A rare anomaly of the femoral vessels: complete transposition of the femoral artery and vein

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Open Conversion after EVAR: Indications and Technical Details

Endovascular aortic aneurysm repair (EVAR) is widely used for the treatment of abdominal aortic aneurysms. Complications secondary to EVAR are also treated with endovascular techniques. When this is not applicable, open surgical repair is mandatory. Surgical re-intervention following EVAR is considered to be more demanding compared with primary open repair and it is related to the type of endograft implanted (infra renal vs. suprarenal fixation), to the indications for surgical conversion (infection vs. non infection), to the setting of presentation (elective vs. emergency) and type of conversion (total vs. partial). While technically challenging, delayed open conversion of EVAR can be accomplished with low morbidity and mortality in both the elective and emergent settings. These results reinforce the justification for long-term surveillance of endografts following EVAR

The role of cross-over bypass graft in the treatment of acute ischaemia of the lower limb

Introduction. The Authors reports their experience with the use of femoro-femoral cross-over bypass graft in the management of acute lower limb ischaemia. Patients and methods. Fourteen femoro-femoral bypass graft were performed for acute lower limb ischaemia due to unilateral thrombosis of iliac and femoral artery in 8 cases, late unilateral occlusion of a branch of previous aortobifemoral bypass in 3 cases, acute thrombosis of abdominal aorta in 2 cases and in the last one for an injury of common iliac artery during urological procedure. In all the cases the operations were carried out under local anaesthesia and a subcutaneous bypass with “C” shape type configuration with 8 mm Dacron prosthesis were performed. The first and second year primary and secondary patency rates and limb salvage rates were evaluated. Results. One and two year patency rate was 83.3 (10/12) and 70% (7/10) respectively. Secondary patency rate and limb salvage rate was 91.6% (11/12) and 80% (8/10) respectively. A tight amputation had to performed in 3 failed reconstruction (3/12, 25%). Two patient died within 30 days after surgery from acute myocardial infarct. In 1 case infection occurred and re-do femorofemoral cross-over bypass with saphenous vein was carried out (8.3%). Conclusions. Cross-over bypass is an attractive technique, especially in case of acute ischemia because of its simplicity, low morbidity and mortality, and good long term results

Persistenza dell’arteria ipoglossa ed endoarteriectomia carotidea. Case report

La persistenza dell’arteria ipoglossa è una malformazione di raro riscontro e può condizionare un alto rischio di ischemia da clampaggio del sistema vertebrobasilare durante endoarterectomia carotidea. Gli Autori riportano la loro esperienza nel trattamento chirurgico di una stenosi carotidea con il riscontro intraoperatorio di tale anomalia vascolare. Il paziente è stato sottoposto a tromboendoarterectomia carotidea in anestesia generale, a coscienza conservata e senza impiego dello shunt in relazione all’ottimo compenso clinico. Il decorso postoperatorio è stato normale. Gli Autori riportano le evidenze desunte dai dati in letteratur

Prejudices and realities in the use of ‘unsuitable’ saphenous vein graft for infrapopliteal revascularization

Background. Aim of this paper is to evaluate the safety and the patency rate of the infrapopliteal bypass grafts performed with the great saphenous vein (GSV) with small (5 mm). Patients and methods. Between January 2003 and May 2007, 73 infragenicular bypass with autologus saphenous vein were performed in patients affected by atherosclerotic femoropopliteal disease. In 8 cases a bypass grafts with small saphenous vein (diameter 2.2-2.5 mm) were performed, in 4 cases a bypass with segmental varicose saphenous vein (diameter 5.7-6.4 mm ) were carried out. In 64 cases the bypass was carried out with the reversed technique, in 9 cases with the in situ technique. Results. Thirty day mortality was 3/82 (3.6%) and 30 day cumulative patency rate was 95.1% (78/82) with limb salvage of 96.3% (79/82). All the patients with small diameter vein showed a normal patency at the follow-up and at the duplex scan examination no complications occurred. The mean calibre of the arterialized vein increased to 2.6-3,4 mm at 1 week with maintenance during the follow-up. Patients with varicose vein implanted present a mean dilatation of 6.4-7. 2 mm at 1 week and no dilatative complication were detected at the follow-up. Conclusion. The risk of stenosis, graft thrombosis or aneurismal degeneration doesn’t seem to be higher respect normal GSV either for small or for large veins. Large series and longer follow up are mandatory for an extensive clinical application

