The aim of this paper is to present our six-year experience in the treatment of critical limb ischaemia, even if in the period (1987-1993) considered the definition of critical ischaemia had been ...partly reviewed in the publication of the "European Consensus Document on Critical Limb Ischaemia" (March 1989). Two hundred thirty-nine patients have been treated in our Unit for critical limb ischaemia: reconstructive surgery was used in 34% of cases, lumbar sympathectomy or spinal cord stimulation in 17% of cases and pharmacotherapy in 14% of cases. Taking into account arterial and graft patency as well as the percentage of limb salvage, our results were similar to those presented in the literature.
The aim of this study is to present a relatively rare case of paradoxical arterial embolism, found in a patient who was sent to us for serious pulmonary embolism. Taking into account that the foramen ...ovale, despite being functionally competent, remains anatomically patent in 30% of the adult population, we cannot neglect the possibility of a paradoxical embolism, in the presence of a sudden embolic limb ischemia unless heart pathology or aortic lesions can be held responsible. Furthermore it must not be forgotten that deep venous thrombosis in the lower limbs or in the pelvic plexus may go unobserved on a purely clinical evaluation.
The aim of this study was to establish whether a preoperative evaluation of cerebral haemodynamic reserve, carried out by means of transcranial Doppler and single photoemission computed tomography ...with a provocative test (acetazolamide) is able to select those patients who require carotid shunting to avoid cerebral ischaemia during clamping. All patients were monitored during operation by means of somatosensitive evoked potentials. Those patients who required shunting because of abnormal evoked potentials were also those who had a poor cerebral reserve with a perfusion and velocity increase below 15%. Only one neurological deficit developed in patients who were not shunted.
The purpose of the present study is to underline the importance of the systematic search for iliocaval venous compression on the part of an aortoiliac aneurysm in the face of a clinical picture of ...suspected deep venous thrombosis. Early diagnosis of this syndrome, although rare in everyday experience, is of decisive importance, as is every other clinical sign of aneurysmal pathology prior to rupture. Correct, systematic diagnostic exclusion procedure, which is capable of leading to certain diagnosis in all cases is therefore necessary.
The aim of this study is to establish whether a preoperative evaluation of the Cerebral Hemodynamic Reserve, carried out by means of transcranial Doppler and SPECT with provocative test ...(acetazolamide) can single out those patients who, because they are supplied with a poor cerebral reserve, are truly in need of intraoperative shunting after carotid clamping. All patients were intraoperatively monitored by means of Somato Sensitive Evoked Potentials (SSEPs). Those patients who were shunted due to abnormalities in SSEPs were also those who showed a perfusion and velocity increase below 15%, and therefore supplied, in our opinion, with a scanty cerebral reserve. No, but one, neurological deficit appeared on awakening in patients who were not shunted.
Anticoagulation, by means of heparin and warfarin is, till now, the most common treatment in deep venous thrombosis. Although thrombolytic agents have been available for over 10 years, their use ...remains quite low, ranging from 15 to 20% of deep venous thromboses. This is due to the relatively high incidence of contraindications as well as to the fact that the potential advantages versus heparin are diminished by the increased bleeding risk and by the potential risk of pulmonary embolism (migration of partially lysed thrombi). Following the example of the "triple armed therapy" proposed by Rosenthal for the treatment of pulmonary embolism, we will evaluate if loco-regional thrombolysis, with the catheter wedged against the thrombus, associated with a temporary vena cava interruption by means of an intraluminal filter, can achieve a better lysis of the thrombus without pulmonary embolism. In our Unit 18 patients affected by proximal deep venous thrombosis were submitted to thrombolytic therapy, 6 to systemic treatment, 3 to local treatment and the last 9 to loco-regional thrombolysis, using recombinant tissue-type Plasminogen Activator. We obtained 10 complete lyses, 1 with systemic and 9 with loco-regional treatment. There were no major complications. Thus, we think that venous loco-regional thrombolysis with rt-PA at lower doses, associated with temporary caval interruption, can probably achieve a better lysis than systemic treatment without risk of pulmonary embolism and with a very low haemorrhagic risk, as in arterial loco-regional thrombolysis. Furthermore, loco-regional thrombolysis, by means of a faster thrombus dissolution, could better prevent post-phlebitic syndrome.
