Stent-triggered 'electric shock' during leg bending 2 years after emergency iliac artery percutaneous revascularization.

We report a case of a 41-year-old woman who underwent surgical removal of an uterine leiomyoma, complicated by accidental injury of the left external iliac artery, treated by suturing. A few days after the intervention the patient was treated with emergency percutaneous stent implantation for acute thrombotic occlusion of the external iliac artery. Two years later, the patient began to complain of pain in the left leg, as an 'electric shock' sensation in the leg during squatting and leg adduction on the trunk. An angiographic control showed a critical in-stent restenosis at the level of a misplaced stent. Thus the patient was submitted to surgical exploration and stent removal.

Functionalization of poly-(L-lactic-co-epsilon-caprolactone): effects of surface modification on endothelial cell proliferation and hemocompatibility [corrected].

A copolymer of L-lactic acid and epsilon-caprolactone (PLLACL) was synthesized with the aim of preparing a bioartificial, small-diameter and partially resorbable vascular graft. The material was submitted to surface functionalizations (i.e. chemical modification by means of hydrolytic 'etching' and plasma discharge) to promote endothelial cell (EC) adhesion and growth avoiding platelet adhesion or coagulation factor absorption. Furthermore, the behaviour of human microvascular endothelial cells (HMVEC) seeded on the untreated and treated copolymer is described, as well as the platelet adhesion and the modifications of coagulation factors determined by the copolymer itself. PLLACL in its native state provided little support for EC adhesion. Improved EC adherence was obtained when functional groups were provided on the polymer surface by surface chemical hydrolysis. HMVEC seeded and cultured on the polymer surface did not show any ultrastructural alteration, thus demonstrating the absence of the polymer cytotoxicity. Moreover, SEM analysis performed on cold plasma modified specimens showed the presence of a subconfluent monolayer of EC, with an elongated spread morphology. Both the untreated and treated copolymers induced only slight variations of platelet number, but determined the activated partial thromboplastin time (APTT) increase, due to factor XI reduction. Finally, a prototype of partially biodegradable vascular prosthesis was prepared with NaOH/HCl-treated copolymer. Pre-cultured HMVEC seeding of the prosthesis by means of a rotation device resulted in an almost completely coverage of the graft inner surface.

Renal anomalies in aortic surgery: contemporary results.

OBJECTIVE: The purpose of this study was to evaluate technical problems and results of surgical treatment of aortic disease associated with major renal anomalies. STUDY DESIGN: Renal anomalies observed during aortic procedures performed over a 19-year period were reviewed. Type of renal anomaly, diagnostic procedures, preoperative renal function, technique of vascular reconstruction, and management of the anomalous kidney were considered and correlated with peri-operative and long-term results. RESULTS: Eighteen patients (1.1%) with major renal abnormalities were found in our experience with more than 1650 aortic procedures. Of these, 10 involved horseshoe kidneys and 8 ectopic kidneys (3 pelvic, 3 lumbar, and 2 crossed ectopias). All elective cases were evaluated with computed tomography, urography, and angiography. Aortic reconstruction was performed in 17 patients for aortic aneurysm (1 urgent repair for rupture) and in 1 patient for obstructive disease. Surgical access was anterior transperitoneal in 16 patients and retroperitoneal/thoracoabdominal in 2. In 8 patients, reimplantation of 1 or both renal arteries was necessary. Division of the renal isthmus was necessary in 3 patients with horseshoe kidney. The perioperative mortality rate was 0%. Renal function was normal at discharge in all patients. At long-term follow-up (median, 5 years; range, 1 to 19 years) neither renal nor aortic complications were detected. In 15 of 17 patients, the aneurysm was confined to the abdominal aorta. CONCLUSION: Although infrequent, renal anomalies encountered during aortic surgery can be effectively treated with accurate diagnosis and preoperative planning.

Exercise renal scintigraphy shows renal ischemia in a transplanted kidney.

Exercise renography is essentially a research method to investigate hypertension and has very limited clinical application. Captopril renography has long been used to study renal artery stenosis causing hypertension with good results. The authors describe a patient with a transplanted kidney supplied by reversal of flow via the external iliac artery. A "steal phenomenon" of the kidney related to ambulation was considered likely. Ischemia of the transplanted kidney was revealed by exercise renography, which showed parenchymal trapping of radiotracer as a result of exercise.