Herramientas para el tamizaje de aneurisma de aorta abdominal / Tools for abdominal aortic aneurysm screening

Introducción. El aneurisma de la aorta abdominal (AAA) es la dilatación de la aorta abdominal mayor de 1,5 veces el diámetro esperado. Su prevalencia es variable, con tasas reportadas de hasta el 12,5 %. Se considera como causa de muerte de más de 10.000 personas al año en los Estados Unidos. El objetivo de esta revisión de la literatura fue describir los factores de riesgo y las herramientas de tamizaje de AAA. Métodos. Se realizó una búsqueda de la literatura utilizando dos ecuaciones en bases de datos electrónicas, empleando términos seleccionados de "Medical Subject Heading" (MeSH) y "Descriptores en Ciencias de la Salud" (DeCS). Se evaluó la calidad de los estudios con la herramienta STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). Resultados. Se recolectaron 40 artículos y a partir de ellos se construyó el texto de revisión, identificando en estos, los factores de riesgo asociados al desarrollo de AAA, tales como sexo masculino, tabaquismo, hipertensión arterial, antecedente familiar y obesidad, entre otros. La diabetes mellitus parece actuar como factor protector. Dentro de los instrumentos de tamizaje, el ultrasonido abdominal es uno de los más usados. Conclusión. El AAA es una patología multifactorial. En la actualidad la ultrasonografía de aorta es el método de elección para el tamizaje, permitiendo la detección precoz. El tamizaje de AAA con métodos no invasivos, como el ultrasonido, es útil sobre todo en zonas con prevalencia alta de la patología y en pacientes con determinados factores de riesgo.

Introduction. Abdominal aortic aneurysm (AAA) is a dilation of the abdominal aorta greater than 1.5 times the expected diameter. Its prevalence is variable, with reported rates of up to 12.5%. It is considered the cause of death of more than 10,000 people a year in the United States. The objective of this literature review was to describe risk factors and screening tools for AAA. Methods. A literature search was conducted using two equations in electronic databases, using terms selected from "Medical Subject Heading" (MeSH) and "Descriptors in Health Sciences" (DeCS). The quality of the studies was evaluated with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) tool. Results. Forty articles were collected and from them the review text was constructed, identifying the risk factors associated with the development of AAA, such as male sex, smoking, high blood pressure, family history and obesity, among others. Diabetes mellitus seems to act as a protective factor. Among the screening instruments, abdominal ultrasound is one of the most used. Conclusion. AAA is a multifactorial pathology. Currently, aortic ultrasonography is the method of choice for screening, allowing early detection. Screening for AAA with non-invasive methods, such as ultrasound, is useful especially in areas with a high prevalence of this pathology and in patients with certain risk factors.

Ascending Aortic Surgery for Small Aneurysms in Men and Women

ABSTRACT Introduction: According to recent data, thoracic aortic surgery has reduced morbidity and mortality including ascending aortic aneurysm treatment; however, women are at increased postoperative risk of adverse outcomes. Objective: Our aim was to evaluate early and late outcomes in male and female patients who underwent pre-emptive ascending aortic replacement (AAR). Methods: From January 2013 to September 2021, 91 patients (56 [61.5%] men and 35 [38.5%] women) underwent AAR for small (ranged from 5.0 to 5.5 cm) non-syndromic aneurysms. A propensity score-based adjustment of the groups was performed. We compared clinical outcomes between males and females. Results: Preoperative normalized aortic diameters were significantly larger in females (2.9 [2.7; 3.2] cm/m2) than in males (2.5 [2.3; 2.6] cm/m2, P<0.001), without differences in absolute values (51 [49; 53] mm vs. 52 [50; 53] mm, P=0.356). There were no significant differences in neurological, cardiac, pulmonary, and renal complications in both groups before and after matching. In-hospital mortality was 1 (1.8%) and 2 (5.7%) (P=0.307) in male and female patients in unmatched groups and 1 (2.9%) and 2 (5.7%) (P=0.553) in matched groups, respectively. Univariate logistic regression analysis revealed that the only risk factor for in-hospital mortality was age (odds ratio 1.117, 95% confidence interval 1.003-1.244; P=0.04). The overall survival rate was 83.5±0.06% in men and 94.3±0.04% in women at 36 months (P=0.404). Conclusion: Ascending aortic surgery for aneurysms ranged from 5.0 to 5.5 cm seems to have tolerable early and late outcomes in men and women.

