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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper presents the results of a retrospective study of 110 percutaneous transluminal angioplasties done over a period of two years on 110 consecutive patients. Anticoagulation or antiplatelet drugs were not used during or after percutaneous transluminal angioplasty. Life-table analysis was used to calculate success rates at one and three months following the procedure. Success rates were determined using three criteria: clinical improvement, pre- and post-percutaneous transluminal angioplasty Doppler studies, and radiographic appearance. Claudication was present in 87 (79%) patients and severe ischemia in 23 (21%) patients. Sixty-eight (62%) PCTAs were done in the iliac arteries, 35 (32%) in the femoral arteries, and 7 (6%) in the popliteal artery. The majority of patients (61%) had 50%-75% arterial stenosis and only 18% had complete occlusion. Percutaneous transluminal angioplasty in the iliac arteries had the best results with cumulative success rates of 90% and 85% at one and three months, respectively. Success rates in the femoral arteries were 83% and 79% and in the popliteal artery 71% and 57% at one and three months, respectively. None of our patients required amputation. Ten patients (9.1%) suffered the following complications within 30 days of percutaneous transluminal angioplasty: death (2), thrombosis (2), perforation (3), minor hematoma (2), and false aneurysm (1). In conclusion, we have shown that percutaneous transluminal angioplasty can be performed safely and effectively without the use of anticoagulation and its associated risks.
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PMID:Percutaneous transluminal angioplasty without anticoagulation. 252 66

From October 1977 to October 1982, 363 unilateral aorto-femoral bypasses using polytetrafluoroethylene (PTFE) prostheses were performed for predominantly unilateral aorto-iliac disease. The distal anastomosis was extended into the deep femoral artery in 57% of the patients. The postoperative mortality was 0.5%. The actuarial patency rate after 6 years was 87% in patients with claudication and 77% in those with critical ischemia. No false aneurysm developed. Thrombosis of the prosthesis was due to progression of distal disease, intimal hyperplasia and postural extrinsic compression. The latter seems to be characteristic of PTFE prostheses and can be treated by thrombectomy. In 21 cases a cross-over femoro-femoral bypass was done during the follow-up period because of contralateral progression of disease.
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PMID:Aorto-femoral bypass with polytetrafluoroethylene prostheses: preliminary results in 363 cases. 350 88

The commonest late complication of aortofemoral prosthetic grafting is graft-limb occlusion, the usual cause of which is outflow obstruction due to anastomotic neointimal hyperplasia or progressive atherosclerosis in the deep femoral artery. Occasionally graft-limb occlusion is due to thrombosis of an anastomotic false aneurysm or is associated with graft infection. Inflow occlusion at the aortic anastomosis is uncommon unless the aortic anastomosis is at the lower end of the aorta distal to the inferior mesenteric artery. When graft-limb occlusion occurs, severe ischemia usually necessitates urgent revascularization to save the leg. Graft thrombectomy and profundaplasty may be successful; however, a cross-femoral graft to the distal patent deep femoral artery is probably the simplest procedure and is usually effective. Occasionally a distal femoropopliteal reconstruction is necessary to establish a satisfactory outflow. Unsuccessful reconstruction of a graft-limb occlusion usually necessitates a high, above-knee amputation.
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PMID:Occlusion of the aortofemoral prosthetic graft. 375 56

During a 5-year period (1979 to 1983), 50 consecutive patients undergoing continuous intraaortic balloon (IAB) pumping were transferred from Evanston Hospital to Northwestern Memorial Hospital (16 miles), where they underwent cardiac operation. All patients had cardiac catheterization before transfer. Indications for IAB were cardiogenic shock (9 patients), postinfarction angina (18 patients), unstable angina (9 patients), evolving myocardial infarction (3 patients), accelerating angina or hemodynamic instability during cardiac catheterization (9 patients) and prophylactic insertion for high-grade left main stenosis (2 patients). Transportation after stabilization was uneventful in all patients. All patients underwent operative coronary revascularization. There was concomitant mitral valve replacement in 3 patients, acute ventricular septal defect repair in 1 patient, aortic valve replacement in 1, and ventricular aneurysmectomy in 1. Three patients (5%) died postoperatively. Nine patients (20%) had complications directly related to IAB insertion. One patient required femoral-femoral arterial bypass preoperatively, 4 patients had postoperative lower limb ischemia treated by IAB removal or thrombectomy and 1 patient had thrombocytopenia (less than 60,000/mm3), 1 false aneurysm, 1 anterior compartment syndrome and 1 prolonged bleeding at the insertion site. Interhospital transfer with IAB pumping in progress should not be restricted to patients with cardiogenic shock, but can be effectively used for all patients who require preoperative IAB insertion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Interhospital transport of patients with ongoing intraaortic balloon pumping. 387 35

Only a few long-term results after replacement of the ascending aorta with a composite graft are available. Twelve patients were therefore evaluated clinically, by computer tomography (CT) and angiography 8-102 months postoperatively. 7 patients had a type I dissecting aneurysm, 1 patient a type II and 4 patients a true aneurysm. Clinically there were no signs of valvular dysfunction or symptoms of lower limb ischemia. All patients were in functional class I or II. On CT all patients with a type I aneurysm showed a chronic dissection with a perfused false lumen extending into the descending aorta. Opacification of the coronary ostia was possible in 4 patients. In 1 patient a false aneurysm at the distal suture line was visualized. Angiography confirmed all CT findings. Coronary angiography demonstrated widely patent coronary ostia. No false aneurysm around the implants was found. Thus, functional results after composite graft operation are good despite the persistence of massive chronic dissection in all patients with a type I aneurysm. CT is an ideal method of evaluating the extent of this dissection. Angiography is necessary to visualize the anatomy of the aortic root and of the coronary ostia.
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PMID:[Radiologic follow-up of the replacement of the ascending aorta with a composite graft. Comparison of angiography and computed tomography]. 408 91

