A clinical case of endovascular treatment of a patient with chronic arterial insufficiency of the brain with critical ischemia of lower extremities

Introduction Chronic arterial insufficiency (CAI) of lower extremities is important socio-economical and healthcare problem, due to its high incidence of morbidity, disability and mortality. Objective The aim of our work was to determine the diagnostic importance of pulse oximetry in the early detection of stage of lower extremities CAI based on peripheral arterial oxygen saturation of haemoglobin (SpO2). Methods Prospectively, we analyzed a group of 50 patients, admitted at the Vascular Department of Surgical Clinic in Nis during the period from September 2006 to October 2007, with evident symptoms and signs of different stages of lower extremities CAI verified by ultrasonography. In patients with lower extremity disorder of tissue arterial capillaries, SpO2 was determined by pulse oximetry. Results Using pulse oximetry, depending on the of stage of lower extremities CAI, we revealed a considerable difference in the stages of functional ischemia SpO2: Fontaine I - 95.33?1.41%, Fontaine IIa - 92.14?2.27% and Fontaine IIb - 79.67?2.73%; in stage critical ischemia SpO2: Fontaine III - 62.54?4.39% and Fontaine IV - 47.67?6.16%. In 3 patients with gangrenous foot and fingers SpO2 was immeasurable and progressive decrease in SpO2 of arterial capillaries (p<0.01 between stages). Conclusion Due to the reliability and simplicity of pulse oximetry it can be a routinely used diagnostic device for patients with early determined stage of lower extremities CAI. .

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Clinical Case: Complications after Endovascular Treatment of Intracranial Aneurysm in a Patient after Subarachnoid Hemorrhage

International Journal of Anesthesiology Research ◽

10.31907/2310-9394.2020.08.02 ◽

2020 ◽

Vol 8 (1) ◽

pp. 9-15

Author(s):

Petrov Nikolay ◽

◽

Marinova R. ◽

Odiseeva Ev.

Keyword(s):

Intracranial Aneurysm ◽

Endovascular Treatment ◽

Clinical Case ◽

Endovascular Coiling ◽

Published Data ◽

Military Medical Academy ◽

Life Threatening ◽

Arachnoid Hemorrhage ◽

The Right ◽

Brain Artery

Abstract: Intracranial aneurysm is one of the most common neurovascular complications. During the recent years the accepted treatment of enraptured cranial aneurysm is noninvasive endovascular coiling. This technique is modern but it is not without complications which can be serious and life-threatening. A clinical case of a patient admitted to the ICU of Military Medical Academy - Sofia with sub arachnoid hemorrhage is described. After a positive clinical course, the check-up magnetic resonance showed intracranial aneurism of the right carotid artery. The patient underwent angiographic endovascular treatment. Vasospasm of the middle and right brain artery and thrombosis were detected during the procedure. Attempt of thromboaspiration was made without success. This article reviews published data on broad-spectrum researches concerning complications of endovascular coiling of intracranial aneurysms and the ways to prevent and reduce them.

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Long-term results of revascularization of the lower extremities in patients with critical ischemia and diabetes mellitus with lesions of the femoral-poplitealtibial arterial segment

Clinical and Experimental Surgery. Petrovsky journal ◽

10.33029/2308-1198-2021-9-3-104-111 ◽

2021 ◽

Vol 9 (3) ◽

pp. 104-111

Author(s):

D.V. Frolov ◽

◽

P.V. Mozgovoy ◽

D.V. Linchenko ◽

M.V. Frolov ◽

...

Keyword(s):

Diabetes Mellitus ◽

Lower Extremities ◽

Long Term Results ◽

Arterial Segment ◽

Critical Ischemia

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A Study of Transcutaneous Oxygen Saturation by Pulse Oximetry in Symptomatic Ischaemic Lower Limb – A Cross Sectional Analytical Study in a Tertiary Care Hospital in Tirupathi

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/550 ◽

2021 ◽

Vol 8 (32) ◽

pp. 3018-3022

Author(s):

Sadhu Nagamuneiah ◽

Gandikota Venkata Prakash ◽

Sabitha P ◽

Jandla Bhulaxmi ◽

Dintyala Venkata S.S.Dintyala Venkata S.S. Mythri ◽

...

