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1.
Vasc Endovascular Surg ; 53(7): 606-608, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31272303

RESUMO

Hydrophilic polymer coatings are now widely applied to catheters and other intravascular devices used in neurovascular, cardiovascular, and peripheral vascular procedures. Emboli consisting of these materials have been previously identified in biopsies and autopsies following pulmonary infarction, stroke, gangrene, or death. We report a case involving a nonhealing foot ulcer that appeared following cardiac catheterization, stenting, and automatic implanted cardiac defibrillator (AICD) implantation in a patient without other evidence of significant peripheral artery disease. An 85-year-old woman with chronic atrial fibrillation, aortic valve stenosis, and coronary artery disease underwent coronary stenting and AICD implantation for ventricular tachycardia and syncope. She developed a toe ulcer shortly thereafter, which did not respond to standard treatment. A histological examination following amputation of the toe found amorphous basophilic material in capillaries adjacent to the edge of the ulcer, which was similar to material associated with hydrophilic polymer coatings. Ischemia and infarcts following endovascular procedures should not be presumed to result from thrombus or vascular disease, even if intravascular devices appear intact or properly placed after the procedure. To help establish the incidence of ischemia caused by hydrophilic polymer device coatings, if excision of ischemic or infarcted tissue after endovascular procedures using coated devices becomes necessary, the tissue should be evaluated microscopically. Surgeons should also consider the tolerance of distal organs to infarct or ischemia when selecting coated intravascular devices.


Assuntos
Materiais Revestidos Biocompatíveis/efeitos adversos , Embolia/etiologia , Úlcera do Pé/etiologia , Migração de Corpo Estranho/etiologia , Isquemia/etiologia , Polímeros/efeitos adversos , Dedos do Pé/irrigação sanguínea , Idoso de 80 Anos ou mais , Amputação , Angiografia , Biópsia , Embolia/diagnóstico por imagem , Embolia/cirurgia , Feminino , Úlcera do Pé/diagnóstico por imagem , Úlcera do Pé/fisiopatologia , Úlcera do Pé/cirurgia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Interações Hidrofóbicas e Hidrofílicas , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Isquemia/cirurgia , Fluxo Sanguíneo Regional , Dedos do Pé/cirurgia , Resultado do Tratamento
2.
Clin Nucl Med ; 44(8): 655-656, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274615

RESUMO

We report a case of a transient focal MIBI uptake in the late, 90 minutes postinjection phase of a parathyroid scintigraphy in which SPECT/CT imaging proved valuable in delineating the nature of this incidental finding.


Assuntos
Embolia/diagnóstico por imagem , Hiperparatireoidismo/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Feminino , Humanos , Hiperparatireoidismo/patologia , Achados Incidentais , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi
3.
BMJ Case Rep ; 12(4)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015242

RESUMO

Lemierre's syndrome is a potentially severe disease characterised by suppurative thrombophlebitis of the internal jugular vein and subsequent disseminated septic embolisation. The profile of this syndrome declined in the mid-20th century, coinciding with the introduction of antibiotics. Currently, lack of awareness of this condition delays appropriate treatment and worsens prognosis. We report a case of Lemierre's syndrome in a 12-year-old girl.


Assuntos
Veias Jugulares/patologia , Síndrome de Lemierre/diagnóstico , Tromboflebite/complicações , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Conscientização , Criança , Embolia/diagnóstico por imagem , Embolia/tratamento farmacológico , Embolia/microbiologia , Feminino , Fusobacterium necrophorum/isolamento & purificação , Humanos , Veias Jugulares/diagnóstico por imagem , Síndrome de Lemierre/tratamento farmacológico , Síndrome de Lemierre/microbiologia , Síndrome de Lemierre/patologia , Doenças Raras , Tomografia Computadorizada por Raios X , Tonsilectomia/métodos , Resultado do Tratamento , Ultrassonografia Doppler
4.
Ann Vasc Surg ; 59: 102-109, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009717

