ABSTRACT
OBJECTIVES: This retrospective study presents the early and late results of pediatric patients who underwent reconstructive surgery for renovascular hypertension (RVH) between 1979 and 2009. METHODS: From 1979 to 2009 44 patients (male 22; mean age 13±5.2 years, range 1-19 years; early childhood 7 [1-6 years], middle childhood 5 [7-10 years]; adolescents 32 [11-19 years]) with renovascular hypertension underwent surgery for abdominal aortic stenoses (n=6), renal artery stenosis (RAS) (n=25) or for combined lesions (n=13). Nineteen aortic stenoses (bypass/interposition 10/5, patch dilatation/thromboendarterectomy 2/2), 51 renal arteries (interposition 36, resection+reimplantation 13, patch dilatation/aneurysmorraphy 1 each), and 10 visceral arteries (resection+reimplantation 6, interposition 3, patch dilatation 1) were reconstructed. Each patient underwent duplex studies and if required intra-arterial digital subtraction angiography. Reoperations within 30 postoperative days were required in four (9%) of the patients for occlusion of four arteries (6%), achieving a combined technical success rate of 94%. RESULTS: After 114±81 months 36 patients were re-examined by duplex and magnetic resonance angiography (2 not surgery-related deaths 7/12 years postoperatively, 8 patients lived abroad). Twelve patients had required a second and three a third procedure. Hypertension was cured early/late postoperatively in 27%/56%, improved in 41%/44%, and remained unchanged in 32%/0%. Best late results were obtained in patients with isolated aortic disease and at the age of middle childhood. CONCLUSIONS: Reconstructive surgery for pediatric RVH yields good results at every age and every type of lesion. However, these children should be followed up closely and to avoid early cardiovascular disease and death in later life, surgery should not be delayed.
Subject(s)
Aortic Diseases/complications , Fibromuscular Dysplasia/complications , Hypertension, Renovascular/surgery , Plastic Surgery Procedures/methods , Renal Artery Obstruction/complications , Renal Artery/surgery , Vascular Surgical Procedures/methods , Adolescent , Angiography, Digital Subtraction , Aortic Diseases/diagnosis , Blood Pressure , Child , Child, Preschool , Diagnosis, Differential , Female , Fibromuscular Dysplasia/diagnosis , Follow-Up Studies , Humans , Hypertension, Renovascular/diagnosis , Hypertension, Renovascular/etiology , Infant , Magnetic Resonance Angiography , Male , Renal Artery Obstruction/diagnosis , Renal Artery Obstruction/surgery , Retrospective Studies , Syndrome , Time Factors , Treatment Outcome , Young AdultABSTRACT
INTRODUCTION: Tumors of the carotid body are rare paragangliomas (incidence 0.012%) originating from sympathetic fibres of the carotid bifurcation. Growth is slow and they frequently become symptomatic through local mechanical compression of neighboring vascular and neural structures. The aim of this study is to present the diagnosis, therapy and course in patients with a carotid body tumor treated at our department of the Düsseldorf University Hospital and to discuss rates of recurrence and also dignity during the long-term follow-up. PATIENTS AND METHODS: Included in this retrospective study were all patients treated for a carotid body tumor between January 1988 and June 2008. At follow-up examination the current history was recorded and a physical examination, sonography and duplex sonography were carried out. Furthermore each patient completed the questionnaires QLQ-C30 of the European Organisation for Research and Treatment of Cancer (EORTC) and the module for head and neck QLQ-H&N35 to assess quality of life. RESULTS: In our collective of 36 patients consisting of 13 men (36%) and 23 women (64%) with an average age of 48.33 years (range 17-78 years), 16 patients presented with a local neck swelling and 5 patients each had difficulties swallowing or hoarseness, respectively. Preoperatively Horner's syndrome was found in one patient. A total of 22 tumors were found on the right side of the neck (52.38%), 20 were found on the left side (47.62%) and 6 patients showed a bilateral carotid body tumor (16.67%), 3 of which were bilaterally excised. The other 3 patients are still under surveillance without surgery. Altogether surgery of 39 carotid body tumors was performed in 36 patients. In all 39 cases (primary surgery n=34, recurrence surgery n=5) the tumors were macroscopically excised in toto. Parts of the vagus nerve had to be resected in 3 patients (7.69% Shamblin type II n=1, Shamblin type III n=1) and resection of blood vessels was necessary during 10 operations. The survival rate after 1 year was 100%, after 2 years 96.3% and after 5 years 92.6%. A local recurrence was diagnosed in 2 patients (5.13%). In one patient a second operation was necessary and in the other patient there was a non-progressive swelling in the carotid bifurcation which had existed for 14 years and which was conservatively left untreated. Peripheral neural lesions could be found in 12% (3/25) at long-term follow-up. None of the patients showed evidence of local or remote metastasization of a carotid body tumor. CONCLUSIONS: Surgical extirpation of carotid body tumors can be regarded as the only curative option with an overall mortality of 0%. Morbidity is low when applying vascular surgical techniques (2.56% for central lesions). The incidence of peripheral nervous lesions is high reflecting the radicality of the resection (64.10%) but is outweighed by the benefits. In the long-term follow-up the rate of permanent peripheral neural lesions decreased to 12%. Due to a potentially infiltrating and disseminating growth, carotid body tumors should be regarded as semi-malignant and should therefore be indicated for surgery at the time of diagnosis. Whether the incidence of carotid body tumors will rise due to increased routine diagnostic examination of the head and neck region using sonography and tomography remains to be seen.
