scholarly journals Endovascular Treatment of Acute Tibioperoneal Trunk Thrombosis. A Clinical Case Report

2019 ◽  
Vol 9 (2) ◽  
pp. 113-117
Author(s):  
D. S. Chigidinova ◽  
B. A. Rudenko ◽  
A. S. Shanoyan ◽  
V. P. Mazaev ◽  
F. B. Shukurov
Keyword(s):  
Clinical Case ◽  
Endovascular Procedures ◽  
High Efficiency ◽  
Early Recognition ◽  
Limb Ischemia ◽  
Lower Leg ◽  
Limb Amputation ◽  
Acute Limb Ischemia ◽  
Acute Thrombosis ◽  
Arterial Perfusion

Introduction. Acute limb ischemia is a severe disorder caused by a sharp drop in the arterial perfusion of the limb. It carries a threat to the limb’s function and viability. The issue of early recognition of acute limb ischemia in surgery is both important and difficult. The current guidelines recommend that patients with acute limb ischemia when the limb is viable should be urgently examined and treated. Restoring the blood flow in patients with acute limb ischemia is a priority, since a significant reduction in arterial perfusion can lead to limb amputation and life-threatening complications. In acute limb ischemia different treatment methods can be used, both open surgery and endovascular procedures. The treatment strategy depends on the localisation, duration of ischemia, neurological deficit, concomitant diseases and risks associated with treatment and its results. Endovascular procedures on the arteries of the lower leg are most often indicated to save a limb. Endovascular procedures on the arteries of the lower leg are indicated more often in patients with critical limb ischemia. Endovascular procedures when the condition is primary demonstrate good outcomes and high efficiency on the arteries of the lower extremities at all levels of the lesion.Materials and methods. This paper presents a clinical case of a successful endovascular procedure performed for the treatment of acute thrombosis of the arteries of the lower leg. Three stents were implanted, with a good angiographically confirmed outcome.Conclusion. Endovascular balloon angioplasty with stenting of the tibioperoneal trunk can result in good outcomes in patients with acute thrombosis of the arteries of the lower leg.

scholarly journals Acute Limb Ischemia in One Dose Vaccination of COVID-19

2021 ◽  
Vol 2 (2) ◽  
pp. 1-4
Author(s):  
Kemas Dahlan ◽  
Yulianto Kusnadi ◽  
Edo Tondas ◽  
Daffa Faturrahman
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Virus Disease ◽  
Limb Ischemia ◽  
Hypercoagulable State ◽  
Anterior Tibial Artery ◽  
Acute Limb Ischemia ◽  
Full Dose ◽  
Arterial Perfusion ◽  
State Management ◽  
Tibial Artery

Introduction: The extraordinary thrombotic manifestations of Corona virus Disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome CoV-2 (SARS-CoV-2) virus, presenting as venous and arterial thrombosis have been reported in several literatures, but in this report, we presented a special case of acute limb ischemia in a patient that has been vaccinated by COVID-19 vaccine. Acute limb ischemia (ALI) is defined as decreasing in arterial perfusion of a limb with a threat to viability of the limb and mortality. COVID-19 has been declared as a global pandemic by the WHO. Patients with COVID-19 have abnormalities in blood coagulation parameters and are prone to thromboembolic events. This hypercoagulable state caused by COVID-19 mainly manifests as venous thromboembolism while peripheral arterial involvement is less frequent. Case: A 54-year diabetic and smoker male has already got one dose COVID-19 vaccination came to our emergency unit with severe acute respiratory syndrome and pain, pale and paresthesia of his left leg. There was pneumonia pattern according to chest X-ray and a ground glass opacity in chest CT-scan, he was confirmed infected by COVID-19 according to RT-PCR test. From CT-Angiography we found multiple thrombosis in the distal aorta, superficial femoral artery (SFA), anterior tibial artery (ATA), and posterior tibial artery (PTA) of left lower extremity. Initial treatment we started with unfractionated heparin, oxygenation, intravenous fluid and analgesia. We managed the patient in isolation ward special for COVID-19. We did thrombectomy to save the limb, nevertheless in few days after we performed amputation at the level of talonavicular joint to the distal part of left foot caused by gangrene. Conclusion: Vaccination can protect from COVID-19 if we vaccinated with full dose and our immune system able to create antibody. The condition will be different in immunocompromised condition and we get not full dose vaccination. Covid-19 Patient with Diabetes and smoker could have higher risk to develop acute limb ischemia because of hypercoagulable state. Management of a COVID-19 patient with cute limb ischemia is more complicated and challenging. Although we have already vaccinated life style modification like wearing a mask, social distancing and using hand sanitizer can give us more protection from Covid 19. Keywords: acute limb ischemia, COVID-19 vaccination, heparinization, thrombectomy

scholarly journals Embolism to the main limb arteries in patients with atrial fibrillation

