RESUMEN
Aneurysms of the iliac veins are very rare but are potentially fatal due to their potential to cause thromboembolic complications or even rupture. We herein report an unusual case of bilateral external iliac venous aneurysms in a 50-year-old male long-distance runner who presented with bilateral groin pain. The aneurysms were successfully treated with tangential aneurysmectomy with lateral venorrhaphy. Possible causes and management of iliac venous aneurysms are also discussed in this article.
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Aneurisma/cirugía , Vena Ilíaca/cirugía , Resistencia Física , Carrera , Aneurisma/diagnóstico por imagen , Aneurisma/fisiopatología , Biopsia , Angiografía por Tomografía Computarizada , Humanos , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/fisiopatología , Masculino , Persona de Mediana Edad , Flebografía/métodos , Resultado del Tratamiento , Ultrasonografía Doppler DúplexRESUMEN
BACKGROUND: This study was performed to investigate the outcomes of surgical treatment for inflammatory abdominal aortic aneurysms (IAAAs) and inflammatory iliac artery aneurysms (IIAAs). METHODS: We retrospectively reviewed the charts of patients who underwent open surgical repair (OSR) between January 2000 and June 2013. RESULTS: Nine male and 2 female patients (median age, 67 years) were treated. Five of the 11 patients who underwent OSR developed hydronephrosis, and ureteral stents were placed preoperatively. There were no intraoperative complications during OSR. After OSR, the conditions of 4 of 5 patients with preoperative hydronephrosis improved. During the follow-up period with a mean of 51 months (range, 6-120 months), 2 patients with OSR developed aneurysmal changes at the anastomosis site (84 and 21 postoperative months, respectively), and reintervention for both patients was needed. One patient died because of malignant disease at 96 months postoperatively. CONCLUSIONS: OSR can be safely performed for IAAAs and IIAAs. When an inflammatory aneurysm, especially an IIAA, is complicated by hydronephrosis, OSR might be an effective treatment procedure.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Aortitis/cirugía , Implantación de Prótesis Vascular , Aneurisma Ilíaco/cirugía , Anciano , Anciano de 80 o más Años , Aneurisma Falso/etiología , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aortitis/complicaciones , Aortitis/diagnóstico por imagen , Aortografía , Implantación de Prótesis Vascular/efectos adversos , Angiografía por Tomografía Computarizada , Femenino , Humanos , Hidronefrosis/etiología , Aneurisma Ilíaco/complicaciones , Aneurisma Ilíaco/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: Patients with lower extremity bypass grafts that develop stenosis commonly undergo endovascular treatment (EVT) procedures. This study was performed to evaluate the outcomes of EVT procedures for infrainguinal grafts with bypass at risk (BAR). METHODS: We performed a retrospective review of 24 grafts in 22 patients from July 2010 to June 2016. The demographic information of the patients and the characteristics of lesions were examined, and the outcomes with regard to the patency and survival rates were calculated. RESULTS: Twenty-four grafts were evaluated; the initial technical success rate of EVT procedure was 91.7%. Sixteen of 24 bypass grafts (66.7%) required multiple EVT procedures due to graft restenosis. Inflow vessels from the superficial femoral artery were associated with significantly higher rates of single EVT procedures (P = 0.0206). At 2 years, the primary, assisted primary, and secondary patency rates were 30.3%, 69.5%, and 78.0%, respectively. CONCLUSIONS: The EVT procedure is one of the treatment options for the treatment of grafts with BAR and might be associated with an acceptable medium-term patency rate.