Procedural and long-term outcomes of elective endovascular abdominal aortic aneurysm repair in octogenarians / Resultados perioperatorios y a largo plazo de la reparación electiva endovascular del aneurisma de aorta abdominal en octogenarios

Abstract Objective: The aim of the study was to compare the immediate and long-term outcomes of endovascular aneurysm repair (EVAR) between patients under and over the age of 80 with abdominal aortic aneurysm (AAA). Methods: From 2011 to 2017, we conducted a retrospective cohort study with AAA patients who received elective EVAR. Primary outcomes included hospital mortality, length of stay, acute kidney injury, and the need for re-interventions. Secondary outcomes included aneurysm-related mortality, acute myocardial infarction, stroke, acute limb ischemia, and prolonged mechanical ventilation. Results: A total of 77 (62.6%) patients under the age of 80 years old and 46 (37.4%) octogenarians were included in the study. The male gender and AAA diameter did not differ among groups (92.2% vs. 82.6%, p = 0.11 and 5.4 cm [4.9-6.2 cm] vs. 5.4 cm [5-6 cm], p = 0.53, respectively). The younger patients had a higher prevalence of tobacco use (72.7% vs. 41.7%, p = 0.01). There were no deaths during the index hospitalization. The incidence of reinterventions (5.3% vs. 15.2%, p = 0.11) and acute kidney injury (14.3% vs. 23.9%, p = 0.18) did not differ between groups, but the length of stay was longer for octogenarian patients (3 days [2-4] vs. 2 days [2-3, p = 0.04]). Endoleaks were the most common cause for re-interventions (81.8%), with a prevalence of 34% across the entire cohort. There were no differences in any of the secondary outcomes between groups. Conclusion: In octogenarian patients with AAA, EVAR represents a safe procedure both during the index hospitalization and during long-term follow-up.

Resumen Objetivo: Comparar los resultados inmediatos y a largo plazo de la reparación endovascular del aneurisma de aorta abdominal (REVA) entre pacientes menores de 80 años y octogenarios. Método: Cohorte retrospectiva que incluyó pacientes con aneurisma de aorta abdominal (AAA) sometidos a REVA electiva desde 2011 hasta 2017. Se evaluaron como punto finales primarios la mortalidad hospitalaria, la duración de la estadía hospitalaria, la incidencia de insuficiencia renal aguda y el requerimiento de reintervenciones. Los puntos finales secundarios incluyeron la mortalidad asociada al aneurisma, infarto agudo de miocardio, accidente cerebrovascular, isquemia arterial aguda de las extremidades y ventilación mecánica prolongada. Resultados: Se incluyeron 77 (62.6%) pacientes menores de 80 años y 46 (37.4%) octogenarios. La prevalencia de sexo masculino y el diámetro del AAA no difirieron entre ambos grupos (92.2% vs. 82.6%, p = 0.11 y 5.4 cm [4.9-6.2 cm] vs. 5.4 cm [5-6 cm], p = 0.53, respectivamente). Los pacientes más jóvenes presentaron una mayor prevalencia de tabaquismo (72.7% vs. 41.7%, p = 0.01). No se registraron muertes durante la hospitalización índice. La incidencia de reintervenciones (5.3% vs. 15.2%, p = 0.11) e insuficiencia renal aguda (14.3% vs. 23.9%, p = 0.18) no difirieron entre ambos grupos, pero la estadía hospitalaria fue más prolongada en pacientes octogenarios (3 días [2-4 días] vs. 2 días [2-3 días], p = 0.04). La causa más frecuente de reintervenciones fue la presencia de endofugas (81.8%), con una prevalencia del 34% en toda la cohorte. No se observaron diferencias en ninguno de los puntos finales secundarios entre ambos grupos. Conclusión: En pacientes octogenarios con AAA, la REVA presentó un buen perfil de seguridad perioperatorio y a largo plazo.

