Volume 7 - Issue 11 - November 2010
Special Focus: CLI »
Critical Limb Ischemia: Surgical Perspectives and Options
Critical limb ischemia (CLI) is a common vascular pathology with profound medical and socioeconomic implications. Eight to ten million Americans are presently thought to suffer from peripheral arterial disease, with approximately 500–1,000 new cases of CLI per million per year.1 The natural history of this disease has been well documented in recent studies: at 1 year, 25% will be dead, 30% will have undergone amputation, with only 45% remaining alive with both limbs.1 Although prevention of CLI remains the ideal, once diagnosed, management of CLI consists first of medical management of underlying cardiovascular risk factors, e.g., dyslipidemia and hypertension. There is evidence to suggest the beneficial effect of statins, thienopyridines and aspirin and, in certain cases, beta-blockers.1–5 Although it is clear that these agents are widely underused,6 it is equally clear that the outcomes remain dismal despite their use. The only established avenue to truly improving CLI outcomes remains revascularization.
Original Contribution »
A Conservative Approach to Acute Upper Limb Ischemia
Few studies report the use of conservative management in the treatment of acute upper limb ischemia (AULI). A retrospective series is presented from a hospital where a conservative approach is used primarily. Methods. A retrospective analysis of patients treated for AULI in our hospital over a 10-year period was carried out. Results. In our series of 17 patients with AULI, 1 was treated surgically and 16 were treated conservatively with anticoagulation as the primary therapy. Fourteen of 16 patients deemed suitable for conservative therapy were treated successfully (88%). Two patients required surgery after a period of failed conservative management, leading to full resolution of symptoms. This was comparable to published reports using embolectomy as the primary management. Conclusions. In selected patients conservative anticoagulation management (with a low threshold for intervention) is a viable alternative to surgical intervention as a first-line therapy in AULI.
Clinical Review »
Percutaneous Pulmonary Embolectomy: Indications, Techniques and Outcomes
Venous thromboembolic disease remains the third most common cardiovascular disease and one of the leading causes of sudden death in the United States. The true incidence of pulmonary embolism (PE) is unknown, but based on historic projections, it is estimated that more than 600,000 cases of PE occur every year in the United States.1 Approximately 10% of patients with PE do not survive their initial event. Of those who do survive, approximately 70% fail to have the diagnosis made and experience a mortality rate of 30%. If the diagnosis of PE is made promptly and appropriate therapy initiated, the mortality rate can be reduced to less than 10%.1–3 Once the diagnosis of acute PE is made, treatment should be initiated as soon as possible. The therapeutic options that are available should be tailored to each patient and clinical scenario.
Case Report »
Rectus Sheath Hematoma as a Complication of Ablation of Atrial Fibrillation
A rectus sheath hematoma is an uncommon condition and, to the best of our knowledge, no case has been reported in the literature as a complication of radiofrequency ablation of atrial fibrillation. Along with review of the pathophysiology and anatomy of this entity we report a case of a rectus sheath hematoma complicating an atrial fibrillation ablation procedure and propose methods for treatment and prevention.
Expert Q&A »
Latest Study Results from VEITHsymposium™ on Ultrasound-Accelerated Catheter-Directed Thrombolysis
At the recently concluded 37th Annual VEITHsymposium™ in New York, Peter H. Lin, MD, Professor of Surgery and Chief, Division of Vascular Surgery and Endovascular Therapy at Baylor College of Medicine (Houston, Texas), reported his findings on a 46-patient study of ultrasound-accelerated catheter-directed thrombolysis to treat acute massive PE.
