Retroperitoneal Aortobifemoral Bypass by a Combination of Horseshoe Kidney and Aortoiliac Occlusive Disease with Stent Thrombosis.

Bilateral aorto-profunda femoris bypass with Dacron bifurcation graft was performed by a patient with aortoiliac occlusive disease (AIOD) and horseshoe kidney (HSK) who had undergone stenting of the right common iliac artery and of the left superficial femoral artery with subsequent stent thrombosis as well as significant subrenal aortic stenosis. As endovascular treatment was not feasible and surgical treatment by means of transperitoneal incision would be associated with high risk of damage to the HSK, the operation was successfully accomplished through left pararectal retroperitoneal approach.

Surgical Treatment of a Patient With Nutcracker Syndrome via Transposition of the Left Renal Vein.

INTRODUCTION: Nutcracker syndrome (NCS) is caused by compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery (SMA) where it passes in the fork formed at the bifurcation of these arteries. NCS leads to LRV hypertension, resulting in left flank and abdominal pain, with or without haematuria and pelvic ureteral varices. REPORT: The patient was a young female with diagnostic criteria of NCS, with severe clinical manifestations. The patient underwent transposition of the LRV approximately 3.0 cm below the original anatomic site and was anastomosed to the inferior vena cava (IVC) outside the meso-aortic compression zone. CONCLUSION: Although NCS is not as common as other clinical scenarios, it may be encountered by physicians in a variety of disciplines, and can cause substantial morbidity and mortality rates. This report addresses the surgical approach used in a particular case, as well as the possible complications and outcomes if not treated in due time.

Arterialized cephalic vein as a femoropopliteal bypass graft: A case report.

The overall therapeutic strategy in patients with diabetes mellitus and peripheral arterial disease affecting several arterial segments is problematic. Usually, the greater saphenous vein (GSV) is the gold standard for bypass. However, alternative venous grafts may be necessary when the GSV is not available. The superficial veins of the arm are not suitable for bypass operations in most cases because of anatomical variations, inadequate diameter or very thin walls. However, arterialization of the cephalic vein can dilate and strengthen the walls, thus avoiding postoperative complications. The present patient, whose case was followed for 20 months postoperatively, suffered both from diabetes and peripheral arterial disease in a setting of gangrene and a lack of the GSV. The treament of the patient and the problems it incurred are discussed. The advantages of preoperative temporary arteriovenous shunting to improve the quality of the cephalic vein as an alternative autogenous graft are analyzed. Currently, the patient has excellent postoperative results, with healing of the ulcers and preserved peripheral pulses.