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Dermal filler complications and management
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
One different strategy for venous occlusion in comparison to arterial occlusion is to relieve the local pressure effects caused by impaired venous drainage. As tissues fill with undrained blood, this compresses upon the arteries and nerves of local tissues with potentially catastrophic results. Therefore, as an emergency measure, the area of clot can be surgically opened (or attempted to be drained with a green needle) to decrease the increased pressure within tissues. This is by no means a definitive treatment, but it may decrease the chance of a localised compartment syndrome secondary to venous occlusion.
Arterial Thrombosis—Diagnosis and Management
Published in E. Nigel Harris, Thomas Exner, Graham R. V. Hughes, Ronald A. Asherson, Phospholipid-Binding Antibodies, 2020
H. Patrick McNeil, Steven A. Krilis, Colin N. Chesterman
The presentation of major arterial occlusion is so dramatic that diagnosis is not usually a problem. Stroke, myocardial infarction and peripheral arterial occlusion are easily recognized clinically, and can be confirmed using standard investigations. Visceral infarction can masquerade as other abdominal pathologies, but angiography usually provides the answer.
The cardiovascular system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Chronic arterial narrowing (stenosis) or blockage (occlusion) is almost invariably the result of atherosclerosis, and develops slowly and insidiously. Acute arterial occlusion may also result from atherosclerotic disease, but in a minority of cases it is due to embolism, and in a smaller minority, due to trauma. An embolism is solid matter, almost always thrombus, that has formed at one site in the cardiovascular system, has broken free and has travelled in the bloodstream until it has reached vessels that are too small to allow its onward passage; here it causes a blockage. The most common source of peripheral embolisation is the left atrium, in patients who have atrial fibrillation, which is why most patients with atrial fibrillation are prophylactically anticoagulated. Aneurysms are also liable to accumulate thrombus within them, and this may embolise distally.
Sensitivity and Specificity of the Platelet-Lymphocyte Ratio and the Neutrophil-Lymphocyte Ratio in Diagnosing Acute Mesenteric Ischemia in Patients Operated on for the Diagnosis of Mesenteric Ischemia: A Retrospective Case-Control Study
Published in Journal of Investigative Surgery, 2020
Erdem Karadeniz, Atıf Bayramoğlu, Sabri Selçuk Atamanalp
In the study group, the etiological cause was arterial occlusion in 119 patients and venous occlusion in 6 patients. Eighty patients had segmentary gangrene in the small intestine, 30 patients had segmentary gangrene in the small and large intestines, 9 patients had total gangrene in the small intestine, and 6 patients had segmentary gangrene in the large intestine. The surgical approach consisted of exploration in the 9 patients with total small intestine gangrene, and resection in the remaining 116 patients. Two of 9 patients with total small intestine gangrene underwent superior mesenteric arteriotomy and embolectomy intraoperatively. Two patients required a second look and a re-resection procedure. Sixty-three of 125 patients (50.4%) died. Three of 116 patients who underwent resection required massive resections. These patients developed a short-bowel syndrome, and there was no mortality in the follow-up.
Specific complications associated with non-surgical rhinoplasty
Published in Journal of Cosmetic and Laser Therapy, 2020
Tuyet A. Nguyen, Shivani Reddy, Nima Gharavi
Skin and soft tissue necrosis are rare but serious complications of filler injection. It is thought that necrosis from filler injections can be caused by two mechanisms: 1) intravascular embolization through direct injection into a vessel or 2) vascular compromise from external pressure from the filler material (8). The angular, dorsal nasal, and supratrochlear arteries are particularly vulnerable to this complication, and are all possible targets in the application of filler for non-surgical rhinoplasty (9). The glabella is also a watershed area with minimal collateral circulation and small caliber vessels making it susceptible to external pressure and tamponade (10). Signs of impending necrosis include severe pain, blanching, edema, and violaceous discoloration (11–13). However, it is important to distinguish arterial from venous occlusion. While arterial occlusion is often immediately accompanied by pain and blanching, venous occlusion may not present with significant pain but demonstrates venous mottling or a livedo-like phenomenon (13). It is important to recognize features of impending necrosis to allow for early intervention and prevention of further complications.
Association between mitral regurgitation and clinical outcome after endovascular thrombectomy in stroke patients
Published in Neurological Research, 2020
Junya Aoki, Kentaro Suzuki, Takuya Kanamaru, Takehiro Katano, Yuki Sakamoto, Akihito Kutsuna, Satoshi Suda, Yasuhiro Nishiyama, Kazumi Kimura
Routine imaging protocol prior to EVT was typically initiated by immediate magnetic resonance imaging (MRI) on a 1.5-T scanner (ECHELON_OVAL, Hitachi Medical Corporation) to examine patients with a suspected stroke. CT was not performed as a routine examination. Therefore, most cases of major arterial occlusion were diagnosed using magnetic resonance angiography (MRA). DWI was performed using the following parameters: repetition time (TR) of 6,000 ms; echo time (TE) of 65 ms; b values 0 and 1,000 s/mm2; field of view of 240 mm; acquisition matrix of 128 × 128; and slice thickness of 4.5 mm with a 2.5-mm gap. Time-of-flight MRA covered the circle of Willis with TR of 23 ms; TE of 6.9 ms; flip angle of 20°; field of view of 200 mm; acquisition matrix of 352 × 224; and section thickness of 1.2 mm. CT and CT angiography were used for patients with contraindications to MRI. Patients who were transferred from other facilities and were already diagnosed as having major arterial lesions, were generally skipped for any imaging before EVT, and were directly transferred to the digital subtraction angiography room. Digital Imaging and Communications in Medicine (DICOM) data on brain images obtained at another hospital were provided to the hospital; therefore, all of the EVT patient images were available at our stroke center.