11/63. athletes with lower limb ischaemia.The case of a young healthy sportsman and acute exacerbation of chronic infragenicular pain is presented. Further investigation revealed an obstruction of the tibiofibular trunk due to an osteochondroma, arising from the fibula, which was immediately resected. osteochondroma is observed in 1-2% of the population and may present with vascular complications. In young patients and athletes, leg pain may be of vascular origin due to an entrapment or compression and should always be considered.- - - - - - - - - - ranking = 1keywords = vascular complication (Clic here for more details about this article) |
12/63. Vascular compression caused by solitary osteochondroma: useful diagnostic methods of magnetic resonance angiography and Doppler ultrasonography.osteochondroma is a common benign bone tumor that sometimes causes vascular complications when the lesion is situated near the knee. Venous complications are seen less frequently. We report two cases of solitary osteochondroma that arose in the distal femur. The patients were an 11-year-old boy and a 16-year-old boy, both of whom were suffering from bone protuberance and lower leg swelling due to congestion. In both patients, magnetic resonance imaging (MRI) revealed dilated popliteal veins at a site distal from the tumors or superficial veins. MR angiography (MRA) showed compressed popliteal arteries, and Doppler ultrasonography revealed weaker blood flow in the dorsalis pedis arteries in the lower leg with the tumor than in the other lower leg. The former patient complained of pain due to swelling in the lower leg, and for this reason the patient underwent resection of the tumor. After resection, both the swelling and the pain were decreased, and Doppler ultrasonography also revealed normal blood flow in the artery. The latter patient had swelling, but no pain, in the lower leg, and accordingly this patient has been followed carefully without resection, since there is always the possibility of irreversible vascular damage caused by osteochondroma, such as arterial or venous occlusion. We present two patients with osteochondroma, both of whom suffered from swelling of the lower leg due to venous compression by the tumor. In both cases, MRI and MRA were useful to show the presence of vascular compression. Doppler ultrasonography could also reveal the blood flow disturbance objectively, even in current osteochondroma cases in which there were no arterial symptoms.- - - - - - - - - - ranking = 1keywords = vascular complication (Clic here for more details about this article) |
13/63. Cobalamin C deficiency complicated by an atypical glomerulopathy.Cobalamin C (cbl C) deficiency, an inherited disorder of vitamin B12 metabolism, causes elevated levels of methylmalonic acid and homocysteine and decreased methionine in all body fluids. Renal complications of cbl C disease are thrombotic microangiopathy (TMA), chronic renal failure, tubulointerstitial nephritis and proximal renal tubular acidosis. There is, however, only one case report of primary glomerular pathology, focal segmental glomerulosclerosis, in a cbl C deficient patient. We report a case of an atypical glomerulopathy in a 16-year-old male patient with cbl C deficiency. The glomerulopathy manifested with proteinuria and progressive renal insufficiency. The renal histologic, immunofluorescent and ultrastructural findings were similar, but not identical, to idiopathic membranoproliferative glomerulonephritis (MPGN) but also overlapped with those of a TMA. The serum complement profile was normal; there were scanty glomerular deposits of C3, no deposits of IgG and ultrastructural findings that were similar to those seen in either MPGN type III or a TMA. On the basis of these findings we have designated the renal disease as an atypical glomerulopathy.- - - - - - - - - - ranking = 0.43592808789997keywords = microangiopathy (Clic here for more details about this article) |
14/63. Beyond peripheral arteries in Buerger's disease: angiographic considerations in thromboangiitis obliterans.thromboangiitis obliterans is an inflammatory peripheral vascular disease that is strongly associated with smoking. It predominantly affects distal small- and medium-sized blood vessels of both the upper and lower extremities. We present histological evidence of this disease process affecting the internal mammary arteries. This can be of paramount clinical significance for patients with Buerger's disease who present with obstructive coronary artery disease and require coronary artery bypass grafting surgery (CABG). Internal mammary arteries involved with thromboangiitis obliterans cannot be utilized as arterial conduits during CABG and other alternatives have to be used. Therefore, we recommend preoperative angiography of both internal mammary arteries in patients with Buerger's disease requiring CABG to prevent extensive intraoperative dissection of diseased internal mammary arteries.- - - - - - - - - - ranking = 40.507176964654keywords = vascular disease (Clic here for more details about this article) |
15/63. Living with peripheral vascular disease: a review of the literature.Peripheral vascular disease is a debilitating condition that can significantly reduce a patient's quality of life. It affects mainly older people and causes severe chronic pain that can make even simple activities of daily living impossible. This paper reviews the literature on the management of PVD, with specific emphasis on the patient experience of living with the condition.- - - - - - - - - - ranking = 202.53588482327keywords = vascular disease (Clic here for more details about this article) |
