scholarly journals Management Strategy in Non-Limb-Threatening Acute Ischaemia of Limbs: Should We Rethink?

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Syed M. Asim Hussain ◽  
Thomas Joseph
Keyword(s):  
Natural History ◽  
Vascular Surgery ◽  
Management Strategy ◽  
Cardiovascular Surgery ◽  
Adverse Outcome ◽  
Limb Ischaemia ◽  
Acute Ischaemia ◽  
First Case ◽  
Acute Limb Ischaemia

The Society of Vascular Surgery and the International Society of Cardiovascular Surgery identify three types of acute limb ischaemia to inform prognosis and management. Type 1 limb ischaemia is non-limb-threatening and is currently managed conservatively. We describe three cases of Type 1 limb ischaemia with femoropopliteal occlusion that were managed differently. The first case was initially managed conservatively but resulted in an adverse outcome following worsening of ischaemia. Overall, the cases managed with earlier intervention had good outcomes suggesting that conservative management alone may not be sufficient despite resolution of symptoms. The trend in other vessel diseases such as NSTEMI and TIA is towards earlier intervention, for example, PCI and CEA. It is likely that acute limb ischaemia has a similar natural history to these conditions. It is time to consider earlier revascularisation in selected patients with non-limb-threatening ischaemia.

Acute limb ischaemia due to vasospasm: a rare presentation

2022 ◽  
Vol 15 (1) ◽  
pp. e246495
Author(s):  
Raed Al Yacoub ◽  
Jaymin Patel ◽  
Neha Solanky ◽  
Nila S Radhakrishnan
Keyword(s):  
Arterial Occlusion ◽  
Limb Ischaemia ◽  
Urine Drug Screen ◽  
Rare Presentation ◽  
Heroin Use ◽  
Acute Ischaemia ◽  
Left Hand ◽  
Ct Angiogram ◽  
Acute Limb Ischaemia ◽  
Urine Drug

A 30-year-old woman with active intravenous drug use presented with pain, blue discolouration, paresthesia and lack of grip strength of left hand for 1 week. Physical examination revealed blue discolouration, decreased sensation and cold to touch in the left hand. She had no palpable radial pulse. She admitted Heroin use only but the urine drug screen was also positive for amphetamine. CT angiogram of the left upper extremity was concerning for acute ischaemia due to arterial occlusion. The initial plan was for amputation. However, to salvage the limb with thrombolysis, an interventional radiology angiogram was performed. The angiogram demonstrated diffuse arterial spasm and response to nitroglycerin. She was treated with nitroglycerin drip and transitioned to a calcium channel blocker. She did improve significantly. To ensure no embolic sequelae, the patient was discharged with a month of oral anticoagulation.

scholarly journals Popliteal Artery Entrapment Syndrome Presenting with Acute Limb Ischaemia: A Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Ramawad Soobrah ◽  
Adam Nawaz ◽  
Tahir Hussain
Keyword(s):  
Popliteal Artery ◽  
Young Patients ◽  
Arterial Occlusion ◽  
Rare Condition ◽  
Limb Ischaemia ◽  
Acute Ischaemia ◽  
Entrapment Syndrome ◽  
Popliteal Artery Entrapment Syndrome ◽  
Acute Limb Ischaemia ◽  
Popliteal Artery Entrapment

Popliteal artery entrapment syndrome (PAES) is a relatively rare condition that occurs in young patients as a result of anomalous anatomic relationships between the popliteal artery and the surrounding musculotendinous structures. Patients usually lack atherogenic risk factors and most commonly present with intermittent claudication in the early stages. In the later stages of undiagnosed PAES, acute ischaemia can occur as a result of complete arterial occlusion or embolism. Hence, early diagnosis and surgical release of the entrapment is crucial for good operative outcome and to prevent limb loss.

scholarly journals Managing Vascular Surgery Emergencies and Referrals During the COVID-19 Pandemic at a Tertiary Centre in Oman

2021 ◽  
Vol 21 (1) ◽  
pp. e116-119
Author(s):  
Edwin Stephen ◽  
Sara S.H. Al-Adawi ◽  
Ibrahim Abdelhady ◽  
Hanan Al Mawali ◽  
Khalifa Al-Wahaibi
Keyword(s):  
Vascular Surgery ◽  
Internal Carotid Artery Stenosis ◽  
University Hospital ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Abdominal Aneurysm ◽  
Arteriovenous Fistulas ◽  
Tertiary Centre ◽  
Acute Limb Ischaemia ◽  
Type B Dissection

Objectives: This study aimed to discuss the different challenges faced while managing emergency vascular surgery cases during the COVID-19 pandemic and how these challenges were overcome. Methods: This study details 14 emergency cases that were managed during a period of one month from mid-March to mid-April at Sultan Qaboos University Hospital, Muscat, Oman. The cases included acute limb ischaemia, critical limb ischaemia, type B dissection of the thoracic aorta, thoraco-abdominal aneurysm, critical internal carotid artery stenosis, trauma, infected arteriovenous forearm loop graft and thrombosed arteriovenous fistulas. Results: Only one patient was confirmed to have COVID-19. Five were negative for COVID-19 while the remaining eight were not tested. Various strategies on how the vascular surgical team accommodated changes in hospital protocols and nationwide lockdown are discussed in detail. Conclusions: With the judicious use of personal protective equipment and consumable surgical and endovascular devices, communication with support services and other hospitals and implementation of triage protocols, it was possible to manage vascular surgery emergencies effectively.   KEYWORDS COVID-19; Vascular Surgery; Emergencies; Oman.

