[Anterior jugular-internal jugular bypass to salvage a dialysis arteriovenous fistula]. / Pontage jugulaire antérieure - jugulaire interne pour sauvetage de fistule artério-veineuse.

Thrombosis of the anonymous vein can compromise the arteriovenous fistula in chronic renal patients on hemodialysis. Clinical manifestations include edema of the arm, stasis acrocyanosis, tugor of the neck and shoulder veins, and severe headache. The fistula may have to be closed to achieve symptom relief, requiring a catheter for dialysis until an new arteriovenous fistula becomes functional. In case of stenosis or occlusion of the brachiocephalic venous axis, the goal is to preserve a functional fistula yet resolve symptoms. Self-expanding stents have been used but results have been less than satisfactory or short-lived. Different surgical bypass techniques have been proposed. We report an anterior jugular-internal jugular bypass used to salvage a dialysis arteriovenous fistula.

[Aneurysms of the celiac artery: case report and review of the literature]. / L'anévrysme de l'artère coeliaque.

Aneurysm of the celiac trunk is uncommun, accounting for 6% of all splanchnic artery aneurysms. Atherosclerosis is the main cause, other causes include fibrodysplasia and more rarely mycotic or post-stenotic conditions. Usually asymptomatic, detection is generally fortuitous. Ultrasound, angiography and CT scan provide the positive diagnosis. Rupture is the most serious complication. The risk is about 13% per year with high mortality (80%). Cure can be achieved by conventional or endovascular surgery. We report an aneurysm of the bifurcation of the celiac trunk in a 70-year-old woman. Diagnosis was fortuitous. The aneurysm was sacciform with a 2.5 cm diameter and a large collar. Because of its locations and shape, no endovascular procedure could be attemped. Reconstruction with a patch was achieved with conventional surgery. The post-operative period was uneventful. Ultrasound at 3, 6, 12 and 36 months showed a normal caliber with regular blood flow in the reconstructed vessels.

[Use of the modified Fogarty in acute occlusions of inverted venous graft. Technique proposal]. / Utilizzazione del Fogarty modificato nelle ostruzioni acute di graft venosi invertiti. Proposta tecnica.

The acute thrombosis of inverted venous graft, although less frequent than of the alloplastic prosthesis graft, represents a problem for the vascular surgeon that on one hand wants to restore the flow and on the other to preserve, as much as possible, the integrity of the venous endothelium without damaging the valvular apparatus. The two objectives are not possible, using a traditional Fogarty balloon catheter: the introduction from the proximal anastomosis, the only possible way for the presence of the valves, requires that, for the removal of the thrombotic material, the instrument is drawn back in a contrary way with unavoidable damage of the valves. Such disadvantage is eliminated using a modified Fogarty catheter, that allows to introduce the instrument in cranio-caudal direction and to draw it back in the same way, with impossibility to stop into the bottom of the valvular border and with a minimal trauma of parietal and valvular endothelium. On the other hand, distal introduction of the traditional Fogarty catheter is difficult, if not impossible, due to the presence of the valves. The use of the Fogarty catheter from the top to the bottom of the graft is feasible after appropriate modifications of the traditional catheter that allow its introduction from the tail and to draw it back towards the periphery (with inflated balloon) according to the direction of the flow. Such modifications of the Fogarty catheter are easily feasible even on the operating table and they don't require particular devices. The technique is simple, does not require additional costs (this particular modified catheter can be, like the traditional, reusable) and allows the graft patency if the thrombosis cause is eliminated.

[Popliteal vein aneurysms]. / Les anévrysmes de la veine poplitée.

We report our experience with four cases of popliteal vein aneurysms treated over the last five years. The pathogenesis of these rare lesions is unknown. The inner wall of true venous aneurysms exhibit a reduced number of muscle fibers and fragmented elastic fibers replaced by fibrous tissue. The most dangerous risk related to popliteal vein aneurysm is pulmonary embolism. Diagnosis is based on phlebography and duplex Doppler findings. Surgery can provide cure and prevent complications. We treated our four patients with an asymptomatic aneurysm of the popliteal vein with aneurysmectomy using an atraumatic clamp and direct suture. Oral anticoagulants were given and elastic compression was maintained for six months, with satisfactory results.

[Renal artery aneurysms. Our experience]. / Les anévrismes de l'artère rénale. Notre expérience.

