Endovascular treatment of a superior mesenteric artery embolism in a high-risk Jehovah's Witness.

Despite recent advances, emergent treatment of acute mesenteric ischemia carries a mortality of 40%-60%. Endovascular therapy provides a reasonable option for high-risk patients with acute mesenteric ischemia who may not tolerate a laparotomy. We present a case of successful endovascular embolectomy of the superior mesenteric artery, visceral aorta, and right iliac artery in a high-risk octogenarian who refused the transfusion of blood products. As older patients present with more comorbidities, endovascular techniques will play an increasingly large role in the treatment of acute mesenteric ischemia.

Clostridium septicum aortitis: Report of two cases and review of the literature.

Clostridium septicum aortitis is a rare infection that has a strong association with occult colonic malignancy. To our knowledge, we report the 25th and 26th cases of C septicum aortitis in the English literature and make recommendations for its management. The first patient was a 75-year-old man who presented with abdominal pain. Computed tomography showed the presence of periaortic gas. He underwent aortic débridement and extra-anatomic bypass after blood cultures revealed C septicum. Four months after the initial presentation, he was readmitted with lethargy, found to have recurrent periaortic gas, and died. The second patient was a 76-year-old woman who presented with a 5-cm abdominal aortic aneurysm with surrounding retroperitoneal gas. She underwent emergency aortic ligation and retroperitoneal débridement. Her blood and intraoperative tissue cultures also grew C septicum. She had a prolonged postoperative course and ultimately died on hospital day 94. Both patients were found to have concurrent colon adenocarcinomas. C septicum aortitis is a lethal disease that necessitates prompt surgical intervention and appropriate antibiotic therapy. The strong association of C septicum with occult malignancy should prompt the astute clinician to undertake an exhaustive search for a neoplastic process.

Intentional coverage of a main renal artery during endovascular juxtarenal aortic aneurysm repair in symptomatic high-risk patients.

PURPOSE: To describe the efficacy and morbidity of intentionally covering a main renal artery during symptomatic juxtarenal endovascular aneurysm repair (EVAR). CASE REPORTS: Two patients with symptomatic juxtarenal abdominal aortic aneurysm (AAA) were felt to be at prohibitive risk for open repair. Each underwent EVAR with intentional coverage of 1 main renal artery to achieve adequate proximal hemostatic seal. One patient died at 24 months; the second is symptom-free at 10 months. Both aneurysms initially decreased in diameter. Both patients had increased serum creatinine and required increased therapy for hypertension, but neither required hemodialysis. Renal volume decreased 48.7% and 68.0%, respectively. CONCLUSION: Intentional coverage of a main renal artery during EVAR for a symptomatic juxtarenal aneurysm resulted in effective short-term AAA repair with no need for dialysis. Despite the increased requirement for antihypertensive medications and the observed decline in renal function, this technique provides an option for treatment of this difficult patient subset.