Prosthetic carotid bypass graft for in-stent restenosis performed for post-endarterectomy recurrent stenosis: technical details.

AIM: Carotid artery stenting (CAS) is the treatment of choice for recurrent stenosis after carotid endarterectomy (CEA). However a significative incidence of in-stent restenosis could be occurred. Despite classical CEA leads to good results, in selective cases bypass graft may be the best treatment of in-stent restenosis. CASE REPORTS: We describe two cases of carotid bypass graft performed to treat a recurrent in-stent stenosis after CAS for post-CEA restenosis. No death and cardiac complication occurred and no cranial nerves impairment was detected. CONCLUSION: Prosthetic bypass graft is safe and effective in treatment of in-stent recurrent restenosis after CEA restenosis.

Short longitudinal versus transverse skin incision for carotid endarterectomy: impact on cranial and cervical nerve injuries and esthetic outcome.

AIM: Nerve injuries, wound complications and especially poor cosmetic results still have an important impact on the carotid endarterectomy (CEA) morbidity. Introduction of the mini skin incision in clinical practice seems to be safe with reduction in postoperative pain and superficial and cranial nerves lesions, and better aesthetics outcomes. The objective of this retrospective study was to compare the results between the short longitudinal with the short transverse cervical incision and to evaluate their impact on cranial and cervical nerves and aesthetic outcomes. METHODS: From January 2007 to December 2009 266 patients underwent 300 consecutive primary CEA procedures. Two-hundred nineteen patients were submitted to short longitudinal cervical incision (group A), in eighty one a short transverse cervical skin incision (group B) was performed. The average of skin incision was about 4-5.5 cm. In all cases a preoperative CEA duplex ultrasounds (US) assisted skin marking was carried out. All patients were submitted to the general anesthesia with Remifentanyl conserved consciousness. Routinely synthetic patch and selective policy intraluminal shunts were used. Incisions were extended when shunts were required or in case of high carotid bifurcation. Preoperative and postoperative cranial nerves evaluation was always performed and a questionnaire about the satisfaction of the aesthetic outcome was proposed to all patients to the discharge and six months follow-up. Stroke/TIA, death, wound complications, cranial and cervical nerves injuries and restenosis rate were reported and analyzed through statistical analysis (χ2 and Student's t test). RESULTS: The 30 days mortality was 0.3% (1/300). The TIA rate was 0.91% in group A and 1.2 % in group B (P>0.9). Wound complications were 1.8% and 1.2 % respectively (P>0.1). No statistically differences were reported in the incidence of cranial and cervical nerves injuries between the two groups (P>0.9). No difference in restenosis rate was detected (P>0.9). In case of lengthening of the incision for high internal carotid (ICA) stenosis and especially to the need of shunt deployment, the longitudinal approach showed unequivocally to be easier and safer. CONCLUSION: No differences were achieved between short longitudinal and transverse incision in term of stroke, wound complications or nerves impairment. A good cosmetic outcome was gained in both groups. The Duplex US skin markings pre-CEA permitted localization and limits of the plaque with appropriate short incision. A longitudinal cervical approach is to prefer as can lead to an easier proximal and distal lengthening in cases of atherosclerotic extension of the plaque and shunt deployment.

[Results of open repair of infrarenal abdominal aortic aneurisms in patients unfit for endovascular treatment]. / Risultati della chirurgia tradizionale nel trattamento degli aneurismi dell'aorta addominale sottorenale con controindicazione alla terapia endovascolare.

INTRODUCTION: Purpose of the study was to assess how the introduction of endovascular treatment has affected mortality and morbidity of the traditional surgery for infrarenal abdominal aortic aneurysms (AAA). PATIENTS AND METHODS: From January 2002 to December 2009 we treated 230 patients with AAA (mean age 71.6; 121 male 70.7%); 171 (74.4%) were treated with surgery, 59 (25.6%) underwent to endovascular exclusion .We divided the patients into two groups: Group A, before the beginning of our "endovascular"; Group B, after the beginning of our endovascular experience. A total of 171 patients were treated with traditional surgical intervention, 99 in Group A and 72 in Group B. We evaluated the morbidity and mortality between the two groups by statistical analysis (by Student t test and χ ² test) considering a significant p-value <0.001. RESULTS: e 30-day mortality was 4% respectively in group A and 5.5% in group B (P = not significative, n.s.). The incidence of renal and ischemic peripheral complications was, respectively, 2% and 4% in group A, and 4.1% and 8.3% in group B showing statistical significance (P <.001). There were no documented statistically significant differences between the two groups in terms of cardiac and respiratory complications (P = n.s.). CONCLUSIONS. The results of the traditional surgery for the infrarenal AAA not suitables for endovascular repair suffer from the difficult anatomy of aorto-iliac district. Although the incidence of complications of open surgery is increased, the mortality is similar to anatomical not complicated aneurysms.

