Intrathoracic desmoid tumor with invasion of the great vessels.

A desmoid tumor of the mediastinum was diagnosed and treated in a 35-year-old white male who presented with a right supraclavicular mass. He was treated with resection, which involved several vascular structures, requiring multiple vascular reconstructions followed by post-operative radiotherapy. The authors concluded that, when located in the mediastinum, the invasive character of such tumors and its tendency to recur may pose a considerable surgical challenge, requiring careful pre-operative planning and long term post-operative follow -up. The role of radiation therapy is limited to the control of local recurrences.

Use of superficial femoral vein in the treatment of infected aortoiliofemoral prosthetic grafts.

PURPOSE: To assess the use of the superficial femoral vein for the reconstruction of the aortoiliofemoral sector in the treatment of prosthetic infections. METHODS: From December 1995 to November 1999, 12 patients with infection involving a synthetic vascular prosthesis were submitted to thirteen surgical procedures involving partial or total resection of a synthetic vascular prosthesis and restoration of arterial flow with an in situ femoral vein. RESULTS: The overall operative mortality rate was 15.3% (2 out of 3 patients who underwent total graft replacement and 0 out of 9 patients who underwent unilateral graft replacement). Major amputations related to the surgical procedures were performed in two cases (an 87.5% rate of limb salvage). The series was followed up on average for 22 months (range: 6-65 months). No patient presented clinically significant edema or signs of chronic venous insufficiency in the lower limbs used as donors of autogenous venous grafts. All surviving patients presented complete resolution of the infectious signs and symptoms and none of them presented late thrombosis of the venous graft. CONCLUSION: The use of the superficial femoral vein is a good surgical alternative for the treatment of prosthetic infections with minimal venous morbidity of the lower limbs used as venous graft donors. The autogenous venous grafts present good long-term patency and excellent adaptation to the aortoiliofemoral position.

Inflammatory aneurysms of infra-renal abdominal aorta. A case-control study.

BACKGROUND: A case-control study was conducted to identify significant differences in risk factors, clinical presentation, treatment and prognosis between patients with inflammatory aortic aneurysms (group 1) and atherosclerotic abdominal aneurysms (group 2 - controls). METHODS: Thirty patients with inflammatory aneurysm were repaired at our institution in a 14-year period and were matched to 60 controls by date of surgery. RESULTS: Both groups presented similar characteristics concerning age, gender, risk factors to atherosclerosis and ischemic heart disease. Patients with inflammatory aneurysms presented abdominal pain significantly more than controls (80 versus 41.7%; p=0,001). Erythrocyte sedimentation rate was significantly high in group 1 as compared to group 2 (26 versus 5%; p=0,005). The aneurysm size was significantly greater in group 1 (8 versus 6.4 cm; p=0,01). The surgical technique required was similar in both groups, but the aortic clamping time and the mean blood reposition were higher in group 1 (49.5 versus 41 min; p=0,01 and 1508 versus 1034 ml; p=0,013). Intraoperative injury to adjacent organs was significantly greater in group 1 (10 versus 0%; p=0,034). The mortality rate was neither statistically different in the early postoperative setting (10 versus 1.67%) nor in the 5-year survival rate (67 versus 62%; p>0.05) for groups 1 and 2, respectively. CONCLUSION: This study showed no differences concerning inflammatory aneurysms in terms of risk factors, treatment required and prognosis. Inflammatory aneurysms tend to present with more symptoms, high erythrocyte sedimentation rate, greater size and retroperitoneal inflammatory reaction than usual aneurysms, making the surgical procedure more difficult.

Factors increasing the mortality rate for patients with ruptured abdominal aortic aneurysms.

The objective of this report was to analyze the current surgical results of operative treatment in patients suffering ruptured AAA (abdominal aortic aneurysms) and to define those independent predictive factors for mortality. During a period of 2 years, from January 1996 to December 1997, 144 patients operated on for ruptured AAA in 10 hospitals were included in a multicenter retrospective study. Among the collected variables concerning each patient, those with potential relation to surgical mortality were studied: gender, age, diabetes, hypertension, cardiopathy, pulmonary obstructive disease, preoperative renal dysfunction, symptomatic cerebrovascular disease, peripheral vascular disease, hematocrit on admission, preoperative hypotension < 80 mmHg, loss of consciousness, cardiac arrest, aortic aneurysm location (infrarenal versus non-infrarenal), iliac involvement, aneurysm size, type of rupture, left renal vein ligature, ligature of a patent inferior mesenteric artery, place of aortic cross-clamping, type of grafting, exclusion of both hypogastric arteries, venous technical complications, associated surgery, use of cell saver, intraoperative blood loss, and postoperative complications (renal failure, sepsis, coagulopathy, cardiac complications, pulmonary complications, colon ischemia, prosthetic graft complications, and need for reoperation). Those variables with statistical significance in the univariate analysis were introduced into a multivariate logistic regression model to determine the independent predictors of death. From our results we concluded that surgery for ruptured abdominal aortic aneurysms continues to have an excessively high mortality rate. Even though some preoperative variables could be identified as predictors of mortality, an absolute mortality risk has not yet been determined and the decision to negate surgery should be individualized rather than taken on that basis only. Early diagnosis and treatment of symptomatic aneurysms would improve mortality figures and selective screening should be contemplated.

Aneurisma da artéria ilíaca interna: um problema a ser resolvido / Internal iliac artery aneurysm: a problem to be solved

O objetivo do presente trabalho é a divulgação da necessidade de diagnóstico precoce e tratamento do aneurisma da artéria ilíaca interna. São relatados 7 casos, que foram diagnosticados, alguns isoladamente, outros associados a aneurisma da artéria ilíaca comum e outros a aneurisma da aorta abdominal roto e operado eletivamente. Todos os pacientes foram submetidos a restauração vascular com sucesso. O aneurisma da artéria hipogástrica deve ser tratado precocemente para evitar sua ruptura e a circulação restaurada, sempre que possível, para evitarmos complicaçöes como isquemia mesentérica e glútea.

Ruptured abdominal aortic aneurysm. Analysis of 50 procedures.

The authors report their experience in the management of 50 patients operated on for ruptured abdominal aortic aneurysms. The importance of an early surgical indication will be discussed. A didactically written chart will be presented to simplify and allow early diagnosis. The results will be analysed as to onset of rupture, quantity of transfused blood and shock condition of the patient.