28 research outputs found
Open surgery for aneurysms of the splenic artery at the hilum of the spleen. Report of three cases
No full textIntroduction: Aneurysms of the splenic artery (SAA) located at the hilum of the spleen are not well fit for endovascular or laparoscopic treatment. Open surgery may still be the best option of treatment. Presentation of cases: We report the cases of 3 female patients of a mean age of 59 years (range, 45–68 years) with a hilar (n = 2) or parahilar (n = 1) SAA undergoing successful open surgical resection, through a short left subcostal access. Recovery was uneventful and mean, postoperative length of stay was 4 days (range, 3–5 days). Discussion: Results of this report support surgical resection and splenectomy for the treatment of SAA located at the hilum of the spleen. For this particular location endovascular treatment may not be advised, as coil embolization can be followed by a massive splenic infarction precipitating the need for splenectomy, due to the exclusion of backflow from the left gastroepiploic artery through the short gastric vessels. As well, endovascular exclusion through insertion of an endograft may not be feasible due to the absence of a distal landing zone, as stent grafting requires a normal caliber artery of sufficient length on each side of the aneurysm. Conclusion: Surgical excision and splenectomy, through a short subcostal incision, remains a viable option of treatment for hilar SAA
Schwannoma of the descending loop of the hypoglossal nerve. Case report
No full textSchwannomas of the descending loop of the hypoglossal nerve are very rare. They are slow-growing tumors that may masquerade a carotid body tumor
Outcome of inferior vena cava and noncaval venous leiomyosarcomas
No full textBackground. Leiomyosarcoma (LMS) is a rare tumor arising from the smooth muscle cells of arteries and
veins. LMS may affect both the inferior vena cava (IVC) and non-IVC veins. Because of its rarity, the
experiencewiththeoutcomeofthediseaseoriginatingfromtheIVCcomparedwiththatwithnon-IVCoffspring
isoveralllimited.Inthisstudy,wecomparedtheclinicalfeaturesandoutcomesafteroperativeresectionofIVC
and non-IVC LMS to detect possible significant differences that could affect treatment and prognosis.
Methods. Twenty-seven patients undergoing operative resection of a venous LMS at a single tertiary care
center and one secondary care hospital were reviewed retrospectively and divided into 2 groups: IVC-LMS
(Group A, n = 18) and non-IVC LMS (Group B, n = 9). As primary end points, postoperative mortality
and morbidity, disease-specific survival and, if applicable, patency of venous reconstruction were consid-
ered. Bivariate differences were compared with the v 2 test. Disease-specific survival was expressed by a life-
table analysis and compared using the log-rank test.
Results. No postoperative mortality was observed in either group. Postoperative morbidity was 28% in
group A and 11% in group B (P = .33). The mean duration of follow-up was 60 months (range, 13–
140). Disease-specific survival was 60% in group A and 75% in group B at 3 years (P = .48), and it
was 54% in group A and 62% in group B at 5 years (P = .63). Seven grafts were occluded in group A
(39%) and 1of 3 were occluded in group B (33%) (P = .85).
Conclusion. IVC and non-IVC LMS exhibit similar outcomes in terms of postoperative course and
survival. Operative resection associated with vascular reconstruction, if applicable, eventually followed by
radiation and chemotherapy may be curative and is associated with good functional results
Internal carotid artery rupture caused by carotid shunt insertion
No full textINTRODUCTION: Shunting
is a well-accepted
method of maintaining cerebral perfusion during carotid
endarterectomy (CEA). Nonetheless, shunt insertion may lead to complications including arterial dissec-
tion,
embolization, and thrombosis.
We present a complication of shunt insertion consisting of arterial
wall rupture, not reported previously.
PRESENTATION
OF CASE:
A 78-year-old woman underwent CEA combined with coronary artery bypass
grafting (CABG). At the time of shunt insertion an arterial rupture at the distal tip of the shunt was detected
and
was repaired via a small saphenous vein patch. Eversion CEA and subsequent CABG completed the
procedure whose postoperative course was uneventful.
DISCUSSION:
Shunting during combined
CEA-CABG may be advisable to assure cerebral protection from
possible hypoperfusion due to potential hemodynamic instability of patients with severe coronary artery
disease.
Awareness and prompt management of possible shunt-related complications, including the
newly reported one, may contribute to limiting their harmful effect.
CONCLUSION:
Arterial wall rupture
is a possible, previously not reported, shunt-related complication to
be aware of when performing CEA
Response to: reimplanting the superior mesenteric artery on the infra-renal aorta
No full textWe thank Manenti et al2 for their comments. Acute intestinal ischemia and intestinal resection associated with chronic, ostial stenosis/ occlusion of the superior mesenteric artery (SMA) represents a completely different clinical setting and pattern of associated problems than chronic mesenteric ischemia associated with long stenosis/occlusion of the SMA, which is the actual object of our article.
