The use of an anti-fibrinolytic agent to reduce endoleak following endovascular repair of multiple aortic aneurysms.

This paper reports on the therapeutic use of tranexamic acid in an elderly patient with severe comorbidities that precluded even endovascular reintervention. Orally administered tranexamic acid mitigated and partially reversed two and a half years of progressive aneurysmal expansion and closed a persistent endoleak after thoracic endovascular aneurysm repair and endovascular aneurysm repair for coexisting lesions. Reappearance of the endoleak when tranexamic acid was accidentally stopped and its re-closure after the resumption of tranexamic acid treatment confirmed causality. This singular experience extends prior published observations that administration of prophylactic tranexamic acid before thoracic endovascular aneurysm repair and endovascular aneurysm repair resulted in significantly greater shrinkage, particularly if an endoleak or coagulopathy was present.

Risk factors for a persistent type 2 endoleak after endovascular aneurysm repair.

PURPOSE: To investigate the natural course of type 2 endoleaks (T2Es) and to identify the risk factors associated with a persistent T2E after endovascular aneurysm repair (EVAR). METHODS: The medical records of patients who underwent EVAR for the treatment of an atherosclerotic abdominal aortic aneurysm between October 2006 and December 2011 at our institute were reviewed. T2Es were diagnosed by contrast-enhanced computed tomography within 4 weeks of EVAR, and patients were followed up at 6 and 12 months. In cases where a T2E was detected, the blood vessels responsible for the T2E were identified and statistically analyzed for their association with a persistent T2E. RESULTS: We identified T2Es in 111 of 469 patients within 4 weeks of undergoing EVAR. During the follow-up, 41 patients (36.9 %) showed spontaneous resolution of their T2E. The percentage of patients with a T2E was 75.4, 69.2 and 58.0 % at 6, 12 and 24 months, respectively. T2E caused by defects in multiple vessels and T2E associated with the fourth lumbar artery were identified as risk factors associated with a persistent T2E in the univariate analysis. In the multivariate analysis, T2E caused by multiple vessels was identified as the only independent risk factor for a persistent T2E. CONCLUSIONS: We identified T2E caused by multiple vessel failure as an independent risk factor for persistent T2E.

Esophago-Pleural Fistula Caused by Compression Necrosis In a Patient With Acute Type B Aortic Dissection.

Esophago-pleural fistula associated with thoracic aortic aneurysm is a rare and lethal complication. We report the case of a 62-year-old male who suffered from esophago-pleural fistula 56 days after thoracoabdominal aortic surgery. Contrasted CT showed that the fistula occurred at the level of the esophagus compressed by rapid dilatation of thoracic aorta and endoscopy revealed no ischemic signs on esophageal mucosa, demonstrating that the cause of esophago-pleural fistula was compression necrosis due to rapid dilatation of the thoracoabdominal aortic aneurysm.

Acute gallbladder necrosis in a patient with acute type B aortic dissection.

Although vascular complications induced by acute aortic dissection are varied and common, gallbladder necrosis induced by acute aortic dissection is rare. We experienced the case of a 42-year-old woman who suffered from acute gallbladder necrosis that occurred the following day after the onset of acute type B aortic dissection. Contrasted computed tomography, which showed the thickened wall of the gallbladder and the pericholecystic fluid, as well as the occluded celiac artery, was an effective diagnostic procedure. We performed cholecystectomy and revascularization of the celiac artery using autologous saphenous vein. Her postoperative course was uneventful, and she was discharged after 20 postoperative days.

[Extirpation of a thrombus during pulmonary metastasectomy in a patient with chronic pulmonary thromboembolism].

A 57-year-old woman with chronic pulmonary thromboembolism was diagnosed to have metastatic lung tumors 6 months after an operation performed for colon cancer. There were no respiratory symptoms associated with the pulmonary thromboembolism. Computed tomography showed 2 pulmonary masses in the right middle and lower lobes, and a thrombus in the inferior trunk of the right pulmonary artery. Excision of the 2 pulmonary metastases was performed and the thrombus in the pulmonary artery was also removed at the same time. Partial improvement of the pulmonary blood flow was observed in the postoperative pulmonary scintigram. Chronic pulmonary thromboembolism without respiratory symptoms is not usually an indication for extirpation of thrombus. However, incidental extirpation of a pulmonary thrombus at the time of other pulmonary surgery should be considered, as it may yield an improvement of the pulmonary blood flow.