Salvage of infected vascular graft via 'perivascular venous banding' technique coupled with rectus abdominis myocutaneous muscle flap transposition.

This is the case of a severe Pseudomonas aeruginosa biological vascular graft infection, completely involving the perianastomotic tract of a femoro - femoral crossover bypass and resulting in repeated bleeding from the offended vessel wall. After the failure of a sartorious rotational muscle flap transposition into the infected groin wound, this 'high-grade' vascular graft infection was finally treated successfully by wrapping a great saphenous vein patch reinforcement circumferentially around the damaged biological vascular conduit and filling the infected wound with a rectus abdominis myocutaneous muscle flap transposition. The aim of this report is to illustrate this novel, to our knowledge, 'perivascular venous banding' technique and to evaluate the prospective of future testing of this surgical procedure. Starting from this singular case, we will also review the role of the rotational muscle flaps in the conservative management of major vascular graft infections.

[Role of endovascular surgery in presence of rupture of the thoracic aorta in patients with severe multisystemic post-traumatic surgical lesions]. / Ruolo della chirurgia endovascolare nelle rotture aortiche del politraumatizzato con lesioni polidistrettuali di pertinenza chirurgica.

The endovascular treatment (ET) of traumatic rupture of the thoracic aorta (TRTA) may represent, particularly in patients with severe multisystemic post-traumatic surgical lesions, an alternative approach to traditional surgery. We observed (October 2001- November 2004) 5 male patients (age: range 23-42 years - average 32,4) affected by TRTA (3 isthmic aortic ruptures - 2 distal descending thoracic aorta ruptures), all successfully treated with an endovascular approach. The Glasgow Coma Score (GCS) ranged between 5 and 13. After performing resuscitation manoeuvres, all patients were investigated with total body CT scans in order to evaluate the thoracic aorta and to identify associated visceral lesions. In 4 cases were evident associated visceral lesions (3 cases: bone, abdominal and neurosurgical trauma - 1 case: bone, abdominal, neurosurgical and thoracic trauma). All the procedures were performed in the operative room using DSA (Digital Subtraction Angiography). The mean operating time was 105 minutes (range 80 - 125). We didn't observed early and late complications (follow-up: average 24 months, range 12-36). In conclusion the ET of TRTA represents in 'critical' patients with severe polytrauma an alternative approach to traditional surgery in order to 'stabilizing' the cardiovascular clinical parameters and to treating 'safety' the other associated surgical lesions.

[Surgical techniques in ruptured abdominal aortic aneurysm]. / Tecniche e tattiche degli aneurismi dell'aorta addominale in fase di rottura.

In recent years we are observing an increasing number of authors. The surgical results, in the elective cases, are improved drammatically, and now, in many Centers, the mortality rate is less than 5%. We haven't observed the same improvements for the emergency cases. In this setting the mortality rate is still around 50% or more. What we are facing, however, is the changing of the clinical picture of this patients. In the most part of cases, the patient dies in the Intensive Care Unit, after a long and complex post-operative course, and not more in the Operating Room. Still, this could be considered a good result, expression of a better surgical experience. The way to obtain higher survival, at the moment, is linked to a better understanding of the physiologic derangements in the Intensive Care Unit. The authors discuss the organizative and technical changes the permitted to achieve this results.

[Aneurysms of the popliteal artery. Our clinical and therapeutic contribution]. / Gli aneurismi della arteria poplitea. Nostro contributo di clinica e terapia.

The authors report their experience in 10 cases of popliteal artery aneurysms. By the data of the literature the popliteal artery is the second place most affected by aneurysmatic injuries, immediately after the abdominal aorta. The authors think that the optimal treatment is the by-pass with the autologous vein graft versus all other types of prostheses.