A patient was seen with symptomatic, rapidly expanding aneurysms that developed in both carotid arteries 4 years after bilateral radiation to the neck, left combined mandibular resection, and radical neck dissection. The presenting symptoms were pain and transient ischemic attacks of cerebrovascular insufficiency. The aneurysms were treated uneventfully be resection and vein-graft replacement at 15-day intervals. Microscopy demonstrated typical radiation changes. Effects of radiation on arteries are reviewed.
During 1968-1973, 122 patients with 126 arterial injuries were treated. In 94 instances (90 patients), these injuries involved extremities. Systolic blood pressure was below 90 mm Hg upon admission in 55.6% of all patients and 37.7% of those with injuries to arteries of the extremities. The decision for operative exploration and repair of arteries of extremities was based largely on clinical grounds (shock, loss of pulse). Preoperative arteriography was needed infrequently, while operative angiography was nearly routine. Although several cases of late revascularization or traumatic thrombosis of renal artery have been reported, hypertension complicates the postoperative period, and early, aggressive approach is essential. Mortality was 10.6%, from aortic injuries. There were no deaths among patients with arterial injuries distal to inguinal ligament or thoracic outlet. The amputation rate from reconstruction failure was 1.1%, none occurring in the last 3 years of the series. The high patency rate and lack of evidence of pulmonary embolization suggest that associated venous injuries be repaired routinely. Arterial injuries represent ideal lesions (normal arterial wall with excellent run-in and run-off). Prompt treatment of shock and early, proper management of patients' mechanical disruptions will salvage many lives and most limbs.
The outstanding angiographic features of small intestinal intussusception are: (a) abrupt disappearance of mesenteric vessels at the neck of the intussusception with crowding of the vasa recta; (b) appearance of long collateral channels at the neck of intussusception; (c) angulation and retraction of major intestinal branches; (d) reversal of the course and angulation of the invaginated mesenteric vessels; (e) overlapping of the mesentery vessels by branches of the intussuscipiens; (f) abrupt change in the appearance of the vasa rectae of the distended intussuscipiens and the distal nondistended small intestines.
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