References

The etiology and treatment of varicose ulcer of the leg. Surg Gynecol Obstet 1917 24 300-11. 2. Bauer G. A roentgenological and clinical study of the sequels of thrombosis. Acta Chir Scand 1942 86. 3. Lees TA, Lambert D. Patterns of venous reflux in limbs with skin changes associated with chronic venous insufficiency. Br J Surg 1993 80 725-8. 4. Hoare MC, Nicolaides A, Miles C. The role of primary varicose veins in venous ulceration. Surgery 1983 82 450. 5. Sethia KK, Darke SG. Long...

Commentary

Investigation of both the arterial and the venous system is mandatory in cases of non-healing ulcer on the leg. Although Doppler examination had only revealed a clear reflux in GSV it is worthwhile to continue with duplex ultrasound scanning as deep venous incompetence and post-thrombotic changes can otherwise be overlooked. This is especially important when reflux is noted at the back of the knee where it is difficult with certainty to differentiate between deep venous reflux in the popliteal...

Question 5

Which of the following are acceptable corrective options for limb-threatening steal following proximal access construction Fig. 39.1. a The operation before the creation of the corrective procedure. b The corrective procedure with ligation of the artery just distal to the AV graft take-off and the venous bypass from a point proximal to the inflow to a point just distal to ligation (DRIL procedure). A, brachial artery AV, axillary vein BV, basilic vein G, arteriovenous PTFE graft VG, vein graft....

Stage V

Elephantiasis with severe limb deformation, scleroindurative pachydermitis, and marked, extensive lymphostatic verrucosis Fig. 47a.7. Clinical instrumental diagnostic staging of lymphoedema. positive in more than 80 per cent of cases, with an even better outcome in patients operated upon precociously (at stages II and III see Fig. 47a.7). The incidence of lymphangitic attacks decreases significantly after microsurgery. The reduction in oedema volume obtained by microsurgery is seen immediately...

Neurogenic Thoracic Outlet Syndrome

A 30-year-old woman presented with complaints of pain in her neck, right shoulder, right trapezius, right anterior chest wall, right arm, elbow, and forearm occipital headaches every other day numbness and tingling in all fingers of the right hand, worse in the fourth and fifth fingers aggravation of her symptoms when elevating her arms, especially to comb or blow dry her hair or drive a car weakness of her right hand and dropping coffee cups and coldness and color changes in her right hand....

Qustion

There is no clear indication to offer any treatment. B. Offer injection sclerotherapy. C. Offer below-knee compression stockings. The patient was advised that the disease progression is very slow. However, the varicosities are likely to deteriorate with age and therefore it is likely that some active measures would need to be taken. Patient compliance and some change in lifestyle, along with conservative measures such as compression stockings, seem to provide symptomatic relief in the...

Chronic Critical Limb Ischemia

An 85-year-old male with a history of diabetes, hypertension, hypercholesterolemia, coronary artery bypass, and active tobacco use presented with a gangrenous right first toe. The patient stated that he had no history of trauma to the area, and complained of rest pain in the foot. The patient had been in otherwise good health since his coronary artery bypass 12 years ago. On physical examination, the patient was in no physical distress. The patient had a well-healed median sternotomy scar....

Erectile Dysfunction due to Aortic Disease

A 60-year-old married man presented with sudden onset of erectile failure about 1 month previously. This occurred in the absence of critical life changes, psychological stress, or known intercurrent illness. Initially, the patient was seen by a general practitioner and treated with sildenafil in incremental doses up to 150 mg. This had only a minor effect ejaculation was maintained but erections remained insufficient for penetration. Risk factors consisted of mild hypertension controlled by an...

A Management of Upper Extremity Lymphoedema with Microsurgical Lymphovenous Anastomosis

Corradino Campisi and Francesco Boccardo A 59-year-old woman presented with an 8-year history of oedema of the left arm. Initially, the oedema appeared in the upper arm. The patient was treated with combined decongestive physiotherapy (manual and mechanical lymphatic drainage), bandaging and exercises three to four times over a 12-month period. Despite these measures, the oedema extended as far as the forearm and hand (Fig. 47a.1), and she had several episodes of erysipeloid lymphangitis. In...

Aortofemoral Graft Infection

A 66-year-old man, an ex-smoker with hypertension and hypercholesterolemia, had undergone a Dacron bifurcated aortic graft and bilateral ureteric stents for an inflammatory aortic aneurysm with ureteric obstruction at another hospital 4 years previously. The left limb of the graft had been anastomosed to the common femoral artery and the right limb to the common iliac bifurcation. Postoperatively he had suffered a mild groin wound infection, which had healed with antibiotics. At follow-up he...