Biomedical subjects

L di Marzo

Publications and source records attributed to L di Marzo.

9 recordsLinked to original sources

PubMed1991

Surgical treatment of popliteal artery entrapment syndrome: a ten-year experience.

Popliteal artery entrapment syndrome is increasingly described in the world literature as a cause of lower limb arterial impairment. It is caused by the anomalous interrelationship between the popliteal artery and its surrounding muscular and/or tendineous structures. The first case surgically treated was reported in 1959 and since then more than 300 cases have been reported including our personal experience (31 cases in 23 patients). We have treated surgically 19 males and four females with symptoms which were moderate (cramping after intensive physical training, paraesthesia, etc.) in 14 limbs, intermittent claudication in 16 and necrosis (first toe) in one. Preoperative arteriography showed arterial occlusion in eight limbs, stenosis in eight and aneurysms in two. In 11 limbs stenosis or occlusion was only shown after active plantar hyperextension and in two arteriography was not done because surgical indications were established on the basis of a venogram positive for popliteal vein entrapment syndrome. Ten different anatomical variants were seen and the medial head of gastrocnemius muscle was involved in 74.2%. Surgical treatment consisted of division of the aberrant musculotendinous tissue in 18 cases (in two of these balloon angioplasty was also used). In 12 cases a vascular reconstruction was also required, while one case was explored without a specific procedure being warranted. Optimal results were obtained when the syndrome was treated at an early stage by simple division of musculotendinous tissue (94.4% long-term patency rate, mean follow-up 46.0 months, min 2, max 120 months). When arterial grafting was required the long-term patency rate was only 58.3% (mean follow-up 43.5 months, min 1, max 100 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Diagnosis of popliteal artery entrapment syndrome: the role of duplex scanning.

The authors present a new diagnostic procedure to quickly and noninvasively diagnose the popliteal artery entrapment syndrome. A large personal experience on the surgical treatment of such a disease (29 cases in 22 patients) allowed us to focus on the optimal diagnostic procedure useful to detect this problem at an early stage. The technique is based on continuous-wave Doppler and duplex scanning studies done both in the resting state and during active contraction of the calf muscles. If compression of the popliteal artery occurs with contraction of the calf muscles, it will be detected by a decrease in flow. This finding will also direct the radiologist to obtain films when the maneuver is repeated. This makes it unlikely that the diagnosis will be missed. Since July 1988 a total of 1212 patients were evaluated with continuous-wave Doppler for suspected chronic ischemia. From this group 41 patients were selected to be studied again with the combined continuous-wave Doppler and duplex scanning method for possible popliteal artery entrapment syndrome. Two cases were discovered and verified by dynamic angiography guided by continuous-wave Doppler and treated surgically.

Adult↗

PubMed1989

Magnetic resonance imaging of abdominal aortic grafts.

The widespread use of abdominal aortic grafting procedures and increasing awareness of related complications suggests the need for a reliable and non-invasive diagnostic technique which will allow early detection of both occlusive and non-occlusive complications. Ultrasound is generally used with satisfactory results, but has several limitations, whereas MRI has shown great promise in the study of cardiovascular disease, being non-invasive, multiplanar and multiparametric. The present research aims to evaluate MRI in the follow-up of abdominal aortic grafts, attempting to define its significance as a screening procedure in non-selected patients. MRI is reliable in ascertaining the normality of the graft as well as the complications, these being partial or total thrombosis, pseudoaneurysms and perigraft collections. The data obtained are highly satisfactory and are almost always superior to those achieved with ultrasound and CT.

Aorta, Abdominal↗

PubMed1989

Popliteal aneurysms.

A 15 year experience with 50 popliteal aneurysms in 36 patients is reviewed. Forty-seven popliteal aneurysms were atherosclerotic while three were related to entrapment of the popliteal artery. Fourteen asymptomatic popliteal aneurysms were observed preoperatively during a mean period of 26 months. Ischemic complications developed in five of these. At admission, 16 limbs were asymptomatic (group 1) while the other 34 limbs presented with ischemic symptoms (group 2). No operation was performed upon three limbs, and another two were surgically explored and amputated. No operative deaths resulted from 45 vascular reconstructions. Results from follow-up study of one to 176 months (a mean of 57 months) revealed a late patency rate of 62 per cent. The late patency rate of autologous saphenous vein (ASV) was 100 per cent; polytetrafluoroethylene (PTFE) and Dacron (polyester fiber) grafts had a patency rate of 74 and 34 per cent, respectively (ASV versus PTFE, p = N.S.; ASV versus Dacron, p less than 0.002). The rate of late salvage of limbs was 88 per cent. The bypass grafts of group 1 and those performed upon limbs with good runoff fared significantly better than others (p less than 0.05 and p less than 0.001). The risk of natural complications of popliteal aneurysms and the good results from surgical treatment suggested that a revascularization procedure in the asymptomatic stage is always recommended. The use of PTFE grafts for repair of popliteal aneurysms is justified when the ASV is not available. The use of Dacron grafts is no longer indicated.

Aged↗

PubMed1989

[Surgical treatment of aneurysms of the abdominal aorta. Consecutive experience for 12 years].