Subject(s)
Carotid Body Tumor/surgery , Adolescent , Adult , Aged , Carotid Body/pathology , Carotid Body Tumor/mortality , Carotid Body Tumor/pathology , Cranial Nerve Injuries/etiology , Female , Follow-Up Studies , Humans , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Male , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Postoperative Complications/etiology , Postoperative Complications/mortality , Postoperative Complications/surgery , Reoperation , Retrospective Studies , Survival Rate , Ultrasonography , Young AdultABSTRACT
BACKGROUND: In 2001 Leschi et al. published a new method to improve perfusion of the superior mesenteric artery (SMA) in operative therapy of acute and chronic visceral ischemia. They presented a retrograde aorto-mesenteric bypass following an arcuate course behind the left renal pedicle. Due to the intricate correct anatomic description of this vascular reconstruction this loop bypass was named the "French bypass". PATIENTS AND METHODS: In our department 84 patients underwent surgery because of an acute or chronic visceral ischemia between January 2002 and December 2007. Out of these patients 27 received a "French bypass". The pre-, intra-, and postoperative data were collected from the patient hospital files retrospectively. The follow-up consisted of a review of the patient history and clinical findings in an outpatient setting, combined with a duplex sonography of the visceral arteries. RESULTS: The group of 27 patients had an average age of 55.0 years: (range: 29-81 years) and consisted of 21 women (78.6 %) and 6 men (21.4 %). The cardinal symptom of all patients was abdominal pain of variable intensities. 14 patients complained about an increased pain post ingestion (abdominal angina) and 12 patients about an involuntary loss of weight. Bypass material was autologous saphenous vein in 18 patients (66.7 %) and in 9 patients (33.3 %) an 8-mm ring-enforced PTFE prosthesis. Apart from 10 patients who only received the French bypass, we performed comprehensive visceral revascularisations in 12 patients. Overall hospital mortality was 18.5 %; 4 out of the 5 deceased patients had undergone surgery due to acute visceral ischemia. The mortality of patients with acute visceral ischemia was 30.8 % and of patients with chronic visceral ischemia 7.1 %. Eight patients had a revision before -discharge from hospital (surgery n = 6, interventional n = 2). Primary and secondary patencies of the bypasses of the surviving patients were 54.6 % (12 out of 22 patients) and 81.8 % (18 out of 22 patients), respectively. Concerning the end-point "freedom from abdominal complaints" 14 out of 27 patients (51.9 %) benefited after a mean follow-up of 38.9 months (range: 3-84 months), 7 patients each in the acute and chronic visceral ischemia group. CONCLUSIONS: The implantation of a "French bypass" represents a good option to reconstruct the SMA, combining the advantages of ante- and retrograde visceral bypasses. Furthermore this -bypass procedure allows to reconstruct distal segments of the -superior mesenteric artery in cases when long distance and peripheral stenosis impeded local thromendarterectomy. Perioperative morbidity and mortality are acceptable when the acute clinical situation is taken into account. The long-term benefit for the patients with regard to the prevention of intestinal ischemia and also the freedom from complaints is high.
Subject(s)
Aorta/surgery , Intestines/blood supply , Ischemia/surgery , Mesenteric Artery, Superior/surgery , Mesenteric Vascular Occlusion/surgery , Vascular Surgical Procedures/methods , Adult , Aged , Aged, 80 and over , Angiography , Blood Vessel Prosthesis , Female , Follow-Up Studies , Hospital Mortality , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Ischemia/diagnosis , Ischemia/mortality , Kidney/surgery , Magnetic Resonance Angiography , Male , Mesenteric Vascular Occlusion/diagnosis , Mesenteric Vascular Occlusion/mortality , Middle Aged , Polytetrafluoroethylene , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Reoperation , Retrospective Studies , Tomography, X-Ray Computed , Ultrasonography, Doppler, Duplex , Veins/transplantationABSTRACT
The superior mesenteric artery syndrome--also known as Wilkie's syndrome or as arteriomesenteric obstruction of the duodenum--is a rare condition of upper intestinal obstruction in which the third part of the duodenum is compressed by the overlying, narrow-angled superior mesenteric artery against the posterior structures. It is characterized by early satiety, recurrent vomiting, abdominal distention, weight loss and postprandial distress. When nonsurgical management is not possible or the problem is refractory, surgical intervention is necessary. Usually a reconstruction of the intestinal passage is performed. We report the first case of successful transposition of the superior mesenteric artery into the infrarenal aorta in the therapy of Wilkie's syndrome.
