Mycotic aneurysm of the tibioperoneal Trunk. An extremely rare localization with pseudo-phlebitis clinical presentation

Since antibiotic have been widely used in the treatment of bacterial endocarditis, mycotic aneurysms caused by septic emboli have become extremely rare. We report the case of a 66-year-old male patient who presented mycotic aneurysm of the right tibioperoneal trunk two weeks after aortic and mitral valve replacement due to Enterococcus fecalis endocarditis. The clinical presentation simulated thrombophlebitis of the deep veins of right calf. A pulsating mass was diagnosed clinically and duplex ultrasound confirmed the diagnosis of a mycotic aneurysm of the tibioperoneal trunk. Surgical treatment included the closure of the orifice of the aneurysm and excision of the aneurysmal sac. Arterial reconstruction was not required. Postoperative course was uneventful. No complication was observed at long-term follow-up. This observation represents the seventh case reported in the literature of mycotic aneurysm at this localization

Brachial to internal jugular vein bypass. a case report

The introduction of percutaneous dialysis catheter placement in the subclavian vein for temporary dialysis has contributed to the high incidence of occlusion of axillary and subclavian veins. We report the case of a 62 year old male patient who had a history of a chronic dissection of the thoracic and abdominal aorta and who was on hemodialysis for chronic renal failure through a right radio-cephalic fistula. The patient complained of recurrent thrombophlebitis of the right upper extremity secondary to a subclavian vein thrombosis after catheter placement. A brachial to internal jugular vein bypass using ring 6mm polytetrafluoroethylene graft was performed to alleviate the symptoms of venous hypertension and to preserve the function of the radio cephalic fistula. This bypass is still patent 24 months after surgery. Many recent studies showed promising results with this bypass favouring its use in selected patients with subclavian venous lesions not amendable with balloon angioplasty and thrombolytic therapy

Digital pulse volume recording: an essential test for the assessment of arteritis in diabetic patients

The high incidence of medial calcification in the distal arteries of lower extremities in diabetic patients is responsible for most of the errors made in measuring ankle-pressure index. Because digital arteries are rarely calcified, digital pulse volume recording has been proposed as a specific and complementary test. Between march 1993 and march 1996, this test was performed in addition to ankle-pressure index in 66 diabetic patients. The ankle-arm index was overestimated and erroneous in 89.4% of cases. Digital arteries were calcified in 74% of cases and diabetic neuropathy present in 53% of cases. Assessment of the severity of arteritis by digital pulse volume recording [category 1 to 5] has led to better prevention and treatment. It is an essential test for the assessment of arteritis in diabetics, but also for the prediction of success of a surgical procedure: distal amputation, lumbar sympathectomy and arterial reconstruction