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Ann Vasc Surg 2012; 26(5)Originals

1.Ann Vasc Surg. 2012 Jul;26(5):734-8. doi: 10.1016/j.avsg.2012.03.003.

Technical strategy for the endovascular management ofascending aortic pseudoaneurysm.

Gray BH,Langan EM 3rd, Manos G,Bair L, Lysak SZ.

Source

Department of Surgery, Greenville Hospital System University Medical Center,

Greenville, SC 29615, USA. [email protected]

Abstract

We present two cases of ascending aortic pseudoaneurysm exclusion with off-the-shelfaortic stent grafts. The right common carotid artery was used for access to facilitategraft delivery. Control of graft deployment was aided using a compliant right atrialocclusion balloon to lower cardiac output at the time of deployment. Transesophagealechocardiography facilitated the sizing and positioning of the right atrial balloon andwas used to survey the heart and ascending aorta on successful exclusion of thepseudoaneurysm. These simple maneuvers made an uncommon procedure straightforward, predictable, and successful.

Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rightsreserved.

PMID:22664284[PubMed - indexed for MEDLINE]

Related citations


Endoluminal treatment of dissecting aortic arch aneurysm aftersurgical treatment of acute type A dissection.

Canaud L, Demaria R, Joyeux F, Hireche K,Berthet JP, D'Annoville T, Marty-An C,Alric P.

Source
http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(12)00156-2

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Department of Thoracic and Cardio-Vascular Surgery, Arnaud de Villeneuve Hospital,Montpellier, France. [email protected]

Abstract

BACKGROUND:

The aim of this study was to evaluate the short- and midterm results followingendovascular repair of dissecting aortic arch aneurysm after surgical treatment of acutetype A dissection.

METHODS:

Between 2003 and 2010, six consecutive patients previously operated for acute type Adissection underwent endovascular repair of dissecting aortic arch aneurysm (six men,mean age: 63 9.8 years); one of the aneurysms was ruptured. Follow-up computedtomography scans were performed at 1 week, at 3 and 6 months, and annually

thereafter.

RESULTS:

All endografts were successfully deployed (TAG [2], Valiant [4]). All the patientsunderwent hybrid technique with supra-aortic debranching (through a sternotomyapproach in four cases and through a cervical approach in two cases) andsimultaneous or staged endovascular stent-grafting. During the same operative time,one patient underwent, on full cardiopulmonary bypass, saphenous vein bypass fromthe ascending aorta to the anterior descending coronary artery. One permanentneurologic event was observed. After a mean follow-up of 22.3 14.6 months, no

aortic-related mortality was observed. No cases of stent-graft migration or secondaryrupture were observed. The ruptured aortic arch aneurysm presented a type I endoleakat 6 months and was successfully treated with a second endograft. One patient died ofan unrelated cause 7 months after surgical repair.

CONCLUSIONS:

Our experience demonstrates promising potential of endovascular repair of dissectingaortic arch aneurysm after surgical treatment of acute type A dissection. The potentialto diminish the magnitude of the surgical procedure and the consequences of aorticarch exposure, and above all avoiding the need for circulatory arrest, is promising andmandates further investigation to determine the efficacy and durability of this technique.



Related citations

3.
http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(12)00074-X

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Ann Vasc Surg. 2012 Jul;26(5):693-9. doi: 10.1016/j.avsg.2011.12.003.

Surgery with vascular reconstruction for soft-tissue sarcomasin the inguinal region: oncologic and functional outcomes.

Emori M, Hamada K,Omori S, Joyama S,Tomita Y,Hashimoto N, Takami H, Naka N,Yoshikawa H,Araki N.

Source

Musculoskeletal Oncology Service, Osaka Medical Center for Cancer andCardiovascular Diseases, Osaka, Japan. [email protected]

Abstract

BACKGROUND:

Treatment of soft-tissue sarcomas involving the inguinal region remains challengingbecause of difficulties in achieving wide surgical margins due to anatomical features.The study aimed to analyze the oncologic and functional outcomes of wide resectionwith vascular reconstruction for inguinal soft-tissue sarcomas.

METHODS:

Three men and seven women were treated for inguinal soft-tissue sarcomas by widesurgical resection with vascular reconstruction.

RESULTS:

Arteries and veins were replaced in nine patients, and artery replacement alone wascarried out in one patient. Femoral nerve resections were performed in six patients.One patient and five patients developed local recurrence and distant metastases,respectively. Limb salvage was achieved in 9 of 10 patients (90%). Six patients andone patient developed vascular (arterial graft occlusion [n = 1], lymphedema [n = 5])and nonvascular (hematoma [n = 1]) complications, respectively. Five-year arterialprimary patency was 77%. Five-year disease-free and overall survival rates were 45%and 77%, respectively. Functional outcome scores at latest follow-up averaged 87.5%for Musculoskeletal Tumor Society 1993.

CONCLUSIONS:

En-bloc resection of major critical structures along with tumor and vascularreconstructions using synthetic grafts is a feasible option in limb salvage surgery foringuinal soft-tissue sarcomas.


PMID:22664282

[PubMed - indexed for MEDLINE]Related citations

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4.

Ann Vasc Surg. 2012 Jul;26(5):665-73. doi: 10.1016/j.avsg.2011.12.004.

The results of surgical treatment for patients with venousmalformations.

Roh YN, Do YS, Park KB, Park HS, Kim YW, Lee BB, Pyon JK, Lim SY, Mun GH, KimDI.

Source

Division of Vascular Surgery, Congenital Vascular Malformation Clinic, Samsung

Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

BACKGROUND:

The objective of this study was to estimate the outcomes of surgical treatment forpatients with venous malformations (VMs).

METHODS:

We retrospectively reviewed the data of 48 patients who underwent surgicalmanagement for VMs from 1994 to 2009 at our institute. The 1-year responses tosurgeries were classified into three groups based on the results: "remission,""improvement," and "no change."

RESULTS:

The indications of surgeries were mass or swelling in 48 patients (100%), intractablepain in 11 (23%), limb length discrepancy in seven (15%), bleeding in three (6%), andlimitation of the range of motion in one (2%). The locations of the VMs were head andneck in 17 patients (35%), abdomen and pelvis in one (2%), perineum and genitalia inthree (6%), upper extremities in 12 (25%), and lower extremities or buttocks in 15

(31%). Of the 48 surgeries for radical excision and debulking, 25 (52%) resulted inremission, 11 (23%) in improvement, and 12 (25%) in no change. During follow-up(mean: 44.8 36.6 months, range: 0-111 months), recurrence after radical excisionoccurred in 10% (3 of 31) of the patients, and size increase after debulking surgery in24% (4 of 17) of the patients.

CONCLUSIONS:

Surgical treatment can be an option in patients with VMs, especially with symptomsthat cannot be managed with conservative therapy or sclerotherapy. After excisional ordebulking surgery in patient with VMs, remission or improvement can be observed in

75%.

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Related citations


A genetic study of chronic venous insufficiency.

Serra R, Buffone G, de Franciscis A, Mastrangelo D, Molinari V, Montemurro R, deFranciscis S.

