1/99. Reversible ischemic myelopathy during scoliosis surgery: a possible role for intravenous lidocaine.An unusual and previously unreported case of partially reversible ischemic myelopathy after limited unilateral segmental vessel ligation during scoliosis surgery is described. Intravenous lidocaine, used intraoperatively for its vasoactive properties, induced an immediate and meaningful recovery of neurologic function. The conceptual and pharmacologic basis for this intervention is discussed in view of this exceedingly rare complication of segmental vessel ligation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/99. Quantitative assessment of vessel flow integrity for aneurysm surgery. Technical note.Quantitative measurement of blood flow in cerebral vessels during aneurysm surgery can help prevent ischemic injury and improve patient outcome. The authors report a case of a superior cerebellar artery (SCA) aneurysm in which perivascular microflow probes were used to measure blood flow quantitatively in both the SCA and the posterior cerebral artery before and after aneurysm clipping. Following aneurysm clipping, blood flow in the SCA was reduced to less than 25% of its initial baseline value. Prompt detection of compromised blood flow gave the surgeon the opportunity to adjust the clip and restore SCA flow to its preclipping value within 5 minutes of initial clip placement. Quantitative vessel-flow measurements were integral to the safe progression of the operation and may have prevented an adverse neurological outcome in this patient. The recommended surgical technique and the principle of operation are described.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
3/99. Iliac vascular injuries during elective laparoscopic surgery.Although it is extremely uncommon, iliac vascular injury is a serious complication of laparoscopic surgery. We performed a retrospective review of five patients who sustained injury to the iliac vessels during elective laparoscopic surgery. We reviewed the mechanism and location of injury for each case and examined ways in which such complications can be prevented. There were four women and one man; their mean age was 32 years. Three patients were undergoing laparoscopy at our institution, and two patients were transferred from outlying facilities soon after the injuries occurred. There were a total of seven iliac vascular injuries among our five patients. Three cases involved injury caused by the insufflation needle; the other two were injured by trocar introduction. Postoperative sequelae included decreased lower-extremity pulses in two patients and lower-extremity edema in three patients. The incidence of iliac vascular injury can be significantly reduced by proper insertion technique, the use of an open (Hasson) approach rather than the percutaneous insufflation needle, and a thorough knowledge of the vascular anatomy in the pelvic region.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/99. Use of the Hasson cannula producing major vascular injury at laparoscopy.Despite the recent demonstration that vascular lesions occur significantly more frequently in patients having closed rather than "open" laparoscopy, there never has been a published case report of injury to the great vessels associated with the open technique of initial access to the peritoneal cavity at laparoscopy. We present the first two such cases reported, along with a brief review of the literature related to such major vascular injuries (MVI) sustained at laparoscopy. Lacking appreciation of aortic anatomy and intraoperative technical factors contribute to the occurrence of these injuries. delayed diagnosis and management contribute to poor outcomes. Secondary injury frequently is associated with MVI at laparoscopy.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/99. Bilateral carotid body paraganglioma: case report.CONTEXT: Surgical treatment of carotid body paragangliomas is a challenge to the surgeon because of the large vascularization of the tumor, involvement of the carotid vessels and the close anatomical relationship with the cranial nerves. CASE REPORT: A 63-year-old patient was submitted to resection of two carotid body paraganglioma tumors found in the right-side and left-side carotid bodies at the bifurcation of the common carotid arteries. Two surgeries were performed at different times and neither of them presented any morbidity. Arteriography was fundamental for diagnosis of the small, asymptomatic tumor on the right side. DESIGN: Case Report- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
6/99. Dystrophic calcification of the radial artery.The radial artery continues to enjoy resurgence in popularity as a conduit for coronary artery bypass grafting but few studies have examined the prevalence of preexisting disease in this vessel. We highlight a potential, avoidable pitfall when use of the radial artery for coronary artery bypass grafting is proposed.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
