1/63. Intravascular fasciitis of the forearm vein: a case report with immunohistochemical characterization.Intravascular fasciitis is a very unusual variant of nodular fasciitis. A unique case of this lesion occurring in the proximal portion of the superficial vein of the forearm in an otherwise healthy 26-year-old man is reported. The intravascular polypoid lesion grew longitudinally along the vascular lumen, was loosely attached to the intimal layer, and was partly anchored beyond the internal elastic lamina into the medial smooth muscle layer. However, extravascular involvement was absent. The histological features were identical to those observed in ordinary cellular nodular fasciitis. Because of its myofibroblastic phenotype exhibited by highly proliferative spindle cells, certain intimomedial myofibroblasts are thought to be the indigenous source of this unique fibroproliferative lesion. Unless the diagnosis of intravascular fasciitis is considered and appropriate differential markers examined, it may be confused with other intravascular lesions, such as intravascular leiomyoma, intravenous pyogenic granuloma, organized thrombus and, even, fibromuscular dysplasia if it arises in the arteries. A simple excision is considered curable. Even so, two recurrent cases have been documented to date.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
2/63. 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) |
3/63. Acute lower limb thrombosis caused by a congenital fibrous ring of the superficial femoral artery.Segmentary isolated stenosis or obstructions of the superficial femoral artery in young people are rarely reported. In patients, most of them women, affected by chronic symptomatology of the lower limbs, the aetiology has been referred to fibromuscular dysplasia with unusual localization. We report a case of acute lower limb thrombosis in a young woman caused by a congenital fibrous ring of the superficial femoral artery and the treatment we performed in this situation including the complication that happened after the percutaneous transluminal angioplasty that we carried out in order to reduce the stenosis of the femoral superficial artery. Histological examination of the lesion demonstrated the nature of the fibrous ring caused by an embryological anomaly, followed by a secondary thrombosis in a woman not using oral contraceptives and without any alteration of the coagulation chain. fibromuscular dysplasia of the femoral artery is commonly caused by previous thigh injuries, thromboembolic events with recanalization of the artery or arteritis, but in some cases appears to be the consequence of primitive intimal dysplasia. When a fibromuscular dysplasia is suspected, all authors agree on the necessity for a screening of the two preferential localizations of the disease: common carotid artery and renal artery, in the case reported the result was negative.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
4/63. Subadventitial hematoma of a patent ductus arteriosus and thrombus formation within the aorta secondary to cardiac catheterization.An 18-month-old boy with patent ductus arteriosus (PDA) underwent surgical closure of PDA. cardiac catheterization determined the PDA was not suitable for transcatheter closure. After the chest was opened, subadventitial hematoma was seen on the aortic end of the PDA. Incision of the aorta revealed a thrombus secondary to intimal laceration. The thrombus was extracted and the PDA was closed using division technique. Because no similar report was found in English-language literature, the technique and the surgical strategy are discussed.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
5/63. Carotid stent thrombosis: report of 2 fatal cases.BACKGROUND: Carotid stenting is receiving increased attention as an alternative to carotid endarterectomy. Carotid stent thrombosis is a rare complication of this procedure. CASE DESCRIPTIONS: We present 2 case reports from a university medical center. Two patients had angiographically confirmed carotid stent (CS) thrombosis with subsequent fatal strokes. The first was a 63-year-old woman who developed stent thrombosis after the procedure was performed for a postendarterectomy intimal flap. The second patient was a 57-year-old man who underwent CS placement for transient ischemic attacks and developed internal carotid artery occlusion at the level of the stent 3 days later. Neither patient was treated with combination antiplatelet therapy before or after CS placement. Both patients died. CONCLUSIONS: CS thrombosis can be a cause of fatal iatrogenic stroke. Combination antiplatelet therapy should be administered to decrease the incidence of this complication.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
6/63. Arterial thrombosis in scleroderma.Clinical and pathological observations are presented on five patients with scleroderma who developed thrombosis of a major vessel. Three died following intestinal infarction or limb gangrene and two had digit or extremity amputation. Severe intimal thickening of major arteries with thrombus formation was noted but no significant abnormality was found in the clotting activity of the blood. Histochemical studies in three cases suggested a reduction of fibrinolytic activity at the site of thrombosis in the diseased vessels. These studies support the view that the vascular system is profoundly altered in scleroderma and may play an important role in some manifestations of the disease.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
