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

Distal embolization of fragmented laminated thrombus and atheroma producing peripheral ischemia or gangrene is an underemphasized complication of arterial reconstruction. A set of techniques has been developed to minimize this important complication. To assess their effectiveness, the incidence of distal embolism in patients undergoing resection of abdominal aortic aneurysm with and without the use of these techniques was studied. In the 434 patients who underwent elective resection of abdominal aneurysm, measures to prevent distal embolism were used in all cases. The incidence of distal embolism was only 0.23 per cent (1 of 434), in contrast to reported incidences of up to 11 per cent. In the 21 patients who underwent emergency resection of ruptured aneurysm, these techniques were not used due to the need for early proximal control for resuscitation; distal embolism of atheromatous material occurred in 2 cases, an incidence of 9 per cent. The application of these techniques to other peripheral vascular procedures has resulted in similar low rates of postoperative distal ischemia.
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PMID:Prevention of distal embolism during arterial reconstruction. 50 90

During the past few years CT has emerged as an unsurpassed diagnostic modality in cerebrovascular disease. CT is of limited value in TIA, but reveals a wide variety of findings in completed infarcts. Ischemic, petechial, and hemorrhagic infarcts can be distinguished. Contrast enhancement, varying with the age of the infarct, is frequent. Also the general density of the infarct varies with time. Differential diagnosis, primarily infarct vs tumor, is made by angiography or by followup CT scans. Saccular aneurysms are directly demonstrable by CT if larger than 0.5 cm in diameter. Sequelae of ruptured aneurysm--hematoma, hydrocephalus, ischemia--are consistently visible. This generally also applies to arteriovenous malformations. Angiography is necessary to clarify anatomical details of aneurysms and vascular malformations, and is often indispensable for differential diagnosis.
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PMID:CT diagnosis of cerebrovascular disorders--a review. 71 88

The rupture of an aneurysm of the sub-renal aorta may give rise to several clinical presentations which it is essential to recognise in order to carry out emergency operation, e.g. attack of pain, retroperitoneal hematoma, hemoperitoneum, rupture into a hollow viscus, infective aneurysm. The special characteristics of the treatment concern resuscitation, site and type of aortic clamping, aorto-caval or aorto-digestive rupture or an infective aneurysm raising special problems. It is the vascular collapse which makes the rupture serious, an aneurysm operated as an emergency without collapse, has a mortality which differs little from a non-ruptured aneurysm, e.g. 3 deaths out of 55 operated cases. On the other hand, out of 44 aneurysms operated in acute collapse, there were 31 deaths. The complications observed are linked to the latter, e.g. cerebro-vascular accidents, acute coronary ischemia, acute ishemia of the limbs, which may also be due to embolism during operation, renal complications due to renal shock. The prevention of these complications has permitted us to reduce mortality by 40 p. 100 the last 5 years.
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PMID:[Ruptured aneurysms of the sub-renal abdominal aorta]. 108 6

Aortic diseases in particular aneurysms may be accompanied by spinal ischemia occurring either spontaneously or as complications of surgical interventions. Surgery of the abdominal or thoraco-abdominal aorta is followed in 5 to 15% by ischemia of the spinal cord, in exclusively abdominal interventions in 1.5%. Clinical manifestation depends largely on anatomy of the spinal vessels. If complete transverse myelopathy does not occur, presentation as anterior or posterior arterial ischemic syndrome is common. Other forms of myelopathy are rare. Perfusion deficits through intercostal and lumbar arteries are important in pathogenesis. The great radicular artery is particularly important. Ischemia occurs after hypotensive episodes (ruptured aneurysm) intraoperative clamping of the suprarenal aorta or by occlusion (thrombotic, arterio-arterial embolism). Careful surgical techniques are important for prevention of these neurologic complications. Possibilities for treatment and chances for spontaneous recovery of established spinal-cord lesions are poor.
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PMID:[Spinal lesions in surgery of the aorta]. 141 Sep 90

Intravenous fluorescein is an accurate predictor of small bowel viability, but its effectiveness in assessing colon perfusion during aortic surgery has not been evaluated. Over a 10 year period 186 of 3,306 patients undergoing aortic reconstruction received 500 to 1000 mg of intravenous fluorescein intraoperatively to evaluate colon viability. Prior history of colectomy, hypogastric or mesenteric arterial occlusive disease, or ruptured aneurysm placed these patients at risk to develop ischemic colitis. Patients were operated on for aneurysmal disease (n = 94), occlusive disease (n = 66), or a combination of both (n = 26): 171 exhibited uniform normal perfusion patterns under Wood's lamp illumination, while in 11 it was "patchy." None of these patients developed full-thickness ischemic colitis (observed specificity: 100%). Fluorescence of the rectosigmoid was absent in four patients. One of these patients with a ruptured aneurysm underwent immediate sigmoid resection, while three underwent inferior mesenteric artery reimplantation. The fluorescein pattern subsequently normalized in two patients, but one underwent sigmoid resection for an expanding mesenteric hematoma. The second patient recovered without complications. The final patient continued to show a segmental sigmoid defect and postoperatively developed full-thickness injury requiring sigmoidectomy. During the same period 18 other patients developed transmural colon ischemia from 3,120 aortic reconstructions (0.6%), with a mortality rate of 56%. None had received intraoperative fluorescein. Selective use of intravenous fluorescein may reduce the mortality of ischemic colitis following aortic reconstruction.
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PMID:The role of intravenous fluorescein in the detection of colon ischemia during aortic reconstruction. 154 82

