Konstantinos Katsenis

External Iliac Venous Aneurysm Treated With Tangential Aneurysmatectomy and Lateral Venorrhaphy: A Case Report and Review of the Literature

Venous aneurysms of the femoro-iliac axis are uncommon abnormalities of the vascular system with a potentially life-threatening course; they can be associated with the disastrous events of thromboembolism or rupture. Therefore, a focused imaging evaluation and prophylactic treatment is essential. The appropriate surgical approach is, however, dictated by the morphological parameters and the extent of the aneurysm. We present an external iliac venous aneurysm in a 31-year-old woman that was revealed incidentally and treated successfully by tangential aneurysmectomy and lateral venorrhaphy. The choice of surgical technique is discussed along with a review of the literature on venous aneurysms.

Acute Iliac Artery Rupture: Endovascular Treatment

The authors present 7 patients who suffered iliac artery rupture over a 2 year period. In 5 patients, the rupture was iatrogenic: 4 cases were secondary to balloon angioplasty for iliac artery stenosis and 1 occurred during coronary angioplasty. In the last 2 patients, the rupture was secondary to iliac artery mycotic aneurysm. Direct placement of a stent-graft was performed in all cases, which was dilated until extravasation was controlled. Placement of the stent-graft was successful in all the cases, without any complications. The techniques used, results, and mid-term follow-up are presented. In conclusion, endovascular placement of a stent-graft is a quick, minimally invasive, efficient, and safe method for emergency treatment of acute iliac artery rupture, with satisfactory short- and mid-term results.

The Effect of Perioperative Ischemia and Reperfusion on Multiorgan Dysfunction following Abdominal Aortic Aneurysm Repair

Abdominal aortic aneurysms (AAAs) are relatively common and are potentially life-threatening medical problems. The aim of this review is to provide an overview of the effect of I/R injury on multiorgan failure following AAA repair. The PubMed, CINAHL, EMBASE, Medline, Cochrane Review, and Scopus databases were comprehensively searched for articles concerning the pathophysiology of I/R and its systemic effects. Cross-referencing was performed using the bibliographies from the articles obtained. Articles retrieved were restricted to those published in English. One of the most prominent characteristics of AAA open repair is the double physiological phenomenon of ischemia-reperfusion (I/R) that happens either at the time of clamping or following the aortic clamp removal. Ischemia-reperfusion injury causes significant pathophysiological disturbances to distant organs, increasing the possibility for postoperative multiorgan failure. Although tissue injury is mediated by diverse mechanisms, microvascular dysfunction seems to be the final outcome of I/R.

The Influence of Total Plasma Homocysteine and Traditional Atherosclerotic Risk Factors on Degree of Abdominal Aortic Aneurysm Tissue Inflammation

Objective: Modulating effects of genetic and environmental risk factors on severity of human abdominal aortic aneurysm (AAA) tissue inflammation remain unclear. We investigated the influence of total plasma homocysteine (tHcy) and traditional atherosclerotic risk factors (ARF) on degree of AAA tissue inflammation. Methods: Aneurysm specimens were obtained from 89 male patients aged 52 to 83 years, underwent asymptomatic not ruptured AAA (mean diameter 5.5 cm) open repair and graded for degree of histologic inflammation. Multivariate analysis was used to determine the association of tHcy and ARF, with degree of inflammation. Results: Current cigarette smoking, odds ratio (OR) 4.4, 95% confidence interval 1.3 to 15.2, P = .01 and no other ARF, neither tHcy levels OR 0.9 (0.9-1.02), P = .2 were associated with high-grade tissue inflammation. Conclusion: These results provide evidence against a major effect of tHcy levels on AAA tissue inflammation, while current cigarette smoking is a significant modulating factor.

Abdominal Aortic Aneurysm With Ectopic Renal Artery Origins: A Case Report

The coexistense of an abdominal aortic aneurysm with ectopic main renal vasculature complicates aortic surgery and mandates a focused imaging evaluation and a carefully planned operation to minimize renal ischemia. We present the case of a 75-year-old man with an abdominal aortic aneurysm and a right kidney with two ectopic main renal arteries, one originating from the aneurysmal distal aorta and the other from the right common iliac artery; the patient underwent a surgical repair and followed an uneventful course with no deterioration of renal function. The preoperative and intraoperative details are reported, along with a review of the literature.

Endovascular Treatment of a Vertebral Artery Pseudoaneurysm in a Drug User

A 26-year-old drug abuser who presented with sepsis was found to have a pseudoaneurysm in the left vertebral artery. This aneurysm was presumed to be post-traumatic, since the patient reported multiple attempts to inject drugs in the left jugular vein 15 days prior to admission. The pseudoaneurysm was treated effectively with stent-graft placement.

The Influence of Diabetes on Degree of Abdominal Aortic Aneurysm Tissue Inflammation

Abdominal aortic aneurysm (AAA) progression and disease resistance are related to transmural degenerative processes and an inflammatory infiltration (INF). Diabetes is associated with low prevalence and growth rate of AAA. We sought to characterize INF in established AAA (INFAAA), in diabetic patients. From 89 male patients aged 52 to 83 years, aneurysm specimens obtained at open asymptomatic nonruptured AAA repair were graded for INF and immunostained using antibodies against T-lymphocytes (CD3) and macrophages (CD68). Diabetic patients had an odds ratio (OR) 3.8, 95% confidence interval ([CI] 1.14-12.96), P = .03, of experiencing above-median INFAAA. These associations were affected by serum glucose (SG) levels (OR 3.6, 95% CI [0.72-18.77]; P = .1). Macrophage subpopulations higher in diabetic patients (1.44 ± 0.78 versus 0.98 ± 0.76; P = .02) were correlated with SG (r = .21, P = .044). Abdominal aortic aneurysms in diabetic patients are associated with higher INF. Macrophage densities are correlated with SG.

