Aortic rupture after spinal correction for scoliosis in the presence of a thoracic stent graft

Corrective surgery for scoliosis often results in a lengthening of the spinal column and relative change of the position of the adjacent anatomical structures such as the aorta. The extent of these anatomical changes could be affected by the presence of a rigid aortic stent graft in the descending thoracic aorta. We present a case of aortic rupture after spinal correction for scoliosis in a 56-year-old female with a thoracic aortic stent graft. Extensive elongation of the aorta with concentration of the stress forces at the lower margin of the stent graft resulted in a weakening of the aortic wall and subsequent rupture

Thoracic and abdominal aortic dimension in 70-year-old men and women – A population-based whole-body magnetic resonance imaging (MRI) study

ObjectiveThe aim of this population-based study was to determine the optimal dividing-line between normal aorta and aneurysm for different aortic segments in 70-year-old men and women by means of whole-body magnetic resonance imaging.MethodsTwo hundred thirty-one subjects (116 men), randomly recruited from a population-based cohort study, were included. The smallest outer diameter (dia) was measured on the axial survey scan on six predefined aortic segments: (1) ascending aorta, (2) descending aorta, (3) supraceliac aorta, (4) suprarenal aorta, (5) largest infrarenal abdominal aorta, and (6) aortic bifurcation. Relative aortic dia were calculated by dividing a given aortic dia by the suprarenal aortic dia. The dividing-line between normal aorta and aneurysm at different aortic segments was estimated by taking the mean dia +2 SD and/or mean ratio of the aortic segment to the suprarenal aorta +2 SD.ResultsThe mean dia of the six segments were 4.0 cm (SD 0.4), 3.2 cm (0.3), 3.0 cm (0.3), 2.8 cm (0.3), 2.4 cm (0.5), and 2.3 cm (0.3) in men. The corresponding dia in women were 3.4 cm (0.4), 2.8 cm (0.3), 2.7 cm (0.3), 2.7 cm (0.3), 2.2 cm (0.3), and 2.0 cm (0.2). The mean ratio to the suprarenal aorta was 1.4 (SD 0.2) for the ascending aorta, 1.2 (0.1) for the descending aorta, and 0.9 (0.2) for the infrarenal aorta in men. The corresponding ratios in women were 1.3 (0.2), 1.0 (0.1), and 0.8 (0.1).ConclusionFor men the suggested dividing-line (dia and ratio) between normal aorta and aneurysm for the ascending aorta is 4.7 cm dia and 1.8 ratio, for the descending aorta 3.7 cm dia and 1.5 ratio, and for the infrarenal aorta is 3.0 cm dia and 1.1 ratio. The corresponding dividing-lines for women are 4.2 cm dia and 1.7 ratio, 3.3 cm dia and 1.3 ratio, and 2.7 cm dia and 1.0 ratio

Paradigm shifts in abdominal aortic aneurysm management based on vascular registries

Abstract Abdominal aortic aneurysm (AAA) is a relatively common and potentially fatal disease. The management of AAA has undergone extensive changes in the last two decades. High quality vascular surgical registries were established early and have been found to be instrumental in the evaluation and monitoring of these changes, most notably the wide implementation of minimally invasive endovascular surgical technology. Trends over the years showed the increased use of endovascular aneurysm repair (EVAR) over open repair, the decreasing perioperative adverse outcomes and the early survival advantage of EVAR. Also, data from the early EVAR years changed the views on endoleak management and showed the importance of tracking the implementation of new techniques. Registry data complemented the randomized trials performed in aortic surgery by showing the high rate of laparotomy related reinterventions after open repair. Also, they are an essential tool for the understanding of outcomes in a broad patient population, evaluating the generalizability of findings from randomized trials and analyzing changes over time. By using large scale data over longer periods of time, the importance of centralization of care to high-volume centers was shown, particularly for open repair. Additionally, large-scale databases can offer an opportunity to assess practice and outcomes in patient subgroups (e.g. treatment of AAA in women and the elderly) as well as in rare aortic pathologies. In this review article, we point out the most important paradigm shifts in AAA management based on vascular registry data.Peer reviewe

Contaminants and minerals in foods for infants and young children. Part 3, Risk and benefit management

In the present survey the National Food Agency (NFA) analysed and assessed contaminants and minerals in infant formulae and certain foods for children. The analysed items cover the relevant products from all producers present in the Swedish market in spring 2011. In total 92 different products were analysed for arsenic, cadmium and lead unintentionally present in foods, so-called contaminants, as well as the essential minerals manganese, iron and copper

International Multi-Institutional Experience with Presentation and Management of Aortic Arch Laterality in Aberrant Subclavian Artery and Kommerell's Diverticulum

Background: Aberrant subclavian artery (ASA) with or without Kommerell's diverticulum (KD) is a rare anatomic aortic arch anomaly that can cause dysphagia and/or life-threatening rupture. The objective of this study is to compare outcomes of ASA/KD repair in patients with a left versus right aortic arch. Methods: Using the Vascular Low Frequency Disease Consortium methodology, a retrospective review was performed of patients ≥18 years old with surgical treatment of ASA/KD from 2000 to 2020 at 20 institutions. Results: 288 patients with ASA with or without KD were identified; 222 left-sided aortic arch (LAA), and 66 right-sided aortic arch (RAA). Mean age at repair was younger in LAA 54 vs. 58 years (P = 0.06). Patients in RAA were more likely to undergo repair due to symptoms (72.7% vs. 55.9%, P = 0.01), and more likely to present with dysphagia (57.6% vs. 39.1%, P < 0.01). The hybrid open/endovascular approach was the most common repair type in both groups. Rates of intraoperative complications, death within 30 days, return to the operating room, symptom relief and endoleaks were not significantly different. For patients with symptom status follow-up data, in LAA, 61.7% had complete relief, 34.0% had partial relief and 4.3% had no change. In RAA, 60.7% had complete relief, 34.4% had partial relief and 4.9% had no change. Conclusions: In patients with ASA/KD, RAA patients were less common than LAA, presented more frequently with dysphagia, had symptoms as an indication for intervention, and underwent treatment at a younger age. Open, endovascular and hybrid repair approaches appear equally effective, regardless of arch laterality

Corrigendum to 'Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections' [European Journal of Vascular &amp; Endovascular Surgery 59/3 (2020) 339-384]

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