Acute Arterial Embolism Research Articles

Clinical efficacy of catheter-directed thrombolysis combined with endovascular interventions for acute lower limb ischemia

Objective: To explore the risk factors and treatment of acute lower limb ischemia with catheter-directed thrombolysis combined with endovascular interventions. Methods: Totally 191 patients (191 lower limbs) with acute lower limb ischemia in department of vascular surgery of the First Affiliated Hospital of Chongqing Medical University from June 2012 to June 2017 who underwent catheter-directed thrombolysis combined with endovascular interventions were collected. According to imaging findings and clinical characteristics, the patients were divided into acute arterial embolism group (n=36) and acute arterial thrombosis group (n=155). The treatment effect, long-term follow-up and the risk factors closely related to primary patency were analyzed. Results: Among the 191 patients, the immediate success rate of surgery was 100%, the amputation rate within 30 days was 8.4% (16/191), and the mortality rate within 30 days was 2.6% (5/191). The mean follow-up was 31.0 (1.0-60.0) months. The 1-year overall survival rate was 92.1% and the 5-year was 79.5%. The primary patency rate was 74.3% within 1 year and 61.5% within 5 years. Primary vascular patency rate within 1 year and 5 years was mainly affected by occlusion segment (OR=3.5, 2.9, P<0.05), outflow tract (OR=3.2, 2.8, P<0.05) and ischemia degree (OR=3.4, 3.6, P<0.05). Conclusion: Catheter-directed thrombolysis combined with endovascular interventions for acute lower limb ischemia is a safe and effective method. Risk factors for primary patency at 1 and 5 years are occlusion segment, outflow tract and ischemia degree.

Acute arterial embolism of lower extremity after mitral valve replacement in a chronic lymphocytic leukaemia patient: a case report

Introduction Acute arterial embolism is a potential severe complication after cardiac surgery: it can be a clinical manifestation of early prosthetic valve (PV) thrombosis, whose incidence is higher in case of mechanical mitral valve or in presence of subtherapeutic anticoagulation, hemodynamic (atrial fibrillation) or haemostatic (obesity, anaemia, renal failure) predisposing factors (1). EACTA guidelines recommend to start anticoagulation during the first 24 hours after surgery, balancing the haemorragic risk(2). Although, in presence of specific comorbidities and risk factors, life-threatening thrombotic events can complicate postoperative period even following the international recommendations. Methods We report a 73-year-old man, suffering from chronic lymphocytic leukaemia (without treatment) and paroxysmal AF who received mitral mechanical valve replacement with a On-X 27/29 mm valve placed on anti-anatomic position because of a severe mitral insufficiency (with chordal systolic anterior movement) and single coronary artery by-pass graft. Unfractionated heparin (UFH) and acetylsalicylic acid were started 18 hours after surgery, in order to maintain an aPTT ratio of 1.5 to 2.5. On postoperative day (POD) 4 patient presented sudden pain and signs of acute hypoperfusion in left leg (distal femoral artery territory), requiring urgent surgery. Transthoracic echocardiography was performed but limited by artefacts and suboptimal acoustic windows. Considering the high risk surgery and the usefulness of early transoesophageal echocardiography (TOE), the patient received a general anaesthesia with tracheal intubation. Results Successful open embolectomy on the common femoral artery was performed; UFH perfusion was maintained during the whole duration of the procedure without haemorrhagic complication. Intraoperative TEO detected spontaneous echo contrast in left atrial appendage and reduced motion with impaired coaptation of the right leaflet (red arrows in figure); neither valvular-atrial-ventricular thrombus nor increased transvalvular gradient nor regurgitation were found. Postoperative TEO (POD 3) showed a PV with normal leaflets movement, without significative stenosis/regurgitation. Warfarin was started on POD 4 and heparin bridging was discontinued when INR target range was reached. Discussion In patient with multiple thrombotic risk factor (id malignancy, AF) adequate anticoagulation level can be difficult to reach: in these cases, serious thrombotic complications must be highly suspected even when guidelines have been followed. Prompt diagnosis and aggressive treatment are crucial to guarantee a good prognosis. Early TOE and a “tailored” anticoagulation therapy play a fundamental role in the management of such complications.