scholarly journals 1476 North Wales Vascular Surgery Zoom Webinar Teaching Programme for Medical Students and Junior Doctors

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Z Iqbal ◽  
A Youssef ◽  
A Abdaldayem ◽  
F Shaikh
Keyword(s):  
Medical Students ◽  
Vascular Surgery ◽  
Aortic Aneurysms ◽  
Junior Doctors ◽  
Limb Ischaemia ◽  
Teaching Programme ◽  
North Wales ◽  
Acute Limb Ischaemia ◽  
Medical Undergraduate ◽  
East And West

Abstract Aim Surgical Education is now more widely delivered on virtual platforms due to the COVID-19 pandemic. Due to centralisation of Vascular Surgery services in North Wales to Glan Clwyd Hospital (Central), Medical Students, Junior Doctors and General Surgical Registrars have reduced exposure to the speciality and the management of common cases in neighbouring hospitals (East and West). Subsequently, we developed a regional virtual teaching programme to help bridge gaps in knowledge and to instil confidence when providing a service. Method We developed a 4-part didactic webinar educational programme which covered parts of the medical undergraduate and MRCS curricula pertaining to Vascular Surgery. Under/Postgraduate educational leads from Central, East and West were contacted to promote our programme. Webinars were delivered on ZOOM video conferencing once weekly throughout December 2020. Feedback forms were collected on Google Forms™ and used 5-point Linkert scales to grade responses and analysis of data was carried out on Microsoft Excel®. Results 186 feedback forms were collected and respondents reported significant improvements in knowledge in each of the subjects covered: [1] Abdominal Aortic Aneurysms - (2.59±1.07/5 to 4.23±0.65/5, p = <0.0001, n = 60), [2] Acute Limb Ischaemia – (2.55±1.11/5 to 4.21±0.72/5, p = <0.0001, n = 42); [3] Chronic Limb Ischaemia (2.57±1.03/5 to 4.23±0.77/5, p = <0.0001, n = 35); [4] Vascular Emergencies (2.94±1.28/5 to 4.37±0.63/5, p = <0.0001, n = 49). Overall topic interest, presentational skills and clinical usefulness was also rated highly. Conclusions Through this virtually delivered regional teaching programme, we successfully enhanced Vascular Surgery knowledge and addressed the educational needs of Medical Students and Junior Doctors across North Wales.

Acute Limb Ischaemia Following Elective Left Upper Lobectomy for Early NSCLC: A Rare but Serious Complication Arising from the Pulmonary Vein Stump

2020 ◽  
pp. 1-2
Author(s):  
James Elliott ◽  
Anand Iyer ◽  
James Elliott
Keyword(s):  
Pulmonary Vein ◽  
Ct Angiography ◽  
Mediastinal Lymph Node ◽  
Case Reports ◽  
Common Femoral Artery ◽  
Sudden Onset ◽  
Leg Pain ◽  
Limb Ischaemia ◽  
Left Upper Lobectomy ◽  
Acute Limb Ischaemia

Patients undergoing Left Upper Lobectomy (LUL) appear to be at risk of a unique post-operative complication that is not well-documented: Pulmonary Vein (PV) stump thrombosis +/- systemic arterial embolisation [1-3]. We describe the details of a rare case from our institution, present a review of this subject from the limited literature available, and suggest potential strategies to anticipate, detect and manage this entity. A 70 year old female patient underwent left upper lobectomy and mediastinal lymph node sampling via repeat left thoracotomy. The procedure was unremarkable apart from some adhesions. She progressed well post-operatively on the ward. On post-operative day 2 the patient developed sudden-onset left leg pain and paraesthesia and CT-Angiography confirmed the diagnosis of left common femoral artery embolus and left superior PV stump thrombosis. The patient returned to theatre for femoral embolectomy, continued systemic anticoagulation, and made an excellent recovery thereafter. The aetiology of this complication has been documented in some case reports, but it is not explored further in trials or thoracic surgery texts [2-3]. One cohort study involving CT-angiography after lobectomy surgeries found that left upper lobectomy was unique as a risk factor for PV stump thrombosis1. It may be related to the relatively longer LSPV stump and stasis of blood in the stump [4].

Tectal Gliomas in Children: The Implications for Natural History and Management Strategy

2003 ◽  
Vol 38 (5) ◽  
pp. 223-231 ◽  
Author(s):  
Ergün Dağlıoğlu ◽  
Oğuz Çataltepe ◽  
Nejat Akalan
Keyword(s):  
Natural History ◽  
Management Strategy
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