1/16. Embolized ischemic lesions of toes in an afibrinogenemic patient: possible relevance to in vivo circulating thrombin.Fibrinogen plays a complex role in hemostasis, thrombosis, and vascular disease. Hyperfibrinogenemia is an independent vascular risk factor and dysfibrinogenemia can provoke thrombosis. afibrinogenemia is usually responsible for hemorrhagic diathesis, and unexpected ischemic lesions are intriguing. We report the case of an afibrinogenemic patient, who at the age of 30 developed ischemic lesions of the feet related to severe stenosis of the iliac and hypogastric arteries. The biopsy of the iliac artery lesion showed an intense myointimal hyperplasia. We performed standard hemostatic analysis and analyzed the activation markers of platelets and coagulation factors and the kinetics of thrombin generation in the patient and in normal control plasmas treated or not with reptilase. Occlusive arterial lesions were attributed to a disruptive hematoma penetrating the vascular lumen. Thrombin concentration after calcium addition increase markedly in the afibrinogenemic patient and in defibrinated normal plasma, as compared to untreated normal plasma. Thrombin-antithrombin complexes (T-AT) were markedly enhanced while F1 2 prothrombin fragments stayed in the normal range. These results suggested activation of coagulation and in vivo circulating thrombin. Thrombin activates the platelets that secrete growth factors for smooth muscle cells and generate the intimal hyperplasia. Recurrent hemorrhage within the vessel wall might induce injury and local thrombin generation. Thrombin not trapped by the clot is available for platelet activation and smooth muscle cell migration and proliferation. The absence of a protective fibrin cap on the intima might account for intima vulnerability and embolization. afibrinogenemia appears in this paradoxical situation as a vascular risk factor.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/16. Vascular occlusions in the eye from cardiac myxomas.Vascular occlusion in the eyes from cardiac myxomas was diagnosed in two cases, belatedly in one and not until after death in the other. Suspicion of a myxomatous origin should be aroused by the combination of unexplained retinal (or choroidal) vascular disease occurring with multifocal neurological symptoms and with systemic symptoms suggesting atypical subacute bacterial endocarditis. The first patient had unilateral retinal artery occlusion by embolic material believed to have been myxomatous. Removal of the cardiac myxoma resulted in disappearance of this material (although the eye remained blind). The second patient who had had evidence of retinal artery occlusion in the clinical course of her multisystemic disease was found at autopsy to have extensive myxomatous involvement of the posterior ciliary arteries and of the choroidal arteries of both eyes and of the retinal artery in one eye.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/16. Efficacy of dual antiplatelet therapy in cerebrovascular disease as demonstrated by a decline in microembolic signals. A report of eight cases.BACKGROUND: The presence of microembolic signals (MES) may indicate an increased risk of recurrent ischemic events in patients with stroke. The optimal management of such patients is uncertain. We report the effect of clopidogrel in addition to aspirin on the number of MES in a series of patients with ischemic stroke and transient ischemic attack (TIA) due to large-vessel disease. methods: 8 patients with either extracranial or intracranial artery stenosis were identified in 30-min MES studies by transcranial Doppler sonography as having MES. All patients were on antiplatelet therapy prior to baseline transcranial Doppler monitoring. The patients were subsequently treated with clopidogrel in addition to aspirin. Repeat MES studies were performed between day 3 and 7 with aspirin and clopidogrel. RESULTS: All patients were Chinese. The median interval time from symptom onset to initial MES study was 7 days (range of 2-30). MES donor sites included 4 severely stenosed or occluded internal carotid arteries and 4 stenosed middle cerebral arteries. The median MES number at baseline was 8 (range 3-51). Repeat MES studies showed a significant decrease in MES (p = 0.012, Wilcoxon signed ranks test). 4 patients had complete cessation of MES and all patients showed a decline in MES. No patient had recurrent strokes or bleeding complications. CONCLUSION: The rapid and significant decline of MES in our stroke and TIA patients suggests the possible efficacy of dual antiplatelet therapy with aspirin and clopidogrel in patients with MES and symptomatic large-artery occlusive disease. Randomized controlled trials should be conducted to confirm this preliminary observation.- - - - - - - - - - ranking = 4keywords = vascular disease (Clic here for more details about this article) |
4/16. Atheroemboli to the lower urinary tract: a marker of atherosclerotic vascular disease--a case report.Atheroemboli to the lower genitourinary tract may serve as a marker for disseminated atheroembolic disease, a highly lethal condition. A case presentation and review of our institional experience is presented.- - - - - - - - - - ranking = 4keywords = vascular disease (Clic here for more details about this article) |
