Injury of the brachial artery accompanying simple closed elbow dislocation: a case report.

BACKGROUND: Elbow dislocation is the second common dislocation in adults, after the shoulder. The anatomical proximity to the joint of the brachial artery could lead to concomitant vascular injuries, even if their occurrence remains very rare. METHOD: It is reported the case of a right-hand-dominant  42-year-old man who sustained a simple closed  posterior elbow dislocation of  his left elbow, associated to a complete brachial artery rupture. He urgently underwent the reduction of the joint dislocation and an artery-repairing surgical procedure using a graft from ipsilateral saphenous vein. RESULTS: The full functional capacity of the elbow was obtained. CONCLUSIONS: The abundance of the brachial artery collateral network may hide the presence of a vascular injury,  potentially associated to a closed elbow dislocation. Therefore, a high index of suspicious should be maintained. The Emergency Team plays a crucial role in its early diagnosis, which is essential to avoid irreversible ischemia related damages. A prompt reduction of the joint dislocation and the vascular injury surgical repair are required. Regarding the treatment of the concomitant collateral ligaments and capsular injuries, the indication to proceed to the simultaneous ligaments reconstruction is still controversial in literature.

Efficacy of a novel method of intravenous infusion of the prostaglandin analogue iloprost for the treatment of lower-limb critical ischemia: An open-label, nonrandomized study in two cohorts.

BACKGROUND: Patients with advanced peripheral atherosclerotic occlusive disease who are no longer candidates for either surgical or intravascular treatment or who have undergone unsuccessful surgical revascularization may be treated with IV prostanoids. OBJECTIVE: The aim of this study was to assess the efficacy, tolerability, compliance, and cost of a new system of prostanoid administration that provides a constant plasma concentration of iloprost and maintains the efficacy of the drug while reducing the risk for adverse effects (AEs) and the overall cost of treatment compared with the actually adopted infusion system. METHODS: This open-label, nonrandomized study was conducted at the University Hospital of Catania (Catania, Italy). Patients with chronic critical ischemia who were not candidates for surgical revascularization were observed. The study population was divided into 2 groups: patients in group A were treated with a continuous 6-hour IV infusion of iloprost 0.5 to 2.0 ng/kg.min once daily for at least 14 consecutive days, and patients in group B were treated with a 20-day iloprost continuous IV infusion at a mean dosage of 25 µg/d by means of a portable elastomeric infusion system. Every 5 days the patient was admitted to the day-hospital setting to replenish the drug. Primary end points were rates of major and minor amputations and death; secondary end points were complete relief or a marked reduction of pain at rest, as reflected by discontinuation of analgesic therapy and by a decrease in the patients' complaints of pain, as well as by the satisfactory healing of ulcerations. Tolerability, compliance, and cost also were assessed. RESULTS: Fifty-six patients (34 men, 22 women; mean [SD] age, 67 [11] years) entered the study. Group A comprised 25 patients; group B, 31 patients. The rate of major amputation in patients at Fontaine stage IV was higher in group A (33.3%) compared with group B (20.0%). The death rate was higher in group A (4.0%) than in group B (3.2%). Pain at rest completely subsided in 37.5% of patients in group A and 68.8% of patients in group B. Trophic lesions healed in 44.4% and 73.3% of patients in groups A and B, respectively. In group A, 40.0% of patients experienced AEs (ie, hyperemia, headache, flushing) that required a reduction in dose. In group B, 6.5% of patients had hyperemia at the injection site that required a reduction in dose. Total cost wasin group B wasd €1995.60, with a mean hospital stay of 6 days. Overall, patients' quality of life, assessed as the ability to resume their normal social activities, improved. CONCLUSIONS: In this study of patients with chronic lower-limb critical ischemia, due to the consistent blood level achieved with iloprost, 20-day iloprost continuous IV infusion at a mean dosage of 25 µg/d administered by means of a portable elastomeric infusion system was shown to be similarly or more effective than the Methods used by the most important European trials (ie, iloprost 0.5-2.0 ng/kg·min once daily for at least 14 consecutive days). Furthermore, the patients were more compliant and the cost of treatment and the length of hospitalization were reduced compared with iloprost 0.5 to 2.0 ng/kg·min once daily for at least 14 consecutive days.

Acute occlusion of abdominal aorta: unusual embolization site for a cardiac tumor mass.

We report a rare case of complete embolization of a left atrial myxoma resulting in total occlusion of the suprarenal abdominal aorta. A 54-year-old man was admitted to hospital because of acute thoracic pain with paraplegia and acute renal failure. Abdominal computed tomography and angiography showed evidence of total occlusion of the suprarenal aorta. Intraoperatively, the aorta was found to be occluded by a hard neoformation, histologically defined as atrial myxoma. A diagnosis of atrial myxoma should be suspected in young patients suffering from acute thoracic pain and affected by paraplegia and acute renal failure. Early diagnosis may significantly abate the morbidity and mortality rates associated with this condition.

Long-term success of endovascular treatment of benign superior vena cava occlusion with chylothorax and chylopericardium.

The most likely etiology of benign obstruction of the superior vena cava (SVC) include fibrosing mediastinitis and iatrogenic etiologies such as sclerosis and obstruction caused by pacemakers and central venous catheter. Percutaneous stenting of SVC has been used with success both in malignant and benign superior vena cava syndrome; however, long-term follow-up of endovascular procedures is not well known. We present a case of a patient with complete occlusion of SVC of benign etiology, presenting dramatically with bilateral chylothorax and chylopericardium with cardiac tamponade, who underwent successful vena caval revascularization with thrombolytic therapy and placement of self-expanding metallic stent. The 42-month follow-up could encourage endovascular procedures even in SVC syndrome of benign etiology.