Aortic pseudoaneurysm after endarterectomy for small aorta syndrome.

INTRODUCTION: Small Aorta Syndrome (SAS) or hypoplastic aorto-iliac syndrome is a rare pathology of the aorta that affects almost exclusively young or middle-aged women and is characterized by smaller dimension of the aorta and iliac axes. Etiopathogenesis is unclear and many factors have been invoked. The smaller caliber of the aorta and iliac arteries may predispose to aorto-iliac occlusive disease development. In the past aorto-iliac endarterectomy (AE) with patch closure was utilized as an alternative to surgical bypass in order to correct steno-obstructive syndromes affecting carriers of SAS. Little is known about long term outcomes of this type of surgery. PRESENTATION OF THE CASE: During investigations for acute colecystitis, an aortic pseudoaneurysm (PA) was diagnosed by ultrasound in a 73 old year woman. She was submitted twenty-two years ago for SAS with disabling claudication to aortic endarterectomy (AE) with patch graft insertion. Considering all the vascular options available she was submitted to open surgery with replacement of the aortic bifurcation. DISCUSSION: Aortic PA is a relatively common complication after bypass surgery but is rarely observed after AE. It requires prompt intervention to prevent subsequent complications such as rupture, thrombosis, distal embolism or aorto-enteric fistula. CONCLUSION: Endovascular treatment for aortic PA should be always considered the treatment of choice but the open surgical option was preferred in this particular case because of the small diameters of the iliac accesses, making them unsuitable for an endovascular approach.

Deep vein thrombosis and pulmonary embolism in a patient affected by uterine fibroids: clinical case.

A 51 year old woman was admitted for night dyspneic attacks and fainting. When hospitalised the patient reported in the previous 10 days dry cough, edema and pain (left leg). The woman's medical history did not show any risk factors for vein thromboembolism, d-dimer dosage appeared increased and arterial blood gas showed hypoxemia and hypocapnia. ECG and chest X-Rays were within normal limits; a chest CT diagnosed pulmonary embolism that was treated with thrombolytic therapy. Venous lower extremity ultrasound detected ilio-femoral and popliteal venous thrombosis and an abdominal CT showed a swollen and fibromatous uterus, obstructing the left iliac vein system. Thrombolytic therapy was effective to for pulmonary embolism and to begin recanalization of the iliac, femoral, and popliteal veins. The patients was sent home in good clinical conditions, with anticoagulant therapy; later the uterine fibroma was treated with hysterectomy.