In this study, we describe our diagnosis and treatment of two patients who presented with femoral vessel compression caused by a cystic lesion in the groin. One case was diagnosed as adventitial cystic disease (ACD) of the common femoral artery resulting in leg claudication and the other was diagnosed as a ganglion cyst (GC) causing femoral vein compression and unilateral leg swelling. The operative findings differed between these two cases with respect to the dissection of the cyst and femoral vessel, but the postoperative histological examination results were similar. The pathogenesis of ACD and GC is not fully understood, and further investigation is needed to delineate the exact pathology of these uncommon conditions.
Adventitia ; Diagnosis ; Femoral Artery ; Femoral Vein ; Ganglion Cysts ; Groin* ; Hip ; Humans ; Leg ; Pathology

The use of ultrasonography and especially of contrast-enhanced ultrasonography (CEUS) in the diagnosis of vascular pathologies before and after interventions has significantly increased over the past years due to the broader availability of modern ultrasound systems with CEUS capabilities and more trained user experience in this imaging modality. For the preinterventional and postinterventional work-up of carotid diseases, duplex ultrasound as well as CEUS have been established as the standard-of-care examination procedures for diagnosis, evaluation, and follow-up. In addition to its use for carotid arterial diseases, ultrasonography has also become the primary modality for the screening of vascular pathologies. This review describes the most common pathologies found in ultrasonography of the carotid arteries, the abdominal aorta, and the femoral arteries.
Aorta, Abdominal ; Arteriovenous Fistula ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Stenosis ; Contrast Media ; Diagnosis ; Femoral Artery ; Follow-Up Studies ; Mass Screening ; Pathology ; Plaque, Atherosclerotic ; Ultrasonography*

OBJECTIVETo assess the clinical efficacy of retrograde puncture subintimal angioplasty (SIA) for treatment of occlusive diseases in the long segment of the infrapopliteal artery.

METHODSThe clinical data of 50 patients with occlusive diseases in the long segment of the infrapopliteal artery were retrospectively analyzed. The patients were divided into control group (n=25) and study group (n=25) and received antegrade SIA and retrograde puncture SIA with long balloon after the failed antegrade SIA, respectively. The ankle brachial index (ABI) and the temperature of the infrapopliteal skin before and after the operation were compared between the two groups.

RESULTSThe technical success rate was 100% in the 50 patients, who showed obviously improved ischemic symptoms without serious complications. The ABI of the study group increased from 0.31 ± 0.12 before the treatment to 0.47 ± 0.09 at 24 h, 0.56 ± 0.06 at 1 week, 0.63 ± 0.07 at 3 months, 0.58 ± 0.06 at 6 months, and 0.49 ± 0.03 at 12 months after the treatment, and the skin temperature increased from 28.13 ± 2.45 before the operation to 33.87 ± 1.24, 34.16 ± 0.44, 34.19 ± 0.25, 32.45 ± 0.25, and 31.05 ± 0.21 at the corresponding time points after the treatment, respectively, showing significant improvements after the operation (P<0.05). ABI, skin temperature and the patency rate were similar between the two groups at each of the postoperative time points (P>0.05).

CONCLUSIONRetrograde puncture SIA is safe and effective for treatment of arteriosclerosis obliterans in the infrapopliteal arteries with a high clinical success rate and a low complication rate after the failure of antegrade SIA.

Angioplasty ; Ankle Brachial Index ; Arterial Occlusive Diseases ; surgery ; Femoral Artery ; pathology ; Humans ; Popliteal Artery ; pathology ; Retrospective Studies

OBJECTIVETo compared 3 approaches to establishing Balb/c mouse models of hind-limb ischemia suitable for studies of regenerative medicine.

METHODSThirty eight-week-old male Balb/c mice were randomly divided into 3 groups for establishing models of hind-limb ischemia by both ligating and transecting the femoral artery proximal to the origin of the deep femoral artery branch, ligating the femoral artery proximal to the origin of the deep femoral artery branch, or ligating the femoral artery distal to the femoral artery trunk. The mice were continuously observed for 5 days after the operation, and hind-limb blood perfusion was monitored by laser Doppler imaging on the second postoperative day.

RESULTSAll the 3 surgical approaches caused blood flow block in the hind-limbs of the mice. In mice with ligation and transaction of the femoral artery proximal to the origin of the deep femoral artery branch, dry gangrene occurred in the whole hind-limb. Dry gangrene also occurred in the legs and paws of mice with ligation of the femoral artery proximal to the origin of the deep femoral artery branch. In mice with femoral artery ligation distal to the origin of the deep femoral artery branch, the sole of the foot was dry with scaling skin and necrosis of several digits; microscopically examination revealed a large quantity of necrotic muscles accompanied by muscle regeneration.

