Acute peripheral ischemia in healthy female patient: an indirect and unanticipated diagnosis of spontaneous thrombus in the aortic arch

Abstract Background In this case we discuss the management of a pediculated floating thrombus in the aortic arch which led to peripheral embolization and acute ischemia oft he left leg. Case presentation A healthy 46 year old female patient presented with pain in her left leg and progressive numbness. Computed Tomography Angiography (CTA) showed an acute ischemia of the left leg (Rutherford 2 B) with a 2 cm thrombus distal of the aortic bifurcation. Emergency operation with embolectomy, selective thrombembolectomy and patch plasty on the tibioperoneal trunk and local lysis was performed. As part of a further diagnostic examination a thoracic CT scan has been performed revealing a pediculated-floating 2 cm thrombus in the aortic arch. Four days after the initial operation thrombus excision via a minimally invasive access way has been performed. After initiation of the extracorporeal circulation, selective unilateral antegrade cerebral perfusion has been established in mild (30–32 °C) systemic hypothermia. Patients postoperative course was uneventful. Histological evaluation of the mass demonstrated thrombotic material without evidence of infection or malignacy. Conclusion A pediculated spontaneous thrombus may develop in aortic arch in patients without traditional risk factors or family history of embolic events. Two stage operation was feasible and safe.

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Minimally Invasive Aortic Arch Repair: Technical Considerations and Mid-Term Outcomes

The Heart Surgery Forum ◽

10.1532/hsf.3235 ◽

2020 ◽

Vol 23 (6) ◽

pp. E803-E808

Author(s):

Petar Risteski ◽

Medhat Radwan ◽

Gjoko Boshkoski ◽

Razan Salem ◽

Annarita Iavazzo ◽

...

Keyword(s):

Aortic Arch ◽

Median Sternotomy ◽

Minimal Invasive ◽

Minimal Access ◽

Organ Protection ◽

Elephant Trunk ◽

Aortic Arch Surgery ◽

Cord Injury ◽

Systemic Hypothermia ◽

Aortic Arch Repair

Background: Reports of minimal invasive aortic arch surgery are scarce. We reviewed our experience with minimal access aortic arch surgery performed through an upper mini-sternotomy, with emphasis on details of operative technique and early and mid-term outcomes. Methods: The medical records of 123 adult patients (mean age 66 ± 12 years), who underwent primary elective minimal access aortic arch surgery in two aortic referral centers, were reviewed. The most common indication was degenerative aortic arch aneurysm in 92 (75%) patients. Standard operative and organ protection techniques used in all patients were upper mini-sternotomy, uninterrupted antegrade cerebral perfusion, and moderate systemic hypothermia (27.4 ± 1°C). Results: Sixty-eight (55%) patients received partial aortic arch replacement; the remaining 55 (45%) patients received total arch replacement, further extended with either a frozen elephant trunk in 43 (35%) patients or a conventional elephant trunk procedure in nine (7%) patients. No conversion to full sternotomy was required. New permanent renal failure occurred in one (0.8%) patient, stroke in two (1.6%), and spinal cord injury in four (3.3%) patients. Early mortality was observed in four (3.3%) patients. At five years, survival was 80 ± 6% and freedom from reoperation was 96 ± 3%. Conclusion: Minimal invasive aortic arch repair through an upper mini-sternotomy can be safely performed, with early and mid-term outcomes well comparable to series performed through a standard median sternotomy.

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Succinate Injection Rescues Vasculature and Improves Functional Recovery Following Acute Peripheral Ischemia in Rodents: A Multimodal Imaging Study

Cells ◽

10.3390/cells10040795 ◽

2021 ◽

Vol 10 (4) ◽

pp. 795

Author(s):

Anaïs Moyon ◽

Philippe Garrigue ◽

Laure Balasse ◽

Samantha Fernandez ◽

Pauline Brige ◽

...

Keyword(s):

Functional Recovery ◽

Imaging Study ◽

Preclinical Study ◽

Control Group ◽

Acute Ischemia ◽

Peripheral Ischemia ◽

Integrin Ligand ◽

Angiogenic Activation ◽

G Protein Coupled ◽

Ischemic Muscle

Succinate influences angiogenesis and neovascularization via a hormonelike effect on G-protein-coupled receptor 91 (GPR91). This effect has been demonstrated in the pathophysiology of diabetic retinopathy and rheumatoid arthritis. To evaluate whether succinate can play a role in acute peripheral ischemia, a preclinical study was conducted with ischemic mice treated with succinate or PBS and evaluated by imaging. Acute ischemia was followed by an increased in GPR91 expression in the ischemic muscle. As assessed with LASER-Doppler, succinate treatment resulted in an earlier and more intense reperfusion of the ischemic hindlimb compared to the control group (* p = 0.0189). A microPET study using a radiolabeled integrin ligand ([68Ga]Ga-RGD2) showed an earlier angiogenic activation in the succinate arm compared to control mice (* p = 0.020) with a prolonged effect. Additionally, clinical recovery following ischemia was better in the succinate group. In conclusion, succinate injection promotes earlier angiogenesis after ischemia, resulting in a more effective revascularization and subsequently a better functional recovery.

