Intravascular ultrasound diagnosis of cystic adventitial degeneration of the popliteal artery: a case report.

The diagnosis of cystic adventitial degeneration (CAD) is difficult. We present the first case in which intravascular ultrasound (IVUS) correctly identified CAD of the popliteal artery when duplex sonography and angiography were inconclusive.     

Retrograde popliteal access as bail-out strategy for challenging occlusions of the superficial femoral artery: a multicenter registry

Background : The concomitant use of femoral and popliteal accesses has been recommended for challenging superficial femoral artery (SFA) occlusions, but no comprehensive comparison of this approach to a strategy of femoral access only is available. We thus aimed to appraise the risk‐benefit balance of retrograde popliteal access as bail‐out strategy for SFA occlusions. Methods : Consecutive patients with symptomatic SFA occlusion and undergoing percutaneous revascularization were enrolled. We distinguished patients in whom retrograde popliteal access was required as bail‐out strategy versus those not requiring such access. The primary end‐point was procedural success. Results : A total of 130 patients (152 limbs) were included, with 23 patients (25 limbs) requiring retrograde popliteal access. Occlusion length was 20.6 ± 8.8 cm in those requiring popliteal access versus 18.5 ± 8.5 cm in those without popliteal access, with TASC C/D lesions in 23 (92%) versus 106 (83%). Procedural success was achieved in 92 out of 107 patients (86.0%) treated with a standard approach and 22 out of 23 patients (95.7%) treated with retrograde popliteal access (total 114 out of 130 [87.7%]) and 112 out of 127 limbs (88.2%) and 24 out of 25 limbs (96.0%), respectively (total 136 out of 152 [89.5%]). No significant increase in early or long‐term adverse events was associated with retrograde popliteal access. Conclusions : Whenever standard access sites do not enable successful recanalization of SFA occlusions, retrograde popliteal access can be safely and effectively envisioned as bail‐out strategy. © 2012 Wiley Periodicals, Inc.     

Haemorrhage into a popliteal cyst: an unusual complication of haemophilia A.

A 7(1/2)-year-old boy with severe haemophilia A had increasing discomfort and pain in his left knee after sledding on ice and landing on his knees. Left knee pain persisted for days despite recombinant factor VIII replacement. Imaging studies showed that by day 10 a popliteal cyst had ruptured, with diffusion of blood into the calf muscles. This case illustrates another possible bleeding complication in patients with a bleeding disorder and a popliteal cyst.     

Rupture of a peripheral popliteal artery plaque documented by intravascular ultrasound: A case report

A 58‐year‐old male with dyslipidemia and coronary spastic angina suddenly experienced pain in the right limb while walking on November 1, 2008. Right‐ankle brachial pressure index (ABI) was decreased (0.80) and left‐ABI was normal (1.24). Bilateral ABI was normal during January 2008. Ultrasonography in the right‐lower limb artery revealed severe stenosis in the right‐popliteal artery with extended and large echolucent plaques containing an isoechoic area. We carried out lower limb angiography: subtotal occlusion of the popliteal artery was found. By intravascular ultrasound (IVUS), right‐popliteal artery plaques were echolucent and eccentric; ulceration with a thin fibrous cap was noted. Percutaneous transluminal angioplasty was done and popliteal artery blood flow was improved. Right‐ABI improved to 1.13 after 4 days. To prevent the progression and rupture of the plaques, lipid‐lowering therapy and antiplatelet therapy were started. Plaque rupture of the popliteal artery was diagnosed by these characteristics on IVUS. Patients with peripheral artery disease may have plaque rupture similar to those with acute coronary syndromes who have identical unstable plaques and unstable atheromas. In addition to appropriate local revascularization, systemic therapy to stabilize the unstable plaque is indicated because failure to do so may cause recurrent events. © 2009 Wiley‐Liss, Inc.     

Anterior tibial compartment syndrome following rupture of a popliteal cyst

 A ruptured popliteal cyst usually results in calf pain and swelling. We report the case of a patient with rheumatoid arthritis who developed anterior compartment syndrome of the leg following rupture of a popliteal cyst. Since acute compartment syndrome requires prompt treatment, clinicians should be aware of this rare complication. Received: May 17, 2002 / Accepted: August 9, 2002     

Aneurysm of the subclavian artery: A complication of retrograde brachial artery catheterization

A case of an aneurysm of an anomalous right subclavian artery following retrograde catheterization of the right brachial artery is described. This complication was not recognized until the patient presented with symptoms related to a superior mediastinal mass. After appropriate studies were performed operative intervention was successful in establishing a patent subclavian artery.     

