Abdominal wall transplantation with microsurgical technique.
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Many patients undergoing intestinal or multivisceral transplantation have a past history of complete midgut removal with the loss of the domain of the abdominal compartment or have severely damaged abdominal walls from repeated laparotomies, tumours or enterocutaneous fistulae. These patients may encounter severe abdominal wall closure problems at the end of transplantation, resulting in increased morbidity and mortality. It is, therefore, of paramount importance to properly cover transplanted organs in order to reduce postoperative complications. Abdominal wall transplantation was recently proposed for closure of patients undergoing both small-bowel and multivisceral transplantation: the results are encouraging. However, the technical procedure proposed requires the procurement of long segments of iliac vessels as far as the vena cava and the aorta. Since donor multiorgan procurement involves many surgical teams, the removal of these vessels, with the abdominal graft, led to their unavailability for vascular surgeons. Here we present three consecutive cases of abdominal wall transplantation in which, by taking advantage of microsurgical experience, we were able to carry out a transplantation of the abdominal wall by direct anastomosis of the epigastric vessels, obtaining a very good outcome. (+info)
Superior epigastric artery pseudoaneurysm--a rare complication of chest drain insertion in coronary artery bypass grafting.
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BACKGROUND: Although chest drain insertion during coronary artery bypass grafting is a fairly standard procedure, however it may result in extremely rare complications. CASE PRESENTATION: This is the first case being reported that demonstrates a pseudoaneurysm of superior epigastric artery resulting from chest drain insertion following coronary artery bypass grafting. CONCLUSION: Adequate caution should be used along with good understanding of the anatomical landmarks during apparently simple and standard operative procedures. (+info)
The rare case of a symptomatic atherosclerotic aneurysm of the superior epigastric artery mimicking an acute cholecystitis.
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True aneurysms of the epigastric artery are rare. We report a case of a 65-year-old female who was admitted for increasing upper abdominal pain. A leukocytosis, pyrexia, breathing stop on inspiration, and a palpable mass next to the right costal arch with severe local pain were suspicious for acute cholecystitis. Surprisingly, sonography and CT scan revealed a 5 x 4 cm structure limited to the abdominal wall directly above the gallbladder, which showed an arterial flow in the duplex scan. After resection and an uneventful postoperative course, the histological findings confirmed the diagnosis of a symptomatic true atherosclerotic aneurysm. (+info)
Effects of venous supercharging in deep inferior epigastric artery perforator flap.
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PURPOSE: To evaluate the effects of venous supercharging in deep inferior epigastric artery perforator flap in rats. METHODS: 20 Wistar rats were randomized in 2 groups: control group (C), all had flaps raised based on the deep inferior epigastric perforator vessels (DIEP), and experimental group (E), which was identical to group C, except that the contralateral superficial inferior epigastric vein was also kept with the flap. Flow studies using laser Doppler flowmetry where performed daily in the four zones of the flap. On the 7th postoperative day rats were killed and flap survival was determined using digital planimetry. RESULTS: Flow values were presented as a percentage of the baseline flow after incision of the flap edges. The surviving flap area was demonstrated as a percentage of the total flap area. Evaluation by digital planimetry showed that flap survival in group E was higher than in group C (97,38%+/-1,32%vs.44,13%+/-4,83%, p=0,0006). CONCLUSION: This study shows that venous supercharging of the rat DIEP flap results in greater flap survival. (+info)
Stable fracture of the pubic rami: a rare cause of life-threatening bleeding from the inferior epigastric artery managed with transcatheter embolization.
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Extraperitoneal bleeding from the inferior epigastric artery (IEA) and its branches is a rare complication of blunt pelvic trauma; however, it can result in life-threatening hemorrhage, even in cases of minimally displaced fractures of the pelvic ring. We report the case of a patient who had posttraumatic pelvic hematoma and cardiovascular collapse caused by avulsion of the right pubic branch of the IEA related to undisplaced fractures of the pubic rami. CT scanning followed by angiography showed leakage of contrast from the IEA. Transcatheter arterial embolization was performed to successfully control the hemorrhage. There have been very few previous reports of IEA injury related to stable fractures of the pubic rami successfully treated by transcatheter arterial embolization. (+info)
The anatomy of superficial inferior epigastric artery flap.
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Radial artery as a graft for coronary artery bypass grafting.
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The radial artery (RA) graft was revived in late 1980 s when it was found that the graft was patent 13-18 years after coronary artery bypass grafting (CABG) after improvement of the technique in harvesting and the use of calcium-channel blockers. Recently, the RA became a reasonable alternative to the saphenous vein (SV) graft with the trend toward complete arterial revascularization and more frequent off-pump CABG to avoid aortic manipulation. To improve the quality of the RA conduit, harvesting technique and topical and systemic antispasmodic medication are important. The RA should be grafted to severe proximal stenosis (>90%) in the native coronary arteries to avoid flow competition, especially in the right coronary territory. The RA graft could be used as an aortocoronary or composite configuration with similar graft patency. Early graft patency of the RA conduit was as good as other arterial grafts, and better than SV graft in the circumflex and right coronary territories, in many studies, especially in diabetic patients. Long-term results of graft patency and cardiac-event-free survival compared with SV graft are still controversial in randomized controlled trials, probably because the incidence of flow competition and the definition of graft patency varied. (+info)
The value of multidetector-row CT angiography for pre-operative planning of breast reconstruction with deep inferior epigastric arterial perforator flaps.
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