1/154. Acute neoplastic arterial embolism after pneumonectomy.Intra-arterial tumour embolism after pneumonectomy is a known but rare complication. It arises because of tumour involvement of pulmonary veins. Usual outcome of this complication is grave when embolism is to a major vessel. If embolism occurs in a peripheral circulation, timely intervention can avoid significant morbidity. We report a case where embolisation occurred in both the femoral arteries. Emergency embolectomy was done successfully avoiding major complication.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
2/154. Asymptomatic unilateral microembolic retinopathy secondary to percutaneous transluminal coronary angioplasty.BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA) for the treatment of coronary artery disease has increased in frequency as technological advances have made the procedure more effective and cost-efficient. In spite of the number of procedures that have been performed, ocular complications have rarely been reported. CASE REPORT: A case of asymptomatic unilateral microembolic retinopathy one month after PTCA is presented. Embolic events to the retinal circulation and their relationship to invasive cardiac procedures is discussed. CONCLUSIONS: The embolic ocular complications of PTCA is probably underestimated due to the lack of symptoms from the partial occlusion of the larger retinal arteries and the total occlusion of the remote smaller vessels.- - - - - - - - - - ranking = 19.326323123109keywords = coronary, circulation (Clic here for more details about this article) |
3/154. death during percutaneous transluminal coronary angioplasty (PTCA) and the medicolegal aspects.Coronary embolisation is a very rare complication of the clinically widespread method of percutaneous transluminal coronary angioplasty (PTCA). The well-documented case of a 64-year-old male patient is presented comparing angiographic and morphological findings. The occluded left anterior descending artery (LAD) was successfully dilated during PTCA. Simultaneously the circumflex artery showed acute occlusion. The patient fell into cardiac shock and died after attempted resuscitation and agonal installation of extracorporeal circulation. The autopsy revealed severe residual stenosis of the proximal LAD by parietal thrombosis and occlusion of the proximal circumflex artery by an unattached intraluminal thrombus (0.8 x 0.3 x 0.2 cm) which had been dislocated during PTCA. autopsy thus confirmed the clinical presumption of coronary embolism and, in addition, disclosed a previously unknown perforation of the femoral artery which had occurred during agonal installation of extracorporeal circulation and contributed to death via severe retroperitoneal hemorrhage. The case is discussed under the aspects of clinical quality control by forensic pathological investigations.- - - - - - - - - - ranking = 20.326323123109keywords = coronary, circulation (Clic here for more details about this article) |
4/154. Intraoperative acute occlusion of aortic bifurcation during extracorporeal circulation.A 36-year-old male patient showed a significant decrease of arterial pressure in the lower extremities during coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC). arterial pressure measured in the femoral artery fell to 10-20 mmHg at the end of ECC, whereas in the upper extremities arterial pressure levels were normal. At the end of the surgery a complete ischemia of both lower extremities was observed. We suspected Leriche's syndrome and performed a successful aortic embolectomy through bilateral femoral arteriotomies immediately. An insufficient anticoagulation could be excluded by prolonged "activated clotting time" (ACT), therefore we presumed that the source of embolus was a small aneurysm of the left ventricle. The shape and superficial structure of the extracted embolus, which was partly covered with endocardium, confirmed our suspicion. No complications occurred throughout the postoperative period. On the 10th postoperative day, the patient left our department for postoperative rehabilitation with a normal perfusion of the lower extremities.- - - - - - - - - - ranking = 8.0543871871848keywords = coronary, circulation (Clic here for more details about this article) |
5/154. Peripheral arterial embolization: Doppler ultrasound scan diagnosis.Use of intraoperative monitoring with transcranial Doppler scanning during carotid endarterectomy has enabled identification of embolus signals in the ultrasound spectrum. Extension of this technique to preoperative screening has enabled identification of actively embolizing lesions and correlation with neurologic deficits. We report embolus signals in the peripheral circulation before operation, which aided diagnosis and decision to operate. The patient had been transferred from another institution after multiple revascularization procedures, including posterior tibial artery thrombectomy. Angiography performed on arrival at our institution confirmed an open bypass graft, although a small indentation was noted at the site of the previous posterior tibial artery thrombectomy. Runoff was intact to the plantar arch where there was attenuation of that vessel and occlusion of most digital branches. Duplex monitoring revealed no embolic signals in the graft or in the posterior tibial artery proximal to the previous arteriotomy. Distal to this site, embolic signals were detected. At the time of operation, a large platelet thrombus was identified at the site of the previous arteriotomy, and platelet thrombus was obtained from the plantar artery. It is concluded that doppler ultrasound scanning enables detection of peripheral embolization and the identification and location of lesions with such embolic activity. Diagnostic accuracy may be improved when there is clinical suspicion of embolization, enabling better patient selection for surgical procedures. This report provides the first clinicopathologic characterization of the emboli detected.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