Source

Unit of Vascular Surgery, Department of Experimental and Clinical Medicine, UniversityMagna Graecia of Catanzaro, Catanzaro, Italy. [email protected]

Abstract

BACKGROUND:

Chronic venous insufficiency (CVI) is an important cause of morbidity in Westerncountries. The aim of this study is to demonstrate the heredity of CVI, focusing onmolecular and genetic aspects of the disease.

METHODS:

The study depended on the recruitment of informative families, accurate determinationof the phenotype of each family member, and blood sample for DNA extraction forgenetic analysis. Each family member was invited to attend a vascular consultation. Agenealogical tree for each recruited family was composed. Then, a peripheral bloodsample for DNA extraction from each member of the recruited families was obtained for

genetic evaluation.

RESULTS:

By the evaluation of genealogical trees, it was evident that CVI segregates, in allfamilies studied, in an autosomal dominant mode with incomplete penetrance. In ninefamilies studied, varicose veins were linked to the candidate marker D16S520 onchromosome 16q24, which may account for the linkage to FOXC2.

CONCLUSION:

In our study, in families with affected patients with the D16S520 marker, there wasevidence of saphenofemoral junction reflux. The fact that there is linkage to acandidate marker for the FOXC2 gene suggests there is a functional variant within, or

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in the vicinity of, which predisposes to varicose veins. Further studies are necessary toidentify genes and mechanism so as to achieve better understanding of the geneticbasis of CVI.



Related citations


Vena cava filter practices of a regional vascular surgery society.

Friedell ML,Nelson PR, Cheatham ML.

Source

Department of Surgical Education, Orlando Health, Orlando, FL, [email protected]

Abstract

BACKGROUND:

Vena cava filter (VCF) use in the United States has increased dramatically withprophylactic indications for placement and the availability of low-profile retrievabledevices, which are overtaking the filter market. We surveyed the practice patterns of alarge group of vascular surgeons from a regional vascular surgery society to seewhether they mirrored current national trends.

METHODS:

A 17-question online VCF survey was offered to all members of the SouthernAssociation of Vascular Surgery. The responses were analyzed using the (2)goodness of fit tests.

RESULTS:

Of the 276 members surveyed, 126 (46%) responded, with 118 (93%) indicating thatthey placed filters during their practice. Highly significant differences were identifiedwith each question (at least P < 0.002). Regarding the inferior vena cava, the preferredpermanent filters were the Greenfield (31%), the TrapEase (15%), the Vena Tech (5%),and a variety of retrievable devices (49%). Fifty percent of the respondents placedretrievable filters selectively; 26% always placed them; and 24% never did. Filters were

placed for prophylactic indications

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the time by 64% of the respondents and

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Eleven patients were included. Samples of vascular segments obtained frommultiorgan donors and samples of the same vascular segments after explantation inthe recipient were analyzed. Blood group, time of cold and warm ischemia, cause ofdeath, time spent in the intensive care unit, time of storage of the cryopreserved grafts,and anatomopathological and immunohistochemical studies were analyzed using thepreimplant samples obtained from the multiorgan donor. For samples obtained from therecipient, blood group, duration for which the tissue from the donor has beenimplanted, reason for graft explantation, and anatomopathological andimmunohistochemical studies were analyzed.

RESULTS:

Histopathologically, the main finding has been the substitution of the muscular cap ofthe arterial wall by an intense fibrosis, in most of the cases, of a symmetrical nature.Besides this degeneration of myocytes, there is marked perivascular fibrosis andfibrointimal thickening also exists. The T lymphocytes suggest the importance of theimmunological mechanism in the distortion of the architecture of the arteries. The

atherosclerosis plays a less relevant role.

CONCLUSIONS:

Evidence of immune-mediated injury was found, and this mechanism seems to beresponsible for the degenerative process in cryopreserved homografts.


PMID:

22542146[PubMed - indexed for MEDLINE]Related citations

8.Ann Vasc Surg. 2012 Jul;26(5):680-4. doi: 10.1016/j.avsg.2011.09.014. Epub 2012 Apr24.

Complications of arteriovenous fistula for hemodialysis: an 8-year study.

Fokou M, Teyang A, Ashuntantang G, Kaze F, Eyenga VC, Chichom Mefire A,Angwafo F 3rd.

Source

Department of Surgery, Yaound General Hospital, Yaound, [email protected]

Abstract

BACKGROUND:

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To assess the frequency and characteristics of complications of arteriovenous fistula(AVF) and their effect on fistula outcome.

METHODS:

We retrospectively reviewed 628 AVFs constructed from November 2002 to October2010 to record the complications and their management options. The associationbetween age, sex, comorbidities (HIV, hypertension, and diabetes), fistula type, andcomplications was sought.

RESULTS:

Most patients were males (73.7%). The mean age was 45.3 years. Comorbidities seenincluded diabetes mellitus (22.12%), hypertension (83.12%), and HIV infection (9.87%).AVFs constructed were mainly radiocephalic (68%) and brachiocephalic (24.9%). Themedian follow-up period was 275 days. The cumulative patency rate was 76% and51% at 1 year and 2 years, respectively. Altogether, 211 complications occurred in

16% of the AVFs. Among them, 36.96% were severe, 25.11% moderate, and 43.91%minor. With respect to the time of occurrence, 63.98% were late complications, 12.79%immediate, and 23.22% early. Aneurysms, failure to mature, and thrombosis were themost frequent complications occurring in 26.54%, 14.69%, and 12.79% of cases,respectively. The management options for the complications included the creation of anew access in 36.96%, a temporary catheter before a new AVF in 10.52%, andnonoperative management in 43.12%. We found no adverse effect of comorbid factorssuch as diabetes mellitus ((2) = 3.58, P > 0.05) or HIV-positive status ((2) = 0.64, P >0.05) on the complication rate.

CONCLUSION:

This study shows an overall frequency of complications of 16%. These results show thepotential for low complication rate of AVF in selected population.

Copyright 2012. Published by Elsevier Inc.


Related citations

9.Ann Vasc Surg. 2012 Jul;26(5):607-11. doi: 10.1016/j.avsg.2011.10.019. Epub 2012Apr 18.

Success of endovenous saphenous and perforator ablation inpatients with symptomatic venous insufficiency receiving long-term warfarin therapy.

Gabriel V, Jimenez JC,Alktaifi A, Lawrence PF, O'Connell J,Derubertis BG,RigbergDA,Gelabert HA.

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Source

Division of Vascular Surgery, UCLA Gonda (Goldschmied) Vascular Center, DavidGeffen School of Medicine, Los Angeles, CA 90095, USA.

Abstract

BACKGROUND:

Endovenous ablation of great (GSV) and short saphenous vein (SSV) reflux hasbecome the initial procedure for most patients with symptomatic venous insufficiency,and perforator ablation is increasingly used to assist in healing venous ulceration.Many patients have comorbid conditions, which require long-term anticoagulation withwarfarin; however, the impact of a long-term anticoagulation therapy on endovenousablation procedures is not understood. This study aims to determine the effects ofchronic anticoagulation on the outcomes of endovenous ablation procedures in patientswith chronic venous insufficiency (CVI).

