Mycotic venous aneurysms in cases in autogenous arteriovenous fistulae for chronic haemodialysis

Mycotic venous aneurysms are presently met with due to the repeated needling of the autogenous arterio-venous fistulae established for chronic hemodialysis. Twenty-four cases were studied. The average age was 40.3 years. The male to female ratio was 5:1. The interval form the establishment of the fistula to the mycotic aneurysms was 4.6 months. The fistula was radio-cephalic in 75% of cases and brachio-cephalic in 25% of cases. In two thirds of cases the mycotic aneurysm was near the site of the fistula and distant in the rest. Diagnosis was easy due to the subcutaneous site and peripheral situation along with the repeated examination of this region during hemodialysis Staph. aureus was the responsible organisms in 83.3% of the cases. Patients were treated by dismanteling of the fistula, ligation of the vein together with excision and drainage of the aneurysm and the infected tissues

Mycotic arterial aneurysms

Fifteen patients with mycotic arterial aneurysms were studied. Fourteen were males with the age averaged 40 years. Pain, palpable swelling, fever and leucocytosis were the commonest clinical features. The source of infection was due to invasive procedure or bullet injury in 11 and unknown in 4. Staphylococcus aureus was the commonest organism [60%]. The common femoral artery was frequently affected, but no peripheral artery was immune. Resection and drainage was the main line of treatment. Reconstruction was attempted if the lesion was encapsulated and restoration of blood flow was essential to the vitality of the limb. A bypass procedure through noninfected area with autologous vein using monofilament sutures was the method recommended

Traumatic aneurysms

Traumatic aneurisms are the classic example of false aneurism and demonstrate the propensity of a full thickness local defect in the arterial wall to lead to a saccular aneurysm without unusual hemodynamic forces and when no abnormal mechanical sheaths are involved. Sixty patients with aneurysm were admitted to the Vascular Surgery Outpatient Clinic in Alexandria University Hospitals and examined by history taking, physical examination, and Doppler ultrasonic detector. Roentgenograms were taken in two planes and routine preoperative arteriogram was performed. Standard vascular reconstruction techniques were employed according to the necessities during the operation. Results were discussed and analyzed

Traumatic arteriovenous fistulae

Fifty-eight patients with TAVF were studied. The diagnosis is not usually difficult, in most cases history taking and clinical examination were sufficient. However, arteriography was always required prior to the operation and Doppler flowmetry is helpful. Measurement of the cardiac output and blood flow through the fistula could determine the physiological significance of the fistula. Penetrating injuries were found in 93.1% of the cases. Pulsating swelling, buzzing sound or sensation and secondary varicosity were the commonest clinical findings. All traumatic AVF should be considered for treatment to avoid complication