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

Kawasaki disease is known to cause a vasculitis of small and medium-sized vessels, with subsequent aneurysm formation. Most of the severe manifestations of the disease occur as a result of coronary aneurysm formation. However, many other arteries have been documented to be involved. A case is presented of a middle-aged man with a history of Kawasaki disease who had an acute ischemic limb from a thrombosed popliteal aneurysm that formed as a result of the disease. This is the first known case report of Kawasaki disease resulting in delayed lower extremity ischemia. Typical findings of patients with Kawasaki disease are presented, along with a case report and review of the literature. A history of Kawasaki disease is an extremely rare but possible cause of peripheral aneurysms, even in middle-aged patients.
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PMID:Popliteal aneurysm presenting as acute thrombosis and ischemia in a middle-aged man with a history of Kawasaki disease. 937 29

This study reviews our experience with duplex ultrasound arterial mapping (DUAM) for preoperative evaluation in 466 patients (262 men) who underwent 485 lower extremity revascularization procedures from January 1, 1998 to May 30, 2001. Preoperative imaging consisted of DUAM alone in 449 procedures and DUAM and contrast angiography (CA) in 36. An attempt to image from the distal aorta to the pedal arteries was made in all the patients. The selection of optimal inflow and outflow bypasses anastomotic sites was based on a schematic drawing following DUAM examination. Inflow disease was also assessed by intraoperative pressure gradient (IPG) between the distal anastomosis and radial arteries, and completion arteriography of the runoff vessels was obtained, which was correlated with the preoperative findings. Indications for surgery were severe claudication in 91 (19%) limbs, tissue loss in 197 (40%), rest pain in 113 (23%), acute ischemia in 46 (10%), popliteal aneurysm in 18 (4%), superficial femoral artery aneurysm in 1, abdominal aortic aneurysm with claudication in 1, and failing graft in 18 (4%). Age ranged from 30 to 97 years (mean 72 +/- 12 (SD) years) and risk factors such as diabetes, hypertension, use of tobacco, coronary artery disease, and end-stage renal disease were present in 45%, 45%, 44%, 44%, and 13% of the patients, respectively. One hundred twenty-one (25%) limbs had at least 1 previous ipsilateral revascularization. The mean DUAM time was 66 +/- 20 (SD) min (30-150 min). Additional preoperative imaging was deemed necessary in 36 cases due to extensive ulcers, edema, severe arterial wall calcification, and very poor runoff. The distal anastomosis was to the popliteal artery in 173 cases and to the tibial and pedal arteries in 255. Inflow procedures to the femoral arteries, embolectomy, thrombectomy, balloon angioplasty, and patch angioplasty accounted for the remaining 57 cases. Overall, 6-, 12-, and -24- month secondary patency rates were 86%, 80%, and 66%, respectively. This early experience shows that high-quality arterial ultrasonography performed by a highly skilled vascular technologist may represent an alternative to conventional arteriography for patients in need of lower extremity revascularization. Because of limitations inherent to the technique and very poor runoff observed on ultrasonographic examination, additional preoperative imaging procedure's are needed for certain patients.
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PMID:Lower extremity revascularization without preoperative contrast arteriography: experience with duplex ultrasound arterial mapping in 485 cases. 1190 14

Untreated popliteal aneurysm (PA) may cause serious complications. Early detection and surgery are beneficial. What are the circumstances under which the diagnosis of PA is made? What risks are associated with the treatment? A total of 36 consecutive PAs in 22 men and 2 women were treated in a single-center series. Altogether, 26 surgical reconstructions (group 1) were performed using a medial approach, and two PAs were resected through a dorsal approach. Eight patients with eight PAs did not undergo surgery (group 2): Two were awaiting surgery, and six had refused it. At the time of diagnosis, 25 PAs were symptomatic: local pain, swelling, or "pulsation" in the popliteal groove (29%); claudication of the foot/calf (39%); critical ischemia (21%). Eleven asymptomatic cases were discovered during screening duplex sonography of known aortic aneurysms. Among the 28 PAs that underwent surgery, 6 produced acute symptoms. The following complications were observed: five postoperative hematomas, one infected polytetrafluoroethylene (PTFE) graft, two early graft occlusions, and two significant stenoses of the distal anastomosis. After a mean follow-up of 15 months (range 2-43 months), group 1 had a limb salvage rate of 100% and a secondary patency rate of 96%. Two patients are still awaiting surgery. Critical ischemia represents an absolute indication for surgical repair, but the observed zero mortality and relatively low morbidity associated with the intervention combined with a favorable patency rate justify the liberal use of surgery even for asymptomatic PAs. The extensible medial approach is preferred. Sequential reconstruction is advised for bilateral PAs.
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PMID:Popliteal aneurysm: diagnostic workup and results of surgical treatment. 1450 6

Popliteal artery entrapment syndrome is a rare cause of acute limb ischemia that most commonly is seen in young adults. The most significant complications associated with popliteal entrapment include aneurysm formation and acute thrombosis. This case presents the youngest patient ever reported with this syndrome and highlights the advantages of multimodal treatment including thrombolysis, popliteal aneurysm resection, and revascularization. Although a significant body of literature exists on popliteal entrapment syndrome in teenagers and young adults, it has not been reported previously in a patient younger than 11 years. Limb salvage was achieved in this patient with a combination of endovascular and surgical techniques.
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PMID:Acute lower extremity ischemia in a 7-year-old boy: an unusual case of popliteal entrapment syndrome. 1519 78

