scholarly journals Acute Aorto-Illiac Occlusion with Bilateral Limb Ischemia Underwent Direct Catheter Thrombolysis in Older Patient: A Case Report

2021 ◽  
Vol 2 (4) ◽  
pp. 31-35
Author(s):  
Irma Kamelia ◽  
Novi Kurnianigsih
Keyword(s):  
Case Report ◽  
Limb Ischemia ◽  
Leg Pain ◽  
Successful Outcome ◽  
Acute Limb Ischemia ◽  
Older Patient ◽  
Left Common Iliac Artery ◽  
Peripheral Arterial Diseases ◽  
Therapeutic Tools ◽  
Catheter Thrombolysis

Background: Peripheral arterial diseases could be a major burden for the health system with a wide clinical spectrum from asymptomatic to limb-threatening. Sudden onset of limb deteriorations represent a vascular emergency and need proper treatment for limb preservation and life-saving. It is still challenging to choose proper management to reduce morbidity and mortality, despite the various advance in diagnostic and therapeutic tools were available. Objective: This case report aimed to elaborate on the management of acute aorto-illiac occlusion with bilateral limb ischemia underwent direct catheter thrombolysis in an older patient. Case Presentation: A 70-years-old man came to our hospital with a chief complaint of leg pain in both of his legs, suddenly since 18 hours before admission. He had paresthesia and paralysis in both of his legs. And the Doppler ultrasonography result was occlusion proximal to the right and left common iliac artery. Then we performed percutaneous intra-arterial thrombolysis using streptokinase with a successful outcome of peripheral revascular- ization but with gastrointestinal bleeding as an adverse event. Conclusion: Despite the various advancement of diagnostic and therapeutic tools available today, Acute Limb Ischemia (ALI) still proceed to be related to increasing major amputation and mortality rates in 20% of patients, more often due to the existing comorbidities such as other atherosclerotic diseases.

Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽  
2020 ◽  
pp. 1-6 ◽  
Author(s):  
Marina Di Pilla ◽  
Stefano Barco ◽  
Clara Sacco ◽  
Giovanni Barosi ◽  
Corrado Lodigiani
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Review Of The Literature ◽  
Heparin Induced Thrombocytopenia ◽  
Lower Limb Ischemia ◽  
Vein Thrombosis ◽  
Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

scholarly journals A case report of multisite arterial thrombosis in a patient with coronavirus disease 2019 (COVID-19)

2020 ◽  
Author(s):  
Marco Angelillis ◽  
Marco De Carlo ◽  
Andrea Christou ◽  
Michele Marconi ◽  
Davide M Mocellin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Arterial Thrombosis ◽  
Leg Pain ◽  
Nasopharyngeal Swab ◽  
Limb Ischaemia ◽  
Total Occlusion ◽  
Left Common Iliac Artery ◽  
Acute Limb Ischaemia ◽  
The Right

Abstract Background A systemic coagulation dysfunction has been associated with COVID-19. In this case report, we describe a COVID-19-positive patient with multisite arterial thrombosis, presenting with acute limb ischaemia and concomitant ST-elevation myocardial infarction and oligo-symptomatic lung disease. Case summary An 83-year-old lady with history of hypertension and chronic kidney disease presented to the Emergency Department with acute-onset left leg pain, pulselessness, and partial loss of motor function. Acute limb ischaemia was diagnosed. At the same time, a routine ECG showed ST-segment elevation, diagnostic for inferior myocardial infarction. On admission, a nasopharyngeal swab was performed to assess the presence of SARS-CoV-2, as per hospital protocol during the current COVID-19 pandemic. A total-body CT angiography was performed to investigate the cause of acute limb ischaemia and to rule out aortic dissection; the examination showed a total occlusion of the left common iliac artery and a non-obstructive thrombosis of a subsegmental pulmonary artery branch in the right basal lobe. Lung CT scan confirmed a typical pattern of interstitial COVID-19 pneumonia. Coronary angiography showed a thrombotic occlusion of the proximal segment of the right coronary artery. Percutaneous coronary intervention was performed, with manual thrombectomy, followed by deployment of two stents. The patient was subsequently transferred to the operating room, where a Fogarty thrombectomy was performed. The patient was then admitted to the COVID area of our hospital. Seven hours later, the swab returned positive for COVID-19. Discussion COVID-19 can have an atypical presentation with thrombosis at multiple sites.

