Phlegmasia cerulea dolens - an uncommon but alarming manifestation of deep vein thrombosis.

In phlegmasia cerulea dolens (PCD), immediate diagnosis and prompt treatment is crucial for limb salvage. Aggressive treatment options including venous intervention, thrombolysis and/or surgical thrombectomy should be considered. Due to the lack of data, the most appropriate intervention depends upon etiology of PCD, clinical presentation and patient's bleeding risk.

Transposition of the persistent sciatic artery for lower limb revascularization after resection of an embolizing proximal sciatic artery aneurysm.

We present a novel surgical technique for lower limb revascularization after resection of an aneurysm of the persistent sciatic artery that had led to recurrent peripheral embolization and severe ischemia. The superficial femoral artery in this patient was hypoplastic, and the sciatic artery continued into the popliteal artery as the source of blood supply to the lower leg. For revascularization, we used the distally pedicled healthy two-thirds of the persistent sciatic artery, transposed it from its posterior position to a nearly anatomic anteromedial position, and anastomosed it to the proximal superficial femoral artery.

Patients' Views on Regional Anesthesia for Elective Unilateral Carotid Endarterectomy--A Prospective Cohort Study.

Background: Carotid endarterectomy (CEA) can be performed under general anesthesia (GA) or locoregional anesthesia (LA). However, the patients' views on the choice between GA and LA are currently poorly understood. We aimed at identifying the preoperative patient information needs, their role in decision-making, and influencing factors associated with LA and anxiety regarding surgery and anesthesia in CEA as a base for improving preoperative consultation and decision-making in the informed consent process.

[Postoperative care following vascular surgery - control of risk factors and guide-lines for physicians in charge of vascular patients].

Patients after major vascular surgery operations present with different problems. Therefore dedicated physicians and good communication between surgeon and physician are required. One of the main goals should be control of cardiovascular risk factors.

Ten years after arterial bypass surgery for claudication: venous bypass is the primary procedure for TASC C and D lesions.

Background: The appropriate role for surgery and endovascular therapy for severe intermittent claudication (IC) remains controversial. We present our results after infrainguinal autogenous bypass for severe IC more than 10 years ago giving a reasoned argument to perform vein bypass as the primary procedure for severe IC.

Methods: Our prospectively designed database includes more than 1,000 infrainguinal bypasses following an all-autogenous policy.

Endarterectomy of the aneurysm sac in open abdominal aortic aneurysm repair reduces perigraft seroma and improves graft incorporation.

Background: Fluid around the graft in the original aneurysm sac after open abdominal aortic aneurysm (AAA) repair is a poorly researched phenomenon. If large, such perigraft seroma can cause symptoms of compression, and cases of rupture have even been described. We assessed whether endarterectomy of the aneurysm sac reduces the incidence of perigraft fluid and improves graft incorporation.

New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS).

Background: The International Carotid Stenting Study (ICSS) of stenting and endarterectomy for symptomatic carotid stenosis found a higher incidence of stroke within 30 days of stenting compared with endarterectomy. We aimed to compare the rate of ischaemic brain injury detectable on MRI between the two groups.

Methods: Patients with recently symptomatic carotid artery stenosis enrolled in ICSS were randomly assigned in a 1:1 ratio to receive carotid artery stenting or endarterectomy.

The probability of restenosis, contralateral disease progression, and late neurologic events following carotid endarterectomy: a long-term follow-up study.

Background: Most studies that have reported on the progression of ipsilateral and/or contralateral internal carotid artery (ICA) stenosis are restricted to a few years.

Methods: Based on a single-center carotid endarterectomy (CEA) registry, we sought all patients with CEA for symptomatic high-grade ICA stenosis between 1970 and 2002. 361 CEA patients (mean age 66 years, 73% male) with annual carotid ultrasound and clinical follow-up were identified.

Major vascular resection and prosthetic replacement for retroperitoneal tumors.

Introduction: Involvement of major vascular structures has been considered a limiting factor for resecting advanced tumors. The objective of this study was to evaluate the outcome after concomitant retroperitoneal tumor and vascular resection with prosthetic replacement of the aorta/vena cava.

Methods: The authors reviewed a 5-year series of eight patients with a median age of 50 years (range 11-68 years) who had undergone resection of a retroperitoneal tumor and concomitant resection and replacement of the abdominal aorta, inferior vena cava, or both.

Combined abdominal aortic aneurysm repair and coronary artery bypass: presentation of 13 cases and review of the literature.

Coronary artery disease remains the major cause of perioperative mortality after abdominal aortic aneurysm (AAA) repair. The beneficial effect of coronary artery bypass (CAB) before AAA repair in patients with severe coronary artery disease has been proven. The coexistence of a very large or symptomatic AAA and coronary artery disease remains a therapeutic challenge since there is the risk of AAA rupture in the interval between CAB and AAA repair.

Endovascular treatment of a post-traumatic thoracic false aneurysm in an adolescent. A case report.

A 17 year old healthy young man suffered a motor-vehicle accident with severe polytrauma. During the rehabilitation a slight hypertension and a blood pressure difference of 30-40 mmHg between arms and legs was recognized. Mindful of a possible aortic lesion, an angio-magnetic resonance imaging (MRI) showed a 2.

Endovascular stent graft for symptomatic mobile thrombus of the thoracic aorta.

