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Journal of Cardiothoracic Surgery May 2022The optimal treatment for aortic thrombus remains to be determined, but surgical treatment is indicated when there is a risk for thromboembolism.
BACKGROUND
The optimal treatment for aortic thrombus remains to be determined, but surgical treatment is indicated when there is a risk for thromboembolism.
CASE PRESENTATION
A 47-year-old male presented with weakness in his left arm upon awakening. Contrast-enhanced computed tomography and transesophageal echocardiography revealed a mobile pedunculated object suggestive of a thrombus arising from the ascending aorta and extending to the left common carotid artery. It was removed under hypothermic circulatory arrest and direct cannulation of the left carotid artery to avoid carotid thromboembolism. Histopathological examination revealed that the object was a thrombus. The patient had an uneventful postoperative course and was discharged 9 days after surgery.
CONCLUSION
When a thrombus in the aortic arch extends to the neck arteries, direct cannulation of the neck arteries with selective cerebral perfusion via cervical incision is a useful technique.
Topics: Aorta, Thoracic; Carotid Artery, Common; Humans; Male; Middle Aged; Perfusion; Thromboembolism; Thrombosis
PubMed: 35505355
DOI: 10.1186/s13019-022-01843-5 -
BJS Open Jan 2022
Topics: Hepatic Artery; Humans; Liver; Liver Transplantation; Thrombosis; Vascular Surgical Procedures
PubMed: 35143624
DOI: 10.1093/bjsopen/zrab146 -
The American Journal of Case Reports Jan 2018BACKGROUND Popliteal artery entrapment syndrome (PAES) results from an anomalous relationship between the popliteal artery and the myofascial structures of the popliteal... (Review)
Review
BACKGROUND Popliteal artery entrapment syndrome (PAES) results from an anomalous relationship between the popliteal artery and the myofascial structures of the popliteal fossa. The most common presenting symptoms include intermittent pain in the feet and calves on exercise, resulting in lameness. PAES can lead to popliteal artery thrombosis, stenosis, distal arterial thromboembolism, or arterial aneurysm. The treatment of PAES includes surgical exploration with fasciotomy, myotomy, or sectioning of fibrous band formation, to release the popliteal artery. However, in cases with thrombotic occlusion, thromboendarterectomy with venous patch arterioplasty, or venous graft arterial bypass surgery may be required. This report describes the presentation and surgical management of a case of PAES presenting with limb pain and includes a review of the literature on this condition. CASE REPORT A previously healthy 47-year-old woman presented with a 20-day history of sudden pain in the left lower limb, associated with pallor and a loss of arterial pulses below the knee. Angiography of the affected limb showed occlusion of the left supragenicular popliteal artery, with arterial occlusion, suggestive of arterial thrombus. Imaging of the right popliteal artery, which was not occluded, showed that it was medially deviated. An ipsilateral saphenous vein graft was used to bypass the left supragenicular popliteal artery to the infragenicular popliteal artery, resulting in resolution of the patient's symptoms. CONCLUSIONS PAES is rare and can be under-diagnosed, possibly due to lack of knowledge of this condition. However, if the diagnosis is made early, the prognosis is usually favorable, following appropriate surgical treatment.
Topics: Angiography; Arterial Occlusive Diseases; Female; Humans; Middle Aged; Popliteal Artery; Saphenous Vein; Syndrome; Thrombosis; Treatment Outcome; Vascular Patency
PubMed: 29311538
DOI: 10.12659/ajcr.905170 -
Tomography (Ann Arbor, Mich.) Mar 2022Stroke in young patients requires thorough evaluation as they often lack risk factors. Antiphospholipid syndrome can cause arterial thrombosis and pregnancy loss; hence,...
Stroke in young patients requires thorough evaluation as they often lack risk factors. Antiphospholipid syndrome can cause arterial thrombosis and pregnancy loss; hence, differential diagnoses should include seronegative antiphospholipid syndrome. We report a case of recurrent ischemic stroke caused by recurrent dissection in a patient with a history of pregnancy loss. A 33-year-old woman was admitted with global aphasia and right hemiparesis. During intra-arterial thrombectomy, a left middle cerebral artery dissection was detected. After 5.5 years, she was re-admitted for dysarthria, left facial palsy, subtle left hemiparesis, and right middle cerebral artery dissection. She tested negative for autoimmune diseases and vasculitis. However, underlying pathologic conditions could not be excluded because of the unique disease course. Finally, she was diagnosed with seronegative antiphospholipid syndrome. The concept of seronegative antiphospholipid syndrome has been proposed for patients with clinical features suggestive of antiphospholipid syndrome but with negative titers. However, this syndrome can only be diagnosed by exclusion. Furthermore, arterial dissection should be considered to be its main pathology. Antiphospholipid syndrome itself can be a risk factor for arterial dissection because it weakens the vessel walls. Therefore, diagnosis is important to prevent future complications in young patients with recurrent cerebral artery dissection, especially those associated with pregnancy-related morbidities.
