ABSTRACT
Two cases of small bowel tumour, resected and considered as benign leiomyomas, are reported. Both developed late hepatic metastases, 6 and 8 years after surgery respectively, diagnosed as leiomyosarcoma. Emphasizing the difficulties in assessing malignancy of these tumours and considering local and far dissemination, a long-term follow-up is recommended after surgical resection.
Subject(s)
Ileal Neoplasms/diagnosis , Leiomyoma/diagnosis , Leiomyosarcoma/secondary , Liver Neoplasms/secondary , Diagnosis, Differential , Fatal Outcome , Follow-Up Studies , Humans , Ileal Neoplasms/surgery , Leiomyoma/surgery , Leiomyosarcoma/diagnosis , Leiomyosarcoma/surgery , Liver Neoplasms/diagnosis , Liver Neoplasms/surgery , Magnetic Resonance Imaging , Male , Middle AgedABSTRACT
PURPOSE: We describe our initial experience with the use of perigeniculate vessels as outflow tracts in infrainguinal revascularizations for critical limb ischemia. METHODS: Twenty-two such reconstructions were carried out in 20 patients over a 2-year period. Indications for surgery consisted of tissue loss in 9 patients and rest pain in the other 13 patients. Inflow was obtained from the femoral vessels. A variety of graft materials were used, including saphenous vein (16 patients), polytetrafluoroethylene (2 patients), composite (1 patient), and arterial homografts (3 patients). The perigeniculate vessels used were the medial sural artery to the gastrocnemius (arteria suralis) in 16 patients and the highest genicular artery (arteria genu suprema) in the other 6 patients. These vessels were approached via a medial above-the-knee popliteal-type exposure. RESULTS: There were three postoperative deaths. Mean follow-up for the other 17 patients averaged 12 months (range, 3 to 37 months). Three grafts failed (thrombosis) during follow-up, leading to two above-the-knee amputations. One graft stenosis was treated with percutaneous angioplasty. The average postoperative increase in the ankle-brachial index was 0.20. CONCLUSION: These early results appear promising with a 1-year primary patency rate of 77%, assisted primary patency rate of 85%, and a limb-salvage rate of 90% according to the Kaplan-Meier life-table method. This technique is particularly useful when adequate length saphenous vein is not available, no other outflow vessels are available, or other outflow vessels are very calcified and not safely clamped. The continued study of the long-term effectiveness is warranted.
Subject(s)
Arterial Occlusive Diseases/surgery , Collateral Circulation/physiology , Ischemia/surgery , Knee/blood supply , Aged , Amputation, Surgical , Angioplasty, Balloon , Arteries/surgery , Blood Pressure/physiology , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation , Female , Femoral Artery/surgery , Follow-Up Studies , Graft Occlusion, Vascular/etiology , Humans , Knee/surgery , Life Tables , Male , Muscle, Skeletal/blood supply , Polytetrafluoroethylene , Popliteal Artery/surgery , Regional Blood Flow/physiology , Saphenous Vein/transplantation , Survival Rate , Thrombosis/etiology , Vascular PatencyABSTRACT
A case of traumatic false aneurysm located in an unusual portion of the ulnar artery is presented and the clinical findings, diagnosis and treatments are considered. The authors report the first use of ultrasound-guided compression closure, as an alternative to surgical management of ulnar artery false aneurysms.
