Augustin Pirvu

Carotid Artery Revascularisation Following Neck Irradiation: Immediate and Long-Term Results

OBJECTIVE Carotid artery stenosis is a complication of neck irradiation. We describe the immediate and long-term results of surgical treatment. METHODS This was a retrospective single centre study. From 1996 to 2009, 24 consecutive patients who had in the past received neck radiation therapy (mean 12 years, 1-41 years) underwent 27 primary carotid artery revascularisation procedures. Six patients (23%) had previous radical neck dissection, three permanent tracheostomies and one cervicoplasty with pectoral muscle flap. Indications for surgery included symptomatic (five transient ischaemic attacks (TIAs), four strokes; 34%) and asymptomatic (18 patients, 66%) stenosis. Four patients had occlusion of the contralateral carotid. General anaesthesia without shunting was used with measurement of stump pressure. Carotid interposition bypass grafting included 23 vein grafts and three polytetrafluoroethylene (PTFE) grafts. RESULTS No perioperative deaths or central neurological events occurred. Three patients suffered transient cranial nerve injuries. Eleven patients died during follow-up, mean interval of 28 months (range 6-120 months), of causes unrelated to surgery. Five patients had recurrent bypass stenosis with one TIA and one stroke. All other surviving patients remained asymptomatic. CONCLUSION Despite no comparative study as evidence, we think that the perioperative risk of stroke is at least comparable with the risk encountered for angioplasty procedures.

Endovascular Treatment of Aortic and Primitive Iliac Artery Aneurysms Associated With Behçet Disease

Behçet disease is a systemic vasculitis that can cause vascular complications. We describe a 42-year-old woman with an aortic aneurysm and common right iliac aneurysm, both saccular and complicating Behçet disease. The patient was successfully treated by an endovascular method, which currently seems to be the best therapeutic choice given the frequent anastomotic complications of conventional surgical treatment.

Midterm results of internal iliac artery aneurysm embolization

OBJECTIVE We describe the immediate and midterm results of endovascular treatment of isolated internal iliac artery aneurysms (IIAA). METHODS This was a retrospective single center study. From 2005 to 2014, data from 20 consecutive patients who had an embolisation for an isolated atherosclerotic internal iliac artery aneurysm underwent an endovascular treatment. We retrospectively evaluated the technical aspects and outcomes. RESULTS The mean aneurysm diameter was 42mm (range 30-97mm). No perioperative deaths or treatment failures occurred. No endoleaks or secondary aneurysm ruptures were observed during the follow-up. Three patients experienced disabling buttock claudication, which was spontaneously remissive in two cases. No relationship was found between buttock claudication and the patency of the contralateral internal iliac artery and the deep femoral artery. Six patients (30%) died during follow-up. Among these, three patients died due to cardiovascular events. The mean follow-up interval was 24 months (range 6-96 months). CONCLUSION The endovascular treatment of isolated internal iliac artery aneurysm is safe in the short-term and could prevent secondary aneurysm rupture at midterm.

Unusual Foreign Body in Urinary Bladder Due to Vascular Surgery Intervention

Iatrogenic bladder injury in vascular surgery is very rare. We report a case of bladder injury by penetration secondary to the tunneling of a vascular graft through the space of Retzius. The diagnosis of an intravesical graft was made by computed tomography 1 week later. The patient underwent open bladder surgery associated with complete graft resection without immediate vascular reconstruction.

Late revelation of a subphrenic extralobar pulmonary sequestration as a suprarenal mass.

Pulmonary sequestrations are some rare congenital anomalies. The incidence was estimated of 0.15% to 1.7%. They are characterized by a mass of non functioning pulmonary tissue that has no communication to the normal bronchial tree. The vascularisation is supplied by systemic arteries. They are classified further as intralobar and extralobar types. Extralobar sequestration, so-called accessory lung, is separated from the normal lung. We present a rare case of subphrenic extralobar pulmonary sequestration in a 57 years old patient. The lesion was initially presented as a non-typical suprarenal mass discovered on CT scan. The approach by laparatomy permitted the resection and the definitive diagnosis.

