Popliteal artery entrapment syndrome

The purpose of this article was to describe popliteal artery entrapment syndrome, which is a cause of intermittent claudication in a young person, and to illustrate the importance of early diagnosis for successful treatment of this entity. A case report of a 28-year-old man with popliteal artery entrapment syndrome is presented. This patient had a classic history of calf pain that worsened with walking and was relieved by rest, running, or bicycle riding. Physical examination revealed evidence of ischemia in the distal extremity, and arteriography demonstrated signs of chronic occlusive disease. Early treatment might have included surgical release of the popliteal artery and arterial grafting. Due to extensive vascular disease, grafting was not possible and a below-knee amputation was performed. It is therefore essential to diagnose popliteal artery syndrome early for appropriate management.     

Cystic adventitial disease of the popliteal artery: features on 3T cardiovascular magnetic resonance

Cystic adventitial disease (CAD) of the popliteal artery is a rare vascular disease of unknown etiology in which a mucin-containing cyst develops in the adventitial layer of the artery. We report the case of a 26-year-old male with CAD of the right popliteal artery diagnosed non-invasively with 3 Tesla cardiovascular magnetic resonance and confirmed on post-operative histopathology.     

Routine clinical cardiovascular magnetic resonance in paediatric and adult congenital heart disease: patients, protocols, questions asked and contributions made

Cystic adventitial disease (CAD) of the popliteal artery is a rare vascular disease of unknown etiology in which a mucin-containing cyst develops in the adventitial layer of the artery. We report the case of a 26-year-old male with CAD of the right popliteal artery diagnosed non-invasively with 3 Tesla cardiovascular magnetic resonance and confirmed on post-operative histopathology.     

Left main coronary artery rotational atherectomy and stenting

BACKGROUND: Coronary artery bypass surgery is a difficult option in patients who are not candidates for bypass surgery and high-risk patients with critical left main coronary artery (LMCA) disease. We report outcomes and short-term follow-up of patients who had LMCA rotational atherectomy and/or stenting, assess the role of these interventions in protected and unprotected significant LMCA stenosis, and review the literature. METHODS: We reviewed the cases of seven men with critical LMCA stenosis for whom coronary artery bypass surgery was considered a high risk. Five patients had rotational atherectomy, one had coronary artery stenting, and one had both. RESULTS: In all cases, angiographic success was achieved, and symptoms were relieved. Six patients were discharged from the hospital in 3 to 6 days. One patient who had cardiogenic shock, respiratory failure, and acute renal failure before the procedure died of arrhythmia 4 days afterward. Another patient had elective coronary artery bypass graft surgery 3 weeks later for recurrent angina. Cardiac catheterization was repeated in 1 month for chest pain in three patients at 4 to 7 months follow-up, and none had progression of residual stenosis in the LMCA. CONCLUSIONS: Our study suggests that LMCA rotational atherectomy and stenting are safe and effective revascularization procedures in high-risk patients and patients who are not candidates for bypass surgery.     

国内首例冠状动脉旋磨术诊治报告

冠状动脉旋磨术是目前治疗冠状动脉严重钙化病变的首选有效方法。本病例介绍1996年葛均波院士在国内进行的中国心血管介入史上第一例冠状动脉旋磨术。该患者共进行了七次冠状动脉介入治疗，旋磨术后成功行五次支架植入术，证明冠状动脉旋磨术对钙化病变治疗的有效性和长期安全性。     

Superficial temporal artery to middle cerebral artery bypass and external carotid reconstruction for carotid restenosis after angioplasty and stent placement

The recent proliferation of endovascular treatment of carotid atherosclerotic disease will increase the number of patients who require treatment for recurrent carotid stenosis after angioplasty and stent placement. The optimal management of these patients has not yet been defined. We describe a 66-year-old woman who required 2 surgical procedures for recurrent in-stent carotid stenosis. She experienced numerous transient ischemic attacks 5 months after left extracranial internal carotid artery angioplasty and stenting for asymptomatic stenosis. Angiography showed high-grade in-stent restenosis, left intracranial carotid artery stenosis, and poor collateral flow to the left middle cerebral artery circulation. The patient underwent a superficial temporal artery to middle cerebral artery bypass, and the transient ischemic attacks resolved. Five months later, angiography showed progressive stenosis of the external carotid artery at the site of the stent. The patient underwent successful external carotid reconstruction with an on-lay patch. Extracranial-intracranial bypass grafting may be used successfully in the treatment of recurrent extracranial carotid artery stenosis after angioplasty and stent placement. Also, external carotid artery reconstruction at the site of an internal carotid artery stent can be performed safely.     