2022 ◽  
Vol 20 (4) ◽  
pp. 14-20
Author(s):  
M. V. Mel’nikov ◽  
A. V. Sotnikov ◽  
D. S. Kozhevnikov ◽  
M. V. Solov’yeva ◽  
S. A . Boldueva
Keyword(s):  
Atrial Fibrillation ◽  
Limb Ischemia ◽  
Limb Amputation ◽  
Acute Ischemia ◽  
Acute Limb Ischemia ◽  
Surgical Department ◽  
The Past ◽  
Group 3 ◽  
Group 1

Introduction. Acute limb ischemia due to embolism in patients with atrial fibrillation remains poorly studied. Objective – to study the clinical significance and role of atrial fibrillation (AF) in the development of embolism to the bifurcation of the aorta and the main arteries of the limbs. Materials and methods. Treatment results of 1816 patients with acute ischemia of the extremities due to embolism treated at a specialized vascular surgical department for the past 30 years were analyzed. 1611 (88.7 %) of them had AF. The distribution into studied groups was according to the period time factor. Group 1 (n = 744) consisted of patients admitted in the period from 1991 to 2000; in group 2 (n = 568) – admitted in the period from 2001 to 2010, in group 3 (n = 299) – from 2011 to 2020. Methods included clinical examination, electrocardiography, Doppler-ultrasound, echocardiography. Results. The role of rheumatic heart disease as a cause of AF has decreased over the past decades by almost 10 times (from 19.5 % in group 1 to 2.0 % in group 3). Currently, the main background diseases for the development of AF are arterial hypertension and various forms of coronary artery disease. Embolism in patients with AF may develop in the arteries of all vascular areas of the systemic circulation, but in the practice of a vascular surgeon more often in the main arteries of minor caliber – the brachial (24.5 %) and popliteal (13.0 %). Multiple embolisms to various vascular areas were found in 2.8 % of patients. Urgent surgical revascularization of the limb by open embolectomy was performed in 1481 (91.9 %) patients that allowed 1348 (83.7 %) to be discharged with limb-sparing. Conclusion. In patients with acute limb ischemia of embologenic ethiology, comorbid AF has 88.7 % of them. Urgent embolectomy allows 83.7 % of patients to be discharged without limb amputation. Hospital mortality in the period 1991–2000 was 15.6 %, the last decade has been reduced to 7.4 %.

Endovascular Procedures For Lower Extremity Vascular Disease: Basics of Endovascular Intervention

2018 ◽  
Author(s):  
Lalithapriya Jayakumar ◽  
Mark Davies
Keyword(s):  
Lower Extremity ◽  
Vascular Disease ◽  
Endovascular Procedures ◽  
Vascular Diseases ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Surgical Approaches ◽  
Acute Ischemia ◽  
Acute Limb Ischemia ◽  
Access Complications

The application of endovascular procedures to lower-extremity vascular disease is well established for many common vascular diseases and has often supplanted conventional open surgical approaches. Endovascular therapy for arterial disease in the lower extremity encompasses treatment of acute ischemia, chronic ischemia, and aneurysmal disease. The fundamental skill set and techniques employed are common to all these processes. This chapter details these techniques and therapies. Key words: access closure, access complications, acute limb ischemia, chronic limb ischemia, intravascular ultrasonography, lower-extremity angiogram, transcollateral access, transpopliteal access

Endovascular Procedures For Lower Extremity Vascular Disease: Basics of Endovascular Intervention

2018 ◽  
Author(s):  
Lalithapriya Jayakumar ◽  
Mark Davies
Keyword(s):  
Lower Extremity ◽  
Vascular Disease ◽  
Endovascular Procedures ◽  
Vascular Diseases ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Surgical Approaches ◽  
Acute Ischemia ◽  
Acute Limb Ischemia ◽  
Access Complications

The application of endovascular procedures to lower-extremity vascular disease is well established for many common vascular diseases and has often supplanted conventional open surgical approaches. Endovascular therapy for arterial disease in the lower extremity encompasses treatment of acute ischemia, chronic ischemia, and aneurysmal disease. The fundamental skill set and techniques employed are common to all these processes. This chapter details these techniques and therapies. Key words: access closure, access complications, acute limb ischemia, chronic limb ischemia, intravascular ultrasonography, lower-extremity angiogram, transcollateral access, transpopliteal access

scholarly journals Recidivne tromboze arterij spodnjega uda pri bolniku s trombocitopenijo, povzročeno s heparinom – Prikaz primera

