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1/32. Ruptured distal aortic arch aneurysm associated with arteriosclerosis obliterans.

    A 73-year-old man with a ruptured distal aortic arch aneurysm into the pericardial space, mediastinum and right pleural space is described. The patient underwent a successful total aortic arch replacement using deep hypothermia, systemic circulatory arrest and selective cerebral perfusion. extracorporeal circulation was established with right axillar arterial perfusion due to arteriosclerosis obliterans (ASO). Presentation and management are discussed. ( info)

2/32. Vascular backache and consideration of its pathomechanisms: report of two cases.

    We experienced two cases whose low back pain was improved after vascular reconstructive surgery for arteriosclerosis obliterans in the abdominal cavity. Based on these observations, we propose the term "vascular backache" and we discuss possible pathomechanisms underlying this condition. One patient had a stenotic lesion in the lower abdominal aorta and was operated transluminally; the other patient had a diffuse stenotic lesion from the abdominal aorta to the femoral arteries and had an axillofemoral bypass operation. After surgery, they experienced a reduction of backache along with an improvement of the vascular intermittent claudication. It is suggested that one factor leading to low back pain in some cases might be various degrees of ischemia of the extensor muscles in the lumbar spine. ( info)

3/32. Regional extra-corporeal circulation to protect transplanted kidney and pancreas from ischemia during vascular reconstruction.

    The development of severe aorto-ilio-femoral atherosclerotic disease in a patient with a previous double transplantation, kidney and pancreas, is a major surgical challenge. The transplanted organs have to be protected from extensive ischemia during the vascular reconstructive procedure and achieve optimal revascularization. The surgical management of a complex case where regional extra-corporeal circulation was used to protect transplanted pancreas and kidney during aorto-bifemoral vascular grafting in a 39 yr old diabetic patient is described.Regional femoro-femoral extra-corporeal circulation with an oxygenator is a safe technique that allows time for the proximal revascularization, minimizes the warm organ ischemia time and results in preservation of organ function. ( info)

4/32. Marked removal of bezafibrate-induced high-density lipoprotein-cholesterol by low-density lipoprotein apheresis.

    BACKGROUND: A case of marked reduction of the bezafibrate-induced increase of high-density lipoprotein (HDL)-cholesterol by low-density lipoprotein apheresis (LDL-apheresis) has not been previously reported. methods: A 68-year-old Japanese man with arteriosclerosis obliterans (ASO), diabetes mellitus, and hyperlipidemia underwent LDL-apheresis, followed by the concomitant bezafibrate administration. plasma lipids of pre- and post-LDL-apheresis were measured and apolipoprotein E (apoE) localization of the pre- and post-LDL-apheresis was detected by agarose gel electrophoresis. RESULTS: plasma concentrations of the total cholesterol, ldl-cholesterol, triglyceride, and HDL-cholesterol of pre-LDL-apheresis were 4.78 /- 0.36, 2.74 /- 0.24, 2.44 /- 0.52, and 0.92 /- 0.10 mmol/l, respectively; those of the post-LDL-apheresis were 1.94 /- 0.31, 0.72 /- 0.13, 0.81 /- 0.38, and 0.86 /- 0.11 mmol/l, respectively. LDL-apheresis reduced HDL-cholesterol by 6.4% (p=0.346). During the bezafibrate administration, plasma concentrations of the above of pre-LDL-apheresis were 5.24 /- 0.34, 3.28 /- 0.22, 1.26 /- 0.25, and 1.39 /- 0.21 mmol/l, respectively; those of the post-LDL-apheresis were 2.25 /- 0.44, 0.80 /- 0.12, 0.58 /- 0.19, and 1.18 /- 0.16 mmol/l, respectively. LDL-apheresis reduced HDL-cholesterol by 15.2% (p<0.01). plasma apolipoprotein E detected between the prebeta- and alpha-mobility was markedly lower after the LDL-apheresis in the agarose gel electrophoresis. CONCLUSIONS: The removal of the bezafibrate induced an increase of the HDL-cholesterol by LDL-apheresis. ( info)

5/32. gas gangrene in patient with atherosclerosis obliterans.