Subject(s)
Intestine, Large/surgery , Mesenteric Artery, Superior/surgery , Plastic Surgery Procedures/methods , Superior Mesenteric Artery Syndrome/diagnosis , Superior Mesenteric Artery Syndrome/surgery , Adult , Female , Humans , Treatment OutcomeSubject(s)
Aneurysm/diagnostic imaging , Arteriovenous Malformations/diagnostic imaging , Femoral Artery/abnormalities , Femoral Vein/abnormalities , Klippel-Trenaunay-Weber Syndrome/diagnostic imaging , Mesenteric Artery, Superior/diagnostic imaging , Renal Artery/abnormalities , Splenic Artery/abnormalities , Adult , Aneurysm/congenital , Aneurysm/surgery , Angiography, Digital Subtraction , Arteriovenous Malformations/surgery , Arteriovenous Shunt, Surgical , Diagnosis, Differential , Dilatation, Pathologic/diagnostic imaging , Dilatation, Pathologic/surgery , Femoral Artery/diagnostic imaging , Femoral Artery/surgery , Femoral Vein/diagnostic imaging , Femoral Vein/surgery , Humans , Klippel-Trenaunay-Weber Syndrome/surgery , Male , Mesenteric Artery, Superior/surgery , Popliteal Artery/abnormalities , Popliteal Artery/diagnostic imaging , Popliteal Artery/surgery , Renal Artery/diagnostic imaging , Renal Artery/surgery , Reoperation , Splenic Artery/diagnostic imaging , Splenic Artery/surgery , Tomography, X-Ray ComputedABSTRACT
Schwannoma are rare. We describe the clinical presentation, diagnostic workup and therapy in sympathetic chain schwannoma in a 54 year old patient. Besides the operative management the differential diagnosis of painless swelling at the carotid bifurcation are discussed.
Subject(s)
Carotid Artery, Internal/surgery , Carotid Stenosis/surgery , Head and Neck Neoplasms/surgery , Neurilemmoma/surgery , Carotid Stenosis/diagnosis , Carotid Stenosis/pathology , Diagnosis, Differential , Female , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/pathology , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Middle Aged , Neck Muscles/pathology , Neck Muscles/surgery , Neurilemmoma/diagnosis , Neurilemmoma/pathology , Ultrasonography, Doppler, Transcranial , Vertigo/etiologyABSTRACT
The Klippel-Trenaunay-syndrom (KTS) is a congenital angiodysplasia of venous vessels characterized by three main symptoms: cutanous vascular naevi, hyperthropy of a limb and varicosis or venous malformations. The coincidence of KTS and arterial malformations such as renal artery aneurysm has been described twice in the literature. We report the case study of a 40-years-old male patient with KTS and aneurysms of a renal artery, the splenic artery, the superior mesenteric artery and of a popliteal artery and popliteal vein. After documenting the diagnostic and therapeutic course we describe this case as it relates to the clinical literature. In the differential diagnosis of KTS two different syndroms have to be pointed out: the Servelle-Martorell-syndrom and the Frederick Parkes Weber-syndrom.
Subject(s)
Aneurysm/diagnostic imaging , Arteriovenous Malformations/diagnostic imaging , Femoral Artery/diagnostic imaging , Femoral Vein/diagnostic imaging , Klippel-Trenaunay-Weber Syndrome/diagnostic imaging , Mesenteric Artery, Superior/diagnostic imaging , Renal Artery/diagnostic imaging , Splenic Artery/diagnostic imaging , Adult , Aneurysm/congenital , Aneurysm/surgery , Angiography, Digital Subtraction , Arteriovenous Malformations/surgery , Arteriovenous Shunt, Surgical , Dilatation, Pathologic/diagnostic imaging , Dilatation, Pathologic/surgery , Femoral Artery/abnormalities , Femoral Artery/surgery , Femoral Vein/abnormalities , Femoral Vein/surgery , Humans , Klippel-Trenaunay-Weber Syndrome/surgery , Male , Mesenteric Artery, Superior/surgery , Popliteal Artery/abnormalities , Popliteal Artery/diagnostic imaging , Popliteal Artery/surgery , Renal Artery/abnormalities , Renal Artery/surgery , Reoperation , Splenic Artery/abnormalities , Splenic Artery/surgery , Tomography, X-Ray ComputedABSTRACT
Haemorrhage is a recognized complication of catheter-directed thrombolysis. We report one case of an afore unknown colo-rectal carcinoma, which was detected due to rectal bleeding following intraarterial thrombolysis. As reported with warfarin induced gastrointestinal bleeding complications, patients with unknown tumor developing rectal bleeding after thrombolysis procedure, should receive full diagnostic work-up of the gastrointestinal tract in order to exclude serious but potentially curable disease.
