Embolism aortic

CHD = myocardial infarction (Ml), significant myocardial ischemia (angina), history of coronary artery bypass graft (CABG), history of coronary angioplasty, angiographic evidence of lesions, carotid endarterectomy, abdominal aortic aneurysm, peripharal vascular disease (claudication), thrombotic/embolic stroke, transient ischemic attack (TIA)... 

In Caucasians, the vast majority of MCA occlusions are of embolic origin with emboli arising from a carotid stenosis, the aortic arch or the heart (Heinsius et al. 1998) or from the venous side in case of a patent foramen ovale. In black or Asian patients a higher prevalence of intracranial occlusive disease is found with subsequent thrombotic arterial occlusion or stenosis (Feldmann et al. 1990). 

Many causes of acute spinal cord infarction (of arterial and venous origin) have been reported (Table 17.2). They include diseases of the aorta and aortic surgery, thromboembolic events and cartilaginous disc embolism, vasculitis, coagulopathy, radiation-induced vasculopathy, toxic effects of contrast medium, epidural anesthesia, periradicu-lar nerve root therapy with crystalline corticoids, decompression illness, shock or cardiac arrest, lumbar artery compression and other etiologies... 

Calcification, and possibly sclerosis, of the aortic and mitral valves may be a cause of embolism of calcific or complicating thrombotic material. However, these degenerative disorders of heart valves are so common, particularly in the elderly, that it has been very difficult to associate them causally with stroke (Boon et al. 1996). 

Myocardial infarction Aortic dissection Paradoxical embolism (Ch. 6)... 

Chest pain may be indicative of a recent myocardial infarction with complicating stroke, aortic dissection (particularly if the pain is also interscapular) or pulmonary embolism and raises the possibility of paradoxical embolism. 

Thorough cardiac examination should look for possible cardiac source of embolism, including atrial fibrillation, mitral stenosis and prosthetic heart valves. Left ventricular hypertrophy suggests hypertension or aortic stenosis, and a displaced apex from a dilated left ventricle indicates underlying cardiac or valvular pathology. 

Possible cardiac source of embolism, or clinical, ECG, transesophageal evidence of embologenic heart ultrasound or radiographic disease, aortic arch dissection... 

Suspected cardiac source at high risk of recurrent embolism prosthetic mechanical heart valve, endocarditis, aortic dissection, acute coronary syndrome, overt congestive heart failure... 

Harrington D, Amplatz K. Cholesterol embolization and spinal infarction following aortic catheterization. Am J Roentgenol Radium Ther Nucl Med I972 II5(I) I7I. ... 

Figure 4.54) and dissecting aortic aneurysm (Figure 7.4). An example of ST-segment elevation in massive pulmonary embolism is shown in Figure 4.54, which coincides with the development of... 

Among the non-ischaemic cardiovascular causes of thoracic pain that should be ruled out, some present a benign prognosis as pericarditis, while others, in turn, point to a much serious prognosis, such as an acute aortic syndrome (dissecting aneurysm or other aortic pathologies) and a pulmonary embolism. On the whole, these account for 5-10% of all cases of thoracic pain. 

Anticoagulants and thrombolytics, particularly warfarin, can systemically embolize cholesterol particles from aortic atherosclerotic plaques to small arteries and arterioles, including renal arterioles. These agents remove or prevent thrombus formation over ulcerative plaques, causing emboh. Cholesterol emboli induce an inflammatory obliterative vascular response, causing renal ischemia. Purple discoloration of the toes and mottled skin over the legs are important clinical clues. 

While studies of platelet and thrombus accumulation on surfaces have provided important information concerning blood-material interactions, that accumulation is not a direct index of the rate of microemboli generation [e.g., kidney embolism induced by implanted aortic rings often was most severe from rings that remained clean (26, 27)]. Thus, analytical tests that directly quantify microemboli are needed. 

Atrial myxoma is a rare atrial tumor that causes multiple emboli of either thrombus or myxomatous tissue. When myxomatous material is embolized from the left atrium into the brain arteries, they may cause the formation of multiple distal cerebral aneurysms with risk of hemorrhage [46]. Papillary fibroelastomas are rare benign cardiac tumors usually involving a heart valve. They are small vascular growths with marked papillary projections. They usually grow on the aortic or mitral valves. The tumor consists of fibrous tissue surrounded by an elastic membrane, which in turn is covered by endothelium. One of the most conunon clinical presentations is of transient ischemic attack or stroke [47,48]. 

The advance of endovascular therapy for aorto-iliac aneurysmal disease has also brought about yet another flourishing application of embolotherapy. Embolization of the internal iliac artery plays an important adjunct initial modality to allow endovascular treatment of aortic aneurysms with extension into the common iliac arteries [78-80], It also plays an crucial role in the secondary management of complications related to endoleaks [81-84],... 

Schoder M, Zaunbauer L, Holzenbein T, et al. (2001) Internal iliac artery embolization before endovascular repair of abdominal aortic aneurysms frequency, efficacy, and clinical results. AJR Am J Roentgenol 177 599-605... 

Golzarian J, Struyven J, Abada HT, et al. (1997) Endovascular aortic stent-grafts transcatheter embolization of persistent perigraft leaks. Radiology 202 731-734... 

Baum RA, Cope C, Fairman RM, Carpenter JP (2001) Translumbar embolization of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms. J Vase Intervent Radiol 12 111-116... 

Su WT, Stone DH, Lamparello PJ, Rockman CB (2004) Gluteal compartment syndrome following elective unilateral internal iliac artery embolization before endovascular abdominal aortic aneurysm repair. J Vase Surg 39 672-675... 

Fig. 10.3.2. A long-reverse curve catheter. Very useful for catheterizations in the pelvis and for uterine artery embolization. Tip is tapered to 4 F. Radiopaque marker at genu of catheter marks the point where the catheter should be positioned over the aortic bifurcation...

Fig. 15.1. a Contrast. enhanced CT of abdomen shows an abdominal aortic aneurysm with patent lumbar and inferior mesenteric arteries. Patient developed a type 11 endoleak after endograft placement, b Non-contrast CT shows glue embolization of the lumbar arteries and the sac through a branch of the internal iliac artery... 

Occasionally, communications between various branches of the IIA and the lumbar arteries may cause retrograde flow into the sac of an aortic aneurysm creating a type-II endoleak. Microcatheter traversal of the entire length of these conununications may not always be possible. Under such circumstances, liquid embolic agents have been employed to occlude the feeder arteries. As mentioned above, this practice may cause ischemic radiculopathy if the targeted vessels are either lateral sacral or iliolumbar arteries. It may be more prudent to coil embo-lize these arteries and use alternative approaches to deal with the possible residual type-II endoleak (see Chap. 14). 

Fig. 15.2a-c. Embolization of IIA before aortic stent graft implantation (courtesy of Dr Luc Stockx). a Right common iliac angiogram demonstrating the internal and external iliac arteries. b,c Coil embolization of the proximal llA. Note the extension of the aneurysm to the level of iliac bifurcation... 

S.Criado EJ, Wilson EP, Velazquez OC et al. (2000) Safety of coil embolization of the internal iliac artery in endovascular grafting of abdominal aortic aneurysms. J Vase Surg 32 684-688... 

Heye S, Nevelsteen A, Maleux G (2005) Internal iliac artery coil embolization in the prevention of potential type-2 endoleak after endovascular repair of abdominal aortic... 

Pulmonary embolism or infarction Aortic aneurysm Pulmonary aneurysm Bronchovascular fistula AV-malformation... 

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