Tratamiento endovascular de aneurismas con anatomía aórtica compleja / Endovascular treatment of aneurysms with complex aortic anatomy

RESUMEN Introducción: la anatomía arterial es la principal limitante para el abordaje aórtico endovascular estándar. Presentamos nuestra experiencia para la reparación endovascular de aneurismas aórticos complejos. Material y métodos: estudio observacional retrospectivo en pacientes con aneurismas complejos (yuxta/pararrenales y toracoabdominales) tratados en forma consecutiva mediante: endoprótesis fenestradas (FEVAR), ramificadas (BEVAR), con EndoAnchors (ESAR), o en chimenea (ChEVAR). La decisión de la técnica fue determinada con base en la anatomía arterial. Resultados: se evaluaron los últimos 50 procedimientos (6 mujeres; edad promedio 71,3 años; diámetro 69,6mm; 3 pacientes con aneurismas complicados), de los cuales 22 recibieron FEVAR (2,8 fenestraciones / paciente), 11 BEVAR, 11 ESAR y 6 ChEVAR (1,8 chimeneas /paciente). La tasa de éxito técnico fue del 100% (ausencia de endoleak I o III con permeabilidad adecuada de los vasos viscerales). A 30 días 3 pacientes fallecieron (6%). Durante el seguimiento, 5 pacientes presentaron oclusión de la arteria renal, repermeabilizada en 4. Cuatro pacientes desarrollaron un endoleak tipo IA (3 ESAR secundarios y un ChEVAR), un paciente un endoleak IC y un cuarto uno IIIB (22%, 3 de los 11 ESAR, ninguno de los FEVAR industriales). En el análisis de supervivencia, la supervivencia global fue del 88,6% al año, y libre de reoperación del 86,5%. Conclusiones: se trata de la primera publicación en nuestro medio que muestra un enfoque global del paciente con un aneurisma de aorta complejo, de acuerdo con sus características anatómicas. Estas tecnologías ya desempeñan un papel primario en el tratamiento de estos pacientes.

ABSTRACT Background: Arterial anatomy is the main limiting factor for standard endovascular aortic (EVAR) approach. We present our experience for endovascular repair of complex aortic aneurysms. Material and Methods: This is a retrospective observational study in patients with complex aneurysms (juxta/pararenal and thoracoabdominal) treated consecutively with: fenestrated (FEVAR), branched (BEVAR), EndoAnchors (ESAR), or chimney (ChEVAR) stents. The decision of the technique was determined based on the arterial anatomy. Results: The last 50 procedures were evaluated (6 women; mean age 71.3 years; diameter 69.6 mm; and 3 patients with complicated aneurysms), among whom 22 received FEVAR (2.8 fenestrated stents/patient), 11 BEVAR, 11 ESAR and 6 ChEVAR (1.8 chimney stents/patient). Technical success rate was 100% (absence of type I or III endoleak with adequate patency of the visceral vessels). Three patients died within the first 30 days (6%). During follow-up, 5 patients presented with renal artery occlusion, treated successfully in 4 cases. Four patients developed type IA endoleak (3 secondary ESAR and one ChEVAR), one patient IC endoleak and almost a quarter of cases type IIIB endoleak (22%, 3 out of 11 patients receiving ESAR, none of the industrial FEVAR group). In survival analysis, overall survival analysis was 88.6% at one year, and 86.5% of cases were free from reoperation. Conclusions: This is the first publication in our setting that shows a global approach to the patient with complex aortic aneurysm, according to the anatomical characteristics. These technologies already play a primary role in the treatment of these patients.

