Carotid artery reconstruction surgery for atherosclerotic lesions of the extracranial cerebral circulation has become the most common peripheral vascular operation. A better understanding of the indications for operative intervention, enhanced monitoring during surgery, and more precise management of intraoperative anesthesia have all decreased the risks associated with internal carotid endarterectomy (ICA). In an effort to evaluate the safety and efficacy of extracranial carotid reconstructive surgery, we reviewed 3028 operations performed in 2198 patients during the past decade (1977-1986). Operation was recommended because of hemispheric symptoms in 59% of cases. Fourteen percent were advised to have endarterectomy because of an asymptomatic, significant ICA stenosis. Postoperative hemiparesis occurred in 24 patients (1.1%) and was associated with thrombosis at the operative site in 18 patients. Antiplatelet drugs utilized during the last four years were effective in preventing thrombosis at the operative site. Operative mortality during the decade was 1.2%. Follow-up has ranged from one to. 104 months with 86% of the patients alive and 87% symptom free.

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Combined aorto-femoral-popliteal arterial reconstruction.

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Lymphangiomatosis and massive osteolysis of the cervical spine. A case report and review of the literature.

On the basis of clinical, radiographic, and pathologic evidence, massive osteolysis can be divided into two forms: Gorham's disease and angiomatosis. The present case is the first report of massive osteolysis of the lymphangiomatosis type involving the cervical spine but without visceral involvement. Originally, plain lymphangiomatosis was diagnosed, but the diagnosis was changed to massive osteolysis. Only one other case of lymphangiomatosis with cervical involvement was found, but in that case the viscera were also involved. Both cases exemplify a prolonged progressive pattern, recalcitrant to treatment and with a devastating outcome. Diagnosis by biopsy is difficult, and incremental radiation therapy early in the disease process should be considered.

Bone Resorption↗