Assessment of carotid artery stenosis and lower limb peripheral ischemia before coronary artery bypass grafting operations: a non-randomized clinical trial

Ali, Ihab; Shokri, Hoda; Jawad, Mohammed Abd Al

doi:10.1186/s13019-020-01340-7

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…Occlusion of both the common iliac artery (CIA) and the external iliac artery (EIA) is indicative of a saddle embolus, a large embolus that straddles the bifurcation of an artery. In this case, the embolus likely originated from the heart, possibly related to the patient's recent CAB and history of DM [4,5,6]. The thrombi removed from the patient's common femoral arteries (CFAs) were likely secondary emboli that further occluded the distal circulation.…”

Section: Discussionmentioning

confidence: 93%

Rare Presentation of Acute Lower Limb Ischemia: Saddle Aortic Embolus with Paraplegia - Case Report

Almadwahi,

Alshujaa,

Al-Hashedi

et al. 2024

Preprint

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Introduction: This case report presents a unique and noteworthy occurrence of acute lower limb ischemia (ALI) accompanied by paraplegia in a 60-year-old male patient with a medical history of diabetes mellitus, hypertension, and ischemic heart disease. The novelty of this case lies in the rare association of ALI with paraplegia, which is an unusual and infrequently reported condition. Case presentation: A patient who underwent coronary artery bypass graft (CABG) surgery presented 12 days post-surgery with sudden onset right lower limb pain followed by paralysis in both lower limbs. Initially, Guillain-Barré syndrome (GBS) was suspected; however, further evaluation revealed occlusion in the abdominal aorta, common iliac artery, and external iliac arteries. The patient's management involved prompt diagnosis, administration of intravenous heparin, bilateral leg fasciotomy, and thrombectomy. These interventions resulted in the restoration of pulses and improvement in the patient's condition. Nonetheless, postoperative complications in the form of acute kidney injury were observed. Conclusions In conclusion, this case highlights the importance of maintaining a broad differential diagnosis when encountering rapidly progressing lower limb paralysis, especially in patients with vascular risk factors. Timely diagnosis and intervention in patients with acute limb ischemia can significantly impact patient outcomes. A multidisciplinary approach involving vascular surgeons, interventional radiologists, critical care specialists, and neurologists is crucial for optimizing patient outcomes in complex scenarios.

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Section: Discussionmentioning

confidence: 93%

Rare Presentation of Acute Lower Limb Ischemia: Saddle Aortic Embolus with Paraplegia - Case Report

Almadwahi,

Alshujaa,

Al-Hashedi

et al. 2024

Preprint

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“…4. Згідно з літературними даними, захворювання периферичних артерій (ЗПА) діагностується у 6,1-20,4 % пацієнтів, шпиталізованих на хірургічну реваскуляризацію міокарда [32,33]. Згідно з європейськими рекомендаціями, першою ланкою діагностики ЗПА з метою скринінгу використовується щиколотково-плечовий індекс, якщо він становить < 0,9 встановлюється ЗПА [16].…”

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“…Передопераційне дуплексне сканування артерій нижніх кінцівок -простий метод діагностики, що впливає на прийняття рішення щодо реваскуляризації та планування кондуїту та дає змогу уникнути виникнення післяопераційної периферичної ішемії та уповільнене загоєння рани кінцівок, а також допомагає спланувати найбільш влучне місце для введення внутрішньоаортального балонного контрпульсатора через стенозовану стегнову артерію. З метою мінімізації ускладнень під час хірургічного втручання необхідно уникати вилучення трансплантата підшкірної вени з ішемізованої нижньої кінцівки, а напередодні планового КШ необхідно проконсультувати пацієнта у судинного хірурга [32].…”

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Comorbidities in Patients before Surgical Myocardial Revascularization: Current State of the Problem. Part IІ

Gogayeva

Lebid²,

Tymoshenko³

2022

ujcvs

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The first part of the article was dedicated to the problem of comorbidities in cardiac surgery patients with coronary artery disease (CAD), considered modern literary sources discussing endocrinopathies, connective tissue diseases, COVID-19-associated autoimmune processes, chronic kidney disease and diseases of the gastrointestinal tract. The aim. To continue the analysis of current literature data on comorbidities in patients hospitalized for surgical myocardial revascularization. Results. When assessing the preoperative status of a cardiac surgery patient with CAD, not only their cardiological status and the percentage of stenotic lesion of the coronary arteries are important, but also the presence of concomitant diseases and the degree of their compensation. According to the modern literary sources, 4-20.5% of patients undergoing coronary artery bypass grafting (CABG) have chronic pulmonary disease (COPD). In order to avoid bronchopulmonary complications in the postoperative period, high-quality preoperative diagnosis based on spirometric research is important. When verifying COPD, even of a moderate degree, a course of preventive therapy is required, and in the case of a severe course of COPD with a forced expiratory volume <50%, the involvement of a pulmonologist is necessary. Hemodynamically marked stenoses of brachiocephalic arteries are found in 6-12% of patients before CABG. According to European recommendations, ultrasound screening of carotid arteries is indicated for patients ≥70 years of age with multivessel lesions of the coronary arteries and a history of neurological disorders <6 months before planned cardiac surgery. Dementia is diagnosed in 9.6-20% of patients before CABG and is characterized by a higher rate of mortality and postoperative complications. It was established that the result of the cognitive function assessment using the Mini-Mental State Examination (MMSE) scale <24 is an independent risk factor for in-hospital mortality and postoperative delirium. Concomitant disease of peripheral arteries is diagnosed in 6.1-20.4% of patients before CABG and negatively affects both immediate and long-term results of myocardial revascularization. Conclusions. Timely verification and compensation of comorbidities is an important point in the perioperative management of cardiac surgery patients with CAD. The systemic nature of the atherosclerotic process leads to multifocal stenotic lesions of the arterial system, which requires from the heart team not only to determine the priority of surgical interventions, but also to choose the optimal method of myocardial revascularization, taking into account comorbidities.

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“…The value of preoperative imaging of the neck vessels and the brain has been studied in patients with multiple atheroma. 10 …”

mentioning

confidence: 99%

“…The value of preoperative imaging of the neck vessels and the brain has been studied in patients with multiple atheroma. 10 Hess and colleagues 11 retrospectively investigated the prevalence of concurrent severe carotid artery stenosis (sCAS) at the time of CABG and its influence on perioperative and follow-up stroke. Stratification was based on 80% stenosis in at least 1 carotid artery evaluated with ultrasonography.…”

mentioning

confidence: 99%

Commentary: Stroke gives me confusion

Mestres

Pereda

2021

JTCVS Open

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Assessment of carotid artery stenosis and lower limb peripheral ischemia before coronary artery bypass grafting operations: a non-randomized clinical trial

Cited by 5 publications

References 25 publications

Rare Presentation of Acute Lower Limb Ischemia: Saddle Aortic Embolus with Paraplegia - Case Report

Rare Presentation of Acute Lower Limb Ischemia: Saddle Aortic Embolus with Paraplegia - Case Report

Comorbidities in Patients before Surgical Myocardial Revascularization: Current State of the Problem. Part IІ

Commentary: Stroke gives me confusion

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