[Treatment of complications of in situ saphenous by-pass]. / Tratamiento de las complicaciones del "by-pass" safeno "in situ".

The early and late (2-12 months) complications of in situ bypass for 24 patients (limb salvage procedures) were presented. The early complications were: 1. Overlook branches of saphenous vein developed into A-V fistulas which religated (2 patients). 2. Graft occlusions (2 patients). A successful thrombectomy was carried out on one patient, while an above knee amputation was performed on the other patient. 3. A deep venous thrombosis (one being crural, the other femoral) was treated with medication therapy. We recorded late complications: two graft occlusions (after 3 and 6 months) where redo surgery was impossible for distal progression of occlusion disease. The following procedures must be done: per-operative angiography, adequate technique of anastomoses and defects of the femoral vein, postoperative application of medication therapy, observation of patients in the later post-operative period and routine control with Doppler US (1, 3, 6, 12 months).

[Reinterventions for the late failures of femoral-distal grafts]. / Reintervenciones para fallos posteriores de los injertos femorodistales.

In this retrospective study of 195 patients treated for late failure of a previous femoral-distal reconstruction, there were 178 men and 17 women ranging in age from 42 to 79 years. The graft material utilised for initial operation was an autogenous vein reversed saphenous vein (75), in situ (1), and arm veins (4) in 80, polytetrafluoroethylene in 51, Dacron in 46, Biografts in 12 and composite grafts in 6 patients. The previous site for distal anastomosis was above the knee in 79, and tibial or peroneal arteries in 18 cases. The most common cause of graft failure was late thrombosis (95), progression of the underlying disease (64), deterioration of the graft (15), pseudoaneurysms (8), and rarely perigraft reactions, hemodynamic insufficiency, late infection, etc. The aim of the reoperation was: graft extension for distal disease (68) desobstruction and patch angioplasty (21), thrombectomy (9) exchange of the graft (17), local repair of the graft (3). Seventeen patients required inflow procedures. Other reinterventions (sympathectomy, catheterisation and prostaglandin perfusion) were used in patients with no chance for reconstructive arterial surgery. Secondary reoperations were performed in 12, tertiary operations in 7 patients. Major amputations rate, operation mortality, wound morbidity and hemodynamic success rates with limb salvage in reoperated patients support usefulness of repeated revascularisation when femoro-distal bypass failure occurs.

[Neoangiogenesis and human amniotic membrane. A clinico-instrumental study in phlebostatic ulcer of the lower extremities]. / Neoangiogénesis y membrana amniótica humana. Estudio clínico-instrumental en la úlcera flebostática de los miembros inferiores.

The present study was made in order to determine if granulation tissue development after treatment with Human Amniotic Membrane (HAM) is related with instrumental photoplethysmographically evidenced changes of the "ulcus layer". Daily, HAM fragments were disposed along the continuity solution of external patients with opened postthrombotic ulcus cruris. Instrumental examinations were made before, a week after and two weeks after treatment, and after the complete ulcus healing. Ulcus with a slight granulous or fibrogranulous layer developed a granulation tissue within the first week of treatment. On the contrary, in continuity solutions with necrotic layer, treatment with HAM failed. After the first week of treatment, a 84% of ulcus with slight granulation and fibrinogranulation, presented some sphygmic variations respect to baseline levels, like: raising in the amplitude and dicrotism appearing. Within the first week, all of the continuity solutions showed significant sphygmograms with a regular vascularization on the layer, this period of time concurred with the complete granulation phase of the ulcus. Long-preserved HAM stimulates in a significant way the appearing of the granulation tissue, within the first week of treatment. Sphygmic raisings are directly proportional with the amount of granulated tissue evidenced on the layer of the continuity solution.

[Reinterventions in late failures of femorodistal grafts]. / Reintervenciones en los fallos tardíos de los injertos femorodistales.

In this retrospective study of 195 patients treated for late failure of a previous femoral-distal reconstruction, there were 178 men and 17 women ranging in age from 42 to 79 years. The graft material utilised for initial operation was an autoenous vein (reversed saphenous vein (75), in situ (1) and arm veins (4) in 80, polytetrafluoroethylene in 51, Dacron in 46, Biografts in 12 and composite grafts in 6 patients. The previous site for distal anastomosis was above the knee in 70 and tibial or peroneal arteries in 18 cases. The most common cause of graft failure was late thrombosis (95), progression of the underlying disease (64), deterioration of the graft (15), pseudoaneurysms (8), and rerelly perigraft reactions, hemodynamic insufficiency, late infection, etc. The aim of the reoperation was: graft extension for distal disease (68) desobstruction and patch angioplasty (21), thrombectomy (9) exchange of the graft (17), local repair of the graft (3). Seventeen patients required inflow procedures. Other reinterventions (sympathectomy, catheterisation and prostaglandin perfusion, were used in patients with no chance for reconstructive arterial surgery. Secondary reoperations were performed in 12, tertiary operations in 7 patients. Major amputations rate, operation mortality, wound morbidity and hemodynamic success rates with limb salvage in reoperated patients support usefulness of repeated revascularisation when femoro-distal bypass failure occurs.

[Varicose disease of the lower limbs: analysis of the most common predisposing factors in a sample of 589 patients from eastern Sicily. A retrospective study]. / Enfermedad varicosa de los miembros inferiores: análisis de los más habituales factores predisponentes bajo una muestra de 589 pacientes de Sicilia oriental. Estudio retrospectivo.

Authors analyze, retrospectively, the principal predisposing factors to varicose illness: age, sex, pregnancy, oral contraceptives, and labour activity, in 589 patients. They consider the correlation between subjective symptomatology and the time of varicose appearance, in order to individualize a pre-clinical status.

[Headache as a postoperative symptom of patients subjected to saphenectomy using subarachnoid analgesia]. / La céphalée vue comme symptôme post-opératoire chez des patients opérés de saphénectomie en analgésie subarachnoïdienne.

Having confirmed the development of cephalea in a large number of patients undergoing saphenectomy under subarachnoidal anasthetic, the authors wanted to research its probable causes. With this in mind, they observed a group of patients who had varices of the lower limbs which they had operated. They present their study methodology, and then examine and discuss the results. The conclude that many factors are responsible for the aetiology of the symptoms of cephalea. The sex, age, and conditions of venous hypertension in the posterior tibial vein are particularly determining factors.