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

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