Repair of Salmonella mycotic aneurysm of the paravisceral abdominal aorta using in situ prosthetic graft

Salmonella infection of the abdominal aorta is associated with a high mortality and morbidity, especially when the paravisceral segment is involved. The presentation may be vague and a high index of suspicion is required in order to make the diagnosis early so that prompt treatment can be instituted. Imaging techniques such as computed tomography and angiogram are useful in arriving at a diagnosis as well as planning of operation. The management of a patient with Salmonella mycotic aortic aneurysm includes potent antibiotics, adequate debridement and revascularization. The method of revascularization, in situ bypass or extra-anatomic bypass, has been the subject of controversy. In situ bypass involves placing a graft in an infected field with potentially fatal graft infection, while extra-anatomic bypass has the problem of inferior patency and the necessity of a future reconstruction. We report here a patient with Salmonella mycotic aneurysm of the paravisceral abdominal aorta successfully treated with in situ prosthetic bypass graft.published_or_final_versio

Carotid stenting for irradiation-associated carotid stenosis 3 years after previous carotid endarterectomy

Extracranial carotid stenosis is a known complication of external irradiation to the head and neck region. We report on a patient with previous carotid endarterectomy for irradiation-associated carotid stenosis. This patient developed symptomatic carotid stenosis over the ipsilateral common carotid artery proximal to the previous endarterectomy site 3 years later, and was successfully treated with carotid angioplasty and stenting. This case illustrates the importance of Duplex scan surveillance after carotid endarterectomy for patients with irradiation-associated carotid stenosis. The complimentary role of carotid endarterectomy and carotid angioplasty for managing such a patient is highlighted.published_or_final_versio

Successful emergency endovascular treatment of juxtarenal and infrarental mycotic aortic aneurysms in patients with small diameter aortae using Cook® Zenith ESLE stentgrafts

BACKGROUND: Endovascular repair of mycotic aneurysm is an alternative to open repair if the patho-anatomy is suitable. The aortic size above and below the mycotic aneurysm may be small. METHODS: A retrospective review was made of prospectively collected departmental computerised database. RESULTS: Three oriental patients with juxta- and infra-renal mycotic aortic aneurysms with a small aortic diameter of 17 mm to 18 mm underwent successful emergency endovascular treatment using Cook® Zenith ESLE stentgrafts. These are ancillary devices aimed at iliac extensions usually. CONCLUSION: This is to our knowledge the fi rst case series of Cook® Zenith ESLE iliac component endografts for the treatment of aortic mycotic aneurysms with small aortae, and short- and mid-term results are encouraging.published_or_final_versio

Hybrid endovascular operation for ruptured thoracic aortic aneurysm

The rupture of a thoracic aortic aneurysm is a life-threatening emergency. Conventional open surgical repair carries a high mortality and morbidity. We report an elderly patient who suffered from rupture of a proximal descending thoracic aortic aneurysm close to the aortic arch. A hybrid operation consisting of a right-to-left carotid bypass followed by endovascular repair of the descending thoracic aorta was carried out. The patient recovered uneventfully. A hybrid endovascular repair should be considered the treatment of choice for rupture of a thoracic aortic aneurysm near the arch.published_or_final_versio

Early experience on the use of cyanoacrylate to treat patients with symptomatic long saphenous vein incompetence

Abstract and Free Paper Presentationpostprin

Outcome and risk factor analysis of patients who underwent open infrarenal aortic aneurysm repair

