Nikolaos Paraskevas

Acute Debranching and Stent Grafting for a Ruptured Penetrating Ulcer of the Aortic Arch

BACKGROUND We report a hybrid treatment for a ruptured penetrating aortic ulcer (PAU) of the aortic arch in emergency conditions. METHODS A 74-year-old man with severe comorbidity was diagnosed with a symptomatic rupture of a PAU of the aortic arch. As he was considered unfit for conventional open repair and it was an emergency condition, an acute endovascular repair with cervical debranching of the supra-aortic trunks could be proposed. The left common carotid artery and left subclavian artery were first debranched and revascularized through cervical access, and the endovascular stent graft was then deployed via femoral access in the aortic arch. At >or=2 years the patient is safe with no sign of progression of the disease. CONCLUSION Acute debranching and stent grafting is feasible in emergency conditions to treat ruptured PAU of the aortic arch, with satisfying short- and mid-term outcomes, and can be proposed to patients considered unfit for conventional open repair.

Superficial femoral artery autograft reconstruction in the treatment of popliteal artery aneurysm: Long-term outcome

OBJECTIVE This prospective, observational study evaluated the safety and efficacy of superficial femoral artery autograft reconstruction in the treatment of popliteal artery aneurysms in the absence of a suitable saphenous vein. METHODS From March 1997 to April 2007, data from patients with popliteal artery aneurysms treated by superficial femoral artery reconstruction were prospectively collected in two centers. The procedure was performed through a medial approach. The superficial femoral artery was harvested in the upper third of the thigh and used as the conduit for reconstruction, and the harvested segment was replaced by a polytetrafluoroethylene graft. The patients were observed for survival, limb salvage, and reconstruction patency. The results were calculated by the Kaplan-Meier method. RESULTS During the 10-year study period, 37 popliteal artery aneurysms in 32 patients (all men; median age, 71 years) were treated by reconstruction using the superficial femoral artery. Indications for surgical treatment were symptomatic or complicated aneurysms in 11 (30%). Four (11%) of the 37 popliteal artery aneurysms were thrombosed, and 33 (89%) were patent. At surgery, 35% had a single vessel runoff. Because of acute ischemia, reconstruction was performed as an emergency procedure in three patients (8%). There were no perioperative deaths, early amputations, or early thrombosis. The mean follow-up period was 36 months (range, 7-103 months). Two grafts thrombosed during follow-up. At 3 years, the primary and secondary patency rates were 86% and 96%, and overall limb salvage was 100%. Follow-up duplex ultrasonography did not detect any aneurysmal dilatation of the autograft. CONCLUSION Our experience shows that superficial femoral arterial reconstruction is a safe and useful treatment option in patients with popliteal artery aneurysms who lack suitable saphenous veins. This reconstruction seems to be a good alternative to prosthetic bypass crossing the knee joint, and our results suggest that this study should be continued.

Totally videoendoscopic descending thoracic aorta-to-femoral artery bypass

Descending thoracic aorta to femoral artery bypass is an effective and safe procedure for the treatment of aortoiliac occlusive disease when an approach to the abdominal aorta is undesirable. The major limitation of this technique has resulted from the morbidity rate associated with thoracotomy in a relatively high-risk vascular surgery population. As a minimally invasive procedure, videoendoscopy has been shown to improve the patient postoperative course and comfort in the field of general and thoracic surgery. The same benefits could be expected from a videoendoscopic surgery involving the thoracic aorta. In 2003 we reported the first case of a totally videoendoscopic descending thoracic aorta-to-femoral artery bypass procedure. In this article we report our additional experience with and the modifications we have made to this technique.

A rare case of leiomyosarcoma arising from a femoral vein tributary: a case report

Abstract Primary vascular tumours are very rare. Most cases are leiomyosarcomas usually arising from large veins such as the inferior vena cava. Involvement of major veins in the limbs is uncommon and of small veins or tributaries extremely uncommon. We report a case of leiomyosarcoma originating from a tributary of the femoral vein in a 55-year-old woman.

Impact of the Introduction of Endovascular Aneurysm Repair in High-Risk Patients on Our Practice of Elective Treatment of Infrarenal Abdominal Aortic Aneurysms

The aim of this work was to evaluate, in terms of activity and immediate postoperative results, the modifications of our elective surgical treatment of infrarenal abdominal aortic aneurysms (AAAs) resulting from the use of stent grafts to treat AAAs, following the recommendations issued by the French Health Products Safety Agency (AFSSAPS) in December 2003. This monocentric and retrospective study used the clinical data of patients operated on for asymptomatic AAA between January 2001 and December 2006. Endovascular treatment of AAAs with aortic stent grafts was introduced in our current practice in January 2004, following the recommendations of the AFSSAPS (high-risk patients for open surgery presenting with an AAA > or =50 mm). Group I was composed of patients operated on between January 2001 and December 2003 according to the standard open technique. Group II was composed of patients operated on between January 2004 and December 2006 with either standard open surgery or endovascular surgery. The main criteria of evaluation were the number of operated patients, their American Society of Anesthesiology (ASA) score of surgical risk, and the intrahospital morbidity and mortality. The number of treated patients significantly increased between these two periods (group I n = 49, group II n = 88, with 38 endovascular treatments; p < 0.001), without any changes in average age (70 vs. 72 years), percentage of men (93.7% vs. 95.5%), and mean AAA size (57.8 vs. 56 mm) between the two groups. ASA scores were significantly higher in group II (ASA III and IV, group I = 20.4% vs. group II = 55.7%; p < 0.0001), whereas the intrahospital mortality rate (4.1% vs. 3.4%) and the rate of major postoperative complications (16.3% vs. 11%) have remained stable. In group II, the median duration of hospitalization was significantly reduced (12 vs. 9 days, p < 0.001). In conclusion, in our center, following the AFSSAPS recommendations, the introduction of endovascular treatment has enabled us to electively treat a greater number of AAA patients with higher surgical risk, without aggravating the immediate postoperative results.

Superficial Femoral Artery Autograft Reconstruction for Complicated Popliteal Artery Entrapment Syndrome

We present an alternative surgical approach to popliteal artery entrapment syndrome with vascular complications in the absence of a suitable saphenous vein. Three patients (29, 35, and 78 years old) with thrombotic and/or aneurysmal lesions of the popliteal artery from popliteal artery entrapment syndrome were treated with superficial femoral artery autograft reconstruction. The procedure was performed through a medial approach. The superficial femoral artery was harvested in the upper third of the thigh and used as the conduit for reconstruction and the harvested segment was replaced by a polytetrafluoroethylene graft. At follow-up, patients were asymptomatic and duplex ultrasound revealed patent reconstruction with no morphological abnormalities.

Anévrisme poplité veineux

es anevrismes poplites veineux sont des lesions rares mais dangereuses du fait de leur potentiel emboligene. Ils doivent etre recherches par un echoDoppler devant toute embolie pulmonaire associee ou non a une thrombose veineuse profonde. L’angio-scanner est un excellent examen pour l’etude arterielle des membres inferieurs mais a ete peu utilise specifiquement pour le reseau veineux, son utilite semble certaine. La prise en charge therapeutique, en dehors des petits anevrismes fusiformes asymptomatiques qui necessitent une surveillance par echo-Doppler, est chirurgicale et repose le plus souvent sur une endoanevrysmorraphie.