1/35. Vascular reconstruction in Buerger's disease.In 23 of 148 patients with Buerger's disease, it was possible to undertake 27 arterial reconstructive procedures: bypass in 22 and thrombo-endarterectomy in 5. In a follow-up of 10 months to 8 years, the overall patency rate was 26 per cent. The long term patency rate of bypass grafting was good in obstruction of main vessels, but unsatisfactory with multiple occlusions. Bypass grafting was preferred to thromboendarterectomy. To obtain long term patency of revascularaized segments, complete abstinence from tobacco is absolutely essential. The preparatory manoeuvres for antogenous venous graft should be as atraumatic as possible. A functional diagnosis is indispensable when considering operative indications and for follow-up study of patients with peripheral arterial occlusive disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/35. popliteal artery entrapment; claudication during youth.We report four patients who presented early in life with intermittent claudication, caused by popliteal artery entrapment. In three of them this was the result of an abnormality in the anatomy of the popliteal fossa. In the fourth, however, muscular hypertrophy alone led to arterial entrapment. Three patients were successfully treated by simple myotomy. In the fourth arteriography showed a total occlusion of the popliteal artery. An arteriotomy was performed. In was then seen that the vessel was still patent, and the opening was closed with a vein patch. The result of this procedure was also satisfactory. It is the authors' opinion, based on their own experience and that of other workers as reported in the literature, that vascular reconstruction is only indicated when irreversible vascular changes have occurred, or where other lesions have complicated the condition.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/35. Internal thoracic artery as a collateral source to the ischemic lower extremity.Based on the superior long-term results, internal thoracic artery is widely used for coronary artery bypass grafting. However, the vessel can play an important role as a collateral source to the chronically ischemic lower limbs. We reported two cases who underwent simultaneous revascularization to the myocardium and lower limbs because this particular condition was anticipated. Selective angiography of internal thoracic artery was useful to determine its role before harvesting in our cases. Careful preoperative examinations and choice of surgical approach are required for such patients to avoid serious vascular complications.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/35. Adventitial cystic disease in the common femoral artery.The rare condition of adventitial cystic disease with massive cysts in the common femoral artery was treated in a 49-year old man. The symptoms were calf and thigh claudication. angiography showed occlusion of the common femoral artery and the deep femoral artery. The condition was obvious peroperatively, and after clearing the deep artery, a bypass (ePTFE) to the two femoral run off vessels was needed. After an uneventful postoperative period, it was observed at three months' follow-up, that the patient had foot pulses.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/35. Covered stent to exclude intravascular thrombus.PURPOSE: To describe the utility of stent-graft implantation to avoid distal embolization from a large thrombus-containing lesion. CASE REPORT: A 67-year-old man was evaluated for recent onset of disabling left leg claudication. angiography disclosed a mobile lobular mass occluding the left common iliac artery; irregular staining suggested an atherothrombotic lesion. Through a percutaneous ipsilateral access and an 8-F sheath, a balloon-expandable Jostent peripheral stent-graft was positioned with the distal edge immediately proximal to the internal iliac artery ostium. A prominent "waist" at the center of the balloon confirmed entrapment of the thrombotic mass. Completion angiography showed an optimal result with no residual stenosis or evidence of distal embolization. At 6-month follow-up, the patient was asymptomatic with angiographically documented luminal patency and no evidence of in-stent stenosis. CONCLUSIONS: Stent-graft implantation appears a viable treatment alternative for thrombus-containing lesions, particularly when the thrombotic material is localized or is in a large vessel.