Successful thrombolysis of acute upper limb ischemia using ekosonic endovascular system ultrasound catheter in a patient with atrial fibrillation

2021 ◽  
Author(s):  
Issameddine Ajmi ◽  
Steffen Schnupp ◽  
Majdi Amami ◽  
Mahmoud Oudeh ◽  
Lukasz Krygier ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Upper Limb ◽  
Limb Ischemia ◽  
Successful Thrombolysis

scholarly journals Acute upper limb ischemia in a patient with newly diagnosed paroxysmal atrial fibrillation

2017 ◽  
Vol 34 (2) ◽  
pp. 242-246
Author(s):  
Dong Shin Kim ◽  
Seunghwan Kim ◽  
Hyang Ki Min ◽  
Chiwoo Song ◽  
Young Bin Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Upper Limb ◽  
Paroxysmal Atrial Fibrillation ◽  
Limb Ischemia ◽  
Newly Diagnosed

scholarly journals Acute upper limb ischemia: 30 years’ experience

2019 ◽  
Vol 178 (4) ◽  
pp. 42-46 ◽  
Author(s):  
M. V. Mel'nikov ◽  
A. V. Sotnikov ◽  
P. A. Susla ◽  
G. G. Papava
Keyword(s):  
Atrial Fibrillation ◽  
Blood Flow ◽  
Upper Limb ◽  
Postoperative Mortality ◽  
Limb Ischemia ◽  
Main Group ◽  
Control Group ◽  
Treatment Results ◽  
The Past ◽  
Current Trends

The OBJECTIVE of the study was to assess the current trends in the surgery of acute upper limb ischemia (AULI). MATERIAL AND METHODS. We performed the comparative analysis of clinical data and treatment results of 261 patients with AULI urgently treated between 2008 and 2018 years (main group) and 162 patients with AULI treated between 1975 and 1985 years (control group). RESULTS. For the past 30 years, there were the growing rate of AULI. In 92.7 % of cases, the main cause of AULI was embolism. The main disease leading to embolism became atrial fibrillation in 80.8 % of cases. For the past decades, there was a significant improvement of treatment results in patients with AULI: complete extremity blood flow supply was achieved in 95 % in main group vs 90.5 % in control group (p<0.05); postoperative mortality rate significantly decreased to 3.5 vs 8.8 % respectively (p<0.05). CONCLUSION. AULI continued to remain the actuality in modern vascular surgery.

scholarly journals Successful Endovascular Treatment of Acute Thromboembolic Upper Limb Ischemia in a Patient with Atrial Fibrillation

2018 ◽  
Vol 28 (04) ◽  
pp. 267-269 ◽  
Author(s):  
Sorin Giusca ◽  
Melanie Schueler ◽  
Eckhard Willersinn ◽  
Grigorios Korosoglou
Keyword(s):  
Atrial Fibrillation ◽  
Upper Limb ◽  
Brachial Artery ◽  
Ulnar Artery ◽  
Limb Ischemia ◽  
Duplex Sonography ◽  
Medical Emergency ◽  
Acute Limb Ischemia ◽  
Right Hand ◽  
Retrograde Filling

AbstractAcute limb ischemia represents a medical emergency that requires prompt diagnosis and treatment to preserve the viability of the affected tissue. The majority of the ischemic events are thrombotic in nature, especially in patients with atrial fibrillation. To date, surgical thrombectomy is usually used for the treatment of acute thromboembolic upper limb ischemia. Herein, we present a case of an 88-year-old patient who presented with right upper limb pain, pulselessness, and paresthesia. Duplex sonography revealed thrombotic occlusion and the absence of flow in both the ulnar and radial arteries. Electrocardiogram exhibited atrial fibrillation with a heart rate of 88 bpm. Antegrade puncture of the brachial artery was performed, and digital subtraction angiography confirmed fresh occlusion of the ulnar and radial arteries with some residual flow in the accessory brachial artery. Thrombus aspiration using a 6-Fr Eliminate aspiration catheter (Terumo Interventional Systems, Eschborn, Germany) was repeatedly performed, resulting in thrombolysis in myocardial infarction (TIMI) III antegrade flow to the right hand, promptly filling of the palmar arch and retrograde filling of the ulnar artery. Pain and paresthesia immediately resolved without need for further pharmacological interventions. The patient was discharged without functional deficits of his right hand, and duplex sonography after 4 weeks and 6 months revealed triphasic flow of the brachial and radial arteries and retrograde flow of the ulnar artery.