Acute colorectal ischemia is a rare though potentially lethal complication of aortic surgery. We reviewed our recent experience with 16 cases in order to analyze its causative and prognostic factors. The incidence was 2.8%, and the inferior mesenteric artery was occluded in all cases. All patients also had severe occlusive disease of at least two of the hypogastric or deep femoral arteries. Hypoperfusion due to arterial ligation, prosthetic occlusion or embolism was responsible in half the cases. Ischemia and perfusion due to aortic cross-clamping or perioperative hemorrhage were involved in the rest of the cases. Postoperative mortality was 31%. The mortality was lower for partial, nontransmural necrosis, and for elective operations. Recurrent intestinal ischemia, transmural necrosis, surgery for ruptured aneurysm, intestinal hemorrhage and pulmonary edema were associated with a higher mortality rate. All patients with anuria or extrarenal epuration and hepatic cytolysis died. Although reconstruction of the inferior mesenteric artery might lessen the incidence of postoperative colonic ischemia due to hypoperfusion, the role of oxygen free radicals should be investigated in humans, in order to afford colonic protection against the consequences of ischemia-reperfusion.
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PMID:Acute colorectal ischemia after aortic surgery: pathophysiology and prognostic criteria. 159 29

Reports of superior mesenteric artery embolization without the sequela of bowel ischemia or infarction are sparse. We report embolization of the main trunk of the superior mesenteric artery for control of a ruptured aneurysm without subsequent ischemia.
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PMID:Transcatheter embolization of a ruptured superior mesenteric artery aneurysm with Gianturco coils: a case report. 212 65

The timing of surgery for the ruptured aneurysm (SAH) remains controversial. After the period of delayed surgery, the early surgery is now more and more frequently advocated. This paper, study our experience in aneurysm surgery in two different periods, considering only patients admitted in grades I to IV, excluding grade V patients (deep coma, decerebration). During the former period (1972-1984) 328 patients were admitted and considered for delayed surgery, usually during the second week following SAH. 94.5% of patients were operated upon. 5.5% patients died before surgery, from ischemia (3%) or from rebleeding (2.5%). 38.5% were admitted between (D.O-D3) after SAH, D.O being the day of SAH. Only 5.7% were operated upon between D.O-D3. The higher peak of surgery was during the second week (41.8%) and during the third week (39.2%). During the later period (1985-1988) 106 patients were admitted, 50% of them between D.O and D3 after SAH. Every patient was operated upon. The patients admitted between D.O and D3 were operated upon as follows: between D.O and D3 = 32.1%, between D4 and D6 = 22.6%, between D7 and D15 = 34%, after D16 = 11.3%. The analysis of these sub-groups demonstrates that the distribution was related to the age and clinical status. Patients being awake and under 50 years of age were considered for early surgery. Patients being obnubilated or stuporous, and over 50 years of age were planned for delayed surgery. Angiographic spasm and extension of blood in CT Scan were taken in consideration to a lesser degree.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The same question for the past 20 years: when should a ruptured intracranial aneurysm be surgically treated? (Experience with 434 cases)]. 228 2

Between 1976 and 1987 93 patients with an infrarenal aortic aneurysm underwent surgical correction. In 62 patients the procedure was performed electively, whilst 13 displayed an unstable aneurysm and in 18 cases a ruptured aneurysm was present at operation. During the past 5 years the mortality was lowered to 2% in elective cases, whereas in cases of ongoing rupture only moderate improvement took place. The most frequent cause of a lethal outcome was pump failure of the heart (6 times), followed by renal insufficiency and haemorrhagic shock and bleeding complications. Among the non-lethal complications, relaparotomy on the basis of postoperative bleeding ranks first, followed by pulmonary insufficiency, peripheral emboli and partial ischemia of the spine. Resection of infrarenal aneurysms should be performed in the stable state of disease, since insufficiency of multiple vital organ systems increases the mortality by up to 20 fold.
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PMID:[Infrarenal aortic aneurysm: results of surgical treatment]. 291 40

This study was done to emphasize the importance of early, accurate diagnosis of arterial aneurysms that show the symptoms of venous obstruction. Fourteen patients were identified as having atherosclerotic aneurysms producing venous compression. Nine patients had popliteal aneurysms, causing popliteal vein thrombosis in three patients and vein compression without thrombosis in six patients. Five patients had iliac artery aneurysms, producing left iliac vein thrombosis in one patient and venous compression without thrombosis in four patients. In 10 patients the cause of the venous compression symptoms was correctly identified and appropriate revascularization was performed with successful results. In four patients, two with iliac artery aneurysms and two with popliteal artery aneurysms, the associated aneurysm was not identified. One patient died of a ruptured aneurysm and three patients had below-knee amputations because of untreatable distal ischemia. Inappropriate treatment of patients with venous obstruction from unrecognized arterial aneurysms is associated with unacceptable morbidity and mortality. Accurate diagnosis with timely aneurysm repair eliminates the risk of aneurysm rupture or thrombosis and simultaneously alleviates venous compression symptoms.
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PMID:Vein compression by arterial aneurysms. 317 84


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