Asunto(s)
Angioplastia de Balón , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Oclusión de Injerto Vascular/terapia , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/cirugía , Falla de Prótesis , Anciano , Angioplastia de Balón/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Femenino , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/fisiopatología , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Recurrencia , Retratamiento , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
BACKGROUND: Platelets and coagulation proteins contribute to the development of peripheral arterial disease, especially atherosclerotic disease. Several experimental studies have proven a significant correlation between hypercoagulability and atherosclerosis. We used dielectric blood coagulometry, which was initially designed to evaluate the coagulable status, to examine the coagulability of peripheral arterial disease patients, and investigated the factors that were significantly correlated with the results. METHODS: We performed dielectric blood coagulometry in 49 peripheral arterial disease patients. In addition, we recorded the patients' demographic information, including the presence of comorbidities, hemodynamic status, and laboratory findings. To investigate coagulability, we calculated the Tmax value, which indicates the time from recalcification to maximum normalized permittivity. RESULTS: The Tmax values of diabetes mellitus patients were significantly lower than those of non-diabetic patients (1 MHz, P = 0.010; 10 MHz, 0.011). Furthermore, the Tmax value was statistically correlated with the activated partial thromboplastin time (1 MHz, ρ = 0.286, P = 0.048; 10 MHz, ρ = 0.301, P = 0.037). CONCLUSIONS: Dielectric blood coagulometry detected the hypercoagulable status in diabetes mellitus patients, and reflected their level of coagulability, which was also evaluated by the activated partial thromboplastin time.
RESUMEN
OBJECTIVE: We propose a new assessment tool to diagnose severe ischemia of the lower limb in peripheral arterial disease, using laser speckle contrast imaging to evaluate heating-induced microcirculatory fluctuations in the proximal and distal sites of the dorsal foot. STUDY DESIGN: A cross-sectional study. METHODS: We recorded the slope describing the behavior of perfusion values (decrease or plateau) following the initial, heating-induced increase in perfusion in 63 feet of patients with clinical signs of peripheral arterial disease. RESULTS: The plateau and decrease groups were defined as having perfusion slopes of <0.20 and ≥0.20 PU/min, respectively. Transcutaneous oxygen tension was significantly lower (P < 0.001) in the plateau than in the decrease group (8 vs. 45 mmHg), indicating more severe ischemia. The laser speckle contrast imaging thermal load test discriminated transcutaneous oxygen tension <30 mmHg with good sensitivity (78.7%) and specificity (96.2%), and an area under the curve of 0.908. CONCLUSIONS: Both transcutaneous oxygen tension and the laser speckle contrast imaging thermal load test are useful in diagnosing severe ischemia in the foot. Lasers Surg. Med. 49:645-651, 2017. © 2017. The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
Asunto(s)
Pie/irrigación sanguínea , Isquemia/diagnóstico por imagen , Láseres de Semiconductores , Imagen Óptica/métodos , Enfermedad Arterial Periférica/complicaciones , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Pie/diagnóstico por imagen , Humanos , Isquemia/etiología , Masculino , Microcirculación , Persona de Mediana Edad , Imagen Óptica/instrumentación , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
Microsurgical procedure of free tissue transfer in critical limb ischemia patients with large ulceration has already been established. The nutrient flap concept was that transferred tissue functioned not only to cover the skin defect but also as a supplementary blood supply to the ischemic lower leg. This report showed the justification for this concept, which was rarely discussed. A 58-year-old male patient with progressive forefoot gangrene caused by arteriosclerosis obliterans was presented. The distal bypass procedure was performed as revascularization surgery, and a latissimus dorsi (LD) myocutaneous flap was transplanted to cover ulceration. The arterial pedicle of the flap was anastomosed to the vein graft in an end-to-end manner, and the venous pedicle was anastomosed to the posterior tibialis vein in an end-to-end manner. Bypass graft blood flow went straight to the LD flap only. The postoperative course was uneventful. The free flap and right foot survived successfully and the patient was ambulatory with no recurrence of ulceration wearing order-made shoes more than three years after transplantation. Vessel-selective angiography was performed two months after surgery. An angiographic catheter was inserted into the bypass graft, which ran straight through the flap nutrient artery. The results obtained showed that not only the transferred flap area, but also the remaining original foot soft tissue (including the sole and heel) was clearly visualized radiologically only through the flap nutrient vessel. This findings of the angiography appear to provide direct evidence for the nutrient flap concept.
