Occlusion of the common iliac artery caused by mycotic endocarditis

Mycotic endocarditis has an incidence of 6.7% of all the forms of endocarditis and in 33-75% of the cases it complicates with peripheral embolization, more frequently to the lower limbs. Although the prognosis of the mycotic endocarditis is improved in the last years, it remains particularly serious especially when it's associated with arterial peripheral embolization. The authors report their experience in the surgical treatment of one case of occlusion of the iliac artery secondary to mycotic endocarditis, making a review of the Literature on this matter.     

Salmonella typhi bacteremia and HIV infection with common iliac artery occlusion

BACKGROUND: The validity of excluding bereavement-related depressive episodes which satisfy all the criteria of major depression is examined in this community study. METHOD: A total of 658 subjects were interviewed in their homes using the Diagnostic Interview Schedule. The length of the episodes of depression, the dysfunction they caused, and the frequency of seeking and receiving treatment were assessed. RESULTS: The risk of recurrence did not differ whether the depressive episodes that satisfy the DSM-III-R criteria of major depression were or were not related to bereavement. CONCLUSIONS: Excluding from the repertoire of depressions all those related to external stressors might need more research, but singling out those related to bereavement does not seem to be supported by our community-based data.     

Stent implantation in acute myocardial infarction

Analysis of the data from 7188 cases seen in the 1980s two general hospitals in Shanghai and comparison of the data with those in the 1950s, 1960s and 1970s revealed that the percentage of heart diseases among the inpatients in medical wards increased in each decades, from 9.89%, 15.69% 20.91% to 23.54% respectively. The constituent ratios of different etiologic types of heart diseases changed. Coronary heart disease constituted the largest proportion, next in number was rheumatic heart disease and congenital heart disease was in the third place. The incidence of congenital heart diseases, myocarditis, cardiac dysrhythmias without organic heart diseases, cardiomyopathy and endocarditis increased and that of rheumatic heart disease, pulmonary heart disease and hypertensive heart disease apparently decreased, syphilitic heart disease was rarely encountered.     

Seat belt-related injury to the common iliac artery: case report and review of the literature

Blunt trauma to the common iliac artery is a rare phenomenon. Although seat belt injuries to the abdominal aorta and the carotid artery have been reported, there is only one previous report in the literature of seat belt injury to the common iliac artery. We report a case of common iliac arterial injury directly related to use of the lap belt and not associated with pelvic or lumbar fractures. The literature related to blunt trauma of the common iliac artery is reviewed.     

Noninvasive detection of iliac artery disease and prediction of its severity from Doppler spectral analysis in common femoral artery

The direct interrogation of iliac artery disease (IAD) with color-coded duplex scanning is limited by the presence of intestinal gas or obesity. The purposes of this study were to examine the diagnostic accuracy of duplex ultrasound (DUS) analysis of spectral waves in common femoral artery (CFA) for detection of IAD and to predict its severity. DUS and arteriography were performed in 107 lower extremities in this study. The following were calculated from the CFA spectral waves obtained by DUS: peak systolic velocity (PSV), acceleration (PSV/pulse rise time), and deceleration (PSV/pulse decay time). In patients with isolated IAD, the treadmill exercise test was also performed to evaluate the ischemic severity expressed as recovery rate of ankle pressure index five minutes after exercise (RR-API). Forty-six lower extremities with IAD and 61 without IAD were diagnosed by arteriography. PSV was significantly reduced in lower extremities with IAD (109.5 +/- 32.7 vs 59.8 +/- 32.9 cm/s, P < 0.05). The deceleration detected IAD with a greater specificity and sensitivity vs acceleration (100.0 vs 82.0% and 97.8 vs 82.6%, respectively). Moreover, the acceleration and deceleration significantly correlated with the RR-API (r = 0.589, P < 0.05 and r = 0.779, P < 0.01, n = 14, respectively). The present evaluation is a simple and accurate technique to augment other examinations for detection of IAD and to assess its ischemic severity.     

