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BACKGROUND: Injury to the popliteal artery after knee dislocation, if not promptly diagnosed and properly treated, can have devastating results. The purpose of this retrospective study was to describe the diagnostic and the treatment protocol we use, as well as provide long-term outcomes for a series of patients treated in our tertiary hospital, emphasizing on the importance of ankle-brachial index (ABI) measurement as an integral component of the diagnostic approach. METHODS: A retrospective analysis of all admissions to our hospital trauma center between November 1996 and July 2023, with a diagnosis of knee dislocation and the presence or absence of concomitant arterial injury resulting from blunt high-energy trauma, was conducted. Before 2006, digital subtraction angiography (DSA) and/or computed tomography angiography (CTA) were part of the diagnostic approach (group A). After 2006, the ABI was used as a first-line test to diagnose arterial damage (group B). The Tegner and Lysholm scores were chosen to assess patients' postoperative impairment between groups, taking also into account the presence or absence of vascular injury. The Mann-Whitney U test and a univariate analysis of variance were used for the statistical analysis of scores. RESULTS: Overall, 55 patients were identified, and 21 of them (38.2%) had injuries to the popliteal artery, all of which were treated with a reversed great saphenous venous bypass. Out of the 21 patients, 4 (4.3%) developed compartment syndrome, which was treated with fasciotomies, and 1 leg (1.8%) was amputated above the knee. With no patients lost to follow-up, all but one (95%) of the vascular repairs are still patent, and the limbs show no signs of ischemia after a mean follow-up of 6 years. The Tegner and Lysholm score means were similar between groups A and B and independent of the presence of vascular injury and the diagnostic protocol used. Interestingly, an ABI below 0.9 proved to be predictive of arterial injury. CONCLUSIONS: A high level of awareness for the presence of popliteal artery injury should exist and an ABI measurement should be routinely performed in the management of all cases of knee dislocation. This way, fewer patients will undergo unnecessary CTA scanning, and hardly any popliteal artery injuries can go missing, as suggested by our study.
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Background/Objectives: this systematic review aims to explore the efficacy and safety of the laparoscopic ligation of the inferior mesenteric artery (IMA) as an emerging trend for addressing a type II endoleak following endovascular aortic aneurysm repair (EVAR). Methods: A comprehensive literature search was conducted across several databases including Medline, Scopus, and the Cochrane Central Register of Controlled Trials, adhering to the PRISMA guidelines. The search focused on articles reporting on the laparoscopic ligation of the IMA for the treatment of a type II endoleak post-EVAR. Data were extracted regarding study characteristics, patient demographics, technical success rates, postoperative outcomes, and follow-up results. Results: Our analysis included ten case studies and two retrospective cohort studies, comprising a total of 26 patients who underwent a laparoscopic ligation of the IMA between 2000 and 2023. The mean age of the cohort was 72.3 years, with a male predominance (92.3%). The mean AAA diameter at the time of intervention was 69.7 mm. The technique demonstrated a high technical success rate of 92.3%, with a mean procedure time of 118.4 min and minimal blood loss. The average follow-up duration was 19.9 months, with 73% of patients experiencing regression of the aneurysmal sac, and no reports of an IMA-related type II endoleak during the follow-up period. Conclusions: The laparoscopic ligation of the IMA for a type II endoleak following EVAR presents a promising, minimally invasive alternative with high technical success rates and favorable postoperative outcomes. Despite its potential advantages, including reduced contrast agent use and radiation exposure, its application remains limited to specialized centers. The findings suggest the need for further research in larger prospective studies to validate the effectiveness of this procedure and potentially broaden its clinical adoption.
