ABSTRACT
OBJECTIVES: To compare aortoenteric fistula (AEF) outcome after endovascular (EV-AEFR) or open repair (O-AEFR). DESIGN: Multicentre retrospective comparative study. MATERIALS/METHODS: 25 patients with AEF (24 secondary, 23 males, median age 75 years) after aortic surgery (median four years). Preoperative sepsis was evident in 19 cases. Eight patients were managed with EV-AEFR and 17 with O-AEFR. RESULTS: The two groups were comparable in preoperative characteristics. In-hospital mortality after EV-AEFR was lower compared to O-AEFR (0% and 35%, respectively, p = 0.13). Similarly, morbidity after EV-AEFR was lower compared to O-AEFR (25% and 77%, respectively, p = 0.028). There was a trend for worse recurrence-free, sepsis-free, re-operation-free and AEF-related death-free rates after EV-AEFR, while the early survival advantage of EV-AEFR was lost after two years and the overall long-term survival rates (perioperative mortality included) of the two groups were similar. Preoperative sepsis had no effect on recurrence and sepsis-free rates (p = 0.94 and p = 0.92, respectively), but it was associated with worse two year overall survival (24% vs 50%, p = 0.32). On multivariate analysis, the number of symptoms (two vs one) at presentation was the single predictor of worse re-operation rates, AEF-related and overall survival. CONCLUSIONS: EV-AEFR was associated with no postoperative mortality in this study and can achieve satisfactory short and long-term results, comparable to O-AEFR. Further trials should focus on the role of EV-AEFR in patients at high risk for O-AEFR, due to shock or co-morbidities, or as a bridging procedure.
Subject(s)
Aorta, Abdominal , Aortic Diseases/surgery , Intestinal Fistula/surgery , Stents , Vascular Fistula/surgery , Vascular Surgical Procedures/methods , Aged , Aged, 80 and over , Aortic Diseases/diagnosis , Female , Follow-Up Studies , Humans , Intestinal Fistula/diagnosis , Male , Middle Aged , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome , Vascular Fistula/diagnosisABSTRACT
Exertional disruption of axillary anastomosis is a well documented, although rare, complication of axillo-femoral grafts. Comprehension of causative mechanisms is of great importance, so that precautions can be taken against it. Here, a case of an early disruption of proximal anastomosis of an axillofemoral graft is reported. Use of crutches was incriminated as the responsible mechanism.
Subject(s)
Anastomosis, Surgical , Aortic Diseases/surgery , Axillary Artery/surgery , Blood Vessel Prosthesis Implantation , Femoral Artery/surgery , Polytetrafluoroethylene , Surgical Wound Dehiscence/surgery , Humans , Male , Middle Aged , ReoperationABSTRACT
The theoretical model of paradoxical embolism requires the presence of four parameters, namely, arterial embolism, venous thrombus, abnormal intracardiac communication and right-to-left shunt. Many aspects, however, of this well known entity are under consideration; diagnosis is often difficult to be established and the long term efficacy of preventive measures is undefined. We comment on a case report of recurrent paradoxical embolism with popliteal vein thrombosis and patent foramen ovale, and we briefly review the literature.
Subject(s)
Embolism, Paradoxical/diagnosis , Popliteal Vein , Diagnosis, Differential , Embolism, Paradoxical/surgery , Female , Heart Septal Defects, Atrial/diagnosis , Heart Septal Defects, Atrial/surgery , Humans , Hypertrophy, Right Ventricular/diagnosis , Hypertrophy, Right Ventricular/surgery , Middle Aged , Pulmonary Heart Disease/diagnosis , Pulmonary Heart Disease/surgery , Vena Cava FiltersABSTRACT
Septic peripheral embolism due to infective complication of vascular infrainguinal procedures has been occasionally reported. The combination, however, of purulent arthritis of the knee joint and septic microembolism of the foot, as consequence of an infected pseudoaneurysm, is a very rare entity. We report a case of an infected anastomotic femoral aneurysm, following an iliofemoral "in situ repair" which was complicated with purulent arthritis of the knee joint and multiple small necrotic lesions of the plantar surface of the foot. Treatment included removal of the infected graft, an extra-anatomic revascularization and arthrotomy with pus evacuation. The patient had an uneventful postoperative course and remained well at four-year follow-up, with a mild dysfunction in the knee joint flexion.
Subject(s)
Aneurysm, False/surgery , Arthritis, Infectious/diagnostic imaging , Embolism/diagnostic imaging , Femoral Artery/surgery , Foot/blood supply , Knee Joint/diagnostic imaging , Postoperative Complications/diagnostic imaging , Pseudomonas Infections/diagnostic imaging , Staphylococcal Infections/diagnostic imaging , Anastomosis, Surgical , Arthritis, Infectious/surgery , Blood Vessel Prosthesis Implantation , Embolism/surgery , Humans , Knee Joint/surgery , Male , Middle Aged , Polytetrafluoroethylene , Postoperative Complications/surgery , Prosthesis-Related Infections/diagnostic imaging , Prosthesis-Related Infections/surgery , Pseudomonas Infections/surgery , Reoperation , Staphylococcal Infections/surgery , Tomography, X-Ray ComputedABSTRACT
Despite the proven reliability of polyethylene terephthlate (PET) grafts, structural defects resulting in graft rupture and false aneurysm formation have been sporadically described. Two cases of late, non anastomotic, false aneurysms of PET femoropopliteal grafts, are reported. The diagnosis is readily apparent on clinical examination and imaging studies, which display an aneurysm along the course of the graft, remote from the anastomosis. The extent of the repair depends on the extent of the degenerative process.
