ann vasc surg 2012;26(2)

Ann Vasc Surg 2012; 26(2)Originals

1.Ann Vasc Surg. 2012 Feb;26(2):280.e5-8. doi: 10.1016/j.avsg.2011.06.015.

Successful treatment for infected aortic aneurysm using endovascular aneurysm repairs as a bridge to delayed open surgery.

Fukunaga N, Hashimoto T, Ozu Y, Yuzaki M, Shomura Y, Fujiwara H, Nasu M, Okada Y.

Source

Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan. [email protected]

Abstract

Management of infected aortic aneurysms, which can be life-threatening, remains challenging. Open surgical treatments, including debridement of the infected aorta and the surrounding tissue and either in situ reconstruction or extra-anatomic bypass covering with omentum or muscle flap, are the mainstay of therapy. However, increasing advances in technology have made endovascular treatment of infected aneurysms feasible. The present study describes the first clinical report of successful treatment of an infected aneurysm using endovascular techniques in the acute phase, followed by delayed open surgery.

Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

PMID:22304872[PubMed - indexed for MEDLINE]

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2.Ann Vasc Surg. 2012 Feb;26(2):268-75. doi: 10.1016/j.avsg.2011.10.006.

Matrine inhibits disturbed flow-enhanced migration via downregulation of ERK1/2-MLCK signaling vascular smooth muscle cells.

Zhu P, Chen JM, Guo HM, Fan XP, Zhang XS, Fan RX, Zheng SY, Wu RB, Xiao XJ, Huang HL, Zhu XL, Liu HP, Long G, Chen YF, Zhuang J.

http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(11)00550-4

Source

Cardiovascular Surgery Department, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, People's Republic of China.

Abstract

BACKGROUND:

To investigate the effects of matrine on the vascular smooth muscle cell (VSMC) migration modulated by disturbed flow and their underlying molecular mechanisms in vitro.

METHODS:

Isolated rat aortic VSMCs were grown to confluence on 20- × 80-mm fibronectin-coated glass cover slides, and then, denuded zones were made at the position calculated to be the oscillating flow-reattachment zone and also in the downstream laminar flow region. VSMCs were treated with different doses of matrine (0, 10, 20, 30, and 40 mg/L), or PD98059 (30 μM), ML-7 (10 μM) combined with matrine (40 mg/L) for 30 minutes before and during the experiments. Then, the wounded monolayers were kept under static conditions or were subjected to laminar or disturbed flow for 21 hours or 10 hours. The VSMC migration was assessed by microscopic images. The extracellular signal-regulated kinase 1/2 (ERK1/2) and myosin light chain kinase (MLCK) proteins were determined by Western blot.

RESULTS:

Disturbed flow significantly increased phosphorylation of ERK1/2. Selective inhibition of ERK1/2 phosphorylation by inhibitor PD98059 and matrine significantly suppressed VSMC migration under disturbed flow. Disturbed flow significantly enhanced phosphorylation of MLCK, whereas both matrine and PD98059 inhibited the phosphorylation of MLCK under disturbed flow. The complete inhibition of MLCK phosphorylation using the selective MLCK inhibitor ML-7 significantly inhibited VSMC migration under disturbed flow.

CONCLUSION:

Matrine inhibits VSMC migration under disturbed flow, in part, by downregulation of ERK1/2-MLCK signaling pathway.



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Pedicled flaps in association with distal bypass for lower-limb salvage.

Laurent B, Millon A, Richer de Forges M, Artru B, Lermusiaux P.

Source

Clinique du Pré, Le Mans, France.

Abstract

BACKGROUND:

After distal bypass for limb salvage, persistence of large ischemic ulcers with exposure of tendons, joints, and bone and secondary graft exposure can lead to amputation, even though the bypass remains patent. Coverage of such defects using free flaps is too lengthy and complex for use in elderly patients. Although quick and simple, pedicled flaps are often considered to be contraindicated in patients with occlusive artery disease. The purpose of this study was to evaluate the outcome of pedicled flaps harvested after evaluation of revascularized territories on angiograms for coverage of tissue defects.

METHODS:

From 1994 to 2000, a total of 23 pedicled flap procedures were performed in 22 patients with a mean age of 75 years (range, 54-91 years). The distal anastomosis of the bypass was located on a tibial or pedal artery in 19 cases and on the popliteal artery in 4. The indication for flap placement was chronic ulcer in 7 cases, secondary graft exposure in 15, and open fracture with acute ischemia in 1. To be considered as usable, the flap had to be vascularized by a pedicle fed by the bypassed artery and have a rotational axis sufficient to cover the defect. Muscle flaps were used in 11 cases, fasciocutaneous flaps in 10, and fascial flaps in 2.

RESULTS:

The flap procedures in this study led to primary healing in 17 cases, secondary healing in 4 cases, and failure due to necrosis in 2. Follow-up examination was carried out with Doppler ultrasonography at 1, 6, and 12 months and every 6 months thereafter. The mean follow-up period was 23 months (range, 3-5 years). Statistical analysis demonstrated bypass patency, limb salvage, and survival rates in agreement with those previously reported in the literature.

CONCLUSIONS:

Our results suggest that pedicle flaps are feasible after distal bypass in patients with lower-extremity occlusive artery disease. This technique expands the indication for limb salvage with low morbidity.



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The results of a needs assessment to guide a vascular surgery skills simulation curriculum.

Woo K, Rowe VL, Weaver FA, Sullivan ME.

Source

Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA 90033, USA. [email protected]

Abstract

BACKGROUND:

In response to economic and societal pressures, a new integrated model of vascular surgery training has emerged that will condense training into 5 years. These new requirements challenge educators to develop innovative training programs that produce competent surgeons despite time constraints. Surgical skills simulation is a proven effective method to teach and evaluate learners in surgery residency programs.

METHODS:

To determine which skills are the most important to include in a vascular surgical skills training curriculum, a needs assessment survey was administered to all attending surgeons and fellows at vascular surgery training institutions in Southern California. Participants were asked to rank 52 vascular procedures and skills on a Likert scale (with scores ranging from 1 [not necessary] to 5 [essential]) based on perceived need for simulation training.

RESULTS:

Nineteen (48.7%) surveys were returned (6 fellows [60%], 13 attending surgeons [44.8%]). Carotid artery stenting was ranked by both fellows and attendings as the most essential procedure for simulation, with a mean score of 4.26. This was followed by open repair of ruptured infrarenal aortic aneurysm (R-AAA) (3.79), renal angioplasty/stent (3.68), thoracic endovascular aortic aneurysm repair (3.53), and open repair of juxtarenal/suprarenal aortic aneurysm (3.47). In addition, fellows gave a rank of 4 or higher to R-AAA, thoracic endovascular aortic aneurysm repair, mesenteric artery angioplasty/bypass, renal angioplasty/stent, and intravascular ultrasonography.


Attendings did not give a mean rank score of 4 or higher to any procedures other than carotid artery stenting.

CONCLUSIONS:

Our needs assessment identified vascular procedures where simulation may be beneficial to improve the skill level of vascular trainees in Southern California. With economic and logistical constraints for simulation at each individual training facility, a potential approach to this educational challenge is a regional Southern California vascular surgery skills simulation center.



