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Li H, Zhao Y, Xu YA, Li T, Yang J, Hu P, Ai T. Acute celiac artery occlusion secondary to blunt trauma: Two case reports. World J Clin Cases 2020; 8:6164-6171. [PMID: 33344619 PMCID: PMC7723708 DOI: 10.12998/wjcc.v8.i23.6164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/27/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute celiac artery (CA) injuries are extremely rare but potentially life-threatening and are more often caused by a penetrating injury rather than a blunt injury. The clinical manifestation of CA injuries is usually atypical, which easily causes missed diagnosis and misdiagnosis. Currently, there are only a few reports of acute traumatic occlusion of CA. The CA artery gives off branches to dominate the liver, stomach. and spleen; however, occluded CA did not cause significant organ ischemia, and the compensatory blood flow from the superior mesenteric artery (SMA) played a pivotal role.
CASE SUMMARY Herein, we report two cases of acute CA occlusion secondary to severe blunt trauma. Case one was a 19-year-old male, suffered from a motorcycle crash. He complained of dyspnea, and the closed drainage was performed soon after the hemopneumothorax was confirmed by ultrasound. Computed tomography (CT) scan revealed hemopneumothorax, multiple rib fractures, right scapular fracture, and liver rupture. Reexamination with contrast-enhanced CT suggested perihepatic fluid was significantly increased, and CA was occluded. Because the hepatic hemorrhage is associated with hepatic artery injury, the CA was retrogradely opened through the SMA, and then, the right hepatic artery was embolized with coils successfully through the conventional pathway. Stent implantation was not performed, and the CA occlusion was managed by conservative treatment. A follow-up CT scan 3 mo after discharge showed the origin of CA remained occluded. Case two was a 37-year-old man, suffered injury from fall from height. He complained of lower back and bilateral heel pain. Contrast-enhanced CT examination revealed multiple rib fractures, bilateral pneumothorax, fourth lumbar (L4) vertebral burst fracture, and pelvic fractures. Furthermore, a small high-density mass in a lesser peritoneal sac and in front of the abdominal aorta was detected. The reexamination 14 h after admission showed the CA was occluded. The patient was conservatively treated. The symptoms of nausea after meals disappeared about 4 wk later, and abdominal distension was significantly relieved after 6 wk. The abdominal CT angiography at 60 d showed that the CA thrombus was not recanalized.
CONCLUSION Patients with CA occlusion will have different clinical manifestations, and the dominant organ will not have obvious ischemia. Conservative treatment is safe, and the patient’s symptoms will be improved with the establishment of collateral circulation.
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Affiliation(s)
- Hui Li
- Department of Traumatology, Chongqing University Central Hospital, Chongqing 400080, China
| | - Yu Zhao
- Department of Radiology, Chongqing University Central Hospital, Chongqing 400080, China
| | - Yan-An Xu
- Department of Traumatology, Chongqing University Central Hospital, Chongqing 400080, China
| | - Tao Li
- Department of Traumatology, Chongqing University Central Hospital, Chongqing 400080, China
| | - Jun Yang
- Department of Traumatology, Chongqing University Central Hospital, Chongqing 400080, China
| | - Ping Hu
- Department of Traumatology, Chongqing University Central Hospital, Chongqing 400080, China
| | - Tao Ai
- Department of Traumatology, Chongqing University Central Hospital, Chongqing 400080, China
