RESUMEN
PURPOSE: We sought to assess the effectiveness of endovascular abdominal aortic aneurysm (AAA) repair (EVAR) through a retrospective review of 6 years' experience at a single centre. MATERIALS AND METHODS: From April 2005 to August 2011, 222 patients affected by abdominal aortic aneurysms underwent EVAR. We evaluated primary technical success, postprocedural mortality, intraprocedural and postprocedural complications with contrast-enhanced computed tomography (CT) and contrast-enhanced ultrasound (US) follow-up at 1, 6 and 12 months and annually thereafter. RESULTS: The procedures were elective in 75.7% and urgent due to symptomatic or ruptured aneurysm in 24.3%. Technical success was 98.6%; three patients (1.4%) required conversion to open surgery. Postoperative mortality rate was 24% for urgent and 2.3% for elective procedures. During a mean follow-up period of 29.6 months, no cases of stent-graft migration were observed; the overall incidence of endoleaks was 27% (60/222) and comprised four type I (1.8%) and one type III (0.45%), all treated by stent-graft extension, and 55 type 2 (24.8%), eight of which (14.5%) were treated by percutaneous injection of thrombin. In 10/222 cases (4.5%), thrombotic occlusion of the iliac extension was detected, which was successfully treated by transcatheter intra-arterial thrombolysis. One patient developed stent-graft infection requiring surgical explantation. Average hospital stay was 4 days, and average time in intensive care was 2 days. CONCLUSIONS: Consistent with the literature data, our study confirms the safety and long-term efficacy of EVAR for treating AAA.
Asunto(s)
Aneurisma Roto/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/métodos , Procedimientos Endovasculares/métodos , Anciano , Anciano de 80 o más Años , Angiografía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Comorbilidad , Medios de Contraste , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , UltrasonografíaRESUMEN
PURPOSE: Popliteal artery aneurysms (PAAs) are a rare condition with an incidence <0.1%. The objective of this study was to evaluate the effectiveness of endovascular treatment of PAA with a covered stent-graft. MATERIALS AND METHODS: Between January 2009 and July 2010, ten patients (nine men and one woman, mean age 69 ± 12 years) with PAA were treated by endovascular placement of a heparin-coated stent-graft. All procedures were evaluated in terms of technical success, patency at 1, 6 and 12 months as assessed by colour Doppler ultrasound, complications, procedure duration and length of postoperative hospital stay. RESULTS: We obtained 100% technical success, with no peri- or postprocedural complications. Average duration of the procedure was 40 min, and mean hospital stay was 3 days. Primary and secondary patency rates at 1, 6 and 12 months were 100% and 100%, 90% and 100%, and 90% and 100%, respectively. Only one case of endoleak occurred. DISCUSSION: In keeping with the literature, our study demonstrates the effectiveness of endovascular repair of PAA, with short- and mid-term patency rates comparable to those of open surgery. Larger series and longer follow-up periods are needed to confirm these preliminary results.
Asunto(s)
Aneurisma/cirugía , Implantación de Prótesis Vascular , Arteria Poplítea , Stents , Anciano , Aneurisma/diagnóstico por imagen , Angiografía , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Tempo Operativo , Complicaciones Posoperatorias/diagnóstico por imagen , Resultado del Tratamiento , Ultrasonografía Doppler en Color , Grado de Desobstrucción VascularRESUMEN
PURPOSE: The aim of this study was to evaluate the efficacy of endovascular treatment of isolated iliac artery aneurysms (IIAA) and compare our data with those reported in the literature. MATERIALS AND METHODS: From May 2005 to December 2010, 32 patients (31 men and one woman; mean age 73±12 years) with a total of 40 IIAAs underwent endovascular treatment at our institute. We evaluated technical success, long-term patency, early and late complications and overall mortality. RESULTS: At a median follow-up of 36 months, we achieved a technical success of 100%, a primary patency of 95% and a secondary patency of 100%, with complete exclusion of the aneurysm in 84.6% of cases. In 12.8% of cases, there was a reduction in aneurysm sac volume, with an incidence of type II endoleak of 12.8%. Overall survival at 1, 2, 3, and 6 years was 96.8%, 84.2%, 66.6% and 64%, respectively. CONCLUSIONS: Our study documents the effectiveness of endovascular treatment of iliac aneurysms, which has become the first-choice treatment at our institute. This finding is consistent with the most recent literature and confirms the safety and long-term patency of stent-graft placement.