Acute limb-threatening ischemia from thrombosis may be the initial presentation of popliteal artery aneurysms (PAA) and is associated with amputation rates of 20-30%. Since contrast angiography may miss the diagnosis, the authors suspect that thrombosis of PAA may be an underappreciated cause of acute ischemia. Routine use of duplex arteriography (DA) may aid in the diagnosis and may help identify the outflow vessels with improved results. One hundred and nine patients (group 1) from 1994 to 1997 and 201 patients from 1998 to 2001 (group 2) presenting with acute limb-threatening ischemia were studied. None of the group 1 patients underwent preoperative DA and no diagnosis of acute popliteal artery aneurysm thrombosis was made. Ten patients with acute ischemia due to thrombosed popliteal artery aneurysms were identified in group 2 when preoperative DA was routinely performed. Urgent revascularization based on the results from DA was performed with use of autogenous saphenous vein in all patients. Six patients had functioning bypasses with a mean follow-up of 15.6 months. There were 3 deaths, 2 within 30 days and 1 after 2(1/2) years with functioning grafts. One patient was lost to follow-up. No major amputations were performed. Incidence of thrombosed popliteal artery aneurysms as the cause of acute limb-threatening ischemia is probably underestimated. Routine use of DA may provide the diagnosis and identifies the available outflow vessels. Contrary to previously published reports, urgent revascularization of an acutely ischemic extremity from thrombosed popliteal aneurysm can provide excellent rates of limb salvage.
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PMID:Impact of duplex arteriography in the evaluation of acute lower limb ischemia from thrombosed popliteal aneurysms. 1645 2

An acute compartment syndrome of the calf due to popliteal vein compression is described in a 71-year-old man who had undergone popliteal aneurysm bypass and ligation 10 years previously. Acute pain and extensive edema of the right leg and a pulsatile mass in the right popliteal fossa prompted arteriography that revealed collateral filling of the aneurysm. Aneurysm decompression by using a posterior approach was completed, including genicular artery ligation, and fasciotomy was performed. Irreversible ischemia of the foot necessitated tibial amputation on the third day after surgery. The literature on complications of excluded popliteal aneurysms after bypass and ligation, clinical presentations, and surgical management is reviewed.
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PMID:Acute compartment syndrome: an unusual complication of a previously bypassed popliteal aneurysm--case report and literature review. 1667 3

Popliteal aneurysms are the most common peripheral arterial aneurysm and occur most commonly among older men with established cardiovascular disease. Popliteal aneurysms are asymptomatic or otherwise present with intermittent claudication, pressure symptoms in the popliteal fossa, distal embolization, and, rarely, rupture. We present a patient with a remarkably large popliteal aneurysm of 10 cm presenting as a popliteal swelling with foot drop and no signs of limb ischemia. According to our literature search, it is the largest reported popliteal aneurysm, and its corresponding symptoms are unusual. The diagnostic workup and treatment are presented.
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PMID:Giant popliteal aneurysm presenting with foot drop. 1701 13

Popliteal artery aneurysms account for 85% of all peripheral aneurysms and are frequently associated with abdominal aortic aneurysms. Up to 75% of all popliteal artery aneurysms are discovered in symptomatic patients who present with arterial insufficiency, leg swelling, or pain. Popliteal artery aneurysms can be diagnosed with duplex ultrasonography. Aneurysm repair should be considered for all symptomatic patients with rest pain or limb-threatening symptoms. Asymptomatic aneurysms larger than 2 cm should also be treated to prevent the development of limb-threatening ischemia and assure better surgical bypass graft patency and longer freedom from amputation. Conventional aneurysm repair consists of either opening the aneurysm sac and interposing a bypass graft or aneurysm ligation combined with bypass grafting. If the aneurysm sac is left intact, side branch perfusion may persist and the aneurysm may continue to enlarge and can rupture. Endovascular popliteal aneurysm repair has not demonstrated clinical equipoise to standard surgery but may be advantageous in select high-risk patients.
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PMID:A contemporary review of popliteal artery aneurysms. 1730 97

We report a unique case of a giant, thrombosed, and ruptured popliteal aneurysm measuring 13.8 cm x 14.0 cm x 14.0 cm in a 93-year-old man. The patient is a hypertensive smoker with asymptomatic swelling behind the knee for several years who developed pain in the swelling with ecchymosis for 2 weeks before presentation. Despite rupture of the aneurysm, this patient exhibited no ischemic symptoms. The patient underwent emergency surgery in which most of the aneurysmal sac was excised and because of satisfactory collateral circulation, the proximal and distal popliteal artery was suture-ligated. Remarkably, the patient did not require a bypass graft and at follow up is pain-free and ambulating with no clinical signs or symptoms of ischemia. This case is unique in several ways: (1) to our knowledge, this is the largest popliteal aneurysm compared with any case that has been documented in the literature, (2) this is also the oldest reported age ever associated with a popliteal aneurysm, and (3) exclusion suture ligation proximally and distally has resulted in an exceptional outcome.
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PMID:A unique case of thrombosed giant popliteal aneurysm. 1830 67

A 44-year-old male presented to our vascular surgery unit with a partially thrombosed 22 mm popliteal aneurysm giving rise to progressive distal ischemia. Microscopy of embolus retrieved from the posterior tibial artery at bypass surgery revealed the unexpected finding of intravascular papillary endothelial hyperplasia (Masson's pseudoangiosarcoma).
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PMID:"Masson's pseudoangiosarcoma" in a popliteal aneurysm: tumor or thrombus? Cause or effect? 1989 19


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