Surgical Management of Arteriovenous Malformation in the Foot: A Case Study

Arteriovenous malformations are frequently found in the head and neck, and are occasionally associated with congenital syndromes. They are rarely reported in the foot and ankle; however, when encountered in these particular locations, they may become painful and interfere with ambulation. Because of the lack of literature on pedal arteriovenous malformations, they remain enigmatic when encountered clinically. They form as a result of atypical development of the vascular system during embryogenesis. The identification, diagnosis, and treatment of an arteriovenous malformation can be challenging, because it may present similarly to more frequent soft-tissue pathologies in podiatric practice. These include fibroma, lipoma, ganglion cyst, or proteinaceous cyst. They have unpredictable behavior and a high recurrence rate. Failure to recognize and treat an arteriovenous malformation appropriately could result in ulceration, hemorrhage, and amputation. The identification and diagnosis must be accompanied with a full vascular work-up to determine the magnitude, flow, and extent of the lesion. After vascular work up, conservative, and surgical treatment options can be explored. This is an unusual case report of an arteriovenous malformation of the plantar foot that was previously misdiagnosed, and later presented to our facility for a second opinion. The steps taken for identification, diagnosis, and treatment are discussed along with surgical technique for excision of an arteriovenous malformation with successful outcome at 1 year follow-up. This case report will provide clinicians with armamentarium for diagnosis, workup, and treatment, when considering arteriovenous malformation in the differential diagnosis.     

保留肋骨、肋间神经的胸椎结核手术入路

目的：探讨胸椎结核手术入路。方法：保留助骨、肋间神经对胸椎结核施行病灶清除、脓肿引流、脊髓减压、椎间植骨术。结果：手术暴露充分,病灶清除彻底,保全肋间神经功能,胸腹壁无麻木区,肋骨术后愈合良好,稳定胸廓骨性支撑。不全截瘫于4－8周内完全恢复。结论：保留肋骨、肋间神经的胸椎结核手术入路是胸椎及胸腰椎结核外科治疗理想的手术入路。     

Anterior Chest Wall Arteriovenous Grafts: An Underutilized Form of Hemodialysis Access

Vascular access dysfunction is a major cause of morbidity in hemodialysis (HD) patients and the maintenance of a functional vascular access is an ongoing challenge. An upper extremity autogenous arteriovenous fistula (AVF) that preferentially involves the cephalic vein is the access of choice for hemodialysis patients, followed by autogenous AVF utilizing the basilic vein and the use of prosthetic arteriovenous grafts (AVG). Unfortunately, upper extremity options for vascular access rapidly become exhausted in a sub‐group of patients and use of alternative sites for access becomes necessary. An anterior chest wall graft, in which the axillary artery is anastomosed to either the ipsilateral or contralateral axillary veins, is a reasonable option in patients who have exhausted their upper extremity as vascular access sites, but still have patent central veins. Major indications include patients predisposed to steal syndrome as well as those with stenotic outflow veins necessitating over the shoulder extension of a brachio‐axillary graft. Recent data suggest that primary and secondary patency rates in anterior chest wall grafts are equivalent to upper extremity AVGs, making them a reasonable alternative vascular access option. This review will discuss the anatomical variations, percutaneous interventions, patency and longevity of anterior chest wall AV grafts.     

先天性右位心合并心血管畸形的诊断与外科治疗

目的总结先天性右位心合并心血管畸形的诊断和外科治疗经验。方法23例先天性右位心患者,其中镜面右位心17例,右旋心6例;所有患者均合并右心室双出口、室间隔缺损、房间隔缺损等心血管畸形。对所有患者的心脏病变施行手术治疗,包括全腔静脉-肺动脉连接术、G lenn手术、Fon tan手术、R aste lli手术、法洛四联症纠治术等。结果围术期死亡2例,死亡原因主要为低心排血量综合征;术后3个月死亡1例,死亡原因为左肺上叶不张、乳糜胸和充血性心力衰竭。随访16例,随访时间8个月~18年,心功能Ⅰ~Ⅱ级14例,Ⅲ级2例。结论超声心动图和胸腹部X线片检查是诊断先天性右位心的主要方法;先天性右位心合并心血管畸形的患者需施行手术治疗;肺动脉高压、肺血管发育不良及K artagener综合征是影响外科治疗效果的主要危险因素。     

先天性肢体动静脉瘘手术治疗体会

报告先天性肢体动静脉瘘48例手术治疗体会。方法:采用瘘管结扎和病变切除;瘘管结扎、病变切除和血流重建;分期分段瘘管结扎三种手术方法。结果:本组除4例失随访外,其余44例已平均随访5.8年。疗效良好者20例,占45.4％;好转16例,占36.3％。总有效率达81.7％。结论:作者认为,术前选择性动脉造影能对诊断和施行手术提供可靠依据,痿管结扎和病变切除是手术成功的关键。