underwent thromboendarterectomy of the right popliteal artery. Subsequently, right lower limb reflex sympathetic dystrophy developed, which was confirmed by scintigraphy and responded well to calcitonin treatment. Typing according to the new classification of CRPS type I or II with possible nerve injury is discussed, and a short review of the literature is included.- - - - - - - - - - ranking = 0.88561281100184keywords = nerve (Clic here for more details about this article) |
10/47. Preoperative evaluation of neurovascular compression in patients with trigeminal neuralgia by use of three-dimensional reconstruction from two types of high-resolution magnetic resonance imaging.OBJECTIVE: To assess the value of three-dimensional (3-D) images reconstructed from 3-D constructive interference in steady state (3-D-CISS) and 3-D fast inflow with steady-state precession (3-D-FISP) images for the visualization of neurovascular compression in patients with trigeminal neuralgia. methods: Twenty-four consecutive patients with trigeminal neuralgia underwent preoperative 3-D-FISP and 3-D-CISS imaging. 3-D reconstruction of nerves and vessels was performed with the use of a volume-rendering method. We compared the 3-D reconstructed images with intraoperative findings. RESULTS: 3-D-CISS and 3-D-FISP images scanned from the same position clearly delineated the trigeminal nerve and vessels. 3-D reconstructed images showed the spatial relationship between the trigeminal nerve and causative vessels. The responsible arteries were identified from the 3-D reconstructed images, which closely simulated the microscopic operative view. CONCLUSION: 3-D reconstructions from two types of high-resolution magnetic resonance images (3-D-CISS and 3-D-FISP) are very useful for creating preoperative simulations and in deciding whether to perform surgery in patients with trigeminal neuralgia.- - - - - - - - - - ranking = 1.3284192165028keywords = nerve (Clic here for more details about this article) |
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