Atherectomy may yield acceptable primary patency and limb salvage in patients with stenotic lesions. Many of the patients treated for occlusive lesions require reintervention. Based on patency and limb salvage, SIA appears superior to atherectomy for the treatment of lower extremity occlusive disease.
Vascular graft infections are associated with the potential for devastating sequelae, including hemorrhage, septicemia, amputation, and death. Graft excision and debridement of the infected bed with revascularization via an extra-anatomic site or orthotopic vein bypass has been the traditional treatment of choice. Because the morbidity of these operations is substantial, less radical graft preservation techniques are desirable, such as myoplasty, omental flap transposition, and vacuum-assisted closure therapy. We report a patient with infection involving a prosthetic graft that was treated with vacuum-assisted closure and transposition of an omental tongue to enable coverage of the exposed graft.
Mesenteric revascularization by standard methods (aortic and visceral arterial inflow or reimplantation) is associated with satisfactory patency rates. There are instances, however, where these sites may be compromised leading to the need for consideration of a novel site of origin, such as the axillary artery. A 56-year-old man presented with acute abdominal pain. He had a history of seminoma at age 16 that was treated by radical orchiectomy, retroperitoneal lymph node dissection, and external-beam radiation therapy. At age 51, bilateral iliac stents were placed for critical ischemia, and 1 year before admission, superior mesenteric arterial stenting was performed for intestinal angina. A current computed tomography scan showed extreme calcification of the abdominal aorta and visceral vessels (A) and mural thrombus of the descending thoracic aorta (B). A left axillomesenteric bypass polytetrafluoroethylene was performed bringing the graft from its normal midaxillary subcutaneous thoracic position into the retroperitoneum from just below the costal margin and then creating an end-to-side anastomosis to the superior mesenteric artery (Cover). Intraoperative duplex scan (C) showed baseline occlusion with retrograde flow, which rose to 106 cm/second antegrade flow after revascularization. The postoperative course was uneventful with relief of the mesenteric ischemic pain. Patency has been maintained at 6-month follow-up and confirmed by duplex sonography scan and MRA. This case represents the third reported in the literature. 1,2 REFERENCES 1. Sparks FC, Ramp JM, Imparato AM. Axillo-mesenteric bypass for acute mesenteric infarction. Vasc Surg 1974;8:90-4. 2. Karkos CD, McMahon GS, Markose G, Sayers RD, Naylor AR. Axillomesenteric bypass: an unusual solution to a difficult problem. J Vasc Surg 2007;45:404-7.
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