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Mitral valve repair clip detachment and embolization is a rare phenomenon, with few reported cases. We describe a case of subacute transcatheter mitral valve repair clip embolization presenting as an inferior ST-segment elevation myocardial infarction, with subsequent successful percutaneous device retrieval. (Level of Difficulty: Intermediate.).

We present a new technique for percutaneous retrieval of a U-kinked displaced Impella catheter. First, the hooker from the left femoral artery snared the catheter tip. Both catheter and hooker were pulled down simultaneously from two opposite sites until the u-kinking sat astride the aortic bifurcation. Finally, the loop was straightened by pulling both catheter and hook. Once unfolded, the hook was released and the catheter retrieved easily from the right femoral artery. This technique is highly reproducible because of several advantages. It is easy to perform, takes a short time, does not require special devices and it isn’t expensive.

Background Transcatheter aortic valve-in-valve replacement (ViV) has been widely accepted as a less invasive alternative to treat failed aortic surgical or transcatheter bioprosthetic valves. Angulated aortas present an additional challenge, particularly when using self-expanding transcatheter heart valves (SE-THV). Methods Two patients with failed surgical bioprosthetic aortic valves and one patient with a failed transcatheter bioprosthetic aortic valve underwent transcatheter aortic ViV using SE-THV. All were deemed high-risk for surgical aortic valve replacement by a heart team. All three patients had initial failed SE-THV delivery using a conventional approach with subsequent successful delivery using the endovascular snare technique. Results In Cases 1 and 2, the SE-THV was biased towards the greater curve of the angulated aorta and behind the outer frame of the bioprosthetic valve frame. An endovascular snare was deployed through a secondary left femoral artery access, and the valve delivery system was advanced through the snare in the ascending aorta. The snare was tightened around the SE-THV capsule proximal to the hat-marker, allowing deflection of the SE-THV and successful delivery. In Case 3, the SE-THV interacted with the tall frame of a failed SE-THV. A snare via the left femoral artery was deployed in the descending artery. The SE-THV was advanced through the snare, and both the snare and SE-THV were advanced together to the ascending aorta where the SE-THV was deflected and successfully delivered. Conclusions The endovascular snare technique is a feasible option for successful delivery of SE-THV during transcatheter aortic ViV in failed transcatheter or surgical bioprosthetic valves in angulated aortas.

Purpose: To modify a surgical catheterization method using the bent needle introducer in small animals. Methods: Eight-week-old male Lewis rats were used in the study. A needle introducer was created by bending a 21G injection needle at 45°. The bent needle introducer was used for catheter insertion into the left femoral artery of the rats under anesthesia. As a control, a catheter was directly inserted into the blood vessel without the introducer. The insertion time of each method was measured. Blood pressure and heart rate were measured 24 h after catheter insertion using the telemetry system. Results: Using the introducer, the catheter was successfully inserted within a short time in all rats. Without the introducer, a longer duration was required for catheter insertion. The frequency of the insertion with no catheter-based errors with the introducer tended to be higher than that without the introducer. The mean arterial pressure and heart rate 24 h after catheter insertion in each group were almost the same. Conclusions: We developed a surgical catheterization method using the introducer in small animals. This could potentially reduce the frequency of the insertion with catheter-based errors and insertion time.

Ischemia-reperfusion leads to damage in cell or tissue due to insufficient blood flow. The aim of present study was to determine the effect of zinc, melatonin and zinc + melatonin supplementations during 3 weeks on muscle tissue and plasma MDA and GSH levels. This study was performed on 38 male Wistar-Albino rats. Experiments groups were designed as sham-control, ischemia-reperfusion (I/R), zinc + I/R, melatonin + I/R and zinc + melatonin + I/R Ischemia-reperfusion was induced by left femoral artery occlusion (1 hour) and reopening (1 hour). At the end of experiments tissue and blood samples were analysed for MDA and GSH. MDA levels were increased, GSH levels decreased in I/R groups. However, zinc and melatonin supplementation inhibited MDA and increased GSH levels in I/R groups. The results of present study show that increased lipid peroxidation in muscle tissue by ischemia-reperfusion may be prevented by zinc and melatonin or zinc plus melatonin supplementation.

