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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 -
British Heart Journal May 1990Data on 205 children who underwent retrograde arterial catheterisation were studied to assess the frequency of femoral artery thrombosis and the safety and efficacy of...
Data on 205 children who underwent retrograde arterial catheterisation were studied to assess the frequency of femoral artery thrombosis and the safety and efficacy of systemic streptokinase treatment for this complication. In 29 (14%) a transarterial balloon dilatation was performed. In 15 (7.3%) patients impaired arterial perfusion due to vascular spasm with or without thrombus formation was seen in the cannulated leg after catheterisation. Despite heparinisation, signs of impaired arterial circulation persisted in nine patients (4.4% of the total). In these patients femoral artery thrombosis was strongly suspected. Six (53%) of these had undergone a balloon dilatation. Therefore in this study the risk of femoral artery thrombosis developing was 12 times greater after transarterial balloon dilatation than after arterial catheterisation without dilatation (20.6% v 1.7%). Systemic infusion of streptokinase was started in all patients with femoral artery thrombosis. Arterial perfusion became normal in all patients, though in one this was delayed. Haematological monitoring showed lengthening of the thrombin time and a decrease of the fibrinogen concentration during streptokinase treatment. There were no serious complications. Systemic infusion of streptokinase is a safe and useful treatment in children with persistent femoral artery thrombosis after arterial cardiac catheterisation.
Topics: Cardiac Catheterization; Catheterization; Child; Child, Preschool; Femoral Artery; Fibrinogen; Humans; Infant; Streptokinase; Thrombin Time; Thrombolytic Therapy; Thrombosis
PubMed: 2278799
DOI: 10.1136/hrt.63.5.291 -
Experimental and Clinical... Jun 2011Summarize the experience of managing patients with hepatic artery thrombosis after orthotopic liver transplant in a single center.
OBJECTIVES
Summarize the experience of managing patients with hepatic artery thrombosis after orthotopic liver transplant in a single center.
MATERIALS AND METHODS
A total of 726 adult patients who received a liver transplant at the Department of Organ Transplantation, the First Affiliated Hospital of Sun Yat-Sen University, between January 2004 and December 2009, were selected. Fourteen patients had hepatic artery thrombosis after the operation, and the clinical data of these patients were analyzed retrospectively.
RESULTS
The incidence rate of hepatic artery thrombosis was 1.9% (14/726), and the mean time of onset was 10 days (range, 1-41 d) after surgery. Six patients had acute deterioration of liver function, 4 had bile leakage, 1 had hepatic abscess, and 3 had no symptoms. Three patients received urgent rearterialization, 2 received intra-arterial thrombolysis, 3 received combined urgent rearterialization and intra-arterial thrombolysis, and 6 patients received a retransplant. The mortality rate associated with hepatic artery thrombosis was 42.9% (6/14); 2 from biliary necrosis and secondary hepatic failure after urgent rearterialization; 1 from recurrent hepatic artery thrombosis and multiple organ failure after intra-arterial thrombolysis; 1 from renal failure and severe infection after combined urgent rearterialization and intra-arterial thrombolysis, and 2 from severe infection after retransplant. The other patients recovered and were followed for 18 to 66 months. Their liver grafts all functioned well with a patent artery. Two died from tumor recurrence at 18 and 29 months after transplant.
CONCLUSIONS
Hepatic artery thrombosis is a severe complication after liver transplant, which leads to graft loss and recipient death. Rearterialization as early as possible before irreversible biliary and liver parenchyma damage can avoid retransplant.
Topics: Adult; Arterial Occlusive Diseases; China; Graft Survival; Hepatic Artery; Humans; Liver Transplantation; Male; Middle Aged; Reoperation; Retrospective Studies; Thrombolytic Therapy; Thrombosis; Time Factors; Treatment Outcome; Ultrasonography, Doppler
PubMed: 21649568
DOI: No ID Found -
Journal of the... Dec 2015Clinical studies demonstrated the benefits of eplerenone (EPL) in reduction of cardiovascular events in diabetic patients. Since acute myocardial infarction (AMI) and...
