A. O. Mansfield

Treatment of high-flow vascular malformations by venous embolization aided by flow occlusion techniques

PurposeTransvenous embolization techniques may be helpful as alternatives to the arterial route when treating high-flow vascular malformations. We present our experience using these techniques in four patients.MethodsIn one patient the venous portion of the arteriovenous malformation (AVM) was punctured directly; in the other three patients it was catheterized via a retrograde venous approach. Flow occlusion techniques were utilized in all patients during embolization, which was performed with absolute alcohol orN-butyl-2-cyanoacrylate.ResultsExcellent clinical and angiographic results were obtained, with obliteration of arteriovenous shunting in all patients. There were no complications.ConclusionThe embolization of certain AVMs using a venous approach is a safe and effective treatment.

Renal dysfunction and prolonged visceral ischaemia increase mortality rate after suprarenal aneurysm repair

Elective juxtarenal abdominal aneurysm repair has a significantly lower mortality rate than suprarenal repair. Identification of factors affecting outcome may lead to a reduction in mortality rate for suprarenal repair.

Vascular graft infection: The role of Indium scanning

Infection of a prosthetic graft is one of the most feared complications of vascular surgery. The difficulties of accurate, objective diagnosis are well recognised. We have used III Indium labelled white blood cell scans (InWBC) in two groups: 9 control patients who underwent uncomplicated aortic aneurysm surgery, and 23 patients with suspected graft sepsis. In the control group there was one positive scan in a patient with an inflammatory aneurysm. In the suspected sepsis group, 11 patients subsequently has proven graft sepsis. Nine were correctly predicted by Indium scanning. Ten of 12 patients who did not have proven graft sepsis had negative scans. There was a total of 5 inflammatory aneurysms in the control and suspected sepsis groups, of whom two had positive scans. False positive scans were not present in the early postoperative period i patients without inflammatory aneurysms. In our experience Indium labelled WBC scanning for suspected graft sepsis has a accuracy of 83% a negative predictive value of 83% and a positive predictive value of 82%. These results suggest that Indium white cell labelling techniques which do not involve substantial cross-labelling of platelets are the best objective methods of establishing the presence or absence of graft sepsis.

ENDOVASCULAR STENTING OF INTERNAL CAROTID ARTERY FALSE ANEURYSM

Internal carotid artery aneurysms are uncommon and are potentially dangerous because they may rupture, thrombose or embolise. 1 Although satisfactory long term results have been reported, ~ surgical resection is technically very difficult especially if the aneurysm is near the base of the skull. 3 We report a case of an internal carotid artery false aneurysm caused by trauma which was successfully managed by endovascular stenting.

Thrombolysis in Arterial Graft Thrombosis

OBJECTIVE to assess the impact of peripheral arterial thrombolysis for vascular graft occlusion. DESIGN Retrospective review. SETTING University Hospital. MATERIALS Thirty-one patients presented with 33 episodes of graft thrombosis. CHIEF OUTCOME MEASURES Successful thrombolysis in terms of total clearance or sufficient clearance to reveal an underlying factor responsible for graft failure. MAIN RESULTS Thrombolysis was successful in seven of 10 suprainguinal grafts (4 of 5 rtPA; 3 of 5 SK). One patient had failed lysis requiring an ilio-femoral graft. Of the seven patients with successful lysis, one required revision of a proximal anastomosis, two required distal anastomotic revisions, and one rethrombosed. Twenty-three thrombosed infrainguinal grafts were managed initially with intraarterial thrombolysis (9rtPA, 14 SK). Of 27 patients surviving at 30 days, seven required major amputation despite aggressive intervention. CONCLUSIONS Thrombosed suprainguinal grafts are amenable to thrombolysis and adjunctive surgery when necessary, with no major haemorrhagic complications. The majority of patients with thrombosed infrainguinal grafts require surgical intervention in order to preserve, or establish long term patency. For polytetrafluoroethylene (PTFE) grafts, thrombolysis was associated with poor success, haemorrhagic complications and a high amputation rate.

Deuterium oxide-based University of Wisconsin solution improves viability of hypothermically stored vascular tissue.

BACKGROUND Preservation of vascular function largely determines the outcome of transplantation. We have investigated replacing the water (H2O) in University of Wisconsin (UW) solution with deuterium oxide (D2O) in an attempt to improve vascular function after hypothermic storage. METHODS Rat aortic segments were stored in UW solutions based on 100% H2O, 25% D2O, 50% D2O, and 100% D2O at 4 degrees C for 24, 48, or 72 hr. Vascular function was measured via contraction and endothelium-dependent relaxation after stimulation with phenylephrine and acetylcholine. RESULTS UW solution with 25% D2O gave a significant (P<0.05) improvement of contraction and relaxation in comparison with H2O-based UW solution and other concentrations of D2O. CONCLUSIONS Low concentrations (25%) of D2O-UW solution are significantly superior to the H2O-based (i.e., commonly used) equivalent at up to 72 hr. These results suggest that low concentrations of D2O-UW solution can improve the quality of hypothermic storage.

Infected false aneurysm at the site of peripheral balloon angioplasty

Aneurysm development at the site of previous percutaneous transluminal angioplasty (PTA) is a rarely detected complication of the procedure. We describe the development of an infected false aneurysm in a patient following PTA of the superficial femoral artery. This complication has not been previously recorded at this site. This case highlights the need for rigorous aseptic technique during angioplasty.

Excision of carotid body chemodectoma

Publisher Summary This chapter describes the excision of carotid body chemodectoma. Paraganglia are widely disseminated organs with sensory and perhaps local neurosecretory function. The APUD cells with an affinity for chrome salts are known as chromaffin paraganglia and their tumors are pheochromocytomas. Those cells that are without chrome salt affinity are the nonchromaffin paraganglia and their commonest tumor affects the carotid body. The second commonest paraganglioma in the neck is of vagal origin. On angiography this is seen as a vascular tumor that does not splay the internal and external carotids apart. When vocal cord paralysis also exists, the preoperative diagnosis is complete. The incision can be made along the anterior border of the sternomastoid muscle from the mastoid process to the lower part of the neck. The exact position depends on the level of the tumor. The internal jugular vein is dissected from the artery throughout its visible course, taking care not to injure the adjacent vagus nerve in the groove between artery and vein.

Edgar Williams Parry

Advanced surgery for venous thrombosis

Avril Gwendoline Parry (née Clarke)

Avril Gwendoline Parry (nee Clarke) was at school in Grove Park School in Wrexham. She had one brother, John, and her father was a chemical engineer at Monsanto. During the second world war the family home was filled with the extended family and evacuees. She was an enthusiastic girl guide and obtained her Queen’s guide award at the age of 16. She began her student career in Liverpool in 1955 and was always an excellent …