Keyword(s):

Lower Extremity ◽

Pulse Oximetry ◽

Analytical Study ◽

Lower Extremities ◽

Care Hospital ◽

Colour Doppler ◽

Duplex Scan ◽

Cross Sectional ◽

Transcutaneous Oxygen ◽

Arterial Insufficiency

BACKGROUND Chronic arterial insufficiency (CAI) results in stenotic-occlusive disease of vascularized arterial disorders of tissues and organs. CAI of the lower extremities represents a significant medical and socio-economic problem due to a high incidence of morbidity, invalidity and mortality. METHODS A cross sectional analytical study was conducted in a group of 100 patients, admitted at the Vascular Department of the Sri Venkateshwara Ramnaraian Ruia Government General Hospital, Tirupati during the period from September 2018 to August 2019, with evident symptoms and signs of different stages of lower extremities CAI verified by ultrasonography. In patients with lower extremity disorder of tissue arterial capillaries, SpO2 was determined by pulse oximetry. CAI of the lower extremity was determined on the basis of clinical findings and colour Doppler duplex scan echo sonography results. Using the conventional method (single-gate) and colour Doppler duplex scan (multi-gate), the presence and localization of stenosis, the segmental predominance (with multisegmental forms) and the degree of progression of stenotic-occlusive lesions were verified. RESULTS Results Using pulse oximetry, depending on the of stage of lower extremities CAI, we revealed a considerable difference in the stages of functional ischemia Mean SpO2: Fontaine I – 95.50 %, Fontaine II – 92.90; in stage critical ischemia SpO2: Fontaine III – 65.00 % and Fontaine IV – 49.87 %. In 29 patients with gangrenous foot and fingers SpO2 was immeasurable and progressive decrease in SpO2 of arterial capillaries (p<0.01 between stages). CONCLUSIONS Due to the reliability and simplicity of pulse oximetry it can be a routinely used diagnostic device for patients with early determined stage of lower extremities CAI. KEYWORDS Chronic Arterial Insufficiency, SPO2, Pulse Oximetry, Ischemia

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Endovascular Advances for Brain Arteriovenous Malformations

Neurosurgery ◽

10.1227/neu.0000000000000176 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S74-S82 ◽

Cited By ~ 57

Author(s):

R. Webster Crowley ◽

Andrew F. Ducruet ◽

Cameron G. McDougall ◽

Felipe C. Albuquerque

Keyword(s):

Endovascular Treatment ◽

Surgical Resection ◽

Arteriovenous Malformations ◽

Treatment Options ◽

Brain Arteriovenous Malformations ◽

Short Period ◽

Cerebral Avms ◽

Brain Avms ◽

The Brain ◽

The Way

Abstract Arteriovenous malformations (AVMs) of the brain represent unique challenges for treating physicians. Although these lesions have traditionally been treated with surgical resection alone, advancements in endovascular and radiosurgical therapies have greatly expanded the treatment options for patients harboring brain AVMs. Perhaps no subspecialty within neurosurgery has seen as many advancements over a relatively short period of time as the endovascular field. A number of these endovascular innovations have been designed primarily for cerebral AVMs, and even those advancements that are not particular to AVMs have resulted in substantial changes to the way cerebral AVMs are treated. These advancements have enabled the embolization of cerebral AVMs to be performed either as a stand-alone treatment, or in conjunction with surgery or radiosurgery. Perhaps nothing has impacted the treatment of brain AVMs as substantially as the development of liquid embolics, most notably Onyx and n-butyl cyanoacrylate. However, of near-equal impact has been the innovations seen in the catheters that help deliver the liquid embolics to the AVMs. These developments include flow-directed catheters, balloon-tipped catheters, detachable-tipped catheters, and distal access catheters. This article aims to review some of the more substantial advancements in the endovascular treatment of brain AVMs and to discuss the literature surrounding the expanding indications for endovascular treatment of these lesions.