High-speed laser speckle imaging to unravel picoliter drop-on-demand to substrate interaction.

Understanding phenomena such as evaporation and imbibition of picoliter droplets into porous substrates is crucial in printing industry to achieve a higher printing quality and print speed. After printing, the residual pigment must remain fixed at the desired location on a substrate and be of a desired volume to yield a high resolution and vibrantly printed page that has become the expectation of modern printing technology. Current research entails not only chemical composition of the ink but also how this links to the dynamics and interactions that occur between the ink and the substrate at every stage of the printed spot formation, including evaporation, wetting, and imbibition. In this paper, we present an instrument that can print on-demand picoliter volume droplets of ink onto substrates and then immediately record on evolution of the resulting dynamics when these two materials interact. This high-speed laser speckle imaging (HS-LSI) technique has been developed to monitor nanometer displacement of the drying and imbibing ink droplet at a high frame rate, up to 20000 Hz, given the short timescales of these interactions. We present the design of the instrument, discuss the related challenges and the theory underlying the LSI technique, specifically how photons non-evasively probe opaque objects in a multiple scattering regime, and show how this technique can unravel the dynamics of drying and imbibition. We will finish giving a validation on the instrument and an example of its usage.

Carotid endarterectomy: general anaesthesia with remifentanyl conscious sedation vs loco-regional anaesthesia.

AIM: To retrospectively evaluate and compare the safety and efficacy of general anesthesia with remifentanyl conscious sedation (RCS) vs local-regional anesthesia (LA) for carotid endarterectomy (CEA). METHODS: From January 2004 to January 2008, 390 CEA performed in 325 patients (M/F 214/111, age 75 +/- 7) were collected in 2 groups: RCS group included 275 consecutive CEA in 230 patients carried out under remifentanyl conscious sedation with stopping of the remifentanyl infusion at the carotid clamping time to evaluate the clinical neurological status; LA group was composed of 115 consecutive CEA in 95 patients, performed under local-regional anesthesia. We evaluated complications, postoperative morbidity and mortality, need for shunt insertion and compared the results by means of Student's t-test and chi2 analysis. P value <0.05 (T=2.28) was considered significant. RESULTS: The 30 days mortality was 0.35% in the RCS group and 0% for LA group (P=NS). The 30 days stroke rates were 0.3% and 0% respectively (P=NS). TIA/RIND rates were 0.3% for RCS group and 1.7% for LA group (P=0.47); shunt usage was 20% for RCS group and 17% for LA group (P=0.26). We found higher postoperative nausea/vomiting in the RCS group (3.9% vs 0.8%, P<0.05). CONCLUSIONS: General anesthesia with remifentanyl conscious sedation seems to be a safe technique, allowing monitoring of the neurological status, cerebral protection during arterial clamping, better control of the airway and a good compliance to both the surgeon and the patient. A randomized control trial is needed to prove RCS to be effective as LA.

[Hypoglossal artery and carotid endarterectomy. Case report]. / Persistenza dell'arteria ipoglossa ed endoarteriectomia carotidea. Case report

The persistence of hypoglossal artery is a rare malformation. Association of carotid stenosis with persistent hypoglossal artery can lead to cerebral posterior symptoms due to ischemia intolerance. The Authors report a case of unexpected intraoperative detection of this anomaly in a patient with high grade stenosis of the right internal carotid artery. Right carotid endarterectomy was performed, and no shunt was used. The postoperative course was normal. The literature was reviewed.

Prejudices and realities in the use of 'unsuitable' saphenous vein graft for infrapopliteal revascularization.

