In this study, we describe our diagnosis and treatment of two patients who presented with femoral vessel compression caused by a cystic lesion in the groin. One case was diagnosed as adventitial cystic disease (ACD) of the common femoral artery resulting in leg claudication and the other was diagnosed as a ganglion cyst (GC) causing femoral vein compression and unilateral leg swelling. The operative findings differed between these two cases with respect to the dissection of the cyst and femoral vessel, but the postoperative histological examination results were similar. The pathogenesis of ACD and GC is not fully understood, and further investigation is needed to delineate the exact pathology of these uncommon conditions.
Adventitia ; Diagnosis ; Femoral Artery ; Femoral Vein ; Ganglion Cysts ; Groin* ; Hip ; Humans ; Leg ; Pathology

OBJECTIVETo assess the clinical efficacy of retrograde puncture subintimal angioplasty (SIA) for treatment of occlusive diseases in the long segment of the infrapopliteal artery.

METHODSThe clinical data of 50 patients with occlusive diseases in the long segment of the infrapopliteal artery were retrospectively analyzed. The patients were divided into control group (n=25) and study group (n=25) and received antegrade SIA and retrograde puncture SIA with long balloon after the failed antegrade SIA, respectively. The ankle brachial index (ABI) and the temperature of the infrapopliteal skin before and after the operation were compared between the two groups.

RESULTSThe technical success rate was 100% in the 50 patients, who showed obviously improved ischemic symptoms without serious complications. The ABI of the study group increased from 0.31 ± 0.12 before the treatment to 0.47 ± 0.09 at 24 h, 0.56 ± 0.06 at 1 week, 0.63 ± 0.07 at 3 months, 0.58 ± 0.06 at 6 months, and 0.49 ± 0.03 at 12 months after the treatment, and the skin temperature increased from 28.13 ± 2.45 before the operation to 33.87 ± 1.24, 34.16 ± 0.44, 34.19 ± 0.25, 32.45 ± 0.25, and 31.05 ± 0.21 at the corresponding time points after the treatment, respectively, showing significant improvements after the operation (P<0.05). ABI, skin temperature and the patency rate were similar between the two groups at each of the postoperative time points (P>0.05).

CONCLUSIONRetrograde puncture SIA is safe and effective for treatment of arteriosclerosis obliterans in the infrapopliteal arteries with a high clinical success rate and a low complication rate after the failure of antegrade SIA.

Angioplasty ; Ankle Brachial Index ; Arterial Occlusive Diseases ; surgery ; Femoral Artery ; pathology ; Humans ; Popliteal Artery ; pathology ; Retrospective Studies

Morphologic features and pathogenesis of arterial changes occurring in Buerger's disease (thromboangiitis obliterans) are still controversial. This study describes histopathologic features of medium sized arteries from patients with Buerger's disease, particularly of the internal elastic lamina in relation to the immunologic mechanism of the injury. Seventeen segments of occluded arteries (femoral or popliteal arteries) from 17 patients with Buerger's disease were analyzed by histopathological and immunohistochemical methods. The most characteristic features were total luminal obliteration, together with a varying degree of recanalization and deposition of hemosiderin pigments. Detailed analysis, however, showed marked undulation and multiplication of the internal elastic lamina (100%) associated with basophilic degeneration and delicate linear calcification (47%). Lymphocytic infiltration along the internal elastic lamina was seen in 71% and was associated with localized edema. Lymphocytes along the lamina were consistently positive for T cell marker. Mild to moderate fibrosis was present at the media in 24%. Adventitial changes included mild, nonspecific and irregular fibrosis seen in 53%. Immunologic injury to the internal elastic lamina associated with T-lymphocytic infiltration might be the initial morphogenetic mechanism of the thrombotic occlusion and organization of medium-sized arteries in Buerger's disease.
Adult ; B-Lymphocytes/pathology ; Elastic Tissue/pathology ; Elastic Tissue/immunology ; Female ; Femoral Artery/pathology* ; Femoral Artery/immunology ; Femoral Artery/anatomy & histology ; Fibrosis ; Human ; Male ; Middle Age ; Popliteal Artery/pathology* ; Popliteal Artery/immunology ; Popliteal Artery/anatomy & histology ; T-Lymphocytes/pathology ; Thromboangiitis Obliterans/pathology* ; Thromboangiitis Obliterans/immunology

Adult ; Aneurysm, False ; therapy ; Catheterization ; methods ; Femoral Artery ; pathology ; Hemostasis ; Humans ; Male

OBJECTIVETo compared 3 approaches to establishing Balb/c mouse models of hind-limb ischemia suitable for studies of regenerative medicine.