Intraarterial pressure gradients after randomized angioplasty or stenting of iliac artery lesions. Dutch Iliac Stent Trial Study Group

PURPOSE: To determine initial technical results of percutaneous transluminal angioplasty (PTA) and stent procedures in the iliac artery, mean intraarterial pressure gradients were recorded before and after each procedure. METHODS: We randomly assigned 213 patients with typical intermittent claudication to primary stent placement (n = 107) or primary PTA (n = 106), with subsequent stenting in the case of a residual mean pressure gradient of > 10 mmHg (n = 45). Eligibility criteria included angiographic iliac artery stenosis (> 50% diameter reduction) and/or a peak systolic velocity ratio > 2.5 on duplex examination. Mean intraarterial pressures were simultaneously recorded above and below the lesion, at rest and also during vasodilatation in the case of a resting gradient < or = 10 mmHg. RESULTS: Pressure gradients in the primary stent group were 14.9 +/- 10.4 mmHg before and 2.9 +/- 3.5 mmHg after stenting. Pressure gradients in the primary PTA group were 17.3 +/- 11.3 mmHg pre-PTA, 4.2 +/- 5.4 mmHg post-PTA, and 2.5 +/- 2.8 mmHg after selective stenting. Compared with primary stent placement, PTA plus selective stent placement avoided application of a stent in 63% (86/137) of cases, resulting in a considerable cost saving. CONCLUSION: Technical results of primary stenting and PTA plus selective stenting are similar in terms of residual pressure gradients.     

Stent implantation of the arterial duct in newborns with duct-dependent circulation

AIMS: Little is known about the medium term results after stenting of the arterial duct in neonates and infants with duct-dependent cyanotic congenital heart disease. We report the results of stent implantation of the arterial duct in 21 neonates and infants. The defects for which the arterial duct was stented included pulmonary atresia with intact ventricular septum, critical pulmonary stenosis, and more complex defects with associated reduced pulmonary blood flow. METHODS AND RESULTS: Palmaz stents were used and successfully implanted in all the 21 patients. There were no major complications during the stent implantation procedure although two hospital deaths occurred 2 and 14 days after stent implantation. Cardiac catheterization was repeated electively 3 to 6 months after stent implantation. Stent stenosis due to intimal proliferation was noted in 11/13 patients who underwent recatheterization. Stenosis of the inner stent lumen ranged from 25% to 100%, mean 74%. Re-dilatation of the stent was required in five patients who were awaiting corrective surgery. In babies with pulmonary atresia or critical pulmonary stenosis, who also underwent additional balloon dilatation of the pulmonary valve, spontaneous closure of the stented arterial duct was well tolerated and when it occurred, the right ventricular size had increased and the circulation was no longer duct-dependent. In patients who required subsequent surgical corrective treatment, stenting of the duct allowed the definite corrective operation to be performed as the first surgical procedure. During the follow-up period, ranging between 2 months and 2 years, mean 8.7 months increased growth of the pulmonary arteries was seen in all the patients. No distortion of the branch pulmonary arteries was seen. CONCLUSION: In patients with cyanotic congenital heart disease stenting of the arterial duct is an effective alternative to surgical aorto-pulmonary shunts.     

Perforation and localized dissection of the left common iliac artery during the modified Bentall procedure: a case report

We performed the modified Bentall procedure for annuloaortic ectasia in a 41-year-old man with Marfan's syndrome. Approximately 15 minutes after initiation of cardiopulmonary bypass with an arterial delivery via the left common femoral artery, perfusion volume gradually decreased and the abdomen of the patient was distended. Retrograde dissection was strongly suggested. Perforation and localized dissection of the left common iliac artery were recognized. Following repair of the lesion, the modified Bentall operation was carried out. Postoperative course was uneventful. The patient has been well for 22 months after the operation.     

Femoro-femoral crossover bypass in monolateral obstructions of the iliac artery

The Authors report the result of their ten-years experience with femoro-femoral crossover bypass in 26 patients affected with unilateral occlusion of the iliac artery. This bypass is an easy and quick procedure, useful in both short and long term. The patency rate after 58 months is 84.6%. Thus, its use indicated in a high number of patients, not only for a limb salvage treatment of a disabling claudication. The indications for this bypass can be extended to low surgical risk subjects, and it does not have to be considered only for the high-risk patients, instead of major surgery procedure on the aorto-iliac axis. The minimal necessary conditions of the limbs for performing the femoro-femoral crossover bypass are a pressure gradient of 35 mmHg and the angiographical demonstration of the unilateral occlusion. If the contralateral axis appears patent, but there are also multiple atherosclerotic sites, we consider other bypasses as therapeutical choices: aorto-bifemoral, ilio-femoral and the femoro-femoral cross-over itself; in the latter case we previously perform a transluminal angioplasty or an endarterectomy of the donor iliac artery. In these situations is essential to evaluate of the benefit/risk rate for every single patient.     