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Preoperative cardiac evaluation and perioperative cardiac therapy in patients undergoing open surgery for abdominal aortic aneurysms: effects on cardiovascular outcome.

Faggiano P, Bonardelli S, De Feo S, Valota M, Frattini S, Cervi E, Guadrini C, Giulini SM, Dei Cas L.

Source

Division of Cardiology, Spedali Civili, University of Brescia, Brescia, Italy. [email protected]

Abstract

BACKGROUND:

Cardiovascular complications, such as death, myocardial infarction, or heart failure, are the leading causes of morbidity and mortality in adult patients undergoing major noncardiac surgery.

OBJECTIVE:

To evaluate the effects of an accurate preoperative cardiac evaluation, together with optimized perioperative drug therapy, in reducing cardiovascular events in patients undergoing open aortic surgery for abdominal aneurysm.

METHODS:


Between January 2000 and December 2008, we considered all consecutive patients undergoing elective abdominal aortic open surgery at the Vascular Surgery Unit of the University of Study-Spedali Civili (Italy). Since January 2003, we have used an intensive cardiac preoperative evaluation: patients with at least one cardiac risk factor received a preoperative cardiac evaluation; all non-invasive and invasive tests were performed preoperatively when indicated by the consultant cardiologist, that also optimized the pharmacological perioperative therapy. The outcome of the 418 patients undergoing surgery between 2003 and 2008 was compared with those of the 204 patients in the previous triennium 2000 to 2002, when only patients with positive history for cardiac disease received a standard preoperative cardiological clinical or instrumental evaluation.

RESULTS:

Patients enrolled in the 2003 to 2008 interval were slightly older and with a higher prevalence of comorbidities compared with those observed in the previous triennium; furthermore, the number of noninvasive tests performed before surgery increased significantly. Nevertheless, the number of major cardiac perioperative complications decreased over time: particularly, in-hospital mortality rate was 0.9% in the latter period, compared with 3.4% in the years 2000 to 2002. Also, the long-term mortality was significantly reduced in patients operated on between 2003 and 2008 compared with those operated on in the previous triennium.

CONCLUSION:

These data suggest a significant benefit of an intensive cardiac preoperative evaluation in reducing the incidence of perioperative and postoperative cardiac morbidity and mortality.



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6.Ann Vasc Surg. 2012 Feb;26(2):250-8. doi: 10.1016/j.avsg.2011.09.003. Epub 2012 Jan 4.

Treatment with simvastatin inhibits the formation of abdominal aortic aneurysms in rabbits.

Mastoraki ST, Toumpoulis IK, Anagnostopoulos CE, Tiniakos D, Papalois A, Chamogeorgakis TP, Angouras DC, Rokkas CK.

Source


Department of Cardiothoracic Surgery, University of Athens School of Medicine, Attikon Hospital, Athens, Greece. [email protected]

Abstract

BACKGROUND:

Abdominal aortic aneurysm (AAA) is a common and lethal disease. AAAs are associated with atherosclerosis, chronic inflammation, and extracellular matrix degradation. The aim of this study was to determine whether treatment with simvastatin can influence the development of experimental aortic aneurysms in a rabbit model.

MATERIALS AND METHODS:

A total of 76 rabbits were randomized in four groups: in group I (n = 12), where the abdominal aortas were exposed to 0.9% NaCl, and in group II (n = 24), group III (n = 24) and group IV (n = 18), where the aortas were exposed to CaCl2 0.5 mol/L for 15 minutes after laparotomy. Group III received 2 mg/kg simvastatin daily starting 7 days before laparotomy, and in group IV, the daily treatment with simvastatin started 7 days after laparotomy. Animals were sacrificed at intervals of first, second, third, and fourth week to obtain measurements of aortic diameter and histological examination. Moreover, immunohistochemistry was used in order to examine the relative distribution of matrix metalloproteinases (MMPs) 2 and 9 (MMP-2 and MMP-9, respectively) and tissue inhibitor 1 of MMPs within the aortic aneurysms.

RESULTS:

The increase of aortic diameter in animals of group I ranged from 4.6% to 7.6%; in group II, from 41% to 85% (P < 0.001 vs. group I); in group III, from 9% to 18% (group II vs. group III, P < 0.001); and in group IV; from 36% to 38%. Moreover, aortic specimens of group II presented a statistically significant increase in MMP-2 and MMP-9 immunoexpression compared with other groups (I, III, IV) (P < 0.05 for all comparisons), with the exception of animals of group IV at the end of second week. Immunoreactivity of tissue inhibitor 1 of MMPs was not statistically different among groups II, III, and IV.

CONCLUSIONS:

Simvastatin may prove clinically significant in suppressing the development and expansion of AAAs and, thereby, in reducing the risk of rupture and the need for repair.



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7.


Ann Vasc Surg. 2012 Feb;26(2):281-91. doi: 10.1016/j.avsg.2011.01.014. Epub 2011 Dec 22.

Update on endovenous radio-frequency closure ablation of varicose veins.

García-Madrid C, Pastor Manrique JO, Gómez-Blasco F, Sala Planell E.

Source

Institut Vascular Sala Planell, Centro Médico Teknon, Hospital Clínic, Barcelona, Spain. [email protected]

Abstract

Until recent years, the gold standard for treatment of truncal varicose veins has been high ligation and stripping of the saphenous vein. In the course of the last decade, new minimally invasive techniques based on endothermal ablation are progressively supplanting conventional surgery in the treatment of varicose veins. The endovenous treatment of varicose veins has been developed to reduce complications associated with conventional surgery and to improve quality of life. Radio frequency ablation (RFA) available since 1999 is now established as a safe and efficacious treatment for the ablation of refluxing saphenous veins. Among the emerging therapies, RFA with VNUS ClosureFAST is promising because it has eliminated almost all disadvantages associated with conventional surgery by "stripping" (bruises, scars, ecchymosis, inguinal recurrence, neovascularization, and mainly, prolonged incapacity) with an immediate occlusion rate close to 100%. When it is compared with endovenous laser ablation, RFA technology is associated with less postprocedural pain, less ecchymosis and tenderness, and better quality of life (QOL) measures. The aim of this article is to summarize the available evidence in the RFA treatment of varicose veins.



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8.Ann Vasc Surg. 2012 Feb;26(2):259-67. doi: 10.1016/j.avsg.2011.10.007. Epub 2011 Dec 21.

Morphological and biomechanical remodeling of the hepatic portal vein in a swine model of portal hypertension.

He XJ, Huang TZ, Wang PJ, Peng XC, Li WC, Wang J, Tang J, Feng N, Yu MH.

Source


Laboratory of Biomechanics, Institute of Basic Medical Sciences, Hubei University of Medicine, Shiyan, China.

Abstract

OBJECTIVES:

To obtain the morphological and biomechanical remodeling of portal veins in swine with portal hypertension (PHT), so as to provide some mechanical references and theoretical basis for clinical practice about PHT.

