Annals of vascular surgery
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We report a case of inferior mesenteric artery aneurysm (IMAA) after the replacement of the thoracoabdominal aorta for a chronic dissected thoracoabdominal aortic aneurysm in which the celiac artery and superior mesenteric artery were occluded. We performed the resection of the IMAA and the revascularization of the superior mesenteric artery, inferior mesenteric artery, and meandering artery. The patient's postoperative course was uneventful, without bowel ischemia. From the findings of intraoperative flow measurement of the visceral arteries, revascularization of the superior mesenteric artery was judged to be appropriate in this situation.
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Prophylactic open surgery is the standard practice in patients with connective tissue and thoracoabdominal aortic aneurysm (TAAA) and aortic arch disease. Branched and fenestrated devices offer a less invasive alternative but there are concerns regarding the durability of the repair and the effect of the stent graft on the fragile aortic wall. The aim of this study is to evaluate mid-term outcomes of fenestrated and/or branched endografting in patients with connective tissue disease. ⋯ The favorable mid-term outcomes in this series that demonstrate fenestrated and/or branched endografting should be considered in patients with connective tissue and TAAA and aortic arch disease, which are considered unfit for open surgery. All patients require close lifetime surveillance at a center specializing in aortic surgery, with sufficient experience in both open and endovascular aortic surgery, so that if endovascular treatment failure occurs it can be recognized early and further treatment offered.
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Case Reports
Thrombolytic Therapy of Acute Massive Pulmonary Embolism Using Swan-Ganz Pulmonary Artery Catheter.
Acute massive pulmonary embolism (PE) is associated with high fatality, and catheter-directed thrombolytic therapy has been shown to be an efficacious treatment for this condition. We herein report a patient who developed acute massive PE but could not undergo the conventional catheter-directed thrombolytic therapy. A Swan-Ganz pulmonary artery catheter was placed at bedside to initiate immediate thrombolytic infusion, which resulted in dramatic clinical improvement. This report underscores a potential role of thrombolytic therapy via a transjugular pulmonary artery catheter in patients with acute massive PE who could not undergo the conventional catheter-based thrombolytic intervention.
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Despite advances in endovascular surgery, lower extremity arterial bypass (LEB) remains the gold standard treatment for severe, symptomatic Peripheral Arterial Disease. With recent changes in health care, there has been an increasing emphasis on reducing the hospital length of stay (LOS). The purpose of this study was to identify the postoperative complications, which occur after discharge from hospital and to find risk factors for developing such complications. ⋯ Wound infection is the most common complication after LEB. Most of these complications occur after discharge from hospital. Patients with risk factors for developing wound infections should be followed and closely monitored after discharge from the hospital.
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Case Reports
Endovascular Repair of Ruptured Thoracoabdominal Aortic Aneurysm with an Off-the-shelf Endoprosthesis.
Thoracoabdominal aortic aneurysm type 3 (TAAA3) is a challenging disease to vascular surgeons. In these cases, the best treatment methodology is conventional surgery, which portends a mortality rate ranging from 8% to 25%. Endovascular treatment has been shown to be a good alternative, with encouraging results. In 2012, a new alternative for endovascular treatment of TAAA3 was presented: Cook T-Branch endoprosthesis (Cook Medical, Bloomington, Indiana). We present the first successful case of endovascular treatment of a ruptured TAAA3 with this stent. ⋯ Until now, the only endovascular alternative for ruptured aortic aneurysm was the parallel prosthesis technique. The development of an off-the-shelf T-Branch prosthesis (Cook Medical) has solved this problem in many cases, enabling immediate treatment of this type of aneurysm in approximately 83% of patients. The fact that the thoracic aorta would be excluded lead the patient to a high risk of spinal cord ischemia. We therefore decided to make a cerebrospinal fluid drainage. There is no consensus regarding the best devices to be used as branches. In this case, we chose to use the previously described covered stents, according to its flexibility and compatibility with the length of arteries. This is the first report of the use of a T-branch (Cook Medical) for treatment of a ruptured TAAA3. The development of an off-the-shelf endoprosthesis has many advantages: it is available for use in an emergency situation, and there is no time lapse for its preparation. The T-Branch stent graft is a valid option for the treatment of ruptured TAAA3.