[The role of transplanted vein graft in arterial reconstruction]. / Il ruolo dell'innesto con vena traslocata nella ricostruzione arteriosa.

The use of the non-reversed saphenous vein has not been properly evaluated yet, for what concerns the features of length and application. In the reported series this technique has been employed for the reconstruction of arterial segments in various anatomic sites. The mean follow-up was 10 months. Between November 1987 and September 1993 at the Department of Vascular Surgery of Pietra Ligure and Imperia 39 arterial grafts with the use of non-reversed autologous saphenous vein were performed, for the treatment of arteriosclerotic, traumatic or aneurysmatic diseases. On the basis of the outcomes (70 to 100% patency of the grafts found at the follow-up), pro and cons of this technique is weighed up and some guidelines about the procedure of choice (among the non-reversed, in situ or reversed saphenous vein) are settled, keeping in mind the different variations who must influence and direct the surgeons' choice (venous diameter, features of the site to revascularize etc.).

[Iliac PTA: long-term results and current prospects]. / PTA iliaca: risultati a distanza e prospettive attuali.

The authors outline their experience with reference to the treatment of segmentary lesions at the level of the iliac artery. They analyse a series of 93 patients undergoing PTA. In 85 cases it was possible to conclude the procedure: 4 patients presented a small occlusion and 81 stenosis which was associated with femoro-popliteal occlusion in 35 cases. The authors analyse the results using life tables and show that treatment is optimal for the common iliac artery whereas the percentage of restenosis increases parallel to progress in a distal direction. In conclusion, the authors affirm that the procedure is safe and in order to improve results, above all at the level of the external iliac artery, il will probably be necessary in the future to use additional endovascular techniques such asm for example, the systematic use of stent.

[Incidence and treatment of vascular prosthesis infection in the groin. Personal experience]. / Incidenza e trattamento della infezione protesica vascolare a livello inguinale. Esperienza personale.

The incidence of prosthesis infection in the groin ranges between 1 and 3%, with high morbidity and mortality rates. Contamination, irrespective of whether it is endogenous or exogenous, may occur during surgery of afterwards due to a secondary bacterial load which is often associated with a traumatic surgical technique for tissues, often in emergency surgery or re-operations. MATERIALS AND METHODS. Over the past 5 years a total of 410 prosthetic alloplastic grafts have been made by our Division of Vascular Surgery with at least one anastomosis at an inguinal level. The materials used for prosthesis were dacron and PTFE. Thirty-one infections were observed in the groin of which 11 involved the prosthesis and 20 were apparently restricted to the superficial and deep layer of the dermis. A cell culture test and antibiogram was always performed. Surgical or medical therapy (loco-regional + general) was used according to individual cases. RESULTS. With regard to the 11 patients with manifest infections of the prosthesis, only trans-obturator bypass surgery gave positive long-term results, whereas other operations (femoro-femoral bypass, axillo-popliteal bypass) were not satisfactory. Of the other 20 patients treated using loco-regional and general medical therapy, 9 developed pseudo aneurysm over time for which it was then necessary to resort to surgery. DISCUSSION AND CONCLUSION. Currently there is no universally accepted treatment protocol for the management of prosthesis infection. However, it is generally considered useful to isolate any pathological agent (using routine biopsies of arterial wall or thrombo-endoluminal fragments during the primary operation) before infection can develop so as to be able to commence specific antibiotic therapy. In this context the authors underline the more devastating action of some bacteria (pseudomonas, Staphylococcus aureus) in comparison to others (Staphylococcus epidermidis). Turning to therapeutic measures, when there are anatomical grounds and with the greatest possible respect for periarterial tissues, it is considered that trans-obturator bypass is preferable in the presence of manifest infection of the prosthesis, whereas medical therapy can be used (loco-regional + general) if infection is limited to the surface layers of the inguinal area. Possible complications over time may be corrected using surgery and in situ reconstruction if infection is no longer present.