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Objective: Popliteal artery aneurysms (PAA) are most frequent among peripheral aneurysms. The most commonly performed surgical repair is proximal and distal ligation with a saphenous vein bypass. We aim to report the early and mid-term outcome of surgical repair of popliteal artery aneurysms via a posterior approach. Methods: A retrospective review of consecutive patients who underwent surgical PAA repair in two vascular surgery units between 1998 and 2009 was performed. Within this group, the posterior approach was used in 28 repairs in 26 patients (25 men). All patients had an ultrasound examination. Eighteen patients underwent conventional angiography while CT angiography with 3-D reconstruction was used from 2003 to evaluate an endovascular option. Primary and secondary graft patency, limb salvage and patient survival rates were determined using Kaplan–Meier methods. Results: All aneurysms did not involve the superficial femoral artery and the popliteal trifurcation. Interposition grafting was performed with a great saphenous vein in 19 repairs while a 6.0-mm–8.0-mm PTFE graft in the remaining nine. The 30-day primary patency rate was 100%. The average popliteal aneurysm diameter was 3.8 cm (range, 2.1–6.4). Three aneurysms were thrombosed at the time of surgery, and two of these presented as acute limb ischemia. Eight patients had chronic symptoms, claudication was present in five and ischemic rest pain in three. The remaining patients were asymptomatic or with mild discomfort. An S-shaped curvilinear incision was preferred in all repairs and no problems with postoperative healing or wound infection were observed. The average length of stay was 4.6 days. Four patients were lost to follow-up. One-year primary graft patency, secondary graft patency, limb salvage and patient survival rates were 92.8%, 96.4%, 96.4% and 100%, respectively. Conclusions: These data demonstrate that surgical PAA repair through a posterior approach is associated with excellent mid-term durability. Moreover, the posterior approach facilitates the resection of aneurysm, avoids continued aneurysm expansion from communicating branches and reduces wound complications frequently seen after femoro-popliteal bypass.

A spontaneous rupture of the external iliac vein revealed as a phlegmasia cerulea dolens with acute lower limb ischemia: Case report and review of the literature.

Two unusual cases of iliac vein spontaneous rupture into the retroperitoneum are presented together with 18 cases reported by the literature. In one patient of ours, entrapment of clots in an IVC filter and proximal iliac vein involvement into the scar tissue surrounding the left limb of an aortoiliac bifurcation graft might have caused flow disturbances and subsequent predisposition to rupture of the thrombosed external iliac vein. Inflammatory parietal changes, including infiltration of macrophages, T and B lymphocytes producing elastin degradation by means of cytokines, may have led ultimately to vein disruption. Despite clinical features and CT scan findings, the physician's awareness of this disease remains the most important factor for the early treatment.

L’articolo tratta le problematiche relative alle vie di accesso ed all’approccio terapeutico delle patologie ostruttive dei vasi sanguigni situati al di sopra del legamento inguinale.

