Aberrant common hepatic artery aneurysm. A case report.

A 45-year-old white woman was found on selective superior mesenteric artery angiography to have an aneurysm arising in an aberrant hepatic artery. The aberrant hepatic artery originated from the superior mesenteric artery, and was the only artery supplying the liver. The aneurysm was excised and continuity of the aberrant artery was restored by insertion of a short segment of autogenous long saphenous vein.

Are carotid body tumours malignant?

Carotid body tumours (CBTs) are slow-growing, malignant neoplasms by virtue of their local spread by continuity and contiguity and metastatic spread by lymph and blood. This article reports the findings of a pathological study of the growth characteristics of CBTs.

Anastomotic aneurysms: facts and fancy.

One hundred and one anastomotic aneurysms were encountered in 74 patients over a 25-year period (1963 through 1988). Ninety-three anastomotic aneurysms (92 percent) were prosthesis-related, one followed a thromboendarterectomy, and seven (para-anastomotic aneurysms) occurred after the use of venous grafts. In the prosthesis-related anastomotic aneurysms, 50 percent of the patients had multiple anastomotic aneurysms. Most anastomotic aneurysms occurred at the femoral region (70.9 percent), but no suture line was immune. The most common cause of the anastomotic aneurysms was a defect in the host artery (90.2 percent), followed by suture failure (4.9 percent), and prosthetic failure (4.9 percent). Although most anastomotic aneurysms appeared about 5 years postoperatively, they may develop at any time. The early appearance of an anastomotic aneurysm (within 2 years) suggests infection as a cause. Because the incidence of complications of anastomotic aneurysms is high, regular follow-up assessment of all anastomoses is desirable. It is postulated that prostheses by virtue of their unphysiological characteristics cause abnormal stresses at the suture line leading to weakness of the host artery.

Management of tender abdominal aortic aneurysm.

Forty-eight patients with tender haemodynamically stable abdominal aortic aneurysms were evaluated. The aneurysms in 18 of these patients (37.5%) were found, at the time of surgery, not to have leaked. The mortality rate in patients with these tender non-leaking aneurysms undergoing emergency surgery was 16.6%. This high mortality rate can be improved by using computed tomography pre-operatively to prevent patients with non-leaking aneurysms from undergoing emergency surgery.

Presentation and management of aortocaval fistula. A report of 6 cases.

Aortocaval fistulisation is a rare condition which results in a high mortality rate if misdiagnosed before surgery. The presentation can be either acute or insidious. The paucity of definitive clinical symptoms, the haemodynamic consequences of a large arteriovenous fistula and the technical difficulties of surgery all contribute to this high mortality rate. We describe 6 patients whose case histories illustrate these points and discuss the management of patients with aortocaval fistulas.

Carotid body tumours. A review of 52 cases.

During a 22-year period (1962-1984) 52 carotid body tumours were encountered in 50 patients. In addition, 2 of the patients had tumours of the glomus intravagale. One patient had a recurrent tumour, the first one having been removed 23 years previously. The ages ranged from 23 to 80 years, the female/male ratio was 2:1, and the right side was affected twice as often as the left. Four patients were treated non-surgically; 3 were too elderly and frail to undergo the operation and in the 4th case the tumour was considered inoperable. In 2 cases excision was attempted but abandoned for technical reasons. In the remaining 44 patients 46 tumours were excised, with grafting of the internal carotid artery in 6 cases. There were 2 deaths (4.5%), 1 after hemiplegia and 1 a pulmonary embolus. Eight patients were left with cranial nerve palsy, which had been present preoperatively in 5 cases. Of the tumours 7 (13.5%) were found to be malignant. The results of endocrine studies when undertaken were normal. Although ultrasonography and computed tomography were used in some cases, arteriography was the definitive mode of investigation.

Pathogenesis of anastomotic aneurysms.

Forty-two anastomotic aneurysms were encountered in 33 patients over a 13-year period. Thirty-six occurred after the use of prostheses, and six occurred after the the use of vein grafts. In the prosthetic group, 28 aneurysmal defects were repaired, and the cause was found in 25 cases. In 23 of these cases the defect was caused by the sutures that had pulled out of the arterial wall; suture failure was recorded in only two cases. There were no defects in any of the prostheses. The suture material was braided Dacron (Tevdek) in 25 anastomotic aneurysms, but it was not recorded in three cases. In the vein graft-related group the aneurysms occurred in the "juxta anastomotic position," with the suture lines intact. They were thus true aneurysms of the vein wall. This study shows that the predominant cause of an anastomotic aneurysm in weakness of the arterial wall and not the mechanical failure of the suture material (braided Dacron) or prosthesis. It would seem, however, that the prosthesis, by virtue of its undesirable physical characteristics-a compliant mismatch with the host artery and some dilatation with the passage of time-results in abnormal shear stress at the anastomosis, leading to disruption of the arterial wall and eventually to false aneurysm formation.

Nonruptured aortic aneurysms.

A retrospective study was undertaken of 221 nonruptured aortic aneurysms treated by operation during a 15 year period. The mortality was 6.3 per cent. Adverse prognostic factors were advanced age, large aneurysms and the presence of associated diseases. One hundred and eighty-eight of the patients were older than 60 years of age and 205 of the aneurysms were 7 centimeters or more in diameter, and associated disease, especially cardiorespiratory, was common. During the same period in which 105 patients with ruptured aortic aneurysms were surgically treated, the mortality was 58 per cent. All patients with abdominal aortic aneurysms had the aneurysms excised, unless there were severe contraindicating factors, such as a limited life expectancy.

Occupational trauma to the ulnar artery.

Thrombosis or aneurysm of the ulnar artery after occupational trauma to the hand is not uncommon. A series of 14 patients with such lesions, diagnosed by arteriography, has been documented. It is concluded that in patients with pain along the ulnar side of the hand after an injury the absence of vascular signs does not exclude injury to the ulnar artery, and arteriography should be carried out to exclude not only an ulnar artery thrombosis but also an aneurysm which may cause symptoms by pressure on the ulnar nerve or by digital embolism.

Ruptured aortic aneurysms.

A retrospective study of 105 patients with ruptured aortic aneurysms treated by surgery over a 15-year period was undertaken. The mortality rate was 58%. A high incidence of cardiorespiratory disease, delay in treatment caused by wrong diagnosis, and preoperative shock were some of the factors responsible. All patients with ruptured aneurysm were operated on, unless moribund. No patient was refused surgery because of age or concomitant disease, unless it seemed that life expectancy from such disease was short. During the same period, 221 patients had elective aneurysmectomies, with a mortality rate of 6.3%, indicating that, with a few exceptions, all abdominal aortic aneurysms should be resected.

The incidence of malignancy in carotid body tumours.

Twenty-three patients with 24 carotid body tumours are reviewed. A high incidence of malignancy (30%) was encountered. It is recommended that all carotid body tumours be removed unless there are contraindicating medical or technical reasons.