Repeat Surgery in Chronic Aortic Dissection: A New Technique without Touching the Native Aorta.

BACKGROUND: Repeat surgery of the chronically dissected aorta following repair of a Type-A acute aortic dissection (AAD) still represents a challenge. The proposed surgical options are as follows: (1) staged procedure with elephant trunk (ET) technique, (2) traditional frozen elephant trunk (FET) intervention, and (3) beating heart cerebral vessel debranching followed by thoracic endovascular aortic repair (TEVAR). However, a marked enlargement of the proximal descending thoracic aorta might make it difficult to perform FET/ET intervention. Furthermore, because in conventional surgery for AAD, a prosthetic graft replacement is generally limited to the ascending aorta, and in repeat surgery, this short Dacron graft rarely provides enough room to allow a beating heart cerebral vessel debranching and obtaining a reliable landing zone for the implantation of a firmly anchored stent graft. METHODS: We retrospectively reviewed all the five consecutive patients treated in our institution, between 2014 and 2017, for chronic aortic dissection after successful surgical treatment of acute Type-A aortic dissection with graft replacement limited to the ascending aorta. The five patients underwent repair utilizing a modified FET technique with total aortic arch and upper descending aorta exclusion without touching the native dissected aorta. RESULTS: No early- or midterm mortality was observed. Mean time interval between the initial and the reoperative procedure was 26 months (range, 3-80 months). No patient had a minor/major neurologic event. Mean circulatory arrest time was 16 minutes (range, 11-25 minutes). Mean follow-up time was 22 months (range, 9-42 months). CONCLUSIONS: We report our initial experience with a modified FET technique realized by anastomosing the stent graft with the previously implanted ascending aortic graft in Hishimaru's zone 0 and by rerouting all cerebral vessels without "touching" the native chronically dissected aorta. A larger number of patients and a longer follow-up will be required to confirm these initial encouraging results.

Electrocardiogram-gated 16-multidetector computed tomographic angiography of the coronary arteries in dogs.

The aims of this study were to assess if ECG-gated 16-multidetector CT (MDCT) provides sufficient temporal and spatial resolution to evaluate canine coronary arteries and provide a detailed description of their anatomy. A total of 24 dogs were included. Images were reviewed to assess: (1) coronary artery opacification and dominance; (2) choice of optimal R-R ECG reconstruction interval for both left coronary artery (LCA) and right coronary artery (RCA); (3) branching patterns of the left main coronary artery (LMCA); and (4) diameter and length of the LCA and RCA and classification of their branches by adapting a previously described segmental coding system. The degree of opacification of the coronary arteries was subjectively judged as excellent or good in five and 19 dogs, respectively. All hearts showed a left coronary dominance. The best R-R reconstruction interval for both LCA and RCA arteries was 75 per cent. Seven different subtypes of LMCA branching patterns were noted. The rami circumflexus and interventricularis paraconalis were divided into three angiographic segments, and the ramus septi interventricularis and the RCA in two and three segments, respectively. ECG-gated 16-MDCT coronary angiography provides adequate resolution to assist the basic anatomy of the main coronary artery branches.

Distal Ulnar Artery Aneurysm Repair by End-to-End Technique: A Case Report.

We report the case of a 33-year-old man presented with a posttraumatic 20-mm left ulnar artery aneurysm without intraluminal thrombus in the left hypothenar eminence. The patient reported left hand paresthesia. Because of symptoms and the embolic risk, we decide to plan an aneurysm resection and an interposition graft with inverted basilic vein for adequacy diameter (∼2 mm), but an end-to-end anastomosis was performed instead. We think that the posttraumatic distal artery aneurysm could be treated without a bypass but, after a meticulous anatomic dissection, with a microvascular anastomosis between the artery stumps.

Magnetic resonance imaging in the postsurgical evaluation of patients with mandibular condyle fractures treated using the transparotid approach: our experience.

PURPOSE: To evaluate the morphostructural and functional modifications of the temporomandibular joint and the onset of parotid complications in patients with extracapsular monocondylar fractures treated by reduction with the application of a titanium microplate via a transparotid approach. MATERIALS AND METHODS: The study was comprised of 20 patients (16 male patients and 4 female patients) with a mean age of 25 years (range, 15-44 years) who had undergone reduction of condyle fractures. Twelve months after surgery, all patients were examined by means of magnetic resonance imaging (MRI) of the temporomandibular joint and parotid gland on the treated side. MRI examination was performed by use of coronal T2-weighted turbo spin echo sequences, as well as parasagittal T1-weighted turbo spin echo and T2-weighted fast field echo sequences. Images were acquired from the resting position to the position of maximum oral opening. RESULTS: The 1-year clinical outcome in our patients was good. MRI showed, on the treated side, 5 cases of anterior dislocation of the disc (25%), 1 case of disc degeneration (5%), and 1 case of parotid fistula (5%). CONCLUSION: Both trauma and surgical intervention can damage the meniscal capsuloligamentous complex. MRI allowed the complications due to the trauma and/or treatment to be identified and made it possible to compare the condyles and joint function.