Topics: Adult; Antiphospholipid Syndrome; Cerebral Arteries; Female; Humans; Pregnancy; Stroke; Thrombectomy; Thrombosis
PubMed: 35314639
DOI: 10.3390/tomography8020062 -
Journal of Vascular Surgery Jun 2021Zilver PTX polymer-free, paclitaxel-coated stents and Viabahn stent grafts are effective for the treatment of femoropopliteal lesions. The aim of this study was to... (Comparative Study)
Comparative Study
OBJECTIVE
Zilver PTX polymer-free, paclitaxel-coated stents and Viabahn stent grafts are effective for the treatment of femoropopliteal lesions. The aim of this study was to compare clinical outcomes between the two devices in patients with symptomatic peripheral arterial disease in real-world settings.
METHODS
This multicenter, retrospective study concerned a clinical database of 445 patients with symptomatic peripheral arterial disease (Rutherford categories 1-6) who underwent either Zilver PTX or Viabahn implantation for a femoropopliteal lesion of 10 cm or longer with reference vessel diameters of 4.0 to 7.5 mm between 2012 and 2018 at five hospitals in Japan. Outcome measures were primary patency, freedom from stent thrombosis, freedom from any target lesion reintervention, limb salvage, and overall survival. After propensity score matching, these clinical outcomes were compared between patients treated with the Zilver PTX and those treated with the Viabahn. Also assessed were the interaction effects of baseline characteristics on the association of the Zilver PTX and Viabahn with restenosis and stent thrombosis.
RESULTS
In total, 271 patients were treated with the Zilver PTX, and 174 patients were treated with the Viabahn. Propensity score matching extracted 133 patient pairs with no major intergroup differences in baseline characteristics. The Zilver PTX group had a lower rate of 3-year primary patency (59.5%; [95% confidence interval (CI), 53.0%-66.2%] vs 69.6% [95% CI, 59.3%-79.4%]; P = .005), but a higher rate of 3-year freedom from stent thrombosis (93.6% [95% CI, 90.0%-96.3%] vs 82.4% [95% CI, 74.5%-89.0%], P = .038). There was no significant difference in overall survival, limb salvage, or freedom from reintervention (all P > .05). An interaction analysis showed that the restenosis risk of the Zilver PTX was significantly higher vs the Viabahn in patients with no or one below-the-knee runoff vessel and in those with intravascular ultrasound use than in patients with two or three below-the-knee runoff vessels and in those without intravascular ultrasound use, respectively (P for interaction = .046 and .010, respectively), whereas the stent thrombosis risk of the Zilver PTX was significantly smaller vs the Viabahn in patients not on dialysis than in those on dialysis (P for interaction = .034).
CONCLUSIONS
Compared with Viabahn stent grafts, Zilver PTX stents have a lower rate of primary patency but a higher rate of freedom from stent thrombosis.
Topics: Aged, 80 and over; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Cardiovascular Agents; Databases, Factual; Drug-Eluting Stents; Endovascular Procedures; Female; Femoral Artery; Graft Occlusion, Vascular; Humans; Japan; Limb Salvage; Male; Middle Aged; Paclitaxel; Peripheral Arterial Disease; Popliteal Artery; Prosthesis Design; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Thrombosis; Time Factors; Treatment Outcome; Vascular Patency
PubMed: 33347998
DOI: 10.1016/j.jvs.2020.12.061 -
Internal Medicine (Tokyo, Japan) May 2023
Topics: Humans; Thrombophilia; Thrombosis; Arteries; Protein S Deficiency; Risk Factors
PubMed: 36198604
DOI: 10.2169/internalmedicine.0677-22 -
Anatolian Journal of Cardiology May 2023
Topics: Humans; Coronary Vessels; Coronary Aneurysm; Thrombosis
PubMed: 37119197
DOI: 10.14744/AnatolJCardiol.2023.3186 -
The American Journal of Case Reports Apr 2020BACKGROUND Takotsubo syndrome is a transient, reversible, stress-induced cardiomyopathy that affects only 1.4% of liver transplant patients and can cause complications,...
BACKGROUND Takotsubo syndrome is a transient, reversible, stress-induced cardiomyopathy that affects only 1.4% of liver transplant patients and can cause complications, including cardiogenic shock, arrhythmia, and thromboembolism. Hepatic artery thrombosis is also rare, affecting just 2-4% of these patients, but can have disastrous consequences. Here, we describe a case of concurrent takotsubo syndrome and hepatic artery thrombosis in a postoperative liver transplant recipient. CASE REPORT The patient was a 66-year-old man who underwent living donor liver transplantation for non-alcoholic steatohepatitis. On postoperative day 3, he became lethargic and tachycardic to the 120 s. Work-up, including EKG, troponin I, BNP, and transthoracic echocardiogram, was characteristic for takotsubo syndrome. His LVEF of 15-20% was markedly reduced compared to his baseline of 50-55% from 6 months prior. Hepatic ultrasonography showed no hepatic arterial flow, prompting emergent return to the OR, where intraoperative evaluation revealed hepatic artery thrombosis. The graft was salvaged after hepatic artery thrombectomy and arterial anastomosis revision. We are unable to determine which event caused the other in this case, as both takotsubo syndrome and hepatic artery thrombosis manifested within the same time frame. CONCLUSIONS It is important to recognize takotsubo syndrome as a potential cause of cardiac dysfunction and hepatic artery thrombosis in liver transplant patients, and also be aware that hepatic artery thrombosis can precipitate takotsubo syndrome.
