Primary infections of the aorta and infected aortic aneurysms are rare and are life threatening. Most of them are due to bacterial infection occurring in an atheromatous plaque or a pre existing aneurysm during bacteremia. Rarely spread from a contiguous septic process may be the cause. The reported hospital mortality ranges from 16–44%. Gram positive bacteria are still the most common causative organisms. More recently, Gram negative bacilli are seen increasingly responsible. The mortality rate is higher for the Gram negative infection since they most often cause supra renal aneurysms and are more prone for rupture. Best results are achieved by appropriate antibiotics and aggressive surgical treatment. Excision of the infected aneurysm sac as well as surrounding tissue and in situ reconstruction of aorta is the preferred treatment. Pedicled omental cover also helps to reduce infection. Long term antibiotic is needed to prevent reinfection. Mortality is high for those who undergo emergency operation, with advanced age and for nonsalmonella infection.
The history of sclerotherapy of varicose veins of lower extremities dates back to 1840’s. The use of stronger sclerosants thereafter led to serious complications, and the use of sclerotherapy decreased for varicose veins. However, sclerotherapy again became popular after introduction of safer sclerosant and compression sclerotherapy. After introduction of sclerosing foam in mid 1990’s, many phlebologists are now in favor of the use of sclerosing foam instead of the use of sclerosing liquid. However, few studies have focused on the efficacy of sclerosing foam compared with that of sclerosing liquid in sclerotherapy of venous insufficiency. In Europe, the 1st and 2nd European Consensus Meetings on Foam Sclerotherapy (ECMFS) were already taken place in Germany. In this review, we discuss the efficacy of sclerosant foam in comparison with liquid form. Furthermore, solved and unsolved questions on safety aspect of foam sclerotherapy are also discussed.
Purpose: To compare two methods of endovenous laser treatment (EVLT) for primary varicose veins of lower extremities: first-EVLT combined with high ligation of great saphenous vein using pulse mode ablation and 12 W laser ; second-EVLT without high ligation and using lower energy (10 W) and continuous mode. Materials and Methods: Ninety-three limbs of 75 patients were treated by 980 nm diode laser into the great saphenous veins from June, 2003. In the first group of 45 patients, (HL group), we performed a division of the sapheno-femoral junction after high ligation and EVLT was done with a 12 W laser in a pulse mode. In the second group of 30 patients (NL group) EVLT was performed without high ligation with a 10 W laser in a continuous mode using a laser fiber drawing device. Results: Operation time was significantly shorter in the NL group compared to the HL group (p < 0.05), and the early occlusion rates were 100% (HL group) and 97% (NL group). Subcutaneous bleeding occurred in 9 limbs (16%) in the HL group and 2 limbs (6%) in the NL group. In the NL group there was one case complicated with thrombus which extended into the femoral vein. Conclusion: High ligation at sapheno-femoral junction is not necessary for EVLT and a lower energy continuous mode laser induces a lower rate of complications compared with a pulse mode ablation at a higher energy level. However, close follow-up with duplex scanning is necessary in early postoperative period.
Background: A part of coronary stenotic lesions treated with directional coronary atherectomy (DCA) occur restenosis several months later. Specimens obtained by first DCA, present the histology of culplit lesions and may predict restenosis after PCI. Methods: The study group comprised 76 patients (male/female 65/11, age 61 ± 11 years). Restenosis, defined as > 50% stenosis diameter by quantitative cineangiography, was present in 26 patients. The other 50 patients (< 50% stenosis) constitute the “no restenosis” group. Inflammatory cells and other atheroma components were planimetrically quantified as a percentage of total tissue area. Results: As regards lymphocytes, neutrophils and smooth muscle cells, the grade of amount of cells did not differ between restenosis group and no restenosis group. The amount of obtained arterial media was similar, too. However, the area occupied by macrophages or calcified fragments was significantly larger in restenosis group than no restenosis group. And there was a tendency toward larger area occupied by cholesterol gruel, thrombus and myxomatous extracellular matrix (ECM) in restenosis group. Conclusion: Rich macrophages infiltration, calcified fragments, cholesterol rich gruel and myxomatous ECM from primary lesions can be predictors of restenosis after DCA, suggesting a possible role in restenotic process after PCI.
