Pseudoaneurysm of the popliteal artery due to osteochondroma of the distal femur.

Osteochondroma is the most common type of benign bone tumour, and is most often found in the knee region. The lesion is usually clinically silent although it may cause different complications such as fractures of the tumour, bone deformities, neurological disorders, malignant transformation and in rare cases vascular disorders. Vascular disorders include stenosis, occlusions, thrombosis, arteriovenous fistula and in rare cases pseudoaneurysm formation. A delay in diagnosis especially of pseudoaneurysm formation may result in life-threatening situations, extensive operations and lengthy hospital stays. We report the case of a 22-year-old woman with an osteochondroma of the distal femur which caused pseudoaneurysm of the popliteal artery.

[Inflammatory aortic aneurysms: Single center experiences with endovascular repair of inflammatory abdominal aortic aneurysms]. / Inflammatorische Aortenaneurysmen: Single-center-Erfahrungen nach endovaskulärer Ausschaltung inflammatorischer Bauchaortenaneurysmen.

We report our single center experience of renal function, hydronephrosis and changes in perianeurysmal fibrosis (PAF) after endovascular repair (EVAR) of inflammatory abdominal aortic aneurysms (IAAA). A total of 6 patients were treated for IAAA with EVAR and the technical success was 100%. During the follow-up period 5 patients showed regression of PAF and 1 patient showed minor progression of PAF on computed tomography scans. In 2 patients hydronephrosis was regressive postoperatively but no patients died within 30 days. There were no secondary complications to report and no secondary intervention was necessary. In the long-term course one patient exhibited complete regression of PAF.In appropriate cases EVAR is a safe method for aneurysm repair for IAAA. In patients with acute inflammation or hydronephrosis individual treatment concepts are required.

Thoracic outlet syndrome: do we have clinical tests as predictors for the outcome after surgery?

OBJECTIVE: Thoracic outlet syndrome (TOS) is a clinical phenomenon resulting from compression of the neurovascular structures at the superior aperture of the thorax which presents with varying symptoms. Regarding to the varying symptoms, the diagnosis of TOS seems to be a challenge and predictors for the outcome are rare. The purpose of this study was therefore to analyze the different clinical examinations and tests relative to their prediction of the clinical outcome subsequent to surgery. METHODS: During a period of five years, 56 patients were diagnosed with TOS. Medical history, clinical tests, operative procedure and complications were recorded and analysed. Mean follow-up of the patients was 55.6 +/- 45.5 months, median age of the patients was 36.4 +/- 12.5 years. RESULTS: Different clinical tests for TOS showed an acceptable sensitivity overall, but a poor specificity. A positive test was not associated with a poor outcome. Analyses of the systolic blood pressure before and after exercise showed, that a distinct decrease in blood pressure of the affected side after exercises was associated with a poor outcome (p = 0.0027). CONCLUSIONS: Clinical tests for TOS show a good sensitivity, but a poor specificity and cannot be used as predictors for the outcome. A distinct decrease in blood pressure of the affected side after exercises was associated with poor outcome and might be useful to predict the patients' outcome.

[Multidetector computed tomography in the diagnosis of non-traumatic vascular emergencies]. / MDCT zur Diagnostik nichttraumatischer vaskulärer Notfälle.

Radiological imaging of the vascular system is an essential component in the clinical evaluation of vascular emergencies. Duplex ultrasound is still in use as a basic diagnostic means and enables initial diagnostic information. Digital subtraction angiography (DSA), the longtime gold standard, is now more often used with therapeutic interventions rather than purely diagnostic studies. However, over the past 10 years, there has been a rapid development of new technology that has deeply changed vascular imaging and allows a non-invasive depiction with a robust technique, greater speed and higher resolution. Advanced cross-sectional imaging techniques such as magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) angiography nowadays enable a dedicated diagnostic evaluation of acute aortic and peripheral arterial pathologies. Due to its enormous innovation and broad and quick availability angiographic multidetector computed tomography (MDCT) could replace catheter-based angiography in the diagnostic assessment. This article summarizes the performance of MDCT angiographic imaging and its diagnostic and therapeutic significance for the diagnostic assessment of non-traumatic aortic and peripheral arterial diseases.

Investigation on radiofrequency and laser (980 nm) effects after endoluminal treatment of saphenous vein insufficiency in an ex-vivo model.

OBJECTIVES: An ex-vivo model for the experimental evaluation of endoluminal thermal procedures for occlusion of saphenous veins was developed. Radiofrequency obliteration (RFO) and endovenous laser therapy (ELT) were compared using this model. DESIGN: Experimental ex-vivo treatment study. MATERIALS AND METHODS: The model consists of the subcutaneous foot veins from freshly slaughtered cows which were reperfused in situ with heparinised bovine blood. The veins were treated with either radiofrequency (RFO n=5) or with endoluminal 980 nm laser light (ELT n=5) using a continuous pull-back for RFO and a stepwise illumination and pull-back protocol for ELT. Immediately after treatment perivenous tissue and veins were examined macroscopically. In a second study the same treatment parameters were used in four further vein segments with RFO (n=2) and ELT (n=2). These vein segments were examined microscopically in HE-stained histological sections. RESULTS: Induration of the vessel wall and contraction of the vessel lumen were observed after RFO. Laser treatment produced carbonised lesions of the vein wall. After 12-24 laser exposures these lesions often became transmural, causing complete perforation of the vessel wall. Histological evaluation after radiofrequency treatment demonstrated homogenous circular thermal tissue alteration with disintegration of intima and media structures. Histological evaluation after endovenous laser treatment showed large variations of thermal tissue effects. Tissue effects ranged from major tissue ablation and vessel wall disruption to minor effects located between laser exposures and on the opposite vessel wall. CONCLUSIONS: Our model is suitable for systematic scientific evaluation of endovenous thermal occlusion procedures. Our first results and theoretical considerations indicate that endovenous laser treatment should be modified in order to ensure controlled homogenous circular thermal damage, avoiding vessel wall perforation and damage to perivascular structures.

[Vascular injuries in extremities]. / Gefässverletzungen an den Extremitäten.

Vascular injuries of the extremities account for most instances of vascular trauma (ca. 70%), and they entail a risk of amputation about 10-20%. According to the kind of force that has acted, arterial trauma is classified as direct or indirect. The scale of hemorrhage and peripheral ischemia depend on the nature and severity of the arterial lesion. In patients with multiple injuries, routine use of Doppler sonography and duplex sonography can facilitate early diagnosis and treatment of vascular injuries. With great certainty, clinical examination and an AB or WB index of >1.0 can rule out the presence of vascular injury that requires treatment. After excluding further life-threatening injuries, surgery should be performed immediately when there is critical ischemia, squirting hemorrhage, or a rapidly expanding hematoma. Angiography or duplex sonography findings determine the further procedure in vascular injuries that do not require immediate treatment. Occlusion of a reconstructed artery, manifestation of a compartment syndrome, and insufficient anticoagulation are the main factors affecting the risk of amputation.