Asunto(s)
Pie/irrigación sanguínea , Colgajos Tisulares Libres/irrigación sanguínea , Gangrena/cirugía , Isquemia/cirugía , Procedimientos de Cirugía Plástica/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Angiografía/métodos , Tomografía Computarizada de Haz Cónico/métodos , Enfermedad Crítica , Estudios de Seguimiento , Pie/cirugía , Enfermedades del Pie/diagnóstico por imagen , Enfermedades del Pie/patología , Enfermedades del Pie/cirugía , Colgajos Tisulares Libres/trasplante , Gangrena/diagnóstico por imagen , Supervivencia de Injerto , Humanos , Isquemia/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Flujo Sanguíneo Regional/fisiología , Resultado del TratamientoRESUMEN
An axillary artery aneurysm (AxAA) is a rare entity. Although some cases with AxAA are asymptomatic, complications including local pain, neurogenic symptoms, upper limb ischemia, and rupture may occur. Therefore, an early diagnosis and treatment are necessary. We herein report a case of bilateral AxAAs, in which the right AxAA showed acute upper limb ischemia and the left AxAA were asymptomatic. Both AxAAs were successfully treated by aneurysmectomy and interposition grafting. In the endovascular era, open surgical treatment for AxAAs remains a promising procedure.
Asunto(s)
Aneurisma/complicaciones , Aneurisma/diagnóstico , Arteria Axilar , Isquemia/etiología , Extremidad Superior/irrigación sanguínea , Anciano , Aneurisma/cirugía , Humanos , MasculinoRESUMEN
The use of endovascular aneurysm repair (EVAR) to treat inflammatory abdominal aortic aneurysms (IAAAs) has been reported, and this procedure appears to be preferable to open surgical repair because of intraoperative difficulties related to inflammation. We herein report a case of IAAA and bilateral inflammatory common iliac artery aneurysms that was successfully treated with bifurcated stent grafting. The perianeurysmal inflammation worsened postoperatively, requiring the placement of a ureteric stent. EVAR is feasible in cases of inflammatory aneurysms; however, the potential for an inflammatory response should be taken into account when considering the application of EVAR in patients with IAAA.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Aortitis/cirugía , Arteritis/cirugía , Implantación de Prótesis Vascular , Aneurisma Ilíaco/cirugía , Anciano , Aortitis/complicaciones , Arteritis/complicaciones , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Progresión de la Enfermedad , Procedimientos Endovasculares , Humanos , Inflamación , Masculino , Stents , Enfermedades Ureterales/etiología , Enfermedades Ureterales/cirugíaRESUMEN
Although providing endovascular treatment for chronic total occlusion (CTO) in patients with peripheral arterial disease is challenging, subintimal angioplasty (SIA) has proven to be an effective procedure. However, the SIA device may not cross CTO lesions because of the inability to achieve re-entry into the distal true lumen in some cases. We herein describe 2 cases of CTO of the superficial femoral artery (SFA) segment in which we failed to cross the site of CTO using the SIA technique and therefore employed the controlled antegrade and retrograde subintimal tracking (CART) technique to successfully treat the CTO lesions of SFA. When using the CART technique, there is no need to perform extension of the region of subintimal dissection beyond the occluded lesion, which may be useful for managing CTO lesions.
Asunto(s)
Angioplastia de Balón/métodos , Arteriopatías Oclusivas/terapia , Arteria Femoral , Claudicación Intermitente/terapia , Anciano , Angioplastia de Balón/instrumentación , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/fisiopatología , Enfermedad Crónica , Femenino , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/fisiopatología , Humanos , Claudicación Intermitente/diagnóstico , Claudicación Intermitente/fisiopatología , Masculino , Radiografía , Flujo Sanguíneo Regional , Stents , Resultado del Tratamiento , Dispositivos de Acceso VascularRESUMEN
BACKGROUND: In this study, we evaluated the accuracy of the indocyanine green angiography (ICGA) test to diagnose peripheral arterial disease (PAD) with isolated infrapopliteal lesions. METHODS: This study was undertaken from a retrospective review of PAD patients with isolated infrapopliteal lesions who underwent ICGA between November 2012 and July 2013. We calculated the ICGA parameters while comparing the findings with the ankle-brachial index (ABI) and toe-brachial index (TBI) in patients with infrapopliteal lesions. RESULTS: Twenty-three limbs with isolated infrapopliteal lesions in 14 PAD patients and 15 limbs without arterial lesions in 9 control patients were examined using ABI, TBI, and ICGA. The Td 90% (the time elapsed from the maximum intensity to 90% of the maximum intensity) correlated most significantly with the ABI value. A cutoff value of Td 90% >25 sec also significantly correlated with the presence of PAD (sensitivity, 82.6%). CONCLUSIONS: ICGA might therefore be useful for assessing the peripheral perfusion quantitatively, even in PAD patients with isolated infrapopliteal lesions. The use of Td 90% on ICGA may also be effective for accurately estimating the presence of PAD.
