Subject(s)
ST Elevation Myocardial Infarction/complications , Shock, Cardiogenic/etiology , Takotsubo Cardiomyopathy/complications , Ventricular Function, Left , Ventricular Outflow Obstruction/etiology , Adrenergic beta-Antagonists/therapeutic use , Diagnosis, Differential , Fluid Therapy , Humans , Male , Middle Aged , Predictive Value of Tests , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/physiopathology , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/physiopathology , Shock, Cardiogenic/therapy , Takotsubo Cardiomyopathy/diagnostic imaging , Takotsubo Cardiomyopathy/physiopathology , Takotsubo Cardiomyopathy/therapy , Treatment Outcome , Ventricular Function, Left/drug effects , Ventricular Outflow Obstruction/diagnostic imaging , Ventricular Outflow Obstruction/physiopathology , Ventricular Outflow Obstruction/therapyABSTRACT
BACKGROUND: The mid-femoral head (F50 ) is a common fluoroscopic target for common femoral artery (CFA) puncture during cardiac catheterization. Punctures above the inguinal ligament (marking the proximal end of CFA) increase the risk of retroperitoneal hemorrhage and are classified as high punctures. METHODS: We retrospectively analyzed 114 CT angiograms for the anatomic relationship of the inguinal ligament to the femoral head (FH) and inferior epigastric artery (IEA). We analyzed 114 CT angiograms and 500 femoral angiograms, for the relation of the mid-point of CFA to F50 and F75 (the junction of upper 3/4th and lower 1/4th of FH). RESULTS: The proximal third of femoral head (F33 ) (-1.4 mm) and IEA nadir (-2.9 mm) were closer approximations to the inguinal ligament than the IEA origin (-12.8 mm) or cranial end of FH (-15.2 mm). The inguinal ligament correlated better with the IEA nadir than F33 (R2 = 0.49 vs. 0.001). F75 was a closer approximation for the mid-point of the CFA than F50 (0.3 mm vs. -9.2 mm). Using F75 as the target for CFA puncture carried the lowest risk for non-CFA punctures (18.6%), while using F50 had a 41.2% risk for non-CFA punctures. F75 had an increased risk for low punctures (14.2%) but F50 had a far higher risk for high punctures (36.6%). CONCLUSIONS: The nadir of IEA is the best landmark for identifying the inguinal ligament (the proximal end of CFA) and defining high punctures. F75 is a more accurate target for successful CFA puncture than F50.
Subject(s)
Anatomic Landmarks , Cardiac Catheterization , Catheterization, Peripheral , Computed Tomography Angiography , Femoral Artery/diagnostic imaging , Adult , Aged , Aged, 80 and over , Catheterization, Peripheral/adverse effects , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Punctures , Retrospective StudiesABSTRACT
Staphylococcus lugdunensis is part of the native flora in the inguinal region of the body. Inguinal surgeries, such as vasectomy, place carriers of this aggressive pathogen at risk for contamination. Native-valve endocarditis caused by coagulase-negative S. lugdunensis has a rapid and complicated clinical course. The pathogenicity of this organism is not limited to cardiac valvular destruction. We report the case of a 36-year-old man who presented with S. lugdunensis endocarditis, dysarthria, and hemiparesis 5 weeks after a vasectomy. To our knowledge, this is the first report of embolic stroke caused by S. lugdunensis endocarditis. In addition, we discuss the relevant medical literature.
