1/68. Repair of type IV thoracoabdominal aneurysm with a combined endovascular and surgical approach.We report an unusual case of type IV Thoracoabdominal Aneurysm (TAA) with Superior Mesenteric Artery (SMA), celiac artery, and bilateral renal artery aneurysms in a patient who underwent an earlier repair of two infrarenal Abdominal aortic aneurysm (AAA) ruptures. Because of the presence of the visceral artery aneurysms and the earlier operation through the retroperitoneum, standard surgical treatment via a retroperitoneal approach with an inclusion grafting technique was considered difficult. A combined surgical approach achieving retrograde perfusion of all four visceral vessels and endovascular grafting allowing exclusion of the TAA was accomplished. Complete exclusion of the aneurysm and normal perfusion of the patient's viscera was documented by means of follow-up examinations at 3 and 6 months. The repair of a type IV TAA with a Combined Endovascular and Surgical Approach (CESA) allowed us to manage both the aortic and visceral aneurysms without thoracotomy or re-do retroperitoneal exposure and minimized visceral ischemia time. If the durability of this approach is confirmed, it may represent an attractive alternative in patients with aneurysmal involvement of the visceral segment of the aorta.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/68. Steroid therapy is effective in a young patient with an inflammatory abdominal aortic aneurysm.We report a successful resection of an inflammatory aneurysm following treatment with steroids in a 23-year-old man. Suffering from fever and severe lumbago, he was admitted to our hospital. An ultrasound and computed tomography of the abdomen revealed an infrarenal abdominal aortic aneurysm surrounded by dense perianeurysmal fibrous tissue. We diagnosed it as an inflammatory abdominal aortic aneurysm based on a symptomatic inflammatory reaction and the findings of ultrasound and computed tomography. Since the aneurysmal wall strongly adhered to the surrounding tissues and surgery was ruled out when it proved impossible to expose the vessels sufficiently to obtain vascular control, steroid therapy was started to control fever and severe lumbago. Five months later, we undertook surgery. Our conclusion is that steroid therapy was very effective against a young patient with inflammatory abdominal aortic aneurysm.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/68. Supraceliac aortic pseudoaneurysms after liver transplantation in infants.BACKGROUND: Reconstruction of the hepatic artery in infants undergoing liver transplantation presents challenging vascular situations. Microvascular techniques ensure arterial blood flow via small caliber vessels but are insufficient when inflow is poor. In these situations, the use of allogeneic grafts to the supraceliac aorta have been advocated. The development of a pseudoaneurysm at the supraceliac aortic suture line requires urgent repair and restoration of arterial flow to the graft. methods: Our study was based on case reports and review of the literature. RESULTS: Definitive diagnosis and successful repair of supraceliac pseudoaneurysm was accomplished in two infants after transplantation. CONCLUSION: We advocate a thoracoabdominal retroperitoneal approach, which provides safe control of the aorta and primary repair or patching of the diseased aortic segment, and also provides access for hepatic revascularization via placement of an infrarenal graft. thrombosis of the artery and subsequent liver necrosis are indications for retransplantation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/68. Staged thoracic and abdominal aortic aneurysm repair using stent graft technology and surgery in a patient with acute renal failure.A 52-year-old male presented with severe hypertension and acute renal failure. carbon dioxide (CO(2)) angiography identified a saccular thoracic aortic aneurysm, right renal artery stenosis, left renal artery occlusion, an infrarenal aortic aneurysm, celiac artery, and inferior mesenteric artery (IMA) orificial stenoses. Via an anterior retroperitoneal approach, bilateral renal artery thromboendarterectomy, infrarenal aortic aneurysmectomy, and IMA reimplantation were performed. The patient's tortuous iliac arteries were straightened to permit future passage of a thoracic stent graft by mobilizing the aortic bifurcation and anastomosing it to a Dacron graft within 4 cm of the renal vessels. Two weeks later, a stent graft was placed via a femoral incision utilizing CO(2) angiography, successfully excluding the saccular thoracic aneurysm. Recovery from both procedures was quick, with rapid return of renal function, and alleviation of the hypertension. At 8 months follow-up, his renal arteries and aorta are patent.