Never too late: A commentary on “Impact of age, sex and exercise on brachial and popliteal artery remodelling in humans”

Lysyl oxidase (LOX) is an enzyme critical for the stability of extracellular matrix and also known to have diverse biological functions. Little is known, however, about the role of LOX in regulating inflammation. Here we demonstrate that LOX suppresses secretion of monocyte chemoattractant protein-1 (MCP-1) in cultured vascular smooth muscle cells. Furthermore, enhancement of LOX activity reduces MCP-1 in a mouse model of abdominal aortic aneurysm (AAA), thereby preventing macrophage infiltration and AAA progression. These findings suggest that LOX has a novel function in resolving inflammation by reducing MCP-1 in AAA.     

Urgent coronary artery bypass surgery in the presence of Dressler's syndrome

The clinical features of Dressler's syndrome which developed in a patient following a third myocardial infarction responded to a short course of prednisolone. However, angina at rest precipitated urgent coronary artery bypass surgery and pericardectomy.     

Percutaneous treatment of a popliteal bifurcation—The value of coronary devices and strategies

In this case report, we describe the use of coronary techniques and devices in the treatment of a complex popliteal artery bifurcation. In particular, we demonstrate that the Venture? wire control catheter is a useful tool not only in coronary lesions but also in wiring angulated peripheral lesions. © 2008 Wiley‐Liss, Inc.     

Factors limiting the enrollment of women in a randomized coronary artery disease trial

Background and hypothesis: Although it is recognized that women have been underrepresented in clinical trials of cardiovascular disease, the reasons for their limited enrollment have not been elucidated. Methods: A prospective tracking system was established in the Asymptomatic Cardiac Ischemia Pilot study (ACIP) to monitor recruitment and identify protocol issues that interfered with the recruitment of women. Patients with stress test evidence for ischemia during the course of routine clinical care were screened for asymptomatic ischemia with an ambulatory electrocardiogram (ECG). Results: Those with at least one episode of asymptomatic ischemia and angiographic evidence of coronary artery disease suited for revascularization could be randomized. Women comprised only 17% of the 1,820 patients screened for asymptomatic ischemia, and only 14% of the 558 patients randomized. The limited number of women screened for ischemia was largely due to the limited number of women (25% of all patients) found to have test evidence for ischemia or coronary artery disease suited for revascularization during the course of routine clinical care. Once patients were identified as having ischemia on stress test and ambulatory ECG, the major difference in eligibility was the difference in disqualifying angiograms, occurring 2¹/₂ times as frequently in women as in men (p < 0.001). Conclusion: The percentage of women recruited was lower than the prevalence of ischemic heart disease in the general population because at participating centers (1) women were found to have ischemia less often than men during the course of routine clinical care, and (2) screening tests for ischemia were less predictive of protocol-defined coronary disease in women than in men.     

Antegrade popliteal artery approach for the treatment of critical limb ischemia in patients with occluded superficial femoral arteries.

Treating patients with critical limb ischemia (CLI) secondary to superficial femoral artery (SFA) occlusions and jeopardized tibial-peroneal run-off is challenging, especially when the SFA cannot be recanalized. These patients are frequently poor candidates for surgical revascularization and thus amputation is the therapy most often recommended. In this article, we describe a new technique for treating these patients, which combines antegrade popliteal arterial access with tibial arterial revascularization using drug eluting stents (DES). Five patients scheduled for below-knee amputations were successfully treated using this endovascular approach. For the duration of follow-up (29 +/- 8 months), all patients remained free of death, amputation, or target lesion revascularization. ABI's post intervention demonstrated a modest improvement (ABI = 0.32 +/- 0.09 vs. 0.58 +/- 0.09 pre vs. post, P 相似文献   