Rationale: As survival prospects improve for long-term patients with hemodialysis, it is common for patients to exhaust all upper extremity access options before other avenues need exploration. The purpose of this case report was to describe our experience in creating a prosthetic graft between left femoral artery and right femoral vein in a patient with history of central venous occlusion and bilateral femoral neck fracture. Patient concerns: A female patient with hemodialysis exhausted all upper extremity access options along with bilateral femoral neck fracture. Diagnoses: Patients with end-stage renal disease exhausted all upper extremity access options. Interventions: We performed a left femoral artery to right femoral vein dialysis access utilizing a prosthetic graft and autologous cephalic vein. Outcome: The graft was used for hemodialysis 3 weeks after the operation. There was no edema of the lower extremity through the immediate postoperative period as well as at follow up. The patient has been using the access for 9 months with no complication of thrombosis, infection, or bleeding. Lessons: Prosthetic graft between the left femoral artery and right femoral vein is a simple, safe and novel approach to creating lower extremity access. This method could be a viable means of hemodialysis access in selected patients.

Purpose: The present investigation evaluated the validity and reliability of carotid-toe PWV (ctPWV) as a non-intrusive measure of systemic arterial stiffness in healthy young adults. Methods: The Validity Trial examined the association and agreement between cfPWV and ctPWV in 33 adults (24 ± 2 years; 14 females), while the Reliability Trial assessed the variability in cfPWV and ctPWV in 13 adults (22 ± 2 years; 5 females) over repeat visits. Proximal pulse waves were acquired (applanation tonometry) from the left common carotid (CCA) for both measures, while distal pulse waves were acquired from the left femoral artery (applanation tonometry) and the second left toe (pulse oximeter) for cfPWV and ctPWV, respectively. Results: cfPWV (5.3 ± 0.7, 3.9–6.5 m/s) and ctPWV (5.4 ± 0.5, 4.6–6.3 m/s) demonstrated a moderate-to-strong positive linear correlation (r = 0.79, P < 0.01) and a strong intra-class correlation (ICC; ICC = 0.86, P < 0.01). The Bland–Altman plot demonstrated agreement between cfPWV and ctPWV with no fixed bias (0.1 m/s, ± 2SD: −0.8 to 0.9 m/s, P > 0.05) and all data points falling within ±2 SD of the mean difference between measures. cfPWV and ctPWV demonstrated reliability across visits as evidenced by low coefficients of variation (cfPWV: 3.4 ± 2.6%, ctPWV: 2.6 ± 2.5%) and strong ICCs (cfPWV: ICC = 0.91, ctPWV: ICC = 0.84, both P < 0.01). Conclusions: Through comparison with cfPWV, this study provides evidence to suggest that ctPWV yields a valid and reliable index of arterial stiffness in healthy young adults.

Missile embolization is a rare phenomenon with most cases reported in the literature as a consequence of direct or indirect vascular trauma. Despite their characterization as toys, traumatic injuries from pellet guns are associated with significant rates of morbidity related to their vascular and neurological complications. We present a 9-year-old boy who was shot in the chest with a pellet gun and suffered a femoral arterial occlusion and a delayed stroke in the middle cerebral arterial distribution.

Objective. To assess possible relationship between osteoporosis and cardiovascular diseases in women of postmenopausal period considering clinical and laboratory data. Material and methods. 98 postmenopausal women aged 45 to 70 years were included (50 in osteoporosis group and 48 in control group). Diagnosis of osteoporosis was confirmed by densitometry (values for spine and proximal femur less than -2,5 SD and more than -1 SD by T criterion respectively). Main risk factors of osteoporosis and cardiovascular diseases were assessed with questionnaires, biochemical measures of lipid and mineral metabolism were evaluated. ECG, EchoCG, carotid arteries and lower extremities vessels Doppler ultrasonography and densitometry were performed. Results. In most cases significant differences between groups were not revealed. Women of control group had later beginning of menopause (50 vs 48 years, p=0,005) and more children in families (2 vs 1, p=0,01). Differences on other risk factors were not revealed. Mineral and lipid metabolism measures, data of ECG and Echo CG did not differ between groups. Doppler ultrasonography (comparison of intima-media complex thickness) showed differences between groups only for right common carotid artery (0,75 vs 0,78, p=0,02), right common carotid artery bulb (0,96 vs 1,03, p=0,02) and left femoral artery (0,81 vs0,75, p=0,04). Conclusion. Cross-sectional cohort study did not reveal definite relationship between osteoporosis and cardiovascular diseases. Further complex studies with clinical, instrumental and biochemical methods are necessary.

