Carotid stenosis and abdominal aortic aneurysm at the follow-up examination in patients treated for acute extremity ischaemia.

BACKGROUND: To evaluate survivors treated for acute extremity ischaemia as a risk-group for carotid stenosis and abdominal aortic aneurysm at the follow-up examination. EXPERIMENTAL DESIGN: Clinical study with median follow-up of 14 (8-32) months. SETTING: Central Hospital of Central Finland. PATIENTS: Eighteen survivors with median age of 77 (51-92) years treated for acute extremity ischaemia during two-year period intended to a separate follow-up examination median 14 (8-32) months after the acute episode of vascular occlusion. Ischaemia was considered as acute in 14 patients and acute on chronic in four patients. INTERVENTIONS: Thromboembolectomy was the primary intervention excluding two patients with distal upper limb ischaemia who were treated by intravenous heparin. MEASURES: Clinical examination, duplex scanning of carotid bifurcation and sonography of abdominal aorta were performed at the follow-up examination. RESULTS: Significant asymptomatic carotid stenosis >60% was found in four patients (22%), two of these patients had significant bilateral carotid stenosis. One patient (60%) had abdominal aortic aneurysm of 5.2 cm. CONCLUSIONS: In survivors treated for acute extremity ischaemia asymptomatic carotid stenosis >60% was found with significantly increased prevalence compared with general population and with equal prevalence when compared with patients with peripheral vascular disease. Occurrence of abdominal aortic aneurysm was parallel with findings in screening surveys.

Low molecular weight heparin (enoxaparin) compared with unfractionated heparin in prophylaxis of deep venous thrombosis and pulmonary embolism in patients undergoing hip replacement.

Prophylactic efficacy and safety of a low molecular weight heparin (LMWH) and those of conventional unfractionated heparin (UH) were investigated in a randomized study. Totally, 167 consecutive patients undergoing total hip replacement were allocated to two groups. Patients in the LMWH-group (n = 83) received a fixed dose of enoxaparin 40 mg once daily, starting 12 hours preoperatively and continuing for 10 days. Patients in the UH-group (n = 84) received UH 5000 IU twice a day subcutaneously (sc), starting two hours before operation and continuing for 10 days. Deep venous thrombosis (DVT) was diagnosed by bilateral ultrasonography and confirmed by venography. Proximal DVTs were observed in four patients of UH-group (4.8%) and in one of LMWH-group (1.2%, P > 0.05). There was only one pulmonary embolism (PE) in a patient belonging to UH-group (1.2%). Low rates of thromboembolic events could be explained, in addition to heparin prophylaxis, also by early mobilization and regional anaesthesia. Local tolerance (size of haematoma), blood loss and transfusion requirements during the operation and the postoperative period did not show differences between the two study groups. The results of our study indicate that enoxaparin once daily is an effective and safe form of DVT prophylaxis in patients undergoing elective hip replacement.

Clinical sequelae and sacroiliac joint changes by computed tomography after recovery from septic sacroiliitis.

Nine cases of septic sacroiliitis were re-examined clinically and by CT after a follow-up period of 1.5-7 years. At the final check-up, six of the patients were asymptomatic, while pain could be provoked by palpation or compression in three cases. The sacroiliac joint CT findings were considered normal in two cases. Joint space narrowing, subchondral sclerosis, cysts, erosions, ankylosis and/or osteophytes were detected in seven cases. We conclude that recovery from septic sacroiliitis is good although destructive and degenerative changes often develop as sequelae of an osteolytic involvement.