Asunto(s)
Angiografía/métodos , Colorantes Fluorescentes , Verde de Indocianina , Imagen de Perfusión/métodos , Enfermedad Arterial Periférica/diagnóstico , Arteria Poplítea , Anciano , Anciano de 80 o más Años , Índice Tobillo Braquial , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/fisiopatología , Arteria Poplítea/fisiopatología , Valor Predictivo de las Pruebas , Flujo Sanguíneo Regional , Estudios Retrospectivos , Factores de TiempoRESUMEN
BACKGROUND: To assess the peripheral blood flow of patients with peripheral arterial disease (PAD) by indocyanine green (ICG) arteriography (ICGA) with intraarterial injection of ICG and evaluate the efficacy of the ICGA tests. METHODS: This study was undertaken from a retrospective review of patients with PAD who underwent ICGA tests during digital subtraction angiography (DSA) between November 2012 and June 2013. We defined some ICGA parameters as the magnitude of intensity of ICG, the time to maximum intensity, and the time from fluorescence onset to half the maximum intensity (T1/2). The ICGA parameters were evaluated in 2 regions, named regions of interest (ROIs). ROI 1 was part of the dorsum of the foot from the Chopart joint to the Lisfranc joint. ROI 2 was in the distal region of the first metatarsal bone and compared with the ankle-brachial pressure index (ABI), ankle pressure, toe-brachial pressure index, and toe pressure. RESULTS: A total of 22 limbs in 16 patients with PAD underwent ICGA tests during DSA. The T1/2 on ROI 2 was the most correlated with the ABI (ρ=-0.622, P=0.003). A value of T1/2 for ROI 2>10 sec was significantly correlated with an ABI value of <0.7 (sensitivity: 0.85, specificity: 1.0). CONCLUSIONS: By measuring the value of T1/2 in ROI 2, ICGA tests can be performed to assess the peripheral blood circulation during DSA. ICGA tests might help to promptly assess the peripheral blood flow during endovascular treatment procedures.
Asunto(s)
Angiografía de Substracción Digital/métodos , Verde de Indocianina/administración & dosificación , Pierna/irrigación sanguínea , Enfermedad Arterial Periférica/diagnóstico por imagen , Flujo Sanguíneo Regional/fisiología , Anciano , Colorantes/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intraarteriales , Masculino , Enfermedad Arterial Periférica/fisiopatología , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
PURPOSE: The aim of this study was to investigate the outcomes correlated with our treatment strategy for prosthetic graft infection. METHODS: Seventeen patients were treated for prosthetic graft infections between 1997 and 2009. Initially, total graft excision was applied in five cases, partial graft excision was applied in six cases and graft preservation with drainage and irrigation was applied in six cases. Among the graft-preserved cases, four patients were infected with methicillin-resistant Staphylococcus aureus (MRSA) and treated with gentian violet (GV). RESULTS: The overall survival rate was 88% at 30 days and 82% at 1 year in this series. Of the excised cases, nine patients survived; however, two patients died. Among the cases in which MRSA-infected grafts were preserved, three patients survived; however, one patient died under a septicemic state. Infected graft preservation was applied at a high rate of 36%, and the mortality rate remained at 16%, without any signs of graft reinfection. CONCLUSIONS: In the treatment of infected grafts, the patient's condition should be considered in order to select the appropriate treatment in each case. Graft preservation should be considered as an alternative treatment option, especially in high-risk patients, and GV can be effective for conservative treatment of prosthetic graft infections, including MRSA infections.
