We treated two patients with popliteal artery entrapment syndrome. In one, the popliteal artery was entrapped and obstructed in its abnormal course around the medial head of the gastrocnemius muscle, which was inserted into the femur laterally and cephalad (type II in Delaney's classification). In the other patient, the popliteal artery followed a normal course but was compressed laterally by the medial head of the gastrocnemius muscle, which was aberrantly inserted into the femur considerably higher and more lateral than usual, and was occluded. This could not be fitted into Delaney's or Insua's classification. Arterial reconstruction was successful with an autovein graft in the former case and an in situ bypass graft in the latter. We suggest a modification of type IV in Delaney's classification, so that when the popliteal artery is compressed by an aberrant muscular or tendinous structure in the popliteal fossa it can be included.

Adult↗

PubMedDate not supplied

Crural artery bypass with adjunctive arteriovenous fistula. A modification in distal anastomosis.

We carried out crural artery bypass with an adjunctive arteriovenous fistula in 8 lower extremities of 7 patients with severe ischemic symptoms and poor distal run-off. Mean blood flow rates in the implanted grafts ranged from 43 to 340 ml/min and those of the reconstructed crural arteries from 20 to 100 ml/min. A stenotic lesion was noted on postoperative angiogram in one patient and stasis symptoms caused by downward blood flow into the distal veins in another. The other patients have remained well with good function of the grafts 1-5 years after surgery. We modified the distal corner of the anastomosis as follows: three additional interrupted simple sutures were made on the anterior wall of the concomitant arteriotomy and venotomy incisions after making the common posterior wall of the vessel incisions. A vascular pocket formed at the distal corner of the anastomosis prevents stricture at the anastomosis. The vein is finally ligated just distal to the fistula to intercept downward blood flow into the distal veins. This modification in technique is recommended to prevent stricture of the distal anastomosis and postoperative stasis symptoms.

Aged↗

PubMedDate not supplied

Antithrombotic and vasodilating effects of OP-41483, a prostacyclin derivative.

Anti-platelet and vasodilating actions of OP-41483, a derivative of prostacyclin, were studied experimentally and clinically. The ADP-induced human platelet aggregation was significantly inhibited in vitro, the rate being 59% with a dose of 3 micrograms/ml, 75% with 6 micrograms/ml and over 90% with 18 micrograms/ml or more. A significant reduction in deposition of platelet and mural thrombi on the chemically injured luminal surface of the canine femoral vein was observed by treatment with topical administration of the solution (10 micrograms/ml) and/or intravenous infusion (10 ng/kg/min). The blood flow rate of the normal canine femoral artery and the anterior or posterior tibial artery of patients with peripheral arterial occlusive disease at the ankle was moderately increased in cases of intravenous infusion of the compound at a rate of 10 ng/kg/min.

Adenosine Diphosphate↗

PubMedDate not supplied

Current status in treatment of the Japanese with chronic arterial occlusive disease of the lower extremities.

For the clinical management of patients with a mild ischemia or intermittent claudication, ambulatory exercise plus the administration of antiplatelets and vasodilators is recommended. Patients with a ischemia related with small ulcer and slight pain at rest often show improvement while on conservative treatment. For patients with a severe ulcer and pain, reconstructive surgery has to be done. In management of patients with extensive or diffuse arterial occlusive lesions amenable to direct reconstruction, A-V shunt procedure, forced pulsatile perfusion technique and artificial CO2 baths have been devised. Tibial artery bypass associated with adjunctive arteriovenous fistula has also been recommended for those with poor distal outflow vessels. To assess the outcome of the reconstructed artery and to prevent early postoperative occlusion, flow waveform analysis is useful. This approach also aids in detecting preocclusive lesions of the reconstructed artery during postoperative follow-up.

Arterial Occlusive Diseases↗

PubMedDate not supplied

Tibial artery autogenous in situ vein bypass with adjunctive arteriovenous fistula.

A man suffering from severe intermittent claudication of the right calf and foot was successfully treated by femoro-tibio-peroneal trunk autogenous vein bypass with adjunctive arteriovenous fistula. Prior to operation, he was unable to walk more than 50 meters without resting. Preoperative arteriography revealed extensive occlusion of the popliteotibial arteries, except for indistinct visualization of the tibio-peroneal trunk, in which conventional reconstructive surgery seemed not to be feasible because of poor distal run-off. An autogenous vein bypass graft between the distal superficial femoral artery and tibio-peroneal trunk was successfully made "in-situ", creating an adjunctive arteriovenous fistula. Postoperatively, the ankle pressure index of the posterior tibial artery was considerably increased from 0 to 0.65, and Doppler flow wave could be recorded. The patient can now walk more than 1,500 meters without resting.

Arteriovenous Shunt, Surgical↗