Cardiac troponin I in patients with acute upper and lower limb ischemia

VASA ◽  
2008 ◽  
Vol 37 (4) ◽  
pp. 327-332 ◽  
Author(s):  
Koutouzis ◽  
Sfyroeras ◽  
Moulakakis ◽  
Kontaras ◽  
Nikolaou ◽  
...  
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Cardiac Troponin ◽  
Cardiac Involvement ◽  
Troponin I ◽  
Limb Ischemia ◽  
Elevated Troponin ◽  
Troponin Elevation ◽  
Lower Limb Ischemia ◽  
Ischemia Group

Background: The aim of this study was to investigate the presence, etiology and clinical significance of elevated troponin I in patients with acute upper or lower limb ischemia. The high sensitivity and specificity of cardiac troponin for the diagnosis of myocardial cell damage suggested a significant role for troponin in the patients investigated for this condition. The initial enthusiasm for the diagnostic potential of troponin was limited by the discovery that elevated cardiac troponin levels are also observed in conditions other than acute myocardial infarction, even conditions without obvious cardiac involvement. Patients and Methods: 71 consecutive patients participated in this study. 31 (44%) of them were men and mean age was 75.4 ± 10.3 years (range 44–92 years). 60 (85%) patients had acute lower limb ischemia and the remaining (11; 15%) had acute upper limb ischemia. Serial creatine kinase (CK), isoenzyme MB (CK-MB) and troponin I measurements were performed in all patients. Results: 33 (46%) patients had elevated peak troponin I (> 0.2 ng/ml) levels, all from the lower limb ischemia group (33/60 vs. 0/11 from the acute upper limb ischemia group; p = 0.04). Patients with lower limb ischemia had higher peak troponin I values than patients with upper limb ischemia (0.97 ± 2.3 [range 0.01–12.1] ng/ml vs. 0.04 ± 0.04 [0.01–0.14] ng/ml respectively; p = 0.003), higher peak CK values (2504 ± 7409 [range 42–45 940] U/ml vs. 340 ± 775 [range 34–2403] U/ml, p = 0.002, respectively, in the two groups) and peak CK-MB values (59.4 ± 84.5 [range 12–480] U/ml vs. 21.2 ± 9.1 [range 12–39] U/ml, respectively, in the two groups; p = 0.04). Peak cardiac troponin I levels were correlated with peak CK and CK-MB values. Conclusions: Patients with lower limb ischemia often have elevated troponin I without a primary cardiac source; this was not observed in patients presenting with acute upper limb ischemia. It is very important for these critically ill patients to focus on the main problem of acute limb ischemia and to attempt to treat the patient rather than the troponin elevation per se. Cardiac troponin elevation should not prevent physicians from providing immediate treatment for limb ischaemia to these patients, espescially when signs, symptoms and electrocardiographic findings preclude acute cardiac involvement.

Acute Upper Limb Ischemia in a Patient with COVID-19 Pneumonia

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Alosaimi Roaa ◽  
Albajri Ahood A ◽  
Albalwi Roaa M
Keyword(s):  
Upper Limb ◽  
Limb Ischemia

Ayurvedic management of Ischemic Gangrene due to Diabetes Mellitus - A Case Report

2017 ◽  
Vol 2 (3) ◽  
Author(s):  
Vikram S. ◽  
Saraswathi Devi H.N.
Keyword(s):  
Diabetes Mellitus ◽  
Upper Limb ◽  
Medical Science ◽  
Limb Ischemia ◽  
Interesting Case ◽  
Therapeutic Interventions ◽  
Acute Ischemia ◽  
Arterial Circulation ◽  
Ct Angiogram ◽  
Choice Of Treatment

