1/432. Bilateral subclavian steal syndrome through different paths and from different sites--a case report.Cases of cerebro-subclavian steal syndrome have been reported in the medical literature since 1960. This most often occurs on the left side because of the higher rate of involvement of the left subclavian artery in comparison to the other brachiocephalic branches of the aortic arch. With the use of the internal mammory artery as a conduit for coronary artery bypass, in the past three decades increasing numbers of coronary-subclavian steal in addition to the cerebro-subclavian steal have been observed. The authors report a case of bilateral subclavian steal syndrome through both vertebral arteries, the right common carotid artery, and the left internal mammory artery, without significant signs and symptoms of cerebral ischemia or anginal pain.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
2/432. University of Miami Division of Clinical pharmacology Therapeutic Rounds: ischemic renal disease.Ischemic renal disease (IRD) is defined as a significant reduction in glomerular filtration rate and/or loss of renal parenchyma caused by hemodynamically significant renal artery stenosis. IRD is a common and often overlooked clinical entity that presents in the setting of extrarenal arteriosclerotic vascular disease in older individuals with azotemia. IRD is an important cause of chronic renal failure and end-stage renal disease (ESRD), and many patients with a presumed diagnosis of hypertensive nephrosclerosis may actually have undiagnosed ischemic nephropathy as the cause of their ESRD. The primary reason for establishing the diagnosis of IRD is the hope that correction of a renal artery stenosis will lead to improvement of renal function or a delay in progression to ESRD. There are six typical clinical settings in which the clinician could suspect IRD: acute renal failure caused by the treatment of hypertension, especially with angiotensin-converting enzyme inhibitors; progressive azotemia in a patient with known renovascular hypertension; acute pulmonary edema superimposed on poorly controlled hypertension and renal failure; progressive azotemia in an elderly patient with refractory or severe hypertension; progressive azotemia in an elderly patient with evidence of atherosclerotic disease; and unexplained progressive azotemia in an elderly patient. It is important for the clinician to identify IRD, because IRD represents a potentially reversible cause of chronic renal failure in a hypertensive patient.- - - - - - - - - - ranking = 0.4keywords = artery (Clic here for more details about this article) |
3/432. Atherosclerotic aneurysms of the superficial femoral artery: report of two ruptured cases and review of the literature.Isolated arteriosclerotic aneurysms of the superficial femoral artery are rare. In citing the literature a total of 30 cases in 28 patients in the last 25 years were found. In addition to the above cases, two aged patients with ruptured aneurysms of the superficial femoral artery are reported; these were managed successfully with partial aneurysmectomy and restoration of the circulation of the extremity with a synthetic graft. The prognosis for this type of aneurysm following surgical therapy is good, despite the advanced age of the patients, and amputation is relatively rare, occurring in only two out of the 30 aneurysms (6.6%) reported. The risk of rupture is 46.6% (14/30) and is greater than that found in peripheral aneurysms. This, in association with the possibility of the creation of thrombosis (5/30; 16.6%) or embolization (1/30; 3.3%), threatens the extremity itself as well as the life of the patient, increasing the risk of complications and even death at a rate of 66.6% (20/30). Timely diagnosis, immediate surgical reconstruction and prompt mobilization, however, can guarantee a good prognosis for these aged patients.- - - - - - - - - - ranking = 1.2keywords = artery (Clic here for more details about this article) |
4/432. Retrograde embolization during saphenous vein graft angioplasty.angioplasty of degenerated saphenous vein grafts is not infrequently complicated by distal embolization of atheromatous debris. We describe an uncommon case in which balloon angioplasty of an old vein graft to a second diagonal branch of the left anterior descending coronary artery was followed by distal embolization. However, the embolization occurred in a retrograde fashion distal to the anastomotic site, resulting in occlusion of the upstream first diagonal branch. The reasons for its occurrence are discussed, together with suggestions for its recognition.- - - - - - - - - - ranking = 0.2keywords = artery (Clic here for more details about this article) |
5/432. Mediastinal irradiation: A risk factor for atherosclerosis of the internal thoracic arteries.Previous radiotherapy to the thorax is a risk factor for coronary artery disease. patients with radiation-induced atherosclerosis tend to be young and frequently have lesions involving the coronary ostia and left anterior descending artery. Bypass is often the most suitable method of revascularization, and given the young age of the patient, arterial conduits would be considered superior to vein grafts. However, the internal thoracic arteries can lie within the radiation field and may not be free of atherosclerosis. A 40-year-old man who required coronary artery bypass grafting for multivessel coronary artery disease 11 years following radiotherapy for Hodgkin's lymphoma is reported. Preoperative angiography showed that the right internal thoracic artery had significant atherosclerosis and was unsuitable as a conduit.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