Ischemic preconditioning-induced microcirculatory protection appears to be a systemic rather than a local phenomenon. This protection induced by remote ischemic preconditioning (RIPC) may be attributed to a humoral rather than a neuronal mechanism. An innervated (Inn, Groups 1 and 4) or denervated (Den, Groups 2 and 3) and vascular isolated right cremaster of the rat was prepared. Left femoral vessels were clamped (Groups 1, 2, and 4) for 45 min or unclamped (Group 3) as a control. After 2 hr of reperfusion in the left lower extremity, 4 hr of ischemia in the right cremaster was applied in Groups 1, 2, and 3. However, in Group 4, 4 hr of ischemia in the cremaster muscle was instituted before reperfusion of the left femoral artery was begun. Microcirculatory responses, including terminal arteriole diameter, capillary perfusion, and endothelium function were evaluated. Four groups (six rats per group) were designed: Group 1: RIPC (Inn); Group 2: RIPC (Den); Group 3: sham RIPC (Den); and Group 4: fake RIPC (Inn). Ischemia of 45 min followed by 2 hr of reperfusion in the left lower extremity of the rat induced a significant microvascular protection against subsequent 4-hr ischemia in both innervated and denervated cremasters. This microvascular protection at a distance was lost in sham RIPC and in fake RIPC groups. The results demonstrated that remote protection induced by ischemic preconditioning is a systemic phenomenon and due to a humoral mechanism.

Laser Doppler flowmetry (LDF) is a good method to investigate tissue microcirculation, but it has many standardization and measuring problems. To exclude these effects, we performed a test using LDF on rat skeletal muscle. In 12 CD outbred anesthetized rats, bilateral femoral vessels and the quadriceps femoris muscle were exposed. The left femoral artery and vein were clamped for 1 h by microvascular clips (ischemic side). On the right side, no other intervention was made (control side). An LDF probe was applied on the medial vastus muscle. Short-term occlusions (2-3 s) were performed before and after the 1-h clamping and on the control side while LDF curves were registered. The halftimes of ascending curves on the ischemic side were significantly elongated vs. the condition before clamping (P = 0.0007) or the control side (P = 0.0017). Microcirculatory changes caused by 1-h ischemia were shown by this simple, quick, and well-reproducible test on rat skeletal muscle.

Donepezil (DPZ) is an acetylcholine-esterase inhibitor currently used as the frontline drug to treat Alzheimer's disease. The aim of this study was to investigate the possibility of postmortem redistribution (PMR) of DPZ, which could complicate the determination of cause of death in medico-legal cases. Additionally, metabolic enzyme DNA polymorphism, drug-drug interaction and the presence of lesions in metabolic and egestion organs were examined to eliminate the possibility of a high antemortem DPZ concentration. Subsequently, the average DPZ concentration of four sites of peripheral blood (right and left femoral artery and vein) was compared with central blood and liver DPZ concentrations in seven postmortem cases. DPZ concentrations ranged from 0.02 to 0.45μg/mL in the peripheral blood, 0.09-0.4μg/mL in central blood, and from 1.2 to 6.7μg/kg in the liver. In most specimens, the concentrations were higher than the therapeutic range (approximately 0.030-0.075μg/mL). DPZ central blood to peripheral blood (C/P) ratios averaged 1.73±1.02 (±standard deviation) while liver to peripheral blood (L/P) ratios were higher and averaged 17.5±7.25. It is documented that a C/P ratio of less than (or about) 1.0 and an L/P ratio less than 5 are not indicative of PMR, whereas a C/P ratio exceeding 2 and L/P ratio exceeding 20 highlight a propensity for significant PMR. Our data suggest that DPZ exhibits a moderate degree of PMR. Additionally, a lowered pH was found in all blood specimens (