CONCLUSIONLigating the femoral artery distal to the origin of the deep femoral artery branch can be optimal for establishing Balb/c mouse models of hind-limb ischemia.

Animals ; Disease Models, Animal ; Femoral Artery ; Hindlimb ; pathology ; Ischemia ; Male ; Mice ; Mice, Inbred BALB C ; Necrosis

Anti-Bacterial Agents ; therapeutic use ; Child, Preschool ; Female ; Femoral Artery ; diagnostic imaging ; surgery ; Humans ; Lower Extremity ; blood supply ; Lung ; diagnostic imaging ; pathology ; Male ; Mycoplasma pneumoniae ; Pneumonia, Mycoplasma ; complications ; microbiology ; therapy ; Thrombolytic Therapy ; methods ; Thrombosis ; etiology ; microbiology ; therapy ; Tomography, X-Ray Computed

The aim of our study was to determine the impact of vascular access on in-hospital major bleeding (IHMB) in acute coronary syndrome (ACS). We analyzed 995 patients with non-ST elevation myocardial infarction and unstable angina at the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) moderate- to very high-bleeding risk scores in trans-radial intervention (TRI) retrospective registry from 16 centers in Korea. A total of 402 patients received TRI and 593 patients did trans-femoral intervention (TFI). The primary end-point was IHMB as defined in the CRUSADE. There were no significant differences in in-hospital and 1-yr mortality rates between two groups. However, TRI had lower incidences of IHMB and blood transfusion than TFI (6.0% vs 9.4%, P = 0.048; 4.5% vs 9.4%, P = 0.003). The patients suffered from IHMB had higher incidences of in-hospital and 1-yr mortality than those free from IHMB (3.1% vs 15.0%, P < 0.001; 7.2% vs 30.0%, P < 0.001). TRI was an independent negative predictor of IHMB (odds ratio, 0.305; 95% confidence interval, 0.109-0.851; P = 0.003). In conclusions, IHMB is still significantly correlated with in-hospital and 1-yr mortality. Our study suggests that compared to TFI, TRI could reduce IHMB in patients with ACS at moderate- to very high-bleeding risk.
Acute Coronary Syndrome/mortality/*pathology ; Aged ; Female ; Femoral Artery ; *Hemorrhage ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Odds Ratio ; Percutaneous Coronary Intervention ; Radial Artery ; Retrospective Studies ; Risk Factors ; Stents ; Treatment Outcome

OBJECTIVETo investigate the role of revascularization procedures with autologous greater saphenous vein in surgical management of iliac-femoral artery pseudoaneurysm in parenteral drug abusers.

METHODSTwenty-one patients with iliac-femoral artery pseudoaneurysm caused by parenteral drug abuse from 2004 to 2007 were enrolled. Among them, 15 patients were male and 6 were female; their average age was 31.3 years. The size of pseudoaneurysms ranged from 3.0 cm to 7.5 cm. Common femoral artery and distal external iliac artery were often involved. We performed arterial reconstruction on these patients with autologous greater saphenous vein as a graft after excising iliac-femoral artery pseudoaneurysm through a single curved inguinal incision. All patients were followed up, and the complications were recorded.

RESULTSThe surgical procedures were finished without intraoperative mortality or perioperative complications. All patients were free of claudication symptoms after the surgery except one case with preoperative popliteal artery stenosis. One case of infection and wound tissue fistula was found later. One case had inguinal incisional hematoma and another complained of numbness in thigh skin.

CONCLUSIONSThe use of autologous greater saphenous venous grafts for arterial reconstruction after pseudoaneurysm excision in drug abusers is safe and effective. This technique offers more advantages than arterial ligation alone without revascularization. An optimal greater saphenous venous graft is a prerequisite for revascularization.

Adult ; Aneurysm, False ; etiology ; surgery ; Female ; Femoral Artery ; pathology ; surgery ; Humans ; Iliac Artery ; pathology ; surgery ; Male ; Middle Aged ; Neovascularization, Physiologic ; Saphenous Vein ; surgery ; Substance Abuse, Intravenous ; complications ; Vascular Surgical Procedures ; methods ; Young Adult