Mobile thoracic aortic thrombus is a potential source of arterial embolism. Therapeutic management remains controversial. Systemic anticoagulation and various open surgical procedures are the commonly used therapeutic modalities.

Does specialization improve outcome in abdominal aortic aneurysm surgery?

Specialization and high volume are reported to be related to a better outcome after abdominal aortic aneurysm repair. The aim of this study was to compare, in patients undergoing abdominal aortic aneurysm repair, the outcomes of those whose surgery was done by general surgeons with the outcomes of those whose surgery was done by specialist vascular surgeons. All patients undergoing abdominal aortic aneurysm repair at the Basel University Hospital (referral center) from January 1990 to December 2000 were included.

Extraanatomic lateral reconstruction to the popliteal vessels.

Objectives: To describe the lateral approach to the popliteal artery in reconstructions after soft tissue sarcoma resection in the thigh.

Design: Case reports. Subjects Four patients with soft tissue sarcoma.

Acute supramesenteric thrombosis of an abdominal aortic aneurysm with deleterious embolism: a case report.

A 55-year-old man was admitted with severe pain, paralysis of both legs and absent femoral pulses. Computed tomographic scan demonstrated a 6 cm juxtarenal abdominal aortic aneurysm (AAA) with thrombosis starting at the level of the celiac trunk. At immediate operation, thrombectomy of visceral arteries was performed and distal neovascularization was achieved with a bifurcated prosthesis.

Aminoterminal propeptide of type III procollagen and matrix metalloproteinases-2 and -9 failed to serve as serum markers for abdominal aortic aneurysm.

Objectives: Matrix-metalloproteinase (MMP)-2 and -9 and aminoterminal propeptide of type III collagen (NIIINP) have been reported to be elevated in patients with abdominal aortic aneurysm (AAA). The aim of our study was to test NIIINP, MMP-2 and -9 as potential serum markers for AAA in a large population group at risk for AAA.

Methods: Fifty-five to 70 year old men were screened for AAA by abdominal ultrasound.

The incidence of iliac aneurysms in patients with abdominal aortic aneurysms: comparison of four centers in Europe and the USA.

Background: The purpose of this study was to compare the anatomy of the aortoiliac vessels in patients scheduled for infrarenal abdominal aortic aneurysm (AAA) repair in four different countries.

Material And Methods: Consecutives series of 100 preoperative CT-scans were evaluated at each center. Diameters of the suprarenal aorta, maximal diameter of the aneurysm, right and left common and external iliac artery as well as the hypogastric arteries were recorded and compared between each center.

Brachial artery dilatation after arteriovenous fistulae in patients after renal transplantation: a 10-year follow-up with ultrasound scan.

Background: Dilatation of the artery proximal to arteriovenous fistula (AF) is not well known but is a potential serious complication in patients for renal transplant.

Methods: From 1991 until 2001, the diameters of the brachial arteries of 29 patients after successful renal transplantation and with existing AF were prospectively evaluated with ultrasound scan. Nine patients with longstanding AF without transplantation were included as a control group.

Present status of infrainguinal arterial bypass procedures following an all autogenous policy--long-term results of a single center.

Objectives: The direction of vein grafts for infrainguinal arterial reconstruction is controversial. Long-term results of a single center following an all autogenous tissue policy in infrainguinal arterial reconstruction are reported with special attention to possible advantages for the in situ and non-reversed bypass using angioscopy.

Methods: From 10/88 until 12/00 540 bypasses with autogenous veins were performed on 497 patients.

Mural thrombus of the aorta in association with homozygous plasminogen activator inhibitor type 1 (PAI-1)-675(4G) and heterozygous GP Ia 807C/T genotypes.

Thrombus formation in the thoracic and abdominal aorta without evidence of arteriosclerotic disease is very uncommon. We present a case of a 50-year-old woman with a mural thrombus of the upper abdominal aorta associated with a combination of two mutations predisposing for thrombophilia. The genetic analysis showed a homozygous mutation of plasminogen activator inhibitor type 1 (PAI-1)-675 (4G) and a heterozygous mutation of GP Ia 807C/T.

Infrainguinal arterial reconstruction: female gender as risk factor for outcome.

Objectives: the effect of gender on the long-term results of infrainguinal arterial reconstruction are poorly investigated.

Methods: all patients undergoing infrainguinal arterial reconstruction with an autogenous vein are as 11 years period was prospectively evaluated.

Results: four hundred and fifty reconstructions (292 man, 160 women) were performed as on 416 patients.

Does fibrin glue reduce complications after femoral artery surgery? A randomised trial.

Objectives: to determine whether application of fibrin glue before closure of inguinal wounds reduces the incidence of lymphatic complications.

Design: we a prospective randomised trial.

Materials And Methods: 224 consecutive patients were enrolled.

CT-guided percutaneous embolization of a lumbar artery maintaining a type II endoleak.

Purpose: To demonstrate the possibility of percutaneous embolization of a type II endoleak guided by computed tomographic (CT) fluoroscopy.

Case Report: A type II endoleak maintained by a hypertrophic fourth lumbar artery failed to occlude spontaneously 7 months after stent-graft deployment for endovascular repair of an infrarenal abdominal aortic aneurysm. A percutaneous procedure was performed to eliminate the endoleak using needle puncture and embolization under CT fluoroscopic guidance.