Manejo del aneurisma de aorta abdominal sintomático no roto: últimos adelanto / Management of symptomatic unruptured abdominal aortic aneurysms: state of the art

RESUMEN El aneurisma de aorta abdominal (AAA) sintomático no roto es una patología que involucra a aquellos pacientes con AAA intacto, pero que presentan dolor abdominal y/o lumbar atribuido al aneurisma. Esta forma de presentación clínica es po tencialmente mortal dado que su etiopatogenia comprende cambios agudos en la pared aórtica, incluyendo inflamación, lo que incrementa la probabilidad de ruptura inminente. Está claro que estos pacientes deben ser derivados a reparación del AAA. Sin embargo, el momento de la intervención es controvertido. Por lo tanto, el objetivo del presente trabajo fue revisar la información actualizada sobre el abordaje diagnóstico-terapéutico del AAA sintomático no roto.

ABSTRACT Symptomatic unruptured abdominal aortic aneurysm (AAA) refers to a group of patients with intact AAA but who present abdominal and/or lumbar pain attributed to the aneurysm. This form of clinical presentation is potentially fatal since its etiopathogenesis, involving acute changes in the aortic wall, including inflammation, increases the probability of impending rupture. It is clear that these patients should be referred to AAA repair. However, the timing of the intervention is contro versial. Therefore, the aim of the present work was to review updated information on the diagnostic-therapeutic approach of symptomatic unruptured AAA.

Difficult Ventilation in a Patient with a Giant Aortic Aneurysm: A Challenge for the Anesthesiologist

Patients with Marfan syndrome present anatomic variations that may increase the risk of a difficult airway. Moreover, they can present large aortic aneurysms, which may cause extrinsic airway compression. Therefore, difficult ventilation during general anesthesia poses a challenge in that the anesthesiologist has to promptly make a crucial differential diagnosis. Multidisciplinary preoperative assessment and planning of the airway and ventilation management are of utmost importance in such uncommon and highly complex clinical cases. Fiberoptic bronchoscopy is probably a really useful tool in order to assess the severity and extent of the airway compression, both preoperatively and intraoperatively. We present a clinical case where difficult ventilation occurred immediately after the induction of general anesthesia.

Nefroprotección en frío para reparo de ectasia aórtica y aneurismas ilíacos bilaterales ante la presencia de riñón ectópico pélvico / Cold nephroprotection for repair of aortic ectasia and bilateral iliac aneurysms in the presence of pelvic ectopic kidney

Resumen Los riñones ectópicos pélvicos solitarios asociados a degeneración aneurismática de las arterias ilíacas y la aorta abdominal son eventos muy raros. Los enfoques quirúrgicos para la corrección de aneurismas con compromiso renal son un desafío por la falta de consenso actual, en especial cuando cursan con riñones ectópicos pélvicos solitarios funcionales asociados. Por tal motivo, una de las estrategias que ha demostrado buenos resultados a corto y mediano plazo es la nefroprotección en frío, la cual puede ser usada con seguridad en estos pacientes. En el caso que se presenta, se evidenció una ectasia aórtica con aneurismas ilíacos bilaterales asociados con un riñón ectópico pélvico solitario en un paciente masculino de 75 años, con hipertensión arterial y dislipidemia. Se realizó una reconstrucción aortoilíaca bilateral y una reconstrucción de la arteria hipogástrica, además de reimplante de la arteria renal ectópica bajo irrigación renal en frío, sin complicaciones y preservación de la función renal.

Abstract Solitary pelvic ectopic kidneys associated with aneurysmal degeneration of the iliac arteries and abdominal aorta are very rare events. Surgical approaches for the correction of aneurysms with renal involvement are challenging due to the lack of current consensus, especially when they are associated with functional solitary pelvic ectopic kidneys. For this reason, one of the strategies that has shown good results in the short and medium term is cold nephroprotection, which can be used safely in these patients. In the present case, aortic ectasia with bilateral iliac aneurysms associated with a solitary pelvic ectopic kidneys was evidenced in a 75-year-old male patient with arterial hypertension and dyslipidemia. Bilateral aortoiliac reconstruction was performed with hypogastric artery reconstruction and reimplantation of the ectopic renal artery under cold renal irrigation, without complications and preservation of renal function.

