RESUMO
AIM: Management of pseudoaneurysms in intravenous drug users poses many questions regarding need for revascularization and type of surgery. The aim of this study was to report on the frequency and management of femoral artery pseudoaneurysms in our department during the last twelve years. METHODS: Retrospective report on patients hospitalized in the Department of Vascular Surgery in Red Cross Hospital, Athens, Greece between January 1999 and May 2010 with femoral artery pseudoaneurysms due to intravenous drug abuse. RESULTS: Overall, 23 patients (18 men, 5 women, mean age 36 years) were identified. Of these, 20 patients underwent revascularization, while femoral artery ligation had to be performed in 3. Intraoperative evaluation of leg perfusion was decisive in choice of treatment. No patient presented with critical limb ischemia postoperatively. No amputations or complications were noted during the follow-up. CONCLUSION: Treatment of common femoral artery pseudoaneurysms in drug abusers should be tailored to individual requirements. Bypass surgery is not always required, due to the pre-existing collateral network in many cases.
Assuntos
Falso Aneurisma/cirurgia , Usuários de Drogas , Artéria Femoral/cirurgia , Abuso de Substâncias por Via Intravenosa/complicações , Procedimentos Cirúrgicos Vasculares , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/fisiopatologia , Implante de Prótese Vascular , Circulação Colateral , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Grécia , Humanos , Ligadura , Salvamento de Membro , Masculino , Seleção de Pacientes , Radiografia , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/métodos , Veias/transplanteRESUMO
Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.
