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

To develop a new technique for ablating arrhythmias by interrupting coronary perfusion of the myocardium, we studied six mongrel dogs, weighing 20-35 kg. Under angiographic guidance a microcatheter (1.0 mm diameter) was introduced into a branch of the left anterior descending or posterior descending coronary artery. A detachable platinum coil (0.0254 cm diameter, 3 cm length) soldered onto a stainless-steel delivery wire (Guglielmi) was inserted through the microcatheter and advanced to occlude the arterial branch. A 0.5-mA electric current applied to the proximal end of the delivery wire resulted in intravascular thrombosis due to attraction of the negatively charged blood cells, platelets, and fibrinogen to the positively charged platinum coil. In approximately 4.5 minutes, as the thrombus was formed, electric current dissolved the soldering and detached the platinum coil from the delivery wire. Electrocardiograms showed focal ST-T changes but no ventricular tachyarrhythmias. Pathologic studies revealed thrombosis around the platinum coil and well-demarcated focal ischemia/infarction that was correlated with elevation of cardiac enzymes. We conclude that intracoronary arterial embolization and electrothrombosis using an electrolytic platinum coil can be selectively performed in a very small coronary arterial branch, resulting in a limited area of myocardial damage. This technique is potentially useful for ablating arrhythmias and may be safer and more controllable than intracoronary alcohol infusion.
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PMID:Intracoronary arterial occlusion: a novel technique potentially useful for ablation of cardiac arrhythmias. 986 45

We previously reported that in vitro hypoxic condition enhanced VEGF level and its receptor expression in hepatic cancer cell line, HepG2. Transcatheter hepatic arterial embolization (TAE) therapy is one of the vasculo-occlusive and hypoxic challenges to hepatocellular carcinoma (HCC). Therefore, we examined the level of VEGF in sera of patients with HCC who underwent TAE during the course of the treatment. Thirty-eight patients with HCC and hepatitis C virus-positive cirrhosis were studied. Peripheral blood samples were taken before and 1, 3 and 7 days after TAE with informed consent. The serum levels of VEGF as well as hepatocyte growth factor (HGF), another hepatic remodeling factor, were measured. The molar ratio (BTR) of serum branched chain amino acid (BCAA) to tyrosine (Tyr), the serum levels of AST, ALT and LDH were also examined. Although the level of AST, ALT and LDH reached the peak value within 1 day after TAE, VEGF level increased significantly 7 days later. On the other hand, there were no significant alterations in the levels of HGF and BTR during the course of TAE. Although the level of HGF was significantly correlated with the level of VEGF before TAE, this correlation was no more observed after TAE. These data collectively suggest that VEGF may be secreted in response to clinical hypoxic intervention, TAE, independent of HGF or altered amino acid metabolism. VEGF may play a role as a sensitive marker for tumor ischemia.
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PMID:Serum vascular endothelial growth factor in the course of transcatheter arterial embolization of hepatocellular carcinoma. 1033 62

Three patients who had undergone hemodialysis for end-stage renal disease, presented with acute small bowel hemorrhage, and were treated with superselective transcatheter arterial embolization via coaxial microcatheters. In all patients pre-procedure upper gastrointestinal (GI) endoscopy and colonoscopy had failed to demonstrate the source of the hemorrhage. Selective diagnostic angiography revealed frank extravasations of contrast from the small bowel arteries (one jejunal artery and two ileal arteries). After superselection of feeding arteries with a microcatheter, transcatheter embolization using Gelfoam and microcoils was performed in all three patients. Immediate hemostasis was achieved in all patients and the patients were discharged free from symptoms 3-5 days after embolization. No evidence of intestinal ischemia or infarction was noted, with the time from procedure to last follow-up ranging from 4 to 12 months. We conclude that superselective angiography is a valuable tool for diagnosing and treating acute small bowel hemorrhage in patients with end-stage renal disease when endoscopic evaluation has failed.
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PMID:Acute small bowel hemorrhage in three patients with end-stage renal disease: diagnosis and management by angiographic intervention. 1190 32

