Recurrent residual or progressive varicose veins: postoperative long term follow-up of 353 patients.

AIM: This study aimed to evaluate the postoperative incidence of recurrent varicose veins (vv) and the possibility to differentiate the different types of recurrence. MATERIAL OF STUDY: Patients who underwent surgery for saphenofemoral junction (SFJ) incompetence, great saphenous vein (GSV) varicosity and at least one perforator incompetence and varicosity of tributaries between January 1998 and December 2003 were selected for the study. Surgery consisted in SFJ flush ligation, GSV stripping, perforator vein ligature, and phlebectomies. Patients were assessed by detailed interview, clinical examination, and color duplex imaging after 10 years. The differentiation in recurrent, residual and progressive vv was done by comparison of the pre-and intraoperative and the phlebographic documentation in particular with the findings on follow-up.. RESULTS: 353 patients (400 legs) were analyzed at 120 ± 21 months. At follow up the vv were classified as recurrent in 23,75%, residual in 23,25%, and progressive in 21% of cases. Nine patients (1.9%) were reoperated after 70 ± 33 months, and 17 (3.5%) underwent sclerotherapy during follow-up. CONCLUSIONS: Recurrent, residual, and progressive vv can be clearly differentiated with the presented methodology. The authors suggest a revised definition (NEVVAS- new vv after surgery) because the term recurrent and the known acronyms do not embrace exactly the three types of vv after surgery. Since residual and many recurrent vv are due to avoidable technical or tactical errors, it is important to classify them properly in order to avoid these complications. KEY WORDS: Neovarices, NEVVAS (New Varicose Veins After Surgery), Neovascularization, Recurrent varicose veins, Residual varicose veins, Progressive varicose veins.

[Linee guida flebo-linfologiche SIF-SICVE 2016 della Società Italiana di Flebologia e della Società Italiana di Chirurgia Vascolare ed Endovascolare].

Phlebology is not a specialty for its own in Italy. Phlebological patients are treated by vascular and general surgeons, dermatologists, phlebologists, angiologists, internists and even general practitioners. Even tough guidelines present a series of recommendations based on evidence-based medicine, guidelines may also be a tool to unify the diagnostic and therapeutic approach in a vast medical field like phlebology. Since vascular surgeons and phlebologists are particularly involved in phlebology-related pathologies the scientific societies of the Italian Society of Phlebology (SIF) and the Italian Society for Vascular and Endovascular Surgery (SICVE) decided to cooperate for the preparation of phlebo-lymphological guidelines. These guidelines comprehend also an important chapter dealing with the lymphology of the lower extremities; phlebological active physicians are often faced with lymphatic pathologies and a good differential diagnosis can be sometimes very helpful. Sclerotherapy and Surgery as the major therapeutical alternatives are extensively analyzed, but also the compression therapy, the medical and physical therapy are presented under the critical view of evidence based analyses. Separate chapters deal with the treatment alternatives for superficial and deep venous thromboses and the recommendations for the treatment of venous ulcers. The current scientific evidences were confronted with the experiences of Italian specialists and the particular practice and reality in Italy. They represent therefore the actual valid positions and recommendations in Italy which shall be updated regularly.

A new strategy in sclerotherapy of varicose veins.

AIM: The aim of our study was to evaluate the efficacy of a new method of compression sclerotherapy of GSV and SSV. MATERIALS AND METHODS: 345 lower extremities with primary varicose veins, with a long reflux of the GSV (C2-6; Ep; As 2, 3; ± p; Pr), have been submitted to sclerotherapy applying the following method: injection of foam (Polidocanol 2%), or liquid sclerosant (iodate solution 4-6% or Polodocanol 3%) in the trunk of the GSV; echoguided compression of sapheno-femoral junction (performed using an inflatable device, the Safeguard); immediate eccentric positive compression on the trunk of the GSV; and short elastic bandage. RESULTS: The results have shown that applying this method of sclerotherapy the failure rate decreases, independently to physical form of sclerosing agent. CONCLUSIONS: The use of Safeguard® interrupts reflux to the lower veins, and these can so be well sclerosed and compressed with short elastic bandage. KEY WORDS: Long compression, Foam, Saphenous vein Sclerotherapy varicose veins.

