Urgent hybrid repair of a symptomatic dissection-related type ii thoracoabdominal aortic aneurysms.

Emergency repair of type II thoraco-abdominal aortic aneurysms is burdened by high perioperative morbidity and mortality. We report the case of a symptomatic type II post-dissection thoraco-abdominal aortic aneurysm that was treated by mean of a hybrid technique. The repair was carried out through two stages. In the first stage, we deployed two imbricated stent grafts in the descending thoracic aorta. A left carotid to left subclavian artery by-pass was preemptively performed in order to obtain a proper proximal landing zone and as part of the spinal cord protective maneuvers. The endovascular first stage was effective in obtaining proximal sealing but, as expected, did not prevent distal reperfusion of the aneurysmatic false lumen. Few hours later, we moved on to the second stage in which we repaired the aneurysmal distal thoracic and abdominal aortic segment by mean of a multibranched synthetic graft. The repair was carried out through a left thoracophrenolaparotomy in the VII intercostal space. A left passive arterial by-pass and selective cold renal and warm visceral perfusion were adopted in order to provide organ protection. Technical success was achieved and radiologically confirmed. The patient experienced a mild postoperative paraplegia, which almost completely regressed after a neuro-motor rehabilitation program.

Emergency Aortic Control for Pedicle Screw Misplacement During Spinal Fixation.

Aortic iatrogenic injuries during spinal instrumentation are rare but carry a high risk of mortality. In this report, we describe the case of a 26-year-old man with traumatic vertebral fracture and subsequent spinal cord injury who underwent posterior vertebral fixation at our trauma center. The neurosurgical procedure was complicated by the misplacement of a spinal pedicle screw, which almost penetrated the descending thoracic aorta. To avoid a possibly fatal bleeding, we safely removed the pedicle screw with the help of a prophylactic proximal compliant aortic balloon ready to be inflated in case of hemorrhage. Follow-up computed tomography scan did not detect any defect of the aortic wall, nor any sign of bleeding. After a 15-month follow-up, the patient is alive and in good physical conditions, with little residual neurologic deficit due to the spinal trauma.

Multiple Idiopathic Aneurysms in a 6-Year-Old Boy.

We report the rare case of a young boy affected by idiopathic multiple aneurysms at different arterial locations who was treated at our institution with different surgical and endovascular techniques.

Resection of right ventricular metastasis subsequent to liver transplant for hepatocellular carcinoma.

We report a case of a 54-year-old Caucasian male with exertional dyspnea who underwent palliative resection of a solitary right ventricular metastasis one year after liver transplant for a multifocal HBV-related hepatocellular carcinoma (HCC). After nine months the patient remains asymptomatic and cardiac MRI shows no local progression of the tumor.