Combined Open and Endovascular Stent Grafting of Internal Carotid Artery Fibromuscular Dysplasia: Long Term Results

AbstractBackgroundSymptomatic fibromuscular dysplasia (FMD) of the internal carotid artery (ICA) can present as thrombo-embolic ischemic events, spontaneous or post-traumatic dissection, aneurysmal degeneration or intracranial haemorrhage and needs definitive surgical treatment.Patients and methodsSix patients and nine ICA with FMD were revascularised using a carotid approach with minimal exposure of the common, external and internal carotid arteries for covered stent repair. All patients were female, the age ranged from 30 to 65 years (mean 44).ResultsOne patient suffered from a perioperative transient neurological deficit. Duplex revealed a patent stent. The patient fully recovered after 5h, not showing any changes on repeat CT scans. One patient developed a recurrent laryngeal nerve palsy. The symptoms gradually resolved within 1 month. No perioperative strokes or deaths occurred. During a mean follow up of 48 months (range 13–63) no thromboembolic neurological events, graft occlusions or haemodynamically significant stenoses occurred.ConclusionICA FMD stent grafting is an alternative to open surgery or percutaneous endovascular intervention with excellent long-term results

Plasma d-Lactate as a Potential Early Marker for Colon Ischaemia After Open Aortic Reconstruction

AbstractBackground and aimThe breakdown of mucosal barrier function due to intestinal hypo-perfusion is the earliest dysfunction of ischaemic colitis. Severe colon ischaemia after aortic reconstruction is associated with mortality rates up to 90%. Therefore, early detection and treatment of patients with extensive ischaemic colitis is of crucial importance. In experimental studies, both d-lactate and bacterial endotoxin have been reported as markers of intestinal mucosal barrier impairment. However, evidence of their value in clinical practice is lacking. The aim of this pilot prospective cohort study was to assess the association between ischaemia of the colon (assessed histologically) and plasma levels of d-lactate and endotoxin in patients undergoing open aortic reconstruction.Patients and methodsTwelve consecutive patients underwent surgery between February and April 2003. Six patients underwent emergency surgery and six patients elective aortic surgery. d-Lactate and endotoxin levels were measured in blood samples collected according to a standardised protocol. For histological examination biopsies were obtained by sigmoidoscopy on days 4–6 after surgery, or earlier if indicated clinically.ResultsAs early as 2h postoperatively, elevated plasma levels of d-lactate were measured in patients with histologically proven ischaemic colitis. The peak of d-lactate elevation was on postoperative days 1 and 2. Concentration of plasma endotoxin was not significantly different in patients with or without ischaemic colitis.ConclusionOur data suggest that plasma d-lactate levels are a useful marker for early detection of ischaemic colitis secondary to aortic surgery