ABSTRACT
Acute mesenteric ischaemia secondary to atherosclerotic disease of the superior mesenteric artery is a surgical emergency associated with a poor prognosis, and requires prompt diagnosis and early revascularisation in order to improve outcome. The traditional management of surgical resection of necrotic bowel plus mesenteric revascularisation by surgical bypass is associated with significant morbidity and mortality. We describe the use of a combined surgical and endovascular approach, using intraoperative retrograde superior mesenteric angioplasty at the time of laparotomy. Four patients have been treated by this combined technique with three surviving, although one subsequently required an open surgical revascularisation procedure.
Subject(s)
Angioplasty, Balloon/methods , Digestive System Surgical Procedures , Intestines/blood supply , Ischemia/therapy , Mesenteric Vascular Occlusion/therapy , Adult , Aged , Angioplasty, Balloon/instrumentation , Female , Humans , Ischemia/diagnostic imaging , Ischemia/etiology , Ischemia/mortality , Ischemia/surgery , Ligation , Male , Mesenteric Artery, Superior/surgery , Mesenteric Vascular Occlusion/complications , Mesenteric Vascular Occlusion/diagnostic imaging , Mesenteric Vascular Occlusion/mortality , Mesenteric Vascular Occlusion/surgery , Middle Aged , Radiography , Reoperation , Stents , Time Factors , Treatment Outcome , Vascular Surgical ProceduresSubject(s)
Brain Injuries/diagnosis , Brain Injuries/therapy , Head Injuries, Closed/diagnosis , Head Injuries, Closed/therapy , Brain Concussion/diagnosis , Brain Concussion/therapy , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/therapy , Emergencies , Humans , Neurologic Examination , Practice Guidelines as Topic , Time FactorsSubject(s)
Angiography/methods , Antineoplastic Agents/administration & dosage , Breast Neoplasms, Male/drug therapy , Breast Neoplasms/drug therapy , Neoplasm Recurrence, Local/drug therapy , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Breast Neoplasms/blood supply , Breast Neoplasms/diagnostic imaging , Breast Neoplasms, Male/blood supply , Breast Neoplasms, Male/diagnostic imaging , Catheterization/methods , Catheters, Indwelling , Coloring Agents , Feasibility Studies , Female , Humans , Infusions, Intra-Arterial , Male , Mammary Arteries , Middle Aged , Neoplasm Recurrence, Local/blood supply , Neoplasm Recurrence, Local/diagnostic imaging , Subclavian Artery , Treatment OutcomeABSTRACT
Twenty-eight patients with locally advanced breast cancer received four doses of regional chemotherapy via angiographically placed percutaneous catheters into the internal mammary artery (IMA) and lateral thoracic artery. Patent blue dye was injected to outline the relative contribution to perfusion of each of these vessels. The IMA was found to perfuse 67 (range 20-95) per cent of the breast and the lateral thoracic artery 15 (range 0-35) per cent. In 33 per cent of patients the lateral thoracic artery did not contribute to breast perfusion and a large area of the lateral aspect of the breast was perfused from a further branch of the subclavian or axillary artery. The blood supply to the breast is extremely variable and must be determined in each patient before delivering regional chemotherapy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Breast Neoplasms/drug therapy , Breast Neoplasms/blood supply , Chemotherapy, Cancer, Regional Perfusion , Coloring Agents , Female , Humans , Infusions, Intra-Arterial , Infusions, Intravenous , Mammary Arteries , Methotrexate/administration & dosage , Mitomycins/administration & dosageSubject(s)
Arteriovenous Fistula/surgery , Diskectomy/adverse effects , Iliac Artery/abnormalities , Iliac Vein/abnormalities , Stents , Alloys , Arteriovenous Fistula/etiology , Humans , Iliac Artery/injuries , Iliac Vein/injuries , Intervertebral Disc/surgery , Male , Middle Aged , Spinal Diseases/surgeryABSTRACT
We describe a case of pneumonitis in a patient receiving selective intra-arterial chemotherapy for locally advanced breast cancer.