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Aneurisma de la Aorta/cirugía , Arteriopatías Oclusivas/cirugía , Implantación de Prótesis Vascular , Falla de Prótesis , Infecciones Relacionadas con Prótesis/terapia , Adulto , Anciano , Anciano de 80 o más Años , Implantación de Prótesis Vascular/efectos adversos , Drenaje , Femenino , Violeta de Genciana/uso terapéutico , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/microbiología , Estudios Retrospectivos , Infecciones Estafilocócicas , Irrigación Terapéutica , Resultado del TratamientoRESUMEN
Tumor resection and caval tumor thrombectomy, with or without cavotomy and inferior vena cava (IVC) replacement are sometimes performed in patients with renal cell carcinoma (RCC) extending into the IVC or liver tumors invading the IVC. Two such cases were treated. Case 1: a 68-year-old female was transferred with a diagnosis of right RCC with tumor thrombus extending into the IVC. A plication was performed to prevent extension into the right atrium before the nephrectomy and cavotomy with removal of the tumor thrombus was accomplished, because the IVC was almost completely obstructed and the hemodynamics were stable during cross-clamping of the IVC. Case 2: a 37-year-old female was transferred with a diagnosis of a giant metastatic liver tumor. A trisegmentectomy with resection of the invaded IVC and IVC replacement was performed while the abdominal aorta was cross-clamped to maintain the hemodynamics. Therefore, abdominal aortic cross-clamping was convenient to maintain the hemodynamics when the IVC replacement was performed during IVC cross-clamping.
Asunto(s)
Implantación de Prótesis Vascular , Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Neoplasias Hepáticas/cirugía , Células Neoplásicas Circulantes , Trombectomía , Vena Cava Inferior/cirugía , Adulto , Anciano , Aorta Abdominal , Carcinoma de Células Renales/patología , Constricción , Femenino , Hepatectomía , Humanos , Neoplasias Renales/patología , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Invasividad Neoplásica , NefrectomíaRESUMEN
PURPOSE: Periodontitis has been associated with atherosclerotic cardiovascular lesions. There may be a link between periodontopathic bacterial infection and atherosclerosis. METHODS: In 53 patients with atherosclerosis, periodontal disease was classified according to the probing depth of the periodontal pocket. To compare the detection rate in different arterial lesion, specimens of diseased arteries (10 primary atherosclerotic lesions, 43 anastomotic lesions) and 21 control arteries without atherosclerotic findings macroscopically and microscopically in the arterial wall, obtained during the surgical procedures were examined for the presence of five species of putative periodontal bacteria using polymerase chain reaction (PCR) analysis. RESULTS: Fifty-one of the 53 patients (96%) had periodontitis, and 34 (64%) of those patients had severe periodontitis or were edentulous. In total, PCR analysis detected DNA specific for periodontal bacteria in 28 of the 53 specimens (52%) of atherosclerotic arterial wall. Only 5 of 21 (23%) were detected in control specimens. CONCLUSIONS: A high percentage of periodontopathic bacteria were detected in atherosclerotic arterial wall specimens from patients with atherosclerosis, especially with primary atherosclerotic lesions, and most cases had severe periodontitis.