Enlarged Ulcer-like Projection and Acute Arterial Embolism in the Lower Limbs of a Patient with Chronic Stanford Type B Aortic Dissection

Enlarged Ulcer-like Projection and Acute Arterial Embolism in the Lower Limbs of a Patient with Chronic Stanford Type B Aortic Dissection

SUCCESSFUL TREATMENT OF PULMONARY EMBOLISM AND ASSOCIATED UPPER EXTREMITY ARTERY THROMBOSIS USING INTRAVENOUS ALTEPLASE: A CASE REPORT

Introduction: Although thrombolytic administration is inevitable in the management of massive pulmonary embolism, contradictions exist in the treatment of sub-massive pulmonary embolism. There are drawbacks to thrombolytic treatment due to potential serious side effects such as cranial hemorrhage. Case Report: An 84-year-old female patient was admitted to the emergency service because of pain and lack of a pulse in her right arm and %61 oxygen saturation without any respiratory system complaints. A computerized tomography showed pulmonary embolism close to totality in the bilateral main pulmonary arteries and peripheral embolism in the right brachial artery. We considered a sub-massive pulmonary embolism in this patient with no hypotension despite bilateral pulmonary artery embolism, good general condition, but a dilated right ventriculi in transthoracic echocardiography. Since the PESI score was 115, it was decided that the patient was in the high-risk group. After administration of 100 mg Alteplase as thrombolytic therapy, her oxygen saturation increased to 95% in the room air and her complaint of right arm completely regressed. Furthermore, none of the possible complications from thrombolytic therapy, such as fatal bleeding, were observed in our patient. Conclusion: In this article, it is emphasized that thrombolytic therapy is an appropriate choice for patients with sub-massive pulmonary embolism and acute arterial embolism.

Limb Salvage After Percutaneous Mechanical Thrombectomy in Patients with Acute Lower Limb Ischemia: A Retrospective Analysis from Two Institutions

To evaluate the short-term outcomes of percutaneous mechanical thrombectomy (PMT) in patients with acute lower limb ischemia (ALI) and to analyze the effect of ALI of different etiologies on the limb salvage. From January 2015 to December 2017, a retrospective analysis was performed on 112 patients (mean age: 66.5 years; 117 limbs in total; 66 limbs in 61 males) with ALI treated with PMT at 2 vascular institutions. Of the 117 limbs, 44 (41 patients) had acute arterial embolism, 36 (34 patients) had acute arterial thrombosis, and 37 (37 patients) had acute stent (31 limbs in 31 patients) or graft (6 limbs in 6 patients) thrombosis. The primary end point was limb salvage rate, and subgroups were analyzed by etiological factors. The secondary end points included patency rates, major bleeding complications, 30-day mortality, and reintervention rates. The 30-day mortality rate was 3.6%. The incidence of major bleeding complications was 2.7%. During the follow-up, the limb salvage rates at 1year and 2years were 83.8% and 74.7%, respectively. Subgroup analysis showed that the limb salvage rate in patients with acute arterial embolism was 92.9% at 2years after PMT, which was higher than that in patients with acute arterial thrombosis (73.3%, P=0.04, hazard ratio [HR]: 3.6, 95% confidence interval [CI]: 1.1-11.7) and acute stent/graft thrombosis (62.5%, P=0.01, HR: 4.7, 95% CI: 1.5-13.6). PMT in patients with ALI is effective in preventing amputations over the 3-year study period with a reasonable safety profile, especially in patients with acute arterial embolism.

Superior Mesenteric Artery Occlusion: A case report and mini Review.

