ABSTRACT
Arterial reconstruction in the upper extremities is rare relative to the incidence of reconstruction in the lower extremities. Twenty-three patients who underwent vascular reconstruction in the upper extremities from 1985 to 2000 were retrospectively reviewed. Atherosclerosis was observed in only two subclavian arteries. The most common cause of occlusion was thromboembolism from the heart, which occurred often in the brachial artery and could be treated successfully with thrombectomy. Seven of eight bypass grafts, including three procedures below the elbow, remained patent during follow-up periods ranging from 2 to 9 years. Arterial reconstruction of the upper extremities differs from that in the lower extremities. Atherosclerosis is a rare cause of ischemia, and the etiology varies with the site of obstruction. Bypass surgery below the elbow is feasible and successful in selected patients. Ischemia of the upper extremity causes significant morbidity and should be treated aggressively whenever possible.
Subject(s)
Arm/blood supply , Arterial Occlusive Diseases/surgery , Blood Vessel Prosthesis Implantation/methods , Ischemia/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Thrombectomy , Thromboembolism/surgery , Treatment OutcomeABSTRACT
A 17-year-old man noted a painful mass on his wrist while fencing (Kendo). An aneurysm of a dorsal superficial antebrachial artery, which is an anomalous branch of the radial artery in the distal forearm, was diagnosed. He was successfully treated by excision with primary anastomosis; pathologic examination revealed a pseudoaneurysm. The anomalous location of this artery placed it at risk for civilian injury as it ran in the subcutaneous tissue of the dorsal forearm.
Subject(s)
Anastomosis, Surgical , Aneurysm, False/diagnosis , Aneurysm, False/etiology , Athletic Injuries/complications , Athletic Injuries/diagnosis , Brachial Artery/diagnostic imaging , Brachial Artery/injuries , Adolescent , Aneurysm, False/surgery , Athletic Injuries/surgery , Brachial Artery/surgery , Humans , Male , RadiographyABSTRACT
Retroperitoneal leiomyosarcoma is a rare neoplasm for which complete surgical removal provides the only effective treatment, as local recurrence adversely affects prognosis. However, invasion of major vessels may occur, making complete resection difficult. This report describes the cases of three patients who required concomitant resection of parts of the inferior vena cava because of direct tumor invasion. The major vessels should be isolated in preference to the tumor capsule during surgery to prevent sudden exsanguination or incomplete tumor resection. Resection of a recurrent sarcoma or a solitary metastasis can be effective in selected patients.
Subject(s)
Leiomyosarcoma/pathology , Leiomyosarcoma/surgery , Retroperitoneal Neoplasms/pathology , Retroperitoneal Neoplasms/surgery , Vena Cava, Inferior/pathology , Adult , Female , Humans , Leiomyosarcoma/diagnostic imaging , Leiomyosarcoma/secondary , Liver Neoplasms/secondary , Male , Middle Aged , Neoplasm Invasiveness , Retroperitoneal Neoplasms/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Multiple visceral artery aneurysms due to fibromuscular dysplasia are rare. A 43-yr-old man with a pulsatile abdominal mass detected by ultrasonography had multiple visceral artery aneurysms diagnosed by angiography. This included a huge superior mesenteric artery aneurysm. Aneurysm resection and arterial reconstruction was performed successfully. Pathologic examination revealed fibromuscular dysplasia of the medial fibroplasia type.
