Repair of abdominal aortic aneurysm in heart transplant patients: before or after left ventricular assist device implantation?

Endovascular abdominal aortic aneurysm repair in decompensated heart failure patients requiring ventricular assist device (VAD) placement needs careful consideration of both complex disease states. We present this clinical dilemma and describe our choice of transcatheter aneurysm repair in the face of advanced refractory heart failure following VAD implantation.

Traumatic ascending aortopulmonary window following pulmonary artery stent dilatation: therapy with aortic endovascular stent graft.

Endovascular stent grafts have become an established therapy in adults for descending thoracic aortic disease. We report a case of a 13-year-old boy with a hemodynamically significant traumatic aortopulmonary window following angioplasty of pulmonary artery stent. Endovascular stent graft implantation into the ascending aorta was performed to seal off the communication, with dramatic hemodynamic improvement.

Laparoscopic approach to the management of intraabdominal unicentric Castleman's disease.

Castleman's disease, or angiofollicular lymphoid hyperplasia, is a rare lymphoproliferative disorder of unknown etiology. We present the case of an 18-year-old woman who was admitted with symptoms of fatigue, weakness, early satiety, and weight gain. A subhepatic mass anterior to the pancreas was discovered on ultrasound. After being treated via the laparoscopic approach with complete surgical resection she recovered well. This case thus represents a new application for laparoscopy and expands the indications for its use.

Incidental asymptomatic cerebral aneurysms in patients with extracranial cerebrovascular disease: is this a case against carotid endarterectomy without arteriography?

As less arteriography is performed before carotid surgery, concern arises about missing occult cerebral aneurysms and possible adverse outcomes. A study was conducted by the divisions of vascular surgery and neurosurgery of Northwestern University Medical School to evaluate the frequency of incidental cerebral aneurysms and outcomes of patients with extracranial cerebrovascular disease and asymptomatic cerebral aneurysms. From October 1995, through March 1997, 200 patients underwent intracranial and extracranial cerebrovascular angiography for evaluation of extracranial disease. Demographic data, symptoms, data of vascular lesions, surgical treatment and outcomes of stroke and death were recorded prospectively. Two patients (1%) had asymptomatic cerebral aneurysms found on angiography. Six more patients were referred with a known asymptomatic cerebral aneurysm with extracranial disease during this same period. Of these eight patients, five underwent extracranial vascular reconstruction surgery and seven received treatment for their aneurysms. There were two stroke complications, both occurred after treatment of a basilar artery aneurysm. One of these patients died. No aneurysms ruptured following 203 extracranial revascularizations during this same period. On the basis of the low prevalence of diagnosing coincidental cerebral aneurysms during work-up of extracranial disease, as well as the lack of evidence that carotid surgery predisposes to aneurysm rupture in these patients in both our study and the literature review, it is concluded that coexisting extracranial disease and asymptomatic cerebral aneurysms do not pose a case against carotid surgery without routine arteriography. However, arteriography should be considered in selected groups of patients where the yield of intracranial aneurysms is high; these include patients with a familial history of cerebral aneurysms, autosomal dominant polycystic kidney disease, extracranial internal carotid artery medial fibrodysplasia, Takayasu's arteritis, alpha1-antitripsin deficiency and atypical clinical presentations, including headache.