Perioperative sclerotherapy. A survey of current practice by Italian phlebologically-active physicians.

AIM: To find out how and when Italian phlebologically-active physicians apply perioperative sclerotherapy. MATERIAL AND METHODS: A questionnaire was e-mailed to the members of three different Italian Societies of Phlebology. The answers were collected in a database (SPSS19 for Windows) and statistically evaluated. RESULTS: Ninety surgeons (87.4%) and 13 (12.6%) phlebologists responded, 57 (56,3%) worked in hospital and 46 (44.7%) in an outpatient clinic. Perioperative sclerotherapy is administred by 63,1% of respondents merely postoperatively. 28,2% use also postoperative sclerotherapy, but sometimes in combination with preoperative (6.8%) or intraoperative sclerotherapy (21.4%). Only 8,7% perform the perioperative sclerotherapy pre-, intra- and/or postoperatively. Postoperative sclerotherapy is programmed in a significantly higher percentage and earlier in private practice. Vascular surgeons performed intraoperative sclerotherapy in a significantly higher percentage in comparison to non-vascular surgeons . DISCUSSION: In contrast to the results of British and Irish surveys, Italian phlebologically-active physicians perform a remarkably higher percentage of perioperative sclerotherapy. Postoperative sclerotherapy is administered after 2,3±1,9 months. Private practitioners sclerose significantly earlier and more often compared to the in hospital operators. Postoperative sclerotherapy can be considered an adjuvant therapy in order to improve the surgical result and may be called "adjuvant sclerotherapy" in order to distinguish it from "sclerosurgery" or " sclerostripping", which are performed intraoperatively. CONCLUSIONS: The answers of 103 partecipants give an acceptable overview on the current behavior of phlebologicallyactive physicians in private and public practice, in Italy. Perioperative sclerotherapy seems widely used, mainly as postoperative sclerotherapy, but also as sclerosurgery and more seldom as adjuvant sclerotherapy, and may lead varicose vein surgery to more miniinvasiveness. The rationale of "sclerosurgery" is manifold.

Does routine completion angiogram during embolectomy for acute upper-limb ischemia improve outcomes?

BACKGROUND: Since 1963, Fogarty balloon catheter thromboembolectomy is usually adopted as the gold standard treatment for acute limb ischemia. As the success of the procedure depends on complete removal of all thromboembolic material, intraoperative arteriography can be used after arterial thromboembolectomy as a guide for extension of the procedure. It is still a matter of debate whether intraoperative angiography should be routinely performed in all cases or only in selected cases, depending on intraoperative findings, when the surgeon suspects an incomplete disobstruction. Most published evidence derives from analysis of lower-limb thromboembolectomies. The aim of our retrospective study was to elucidate the value of routine completion angiogram in acute arterial embolism of the upper limb. METHODS: Clinical and demographic data of 100 patients with acute embolic upper-limb ischemia were prospectively recorded during an 18-year period in a central hospital vascular unit setting. The relevance of intraoperative angiography was retrospectively analyzed. The procedures were divided into two groups: group A, when intraoperative angiography was performed in selected cases (selective angiography); and group B, when angiography was performed as a routine procedure in all cases (routine angiography). All factors associated with reocclusion and mortality were investigated to produce meaningful information that could assist the surgeon to predict outcomes. RESULTS: Cumulative reocclusion and mortality rates at 24 months were 14.0% and 70.0%, respectively. After upper-limb arterial embolectomy, the rate of extension of the procedure was significantly higher in group B than in group A (26.0% vs. 4.0%, P = 0.002). At 24 months after embolectomy, group B resulted in a lower incidence of reocclusion compared with group A (12.0% vs. 2.0%, P = 0.05), whereas there was no statistical difference between the two groups in terms of mortality (P > 0.05). On univariate analysis, the factor associated with increased 2-year reocclusion rate was only the avoidance of completion angiography, although it lost some of its predictive value on multivariate analysis. Factors associated with increased 2-year mortality rate on univariate analysis included age >80 years, diabetes mellitus [DM], and antiplatelet drug use. Only DM was significantly associated on multivariate analysis. CONCLUSION: Routine use of intraoperative angiography influences outcome after embolectomy for upper-limb acute arterial occlusion. Routine use of intraoperative angiography, compared with selective use, results in a higher rate of extension of the procedure for residual lesion and in a lower rate of reocclusion at 24 months. In prevention of reocclusion, completion angiogram has a hazard ratio of 5.44 on multivariate analysis. Postoperative late mortality is mainly affected by old age and DM.

