Mustafa Nazzal

Prevention of cardiopulmonary embolization of polymethylmethacrylate cement fragment after kyphoplasty with insertion of inferior vena cava filter

We report the case of a 51-year-old woman who underwent kyphoplasty with polymethylmethacrylate for painful compression fracture of the third lumbar vertebra. Infiltration of cement into the inferior vena cava, noted intraoperatively, was confirmed with postoperative CT scan. A Greenfield filter was placed to prevent cardiopulmonary embolization of the fragment. On follow-up x-rays, the cement fragment was found to have detached and embolized into the vena cava filter. Endovascular technique was used to retrieve it to the common femoral vein with subsequent successful removal of the crescent-like fragment with operative exploration. Patient was asymptomatic at four-week follow-up visit.

Celiac artery compression syndrome: a radiological finding without clinical symptoms?

The aim of the paper is to determine the incidence of celiac artery compression (CAC) based on computed tomography (CT) scan and correlate the findings to the clinical presentation of patients presenting for CT scan in a hospital. Abdominal CT scans of patients were reviewed between September 2010 and November 2010. CAC was diagnosed if the celiac axis appeared to have a hook or U-shaped appearance with stenosis. The medical records of the patients were reviewed for gastrointestinal symptoms (abdominal pain, nausea, vomiting, constipation, diarrhea), as well as food fear and weight loss. Patients with CAC had lower incidence of symptoms compared with those without CAC (42.1 versus 65.3%, P = 0.042). A total of 450 patients were evaluated. In the end, 284 had both complete medical records and CT scans. The mean age for all patients was 51.3 ± 1.2 years. There were 124 men (42.6%) and 160 (57.4%) women. Nineteen (6.7%) patients had radiological evidence of CAC. CAC is not an uncommon CT finding in patients presenting for CT scan.

A unique presentation of Takayasu's arteritis in a 39-year-old male with chest pain, vertigo, and blindness

Takayasus arteritis is a rare form of aortic vasculitis, typically described in young Asian females. In this article, we report a unique presentation of type V Takayasus arteritis in a Hispanic male. To the best of our knowledge, this is the first case of Takayasus arteritis presenting with the triad of angina, amaurosis fugax, and subclavian steal syndrome. On diagnostic imaging, he was found to have left subclavian and axillary artery stenosis requiring balloon angioplasty. The patient responded to the combination of medical and surgical treatment with full recovery.

Complications Secondary to the Bard Retrievable Filter : A Case Report

Recent trials have demonstrated the efficacy of short-term insertion of inferior vena cava filters in the treatment and prophylaxis of venous thromboembolism certain populations, especially those with a reversible contraindication to anticoagulation. This has widened the use of retrievable filters in the hope of avoiding the long-term complications of permanent filters. However, no trials have demonstrated complications for each individual retrievable filter; and therefore, the decision for insertion of caval filter should be thoroughly studied and the benefit clearly determined. We discuss our experience with complications that we have encountered during retrieval of the Bard recovery filter in two patients.

Incidence and clinical significance of iliac vein compression.

Objectives To determine the frequency of left common iliac vein (CIV) compression by the right common iliac artery (CIA) based on CT scan images. Methods CT scan images were reviewed and the diameter of CIV was measured at the area of minimal diameter and compared to the distal adjacent segment and the contralateral CIV at the same level. Medical records were reviewed for symptoms, deep vein thrombosis (DVT) and risk factors that might be associated with DVT. Data were analyzed with SPSS program using both Chi square and t test. A p < 0.05 was considered statistically significant. Linear regression (R2) was used to evaluate correlation. Results A total of 300 complete records were reviewed. The mean age was 51.89 years, with 126 (42%) males. Comparison between the two groups (>70% vs <70%) showed similar clinical factors such as history of DVT, surgery, immobilization, malignancy, limb trauma, pregnancy, obesity, CHF, and smoking. There were more females with CIV compression of 70% or more than males (19.5% vs 11.1% P < .049). Conclusion Diameter stenosis more than 70% was present in 30.6% of cases with higher incidence in females. The presence of stenosis was not associated with the presence of clinical symptoms.

Stent fracture in the brachiocephalic trunk

Stents are commonly used as a tool for revascularization of different vascular beds in the body. However, many pitfalls have been reported with their use, such as thrombosis, migration, restenosis or fractures. The latter have been strongly correlated to in-stent restenosis with long-term follow-up. We report a rare case of an early stent fracture in the brachiocephalic trunk with in-stent restenosis and recurrence of symptoms. To our knowledge there has been only one case report of a delayed brachiocephalic stent fracture in the English literature. We believe that our case is the first report of an early stent fracture in the brachiocephalic trunk.