Tandem lesions of the carotid circulation: combined extracranial endarterectomy and intracranial transluminal angioplasty.

A case series is presented demonstrating a unique approach to the treatment of tandem atherosclerotic lesions of the internal carotid artery. Between 1994 and 1999 eight patients with tandem lesions of the internal carotid artery were treated by combined carotid endarterectomy for the proximal lesion and intraoperative angioplasty of the distal intracranial lesion via the carotid arteriotomy. The success and complication rates were evaluated. A 100% technical success rate was achieved with one post procedural complication by ipsilateral stroke within 24 h. The advantages of this technique include the treatment of tandem lesions by the one procedure, improved transluminal access to the intracranial lesion and the ability to reduce the risk of embolism by flow control during balloon inflation.

Mycotic cervical carotid aneurysm.

Mycotic aneurysms of the extracranial carotid arteries are rare, with only 27 cases reported in the English literature. The causative organism is most frequently Staphylococcus but infections due to Streptococcus, Salmonella and Klebsiella have been reported. Escherichia coli has been reported as the causative organism in three cases. Mycotic aneurysms usually present in the setting of generalized sepsis such as postoperative infection, septicaemia, dental sepsis, drug addiction or bacterial endocarditis. We report a patient who presented with a mycotic aneurysm of the internal carotid artery 2 months after undergoing a laparotomy for perineal sepsis.

The role of physical and chemical characteristics in assessing the performance of a new biological vascular graft.

Information obtained from physical and chemical characterization of vascular grafts can prove valuable in obtaining a preliminary assessment of potential in vivo performance. The data presented illustrate the concept and show that the new biological graft made from bovine ureters has adequate performance characteristics for use as a potentially successful vascular graft.

Blunt trauma to the carotid artery.

Non-penetrating trauma to the internal carotid artery presenting as an immediate or delayed neurological deficit is an uncommon clinical entity. It has a high reported morbidity and mortality. Three cases are presented with long-term clinical and radiological follow-up. The mechanisms of injury, clinical features and possible treatment modalities are discussed.

A new replacement for small vessels.

A new modification of the mandril-grown vascular prosthesis appears to combine the best features of presently available synthetic vascular replacement materials. Glutaraldehyde-tanned polyester mesh-supported conduits (diameters 4, 6, and 8 mm) grown in the subcutaneous tissue of sheep, maintain 100% patency in the aortic, aortoiliac, and common iliac positions of canine recipients for over 2 years. One-millimeter diameter grafts placed in the infrarenal abdominal aorta of rat recipients were patent in 72% for 6-month follow-up periods. The grafts maintained a modicum of antigenicity despite tanning, as evidenced by the slightly elevated hemagglutination (0 to 2 dilutions) titers against sheep red blood cells in ovine graft recipients and the accelerated rejection of the donor strain skin grafts in Fischer rats receiving Brown-Norway conduits. Finally, in a limited clinical study, 21 of 24 femoropopliteal and three of three femoroposterior tibial grafts remained patent in short follow-up periods (2 to 16 months). Two aortocoronary bypass grafts have continued to function in one patient for 19 months. Minimal inflammatory reaction and no aneurysmal degeneration were found in the material studied.

Mesenteric venous thrombosis associated with oral contraceptives: a case report.

Small-bowel infarction resulting from mesenteric venous thrombosis is a rare but life-threatening complication to which young women taking oral contraceptives are liable. The patient characteristically presents with an "acute abdomen" after a variable prodromal period of vague abdominal pain. The correct diagnosis can be made from the macroscopic appearance at laparotomy, provided the surgeon is alert to the condition. An accurate diagnosis is important, as anticoagulation measures must be instituted early to counter the commonly associated thromboembolic phenomena.

PIP: A case report of mesenteric venous thrombosis with small bowel infarction in a 38-year-old woman who had been taking oral contraceptives is reported. The patient was admitted complaining of severe abdominal pain and vomiting for 36 hours. On admission, temperature was 37.5 degrees C and pulse 120/minute. Abdominal rigidity and left-sided abdominal tenderness were present. X-ray of the abdomen showed 2 distended loops of small bowel and 3 fluid levels. Serum amylase was normal. White cell count was 10,000/cu mm. There was a history of abdominal pain and diarrhea over a period of several years. For 6 months she had been taking Ovulen (mestranol .1 mg and ethynodiol diacetate .5 mg) for menstrual irregularity. 2 weeks earlier she had suffered an influenzalike illness with pleuristic chest pain, loin pain, urinary frequency, and dysuria. Chest X-ray and intravenous pylography were then reported as normal. At immediate operation, a 15 cm segment of ileum was found to be infarcted. Semipurulent fluid was present in the abdomen and areas of fibrinous peritonitis were observed. The involved segment of ileum was resected. A small thrombus was extracted from a mesenteric vein. Initial postoperative course was good but 3 days after operation chest pain, dyspnea, and giddiness developed and cardiac arrest followed. Resuscitation was successful. Pulmonary angiography then showed thrombi in all branches of the pulmonary artery. After heparin therapy symptoms improved and the patient left the hospital in 2 weeks, her condition being stabilized with warfarin and dipyridamole (Persantin). The diagnosis was confirmed by histological examination. Early recanalization of a mesenteric vein was noted. Other reported cases have shown an average prodromal phase of 4 or 5 days. The long-term diarrhea was considered as not connected with the present illness but the presumed influenza illness 2 weeks earlier may have been due to a pulmonary embolism. Of reported cases, 5 of 13 have died. Early diagnosis, prompt surgery, and heparin therpay are considered important.