SummaryIntroductionThe aim of this study was to evaluate the short- and long-term outcomes in patients who underwent open infrarenal aortic aneurysm repair.MethodsConsecutive patients who underwent open repair of infrarenal aortic aneurysms at our institution from July 1st 1990 to June 30th 2012 were reviewed from a prospective collected departmental database. Short-term outcomes included 30-day mortality and peri-operative complications. Independent risk factors to predict 30-day mortality were identified. Long-term survival and secondary interventions were also reported.ResultsThree hundred and eighty-three patients (317 males, median age 72 years with a range of 15–90 years) underwent open infrarenal aortic aneurysm repair during the period, of whom 266 (69.5%) were elective, 18 (4.7%) were urgent for symptomatic but nonruptured cases, and 99 (25.8%) were emergency procedures for ruptured aneurysms. Mean aneurysm size was 6.5 cm (ranging from 2.5 cm to15 cm). All patients were followed up for at least 24 months with a mean follow up period 163 months. Overall 30-day mortality was 11.0% (36.4% for ruptured cases, 11.1% for symptomatic cases, and 1.5% for elective cases; p < 0.001). Preexisting renal disease and ruptured aneurysms were independent risk factors for 30-day mortality (p = 0.001 and p = 0.006 respectively). Systemic complications included 50 cardiac events, 52 respiratory events, six renal events, three cerebral vascular accidents, and one deep vein thrombosis/pulmonary embolism. Local complications included two anastomotic/graft hemorrhage, 10 distal thrombosis/embolisms, five bowel ischemias, one spinal cord ischemia, and 17 wound complications. The ruptured group presented survival rates of 53.5%, 50.5%, 47.5%, 42.3%, 38.0%, 21.9%, and 12.5% at 1 year, 2 years, 3 years, 4 years, 5 years, 10 years, and 15 years, respectively; while nonruptured survival rates were 91.5%, 88.0%, 83.7%, 78.3%, 73.0%, 43.0%, and 25.3%, respectively (log rank p < 0.001). For those who died 30 days after the operation, only six patients (1.8%) died from aneurysm related mortality. A total of three (0.9%) patients underwent late re-interventions, one for late aorto-enteric fistulae and two for anastomotic pseudoaneurysms.ConclusionIn the current era of endovascular repair, open infrarenal aneurysm repair is effective and durable, and has very low secondary interventions rates

Early single-centre comparative results on non-thermal ablation of symptomatic incompetent great saphenous veins (GSV): cyanoacrylate glue (VenaSeal) versus mechanicochemical ablation (ClariVein)

Speakers' corner: Selected original research abstracts - supraaortic and venouspublished_or_final_versio

Access complications from endovascular interventions

Session: Vascular Emergencie

Femoral pseudoaneurysms in drug addicts

Femoral pseudoaneurysm is a serious complication in drug addicts who habitually inject via the groin. A total of 33 drug addicts presenting with 34 infected femoral pseudoaneurysms were treated in the Department of Surgery, the University of Hong Kong, Queen Mary Hospital from July 1993 to June 1996. There were 27 men and 6 women, with ages ranging from 23 to 76 years (mean 39.6 years). Positive intraoperative tissue cultures were seen m 29 (85%), with 17 being pure growth of methicillin-sensitive Staphylococcus aureus (MSSA). Twenty-four pseudoaneurysms involved the femoral bifurcation and were treated by triple ligation of the common femoral, superficial femoral, and profunda femoris arteries. Seven other limbs underwent ligation of the common femoral artery alone, and three had superficial femoral artery ligation. Nineteen limbs had the external iliac artery ligated in addition to the femoral ligation for better proximal control. The mean postoperative ankle-brachial index (ABI) was 0.43 and 0.52 in those with triple ligation and those with single-vessel ligation, respectively. There was no hospital mortality, and all patients were discharged with a viable limb. The duration of follow-up ranged from 2 to 36 months (mean 15.5 months). Four patients were asymptomatic, but the rest suffered some degree of intermittent claudication. No delayed limb loss was identified. We conclude that systemic antibiotics active against MSSA are the antibiotics of choice in drug addicts with infected fernoral pseudoaneurysms. Ligation and excision of the pseudoaneurysm without revascularization is safe, with acceptable morbidity and a low limb loss rate.link_to_subscribed_fulltex