Asunto(s)
Procedimientos Endovasculares , Aneurisma Ilíaco/cirugía , Anciano , Angiografía , Implantación de Prótesis Vascular , Femenino , Estudios de Seguimiento , Humanos , Aneurisma Ilíaco/diagnóstico por imagen , Aneurisma Ilíaco/mortalidad , Masculino , Radiografía Intervencional , Stents , Tasa de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
PURPOSE: We evaluated the effectiveness of endovascular treatment with percutaneous transluminal balloon angioplasty (PTA)/stenting of transplanted renal artery stenosis (TRAS). MATERIALS AND METHODS: Between January 2005 and December 2010, 17 patients (4 women, 13 men; mean age 60.9 years) with TRAS underwent PTA/stenting. The parameters analysed were: technical success, pre- and post-treatment serum creatinine (SCr) and blood pressure (BP), average number of antihypertensive drugs administered before and after treatment and vessel patency on colour Doppler ultrasound (CDUS) at 1, 3, 6 and 12 months and once a year thereafter. RESULTS: Technical success was 100%. During a mean follow-up of 28.3±18.7 months, there was a statistically significant reduction in SCr and BP values. In 18 % of cases, moderate (<60%) restenosis was observed on CDUS without renal failure and not requiring new treatment. There was a reduction in antihypertensive drugs from an average of 3.5±0.5 to 1.5±0.5. CONCLUSIONS: Consistent with the literature data, our experience shows that endovascular treatment with PTA/stenting is a safe and effective option for managing TRAS and can thus be considered the method of choice.
Asunto(s)
Angioplastia , Trasplante de Riñón , Complicaciones Posoperatorias/terapia , Obstrucción de la Arteria Renal/terapia , Stents , Adulto , Anciano , Angiografía , Antihipertensivos/administración & dosificación , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Obstrucción de la Arteria Renal/diagnóstico por imagen , Resultado del Tratamiento , Ácidos TriyodobenzoicosRESUMEN
The hepatic artery is the second most common site for aneurysms formation within the splanchnic circulation. Most hepatic artery aneurysms (HAA) are diagnosed incidentally by a computed tomography(CT) scan or a Doppler ultrasonography. We present the case of a HAA diagnosed preoperatively in a 82-year old man, who was treated with an endovascular procedure. An abdominal ultrasonography revealed by chance the presence of a HAA. The abdominal CT scan confirmed an aneurysm of the common hepatic artery, specifically at the origin of the gastroduodenal artery. The gastroduodenal artery was embolized using coils then a heparin-bonded covered stent was deployed into the common hepatic artery to exclude the aneurysm. Final arteriogram documented the regular patency of the stent and the complete exclusion of the aneurysm. No complication occurred and the patient was discharged on the second postoperative day. Six months later, a follow-up with a Duplex scan confirmed the regular patency of the stent, and the patient was in good clinical conditions.
Asunto(s)
Aneurisma/terapia , Anticoagulantes/administración & dosificación , Stents Liberadores de Fármacos , Heparina/administración & dosificación , Arteria Hepática , Anciano de 80 o más Años , Aneurisma/diagnóstico por imagen , Estudios de Seguimiento , Arteria Hepática/diagnóstico por imagen , Humanos , Hallazgos Incidentales , Masculino , Radiografía , Resultado del Tratamiento , Ultrasonografía , Grado de Desobstrucción VascularRESUMEN
In our department we started a program in order to offer a mini-invasive approach to all patients affected by abdominal aortic aneurysms (AAAs), trying to offer this option also to patients not eligible for endovascular aneurysm repair (EVAR) due to unfavorable anatomy, age under 65 years and aorto-iliac occlusive disease, considering nowadays EVAR is the gold-standard for the mini-invasive treatment of AAAs. The aim of this study was to compare endovascular versus fast-track surgical treatment in patients undergoing elective surgery for AAAs. We wanted to verify if it was possible to be totally mini-invasive in the treatment of AAAs. A total of 128 patients were chosen for the study. Ninety-four patients were enrolled in the OPEN group and 34 were enrolled in the EVAR group. This study demonstrates that minimally invasive treatment with the fast-track protocol may be a valid alternative to EVAR.
