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ABSTRACT: We present a case of left-sided inferior vena cava unexpectedly observed during an operation of aorto bifemoral bypass in a patient with severe Leriche syndrome and almost complete obstruction of the infrarenal aorta. This very rare congenital malformation (0.2-0.5%) was not recognized by the duplex scanner performed preoperatively, probably because of the low level of suspicion carried on by an experienced operator. AngioCT or angioMR, which would have surely shown us the anomaly, were not done because, in the lack of an aneurysmal disease or other abdominal pathological situations, these investigations were not required before operation. The possible hazards of such an unrecognized malformation are great, mostly in terms of incontrollable intraoperative hemorrhages, but the final outcome of this case was positive.
The Journal of cardiovascular surgery 11/1997; 38(5):489-93. · 1.56 Impact Factor
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ABSTRACT: The objective of this article is the presentation of a new device, simple, easy to use, at low cost, for the prevention of postoperative haematoma following surgery of varicose veins of the lower limbs. It consists in a two-part device that functions as an elastic and pneumatic bandage, that wraps thigh and leg, with the knee articulation free and that is placed immediately before the stripping of the saphenous vein when all the surgical wounds are closed, except the supramalleolar one. While the head of the stripper is pulled, the device is inflated by air with a compression of 40-50 mmHg and the last surgical wound is sutured. Pneumatic compression is held for 24-36 hours, allowing the patients to walk and, in the meantime, to control the colour and the temperature of the foot. The advantages of this device are: easy use and low costs; compression on the area of the saphenous vein and of the main collaterals; uniform but moderate pressure on all the limb circumference.
The Journal of cardiovascular surgery 05/1997; 38(2):177-80. · 1.56 Impact Factor
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ABSTRACT: A case of post stenotic aneurysm of the inferior mesenteric artery (IMA) is reported. This case underlines the importance of a correct diagnosis by instrumental methods such as Duplex Scanner, CT and Arteriography, mainly when the first diagnosis is aneurysm of the abdominal aorta (AAA). Our patient showed, furthermore, the occlusion of the celic axis, of the superior mesenteric artery and of both hypogastric arteries; thus his intestinal vascularization was represented, from the gastric fundus until the rectum, only by the inferior mesenteric artery and its collateral network. The operation consisted in the resection and reimplantation of the vessel on the left side of the terminal abdominal aorta, after removal of the dilated segment. This location was chosen because of the coexistence of a mild dilatation of the aorta of 2.8 cm and considering possible aortic surgery for AAA in the future.
The Journal of cardiovascular surgery 09/1996; 37(4):359-62. · 1.56 Impact Factor
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ABSTRACT: In a recent publication, reporting the sixth case of aortic angiosarcoma, probably induced by the implantation of a dacron vascular prosthesis, Weiss et al. have done a literature review concerning the association between the presence of vascular prostheses and the onset of mesenchymal neoplasms. Although they consider the incidence of this association very low, they also point out the hypothesis, largely supported by experimental studies, that vascular prostheses can play the role of aetiological co-factor or factor in the onset of these tumors. We consider useful to report a case of malignant fibro histiocytoma arising around a femoral vascular prosthesis in a patient operated on for aneurysm of the femoral artery.
Minerva chirurgica 11/1993; 48(20):1227-32. · 0.77 Impact Factor
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ABSTRACT: Thirty-one patients, ranging in age from 57 to 78 years (mean 66), with the exclusion of cases with doubtful possible results, underwent abdominal aortic aneurysmectomy for asymptomatic AAA and had cultures from the aneurysmal wall and endovascular thrombus to identify possible microbiological source of future graft infection; 5 (16%) of 31 cultures yielded bacterial growth and the most common organism isolated was staphylococcus epidermidis. During an average follow-up of 15.4 months no graft infection was noted in patients with positive or negative aortic cultured. A literature review stresses the same disparity between positive cultures obtained at the aneurysmectomy and subsequent low graft-infection rate. It is concluded that the aneurysm wall itself does not represent an important source of early or late graft infection and it's suggested that the bacterial presence both in the wall and thrombus could be explained by an exogenous contamination at the operation time.
Minerva cardioangiologica 11/1992; 40(10):375-81.
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ABSTRACT: Mesoglycan is a natural glycosaminoglycans preparation, with antithrombotic and pro-fibrinolytic activities, which has been shown to be clinically effective in a number of vascular atherosclerotic disorders with thrombotic risk.
In the present investigation we studied the effect of mesoglycan in patients with acute episodes of relative lower limb ischemia (Stage IIb according to Leriche-Fontaine classification) coming to our observation. Mesoglycan was administered according to the following schedule: a 10-days period of endovenous mesoglycan (90 mg/day), given in day-hospital regimen, followed by a 20-days period of oral mesoglycan (100 mg/day). The treatment schedule was repeated for two months and then patient continued with oral mesoglycan. We present the preliminary results obtained on 36 patients which were followed for a mean period of 12 months.
From February 1995 thirty-six patients, 24 males and 12 females, aged between 45 and 83 years (mean +/- SD: 69.8 +/- 7.5) coming to our observation for acute relative lower limb ischemia were enrolled. At baseline, the diagnosis was Fontaine's IIb stage (walking distance < or = 200 m) in all patients, 17 patients presenting walking distance < 100 m. After 3 and 6 months of mesoglycan treatment a significant improvement of symptoms and signs was observed in all patients but one. At the end of the 6-months period, 29 patients (81% of the study population) became to a Fontaine's IIa degree, with a significant increase in walking distance (in 70% three times their basal value) and improvement of symptoms and recovery time. After treatment, Winsor Index was not significantly modified. Similar results were obtained after 12 months of follow-up. During the study period only one patient included in the trial needed surgical revascularisation. The administration of mesoglycan was well tolerated, with only minor complaints in two patients (one case of headache and one of diarrhea). During the endovenous administration of mesoglycan most patients (81%) presented values of aPTT almost double than baseline, which returned to normal values at the end of the administration.
The present preliminary results show that, in patients with acute episodes of relative lower limb ischemia, mesoglycan (administered according to the described protocol) is an effective and safe agent able to improve symptoms (walking distance, pain, leg appearance) and to possibly delay the need of surgical interventions.
Minerva cardioangiologica 45(7-8):383-92.
