Outcome of Open Repair of Thoracoabdominal Aortic Aneurysm in Takayasu Arteritis: A Retrospective Analysis.

BACKGROUND: Takayasu Arteritis (TA) is an immune mediated arteritis causing inflammation of the aorta and its branches, which can result in aortic aneurysms. Our aim is to describe the outcome of surgical management in these patients who presented with Thoracoabdominal aortic aneurysm (TAAA). METHODS: Between 2003 and 2023, 40 TA patients with TAAA underwent operative repair. RESULTS: There were 24 females and 16 males, in the age group of 19-53 years, with hypertension in 20 patients. Raised Erythrocyte sedimentation Rate was present in 13 patients. According to Crawford classification, there were 2 patients with type I, 2 with type II, 17 with type III, 12 patients with type IV and 7 with type V aneurysm. Multiple steno-occlusive lesions of aortic branches were present in 21 patients, with majority affecting the renal artery. Femoral Artery Femoral Vein Partial cardiopulmonary bypass was used for types I, II, III and V. Separate bypass to visceral branches was done in eight patients, of whom five had multiple bypasses and three patients only had renal bypass. Twelve patients underwent reimplantation of branches, out of which nine had multiple vessel reimplantation. Four patients underwent staged repair of the aneurysm, which included visceral debranching in the first day, followed by repair of the aneurysm in the next day. In the immediate postoperative period, ten patients developed acute kidney injury and two required dialysis. Other morbidities included acute respiratory distress syndrome (ARDS), spinal cord dysfunction, bleeding, and wound complications. Three patients expired in the immediate postoperative period. Mean duration of intensive care unit stay was 4.1 days and hospital stay was 12.7 days. Comparison of disease activity with morbidity and mortality was statistically insignificant. Patients were on follow-up for a range of 6 months to 14 years and median follow-up of 25 months. Over this time period four patients expired and four developed anastomotic pseudoaneurysm requiring intervention. On comparing the disease activity at the time of surgery with the long-term arteritis related complications that required intervention, the P value was 0.653 and hence statistically not significant. The 10-year survival rate is 84.4%. CONCLUSIONS: Surgical repair has good and satisfactory outcome, with low early and late mortality rates. Progression of disease can occur at any stage of the disease, hence indicating the need for long term follow-up and frequent imaging.

Autologous versus allogeneic blood transfusion: A comparative study of the peri-operative outcomes in a tertiary care hospital in South India amidst the COVID-19 pandemic.

Autologous blood transfusion is known to have advantages over allogeneic transfusion. The COVID-19 pandemic intensified the already existing shortage of allogeneic blood supply. We carried out a study during this period with the aim to elicit the effects of autologous blood collection and transfusion, to compare the peri-operative outcomes of autologous and allogeneic transfusion practices and also to assess the influence of the autologous transfusion programme in the Blood Centre inventory. It was prospective observational comparative study among neurosurgical and vascular surgical patients in a tertiary care centre in South India. 141 patients were allocated into Group I (n = 71) who received autologous transfusion and those who received conventional allogeneic transfusion were clustered as Group II (n = 72) for analysis. We employed Acute Normovolemic Hemodilution (ANH), Pre-deposit Autologous Donation (PAD) and Intra-operative Cell Salvage (ICS) as various modalities for autologous blood collection. In our study, 43 (60.6%) from Group I received exclusive autologous blood transfusion, whereas 28 (39.4%) required additional allogeneic transfusion. No significant difference in hemoglobin, hematocrit, platelet count and INR were observed between the groups post transfusion. Significant difference was observed in the thoracoabdominal aortic aneurysm (TAAA) patients with respect to duration of ICU stay (2.7 ± 1.1 days in Group I and 6.2 ± 0.8 days in Group II; p = 0.002) and re-exploration due to bleeding (16.7% in Group I and 40% in Group II; p = 0.048). Autologous blood transfusion is safe and effective. It can be employed as routine practice and also during any acute shortage or pandemic.

A rare case of retro-hepatic inferior vena caval leiomyosarcoma - Computed tomography, surgical and intraoperative echocardiography imaging.