Introduction: Acute mesenteric ischemia/occlusion is a life-threatening vascular emergency that requires early diagnosis and intervention to restore mesenteric blood flow and to prevent loss of life. Despite progress in our understanding about the mesenteric ischemia, diagnostic modalities, and treatment options, the mesenteric ischemia remains a diagnostic challenge. This leads to delayed implementation of treatment and thus contributes to high mortality and morbidity. Methods: Here, we have presented a case report of superior mesenteric artery thrombosis. It discusses the various aspects of superior mesenteric artery occlusion, the etiology, the difficulty with diagnosis, and the best possible course of action. Results: The Superior Mesenteric Artery (SMA) supplies the whole of the small intestine except the superior part of the duodenum. It also supplies the caecum, ascending colon and most of the transverse colon. Acute mesenteric ischemia (AMI) is a syndrome caused by inadequate blood flow through the mesenteric vessels, resulting in ischemia and eventual gangrene of the bowel wall. Conclusion: The acute mesenteric ischemia (AMI) comprises four different primary clinical entities, Non-occlusive mesenteric ischemia (NOMI), and occlusive mesenteric artery ischemia (OMAI).This OMAI is further subdivided into acute mesenteric arterial embolism (AMRE) and acute mesenteric arterial thrombosis (AMRT). The AMI as the venous disease takes the form of Mesenteric venous thrombosis. (MVT). The overall prevalence of AMI is 0.1% of all hospital admissions; venous thrombosis is found in approximately 0.001% of patients who undergo exploratory laparotomy. The risk factor for AMI includes arrhythmia, heart diseases, mitral stenosis, endocarditis, recent MI, and intra-abdominal malignancies.

Acute arterial embolism of aorta and main limb arteries in patients with myocardium infarction

The objectiveof the study was to reveal the features of development and clinical course of acute arterial embolism (AAE) of aorta and main limb arteries in patients with myocardium infarction (MI).Material and methods. Since 1991 until 2018 in the department of cardiovascular surgery of «North-Western State Medical University named after I. I. Mechnikov» 1782 patients with AAE of aorta and main limb arteries were urgently treated. 102 (5.7 %) patients of them waswith acute IM.Results.In patients with AAE in acute phase of Q-IM the embolism to large profile arteries was typical. AAE led to rapid progression of limb ischemia. The severity of the general condition of patients due to myocardial lesions, and specific complications associated with limb revascularization and ischemic syndrome, significantly influenced the results of treatment. Postoperative mortality reached 38.8 %.Conclusion.AAE of aorta and main limb arteries is a threatening complication of acute MI, and it significantly worsens prognosis.

Dabigatran, Rivaroxaban, and Warfarin in the Oldest Adults with Atrial Fibrillation in Taiwan

To compare the effectiveness and safety of reduced-dose dabigatran, reduced-dose rivaroxaban, and warfarin in individuals aged 85 and older with atrial fibrillation (AF). Retrospective cohort study. Taiwan National Health Insurance claims database, 2011∼2015. Individuals with AF aged 85 and older (mean 88.6) with incident use of oral anticoagulants between June 1, 2012 and May 31, 2015 (N=4,722; dabigatran 110 mg, n=1,489; rivaroxaban 15 mg/10 mg, n=1,736; warfarin, n=1,497). Clinical outcomes included all-cause death, cardiovascular death, ischemic stroke, acute myocardial infarction, arterial embolism or thrombosis, intracranial hemorrhage, and gastrointestinal hemorrhage needing transfusion. Propensity score-matched analysis was performed, and the marginal proportional hazards model was used to estimate the relative risk of various clinical outcomes in a matched dabigatran-warfarin cohort (n=1,180 in each group) and a rivaroxaban-warfarin cohort (n=1,207 in each group) RESULTS: Mean follow-up was 6.6 months for the overall population. Dabigatran group participants had lower risks of all-cause death (hazard ratio (HR)=0.59, 95% confidence interval (CI)=0.45-0.77) and cardiovascular death (HR=0.45, 95% CI=0.30-0.68) than warfarin group participants. Rivaroxaban users also had lower risks of all-cause death (HR=0.61, 95% CI=0.47-0.79) and cardiovascular death (HR=0.52, 95% CI=0.35-0.75) than warfarin users. Dabigatran users also had a lower risk of intracranial hemorrhage than warfarin users (HR=0.31, 95% CI=0.10-0.97). Individuals with AF aged 85 and older who used reduced-dose dabigatran or reduced-dose rivaroxaban had statistically significantly lower all-cause mortality and cardiovascular mortality than those who used warfarin. Reduced-dose dabigatran was also associated with lower risk of intracranial hemorrhage than warfarin.