A 48 year old man, victim of a serious road traffic accident (multiple limb fractures, closed trauma of the left hemithorax) was immediately diagnosed as having a systolic regurgitant murmur. The initial ECG recordings showed anterior subepicardial ischemia, and later, a low antero-septal and apical infarction. The hemodynamic status progressively deteriorated, leading to catheterisation 7 months after the accident showing an inferiorly situated VSD (oxymetry and dye dilution techniques). Angiography visualised the traumatic rupture of the lower part of the septum and an inferior posterior left ventricular aneurysm. AT surgery, the septal rupture was repaired by a Dacron patch and a false aneurysm was plicated. The patient was asymptomatic after surgery, and control catheterisation and angiography one year later showed the absence of a residual shunt and good movement of the inferior posterior left ventricular wall. The lesional mechanisms associated instantaneous septal rupture by deceleration, contusion of the apex and progressive development of an inferior posterior wall false aneurysm.
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PMID:[Acquired interventricular communication and false left ventricular aneurysm caused by non-penetrating trauma of the thorax]. 641 17

Twenty-eight consecutive patients with tibial or peroneal artery injury are reported. Of these, eight underwent direct arterial repair, eight received vein graft reconstruction, and the involved artery was ligated in the remainder, with amputation required for various reasons in four. Tibial or peroneal artery injury is a relatively common problem. Successful management requires an aggressive approach to early diagnosis, which in turn requires a high index of suspicion and arteriography. Early appropriate management will prevent the serious complications of ischemia, false aneurysm, arteriovenous fistula, and fascial compartment compression. The reconstruction of injured arteries of the lower leg is usually possible and should be accorded more attention than it has received in the past.
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PMID:Tibial artery injuries. 711 80

The experience in the surgical treatment of traumatic rupture of the thoracic aorta is discussed. Twenty-two patients were seen from 1970 to 1980. They were divided into three groups, according to delay between injury and aortic repair: 1 degree emergency group: 16 patients; 2 degree delayed group: 3 patients; 3 degrees chronic group: 3 patients. All patients had a widened mediastinum and the aortography confirmed the diagnosis. In the first group four patients died before surgery could be started and four after aortic repair from 10 days to 6 seeks postoperatively. In the second and third group all patients survived. Of 22 cases, 21 ruptures were located at the aortic isthmus and 1 at the aortic arch. Many patients had various other injuries, skeletal, abdominal or cerebral. All, but one patient, were operated with the aid of a partial pulsatile left heart bypass to avoid cerebral hypertension and cardiac overload, and to prevent kidney and spinal cord ischemia. One patient was operated, according to the method of Crawford, with blood pressure controlled with nitroprusside. We have not observed in our patients paresis or paraplegia after surgery. The hospital mortality of the surgical treated patients was 34% in the emergency group and 0% in the delayed and chronic group. Surgical treatment is essential in emergency situation, as a complete rupture may be fatal and repair of the chronic post-traumatic false aneurysm is advocated, as their prognosis is unpredictable.
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PMID:Traumatic rupture of the thoracic aorta. 714 91

Eight-nine consecutive patients who were considered candidates for counterpulsation were reviewed for complications of the percutaneous intraaortic balloon pump (PIABP). Indications for counterpulsation were cardiogenic shock in 37 patients, refractory ischemia in 35, postcardiotomy shock in nine, acute infarction with threatened extension in four, septic shock in three and elective preoperative use in one patient. In 67 patients (75.3%), successful passage of the balloon was accomplished in a single attempt; the opposite-side attempt was successful in 10 patients (11.2%) and neither attempt was successful in 12 (13.5%). Seventy-seven patients who underwent PIABP had major complications, including limb ischemia in 12, bleeding at the puncture site in three, permanent foot drop in three, aortic dissection in three, renal embolism in one and false aneurysm at the puncture site in one. Fourteen patients had minor complications: asymptomatic loss of pedal pulses in eight, transient bacteremia in two, parasthesias in two and wound hematoma in two. No patient had free perforation, balloon rupture or wound infection. The rate and severity of complications of PIABP are similar to those with conventional IABP insertion. Ease of insertion alone should not be grounds for using PIABP in patients who can be managed without counterpulsation.
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PMID:Complications of percutaneous intraaortic balloon pumping. 724 11

A case is reported of double-outlet right ventricle (DORV) with restrictive subaortic ventricular septal defect (VSD) in which enlargement of the defect at the time of surgical repair was associated with the late postoperative development of a false aneurysm of the left ventricle. The enlarging fale aneurysm caused extrinsic compression of the dominant left circumflex coronary artery, with subsequent ischemia and infarction of the posterolateral left ventricle. The anatomy and surgical implications of restrictive VSD are discussed.
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PMID:Postoperative false aneurysm of left ventricle and obstruction of left circumflex coronary artery complicating enlargement of restrictive ventricular septal defect in double-outlet right ventricle. 738 28


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