1/58. Acute arterial occlusion associated with total knee arthroplasty.Acute arterial occlusion is a rare but limb-threatening complication in total knee arthroplasty. Most of the previously reported cases of this complication required surgical intervention. This report illustrates an unusual case of this complication that was managed conservatively with an acceptable outcome. The case is also indicative of the etiology and the optimal prevention of this complication. In a patient with advanced arteriosclerosis, as indicated by vascular calcification around the knee or in the abdomen, knee arthroplasty should be performed without a tourniquet, and intra-operative manipulation should be done cautiously because of the potential for intimal disruption.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
2/58. 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 = 2.1894166231339keywords = intima, vasorum (Clic here for more details about this article) |
3/58. Histological and ultrastructural features of atherosclerosis in progeria.This histological and ultrastructural study of a limited amount of vascular tissue from a progeric woman of 20 years who died of traumatic subdural hemorrhage supports the belief that the vascular changes are atherosclerotic. The unusual features observed were collagen fibrils with a relatively small diameter in the atherosclerotic intima and media, extensive loss of mural smooth muscle cells particularly in the aorta, and widespread contraction bands in smooth muscle cells in vascular and nonvascular tissues. Smooth muscle cells appear to be unusually susceptible to hemodynamic and ischemic stress. Further autopsy studies are required to elucidate the etiology and pathogenesis of this unique disease.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
4/58. Acute mesenteric infarction caused by small vessel disease.A case of acute mesenteric infarction caused by small vessel disease is reported. The patient recovered after 2 operations by which extensive bowel-resections were performed. The resected bowel showed intimal hyperplasia and atherosclerosis of the small mesenteric arteries. Since also thrombocytosis and increased platelet aggregation was demonstrated the main cause of thrombosis however is supposed to be hypercoagulability.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
5/58. Endovascular treatment of noncarotid extracranial cerebrovascular disease.The last two decades have witnessed a growing application of endovascular techniques for the treatment of atherosclerotic disease of the extracranial vertebral arteries, subclavian arteries, and brachiocephalic artery. Beginning with simple balloon angioplasty, these minimally invasive techniques have now progressed to the use of stent-supported angioplasty. Stent-supported angioplasty is currently providing a therapeutic alternative to traditional methods of open surgery for revascularization of these vessels and increasing the therapeutic options available for patients who have failed maximal medical therapy. Additionally, endovascular techniques are also being used successfully to treat a variety of nonatherosclerotic diseases affecting the noncarotid extacranial arteries, such as inflammatory, radiation, and anastomotic-graft strictures; acute intimal dissection; traumatic and spontaneous arteriovenous fistulas; and aneurysms or pseudoaneurysms. Continued innovation and refinement of endovascular devices and techniques will inevitably improve technical success rates, reduce procedure-related complications, and broaden the endovascular therapeutic spectrum for extracranial cerebrovascular disease.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
6/58. A case of penetrating aortic atherosclerotic ulcer with hemoptysis.A 69-year old Japanese woman with hypertension was admitted because of continuous back pain and recurrent hemoptysis. Radiographic findings showed an enhanced irregular mass, at the aortic arch fed by the tracheal artery, which implied both a penetrating aortic atherosclerotic ulcer and lung cancer. Diagnostic surgery revealed no evidence of cancer but did reveal a rupture of the intima at the distal part of the aortic arch. It is assumed that the transmural oozing occurred after development of the penetrating aortic ulcer, which formed an extra-aortic hematoma and caused surrounding inflammation, and led to tracheal artery feeding. The intramural hematoma might have weakened vascular wall tension from the aorta, and formed an oozing extra-aortic hematoma instead of an acute rupture.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
7/58. Different roles of arteriosclerosis in the rupture of intracranial dissecting aneurysms.AIMS: Although intracranial dissecting aneurysm (IDA) is a newly described variant of the brain aneurysms that affects mainly the vertebrobasilar arterial system, its pathogenesis remains obscure. We aimed to clarify the role of arteriosclerosis in the pathogenesis of IDA based on histopathological findings in seven autopsy cases of IDA. methods AND RESULTS: All cases exhibited systemic hypertension or left ventricular hypertrophy. Macroscopically, all cases exhibited subarachnoid haemorrhage. Two types of dissection were recognized in the vertebral artery. Six of seven IDA cases showed a widespread disruption of the entire thickness of the arterial wall with the formation of a dilated pseudoaneurysm, which consisted of thin adventitia (arterial wall disruption type). Medial disruption of the arterial wall and subadventitial dissecting haemorrhage were also found, resulting in the formation of a false lumen and stenosis of the 'true' lumen of