Coronary atherectomy: overview and implications for nursing.

Coronary atherectomy, a new invasive procedure for the treatment of atherosclerotic heart disease, consists of the excision and removal of atherosclerotic tissue from coronary artery walls. This article provides current information on atherectomy, including its potential advantages over percutaneous transluminal coronary angioplasty (PTCA). Indications, limitations, medical research, and implications for nursing research are described. A case study is presented.     

腘血管陷迫综合征超声表现及误诊原因

目的 分析腘血管陷迫综合征(popliteal vascular entrapment syndrome,PVES)超声表现及误诊原因、防范措施.方法 回顾性分析6例PVES的临床资料.结果 PVES 6例中超声检查误诊1例,误诊率16.7％.6例均表现为患肢间歇性跛行,超声检查可见腘动脉近段向内侧不同程度移位,腘动静...     

腘动脉瘤治疗方法的探讨与分析

目的 探讨腘动脉瘤有效的治疗方法.方法 回顾分析2008年3月至2011年3月26例腘动脉瘤患者的临床资料和随访情况.结果 所有患者经B超、CTA或DSA检查确诊,20例接受外科手术治疗、6例接受覆膜支架腔内隔绝术.其中腘动脉瘤切除并自体大隐静脉移植术11例;腘动脉瘤切除并人造血管移植术5例;动脉瘤壁部分切除并补片修补术4例.随访6个月～3年,11例行自体大隐静脉移植术患者移植血管通畅性良好;5例行人造血管移植术的患者3例通畅性良好,2例管腔闭塞;4例动脉瘤壁部分切除并补片修补术患者管腔通畅良好;6例行覆膜支架腔内隔绝术患者4例通畅良好,2例术后1年管腔闭塞.结论 外科手术是治疗腘动脉瘤的首选方法.自体静脉移植和补片修补术是最为有效的.身体状况较差的患者可考虑腔内治疗.     

Chronic fusiform extracranial vertebral artery aneurysm with recurrent posterior circulation emboli: Case report and review of the literature

We report a case of a 64-year-old man with a fusiform right extracranial vertebral artery aneurysm, spanning over half the extra-cranial V2 (foraminal) segment, presenting with recurrent multi-focal posterior circulation embolic ischaemic stroke. The patient was treated with endovascular embolisation of the right vertebral artery to prevent further thrombo-embolic events. Distal and proximal occlusion of the aneurysmal vertebral artery was performed with a micro-vascular plug with partial aneurysm sack embolisation to aid thrombosis and reduce the risk of recanalisation. Two months post procedure MR angiography confirmed successful aneurysm occlusion with no post-procedural complication. The patient returned to his normal independent life. Endovascular treatment with vessel sacrifice is an effective treatment with low morbidity and we believe the MVP device to be a efficacious option in the vertebral artery.     

Role of Calcium Scoring in the Patient with a Normal SPECT

Effective medical management and strategies of secondary prevention for coronary artery disease (CAD) have greatly contributed to the dramatic improvement in heart disease mortality rates seen in the United States during the past decade. Myocardial perfusion imaging (MPI) is useful for diagnosing cardiac ischemia and is a powerful tool for risk stratification of patients with CAD. Indeed, patients with a normal MPI have a very good short to intermediate prognosis. Coronary artery calcium scoring (CACS) using multi-slice or electron beam CT assists in the diagnosis of subclinical CAD, potentially allowing risk factor reduction to begin before physiological significant CAD and coronary events develop. Combining CACS during MPI or performing it after MPI to assist in detecting CAD in patients with normal MPI studies is being utilized with increasing frequency. The additional information obtained by CACS allows the detection of many patients with subclinical disease, alters the prognostic advice to them, leads to alteration in prescribed medical treatment and patient lifestyle, and results in improved risk factor profiles. These cardiovascular risk factor modification and lifestyle changes will presumably result in a reduction in mortality and morbidity related to cardiovascular disease. This review discusses the clinical implications in the diagnosis and treatment of CAD when coronary artery calcium scoring is performed in patients who have a normal myocardial perfusion imaging study.     