METHODS:

Consecutive patients undergoing endovenous ablation for to Clinical severity (CEAP)class 2 through 6 CVI between January 1, 2005 and May 1, 2011 were evaluated; 781patients with chronic venous reflux underwent 1,180 endovenous ablation procedures.We identified 45 patients receiving long-term anticoagulation therapy who underwent71 endovenous ablation procedures, including 37 GSVs, 12 SSVs, and 22 perforatorvein procedures. All patients underwent wound examination and duplexultrasonography within 48 to 72 hours. Outcomes evaluated included closure rate andpostoperative complications.

RESULTS:

The mean age of the patients was 69.7 13 years. Most patients treated presentedwith active venous ulceration (59% CEAP 6). Indications for anticoagulation includedatrial fibrillation (n = 9, 20%), previous deep venous thrombosis (n = 16, 36%),hypercoagulable state (n = 9, 20%), prosthetic valve (n = 2, 4%), and others (n = 9,20%). All patients receiving warfarin therapy (100%) underwent a postprocedureultrasonography, which confirmed the successful closure of the GSVs and SSVs;successful initial perforator closure was achieved in 59% of patients (13/22). Repeatperforator ablation yielded a closure rate of 77%. Compared with a matched cohortgroup of 35 patients (61 perforators) undergoing perforator ablation without

anticoagulation, treated during the same period, there was no significant difference inthe rates of successful closure between the groups. No patients developedpostoperative deep venous thrombosis or pulmonary embolus. No additionalthrombotic complications were noted. Three patients (4.2%) developed a smallhematoma after the procedure, which resolved with conservative treatment. Nopatients required postoperative hospital admission, and no postprocedure deathsoccurred.

CONCLUSIONS:

Based on our protocol, patients with severe CVI who were receiving long-term warfarintherapy can be treated safely and effectively with endovenous radiofrequency ablationfor incompetent GSVs, SSVs, and perforator veins. Long-term warfarin therapy did nothave a significant effect on perforator closure rates compared with no anticoagulation.

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Copyright 2012 Annals of Vascular Surgery Inc. All rights reserved.


Related citations

10.Ann Vasc Surg. 2012 Jul;26(5):700-6. doi: 10.1016/j.avsg.2011.10.020. Epub 2012 Apr12.

A diabetic foot service established by a department of vascularsurgery: an observational study.

Williams DT, Majeed MU, Shingler G,Akbar MJ,Adamson DG, Whitaker CJ.

Source

Department of Vascular Surgery, Ysbyty Gwynedd Hospital, Bangor, Gwynedd, [email protected]

Abstract

BACKGROUND:

The mechanism by which the multidisciplinary approach to diabetic foot diseasereduces amputation rates is unclear. Ischemia, sepsis, and necrosis represent aspectsof severe diabetic foot disease amenable to intervention. In 2006, a vascular unitintroduced a rapid access service for severe foot disease, augmenting the establishedcommunity provision. This study aimed to determine whether concurrent changes inamputation rates were observed, and to identify areas that may have influencedoutcomes.

METHODS:

Unit data prospectively collected during 4 years for patients with lower-limb disease

were compared with data retrieved over 2 years before the foot service. Outcomemeasurements were major amputations, foot surgery, vascular interventions,admissions, and length of stay.

RESULTS:

Major amputation rates associated with diabetes peaked in 2005 at 24.7/10,000 vs.1.07/10,000 in 2009; (relative risk = 0.043, 95% confidence interval = 0.006-0.322).The proportion of diabetic to nondiabetic amputations decreased; foot surgery ratesalso dropped (53.7/10,000 in 2006 vs. 7.5/10,000 in 2009). The number of openrevascularization procedures decreased, but the rates of endovascular proceduresremained generally constant. Hospital admission rates decreased after initially peaking,and the length of stay was unchanged (16 vs. 15.5 days in 2004 and 2009,respectively).

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CONCLUSIONS:

The integration of a vascular unit with community care has been associated withimproved outcomes for patients with diabetic foot disease. Improvements were notrelated to the increased number of vascular procedures or hospitalizations, but didcoincide with a greater proportion of patients attending the foot unit. The referral ofpatients to the unit facilitates the rapid management of severe disease, reducing delaysdeleterious to outcomes.



Related citations

11.Ann Vasc Surg. 2012 Jul;26(5):620-9. doi: 10.1016/j.avsg.2011.02.051. Epub 2012 Mar19.

Influence of aspirin therapy in the ulcer associated with chronicvenous insufficiency.

del Ro Sol ML,Antonio J,Fajardo G,Vaquero Puerta C.

Source

Division of Vascular Surgery, University Hospital of Valladolid, Valladolid, [email protected]

Abstract

BACKGROUND:

To determine the effect of aspirin on ulcer healing rate in patients with chronic venous

insufficiency, and to establish prognostic factors that influence ulcer evolution.

METHODS:

Between 2001 and 2005, 78 patients with ulcerated lesions of diameter >2 cm andassociated with chronic venous insufficiency were evaluated in our hospital. Of these,51 patients (22 men, 29 women) with mean age of 60 years (range: 36-86) wereincluded in a prospective randomized trial with a parallel control group. The treatmentgroup received 300 mg of aspirin and the control group received no drug treatment; inboth groups, healing was associated with standard compression therapy. During follow-up, held weekly in a blinded fashion, there was ulcer healing as well as cases ofrecurrence. Results were analyzed by intention-to-treat approach. Cure rate wasestimated using Kaplan-Meier survival analysis, and the influence of prognostic factorswas analyzed by applying the Cox proportional hazards model.

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RESULTS:

In the presence of gradual compression therapy, healing occurred more rapidly inpatients receiving aspirin versus the control subjects (12 weeks in the treated group vs.22 weeks in the control group), with a 46% reduction in healing time. The mainprognostic factor was estimated initial area of injury (P = 0.032). Age, sex, systemictherapy, and infection showed little relevance to evolution.

CONCLUSIONS:

The administration of aspirin daily dose of 300 mg shortens the healing time ofulcerated lesions in the chronic venous insufficiency (CVI). The main prognostic factorfor healing of venous ulcerated lesions is the initial surface area of the ulcer.



Related citations

12.Ann Vasc Surg. 2012 Jul;26(5):707-14. doi: 10.1016/j.avsg.2011.11.011. Epub 2012Feb 10.

Crossover femoropopliteal bypass: single graft or doublegrafts.

Gokalp O,Yurekli I,Yilik L, Bayrak S, Yasa H, Sahin A,Kestelli M, Yetkin U, Gurbuz A.

Source

Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital,Izmir, Turkey.

Abstract

BACKGROUND:

Both single-graft crossover femoropopliteal (COFP) bypass and crossoverfemorofemoral plus femoropopliteal bypasses using double grafts may be performedfor patients with a medical history of abdominal vascular operations or comorbidity,thereby ineligible for retroperitoneal or transperitoneal approaches. In this study, thesetwo methods were compared.

METHODS:

A total of 15 patients who were operated on between February 2002 and March 2010were included and studied retrospectively. Eight of them underwent crossover

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femorofemoral bypass plus femoropopliteal bypass with double grafts (group 1),whereas the rest seven underwent single-graft COFP bypass (group 2). All the patientswere included either in class 3 or class 4 according to Fontaine classification.Preoperative arterial Doppler ultrasound and arteriography were obtained from everypatient. Pre- and postoperative ankle-brachial indices were measured. Postoperativeclinical parameters were obtained from medical records.

