Popliteal artery injuries, such as arterial occlusion and rupture caused by blunt injuries in the vicinity of the knee joint, are rare. However, when they occur popliteal artery injuries can be serious, frequently requiring leg amputation. In some cases, it has been possible to avert serious complications from myonephropathic metabolic syndrome (MNMS). This is a condition that frequently develops after revascularization due to acute arterial occlusion. By administering postoperative continuous hemodiafiltration (CHDF) it may be averted. This paper reports the authors’ findings on the efficacy of postoperative CHDF. These findings suggest that early administration of CHDF can be effective in averting serious complications from MNMS.
Chronic wounds due to diabetes mellitus (DM) and/or peripheral arterial disease (PAD) often occur in the pedal region peripheral to the ankle. To predict wound healing potential of limb ulcers, skin perfusion pressure (SPP) and transcutaneous oxygen tension (TcPO2) have recently become popular as the parameters that reflect skin microcirculation. On the other hand, ultrasonography for the macrocirculatory vessels has already prevailed widely as the standard vascular investigation. The skin microcirculation peripheral to the ankle probably depends on the macrocirculatory blood flow at the ankle level. Thus, this study aims to estimate whether the blood flow of the anterior tibial artery (ATA) and the posterior tibial artery, at the ankle level, reflect the values of SPP and TcPO2 on the foot. The protocol enrolled 88 patients (122 limbs) with foot ulcers due to DM and/or PAD. The statistical analysis revealed that the sum of blood flow of the ATA and the PTA, at the ankle level, significantly correlated with SPP on the foot. The findings support the availability of conventional ultrasonographic investigation to estimate microcirculation of the foot crucial for wound healing.
A 60-year-old woman with end-stage renal disease on hemodialysis, peripheral artery disease, chronic rheumatoid arthritis, and multi-drug resistant tuberculosis had complained of fever, left inguinal swelling, and pain. The level of CRP was 17.5 mg/dl and computed tomography displayed a left deep femoral artery pseudoaneurysm. We performed an emergency resection of the aneurysm and debridement. On day 5, Helicobacter cinaedi (H. cinaedi) was detected by blood culture. Imipenem-cilastatin was administered for 10 days and the antibiotic was switched to sulbactam-ampicillin for 1 month. There has been no recurrence for a period of 4 months. H. cinaedi could be a source of mycotic aneurysm in immunocompromised patients.
We report a rare case of a pseudoaneurysm of the posterior tibial artery 12 years after non-operative therapy for medial malleolus fracture. The patient was a 44-year-old man. Since December 2009, he had experienced gradually increasing pain and swelling in the left medial aspect of his ankle after playing golf. Twelve years previously, he had received non-operative therapy for left medial malleolus fracture. He consulted our hospital in September 2010. Computed tomography and ultrasonography showed a pseudoaneurysm of the posterior tibial artery. The aneurysm was excised without revascularization, and the postoperative course was uneventful.
We report a rare case of a ruptured aneurysm of a branch of celiac artery diagnosed by overall judgment with 3D-computed tomography (3D-CT). A 69-year-old woman was transferred to our emergency unit complaining of severe abdominal pain with symptoms of shock. Abdominal CT revealed a tumor and a hematoma in the retroperitoneum. Immediately, she was treated conservatively with painkillers, fluid infusion and a blood transfusion. However, she rapidly fell into cardiopulmonary arrest 4 hours after arrival. Finally, we made a diagnosis of a ruptured aneurysm of accessory middle colic artery by 3D-CT.