Airton Delduque Frankini

Popliteal artery aneurysm surgery: the role of emergency setting.

The aim of this study was to compare the outcomes of emergent surgery caused by acute complications versus elective surgery of popliteal artery aneurysms (PAAs) and to evaluate the advantages of elective repair related to limb salvage and bypass patency rates. Fifty PAAs were operated on in 40 patients from January 2000 to December 2004. Surgery was elective in 34 cases (68%) and emergent in 16 (32%). Emergent repair was performed because of acute complications. All patients were treated surgically. Early results in terms of limb salvage, primary patency, and assisted patency were assessed. Follow-up consisted of clinical and/or ultrasonographic examinations at 10 days and 1, 3, 6, and 12 months and yearly thereafter. Long-term limb salvage and bypass patency rates were analyzed. The mean follow-up was 17 months. The 1-year limb salvage rate in the elective group was 97.1% versus 56.3% in the emergent group (P = .0007). The bypass patency rate at 1 year was 94.1% in the elective group versus 66.7% in the emergent group (P = .03). In this study, the outcomes of the PAA repair were significantly better in the group operated electively and without acute symptoms at presentation compared with the group with acute complications, operated on emergently, especially related to limb salvage and bypass patency rates.

Infecção em endoprótese

Infection involving stent grafts is an infrequent complication associated with high mortality rates. The clinical presentation is usually delayed and it may vary from nonspecific symptoms to severe complications such as pseudoaneurysm and aorto-enteric fistula. The diagnosis involves a high index of suspicion and investigation with imaging and laboratory exams. The treatment follows the precepts of graft infection in conventional surgery, and surgical excision is recommended for most patients, followed by in situ or extra-anatomic revascularization. Conservative treatment is reserved for selected cases.

Prevalência de resistência bacteriana nas infecções de ferida operatória em cirurgia arterial periférica

CONTEXTO: A infeccao de sitio cirurgico e uma complicacao grave da cirurgia vascular periferica. O recente aparecimento de microorganismos resistentes e agressivos gera uma nova preocupacao com relacao ao manejo dessas infeccoes. OBJETIVO: Verificar a prevalencia de resistencia bacteriana, a epidemiologia, os possiveis fatores associados e o padrao de resistencia nas infeccoes de ferida operatoria das cirurgias arteriais perifericas. METODOS: Estudo de prevalencia, envolvendo 40 pacientes portadores de infeccao da ferida operatoria e submetidos a cirurgia de revascularizacao arterial periferica no periodo de janeiro de 2007 a maio de 2008. RESULTADOS: Participaram do estudo pacientes com media de idade de 64,2 anos, predominantemente do sexo masculino (70%). A prevalencia geral de resistencia bacteriana foi 72,5%, e de multirresistencia, 60%. O microorganismo mais frequentemente isolado foi o Staphylococcus aureus (40%), sendo 11 das 16 culturas (68,7%) resistentes a oxacilina. As taxas de resistencia aos principais antimicrobianos testados foram: ampicilina, 85,7%; cefalosporina, 76,9%; oxacilina, 65%; e ciprofloxacina, 62,5%. Nao foi identificada resistencia a vancomicina e ao imipenem. CONCLUSOES: Os achados deste estudo sugerem que a resistencia bacteriana e um problema atual e muito prevalente nas cirurgias arteriais perifericas. O Staphylococcus aureus segue sendo o principal patogeno envolvido, demonstrando altas taxas de resistencia. A vancomicina e o imipenem seguem sendo as principais opcoes terapeuticas para esse tipo de infeccao.

Derivação arterial extra-anatômica no segmento aorto-ilíaco: experiência de 15 anos

BACKGROUND: Extra-anatomical bypass, which is an alternative procedure to classical surgery, aims at simplifying a complex procedure such as aortoiliac reconstruction. OBJECTIVES: To analyze long-term outcomes of extra-anatomical bypass of the aortoiliac segment. METHODS: Longitudinal retrospective study including 79 extra-anatomical bypasses of the aortoiliac segment, performed in 75 patients between December 1991 and December 2006. RESULTS: Mean age was 64.2 years, and male gender was predominant (64%). Critical ischemia accounted for most indications for surgery (86.1%); crossover iliofemoral bypass represented 41.8% of all procedures. Mortality, patency and limb salvage rates were 28, 70.3 and 67.6%, respectively, at five years. CONCLUSIONS: Extra-anatomical bypasses should remain as alternative procedures because of their lower patency rates in comparison to anatomic procedures and considerable morbidity and mortality rates. However, they are important procedures when anatomic revascularization cannot be accomplished due to clinical and local limitations. Crossover bypasses demonstrated better patency rates than axillofemoral bypasses, and crossover iliofemoral bypasses showed the best patency rates of all (77.3% at five years).

Arteriosclerose de Monckeberg como causa de isquemia crítica de membros inferiores: relato de caso

Monckebergs arteriosclerosis can be a rare cause of severe lower limb ischemia. We report the case of a patient with critical lower limb ischemia without revascularization conditions progressing to limb amputation. The patient did not present any traditional risk factors associated with atherosclerosis. Histopathological diagnosis showed arteriosclerosis associated with Monckebergs medial calcification.