Objective: Our experience with unilateral iliac reconstructive surgery was retrospectively reviewed, and the long-term patency and the morphological information was disclosed. In addition, the prognosis of contralateral iliac artery was examined, because future contralateral iliac events seem to be important for durability of unilateral iliac revascularizations. Materials and Methods: 148 patients (mean age, 66.9 years; 88% male) who had undergone unilateral aortoiliac reconstruction without contralateral iliac lesions were evaluated. The unilateral aortoiliac reconstructive procedures included 112 (76%) aorto or iliofemoral bypasses, 27 (18%) femorofemoral bypasses, and 9 (6%) axillofemoral bypasses. The indications for arterial reconstruction were disabling claudication and limb salvage in 125 (84%) and 23 (16%) patients, respectively. Preoperative arteriograms were reviewed to determine the Inter-Society Consensus (TASC II) classification categorizing iliac artery lesions. Contralateral iliac events were defined as any arterial reconstructive procedure, intervention, amputation for progression of contralateral iliac disease, or repair of abdominal aortic aneurysm (AAA). The Kaplan-Meier survival analysis was used to predict long-term results in patients grouped based on various factors which were compared using univariate and multivariate analyses. Results: In the 148 patients, unilateral iliac reconstructive procedures were undertaken in 83 (56%) patients with TASC II type D lesions, 34 (23%) patients with TASC II type C lesions, and 31 (21%) patients with TASC II type B lesions. Overall primary and secondary patency rates were 93.8% and 96.5% at 3 years and 90.0% and 93.9% at 5 years. A multivariate analysis disclosed critical limb ischemia influencing primary patency rates, and type of aortoiliac reconstruction or gender influencing secondary patency rates. TASC II classification did not affect primary or secondary patency rates. During the follow-up period, 15 contralateral iliac events occurred, including 11 aortoiliac reconstructive or interventional procedures, 3 repairs of AAA, and one case of bilateral thigh amputation due to acute aortic occlusion. The overall probability of contralateral iliac events was 2.2% at 3 years and 5.9% at 5 years. Conclusion: The long-term patency following unilateral iliac reconstructive surgery was satisfactory, and not affected by morphology of the iliac artery. Also, the future risk of contralateral iliac events appeared to be low.
Venous thromboembolic complications are frequently caused by nephrotic syndrome, while arterial thrombosis has rarely been reported. We report the successful treatment of a 53-year-old man who suffered from sudden severe pain of the left lower limb and facial edema. Abdominal computed tomography showed that the left common iliac artery was occluded from its origin. Although he had left peroneal nerve paralysis, thrombectomy and fasciotomy were performed for limb salvage. Renal biopsy revealed minimal change nephrotic syndrome after the operation. No recurrence has been observed. Nephrotic syndrome might be considered as a cause of acute arterial thrombosis.
A persistent sciatic artery is a rare anomaly. On the other hand, a persistent sciatic vein is frequently associated with Klippel-Trenaunay syndrome. In a 71-year-old female with a complete-type persistent sciatic artery aneurysm, we performed aneurysmectomy and right femoropopliteal bypass surgery. The right popliteal vein drained into the femoral vein via a lower-type persistent sciatic vein and the deep femoral vein. The superficial femoral artery and vein were hypoplastic. Since only 4 cases of a coexisting persistent sciatic artery and vein have been reported, we report this extremely rare case.
Introduction: Ruptured common iliac aneurysms present with diagnostic and therapeutic challenges. This case describes the successful outcome in a patient with complex vascular surgical history. Case presentation: An elderly patient presented with abdominal pain confirmed by CT as leaking iliac aneurysm. He had previously undergone an aorto-bifemoral bypass graft for ruptured abdominal aortic aneurysm. The iliac aneurysm was treated by simple ligation of the external iliac artery. Discussion: Aorto-bifemoral bypass graft may be required for aortic aneurysm repair in severe iliac calicification. Iliac artery fed by retrograde blood flow from the aorto-bifemoral bypass graft contributed to aneurysm development here
Acute occlusion of the digital arteries frequently causes painful infarction requiring digital amputation. We describe a 55-year-old male patient who presented with acute onset of digital ischemia with impending gangrene on the right hand. Because angiography revealed bypass surgery was not feasible, he underwent thoracoscopic sympathectomy (TS) one week after onset of the symptom, which resulted in rapid pain resolution. He was diagnosed, thereafter, with malignant rheumatoid arthritis and methotrexate was administered. Postoperative angiography revealed that the occluded digital artery had become recanalized. Timely TS is therefore a treatment of choice for acute digital ischemia.
A 54-year-old male who had been experiencing a high fever for a month was admitted to a local hospital for examination. Computed tomography revealed saccular aneurysms in the descending thoracic aorta and infrarenal abdominal aorta. The walls of the aneurysms were thickened and enhanced by intravenous contrast which suggested the inflammatory change. He was transferred to this hospital and underwent graft replacement of both the descending thoracic aorta and the abdominal aorta simultaneously. Simultaneous surgery should be considered in patients presenting with multiple inflammatory aneurysms, since inflammatory aneurysms have a risk of demonstrating rapid enlargement.
We used the Enclose®II anastomosis assist device (Novare Surgical Systems, Inc., CA, USA), which was originally developed as an ancillary device for proximal anastomosis in off-pump coronary artery bypass grafting (OPCAB), to assist anastomosis for the vascular grafts without clamping those conduits in two cases. In these cases, it was difficult to clump vascular graft partially, because vascular graft was short. So we used Enclose®II anastomosis assist device for these cases. The advantage of this method is that the Enclose®II anastomosis assist device facilitates the anastomosis of arterial side branches to the artificial graft (1) by eliminating the use of partial clamp on the artificial conduits and (2) by providing a plane surface for easy handling for suture.