Focal aneurysmal change after spontaneous superior mesenteric artery (SMA) dissection has been reported rarely. A stent graft implantation can exclude false lumen and possibly make major abdominal operation avoidable. A 52-year-old male patient was admitted due to abdominal pain for 10 days. A CT scan showed severe narrowing of the true lumen of SMA, approximately a 7 cm segment from the origin, due to compression by the thrombosed false lumen. Five days after admission, abdominal pain aggravated progressively. The follow-up CT revealed focal aneurysmal dilatation of the dissected SMA segment. I report here an endovascular treatment with stent graft implantation for a focal aneurysmal change after SMA dissection.
Abdominal Pain ; Aneurysm ; Dilatation ; Follow-Up Studies ; Humans ; Male ; Mesenteric Artery, Superior ; Middle Aged ; Polyenes ; Stents ; Transplants

PURPOSE: Which graft material is appropriate for the above-knee femoropopliteal (AK fem-pop) bypass has been a controversy. We were to evaluate the usefulness of PTFE graft in AK fem-pop bypass by comparing the results of autogenous vein graft in below-knee femoropopliteal bypass. METHODS: This was a retrospective study of data for Fem-Pop bypass from August 1999 to August 2008. The median follow-up was 59.9+/-27.3 months. The demographic data, patency rate, secondary procedures, and amputation rate were compared, and statistical comparison was performed by Kaplan-Meier method, Log-rank test, and Chi-square test. RESULTS: Seventy-three bypasses were performed in 63 patients: PTFE graft in 48 cases (Group A), autogenous vein in 25 cases (Group B). Sixty-one patients (96.81%) were men. The mean age was 67.3+/-8.0 years. The indication for surgery was intermittent claudication in 27 cases (37.0%), critical limb in 46 cases (63.0%). The 6-yr primary patency rates were 28.1%; 60.3%, the 6-yr secondary patency rates were 37.2+/-8.4%, 67.0+/-14.7% in Group A and Group B, respectively (P<0.05). The number of secondary procedures was 31 and 3, respectively (P<0.05). Major amputation at later periods was not needed in Group B, but there were 9 cases in group A (P<0.05). CONCLUSION: PTFE graft for above-knee femoropopliteal bypass shows poor long-term patency with a large number of secondary procedures and a higher amputation rate than vein graft in BK Fem-Pop bypass. PTFE graft should be limited to patients with high operative risk, or poor venous graft.
Amputation ; Arteries ; Extremities ; Follow-Up Studies ; Humans ; Intermittent Claudication ; Male ; Polytetrafluoroethylene ; Retrospective Studies ; Transplants ; Veins

No abstract available.
Diagnosis* ; Venous Thrombosis*

The small saphenous vein (SSV) is an important graft in limb salvage surgery. It is frequently translocated for bypass surgery. Sometimes, the use of the SSV as an in-situ graft for posterior tibial artery or peroneal artery reconstruction offers the advantages of reduced vein graft injury and improved patency. Recently, saphenous vein mapping through computed tomography (CT) volume rendering technique offers a great quality view to the surgeon. We experienced a patient in whom a CT image with volume rendering technique revealed an aberrant SSV connected with the great saphenous vein at the medial malleolus level. This case indicates that an aberrant SSV may be successfully used as an in-situ conduit for bypass to the dorsalis pedis artery. Here, we present the case of a popliteal-to-dorsalis pedis in-situ vein bypass using a LeMaitre valvulotome (LeMaitre Vascular Inc., USA) under mapping of the aberrant SSV by CT volume rendering technique.
Arteries ; Humans ; Limb Salvage ; Saphenous Vein* ; Tibial Arteries ; Transplants ; Veins

No abstract available.
Hemodynamics*

No abstract available.
Hemodynamics*

This study was designed to evaluate the potential applicability of magnetic resonance imaging (MRI) for the diagnosis of acute renal vein thrombosis. Renal vein thrombosis was experimentally induced by surgical ligation of the left renal vein in a total of 21 rabbits. MRI was performed with a 0.5 Tesla superconductive magnetic system. Spin echo technique was used with varying TR and TE parameters. Spin echo images of the rabbit kidney were analysed for morphology and signal intensity. T1 and T2 relaxation times of the renal cortex and medulla were calculated from the images. After venous ligation, kidneys became enlarged. Low signal band along the outer medulla in T2 weighted images were characteristically shown from 1 hour to 3 days after ligation, Changes of cortex to medullar contrast (CMC) values were significant (p<0.05) in T1 - and T2- weighted images of the ligated side. T1 and T2 relaxation times were significantly prolonged (p<0.05) on the ligated side, both in the cortex and medulla from 1 hour to 2 weeks after the ligation, while T2 relaxation time on the contralateral side was significantly prolonged both in the cortex and medulla 2 weeks after venous ligation. The most useful MRI criteria for the diagnosis of renal vein thrombosis were enlarged renal size, and the low signal band along the outer medulla of ligated kidney. The relative intensity difference between cortex and medulla (CMC) in T1-and T2-weighted images, and T1 and T2 relaxation times were suggested to be the useful MR parameters for the diagnosis of acute renal vein thrombosis.
Diagnosis ; Kidney* ; Ligation* ; Magnetic Resonance Imaging* ; Rabbits ; Relaxation ; Renal Veins* ; Thrombosis

