-
[show abstract]
[hide abstract]
ABSTRACT: Stroke of unknown origin in young patients is seen to be closely correlated with patent foramen ovale (PFO) than stroke in patients with established stroke mechanisms. We report a case of a young woman without cardiovascular risk factors who was admitted to our emergency department with listlessness and altered mental status. The clinical examination revealed right lower limb swelling. Magnetic resonance imaging and contrast-enhanced computed tomographic scans revealed a free floating thrombus of the left internal carotid artery (ICA) with a large bilateral frontal ischemic lesion. The diagnosis of a medium-sized PFO with moderate right-to-left contrast shunting was made after transesophageal echocardiography. No other cardiac sources for embolization were detected, while an ascending thrombophlebitis of the right greater saphenous vein was detected by venous Doppler ultrasonography. These findings support the diagnosis of ICA free-floating thrombus caused by paradoxical embolization (via the PFO) of clot from the greater saphenous vein. The patient underwent emergency saphenofemoral disconnection with femoral vein thrombectomy and subsequently carotid artery thrombectomy under general anesthesia. No carotid atheromatous wall lesions were detected at surgical exploration; no immunologic pathology, hypercoagulable status, or malignancy were recorded. No hemorrhagic cerebral complications were observed in the postoperative period, and the patient had an improvement of her neurologic status (a reduction of the National Institutes of Health Stroke Scale score from 7 to 3). Her recovery was uneventful. The patient was transferred for rehabilitation on postoperative day 5 with oral anticoagulation. Six-month ultrasound follow-up revealed deep and superficial venous system and carotid artery patency. The patient was asymptomatic and anticoagulation was discontinued. Paradoxical cerebral embolization through a PFO is a rare phenomenon that, in our patient, appeared to have resulted in stroke caused by a free-floating thrombus in the ICA. Accurate evaluation of carotid and lower limb veins by duplex scan is mandatory in cases of stroke of unknown origin, and urgent surgical repair can be useful in order to improve the clinical outcome.
Annals of Vascular Surgery 05/2013; 27(4):499.e13-7. · 1.03 Impact Factor
-
Vascular 03/2013; · 0.89 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: This study evaluated outcomes of remote endarterectomy (RE) vs endovascular (ENDO) interventions on Trans-Atlantic Inter-Societal Consensus (TASC) II D femoropopliteal lesions and identified factors predictive of restenosis. METHODS: From October 2004 to December 2008, 95 patients with TASC-II D lesions were randomized 1:1 to receive RE of the superficial femoral artery (SFA) with end point stenting (51 patients) or ENDO, consisting of subintimal angioplasty with stenting (44 patients). The groups were balanced for age, sex, atherosclerotic risk factors, and comorbidities. Categoric data were analyzed with χ(2) tests, and time to event provided two-sided P values with a level of significance at .05 and 95% confidence intervals (CIs). Survival curves for primary patency were plotted using the Kaplan-Meier method. Univariate analysis for diabetes, hypertension, dyslipidemia, smoking, and critical ischemia was performed according to the Cox proportional hazards model. RESULTS: The mean follow-up was 52.5 months (range, 35-75 months). Five RE patients and four ENDO patients were lost to follow-up (censored). Primary patency was 76.5% (39 of 51) in RE and 56.8% (25 of 44) in ENDO (hazard ratio [HR], 2.6; 95% CI, 0.99-4.2; P = .05) at 24 months and was 62.7% (32 of 46) in RE and 47.7% (21 of 40) in ENDO (HR, 1.89; 95% CI, 0.94-3.78; P = .07) at 36 months. Assisted primary patency was 70.6% (36 of 51) in RE and 52.3% (23 of 44) in ENDO (HR, 2.45; 95% CI, 1.20-5.02; P = .01). Secondary patency overlapped the primary comparison data at 12 and 24 months; at 36 months, there was a slight but significative advantage for RE (HR, 2.26; 95% CI, 1.05-4.86; P = .03). Univariate analysis demonstrated that hypercholesterolemia and critical limb ischemia (CLI) were significantly related to patency failure, whereas diabetes was significant only in ENDO. These factors (hypercholesterolemia and CLI) were independent predictors of patency on Cox multivariate analysis. CONCLUSIONS: RE is a safe, effective, and durable procedure for TASC II D lesions. Our data demonstrate a significantly higher primary, assisted primary, and secondary patency of RE vs ENDO procedures. Furthermore, overall secondary patency rates remain within the standard limits, although preoperative CLI and dyslipidemia continue to be associated with worse outcomes. Taken together, these data suggest that remote endarterectomy should be considered better than an endovascular procedure in SFA long-segment occlusion treatment.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 10/2012; · 3.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Venous hypertension and outflow stenosis of arteriovenous hemodialysis access managed using endovascular procedures usually present a high technical success rate, with few complications. We reported a rare and fatal complication of superior vena cava perforation with pericardial tamponade 3 months after subclavian vein stenting. Interventional recanalization with stenting for the management of superior vena cava syndrome or central vein stenosis is a safe procedure with a low complication rate. Stent misplacement, reocclusion, migration, or access-related complications appear to occur most frequently.
