Search

Internal carotid artery kinking is frequently accompanied by atheromatous disease at the carotid bifurcation, and in this case both lesions may be treated simultaneously. Various surgical techniques have been used to correct carotid kinking but no particular one has been widely established. We conducted a retrospective review of 18 patients operated upon for internal carotid kinking during the last 5 years, which represents 4.1 per cent of the total carotid procedures performed during the same period. In 13 of the 18 patients carotid endarterectomy was performed before the repair of the kink. In four patients resection of the kinked segment with end-to-end anastomosis was performed combined with longitudinal arteriotomy at the carotid bifurcation. Two patients developed restenosis at the site of anastomosis requiring reoperation with patch angioplasty. Three patients were treated with eversion endarterectomy and end-to-side anastomosis, whereas in six patients we performed resection of the redundant internal carotid artery combined with longitudinal arteriotomy at the bifurcation. The posterior wall was reconstructed with interrupted sutures and the procedure was completed with patch angioplasty of the anterior wall. In four of these cases we used the autogenous resected arterial segment as patch material. None of these patients developed restenosis or symptoms in a follow-up period of 3 to 32 months. In cases in which significant carotid artery stenosis and internal carotid kinking coexist resection of the involved segment with end-to-end anastomosis of the posterior wall and patch angioplasty using the resected autogenous arterial segment constitute a convenient and satisfactory method of reconstruction.

The objective of this study was to determine the relationship between plaque echogenicity as measured by computer and the incidence of cerebrovascular symptoms and cerebral infarction. The correlation between carotid plaque echogenicity and plaque histology was also evaluated. In this prospective nonrandomized study, 38 consecutive patients with 54 atherosclerotic carotid plaques producing 50-99% stenosis were reviewed. The ultrasonic images of the plaques were digitized and transferred to a computer. A histogram for each plaque representing its composition was obtained. The median of the gray scale (GSM) of each histogram was used as measure of plaque echogenicity. All patients had a computed tomography (CT) brain scan performed to determine the presence of cerebral infarction. Twenty-eight plaques were examined histologically to determine the deposition of calcium, hemorrhage, cholesterol, and amorphous granular material. It is possible to identify carotid plaques at high risk for development of cerebrovascular symptoms and cerebral infarction by the computerized measurement of plaque echogenicity. This method may be used to improve the criteria of patients selection for carotid endarterectomy.

The coexistence of an abdominal aortic aneurysm and an acute aortic dissection seems to be rare and only a few reports are to be found in the literature. We report a case of a patient with acute aortic dissection of the descending thoracic aorta that caused rupture of a pre-existing abdominal aortic aneurysm. The literature is also thoroughly reviewed.

Over the past 25 years angioscopy has been successfully applied in three areas of Vascular Surgery: The in situ vein femoro-popliteal bypass, thromboembolectomy procedures and in peripheral vascular reconstructions, in order to evaluate the quality of distal anastomoses. During the first one, angioscopy may be used to facilitate the cutting of the valve cusps, to locate the exact position of tributaries to be ligated and to evaluate the distal anastomosis. Benefits derived from its use, in this operation, include: small incisions instead of the thigh-long performed in order to find and ligate the tributaries, no retained valve cusps and shorter operative times since it is no longer necessary to perform completion angiogram or Doppler studies. During thromboembolectomy procedures angioscopy may be used to assess the arterial tree for remaining thrombi/emboli and to guide thrombectomy catheters into vessels that remain occluded despite repeated attempts to unblock them. Checking the distal anastomosis in peripheral reconstructions may be of benefit, as it may depict intimal flaps or misplaced sutures that may produce early graft failure. Angioscopy has also been experimentally used to assist percutaneous interventional procedures, or as a diagnostic modality in the place of angiography. The benefits derived from its use have to be weighed against the cost of the equipment and the time it takes the would-be angioscopist to become familiar with its use and the interpretation of the obtained images.