scholarly journals Axillobifemoral Bypass: A Brief Surgical and Historical Review

2017 ◽  
Vol 31 (1&2) ◽  
pp. 6 ◽  
Author(s):  
Priti L Mishall ◽  
Jason D. Matakas ◽  
Keara English ◽  
Katherine Allyn ◽  
Diane Algava ◽  
...  
Keyword(s):  
Blood Flow ◽  
Historical Review ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Arterial System ◽  
Skin Ulcers ◽  
Artificial Graft ◽  
Major Vessel ◽  
Artery Disease ◽  
Axillobifemoral Bypass

Peripheral artery disease (PAD) occurs when plaque accumulates in the arterial system and obstructs blood flow. Narrowing of the abdominal aorta and the common iliac arteries due to atherosclerotic plaques restricts blood supply to the lower limbs. Clinically, the lower limb symptoms of PAD are intermittent claudication, discoloration of the toes, and skin ulcers, all due to arterial insufficiency. Surgical revascularization is the primary mode of treatment for patients with severe limb ischemia. The objective of the surgical procedure is to bypass a blockage in an occluded major vessel by constructing an alternate route for blood flow using an artificial graft. This article presents information on aortoiliac reconstruction, with an emphasis on axillobifemoral bypass grafting. 

scholarly journals A Case of Bilateral Acute Inferior Limb Ischemia in a Patient With Ulcerative Colitis

2020 ◽  
Vol 13 ◽  
pp. 117954762091273
Author(s):  
Mimari Kanazawa ◽  
Takeshi Sugaya ◽  
Fumiaki Takahashi ◽  
Kazuhiro Takenaka ◽  
Kouhei Tsuchida ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Blood Flow ◽  
Balloon Catheter ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Bloody Stool ◽  
Mayo Score ◽  
High Incidence ◽  
Inflammatory Bowel ◽  
Inferior Limb

A patient was diagnosed with ulcerative colitis (UC) in 2010. In March 2015, she had abdominal pain, diarrhea, bloody stool, and UC has relapsed. In June 2015, pain and sensory disturbance of both lower limbs appeared. Blood flow at the distal femoral artery was not confirmed with magnetic resonance angiography, and it was diagnosed as bilateral acute inferior limb ischemia. Arterial thrombolectomy with Fogarty’s balloon catheter was performed and blood flow was improved. The severity of UC was moderate with Mayo score 8. Thrombosis is considered to be a complication with a high incidence in inflammatory bowel disease. Reports of arterial thrombosis are very rare. It is important to evaluate the risk of bleeding and thrombosis in active or severe cases in UC and need to do thrombotic prophylactic treatment simultaneously with UC treatment.

scholarly journals A rare case of sigmoid colon cancer in which the lower limbs received collateral blood flow from the inferior mesenteric artery owing to peripheral artery disease

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kyoichi Kihara ◽  
Hiromu Horie ◽  
Kozo Miyatani ◽  
Masayuki Endo ◽  
Tomoyuki Matsunaga ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Sigmoid Colon ◽  
Peripheral Artery Disease ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Sigmoid Colon Cancer ◽  
Peripheral Artery ◽  
Artery Disease

Abstract Background Colorectal cancer and peripheral artery disease are common conditions in older adults and may coexist in this population. Lymph node dissection along the inferior mesenteric artery is a vital procedure in cases of left-sided colorectal cancer. However, the inferior mesenteric artery may show a collateral blood pathway in rare cases of peripheral artery disease. We report a case of advanced sigmoid colon cancer in which the lower limbs received inferior mesenteric artery flow owing to asymptomatic peripheral artery disease. The possibility of catastrophic lower-limb ischemia because of complete mesenteric excision with ligation of the inferior mesenteric artery was a matter of concern in this case. Case presentation A 73-year-old man with asymptomatic peripheral artery disease was diagnosed with stage IIIB advanced sigmoid colon cancer. Angiography using a balloon-occlusion catheter revealed that his lower limbs received prominent inferior mesenteric artery blood flow through a collateral pathway. Therefore, interventional radiologists and cardiovascular surgeons evaluated the indications for endovascular stents or bypass grafts. The patient also had dilated cardiomyopathy, so the cardiovascular physicians evaluated his tolerance in the worst-case scenario of a colorectal anastomotic leak. The patient underwent axillofemoral artery bypass and two-stage laparoscopic sigmoid colectomy without anastomosis. The postoperative course was uneventful, and he resumed his job within a month after the resection. Conclusions Although collateral flow from the inferior mesenteric artery is rare in patients with peripheral artery disease, a few case reports have described fatal lower-limb ischemia following anterior resection. The perioperative multidisciplinary evaluation enabled us to understand the patient’s condition and risks, and allowed successful cancer treatment without ischemia of the lower limbs.