Asunto(s)
Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma de la Aorta Abdominal/cirugía , Procedimientos Endovasculares/normas , Procedimientos Quirúrgicos Mínimamente Invasivos/normas , Complicaciones Posoperatorias/epidemiología , Anciano , Anciano de 80 o más Años , Comorbilidad , Procedimientos Quirúrgicos Electivos/métodos , Procedimientos Quirúrgicos Electivos/normas , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Procedimientos Endovasculares/métodos , Procedimientos Endovasculares/estadística & datos numéricos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/estadística & datos numéricos , Estándares de Referencia , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
Chronic pain is a symptom that inevitably goes along with a condition of critical ischemia of the lower limbs, termed also as "obstructive peripheral arteriopathy". This sometimes displays worsening, provoking difficult physical and psychological behaviors of the patients. The complexity of this kind of patients results in difficulties in their clinical management. A multidisciplinary team, namely the close and coordinated collaboration of various kinds of professionists, could give better results, than an individual approach, thanks to strategies of re-equilibrating the systemic homeostasis of the given patient.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Dolor , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica , Enfermedad Crónica , Extremidades/irrigación sanguínea , Extremidades/fisiopatología , Extremidades/cirugía , Femenino , Humanos , Isquemia/fisiopatología , Masculino , Dolor/tratamiento farmacológico , Dolor/fisiopatología , Dolor/psicología , Miembro Fantasma/tratamiento farmacológico , Miembro Fantasma/fisiopatología , Miembro Fantasma/psicologíaRESUMEN
The patients affected by critical limb ischemia (CLI) are patients generally considered difficult cases, destined to repeated approach to the sanitary structures. They are patients affected by many pathologies since years, that they know to be potentially lethal often have already faced many interventions, with partial and not long-lasting benefits, they go from one specialist to another and sometimes they entrust themselves to alternative medicine. Physicians have to take in charge not the pathology but to take in charge the patient. For the control of the pain it turns out essential, near the block of the perception of the pain, to act with psychological participation, in order to interfere with the perception of the pain and the meant one of the pain, modify the feelings associated to the pain, modify the behavior induced by pain.
Asunto(s)
Dolor/epidemiología , Dolor/psicología , Anciano , Depresión/epidemiología , Depresión/psicología , Extremidades/irrigación sanguínea , Humanos , Isquemia/fisiopatología , Enfermedades Vasculares Periféricas/epidemiologíaRESUMEN
AIM: Clinical experience in gastrointestinal surgery demonstrated that a multimodal approach can improve the outcome and reduce the length of hospital stay. In this paper we investigate the impact of a multimodal clinical program, based on mininvasive surgery, epidural anesthesia and early feeding and mobilization, on postoperative morbidity and hospitalization after abdominal aortic surgery. METHODS: A 2-armed study was designed. All patients undergoing abdominal aortic surgery between May 2000 and April 2001 were enrolled in a multidisciplinary clinical program including thoracic epidural anesthesia and analgesia, left sub-costal minilaparotomy without evisceration, encouragement to feed and mobilize soon after surgery (Multidisciplinary group: n=82). For comparison purposes, a retrospective analysis was conducted using the data of all patients operated on between January and December 1997, receiving standard anesthesia care and a standard surgical and nursing program (Standard group: n=64). RESULTS: In the Multidisciplinary group we observed significantly better pain relief (p<0.01), earlier restoration of ambulation (p<0.01), earlier feeding (p<0.01) and passage of stools (p<0.01). The incidence of complications was significantly lower in the Multidisciplinary group: pulmonary (0% vs 14.1%), cardiac (2.4% vs 9.4% ) and gastrointestinal (0% vs 10.9%). None of the patients in the Multidisciplinary group required admission to Intensive Care. Median postoperative hospitalization was 3 days in the Multidisciplinary group compared to 9 days in the Standard group (p<0.01). CONCLUSION: These results suggest that a multidisciplinary intervention with review of the traditional surgical care program would enhance recovery, decrease morbidity and hospitalization after abdominal aortic surgery.
