Use of superficial femoral vein in the treatment of infected aortoiliofemoral prosthetic grafts.

PURPOSE: To assess the use of the superficial femoral vein for the reconstruction of the aortoiliofemoral sector in the treatment of prosthetic infections. METHODS: From December 1995 to November 1999, 12 patients with infection involving a synthetic vascular prosthesis were submitted to thirteen surgical procedures involving partial or total resection of a synthetic vascular prosthesis and restoration of arterial flow with an in situ femoral vein. RESULTS: The overall operative mortality rate was 15.3% (2 out of 3 patients who underwent total graft replacement and 0 out of 9 patients who underwent unilateral graft replacement). Major amputations related to the surgical procedures were performed in two cases (an 87.5% rate of limb salvage). The series was followed up on average for 22 months (range: 6-65 months). No patient presented clinically significant edema or signs of chronic venous insufficiency in the lower limbs used as donors of autogenous venous grafts. All surviving patients presented complete resolution of the infectious signs and symptoms and none of them presented late thrombosis of the venous graft. CONCLUSION: The use of the superficial femoral vein is a good surgical alternative for the treatment of prosthetic infections with minimal venous morbidity of the lower limbs used as venous graft donors. The autogenous venous grafts present good long-term patency and excellent adaptation to the aortoiliofemoral position.

Anti-factor VIII inhibitors and lupus anticoagulants in haemophilia A patients.

In a study of 170 haemophilia A patients, 43 were found to have an inhibitory effect; seven had anti-factor VIII inhibitors (a-fVIII)(A), 18 had lupus anticoagulants (LAs) with a strong (B: 12) or weak (C: 6) time-dependent effect and 18 had no time-dependent LAs (D). The a-fVIII showed a neutralizing effect only against factor VIII and negative diluted Russell viper venom time (dRVVT). The LAs were diagnosed by dRVVT; the Staclot LA agreed with the dRVVT. During the study, three patients changed from an a-fVIII to an LA pattern; they also modified their clinical response. Our prevalence of a-fVIII was low (4%) and we found 21% of LA, with a high (50%) prevalence of time-dependent inhibition. This pattern raises the possibility of the coexistence of LA and a-fVIII, stressing the need to develop specific tests to identify a-fVIII and LA.

Fístulas arteriovenosas braquiocefálicas e braquiobasílicas para hemodiálise: seguimento precoce e tardio / Brachiocephalic and brachiobasilic arteriovenous fistulas for hemodialysis at the early and late follow-up

Entre junho de 1985 e setembro de 1992 foram realizadas 78 fístulas arteriovenosas em pacientes portadores de insuficiência renal crônica terminal, distribuídas em dois grupos: 59 fístulas do tipo braquiocefálica, realizada em 54 pacientes, e 19 fístulas do tipo braquiobasílica com superficializaçäo da veia basílica, executadas em 18 pacientes. Os grupos foram estudados em dois períodos distintos - seguimentos precoce e tardio - e analisados em funçäo da perviedade e das complicaçöes. Os resultadosbtdiso permitem concluir que ambas as técnicas säo alternativas válidas para a manutençäo de pacientes com insuficiência renal crônica terminal em programa de hemodiálise, especialmente quando näo há condiçöes de realizaçäo ou de preservaçäo de acesso na altura do antebraço, pois apresentam poucas complicaçöes e alto índice de perviedade no seguimento tardio.