Quadricuspid Aortic Valve with Ruptured Sinus of Valsalva Aneurysm: a Case Report

Abstract Quadricuspid aortic valve (QAV) and sinus of Valsalva aneurysm (SVA) are rare congenital anomalies. We report an elderly patient with QAV associated with a ruptured SVA to the right atrium. Transthoracic echocardiographic and computed tomographic images are presented. We emphasize the important role of computed tomography angiography in establishing and confirming the diagnosis and facilitating treatment planning. The patient was successfully operated by a minimally invasive approach.

Impact of Reconstructing Intercostal Artery on Spinal Cord Circulation During Open Surgery for Thoracoabdominal Aortic Aneurysm

ABSTRACT Introduction: We evaluated the outcomes of the selective intercostal artery reconstruction for preventing spinal cord injury during thoracoabdominal aortic aneurysm repair. Methods: We retrospectively assessed 84 consecutive patients who underwent thoracoabdominal aortic aneurysm repairs between 2004 and 2016. The mean age of the patients was 57.3 years. We performed preoperative multidetector computed tomography in 74 patients (88.0%) to identify the Adamkiewicz artery. Spinal cord injury preventive measures included motor evoked potential monitoring, hypothermia induction, Adamkiewicz artery or other intercostal artery reconstruction, and cerebrospinal fluid drainage. Results: The hospital death rate was 5.9%, and paraplegia occurred in four patients (4.7%). The Adamkiewicz artery or other intercostal arteries were reconstructed selectively in 46 patients (54.7%). Of these patients, 41 underwent postoperative multidetector computed tomography, which revealed occlusion of the reconstructed grafts in 23 patients (56.0%). There was no paraplegia in the patients who underwent reconstruction of the Adamkiewicz artery, which was patent on postoperative multidetector computed tomography. Univariate analysis showed no significant effect of various risk factors on the development of spinal cord injury. Conclusion: Outcome of open surgery for thoracoabdominal aortic aneurysm in our institution regarding spinal cord injury was satisfactory. The benefits of Adamkiewicz artery reconstruction remain inconclusive, and further larger studies are required to identify its validation for spinal cord protection in thoracoabdominal aortic aneurysm repair.

Fast-track protocol of endovascular aneurysm repair for ruptured abdominal aortic aneurysm / 中国医师进修杂志

Objective:To analyze the effective and safety of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (RAAA) at one tertiary center, and to improve the outcomes of RAAA under fast-track protocol.Methods:Nineteen cases of RAAA in the 940th Hospital of Joint Logistic Support Force of PLA from January 2014 to December 2020 were reviewed retrospectively. EVAR-fist strategy was employed from the emergency room to the operating room by using fast-track protocol. Preoperative management, anatomic characteristics, choice of anesthesia, operative procedures and postoperative complications were collected and analyzed. Abdominal compartment syndrome (ACS) and hospital mortality were paid special attention.Results:Nineteen cases were undergone EVAR procedures. The age was (73.4 ± 7.4) years old, and the AAA size was (67.8 ± 13.6) mm. Two cases underwent cardiopulmonary resuscitation at emergency department. General anesthesia was used in 13 patients and local anaesthesia in 6 patients. Successful stent graft deployment was achieved in all cases. The duration from emergency room to operating room was (84.8 ± 22.4) min. The hospital stay time was (9.7 ± 5.7) d. The hospital mortality was 5/19. The 5 deaths were reviewed: 3 died for multiple organ failure, 1 for irreversible shock, and 1 for ongoing bleeding.Conclusions:Excellent results were confirmed by using EVAR-first strategy for RAAA. The management of hemodynamically unstable state, standardized endovascular procedure, fast-track program and multidiscipline team collaboration were the very important determining factors for the implementation of EVAR. Focused efforts to reduce RAAA mortality are warranted.

