Results of Infrainguinal Chronic Arterial Occlusion: Difference in Medical and Surgical Management

PURPOSE: In order to evaluate the result of medical treatment and compare with surgical management in infrainguinal arterial occlusion, we analyzed 145 cases of infrainguinal chronic arterial occlusion that admitted our department during recent 5 years. METHOD: Patients were grouped into 2 according to their treatment. Group 1 was patients who underwent arterial bypass surgery (n=84) and group 2 with conservative management of exercise and medication (n=61). In case of significant iliac arterial stenosis, balloon angioplasty or stent insertion were added in both groups (17 in group 1, 16 in group 2). Changing of clinical manifestation and ankle-brachial index, claudication distance, rate of major amputation and mortality were compared between groups. RESULT: There was a big difference in the rate of improving claudication distance at the end of one year after treatment (86.5% in group 1 vs 40.0% in group 2) but 5.4% of group 1 and 32.0% of group 2 showed aggravation of the symptoms. Improved ankle-brachial index (ABI) noted in 88.1% of group 1 but in group 2, 39.3% showed increasing of ABI only under the conservative management. The proximal inflow procedure had more significant effect in improving ischemic symptoms and ABI in group 2 compare to group 1. One fourth of group 1 and 18.2% of group 2 showed spontaneous healing of their toe gangrene but 3.1% of group 1 and 54.5% of group 2 needed major amputation because of disease progress. New gangrene developed during their follow up and this also ended with major amputation in group 2. The difference of mortality rate between groups might be due to old age and associated cardiac disease. CONCLUSION: Better results in improving ischemic symptoms and ABI with low rate of amputation and mortality encourage us to do an aggressive surgery. But significant portion of conservative group especially in patients with inflow procedures also showed improving symptoms, and this suggest us a need of significant consideration of medical and exercise treatment in selected cases.

Functioning Paraganglioma Manifested Cerebral Hemorrhage and Combined with Coronary Arterio-Venous Fistula

Extra-adrenal pheochromocytomas, also called functioning paragangliomas are uncommon retroperitoneal tumor, manifesting with similar symptoms and signs to adrenal pheochromocytoma. In this report, we present a case of a 46-year-old women who had had paroxysmal hypertension and palpitation for four years. An abdominal mass, the size of an adult fist, was noted, with symptom of a cerebral hemor rhage and cardiac ischemia caused by a coronary arterio-venous fistula. The cerebral hemorrhage symptoms were improved spontaneously. The abdominal mass determined to be a functioning paraganglioma by complete resection. The coronary arterio-venous fistula was surgically corrected a month after resection of the tumor. The patient was freed from the symptoms and signs of a pheochromocytoma, including palpitations and hypertension. There has been norecurrence for a year and half following the removal of the mass.