Infected ruptured popliteal artery aneurysm by Listeria monocytogenes. A case report and review of the literatures.

We describe a case of a voluminous infected aneurysm of the popliteal artery, with Listeria monocytogenes (LM) associated with rupture, in a 72-year old man. After radical resection of the aneurysm a reconstruction was not necessary, because of the sufficient blood supply, due to the pre-existent good development of collateral circulation. The patient was discharged on the 12th postoperative day with primary healing of the wound and viable leg. Adequate antibiotic treatment was continued for 4 weeks. In the following 18 months the serial clinical examinations, laboratory tests and ultrasound scans have shown no evidence of reinfection.

Endovascular repair of a traumatic popliteal arteriovenous fistula.

We report a case of an arteriovenous fistula (AVF) following osteosynthetic treatment of a fracture of the lower limb 13 years ago. A stent-graft technique had been used to close a high flow traumatic AVF between the popliteal artery and the popliteal vein. The failure to properly evaluate traumatic AVF may sometimes lead to remarkable delay in diagnosis with devastating consequences including edema, ischaemia, ulceration and high output heart failure. Endovascular treatment of these lesions is promising but long-term follow-up will be required to determine the durable patency and the onset of potential complications.

Late non-anastomotic false aneurysm formation in femoropopliteal polyethylene terephthalate grafts.

Despite the proven reliability of polyethylene terephthlate (PET) grafts, structural defects resulting in graft rupture and false aneurysm formation have been sporadically described. Two cases of late, non anastomotic, false aneurysms of PET femoropopliteal grafts, are reported. The diagnosis is readily apparent on clinical examination and imaging studies, which display an aneurysm along the course of the graft, remote from the anastomosis. The extent of the repair depends on the extent of the degenerative process.

Late outcome of spinal cord stimulation for unreconstructable and limb-threatening lower limb ischemia.

OBJECTIVES: To determine whether the initial benefits of spinal cord stimulation (SCS) treatment for critical limb ischemia (CLI) persist over years. DESIGN: Analysis of data prospectively collected for every CLI patient receiving permanent SCS. Follow-up range 12 to 98 months (mean 46+/-23, median 50 months). POPULATION: 87 patients (28% stage III, 72%stage IV) with unreconstructable CLI due (83%) or not (17%) to atherosclerosis and with an initial sitting/supine transcutaneous pO2 gradient >15 mmHg. METHODS: Assessment of actuarial patient survival (PS), limb salvage (LS) and amputation-free patient survival (AFPS). Analysis of the impact of 15 risk factors on long-term outcomes using the Fischer's exact test for categorical variables and the t test for continuous variables. RESULTS: Follow-up was complete for patient and limb survival. A single non-atherosclerotic patient died during follow-up. Among atherosclerotic patients PS decreased from 88% at 1y, to 76% at 3y, 64% at 5y and 57% at 7y. LS reached 84% at 1y, 78% at 2y, 75% at 3y and remained stable thereafter. Diabetes was found to affect LS (p<0.05) and heart disease to reduce PS (p<0.01). AFPS was reduced in heart patients (p<0.01), diabetics (p<0.05) and in patients with previous stroke (p<0.05). CONCLUSIONS: In CLI patients the beneficial effects of SCS persist far beyond the first year of treatment and major amputation becomes infrequent after the second year.