scholarly journals Angio-Seal Vascular Closure Related Acute Limb Ischemia: A Case Report

2019 ◽  
Vol 8 (2) ◽  
pp. 49-52
Author(s):  
Maya Srinivasan ◽  
Pramod Theetha Kariyanna ◽  
Jeremy Smith ◽  
Sushruth Das ◽  
Amog Jayarangaiah ◽  
...  
Keyword(s):  
Case Report ◽  
Limb Ischemia ◽  
Acute Limb Ischemia

scholarly journals The Role of Catheter Directed Thrombolysis on Acute Limb Ischemia (an Evidence-Based Case Report)

2021 ◽  
Vol 49 (1) ◽  
pp. 3-24
Author(s):  
Ali Farhan Fathoni ◽  
Raden Suhartono
Keyword(s):  
Case Report ◽  
Adult Patient ◽  
Controlled Trial ◽  
Limb Ischemia ◽  
Evidence Based ◽  
Acute Limb Ischemia ◽  
First Line ◽  
Bleeding Events ◽  
Catheter Directed Thrombolysis ◽  
Significant Difference

Introduction. Acute limb ischemia can be managed both with surgery and thrombolysis, especially catheter-directed thrombolysis. The risk, benefit and indication of thrombolysis is already well known. However, as a first line therapy, it is unclear which intervention is more beneficial; the catheter directed thrombolysis or surgery. This report aims to elucidate which technique is more effective and safer. Method. This is an Evidence-Based Case Report based on a case of a geriatric, diabetic patient whom suffered acute limb ischemia. The report systematically search for meta-analysis, systematic review, randomized controlled trial and cohort studies from Cochrane central and PubMed for all adult patient suffering from acute limb ischemia whose are treated with catheter-directed thrombolysis or surgery as first-line intervention and comparing the outcome in terms of efficacy (clinical outcome such as patency and amputation-free rates) and safety (mortality and morbidity). Results. Subjects’ characteristics should be placed first to draw the demography. Put the study finding(s) here with no interpretation. For all adult patient regardless of their diabetic status and age there is no statistically significant difference for limb salvage, amputation, and mortality between two technique, however catheter directed thrombolysis showed reduced need for additional intervention whilst increasing risk of bleeding events. Conclusion. Neither techniques are more superior than the other but catheter-directed thrombolysis can be considered given that it reduce the need for further intervention, less invasive and even though it has risks for bleeding complication it is still lower compared to systemic thrombolysis. The selection of which technique can be up to clinician’s discretion in consideration of risk and benefit for each patient.

scholarly journals Primary Stenting Immediatly after Surgery in Occluded Anastomoses of Aortoaortic Tube Graft: A Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
M. Rabellino ◽  
L. García-Nielsen ◽  
T. Zander ◽  
S. Baldi ◽  
A. Estigarribia ◽  
...  
Keyword(s):  
Case Report ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Abdominal Aortic Aneurysm Repair ◽  
Left Common Iliac Artery ◽  
Limb Perfusion ◽  
Left Limb ◽  
Distal Pulse ◽  
Primary Stenting ◽  
Aneurysm Repair

The conventional elective open procedures for abdominal aortic aneurysm repair are reliable and yield durable results. The aortoaortic tube graft has the lowest morbidity incidence when compared with different techniques. Albeit infrequent, thrombosis can be present in the first 30 days. Its treatment consists in thrombectomy and anastomosis evaluation, but with an increase in morbidity, especially in patients with urgent reintervention. This is a case report of a patient with aortoaortic tube graft, who present critical left limb ischemia immediately after surgical procedure. Angiography showed complete occlusion of left common iliac artery, affecting the distal graft anastomosis. The occlusion was resolved with endovascular treatment, and a noncovered, self-expanding, nitinol stent was deployed (primary stenting) covering the distal bypass anastomosis, with no complications and complete lower limb perfusion recovery. One month later, the patient was still asymptomatic, with distal pulse palpable and ankle-brachial index 1.