RESUMO

BACKGROUND: Fenestrated/branched endografts for aortic repair (FB-EVAR) are valid options to treat thoracoabdominal aortic aneurysms (TAAAs). Successful repair requires manipulation of target visceral vessels (TVVs) with possible splanchnic ischemia. The aim of the study was to evaluate the clinical impact of splanchnic ischemia occurring in FB-EVAR for TAAA. METHODS: Between 2010 and 2015, patients with TAAAs undergoing FB-EVAR were prospectively enrolled. Clinical, morphological, procedural, and 30-day data were evaluated. Splanchnic ischemia was defined as the presence of splanchnic ischemic lesions (SILs) visible at perioperative computed tomography angiography. Preoperative, postoperative, and 30-day hepatic/pancreatic/renal laboratory functions were analyzed. End points were incidence of SILs, laboratory splanchnic functions worsening (≥25% of baseline), and presence of related clinical/morphological and procedural risk factors. RESULTS: Thirty-six patients (male: 78%; age: 73 ± 7 years) with 27 (75%) type I-III and 9 (25%) type IV TAAA who underwent FB-EVAR for a total of 127 TVV (branches: 47-60%; fenestrations: 53-67%). Fourteen SILs occurred in 12 (33%) patients: 4 (29%) in pancreas, 3 (21%) in spleen, 2 (14%) in bowel, 5 (36%) in kidney. The cause was embolic in 79% and thrombotic in 21%. No preoperative clinical/morphological data or procedural data were correlated with SIL. Pancreatic, hepatic, or renal function worsening occurred at 24 hr in 16 (44%), 16 (44%), and 9 (25%) cases, respectively. Overall, SILs were associated with increased values of C-reactive protein (CRP) (17.9 ± 0.4 vs. 9.9 ± 9.0 mg/dL; P = 0.03) and bilirubin (1.2 ± 2.3 vs. 1.0 ± 0.5 mg/dL; P = 0.02) at 24 hr. Specifically, SIL of the celiac trunk and superior mesenteric and renal arteries' parenchyma were associated with the significant laboratory function changes 24 hr. SIL of the superior mesenteric artery was associated with increased 30-day mortality (50% vs. 7 %; P = 0.002). Pancreatic, hepatic, or renal function worsening occurred at 30 days in 2 (6%), 0 (0%), and 4 (12%) cases, with similar laboratory tests in patients with and without SIL. CONCLUSIONS: SIL can be frequently detected after FB-EVAR for TAAA and appears mainly of embolic origin. No clinical, morphological, or procedural predictors could be identified in our series. Postoperative laboratory changes of CRP, bilirubin, activated partial thromboplastin time, and amylases are associated with SIL but disappear without clinical consequences within 30 days. However, SIL occurring in the superior mesenteric artery are associated with an increased 30-day mortality.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Embolia/etiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Artéria Mesentérica Superior/fisiopatologia , Isquemia Mesentérica/etiologia , Oclusão Vascular Mesentérica/etiologia , Circulação Esplâncnica , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/fisiopatologia , Implante de Prótese Vascular/mortalidade , Angiografia por Tomografia Computadorizada , Bases de Dados Factuais , Embolia/diagnóstico por imagem , Embolia/mortalidade , Embolia/fisiopatologia , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/mortalidade , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/mortalidade , Oclusão Vascular Mesentérica/fisiopatologia , Estudos Prospectivos , Desenho de Prótese , Fatores de Risco , Trombose/etiologia , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
5.
J Stroke Cerebrovasc Dis ; 28(6): e66-e67, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30930242

RESUMO

Fibrocartilaginous embolism (FCE) is an uncommon cause of spinal cord infarction often misdiagnosed as transverse myelitis. The mechanism of ischemia is suspected to be due to retrograde embolization of nucleus pulposus material originating from Schmorl's nodes to the spinal vessels following acute disk herniation. We describe the clinical and imaging findings of FCE in 3 healthy young women with history of trivial spinal cord trauma, and recommend that FCE should be considered in the differential diagnosis of acute myelopathy.


Assuntos
Doenças das Cartilagens/complicações , Embolia/complicações , Infarto/etiologia , Extremidade Inferior/inervação , Isquemia do Cordão Espinal/etiologia , Medula Espinal/irrigação sanguínea , Extremidade Superior/inervação , Adolescente , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/terapia , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Embolia/diagnóstico por imagem , Embolia/terapia , Feminino , Humanos , Infarto/diagnóstico por imagem , Infarto/fisiopatologia , Infarto/terapia , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/fisiopatologia , Isquemia do Cordão Espinal/terapia , Resultado do Tratamento , Adulto Jovem
6.
J Vasc Surg ; 69(4): 1174-1179, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30777685

