Benefits of early haemofiltration during aorto-bifemural bypass with mesenteric revascularization - a case report.

The intraoperative vs postoperative initiation of haemofiltration procedures in patients submitted for major vascular surgery is a controversial issue and a subject of debate in recent literature. We report the case of a 50 yr old patient scheduled for aorto-bifemoral bypass with mesenteric revascularization in whom the haemofiltration procedure (Prismaflex with Onix filter) was installed intraoperatively. Known to have non-insulin-dependent type 2 diabetes, the patient was admitted for Leriche syndrome, abdominal aorta thrombosis, superior and inferior mesenteric artery occlusion, celiac trunk occlusion, bilateral critical limb ischemia and mild renal impairment. The filtration rate was 25 ml/kg/h, ultrafiltration rate of 50 ml/h and 2 h clampation time. Haemofiltration was continued postoperatively in the ICU for another 48 h. The patient had a favorable evolution with restoration of renal function and a significant improvement of the biochemical parameters. In conclusion the early haemofiltration applied in this case provided clear beneficial effects, probably preventing the evolution towards multiple organ dysfunction syndrome.

Safety of vascular endothelial and hepatocyte growth factor gene therapy in patients with critical limb ischemia.

UNLABELLED: The present clinical trial analyzed the safety of gene therapy using plasmidial constructs expressing vascular endothelial and hepatocyte growth factors in patients with critical limb ischemia. The study included 43 patients: 29 in the treatment group and 14 allocated to the placebo group. The primary end points were the rate of major amputations and the clinical safety of the method. Secondary end points were improvement of pain at rest, walking ability and the ankle/brachial pressure index. The overall major amputation rate was 31.04% in the treatment group and 71.42% in the placebo group (p = 0.029). Pain at rest was improved in 65% of patients in the gene therapy group and in 7% in the placebo group (p = 0.0006). There were no significant adverse effects in the treatment group. CONCLUSION: Gene therapy with vascular endothelial and hepatocyte growth factors is therapeutically safe and reduces the rate of major amputations and relieves pain at rest in patients with critical limb ischemia.

The versatility of propeller flaps for lower limb reconstruction in patients with peripheral arterial obstructive disease: initial experience.

In this study, we evaluate the feasibility of propeller flaps, for soft tissue reconstruction in patients with peripheral arterial obstructive disease (PAOD). Five patients (average age, 72 years old), presenting with necrosis of several foot units, were diagnosed with stage IV PAOD and diabetes mellitus. All underwent revascularization, followed by soft tissue reconstruction using propeller flaps. A total of 6 flaps were performed, with dimensions ranging from 4 x 7 cm to 8 x 31 cm. Perforator origin was the peroneal (5 flaps) or the tibial posterior artery (1 flap). Average operative time was 190 minutes. Overall patency was 83.3%; 1 case was complicated with total flap loss followed by below-knee amputation; 1 case developed partial necrosis necessitating skin grafting. All flaps developed mild postoperative edema, which resolved spontaneously. Propeller flaps prove to be useful tools for soft tissue reconstruction in patients with PAOD because of low operative morbidity, easy technique with fast learning curve, and low complications rate.