Mid-term results of endovascular repair for abdominal aortic aneurysm, with loco-regional anesthesia, in high-risk patients.

BACKGROUND: Aim of this study was to evaluate the results of endovascular repair of abdominal aortic aneurysm (AAA) in patients considered not suitable for traditional open surgical repair because of the high anesthesiological risk. METHODS: We have retrospectively evaluated the result of the endovascular treatment of 11 patients with AAA of more than 6 cm diameter and high surgical risk due to cardiac hypokinesia and/or respiratory insufficiency. Patients were selected by a team composed of vascular surgeons and vascular radiologists who decided to implant the graft according to anatomical features of the AAA and of the iliac arteries. The treatment was performed in loco-regional anesthesia. The main end-points were: implantation success, mortality, morbidity, the absence of endoleak during the follow up that lasted two years. RESULTS: All the grafts were successfully implanted. There were no complications caused by anesthesiological manouvres. We had a minor intra-operative vascular complication and we performed three adjunctive endovascular procedures. A patient died of acute myocardial infarction, in the post operative period. Mean stay was six days. Pre-discharge scan showed 3 endoleaks (type I), two of these healed spontaneously and one sealed by percutaneous endovascular treatment. During follow-up (3-24 months) no patient died. One endoleak (type II) still persists. CONCLUSIONS The use of loco-regional anaesthesia allows us to treat high risk patients. Following strictly the criteria of patient selection, the surgical high risk seems not to influence significantly the mid term results that are almost equal to the ones obtained in low-risk patients.

Prospects of prostanoid therapy. Preliminary results.

BACKGROUND: To evaluate the efficacy of treatment with prostaglandins (Iloprost and Alprostadil) in patients with peripheral arterial disease in whom a surgical act or a redo operation is not proposable and to set the role of these drugs in the therapy of arterial diseases. METHODS: We analyzed the results of 96 treatments in patients with peripheral arterial diseases of different etiology, treated in the Day Hospital in the Division of Vascular Surgery from the 1/1/1993 to the 30/6/1998. The efficacy of the treatment has been evaluated on the basis of the clinical picture (healing or reduction of ulcers, reduction of rest-pain, improvement of the ability to walk). RESULTS: We had positive results in 60% of the patients who completed the treatment, a good outcome for patients with particularly severe arterial disease. Interruptions induced by the occurrence of uncontrolled side-effects are a few (6.25%). Better results have been found in a special category of disease (arterial diseases not associated with diabetes, not very advanced clinical picture, female gender). Iloprost proved to be superior to Alprostadil. CONCLUSIONS: Prostaglandins today represent an effective therapeutic solution to be considered. Further studies need to be done to find a category of patients who can have the best benefit from this kind of drug.

[Post-traumatic pseudoaneurysm of the common carotid artery]. / Pseudoaneurisma post-traumatico della carotide comune.

The authors report their experience of one single case of carotid pseudo-aneurysm consequent on cervical trauma. The treatment required the substitution of the interested carotid segment by PTFE no. 6. This case is a rare event but the surgeon must always keep it in mind in the presence of cervical trauma.

[Carotid-subclavian bypass. Our experience with locoregional anesthesia]. / Bypass carotido-succlavio. Esperienza in anestesia loco-regionale.

Carotid-subclavian bypass has been adopted since 1956. The commonest indication is to abolish arterial occlusion or stenosis in patients with subclavian steal syndrome. Ten patients were submitted to carotid-subclavian bypass under regional anaesthesia: block of anterior rami of spinal nerves C3-C4 and block of cervico-brachial plexus by injection into the continuous perineural connective tissue space at the level of C6. The surgical procedure required carotid occlusion and cerebral function monitoring. The advantages of regional anaesthesia are the ability to monitor the patient's cerebral perfusion and function, to detect intraoperative ischaemia and embolisation and minimal interference with the cardiovascular and respiratory function.

[15 cases of femoro-popliteal bypass with PTFE graft]. / Considerazioni su 15 casi di by-pass femoro-popliteo in PTFEE.

The authors report their clinical experience of 15 cases of femoro-popliteal by-pass with PTFE; all patients underwent postoperative anti-platelet therapy, in 8 cases with ASA and dipyridamole, in 7 with indobufene in accordance with a double blind randomized work. The Authors report the results of a one year follow-up. They deal with patency duration results and tolerance of pharmacological treatment.

[Considerations on 12 cases of mesenteric embolism treated surgically]. / Considerazioni su 12 casi di embolia mesenterica trattati chirurgicamente.

Twelve cases of mesenteric artery embolism surgically treated with a surviving rate of 66% are reported. The Authors point out the diagnostic features and the various factors affecting the surgical result.

[Pseudomembranous colitis caused by antibiotic therapy during aorto-iliac surgery]. / Colite pseudomembranosa da antibiotico-terapia in corso di chirurgia del distretto aorto-iliaco.

Pseudomembranous colitis is not a rare complication of antibiotic therapy. 2000 surgical procedures with implantation of grafts in the aorto-iliac region were performed from 1974 through 1988; during this period 11 cases of CMP were observed. The Authors report their experience in regard to the various antibiotics administered.

[Clinical aspects of persistent sciatic artery. Description of 2 cases with angiographic demonstration]. / Aspetti clinici della persistenza dell'arteria ischiatica. Descrizione di due casi dimostrati angiograficamente.

We report 2 additional cases with angiographic demonstration. The embryology and radiological findings are discussed. This anomaly should be kept in mind in the clinical assessment of a patient with unexplained sciatic or buttock pain or a pulsatile buttock mass with or without symptoms of peripheral vascular disease. It also represents a potential hazard during renal transplant surgery.