1/99. Abdominal pulsatile tumor after endovascular abdominal aortic aneurysm repair.A 70 years old patient was successfully treated for infrarenal aortic aneurysm by an endovascular bifurcated prosthesis. Three months later, because of dysuria, he underwent urological examination revealing an abdominal pulsatile tumor. Thereafter, the patient was sent to our emergency ward with suspected symptomatical endoleak. Radiological screening by computer tomography and magnetic resonance angiography showed good post-operative results without endoleak. Patient was treated with antispasmodic medication and is doing well today. Because endovascular repair of aortic aneurysm, in contrast to an open approach, does not eliminate the aneurysm itself, post-operative abdominal palpation can be ambiguous. magnetic resonance angiography--without the need of nephrotoxic contrast medium--compares favourably to CT and provides excellent pictures with less artefacts for post-operative screening of endoleak. If reperfusion can be excluded, pulsation is due to the transmission of the blood-pressure wave to the thrombosed aneurysm.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/99. Right lateral transthoracic approach mimicking standard transesophageal echocardiographic views in a patient with giant left atrium.We describe the case of a patient with long-standing severe mitral periprosthetic regurgitation and a giant left atrium. The patient was referred for surgery. On the third postoperative day, after resuture of the dehiscence of the valve sewing ring, the patient complained of dyspnea. Transthoracic ultrasound examination was performed to eliminate pleural effusion. The severe right lateral displacement of an aneurysmatic left atrial cavity contacting with the thoracic wall allowed us to obtain excellent images of the posterior cardiac anatomy by a right lateral thoracic view. The new transthoracic approach made it possible to safely assess the atrial side of the mitral prosthesis, eliminating mitral regurgitation after surgery without transesophageal echocardiographic examination.- - - - - - - - - - ranking = 0.125keywords = aneurysm (Clic here for more details about this article) |
3/99. Aortoduodenal fistula arising from the dilatation of a knitted Dacron graft: report of a case.A fatal aortoduodenal fistula occurred in a 72-year-old man who underwent a repair of an abdominal aortic aneurysm 16 years previously with a 20 x 10 mm bifurcated knitted Dacron graft. The aortic part of his bifurcated graft had dilated to 40 mm in diameter, with a discrepancy of 20 mm in the diameter between the graft and infrarenal aorta. The fourth portion of the duodenum adhered to the left side of the anastomosis, where the aortoenteric fistula had occurred. We believe that the graft dilatation was the cause of the anastomotic failure, although other factors such as atherosclerotic degeneration of the host aorta should also be considered. Knitted Dacron grafts that have been implanted for more than 10 years should therefore be monitored carefully because they have an inherent tendency to dilate, especially those manufactured before 1981.- - - - - - - - - - ranking = 0.125keywords = aneurysm (Clic here for more details about this article) |
4/99. Periprosthetic leak and rupture after endovascular repair of abdominal aortic aneurysm: the significance of device design for long-term results.We present a case of abdominal aortic aneurysm treated with an endovascular bifurcated aortic graft in which a periprosthetic leak caused by a tear in the polyester prosthesis appeared between 9 and 12 months after surgery. The tear appeared adjacent to a suture breakage that caused separation of two struts of the nitinol wire framework in the body of the stent graft. The leak was sealed with insertion of a new endovascular tube graft into the body of the bifurcation. Eight months later, the patient had a nonfatal rupture of the abdominal aortic aneurysm because detachment of the second limb from the bifurcation caused a new major periprosthetic leak. According to the manufacturer of this device, suture breakage with separation of metal components is commonly seen, but perforation of the polyester prosthesis caused by movement of the metal stent against the fabric has not been reported. It is likely that this occurred in our patient. Detachment of the second limb from the bifurcated stent, causing a rupture, has been described before. Increasing angulation and tortuosity of the stent graft, as a result of either remodeling of the sac or elongation of the stent, and reduced compliance to angulation after the stent-in-stent procedure might have contributed to the detachment in this case.- - - - - - - - - - ranking = 0.75keywords = aneurysm (Clic here for more details about this article) |
5/99. Aortoduodenal fistula: a late complication of intraluminal exclusion of an infrarenal aortic aneurysm.During recent years, considerable clinical experience has been gained with endoluminal stent-graft procedures. Several studies have shown promising results up to a period of 4.5 years. However, long-term follow-up studies are still limited. Late endoleaks caused by stent-graft migration, disconnection of single components in modular stent-grafts, and limb thrombosis have been observed as long-term complications. We report a case in which a migrated and kinked bifurcated stent-graft caused an aortoduodenal fistula 20 months after stent-graft insertion. To our knowledge, such a complication has not been reported before.- - - - - - - - - - ranking = 0.5keywords = aneurysm (Clic here for more details about this article) |
