Case Report Absence of Clinical and Hemodynamic Consequences due to Posterior Tibial Artery Congenital Aplasia

The exact knowledge of popliteal artery and its branches' anatomic variations is important for the clinical practice of angiology, vascular surgery, and interventional procedures. Congenital absence of the artery leads, in some cases, to early malformations of the extremity in the childhood; however, it may also remain asymptomatic. We present an unusual case of a 76-year-old male patient complaining of paraesthesia in both limbs and bilateral aplasia of posterior tibial artery (PTA). Physical examination, ankle-brachial indexes, before and after exercise, arterial duplex scan, and magnetic resonance arteriography were performed. Arterial pulses for PTA at the level of the ankle were normal; arterial duplex study showed biphasic arterial flow at the level of the ankle. Color duplex ultrasound as well as magnetic resonance arteriography revealed the absence of the PTA in both limbs. The vascularization of the fibula was bilaterally normal. The patient underwent also neurological examination and electromyography, which were normal. The evaluation of the possible clinical signs and symptoms and the hemodynamic consequences of this condition are further discussed

An asymptomatic double aortic arch with separate right vertebral artery and left subclavian artery originating from Kommerell Diverticulum combined with congenital asplenia and absence of celiac trunk

This report describes the unique case of a completely patent Double Aortic Arch (DAA) combined with Kommerell Diverticulum (KD), absence of celiac trunk and congenital asplenia. The anatomical variants described were identified and assessed in a 51-year old female from a computed-tomography angiography (CTA) images with 3D-volume rendered reconstructions during her follow-up after hysterectomy. The reconstructed CTA images showed a DAA with the left common carotid artery stemming from the hypoplastic left aortic arch while  the left subclavian artery originated from a KD in the descending thoracic aorta. A symmetric arrangement of the aortic arch branches was demonstrated, comprising a full vascular ring. Since the patient had been completely asymptomatic and with no symptoms of compression of the esophagus or trachea, no surgical management was advised. The abdomen CTA imaging revealed absence of the celiac trunk with direct origin of the common hepatic and the left gastric artery from the superior mesenteric artery as well as asplenia. We presented a case of asymptomatic DAA of completely patent arches with  the right vertebral artery branching separately of and the left SCA originating from KD in the descending aorta. The term KD can be identified also in other arch anomalies than the one originally described. Since anatomical anomalies can be frequently combined, thorough imaging inspection with CTA of both thorax and abdomen is suggested

Combined Less-invasive Surgical and Endovascular Technique to Minimise Operative Trauma and Treat Excessive Aortoiliac Thrombotic Obliteration with Popliteo-crural Involvement and Acute Limb Ischaemia

This article demonstrates a less-invasive combined surgical and endovascular alternative approach in a case in which an excessive thrombotic formation in the infrarenal aorta caused occlusion of the iliac artery and the ipsilateral crural arteries. A 51-year-old man was admitted to the authors’ hospital with symptomatology of acute lower limb ischaemia. He had undergone endovascular treatment with placement of kissing stents in the common iliac arteries 2 years previously. A CT angiography scan revealed an extensive thrombus formation in the entire infrarenal aorta occluding the distal infrarenal aorta, the iliac artery and the crural arteries. He underwent a hybrid approach, with exposure of only the right common femoral artery and over-the-wire embolectomy of the infrarenal aorta and the iliac artery, and after the restoration of the inflow, an embolectomy of the peripheral vessels was carried out. To cover the residual aortic thrombus and to restore the severe in-stent restenosis of the previously deployed bare stents, three covered balloon-expandable stents were deployed in kissing technique. The patient was discharged on the fourth postoperative day with palpable peripheral pulses. Combined surgical and endovascular techniques minimise the operative trauma and length of hospital stay for the patient, successfully restoring the perfusion in a physiological manner

Urine (NGAL) as a biomarker of kidney damage after on-and off-pump coronary artery bypass graft surgery: a prospective pilot study

