Late results of iliofemoral venous thrombectomy

AbstractPurpose: Although anticoagulation therapy for iliofemoral venous thrombosis prevents pulmonary embolism, it is not designed to avoid the postthrombotic syndrome. Mechanical removal of the thrombus in the form of venous thrombectomy should yield better long-term results. The purpose of our study was to analyze the clinical outcome and venous valvular function of limbs 5 to 13 years after iliofemoral venous thrombectomy.Methods: Seventy-seven lower extremities underwent venous thrombectomy for acute iliofemoral venous thrombosis and were monitored for a mean follow-up of 8 ½ years (range, 5 to 13 years). Patency of the iliofemoral venous system, competence of the femoral popliteal valves, and clinical signs and symptoms of chronic venous insufficiency were evaluated in each case.Results: Subsequent to early perioperative failure, patency remained stable over time at 84%. Valvular competence was preserved in 80% at 5 years; however, it decreased to 56% at 10 years. It is important that more than 90% of the limbs had no symptoms or mild symptoms of chronic venous insufficiency.Conclusions: Venous thrombectomy should be considered for primary treatment in selected cases of early iliofemoral venous thrombosis. (J Vasc Surg 1997;25:417-22.

Are Laparoscopic Staplers Effective for Ligation of Large Intraabdominal Arteries?

AbstractObjectives. To evaluate ligation of aortoiliac arteries with laparoscopic staplers in order to develop specifically designed staplers.Methods. Cadaveric study. Seven human cadaver aortas were stapled using EndoGIA60® staplers. Efficiency was evaluated macroscopically and on a hydrodynamic bench.Clinical study. Twelve patients had ligation of 14 large abdominal arteries (aorta: nine, iliac artery: four, hepatic artery: one) using a laparoscopic stapler. Stapling efficiency was judged on peroperative clinical and postoperative CT scan criteria.Results. Cadaveric study. Stapling was performed perfectly on four moderately calcified aortas, without leakage with a pulsatile pressure of >250 mmHg. For three aortas with severe calcification, stapling was not efficient and major leakage occurred.Clinical study. Stapling appeared clinically efficient on all arteries but one aorta: this severely calcified aorta was ligated conventionally. The staplers are not easy to use due to their shape and their lack of articulation. After a mean follow-up of 31.3 months, all the other stapled arteries were effectively ligated.Conclusion. The commercially available staplers can be used securely on moderately calcified arteries but stapling of severely calcified arteries should be avoided. These devices should be redesigned to facilitate their use in vascular surgery

Obstructive urolithiasis in a 11/2 – year old Ouda–Yankasa ram: case report

Obstructive urolithiasis is the retention of urine subsequent to the lodgement of calculi in the urinary tract from the kidney up to the urethral orifice. This report describes the post-mortem and chemical analysis findings of the calculi in an 18-month old Ouda-Yankasa cross ram presented at the Large Animal Clinic of the Veterinary Teaching Hospital, Usmanu Danfodiyo University, Sokoto. The patient was presented on 20th of March, 2013 with reports of anorexia, disinclination to drink water and anuria that developed four days before presentation at the clinic. On clinical examination, urethral blockage and mild ascites were observed. Cystocentesis was performed to relieve the patient and plain radiograph taken but was not diagnostic. The patient died before definitive diagnosis was made for rational treatment. The post - mortem findings include frothy exudate in the trachea and bronchial airways, congestion of the lungs, hydroperitoneum with recovered fluid measuring 2,350 ml, splenomegaly, hydronephrosis, distended urinary bladder, severe haemorrhagic cystitis, urinary calculi in the bladder and throughout the urethral length and urethral stricture. The urinary calculi recovered were white, friable and amorphous, ranging from small particles to 5mm in diameter. Histopathologic section of the kidney showed atrophied glomeruli. It can thus be concluded that the atrophied glomeruli in turn impaired glomerular filtration which invariably pre-disposed the patient to uraemia leading to its death. The chemical analysis of the calculi showed that the calculi was either oxalate, phosphate or silicate, or any of these mixtures.Keywords: calculi, obstruction, phosphate, uraemi

Risk Factor Analysis of Bird Beak Occurrence after Thoracic Endovascular Aortic Repair

ObjectivesThe aim was to analyze the role played by anatomy and stent graft in the incidence of incomplete apposition to aortic arch.MethodsBetween 2007 and 2014 data including available and suitable computed tomographic angiography (CTA) imaging of patients who had undergone thoracic endovascular aortic repair were reviewed. The study included 80 patients (65 men, 54 ± 21 years) treated for traumatic aortic rupture (n = 27), thoracic aortic aneurysm (n = 15), type B aortic dissection (n = 24), penetrating aortic ulcer (n = 5), intramural hematoma (n = 2), aorto-oesophageal fistula (n = 2), and aortic mural thrombus (n = 5). Pre- and post-operative CTA images were analyzed to characterize bird beak in terms of length and angle, and to calculate aortic angulation within a 30 mm range at the proximal deployment zone.ResultsBird beak configuration was detected in 46 patients (57%): mean stent protrusion length was 16 mm (range: 8–29 mm) and mean bird beak angle was 20° (range: 7–40°). The bird beak effect was significantly more frequent after traumatic aortic rupture treatment (p = .05) and in landing zone 2 (p = .01). No influence of either stent graft type or generation, or degree of oversizing was observed (p = .29, p = .28, p = .81 respectively). However, the mean aortic angle of patients with bird beak was higher in the Pro-form group than that in the Zenith TX2 group (62° vs. 48°, p = .13). Multivariate analysis identified the aortic angle of the deployment zone as the unique independent risk factor of malapposition (HR = 1.05, 95% CI 1–1.10, p = .005). The cutoff value of 51° was found to be predictive of bird beak occurrence with a sensitivity of 58% and a specificity of 85%.ConclusionsAssessment of proximal landing zone morphology to avoid deployment zones generating an aortic angle of over 50° can be recommended to improve aortic curvature apposition with the current available devices