11/137. 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.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
12/137. Endovascular interventions on persistent sciatic arteries.PURPOSE: To report our experience with interventional procedures used to treat complete and incomplete persistent sciatic arteries (PSA). case reports: Three female patients with PSAs displayed varying symptoms referable to this rare anatomical variant. In the first woman, a 1-year history of intermittent lower limb ischemia and an acute event prompted angiography, which demonstrated proximal occlusion of 2 crural vessels and a partially thrombosed sciatic artery aneurysm. To prevent further embolism, the aneurysm was excluded with a stent-graft. Endograft patency and aneurysm exclusion have been maintained up to 22 months. In a 41-year-old diabetic with chronic limb ischemia and digital gangrene, a flow-limiting stenosis of the sciatic artery was stented, restoring adequate pedal perfusion. The stent remained patent at the 18-month follow-up. The third patient suffered from a tumor-related pelvic hemorrhage originating from retrograde perfusion through the PSA, which had been ligated during previous surgery. Attempted embolization via a collateral connection between the incomplete PSA and the popliteal artery failed, and the patient died. CONCLUSIONS: Vasculopathies involving the sciatic artery are uncommon but may be amenable to interventional techniques, such as coil embolization and stent implantation. PSA aneurysm exclusion with a stent-graft may represent a new therapeutic alternative to standard surgery that obviates potential sciatic nerve damage, but the durability of the repair remains to be determined.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
13/137. The hemodialysis patient and hand amputation.The hemodialysis patient requires continued attention once an access surgery has been performed. These procedures lead to an anticipated physiological steal in the involved hand, but rarely lead to hand loss. When the patient has had previous peripheral vascular disease, known diabetes mellitus, multiple interventions on the same extremity, and the use of a synthetic graft, the incidence of digital or hand ischemia is significantly increased. This article represents 3 individuals who required hand amputation for severe ischemia. The pertinent clinical features in each individual will be explained and the literature reviewed for the factors promoting this complication and the all-autogenous access policies which may help to prevent hand ischemia.- - - - - - - - - - ranking = 3.8087199327872keywords = vascular disease (Clic here for more details about this article) |
14/137. Successful treatment of threatening limb loss ischemia of the upper limb caused by ergotamine. A case report and review of the literature.We report a case of ischemia limited to the upper limb caused by chronic use of ergotamine. The effect of this drug was not related to hypersensitivity or to the potentiating effects of other medications. The patient was successfully treated discontinuing ergotamine and administering an alpha-blocking agent for three months. A review of the literature of the vascular complications of ergotamine is presented.- - - - - - - - - - ranking = 7.5522739906416keywords = vascular complication (Clic here for more details about this article) |
15/137. Retinal ischemia in diabetic retinopathy.Eight patients with proliferative diabetic retinopathy developed extensive retinal arteriolar and capillary obstruction. ophthalmoscopy showed many white, thread-like retinal arterioles associated with capillary and venous dilatation. Widespread retinal arteriolar and capillary nonperfusion was demonstrated by fluorescein angiography. Ischemic maculopathy resulted in severe loss of visual acuity in some eyes. The severe degree of retinal ischemia was accompanied by optic disc pallor and neovascularization and a high incidence of rubeosis iridis with neovascular glaucoma. patients with this variety of diabetic retinopathy have a poor prognosis of retaining useful vision.- - - - - - - - - - ranking = 6keywords = diabetic (Clic here for more details about this article) |
16/137. Reversal of steal syndrome following creation of arteriovenous fistula by banding with a Gore-Tex cuff: a new technique.Steal syndrome, especially in elderly patients with peripheral vascular disease, is a serious complication following creation of an arteriovenous fistula (AVF) that, if neglected, can lead to amputation. The classic maneuver to deal with the steal syndrome is the ligation of the AVF and performance of another procedure to gain dialysis access. We describe a simple technique of effectively reversing the steal syndrome by banding the vein of the AVF with a ringed Gore-Tex cuff that salvages the AVF and allows its immediate use for dialysis.- - - - - - - - - - ranking = 3.8087199327872keywords = vascular disease (Clic here for more details about this article) |
17/137. Multiple arterial thrombi and in utero leg gangrene in an infant of a diabetic mother.This case report is of an infant of a diabetic mother who presented with lower extremity gangrene occurring in utero that necessitated a below the knee amputation at 3 hours of age. The association of venous thrombi in infants of diabetic mothers (IDMs) has been firmly established. However, in this case the thrombi were arterial and resulted in gangrene during the second trimester of gestation. The reason for the increased tendency to develop thrombi in infant of diabetic mothers has not been elucidated. We did an extensive workup of this infant to look for a cause of the arterial thrombus. The only abnormality found was in the plasminogen activity, which was significantly lower than the reference values for infants of the same gestational and chronological age. The significance of this finding on the propensity of IDMs to develop thrombi is discussed.- - - - - - - - - - ranking = 7keywords = diabetic (Clic here for more details about this article) |
18/137. Introduction to some common cutaneous foot conditions and their management.Problems that happen to the body through injury or disease can also happen to the owner's feet, and there are additional complications associated with the feet. Feet are a long way from the core, are in contact with an unclean environment (the ground), can be abused through poor-fitting footwear and are subjected to more general wear and tear than many other parts of the body. There are a large number of conditions affecting the feet, many associated with medical disorders such as diabetes, rheumatoid arthritis or peripheral vascular disease. The symptom of pain often triggers help being sought, but change in the appearance of the skin is a very important indicator of the state of superficial and deeper tissues. health-care professionals may be called upon to comment on these conditions and treat and/or refer accordingly, so a multidisciplinary approach is required. Clinical skill is required to identify the conditions which are treatable, or those which should be referred for treatment by someone in another specialism. This paper provides information for clinicians and interested others in the form of an introduction to some common cutaneous foot conditions through outline case examples and their treatment.- - - - - - - - - - ranking = 3.8087199327872keywords = vascular disease (Clic here for more details about this article) |
19/137. Clostridial enteritis necroticans versus secondary clostridial infection superimposed upon ischemic bowel disease.Clostridial enteritis necroticans, or pig-bel, as seen in papua new guinea, is a necrotizing, segmental gangrene of the small intestine occurring in members of a malnourished population, who become ill after consuming large quantities of pork contaminated with Type C. clostridium perfringens. We report a case of possible Clostridial enteritis necroticans with concomitant ischemic intestinal disease secondary to superior mesenteric arterial thrombosis occurring in a 53-year-old woman with a long history of diabetes mellitus, hypertension, and peripheral vascular disease. The differential diagnosis and the pathogenesis of C. perfringens enteritis necroticans are discussed.- - - - - - - - - - ranking = 3.8087199327872keywords = vascular disease (Clic here for more details about this article) |
20/137. Severe potential consequences of delayed diagnosis in patients with hip claudication.delayed diagnosis in patients with hip claudication can lead to severe consequences. We report on patients with ischaemic hip claudication which had primarily been attributed to coxarthrosis. One patient went through a variety of treatments including hip arthroplasty. The second patient had a life-threatening abdominal aortic aneurysm (AAA) which remained undiagnosed. Orthopaedic surgeons should maintain a high degree of suspicion for vascular disease. Moreover, we strongly advocate that all men over 60 years old who seek medical advice for whatever reason should be screened once for AAA by ultrasonography.- - - - - - - - - - ranking = 3.8087199327872keywords = vascular disease (Clic here for more details about this article) |
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