Endovascular obliteration of a ruptured right gastric artery aneurysm.

Aneurysms of the right gastric artery are extremely rare lesions. They constitute less than 0.001% of reported visceral artery aneurysms. A unique case of a ruptured right gastric artery aneurysm is presented. Angiographic diagnosis and endovascular treatment by right gastric artery embolization proved safe and efficacious, resulting in complete obliteration of the aneurysm with no adverse sequelae.

Three-dimensional CT evaluation for endovascular abdominal aortic aneurysm repair. Quantitative assessment of the infrarenal aortic neck.

Endovascular grafting of abdominal aortic aneurysms should be offered only to those patients with suitable anatomy. This is especially true at the level of the proximal aortic neck in order to secure long-term proximal fixation. Aortoiliac anatomy is easy to understand conceptually, however, it is difficult to define and measure quantitatively. In this article, we discuss the use of three dimensional computed tomographic angiography to determine aneurysm morphology and select patients for endovascular repair. Specifically, we apply our methods to define and measure angulation of the aorta and iliac arteries. The anatomic definition of the angulation of the proximal aortic neck is emphasized.

Aortoiliac angulation and the need for secondary procedures to secure stent graft fixation: which angle is important?

BACKGROUND: The purpose of this study was to quantify the degree of aortoiliac tortuosity and determine the relationship between aortoiliac angulation and the need for a secondary procedure following endovascular repair. METHODS: Among 206 patients treated with the AneuRx stent graft, 3-year follow up data were available in 71 patients. Twenty eight patients without duplex and CT angiograms (CT angiography) on follow-up were excluded. The anatomy of the preoperative proximal aortic neck was evaluated using 3D-CT angiography reconstructed images in: a) Group I: 15 patients who required secondary procedures and b) Group II: 18 patients without any endovascular leak during follow up. The groups did not differ in age (72.9+/-6.1 versus 73.3+/-9.1) or aneurysm diameter (60.1+/-9.1 versus 60.5+/-10.1). In order to determine the aortoiliac tortuosity, we measured: a) the suprarenal aorta-infrarenal aortic neck angle: angle of the aorta at the level of the renal arteries, b) infrarenal aortic neck-aneurysm angle: angle of the aorta at the start of aneurysm, c) right iliac angle, d) left iliac angle, e) aortic neck length, f) aortic neck diameter. RESULTS: Computer-based measurements on 3D-CT angiography reconstructed images were: a) suprarenal aorta-infrarenal aortic neck angle: group I: (22.6+/-16.2), group II: (11.9+/-6.9), p<0.05; b) infrarenal aortic neck-aneurysm angle: group I: 17.6+/-12.4, group II: 18.8+/-9.4, p=NS; c) right iliac angle: group I: 22.9+/-12.6, group II: 20.4+/-9.5, p=NS; d) left iliac angle: group I: 22.4+/-10.5, group II: 19.1+/-12.2, p=NS; e) aortic neck length: group I: 18.9+/-5.3 mm, group II: 20.4+/-5.3 mm, p=NS; f) aortic neck diameter: group I: 24.1+/-1.0 mm, group II: 23.3+/-1.6, p=NS. CONCLUSIONS: Aortoiliac angulation can be defined and quantified. In patients requiring secondary procedures, there is an increased angulation at the proximal aortic neck angle.

Therapeutic efficacy of flavonoids in oedema following reperfusion on acutely ischaemic legs.

BACKGROUND: The aim of this study was to investigate the effect of a purified, micronised, flavonoid fraction (Daflon) in lower limb oedema developed after delayed embolectomy and successful reperfusion of acutely ischaemic legs. METHODS: Our series consisted of 19 patients with prolonged, acute ischaemia of the lower extremity caused by arterial embolism, who had undergone successful embolectomy. Patients were randomised into two groups; ten patients (group I) treated with flavonoids, were compared to nine given a placebo. Ankle and calf circumferences, venous capacitance and venous emptying time were measured preoperatively [T1], on the 2nd [T2], 5th [T3], 8th [T4] and 30th [T5] postoperative days. RESULTS: An increase of ankle and calf circumference up to 9% and 13.5% respectively, as compared with preoperative values was demonstrated. There was a reduction in oedema formation in patients with the Daflon group, which reached statistical significance only in the ankles (p=0.0276). Calf differences were statistically significant on the second and fifth postoperative days (p<0.05). Venous haemodynamics were considerably improved by Daflon (p<0.001). CONCLUSIONS: Daflon 500 mg had an inhibitory effect on moderate oedema developed after revascularisation of an ischaemic limb.