Carotid endarterectomy (CEA) is safe and effective in reducing the risk of stroke in symptomatic severe carotid artery stenosis. Having information about cross-clamping (CC) intolerance before surgery may reduce the complication rate. The purpose of this study was to assess the usefulness of magnetic resonance angiography (MRA) and magnetic resonance angiography perfusion (P-MR) in determining the risk of CC intolerance during CEA. Material and methods: 40 patients after CEA with CC intolerance were included in Group I, and 15 with CC tolerance in Group II. All patients underwent MRA of the circle of Willis (CoW), P-MR with or without Acetazolamide; P(A)-MR in the postoperative period. Results: CoW was normal in the MRA in three cases (7.5%) in Group I, and in eight (53%) in Group II. We found P-MR abnormalities in all patients from Group I and in 40% from Group II. Using a calculated cut-off point of 0.322, the patients were classified as CC tolerant with 100% sensitivity or as CC intolerant with 95% specificity. After evaluating P-MR or MRA alone, the percentage of false negative results significantly increased. Conclusion: The highest value in predicting cross-clamping intolerance is achieved by using analysis of P(A)-MR and MRA of the CoW in combination.
Introduction. One of the methods of treating the limbs ischaemia is local intravascular fibrinolysis. The aim of using this method is fast restoration of arteries
Retained neuroprotection filter after carotid stenting (CAS) is an extremely rare complication. We report the case of a 61-year old patient with an accidentally retained neuroprotection filter after urgent CAS. The patient did not consent to open surgical removal of the retained basket. We did not observe any flow disturbances in the filter and the patient remains asymptomatic in ten years follow-up. In some cases, the neuroprotection filter left in the internal carotid artery may not cause cerebral flow disturbances or occlusion of the stent. In case of the poor neurological or general condition of the patient, we can wait for its improvement or stenting.
Introduction. Acute peripheral arterial occlusion is a serious medical condition that requires an immediate action. Delays in diagnosis or treatment could lead to death or serious disability. The appropriate and early clinical evaluation of acute ischaemia is crucial. The goal of therapy for both acute embolic and thrombotic occlusion is reperfusion of the ischaemic organ. Materials and methods. The aim of this study was a retrospective analysis of the demographic and epidemiological data of patients admitted to Surgical Department of Mazovian Brodnowski Hospital in Warsaw from 2014 to 2018 due to displaying symptoms of acute peripheral arterial ischaemia. 208 patients were evaluated. Our analysis included anthropometric parameters, history of cardiovascular and other important chronic diseases, and addictions. The aetiology, localisation, and type of primary surgery were also assessed. Results. The analysed group contained 112 men (53.8%, average age: 67.9 years) and 96 women (46.2%, average age: 76.4). We find a statistically significant correlation was found between epidemiological factors [i.e. age, hypertension, atrial fibrillation (AF), peripheral artery disease, myocardial infarction, and smoking] and gender. Embolic ischaemia occurred in 50.5% of cases. Thrombosis was diagnosed in the remaining 49.5%. Lower extremity ischaemia occurred most frequently (81.3%). Open embolectomy/thrombectomy was the primary surgery in 155 cases. We find significance of the aetiology in relation to the type of intervention and to the ischaemia localisation, but there was no significance in terms of mortality. The presence of ischaemic heart disease, atherosclerosis and tobacco smoking were relevant factors affecting the aetiology of acute ischaemia. Conclusion. Acute arterial ischaemia can occur regardless of gender. Embolic and thrombotic aetiologies occur with a very similar frequencies. Upper extremity arterial thrombosis occurs very rarely. An embolism is more often responsible for acute intestinal ischaemia. In patients with atherosclerosis and a history of previous vascular surgery, the presence of a vascular graft/stent graft is associated with a higher risk of arterial thrombosis. Among patients with AF and who were receiving vitamin K antagonists, the average level of international normalized ratio was non-therapeutic.
Introduction. Acute limb ischaemia (ALI) is a potentially treatable disease of the arteries. ALI can be caused by many factors. A rare cause of ALI is embolisation due to a penetrating aortic ulcer (PAU). The endovascular approach has made progress as an alternative treatment for ALI. However, using only one method of treatment may not be enough to salvage the limb. Case report. We present a case of an iatrogenic, intraoperative embolisation of the lower limb arteries after left external iliac artery (EIA) stenting in a patient with a potential source of embolisation from a PAU. In the treatment process, we performed an elective percutaneous transluminal angioplasty, left EIA stenting, and emergency intra-arterial thrombolysis. The patient was discharged from the clinic in a good condition and without limb ischaemia. After one month, an aortic stent graft was implanted to supply abdominal aortic aneurysm with PAU. Control angiography of computed tomography of the abdominal aorta and lower limb arteries was performed, and a correct stent graft and stent patency in left EIA was demonstrated. Conclusions. Endovascular treatment of acute limb ischaemia may require the use of different techniques to solve the problem, especially in complicated cases. Catheter directed thrombolysis is an effective method of treatment in an iatrogenic, distal embolisation. Stent graft implantation seems to be an effective method of eliminating emboli sourced from the aortic ulcer.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.