Endovascular Aneurysm Repair with Bifurcated Stent Grafts in Patients with Narrow Versus Regular Aortic Bifurcation: Systematic Review and Meta-analysis of Comparative Studies.

BACKGROUND: Narrow aortic bifurcation (NAB) is considered as a risk factor for endograft limb thrombosis. The purpose of the study was to investigate the effect of narrow aortic bifurcation on outcomes of elective endovascular aneurysm repair (EVAR). METHODS: A systematic review that conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. We searched electronic bibliographic databases using a combination of controlled vocabulary (thesaurus) and free-text terms to identify relevant studies comparing outcomes of EVAR in patients with NAB versus those with regular aortic bifurcation. Pooled estimates of dichotomous outcomes were calculated using odds ratio (OR) and those of continuous outcomes using mean difference and 95% confidence interval (CI). To account for expected heterogeneity, the random-effects model was applied for statistical analysis. RESULTS: Six observational studies were included, reporting a total of 2,673 patients (412 with NAR and 2,261 with friendly anatomy). Perioperative mortality was similar between the groups (OR 1.14, 95% CI 0.30-4.34, P = 0.85, I2 = 0%). Limb stenosis and kinking requiring additional intraoperative procedures was significantly more common among patients with NAB (OR 3.02, 95% CI 2.16-4.22, P < 0.00001, I2 = 0%). Nevertheless, 30-day reintervention rate was similar between the groups, as was the rate of limb occlusion during follow-up. CONCLUSIONS: Available evidence suggests that at the expense of significantly more intraoperative additional procedures, EVAR with bifurcated devices can be safely performed in patients with NAB.

Acute aortic occlusion due to tumor embolism in a patient with lung malignancy.

OBJECTIVES: Acute lower limb ischemia caused by tumor embolization is rare, despite the fact that cancer is a common cause of hypercoagulability predisposing to venous thrombosis. Arterial embolization is mostly associated with intracardiac tumors while lung malignancies are the second most common cause of tumor embolism. METHODS: In this report, we present a male patient who developed acute bilateral lower limb ischemia in the immediate postoperative period after a thoracotomy for attempted left upper lobe resection for lung cancer. RESULTS: The patient was treated with a subclavian-bifemoral bypass, since an initial attempted embolectomy was unsuccessful. Histopathological characteristics of thrombus obtained during embolectomy were consistent with the histopathology of the primary tumor. CONCLUSION: Acute ischemia is an emergency that should be diagnosed and treated immediately. Interestingly, in this case, the presence of epidural anesthesia masked the initial symptoms and delayed diagnosis. Preoperative assessment with transesophageal echocardiography may reveal patients at high risk for tumor embolism.

Pneumorachis associated with persistent tachycardia after blunt thoracic trauma.

Pneumorachis, or intraspinal air, can be a rare result of blunt thoracic trauma. We report the case of a 40-year-old man with multiple injuries and pneumorachis associated with persistent tachycardia. As factors that increase heart rate were gradually ruled out, intraspinal air was considered the potential culprit. Computed tomography revealed intraspinal air at the thoracic level, which possibly promoted cardiac arrhythmogenesis. Air may transiently compress the preganglionic cardiac sympathetic nerves and increase sympathetic output to the heart.