We agree with Manenti and his associates that reimplantation of the SMA on the aorta, usually on its right antero-lateral aspect just below the origin of the renal arteries is an excellent method of revascularization. It is the ideal technique when the quality of the aortic wall is good or a well-patent aortic graft is in place and the lesion is confined to the first centimeter of the SMA.1 Short, ostial stenoses of the SMA associated with soft or mildly calcified plaques are well managed by endovascular treatment, whereas we think that heavily calcified stenoses or occlusions are still best treated by operative
revascularization.
Acute ischemia due to embolism to an undiseased SMA is treated by embolectomy via a transverse arteriotomy after dissecting the artery just out the root of the mesentery. When dealing with long SMA stenoses in contaminated fields,
bypass with autogenous greater saphenous vein is a viable alternative, but can involve an excessively long course of the graft, because the greater saphenous vein is more prone to twisting and kinking than Dacron (Intervascular Datascope, La Ciotat, France) or polytetrafluoroethylene
Infrarenal aorta as the donor site for bypasses to the superior mesenteric artery for chronic mesenteric ischemia. A prospective clinical series of 24 patients
No full textBackground. Treatment of symptomatic, chronic mesenteric ischemia is indicated to relieve symptoms
and prevent acute ischemia and death. Current therapeutic options include endovascular and open
surgery. The purpose of this prospective study was to evaluate the results of bypasses to the superior
mesenteric artery arising from the infrarenal aorta or infrarenal aortic grafts.
Methods. From January 1999 to December 2016, 24 consecutive patients with a mean age of 61 years
underwent a prosthetic bypass to the superior mesenteric artery. Nine patients (37%) presented with an
associated clinically important stenosis of the celiac artery and 10 (42%) of the inferior mesenteric
artery. Five patients (21%) received preoperative parenteral nutrition. Four patients (17%) underwent
dual antiplatelet treatment. The donor site was the infrarenal aorta in 19 patients (79%) and an
infrarenal, Dacron graft was used in 5 (21%). The origin of the bypass was from the distal infrarenal
aorta or Dacron graft in 19 patients (79%) and from the proximal infrarenal aorta in 5 patients
(21%). The graft material consisted of 7 mm polytetrafluoroethylene in 19 cases (79%) and 7 mm
Dacron in 5 cases (21%). A concomitant bypass to the inferior mesenteric artery was performed in 4
patients (17%). The primary end points were postoperative mortality, morbidity, graft infection, late
survival, primary patency, and symptom-free rate. The secondary end point was postoperative
hemorrhagic complications.
Results. No postoperative mortality occurred. Postoperative morbidity included a prolonged postoperative
ileus in 4 patients (17%), transitory postoperative increases in serum creatinine concentrations in 3
patients (12%), and myocardial ischemia in 2 patients (8%). No postoperative hemorrhagic
complications or graft infection were observed. Overall, the cumulative survival rate was 77% at
60 months. The overall late-patency rate and freedom from recurrence of symptoms were both 87% at
60 months.
Conclusion. Infrarenal aorta and infrarenal aortic grafts are an excellent source for the revascularization
of the superior mesenteric artery. Bypasses to the superior mesenteric artery from the infrarenal
aorta, either isolated or associated with adjunctive bypass to the inferior mesenteric artery, yield results
that are comparable with those obtained with complete digestive artery revascularization using other
donor sources
Prosthetic bypass for restenosis after endarterectomy or stenting of the carotid artery
No full textOBJECTIVE:
The objective of this study was to evaluate the results of prosthetic carotid bypass (PCB) with polytetrafluoroethylene (PTFE) grafts as an alternative to carotid endarterectomy (CEA) in treatment of restenosis after CEA or carotid artery stenting (CAS).
METHODS:
From January 2000 to December 2014, 66 patients (57 men and 9 women; mean age, 71 years) presenting with recurrent carotid artery stenosis ≥70% (North American Symptomatic Carotid Endarterectomy Trial [NASCET] criteria) were enrolled in a prospective study in three centers. The study was approved by an Institutional Review Board. Informed consent was obtained from all patients. During the same period, a total of 4321 CEAs were completed in the three centers. In these 66 patients, the primary treatment of the initial carotid artery stenosis was CEA in 57 patients (86%) and CAS in nine patients (14%). The median delay between primary and redo revascularization was 32 months. Carotid restenosis was symptomatic in 38 patients (58%) with transient ischemic attack (n = 20) or stroke (n = 18). In this series, all patients received statins; 28 patients (42%) received dual antiplatelet therapy, and 38 patients (58%) received single antiplatelet therapy. All PCBs were performed under general anesthesia. No shunt was used in this series. Nasal intubation to improve distal control of the internal carotid artery was performed in 33 patients (50%), including those with intrastent restenosis. A PTFE graft of 6 or 7 mm in diameter was used in 6 and 60 patients, respectively. Distal anastomosis was end to end in 22 patients and end to side with a clip distal to the atherosclerotic lesions in 44 patients. Completion angiography was performed in all cases. The patients were discharged under statin and antiplatelet treatment. After discharge, all of the patients underwent clinical and Doppler ultrasound follow-up every 6 months. Median length of follow-up was 5 years.
