ABSTRACT
OBJECTIVES: Between 2000-2007 we performed 31 surgical procedures for thoracic outlet syndrome, two patients underwent bilateral procedure. METHODS AND RESULTS: 26 patients had venous TOS, 4 neurovascular and 1 arterial TOS. Rib resection and scalenotomy were performed at 23 patients, rib resection, scalenotomy and deliberation at 9 patients, in one case re-operation. CONCLUSION: 76% patients were without difficulties after combined endovascular and surgical procedures.
Subject(s)
Thoracic Outlet Syndrome/surgery , Adult , Endovascular Procedures/methods , Female , Humans , Male , Middle Aged , Muscle, Skeletal/surgery , Ribs/surgery , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Femoropopliteal bypass is a common vascular reconstructive procedure. A significant proportion of bypasses become ineffective within 1 year because of occlusion due to progression of intimal hyperplasia (IH). METHODS: The clinical part of the study involved an analysis of 43 patients with proximal femoropopliteal bypass, which became occluded no later than 1 year from the procedure, who were successfully treated with thrombolysis. Morphological changes of intima in the anastomosis (evaluated angiographically) and the angle of the distal end-to-side anastomosis were evaluated. In the second part of the study, blood flow in the distal end-to-side anastomosis was modeled experimentally (by particle image velocimetry) and numerically (by computational fluid dynamics). The results were correlated with the previously identified locations of IH. RESULTS: We proved that the locations of IH correlate with the locations of disturbed blood flow, increased wall shear stress, and stagnation points as documented by experimental visualization and angiographic findings. We also confirmed that anastomoses with more acute angles are less prone to IH and occlusion of the lumen. CONCLUSION: We suggest that a better understanding of the hemodynamics and its influence on IH should lead to an optimized graft design by adopting a more acute angle of the anastomosis.
Subject(s)
Arterial Occlusive Diseases/surgery , Femoral Artery/surgery , Graft Occlusion, Vascular/etiology , Popliteal Artery/surgery , Vascular Patency , Vascular Surgical Procedures/adverse effects , Anastomosis, Surgical , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/physiopathology , Computer Simulation , Femoral Artery/diagnostic imaging , Femoral Artery/physiopathology , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/drug therapy , Graft Occlusion, Vascular/physiopathology , Hemodynamics , Humans , Hyperplasia , Models, Cardiovascular , Popliteal Artery/diagnostic imaging , Popliteal Artery/physiopathology , Radiography , Recurrence , Stress, Mechanical , Thrombolytic Therapy , Time Factors , Treatment Outcome , Tunica Intima/diagnostic imaging , Vascular Surgical Procedures/methodsABSTRACT
INTRODUCTION: Hemobilia, defined as a bleeding into the bile duct, is a rare disease. One of its infrequent causes is a hepatic artery pseudoaneurysm, usually developed after arterial iatrogenic leasion. MATERIAL AND METHODS: A case review, presenting right hepatic artery pseudoaneurysm with a biliovascular fistula as a consequence of hepatic artery and bile duct injuries during "uncomplicated" laparoscopic cholecystectomy. DISCUSSION: Bile duct injury is one of the most serious complication after laparoscopic cholecystectomy. Hepatic artery may be injured simultaneously, resulting in the pseudoaneurysm and/or biliovascular fistula, presenting with hemobilia. Time interval from the injury to symptoms widely varies from few hours to weeks or even several months. CONCLUSION: Melena or hematemesis after recent laparoscopic cholecystectomy should be always suspicious from hepatic artery and/or bile duct injuries, manifesting with hemobilia.
Subject(s)
Aneurysm, False/etiology , Cholecystectomy, Laparoscopic/adverse effects , Hemobilia/etiology , Hepatic Artery/injuries , Aged , Aneurysm, False/diagnosis , Bile Duct Diseases/etiology , Bile Ducts, Extrahepatic/injuries , Biliary Fistula/etiology , Humans , Male , Vascular Fistula/etiologyABSTRACT
Chronic visceral ischemia represents about 1% of cases of the abdominal pain due to which patients are accepted to the medical centres. The diagnose and the treatment are frequently not adequate and the reliable data from the Czech Republic show mortality of subsequent intervention in tens of percent, which is more than the global level. The essential condition for the lowering of the high morbidity and mortality is namely the knowledge of symptoms, diagnose and therapy among the medical doctors of the first and second line. The other step is the centralization of patients with this rare diagnosis in specialized centre.
Subject(s)
Ischemia/diagnosis , Mesenteric Vascular Occlusion/diagnosis , Viscera/blood supply , Chronic Disease , Humans , Intestines/blood supply , Ischemia/therapy , Mesenteric Arteries , Mesenteric Vascular Occlusion/therapyABSTRACT
We present the case of patient with autovenous ilicofemoral bypass after 21 years. The indication was traumatic demage of left iliac artery during car accident. The arterial reconstruction was patent for more than two decades with gradual arterialisation of graft. Excessive dilatation has caused the late occlusion of bypass. Ischaemia of the left limb was treated by crossover ilico-femoral bypass.
