A new strategy for treatment of a congenital arteriovenous fistula of the neck. Case report.

Congenital arteriovenous fistulas (AVF) without associated vascular malformations are uncommon. Only a very few cases of AVF have been reported in the neck. We describe our findings in a patient with AVF treated by a combined vascular and endovascular approach.

[Endovascular treatment of aneurysms in the elderly]. / Trattamento endovascolare degli aneurismi nell'anziano.

The constant increase in the median age over 80 requires more and more care from vascular surgeons to obtain better results in the treatment of aortic degenerative diseases. In the last years a remarkable improvement in the procedures of endovascular surgery of abdominal aortic aneurysms has been reached. Actually different prostheses are available for the treatment of aortic aneurysms. The early results of these procedures are similar to the traditional surgical techniques, but at the moment long term results are not yet available. The Authors underline the importance of a long term follow up to allow a correct evaluation of physiopathological modifications in the aortic circulation.

[Management of thoracic and thoraco-abdominal aneurysms in the elderly]. / Gestione degli aneurismi toracici e toraco-addominali negli anziani.

Repair of descending thoracic aneurysm or thoracoabdominal involves transient ischaemia of many organs with high risk of complications. The elderly patient may be more at risk depending on the presence or absence of significant comorbidity factors. Careful preoperative evaluation and patient selection considerably reduce the risk of operative mortality and morbidity. We review the management of thoracic and thoracoabdominal aneurysms in the elderly and briefly describe our surgical approach in order to minimize operative risk and improve surgical results.

[Carotid endarterectomy in the elderly]. / L'endoarterectomia carotidea negli anziani.

The elderly population has the highest risk for developing stroke and the annual death rate is some 394/100,000 population. Moreover, the elderly are the fastest growing segment in our society. In carefully selected patients carotid endarterectomy may provide to prophylaxis against stroke. With a careful selection, acceptable low operative motality and morbidity rates may be achieved, comparable to the 4.3% and the 2.3% of the Veterans Affair and ACAS studies, in which the patients' mean ages were 64.1 and 67 years respectively.

[Carotid body tumors: an analysis of 10 cases]. / Tumori del glomo carotideo: analisi di 10 casi.

Some problems of carotid body tumors regarding diagnosis and treatment are still controversial. From 1988 to 1998 we operated on 10 cervical paragangliomas in our Division of Vascular Surgery of Bari University. Three were bilateral and 2 were II Shamblin class. Seven tumors were considered familiar type (5 patients in the same family). Subadventitial dissection was performed in all cases after 4 vessel angiographies and Echo-dopplers. No complications occurred during the operation or post-operatively. Operative bleeding was reduced significantly by the use of subadventitial dissection which was accomplished in short times, thus avoiding more complicated and even hazardous techniques like clamping, sectioning or ligatures of the external carotid artery.

Femoro-femoral graft after unilateral obstruction of aorto-bifemoral bypass.

BACKGROUND: Thrombosis is the most frequent late complication of surgical procedures in the aortofemoral area. In the presence of aortobifemoral bypass, graft limb occlusion generally occurs within the first two years. Various techniques have been proposed to revascularize the ischemic limb. Personal experience in the treatment of occlusions of aorto-femoral bypasses branch by femoro-femoral bypasses is reported and the immediate and long-term results are analyzed. METHODS: The study was retrospective and the medium follow-up was 51 months (1-14 years). The patients were all operated from 1976 to 1995 in the Division of Vascular Surgery of the University of Bari. The group consisted of 40 patients affected by unilateral occlusion that occurred after aorto-femoral bypass. The femoro-femoral bypass was performed using non-ringed 6 or 8 mm Dacron prostheses; the proximal anastomosis was made a few cm above the femoral anastomosis of the permeable branch of the existing aorto-bifemoral bypass and the distal anastomosis on the cross-leg profunda femoris. Postoperative follow-up consisted of clinical examination, continuous wave Doppler examination or US-color-Doppler scan in order to assess the permeability of the graft. RESULTS: The immediate results showed 2 and long-term results 9 occlusions of the bypass. No perioperative mortality was observed. CONCLUSIONS: In conclusion the authors consider the use of femoro-femoral bypass indicated in a high number of patients affected by unilateral occlusion of the aorto-bifemoral bypass.