BACKGROUND: Aim of this paper is to evaluate the safety and the patency rate of the infrapopliteal bypass grafts performed with the great saphenous vein (GSV) with small (<2.5 mm) or large calibre (>5 mm). PATIENTS AND METHODS: Between January 2003 and May 2007, 73 infra-genicular bypass with autologous saphenous vein were performed in patients affected by atherosclerotic femoropopliteal disease. In 8 cases a bypass grafts with small saphenous vein (diameter 2.2-2.5 mm) were performed, in 4 cases a bypass with segmental varicose saphenous vein (diameter 5.7-6.4 mm ) were carried out. In 64 cases the bypass was carried out with the reversed technique, in 9 cases with the in situ technique. RESULTS: Thirty day mortality was 3/82 (3.6%) and 30 day cumulative patency rate was 95.1% (78/82) with limb salvage of 96.3% (79/82). All the patients with small diameter vein showed a normal patency at the follow-up and at the duplex scan examination no complications occurred. The mean calibre of the arterialized vein increased to 2.6-3,4 mm at 1 week with maintenance during the follow-up. Patients with varicose vein implanted present a mean dilatation of 6.4-7.2 mm at 1 week and no dilatative complication were detected at the follow-up. CONCLUSION: The risk of stenosis, graft thrombosis or aneurysm degeneration doesn't seem to be higher respect normal GSV either for small or for large veins. Large series and longer follow up are mandatory for an extensive clinical application.

The role of cross-over bypass graft in the treatment of acute ischaemia of the lower limb.

INTRODUCTION: The Authors reports their experience with the use of femoro-femoral cross-over bypass graft in the management of acute lower limb ischaemia. PATIENTS AND METHODS: Fourteen femoro-femoral bypass graft were performed for acute lower limb ischaemia due to unilateral thrombosis of iliac and femoral artery in 8 cases, late unilateral occlusion of a branch of previous aortobifemoral bypass in 3 cases, acute thrombosis of abdominal aorta in 2 cases and in the last one for an injury of common iliac artery during urological procedure. In all the cases the operations were carried out under local anaesthesia and a subcutaneous bypass with 'C' shape type configuration with 8 mm Dacron prosthesis were performed. The first and second year primary and secondary patency rates and limb salvage rates were evaluated. RESULTS: One and two year patency rate was 83.3 (10/12) and 70% (7/10) respectively. Secondary patency rate and limb salvage rate was 91.6% (11/12) and 80% (8/10) respectively. A tight amputation had to performed in 3 failed reconstruction (3/12, 25%). Two patient died within 30 days after surgery from acute myocardial infarct. In 1 case infection occurred and re-do femorofemoral cross-over bypass with saphenous vein was carried out (8.3%). CONCLUSIONS: Cross-over bypass is an attractive technique, especially in case of acute ischemia because of its simplicity, low morbidity and mortality, and good long term results.

An unexpected anatomical variant of the femoral artery in a patient with acute lower limb ischemia: case report.

We report a case of acute embolic ischemia of the right lower limb in a patient with unexpected intraoperative anatomic variant of femoral artery. In this anomaly, the deep femoral artery arises from the external iliac artery, 2 cm above the inguinal ligament, runs with a parallel course with the superficial femoral artery, and placed between the branches of femoral nerve. In consideration of the difficulty to achieve extensive and optimal control of the external iliac artery with the femoral approach, a retrograde embolectomy of the iliac artery by two separate arteriotomies on the deep and superficial femoral arteries were successfully performed. The literature reviewed about this anomalies. In these unexpected intraoperative cases a ductile and ingenious approach seems to be mandatory to perform a safe operation with low systemic impact.

Creating an integrated care model for childhood obesity: a randomized pilot study utilizing telehealth in a community primary care setting.

In an integrated care model, involving primary care providers (PCPs) and obesity specialists, telehealth may be useful for overcoming barriers to treating childhood obesity. We conducted a pilot study comparing body mass index (BMI) changes between two arms (i) PCP in-person clinic visits plus obesity specialist tele-visits ( PCP visits + specialist tele-visits) and (ii) PCP in-person clinic visits only ( PCP visits only), with ongoing tele-consultation between PCPs and obesity specialists for both arms. Patients (N = 40, 10-17 years, BMI ≥ 95th percentile) were randomized to Group 1 or 2. Both groups had PCP visits every 3 months for 12 months. Using a cross-over protocol, Group 1 had PCP visits + specialist tele-visits during the first 6 months and PCP visits only during the second 6 months, and Group 2 followed the opposite sequence. Each of 12 tele-visits was conducted by a dietitian or psychologist with a patient and parent. Retention rates were 90% at 6 months and 80% at 12 months. BMI (z-score) decreased more for Group 1 (started with PCP visits + specialist tele-visits) vs. Group 2 (started with PCP visits only) at 3 months (-0.11 vs. -0.05, P = 0.049) following frequent tele-visits. At 6 months (primary outcome), BMI was lower than baseline within Group 1 (-0.11, P = 0.0006) but not Group 2 (-0.06, P = 0.08); however, decrease in BMI at 6 months did not differ between groups. After crossover, BMI remained lower than baseline for Group 1 and dropped below baseline for Group 2. An integrated care model utilizing telehealth holds promise for treating children with obesity.