Risk Factors for Thirty-Day Readmissions After Lower Extremity Amputation in Patients With Vascular Disease

BackgroundUnderstanding risk factors associated with readmission after lower extremity amputation may indicate targets for reducing readmission. ObjectiveTo evaluate factors associated with all-cause 30-day readmission after lower extremity amputation procedures. DesignRetrospective cohort study. SettingInpatient. PatientsA total of 2480 patients who had lower extremity amputations between 2008 and 2014 were selected from national electronic medical record database, Cerner Health Facts. MethodsUnivariate analysis of demographics, diagnoses, postoperative medications, and laboratory results were examined. Multivariate logistic regression models were used to identify characteristics independently associated with readmission overall and by amputation location—above the knee (AKA) or below the knee (BKA). Main Outcome MeasurementReadmission within 30 days of discharge. ResultsMore than one half of patients (1403, 57%) underwent BKA and 1077 (43%) underwent AKA. Readmission within 30 days was 22% (24.1% BKA versus 19.4% AKA, P = .005). In multivariable logistic regression, factors associated with 30-day readmission after any amputation included BKA (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.15-1.74, P = .001), hypertension (OR 1.70, 95% CI 1.33-2.16), surgical-site infections (OR 1.44, 95% CI 1.02-2.04), heart failure (OR 1.39, 95% CI 1.10-1.75), discharge to a skilled nursing facility (OR 1.88, 95% CI 1.41-2.51), and emergency/urgent procedures (OR 1.32, 95% CI 1.04-1.67). At readmission, 13.3% of patients with a BKA required an AKA revision, and 21.3% had a diagnosis of surgical-site infection. ConclusionsRisk factors for readmission after any amputation included cardiac comorbidities, associated postoperative medications, and discharge to a skilled nursing facility. The finding that acute arterial embolism or thrombosis and a BKA during the index admission was highly associated with readmission, combined with the high rates of 30-day conversion to an AKA when readmitted, suggests these patients more often develop stump complications or may be undertreated during the initial hospitalization. Level of EvidenceIII

PP-158 - Femoro-Popliteal Bypass With Local Anesthetic Is Possible?: Case Reports

Peripheral arterial disease (PAH) due to atherosclerosis is seen in 30% of the population over 65 years of age. Acute arterial embolism in chronic PAH is one of the most common causes of emergency in this age group. We aimed to present two patients had critical leg ischemia who underwent femoro popliteal bypass with local anesthesia for emergency acute arterial embolism on chronic PAH.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Are Effective Predictors of Prognosis in Patients with Acute Mesenteric Arterial Embolism and Thrombosis

