1/65. Type A aortic dissection involving a right-sided aortic arch.We report a rare case of a 39-year-old man with type A aortic dissection involving a right-sided aortic arch with the symptom of vascular ring. Computed tomography scanning and angiography were performed to define the extent of the dissection and the anatomy of the branching vessels. The ascending aorta was replaced through a median sternotomy and right thoracotomy using a hypothermic cardiopulmonary bypass associated with selective cerebral perfusion and partial circulatory arrest, and his symptom of vascular ring disappeared postoperatively.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/65. Simultaneous selective cerebral perfusion and systemic circulatory arrest through the right axillary artery for aortic surgery.The duration of safe circulatory arrest for replacement of the ascending aorta for a type A dissection, without additional cerebral perfusion measures, is not clearly defined. If prolonged periods (> 60 minutes) are anticipated, retrograde cerebral perfusion or selective antegrade carotid perfusion may be required. The latter requires separate cannulas with subsequent snaring of the cerebral vessels, which may be time consuming and cumbersome. We propose an alternative method whereby the right axillary artery is cannulated for cardiopulmonary bypass and, when the desired hypothermic temperature is achieved, the flows are turned down to 500 mL/min. The origin of the innominate artery is then occluded establishing selective antegrade right carotid artery perfusion. The distal ascending or aortic arch anastomosis is then performed while the remainder of the body is under selective systemic circulatory arrest. The proximal aortic anastomosis is performed after the graft is clamped proximally and flows return to appropriate perfusion levels.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/65. Combined coronary artery bypass grafting and repair of aneurysm of the descending aorta.The outcome of patients with thoracic or thoracoabdominal aortic aneurysm is often determined by the concomitant coronary artery disease. Two patients with thoracic and thoracoabdominal aortic aneurysm and concomitant single-vessel coronary artery disease underwent combined myocardial revascularization and repair of aortic aneurysm. The operations were performed through a left thoracotomy and thoracoabdominal incision with distal aortic perfusion using a partial femoro-femoral bypass and selective right lung ventilation. Coronary anastomoses were performed on the beating heart, and the aneurysm was replaced with a woven Dacron tube graft.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/65. An uncommon cause of stroke in young adults.We describe a previously healthy 48-year-old man who presented with clinical characteristics suggestive of internal carotid artery dissection, confirmed by magnetic resonance imaging. He developed a massive infarction of the left cerebral hemisphere and died after 3 days of transtentorial herniation. Post-mortem examination identified a dissection of the thoracic aorta caused by Erdheim-Gsell cystic medionecrosis, with the characteristic degeneration of the elastic fibers of the lamina media. The dissection showed an unusually large extension not only distally into both iliac arteries, but also proximally into both carotid arteries. To our knowledge, such an extensive dissection has not been described previously. Underlying vessel wall disorders of the aorta, such as Erdheim Gsell cystic medionecrosis, should be considered in young patients with spontaneous arterial dissection.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/65. 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) |
6/65. Type A dissection of the ascending thoracic aorta during percutaneous coronary intervention.Retrograde dissection of the aorta is extremely rare during percutaneous coronary intervention (PCI), but is a recognized and potentially life-threatening complication. We describe a case in which retrograde dissection of the aorta, necessitating urgent surgical repair, occurred during an attempt to open a chronically occluded right coronary artery. Initially localized, the dissection extended during an attempt to seal the right coronary ostium. Our experience suggests that if localized aortic retrograde dissection occurs, the management will depend on the stability of the distal coronary vessel. If stable, a conservative approach may be preferable to an attempt to seal the dissection.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/65. 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) |
8/65. Mycotic pseudoaneurysm of the aortic arch: an unusual complication of invasive pulmonary aspergillosis.invasive pulmonary aspergillosis (IPA) is usually a condition of the immunocompromised patients. The organism has a tendency to invade pulmonary blood vessels. Extension of a pulmonary parenchymal lesion to involve the mediastinal great vessels is very rare. This is the first case where the extension of IPA to the aortic arch and the formation of a pseudoaneurysm were demonstrated on serial CT scans.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
9/65. Replacement of the entire thoracic aorta according to the reversed Elephant Trunk technique.The aim of this work is to present our modified Elephant Trunk technique to reduce circulatory arrest time and consequently mortality and morbidity rates. According to Borst's technique the ascending aorta and aortic arch are replaced first, under deep hypothermic circulatory arrest, while a graft segment is left in the descending thoracic aorta. In the second stage of the operation, the descending thoracic aorta is replaced through left thoracotomy using this graft segment. In our modified technique, after the flexion in the proximal segment of the graft, the descending thoracic aorta is replaced first through left thoracotomy in Bio-Pump protection, choosing the best aortic segment for proximal anastomosis. In the second stage we replace the ascending aorta and the aortic arch using the graft and applying Carrel patch anastamosis only to the epiaortic vessels, under deep hypothermic circulatory arrest. It is our opinion that the mortality incidence of this technique is similar to that obtained with Borst's technique, though certainly inferior to the one stage procedure , while the morbidity results are better than those obtained with the Borst Elephant Trunk technique and with the one stage procedure. In fact there are fewer stroke incidents thanks to the reduced times of deep hypothermic circulatory arrest, and fewer postoperative bleedings and respiratory failures thanks to the reduced times of the total cardiopulmonary bypass. At the beginning we used this technique to replace symptomatic aneurysms, covered ruptures, and hematomas of the wall of the descending thoracic aorta, which required replacement of the descending thoracic aorta first; we later extended the treatment to all types of thoracic aorta aneurysms.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/65. Simultaneous surgery for ischemic heart disease, type A aortic dissection and abdominal aneurysm.The patient was a 72-year-old male with three-vessel coronary artery disease, chronic dissecting aneurysm of the ascending aorta with moderate aortic regurgitation, and abdominal aortic aneurysm 7 cm in diameter. Because staged procedure seemed to exacerbate the risk due to the remaining lesion, simultaneous procedures (double coronary artery bypass, aortic root remodeling, tube replacement of the ascending aorta and Y-graft replacement of the abdominal aneurysm) were performed. The patient recovered completely without any serious complication.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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