Unexpected intraoperative desaturation and lobar atelectasis due to left bronchial occlusion by concealed ascending aortic aneurysm

An 81-year-old male scheduled for debridement of a perianal abscess sustained acute upper airway obstruction with atelectasis of the left lower lobe during induction of anesthesia. Results of a fiberoptic bronchoscopy revealed dorsal bulging and obstruction of the left bronchus. Under the context of tortuous aorta and calcified left border of the heart silhouette, aortic aneurysm was suspected; the diagnosis was confirmed by a computed tomography scan. Aortic aneurysm without specific symptoms cannot be screened by a single preoperative chest X-ray. The anesthesiologist should promptly request further radiographic studies to rule out potential aortic pathology if in doubt.     

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目的 探讨腹主动脉瘤切除术中常规应用Baxter球囊导管暂时阻断髂动脉，防止下肢动脉栓塞并发症发生的有关问题。方法 对2001年10月至2002年4月应用Baxter阻断球囊导管行标准的腹主动脉瘤切除术25例，对其围手术期并发症作一总结。结果 围手术期除1例于术后第3天死于广泛心肌梗死之外，其余病例无一发生下肢动脉栓塞并发症。结论 术中常规应用Baxter阻断球囊导管具有易于手术操作，有效防止下肢缺血等优点，有助于进一步完善经典的腹主动脉瘤手术，对于国内开展该术式有一定借鉴。     

David's procedure for pulmonary artery aneurysm

Pulmonary artery aneurysm (PAA) is a rare entity with fatal complications. Its silent course contributes to large aneurysms with compression symptoms. We present a 39-year-old female idiopathic pulmonary arterial hypertension patient with a giant PAA causing severe pulmonary regurgitation (PR) and symptomatic left main coronary artery compression (LMCA). Since she had a failed LMCA stenting attempt, she underwent surgery. A valve-sparing David-like pulmonary trunk reconstruction and coronary artery bypass were performed. This case illustrates that David-like reconstruction procedure can be applied to the PAA with severe PR.     

Delayed rupture of an internal iliac artery aneurysm following proximal ligation for abdominal aortic aneurysm repair

This is a report of a patient presenting with a contained rupture of an internal iliac aneurysm following proximal ligation after abdominal aortic aneurysm repair three years earlier. The patient presented with a large pelvic mass with symptoms of urgency, frequency, dysuria, tenesmus and fevers associated with anemia. Following evacuation of the aneurysm and direct suture ligation of the distal branches of the internal iliac artery, the patient's aortic graft was covered with omentum which also filled the pelvic cavity. The importance of proximal and distal control of aneurysms and/or the importance of complete luminal control of internal iliac artery aneurysms is emphasized by this case.     

腹主动脉瘤腔内修复术后髂支闭塞的危险因素分析

目的探讨腹主动脉瘤腔内修复手术(endovascular repair,EVAR)后髂支闭塞的危险因素。方法对2008年1月至2018年3月在新疆维吾尔自治区人民医院诊治的146例腹主动脉瘤EVAR病人的临床资料进行回顾性分析,按髂支闭塞情况分为闭塞组和非闭塞组,在单因素分析后,行多因素Logistic回归分析。结果 146例病人术后髂支闭塞17例(11.6%),两组间差异有检验效应(P<0.05)的因素为:合并高脂血症、慢性支气管炎,中性粒细胞百分比,活化部分凝血活酶时间,凝血酶比率,手术入路为切开显露,手术时间(min),右髂总动脉直径分层(≤12 mm、12～16 mm、≥16 mm),髂动脉狭窄或钙化≥50%,髂动脉扭曲成角≥60°,术后髂动脉流出道狭窄,髂内动脉流出道闭塞,支架远端延伸到髂外动脉。行多因素Logistic回归分析,EVAR术后髂支闭塞危险因素(OR>1)为:髂动脉狭窄或钙化≥50%[OR=7.727,95%CI(1.045,57.149),P=0.045];髂动脉扭曲成角≥60°[OR=5.258,95%CI(1.055,26.198),P=0.0...     

Left axillary arterial perfusion for cerebrospinal protection in proximal descending aortic aneurysm

A 73-year-old man presented with DeBakey type IIIa chronic aortic dissection. The aneurysm of the descending aorta was replaced using an open proximal technique with hypothermic circulatory arrest. For cerebrospinal protection, the left axillary artery was cannulated, which perfuses the vertebral artery and affects the Willis arterial circle, the anterior spinal artery, and the collateral blood supply to the spinal cord. Cannulation of the left axillary artery was a safe and effective surgical option for antegrade cerebral perfusion and spinal protection. This article was presented at the Aortic Surgery Symposium X, New York, 2006     

胸主动脉瘤合并冠心病同期外科治疗(附15例报告)