Introduction: Acute kidney injury (AKI) is a relatively frequent complication after coronary artery bypass graft surgery (CABG). We compared the off-and-on-pump CABG procedures with respect to changes in renal function as reflected by the urine NGAL (UrNGAL) levels.Methods: In a prospective design, we studied patients who underwent CABG, off-and-on-pump, with respect to alterations of glomerular filtration rate (GFR) and UrNGAL pre- and postoperatively. We recorded patients’ demographics, past medical history, cardiac function and labs. Patients were grouped by the CABG type. UrNGAL was measured using a chemiluminescent microparticle immunoassay.Results: Of 72 patients, 31 underwent off-pump and 41 on-pump CABG. The mean age was 65.7(±8.1) years and 81.9% were males. Groups were similar with respect to the prevalence of hypertension, diabetes, dyslipidaemia, BMI, and smoking at entry. No one experienced Acute Renal Failure (ARF) and there were no deaths. At both time points, the UrNGAL levels were similar in the two groups. Patients in the on-pump group showed a significant improvement in renal function 48 hours postoperatively compared to baseline (p<0.001). UrNGAL levels decreased significantly 3 hours after surgery in the on-pump group (p=0.001), while tended to decrease in the off-pump group (p=0.057). The overall change of UrNGAL was not significantly different between groups.Conclusions: UrNGAL measurements showed no superiority of either of the two CABG techniques concerning their influence on postoperative renal function. Renal function significantly improved in the on-pump group while UrNGAL levels decreased after surgery in the same group.ΣΚΟΠΟΣ: Η Οξεία νεφρική βλάβη είναι μία σχετικά συχνή επιπλοκή μετά από αορτοστεφανιαία παράκαμψη (CABG). Συγκρίναμε την τεχνική της αορτοστεφανιαίας παράκαμψης με την χρήση εξωσωματικής κυκλοφορίας (on-pump CABG) με αυτή χωρίς την χρήση εξωσωματικής κυκλοφορίας (off-pump CABG) με σκοπό να μελετήσουμε τις μεταβολές της νεφρικής λειτουργίας όπως αντανακλώνται από τις μετρήσεις του βιοδείκτη της Λιποκαλίνης (NGAL) στα ούρα. ΜΕΘΟΔΟΣ: Στην προοπτική μας μελέτη, μελετήσαμε την νεφρική λειτουργία και τυχόν μεταβολές της σε ασθενείς που υποβλήθηκαν σε αορτοστεφανιαία παράκαμψη με ή χωρίς εξωσωματική κυκλοφορία (off-on pump), όπως αυτή προκύπτει από τις μεταβολές της νεφρικής κάθαρσης (GFR) και των τιμών της Λιποκαλίνης των ούρων προεγχειρητικά και μετεγχειρητικά. Καταγράψαμε τα δημογραφικά στοιχεία, το ιατρικό ιστορικό, το εργαστηριακό προφίλ και την καρδιακή λειτουργία για κάθε ασθενή ξεχωριστά. Οι ασθενείς ομαδοποιήθηκαν με βάση τον τύπο αορτοστεφανιαίας παράκαμψης στην οποία υποβλήθηκαν. Ο βιοδείκτης της Λιποκαλίνης (UrNGAL) στα ούρα μετρήθηκε χρησιμοποιώντας την μέθοδο της Άμεσης Χημειοφωταύγειας, που καθιστά δυνατή την τυχαία και συνεχή προσπέλαση καθώς και την επεξεργασία κατά προτεραιότητα. ΑΠΟΤΕΛΕΣΜΑΤΑ: Στην μελέτη μας συμπεριλήφθηκαν 72 ασθενείς, εκ των οποίων 31 υποβλήθηκαν σε αορτοστεφανιαία παράκαμψη χωρίς την χρήση εξωσωματικής (off-pump) και 41 με την χρήση εξωσωματικής (on-pump). Ο μέσος όρος ηλικίας ήταν 65.7 (±8.1), ενώ 81.9% ήταν άνδρες. Οι δύο ομάδες ασθενών ήταν όμοιες ως προς τη συχνότητα εμφάνισης υπέρτασης, σακχαρώδη διαβήτη, δυσλιπιδαιμίας, ως προς το δείκτη μάζας σώματος και τις συνήθειες καπνίσματος κατά την εισαγωγή. Κανείς δεν παρουσίασε οξεία νεφρική βλάβη και δεν καταγράφηκαν θάνατοι. Στις δύο χρονικές στιγμές τα επίπεδα της Λιποκαλίνης ήταν όμοια και στις δύο ομάδες ασθενών. Στους ασθενείς που υποβλήθηκαν σε αορτοστεφανιαία παράκαμψη με την χρήση εξωσωματικής κυκλοφορίας αναδείχθηκε μία σημαντική βελτίωση της νεφρικής λειτουργίας 48 ώρες μετά το πέρας της επέμβασης (p<0.001). Η τιμή της Λιποκαλίνης (NGAL) μειώνεται σημαντικά 3 ώρες μετεγχειρητικά στους ασθενείς με εξωσωματική κυκλοφορία (p=0.001) ενώ τείνει να μειωθεί σημαντικά σε εκείνους χωρίς την χρήση εξωσωματικής (p=0.057). Η ολική μεταβολή του βιοδείκτη δεν παρουσίασε σημαντική διαφορά στις δύο ομάδες ασθενών. ΣΥΜΠΕΡΑΣΜΑ: Με βάση τις μετρήσεις του βιοδείκτη της Λιποκαλίνης των ούρων, καμία από τις δύο καρδιοχειρουργικές τεχνικές δεν αναδείχθηκε καλύτερη όσον αφορά την επίδραση στη μετεγχειρητική νεφρική λειτουργία. Η νεφρική λειτουργία βελτιώνεται σημαντικά στους ασθενείς με την χρήση εξωσωματικής κυκλοφορίας ενώ η τιμή της Λιποκαλίνης (NGAL) στα ούρα μειώνεται στην ίδια ομάδα μετεγχειρητικά

