Saccular mycotic aneurysm of descending thoracic aorta secondary to vertebral hydatid disease: A rare case.

BACKGROUND/OBJECTIVE: Hydatid disease of the aorta is very rare. Hydatid disease can result in saccular aneurysm of the thoracic and abdominal aorta. CASE REPORT: We report a rare case of saccular aneurysm of the distal descending thoracic aorta. The diameter of the aneurysm was 60 mm. It was managed by Thoracic Endovascular Aneurysm Repair. After 41 months, computed tomography angiography revealed a multi-loculated cystic lesion with 86 × 83×80 mm dimensions in the prevertebral area at the T10-T11 level with bony destruction and erosion of the anterior margin of the vertebral bodies. A computed tomography-guided fine-needle aspiration of the paravertebral cystic lesion was performed. Microscopic study of the fine-needle aspiration specimen demonstrated Echinococcosis granulosus diagnostic of hydatid disease. CONCLUSION: It is concluded that the case was a mycotic aneurysm of the thoracic aorta secondary to vertebral hydatid disease.

Axillary Artery Aneurysm in a 3-Year-Old Child: A Rare Case and Review of the Literature.

We report a rare case of 4 cm true aneurysm of left axillary artery in a 3-year-old girl. Computed tomography angiography confirmed the diagnosis. Open surgical repair with resection and primary end-to-end anastomosis was performed. The patient did not have any complication after 1-year follow-up. Axillary artery aneurysm is extremely rare in pediatric population. Previous reports of this rare entity are discussed comprehensively.

Endovenous laser ablation of the great saphenous vein versus high ligation: long-term results.

Endovenous laser therapy (EVLT) for greater saphenous vein (GSV) insufficiency is a relatively new method of treatment only recently made available in Iran. This is the first long-term randomized trial comparing EVLT with high ligation of saphenous vein (HLS) in the Iranian population. Sixty-five patients met the inclusion criteria and were divided into homogenous treatment groups of EVLT (n = 30) or HLS (n = 35). Clinical severity, etiology, anatomy, pathophysiology (CEAP) classification and Aberdeen Varicose Vein Symptom Severity Scores (AVSS) were used to determine disease severity and symptoms before and after the procedure in both groups. Outcome was measured by the rate of recurrence as shown in Doppler ultrasonography evaluation. Follow-up was conducted 1 week and 3, 6, 12, and 18 months after the intervention. The occlusion rate of GSV was similar in both groups (93.6% for EVLT, 88.3 for HLS) at 18 months of follow-up. The median CEAP score showed a dramatic decrease in both groups after 1 week which was sustained for the rest of the study. The Aberdeen Varicose Vein Symptom Severity score was significantly lower in the EVLT group at 12 and 18 months of follow-up. There was no significant difference in patient satisfaction in both groups. Our findings show that EVLT may offer a better long-term relief of symptoms. This, alongside its better cosmetic outcome, and less invasive anesthesia requirements may make it the favorable choice for treatment of GSV insufficiency.

Innominate artery aneurysm in behcet disease; report of one case.

INTRODUCTION: Behçet disease (BD) is a multisystemic recurrent inflammatory disorder that was originally described as a triad of oral and genital ulcerations with uveitis (Behcet, 1937 [1]). Arterial involvement is the most common cause of mortality in patients with BD. Aneurysms are common among the arterial lesions and affect various arteries, but mostly the abdominal aorta. Vascular lesions are encountered in 7 %-29 % of patients, gravely affecting the course of the disease. Extracranial carotid aneurysms due to Behçet's disease are extremely rare (Bouarhroum et al. (2006) [2]). CASE PRESENTATION: Herein, we present a 19 year old man presented with hoarsness due to pressure effect to our outpatient clinic. CLINICAL DISCUSSION: Due to findings in the computed angiography, he underwent surgery twice.A 100*8 COVERA-covered stent was deployed at the bifurcation of the brachiocephalic artery. Then a 40*13.5 FLUENCY stent with a 2 cm overlap from the previous stent was deployed. CONCLUSION: Further investigations regarding endovascular approach for this rare disease is recommended.

Superior mesenteric artery thrombosis with concomitant pancreaticoduodenal artery pseudoaneurysm in a 60-year-old male patient - A case report.