A retrospective study concerned 8 aneurysms of the renal artery. There were 6 females and 2 males with a mean age of 50.7 years. Diagnosis was obtained angiographically in all cases, in 7 during a reno-vascular work-up for hypertension and fortuitously in 1 after angiography for arteriopathy of the lower limbs. The aneurysm was due to fibromuscular dysplasia in 5 cases and to atheromatous lesions in 3. Reconstruction techniques and their indications were analyzed on the basis of a review of the literature. Outcome for hypertensive patients are the same for the different techniques.

[Reducing bleeding during extracorporeal circulation interventions by high doses of aprotinin]. / Riduzione del sanguinamento negli interventi in circolazione extracorporea mediante l'uso di alte dosi di aprotinina.

The great risk of severe infectious diseases transmission through blood transfusion, has increased during the last years the effort to reduce the bank blood and its derivates use. Many techniques have proposed to achieve this purpose during and post cardiopulmonary bypass: normovolemic hemodilution, perioperative blood autotransfusion, postoperative return of extra corporeal circuit and chest drains blood and the particular use of some drugs. In the last few years several reports have been presented in the literature concerning the reduction of intra and postoperative bleeding in cardiac surgery by high dose Aprotinin administration. A randomized study with the use of this pharmacologic agent is presented: a group of patients was treated with Aprotinin (shared in two subgroups receiving respectively a different dose of the drug) and a control group. The results were highly encouraging both because of the reduction of peri and postoperative bleeding and because of the bank blood use important reduction.

[Popliteal artery entrapment syndrome in our experience]. / La sindrome da intrappolamento dell'arteria poplitea nella nostra esperienza.

Six cases of popliteal entrapment syndrome are presented with emphasis on the diagnostic difficulties related to this disease in its initial functional phase. The utility of Doppler ultrasonography associated with dynamic angiography is underlined. Normally surgical treatment of the disease is problem-free. The important determining factor seems to be medial gemellus hypertrophy. In this case the procedure of choice is thought to be vascular reconstruction associated with the disinsertion of this muscle followed by its reimplantation in a lower and medial position on the semi-membranous tendon muscle in order to avoid any secondary arterial compression.

[Revascularization of the distal arteries of the lower limbs with "in situ" saphenous vein]. / La rivascolarizzazione delle arterie distali degli arti inferiori con safena "in situ".

Over a 3-year period 21 patients underwent "in situ" saphenous vein by-pass graft for lower extremity arterial occlusive disease, all of them with critical ischemia for limb salvage. The proximal anastomosis was performed in all patients end to end to the first segment of the previously endarterectomized superficial femoral artery. The distal graft was taken to the popliteal artery below the knee in 8 cases, to the tibial-peroneal trunk in 4, to the posterior tibial artery in 3, to the peroneal artery in 3, to the anterior tibial artery in 2 and last a sequential posterior tibial-peroneal by-pass graft was performed. The perioperative mortality was nil. The immediate patency rate was 90.5%, while the cumulative patency rate at 36 months was 71.4% overall, 87.5% for the popliteal grafts and 61.1% for the infrapopliteal ones. If we consider that was successful for limb salvage in more than 80% and if the encouraging preliminary results of this technique will be confirmed at a longer follow-up, we believe that this technique could become the procedure of choice for limb salvage even in the high risk patients group.

[Development of lipomas on a surgical wound following radial saphenectomy. An unusual complication]. / Evolution lipomateuse sur plaie chirurgicale après saphénectomie radiale. Une complication exceptionnelle.

Radical saphenectomy is a common practice in treatment of the varicose veins of the limbs, and its early and late complications are very well known. Nevertheless, the authors have observed an exceptional pathologic picture in one patient operated five years ago, which developed multiple nodular lipomas in the sites of the surgical scars for varicectomy. This unusual complication, in spite of lack of clear etiopathogenesis, suggest to reduce as less as possible the surgical subcutaneous traumatism.

[An unusual case of perforation of Meckel's diverticulum]. / Su di un raro caso di perforazione di diverticolo di Meckel

An infrequent case of puncture of Meckel's diverticulum whose aetiopathogenesis was attributed to a segmentary intestinal dyskinetic phenomenon is reported. The pneumoperitoneum consequent on the puncture was not associated with peritonitis and histology showed that the diverticulum did not show either inflammatory phenomena or areas of ectopic mucosa, namely none of the causes which are usually at the origin of Meckel's diverticulum puncture.