Reviews in Vascular Medicine最新文献

Introduction

Fertility preserving surgery is rarely performed in placenta accreta and atonic thinned out lower uterine segment is frequently encountered.

Aim

To evaluate our new method of uterine conservation in abnormal placentation and oozing from the lower uterine segment.

Methods

Multiple interrupted uterine plicating transverse compression sutures with combined multiple level uterine artery ligation were performed over 24 cases.

Results

Six cases were excluded for hemodynamic instability and placenta percreta. It was sucessful in all cases of thinned out lower segment and placenta previa but failed in two cases of placenta accreta.

Conclusion

Conservative management for atonic lower uterine segment and abnormal placentation through modified transverse B-lynch suture can be performed with high success and conserving female fertility.

Autologous veins are the conduit of choice when performing an infra-inguinal arterial bypass procedure. However these grafts are at risk of failure. This is multifactorial in nature and relates to patient factors, factors relating to the procedure as well as adaptive processes which occur after the formation of an infrainguinal bypass graft. Duplex ultrasound assessment of haemodynamic findings within the graft is the most accurate method of identifying vein graft stenosis and identifying grafts which are at risk of failure. Duplex ultrasound examination findings together with clinical factors can be used to individualise vein graft surveillance. This review examines the steps involved in a successful vein graft surveillance program, how to optimise the cost utility of vein graft surveillance by identifying the grafts which are at highest risk of failure and how there has been a paradigm shift away from surgical revision and towards endovascular revision of failing infrainguinal grafts.

Purpose

Abnormal uterine bleeding after abortion or delivery requires special management. Sonography with clinical and laboratory findings are important to narrow the differential diagnoses. Presence of increased uterine vascularity and arteriovenous shunting can be detected in retained trophoblastic tissue, gestational trophoblastic disease, and placental polyps and uterine vascular malformation are mainly related to failure of detection of associated pathology in the uterus on ultrasound. Here we are describing to both as a same entity for simplicity.

Methods and results

We present two cases of placental polyp with uterine vascular malformation, one case after abortion and the other case after vaginal delivery. The first case was multiparous female complaining of abnormal uterine bleeding three month after delivery. Ultrasound revealed diffuse uterine vascularity with echogenic vascular mass with blood flow velocity less than 40 cm/s that was evacuated and packed using hysteroscopy. The second case was also multiparus female complaining of abnormal uterine bleeding two months after abortion. Ultrasound revealed abnormal vascularity from perimetrium to the endmometrial mass. Hysteroscopic removal of the mass was done. Both patients were discharged after two days with menses resumed regularly afterwards.

Conclusions

Uterine vascular malformations may be associated with heavy bleeding. They should be suspected on ultrasound with anechoic structures with positive Doppler signal. Dilatation and curettage is therapeutic for evacuation of placental polyps but can induce massive, life-threatening bleeding in cases with uterine arteriovenous shunting or malfomration (AVM), thus it should be done with caution in endometrial pathology with high velocity flow more than 40 cm/s as infection and adhesions are associated. Treatment of uterine AVM varies from medical management (hormonal therapy), minimally invasive uterine artery embolization to more definitive surgical hysterectomy, depending upon age of the patient, size, site of the lesion, and the desire to retain future fertility.

Purpura Fulminans is a severe disorder of acute onset with high morbidity and mortality. Purpura fulminans (PF) is a hematological emergency in which there is skin necrosis and disseminated intravascular coagulation. This may progress rapidly to multi-organ failure caused by thrombotic occlusion of small and medium-sized blood vessels. PF may complicate severe sepsis. It most often occurs with sudden appearance of symmetrical, tender, ecchymotic skin lesions usually involving the lower extremities. Early recognition and early therapy with appropriate antibiotics and heparin is known to limit both morbidity and mortality. This article reports a case of Purpura Fulminans presented with DIC after hemorrhagic shock of postpartum hemorrhage.

The phenomenon of vasomotion, consisting in periodic oscillations of blood vessels walls is particularly important at the scale of small vessels and exhibits different features in arterioles (in which flow is mainly driven by the hydraulic pressure gradient) and in venules provided with valves preventing back flow and helping centripetal hematic propulsion. Here we formulate a model for both situations, based on approximations of the flow equations implied by the smallness of the radius-to-length ratio. For venules we postulate the presence of an inlet and an outlet valve and we show that the model reproduces the periodic pressure pulses that have been detected in the experimental literature devoted to venules of the batwing.

We have developed a model for describing the vasomotion, i.e. the flow in oscillating arterioles and oscillating venules. In arterioles vasomotion has little effect while in venules equipped with valves contraction-expansion cycles exert a propulsive action on the blood. The model reproduces reasonably well the data reported in the experimental literature.

Post-thrombotic syndrome (PTS) is the most frequent chronic complication of acute deep vein thrombosis (DVT). However, gaps in our current understanding of the risk factors, diagnostic criteria, preventive strategies, and even treatment modalities for PTS prevent clinicians from employing measures that could reduce the occurrence of this disorder and the associated morbidity. This review provides an overview of the important elements of PTS, including recent multifaceted aspects related to its definition, pathophysiology, risk factors, prevention and management.