1/10. Multisection CT evaluation of the reoperative cardiac surgery patient.Development of electrocardiographically (ECG) gated multisection computed tomography (CT) has had a significant, immediate impact in cardiovascular imaging. The capabilities of this new technique have become particularly important in the preoperative assessment of the cardiac surgery patient. Cardiac surgery in the 21st century has become increasingly complex because of an aging population needing multiple procedures. As patients live longer, reoperative surgery is often needed, requiring further complicated intervention. Recent research in cardiac surgery patients has linked atherosclerotic disease of the aorta to the risk of perioperative stroke. Multisection CT has been effective in evaluations of the atherosclerotic aorta, minimizing perioperative stroke risk in these often elderly patients. By using the capabilities of ECG gating, improved CT imaging of the aortic valve has helped guide the surgeon in decisions of aortic valve replacement. Injury to preexisting coronary artery grafts is associated with significant perioperative morbidity and mortality. The superior imaging features of ECG-gated CT have enabled preoperative identification of coronary grafts, preventing injury to these important structures during reoperative surgery. Assessment of normal anatomic structures is also important in preoperative planning. Proximity of the aorta, pulmonary artery, and native coronary arteries to the sternum is an important potential cause of morbidity and mortality, and it can be preoperatively assessed with multisection CT. The advancement of ECG gating has enabled accurate assessment of the coronary arteries, which is particularly important in the preoperative identification of congenital and acquired abnormalities. With continued advances, ECG-gated multisection CT will play an increasingly important role in the evaluation of patients with cardiovascular disease.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/10. Clinical outcome of standard extracranial-intracranial bypass surgery in patients with symptomatic atherosclerotic occlusion of the internal carotid artery.OBJECTIVE: In this retrospective study we wanted to determine the role of cerebral revascularization in patients with symptomatic occlusive cerebrovascular disease. Special emphasis was put on subsequent cerebrovascular events, benefit in neurological functioning and bypass patency, as evaluated during the follow-up period. methods: A total of 73 superficial temporal artery to the middle cerebral artery bypasses were performed on 67 patients from 1986-2000. All patients exhibited a symptomatic occlusion of the internal carotid artery verified by angiography. All patients in our group were refractory to medical treatment. 65 patients (69 bypasses) with a mean age of 61 years (range: 38-79 years) were followed up over an average time of 44 months (range: 1.5-150 months). RESULTS: The peri-operative morbidity rate was 3% with no mortality. 55 patients (85%) had no further cerebrovascular events after surgery, and only 7 (11%) patients experienced another cerebrovascular event. 57 (88%) patients showed an improvement of symptoms after surgery and only 1 patient fared worse during the follow-up period due to a stroke he suffered two years after bypass surgery. 90% of all bypasses remained patent during the follow-up. CONCLUSIONS: Although bypass surgery for occlusive cerebrovascular disease is still controversial, our retrospective study suggests both an improvement of symptoms and signs and a risk-reduction for future cerebrovascular events after surgery.- - - - - - - - - - ranking = 2keywords = vascular disease (Clic here for more details about this article) |
3/10. Occult stenosis of the common carotid artery complicating mandibular reconstruction with a fibular free flap.An unsuspected severely stenosed common carotid artery that compromised a free flap for mandibular reconstruction is described. To our knowledge no one has advocated the assessment of the carotid tree before transfer of free tissue. We suggest that patients with several risk factors for peripheral vascular disease should have colour flow duplex imaging of the carotid system if transfer of free tissue is being considered.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/10. Iatrogenic entrapment: femoro-popliteal vein bypass graft.A rare cause of occlusive vascular disease is the "popliteal artery Entrapment syndrome." The most common cause of this problem is abnormal position of the popliteal artery caused by abnormal migration of the medial head of the gastrocnemius. An acquired form can occur because of tunneling defects by inadvertent placement of venous bypass graft medial to the medial head of the gastrocnemius muscle. We present 2 cases of iatrogenic entrapment of the femoropopliteal bypass graft. Investigations revealed compression of the graft with extension of the knee. Both cases were treated surgically. Intraoperatively there was evidence of compression of the graft between the tendons of the semitendinosus and the gracilis muscles and the medial head of the gastrocnemius muscle. Treatment involved division of the medial head of the gastrocnemius in 1 patient, and in the other, the tendons of gracilis and semitendinosus were divided. No compression of the graft was noted postoperatively by noninvasive test. No significant mobility issues caused by the division of muscle or the tendons were present in the postoperative period.