ABSTRACT
A 52-year-old man suddenly felt severe back pain and numbness in the lower extremities. Enhanced CT revealed an acute Stanford type B dissection. The true lumen of the left common iliac artery was severely compressed by the thrombosed false lumen. We performed a femoro-femoral bypass and symptoms in the lower limbs disappeared. On day 4 of hospitalization, the patient suddenly presented with pain at rest and cyanosis in both lower extremities. CT revealed nearly total occlusion of the abdominal aorta due to severe compression of the false lumen. We performed emergency open graft replacement in the infrarenal aorta. Although ischemia in the lower extremities improved, the patient developed myonephropathic metabolic syndrome (MNMS) and received continuous hemodiafiltration to treat acute renal insufficiency. The patient's ankle-branchial pressure index improved and he was weaned from continuous hemodiafiltration. The patient had no paralysis and was able to walk unassisted, so he was discharged on day 34 of hospitalization. In the event of acute aortic dissection and organ ischemia, emergency open graft replacement may be required and must be performed promptly as a lifesaving measure.
ABSTRACT
BACKGROUND: Because of the prevalence of diabetes, the treatment of diabetic foot is still challenging. Even an exactly proved effective and practical method can't be listed except vascular surgery which is not a long-term way for it. Spinal cord stimulation (SCS) is a very promising option in the treatment algorithm of inoperable chronic critical leg ischemia (CLI). DATA SOURCES: We searched Pubmed database with key words or terms such as "spinal cord stimulation", "ischemic pain" and "limb ischemia" appeared in the last five years. RESULTS: The mechanism of SCS is unclear. Two theories have emerged to interpret the benefits of SCS. Pain relief from SCS can be confirmed by a majority of the studies, while limb salvage and other more ambitious improvements have not come to an agreement. The complications of SCS are not fatal, but most of them are lead migration, lead connection failure, and local infection. CONCLUSIONS: SCS is a safe, promising treatment for patients with inoperable CLI. It is effective in pain reduction compared with traditional medical treatment.
ABSTRACT
Leg ischemia due to multi-level arterial occlusions connotes an advanced stage of atheroslcerosis. The characteristics of the patients with multi-level arterial occlusions are older, present more common as critical limb ischemia and associated with other organ dysfunctions. For treatment of those patients, various treatment modalities including open surgical and endovascular procedures can be used after considering the risks accompanied with the treatment. I would like to describe my own practical view points regarding the treatment of the patients with leg ischemia due to multi-level arterial occlusions.
Subject(s)
Humans , Arterial Occlusive Diseases , Atherosclerosis , Endovascular Procedures , Extremities , Ischemia , Leg , Lower ExtremityABSTRACT
Leg ischemia due to multi-level arterial occlusions connotes an advanced stage of atheroslcerosis. The characteristics of the patients with multi-level arterial occlusions are older, present more common as critical limb ischemia and associated with other organ dysfunctions. For treatment of those patients, various treatment modalities including open surgical and endovascular procedures can be used after considering the risks accompanied with the treatment. I would like to describe my own practical view points regarding the treatment of the patients with leg ischemia due to multi-level arterial occlusions.
Subject(s)
Humans , Arterial Occlusive Diseases , Atherosclerosis , Endovascular Procedures , Extremities , Ischemia , Leg , Lower ExtremityABSTRACT
We report a 47-year-old man who presented with acute right leg pain without any other symptoms on visit to ER. But he had the severe back pain when the leg pain developed. Contrast CT revealed no enhancement on right common iliac artery and aortic dissection from the lower level of right renal artery to the iliac artery bifurcation. Angiographic stent insertion was performed immediately, but the patient showed reperfusion syndrome and died after 3 days. Aortic dissection with the isolated peripheral vascular complications is rare. Aortic dissection should be included in the differential diagnosis of patients with acute lower leg ischemia like peripheral arterial occlusive disease.