Journal of vascular surgery
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Case Reports
Embolus of surgical adhesive to the extremities causing acute ischemia: report of two cases.
We present 2 cases in which a surgical adhesive embolized to the extremities. In the first case an adhesive was successfully used in the repair of a DeBakey type I aortic dissection. ⋯ In the second case the adhesive was used to seal a pericardial patch during repair of a ventricular septal defect. This patient was seen 1 day postoperatively with acute arm ischemia, and the adhesive particle was extracted from the brachial artery during embolectomy.
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The cause of the coagulopathy seen with supraceliac aortic cross-clamping (SC AXC) is unclear. SC AXC for 30 minutes results in both clotting factor consumption and activation of fibrinolytic pathways. This study was undertaken to define the hemostatic alterations that occur with longer intervals of SC AXC. ⋯ The coagulopathy frequently associated with thoracoabdominal aortic aneurysm repair is thought to revolt visceral ischemia-reperfusion. The nature of this coagulopathy is controversial. The current study demonstrates that the major hemostatic alteration associated with supraceliac aortic cross-clamping is activation of fibrinolytic pathways. The magnitude of this fibrinolytic response is directly related to the duration of supraceliac aortic occlusion. Future efforts to treat this coagulopathy may well include judicious use of autofibrinolytic agents.
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Comparative Study
Blunt popliteal artery injury with complete lower limb ischemia: is routine use of temporary intraluminal arterial shunt justified?
Complete lower limb ischemia as a result of blunt popliteal artery injury is associated with the highest morbidity and amputation rates among all of the peripheral vascular injuries. The purpose of this study was to determine the possible benefits of routine use of a temporary intraluminal arterial shunt in patients with complete limb ischemia from blunt popliteal trauma. ⋯ Temporary arterial shunting after blunt lower limb trauma significantly reduces total ischemic time, complications, repeat operations, amputation, and hospitalization. I recommend routine use of shunts in blunt popliteal artery injuries with complete lower limb ischemia.
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The cardioprotective effect of red wine has been attributed to resveratrol. The resveratrol-induced protection against ischemia-reperfusion (I/R) injury has been documented in heart, kidney, and brain. Resveratrol scavenges free O(2) radicals and upregulates nitric oxide (NO). However, the presence of resveratrol-induced spinal cord protection against I/R injury has not been reported in the literature. The objective of this study was to evaluate the effects of resveratrol on neurologic functions, histopathologic changes, and NO metabolism following temporary spinal cord ischemia (SCI) in rabbits. Material and methods SCI was induced with occlusion of the infrarenal aorta in rabbits. In addition to the sham group (group S, n = 7), group C (n = 7) received vehicle 30 minutes before ischemia. Group R1 (n = 7) and R10 (n = 7) received 1 mg/kg and 10 mg/kg resveratrol instead of vehicle, respectively. Blood samples were taken to obtain nitrite/nitrate levels during the surgical procedure. After neurologic evaluation at the 48th hour of reperfusion, lumbar spinal cords were removed for histopathologic examination and malondialdehyde measurement as a marker of oxidative stress. ⋯ Paraplegia that results from spinal cord ischemia is a catastrophic complication of thoracic and thoracoabdominal aorta surgical procedures. Despite several surgical modifications and pharmacologic approaches, paraplegia has not been totally eliminated. On clinical grounds, the efficiency of currently used pharmacologic agents to prevent spinal cord injury during thoracic and thoracoabdominal aorta surgery is very limited and their benefit is controversial. Preischemic infusion of resveratrol protects the spinal cord from ischemia reperfusion injury in rabbits. Following clarification of the underlying protective mechanism, optimal dose, and timing, resveratrol may used in humans as an adjunct to eliminate this catastrophic complication.
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The purpose of this study was to evaluate the neurologic tolerance and changes in ipsilateral hemispheric oxygen saturation during transcervical carotid artery stenting with internal carotid artery (ICA) flow reversal for embolic protection. ⋯ Our data suggest that transcervical carotid angioplasty and stenting with ICA flow reversal is well tolerated in the awake patient, even in the presence of symptomatic carotid artery disease. Cerebral oxygenation during ICA flow reversal is comparable to that during CCA occlusion. ICA angioplasty balloon inflation produces a decrease in cerebral SVO(2) significantly greater than that occurring during ICA flow reversal.