Complicated course of a compression syndrome of the popliteal artery in a 36-year-old patient

The popliteal entrapment syndrome is an entity increasingly reported over the past few years. Anatomical variations should be considered if a localized stenosis or occlusion of the popliteal artery is diagnosed in a young, otherwise healthy individual. This case report documents a complicated course of the disease in a young man in whom diagnosis was made only after futile attempts of intraarterial lysis and dilatation at the time of a second operation. A complex crural reconstruction was necessary in order to revascularize the treatment limb.     

Primary balloon angioplasty for chronic occlusion of intracranial internal carotid artery: A case report

Chronic occlusion of large intracranial arteries is the main cause of ischemic stroke in China. Patients with symptomatic intracranial artery occlusion and hemodynamic impairment are at high risk of recurrent stroke. Chronic occlusion of the intracranial segment of the internal carotid artery is a common type of intracranial artery occlusion. Medical management is regarded as the standard treatment for this disease. With the development of endovascular treatment, some patients with chronic cerebral artery occlusion have achieved satisfactory results with endovascular therapy. We reported a patient with symptomatic chronic occlusion of the ophthalmic segment of the internal carotid artery. Simple balloon angioplasty was performed, and the occluded ophthalmic segment of the internal carotid artery was successfully recanalized without perioperative complications. At 4 months follow-up, the internal carotid artery remained patent and perfusion of the right cerebral hemisphere improved dramatically. In addition, we briefly reviewed the relevant literature.     

Coronary atherectomy: first 50 patients at the Mayo Clinic

The safety and efficacy of a novel coronary atherectomy device were evaluated in the first 50 patients who underwent 53 such procedures at the Mayo Clinic. This treatment was used for atheromatous lesions in 27 patients and for restenosis after percutaneous transluminal coronary angioplasty in 23; in 3 patients, it was repeated for recurrent stenosis (2) or a persistent intimal flap (1). Successful results, defined as a reduction of the stenosis by 40% or more in association with removal of tissue, absence of Q-wave infarction, and no need for a bypass surgical procedure during in-hospital follow-up, were achieved in 47 of the 53 procedures (89%). Atherectomy reduced the stenoses from a mean of 87% to 15%. Failures occurred in 6 of the 53 procedures (11%). Three of these patients subsequently underwent successful conventional balloon angioplasty, and three required surgical treatment. Six patients had minor complications--embolization of atheromatous material in two, intimal dissection in two, and side-branch occlusion and transient thrombosis in one each. Coronary atherectomy with use of this device promises to be a relatively safe and efficient treatment of coronary artery stenosis.     

Treatment of Chronic Subdural Hematomas Utilizing Middle Meningeal Artery Embolization

Chronic subdural hematomas (cSDH) are a common condition encountered by neurosurgeons with the potential for a high morbidity or mortality. A standard treatment regimen still remains highly discussed and controversial. Current treatments include surgical evacuation as well as medical therapies including statins, steroids, and tranexamic acid with ongoing studies to investigate their efficacy. Middle meningeal artery (MMA) embolization is a technique first described in the year 2000, which has shown promising results for cSDH treatment. The procedure is performed in the angiography suite under minimal sedation using embolization materials to block the MMA. This is thought to disrupt the primary blood supply to the cSDH allowing for resolution. Embolization can be utilized as the primary treatment or in addition to surgical evacuation. Current literature suggests that surgically evacuated cSDH can have a recurrence rate from 2% to 37% where the rate after MMA embolization is reported from 2.1% to 4.1%. When used as the primary treatment, MMA embolization can also potentially reduce the morbidity of a surgical procedure under general anesthesia to an elderly patient. Here we present a case of MMA embolization utilized after a postoperative cSDH recurrence with good results.     

Endovascular management of a carotid aneurysm into the sphenoid sinus presenting with epistaxis

Non-traumatic cavernous internal carotid artery (ICA) aneurysms are rare, and favour the occurrence of massive recurrent epistaxis, which is associated with a high mortality rate. We report the case of a 67-year-old woman presenting a ruptured ICA aneurysm extending into the sphenoid sinus, revealed by epistaxis. Selective coil embolization of the aneurysm was performed. Flow-diverter stents were deployed in order to utterly exclude the aneurysm and prevent revascularization. Anti-platelet treatment was provided to lower the risk of in-stent thrombosis. A left frontal hematoma associated with a subarachnoid haemorrhage occurred at day 2. Outcome was favourable with no neurological sequelae, and no clinical recurrence of epistaxis occurred. A 4 months follow-up digital subtraction angiography showed a complete exclusion of the aneurysm. In addition, a magnetic resonance cerebral angiography at 16 months showed stable results. Thus, this two-stage endovascular procedure has proven its effectiveness in preventing epistaxis recurrence while preserving the ICA patency.     

