[Immediate reocclusion of the infrapopliteal segment after thrombolysis in acute ischemia of the lower limb of the thrombotic nature]. / La riocclusione immediata del segmento sottopopliteo dopo trombolisi nell'ischemia acuta dell'arto inferiore di natura trombotica.

Early reocclusion of below knee segment after fibrinolytic therapy is mainly due to thrombo-embolism, coagulopathy or to the arterial wall condition. 42 patients facing acute lower limb ischaemia because of iliofemoral thrombosis (prosthesis 19, native artery 23) underwent locoregional thrombolysis. UK was given in 33 cases while the others received rt-PA. The early reocclusion after fibrinolysis leads to a serious worsening in these patients; thrombosis in distal vessels and in microvasculature make any surgical approach unserviceable. Major amputation was required in 3 cases. We believe that fibrinolytic treatment has taken on great importance in making accurate diagnosing of thromboembolism and, once restored patency of distal vessels, allows to perform revascularization procedures.

[Composite bypass using endarterectomized autologous superficial femoral artery. A valid concept in the extension of lower limb salvage surgery]. / By-pass composito con arteria femorale superficiale autologa endoarterectomizzata. Un valido concetto nell'estensione della chirurgia di salvataggio dell'arto inferiore.

Saphenous vein is nowadays the material of choice performing on femoro-distal revascularisation; when this is not available, it is important to use a material which gives the closest approximation of an ideal conduit and for same time an easy handling during the execution of the anastomosis. Although vein's degenerative alterations are very rare, it has now been shown that there is widespread destruction of the endothelium among infrainguinal vein grafting, producing a relatively thrombogenic surface. These factors may contribute to the initial failure rate of these bypasses. For this reason we suggest to employ a segment of thromboendarterectomized SFA (superficial femoral artery) as a distal part of a composite bypass. Twenty-four composite bypasses were performed using three different methods over a total of 123 femoro-distal revascularizations. Eighteen months follow-up showed more than 50% and more than 75% patency rate comparing type B (graft or thromboendarterectomized SFA + autogenous saphenous vein) and type C (thromboendarterectomyied SFA + graft). We believe, waiting for a wider follow-up, that this technique could be a valid alternative to a femoro-distal revascularization when saphenous vein is not available.

Aneurysm of the abdominal aorta in a young woman. Atherosclerotic or inflammatory in origin?

The case is described of a 27 year old woman with aneurysms of the abdominal aorta. In the absence of any signs of atherosclerotic disease, an inflammatory aetiology was suspected, a view that was supported by the macroscopic intraoperative findings and preoperative autoimmune assays. The literature on this rare pathology is examined.