Search

The authors outline their experience with reference to the treatment of segmentary lesions at the level of the iliac artery. They analyse a series of 93 patients undergoing PTA. In 85 cases it was possible to conclude the procedure: 4 patients presented a small occlusion and 81 stenosis which was associated with femoro-popliteal occlusion in 35 cases. The authors analyse the results using life tables and show that treatment is optimal for the common iliac artery whereas the percentage of restenosis increases parallel to progress in a distal direction. In conclusion, the authors affirm that the procedure is safe and in order to improve results, above all at the level of the external iliac artery, il will probably be necessary in the future to use additional endovascular techniques such asm for example, the systematic use of stent.

The incidence of prosthesis infection in the groin ranges between 1 and 3%, with high morbidity and mortality rates. Contamination, irrespective of whether it is endogenous or exogenous, may occur during surgery of afterwards due to a secondary bacterial load which is often associated with a traumatic surgical technique for tissues, often in emergency surgery or re-operations. MATERIALS AND METHODS. Over the past 5 years a total of 410 prosthetic alloplastic grafts have been made by our Division of Vascular Surgery with at least one anastomosis at an inguinal level. The materials used for prosthesis were dacron and PTFE. Thirty-one infections were observed in the groin of which 11 involved the prosthesis and 20 were apparently restricted to the superficial and deep layer of the dermis. A cell culture test and antibiogram was always performed. Surgical or medical therapy (loco-regional + general) was used according to individual cases. RESULTS. With regard to the 11 patients with manifest infections of the prosthesis, only trans-obturator bypass surgery gave positive long-term results, whereas other operations (femoro-femoral bypass, axillo-popliteal bypass) were not satisfactory. Of the other 20 patients treated using loco-regional and general medical therapy, 9 developed pseudo aneurysm over time for which it was then necessary to resort to surgery. DISCUSSION AND CONCLUSION. Currently there is no universally accepted treatment protocol for the management of prosthesis infection. However, it is generally considered useful to isolate any pathological agent (using routine biopsies of arterial wall or thrombo-endoluminal fragments during the primary operation) before infection can develop so as to be able to commence specific antibiotic therapy. In this context the authors underline the more devastating action of some bacteria (pseudomonas, Staphylococcus aureus) in comparison to others (Staphylococcus epidermidis). Turning to therapeutic measures, when there are anatomical grounds and with the greatest possible respect for periarterial tissues, it is considered that trans-obturator bypass is preferable in the presence of manifest infection of the prosthesis, whereas medical therapy can be used (loco-regional + general) if infection is limited to the surface layers of the inguinal area. Possible complications over time may be corrected using surgery and in situ reconstruction if infection is no longer present.

Having outlined their 20-year experience in the treatment of popliteal aneurysms (PA), the authors discuss the type of therapeutic approach used. From the authors' point of view an overly aggressive approach to PA is unnecessary, and the decision to adopt a given therapy must instead be weighed up on the basis of the careful clinical evaluation of each individual case, taking into account the patient's clinical conditions at the time, the pathological anatomy of the lesion and its consequences. The authors divide primary PA into symptomatic and asymptomatic cases; in the latter surgery is definitely indicated and the possible contraindications represented by anesthesiological risk or small aneurysm diameter need not be evaluated. In the case of symptomatic PA, treatment varies depending on whether they are manifested by rupture, acute ischemia or chronic ischemia. While there are no grounds for uncertainty regarding the need for immediate surgery in the first case, in the second and third cases the authors attribute decisive importance to the evaluation and possible improvement of run-off before surgical correction. In the event of acute arterial insufficiency of the limb, the careful assessment of clinical conditions (degree of loss of sensitivity, motility and cutaneous vascularization) and anamnestic data (possible presence of signs and symptoms of previous chronic arterial insufficiency) allow the surgeon to decide whether or not to resort to immediate surgery or to obtain an improved run-off by using loco-regional fibrinolytic therapy and therefore postpone surgical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

The Authors reported experiences from 26 traumas of popliteal artery; 2 are related to continuous microtrauma from exotosis; 2 vasospasms implied vascular intervention. Tibial artery bypasses with vein grafts have been advocated to obviate any exploration of popliteal hematoma. A multidisciplinary approach consisting of orthopedist, plastic and vascular surgeons should be employed.

There is no consensus of opinion regarding the type of suture to be used followed carotid TEA. The paper reports a study carried out in 123 operated patients who were followed for a variable period ranging from 6 months to 4 years with six-monthly controls using B-mode echotomography, supplemented by digital angiography via a venous route if necessary. A direct suture was used in 92 of the patients, while a venous patch was applied in the remaining 31. Subsequent controls revealed a relative frequency of restenosis of a fundamentally benign nature at a point which was proximal or distal to TEA. In addition, the study showed that continuous suture may be valid in male patients but doubts continue to exist regarding its use in female patients. In the latter, it is therefore preferable to encourage a more widespread use of the venous patch.

Personal experience in the management of 70 ruptured abdominal aortic aneurysm over the past 5 years is reported dividing patients into 2 groups, before and after establishment of intensive care unit: survival was 30.76% on the first, 66.66% in the second. Factors that allowed that result are discussed.

The treatment of atheromatous carotid lesions combined with occlusion of the contralateral carotid artery remains a problem and one that is much debated. With this in mind the present paper reports personal experience of 25 cases, 16 treated surgically and 9 medically. The criteria for the selection of either type of treatment on the basis of the clinical situations, angiographic findings and Doppler ultrasound studies of the carotid plaque, are analysed. The surgical technique and the methods used in monitoring and protecting the brain during the operation are reported as are the short and long-term results. Finally, it is claimed that an "aggressive" approach is appropriate in such cases, thought there are situations in which careful monitoring of the lesion may be the first logical reaction to the treatment of these patients.

Personal experience in the treatment of 70 ruptures of the subrenal abdominal aorta over the past 15 years is reported. The various factors determining prognosis are analysed with particular reference to the time between onset of symptoms and admission to hospital, clinical condition (state of shock, kidney function) and rupture location (anterior or posterior). Preoperative investigations and types of surgical treatment are described together with results. Despite the high mortality rate it is concluded that time and rupture location are the decisive factors in the prognosis for these patients, since all other factors are more easy to monitor and modify using modern techniques of intensive postoperative care.

Four personal cases and the treatment adopted are described. The incidence of this event is discussed. Attention is drawn to what is felt to be the most suitable treatment of traumatic ischaemia with a possibility of underlying spasm at in the light of the existing knowledge.