Subject(s)
Adenocarcinoma/diagnosis , Fibrinolytic Agents/adverse effects , Gastrointestinal Hemorrhage/chemically induced , Paraneoplastic Syndromes/drug therapy , Popliteal Artery , Rectal Neoplasms/diagnosis , Thrombolytic Therapy/adverse effects , Thrombosis/drug therapy , Tissue Plasminogen Activator/adverse effects , Adenocarcinoma/complications , Adenocarcinoma/pathology , Female , Fibrinolytic Agents/therapeutic use , Humans , Middle Aged , Neoplasm Staging , Postoperative Complications/drug therapy , Rectal Neoplasms/complications , Rectal Neoplasms/pathology , Thrombectomy , Tissue Plasminogen Activator/therapeutic use , Tomography, Spiral ComputedSubject(s)
Delirium/diagnosis , Postoperative Complications/diagnosis , Alcohol Withdrawal Delirium/diagnosis , Delirium/drug therapy , Delirium/etiology , Humans , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Prognosis , Psychotropic Drugs/therapeutic use , Risk Factors , Terminology as TopicABSTRACT
Extracranial aneurysms of the carotid artery in childhood are rare, and we found just nine cases described in the literature within the last 20 years. We report on the clinical appearance, diagnosis, and therapy of a carotid artery aneurysm in a 12-year-old girl and review the literature.
Subject(s)
Aneurysm/surgery , Carotid Artery Diseases/surgery , Carotid Artery, Common/surgery , Aneurysm/diagnosis , Aneurysm/pathology , Carotid Artery Diseases/diagnosis , Carotid Artery Diseases/pathology , Carotid Artery, Common/pathology , Child , Female , Follow-Up Studies , Humans , Image Processing, Computer-Assisted , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Postoperative Complications/diagnosis , Veins/transplantationABSTRACT
We report 96 patients (107 legs) with recurrence after varicose vein surgery. We define a recurrent varicose vein as a new transfascial insufficiency after incomplete interruption of the saphenofemoral as well as popliteal junction with reflux in the epifascial venous system. 92 patients underwent external primary surgery. Morphologically an insufficient high ligation of the V. saphena magna (Moszkowicz's operation) led in 30 cases to a recurrent varicose vein. In 47 cases an incomplete isolated, in 29 cases an incomplete saphenofemoral ligation during a Babcock procedure and in one case an incomplete saphenopopliteal ligation for V. saphena parva insufficiency were the reasons for the recurrence. As recurrent surgery we performed 106 ligations of the saphenofemoral junction. In 38 of these cases an isolated saphenofemoral ligation and in 68 cases an additional stage-adjusted ligation of the V. saphena magna were carried out. In one case of recurrent saphenopopliteal insufficiency a repeated ligation of the V. saphena parva was performed. The recurrence is an avoidable complication of a not perfect primary surgery. The main cause is an inadequate access with incomplete saphenofemoral or -popliteal ligation.
Subject(s)
Postoperative Complications/surgery , Varicose Veins/surgery , Female , Femoral Vein/surgery , Humans , Ligation , Male , Middle Aged , Phlebography , Postoperative Complications/diagnostic imaging , Recurrence , Reoperation , Saphenous Vein/surgery , Treatment Outcome , Varicose Ulcer/diagnostic imaging , Varicose Ulcer/surgery , Varicose Veins/diagnostic imaging , Venous Insufficiency/diagnostic imaging , Venous Insufficiency/surgeryABSTRACT
A major complication of portal and mesenteric vein thrombosis is acute bowel ischaemia resulting in infarction and requiring immediate resection of the involved segment. Sufficient collaterals can prevent acute haemorrhagic infarction, but bowel stenosis due to chronic ischaemia may develop. We report two cases of ischaemic jejunal stenosis occurring 4 weeks after successful treatment of portal and mesenteric vein thrombosis. Diagnosis of high-grade segmental stenosis of the jejunum was established by contrast medium radiography of the gastrointestinal tract. After laparotomy and resection of the stenosed jejunal segment, both patients recovered well from the operation and were released from hospital. Follow-up examinations revealed an unremarkable state of health. Ischaemic bowel stenosis should be considered in patients with recurring abdominal pain after mesenteric and portal vein thrombosis. A close follow-up of every patient after treatment for mesenteric and portal vein thrombosis should be carried out to ensure early diagnosis of this complication.