scholarly journals Acute limb ischemia following perineal reconstruction in lithotomy position: take-home message for plastic surgeons

2021 ◽  
Vol 48 (5) ◽  
pp. 543-546
Author(s):  
Gianluca Sapino ◽  
Sebastien Deglise ◽  
Wassim Raffoul ◽  
Pietro G. di Summa
Keyword(s):  
Limb Ischemia ◽  
Anterolateral Thigh Flap ◽  
Lithotomy Position ◽  
Acute Limb Ischemia ◽  
Anterolateral Thigh ◽  
Internal Iliac ◽  
Life Threatening ◽  
Polytrauma Patient ◽  
Internal Iliac Artery Embolization ◽  
Tomography Scan

Despite the extensive use of lithotomy position in several plastic surgery procedures, most reports regarding the related incidence of complications are presented in the urologic, gynecologic, and anesthesiologic fields. We present the case of a 54-year-old male patient. polytrauma patient who underwent internal iliac artery embolization leading to extensive gluteal necrosis requiring: debridement, abdominoperineal resection and composite anterolateral thigh flap reconstruction with prolonged lithotomy position. The patient presented lower limb ischemia briefly after surgical theater. A computed tomography scan revealed the obstruction of the left superficial femoral artery requiring emergency revascularization. Arterial thrombosis is a potentially devastating complication and plastic surgeons should be aware of the possible dangers when performing surgeries in prolonged lithotomy position. Preoperative detection of patients at high risks for developing complications should be performed in order to implement preventive measures and avoid potentially life-threatening sequelae.

scholarly journals Use of anterolateral thigh flap for reconstruction of traumatic bilateral hemipelvectomy after major pelvic trauma: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Saleh Al-wageeh ◽  
Faisal Ahmed ◽  
Khalil Al-naggar ◽  
Mohammad Reza Askarpour ◽  
Ebrahim Al-shami
Keyword(s):  
Case Report ◽  
Cause Of Death ◽  
Axial Skeleton ◽  
High Energy ◽  
Pelvic Trauma ◽  
Anterolateral Thigh Flap ◽  
Trauma Patients ◽  
Anterolateral Thigh ◽  
Life Threatening

Abstract Background Major pelvic trauma (MPT) with traumatic hemipelvectomy (THP) is rare, but it is a catastrophic health problem caused by high-energy injury leading to separation of the lower extremity from the axial skeleton, which is associated with a high incidence of intra-abdominal and multi-systemic injuries. THP is generally performed as a lifesaving protocol to return the patient to an active life. Case report A 12-year male patient exposed to major pelvic trauma with bilateral THP survived the trauma and multiple lifesaving operations. The anterolateral thigh flap is the method used for wound reconstruction. The follow-up was ended with colostomy and cystostomy with wheelchair mobilization. To the best of our knowledge, there have been a few bilateral THP reports, and our case is the second one to be successfully treated with an anterolateral thigh flap. Conclusion MPT with THP is the primary cause of death among trauma patients. Life-threatening hemorrhage is the usual cause of death, which is a strong indication for THP to save life.

scholarly journals Immediate Lower Extremity Reconstruction Using an Anterolateral Thigh Free Flap With Simultaneous Interposition Graft of Descending Branches of Lateral Circumflex Femoral Vessels

2018 ◽  
Vol 18 (1) ◽  
pp. 89-93
Author(s):  
Joonho Lim ◽  
Heeyeon Kwon ◽  
Kyoung Min Lee ◽  
Changsik Pak
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Limb Ischemia ◽  
Soft Tissue Defect ◽  
Acute Limb Ischemia ◽  
Interposition Graft ◽  
Tissue Defect ◽  
Anterolateral Thigh ◽  
Femoral Vessels ◽  
Lateral Circumflex Femoral

In a severely injured leg with acute limb ischemia, both immediate revascularization of an endangered part and coverage of soft tissue defect are crucial to limb salvage. In this article, we report a case of an anterolateral thigh free flap with interposition graft of descending branches of the lateral circumflex femoral vessels. A 18-cm-long graft was harvested and used to replace the injured anterior tibial vessels. One month later, a duplex sonogram revealed intact circulation to both the interposition graft and the flap. Despite anatomic inconstancy, the anterolateral thigh free flap is commonly utilized in reconstructive surgeries. When descending branches of the lateral femoral circumflex vessels were included sufficiently, its pedicle can be used to bridge a vascular defect in the extremity while covering soft tissue defect.

