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Prosthetic graft infection after vascular reconstruction is a rare but serious complication. We report a case of infection occurring late after implantation of an iliofemoral prosthetic vascular graft. The Staphylococcus aureus infection was revealed by vascular purpura localized on the right leg 7 years after implantation of a vascular prosthesis. This case illustrates an uncommonly late clinical manifestation presenting as an acute infection 7 years after the primary operation. In this situation, the presentation differs from early infection, which generally occurs within the first four postoperative months. Diagnosis and treatment remain a difficult challenge because prosthetic graft infection is a potentially life-threatening complication. Morbidity and mortality rates are high. Here we detail specific aspects of the clinical and radiological presentation., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: Several studies, including three randomized controlled trials (RCTs), have shown that endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) offered better early results than open surgical repair (OSR) but a similar medium-term to long-term mortality and a higher incidence of reinterventions. Thus, the role of EVAR, most notably in low-risk patients, remains debated., Methods: The ACE (Anevrysme de l'aorte abdominale: Chirurgie versus Endoprothese) trial compared mortality and major adverse events after EVAR and OSR in patients with AAA anatomically suitable for EVAR and at low-risk or intermediate-risk for open surgery. A total of 316 patients with >5 cm aneurysms were randomized in institutions with proven expertise for both treatments: 299 patients were available for analysis, and 149 were assigned to OSR and 150 to EVAR. Patients were monitored for 5 years after treatment. Statistical analysis was by intention to treat., Results: With a median follow-up of 3 years (range, 0-4.8 years), there was no difference in the cumulative survival free of death or major events rates between OSR and EVAR: 95.9% ± 1.6% vs 93.2% ± 2.1% at 1 year and 85.1% ± 4.5% vs 82.4% ± 3.7% at 3 years, respectively (P = .09). In-hospital mortality (0.6% vs 1.3%; P = 1.0), survival, and the percentage of minor complications were not statistically different. In the EVAR group, however, the crude percentage of reintervention was higher (2.4% vs 16%, P < .0001), with a trend toward a higher aneurysm-related mortality (0.7% vs 4%; P = .12)., Conclusions: In patients with low to intermediate risk factors, open repair of AAA is as safe as EVAR and remains a more durable option., (Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Introduction: The blood vessel wall is almost always nourished by two ways; from the blood stream itself and through the outer part of the wall by vasa vasorum., Aim of the Study: The aim of this study was to demonstrate that this kind of nutrition is also available for the venous wall and to define the distribution pattern in superficial venous walls., Materials and Methods: 50 long saphenous veins and 20 short saphenous veins latex or barium injections, dissections with magnifying glasses and microradiographies. Topographical evaluation of the origin of vasa vasorum., Results: The results showed that vasa vasorum originated from perforating arteries coming from several levels and getting a lot of anastomosis. We showed that the main sources for the long saphenous vein are the external pudendal artery and descending artery of the knee and for the short saphenous vein, the short saphenous vein artery. In thrombosis and varicose veins, the vasa were strongly altered., Conclusion: This study outlines the fact that superficial veins are supplied by arterial and venous vasa vasorum, and the role of vasa vasorum must be considered when questioning the pathogenesis of varicose and post thrombotic disease.

The problems generally encountered in interpreting written reports of echo-Doppler examinations led us to develop a graphic software system to visualize the vascular network: Echotrace. The objective of the present work was to evaluate the reliability of Echotrace in patients with atherosclerosis of the lower limbs using arteriography as the standard for assessing sonographic findings. This prospective study was conducted in 29 consecutive patients. Nineteen strategic sites of the arterial network were investigated with duplex-scan and arteriography: lesions scores were attributed for each examination and data for a given site were compared. On the 551 sites compared, we found 26 disagreements including 23 concerning lesion quantification and 3 on localizations. There were also 21 minor disagreements with a single variation in the pathology score. The statistical comparisons could not be made on these scores so the results were compared with the arteriography data on the basis of therapeutic decision taking into account all the arterial lesions and the patient's general status. We observed a perfect agreement between the two imaging techniques in 12 patients, one disagreement which would not change the treatment in 15 patients and, in 2 patients, a disagreement which would modify treatment. This study demonstrated that graphic visualization of arterial lesions with Echotrace is a reliable, easy-to-interpret method.

