External stenting and disease progression in vein grafts 1 year after open surgical repair of popliteal artery aneurysm.

OBJECTIVE: Open surgical repair remains the gold standard treatment for popliteal artery aneurysms (PAA). The objective of this study was to evaluate the safety of external stenting and its medium-term effect on vein graft disease after open PAA repair. METHODS: Between December 2017 and September 2019, 12 consecutive patients with PAA underwent open surgical repair with externally stented saphenous vein grafts. Duplex ultrasound scanning of the grafts was performed at discharge and at 3, 6, and 12 months after the procedure to evaluate graft patency, average lumen diameter and lumen uniformity. RESULTS: Eleven patients underwent aneurysm ligation and bypass grafting and one patient was treated with aneurysm exclusion and interposition of a venous segment. External stenting of the vein graft was successful in all patients. The mean follow-up time was 12 months (range, 7-17 months), with a primary patency rate of 100% and no graft revisions or reinterventions. The mean lumen diameters at 3, 6, and 12 months were 5.9 ± 1.2 mm, 5.7 ± 0.8 mm, and 5.7 ± 0.7 mm, respectively, with no significant changes between 3 and 6 (P = .34) and between 6 and 12 months (P = .34). The coefficient of variance at 3, 6, and 12 months was 8.2 ± 9.3, 9.4 ± 7.2, and 10.4 ± 8.9, respectively, with no significant change between 3 and 6 months (P = .78) or 6 and 12 months (P = .98). No mortality or amputations were recorded throughout the follow-up period. CONCLUSIONS: External stenting of vein grafts in open surgical repair of PAA is feasible and safe. This technique may potentially improve the outcomes of surgical repair in patients with PAA.

Incidental deep soft tissue leiomyoma of the groin - a case report and comprehensive review of literature.

Leiomyomas are rare, benign tumors arising from smooth muscle cells. Due to the heterogeneous anatomical locations, as well as clinical and radiological findings, early and correct diagnosis is usually tricky. The clinical symptoms depend on the anatomical structure the tumors are compromising by their growth. We present a case of a 53-year-old male patient who suffered from swelling of the right foot and ankle. Initially, arthritis and deep vein thrombosis were ruled out. As the swelling progressed to the entire leg, CT scan was performed showing a tumor compressing the right femoral vein. However, a magnetic resonance imaging (MRI) and a biopsy did not show any conclusive findings. Tumor excision was planned and immunohistochemical staining confirmed leiomyoma. The authors conclude that unspecific, progressive symptoms should prompt further investigation and whenever planning a biopsy, a possible malignant finding should be considered and excision of the biopsy canal together with the tumor must be assured.

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. For this review only patients operated on for severe IC at least 10 years ago were included. The primary end points were survival and primary and assisted-primary patency rates. RESULTS: From October 1988 until December 2000, 124 bypasses for IC were performed. Ninety-five patients were male and the mean age was 64.5 ± 10.8 years. Survival after 10 years was 50.3% according to life table analysis. Forty bypasses were to the supragenicular artery, 62 to the infragenicular popliteal artery, and 22 to the tibial artery. Thirty-day mortality was 0.8% (1 patient). The primary patency rate after 10 years was 63.5% and the assisted-primary patency rate 87.3%. CONCLUSION: Infrainguinal venous bypass for severe IC has excellent long-term results. Our results are strong arguments against the liberal use of stenting long lesions of the femoropopliteal artery. Venous bypass remains the primary procedure for TASC C and D lesions in claudicants.

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. DESIGN AND METHODS: Starting in July 2005, all patients with elective open AAA repair were alternately treated either with conventional thrombectomy or thrombectomy plus endarterectomy of the aneurysm sac. All patients were treated with a polytetrafluoroethylene (PTFE) graft. The maximum axial width of the perigraft fluid collection was measured on computed tomography (CT) scans 1 year after operation. RESULTS: The CT scans of 115 patients were available; 56 had endarterectomy of the aneurysm sac and 59 did not. Fluid collections were significantly smaller in patients with endarterectomy (median width 4.0 versus 8.0 mm; P = 0.0001). Eight patients with endarterectomy had a fluid collection wider than 10 mm compared to 28 patients without endarterectomy (OR 0.18, 95% CI 0.07-0.46). After endarterectomy, 17 patients had radiological signs of complete graft incorporation in comparison to only 6 patients without endarterectomy (OR 3.85, 95% CI 1.39-10.66). No patients were symptomatic or reoperated for perigraft seroma. CONCLUSIONS: Endarterectomy of the aneurysm sac in open AAA repair appears to improve graft incorporation. The high rate of asymptomatic perigraft seroma is surprising, and its clinical significance is unknown. Ultrafiltration of PTFE grafts may be an underlying mechanism.

The role of preoperative blood parameters to predict the risk of surgical site infection.

BACKGROUND: Routine preoperative blood work is not recommended but selected biochemical markers may predict the risk of surgical site infection (SSI). This study examines the association between preoperative biochemical markers and the risk of SSI. METHODS: This observational cohort study, nested in a randomized controlled trial, was conducted at two tertiary referral centers in Switzerland. RESULTS: 122 (5.8%) of 2093 patients experienced SSI. Preoperative increasing levels of albumin (OR 0.93), CRP (OR 1.34), hemoglobin (OR 0.87) and eGFR (OR 0.90) were significantly associated with the odds of SSI. The same accounts for categorized parameters. The highest area under the curve from ROC curves was 0.62 for albumin. Positive predictive values ranged from 6.4% to 9.5% and negative predictive values from 94.8% to 95.7%. The association of CRP, mildly and moderately decreased eGFR and hemoglobin with the odds of SSI remained significant on multivariate analysis. CONCLUSIONS: Our results do not support generally delaying elective surgery based on preoperative blood results. However, it may be considered in situations with potentially severe sequelae of SSI.