Recurrent Aortic Infections Due to Unrecognized Aorto-Enteric Fistula.

We report a case of an infrarenal abdominal aortic aneurysm (AAA) with unrecognized primary aortoduodenal fistula (ADF), treated by endovascular aortic repair (EVAR). Endograft infection was diagnosed 12 months thereafter. The associated ADF was uncovered during open surgery, which included endograft extraction, in situ aortic reconstruction with a cryopreserved homograft (CHG) and duodenal repair. The patient was urgently reoperated in the early postoperative course, due to CHG rupture and subsequent hemorrhagic shock. After establishing control of hemorrhage, CHG was explanted, followed by aortic ligation and extraanatomical reconstruction with axillofemoral bypass. The importance of timely diagnosis of primary ADF prior to AAA repair, as well as treatment options and optimal materials for simultaneous aortic and bowel reconstruction in the setting of primary or secondary ADF, are discussed.

Endovascular Treatment of a Late False Aneurysm Complicating Open Suprarenal Mycotic Aneurysm Repair with a Cryopreserved Aortic Homograft.

We report a patient who was initially treated for a suprarenal mycotic aortic aneurysm. The aneurysm repair was performed using a cryopreserved arterial homograft and debranching of visceral arteries. Five years later, the patient was referred due to a large symptomatic false aneurysm at the distal homograft anastomosis. Endovascular repair was indicated and performed using a bifurcated Medtronic composite stent graft. The procedure was uneventful, while control angiography showed complete exclusion of the false aneurysm. Within 6 months of follow-up, the endograft showed favorable position and maintained patency with no signs of endoleaks. We discuss the role of the cryopreserved homografts for in situ repair of mycotic aortic aneurysms and comment on possible late complications after placing those grafts.

Cryopreserved aortic homograft for in situ replacement of infected thoracic stent graft associated with distal aortic arch rupture and hematemesis.

Endograft infections present a potentially lethal complication of thoracic endovascular aortic repair (TEVAR). We report a case of a young male patient who was referred to our institution because of a stent graft infection that occurred 10 months after TEVAR. Contained distal aortic arch rupture and hematemesis were associated with the endograft infection. Emergent open surgical repair was undertaken with deep hypothermic circulatory arrest. After the removal of the infected endograft, the distal aortic arch and proximal descending thoracic aorta were replaced with a cryopreserved aortic homograft. Fifteen-month follow-up was uneventful. We discuss techniques and materials for replacement of the infected endograft. The article provides an outline of the potential benefit of cryopreserved aortic homografts within the setting of a complex thoracic aortic infection.

In situ repair of a mycotic suprarenal aortic aneurysm using a cryopreserved aortic homograft and visceral debranching in a patient with spondylodiscitis and left psoas muscle abscess.

We present a patient with ruptured suprarenal aortic aneurysm, involving origins of visceral and renal arteries. Associated spondylodiscitis and left psoas muscle abscess were also diagnosed. The patient was initially treated with antibiotics. Diagnostic survey showed progression of the aneurysm diameter and enlargement of the psoas muscle abscess. Surgical treatment using a cryopreserved aortic homograft with debranching of visceral arteries was performed. Different modalities of surgical repair within the infected aortic segment and the rationale for usage of cryopreserved homografts are considered. The importance of optimal timing for surgery is emphasized as well.

Thoracoabdominal and coronary arterial aneurysms in a young man with a history of Kawasaki disease.

We report a case of a large symptomatic thoracoabdominal aortic aneurysm in a 22-year-old man with a history of Kawasaki disease in childhood. According to multislice computed tomography scan findings, the aneurysm was classified as Crawford type III. Coronary angiography revealed a giant aneurysm of the left coronary artery and aneurysm of the circumflex artery. Functional tests for myocardial perfusion and function revealed no significant ischemic territories. Because of symptoms of imminent rupture, aneurysm resection and aortic reconstruction with a 26-mm zero porosity Dacron graft was performed and was successful. Cardiovascular consequences of Kawasaki disease are discussed with attention to the late sequelae. Indications for surgical treatment and importance of follow-up into adulthood are emphasized.

The value of cholinesterase activity after Kasai operation.

Cholinesterase (ChE) is an enzyme synthesized in the liver. The aim of this study was to determine the value of ChE as an index of liver function. We measured the ChE activity as well as the values of bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase, aminotransferases and albumin before and 7 days after Kasai operation in 25 infants with biliary atresia. The increased activity of ChE in plasma after Kasai operation was accompanied by a decrease of other measured values ( P<0.0001), except for albumin. We can conclude that the increase of ChE activity together with the decrease of bilirubin, alkaline phosphatase and gamma-glutamyl transpeptidase show early improvement of liver function after Kasai operation. ChE activity can be used to assess liver function in terms of synthesis.