Aortic arch aneurysms.

Aneurysms involving the aortic arch are formidable surgical challenges. Though the first successful surgery was performed more than 40 years ago, the risk of surgical treatment remained prohibitively high until recently. Intra-operative protection of the brain from ischaemic injury was the main concern. Deep hypothermic circulatory arrest with retrograde cerebral perfusion technique has considerably reduced the risk of surgery to acceptable levels.

Balloon angioplasty of the femoro-popliteal segment: follow up results from southern India.

BACKGROUND. Disease of the femoral and popliteal arteries, though one of the commonest manifestations of atherosclerosis, is under-recognized because the morbidity it produces is less catastrophic than coronary or cerebrovascular arterial involvement. Percutaneous transluminal angioplasty is performed for femoro-popliteal lesions at different centres in India, but post-angioplasty follow up data are scarce. We present our results after femoro-popliteal balloon angioplasty in 140 lesions. METHODS. Between 1986 and 1993, 140 femoro-popliteal angioplasties were performed in 119 patients with symptomatic limb ischaemia. Seventy-one per cent of patients had claudication and the others also had tissue loss. Eighty-two per cent of the lesions were occlusions. The average length of the lesions was 10.7 cm. Conventional wire-balloon angioplasty was performed in 128 lesions; in 12 others, laser-assisted balloon angioplasty was performed using an Nd-YAG laser thermal probe. Patients were followed up at regular intervals for any recurrence of symptoms and for objective evidence of restenosis or re-occlusion. RESULTS. Despite a technical success in 83% of the lesions, cumulative primary patency calculated by the life-table method showed a slow decline which plateaued at 40% after 36 months. Long occlusions and multifocal stenoses showed shorter cumulative patency following angioplasty (27 months and 5.8 months respectively). Extensive luminal irregularity due to post-angioplasty intimal flaps was reduced by using warm contrast for balloon dilatation in 16 patients. In 14 patients who had repeat angioplasty for restenosis, the secondary patency showed a satisfactory figure of 84% at 60 months. CONCLUSION. Percutaneous transluminal angioplasty is a satisfactory alternative to surgery in femoro-popliteal stenotic or occlusive disease. Regular follow up of such patients is essential in the first three years because re-occlusion can occur. We found that patency remained fairly constant after 36 months. Repeated angioplasty can maintain patency in patients with restenosis.

Transverse aortic arch aneurysms--a challenge ahead.

Deep Hypothermia and Circulatory Arrest (DHCA) is widely used to repair complex congenital heart lesions in children. We report our experience of DHCA in seven patients of transverse aortic arch aneurysm repair. Anaesthesia consisted of Nitrous Oxide, Oxygen, morphine 1 to 1.5 mg kg-1, halothane and pancuronium. Core cooling on cardiopulmonary bypass was used. At 19 +/- 0.64 degrees C (rectal) temperature, Total Circulatory Arrest (TCA) was established. Thiopentone 30 mg.kg-1 and hydrocortisone hemisuccinate 400 mg was administered before arrest. Head was packed with ice during cooling and patients were placed in steep Trendelenberg's position before opening the aneurysm sac. Mean cardiopulmonary bypass time was 151.4 +/- 8.7 minutes. Mean duration of circulatory arrest was 38.6 +/- 6.9 minutes (range, 15 to 77 minutes). Permanent neurological deficit was found in two patients. Tracheostomy was performed in one of these patients for prolonged ventilation. Two patients died of persistent bleeding, low cardiac output and hypoxia due to right lung collapse.