A case study on thrombolytic treatment of acute aortic saddle embolism using bilateral femoral arterial puncture catheter.

Although peripheral arterial embolism is a common vascular disease, abdominal aortic saddle embolism (ASE) is rare. However, ASE is considered to be quite severe. A rapid and accurate diagnosis followed by timely and appropriate medical intervention is the key to minimize the risk of severe complications and reduce the risk of mortality. We report the case of an 84-year-old female patient who was diagnosed with acute ASE. She was successfully treated using thrombolytic therapy through a bilateral femoral arterial puncture catheter. Our report aims at raising awareness of this potentially fatal disease, highlighting the importance of rapid diagnosis and timely treatment, and exploring the possibility of endovascular treatment for ASE in the future.

Pretreatment with the Free Radical Scavenger Edaravone Mitigates Kidney Glycogen Depletion and Neutrophil Infiltration after Leg Ischemia in a Rat Model: A Pilot Study.

Objective: We have previously shown that pretreatment with the free radical scavenger edaravone (Radicut®, Mitsubishi Tanabe Pharma Co., Japan) mitigated skeletal muscle damage due to ischemia reperfusion. In this study, we sought to validate its use in an experimental model of myonephropathic-metabolic syndrome (MNMS). Methods: Either edaravone (3.0 mg/kg; edaravone group; n=4) or saline (saline group; n=6) was intraperitoneally injected into male Lewis rats (508±31 g). Normal kidneys were harvested as control (n=3). MNMS was induced by bilaterally clamping the common femoral arteries for 5 h and declamping 5 h later. Kidney damage was evaluated by quantifying Periodic Acid Schiff (PAS)-positive area (glycogen storage) and esterase-positive cells (neutrophil infiltration). Results: The PAS-positive area in the saline group was significantly lower than that in the normal group (36.9±2.6 vs. 66.9±1.2%, P<0.01); the PAS-positive area in the edaravone group remained comparable to that in the normal group (52.9±0.9%, P<0.01). Esterase-positive cells in the saline group were significantly higher than in normal kidneys (62.4±5.6 vs. 17.5±2.4 cells/mm2, P<0.01), while they were significantly reduced in the edaravone group (32.8±5.7 cells/mm2, P<0.01). Conclusion: Edaravone pretreatment mitigates MNMS-induced kidney damage by reducing both glycogen depletion and neutrophil infiltration.

Edaravone injected at the start of reperfusion suppresses myonephropathic metabolic syndrome in rats.

The purpose of this study was to evaluate whether edaravone (Radicut(®), Mitsubishi Tanabe Pharma Co., Osaka, Japan) injected at the start of reperfusion can suppress myonephropathic-metabolic syndrome (MNMS). MNMS models were made by clamping the bilateral common femoral arteries for 5 hours. At de-clamping (at the start of reperfusion), they were intra-peritoneal injected with 9.0 mg/kg of edaravone (the edaravone group, n = 5) or an equal volume of saline (the control group, n = 5). At five hours after de-clamping, the lower extremity muscles were stained with hematoxylin & eosin (H&E) to count the viable cells, and periodic acid- Schiff (PAS) to assess the glycogen storage. The lungs were also stained with H&E to expresse the alveolar wall thickness, and naphthol AS-D chloroacetate esterase to label infiltrating active neutrophils. The viable muscle cells in the edaravone group was significantly greater than that of the control group (593 ± 60 vs. 258 ± 31 cells/mm(2), p < 0.01). The PAS-positive area in the edaravone group was also significantly higher than that in the control group (30.1 ± 6.9 vs. 7.3 ± 2.1%, p < 0.001). The alveolar wall thickness in the edaravone group was significantly lower than that in the control group (63.6 ± 5.6 vs. 17.2 ± 5.2%, p < 0.001). The active neutrophil infiltration in the edaravone group was also significantly lower than that in the control group (249 ± 59 vs. 68 ± 8 cells/mm(2), p < 0.001). We conclude that edaravone injected at the start of reperfusion can suppress not only muscle reperfusion injury but also lung damage.

