Comparison of the Effectiveness of Carotid Artery Endarterectomy and Carotid Endarterectomy + Patch Plasty in Preventing Restenosis and Stroke in Carotid Artery Occlusions.

BackgroundCarotid artery stenosis is one of the most important causes of stroke, and atherosclerosis plays a role in one third of all strokes. It has been reported in some studies that the patency rate of carotid endarterectomies performed with patplasty is better than standard surgical treatment. In this retrospective study, we investigated vascular patency rates and strokes due to postoperative restenosis in patients who underwent classical carotid endarterctomy and patch plasty endarterctomy due to carotid artery stenosis.We investigated 126 patients diagnosed with carotid artery occlusion between January 2015 and January 2021. We retrospectively analyzed and compared 44 patients who were operated on using carotid endarterectomy (CAE) with patch technique and 82 patients who underwent only carotid endarterectomy in terms of risk factors, restenosis and stroke. Color Doppler Ultrasonography (CDUS) and Computed Tomographic Angiography (CTA) were used in the diagnosis of carotid artery occlusions and the evaluation of restenosis.Results:The characteristics of the risk factors of the patients were examined and recorded. PTFE graft was used as a patch in patients. There were no significant complications during or after the operation. Restenosis and stroke were investigated at the 10th day, third month, sixth month, and first year after discharge, and mostly by imaging with CDUS. Restenosis was detected in one patient in the study group and in thirteen patients in the control group. Stroke was detected in none of the patients in the study group and in four patients in the control group.Conclusion: In our clinic, patch-based CAE is preferred to primary CAE due to its successful results and very low risk of restenosis. We think that CAE with the patch is a much more effective method in protecting patients from neurological pathologies.

Inferior Vena Cava Reconstruction Using a Ringed Polytetrafluoroethylene Interposition Graft and Inferior Vena Cava Filter Placement Following Resection of Renal Cell Carcinoma With a Tumor Thrombus Directly Infiltrating the Inferior Vena Cava

Background Renal cell carcinoma (RCC) with tumor thrombus (TT) may extend into and, in rare cases, actually invade the inferior vena cava (IVC). Techniques of IVC reconstruction after removal of the RCC, TT, and infiltrated portion of the IVC have not been well documented. Methods A ringed polytetrafluoroethylene (PTFE) interposition graft along with an IVC filter placed within the graft (to prevent the development of pulmonary emboli) was used for patients who underwent surgical resection of RCC with TT extending into and directly invading the wall of the IVC. Demographic information about these patients along with their pathology reports, surgical procedures, and patency of the PTFE graft was obtained and described. Results Four male patients were identified as having RCC and TT with histologic invasion of the IVC requiring IVC dissection and replacement with a PTFE graft (as described above); their TT levels were II, IIIa, IIIc, and IV, respectively. Patient ages were 58, 65, 58, and 51 years and tumor sizes were 7.5, 7.5, 15.0, and 6.5 cm, respectively. These patients were followed for 36, 24, 32, and 48 months, respectively. At last follow-up, each patient had a patent IVC graft, and none of them developed any pulmonary emboli post-operatively. Conclusions Ringed PTFE interposition graft along with an IVC filter deployed inside the graft appears to be a safe vascular conduit for IVC reconstruction after surgical resection of RCC with TT directly invading the IVC.

Management of Post-traumatic Peripheral Arterial Pseudoaneurysm in Antananarivo

Background: Pseudoaneurysm is the usual complication of arterial injury. The aim of this study is to describe the etiology and the management of post-traumatic peripheral arterial pseudoaneurysm in Antananarivo. Methods: This is a bicentric retrospective study for 10 years period (January 2010 to December 2019), performed in Cardiovascular Unit in Joseph Ravoahangy Andrianavalona Teaching Hospital and in Vascular Unit in Soavinandriana Hospital Center, including all patient who underwent a surgical procedure of post-traumatic peripheral arterial pseudoaneurysm. Results: 38 patients were recorded in 10 years period, which 26 patients recorded in JRA hospital and 12 patients in Soavinandriana Hospital. Patients were 33 males (86.84%) and 5 females (13.15%). Gunshots wounds (47.36%) and stabs wounds (34.21%) were the commonest circumstances of etiology. Pulsatile mass (84.21%), pain (60.52%) and palpable thrill (71.05%) were the usual of peripheral pseudoaneurysm. Doppler ultrasound (94.73%) and computed tomographic angiography (13.15%) performed the diagnosis of the pseudoaneurysm. Femoral artery (39.47%) and brachial artery (31.57%) were the most involved vessels. All patients underwent an open surgery. Surgical procedures were arterial repair in 26 patients (68.42%), reversed saphenous vein interposition in 5 patients (13.15%), PTFE graft in 2 patients (5.26%) and ligation excision in 5 patients (13.15%). There was no reoperation or mortality in early postoperative period. Conclusion: Trauma is the most common etiology of pseudoaneurysm in Antananarivo. Open surgical repair remains the procedure to treat the post-traumatic peripheral arterial pseudoaneurysm in our experience.

