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Biomedical subjects

P Sapienza

Publications and source records attributed to P Sapienza.

At least 37 records · Page 2Linked to original sources
PubMed1999

Iliorenal bypass for the treatment of type-3 Takayasu's disease. A case report with 10-year follow-up.

The case of a 16-year old female with severe renovascular hypertension resulting from type-3 Takayasu's arteritis is reported. The entire thoracic and abdominal aorta was affected by an active inflammatory process and all its branches were stenotic or occluded. After the early failure of a percutaneous balloon angioplasty of the left renal artery, an iliac to renal artery bypass graft using a reversed autologous saphenous vein was performed through a retroperitoneal tunnel The patient is asymptomatic and the graft is patent at 10-year follow-up.

Adolescent↗
PubMed1999

Inflammatory aneurysm of the abdominal aorta. A prospective clinical study.

OBJECTIVE: This study was undertaken to investigate a consecutive series of abdominal aortic aneurysm studied with histology to highlight the etiology, the incidence, the value of preoperative studies and intraoperative findings. EXPERIMENTAL DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Between 1992 and 1994, 102 patients underwent elective surgical repair of an abdominal aortic aneurysm. The patients were prospectively divided as having an inflammatory aneurysm (IA) or an atherosclerotic aneurysm (AA) on the basis of preoperative and intraoperative findings. Further histological evaluation assigned the patients to one of the two groups. RESULTS: The incidence of IA was 15%. Overall, symptoms, CT scan studies, aneurysmal wall thickness, white glistening perianeurysmal fibrosis, bleeding from the aneurysmal wall and adhesion to the duodenum diagnosed 11 (73%) cases of IA. Histology showed that a granulomatous reaction against some components of the atherosclerotic plaques resulting in an auto-allergic response to this component could initiate the inflammatory process thus resulting in a progressive adventitial and peri-adventitial fibrosis with inflammation, lymphadenitis and lymphatic dilatation. CONCLUSIONS: Preoperative and intraoperative findings underestimate the incidence of IA. Aortic resection can prevent the progression of the inflammatory process and the complications usually observed when the exposure to the allergen determines an involvement of the periaortic structures.

Aged↗
PubMed1999

31Phosphorus magnetic resonance spectroscopy to evaluate medical therapy efficacy in peripheral arterial disease. A pilot study.

BACKGROUND: Human and animal studies have shown that propionyl-L-carnitine, increasing carnitine content, improves the energy metabolism of ischemic skeletal muscle. The aim of the study was to evaluate the accuracy of Doppler continuous wave, Treadmill test and 31Phosphorus magnetic resonance spectroscopy in determining the efficacy of propionyl-L-carnitine in patients with peripheral arterial disease. METHODS EXPERIMENTAL DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Eighteen male patients with peripheral arterial disease (category 3) and 8 healthy volunteers form the basis of the study. Patients quit smoking, start physical training (2-3 Km walk per day) and were assigned to medical therapy consisting of propionyl-L-carnitine (8 patients) or placebo (10 patients). Patients were studied with Doppler continuous wave, Treadmill test and 31Phosphorus magnetic resonance spectroscopy at day 0 and at day 90. The following parameters were assessed by the principal component analysis: clinical (absolute claudication, ankle brachial index at rest and at 2, 5 and 10 minutes after completing Treadmill exercises) and biochemical (inorganic phosphorus/phosphocreatine ratio and pH profiles at 20% and 50% of the maximum load, the recovery half time of phosphocreatine, number of exercise steps and slope of linear relationship between muscle power and inorganic phosphorus/phosphocreatine ratio). RESULTS: Final evaluation showed a significant improvement of clinical and biochemical variables (p < 0.05 and p < 0.02 respectively). Breaking down the results on the basis of the two study arms, 31Phosphorus magnetic resonance spectroscopy showed a significant improvement of biochemical variables in the group of patients treated with propionyl-L-carnitine (p < 0.05) and was more sensitive in the evaluation of changes induced by 90-day treatment as compared with the other noninvasive examinations. CONCLUSIONS: 31P-MRS permits the evaluation of muscle metabolic effect induced by PLC after a 90-day-period in patients affected by category 3 of peripheral arterial disease and it is a more sensitive tool in the evaluation of the pharmacological effects of medical therapy.

