Objective: An evaluation of the treatment of patients with venous angiodysplasia and severe chronic insufficiency. Design: The clinical series of patients with venous angiodysplasia of Klippel-Trenaunay (K-T) and Servelle-Martorell (S-M) type. Setting: Primary care teaching hospital. Patients: Eighty-three patients with angiodysplasia type K-T characterized by the triad of local giantism, varicose veins and naevus flammeus. Malformations of the deep venous system were present in 96%. The predominant vascular lesion in patients with the S-M syndrome ( n=34) was a haemangiomatosis, involving both the skeleton and soft tissues, causing growth retardation in the affected extremity. A malformation of the deep venous system could be seen in all patients. Main outcome measures: Healing of skin ulcers and varicose bleeding of the lower extremities. Interventions: Conservative treatments included external compression bandages or stockings. In 14 patients, surgical extirpation of superficial veins was used. Results: All the ulcers were treated successfully, and no haemorrhage reoccurred. Haemodynamic studies showed an improvement of the venous reflux disease in 86% of patients. Conclusion: Venous angiodysplasia of the lower extremity is nearly always associated with malformation of the deep venous system. Surgery is indicated for the elimination of a pathological short circuit flow in atypical drainage veins of the affected leg, especially when skin lesions are present. For any type of surgery, a careful preoperative angiographic and haemodynamic evaluation is mandatory.
Perigraft reaction can be defined as an aseptic biological incompatibility of synthetic vascular prostheses. The clinical picture is characterized by an indolent fluctuating swelling around the prosthesis, consisting of sterile fluid surrounded by a fibrous capsule. Since 1979, a total Of 22 perigraft reactions in 2,554 implanted vascular grafts were observed and analyzed. The incidence of this complication is about 8/1,000 both for Dacron | double-velour and expanded polytetrafluoroethylene (PTFE). Including 306 reports from the literature, prostheses in the extraanatomical position comprise nearly 75% of the material analyzed. The time interval between graft implantation and clinical manifestation is, on average, 25 months. Although the etiology is still unclear, the pathogenesis is supposed to be multifactoriah (a) there is mechanical trauma due to continuous shifting of the prosthesis in the surrounding tissue (especially in the case of extraanatomic grafts), (b) there is physicochemical irritation of the tissue bed by the graft material (velour surface, organic solvents), and (c) poor incorporation of the graft may lead to periprosthetic gap formation and fluid accumulation around the prosthesis. Infections, or immunologic or allergic causes can be excluded. Therapy includes total or partial replacement of the affected portion of the graft and cyst wall with substitution by a prosthesis of a different synthetic material. Repeated aspiration of the periprosthetic cyst should be avoided because of the high failure rate and danger of secondary infection.
A retrospective analysis of 545 patients, operated on between 1970 and 1987 for a closed or ruptured infrarenal aneurysm of the abdominal aorta (AAA), revealed an incidence of 5.1% of unilateral leg amputations among them (20 above, 8 below the knee) during the Second World War. Patients in both groups (with or without amputation) had one or more arteriosclerotic risk factors, their frequency rising with increasing age. There were differences between the two groups in the frequency of certain morphological characteristics in the area of the bifurcation and the terminal aorta affecting the haemodynamics of these regions. Stenosis or occlusion of the ipsilateral iliac arteries may be a possible pathogenetic factor. A prospective study will be required to decide whether the coincidence between leg amputation and AAA is pathogenetic or accidental.
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