METHODSThirty eight-week-old male Balb/c mice were randomly divided into 3 groups for establishing models of hind-limb ischemia by both ligating and transecting the femoral artery proximal to the origin of the deep femoral artery branch, ligating the femoral artery proximal to the origin of the deep femoral artery branch, or ligating the femoral artery distal to the femoral artery trunk. The mice were continuously observed for 5 days after the operation, and hind-limb blood perfusion was monitored by laser Doppler imaging on the second postoperative day.

RESULTSAll the 3 surgical approaches caused blood flow block in the hind-limbs of the mice. In mice with ligation and transaction of the femoral artery proximal to the origin of the deep femoral artery branch, dry gangrene occurred in the whole hind-limb. Dry gangrene also occurred in the legs and paws of mice with ligation of the femoral artery proximal to the origin of the deep femoral artery branch. In mice with femoral artery ligation distal to the origin of the deep femoral artery branch, the sole of the foot was dry with scaling skin and necrosis of several digits; microscopically examination revealed a large quantity of necrotic muscles accompanied by muscle regeneration.

CONCLUSIONLigating the femoral artery distal to the origin of the deep femoral artery branch can be optimal for establishing Balb/c mouse models of hind-limb ischemia.

Animals ; Disease Models, Animal ; Femoral Artery ; Hindlimb ; pathology ; Ischemia ; Male ; Mice ; Mice, Inbred BALB C ; Necrosis

BACKGROUNDThe methods for the treatment of postcatheterization femoral arteriovenous fistulas (AVF-s) - simple observation, ultrasound guided compression, covered stents implantation and coil embolization have poor outcome. Surgery is the standard method for treatment of femoral AVFs, but it is a traumatic operation. In this study, we report the results of the treatment of postcatheterization femoral AVFs by simple prolonged compressing bandage.

METHODSTo treat iatrogenic femoral AVFs caused by transfemoral catheterization, prolonged binding with elastic or common bandage was applied in 16 cases. Catheterization was performed in 7 cases for radiofrequency current catheter ablation, in 4 for occlusion of congenital heart disease, in 3 for percutaneous coronary intervention, in 1 for coronary angiography and in 1 for right heart catheterization.

RESULTSAll iatrogenic femoral AVFs were healed after simple binding with elastic or common bandage for 4 - 46 days (mean (15 +/- 10) days). During the period of binding, local skins ulceration occurred at puncture site in two cases and femoral vein thrombus was found in one patient. During 6 - 24 months (mean (11.8 +/- 3.6) months) followup with colour Doppler ultrasonography, no recurrent arteriovenous shunting or other complications were observed.

CONCLUSIONThe results suggest that simple prolonged bandaging for postcatheterization femoral AVFs is an effective and economical procedure.

Adolescent ; Adult ; Aged ; Arteriovenous Fistula ; etiology ; therapy ; Bandages ; Catheterization, Peripheral ; adverse effects ; Female ; Femoral Artery ; pathology ; Femoral Vein ; pathology ; Humans ; Male ; Middle Aged

OBJECTIVETo observe the urokinase receptor (uPAR) expression in atherosclerotic plaques of human femoral arteries.

METHODSHuman femoral artery samples were collected from patients underwent femoral endarterectomy. Normal internal mammary artery samples were taken from bypass surgery served as control. uPAR protein distribution at shoulders, lipid pool and rupture sites of a plaque and the association with macrophages and smooth muscle cells (SMCs) were detected by immunohistochemistry methods.

RESULTSThere was no uPAR expression in intima or tunica media of normal internal mammary arteries. In atherosclerotic lesions of femoral artery, the mean optical density (A) of uPAR was 92 +/- 37 in intima and 46 +/- 28 in tunica media (P < 0.05). The intimal uPAR was coexisted with macrophages and SMCs. uPAR expression was observed at plaque shoulders and lipid pool, while the maximal expression was found at rupture sites.

CONCLUSIONThe increased expression of uPAR in atherosclerotic lesion and uPAR distribution at shoulders, lipid pool, as well as rupture sites of plaques suggest a role of uPAR in plaque rupture process.

