1/4. Pseudoaneurysms of large arteries associated with AIDS.BACKGROUND: Several vascular complications are known to occur in association with the acquired immunodeficiency syndrome (AIDS) and recent publications have called attention to the development of pseudoaneurysms of large arteries in patients with AIDS. CASE REPORT: We report on 2 patients with AIDS aged 23 and 31 years with pseudoaneurysms of the abdominal aorta and common iliac arteries. After clinical and radiological evaluation by arteriography and computed tomography, the patients were submitted to aneurysmectomy, with the placement of a patch of dacron in the first case and the interposition of a right aorto-iliac and left femoral prosthesis in the second. The second patient developed new aneurysms of the right subclavian and left popliteal arteries 2 months after surgery. Proximal ligation of the right subclavian artery was performed to treat the first aneurysm and resection and interposition of a reversed saphenous vein was carried out to treat the pseudoaneurysm of the popliteal artery. Histopathological examination of the popliteal artery revealed necrotizing arteritis.- - - - - - - - - - ranking = 1keywords = vascular complication (Clic here for more details about this article) |
2/4. Ruptured dissecting aneurysm in bilateral iliac arteries caused by Ehlers-Danlos syndrome type IV: report of a case.ehlers-danlos syndrome (EDS) is an inherited disorder of connective tissue characterized by hyperextensible skin, hypermobile joints, and abnormalities of the cardiovascular system. Ten types and several subtypes of EDS have so far been recognized based on genetic, clinical, and biochemical characteristics. The spectrum of the disorder varies from mild to life-threatening vascular complications. EDS type IV is a particularly dangerous form with a lethal spontaneous rupture of the major arteries and aneurysmal formation. We present herein a case of a ruptured dissecting aneurysm in the bilateral iliac arteries caused by EDS type IV. A previously healthy 33-year-old man without any physical features of this connective tissue disorder experienced a metachronous vascular rupture two times. Successful synthetic bypass grafting was performed with great difficulty. The diagnosis of EDS type IV was made afterwards based on an electrophoresis analysis of a skin biopsy specimen which revealed a lack of type III collagen. Surgical intervention in cases of arterial complications in EDS type IV patients have been reported to be both difficult and frequently unsuccessful. The early clinical recognition of this syndrome is therefore of great importance due to the hazards of such surgical therapies.- - - - - - - - - - ranking = 1keywords = vascular complication (Clic here for more details about this article) |
3/4. Early vascular complications after endovascular repair of aortoiliac aneurysms.The purpose of this study was to estimate the frequency of and review the treatment options for intraoperative endograft access-related vascular complications and early postoperative vascular complications of endovascular repair for aortoiliac aneuryms (EVAR). Between February 1998 and April 2000, 53 patients (46 males, 7 females) with aneurysms of the abdominal aorta (AAA) and iliac arteries were treated with endovascular grafts (48 AAA, and 5 iliac aneurysms). All procedures were performed using open exposure of the femoral arteries. One patient with an AAA was converted to open repair (primary technical success, 98.1%). We recorded the need for adjunctive vascular procedures or intervention to the access arteries (iliofemoral) or the endograft because of thrombosis or distal embolization. Events were classified as either intraoperative, early postoperative (< 30 postoperative days), or late postoperative. Their etiology and treatment were recorded. The results were compared to those from other series reported in the literature and to published registry data. From our results we concluded that the need for adjunctive vascular procedures to the iliofemoral arteries at the time of EVAR is significant. These procedures are necessary to either repair damage to the access arteries from the delivery system or provide a conduit for graft delivery in cases where the access arteries are inadequate. Early postoperative vascular complications are due to technical factors resulting in residual graft limb stenoses. Both intraoperative and early postoperative vascular complications after EVAR are more common in female patients. These complications can be effectively treated with a variety of open surgical and transfemoral endovascular techniques.- - - - - - - - - - ranking = 8keywords = vascular complication (Clic here for more details about this article) |
4/4. Vascular complications in ehlers-danlos syndrome.ehlers-danlos syndrome (EDS) type IV results in a high incidence of vascular lesions. The extreme fragility of arteries is associated with multiple aneurysm formation, spontaneous rupture, and dissection. Surgical management of patients with this disorder is hazardous and often unrewarding. In this report we describe the difficulties encountered in the management of three patients with EDS-related vascular lesions. Three patients presented with pain and exhibited characteristic features of EDS. Diagnostic modalities included computerized tomography, transesophageal echocardiography, and magnetic resonance. aortography was performed only in specific situations. One patient with pericardial and mediastinal hemorrhage was stabilized and treated conservatively, with a good outcome. An adolescent with a ruptured aortic pseudoaneurysm died at surgery. The third patient underwent successful surgical correction of multiple aortic and renal aneurysms. In view of the increased risk of fatal vascular complications, surgeons should identify patients with EDS before performing invasive procedures. Arteriography should be used only when necessary. Although operative mortality remains at a high level due to the tendency of vessels to tear with even minimal manipulation, mortality from hemorrhage without surgical intervention is even greater. The key to favorable outcomes lies in identification of the syndrome preoperatively, surgical intervention only in life- or limb-threatening situations, and appropriate modification of surgical technique.- - - - - - - - - - ranking = 1keywords = vascular complication (Clic here for more details about this article) |