Background: Lymphedema is the result of impaired lymphatic drainage from the affected organ. This abnormality can be primary or secondary. Different nonoperative and operative approaches have been introduced to treat chronic lymphedema. In this study, we describe a new surgical technique and compare its results with other more commonplace methods. Materials and methods: We included 296 patients given a diagnosis of chronic lower extremity lymphedema who had not responded to nonoperative management for at least 6 months. They were collected during 15 years between March 1987 and March 2002. Doppler ultrasonography of the deep venous system to confirm its patency was routinely performed in all. Then, they underwent surgery and were followed for at least 1 year postoperatively. Results: All patients were operated by our new technique which is a modified form of Miller’s or Homan’s. The outcome was excellent and 89.2% of patients had no complications. A 10.8% total complication rate was achieved, the most common of all was wound seroma. Conclusion: According to the difficulties with treatment of chronic lymphedema and variety of surgical options, our method achieved excellent health and could be the standard operative procedure to treat the intractable forms of disease.
Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA) involving fewer than 1% of all AAAs. ACF through a contained ruptured aortic aneurysm is an extremely uncommon complication following ruptured abdominal aortic aneurysm. ACF may cause severe hemodynamic disturbance due to a left-to-right shunt. We report here a case of ACF secondary to a contained ruptured abdominal aortic aneurysm, in a 65-year-old woman, which to our knowledge has not been reported in the literature before. Its diagnosis and treatment are presented in this article.