The significance of double mandibular osteotomy for surgical treatment of large aneurysm of internal carotid artery above mandibular angle. A case report and literature review.

The aim of this study is to report a case of an unusual large aneurysm of the internal carotid approached with a doubly mandibular osteotomy in order to prove the significance and the excellent result of the specified surgical procedure because of the cooperation of maxillofacial and vascular surgeons. The double mandibular osteotomy is described, as well as the bypass of the aneurysm and the anastomosis of the peripheral edges of the artery. The double mandibular osteotomy can deliver the internal carotid artery from the bifurcation to its entrance to the skull base through the carotid canal and can offer the opportunity to the vascular surgeon to perform the anastomosis easily, quickly and safely.

Tinzaparin in intermediate dose for the treatment of superficial vein thrombosis: Results from an observational multicenter study-SeVEN study.

Objectives Low-molecular-weight heparins are recommended in the treatment of superficial vein thrombosis but with low grade of evidence. This study was conducted to assess the treatment outcomes of acute superficial vein thrombosis with intermediate dose of Tinzaparin. Methods Retrospective analysis of records from outpatients over a period of 16 months treated in seven centers with Tinzaparin 0.5 ml (10,000 anti-Xa IU) once daily for a period that was at the treating physician's discretion. All the patients were followed up for at least 12 weeks. Results A total of 296 patients (189 females, mean age 57.4 years) were included. Two thirds of the patients (191/296, 64.5%) received treatment for approximately five weeks (mean 36.9 days) and the remaining (105/296, 35.5%) for a shorter period (mean 16.2 days). There was no difference in patients' characteristics between the two treatment duration groups. The presence of thrombus above the knee and restricted daily activity were associated with longer period of treatment. Only one case with minor bleeding was observed. Recurrence of thrombosis over a 12-week follow-up period occurred in 6% (superficial vein thrombosis in 14 (4.7%), deep vein thrombosis in 3 (1%) and thrombus extension in the superficial veins in 1 (0.3%)). Recurrence was not related to the duration of treatment. Conclusions Intermediate dose of Tinzaparin was an effective and safe treatment for superficial vein thrombosis in the setting of real world practice. Location of thrombus and status of patients' mobilization were associated with longer duration of treatment. Future prospective randomized studies are needed to corroborate these findings.

Traumatic pseudoaneurysm of the popliteal artery after blunt trauma: case report and a review of the literature.

Pseudoaneurysms of the popliteal artery following trauma are rare lesions. We present 3 cases of pseudoaneurysms of the popliteal artery (4, 20, and 45 years old respectively) with a delayed presentation, following blunt trauma, presenting over a 3-year period, and a short review of the relevant literature. A delayed pattern of presentation, over 2 years after blunt popliteal trauma, was observed in all patients. They presented with a painful pulsatile mass in the popliteal fossa, and their peripheral pulses were normal. Orthopedic and rheumatologic evaluation findings were negative. Diagnostic evaluation included triplex, arteriography, and computed tomography angiography. A posterior popliteal approach was used, and after aneurysmal excision, reversed great saphenous vein and lesser saphenous vein (1 patient) grafts were used. After 2 to 4 years of follow-up, all grafts remain patent and the patients have fully functional limbs. A literature search revealed 70 cases of pseudoaneurysms of the popliteal artery reported in civilian settings. These lesions should be repaired shortly because their complications (rupture, thromboembolic episodes) carry a high risk for limb dysfunction and amputation. Penetrating or blunt trauma is the main causative factor (62.5%), but iatrogenic trauma accounts for an increasing number of reports (37.5%). Strict follow-up of popliteal trauma is essential. A high level of suspicion and awareness can lead to early diagnosis and treatment of pseudoaneurysms of the popliteal artery and prevent the serious complications associated with these lesions.