Pseudoaneurysm of the popliteal artery in a child: an unusual complication of reconstruction of traumatic tibial fracture using Kirschner wire.

Kirschner pins are being increasingly used by orthopedic surgeons in the treatment of skeletal fractures after severe bodily injuries. As a result, there have been reports in the literature about the various complications caused by the Kirschner pin, such as wound laceration or hematoma. However, to our knowledge, pseudoaneurysm of the popliteal artery due to Kirschner pin in the late postoperative period has not been reported previously in the English literature. Herein, we present a child with pseudoaneurysm of the popliteal artery after reconstruction of a tibia fracture using Kirschner pin insertion.

Hyaluronan based heparin free coated open and closed extracorporeal circuits for high risk coronary revascularization.

This prospective randomized study compares the inflammatory response and fibrinolytic activation of fully coated/uncoated and open/closed extracorporeal circuits (ECC) in high risk patients. Over a 2-month period, 48 patients with EuroSCOREs 6 or greater undergoing coronary revascularization were prospectively randomized to one of the four perfusion protocols: Group 1: Closed and totally hyaluronan based heparin free coated (Vision HFO-GBS-HF, Gish Biomedical, Rancho Santa Margarita, CA) ECC with a soft-shell coated venous reservoir (SVR11S2-HFC, Gish Biomedical) and a hard-shell cardiotomy (CAPVRF44, Gish Biomedical) (n = 12); Group 2: Closed and totally uncoated identical ECC with soft-shell uncoated venous reservoir and a hard-shell cardiotomy (n = 12); Group 3: Open, totally hyaluronan based heparin free coated ECC (n = 12); and Group 4: Control-open, uncoated ECC (n = 12). Blood samples were collected at T1: Baseline; T2: 15 minutes after cardiopulmonary bypass (CPB) initiation; T3: before cessation of CPB; T4: 15 minutes after protamine reversal, and T5: in the intensive care unit. Serum IL-6 levels were significantly lower at T2 in all study groups, at T3 for coated groups, and T4 for closed+coated group (p < .05 versus control). Creatine kinase M-band (MB) levels in coronary sinus blood demonstrated well preserved myocardium after CPB in both coated groups versus Control (p < .05). Neutrophil CD11b/CD18 levels were significantly lower for all study groups versus control at T2, for both coated groups at T3 and only for closed + coated group at T4 (p < .05). Postoperative hemorrhage (mL) was 510 +/- 40 in closed + coated and 536 +/- 40 in open + coated groups (control: 784 +/- 48, p < .05). No significant differences in thrombin-antithrombin complex and free plasma hemoglobin were observed. Desorbed protein amount on ECC (mg/dL) was 1.7 +/- .01 in closed+coated, 2.01 +/- .01 in open+coated, and 3.3 +/- .015 in control groups (p < or = .05). Use of a closed and completely heparin free coated ECC may reduce neutrophil degradation, cytokine release characterized by improved clinical outcomes including reduced blood loss, reduced requirement for inotropes, and reduced atrial fibrillation.

Ruptured type B aortic dissection presenting with right hemothorax.

We report a patient with type B aortic dissection which ruptured into the right hemithorax to call attention to this infrequent presentation and to accentuate the value of computed tomography angiography (CTA) with multiplanar reformatting in localizing the dissection and demonstrating the rupture site. CTA in combination with 2- and 3-dimensional reformatting is crucial for surgical planning because of the low specificity of transesophageal echocardiography in the ascending aorta.

Stent-graft applications in peripheral non-atherosclerotic arterial lesions.

PURPOSE: To retrospectively evaluate peripheral arterial lesions treated with stent-grafts in various territories and to identify the role of computed tomography angiography (CTA), both in diagnosis and follow-up. MATERIALS AND METHODS: The study included 19 patients (11 male, 8 female) aged between 24 and 85 years. In all, 24 stent-grafts were used to seal an extravasation in 3 patients, a pseudoaneurysm/aneurysm in 12 patients, and an arteriovenous fistula in 4 patients. Self-expandable and balloon-expandable stent-grafts were used, all of which were covered with polytetrafluoroethylene material. Iatrogenic etiologies were responsible in 11 of the patients. In total, 5 superficial femoral, 2 deep femoral, 4 external iliac, 3 common iliac, 1 common carotid, 1 internal carotid, 1 subclavian, 1 renal artery, and 1 thyrocervical trunk lesion were treated. RESULTS: The technical success rate was 100%, with no periprocedural complications. Mean follow-up was 18 months (range: 1-72 months). CTA was performed in 10 patients for diagnosis and in 7 patients for follow- up. There was no stent migration, but 1 stent crush. The total vessel occlusion rate was 16.6%, all diagnosed using CTA. CONCLUSION: Stent-graft applications offer quick, single-step treatment, with few procedural complications. However, long-term durability remains a major concern. CTA is a very valuable tool, both for diagnosis and follow- up. Pseudoaneurysms and extravasations can be demonstrated successfully, as well as incomplete arteriovenous fistula closure, and patent or occluded stent-grafts.