INTRODUCTION
Clinical studies demonstrated the benefits of eplerenone (EPL) in reduction of cardiovascular events in diabetic patients. Since acute myocardial infarction (AMI) and stroke are related to acute intravascular thrombosis, we postulate that the beneficial effects of EPL may result from its antithrombotic action.
MATERIALS AND METHODS
Streptozotocin (STZ)-induced diabetic rats were treated with EPL (100 mg/kg/day) for 10 days. Thrombosis in the carotid artery was stimulated electrically.
RESULTS
Thrombosis development was enhanced in STZ-induced diabetic rats as compared to normoglycaemic controls. EPL caused prolongation of the time to artery occlusion, reduction in the incidence of occlusion and decrease in thrombus weight. Changes in the thrombi structure and the inhibition of hypertrophy of the tunica media in the artery wall were also observed. EPL caused reduction in tissue factor, plasminogen activator inhibitor type 1 and interleukin-1β plasma levels.
CONCLUSIONS
Our study demonstrated the antithrombotic effect of EPL manifested by a decrease in the dynamics of thrombus formation and changes in its structure. The changes in thrombosis process were accompanied by antihaemostatic, profibrinolytic and anti-inflammatory effects. The aldosterone blockade with EPL seems to be an additional pharmacological strategy for the prevention and treatment of thrombotic disorders in diabetes.
Topics: Animals; Carotid Arteries; Diabetes Mellitus, Experimental; Eplerenone; Hemostasis; Interleukins; Male; Rats, Wistar; Regional Blood Flow; Spironolactone; Thrombosis; Vascular Patency
PubMed: 25031293
DOI: 10.1177/1470320313515037 -
The use of an absorbable collagen cover (NeuraWrap) improves patency of interpositional vein grafts.Acta Orthopaedica Et Traumatologica... 2010Autologous interpositional vein grafts are used in peripheral arterial bypass procedures. Sudden exposure of vein grafts to arterial blood pressure is associated with...
OBJECTIVES
Autologous interpositional vein grafts are used in peripheral arterial bypass procedures. Sudden exposure of vein grafts to arterial blood pressure is associated with increased wall tension leading to overdistension of the graft and changes in flow patterns. Overdistension of vein grafts often results in anastomotic leaks, thrombosis, and loss of patency. This study was designed to evaluate the use of a biodegradable collagen cover as a means of preventing overdistension of venous bypass grafts in a rat model.
METHODS
Twenty-two Sprague-Dawley female rats weighing 250-350 g were randomly assigned to two groups: study group (n= 15) and control group (n=7). In all the rats, a 10-mm segment of the left femoral vein was harvested and used as a graft in repair of a right femoral artery injury. Following this procedure, control rats remained untreated. After completion of the femoral artery repair in the study group, the graft was wrapped with a collagen cover of appropriate length (NeuraWrap Nerve Protector) and sutured to form a tube around the vein graft. At the end of the procedure, the intensity and duration of bleeding, and vessel patency were recorded and the proximal and distal arterial segments were examined by Doppler ultrasonography. All observations and measurements were repeated at 1 and 2 hours after surgery. After the second hour, all the rats were sacrificed and vein graft samples with the arterial portions were removed for histological study.
RESULTS
After removal of the vascular clamps of the control group, a sudden distension was observed in all the vein grafts. In this group, bleeding at the anastomosis site lasted for 1 to 3 minutes and was followed by ballooning of the grafts. In the study group, however, none of the samples exhibited distension and ballooning. There was no bleeding in 11 samples at all, and bleeding time was less than one minute in the remaining four samples. In the control group, only one graft was patent at two hours, one of the grafts was occluded after only three minutes. In the study group, all the grafts were patent and no thrombosis was noted. The mean blood flow velocity of the control group measured at 0 hour by Doppler ultrasonography was 0.93+/-0.33 cm/sec in the proximal artery, and 0.73+/-0.44 cm/sec in the distal artery. The mean blood flow velocities in the proximal and distal arteries of the study group were as follows, respectively: at 0 hour: 0.45+/-0.27 and 0.46+/-0.22 cm/sec; at 1 hour: 0.40+/-0.22 and 0.62+/-0.40 cm/sec; and at 2 hours: 0.55+/-0.22 and 0.64+/-0.37 cm/sec.