Aortic bypass surgery for asymptomatic patients awaiting a kidney transplant: A word of caution

In the presence of severe aorto‐iliac calcification, aortic bypass surgery can be mandatory to allow kidney transplantation. The aim of our study was to evaluate the safety and outcomes of this strategy among asymptomatic patients.

Uretero-arterial fistula due to a hypogastric aneurysm

Abstract Uretero-arterial fistula is a rare condition that can result in life-threatening haematuria, which should be diagnosed and treated immediately. We report a case of uretero-arterial fistula due to a hypogastric aneurysm. The patient underwent an endovascular treatment of the hypogastric aneurysm associated with a percutaneous nephrostomy. Most fistulae are not identified on computed tomography (CT) and a high degree of suspicion is needed. Presence of unexplained haematuria with CT diagnosis of hypogastric aneurysm should raise suspicions of uretero-arterial fistula as a possible cause.

Cryopreserved arterial allograft vascular reconstruction for lower limb salvage during sarcoma surgery

bones in the South African Bantu. J. Bone Joint Surg. Br. 1952; 34‐B: 45–8. 8. Cockshott WP. Carpal fusions. Am. J. Roentgenol. Radium Ther. Nucl. Med. 1963; 89: 1260–71. 9. Ritt MJ, Maas M, Bos KE. Minnaar type 1 symptomatic lunotriquetral coalition: a report of nine patients. J. Hand Surg. [Am] 2001; 26: 261–70. 10. Simmons BP, McKenzie WD. Symptomatic carpal coalition. J. Hand Surg. [Am] 1985; 10: 190–3. Yoshio Robert Hinde,* MBBS Dylan Amali,† Andrew Kanawati,* MBBS *Orthopaedic Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia and †School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia

Evaluation of the Mid- and Long Term Results of the Covered Stainless steel Stents in the Treatment of Aorto-iliac Occlusive Lesions

method of arterial puncture (AP), themode of closure of the puncture site, the immediate postoperative course and the time before discharge were collected. The patients were re-examined at one month with an echo-Doppler (ED) studying the point of puncture specifically. Results: PA was performed under ultrasound guidance in 44% of the cases, using a Cathlon (63%) or a full needle (37%), with a 6F introducer in 90.5% of the cases, and 7F introducers in the others. Arterial closure was obtained by manual compression followed by a compression bandage (51.5%), or by direct closure (48.5%) including three Angioseals, 45 Femoseals, 25 Exoseals, one Proglide and five sutures). The patients remained on average 386 minutes in the institution. One patient came back 12 hours after an ultrasound guided puncture and Femoseal closure presenting a 3.5cm partially circulating false aneurism treated by compression bandage. Control ED was satisfactory and the patient left the following day. All the patients were re-examined at one month with ED study of the point of puncture which found no false aneurism and no arteriovenous fistula. Age, gender, vascular risk factors, the mode and the method of puncture as well as the technique of closure did not show significant differences. Conclusion: From these results the ambulatory realization of endovascular procedures, more comfortable for the patients, is licit if the criteria of eligibility for ambulatory procedures recommended by the High Health Authority are respected. It appears nevertheless that only 11% of the private surgeons apply this concept which requires investing in material: ultrasound guided puncture, closure devices which are not reimbursed as well as a closemonitoring by themedical team, and a lower payment for the institutions.

Vascular Access-Induced Hand Ischemia: Risks and Safe Management

Hand ischemia is rare but complex and multifactorial. Distal arteriopathy below the vascular access (VA) is responsible in the vast majority of patients and not a problem of high flow of the VA. Therefore, surgical technique should focus on improving blood flow and pressure instead of reducing blood flow. We present an overview of the standard techniques which are recommended to treat VA-induced hand ischemia. The banding techniques, most of which empirical and not codified, have been abandoned by the majority of the authors because of a high rate of failure and reintervention. Ligation may be necessary in patients with severe ischemia and diffuse arterial lesions and in case of ischemic monomelic neuropathy.