RESUMO
We investigated the factors implicated in the pathogenesis of anastomotic aneurysm formation and the postoperative course of patients with such a complication. Forty-five patients with 49 anastomotic aneurysms were diagnosed and treated in two vascular surgery departments in Athens, Greece, during an 8-year period. Emergent complications occurred in 15 cases, rupture in 11, and thromboembolic episodes in another four. Preoperative diagnostic workup in the remaining elective cases (n = 34) included color duplex scan, computed tomographic scan, and angiography. All patients underwent operation, and cultures were obtained during the surgical procedures. Histological examination of the host artery wall adjacent to the aneurysm was also performed. Aortobifemoral bypass was the original operation performed in the majority of cases (71%), and the femoral anastomosis was the most frequent site involved (85.7%). Emergent procedures were associated with increased mortality (46.6%), whereas elective operation resulted in high patency rates and no mortality. In an attempt to isolate predisposing factors that contributed to aneurysm formation, we concluded that the etiology was multifactorial in approximately one-third of the cases and degenerative host artery disease was the main cause (40%). Arterial degeneration is the leading cause of anastomotic aneurysm formation, and emergency arterial reconstruction in cases of aneurysm complication is associated with a poor prognosis.
Assuntos
Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Aneurisma Roto/etiologia , Aneurisma Roto/cirurgia , Procedimentos Cirúrgicos Eletivos , Serviços Médicos de Emergência , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Anastomose Cirúrgica , Falso Aneurisma/patologia , Falso Aneurisma/fisiopatologia , Aneurisma Roto/patologia , Aneurisma Roto/fisiopatologia , Angiografia Digital , Ruptura Aórtica/etiologia , Ruptura Aórtica/cirurgia , Feminino , Artéria Femoral/cirurgia , Seguimentos , Grécia , Humanos , Aneurisma Ilíaco/etiologia , Aneurisma Ilíaco/cirurgia , Masculino , Artéria Poplítea/cirurgia , Prognóstico , Infecções Relacionadas à Prótese/complicações , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Grau de Desobstrução VascularAssuntos
Arteriopatias Oclusivas/parasitologia , Equinococose/diagnóstico , Artéria Femoral/parasitologia , Doença Crônica , Doenças dos Genitais Masculinos/parasitologia , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/parasitologia , Doenças Musculares/parasitologia , Artéria Poplítea/parasitologia , Escroto/parasitologiaRESUMO
The purpose of the present study was to assess the efficacy of endarterectomy without patch and shunt using a homogeneous group of patients. From January 1987 through December 1994, ninety-eight patients (70 males and 28 females) with mean age 67 years and unilateral atherosclerotic carotid stenosis underwent endarterectomy without the use of a shunt, patch, EEG, stump pressure measurements or other methods. The patients were preoperatively classified into three groups according to clinical symptoms. The overall neurologic morbidity consisted of 2 (2%) permanent and 3 (4%) temporary deficits. Based on our results we concluded that endarterectomy without a shunt is a simple, safe method in cases with no hemodynamically concomitant significant lesions. The neurological complications are probably due to embolization rather than temporary ischemia during operation.
