Comparison of the impact of open and endovascular abdominal aortic aneurysm repair on renal function.

OBJECTIVE: The impact of any intervention on renal function is a crucial determinant of outcome. Open (OR) and endovascular (EVAR) abdominal aortic aneurysm (AAA) repair can affect renal function during the short and longer term. This study aimed to directly compare the effect of those different types of aneurysm repair during a period of 2 years. METHODS: This was a nested case-control study including patients undergoing either OR or EVAR of an infrarenal AAA. Three groups were included: OR, EVAR with suprarenal endograft fixation, and EVAR with infrarenal fixation. These were matched for age (within 2 years), sex, AAA size (within 1 cm), hypertension, smoking, and proximal neck diameter (within 5 mm). The primary end point was change in estimated glomerular filtration rate (eGFR) calculated by the Chronic Kidney Disease Epidemiology Collaboration formula at baseline, 6 months, 12 months, and 2 years. RESULTS: A total of 225 patients were included [(45 ORs matched vs 90 suprarenal and 90 infrarenal fixation EVARs; 35 women (16%); age, 71 ± 8 years; AAA size, 6.4 ± 1 cm]. Groups did not differ significantly in terms of diabetes, hypercholesterolemia, or baseline eGFR (P = .89). On average, those undergoing OR lost a mean 5.39 mL/min/1.73 m(2) (P = .48) within 1 year and 5.49 units (P = .42) after 2 years. The suprarenal fixation patients lost 5.58 units (P = .002) after 1 year and 6.57 units (P = .001) after 2 years. Finally, the infrarenal fixation patients lost 0.53 unit (P = .74) after 1 year and 2.24 units (P = .22) after 2 years. CONCLUSIONS: OR and suprarenal fixation EVAR are associated with significant declines in renal function during 2 years, in contrast to infrarenal EVAR fixation. The patterns of eGFR decline in OR and suprarenal fixation EVAR are not similar, suggesting different causal mechanisms.

Ewing's sarcoma of the inferior vena cava.

Ewing's sarcoma most commonly arises from bone but may also arise from soft tissues. Sarcoma of the inferior vena cava is a rare entity that requires multimodal therapy including surgical resection and vascular reconstruction. We describe the first reported case of Ewing's sarcoma of the inferior vena cava.

True aneurysm in a femoro-popliteal dacron graft -- a case report and literature review.

Infection and anastomotic pseudo-aneurysm formation are the usually reported complications in the use of dacron prosthesis in arterial by-pass surgery. We report a case of true aneurysm formation in the body of a knitted dacron graft used to by-pass a symptomatic above knee occlusion of the superficial femoral artery when suitable long saphenous vein was not available. This was diagnosed 10 years after surgery. A true aneurysm may be a result of pre-implantation trauma to the graft or to late fibre degeneration. Microscopic examination revealed that the dacron fibres had stretched to form a local aneurysm before rupturing to form an associated false aneurysm. Two other areas of the graft had small saccular aneurysms without rupture. The damaged portion was excised and replaced by an interposition graft of the same material.