Leiomyosarcoma of retro-hepatic portion of inferior vena cava (IVC) is a rare vascular tumor with poor prognosis if adequate surgical resection is not achieved. Surgical repair includes dissection of the tumor and reconstruction of the IVC with a tube graft. Establishing a normal flow and gradient in IVC and hepatic veins is imperative for a successful repair. We report a case of retro hepatic IVC leiomyosarcoma where the preoperative computed tomography described the anatomy and extension of the tumor whereas intraoperative transesophageal echocardiography helped in the assessment of adequacy of surgical repair.

Femoral Vein Intravascular Synovial Sarcoma Mimicking Primary Deep Vein Thrombosis-A Rare Cause of Deep Vein Thrombosis.

Synovial sarcomas are rare malignant mesenchymal soft tissue tumors. We presented the case of a 53-year-old woman patient presenting with acute deep vein thrombosis, later diagnosed as a deep synovial sarcoma of the femoral vein wall. The tumor was identified through cross-sectional magnetic resonance angiography and computed tomography, followed by ultrasound-guided core biopsy. The case report emphasized the importance of considering the possibility of an intravascular neoplasm mimicking thrombus, particularly if calcifications, vein expansion with intravascular cystic spaces, fluid-fluid levels, and septations within a thrombosed vein are seen in imaging.

Double-barrel plugging in a recurrent aorto-enteric fistula.

Aorto-enteric fistulas (AEF) are uncommon causes of gastrointestinal bleeding. Both surgical and endovascular options are described for the management of AEF. A hybrid approach is recommended in cases of recurrent AEF. Herein we present a patient with recurrent secondary AEF with severe hypotension, melaena, and hematemesis, who underwent embolization of the residual aortic stump with the parallel placement of two vascular plugs and onyx for control of the situation. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-022-01342-1.

Symptomatic aberrant right subclavian artery-A case report and anesthetic implications.

Vascular compression of the esophagus by an aberrant right subclavian artery (aRSA) leading to dysphagia is a rare occurrence. There has been a significant advancement in the diagnostic and surgical treatment modalities available for this disorder. Anesthetic management has evolved too and this case report highlights the anesthetic management of a 41-year-old woman presenting with symptoms of dysphagia because of compression of esophagus by an aRSA, who subsequently underwent re-implantation of aRSA into ascending aorta.

Carotid endarterectomy for symptomatic carotid stenosis: differences in patient profile in a Low-Middle Income Country.

INTRODUCTION: Carotid Endarterectomy (CEA) is the standard treatment for patients with symptomatic carotid stenosis. Data from Low- and Middle-Income Countries (LMIC) is sparse on CEA and its outcomes. We aimed to describe the profile of our patients, and factors associated with periprocedural cerebral ischemic events in patients with symptomatic carotid stenosis who underwent CEA in our institute. METHODS: Retrospective review of patients with symptomatic carotid stenosis(50-99%) who underwent CEA between January 2011 and December 2021 was done. Clinical and imaging parameters and their influence on periprocedural cerebral ischemic events were analysed. RESULTS: Of the 319 patients (77% males) with a mean age of 64 years (SD ±8.6), 207 (65%) presented only after a stroke. Majority (85%) had high grade stenosis (70%) of the symptomatic carotid. The mean time to CEA was 50 days (SD ±36), however only 26 patients (8.2%) underwent surgery within 2 weeks. Minor strokes and TIA occurred in 2.2%, while major strokes and death occurred in 4.1% patients. None of the clinical or imaging parameters predicted the periprocedural cerebral ischemic events. The presence of co-existing significant (50%) tandem intracranial atherosclerosis (n=77, 24%) or contralateral occlusion (n=24, 7.5%) did not influence the periprocedural stroke risk. CONCLUSION: There is a delay in patients undergoing CEA for symptomatic carotid stenosis. Majority have high grade stenosis and present late only after a stroke reflecting a lack of awareness. CEA can be performed safely even in patients with significant intracranial tandem stenosis and contralateral carotid occlusion.