RESUMO

OBJECTIVE: The primary objective was to evaluate the safety of transfer, type of procedure, and factors associated with limb salvage in patients with acute limb ischemia (ALI) treated at a quaternary referral center. METHODS: A retrospective review of all patients with ALI secondary to thrombotic or embolic occlusion at a quaternary referral hospital from 2013 to 2016 was conducted. Patients were transferred from throughout Washington and Alaska by ambulance, helicopter, or fixed-wing modes of transportation. Demographics, transport and operative timing, Rutherford classification, level of occlusion, procedural information, and fasciotomy characteristics were reviewed. Outcomes measured included limb salvage rates, discharge disposition, and mortality. RESULTS: One hundred twelve patients with ALI were identified, with 82% due to thrombosis and 18% due to arterial embolization. Fifty-seven percent of patients were transferred from a referring hospital with low mean transfer times (1.9 hours for embolic, 2.7 hours for thrombotic). Although the initial operative strategy varied according to the etiology, with 50% of thrombotic occlusions treated with endovascular therapies and 80% of embolic occlusions treated with open thrombectomy, the rates of limb salvage did not vary based on operative approach (92% endovascular first, 90% open first). Further, limb salvage rates were identical between transferred and nontransferred patients (77%). Limb salvage was successful in 91% of patients with Rutherford class 1 and 2 disease, but only 8% in patients with Rutherford class 3 disease. In-hospital and 30-day mortality rates were not different based on ischemic etiology (5%), although patients with Rutherford class 3 disease had significantly higher mortality rates (15%) compared with patients with class 1 (6%), class 2a (6%), and class 2b (2%) disease. Fasciotomy was performed in 29% of patients, with 59% of fasciotomy wounds closed primarily. Predictors of amputation include multiple attempts at limb salvage, higher Rutherford class, multilevel occlusion, more proximal levels of occlusion, and nonviable muscle seen after fasciotomy, with ischemic times trending toward higher amputation rates without statistical significance. There was no difference in discharge disposition based on ischemic etiology. CONCLUSIONS: The modern treatment of patients with ALI is effective, with high rates of limb salvage and low mortality regardless of transfer status, etiology, or initial operation performed. In situations where compartment syndrome is unclear, fasciotomy should not be withheld because it provides valuable predictive information regarding limb salvage.


Assuntos
Resgate Aéreo , Embolia/cirurgia , Procedimentos Endovasculares , Isquemia/cirurgia , Salvamento de Membro , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Trombectomia , Trombose/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Amputação , Embolia/diagnóstico por imagem , Embolia/mortalidade , Embolia/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Fasciotomia , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/mortalidade , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Trombose/diagnóstico por imagem , Trombose/mortalidade , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
7.
Cardiovasc Pathol ; 40: 12-18, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30769235

RESUMO

INTRODUCTION: Iatrogenic embolization following cardiac investigative procedures may result from hydrophilic polymer emboli (HPE) from catheter valve and vessel wall calcifications, and air embolism from open heart surgery. This retrospective clinical pathologic analysis was undertaken to ascertain the frequency and extent of these potentially fatal complications. METHODS: This retrospective clinical pathologic autopsy analysis with premortem diagnostic imaging correlation identified 110 individuals who had undergone endovascular procedures between 2010 and 2016 within 90 days of death and followed by hospital autopsy. Clinical outcomes, radiologic studies, and autopsy materials were reviewed. RESULTS: Iatrogenic emboli were assessed as causing death in 9/110 autopsy cases (8.2%) and 9/34 (26.5%) cases with proven iatrogenic emboli. Iatrogenic emboli caused strokes in 10/110 (9.1%) autopsy cases including calcified emboli (CE, n=6), HPE (n=2), cardiac valvular tissue (n=1), and air embolism (n=1). Seven cases of calcified emboli complicating endovascular procedures were identified: four of the CE were thought to be the cause of death due to fatal strokes (n=2) and fatal myocardial (n=1) and colonic infarction (n=1). The CE likely originated from calcified aortic valves and atherosclerotic aortic plaques. Histologic evidence of HPE was found in 23% (25/110) of cases; 54% (26/48) showed evidence of infarction in postprocedural imaging, with radiologic evidence of infarction in 32% (8/25) of cases with HPE histology. Endovascular aortic repair was associated with the greatest density/distribution of HPE. HPE material showed degradation with time and was often associated with an inflammatory response. HPE directly contributed to death in three cases. One fatal air embolism followed open heart surgery, and one cardiac tissue embolus resulted in a major stroke. CONCLUSIONS: We advocate for greater awareness of these underrecognized and occasionally fatal complications of endovascular procedures. Targeted postprocedural imaging has a role in the identification of iatrogenic embolic infarcts.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Embolia/etiologia , Procedimentos Endovasculares/efeitos adversos , Migração de Corpo Estranho/etiologia , Doença Iatrogênica , Polímeros/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/complicações , Autopsia , Calcinose/complicações , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/mortalidade , Causas de Morte , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Embolia/diagnóstico por imagem , Embolia/mortalidade , Embolia/patologia , Embolia Aérea/etiologia , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/mortalidade , Migração de Corpo Estranho/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
8.
BMJ Case Rep ; 12(1)2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30696644