2017 ◽  
Vol 86 ◽  
Author(s):  
Blanka Mahne ◽  
Mladen Gasparini ◽  
Matija Kozak
Keyword(s):  
Platelet Count ◽  
Venous Thrombosis ◽  
Lower Limb ◽  
Early Recognition ◽  
Coronary Bypass ◽  
Posterior Tibial Artery ◽  
Heparin Therapy ◽  
Limb Amputation ◽  
Heparin Induced Thrombocytopenia ◽  
Acute Thrombosis

Background: Heparin-induced thrombocytopenia (HIT) is an immune-mediated disorder following heparin therapy presenting with thrombocytopenia and associated arterial or/and venous thrombosis (heparin induced thrombocytopenia with thrombosis–HITT). Unrecognised HIT can lead to severe complications like limb amputation and death.Case report: We report a case of a patient who presented with HIT-associated recurrent lower limb arterial thrombotic occlusions and popliteal venous thrombosis 29 days after coronary bypass graf surgery. The patient underwent urgent thrombectomy of superfcial femoral, popliteal and posterior tibial artery. Because of recurrent thrombotic occlusions of lower limb arteries three surgical revisions were performed. Te platelet count decreased from 124 × 109/l to 53 × 109/l on the fifth day after the first intervention. After clinical suspicion of HIT, heparin was discontinued and fondaparinux was started. Arterial thrombosis did not recur and the patient recovered without consequences.Conclusions: HIT occurs in 1–3 % of patients after cardiac surgery. Strict following of international guidelines regarding the frequency of platelet count monitoring, assessing probability for HIT and laboratory testing is mandatory in order not to miss the diagnosis of HIT. HIT can manifest clinically several days after the first exposure to heparin. If a patient presents with acute thrombosis and thrombocytopenia, HITT should be suspected. Postoperative HIT is associated with higher morbidity and mortality. Early recognition is crucial to prevent severe complications and death.

scholarly journals Acute Thromboembolism from Trauma in a Patient with Abdominal Aortic Aneurysm

2021 ◽  
Vol 5 (3) ◽  
pp. 357-359
Author(s):  
Solomon Sebt ◽  
Chris Kim ◽  
Wirachin Hoonpongsimanont ◽  
Eric Leroux
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Rare Complication ◽  
Limb Ischemia ◽  
Point Of Care Ultrasound ◽  
Acute Limb Ischemia ◽  
Thromboembolic Events ◽  
Acute Thrombosis ◽  
Abdominal Aortic ◽  
History Of

Case Presentation: A 64-year-old man with a history of a 5.5-centimeter (cm) abdominal aortic aneurysm (AAA) presented to the emergency department (ED) complaining of severe back pain after climbing over a fence and falling a distance of eight feet. Prior to arrival, the prehospital paramedics reported that the patient did not have palpable pulses in either lower extremity. The initial physical examination in the ED was significant for absent dorsalis pedis pulses bilaterally as well as absent posterior tibialis pulses bilaterally and cold, insensate lower extremities. Point-of-care ultrasound identified an approximate 7-cm infrarenal AAA with a mural thrombus present. After receiving several computed tomography (CT) studies including CT head without contrast and CT angiography of the chest, abdomen and pelvis, the patient was diagnosed with acute thrombosis of AAA and associated thromboembolic occlusion of both his right and left distal iliac vessels causing bilateral acute limb ischemia. He immediately received unfractionated heparin and was admitted to the hospital for embolectomy and intra-arterial tissue plasminogen activator. Discussion: Acute thrombosis of AAA and subsequent thromboembolic events are a rare but significant complication that can occur in patients with a history of AAA. Thromboembolic events may occur spontaneously or in the setting of blunt abdominal trauma. Common presenting signs and symptoms include distal limb ischemia and absent femoral pulses. Timely management and recognition of this rare complication is vital as this condition can ultimately result in limb loss or death if not treated in a timely manner. Heparinization after confirmation of non-ruptured AAA as well as vascular surgery, and therapeutic and vascular interventional radiology consultations are key steps that should be taken to decrease patient morbidity and mortality.

Endovascular Procedures For Lower Extremity Vascular Disease: Specifics of Endovascular Treatment

2018 ◽  
Author(s):  
Lalithapriya Jayakumar ◽  
Mark Davies
Keyword(s):  
Lower Extremity ◽  
Endovascular Treatment ◽  
Vascular Disease ◽  
Endovascular Procedures ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Surgical Approaches ◽  
Acute Ischemia ◽  
Acute Limb Ischemia ◽  
Chronic Ischemia

The application of endovascular procedures to lower-extremity vascular disease is well established for many common vascular diseases and has often supplanted conventional open surgical approaches. Endovascular therapy for arterial disease in the lower extremity encompasses treatment of acute ischemia, chronic ischemia, and aneurysmal disease. The fundamental skill set and techniques employed are common to all these processes. This chapter details the management of chronic ischemia, acute lower-extremity arterial ischemia, pseudoaneurysms and aneurysms, and arteriovenous malformations. Key words: access closure, access complications, acute limb ischemia, aneurysm endovascular treatment, chronic limb ischemia, intravascular ultrasonography, lower-extremity angiogram, lower limb ischemia, percutaneous transluminal angioplasty, transcollateral access, transpopliteal access

