Diagnosis of celiac artery in-stent thrombosis by transesophageal echocardiography.

We present a case of a 70-year-old woman with severe peripheral arterial disease presenting with celiac artery in-stent thrombosis diagnosed by transesophageal echocardiography (TEE). Routine assessment of the visceral arteries is not performed in most TEE studies. A review of the literature shows that the celiac and superior mesenteric arteries can be successfully visualized during transgastric views of the abdominal aorta. We propose that two-dimensional and color Doppler echocardiography have several intrinsic advantages over computed tomography, magnetic resonance angiography and catheterization when assessing aortic and visceral arterial pathology.

Short-term predictors and long-term outcome after ruptured abdominal aortic aneurysm repair.

Few data exist in regard to long-term and functional outcome after ruptured abdominal aortic aneurysm (rAAA) repair. The present study provides such follow-up and defines the impact of variables used to grade resuscitation efforts [base deficit (BD) and core temperature (cT)]. One hundred forty-seven patients presenting with rAAA were retrospectively reviewed. Overall perioperative mortality was 35 per cent (51/147) and mean age was 72 years. Survival data were available for 99 per cent of patients with a mean and median follow-up of 45 months. Life table analysis revealed one-, 2-, and 5-year survival to be 81, 75, and 58 per cent, respectively. Eighty-three per cent of patients reported a quality of life equal to that of their preoperative status. Both initial cT (P = 0.02) and BD (P = 0.03) were significantly associated with perioperative mortality. Using a logistic regression model cT remained a significant factor (P = 0.006) associated with survival. Smoking, hypertension, diabetes, chronic obstructive pulmonary disease, mode of transportation, and surgeon's training were not significant. Despite the advanced age of the present cohort, acceptable perioperative mortality and long-term survival rates were attained. The majority of patients resumed a lifestyle comparable to that of their preoperative state; therefore, long-term longitudinal follow-up suggests that aggressive management with rapid correction of BD and cT results in excellent functional outcome.