RESUMO

A 75-year-old man presenting with intermittent discolouration of his left toes was referred to vascular surgery with suspicion of embolic vascular disease. A contrast-enhanced MR angiogram was performed which revealed bilateral dominant peroneal arteries (PRAs). There was evidence of short atherosclerotic stenosis directly at the point where the left PRA passes through the tibiofibular interosseous membrane which we postulate to be the source of the emboli. We present what is believed to be the first reported case of PRA entrapment complicated by distal toe emboli.


Assuntos
Aterosclerose/complicações , Embolia/complicações , Doenças Vasculares Periféricas/complicações , Artérias da Tíbia/diagnóstico por imagem , Idoso , Aterosclerose/diagnóstico por imagem , Aterosclerose/tratamento farmacológico , Clopidogrel/uso terapêutico , Constrição Patológica , Diagnóstico Diferencial , Embolia/diagnóstico por imagem , Embolia/tratamento farmacológico , Humanos , Perna (Membro)/irrigação sanguínea , Angiografia por Ressonância Magnética/métodos , Masculino , Doenças Vasculares Periféricas/diagnóstico por imagem , Doenças Vasculares Periféricas/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Síndrome , Dedos do Pé
9.
J Vasc Interv Radiol ; 30(1): 43-48, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30527655

RESUMO

PURPOSE: To review preliminary efficacy and safety outcomes of mechanical thrombectomy using the Solitaire AB device combined with thromboaspiration for treatment of acute embolic occlusion of the superior mesenteric artery (SMA). MATERIALS AND METHODS: Between October 2015 and October 2017, 9 patients (average age, 77 y; range, 62-84 y) presenting with acute mesenteric ischemia attributable to embolic occlusion at the stem of the SMA were retrospectively evaluated for mechanical thrombectomy using the Solitaire AB device combined with manual thromboaspiration. Adjunctive stent implantation was performed to correct pre-existing atherosclerotic stenosis or as a rapid recanalization solution after unsuccessful thrombectomy. Technical success was defined as successful deployment of the Solitaire device across the thrombus and successful retrieval of the device. Clinical success was defined as successful embolus retrieval and SMA recanalization. Adjunctive procedures and periprocedural complications were noted. Technical success, clinical success, and follow-up outcomes were assessed. RESULTS: Technical success was achieved in all patients. Clinical success was achieved in 7 (78%) patients. An adjunctive stent was required in 3 (33%) patients, including 1 unsuccessful thrombectomy. All patients had notable relief from abdominal pain after the procedure. No device-related complications or distal embolization events were noted during the procedures. Bowel resection was prevented in all patients. In-hospital mortality was 11% (1/9). During median follow-up of 6 months (range, 3-12 months), all surviving patients remained symptom-free, and stent patency was achieved in all patients. CONCLUSIONS: Preliminary outcomes suggest that mechanical thrombectomy using the Solitaire AB device with manual thromboaspiration is associated with rapid, effective, and safe recanalization for acute embolic occlusion at the stem of the SMA.