Clinical application of G-iliac? iliac branch device in the treatment of common iliac artery aneurysm / 国际外科学杂志

Objective:To analyze the safety and efficacy of G-iliac? iliac branch device (IBD) in the treatment of common iliac artery aneurysm.Methods:The clinical data of 7 patients with common iliac artery aneurysm who were treated with G-iliac? IBD and internal iliac artery (IIA) preserved were retrospectively analyzed in the Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University from June 2021 to June 2022, and the surgical effects and related complications were analyzed.Results:All 7 patients were male, aged from 57 to 80 years, with an average age of 70.9 years. There were 6 cases of abdominal aortic aneurysm combined with common iliac artery aneurysm and 1 case of simple common iliac artery aneurysm, all of them were successfully applied with G-iliac? IBD to preserve IIA. Cardiogenic shock occurred in 1 patient after the operation. 7 patients were followed up for 3-15 months, with an average of 8 months. During the follow-up period, the iliac artery and IIA stents were all patency, and there was no IBD-related endoleak, stent displacement, buttock claudication, sexual dysfunction, or aortic-related death. The diameter of abdominal aortic aneurysm and common iliac artery aneurysm were stable.Conclusion:For patients with common iliac artery aneurysm, preservation of IIA with G-iliac? IBD is a safe and effective technique with a high technical success rate and IIA patency rate, and has a low complication rate, but the long-term effect still requires more data and longer follow-up data to support.

Effects of Aneurysmal Neck Angle on Stent Displacement after Endovascular Repair of Abdominal Aortic Aneurysm / 医用生物力学

Objective To study the effects of aneurysmal neck angle on stent displacement after endovascular repair of abdominal aortic aneurysm (AAA). Methods The CT images of 28 patients were selected to establish preoperative AAA model, postoperative AAA model and covered stent model respectively, and the models were divided into non-severe angulation group ( n = 14) and severe angulation group ( n = 14) according to the preoperative angle of tumor neck. The geometric shape of each model was measured, and the changes of AAA geometric parameters and postoperative stent displacements before and after surgery were analyzed. The displacement force of the model during the first follow-up was calculated by hemodynamic simulation. Results Significant differences were found in tumor length, maximum diameter, displacement force, tumor neck length and tumor volume between two groups of patients (P 0. 05). For the incidence of internal leakage, there were 2 cases in non-severe angulation group and 4 cases in severe angulation group (P>0. 05).Conclusions Severe neck angulation can lead to a significant increase in support displacement force and decrease in proximal anchorage zone, and thus increase the possibility of support displacement. It is suggested that doctors should strengthen postoperative follow-up for patients with severe neck angulation and be vigilant of the occurrence of long-term internal leakage in clinic.

A Case of Effective Zone 0 TEVAR Using Squid-Capture Assisted in situ Stent-Graft Fenestration, for Endoleak from the Fenestration of Najuta / 日本心臓血管外科学会雑誌

We report the case of a 76-year-old man who developed type IA endoleak through the fenestration after 1-debranch TEVAR using a Najuta endograft. The patient was admitted with expansion of the aneurysm after TEVAR, for additional therapy. Type IA endoleak through a fenestration has remained a significant clinical concern and its treatment is challenging. We performed Zone 0 TEVAR using the “Squid-Capture” technique assisted in situ stent-graft fenestration. Cerebral vessels were perfused by a percutaneous cardiopulmonary support system during in situ stent-graft fenestration, and the cerebral branch was clamped at the proximal site. It is difficult to operate the catheter inside the endoskeleton structure of a Najuta endograft, but several innovations were effective. Test dilation of the balloon catheter was performed to ensure that the wire did not interfere with the endoskeleton. Avoiding interference with the endoskeleton is important. The Squid-Capture technique allows safe and secure puncture of the graft. The operation was completed successfully. After this procedure, the endoleak disappeared. It is considered to be a useful method for treatment of endoleak through the fenestration.