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Inibidores de Hidroximetilglutaril-CoA Redutases , Doença Arterial Periférica , Humanos , LDL-Colesterol , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/tratamento farmacológico , Pró-Proteína Convertases , SubtilisinasAssuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Stents , Feminino , Humanos , MasculinoRESUMO
BACKGROUND AND PURPOSE: ONP is a well-known presentation of PcomA aneurysms. Reports on recovery of ONP with endovascular coiling have been limited to small case series. We assessed the safety and efficacy of endovascular therapy in a series of PcomA aneurysms with ONP. MATERIALS AND METHODS: We reviewed 37 patients with ONP who underwent endovascular treatment in our institution between 2005 and 2011. Published studies were also reviewed to determine the overall rate of ONP recovery with endovascular therapy. RESULTS: Nineteen patients (51.4%) presented with complete ONP, and 18 (48.6%), with partial ONP. Conventional coiling was performed in 31 (83.8%) patients; stent-assisted coiling, in 4 (10.8%); and balloon remodeling, in 2 (5.4%). There was 1 (2.7%) procedural complication (a transient thromboembolic event). Twenty-seven (73%) patients were treated within 3 days from symptom onset. At the last available clinical follow-up, ONP resolution was complete in 14 (37.8%) patients and partial in 19 (51.4%). Only 4 (10.8%) patients showed no signs of nerve recovery. In multivariate analysis, partial ONP and longer follow-up durations were predictors of complete nerve recovery. Treatment timing, type of endovascular embolization, subarachnoid hemorrhage, and initial degree of aneurysm occlusion were not predictors of nerve recovery. Of 169 patients reported in the literature (including ours), ONP resolved completely in 73 (43.2%) patients and partially in 73 (43.2%). CONCLUSIONS: Endovascular therapy is a safe and highly efficient alternative to surgical clipping for PcomA aneurysms with ONP.
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Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Doenças do Nervo Oculomotor/complicações , Recuperação de Função Fisiológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do TratamentoRESUMO
This study reports on the frequency and management of aortocaval fistulas (ACFs) in our department between 1998 and 2009. Overall frequency of ACFs among ruptured abdominal aortic aneurysms was 5.5%. Patients presented with low back pain (92.8%), abdominal tenderness (78.6%), hemorrhagic shock (28.6%), congestive heart failure (21.4%), dyspnea (42.8%), and palpitations (57.1%). The most reliable clinical sign was the presence of palpable pulsating abdominal mass (92.8%). Other clinical findings included increased central venous pressure (21.4%), lower extremity edema (71.4%), hematuria (21.4%), and scrotal edema (14.3%). Diagnosis was established preoperatively in 85.7% and intraoperatively in 14.3% of cases. Surgery was successful in promptly improving clinical signs and symptoms. Mortality rate was 7.1%. After a mean follow-up of 18.5 months, all surviving patients remained free from complications. In conclusion, ACFs represent a life-threatening emergency for vascular surgeons but can be successfully managed.
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Aorta Abdominal , Aneurisma da Aorta Abdominal/complicações , Ruptura Aórtica/etiologia , Fístula Arteriovenosa/etiologia , Veia Cava Inferior , Idoso , Angiografia Digital , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/mortalidade , Ruptura Aórtica/cirurgia , Aortografia/métodos , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/mortalidade , Fístula Arteriovenosa/cirurgia , Grécia , Humanos , Pessoa de Meia-Idade , Flebografia/métodos , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia , Procedimentos Cirúrgicos Vasculares , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgiaRESUMO
BACKGROUND: The structure of health care in Greece is receiving increased attention to improve its cost-effectiveness. We sought to examine the epidemiological characteristics of patients presenting to the vascular emergency department of a Greek tertiary care hospital during a 2-year period. We studied all patients presenting to the emergency department of vascular surgery at Red Cross Hospital, Athens, Greece between 1st January 2009 and 31st December 2010. RESULTS: Overall, 2452 (49.4%) out of 4961 patients suffered from pathologies that should have been treated in primary health care. Only 2509 (50.6%) needed vascular surgical intervention. CONCLUSIONS: The emergency department of vascular surgery in a Greek tertiary care hospital has to treat a remarkably high percentage of patients suitable for the primary health care level. These results suggest that an improvement in the structure of health care is needed in Greece.
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A 75-year old man presented with signs and symptoms of acute abdomen and a clinical picture of hypovolemic shock. An emergency CT scan revealed a ruptured para-anastomotic left common iliac artery aneurysm. The patient had undergone an elective abdominal aortic aneurysm repair operation and placement of an aortoiliac bifurcated graft 10 years before. Para-anastomotic aneurysms had developed in all 3 (aortic and the 2 iliac) anastomosis. As the patient was highrisk, a combined endovascular/surgical approach was undertaken. The patient was discharged 4 days later.This article discusses the applicability of endovascular procedures in emergency settings to high-risk patients.