Assuntos
Embolia/cirurgia , Artéria Mesentérica Superior/cirurgia , Isquemia Mesentérica/cirurgia , Oclusão Vascular Mesentérica/cirurgia , Stents , Trombectomia/instrumentação , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Embolia/diagnóstico por imagem , Embolia/mortalidade , Embolia/fisiopatologia , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/mortalidade , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/mortalidade , Oclusão Vascular Mesentérica/fisiopatologia , Pessoa de Meia-Idade , Dados Preliminares , Estudos Retrospectivos , Circulação Esplâncnica , Sucção , Trombectomia/efeitos adversos , Trombectomia/métodos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
10.
Kyobu Geka ; 71(13): 1125-1128, 2018 12.
Artigo em Japonês | MEDLINE | ID: mdl-30587756

RESUMO

We report a very rare case of floating thrombus in the thoracic descending aorta (TDA). A 54-yearold man complaining of severe lower abdominal pain was admitted to our facility. Enhanced computed tomography demonstrated a filling defect in the TDA, embolism of the superior mesenteric artery (SMA), and bilateral renal infarction. Transesophageal echocardiography revealed that the mass in the TDA was pedunculated, floating, and multiple with maximal diameter of 30 mm. To avoid bowel necrosis, we proceeded with emergent thrombectomy of the SMA. The TDA, including the mass, was removed en bloc for diagnostic confirmation and replaced with prosthesis under cardiopulmonary bypass for prevention of recurrent embolism. The postoperative course was uneventful. On histological examination, the mass proved to be a blood clot on the atherosclerotic wall. No recurrent thrombosis was observed during the 1-year follow-up period.


Assuntos
Aorta Torácica/cirurgia , Trombose Coronária/cirurgia , Embolia/cirurgia , Trombectomia , Dor Abdominal/etiologia , Aorta Torácica/diagnóstico por imagem , Trombose Coronária/diagnóstico por imagem , Ecocardiografia Transesofagiana , Embolia/diagnóstico por imagem , Humanos , Infarto/diagnóstico por imagem , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Prevenção Secundária
12.
J Stroke Cerebrovasc Dis ; 27(10): 2712-2719, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30033098

RESUMO

OBJECTIVE: To characterize isolated upper extremity (UE) weakness from stroke. METHODS: In our Get with the Guidelines-Stroke dataset (n = 7643), 87 patients (1.14%) had isolated UE weakness and underwent thorough stroke evaluation with diffusion-weighted magnetic resonance imaging and good-quality arterial imaging. We analyzed clinical-imaging features, etiology, management, and outcome. Since isolated UE weakness is typically associated with contralateral hand-knob area infarcts, patients were classified into Group-A (motor strip infarct) or Group-B (non-motor strip infarct). RESULTS: The mean age was 68 years; 66% were male, 72% had hypertension, 22% diabetes, 53% hyperlipidemia, and 16% were smokers. In Group-A (n = 71), 18 patients had single and 53 had multiple infarcts involving the contralateral motor strip. In Group-B (n = 16), 6 patients had contralateral subcortical white matter infarcts, 9 had bihemispheric infarcts and 1 had a brainstem infarct. Compared to Group-B, patients in Group-A more often had carotid artery stenosis or irregular plaque (84.5% versus 50%, P = .006) and large-artery atherosclerosis mechanism (46% versus 19%, P = .05), and less often cardioembolic mechanism (13% versus 44%, P = .008). Among 36 patients with large-artery mechanism, 27 had less than 70% stenosis including 19 with plaque ulceration/thrombus. Recurrent strokes occurred in 10 patients (11.5%), including 5 with mild-moderate carotid stenosis and plaque ulceration/thrombosis, over 1515 days follow-up. CONCLUSION: Stroke mechanism in acute isolated UE weakness is variable. Contralateral motor-strip infarcts are associated with carotid stenosis, often with plaque ulceration ("vulnerable carotid plaque"), and infarcts in other locations with cardioembolism. Recurrent stroke risk is high especially with mild-moderate carotid artery stenosis and plaque ulceration/thrombus.


Assuntos
Isquemia Encefálica/etiologia , Córtex Motor/fisiopatologia , Força Muscular , Debilidade Muscular/etiologia , Músculo Esquelético/inervação , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/terapia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Imagem de Difusão por Ressonância Magnética , Avaliação da Deficiência , Embolia/complicações , Embolia/diagnóstico por imagem , Feminino , Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Atividade Motora , Córtex Motor/diagnóstico por imagem , Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Placa Aterosclerótica , Prognóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Ruptura Espontânea , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Extremidade Superior
13.
BMJ Case Rep ; 20182018 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-29866678

