Aortoesophageal fistula (AEF) is a rare but fatal complication caused by foreign body ingestion. Aortic replacement and endovascular stent graft are the common repair surgeries. The materials to repair an aortic defect in AEF are typically homograft or allograft, but the use of an autologous pericardium patch is rarely reported. Here we reported a patient with AEF and severe mediastinal infection induced by chicken bone ingestion. In this case, the autologous pericardium patch was used as the repair material.
Aorta ; injuries ; surgery ; Aortic Diseases ; etiology ; surgery ; Autografts ; transplantation ; Esophageal Fistula ; etiology ; surgery ; Foreign Bodies ; complications ; Gastrointestinal Hemorrhage ; etiology ; surgery ; Humans ; Mediastinal Diseases ; surgery ; Pericardium ; transplantation ; Stents ; Transplantation, Autologous ; methods ; Vascular Fistula ; etiology ; surgery ; Vascular Grafting ; methods

Severe portal vein thrombosis (PVT) is often considered a relative contraindication for living donor liver transplantation due to high associated risks and morbidity. Meanwhile, improvement in operative techniques, resulting in higher success rates has removed PVT from the list of contraindications in deceased donor liver transplantation (DDLT). In this report, we describe a surgical technique for DDLT using polytetrafluoroethylene graft from the inferior mesenteric vein for portal inflow in patient with portomesenteric thrombosis.
End Stage Liver Disease/complications/*surgery ; Humans ; Liver Transplantation/*methods ; Male ; Mesenteric Veins/surgery ; Middle Aged ; Polytetrafluoroethylene ; Portal Vein/*surgery ; Tissue Donors ; Treatment Outcome ; Ultrasonography, Doppler ; *Vascular Grafting ; Venous Thrombosis/etiology/*surgery/ultrasonography

OBJECTIVETo evaluate the surgical techniques for acute left deep venous thrombosis (LDVT) secondary to left iliac vein compression syndrome (IVCS).

METHODSThirty-six patients with acute LDVT secondary to IVCS received inferior vena cava filter placement, and in 2 of the cases, stent implantation was canceled for acute episode of obsolete DVT. The remaining 34 patients underwent left femoral venotomy for iliofemoral thrombectomy with Fogarty catheter and distal femoral vein thrombus removal by sequential compression of the legs, followed by implantation of stent-graft (2 cases) or bare-metal stents (32 cases) in the left common iliac veins. With routine anticoagulation and thrombolytic treatments, the patients were regularly examined for postoperative blood flow in the affected limb.

RESULTSIn 2 of the cases undergoing bare-metal stent implantation, the residue thrombi were squeezed into the stent by balloon, which was managed subsequently with local thrombolysis. One patient with bare-metal stent implantation received a secondary stenting for posterior stent displacement. Three patients had self-limited bleeding due to decreased serum FBG. Significant improvements were achieved at 3, 6, 30 and 180 days postoperatively in the circumferences of the affected limb (P<0.05) and in the levels of D-dimer (P=0.011), and FBG level showed no significant variations (F=1.163, P=0.345). The total rate of excellent outcomes was 83.3% (26/34) with a total effective rate of 91.2% (31/34) in these cases.

CONCLUSIONSThrombectomy to revascularize the inflow tract and stent implantation to enlarge stenosed iliac veins are key issues in treatment of acute LDVT secondary to IVCS.

Femoral Vein ; surgery ; Humans ; Leg ; pathology ; May-Thurner Syndrome ; complications ; surgery ; Stents ; Thrombectomy ; Vascular Grafting ; Venous Thrombosis ; etiology ; surgery

Arterial thoracic outlet syndrome (TOS) causes ischemic symptoms; it is the rarest type, occurring in 5% of all TOS cases. This paper is a case report of a 38-year-old male patient diagnosed with arterial TOS, displaying symptoms of acute critical limb ischemia caused by thromboembolism. Brachial artery of the patient has been diffusely damaged by repeated occurrence of thromboembolism. It was thought to be not enough only decompression of subclavian artery to relieve the symptoms of hand ischemia; therefore, bypass surgery using reversed great saphenous vein was performed.
Adult ; Brachial Artery ; Decompression ; Extremities ; Hand ; Humans ; Ischemia ; Male ; Saphenous Vein ; Subclavian Artery ; Thoracic Outlet Syndrome* ; Thromboembolism ; Vascular Grafting

OBJECTIVETo analyze the trends in treatments of lower extremity peripheral arterial disease and their prognosis in the recent 10 years.

METHODSClinical data of inpatients with lower extremity peripheral arterial disease who received surgical treatments in Xuanwu Hospital from January 2002 to December 2011 were analyzed retrospectively. Patients were stratified into two groups (group 1: from 2002 to 2006, group 2: from 2007 to 2011). The demographics, risk factors, clinical presentation, lesion anatomy, therapies, limb salvage and survival were observed. χ(2) test, Fisher exact test, and t test were used to compare the data between the two groups.

RESULTSFrom 2002 to 2006, 170 limbs (47.49%) underwent conventional bypass surgery, 72 limbs (20.11%) underwent endovascular interventions and the rest 116 limbs (32.40%) received stem cell treatment. While from 2007 to 2011, the percentages were 18.49%, 68.73%, 8.27%, respectively. Furthermore, gene-based drug appeared, 67 limbs (4.51%) underwent the new treatment. Former group had decreased limb salvage rates compared with latter group (87.15% vs. 93.41%, χ(2)=15.71, P=0.000). However, survival rates did not differ from the two groups (84.67% vs. 84.31%, χ(2)=0.02, P=0.880).