Atherosclerosis ; metabolism ; pathology ; Endarterectomy ; Femoral Artery ; pathology ; Humans ; Receptors, Urokinase Plasminogen Activator ; metabolism ; Urokinase-Type Plasminogen Activator ; metabolism

BACKGROUND: The femoral artery is the most common site of cannulation for cardiopulmonary bypass in surgery for type A aortic dissection. Recently, many surgeons prefer the axillary artery to the femoral artery as the arterial cannulation site for several benefits. We evaluated the safety and usefulness of axillary artery cannulation in surgery for acute type A aortic dissection. MATERIAL AND METHOD: Between Oct. 1995 and Sep. 2001, 71 patients underwent operations for acute type A aortic dissection. The arterial cannula was inserted into the axillary artery in 31 patients (AXILLARY group, mean age=56), and into the femoral artery in 40 patients (FEMORAL group, mean age=57). We retrospectively compared the incidence of mortality, morbidities, and hospital course. RESULT: The mean duration of cardiopulmonary bypass and circulatory arrest were significantly shorter in the AXILLARY group (207 min and 39min, respectively) than in the FEMORAL group (263 min and 49 min, respectively; p<0.05). Postoperative hospital stay was significantly shorter in the AXILLARY group than in the FEMORAL group (mean 15 days vs. 35 days, p<0.05). Although there was no difference in the incidence of new-onset permanent neurological dysfunction (3.2% in the AXILLARY group, 2.5% in the FEMORAL group), the incidence of transient neurological dysfunction was significantly lower in the AXILLARY group (12.9% vs. 25%, p<0.05). In the FEMORAL group, two patients needed urgent conversion to cannulation site due to arch vessel malperfusion. In the AXILLARY group, there was only one patient who had a complication related to the cannulation, i.e., median nerve injury. CONCLUSION: Axillary artery cannulation was safe and helpful in decreasing the cerebral ischemic time and incidence of transient neuroligcal dysfunction in surgery for acute type A aortic dissection. It enabled us to approach the patients with aortic arch pathology more aggressively.
Aneurysm, Dissecting ; Aorta, Thoracic ; Axillary Artery* ; Cardiopulmonary Bypass ; Catheterization* ; Catheters ; Femoral Artery ; Humans ; Incidence ; Length of Stay ; Median Nerve ; Mortality ; Pathology ; Retrospective Studies

The use of ultrasonography and especially of contrast-enhanced ultrasonography (CEUS) in the diagnosis of vascular pathologies before and after interventions has significantly increased over the past years due to the broader availability of modern ultrasound systems with CEUS capabilities and more trained user experience in this imaging modality. For the preinterventional and postinterventional work-up of carotid diseases, duplex ultrasound as well as CEUS have been established as the standard-of-care examination procedures for diagnosis, evaluation, and follow-up. In addition to its use for carotid arterial diseases, ultrasonography has also become the primary modality for the screening of vascular pathologies. This review describes the most common pathologies found in ultrasonography of the carotid arteries, the abdominal aorta, and the femoral arteries.
Aorta, Abdominal ; Arteriovenous Fistula ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Stenosis ; Contrast Media ; Diagnosis ; Femoral Artery ; Follow-Up Studies ; Mass Screening ; Pathology ; Plaque, Atherosclerotic ; Ultrasonography*

The search for a new flap with minimal donor morbidity has been pursued by many plastic surgeons. Numerous donor sites available for microsurgical composite tissue transplantation have been described owing to the tremendous advances made in the field of microsurgery. To be suifable for use as a free flap, a sizable vessel must be included within the tissue, leading to significant donor morbidity. There have been studies for prefabrication of an axial pattern flap in an effort to create a new flap, but most of these methods relied solely on revascularization of a preexisting composite tissue. Our experiment, using an isolated femoral artery and vein as the main pedicle, led to formation of a capsule flap through a normal foreign body reaction between 2 silastic sheet implants. On this induced capsule flap, a skin graft was performed and a total of 40 axial pattern capsulo-cutaneous flaps from 20 Sprague-Dawley rats were successfully obtained after nearly 12 weeks through 4 stages of experiment, including a delay procedure at the second stage. Pathology revealed neovascularization, and abundantly impregnated vascular structures near the pedicle were observed along with random pattern collagen fibers. The skin graft took 100% on this newlyformed axial pattern capsular flap and thus implied that the capsule structure was able to survive on it`s own and was able to support skin grafts. This new flap using only the isolated artery and vein structure can be induced according to various needs with minimal donor morbidity.
Arteries ; Collagen ; Femoral Artery ; Foreign-Body Reaction ; Free Tissue Flaps ; Humans ; Microsurgery ; Pathology ; Rats, Sprague-Dawley ; Skin ; Tissue Donors ; Tissue Transplantation ; Transplants ; Veins