A 65-year-old woman, recently diagnosed with diabetes, presented with fever and a warm, pulsatile, tender mass over the medial aspect of her left thigh. She gave a history of diarrhea two weeks earlier. All lower limb pulses were present. CRP was 18.3 mg/l with evidence of neutrophil leukocytosis. Contrast angiography demonstrated a saccular aneurysm in her left superficial femoral artery (SFA). The aneurysm and surrounding infected, necrotic muscle was excised, and the limb was re-vascularized in-situ. Cultures from the aneurysmal wall grew both coliform bacilli and staphylococcus aureus. A mycotic aneurysm of the SFA, following a previous gastroenteritis, harbouring both staphylococcal and coliforms, makes this case unique.
Co-occurrence of acute limb ischemia (ALI) and arteriovenous fistula (AVF) as a manifestation of inadvertent arterial injury during percutaneous femoral vein dialysis catheter insertion is a rare and dangerous, but preventable complication. Iatrogenic femoral AVF commonly presents late, with leg swelling or high output cardiac failure. However, the co-occurrence of a femoral AVF with both progressive leg swelling, and acute thromboembolism has not been previously reported. We report the case of an iatrogenic femoral AVF with superficial femoral artery (SFA) thrombosis and distal embolism in a 53-year-old female who underwent percutaneous femoral access for temporary hemodialysis. Both the SFA and AVF were managed with open surgical repair.
Objective The study aimed to investigate the temporal evolution of markers of skeletal muscle ischaemia reperfusion injury (IRI) to shed more light into its pathogenesis towards finding a clinical therapeutic intervention. P-selectin, Myeloperoxidase and TNF-alpha were selected as markers of IRI based on their role in its pathogenesis. An observational study was conducted on patients with skeletal muscle ischaemia requiring revascularization. Loco-regional venous sampling was performed at 0, +2, +4, +6, +12 and +24 hours post-reperfusion to demonstrate the temporal evolution of surrogate markers of IRI.Results Levels of P-Selectin, Myeloperoxidase and TNF-alpha demonstrated a significant peak elevation during 2h - 4h following reperfusion when compared to baseline values. (P-selectin 59.48pg/ml to 125.91pg/ml, p=0.008; Myeloperoxidase 78.84pg/ml to 116.86pg/ml, p=0.051; TNF-alpha 1.80pg/ml to 34.53pg/ml, p=0.002) All three markers gradually subsided with time and reached baseline pre-perfusion values between 6h – 8h from time of reperfusion. The study suggests that skeletal muscle IRI in humans is associated with an early exaggerated pro-inflammatory response, as supported by increased expression of reperfusion injury markers in the venous effluent. They demonstrate potential for use as markers of IRI for future clinical trials.
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