CONCLUSION
Prevention of overdistension of vein grafts with the use of an external cover decreases anastomotic leaks, protects the intimal media, maintains blood flow, reduces the incidence of thrombosis, and thus provides a higher patency rate.
Topics: Anastomosis, Surgical; Animals; Bleeding Time; Collagen; Female; Femoral Artery; Femoral Vein; Graft Occlusion, Vascular; Primary Graft Dysfunction; Rats; Rats, Sprague-Dawley; Thrombosis; Tissue and Organ Harvesting; Ultrasonography
PubMed: 20676019
DOI: 10.3944/AOTT.2010.2298 -
Annals of Vascular Surgery Jan 2021SARS-CoV-2 (COVID-19) patients with associated thromboembolic events have demonstrated poor outcomes despite the use of anticoagulation therapy and surgical...
SARS-CoV-2 (COVID-19) patients with associated thromboembolic events have demonstrated poor outcomes despite the use of anticoagulation therapy and surgical intervention. We present a COVID-19 patient with acute limb ischemia, secondary to extensive thrombosis of an aortic aneurysm, iliac arteries, and infrainguinal arteries. Initial treatment with systemic thrombolysis, which restored patency of the aortoiliac occlusion, was followed by open thrombectomies of the infrainguinal occlusions.
Topics: Aged; Aortic Aneurysm, Abdominal; Arterial Occlusive Diseases; COVID-19; Fibrinolytic Agents; Humans; Iliac Artery; Infusions, Intravenous; Male; Thrombectomy; Thrombolytic Therapy; Thrombosis; Tissue Plasminogen Activator; Treatment Outcome; Vascular Patency
PubMed: 32861850
DOI: 10.1016/j.avsg.2020.08.083 -
Blood Jun 2013Platelets are essential mediators of hemostasis and thrombosis. Platelet counts (PCs) in humans average 250 platelets/nL, but it is not entirely clear how platelet...
Platelets are essential mediators of hemostasis and thrombosis. Platelet counts (PCs) in humans average 250 platelets/nL, but it is not entirely clear how platelet numbers affect hemostasis and occurrence of thrombotic events. Mice, displaying PCs of ~1000 platelets/nL, are widely used to assess platelet function in (patho-)physiology, but also in this species, the significance of PC for hemostasis and thrombotic disease is not established. We reduced PCs in mice to defined ranges between 0 and 1000 platelets/nL by platelet-depleting antibodies and challenged them in different arterial thrombosis models: the transient middle cerebral artery occlusion (tMCAO) stroke model and tail bleeding experiments. We show that thrombotic occlusion of the injured aorta and the carotid artery were partially impaired when PCs were reduced by 70% or 80%, respectively. In contrast, tail bleeding times and thrombus formation in small arterioles were largely unaffected by reductions of PC up to 97.5%. Similarly, infarct growth and neurological deficits after tMCAO were unaffected by reductions of PCs up to 90%, whereas a further reduction was protective. These results reveal that arterial thrombosis, cerebral infarction, and hemostasis in mice efficiently occur at unexpectedly low PCs, which may have implications for humans at risk of thrombotic or hemorrhagic disease.
Topics: Animals; Aorta; Blood Platelets; Carotid Arteries; Disease Models, Animal; Hemorrhage; Mice; Platelet Count; Stroke; Thrombocytopenia; Thrombosis
PubMed: 23584880
DOI: 10.1182/blood-2012-10-461459 -
Liver Transplantation : Official... Oct 2001Hepatic artery thrombosis (HAT) is the most common vascular complication after orthotopic liver transplantation (OLT) and has traditionally been managed with re-OLT.... (Review)
Review
Use of autologous radial artery for revascularization of hepatic artery thrombosis after orthotopic liver transplantation: case report and review of indications and options for urgent hepatic artery reconstruction.
