Thoracic endovascular aortic repair (TEVAR) is the standard of care for ruptured thoracic aortic aneurysms. A 92-year-old man had presented in stable condition but with acute severe back pain. Computed tomography revealed a ruptured thoracic aortic aneurysm. TEVAR (Valiant; Medtronic Vascular, Santa Rosa, Calif) into zone 2 with intentional coverage of the left subclavian artery was planned. After release of the stent-graft body, proximal release of the bare springs was impossible. Troubleshooting techniques were applied; but tip capture could not be released. Emergent conversion to open repair was performed. Intraoperative device deployment failure in TEVAR is rare. The findings from the present report have demonstrated the advantages of having in-house cardiac surgery backup available.
Abstract We describe the case of a 23-year-old patient presenting for redo aortic arch surgery because of recoarctation and poststenotic aneurysm formation after patch aortoplasty in infancy. Using the hemi-clamshell approach, the entire aortic arch was replaced and the supraaortic branches were reimplanted. The applied surgical technique using hypothermic extracorporeal circulation without cardiac arrest allowed an uninterrupted cerebral and spinal cord perfusion due to stepwise clamping of the aortic arch during reconstruction and resulted in an excellent neurologic outcome at six-month follow-up. (J Card Surg 2010;25:560-562)
Problems of wound healing following vascular surgery through inguinal incisions include hematoma formation, infection, lymphocele and lymph fistula, and occur in up to 20% of the cases. Closure of chronic wounds is sometimes obtained only after plastic reconstructions such as muscle flaps. We have examined if the use of the less invasive method of vacuum-assisted closure (VAC) may be beneficial. Between January 1999 and May 2002, 36 (2.6%) inguinal wound healing problems were retrospectively identified among 1410 operations originally involving inguinal dissection. There were 15 (42%) females and 21 (58%) males, with a median age of 72 years (range 46–98 years). The indication for the initial operation was arterial surgery in 31 (86%), including aortofemoral reconstruction, arterial reconstruction or endarterectomy with a patch plasty of the femoral artery. Three patients (8%) were operated on for pseudoaneurysm after radiological intervention, two (6%) because of a lymph fistula. Of the 36 patients, 13 (36%) had a frank infection, 12 (33%) were deemed clinically contaminated, and 11 (31%) were non-infected. Operative strategy included vacuum-assisted closure of the wound. Change of the vacuum system was performed a median of 1.8 times (range 1–9) in the operating room. The median length of therapy was 9.2 days (range 3–29). Direct delayed secondary suture was possible in 25 (69%) cases. In 9 (25%) the defect was covered with a split-skin graft. Two patients (6%) required a secondary plastic reconstruction. One leg (2.8%), originally treated for phlegmasia coerulea dolens was amputated. One patient (2.8%) with an infected aortofemoral Dacron graft died from intractable bleeding after homograft reconstruction. No grafts were lost. Vacuum-assisted wound management led to healing of 34 (94%) wounds during initial hospitalisation. Initial strategy was changed twice (6%). Vacuum-assisted closure system is one of the most efficient tools in the treatment of problematic groin wounds in vascular surgery as well as endovascular interventions.
The aim of the present comprehensive review was to present an overview of the clinical presentation and treatment options for external (EJVAs) and internal jugular vein aneurysms (IJVAs) to help clinicians in evidence-based decision making.A systematic literature search was conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement and included MEDLINE, Embase, Cochrane Library, Scopus, WHO (World Health Organization) trial register, ClinicalTrials.gov, and the LIVIVO search portal. The inclusion criteria were studies of patients who had presented with IJVAs or EJVAs. The exclusion criteria were animal and cadaver studies and reports on interventions using the healthy jugular vein for access only (ie, catheterization). Analysis of the pooled data from all eligible case reports was performed.From 1840 identified reports, 196 studies were eligible. A total of 256 patients with JVAs were reported, with 183 IJVAs and 73 EJVAs. IJVAs were reported to occur in 66% on the right side compared with the left side (P = .011). The patients with IJVAs were mostly children (median age, 12 years; interquartile range, 5.8-45.2 years). The patients with EJVAs were young adults (median age, 30 years; interquartile range, 11.0-46.5 years). EJVAs were more frequently reported in women and IJVAs in men (P = .008). Most of the patients were asymptomatic. Pulmonary embolization in association with thrombosed EJVAs was only reported for one patient. A report of the outcomes after surgery and conservative management was missing for ∼50% of the patients. No relevant complications were reported after ligation of the EJVA without reconstruction. Intracranial hypertension after ligation of the right-sided IJVA was reported in three children; in one of them, a pontine infarction was observed.JVAs are a disease of the younger population but can occur at any age. It seems to be safe to observe patients with nonthrombosed JVAs. However, in the presence of thrombus or pulmonary embolization, surgical treatment should be considered. A reconstruction technique of the IJVA with venous patency preservation should be preferred.