Single Tertiary Care Center Outcomes After Lower Extremity Cadaveric Vein Bypass for Limb Salvage

2020 ◽  
Vol 54 (5) ◽  
pp. 430-435
Author(s):  
Kuldeep Singh ◽  
Amandeep Juneja ◽  
Tushar Bajaj ◽  
Christian Voto ◽  
Jonathan Schor ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Saphenous Vein ◽  
Tertiary Care ◽  
Limb Ischemia ◽  
Primary Patency ◽  
Limb Amputation ◽  
Secondary Patency ◽  
Acute Limb Ischemia ◽  
Long Term Outcome

Objective: Cadaveric saphenous vein (CV) conduits are used in rare instances for limb salvage in patients without autogenous veins although long-term outcome data are scarce. This study was designed to evaluate the outcomes of CV bypass in patients with threatened limbs. Methods: We retrospectively reviewed the charts from 2010 to 2017 of 25 patients who underwent 30 CV allografts for critical limb ischemia and acute limb ischemia. Patient charts were reviewed for demographics, comorbidities, smoking status, indications for bypass, and outcomes. Primary outcomes included graft patency, major amputation rates, and mortality. Secondary outcomes measured included infection rates, 30-day major adverse cardiac events (MACE) and major adverse limb events (MALE). Statistical analysis was performed using time series and Kaplan-Meier survival curves. Results: A total of 30 limbs received CV lower extremity bypasses (20 males, 10 female), and the average age was 68 ± 4 years. Primary patency rates were 71%, 42%, and 28% at 3, 6, and 12 months, respectively. Assisted primary patency rates were 78%, 56%, and 37% at 3, 6, and 12 months, respectively. Secondary patency rates were 77%, 59%, and 28% at 3, 6, and 12 months, respectively. Minor amputations, defined as amputations below the transmetatarsal level occurred in 5 (20%) patients. Wound infection occurred in 8 (32%) patients which was managed with local wound care and no patients required an extraanatomic bypass for limb salvage. Thirty-day MALE occurred in 7 (23.3%) patients. We had no 30-day mortality or MACE. The average graft length was 64.2 ± 8 cm with an average graft diameter of 3.9 ± 2 mm. Amputation-free survival and overall survival at 12 months were 20 (68%) and 21 (84%), respectively. Conclusions: Cadaveric saphenous vein allograft may be used as a bypass conduit as a viable surgical option before limb amputation. Despite the poor patency rates, the limb salvage rates of cadaveric vein grafts demonstrate that this alternate conduit may be considered when no autogenous vein is available.

scholarly journals Acute limb ischemia in COVID-19 patients: an overview

2021 ◽  
Author(s):  
Hashem Bark Abood ◽  
Wael Hamed Alsaedi ◽  
Abdulwahab Mohammad Bokhari ◽  
Ahmad Mohammed Almughalleq ◽  
Ranin Owaidh Algethami ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Arterial Perfusion ◽  
Arterial Involvement ◽  
Cardiovascular Involvement ◽  
Wide Range ◽  
Peripheral Arterial ◽  
Prevention Methods ◽  
Specific Symptoms

COVID-19 causes a wide range of clinical symptoms. COVID-19 hematologic and cardiovascular involvement induces thromboembolic symptoms in various organs, most notably venous thromboembolism (VTE); peripheral arterial involvement is uncommon. Acute limb ischemia (ALI) is a vascular emergency known as a dramatic drop in arterial perfusion of a limb that poses a challenge to the limb's viability. Given routine need for thromboprophylaxis, hospitalised COVID-19 patients are at an elevated risk of ALI, limb loss, or even mortality. Understanding the various specific symptoms of COVID-19 patients, especially extrapulmonary manifests, is crucial for both better patient care and the development of adequate infection prevention methods. Although ALI is a complication of COVID-19 in hospitalized patients, it is now being understood that it can arise in patients with mild COVID-19 symptoms, and that ALI can be the first presenting sign of COVID-19 even in the absence of respiratory symptoms. It is recommended that acutely admitted COVID-19 cases should be given pharmacologic thromboprophylaxis with low molecular weight heparin (LMWH) or fondaparinux unless there is a chance of bleeding or contraindicated. Anticoagulant treatment, primarily with LMWH, correlates strongly with an improved prognosis in serious COVID-19 patients who follow sepsis-induced coagulopathy requirements or have significantly elevated D-dimer levels.

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