RESULTS:

Median primary and secondary patency rates were 40.5 (7-105) months and 58 (7-105)months in group 1, respectively. In group 2, these rates were 42 (2-84) months and 44(11-84) months, respectively. Two patients in group 1 and one patient in group 2 wereamputated. There were no significant differences between both groups in terms ofduration of hospital stay, duration of intensive care unit stay, and units of packed redblood cells transfused (P > 0.05). In addition, postoperative ankle-brachial indices weresignificantly improved in both groups (P < 0.05). COFP bypass can be performed forlimb salvage in cases with critical limb ischemia with a medical history of previous

vascular surgery or comorbidity, thereby ineligible for aortic reconstruction.

CONCLUSION:

This procedure may also be performed as continuous COFP bypass using a singlegraft.


PMID:

22325924[PubMed - indexed for MEDLINE]Related citations

13.Ann Vasc Surg. 2012 Jul;26(5):655-64. doi: 10.1016/j.avsg.2011.11.010. Epub 2012Feb 8.

A five-year review of management of upper-extremity arterialinjuries at an urban level I trauma center.

Franz RW, Skytta CK, Shah KJ,Hartman JF, Wright ML.

Source

The Vascular and Vein Center, Grant Medical Center, Columbus, OH, [email protected]

Abstract

BACKGROUND:

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Upper-extremity arterial injuries are relatively uncommon, but they may significantlyimpact patient outcome. Management of these injuries was reviewed to determineincidence, assess the current management strategy, and evaluate hospital outcome.

METHODS:

Upper-extremity trauma patients presenting with arterial injury between January 2005and July 2010 were included in this retrospective review. Descriptive statistics wereused to describe demographic, injury, treatment, and outcome data. These variablesalso were compared between blunt and penetrating arterial injuries and betweenproximal and distal arterial injuries.

RESULTS:

During a 5.6-year period, 135 patients with 159 upper-extremity arterial injuries wereadmitted, yielding an incidence of 0.74% among trauma admissions. The majority ofpatients (78.5%) suffered concomitant upper-extremity injuries. The most common

injury mechanism was laceration by glass (26.4%). Arterial injuries were categorizedinto 116 penetrating (73.0%) and 43 blunt (27.0%) mechanisms. Arterial distributioninvolved was as follows: 13 axillary (8.2%), 40 brachial (25.2%), 52 radial (32.7%), 51ulnar (32.1%), and 3 other (1.9%). The types of arterial injuries were as follows: 69transection (43.4%), 68 laceration (42.8%), 16 occlusion (10.1%), 3 avulsion (1.9%),and 3 entrapment (1.9%). One patient (0.7%) required a primary above-elbowamputation. The majority of injuries (96.8%) receiving vascular managementunderwent surgical intervention--76 primary repair (49.7%), 41 ligation (26.8%), 31bypass (20.3%), and 5 endovascular (3.3%). Conservative treatment was the primarystrategy for five arterial injuries (3.3%). Of the patients receiving vascular intervention,three (2.2%) required major and three (2.2%) required minor amputations duringhospitalization and no patients expired.

CONCLUSION:

The current multidisciplinary team management approach with prompt surgicalmanagement resulted in successful outcomes after upper-extremity arterial injuries. Nooutcome differences between penetrating and blunt or between proximal and distalarterial injuries were calculated. This management approach will continue to be used.



Related citations

14.Ann Vasc Surg. 2012 Jul;26(5):612-9. doi: 10.1016/j.avsg.2011.10.013. Epub 2012 Feb8.

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Benefit of a single dose of preoperative antibiotic on surgicalsite infection in varicose vein surgery.

Singh R, Mesh CL,Aryaie A,Dwivedi AK, Marsden B, Shukla R,Annenberg AJ,ZenniGC.

Source

Department of Surgery, Mercy Jewish Hospital, Cincinnati, OH, USA.

Abstract

BACKGROUND:

Ligation and division of the saphenofemoral junction (L/D SFJ) can protect against thedanger of venous thromboembolism (VTE) associated with greater saphenous vein

(GSV) radiofrequency ablation (RFA). Although this procedure is regarded as cleanfrom an infection standpoint, surgical site infection (SSI) can offset its thromboembolicbenefit. We questioned whether SSI associated with L/D SFJ could be minimized by asingle preoperative dose of antibiotic.

METHODS:

A retrospective cohort study was performed on 902 ambulatory surgery patients whounderwent 953 consecutive RFAs of the GSV in combination with L/D SFJ. A singledose of preoperative antibiotic was administered 1 hour before incision to somepatients (n = 449 extremities), with all other patients receiving no antibiotic (n = 504).Primary outcome measure was SSI categorized based on type of therapy required (1:oral antibiotic, 2: hospitalization for intravenous antibiotic and/or wound debridement),with a secondary outcome measure of VTE.

RESULTS:

VTE occurred in 10 patients (1%) and included three pulmonary emboli. The majority ofVTE were calf deep vein thromboses (n = 7). SSI developed in 78 patients (8.2%) withgroin, thigh, and calf distributions of 47%, 8%, and 45%, respectively. All category 2infections (n = 8, 10%) occurred in control subjects, and the majority were located inthe groin. Body mass index significantly increased risk for both overall (odds ratio [OR]:1.09, 95% confidence interval [CI]: 1.05-1.14, P < 0.0001) and groin (OR: 1.08, 95%

CI: 1.02-1.14, P = 0.01) SSI as well as VTE (OR: 1.17, 95% CI: 1.08-1.30, P = 0.003).Diabetes was a significant risk for groin SSI (OR: 5.13, 95% CI: 1.44-18.26, P = 0.01).Antibiotic was associated with a significantly reduced risk for both overall (OR: 0.54,95% CI: 0.37-0.89, P = 0.02) and groin (OR: 0.34, 95% CI: 0.16-0.73, P = 0.01) SSI.Furthermore, prophylaxis eliminated category 2 infections (P = 0.008) and wasassociated with a significantly lower risk of VTE (OR: 0.11, 95% CI: 0.01-0.85, P =0.01). Although SSI was noted more commonly in extremities with thromboemboliccomplications (20% [n = 2] vs. 8.1% [n = 76] in those without), this trend was notsignificant and could not account for the antibiotic effect on VTE.

CONCLUSIONS:

L/D SFJ combined with RFA of the GSV, when treated as a clean procedure and notprophylaxed with antibiotic, carries a significant risk of SSI. While diabetes and high

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body mass index are patient-associated SSI risk factors, a single dose of preoperativeantibiotic significantly reduces the rate of all infection, eliminates the danger of seriousinfection, and is associated with minimal VTE.



Related citations

15.Ann Vasc Surg. 2012 Jul;26(5):685-92. doi: 10.1016/j.avsg.2011.11.009. Epub 2012

Feb 4.

Vascular surgery collaboration duringpancreaticoduodenectomy with vascular reconstruction.

Turley RS, Peterson K,Barbas AS, Ceppa EP,Paulson EK, Blazer DG 3rd, Clary BM,Pappas TN, Tyler DS, McCann RL,White RR.

Source

Department of Surgery, Duke University, Durham, NC 27710, USA.

