Artery Compression Research Articles

Short-lasting tentorial herniation may cause cortical blindness. A case report and systematic literature review

Cortical blindness occurs with bilateral damage to the visual cortex. It can be caused by various reasons, including the posterior cerebral arteries stroke due to the tentorial herniation. A case of a 40-year-old patient with a large right-sided sphenoidal meningioma. A systematic review on the problem of cortical blindness after tentorial herniation according to the PRISMA guideline. Subtotal removal of dense meningioma. At night after the operation, there was an acute headache, then a coma. Immediately dehydration therapy, tracheal intubation, mechanical ventilation. CT scan showed a small hemorrhage in the tumor bed and subarachnoid space, brain edema and dislocation. After 53 minutes, ventricular drainage was installed, intracranial pressure was normal and ranged from 6 to 14 mmHg. After sedation withdrawal, cortical blindness was detected, which did not regress for 1.5 years. There are no other neurological symptoms, the patient walks, serves herself. Radiation therapy in a total of 54 Gy for the remainder of the grade 1 meningioma ensured tumor control. The time window for restoration of the cerebral blood flow, according to the European Stroke Organization guidelines, is 4.5 hours. In this case, compression of the posterior cerebral arteries lasted less than 53 minutes, however, irreversible ischemia developed in their territory; the outcome on the modified Rankine scale was 4 points. Similar cases are not described in the literature. Patients should be warned about even the non-obvious risks of neurosurgical intervention, since even timely measures taken do not always avoid complications.

A Case of Bony Stroke Involving a Vertebral Artery Detected by Dynamic Three-dimensional Computed Tomography Angiography.

When an ischemic stroke occurs due to bone or cartilage dynamically affecting vessels supplying the brain, it is called bony stroke. We herein report a patient with recurrent cryptogenic stroke that was thought to be a bony stroke. Dynamic three-dimensional computed tomography angiography revealed mechanical compression of the vertebral artery by the hyoid bone and thyroid cartilage. The patient had a recurrent stroke during antiplatelet therapy. Surgical removal of bone tissue prevents stroke recurrence.

Eisenmenger syndrome complicated by the presence of an aneurysm of the pulmonary trunk and compression of the left main coronary artery.

Eisenmenger syndrome complicated by the presence of an aneurysm of the pulmonary trunk and compression of the left main coronary artery.

Complications of Reconstructive Surgery in Head and Neck Region: A Cross-Sectional Study from Bangladesh

Background Microvascular free flaps are ideal for reconstructing post-oncological surgery defects in the head and neck region. Free flaps provide ample tissue for reconstructing even large, complex defects, which gives oncosurgeons flexibility during tumor resections. Methods We performed 50 free flap head and neck reconstructions in 978 patients from June 2015 to September 2018. For reconstructing bone defects, our flap of choice was the free fibula. The surgical outcomes and complications according to flap were retrospectively reviewed and analyzed. Results The overall flap success rate was 98.1%. A total of 45 cases required emergency surgical re-exploration for compromised flaps and 19 of these flaps could not be salvaged. Venous insufficiency was the most common cause of surgical re-exploration. Flaps with delayed arterial thrombosis and vascular compression could not be salvaged. Other complications were partial flap necrosis, oro-cutaneous fistula, and donor site complications. No statistically significant differences were noted for complications in elderly and post-radiotherapy patients. Conclusions Free flap reconstruction is a robust and highly reliable option for head and neck defects and free flaps are a safe option for treating large defects. A second free flap should be the first choice in failed cases after the medical optimization of the patient. Free flap reconstruction is safe in elderly and post-radiotherapy patients.

Endoscope Assisted Microvascular Decompression for Trigeminal Neuralgia: Surgical Safety and Efficacy.