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/10. Successful angioplasty of a chronically occluded saphenous vein graft using a prolonged urokinase infusion from the brachial route.A 68-year-old man who presented with unstable angina had had cardiac bypass surgery 12 years earlier and successful angioplasty of a native circumflex lesion 18 months previously. Repeat catheterization showed a widely patent angioplasty site but interval closure of a saphenous vein graft to a large marginal branch that was totally occluded proximally. A stress test revealed significant myocardial ischemia. Severe peripheral peripheral vascular disease with known bilateral iliac artery occlusions mandated a brachial approach. Because of his high risk for repeat cardiac surgery, it was elected to attempt saphenous graft angioplasty following a prolonged urokinase infusion. After an infusion of urokinase for 36 hr, antegrade flow was restored and angioplasty was carried out successfully on a discrete mid-graft legion. Subsequent stress testing showed resolution of the ischemia. There were no vascular complications.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/10. thrombosis of axillary-femoral bypass secondary to prosthesis suspension belt.patients with peripheral vascular disease and lower extremity amputation frequently undergo arterial bypass surgery to salvage the opposite leg. Compression of axillary-femoral bypass grafts can occur from a variety of causes. The primary physician should monitor graft pulses closely. Compression should be avoided by using forearm crutches instead of axillary crutches. Waist belts for prosthetic support should not be used, and alternatives such as a thigh corset or shoulder suspension should be used. The patient should avoid sleeping on the graft, using a wrist restraint when necessary. If the patient gains weight, garments should be adjusted so as not to be constricting. upper extremity exercises, particularly in should abduction and extension, should not be so vigorous as to put tension on the graft. A 77-year-old woman with a left below-knee amputation underwent an axillary-femoral bypass for right lower extremity arterial insufficiency which subsequently thrombosed due to compression by the waist belt of her below-knee prosthesis. A series of guidelines are outlined, so that the physiatrist can help maintain graft patency, prolong limb salvage, and avert similar complications in such patients.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
7/10. Axillary-femoral graft compression by prosthetic belt.In severe peripheral vascular disease, a patient may need not only an amputation but an axillary-femoral bypass. In order to prevent the potential problem of axillary-femoral graft compression by a prosthetic belt, the importance of amputation length is stressed in this case report discussion.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
8/10. Ischemic monomelic neuropathy: an under-recognized complication of hemodialysis access.During the past 3 years six episodes of ischemic monomelic neuropathy (IMN) have been identified in five patients as a complication of upper extremity dialysis grafts. All patients had long-standing insulin-dependent diabetes, peripheral neuropathy, and brachial artery graft origins, whereas 60% had peripheral vascular disease. Five episodes occurred immediately after graft placement, whereas one was due to a graft-related thromboembolus. Diagnostic delay was common with initial findings attributed to anesthesia, positioning, or surgical trauma. Electrophysiologic studies showed underlying diabetic neuropathy with severe multifocal neuropathy distal to the grafts. Digital pressure indices were reduced but there was no critical ischemia. In three cases ischemia was completely corrected with improvement in one. One patient had proximal balloon angioplasty with no improvement and of the two untreated patients, one improved slightly. Ischemic monomelic neuropathy is a rare but disabling complication of dialysis access in diabetic uremic patients. Its occurrence is unpredictable and diagnostic delay is common. Correction of ischemia is indicated but usually does not improve the neuropathy. Prevention requires further research to more accurately characterize the patients at risk.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
9/10. Intraoperative arterial occlusion in total joint arthroplasty.Major arterial occlusion during surgery is an uncommon complication. The authors report on two patients who developed intraoperative arterial occlusion during total joint arthroplasty. Both of the patients were smokers and had significant peripheral vascular disease.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
10/10. Successful use of the right brachial approach to perform directional atherectomy of the left coronary artery.Although directional coronary atherectomy permits the treatment of complex coronary lesions, its use is limited in patients with peripheral vascular disease by the need to use a large guiding catheter. We describe a patient in whom the right brachial approach was successfully used to perform atherectomy of a semi-protected left main coronary stenosis.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
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