Intraoperative Vascular Surgical Consultation during Non-Vascular Surgeries in Tertiary Centers by Vascular Surgeon

PURPOSE: There are many types of intraoperative consultations by vascular surgeons during non-vascular surgery. Therefore, we examined the current state of intraoperative consultations during non-vascular surgery in a single center. MATERIALS AND METHODS: From January 2014 to December 2015, we reviewed records of 40 patients (0.3%) who received an intraoperative consultation from a vascular surgeon for 10,734 non-vascular surgeries in Inha University Hospital. We examined patient characteristics, operative details, and clinical results. RESULTS: There were 40 intraoperative vascular surgical consultations relating to bleeding (n=14, 35.0%), dissection from the vessel (n=13, 32.5%), arterial occlusion (n=10, 25.0%), and retroperitoneal approach (n=3, 7.5%). The locations of surgery were lower extremity (n=10, 25.0%), kidney (n=8, 20.0%), spine (n=6, 15.0%), pelvis (n=6, 15.0%), head and neck (n=4, 10.0%), abdomen (n=4, 10.0%), and upper extremity (n=2, 5.0%). The methods of surgery included primary closure or ligation (n=17, 42.5%), end-to-end anastomosis (n=12, 30.0%), bypass (n=10, 25.0%), thrombectomy (n=4, 10.0%), retroperitoneal approach (n=3, 7.5%), and embolization (n=2, 5.0%). Postoperative treatment was performed in the intensive care unit for 13 patients (32.5%), while 3 patients (7.5%) died following surgery. CONCLUSION: Intraoperative consultation by vascular surgeons during non-vascular surgery occurred in approximately 0.3% of non-vascular surgeries. The region undergoing operation and type of surgery were variable. Therefore, it is necessary for vascular surgeons to have a comprehensive knowledge of vascular anatomy and to make rapid surgical decisions.

Right iliac arterial aneurysm in a 4-year-old girl who does not have a right external iliac artery

Pediatric arterial aneurysm is rare disease. Among them, idiopathic-congenital arterial aneurysm is extremely rare. This is a case report of right common iliac artery idiopathic aneurysm with absence of right external iliac artery. A 4-year-old girl who had been complaining of intermittent abdominal pain since 2 years prior presented with a right lower abdominal mass that had been palpable since 6 months prior. Abdominal CT revealed a 5.2 cm × 4.5 cm × 5.1 cm, right-sided, partially thrombosed, saccular, iliac artery aneurysm. She underwent to operation, aneurismal resection. A pathological examination confirmed that it was a true aneurysm, considering that all layers of the vascular wall were stretched with no deficit. The patient was discharged 3 days after the surgery without any complication. Five months passed since the surgery, and the patient is doing well without any abdominal or leg pain.

An Unruptured Anterior Communicating Artery Aneurysm with Bilateral Infraoptic Anterior Cerebral Arteries. Case Report and Review of the Literature

Variations of the anterior cerebral artery-anterior communicating artery complex are commonly identified in aneurysm surgery. An infraoptic course of the anterior cerebral artery is exceedingly rare. Robison first described this anomaly from an anatomic dissection in 1959. A unilateral anomalous infraoptic anterior cerebral artery is more common than anomalies of bilateral infraoptic anterior cerebral arteries. We present the case of an unruptured aneurysm at the anterior communicating artery in a patient with bilateral infraoptic anterior cerebral arteries, identified by computed tomography angiography and verified during surgery. Implications for aneurysm formation and surgical treatment are discussed.

Clinical Utility of Coronary CT Angiography with Stress Perfusion CT in Preoperative Cardiac Risk Evaluation

BACKGROUND AND OBJECTIVES: Vascular surgery carries high operative risk. Recently developed cardiac computed tomography (CT) provides excellent imaging of coronary artery disease (CAD), as well as myocardial perfusions. We investigated the role of stress perfusion CT with coronary computed tomography angiography (CCTA) using 128-slice dual source CT (DSCT) in preoperative cardiac risk evaluation. SUBJECTS AND METHODS: Patients scheduled for vascular surgery were admitted and underwent the adenosine stress perfusion CT with CCTA using DSCT. Patients who presented with unstable angina, recent myocardial infarction, decompensated heart failure, or renal failure were excluded. Stress perfusion CT was first acquired using sequential mode during adenosine infusion, after which, scanning for CT angiography was followed by helical mode. Perioperative events were followed up for 1 month. RESULTS: Ninety-one patients completed the study. Most patients (94.5%) had coronary atherosclerosis, with 36 (39.6%) patients had more than 50% coronary artery stenosis. Perfusion defects with significant stenosis were found in 12 cases (13.2%). Revascularization after DSCT was rarely performed. Four patients (4.4%) experienced cardiac events in the perioperative period: two experienced heart failure and two had non-fatal myocardial infarction. CONCLUSION: We cannot conclude that the stress perfusion CT, with CCTA using DSCT, plays a significant role in preoperative risk evaluation from this study. However, the coronary atherosclerosis and the significant CAD were commonly found. The perfusion defects with significant lesions were found in only small fraction of the patients, and did not contribute to perioperative myocardial infarction or heart failure.

Early diagnosis and treatment for severe thoracic and abdominal vascular injuries:report of 81 cases / 解放军医学杂志

Objective To explore the methods for early diagnosis and treatment on severe thoracic and abdominal vascular injuries.Methods Eighty one patients were diagnosed as severe thoracic and abdominal vascular injuries and treated from January 2000 to October 2007.Twenty two cases suffered from hemorrhagic shock when admitted to the Emergency Department,from whom amount of inagglutinable blood were drawn out by thoracentesis or peritoneocentesis,and underwent operation immediately;38 cases were diagnosed by spiral CT and angiography(CTA);21 cases were diagnosed by digital substraction angiography.Forty-five patients accepted operation,and 36 cases underwent blood vessel suture and repair.Angiography was performed and blood vessels were blocked by sacculus in 12 cases before operation.Nine cases underwent artificial blood vessel anastomosis,among them 3 cases had to receive damage control for heavy injury,i.e.temporary shunting was made by intubating in the severe damaged blood vessel,the patients were then resuscitated in ICU to improve system condition,and operations were performed in 48 hours.Thirty six patients,including 31 cases of retroperitoneal blood vessel injuries in pelvic cavity,were treated by arterial embolization.Results Of the 81 patients,73 cases were cured(90.1%).Thirty-five cases developed severe complications,including 6 cases of sepsis,8 ARDS and 23 MODS.Eight cases died,of them 6 cases died of multiple organs damaged and hemorrhagic shock within 12 hours after injury,and 2 cases died of sepsis and MODS respectively at 8 and 16 days after injury.Conclusions Examination and diagnosis must be done immediately when the thoracic and abdominal vascular injured,and then the urgent operation of blood vessel repair or anastomosis should be performed.Some abdominal and retroperitoneal vascular injuries may be treated with artery embolization.