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Journal of Vascular Surgery May 2009The aortovenous fistulas are rare, most of them are aortocaval fistula. The non-caval communication of the fistula is sparse. Herein we report a 47-year-old female...
The aortovenous fistulas are rare, most of them are aortocaval fistula. The non-caval communication of the fistula is sparse. Herein we report a 47-year-old female diagnosed as traumatic aorto-superior mesenteric vein (Ao-SMV) fistula. The abdominal pain, fullness, and frank bruit on abdominal auscultation suggested the diagnosis of an intra-abdominal arteriovenous fistula. The diagnosis of Ao-SMV was further confirmed by the computed tomography (CT) and aortography. The fistula was successfully treated with transcatheter coil embolization. This is the first case of Ao-SMV fistula. It provides an alternative option of treatment other than conventional surgery.
Topics: Abdominal Pain; Accidental Falls; Aorta; Aortography; Arteriovenous Fistula; Auscultation; Embolization, Therapeutic; Female; Humans; Mesenteric Veins; Middle Aged; Phlebography; Tomography, X-Ray Computed; Treatment Outcome; Wounds, Nonpenetrating
PubMed: 19327940
DOI: 10.1016/j.jvs.2008.12.047 -
European Journal of Vascular and... Jan 2005Controversy exists regarding the optimal management of patients with coexisting coronary and extracranial carotid artery disease. This study investigates the incidence...
OBJECTIVES
Controversy exists regarding the optimal management of patients with coexisting coronary and extracranial carotid artery disease. This study investigates the incidence of death, cerebrovascular events and myocardial infarction (MI) in patients with asymptomatic significant carotid artery disease undergoing coronary artery bypass graft (CABG) surgery.
DESIGN
Prospective cohort.
METHODS
Fifty patients with asymptomatic carotid stenoses > or =70% associated with cervical bruits undergoing CABG without prophylactic carotid endarterectomy (CEA) were followed up over a median period of 68 months following surgery cerebrovascular events, MI and mortality were recorded. All patients received optimal secondary prevention for cardiovascular disease unless contraindicated.
RESULTS
No cerebrovascular events occurred within 30 days of surgery. One patient suffered an ipsilateral transient ischaemic attack (TIA) 14 months after CABG. Two patients died within 30 days; one from an MI, the other from pancreatitis. Three deaths occurred after 30 days; one from MI, one from primary lung cancer and one following rupture of an abdominal aortic aneurysm. No non-fatal MIs occurred.
CONCLUSIONS
In this patient group the overall risk of death, cerebrovascular events and MI was 4% during the first 30 days postoperatively and 8% thereafter. This compares favourably with published series for staged or combined CEA-CABG procedures. For asymptomatic significant carotid disease, prophylactic CEA prior to CABG does not appear to confer any advantage over CABG alone.
Topics: Aged; Carotid Stenosis; Coronary Artery Bypass; Coronary Artery Disease; Female; Humans; Incidence; Male; Middle Aged; Myocardial Infarction; Prospective Studies; Stroke; Treatment Outcome
PubMed: 15570278
DOI: 10.1016/j.ejvs.2004.07.011 -
Annals of the Royal College of Surgeons... Sep 1996Coeliac axis compression syndrome is a rare condition, characterised by chronic intermittent colicky upper abdominal pain after eating, associated with weight loss and...
Coeliac axis compression syndrome is a rare condition, characterised by chronic intermittent colicky upper abdominal pain after eating, associated with weight loss and an epigastric bruit. Typically, the patient is an otherwise fit young to middle-aged adult. The diagnosis requires the exclusion to other causes of upper gastrointestinal pathology, and is suggested by narrowing or occlusion of the coeliac axis on angiography. The pathophysiology of this finding and the complex of symptoms in a typical patient remains unclear. Carefully selected patients seem to derive long-term benefit from decompression.
Topics: Abdominal Pain; Adult; Arterial Occlusive Diseases; Celiac Artery; Chronic Disease; Female; Humans; Ligaments; Male; Radiography; Weight Loss
PubMed: 8881735
DOI: No ID Found -
Swiss Medical Weekly Jun 2007A malposition of the median arcuate ligament (MAL) is a rare entity causing the celiac axis compression syndrome (CACS), first described by Harjola in 1963. The presence...
