Pancreaticoduodenal artery aneurysm formation with superior mesenteric artery stenosis.

Celiac stenosis or occlusion is attributed partly to increase blood flow at pancreatic arcade from the superior mesenteric artery (SMA) system and may play a causal role in true aneurysm of pancreaticoduodenal artery (PDAA) formation. However, despite possible increased blood flow in the pancreatic arcades like celiac stenosis, PDAAs with a stenotic SMA are extremely rare, with only three cases have been reported in the literature. We report a case of PDAA with SMA stenosis and review the literature.

Obstruction of the superior mesenteric artery due to emboli from the thoracic aorta in a patient with thromboangiitis obliterans.

A 48-year-old woman presented at our hospital with acute abdominal pain 3 years after being diagnosed with thromboangiitis obliterans (TAO). Computed tomography revealed occlusion of the superior mesenteric artery (SMA) and multiple kidney infarction with thrombus floating in the thoracic aorta connected with the intercostal artery. Despite emergency embolectomy, further thromboembolism eventually required massive resection of the intestine with jejunostomy and colostomy and permanent intravenous hyper-alimentation therapy. Although TAO rarely involves the large artery, the aorta could be the source of embolization in patients with TAO.

Early use of brachial-basilic arteriovenous fistula.

PURPOSE: The aim of this study was to evaluate the long-term patency rate and complications associated with the use of the BBAVF in the early period. METHODS: The records of all patients undergoing BBAVFs for hemodialysis access between June 2001 and June 2011 were retrospectively evaluated. We allowed the use of the BBAVF beginning two weeks after the fistula creation. The primary and secondary patencies were estimated using the Kaplan-Meier method. RESULTS: A total of 44 BBAVFs were created for 41 patients. Most (73.2%) of the patients had previously been on hemodialysis. A previous history of AVG creation was noted in 36.6% and previous insertion of a catheter was reported for 72.7% of the patients, respectively. The mean time to the first cannulation of the BBAVF was 18.8 days (13-42 days). In two cases, the BBAVFs were not used. Postoperative complications were noted in 2 cases, and included prolonged arm edema and thrombosis. There was no infection of the wound or steal syndrome. The primary and secondary patency rates were 68.1% and 84.2% at 1 year, 55.0% and 80.7% at 2 years, and 38.1% and 70.1% at 5 years, respectively. CONCLUSIONS: In this study, the patency rates following the early use of the BBAVFs were not inferior to the previously reported patency rates in the literature. In cases where the patients already have an inserted central catheter, the early use of the BBAVFs decreases the complications associated with catheters.

Sural Artery Bypass in Buerger's Disease: Report of a Case.

A 72 year-old man was admitted to the hospital to receive treatment for resting pain and an ulcer, which had developed on an amputation stump, 4 months after he had undergone a thrombectomy, below-the-knee popliteal-dorsal pedis artery bypass of his left leg, and digital amputation of his 2nd toe. Angiography demonstrated diffuse arterial and bypass occlusion in his left leg that did not include a sural artery, which was the main collateral. Therefore, the patient underwent reversed saphenous vein bypass from the common femoral artery to the medial sural artery. His leg pain disappeared, and the ulcer healed promptly.

Femoral vein compression resulting from a ganglion of the hip joint: a case report.

The development of a ganglion in the hip joint is a rare cause of lower limb swelling. We herein describe a case of a ganglion of the hip with compression of the femoral vein that produced signs and symptoms that mimicked a deep vein thrombosis. Needle aspiration of the ganglion was easily performed, and swelling of the left lower limb promptly improved. Intensive follow-up of this case was important because the recurrence rate of ganglions after needle aspiration is high.

CHADS2 Score is a Poor Predictor of Non-cerebral Acute Arterial Occlusion in Patients with Non-valvular Atrial Fibrillation.

OBJECTIVE: The CHADS2 score is a stroke risk stratification scheme in patients with non-valvular atrial fibrillation (NVAF). The aim of this study was to determine whether the CHADS2 score can help to predict the risk of non-cerebral acute arterial embolism. MATERIALS AND METHODS: One hundred and seventeen patients who underwent surgery for non-cerebral acute arterial embolism with NVAF between 1997 and 2009 were enrolled in the cross sectional study. The CHADS2 score of each patient was calculated at the onset of symptoms. The distribution of the CHADS2 score was compared with that of other studies analyzing patients with stroke. RESULTS: The perioperative mortality was 11.1%. A comparison of patients with stroke revealed that our distribution curves were significantly shifted to the left, showing that the CHADS2 score did better in predicting stroke than non-cerebral embolism. On the other hand, the distribution in our series coincides with that of NVAF patients in general. These results indicated that the risk of non-cerebral embolism occurs at the same rate regardless of the CHADS2 score. CONCLUSIONS: The CHADS2 scoring system seems to be an unreliable predictor of non-cerebral embolism, and may not contribute in avoiding potentially life-threatening acute arterial occlusion of the peripheral artery.

Preoperative Non-ambulatory Status Predicts Poor Outcome after Below Knee Bypass Surgery.

OBJECTIVE: To identify the outcome of below knee bypass that focuses on the functional status and to investigate whether preoperative functional status can predict these outcomes. MATERIALS AND METHODS: One hundred and fifty one limbs in one hundred and thirty two patients that underwent below knee bypass between 2004 and 2008 were retrospectively reviewed. The patients were grouped as "ambulatory," "non-ambulatory transfer" and "non-ambulatory bedridden," according to their functional status. Clinical success was defined as the achievement of all of following end points; graft patency to wound healing, limb salvage for 1 year or until death, maintenance of ambulatory status for 1 year, and survival for 6 months. The effect of preoperative ambulatory status was analyzed. RESULTS: The overall primary and secondary graft patency, limb salvage and survival at 1 year were 76.3%, 81.8%, 89.1% and 84.1%, respectively. The overall success rate was 62.0%. Clinical success rates for the ambulatory and non-ambulatory groups were 75.6% and 34.9% (P = 0.0009, OR: 4.4; 95% CI: 1.8-10.6). CONCLUSIONS: Bypass surgery is justified for maintaining the independent status of ambulatory patients. On the other hand, the high likelihood of poor outcomes for non-ambulatory patients must be considered before performing bypass surgery.

Acute palmer digital artery occlusion treated using endoscopic ablation of the thoracic sympathetic.

Acute occlusion of the digital arteries frequently causes painful infarction requiring digital amputation. We describe a 55-year-old male patient who presented with acute onset of digital ischemia with impending gangrene on the right hand. Because angiography revealed bypass surgery was not feasible, he underwent thoracoscopic sympathectomy (TS) one week after onset of the symptom, which resulted in rapid pain resolution. He was diagnosed, thereafter, with malignant rheumatoid arthritis and methotrexate was administered. Postoperative angiography revealed that the occluded digital artery had become recanalized. Timely TS is therefore a treatment of choice for acute digital ischemia.