Asunto(s)
Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Tiempo de Internación/estadística & datos numéricos , Procedimientos Quirúrgicos Vasculares/métodos , Anciano , Anestesia Epidural , Aorta Abdominal/patología , Aneurisma de la Aorta Abdominal/patología , Procedimientos Quirúrgicos Electivos/métodos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Femenino , Humanos , Laparotomía/métodos , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos , Grupo de Atención al Paciente , Alta del Paciente/estadística & datos numéricos , Atención Perioperativa/métodos , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/estadística & datos numéricosRESUMEN
Aim of this work is to present our surgical technique, i.e. a left sub costal transperitoneal minilaparotomy, used in 40 patients operated on in the last year for atherosclerotic aorto-iliac occlusive disease (aortofemoral bypass) and aortic or aorto-iliac aneurysm (aorto-aortic graft or aorto-iliac bifurcated graft sutured on the common iliac arteries). The patients are placed in a dorsal decubitus. The cutaneous incision of 10 to 15 cm, depending on the abdominal size, is parallel to the condro-costal edge and spreads from the linea alba to the edge of the rectus muscle. The linea alba is usually incised; the oblique and the transverse muscles are not touched. The bowel is maintained within the abdominal cavity. Usually we do not use self-retaining retractors. The abdominal wall and the bowel are retracted with moistened towels maintained by blade intestinal retractors. When the abdominal cavity is gained, conventional dissection of the aorta and iliac arteries is carried out. These manoeuvres and the following surgical procedure are performed as usually with standard vascular instruments. Nasogastric suction and drains are not used routinely. In our series, this minilaparotomy technique, joined to <
Asunto(s)
Aorta Abdominal/cirugía , Implantación de Prótesis Vascular , Laparotomía/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos , Aneurisma/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Enfermedades de la Aorta/cirugía , Arteriopatías Oclusivas/cirugía , Arteria Femoral/cirugía , Humanos , Arteria Ilíaca/cirugía , Pierna/irrigación sanguíneaRESUMEN
A multimodal, rehabilitative, fast discharge approach to abdominal aortic surgery is analyzed. The approach was developed in two phases during the years 1997-2000: in the first phase (1997) patients had thoracic epidural anesthesia plus TIVA and analgesia. They had improvement of the classical surrogate outcomes and analgesia: pain relief, nasogastric tube withdrawal, mobilization, ileus, hospital length of stay were significantly (p< 0,01) improved when compared to a historical, standard management group (1996: general anesthesia or lumbar epidural anesthesia plus general anesthesia with gas). In the second phase we started a more aggressive perioperative approach based on thoracic epidural anesthesia plus general anesthesia with gas and spontaneous breathing and postoperative epidural analgesia, left subcostal minilaparotomy incisions, aggressive postoperative nursing and pain relief on the ward. Preliminary results on 44 patients show no mortality, low postoperative morbility (cardiac complications 2,2%, peripheral embolization 2,2%, no pulmonary complications), no ICU stay and fast hospital discharge (median: 3,5 days, range: 2-8 days) without complications. We conclude that preliminary data support the safety and the need for further improvement of a multimodal, aggressive rehabilitative approach in abdominal vascular surgery.
Asunto(s)
Periodo de Recuperación de la Anestesia , Anestesia de Conducción/métodos , Alta del Paciente/estadística & datos numéricos , Procedimientos Quirúrgicos Vasculares , Vías Clínicas , Humanos , Grupo de Atención al Paciente , Factores de TiempoRESUMEN
The aim of this paper is to present our six-year experience in the treatment of critical limb ischaemia, even if in the period (1987-1993) considered the definition of critical ischaemia had been partly reviewed in the publication of the "European Consensus Document on Critical Limb Ischaemia" (March 1989). Two hundred thirty-nine patients have been treated in our Unit for critical limb ischaemia: reconstructive surgery was used in 34% of cases, lumbar sympathectomy or spinal cord stimulation in 17% of cases and pharmacotherapy in 14% of cases. Taking into account arterial and graft patency as well as the percentage of limb salvage, our results were similar to those presented in the literature.
Asunto(s)
Isquemia/terapia , Pierna/irrigación sanguínea , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crítica , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The aim of this study was to establish whether a preoperative evaluation of cerebral haemodynamic reserve, carried out by means of transcranial Doppler and single photoemission computed tomography with a provocative test (acetazolamide) is able to select those patients who require carotid shunting to avoid cerebral ischaemia during clamping. All patients were monitored during operation by means of somatosensitive evoked potentials. Those patients who required shunting because of abnormal evoked potentials were also those who had a poor cerebral reserve with a perfusion and velocity increase below 15%. Only one neurological deficit developed in patients who were not shunted.
Asunto(s)
Arterias Carótidas/cirugía , Circulación Cerebrovascular/fisiología , Acetazolamida , Anciano , Isquemia Encefálica/prevención & control , Potenciales Evocados Somatosensoriales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio , Cuidados Preoperatorios , Tomografía Computarizada de Emisión de Fotón Único , Ultrasonografía Doppler TranscranealRESUMEN
Anticoagulation, by means of heparin and warfarin is, till now, the most common treatment in deep venous thrombosis. Although thrombolytic agents have been available for over 10 years, their use remains quite low, ranging from 15 to 20% of deep venous thromboses. This is due to the relatively high incidence of contraindications as well as to the fact that the potential advantages versus heparin are diminished by the increased bleeding risk and by the potential risk of pulmonary embolism (migration of partially lysed thrombi). Following the example of the "triple armed therapy" proposed by Rosenthal for the treatment of pulmonary embolism, we will evaluate if loco-regional thrombolysis, with the catheter wedged against the thrombus, associated with a temporary vena cava interruption by means of an intraluminal filter, can achieve a better lysis of the thrombus without pulmonary embolism. In our Unit 18 patients affected by proximal deep venous thrombosis were submitted to thrombolytic therapy, 6 to systemic treatment, 3 to local treatment and the last 9 to loco-regional thrombolysis, using recombinant tissue-type Plasminogen Activator. We obtained 10 complete lyses, 1 with systemic and 9 with loco-regional treatment. There were no major complications. Thus, we think that venous loco-regional thrombolysis with rt-PA at lower doses, associated with temporary caval interruption, can probably achieve a better lysis than systemic treatment without risk of pulmonary embolism and with a very low haemorrhagic risk, as in arterial loco-regional thrombolysis. Furthermore, loco-regional thrombolysis, by means of a faster thrombus dissolution, could better prevent post-phlebitic syndrome.
