[Surgical options in the treatment of chronic venous ulcers]

Surgery offers several options in prevention of chronic venous insufficiency and its sequelae. Both the operation on veins with valve dysfunction to reduce reflux and the elimination of obstruction in thrombosed veins aim for the reduction of venous hypertension. Elevated venous pressure, impairment of cutaneous capillaries and a chronic inflammatory process result in sclerosis of skin and subcutaneous tissue and might proceed to the fascia resulting in a chronic compartment syndrome. Non- healing chronic venous ulcers under conservative therapy for more than three months may be treated by vein-surgery, local wound care therapy like shaving and negative pressure treatment and if necessary by lowering of elevated intracompartimental pressure by fasciotomy or even fasciectomy

Posterior Approach for Revascularization in Blunt Popliteal Vessel Injury.

BACKGROUND Popliteal vessel injuries are associated with traumatic knee injury often requiring emergency revascularization. Medial and posterior approaches to the popliteal space have been proposed. This study evaluates the outcome of patients treated for traumatic popliteal vessel injuries via a posterior approach. METHODS Consecutive patients with traumatic vascular injuries in the popliteal segments II and III undergoing surgical repair via a posterior approach between October 2008 and December 2016 were analyzed. The level of the arterial injury was preoperatively confirmed by computed tomography angiography or duplex ultrasound. Surgery was performed in prone position. Perioperative and long-term outcomes were analyzed including a survey of all patients in January 2017 assessing survival, limb salvage, and claudication. RESULTS Ten patients (8 female; median age 66 years, range 22-88) with blunt knee trauma were identified, 8 of them after spontaneous knee dislocation. Five patients had local intimal disruption and 5 had complete transection of the popliteal artery. In 6 patients, an interposition graft (vein n = 5; xenograft n = 1) was used for revascularization. Two patients underwent direct reanastomosis and in 2 patients longitudinal arteriotomy with patch plasty was performed. All arterial reconstructions were patent at discharge. Two patients had additional transection of the popliteal vein; in one, reconstruction was performed by direct reanastomosis and in another by interposition of a vein graft. The latter had asymptomatic early postoperative occlusion of the vein graft. After a median follow-up of 56 months (range 45-99), no death, limb loss, or claudication was observed. CONCLUSIONS After traumatic knee injury, posterior approach to the popliteal vessels is feasible and effective. It allows revascularization by direct repair or a short segment interposition graft avoiding long distance bypass. A high limb salvage rate can be achieved with excellent long-term outcomes

Thoracic endovascular aortic repair as emergency therapy despite suspected aortic infection

To evaluate thoracic endovascular aortic repair (TEVAR) as emergency therapy despite suspected aortic infection

Self-made pericardial tube graft: a new surgical concept for treatment of graft infections after thoracic and abdominal aortic procedures

The aim of this study was to evaluate a new surgical concept for the treatment of graft infections after operation or endovascular treatment of thoracic, thoracoabdominal, and abdominal aortic diseases