[Abdominal angina due to fibromuscular dysplasia of the celiac axis. Surgical management].

The clinical case of a 27-year old man with the diagnosis of chronic mesenteric ischemia ("abdominal angina") is reported, whose chief complaints were severe postprandial pain and remarkable weight loss, for the last 4 months. Following na inconclusive observation in gastroenterology, he underwent an angiographic-CT examination, that disclosed a critical stenosis at the origin of the celiac axis. The remaining digestive vessels, superior and inferior mesenteric arteries, were found free of lesions.

[Chronic mesenteric ischemia revisited].

The authors report two clinical cases of rare and complex situations - an aortic dissection and an aortitis -, which had as a common denominator a chronic mesenteric ischemia. They discuss the indications and surgical strategies adopted.

["Ex-vivo" surgical repair of renal artery branches aneurysms].

The authors report the clinical case of complex aneurysms of intra-hilar branches of the renal artery, managed recently through a renal auto-transplantation procedures with "ex-vivo" repair, discussing the technique, the principles and the indications for this kind of procedure.

[Reconstructive surgery of deep veins of the lower extremities: the Palma operation revisited].

It has been grossly estimated that one fifth of the patients with post thrombotic chronic venous diseases suffer from obstructive or hypertensive symptoms, due to a failure of the physiologic repermeabilization mechanisms. In clinical practice, only a small group of these patients, with disabling symptoms, fill the essential requirements for a deep vein reconstructive surgery. The authors report the clinical case of a 27 years old male, with a chronic segmentar thrombotic occlusion of the right external iliac and common femoral veins, causing disabling symptoms to his normal professional activity.

[Surgical management of abdominal aortic aneurysms in kidney transplanted patients].

From April 1995 to April 2006, four patients, three male and one female, age range 56 to 68 years (average 62), with a renal transplant, underwent the surgical management of an abdominal aortic aneurysm. As a consequence of the high vulnerability of the transplanted kidney to the ischemia and the occurrence of frequent calcifications of the arterial wall in these patients, the aortic clamping time required for the aneurysm repair is sometimes unpredictable and prolonged ischemia may have deleterious effects on the renal function. To avoid this potential and ominous complication, the authors employed a method for renal protection, consisting in the temporary implantation of an extracorporeal axillary-femoral bypass, removed at the end of the operation.

[Infectious endocarditis: a current overview on an "old" disease].

The infectious endocarditis, first described by William Osler in 1885, is and still remains nowadays as a severe disease, with difficult diagnosis and coursing with high morbi-mortality rates. However, along the years, the disease showed significant modifications in its epidemiology, risk factors, etiologic agents, new study and diagnostic tests and new treatment modalities, medical and surgical, which are the subject of an extensive review by the author, based on an accumulated clinical experience during the last three decades.

[Aneurysm of the superior mesenteric artery in the context of a multianeurismatic disease. Case report].

Aneurysms of the superior mesenteric artery are one of the most uncommon visceral artery aneurysms. Despite its rarity they course with high risks of rupture and many constitute a permanent threat to patients's life. The authors report the clinical condition of a male patient, with a large aneurysm of the superior mesenteric artery, diagnosed through the image techniques made during the follow-up of a previously operated aorto-iliac and bilateral popliteal aneurysms.

[Lemierre's syndrome].

Lemierre's syndrome (LS) is an uncommon but potentially life-threatening complication of an anaerobic oropharyngeal infection, affecting young adults and adolescents. The disease is characterised by a septic thrombophlebitis of the internal jugular vein and "metastatic" infections, which can be followed by fulminant sepsis and rapid death. More recently, it has been reported a recrudescence of this condition, which could be attributable to alterations in antibiotic usage patterns.

[Eversion carotid endarterectomy].

It is widely accepted and proved the role of carotid endarterectomy in the prevention of cerebrovascular insufficiency. Some mater of controversy lies, presently, apart the role of the endovascular treatment, in the techniques of choice for the endarterectomy, as well as in the method employed for the arteriotomy closure. The authors report their experience with the eversion endarterectomy technique, discussing the results and enhancing the main indications of this alternative method for carotid endarterectomy.

[The use of superficial femoral veins in reconstructive surgery of aortic prosthesis infection (Clagett's operation)].

Prosthetic aortic infection still represents an enormous challenge to the possibilities of contemporary reconstructive vascular surgery, particularly in terms of diagnosis and surgical management, and is accompanied by high mortality and morbidity rates. Several surgical methods have been devised and employed, including the extra-anatomic bypasses and the in "situ" revascularization. The later uses either antibiotic bounded prosthesis, or biologic homologous conduits, including cryopreserved allografts or autologous arteries and veins.

[Mycotic rupture of the reno-external iliac artery anastomosi following kidney transplantation].

Two clinical cases of an unusual complication of the renal transplantation are reported, consisting in the infection of the arterial wall by fungi of the species Candida Albicans and Aspergillus, which caused acute ruptures of the external iliac artery and hypovolemic shock. The main features of the pathogenesis of the infection, its diagnosis, management and prevention are subjected to analysis and discussion.

[Isolated obstructive lesions of the cervical common carotid: clinical and surgical aspects].

Isolated lesions of the extra-thoracic common carotid arteries are unusual in clinical practice. Contrarily to the well known lesions of carotid bifurcation, its natural history is poorly understood and indications for surgical management are not well defined. In this paper, seven patients with isolated lesions of the common carotid arteries are reported, being two symptomatic (TIA's).

[Rupture of an abdominal aortic aneurysm with concomitant aorto-caval fistula].

Aorto-caval fistulas are one of the most uncommon complications of infrarenal aortic aneurysms and have a high pre and perioperative mortality rates. Its prompt diagnosis and early treatment may be helpful in lowering the surgical morbidity and mortality. One successfully treated case of a ruptured aortic aneurysm with concomitant aorto-caval fistula is reported, discussing the clinical presentation, the diagnosis and the details of the surgical techniques employed.

Use of external iliac artery in renal revascularization surgery: long-term angiographic assessment.

Purpose: The external iliac artery has physical characteristics, in particular, caliber and length, similar to those of the renal artery and would thus seem to be an ideal substitute for it. However, there are no studies in the literature designed to confirm this possibility. The present study was designed to demonstrate the feasibility of use of the external iliac artery as a substitute for the renal artery in surgical revascularization of renal artery fibrodysplasia and to assess the long-term biologic behavior of the external iliac artery so used.

A new approach for the surgical management of unilateral iliac artery occlusive disease: the iliofemoral crossover transposition.

Aortobifemoral bypass remains the standard therapy for aortoiliac occlusive disease. Extraanatomic revascularization has been considered as an acceptable alternative and provides reasonable long-term results. Because some of the causes for its failure are related to the prosthetic material used, a technique that uses autologous material and is applicable in patients with unilateral common iliac lesions was developed.