METHODS:

Twenty white pigs were used in this study, 14 of them were subjected to both carbon tetrachloride- and pentobarbital-containing diet to induce experimental liver cirrhosis and PHT, and the remaining animals served as the normal controls. The morphological remodeling of portal veins was observed. Endothelial nitric oxide synthase expression profile in the vessel wall was assessed at both mRNA and protein level. The biomechanical changes of the hepatic portal veins were evaluated through assessing the following indicators: the incremental elastic modulus, pressure-strain elastic modulus, volume elastic modulus, and the incremental compliance.

RESULTS:

The swine PHT model was successfully established. The percentages for the microstructural components and the histological data significantly changed in the experimental group. Endothelial nitric oxide synthase expression was significantly downregulated in the portal veins of the experimental group. Three incremental elastic moduli (the incremental elastic modulus, pressure-strain elastic modulus, and volume elastic modulus) of the portal veins from PHT animals were significantly larger than those of the controls (P < 0.05), whereas the incremental compliance of hepatic portal vein decreased.

CONCLUSIONS:

Our study suggests that the morphological and biomechanical properties of swine hepatic portal veins change significantly during the PHT process, which may play a critical role in the development of PHT and serve as potential therapeutic targets during clinical practice.



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9.


Ann Vasc Surg. 2012 Feb;26(2):292-7. doi: 10.1016/j.avsg.2011.08.010. Epub 2011 Dec 20.

Basic data related to thrombolytic therapy for acute arterial thrombosis.

Ochoa C, Weaver FA.

Source

Division of Vascular Surgery and Endovascular Therapy, USC Cardiovascular Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90012, USA.


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10.Ann Vasc Surg. 2012 Feb;26(2):175-84. doi: 10.1016/j.avsg.2010.10.021. Epub 2011 Nov 9.

Management of perioperative endoleaks during endovascular treatment of juxta-renal aneurysms.

Coscas R, Becquemin JP, Majewski M, Mayer J, Marzelle J, Allaire E, You K, Desgranges P, Kobeiter H.

Source

Service de Chirurgie Vasculaire, Hôpital Henri Mondor, Université Paris XII, Créteil, France.

Abstract

BACKGROUND:

Evolution of stentgraft and vascular imaging technologies allows endovascular treatment (ET) of juxta-renal aneurysms (JRA). However, endoleaks rates and implants stability are not well documented. The aim of this study was to report the incidence and the perioperative treatment of the endoleaks occurring during ET for JRA.

MATERIAL AND METHODS:

Between January 2000 and April 2010, a total of 957 treated aneurysms were prospectively collected in a database. ET cases for JRA were selected from this database. Pre- and postoperative imaging was retrospectively analyzed to determine


the incidence, localization, and treatment of the endoleaks detected following this technique.

RESULTS:

The series included 50 patients (5%; age, 73 ± 12 years; 44 men). Mean diameter was 60 ± 12 mm. The ET included 38 fenestrated and/or branched endografts and 12 endografts implanted according to the chimney technique. One hundred and forty-three target vessels were perfused. Immediately after endograft deployment, angiography showed endoleaks in 15 patients (30%): 11 type Ia, 1 type II, and 3 type III endoleaks. These endoleaks were treated by aortic endograft modeling and/or stenting in 11 patients, and by placing an aortic extension in two patients. Despite modeling, two patients had a persistent type Ia endoleak and were respectively treated by placing a Palmaz stent and by performing proximal embolization. Despite these procedures, completion angiography showed five residual endoleaks (10%): two type Ia, two type II, and one type III. Immediate postoperative computed tomography (CT) angiography showed endoleaks in 13 patients (28%): six type I, six type II, and one mixed type II/III. Among these 13 patients, on the initial angiography, nine presented with an endoleak, three with a type II and one with a type Ib. Early mortality (<30 days) was 8% (four patients). With a mean follow-up of 12 months, (range, 1-42), six patients presented with a persisting endoleak (four type II, one type Ia, and one multiple type). Aneurysm growth (≥5 mm) was reported in two patients (4%), and nine secondary endovascular procedures were performed to treat these endoleaks.

CONCLUSION:

Endoleaks are frequent during ET of JRA. They are treated not only according to their type but also according to the implant characteristics (fenestrated or chimney). Although most endoleaks can be perioperatively treated with simple endovascular means, treatment of persisting type Ia endoleaks remains challenging.



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Magnetic resonance imaging reveals edema-like changes not only subcutaneously, but also in muscle tissue after femoropopliteal bypass surgery.

te Slaa A, Tetteroo E, Mulder PG, Ho GH, Vos LD, Moll FL, van der Laan L.

Source


Department of Surgery, Amphia Hospital, Breda, The Netherlands.

Abstract

BACKGROUND:

The pathophysiological mechanisms that induce postrevascularization edema after femoropopliteal bypass surgery are not completely understood. Reperfusion-associated injury to revascularized tissue and damage to lymphatic structures are both likely to play a role. Aim of this study was to study edema formation after peripheral bypass surgery with magnetic resonance imaging.

MATERIALS AND METHODS:

Nine patients suffering from severe peripheral arterial occlusive disease were subjected to magnetic resonance imaging scans before and 1 week after autologous femoropopliteal or femorocrural bypass surgery.

RESULTS:

A 12% increase in volume of the upper legs and an 11% increase in volume of the lower legs were measured in patients postoperatively. The increase of volume was largely due to expansion of the subcutaneous compartments: a 35% increase in the upper legs and a 41% increase in the lower legs. Edema in the upper legs was predominantly located medially at the site of the surgical wound. In contrast, edema in the lower legs was homogenously distributed around the entire leg circumference. The muscle compartment showed no significant change of volume. However, in the majority of patients, edema-like changes were seen in selected muscles as well after a peripheral bypass reconstruction.

CONCLUSION:

Swelling of the subcutaneous compartments is mainly responsible for the volume increases in upper and lower legs similar to lymphatic edema. In addition, in a majority of patients, edema-like changes in selected muscles were seen especially in the upper legs. Reperfusion-associated injury as a cause of these changes cannot be ruled out.



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Early protection and compression of residual limbs may improve and accelerate prosthetic fit: a preliminary study.

Duwayri Y, Vallabhaneni R, Kirby JP, Mueller MJ, Volshteyn O, Geraghty PJ, Sicard GA, Curci JA.

Source

Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.

Abstract

BACKGROUND:

The goal of rehabilitation following lower extremity amputation is to restore the highest level of independent function. As much as possible, this includes the functional use of a prosthetic device fitted to the residual limb. Early prosthetic fit depends, in turn, on rapid healing of the amputation site.

METHODS:

We hypothesized that compliance with a novel custom-designed amputation protection and compression system (CAPCS) to the residual limb can accelerate and improve the likelihood of successful prosthesis use. We conducted a retrospective study of all patients who were offered CAPCS by certified prosthetists (Hanger Prosthetics and Orthotics, Bethesda, MD) during the period between April 2004 and November 2009. Variables included age, sex, indication for amputation, and compliance with CAPCS. Compliance was defined as consistent observed wearing of the CAPCS as directed. The primary end point was the fitting of a prosthetic device to the amputated limb, with time to prosthetic fit being the secondary outcome.

