Peripheral Emergencies
Keywords:
Interventional radiology, Peripheral Artery Disease, Peripheral Intervention, Endovascular TechniquesAbstract
Early and adequate diagnosis is important for improving the patient`s quality of life and for reducing the risk of secondary vascular attacks. Patients with Peripheral vascular injuries present daily in emergency departments. A basic understanding of both blunt and penetrating injuries to the extremities and the resultant vascular abnormalities that occur with these injuries helps minimize mortality and morbidity. Management of peripheral vascular trauma utilizing endovascular techniques has increased in frequency as trauma surgeons have been more familiar with capabilities and more interventionalists experienced in these techniques become available. Extremity vascular and iliac artery trauma are common in most urban trauma centers with significant morbidity and mortality. Iliac artery injury has a reported 40% mortality. However, for the purposes of endovascular therapy, separation of the peripheral vascular bed into vascular segments and territories is useful, mainly because of differences in vessel structure and morphology that prescribe different interventional strategies. In specific vascular beds other etiologies must be considered in differential diagnostics. The response to arterial wall injury induces an inflammatory reaction, which over time forms the histopathological basis of PAD, identical to that seen in the coronary vasculature and brain vascular bed by development of atherosclerosis and subsequent plaque instability. The histopathological basis of disease is identical to that seen in the coronary vasculature and other vascular beds.
Although diagnostic and therapeutic decisions in patients with vascular disease are guided primarily by the history and physical examination, the use of non-invasive investigations has increased significantly in recent years, mainly as a result of technological advances in ultrasonography. Spiral computed tomography and Magnetic resonance angiography are new, minimally invasive techniques for vascular imaging. CTA and MRA replaced already the invasive angiography. Magnetic resonance angiography has the advantage of imaging a moving column of blood and does not require ionising radiation or iodinated contrast, but the technique has obvious drawbacks in terms of cost efficiency and accessibility to scanners.
Endovascular treatment with balloon angioplasty is well accepted for short segmental disease of the femoropopliteal artery. The immediate technical success of revascularization of the femoropopliteal segment by balloon angioplasty is reportedby almost all working groups to be very high.
Communication inside the highly specialized vascular team is necessary to make a therapy plan with low risk for the patient.
Exact knowledge of peripheral vascular anatomy is required for optimum image acquisition and interpretation. The development of duplex mapping, computer tomography (CTA), and magnetic resonance arteriography (MRA) is likely to obviate the need for much, of the strategic arteriography performed. DSA is reserved for interventional procedures.
References
• Björck, M., & Ravn, H. (n.d.). Authors' reply: Risk of new aneurysms after surgery for popliteal artery aneurysm (2008; 95: 571-575). British Journal of Surgery, 1185-1185.
• Brountzos, E. (2004). Iliac Artery Angioplasty : Technique and Results. 104, 532-539.
• Chatt, J. (2010). Semin intervent radiol, 38–43.
• Demirbas, O. (2005). Femoral Pseudoaneurysm Due to Diagnostic or Interventional Angiographic Procedures. Angiology, 553-556.
• Diwan, A., Sarkar, R., & Stanley, J. (2000). Incidence of Femoral and Popliteal Artery Aneurysms in Patients with Abdominal Aortic Aneurysms. Journal of Diagnostic Medical Sonography, 31(863), 175-175.
• Garcia, L. (2006). Epidemiology and Pathophysiology of Lower Extremity Peripheral Arterial Disease. (13), II-9.
• Heuser, R. (2005). Peripheral vascular stenting (2nd ed.). London: Taylor & Francis.
• Lanzer, P. (2007). Mastering endovascular techniques: A guide to excellence. Philadelphia, PA: Lippincott Williams & Wilkins.
• Layden, J., Michaels, J., Bermingham, S., & Higgins, B. (2012). Diagnosis and management of lower limb peripheral arterial disease: Summary of NICE guidance. BMJ, E4947-E4947.
• Schneider, P. (2013). Endovascular Skills Guidewire and Catheter Skills for Endovascular Surgery, Second Edition. Hoboken: Taylor and Francis.
• Serrano, F., Martin conejero, H., & Martin conejero, A. (2007). Peripheral Artery Disease: Pathophysiology, Diagnosis, and Treatment, 969-82.
• Trickett, J. (2002). Screening and management of asymptomatic popliteal aneurysms. Journal of Medical Screening, 92-93.
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