目的 总结胸主动脉手术同期行冠状动脉旁路移植术的经验。方法1999年6月至2002年7月，胸主动脉瘤手术同期行冠状动脉旁路移植术15例，均为男性；年龄40～66岁，平均57．2岁；体重60～89kg，平均70．2kg。病种包括主动脉根部瘤5例、升主动脉瘤2例、弓部瘤3例、主动脉夹层5例。经胸骨正中切口在全麻低温体外循环下手术14例；左外侧切口非体外循环下冠状动脉旁路移植同期股股转流降主动脉置换术1例。结果术后早期30d内死亡1例，随访1～36个月，无远期死亡，无再次手术及冠心病相关事件发生。结论胸主动脉置换术与冠状动脉旁路移植术能够安全同期进行，同期冠心病的再血管化对预防冠心病相关事件的发生有积极作用。     

Thoracoabdominal or descending aortic aneurysm repair after preoperative demonstration of the Adamkiewicz artery by magnetic resonance angiography

Objective: The outcome of thoracoabdominal or descending aortic aneurysm repair after preoperative demonstration of the artery of Adamkiewicz (ARM) by magnetic resonance angiography (MRA) was investigated. Methods: Between January 2000 and December 2001, 40 consecutive patients who had aneurysms of the thoracoabdominal or descending aorta underwent preoperative MRA to visualize the ARM. Thirty-two patients underwent replacement of the aneurysms, and 25 patients (TAAA, 11; TAA, 14) underwent replacement of the aneurysms with preoperative detection of the ARM. Only intercostal or lumbar arteries in aneurysms, which were detected as the origin of the ARM, were reattached to the graft. The results of thoracoabdominal aortic aneurysm operations in 11 patients in whom the ARM was preoperatively detected (group I) were compared with the results of TAAA operations in 26 patients in whom the ARM was not preoperatively detected (group II). Results: MRA demonstrated the ARM in 29 (73%) of the 40 patients. The laterality of the arteries originated from the left side in 29 (100%) and between Th9 and Th12 in 25 (86%), between Th9 and L1 in 28 (97%) of the 29 patients. No spinal cord injury occurred in patients (TAAA and TAA) in whom the ARM had been preoperatively detected. Major complications following TAAA operations included paraplegia (0% in group I and 8% in group II), respiratory failure (9% in group I and 23% in group II), and renal failure requiring hemodialysis (18% in group I and 22% in group II). Operation times were 439±99 min in group I and 620±200 min in group II (P=0.008). Conclusions: Preoperative detection of the ARM is possible by MRA and is very useful for reducing the incidence of ischemic injury of the spinal cord and for reducing the time of an operation for repair of an aneurysm of the thoracoabdominal or descending aorta.     

Mycotic pulmonary artery aneurysm following pulmonary artery banding

A neonate with situs inversus, transposition of the great arteries, ventricular septal defect, cross-crossventricles and hypoplastic right ventricle underwent pulmonary artery banding at the age of 7 days. The course was complicated by septicaemia and subsequently the development of an aneurysm of the pulmonary artery. Serratia marcessans was grown from the band site. The pulmonary artery aneurysm was resected and the pulmonary artery was repaired. The literature is reviewed with the emphasis on diagnosis, natural history and surgical management.     

Infected abdominal aortic aneurysm due to Escherichia coli

Early diagnosis of infected abdominal aortic aneurysm (IAAA) is still a medical challenge due to its diverse and non-specific symptoms and signs. The most common responsible pathogens are Salmonella, Staphylococcus, Campylobacter and Streptococcus species. The authors report the case of a 67-year-old man, admitted for high fever and finally diagnosed with Escherichia coli (E.coli)-related IAAA. The IAAA ruptured during the general anaesthesia induction, leading to an emergency surgery. The authors successfully proceeded to an open aneurysmectomy with extensive debridement and in situ graft replacement. This case emphasizes the potential for rapid IAAA expansion, its high-rupture risk and the importance of computed tomography as a diagnostic tool.     

Single-stage repair for ascending aortic aneurysm,artery stenosis and occlusion of neck vessels caused by Takayasu arteritis

Takayasu arteritis results in a variety of vascular symptoms, and there are some cases in which progressive vascular lesions require surgical intervention. We present a case with ascending aortic aneurysm, right common carotid artery stenosis, left common carotid artery occlusion and left subclavian artery stenosis caused by Takayasu arteritis that was successfully treated with total arch replacement and ascending aorta to right internal carotid artery bypass.     

Myocardial ischemia due to compression of an unruptured thoracic aortic aneurysm in a patient with Marfan syndrome

We report a 33-year-old woman who had a 60-mm thoracic aneurysm of the ascending aorta with Marfan syndrome and effort angina due to compression of the right coronary artery (RCA) by the aneurysm. Surgery was performed using the Bentall procedure and a coronary artery bypass graft to the RCA. Postoperatively, coronary angiography showed that the coronary flow of the RCA was restored by removing the aneurysmal compression. The patient was discharged without angina on postoperative day 21.     