RESULTS:

Out of 100 patients who were offered CAPCS (n = 100) during the study period, 76% were considered compliant (n = 76). Sixty five patients (65%) were ultimately fitted with prosthetic limbs. In multivariate analysis, we found that patients who had compliant use of CAPCS were significantly more likely to be successfully fit with prosthesis (72 vs. 42%, p = 0.005). At 100 days post amputation, the cumulative incidence of prosthesis fitting was significantly higher in CAPCS compliant patients (69.7 vs. 22.2%, p = 0.012).

CONCLUSIONS:

Compliant use of a CAPCS following amputation is associated with earlier and more frequent use of a prosthetic. Based on this limited data set, a conclusion can be drawn that the potential exists to significantly improve functional outcomes after amputation, but well-designed prospective studies are needed to confirm this association.

Published by Elsevier Inc.

PMID:22050879

[PubMed - indexed for MEDLINE] Related citations


Limits of infrainguinal bypass surgery for critical leg ischemia in high-risk patients (Finnvasc score 3-4).

Kechagias A, Ylönen K, Kechagias G, Juvonen T, Biancari F.

Source

Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland. [email protected]

Abstract

BACKGROUND:

The aim of the present study was to compare the early- and midterm outcomes after infrainguinal bypass surgery in the treatment of low- and high-risk patients with critical limb ischemia (CLI) (Finnvasc score 0-2 and 3-4, respectively), and to evaluate limits of infrainguinal bypass surgery in treatment of the latter group.

METHODS:

Two hundred seventy-four infrainguinal bypass procedures performed in 218 patients were retrospectively reviewed. The Finnvasc score (range: 0-4) was calculated by assigning one point to each of four preoperative risk factors, that is, coronary artery disease, diabetes, urgency of the procedure, and gangrene. Major outcome end points were survival, limb salvage, and amputation-free survival.

RESULTS:

Among 274 infrainguinal bypass procedures performed for CLI, 92 procedures (33.6%) were performed in patients with Finnvasc score 3-4. They had significantly lower leg salvage (at 3-year follow-up, 53.7 vs. 70.6%; log-rank: p = 0.004), survival (at 3-year follow-up, 49.7 vs. 69.7%; log-rank: p < 0.0001), and amputation-free survival (at 3-year follow-up, 27.7 vs. 53.1%; log-rank: p < 0.0001) compared with patients with Finnvasc score 0-2. Patients with Finnvasc score 3-4 and a preoperative serum creatinine level of >150 μmol/L had 1-year amputation-free survival of 12.5%, whereas patients with lower level of creatinine had 1-year amputation-free survival of 53.1% (p = 0.028).

CONCLUSIONS:

Infrainguinal bypass revascularization in CLI patients who present with Finnvasc score 3-4 can be considered at higher risk of poor intermediate outcome in terms of survival,


leg salvage, and amputation-free survival. Poor outcome is particularly expected in patients with Finnvasc score 3-4 and renal failure. In this subgroup of patients, primary amputation should be considered.



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14.Ann Vasc Surg. 2012 Feb;26(2):166-74. doi: 10.1016/j.avsg.2011.02.047. Epub 2011 Oct 28.

Secondary procedures after infrarenal abdominal aortic aneurysms endovascular repair with second-generation endografts.

Bartoli MA, Thevenin B, Sarlon G, Giorgi R, Albertini JN, Lerussi G, Branchereau A, Magnan PE.

Source

Service de Chirurgie Vasculaire, Université de la Méditerranée, Assistance Publique Hôpitaux de Marseille-Hôpital de la Timone, Marseille, France. [email protected]

Abstract

BACKGROUND:

To study the incidence, the types, and the results of secondary procedures performed after endovascular treatment of infrarenal abdominal aortic aneurysm (AAA). To compare the population of patients who underwent secondary procedure (P2) with the population of those who did not require it.

MATERIAL AND METHODS:

Between 1998 and 2008, this study included all the patients electively treated for AAA with stentgrafts that were still available on the market on January 1, 2009. Data were prospectively collected and retrospectively analyzed. The postoperative follow-up included at least a systematic computed tomography scan at 6, 12, 18, and 24 months and then every year. P2 were defined as any additionnal procedures performed to treat aneurysm related complications after initial stentgraft implantation.

RESULTS:

We studied 162 patients with a mean 40 ± 31 months' follow-up. In 32 patients (19.7%), there were 46 P2, 3 of them were surgical conversion and 1 with endovascular


conversion. Thirty-nine P2 were scheduled, and seven were performed in emergency. Nine patients underwent more than one P2. P2 was indicated for type II endoleak in 17 cases, 13 of them with a diameter increase; for type I endoleak in 10 cases; for AAA rupture in 3 cases; for occlusion or stentgraft stenosis in 13 cases; and for 1 type III endoleak, 1 endotension, and 1 femoro-femoral crossover bypass infection. Two ruptures occurred in patients who had undergone P2. The immediate technical success was 89.1%. At 30 days, morbidity was 10.9%, and there was no mortality. Survival rates at 3 and 5 years were respectively 85.2% and 71.9% in patients with secondary procedure and 70.6% and 47.5% in the others (p = 0.046).

CONCLUSIONS:

In patients treated for AAA with second generation stentgrafts, in the long term, secondary procedure rate was 19.7%. Survival rate for patients who underwent a secondary procedure was better, which was probably related to the fact that they were younger at the time of stentgraft implantation. Large AAA diameter was a secondary-procedure risk factor.



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Skin grafting followed by low-molecular-weight heparin long-term therapy in chronic venous leg ulcers.

Serra R, Buffone G, de Franciscis A, Mastrangelo D, Vitagliano T, Greco M, de Franciscis S.

Source

Unit of Vascular Surgery, University Magna Graecia of Catanzaro, Catanzaro, Italy.

Abstract

BACKGROUND:

Venous leg ulcers are responsible for more than half of lower extremity ulcerations, with an overall prevalence ranging from 0.06 to 2% in the general population.

METHODS:

http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(11)00361-X

A total number of 120 patients with chronic venous leg ulcers (CEAP C6), secondary to primary chronic venous insufficiency, were recruited (81 F, 39 M, age range: 50-79, mean age: 64.6). All patients enrolled in this study had wounds that had failed to heal for more than 2 months and were refractory to conventional medical and physical therapy. Sixty patients (group A) underwent skin grafting followed by low-molecular-weight heparin long-term therapy. Sixty patients (group B) underwent skin grafting as sole procedure. The follow-up was of 5 years.

RESULTS:

At hospital discharge, all patients had healed ulcers. In group A, at 5 years, about 90% of the ulcers remained healed. In group B, at 5 years, about 56% of the ulcers remained healed.

CONCLUSIONS:

In our experience, long-term treatment with low-molecular-weight heparin seems to have improved early and late results of patients, who underwent reconstructive surgery for chronic venous ulcer; 90% of the ulcers remained healed at 5 years of follow-up. Probably, extracellular matrix-modulating treatments, such as heparin administration, may complete the management strategy for difficult-to-heal or chronic wounds.

Copyright © 2012. Published by Elsevier Inc.


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Iliac-femoral venous stenting for lower extremity venous stasis symptoms.

