A. Cavallaro

Femoral artery aneurysms: long-term follow-up and results of surgical treatment

Aneurysmal dilatation of the femoral artery is a rare condition of uncertain aetiology. Between January 1972 and December 1992, 31 atherosclerotic femoral aneurysms in 22 patients were seen. There were 21 men and 1 woman; mean(s.d.) age was 70.1(10.4) years. Thirteen (42%) femoral aneurysms (group 1) were isolated aneurysms, two being bilateral. Eighteen (58%) were associated with a non-contiguous abdominal aortic aneurysm, four being unilateral and seven bilateral femoral aneurysms (group 2). The mean(s.d.) size of these aneurysms was 4.7(1.5) and 3.5(0.7)cm in groups 1 and 2 respectively (P< 0.01). Of the limbs in group 1,12 were treated by an interposition bypass. A ruptured profunda femoris artery aneurysm was ligated in one limb as an emergency operation. All patients in group 2 underwent an aortobifemoral graft. There was one operative death. Three early thromboses were observed; two autogenous saphenous vein interposition grafts and one limb of an aortobifemoral. One late thrombosis occurred in an expanded polytetrafluoroethylene graft in group 1. The five-year patency rate was 80% for group 1 and 88.9% for group 2 (P=n.s.). The overall 10-year limb salvage rate was 100%. These findings suggest that isolated femoral aneurysms are larger and more frequently symptomatic than femoral aneurysms associated with an abdominal aortic aneurysm. The association between femoral aneurysm and abdominal aortic aneurysm was found to be higher in patients with bilateral femoral aneurysms compared with those with unilateral lesions (P< 0.05). In the treatment of isolated femoral aneurysms better early results were obtained with expanded polytetrafluoroethylene interposition grafts.

MMP and TIMP Alterations in Asymptomatic and Symptomatic Severe Recurrent Carotid Artery Stenosis

OBJECTIVES This study aimed to determine whether the plasma levels of matrix metalloproteinases (MMPs)-2 and -9 and their specific inhibitors (tissue inhibitors of metalloproteinases (TIMPs-1 and -2)) were altered in patients with symptomatic and asymptomatic, severe, recurrent carotid artery stenosis. PATIENTS Fifty-two patients (out of a total of 621) who had undergone successful carotid artery endarterectomy (CEA) between 1999 and 2003 and developed recurrent carotid artery stenosis (>/=70%) were included in the study. Restenosis was symptomatic in 23 patients and asymptomatic in 29 patients. METHODS Recurrent carotid artery stenosis was classified based on presentation, and as early-intermediate (6 months to 3 years) or late (>3 years). A detailed clinical history was taken and two blood samples were drawn from each patient to determine plasma levels of MMPs and TIMPs along with other biological parameters. Recurrent stenosis was confirmed with computed tomographic angiography. RESULTS Patients with symptomatic restenosis had significantly (p<0.001) higher active MMP-2 and -9 plasma values and significantly (p<0.001) lower TIMP-1 and -2 plasma values when compared to patients with asymptomatic restenosis. Plasma concentrations of active MMPs were higher and TIMPs lower in patients affected with late recurrent stenosis as compared to early-intermediate restenosis (p<0.001). No differences were recorded in latent MMP plasma values. Multivariate analysis showed that active MMP-2 and -9 were independent predictors of late recurrent carotid artery stenosis (p<0.03 and p<0.001, respectively). CONCLUSIONS Higher plasma concentrations of active MMP-2 and -9 were associated with an increased risk of carotid restenosis with plaque recurrence.

In vivo study of Dacron aortic grafts through B-mode ultrasonography.

Real‐time B‐mode ultrasonography was used to study in vivo the behavior of bifurcated aortic grafts (Dacron knitted) implanted over a period of 1 to 88 months previously in 67 patients, 28 of whom (42 per cent) were hypertensive. Most grafts showed an increase in size, when compared with the original one, which appeared to be closely related to arterial pressure (P less than 0.05). This increase was not dependent on the time elapsed from implant.

Pretreatment of Dacron Prostheses with Gelatin: Experimental Research and Clinical Evaluation

Experimental evaluation of a new type of dacron graft, pretreated with mod ified mammalian gelatin, has been performed on the beagle dog. After grafting of the infrarenal aorta, dogs were monitored from three days to three months. Pretreatment with gelatin effectively avoided the need for preclotting and did not affect the normal healing of the prosthesis as compared with similarly tex tured not pretreated grafts. This graft, when applied in man as an abdominal aortic substitute, has yielded uniformly gratifying results (within a follow-up range of twenty to twenty-seven months).

Motor Nerve Conduction Study in Raynaud's Phenomenon

The term Raynauds phenomenon is the eponym of a clinical picture culmi nating into and dominated by accessorial vasomotor crysis which are triggered by different stimuli (cold, cigarette smoking, emotional stress); cold sensitivity however, is a rather constant feature. Little is known about peripheral nerve involvement in Raynauds phenome non but for cases secondary to thoracic outlet syndrome or to primary neuro logic diseases, systemic or not. The aim of the present work was to evaluate non-invasively the involvement of arterial flow as well as of nerve function in subjects complaining of Ray nauds phenomenon.

Aorto-femoro-popliteal and Aorto-femoro-tibial Reconstructions: 10-Years Experience

The very high incidence of cases in which significant lesions of the aortoiliac and of the femoropopliteal tracts coexist poses the problem of the surgical tactics to be used to achieve the best result.