The authors present their experience with abdominal aortic aneurysm during the last 12 years. From 1976 up to now they treated 70 patients with abdominal aortic aneurysms. Sixty-seven patients (96%) were male, while 3 (4%) female. Mean age was 65 years (S.D. +/- 7.97). 82% of the patients were heavy smokers. Sixty-five patients were treated by means of resection and vascular reconstruction. Their associated pathologies were: M.I. or severe heart ischemia 34 (52.3%), diabetes 13 (20%), hypertension 25 (38.4%), T.I.A. 6 (9.2%), renal insufficiency 13 (20%), and respiratory insufficiency 18 (27.6%). Results demonstrated a 12-year patency rate of 91.8%. Five high-risk patients were treated by means of "palliative" treatment. Associated pathologies and risk factors were: smoking 5 (100%), M.I. or severe heart ischemia 5 (100%), diabetes 2 (40%), hypertension 4 (80%), T.I.A. 2 (40%), renal insufficiency 2 (40%), respiratory insufficiency 3 (60%). Treatment consisted in the sac thrombosis by means of Gianturco-Wallace coils into the aneurysm (2 cases) and iliac artery ligation (3 cases). Both techniques allowed acute thrombosis of the aneurysm. Vascular supply to the lower limbs was performed by means of an axillo-bifemoral reconstruction in all cases. Long-term prognosis of these five patients was poor due to their general condition.

Aged↗

PubMed1987

Reoperation for femoral anastomotic false aneurysm. A 15-year experience.

An experience on the surgical treatment of anastomotic false aneurysms during the last 15 years was reviewed. Fifty-nine were femoral anastomoses complicated by false aneurysm appearance requiring surgical excision. They represented 2.9% of all femoral anastomoses performed, whereas they represented 3.3% when considering reconstruction in which the femoral artery was the distal anastomosis. Reconstructions with distal anastomosis performed on the femoral artery were primarily involved (58 of 59), whereas grafts with "take off" from the femoral artery were rarely affected (p less than 0.05). A higher incidence of false aneurysm formation was demonstrated in hypertensive patients (p less than 0.05) as well as those who previously had femoral thromboendarterectomy (p less than 0.01). Infection was considered a causative factor even if it developed before (6-14 months) false aneurysm appearance. When a false aneurysm was resected, the best hemodynamic reconstruction, to avoid recurrence, was considered a bypass with distal anastomosis performed end-to-end on the femoral artery (p less than 0.05). The surgical treatment of choice was false aneurysm resection and graft interposition. However, a reanastomosis in the presence of small false aneurysms, when technically possible, has been successfully performed. Both treatments allowed good long-term results.

Aged↗

PubMed1987

Cystic adventitial degeneration of the femoral artery: is evacuation and cyst excision worthwhile as a definitive therapy?

A case of cystic adventitial degeneration of the left common femoral artery in a patient with localized left groin pain, normal distal pulses, and normal arteriographic findings is reported. This patient was first treated with evacuation and cyst excision. Recurrence was noted after 20 months, and an excision of the cyst and a segment of the common femoral artery with graft interposition was required. At gross examination, the cyst was unilocular and contained gelatinous material. The cyst appeared to be situated in the tunica adventitia and did not communicate with the vascular lumen. No synovial lining was present. Histologically, it was similar to a ganglion cyst with contents rich in hyaluronic acid. A review of the literature was undertaken to determine the results of treating this lesion. The disease is rare. All senior authors of case reports were contacted to construct follow-up information. A high incidence of recurrence was noted in patients treated by evacuation and cyst excision. We believe that total cyst excision with the involved artery and graft interposition at the femoral site can be done easily, safely, and with virtually no chance for recurrence.

Arterial Occlusive Diseases↗

PubMedDate not supplied

[Ileal diverticula: apropos of a case].

The authors report a case of abdominal aortic aneurysm surgically treated. At surgical exploration an ileal diverticulum was discovered. A 15 cm ileum tract was hyperemic and oedematous. The abdominal aortic aneurysm was resected and an aorto aortic graft implanted. The retroperitoneal space was carefully closed and then the diverticulum resected and an end-to end intestinal anastomosis performed. An etiological review of this pathology was done identifying two possible causes: true and false diverticula. The true diverticulum is a congenital lesion involving the 3 layers of the intestinal wall. On the contrary the false diverticulum is acquired and generally develops on the mesenteric site due to a pulsion mechanism. The wall involves the mucosa and serosa layers only. Diagnosis is often done during abdominal exploration for other cause (as in our case) or for complicated diverticula. Preoperative radiologic diagnosis is rare and doesn't always require surgical treatment.

Aged↗

PubMedDate not supplied

The effect of body weight compression on axillo-femoral by-pass patency.

The influence of external compression on extra-anatomic bypass patency is still debated. The specific purpose of this study is the evaluation of ankle Pressure Index (P.I.) and Pulse Volume Recorder (P.V.R.) wave amplitude changes after 5 and 10 minutes of external bypass compression by body weight, lying on the side of the reconstruction. Eight patients with axillo-femoral bypass (mean follow-up 15.5 months) have been evaluated. The external body weight compression caused important changes of graft haemodynamics: (1) decrease in ankle Pressure Index at 5 min (p less than 0.005) or 10 min (p less than 0.0005); (2) decrease in P.V.R. wave amplitude at 5 min (p less than 0.005) and 10 min (p less than 0.025).

Aged↗