Primary popliteal venous aneurysm with recurrent pulmonary emboli.

Primary venous aneurysms are infrequently noted and rarely have clinical significance. An important exception, however, is an aneurysm of the popliteal vein that is known to be a source for pulmonary emboli. We present the case of a previously healthy 57-year-old man with recurrent episodes of occult pulmonary embolism. Initial diagnostic investigations were compatible with multiple pulmonary emboli, but no source was identified. Subsequently, an indium 111-labeled platelet scan confirmed a site of active thrombus formation in the right lower extremity above the knee. Magnetic resonance imaging defined a saccular aneurysm of the popliteal vein, which was confirmed by contrast venography. Thereafter, the patient had resection of the venous aneurysm and tangential venorrhaphy. After operation duplex scanning confirmed patency of the venous repair. This is the eleventh report in the English-language literature of pulmonary emboli suspected of having originated from a popliteal venous aneurysm.

Surgical treatment of chronic mesenteric arterial insufficiency.

The treatment of 41 patients with chronic mesenteric insufficiency is reviewed: 20 men and 21 women with a mean age of 59 years were treated and observed for an average of 42 months. Thirty-one patients had symptoms of intestinal angina whereas 10 patients underwent prophylactic revascularization during other aortic operations. All but one patient had revascularization of the superior mesenteric artery, alone or in combination with another revascularization. Various surgical techniques were used, including retrograde bypass in 24 patients, antegrade bypass in 11 patients, and endarterectomy in the remaining six patients. Seven patients had acute abdominal symptoms and required emergency operation while in the hospital awaiting elective revascularization. There were two deaths in the perioperative period (4.9%), both caused by bowel necrosis. Six patients are known to have had late revascularization failure, resulting in recurrent symptoms in three patients and two subsequent deaths. All patients who remained asymptomatic after late graft failure had undergone multiple vessel revascularization; no patient revascularized prophylactically had symptoms of intestinal angina during the follow-up period. Early mesenteric revascularization is a safe and effective method of relieving the symptoms of chronic visceral ischemia and may prevent the development of fatal bowel necrosis.

Duodenocaval fistula: case report and literature review.

Duodenocaval fistulae are rare but may well be the source of gastrointestinal hemorrhage with associated sepsis in patients undergoing surgery and subsequently receiving radiation to the right upper abdomen. Management of these fistulae may be challenging. Diagnosis usually requires a high index of suspicion, particularly in post irradiated patients.