Asunto(s)
Aterosclerosis/microbiología , Bacterias/aislamiento & purificación , Periodontitis/complicaciones , Anciano , Anciano de 80 o más Años , Aterosclerosis/complicaciones , Bacterias/genética , Bacteroidetes/genética , Bacteroidetes/aislamiento & purificación , Estudios de Casos y Controles , ADN Bacteriano/química , ADN Bacteriano/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Pasteurellaceae/genética , Pasteurellaceae/aislamiento & purificación , Bolsa Periodontal/complicaciones , Periodontitis/microbiología , Reacción en Cadena de la Polimerasa , Porphyromonas gingivalis/genética , Porphyromonas gingivalis/aislamiento & purificación , Prevotella intermedia/genética , Prevotella intermedia/aislamiento & purificación , Estudios Prospectivos , Treponema denticola/genética , Treponema denticola/aislamiento & purificaciónRESUMEN
OBJECTIVE: This study investigated the skin microcirculatory response to a thermal load test using a laser Doppler flowmetry device to evaluate the severity of limb ischaemia and the outcomes of revascularisation in patients with peripheral arterial disease (PAD). METHODS: A total of 34 PAD patients (39 limbs) including 17 critical limb ischaemia (CLI) patients (21 limbs) who underwent revascularisation were enrolled. The skin microcirculation of the dorsal side of the affected foot was investigated for 15 minutes after local heating. The tests were performed both before and after revascularisation, and several parameters gleaned from the microcirculatory fluctuations were analysed and compared with the ankle brachial pressure index and the transcutaneous oxygen tension (tcPO2) values. RESULTS: Among the parameters, significant differences were observed between the CLI patients and patients with claudication with regard to the increasing phase time (Tinc), the difference in the perfusion values at the onset and the peak of the transient increase in blood perfusion (PΔ), the slope of the transient increase in blood perfusion (Sin), and the slope of the decrease in blood perfusion after the peak (Sde). In CLI patients, the PΔ, Sin, and Sde values increased significantly after revascularisation. In the patients with claudication, the changes in the parameters after revascularisation were not statistically significant. The Sde showed the most statistically significant correlation with the tcPO2 value (ρ .759, p < .001). CONCLUSIONS: Thermal load testing can be used to evaluate the severity of limb ischaemia in patients with PAD.
RESUMEN
In Behçet's disease (BD) patients, endovascular repair is a reasonable alternative treatment for aortic aneurysms to avoid postoperative anastomotic pseudoaneurysms. However, there are some complications that may occur after endovascular repair. We herein report the case of a 40-year-old man with active BD developed recurrent aortic pseudoaneurysms at the proximal and distal margins of the stent graft and a femoral puncture site pseudoaneurysm 3 months after endovascular abdominal aortic aneurysm (AAA) repair. The aortic pseudoaneurysms were treated endovascularly, including the use of the chimney technique for the proximal pseudoaneurysm close to the renal arteries and the femoral pseudoaneurysm with surgical excision and reconstruction. Intensive immunosuppressive therapy was initiated immediately after the operation. The patient is in good condition without any complications at 8-month follow-up. This case suggests the utility of the chimney technique and postoperative immediate intensive immunosuppressive therapy in treating recurrent aortic pseudoaneurysms in emergency, active BD patients.
Asunto(s)
Aneurisma Falso/etiología , Aneurisma de la Aorta Abdominal/cirugía , Síndrome de Behçet/complicaciones , Implantación de Prótesis Vascular/efectos adversos , Cateterismo Periférico/efectos adversos , Procedimientos Endovasculares/efectos adversos , Arteria Femoral/lesiones , Lesiones del Sistema Vascular/etiología , Adulto , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/etiología , Aortografía/métodos , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamiento farmacológico , Angiografía por Tomografía Computarizada , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/cirugía , Humanos , Inmunosupresores/uso terapéutico , Masculino , Punciones , Recurrencia , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/cirugíaRESUMEN
We evaluated the endothelial function of patients with Buerger disease using peripheral arterial tonometry test, and examined the factors that are significantly correlated with the endothelial dysfunction in these patients. We performed the peripheral arterial tonometry test in 22 patients with Buerger disease. We recorded the patients' characteristics, including ankle brachial pressure index and reactive hyperemia index, which reflect the endothelial dysfunction. We divided the patients with Buerger disease into the conservative treatment and lumbar sympathectomy group. While the reactive hyperemia index was not significantly different between these two groups, the ankle brachial pressure index was significantly different (1.12 versus 0.83, P=0.003). Furthermore, the reactive hyperemia index was significantly correlated with the ankle brachial pressure index value in the patients in the lumbar sympathectomy group (ρ=0.848, P=0.005). Given that patients with Buerger disease show impairment of the sympathetic nervous system, we should consider the after-effects of such an impaired system on the condition of these patients. The patients treated with lumbar sympathectomy might be more appropriate to evaluate their endothelial function by a peripheral arterial tonometry test.