The cranial nerve (CN) V and adjacent neurovascular structures are crucial landmarks in microvascular decompression (MVD). MVD of CN V is the most effective treatment for patients with drug-resistant trigeminal neuralgia (TN) diagnosis. The endoscope-assisted retrosigmoid approach (RSA) provides better exposure and less cerebellar retraction in the corridor towards the cerebellopontine angle (CPA). Five adult cadaver heads (10 sides) underwent dissection of the MVD in park bench position. MVD was simulated using microsurgical RSA, and the anatomical landmarks were defined. Microsurgical dissections were additionally performed along the endoscopic surgical path. Additionally, we present an illustrative case with TN caused by anterior inferior cerebellar artery (AICA) compression. The CN V and its close relationships were demonstrated. Endoscopic and microscopic three-dimensional pictures were obtained. This study increases the anatomical and surgical orientation for CN V and surrounding structures. The CN V arises from the lateral part of the pons and runs obliquely upward toward the petrous apex. It has motor roots that leave from pons antero-supero-medial direction to the sensory root. The endoscopic instruments provide perfect visualization with minimal cerebellar retraction during MVD. MVD surgically targets the offending vessel(s) leading to TN and aims to create a disconnected area. The combination of preoperative radiographic assessment with and anatomical correlation provides safe and effective application while facilitating selection of the most appropriate approach. The RSA allows satisfactory visualization for CN V. Endoscope-assisted microsurgery through the CPA is a challenge, it should be performed with advanced anatomical knowledge.

Validity of Ultrasound for the Diagnosis of Arterial Thoracic Outlet Syndrome

ObjectiveThoracic outlet syndrome (TOS) is a rare disorder mostly seen in younger individuals. Although patients’ wellbeing is relevantly impaired, it often takes a long time before the diagnosis is made. Digital subtraction angiography (DSA) is routinely used despite its radiation exposure, which is a major concern in this young patient population. Moreover, DSA offers limited opportunities for functional assessment. In contrast, ultrasonography is widely accessible without causing radiation exposure and allows for flexible functional assessment. The main goal of the study was to investigate whether ultrasound (US) is a viable alternative to DSA in diagnosing arterial TOS (aTOS). MethodsPatients referred to a tertiary centre for evaluation of suspected TOS were recruited into the study. DSA was routinely performed with the patient’s arms both in the raised (abducted) and neutral (adducted) position. Two vascular surgeons and two radiologists assessed the resulting images for presence of aTOS. Additionally, two examiners performed US according to a standardised protocol. The reference for presence of aTOS was the DSA based interdisciplinary vascular conference consensus. Inter-rater agreement and latent class analysis (LCA) were performed between assessors and diagnostic methods. ResultsFifty one consecutive patients (two thirds female) aged 39.3 ± 13.0 years were included within 11 months. US agreement was excellent at 0.94 (0.841 – 0.980), DSA agreement for vascular surgeons was good at 0.779 (0.479 – 1.000), whereas it was moderate at 0.546 (0.046 – 1.000) for radiologists. Results suggest that DSA is untenable as the gold standard for aTOS diagnosis. In LCA, US was shown to be a reliable diagnostic tool for the detection of aTOS. ConclusionUS examination is a valid test for the detection of haemodynamically relevant compression of arteries in the diagnostic work up of aTOS using a standardised protocol. The role of DSA as the gold standard should be reviewed and needs to be reconsidered.

Investigating optimal compression approach following radial artery puncture: a retrospective study.

The method for compressing hemorrhagic sites after transradial access has been a topic of interest, yet definitive guidelines remain elusive. This study aims to address this gap by optimizing the mechanical compression hemostasis protocol after transradial access. This retrospective analysis included 300 patients from the Department of Cerebrovascular Diseases, Shanghai Fourth People's Hospital affiliated to Tongji University, who underwent transradial access for cerebrovascular angiography. Following the procedure, patients received radial artery compression hemostasis using a balloon compressor. They were divided into group A (n=100, continuous deflation) and group B (n=200, intermittent deflation) according to different hemostasis methods. The incidence of bleeding at the puncture site and complications were compared between the two groups. The rate of bleeding at the puncture site was significantly lower in group B (20 out of 200 patients) compared to group A (20 out of 100 patients) (P=0.032). Similarly, the incidence of puncture site complications, such as edema, congestion, and wound infection was lower in group B (5 out of 200 patients) compared to group A (10 out of 100 patients) (P=0.006). Four hours of compression with intermittent deflation (group B) emerged as the optimal compression method after transradial access, demonstrating fewer complications at the patient's puncture site.