Medical science says that ischemia is a common complication in Diabetes, especially in the lower limb but this is a case presenting ischemic changes in upper limb which is unique and also in such type of acute ischemia amputation is the only choice of treatment to save the life of patient from septicaemia. Such a rare and interesting case was taken at Sri Sri Ayurveda Hospital and handled by proper Ayurvedic line of treatment by which circulation is re-established which saved both limb and life of patient. A patient by name Sundaramma, 62yr Female, visited Sri Sri Ayurveda Hospital on 29/2/2016 with a diagnosis of Right upper limb Ischemia with Diabetes Mellitus and Active TB. The main symptoms were severe pain and burning sensation in Right hand and forearm, discolouration of fingers with ulcers, Bluish black discolouration over right thumb, necrosis, pus dischargeand stiffness, associated with difficulty in movement of right arm, shoulder joint, elbow joint, palm and fingers. Diagnosed as Right Upper Limb Ischemia with Diabetes Mellitus and active TB. Therapeutic interventions like Right upper limb Doppler and CT angiogram were done. Such a complicated case was taken at Sri Sri Ayurveda Hospital, and carefully handled by Ayurvedic methods of management, which was ended up by preventing amputation of the limb and also achieving the re-establishment of arterial circulation.

Upper Limb Ischemia: 20 Years Experience from a Single Center

Vascular ◽  
2005 ◽  
Vol 13 (2) ◽  
pp. 84-91 ◽  
Author(s):  
Jean Deguara ◽  
Tahir Ali ◽  
Bijan Modarai ◽  
Kevin G. Burnand
Keyword(s):  
Upper Limb ◽  
Primary Repair ◽  
Limb Ischemia ◽  
Subclavian Steal Syndrome ◽  
Arm Amputation ◽  
Locoregional Anesthesia ◽  
Vein Bypass ◽  
Almost All ◽  
Revascularization Procedures ◽  
Steal Syndrome

The objective of this study was to review a single center's experience of upper limb revascularization over 20 years. All patients undergoing operative or endovascular upper limb revascularization between June 1983 and July 2003 were identified. One hundred eighty-four upper limb revascularization procedures were carried out on 172 patients. Sixty-one patients had a thromboembolic event (35%), 53 patients presented with a traumatic vascular injury (31%), and 29 patients had symptoms of chronic atherosclerotic upper limb ischemia (17%). Fifteen patients had subclavian steal syndrome, eight patients had thoracic outlet compression, and six patients had iatrogenic injuries of the upper limb arteries. Fifty-five thromboembolectomies were performed, 37 under locoregional anesthesia. Ten patients (18.2%) died from cardiopulmonary causes following embolectomy. Fifteen reversed saphenous vein bypass grafts were performed for traumatic damage. Twenty-seven patients had a primary repair, and five required a vein patch. One patient subsequently had an arm amputation, and two patients died. Twelve patients presenting with chronic arm ischemia had a subclavian angioplasty, 12 patients had a proximal bypass, and in 5 patients, stenoses were stented. The mortality in this group was 6.9% (2 of 29). The mortality for upper limb revascularization was 8.7%. Almost all deaths occurred after upper limb embolectomy, and the mortality of this procedure was similar to that of lower limb embolectomy. Deaths were the result of cardiac comorbidity, and this should be actively sought and treated if outcomes are to improve.

