Clinical Outcomes of Atypical Inflammatory Variants of Abdominal Aortic Aneurysm

Background@#Most abdominal aortic aneurysms are degenerative atherosclerotic aneurysms. Inflammatory or infected abdominal aortic aneurysms, which show a slightly different clinical course, are rarely encountered in clinical settings. Therefore, we aimed to investigate the clinical course of these variants of abdominal aortic aneurysms. @*Methods@#This retrospective study included 32 patients with atypical inflammatory or infected abdominal aortic aneurysms who underwent emergent graft replacement between November 1997 and December 2017. Patients were followed up at the outpatient clinic for a mean period of 4.9±6.9 years. We analyzed the patients’ clinical course and compared it with that of patients with atherosclerotic abdominal aortic aneurysms. @*Results@#There was 1 surgical mortality (3.0%) in a case complicated by aneurysmal free rupture. In 2 cases of infected abdominal aortic aneurysms, anastomotic complications developed immediately postoperatively. During the follow-up period, 10 patients (30%) developed graft complications, and 9 of them underwent reoperations; of these, 2 patients (22.2%) died of postoperative complications after the second operation, whereas 2 patients survived despite graft occlusion. @*Conclusion@#Patients with inflammatory abdominal aneurysms frequently develop postoperative graft complications requiring secondary surgical treatment, so they require close mandatory postoperative follow-up.

Long-Term Changes in the Distal Aorta after Aortic Arch Replacement in Acute DeBakey Type I Aortic Dissection

BACKGROUND: We analyzed the long-term results of ascending aortic replacement and arch aortic replacement in acute DeBakey type I aortic dissections to measure the differences in the distal aortic changes with extension of the aortic replacement. METHODS: We reviewed 142 cases of acute DeBakey type I aortic dissections (1996–2015). Seventy percent of the cases were ascending aortic replacements, and 30% of the cases underwent total arch aortic replacement, which includes the aorta from the root to the beginning of the descending aorta with the 3 arch branches. Fourteen percent (20 cases) resulted in surgical mortality and 86% of cases that survived had a mean follow-up period of 6.6±4.6 years. Among these cases, 64% of the patients were followed up with computed tomography (CT) angiograms with the duration of the final CT check period of 4.9±2.9 years. RESULTS: There were 15 cases of reoperation in 13 patients. Of these 15 cases, 13 cases were in the ascending aortic replacement group and 2 cases were in the total arch aortic replacement group. Late mortality occurred in 13 cases; 10 cases were in the ascending aortic replacement group and 3 cases were in the total arch aortic replacement group. Eight patients died of a distal aortic problem in the ascending aortic replacement group, and 1 patient died of distal aortic rupture in the total arch aortic replacement group. The follow-up CT angiogram showed that 69.8% of the ascending aortic replacement group and 35.7% of the total arch aortic replacement group developed distal aortic dilatation (p=0.0022). CONCLUSION: The total arch aortic replacement procedure developed fewer distal remnant aortic problems from dilatation than the ascending aortic replacement procedure in acute type I aortic dissections.

Isolated Popliteal Artery Disease

PURPOSE: An isolated popliteal artery lesion is relatively rare, with different clinical characteristics to those of atherosclerosis. There are several diseases found at the artery around the knee joint. The cases of knee joint artery experienced by the author studied, and the clinical characteristics evaluated. METHOD: Between 2001 and 2005, 8 patients underwent surgical treatment for isolated popliteal disease at our hospital. Of these 5 cases were for popliteal entrapment syndrome, one case for popliteal adventitial cystic disease, and 2 cases for an isolated popliteal artery aneurysm. The two cases of popliteal entrapment syndrome had bilateral involvement; therefore, a total of 10 legs were treated surgically. We analysed the clinical characteristics and surgical results from the patients' medical records. RESULT: The popliteal entrapment syndrome patients were younger than those with the other diseases. The main symptom of popliteal entrapment syndrome and adventitial cystic disease was calf claudication, which occurred insidiously after physical abuse, but the symptom of the popliteal artery aneurysm was due to acute venous congestion or arterial occlusion. Most of the cases were diagnosed with a CT angiogram. One gastrocnemius myomectomy and 6 popliteal interposition bypasses using the autogenous saphenous vein, were performed in the cases of popliteal entrapment syndrome. An arterial reconstruction, with an open cystectomy, was performed in the case of the adventitial cystic disease. Popliteal interposition bypass, with isolation of the popliteal aneurysm, was performed in the popliteal aneurysm. During the mean follow up period of 10.8+/-10 months, the arterial flows to the involved feet were patent in all cases. CONCLUSION: Isolated popliteal artery disease is not usually suspected but easy to diagnose with recently developed imaging study. If diagnosed properly and treated timely, the result of the surgical treatment of isolated popliteal artery disease can be excellent.

A Case of Adventitial Cystic Disease of the Femoral Vein

Adventitial cystic disease of veins is such a rare malady that only about 20 cases have been reported in the world literature. This low rate of reporting may be due to not only its low incidence but also to the difficulty of its diagnosis. A 52 year old man developed sudden painless edema of the left leg after physical abuse, and he was without any previous history of venous disease. He was found to have a bean-size cyst compressing the lumen of the left femoral vein. The intramural cyst was drained surgically and it was found to contain mucoid material. The patient has been followed up for about 11 months and he now has no venous problems in his left leg. Surgical excision and drainage shows a good result for treating the adventitial cystic disease of vein.

Clinical Results of Abdominal Aortic Aneurysm from the Preoperative States

PURPOSE: Abdominal aortic aneurysm is a complex disease that has too many clinical manifestations for classifying these patients as the ruptured and nonruptured groups. To evaluate the effect of the patients preoperative status to the surgical outcomes, the authors classified the abdominal aortic aneurysm patient's into four groups according to their preoperative status and we studied their outcomes. METHOD: Between 1992 and 2004, 117 patients underwent abdominal aortic surgery. Among the patients, 47 asymptomatic abdominal aortic aneurysm patients were classified as group I. 34 abdominal aortic aneurysm patients with abdominal pain were classified as group II. 20 ruptured abdominal aortic aneurysm patients without hemodynamic instability were classified as group III. 16 ruptured abdominal aortic aneurysm patients with hemodynamic instability were classified as group IV. We then analysed their clinical outcomes retrospectively. RESULT: Group IV received the highest number of transfusions and they showed the highest incidence of postoperative ARDS and the highest mortality rate. Group III received more transfusions and they showed a higher incidence of ARDS than Group I and II, but they had the lowest mortality rate. There were no significant differences in the transfusion amount, complication and mortality between Group I and II. CONCLUSION: Massive transfusion causes postoperative ARDS and multiorgan failure and this causes death for patients with ruptured abdominal aortic aneurysm. Preoperative hemodynamic instablity is a definite factor for massive transfusion, whitch causes ARDS and death.