Dissection of left iliac artery during anterior lumbar interspace fusion: Report of a case

Vascular ◽  
2014 ◽  
Vol 23 (2) ◽  
pp. 176-178 ◽  
Author(s):  
Uwe M Fischer ◽  
Mark G Davies ◽  
Hosam El Sayed
Keyword(s):  
Iliac Artery ◽  
Interbody Fusion ◽  
Limb Ischemia ◽  
Anterior Lumbar Interbody Fusion ◽  
Artery Dissection ◽  
Acute Limb Ischemia ◽  
Vascular Injuries ◽  
Lumbar Interbody Fusion ◽  
Left Common Iliac Artery ◽  
Great Vessels

Vascular injury is an uncommon complication of spine surgery. Among the different approaches, anterior lumbar interbody fusion has increased potential for vascular injuries, since the great vessels and their branches overly the disc spaces to be operated on, and retraction of these vessels is necessary to gain adequate surgical exposure. The reported incidence for anterior lumbar interbody fusion-associated vascular injuries ranges from 0% to 18.1%, with venous laceration as the most common type. We report a case of anterior lumbar interbody fusion-associated left common iliac artery dissection leading to delayed acute limb ischemia developing in early post-operative period.

scholarly journals Superior Mesenteric Arterial Embolism Associated with an Acute Limb Ischemia: A Case Report and Literature Review

2014 ◽  
Vol 04 (04) ◽  
pp. 181-186 ◽  
Author(s):  
Abdesslam Bouassria ◽  
Elbachir Benjelloun ◽  
Imane Kamaoui ◽  
Hicham Elbouhaddouti ◽  
Ouadii Mouaqit ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Arterial Embolism

Abstract 275: Angioscore Balloon in the Treatment of Collagen Plug Occlusion and Acute Limb Ischemia: Case Report

2012 ◽  
Vol 32 (suppl_1) ◽  
Author(s):  
Pooja M Swamy ◽  
Abeer Berry ◽  
Mahir D Elder
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Closure Device ◽  
Acute Limb Ischemia ◽  
Access Site ◽  
Left Lower Extremity

BACKGROUND: Complications of the vascular access-site (VAS) are not uncommon. With the evolution of hemostatic techniques used in the access site closure, in the last two decades, the rate of VAS related complications has significantly reduced from 6% to 2%. However, they still remain to be an important cause of morbidity following catheterization procedures. The most common complications encountered with closure of VAS are hematoma formation, arterio-venous fistula, dissection, pseudo -aneurysm and limb ischemia. According to two meta-analyses, the incidences of these complications were very low. The incidence of collagen plug from an Angioseal(™) device causing acute leg ischemia is low and upon occurrence, the use of an Angioscore(™) balloon in successful revascularization has never been reported. CASE PRESENTATION: A 62-year-old male with known severe peripheral artery disease, diabetes mellitus, hypertension and hypercholesterolemia had a successful angioplasty of a 100% chronically occluded right superficial femoral artery (SFA) via the left common femoral artery. An Angioseal (™) closure device was used to achieve hemostasis. The patient was discharged home after an uneventful post procedural course. Two days later, he presented to the ER with a cold and numb left lower extremity. On exam, the left lower extremity had no palpable pulse from below right femoral artery, confirmed by Doppler. The extremity was cold to touch with decreased sensory perception. Patient was found to have critical left lower extremity ischemia. He was emergently taken for a selective left lower extremity angiogram using the right common femoral artery for access. Fragments of the closure device and a collagen plug causing a total occlusion of the left common femoral artery were found. After a pre-dilatation with a 4.0x 40 balloon under prolonged inflations, a lesion reduction from 100 % to 30% with a TIMI 0 to TIMI 3 flow was achieved using an Angioscore (™) 5.0x 40 balloon inflated at 10 atmospheres. Subsequently, using laser 2.0 atherectomy of the left common femoral artery was performed. Flow in the dorsalis pedis artery was confirmed with Doppler. DISCUSSION: The Angio-Seal(™) device has a polylactide and polyglycolide polymer anchor, a collagen plug and a suture contained within a carrier system. Hemostasis is achieved by compressing the arterial puncture site between the anchor and the collagen plug. With newer studies, it appears that the occurrence of critical limb ischemia from collagen plug is under recognized. We therefore, with this case report urge the physicians to be aware of this serious though rare complication of closure devise and also highlight the successful use of Angioscore (™) balloon in the emergent treatment of non-athermatous vascular occlusion causing critical limb ischemia.

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