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/68. Periaortitis and aortic dissection due to Wegener's granulomatosis.We describe here a patient with abdominal periaortitis and intramural dissection as early manifestations of Wegener's granulomatosis (WG). Surgical biopsies taken from the retroperitoneal inflammatory tissue surrounding the aorta showed granulomatous vasculitis. The patient had antiproteinase-3 antibodies and suffered from nasal, pulmonary, nervous and renal WG involvement. Although being a vasculitis of medium size and small vessels, WG should be included in the systemic vasculitides which can give rise to (peri)aortic inflammation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/68. A case report of nonresective staple exclusion of abdominal aortic aneurysm associated with horseshoe kidney.A 55 year old male with a history of intermittent claudication presented with an abdominal mass, and was diagnosed by abdominal computed tomography (CT) with an abdominal aortic aneurysm accompanying horseshoe kidney. The horseshoe kidney configuration and governing vessels, urinary duct course, and right common iliac arterial stenosis were shown by methods such as angiogram, spiral CT, and intravenous pyelogram before operation. At the operation, the abdomen was opened by a median incision and, using a staple exclusion technique, the abnormal renal artery was reconstructed using 189 mm knitted Y shaped dacron graft replacement and the great saphenous vein. The isthmus was not resected. There were no post operative complications, nor was there any large decrease in renal function. Good results were obtained, and we herein report our results together with a discussion of the literature.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/68. Operative management of abdominal aortic aneurysm with left-sided inferior vena cava.Abdominal aortic aneurysm with left-sided inferior vena cava (IVC) is rare. In preoperative examination, it is important to conduct roentgenologic studies and determine any venous anomalies. Proximal anastomosis is technically difficult because the IVC crosses to the right on the aneurysmal neck. In this case of a 71-year-old Japanese man, proximal anastomosis was conducted safely under wide vena cava mobilization and contraction in the superior direction. In vein resection, vessels should be reconstructed because vein communication is not methodical.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/68. Regression of inflammatory abdominal aortic aneurysm after endoluminal treatment with bare-metal Wallstent endoprostheses.Bare-metal Wallstent endoprostheses were used to treat a 60-year-old man who had an inflammatory abdominal aortic aneurysm, as confirmed by clinical and computed tomographic findings. The patient had concomitant coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and severe iliofemoral disease. Because of high surgical risk due to coexisting disease (including severe peripheral vascular disease), the patient was not a candidate for current endovascular methods or surgical repair. Therefore, we used the novel endovascular approach described. Serial, spiral, computed tomographic scans during a 2-year follow-up period revealed a reduction in the maximal diameter of the abdominal aortic aneurysm from 44 mm to 36 mm. Stabilization of thrombus and regression of the periaortitis were also noted. To our knowledge, this is the 1st reported case of endoluminal therapy with an uncovered stent for an inflammatory abdominal aortic aneurysm. Bare-metal Wallstent exclusion of inflammatory abdominal aortic aneurysms presents a treatment option for patients who are at high risk for surgery and cannot be treated with covered stent-grafts due to severe disease of the iliofemoral vessels.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/68. Endovascular repair of perisplanchnic abdominal aortic aneurysm with visceral vessel transposition.PURPOSE: To report a combined endoluminal and open surgical approach for a suprarenal abdominal aortic aneurysm (AAA) with coexistent splanchnic vessel stenoses. methods AND RESULTS: A 64-year-old man presented with an aneurysm of the proximal abdominal aorta and severe stenoses of the celiac axis and superior mesenteric artery (SMA). An initial 2-stage plan to stent the visceral vessel stenoses and exclude the aneurysm with a fenestrated stent-graft failed when the celiac lesion could not be crossed. The approach was changed to restore visceral perfusion with a bifurcated left iliosplenic and ilio-SMA bypass graft. Exclusion of the aneurysm was achieved with a custom-made suprarenal aortic tube stent-graft (Ivancev-Malmo) system. The patient is free of symptoms at 22 months, and there was no aneurysm visible on the 14-month CT scan. CONCLUSIONS: Hybrid techniques are an alternative treatment for complex perivisceral aortic aneurysms when total endovascular reconstruction is not possible.- - - - - - - - - - ranking = 6keywords = vessel (Clic here for more details about this article) |
10/68. Multiple coronary artery aneurysms combined with abdominal aortic aneurysm.Coronary artery aneurysm (CAA) is defined as coronary dilatation which exceeds the diameter of a normal adjacent segment or the diameter of the patients's largest coronary vessel by as much as 1.5 times. It is an uncommon pathology with a frequency of 1-4% in routine autopsies or coronary angiographies. atherosclerosis plays an important role in the development of CAA, and it may be a predominant cause in the majority of patients. However, the timing of surgical intervention and the treatment options for CAA are still controversial. In this report, we present a patient who had multiple CAAs of all main coronary arteries and abdominal aortic aneurysm. Different treatment modalities and indications are also discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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