RESUMO

A 43-year-old woman with no known cardiovascular risk factors was admitted with a second episode of ischaemic stroke. She was not a known case of connective tissue disease like systemic lupus erythematosus or antiphospholipid syndrome (APS). During the current episode, she was found to have markedly deranged coagulation parameters and laboratory evidence of microangiopathic haemolysis, but no evidence of sepsis or active bleeding. Further investigation revealed multiple organ infarcts. A diagnosis of probable catastrophic APS was made and she improved dramatically with a combination of plasmapheresis, corticosteroids and therapeutic anticoagulation. Serological markers of APS were negative. Her hospital course was complicated by Libman Sacks endocarditis with significant aortic regurgitation that improved markedly with anticoagulation obviating the need for high-risk cardiac surgery. At discharge, she was stable and well and was advised long-term anticoagulation and rheumatology follow-up.


Assuntos
Síndrome Antifosfolipídica/diagnóstico , Embolia/diagnóstico por imagem , Endocardite/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Corticosteroides/uso terapêutico , Adulto , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/terapia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Encéfalo/diagnóstico por imagem , Doença Catastrófica , Intervenção Médica Precoce , Embolia/etiologia , Embolia/terapia , Endocardite/etiologia , Endocardite/terapia , Feminino , Humanos , Infarto/diagnóstico por imagem , Infarto/etiologia , Nefropatias/diagnóstico por imagem , Nefropatias/etiologia , Plasmaferese , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Recidiva , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/etiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Tomografia Computadorizada por Raios X
14.
J Comput Assist Tomogr ; 42(5): 767-770, 2018 Sep/Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29613995

RESUMO

Perforation of a peptic ulcer into the ventricle is uncommon, and the definitive diagnosis is difficult in living patients. We herein report a case of perforation of a peptic ulcer in a hiatal hernia into the left ventricle with systemic air and food embolism. This is the first case report of the perforation diagnosed by computed tomography and confirmed by autopsy. Computed tomography was useful for the diagnosis of perforation into the ventricle.


Assuntos
Embolia/complicações , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/lesões , Hérnia Hiatal/complicações , Úlcera Péptica/complicações , Perfuração Espontânea/complicações , Idoso , Autopsia , Embolia/diagnóstico por imagem , Embolia Aérea/complicações , Embolia Aérea/diagnóstico por imagem , Evolução Fatal , Feminino , Alimentos , Hérnia Hiatal/diagnóstico por imagem , Humanos , Úlcera Péptica/diagnóstico por imagem , Perfuração Espontânea/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
15.
Vasc Endovascular Surg ; 52(6): 440-447, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29669475

RESUMO

The application of advanced endovascular techniques in very complex femoropopliteal atherosclerotic lesions has shown to expose patients to a higher risk of distal embolization (DE). This complication can affect both the short- and long-term outcomes, leading to worsening ischemia, early minor/major amputation, and longer hospital stay. Recently, there has been an increasing body of evidence on pathophysiology and clinical-radiological management of DE that however has not been systematically addressed by guidelines. The aim of this review was to analyze the current evidence outlining definition and classification, risk assessment, prevention, and management strategies of DE in femoropopliteal endovascular interventions.


Assuntos
Embolia/etiologia , Procedimentos Endovasculares/efeitos adversos , Artéria Femoral , Doença Arterial Periférica/terapia , Artéria Poplítea , Idoso , Angiografia por Tomografia Computadorizada , Embolia/diagnóstico por imagem , Embolia/terapia , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Artéria Poplítea/diagnóstico por imagem , Fatores de Risco , Resultado do Tratamento
17.
Vasc Endovascular Surg ; 52(4): 295-298, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29552944

RESUMO

Bullet embolization to the right heart through the vasculature is seen infrequently in cases presenting with penetrating trauma. Patients with unstable hemodynamic status are managed operatively. For a patient with stable hemodynamic parameters, diagnostic evaluation such as computed tomography angiogram, echocardiogram, or angiography could be performed to select the best treatment option. Endovascular treatment is employed infrequently in these cases but can be a viable option for select patients. We present a case of a bullet embolus to the right ventricle treated successfully with endovascular approach and discuss the technical aspects of this approach.