Developmental History of Microvascular Decompression Surgery for Cranial Nerve Dysfunction

Trigeminal neuralgia is characterized by severe lancinating pain in the face and hemifacial spasms displayed by continuous facial muscle twitching, which may impair a patient's quality of life. Before 1960, in the United States of America, the treatment of such symptoms was only partial rhizotomy of the cranial nerves, which resulted in postoperative complications.1, 2) Afterwards, in the late 1960s, it became evident that the etiology of symptoms was an elicited arterial compression of the cranial nerves at the "Root Entry/Exit zone." Microvascular decompression(MVD)was introduced and finally became largely popularized by Gardner and Jannetta et al.3, 4) In 1978, at the Neurosurgical Meeting in New York, I incidentally witnessed slides of MVD proposed by Jannetta, which gave me a big surprise since we were then treating such patients by old-fashioned rhizotomy. Despite much ignorance displayed even in the neurosurgical meeting, I started MVD in 1980.5) In addition, in 1998 we held an Annual Meeting of the Japan Society for Microvascular Decompression Surgery, which has become more active in the fields of microsurgical techniques, diagnosis, monitoring, and long-term follow-up studies.6-8) MVD is a functional neurosurgery and satisfactory results should entail a complete and permanent cure of symptoms without any postoperative sequelae. This makes MVD a sustainable surgery.

ДИФФУЗНОЕ АЛЬВЕОЛЯРНОЕ ПОВРЕЖДЕНИЕ ЛЕГКИХ ПРИ COVID-19 В СОЧЕТАНИИ С ДИФФУЗНОЙ В-КРУПНОКЛЕТОЧНОЙ ЛИМФОМОЙ И ИНФАРКТОМ МИОКАРДА. КЛИНИКО-МОРФОЛОГИЧЕСКОЕ НАБЛЮДЕНИЕ

In this article, we report a case of the combination of COVID-19 with diffuse alveolar lung injury and diffuse large B-cell lymphoma with coronary artery compression by tumor nodules in the epicardium, resulting in myocardial infarction and subsequent fatal outcome. The article reviews the complex interaction between COVID-19 and oncological diseases, demonstrating how the coronavirus infection can significantly exacerbate the progression of malignant neoplasms through different mechanisms.

Comparison of the Safety and Efficacy of Arterial Compression Tourniquet and Bandaging Used in Patients with Hepatocellular Carcinoma after Transfemoral Arterial Chemoembolization

Objective: To compare the safety and efficacy of arterial compression tourniquet with bandaging in patients with hepatocellular carcinoma (HCC) after trans-femoral arterial chemoembolization (f-TACE). Materials and Methods: Between the January 2020 and December 2022, 80 patients with HCC who received transfemoral TACE in our hospital were retrospectively analyzed. Forty patients used arterial compression tourniquet for hemostasis (group A), while other 40 patients used bandaging for hemostasis (group B). The hemostasis success rate, operation time, time in bed, and the incidence of complications between the two groups were compared. Results: The hemostasis success rate was 100% in both groups, no patients experienced hemorrhage related death. The mean operation time in the Group A was significant shorter than that of Group B (4.2 min vs. 9.3 min, P<0.001). Correspondingly, the mean time in bed was also significant shorter in Group A compared with Group B (6.7 h vs. 20.3 h, P<0.001). The incidence of inguinal hematoma and ecchymosis in the group A and group B were 10%, and 7.5%, (P=0.692); and the incidence of urinary retention was 5% vs. 12.5%, (P=0.432), respectively. Conclusion: Arterial compression tourniquet is effective for hemostasis in patients with HCC after transfemoral TACE. Compared to bandaging, arterial compression tourniquet can reduces the operate time and time in bed, and in the certain extent it can reduces the incidence rate of complications.