下肢动脉硬化闭塞症的杂交手术治疗

目的探讨下肢动脉硬化闭塞症杂交（hybrid）手术治疗的适应证选择、手术方法及疗效分析。方法回顾性的分析我院2005年至2008年来血管杂交手术治疗20例下肢动脉硬化闭塞症的资料。根据患者介入探查情况行杂交手术治疗治疗。结果近期有效率95％。治疗后平均缈肱比值（ABI）提高0．56,足背或胫后动脉搏动者8例,占40％。结论下肢动脉硬化闭塞症血管杂交手术治疗是一种有效的治疗手段,对于复杂的动脉硬化闭塞症患者。较单一的手术或腔内治疗,具有优势互补、减少创伤、安全的特点,能最大程度的挽救肢体。     

Monitoring plasma cardiac troponin I for the detection of myocardial injury after percutaneous transluminal coronary angioplasty

The objective of this study was to detect myocardial injury defined by an increase of plasma cardiac troponin I (cTnI) following percutaneous transluminal coronary angioplasty (PTCA) and compare plasma cTnI with the risk of cardiac complications at 30 days. Plasma cTnI, creatine kinase (CK) MB, and total CK were determined in 83 patients before (baseline) and 6, 12 and 24 h after PTCA. Thirty-eight patients underwent conventional PTCA, 39 PTCA-stent and six rotational atherectomy. Patients with acute myocardial infarction (AMI) and increased pre-procedural cTnI >0.8 microg/l were categorized into group 1 (n=23). The remaining 60 patients (pre-procedural cTnI=0.8 microg/l) were categorized as follows: group 2 (n=15) AMI; group 3 (n=20) unstable angina (UA); group 4 (n=25) coronary artery disease (CAD). Twelve hours post-procedure, all three cardiac markers were more frequently increased over baseline in group 2 patients (40-60%) compared to patients in group 3 (5-29%, P<0.03) or group 4 (0.5-5%, P<0.01). This was also true for patients undergoing PTCA-stent compared to conventional PTCA or rotational atherectomy (27-40 vs. 4-14%, P<0.02). cTnI was more sensitive (60%) to detect release of myocardial protein after PTCA compared to total CK (47%) or CKMB (43%). A moderate increase of cTnI (0.8-1.5 microg/l) in groups 2, 3 and 4 was associated with higher risk of complications 30 days post-procedure.     

Noninvasive revascularization by enhanced external counterpulsation: a case study and literature review

Nearly 8 million people in the United States suffer from symptoms of coronary artery disease (CAD). Unfortunately, the population of patients with ischemic coronary disease that is not readily amenable to surgical or percutaneous revascularization continues to grow. For patients who are not candidates for standard revascularization procedures and in whom aggressive medical therapy fails to control symptoms, enhanced external counterpulsation (EECP) is a new, noninvasive outpatient method to improve quality of life by decreasing ischemic symptoms and permit increased activity. We report the case of a 56-year-old woman with severe, symptomatic CAD receiving maximal medical therapy who underwent a course of EECP therapy because she was not a good candidate for other forms of revascularization. She demonstrated dramatic improvement in her anginal symptoms and complete resolution of myocardial ischemia on repeat nuclear stress imaging. This case suggests that EECP is a safe and effective method for reducing symptoms of myocardial ischemia in patients for whom standard percutaneous or surgical revascularization is not suitable treatment.     

Endovascular management of an axillary arterial injury post shoulder dislocation

Axillary arterial injury is a rare complication of non‐recurrent glenohumeral joint dislocation. Previously this type of injury would have required open exploration of the axillary artery with associated risk of iatrogenic injury to the axillary vein or brachial plexus. We present the case of a 75‐year‐old lady, who following a fall in her own home, sustained a dislocation of her right shoulder joint complicated by avulsion of a branch of her axillary artery. We describe the successful endovascular management of the injury using a self‐expanding stent and propose this as the preferred surgical option where the artery is not completely transected.