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Aortic arch calcification detectable on chest X-ray is a strong independent predictor of cardiovascular events beyond traditional risk factors

Atherosclerosis ◽

10.1016/j.atherosclerosis.2009.11.012 ◽

2010 ◽

Vol 210 (1) ◽

pp. 137-144 ◽

Cited By ~ 50

Author(s):

Katsuya Iijima ◽

Hiroko Hashimoto ◽

Masayoshi Hashimoto ◽

Bo-Kyung Son ◽

Hidetaka Ota ◽

...

Keyword(s):

Risk Factors ◽

Aortic Arch ◽

Cardiovascular Events ◽

Independent Predictor ◽

X Ray ◽

Chest X Ray ◽

Traditional Risk Factors ◽

Strong Independent Predictor ◽

Aortic Arch Calcification

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Aortic Arch Surgery using Moderate Systemic Hypothermia and Antegrade Cerebral Perfusion via the Right Subclavian Artery*

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2001-17806 ◽

2001 ◽

Vol 49 (5) ◽

pp. 283-286 ◽

Cited By ~ 11

Author(s):

H. Aebert ◽

D. Reber ◽

R. Kobuch ◽

A. Philipp ◽

D. E. Birnbaum

Keyword(s):

Aortic Arch ◽

Subclavian Artery ◽

Cerebral Perfusion ◽

Aortic Arch Surgery ◽

Systemic Hypothermia ◽

The Right ◽

Antegrade Cerebral Perfusion

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Reoperative Aortic Arch Surgery under Mild Systemic Hypothermia: Two-Center Experience

Aorta ◽

10.1055/s-0041-1725073 ◽

2021 ◽

Author(s):

Petar Risteski ◽

Isabel Radacki ◽

Andreas Zierer ◽

Aris Lenos ◽

Anton Moritz ◽

...

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Operative Mortality ◽

Mild Hypothermia ◽

Aortic Surgery ◽

Graft Infection ◽

Elephant Trunk ◽

Aortic Arch Surgery ◽

Systemic Hypothermia ◽

Antegrade Cerebral Perfusion

Abstract Background The aim of the study was to assess the indications, surgical strategies, and outcomes after reoperative aortic arch surgery performed generally under mild hypothermia. Methods Ninety consecutive patients (60 males, mean age, 55 ± 16 years) underwent open reoperative aortic arch surgery after previous cardiac aortic surgery. The indications included chronic-progressive arch aneurysm (55.5%), chronic aortic dissection (17.8%), contained arch rupture (16.7%), and graft infection (10%). The reoperation was performed through a repeat sternotomy (96%) or clamshell thoracotomy (4%) using antegrade cerebral perfusion under mild systemic hypothermia (28.9 ± 2.5°C) in all except three patients. Results The surgery comprised hemiarch or total arch replacement in 41 (46%) and 49 (54%) patients, respectively. The distal extension included classic or frozen elephant trunk technique, each in 12 patients, and total descending aorta replacement in 4 patients. Operative mortality was 6 (6.7%) among all patients, with age identified as the only independent predictor of operative mortality (p = 0.05). Permanent and transient neurologic deficits occurred in 1% and 9% of the patients, respectively. Estimated survival at 8 years was 59 ± 8% with advanced heart failure predictive for late mortality (p = 0.014). Freedom from second reoperation or intervention on the aorta was 78 ± 6% at 8 years, with most of these events occurring downstream in patients with chronic degenerative aneurysms. Conclusion Aortic arch reoperations performed using antegrade cerebral perfusion under mild systemic hypothermia offer favorable operative outcomes with an exceptionally low rate of neurologic morbidity without any difference between hemiarch and complex arch procedures.

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Giant aneurysmal dermatofibroma: a case of the rare variant of dermatofibroma

Journal of Dermatology & Cosmetology ◽

10.15406/jdc.2019.03.00136 ◽

2019 ◽

Vol 3 (6) ◽

pp. 159-161

Author(s):

Rogério Nabor Kondo

Keyword(s):

Female Patient ◽

Rare Variant ◽

Tumor Stroma ◽

Skin Tumor ◽

Histological Evaluation ◽

Histological Variant ◽

Venous Lakes

Dermatofibroma is a benign skin tumor that may have a rare aneurysmal histological variant, aneurysmal dermatofibroma (AD). The diagnosis is by histological evaluation, which shows vascular spaces that dissect the tumor stroma, forming in some cases true venous lakes. However, AD is usually less than 20mm in diameter. We describe the case of a female patient whit a 45mm tumor in her right leg.

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