scholarly journals Carbon dioxide as a substitute for iodine contrast in arteriography during embolectomy

2015 ◽  
Vol 13 (2) ◽  
pp. 273-275 ◽  
Author(s):  
Nelson Wolosker ◽  
Marcelo Passos Teivelis ◽  
Cynthia de Almeida Mendes ◽  
Kenji Nishinari ◽  
Mariângela de Freitas Ribeiro ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Renal Failure ◽  
Renal Insufficiency ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Ischemic Limb ◽  
Life Threatening

Acute limb ischemia can be potentially harmful to the limb and life threatening. Renal failure is a possible outcome associated with release of products of ischemic limb reperfusion. Some authors reported the benefit of performing angiography after embolectomy, even though iodine contrast is also nephrotoxic. We report a case of embolectomy on a patient with renal insufficiency in whom carbon dioxide was used as a substitute for iodine contrast.

scholarly journals Acute Limb Ischemia Therapies: When and How to Treat Endovascularly

2018 ◽  
Vol 35 (05) ◽  
pp. 453-460 ◽  
Author(s):  
Anthony Hage ◽  
Joseph McDevitt ◽  
Jeffrey Chick ◽  
Venu Vadlamudi
Keyword(s):  
Management Strategy ◽  
Limb Ischemia ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Acute Limb Ischemia ◽  
Success Rates ◽  
Imaging Evaluation ◽  
Perioperative Morbidity ◽  
Threatening Condition ◽  
Life Threatening

AbstractAcute limb ischemia is an emergent limb and life-threatening condition with high morbidity and mortality. An understanding of the presentation, clinical evaluation, and initial workup, including noninvasive imaging evaluation, is critical to determine an appropriate management strategy. Modern series have shown endovascular revascularization for acute limb ischemia to be safe and effective with success rates approaching surgical series and with similar, or even decreased, perioperative morbidity and mortality. A thorough understanding of endovascular techniques, associated pharmacology, and perioperative care is paramount to the endovascular management of patients presenting with acute limb ischemia. This article discusses the diagnosis and strategies for endovascular treatment of acute limb ischemia.

scholarly journals Acute Limb Ischemia in Critically ill COVID-19 Patients: a Case Series and Literature Review

2021 ◽  
pp. 917-922
Author(s):  
Soumaya Touzani ◽  
Fatimazahra Haddari ◽  
Abderrahim Elbouazzaoui ◽  
Nawfal Houari ◽  
Brahim Boukatta ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Clinical Presentation ◽  
Case Series ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Vein Thrombosis ◽  
Life Threatening ◽  
The Mean ◽  
Deep Vein ◽  
Vascular Burden

Background: The vascular burden increased by COVID-19 infection and including acute limb ischemia (ALI) quickly emerged as a major medical challenge with devastating consequences such as limb loss, multiorgan dysfunction and death. We report a case series of COVID-19 infection associated with ALI to raise awareness and knowledge towards this life-threatening association. Methods: COVIDS-19 patients with acute limb ischemia (ALI) managed in a Moroccan 14 beds COVID-19 ICU between March 2020 and January 2021, were reviewed. Data collected included demographics, clinical presentation, treatments and outcomes. Results: Over the 10-month period, our ICU cared for 407 hospitalized patients with confirmed COVID-19. A total of 6 COVID-19 patients with ALI were identified. The mean age was 61 years (52 - 70) and 5 were men. The most common preexisting condition was diabetes (50%). The mean CRP level was 219 mg/L. Five patients had thrombus in multiple locations. No concomitant deep vein thrombosis was identified. Four patients presented with signs of acute No arterial ischemia with or without respiratory symptoms and were subsequently diagnosed with COVID-19. The remaining two patients developed ischemia during hospitalization. Mean SOFA score was 5 (2 -9). Respiratory support, corticosteroids and heparin therapies were used in all patients. Intubation and vasopressors were required in four patients. Revascularization was performed in five patients and reintervention was necessary in three cases. Four patients died in the ICU while two were successfully discharged. Conclusion: ALI in COVID-19 patients is a challenging life-threatening vascular emergency that requires appropriate multidisciplinary management (intensivists, anesthesiologists, vascular surgeons and interventionists, radiologists, haematologists…) and further studies focused on anticoagulation. Keywords: Acute Limb ischemia, Coagulopathy, COVID-19, SARS-CoV-2, Thrombosis

scholarly journals Two effective cases of additional pedal artery angioplasty for severe lower limb ischemia following acute thrombotic artery occlusion with hypercoagulable state diseases

