ABSTRACT
Late failure of microsurgical flaps is a rare event and it has been reported as a consequence of compression of the vascular pedicle or late infection. We report a case of late partial failure occurring 3 weeks post-operatively which was shown by vascular imaging to be caused by a previously unidentified complete occlusion of the right external iliac artery. After successful vascular bypass surgery, the suffering flap developed granulation tissue and was skin grafted. In patients carrying multiple risk factors for peripheral vascular disease, the risk of proximal vessel occlusion as a cause of flap failure, should be kept in mind.
Subject(s)
Fibula/injuries , Fracture Fixation, Internal/methods , Fractures, Open/surgery , Free Tissue Flaps , Graft Rejection , Leg Injuries/surgery , Postoperative Complications/surgery , Tibial Fractures/surgery , Vascular Surgical Procedures/methods , Accidental Falls , Anastomosis, Surgical , Debridement , Humans , Male , Microsurgery , Middle Aged , Risk Factors , ThighSubject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/surgery , Blood Vessel Prosthesis Implantation/standards , Endovascular Procedures/standards , Evidence-Based Emergency Medicine/standards , Outcome and Process Assessment, Health Care/standards , Quality Indicators, Health Care/standards , Age Factors , Aortic Aneurysm, Abdominal/diagnosis , Aortic Aneurysm, Abdominal/mortality , Aortic Rupture/diagnosis , Aortic Rupture/mortality , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/mortality , Comorbidity , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Endovascular Procedures/mortality , Female , Humans , Kidney/physiopathology , Male , Prosthesis Design , Risk Assessment , Risk Factors , Sex Factors , Stents , Treatment OutcomeABSTRACT
Venous obliteration using foam sclerosant is a relatively new procedure that holds great promise and may prove to be as effective as conventional surgical treatments in obliteration of the great saphenous vein. Foam sclerotherapy can have minor and major complications, most of which occur as a result of gas or sclerosant leakage into the systemic venous system. Conventionally, the saphenofemoral junction is occluded by digital pressure to prevent escape of sclerosant foam into the deep venous system. We propose balloon control of the saphenofemoral junction to prevent sclerosant leakage. This also promotes foam contact with the endothelium in a prolonged, controlled fashion. This method requires no anesthesia, is suitable for ambulatory care, and has been safe and successful in all five cases. Duplex examinations at 1 week and 3 months have shown complete obliteration of the great saphenous vein using this technique.
Subject(s)
Catheterization/instrumentation , Femoral Vein , Saphenous Vein , Sclerosing Solutions/therapeutic use , Sclerotherapy/instrumentation , Sodium Tetradecyl Sulfate/therapeutic use , Venous Insufficiency/therapy , Aged , Femoral Vein/diagnostic imaging , Follow-Up Studies , Humans , Saphenous Vein/diagnostic imaging , Sclerotherapy/adverse effects , Treatment Outcome , Ultrasonography, Doppler, Duplex , Ultrasonography, Interventional , Venous Insufficiency/diagnostic imagingABSTRACT
Several different modes of achieving a bloodless operating field by proximal and distal occlusion of blood vessels have been described. Vascular clamps, vessel loops, intraluminal occluding devices, and tourniquets have been used to control the tibial and pedal vessels but may cause injury or fail to control heavily calcified arteries. We describe an alternative way to control proximal and distal small arteries by using small, umbilical vein, feeding catheters. The catheters are introduced in the proximal and distal arterial lumen and in the vein graft lumen, achieving hemostasis, technically facilitating the suturing, and providing a means for the administration of vasodilator or thrombolytic agents as well as for a completion angiography.
