1/54. Chronic traumatic aortic pseudoaneurysm: resolution with observation.Immediate operative repair is the most commonly recommended treatment for traumatic aortic ruptures, regardless of age or size of the lesion. We report a patient who presented with a large chronic aortic pseudoaneurysm and has been thus far managed nonoperatively with shrinkage of his lesion and no symptoms.- - - - - - - - - - ranking = 1keywords = pseudoaneurysm (Clic here for more details about this article) |
2/54. The spectrum of aortic complications after heart transplantation.BACKGROUND: The connection between the donor and the recipient aorta is a potential source of early and late complications as a result of infection, compliance mismatch, and technical and hemodynamic factors. Moreover, the abrupt change in systolic pressure after heart transplantation involves the entire thoracic aorta in the risk of aneurysm formation. The aim of this study was to analyze the types of aortic complications encountered in our heart transplantation series and to discuss etiology, diagnostic approach, and modes of treatment. methods: Of the 442 patients having orthotopic heart transplantation and the 11 patients having heterotopic heart transplantation at our center, 9 (2%) sustained complications involving the thoracic aorta. These 9 patients were divided into four groups according to the aortic disease: acute aortic rupture (2 patients); infective pseudoaneurysm (3 patients); true aneurysm and dissection of native aorta (2 patients); and aortic dissection after heterotopic heart transplantation (2 patients). Surgical intervention was undertaken in 8. RESULTS: Five (83%) of 6 patients who underwent surgical treatment for noninfective complications survived the operation, and 4 are long-term survivors. One patient who underwent a Bentall procedure 71/2 years after heterotopic heart transplantation died in the perioperative period of low-output syndrome secondary to underestimated chronic rejection of the graft. One patient with pseudoaneurysm survives without surgical treatment but died several years later of cardiac arrest due to chronic rejection. Both patients operated on for evolving infective pseudoaneurysm died in the perioperative period. CONCLUSIONS: Infective pseudoaneurysms of the aortic anastomosis are associated with a significant mortality. In noninfective complications, an aggressive surgical approach offers good long-term results. The possibility of retransplantation in spite of complex surgical repair should be considered in the late follow-up after heart transplantation, due to the increasing incidence of chronic rejection.- - - - - - - - - - ranking = 0.8keywords = pseudoaneurysm (Clic here for more details about this article) |
3/54. Unusual origin and fistulization of an aortic pseudoaneurysm: "off-pump" surgical repair.Aortic pseudoaneurysm is an unusual complication of cardiac operations. The origin depends on the site of arterial wall disruption. Rupture into the right side of the bronchial tree is an exceedingly rare evolution. Repair is commonly performed using cardiopulmonary bypass. In our report a male patient underwent two procedures for aortic dissection, and 6 months after the second operation massive hemoptysis appeared abruptly. A false aneurysm rose from a graft-to-graft anastomotic site and ruptured into a segmental bronchus of the right upper lobe. Repair was performed without cardiopulmonary bypass.- - - - - - - - - - ranking = 1keywords = pseudoaneurysm (Clic here for more details about this article) |
4/54. The use of endovascular stents in the treatment of penetrating ulcers of the thoracic aorta.Penetrating atheromatous ulcers of the aorta are increasingly recognized as a distinct entity. Although their natural history remains ill-defined, such ulcers may lead to pseudoaneurysmal formation, dissection, rupture, or embolization. Given the morbidity associated with open repair, endovascular repair of penetrating atheromatous ulcers may be the treatment of choice. Although stent-graft replacement of acute aortic dissections has recently been described, endovascular repair of penetrating thoracic aortic ulcers has not previously been reported. We report two cases of successful endovascular repair of penetrating atheromatous ulcers that previously ruptured.- - - - - - - - - - ranking = 0.2keywords = pseudoaneurysm (Clic here for more details about this article) |
5/54. Impending rupture of the descending aorta by enlargement of the false lumen after graft replacement with the elephant trunk technique: report of a case.We report herein a case of an impending rupture of the descending aorta caused by an enlargement of the false lumen after a graft replacement using the elephant trunk technique. The patient was a 51-year-old woman who had received a graft replacement of the ascending aorta for an acute Stanford type A aortic dissection 6 years previously. An enhanced computed tomographic scan and digital subtraction angiography revealed pseudoaneurysms at the proximal and distal anastomotic site, and a residual dissection of the aortic arch. A graft replacement of the ascending aorta to the aortic arch was performed with the distal site using the elephant trunk technique. Five days after the operation, massive bleeding from the drainage tube occurred. A chest enhanced computed tomographic scan suggested an impending rupture of the descending aorta caused by an enlargement of the false lumen. A graft replacement of the descending aorta was carried out. Postoperatively she had no complications, and digital subtraction angiography showed an excellent reconstruction of the thoracic aorta. One month after the second operation, she was discharged from hospital.- - - - - - - - - - ranking = 0.2keywords = pseudoaneurysm (Clic here for more details about this article) |