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been shown to be valuable prognostic markers for a variety of pathological conditions including solid tumors, sepsis, and others. However, the prognostic values of the NLR and PLR in patients with acute mesenteric arterial embolism (AMAE) and acute mesenteric arterial thrombosis (AMAT) have not been elucidated. The aim of this study was to determine the predictive value of the NLR and PLR for poor prognosis in patients with AMAE and AMAT. A total of 137 patients with AMAE (n=77) or AMAT (n=60) were divided into a poor outcome group (cases of intestinal necrosis or death) and a better outcome group (cases without intestinal necrosis who survived successfully), according to prognosis. Neutrophil, platelet, and lymphocyte counts were recorded before pharmacotherapy or surgery. The NLR and PLR were calculated, and logistic regression analysis was performed to test their prognostic values. The cutoff values for NLR and PLR were 11.05 and 156.26, respectively. The PLR was linearly associated with the NLR (R=0.769, P<0.001). NLR (odds ratio [OR]=6.835, 95% confidence interval [CI]=2.282-20.469, P=0.001), PLR (OR=4.871, 95% CI=1.627-14.587, P=0.005), and coronary heart disease (OR=3.388, 95% CI=1.156-9.929, P=0.026) were found to be independent prognostic factors for the patients. NLR ≥ 11.05, PLR ≥ 156.26, and coronary heart disease were shown to be risk factors for poor prognosis in patients with AMAE and AMAT. According to these factors, patients can be divided into 3 prognostic groups: good, NLR < 11.05 with PLR < 156.26; moderate, NLR < 11.05 with PLR ≥ 156.26 or NLR ≥ 11.05 with PLR < 156.26; and poor, NLR ≥ 11.05 with PLR ≥ 156.26.

The modified cone reconstruction in the treatment of Ebstein's anomaly: Case reports.

Rationale:To investigate the early and mid-term clinical outcomes of the modified cone reconstruction in the treatment of Ebstein's anomaly (EA) which provide appropriate surgical treatment for clinical and reduce the incidence of re-operation and valve replacement.Patient concerns:Clinical data of 18 consecutive patients with EA in our hospital between May 2008 and August 2015 were analyzed retrospectively. All patients were diagnosed by echocardiography. Among these patients, according to New York Heart Association functional grade, there were 12 patients with grade II cardiac function and 6 patients with grade III. All patients had severe tricuspid regurgitation grade.Diagnoses:All patients were diagnosed EA. One case was with acute arterial embolism and amputation of left lower extremity caused by paradoxical embolism of combined secundum atrial septal defect.Interventions:The modified cone reconstruction in the treatment of EA of the tricuspid valve uses its own tissues to form not only central bloodstream, but also the coaption between 2 leaflets. For those patients whose anterior leaflet developed poor and smaller, the valve leaflet was widened by using autologous pericardial. For all patients, tricuspid annulus were reinforced by autologous pericardial. One case was combined with double-orifice technique due to postoperative poor closure of the tricuspid valve.Outcomes:There were 2 cases with arrhythmia, and they returned to normal after medication. The rest patients recovered smoothly with no death. Review of echocardiography: 1 patient with moderate regurgitation, the rest of patients’ leaflets coapted well and had no tricuspid stenosis. All cases were followed up postoperatively for 9 to 38 months, and there were 14 patients with grade I cardiac function and 4 patients with grade II.Lessons:The early and mid-term clinical outcomes of the modified cone reconstruction in the treatment of EA were which can make leaflets coapt and had a strong antiregurgitation ability, reducing the incidence of re-operation, valve replacement, and postoperative mortality.

