Post-traumatic pseudoaneurysm of the great saphenous vein: a case report.

Venous (pseudo)aneurysms are rare entities. Herewith we report a case of the right lower extremity in a 42-year-old woman in whom a non-pulsatile mass was diagnosed only by physical examination as a hematoma and was treated conservatively. Six months later ultrasound and phlebography identified a pseudoaneurysm of the great saphenous vein. Post-traumatic venous pseudoaneurysm should be considered among the differential diagnostic options of a subcutaneous non-pulsatile mass in patients with a history of physical trauma. Surgery was offered which was rejected by the patient. Further one month follow-up showed no change.

Changes in the plasma concentration of soluble thrombomodulin in patients with severe carotid artery stenosis after eversion endarterectomy.

OBJECTIVE AND DESIGN: The purpose of the study was to investigate the putative role of soluble thrombomodulin (sTM) in severe carotid artery stenosis. MATERIALS AND METHODS: We prospectively studied 64 patients who were undergoing carotid endarterectomy (2001-2003). Plasma sTM concentration was determined in each patient before surgery and at 14 months postsurgery. -308 TNF-alpha promoter polymorphism was also determined. RESULTS: Strong negative correlation was found between the preoperative duplex scan values and the plasma sTM concentrations (R = -0.418, p = 0.0006). Patients with 308 A TNF-alpha genotype had significantly lower (p = 0.0415) preoperative sTM values than their counterparts with no such polymorphism. Soluble TM concentrations measured in plasma samples taken at the end of the postsurgical follow-up period of 14 months duration were significantly higher compared to the preoperative values (p < 0.0001). CONCLUSIONS: Our present findings indicate that sTM may be adsorbed to the atherosclerotic plaques or inflamed endothelium in carotid arteries. The pathological significance of this adsorption remains to be determined.

[Management of carotid injuries]. / Az arteria carotis sérülései és azok ellátása.

The occurrence of carotid arterial injuries is relatively infrequent but have serious outcome. At the Department of Cardiovascular Surgery we have performed surgical interventions in 16 instances (7 penetrating and 9 blunt trauma patients) due to carotid injuries. Preoperatively all these patients developed neurological deficits and in the postoperative period 7 patients became asymptomatic. We lost two patients owing to stroke. Vascular injuries are generally characterized by hemorrhage and ischemia in the area supplied. In addition to the symptoms of hemorrhagic shock, penetrating vascular injuries may lead to embolism from the injured intimal surface, thrombus formation and subsequent occlusion may occur. In other instances pulsating hematomas can be formed and with combined arterial and venous trauma A-V fistula can develop. In blunt trauma patients stretching or compression of the vessel may cause intimal rupture with subsequent formation of subintimal hematoma, dissection and later pseudoaneurysm. The disruption of the atherosclerotic plaque or the accumulation on the injured intimal surface may serve as source of embolism and thrombosis. In symptomatic patients the urgent performance of the surgical correction of the carotid arterial injuries is mandatory, nevertheless in asymptomatic patients and in chronic cases the prevention of the late complications is also justified as soon as possible.

[Simultaneous carotid and coronary operations: experience and results of 11 years (1990-2000)]. / Szimultán végzett carotis-coronaria mútétek: 11 év tapasztalatai és eredményei (1990-2000).

Between 1990-2000 163 coronary + carotid procedures were performed. The mean age was 4 years higher than it was at patients underwent isolated CABG (63.4 y vs 59.8 y). Clinically proven obliterative artery diseases in other anatomical regions were also present in more than 60% of patients. The half of the procedures were performed under emergency and urgent circumstances. The cardiac status and the coronary morphology were found to be unstable in half of the patients. The "Euroscore" risk evaluation model was used for risk scoring. The mean score value was as high as 6.26. According to this the estimated surgical lethality could have been as high as 11.2%. The real surgical lethality value was far under this estimated level (7.36%). The 1, 5, 10 year survival rate were as high as 89%, 82%, 68% (Kaplan-Meier). The majority of the patients was in NYHA I-II at the end of the follow-up period. The majority of the early and late deaths were found to be myocardial in origin. The estimated surgical risk of the simultaneous procedures could be reduce by accepting of the severe surgical indications existing at this surgical field and with the availability of an experienced operating team.