6/432. coronary artery bypass grafting in a case with severe aortic atheromatosis associated with abdominal aortic aneurysm.A 69-year-old man with coronary artery disease associated with abdominal aortic aneurysm underwent a one-stage operation utilizing a low-flow cardiopulmonary bypass. Ordinary cardiopulmonary bypass was abandoned as a result of severe atheromatous finding in the entire aorta. However, coronary artery bypass grafting without cardiopulmonary bypass was hazardous as a result of heart enlargement and deteriorating function. Therefore, the abdominal aortic aneurysm was first replaced with a bifurcated graft. coronary artery bypass grafting with two arterial grafts was then performed successfully on the beating heart with the support of a low-flow cardiopulmonary bypass connected to the bifurcated graft.- - - - - - - - - - ranking = 1.4keywords = artery (Clic here for more details about this article) |
7/432. Mobile carotid plaques: the natural history of two asymptomatic and non-operated cases.We studied two cases of mobile internal carotid artery lesions in symptom-free patients. Both cases were diagnosed by means of routine carotid duplex ultrasound scanning, and neither patient was operated on. With medical therapy with oral anticoagulants, the two lesions spontaneously disappeared without any clinical sequel, and no evidence of infarcts was shown by means of repeated computed tomography brain scans. After uneventful 2- and 3-year follow-up periods, there was no evidence of recurrence. This is the first published data on asymptomatic mobile carotid lesions and their natural history that shows a benign course in a long-term follow-up period. We suggest that a non-surgical approach may be considered selectively in high-risk symptom-free patients who have mobile and floating internal carotid artery lesions.- - - - - - - - - - ranking = 0.4keywords = artery (Clic here for more details about this article) |
8/432. Pseudoaneurysm of the internal carotid artery after shrapnel injury in World war II: demonstration by CT angiography with 3D MIP reconstruction.A case of pseudoaneurysm of the left internal carotid artery (ICA) after shrapnel injury is demonstrated by intra-arterial digital subtraction angiography (DSA) and computed tomography angiography (CTA) with subtraction technique. Although the pseudoaneurysm was well demonstrated by intra-arterial DSA, CTA was the only modality to demonstrate the three-dimensional shape of the perfused part of pseudoaneurysm and the aneurysmal neck, which affected the therapeutic strategy. The CTA technique is useful in the assessment of large pseudoaneurysms and for therapeutic planning.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
9/432. Epstein-Barr virus-containing T-cell lymphoma and atherosclerotic abdominal aortic aneurysm in a young adult.Malignant lymphoma infiltrating the abdominal aorta and resulting in an aortic aneurysm has never been documented. We report here a case of angiocentric T-cell lymphoma in a 33-year-old man who for months presented intermittent fever, splenomegaly, and an abdominal pulsatile mass. angiography revealed extensive aneurysmal dilatation of the infrarenal abdominal aorta, bilateral iliac artery, and right common femoral artery. Splenic abscess and infected abdominal aortic aneurysm were initially suspected. An urgent splenectomy and aneurysmectomy with an aortic bifemoral bypass were performed. Pathological examination of the aortic aneurysm showed extensive necrosis, severe atherosclerosis, and lymphoma cell infiltration of the aortic wall. The lymphoid cells in the aorta and spleen were stained positive for CD45RO, CD56, and CD8, but negative for CD4 and CD19. Double-labeling immunohistochemistry and in situ hybridization using EBER1 for Epstein-Barr virus (EBV) revealed positive nuclear staining in the atypical T-lymphoid cells. This is the first definitive proof of peripheral T-cell lymphoma involving the abdominal aorta. Our evidence also supports that the EBV infection of T cells could be responsible for the atherosclerosis and hypertriglyceridemia, and the angiocentricity of the tumor cells apparently results in the presenting atherosclerotic aortic wall destruction, providing an additional causative concept for abdominal aortic aneurysm.- - - - - - - - - - ranking = 0.4keywords = artery (Clic here for more details about this article) |
10/432. Revascularization of occluded internal carotid arteries by hypertrophied vasa vasorum: report of four cases.OBJECTIVE AND IMPORTANCE: The vasa vasorum are involved in the pathophysiological development of carotid artery atherosclerosis, providing vascular support to the thickened intima and plaque. When advanced atherosclerosis causes carotid artery occlusion, the vasa vasorum may serve as a means of revascularization. CLINICAL PRESENTATION: We studied four patients with internal carotid artery occlusion who exhibited revascularization, distal to the occlusion, by small vascular channels that were inconsistent with recanalization through the thrombus. The channels had an angiographic appearance consistent with their being hypertrophied vasa vasorum. Significant collateral circulation was provided by the revascularization. INTERVENTION: All four patients exhibited adequate collateral circulation and were treated with antiplatelet or anticoagulation medication. CONCLUSION: The vasa vasorum have not been previously reported to contribute to the revascularization of occluded arteries. The four cases presented in this report suggest that the vasa vasorum can be a source of collateral circulation after carotid artery occlusion secondary to atherosclerotic disease.- - - - - - - - - - ranking = 0.8keywords = artery (Clic here for more details about this article) |
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