Pantaloon vein graft technique in tibial revascularization with arteriovenous fistula for limb salvage.

Graft patency and limb salvage in 91 successive patients operated upon between April 1989 and April 1994 with a human umbilical vein graft combined with an adjunctive arteriovenous fistula at the distal anastomosis of the prosthetic graft in a single limb were evaluated. All the patients operated on were in the 'limb salvage' category. On discharge from hospital 91% of the revascularized limbs were salvaged. Secondary cumulative patency at 57 months was 57.3% with a 61.5% limb salvage rate. This technique, which has anatomical and haemodynamic advantages, results in improved graft patency and foot salvage rates in patients with critical leg ischaemia and poor distal run-off when autologous saphenous vein is absent or cannot be used.

[Spontaneous limited dissection of the external iliac artery. Case report after 14 year follow-up]. / Spontane limitierte Dissektion der A. iliaca externa. Fallbeschreibung nach 14 Jahren Beobachtungszeit.

The case of a limited dissection of the external iliac artery in a 31-year-old woman is described. The clinical symptomatology was that of an acute ischemia of the right lower extremity. Histology revealed the existence of a cystic Medionecrosis. With reference to the literature, the clinical and surgical aspects are discussed.

[Evaluation of anti-thrombophilic properties of heparan sulfate in venous vascular pathology. A controlled clinical study versus active reference]. / Valutazione delle proprietà antitrombofiliche dell'eparansolfato in patologia vascolare venosa. Studio clinico controllato verso reference attivo.

Forty adult patients (31 females and 9 males), mean age 48.41 years with chronic venous insufficiency of the lower limbs due to a variety of etiopathogenesis, were randomly divided into two groups of twenty subjects and treated with heparan sulphate and sulodexide. The experimental clinical protocol was formulated using a single blind model. The following dosages were used: a tablet of heparan sulphate in the morning and evening (200 mg/die), and one capsule of sulodexide in the morning and evening (500 ULS/die); treatment lasted 60 days. The aim of the study was to compare the two compounds in terms of efficacy and tolerability. The clinical effect of the two drugs was substantially similar: in particular the symptoms of itch, edema, spontaneous pain and nocturnal cramp responded significantly to (p less than 0.01) to both forms of treatment. The response of fibrin degradation products to heparan sulphate treatment was more positive and differed significantly from that obtained using sulodexide (p less than 0.001). Other parameters, namely erythrocytic filtration and blood viscosity, responded significantly to heparan sulphate treatment in comparison to sulodexide (p less than 0.001). Other blood coagulation and hemorheological parameters and Doppler response showed no change using either drug. With regard to side effects, five cases of digestive intolerance were observed using heparan sulphate and two with sulodexide. Two patients failed to complete heparan sulphate treatment, and one sulodexide treatment. In conclusion, heparan sulphate showed a marked pro-fibrinolytic and prohemorheological effect compared to the reference drug.

The role of antiplatelet agents in modifying the extent of restenosis following percutaneous transluminal coronary angioplasty.

We previously reported that a combination of aspirin and dipyridamole given before, during, and for 6 months following percutaneous transluminal coronary angioplasty (PTCA) did not reduce the incidence of restenosis. In that trial, a total of 272 successfully dilated segments in 243 patients reached final quantitative angiography and of these, 86 segments (31.6%) had restenosed (46 of 130 segments in the group of patients given placebo and 40 of 142 segments in the aspirin-dipyridamole group). A secondary analysis of these 86 segments revealed that at follow-up angiography the severity of restenosis was greater in the 46 segments in the placebo group than in the 40 segments in the active treatment group (mean minimal luminal diameter at the stenosis = 0.76 +/- 0.52 and 1.03 +/- 0.45 mm, respectively, p = 0.01). The frequency of total or subtotal occlusions was higher in the placebo group (17.4%) than in the active treatment group (5.0%), but this observation did not reach statistical significance (p = 0.07). Although long-term treatment with aspirin and dipyridamole after successful PTCA does not reduce the incidence of recurrence, this secondary analysis suggests that it is associated with a decreased likelihood of severe restenosis.

Complications associated with the guide wire in percutaneous transluminal coronary angioplasty.

This report describes three cases of unraveling of the platinum coil of the guide wire during percutaneous transluminal coronary angioplasty. In one case the wire ruptured and required surgical removal. The exact cause of this phenomenon is not known, but wire entrapment may be a factor. This is more likely to occur with tortuous vessels. Precautions to avoid uncoiling and rupture of guide wires during coronary angioplasty are discussed.