    Clostridia are the main cause of nontraumatic spontaneous gas gangrene. Poor blood flow due to arterial occlusion exacerbates the anaerobic condition. Fulminant gas gangrene in a 54-year-old man with atherosclerosis obliterans was treated by revascularization of the iliac artery using endarterectomy, and his gangrenous lower leg was amputated. However, he died from renal failure. ( info)

6/32. polycythemia vera--a case report and discussion on pathogenic mechanisms of increased thrombosis.

    polycythemia vera is a myeloproliferative disorder characterized by increased red cell mass and frequently complicated by venous and arterial thrombosis. The mechanism underlying the increased incidence of thrombotic events remains illusive. Presented in this report are a case of a 77-year-old man diagnosed with polycythemia vera and a review of the current literature on the mechanisms underlying the increased incidence of thrombotic events in polycythemia vera. ( info)

7/32. Ultrasound ablation of intravascular plaque for treating atherosclerosis obliterans of bilateral iliofemoral arteries: report of one case.

    OBJECTIVE: A patient with atherosclerosis obliterans of bilateral iliofemoral arteries was successfully treated by ultrasound ablation of intravascular plaque, who had an uneventful postoperative recovery. ( info)

8/32. Improvements in artery occlusion by low-density lipoprotein apheresis in a patient with peripheral arterial disease.

    peripheral arterial disease (PAD; arteriosclerosis obliterans) shows ischemic symptoms along the peripheral arteries due to reduced blood flow, and the number of patients with PAD is increasing. Several papers have reported on the clinical effect of low-density lipoprotein apheresis (LDL-A) on PAD, but there has been no report so far on the improvement of total peripheral artery stenosis by LDL-A. We report on the clinical course of a female PAD patient with intractable decubitus in her heel due to the complete occlusion of anterior tibial artery who was treated by a series of LDL-A sessions. The complete occlusion of the anterior tibial artery improved as seen on angiography, and the decubitus in her heel also markedly improved after LDL-A therapy. This report supports the clinical benefit of LDL-A for the treatment of PAD. ( info)

9/32. Percutaneous transluminal angioplasty against arteriosclerosis obliterans in dialysis patients.

    The incidence of peripheral arteriosclerosis is on the increase in chronic hemodialysis patients. Recently, the intervention (IV) treatment is conducted to deal with this problem. IV was performed in 4 dialysis patients against the complication of arteriosclerosis obliterans (ASO) but the result was unsuccessful in 3 of them. These 3 failure cases were investigated to find the problems associated with percutaneous transluminal angioplasty (PTA). Cases 1, 2 and 3 had intermittent claudication while case 4 had gangrenous toes as the major complaint. The symptoms in these cases were attributable to 90-100% stenosis and occlusion of superficial femoral artery, bilateral iliac arteries, bilateral superficial femoral-popliteal artery, branch of right iliac artery and left iliac artery region, respectively. IV was successful in case 1 but failed in cases 2 and 4 because the catheter itself did not go through due to the severe stenosis of vessel or the procedure of forcefully dilating the vessel caused dispersion of minute thrombi. In case 3, acute myocardial infarction occurred at 10 h after successful IV, resulting in sudden death. In view of the extent of invasion, IV is a treatment method selected against ASO in dialysis patients. However, the method has a high risk of causing thrombus formation, vessel rupture and organ failure. In this regard, it is advisable to evaluate the systemic condition and conduct IV if the extent of stenosis is mild. ( info)

10/32. Acute carotid obliteration: a new vascular manifestation in poems syndrome.

    The case of a 65-year-old woman with polyneuropathy, organomegaly, skin changes and monoclonal gammopathy of IgG-lambda type is described. This patient developed an acute carotid obliteration during oral anticoagulation and despite absence of vascular risk factors. Macroangiopathy has been described as a rare systemic manifestation of poems syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal spike and skin changes), affecting the coronary and lower limbs arteries. To our knowledge, this is the second case of poems syndrome with a cerebrovascular manifestation. ( info)
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