The posterior approach in the treatment of popliteal artery aneurysm: feasibility and analysis of outcome.

BACKGROUND: This review evaluates the results of our 18-year experience with surgical treatment of popliteal artery aneurysms (PAAs), examining the effects of the variables of clinical presentations, surgical technique, graft material, and runoff on operative results in the management of popliteal aneurysms. METHODS: We reviewed 49 PAAs consecutively repaired in 35 patients. We preferentially use, if possible, the posterior approach for repair of popliteal aneurysms. We repaired aneurysms passing above the Hunter canal using a medial approach to allow for adequate exposure of the proximal neck of the aneurysm. We separately analyzed the results of patients who underwent the posterior approach (group A) and those that underwent the medial approach (group B). Primary, primary assisted, and secondary patency were established using life-tables analysis. RESULTS: In our experience, the posterior approach was used in 38 repairs (77.6%), followed by graft interposition (group A). PAAs were asymptomatic in 29 (59.2%) of 49 cases. Among 20 symptomatic PAAs, nine (18.4%) caused intermittent claudication, one (2.0%) caused rest pain and trophic wound, and the remaining 10 limbs (20.4%) presented with acute ischemia and limb threat. A total of 11 popliteal aneurysms (22.4%) required repair with a medial approach (group B) because the extension of the aneurysm was proximal to the adductor hiatus. The primary patency rates at 6 and 8 years were 94.3 and 83.8%, respectively, for group A and 100% (p = .43) and 19.1% (p = .001) for group B, the respective assisted primary patency rates were 97.3 and 86.3%, in group A and 100% (p = .43) and 19.1% (p = .001) for group B. The secondary patency rates at 6 months and 8 years were 97.3 and 97.3%, respectively, in group A and 90.9% (p = .34) and 77.9% (p = .05) in group B. Amputation occurred in two (4.1%) of 49 limbs and 30-day postoperative mortality was 2.0% (1/49 patients). There was no statistical difference in amputation rate in symptomatic and asymptomatic limbs, and in group A and B. CONCLUSION: We believe that the posterior approach is the gold standard surgical therapy to treat PPAs not extending above the Hunter canal. In our experience, the posterior approach was possible in 77.6% of cases. It has excellent patency and prevents further aneurysm expansion by completely interrupting the collateral circulation to the aneurysm sac. In contrast, the posterior approach had a slightly higher tibial nerve injury (p = .43), especially during the learning curve. The preoperative symptoms and the use of venous material for reconstruction affect significantly long-term patency.

Asleep-awake-asleep technique during carotid endarterectomy: a case series.