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NEXT AND LONG-TERM RESULTS OF X-RAY ENDOVASCULAR INTERVENTIONS IN TREATMENT OF CHRONIC CRITICAL ATHERODIABETIC ISCHEMIA OF LOWER EXTREMITIES

Journal of the Grodno State Medical University ◽

10.25298/2221-8785-2020-18-6-710-715 ◽

2020 ◽

Vol 18 (6) ◽

pp. 710-715

Author(s):

N. N. Ioskevich ◽

◽

L. F. Vasilchuk ◽

P. E. Vankovich ◽

S. P. Antonenko ◽

...

Keyword(s):

Lower Limb ◽

Type I Diabetes ◽

Lower Extremities ◽

Limb Ischemia ◽

Type I ◽

Critical Ischemia ◽

Lower Limb Ischemia ◽

X Ray ◽

Endovascular Interventions

Background. The treatment of chronic critical ischemia of the lower extremities with their combined atherodiabetic lesion is one of the far from the resolved problems of modern surgery. Aim of the study. Analysis of the results of X-ray endovascular interventions in patients with critical lower limb ischemia due to atherodiabetic lesions of the femoral-popliteal-tibial segment. Material and methods. We analyzed the results of REVS in 60 patients with diabetes mellitus with critical ischemia of the lower extremities due to infra-anginal atherosclerotic occlusions with a follow-up period of up to 5 years from the moment of the manipulation. Results. The total shelf life of the lower limb after REVV was 492.4 ± 10.1 days. Out of 26 amputations performed, balloon angioplasty was performed in 18 cases and stenting in 8 cases. In individuals with type I diabetes, the duration of painless period was 415.4 ± 5.1 days, and the total shelf life of the leg was 465.4 ± 4.3 days. In type II diabetes, these indicators were, respectively, 181.4 ± 4.4 days and 317.8 ± 6.7 days. In the group of patients with type I diabetes, the lower limb was saved in 55.6% of cases (in 20 out of 36 patients), and in type II diabetes - in 58.3% (in 14 out of 24 people). Conclusions. The presence of simultaneously obliterating atherosclerosis and diabetes mellitus in patients leads to a combined atherodiabetic lesion of the arterial bed, including infra-anginal arteries. X-ray endovascular interventions (balloon angioplasty and stenting) on the arterial femoral-popliteal-tibial segment are a rather effective method of eliminating chronic critical lower limb ischemia, which allows preserving the lower limb in 56.7% patients with a follow-up period of up to 5 years from the date of surgery. Improving the results of X-ray endovascular interventions in case of chronic critical atherodiabetic lower limb ischemia requires a comprehensive study of the possible causes of occlusions of reconstructed arterial segments (blood coagulation potential, non-optimal processes in the intervention zone).

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Combination of ulcerative colitis with cirrhosis of the liver in the outcome of primary sclerosing cholangitis

Experimental and Clinical Gastroenterology ◽

10.31146/1682-8658-ecg-177-5-104-107 ◽

2020 ◽

Vol 174 (5) ◽

pp. 104-107

Author(s):

A. V. Nikitin ◽

A. I. Khavkin ◽

T. A. Skvortsova ◽

G. V. Volynets ◽

A. O. Atameeva

Keyword(s):

Ulcerative Colitis ◽

Weight Loss ◽

Primary Sclerosing Cholangitis ◽

Liver Damage ◽

Sclerosing Cholangitis ◽

Clinical Case ◽

Clinical Observation ◽

Lower Extremities ◽

Cirrhosis Of The Liver ◽

Extraintestinal Manifestation

A clinical case of a combination of ulcerative colitis with cirrhosis in the outcome of primary sclerosing cholangitis in a twelve-year-old child is presented. The uniqueness of the clinical observation lies in the atypical onset of ulcerative colitis in the form of complaints of weakness and headache, as well as detected anemia of 3 severity. It is important that the child lacked diarrhea, blood in the stool, tenesmus, weight loss, and fever. Of the most characteristic signs of liver damage, only itching of the skin of the lower extremities was noted. As a result, the child was diagnosed with cirrhosis of the liver at the end of the extraintestinal manifestation of ulcerative colitis — primary sclerosing cholangitis.