Bilateral Iliac Arteries Stent Compression Following Pelvic Surgery: A Case Report and Review of Literature

Extrinsic compression of iliac arteries stents has been reported from different causes, such as uterine fibroids and orthopedic surgery. Although extrinsic compression of stents in the iliac veins has been widely studied, stent compression in the iliac arteries is less common. Here we presented a case with bilateral common iliac arteries stent compression following pelvic surgery. A patient (65-year-old woman) presented with acute critical right limb ischemia. Computed tomography angiography (CTA) showed occlusion of the right common and external iliac artery, and severe stenosis in the left common iliac artery. In addition, there was evidence of a Brenner tumor originating from the left ovary. The patient underwent endovascular recanalization of the right iliac arteries and bilateral balloon-expandable stent deployment, and the ovarian tumor was removed after three weeks. The control CTA scan showed asymmetric bilateral iliac arteries stent compression more prominent on the right side, then self-expanding stents were implanted bilaterally. In Conclusion although iatrogenic compression of the stent in the iliac artery is rare despite scarcity, it is important to maintain a high index of suspicion in selected cases and choose the proper stent accordingly.

Cardiac Adaptation and Preferential Streaming in Fetuses with Multiple Nuchal Cords.

The echocardiographic monitoring of a fetus with multiple nuchal cords around the fetal neck is important as it may result in cardiac remodeling and preferential streaming, thus affecting the condition of the fetus. The main aim of our study was to assess whether the collision of the umbilical cord around the fetal neck can lead to discrepancies in the size of the pulmonary artery and the aorta in the three-vessel view and to an increase in the size of the heart, which may result from the compression of the carotid arteries caused by the umbilical cord wrapping around the fetal neck. A total number of 854 patients were included in this study and divided into three groups. Group A (control group) included 716 fetuses (84%) without the umbilical cord around the fetal neck. Group B (study group B) included 102 fetuses (12%) with one coil of the umbilical cord around the fetal neck. Group C (study group C) included 32 fetuses (4%) with two coils of the umbilical cord around the fetal neck. The range of the gestational age of the patients considered for this study was 27-40.2 weeks based on the ultrasound biometry and was not statistically different between the analyzed groups A, B and C (p > 0.05). The Pa/Ao index was calculated by dividing the value of the width of the pulmonary artery (in mm) to the width of the aorta (in mm) measured in the ultrasound three-vessel view. We found that fetuses that the fetuses with one and two coils of the umbilical cord around the neck showed significantly higher values of the width of the pulmonary trunk with the unchanged value of the aorta width. Therefore, we also observed significantly higher values of the ratio of the pulmonary trunk to the aorta for the fetuses wrapped with the umbilical cord around the neck compared with the control group without the umbilical cord around the neck (. Moreover, in the fetuses with one and two coils of the umbilical cord around the fetal neck, an increased amount of amniotic fluid was observed, whereas larger dimensions of CTAR in the fetuses with two coils of the umbilical cord around the neck were present (p < 0.05). The wrapping of the fetus with the umbilical cord around the fetal neck may induce the redistribution of blood flow, leading to fetal heart enlargement and disproportion and may be the cause of polyhydramnios.

Analysis of the history of the search for methods of protecting the brain during operations on the internal carotid artery

The review covers the first studies of the vessels of the brain. The history of the emergence and development of the doctrine of protecting the brain during operations on the carotid arteries is given. Experience has been accumulated in the development of the doctrine of surgical protection of the brain during primary operations on the carotid arteries and compression of the carotid arteries. The analysis of existing and existing methods was carried out. Based on the above analysis, ways of further development of methods of protecting the brain during operations on the carotid arteries are shown.

The Pulsating Stent Sign in May-Thurner Syndrome.

