Stroke and intracranial interventions

Can interventions for Intracranial vascular disease prevent stroke better than medical therapies?

Carotid artery disease is recognized as a predisposing factor for the stroke in the diabetic or elderly hypertensive patients. The stroke in such patients is prevented by medical therapies and interventions. Segmental extra cranial carotid artery disease is amenable for endarterectomy or angioplasty stenting. But the intracranial vascular disease is not easily amenable for the operations or interventions. After succeeding with angioplasty and stenting of the extra cranial vessels the attention is now focused on the intracranial vascular repairs with angioplasty and stenting. The intracranial vessels are small and delicate. They can need much more careful handling and softer devices to pass through them and at the same time hard enough to dilate stenotic lesions.The 30-day rate of stroke or death associated with stenting in the SAMMPRIS trial (14.7%) is nearly 2.5 times as high as the 6% rate associated with stenting of symptomatic extracranial carotid-artery stenoses in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST, NCT00004732).

Large vessels with wall inflammation may have symptoms such as fever and body pains. These symptoms may be present even before the development of vascular dilatation or occlusions. MRI and CT scan may show the vascular wall thickness but PET CT ( FDG scan) can show the metabolically active endothelium.

Large Carotid body Tumors - Neurovascular importance

Subclavian artery thrombosis extending in to the Thoracic Aorta

Pulsatile swelling in the forearm

A middle aged man presented with pulsatile swelling in the upper part of the right forearm. There was no history of trauma. There were no dilated pulsatile veins. Radial and ulnar arteries were palpable at the wrist. Duplex scan reported it as a vascular tumor. The Spiral CT angiogram showed lesion arising from the proximal 1/3 of the radial artery. Abnormal dilatations connected with normal radial artery. The picture was not typical of aneurysm. During surgery mass looking like thrombosed aneurysm was completely excised and sent for histopathological examination. The report came as Masson's hemangioma (benign condition) and complete excision is the curative treatment.

AP BlackBerry Client: WHO: Blood tests for tuberculosis are unreliable

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Tuberous sclerosis is a group of two genetic disorders that affect the skin, brain/nervous system, kidneys, and heart, and cause tumors to grow. The diseases are named after a tuber- or root-shaped growth in the brain. Recently we have seen a young boy with acute ischemia of the left upper limb due to obstruction starting at the level of left axillary artery. Distally the vessel is diffusely narrowed. Incidentally we have noted abnormalities in the bones and face suggestive of tuberous sclerosis .  We evaluating the brain, kidneys, heart for any associated tumors.

IMG-20110713-00185.jpg

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Lymphatic malformation

Isolated lymphatic malformations are uncommon on the lateral side of the thigh. Completely excised.
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Aneurysm at the level of the renal arteries ( occlusion of the right renal artery and left renal artery arising from the aneurysm)-

Infra renal abdominal aortic aneurysms are common and relatively they are considered to be straight forward operations technically. But when the renal arteries are involved we need to do the addition planning to preserve the kidneys (at least one kidney) and repair the aneurysm. In the patients (see figure CT angio) there is occlusion of the right renal artery and left renal artery is arising from the aneurysm. The origin of the superior mesentric artery is abutting on the upper margin of  the aneurysm. In such a situation we need to plan to re-implant the left renal artery to the graft or auto transplant the kidney. Preservation of the right kidney is questionable when the artery is already for a very long time.

PEPFAR and AIDS future

Dear APVASCULAR.BLOGSPOT.COM,
Pinjala (pinjala@hotmail.com) has sent you an article from The Economist
online
Pinjala has also included the following message for you:
-----------------------------------------------------------------------
This is important to know how the focus on the AIDS management is going to
change in the coming few years with the available funds from different
sources.
-----------------------------------------------------------------------

Well, I declare!
Jun 9th 2011
MORE money, probably. That was the bottom line of the declaration that came
out of the UN General Assembly's high-level meeting on AIDS, which closed
on June 10th. It was, however, accompanied by a promise of more money for
real by PEPFAR, the American President's Emergency Plan For AIDS Relief,
and a series of PEPFAR's allies.The UN "recognised", in the nuanced
argot of diplomacy, an estimate made by scientists at its agency, UNAIDS,
that the amount of money which needs to be spent on AIDS per year in poor and
middle-income countries should reach something between $22 billion and $24
billion by 2015. However that recognition was prefaced, in a phrase that bore
the hallmarks of arm-wrestling behind the scenes, by a commitment only to
reach a "significant level" of annual global expenditure on the
disease.Not quite a target, then, but perhaps the best that could be expected
in these stringent times.

AP BlackBerry Client: India health costs a crisis impoverishing millions

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Superficial Femoral Artery (SFA) aneurysm - Ruptured

Isolated aneurysms of superficial artery are less common. When this happens in the rural villages these people get access to the vascular centers very late and there are some complications associated with it.  This is a case of SFA aneurysm which has ruptured and presented to us very late. We operated this patient under the Rajiv Aarogyasri scheme. A vein graft was interposed to repair the SFA (proximal saphenous vein). Post operative out come uneventful. Pulses were palpable and there were no aneurysms at the other sites. This patient received  two antiplatelet drugs in the post operative period and advised to continue them for 6 months. Some surgeons may be using only one antiplatelet drug such as Tablet Aspirin 75 mg or 150 mg once daily.

Tibial vessel injuries (3) - Repair of the posterior tibial artery!

Fig: Spiral CT and Intra -Operative photo

 

Tibial vessel injuries are generally managed conservatively as one of the three is usually is patent and supplies adequate blood to the distal leg and foot. Rarely we see all the three vessels are injured and distal foot is ischemic. In such situations we do consider repair of one of the tibial vessels to save the ischemic foot. In this case ( fig) posterior tibial artery was repaired ( resection and anastomosis) and the other occluded vessels are not repaired. Nerve injury is left for the secondary repair. At the end of the procedure the repaired posterior tibial artery is pulsting well beyond the anastomosis.