1/96. Aortic calcification contributing to bone densitometry measurement.A 75-yr-old glucocorticoid-dependent asthmatic male had a bone mineral density study to assess possible osteoporosis prior to initiating therapy. A radiograph of the lumbar spine revealed an asymmetrical compression of the second lumbar vertebra, marked scoliosis, vertebral osteopenia, and a highly calcified abdominal aorta. Bone mineral density (dual X-ray absolptiometry [DXA]) revealed low bone mass in L2-L4 and a markedly abnonrnal pattern, with a linear central density representing a calcified aorta. Posterior-anterior measurements of the midlumbar region with and without the overlying aorta indicated that the calcified vessel contributed up to 33% of the measured density. This was a far higher contribution than reported in other studies. Lateral DXA measurements of the L2 vertebra and the overlying aorta were performed to validate this finding. The density of the L2 vertebra was 0.215 g/cm(2), and that of the overlying calcified aorta was 0. 210 g/cm(2). This case suggests that aortic calcifications may contribute sign)ficantly to overall lumbar bone density and, unless recognized, can inadvertently lead to misclassification of osteoporosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/96. The acute diagnosis of Takayasu's arteritis based on helical CT angiography of the chest and neck in the emergency room.Recently, a young woman presented acutely with a left hemispheric stroke and differing blood pressures in the arms as her initial manifestation of Takayasu's arteritis. Helical CT angiography, performed to rule out aortic dissection, revealed a thickened wall of the aortic arch with stenoses and occlusions of the great vessels, suggesting the diagnosis. The sequence of imaging studies and findings in this unusually catastrophic presentation of a typically insidious disease are highlighted.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/96. Primary stenting for chronic total occlusion of the infrarenal aorta.PURPOSE: To present a rare case of chronic total occlusion of the infrarenal aorta treated with a self-expanding endoluminal stent implanted without preliminary dilation. methods AND RESULTS: A 68-year-old woman presented with severe bilateral buttock and thigh claudication. angiography revealed total occlusion of the infrarenal abdominal aorta and relatively normal iliac vessels. Via a right groin puncture and a 9-F sheath, a 14-mm x 5-cm self-expanding Wallstent was deployed in the abdominal aorta and expanded with an angioplasty balloon. Completion angiography showed successful recanalization of the aorta with satisfactory distal flow. Palpable distal pulses were restored, and the patient's symptoms were alleviated. She remained asymptomatic until her death from a major stroke 11 months after aortic stent implantation. CONCLUSIONS: Primary stenting may be considered a viable alternative to conventional surgery in selected patients with total infrarenal aortic occlusion.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/96. Axillocoronary bypass in a patient with a severely atherosclerotic aorta.We report an axillocoronary bypass in a 70-year-old man with a severely atherosclerotic, calcified aorta. The patient had insulin-dependent diabetes mellitus and had 2-vessel coronary artery disease with a lesion in the left main coronary artery. He underwent an axillary artery-circumflex artery bypass with a saphenous vein graft combined with a bypass of the left internal thoracic artery to the left anterior descending artery without aortic cross-clamping. An easy, safe procedure, axillocoronary bypass is a viable option in coronary artery bypass grafting for patients with severely atherosclerotic, calcified aortas.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/96. Simplified retrograde systemic perfusion for removal of air from the aorta in an infant.Total circulatory arrest with full venous drainage can result in air entering the arterial system through several possible sites such as the aortic cannulation site or collateral vessels. air present in the arterial system during total circulatory arrest imposes a special problem. We describe a simple technique of short-term retrograde systemic perfusion to remove air from the arterial system before restarting systemic arterial perfusion after total circulatory arrest.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/96. Medical management of a large aortic thrombus in a young woman with essential thrombocythemia.Aortic thrombus formation is rare in the patients with essential thrombocytosis (ET); therefore, no guidelines for its management have been established. embolism from ET-associated large vessel thrombi is potentially lethal and has been managed surgically in a few reported cases. We describe herein a 45-year-old black woman with ET found to have a 3.5-cm, pedunculated intra-aortic thrombus at the thoracoabdominal junction. How to treat this potentially devastating aortic thrombus was a management dilemma. We believed, based on the patient's diagnosis of ET and the histology of similar thrombi in 1 reported series, that the aortic thrombus was a "white thrombus" consisting primarily of aggregated platelets with a minimal fibrin network and almost no entrapped erythrocytes. The patient was treated with aspirin, 325 mg daily, as a platelet antiaggregating agent and hydroxyurea, 1,500 mg daily, to reduce the platelet count to less than 450 x 10(9)/L. The thrombus resolved without severe thromboembolic events. To our knowledge, this is the first reported case of a large intra-aortic thrombosis associated with ET that has been successfully managed with medical therapy alone.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/96. Langerhans' cell histiocytosis presenting with a para-aortic lesion and heart failure.Langerhans' cell histiocytosis (LCH) is an uncommon disease with variable manifestations. We report a case of LCH with the unusual initial presentations of chest pain and progressive heart failure in a 5-year-old boy. Chest radiography revealed a wide mediastinum with cardiomegaly. electrocardiography showed first-degree atrioventricular block and an inverted T wave over V4-V6. echocardiography, computed tomography, and magnetic resonance imaging of the chest all showed an infiltrating lesion that enveloped the entire heart, great vessels, and coronary arteries. Pathologic examination of the biopsy specimen revealed LCH. Chemotherapy, which included prednisolone, vincristine, methotrexate, and 6-mercaptopurine, had only a minimal effect on the tumor. After the addition of etoposide, the lesion decreased in size, and the symptoms and signs of heart failure and chest pain were ameliorated.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/96. Oblique aortic valve replacement and coronary artery bypass grafting for severely calcified narrow aortic root with unstable angina.We report an 84-year-old woman diagnosed with aortic stenosis and regurgitation with a severely calcified narrow aortic root and left main coronary artery trunk stenosis with triple-vessel coronary artery disease. Emergency aortic valve replacement and triple coronary artery bypass grafting were successful. The aortic annulus was small and heavily calcified, and the ascending aorta, the sinus of valsalva and the anterior leaflet of the mitral valve were severely calcified. A St. Jude Medical valve 19A (St. Jude Medical Inc., St. Paul, MN) was inserted obliquely along the noncoronary sinus. This technique is a useful alternative in cases where the patient's life is at risk in situations involving severe extensive calcification of a narrow aortic root.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/96. Management of porcelain aorta and calcified great vessels in coronary artery bypass grafting with off-pump and no-touch technology.A 69-year-old woman presented with postinfarct unstable angina and decreased ventricular function secondary to significant left main coronary artery stenosis in combination with total right coronary artery occlusion. We did successful off-pump coronary revascularization in this patient with severely calcified ascending aorta and great vessels, subtotal aortobiiliac stenoses, a history of previous stroke, and right carotid endarterectomy.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
10/96. Unusual case of refractory hypertension: late presentation of the mid-aortic syndrome.A 58 year old patient with refractory hypertension, chronic renal failure, and widespread arterial bruits is described. Investigations found hypoplasia of the major blood vessels, particularly the aorta, leading to low flow nephropathy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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