Aged↗
PubMed1998

Release of PDGF-BB and bFGF by human endothelial cells seeded on expanded polytetrafluoroethylene vascular grafts.

BACKGROUND: The majority of endothelial cell (EC) seeded graft failures are due to anastomotic neointimal fibrous hyperplasia. We investigated the PDGF-BB and bFGF release in vitro by umbilical vein EC seeded on precoated expanded polytetrafluoroethylene (ePTFE) prostheses. MATERIALS: EC harvested from human umbilical veins were seeded into ePTFE (30 microns internodal distance, 1 cm2 in diameter) disks. ePTFE disks uncoated or precoated with collagen type I, fibronectin, and Matrigel were used, and EC seeded into plastic wells coated as ePTFE disks or uncoated plastic wells served as controls. Scanning electron microscopy study assessed EC coverage. The presence of bFGF and PDGF-BB in serum-free conditioned media from EC seeded into ePTFE grafts and EC seeded into wells was determined by the inhibition antibody-binding assay 72 h after seeding. RESULTS: EC coverage was similar in uncoated and coated ePTFE grafts. The release of PDGF-BB and bFGF by EC seeded into ePTFE grafts was significantly higher than that observed in EC seeded into plastic wells. The release of PDGF-BB and bFGF was independent from the various substrates used in the experiments in EC seeded into either ePTFE grafts or plastic wells. CONCLUSIONS: Our findings pointed out that in seeded ePTFE grafts, anastomotic smooth muscle cell proliferation and intimal thickening could take place underneath an intact endothelium because seeded EC may release several growth factors.

Becaplermin↗
PubMed1998

[High-porosity and normal-porosity prostheses. Differences in growth factor release].

BACKGROUND: The majority of mid- and long-term synthetic vascular graft failures are due to anastomotic neointimal fibrous hyperplasia. The major cause of this phenomenon is the absence of an endothelial lining within prosthetic grafts. We investigated the PDGF-BB and bFGF release by umbilical vein endothelial cell cultured on precoated standard porosity or high porosity expanded polytetrafluoroethylene (ePTFE) vascular grafts. METHODS: Endothelial cell harvested from umbilical veins were cultured into standard (30 microns internodal distance) or high porosity (60 microns internodal distance) cPTFE disks. ePTFE disks uncoated or precoated with collagen type I, fibronectin and Matrigel were used and endothelial cell cultured into plastic wells coated as ePTFE disks or uncoated plastic wells served as controls. Scanning electron microscopy study assessed endothelial cell coverage. The presence of PDGF-BB and bFGF in serum-free conditioned media from endothelial cells cultured into ePTFE grafts and endothelial cell cultured into wells was determined by the inhibition antibody-binding assay 48 hours after insertion. RESULTS: Endothelial cell coverage was similar in uncoated and coated ePTFE grafts and no differences were observed between standard or high porosity grafts. The release of PDGF-BB and bFGF was significantly higher either for standard porosity or high porosity ePTFE grafts as compared with endothelial cell cultured into plastic wells (p < 0.05 and p < 0.05, respectively). The release of PDGF-BB and bFGF was independent from the various substrates either for endothelial cell cultured into standard or high porosity ePTFE grafts or plastic wells. CONCLUSIONS: Our findings pointed out that in ePTFE grafts smooth muscle cellsc proliferated only under endothelial cell at the anastomoses, along seeded synthetic grafts or in areas of transmural ingrowth where smooth muscle cells followed endothelial cell migrating into the graft. This is probably due to an alteration of the interactions between the endothelial cell, the matrices and the synthetic prosthesis.