Forty cases of arterial popliteal traumas occurring in the course of 1992 were collected by 20 centers. The purpose of this prospective study was to evaluate a preoperative prognosis score suggested by Crolais from a retrospective study. Five clinical criteria are taken in account to establish the score: delay, degree of ischemia, contusion, general condition of the patient and wound apperture. Each of the criteria is affected by a progressive note according to the gravity. Analysis of our series confirms the seriousness of this pathology: one death, 8 major amputations and 50% of morbidity. The statistical analysis of pre-operative score and post-operative recovery confirms the existence of three groups at progressive risk: Low risk, score < 30 points. Revascularization must be done. Post-operative recovery is simple. Average risk, score is between 31 and 50 points. Revascularization must be done. Post-operative recovery is particularly simple as the delay before revascularisation will be short and systematic fasciotomies will be done. Major risk, score > 50 points. An amputation must be carried out.

Although their frequency is probably underestimated, medullary complications of abdominal aorta surgery are rare but serious, and may be the cause of medico-legal actions. Referral of a patient allowed the collection of 26 unpublished cases: 18 with aneurysms, including 6 ruptured lesions and 12 undergoing cold surgery, and 8 with aorto-iliac occlusion, these 26 cases representing 0.16% of abdominal aorta interventions performed during the same period. Mortality (6 cases) was due principally to neurological complications, total in 4 cases, partial in 3 and persistent in 13. Risk factors were perioperative collapse (explaining the elevated frequency in ruptured aneurysms) and the occlusion of the internal iliac arteries. Duration of clamping was not significant. No certain method of prevention could be elucidated, either by a literature review or by analysis of the personal series.

Angioscopy is a useful investigation in patients referred for vascular surgery. The material has been improved over the last few years to make available angioscopes with external diameters ranging from 0.55 to 3.2 mm. The angioscopes are either rigid, composed of two groups of fibre optics (image and light transmission) or orientable and more complex. Both systems may carry operating channels. The angioscopy may be performed peroperatively or percutaneously. Other essential equipment includes catheter guides, balloon catheters, counterpulsation balloons or perfusion pumps. This investigation is used for diagnostic evaluation but when used peroperatively it may also help guide therapeutic intervention. Angioscopy is complementary to ultrasonic and radiological methods of vessel imaging.

The study of 44 patients treated with intra-arterial fibrinolysis is reported. All these patients had an impending subacute ischemia of the lower limbs, a major complication of atheromatous disease. The criteria for patient selection were clinical, hemodynamic and radiological. The procedure of the treatment associating Urokinase, Heparin and Naphthidrofluril are defined, as well as its follow-up. The results have been evaluated according to the clinical and radiological improvement. 2 patients died when the treatment ceased and 10 were amputated, ie 27% of failures. The fibrinolytic treatment allowed identifying the patients who might quickly receive an additional treatment. In our experience, this treatment seems to improve the prognosis of impending subacute ischemia.

114 patients aged over 75 underwent surgery for aneurysm of the infra-renal abdominal aorta in the University Teaching Hospitals in Nantes and Angers between 1979 and 1988. A retrospective study of these patients was performed to evaluate the immediate and long-term results. The mean age of the patients was 79 (+/- 4) years, the oldest being 94. 70% were men. Half of the patients underwent emergency or semi-emergency surgery (52 cases). Cardiovascular factors (in particular coronary insufficiency in 17% of cases) were the most common risk factors. In all cases grafting after laying open the aneurysm was performed, with an aorto-aortic graft in 32% of patients, an aorto-iliac graft in 37% or an aorto-bifemoral graft in 27% of patients. Combined intestinal revascularisation was performed in 10% of case either involving the inferior mesenteric artery or at least one internal iliac artery; renal revascularisation was performed in 3.5% of cases. 75% of patients underwent simple grafting. The mean duration of hospitalisation was 14 days (+/- 6), including a mean period of 7 days in ICU. 36 patients (31%) died in the first post-operative month. The mortality rate in patients who underwent emergency surgery for a complication of the aneurysm (essentially rupture) was 61% versus 6' for elective surgery. 96% of the patients who survived the first post-operative month were independent at the end of the study or at the time of their death.(ABSTRACT TRUNCATED AT 250 WORDS)

Injuries of the popliteal region remain a serious problem as far as the outcome is concerned. The role and the risks of revascularization have yet to be properly evaluated. It's always difficult to decide on a major amputation. A retrospective study was applied to 37 cases referred to the CHRU d'Angers, between 1976 and 1987. We were then able to establish a prognostic scale with 120 ischaemia, the contusion, the clinical context and the open wound. The scale is used before any decision and allows us to decide whether revascularization or amputation have to be performed. In this series, 2 patients (5%) eventually died; 11 (33%) underwent a major amputation and 24 (65%) were successfully revascularized. The results are analyzed in relation to the prognostic scale and the literature.

A rarely reported method for revascularization of lower limbs is the use of descending thoracic aorta and a prosthesis passing through the subpleural and subperitoneal tissues. It is nevertheless a valuable procedure in patients in good general condition in whom there is a local contraindication to the abdominal approach. It appears to be more reliable in the long term than a conventional axillofemoral shunt.

