Endovascular Treatment of Complicated Popliteal Aneurysms Using the Novel "Trap and Fix" Technique.

Herein, we present 2 patients with lower limb ischemia caused by complicated popliteal aneurysms with thrombosis and distal embolization, compromising blood flow to the foot. In both cases, covered stents were first implanted guided by intravascular ultrasound and computed tomography angiography, respectively. After "trapping" the thrombi, mechanical thrombectomy or further stent implantations were performed, "fixing" the remaining lesions and preventing embolization. (Level of Difficulty: Intermediate.).

In vitro comparison of three different mesh constructions.

BACKGROUND: Material amount and pore size have been recently discussed as probable important determinants of biocompatibility of mesh implants used in hernia repair. This study aimed to find out whether other constructional parameters affect the extent of early foreign body reaction in vitro. MATERIALS AND METHODS: An NRK-49F (mixed culture of normal rat kidney cells) fibroblast culture was incubated in the presence of a 'light' microporous mesh (35 g/m(2), 0.25 mm thick), a 'heavy' polypropylene knitted mesh (95 g/m(2), 0.55 mm thick) and a polypropylene/polyglactin composite mesh (35 g/m(2), 0.5 mm thick). A mesh-free cell suspension was used as a control group. Fibroblasts' proliferation, invasion and apoptosis rates were measured by commercially available quantification tests. Levels of tumour necrosis factor-alpha, transforming growth factor-beta1, interleukin (IL)-1 beta, IL-6 and IL-10 secreted by the fibroblasts in the supernatant were dynamically measured in a time kinetics of 6-96 h. RESULTS: Invasion potential as well as proliferation and apoptosis rates of fibroblasts were enhanced by all meshes. The composite mesh stimulated the cell turnover with correspondingly increased levels of IL-6 and suppressed levels of transforming growth factor-beta1 significantly more than the two pure polypropylene meshes and the control group. CONCLUSION: Early biological response of fibroblasts as a major component of foreign body reaction was most affected by the filament construction of the mesh combining polypropylene with multifilament, partially absorbable polyglactin fibres. Material reduction did not weaken foreign body reaction. Confirming previous findings from animal experiments and clinical observations, the described in vitro model seems to be an appropriate primary tool for studying the biological tolerance towards meshes.

Improving outcomes in hernia repair by the use of light meshes--a comparison of different implant constructions based on a critical appraisal of the literature.

BACKGROUND: Despite convincing advantages offered by meshes, their use in hernia surgery remains controversial because of fears concerning the long-term effects of their implantation. To improve biocompatibility, a large variety of newly developed light meshes has been introduced to the market. This overview of the literature aimed to establish whether absolute material reduction (g per implanted mesh), use of absorbable components, and coating by inert materials are evidence-based ways to improve biocompatibility of meshes. METHOD: A review of the current English and German language literature on the outcome of groin und incisional hernia mesh repair was performed. Both basic research and clinical trials were used as sources of data. Meta-analyses and randomized controlled trials were given priority and were referred to whenever possible. RESULTS: Operative technique was an independent prognostic factor for the clinical outcome. Mesh construction and composition as characterized by pore size and filament structure appeared to be more important determinants of foreign body reaction after implantation than absolute material reduction of 1 g or more per implant. No data exist about an oncogenic effect of alloplastic materials in humans, but disturbed fertility in animal studies remains an issue of concern and should be further investigated. CONCLUSIONS: According to data from current randomized controlled trials and retrospective studies, light meshes seem to have some advantages with respect to postoperative pain and foreign body sensation. However, their use is associated with increased recurrence rates. Light meshes offer no advantages with respect to alleviating severe chronic groin pain. At the same time, experimental data reveal that material composition and mesh structure may significantly affect foreign body reaction.