Analysis of Variance↗
PubMed1997

Functional and morphological evaluation of canine veins following preservation in different storage media.

Injuries of endothelial and smooth muscle cells of autologous vein due to preservation in standard storage media may be responsible for graft failure. The effects of vein preservation with University of Wisconsin solution (UWs) on endothelial and smooth muscle cell function and morphology were compared to the effects of preservation with autologous whole blood (AWB) and normal saline (NS), which are frequently used in cardiovascular surgery. Canine external jugular and common femoral vein segments were preserved in the different solutions at 4 degrees C for 45 min and 24 hr. Rings (4-5 mm in length) from control and preserved veins were evaluated by isometric tension studies at 37 degrees C and by scanning and transmission electron microscopy. Differences between groups were evaluated by Student's t test or Mann-Whitney U test and by analysis of the variance, and considered to be significant at P < 0.05. Sensitivities to norepinephrine (NE) showed that a 45-min vein storage in AWB (5.7 +/- 0.2 mumol/L) but not in NS (5.8 +/- 0.2 mumol/L) or UWs (6.5 +/- 0.2 mumol/L) had a deleterious effect on function of smooth muscle (P < 0.05) when compared to control veins (6.6 +/- 0.2 mumol/L). Maximum contractile responses and sensitivities to NE were significantly altered (P < 0.05) after 24-hr vein storage in AWB (0.09 +/- 0.02 g/mm2 and 5.4 +/- 0.07 mumol/L) and NS (0.12 +/- 0.03 g/mm2 and 5.6 +/- 0.08 mumol/L) but not in UWs (0.36 +/- 0.06 g/mm2 and 6.4 +/- 0.07 mumol/L). With both storage times, acetylcholine-induced endothelium-dependent maximum relaxations and sensitivities were significantly reduced (P < 0.05) in veins stored in AWB and NS, but not in UWs, compared with controls. Similarly, transmission electron microscopy revealed marked neutrophil migration beneath the intimal surface of vessels and extensive separation and desquamation of endothelial cells with exposure of subendothelial structures in veins stored in AWB and NS. The results suggest that UWs is a suitable storage medium when compared to AWB and NS.

Animals↗
PubMed1997

Descending thoracic aorta-to-femoral artery bypass grafts.

BACKGROUND: Descending thoracic aorta-to-femoral artery (DTAFA) bypass graft is an alternative procedure to revascularize lower limbs. METHODS: Between 1976 and 1996, 41 patients underwent DTAFA bypass grafts. Operative indications consisted of previous abdominal graft thrombosis (22 cases, group 1), abdominal operations (8, group 2), initial vascular operation in the presence of difficult aortas (6, group 3), and infection of aortic grafts (5, group 4). RESULTS: Perioperative mortality was 5%. Cumulative 10-year primary patency, limb salvage, and survival rates were 64%, 79%, and 55%, respectively. Breaking down the result on the basis of the four groups, DTAFA bypass grafts performed for infection of previous aortic grafts had a significantly lower primary patency rate (25% at 24 months; P < 0.004) with dismal limb salvage (31% at 24 months; P < 0.001) and survival rates (0% at 24 months; P < 0.005). CONCLUSIONS: DTAFA bypass grafts can be safely and durably used in patients who had thrombosis of previous abdominal grafts or had a difficult abdomen or as the initial vascular operation in the presence of difficult aortas. Conversely, dismal results are obtained in the treatment of aortic graft infection.

Aged↗
PubMed1997

Aortoiliofemoral bypass graft in young adults: long-term results in a series of sixty-eight patients.