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Wang X, Luo X, Zhao M, Song J, Li X, Yang L. Prognostic Factors for Acute Transjugular Intrahepatic Portosystemic Shunt Occlusion Using Expanded Polytetrafluoroethylene-Covered Stent. Dig Dis Sci 2020; 65:3032-3039. [PMID: 31853780 DOI: 10.1007/s10620-019-06008-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/10/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The expanded polytetrafluoroethylene (ePTFE)-covered stent has been widely used in the transjugular intrahepatic portosystemic shunt (TIPS) procedure. However, the epidemiologic data of acute TIPS occlusion (ATO) and the underlying mechanisms are scarce. AIMS The purpose of this study was to evaluate the incidence and prognostic factors for ATO within 1 week in TIPS recipients using ePTFE-covered stents. METHODS We identified 222 patients who underwent ePTFE-covered TIPS creation for complications of portal hypertension between June 2015 and June 2017 at a large tertiary center. Medical records and TIPS procedure data were retrospectively reviewed, and the influence of these variables on ATO was assessed by multivariate logistic regression analysis. RESULTS TIPS technical success was achieved in 219 patients (98.6%). Two patients were excluded due to missing data, leaving 217 patients for final analysis. ATO occurred in nine patients (4.1%). Blood flow was restored by balloon angioplasty (n = 4), additional stent insertion (n = 4), and parallel TIPS (n = 1). In multivariable logistic regression, intrastent stenosis (HR 43.871; 95% CI 3.816, 504.373; P = 0.002), previous splenectomy (HR 26.843; 95% CI 2.106, 342.124; P = 0.011), and stent shortening in the hepatic vein (HR 11.54; 95% CI 1.021, 130.416; P = 0.048) were demonstrated as independent significant risk factors for ATO. CONCLUSIONS These findings suggest that the intrastent stenosis, previous splenectomy, and stent shortening in the hepatic vein are vital prognostic factors for ATO in TIPS recipients. Individualized post-TIPS management strategy was required.
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Affiliation(s)
- Xiaoze Wang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xuefeng Luo
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Ming Zhao
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jinlei Song
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Li Yang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
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Kwon HJ, Lim KH. Conservative treatment of acute traumatic left renal vein occlusion: Importance of left gonadal vein, case report. Int J Surg Case Rep 2020; 69:10-12. [PMID: 32248009 PMCID: PMC7132048 DOI: 10.1016/j.ijscr.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/12/2020] [Indexed: 11/18/2022] Open
Abstract
A blunt renal injury commonly leads to thrombotic partial renal infarct, but only rarely to an isolated acute renal vein occlusion. The surgical approach of thrombosed renal vein for preserving the kidney is likely to be an extensive operation, otherwise nephrectomy. Collateral pathway of the left renal venous drainage may be well known to urologists, but may be unfamiliar to trauma surgeons. If the gonadal vein is patent, left renal vein occlusion could be treated conservatively.
Introduction Isolated acute traumatic renal vein occlusion is rare. As both kidneys have limited capsular and peripelvic vein collaterals, acute renal vein occlusion could lead to renal infarction. However, the left renal vein has potential collateral pathways through the gonadal vein. Presentation of case A 56-year-old woman was transferred to our trauma center after a pedestrian accident. Computed Tomography (CT) with contrast enhancement showed that no delineation of left renal vein with adjacent retroperitoneal hematoma around renal vessels, but left renal venous flow was being drained through left gonadal vein, therefore, left kidney was not congested. Her serum creatinine concentration was normal. We elected to treat her left renal vein occlusion conservatively because of the collateral pathway into the gonadal vein. Discussion Collateral pathway of the left renal venous drainage may be well known to urologists or vascular surgeons, but may be unfamiliar to trauma surgeons. Therefore, trauma surgeon’s attempts for revascularization of thrombosed left renal vein may lead to massive bleeding or nephrectomy. Conclusion Acute left renal vein occlusion close to the inferior vena cava can result in temporary venous hypertension and congestion followed by complete or nearly complete return of function as collateral veins enlarge. If the gonadal vein is patent, left renal vein occlusion could be treated conservatively.
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Affiliation(s)
- Hyung Jun Kwon
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Kyoung Hoon Lim
- Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea.
