SURGICAL MANAGEMENT OF MULTIPLE INSTENT RESTENOSIS WITH CORONARY ENDARTERECTOMY AND STENTECTOMY

In-stent restenosis remain the most important problem of coronary stent implantation. The number of patients with in-stent restenosis of coronary arteries is increasing in the practice of heart surgeons. We report a successful treatment of a patient with multiple in-stent restenosis of coronary arteries. LAD was treated with long arteriotomy of about 8 sm followed by open coronary endarteriectomy and stentectomy. The arteriotomy was then reconstructed with a venous patch and distal anastomosis with the LIMA then performed. The patient’s postoperative period was uncomplicated. At a 6-month followup examination, the patient is doing well and is asymptomatic. Combined open endarterectomy and stentectomy appears to be an effective alternative surgical treatment of FMJ-LAD and multiple intra-stent restenoses and gives a chance of full revascularization for such patients. Key words: Surgical management, coronary endarterectomy, stentectomy, arteriotomy, patient, FMJ-LAD

Surgical technique for venous patch aneurysms with no neck in a rabbit model

BackgroundAnimal experimental studies are crucial for the development of endovascular devices and embolization techniques for intracranial aneurysms. The aim of the study was to describe the surgical creation technique for an aneurysm with a dilated shape and no definable aneurysm neck. The model should be reproducible in size and shape and stay patent over a long period of time. It should constitute a challenge to endovascular therapy and provide a valuable testing environment for new endovascular devices and techniques.MethodsSurgical creation of 30 no-neck aneurysms was attempted in 15 New Zealand White rabbits using a segment of jugular vein, which was transected, longitudinally opened and sutured to the anterior aspect of the common carotid artery. The first 14 aneurysms were used to develop the technique. Once the technique was mastered and the procedure was standardized, 16 consecutive aneurysms were created. For these aneurysms, digital subtraction angiography was employed after a mean of 120 days to confirm size and patency. All aneurysms were evaluated for patency.ResultsOverall aneurysm patency was 93%. Three complications occurred, two of which were related to the vascular anastomosis. Angiographic follow-up showed a median (SD) aneurysm base and height of 6.7 (0.76) mm and 3.2 (0.85) mm), respectively.ConclusionsThis technique allows creation of aneurysms without a neck which are reproducible in size and shape, and which remain patent. The model contributes to the list of aneurysm models fit for evaluation of embolization devices and techniques. It is particularly useful in exploring treatment options for wide-neck aneurysms and aneurysms which presently do not qualify for conventional coiling.

Acute Thrombotic Occlusion of the Popliteal Artery following Knee Dislocation: A Case Report of Management, Local Unit Practice, and a Review of the Literature

Arterial complications following traumatic knee injury are relatively rare but mandate timely recognition and treatment to avoid significant comorbidity and medicolegal ramifications. In this report we describe a case of acute thrombotic occlusion of the popliteal artery occurring after knee dislocation, successfully repaired by intimal fixation and a limited venous patch reconstruction. We present a review of local practice in screening vascular injuries following knee dislocation, aligned with a review of the literature and considerations for practice.

Surgical repair of an extracranial carotid aneurysm

Aneurysms of the supra-aortic trunks are rare conditions that can cause peripheral neurological conditions or embolization resulting in stroke. The upper airways can even be affected and rupture is potentially fatal. We present a case of a patient with an aneurysm of the carotid bifurcation who was treated conventionally with reconstruction of the carotid bifurcation using a venous patch. Surgical treatment enabled accurate histopathological diagnosis and anatomic correction of the carotid bifurcation.

Long-term outcomes of surgical treatment in patients with popliteal artery entrapment syndrome

The object of the study is to determine the long-term outcomes of surgical treatment of patients with popliteal artery entrapment syndrome at a single institute. We retrospectively reviewed 19 limbs of 16 consecutive patients who underwent surgery for popliteal artery entrapment syndrome at our hospital over the past 36 years. The popliteal artery was stenotic in 11 limbs, occlusive in 7 limbs, and compressed and deviated by the medial head of the gastrocnemius muscle but not damaged in 1 limb. Six limbs were treated with autologous saphenous vein bypass, 10 with bypass or venous patch graft concomitant with musculotendinous section, and 3 limbs underwent musculotendinous section alone. The 10-year cumulative patency of the 13 limbs treated with bypass was 100%, although two of them showed occlusion at 23 and 12 years after surgery. One patient who received a venous patch graft showed occlusion 15 years after surgery. Additionally, one asymptomatic patient with an apparently non-damaged popliteal artery who received preventive musculotendinous section alone showed stenosis of the artery 2 years after musculotendinous section. In conclusion, the bypass patency observed in this study was excellent in the long term. Careful examination of popliteal artery anatomy using imaging studies is essential for selecting the appropriate surgical procedure for popliteal artery entrapment syndrome.