Abstract

BACKGROUND:

Once thought to have unresectable disease, pancreatic cancer patients with portalvenous involvement are now reported to have comparable survival afterpancreaticoduodenectomy (PD) with vascular reconstruction (VR) as compared withpatients without vascular involvement. We hypothesize that a multidisciplinaryapproach involving a vascular surgeon will minimize morbidity and improve patency ofVRs.

METHODS:

We identified 204 patients who underwent PD for pancreatic adenocarcinoma from1997 to 2008. Patients who underwent PD with VR (N = 42) were compared with thosewho underwent standard PD (N = 162). VRs were performed by a vascular surgeonand involved primary repair (N = 8), vein patch (N = 25), or interposition grafting (N = 9)with femoral or other venous conduit.

RESULTS:

Patients undergoing PD with VR had larger tumors (3.0 cm vs. 2.5 cm, P < 0.01) butdid not have different rates of tumor-free margins (73% vs. 72%, P = 0.84) or lymphnodes metastases (50% vs. 38%, P = 0.14). The VR group had higher median blood

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loss (875 mL vs. 550 mL, P = 0

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17.Ann Vasc Surg. 2012 Jul;26(5):649-54. doi: 10.1016/j.avsg.2011.10.009. Epub 2012Jan 30.

Temporal artery biopsy is not required in all cases of suspectedgiant cell arteritis.

Quinn EM, Kearney DE,Kelly J, Keohane C, Redmond HP.

Source

Department of Academic Surgery, Cork University Hospital, Wilton, Cork, [email protected]

Abstract

BACKGROUND:

Temporal artery biopsy (TAB) is performed during the diagnostic workup for giant cellarteritis (GCA), a vasculitis with the potential to cause irreversible blindness or stroke.However, treatment is often started on clinical grounds, and TAB result frequently doesnot influence patient management. The aim of this study was to assess the need forTAB in cases of suspected GCA.

METHODS:

We performed a retrospective review of 185 TABs performed in our institution from1990 to 2010. Patients were identified through the Hospital In-Patient Enquiry databaseand theater records. Clinical findings, erythrocyte sedimentation rate, steroid treatmentpreoperatively, American College of Rheumatology (ACR) criteria for GCA score,biopsy result, and follow-up were recorded.

RESULTS:

Fifty-eight (31.4%) biopsies were positive for GCA. Presence of jaw claudication (P =0.001), abnormal fundoscopy (P = 0.001), and raised erythrocyte sedimentation rate (P= 0.001) were significantly associated with GCA. The strongest association withpositive biopsy was seen with the prebiopsy ACR score (P < 0.001). Twenty-four(13.7%) patients had undergone biopsy, despite no potential for meeting ACR criteriapreoperatively. None of these were positive. Overall, 29 (16.4%) patients hadmanagement altered by TAB result.

CONCLUSIONS:

Our results confirm that TAB does not affect management in the majority of patientswith suspected GCA. We conclude that TAB has benefit only for patients who score 2or 3 on the ACR criteria for GCA without biopsy.

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Related citations

18.Ann Vasc Surg. 2012 Jul;26(5):674-9. doi: 10.1016/j.avsg.2011.07.019. Epub 2012 Jan27.

Patients characteristics and outcome of 518 arteriovenous

fistulas for hemodialysis in a sub-Saharan African setting.Fokou M,Ashuntantang G, Teyang A,Kaze F, Chichom Mefire A, Halle MP,AngwafoF 3rd, Takongmo S,Sandmann W.

Source

Department of Surgery, Yaound General Hospital, Yaounde, [email protected]

Abstract

BACKGROUND:

To present the particular aspects of arteriovenous fistula (AVF) for hemodialysis in sub-Saharan Africa in terms of patients' characteristics, patency and complication rates, aswell as factors influencing them.

METHODS:

From November 2002 to November 2009, 518 fistulas were constructed on adults.Demographic data, patency, and complications were analyzed. The associationbetween age, sex, and comorbidities (HIV, hypertension, diabetes) on one hand and

complications as well as AVF patency on the other was sought.

RESULTS:

Males represented 73.7% of the patient population, and the mean age of the populationwas 45.3 years. As far as etiologies of end-stage renal disease (ESRD) andcomorbidities are concerned, chronic glomerulonephritis was the leading cause ofESRD (134; 25.9%), followed by hypertension (22.3%), although prevalent in 83.2% ofpatients, and diabetes (20.1%), although prevalent in 22.2%. No cause for the ESRDcould be identified in 89 patients (17.2%). Only 20.64% had AVF as the initial vascularaccess. The main types of AVF constructed were radiocephalic (68%) andbrachiocephalic (24.9%). The median follow-up period was 275 days. The cumulativepatency rate at 1 year and 2 years was 76% and 51%, respectively. Altogether, 188complications occurred in 16% of the AVFs. Aneurysms, failure to mature, and

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thrombosis were the most frequent complications occurring in 27.65%, 14.89%, and10.63% of cases, respectively. The management options for the complications includedthe creation of a new access for 63 complications (33.51%) and nonoperativemanagement in 44.14% of the cases. We found no adverse effect of comorbid factorslike diabetes mellitus ((2) = 3.58, P > 0.05) and HIV-positive status ((2) = 0.64, P >0.05) on the complications rate.

CONCLUSION:

According to our patients' characteristics, there is a possibility of constructing AVF onnearly every hemodialysis patient with a good outcome.

Copyright 2012. Published by Elsevier Inc.


Related citations

19.Ann Vasc Surg. 2012 Jul;26(5):643-8. doi: 10.1016/j.avsg.2011.08.016. Epub 2012 Jan23.

Treatment of arteriovenous malformations involving the hand.

Park UJ,Do YS, Park KB,Park HS, Kim YW,Lee BB, Kim DI.

Source

Vascular Malformation Clinic, Samsung Medical Center, Sungkyunkwan UniversitySchool of Medicine, Seoul, Republic of Korea.

Abstract

BACKGROUND:

Hand arteriovenous malformations (AVMs) are difficult to treat because of thenecessity to maintain function and the high complication rate of treatment. The purposeof this study was to review the treatment of hand AVMs with embolo/sclerotherapy andthe surgical procedures at a single institute.

MATERIAL AND METHODS:

We retrospectively reviewed the medical records and identified the patients who werereferred to the vascular division owing to hand AVMs between 1995 and 2009. Thelesions were classified according to their affected areas. The treatments used at theclinic included conservative treatment, amputation, and embolo/sclerotherapy. Weinvestigated the clinical data and assessed the treatment results.

RESULTS:

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Sixty-four patients were involved in this study. The median follow-up duration was 26.9months (range: 3.5-141.8 months). The median age of the patients was 31.5 years(range: 0.3-75.0 years). All of the lesions were of the extratruncal (ET) form, and 37cases (57.8%) were of the infiltrating type. Sixteen patients were treatedconservatively. Primary amputation was performed in seven cases with previouscomplications such as ulcer, bleeding, or functional limitations. Embolo/sclerotherapywith ethanol was performed in 41 patients. Sixteen (39.0%) of them showed clinicalimprovement. The treatment of 20 (48.8%) of the 41 patients was interrupted owing toa variety of complications, and 2 (4.9%) of these patients failed withembolo/sclerotherapy. Skin necrosis was the major complication, and this occurred in17 patients treated with embolo/sclerotherapy--14 of these cases were small and theskin necrosis healed with conservative treatment; 1 patient had autoamputation owingto necrosis; and 2 patients underwent amputation surgery owing to gangrene. The riskfor skin necrosis was higher for the AVMs that involved the subcutaneous layer and theAVMs that extended diffusely (P = 0.021, P = 0.011). Seven neuropathic complicationsdeveloped after embolo/sclerotherapy, and all of them were transient.

