The incidence of cerebrovascular disease (CVD) and postoperative cerebrovascular adverse events in Japanese patients with peripheral arterial disease (PAD) is not well known. We therefore retrospectively investigated 46 consecutive patients with PAD who underwent preoperative screening for carotid and intracranial artery diseases by magnetic resonance angiography (MRA) at our institute between April 2015 and January 2016. MRA revealed abnormalities of cerebrovascular lesions in 37 patients (73.9%), including cerebral infarction in 34, carotid artery stenosis in 27, and cerebral aneurysm in 5. Eight patients (17.4%) required cerebrovascular surgery prior to the surgery for PAD. Postoperative cerebrovascular adverse events were not detected in any of the patients undergoing surgery for PAD in our series. If preoperative screening for carotid and intracranial artery diseases had not been carried out, the affected patients might have developed cerebrovascular adverse events after surgery for PAD. In conclusion, screening for carotid and intracranial artery diseases by MRA may be useful for evaluating cerebrovascular lesions in patients with PAD undergoing elective revascularization surgery.
A 60-year-old man with chronic renal failure was admitted our department with infection of prosthetic loop access in his right forearm. After the infection was cured, we created new blood access. There was a possibility of a relapse of the infection in the right upper limb. His left brachial artery was occluded. There was a rash of Darier’s disease on his trunk, axilla and upper arm. Therefore, we created a loop access using saphenous vein grft at the thigh. During the course, endovascular therapy was necessary. 14 months have passed after the surgery, he died, but was able to perform the dialysis until then.
Even though the anticoagulant treatment for acute deep venous thrombosis has been standard treatment, such treatment, especially for iliofemoral venous thrombosis, imperfectly protects against the occurrence of post-thrombotic syndrome (PST). Therefore, early revascularization procedure should be considered. We herein report a case of acute iliofemoral venous thrombosis treated by catheter-directed thrombolysis (CDT). We suggest that thrombolysis with CDT should be performed in selected patients.