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Ischemic Complications (ischemic + complications)
Selected AbstractsLong-segment substernal jejunal esophageal replacement with internal mammary vascular augmentationDISEASES OF THE ESOPHAGUS, Issue 3 2000R. F. Heitmiller We describe a technique that uses the internal mammary vessels to enhance long-segment jejunal graft blood supply in addition to an intact distal mesenteric vascular arcade. We believe that this technique, called vascular augmentation, improves jejunal graft perfusion and decreases ischemic complications. [source] Microemboli in Aneurysmal Subarachnoid HemorrhageJOURNAL OF NEUROIMAGING, Issue 4 2008Jose G. Romano MD ABSTRACT BACKGROUND AND PURPOSE The determinants of ischemic complications in subarachnoid hemorrhage (SAH) are not well defined. The objective of this study is to evaluate the role of microemboli in SAH-related cerebral ischemia. METHODS Forty patients with aneurysmal SAH were monitored with transcranial Doppler (TCD) for the presence of embolic signals (ES) and vasospasm, and followed clinically for the development of cerebral ischemic symptoms, from the time the aneurysm was secured until day 14 posthemorrhage or discharge. RESULTS Microembolic signals were detected in 15/40 patients, appeared at a mean of 6.7 days after hemorrhage, and were often noted bilaterally. There was a close association between ES and cerebral ischemic symptoms (P= .003), and ES were commonly present in the distribution of the vessel with ischemic symptoms. Ultrasonographic vasospasm did not correlate with ischemia and there was no relationship between microembolic signals and vasospasm. CONCLUSIONS In this study, ES detected in over a third of SAH victims, were associated with the development of cerebral ischemic symptoms, and were not related to vasospasm, but rather appeared to be an independent risk factor for the development of ischemic symptoms in SAH. [source] Magnetic resonance angiography in reversible cerebral vasoconstriction syndromesANNALS OF NEUROLOGY, Issue 5 2010Shih-Pin Chen MD Objective To investigate the evolution and clinical significance of vasoconstriction on magnetic resonance angiography (MRA) in patients with reversible cerebral vasoconstriction syndromes (RCVS). Methods Patients with RCVS were recruited and followed up with MRA examinations until normalization of vasoconstriction or for 6 months. The vasoconstriction severity of the major cerebral arterial segments (M1, M2, A1, A2, P1, P2, and basilar artery) was scored on a 5-point scale: 0 (0,<10%), 1 (10,<25%), 2 (25,<50%), 3 (50,<75%), and 4 (,75%). Subjects with at least 1 segment with a vasoconstriction score ,2 were eligible for the study. Initial mean scores of single or combined arterial segments were used to predict ischemic complications. Results Seventy-seven patients with RCVS (8 men/69 women; average age 47.7 ± 11.6 years) finished the study with a total of 225 MRAs performed. The mean number of arterial segments involved was 5.3 ± 3.0 in the initial MRA. Vasoconstriction scores reached their maximum 16.3 ± 10.2 days after headache onset, close to the average timing of headache resolution (16.7 ± 8.6 days). Vasoconstriction evolved in a parallel trend among different arterial segments. Seven (9.1%) patients developed posterior reversible encephalopathy syndromes (PRES). Six (7.8%) patients had ischemic stroke. A logistic regression model demonstrated that the M1,P2 combined score was associated with highest risk of PRES (odds ratio [OR], 11.6, p = 0.005) and ischemic stroke (OR, 3.4; p = 0.026). Interpretation MRA evaluation in patients with RCVS is valid. Vasoconstriction was pervasive and outlasted headache resolution. Vasoconstrictions in M1 and P2 are important determinants for PRES and ischemic stroke. ANN NEUROL 2010;67:648,656 [source] Endothelial nitric oxide synthase gene polymorphisms in giant cell arteritisARTHRITIS & RHEUMATISM, Issue 11 2003Carlo Salvarani Objective To examine potential associations of the Glu/Asp298 polymorphism in exon 7 and the 4a/b polymorphism in intron 4 of the endothelial nitric oxide synthase (eNOS) gene with susceptibility to and clinical expression of giant cell arteritis (GCA), particularly in patients with versus those without ischemic complications. Methods Ninety-one consecutive patients with biopsy-proven GCA, who were residents of Reggio Emilia, Italy, and 133 population-based controls from the same geographic area were genotyped by polymerase chain reaction and allele-specific oligonucleotide techniques for eNOS polymorphisms in exon 7 and intron 4. The patients were separated into 2 subgroups according to the presence or absence of ischemic complications (visual loss and/or jaw claudication and/or aortic arch syndrome). Results The distribution of the Glu/Asp298 genotype differed significantly between GCA patients and controls (corrected P [Pcorr] = 0.003). Carriers of the Asp298 allele (Asp/Asp or Glu/Asp) were significantly more frequent among the GCA patients than among the controls (Pcorr = 0.0002, odds ratio 3.3, 95% confidence interval 1.7,6.3). The distribution of the 4a/b genotype was similar in GCA patients and controls. No significant associations were found when GCA patients with and without ischemic complications were compared. Conclusion Our findings show that the Glu/Asp298 polymorphism of the eNOS gene is associated with GCA susceptibility. [source] Strategy of Circulatory Support with Percutaneous Cardiopulmonary SupportARTIFICIAL ORGANS, Issue 8 2000Mitsumasa