Surgical management of ascending aortic aneurysm due to non-infectious aortitis

Objectives. We reviewed the spectrum of disease and early outcomes of patients undergoing ascending aortic surgery for Giant cell aortitis (GCA). Design. Of 1 259 patients undergoing repair of ascending aortic aneurysms between January 1993 and July 2006, 100 had histologic evidence of GCA or lymphoplasmacytic aortitis. Results. Operative Mortality was 4% (4/100). One patient underwent aortoplasty and aortic valve replacement (AVR). Among 99 patients undergoing graft replacement of the ascending aorta, distal disease required hemiarch replacement in 33 and total arch replacement in 14. Proximal aneurismal disease of the root was managed by mechanical or biological root replacement (n=18), Yacoub remodeling (n=2) or David reimplantation (n=9). Another 12 patients had separate AVR and ascending graft, while 26 had AR corrected by restoration of proper sinotubular junction diameter. In total, of 63 patients with AR, 38 had a valve-preserving procedure (61%). Conclusions. Ascending aortic aneurismal disease due to GCA is frequently associated with proximal and/or distal disease. Valve sparing procedures are technically feasible for many, although late durability is uncertain.     

Adjunctive renal artery revascularization during juxtarenal and suprarenal abdominal aortic aneurysm repairs

Background

We report a 15-year experience with renal artery revascularization during abdominal aortic aneurysm (AAA) repair.

Methods

AAA repairs from 1994 to 2009 were reviewed. Postoperative complications, renal function, patency, and survival in patients undergoing renal artery revascularization were evaluated and compared with a control group of patients undergoing juxtarenal AAA repairs not requiring renal artery revascularization.

Results

Sixty patients underwent renal artery revascularization during AAA repair. Transient postoperative renal insufficiency occurred in 20 patients. Temporary hemodialysis was required in 3 patients, with none requiring permanent hemodialysis. There was 1 postoperative death. There was 1 renal artery revascularization failure at 1 month but no other graft failures at 12 months median follow-up evaluation (1-year patency, 97%). In comparison with the control group, transient renal insufficiency and pulmonary complications (33.3% vs 19.8%; P = .042) were more common with renal artery revascularization, with no differences in long-term renal complications or mortality.

Conclusions

Renal artery revascularization can be performed during AAA repair with excellent patency and minimal morbidity.     

Concomitant pulmonary carcinoma and abdominal aortic aneurysm: Therapeutic strategies

PURPOSE: A diagnosis of concomitant pulmonary carcinoma and abdominal aortic aneurysm is rare (<1% of treated cases). However, such an association makes the therapeutic decisions critical, especially regarding the priority and timing of treatment. This article reports on our experience of 14 cases of concomitant pulmonary carcinoma and abdominal aortic aneurysm. METHODS: From April 1987 to June 2006 we observed 14 cases of concomitant pulmonary carcinoma and abdominal aortic aneurysm. In patients for whom simultaneous treatment was not indicated due to a poor general condition, priority was given to lung cancer except for cases in which the aneurysm needed an urgent approach. Patients observed after 2000 and scheduled for a two-stage treatment were treated with endovascular procedures whenever possible. RESULTS: Only one patient was treated by a simultaneous aneurysmectomy and a left lower lobectomy, while in the other 13 patients two-stage treatment was performed. Lung carcinoma was operated on first in 7 cases but one patient underwent an urgent aneurysmectomy after chest surgery due to a rupture of the aneurysm. Priority was given to an aneurysmectomy in 2 patients. An endovascular approach was performed in 4 patients, thus allowing a pulmonary resection during the same period of hospitalization, 2 days after 2 uneventful endovascular procedures and on the 6th and 7th postoperative days in 2 cases due to an intraoperative rupture of right iliac artery and type I postoperative endoleak, respectively. CONCLUSION: An endovascular exclusion of the aneurysm may therefore be proposed in order to achieve a concomitant treatment of both diseases. Such an approach excludes complications due to a postoperative rupture of the aneurysm when a pulmonary resection would be first performed; moreover, it does not delay the performance of a pulmonary resection when treatment of the aneurysm is considered to have priority.     

Ruptured intracranial aneurysm associated with spontaneous occlusion of internal carotid artery

Summary Out of 921 patients diagnosed and treated for intracranial aneurysm in 5 cases (0,5%) the co-existence of ruptured aneurysm and occlusion of the internal carotid artery was found. 4 patients were treated surgically-aneurysm clipping-without serious post-operative complications and 6 months follow-up showed satisfactory results. In 4 of 5 cases the aneurysm was located on the anterior communicating artery (ACA); this fact may support the hypothesis concerning a possible role of enhanced blood flow in aneurysm formation and rupture. In cases with good collateral blood flow extra-/intracranial bypass before aneurysm occlusion seems not to be necessary. The risk of operation in those patients is not as high, as might be expected.