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Endotelio Vascular/fisiopatología , Enfermedad Arterial Periférica/fisiopatología , Tromboangitis Obliterante/fisiopatología , Índice Tobillo Braquial , Endotelio Vascular/inervación , Femenino , Humanos , Hiperemia/fisiopatología , Vértebras Lumbares/inervación , Masculino , Manometría , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/cirugía , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Simpatectomía , Sistema Nervioso Simpático/fisiopatología , Sistema Nervioso Simpático/cirugía , Tromboangitis Obliterante/diagnóstico , Tromboangitis Obliterante/cirugía , Resultado del TratamientoRESUMEN
An arterioenteric fistula is a devastating and life-threatening condition that requires urgent treatment. Less-invasive endovascular treatment has emerged as an alternative to conventional open repair, but postoperative graft infection remains a major concern. We herein report a case of late stent graft infection after emergency endovascular repair of a secondary iliac artery-enteric fistula. The patient was a 63-year-old male who presented with a fever, who had undergone successful endovascular stent grafting for a secondary common iliac artery-enteric fistula 29 months prior. The diagnosis of a stent graft infection was confirmed via computed tomography. He underwent graft removal and in situ reconstruction with femoral vein grafts. At 6-month follow-up, the patient is in a good general condition without any symptoms.
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Implantación de Prótesis Vascular/efectos adversos , Prótesis Vascular/efectos adversos , Remoción de Dispositivos , Procedimientos Endovasculares/efectos adversos , Arteria Femoral/cirugía , Vena Femoral/cirugía , Fístula Intestinal/cirugía , Infecciones Relacionadas con Prótesis/cirugía , Stents/efectos adversos , Fístula Vascular/cirugía , Aortografía/métodos , Implantación de Prótesis Vascular/instrumentación , Angiografía por Tomografía Computarizada , Urgencias Médicas , Procedimientos Endovasculares/instrumentación , Arteria Femoral/diagnóstico por imagen , Vena Femoral/diagnóstico por imagen , Humanos , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/microbiología , Factores de Tiempo , Resultado del Tratamiento , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiologíaRESUMEN
The aim of the present study is to assess the effects of unilateral revascularization on the contralateral foot circulation using indocyanine green (ICG). From January 2016 to April 2016, a total of twenty-one patients were included in this study. The patients underwent elective unilateral revascularization at our institution and we evaluated the feet circulation by indocyanine green angiography (ICGA) tests preoperatively and postoperatively. The ICGA parameters included the magnitude of intensity from the onset of ICG to the maximum intensity (Imax), the time from the onset of ICG to the maximum intensity (Tmax), and the time required to reach the half maximum intensity from the onset of ICG (T1/2). There were significant differences in the treated limb Tmax (P = 0.016) and T1/2 (P = 0.013) values and in the contralateral limb Tmax (P = 0.013), and T1/2 (P < 0.001) values on the perioperative ICGA tests. These results reflect the increase in skin perfusion in the treated limb and the decrease in skin perfusion in the contralateral limb. Unilateral revascularization decreases contralateral foot circulation. The preoperative contralateral lesion should be evaluated when revascularization is performed.
Asunto(s)
Angiografía/métodos , Verde de Indocianina/análisis , Anciano , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Dislipidemias/fisiopatología , Femenino , Pie/irrigación sanguínea , Humanos , Masculino , Imagen Óptica , Flujo Sanguíneo Regional/fisiología , Estudios Retrospectivos , Triglicéridos/sangre , Procedimientos Quirúrgicos VascularesRESUMEN
Venous malformations (VMs) are the most common type of vascular malformations, resulting from errors in vascular morphogenesis. Because of the wide variety in their presentations, selecting the appropriate treatment, especially for large VMs, may be challenging. Herein, we report a case of a 59-year-old man with a large VM in the lower extremity who achieved favorable outcomes by complete surgical resection. Even large VMs can be successfully treated with surgery when patients are properly selected. An accurate and careful evaluation is essential for achieving optimal outcome in patients with VMs.