1/65. Intravascular and diffuse dermal reactive angioendotheliomatosis secondary to iatrogenic arteriovenous fistulas.Reactive angioendotheliomatosis is a rare benign process that has been mainly described in patients with systemic infections, such as subacute bacterial endocarditis or tuberculosis, and in association with intravascular deposition of cryoproteins. Histopathologically, it is characterized by a proliferation of endothelial cells within vascular lumina resulting in the obliteration of the involved vessels. Another rare variant of reactive angioendotheliomatosis has been described in the lower extremities of patients with severe peripheral vascular atherosclerotic disease. It consists of violaceous and purpuric plaques histopathologically characterized by diffuse proliferation of endothelial cells interstitially arranged between collagen bundles of the reticular dermis. This second variant has been named diffuse dermal reactive angioendotheliomatosis. We report two patients with reactive cutaneous angioendotheliomatosis appearing distally to arteriovenous fistulas used for hemodialysis because of chronic renal failure. The first patient showed intravascular reactive angioendotheliomatosis, while the second one had purpuric plaques that were characterized histopathologically by diffuse dermal angioendotheliomatosis. Both patients showed an arteriovenous "steal" syndrome with distal ischemia, and it is possible that a local increase of vascular endothelial growth factor, as is the case in hypoxia situations, induces the endothelial proliferation. To the best of our knowledge, cutaneous reactive angioendotheliomatosis has not been previously described in association with arteriovenous shunts.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/65. Five cases of calciphylaxis and a review of the literature.calciphylaxis is a rare phenomenon of cutaneous necrosis that typically occurs in association with renal failure and has a poor prognosis. We report 5 new cases of calciphylaxis that illustrate the important clinical and histopathologic features of the disease. All patients had end-stage renal failure at the time that purpuric plaques and nodules were noted; these subsequently progressed to necrotic ulcers with eschars. All skin biopsy specimens showed varying degrees of calcification of the medial layer of blood vessel walls in the dermis and subcutaneous fat. Neither the product of serum calcium and phosphorus concentrations nor parathyroid hormone levels correlated temporally with the clinical observations in every case, emphasizing the importance of clinical-histopathologic correlation. Although certain features of calciphylaxis in humans resemble the animal model originally proposed, there are also some crucial differences. We review the pathogenesis, epidemiology, clinical and histopathologic features, and treatment of this disease.- - - - - - - - - - ranking = 5.9759147020042keywords = blood vessel, vessel (Clic here for more details about this article) |
3/65. Dieulafoy-like lesions of colon and rectum in patients with chronic renal failure on long-term hemodialysis.Two rare cases with Dieulafoy-like ulcer bleeding of the colon and rectum are reported. The patients have been suffering from chronic renal failure (CRF) on long-term hemodialysis (HD), and they were brought to Saiseikai Yahata General Hospital with anal bleeding. In both patients, colonoscopy was performed, showing arterial bleeding from a protuberant vessel on the mucosa of the rectum in Case 1 and gradual arterial bleeding from the protuberant vessel on the ascending colon in Case 2. For both cases, endoscopic clipping treatment was done for hemostasis and was successful.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
4/65. Self-expandable endovascular stent for treatment of venous stenoses.The increase in survival among patients undergoing haemodialysis, the non-limitation of patient age regarding the start of renal substitution treatment, and the high incidence of vascular problems--particularly in diabetics--have caused the positioning of percutaneous catheters in central vessels to become a common practice in haemodialysis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/65. calciphylaxis.calciphylaxis is a rare, life-threatening condition of widespread metastatic calcification most commonly seen in the setting of end-stage renal disease. The etiology of calciphylaxis is not well described, though there are several hypotheses. Cutaneous lesions are characteristically found on the abdomen, buttocks, or thighs as reticulated, painful, purple plaques that often undergo ulceration and may serve as a portal of entry for potentially life-threatening infectious agents. histology reveals medial calcification with intimal proliferation involving small vessels in the subcutaneous fat, associated with a lymphohistiocytic infiltrate of the affected lobules. Treatment, including phosphate binders and parathyroidectomy, is not universally effective. We present one case of calciphylaxis and discuss the clinical features, pathophysiology, histology, and treatment of the condition.