The term bland arterial embolization refers to catheter-directed delivery of particulate material for the purpose of embolizing selected arteries. This technique is used in humans to treat a number of conditions, including arteriovenous malformations, uterine fibroids, and epistaxis. The term chemoembolization refers to selective intra-arterial delivery of chemotherapeutic agents in conjunction with particulate material for the purpose of embolizing arteries supplying blood to a tumor. Compared with traditional modes of drug delivery, chemoembolization increases local concentration and dwell time of the chemotherapeutic agent, augments tumor ischemia, and minimizes systemic toxic effects. In humans, the technique has shown encouraging results in the treatment of a variety of nonresectable tumors. The present report describes techniques for percutaneous bland arterial embolization and chemoembolization in dogs and goats and results of these techniques in 3 dogs and a goat. Bland arterial embolization was performed in 2 dogs and the goat. The goals of treatment included pain palliation, reduction of tumor growth, and control of hemorrhage, and each animal was considered to have benefited from the procedure on the basis of the preprocedural goals. Chemoembolization was performed in 1 dog for treatment of a nonresectable hepatocellular carcinoma. Unfortunately, this dog did not live long enough to identify any response to treatment. Results for animals studied illustrate the feasibility of bland arterial embolization and chemoembolization in veterinary patients and suggest that embolization may provide an alternative method of treatment for animals with inoperable lesions.
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PMID:Percutaneous arterial embolization and chemoembolization for treatment of benign and malignant tumors in three dogs and a goat. 1245 12

The surgical treatment of 30 cases of vascular thoracic outlet syndrome (TOS) in 25 patients is presented. Patients included 17 women and 8 men with average age of 26.1 years. The causes of compression were cervical rib ( n = 16), soft tissue anomalies ( n = 12), and scar tissue after clavicle fracture ( n = 2). Ten subclavian artery aneurysms containing intraluminal thrombus as well as one subclavian artery occlusion were found. All such cases had multiple distal arterial embolization. Presenting features of cases with arterial TOS included: hand ischemia ( n = 11), transient ischemic attack (TIA) ( n = 1), and claudication or vasomotor phenomena during the arm hyperabduction ( n = 11). Two patients with venous TOS developed hand edema during arm hyperabduction, and five other patients had axillary-subclavian venous thrombosis. In all cases decompressive procedures using a combined supraclavicular and infraclavicular approach were performed. Decompression was achieved by cervical rib excision ( n = 12), combined cervical and first rib excision ( n = 4), and first rib excision ( n = 14). In all cases division of all soft tissue elements was also accomplished. Associated vascular procedures included resection and replacement of 10 subclavian artery aneurysms, one subclavian-axillary and one axillary-brachial bypass, as well as nine brachial embolectomies. All five cases with axillary-subclavian vein thrombosis before decompression were treated with anticoagulant therapy. The mean follow-up period was 3 years and 2 months (range 1 to 6 years). Two pleural entry injuries and two transient brachial plexus injuries were noted. All reconstructed arteries were patent during the follow-up period. Complete resolution of symptoms with a return to full activity was noticed in all cases with arterial TOS and in two cases with venous TOS without axillary-subclavian vein thrombosis. In cases with axillary-subclavian vein thrombosis relief of symptoms was mild, and there were limitations on daily activity. Vascular TOS is seen less frequently than the neurogenic form; however, in most cases it requires surgical treatment. We prefer a combined supraclavicular and infraclavicular approach because it offers complete exposure of the subclavian artery, cervical and first ribs, and all soft tissue anomalies.
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PMID:Vascular thoracic outlet syndrome. 1271 20

