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Complications of open aortofemoral bypass
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
While not as common as infrainguinal occlusive disease, atherosclerotic occlusive aortoiliac disease remains a common cause of lower extremity ischemic symptoms in middle age and elderly patients. Though aortoiliac occlusive disease alone is rarely the cause of critical limb ischemia due to sufficient collateral circulation, it can result in disabling claudication involving the hips, buttocks, thighs, and calves. Critical limb ischemia may develop when this disease pattern develops in conjunction with infrainguinal disease. In males, this can also lead to impotence as a result of internal pudendal artery hypoperfusion. The triad of Leriche's syndrome is described as impotence, thigh and buttock claudication, and decreased femoral pulses, and should warrant a search for aortoililac occlusive disease. Aortoililac plaque can also be the cause of the microembolization of atherosclerotic debris to the terminal vessels in the feet, causing “blue toe syndrome” and leading to significant pain and potentially tissue loss despite adequate resting perfusion pressures and sometimes intact distal pulses.
Indications, techniques, and results of inferior vena cava filters
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
Scott T. Robinson, Venkataramu N. Krishnamurthy, John E. Rectenwald
Bleeding may also occur in up to 10% of patients treated with warfarin (Coumadin). The degree of bleeding is most often associated with the inactivation of the clotting cascade as indicated by an elevated international normalized ratio (INR). Patients with significantly elevated INRs are more likely to develop major hemorrhagic complications than those with mildly elevated levels.13 Routine monitoring and dietary counseling will help to prevent such complications. Monitoring should also be undertaken when there has been a change in concomitant medications. Several drugs have either a synergistic or antagonistic interaction with warfarin, resulting in decreased efficacy or increased risk of adverse events. In addition to bleeding complications, a small number of patients develop warfarin-associated skin necrosis, which usually is seen early and in the absence of adequate concurrent heparin treatment. This is most likely to occur in areas of increased subcutaneous fat and may also be associated with the “blue toe” syndrome. Should this develop, the drug must be promptly discontinued.14
Peripheral Vascular Disease
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Causes➢ Acute thrombus with pre-existing atherosclerosis (Acute-on-chronic Ischaemia) Often patient has a history of claudication.Usually no obvious source of emboli➢ Embolus Classically lodges at branching points of vessels.Cardiac sources account for 70-80% of emboli (mural thrombus after MI, arrhythmias, infective endocarditis, prosthetic heart valves, atrial myxoma).Can occur from pre-existing atheromas or arterial aneurysms.Blue toe syndrome- Atheroembolic debris resulting in distal small arterial occlusion with blueish discoloration of distal footParadoxical emboli can occur from intracardiac shunts (e.g. PFO) or AV malformations.➢ Other causes Direct arterial trauma.Intra-arterial drug injection.Aortic dissection.Popliteal aneurysm.Iatrogenic.
Disastrous Cholesterol Crystal Embolization After Transcatheter Aortic Valve Replacement
Published in Structural Heart, 2021
Kota Nishida, Ryosuke Higuchi, Mike Saji, Itaru Takamisawa, Mamoru Nanasato
Cholesterol crystal embolization (CCE) can occur after catheter manipulations including percutaneous coronary intervention and endvascular treatment. CCE leads to renal dysfunction and/or blue toe syndrome, and occasionally other systemic embolism. Transfemoral transcatheter aortic valve replacement (TAVR) requires a bulky catheter, and patients receiving TAVR frequently possess multiple atherosclerotic risks; therefore, CCE following TAVR might be underdiagnosed.