[Surgical treatment of aorto-iliac atherosclerosis]. / Tratamentul chirurgical al bolii aterosclerotice aorto-iliace.

The occlusive aorto-iliac disease is the consequence of a diffuse atherosclerotic process aggravated by risk factors and existing co-morbidity. The treatment aims at correcting the risk factors, balancing and compensating the associated diseases, the surgical re-vascularization of the lower limbs (by pass, particular techniques for the aortic aneurysms, necessity interventions). Aortic and peripheral angiographic exploration is required for the establishment of surgical strategy. The lot studied includes 77 patients hospitalized in the period between 2000-2006 in the Surgery Clinic no. II, Cluj-Napoca. 33 cases had an obstruction of a single iliac artery. The bilateral affection has been present in 27 cases, while that of the terminal trunk of the aorta and of its bifurcation has been present in 17 cases. The most frequent intervention has been the aorto-bifemoral prosthesis, the prosthesis used being: Terom, Dacron and PTFE. The thrombendarterectomy was used as an independent method or associated with the by-pass. At the same time, the aortoiliac interventions were associated with aorto-inguinal bypass, crossover as well as disarticulations and amputations of toes. 26% of the 77 patients, had early post-surgery complications (hemorrhage, infection, the thrombosis of the graft). The re-vascularization failed in 3.8% of cases, a major amputation of the limb being necessary. 11 deaths (14.3%) were recorded which occurred as a result of systemic complications.

Cryoglobulinemic vasculitis with multiple digital necrosis in viral hepatitis.

Cryoglobulinemic vasculitis (CV) associated with viral hepatitis C (VHC) is halfway between classical autoimmune disease and neoplasia. The extrahepatic manifestations of viral hepatitis C are various, their majority being due to mixed cryoglobulinemia. Patients diagnosed with viral hepatitis C often have mixed serum cryoglobulins, but only 5-10% of them will develop clinically manifest cryoglobulinemic vasculitis. CV symptomatology is most frequently obvious at skin level. The clinical manifestation characteristic of CV is purpura. Digital necrosis as the last stage of trophic disorders associated with CV has been rarely described in the literature. All CV types may be complicated by renal impairment. A 10-30% proportion of patients with VHC infection will develop glomerulonephritis. The treatment of cryobulinemic vasculitis associated with viral hepatitis C is focused on the reduction of viral load, the control of vasculitis symptoms using corticoids, plasmapheresis, immunosuppressive drugs, and the reduction of the amount of cryoglobulins acting on B lymphocytes. We present a rare case of cryoglobulinemic vasculitis with multiple digital necrosis associated with viral hepatitis C.