[Late results after eversion endarterectomy of the internal carotid artery]. / Késói eredmények az arteria carotis interna everziós endarteriektómiája után.

OBJECTIVES: The eversion endarterectomy of the internal carotid artery was introduced in Hungary in 1991. The aim of this study was to define the long-term restenosis rate of this new method. MATERIALS AND METHODS: Between 1991 and 1993, 171 operations were performed by one surgeon on 151 patients: 109 patients had enough compliance to take part in long-term follow-up, which included annual physical and ultrasound (Ultramark 9) investigations. Restenosis rate and plaque morphology was defined. Survival and patency rates were calculated by life-table method. RESULTS: The perioperative combined stroke morbidity and mortality rate was 0.8%. The 5-year patient survival rate was 85%, the recurrent stenosis free rate was 88%/5 years, and 9% of the patients had restenosis greater than 70% in this period. The plaque morphology showed calcification in 1 case. Two patients needed 3 reoperations (2.4%). Plaque histology showed myointimal hyperplasia in every 3 cases. CONCLUSIONS: Comparing our results to the literature (2-34% restenosis rate) it seems to be acceptable and encouraging for the future. The ultrasound and histological findings suggest that arteriosclerosis does not play significant role in development of restenosis after the eversion method.

[Surgical considerations in type-B aortic dissection]. / Sebészi megfontolások B típusú aorta disszekció esetében.

Inspite of remarkable progress in both diagnostic and therapeutic development in treating aortic dissections this continues to be one of the most severe vascular catastrophies complicated by high mortality. While aortic dissections Type A are to treat surgically in our days, in majority of patients with Type B dissections hypotensive treatment is the method of choice providing better chance for survival preventing effectively aneurysm formation and rupture at the site of intimal tear. However in certain cases Type B dissection produces either isthmic aneurysm formation, or with distal progression may afflict long segmental thoracic, thoracoabdominal or abdominal deterioration of the aorta and its side branches. The spinal, visceral, renal and lower limb ischemia threatens viability of these organs and hypotensive medication may enhance risk. Prompt evaluation and selection of these cases with proper surgical reconstruction help us to reduce mortality. At our department we have performed 33 thoracoabdominal endoaortectomies with meticulous reconstruction of renal and visceral orifices. The mortality rate in this subgroup of patients was 6%, meanwhile almost 70% in those, treated medically but had the severe distal branch involvement. Based on our experiences in selected patients with Type B aortic dissections we recommend this procedure in order to achieve improvement of results.

Comparison of perioperative results obtained with carotid eversion endarterectomy and with conventional patch plasty.

After limited experience with eversion endarterectomy of the internal carotid artery, comparison has been made between perioperative results obtained with the eversion technique and with the conventional method. The perioperative results of 715 consecutive cases of patch plasty of the internal carotid artery performed between January 1986 and December 1990 were reviewed and compared with perioperative data of 739 consecutive cases of eversion endarterectomy, performed between January 1991 and December 1993. The duration of surgery was also recorded. Statistical analysis was carried out, using chi2 test, Fisher's Z test and Student's t-test. The postoperative stroke rate was 2.9% in the conventional endarterectomy group, and 0.95% in cases of eversion endarterectomy (P<0.01); the stroke mortality rates were 1.8% and 0.54% respectively (P<0.05). Overall mortality rate was 2.9% in the conventional group and 0.95% in the eversion group (P<0.01): combined morbidity and mortality rate was 4% versus 1.35% (P<0.001). A statistically significant difference was found in favour of the eversion method between the duration of surgery (90.9 min versus 52.8 min; P<0.005) and between the mean clamp time (34.9 min versus 22.4 min: P<0.005). On the basis of these results, it is concluded that eversion endarterectomy of the internal carotid artery is a safe and rapid technique and its immediate results were superior to those obtained after conventional endarterectomy and patch plasty.

[Simultaneous occurrence of moyamoya disease and subclavian steal syndrome]. / A moyamoya betegség és a subclavian steal syndroma együttes elöfordulása.

The authors present a case of moyamoya disease associated with subclavian steal syndrome. They could not find any report in literature about the combination of these syndromes. The Doppler, MR, and angiographic findings as well as the clinical importance of subclavian steal and moyamoya syndromes are briefly summarized.