Treatment of a hepatic artery aneurysm by endovascular stent-grafting.

Aneurysms of the visceral arteries are rare. Traditional treatment has been surgical or endovascular with coil embolization. Recently, however, reports on endovascular therapy with stent-grafts have been published. We report the case of a 61-year-old man who was successfully treated with a stent-graft for a symptomatic combined celiac/hepatic artery aneurysm.

[Intermittent claudication--diagnosis and treatment]. / Claudicatio intermittens--diagnostikk og behandling.

BACKGROUND: Intermittent claudication occurs in 5% of the population over 60 years, and may involve reduced walking distance, pain and a reduced quality of life. The mortality rate is 5% per year and the annual amputation rate 1%. This review article gives an update on diagnosis and medical, endovascular and surgical treatment of intermittent claudication. MATERIAL AND METHODS: The article is based on publications found on Pubmed, supplemented by clinical experience. RESULTS AND INTERPRETATION: The aims of medical, endovascular and surgical treatments are to enable the patient to walk further, obtain an improved quality of life and to live longer. Patients should first be treated medically. Endovascular treatment or open surgery, are options for patients with reduced quality of life due to limited walking distance. The treatment choice depends on the location of the arterial lesions and if the patient has any other illness.

Flow measurement before and after papaverine injection in above-knee prosthetic femoropopliteal bypass.

OBJECTIVE: To investigate the value of intraoperative blood flow measurements on early and long-term patency of above-knee prosthetic femoropopliteal bypass. METHODS: Flow was measured with a transit time flowmeter before (basal flow) and after an intragraft injection of papaverine (papaverine flow) in 87 operations (86 patients) between January 1990 and December 2001. Sixty-one grafts were of polyester, and 26 were of polytetrafluoroethylene. The operations were done under epidural anesthesia. The preoperative angiographic run-off score and clinical risk factors were recorded. Patency rates were analyzed with the product limit method and compared with the log-rank test. Variables found to be near significantly related to patency rates (P < .1) were included in a multivariate analysis performed with the Cox proportional hazard model. RESULTS: Basal flow measurements were not related to patency. The 2- and 5-year patency rates for grafts with a papaverine flow < or = 500 mL/min were 48% and 18% compared with 66% and 52% for grafts with a papaverine flow > or = 500 mL/min. These differences were statistically significant (P = .012, hazard ratio, 2.6). Two- and 5-year patency rates for smokers vs nonsmokers were 44% and 18% vs 69% and 54%. The patency rates for patients with poor vs good run-off were 42% and 27% vs 66% and 31%. Smoking (P = .008, hazard ratio, 2.75) and poor run-off score (P = .009, hazard ratio, 2.38) were found to be independent risk factors for reduced patency rates. Poor run-off score did not correlate with low values of measured basal or papaverine flow. CONCLUSIONS: Papaverine flow of < or = 500 mL/min is associated with reduced mid- and long-term patency rates. Additional antithrombotic medication and frequent follow-up for these grafts should be considered. The inferior patency rates of smokers and patients with poor run-off indicate that prosthetic bypass is less suitable for these groups of patients.

Local infections after above-knee prosthetic femoropopliteal bypass for intermittent claudication.

BACKGROUND: The use of prosthetic grafts in the treatment of intermittent claudication is still a controversy. Prosthetic bypass for this usually benign condition may in some cases lead to a graft infection. This potentially disastrous complication is difficult to manage. METHODS: One hundred forty-one consecutive operations done on 129 patients between January, 1990 and December, 2001 in a single university vascular unit have been studied. Lymphatic complications and local infections have been related to preoperative risk factors, complications, secondary procedures, and outcome. RESULTS: During a mean follow-up period of 42 months, lymph complications occurred after 18 operations, surgical site infection after 11 procedures, and graft infection after 17 operations. Eleven infected grafts were treated successfully without graft excision. Six of these grafts healed with antibiotics only. The risk of developing a local infection was significantly correlated with postoperative lymph fistula. Reoperative surgery was associated with graft infection. Graft infection caused by Staphylococcus aureus always warranted surgery, either local revision or graft excision. CONCLUSIONS: The present series had a high frequency of graft infections. Our data suggest that a selective approach should be taken towards excision of infected femoropopliteal prostheses. The need for and extent of surgery should be individualized according to the clinical presentation of the graft infection and the type of bacteria involved. We advocate a conservative attitude towards surgical treatment of intermittent claudication.

[Use of stents in abdominal aortic aneurysms]. / Bruk av stentgraft ved abdominale aortaaneurismer.

BACKGROUND: Endovascular treatment of aortic aneurysms has acquired a widespread application. We present the results of endovascular treatment of infrarenal, abdominal aortic aneurysms in our hospital from 1995 through 2002. MATERIAL AND METHOD: Seventy-one stent graft procedures were performed on 69 patients (64 men), mean age 72 years (range 48-96 years). Mean aneurysm diameter was 57 mm (range 35-100 mm). Sixty-nine procedures were elective and two were emergency procedures. All data were registered prospectively. RESULTS: Two procedures failed initially because of technical problems. Both patients underwent a successful procedure later. Immediate conversion to open surgery was done in one case because of a collapse of the graft into the aneurysm sac. There was no 30-day mortality for elective procedures. The conversion rate after a mean observation time of 42 months was 11%. Late complications resulted in 47 re-interventions in 29 patients, of which 96% were done in cases treated with Stentor or Vanguard prostheses. CONCLUSION: Endovascular treatment of aortic aneurysms is an alternative to open surgery. Stent graft failure can be serious and difficult to predict. This treatment should not be recommended to patients younger than 70 years and fit for open surgery.

[Stenting of failing above-knee femoropopliteal percutaneous transluminal angioplasty]. / Stentbehandling i det femoropopliteale segmentet ovenfor kneet.

BACKGROUND: Percutaneous transluminal angioplasty (PTA) is increasingly used in the treatment of stenoses and short occlusions of the superficial femoral and proximal popliteal arteries. Routine treatment with arterial stents does not seem to improve the results compared to PTA without stent but the efficacy of stenting as a repair procedure of a failing PTA is not known. PATIENTS AND METHODS: In our hospital, intraluminal arterial stenting of the above knee femoropopliteal segment has been used as a repair procedure when PTA alone fails because of dissection or recoil. From 1995 to 2001, 264 above-knee femoropopliteal PTAs were performed in 203 patients. Fifteen procedures were considered failures; these cases are reported in this study. RESULTS: Arterial stents were successfully implanted in all fifteen patients. One year postoperatively, five stents had occluded, seven reconstructions were still patent. Three patients could not be followed up; they were diseased at the time of the study. INTERPRETATION: In spite of the limited patency achieved, intraluminal arterial stenting in the above-knee femoropopliteal segment can be useful as a repair procedure when PTA alone fails.