Spontaneous brachial pseudo-aneurysm in a 12-year-old with kyphoscoliosis-type Ehlers-Danlos Syndrome.

The Ehlers-Danlos Syndrome (EDS) is a rare connective tissue disorder characterised by fragility of the soft connective tissues and widespread manifestations in skin, ligaments, joints, blood vessels and internal organs. We report a case of a 12-year-old boy, previously diagnosed with kyphoscoliosis-type EDS (type VI), presenting with a left brachial artery pseudo-aneursym with history of multiple spontaneous and post-traumatic arterial ruptures. Surgical management of this patient was performed successfully by primary repair of brachial artery lesion.

Pseudoaneurysm of the supracoeliac aorta following blunt trauma in a 83-year-old woman.

We report on the case of an 83-year-old hemiplegic female patient presenting with post-traumatic pseudoaneurysm of the supracoeliac aorta, treated with 38 mm x 100 mm Talent Endoluminal Stent-Graft (Medtronic Inc., Santa Rosa, CA) using local anaesthesia. The patient was discharged on day 3 and the 8 month follow-up was without complications.

Comparison of transperitoneal and retroperitoneal approaches in abdominal aortic surgery.

BACKGROUND: The transperitoneal approach (TP) to the aorta is the most widely accepted surgical approach in aortic surgery as it is simple, fast and provides excellent exposure of the intra-abdominal cavity and vascular structures. In recent years, there has been an increasing interest in the retroperitoneal (RP) approach to the aorta since it has been described as having a better outcome, i.e., preserving pulmonary function and gastro-intestinal physiology, reducing the intra-operative blood loss, minimising patient discomfort or pain, decreasing the incidence of wound complications and shortening ICU and hospital stay. The aim of this study is to compare the transperitoneal and retroperitoneal approaches in aortic surgery for aorto-iliac occlusive disease (AIOD). METHODS: From December 2003 to June 2006, a total of 153 consecutive patients who had undergone aortic surgery for AIOD, were studied retrospectively. The TP approach was used in 85 patients and the RP approach in 68 patients. Demographic features, intra-operative and postoperative data were analysed and compared according to the approach used. RESULTS: The mean operating time (83.6 +/- 23 vs. 104.4 +/- 30 min, p < 0.001) and mean aortic cross-clamp time (18.4 +/- 3 vs. 15.2 +/- 3 min, p < 0.0412) were significantly longer in the RP group. Peri-operative blood loss (700 +/- 350 vs. 650 +/- 330 ml, p < 0.683) and mortality rate < or = 30 day (1/1.2% vs. 0/0.0%, p < 0.896) were similar between the groups. The operative 30 day mortality rate was 0.7% (1 of 153) overall. The RP group had an earlier return of bowel functions (17.1 < or = 3 vs. 24.2 < or = 5 hrs, p < 0.001), earlier resumption of diet (26.4 < or = 4 vs. 31.4 < or = 5 hrs, p < 0.001), shorter period of intubation (3.5 < or = 2 vs. 6.5 < or = 3 hrs, p < 0.001), ICU stay (1.5 < or = 1 vs. 4.2 < or = 1 hrs, p < 0.001) and hospital stay (4.0 < or = 1 vs. 5.9 < or = 1 days, p < 0.001). Mean effort-pain scores were significantly lower in the RP group (3.8 < or = 1 vs. 5.3 < or = 1, p < 0.001). Incidence of pulmonary complications (4.4%, 3 of 68 vs. 7.3%, 8 of 85, p < 0.001), paralytic ileus (1.5%, 1 of 68 vs. 3.5%. 3 of 85, p < 0.001) were also lower in the RP group. Wound complications were more common in the TP group (4.7%, 4 of 85 vs. 10.3%, 7 of 86, p < 0.001). Most cases in both groups were related to incisional hernia or evisceration. CONCLUSION: This report presents our experience with the use of TP and RP approaches in a patient population merely consisting of AIOD. The RP approach was associated with a significantly lower incidence of postoperative pulmonary complications, rapid recovery of gastro-intestinal functions, shorter ICU and hospital stay, less peri-operative blood loss and lower mean effort-pain scores. We conclude that the RP approach is a safe and feasible technique that exposes patients to less postoperative complications.

Treatment of chronic type B aortic dissection by endovascular grafting in a previously CABG patient. Case report.

High mortality rates resulting from the surgical treatment of Type B aortic dissections have played an important role in seeking newer alternative therapy modalities for the treatment of the pathology. Especially since the early 1990s, endovascular grafting has become a popular option in the treatment of aortic diseases and with the increasing experience and advances in technology, it has, in recent years, become an alternative approach for the treatment of aortic dissections. In this report, we present the treatment of a 56-year-old male patient with a history of a coronary artery bypass grafting who presented with chronic type B aortic dissection. Endovascular stent graft implantation was performed with a hybrid therapy type of preliminary right subclavian artery to left subclavian artery bypass, followed by endovascular stent graft implantation to the dilated aneurismal segment of the descending aorta, for the treatment of chronic type B aortic dissection. The procedure and the postoperative course were uneventful; moreover, they were very comfortable for the patient undergoing an investigation of the descending aorta, when compared with the conventional surgical treatment modalities.