Asunto(s)
Terapia Trombolítica/métodos , Tromboflebitis/tratamiento farmacológico , Activador de Tejido Plasminógeno/uso terapéutico , Cateterismo Periférico , Embolia/prevención & control , Vena Femoral , Hemorragia/prevención & control , Heparina/administración & dosificación , Heparina/uso terapéutico , Humanos , Vena Ilíaca , Flebografía , Recurrencia , Tromboflebitis/diagnóstico por imagen , Activador de Tejido Plasminógeno/administración & dosificación , Activador de Plasminógeno de Tipo Uroquinasa/administración & dosificación , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéutico , Filtros de Vena CavaRESUMEN
The aim of this study is to establish whether a preoperative evaluation of the Cerebral Hemodynamic Reserve, carried out by means of transcranial Doppler and SPECT with provocative test (acetazolamide) can single out those patients who, because they are supplied with a poor cerebral reserve, are truly in need of intraoperative shunting after carotid clamping. All patients were intraoperatively monitored by means of Somato Sensitive Evoked Potentials (SSEPs). Those patients who were shunted due to abnormalities in SSEPs were also those who showed a perfusion and velocity increase below 15%, and therefore supplied, in our opinion, with a scanty cerebral reserve. No, but one, neurological deficit appeared on awakening in patients who were not shunted.
Asunto(s)
Arterias Carótidas/cirugía , Circulación Cerebrovascular , Acetazolamida , Anciano , Enfermedades de las Arterias Carótidas/diagnóstico , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/fisiopatología , Potenciales Evocados Somatosensoriales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
The aim of this study is to present a relatively rare case of paradoxical arterial embolism, found in a patient who was sent to us for serious pulmonary embolism. Taking into account that the foramen ovale, despite being functionally competent, remains anatomically patent in 30% of the adult population, we cannot neglect the possibility of a paradoxical embolism, in the presence of a sudden embolic limb ischemia unless heart pathology or aortic lesions can be held responsible. Furthermore it must not be forgotten that deep venous thrombosis in the lower limbs or in the pelvic plexus may go unobserved on a purely clinical evaluation.
Asunto(s)
Arteria Axilar , Embolia/complicaciones , Embolia Pulmonar/complicaciones , Tromboflebitis/complicaciones , Embolia/diagnóstico , Femenino , Humanos , Vena Ilíaca , Persona de Mediana Edad , Embolia Pulmonar/diagnóstico , Venas Renales , Tromboflebitis/diagnóstico , Tromboflebitis/cirugía , Vena Cava InferiorRESUMEN
The purpose of the present study is to underline the importance of the systematic search for iliocaval venous compression on the part of an aortoiliac aneurysm in the face of a clinical picture of suspected deep venous thrombosis. Early diagnosis of this syndrome, although rare in everyday experience, is of decisive importance, as is every other clinical sign of aneurysmal pathology prior to rupture. Correct, systematic diagnostic exclusion procedure, which is capable of leading to certain diagnosis in all cases is therefore necessary.
Asunto(s)
Aneurisma/diagnóstico , Aneurisma de la Aorta/diagnóstico , Arteria Ilíaca , Vena Ilíaca , Trombosis/diagnóstico , Anciano , Aneurisma/complicaciones , Aneurisma/cirugía , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/cirugía , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/cirugía , Masculino , Persona de Mediana Edad , Radiografía , Trombosis/etiología , Trombosis/cirugía , UltrasonografíaRESUMEN
Ergotamine tartrate and caffeine has been widely prescribed for the prevention and treatment of migraine headaches. Rarely the ergotamine can cause symptoms of peripheral vascular insufficiency, often concerning the lower extremities. A case report of bilateral severe ischemia to the upper limbs, caused by a chronic assumption of ergotamine tartrate is presented.