Case Reports in Vascular Medicine最新文献

{"title":"Rare Clinical Course of Immunoglobulin G4-Related Inflammatory Abdominal Aortic Aneurysm with Multiple Rare Complications.","authors":"Yuji Naito,&nbsp;Tsukasa Miyatake,&nbsp;Manami Iwasaki,&nbsp;Atsushi Okuyama,&nbsp;Akio Takada,&nbsp;Koji Chiba,&nbsp;Masahiko Obata,&nbsp;Junichi Oba","doi":"10.1155/2019/8249061","DOIUrl":"https://doi.org/10.1155/2019/8249061","url":null,"abstract":"<p><p>Immunoglobulin G4- (IgG4-) related inflammatory abdominal aortic aneurysm (AAA) has been recognized as a manifestation of IgG4-related disease (IgG4-RD). We experienced one patient with multiple consecutive manifestations before and after endovascular stent grafting for IgG4-related inflammatory AAA (IAAA). A 71-year-old man was diagnosed with IgG4-RD due to increased IgG4 serum concentration, typical findings of parotid gland biopsy, and periaortitis in another hospital 2 years and 7 months before visiting our hospital. He came to our hospital because of abdominal pain and IAAA. He developed paraplegia after hospitalization and underwent endovascular stent grafting for the IAAA. About one month after stent grafting, he developed perforation of the sigmoid colon due to enteritis. He also had myocardial infarction. Finally, he died of intestinal bleeding. Here, we describe this case with rare, multiple, consecutive manifestations of IgG4-RD, some of which might be caused by IgG4-related IAAA or side effects of treatments rather than by IgG4-RD itself. We report this case because the clinical course seemed rare for IgG4-RD or IgG4-related IAAA. For treating IgG4-RD with IgG4-related IAAA, we should consider factors causing the symptoms and carefully select the proper treatment.</p>","PeriodicalId":9632,"journal":{"name":"Case Reports in Vascular Medicine","volume":"2019 ","pages":"8249061"},"PeriodicalIF":0.0,"publicationDate":"2019-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/8249061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37119924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"May-Thurner Syndrome with Large Abdominal Varicosity, Treated Successfully Using Multiple Approaches.","authors":"Lori Jia,&nbsp;Jason Alexander,&nbsp;Nedaa Skeik","doi":"10.1155/2019/7079307","DOIUrl":"https://doi.org/10.1155/2019/7079307","url":null,"abstract":"<p><p>May-Thurner syndrome (MTS) is a venous outflow obstruction disorder characterized by compression of the left common iliac vein by an overriding right common iliac artery. MTS primarily affects young to middle-aged women, although many patients remain entirely asymptomatic. Anatomic variations of MTS, while uncommon, have been described. Treatment usually involves endovascular management, including thrombolysis and/or thrombectomy with or without inferior vena cava filter placement, followed by angioplasty and stenting of the left common iliac vein. We report a unique case of a 31-year-old woman who presented with MTS-related deep vein thrombosis accompanied by symptomatic abdominal and pelvic varicosities. The varicosities were treated successfully using multiple procedures, resulting in complete resolution of all symptoms. Our case discusses a treatment approach for an unusual presentation of MTS-related postthrombotic syndrome, and provides a brief literature review of MTS complications and management.</p>","PeriodicalId":9632,"journal":{"name":"Case Reports in Vascular Medicine","volume":"2019 ","pages":"7079307"},"PeriodicalIF":0.0,"publicationDate":"2019-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/7079307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37315159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Use of Excimer Laser and High-Speed Rotational Atherectomy to Overcome a Severely Calcified Lesion in Endovascular Therapy.","authors":"Keisuke Nakabayashi,&nbsp;Shinya Hata,&nbsp;Nobuhito Kaneko,&nbsp;Akihiro Matsui,&nbsp;Kazuhiko Tanaka,&nbsp;Hiroshi Ando,&nbsp;Minoru Shimizu","doi":"10.1155/2019/1719035","DOIUrl":"https://doi.org/10.1155/2019/1719035","url":null,"abstract":"<p><p>Although endovascular therapy (EVT) is commonly used in treatment of peripheral artery disease (PAD), severely calcified lesions pose a challenge, in spite of the technical advancement. In this report, we discuss the case of a 74-year-old male with coronary artery disease and end-stage renal disease who presented at our institution with bilateral intermittent claudication. Angiography showed chronic total occlusion (CTO) of the right superficial femoral arteries (SFA). Because the bilateral external iliac arteries demonstrated moderate stenosis, we performed endovascular therapy on the right SFA-CTO using a contralateral approach. With the antegrade wire progressing into the subintimal space, direct distal-SFA puncture was performed and wire externalization was established. However, no