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Giusca S, Raupp D, Dreyer D, Eisenbach C, Korosoglou G. Successful endovascular treatment in patients with acute thromboembolic ischemia of the lower limb including the crural arteries. World J Cardiol 2018; 10:145-152. [PMID: 30386492 PMCID: PMC6205845 DOI: 10.4330/wjc.v10.i10.145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/07/2018] [Accepted: 08/11/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To examine the efficacy and safety of the 6 French (6F) Rotarex®S catheter system in patients with acute limb ischemia (ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.
METHODS The files of patients in our department with ALI between 2015 and 2017 were examined. In seven patients, the Rotarex®S catheter was used in the proximal segment of the crural arteries. Data related to the clinical examination, Doppler sonography, angiography and follow-up from these patients were further used for analysis.
RESULTS Two patients (29%) had thrombotic occlusion of the common femoral artery, and the remaining five exhibited thrombosis of the superficial femoral artery and popliteal artery. Mechanical thrombectomy was performed in all cases using a 6F Rotarex®S catheter. Additional Rotarex®S catheter thrombectomy due to remaining thrombus formation with no reflow was performed in the anterior tibial artery in two of seven cases (29%), in the tibiofibular tract and posterior tibial artery in two of seven cases (29%) and in the tibiofibular tract and fibular artery in the remaining three of seven cases (43%). Ischemic symptoms resolved promptly in all, and none of the patients experienced a procedural complication, such as crural vessel dissection, perforation or thrombus embolization.
CONCLUSION Mechanical debulking using the 6F Rotarex®S catheter system may be a safe and effective treatment option in case of thrombotic or thromboembolic occlusion of the proximal and mid-portion of crural arteries.
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Affiliation(s)
- Sorin Giusca
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim 69469, Germany
| | - Dorothea Raupp
- Department of Gastroenterology and Diabetology, GRN Hospital Weinheim, Weinheim 69469, Germany
| | - Dirk Dreyer
- Straub Medical AG, Wangs CH-7323, Switzerland
| | - Christoph Eisenbach
- Department of Gastroenterology and Diabetology, GRN Hospital Weinheim, Weinheim 69469, Germany
| | - Grigorios Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim 69469, Germany
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Yi TY, Chen WH, Wu YM, Zhang MF, Chen YH, Wu ZZ, Shi YC, Chen BL. Special Endovascular Treatment for Acute Large Artery Occlusion Resulting From Atherosclerotic Disease. World Neurosurg 2017; 103:65-72. [PMID: 28377257 DOI: 10.1016/j.wneu.2017.03.108] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute intracranial atherosclerotic disease (IAD)-related large artery occlusion (LAO) is typically refractory to mechanical thrombectomy. We evaluated the feasibility and safety of emergency balloon-assisted or stent-assisted angioplasty performed with tirofiban administration for acute IAD-related LAO. METHODS We identified, from among 55 consecutive patients who underwent endovascular treatment for LAO, 12 patients with acute IAD-related LAO who underwent balloon-assisted or stent-assisted angioplasty with (n = 3) or without passage of a stent retriever. The treatment included tirofiban administration. We obtained, from patients' clinical records, thrombolysis in cerebral infarction scores (to assess the extent of reperfusion), follow-up magnetic resonance angiography images (to assess patency of the responsive arteries), and 90-day modified Rankin (mRS) scores (to assess outcomes). RESULTS Temporary blood flow and severe stenosis were observed angiographically in all 12 patients, either when the stent retriever was deployed or when a microcatheter was advanced through the site of occlusion. Persistent recanalization was achieved in all patients, and there was no operative complication or arterial reocclusion. All 8 patients with an occluded major artery in the anterior circulation had a good outcome, with an mRS score of ≤2. Two of the 4 patients with basilar artery occlusion had a good outcome, with an mRS score of ≤2. One patient (25%) died within 72 hours after procedure. CONCLUSIONS Our data point to the safety and feasibility of emergency balloon-assisted or stent-assisted angioplasty performed with tirofiban administration and a single or no passage of the stent retriever for acute IAD-related LAO.