Assuntos
Cateterismo Cardíaco , Embolia/terapia , Procedimentos Endovasculares , Migração de Corpo Estranho/terapia , Ventrículos do Coração , Ferimentos por Arma de Fogo/complicações , Adulto , Embolia/diagnóstico por imagem , Embolia/etiologia , Veia Femoral/diagnóstico por imagem , Veia Femoral/cirurgia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Venostomia , Ferimentos por Arma de Fogo/diagnóstico por imagem
18.
Vasc Endovascular Surg ; 52(5): 391-394, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29554859

RESUMO

Acute renal artery embolism (RAE) is a rare condition associated with significant morbidity and mortality. The treatment strategy for RAE includes anticoagulation with or without thrombolysis or surgical or endovascular embolectomy. We describe here a case presentation of acute RAE secondary to atrial fibrillation treated successfully with Penumbra Indigo Aspiration System, a novel device in peripheral endovascular interventions. Our patient had ongoing symptoms and acute renal failure on presentation with contraindication to thrombolysis given hypertensive emergency. A 6F Penumbra Aspiration catheter was used to aspirate large amounts of thrombus from segmental renal arteries with restoration of flow. Patient's symptoms and renal function returned to baseline after intervention. Penumbra system is used routinely in cerebral endovascular intervention, yet here we describe its potential use in peripheral vascular interventions in addition to a literature review of all available evidence for the different treatment modalities of acute RAE.


Assuntos
Embolia/terapia , Obstrução da Artéria Renal/terapia , Artéria Renal , Trombectomia/instrumentação , Dispositivos de Acesso Vascular , Fibrilação Atrial/complicações , Angiografia por Tomografia Computadorizada , Embolia/diagnóstico por imagem , Embolia/etiologia , Embolia/fisiopatologia , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/fisiopatologia , Trombectomia/métodos , Resultado do Tratamento , Grau de Desobstrução Vascular
19.
Vasc Endovascular Surg ; 52(5): 361-366, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29519203

RESUMO

Several types of intravascular devices and catheters are frequently used for long-term drug therapy, especially for oncological patients. As a result, complications are becoming increasingly common, namely catheter embolization. Retrieving these devices is important, as embolized fragments may lead to serious consequences, such as arrhythmias, myocardial injury, thrombosis, infection, and even perforation and death. We describe 2 cases of long-term drug catheter (Port-A-Cath) fracture, incidentally documented in a routine chest radiograph. In both cases, percutaneous extraction was attempted, yet the procedure was complicated by embolization of smaller fragments into the arterial pulmonary vasculature. We describe unusual approaches in successfully retrieving the remaining fragments. The ideal approaches for removal of foreign bodies from the cardiovascular system differ from case to case, but percutaneous extraction should be preferred in most of the cases. Less common techniques may be helpful in challenging cases.


Assuntos
Antineoplásicos/administração & dosagem , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Remoção de Dispositivo/métodos , Embolia/terapia , Migração de Corpo Estranho/terapia , Artéria Pulmonar , Dispositivos de Acesso Vascular/efeitos adversos , Administração Intravenosa , Embolia/diagnóstico por imagem , Embolia/etiologia , Desenho de Equipamento , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Resultado do Tratamento
20.
Ann Vasc Surg ; 48: 255.e1-255.e3, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29428532

RESUMO

Cement pulmonary embolism (cPE) and inferior vena cava embolism (cIE) are rare but potentially life-threatening complications of percutaneous vertebroplasty (PVP). Most cPE and cIE occurred simultaneously. In this case, a 65-year-old woman complained of dyspnea after PVP for 4 days. Patient's symptom and image tests manifest that the cPE was secondary to cIE. Although cIE was found at the first day after PVP, the local surgeons treat the patient with a regular anticoagulant without another more effective therapeutic measure. Eventually, the long cement inferior vena cava embolus was broken and result in left pulmonary embolism via the systemic circulation. She was admitted to our hospital and performed with embolectomy surgery by cardiopulmonary bypass and discharged after 7 days. We report this case to show that cIE embolism is still underestimated by some spine surgeons in China, and cIE may be developed to severe cPE during conservation management with anticoagulation.


Assuntos
Cimentos para Ossos/efeitos adversos , Cementoplastia/efeitos adversos , Embolia/etiologia , Migração de Corpo Estranho/etiologia , Embolia Pulmonar/etiologia , Veia Cava Inferior , Idoso , Ponte Cardiopulmonar , Angiografia por Tomografia Computadorizada , Embolectomia , Embolia/diagnóstico por imagem , Embolia/cirurgia , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Flebografia/métodos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Índice de Gravidade de Doença , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
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