RESUMO
Femoropopliteal and femorocrural bypass, managed by "in situ" procedure with the use of angioscope, became a standard surgical method in the treatment of occlusive process in the arteries of lower extremities in the Department of Vascular Surgery, Clinical Hospital "Sestre milosrdnice" in Zagreb. The capabilities of angioscopy in diagnosis and in surgery are presented, with special emphasis on bypass "in situ" procedure. Technical difficulties encountered in bypass formation and our solutions are described. From December 1993 to December 1994, eleven patients were operated. Common femoral artery was used for proximal anastomosis in four patients. Superficial femoral artery was used in five patients, and profound femoral artery was used in two patients. The third segment of popliteal artery was used for distal anastomosis in five cases. In six cases crural bypass was done. Three of them were on posterior tibial artery, two were on fibular artery and one was on anterior tibial artery. Two out of four or 50% of femoropopliteal bypasses are patent after the first year. One patient died of cardiorespiratory complications in the early postoperative period. Femorocrural bypasses are patent in five out of six patients or 83.3%. Bypass with great saphenous vein "in situ" is the procedure of choice, especially in femorocrural position.
Assuntos
Angioscopia , Endoscopia , Perna (Membro)/irrigação sanguínea , Procedimentos Cirúrgicos Vasculares , Idoso , Feminino , Artéria Femoral/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/cirurgia , Artérias da Tíbia/cirurgia , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
The purpose of this article is to take firm position on the surgical treatment of the carotid artery aneurysm on the basis of ten years of experience, considering their rare occurrence and significant pathology. From January 1984 to December 1994, ten patients with aneurysms or pseudoaneurysms of extracranial carotid arteries were diagnosed and operated in the Department of Vascular Surgery, Clinical Hospital "Sestre milosrdnice" in Zagreb. In the same period, eight hundred operations of extracranial carotid arteries were performed. Special emphasis is put on the etiology of the disease where atherosclerosis is prevalent, but cases of traumatic, mycotic and postoperative aneurysms are also shown. In symptomatology, signs of palpable local tumor dominated in six patients, while in three patients central nervous system symptoms were found. All patients with neurologic symptoms were in the group with atherosclerotic aneurysms. In nine patients resection of the aneurysm and reconstruction with the interposition of a part of vena saphena magna or with allograft was performed. In one patient, neoanastomosis of the internal carotid artery in the common carotid artery was performed following the resection of a small aneurysm. In the early postoperative period there was no morbidity nor mortality. In view of frequent preoperative neurologic complications and good postoperative results, surgical treatment is indicated in all cases. Reconstruction is always indicated, and the procedure of choice is reconstruction with the interposition of a part of great saphenous vein.
Assuntos
Aneurisma/cirurgia , Doenças das Artérias Carótidas/cirurgia , Adulto , Aneurisma/diagnóstico , Aneurisma/etiologia , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Arteriosclerose/complicações , Arteriosclerose/diagnóstico , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
In order to evaluate the outcome of endarterectomy, we estimated the cerebral vasoreactive capacity in 3 main patient groups with carotid artery disease: A. occlusion, B. high-grade, and C. low-grade carotid stenosis. The results showed that certain proportion of patients with reduced CVC can be distinguished in the each investigated groups, indicating thus, those patients in whom endarterectomy can benefit. Our study provides evidence that acetazolamide test with TCD measuring may be used to assess the CVC before and after endarterectomy. Carotid endarterectomy improves CVC in patients who had compromised cerebral perfusion reserve before operation. We suggest that the endarterectomy can also benefit in the patients with carotid occlusion and low grade stenosis if CVC is estimated.
Assuntos
Estenose das Carótidas/fisiopatologia , Circulação Cerebrovascular , Endarterectomia das Carótidas , Acetazolamida/farmacologia , Idoso , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Estenose das Carótidas/cirurgia , Ecoencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-OperatóriosRESUMO
Records of perioperative complications following 407 consecutive carotid endarterectomies performed in 366 patients in the 18-year period have been presented. The complications are categorized according to the clinical stage of vascular disease, that is, according to the indications for the surgery. Out of the total number, 46 (11.3%) operations were done in the 1st, asymptomatic stage of disease, for the haemodinamically significant stenoses and ulcerated plaques; 173 (42.5%) in the 2nd clinical stage for hemispheral and nonhemispheral transient ishemic attacks (TIA) and reversible neurologic deficits (RIND); 3 (0.7%) in the 3rd stage which is a progressive cerebrovascular stroke and 185 (45.5%) in the 4th clinical stage of the disease, in patients with previous cerebral infarction and a permanent neurologic deficit. The rate of a temporary and permanent neurologic deficit, as well as mortality in the first stage of the disease equals zero. In the second stage of the disease, the rate of a temporary neurologic postoperative morbidity increases to 1.7%, of a permanent neurologic morbidity to 1.2%, while the rate of mortality is 1.2%. In the 3rd and 4th stage, those rates amount to 66.7%, 0% and 33.3%, and 1.1%, 3.8% and 1.6%, respectively. The rates of perioperative morbidity and mortality are in proportion to the scope of preoperative brain dysfunction. Results of this work suggest the necessity of categorization of patients, candidates for carotid endarterectomy, according to the clinical stage of the disease, which will enable a better comparison with other authors' results, give a more reliable view on the efficacy of the surgical treatment and justify the surgeons' attitude towards indications.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Artérias Carótidas/cirurgia , Transtornos Cerebrovasculares/patologia , Endarterectomia/efeitos adversos , Complicações Pós-Operatórias , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Cerebrovasculares/cirurgia , Feminino , Humanos , Ataque Isquêmico Transitório/patologia , Ataque Isquêmico Transitório/cirurgia , Masculino , Pessoa de Meia-IdadeAssuntos
Artéria Subclávia/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Adolescente , Adulto , Síndrome da Costela Cervical/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Síndrome do Desfiladeiro Torácico/patologiaAssuntos
Artéria Celíaca , Diafragma , Ligamentos , Adolescente , Constrição Patológica , Feminino , HumanosRESUMO
Some technical problems encountered in the thrombectomy of iliofemoral veins and in Palma's reconstruction of unilaterally occluded pelvic veins are presented. These surgical interventions give better results than conservative therapy and the authors especially recommend the use of temporary arterio-venous fistula. As the best results were achieved by this technique the authors recommend its use in all cases where it is not contraindicated (cardiopaths).