Open reconstruction of multiple huge superior mesenteric artery aneurysms.

Open reconstruction of superior mesenteric artery aneurysms is very difficult, especially if the lesion is extensive. Aneurysmal lesions were found in a 74-year-old woman during a medical checkup. Computed tomography scan showed a 6.8-cm aneurysm arising 4 cm distal to the superior mesenteric artery origin, in succession to a 2.7-cm aneurysm, and further distal small aneurysms with string-of-beads appearance. The first, second, and third jejunoileal arteries, the middle colic artery, and the ileocolic artery were originated from the aneurysms. Open reconstruction was done using a branched saphenous vein graft. Computed tomography scan confirmed the patency of the grafts. She had no major troubles for another 4 years.

Arterial reconstruction in the upper extremities.

Arterial reconstruction in the upper extremities is rare relative to the incidence of reconstruction in the lower extremities. Twenty-three patients who underwent vascular reconstruction in the upper extremities from 1985 to 2000 were retrospectively reviewed. Atherosclerosis was observed in only two subclavian arteries. The most common cause of occlusion was thromboembolism from the heart, which occurred often in the brachial artery and could be treated successfully with thrombectomy. Seven of eight bypass grafts, including three procedures below the elbow, remained patent during follow-up periods ranging from 2 to 9 years. Arterial reconstruction of the upper extremities differs from that in the lower extremities. Atherosclerosis is a rare cause of ischemia, and the etiology varies with the site of obstruction. Bypass surgery below the elbow is feasible and successful in selected patients. Ischemia of the upper extremity causes significant morbidity and should be treated aggressively whenever possible.

Aneurysm of the gastroduodenal artery associated with absence of the celiac axis: report of a case.

A 65-year-old woman was referred to us for treatment of an aneurysm, found incidentally by abdominal ultrasonography. Angiography demonstrated a saccular aneurysm of the gastroduodenal artery and absence of blood flow from the celiac axis. The blood flow in the hepatic artery, splenic artery, and other arteries originating from the celiac axis was supplied by the superior mesenteric artery through one dilated and elongated pancreaticoduodenal artery and the gastroduodenal artery. The aneurysm was resected, and the inflow and outflow arteries were reconstructed with end-to-end anastomoses. Pathologic examination of the aneurysm sac showed diffuse intimal thickening with focal atheromas. We speculate that the increased blood flow compensating for the absence of blood flow from the celiac axis was an etiologic factor predisposing to the formation of this gastroduodenal artery aneurysm.

Surgical treatment of retroperitoneal leiomyosarcoma invading the inferior vena cava: report of three cases.

Retroperitoneal leiomyosarcoma is a rare neoplasm for which complete surgical removal provides the only effective treatment, as local recurrence adversely affects prognosis. However, invasion of major vessels may occur, making complete resection difficult. This report describes the cases of three patients who required concomitant resection of parts of the inferior vena cava because of direct tumor invasion. The major vessels should be isolated in preference to the tumor capsule during surgery to prevent sudden exsanguination or incomplete tumor resection. Resection of a recurrent sarcoma or a solitary metastasis can be effective in selected patients.

Successful surgical treatment of a patient with multiple visceral artery aneurysms due to fibromuscular dysplasia.

Multiple visceral artery aneurysms due to fibromuscular dysplasia are rare. A 43-yr-old man with a pulsatile abdominal mass detected by ultrasonography had multiple visceral artery aneurysms diagnosed by angiography. This included a huge superior mesenteric artery aneurysm. Aneurysm resection and arterial reconstruction was performed successfully. Pathologic examination revealed fibromuscular dysplasia of the medial fibroplasia type.