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Affiliation(s)
- Ting-Yu Yi
- Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China
| | - Wen-Huo Chen
- Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China.
| | - Yan-Min Wu
- Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China
| | - Mei-Fang Zhang
- Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China
| | - Yue-Hong Chen
- Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China
| | - Zong-Zhong Wu
- Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China
| | - Yan-Chuan Shi
- Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China
| | - Bai-Ling Chen
- Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China
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Luo Y, Gong Z, Zhou Y, Chang B, Chai C, Liu T, Han Y, Wang M, Qian T, Haacke EM, Xia S. Increased susceptibility of asymmetrically prominent cortical veins correlates with misery perfusion in patients with occlusion of the middle cerebral artery. Eur Radiol 2016; 27:2381-2390. [PMID: 27655300 DOI: 10.1007/s00330-016-4593-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/09/2016] [Accepted: 08/30/2016] [Indexed: 03/06/2023]
Abstract
OBJECTIVES To evaluate tissue perfusion and venous susceptibility in ischaemic stroke patients as a means to predict clinical status and early prognosis. METHODS A retrospective study of 51 ischaemic stroke patients were enrolled in this study. Susceptibility, perfusion and National Institute of Health stroke scale (NIHSS) were compared between patients with and without asymmetrically prominent cortical veins (APCVs). The correlation between susceptibility, perfusion and NIHSS was performed. RESULTS Compared to patients without APCVs, the age of patients with APCVs was statistically older (p = 0.017). Patients with APCVs at discharge showed clinical deterioration in their NIHSS. Mean transit time (MTT), time to peak (TTP) and cerebral blood flow (CBF) in the stroke hemisphere were statistically delayed/decreased in patients with and without APCVs (all p < 0.05). In patients with APCVs, the changes in susceptibility positively correlated with increases in MTT and TTP (p < 0.05). Susceptibility and TTP positively correlated and CBF negatively correlated with NIHSS both at admission and discharge (p < 0.05). CONCLUSIONS Patients with APCVs have a tendency of deterioration. The presence of APCVs indicates the tissue has increased oxygen extraction fraction. Increased susceptibility from APCVs positively correlated with the delayed MTT and TTP, which reflects the clinical status at admission and predicts an early prognosis. KEY POINTS • Patients with and without APCVs have similar misery perfusion. • Patients with APCVs have a tendency of deterioration compared to those without. • The presence of APCVs indicated the tissue has increased oxygen extraction fraction. • Increased susceptibility from APCVs positively correlated with the MTT and TTP. • Increased susceptibility from APCVs reflected the clinical status at admission.
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Affiliation(s)
- Yu Luo
- Radiology Department, Branch of Shanghai First Hospital No.1878, North Sichuan Road, Shanghai, China, 200081
| | - Zhongying Gong
- Neurological Department, Tianjin First Central Hospital, Tianjin, China, 300192
| | - Yongming Zhou
- Radiology Department, Branch of Shanghai First Hospital No.1878, North Sichuan Road, Shanghai, China, 200081
| | - Binge Chang
- Neurosurgery Department, Tianjin First Central Hospital, Tianjin, China, 300192
| | - Chao Chai
- Radiology Department, Tianjin First Central Hospital, Tianjin, China, 300192
| | - Taiyuan Liu
- Radiology Department, Zhengzhou University People's Hospital, Zhengzhou, China, 450003
| | - Yanhong Han
- Radiology Department, Zhengzhou University People's Hospital, Zhengzhou, China, 450003
| | - Meiyun Wang
- Radiology Department, Zhengzhou University People's Hospital, Zhengzhou, China, 450003.
| | - Tianyi Qian
- Siemens Healthcare, MR collaboration, Northeast Asia, No.7, Wangjing Zhonghuan South Road, Beijing, China, 100102
| | - E Mark Haacke
- Radiology Department, Wayne State University, Detroit, MI, USA
| | - Shuang Xia
- Radiology Department, Tianjin First Central Hospital, Tianjin, China, 300192.
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