INTRODUCTION: Vascular complications like superior mesenteric artery (SMA) thrombosis and pancreaticoduodenal artery (PDA) pseudoaneurysm carry high morbidity and mortality. SMA provides the primary arterial supply to the small intestine and ascending colon. PDA aneurysms are extremely rare, accounting for only 2 % of all visceral artery aneurysms. We present a rare case of SMA thrombosis with concomitant PDA pseudoaneurysm. CASE PRESENTATION: Herein is the case of a 60-year-old male who presented with rectorrhagia, persistent generalized abdominal pain. After being diagnosed with colitis and mesenteric artery thrombosis based on a computed tomography (CT) scan, he was discharged from the hospital with rivaroxaban and mesalazin. However, he had to return to the hospital due to worsening of the symptoms. After a proper workout, SMA artery thrombosis with a concomitant PDA pseudoaneurysm was diagnosed for him. Therefore, he underwent surgery to stent the thrombosis and coil the pseudoaneurysm. His symptoms dramatically improved after the treatment. DISCUSSION: Angiography is the diagnostic and, with embolization, therapeutic procedure of choice, with surgery as a backup if embolization fails. However, even with these procedures, the mortality rate is high if the pseudoaneurysm ruptures. CONCLUSION: In order to carry out the proper choice of surgical treatment before further complications occur, SMA thrombosis and PDA pseudoaneurysms must be investigated in each patient presenting with nonspecific abdominal pain, regardless of the risk factors.

In-hospital outcomes of ruptured abdominal aortic aneurysms: A single center experience.

Introduction: Ruptured abdominal aortic aneurysm (RAAA) is a catastrophic condition with in-hospital mortalities up to 89%. Patient survival depends on multiple factors; however, prompt surgery is essential to prevent mortality. We report the in-hospital outcomes of RAAA at a high-volume and teaching vascular surgery center in Iran. Methods: This study is a single-center retrospective analysis of patients with infrarenal RAAA during February 20, 2012 to December 21, 2019 at Shohada-Tajrish Medical Center, Tehran,Iran. We identified 66 patients with RAAA during the study period. The patients were dividedinto two groups based on their transfer status (Transfer group versus non-transfer group). The primary outcome was in-hospital death. The secondary outcomes were in-hospital myocardial infarction (MI), abdominal compartment syndrome (ACS) and postoperative renal dysfunction requiring dialysis. Results: The mean age of the patients was 74.2 ± 8.3 years. Forty-seven patients (71.2%) were transferred to our center from other institutions. There were 46 in-hospital deaths (69.7%) and three in-hospital MIs (4.5%). Three patients (4.5%) had postoperative ACS and six patients (9.1%)had postoperative renal dysfunction requiring dialysis. Transfer patients had an increased rate of in-hospital death compared to non-transferred patients (76.6.1% versus 52.6%); however, the difference was not statistically significant (P =0.055). Conclusion: We found no significant different between operative mortality of transferred and non-transferred RAAA patients. Transfer of patients to tertiary centers with experienced vascular surgeons may delay the surgery. However, the transfer may be inevitable in areas where the optimal care of RAAA patients is not possible.

Simultaneous resection of abdominal aortic aneurysm and left renal cell carcinoma: A rare case and review of the literature.

We report a rare case of concomitant abdominal aortic aneurysm (AAA) and left renal cell carcinoma (RCC). The patient was an 81-year old man who presented with vague abdominal pain. The investigations revealed a 110*73*62 mm AAA together with 69*56 left renal mass. Open repair of AAA with left radical nephrectomy was conducted. A simultaneous procedure is safe and does not increase morbidity and mortality in selected cases.

Rare presentation of retroperitoneal schwannoma: a case report.

The deadly Schwannomas, as uncommon subtype of soft tissue tumors originate from peripheral nerve sheaths. Retro peritoneum is an uncommon site for these tumors. Here we present the clinical feature and therapeutic implication of a 38-year-old man affected by recurrent retroperitoneal schwannoma who admitted to emergency ward following abdominal pain. Computed Tomorgraphic Scan showed a solid well-differentiated heterogeneous mass, 8.5x6 cm size in portahepatis beneath liver and right periumbilical .On laboratory tests Cancer Antigen 19-9 and Cancer Embryonic Antigen were in normal range. In surgery, a 7x8cm round mass was discovered at juxta renal juxta duodenal retro peritoneum, It was completely adhered to second part of duodenum with no signs of infiltration of the liver and right kidney, unable to simply being enucleated, curative resection was performed by classical whipple procedure. The patient`s hospitalization course was uneventful and on the second week he was discharged from the hospital with complete recovery. Due to the high recurrent rate of retroperitoneal Schwannomas even in benign circumstances, radical resection would be the treatment of choice.

Familial adenomatous polyposis: ileo-anal pouch versus ileo-rectal anastomosis.