BACKGROUND: The aim of this study was to investigate surgical indications and the long-term outcomes of aoroiliofemoral reconstructions in adults younger than 45 years. METHODS: Between 1973 and 1990, 1256 patients underwent infrarenal abdominal aortic reconstruction for aortoiliofemoral occlusive disease. Sixty-eight (5.4%) patients (group 1) were less than 45 years old and form the basis of the analysis. They were retrospectively compared with two additional groups of patients 45 years and older selected from the entire series. Patients in group 2 (n = 100) were randomly chosen to determine differences in risk factors, associated diseases, operative indications, preoperative findings, and outcomes. Patients in group 3 (n = 70) were matched with those in group 1 for gender, risk factors, associated diseases, preoperative findings, and operative indications to assess the importance of age in determining the short- and long-term outcomes of aortoiliofemoral reconstructions. RESULTS: Postoperative mortality rates (1.5%, 4%, and 4.3% for groups 1, 2, and 3, respectively) and major complication rates (4.4%, 7%, and 7.1% for groups 1, 2, and 3, respectively) were comparable among the three groups. Ten-year secondary patency rates were 84.6%, 70.6%, and 80.3%, for groups 1, 2, and 3, respectively (p = not significant). Ten-year limb salvage rates were 86.9%, 78.2%, and 80.6%, for groups 1, 2, and 3, respectively (p = not significant). During follow-up a significantly higher percentage of myocardial infarction was recorded in group 1 as compared with group 2 (p < 0.03) and group 3 (p < 0.04). The 10-year survival rate for group 1 was significantly lower than that of group 2 (29.0% versus 46.9%; p < 0.005). CONCLUSIONS: Aortoliofemoral reconstruction in patients younger than 45 years is a safe procedure with low operative risks and good long-term results in patency and limb salvage rates. However, life expectancy is poor because of the high incidence of deaths related to coronary artery disease.

Adult↗
PubMed1997

Short-term preservation of autogenous vein grafts: effectiveness of University of Wisconsin solution.

BACKGROUND: Suboptimal preservation of autologous veins in storage solutions causes endothelial cell damage that can contribute to graft failure. The purpose of this study was to compare the effects of short-term storage of veins in autologous whole blood (AWB), 0.9% normal saline solution (NS), and University of Wisconsin solution (UWs) on vein structure and function after grafting. METHODS: Autogenous jugular and femoral veins were atraumatically harvested from mongrel dogs. One vein segment was immediately implanted to serve as a control, and the other segments were stored for 45 minutes in AWB, NS, or UWs. The veins were implanted as reversed interposition graft in the carotid or femoral arteries. After 6 weeks light and scanning electron microscopy and isometric tension studies were performed on explanted vein grafts. RESULTS: Morphologic studies revealed an intact endothelium that stained positively for factor VIII. Intimal thickness was similar between controls (48 +/- 12 microns) and veins stored in UWs (53 +/- 8 microns) (p = not significant), but it was significantly increased in veins stored in AWB (151 +/- 29 microns) and NS (149 +/- 18 microns) (p < 0.05). Sensitivity and maximum contraction to norepinephrine were not altered in veins preserved in UWs (6.0 +/- 0.1 mumol/L and 0.19 +/- 0.02 gm/mm2) but were significantly reduced (p < 0.05) in those stored in AWB (7.2 +/- 0.1 mumol/L and 0.08 +/- 0.02 gm/mm2) and NS (7.0 +/- 0.3 mumol/L and 0.09 +/- 0.02 gm/mm2) compared with controls (5.9 +/- 0.2 mumol/L and 0.20 +/- 0.02 gm/mm2). The sensitivity and maximum relaxation to acetylcholine and sodium nitroprusside of veins preserved in AWB, NS, and UWs were similar to controls (p = not significant). CONCLUSIONS: Vein storage in UWs preserves smooth muscle cell function compared with veins stored in NS or AWB. Therefore UWs is a more suitable medium for short-term preservation of veins in cardiovascular operation.

Adenosine↗
PubMed1997

Popliteal artery entrapment syndrome: the role of early diagnosis and treatment.