Prevention of myonephropathic metabolic syndrome after operation of acute arterial occlusion by continuous renal replacement therapy / 上海第二医科大学学报

Objective To study the effect of continuous renal replacement therapy(CRRT) in preventing myonephropathic metabolic syndrome(MNMS) after operation of acute arterial occlusion. Methods Twenty-four patients with acute arterial occlusion were divided randomly into 2 groups: CRRT group(n=11) and control group(n=13).The patients were treated with embolectomy or revascularization.In control group,we used conventional therapy such as anti-inflammation,expansion of blood capacity,anticoagulation,and correcting acidosis and electrolyte disorder.In CRRT group,patients were treated by continuous veno-venous hemofiltration(CVVH) with 6 h during operation and 24 h after operation. Results In control group,24 h after operation,the serum potassium,blood urea nitrogen(BUN),serum creatinine(SCr),and myoglobin(Mb) were significantly increased(P

The management and prevention of acute abdominal aortic occlusion and myonephropathic metabolic syndrome / 中华胸心血管外科杂志

Objective: To summarize the experience in the management of acute abdominal aortic occlusion and myonephropathic metabolic syndrome. Methods: Thirty two cases of acute abdominal aortic occlusion treated between Aug. 1987 and Aug. 2003 in this department were analyzed retrospectively. Results: There were 11 deaths in surgical group (36 6%), mainly due to acute renal failure, metabolic acidosis and hyperkalemia postoperatively. Conclusion: Acute abdominal aortic occlusion is a potentially lethal disease, which would lead to limb. Early diagnosis and surgical restoration of aortic circulation might be helpful decrease the morbidity and mortality. The effective management of myonephropathic metabolic syndrome (MNMS), a common and severe complication of AAO would have a great impact on the therapeutic outcome. However, the mechanism, prevention and treatment of this syndrome further study.

The Extended Retroperitoneal Approach for Treatment of Abdominal Aortic Aneurysms / 日本心臓血管外科学会雑誌

From July 1984 to June 1998, 159 patients with infrarenal abdominal aortic aneurysms (AAA) were surgically treated in our hospital by the extended retroperitoneal (ERP) approach described by Williams et al. There were 132 men and 27 women, with a mean age of 69.3 years. Of the 159 patients, 82 (52%) had hypertension, 62 (39%) had coronary artery disease, of which 20 cases had previously received coronary artery bypass grafting, 17 (11%) had diabetes, 16 (10%) had thoracic aortic disease, 15 (9.4%) had cerebrovascular disease, and 14 (8.8%) had chronic renal dysfunction, including 6 cases on hemodialysis. Among these patients treated with this approach, 67 cases underwent tube grafting and 92 received Y-grafting. Patent inferior mesenteric arteries were ligated in all cases except one. Postoperative morbidity was observed in 54 cases (34%); lower extremity ischemia including microembolism or acute graft occlusion in 13, abdominal complication including paralytic ileus, liver dysfunction, or gastrointestinal hemorrhage in 11, wound complication in 9, pulmonary in 7, cardiac in 6, cerebral in 4, and the others in 4. No patient suffered ischemic colitis. There was hospital mortality in 4 cases (2.5%). Two patients died because of myonephropathic metabolic syndrome on second postoperative day. Two patients with combinations of several co-existing diseases died because of respiratory failure or multi-organ failure on the 48th and 141st postoperative day. Oral feeding was restarted at a mean of 2.7 days after the operation, and 64% of the cases did not require blood products. The mean postoperative hospital stay of survivors was 16.9 days (range, 7-63 days). Based on our clinical experience, we believe that the ERP approach is a safe and useful procedure for elective surgery for AAA to enable fast recovery and short hospital stay, especially in older and high-risk patients.

