Susumu Konno

Impalement wounds of the head and chest by reinforced steel bars with recovery: an unusual case report.

A 31-year-old male who sustained completely penetrating impalement wounds of the head and chest by reinforced steel bars in a fall at a ferroconcrete building construction with a miraculous survival is reported. The bars were successfully removed; a surgical mallet was required to loosen the bar impacted in the patients head. After 12 days he was discharged, and he has returned to construction work and is well 3 years postinjury.

Bilateral popliteal artery entrapment syndrome--report of a case.

A 15-year old female presented with bilateral popliteal artery entrapment syndrome. The left popliteal artery was completely occluded and thromboendarterectomy was performed. Angiography on passive dorsiflexion revealed compression of the right popliteal artery, although it was free of symptoms and of normal caliber. End-to-end anastomosis in the normal anatomical position without division of the medial head of the gastrocnemius muscle was performed on both sides.

Surgical treatment of juxtarenal aortic occlusion

From 1974 to 1976, four patients with juxtarenal aortic occlusion were operated upon with no surgical mortality. Thromboendarterectomy (TEA) of the aorta with renal revascularization was performed in one patient, and TEA with grafting in three. Intraoperative renal protection was particularly important, since suprarenal aortic clamping was often required in these cases. Possible renal embolism developed in one patient postoperatively. In order to prevent renal embolism and to minimize ischemic insult to the kidney, the value of the following procedures was stressed; (a) irrigation of aortic lumen with saline after TEA under suprarenal aortic clamping with renal arteries kept occluded, and (b) re-application of aortic clamp below the renal arteries after irrigation.Since the most distal level of occlusive process was the common femoral artery in our series, the patient with this desease entity should be treated more actively.

Perioperative management of juxtarenal aortic occlusion

The authors reviewed the surgical treatment and outcome in patients with juxtarenal aortic occlusion. From 1975 to 1993, 44 patients (37 men) with a mean age of 62.6 years underwent surgery for this condition. The vascular lesions included renal-level segmental aortic occlusion in 2 patients, infrarenal complete aortic occlusion in 30, and high aortic occlusion with a patent inferior mesenteric artery in 12. Four patients had subacute occlusion and 40 had chronic occlusion. In the chronic group, the symptom was intermittent claudication in 31 cases, rest pain in 4, and gangrene or ulceration in 5. Impotence was present in most of the men. Surgical treatment included transaortic thromboendarterectomy in 2 patients, axillobifemoral bypass in 12, and high aortic thromboendarterectomy plus aortobifemoral bypass in 29. Suprarenal aortic clamping was done in 22 patients, with a mean renal occlusion time of 9.3 minutes. Simultaneous renal artery reconstruction was performed in 3 patients. There were 4 operative deaths (mortality rate 9%), with 2 in the subacute group. Late death from unrelated causes occurred in 9 patients within five years. Lower limb ischemia was cured in all patients and impotence cured in 4 cases. Graft patency was satisfactory after both extra-anatomic and anatomic bypass. Transanal Doppler ultrasound monitoring during the surgery was easy to set and gave the authors useful information about accurate visceral circulation in reference to aortic reconstruction.

Successful resection of an aortic arch aneurysm using a temporary trifurcation bypass graft.

Resection of a syphilitic aortic arch aneurysm in a 62-yearold woman was accomplished using a trifurcation temporary bypass system. The bifurcation graft was sutured end-to-side to the ascending thoracic aorta, to the brachiocephalic trunk and to the left common carotid artery, respectively. The attached third limb end was anastomosed end-to-side to the infrarenal abdominal aorta. This technique enabled a larger shunt into the abdominal aorta. Occlusion of the iliac arteries proved to be effective in coping with hypotension while attending to the bypass and the volume replacement. The post-operative recovery was uneventful and the patient has remained well after 43 months.