[Aneurysms of the splenic artery: our experience]. / Aneurismi dell'arteria splenica: nostra esperienza.

Splenic artery aneurysms, although rare, are the most common visceral artery aneurysms with a high risk of rupture. The purpose of this retrospective study was to analyse our experience with such aneurysms. Eight patients (6 women, 2 men; mean age: 60.2 years; range: 33-76 years) with a diagnoses of splenic artery aneurysm were reviewed. Six patients were asymptomatic and two had chronic pancreatitis with left flank pain. The condition was diagnosed by ultrasonography and computed tomography. Five patients underwent surgery, two requiring splenectomy, and three patients were treated by embolisation. There were no postoperative deaths. Follow-up data were available for 7 patients, the mean follow-up period being 60 months (range: 2-72 months). Although open surgical repair remains the gold standard, endovascular techniques may, in selected cases, offer a viable alternative in high-risk patients with significant co-morbid conditions.

Outcome of iatrogenic injuries to the abdominal and pelvic veins.

PURPOSE: To analyze the management and outcome of iatrogenic injuries to the abdominal and pelvic veins. METHODS: We reviewed a series of patients who sustained iatrogenic vein injuries between 1989 and 2004. RESULTS: Thirty patients (21 men and 9 women ranging in age from 38 to 82 years; mean age, 53.6 years) sustained major vein injuries during general (46%), gynecological (20%), orthopedic (13%), colorectal (10%), or urologic (10%) operations. The following veins were injured: inferior vena cava (n=10), portal vein (n=4), iliac vein (n=15), and renal vein (n=1). The following types of repair were carried out: venorrhaphy (56%), end-to-end anastomosis (10%), and an interposition graft (33%). Seven patients (23%) died of injury-related causes and 18 (60%) suffered major injury-related complications, including bleeding requiring repeat exploration (n=7), disseminated vascular coagulopathy (DIC; n=5), venous thrombosis (n=4), and lower limb arterial ischemia (n=2). There were two cases of late venous thrombosis. CONCLUSION: Iatrogenic vein injuries can occur during radical surgery for cancer and are associated with high morbidity and mortality as a result of massive bleeding. Rapid vascular control and venous repair improve early and late outcome.

[Popliteal aneurysms: comparison of the results of elective and emergent treatment]. / Gli aneurismi poplitei. Comparazione tra risultati del trattamento in elezione e in urgenza.

The purpose of this study was to compare the outcomes of elective versus emergent operative repair of popliteal artery aneurysms. From 1988 to 2004, 108 popliteal aneurysms were repaired in 76 patients (mean age: 66 years; range: 42-86). Repair was elective in 70 cases - 19 asymptomatic (17%), 51 symptomatic (46%); and emergent in 38 cases; 12 of these with no identified outflow target vessel at initial arteriogram underwent intra-arterial thrombolysis. Proximal anastomosis was performed to the superficial femoral artery in 56 cases, to the popliteal artery in 24, to the common femoral artery in 28. Distal anastomosis was performed to the distal popliteal artery in 32 cases (29%) and to the infrapopliteal artery in 76 (70%). In the postoperative period, in the elective group one bypass was occluded and repaired, whereas in the emergent group 4 bypasses were occluded and amputated. During follow-up (mean duration: 57.8 months), in the elective group, 4 bypasses were revised, 5 occluded, and 2 amputated; in the emergent group, 5 bypasses were revised, and 3 were occluded and amputated. Primary patency was 98% and 79% in the elective group, as against 89% and 71% in the emergent group at 1 and 5 years, respectively. Limb salvage was 100% and 94% in the elective group, as against 89% and 81% in the emergent group at 1 and 5 years, respectively. The outcome is better with surgical treatment of elective popliteal aneurysms compared with emergency treated aneurysms. Aggressive reconstruction in patients with acute limb ischaemia is mandatory. Thrombolytic therapy may be useful in patients with no identified outflow target vessel.

[Comparison between magnetic resonance angiography and duplex ultrasound for preoperative planning of lower limb revascularisation]. / Comparazione tra angio-RMN ed ecocolordoppler nella diagnostica preoperatoria delle rivascolarizzazioni degli arti inferiori.

The purpose of this study was to compare magnetic resonance angiography with duplex ultrasound for defining anatomical features relevant to performing lower limb revascularisation. From June 2003 to June 2004, 30 consecutive patients with chronic lower limb ischaemia underwent magnetic resonance angiography and duplex ultrasound investigations before undergoing lower limb revascularisation procedures. The mean age was 72 years (range: 45-93). Indications for the procedure included resting pain (6 cases), ischaemic ulcer (8 cases), and gangrene (16 cases). We compared magnetic resonance angiography and duplex ultrasonography findings and the differences in the aorto-iliac, femoro-popliteal and infrapoliteal segments were noted. Magnetic resonance angiography and duplex ultrasound findings agreed in 13/15 cases (86%) in the aorto-iliac segment, in 14/17 (82%) in the femoro-popliteal segment, and in 8/11 (74%) in the infrapopliteal segment. In all, duplex ultrasound agreed with intraoperative findings in 97% of cases while magnetic resonance angiography agreed in 81%. These data show that magnetic resonance angiography is less accurate than duplex ultrasound in the infrapopliteal segment. Adeguate training is necessary before duplex ultrasound can be used as the only preoperative imaging procedure.

[Aneurysm of the abdominal aorta associated with an ectopic pelvic kidney and abnormal vascularisation: a case report]. / Aneurisma dell'aorta addominale associato a rene ectopico e anomala vascolarizzazione: caso clinico.

Renal malformations during surgery for repair of an abdominal aortic aneurysm are a rare occurrence that can create technical problems during the operation in terms of preservation of renal parenchyma and vascularisation. A case of abdominal aortic aneurysmectomy associated with an ectopic pelvic kidney is presented. Preoperative diagnosis is necessary in order to plan the surgical technique to be employed in each anatomical variant encountered.

[Retroperitoneal approach in the treatment of supra- and infrarenal aortic aneurysms]. / L'accesso retroperitoneale nel trattamento degli aneurismi dell'aorta sopra e infrarenale.

The retroperitoneal approach for the treatment of thoracoabdominal type IV and infrarenal aortic aneurysms is an accepted alternative to thoraco-phrenolaparotomy. The purpose of this retrospective study was to report our experience and results in terms of respiratory and renal complications. From January 1997 to December 2003, 48 patients (36 with thoracoabdominal type IV and 12 with infrarenal aortic aneurysms) were treated by a retroperitoneal extrapleural approach in intercostal space X or XI. We performed 40 aorto-aortic and 8 aorto-basilar reconstructions. The perioperative mortality was 2%. Postoperative respiratory insufficiency was 8%, and postoperative renal insufficiency 12%. Permanent dialysis was necessary in 4% of cases. The survival rates were 98%, 89.4% and 58.7 at 1, 5 and 7 years, respectively. Retroperitoneal extrapleural access with a partial phrenotomy results in a significantly reduced incidence of postoperative respiratory complications.