Solitary internal jugular vein invasion by thyroid carcinoma: resection and reconstruction

Thyroid carcinoma usually presents as asymptomatic thyroid nodule. Thyroid cancer may show microscopic vascular invasion; however, internal jugular vein (IJV) invasion is a rare complication of thyroid cancer. We present a case of unilateral invasion of IJV caused by local nodal recurrence of the primary thyroid carcinoma. The patient had undergone a near total thyroidectomy, followed by modified left lymph node resection with left IJV resection. In this case, the infiltrated part of the right IJV was resected, and the vessel was reconstructed using saphenous vein autograft. In locally advanced, well-differentiated thyroid cancers, only the radical resection relieves symptoms and increases survival.

Beneficial effect of MPFF administration on the healing process of venous ulcer

IntroductionVenous hypertension underlies all clinical manifestations of chronic venous insufficiency (CVI). It is transmitted to the microcirculation and results in capillary changes which lead to edema, skin damage and eventually venous ulceration. The venoactive drugs are believed to have a therapeutic effect in venous disorders. This study evaluated the effect on the healing process of venous leg ulcers of systemic treatment with a semi-synthetic micronized purified flaνοnoid fraction (MPFF).Material and MethodThe study population comprised 60 patients with CVI and venous ulcer of the lower extremities, who were randomised into three groups, each of 20 patients. The patients in group Α, considered as the control group, used only elastic compression stockings. Group Β patients used elastic compression stockings and took MPFF 500mg orally, twice daily, until the complete healing of the ulcer. Group C used elastic compression stockings, and took MPFF 500mg twice daily until the complete healing of the ulcer, plus antibiotics. The ulcer healing rate was measured based on the healing index Η = (D0-Dx/D0) × 100, where D is the day from starting treatment. Venous blood samples were collected from each patient, before, and 20 and 40 days after the beginning of treatment, from the ulceration site and from an upper extremity vein (systemic circulation), for measurement of the white blood cells (WBCs).ResultsHealing time was statistically significantly shorter in groups Β and C than in the control group Α (p = 0.01 and p = 0.001, respectively). The difference between groups Β and C was not significant. Comparison between the initial blood sample and that after 20 days of treatment showed that the WBC trapping rate in the capillaries around the ulcer was reduced by half with the administration of MPFF.ConclusionAdministration of MPFF has a beneficial effect on capillary permeability and improves the microcirculation, with particular effect on the WBCs trapped in the capillaries around the venous leg ulcer. As a consequence MPFF administration improves the healing rate of the venous ulcers.

The effect of MPFF on skin temperature at different stages of chronic venous insufficiency

IntroductionIt has been established that the microcirculation guides the autonomic regulation of skin temperature. The effects of venous hypertension on the microcirculation may result in disturbance of autonomic regulation, leading to the development of skin disorders from a local increase in temperature. The aim of this clinical trial was to study the skin temperature of the lower extremities of patients with chronic venous insufficiency (CVI) at the different stages of the CEAP classification, and to investigate the effect on the skin temperature of administration of micronized purified flavonoid fraction (MPFF) (Daflon®).Materials-MethodsStudy was made of 35 patients with CVI (24 females and 11 males with a mean age of 62.0±9.1 years). The CVI of these patients was classified according to the 6 stages of the CEAP classification system. A control group consisting of 10 healthy adults (7 females and 3 males with a mean age of 21 years) was also investigated. The skin temperature was measured at 3 sites on the lower limb - the medial malleolus, the upper one third of the medial surface of the calf (the tibia) and the medial surface of the thigh. Skin temperature measured on the arm above the deltoid muscle was considered the reference temperature for each individual. Measurements were carried out in a climate controlled room, in the supine and the upright positions, with an interval time of 10 min. For the second phase of the study, the participants of the CVI group received oral Daflon® 500 mg twice daily and the skin temperature measurements were repeated on the 7th and 15th days of administration.ResultsAn increase was detected in the skin temperature of the lower limb from the lower to the higher of the 6 stages of CVI, according to the CEAP classification system, before treatment with Daflon®. The mean skin temperature on the lower limb decreased after treatment with Daflon®, but to a lesser degree at the higher stages (5 and 6) of CVI. On treatment with Daflon®, in the upright position, the mean skin temperature at the sites οn the lower limbs decreased, although this decrease was significant only at the thigh (p=0.041). The skin temperature difference between the arm and lower limb decreased significantly with Daflon® treatment at the malleolus (p=0.047), the tibia (p=0.027) and the thigh (p=0.024). In the supine position, the mean skin temperature at the malleolus and tibia decreased, but not to a significant degree, on treatment with Daflon®. The skin temperature difference between upper and lower limbs decreased significantly on Daflon® treatment at the malleolus (p=0.050), and the thigh (p=0.041), but less at the tibia (p=0.074).ConclusionThis study has shown that CVI is associated with skin temperature increases in the lower limbs, in relation to the 6 different stages of the CEAP classification. Skin temperature, however, cannot be used as a parameter for evaluation of the clinical outcome. Daflon® administration appears to have a beneficial effect on the skin temperature elevation occurring in the legs of patients with CVI at the different stages of the CEAP classification, and consequently is likely to help to prevent complications, such as venous ulcers.