devices (minimal balloon, microcatheter, or Crosser system) were able to pass the lesion in antegrade or retrograde manner, even though the child catheter support or needle cracking technique from outside/inside was applied. Therefore, we used a combination of an excimer laser and high-speed rotational atherectomy to overcome the severely calcified lesion. First, the excimer laser catheter (Turbo Elite 0.9 mm) ablated the entry to the CTO; however, it did not pass through completely. Thereafter, the thin microcatheter (Caravel) succeeded in crossing the CTO in an antegrade manner using the BAlloon Deployment using FORcible Manner (BADFORM) technique. After wire-exchange to the Rota-wire, rotational atherectomy (RotaLink Plus 1.5 mm) passed through the CTO. Subsequently, we could dilate the CTO lesion with a conventional balloon followed by bare metal stent deployment. The right ankle-brachial index of the patient improved from being unmeasurable to 0.79, and the intermittent claudication disappeared. This combination therapy, described as the \"RASER\" technique in coronary section, is accepted for reimbursement. However, these devices in EVT section are considered off-label use in Japan. Therefore, we have to refrain from frequent use of this strategy; however, this method provides an option for severely calcified lesions.</p>","PeriodicalId":9632,"journal":{"name":"Case Reports in Vascular Medicine","volume":"2019 ","pages":"1719035"},"PeriodicalIF":0.0,"publicationDate":"2019-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/1719035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37284295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Off-Label Use of a Unibody Aortic Stent-Graft System for the Treatment of Infrarenal Abdominal Aortic Dissections.","authors":"Joseph Faraj,&nbsp;Rebekah L W Tan,&nbsp;Bibombe P Mwipatayi","doi":"10.1155/2019/6853135","DOIUrl":"https://doi.org/10.1155/2019/6853135","url":null,"abstract":"<p><p>Infrarenal abdominal aortic dissections (IAAD) are exceedingly rare, accounting for 1-4% of all aortic dissections. The evidence is scarce on how to best manage IAAD when they become symptomatic. Two main interventional approaches exist, open surgery and the endovascular approach. Conventional stent-graft systems make it difficult to treat nonaneurysmal aortic disease due to limb competition in a narrow distal aorta. Thus, we present a novel use of the Endologix Anatomical Fixation 2 (AFX2) Abdominal Aortic Aneurysm (AAA) endograft system for the treatment of four patients with IAAD. We also highlight an individual case study that was treated with an alternative endovascular approach and the complications that followed. This was to highlight and compare our successful experience with Endologix AFX2 AAA endograft system. There were multiple benefits for choosing this stent-graft; however the main advantage is its suitability in the narrow distal aorta. Our aim was to highlight an alternative endovascular approach for the successful treatment of a rare, challenging, and potentially fatal pathology.</p>","PeriodicalId":9632,"journal":{"name":"Case Reports in Vascular Medicine","volume":"2019 ","pages":"6853135"},"PeriodicalIF":0.0,"publicationDate":"2019-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/6853135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37244796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Study of Malrotated Kidneys with Asymmetric Multiple Renal Arteries, Variant Venous Drainage, and Unilateral Ureteral Duplication.","authors":"Martine Dunnwald,&nbsp;Marc A Pizzimenti","doi":"10.1155/2019/1893137","DOIUrl":"https://doi.org/10.1155/2019/1893137","url":null,"abstract":"<p><p>Variations in the arterial, venous, and ureteral patterning of the right (r) and left (l) kidneys are common; however, concomitant involvement with all three systems is rare. Specimens that demonstrate anatomic variation across multiple systems provide an opportunity to illustrate links between anatomic concepts, embryologic development, clinical practice, and education. During anatomic study of the abdominal cavity, a total of five major arteries (3l and 2r) emerged from the aortic and common iliac axes in a cadaveric donor. Through continued study, multiple contributing veins, of different caliber, coalesced into four major renal veins (2l and 2r) that returned blood from the kidneys to the inferior vena cava (IVC) at different locations. In addition, unilateral duplication of the kidney with concomitant ureters was evident on the right side. Both ureters continued inferiorly and independently entered the bladder, each with an observable orifice adjacent to the bladder trigone. Most evident in the specimen was the anteriorly directed hilum for both kidneys. Reported measures for each of the observed anatomic variations suggest that the current specimen has an estimated incidence of less than 0.3%. This comparatively rare specimen provides an example of important anatomic concepts that are relevant to educational and clinical practices.