Bypass in situ distal / Distal bypass in situ

La revascularización distal de las extremidades inferiores siempre fue motivo de controversia en la década de losaños ochenta del siglo pasado entre los que defendían el bypass de vena safena invertida frente al bypass de venasafena in situ, aunque los resultados, como se demostró posteriormente, fueron similares. Lo importante era elmaterial sustitutivo (la vena autóloga) y la técnica de revascularización del cirujano. el bypass in situ permitía una disposición anatómica sin generar disparidad de calibres en la parte proximal y distalde las anastomosis vasculares, lo que evitaba el riesgo de torsiones. es cierto que comportaba riesgos secundarios,como la persistencia de fístulas arteriovenosas y la necesidad inherente de rasgar las válvulas venosas. Diversosartilugios y métodos se usaron a lo largo del tiempo, pero finalmente el valvulotomo de Lemaitre se estableciócomo uno de los más seguros. Los autores de este artículo describen cómo lo hacen y señalan los puntos críticospara optimizar el resultado, si bien son conscientes de que habrá variantes entre grupos quirúrgicos, pero mante-niendo la esencia del procedimiento.(AU)

Distal revascularization of the lower extremities was always a source of controversy in the 1980s among thosewho advocated reverse saphenous vein bypass versus in situ saphenous vein bypass, although the late resultsdemonstrated that both approaches were similar. the important fact was the substitute material (the autologousvein) and the revascularization technique of the vascular surgeon.the in-situ bypass allowed an anatomical position without produces caliber disparity in the proximal and distalvascular anastomoses, avoiding the risk of twisting. It is true that it carried secondary risks such as the persistenceof arteriovenous fistulas and the inherent need to tear the venous valves. Various methods were used over time,but eventually Lemaitre's valvulotome established itself as one of the safest. the authors of this article describehow they do it and point out the critical points to optimize the result, although they are aware that there will bevariations between surgical groups, but maintaining the essence of the procedure.(AU)

Treatment of Thoracic Outlet Syndrome Complications Assisted with a Cerebral Embolism Protection Device.

We report a case of a stroke and upper limb ischemia in a 27-year-old female secondary to a right cervical rib and retrograde thromboembolization. Follow-up showed complete patency of the vessels after thrombectomy and internal carotid artery stenting followed by transbrachial embolectomy performed with a cerebral protection device. The cervical rib was surgically removed to prevent additional events.