Combining superficial femoral artery endovascular treatment with distal vein bypass.

AIM: Significant strides have been made using endovascular solutions for the treatment of patients with peripheral vascular disease (PAD) and for tissue loss. But the Trans-Atlantic Inter-Society Consensus (TASC) II classification states that surgery still remains the best solution for C and D lesions, though endovascular management of superficial femoral artery (SFA) can improve inflow for distal origin bypass grafts. Our aim was to evaluate the results of combining endovascular treatment of SFA with distal vein bypass in patients with critical limb ischemia (CLI) and great tissue loss or in the cases where the below-knee endoluminal techniques alone were unable to salvage limbs. METHODS: A retrospective study of the combined interventions carried out from January 2006 and June 2013 was performed. Twenty-seven angioplasties or selective stentings of SFA combined with popliteal-distal bypass in 23 patients with stage 4, 5 or 6 Rutherford classification were performed. There were 14 men and 9 women, four were bilateral. Mean age was 71.5 years (55-91); 21 (91.3%) were diabetic, and in these, there was almost always deep debridement of necrotic or infected tissue. In 17 cases (62.9%) SFA angioplasty was performed alone, a self-expendable stent was released in the other 10 (37.1%). Distal bypass originated from distal SFA in 5 cases (18.5%), from above-knee popliteal artery in 8 (29.6%) and from below-knee popliteal artery in 14 (51.8%). Reversed saphenous vein was used for bypass in all cases. The target vessel was the posterior tibial artery in 6 cases, anterior tibial artery in 10 and dorsalis pedis in eleven. Follow-up ranged from 4 months to 6 years (with a mean of 37 months). RESULTS: There were no deaths, but two early graft failures and three major amputations during the perioperative period. Primary patency rate of both the endovascular SFA and the bypass was 81.6% (N.=22) and secondary patency was 88.8% (N.=24). Three years primary and secondary patency rate were, respectively, 74.1% (N.=20) and 81.6% (N.=22). One-year limb salvage rate was 88.8%, at three years was 86.1% and fifteen minor amputations were performed in 13 patients. CONCLUSION: The endovascular treatment of SFA associated with surgical distal vein bypass is a useful and effective strategy in patients with severe lower extremity arterial disease. This strategy allows a good inflow on SFA in selected patients with the opportunity to perform shorter bypass, use of limited autologous conduit and good expectation of patency.

A comparison of lateral versus anterior-posterior spine dual energy x-ray absorptiometry for the diagnosis of osteopenia.

Because bone mineral density (BMD) measurements at various sites differ in the relative amounts of cortical and trabecular bone that they assess, they also differ in their sensitivity for detecting osteopenia. Lateral spine dual energy x-ray absorptiometry (DXA) allows measurement of BMD of the vertebral bodies, which contain mainly trabecular bone, without contribution from the posterior vertebral elements, which are rich in cortical bone. Thus, we hypothesized that lateral spine DXA would detect osteopenia more frequently than anterior-posterior (AP) spine DXA. To assess the ability of DXA to estimate trabecular bone mass, we compared AP and lateral DXA spine measurements with trabecular bone measurements by quantitative computed tomography (QCT) in 58 patients. We then compared AP vs. lateral spine DXA measurements in 1) 300 women referred for routine bone densitometry, 2) 30 glucocorticoid-treated women, and 3) 44 women with vertebral compression fractures. To compare short term reproducibility, we performed repeat AP and lateral DXA scans in 50 women. The association between QCT and DXA measurements was stronger when DXA measurements were made in the lateral (r = 0.784) or midlateral (r = 0.823) projection than in the AP (r = 0.571) projection. The association of BMD with age was stronger when DXA measurements were made in the lateral (r = 0.536) or midlateral (r = 0.536) projection than in the AP (r = 0.382) projection. The declines in BMD with age for AP, lateral, and midlateral DXA measurements were 0.48%, 0.60%, and 0.88%/yr, respectively. In the women referred for routine densitometry, lateral DXA measurements were significantly (P < 0.05) more abnormal than AP measurements compared with those in young women. This was also true in the women treated with glucocorticoids and women with vertebral compression fractures. Lateral DXA often detected osteopenia in patients whose AP DXA was normal. The 95% confidence limits for changes in BMD attributable to measurement error for AP, lateral, and midlateral DXA were 0.027, 0.038, and 0.057 g/cm2, respectively. These results indicate that lateral DXA measurements identify patients with osteopenia more often than AP DXA measurements, probably because lateral DXA more accurately estimates trabecular bone mass. Short term reproducibility of lateral DXA is nearly as good as that for AP DXA.