A malposition of the median arcuate ligament (MAL) is a rare entity causing the celiac axis compression syndrome (CACS), first described by Harjola in 1963. The presence of anomalous fibrous diaphragmatic bands of the diaphragm compresses the celiac axis, especially during the expiration. In this report we present the fourth case in literature that was ever successfully treated by laparoscopy. A 38-year-old male presented with a history of intermittent epigastric pain, 15 kg weight loss caused by inappetence and frequent diarrhoea, over a 5-year period. The clinical examination revealed only a loud systolic bruit in the epigastrium, with loss of intensity during deep inspiration. Suspecting CACS, a spiral CT angiography was requested. The CT demonstrated the MAL crossing anteriorly to the celiac artery (CA) and the sagittal and the tridimensional reconstructions demonstrated the CA narrowing due to compression, while the superior mesenteric artery (SMA) was normal. The MAL was laparoscopically divided, releasing the celiac axis. The surgical time was 130 minutes, without significant blood losses. At 3-months follow-up, the CT-scan demonstrated no evidence of CACS with complete recovery.
Topics: Abdominal Pain; Adult; Angiography; Arterial Occlusive Diseases; Celiac Artery; Decompression, Surgical; Humans; Laparoscopy; Ligaments; Male; Minimally Invasive Surgical Procedures; Syndrome; Tomography, Spiral Computed; Weight Loss
PubMed: 17629806
DOI: 10.4414/smw.2007.11827 -
Annals of Hepatology 2004A 30-year-old woman presented with hepatomegaly and an audible hepatic bruit at 24 weeks gestation. Non-contrast MRI demonstrated an exophytic 12.6 x 7.8 x 12.8 cm mass...
A 30-year-old woman presented with hepatomegaly and an audible hepatic bruit at 24 weeks gestation. Non-contrast MRI demonstrated an exophytic 12.6 x 7.8 x 12.8 cm mass arising from the right lobe of the liver with a central scar, suggestive of focal nodular hyperplasia (FNH). Conservative management included monthly abdominal ultrasound examinations until the time of delivery, to assess growth of the mass and monitor for risk of rupture. Seven weeks post partum the patient experienced severe right upper quadrant pain. A CT angiogram of the liver demonstrated a stable mass with no evidence of bleed or rupture and multiple hypervascular masses throughout the liver. Surgical resection of the dominant lesion was performed. Histological examination of the lesion confirmed FNH. The patient is now 22 months post surgery with radiographic evidence of stable multifocal FNH.
Topics: Abdominal Pain; Adult; Female; Focal Nodular Hyperplasia; Humans; Pregnancy; Pregnancy Complications; Prenatal Diagnosis
PubMed: 15118579
DOI: No ID Found -
The Journal of the Royal College of... Nov 1977Two patients with coeliac artery compression syndrome' are described.Symptoms were vague and nonspecific, and the diagnosis was made by finding an epigastric bruit on...
Two patients with coeliac artery compression syndrome' are described.Symptoms were vague and nonspecific, and the diagnosis was made by finding an epigastric bruit on auscultation of the abdomen and confirming the presence of a vascular lesion by angiography. Both patients were cured by surgical decompression of the coeliac trunk. Auscultation of the abdomen can be a useful part of physical examination in general practice.
Topics: Adult; Celiac Artery; Constriction, Pathologic; Female; Humans
PubMed: 616859
DOI: No ID Found -
The Turkish Journal of Gastroenterology... Sep 2004Spontaneous aortocaval fistula is rare, occurring only in 3%-6% of all ruptured abdominal aortic aneurysms. A definitive diagnosis of aortocaval fistula is sometimes...
Spontaneous aortocaval fistula is rare, occurring only in 3%-6% of all ruptured abdominal aortic aneurysms. A definitive diagnosis of aortocaval fistula is sometimes difficult, as the classic diagnostic signs (pulsatile abdominal mass with bruit, high-output heart failure and acute dyspnea) are present only in 20%-50% of all such cases. Pre-operative diagnosis is crucial, as adequate preparation has to be made for the massive bleeding expected at operation. Surgical repair of aortocaval fistula is now standardized repair of the fistula. We report herein a case of spontaneous aortocaval fistula, which presented with liver and renal failure.