WOS: 000364708300012, Purpose: To investigate the re-endothelialization potential of erythropoietin (EPO) following microvascular anastomosis in rat femoral artery. Methods: Ninety-six male Sprague-Dawley rats weighing between 300 g and 320 g were allocated randomly into two groups (control and EPO, n = 48). Left femoral artery microvascular anastomosis was performed in the rats. The control group was given 0.5 mL of 0.09 % NaCl subcutaneously 48 h post-operatively while the EPO group was given 150 U/kg recombinant human erythropoietin subcutaneously 48 h post-operatively. Tissue was harvested from each group after 1, 3, 5, and 7 days. All of the rats were sacrificed for morphometric analysis. Each arterial segment was analyzed morphometrically using Clemex Image Analysis software by a single examiner. The cross-sectional area of the media and neointima was measured and the intima/media ratio was calculated. Hematocrit measurement was carried out for all the rats. Results: The I/M ratio differed significantly (p < 0.05) between the control and erythropoietin groups, at all time-points. The hematocrit was significantly (p < 0.05) lower in the control group than in the erythropoietin groups on day 7, but not on the other days. Conclusion: This study demonstrates that erythropoietin markedly inhibits neointima formation with accelerated re-endothelialization in rat femoral arteries following microvascular anastomosis.

The purpose of our research consists of studying a new dye which, besides allowing the macroscopic study of small vessels ¾ following the pioneer research of Salmon(3) ¾, permits the radiographic study due to its radiopacity. To do so, ten rats were utilized and their abdominal aorta was catheterized for the injection of the dye towards the periphery, being the flow of the dye observed along the left femoral artery (the right one was cauterized for occlusion). The results of this injection revealed that the dye penetrates well in extremely small vessels and allows dissection without extravasations. Thus, we believe that this dye has the necessary requirements for the study of details of the vascular anatomy. A proposta do nosso trabalho consiste no estudo de um novo corante que, além de permitir o estudo macroscópico de pequenos vasos ¾ seguindo a pesquisa pioneira de Salmon(3) ¾, possibilita o estudo radiológico por ser uma solução radiopaca. Para tanto foram utilizados 10 ratos e cateterizadas suas aortas abdominais para a injeção do corante no sentido da periferia, acompanhando o seu fluxo pela artéria femoral esquerda (a direita foi cauterizada). Os resultados de sua utilização na artéria femoral de rato mostraram tratar-se de uma solução com boa capacidade de penetração em vasos extremamente pequenos e que permite a dissecção sem que haja extravasamento do corante. Tendo em vista os resultados obtidos em ratos, acreditamos que o corante reúne os quesitos necessários para o estudo de detalhes da anatomia vascular.

An occupational hazard peculiar to fishermen, is an injury from a sharp fish spine. Such spines can cause envenomation injury, infectious sequelae or trauma to anatomical structures. The management of two fishermen with penetrating ratfish (Chimaera) spine injuries to the lower limb is described. Both were managed by removal of the spine under general anaesthesia. In the second patient, the spine was embedded adjacent to the left femoral artery, highlighting the potential for major haemorrhage and supporting the use of surgical wound exploration when important structures may be involved. Herein, we describe the first report in English of Chimaera spine injury. In addition, we surveyed nine northeast Atlantic deep-sea fishermen to gain information on exposure to, and injuries from, this type of fish. The most commonly identified species was Chimaera monstrosa. Five fishermen reported injuries to their feet or hands from Chimaera spines and two had sought medical attention. The evidence indicates that deep-sea trawler fishermen of the northeast Atlantic frequently encounter Chimaera species and can suffer dangerous penetrating wounds from its dorsal spine.

Epithelioid hemangioendothelioma (EHE) is an extremely rare tumor of vascular origin with intermediate malignancy potential. It usually originates from veins and very rarely from arteries. This case report presents a patient who underwent femoral mass resection after multiple femoral artery interventions for coronary heart disease with a probable preoperative diagnosis of pseudoaneurysm of the femoral artery. He had complete resection of the mass with corresponding segment of femoral artery because of atypical gross appearance. The histopathology revealed an intravascular EHE with moderate mitotic index and mild cellular abnormalities.

