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Thushan Gooneratne,Mandika Wijeyaratne 대한혈관외과학회 2021 Vascular Specialist International Vol.37 No.3
Contemporary management of iatrogenic pseudoaneurysms is mostly performed using non-surgical techniques. Herein, we present a rare case of deep femoral artery (DFA) pseudoaneurysm with compression neuropathy, which required open repair. A 67-year-old female patient presented with increasing pain in the right groin, sensory neuropathy of the anteromedial thigh and upper leg, and quadriceps paralysis 4 days after coronary angiography via femoral puncture. Computed tomography angiography revealed a pseudoaneurysm of the DFA. The disabling compressive neuropathy warranted urgent open decompression rather than thrombin injection or endovascular therapy. Timely open evacuation of the hematoma, release of compression on the femoral nerve, and postoperative physiotherapy resulted in complete recovery of quadriceps power. The patient was pain free within 12 weeks and able to ambulate independently. This case report highlights the role of prompt open surgery for pseudoaneurysms with compression neuropathy.
Beneficial Effects of Insulin on Ischemia Reperfusion Injury in Human Skeletal Muscle
Thushan Dhananja Gooneratne,Shervanthi Homer-Vanniasinkam,Serosha Mandika Wijeyaratne 대한혈관외과학회 2022 Vascular Specialist International Vol.38 No.3
Purpose: Exaggerated leucocyte activity is a crucial step in the pathophysiology of skeletal muscle ischemia-reperfusion injury (IRI). We tested the hypothesis that insulin, via its’ anti-leukocyte activity, attenuates skeletal muscle IRI in humans. Materials and Methods: This randomized, blinded, placebo-controlled trial was conducted in patients with skeletal muscle ischemia who required revascularization. Treatment protocols were similar among them except for the insulin group, which received an infusion of insulin at 2.5 U/h. The degree of endothelial adhesiveness; leukocyte activity and pro-inflammatory status via P-selectin, tumor necrosis factor (TNF)-alpha, and myeloperoxidase (MPO) levels in the venous effluent; and clinical outcomes were measured. Results: Twenty-four consenting patients were randomized to the insulin or control group. There were no significant differences between the two groups except for the median serum insulin level, which was higher in the insulin group (P<0.01). No serious intervention-related adverse events were observed. P-selectin (55.04-99.86 pg/mL; P<0.001), MPO (110.8-160.6 pg/mL; P<0.001), and TNF-alpha (12.16-36.01 pg/mL; P<0.001) levels demonstrated a significant increase post-reperfusion in the ‘control’ group, reaching a peak value at 2 hours post-reperfusion. The increase in all three markers from baseline was significantly diminished in the insulin group at the two-hour (P-selectin, P=0.001; MPO, P=0.001; TNF-alpha, P=0.005) and four-hour (P-selectin, P=0.003; MPO, P=0.002; TNF-alpha, P=0.01) intervals. The differences in clinical outcomes between the insulin and control groups were not statistically significant. Conclusion: In clinical practice, insulin has the potential to attenuate the severity of skeletal muscle IRI inhibiting P-selectin, MPO, and TNF-alpha levels.
Spontaneous Transection of the Superficial Femoral Artery with Devastating Outcomes: A Case Report
Thilina Gunawardena,Manujaya Godakandage,Sachith Abeywickrama,Rezni Cassim,Mandika Wijeyaratne 대한혈관외과학회 2021 Vascular Specialist International Vol.37 No.3
Non-traumatic, simultaneous pseudoaneurysms of the bilateral superficial femoral arteries (SFAs) are extremely rare. Spontaneous transection of the SFA is another unique pathology. Here, we present a patient with end stage kidney disease who was diagnosed with bilateral, simultaneous SFA pseudoaneurysms. He had a recent history of methicillin-sensitive Staphylococcus aureus septicemia; therefore, infection was suspected to be the main cause. Complete transection of the SFA was noted during the operative exploration of the symptomatic left side. Wide debridement and autologous vein bypass were performed via a clean route. Unfortunately, two months later, recurrent surgical site infection caused distal anastomotic rupture and fatal sepsis.
Thilina Gunawardena,Manujaya Godakandage,Sachith Abeywickrama,Rezni Cassim,Mandika Wijeyaratne 대한혈관외과학회 2021 Vascular Specialist International Vol.37 No.4
It is uncommon for infective spondylitis to coexist with an infected aneurysm of the adjacent abdominal aorta. Also, pre-aortic confluence of the iliac veins or marsupial vena cava is a rare anatomical variant, which increases the potential for venous injury and hemorrhage during an emergency operation. Herein, we report the case of a 57-year-old male with these three pathologies, who was successfully treated with emergency open surgery. During surgery, we noted this anomaly and extensive destruction of the lumbar vertebral bodies. We discuss options to treat these rare pathologies with literature review.