Anastomotic pseudoaneurysms: our experience with 49 cases.

We investigated the factors implicated in the pathogenesis of anastomotic aneurysm formation and the postoperative course of patients with such a complication. Forty-five patients with 49 anastomotic aneurysms were diagnosed and treated in two vascular surgery departments in Athens, Greece, during an 8-year period. Emergent complications occurred in 15 cases, rupture in 11, and thromboembolic episodes in another four. Preoperative diagnostic workup in the remaining elective cases (n = 34) included color duplex scan, computed tomographic scan, and angiography. All patients underwent operation, and cultures were obtained during the surgical procedures. Histological examination of the host artery wall adjacent to the aneurysm was also performed. Aortobifemoral bypass was the original operation performed in the majority of cases (71%), and the femoral anastomosis was the most frequent site involved (85.7%). Emergent procedures were associated with increased mortality (46.6%), whereas elective operation resulted in high patency rates and no mortality. In an attempt to isolate predisposing factors that contributed to aneurysm formation, we concluded that the etiology was multifactorial in approximately one-third of the cases and degenerative host artery disease was the main cause (40%). Arterial degeneration is the leading cause of anastomotic aneurysm formation, and emergency arterial reconstruction in cases of aneurysm complication is associated with a poor prognosis.

Klippel-Trenaunay syndrome: an unusual cause of pulmonary embolism.

A 36-year-old female patient was admitted to the emergency department of our hospital with symptoms and signs of pulmonary embolism. Further evaluation established the diagnosis and anticoagulant therapy was immediately started. Physical examination revealed left lower extremity edema, prominent varicose veins, greater length of the involved limb and a capillary malformation extending from the lower abdomen down to the left knee. The diagnosis of Klippel-Trenaunay syndrome (KTS) was suspected and a color duplex scan was next performed revealing derangements in the lower extremity venous system including deep venous thrombosis. KTS is a congenital anomaly characterized by capillary malformation, extensive varicosities and limb hypertrophy. Anomalies of the deep and perforator venous system coexist and predispose to thromboembolic events. Pulmonary embolism is infrequently encountered in the setting of this syndrome.

The European experience with vascular injuries.

The rich and diverse heritage of the management of vascular injuries in the 45 independent European countries prevents the authors from revealing a uniform picture of the European experience, but some trends are clearly emerging. In countries with a low incidence of penetrating trauma and increasing use of interventional vascular procedures, the proportion of iatrogenic vascular trauma exceeds 40% of all vascular injuries, whereas on other parts of the continent, armed conflicts are still a major cause of vascular trauma. National vascular registries, mostly in the Scandinavian countries, produce useful, nationwide data about vascular trauma and its management but suffer still from inadequate data collection. Despite a relatively low incidence of vascular trauma in most European countries, the results are satisfactory, probably in most cases because of active and early management by surgeons on call, whether with vascular training or not, treating all kinds of vascular surgical emergencies. In some countries, attempts at developing a trauma and emergency surgical specialty, including expertise in the management of vascular injuries, are on their way.

Arterial injuries associated with lower-extremity fractures.

The records of 110 patients with arterial injuries of the lower extremities associated with bone fractures, and managed in the authors' vascular surgery clinic, were reviewed. The majority (72%) were young men; 66 had blunt and 44 penetrating arterial injuries. A total of 92 patients were treated by saphenous vein interposition grafting, 12 with composite grafts and six with polytetrafluoroethylene grafts. The limb salvage rate was 93%. All eight amputations were in neglected cases with arterial injury at the popliteal or infrapopliteal level and associated with muscle loss.