Pseudoaneurysm is an accumulation of blood extravascularly in a space or cavity related to an artery, associated with disruptions of vessel layers. We reported a 51-year-old male with a pseuudoaneurysm of the left femoral artery. A lump in the left inguinal region occured due to a instrument wound during his fifth hemodialysis. The 6x5 cm-sized lump was hard, fixed, and painful in palpation, and had a bluish red center. A bruit was detected on auscultation. Diagnosis was based on the occurence of the lump in the inguinal region after the fifth hemodyalisis, a bruit on the lump, and a USG doppler examination that showed an aneurysm of the left femoral artery. The patient was operated on, and a pseudoaneurysm of the left femoral artery was found during the exploration. On day 36, the patient’s physical condition was improved and he was permitted to leave the hospital. From the pseudoaneurysm aspect, the prognosis of this patient was good, but in general the prognosis was dubia ad malam.Key words: pseudoaneurysm, femoral arteryAbstrak: Pseudoaneurisma atau aneurisma palsu adalah akumulasi darah ekstravaskuler dalam suatu rongga yang terhubung dengan arteri, disertai disrupsi lapisan pembuluh darah. Kami melaporkan kasus seorang laki-laki berusia 51 tahun dengan pseudoaneurisma arteri femoralis. Diagnosis ditegakkan berdasarkan gejala dan tanda klinis dimana ditemukan benjolan di lipat paha kiri yang timbul akibat tusukan pada saat menjalani hemodialis kelima, pemeriksaan fisik adanya bruit pada benjolan, dan USG doppler memperlihatkan adanya aneurisma arteri femoralis kiri. Pasien dilakukan pembedahan, dan pada saat eksplorasi ditemukan adanya pseudoaneurisma arteri femoralis kiri. Setelah perawatan hari ke-36, keadaan pasien membaik dan bisa dipulangkan. Prognosis pseudoaneurisma pada pasien ini baik, tetapi secara keseluruhan dubia ad malam.Kata kunci: pseudoaneurisma, ateri femoralis

External hyperthermia has frequently been used to treat superficial malignant tumors. We postulated that transarterial internal hyperthermia may be effective for deeply located hypervascular tumors. We performed intravascular hyperthermia (IVH) for malignant hypervascular tumors that were transplanted into animals and evaluated the resulting histologic changes and antitumoral effects.We designed a special catheter to heat the injected saline. Sixteen rabbits with hypervascular VX2 tumors ranging from 2 to 2.5 cm in diameter in their left hindlimb muscles served as subjects. IVH was performed via the left femoral artery (temperature = 50 degrees C) in 11 rabbits. Two sessions of IVH were performed during 1 week. Two weeks after the two sessions of IVH, the rabbits were sacrificed and their tumors and feeding arteries were resected. Five control rabbits had 37 degrees C saline infused using the same technique.The temperature in the central zone of the tumor increased markedly to 42.3 +/- 0.5 degrees C (mean +/- standard deviation), compared with 40.3 +/- 0.4 degrees C and 39.2 +/- 0.5 degrees C in the peripheral zones of the tumor and the surrounding tissue, respectively. Tumor sizes were calculated on angiograms as having decreased by 63 +/- 35% of their initial sizes during the 2 weeks after the two IVH sessions. However, tumor sizes increased to 171 +/- 41% in the control group (p.01). Necrosis in the peripheral zones of the tumors in the IVH group was more severe than that in the control group (p.05). Necrosis in the central zones of the tumors in the IVH group was slightly more severe. The surrounding tissue was not damaged. Although the femoral artery was not severely damaged, there was severe damage to the feeding arteries.IVH reduced the size of hypervascular tumors in our rabbits. The antitumoral effects are attributed to direct damage of the tumor vessels and to the effect of heat on the tumor cells.