7/99. Delayed epistaxis resulting from external carotid artery injury requiring embolization: a rare complication of transsphenoidal surgery: case report.OBJECTIVE AND IMPORTANCE: Delayed epistaxis resulting from trauma to branches of the external carotid artery is an infrequent but potentially serious complication of transsphenoidal surgery. We report two cases of severe, delayed epistaxis in patients who had undergone transsphenoidal surgery. In both cases, noninvasive treatment failed, necessitating endovascular intervention. CLINICAL PRESENTATION: The first patient, a 52-year-old woman with a prolactinoma, underwent a second transsphenoidal resection 18 months after the first surgery. She was readmitted on postoperative Day 15 with massive epistaxis. The second patient, a 40-year-old woman, had undergone two transsphenoidal surgeries, 14 years apart, for an adrenocorticotropic hormone-secreting adenoma. She was readmitted with massive epistaxis on postoperative Day 17. INTERVENTION: Both patients were initially treated with nasal balloon packing but experienced recurrent hemorrhage when the balloon was deflated, necessitating referral to the interventional radiology department for embolization. At arteriography, the first patient was found to have a pseudoaneurysm of the medial branch of the left internal maxillary artery, which was subsequently embolized. Arteriography in the second patient revealed an abnormally dilated midline branch of the right internal maxillary artery in the nasal septum; this vessel was occluded at arteriography. CONCLUSION: Delayed massive epistaxis is a rare but significant complication of transsphenoidal surgery. Injury to branches of the external carotid artery, along with injury to the internal carotid artery, should be suspected in patients who present with delayed epistaxis after transsphenoidal surgery. angiography performed in patients with refractory bleeding should include selective external carotid injections. epistaxis that is refractory to anterior and posterior nasal packing may be effectively treated with endovascular embolization.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
8/99. Litigation of laparoscopic major vessel injuries in canada.This study is a review of conditions and circumstances associated with 15 injuries to great vessels during laparoscopic surgery. Thirteen cases were litigated in canada and two occurred in the author's operating room. Body habitus may have been an underlying factor in the injuries. Most injuries were entry related and independent on complexity of surgery. One was caused by the Veress needle and one by a secondary trocar, and three occurred during dissection of adhesions. Ten were primary trocar injuries, 9 after pneumoperitoneum and 1 at direct trocar insertion. Of these, five were caused by reusable and five by disposable trocars with so-called safety shields. In 6 of 15 cases recognition of the injury was delayed; 5 in the recovery room. Eleven women had uncomplicated recovery. Of 13 litigated cases, 8 (62%) resulted in settlement.- - - - - - - - - - ranking = 2.5keywords = vessel (Clic here for more details about this article) |
9/99. Atherosclerotic disruption of the aortic arch during coronary artery bypass operation.A 70-year-old-man presented with a symptomatic three vessel coronary artery disease and was scheduled for myocardial revascularization. During extracorporeal circulation an intrathoracal bleeding occurred and aortic rupture was suspected. An iatrogenic plaque rupture in the concavity of the aortic arch was found due to cannulation attempts. The aortic arch was grafted in the so-called elephant trunk technique. Thereafter bypass grafts were anastomosed to the stenosed coronary arteries. The patient was discharged from hospital after 2 weeks in good condition.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
10/99. Control of major hemorrhage from the spleno-mesenteric vein junction during pancreaticoduodenectomy: successful use of an occlusion balloon catheter.BACKGROUND/AIMS: Vascular disruption is sometimes associated with intractable hemorrhage due to either vessel fragility or increased blood flow rates in patients with chronic pancreatitis during surgical operation. This paper describes the successful use of an occlusion catheter for repairing a major laceration at the spleno-mesenteric vein junction. methods: A 14-Fr Fogarty occlusion balloon catheter was directly inserted into the splenic vein through the site of venous laceration and inflated to stop blood flow from the splenic vein. RESULTS: This procedure perfectly controlled massive hemorrhage from the spleno-mesenteric vein junction. The injured site was repaired with a continuous suture in 5 min. CONCLUSION: The direct insertion of a balloon catheter to the injured site is simple and expeditious to control major hemorrhage from the spleno-mesenteric vein junction when the situation is otherwise unmanageable.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
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