Case Reports in Vascular Medicine最新文献

Acute limb ischemia (ALI) in neonates is a rare but critical condition often resulting from iatrogenic causes, such as arterial catheterization. This case highlights the unique challenges in diagnosing and managing ALI in this population, where evidence-based guidelines are scarce and treatment decisions rely heavily on expert consensus and extrapolation from adult data. We report the case of a premature neonate, born at 30 weeks' gestation, who developed ALI secondary to femoral artery thrombosis following arterial line insertion. The patient presented with bluish discoloration, diminished capillary refill, and absent distal pulses in the affected limb. Duplex ultrasonography confirmed occlusion of the right common femoral artery. Conservative management with anticoagulation and close observation was adopted by multidisciplinary consensus involving neonatology and vascular surgery. Despite signs of worsening ischemia and skin necrosis during therapeutic anticoagulation, the team opted to continue conservative management due to the high surgical risk posed by the patient's prematurity and multiple comorbidities. Over the next week, gradual clinical and imaging improvements were noted, including recanalization of the occluded artery and restoration of arterial flow, ultimately leading to successful limb salvage. This case underscores the importance of individualized, multidisciplinary decision-making in managing neonatal ALI. Conservative management with therapeutic anticoagulation can achieve favorable outcomes, even in cases with worsening ischemia, provided that close monitoring and optimal supportive care are ensured. It also highlights the need for further research to develop standardized pediatric guidelines for this rare but potentially devastating condition.

Introduction: Postthrombotic syndrome (PTS) describes a condition arising after an acute deep venous thrombosis (DVT) that is characterised by leg heaviness, discomfort, and recurrent venous ulceration. Venous disease is associated with significant morbidity and impairment of mobility due to pain, infection, and oedema. Report: We present a patient in his 40s attending with left lower limb ulceration, swelling, and refractory pain despite previous best medical management and superficial radiofrequency ablation. A venous duplex ultrasound revealed a trifid femoral vein with a competent and incompetent component. Venography showed patent deep veins but failed to offer the same level of detail as duplex. The patient underwent a femoral vein ligation after multidisciplinary discussion. The role of intraoperative duplex ultrasound was essential. The patient clinically improved and is now free of his venous ulcerations. Conclusion: Duplex provided vital information for surgical planning, which venogram was unable to offer. This is an imaging pitfall that is important to be aware of in patients presenting with recurrent venous disease. Our case highlights the importance of thorough clinical assessment and the value of the Doppler ultrasonography assessment in confirming venous incompetence.

Implantable subcutaneous chemoports are routinely employed for delivering chemotherapy in oncology. Spontaneous catheter dislodgement and embolization of the catheters are rare complications of the procedure. Herein, we report our experience with a patient presenting with spontaneous dislodgement and migration of the catheter to the pulmonary artery. The patient having familial adenomatous polyposis with adenocarcinoma of the right colon underwent total proctocolectomy and had placement of the chemoport through the internal jugular vein for adjuvant FOLFOX chemotherapy. The entrapped catheter was successfully managed by percutaneous retrieval by an interventional cardiologist.

Jugular venous compression syndrome (JVCS) is caused by internal jugular vein compression, leading to headaches, neck discomfort, tinnitus, vertigo, confusion, and blurred vision. These impairments can diminish functional outcomes and compromise quality of life for patients. Literature-based treatments focus on surgical approaches and do not include chemodenervation. However, chemodenervation may be an additional treatment modality to consider. We present the first published case of chemodenervation utilized to successfully treat debilitating neck pain, headaches, and vertigo symptoms for JVCS, resulting in improved functionality and quality of life. This chemical denervation to the anterior neck musculature was trialed in hopes of avoiding surgical intervention. After three treatments, significant symptomatic relief with improved ability to work, improved performance of activities of daily living, and enhanced quality of life were noted. Educating physicians about JVCS and the various treatment modalities available is essential, as less invasive treatment options may not only become available to assist with the functional component of the condition but could also serve as potential alternatives to surgical and endovascular management in carefully selected patients, with the goal of optimizing function and improving quality of life among patients.