A three-dimensional flow simulation at Repeak = 192 and 580 was made in a smooth reverse curvature model that conformed to the gentle “S” shape from a human left femoral artery angiogram. The objective of this numerical investigation was to find the changes in pressure, shear stress, velocity profile, and particle path occurring in the double-curved arterial vessel. Due to the impingement of blood at the outer wall in the first bend region, the wall shear stress approached 40 dyne/cm2—a value over twice as large as in the straight upstream segment. Conversely, at the inner wall in the first bend, a low shear stress region was found where the value of the shear stress was consistently smaller than that in the straight section. The initiation of centrifugal effects caused by the first bend could clearly be seen at Repeak = 580, but due to the close proximity of the reverse curvature segment, the momentum effect due to the second bend overshadowed the centrifugal effect. Hence, only near the end of the second bend did the centrifugal effect due to the second bend result in a double-spiral-secondary motion. In addition, the numerically calculated pressure drop data were in agreement with prior experimental values.

An 88-year-old woman with a history of breast cancer and aortic stenosis presented with heart failure. Echocardiogram showed severe aortic stenosis and valve area of 0.5 cm2. Due to her comorbidities, she was deemed to be at high risk for valve surgery and was evaluated for transcatheter aortic

Patient initials or identifier number ID:0000465632 ### Relevant clinical history and physical exam In September 2013, intermittent claudication of his left lower limb was appeared. The pulse of the left femoral artery was palpable. However, the pulse below the left popliteal artery was

The wave speed (c) and the arrival time of reflected wave (Trw) in the common left carotid artery and common left femoral artery have been evaluated in 70 healthy subjects, aged 35-55 years with a non-invasive method. Wave speed and the arrival time of reflected waves were determined with InDU-loop and non-invasive wave intensity analysis (ndl) techniques, respectively. Diameter (D) was measured with ultrasound echo wall tracking and velocity (U) was obtained by ultrasonography. A statistical analysis has been carried out in order to establish a potential relation of c and Trw with gender and age in the study population. Subjects have been divided in two classes of age, one from 35 to 45 years and the other from 45 to 55 years. Results show that c and Trw in the femoral artery are higher than those in carotid, in both men and women (P < 0.001). Also, the distance of the reflection (L) site from the point of measurement is higher in the femoral than in the carotid artery. We did not find statistically significant differences between c, age or gender in femoral artery. However, c in the carotid artery increases with age (P < 0.05), but did not change between men and women. In this paper InDU-loop has been used for the first time to determine c and Trw in carotid and femoral arteries in a large population of healthy subjects.

Persistence of the embryonic sciatic artery as the major arterial channel to the lower leg is a rare anomaly. Twenty-one cases of sneurysm of a persistent sciatic artery have been reported in the world. This paper describes a case of aneurysm of a persistent sciatic artery. A 74-year-old woman was admitted to the hospital because of a pulsatile mass in the left buttock. Angiography showed a persistent left sciatic artery with an aneurysm and a hypoplastic left femoral artery. The persistent sciatic artery was supplying the entire circulation to the left lower leg. A left internal ilio-popliteal bypass was performed with resection of the aneurysm. A postoperative angiography showed the graft to be patent. The position of the aneurysm in the buttock is apt to result in rupture of the aneurysm. Therefore, patients with aneurysm of a persistent sciatic artery should be treated with an operation.

The availability of glyceryl trinitrate (GTN) and the differential formation of dinitrate metabolites (GDNs) in various organs as a function of routes of administration were investigated in the rat. GTN was infused at 2.0 µg/min via the left femoral vein (LFV), left external jugular vein (LJV), left femoral artery (LFA), and hepatic portal vein (HPV). Blood concentrations of GTN and GDNs were measured in femoral arterial samples. Different infusions yielded GTN steady-state concentrations in the following rank order: LJV ≥ LFV > LFA ≥ HPV. Furthermore, the GDN formation ratios (1,2-GDN/1,3-GDN) are different: LFV ≥ LJV > LFA > HPV. The availabilities of GTN through the leg, vein, and liver were derived. GTN is significantly extracted and metabolized in these organs, and the leg and the vein prefer 1,2-GDN formation, while the liver forms 1,3-GDN predominantly.

Modern air-nailing tools are known to cause penetrating trauma. We report the unusual case of a pneumatically fired carpenter's nail that penetrated the chest of a 30-year-old man and subsequently embolized from the heart to the left femoral artery without clinical evidence of having entered the heart. The nail was surgically removed, and the patient was discharged from hospital without sequelae after 10 days. This case and the relevant literature are discussed from the perspective of the emergency department investigation and care of such patients.