OBJECTIVE: Carotid endarterectomy (CEA) has become one of the most common vascular procedures in the world. It can be performed both under general anesthesia (GA) and regional anesthesia (RA). The aim of this study was to present results of a technique for CEA in which the patients anesthetized with target-controlled infusions of propofol and remifentanil were awake during the endarterectomy phase. Neurologic function was evaluated as if under RA. Patient satisfaction and the incidence of major complications also were investigated. DESIGN: A prospective nonrandomized case series. SETTING: A single-institution, regional hospital. PARTICIPANTS: One hundred eight patients with carotid artery stenosis undergoing CEA. INTERVENTIONS: Anesthesia was induced using TCI remifentanil at an initial effect-site concentration of 3 ng/mL and propofol TCI at an effect-site concentration of 2.5 to 3 microg/mL. Both drugs gradually were reduced shortly before the clamping phase until the patients were awake. The patients were asked to squeeze a child's toy placed in the contralateral hand from the side of the operation. If a deficiency of motor function occurred, the level of anesthesia was increased and a shunt was inserted. When the carotid artery was unclamped and there was no evidence that any other neurologic deficiency had occurred, both propofol and remifentanil infusions were increased until the patient fell asleep. MEASUREMENTS AND RESULTS: Seventeen patients (15.7%) developed a neurologic deficiency within 13 minutes of the carotid artery clamping, which required a shunt. All patients were interviewed the next day; 2 patients (1.8%) felt a sense of anxiety when the technique was explained to them. No patients suffered from anxiety or agitation during the intraoperative awakening. One patient (0.9%) complained about discomfort because of the orotracheal tube, and 2 patients suffered from slight pain. One patient (0.9%) suffered from angina pectoris the following day, but no other major complication occurred. Six months later, a telephone interview was held with the patients included in the study; 5 had died and 2 had had a stroke within this period. All the interviewed patients judged this technique good, and they would recommend it to other patients. CONCLUSIONS: Although this is a case series, the authors believe that this technique combines the advantages of RA (good evaluation of the patients' neurologic status) and GA (patients relaxed and comfortable). Moreover, the analysis of the results of the questionnaire suggests that the patients can tolerate the operation awake under propofol and remifentanil, and major complications also were low. It can be concluded that this technique appears to be safe and well accepted by patients and could be a good alternative in patients in whom RA cannot be performed.

Routine versus selective use of intraoperative angiography during thromboembolectomy for acute lower limb ischemia: analysis of outcomes.

BACKGROUND: The success of thromboembolectomy for acute lower limb ischemia depends on the complete removal of all thromboembolic material accessible to the Fogarty catheter. Intraoperative arteriography can be used during arterial thromboembolectomy as a guide for extension of procedure to ensure complete clearance of the arterial tree and distal patency. However, it is still matter of debate if intraoperative angiography should be routinely performed in all cases or only in selected cases, depending on intraoperative findings, when the surgeon suspects an incomplete desobstruction. METHODS: Details of 380 thromboembolectomies in 361 patients with acute lower limb ischemia due to native vessel occlusion were prospectively recorded over a 12-year period in a central hospital vascular unit setting. The relevance of intraoperative angiography was retrospectively analyzed. The procedures were divided into two groups: group A, when intraoperative angiography was performed in selected cases (selective angiography), and group B, when angiography was performed as a routine procedure in all cases (routine angiography). Thrombectomy and embolectomy cases were separately analyzed. RESULTS: "On-table" angiography was used in 57 (26.4%) of 216 cases in group A and in all 164 cases (100%) of group B. Included in this study were 225 embolectomies and 155 thrombectomies of native vessels. After thrombectomy, the adoption of routine intraoperative angiography (group B) resulted in a statistically significant higher intraoperative reintervention rate than did selective intraoperative angiography (group A) (53.4% vs. 29.9%; p < 0.05). Also, after embolectomy extension of procedure, the rate was higher in group B than in group A (17% vs. 9.2%), but it did not reach statistical significance (p > 0.05). Considering the overall casuistic, at 24 months after thromboembolectomy, group B resulted in a lower incidence of reocclusion in comparison with group A (p < 0.05), whereas there was no statistical difference between the two groups in terms of amputation (p > 0.05) or of mortality (p > 0.05). Considering separately patients treated by embolectomy and by thrombectomy, reocclusion rate at 24 months was lower in group B than in group A, after thrombectomy and after embolectomy, with a statistical significance (p < 0.05). Amputation rate at 24 months was similar in group A and group B after embolectomy (10.7% vs. 8.9%; p > 0.05). After thrombectomy, there was in group B a slight advantage in comparison with group A, although not reaching statistical significance (31.3% vs. 46.2%; p > 0.05). There was no difference in mortality rate according to treatment group. CONCLUSION: Routine use of intraoperative angiography influences outcome after thromboembolectomy for lower limb acute arterial occlusion. Routine use of intraoperative angiography, compared with selective use, results in higher rate of extension of the procedure for residual lesion and in a lower reocclusion rate at 24 months.