Topics: Aged; Hepatic Artery; Humans; Liver Transplantation; Living Donors; Male; Non-alcoholic Fatty Liver Disease; Takotsubo Cardiomyopathy; Thrombectomy; Thrombosis; Ultrasonography
PubMed: 32287173
DOI: 10.12659/AJCR.920263 -
Archives of Orthopaedic and Trauma... Apr 2020Postoperative thrombosis of the external iliac artery (EIA) following open reduction and internal fixation for acetabular fracture is extremely rare. (Review)
Review
BACKGROUND
Postoperative thrombosis of the external iliac artery (EIA) following open reduction and internal fixation for acetabular fracture is extremely rare.
PURPOSE
To report a patient with EIA thrombosis following open reduction and internal fixation using the modified ilioinguinal approach for acetabular fractures.
STUDY DESIGN
This is a case report of a 69-year-old male with a left acetabular fracture who was treated surgically.
METHODS
A 69-year-old male presented with left hip pain after a 1.5-m fall. Radiographs revealed left acetabular anterior wall and posterior hemitransverse fractures with dome impaction. Computed tomography (CT) showed atherosclerotic changes in many arteries. Open reduction and internal fixation were performed using the modified ilioinguinal approach. Adhesion around the external iliac vessels was severe, and the external iliac vein (EIV) ruptured during exposure. After EIV repair, anatomical reduction was achieved and the fracture was fixed using a reconstruction plate. Nine hours after surgery, the left lower limb showed acute ischemic symptoms. Contrast-enhanced CT indicated complete occlusion of the left EIA. The patient was immediately taken for a thrombectomy via EIA cut-down using a Fogarty catheter. Postoperatively, he had palpable dorsalis pedis and posterior tibial pulses; however, post-reperfusion compartment syndrome developed. Fasciotomy of the left leg was performed.
RESULTS
At the 2-year and 4-month follow-up, he was pain-free in his hip and leg. Although he was walking with a cane, activity was limited due to a mild foot drop.
CONCLUSIONS
It is very important for surgeons to consider EIA thrombosis as a potential complication following open reduction and internal fixation. In this case, EIA thrombosis could be explained by preoperative atherosclerotic changes and intraoperative vascular handling procedures. Preoperative screening and management, and meticulous surgical procedures are necessary for patients with a high risk of thrombosis.
Topics: Acetabulum; Aged; Hip Fractures; Humans; Iliac Artery; Male; Open Fracture Reduction; Thrombosis
PubMed: 31642955
DOI: 10.1007/s00402-019-03288-3 -
American Journal of Physiology. Heart... Jun 2015Endothelial cells play an important role in the process of coagulation and the function of platelets. We have previously reported that 20-hydroxyeicosatetraenoic acid...
Endothelial cells play an important role in the process of coagulation and the function of platelets. We have previously reported that 20-hydroxyeicosatetraenoic acid (20-HETE), a metabolite of arachidonic acid, increased platelet aggregation and induced hemostasis. The purpose of the present study is to investigate whether 20-HETE-mediated endothelial activation has effect on the coagulation and platelet aggregation. C57Bl/6 mice were treated with PBS or 20-HETE (20 μg/kg) for 2 h, and then we performed a carotid artery or femoral artery thrombosis model by FeCl3. Detection of blood flow indicated that 20-HETE pretreatment accelerated formation of thrombus in both common carotid artery and femoral artery. In vitro, the secretion and expression of von Willebrand factor (vWF) in cultured human umbilical vein endothelial cells (HUVECs) with 20-HETE stimulation were increased, subsequently. The protein level of vWF in HUVECs was decreased at 1 h but increased with prolonged treatment with 20-HETE (>4 h). In contrast, vWF in the culture medium was increased under administration of 20-HETE at 1 h. As a result, adhesion of platelets on HUVECs was significantly increased by 20-HETE. In HUVECs, the extracellular signal-regulated kinase (ERK) pathway was activated by 20-HETE in a dose-dependent manner, and the inhibitors of ERK and L-type Ca(2+) channel blocked the release of vWF mediated by 20-HETE. In conclusion, 20-HETE instigates endothelial activation and induces the expression and secretion of vWF via the activation of ERK and calcium channel and therefore triggers thrombosis.
Topics: Animals; Blood Coagulation; Calcium Channel Blockers; Carotid Arteries; Femoral Artery; Human Umbilical Vein Endothelial Cells; Humans; Hydroxyeicosatetraenoic Acids; MAP Kinase Signaling System; Mice; Mice, Inbred C57BL; Platelet Aggregation; Protein Kinase Inhibitors; Rats; Rats, Sprague-Dawley; Thrombosis; von Willebrand Factor
PubMed: 25820395
DOI: 10.1152/ajpheart.00802.2014