[Percutaneous transluminal angioplasty in the treatment of occlusion of the subclavian artery. Preliminary results]. / L'impiego dell'angioplastica percutanea transluminale nel trattamento delle steno-occlusioni dell'arteria succlavia. Risultati preliminari.

BACKGROUND AND AIMS: The authors examine the treatment of steno-occlusive diseases of the subclavian artery using transluminal percutaneous angioplasty in order to evaluate the correct indications and analyse the results. METHODS: The classic method was used according to Gruentzig's technique, following the surgical isolation of the brachial artery. All 15 patients (11 males, 4 females, mean age 64 years old) were suffering from stenosis of the subclavian ischemia during physical exercise (13), resting (2) or vertebrobasilar insufficiency. Diagnostic evaluation took the form of bilateral sphynghomanometric measurement, echo-Doppler of the cervico-brachial vessels when resting and during exercise, as well as selective arteriography in 13 cases. Intra- and postoperative arteriographic control was always performed and the method was declared successful if residual stenosis was less than 30% with a delta AP between the two lower limbs of less than 10 mmHg. Mean follow-up was 12 months. RESULTS: The immediate results included the onset of complications linked to hematoma of the arm and two small dissections of the subclavian artery which were treated conservatively. Residual stenosis, albeit not hemodynamically significant, appeared in 26.7% of patients (4 cases). One case of total occlusion without clinical symptoms and two non-hemodynamically significant re-stenoses were observed in the long term. CONCLUSIONS: The authors discuss the indications and results of this method and compare them with the data reported in the literature.

Pseudo-occlusion of the internal carotid artery: report of 15 cases and review of the literature.

Pseudo-occlusion of the internal carotid artery represents a difficult diagnostic problem. Meticulous investigation is mandatory whenever there is any suspicion of pseudo-occlusion, since it can easily be removed with endoarterectomy. Fifteen patients were selected in the last twelve years from those participating in a prospective study on the natural history of total occlusion of the internal carotid artery. The mean follow-up was 4.2 years (ranging from 1 to 12). Pseudo-occlusion was diagnosed by duplex examination in the presence of a continuous signal with filling in of the spectral waveform window and no pulsatile flow. Arteriography showed a segmental occlusion of the internal carotid artery with reconstitution of flow in the distal portion of the vessel. Operations were performed under general anesthesia with EEG monitoring. Intraluminal shunt was necessary in only one patient. Patch closure of the arteriotomy was performed in two patients. All patients were put on Ticlopidin "sine die" after the operation. No mortality or strokes occurred in the perioperative period. Two patients presented with ipsilateral TIA after 7 months and one year, respectively. We conclude that: the incidence of this disease is low; the performance of duplex scan in combination with arteriography is essential in order to obtain the diagnosis of pseudo-occlusion; a strong suspicion of carotid pseudo-occlusion should always spring to mind when an apparently occluded carotid artery continues to be symptomatic or when, in asymptomatic patients, there is some discordance between angiography and Doppler or duplex scan findings; pseudo-occlusion should be considered an indication for urgent operation only in selected symptomatic patients.

Plasma lipids as a risk factor in peripheral vascular disease.

Plasma lipids were tested in 59 patients with symptomatic peripheral vascular disease (PVD) (confirmed by angiographic and, in many cases, operative examinations) and compared with the lipid balance in 47 nonarteriopathic subjects constituting the control group. Of all the elements considered, only the hypertriglyceridemia and the fall in the HDL cholesterol/total cholesterol ratio showed a statistically significant difference between the two groups. In particular, there was a significant difference between the two groups. In particular, there was a significant difference in the triglyceridemia present in the arteriopathic patients, as evidenced by the double check afforded by the frequency test (PVD: 25/59; control: 8/47; p less than 0.01) and the averages test (PVD: 201 +/- 131; control: 138 +/- 98; p less than 0.01).