Annals of Vascular Surgery 07/2012; 26(5):733.e9-12. · 1.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Venous aneurysms (VAs) have been described in quite of all the major veins. They represent uncommon events but often life-threatening because of pulmonary or paradoxical embolism. We describe our twelve patients' series with acute pulmonary emboli due to venous aneurysm thrombosis. Our experience underlines the importance of a multilevel case-by-case approach and the immediate venous lower limbs duplex scan evaluation in pulmonary embolism events. Our data confirm that anticoagulant alone is not effective in preventing pulmonary embolism. We believe that all the VAs of the deep venous system of the extremities should be treated with surgery as well as symptomatic superficial venous aneurysm. A simple excision can significantly improve symptoms and prevent pulmonary embolism.
TheScientificWorldJOURNAL 01/2012; 2012:386478. · 1.66 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Celiac trunk aneurysm is one of the rarest forms of splanchnic artery aneurysm. Conventional open vascular surgery is associated with increased rates of morbidity and mortality and can require complex vascular reconstruction.We describe the case of a 42-year-old patient with celiac trunk aneurysm whom we treated by means of a hybrid surgical-endovascular procedure. We performed a left reno-splenic bypass, after which we used a direct splenic artery approach to deploy a self-expandable 6 × 50-mm stent-graft across the splenic and hepatic arteries. One year later, the stability of the repair was confirmed.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2012; 39(3):408-11. · 0.65 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Most peripheral artery emboli originate in the heart, and systemic neoplastic emboli are infrequently associated with bronchogenic carcinoma. To our knowledge, there have been no reports of pulmonary vein infiltration by small cell lung cancer.We describe a highly unusual case of multiple instances of peripheral embolism as the first overt sign of occult primary small cell lung cancer. Tumor emboli infiltrated the pulmonary veins of a 62-year-old man who presented first with a transient ischemic attack and then with other ischemic symptoms. The uncommonly wide distribution of tumor emboli over a short time resulted in death.Improvements in diagnostic imaging have led to the early identification of relatively isolated small cell lung cancers. This patient's case underscores the importance of transesophageal echocardiography in detecting cardiac emboli when the cause of cerebral ischemic attack is unknown or if there might be multiple instances of arterial embolism. Computed tomography also has a role in the investigation of possible sources of emboli and unrecognized, asymptomatic embolization.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2012; 39(3):420-3. · 0.65 Impact Factor
-
The journal of vascular access 09/2011; 13(1):126-7. · 1.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Heparin-induced thrombocytopenia type II is an immune-mediated syndrome that may arise in a time-dependent manner after heparin therapy. Thrombocytopenia and thrombosis in patients exposed to heparin are suggestive of this syndrome.
Annals of Vascular Surgery 05/2011; 25(6):840.e9-12. · 1.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The association of a retroaortic left renal vein and an abdominal aortic aneurysm (AAA) fistula is an infrequent event. We present two cases of AAA rupture into the retroaortic left renal vein. Preoperative computed tomography (CT) assessment showed retroperitoneal bleeding due to a large AAA rupture with an associated unusual retroaortic left renal vein. Patients underwent successful arteriovenous fistula sutures with abdominal aortoiliac replacement. The patients had uneventful recoveries, and they were discharged on the seventh to ninth postoperative day (POD) without renal complications. The clinical onset was characterized by the unique syndrome: continuous abdominal bruit, abdominal and left flank pain with an associated pulsatile mass (Mansour Triad). Moreover patients presented with haematuria, proteinuria and a large non-functional left kidney on the imaging scan. The CT-scan may suggest the presence of the venous anomaly. Unusual anatomical presentation recommends a careful surgical approach during AAA operations.
Interactive cardiovascular and thoracic surgery 02/2011; 12(2):278-80.
-
[show abstract]
[hide abstract]
ABSTRACT: We report the case of a 42-year-old man with pleuritic chest pain, shortness of breath, and associated tachycardia. Three months before, he had been treated for similar features with the diagnosis of pulmonary emboli. Computed tomography scan showed multiple bilateral pulmonary emboli. He had no clinical evidence of deep venous thrombosis, but an accurate venous duplex examination revealed a thrombosis of the posterior tibial vein aneurysm. Thrombolysis, a temporary inferior cava filter (ICV filter), and tangential aneurysmectomy and lateral venorrhaphy were performed. Accurate duplex scan evaluation of lower limb venous system is mandatory in all cases of pulmonary embolism; anticoagulation may be ineffective in preventing pulmonary embolism, and the surgical repair is treatment of choice of this pathology because it is safe and effective.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 08/2010; 52(2):464-6. · 3.52 Impact Factor
