The recent appearance of multislice computed tomography (CT) has enabled noninvasive imaging of the coronary artery. Particularly, the appearance of 64-row CT has rapidly promoted its spread into routine medical practice. In this report, progress and current state of coronary CT employing multislice CT are outlined.
Patients with deep venous thrombosis (DVT) of the lower extremities have an increased risk of pulmonary emboli and post-thrombotic syndrome. Traditionally, they are treated medicinally, with anticoagulation therapy. Currently, endovascular therapies, with their higher efficiency, have replaced previously attempted systemic fibrinolytic therapies. There is a continuing controversy in the temporary use of filters in the inferior vena cava during these endovascular therapies, which may include catheter-directed thrombolysis, manual aspiration, mechanical thrombectomy, percutaneous transluminal angioplasty and placement of self-expandable metallic stents. Here, we present an overview of the literature and analysis on the application of prophylactic implantation of an inferior vena cava filter during endovascular therapy for DVT of the lower extremities.
Purpose: Despite advances in therapeutic angiogenesis by bone marrow cell implantation (BMCI), limb amputation remains a major unfavorable outcome in patients with critical limb ischemia (CLI). We sought to identify predictor(s) of limb salvage in CLI patients who received BMCI. Materials and Methods: Nineteen patients with CLI who treated by BMCI were divided into two groups; four patients with above-the-ankle amputation by 12 weeks after BMCI (amputation group) and the remaining 15 patients without (salvage group). We performed several blood-flow examinations before BMCI. Ankle-brachial index (ABI) was measured with the standard method. Transcutaneous oxygen tension (TcPO2) was measured at the dorsum of the foot, in the absence (baseline) and presence (maximum TcPO2) of oxygen inhalation. 99mtechnetium-tetrofosmin (99mTc-TF) perfusion index was determined at the foot and lower leg as the ratio of brain. Results: Maximum TcPO2 (p = 0.031) and 99mTc-TF perfusion index in the foot (p = 0.0068) was significantly higher in the salvage group than in the amputation group. Receiver operating characteristic (ROC) curve analysis identified maximum TcPO2 and 99mTc-TF perfusion index in the foot as having high predictive accuracy for limb salvage. Conclusion: Maximum TcPO2 and 99mTc-TF perfusion index in the foot are promising predictors of limb salvage after BMCI in CLI.
Objective: A modified Bentall procedure with a Carrel patch and inclusion technique (Modified Bentall Procedure) has been used to treat combined disease of the aortic valve and aortic root. The current study examined the outcomes of this surgical technique. Materials and Methods: Between April 1999 and March 2009, 16 patients (10 males, 6 females; 63.3 ± 9.4 years) underwent elective surgery involving the Modified Bentall Procedure and no additional surgery, so they were included in the study. Results: The mean cardiopulmonary bypass time was 140.2 ± 34.4 min (range: 97–232 min), and aortic cross-clamp time was 97.3 ± 16.6 min (range: 76–132 min). There were no hospital deaths. No patients required additional surgery to correct excessive bleeding. The follow-up rate was 100% (16/16). The mean follow-up period was 5.6 ± 2.8 years (range: 0.7–9.9 years). One of the 16 patients died (6.3%) due to lung cancer, and 1 of the 15 surviving patients required additional surgery (6.7%) for a thoracic aortic aneurysm. Kaplan-Meier analysis found that 1-year and 5-year survival and event-free survival rates were all 100%. Conclusions: The Modified Bentall Procedure provided satisfactory results over both the short term and long term.
We described the first case of limb ischemia induced by acute aortic dissection in the patient with previous abdominal aortic aneurysm (AAA) repair. A 56-year-old male was referred for severe limb ischemia. He underwent AAA repair one month before the referral. Computed tomography (CT) scan revealed Stanford type B aortic dissection extended to the proximal anastomosis site of the AAA repair. The false lumen made the complete interruption of antegrade blood flow at the proximal anastomosis site of the AAA repair.
Purpose: To describe a case of successful retrieval of OptEase filter, using the balloon-trapped technique, after failure of its retrieval by the standard techniques. Case report: An 82-year-old man had an inferior vena cava filter placed for deep venous thrombosis prophylactically. Seven days after successful catheter-directed thrombolysis, the filter was retrieved after changing the position to caudal, using a standard angioplasty balloon. The patient was discharged on warfarin anticoagulant. Conclusion: Balloon-trapped removal of the OptEase filter that failed standard retrieval attempt is an effective and safe technique that can be performed using commonly available tools and familiar to most interventionalists.