Topics: Acute Kidney Injury; Aged; Angiography; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Arteriovenous Fistula; Fatal Outcome; Humans; Liver Failure, Acute; Male; Thrombosis; Tomography, X-Ray Computed; Vena Cava, Inferior
PubMed: 15492916
DOI: No ID Found -
Journal of Nuclear Medicine : Official... Oct 1975A man with a history of gunshot wounds presented with jaundice and a bruit over the upper abdomen. The radionuclide flow sequence revealed simultaneous perfusion of the...
A man with a history of gunshot wounds presented with jaundice and a bruit over the upper abdomen. The radionuclide flow sequence revealed simultaneous perfusion of the liver with transit of the activity down the aorta. The was considered compatible with a fistula between the hepatic artery artery and portal vein (confirmed angiographically and at autopsy). An expanding aneurysm of the hepatic artery produced an enlarging focal parenchymal defect.
Topics: Arteriovenous Fistula; Hepatic Artery; Humans; Male; Middle Aged; Portal Vein; Radiography; Radionuclide Imaging; Technetium; Wounds, Gunshot
PubMed: 1177020
DOI: No ID Found -
Annals of Surgery Jul 1976A patient with an abdominal aortic aneurysm with a preaortic left renal vein fistula is presented. Review of the 7 reported cases of aorto-left renal vein fistulae...
A patient with an abdominal aortic aneurysm with a preaortic left renal vein fistula is presented. Review of the 7 reported cases of aorto-left renal vein fistulae demonstrates many similarities in the clinical presentation with aorto-caval fisulae. However, in addition to the triad of pain, pulsatile abdominal mass and bruit, commonly found in aorto-caval fistulae, the presence of hematuria, proteinuria, and azotemia suggests a renal vein fistula. Radiographic studies often demonstrate a large non-functional left kidney. Operative management of the fistula may be performed by a variety of maneuvers. All 7 patients survived. When repair was undertaken without delay, function in the left kidney returned to normal within two months postoperatively.
Topics: Acute Kidney Injury; Aorta, Abdominal; Aortic Aneurysm; Arteriovenous Fistula; Follow-Up Studies; Hematuria; Humans; Kidney; Male; Middle Aged; Pain; Proteinuria; Renal Veins; Uremia; Urography
PubMed: 938115
DOI: 10.1097/00000658-197607000-00005 -
International Heart Journal Mar 2005A 37-year old woman was suspected of having renovascular hypertension because of recent onset severe hypertension (blood pressure 220/135 mmHg; compared to 132/65 mmHg...
A 37-year old woman was suspected of having renovascular hypertension because of recent onset severe hypertension (blood pressure 220/135 mmHg; compared to 132/65 mmHg two years earlier) and an abdominal bruit. A captopril renal scan indicated the presence of right renal artery stenosis. Additionally, a captopril plasma renin activity (PRA) provocation test showed a positive result for renovascular hypertension (baseline PRA = 291 microU/mL; 1 hour post-captopril PRA = 1444 microU/mL). Selective renal angiography demonstrated a severe critical stenotic lesion at the distal portion of the right renal artery. Blood pressure (BP) decreased to 136/80 mmHg one day after successful percutaneous transluminal renal angioplasty and stenting. Repeat renal angiography six months after the procedure revealed no evidence of in-stent restenosis. Blood pressure (BP = 137/76 mmHg) and plasma renin profile (baseline PRA = 23.8 microU/mL; 1 hour post-captopril PRA=22.3 microu/mL) also were normal six months following initial revascularization. Moreover, blood pressure (137/84 mmHg) and renin profile remained normal 2.5 years after the procedure (baseline PRA = 24.3 microU/mL; 1 hour post-captopril = 25.6 microU/mL). The results of this study have thus demonstrated a case of renin-dependent renovascular hypertension in which both the blood pressure and plasma renin activity profile normalized following successful percutaneous transluminal angioplasty and stenting.
Topics: Adult; Angioplasty, Balloon; Female; Humans; Hypertension, Renovascular; Radiography; Renal Artery; Renal Artery Obstruction; Renin; Stents
PubMed: 15876819
DOI: 10.1536/ihj.46.339