Restoration Of Arterial Continuity Research Articles

Microvascular anastomotic aneurysms in the clinical setting: Case report and review of the literature

Microvascular anastomotic aneurysms are an uncommon complication in reconstructive surgery, which can lead to free flap failure or even threaten the life of the patient. The literature referring to microvascular anastomotic aneurysms was reviewed in order to highlight their clinical presentation, diagnostic work-up, and therapeutic management. Also, a case of a ruptured aneurysm following free transfer of a fibula flap to the lower face is presented. No prospective studies were found. Only few case reports and some sporadic cases in retrospective studies referring to free flap complications were identified. All the aneurysms were false, the main etiologic factor was assumed to be infection, and the presenting signs were either arterial bleeding, as a result of rupture, or the presence of a pulsating mass. No widely accepted therapeutic guidelines were found, and the treatment was tailored to the specific clinical presentation of each case. Regarding the reported case, excision of the ruptured aneurysm and restoration of vascular continuity with a vein graft ensured complete survival of the flap. In conclusion, microvascular anastomotic aneurysms, although uncommon, represent a complication that every reconstructive surgeon should be aware of. Early diagnosis and proper treatment are crucial for a successful outcome. Selection of the appropriate treatment should be based on the presenting sign, the location, the degree of flap neovascularization as well as the condition and quality of the recipient bed; and comprises either ligation of the nutrient artery or excision of the aneurysm and restoration of arterial continuity.

A ruptured aneurysm of superior mesenteric artery to duodenum and reconstruction with saphenous vein graft

Eur J Vasc Endovasc Surg 25, 590-591 (2003)

Transfemoral endovascular stented graft treatment of aorto-iliac and femoropopliteal occlusive disease for limb salvage

Endovascular stented grafts employ a new technique that blends intravascular stent and prosthetic graft technologies. These devices may be used to treat arterial aneurysms, occlusive disease, and vascular injuries. This report describes the application of stented grafts to the treatment of limb-threatening ischemia secondary to occlusive disease of the aorta, iliac, and femoral arteries. Three patients with limb-threatening ischemia and severe comorbid medical illnesses were treated with transvascular stented grafts that were composed of 6-mm thin-walled polytetrafluoroethylene grafts and Palmaz balloon expandable stents. The grafts were inserted through a cutdown in an artery remote from the site of occlusion and introduced into the vascular system within 14-Fr introducer sheaths. Technical success was documented in all three patients with restoration of arterial continuity following stent graft deployment. Patency and limb salvage has been achieved to 1 year. One patient required further dilatation of the proximal stent at 6 weeks. Complications were limited to an iliofemoral deep vein thrombosis in one patient. Endovascular stented grafts can be inserted to treat limb-threatening ischemia. Although these initial results are encouraging, greater experience in more patients observed for longer periods of time is necessary before this technique can be advocated for widespread use.

Diagnostic hémodynamique d'une fistule aortocave compliquant un anévrysme de l'aorte abdominale

A 78-year-old man with a history of hypertension was admitted for a fall with back pain. The blood pressure was at 110/50 mmHg and the pulse at 115 b · min −1. A pulsatile abdominal mass was palpated. No signs of respiratory insufficiency or congestive heart failure were found. The diagnosis of abdominal aortic aneurysm was promptly confirmed by echography. Before laparotomy, a pulmonary artery catheter was inserted for haemodynamic monitoring which showed a high cardiac output, low systemic vascular resistances, increased pulmonary artery wedge pressure and a high Sv̄o 2 (93 %). This was not consistent with a hypovolaemic shock but rather an aortocaval fistula. After incision and aortic clamping, surgical procedure consisted of transaortic closure of the fistula and restoration of arterial continuity with a prosthetic graft. Initial control of venous bleeding was obtained by passing a Foley's catheter distally and by clamping the vena cava. The postoperative course was initially satisfactory. The patient was extubated, but remained with a major renal insufficiency. After a stay of 15 days in the intensive care unit, he died from nosocomial pneumonia. Aortocaval fistulas are either traumatic or spontaneous. Spontaneous fistulas are more common, and in about 90 % of the cases result from a rupture of an atherosclerotic aortic aneurysm. Clinical findings include signs of high cardiac output symptoms of venous hypertension and regional arterial insufficiency. Haemodynamic changes can be of value for the recognition of an aortocaval fistula. Most authors emphasize the importance of preoperative diagnosis, allowing the use of appropriate operative techniques and a prompt control of the fistula. This could decrease haemodynamic instability and transfusion requirements.