Alhalbouni S, Hingorani A, Shiferson A, Gopal K, Jung D, Novak D, Marks N, Ascher E.

Source

Department of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA. [email protected]

Abstract

BACKGROUND:

Venous outflow obstruction may play a role in patients with chronic venous stasis symptoms who fail to improve despite conventional modalities of treatment that focus on the reflux component of the disease with little attention to the possibility of an


obstructive component. The introduction of minimally invasive venous stenting using venography and intravenous ultrasonography (IVUS) provides the ability to treat the "obstructive" component of the disease.

METHODS:

We undertook a retrospective review of 56 limbs in 53 patients with chronic venous stasis symptoms. Initial transcutaneous Doppler ultrasonographic evaluation of the inferior vena cava, iliac, femoral, greater saphenous, and perforator veins was performed looking for any evidence of deep venous thrombosis, superficial venous thrombosis, perforator veins, and reflux (location and degree). Afterword, the patients were managed in the conventional fashion (leg elevation, compression, and great saphenous vein (GSV) and perforator ablation, if present) for a period of 3 months. If ulcer healing was not noted, iliac-femoral venography and IVUS were undertaken. A significant stenosis was defined as a 50% reduction in vein cross-sectional area as measured by IVUS.(1,2,3) Stenotic lesions were managed with stenting followed by balloon angioplasty. Patients were followed up for ulcer healing or improvement of stasis symptoms.

RESULTS:

Of the 56 limbs, 10 (17.8%) had postthrombotic changes, 7 (12.5%) had incompetent perforators, and 27 (48.2%) had an incompetent superficial venous system. In the stented group (n = 29), 3 limbs had perforator ablation alone, 13 limbs had GSV ablation alone, and 1 limb had both perforator and GSV ablation. In the unstented group (n = 27), 10 limbs had GSV ablation alone, and 3 limbs had both perforator and GSV ablation. The overall incidence of deep reflux was 51.8%; 17 of 29 limbs (58.6%) in the stented group had evidence of deep reflux, and 12 of 27 limbs (44.4%) in the unstented group had deep reflux. All venograms except one (98.2%) were performed under local anesthesia with sedation. The procedure was performed in an ambulatory setting in 69.6% (39 of 56) of the limbs. CEAP clinical severity class distribution was as follows: C2, 4%; C3, 16%; C4, 18%; C5, 5%; C6, 57%. Over half of the limbs (29 of 56) were found to have stenotic lesions and required stenting. Eight patients (11 limbs) did not return for ulcer healing assessment. The majority (19 of 29) of limbs in the stented group had a CEAP of 6. Among the patients with CEAP 6 who returned for follow-up (n = 26), 7 had no evidence of stenosis and required no stenting. Only one of those (14.3%) healed his ulcers after 3 months (average follow-up of 4.8 months). The remainder 19 limbs were found to have stenotic lesions and underwent stenting. The ulcers healed in 11 of those (58%) over a period of 1 week to 8 months (average of 5 months), with average follow-up of 3.6 months (p = 0.08). The cumulative primary and secondary patency rates were 93.1% (27 of 29) and 100% (29 of 29), respectively. Two stent thromboses occurred within 4 weeks of the initial procedure. Both occurred in patients with postthrombotic obstruction. One patient developed a superficial femoral artery pseudoaneurysm.

CONCLUSION:

Over half of our patients with open ulcers had stenotic lesions. The ulcers healed in 58% of the stented limbs. That indicates that outflow obstruction may play a significant role in patients with chronic venous stasis symptoms, especially those with open ulcers who failed to respond to other treatment modalities. The procedure itself is relatively safe and simple and can be performed on an ambulatory basis.



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Postoperative pulmonary function after open abdominal aortic aneurysm repair in patients with chronic obstructive pulmonary disease: epidural versus intravenous analgesia.

Panaretou V, Toufektzian L, Siafaka I, Kouroukli I, Sigala F, Vlachopoulos C, Katsaragakis S, Zografos G, Filis K.

Source

Department of Anesthesiology, Hippokration Hospital, Athens, Greece.

Abstract

BACKGROUND:

We reviewed our experience to determine the effect of epidural versus intravenous analgesia on postoperative pulmonary function and pain control in patients with chronic obstructive pulmonary disease (COPD) undergoing open surgery for abdominal aortic aneurysm.

METHODS:

A retrospective study with prospective collection of data of 30 COPD patients undergoing open abdominal aortic aneurysm repair, during a 5-year period. Group I (n = 16) was operated under combined general and epidural anesthesia and epidural analgesia; group II (n = 14), under general anesthesia and intravenous analgesia. All patients performed pulmonary function tests (PFTs) preoperatively and during postoperative days 1 and 4. Pain assessment was performed on all patients during rest and activity on postoperative days 1, 2, and 4 by using the visual analog scale. Data were recorded for PFTs, postoperative pain, length of hospital stay, length of ICU stay, and postoperative pulmonary morbidity, including atelectasis and pulmonary infections.

RESULTS:

There was no in-hospital mortality. Hospital stay was similar between the two groups (group I: 7.1 ± 1.0, group II: 7.5 ± 1.1). Group I patients showed significantly increased postoperative PFT values compared with group II patients at all time points (postoperative day 1: FEV(1)(%): 32.3 ± 4.4 vs. 27.1 ± 1.6, p = 0.007, FVC(%): 35.4 ±


8,5 vs. 28.3 ± 2.3, p = 0.035; postoperative day 4: FEV(1)(%): 50.4 ± 6.8 vs. 41.9 ± 6.8, p = 0.017, FVC(%): 51.3 ± 8.3 vs. 43.0 ± 7.9, p = 0.046). However, postoperative clinical pulmonary morbidity was not different between groups. Group I patients showed significantly reduced postoperative pain at all time points compared with group II patients. These differences were more pronounced during postoperative days 1 and 2, both at rest (visual analog score: 1.1 ± 0.9 vs. 2.6 ± 1.6, p = 0.02 and 0.7 ± 0.8 vs. 1.9 ± 1.1, p = 0.021, respectively) and during activity (2.3 ± 0.8 vs. 4.0 ± 1.7, p = 0.013 and 1.6 ± 0.7 vs. 2.8 ± 1.2, p = 0.019, respectively).

CONCLUSIONS:

Epidural anesthesia and postoperative epidural analgesia improve the postoperative respiratory function, compared with general anesthesia and systemic analgesia, and reduce postoperative pain as well, in COPD patients undergoing elective infrarenal abdominal aortic aneurysm repair.



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18.Ann Vasc Surg. 2012 Feb;26(2):225-32. doi: 10.1016/j.avsg.2011.05.029. Epub 2011 Sep 23.

Long-term quality of life and mobility after prosthetic above-the-knee bypass surgery.

Bosma J, Turkçan K, Assink J, Wisselink W, Vahl AC.

Source

Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. [email protected]

Abstract

BACKGROUND:

Multiple studies have addressed above-the-knee femoral artery bypass grafting; however, information on late quality of life (QoL) and mobility is scarce. We studied long-term QoL and mobility after above-the-knee bypass surgery.

