Iatrogenic pseudoaneurysm of the popliteal artery following corrective tibial osteotomy.

Due to its anatomical location the popliteal artery is exposed to injury during surgical procedures in the region of the knee joint, in particular during high-level corrective osteotomies of the proximal tibial epiphysis. Nevertheless, posttraumatic (iatrogenic) pseudoaneurysm constitutes a very rare complication of the procedure. Only few reports of such complication have been published and they were usually connected with lateral tibial osteotomy - the accidents after medial osteotomy are seldom. The complication we report was observed in a 52-year-old female patient after corrective osteotomy of the medial portion of the proximal tibial epiphysis. The complication was diagnosed 7 days after surgery on US-examination and subsequently confirmed by emergently performed angio-CT. The patient was referred for urgent reconstructive surgery. No significant complications were observed, neither postoperatively nor during follow-up visits.

In situ revascularisation with silver-coated polyester prostheses and arterial homografts in patients with aortic graft infection--a prospective, comparative, single-centre study.

OBJECTIVE: The aim of our study was to evaluate the effectiveness of in situ revascularisation with the use of arterial homografts and silver-coated prostheses in the treatment of aortic graft infection. MATERIALS: A total of 77 consecutive patients (74 males, three females, mean age: 58 years), hospitalised between 2001 and 2008, were enrolled into the study. Patients were assigned to three groups: group 1 (n = 24)--fresh arterial homograft with subsequent immunosuppression, group 2 (n = 26)--fresh arterial homograft without immunosuppression and group 3 (n = 27)--silver-coated prosthesis. METHODS: The course of infection was assessed by scintigraphy with (99m)Technetium-labelled leucocytes, Duplex-Doppler ultrasound, angio-computed tomography (CT) and microbiological examination. RESULTS: The mean follow-up was 22.8 (±10.1) months. There was a significant decrease in leucocyte accumulation around the graft among all groups (group 1: p = 0.012, group 2: p = 0.006 and group 3: p = 0.021). The postoperative mortality rate in groups 1,2 and 3 was 8%, 23% and 11%, respectively. The postoperative morbidity was 35% in group 2, 16% in group 1 and 7% in group 3. CONCLUSION: Our study suggests that silver-coated prostheses can be as effective as arterial allografts in the treatment of infections of vascular prostheses.

Iatrogenic injuries of the carotid arteries.

BACKGROUND: Iatrogenic trauma of the carotid artery (CA) is a dangerous intraoperative complication, especially during oncological and endocrinological procedures. In these cases massive hemorrhage and severe neurological complications may occur. The outcome of reconstructive procedures is often fatal because of the long delay of surgery after the injuries occuring in non-vascular centers. PATIENTS AND METHODS: In this paper 22 cases of iatrogenic CA trauma will be presented, operated in the period of 1980-2003. Different methods of operation were performed according to the extent of trauma and anatomical changes. RESULTS: In spite of emergency help two patients died. In three cases cerebral stroke was observed. Additionally peripheral nervous damages were noted. CONCLUSIONS: Iatrogenic CA trauma is one of the most dangerous vascular injuries, connected with hemorrhage and neurological complications. We recommend intravenous administration of 5000 units unfractionated Heparin, anatomical artery preparation, then shunt inserting. Autogenous material should be used if possible. For reconstruction of the initial part of internal carotid artery the transposition of the external carotid artery is useful.

The detection of Chlamydia pneumoniae in aneurysm of abdominal aorta and in normal aortic wall of organ donors.

Sixty patients underwent surgery due to abdominal aortic aneurysms; the group included 30 patients with asymptomatic aneurysm and 30 with ruptured aneurysm. A control group comprised 30 organ donors. Surgical specimens derived from aneurysm or aorta fragments were investigated for Chlamydia pneumoniae DNA using PCR. In asymptomatic aneurysms, DNA was found in 9 cases (29%), and in ruptured aneurysms in 14 cases (49%). In the control group, C. pneumoniae DNA was not detected in an aortic wall. These results suggest that healthy aortic wall is not susceptible to chlamydial infection. A large number of aneurysm infections implies C. pneumoniae role in proteolysis and degradation of the aneurysm wall. The biological effect of this process may cause an enlargement of the aneurysm.

[Clinical evaluation of a polyester vascular prosthesis impregnated with albumins from material of the Vascular Surgical Clinic AM in Wroclaw in the years 1994-1997. Introductory report]. / Ocena kliniczna poliestrowej impregnowanej albuminami protezy naczyniowej w materiale Kliniki Chirurgii Naczyniowej AM we Wroclawiu w latach 1994-1997. Doniesienie wstepne.

The aim of this work was clinical evaluation of impregnated (albumins) prostheses of Polish production. Those prostheses were compared with polyester knitted vascular prostheses. We evaluated a group of 48 patients to whom prostheses covered with albumins were implanted and 52 patients to whom nonimpregnated prosthesis was implanted in 1994-1997. The prostheses were implanted in aortofemoral segment. The achieved results prove the good quality of the impregnated prosthesis and its high value for vascular reconstructive surgery.

[Abdominal aortic aneurysm treated concurrently with neoplasms in the abdominal cavity and retroperitoneal space]. / Tetniaki aorty brzusznej leczone jednoczasowo z nowotworami jamy otrzewnowej i przestrzeni zaotrzewnowej.

The authors report 489 patients. With abdominal aortic aneurysms (AAA). Twelve patients underwent operation for AAA and oncological resection in abdominal cavity. In this group were five patients with AAA and colorectal carcinoma. All oncological patients with AAA were operated electively. The reconstruction of AAA and oncological resection were done at the same time. No patient died in the first 30 postoperative days. The authors conclude that AAA repair and oncological resection should be performed simultaneously in elective patients.

[Radioisotopic diagnosis of infected anastomotic groin aneurysms after complications with aorto-bifemoral vascular prosthesis]. / Diagnostyka radioizotopowa tetniaków zespoleniowych w pachwinie po zabiegach wszczepienia protezy aortalno-dwuudowej.

UNLABELLED: Between 1990 and 1996 at the Department of Vascular Surgery, Medical Academy in Wroclaw 34 patients with groin aneurysms were operated. All patients had aorto-bifemoral graft implantation before. The age range between 41 and 81 years. Among patients there were 4 women and 30 men. The diagnosis of groin aneurysm was based on physical and ultrasound examination. In each case scintigraphy with 99Tc labeled leukocytes was performed. Scintigraphic picture showed graft infection in eight (23.5%) patients (group I). In 26 (76.5%) cases (group II) there was no infection on scintigraphy. In group I all patients were operated-the infected graft was excised and then implantation of straight PTFE or venous by-pass "in situ" was performed. In group II all patient were also operated, but through the groin approach only -in 9 cases reconstruction of the anastomosis between graft and artery was done and in 17 cases PTFE by-pass was performed. In group I the results of the treatment were good in 6 cases; in remaining two patients the amputation of the leg had to be done. In group II the results of the operation was good in 24 cases and 2 patients had amputation of the leg. CONCLUSION: Scintigraphy with 99Tc labeled leukocytes is beneficial in the diagnosis of infected groin aneurysms after previous vascular reconstruction.