A rationale is presented for extra-anatomic carotid cross-over bypass to maintain or restore blood flow to the internal carotid artery distal to sites of disruption and ligation of a common carotid artery. Anatomic evidence indicates that the attachment of the carotid sheath to the hyoid bone is a barrier to spread of infection cephalad to that level. A patient with infected and disrupted right common carotid artery associated with an esophageal fistula was treated by double ligation of the artery. Contralateral hemiplegia 48 hours later forced consideration of cerebral revascularization. Left carotid angiography demonstrated patent cerebral vessels on the right, with retrograde filling of the right internal carotid artery to the bifurcation. These findings were interpreted as consistent with technical feasibility of external carotid to external carotid cross-over vein bypass in a suprahyoid location, avoiding reconstruction in an infected area and resulting in prompt recovery of function.

Brain↗

PubMedDate not supplied

Dissecting hematoma presents as acute lower limb ischemia: diagnostic patient profile and management.

Three unusual cases with dissecting hematoma of the thoracic aorta, presenting solely with unilateral ischemia of the right lower extremity, are described. The world literature is reviewed. We present the following patient profile to facilitate the diagnosis: (1) hypertensive middle aged black male, or (2) young white male with stigmata of Marfan's syndrome, both complaining of sudden unilateral ischemia of the right lower extremity. Common causes of acute arterial occlusion are absent. The diagnosis, once suspected, must be confirmed by immediate angiography before planning the treatment for the limb ischemia. We advocate femoro-femoral bypass to relieve acute limb-threatening when definitive management involves delay in scheduling or requires transfer to another institution.

Aorta, Thoracic↗

PubMedDate not supplied

The evolution of counterpulsation techniques.

Assisted circulation techniques are an outgrowth of extracorporeal pump oxygenator systems developed in the mid 1950s. But the differences in physiology of total perfusions and of parital perfusions for assisting circulation delayed the clinical application of the intra-aortic balloon. The problems and risks in providing circulation assistance and the approaches used to overcome them are discussed. The various counterpulsation techniques are described and data presented to demonstrate the increased survival in patients with myocardial infarction and cardiogenic shock.

Assisted Circulation↗

PubMedDate not supplied

Counterpulsation--as exciting as politics.

Explore the source record for details and available documents.

Assisted Circulation↗