Peripheral arterial disease (PAD) affects more than 230 million adults worldwide. Revascularization via angioplasty is a common method to manage stenosis in the superficial femoral artery (SFA). In-stent restenosis, however, is a common complication in endovascular interventions, especially in the SFA. Here, we present a case that involves recanalization of the SFA in a patient with a previously occluded stent and failed surgical revascularization. This patient initially presented with an occluded SFA which was stented. Four years later, the stent was reoccluded and surgical endarterectomy of the artery was performed with partial removal of the stent. Ten years later, the SFA is again occluded. Recanalization of the SFA using laser atherectomy and restenting of the occluded stent with GORE VIABAHN endoprosthesis was performed successfully. The combination of such methods is a suitable way to manage chronic lesions and minimize restenosis in patients with PAD.

This case report describes an instance of vulvar lymphangioma occurring in the setting of May-Thurner syndrome (MTS), an association between two vascular conditions that we do not believe has been previously reported. Lymphangioma, also known as lymphatic malformation, is a benign lesion typified by dilatation of endothelial-lined lymphatic channels involving the skin and subcutis, which can occur either as a congenital abnormality or as a result of acquired damage to lymphatic channels. Lymphangioma is a rare lesion in the vulva. MTS, also known as iliac vein compression syndrome or Cockett's syndrome, is a condition of left iliac vein obstruction due to overriding the right common iliac artery which can lead to iliofemoral deep vein thrombosis. In this report, we describe the case of a 29-year-old woman with MTS diagnosed at 7 years of age with poor lymphatic drainage and pelvic pain requiring left iliac vein stenting. She presented with left vulvar discomfort and chronic lower extremity edema and was found to have warty vulvar masses, with histopathological examination showing lymphangioma of the vulva. We believe that this is the first report of vulvar lymphangioma recognized in the setting of MTS, and we will discuss the clinical features, etiology, and possible pathophysiologic association between these two entities.

Nutcracker syndrome (NCS), a rare but impactful vascular condition, emerges from the compression of the left renal vein by adjacent major arteries, leading to a diverse array of symptoms such as hematuria, flank pain, and renal challenges. Highlighting the case of a 30-year-old male with an atypical presentation of NCS, this report explores the diagnostic complexities arising from its varied presentations and therapeutic options. It emphasizes the critical role of computed tomography (CT) in unveiling the underlying vascular constriction. Through this lens, the case underscores the necessity of considering NCS in the differential diagnosis of abdominal pain, advocating for a prompt and accurate diagnosis to guide effective management strategies, ranging from conservative approaches to surgical intervention. This stresses the importance of heightened awareness and ongoing research for optimizing patient outcomes in the face of this elusive condition.

Background: Previous reports have revealed various endovascular intervention techniques for prosthetic femoropopliteal bypass occlusion (PFPBO); however, treatment for PFPBO remains challenging for most interventionalists and vascular surgeons because the procedure is complicated. Most of the reported techniques involve device implantation. In the present study, we performed a combination of surgical graft thrombectomy and drug-coated balloon angioplasty for PFPBO without implanting any additional devices. Furthermore, we determined the favorable long-term results of this treatment using follow-up angiography. Case Presentation. A 77-year-old man with a history of chronic kidney disease and coronary artery disease presented to our clinic with rest pain on his left leg. Seven years prior to the current consult, he underwent femoropopliteal bypass (FPB) surgery using a prosthetic graft due to in-stent occlusion of the left superficial femoral artery (SFA). Four years after surgery, a duplex ultrasound scan revealed stenosis of the proximal anastomosis site; hence, medical therapy was continued. On the current consult, diagnostic angiography revealed occlusion of the FPB and infrapopliteal vessels. In the first attempt at recanalization, the guidewire was unable to pass through the occluded SFA. Therefore, another technique was performed to revascularize the FPBO and infrapopliteal vessels. We obtained an angiography of the left leg after inserting the guiding sheath via the right common femoral artery (CFA). First, surgical thrombectomy using a Fogarty catheter via the exposed left CFA was performed. Following endovascular therapy via the right CFA, we performed drug-coated balloon angioplasty for anastomotic stenosis and recanalized occlusive infrapopliteal vessels. Restenosis was not observed on follow-up angiograms. On further follow-up angiography, there was notable regression of the residual stenosis at the proximal anastomosis of the prosthetic graft.

Conclusion: This novel revascularization strategy may be a viable treatment option for PFPBO.