Ljiljana Banfić

Correlation of Femoral Intima-Media Thickness and the Severity of Coronary Artery Disease

The carotid artery intima—media thickness (IMT) is an established surrogate marker of vascular risk. We assessed the common femoral artery IMT and its correlation with coronary artery disease (CAD). We also assessed the influence of vascular risk factors on the femoral IMT. Patients (n = 180; mean age 60.4 ± 10.5 years) who had undergone coronary angiography due to symptoms of CAD were enrolled in this study. We found significantly higher values of femoral IMT in patients with CAD than in those without CAD (P = .0000). A strong positive correlation between femoral IMT and the severity of CAD expressed by the Gensini Score (P = .0000) was observed. There was a positive correlation between femoral IMT and levels of triglycerides (P = .017), body mass index (BMI; P = .036), male gender (P = .0000), and smoking (P = .028). There was a negative correlation between femoral IMT and the level of high-density lipoprotein—cholesterol (P = .001). Femoral IMT could be a novel cardiovascular risk marker.

Ascending aorta and aortic arch pseudoanaeurysm — case report

Cardiologia CROATICA We present a 53-year-old patient who was admitted with high fever, cough and nasal discharge. She received her kidney transplant ten years ago with subsequent taking of common immunosupressive therapy with several past hospitalizations due to respiratory infections and respiratory failure. Twenty years ago, she underwent an urgent neurosurgical procedure due to subarachnoid bleeding with underlying ruptured intracranial anaeurysm. One month before actual hospitalization, the patient was complaining of chest pain. Diagnostic work-up of the infection included native computerised tomography (CT) of the thorax and abdomen with coincidental finding of the ascending aorta and aortic arch anaeurysm. Subsequent CT aortography with reconstructions was performed showing pseudoanaeurysm of the ascending aorta and aortic arch (6.2x2.7cm) anteriorly and laterally of the ascending aorta and arch until the origin of the left common carotid and left subclavian artery with wide communication of the aorta and pseudoanaeurysm. Anaeurysmatic dilatation of the splenic artery was diagnosed as well (2.6 cm). Cardiothoracic operation was planned and coronary angiography (transfemoral) was performed as well with the normal finding of the epicardial coronary arteries but with postprocedural haemorrhagic complication with large ipsilateral haematoma of the rectus abdominis and retroperitoneum requiring percutaneous occlusion with BeadBlock Terumo spheric particles of the inferior epigastric artery with an optimal result. Several heamodialysis procedures were undertaken after all contrast imaging procedures in order to protect the transplanted renal graft. Due to a blood loss, the patient was transfused with seven units of blood altogether. She was treated with meropenem and is afebrile with good general condition pending operation of the aorta.

Catheter directed thrombolysis for acute limb ischemia: eight cases in two years

Cardiologia CROATICA Introduction: Acute limb ischemia (ALI) is a challenging problem in angiology. It can be associated with significant morbidity or death even after successful limb revascularization. Management of ALI depends on the clinical status of the affected limb and patient comorbidities. We assessed the efficacy and complication of catheter directed thrombolysis for ALI in our institution during 2012 and 2013. Patients and Methods: During the period of 24 months, eight ALI patients were treated by catheter directed infusion with recombinant tissue plasminogen activator (r-tPA). Standard endovascular access and catheter techniques were involved starting with 5 mg bolus of r-TPA, followed by continuous infusion of 0.5-2 mg/h. Concomitant heparin at low dose was applied to prevent catheter-associated thrombus development. During r-TPA, infusion angiography was repeated to determine success of thrombus dissolution. Results: There were 5 males and 3 females, mean age of 74.8 years (range, 54-90 years). One patient had upper extremity ischemia, others had lower ALI. The average duration of symptoms was 3.6 days (1-10 days). Mean duration of r-TPA infusion was 24.2 hours (16 to 4 hours), with mean dosage of 36.6 mg (range 17 to 60 mg).Three patients (38%) had complete reestablishment of blood flow with catheter thrombolysis and mean ankle — brachial index (ABI) improved from 0.22 to 0.85. The other 4 patients (50%) had partial restoration of flow and needed additional endovascular or surgical intervention with final mean ABI improvement from 0.39 to 0.98. In one case catheter directed thrombolysis failed to reestablish blood flow and the patient underwent the bypass surgery. Only one patient had severe periprocedural complication (gastrointestinal bleeding) requiring a blood transfusion. Small access site hematoma was noticed in all of the treated patients. In the follow-up period (7 to 20 months) one patient had unfavorable course of affected limb which ended with an amputation 15 months after thrombolysis. The other seven patients were stabile, without significant impairment of the treated limb. Conclusion: Selective thrombolysis should be considered for ALI patients with the symptom onset less than 14 days and without motor deficit of the affected limb. It is a timeconsuming procedure with potential severe hemorrhagic complications. With the proper patient selection and coordinated multidisciplinary team, it could result in the reestablishment of flow and an acceptable bleeding complication rate.