BACKGROUND: The purpose of this study was to evaluate whether certain factors could influence arterial impairment at presentation for treatment of popliteal artery entrapment syndrome (PAES) and whether its early diagnosis could optimize long-term results. METHODS: Between 1979 and 1995, 30 patients were treated for PAES at our institution. Patients were characterized by age, risk factors, associated diseases, preoperative symptoms, affected side, dominant limb, duration of symptoms, musculotendinous structure causing the compression, arteriographic findings, arterial status at presentation, type of operation, postoperative complications, and long-term follow-up. RESULTS: Twenty-nine (65%) limbs underwent musculotendinous section (MTS), 15 (33%) limbs underwent vascular reconstruction, and 1 (2%) was surgically explored. Patients submitted to MTS were younger (mean, 31 +/- 3 years) than patients who underwent vascular reconstruction (mean, 41 +/- 4 years; p < 0.05). MTS limbs had a greater number of minor symptoms compared with those that underwent vascular reconstruction (62% versus 20%; p < 0.02). Arteriogram showed that MTS limbs had a greater number of normal findings at rest when compared with limbs that underwent conventional reconstruction (85% versus 0%; p < 0.001). No specific factors influenced the arterial status at presentation. During follow-up, treadmill examination revealed that MTS limbs had a better response (96%) than limbs that had undergone vascular procedures (67%; p < 0.02). MTS limbs had a better long-term patency rate (mean, 87 +/- 7 months) compared with limbs that were submitted to vascular reconstruction (mean, 107 +/- 8 months) (95% versus 65%; p < 0.02). CONCLUSIONS: Because PAES is a progressive disease that can create serious vascular obstructive disease and no specific factors seem to influence the degree of vascular impairment, the detection and treatment of PAES at an early stage permit better long-term results.

Adolescent↗
PubMed1997

Carotid endarterectomy in young adults: is it a worthwhile procedure?

PURPOSE: The aim of the study was to investigate surgical indication and long-term outcome of carotid endarterectomy (CE) in young adults. METHODS: Between 1973 and 1990, 1693 patients underwent CE. Forty-nine patients (group T) 35 to 45 years of age who had carotid artery stenosis greater than 70%, formed the basis for the analysis. They were compared with two additional groups of patients older than 45 years of age selected from the entire series. Group 2 was randomly chosen to determine differences in risk factors, associated diseases, operative indications, preoperative findings, and outcome. Group 3 was matched with patients in group 1 for sex, risk factors, associated diseases, preoperative findings, and operative indications to assess the importance of age in determining the short- and long-term outcome of CE. RESULTS: Postoperative mortality, cerebrovascular accidents, and cardiac complications in patients of group 1 (2%, 2%, and 2%, respectively) were similar to those of the other groups (p = NS). During the follow-up (76.7 +/- 3.6 months; range, 1 to 120 months) the incidence of strokes and transient ischemic attacks in group 1 was lower than in group 2 (p < 0.05) but similar to group 3 (p = NS). Ten-year disease-free intervals were 75.7%, 58.7%, and 77.6%, respectively, for groups 1, 2, and 3. Mortality rate unrelated to cerebrovascular disease was similar between group 1 and group 3 (p = NS) but was higher in group 1 than in group 2 (p < 0.02). Ten-year survival rates were 46.1%, 71.7%, and 55.5%, respectively, for groups 1, 2, and 3. CONCLUSIONS: CE in patients younger than 45 years of age is a safe procedure with low operative risks and good disease-free intervals. However, life expectancy is poor because of the high incidence of deaths resulting from complications of atherosclerosis.

Adult↗
PubMed1997

Management of abdominal aortic prosthetic graft infection requiring emergent treatment.

