Traumatic variation of popliteal artery entrapment syndrome.

Popliteal artery entrapment syndrome is a well recognised sequelae of anatomical variation in the origin of the medial head of gastrocnemius. It classically presents with distal ischaemia from progressive intimal fibrosis and eventual thrombosis. We present a unique case of acute lower limb ischaemia precipitated by trauma in a young man with undiagnosed popliteal artery entrapment. In this case sudden stress of the lower limb resulted in tearing of the tunica intima of the entrapped artery and exposure of the subendothelium with subsequent thrombus, distal embolisation and acute ischaemia. Successful limb salvage was achieved through endovascular thrombolysis and arterial reconstruction.

Varicose veins--an old dog and some new tricks.

There are many new methods to treat varicose veins being tried and tested around the world, many using patented techniques. They would appear to demonstrate many of the features a military surgeon might deem beneficial for treating a service population, a rapid return to duties amongst them. There are some significant drawbacks. All of these modalities need to offer long-term evidence of efficacy to demonstrate advantage over current standard. The endovenous therapies utilise expensive equipment that limit their introduction and provide a potential for novel complications as well as novel therapy. Modified sclerotherapy as described here has many advantages; it is incredibly cheap, minimally invasive and easily repeatable--in fact planned re-intervention is used in some protocols. Until long-term results are available, it would seem premature to recommend any of these new treatments for use in service personnel with primary varicose veins. Military vascular surgeons will await these results with interest, as the service population would have much to gain from a modality that reliably treats the veins and ensures a swift return to service.

Effect of chronic renal failure on mortality rate following arterial reconstruction.

BACKGROUND: There is some evidence that patients with renal failure who have arterial procedures may have a poor outcome. This study compared the hospital mortality rate of arterial surgery in patients with chronic renal failure and those with normal renal function. METHODS: A consecutive series of 1718 patients undergoing arterial reconstructive surgery (excluding amputation) was entered prospectively on to a computerized database. Chronic renal failure was defined as a serum creatinine level over 400 micromol/l, or dialysis (either peritoneal or haemodialysis), or a successful renal transplant. Mortality was assessed at 30 days or in hospital. RESULTS: There were 69 patients (4.0 per cent) who were defined as having chronic renal failure. The mortality rate in this group was 23 per cent (16 patients) compared with 7.3 per cent (120 patients) of the 1649 patients without renal failure. The mortality rate was highest in patients undergoing urgent or emergency surgery and in those undergoing reconstruction for lower limb occlusive disease. The main causes of death were related to the cardiovascular system. CONCLUSION: Patients with chronic renal failure undergoing arterial surgery have a poor outcome compared with those with normal renal function.

Pacemaker longevity modelling.

A generalized mathematical technique is presented for computing the elapsed time necessary for a lithium iodine powered pacemaker to reach any specified battery voltage or degree of battery discharge within its life span. In particular, the method yields a direct mathematical expression for the longevity of pacemakers the circuits of which possess linear load lines. Because the current-voltage relationship, which defines the load line, is affected by programmed output settings, electrode/tissue interface impedance and degree of inhibition, the method enables the direct determination of the effect of these parameters on pacemaker longevity.