Wrapped autologous greater saphenous vein bypass for severe limb ischemia in patients with varicose veins. Preliminary report.

The greater saphenous veins in patients with varicose veins has been overlooked as a conduit for arterial bypass. Greater saphenous veins is often normal and when only parts of the greater saphenous veins are of normal size, a veno-venous or a graft composite bypass may be performed. The goal of this preliminary study was to asses if wrapped autologous greater saphenous veins could be suitable conduits for arterial bypass in patients presenting with critical ischemia. In three patients the greater saphenous veins had one to four dilatations which were wrapped with short segments of Polytetrafluoroethylene graft. In three other patients, the dilated area being longer, the greater saphenous veins were totally wrapped in a hand-made mesh of Dacron. No complications were due to the wrapping procedure and the unwrapped segments did not dilate during a mean three year follow-up. We conclude that wrapped autologous greater saphenous veins may help save limbs of patients with critical ischemia. As an underestimated proportion of patients presenting with varicose tributaries have normal or quite normal greater saphenous veins, the caliber of the greater saphenous veins should be carefully measured before treating the varicose veins. All greater saphenous veins suitable for an arterial bypass should be preserved remembering that one or several dilatations may be wrapped if the greater saphenous veins is used as an arterial substitute. Patients should be informed of the reasons for this choice.

[Is it possible to cure various disorders of stability or vertigo by surgical correction of tight stenosis of a supra-aortic artery?]. / Peut-on guérir certains troubles de stabilité ou vertiges en corrigeant chirurgicalement une sténose serrée d'une artère supra-aortique?

While the efficacy of vertebral arteries revascularisation on the symptoms of vertebrobasilar insufficiency (VBI = IVB in text) is well established, the effect of correction of stenosis of vessels other than the vertebral arteries on stability disorders and vertigo do not appear to have been studied to any extent. Furthermore, vertigo is not considered as specific to VBI. A retrospective study was therefore carried out to determine the outcome in 33 patients with static disorders or vertigo operated upon for a severe stenosis of a brachiocephalic trunk, a carotid artery or a subclavian artery, with or without associated stenosis of a vertebral artery which in all cases had been neglected. Two patients (6%) died during the early stages of this series. Mean duration of follow up was a little longer than 5 years. One month post-operation 61% of the survivors were asymptomatic, all the others reported marked improvement in their symptoms and all had resumed their social life. At a later stage two patients had a clinical relapse associated with new arterial stenosis. Findings in this small series suggest that it is possible to cure or improve patients with stability disorders or vertigo by the surgical correction of a severe stenosis of a supra-aortic artery other than a vertebral artery.

Recurrent femoral anastomotic false aneurysms: is long term repair possible?

This study was undertaken to evaluate the operative problems and the fate of patients operated on for recurrent femoral anastomotic false aneurysms, following aortofemoral bypass. It was found that 58 of 66 anastomotic false aneurysms which developed after aortoiliac or aortofemoral reconstruction were located at the femoral level, six at the anastomosis of the graft to the aorta and two at the iliac artery anastomosis. Six recurrences developed after surgical repair of femoral anastomotic false aneurysms but there were none after repair of aortic or iliac anastomotic false aneurysms. Of the six recurrences one patient was treated by direct repair and the remaining five by interposition of a prosthetic graft. There were no ischaemic complications or recurrences in a mean of three years. Elective, repeated repair is therefore a successful method of treating anastomotic false aneurysms. Deep sutures should be inserted into the arterial wall, tension should be avoided by placing an interposition graft when necessary, using a careful aseptic technique. Patients should be told to avoid extreme extension and rapid flexion-extension of the hip joint for the rest of their life.