Akut üst ekstremite arteryel embolileri: 2 yıllık klinik deneyimimiz

Objective: Extremity thromboembolism is a serious cause of morbidity and mortality in cardiovascular diseases. Comparing with the lower extremity arteries, upper extremity acute arterial occlusions are rarer and constitute 15-32% of all cases. Trauma, collagen vascular diseases, malignant tumors, myxoma, subclavian artery stenosis, myocardial infarction and thromboangiitis obliterans are often identified as etiologic factors. The first option in the treatment of these patients is surgical embolectomy. Endarterectomy, patchplasty and arterial bypass operations can be counted in treatment options of chronic patients. Material and Methods: In this study, we retrospectively analyzed clinical features and prognosis of 58 patients consisting of 31 women and 27 males who were admitted to our emergency department with acute arterial embolism. Results: Mean age of our group was 67.05±17.09. Proximal brachial artery thrombosis was found in 3 patients. The other 55 patients had thrombosis in the brachial artery and its distal branches. After the diagnosis of patients in the emergency room 100 units/kg of subcutaneous enoxaparine was applied. Selective arterial embolectomy surgery was performed under local anesthesia in all patients with access from the antecubital region. Arteriotomy was closed using saphenous patch plasty technique in two patients. Compared with preoperative demographic data and thromboembolism etiology, 21 (36%) patients were diagnosed as atrial fibrillation. Those patients had not been followed and treated for atrial fibrillation. In 5 (8.6%) patients malignancy was detected as an etiologic factor. Four (6.8%) patients died during their follow-ups in the clinic, 3 (75%) of those patients had an atrial fibrillation. Conclusion: Acute peripheral arterial occlusion constitutes a significant part in emergency vascular surgery. Therefore early diagnosis and prompt surgical treatment are very important for the results. Atrial fibrillation (AF) holds an important place in upper extremity acute arterial occlusion, but other etiological factors such as malignancy is necessary to not forget. AF who has acute upper extremity arterial embolism patients with AF have higher mortality rates and the clinical management and treatment of those patients must be monitored more closely. We believe that the development of treatment modalities and further work needs to be done in order to find an appropriate treatment.

Acute brachial artery thrombosis with diabetic ketoacidosis

Background: Diabetes Mellitus is a worldwide disease that leads to several acute complications including diabetic ketoacidosis. Diabetic ketoacidosis is usually preceded by infection, acute myocardial infarction, stroke, or other dire events. There is one report where diabetic ketoacidosis was reported to be associated with acute arterial embolism. Acute arterial thrombosis is a rare disease that requires immediate treatment. Methods: We present a diabetic patient who presented with acute arterial embolism and developed diabetic ketoacidosis. This is the first case in our hospital in which we have reported with acute brachial artery thrombosis and DKA. Results: We present a 68 years old male chronic smoker with a 25 year history of type 2 Diabetes (non-compliant to medications), Peripheral vascular disease, dyslipidemia and transient ischemic attack. He experienced severe pain and numbness in his right arm and forearm with no wound, puncture lesion or ecchymosis. Forearm was cold, pale with delayed capillary refill on right hand. Right brachial, right radial and right ulnar arteries were not palpable. Strong pulsations of the right subclavicular and right carotid arteries were palpated. This led to a strong suspicion of an acute thrombosis of the right brachial artery. Emergency thrombectomy with +/ − fasciotomy was planned. Patient was anticoagulated with intravenous heparin. Patient's blood sugar was persistently elevated and blood gases showed mild acidosis. Urinary examination confirmed presence of diabetic ketoacidosis. Conclusions: A high index of suspicion of diabetic ketoacidosis in patients with acute arterial thrombosis may lead to early recognition and treatment, avoiding any adverse outcome.