Carbamyl-phosphate synthetase domain of the yeast multifunctional protein Ura2 is necessary for aspartate transcarbamylase inhibition by UTP.

In Saccharomyces cerevisiae, the first two reactions of pyrimidine biosynthesis are catalyzed by the multifunctional protein Ura2 carrying both carbamyl-phosphate synthetase (CPSase) and aspartate transcarbamylase (ATCase) enzyme activities. In order to study how UTP regulates both of these activities mutant strains were constructed: one strain which expressed the Ura2 protein fused to the green fluorescent protein, and two strains expressed truncated Ura2 proteins. These strains exhibited a phenotype associated with a modified regulation of the pyrimidine pathway. Results presented in this report provide arguments in favor of a single UTP binding site located on the CPSase domain, and support a model in which ATCase activity is inhibited by UTP only when it can interact with the CPSase domain.

Slow coronary run-off in patients with angina pectoris: clinical significance and thallium-201 scintigraphic study.

To determine whether or not slow coronary flow (SF) depends on hemodynamic variables, we studied 17 patients (15 men, mean age = 47.8 years) with SF at coronariography. Exercise thallium-201 myocardial scintigraphy revealed perfusion abnormalities in 13 (76.4%) patients. We then selected 89 individuals submitted to cinecoronariography for comparison: 15 were normal and 74 had heart disease. The coronary flow velocity was evaluated by the number of heart beats (HB) needed for coronary artery dye filling. The patients in the SF group had normal hemodynamic variables which were significantly different from those of patients with heart disease (P = 0.001). Patients with heart disease needed no more than 4 HB to fill their arteries, in contrast to 6.88 +/- 1.68 (5 to 11) in the SF group (P < 0.0001). Thus, in our patients with myocardial scintigraphy suggesting ischemia, SF was found to be an event which did not depend on hemodynamic factors.

Plasma calcitonin and tumors.

Plasma levels of calcium, phosphorus, immunoreactive calcitonin (iCT), immunoreactive parathyroid hormone (iPTH), and carcinoembryonic antigen (CEA) were measured in patients affected by tumors of various organs: 22 breast, 41 lung, 23 kidney, 16 gastrointestinal tract, and 8 other types, iCT plasma level was elevated in 53.6% of patients with bronchogenic cancer, in 31.8% with breast cancer, in 65.3% with renal cancer, in 31.2% with gastrointestinal cancer, and in 62.5% with other tumors. Blood calcium level was increased in 6 patients suffering from lung cancer; iCT plasma level was increased in all but one of these subjects. iPTH plasma level, measured in 35 patients, was elevated only in one case, in which normo-calcemia was present. Our results demonstrate that plasma iCT is increased in a high percentage of cancer patients and that it is probably a good tumor marker. The simultaneous measurement of CEA increases the diagnostic probability of the individual marker. The incidence of laboratory findings suggestive of primary or ectopic hyperparathyroidism was very low in our series of patients.

[The role of vena cava filters in the prevention of pulmonary embolism and hemodynamic changes in the venous system of the lower limbs]. / Il ruolo dei filtri cavali nella prevenzione dell'embolia polmonare e sue applicazioni emodinamiche nel distretto venoso degli arti inferiori.