7/63. Renal failure due to scleroderma with thrombotic microangiopathy developing in a woman treated with carboplatin for ovarian cancer.Acute renal failure in association with microangiopathic hemolytic anemia and the pathological finding of thrombotic microangiopathy may occur in a number of conditions including hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and systemic sclerosis. Distinguishing between these conditions on clinical grounds may be difficult, and further investigations, including serological tests, are normally helpful. We present a patient who was treated with 5 doses of monthly carboplatin chemotherapy for stage IIb ovarian carcinoma and who subsequently developed acute renal failure and microangiopathic hemolysis together with some cutaneous features of systemic sclerosis. Initial serological tests, including anti-nuclear antibody titers measured using rat hepatocytes, were normal, and renal biopsy showed features of microangiopathic hemolysis, fibrinoid change, patchy tubular atrophy, and concentric intimal proliferation. A clinical diagnosis of diarrhea-negative hemolytic uremic syndrome was made and she was treated with plasma exchange and fresh frozen plasma infusion. However, she remained dialysis-dependent. Several weeks later she died following a cardiac arrest. Post-mortem examination revealed medial hypertrophy, concentric intimal proliferation, and thrombi within the small arteries of the kidneys and lungs. Subsequent results from tests taken at the time of her presentation with acute renal failure revealed a normal von willebrand factor qualitative distribution, and a positive anti-nuclear antibody titer (using a human cell line) in association with positive autoantibodies to rna polymerase types I, II, and III. Taken together, the clinical, laboratory, and post-mortem findings were suggestive of a diagnosis of systemic sclerosis. We discuss the differential diagnoses, and the associations between these and malignancy and chemotherapy. Finally, we consider the serological tests used for the diagnosis of systemic sclerosis that were, in this case, initially misleading.- - - - - - - - - - ranking = 2keywords = intima (Clic here for more details about this article) |
8/63. Blunt injury to the external iliac artery: a case report.Blunt vascular trauma is rare as compared with penetrating vascular trauma. The incidence of iliac artery injury has been reported as low as 0.4 per cent of total arterial trauma. iliac artery injury in blunt trauma is rare because of its anatomic location and protection by the pelvis. This article presents a case of external iliac artery injury secondary to blunt trauma. A deceleration-type mechanism is suggested that results in the production of an intimal flap and later vessel thrombosis. We discuss the clinical details of presentation and angiographic diagnosis as well as treatment options.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
9/63. Arterial complications following anterior lumbar interbody fusion: report of eight cases.The objective of this study is to report eight cases of arterial complication following anterior lumbar interbody fusion (ALIF) and to analyze the data in order to identify possible risk factors. The authors have encountered six cases of common iliac artery occlusion and two cases of acute vasospasm as a complication of ALIF using two different approaches to spine: hypogastric-midline-transperitoneal approach at one center and minimally invasive muscle-sparing retroperitoneal approach at the other. All cases involved surgery at the L4-L5 level. All patients were smokers, and three had an existing history of vascular disease. The left iliac and common femoral arteries were involved in seven cases, while the right common iliac was involved in one case. Five patients had thromboembolism, one patient had an intimal tear and two had functional vasospasm. Circulation to the lower limb was restored by thrombectomy (five patients) and arterioplasty for the intimal tear (one patient). One of the vasospasm cases was explored (false-positive), while the other was treated conservatively. One of the patients with thrombosis developed rhabdomyolysis resulting in fatal acidosis. All but the first case at each center was diagnosed either intraoperatively or within 2 h of surgery. We believe that awareness of this potentially serious complication will lead to precautionary measures for prevention of the problem as well as early diagnosis and management of the complication if it does occur. Intraoperative monitoring of lower limb blood flow by measuring the toe oxygenation with a pulse oxymeter can prove to be helpful in early diagnosis.- - - - - - - - - - ranking = 2keywords = intima (Clic here for more details about this article) |
10/63. Derman necrosis due to thrombosis in severe secondary hyperparathyroidism.Two patients had gangrenous dermal necrosis associated with chronic renal disease and secondary hyperparathyroidism. Thromobosed and heavily calcified small arteries were underlying the infarcted areas. One patient had severe hypotension secondary to hemorrhage, which immediately preceded the appearance of dermal lesions. Both patients had notably elevated serum parathyroid hormone and serum alkaline phosphatase levels, as well as severe hyperphosphatemia. Therapy with phosphate binders and calcium and vitamin d supplementation corrected the hyperphosphatemia and reduced serum alkaline phosphatase levels. One patient died; the other patient's dermal lesions healed completely. Localized thrombosis, rather than obliterative intimal proliferation, represents a unique cause of dermal necrosis in this condition.- - - - - - - - - - ranking = 1keywords = intima (Clic here for more details about this article) |
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