PURPOSE: A prosthetic graft infection is a rare but often disastrous complication during vascular surgery. Diagnosis of a prosthetic graft infection is not always easy, particularly with a low virulent bacterial infection or in a deeply placed graft in the retroperitoneal space. Recently, fludeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has been proposed as a diagnostic modality for prosthetic graft infection. However, some reports have indicated that high FDG uptake occur in grafts without infections. This study analyzed FDG uptake patterns in prosthetic grafts of asymptomatic patients. METHODS: We reviewed 14,545 patients who had received PET/CT in a tertiary hospital between July 2007 and March 2010. Of them, 11 patients who had undergone previous bypass surgery with a prosthetic graft were identified. Four underwent an aortic bypass and the others received lower extremity bypass grafting. PET/CT images and patient clinical data were reviewed retrospectively. The maximum standardized uptake value (SUVmax, A) in the graft, the mean SUV (SUVmean, B) of the blood-pool, and the target-to-background ratio (T/B, A/B) were calculated. RESULTS: The mean duration between bypass grafting and the PET/CT scan was 21 months (range, 1~80 months). No clinical evidence of graft infection was observed in any of the patients. PET/CT revealed an uneven, diffuse FDG uptake pattern on the grafts, and the mean T/B was 2.0 (range, 0.9~4.6). T/B was greater than 2.0 in six patients (55%). CONCLUSION: A prosthetic graft without an infection can result in increased FDG uptake during PET/CT. A further prospective study is necessary to evaluate the usefulness of FDG PET/CT for diagnosing a prosthetic graft infection.
Bacterial Infections ; Electrons ; Humans ; Lower Extremity ; Positron-Emission Tomography ; Retroperitoneal Space ; Retrospective Studies ; Tertiary Care Centers ; Transplants

Intimal hyperplasia is a feature of the normal adaptive response of vessels to hemodynamic stresses as well as a characteristic of the healing of vessel injuries. The events leading to intimal hyperplasia formation involve numerous cellular and molecular components. Various cellular elements of the vessel wall are involved as are leucocyte-endothelial interactions that trigger the coagulation cascade leading to localized thrombus formation. Subsequent phenotypic modification of the medial smooth muscle cells and their intimal migration is the basis of the lesion formation that is thought to be propagated by an immune-mediated reaction. Intimal hyperplasia in the region of endarterectomy, balloon angioplasty, and vascular bypass graft anastomosis is a major problem of long-term failure of vascular reconstruction. The underlying causes of intimal hyperplasia are proliferation and migration of vascular smooth muscle cells provoked by injury, inflammation, and stretch. This review discusses the cellular and molecular mechanisms in the pathophysiology of intimal hyperplasia, and the different anastomosing techniques to improve the patency of peripheral arterial bypass.
Angioplasty, Balloon ; Arteriosclerosis ; Endarterectomy ; Glycosaminoglycans ; Hemodynamics ; Hyperplasia ; Inflammation ; Muscle, Smooth, Vascular ; Myocytes, Smooth Muscle ; Thrombosis ; Transplants

The management of abdominal aortic aneurysms has dramatically changed since the endovascular aneurysm repair (EVAR) procedure was introduced in 1991 for the treatment of abdominal aortic aneurysm (AAA). EVAR is a less invasive alternative as compared to conventional open repair for abdominal aortic aneurysms. The use of EVAR has increased and is used in fit patients provided that they are regarded as anatomically suitable for a device. Endovascular repair has been shown to decrease the early mortality rate, shorten the hospital stay and decrease blood loss. However, EVAR has a higher rate of graft-related complications and fewer systemic complications. So, the patients who are treated by EVAR need close follow up and diligent graft surveillance. This review of endovascular complications will help physicians gain a thorough understanding of the complications and appropriate managements strategies of AAA.
Aneurysm ; Aortic Aneurysm, Abdominal ; Follow-Up Studies ; Humans ; Length of Stay ; Transplants

No abstract available.
Ischemia*

For the patients with chronic mesenteric ischemia, various surgical procedures can be performed to reestablish mesenteric blood flow. Recently endovascular procedure are also tried in selected patients. But there still exist debates on which procedure is easier and safer to perform and more endurable for this uncommon arterial lesion. We will discuss here the indications for treatment, the merits and demerits of vairous mesenteric revascularization procedures.
Endovascular Procedures ; Humans ; Ischemia*

No abstract available.
Ischemia* ; Mesenteric Veins* ; Thrombosis*

No abstract available.
Ischemia*

No abstract available.
Diagnosis* ; Ischemia*

Acute aortic occlusion is rare but poses a high mortality and morbidity. Prompt diagnosis and treatment is essential. Typical presentation is rest pain with bilateral absent femoral pulse. When the non-typical symptoms predominate such as paraplegia, acute abdomen or sudden-onset hypertension, diagnosis may be difficult. We experienced a case of acute aortic thrombosis who suddenly developed paraplegia and rapidly deteriorated within several hours. When the paraplegia developed, he was under treatment with heparin and urokinase, was thrombocytopenic, and the femoral arteries were pulsatile. Spinal cord compression due to bleeding complication had to be ruled out. Duplex sonography and lumbar CT scan were not diagnostic. Aortic thrombosis was diagnosed by abdominal CT scan. This case illustrates the need for high suspicion of acute aortic occlusion presenting with paraplegia especially in patients with associated atherosclerotic disease.
Abdomen, Acute ; Aorta ; Diagnosis ; Femoral Artery ; Hemorrhage ; Heparin ; Humans ; Hypertension ; Mortality ; Paraplegia* ; Spinal Cord Compression ; Thrombosis* ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator

Isolated true atherosclerotic aneurysm of the distal superficial femoral artery is rare disease. We experienced a case of distal superficial femoral artery aneurysm not associated with dilatation of the common femoral or popliteal artery. True arterial aneurysms are attributed to the weakening of the arterial wall due to atherosclerosis. True superficial femoral artery aneurysms were predominantly founded in elderly men and used to be diagnosed by ultrasonography, CT or angiogram. We report a case of distal superficial femoral arterial aneurysmal rupture in elderly woman who has a rheumatoid athritis and diagnosed by ultrasonography. We performed aneurysmal excision and interposition graft with PTFE.
Aged ; Aneurysm* ; Arteries ; Arthritis, Rheumatoid* ; Atherosclerosis ; Dilatation ; Female ; Femoral Artery ; Humans ; Male ; Polytetrafluoroethylene ; Popliteal Artery ; Rare Diseases ; Rupture* ; Transplants ; Ultrasonography