BACKGROUND: On the basis of recent investigations, pulmonary embolism represents the third cause of death. If only hospitalized population over 65 years of age is considered, this pathology is quite the first cause of mortality. As deep venous thrombosis of the lower limbs represents the main cause of pulmonary embolism (90%), it should be right to suggest interruption of venous flow at caval level. The aim of this prospective report is to evaluate the efficacy of vena cava filter in pulmonary embolism prevention and the hemodynamic variations it can cause in the venous district of lower limbs. METHODS: 137 definitive caval filters were positionated from 1989 to 1996. Average follow-up was 12.6 months. Patients were controlled at 2-7 days, 1 month and than every 6 months. RESULTS: Filter perviousness was observed with Kaplan and Meyer's curve and it was 94.7%. There was pulmonary embolism in just 2 cases (1.4%). Filter perviousness was not depending on anticoagulant treatment. CONCLUSIONS: In conclusion, this prospective experience underlines that: caval filter is effective in pulmonary embolism prophylaxis; there are not important hemodynamic alterations of inferior vena cava, below filter; anticoagulating treatment does not influence filter perviousness; there are not hemodynamic alterations after slight dislocations of caval filter; finally there is a direct relation between level of deep venous thrombosis and post-phlebitic manifestations.

[Ultrastructural changes in the saphenous vein removed during aorto-coronary bypass]. / Modifications ultrastructurales de la veine saphène prélevée en cours d'intervention de pontage aorto-coronarien.

In order to observe ultrastructural changes of the saphenous vein before implantation during coronary artery by-pass surgery, 58 fragments from a series of 29 consecutive patients, were studied by means of scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Two fragments were taken: the first just before the distal anastomosis; the second just before the last anastomosis on the aorta. The vein graft was kept in a finger solution of 10% nitroglycerin. Forced dilatation was avoided. The EM showed areas of early loss of the endothelial layer, not time-related, deposits of fibrin and blood corpuscular elements with muscular contraction in 75% of the examined grafts. From our experience and according to the literature, loss of the endothelial layer, spasm and early platelet and fibrin aggregation, are constant features of the explanted saphenous vein. In clinical practice, we emphasize, in addition to the "no touch technique", the early use of antiplatelet drugs during coronary artery by-pass coronary surgery.

[Spontaneous variability of ventricular extrasystole in chronic Chagas cardiopathy]. / Variabilidade espontânea da extra-sistolia ventricular na cardiopatia chagásica crônica.

PURPOSE: To study the spontaneous variability of single (VPCs) and coupled (CVPCs) in patients with chronic Chagas' disease (CCD). PATIENTS AND METHODS: Twenty patients with CCD, 14 male, in class I and II NYHA, with frequent VPCs and VCPCs, free of drug therapy were studied. 21 hour Holter monitoring was done for 4 subsequent days. The data analysis assessed the variation in the frequency of VPCs and CVPCs between patients, seven hour periods one hour periods in a hierarchical model by a Poisson process. RESULTS: a) the frequency of VPCs follows a circadian rhythm, closely related to the hourly variations of the mean heart rate; b) disregarding the heart rate influence on the variability of the ventricular arrhythmia, its behavior was at random and unpredictable; c) the minimal percentual reduction in VPCs/h that discriminated between antiarrhythmic effect and spontaneous between antiarrhythmic effect and spontaneous between antiarrhythmic effect and spontaneous variability was 121.86% for seven-hour, 58.42% for 21-hour and 38.45% for 42-hour electrocardiographic monitoring periods; d) the same approach for the VCPCs revealed values of 133.6%, 63.21% and 41.3% respectively. CONCLUSION: The large variability of ventricular arrhythmia in CCD during a 24 hour period makes necessary observations always longer. The minimal percentual reduction in VPCs/h that discriminated between antiarrhythmic effect and spontaneous variability might be 58.42% for two 21-hour electrocardiography monitoring periods.

[An atypical case of visceral leishmaniasis]. / Su un caso atipico di leishmaniosi viscerale.

The authors report a case of infant visceral Leishmaniosis observed in their Department, that showed unusual clinical finding (absence of fever). They emphasize the current epidemiologic situation and recommend to consider the disease in the diagnosis of long term syndroms occurring without fever and with hepatosplenomegaly.

[Revascularization of distal arteries of the leg: critical considerations on more than 2000 cases reported in the literature]. / Le rivascolarizzazioni delle arterie distali della gamba: considerazioni critiche su oltre 2000 casi raccolti in letteratura.

The Authors review the results of more than 2000 cases of lower extremity revascularization, treated from 1969 to 1991 and reported in the literature. They evaluate indications, contraindications and results at 12 and 24 months from operation performed with saphenous vein "in situ" and reversed. Finally they stress the greater reliability of by-passes performed with "in situ" saphenous vein graft.