[The vascular manifestations of Behçet's disease: a case report]. / Les manifestations vasculaires de la Maladie de Behçet: a propos d'un cas.

Behçet's disease is an inflammatory vasculitis which affects the arteries and veins. The vascular pathologies are the rare complications of this disease. We present here a patient with Behçet's disease who has been hospitalized several times because of plurifocal vascular manifestations.

The surgical treatment of abdominal aortic aneurysms in patients with light to moderate renal dysfunction.

OBJECTIVE: The incremental surgical risk caused by mild or moderate renal dysfunction in patients undergoing surgery for an abdominal aortic aneurysm is not well defined. The aim of this study is to analyze the prognostic significance of mild or moderate renal dysfunction in 79 patients who have undergone repair of an infrarenal abdominal aortic aneurysm at our institution. METHODS: The postoperative results of 35 non-dialysis-dependent patients (Group I) with renal dysfunction were included and compared with a group of 44 patients (Group II) with similar characteristics of age, gender and pre-operative risk factors. All operations were performed through a standard transperitoneal median laparotomy. RESULTS: The mean operation and aortic cross-clamp times did not differ significantly between the two groups (234+/-15 min vs. 189+/-17min ; p = 0.25 and 57+/-12 min. vs. 52+/-9 min. ; p = 0.52). Early operative mortality was 5.71% in patients with renal dysfunction and did not differ significantly when compared with the other group of patients 4.5%; p = 0.083). Blood requirement was higher (p < 0.01) and the hospital stay was longer (p < 0.001) in group I. There were 18 patients in group I (51.4%) and three patients in group II (6.8%) in whom the pre-operative serum creatinine level increased above 2.5 mg/dl during the postoperative period. The postoperative increase of creatinine level differed significantly in patients with pre-operative renal dysfunction (p < 0.001). There were nine patients (25.7%) in group I and four patients (9.1%) in group II who required mechanical ventilation for more than 24 hours (p = 0.025). There was no significant difference between the two groups in terms of cardiac morbidity p = 0.234). CONCLUSION: Patients with even a mild or moderate degree of renal dysfunction require close monitoring and prolonged hospital care during the postoperative period. Although satisfactory early surgical outcomes may be expected in this particular group of patients, pulmonary and renal morbidity rates are higher than in patients with normal renal function.

A comparison between minilaparotomy and standard median laparotomy for reconstruction of aorto-iliac occlusive disease.

OBJECTIVE: Minimally invasive surgical procedures have become increasingly used in all surgical branches. In this respect we compared the minilaparotomy (ML) technique with standard median laparotomy (SML) for the surgical treatment of aorto-iliac occlusive disease. METHODS: 120 patients were included in this prospective study, with 60 patients in the minilaparotomy group and 60 patients in standard median laparotomy group. The two approaches were used within the same time period. Both groups were compared in terms of operating and aortic cross clamp time, the amount of blood transfusion, length of stay in the intensive care unit and hospital, and time for normalization of bowel functions. RESULTS: There were no significant differences in terms of the amount of blood transfusion, or aortic cross clamp time. The minilaparotomy approach has the advantages of less operating time, earlier return to a general diet, decreased length of stay in the intensive care unit and hospital and reduced cost. CONCLUSIONS: As a conclusion, we believe that the minilaparotomy technique will be the standard treatment of choice for aorto-iliac occlusive disease in the future with reduced use of facilities and lower cost than the laparoscopic or the standard technique.

Anterior spinal artery syndrome after infrarenal abdominal aortic surgery.

BACKGROUND: Neurological complications such as paraplegia or paraparesis due to spinal cord ischemia has been an unpredictable, devastating event after infrarenal abdominal aortic surgery. The aim of our study is to focus the importance of this entity and in this connection to review the vascular anatomy of the spinal cord, incidence and etiology of spinal cord ischemia, methods of prevention, and management of the patient. METHODS: Eight patients were identified with spinal cord ischemia manifested by paraplegia or paraparesis after 1331 abdominal aortic operations. All the patients who had spinal cord ischemia were examined for risk factors. RESULTS: Three anterior spinal artery syndrome neurological recovery occurred but 5 of them remained unchanged. Two patients died within 30 days of operation. CONCLUSIONS: Complete paraplegia due to ischemic spinal cord injury was thought to be caused by interruption of critical collateral blood supply to the spinal cord. For this reason avoidance of prolonged aortic cross clamp time, hypotension, and its associated low flow to the spinal cord, paying attention to prevent atheromatous embolization of Adamkiewicz artery and pelvic circulation can prevent this complication. If the greater medullary artery is anomalously low from the anatomic localization the blood supply of the cord may be inadequate, so this complication cannot be avoided.

A complication of pectus excavatum operation: endomyocardial steel strut.

An 18-year-old patient who had correction of pectus excavatum deformity in our department 4 years earlier was admitted because of stabbing chest pain. He had not attended to postoperative controls and had not come for extraction of the steel strut, although he had been contacted. He was diagnosed to have a broken steel strut, and the strut was noted to be embedded in the myocardium. This unreported complication of pectus excavatum operation forced us to review sternal support techniques.