Two Cases of Descending Aortic Diverticulum Associated with the Right-Sided Aortic Arch / 日本心臓血管外科学会雑誌

Case 1 is a 70-year-old male. He has a history of cholelithiasis and left inguinal hernia. A preoperative examination of the inguinal hernia showed the enlargement of the mediastinal shadow, and he was referred to our department. A close examination revealed a right-sided aortic arch, a right descending aorta, and a descending aortic diverticulum. No subjective symptoms, intracardiac malformations, or other cardiovascular diseases were observed. The surgery was scheduled for descending aorta replacement including a diverticulum with right posterior lateral 4th intercostal thoracotomy and lower body partial extracorporeal circulation. However, due to aortic intima injury at the proximal end, hypothermic cerebral circulatory arrest and proximal anastomosis were performed by the open proximal method. There was no problem with the postoperative course, and he was discharged 19 days after surgery. Case 2 is a 51-year-old female. Born in China, she has lived in Japan for 15 years. No notable history. An abnormal shadow was shown on chest Xp performed in a medical examination, and aortic malformation was suspected on chest CT. She was referred to our department. The diagnosis was right-sided aortic arch, right descending aorta, aberrant left subclavian artery, and Kommerell diverticulum. There were no subjective symptoms and no intracardiac malformations. The operation was a two-stage operation. As the initial surgery, median sternotomy was performed, total arch replacement with intrathoracic reconstruction of the left subclavian artery, and open stent graft insertion, and the Kommerell diverticulum was covered with an open stent graft. We did not treat the diverticulum because it was located on the dorsal side. At 15 days after surgery, we performed embolization of the origin of the left subclavian artery from the Kommerell diverticulum. There was no problem with the postoperative course, and she was discharged 19 days after the initial surgery.

Treating Neurogenic Heterotopic Ossification around a Femur Following Paraplegia after an Open Surgery for Thoracoabdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

A 59-year-old man who was diagnosed with hypertension and a large thoracoabdominal aortic aneurysm was referred to our hospital for surgical treatment. He underwent open surgery and thoracic endovascular aneurysm repair in three stages. He developed paraplegia after the third surgery. Despite acute postoperative treatment and rehabilitation, his lower extremity motor function and bladder and bowel dysfunction did not improve. He was transferred to a recovery hospital 67 days after the third surgery. However, he was readmitted to our hospital about four months later for management of a refractory decubitus ulcer and recurrent urinary tract infections. Computed tomography revealed hematoma and calcification around the femur. Based on the clinical course and imaging findings, we diagnosed neurogenic heterotopic ossification associated with postoperative paraplegia in this patient. He had flap reconstruction for the ulcer. Finally, he was discharged 79 days after readmission. To date, no study has reported neurogenic heterotopic ossification associated with postoperative aortic aneurysm paraplegia. The mechanism underlying this condition is similar to the widely accepted process associated with traumatic spinal cord injury, and conservative treatment comprising pressure ulcer treatment and antibiotics was continued. Although acute rehabilitation is important after highly invasive aortic aneurysm surgery, rehabilitation is limited by the risk of neurogenic heterotopic ossification in patients with postoperative paraplegia, and recovery and maintenance of activities of daily living are challenging. To our knowledge, early diagnosis and prompt treatment for these complications are important considering neurogenic heterotopic ossification.

Intrapleural Urokinase and Antibiotic Therapy for Empyema after In Situ Reconstruction of the Aorta and Lobectomy for Aortopulmonary Fistula due to Thoracic Aortic Aneurysm Rupture / 日本心臓血管外科学会雑誌

A 62-year-old man presented with hemoptysis and hoarseness. He was diagnosed with an aortopulmonary fistula due to a thoracic aortic aneurysm rupture and was referred to our department. Emergency in-situ reconstruction of the aorta and pulmonary lobectomy were performed. Nine days postoperative, he developed empyema. Intrapleural urokinase and antibiotic therapy were selected as management instead of a video-assisted thoracoscopic debridement and decortication due to his worsening condition. The treatment was successful, and he was discharged from the hospital without any further complications. This study highlights the benefit of intrapleural administration of urokinase and antibiotics in patients with acute empyema, when surgical treatment is inappropriate.

