ABSTRACT
We report, to our knowledge, the first case of a rare syphilitic infrarenal aortouniiliac aneurysm with contained rupture that presented with midepigastric abdominal pain. Review of the patient's medical history revealed untreated syphilis and poorly treated congestive heart failure. Given his comorbidities, the patient was treated with an emergent endovascular aneurysm repair. His 30-day postoperative recovery period was uneventful, and follow-up imaging revealed complete resolution of the aneurysms. Syphilitic infrarenal aortic aneurysm is currently considered a rare entity in this era of antibiotics. The present article provides a brief case report and short review of literature pertaining to syphilitic aortic aneurysms.
Subject(s)
Aneurysm, Infected/microbiology , Aortic Aneurysm, Abdominal/microbiology , Aortic Rupture/microbiology , Syphilis, Cardiovascular/microbiology , Abdominal Pain/etiology , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/surgery , Anti-Bacterial Agents/therapeutic use , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/diagnostic imaging , Aortic Rupture/surgery , Aortography/methods , Blood Vessel Prosthesis Implantation , Computed Tomography Angiography , Humans , Male , Middle Aged , Syphilis, Cardiovascular/diagnosis , Syphilis, Cardiovascular/surgery , Treatment OutcomeSubject(s)
Bile Duct Diseases/surgery , Bile Ducts/injuries , Cholecystectomy, Laparoscopic/adverse effects , Postoperative Complications , Anastomosis, Surgical/methods , Bile Duct Diseases/diagnosis , Bile Duct Diseases/etiology , Bile Ducts/surgery , Cholangiopancreatography, Endoscopic Retrograde , Female , Humans , Middle Aged , Reoperation , StentsABSTRACT
BACKGROUND: Cardiovascular disease is the main cause of morbidity and mortality in patients with Marfan syndrome. Many patients with presumed Marfan syndrome do not meet current diagnostic criteria. This study reviews the surgical aspects of aortic disease in 300 patients referred with the diagnosis of Marfan syndrome. METHODS: During a 16-year period, 300 patients with presumed Marfan syndrome underwent 398 operations on the aorta and branch arteries, including 125 aortic root operations, 59 aortic arch repairs, 31 descending thoracic aortic repairs, and 178 thoracoabdominal aortic repairs. Based on medical record review, patients were classified as confirmed Marfan syndrome if documented features satisfied current diagnostic criteria; patients not meeting these criteria were classified as suspected Marfan syndrome. RESULTS: There were 17 operative deaths (4.3%) after the 398 operations. Survival after the initial referral operation was 96.2% +/- 1.5% at 1 year, 82.7% +/- 2.4% at 5 years, and 74.6% +/- 3.1% at 10 years. Presentations, operative details, and outcomes were remarkably similar in the 137 patients (45.7%) with confirmed Marfan syndrome and the 163 patients (54.3%) with suspected Marfan syndrome. Freedom from repair failure, however, was significantly better in patients with confirmed Marfan syndrome (90.3% +/- 2.3% at 10 years) than in those with suspected Marfan syndrome (82.0% +/- 3.1% at 10 years; p = 0.001). CONCLUSIONS: Operative treatment of the full spectrum of aortic disease in Marfan patients enables excellent long-term survival. Similarities in surgical aspects of aortic disease suggest that patients with features of Marfan syndrome who do not meet diagnostic criteria should be managed in the same manner as patients with confirmed Marfan syndrome.
