Treatment of acute aortic dissection type A with paraplegia and distal limb ischemia within a hybrid operating room.

OBJECTIVE: Acute aortic dissection type A is among the most lethal surgical emergencies. Patients may suffer from occlusion of the aorta or its branches causing end-organ malperfusion complicating the diagnosis and worsening the prognosis. Paraplegia is a rare manifestation that affects less than 5% of patients. If type A aortic dissection and occlusion of the downstream thoraco-abdominal aorta occur simultaneously and require acute treatment, a medical dilemma occurs; what should be treated first? CASE REPORT: We describe a case with an extensive acute type A aortic dissection with signs of consciousness and severe malperfusion syndrome. RESULTS: The treatment was successfully performed within a hybrid surgery suite with simultaneous open surgery and endovascular repair techniques supported by cardiopulmonary bypass circulation. CONCLUSION: A hybrid operating room might offer the opportunity to simultaneously repair complicated aortic dissection with malperfusion syndrome, by open aortic surgery and endovascular techniques.

Pseudoaneurysm of the abdominal aorta due to a needle-like osteophyte on the first lumbar vertebra.

A 46-year-old woman was admitted with acute abdominal pain radiating to the back. Computed tomography examinations showed a needle-thin perforation of the aorta, opposite the origin of the superior mesenteric artery, with a pseudoaneurysm. A needle-sharp spinal osteophyte was located exactly opposite the perforation. There was no sign of infection, and the perforation seemed to have been caused by the osteophyte. This aortic perforation occurred without any major trauma, but repeated minor occupational trauma to her abdomen may have played an etiologic role. The pseudoaneurysm and adjacent aorta were exposed through a thoracolaparotomy. The aortic wall was normal, with good tensile strength; therefore, the perforation in the aortic wall was sutured with a double vascular suture, and the osteophyte was resected. To our knowledge, aortic perforation due to a vertebral osteophyte in the absence of major trauma has not previously been described.

Treatment of a hepatic artery aneurysm by endovascular stent-grafting.

Aneurysms of the visceral arteries are rare. Traditional treatment has been surgical or endovascular with coil embolization. Recently, however, reports on endovascular therapy with stent-grafts have been published. We report the case of a 61-year-old man who was successfully treated with a stent-graft for a symptomatic combined celiac/hepatic artery aneurysm.

[Use of stents in abdominal aortic aneurysms]. / Bruk av stentgraft ved abdominale aortaaneurismer.

BACKGROUND: Endovascular treatment of aortic aneurysms has acquired a widespread application. We present the results of endovascular treatment of infrarenal, abdominal aortic aneurysms in our hospital from 1995 through 2002. MATERIAL AND METHOD: Seventy-one stent graft procedures were performed on 69 patients (64 men), mean age 72 years (range 48-96 years). Mean aneurysm diameter was 57 mm (range 35-100 mm). Sixty-nine procedures were elective and two were emergency procedures. All data were registered prospectively. RESULTS: Two procedures failed initially because of technical problems. Both patients underwent a successful procedure later. Immediate conversion to open surgery was done in one case because of a collapse of the graft into the aneurysm sac. There was no 30-day mortality for elective procedures. The conversion rate after a mean observation time of 42 months was 11%. Late complications resulted in 47 re-interventions in 29 patients, of which 96% were done in cases treated with Stentor or Vanguard prostheses. CONCLUSION: Endovascular treatment of aortic aneurysms is an alternative to open surgery. Stent graft failure can be serious and difficult to predict. This treatment should not be recommended to patients younger than 70 years and fit for open surgery.

[Interventional radiology in Norwegian hospitals]. / Intervensjonsradiologisk aktivitet ved norske sykehus.

BACKGROUND: In recent years, interventional radiology has gained in importance in patient treatment. In order to assess the impact of this trend, the executive committee of the Norwegian Society for Interventional Radiology made a registration of all interventional procedures in Norwegian hospitals in the year 2000. MATERIAL AND METHODS: Data were collected by a questionnaire sent to all Norwegian hospitals. Coronary interventions were not included. RESULTS: Forty-four out of 58 departments returned the questionnaire; 33 stated that they performed interventional procedures. A total of 18 135 procedures were performed in Norway in 2000; we present data on the distribution of types of procedures on different categories of hospitals. INTERPRETATION: A large number of interventional radiological procedures were performed in Norwegian hospitals in the year 2000, types of intervention that are considered very important in patient management in small hospitals, too.