CONCLUSIONWith the appearance of new medical instruments and operating methods, the percentage of the patients with lower extremity peripheral arterial disease receive endovascular interventions increases, with a improved limb salvage rates.

Humans ; Ischemia ; Limb Salvage ; Lower Extremity ; pathology ; Peripheral Arterial Disease ; diagnosis ; surgery ; therapy ; Prognosis ; Retrospective Studies ; Risk Factors ; Stem Cell Transplantation ; Survival Rate ; Treatment Outcome ; Vascular Grafting ; Vascular Patency

This study evaluated the outcomes of off-pump coronary artery bypass surgery (OPCAB) with severe left ventricular dysfunction using composite bilateral internal thoracic artery grafting. From January 2001 to December 2008, 1,842 patients underwent primary isolated OPCAB with composite bilateral internal thoracic artery grafting. A total of 131 of these patients were diagnosed with a severely depressed preoperative left ventricle ejection fraction (LVEF) (< or =0.35). These patient outcomes were compared with the outcomes of 830 patients that had mildly or moderately depressed LVEF (0.36 to 0.59) and 881 patients with normal LVEF (>0.6). The early mortality for patients with severe LVEF was 2.3%. The 3-yr and 7-yr survival rate for patients with severe LV dysfunction was 86.0% and 82.8%, respectively. Multivariate analysis showed that severe LV dysfunction EF increased the risk of all-cause death (P=0.012; hazard ratio [HR],2.14; 95% confidence interval [CI],1.19-3.88) and the risk of cardiac-related death (P=0.008; HR,3.38; 95% CI, 1.37-8.341). The study identified positive surgical outcomes of OPCAB, although severe LVEF was associated with two-fold increase in mortality risk compared with patients who had normal LVEF.
Coronary Artery Bypass, Off-Pump/methods/*mortality ; Female ; Heart ; Humans ; Male ; Mammary Arteries/*transplantation ; Middle Aged ; Retrospective Studies ; Stroke Volume ; Survival Rate ; Treatment Outcome ; Vascular Grafting/methods/*mortality ; Ventricular Dysfunction, Left/mortality/*surgery ; Ventricular Function, Left

Adolescent ; Adult ; Child ; Child, Preschool ; Humans ; Hypertension, Portal ; surgery ; Male ; Portal Vein ; surgery ; Vascular Grafting ; methods ; Young Adult

Pseudoaneurysm resulting from vascular impingement by an osteochondroma is extremely rare. The authors report on the case of a 16-year-old male who had a brachial artery pseudoaneurysm and vessel rupture associated with a humeral osteochondroma. This case suggests that pseudoaneurysm should be considered for the differential diagnosis in patients with soft tissue masses and a cuspidal osteochondroma located near the neurovascular bundle and recommends Doppler sonography or angiography.
Aneurysm, False ; Angiography ; Brachial Artery ; Cuspid ; Diagnosis, Differential ; Glycosaminoglycans ; Humans ; Male ; Osteochondroma ; Rupture ; Vascular Grafting

We experienced satisfactory outcomes by synchronously transplanting an artery and vein using an anterolateral thigh flap pedicle between the vascular pedicle and recipient vessel of a flap for scalp reconstruction. A 45-year-old man developed a subdural hemorrhage due to a fall injury. In this patient, the right temporal cranium was missing and the patient had 4x3 cm and 6x5 cm scalp defects. We planned a scalp reconstruction using a latissimus dorsi free flap. Intraoperatively, there was a severe injury to the right superficial temporal vessel because of previous neurosurgical operations. A 15 cm long pedicle defect was needed to reach the recipient facial vessels. For the vascular graft, the descending branch of the lateral circumflex femoral artery and two venae comitantes were harvested. The flap survived well and the skin graft was successful with no notable complications. When an interposition graft is needed in the reconstruction of the head and neck region for which mobility is mandatory to a greater extent, a sufficient length of graft from an anterolateral flap pedicle could easily be harvested. Thus, this could contribute to not only resolving the disadvantages of a venous graft but also to successfully performing a vascular anastomosis.
Arteries ; Femoral Artery ; Free Tissue Flaps ; Glycosaminoglycans ; Head ; Hematoma, Subdural ; Humans ; Middle Aged ; Neck ; Scalp ; Skin ; Skull ; Thigh ; Transplants ; Vascular Grafting ; Veins

We present a case of a near total amputation at the distal tibial level, in which the patient emphatically wanted to save the leg. The anterior and posterior tibial nerves were intact, indicating a high possibility of sensory recovery after revascularization. The patient had open fractures at the tibia and fibula, but no bone shortening was performed. The posterior tibial vessels were reconstructed with an interposition saphenous vein graft from the contralateral side and a usable anterior tibial artery graft from the undamaged ipsilateral distal portions. The skin and soft tissue defects were covered using a subatmospheric pressure system for demarcating the wound, and a latissimus dorsi myocutaneous free flap for definite coverage of the wound. At 6 months after surgery, the patient was ambulatory without requiring additional procedures. Replantation without bone shortening, with use of vessel grafts and temporary coverage of the wound with subatmospheric pressure dressings before definite coverage, can shorten recovery time.
Amputation ; Bandages ; Fibula ; Fractures, Open ; Free Tissue Flaps ; Glycosaminoglycans ; Humans ; Leg ; Limb Salvage ; Negative-Pressure Wound Therapy ; Replantation ; Saphenous Vein ; Skin ; Tibia ; Tibial Arteries ; Tibial Nerve ; Transplants ; Vascular Grafting