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The analysis of database of registered diseases of peripheral arteries in Yekaterinburg

Health Care of the Russian Federation ◽

10.18821/0044-197x-2016-60-6-288-292 ◽

2019 ◽

Vol 60 (6) ◽

pp. 288-292 ◽

Cited By ~ 2

Author(s):

Elena P. Burleva ◽

Yu. V. Babushkina ◽

D. A. Lobanova ◽

T. A. Barkan

Keyword(s):

Medical Records ◽

Statistical Processing ◽

Lower Extremities ◽

Management Decision ◽

Peripheral Arteries ◽

Critical Ischemia ◽

Number Of Patients ◽

Target Values ◽

Management Decision Making ◽

Quality Of Medical Care

The study was carried out to analyze database of registered diseases of peripheral arteries in patients of Yekaterinburg during 2009-2013. The database of the territorial foundation of mandatory medical insurance of the Sverdlovsk region in 2009-2013 was used as study material. The number of registered cases of treatment of diseases of peripheral arteries was analyzed. The sampling of patients with diseases of peripheral arteries taking treatment in twenty-four-hours and day-time hospitals. The statistical processing was applied to all cases ranged by years: patients with compensated blood circulation, critical ischemia of extremities and mortification. The audit was applied to randomly selected 40 medical records of patients with diseases of peripheral arteries, receiving treatment in twenty-four-hours and day-time hospitals during 2014 and 50 medical records ofpatients with diseases ofperipheral arteries against the background of diabetes mellitus from register of the oblast podiatry consulting room. The total number of treated patients with diseases ofperipheral arteries in Yekaterinburg during five years made up to 31,309, including 19% ofpatients with diabetic affection of lower extremities. In twenty-four-hours hospital 12,716 (40.6%) patients were treated and 18,593 (59.4%) were treated in day-time hospital. The study established increasing in day-time hospitals number of patients with arteriosclerosis obliterans up to 1.8 times, with diabetic angiopathy up to 3.6 times. At increasing of number of treated patients number ofpatients with critical ischemia of lower extremities during 5 years decreased insignificantly and number of large amputations have a certain trend to decreasing (up to 2.5%). The study established deviations under application of medicinal therapy in patients with diseases of peripheral arteries at pre-specialized stage and absence of achievement of target values of main laboratory parameters. The database of registered diseases of peripheral arteries can be used as a tool for data analysis and further management decision making with purpose of enhancing quality of medical care of patients residing in municipality.

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Possibilities of combined surgical treatment of pyonecrotic lesions in the neuroischemic form of diabetic foot syndrome

Diabetes Mellitus ◽

10.14341/2072-0351-5412 ◽

2009 ◽

Vol 12 (1) ◽

pp. 8-13

Author(s):

Valeriy Afanas'evich Mitish ◽

I A Eroshkin ◽

Gagik Radikovich Galstyan ◽

Lyudmila Petrovna Doronina ◽

Yu S Paskhalova ◽

...

Keyword(s):

Surgical Treatment ◽

Diabetic Foot ◽

Lower Extremities ◽

Lower Leg ◽

Diabetic Foot Syndrome ◽

Diagnostic Tools ◽

Critical Ischemia ◽

Adequate Treatment ◽

Patients With Diabetes ◽

Foot Lesions

Aim. To present results of combined surgical treatment of the ischemic form of diabetic foot syndrome complicated by pyonecrotic process. To show thatthe use of modern diagnostic tools and the choice of adequate treatment strategy permits to substantially reduce the number of above-the-knee amputations. Materials and methods. A total of 140 patients with diabetes mellitus and critical ischemia of lower extremities were under observation during 2004-2008.All of them had purulent and/or necrotic foot lesions. The patients were examined by X-ray, computed and magneto-resonance tomography of the feet,duplex scanning of lower leg vasculature, transcutaneous measurement of PO2, pelvic and lower leg arterial angiography. Results. A strategy of surgical treatment was developed to be used depending on the patients health status, clinical features and severity of pyonecroticprocesses in the foot, and the degree of involvement of the main blood vessels of lower extremities. Conclusion. Combination of endovascular surgery with various methods for plastic wound closure permits to extend the range of possibilities for the treatmentof high-risk patients, such as those with pyonecrotic lesions and neuroischemic form of diabetic foot syndrome. This approach opens up prospects fora significant decrease of percentage of above-the-knee amputations and improves the quality of life in these patients.

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