This study was designed to evaluate the potential applicability of magnetic resonance imaging (MRI) for the diagnosis of acute renal vein thrombosis. Renal vein thrombosis was experimentally induced by surgical ligation of the left renal vein in a total of 21 rabbits. MRI was performed with a 0.5 Tesla superconductive magnetic system. Spin echo technique was used with varying TR and TE parameters. Spin echo images of the rabbit kidney were analysed for morphology and signal intensity. T1 and T2 relaxation times of the renal cortex and medulla were calculated from the images. After venous ligation, kidneys became enlarged. Low signal band along the outer medulla in T2 weighted images were characteristically shown from 1 hour to 3 days after ligation, Changes of cortex to medullar contrast (CMC) values were significant (p<0.05) in T1 - and T2- weighted images of the ligated side. T1 and T2 relaxation times were significantly prolonged (p<0.05) on the ligated side, both in the cortex and medulla from 1 hour to 2 weeks after the ligation, while T2 relaxation time on the contralateral side was significantly prolonged both in the cortex and medulla 2 weeks after venous ligation. The most useful MRI criteria for the diagnosis of renal vein thrombosis were enlarged renal size, and the low signal band along the outer medulla of ligated kidney. The relative intensity difference between cortex and medulla (CMC) in T1-and T2-weighted images, and T1 and T2 relaxation times were suggested to be the useful MR parameters for the diagnosis of acute renal vein thrombosis.
Diagnosis ; Kidney* ; Ligation* ; Magnetic Resonance Imaging* ; Rabbits ; Relaxation ; Renal Veins* ; Thrombosis

To report a case of acute superior mesenteric artery (SMA) embolism successfully treated with aspiration and pharmacological thrombolysis. A 74-year-old female was admitted to the hospital with acute abdominal pain 5 hours in duration. Computed tomography angiography revealed a complete embolic occlusion distal to the first jejunal branch of the SMA. Aspiration and local continuous thrombolysis with urokinase resulted in near complete revascularization of the mesenteric flow after 4 hours and almost complete restoration after 20 hours. The patient made a complete recovery and continues to do well on warfarin therapy after treatment. Aspiration and thrombolytic therapy can be an alternative treatment modality in surgical high risk patient.
Abdominal Pain ; Aged ; Angiography ; Embolism ; Female ; Humans ; Mesenteric Artery, Superior ; Thrombolytic Therapy ; Urokinase-Type Plasminogen Activator ; Warfarin

PURPOSE: To evaluate the usefulness of comparison of the signal intensity of uterine septum in the differential diagnosis of bicornuate and septate uterus on magnetic resonance (MR) imaging. MATERIALS AND METHODS: Preoperative MR imaging findings of surgically proven 5 bicornuate and 6 septate uteri were retrospectively analyzed. Because preoperative differential diagnosis of both was possible in all cases in terms of the intercornual distance, external contour of uterine fundus, and divergent angle of two uterine cavities, these criteria were excluded in this study. The signal intensity of uterine septum in patients with bicornuate and septate uterus was analyzed on T1-weighted and fast spin echo T2-weighted images obtained in the axial and coronal planes, using a 1.5-T MR scanner. The signal intensity of uterine septum especially on T2-weighted images was compared with that of myometrium or junctional zone. RESULTS: The signal intensity of uterine septum in patients with bicornuate uterus (n=5) and septate uterus (n=6) was similar to that of myometrium in all cases on T1-weighted images. The septum of bicornuate uterus (n=5) on fast spin echo T2-weighted images was isointense with myometrium in three and hypointense in two cases. The uterine septum of septate uterus (n=6) on T2-weighted images was isointense with myometrium in two, hypointense in two, and isointense with or more hypointense than junctional zone in two cases. No patient showed different signal intensity between upper and lower uterine septum. CONCLUSION: Because the MR signal intensity of the uterine septum in bicornuate or septate uterus is variable, it should not be used alone in the differential diagnosis of them. In these clinically important differentiation, therefore, comprehensive analysis of MR findings in terms of the external contour of uterine fundus, intercornual distance, divergent angle of two uterine cavities, in addition to the signal intensity of the uterine septum, should be considered.
Animals ; Diagnosis, Differential* ; Female ; Humans ; Magnetic Resonance Imaging ; Mice ; Myometrium ; Retrospective Studies ; Uterus*