Superficial femoral vein graft interposition in situ repair for femoral mycotic aneurysm.

Femoral mycotic aneurysms require surgical treatment to prevent progressive sepsis and hemorrhage. Some surgeons recommend simple debridement and ligation of the femoral artery, whereas others recommend reconstruction in selected cases or all cases due to concerns about high risk of limb loss. In situ reconstruction has been discouraged due to concerns about anastomotic or graft disruption by persistent infection. However, the superficial femoral vein has been used successfully as an in situ replacement after removal of infected aortic prostheses. We present two patients with femoral mycotic aneurysms, both of whom were treated successfully with in situ reconstruction using autogenous superficial femoral vein.

Inflammatory and thrombotic blood markers and walking-related disability in men and women with and without peripheral arterial disease.

OBJECTIVES: To determine whether higher circulating levels of thrombotic and inflammatory markers are associated with greater disability. DESIGN: Cross-sectional. SETTING: Academic medical center. PARTICIPANTS: A total of 346 men and women with peripheral arterial disease (PAD) and 203 without PAD. MEASUREMENTS: Disability measures were the Walking Impairment Questionnaire (WIQ) distance, speed, and stair-climbing scores and the 36-item Short-Form (SF-36) physical functioning score. The SF-36 and WIQ are scored on a 0 to 100 scale (100=best). RESULTS: In persons with PAD, higher D-dimer levels were associated with lower WIQ speed scores (P<.001), lower stair-climbing scores (P<.04), and poorer SF-36 physical functioning scores (P<.01), adjusting for known and potential confounders. In participants without PAD, higher D-dimer levels were associated with lower WIQ distance scores (P<.03), lower speed scores (P<.05), and poorer SF-36 physical functioning scores (P<.02). Higher high-sensitivity C-reactive protein (hsCRP) levels were associated with lower WIQ distance (P<.02) and speed scores (P<.001) in persons without PAD. Most of these associations were attenuated after additional adjustment for objectively measured functional limitations. CONCLUSION: Higher circulating D-dimer and hsCRP levels are associated with greater disability in walking and physical functioning in individuals with and without PAD. Physiological changes that result in walking disability may mediate these associations.