Diagnosis of Aortocaval Fistula by Computed Tomography

A case of an aortocaval fistula documented by contrast-enhancement computed tomography is reported. In the presence of a large abdominal aortic aneurysm, the computed tomography (CT) triad findings of: (1) vena caval effacement, (2) loss of the fat plane between the aorta and vena cava, and (3) rapid flow of contrast from the aorta into a dilated inferior vena cava is characteristic of an aortocaval fistula

Diagnosis of Aortocaval Fistula by Computed Tomography

A case of an aortocaval fistula documented by contrast-enhancement computed tomography is reported. In the presence of a large abdominal aortic aneurysm, the computed tomography (CT) triad findings of: (1) vena caval effacement, (2) loss of the fat plane between the aorta and vena cava, and (3) rapid flow of contrast from the aorta into a dilated inferior vena cava is characteristic of an aortocaval fistula

Popliteal Artery Aneurysm Treated With a Minimally Invasive Endovascular Approach: An Initial Report

Purpose: To report a minimally invasive approach to popliteal artery aneurysm (PAA) treatment. Methods and Results: A 48-year-old male with a 3-cm PAA was treated electively with an endovascular in situ saphenous vein bypass and transluminal antegrade coil embolization of the PAA prior to completion of the proximal anastomosis. Two short incisions at the anastomosis sites resulted in no wound complications, and the patient was discharged after 2 days. After 14 months of follow-up, the patient is asymptomatic with continued patency of the in situ bypass and occlusion of the PAA. Conclusions: This endovascular approach for minimally invasive femoropopliteal in situ saphenous vein bypass grafting appears feasible for treatment of PAAs. This method may reduce the rate of wound complications attending classic open in situ bypass grafts

Jugular Venous Phlebectasia

Phlebectasia of the jugular vein is a rare entity, manifested as a compressible cystic mass in the neck that appears on straining. The authors report the postpartum presentation of jugular phlebectasia and discuss the benefit of color-flow duplex imaging in the diagnosis and follow-up of this condition

Jugular Venous Phlebectasia

Phlebectasia of the jugular vein is a rare entity, manifested as a compressible cystic mass in the neck that appears on straining. The authors report the postpartum presentation of jugular phlebectasia and discuss the benefit of color-flow duplex imaging in the diagnosis and follow-up of this condition

Popliteal Artery Aneurysm Treated With a Minimally Invasive Endovascular Approach: An Initial Report

Purpose: To report a minimally invasive approach to popliteal artery aneurysm (PAA) treatment. Methods and Results: A 48-year-old male with a 3-cm PAA was treated electively with an endovascular in situ saphenous vein bypass and transluminal antegrade coil embolization of the PAA prior to completion of the proximal anastomosis. Two short incisions at the anastomosis sites resulted in no wound complications, and the patient was discharged after 2 days. After 14 months of follow-up, the patient is asymptomatic with continued patency of the in situ bypass and occlusion of the PAA. Conclusions: This endovascular approach for minimally invasive femoropopliteal in situ saphenous vein bypass grafting appears feasible for treatment of PAAs. This method may reduce the rate of wound complications attending classic open in situ bypass grafts

Comparison between the Transabdominal and Retroperitoneal Approaches for Aortic Reconstruction in Patients at High Risk