To report a case of a patient with May-Thurner syndrome who underwent endovenous stenting and was found to have pulsating arterial compression on the venous stent. A 74-year-old man presented with 18 months of progressive right thigh and calf edema. After an extensive work-up, the patient underwent a venogram with intravascular ultrasound (IVUS), revealing compression of the right iliac vein by the external iliac artery and psoas muscle. Following stent deployment, fluoroscopy revealed extrinsic compression by an artery, but IVUS confirmed sufficient stent expansion. On follow-up, there was a significant resolution of right limb edema, and adjacent arterial pulsation/compression was deemed non-significant. The choice of venous stents is essential to prevent collapse from extrinsic compression, such as that from an adjacent artery. Carefully choosing venous stents is essential to ensure stent patency in the face of external compression.

Ultrasound characteristics of abdominal vascular compression syndromes.

Abdominal vascular compression syndrome (AVCS) is caused by the compression of abdominal blood vessels by adjacent structures or the compression of abdominal organs by neighboring blood vessels. Such compressions can result in a variety of clinical symptoms. They are not commonly seen in ultrasound practices, and their presence may have been underrecognized and underdiagnosed. This article reviews the clinical features, ultrasound characteristics, and diagnostic criteria of four types of AVCS, namely, celiac artery compression syndrome, renal vein compression syndrome, iliac vein compression syndrome, and superior mesenteric artery syndrome to increase awareness of these conditions among ultrasound practitioners. The ultrasound criteria for AVCS are primarily based on studies with small sample sizes, and therefore, it is important to exercise caution if these criteria are used.

Vertebrobasilar Insufficiency Syndrome in Extension: Insights into Surgical Treatment

Rotational vertebrobasilar artery syndrome, or bow hunter syndrome, is a rare yet well-documented pathology. This study presents a surgical approach to a latent manifestation of dynamic, extension-only, bilateral codominant vertebral artery compression in the V3 segment, associated with craniocervical instability and central canal stenosis. The clinical presentation involves the treatment of positional vertigo resulting from left and high-grade right vertebral artery stenosis during neck extension only. Diagnosis was confirmed through a formal angiogram under provocative maneuvers. Surgical intervention, detailed in this section, employed a multidisciplinary approach, including intraoperative angiograms to ensure patent vertebral arteries precraniocervical fusion. The surgical treatment demonstrated success in addressing extension-only vertebrobasilar syndrome and associated complications of C1-2 pannus and craniocervical instability. Intraoperative angiograms confirmed vertebral artery patency pre- and postsurgical positioning, ensuring the effectiveness of the multidisciplinary approach. This study concludes by highlighting the successful multidisciplinary surgical treatment of a patient with nonunion of a C1 Jefferson fracture, leading to extension-only vertebrobasilar syndrome complicated by C1-2 pannus and craniocervical instability. The importance of considering vertebral artery dynamic stenosis in cases of positional vertigo or transient neurological symptoms following an injury is emphasized. Surgical stabilization, particularly when conservative measures prove ineffective, is recommended, with careful attention to pre- and postsurgical positioning to verify vertebral artery patency and posterior vasculature integrity.

Osteovascular Conflicts in the Neck Region and Cerebrovascular Events: Illustrative Cases and Literature Review.

Literature Review. Abnormal bone structures in the neck can cause headache, neck pain, and difficulty swallowing, but also cerebrovascular events. We introduce the term "osteovascular conflicts" to describe this phenomenon. The objective of this study was to conduct a literature review of such conflicts involving the anterior and posterior cerebral circulation. Furthermore, we aimed at presenting additional illustrative cases from our institution both for increasing awareness for unusual osteovascular conflicts, and for assessing the practice and care of such patients. We focused on osteovascular conflicts in the neck leading to cerebrovascular events related to an abnormal bone structure causing arterial or venous compression, dissection, and/or occlusion. We excluded pure vascular forms without cerebrovascular repercussions. Our PubMed/MEDLINE search for articles published in any language and for which an English abstract was available (from 1966 to 2022) included Eagle's neurovascular, bow hunter's syndrome, and golfer's stroke, excluding trauma-induced artery dissections or compressions and those concerning systemic bone disorders. We also provided illustrative cases collected by the authors. All studies were either case reports or small case series. We found 82 cases of Eagle's neurovascular, 258 of bow hunter's syndrome, and 17 golfer's stroke cases. Mean ages were 52, 48, and 47years, respectively. Male predominance was evident: 81% for Eagle's, 74% for bow hunter's, and 93% for golfer's. Osteovascular conflicts are rare but important causes of cerebrovascular events and often go unrecognised. A greater awareness of cerebrovascular symptoms related to these conflicts can facilitate early diagnosis and treatment.

