Axillary artery transection and bilateral pulmonary embolism after anterior shoulder dislocation: case report.

INTRODUCTION: Anterior shoulder dislocation can be associated with vascular and neurological complications. However, axillary artery injury associated with shoulder dislocation is rare and extremely rare without bone fracture. An early diagnosis of these complications allows predicting long-term functional outcomes. METHODS: This article reports the case of a 66-year-old patient who presented an anterior shoulder dislocation after a ski fall without any neurological dysfunction or pulse deficit. RESULTS: The first reduction attempts were unsuccessful and during the new attempt, we observed a hematoma. A CT scan showed a disruption of the axillary artery and a bilateral pulmonary embolism. CONCLUSION: Neurovascular injury must be systematically sought before and after reduction, and a multidisciplinary approach is always necessary.

Carotid endarterectomy in octogenarian: short- and midterm results.

BACKGROUND: Randomized controlled trials that have established recommendations for carotid surgery have excluded patients >79 years of age, and in our day to day practice, patients in this age group are becoming more common. We sought to analyze the outcomes of carotid endarterectomy (CEA) in octogenarians, determine the risk factors of morbidity and mortality, and evaluate the midterm survey of these patients. METHODS: Age was the only selection criteria for inclusion in this study. We compared symptomatic and asymptomatic populations and retrospectively analyzed the CEA results performed in patients ≥80 years of age in each group. We calculated the combined ipsilateral stroke/death for each group. RESULTS: In the 6-year study period (2002-2007), 132 CEAs were performed in 118 octogenarians. The mean age was 83.2 years (range: 80-93), and there were 70 men (59.3%) and 48 women (40.6%). In this study group, 37.9% of patients were symptomatic and 62.1% were asymptomatic; the rate of internal carotid stenosis was 81.6% (standard deviation: ±8.5%). The combined ipsilateral stroke/death rate was 3.79% (4 deaths and 1 stroke): 2% in the symptomatic patients and 4.88% in the asymptomatic patients. No differences were found between the groups' combined ipsilateral stroke/death rate (P > 0.05), but there were significant more patients with coronary artery disease and peripheral artery disease in the asymptomatic patients. A contralateral significant internal carotid stenosis was a risk factor of combined ipsilateral stroke and death (P = 0.024). The mean duration of follow-up was 3.8 ± 2.0 years, and 73% ± 5% of the patients were alive at 3 years. CONCLUSION: The good immediate results and good probability of survival at 3 years after surgery conveys a real benefit of this surgery in this age group, but patients should be selected on a case by case basis. In our experience, the presence of bilateral lesions should be a significant influence criterion in the preoperative risk assessment. Other evaluation criteria, such as cardiac status, are needed to optimize the selection of asymptomatic patients in particular.

Femorofemoral bypass as an alternative to a direct aortic approach in daily practice: appraisal of its current indications and midterm results.

BACKGROUND: To assess our current practice concerning the indications and the immediate and midterm results of femorofemoral bypass. METHODS: We retrospectively included all patients, from 1997 to 2008, operated on for aortoiliac occlusive disease using an extra-anatomical bypass from a donor iliac artery or a femoral artery to the contralateral femoral artery (common or profunda artery). Demographic data, initial clinical status, characteristics of the interventions, and short- and midterm results were collected. Elective surgery was distinguished from urgent surgery (critical limb ischemia, acute ischemia, vascular infection). RESULTS: One hundred twenty-four femorofemoral bypasses were performed (103 male), mean age 68 (±12) years. Indications were critical limb ischemia (47.1%), intermittent claudication (38.8%), acute ischemia (12.1%), and vascular infections (1.7%). Perioperative outcomes were 5.6% mortality (elective surgery 0.0%, urgent surgery 9.7%, P = 0.02) and 27.4% morbidity without any secondary graft infections (elective surgery 22.5%, urgent surgery 31.9%, P = 0.17). Mean follow-up period was 3 years, and overall survival was 69.4% (elective surgery 88.7%, urgent surgery 56.7%, P = 0.08). At 3 years, primary patency was 81.8% and secondary patency was 89.3% (elective surgery 96.4%, urgent surgery 84.2%, P = 0.68). No significant risk factors for immediate and secondary thromboses were found. CONCLUSION: In our current practice, femorofemoral bypasses are applied mainly for urgent procedures when avoiding a direct aortic approach is mandatory, with good midterm results. Although indications are limited for good-fit patients, femorofemoral bypass has confirmed safety (no perioperative deaths, no infections) and high durability (good secondary patency).