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Popliteal Artery Aneurysms: A 25-Year Surgical Experience
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
The growing popularity and availability of two techniques have in recent years exerted increasing influence on the risk benefit analysis surrounding repair of asymptomatic popliteal aneurysms. Endovascular options allowing popliteal aneurysm repair with less physiologic stress have continued the shift toward intervention.12–16 In addition, more sophisticated endovascular clot removal strategies have allowed some patients presenting with acute limb ischemia to be emergently managed with delayed elective definitive repairs. This strategy has been reported to result in limb-related outcomes similar to patients who did not present with acute limb ischemia,16,17 potentially mitigating the risks of observation of asymptomatic aneurysms.
Vascular emergencies
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Acute limb ischaemia is a vascular emergency that occurs when there is a sudden occlusion of the arterial supply to a limb. It is commonly caused by either an acute thrombotic occlusion of a previously stenosed arterial segment, or an acute embolic occlusion, most frequently cardiac in origin (atrial fibrillation, MI). Other causes include trauma and aortic dissection. The incidence of acute limb ischaemia in the UK is approximately 1 in 6000 per year and carries a significant mortality rate of 15%–25%.
The cardiovascular system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Paraesthesia This means abnormal sensations. Patients with acute limb ischaemia may have tingling sensations as well as pain, but usually they have reduced sensation. In the most severe or advanced cases, this amounts to frank numbness but, in less severe or earlier cases, the reduction in sensation may be mild and may be missed by a cursory assessment. Systematic testing of the sensory system to light touch and pin-prick, comparing the symptomatic limb with the opposite one, should be undertaken.
Symptomatic arterial thrombosis associated with novel coronavirus disease 2019 (COVID-19): report of two cases
Published in Acta Chirurgica Belgica, 2023
Nicolas De Hous, Paul Hollering, Ruth Van Looveren, Tu Tran, Dominik De Roover, Sven Vercauteren
The second patient was a 65-year-old man that presented to the emergency department with a 1 day history of cold, pale and painful feet. He had been diagnosed with a mild COVID-19 infection a week earlier and was in quarantine. He had no relevant medical history except for treated arterial hypertension (with an ACE inhibitor and calcium channel blocker), and he was an active smoker. On admission, he was afebrile and had a normal oxygen saturation (97%). Physical examination showed absent posterior tibial and dorsalis pedis pulses in both legs, but intact mobility and sensation, indicating bilateral viable ischemia (grade IIa according to Rutherford’s classification of acute limb ischemia). Furthermore, the patient was tachypneic (24 breaths/min) and had bilateral diminished breath sounds on lung auscultation.
Upper extremity necrotizing fasciitis in a Covid-19 patient
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Sriram Sankaranarayanan, Amanda F. Spielman, Anne-Sophie Lessard, Tarik Husain
In a recent review of 42 patients with COVID-19 and Acute Limb Ischaemia (ALI), Wohlauer et al. [10] found that the upper extremity was involved in 14% of the patients. Age > 60 years, hypertension, peripheral vascular disease and diabetes were found to be risk factors for the development of Acute Limb Ischaemia. Interestingly, the authors found that while ALI may be seen in patients with severe COVID-19, it is also being recognized to occur in patients with even mild to moderate COVID-19 symptoms. In their review, ALI has also been an initial presenting symptom of COVID-19 in the absence of respiratory symptoms. The patient presented in this case report developed ischaemia and gangrene in his finger insidiously. He did not recall any trauma or other inciting factors. The patient had only mild to moderate COVID-19 pulmonary symptoms. These findings are similar to the findings of Wohlauer et al. in their review.
Spinal cord stimulation in the treatment of peripheral vascular disease: a systematic review – revival of a promising therapeutic option?
Published in British Journal of Neurosurgery, 2022
Evridiki Asimakidou, Georgios K. Matis
Critical Limb Ischemia (CLI) is the advanced state of PVD, in which arterial blood flow to the lower limbs is markedly reduced. As a result, the basal tissue metabolism cannot be sustained and the limb’s viability is endangered. According to the clinical definition of the TransAtlantic Inter-Society Consensus II (TASC II), ‘the term critical limb ischemia should be used for all patients with chronic ischemic rest pain, ulcers or gangrene attributable to objectively proven arterial occlusive disease. The term CLI implies chronicity and is to be distinguished from acute limb ischemia.’3 CLI corresponds to Fontaine stages III and IV and Rutherford stages 4, 5 and 6. The treatment of choice for CLI is revascularization, either through percutaneous angioplasty or through bypass grafting. However, there are patients with non-reconstructable CLI because of no suitable vessels in selective angiography, previously failed bypass surgery or unfeasibility of a surgical intervention due to comorbidities and overall health status. For these patients, Spinal Cord Stimulation (SCS) appears to be an alternative solution instead of conservative treatment and amputation.