1/19. natural history of congenital arteriovenous fistula.There is no more difficult lesion to manage than congenital arteriovenous fistula. The advanced lesions are extremely vascular and unless they lend themselves to total excision, prompt recurrence is the rule. For the same reason, embolization is not successful and as the major feeding vessels are occluded, access to the tumor becomes more and more limited. In order to obliterate the tumor, it must be destroyed at the microvascular level. So far, only ethanol has proved effective in this regard, and this agent must be used conservatively to avoid excessive destruction of normal tissue and systemic damage.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/19. Vascular complications in lumbar spinal surgery: percutaneous endovascular treatment.Four patients underwent endovascular treatment of vascular injuries complicating lumbar spinal surgery. In two patients with massive retroperitoneal hemorrhage, the extravasating lumbar arteries were successfully embolized with microcoils. Two patients with large iliac arteriovenous fistula (AVF) were treated, one with embolization using a detachable balloon and coils, which failed, and the other with placement of a stent graft after embolization of distal runoff vessels, which occluded the fistula. We conclude that acute arterial laceration or delayed AVF complicating lumbar spinal surgery can be managed effectively with selective embolization or stent-graft placement, respectively.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/19. Fatal fungal infection complicating aortic dissection following coronary artery bypass grafting.The case of a 52-year-old man with severe coronary atheroma/ischaemic heart disease, who underwent successful triple vessel coronary artery bypass grafting is described. One month later this was complicated by aortic dissection arising at the aortic cannulation site. An emergency resection and Dacron graft placement were performed. Five weeks later he represented with haemoptysis. Despite inconclusive investigations the patient went on to suffer a massive fatal haemoptysis. autopsy revealed candida infection of the graft with a secondary aortobronchial fistula.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/19. rupture of pseudointima in an implanted vascular prosthesis: immunohistological study of plasminogen activators and matrix metalloproteinases.We investigated late-onset anastomotic stenosis in an implanted prosthetic graft. rupture of the pseudointima and hemorrhaging from the vasa vasorum were observed at the border of the collagenous tissue and fibrin layer. An immunohistological study showed that the fibrin layer was positive for tPA, but weakly positive for PAI-1. Some neutrophils and monocyte/macrophages in the fibrin layer were immunostained for tPA, uPA, uPAR, and MMP-1, -2 and -3. Some spindle-shaped cells surrounding the graft were immunostained for uPA, uPAR, MMP-1, -2, -3, -7 and -9, and TIMP-1 and -2. The endothelial cells of some microvessels were positive for MMP-1 and -2, and tPA. Some multi-nucleated giant cells were immunostained for MMP-7 and-9, tPA, PAI-1, uPA, and uPAR. Overexpressed MMPs and PAs possibly caused instability of the pseudointima.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/19. Endovascular access to the meningohypophyseal trunk.SUMMARY: We describe a novel technique to selectively catheterize the meningohypophyseal trunk (MHT) and its branches. We emphasize the difficulty in accessing the MHT via an ipsilateral approach because of the geometric orientation of this vessel to the parent internal carotid artery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/19. Tentorial vascularization in solid hemangioblastoma--case report.A 40-year-old female was admitted to the hospital with complaints of headache worsening gradually over a 1-month duration. Her past history included surgery to treat a left cerebellar cystic lesion 3 years before, and an untreated small solid right supracerebellar lesion of 1 cm diameter. On admission, magnetic resonance imaging showed that the right cerebellar lesion had grown to approximately 4 cm diameter abutting the tentorium and causing obstructive hydrocephalus. She also had two more small lesions, a right supratentorial solid lesion with cystic component near the splenium and an intramedullary cystic lesion at the C-2 level. Right suboccipital craniectomy was done. The vascular attachments between the superior aspect of the tumor and the tentorium were coagulated and the tumor was totally removed. C1-2 laminectomy was also performed to drain the intramedullary cyst. The patient deteriorated and lost consciousness with respiratory arrest 6 hours postoperatively and was reoperated for intracerebellar hematoma due to oozing from the tentorial vessels. Histological investigation revealed hemangioblastoma. Dural tentorial vascular attachments in solid hemangioblastomas located subjacent to the tentorium may cause early postoperative complications of hematoma at the site of vascular attachment following the resection. Computed tomography study in the early postoperative period is helpful to identify this problem.