Xanthogranulomatous Inflammation of the Aortic Aneurysm Wall after Endovascular Aortic Repair for Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

A 77-year-old woman underwent endovascular abdominal aortic repair (EVAR) for an abdominal aortic aneurysm (AAA)．Five years after surgery, she visited the hospital with the chief complaint of a fever. Enhanced computed tomography (CT) showed enlargement of the AAA around the stent-graft and a mass, which was suspected to be an abscess, outside the aneurysm. A blood test revealed a high level of inflammatory response. The patient was diagnosed with infectious AAA. She received antibiotics; however, the inflammatory response did not completely improve. A second CT scan revealed that the suspected abscess had a spreading tendency. The patient was referred to our hospital for a highly suspected stent-graft infection. We performed Y-graft replacement using a rifampicin-immersed graft, and as much as possible of the wall around the aortic aneurysm was removed. The inflammatory response improved rapidly after the operation, and the patient was discharged 15 days later. According to the results of a pathological examination, a diagnosis of xanthogranulomatous inflammation and fibrosis was made. Here, we report a rare case of xanthogranulomatous inflammation of the aortic aneurysm wall after EVAR.

Machine learning model predicts the occurrence of acute kidney injury after open surgery for abdominal aortic aneurysm repair / 中南大学学报(医学版)

OBJECTIVES@#Abdominal aortic aneurysm is a pathological condition in which the abdominal aorta is dilated beyond 3.0 cm. The surgical options include open surgical repair (OSR) and endovascular aneurysm repair (EVAR). Prediction of acute kidney injury (AKI) after OSR is helpful for decision-making during the postoperative phase. To find a more efficient method for making a prediction, this study aims to perform tests on the efficacy of different machine learning models.@*METHODS@#Perioperative data of 80 OSR patients were retrospectively collected from January 2009 to December 2021 at Xiangya Hospital, Central South University. The vascular surgeon performed the surgical operation. Four commonly used machine learning classification models (logistic regression, linear kernel support vector machine, Gaussian kernel support vector machine, and random forest) were chosen to predict AKI. The efficacy of the models was validated by five-fold cross-validation.@*RESULTS@#AKI was identified in 33 patients. Five-fold cross-validation showed that among the 4 classification models, random forest was the most precise model for predicting AKI, with an area under the curve of 0.90±0.12.@*CONCLUSIONS@#Machine learning models can precisely predict AKI during early stages after surgery, which allows vascular surgeons to address complications earlier and may help improve the clinical outcomes of OSR.

Report on Cardiac Gross Pathologic Measurements of Sudden Cardiac Death in Adults / 法医学杂志

OBJECTIVES@#To analyze the gross pathological data of sudden cardiac death (SCD) with different causes, to provide data support for the identification of sudden cardiac death with unknown causes.@*METHODS@#A total of 167 adult SCD cases in the archive of the Forensic Expertise Institute of Nanjing Medical University from 2010 to 2020 were collected. The gross pathological data of SCD cases were summarized and the characteristics of different causes of death were statistically analyzed.@*RESULTS@#The ratio of male to female SCD cases was 3.4∶1. Coronary heart disease was the leading cause of SCD, and mainly distributed in people over 40 years old. SCD caused by myocarditis was mainly distributed in young people and the mean age of death was (34.00±9.55) years. By analyzing the differences in cardiac pathological parameters of SCD with different causes, it was found that the aortic valve circumference was significantly dilated in the SCD caused by aortic aneurysm or dissection (P<0.05). The heart weight of SCD caused by aortic aneurysm or dissection and combined factors was greater, and both pulmonary and tricuspid valvular rings were dilated in the SCD caused by combined factors in adult males (P<0.05).@*CONCLUSIONS@#Various gross pathological measures of SCD with different causes are different, which has reference value in the cause of death identification of SCD.

Rare association between giant-cell aortitis and giant-cell aortic valvulitis

ABSTRACT Giant cell arteritis (GCA) is a type of chronic vasculitis that affects medium and large-caliber arteries, frequently related to aortic involvement and, consequently, to aneurysm formation. However, associated valvulitis with giant cells is uncommon. We describe the case of a 50-year-old female patient with aortic aneurysm and valvular insufficiency, whose anatomopathological examination revealed giant-cell aortic valvulitis associated with giant cell aortitis.