CONCLUSIONS:

The symptoms and characteristics of the lesions are important factors in devising atreatment plan for AVMs. AVM treatment, and especially embolo/sclerotherapy, is along-term prospect, and it carries a potential risk for serious complications. After everytreatment, the lesions must be reevaluated and new treatment plans must be made bythe members of a multidisciplinary team.



Related citations

20.Ann Vasc Surg. 2012 Jul;26(5):739-46. doi: 10.1016/j.avsg.2011.06.011. Epub 2011Dec 22.

Paradoxical pulmonary embolism with spontaneous aortocavalfistula.

De Rango P, Parlani G, Cieri E, Verzini F,Isernia G,Silvestri V,Cao P.

Source

Unit of Vascular and Endovascular Surgery, Hospital S. M. Misericordia, University ofPerugia, Perugia, Italy. [email protected]

Abstract

BACKGROUND:

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Paradoxical pulmonary embolisms are uncommon emergencies and can occur as aconsequence of an aortocaval fistula due to unrecognized dislodgement of thrombusfrom aortic sac into pulmonary circulation. This study reviewed current literature andtherapeutic options in this emergency condition requiring prompt management andrepair.

METHODS:

Literature was systematically searched for paradoxical pulmonary embolism associatedwith aortocaval rupture.

RESULTS:

Eight published cases were identified. However, many other paradoxical pulmonaryemboli could have remained undiagnosed due to challenging clinical presentation.Symptoms of high-output cardiac failure and respiratory distress in the presence oflarge aortoiliac aneurysm and venous hypertension are findings of a possible major

abdominal arteriovenous fistula with paradoxical pulmonary embolism. Successfultreatment depends on prevention of new embolism and proper management ofperioperative hemodynamics and massive bleeding during fistula repair. Endovascularprocedures have been recently used as useful tools in this field. Cava filter placementmay be a first step to prevent further thrombus dislodgements during aortocaval repair.Immediate subsequent aortic stent-grafting can allow repair of aortocavalcommunication and exclusion of the abdominal aortic aneurysm from circulation withsuccessful reversal of altered hemodynamic features. However, experience (especiallyin the long-term) is limited.

CONCLUSIONS:

Paradoxical pulmonary embolism from aortocaval fistula represents an extremely rarebut true clinical emergency with high fatality rate. Recent advances in diagnostictechnology and endovascular techniques can substantially improve outcomes of thedisease. Clinical competence in early detection and diagnosis is essential forappropriate emergent management.


PMID:22197523


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Ann Vasc Surg 2012; 26(5)Case Reports

1.Ann Vasc Surg. 2012 Jul;26(5):733.e9-12. doi: 10.1016/j.avsg.2011.10.024.

Endovascular central venous stenosis treatment ended withsuperior vena cava perforation, pericardial tamponade, andexitus.

Siani A, Marcucci G,Accrocca F,Antonelli R, Mounayergi F,Rosati MS,Gabrielli R.

Source

Department of Vascular Surgery, ASL-RMF San Paolo Hospital Civitavecchia, Rome,Italy.

Abstract

Venous hypertension and outflow stenosis of arteriovenous hemodialysis accessmanaged using endovascular procedures usually present a high technical successrate, with few complications. We reported a rare and fatal complication of superior venacava perforation with pericardial tamponade 3 months after subclavian vein stenting.Interventional recanalization with stenting for the management of superior vena cavasyndrome or central vein stenosis is a safe procedure with a low complication rate.Stent misplacement, reocclusion, migration, or access-related complications appear tooccur most frequently.

Copyright 2012 Annals of Vascular Surgery Inc. All rights reserved.


Related citations


Aneurysm of the superior labial artery.

Seidel AC, Rossetti LP,Mangolim AS, Gomes JR, de Almeida Rollo H.

Source

Department of Angiology and Vascular Surgery, Medical School of UniversidadeEstadual de Maring, Maring, Paran, Brazil.
http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(12)00088-X

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Abstract

This is a case report of a true and dissecting aneurysm of the superior labial artery in a51-year-old patient without risk factors for vascular pathology. The patient complainedof swelling of the upper lip, mostly on the left side. A Doppler ultrasonography wasused in the diagnosis. The definitive treatment was surgical resection, and thehistopathological analysis confirmed the diagnosis. The progress of the patient wassatisfactory, leaving a slight change in sensitivity in the area. This seems to be the firstreported case of true and dissecting aneurysm of the superior labial artery in themedical literature.



Related citations


Endovascular treatment of an iatrogenic perforation of theinternal iliac vein.

Willaert W,Van Herzeele I, Ceelen W,Van De Putte D, Vermassen F,Pattyn P.

Source

Department of Surgery, Ghent University Hospital, Ghent, [email protected]

Abstract

We describe the case of a 48-year-old woman who developed a pelvic abscess afterextensive surgery for recurrent ovarian cancer. While draining the abscess, a massive

venous bleeding occurred. The bleeding was controlled by introducing a Foley cathetertransrectally, occluding the perforated internal iliac vein. However, the catheter waspositioned unintentionally in the inferior vena cava, causing hemodynamic instability.The iatrogenic perforation of the internal iliac vein was managed successfully with anendovascular approach using thrombin in combination with balloon-inducedthrombosis. If iatrogenic venous bleeding occurs and the placement of a stent isprecluded, balloon-induced thrombosis in combination with thrombin injection can beused successfully.


PMID:22664295

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Incapacitating pelvic congestion syndrome in a patient with ahistory of May-Thurner syndrome and left ovarian veinembolization.

Rastogi N,Kabutey NK,Kim D.

Source

Division of Interventional Radiology, Department of Radiology, Boston Medical Center,Boston, MA 02118, USA. [email protected]

Abstract

BACKGROUND:

The aim of this article is to report a rare case of unresolved incapacitating pelviccongestion syndrome (PCS) in a patient with a history of May-Thurner syndromepreviously treated with stenting and left ovarian vein embolization. Additionally, this

article highlights the role of pelvic venography in patients with PCS and reviews thecoexistence.

METHODS:

A 32-year-old woman was referred to us for the evaluation of recurrent pelvic pain anddyspareunia requiring analgesics. Initially, she developed left lower-extremity deep veinthrombosis a few months after her first pregnancy. On further workup, she wasdiagnosed with May-Thurner syndrome and underwent left common iliac and leftexternal iliac vein stenting. Furthermore, left ovarian vein coil embolization wasperformed for symptoms suggesting PCS at the same outside facility. The patient wasreferred to us for persistent pelvic pain approximately 1 year after she underwent left

ovarian vein coil embolization. A diagnosis of incompletely resolved PCS wasconsidered.

RESULTS:

Iliocaval venogram demonstrated patent left common iliac and external iliac venousstents in situ. Subsequent right ovarian venogram revealed a patent, but grosslydilated, right ovarian vein with retrograde flow and cross-pelvic collaterals confirminggrade III PCS. Right ovarian vein coil embolization was performed, with excellentpatient outcome.