Capillary leak syndrome: State of the art in 2021

Capillary leak syndrome (CLS) is an increasingly acknowledged multifaceted and potentially lethal disease. Initial nonspecific symptoms are followed by the intriguing CLS hallmark: the double paradox associating diffuse severe edema and hypovolemia, along with hemoconcentration and hypoalbuminemia. Spontaneous resolutive phase is often associated with poor outcome due to iatrogenic fluid overload during leak phase. CLS is mainly triggered by drugs (anti-tumoral therapies), malignancy, infections (mostly viruses) and inflammatory diseases. Its idiopathic form is named after its eponymous finder: Clarkson's disease. CLS pathophysiology involves a severe, transient and multifactorial endothelial disruption which mechanisms are still unclear. Empirical and based-on-experience treatment implies symptomatic care during the acute phase (with the eventual addition of drugs amplifying cAMP levels in the severest cases), and the prophylactic use of monthly polyvalent immunoglobulins to prevent relapses. As CLS literature is scattered, we aimed to collect and summarize the current knowledge on CLS to facilitate its diagnosis, understanding and management.     

Bile duct cyst type V (Caroli's disease): surgical strategy and results

Background. Caroli''s disease (CD) is a benign congenital disorder characterized by segmental cystic dilatation of the intrahepatic biliary ducts. Therapeutic strategy includes medical treatment, percutaneous, endoscopic or surgical drainage of the affected bile ducts, liver resection or transplantation. The aim of this study was to analyse the results and long-term follow-up of a consecutive series of patients who underwent surgical treatment for CD. Patients and methods. Between 1995 and 2005, 10 patients were surgically treated for CD. Variables evaluated were: age, gender, clinical presentation, diagnostic procedures, percutaneous and surgical treatments, histopathological analysis and outcome. Results. The average age of the patients was 45.8 years. Recurrent cholangitis was the main clinical manifestation (70%). In unilateral CD a liver resection was performed in nine patients (left lateral sectionectomy in seven, left hepatectomy in one and right hepatectomy in one). In bilateral disease a cholecystectomy, duct exploration, hepaticojejunostomy and liver biopsy of both lobes were performed. Average follow-up was 60 months. All the patients are alive and free of symptoms without recurrence in the remnant liver. Discussion. Liver resection is the preferred therapeutic option for unilateral CD, demonstrating good results in long-term follow-up. In bilateral disease, hepaticojejunostomy could be considered as an alternative or a previous step to liver transplantation, which still remains the ultimate option.     

Usefulness of waveform analysis of popliteal artery in Type II diabetic patients using gated magnetic resonance 2D-cine-PC imaging and 31P spectroscopy

Abstract Aims/hypothesis. We studied 76 patients with Type II (non-insulin-dependent) diabetes mellitus and 16 age-matched non-diabetic subjects (control group) to clarify qualitative and quantitative abnormalities of waveform and flow volume of the popliteal artery. Methods. The 76 diabetic patients comprised 16 patients with occlusive arterial disease in the lower extremities [arteriosclerosis obliterans (ASO) group] and 60 patients free from this disease (non-ASO group). We flow analysed the popliteal artery and measured the phosphocreatine to inorganic phosphate ratio of resting plantar muscles to identify risk factors for foot lesions using gated magnetic resonance two-dimensional cine-mode phase-contrast imaging and ³¹P spectroscopy. Results. The control and non-ASO groups had a triphasic waveform with systolic, early and late diastolic components. All ASO patients had an abnormal monophasic waveform and a lower ankle brachial index than that of the control and non-ASO groups. To clarify the mechanism of reduced flow volume of lower extremities, we assigned the 60 patients of the non-ASO group to the three subgroups based on their levels of total flow volume of the popliteal artery. The lowest group showed an abnormal triphasic waveform with lower amplitudes of systolic and late diastolic components and flow velocities in foot arteries than those of the highest group although ABI was similar. From stepwise multiple regression analysis, late diastolic flow volume was identified as an independent determinant for the phosphocreatine to inorganic phosphate ratio (r ² = 0.484, p < 0.001). Conclusion/interpretation. Waveform analysis of popliteal artery provides a powerful tool for identifying impaired peripheral circulation caused by either occlusive arterial disease or increased arterial resistance in diabetic patients. [Diabetologia (2000) 43: 1031–1038] Received: 24 January 2000 and in revised form: 31 March 2000