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Keisuke Shoji ◽  
Kan Zen ◽  
Kenji Yanishi ◽  
Noriyuki Wakana ◽  
Naohiko Nakanishi ◽  
...  
Keyword(s):  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Artery Occlusion ◽  
Hypercoagulable State ◽  
Acute Limb Ischemia ◽  
Residual Limb ◽  
Case Presentation ◽  
Run Off ◽  
Life Threatening ◽  
Surgical Thrombectomy

Abstract Background Acute limb ischemia (ALI) and critical limb ischemia (CLI) following ALI are life-threatening diseases. The rare potential causes of ALI include hypercoagulable state diseases, such as antiphospholipid syndrome (APS) and essential thrombocythemia (ET). Hypercoagulability often make revascularization for arterial occlusion, especially associated with infrapopliteal lesions, difficult. This is because the vessels have poor run-off, and elevated peripheral vascular resistance associated with microcirculation failure, due to a high thrombus burden. There is no established treatment for this issue. Case presentation A 45 years-old and a 56 years-old male suffered from thrombotic arterial occlusion as a first manifestation of APS and ET, respectively. Combination therapy with aggressive anti-thrombotic therapy and revascularization, such as endovascular therapy and surgical thrombectomy based on the angiosome concept, was performed. However, the high thrombus burden caused a poor pedal outflow, and significant limb ischemia remained. Additional pedal artery angioplasty was performed to improve residual limb ischemia in each case and provided sufficient blood flow to the foot. Conclusion The pedal artery angioplasty for thrombotic pedal artery occlusion cases, associated with hypercoagulable state diseases, seems to be a treatment option for relieving residual limb ischemia.

scholarly journals Aortic dissection: A life-threatening stroke mimicker

2017 ◽  
Vol 25 (2) ◽  
pp. 98-101 ◽  
Author(s):  
Nurul Huda Ahmad ◽  
Toh Leong Tan
Keyword(s):  
Aortic Dissection ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Type A Aortic Dissection ◽  
Atypical Symptoms ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
Malperfusion Syndrome ◽  
Medical Advances

Aortic dissection is a life-threatening cardiovascular emergency, and despite medical advances, its diagnosis is often shrouded by the diversity of its clinical presentation. Physician must have high index of suspicion, especially in those with unusual combination of features that may occur in acute painless dissection. We report a case of a man presented with right-sided weakness and syncope associated with pulse deficits at multiple levels. Physical examination of the lower limb is consistent with acute limb ischemia. Computed tomogram thorax done after emergency embolectomy revealed extensive Stanford type A aortic dissection down to the level of abdominal aortic bifurcation. The diagnosis of aortic dissection is delayed due to his atypical symptoms, which is likely resulted from malperfusion syndrome of aortic dissection.

scholarly journals Hypogastric Chimney Patency in Aortic Monoiliacal Endograft Thrombosis: A Life Saved by Collateral Pelvic Circulation

2017 ◽  
Vol 27 (01) ◽  
pp. 046-049 ◽  
Author(s):  
Africa Santos ◽  
Julia Guaita ◽  
Claudio Gandarias ◽  
Andrés Reyes Valdivia
Keyword(s):  
High Risk Patient ◽  
Infrarenal Aorta ◽  
Aortobifemoral Bypass ◽  
Axillofemoral Bypass ◽  
Second Stage ◽  
Internal Iliac ◽  
Life Threatening ◽  
Endovascular Approach ◽  
Good Patency ◽  
Tomography Scan

Background To report a case of a high-risk patient treated with hypogastric chimney and aortic endograft for a native infrarenal aorta aneurysmal degeneration, 20 years after an aortobifemoral bypass procedure for severe iliac occlusive disease. Methods A two-stage procedure was planned. The first stage was right internal iliac artery (IIA) embolization and simple angioplasty of left IIA. The second stage consisted of aortouniiliac endograft with femoral crossover and left IIA chimney. Results Femoral crossover complicated with early thrombosis, but a decision on conservative medical treatment with anticoagulation was made based on no rest pain or severe claudication. After 3 months the patient presented with moderate claudication alone. Scheduled computed tomography scan showed femoral crossover graft and aortic endograft thrombosis with left IIA patency. The axillofemoral bypass was scheduled a week later, and the patient discharged home. Conclusion Preservation of pelvic circulation is mandatory to avoid life-threatening complications. The chimney technique demonstrates good patency and should be considered in the endovascular approach armamentarium for hypogastric artery revascularization.

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.

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