An unexpected anatomical variant of the femoral artery in a patient with acute lower limb ischemia: case report

We report a case of acute embolic ischemia of the right lower limb in a patient with unexpected intraoperative anatomic variant of femoral artery. In this anomaly, the deep femoral artery arises from the external iliac artery, 2 cm above the inguinal ligament, runs with a parallel course with the superficial femoral artery, and placed between the branches of femoral nerve. In consideration of the difficulty to achieved an extensive and optimal control of the external iliac artery with the femoral approach, a retrograde embolectomy of the iliac artery by two separate arteriotomies on the deep and superficial femoral arteries were successful performed. The literature reviewed about this anomalies. In these unexpected intraoperativecases a ductile and ingenious approach seems to be mandatory to perform a safe operation with low systemic impact

Prosthetic carotid bypass graft for in-stent restenosis performed for post-endarterectomy recurrent stenosis: technical details

Aim. Carotid artery stenting (CAS) is the treatment of choice for recurrent stenosis after carotid endarterectomy (CEA). However a significative incidence of in-stent restenosis could be occurred. Despite classical CEA leads to good results, in selective cases bypass graft may be the best treatment of in-stent restenosis. Case reports. We describe two cases of carotid bypass graft performed to treat a recurrent in-stent stenosis after CAS for post-CEA restenosis. No death and cardiac complication occurred and no cranial nerves impairment was detected. Conclusion. Prosthetic bypass graft is safe and effective in treatment of in-stent recurrent restenosis after CEA restenosis

Type 2 Endoleak Incidence and Fate After Endovascular Aneurysms Repair in a Multicentric Series: Different Results with Different Devices?

Background: The aim of this work is describing incidence and fate of type 2 endoleaks (T2ELs) in a multicentric cohort of patients treated by endovascular aneurysms repair using the Ovation device (Endologix) and comparing them with a group treated using the Excluder (W. L. Gore & Associates).Methods: This is a retrospective study conducted on 261 patients treated using the Ovation device and 203 using the Excluder. Outcomes were intraprocedural, 30-day, 12-month, and mean time follow-up T2EL incidence and related reinterventions. Patent inferior mesenteric artery (IMA), >= 3 lumbar arteries (LAs), intrasac thrombus volume, the mean diameter of common and external iliac arteries, external iliac artery stenosis (>70%), diameter <= 5 mm, iliac tortuosity ratio <= 0.5, thrombosis, and calcification were noted and considered as potentially influencing outcomes.Results: Patients of the Ovation group presented significantly more thrombosed, calcified, and tortuous iliac vessels than those in the Excluder group. No significant differences were noted in sac thrombosis, IMA, and LA patency. At completion angiography, T2EL was evident in 57 Ovation and 46 Excluder patients (P = 0.832). At 1 month, it was evident in 33 Ovation group and 28 Excluder group patients (P = 0.726). At 12-month and mean time (30.14 months) follow-up, no differences were evident between the 2 groups (P = 0.940 and 0.951, respectively). The log-rank test showed that the rate of T2EL-related reintervention was not different between the 2 groups (P= 0.46). Regarding anatomical characteristics, a statistically significant difference was not observed between patients presenting or not with T2EL (P > 0.05).Conclusions: Data showed no significant differences in terms of T2EL incidence between the 2 study groups. None of preoperative anatomical features were found to be significantly associated with the appearance of T2EL