This study sought to find out whether the femoral artery of rabbit could be occluded after microbubbles mediated intermitten ultrasound exposure. One hundred and eight rabbits were randomly divided into 3 groups subjected to 3 different factors, namely ultrasound, HIFU combined with Microbubble (the intermitten mode and the continuous mode). After exposure, HE staining was used for visual inspection of the histopathologic change of femoral artery. Electron microscope was used for observation of the ultramicrostructural change; digital subtraction radiography (DSA) was used for inspections of the change in blood flow. There were thrombi formed in the femoral artery and the blood flow was occluded; the endarterium of the femoral artery of rabbits was damaged, and there was cavitation observed in the intermitten exposure group. In the other two groups, there was no change in the the femoral artery of rabbits. Thrombus could be formed in the femoral artery, and blood flow was occluded after exposure to microbubbles-mediated intermitten HIFU.
Animals ; Blood Flow Velocity ; radiation effects ; Embolization, Therapeutic ; methods ; Female ; Femoral Artery ; pathology ; physiopathology ; radiation effects ; Male ; Microbubbles ; Rabbits ; Regional Blood Flow ; Ultrasonic Therapy ; methods

OBJECTIVE: We assessed the outcomes of a simplified technique for the percutaneous placement of a hepatic artery port-catheter system for chemotherapy infusion in advanced hepatocellular carcinoma with portal vein invasion. MATERIALS AND METHODS: From February 2003 to February 2008, percutaneous hepatic artery port-catheter insertion was performed in 122 patients who had hepatocellular carcinoma with portal vein invasion. The arterial access route was the common femoral artery. The tip of the catheter was wedged into the right gastroepiploic artery without an additional fixation device. A side hole was positioned at the distal common hepatic artery to allow the delivery of chemotherapeutic agents into the hepatic arteries. Coil embolization was performed only to redistribute to the hepatic arteries or to prevent the inadvertent delivery of chemotherapeutic agents into extrahepatic arteries. The port chamber was created at either the supra-inguinal or infra-inguinal region. RESULTS: Technical success was achieved in all patients. Proper positioning of the side hole was checked before each scheduled chemotherapy session by port angiography. Catheter-related complications occurred in 19 patients (16%). Revision was achieved in 15 of 18 patients (83%). CONCLUSION: This simplified method demonstrates excellent technical feasibility, an acceptable range of complications, and is hence recommended for the management of advanced hepatocellular carcinoma with portal vein thrombosis.
Angiography ; Antineoplastic Agents/*administration & dosage ; Carcinoma, Hepatocellular/*drug therapy/pathology ; *Catheters, Indwelling/adverse effects ; Embolization, Therapeutic ; Female ; Femoral Artery/surgery ; Fluoroscopy ; *Hepatic Artery ; Humans ; Infusions, Intra-Arterial ; Liver Neoplasms/*drug therapy/pathology ; Male ; Middle Aged ; Portal Vein/*pathology ; *Radiography, Interventional ; Treatment Outcome

OBJECTIVETo investigate the effect of interferon regulatory factors (IRFs) on neointimal formation after vascular injury in the mouse, and its possible mechanism.

METHODSVascular injury was induced by polyethylene cuff placement around the left femoral artery of IRF-1-deficient mice and C57BL/6J mice. The mRNA expressions of IRF-1, IRF-2, angiotensin II type 2 (AT2) receptor, interleukin-1 beta converting enzyme (ICE), inducible nitric oxide synthase (iNOS) were detected by RT-PCR and immunohistochemical staining.

RESULTSNeointimal formation after vascular injury was significantly greater in IRF-1-deficient mice than that in C57BL/6J mice (P<0.05). In contrast, TUNEL-positive nuclei to total nuclei in the neointima and media in vascular smooth muscle cell (VSMC) in the injured artery significantly attenuated in IRF-1-deficient mice compared to C57BL/6J mice (P<0.05). The expressions of AT2 receptor as well as pro-apoptotic genes such as ICE and iNOS in C57BL/6J mice were up-regulated in response to vascular injury, but this upregulation was attenuated in IRF-1-deficient mice.

CONCLUSIONSOur results suggest that IRF-1 induces VSMC apoptosis and inhibits neointimal formation after vascular injury at least partly due to the upregulation of AT2 receptor, ICE and iNOS expressions. These results indicate that IRF-1 exerts an inhibitory effect on neointimal formation through the induction of apoptosis in VSMCs.

Animals ; Apoptosis ; physiology ; Caspase 1 ; genetics ; metabolism ; Femoral Artery ; anatomy & histology ; pathology ; Interferon Regulatory Factor-1 ; genetics ; metabolism ; Interferon Regulatory Factor-2 ; genetics ; metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Knockout ; Muscle, Smooth, Vascular ; cytology ; metabolism ; pathology ; Nitric Oxide Synthase Type II ; genetics ; metabolism ; Platelet Endothelial Cell Adhesion Molecule-1 ; genetics ; metabolism ; Receptor, Angiotensin, Type 2 ; genetics ; metabolism ; Tunica Intima ; pathology ; physiology