5/16. Embolic anterior ischemic optic neuropathy.The presumed cause of anterior ischemic optic neuropathy is atherosclerotic vascular changes. Small-vessel occlusive vascular disease most likely causes occlusion of one or more posterior ciliary arteries, compromising blood flow to the optic nerve head and choroid. We present the case of a 59-year-old black man with cholesterol emboli within the retinal vasculature combined with a clinical picture of anterior ischemic optic neuropathy and choroidal nonperfusion demonstrated by i.v. fluorescein angiography. We believe this is evidence that, in a rare case, embolic phenomena may be the cause of anterior ischemic optic neuropathy.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/16. cholesterol emboli after cardiac catheterization. Eight cases and a review of the literature.cholesterol embolization is a puzzling event that may be increasingly iatrogenic in origin. diagnosis is difficult and requires a high index of suspicion, an appropriate clinical picture, and usually, confirmation by biopsy. Certain laboratory abnormalities may be helpful; the elevated sedimentation rate and relative eosinophilia found in our patients concurs with other cases reported in the literature. prognosis is related to the extent of systemic involvement, but renal disease is particularly threatening and gangrene and infection can be lethal. Multiple therapeutic regimens have been generally unsuccessful in altering the course of the disease process. The most significant impact on the disease can be made by its prevention. cholesterol emboli occur spontaneously, but also after invasive aortic procedures such as diagnostic angiography or cardiovascular surgery. In addition, cardiac catheterization and percutaneous transluminal coronary angioplasty have the potential for arterial trauma and consequent cholesterol embolization. Although the apparent increasing numbers of cholesterol emboli may be a reflection of the increased use of arterial invasive procedures, they are being performed on an older, more severely ill population, with other risk factors for the development of embolic phenomena, i.e., age, smoking history, diabetes mellitus, hypertension, and peripheral vascular disease. Our observed cases and review of the literature do not furnish information concerning the comparative incidences of embolization as related to the suggested etiologies. Careful documentation of the clinical situation preceding the event, the type of procedure, the site of arterial entry, and the duration, difficulty, and extent of the intravascular invasion (i.e., above or below the left subclavian artery) are necessary for this purpose. Such data should help to develop guidelines for patient and procedure selection in order to minimize the possibility of cholesterol embolization.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
7/16. Bilateral renal artery embolism: a diagnostic and therapeutic problem.A case of bilateral renal artery embolism in a patient occurring after coronary artery bypass operation is reported, describing the diagnostic techniques and therapeutic aspects of management of this unusual disease. The diagnosis should be suspected in patients with underlying cardiovascular disease who have acute renal failure.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
8/16. renal artery thrombosis and embolization associated with intravenous cocaine injection.I have described a young man with unilateral renal artery thrombosis and embolization temporally related to the intravenous injection of cocaine. patients with underlying vascular disease may be risking cardiovascular complications from recreational or medical use of cocaine.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
9/16. Spontaneous bladder rupture owing to atherosclerotic emboli: a case report.We report a case of spontaneous intraperitoneal rupture of the bladder in an elderly man with severe atherosclerotic vascular disease who had widespread systemic evidence of an arterial embolic phenomenon after elective abdominal aortic aneurysm repair. Atherosclerotic plaques were identified in the vesical arteries and were believed to be the primary event responsible for spontaneous vesical perforation. The clinical presentation, diagnosis and principles of management of vesical rupture are discussed.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
10/16. ischemia of the upper extremity due to noncardiac emboli.Nine cases of microemboli of arterial origin to the upper extremity are reported. The source of emboli in five of these cases was in the subclavian artery compressed by osseous anomalies in the thoracic outlet. Three aneurysms, one in a subclavian vein graft and two traumatic false aneurysms in the hand, were also noted to be the sources of distal emboli. One unproved case of emboli from an atherosclerotic plaque of the subclavian artery is also reported. Chronicity of symptoms and delay in operation are often noted and lead to difficulties in surgical management. The compressing osseous structures causing the vascular lesion in the thoracic outlet syndrome must be resected, along with removal of the source of emboli. Cervicodorsal sympathectomy is often needed in cases of extensive thrombosis and/or long-standing ischemia. embolectomy is usually a futile procedure when the main arterial trunk contains old, organized thrombus. Differential diagnostic problems between collagen vascular disease, vasculitis, vasospastic disease, and microembolic disease in cases of unilateral Raynaud's phenomenon are pointed out.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
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