Aim. To eval¬u¬ate the effi¬ca¬cy of ¬intra-arte¬ri¬al throm¬bol¬y¬sis and adjunc¬tive endo¬vas¬cu¬lar pro¬ce¬dures for infra¬in¬gui¬nal ¬native ¬artery chron¬ic occlu¬sions, ¬that ¬result in a ¬recent wors¬en¬ing of symp¬toms ¬because of throm¬bo¬sis super¬im¬posed on under¬ly¬ing path¬o¬log¬ic ¬lesions. Methods. Intra-arte¬ri¬al cath¬e¬ter-direct¬ed throm¬bol¬y¬sis ¬with urok¬i¬nase 300000 IU ¬bolus fol¬lowed by 70000 IU /h for 24-48 ¬hours was admin¬is¬tered to 54 ¬patients affect¬ed ¬with low¬er ¬limb ische¬mia. Twenty-¬three ¬patients (25 ¬limbs) pre¬sent¬ed ¬severe clau¬di¬ca¬tio and 31 -patients (34 ¬limbs) crit¬i¬cal leg ische¬mia; sub¬acute (14 ¬days-3 ¬months) symp¬toms ¬were ¬present in 60.9% and 77.4% , respec¬tive¬ly. After suc¬cess¬ful throm¬bol¬y¬sis, endo¬vas¬cu¬lar pro¬ce¬dures (i.e., angio¬plas¬ty, endo¬lu¬mi¬nal stent¬ing, endo¬pros¬the¬sis place¬ment) ¬were per¬formed in 72% and 67.6%, respec¬tive¬ly. In addi¬tion, infra¬in¬gui¬nal autog¬e¬nous ¬vein recon¬struc¬tion was per¬formed in 5 ¬patients ¬with crit¬i¬cal leg ische¬mia. Results. Initial clin¬i¬cal improve¬ment was ¬seen in 76% of 25 extrem¬ities in ¬group I, ¬with a 30-day pri¬mary paten¬cy and ¬relief of clau¬di¬ca¬tio in 68%. Arterial rec¬a¬nal¬iza¬tion was ¬achieved in 23 (67.6%) and res¬to¬ra¬tion of ¬flow in tar¬get ves¬sels for sub¬se¬quent ¬bypass in 5 (14.7%) of 34 extrem¬ities in ¬group II. The 30-day ¬limb-sal¬vage was 73.5%; ¬limb ¬loss includ¬ed 2 ampu¬ta¬tions (5.9%) as a ¬result of infec¬tion and/or necro¬sis in dia¬bet¬ic ¬patients, ¬despite ana¬tom¬ic paten¬cy at the endo¬vas¬cu¬lar pro¬ce¬dure ¬site. Relief of ische¬mia was ¬achieved in 56% of clau¬di¬cants (¬mean fol¬low-up, 42 ¬months) and ¬limb sal¬vage in 52.9% of ¬patients ¬with crit¬i¬cal ische¬mia (¬mean fol¬low-up, 36 ¬months). Conclusion. Thrombolysis and adjunc¬tive endo¬vas¬cu¬lar pro¬ce¬dures are an accept¬able ther¬a¬peu¬tic ¬option for the treat¬ment of wors¬en¬ing man¬i¬fes¬ta¬tions of chron¬ic occlu¬sive dis¬ease of the femor¬o¬pop¬li¬teal arte¬ri¬al seg¬ment.

A unique case of true inferior pancreaticoduodenal artery aneurysm (IPDA) associated with occlusion of common hepatic artery is reported. Radiological and MRI findings are described. Because of high risk of visceral ischemia that contraindicated a percutaneous transluminal embolization, a successful tangential resection of aneurysm was performed.

INTRODUCTION: Abdominal aortic pseudoaneurysms are a rare but serious complication of aortic surgery. Treatment with traditional open surgery is associated with a high rate of perioperative mortality and morbidity. Endovascular treatment is less invasive and guarantees lower mortality and morbidity rates. The aim of this study was to evaluate the role of short-, medium- and long-term endovascular treatment of these pseudoaneurysms. MATERIALS AND METHODS: Over the past 10 years, 14 patients with abdominal aortic aneurysms, which developed after prior aortic surgery, underwent endovascular treatment involving implantation of an endoprosthesis at our institutions. Exclusion criteria were emergency treatment and suspicion of an infected prosthesis. A Cheatham-platinum covered stent mounted on a balloon catheter was implanted in one patient and self-expandable stent-graft in the other 13. No fenestrated or custom-made prostheses were used. RESULTS: The procedure had a 100% technical success rate. There was no postoperative mortality. Two type I endoleaks, observed at aortography at the end of the procedure, were not seen on the CT scan taken one month later. Three patients (21.4%) had major perioperative complications which consisted of early occlusion of a branch of the endoprosthesis, (treated with a femoro-femoral crossover bypass graft), a transient ischemic attack, and jaundice. The long-term mortality rate, at an average follow-up of 37.4 months, was 21.4%. None of the deaths was related to the procedure. CONCLUSIONS: Endovascular treatment of patients who develop anastomotic pseudoaneurysm after surgery of the abdominal aorta is safe and effective both in the short and long term. In our opinion it is the treatment of choice for this category of patients.