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Peripheral artery aneurysms,with low incidence and complex anatomic structure,often involve important branches.This paper introduces a new surgical technique-sleeve shaping on the basis of two cases.The basic data,including characteristics,imaging,operation and follow-up data of the cases,were collected.The data were then combined with the previous literature for explaining in detail that this technique can be used as a supplementary method of reconstruction following resection or endovascular repair.
Subject(s)
Humans , Aneurysm/surgery , Arteries , Treatment OutcomeABSTRACT
Objective To summarize the experiences of aneurysmorrhaphy for arteriovenous fistula aneurysms with acute thrombosis in hemodialysis patients.Methods There were 7 cases of arteriovenous fistula with acute thrombosis from Nov 2015 to Feb 2017 at our department of vascular surgery,Longhua Hospital.Results In all cases thrombosis was secondary to proximal stenosis or occlusion.The stenosis and occlusion were corrected with embolectomy and aneurysmorrhaphy.The proximal part of the cephalic vein was translocated to the basilic vein in 1 case,axillary vein in 2 cases;autologous vein graft in 1 case;resection of the occlusion,end-to-end anastomosis in 1 case;autogenous patch in 1 case.No perioperative complications occurred.The operation site was cannulated within one month after operation in all cases.Patients were followed up for 7 months to 23 months,all cases were patent.Conclusions Aneurysmorrhaphy is effective,reliable and safe for arteriovenous fistula aneurysms with acute thrombosis in hemodialysis patients.
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Background : Persistent endoleak is a major cause of aneurysmal enlargement or rupture after endovascular aneurysm repair (EVAR). Although several reports have described ligation of lumbar arteries and stent graft-conserving aneurysmorrhaphy as useful strategies, treatment for type II endoleak after EVAR is controversial. Objectives : We investigated the early results in 5 patients who underwent ligation of lumbar arteries and stent graft-conserving aneurysmorrhaphy for type II endoleak. Methods : A>10 mm increase in aneurysm diameter after primary EVAR or a maximum diameter>65 mm serve as indications for intervention for type II endoleak. Under general anesthesia, following transperitoneal exposure of the abdominal aorta, the infrarenal aorta was banded using a tape at the proximal landing zone. After the aorta was opened without clamping, the lumbar arteries were ligated, and a stent graft-conserving aneurysmorrhaphy was performed. Results : The mean interval from the primary EVAR was 47±17 months. The mean operation time was 215±76 min. Blood transfusion was necessary in 4 patients (estimated blood loss 1,260±710 ml). No in-hospital deaths were observed, and the mean postoperative hospital stay was 26±20 days. One patient developed aspiration pneumonia and 1 developed surgical site infection post-surgery. The diameter of the aneurysm changed from 68±8 to 47±5 mm during hospitalization and decreased further to 36±7 mm at the last follow-up. Conclusions : The early results of ligation of lumbar arteries and stent graft-conserving aneurysmorrhaphy were favorable. Although this strategy could be useful for aneurysmal dilatation secondary to persistent type II endoleak after EVAR, the indications for this approach should be determined following careful evaluation of the patient's status considering the invasiveness of the procedure.
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Hyperfunctioning fistulas are rare complications of hemodialysis access. They give rise to devastating complications, including a steal syndrome with reduced perfusion to the dependent limb and cardiac insufficiency caused by the high shunt volume. Numerous techniques such as fistula ligation, banding, plication, T-banding and distal revascularization with interval ligation have been developed. However, each technique bears the potential for its own complications, such as failure to resolve symptoms, recurrence and technical difficulty. Herein, we report a new technique that remedies the shortcomings of the other procedures. All the patients first underwent partial aneurysmal resection and lateral aneurysmorrhaphy of the enlarged vein from just distal to the anastomosis using a 6-0 prolene running sutures and then external wrapping with an 8 mm expanded polytetrafluoroethylene graft was done for a length of approximately 5 cm. Two patients with hyperfunctioning brachiocephalic arteriovenous fistula were treated this way. Doppler measurement of the fistula flow showed a mean flow reduction of about 60%. The procedure was effective and safe, with a mean follow up of 2 months.
Subject(s)
Humans , Aneurysm , Arteriovenous Fistula , Extremities , Fistula , Follow-Up Studies , Ligation , Perfusion , Polypropylenes , Polytetrafluoroethylene , Recurrence , Renal Dialysis , Running , Sutures , Transplants , Ursidae , VeinsABSTRACT
Simultaneous pulmonary trunk and ascending aortic aneurysms are very rare, and the role of surgery in this entity is not well defined. We report a rare case of aneurysm of both the pulmonary trunk and the ascending aorta, associated with pulmonary and aortic valve insufficiency in a 17-year-old boy. Cardiac disease had been diagnosed at the age of 5, and at that time, pulmonary and aortic valve insufficiency were found by ultrasound cardiography (UCG). At regular follow-up, both cardiac valve regurgitation and the dilatation of the aneurysm gradually increased. A recent computed tomographic scan revealed that the ascending aortic aneurysm was 55 mm and the pulmonary trunk aneurysm was 60 mm. A UCG also showed severe aortic valve regurgitation and moderate pulmonary valve regurgitation with no pulmonary hypertension. Surgical repair was performed successfully. The aortic valve was replaced with a mechanical valve. The dilated ascending aortic aneurysm was excised and replaced with a Dacron graft. The pulmonary trunk aneurysm was incised longitudinally. The pulmonary valve was tricuspid, and no organic leaflets change was observed. Pulmonary valvuloplasty by commissure plication of the prolapsed cusps was performed. A large portion of the anterior pulmonary aneurysm wall was excised and plicated to reduce the radius diameter. The pathology of the aneurysm wall showed infiltration of inflammatory cells in the tunica media, fragmentation and decrease of elastic fiber, loss of muscular tissue, and increase in collagen fibers. No cystic medial necrosis was observed in the pathologic specimen. The postoperative course was uneventful, and there were no adverse events or complications at 2 years follow-up. The following image study revealed the normal size of the great vessels.
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Giant serpentine aneurysm(GSA) is a giant aneurysm containing a serpentine channel which enters and exits at separate sites and is continuous with the parent vessel. This 33-year-old man with a two-year history of frontal headache presented with bitemporal hemianopsia three months before admission. Suprasellar mass of computed tomography revealed a giant(3X2.5X2cm) mixed density, mimicking a brain tumor. Cerebral magnetic resonance images showed a flow void within the mass, and this was consistent with the serpentine vascular channel demonstrated by angiography. The aneurysm was revealed by surgery involving the frontobasal interhemispheric approach, left A1 & A2 were clipped and the mass of the aneurysm was removed in toto an aneurysmorrhaphy was constructed, and to preserve the distal blood flow to the left A2, the patient made an unevenful recovery.