CONCLUSION:

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In the setting of a combined diagnosis of PCS and May-Thurner syndrome, persistentincapacitating PCS after initial iliac stenting should be followed with a complete pelvicvenous evaluation including ovarian and left renal venography to rule out residualpelvic congestion secondary to any coexisting ovarian vein incompetencies ornutcracker syndrome.



Related citations


Acute expansion of a hospital-acquired methicillin-resistantStaphylococcus aureus-infected abdominal aortic aneurysm.

Reslan OM, Ebaugh JL, Gupta N, Brecher SM, Itani KM,Raffetto JD.

Source

Department of Surgery, VA Boston HCS, West Roxbury, MA 02132, USA.

Abstract

Infected aortic aneurysms (IAAs) are rare but can have devastating outcomes,particularly if diagnosis and treatment are delayed. The incidence of IAA is between0.65% and 2% of all aortic aneurysms. The disease has a poor prognosis becausethese aneurysms have an increased tendency to grow rapidly and to rupture, andpatients often have severe comorbidities and coexisting sepsis. Typicalmicroorganisms associated with IAA are Salmonella, Streptococci, and Staphylococcusaureus. Methicillin-resistant Staphylococcus aureus (MRSA) continues to emerge as acause of serious infections, but its association with IAA is extremely rare. We present a

rare case of infected abdominal aortic aneurysm caused by hospital-acquired (HA)MRSA. This case adds another presentation to the clinical spectrum of HA MRSAinfections, and it highlights the problems encountered in the choice of the therapy ofserious HA or health care-acquired infections in an era of increasing MRSA infections.We will discuss the clinical spectrum of HA MRSA infections as well as the problemsencountered in the management of IAA, and will review the relevant literature.

Published by Elsevier Inc.


Related citations
http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(12)00086-6http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(12)00085-4

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Stepwise revascularization by carotid endarterectomy afterballoon angioplasty for symptomatic severe carotid arterystenosis.

Egashira Y, Yoshimura S, Yamada K,Enomoto Y,Asano T, Iwama T.

Source

Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu,Japan. [email protected]

Abstract

The authors report a novel stepwise carotid revascularization method to preventperioperative complication. A 68-year-old man presented with left hemiparesis anddysarthria caused by severe stenosis of the right cervical internal carotid artery.According to the preoperative cerebral blood flow evaluation and plaquecharacterization, the patient was at risk for postoperative hyperperfusion and ischemiccomplications after carotid artery stenting. Initially, the patient underwent percutaneousangioplasty using an undersized balloon. Fifteen days later, the patient underwent acarotid endarterectomy. The surgical specimen obtained during the carotidendarterectomy showed the presence of typical vulnerable plaque. Of note was the

complete preservation of the thin fibrous cap. The postoperative single-photonemission tomography images showed no signs of hyperperfusion, and the patientdeveloped no neurological symptoms after each of the procedures.



Related citations


Endovascular stent graft repair for a Salmonella-infectedaneurysm of thoracic aorta.

Lao WF, Huang CH, Lin CH, Lu MJ, Hung CR.

Source

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Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.

Abstract

Thoracic endovascular aneurysm repair using stent graft has been reported as a

feasible and effective treatment for aortic aneurysm. However, its application fortreating infected aortic aneurysms is still controversial and less reported. We report a74-year-old male diabetic patient diagnosed with Salmonella-infected aortic aneurysm,who was successfully treated with endovascular stent graft repair followed by a 2-month course of intravenous antibiotics and long-term oral antibiotic therapy.Sequential computed tomography scans demonstrated the shrinkage of the aneurysmand no evidence of relapse 11 months later.


PMID:

22664291[PubMed - indexed for MEDLINE]

Related citations


Fenestrate what you can't snorkel?

Zayed MA,Chowdhury M, Casey K, Dalman RL, Lee JT.

Source

Department of Surgery, Stanford University Medical Center, Stanford, CA 94305, USA.

Abstract

BACKGROUND:

Although challenging proximal necks have limited the utility of standard endovascularaneurysm repair (EVAR) devices, sophisticated endovascular techniques have evolvedin recent years for the repair of juxtarenal abdominal aortic aneurysms (AAAs). Amongthese techniques, snorkel or chimney EVAR (sn-EVAR) and fenestrated EVAR (f-EVAR) have emerged as options for repairing anatomic high-risk AAAs. Unfortunately,in the United States, except in the context of a clinical trial or physician-sponsoreddevice exemption, limited long-term data exist on the treatment of juxta- and suprarenalAAAs with either sn-EVAR or f-EVAR. Owing to these limitations, comparison of thesetwo techniques is challenging, and we sought to describe a case when one wasfavored over the other.

METHODS AND RESULTS:

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A 72-year-old man presented with an enlarging, asymptomatic, juxtarenal fusiform AAA(5.9 cm), a moderately enlarged right common iliac artery (2.8 cm), a history of oxygen-dependent chronic obstructive pulmonary disease, and a previous right nephrectomy.An initial sn-EVAR was attempted but was unsuccessful owing to the inability to deliverthe "snorkel" covered stent via a brachial approach because of renal ostial stenosisand cephalad angulation of the patient's left renal artery. A subsequent f-EVARapproach was successfully used to repair the juxtarenal AAA while preservingadequate renal artery blood flow. Two-year postoperative follow-up demonstrated astable endovascular repair without endoleaks, a shrinking aneurysm sac, and stablerenal function.

CONCLUSION:

The sn-EVAR configuration in this case report was precluded by cephalad renalangulation, and the AAA was instead repaired using an f-EVAR approach, with good 2-year follow-up outcomes. The sn-EVAR strategy requires downward pointing renalarteries in addition to adequate brachial/axillary artery access dimensions to facilitate

successful repair. With improving techniques and technology for either approach,anatomic specifications and indications for these advanced EVAR strategies will needto be delineated.



Related citations


Subclavian artery aneurysm in Marfan syndrome.

Morisaki K, Kobayashi M,Miyachi H, Maekawa T, Tamai H, Takahashi N, Watanabe Y,Morimae H, Ihara T, Kodama A,Narita H, Banno H, Yamamoto K,Komori K.

Source

Division of Vascular Surgery, Department of Surgery, Nagoya University GraduateSchool of Medicine, Nagoya, Japan.

Abstract

We present a case of a left subclavian artery aneurysm in a 48-year-old man withMarfan syndrome. Aneurysms of the subclavian artery are rare in patients with Marfansyndrome. Resection of the aneurysm and interposition with a synthetic graft wereperformed through a supra- and infraclavicular incision, without resecting the clavicle.

Histological findings were compatible with Marfan syndrome. In patients with Marfan

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syndrome, regular follow-up is important because of the occurrence of peripheralaneurysms other than the aorta.



Related citations


Pancreatitis-related abdominal aortic pseudoaneurysms treatedwith stent-grafts.

Stefaczyk L, Elgalal MT, Chrzstek J,Szubert W, Czeczotka J, Papiewski A, Piotr S.

Source

Department of Radiology, Medical University of Lodz, Lodz, Poland.