Hepatic artery aneurysm

To present a successfully treated case of hepatic artery aneurysm. A 76-year-old, retired male Caucasian presented with acute abdominal pain which was diagnosed as acute cholecystitis. An aneurysm of the hepatic artery was found at operation for cholecystectomy, and an arteriogram confirmed the position of the aneurysm, distal to the origin of the gastroduodenal artery. The aneurysm was resected and replaced with an 8 mm diameter woven Dacron graft. The postoperative course was uneventful and the patient was discharged on the ninth postoperative day. Aneurysms of the hepatic artery can be resected with restoration of arterial continuity.

Mycotic aneurysms of the suprarenal abdominal aorta: Prolonged survival after in situ aortic and visceral reconstruction

Necrotizing infection of the arterial wall causes rupture and false (“mycotic”) aneurysm formation, with a very poor prognosis if untreated. Cure can be achieved by surgical drainage and debridement, with restoration of arterial continuity through uncontaminated tissues. The dilemma of applying these principles to the treatment of mycotic aneurysms of the suprarenal aorta is that no remote or extraanatomic routes are available to maintain perfusion to the viscera. We report the first case of Klebsiella suprarenal mycotic aortic aneurysm successfully treated with in situ prosthetic reconstruction of the aorta and visceral arteries, and we have reviewed the 21 other suprarenal mycotic aortic aneurysms reported in the English-language literature. Repair was performed in 20 of the 22 cases, with in situ prosthetic reconstruction performed in 18. Prolonged survival has been achieved in 16 patients after in situ repair. No long-term survival has been reported after extraanatomic reconstruction of the aorta and visceral arteries in patients with such aneurysms. We conclude that in situ prosthetic reconstruction, accompanied by thorough drainage and debridement, prolonged parenteral antibiotic therapy, and permanent suppressive oral antibiotics, offers the best chance for survival in these patients.

Mycotic Cervical Carotid Artery Aneurysms: A Case Report and Review of the Literature

Mycotic cervical carotid artery aneurysms are rare. We report one case successfully treated by resection and reconstruction with a saphenous vein interposition graft. A review of the English world literature revealed 22 additional cases. Principles of management include appropriate and timely antibiotic use, resection of the aneurysm, debridement of all infected tissue, and restoration of arterial continuity with autogenous tissue through uninvolved tissue planes.

Adductor Canal Compression Syndrome — A Case Report

Adductor canal compression syndrome is an unusual cause of acute arterial occlusion in younger men. The arterial occlusion results from extrinsic com pression by an abnormal musculotendinous band arising from the adductor magnus muscle. The mechanism of this syndrome is similar to that of thoracic outlet and popliteal fossa entrapment syndromes. The present case report is the sixth in the literature. Treatment consists of division of the abnormal band and restoration of arterial continuity by appropriate means.

Celiac artery aneurysmectomy with pancreatectomy

A case of symptomatic celiac artery aneurysm with pancreatic involvement treated by excision, 85% pancreatectomy, and direct reanastomosis of the common hepatic artery with restoration of arterial continuity is reported. This is the first reported case, of which we are aware, in which celiac artery aneurysm resection also required partial pancreatectomy. Pancreatic involvement by celiac artery aneurysm is discussed. The rationale for early diagnosis and recommended treatment is presented.