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/35. Endovascular gamma-irradiation to prevent recurrent femoral in-stent restenosis. A case report.We report about a patient with twice recurrence of femoral in-stent restenoses. Centered endoluminal gamma-irradiation with 192 iridium was performed immediately after the second stent recanalization. The irradiation dose was 14 Gy calculated at 2-mm depth of vessel wall. One-year follow-up demonstrates neither clinical nor angiographic evidence of restenosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/35. Percutaneous transluminal angioplasty against arteriosclerosis obliterans in dialysis patients.The incidence of peripheral arteriosclerosis is on the increase in chronic hemodialysis patients. Recently, the intervention (IV) treatment is conducted to deal with this problem. IV was performed in 4 dialysis patients against the complication of arteriosclerosis obliterans (ASO) but the result was unsuccessful in 3 of them. These 3 failure cases were investigated to find the problems associated with percutaneous transluminal angioplasty (PTA). Cases 1, 2 and 3 had intermittent claudication while case 4 had gangrenous toes as the major complaint. The symptoms in these cases were attributable to 90-100% stenosis and occlusion of superficial femoral artery, bilateral iliac arteries, bilateral superficial femoral-popliteal artery, branch of right iliac artery and left iliac artery region, respectively. IV was successful in case 1 but failed in cases 2 and 4 because the catheter itself did not go through due to the severe stenosis of vessel or the procedure of forcefully dilating the vessel caused dispersion of minute thrombi. In case 3, acute myocardial infarction occurred at 10 h after successful IV, resulting in sudden death. In view of the extent of invasion, IV is a treatment method selected against ASO in dialysis patients. However, the method has a high risk of causing thrombus formation, vessel rupture and organ failure. In this regard, it is advisable to evaluate the systemic condition and conduct IV if the extent of stenosis is mild.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
8/35. Acute arterial thrombosis in acute promyelocytic leukaemia.INTRODUCTION: Localized large vessel thrombosis in acute leukaemia is rare, haemorrhagic complications being more common. METHOD: We present a patient with acute promyelocytic leukaemia (APL) presenting with an acutely ischaemic lower limb. Large vessel thrombosis is a rare presentation of APL. We reviewed the literature on the coagulopathy of APL and discuss the pathology and current treatment options. DISCUSSION: Disordered haemostasis is typical of acute promyelocytic leukaemia (FAB M3) and relates to the intrinsic properties of the blast cells as well as thrombocytopenia from bone marrow involvement. Expression of procoagulants, stimulation of cytokines and alterations in endothelial cell anticoagulant properties initiate a disseminated intravascular coagulation (DIC) resulting in the typical clinical and laboratory findings in APL. The promyelocytes are characterized by the balanced reciprocal translocation between chromosomes 15 and 17. All-trans-retinoic acid (ATRA) induces differentiation in these cells, revolutionizing the treatment of APL. CONCLUSION: Unexpected limb ischaemia in a young, apparently healthy patient might be the presenting symptom of an underlying haematological disorder such as APL. A thorough haematological investigation should be performed prior to contemplating surgery. New treatment strategies based on knowledge of the molecular biology of APL has improved the prognosis of patients suffering from APL.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
9/35. Bilateral intermittent claudication and the aorta.With the increasing utilization of imaging strategies such as transesophageal echocardiography and magnetic resonance imaging, thrombi of the aorta are becoming increasingly recognized as sources of peripheral emboli. This report describes a 70-year-old man with bilateral intermittent claudication. Arteriography revealed occlusion of the distal part of the right tibialis posterior artery and the left tibialis anterior artery, but no occlusive atherosclerotic disease of the iliac, femoral, or popliteal artery. Additionally, no calcification of the vessels could be demonstrated. In contrast, a giant thrombus of the descending aorta was identified as the source of systemic thromboembolism. The patient was treated successfully with long-term anticoagulation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/35. Sheath introducer technique for recanalizing total occlusions of the superficial femoral artery.Symptomatic patients with total superficial femoral artery occlusions were approached with a modified Dotter technique followed by PTA and/or atherectomy. In 21 lesions studied, 7 (33%) were crossed with a conventional guide wire. Of the remaining 14 lesions (67%), 12/14 (86%) were crossed successfully using the pliable distal tip of the sheath introducer. The average angiographic lesion length crossed was 42 /- 29 mm (range 8-109 mm). One insertion site vessel complication requiring surgical repair was seen. Although more advanced technologies have been developed to treat "wire resistant" total occlusions, the use of the introducer technique described is effective in many patients and adds no additional cost or time to the standard angioplasty procedure.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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