AIM: In this study we describe the presentation, treatment, and complications of 27 FAP patients. BACKGROUND: Treatment of Familial adenomatous polyposis (FAP) is centered on early recognition and curative surgery with either restorative proctocolectomy with ileal-pouch-anal-anastomosis (IPAA) or colectomy with ileo-rectal anastomosis (IRA). PATIENTS AND METHODS: All patients diagnosed with FAP at our center from 2008 to 2012 were included in this case series. Either IPAA or IRA was used for treatment. Complications were recorded for 12 months after the procedure. RESULTS: Overall 27 patients were included, 12 (44.44%) index patients, and 15 (55.55%) relatives diagnosed by screening. Eight Index patients presented with rectal bleeding, two with occult fecal blood and two with abdominal masses found to be desmoid tumors. Nineteen patients were treated by IPAA, 6 with IRA, and 2 were inoperable due to diffuse desmoid tumors. Daytime stool frequency was the most common side effect (70.37%), followed by bowel discomfort episodes (55.56%), requiring dietary restrictions (37.4%), passive incontinence (25.93%), soiling (22.22%), nighttime stool frequency (18.52%), flatus incontinence (16.0%), and anastomosis leakage (3.70%). On average patients treated by IPAA experienced less complication than those treated by IRA. CONCLUSION: compared with previous reports, this series had older age of diagnosis, higher rate of adenocarcinoma at diagnosis, and fewer side effects after IPAA than IRA. The latter may reflect technique improvement with experience, and if supported by future studies, will cement IPAA as the treatment of choice in FAP.

Neo-adjuvant chemoradiotherapy; an opportunity in sphincter preserving procedure for rectal cancer.

AIM: The present study was designed to assess the impact of neo-adjuvant chemoradiotherapy on the possibility of utilizing sphincter preserving techniques in rectal cancer surgery. BACKGROUND: For both patients and surgeons anal sphincter preserving surgery serves as the ideal procedure to treat rectal cancer. PATIENTS AND METHODS: Patients with rectal cancer who were admitted to Shohadaye Tajrish hospital between 2001 and 2011 and underwent sphincter preserving or non-preserving surgery were identified. They were divided into those who had received neo-adjuvant chemo-radiotherapy prior to surgery and those who didn't, and the type of surgical procedure they underwent was compared between the two arms. Data regarding tumor pathology, tumor size and distance from anal verge before and after neo-adjuvant therapy, together with the duration of chemo-radiotherapy were also assessed. RESULTS: 103 patients with documented rectal cancer were included in our analysis. Among 47 patients who had not received neo-adjuvant therapy, 26 (55%) underwent APR while 15(32%) and 6(13%) patients were treated with LAR and VLAR respectively. Of the 56 patients who had gone through chemo-radiotherapy prior to surgery, 30 (53%) underwent APR while 14 (25%) and 10 (18%) patients were treated with LAR and VLAR respectively. 2 patients had unresectable tumor. Tumor staging before and after neo-adjuvant therapy showed a statistically significant difference (p=0.0001). CONCLUSION: Neo-adjuvant chemo-radiotherpy can decrease tumor size, increase the distance between the tumor and anal verge, and downgrade the staging. However, it does not necessarily increase the possibility of performing sphincter preserving surgery on patients suffering from low-lying tumors.

Effectiveness of aspirin on double lumen permanent catheter efficacy in ESRD.

BACKGROUND: The complications of vascular access are the most imperative etiology for hospitalization, morbidity and mortality in chronic hemodialysis. The most prevalent complication of central catheter is dysfunction due to thrombosis. Aspirin is an anti-aggregative platelet drug that may increase the patency of permanent catheters (perm-cath). OBJECTIVES: The aim of this study was to evaluate the role of Aspirin in perm-cath survival. PATIENTS AND METHODS: This study included a total of 185 ESRD cases according to the inclusion criteria for perm-cath insertion in hemodialysis. One hundred and eighty patients following perm-cath insertion had proper blood flow through perm-cath during hemodialysis. Patients were randomly divided between intervention (80 mg/day Aspirin initiated a day following catheter insertion) and control (placebo) groups. The average time that the perm-cath was functional was noted. Demographic characteristics included comorbidities and past history were also used to address probable influence on perm-cath function and patency. RESULTS: The mean survival time of the catheter in Aspirin group was significantly higher than the control group (5.3 ± 4.7 month versus 3.9 ± 2.7 month, P = 0.012). No significant difference in major complications of Aspirin use (such as GI bleeding) was noted between two groups (P = 0.52). In terms of the patient's demographic characteristics, those of the female gender and a history of diabetes mellitus were found to have significant influence on median survival rate of the catheters (P = 0.021, 0.043 respectively). CONCLUSIONS: These results suggest that Aspirin use following perm-cath insertion might be beneficial for catheter survival. This increased survival time might enable patient's use of AVF maturation for long term dialysis access.