Sub-crural bypass operations on a single leg artery were analysed retrospectively with a follow-up period ranging from six months to eight years. The vitality of the limb was threatened in the majority of cases (91/96). Whenever possible (79/96) the internal saphenous vein was used as a graft, preferably by the in situ technique. Mortality was 6%. Morbidity with the exception of thromboses was 14.5%. Patency by actuarial analysis was 71.6% at 5 years and 65.8% beyond. The majority of thromboses occurred during the first few months and led, in the majority of cases, to amputation. Secondary thromboses were better tolerated. The influence of various parameters was studied: clinical stage, peroperative flowmeter results, material used, technique, associated procedure (sympathectomy), implantation site and permeable vessel.

Over the last two years, 15 patients have undergone revascularization surgery to a total of 17 distal extremities at the level of or distal to the last phalangeal joint. Operations were performed by three surgeons trained in microsurgical techniques, making the series a homogeneous one. Results were analyzed using Tamai and Nakamura's scores. Determinant factors, social and economic costs and effects on occupation are emphasized. The mean success rate of 65% is influenced by the total or partial nature of the section, its localization to the thumb or long fingers and the mechanism of section. The good functional results obtained were due to distal forms of amputation, recognized despite the technical difficulties as being an indication of choice for this reimplantation surgery. All patients in this group were able to return to work, with or without adaptation, within a variable lapse of time.

Femoro-popliteal bypass is difficult to perform when the posterior tibial artery originates at a high level in the lower limb. The problems arising from this anatomical variation, in which the tibio-peroneal trunk is, at least classically, anterior to the popliteal muscle, can be overcome by the technique described.

This case of aorto-duodenal fistula was due to fistulization of a tuberculous lymph node between an atheromatous aneurysm of the infra-renal aorta and the third part of the duodenum. CAT scan provided the diagnosis of an aorto-duodenal fistula. The tuberculous origin of the fistula was confirmed by bacteriological and histological examinations. The outcome was favourable after revascularisation "in situ" combined with epiplooplasty and prolonged antituberculous drug therapy.

The arterial vascularisation of the anterior loge of the leg is supply by the anterior tibial artery. Three muscles are contained in an inextensible space. Each of this muscles received an arterial supply proportional to his volume. The fragility to ischemy of the extensor hallucis longus is not explained by insufficiency of this arterial branches.

A rare case of thrombosis of the popliteal artery due to an exostosis of upper end of tibia is reported. It is rare for exostoses to develop at the upper metaphysial region of the tibia, rare fore vascular complications to develop and particularly rare for these to consist of thromboses. This lesion is a differential diagnosis in young adults with lower limb ischemia. Follow up of these exostoses should be by Doppler, after dynamic arteriography to serve as a reference. Surgical treatment should be adapted to the degree of functional disability and the course of the exostosis or the complications it provokes.

An anatomic study was conducted on 100 specimens. Investigation of vascularization involved various techniques to avoid pitfalls inherent in each method. Injections, radiographs, microdissection, corrosion and transillumination allowed establishment of groups to describe variations in palmar, dorsal, pulpal and ungual artery distribution. Vasculo-neural relations are described and practical applications envisaged as a function of vascular anatomy.

Crossed shunts between the two femoral axes constitute a useful safeguard in unilateral iliac occlusions when the abdominal approach is contraindicated. Hemodynamic considerations suggest the need for iliac implantation from the donor side. This simple technique does not complicate the operation and provides a more satisfactory result than the interfemoral shunt.

In the light of a case of endotheliosarcoma of the thoracic aorta, the authors found in the literature 33 cases of aortic sarcomas and 13 of sarcomas of peripheral arteries. The clinical diagnosis of this rare tumor is difficult. The diagnosis can be made before surgery only on the basis of angiographic and CT scan findings, whilst in most instances common arterial lesions are suspected whether of atheromatous or embolic origin. The positive diagnosis of arterial sarcoma remains histological. The diagnosis of an endothelial tumor can be made with the help of the techniques of factor VIII, antigen H and, more recently, lectins. Surgical treatment by excision and restoration of continuity has most often been used. Alone or in combination with chemo and/or radiotherapy, it would seem to be inadequate to prevent progression which involves the invasion of adjacent tissues, tumor emboli or generalized metastases. The prognosis of such a tumor remains gloomy with an average life expectancy of one year and 7 months, regardless of the histological type of arterial sarcoma.

The isolated azygos continuation of the inferior vena cave is a very rare variation of this organ. It is accompanied by the absence of the retrohepatic segment of the vena cava with two new observations, the literature is revised and the origin discussed.