Conventional Carotid Endarterectomy with Shunt versus Eversion Carotid Endarterectomy without Shunt does the Technique Influence the Outcome in Symptomatic Critical Carotid Stenosis.

INTRODUCTION: Carotid endarterectomy (CEA) is a surgical procedure done to prevent future embolic stroke in patients with internal carotid artery (ICA) stenosis. Conventional CEA (c-CEA) and eversion CEA (e-CEA) are two surgical techniques used for the above. As carotid shunt is rarely used in e-CEA, a certain amount of cerebral ischemia occurs in patients who were already having carotid stenosis. In this study, we have evaluated the outcome of two surgical techniques in severe carotid stenosis and impact of carotid shunting on the postoperative outcome. MATERIALS AND METHODS: In this single-center prospective nonrandomized trial, a total of 62 patients who underwent CEA (c-CEA, n = 31; e-CEA, n = 31) for symptomatic ipsilateral ICA stenosis ≥50% between January 2018 and December 2019 were included. RESULTS: A total of 62 patients who underwent CEA (c-CEA, n = 31; e-CEA, n = 31) for symptomatic ipsilateral ICA stenosis ≥50% were included in the study. There was no major stroke or stroke related death in both the study groups. One patient in e-CEA had carotid occlusion and minor stroke. There was no statistically significant difference in minor stroke (e-CEA [3.2%], c-CEA [3.2%], P = 1), transient ischemic attack (e-CEA [3.2%], c-CEA n = 0, P = 0.3), postoperative MI (e-CEA (3.2%), c-CEA (3.2%), P = 1), hematoma (e-CEA [3.2%], c-CEA n = 0, P = 0.3), and re-exploration (e-CEA [3.2%], c-CEA n = 0, P = 0.3). The incidence of cranial nerve (CN) dysfunction was significantly higher in eversion group as compared to c-CEA (e-CEA n = 6 [19.4%], c-CEA n = 1, [3.2%] P = 0.045). CONCLUSION: Our study showed that the early outcomes of both c-CEA and e-CEA techniques are comparable. The routine insertion of carotid shunt even though decreases the cerebral ischemic time, it does not offer any additional advantage of decreasing perioperative stroke. The choice of the CEA technique depends on the experience and familiarity of the individual surgeon as both the techniques have their own advantages and disadvantages.

Intracardiac extension of intravenous leiomyomatosis in a patient with vascular pelvic tumor and prior hysterectomy: A case report.

Uterine leiomyoma (UL) is the most common benign smooth muscle tumour of the premenopausal women. Rarely it shows malignant behaviour by metastasizing through the pelvic veins into systemic veins, inferior vena cava (IVC), there it is termed as intravenous leiomyomatosis (IVL). IVL may restrict itself within the IVC or it may extend into right heart chambers reaching up to pulmonary arteries. Here we report a case of single staged excision of intracardiac(IC) extension of IVL of a 45 -year -old premenopausal women, who have undergone abdominal hysterectomy five years ago, with the complaints of shortness of breath aggravated on bending forward for the past two years.

Gargantuan internal carotid artery aneurysm-a surgical challenge.

Extracranial carotid artery aneurysms are a rarely reported entity. Here, we describe an unusually large internal carotid artery aneurysm in a 76-year-old female, with progressive enlargement and history of thromboembolic event. She was managed successfully with an open repair and common carotid artery to internal carotid artery bypass.

Brucella-Induced Ruptured Infrarenal Dissecting Abdominal Aortic Aneurysm.

Mycotic aneurysms, often saccular, accounting for approximately 2.5% of all abdominal aortic aneurysms, possess increased risk of rupture, uncontrolled sepsis, and protracted hospital stay and are associated with high morbidity and mortality. The authors report the case of a 49-year-old female with no known comorbidities who presented with free rupture of an infrarenal dissecting mycotic aneurysm and underwent emergent open repair successfully. The etiological agent, Brucella melitensis, a Gram-negative zoonotic coccobacillus, is rarely reported to cause mycotic aneurysm.