Laparoscopic lateral duodenojejunostomy for pediatric superior mesenteric artery compression syndrome: a cohort retrospective study

PurposeThere are only a few case reports of laparoscopic lateral duodenojejunostomy (LLDJ) in children with Wilkie’s syndrome, also known as superior mesenteric artery compression syndrome (SMAS). We aimed to describe our laparoscopic technique and evaluate its outcomes for SMAS in children.MethodsFrom January 2013 to May 2021, SMAS children who received LLDJ were included. The procedure was carried out utilizing the four-trocar technique. The elevation of the transverse colon allows good exposure of the dilated and bulging second and third sections of the duodenum. Using a linear stapler, we established a lateral anastomosis connecting the proximal jejunum with the third part of the duodenum. Following that, a running suture was used to intracorporeally close the common enterotomy. Clinical data on patients was collected for analysis. The demographics, diagnostic findings, and postoperative outcomes were analyzed retrospectively.ResultsWe retrospectively analyzed 9 SMAS patients (6 females and 3 males) who underwent LLDJ, aged between 7 and 17 years old. The mean operative time was 118.4 ± 16.5 min and the mean estimated blood loss was 5.6 ± 1.4 ml. There were no conversion, intraoperative complications or immediate postoperative complications. The mean postoperative hospital stay was 6.8 ± 1.9 days and the mean follow-up time was 5.4 ± 3.0 years. During follow-up, seven patients (77.8%) experienced complete recovery of symptoms prior to surgery. One patient (11.1%) still had mild vomiting, which resolved with medication. Another patient (11.1%) developed psychological-induced nausea, which significantly improved after treatment with education, training and diet management.ConclusionsLLDJ represents a feasible and safe treatment option for SMAS in well-selected children. Further evaluation with more cases and case-control studies is required for the real benefits.

A Case of Intractable Vomiting Due to Superior Mesenteric Artery Syndrome

Superior Mesenteric Artery Syndrome (SMAS) is a chronic mechanical obstruction of the duodenum due to compression of the superior mesenteric artery (SMA) at the level of the duodenum, with corresponding symptoms that can be improved with postural changes. Gastrointestinal symptoms may improve with positional changes. This kind of disease is very rare in clinic, we now review a case of intractable vomiting caused by superior mesenteric artery syndrome in our hospital, and report the details as follows.

Functional bony entrapment of the dorsalis pedis artery caused by cranial subluxation in the talonavicular joint

A 66-year-old female presented in the emergency department with Blue-Toe-Syndrome (BTS) and signs of osteitis of her left big toe. Imaging workup of the peripheral vasculature showed no findings. Upon invasive angiography, severe focal stenosis of the dorsalis pedis artery (DPA) could be seen at the talonavicular joint. Complete regression of the stenosis was inducible by dorsal extension in the ankle joint. Further imaging revealed an underlying subluxation of the talonavicular joint as cause of the arterial compression. Entrapment of the DPA is a rare condition and most often described in relation to connective tissue bands or variant muscular tendons (McCabe et al. 70:213–8, 2021; Weichman et al. 24:113, 2010; Smith et al.58:212–4, 2013; Griffin et al. 20:325–8; 2012). In the presented case, bony compression of the PDA due to cranial subluxation of the talus was seen as the cause of BTS and osteitis of the phalanx of the first toe.