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Superficialization of arteriovenous fistulae allows for improved dialysis access allowing for prolonged utilization and more efficient dialysis treatment. Multiple methods are described for superficializing arteriovenous fistulae, and minimizing the surgical intervention is advantageous for patient recovery and potentially improved outcomes. We describe a novel technique of superficialization of an upper extremity arteriovenous fistula employing ultrasound-guided liposuction. This article describes the suction lipectomy technique and the tools necessary for superficialization of an upper extremity arteriovenous fistula.

Functional popliteal entrapment syndrome (FPES) was first described by Rignault and colleagues in 1985 (Int. Angiol. 1985;4:341-343). This syndrome results from compression of the popliteal artery by a hypertrophied medial head of the gastrocnemius muscle with no other identifiable anatomical abnormality. The incidence, significance, natural history, and appropriate treatment of this syndrome remain controversial. We present three cases of FPES where intraoperative positional duplex scans guided gastrocnemius muscle resection and confirmed appropriate resection. Additionally, B-mode duplex obtained during one of the cases demonstrated intimal changes consistent with repetitive vessel trauma. All patients had resolution of their claudication and normal physiological testing postoperatively.

Le syndrome de piege poplite fonctionnel (SPPF) a ete decrit la premiere fois par Rignault et al. en 1985 (Int Angiol 19854:341–343). Ce syndrome resulte de la compression de l’artere poplitee par une insersion mediale hypertrophiee du muscle gastrocnemien sans autre anomalie anatomique identifiable. L’incidence, la signification, l’histoire naturelle, et le traitement approprie de ce syndrome demeurent controverses. Nous presentons trois cas de SPPF ou l’echodoppler peroperatoire a guide la resection du muscle gastrocnemien et a confirme la resection appropriee. En plus, l’echodoppler obtenu pendant l’un des cas a demontre des modifications intimales compatibles avec un traumatisme repete du vaisseau. Tous les patients avaient une resolution de leur claudication et un test physiologique normal en postoperatoire.

Recent combat casualties have stimulated a reassessment of the principles of management of high-risk extremity injuries with a normal vascular examination. Rapid evacuations have presented numerous U.S. soldiers to our service for evaluation in the early postinjury period. The objective of this single-institution report is to analyze the application of liberal arteriography in the delayed evaluation of modern wartime extremity injuries. Data from consecutive wartime evacuees evaluated for extremity injuries between March 2002 and November 2004 were prospectively entered into a database and retrospectively reviewed. Analysis was focused on arteriography and its role in our current diagnostic and therapeutic approach. Information including injury sites and mechanisms, associated trauma, battlefield repairs performed, arteriography technique, complications, findings, and need for further intervention were reviewed. Indications for imaging in this high-risk group included proximity to vascular structures, abnormal or equivocal physical examination, adjunctive operative planning, and evaluation of battlefield repair. Ninety-nine of 179 patients (55%) with extremity injuries underwent arteriography, with 142 total limbs studied. The majority of them were wounded by explosive devices (82%) or high-velocity rifle munitions (14%). Abnormalities were found in 75 of 142 (52.8%) imaged limbs in 46 of the 99 (46.5%) patients. Twenty-four of these patients (52.2%) required additional operative intervention. Occult vascular injury findings were associated with bony fracture in 68% and nerve injury in 16%. Median delay between injury and stateside evaluation was 6 days. Two thirds of these soldiers presented with a normal physical examination result. There were no access site complications or incidents of contrast-induced acute renal failure. The liberal application of arteriography is a low-risk method to provide high-yield data in the delayed vascular evaluation of extremities injured from modern military munitions. Physical examination findings remain the most useful indicator, but a normal examination can be misleading and should not guide the decision for invasive imaging. Lesions are found and require further intervention at a higher rate than expected from the typical civilian trauma experience.

Traumatic hemorrhage and vascular injury management have been concerns for both civilian and military physicians. During the 20th century, advances in technique allowed surgeons to focus on vascular repair, restoration of perfusion, limb salvage, and life preservation. Military surgeons such as Makins, DeBakey, Hughes, Rich, and others made significant contributions to the field of surgery in general and vascular surgery in particular. Casualties from combat in Afghanistan and Iraq confront physicians and surgeons with devastating injuries. The current generation of providers is challenged with applying contemporary care while expanding upon the lessons taught by our predecessors. The objective of this report is to review the historical experience with managing military upper extremity arterial injuries and compare that experience with current management.

The battlefield has provided a multitude of advancements in the management of hemorrhage and vascular repair. Basic understanding of the anatomy and exposures of lower extremity injuries is essential to any surgeon caring for these patients. The techniques of repair and potential adjunctive measures (eg, shunts) available should always be considered when approaching a vascular injury. The most important concept from a vascular standpoint is the fact that a multidisciplinary approach to these complex patients is required with maximal tissue preservation when feasible and safe.

The human oxytocin receptor regulates parturition and myometrial contractility, breast milk let-down, and reproductive behaviors in the mammalian central nervous system. Kimura et al. recently identified a human oxytocin receptor cDNA by means of expression cloning from a human myometrial cDNA library. To elucidate further the molecular mechanisms that regulate oxytocin receptor gene expression and to define the expected Mendelian inheritance of possible human disease states, we must determine the number of genes, their localization, and their organization and structure. We summarize below our data indicating that the human oxytocin receptor gene is localized to 3p25 and exists as a single copy in the haploid genome. 9 refs., 2 figs.