Surgical resection and survival of patients with unsuspected single node positive lung cancer (NSCLC) invading the descending aorta.

BACKGROUND: Surgical treatment of non-small cell lung cancer (NSCLC) with aortic invasion is still debated. METHODS: Thirteen patients with locally advanced (T4) NSCLC and invasion of the descending aorta underwent pneumonectomy (n=9) or lobectomy (n=4) together with aorta en bloc resection and reconstruction (n=8) or subadventitial dissection (n=5), complete lymph node dissection, and had microscopic unsuspected node metastasis at N1 (n=5) and N2/3 (n=8) levels of whom 12 received radiation therapy. Clamp-and-sew was used to resect and reconstruct the aorta. RESULTS: Operative mortality and morbidity rate was 0% and 23%, respectively. Four patients died of systemic tumor relapse and 2 of local recurrence. Six patients were alive after a median follow-up of 40 months (range 15-125 months). Overall 5-year survival rate was 45%. Median survival time and 5-year survival rate of patients after aortic resection was 35 months and 67%, respectively, and was 17 months and 0%, respectively, after aortic subadventi-tial dissection (p=0.001). N1 and N2 nodal status adversely affected survival, but survival difference was not significant (N1 versus N2/3; 52% versus 39% at 5 years; p=0.998). CONCLUSIONS: Aortic resection with single station node positive T4 lung cancer can achieve long-term survival. The data indicate that aortic resection-reconstruction is associated with better outcome than subadventitial dissection.

[Leg ulcer: proposal of a new method for comparing different wound dressings]. / Ulcere della gamba: proposta di un nuovo metodo per confrontare medicazioni differenti.

The study proposes a new method for measuring peripheral trophic lesions (leg ulcers) of the same patient medicated with different type of dressing, avoiding errors of evaluation due to comparing different patients who generally present different concomitant pathologies and aetiologies wigh are hard to compare. We studied the wound care of 11 patients with leg ulcers. Half of the ulceration was treated with a traditional dressing (group A) and the other half with a more advanced type of dressing (group B). We first photographed the ulceration at a predefined distance an then the ulcer was separated in two identical parts and measured with millimetre paper. The limits and sides of each part were marked with a indelible marker pencil. The dressings were changed at regular interval and the ulcers were re-measured and photographed every week from the same distance. We examined 19 ulcers of the 11 patients (7 men, 4 women; mean age: 71 years). Although wound healing appeared to be faster in group B, the difference was not statistically significant (p = 0,246), but the aim of the study was not to explore the difference or otherwise in healing rate between two dressings. The study confirms that this method enables the physician to compare two different wound care dressings on the same ulcer. Interpatient variability is thus avoided by applying the dressings to the same ulcer. Changes in ulcer size are easily monitored and the statistical analysis of the areas compared allows objective assessment of the wound treatments, avoiding the common bias due to comparing different ulcers on different patients with different underlying pathologies.

[Ascending thrombophlebitis of the greater saphenous vein: proposal of a new morphological classification]. / La tromboflebite ascendente della vena safena magna: proposta di una nuova classificazione morfologica.