Hepatic artery thrombosis (HAT) is the most common vascular complication after orthotopic liver transplantation (OLT) and has traditionally been managed with re-OLT. However, several reports have shown that urgent revascularization is frequently an effective means of graft salvage. This most often involves hepatic artery (HA) thrombectomy and thrombolysis, with reestablishment of arterial inflow through a donor iliac artery conduit based on the supraceliac or infrarenal aorta. We report a 46-year-old man who developed HAT 13 days after OLT after angiographic splenic artery embolization to reduce splenic artery steal. A suitable donor iliac artery was not available for arterial reconstruction and could not be obtained from neighboring transplant centers. The patient underwent urgent HA thrombectomy, intrahepatic arterial thrombolysis, and revascularization using an autologous radial artery (RA) conduit based on the supraceliac aorta. The patient is alive more than 1 year after revascularization, with normal liver function and documented flow in the arterial conduit by Doppler ultrasound and arteriography. He has not developed late biliary complications or adverse sequelae of RA harvest. Autologous RA can be safely and successfully used as an aortic-based arterial conduit in urgent revascularization of HAT after OLT. RA should be considered for use in HA revascularization if an adequate donor iliac artery is not available and other potential conduits are not usable or desirable. The availability of autologous RA expands the armamentarium of vascular conduits that can be used in HA revascularization and may help minimize re-OLT for otherwise potentially salvageable liver allografts.
Topics: Arterial Occlusive Diseases; Follow-Up Studies; Hepatic Artery; Humans; Liver Circulation; Liver Failure; Liver Transplantation; Male; Middle Aged; Radial Artery; Reoperation; Thrombosis; Transplantation, Autologous; Treatment Outcome; Vascular Patency
PubMed: 11679992
DOI: 10.1053/jlts.2001.26926 -
Journal of the American College of... Dec 1986Although it is not clear why coronary occlusion and restenosis occur after successful coronary angioplasty, factors related to the procedure may influence early and late...
Deep arterial injury during experimental angioplasty: relation to a positive indium-111-labeled platelet scintigram, quantitative platelet deposition and mural thrombosis.
Although it is not clear why coronary occlusion and restenosis occur after successful coronary angioplasty, factors related to the procedure may influence early and late results. The possible adverse effects of a medial tear documented histologically and produced during balloon angioplasty of the common carotid arteries were studied in 30 fully heparinized (100 U/kg body weight) normal pigs. Scanning electron microscopy showed endothelial denudation and extensive platelet deposition in all dilated arterial segments. Visible macroscopic mural thrombus was present within an hour of the procedure in 29 (91%) of the 32 arteries that had a medial tear documented by histologic study; the tear produced an indium-111-labeled platelet deposition of 116.4 +/- 26.5 X 10(6)/cm2 (mean +/- SE) and total thrombotic occlusion in 2 arteries (4%). None of the 24 arteries without a medial tear had a thrombus, and the mean platelet deposition in that group was 7.0 +/- 0.5 X 10(6)/cm2 (p less than 0.0008). In 12 pigs scanned with a gamma camera, visible thrombus was associated with platelet deposition in excess of 20 X 10(6)/cm2 in 12 arteries, 9 of which had a positive indium-111-labeled platelet scintigram. Thus, arterial angioplasty causes deep arterial injury, which appears to be a major cause of mural thrombosis, heavy platelet deposition, a positive indium-111-labeled platelet scintigram and acute arterial occlusion. A positive indium-111-labeled platelet scintigram was always associated with macroscopic thrombus of at least 20 > 10(6) platelets/cm2 and underlying deep arterial injury.
Topics: Angioplasty, Balloon; Animals; Arteries; Blood Platelets; Heart Diseases; Indium; Microscopy, Electron, Scanning; Radioisotopes; Radionuclide Imaging; Swine; Thrombosis; Wounds, Penetrating
PubMed: 2946742
DOI: 10.1016/s0735-1097(86)80311-4