Acute Leg Ischemia Research Articles

A prospective randomized study comparing surgical and percutaneous removal of intraaortic balloon pump

This prospective randomized study of 50 patients compares the prevalence of complications between surgical and percutaneous methods of removal of intraaortic balloons. All patients who had percutaneous placement of a 9.5F intraaortic balloon during a 6-month period were eligible for the study. Patients were excluded if the intraaortic balloon was placed surgically, if a coagulopathy was present, or if acute leg ischemia developed at any time after insertion. After informed consent, 25 patients were randomized to each method of removal. Two complications occurred in the surgical group, including a wound infection and a lymph fistula. In one patient in the percutaneous group, a false aneurysm of the femoral artery developed. There was no significant difference between the mean of 59 minutes for percutaneous removal and 47 minutes for operative removal of the balloon (p = 0.74). The percutaneous method is therefore more cost-effective, because it does not require the use of operating room personnel or equipment necessary for surgical removal. The results of this study indicate that the majority of percutaneously placed intraaortic balloons may be safely removed percutaneously. Surgical removal of 9.5F intraaortic balloons is recommended for patients with bleeding diatheses, hemorrhagic or ischemic complications, or for those in whom the intraaortic balloon was inserted with a surgical procedure.

Aortic dissection presenting as acute leg ischaemia

Lower limb ischaemia as the only or main clinical manifestation of aortic dissection is a rare event. Two cases are presented where this occurred resulting in attempted embolectomy before the correct diagnosis was made. The diagnosis should be considered when embolectomy fails to retrieve thrombus and when angiography demonstrates spiral lucencies within the lumen of large vessels or non-filling of major vascular branches. The value of pre-operative angiography is emphasized.

Follow-up after coronary revascularisation in patients with renal transplants.

Seven patients underwent coronary revascularisation 12-145 months (mean: 63.4 months) after receiving cadaver renal transplants. There was no operative mortality and in all patients satisfactory renal function was maintained perioperatively. Hospital stay ranged from 7 days to 10 days (mean: 8 days). During the period of follow-up (5-72 months, mean: 35 months): one patient remained angina-free at 7 months postoperatively; one patient developed meningitis with Listeria monocytogenes 9 weeks after surgery, and died of streptococcal septicaemia 11 weeks later. The other five patients (71.4%) developed recurrence of angina requiring antianginal therapy, and three of them sustained myocardial infarctions. Three patients developed intermittent claudication, two of whom sustained acute leg ischaemia. Two patients developed heart failure, one of whom died 38 months postoperatively. In four patients who were restudied with cardiac catheterisation and coronary angiography (2-17 months postoperatively) there was evidence of progression of the coronary arterial disease in three, although all coronary grafts were patent. Renal function remained satisfactory in 5 patients, and deteriorated in two patients; in one secondary to advanced heart failure; and in one as a terminal event secondary to septicaemia. Although patients with renal transplants can safely undergo open cardiac procedures, the long-term results of coronary surgery are adversely affected by the progressive disease from which they suffer.

Fibromuscular dysplasia and thrombosed aneurysm of the popliteal artery in a child

A case is reported of bilateral congenital popliteal aneurysms in a 10-year-old girl. Spontaneous thrombosis of the left aneurysm resulted in acute ischemia of the left leg below the knee, and the aneurysm was bypassed with an autogenous saphenous vein graft. Elective resection of the right aneurysm revealed fibromuscular dysplasia, of the medial hyperplasia type, as the cause of the aneurysm. One year after operation, the grafts remained patent, and the patient was asymptomatic.

Femorofemoral bypass to relieve acute leg ischemia during intra-aortic balloon pump cardiac support

This study reports our experience with 10 patients who underwent the emergent construction of a femorofemoral bypass graft to salvage an acutely ischemic lower extremity following the insertion of a transfemoral intra-aortic balloon pump catheter. All patients had excellent resolution of the ischemia and salvage of the extremity. Half of the procedures were done at the bedside with the remainder performed in the operating room. No long-term infections or ischemic sequelae resulted from the procedures in the nine patients available for long-term follow-up. The use of femorofemoral bypass grafting is, therefore, recommended in patients with severe ipsilateral limb ischemia who are dependent on an intra-aortic balloon pump to prevent extremity tissue loss as well as the systemic metabolic manifestations of ongoing tissue ischemia and necrosis. Patient selection, technical considerations, and postoperative management are discussed.