Midterm results of endovascular infrarenal abdominal aortic aneurysm repair in high-risk patients.

Short-term and midterm clinical outcomes after endovascular repair of abdominal aortic aneurysms (AAAs) have been well documented. Evaluation of longer term outcomes is now possible. Here we describe our initial 100 high-risk patients treated with endovascular aneurysm repair (EVAR), all with a minimum of 5 years of follow-up. A retrospective review of prospectively recorded data in a departmental database was undertaken for the first 100 consecutive EVAR patients with a minimum of 5 years (range, 60-105 months) of follow-up performed between December 1997 and June 2001. Information was obtained from surgical follow-up visits and family doctors' offices. Endovascular repair of AAA in high-risk patients can be achieved with acceptably low postoperative mortality and morbidity. Longer term results in this high-risk cohort suggest that EVAR is effective in preventing aneurysm-related deaths at 5 years and beyond. All late mortalities were due to patients' comorbid diseases.

Spontaneous aortic arch thrombus presenting as acute critical limb ischemia.

We report a case of a 52-year-old male who presented with acute leg ischemia and underwent successful femoral embolectomy and fasciotomies. Investigations revealed a pedunculated mass in the aortic arch, floating under the innominate and left common carotid arteries. Urgent resection was performed through a longitudinal aortotomy with deep hypothermic circulatory arrest and axillary artery perfusion to reveal a 2.5 x 1.5 cm pedunculated mass attached to the posterior aspect of the arch that was resected. Histology revealed thrombus material prompting lifelong systemic anticoagulation. On 3 months follow-up, the patient had returned to normal activities and computed tomography confirmed complete resection without recurrence. This case study demonstrates that spontaneous thrombus formation is possible in high-flow vascular regions such as the aortic arch and also confirms the importance of evaluating central sources of thromboemboli in patients presenting with acute limb ischemia. Urgent surgical removal is recommended and can be performed safely.