Right Axillary Artery Cannulation for Endovascular Repair of an Acute Type A Aortic Dissection.

We present the case of a 48-year-old woman with an acute type A aortic dissection that was treated with thoracic endovascular aortic repair at our institution. The patient was found to have a focal type A dissection with pericardial effusion but no tamponade physiology and no involvement of the aortic valve or root. We elected to treat the patient's type A aortic dissection with an endovascular stent because of the patient's favorable anatomy and no evidence of neurologic deficits or signs of distal malperfusion. The patient was successfully treated with an abdominal aortic cuff deployed through the axillary artery. An axillary approach was necessary because of the short length of the delivery sheath preventing a transfemoral delivery. At 2-year follow-up, the patient remains free of complications with computed tomography scan revealing complete false lumen thrombosis and a stable endovascular repair. This report demonstrates a case of acute type A aortic dissection successfully treated using thoracic endovascular aortic repair and illustrates the utility of axillary cannulation for precise deployment of stent grafts in the ascending aorta.

Epiphrenic esophageal diverticula: spectrum of symptoms and consequences.

Patients with esophageal diverticula may present with a variety of symptoms. Many of these symptoms mimic less serious disease, making diagnosis of esophageal diverticulum difficult for many primary care physicians. Delayed or missed diagnosis of this disorder may lead to more serious problems including gastrointestinal bleeding, aspiration pneumonia, and cancer. Our case series illustrates a variety of symptoms observed among three patients who were diagnosed and surgically treated for esophageal diverticulum. Appropriate diagnosis and management of esophageal diverticulum results in resolution of symptoms and decreased risk of morbidity.