RESUMEN
OBJECTIVE: To evaluate the incidence of wound complications after the retroperitoneal approach for abdominal aortic aneurysm (AAA) repair, and to ascertain the cause of abdominal bulge (AB). SUBJECTS AND METHODS: Forty-three patients with AAA repair via the retroperitoneal space were retrospectively investigated. Wound complications and their incidence were studied by chart review. The thickness of the abdominal wall muscle was measured by follow-up computed tomography films. Compound muscle action potentials (CMAPs) of the abdominal rectus muscle were examined for three bulge patients and three non-bulge patients. RESULTS: Wound hypoesthesia (30%), wound numbness (21%), AB (7%), and wound pain (2%) were found in these patients. The thickness of the abdominal wall muscle was reduced in the incision side. CMAP of abdominal rectus muscle in the incision side disappeared only in AB patients. CONCLUSIONS: (1) Wound hypoesthesia and numbness displayed a high incidence. (2) Atrophy of the abdominal wall muscle in the incision side was found in these patients. (3) The cause of AB is considered to be muscle atrophy induced by denervation injury of an 11th intercostal nerve. (4) To avoid an eleventh intercostal nerve injury must be deemed the most effective method for preventing AB.
RESUMEN
We report the case of a patient who underwent treatment for a macroembolism in the right lower leg, which led to shaggy aorta syndrome. Anticoagulant therapy for the macroembolism and intra-aortic catheterization exacerbated the patient's renal function and triggered another massive microembolization of the visceral arteries, with a fatal outcome. To minimize the incremental complications inherent to this syndrome, awareness and prompt diagnosis with enhanced computed tomography or intravenous digital subtraction aortography are essential. Axillo-bifemoral bypass with bilateral external iliac artery ligations, performed with optimal timing, could save patients with shaggy aorta syndrome.