METHODS:

Consecutive patients presenting with claudication, ischemic rest pain, or gangrene who received above-the-knee prosthetic bypass grafting between December 1997 and


January 2003 were included in this observational study. Data used were recorded in a prospectively collected database of patients receiving Dacron and polytetrafluoroethylene (PTFE) supragenicular bypasses for lower limb ischemia. Primary outcomes were QoL and mobility, and secondary outcomes were patency and patient survival. QoL was measured with the EuroQol questionnaire (EQ-5D/EQ-VAS). Mobility was assessed with the Walking Impairment Questionnaire (WIQ) and analyzed in univariate and multivariate models. Patency and survival were computed with Cox regression.

RESULTS:

One hundred forty patients were treated during the study period. Sixty-nine patients (50%) died during follow-up, leaving 71 survivors who were asked (63 [89%] complied) to complete the EQ-5D/EQ-VAS and WIQ questionnaires. None of the primary outcome parameters (WIQ, EQ-5D, EQ-VAS) were affected by primary bypass occlusion (p = 0.34, p = 0.44, and p = 0.27, respectively) or long-term patency (p = 0.07, p = 0.54, and p = 0.36, respectively). Male sex was significantly associated with a better outcome on all primary outcome parameters. Patients with Dacron versus PTFE grafts had WIQ scores of 0.49 and 0.26, respectively (p = 0.01). EQ-5D scores of patients with Dacron and PTFE were 0.576 and 0.409 (p = 0.08) and EQ-VAS scores were 61 and 54, respectively (p = 0.24). Graft type was not independently associated with occlusion, but runoff was. The 5-year and 10-year patient survival rates were 58% and 51%, respectively.

CONCLUSIONS:

In this study, long-term QoL and mobility did not seem to be associated with bypass patency, as assessed in a single late follow-up. Revision of bypasses did not contribute to long-term QoL and walking ability. Therefore, the necessity of graft surveillance and subsequent revision and/or thrombectomy in case of synthetic bypass failure in absence of critical limb ischemia seems to be questionable.



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19.Ann Vasc Surg. 2012 Feb;26(2):219-24. doi: 10.1016/j.avsg.2011.05.012. Epub 2011 Jun 25.

Incidence and risk factors for 30-day postdischarge mortality in patients with vascular disease undergoing major lower extremity amputation.

Davenport DL, Ritchie JD, Xenos ES.


Source

Department of Surgery, University of Kentucky College of Medicine, Lexington, KY 40536-0298, USA. [email protected]

Abstract

BACKGROUND:

Our goal was to analyze the incidence and risk factors for 30-day postdischarge mortality in patients with vascular disease undergoing major lower extremity amputation.

METHODS:

We queried the American College of Surgeons National Surgery Quality Improvement Program data set from the years 2005 to 2009 for amputations with vascular disease diagnosis codes. We analyzed in-hospital mortality and postdischarge mortality by year of the study and relative to length of hospital stay. Patients with American Society of Anesthesiologists physical status classification level 5, do-not-resuscitate status, disseminated cancer, and emergent operations were excluded to highlight risk among patients more likely to survive. We compared risk factors for each mortality group using separate multivariate logistic regressions.

RESULTS:

Our query resulted in 6,188 patients with mean age of 67 ± 14 years; of these, 39.1% were female. Thirty-day mortality was 7.6%; 4.2% in-hospital mortality and 3.4% postdischarge mortality. After postoperative day 14, the majority of deaths were after discharge and the daily death risk was almost constant until postoperative day 30 at around 2.1 per 1000 survivors. The postdischarge death rates were consistent across the 5 years of the study (χ(2): p = 0.59), despite the fact that median hospital length of stay decreased from 12 to 9 days (Kruskal-Wallis: p < 0.001). Preoperative risk factors for postdischarge death included age, functional status, lower serum albumin, serum creatinine level of >1.2 mg/dL, dialysis, serum bilirubin level of >1.0 mg/dL, black race (protective), systemic inflammatory response syndrome, steroid use for chronic condition, impaired sensorium, alcohol abuse, recent weight loss, and dyspnea.

CONCLUSIONS:

Patients with vascular disease undergoing major amputation are at high risk for postdischarge mortality. This risk is not associated with recent decrease in hospital stay. Systemic comorbid risk factors were identified, thus highlighting the need for adequate medical management of these patients in the 30 days after the operation. Coordination of postdischarge care to ensure management of systemic illness could potentially improve outcomes.



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Ann Vasc Surg 2012; 26(2)Case Reports


Successful treatment for infected aortic aneurysm using endovascular aneurysm repairs as a bridge to delayed open surgery.

Fukunaga N, Hashimoto T, Ozu Y, Yuzaki M, Shomura Y, Fujiwara H, Nasu M, Okada Y.

Source

Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan. [email protected]

Abstract

Management of infected aortic aneurysms, which can be life-threatening, remains challenging. Open surgical treatments, including debridement of the infected aorta and the surrounding tissue and either in situ reconstruction or extra-anatomic bypass covering with omentum or muscle flap, are the mainstay of therapy. However, increasing advances in technology have made endovascular treatment of infected aneurysms feasible. The present study describes the first clinical report of successful treatment of an infected aneurysm using endovascular techniques in the acute phase, followed by delayed open surgery.



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Clostridium septicum aortitis with associated sigmoid colon adenocarcinoma.

Ge PS, de Virgilio C.

Source


Department of Medicine, UCLA Medical Center, Los Angeles, CA 90309, USA.

Abstract

We report an unusual case of Clostridium septicum aortitis with associated adenocarcinoma of the sigmoid colon. An 87-year-old man with multiple medical comorbidities presented with a 1-week history of severe abdominal pain in the left lower quadrant of his abdomen. Abdominal computed tomography showed, in addition to a mass in the sigmoid colon, a gas density within the wall of the abdominal aorta with extensive periaortic fat stranding and some additional gas densities in the proximal left common iliac artery. The patient refused surgery, and was treated with intravenous antibiotics. He died 5 weeks later. The development of Clostridiumsepticum aortitis, an extremely rare but life-threatening infection, is highly associated with an underlying colonic malignancy and demands immediate surgical intervention.



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Delayed axillary artery pseudoaneurysm as an isolated consequence to anterior dislocation of the shoulder.

Palcau L, Gouicem D, Dufranc J, Mackowiak E, Berger L.

Source

Department of Vascular Surgery, University Hospital, Caen, France.

Abstract

Injury to the axillary artery after anterior shoulder dislocation is a very rare occurrence; although infrequently seen as an iatrogenic complication, very few cases have been reported. We describe a case of delayed axillary artery pseudoaneurysm, presenting as single complication after anterior shoulder dislocation reduction, which was successfully managed by surgical intervention-resection-anastomosis. Although uncommon, pseudoaneurysms should not be forgotten after trivial trauma. The early diagnosis of upper-limb pseudoaneurysms should prevent the risk of vascular and neurological compromises with potential serious long-term sequelae.


PMID:


22304870[PubMed - indexed for MEDLINE]

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Infected abdominal aneurysm due to Salmonella sepsis: report of a unique case treated using the superficial femoral vein.