Bilateral Axillary Artery Aneurysms Presenting as Upper Limb Ischemia

2015 ◽  
Vol 29 (8) ◽  
pp. 1659.e9-1659.e12 ◽  
Author(s):  
Kimihiro Igari ◽  
Toshifumi Kudo ◽  
Takahiro Toyofuku ◽  
Yoshinori Inoue
Keyword(s):  
Upper Limb ◽  
Axillary Artery ◽  
Limb Ischemia

scholarly journals Atrial Fibrillation is Associated with Femoropopliteal Totally Occlusive In-Stent Restenosis: A Single-Center, Retrospective, Observational Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Yohsuke Honda ◽  
Keisuke Hirano ◽  
Masahiro Yamawaki ◽  
Motoharu Araki ◽  
Norihiro Kobayashi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
De Novo ◽  
Limb Ischemia ◽  
Hazard Ratio ◽  
Acute Limb Ischemia ◽  
Stent Occlusion ◽  
Stent Restenosis ◽  
Artery Disease ◽  
In Stent Restenosis

Introduction. The proportion of patients with comorbid atrial fibrillation (AF) and peripheral artery disease (PAD) has increased in this era. This study aimed to assess the relationship between AF and totally occlusive in-stent restenosis (ISR) in femoropopliteal (FP) lesions. Methods. In this study, 363 patients (461 stents) who underwent endovascular therapy with de novo stent implantation in our hospital between April 2007 and December 2016 were retrospectively evaluated. The patients were divided into two groups according to the AF status (AF group, 61 patients; sinus group, 302 patients). The primary endpoint was the incidence of totally occlusive ISR within 3 years. The secondary endpoint was the incidence of acute limb ischemia (ALI) due to FP stent occlusion. Results. Baseline characteristics were similar, except for higher age and a lower prevalence of dyslipidemia in the AF group. The incidence of a totally occlusive ISR was higher in the AF group than in the sinus group (29.5% vs. 14.6%, p = 0.004 ). A multiple Cox regression model suggested that presence of AF (hazard ratio, 2.10) and CTO lesion (hazard ratio, 1.97) which were the independent predictors of a totally occlusive ISR within 3 years. The incidence of ALI was significantly higher in the AF group than in the sinus group (3.9% vs. 0%, p = 0.0001 ). In the AF group, the introduction of an anticoagulant did not prevent the occurrence of totally occlusive ISR ( p = 0.71 ) for ALI ( p = 0.79 ). Conclusions. AF is independently associated with totally occlusive ISR of FP stents; however, anticoagulant use does not prevent stent occlusion.

scholarly journals Clinical experience of upper limb ischemia: a retrospective study

2020 ◽  
Vol 7 (5) ◽  
pp. 1562
Author(s):  
Jitesh Tolia ◽  
Arvind Bhatt
Keyword(s):  
Upper Extremity ◽  
Upper Limb ◽  
Primary Repair ◽  
Balloon Catheter ◽  
Duplex Ultrasound ◽  
Limb Ischemia ◽  
Diagnostic Methods ◽  
Conventional Angiography ◽  
Duration Of Symptoms ◽  
Catheter Directed Thrombolysis

Background: Arterial disorders of the upper extremity are much less common than those of the lower extremity, but when they result in symptoms of acute or chronic ischemia, surgical or endovascular techniques for upper extremity revascularization may be needed. This study presents a review of the epidemiology, aetiology, and clinical characteristics of upper limb ischemia.Methods: The records of 70 patients with upper limb ischemia who underwent treatment from were retrospectively reviewed.Results: A total of 44 patients were diagnosed by CT. Other diagnostic methods and tools used were conventional angiography and duplex ultrasound. Four cases were diagnosed solely on the basis of a medical history and physical examination. A total of 56 surgeries were performed. Rest of the 14 patients went under conservative therapy. The operations included embolectomy and thrombectomy using a Fogarty balloon catheter (n=32), bypass surgery using the great saphenous vein (n=10), percutaneous catheter-directed thrombolysis (n=8), and primary repair (n=4). Patients with Raynaud’s phenomenon or Burger’s disease were either treated with medication only (n=14) or with sympathectomy (n=2).Conclusions: The duration of symptoms in cases of upper limb ischemia may vary from two hours to a year, depending on the aetiology and severity of the illness. Many debates have addressed whether the time gap between the onset of symptoms and treatment predicts long-term arm function.

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