Reinterventions in the superficial femoral artery.

The management of peripheral arterial disease (PAD) has drastically changed since the introduction and advancement of endovascular surgery. The majority of PAD that requires mechanical treatment is managed with endovascular interventions using a variety of techniques and devices. The infrainguinal vasculature, especially the superficial femoral artery (SFA), poses a significant challenge to successful long-term outcomes for a variety of reasons. Because some of these procedures have limited longevity, the management of patients that require reintervention is worthy of special consideration and strategic discussion. This article reviews the risks and failure modes of SFA interventions and the treatment options and techniques for reinterventions.

Heterotopic ossificans in chronic venous insufficiency: a new consideration for clinical, aetiology, anatomy and pathophysiology staging.

OBJECTIVES: Heterotopic ossification is defined as the abnormal formation of true bone within extra-skeletal soft tissues. It may be associated with a variety of clinical conditions, but is most frequently seen with musculoskeletal trauma, neurologic injury or genetic abnormalities. It has also been described in patients with chronic venous insufficiency; however, it often goes underdiagnosed due to chronic ulceration that masks exam findings. To date, few reports of heterotopic ossification due to chronic venous disease exist within the literature with the most recent dating back to the 1970s. METHODS: We present a case study of a man presenting with extensive leg ulceration and a history of chronic venous insufficency. He had a large non-healing venous stasis ulcer of the left lower extremity with extensive heterotopic ossification discovered intraoperatively. RESULTS: The patient was managed with serial wound debridement, innovative woundcare and eventual split thickness skin grafting that achieved limb salvage despite the complexity of his wound. CONCLUSIONS: Our discussion focuses on the epidemiology, pathophysiology, diagnostic work-up and management of heterotopic ossification in the setting of chronic venous insufficiency. We propose that heterotopic ossification be included in any future modifications of the clinical, aetiology, anatomy and pathophysiology system classification as a complication of chronic venous disease.