6/154. Ocular massage in a case of central retinal artery occlusion the successful treatment of a hitherto undescribed type of embolism.BACKGROUND: The pathogenesis of central retinal artery occlusions (CRAO) varies, depending upon the underlying disease. An embolic origin of an occlusion often occurs. PATIENT AND methods: A 50-year-old man with an occlusion of the left internal carotid artery was examined because of a left central retinal artery occlusion. fluorescein angiography revealed that in no blood vessel could any circulation of blood be demonstrated. The slight vascular filling with dye mainly came from collateral circulation at the disc. RESULTS: Ocular massage was carried out. After a delay of several minutes, the vessels of the fundus became increasingly filled with blood. The patient noticed continuing recovery in the vision of his left eye. During fluorescein angiography, carried out one day later, white embolic clots appeared in the arteries of the papilla, some of them moving with the velocity of the blood flow through the retinal vessels and reaching the periphery of the retina and immediately disappearing. Others moved more slowly. This was seen repeatedly over several minutes. CONCLUSIONS: In this patient we have recorded in a fluorescein angiogram bright boluses visible in the blood of the retinal arteries. We suggest that conglomerations of blood cells can also cause an obstruction of blood flow. The observation of this kind of bright clots (boluses) visible in the blood of the retinal arteries we did not find described in the literature. In such a situation ocular massage is extremely helpful. Therefore, ocular massage should be carried out in every patient with CRAO.- - - - - - - - - - ranking = 2keywords = circulation (Clic here for more details about this article) |
7/154. Community-acquired methicillin-resistant staphylococcus aureus endocarditis with septic embolism of popliteal artery: a case report.A 20-year-old man presented with a 14-day course of fever. physical examination showed petechiae of the conjunctivae, Janeway lesions on both hands, a grade III/VI systolic murmur over the apex, pulseless dorsal pedal artery and posterior tibial artery of the right leg, and a pale right foot. Femoral arteriogram of the right leg revealed total occlusion of the popliteal artery with collateral circulation of the posterior tibial artery. Transthoracic echocardiogram showed trace mitral regurgitation. embolectomy of the right popliteal artery was done, and penicillin and gentamicin treatment was administered. However, postoperative fever developed intermittently. Transesophageal echocardiogram disclosed vegetation over the anterior leaflet of the mitral valve. methicillin-resistant staphylococcus aureus (MRSA) was isolated from all three cultures of blood drawn at admission and from the septic embolus during operation. He had neither evidence of underlying heart disease, nor history of intravenous drug abuse or hospitalization. Exploratory cardiotomy with removal of vegetation on the mitral valve was performed followed by a 4-week treatment with intravenous vancomycin. After discharge, he was well at 2-year follow-up.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
8/154. hearing loss after cardiopulmonary bypass surgery.hearing loss (HL) is a rare complication following cardiac surgery with extracorporal circulation (CSWEC) or other non-otologic surgery under general anesthesia, as is HL caused by loss of cerebrospinal fluid during neurosurgery or spinal anesthesia. The incidence of HL after CSWEC is not known since preoperative hearing testing is not commonly done and a perioperative HL may occur unnoticed. We present four cases of profound sensorineural hearing loss following CSWEC for coronary artery bypass or cardiac valve surgery. The hearing loss was noticed immediately on waking from anesthesia in three of the patients, whereas the fourth patient noticed decreased hearing during the first postoperative week. In all patients audiological investigation suggested a cochlear etiology of the HL. The possible mechanisms for HL are discussed. HL after CSWEC is most likely caused by a microembolism generated by atheromatous material.- - - - - - - - - - ranking = 4.0543871871848keywords = coronary, circulation (Clic here for more details about this article) |
9/154. An unusual cause of femoral embolus.Acute lower limb ischaemia is associated with high morbidity and mortality. The authors describe an unusual cause of arterial occlusion two weeks following aorto-coronary bypass surgery. This case should make vascular surgeons aware of the possibility of prosthetic materials acting as emboli. Furthermore, they should also be mindful that the presenting symptom may be at a site and time remote from the original intervention.- - - - - - - - - - ranking = 3.0543871871848keywords = coronary (Clic here for more details about this article) |
10/154. balloon occlusion and transluminal aspiration of saphenous vein grafts to prevent distal embolization.Distal embolization is a common complication of percutaneous intervention in saphenous vein grafts. This may lead to the "no reflow" phenomenon and subsequent myocardial infarction. We describe a case in which we occluded the distal portion of a saphenous vein graft with a balloon to prevent distal embolization, performed percutaneous transluminal coronary angioplasty, and then successfully aspirated the particulate debris with a Dorros/Probing catheter.- - - - - - - - - - ranking = 3.0543871871848keywords = coronary (Clic here for more details about this article) |
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