For various reasons some patients are unable to undergo intra-arterial thrombolysis for acute limb ischaemia. This interventional case series study prospectively evaluated the effect of thrombolytic treatment with 100 mg recombinant tissue plasminogen activator (rt-PA), administered intravenously, in patients with acute thrombosis of the lower limb arteries and onset of symptoms within 12 h prior to treatment. During a 3-year period (2007-2009), 18 of 86 patients satisfied the inclusion criteria and were included in the study (age range 65 - 80 years; 11 women). Complete and partial thrombolysis was observed in eight (44.4 %) and six (33.3 %) patients, respectively. All patients experienced clinical improvement. There were no amputations during the 36-month follow-up period and no haemorrhagic complications in the first 30 days post-treatment. Five patients died (27.8 %) during follow-up from unrelated causes. This small study demonstrated that thrombolytic treatment with intravenous rt-PA in selected patients with acute limb ischaemia is feasible.
COBISS.SI-ID: 3998271
Serious complications of endoscopic injection therapy may be avoided by using of adhesive agents to treat bleeding gastric ulcers. However, as the present case and a few similar cases show, inadvertent injection of any sclerosant can result in thrombosis of the splenic artery. Endoscopists should be aware of the close anatomic relationship between the stomach wall and the splenic artery. Inadvertent injection of Histoacryl into the splenic artery, in comparison with other agents, tends to obliterate several vessels of the celiac axis. As suggested previously, Histoacryl injection should be considered as a last resort in the endoscopic treatment in patients with bleeding ulcers.
COBISS.SI-ID: 4475199
Background. Superficial inferior epigastric artery (SIEA) flap has a great advantage over other flaps of the area, that is, readily non-existent donor-site problems. The main reason why the SIEA flap has never been extensively used in breast reconstruction is the small diameter and variable anatomy of its donor artery. This study presents a possibility of enlarging the SIEA diameter using the delay-phenomenon mechanism. Methods. A prospective clinical study of 26 patients was undertaken. Prior to surgery, ultrasound examinations were performed, measuring the diameter of SIEA and the velocity of blood flow in SIEA. The ipsilateral deep inferior epigastric artery (DIEA) was then ligated in all patients who had a measurable SIEA preoperatively. Two weeks later, measurements were repeated. The blood flow through SIEA was calculated and statistical analysis was applied. Results. Twenty-one patients had an identifiable SIEA on preoperative measurements. On postoperative measurements, we confirmed ligation of DIEA in 19 patients, of these 17 patients had an augmentation in diameter (mean: 29%) and 18 in blood flow (mean: 127%). Conclusions. This study shows that ligating a single of the three main arteries (DIEA, SIEA and superficial circumflex iliac artery) irrigating skin/soft tissue of the lower abdomen, although the dominant one, results in widening of diameter and enlarging of blood flow of another artery (SIEA) supplying the same angiosome. The results of the present study might be used in future to increase the diameter and flow in SIEA when the vessel diameter found on preoperative imaging was too small for clinical microsurgical transfer. The drawback of the proposed delay procedure is the sacrifice of ipsilateral DIEA and an added operative procedure. Statement. The clinical trial is registered with Clinical Trials (http://www.clinicaltrials.gov/). The clinical trial registration number is NCT01247129.
COBISS.SI-ID: 4000831
Background. If carotid artery narrowing remains asymptomatic (ie, has caused no recent stroke or other neurological symptoms), successful carotid endarterectomy (CEA) reduces stroke incidence for some years. We assessed the long-term effects of successful CEA. Methods. Between 1993 and 2003, 3120 asymptomatic patients from 126 centres in 30 countries were allocated equally, by blinded minimised randomisation, to immediate CEA (median delay 1 month, IQR 0.3-2.5) or to indefinite deferral of any carotid procedure, and were followed up until death or for a median among survivors of 9 years (IQR 6-11). The primary outcomes were perioperative mortality and morbidity (death or stroke within 30 days) and non-perioperative stroke. Kaplan-Meier percentages and logrank p values are from intention-to-treat analyses. This study is registered, number ISRCTN26156392. Findings. 1560 patients were allocated immediate CEA versus 1560 allocated deferral of any carotid procedure. The proportions operated on while still asymptomatic were 89.7% versus 4.8% at 1 year (and 92.1% vs 16.5% at 5 years). Perioperative risk of stroke or death within 30 days was 3.0% (95% CI 2.4-3.9; 26 non-disabling strokes plus 34 disabling or fatal perioperative events in 1979 CEAs). Excluding perioperative events and non-stroke mortality, stroke risks (immediate vs deferred CEA) were 4.1% versus 10.0% at 5 years (gain 5.9%, 95% CI 4.0-7.8) and 10.8% versus 16.9% at 10 years (gain 6.1%, 2.7-9.4); ratio of stroke incidence rates 0.54, 95% CI 0.43-0.68, p(0.0001. 62 versus 104 had a disabling or fatal stroke, and 37 versus 84 others had a non-disabling stroke. Combining perioperative events and strokes, net risks were 6.9% versus 10.9% at 5 years (gain 4.1%, 2.0-6.2) and 13.4% versus 17.9% at 10 years (gain 4.6%, 1.2-7.9). Medication was similar in both groups; throughout the study, most were on antithrombotic and antihypertensive therapy. Net benefits were significant both for those on lipid-lowering therapy and for those not, and both for men and for women up to 75 years of age at entry (although not for older patients). Interpretation-Successful CEA for asymptomatic patients younger than 75 years of age reduces 10-year stroke risks. Half this reductionis in disabling or fatal strokes. Net benefit in future patients will depend on their risks from unoperated carotid lesions (which will be reduced by medication), on future surgical risks (which might differ from those in trials), and on whether life expectancy exceeds 10 years.
COBISS.SI-ID: 3764287
Background: Complex renal artery aneurysms (RAA) involving major branches of renal artery are difficult to treat. Surgery may be associated with extensive invasiveness and morbidity in the context of major intra-abdominal surgery. Stentgrafts or selective coil embolization are contraindicated when large branches are involved in the aneurysmal sac. A case of the patient with complex renal artery aneurysm involving all major arterial branches treated with a new type of multilayer stent is described. Case report: A 56-year old woman whose right kidney had been removed five years before because of renal cell carcinoma was incidentally found to have a large (22 x 26 mm) saccular aneurysm in the main left renal artery involving all three major branches of the renal artery. Via a percutaneous femoral approach a multilayer stent was deployed without complications. Blood flow inside the sac was immediately and significantly reduced. All the renal branches remained patent. Conclusion: Newmultilayer fluid modulating stent concept appears to be a very useful and attractive alternative to surgery or other endovascular techniques for those RAA involving or very close to major branch vessels, especially in patients with very high risk of loosing the only viable kidney, as in our case.
COBISS.SI-ID: 30240729