International angiology : a journal of the International Union of Angiology
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Spinal cord stimulation (SCS) is available as an alternative therapy for patients suffering from inoperable critical limb ischemia (CLI). Selection of patients is essential to achieve the best treatment effect. For this purpose transcutaneous oxygen (TcpO(2)) measurements have frequently been applied. So far, it is unclear which TcpO(2) parameters serve this purpose best. ⋯ The TcpO(2) parameters mentioned above are capable of detecting the effect of SCS treatment. Selection using (a combination of) TcpO(2) measurements substantially improves limb salvage of patients treated with SCS for inoperable CLI.
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A 36-year-old woman with effort dyspnea for 2 years, venous congestion of the left arm for 6 months and who did not have a history of a thoracic trauma was hospitalized. Posterior bilateral dislocation of the sternoclavicular joints and compression of the brachiocephalic vein were diagnosed and conformed by computed tomography (CT). ⋯ The heads of the clavicles were resected and the vein compression was eliminated. Six weeks later, venous congestion disappeared and the brachiocephalic vein was patent.
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Selective use of the intensive care unit after elective infrarenal abdominal aortic aneurysm repair.
Abdominal aortic aneurysm (AAA) repair has traditionally involved admission to the intensive care unit (ICU). This paper reports on an experience of using preoperative medical criteria and a list of intraoperative factors for selective use of the ICU. These criteria were evaluated in relation to their impact on the safety and short term results after open AAA repair. ⋯ Elective AAA repair with selective use of the ICU can be a considerable safe policy in a single high volume hospital. It can reduce resource use without a negative impact on the quality of care.
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Comparative Study
Alteration of left ventriculo-arterial coupling and mechanical efficiency during acute myocardial ischemia.
Myocardial revascularisation being frequently performed during acute myocardial ischemia, in a hostile hemodynamic environment, we evaluated left ventriculo-arterial (VA) coupling, left ventricular (LV) mechanical efficiency, and the mechanical properties of the systemic vasculature during acute myocardial ischemia. ⋯ Acute myocardial ischemia severely altered left ventriculo-arterial coupling and LV mechanical efficiency. Impaired left VA coupling was due to a combination of augmented arterial elastance, secondary to early vasoconstriction later associated with decreased arterial compliance, and decreased LV contractility.
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Case Reports
Treatment of thoracoabdominal aortic aneurysms with a combined endovascular and surgical approach.
The conventional approach for the repair of thoracoabdominal aneurysms remains complex and demanding and is associated with substantial morbidity and mortality. Moreover, in cases of reoperation the impact can be dramatic either in survival or in quality of life of the patients, albeit the use of adjuncts. A combined endovascular and surgical approach with retrograde perfusion of visceral and renal vessels has been realized in order to minimize intraoperative and postoperative complications. ⋯ The combined endovascular and surgical approach is feasible, without cross-clamping of the aorta and with minimized ischemia time for renal and visceral arteries, and seems the appropriate strategy for high risk and previously operated, with a thoracoabdominal trans-diaphragmatic approach, patients.