Repair of Preduodenal Portal Vein Injury with Polytetrafluoroethylene Graft with Midgut Rotation and Left Sided Inferior Vena Cava

Preduodenal Portal Vein (PDPV) is a rare congenital anomaly. The presence of PDPV carries the risk of injury to Portal Vein (PV) during operations involving biliary duct, duodenum and pancreas. This report is about a 50-year-old female patient with PDPV associated with midgut malrotation and left sided Inferior Vena Cava (IVC). The patient was operated for Recurrent Pyogenic Cholangitis (RPC) and associated biliary stones. The patient sustained iatrogenic injury to PV during surgery which was subsequently repaired with Polytetrafluoroethylene (PTFE) graft doppler showed patent graft at three months of follow-up. This report highlights the fact that pre-existing inflammatory conditions of bile duct and hepatoduodenal ligament further increase the risk of injury to PDPV during surgery.

Descriptive cohort study of Ligation of femoral artery in infected femoral pseudoanurysm in injectable drug abuser

Background: Infected femoral pseudoanurysm with impending rupture presents most of the time in the late stage in drug abuser with features of sepsis. These cases are managed immediately by exploration with ligation of femoral artery when bypass is not feasible in emergency. Methods: This is the retrospective descriptive study of 11 years of bir hospital. Datas were collected from the record and subsequent out patient department visits of the cases having femoral infected pseudoanurysm with impending rupture with sepsis of injectable drug abuser. The data collected were patients profile, type of procedure like ligation of femoral artery, bypass like reverse long saphenous graft and synthetic dacron or ptfe graft and complications were also recorded with subsequent. The type of procedure were compared with amputation as final end point. Datas were analysed by SPSS softwear. Results: We recorded the datas of 45 patients with almost all were male with very few female having mean age of 27.91 years. Twenty two patients had seropositive status and 13 patients had negative. Thirty five patients had ligation of femoral artery,7 patients had interposition synthetic bypass graft and 3 patients had reversed long saphenous vein graft. Nine patients had undergone revision after graft failure as ligation. No complication in 20 cases .Nine cases had rethrombosis with infection, 7 had minor complication and 1 had severe claudication. Conclusions: In emergency setting, simple ligation of the femoral artery can be both life and limb saving procedure in difficult situation like infection and sepsis.

Transplant Renal Artery Stenosis Revascularization: Common Distal External Iliac Bypass

Stenosis proximal to transplant renal artery anastomoses are complications leading to allograft dysfunction. This study was aimed to evaluate a novel surgical approach to renal allograft revascularization, taking into consideration the length of time elapsed since transplantation. We describe an arterial bypass using a polytetrafluoroethylene (PTFE) graft from the common iliac artery (proximal to the renal artery implantation) to the external iliac artery (distal to the renal artery implantation) that allows the adequate revascularization of both the transplant kidney, as well as the lower extremity. This technique provides several advantages when compared with previously described procedures to revascularize a transplanted kidney with an iliac artery stenosis proximal to the allograft implantation site. Benefits of this technique include (1) no need to repair the stenosis, (2) no need to take down and redo the arterial anastomosis, (3) no need to perform a dissection around the renal hilum of the transplanted kidney, (4) no requirement to address the anastomosis transfer, and (5) no need to perfuse the kidney with preservation fluid at the time of repair and/or (6) avoidance of potential injury to the renal parenchyma and/or hilum during dissections. Adequate perfusion of the organ, as well as of the lower extremity was verified by serial Doppler duplex ultrasound evaluations. Hence, we describe a novel revascularization technique in instances of kidney transplant and lower extremity ischemia.