Abstract

Endovascular treatment of pseudoaneurysms that develop as a complication ofpancreatitis is increasingly more common. A case of a pseudoaneurysm of theabdominal aorta initially treated by implantation of a straight aortic stent-graft ispresented. In the 4 months after the procedure, chronic inflammation of theretroperitoneal space caused a further perforation on the posterior wall of the aorta inthe area of the bifurcation, distal to the graft. Implantation of a bifurcated stent-graftwas subsequently performed. The aneurysm was excluded, with the implant andperipheral arteries remaining patent.



Related citations


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Stent graft exclusion of a ruptured mycotic poplitealpseudoaneurysm complicating sternoclavicular joint infection.

Ghassani A, Delva JC, Berard X, Deglise S,Ducasse E, Midy D.

Source

Department of Vascular Surgery, University Hospital of Bordeaux, Bordeaux, [email protected]

Abstract

A mycotic pseudoaneurysm of the popliteal artery is usually a consequence of septicembolization and often a result of bacterial endocarditis. Conventional treatment issurgical and avoids the placement of foreign material in infected sites. Here we reportour treatment of a 59-year-old man who presented with a rupture of a mycotic

pseudoaneurysm of the popliteal artery due to septic embolism from sternoclavicularinfectious arthritis. Radiological investigations are included. This is the first documentedcase of septic arthritis complicated by a rupture of a mycotic popliteal false aneurysmand treated using an endovascular procedure. Combining endovascular stent graftswith evacuation of the joint abscess and antibiotic therapy can offer a safe alternativefor frail and unstable patients.


PMID:22664287



Fibular nerve injury after small saphenous vein surgery.

de Alvarenga Yoshida R, Yoshida WB, Sardenberg T, Sobreira ML, Rollo HA, MouraR.

Source

Department of Vascular and Endovascular Surgery, Botucatu School of Medicine, SoPaulo State University, So Paulo, Brazil. [email protected]

Abstract

Superficial nerve injuries are very common during varicose vein surgery. In contrast,

deep nerve injuries are rare and reported especially when surgery involves the smallsaphenous vein (SSV). The deep motor nerves most commonly injured are the tibial

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nerve and the peroneal nerve, which are directly or indirectly affected by extrinsiccompression, stretching, or healing process involvement. In this report, two cases ofcommon fibular nerve injury after SSV stripping are described, including treatmentused and patient outcomes. Nerve damage mechanisms, anatomy, and preventionstrategies are also discussed. In conclusion, fibular nerve damage may occur duringSSV stripping. Preventive measures include careful preoperative ultrasonographicinvestigation of the anatomy of the vein, determining location of the saphenopoplitealjoint, and careful dissection far from fibular nerve and restricted to the popliteal fossa.



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Eagle syndrome revisited: cerebrovascular complications.

Todo T,Alexander M, Stokol C,Lyden P, Braunstein G,Gewertz B.

Source

Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

Abstract

Cervical pain caused by the elongation of the styloid process (Eagle syndrome) is wellknown to otolaryngologists but is rarely considered by vascular surgeons. We reporttwo patients with cerebrovascular symptoms of Eagle syndrome treated in our medicalcenter in the past year. Case 1: an 80-year-old man with acromegaly presented withdizziness and syncope with neck rotation. The patient was noted to have bilateralelongated styloid processes impinging on the internal carotid arteries. After stagedresections of the styloid processes through cervical approaches, the symptomsresolved completely. Case 2: a 57-year-old man presented with acute-onset left-sidedneck pain radiating to his head immediately after a vigorous neck massage. Hospitalcourse was complicated by a 15-minute transient ischemic attack resulting in aphasia.Angiography revealed bilateral dissections of his internal carotid arteries, with adissecting aneurysm on the right. Both injuries were immediately adjacent to thebilateral elongated styloid processes. Despite immediate anticoagulation therapy, heexperienced aphasia and right hemiparesis associated with an occlusion of his leftcarotid artery. He underwent emergent catheter thrombectomy and carotid stentplacement, with near-complete resolution of his symptoms. Elongated styloidprocesses characteristic of Eagle syndrome can result in both temporary impingementand permanent injury to the extracranial carotid arteries. Although rare, Eagle

syndrome should be considered in the differential diagnosis in patients withcerebrovascular symptoms, especially those induced by positional change.

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Related citations

14.Ann Vasc Surg.2012 Jul;26(5):730.e1-5. doi: 10.1016/j.avsg.2011.11.030. Epub 2012Apr 12.

Primary aortoduodenal fistula in a patient with pararenal

abdominal aortic aneurysm.Genovs-Gasc B, Torres-Blanco , Plaza-Martnez , Olmos-Snchez D, Gmez-Palons F, Ortiz-Monzn E.

Source

Servicio de Angiologa y Ciruga Vascular, Hospital Universitario Dr. Peset, Valencia,Espaa. [email protected]

Abstract

Primary aortoenteric fistula is a rare and extremely serious condition. In most cases, itis caused by an abdominal aortic aneurysm presenting with symptoms ofgastrointestinal bleeding. Diagnosis is difficult owing to its rarity and the fact thatdiagnostic tests are not definitive in many cases. Surgery is performed urgently in mostcases and is associated with high mortality. We report a case of a 65-year-old manpresenting with symptoms of abdominal pain and massive rectal hemorrhage.Computed tomography revealed a pararenal abdominal aortic aneurysm andsuspected aortoenteric fistula. The patient underwent an emergency surgery,confirming the suspected diagnosis. The surgery performed was the traditionallyrecommended extra-anatomical bypass with aortic ligation and repair of the intestinaldefect. We describe the clinical condition and provide an up-to-date overview of

diagnosis and treatment by reviewing the literature. We believe the therapeuticdecision should be personalized by assessing the anatomy of the aneurysm, thepatient's clinical status, the degree of local contamination, and the surgeon'sexperience with each of the techniques.



Related citations

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15.Ann Vasc Surg.2012 Jul;26(5):729.e7-9. doi: 10.1016/j.avsg.2011.11.027. Epub 2012Apr 10.

Surgical therapy of an asymptomatic primary popliteal venousaneurysm.

Lutz HJ,Sacuiu RD, Savolainen H.

Source

Department of Vascular and Endovascular Surgery, VerbundkrankenhausBernkastel/Wittlich, Wittlich, Germany. [email protected]

Abstract

Primary popliteal venous aneurysm is a rare condition. To date, approximately 150cases have been reported. In the present article, we report a 59-year-old man whopresented with a swelling of the left popliteal fossa. Duplex ultrasound scan revealed asaccular aneurysm of the popliteal vein, with a diameter of 2.5 2.5 cm. The distal partof the popliteal vein was dilated in a fusiform configuration up to 2.0 cm on both sides.The diagnosis was confirmed using magnetic resonance imaging and ascendingphlebography. There was no sign of venous thrombosis. Our patient presented withoutany previous clinical evidence of pulmonary emboli. Surgery was deemed indicated. Atraditional tangential aneurysmectomy and lateral venorrhaphy of the distal fusiformpart of the popliteal lesion was performed as well as resection of the saccular partusing a dorsal approach. Surgery and recovery were uneventful. The patient presented

for follow-up after 6 and 12 weeks without any complaints. Duplex ultrasound scanningand ascending phlebography (only once after 12 weeks) were performed, whichconfirmed patency.



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