Endarteriectomy in the treatment of chronic endarteritis obliterans of the limbs and abdominal aorta.
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We report on the successful treatment of a patient with a mycotic aneurysm of the suprarenal aorta. The aorta was resected and reconstructed using an in-situ polytetrafluoroethylene graft with a side arm branch to the left renal artery. The use of polytetrafluoroethylene graft for aortic reconstruction after suprarenal mycotic aneurysm resection has not been previously reported. The etiology, bacteriology, diagnosis, and principles of management of mycotic aneurysms of the suprarenal aorta are discussed.
One of the most common source of lower extremity atheroembolization is the aorta and particularly the infrarenal segment. Complex atherosclerotic plaque can lead the patient to gangrene and major amputation. When the origin of embolization is a focal lesion, endoluminal methods could be an alternative to surgical treatment. Although the experience with aortic stent is limited, the results obtained so far seem to be encouraging. The case of a mid-age heavy smoker woman with a history of the abrupt onset of painfull cyanotic toes in the left foot and subsequent complete gangrene of the first digit in the same foot is herein reported. Angiography and CT scan revealed an high-grade calcified aortic infrarenal plaque. Because of the discrete characteristic of the lesion, an endovascular approach with a Palmaz stent was elected. The stenosis was successfully treated: the patient experienced the complete resolution of the toe painfull cyanosis within 3 months, the stent remained patent through a 24 months follow-up and no subsequent embolic episodes were observed.
Stenosis with 55.2% cross section area reduction was introduced into the rabbit aorta. Using Evans blue dye and scanning microscope, we observed the morphology of endothelial cells and the permeability of endothelium to albumin in the stenotic aorta. Numerical simulation of blood flow in the stenotic aorta was performed to obtain the distribution of wall shear rate. The results showed that in the immediately proximal and distal vicinity of stenosis, blood flow was disturbed significantly, resulting in apparent changes in the morphology of endothelial cells and the permeability of endothelium to albumin. These changes were not only attributed to the value of wall shear stress, but also attributed to the flow pattern in the stenosis. The result therefore is in good consistent with the clinical observation that atherosclerosis often occurs in the areas where blood flow is disturbed and flow separation occurs.
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Plasma cortisol and PRL were measured in two groups of patients undergoing reconstructive aortic surgery under either general anaesthesia and continuous epidural analgesia with supplemental general anaesthesia. The results confirmed that epidural analgesia with light general anaesthesia is much able than general anaesthesia to suppress the metabolic response associated with aortic surgery procedures.
AIM: The prevalence of carotid stenosis is reported to be high among patients with arteriosclerosis, but the hazards of carotid stenosis and the benefits of carotid endarterectomy (CEA) on long-term event-free survival are still unknown. The aim of this prospective study was to screen preoperative patients with arterial disease for carotid stenosis, and to determine whether CEA had any effect on stroke during the postoperative follow-up period. METHODS: From 1999 to 2003, 406 consecutive preoperative patients with arterial disease underwent routine carotid duplex scan. Patients with known carotid stenosis and those due to undergo operation in emergency were excluded from the study. CEA was performed before or simultaneously with vascular surgery if necessary. The prevalence and risk factors for carotid stenosis were studied, and the patients were followed up for stroke or death. RESULTS: Among the 406 patients examined, 19.4% had greater than 50% stenosis and 11.3% had greater than 70% stenosis. The risk factors for carotid stenosis were having occlusive arterial disease (P=0.0001), and history of stroke (P=0.0038). Long-term follow-up study revealed that patients with greater than 70% carotid stenosis without CEA had a higher tendency for stroke or death, but the stroke rate in patients with severe stenosis who underwent CEA remained low, as in patients with less than 70% stenosis. CONCLUSIONS: Patients with greater than 70% carotid stenosis, diagnosed before arterial operation who did not undergo CEA, had a higher risk for stroke during the postoperative follow-up period. However, their risk could be reduced by performing CEA before or simultaneously with scheduled vascular surgery.
The study is based on the analysis of the results of examination and operative treatment of 692 patients with atherosclerotic lesions of the aorta, its branches, and the limb arteries. The advantages of the extraperitoneal approach to the aorta over the transperitoneal approach in aorto-femoral reconstructions is proved. Stable postoperative intestinal paresis, peritonitis, intraabdominal bleeding, eventration, and adhesive disease do not occur with this approach. Such operations are not attended by a high incidence of coronary and cerebral vascular complications during and after the operation. The work gives the first appraisal of the results of postoperative plasmapheresis (21 patients) applied for normalization of hemorheological and lipoprotein disorders in different periods after the operation. The suggested complex approach to the treatment of atherosclerosis obliterans facilitates improvement of the immediate and late-term results of reconstructive operations on the vessels.
Late complications of radiation therapy will become more common as treatment of neoplasms in childhood becomes more successful. A patient with a successfully treated Wilm's tumour presented with hypertension 3 years after therapy. Angiography revealed extensive damage to the aorta and left common iliac artery, probably caused by the radiation therapy. The hypertension was the result of renal artery stenosis.
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Clostridial mycotic aneurysms are unusual. We therefore record a fatal case of a ruptured clostridial mycotic aneurysm of the suprarenal aorta which developed several weeks after the resection of a segment of gangrenous small bowel.
The advantages of computer tomography are obvious. They include the non-invasive character of examination, the detection of aneurysms with a small diameter and the opportunity to check them systematically. Computer tomography is in the authors' opinion most effective in the differential diagnosis and for the assessment of the character of aneurysms--stable or unstable, and in particular in the diagnosis of initial stages of ruptures.