Here, we report a case of a 59-year-old woman with a coronary-pulmonary artery fistula with a concomitant coronary artery aneurysm, which comprised an anomalous coronary artery originating at the right coronary cusp, an aberrant branch of the left anterior descending artery, and a coronary artery aneurysm draining into the main pulmonary artery. Histopathologically, non-dilated anomalous coronary artery showed the preservation of internal elastic lamina and medial smooth muscle cell phenotype which lacked in the aneurysmal wall. Thus, the disrupted internal elastic lamina and phenotypic change of medial smooth muscle cells might contribute to aneurysm formation in a coronary-pulmonary arterial fistula.
Tuberculous false aneurysm of the aorta is rare and has an unpredictable complication of aneurysm rupture. We report a case of a 32-year old woman who was referred to the Department of Vascular Surgery, Avicenne Hospital for severe abdominal pain. Chest x-ray revealed miliary tuberculosis. Contrast enhanced computed tomography (CT) scan showed a false aortic aneurysm involving the juxtarenal aorta. Antituberculous treatment was started because of high presumption of tuberculosis. Five days later, the patient presented with symptoms of aneurysm rupture. She underwent an emergency a surgical resection of the aneurysm with repair of the aortic wall defect by a Dacron Silver patch. The histopathologic examination of the aortic wall showed features of tuberculosis.
A hybrid approach, combining open and endovascular procedures, may be a less invasive substitute to correct aortic arch pathologies in high-risk patients. We describe an 82-year-old male patient with an atherosclerotic aortic arch aneurysm, which was treated with proximal transposition of all arch branches and endovascular aortic arch repair. During the left common carotid artery reconstruction, oxygen saturation level of the left cerebral hemisphere decreased lower than the safety limit. To re-establish brain perfusion, we installed an external shunt from the right common femoral artery to the left common carotid artery. The oxygen saturation was restored to an acceptably safe level, and the patient tolerated the procedure without any signs of postoperative ischemic stroke.
We report a case of a life-threatening massive hemothorax caused by iatrogenic injury of the right subclavian artery. The patient was successfully treated with placement of a covered stent. During the procedure, occlusion balloon catheters rapidly controlled the massive bleeding.
We report a rare case of mycotic abdominal aortic aneurysm associated with Campylobacter fetus. A 72-year-old male admitted to the hospital because of pain in the right lower quadrant with pyrexia. The enhanced abdominal computed tomography (CT) examination showed abdominal aortic aneurysm (AAA) measuring 50 mm in maximum diameter and a high-density area of soft tissue density from the right lateral wall to the anterior wall of the aorta. However, since the patient showed no significant signs of defervescence after antibiotics administration, so we performed emergency surgery on the patient based on the diagnosis of impending rupture of mycotic AAA. The aneurysm was resected in situ reconstruction using a bifurcated albumin-coated knitted Dacron graft was performed. The cultures of blood and aneurysmal wall grew Campylobacter fetus, allowing early diagnosis and appropriate surgical management in this case, and the patient is making satisfactory progress. This is the fifth report of mycotic AAA characterizing culture positive for Campylobacter fetus in blood and tissue culture of the aortic aneurysm wall.
A 71-year-old man had a right subclavian artery aneurysm (dimension, 30 × 38 mm) that was adjacent to the right common carotid artery and exceedingly close to the right vertebral artery. The patient had a marked hypoplastic left vertebral artery, dominant right vertebral artery, and an incompletely formed and underdeveloped circle of Willis in the skull. While performing a median sternotomy and supraclavicular incision during the operation, we used temporal shunting for the cerebral perfusion. The subclavian artery aneurysm was resected, and a 10-mm diameter woven Dacron graft was used for reconstructing the subclavian artery. The postoperative course was uneventful, and the patient was discharged from the hospital 18 days after surgery. Temporal shunting for maintaining cerebral perfusion was useful in preventing cerebral ischemia, and the median sternotomy plus supraclavicular incision approach afforded an unobstructed view of the surgical field.
A 65-year-old man with sudden back pain was transferred to our hospital by ambulance, who also complained of sensory and motor disorder of bilateral legs on arrival. The neurological disorder was gradually aggravated and paraplegia below the level of Th10 was manifested. Computed tomography demonstrated DeBakey IIIb acute aortic dissection; therefore, the paraplegia was thought to be due to spinal cord ischemia caused by the acute aortic dissection. Emergent cerebrospinal fluid drainage was performed, and it was very effective for the relief from paraplegia.The hospital course after the drainage was uneventful and he was discharged on the 39th day after the onset of symptoms.