Compliance of geriatric patients subjected to antiplatelet agents with Triflusal in peripheral arteriopathy. Preliminary data.

BACKGROUND: Triflusal is an irreversible inhibitor of platelet cyclooxygenase. Triflusal significantly reduced the incidence of nonfatal myocardial infarction in patients with unstable angina. Antithrombotic properties have also been demonstrated in patients with aortocoronary vein grafting, coronary angioplasty, peripheral arteriopathy and cerebrovascular disease. Moreover, in diabetic patients it has a protective effect against retinal microangiopathy, improves renal flow and reduces proteinuria. The drug has a high tolerability and has low incidence of side effects, with prevalence of gastrointestinal and skin disorders. Because of its demonstrated effectiveness and its good handling, we decided to use Triflusal in treatment of geriatric patients with peripheral arteriopathy. Often these patients have a diffused arteriopathic disease which can be associated with chronic diseases. For this reason there are severe problems of compliance due to contemporary administration of several drugs; so the utilization of effective drugs, without side effects, promotes a safer clinical management of patients. METHODS: Between April 2000 and March 2001, we treated with Triflusal 70 patients, over 65 years old, with peripheral arteriopathy. The group comprises patients who had undergone traditional vascular surgery, or endovascular surgery and patients treated exclusively with drug therapy. During the follow-up we obser-ved the possible clinical development of side effects of the drug reported in the literature (nausea, vomiting, etc.). RESULTS: One patient, already affected by gastroduodenal disease, suspended the therapy because of severe epigastric burning. CONCLUSIONS: The follow-up of the patients goes on in order to evaluate the tolerability and handling of Triflusal, observing a larger number of patients.

Small aorta syndrome: hypothesis or reality?

A syndrome of peripheral obliterating arterial disease characterised by aortoiliac steno-occlusion is reported in the literature under the name small aorta syndrome, occurring in young women of small stature with relatively typical risk factors. Starting from an analysis of the studies reported in the literature and on the basis of our own results, we have attempted to ascertain whether small aorta syndrome represents an independent nosological entity. By analysing studies on the small aorta syndrome and in the light of a recent study made by our group on arterial diameters measured in cadavers, which highlights a significant correlation between aortic diameter and age, it can be affirmed that a pathology of this nature does not respond to absolute criteria for existence. Therefore, the aortoiliac diameter in women suspected of being affected by small aorta syndrome appears to be broadly in proportion to that expected in healthy women of the same age. Small aorta syndrome does not therefore appear to represent a separate nosological entity. It takes the form of a hypoplastic vascular disorder, which is probably congenital, correlated to other arterial districts in the same subject. However, it may encourage the onset of early symptoms in women of small stature.

[Retroperitoneal fibrosis associated with neuritis symptomatology due to external iliac artery stent subadventitial migration]. / Fibrosi retroperitoneale associata a sintomatologia nevritica dovuta alla migrazione sottoavventiziale di stent dell'arteria iliaca esterna.

The occurrence of a neuritis of the ischiatic nerve and the genito-femoral nerve due to the implant of three stents in the iliac artery, is an extremely rare complication, especially if associated with retroperitoneal fibrosis which caused a nevritis symptomatology. A case of stent migration in the subadventitial space which caused 4 years from angioplasty and stents implant, a nevritis symptomatology. Retroperitoneal fibrosis has been considered as a consequence of the stents presence and of their chronic irritational activity, especially for what concerns the stent migrated in the subadventitial space; the procedure personally performed in this case is reported.

[Anomalies of the inferior vena cava in patients treated with surgical vascular procedures in the aorto iliac area. Report of 2 cases and review of the literature]. / Anomalie della vena cava inferiore in pazienti sottoposti a chirurgia del distretto aorto iliaco. A proposito di due casi operati e revisione della letteratura.

Two cases of left-sided inferior vena cava observed in a patient affected by Leriche syndrome and the other affected by aortic abdominal aneurysm (AAA) are presented. This very rare congenital malformation (0.2-0.5) was not recognized by the duplex scanner performed preoperatively probably because of the low level of suspicion carried on by an experienced operator. Angio-CT e angio-MR which would have surely showed the anomaly, were not done because in the absence of an aneurysmal disease or other abdominal situations, these investigations were not required before operation. An angio-CT was performed routinely to the patient affected by AAA and so the left-sided vena cava was observed before operation; and then an abdominal arteriography and an ilio-caval venography were required which documented the vena cava anomaly. Surgical interventions didn t have complications. In the case of Leriche syndrome an aorto-bifemoral bypass was performed, and in the case of abdominal AAA an aortic left-iliac right-femoral bypass. Preoperative unrecognizing of this venous malformation is very hazardous mostly in terms of uncontrollable intraoperative hemorrhages. Ultrasonographic diagnosis with duplex scanner has to be very accurate in order to observe not only arterial diseases but also the possible venous anomalies of the abdominal district.

Acute lower limb thrombosis caused by a congenital fibrous ring of the superficial femoral artery.

Segmentary isolated stenosis or obstructions of the superficial femoral artery in young people are rarely reported. In patients, most of them women, affected by chronic symptomatology of the lower limbs, the aetiology has been referred to fibromuscular dysplasia with unusual localization. We report a case of acute lower limb thrombosis in a young woman caused by a congenital fibrous ring of the superficial femoral artery and the treatment we performed in this situation including the complication that happened after the percutaneous transluminal angioplasty that we carried out in order to reduce the stenosis of the femoral superficial artery. Histological examination of the lesion demonstrated the nature of the fibrous ring caused by an embryological anomaly, followed by a secondary thrombosis in a woman not using oral contraceptives and without any alteration of the coagulation chain. Fibromuscular dysplasia of the femoral artery is commonly caused by previous thigh injuries, thromboembolic events with recanalization of the artery or arteritis, but in some cases appears to be the consequence of primitive intimal dysplasia. When a fibromuscular dysplasia is suspected, all authors agree on the necessity for a screening of the two preferential localizations of the disease: common carotid artery and renal artery, in the case reported the result was negative.

[Vascular pathology of surgical interest in drug addicts]. / Patologie vascolari di interesse chirurgico nei tossicodipendenti.

The incidence of vascular complications due to drug abuse is at present increasing due to new types of drugs and to the different ways of intake of such substances. The vascular complications related to drug abuse may affect venous, arterious and lymphatic districts and in particular: ischemia following intra-arterial injections, arterious and venous pseudoaneurysm, vasculitis, aneurysms, aortic dissections, abscesses complicated by erosions of vessels, arteriovenous fistulas, compartment syndrome, superficial and deep venous thrombosis, septic trombophlebitis, puffy hand syndrome. The scientific knowledge in this matter is incomplete because of the new pathological cases and the lack of information regarding the efficacy of different treatments. The authors report four patients affected by vascular pathologies due to drug abuse. In one case, a heroin addict has undergone multiple fasciotomies for compartimental syndrome arising because the patient maintained an innatural posture for several hours during an overdose coma. In a second case, a segmental right subclavear deep venous thrombosis has been treated by pharmacological therapy with satisfactory functional recovery of the arm. A third patient has been successfully submitted to intra-arterial pharmacological vasodilatation for generalised lower limbs vasospasm caused by drug abuse. In the last case, the voluntary swallowing of a great dose of cocaine caused the patient's death after multiple ischemic and hemorrhagic cerebral episodes. After the description of these cases, a review of the recent literature and some observations on this topic are presented. A better knowledge of vascular complications due to drug abuse should improve the therapeutical approach of these patients.