Cases reported "Arteriosclerosis"

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1/6. Combined surgery and endovascular stenting for basilar artery stenosis refractory to balloon angioplasty: technical case report.

    The authors report a case of symptomatic basilar artery stenosis treated by stenting via the surgically exposed C1 vertebral artery. This case was initially treated by percutaneous transluminal angioplasty via a transfemoral route but resulted in unsatisfactory dilatation. Stenting via a transfemoral route also resulted in failure because of the coiling of the proximal vertebral artery. Direct puncture of the vertebral artery beyond the coiling portion was tried but a stent could not be delivered beyond the C2 vertebrae. Finally, the vertebral artery was surgically exposed between C1 and the occipital bone and a stent was introduced into the lesion from this portion under fluoroscopic control. The basilar artery was fully opened by stenting without new neurological deficits. Stenting of the basilar artery via a transfemoral route is not always possible even with newer generation stents if the vertebral artery has elongated tortuous curves. Combined surgery and endovascular stenting is one of the alternatives in such cases including our case.
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2/6. 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.
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keywords = puncture
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3/6. Vascular complications of the intra-aortic balloon counterpulsation.

    From September 1994 to December 2002, 6,274 cardiosurgery operations were performed at the Department of Cardiac Surgery, University Hospital, Hradec Kralove, czech republic. Intra-aortic balloon counterpulsation (IABP) was applied in 192 cases (3.1%). From this group of 192 counterpulsated patients 103 were successfully treated (53.6%); 89 counterpulsated patients (46.4%) died from the surgical procedure (30-day mortality rate). In 5 cases (2.6%) from the group of 192, the IABP was introduced before the operation. Ischemic changes of the limb were observed in 11 cases (5.7%). Significant bleeding occurred at the site of puncture in 6 cases (3.1%). dissection of the femoral and iliac arteries was found in 2 patients (1.0%), perforation of the iliac artery in 1 case (0.5%). In 2 cases (1.0%) the balloon was led into the venous system. In case report No. 1 an introduction of the balloon under a sclerotic plaque of the descending aorta and iliac artery is described. In case report No. 2 a placement of the balloon in the venous bloodstream is reported.
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keywords = puncture
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4/6. Pseudoaneurysms after nephrostomy.

    Significant persistent or recurrent bleeding associated with renal arterial pseudoaneurysms was noted in three of 300 nephrostomy procedures. The angiographic diagnosis was made at 9, 6, and 21 days after nephrostomy. The lesions were successfully treated by embolization in two and by intimal dissection in one. The arterial tears were caused by a 16 gauge Teflon-sheathed needle inserted too deeply into the kidney. It is suggested that the lesions can be largely prevented by using only 22 gauge needles for renal puncture and dilating the skinny needle tract by a special guide wire exchanger. A renal angiogram should be obtained promptly if the urine continues to be grossly bloody 3-4 days after nephrostomy. Embolization of a bleeding segmental renal vessel is simple and safe, whereas a conservative approach may lead to severe complications.
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keywords = puncture
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5/6. Atheromatous changes in expanded polytetrafluoroethylene grafts.

    Expanded polytetrafluoroethylene (PTFE) has shown promise as an arterial and venous subsitute. Experimental and clinical reports on its use as a vascular prosthesis have documented excellent tissue incorporation with the development of a thin neointimal lining. We have recovered three PTFE grafts within which atheromatous changes of the neointimal were discovered on pathological examination. Anatomic location, radiographic findings, and special stains differentiated these changes from suture-line neointimal hyperplasia. Two of the three grafts were placed as angioaccess conduits for chronic hemodialysis. The potential for accelerated atherogenesis in chronic renal failure and repeated needle punctures of the grafts may have been contributory factors in these patients. These findings suggest that further evaluation is necessary to determine if PTFE allows for optimal neointimal healing or if, in fact, expanded PTFE has atherogenic potential.
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keywords = puncture
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6/6. Haemorrhage due to laceration of an aberrant inferior epigastric artery during femoropopliteal PTA in an obese patient; a rare complication of a high antegrade femoral puncture.

    Haemorrhage due to laceration of the proximal inferior epigastric artery during femoro-popliteal PTA in an obese 79-year-old woman is reported as a rare complication of a high antegrade femoral puncture. The post procedural haemorrhage was caused by a high antegrade puncture lacerating a low overriding inferior epigastric artery.
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ranking = 6
keywords = puncture
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