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/65. Transverse cervical artery pseudoaneurysm: a rare complication of internal jugular vein cannulation.Internal jugular vein cannulation has become the preferred approach for temporary hemodialysis catheter placement following reports of an increased incidence of subclavian vein stenosis due to subclavian vein catheterization. Internal jugular vein catheterization is associated with a high rate of successful catheter placement. However, significant complications such as internal carotid artery (ICA) puncture, pneumothorax, vessel erosion, thrombosis, airway obstruction and infection can occur. The most common complication is ICA puncture. More recently a few cases of thyrocervical trunk pseudoaneurysm and fistula following internal jugular vein and subclavian vein catheterization attempts have been reported. patients with renal failure who are on hemodialysis may have to undergo multiple catheter placements and vascular access interventions. This, along with their comorbid conditions, increases the risk of such complications. Here we report a patient on hemodialysis who developed transverse cervical artery pseudoaneurysm following an attempted right internal jugular vein catheterization. We report this case because of its rarity, to raise awareness of such a complication and to discuss different treatment options, in particular endovascular coil occlusion. A review of relevant literature is also presented.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/65. calciphylaxis in a patient with end-stage renal disease.calciphylaxis is a rare and life-threatening condition of progressive cutaneous necrosis secondary to small and medium-sized vessel calcification. It is seen almost exclusively in patients with end-stage renal disease and secondary hyperparathyroidism. We experienced a case of 67-year-old man with calciphylaxis that manifested with characteristic skin lesions, pathologic findings, and laboratory changes. His skin lesions began as painful erythematous patches and subsequently progressed to necrotic ulcers with eschars on the distal aspect of the extremities. Pathologically, calcification was found in small and medium-sized blood vessels in the deep dermis and subcutaneous tissue. His serum calcium was 9.5 mg/dL, phosphorus was 7.8 mg/dL, and nPTH was 99.9 pg/mL. The patient had been treated with surgical debridement and other supportive treatment. However, he eventually underwent an amputation below the right knee and died from sepsis.- - - - - - - - - - ranking = 6.9759147020042keywords = blood vessel, vessel (Clic here for more details about this article) |
8/65. heparin-induced skin necrosis in a patient with end-stage renal failure and functional protein s deficiency.skin ulceration is a well-characterized thrombotic complication of the heparin-induced thrombocytopenia (HIT) syndrome. We present the case of a 73-year-old diabetic woman nearing end-stage renal failure who developed extensive upper thigh, abdominal and buttock ulceration following initiation of subcutaneous heparin for prophylaxis against deep vein thrombosis. A preliminary diagnosis of calciphylaxis was made based on the classical distribution and macroscopic appearance of the ulceration in a patient with end-stage renal failure and secondary hyperparathyroidism. However skin biopsy showed complete absence of calcium deposits in the dermal microvasculature. The presence of extensive microthrombi within dermal vessels prompted serologic testing to detect a prothrombotic state. We identified the combined presence of heparin-dependent platelet activating (HIT) antibodies and functional protein s deficiency. To our knowledge this is the first reported case of a dialysis patient presenting with skin ulceration induced by heparin and protein s deficiency. This case highlights the importance of a skin biopsy and testing for a hypercoaguable state in patients with end-stage renal disease and skin ulceration. We suggest that HIT antibodies should be requested in all dialysis patients presenting with skin ulceration.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/65. calciphylaxis in two patients with end-stage renal disease.Fatal calciphylaxis (CPX) occurred in two 71-year-old females both requiring haemodialysis for end-stage renal disease. Case 2 also had an associated follicular lymphoplasmocytoid lymphoma. Although laboratory tests disclosed normal coagulation parameters, this woman had a striking cutaneous histological picture of vessel thrombosis and finally died of disseminated intravascular coagulation. CPX is a rare but potentially life-threatening complication of renal failure. The clinical picture is primarily characterized by livedoid purpura with subsequent cutaneous ischaemia and painful ulcerations. Cutaneous ischaemic phenomena are sustained by a progressive process of vascular calcification and thrombosis involving small to medium size arteries of the dermis and subcutis. Although not yet clearly explained, the pathogenetic role of a predisposing hypercoagulability state is currently the most frequently considered hypothesis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/65. 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 = 5.9759147020042keywords = blood vessel, vessel (Clic here for more details about this article) |
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