6/54. Emergency endovascular treatment of an acute traumatic rupture of the thoracic aorta complicated by a distal low-flow syndrome.We report the case of a patient who suffered major trauma following a motorcycle accident that resulted in multiple fractures, bilateral hemopneumothorax, pulmonary contusions, and an isthmic rupture of the aorta with a pseudoaneurysm compressing the descending aorta. This compression was responsible for distal hypotension and low flow, leading to acute renal insufficiency and massive rhabdomyolysis. Due to the critical clinical status of the patient, which prevented any type of open thoracic surgery, endovascular treatment was performed. An initial stent-graft permitted alleviation of the compression and the re-establishment of normal hemodynamic conditions, but its low position did not allow sufficient coverage of the rupture. A second stent-graft permitted total exclusion of the pseudoaneurysm while preserving the patency of the left subclavian artery.- - - - - - - - - - ranking = 0.4keywords = pseudoaneurysm (Clic here for more details about this article) |
7/54. Common iliac artery pseudoaneurysm following inguinal hernia repair--a case report and literature review.The authors report a patient presented with a ruptured infected iliac artery pseudoaneurysm 2 weeks after ipsilateral inguinal hernia repair. Pseudoaneurysms that occur because of infection develop rapidly and mandate ligation of the affected artery and extraanatomic bypass. Noninfected pseudoaneurysms are usually discovered incidentally and may be managed with either endovascular or standard surgical techniques. A percutaneously placed aortic occlusion balloon may prevent exsanguination, when used as an adjunct to surgical repair in cases of ruptured pseudoaneurysm.- - - - - - - - - - ranking = 1.4keywords = pseudoaneurysm (Clic here for more details about this article) |
8/54. Aortic nonanastomotic pseudoaneurysm eroding lumbar vertebra--a case report.Nonanastomotic pseudoaneurysms are uncommon complications of prosthetic grafts, which are mostly associated with axillofemoral grafts. The case presented describes a pseudoaneurysm secondary to a previously placed end-to-side aortobifemoral bypass. back pain developed 3 years after the original bypass and was not relieved with narcotics and muscle relaxants. The patient also complained of a 20-pound weight loss, night sweats, and frequent emesis. Approximately 1 year after the onset of back pain, left leg claudication developed. He eventually underwent magnetic resonance imaging of the lumbosacral spine, which depicted a tumorlike mass eroding the vertebral bodies of L2 and L3. Full oncologic workup was pursued preoperatively. The patient also underwent aortography, computed tomography of the abdomen and pelvis, and an inferior venacavogram to elucidate the relationships between the mass and the major vascular structures. On exploration, no malignancy was present. A hole in the native aorta approximately 2 cm above the level of the end-to-side aortic anastomosis was discovered. This was contiguous with the vertebral bodies and the left psoas muscle. The pseudoaneurysm was repaired by conversion of the proximal anastomosis to an end-to-end aorto right iliac and left femoral bypass. All of the preoperative symptoms resolved after repair of the pseudoaneurysm. Chronic aortic rupture or pseudoaneurysms are difficult to diagnose due to the unusual clinical presentations. Despite complete radiologic evaluation, preoperative diagnosis may be difficult or impossible without a high degree of suspicion. Surgical repair will depend on the cause of the pseudoaneurysm--all but infected aneurysms may be repaired in line by creating a proximal anastomosis above the level of the pseudoaneurysm. Atypical back pain in patients with previous aortic reconstructions should alert the clinician to the possibility of vascular involvement. patients with aortic pseudoaneurysms should undergo prompt repair to avert the potential risk for rupture when the surrounding structures are no longer able to contain the pulsatile flow.- - - - - - - - - - ranking = 2.4keywords = pseudoaneurysm (Clic here for more details about this article) |
9/54. Delayed aortic rupture caused by an implanted anterior spinal device. Case report.The authors describe a case of delayed aortic rupture following the application of a smooth-rod Kaneda (SRK) instrument. This is a rare but critical complication of anterior spinal fusion in which instrumentation is placed, and the authors wish to draw attention to the possible complications arising from such surgery. A few cases of this complication were reported in 1986. No reports have been published since then; perhaps because techniques and implant design have improved. In this case, a 53-year-old man suffered a T-11 fracture and related paraparesis, and he underwent decompression and anterior fusion in which an iliac bone graft was placed using an SRK device. Although his neurological deficit resolved postoperatively, nonunion of the grafted bone caused progressive kyphosis of the thoracolumbar spine. Twenty months after surgery, he complained of progressive gastrointestinal symptoms, and a delayed aortic rupture with a pseudoaneurysm was found surrounding the implant. The aortic pseudoaneurysm was replaced with an artificial vessel, and the SRK device was removed immediately. Delayed aortic rupture associated with anterior instrumentation is extremely rare but can occur. Even if the design of the implants can be improved, the placement of implants near the aorta and subsequent changes in the close anatomical relationship between the aorta and the implant eventually may result in this life-threatening complication. Careful follow-up examination and early removal of the implant, if necessary, are important.- - - - - - - - - - ranking = 0.4keywords = pseudoaneurysm (Clic here for more details about this article) |
10/54. Vertebral mass resulting from a chronic-contained rupture of an abdominal aortic aneurysm repair graft.We describe a case of a 63-year-old man with chronic-contained rupture of an abdominal aortic aneurysm at the site of prior graft repair of the aneurysm. Initially misinterpreted as osteomyelitis on the basis of CT findings, this chronic-contained rupture of the abdominal aorta eroding the vertebrae was preoperatively diagnosed at MR imaging and confirmed at surgery. A conventional angiogram failed to show the pseudoaneurysm. Owing to a major difference in the management of a contained aortic aneurysm rupture versus that for osteomyelitis, MR imaging with CT or MR angiography is recommended before any operative or invasive procedure.- - - - - - - - - - ranking = 0.2keywords = pseudoaneurysm (Clic here for more details about this article) |
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