Contemporary Strategies in the Management of Civilian Neck Zone II Vascular Trauma

Neck trauma is the leading cause of death mainly in younger persons posing to surgeons the dilemma whether to proceed with reconstruction of vascular injuries either in the presence of coma or in severe neurological deficit. Vascular injuries in zone II predominate over the other injuries located in zones I/III of the neck. Conventional open repair of carotid injuries with primary closure or interposition grafting is always recommended due to the effective long-term results for penetrating injuries or for patients unfit for endovascular intervention. In cases of blunt trauma, anticoagulation or antiplatelet therapy should be administered first in neurologically stable patients. In case of worsening of the neurological status of the patient despite adequate anticoagulation endovascular means should be considered in cases of appropriate anatomy of the arterial trauma. We provide an update on penetrating/blunt trauma in zone II of the neck, giving emphasis on the anticoagulant and endovascular treatment

Ureteral endometriosis: A systematic literature review

Introduction: Ureteral endometriosis is a rare disease affecting women of childbearing age which presents with nonspecific symptoms and it may result in severe morbidity. The aim of this study was to review evidence about incidence, pathogenesis, clinical presentation, diagnosis, and management of ureteral endometriosis. Materials and Methods: PubMed Central database was searched to identify studies reporting cases of ureteral endometriosis. “Ureter” or “Ureteral” and “Endometriosis” were used as key words. Database was searched for articles published since 1996, in English without restrictions regarding the study design. Results: From 420 studies obtained through database search, 104 articles were finally included in this review, including a total of 1384 patients with ureteral endometriosis. Data regarding age, location, pathological findings, and interventions were extracted. Mean patients' age was 38.6 years, whereas the therapeutic arsenal included hormonal, endoscopic, and/or surgical treatment. Conclusions: Ureteral endometriosis represents a diagnostic and therapeutic challenge for the clinicians and high clinical suspicion is needed to identify it

Sentinel lymph node biopsy in uterine cervical cancer patients: ready for clinical use? A review of the literature.

Sentinel lymph node biopsy has been widely studied in a number of cancer types. As far as cervical cancer is concerned, this technique has already been used, revealing both positive results and several issues to be solved. The debate on the role of sentinel lymph node biopsy in cervical cancer is still open although most of the studies have already revealed its superiority over complete lymphadenectomy and the best handling possible of the emerging practical problems. Further research should be made in order to standardize this method and include it in the clinical routine