Superficial thrombophlebitis has been considered a self-limiting, benign disease without any significant incidence of morbidity or mortality. Thrombosis of the saphenous vein close to the deep venous system is a potentially dangerous clinical situation that may progress to deep venous thrombosis and pulmonary embolism. We retrospectively analysed 32 patients with ascending thrombophlebitis of the proximal greater saphenous vein who underwent emergency surgical ligation of the saphenofemoral junction. In 3 patients (9%) a femoral thrombectomy was performed because we observed an extension of the thrombus to the femoral vein intraoperatively. The postoperative morbidity and mortality rates were 0%, while the incidence of postoperative pulmonary embolism was 3%. In our opinion, emergency surgical ligation of the saphenofemoral junction is a valid alternative to medical treatment for thrombophlebitis of the proximal greater saphenous vein. At the moment no randomised comparison of the efficacy of different treatments tested in a large series is available. According to our experience and on the basis of the anatomical and haemodynamic studies conducted by Bisacci and Genovese, we have identified 2 different types of thrombophlebitis of the proximal greater saphenous vein, which require different treatments. In type 1, the thrombus does not reach the pre-ostial valve; simple ligation of the saphenofemoral junction after its opening is necessary. In type 2, the thrombus goes beyond the pre-ostial valve; thrombectomy, saphenofemoral disconnection and postoperative anticoagulation are mandatory.

Surgical management of hepatic artery aneurysm: a case report.

Hepatic artery aneurysms are uncommon and account for 20% of splanchnic artery aneurysms. The real incidence is unknown, but it is estimated to be 0.4% or less. Therapeutic procedures can be performed either surgically or as endovascular treatment. We report a case of a 77-year old man who was referred to our institute for an asymptomatic atherosclerotic hepatic artery aneurysm, measuring 4.5 cm in diameter, without evidence of dissection or rupture, involving the common and the proper hepatic artery. Resection of the aneurysm was performed, and the gastroduodenal artery was ligated. Reconstruction consisted in placement of an end-to-end prosthetic graft between the origin of the common hepatic artery and the distal third of the proper hepatic artery. An intraoperative arteriogram revealed a complete interruption of flow in the left hepatic artery. Intraoperatively, dissection of the left hepatic artery was revealed. Therefore the left hepatic artery was ligated and a new end-to-end prosthetic graft was performed between the origin of the common hepatic artery and the right hepatic artery. The postoperative course was complicated by respiratory failure requiring ventilator-assisted breathing. The patient was subsequently weaned from the ventilator and was discharged to our ward 4 days after surgery. No long-term hepatic or pancreatic complications were detected.

Erlotinib in advanced well-differentiated thymic carcinoma with overexpression of EGFR: a case report.

AIMS AND BACKGROUND: Advanced chemorefractory epithelial thymic tumors are still a challenge in clinical oncology. A therapeutic approach targeting a key molecular pathway could be the ideal solution in a neoplasm that can overexpress epidermal growth factor receptor (EGFR) in the epithelial component. METHODS: A patient with metastatic heavily pretreated thymic carcinoma was evaluated for EGFR expression in the primary tumor. RESULTS: Strong EGFR expression was revealed by immunohistochemistry. The patient received erlotinib therapy but had obtained no response after four months of treatment. CONCLUSION: This preliminary experience suggests that erlotinib may not be a useful therapeutic choice in advanced pretreated thymic carcinomas.

[Video-assisted thoracoscopic biopsy in the diagnosis of idiopathic interstitial lung disease]. / Biopsia chirurgica nella diagosi della fibrosi polmonare idiopatica in VATS.