RESULTS:No patient died, sustained a stroke, or presented with a cervical hematoma during the postoperative period. One transient facial nerve palsy and two transient recurrent nerve palsies occurred. Two late strokes in relation to two PCB occlusions occurred at 2 years and 4 years; no other graft stenosis or infection was observed. At 5 years, overall actuarial survival was 81% ± 7%, and the actuarial stroke-free rate was 93% ± 2%. There were no fatal strokes.
CONCLUSIONS:
PCB with PTFE grafts is a safe and durable alternative to CEA in patients with carotid restenosis after CEA or CAS in situations in which CEA is deemed either hazardous or inadvisable
Fondaparinux for intra and perioperative anticoagulation in patients with heparin-induced thrombocytopenia candidates for peripheral vascular surgery. Report of 4 cases
No full textINTRODUCTION:
Intra and perioperative anticoagulation in patients with heparin induced thrombocytopenia (HIT), candidates for peripheral vascular surgery remains a challenge, as the best alternative to heparin has not yet been established. We evaluated the off-label use of fondaparinux in four patients with HIT, undergoing peripheral vascular surgery procedures.
PRESENTATION OF CASES:
Four patients of whom 3 men of a mean age of 66 years, with proven heparin induced thrombocytopenia (HIT) underwent two axillo-femoral bypasses, one femoro-popliteal bypass and one resection of a splenic artery aneurysm under fondaparinux. No intra or perioperative bleeding or thrombosis of new onset was observed.
DISCUSSION:
In the absence of a valid alternative to heparin for intra and perioperative anticoagulation in HIT, several other anticoagulants can be used in an off-label setting. However, no general consensus exist on which should be the one of choice. In this small series fondaparinux appeared to be both safe and effective.
CONCLUSIONS:
These preliminary results seem to justify the off-label use of fondaparinux for intra and perioperative anticoagulation in patients with HIT, candidates for peripheral vascular surgery interventions
True aneurysm of the proximal occipital artery. Case report
No full textINTRODUCTION:
True aneurysms of the proximal occipital artery are rare, may cause neurological symptoms due to compression of the hypoglossal nerve and their resection may be technically demanding.
PRESENTATION OF CASE:
The case of an aneurysm of the proximal occipital artery causing discomfort and tongue deviation by compression on the hypoglossal nerve is reported. Postoperative course after resection was followed by complete regression of symptoms.
CONCLUSION:
Surgical resection, as standard treatment of aneurysms of the occipital artery, with the eventual technical adjunct of intubation by the nose is effective in durably relieving symptoms and preventing aneurysm-related complicatio
Hybrid treatment of tandem, common carotid/innominate artery and ipsilateral carotid bifurcation stenoses by simultaneous, retrograde proximal stenting and eversion carotid endarterectomy. Preliminary results of a case series
No full textBACKGROUND:
Tandem stenoses of the internal carotid artery (ICA) and proximal, ipsilateral common carotid artery (CCA) or innominate artery can be treated with a hybrid approach, combining conventional carotid endarterectomy (CEA) and retrograde stenting of the proximal stenosis, through surgical exposure of the carotid bifurcation. The purpose of this study was to evaluate the results of combining eversion CEA with retrograde CCA/innominate artery stenting.
MATERIAL AND METHODS:
From January 2015 to July 2017, 7 patients, 6 men of a mean age of 72 years (range 59-83 years) underwent simultaneous, retrograde stenting of the proximal CCA/innominate artery and an eversion CEA of the ipsilateral ICA, through surgical exposure of the carotid bifurcation, for severe tandem stenoses. The proximal stenosis involved the left proximal CCA in 4 patients, the proximal innominate artery in 2 patients and the right CCA in one patient. The procedure was performed under general anesthesia in a conventional operating room equipped with a mobile C-arm. A covered, balloon expandable stent was deployed over the proximal stenosis via a 6-F sheath directly introduced into the proximal CCA through the obliquely transected carotid bulb. After removing the sheath, debris were flushed through the carotid bulb and eversion CEA completed the procedure. Study endpoints were: postoperative stroke/mortality rate, cardiac mortality and morbidity, peripheral nerve injury, cervical hematoma, overall late survival, freedom from ipsilateral stroke and patency of arterial reconstruction.
RESULTS:
No postoperative mortality or neurologic morbidity was observed in any patient. Cervical hematomas and peripheral nerve injuries were likewise absent. At a mean follow-up of 18 months, all the patients were alive, free from neurologic events of new onset and free from restenosis.
CONCLUSION:
Combined proximal stenting and eversion CEA for tandem lesions seems a valid treatment, with the advantages of eversion CEA over other techniques of carotid bifurcation revascularizatio
