Inflammatory Abdominal Aortic Aneurysm (IAAA)

Purpose: The aim of this study is to report our experience about the inflammatory abdominal aortic aneurysm (IAAA). Methods: Between January 1999 and January 2008 we treated 8 cases of IAAA. Two patients underwent surgery in emergency. The preoperative diagnostic procedures were ultrasound (US), computed tomography (CT) and intravenous urography (IVU). In 6 elective patients the diagnosis of IAAA was obtained preoperatively. In one case a left hydroureteronephrosis was demonstrated by intravenous urography (IVU). All patients underwent open surgery with midline incision and transperitoneal access. Results: No 30-days mortality occurred. A case of pancreatitis was treated with conservative therapy. All patients had 60-days corticosteroid therapy. Conclusions: Our data suggest that because IAAA have the same rate of rupture of AAA, they need the same preventive treatment as non inflammatory abdominal aortic aneurysm (AAA) The kind of approach OPEN-EVAR should be chosen with the same criteria as AAA, even if EVAR teatment doesn't allow us to obtain the biopsy. Furthermore there are no sufficient evidences about regression of retroperitoneal fibrosis after EVAR treatment. Also the premature onset should be considered in the choice of treatment

Endograft connector technique to treat popliteal artery aneurysm in a morbid obese patient.

Surgical repair of popliteal artery aneurysm in morbid obese patients poses additional challenges. We report a morbid obese patient who had a 59mm right popliteal artery aneurysm which was successfully treated with the endograft connector technique. This technique was used to perform the distal anastomosis of the below-knee femoro-popliteal bypass. A 10mm Dacron graft was used as a main graft bypass and an 11 mm/10 cm stentgraft as endograft connector. Following the respective tunnel of the Dacron graft, an end-to-side proximal anastomosis was performed at distal femoral artery. The aneurysm exclusion was obtained through a proximal and a distal ligation. Postoperative duplex showed adequate bypass patency. Knee x-rays demonstrated no signs of stent kinking/fractures. The postoperative course was uneventful and the patient was discharged home on fourth day post operative. The six-month computed tomography scan and the 12-month duplex control showed a patent bypass with no signs of stenosis

The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0 % were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5 %). The diagnosis was deep-vein thrombosis (DVT) in 59.5 % and pulmonary embolism (PE) in 40.5 %. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5 %), hypertension (42.3 %) and dyslipidaemia (21.1 %). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2 %), almost half received a vitamin K antagonist (48.7 %) and nearly a quarter received a DOAC (24.5 %). Almost a quarter of all presentations were for recurrent VTE, with >80 % of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes

La Sindrome Compartimentale Addominale (ACS) dopo chirurgia dell'Aneurisma dell'Aorta Addominale (AAA)

Introduction: The Abdominal Compartment Syndrome (ACS) is a \u201ccondition in which increased tissue pressure in a confined anatomic space, causes decreased blood flow leading to ischaemia and dysfunction and may lead to permanent impairment of function\u201d Materials and Methods: between june 2007 and june 2008 we treated surgically 23 cases of AAA (14 in election and 9 in emergency), with indirect intra-abdominal pressure (IAP) monitoring (intra-vescical catheter). Mean age was 68 (64-84) years. Mean transverse diameter was 6,2 cm (min 5,5 e max 9,0). Rise in IAP more then 20 mmHg was considered for surgical decompression. In 1 case we registered preoperatively IAP more than 20 mmHg treated with only skin suture. Discussion: is possible to distinguish an acute and a chronic ACS.In vascular patients the ACS may occur following free intraperitoneal or contained retroperitoneal aneurysm rupture due to increased IAP. Recently ACS was defined as "killer number one" in the vascular surgical treatment of rAAA. The suggested management for patients with raised IAP, or at risk of developing the ACS following aortic surgery, is to consider urgent decompression in any patients with IAP over 20 mmHg or at lower pressures associated with worsening organ dysfunction. Measurement of IAP may be performed directly or indirectly. All this methods have as objective IPA monitoring befor its clinical manifestation. Conclusion: ACS can be considered a reliable predictive factor for aneurysm surgery outcome. Prevention of the ACS, with early recognition of rising IAP and urgent intervention to decompress the tense abdomen can lead to mortality reduction after aneurysm rupture (after both Open or EVAR treatment). The measurement of IAP is simple and non-invasive, and should be a routine component of physiological monitoring in patients following ruptured aneurysm repair in association with hypotensive hemostasis

A popliteal artery aneurysm presenting with ab extrinseco popliteal vein occlusion and compartment syndrome

INTRODUCTION: Aneurysms of popliteal artery are the most frequently reported aneurysm after abdominal aorta. An unusual presentation is compression to adjacent structure. CASE PRESENTATION: A 67 years old caucasian man presenting deep vein thrombosis signs to the right leg including functional impotence was admitted in emergency setting to Vascular Surgery Unit. A pulsing mass was present in the popliteal cave at inspection. The computed tomography angiography demonstrated a 53.2 mm popliteal artery aneurysm causing an ab extrinseco compression of the popliteal vein and a dislocation of popliteal nerve. A surgical open reconstruction with a reinforced Dacron graft was performed via a posterior approach. Patient was discharged on the fourth postoperative day with no functional impotence. At three and six months Doppler ultrasound followup both popliteal arterial graft and popliteal vein were patent. CONCLUSION: An unusual presentation of a popliteal artery aneurysm can be a popliteal compartment syndrome, especially in large aneurysms. Deep popliteal vein compression and/or popliteal nerve dislocation signs can rarely represent the clinical symptoms. The popliteal artery aneurysm repair is generally required to avoid a distal embolization and rupture. Through a surgical open repair was possible to achieve both popliteal cave decompression and the popliteal artery aneurysm repair

A popliteal artery aneurysm presenting with ab extrinseco popliteal vein occlusion and compartment syndrome: a case report.

Introduction: Aneurysms of popliteal artery are the most frequently reported aneurysm after abdominal aorta. An unusual presentation is compression to adjacent structure. Case presentation: A 67 years old caucasian man presenting deep vein thrombosis signs to the right leg including functional impotence was admitted in emergency setting to Vascular Surgery Unit. A pulsing mass was present in the popliteal cave at inspection. The computed tomography angiography demonstrated a 53.2 mm popliteal artery aneurysm causing an ab extrinseco compression of the popliteal vein and a dislocation of popliteal nerve. A surgical open reconstruction with a reinforced Dacron graft was performed via a posterior approach. Patient was discharged on the fourth postoperative day with no functional impotence. At three and six months Doppler ultrasound followup both popliteal arterial graft and popliteal vein were patent. Conclusion: An unusual presentation of a popliteal artery aneurysm can be a popliteal compartment syndrome, especially in large aneurysms. Deep popliteal vein compression and/or popliteal nerve dislocation signs can rarely represent the clinical symptoms. The popliteal artery aneurysm repair is generally required to avoid a distal embolization and rupture. Through a surgical open repair was possible to achieve both popliteal cave decompression and the popliteal artery aneurysm repair