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CLINICAL EXPERIENCE WITH A NEW HYBRID CORONARY WIRE
On Demand Web ArchiveNon-Accredited
Target Audience: Physicians, nurses, and technologists.
This activity is supported by an educational grant from Terumo Medical Corporation.
Case Study
Simvastatin-Induced Vasculitis with Secondary Mesenteric Ischemia and Intestinal Infarction
Abstract
We report an unusual presentation of vasculitis associated with simvastatin. A 69-year-old female patient presented with a 1-day history of acute abdominal pain. However, she had recently been placed on a statin and had started to complain of abdominal pain 2 weeks after starting the medication. Initial investigation of her abdominal pain was negative. An exploratory laparotomy revealed necrotic bowel, which was resected. A pathology report noted acute and chronic vasculitis. A computed tomographic angiogram prior to her exploratory laparotomy showed no arterial
Delayed Carotid Artery-Internal Jugular Vein Fistula after Central Vein Cannulation for Coronary Bypass Surgery
Imad F. Tabry, MD
Case Presentation
A 91-year-old female was admitted in June 2009 with left-sided hemiplegia and congestive heart failure. She had undergone aortic valve replacement with coronary bypass surgery in 2003, an inferior vena cava filter insertion in 2006 and re-do coronary bypass off-pump in 2008. In addition to her neurologic findings, she also had a loud bruit at the base of the right neck associated with a palpable thrill. Review of her most recent surgery records confirmed the use of a right internal jugular central venous catheter f
Unusual Life-Threatening Complications of a Ruptured Infrarenal Aortic Aneurysm in a Young Adult
Case Report
A 34-year-old man presented with a ruptured infrarenal abdominal aortic aneurysm (AAA) (Figure 1). He reported no previous symptoms or illness. His father died at the age of 46 years from a drug overdose. His mother died of AIDS at the age of 44 years. The patient underwent emergency repair of the AAA with a Dacron tube graft and had a smooth postoperative recovery. However, he was readmitted 18 months later with severe abdominal pains. A computed tomography (CT) scan and magnetic resonance angiogram of the aorta indicated a false aneurysm of the distal aortic suture line
Endovascular Repair of Abdominal Aortic Aneurysm Revealed by Reversible Segmental Colonic Ischemia
Introduction
The natural history of undetected abdominal aortic aneurysms (AAA) includes ischemic complications that may affect peripheral limb or organ circulation. Distal embolization or thrombosis is the usual pathological process related to either migration of cholesterolic particles, or extension of wall thrombosis from the aneurysm sac. In that circumstance, ischemic colitis remains an uncommon primary mode of revelation for aneurysm occurring when patency of the inferior mesenteric artery (IMA) is suddenly affected.1 We report a successful endovascular treatme
Autotransplant and Renal Artery Aneurysm Repair in a Patient with a Congenital Solitary Kidney
Case Report. A 44-year-old, normotensive woman with a 28-pack year history of smoking and a congenital solitary kidney was referred for a right renal artery aneurysm (RAA) seen on magnetic resonance imaging (MRI). The MRI was done as part of a work up for back pain 2 years previously. The patient subsequently had a computed tomography (CT) angiogram where a 2-cm aneurysm was seen in the right renal artery at the hilum of the kidney, with 5 of 7 branches of the renal artery arising from the aneurysm, excluding endovascular repair. The patient initially opted for watchful observation.
Successful Prophylactic Use of an Inferior Vena Cava Filter Prevented a Fatal Pulmonary Embolism
Background
Nearly 200,000 cases of deep venous thrombosis (DVT) occur each year.1 Dislodgement of a DVT with embolization to the pulmonary circulation results in a pulmonary embolism. One registry of 2454 patients diagnosed with a pulmonary embolism showed a three-month mortality rate of 17.5%.2 Perioperative prophylactic low-molecular weight heparin, fondaparinux, vitamin K antagonists, or sequential pneumatic compression stockings have been recommended to reduce risk of DVTs. For two decades, permanent inferior vena cava filters (IVCF) have served as an alternat
Rapidly Enlarging Rectus Sheath Hematomas: The Value of CT Angiography in the Identification of Active Bleeding
Introduction
Most patients described in the literature with spontaneous rectus sheath hematomas are on a form of medical anticoagulant therapy or have a bleeding diathesis.1–3 The indication for angiography includes persistent bleeding and hemodynamic instability, despite reversal of anticoagulation.10 The majority of these indicated cases were treated by transarterial embolization (TAE).1,2,4,5
Case 1
A 67-year-old male presented to the emergency department with a swollen left lower limb and confirmed deep venous thrombosis (DVT) follow
Subintimal Snare-assisted Dissection for Iliac Recanalization: A Potentially Useful Tool
Introduction
Iliac stenting for occlusive atherosclerotic disease is an accepted therapeutic modality. Completely occluded iliac arteries can be wire recanalized with a high degree of success1 and acceptable long-term results. The technical aspects of crossing an iliac chronic total occlusion (CTO) can however remain challenging. We describe a novel technical modality to facilitate wire recanalization in difficult cases.
Case Report
A 60-year-old Hispanic male presented with right-sided buttock and thigh claudication after walking one block. Risk factors for pe
Use of Bivalirudin for Suspected Heparin-Induced Thrombocytopenia during Lower Extremity Revascularization
Introduction
Advantages of various direct thrombin inhibitors, a modified dosing schedule for bivalrudin, and experience with monitoring parameters are described. These advantages may form the basis for consideration when alternative anticoagulation to heparin is desired during peripheral vascular procedures.
Case Report
An 82-year-old, 65 kg, white male underwent evaluation for progressive fatigue and shortness of breath. He had undergone a Hancock porcine mitral valve replacement in conjunction with a one-vessel coronary artery bypass 12 years previously. He also had a
Description of a New Angiographic Sign: Dynamic Left Subclavian Artery Obstruction
Introduction
With the increase in the use of endovascular treatment of peripheral arterial disease, the heretofore underappreciated dynamics of arterial movement are now known to be important in long-term outcomes. Several forces are known to exert torsion and strain on the superficial femoral artery (SFA), particularly the distal portion. Diaz et al demonstrated that the area of greatest flexion is at the upper edge of the patella (aligned with the medial supracondylar tubercle of the femur).1 Considerable amount of force is applied to stents implanted in this region. Inde
Vascular Disease Blogs
Frank J. Criado, MD, FACS, FSVM
Robert S. Dieter, MD, RVT and Aravinda Nanjundappa, MD, RVT
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Digital Supplements
Terumo Clinical Case Update This clinical case update was supported through an unrestricted educational grant from Terumo Medical Corporation.
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CME Showcase
"Diabetic Peripheral Neuropathy"
Upcoming Accredited Webcast Release Date: December 22, 2008 Expiration Date: December 22, 2009 This activity is supported by an educational grant from PamLabs. To register for this Webcast, visit www.naccme.com/program/n-558/ |
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