Purpose: The purpose of this study was to compare the transabdominal approach with the retroperitoneal approach for elective aortic reconstruction in the patient who is at high risk. Methods: From January 1992 through January 1997, 148 patients underwent aortic operations: 92 of the patients were classified as American Society of Anesthesia (ASA) class IV. Forty-four operations on the patients of ASA class IV were performed with the transabdominal approach (25 for abdominal aortic aneurysms and 19 for aortoiliac occlusive disease), and 48 operations were performed with the retroperitoneal approach (27 for abdominal aortic aneurysms and 21 for aortoiliac occlusive disease). There were no significant differences between the groups for comorbid risk factors or perioperative care. Results: Among the patients of ASA class IV, eight (8.7%) died after operation (retroperitoneal, 3 [6.26%]; transabdominal, 5 [11.3%]; P = .5). There was no difference between groups in the number of pulmonary complications (retroperitoneal, 23 [47.9%]; transabdominal, 19 [43.2%]; P = .7) or in the development of incisional hernias (retroperitoneal, 6 [12.5%]; transabdominal, 5 [11.3%]; P = .5). The retroperitoneal approach was associated with a significant reduction in cardiac complications (retroperitoneal, 6 [12.5%]; transabdominal, 10 [22.7%]; P = .004) and in gastrointestinal complications (retroperitoneal, 5 [8.3%]; transabdominal, 15 [34.1%]). Operative time was significantly longer in the retroperitoneal group (retroperitoneal, 3.35 hours; transabdominal, 2.98 hours; P = .006), as was blood loss (retroperitoneal, 803 mL; transabdominal, 647 mL; P = .012). The patients in the retroperitoneal group required less intravenous narcotics (retroperitoneal, 36.6 ± 21 mg; transabdominal, 49.5 ± 28.5 mg; P = .004) and less epidural analgesics (retroperitoneal, 39.5 ± 6.4 mg; transabdominal, 56.6 ± 9.5 mg; P = .004). Hospital length of stay (retroperitoneal, 7.2 ± 1.6 days; transabdominal, 12.8 ± 2.3 days; P = .024) and hospital charges (retroperitoneal, $35,587 ±$980; transabdominal, $54,832 ±$1105; P = .04) were significantly lower in the retroperitoneal group. The survival rates at the 40-month follow-up period were similar between the groups (retroperitoneal, 81.3%; transabdominal, 78.7%; P = .53). Conclusion: In this subset of patients who were at high risk for aortic reconstruction, the postoperative complications were common. However, the number of complications was significantly lower in the retroperitoneal group. Aortic reconstruction in patients of ASA class IV appears to be more safely and economically performed with the retroperitoneal approach. (J Vasc Surg 1999;30:400-6.

Comparison between the Transabdominal and Retroperitoneal Approaches for Aortic Reconstruction in Patients at High Risk

Purpose: The purpose of this study was to compare the transabdominal approach with the retroperitoneal approach for elective aortic reconstruction in the patient who is at high risk. Methods: From January 1992 through January 1997, 148 patients underwent aortic operations: 92 of the patients were classified as American Society of Anesthesia (ASA) class IV. Forty-four operations on the patients of ASA class IV were performed with the transabdominal approach (25 for abdominal aortic aneurysms and 19 for aortoiliac occlusive disease), and 48 operations were performed with the retroperitoneal approach (27 for abdominal aortic aneurysms and 21 for aortoiliac occlusive disease). There were no significant differences between the groups for comorbid risk factors or perioperative care. Results: Among the patients of ASA class IV, eight (8.7%) died after operation (retroperitoneal, 3 [6.26%]; transabdominal, 5 [11.3%]; P = .5). There was no difference between groups in the number of pulmonary complications (retroperitoneal, 23 [47.9%]; transabdominal, 19 [43.2%]; P = .7) or in the development of incisional hernias (retroperitoneal, 6 [12.5%]; transabdominal, 5 [11.3%]; P = .5). The retroperitoneal approach was associated with a significant reduction in cardiac complications (retroperitoneal, 6 [12.5%]; transabdominal, 10 [22.7%]; P = .004) and in gastrointestinal complications (retroperitoneal, 5 [8.3%]; transabdominal, 15 [34.1%]). Operative time was significantly longer in the retroperitoneal group (retroperitoneal, 3.35 hours; transabdominal, 2.98 hours; P = .006), as was blood loss (retroperitoneal, 803 mL; transabdominal, 647 mL; P = .012). The patients in the retroperitoneal group required less intravenous narcotics (retroperitoneal, 36.6 ± 21 mg; transabdominal, 49.5 ± 28.5 mg; P = .004) and less epidural analgesics (retroperitoneal, 39.5 ± 6.4 mg; transabdominal, 56.6 ± 9.5 mg; P = .004). Hospital length of stay (retroperitoneal, 7.2 ± 1.6 days; transabdominal, 12.8 ± 2.3 days; P = .024) and hospital charges (retroperitoneal, $35,587 ±$980; transabdominal, $54,832 ±$1105; P = .04) were significantly lower in the retroperitoneal group. The survival rates at the 40-month follow-up period were similar between the groups (retroperitoneal, 81.3%; transabdominal, 78.7%; P = .53). Conclusion: In this subset of patients who were at high risk for aortic reconstruction, the postoperative complications were common. However, the number of complications was significantly lower in the retroperitoneal group. Aortic reconstruction in patients of ASA class IV appears to be more safely and economically performed with the retroperitoneal approach. (J Vasc Surg 1999;30:400-6.