Isolated Multiple Subepicardiac and Epicardiac Echinococcosis

To the Editor : We are describing an extremely rare case of isolated pericardial and subepicardial Echinococcosis (EC) associated with pericardial effusion. The cardiac locations of these cysts in our case are extremely rare (subepicardiac region). An 11-y-old girl was admitted for evaluation of new onset fever, cough, dyspnea on exertion and chest pain for 1 mo. Chest radiograph showed enlarged cardiac silhouette suggestive of pericardial effusion. Transthoracic echocardiography showed large pericardial effusion and multiple, well defined cysts in the pericardial space and subepicardium (Fig. 1). Chest CT, brain CT and abdominal ultrasound were normal. Albendazole was started and then successful surgical excision of the pericardial cyst and evacuations of the subepicardial cysts with removal of most of the walls were performed. Perioperative course was free of complications. The patient was discharged home on Albendazole. Further follow up showed no further cyst formation, no pericardial or pleural effusion. EC most commonly involves the liver (60–70 %) followed by lungs (10–15 %). Cardiac and pericardial EC are rare (0.5–2 %) and are usually associated with liver and lungs involvement. Only few cases with isolated cardiac involvement were reported in the literature. The most affected sites of the heart are the left ventricle (LV) (75 %), right ventricle (RV) (18 %), and the interventricular septum, whereas the pericardium as well as left and right atria are the least affected [1–4]. Rupture of intracardiac cysts can lead to multiple significant complications. Anaphylaxis is one of the most serious complications. Other possible complications include, acute pulmonary hypertension and systemic arterial embolization which may occur secondary to embolization of parts of the EC cysts into the pulmonary and systemic circulations, respectively. In addition, acute pericarditis and tamponade may result from rupture of cysts into the pericardial space. Morbidity and mortality in these cases arise primarily from the complications in the perioperative period. Although surgical mortality is relatively high, the surgery risk should be evaluated in the face of high mortality rate of untreated patients that reaches up to 27 % [5]. In general, treatment of cardiac Echinococcosis requires a combined medical and surgical approach. Early diagnosis and management is associated with a favorable outcome. * Bassel Mohammad Nijres basselmn@yahoo.com

Undifferentiated Pleomorphic Sarcoma of the Thoracic Aorta: A Case Report

Primary sarcomas of the great vessels are extremely uncommon tumors, with aortic sarcoma being the rarest type. They tend to occur in the thoracic aorta, followed by the abdominal aorta and the thoracoabdominal aorta. They have a propensity for metastases and they cause acute arterial embolism (1). Undifferentiated pleomorphic sarcoma, also called malignant fibrous histiocytoma, has been defined as a group of pleomorphic, high-grade sarcomas that fail to show any line of differentiation using currently available ancillary techniques (2). To the best of our knowledge, no fewer than 24 cases of undifferentiated pleomorphic sarcoma originating from the aorta have been reported in the worldwide literature, but imaging findings have been rarely reported (3-7). Herein, we describe the case of a 67-year-old male who had a primary undifferentiated pleomorphic sarcoma of the descending thoracic aorta with an emphasis on computed tomography (CT) and magnetic resonance imaging (MRI) findings. CASE REPORT

Acute Peripheral Arterial Tumorous Embolism after Lung Cancer Surgery

Embolism of peripheral arteries originating from malignant tumors is considered a rare manifestation of cancer.[1] Although uncommon, during the pulmonary resection, a fragment of tumor that has invaded a pulmonary vein can embolize and result in arterial occlusion.[2] Symptoms are related to the location of emboli and the most common events are lower extremity, cerebral, myocardial, and limb ischemic events. Here, we present the case of a 70-year-old woman with tumor embolism of the both lower extremities after left pneumonectomy for lung cancer, which was treated successfully with surgical intervention.

急性下肢动脉栓塞介入术后迷走神经反射发作的护理

目的：探讨急性下肢动脉栓塞介入术后迷走神经反射发作的护理。方法：总结我院自2010年至2013年16例急性下肢动脉栓塞介入术后迷走神经反射发作的护理经验。结果：16例患者介入治疗顺利，栓塞动脉完全开通，临床症状缓解。结论：对下肢动脉栓塞介入术后迷走神经反射发作患者进行切实有效的护理干预对促进患者早日康复，提高患者生活质量有重要意义。 Aim: To discuss the nursing care of vagal reflex after interventional treatment for acute lower limb arterial embolism. Method: The nursing care of 16 patients with vagal reflex after interventional treatment for acute lower limb arterial embolism from 2010 to 2013 in our hospital was introduced. Results: Interventional treatments for the patients were performed smoothly; blood flow reverted; and clinical symptoms were relieved in all cases. Conclusions: Prompt and effective nursing care for the patients with vagal reflex after interventional treatment for acute lower limb arterial embolism is of great significance for improving the quality of life for patients and promoting their recovery.