Aerts PD, van Zitteren M, Kotsopoulos AM, van Berge Henegouwen DP, Vriens PW, Heyligers JM.

Source

Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands. [email protected]

Abstract

We describe a 61-year-old patient with an infected aneurysm of the abdominal aorta due to Salmonella sepsis. Treatment was successful and included aneurysm resection, extensive debridement, and reconstruction of the abdominal aorta using the superficial femoral vein, combined with long-term antibiotic therapy.



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Giant, metachronous bilateral dorsalis pedis artery true aneurysms.

Bittner JG 4th, Hardy D, Biddinger PW, Agarwal G.

Source

Department of Surgery, Georgia Health Sciences University Medical College of Georgia, Augusta, GA 30912, USA. [email protected]



Abstract

This report is the first to describe the clinical, radiographic, operative, and pathologic findings associated with large, bilateral dorsalis pedis artery true aneurysms in a single patient. A 61-year-old African American woman complained of difficulty in wearing shoes. She had a moderately firm, nontender, pulsatile mass on the dorsum of her right foot. Computed tomography and angiography confirmed dorsalis pedis artery aneurysm with sufficient collateralization. She underwent resection without reconstruction. Pathologic analysis revealed a true aneurysm (8 × 5.3 × 4.1 cm(3)) containing intralumenal thrombus. Treatment for small symptomatic and large dorsalis pedis artery aneurysms remains resection with or without reconstruction.



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Bilateral femoral artery aneurysm mimicking soft tissue sarcoma.

Adeoye PO, Adebola SO, Adesiyun OA, Braimoh KT.

Source

Division of Thoracic and Cardiovascular Surgery, College of Medicine, University College Hospital, Ibadan, Nigeria. [email protected]

Abstract

Despite the rarity of femoral aneurysm and the plethora of other causes of swelling in and around its anatomic location, the possibility of its existence must always be borne in mind. A rare case of metachronously bilateral femoral aneurysms mimicking soft tissue sarcoma in a young Nigerian man is presented. Caution in the diagnosis of groin masses is hereby re-emphasized.



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Anatomic bifurcated reconstruction of chronic bilateral innominate-superior vena cava occlusion using the Y-stenting technique.

Amin P, Sharafuddin MJ, Laurich C, Nicholson RM, Sun RC, Roh S, Kresowik TF, Sharp WJ.

Source

Department of Surgery, University of Iowa, Iowa City, IA, USA. [email protected]

Erratum in

Ann Vasc Surg. 2012 May;26(4):606. Sharafuddin, Mel J [added] Laurich, Chad [added]; Nicholson, Rachael M [added]; Sun, Raphael C [added]; Roh, Simon [added]; Kresowik, Timothy F [added]; Sharp, William J [added].

Abstract

This article presents the case of a 42-year-old man who presented with superior vena cava (SVC) syndrome due to fibrosing mediastinitis with multiple failed attempts at recanalization. We initially treated him with unilateral sharp needle recanalization of the right innominate vein into the SVC stump followed by stenting. Although his symptoms improved immediately, they did not completely resolve. Six months later, he returned with worsening symptoms, and venography revealed in-stent restenosis. The patient requested simultaneous treatment on the left side. The right stent was dilated, and a 3-cm-long occlusion of the left innominate vein was recanalized, again using sharp needle technique, homing into the struts of the right-sided stent. Following fenestration of the stent, a second stent was deployed from the left side into the SVC, and the two Y limbs were sequentially dilated to allow a true bifurcation anatomy (figure). The patient had complete resolution of his symptoms and continues to do well 6 months later.



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Aortic endograft infection with aortoduodenal fistula associated with adjacent vertebral body mycobacterial osteomyelitis (Pott's disease).

Solomon B, Kim B, Rockman C, Veith FJ, Jacobowitz G.

Source

Division of Vascular Surgery, New York University Langone Medical Center, New York, NY 10016, USA.

Abstract

Aortoenteric fistulas (AEFs) are a rare complication of infrarenal abdominal aortic aneurysm repair. They occur in <1% of aortic grafting procedures, result from graft defects, foreign bodies, and trauma, and are associated with a high mortality rate. We report a complex AEF associated with vertebral body osteomyelitis, likely secondary to tuberculous infection. A 78-year-old man presented with a 2-week history of abdominal pain, fever, and anemia. Past surgical history is significant for open repair of infrarenal abdominal aortic aneurysm followed later by an endovascular repair of a proximal para-anastomotic aneurysm. Computed tomography angiography revealed air in the aneurysm sac, without evidence of endoleak. The posterior aspect of the aneurysm was noted to be in continuity with a destructive osteomyelitis of the second lumbar vertebral body and an adjacent psoas abscess. Percutaneous drainage revealed purulent fluid containing mixed enteric flora. With fluoroscopic guidance, injection of contrast in the aortic sac drainage catheter demonstrated complex fistulous communications from the aortic sac to the overlying small intestine. After a course of drainage, antibiotic therapy, and parenteral nutrition, the patient underwent a transperitoneal repair of the AEF with duodeno-duodenectomy and wide debridement of the aortic sac and Dacron graft. Pathology revealed giant cell granulomas, highly suggestive of tuberculosis.



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9.Ann Vasc Surg. 2012 Feb;26(2):277.e5-9. doi: 10.1016/j.avsg.2011.06.010. Epub 2011 Dec 20.

Midterm results with endovascular approach to abdominal aortic pathologies in Behçet's disease.

Goksel OS, Torlak Z, Çınar B, Sahin S, Karatepe C, Eren E.


Source

Department of Cardiovascular Surgery, Istanbul University, Istanbul, Turkey.

Abstract

BACKGROUND:

Vascular involvement in Behcet's disease is rare, but may be at the forefront of the clinical picture with possible life-threatening scenarios. We reviewed our preliminary results with endovascular treatment of abdominal aortic pathologies in Behçet's disease.

METHODS:

Data regarding seven patients with abdominal aortic pathologies (aneurysm, pseudoaneurysm, and aortoenteric fistula) and Behçet's disease were treated with endovascular stent-grafting between 2002 and 2006.

RESULTS:

Seven patients (aged, 39.1 ± 9; range, 27-52 years) with a mean aortic diameter of 58.4 ± 6.3 mm received endovascular stent-grafts, two patients being in emergency settings. Two patients were in active disease state. Four tube-shaped, two aorto-bi-iliac, and one aorto-uni-iliac stents were implanted. One patient expired on day 28 with multiorgan failure after emergency stent-grafting owing to enlarging periprosthetic hematoma following open surgery for ruptured aneurysm. Another patient was declined for endovascular therapy owing to hypoplastic aortoiliac vasculature.

CONCLUSION:

Endovascular approach provides a reasonable alternative to open repair for the treatment of abdominal aortic aneurysms in select cases; however, in emergency settings, endovascular repair may well have an important, but limited, role in select patients with aortoenteric fistulae, it may yet require a surgical intervention.



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10.Ann Vasc Surg. 2012 Feb;26(2):278.e1-6. doi: 10.1016/j.avsg.2011.08.007. Epub 2011 Nov 12.

