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Stroke
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Most transient ischemic attacks are caused by emboli that usually come from the carotid or vertebral arteries. Rarely, TIAs occur from impaired perfusion caused by severe hypoxemia, a lowered oxygen-carrying capacity of the blood, or increased viscosity – especially in arteries of the brain that have become stenotic. Reduced oxygen-carrying capacity of the blood may be caused by extreme anemia or carbon monoxide poisoning. Increased viscosity may be due to severe polycythemia. Cerebral ischemia is usually not caused by systemic hypotension unless it is extreme or there is preexisting arterial stenosis. This is because autoregulation regulates blood flow in the brain, to be nearly normal over widely ranging systemic blood pressure. Subclavian steal syndrome involves a subclavian artery that is stenosed, proximal to the start of the vertebral artery. The stenosed artery “steals” blood from the vertebral artery. The blood flow becomes reversed in the vertebral artery. Since the vertebral artery supplies the arms during physical exertion, there are signs of vertebrobasilar ischemia. Sometimes, a TIA can occur in a child that has an extreme cardiovascular disorder producing emboli, or with very high hematocrit levels.
Absent Radial Pulse (Either Side)
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Other common peripheral vascular conditions which appear in the short cases include: Abnormal position of the radial artery.Thrombosis/embolism in a peripheral (upper or lower limb) artery.Takayasu's arteritis.Subclavian artery stenosis.Brachial artery catheter.A-V shunt (for dialysis).Deep vein thrombosis.
Cardiovascular system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The vertebral arteries are similarly assessed using colourflow and spectral Doppler in order to determine whether there is antegrade flow, in other words the normal direction towards the head and brain, or abnormal retrograde flow away from the head. A vertebral artery is shown in Fig. 9.48a; the colour has been used in this instance to help identify the anatomy, which can be difficult to visualise. Figure 9.48b shows retrograde flow in the vertebral artery. This is indicative of subclavian steal syndrome, caused by blood pressure differentials and suggestive of severe stenosis or even occlusion in the subclavian artery proximal to the origin of the vertebral artery. Blood is ‘stolen’ from the vertebral artery to perfuse the arm, causing the retrograde flow.
Efficacy of tramadol versus dexamethasone in ultrasound guided supraclavicular block for forearm fractures. Does it make a difference?
Published in Egyptian Journal of Anaesthesia, 2023
Wesam Nashat Ali, Mohamed Hassan Bakri, Marwa Mahmoud AbdelRady, Norhan M Bakri, Esraa Gamal Abdel Nasser Fathy, Ola Wahba
The ultrasound machine was on one side, while the anesthesiologist was behind the patient’s head. Without a pillow, the patient’s head was directly on the operation table, facing the opposite direction. The patient’s jaw was being pressed by the hand carrying the probe. The coronal oblique plane of the supraclavicular fossa received the probe. The lateral side was used to insert the needle. It was possible to identify the pulsing hypoechoic supraclavicular artery. The bed’s head was slightly lifted to allow for a small amount of shoulder flexion and opening of the supraclavicular joint. The pleura and first rib could be seen because of the probe’s position. The subclavian artery is generally surrounded by a collection of hypoechoic circular formations that look like a bunch of grapes and are superior and posterolateral to the subclavian artery, typically representing the nerve structures (trunks or divisions).
Arteria lusoria: a trick of nature
Published in Scandinavian Journal of Gastroenterology, 2021
Sarah S. Jakobsen, Jens B. Frøkjaer, Anders C. Larsen
A barium swallowing test was performed, showing a narrow passage in the esophagus at the level of the third thoracic vertebra with an esophageal lumen of 7 mm (Figure 1). A gastroscopy confirmed the finding at approximately 20 cm beneath the teeth, in an otherwise normal esophagus and ventricle (Supplementary Video). For further diagnostics, a computed tomography (CT) of the thorax and abdomen was made, demonstrating an aberrant right subclavian artery, also called arteria lusoria, coursing posterior to the esophagus (Figures 2 and 3). Additionally, biopsies of the esophagus were taken during a second endoscopy for the purpose of differential diagnosis. The endoscopic reference score [3,4] was 1–2 depending on the endoscopist (see Supplementary Video). The histopathological examination identified an eosinophilic inflammation (38 eosinophilic granulocytes in one high power field at 4 cm above the gastroesophageal junction and none at 14 cm) below the narrowing. Proton pump inhibitor was prescribed as treatment and for improving symptoms. The result was a relief of odynophagia, but dysphagia remained, and the patient is now enrolled in an individual surveillance program consisting of both gastroenterologists and thoracic surgeons.
Percutaneous Transaxillary versus Surgically-Assisted Transsubclavian TAVR: A Single Center Experience
Published in Structural Heart, 2021
Ben Wilkins, Gintautas Bielauskas, Giulia Costa, Motoki Fukutomi, Lars Søndergaard, Ole De Backer
Details of the surgical access technique used for transsubclavian TAVR have been previously reported.7 To summarize, a 5–7 cm long incision just below and parallel to the clavicle was made from the mid-clavicular line to the axillary line. The subclavian artery was isolated by use of two rubber vascular loops passed around its proximal and distal portions and clamped at both ends. Heparin was administered to an activated clotting time (ACT) of <250 sec. A large 18–20 Fr Cook introducer sheath was amputated (10–12 cm length) and connected with the subclavian artery by means of a 15 cm x 8 mm GelweaveTM polyester vascular prosthesis (Vascutek-Terumo, UK) using a so-called “chimney” approach, i.e., the vascular graft was anastomosed (end-to-side) onto a lateral incision on the subclavian artery (at the distal end) and the 10–12 cm long introducer sheath was inserted into the vascular prosthesis and sealed to it by a 2–0 silk suture (at the proximal end). In this way, the introducer sheath did not extend into the subclavian artery and the TAVR device could be inserted and advanced “sheathless” through the subclavian artery. Once the TAVR device was implanted, the graft was clamped with vascular staple clips just above the anastomosis with the subclavian artery, avoiding additional manipulation of the vessel. Following hemostasis, routine surgical wound closure was obtained with an intradermic suture.