Outcome of percutaneous intervention in iliac artery stents

PURPOSE: To assess the safety and efficacy of secondary procedures in iliac artery stents. MATERIALS AND METHODS: Thirty-four patients (36 limbs) underwent one or more interventional procedures in iliac artery stents to treat restenosis (n = 30) or occlusion (n = 6). All patients were followed up by means of clinical and angiographic examination. Primary and secondary patency were assessed with angiography, duplex ultrasound, or both. Primary patency was determined after one interventional procedure, and secondary patency was determined at the end of the study (mean +/- standard deviation, 20.1 months +/- 17.5; range, 1-58 months). RESULTS: Immediate angiographic success was achieved in all cases. Four complications were observed. The primary and secondary cumulative patency rates were 77.5% +/- 7.6 and 94% +/- 4.1 at 6 months, 73% +/- 8.4 and 89.3% +/- 6 at 12 months, and 51.4% +/- 10.9 and 78.8% +/- 8.8 at 2 years. At the end of the study, 80% of the arteries were still nominally patent. CONCLUSION: Restenosis and chronic occlusion in iliac artery stents can be treated with percutaneous interventional procedures; however, stenosis can still recur.     

Spontaneous rupture of right iliac arterial aneurysm into ureter

Severe hypoxia unresponsive to maximum ventilatory support occurs both in idiopathic respiratory distress syndrome and meconium aspiration. We recently encountered a 980 g female infant with respiratory distress syndrome and 3 300 g female infant with meconium aspiration and persistant fetal circulation whose clinical course necessitated the use of tolazoline and dopamine to reduce pulmonary and to stabilize systemic pressures. The infant with respiratory distress syndrome responded with a PaO2 increase of 2.7 kPa while the infant with persistant fetal circulation and meconium aspiration showed a 51.6 kPa rise. Combined pharmacologic therapy may have a role in improving oxygenation status in severely hypoxemic infants receiving maximum support.     

Predilection of occlusive disease for the left iliac artery

Eighty-six consecutive patients operated on for atherosclerotic occlusion of the aortoiliac segment were examined regarding the severity of the disease in the left or right iliac arteries. Sixty-nine percent of 78 patients were found to have predominantly more severe lesions on the left side. A study of the geometric anatomy of the aortoiliac region in 14 male and 12 female cadavers revealed that the right common iliac take-off angle was wider than the left and the radius of curvature of the right osculating circle at the aortoiliac bifurcation was smaller than the left, with the asymmetry of the region being much more marked in males than in females. The predilection of occlusive disease for the left iliac artery is explained on the basis of these differences in local geometric anatomy and their effect on the local hemodynamics.     

Endovascular treatment of internal iliac artery aneurysms

BACKGROUND: Homeless people with mental illness have relatively high rates of human immunodeficiency virus, comorbid antisocial personality disorder, and may be homeless more frequently and for greater lengths of time. All of these factors may increase the risk of tuberculosis. METHODS: Our study was done to ascertain if homeless men with psychotic disorders are at an increased risk for tuberculosis infection. One hundred fifty homeless men were interviewed and given purified protein derivatives (PPDs) at a downtown shelter in New Orleans, Louisiana, during a 3-month period. RESULTS: The findings show a strong relationship between psychotic disorders and positive PPDs, with a relative risk of 4.48. CONCLUSIONS: Homelessness and mental illness present barriers to seeking and completing treatment for medical illnesses such as tuberculosis. Use of services may be low even when available; therefore, homeless men with psychotic disorders may be serving as a reservoir for tuberculosis.     

Renal artery aneurysm: case report of a ruptured calcified renal artery aneurysm

Renal artery aneurysms constitute one per cent of all aneurysms. To our knowledge, this is the first reported case of a calcified saccular arteriosclerotic renal artery aneurysm rupturing. Because the patient was in hemorrhagic shock, nephrectomy was performed. The postoperative course was complicated by acute renal failure, pneumonia, and small-bowel fistula, which responded to hemodialysis, antibiotics, and central hyperalimentation, respectively. This case and review of the literature emphasizes the need for elective revascularization of renal artery aneurysms by primary repair or bypass graft, rather than performing an emergency nephrectomy.     

Giant aneurysm of the middle cerebral artery

A case of a giant aneurysm of the middle cerebral artery, (4.5 X 4.5 X 9.5 CM) presenting as a mass lesion, which was successfully excised is described. This case is compared to the few previous accounts of giant aneurysms of the middle cerebral artery larger than 3 cm in diameter.