16/63. Cartilaginous metaplasia in calcified diabetic peripheral vascular disease: morphologic evidence of enchondral ossification.The mechanism of arterial calcification is not clear. We examined histological sections of major arteries from lower extremities of two patients with longstanding type II (or non-insulin-dependent) diabetes mellitus, and found morphological evidence of cartilaginous metaplasia and ectopic ossification with associated severe medial arterial calcification and atherosclerosis. hematoxylin and eosin, alcian blue, and toluidine blue stains were applied for the demonstration of cartilage cells and their specific matrix proteins, and immunohistochemical studies for type II collagen. To our knowledge, cartilaginous metaplasia has not previously been described in medium-sized human muscular arteries. This observation supports the hypothesis that active enchondral ossification may be a pathway leading to arterial calcification in diabetic obstructive peripheral vascular disease.- - - - - - - - - - ranking = 202.89899760278keywords = vascular disease, diabetic (Clic here for more details about this article) |
17/63. Acute renal failure secondary to angiotensin ii receptor blockade in a patient with bilateral renal artery stenosis.A 54-year-old man with diabetes mellitus, peripheral vascular disease, and hypertension was admitted to the hospital for an acute exacerbation of chronic heart failure. Therapy with intravenous furosemide and oral losartan 100 mg twice/day was begun. Ten days later, the patient's blood urea nitrogen and serum creatinine levels rose and peaked at 110 and 6.0 mg/dl, respectively. His serum potassium level increased to 5.7 mg/dl, urine output dropped to 400 ml over 24 hours, and mental status changes occurred. magnetic resonance angiography revealed bilateral renal artery stenosis. After losartan was discontinued and hemodialysis was performed for 3 consecutive days, the patient's renal function returned to his baseline level. Reports in the medical literature reinforce the importance of recognizing that angiotensin-converting enzyme inhibitors should be used with caution in patients with bilateral renal artery stenosis. However, the literature is not as definitive about using of angiotensin ii receptor blockers (ARBs) in these patients. Our patient's experience suggests that ARBs should be used with caution in patients with bilateral renal artery stenosis. Clinicians should be aware that renal failure might occur when using ARBs in these patients.- - - - - - - - - - ranking = 40.507176964654keywords = vascular disease (Clic here for more details about this article) |
18/63. Clinical utility of rapid prescreening magnetic resonance angiography of peripheral vascular disease prior to cardiac catheterization.PURPOSE: The presence of peripheral vascular disease, in particular iliofemoral disease, is responsible in part for vascular complications from femoral artery cannulation. We investigated whether prescreening for vascular obstructions with magnetic resonance angiography (MRA) in high-risk patients with peripheral vascular disease (PVD) would provide useful information to angiographers seeking to improve the safety and efficiency of femoral artery access at cardiac catheterization. methods: Twelve consecutive patients with known or suspected PVD underwent contrast-enhanced, aorto-iliofemoral MRA using a real-time BolusTrak technique. Contrast-to-noise ratios for each patient were calculated. The cardiac angiographer reviewed the MRA prior to catheterization and selected an access site. The patients' subsequent clinical course was evaluated, and a postprocedure questionnaire was completed by the angiographer to define the value of the prescreening MRA. RESULTS: No significant vascular complications occurred in these patients as defined by failure of initially chosen access site, arterial dissection, limb ischemia, pseudoaneurysm formation, hemorrhage (including retroperitoneal hematoma), or need for blood transfusion or emergency vascular surgical repair. Statistical frequency analysis of the responses in the postprocedure questionnaire demonstrated that the MR data were clinically valuable in (1) influencing the initial choice of access site; (2) influencing technical alterations to the standard access; and, (3) enhancing confidence in the selection of access site. CONCLUSIONS: MRA prescreening in patients with PVD is an effective, novel adjunct to cardiac catheterization in selected patients that improves physician confidence and influences technical choices during coronary angiography from the femoral artery approach.- - - - - - - - - - ranking = 245.04306178792keywords = vascular disease, vascular complication (Clic here for more details about this article) |
19/63. Ultrasound guidance for difficult lateral popliteal catheter insertion in a patient with peripheral vascular disease.OBJECTIVE: Interest in ultrasound-guided nerve block is increasing, but clinical utility still is being determined. We report a case in which ultrasound imaging aided nerve localization during popliteal block. CASE REPORT: We report a case in which failure of nerve stimulation to locate the sciatic nerve at the popliteal fossa in a patient with underlying neuropathy was overcome by ultrasound guidance, which allowed quick and easy catheter placement. After failure of the stimulation technique, ultrasound permitted us to observe advancement of the needle, placement of the catheter, and spread of local anesthetic around the nerve. CONCLUSION: Ultrasound guidance can facilitate lateral popliteal catheter insertion in patients in whom electrolocation has failed.- - - - - - - - - - ranking = 162.02870785861keywords = vascular disease (Clic here for more details about this article) |
20/63. role of antiplatelet therapy in cardiovascular disease III: peripheral arterial disease.peripheral arterial disease (PAD) is a common manifestation of the atherosclerotic disease process, typically affecting vascular beds in the lower extremities. In its most severe form PAD may lead to limb amputation. patients with PAD are also at increased cross-risk of thrombosis at coronary and cerebrovascular sites. However, despite its prevalence and severity, PAD is underdiagnosed and undertreated. In this collection of case studies, the role of the antiplatelet agent clopidogrel in current treatment strategies for the management of PAD is highlighted.- - - - - - - - - - ranking = 162.02870785861keywords = vascular disease (Clic here for more details about this article) |
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