</p>","PeriodicalId":9632,"journal":{"name":"Case Reports in Vascular Medicine","volume":"2019 ","pages":"1893137"},"PeriodicalIF":0.0,"publicationDate":"2019-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/1893137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37177080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Popliteal Artery Entrapment Syndrome (PAES) in a 17-Year-Old Adolescent.","authors":"Viktor Labmayr,&nbsp;Aryan Aliabadi,&nbsp;Kurt Tiesenhausen,&nbsp;Marianne Brodmann,&nbsp;Florian Schmid,&nbsp;Dana Moore","doi":"10.1155/2019/8540631","DOIUrl":"https://doi.org/10.1155/2019/8540631","url":null,"abstract":"<p><strong>Introduction: </strong>Popliteal artery entrapment syndrome (PAES) is caused by compression of the popliteal artery (PA) due to deranged myotendinous structures. It can be asymptomatic or may present with exercise intolerance, claudication, or even limb-threatening ischemia. The clinical picture depends on the anatomy and degree of vascular compromise.</p><p><strong>Case description: </strong>We report a case of a 17-year-old Caucasian male with PAES Type II presenting with intermittent claudication and progression towards acute limb ischemia.</p><p><strong>Diagnostics: </strong>MRI and MRA helped identifying the aberrant anatomy and thrombotic occlusion. Doppler ultrasound and conventional angiography have also been employed in a stepwise approach.</p><p><strong>Intervention: </strong>The thrombus at the site of occlusion was removed by the use of catheter-directed lysis. Subsequently, popliteal artery release was achieved by myotomy of the aberrant medial head of gastrocnemius muscle (MHGM) and muscle transfer to the medial femoral condyle. A three-month regimen of 60mg edoxaban was recommended after surgery.</p><p><strong>Outcome: </strong>Surgical correction of the anomalous anatomy and postoperative anticoagulation led to freedom of symptoms.</p><p><strong>Lesson: </strong>Clinical presentation of PAES mimicking peripheral artery occlusive disease is very rare but potentially limb-threatening. PAES should be considered in young and otherwise healthy individuals.</p>","PeriodicalId":9632,"journal":{"name":"Case Reports in Vascular Medicine","volume":"2019 ","pages":"8540631"},"PeriodicalIF":0.0,"publicationDate":"2019-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/8540631","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37150764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carotid Paraganglioma in Adolescence-Clinical Picture-Surgical Technique and Review of the Literature.","authors":"Thomas Kotsis,&nbsp;Panagitsa Christoforou,&nbsp;Constantinos Nastos","doi":"10.1155/2019/6182783","DOIUrl":"https://doi.org/10.1155/2019/6182783","url":null,"abstract":"<p><p>Paraganglia are clusters of cells originating from the neural crest with histological and cytochemical characteristics of neuroendocrine cells. Paragangliomas of the head and neck represent less than 0.5% of all head and neck tumors and they usually occur between the ages of 40 and 50. Paragangliomas in childhood and in adolescence are extremely rare; only 23 case reports have been reported in the recent literature. In childhood, the estimation of malignant potential is 3-10%; therefore, early diagnosis and treatment of carotid body paragangliomas are mandatory. However, due to the rarity of these lesions in young patients, they are often not included in the differential diagnosis of solid masses in the neck area, a fact that may lead to misdiagnosis or delay in treatment. We present, herein, two extremely rare cases of patients in adolescence who were diagnosed with a carotid body paraganglioma and were treated surgically in our unit. One of the patients was diagnosed and treated at the age of 15 years while the other had a long-standing tumor in the neck that was followed up by a general surgery outpatient service as a branchial cleft cyst at the age of 15 years and was eventually treated surgically 8 years later. Carotid body tumor was not considered in the initial differential diagnosis because of its rarity at this age range.