scholarly journals Neural JNK3 regulates blood flow recovery after hindlimb ischemia in mice via an Egr1/Creb1 axis

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Shashi Kant ◽  
Siobhan M. Craige ◽  
Kai Chen ◽  
Michaella M. Reif ◽  
Heather Learnard ◽  
...  
Keyword(s):  
Blood Flow ◽  
Growth Factors ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Limb Ischemia ◽  
The United States ◽  
Hindlimb Ischemia ◽  
Peripheral Ischemia ◽  
Artery Disease

Abstract Diseases related to impaired blood flow such as peripheral artery disease (PAD) impact nearly 10 million people in the United States alone, yet patients with clinical manifestations of PAD (e.g., claudication and limb ischemia) have limited treatment options. In ischemic tissues, stress kinases such as c-Jun N-terminal kinases (JNKs), are activated. Here, we show that inhibition of the JNK3 (Mapk10) in the neural compartment strikingly potentiates blood flow recovery from mouse hindlimb ischemia. JNK3 deficiency leads to upregulation of growth factors such as Vegfa, Pdgfb, Pgf, Hbegf and Tgfb3 in ischemic muscle by activation of the transcription factors Egr1/Creb1. JNK3 acts through Forkhead box O3 (Foxo3a) to suppress the activity of Egr1/Creb1 transcription regulators in vitro. In JNK3-deficient cells, Foxo3a is suppressed which leads to Egr1/Creb1 activation and upregulation of downstream growth factors. Collectively, these data suggest that the JNK3-Foxo3a-Egr1/Creb1 axis coordinates the vascular remodeling response in peripheral ischemia.

“Silent” thrombosis of an abdominal aortic aneurysm not producing acute limb ischemia

VASA ◽  
2010 ◽  
Vol 39 (3) ◽  
pp. 265-267 ◽  
Author(s):  
Moulakakis ◽  
Maras ◽  
Bountouris ◽  
Pomoni ◽  
Georgakis ◽  
...  
Keyword(s):  
Blood Flow ◽  
Abdominal Aortic Aneurysm ◽  
Mortality Rate ◽  
Aortic Aneurysm ◽  
Acute Pain ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Acute Limb Ischemia ◽  
Abdominal Aortic ◽  
Flow Through

Thrombosis of an abdominal aortic aneurysm is a rare devastating complication with an estimated mortality rate of 50%. Simultaneous acute pain, pallor and coldness of the lower limbs, mottling from the level of iliac crests or umbilicus, paraplegia and absence of femoral pulses are all manifestations of a sudden and acute interruption of blood flow through the aneurysmatic aorta. We report a case of an occlusion of an abdominal aortic aneurysm during hospitalization which was not manifested with symptoms of limb ischemia. In this case we feature the rare and unusually “silent” presentation of the event.

scholarly journals Case of persistent sciatic artery in a dialysis patient with critical limb ischemia

2022 ◽  
Vol 10 ◽  
pp. 2050313X2110685
Author(s):  
Yasuhito Nakamura ◽  
Yoshitaka Kumada ◽  
Akihiro Mori ◽  
Norikazu Kawai ◽  
Narihiro Ishida
Keyword(s):  
Blood Flow ◽  
Saphenous Vein Graft ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Whole Body ◽  
Persistent Sciatic Artery ◽  
Stenotic Lesion ◽  
Contrast Enhanced ◽  
Pain At Rest ◽  
Enhanced Computed Tomography