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Aterosclerose/imunologia , Proteína C-Reativa/análise , Doenças Cardiovasculares/imunologia , Doenças Vasculares Periféricas/imunologia , Aterosclerose/complicações , Biomarcadores/análise , Humanos , Doenças Vasculares Periféricas/complicações , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Regulação para CimaAssuntos
Disfunção Erétil/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Comorbidade , Disfunção Erétil/complicações , Disfunção Erétil/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Catar/epidemiologia , Qualidade de Vida , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Inquéritos e QuestionáriosRESUMO
Established vascular risk factors (ie, smoking, hypertension, diabetes mellitus, and dyslipidemia) play an important role in the development of vascular disease. Emerging evidence suggests that some of these risk factors may have a more intense effect on specific arterial beds, a finding that holds implications for a prognostic role for certain types of vascular disease.
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Doenças Cardiovasculares/etiologia , Complicações do Diabetes/etiologia , Hiperlipidemias/complicações , Hipertensão/complicações , Fumar/efeitos adversos , Animais , Transtornos Cerebrovasculares/etiologia , Doença das Coronárias/etiologia , Humanos , Doenças Vasculares Periféricas/etiologia , Medição de Risco , Fatores de RiscoAssuntos
Doenças Vasculares Periféricas/terapia , Indutores da Angiogênese/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/fisiopatologia , Progressão da Doença , Dislipidemias/tratamento farmacológico , Dislipidemias/fisiopatologia , Exercício Físico/fisiologia , Humanos , Neovascularização Fisiológica/efeitos dos fármacos , Doenças Vasculares Periféricas/fisiopatologia , Inibidores da Agregação Plaquetária/uso terapêutico , Fumar/fisiopatologia , Abandono do Hábito de FumarRESUMO
BACKGROUND: Carotid stenosis can produce visual changes. This study examines perimetric and retrobulbar blood flow changes following carotid endarterectomy (CEA) in patients without visual symptoms. METHODS: Sixteen patients (13 male, three female) with bilateral carotid stenosis were included. Patients with a history of ophthalmic disease, including glaucoma, were excluded. Peak systolic velocity (PSV) in the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (SPCAs) was measured preoperatively and 12 months following CEA with color Doppler imaging (CDI), using a 7.5 MHz probe, at both the side operated upon and its fellow side. Automated static perimetry (Octopus 500 perimeter, G1x program) was performed at the same intervals. Mean sensitivity (MS), mean defect (MD), loss variance (LV) and corrected loss variance (CLV) were recorded. RESULTS: Preoperative PSV in the OA was significantly lower in the side operated on. Preoperative perimetric parameters were significantly compromised, compared with normative data, in both eyes. Postoperatively, PSV had significantly improved in all vessels examined in the carotid that was operated on, but only in the OA and SPCAs in the fellow side. MD had significantly improved postoperatively for both eyes, whereas improvement in the other perimetric parameters examined was not statistically significant. CONCLUSIONS: Perimetric changes occur in carotid stenosis. CEA results in the improvement of retrobulbar blood flow and perimetric parameters. Further research will be required to determine whether perimetric parameters may be used as additional indicators for carotid endarterectomy.
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Estenose das Carótidas/fisiopatologia , Artérias Ciliares/fisiologia , Endarterectomia das Carótidas , Artéria Oftálmica/fisiologia , Órbita/irrigação sanguínea , Artéria Retiniana/fisiologia , Idoso , Velocidade do Fluxo Sanguíneo , Artéria Carótida Interna/fisiopatologia , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Feminino , Humanos , Fluxometria por Laser-Doppler , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fluxo Sanguíneo Regional , Testes de Campo VisualRESUMO
Adventitial cystic disease (ACD) is an uncommon and rare vascular entity characterized by a highly viscous and mucinous cyst located in the adventitia of an artery. Although first described in the external iliac artery, the disease is more frequently sited in the popliteal artery. ACD characteristically occurs in young adults, mostly male, with intermittent claudication as the initial presenting symptom. As the cyst enlarges, it leads to vascular compression with stenosis or occlusion. Because cystic formation of the popliteal artery is uncommon, the disease is often unrecognized. We report a case of popliteal artery ACD in a 54-year-old woman who was successfully treated surgically.