Acute Abdominal Aortic Occlusion: Two Cases of Successful Prophylaxis of Myonephropathic Metabolic Syndrome / 日本心臓血管外科学会雑誌

We report two cases, a 58-year-old male and a 60-year-old female with acute aortic occlusion probably ascribable to intracardiac thrombosis associated with atrial fibrillation. Thrombectomy was performed at about 5.5 hours and 4 hours respectively, after the onset of occlusion, and revascularization was successful. To prevent MNMS after revascularization, about 2, 000ml of blood was taken from the femoral vein of the male patient, and 1, 000ml of blood from the female patient, and this blood was returned in the form of abluted erythrocytes in transfusion through a cell saver to the patients. We suspected slight myoglobinuria after the operations, but they did not develop MNMS because a urine volume of about 3, 000ml was maintained by administration of infusion solution and diuretics and by replenishment of electrolytes and correction of acidosis. It was concluded that the technique involving the removal of a large volume of blood from distal veins and its transfusion through a cell saver was effective in preventing MNMS.

Clinical Experiences of Dissecting Aortic Aneurysm with Organ Ischemia / 日本心臓血管外科学会雑誌

We studied 6 surgical cases of dissecting aortic aneurysm with organ ischemia, consisting of 4 cases of DeBakey type I dissection and 2 cases of DeBakey type III b dissection and the average age was 62 years old. The ischemic organs were, the brain and upper extremities, intestine and kidney, kidney, kidney and lower extremity, and bilateral lower extremities, respectively. We performed the graft replacements of the ascending aorta or ascending aorta and arch for DeBakey type I dissection, and bypass or Y-graft replacement for DeBakey type III b dissection. In one case of DeBakey type I dissection we performed a second Y-graft replacement two days after the first operation. MNMS (myonephropathic metabolic syndrome) developed in two cases of 3 lower extremity ischemia. The results were unsatisfactory because 3 patients died. To improve of the outcome of surgical treatment in case of dissecting aortic aneurysm with organ ischemia, preoperative appropriate diagnosis and appropriate surgical planning are necessary.

A Case of Blue Toe Syndrome and Myonephropathic Metabolic Syndrome with Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

A 49-year-old man presented in emergency center with complaints of severe lumbago and severe pain of the right lower limb. Symptoms were suggestive of hernia nuclei pulposi and he was referred to orthopedic department of our hospital. His pain was not relieved by analgesics and the right lower leg was cyanotic with a swollen, hard, and tender calf. On palpation a pulsating mass was revealed in the mid-abdomen. He was transferred to the cardiovascular floor. CT and IA-DSA revealed an abdominal aortic aneurysm and no occlusion of the major arteries of the right lower leg. The serum glutamic oxaloacetic, lactic dehydrogenase levels all increased especially the creatinine phosphokinase increased to 46, 460IU/<i>l</i>, and the urine myoglobin level was 4, 200ng/ml. Myonephropathic metabolic syndrome (MNMS) was suspected. Urine volume was maintained with fluid infusion and diuretics. The blood urea nitrogen and potassium levels remained within normal limits throughout the course. The immediate recognition of MNMS and treatment of the condition were successful in preventing serious complications. But all the toes of the right foot became necrotic and they were amputated. Two months after admission, replacement of the abdominal aortic aneurysm was performed successfully. The patient was discharged in good condition one month after the operation.

A Case of Acute Abdominal Aortic Occlusion as a Result of Blunt Trauma / 日本心臓血管外科学会雑誌

Abdominal aortic injury caused by blunt trauma is rare. We examined a 69-year-old-male with acute abdominal aortic occlusion due to a steering wheel injury in an automobile accident. At the time of the emergency operation, the infra-renal abdominal aorta was occluded with a complete transection of the intima and media, resulting in a flap formation and thrombosis. Aortoiliac arterial replacement was performed with a bifurcated Dacron graft. The postoperative course was complicated and included acute cardiac failure, respiratory distress, and myonephropathic metabolic syndrome. The patient gradually recovered, and to date remains well, 6 months after surgery.