BACKGROUND: Uncontrolled bleeding is the first leading cause of preventable death in the battlefield and the 2nd cause of mortality in civil accidents. Incompressible hemorrhage control is among the interventions that drastically increase the survival rate in wound individuals. We have previously shown that a certain mixture of bentonite and zeolite minerals can significantly decrease the bleeding in rats. METHODS: In this study, nine healthy hybrid dogs were selected and after induction of anesthesia with ether, either arterial puncture by a needle or arteriotomy was performed on both groin regions of the dogs. For control arteries (either the right or left femoral artery), only pressure by sterilized gauze was performed, while for the femoral arteries of the opposite side, our invented hemostatic agent, namely CoolClot, was topically used before applying the pressure. In the second stage of the study, to assess the coagulation time, blood samples were collected from 10 volunteer students. RESULTS: CoolClot significantly decreased the bleeding time in animals whose femoral arteries were cut or punctured. In the human phase of the study, the mean coagulation time in control blood samples was 253.4±44.1 seconds, whereas it was 149.5±50.0, 162.3±74.6 and 143.4±114.6 seconds, respectively in blood samples treated with bentonite, zeolite and CoolClot (P

A small, nonmagnetic coil was fluoroscopically guided into the left circumflex coronary artery (LCXA) at the midventricular level via the left femoral artery in seven rabbits. Coronary artery occlusion was confirmed by intracoronary contrast injection, electrocardiographic changes, akinesis of the posterolateral wall distal to the occluded area, and histopathological staining of the myocardium. This new model of a closed-chest coronary artery occlusion in the rabbit may be suitable for acute ischemic myocardium studies that do not require reperfusion.

A 35-year-old drug abuser inadvertently injected adulterated heroin into her left femoral artery and presented with critical ischaemia of her left leg. Treatment with intravenous Iloprost, a stable prostacycline analogue, combined with Heparin, produced a dramatic improvement in her circulation within 4 h.

We will describe a case of a gunshot wound of the abdominal aorta, in which occurred embolization of the bullet that lodged in the left femoral artery. What led us to describe this case was the rarity of this event, the high morbidity and mortality of such wounds and the surgical technique employed.

Experiments were performed in unanaesthetized rabbits with electrodes implanted in the skull (ECoG) and within the limb muscles (EMG). A teflon cannula was also introduced into the left femoral artery for monitoring arterial blood pressure. During control periods, in the absence of movements, the heart rate and the blood pressure were very regular. During manipulations for the induction of hypnosis, the blood pressure showed a series of oscillations, and, when the animal was put on its back, a considerable hypertension developed. Later in the hypnotic state itself blood pressure and heart rate did not differ greatly from control values, the highest values being always recorded during initial seconds of the episode. A gradual and slow decrease in blood pressure and heart rate could then occur, especially in longer hypnotic episodes. In rabbits not accustomed to the recording environment, the heart rate levels oscillated during control periods and were reduced during hypnosis. However, a few hours later, when adaptation had occured, the heart rate levels were reduced during control periods, and no further reduction was observed during hypnosis.

A case of bullet embolism is reported wherein a handgun missile, fired during a "shoot-out," perforated (among other structures) the anterior and posterior walls of the thoracic aorta, rebounded into the aortic lumen, and was transported to the left femoral artery where it came to rest. Roentgenographic study was instrumental in promptly locating the errant bullet whose recovery established the identity of the responsible firearm. The implications of bullet embolism of the arterial, venous, and paradoxical types for the forensic pathologist and the clinician are discussed briefly. Language: en