Using indocyanine green fluorescent lymphography and lymphatic-venous anastomosis for cancer-related lymphedema.


Mihara M, Murai N, Hayashi Y, Hara H, Iida T, Narushima M, Todokoro T, Uchida G, Yamamoto T, Koshima I.

Source

Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan. [email protected]

Abstract

Advances in cancer therapy have increased the importance of improvement of quality of life after cancer survival. Cancer-related lymphedema or secondary lymphedema that occurs after lymph node dissection in resection of tumors of abdominal visceral organs can impair quality of life. However, standard curative treatment for secondary lymphedema has not been established. This may be due to the lack of a method for early diagnosis of lymphedema, and because of selection of conservative treatment such as compression therapy to delay edema progression in many cases. To develop a curative approach, we have performed definite diagnosis of early-stage lymphedema using magnetic resonance imaging and an indocyanine green fluorescent lymphography, followed by surgical treatment with lymphatic-venous anastomosis using supermicrosurgery. Herein, we report the first case of secondary lymphedema in which we performed early diagnosis and surgery using these techniques and achieved an almost complete cure of lymphedema. We suggest that early diagnostic imaging and early microsurgery is the key of lymphedema treatment.



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Case report of a patient with iliac occlusive disease due to pseudoxantoma elasticum and review of the bibliography.

Siskos D, Giannakakis S, Makris S, Pirgakis K, Psyllas A, Maltezos C.

Source

Department of Vascular Surgery, General Hospital of Athens KAT, Kiffisia, Attica, Greece. [email protected]

Abstract

BACKGROUND:


Pseudoxanthoma elasticum (PXE) is a rare genetic disorder characterized by progressive calcification and fragmentation of elastic fibers in the skin, the retina, and the cardiovascular system, and is also termed as elastorrhexia. The purpose of this case presentation is to report the case of a PXE patient with an atypical localization of atherosclerotic lesion (iliac arteries) and that this rare disease should always be included in the differential diagnosis of patients with premature atheromatosis.

METHODS AND RESULTS:

A 58-year-old patient, suffering from PXE, came to our clinic to seek advice for his severe lower limb claudication. The image of the magnetic resonance angiography of his aorta, iliac arteries, and lower limb arteries demonstrated total occlusion of the left common iliac artery and preocclusive stenosis of the orifice on the right common iliac artery. The patient was treated successfully by angioplasty with kissing stent placement at the iliac arteries, and 6 months later, he is symptom-free, with ankle-brachial indexes of 1.0 and 1.05 on the left and right legs, respectively.

CONCLUSION:

This case report presentation has a primary goal to show that the disease may cause atypical localizations of atherosclerosis (iliac arteries) and a secondary goal to demonstrate that endovascular treatment in these patients may be a safe and viable option. It is also a good opportunity for a brief review of the bibliography.



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Symptomatic aneurysm of a perforating peroneal artery after a blunt trauma.

Ferrero E, Ferri M, Carbonatto P, Robaldo A, Viazzo A, Calvo A, Berardi G, Pecchio A, Piazza S, Cumbo P, Nessi F.

Source

Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy. [email protected]

Abstract


A 48-year-old woman was referred to us for a pulsatile and painful mass on the right leg after a trauma occurred 2 months earlier. The duplex scan revealed the presence of an aneurysm of the perforating peroneal artery. The patient underwent an endovascular coil embolization of the aneurysm. The duplex-scan follow-up showed the patency of the peroneal vessel and the complete aneurysm thrombosis. The patient was discharged in good condition without pain. In literature, only four cases of aneurysm of perforating peroneal artery aneurysm, all with a clear traumatic etiology, are reported. In this case, the endovascular treatment was safe and effective.



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Mesocavoatrial shunt for Budd-Chiari syndrome: a case report with long-term follow-up.

Zhang CC, Wang ZG, Li CM, Duan HY, Li JX, Gu YQ, Yu HX, Qi LX, Chen B, Li Z, Bian C.

Source

Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.

Abstract

BACKGROUND:

A case of mesocavoatrial shunting for the treatment of Budd-Chiari syndrome (BCS) with long-term follow-up is reported.

METHODS:

A 25-year-old man with stage II BCS was treated with a mesocavoatrial shunt to decompress the portal and IVC hypertension. During the 6-year follow-up, the patient was able to resume work as a salesperson and has since led a normal life. His graft remains patent.

CONCLUSION:

A mesocavoatrial shunt can simultaneously decompress portal and IVC hypertension and has satisfactory long-term patency. A mesocavoatrial shunt can be used to treat


patients with severe BCS who could not be successfully treated with medical therapy and intervention.



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Thromboexclusion of the complete aorta in the treatment of chronic type B aneurysm.

Kovacevic P, Velicki L, Mojasevic R, Kieffer E.

Source

Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Republic of Serbia.

Abstract

We report a case of a 55-year-old woman who was referred to us with a huge chronic postdissection thoracoabdominal aneurysm of a maximal intrathoracic diameter of 13.5 cm and signs of intrathoracic imminent rupture with subparietal pleural hemorrhagic effusion. Computed tomography examination revealed that the left lung had undergone complete atelectasis and carnification owing to compression of the left principal bronchus. There were also signs of left kidney atrophy because of the left renal artery originating from the thrombosed false lumen. Owing to delicate preoperative condition, we decided to perform thromboexclusion of the complete aorta with reattachment of all the supra-aortic and visceral branches and complete bipolar exclusion of thoracoabdominal aorta. The patient was discharged from the hospital on the 35th postoperative day in a good condition. Following computed tomography scan revealed complete thrombosis of the excluded portion of the aorta.



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Alternative management of iliac vein injury during anterior lumbar spine exposure.

Zahradnik V, Kashyap VS.

Source

Department of Vascular Surgery, The Cleveland Clinic, Cleveland, OH 44195, USA. [email protected]

Abstract

Vascular injuries are, unfortunately, common complications during anterior approach to lumbar spine, with venous injuries occurring most frequently. The L4-L5 level of exposure is associated most commonly with venous injuries because it requires significant mobilization of the vascular structures. We present two cases of left common iliac vein tears encountered during redo anterior exposure for spine revision. This was in the setting of an anterior lumbar interbody fusion at the L4-L5 level and for the repeat disc arthroplasty at the L5-S1 level. We describe the endovascular technique used to successfully repair venous tear with the deployment of a covered stent across the injury, preventing the ligation of the left common iliac vein.



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Surgical treatment of renal artery compression by diaphragmatic crus.

Song X, Liu Q, Zheng Y, Liu C, Liu D, Ji Z.

Source

Departments of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.


Abstract

Symptomatic compression of the renal artery by the diaphragmatic crus is a rare disorder. To our knowledge, renal artery compression by the diaphragmatic crus complicated with poststenosis aneurysm has not been reported. We present the case of a 28-year-old man with refractory hypertension. Extrinsic compression of the bilateral renal arteries and celiac artery and the aneurysm were proven by surgical exploration. We successfully performed left renal artery revascularization and renal autotransplantation in situ. Normal perfusion of the two bypass graft vessels was proven by computed tomography angiography.



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ann vasc surg 2012;26(2)

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