the artery. However, these lesions were connected to the site of rupture of the entire arterial wall. Within 1 day after onset of IDA, the autopsy cases showed formation of fibrin thrombus, marked leucocyte infiltration and necrosis of the arterial wall at the site of the lesion. Cases that survived more than 1 week showed smooth muscle cell proliferation, macrophage accumulation and lymphocytic infiltration in the lesions. These cases showed no atherosclerotic plaque, but non-atherosclerotic fibrocellular intima. The thickness of intima and media was significantly less in the vertebral artery of IDA patients than that of non-IDA patients with systemic hypertension. On the other hand, the remaining case showed severe atherosclerosis with haemorrhage into the lipid core without connection to the arterial lumen (intra-atheromatous plaque haemorrhage type). However, unusual arterioles and neovascularization of the intra-and peri-arterial walls were observed. CONCLUSIONS: Our results suggest that disruption of the entire arterial wall may be a critical event in the development of IDA and result in the medial disruption and subadventitial haemorrhage. Non-atheromatous intima might function as a protective factor in arterial wall disruption. On the other hand, atherosclerosis may predispose to intra-atheromatous plaque haemorrhage type of IDA through intramural haemorrhage originating from the newly formed vessels.- - - - - - - - - - ranking = 3keywords = intima (Clic here for more details about this article) |
8/58. renal artery stenosis: a complication of needle puncture for manometry. Case of subintimal dissection with spontaneous resolution.After aortorenal bypass for renovascular hypertension secondary to atherosclerosis of the renal artery of a solitary left kidney a high-grade stenosing lesion developed distal to the site of insertion of a Dacron graft. In the immediate postoperative period the blood pressure was restored to normal, but one week later hypertension recurred. An arteriogram disclosed an area of stenosis 1 cm distal to the site of insertion of the graft in the renal artery. During the next year, serial arteriograms were made, renal function remained normal, and hypertension gradually abated. One year after the discovery of the postbypass stenosis, an arteriogram showed disappearance of the constricting lesion. The postoperative stenosis was, in all probability, caused by subintimal dissection secondary to needle puncture for strain gauge manometry.- - - - - - - - - - ranking = 5keywords = intima (Clic here for more details about this article) |
9/58. Surgical endovascular stent grafting for a ruptured penetrating atherosclerotic ulcer of the aortic arch.Penetrating atherosclerotic ulcer (PAU) is defined as an atherosclerotic lesion in which an ulceration occurs in the diseased aortic intima leading to disruption of the internal elastic lamina. It may cause a pseudoaneurysm formation or transmural aortic rupture. We describe a patient in whom a ruptured PAU in the distal aortic arch was treated successfully by a surgical endovascular stent graft. Through a median sternotomy and under deep hypothermic circulatory arrest, the aorta was transected between the left common carotid and subclavian arteries. A dacron prosthetic graft with self-expanding original Z type stents attached inside of the distal half was inserted through the aortotomy to exclude the PAU. By performing the procedure through a median sternotomy, we could eliminate dissection around the ruptured aortic wall. The stented graft was secured safely in the thoracic aorta to exclude the ruptured ulceration located distal to the left subclavian artery. PAU should be recognized widely as a distinct cardiovascular surgical problem which may lead to intramural hematoma with or without dissection or rupture.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
10/58. Accelerated atherosclerosis with apolipoprotein(a) and oxidized low-density lipoprotein deposition in acute rejection of transplanted kidney: analogous to atherosclerosis.atherosclerosis is a chronic inflammatory process affecting mainly elastic and muscular arteries. Although small arteries and arterioles are usually spared, atherosclerosis can occur in these small vasculatures for a very short period. Here we report a case of atherosclerosis-like lesions that occurred in a transplanted kidney showing acute accelerated rejection in a 43-year-old man. Histologically, biopsy specimens at 14 and 28 days and nephrectomy material at 52 days post-transplantation showed atherosclerosis-like lesions in various-sized arteries. The lesions were characterized by the intimal infiltration of inflammatory cells, including foamy macrophages and a variable number of t-lymphocytes, with smooth muscle cell proliferation. immunohistochemistry disclosed that the foam cells expressing CD68 contained oxidized LDL. In addition, apolipoprotein(a) (Lp(a)), another major atherogenic lipoprotein, was found in the intimal smooth muscle layer, suggesting that Lp(a) induced smooth muscle cell proliferation in the rejected kidney as a mechanism of atherosclerosis. This case shows that immunoinflammatory reactions during a relatively short period can mimic the chronic atherosclerotic process even in small arteries and arterioles. Furthermore, the deposition of atherogenic lipoproteins, Lp(a) and oxidized LDL in lesions of rejected tissue present an analogy between vascular rejection in transplanted kidney and atherosclerosis.- - - - - - - - - - ranking = 2keywords = intima (Clic here for more details about this article) |
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