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/19. Indications for interventional arteriography in post-tonsillectomy hemorrhage.OBJECTIVE: To determine the incidence of post-tonsillectomy hemorrhage (PTH) and required measures of treatment. Design: Retrospective chart review. SETTING: Department of otolaryngology-Plastic Head and neck Surgery, St. Anna Hospital, Duisburg, germany. methods: The charts of 5,539 patients at risk for PTH (post-tonsillectomy) and seen in our department between 1988 and 1998 were reviewed including 65 patients primarily operated on elsewhere. MAIN OUTCOME MEASURES: Success and failure of surgical methods. RESULTS: Surgical treatment of PTH was necessary in 145 of our patients (2.65%). Owing to recurrent bleeding in 7 patients, 153 surgical procedures to stop bleeding became necessary. There was one case with lethal outcome (0.018%). Massive bleeding indicated ligature of the external carotid artery (ECA) in 5 patients (0.09%). Despite this procedure, hemorrhage recurred in another 3 patients, all of whom had undergone tonsillectomy elsewhere. In 2 of these cases, arteriography revealed arterial blood supply originating from branches of the internal carotid artery (ICA) or the carotid bulb. CONCLUSION: When ligation of the ECA is considered, a complete dissection of the ICA, ECA, and carotid bulb should be performed to exclude any vascular abnormality. In cases with unclear blood supply of the tonsillar lodge or continuous bleeding despite ligation of the ECA, immediate arteriography of the carotid artery should be indicated. If possible, simultaneous selective embolization of the bleeding vessel should be performed to replace a mutilating approach associated wit exposure and ligation of the ECA.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/19. Retropericardial hematoma complicating off-pump coronary artery bypass surgery.We report the case of a retropericardial hematoma after triple-vessel off-pump coronary artery bypass grafting. Transesophageal echocardiography demonstrated a retropericardial hematoma that compressed the left atrium anteriorly and suppressed cardiac function. Injury to the pulmonary vein during placement of deep pericardial sutures and postoperative infusion of heparin were the likely causes of this rare but potentially fatal complication of an off-pump bypass operation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/19. Perigraft-to-right atrial shunt for aortic root hemostasis.We have modified the technique of perigraft-to-right atrial shunt to control hemorrhage after aortic root replacement. We have performed this operation in 2 patients, including one who had acute aortic dissection and another who underwent aortic root replacement and single-vessel coronary artery bypass. Neither patient required re-exploration for bleeding, and both shunts closed spontaneously during the follow-up period without any related complications. With this modification, even in the presence of concomitant coronary artery bypass grafting, hemostasis was achieved with preservation of the proximal vein graft.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/19. Delayed, massive bleeding as an unusual complication of laser conization. A case report.BACKGROUND: Although delayed bleeding following cervical conization is a common complication of this surgical procedure, the amount of blood loss is usually not life threatening. CASE: A 27-year-old woman underwent conization with a KTP laser for the treatment of microinvasive cervical adenocarcinoma. Eight days later the patient experienced sudden, massive genital bleeding at her workplace. The source of the bleeding was identified as a descending branch of the left uterine artery exposed to the wound surface. hemostasis was achieved completely with direct surgical ligature of the exposed blood vessel. The patient's blood loss during the course of the events was estimated to be 3.2 L, for which she received 1.4 L of packed red blood cells. She had an uneventful postoperative recovery. There was no bleeding or recurrence of the disease during 4 years of follow-up. CONCLUSION: Clinicians should be alert to the possibility of massive bleeding as a delayed surgical complication of cervical conization.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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