To report two cases of life-threatening aortic infection after percutaneous endovascular coil embolization prior to endovascular abdominal aortic aneurysm (AAA) repair (EVAR).Two 76-year-old patients were readmitted 5 days and 3 weeks, respectively, after technically successful percutaneous coil embolization of aortic side branches in advance of scheduled EVAR. In the first patient, the right hypogastric artery, the inferior mesenteric artery (IMA), and a lumbar artery had been embolized, whereas in the second patient only the right hypogastric artery and the IMA had been occluded. On admission, both patients presented with severe abdominal pain. Investigations revealed acute aortic infection in both patients, combined with substantial AAA enlargement in one. Open surgical infrarenal aortic replacement was performed using homografts, and antibiotic therapy was initiated. After uneventful recovery, both patients were asymptomatic, had intact aortic homografts, and showed no evidence of infection after 12 and 18 months of follow-up, respectively.Endovascular infections are a potentially serious complication following percutaneous coil embolization of major aortic branches. Early diagnosis and dedicated therapy are mandatory. Immediate resection of the infected aorta and replacement with homografts in association with prolonged antibiotic treatment showed good midterm results.
BackgroundMinimal extracorporeal circulation (MECC) is a promising perfusion technology, taking the advantage of an ECC while having a significantly reduced priming volume. We analyzed the actual possible benefits of using MECC in patients undergoing CABG procedures and compared the results with conventional extracorporeal circulation (CECC).MethodsOne thousand fifty-three consecutive patients underwent CABG surgery using the MECC perfusion technique. Subgroup analyses focused on perioperative myocardial markers (cardiac troponin I [cTnI]), incidence of atrial fibrillation (AF), and perioperative evaluation of inflammatory markers and data were compared with those of patients who underwent CABG using CECC. A propensity score analysis was performed.ResultsPatient characteristics and distribution of EuroSCORE risk were similar in both groups. Severity of coronary artery disease and extent of revascularization were also comparable in both groups (number of distal anastomoses: 3.2 ± 1.1 in CECC vs 3.2 ± 0.9 in MECC; p = not significant [ns]). The cTnI was significantly lower in the MECC group (11.0 ± 10.8 μg/L in MECC vs 24.7 ± 25.3 μg/L in CECC; p < 0.05). Incidence of AF was 11.1% in MECC and 39.0% in CECC (p < 0.05). Inflammatory markers (interleukin-6, SC5b-9) were lower in MECC patients (p < 0.05). Propensity score analysis confirmed faster recovery in MECC patients and lower incidence of AF.ConclusionsMinimal extracorporeal circulation is a safe perfusion technique for CABG and may therefore concurrence OPCAB and traditional CABG under CECC. Minimal extracorporeal circulation (MECC) is a promising perfusion technology, taking the advantage of an ECC while having a significantly reduced priming volume. We analyzed the actual possible benefits of using MECC in patients undergoing CABG procedures and compared the results with conventional extracorporeal circulation (CECC). One thousand fifty-three consecutive patients underwent CABG surgery using the MECC perfusion technique. Subgroup analyses focused on perioperative myocardial markers (cardiac troponin I [cTnI]), incidence of atrial fibrillation (AF), and perioperative evaluation of inflammatory markers and data were compared with those of patients who underwent CABG using CECC. A propensity score analysis was performed. Patient characteristics and distribution of EuroSCORE risk were similar in both groups. Severity of coronary artery disease and extent of revascularization were also comparable in both groups (number of distal anastomoses: 3.2 ± 1.1 in CECC vs 3.2 ± 0.9 in MECC; p = not significant [ns]). The cTnI was significantly lower in the MECC group (11.0 ± 10.8 μg/L in MECC vs 24.7 ± 25.3 μg/L in CECC; p < 0.05). Incidence of AF was 11.1% in MECC and 39.0% in CECC (p < 0.05). Inflammatory markers (interleukin-6, SC5b-9) were lower in MECC patients (p < 0.05). Propensity score analysis confirmed faster recovery in MECC patients and lower incidence of AF. Minimal extracorporeal circulation is a safe perfusion technique for CABG and may therefore concurrence OPCAB and traditional CABG under CECC.