Surgical lung biopsy is indicated in the diagnosis of idiopathic interstitial lung disease in more than 30% of patients. Our study analyses the technical evolution of the surgery during recent years in our department and the results of thoracoscopic lung biopsy. We retrospectively analysed 31 consecutive patients who underwent thoracoscopic lung biopsy from Jan. 1 2000 to Dec. 31 2004; 16 were male and 15 female with a mean age of 58.17 +/- 11.84 years. From September 1991 to December 1999 we performed another 40 lung biopsies. The SPSS software package was used to process the data. All patients but one underwent bronchial lavage and transbronchial biopsy preoperatively, without obtaining a correct diagnosis. Surgical biopsy findings were diagnostic in all patients. The conversion rate to thoracotomy was 20.7%. The mean operative time was 67.9 +/- 16.7 minutes and a mean number of 2.4 +/- 0.8 wedge lung biopsies were performed. The mean chest drain duration and hospital stay were 6.0 +/- 4.7 days and 7.9 +/- 4.7 days, respectively. The perioperative minor complication rate was 6.9% and the mortality rate 0%. Our results confirm that thoracoscopy has a diagnostic accuracy of 100% with low complication and mortality rates. These results compare well with those of open lung biopsy.

Candida sepsis following infected iliocaval thrombosis: a case report.

The authors report the case of a patient who developed a thrombosis of the right iliac vein involving also the inferior vena cava (IVC), in association with Candida sepsis. Despite adequate and prolonged antimycotic treatment, the patient recovered from the fungal sepsis only following the surgical removal of the infected thrombus.

[Causes and treatment of recurrent varices of the lower limbs]. / Cause e trattamento delle varici recidive degli arti inferiori.

Recurrence of varicose veins following surgery is a common, complex and costly problem in vascular surgery. The aims of our study were to determine the causes of recurrent varicose vein disease, to compare the preoperative duplex ultrasound findings with surgical findings, and to evaluate the efficacy of our surgical policy. We retrospectively studied 49 limbs operated on for recurrent varicose veins. All patients were monitored 6 weeks and 6 months after surgery and then underwent clinical examination in June 2005. Preoperative duplex ultrasound showed 100% specificity and 97% sensitivity. The patients were operated on for recurrence 152.2 +/- 95.5 months after the primary operation. The incidence of postoperative minor complications was 8.1% and of re-recurrence 10.2%. In 73.5% of patients during surgical re-exploration of the groin we found one or more tributaries of the great saphenous vein/common femoral vein, producing reflux. In 90.1% of cases we also treated incontinent perforator vessels. We recommend surgical re-exploration of the sapheno-femoral venous junction and thorough preoperative study of the perforator vessels in all patients with recurrent varicose veins.

The role of intraoperative angiography in arterial thromboembolectomy for non-traumatic acute upper limb ischaemia.

The aim of the study was to investigate the influence of intraoperative arteriography on the outcome of upper limb acute arterial thromboembolectomy. In a retrospective study, 63 thromboembolectomies were analysed in 59 patients with acute ischaemia of the upper limbs (51 embolectomies and 12 thrombectomies). In 19 interventions, intraoperative angiography was performed either routinely or because of difficulty in passing the Fogarty catheter and/or absence of backflow. No angiography was performed in 44 interventions because the surgeons were dubious as to the benefits of the procedure. In 6/19 cases (32%) intraoperative angiography led to an extension of the intervention, with 1 intraoperative transluminal angioplasty, 2 patchplasties, 4 distal thromboembolectomies and 2 thromboendarterectomies. In patients with embolic occlusion, the adoption of routine intraoperative angiography resulted in a significantly lower re-occlusion rate at 6 months in comparison with patients who were not submitted to angiography (P<0.05). Also in patients with thrombotic occlusion, the adoption of angiography resulted in a lower re-occlusion rate at 6 months compared to patients not submitted to angiography (P<0.05). There were no amputations at 1 month. We recommend intraoperative arteriography as a routine procedure due to its positive influence on the outcome of thromboembolectomy for acute upper limb ischaemia.