Aneurysm of the Extracranial Carotid Artery

Aneurysms of the extracranial carotid artery are rare vascular lesions. These aneurysms usually present to the otolaryngologist or vascular surgeon as a cervical or parapharyngeal pulsatile mass. Rupture and hemorrhage are unusual complications. Central nervous system symptoms secondary to embolism or thrombosis, however, are relatively common. Because of these serious complications, surgical resection of the aneurysm with restoration of arterial continuity is the treatment of choice. We describe herein three cases of the extracranial carotid aneurysm treated at the Mie University Hospital, Tsu, Japan, in the past two years. Surgical treatments include end-to-end anastomosis, saphenous vein autograft replacement, and direct closure utilizing an internal shunt, respectively, after resection of the aneurysm. In all patients, the postoperative course was uneventful, and angiography six weeks after the operation demonstrated good blood flow through the repaired artery.

Carotid artery aneurysm. Review of the literature and report of a case with rupture into the oropharynx.

A rapidly expanding carotid aneurysm initially produced partial upper respiratory obstruction and then suddenly ruptured into the oropharynx. Emergency replacement of the aneurysm with use of an internal shunt was successful. The English literature contains reports on 42 patients who have undergone resection of a primary carotid artery aneurysm with restoration of arterial continuity. Arteriosclerosis was the most common cause, and reconstruction consisted of either primary anastomosis (26 patients) or insertion of a graft (16 patients). A neurologic deficit developed in six of the 21 patients who were operated on without benefit of cerebral protection, compared to four of the 21 who had some form of cerebral protection from ischemia.

Surgical Management of Vascular Complications in Intravenous Drug Abusers: Experience at the National Institute of Cardiovascular Diseases (NICVD), Bangladesh

Background: Intravenous drug abuse (IVDA) is a global health care problem that has tremendous socio-economic implications. Vascular complications following IVDA are not uncommon and may have serious consequences. At the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, there has been a steady increase in the number of cases with vascular complications of IVDA in the recent years. Objectives: The present study was undertaken to evaluate our surgical strategy for the management of various vascular complications following IVDA. Materials and Methods: Over the last 5 years, a total of 45 patients presented at the NICVD with various complications of IVDA. Thirty seven patients presented at the emergency department with bleeding from ruptured aneurysm or with impending aneurysm rupture. The remaining 8 patients presented at the vascular outpatient with deep venous thrombosis, superficial thrombophlebitis and chronic venous insufficiency. After resuscitation when necessary, excision of aneurysm was done either with simple ligation of the artery (Group A) or with restoration of arterial continuity (Group B). Outcome in the two groups were compared against the following parameters; acute limb ischemia, chronic limb ischemia, wound infection and lymphorrhoea. Results: There was no in-hospital mortality in this series. Both ligation and restoration of arterial continuity following aneurysmectomy were effective in treating the bleeding aneurysm. However, statistically significant differences were seen between the two groups in terms of acute and chronic limb ischemia. Restoration of arterial continuity was more effective in preventing acute and chronic limb ischemia. Conclusions: In Bangladesh, the incidence of IVDA with vascular complications is increasing at an alarming rate. In patients presenting with arterial pseudoaneurysms, surgical management should be aimed at restoration of arterial continuity whenever feasible. Key words: Intravenous drug abuse, Vascular complication, Aneurysm. DOI: 10.3329/cardio.v3i1.6426Cardiovasc. j. 2010; 3(1): 45-49

Cervical carotid aneurysms: Treatment by excision and restoration of arterial continuity

Cervical carotid aneurysms are uncommon. Aneurysmectomy with restoration of arterial continuity at present is the treatment of choice. A review of the recent literature reveals twenty-two cases in which this approach has been utilized. Two additional cases encountered at the Mayo Clinic are presented. Certain problems were posed by the anatomic location of the lesion, and various technics were employed to cope with them. Differential diagnosis includes “buckled” carotid artery and chemodectoma. Arteriography is a valuable adjunct not only in diagnosis but also in accurate localization of carotid aneurysms. After excision, direct end to end or end to side anastomosis or replacement with a prosthetic graft was successfully employed. Protection of cerebral function during the operative procedure by means of a temporary vascular shunt is desirable.

