Two patients had inferior epigastric artery pseudoaneurysms after therapeutic paracentesis for ascites caused by portal hypertension. The first patient, a 62-year-old man, had a two-week history of left lower quadrant pain, tenderness, and nonpulsatile mass after a paracentesis for ascites. A left inferior epigastric artery pseudoaneurysm measuring 10 cm in diameter and 20 cm in length was diagnosed by means of Duplex ultrasound and arteriography. The patient was treated with percutaneous embolization, with successful thrombosis of the pseudoaneurysm. The second patient, a 33-year-old woman, had a six-week history of left lower quadrant pain, tenderness, and nonpulsatile mass after a paracentesis for ascites. Computerized tomography and arteriography showed a left inferior epigastric artery pseudoaneurysm, measuring 7 cm in diameter and 9 cm in length. The patient was treated with percutaneous embolization with successful thrombosis of the pseudoaneurysm. Both patients were discharged in good condition 2 days after embolization. Inferior epigastric artery pseudoaneurysm is a complication of paracentesis, and percutaneous embolization may be preferable to surgical repair in patients with chronic liver failure and portal hypertension.
In this study, the presence of APL in patients undergoing lower extremity bypass operations was a significant independent risk factor for progression of LEAOD. We conclude that this patient group should be closely monitored in the postoperative period and appears ideally suited for prospective studies of therapies to modify LEAOD progression.
A proximal AIB anastomosis located directly on the PI is an independent risk factor for decreased AIB patency of equal or greater importance than current smoking, hypertension, or PI occlusion. The proximal anastomosis of an AIB in a patient with an ipsilateral PI should be placed on a distal native artery.
Chronic venous ulcers are a common medical problem that have a dramatic medical, economic, and psychosocial impact on patients. Nonoperative therapy has been proven to be effective in controlling the symproms of chronic venous insufficiency and promoting healing of chronic venous leg ulcers. The mainstays of nonoperative treatment continue to be leg elevation and compression therapy. Recently, bioengineered skin substitutes, ranging from an epidermal or dermal layer to a bilayered living skin construct, have been developed to aid in local wound healing and represent an added nonoperative treatment option for venous ulcers.
Keywords Venous ulcer, nonoperative treatment, skin substitutesChronic venous leg ulcers are a major and costly medical problem affecting an estimated 600,000 patients in the United States. 1 In addition, chronic leg ulcers carry significant negative physical, financial, and psychological implications. In a recent quality-of-life study, 65% of chronic leg ulcer patients had severe pain, 81% had decreased mobility, and 100% experienced a negative impact of their disease on their work capacity. 2 The socioeconomic impact of chronic venous leg ulcers is staggering, with an estimated 2 million workdays lost per year. 3 69
The rate of performance of carotid endarterecto-Corporation suggested that 32% of 1,302 carotid my, as well as any other surgical procedure, endarterectomies were performed for inapproprishould be closely linked to data concerning effi-ate indications with an operative mortality of cacy and complications. In the mid-1980s, carotid 3.4% and a perioperative stroke rate of 6.4%.3 endarterectomy had become one of the most Prominent neurologists seriously questioned the commonly performed operations in the United efficacy of carotid endarterectomy4 and fewer opStates. Enthusiasm was fueled by reports of im-erations were performed. proved neurologic outcome after carotid endSeveral prospective, randomized trials of arterectomy for patients with both symptomatic carotid endarterectomy versus medical manageand asymptomatic carotid stenosis.1,2 These stud-ment were begun in the mid to late 1980s. The ies, however, while presumably honestly analyzed results of these studies are now widely known and reported, were not prospective or random-and have unequivocally demonstrated the superiized and therefore were potentially subject to ob-ority of carotid endarterectomy over medical therserver bias. An influential report by the Rand apy for certain subgroups of patients. The details
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