Tissue ischemia, necrosis, and gangrene are uncommon but well-described complications of arterial catheterization in the neonate. Treatment options for progressive tissue necrosis following arterial embolization and/or vasospasm are limited in these patients secondary to unpredictable pharmacokinetics and risks associated with systemic anticoagulation or vasodilatation in newborns. We report a case of a multidose regimen of topical 2% nitroglycerin ointment for reversing severe tissue ischemia following peripheral arterial line placement. The favorable response in this infant suggests that topical nitroglycerin therapy should be considered as potential therapy to ameliorate the effects of vascular compromise following arterial line placement in neonates.
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PMID:Resolution of peripheral artery catheter-induced ischemic injury following prolonged treatment with topical nitroglycerin ointment in a newborn: a case report. 1506 2

Acute arterial occlusion can be the result of acute thrombosis or systemic embolism. Paradoxical embolism of a venous thrombosis through a right-to-left shunt is an important cause of acute limb ischemia. We describe a young patient with acute limb ischemia who was found to have multiple deep venous thromboses causing arterial embolization through a patent foramen ovale. Essential thrombocytosis was found to be the risk factor for venous thromboses in this patient. The patient was managed with embolectomy and anticoagulation along with chemotherapeutic cytoreduction of platelet count. This case illustrates the importance of considering the systemic embolism as a cause of acute arterial occlusion. The presence of a hypercoagulable status such as chronic myeloproliferative disorder does not eliminate the possibility of systemic embolism in the event of acute arterial occlusion. Patients presenting with acute limb ischemia should be evaluated for embolic sources. The presence of deep venous thrombosis in such a patient should prompt the evaluation for a patent foramen ovale.
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PMID:Paradoxical arterial emboli causing acute limb ischemia in a patient with essential thrombocytosis. 1450 Dec 34

The diagnosis of acute peripheral ischemia can be obtained based on clinical presentation, inspection, and palpation of the affected extremity. Unfractionated heparin as a single shot is immediately given followed by continuous infusion when diagnosis is clinically evident and contraindications are excluded. Thromboembolectomy using a Fogarty catheter is immediately performed in patients with evidence of arterial embolization and signs of advanced ischemia (TASC IIb/III) followed by intraoperative angiography. Patients with evidence of arterial thrombosis require urgent angiography followed by thrombectomy and probably subsequent endovascular or surgical interventions and vascular reconstruction. For patients with moderate ischemia (TASC IIa), initial diagnostic angiography is recommended followed by primary thrombectomy with subsequent intraoperative angiography and immediate endovascular or operative treatment of remaining vascular problems. As an alternative therapeutic option initial catheter-guided local thrombolysis can be performed in selected patients with the intention of subsequent limb revascularization or unmasking relevant vessel alterations leading to specific endovascular or surgically performed vascular reconstruction. Possible development of muscle ischemia because of increased compartment pressure should be considered and fasciotomy performed when indicated. Primary amputation of the severely ischemic limb after initial thrombectomy might be recommended in patients with life-threatening organ failure related to muscle necrosis.
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PMID:[Acute limb ischemia from the general surgeon's point of view. How much knowledge of vascular surgery is necessary?]. 1467 31

This article has reviewed indications, methods, and results of PVE and TACE for hepatobiliary tumors. PVE is applied mainly to increase the safety of major hepatic resection in patients with hilar cholangiocarcinoma, HCC, or metastatic liver tumors. Hepatic arterial embolization causes selective ischemia of the liver tumor and enhances the cytotoxicity of the chemotherapeutic agent administered concomitantly. A survival benefit of TACE in patients with unresectable or recurrent HCC has been demonstrated. The significance of preoperative TACE is still controversial. TACE is routinely performed before PVE in HCC patients.
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PMID:Current role of portal vein embolization/hepatic artery chemoembolization. 1506 66

Peripheral arterial embolism arising from a malignant tumor is an infrequent manifestation of neoplastic disease and also a rare cause of acute arterial occlusion. A diagnosis of lower limb acute ischemia in young adults could be overlooked because the condition is quite uncommon in this age group. A case of lower extremities arterial embolization from metastatic lung cancer of germ cell origin is reported and the literature is reviewed.
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PMID:Tumor embolization causing acute ischemia with sometimes fatal results. Case report and review of literature. 1515 36


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