Aneurysm of the renal-artery bifurcation. Resection with restoration of arterial continuity.

ANEURYSM of the renal artery is not a rare clinical finding. Garritano1 reviewed 175 cases in 1957 and noted that a third had been reported in the preceding five years. Individual series of 102 , 3 and 12 cases4 have been reported. Most of these aneurysms are located peripherally, involving the bifurcation of the main renal artery or one of its branches, in contrast to the less common, more centrally placed aneurysm, which is often a poststenotic dilatation. The ring shadow on roentgenograms of the abdomen, produced by calcification within the wall of the aneurysm, is often diagnostic. The diagnosis is best . . .

Extracranial aneurysms of the carotid artery. Report of seven cases.

Excision with restoration of arterial continuity has become the treatment of choice for extracranial carotid aneurysms. Three of the seven cases reported here involved the common carotid artery, and four the internal carotid artery. Technics included excision and primary repair, excision and graft, temporary external or internal shunts, and permanent bypass graft. The one patient who died had congenital absence of a portion of the circle of Willis. The other six patients recovered without neurologic sequelae.

A comparative evaluation of prosthetic and homologous artery grafts used in the treatment of occlusive disease of the superficial femoral artery

1. 1. A comparative evaluation of homografts versus prostheses employed in treating occlusive disease of the superficial femoral artery is presented. 2. 2. Three cases of aneurysmal formation in iliofemoral homografts are reported with successful excision and restoration of arterial continuity in two of the three patients. 3. 3. Structural failure as a cause of graft failure in peripherally implanted homografts is stressed. This deficiency has not been noted in Dacron prostheses.

Reconstructive Arterial Surgery in Upper-Extremity Injuries

A plea is immade for primary restoration of arterial continuity in cases of upper-extremity traunma involving injury to major arteries. This is justified by the high incidence of limb loss in such injuries and is particularly important where there is conconmitant injury in the distal, relatively ischaemic portion of the extremity. Such efforts can be rewarding even in late and neglected cases. Excellent flow through the reconstructed vessel is essential to success. This requires scrupulous attention to the avoidance of stricture at the suture line and complete removal of distal thrombus in the artery. The latter can be accomplished by retrograde flushing or by the use of instruments from an unthrombosed point in the distal portion of the artery. Re-exploration in the event of postoperative thrombosis is urged since this frequently will convert failure to success if the reason for thrombosis is recognized and corrected. The free use of venous autografts is recommended. Extremes of heat and cold are to be avoided in the extremity with marginal circulation since both can cause serious tissue injury. The extremity should be warmed to a temperature of from 80 to 90 degrees Fahrenheit. Even severe degrees of ischaemic injury resulting from long periods of circulatory arrest will heal and allow salvage of a useful extremity if the circulation is restored. Conservatism is urged in the treatment of such cases.

Surgical considerations of peripheral arterial aneurysms; analysis of one hundred seven cases.

Peripheral arterial aneurysms are usually caused by arteriosclerosis, trauma, infection, or poststenotic abnormalities. They occur most frequently in the extremities, since the arteriosclerotic forms are commonest and in the great majority of instances are located in the popliteal or femoral region. Least common is the poststenotic type, which usually occurs in the supraclavicular fossa. Despite differences in etiology and location, these aneurysms are frequently associated with complications that lead to arterial insufficiency, gangrene of the involved extremity, and even death.11Treatment usually has been conservative or has consisted of resection without restoration of arterial continuity. Conservative therapy has been associated with subsequent complications in 50% of patients followed from three to five years, and, although excision without arterial reconstruction has provided significant improvement in the treatment of these lesions, many patients continue to have symptoms of arterial insufficiency.11Recent developments in arterial replacements for segmental arterial lesions have