Persistent sciatic artery is a rare congenital malformation (incidence rate, 0.03%–0.06%). We report the case of a 72-year-old male patient with persistent sciatic artery suffering from pain at rest and an ulcer on the left first toe. Angiography findings showed 90% stenosis in the distal persistent sciatic artery. Endovascular therapy was considered difficult because of a long stenotic lesion from the persistent sciatic artery to the popliteal artery and extremely high calcification of the whole body. Because of poor blood flow to the lower leg, vascular prosthesis would have increased the risk of thrombotic occlusion. Therefore, below-knee femoropopliteal bypass using the great saphenous vein graft was performed, which led to the healing of the ulcer on the left first toe. Contrast-enhanced computed tomography of the lower limbs was performed to confirm that the bypass blood flow was good. The patient was discharged on postoperative day 5.

scholarly journals Critical limb ischemia combined with coronary artery disease (literature review)

2020 ◽  
pp. 4-8
Author(s):  
Б.Г. Алекян ◽  
Н.Г. Карапетян ◽  
А.Б. Варава ◽  
А.М. Норвардян
Keyword(s):  
Coronary Artery ◽  
Literature Review ◽  
Limb Ischemia ◽  
Coronary Intervention ◽  
Review Article ◽  
Lower Limbs ◽  
Current Trends ◽  
Points Of View ◽  
Artery Disease

В данной обзорной статье представлены современные тенденции лечения пациентов с критической ишемией нижних конечностей (КИНК) в сочетании с ишемической болезнью сердца. В статье рассмотрены различные точки зрения относительно необходимости выполнения реваскуляризации коронарных артерий (чрескожное коронарное вмешательствос и коронарное шунтирование) у больных с КИНК. Также рассматривается частота поражения коронарных артерий, ампутаций и больших сердечно-сосудистых событий (смерть, инфаркт мио­карда, инсульт) у данной категории пациентов, а также роль мультидисциплинарной команды в принятии решений относительно стратегии лечения этих пациентов This literature review article presents current trends in the management of patients with critical lower limb ischemia combined with coronary heart disease. The article discusses various points of view regarding the need to perform рercutaneous coronary intervention (PCI) before surgery on the arteries of the lower limbs. The frequency of coronary artery damage, amputations, and mortality in this category of patients is also considered. Moreover, the role of the multidisciplinary team in making decisions about the treatment of these patients

scholarly journals Pathogenesis of ischemia/reperfusion syndrome

2018 ◽  
Vol 99 (4) ◽  
pp. 640-644 ◽  
Author(s):  
D E Kutepov ◽  
M S Zhigalova ◽  
I N Pasechnik
Keyword(s):  
Blood Flow ◽  
Lower Limb ◽  
Ischemia Reperfusion ◽  
Vascular Complications ◽  
Limb Ischemia ◽  
Biologically Active ◽  
Lower Limbs ◽  
Ion Pump ◽  
Critical Ischemia ◽  
Lower Limb Ischemia

Ischemia/reperfusion syndrome is a collective concept that combines various pathological conditions developing against the background of the restoration of the main blood flow in the organ or limb segment, which has long been subjected to ischemia or traumatic amputation. Intensive care physicians often see ischemia/reperfusion syndrome after restoration of blood supply in patients with critical ischemia of the lower limb. The rate of critical ischemia of the lower limbs ranges from 400 to 1000 cases per 1 million of the population. The number of lower limb amputations due to critical lower limb ischemia in economically developed countries is 13.7-32.3 cases per 100,000 of the population. The main etiological factors of critical lower limb ischemia are atherosclerosis of peripheral vessels and vascular complications of diabetes. The pathogenesis of ischemia/reperfusion syndrome is based on a complex of pathophysiological changes resulting from the restoration of blood flow in previously ischemic lower limb. Restoration of blood circulation leads to massive flow into the systemic bloodstream of anaerobic metabolism products, free myoglobin, biologically active substances and inflammatory mediators. The main sources of reperfusion damage are activated forms of oxygen, in particular, superoxide radical О2-, nitric oxide, lipid peroxidation products. In the conditions of primary ischemia, and then tissue reperfusion, excessive production of activated oxygen forms leads to damage of biological structures (lipids, proteins, deoxyribonucleic acid), which causes disruption of normal cell functioning or its death due to necrosis or apoptosis, ion pump dysfunction, adhesion of leukocytes and increased vascular permeability.

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