The purpose of this study was to investigate mortality and morbidity rates and long-term outcome of patients who underwent emergency treatment of abdominal aortic prosthetic graft infection. Between January 1984 and December 1993, 18 men aged fifty-nine +/- sixteen years were operated on as an emergency for an acute life-threatening complication of aortic prosthetic graft infection. The grafts had been implanted for abdominal aortic aneurysm in 9 patients and aortoiliac occlusive disease in 9, from one to one hundred seventy months previously. Five (28%) patients presented with a hemorrhagic shock due to a fistula between the vascular reconstruction and the small bowel (4 patients) or the right ureter (1 patient) and 13 (72%) had generalized sepsis. The grafts were always radically explanted. Extraanatomic revascularization procedures included 6 axillopopliteal and 12 axillofemoral bypass grafts. Operative mortality was 39% (7 patients), and 3 (9%) limbs were amputated within thirty days. Two (11%) patients died after seven and twelve months, respectively, of septic complications, and 1 (5%) patient died after six months from an unrelated cause. Eight (73%) patients are still alive at a mean follow-up of fifty +/- thirty-four months, but in 3 the extraanatomic bypass was removed for infection and 5 major amputations were performed. Two-year survival and limb salvage rates were 44% and 50%, respectively. Aortic prosthetic graft infections that require emergent treatment continue to demonstrate high early and late mortality and limb loss rates despite aggressive intervention and limb salvage procedures. Newer methods of managing these complications should continue to be investigated.

Amputation, Surgical↗
PubMed1997

[A case of retroperitoneal fibrosis with spontaneous regression].

Retroperitoneal fibrosis has an unknown pathogenesis. Medical treatment should be preferred to surgery. However, surgical treatment is required when an ureteral involvement is present. A case of retroperitoneal fibrosis with spontaneous regression is reported. Current knowledge on pathogenesis, diagnosis and preferred treatment is outlined.

Aged↗
PubMed1996

Fresh vein allograft survival in dogs after cyclosporine treatment.

Synthetic grafts are widely used for peripheral arterial reconstructions when autologous veins are not available, but their results have not been satisfactory. Venous allograft may be used as an alternative to synthetic prostheses. The aim of the study was to explore the immunosuppressive efficacy of Cyclosporine A (CyA) as a means of preventing venous allograft failures and rejection. We utilized 56 mongrel dogs. Immunological incompatibility was checked with the skin graft method. Donor inferior vena cava was transplanted into the infrarenal abdominal aorta of recipient animals. One group (group 1, 10 dogs) served as a control and three groups received CyA treatment regimens. Group 2 (10 dogs) received postoperative oral CyA treatment for 30 days. Group 3 (12 dogs) received a vein graft pretreated with a CyA solution without postoperative immunosuppressive therapy. Group 4 (9 dogs) received a vein graft pretreated with a CyA solution and postoperative CyA treatment for 30 days. Allografts were examined at 30 days for patency, aneurysmal dilatation, gross structural changes, inflammatory response, and lymphocytic infiltration. Sex chromatine assessment determined the origin (donor or recipient) of the endothelial cells. The allografts from groups 1 and 3 showed significant aneurysmal dilatation and perivenous inflammation when compared to dogs treated with oral CyA therapy (P < 0.0002). Moreover allografts treated with CyA therapy had a better-developed venous neointima (P < 0.009) with less fibrin (P < 0.02) and thinner medial (P < 0.0009) with less fibrin (P < 0.02), and thinner medial (P < 0.0009) and adventitial layers (P < 0.02). No significant differences were observed in neointimal thickness among the four groups. Lymphocytic infiltration was greater in the group of animals who did not receive oral CyA therapy (P < 0.0004). Barr bodies status showed significant differences between oral CyA treated groups and nontreated groups (P < 0.0003). Oral CyA therapy reduced aneurysmal dilatation and immunological response, promoted the development of a neoendothelium, and preserved the structure of the venous layers. Graft pretreatment with CyA flushing did not have a significant immunosuppressive effect.

Animals↗
PubMed1996

Ischemia-induced peripheral arterial vasospasm role of alpha 1- and alpha 2-adrenoceptors.