</p>","PeriodicalId":9632,"journal":{"name":"Case Reports in Vascular Medicine","volume":"2019 ","pages":"6182783"},"PeriodicalIF":0.0,"publicationDate":"2019-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/6182783","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37135348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Slippery Stents: A Case Report and Review of the Literature Describing Patients with May-Thurner Syndrome That Experienced Stent Migration.","authors":"Ramy Mando, Priscilla Sigua-Arce, Lisa Spencer, Alexandra Halalau","doi":"10.1155/2019/7606727","DOIUrl":"10.1155/2019/7606727","url":null,"abstract":"<p><p>Endovascular stent placement is an effective treatment for relieving chronic venous obstruction in patients with May-Thurner Syndrome (MTS) with or without the presence of thrombotic lesions. Stent migration is a rare but potentially life-threatening complication of endovascular stenting. Herein, we describe a case of stent migration from the left common iliac vein into the right heart, requiring open-heart surgery. We also completed a literature review of MTS patients with stent migration in hopes of raising awareness of this rare and life-threatening complication.</p>","PeriodicalId":9632,"journal":{"name":"Case Reports in Vascular Medicine","volume":"2019 ","pages":"7606727"},"PeriodicalIF":0.0,"publicationDate":"2019-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6425386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37128421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elephantiasis and Directed Occupational Rehabilitation.","authors":"Jose Maria Pereira de Godoy,&nbsp;Henrique Jose Pereira de Godoy,&nbsp;Ana Carolina Pereira de Godoy,&nbsp;Maria de Fátima Guerreiro Godoy","doi":"10.1155/2019/6486158","DOIUrl":"https://doi.org/10.1155/2019/6486158","url":null,"abstract":"<p><p>The aim of the present study was to demonstrate the cure of elephantiasis over a ten-year follow-up period and novel discoveries with directed occupational rehabilitation. A 66-year-old female patient with a history of bilateral lower limb lymphedema reported the aggravation of the condition over the years, reaching stage III (elephantiasis). The physical examination confirmed elephantiasis. The circumference of the left lower limb was 106 cm. Her body weight was 106 kilograms, height was 160 cm, and the body mass index (BMI) was 41.6 kg/m². The patient was submitted to intensive treatment for three weeks, which led to a 21-kg reduction in weight and 66 cm reduction in leg circumference. Ten years after treatment, the patient has maintained the results with the compression stockings. Elephantiasis can be cured, although lymphedema cannot. The cure of elephantiasis depends on maintaining the treatment of lymphedema after normalization or near normalization. Directed occupational therapy stimulates the search for new activities and a life closer to normality.</p>","PeriodicalId":9632,"journal":{"name":"Case Reports in Vascular Medicine","volume":"2019 ","pages":"6486158"},"PeriodicalIF":0.0,"publicationDate":"2019-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/6486158","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37244606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transient Complete Unilateral Oculomotor Nerve Palsy following Clipping of Ruptured Anterior Communicating Artery Aneurysm: An Abstruse Phenomenon.","authors":"Joe M Das,&nbsp;Rashmi Sapkota,&nbsp;Manish Mishra","doi":"10.1155/2019/3185023","DOIUrl":"https://doi.org/10.1155/2019/3185023","url":null,"abstract":"<p><strong>Background: </strong>Aneurysmal subarachnoid hemorrhage may be associated with different cranial nerve palsies, with oculomotor nerve palsy (ONP) being the most common. ONP is especially associated with posterior communicating artery aneurysms, due to the anatomical proximity of the nerve to the aneurysmal wall. Anterior communicating artery (Acom) aneurysms are very unlikely to produce ONP due to the widely separated anatomical locations of Acom and oculomotor nerve.</p><p><strong>Case description: </strong>Here we describe the case of a 60-year-old nondiabetic lady who presented with Acom aneurysmal subarachnoid hemorrhage having a World Federation of Neurosurgical Societies (WFNS) grade I. She underwent an uneventful right pterional craniotomy and clipping of the aneurysm, except for a short period of controlled rupture of the aneurysm. Postoperatively she developed complete ONP on the right side, though her sensorium was preserved. Computed Tomogram and Magnetic Resonance Imaging scans of the brain did not yield any useful information regarding its etiology. She was conservatively managed and kept on regular follow-up. She had a gradual recovery of ONP in the following order: pupillary reaction, ocular movements, and finally ptosis. On postoperative day 61, she had complete recovery from ONP.</p><p><strong>Conclusion: </strong>We describe a very unusual case of complete ONP following Acom aneurysm clipping and its management by masterly inactivity.</p>","PeriodicalId":9632,"journal":{"name":"Case Reports in Vascular Medicine","volume":"2019 ","pages":"3185023"},"PeriodicalIF":0.0,"publicationDate":"2019-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/3185023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37214557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}