Thirty-nine Wistar female rats, weighing from 250 to 350g, were employed in order to investigate in detail the healing processes of venous grafts interposed in microartery.A segment of the right femoral artery was excised and replaced with the epigastric vein. The grafts were retrieved over a period of time ranging from 4th, 7th, 14th, 28th, 56th and 168 th day postoperatively. The left femoral artery and epigastric vein served as controls. First, patency rate was checked and then changes of the grafted wall were evaluated by light and scanning electron microscope.The following results were obtained:1. Throughout the experimental periods, patency rates were 56. 4%(22/39); that is, 4 th day, 60.0%(3/5), 7 th day, 42.9%(3/7), 14 th day, 80.0%(4/5), 28 th day, 44.4%(4/9), 56 th day, 62.5%(5/8) and 168 th day, 60.0%(3/5) respectively.2. In grafts of 4 days' duration, grafted veins had hyaline degeneration and swelling so that endothelial sloughings were nearly completed on grafts. In grafts of 7 days' one, migrations of new endothelial cells from femoral artery into grafts could be observed, they were almost covered with endothelial cells on 28 th day and were completed on 56 th day postoperatively. The walls of grafted veins started to be replaced by the 14 th day and resulted in fibrous connective tissues at 28 th day. Subintimal hyperplasia, being rich in cellular and fibrous components, appeared around the suture line at 14 th day and could be observed almost all over the graft at 28 th day so that there were no differences of the internal diameter between grafts and femoral arteries at 56 th day.3. Scanning electron microscopic findings nearly coincided with the histopathological ones.In short, it is suggested that there may be no direct relatioships between patency rate and healing process of the venous grafts interposed in microartery.

Arteriovenous fistulae in rabbits obtained by percutaneous puncture of the kidneys were demonstrated by selective renal angiography. The mean systemic blood pressure before and after the creation of the fistulae did not demonstrate significant changes. It is assumed that arteriovenous fistulae of the kidney rarely cause hypertension and that the treatment should be conservative. kidneys (in a few cases both) was punctured one to four times through the skin with a steel cannula (I.D./O.D. 0.5/0.7 mm).After a time interval varying between 7 and 42 days repeat catheterization was made from the left femoral artery. The arterial blood pressure was measured and bilateral renal angiography performed.

Dogs were anesthetized with pentobarbital 30 mg/kg. Cannulas were placed for measurement of arterial and central venous blood pressures. The left femoral artery was cannulated and attachment was made to a reservoir set to maintain arterial blood pressure at 40 mm Hg. Blood pH, pCO2, and pO2 were obtained concomitantly with measurements of blood epinephrine levels utilizing the rat uterus assay method. Rapid hemorrhage to 40 mm Hg blood pressure elicited increments in blood epinephrine levels that closely followed the development of uncompensated acidosis. Correction of the acidosis by intravenous administration of tromethamine or sodium bicarbonate at a blood pressure of 40 mm Hg reduced the blood epinephrine levels by at least 50%, markedly improved cardiac function, increased hemorrhage volume, reduced respiratory rate, and, paradoxically, increased arterial pO2. In vitro studies showed that acidosis did not inhibit destruction of epinephrine added to blood. It was concluded that the adrenal gland is stimulated by acidosis to secrete epinephrine. This stimulation is an important source of blood epinephrine during periods of hypotension associated with shock.

A case of calcium embolism from the aortic valve to the femoral artery during left heart catheterization is reported. Emboli from various sites during this procedure have been reported before, but the occurrence of a large calcific embolus from the aortic valve has not been documented.

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A case of extensive injury to the left femoral artery and vein is presented. As circumstances did not permit the use of autogenous vein grafts, human umbilical cord vein grafts were used. Almost one year afterwards the patient is doing well and both grafts are patent.

A bullet migrated from the heart to the left femoral artery in a youth ten days after he sustained a gunshot wound to the right chest. The bullet apparently traversed the pulmonary venous system at the time of the injury and lodged in the interior of the left ventricle. The production of an embolism in the systemic circulation was a delayed and unanticipated event.

Publisher Summary This chapter describes the alterations of the alveolar surfactant in hemorrhagic shock. In a study described in the chapter, 20 mongrel dogs of both sexes were anesthetized. The animals were divided into four groups of which one group served as control. Hemorrhagic shock was induced on 15 dogs hemorrhaged from the left femoral artery. Shed blood was stored at room temperature, and clotting was prevented by Heparin. The blood pressure of the animals was adjusted to 40 mmHg, and it was maintained until the spontaneous withdrawal of 30% of the shed blood. The second group of animals was killed immediately after the spontaneous withdrawal. Examination of both re-transfused animal groups showed that this process was reversible. The lipid layer of the surfactant was continuous and thin.

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