Ischemia produces functional and structural alterations in peripheral blood vessels. Our study was designed to investigate alpha-adrenoceptor modifications induced by prolonged ischemia and their role in enhancing the contractile response during reperfusion in canine femoral arteries. Unilateral vessel ischemia was created by double crossclamping a femoral artery and was maintained for 3 hr. Reperfusion was allowed for 1 hr. The contralateral femoral artery was utilized as a control. The vessels were harvested for contractile and binding studies. Isometric tension studies revealed that the magnitude of the maximum contractile response to norepinephrine (NE), potassium chloride (KCl), and methoxamine was 671 +/- 82 mg/mm2 versus 245 +/- 43 mg/mm2 (P < 0.01), 485 +/- 46 mg/mm2 versus 229 +/- 62 mg/mm2 (P < 0.05), and 486 +/- 88 mg/mm2 versus 126 +/- 38 mg/mm2 (P < 0.01), respectively for ischemic and nonischemic femoral arteries. EC50 values showed that ischemic vessels were more sensitive to NE, KCl, and methoxamine (P < 0.05). Sodium nitroprusside induced concentration-dependent and complete relaxation in all arterial rings (100% relaxation) but the ischemic femoral artery showed less sensitivity (P < 0.05). Binding studies showed that the number of binding sites (Bmax) for [3H]Prazosin and [3H]Rauwolscine were significantly increased in ischemic versus nonischemic vessels (1261 +/- 95 fmole/mg versus 704 +/- 113 fmole/mg, P < 0.03, and 490 +/- 86 fmole/mg versus 175 +/- 15 fmole/mg, P < 0.04, respectively). Furthermore, a significant decrease in affinity (Kd) for [3H]Prazosin and [3H]Rauwolscine was observed in ischemic versus nonischemic tissues (9.4 +/- 1.7 nM versus 4 +/- 0.2 nM, P < 0.02, and 6.4 +/- 1.5 nM versus 1.8 +/- 0.6 nM, P < 0.01, respectively). The increase in canine femoral artery vasoreactivity, following prolonged ischemia, seems to be also due to an increased density and functional activity of alpha-adrenoceptors expressed by the ischemic arterial smooth muscle cells.

Animals↗
PubMed1996

Femoral artery aneurysms: long-term follow-up and results of surgical treatment.

Aneurysmal dilatation of the femoral artery is a rare condition of uncertain aetiology. Between January 1972 and December 1992, 31 atherosclerotic femoral aneurysms in 22 patients were seen. There were 21 men and 1 woman; mean(s.d.) age was 70.1(10.4) years. Thirteen (42%) femoral aneurysms (group 1) were isolated aneurysms, two being bilateral. Eighteen (58%) were associated with a non-contiguous abdominal aortic aneurysm, four being unilateral and seven bilateral femoral aneurysms (group 2). The mean(s.d.) size of these aneurysms was 4.7(1.5) and 3.5(0.7)cm in groups 1 and 2 respectively (P< 0.01). Of the limbs in group 1,12 were treated by an interposition bypass. A ruptured profunda femoris artery aneurysm was ligated in one limb as an emergency operation. All patients in group 2 underwent an aortobifemoral graft. There was one operative death. Three early thromboses were observed; two autogenous saphenous vein interposition grafts and one limb of an aortobifemoral. One late thrombosis occurred in an expanded polytetrafluoroethylene graft in group 1. The five-year patency rate was 80% for group 1 and 88.9% for group 2 (P=n.s.). The overall 10-year limb salvage rate was 100%. These findings suggest that isolated femoral aneurysms are larger and more frequently symptomatic than femoral aneurysms associated with an abdominal aortic aneurysm. The association between femoral aneurysm and abdominal aortic aneurysm was found to be higher in patients with bilateral femoral aneurysms compared with those with unilateral lesions (P< 0.05). In the treatment of isolated femoral aneurysms better early results were obtained with expanded polytetrafluoroethylene interposition grafts.

Aged↗