Heterotopic cesarean scar pregnancy: how should it be managed?

Heterotopic cesarean scar pregnancy is an extremely rare condition that may cause life-threatening complications. A 24-year-old woman gravida 2, para 1, presented with vaginal bleeding. Vaginal sonography demonstrated 2 gestational sacs containing viable embryos, one located in the uterine fundus and the other in the previous cesarean scar. Fetal reduction of the cesarean scar pregnancy was performed with intracardiac KCl injection and the ongoing intrauterine pregnancy was delivered by cesarean section at 34 week's gestation. To prevent serious complications and preserve intrauterine pregnancy, heterotopic cesarean scar pregnancy must be diagnosed early in gestation. Favorable pregnancy outcome can be achieved with conservative management. However, such management increases the risk of massive bleeding during ongoing pregnancy and cesarean section.

[Endovascular treatment of aortic lesions using the Medtronic Talent system: single center experience with mid-term follow-up]. / Aortik lezyonlarin Medtronic Talent stent-greft ile endovasküler tedavisi: Tek merkez deneyimi ve orta dönem takip sonuçlari.

OBJECTIVE: The aim of this retrospective study is to investigate the safety and efficacy of endovascular repair of aortic lesions with the Medtronic Talent stent-graft system and to present mid-term results of endovascular aortic repair performed in our center. METHODS: Between December 2002 and March 2007, 54 patients (6 women) with aortic (14 thoracic and 40 abdominal) lesions underwent treatment with Talent stent-graft. The average age of the patients was 64.8 (20-88) years. Duration of follow-up period ranged from 1 to 49 months (average 21 months). Indications for endovascular repair were degenerative aneurysm in 45, degenerative aneurysm and penetrating ulcer in 2, only penetrating ulcer in 1, traumatic thoracic isthmic transsection in 4 and vasculitic aneurysm secondary to Behcet's disease in 2 patients. RESULTS: Repair was performed with the tubular (16), aortouniiliac (1) or bifurcated (37) stent-grafts. Technical success rate was 100%. No death, major complication or need of immediate conversion to open repair was seen. Endoleak rate was 18.5% at 1 month follow-up period. Thirty-day mortality was 1.8% and morbidity (other than endoleaks) rate was 12.9%. During the follow-up period, secondary intervention was required in 12.9% of patients. Iliac limb occlusion was detected in 1 patient (1.8%). Graft migration causing type 1 endoleak and requiring open surgical treatment was seen in 1 patient (1.8%). Four patients (7.4%) are still under follow-up for type-2 endoleaks that do not require intervention. No graft infection or death due to aneurysm rupture was detected. CONCLUSION: Endovascular treatment of aortic lesions in selected patients with comorbid conditions using the Talent stent-graft exhibits a high degree of technical success with a low perioperative morbidity and mortality rate. The major disadvantage of endovascular aortic repair is necessity of life-long imaging follow-up and secondary interventions.