Outcome of Early Surgical Intervention in Acute Lower Limb Ischemia due to Thromboembolism

Background: Acute lower extremity ischemia is a common vascular disease and considered limb- and life- threatening. The present study evaluated and compared the outcome of early and late surgical intervention in acute lower limb ischemia due to thromboembolism. Methodology: This non randomized comparative parallel study was conducted at the Department of Cardiovascular Surgery, NICVD, Dhaka, Bangladesh from January 2007 to December 2008 for duration of two year. Total 80 patients were enrolled in this study. The patients were divided into equal two groups, Group A, for early surgical intervention (with in 24 hours) and Group B, late surgical intervention (more than 24 hours). Results: Mean (±SD) age of both Group A and Group B was 51.93 (±11.73) and 47.00 (± 11.01) years. Male and female ratio of the total study population was 1.76:1 Pain and absence of pulse distal to occlusion was common for all. Cold extremity, sensory deficit, motor deficit, diminish vascular flow was the commonest findings of both group. In Group A, 57.5% had superficial femoral artery occlusion, 22.5% had iliac artery and 20.0% popliteal artery occlusion. In Group B, 42.5% had superficial femoral artery occlusion, 32.5% had popliteal artery occlusion and 25.0% had iliac artery occlusion. Fasciotomy was performed in 15.0% patients of Group A and in 22.0% patients of Group B. After Fogarty embolectomy in group A and group B had warm extremity (80.0% vs. 65.0%), pulsation distal to occlusion (90.0% vs. 75.0%), intact sensory function (82.5% vs. 67.5%), intact motor function (80.0% vs. 65.0%), and normal vascular flow by Doppler US (80.0% vs. 65.0%). During postoperative period history of bleeding, infection, reperfusion injury, muscle necrosis and limb amputation were 12.5% vs. 10.0%, 5.0% and 7.5%, 17.5% vs. 35.0%, 15.0% vs. 12.5% and 37.5% vs. 32.5% respectively. Conclusion: Duration of embolism may be the significant factor determining the outcomes of the management of acute arterial embolism in the lower extremities. The 24- hour duration of arterial embolism is a crucial factor influencing the surgical the management and early diagnosis and shifting of patients to specified centre as early as possible to save limb as well as life. DOI: http://dx.doi.org/10.3329/cardio.v7i1.20799 Cardiovasc. j. 2014; 7(1): 38-43

Risk factors for predicting postoperative complications after open infrarenal abdominal aortic aneurysm repair: results from a single vascular center in China

Study ObjectiveTo identify the risk factors of, and develop a prediction model for, postoperative complications of patients undergoing infrarenal abdominal aortic aneurysm (IAAA) repair. DesignRetrospective analysis. SettingVascular surgery center of a university hospital. MeasurementsThe clinical data of 316 IAAA cases were collected from January 2004 to October 2010 at a single vascular center in China. Postoperative complications were observed within 30 days after surgery. Patient-specific and operation-specific characteristics were analyzed in relation to postoperative complications using multiple logistic regression analysis. Main ResultsOverall incidence of postoperative complications and overall 30-day mortality of IAAA repair patients were 48.4% (153/316) and 8.8% (28/316), respectively. Postoperative complications involved pulmonary (18.9%), cardiac (14.2%), renal (7.3%), gastrointestinal (5.4%), neurologic (1.3%), and hepatic (0.9%) systems, and acute arterial embolism of the lower limb occurred in 1.3% of cases. Risk factors were age [> 65 yrs; odds ratio (OR) 1.6], aortic occlusion time (> 90 min; OR 2.4), history of chronic obstructive pulmonary disease (COPD; OR 4.4), emergency operation (OR 6.1), and history of cardiac dysfunction (OR 2.1). ConclusionsA combination of age, COPD, emergency operation, history of cardiac dysfunction and aortic occlusion time has significant impact on postoperative complications after open IAAA repair.