Hata Abstract: We evaluated the efficacy and problems of circulatory support with percutaneous cardiopulmonary support (PCPS) for severe cardiogenic shock and discussed our strategy of mechanical circulatory assist for severe cardiopulmonary failure. We also described the effects of an alternative way of PCPS as venoarterial (VA) bypass from the right atrium (RA) to the ascending aorta (Ao), which was used recently in 3 patients. Over the past 9 years, 30 patients (20 men and 10 women; mean age: 61 years) received perioperative PCPS at our institution. Indications of PCPS were cardiopulmonary bypass weaning in 13 patients, postoperative low output syndrome (LOS) in 14 patients, and preoperative cardiogenic shock in 3 patients. Approaches of the PCPS system were the femoral artery to the femoral vein (F-F) in 21 patients, the RA to the femoral artery (RA-FA) in 5 patients, the RA to the Ao (RA-Ao) in 3 patients, and the right and left atrium to the Ao in 1 patient. Seventeen (56.7%) patients were weaned from mechanical circulatory support (Group 1) and the remaining 13 patients were not (Group 2). In Group 1, PCPS running time was 33.1 ± 13.6 h, which was significantly shorter than that of Group 2 (70.6 ± 44.4 h). Left ventricular ejection fraction was improved from 34.8 ± 12.0% at the pump to 42.5 ± 4.6% after 24 h support in Group 1, which was significantly better than that of Group 2 (21.6 ± 3.5%). In particular, it was 48.6 ± 5.7% in the patients with RA-Ao, which was further improved. Two of 3 patients with RA-Ao were discharged. Thrombectomy was carried out for ischemic complication of the lower extremity in 5 patients with F-F and 1 patient with RA-FA. One patient with F-F needed amputation of the leg due to necrosis. Thirteen patients (43.3%) were discharged. Hospital mortality indicated 17 patients (56.7%). Fifteen patients died with multiple organ failure. In conclusion, our alternate strategy of assisted circulation for severe cardiac failure is as follows. In patients with postcardiotomy cardiogenic shock or LOS, PCPS should be applied first under intraaortic balloon pumping (IABP) assist for a maximum of 2 or 3 days. In older aged patients particularly, the RA-Ao approach of PCPS is superior to control flow rate easily, with less of the left ventricular afterload and ischemic complications of the lower extremity. If native cardiac function does not recover and longer support is necessary, several types of ventricular assist devices should be introduced, according to end-organ function and the expected support period. [source] Endovascular treatment of Angio-SealÔ-related limb ischemia,Primary results and long-term follow-up,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2010Christoph Thalhammer MD Abstract Objectives: To investigate primary success rates and long term follow-up of endovascular treatment of AngioSealÔ-related limb ischemia. Background: Current knowledge on optimal therapy of ischemic complications following application of AngioSealÔ is limited. Methods: A single-center prospectively maintained database was retrospectively interrogated and AngioSealÔ,related complications requiring endovascular treatment over an 8-year-time period was identified. Results: Fifteen patients fulfilling the inclusion criteria were identified, resulting in an approximated incidence of 0.26% of all devices implanted at our institution. In all cases, the complication was managed successfully in the absence of complications. Eleven patients were treated with balloon angioplasty (PTA) and four with stent implantation because of suboptimal PTA results. Twelve patients were available for noninvasive vascular follow-up examination for a median time of 40 months postinterventionally. Only two patients needed a second intervention consisting of balloon angioplasty due to symptomatic restenosis. At final follow-up all patients were asymptomatic with no relevant restenosis. Conclusion: Endovascular treatment for AngioSealÔ-related limb ischemia with or without stent implantation results in an excellent immediate and long-term clinical and hemodynamic outcome. © 2009 Wiley-Liss, Inc. [source] Direct stent implantation without predilatation through 5 French guiding catheter following transfemoral coronary angiogram: A feasibility studyCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2003Camille Brasselet MD Abstract Direct stenting (DS) is accepted as reducing procedural cost and duration and 5 Fr guiding catheters as lowering peripheral vascular complications. We aimed to evaluate the feasibility and safety of both strategies. We retrospectively studied 150 consecutive patients treated with DS strategy using a 5 Fr femoral approach. A need for 6 Fr devices or balloon predilatation defined 5 Fr DS failure. Procedural success was defined as good angiographic result (residual stenosis < 30% and TIMI flow 3) without ischemic complications. A total of 161 out of 174 lesions were elected as suitable for DS. The success rate of 5 Fr DS was 87.6% (141/161 lesions). The procedural success rate was 92% (138/150 patients). The angiographic success rate was 96.3% (155/161 lesions). Other complications were six non-Q-wave MI and one repeat angioplasty for acute in-stent thrombosis. Only one major peripheral vascular complication occurred. Direct stenting through 5 Fr guiding catheters in selected lesions is safe and effective with a low incidence of peripheral arterial complications. Catheter Cardiovasc Interv 2003;60:354,359. © 2003 Wiley-Liss, Inc. [source] | ||||||||||