6/99. Separate revascularization of the visceral arteries in thoracoabdominal aneurysm repair.We successfully repaired a ruptured aortic patch containing the visceral arteries after thoracoabdominal aneurysm repair in a young patient with marfan syndrome. This unexpected and tricky situation was treated by separate revascularization of each visceral artery using small-caliber prosthetic grafts as interposition between the aortic prosthesis and the ostia of the visceral arteries.- - - - - - - - - - ranking = 0.625keywords = aneurysm (Clic here for more details about this article) |
7/99. Graft-wall endoleak 18 months after successful endoluminal AAA repair.PURPOSE: To describe a case of graft-wall endoleak 18 months after successful endoluminal repair of an abdominal aortic aneurysm (AAA). methods AND RESULTS: A 71-year-old man with infrarenal AAA was successfully treated with an endoluminal aortomonoiliac graft and femorofemoral crossover bypass with surgical ligation of the right external iliac artery. The stent-graft was made from 2 Gianturco Z-stents and a tapered thin-walled (0.1-mm) Dacron graft. Eighteen months after endografting, the patient complained of a pulsatile abdominal mass. Angiography and computed tomography showed graft-wall endoleak. Aneurysmectomy was performed, and the aneurysm was successfully replaced with a Y-shaped knitted Dacron graft. A hole in the graft wall was found 3 cm from the proximal edge of the stent-graft. CONCLUSIONS: This case suggests that the use of thin-walled graft material in endografts may not be sufficiently durable.- - - - - - - - - - ranking = 0.25keywords = aneurysm (Clic here for more details about this article) |
8/99. Deformation of self-expanding stent-grafts complicating endovascular peripheral aneurysm repair.PURPOSE: To demonstrate the deformation of self-expandable stents after endovascular repair of peripheral aneurysms. methods AND RESULTS: The Corvita Endoluminal Graft was used to treat a traumatic false aneurysm of the right subclavian artery and a common iliac artery aneurysm in 2 patients. In the subclavian case, the stent-graft showed a "cigar-shaped" deformation with hemodynamically significant stenoses at the proximal and distal ends at 3 months. In the second case, the same type of deformity was noted only 1 day after implantation. Two months later, the stent-graft occluded, necessitating surgical repair. CONCLUSIONS: Both cases demonstrate the possibility of stent deformation of self-expanding stent-grafts implanted at arterial sites not subject to external compression.- - - - - - - - - - ranking = 0.875keywords = aneurysm (Clic here for more details about this article) |
9/99. Use of contrast-enhanced ultrasound in follow-up after endovascular aortic aneurysm repair.PURPOSE: To investigate the use of contrast-enhanced ultrasound in the detection of endoleak after endovascular repair of abdominal aortic aneurysm. MATERIALS AND methods: Eighteen patients underwent follow-up on 20 occasions after endovascular aortic aneurysm repair by arterial-phase contrast-enhanced spiral computed tomography (CT). All patients had unenhanced color Doppler ultrasound and Levovist-enhanced ultrasound on the same day. The ultrasound examinations were reported in a manner that was blind to the CT results. CT was regarded as the gold standard for the purposes of the study. RESULTS: There were three endoleaks shown by CT. Unenhanced ultrasound detected only one endoleak (sensitivity, 33%). Levovist-enhanced ultrasound detected all three endoleaks (sensitivity, 100%). Levovist-enhanced ultrasound indicated an additional six endoleaks that were not confirmed by CT (specificity, 67%; positive predictive value, 33%). In one of these six cases, the aneurysm increased in size, which indicates a likelihood of endoleak. Two of the remaining false-positive results occurred in patients known to have a distal implantation leak at completion angiography. CONCLUSION: In this small group of patients, contrast-enhanced ultrasound appears to be a reliable screening test for endoleak. The false-positive results with enhanced ultrasound may be due to the failure of CT to detect slow flow collateral pathways. Although the number of patients in this study is small, enhanced ultrasound may be more reliable than CT in detecting endoleak.- - - - - - - - - - ranking = 0.875keywords = aneurysm (Clic here for more details about this article) |
10/99. Late aneurysm formation in a femoro-popliteal polytetrafluoroethylene graft.Since improvement in the material, true aneurysms and pseudoaneurysm formations have become relatively rare complications after femoro-popliteal reconstruction with polytetrafluoroethylene (PTFE) grafts. We report a case of late graft rupture and pseudoaneurysm formation within the straight femoral part of a femoro-popliteal bypass with reinforced (PTFE-wrapped) Gore-Tex graft. The rupture occurred 7 years after implantation without history of direct traumatization. Intraoperatively the whole bypass showed macro- and microscopically visible deterioration of the wall with almost complete disruption at the site of the aneurysm. The graft had to be replaced completely. In conclusion, we recommend continuous long-term follow-up of these patients preferably with duplex ultrasonography.- - - - - - - - - - ranking = 1.2768970684482keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
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