Arterial clamping leads to stenosis at clamp sites after femoropopliteal bypass surgery.

BACKGROUND: To date, the incidence and clinical relevance of arterial stenosis at clamp sites after femoropopliteal bypass surgery is unknown. METHODS: Ninety-four patients underwent a femoropopliteal bypass in which the arterial inflow and outflow clamp sites were controlled by the Fogarty-Soft-Inlay clamp and marked with an hemoclip. The number of pre-existing atherosclerotic segments, clamp force, and clamp time were recorded and the occurrence of a stenosis at the clamp site was determined. RESULTS: After a mean follow-up of 83 months, a significant stenosis was confirmed at 23 of the 178 clamp sites (12.9%; 95% confidence interval 8.4 to 18.8). The mean number of pre-existing atherosclerotic segments (P = .28) and the mean clamp force (P = .55) was similar between the groups with and without a stenosis. There was a significant difference regarding clamp time between the group with and without a stenosis (38 minutes and 26 minutes, P = .001). CONCLUSION: Arterial clamping, even with the Fogarty-Soft-Inlay clamp, can lead to clamp stenosis and seems to be related to the duration of clamping, but not to pre-existent atherosclerotic burden.

Retroperitoneal endoscopic release in the management of celiac artery compression syndrome.

INTRODUCTION: Celiac artery compression syndrome (CACS) can be treated successfully by division of the median arcuate ligament and celiac plexus fibers. The standard technique is the open approach by an upper midline or left subcostal incision. Only six single cases in which a laparoscopic transabdominal approach for CACS was used have been reported. We prospectively evaluated the feasibility of the endoscopic retroperitoneal approach for treatment of CACS. METHODS: All patients with symptoms suggestive of CACS were evaluated using splanchnic duplex ultrasound scanning, gastric exercise tonometry (GET), and multiplane selective splanchnic angiography. The criteria for treatment were chronic abdominal symptoms, respiratory-dependent CA stenosis, and abnormal GET result. The release was performed by a retroperitoneal endoscopic approach. Anatomic success of the procedure was confirmed by angiography. RESULTS: The endoscopic retroperitoneal approach was used to treat 46 patients with CACS. One patient (2%) required conversion to an open procedure due to suprarenal artery bleeding. Release was ended prematurely in one patient due to a pneumothorax resulting in loss of working space. A postoperative pneumothorax developed in two patients, of which one needed treatment. No other complications were observed. Postoperative angiography during inspiration and expiration showed normal vessel anatomy in 36 of 46 patients. Six of 10 patients with persisting intraluminal stenoses were treated endovascularly. Five of these were successful, which brings the primary-assisted anatomic patency for the total group to 89% (41 of 46 patients). Three patients are being observed, and endovascular treatment remains an option in case of insufficient improvement. On median follow-up of 20 months (range, 2-42 months) 41 patients were free of symptoms or showed significant improvement. CONCLUSIONS: The endoscopic retroperitoneal approach for the release of the CA in CACS, with additional endovascular treatment of persistent stenosis, is feasible and effective. Short-term results were comparable with the open procedure.

Giant mucinous cystadenoma of the appendix.

Mucocele of the appendix is a rare entity, characterized by distension of the lumen caused by an accumulation of mucoid substance. We report herein the case of a 73-year-old man with a 3-week history of abdominal pain caused by a large mucinous cystadenoma. The lesion was removed intact, which is the optimal treatment.