Spontaneous dissection of the common carotid artery. Case report and review of the literature.

Spontaneous dissection of the internal carotid artery is not a rare occurrence. However, spontaneous dissection of the common carotid artery has not been recognized and the first reported case and its management are described.

Diagnostic and surgical considerations in the treatment of thoracoabdominal and suprarenal aortic aneurysms.

Thoracoabdominal and suprarenal aortic aneurysms may occur more frequently than originally thought. A review of our operative experience with aortic aneurysm during a 4 1/2 year period disclosed 17 (8 percent) aneurysms of the thoracoabdominal and suprarenal aorta. Acute rupture in five patients (29 percent) emphasizes the possible need for urgent treatment precluding transfer to a major university referral center. Nine patients (53 percent) had previously been operated on for aortic aneurysm, illustrating the systemic nature of aortic aneurysm disease and the need for lifelong follow-up. All patients survived, but paraplegia resulted in 2 patients (12 percent) with ruptured aneurysms. Pulmonary insufficiency was the major cause of postoperative morbidity. The high incidence of paraplegia reported for extensive chronic dissecting aneurysms has influenced our decision to postpone resection and carefully follow three additional patients with such lesions.

Operative management of acute aortic arch dissection using profound hypothermia and circulatory arrest.

Six consecutive patients with acute aortic dissection involving the transverse aortic arch underwent surgical repair using profound hypothermia and circulatory arrest. All patients survived without neurological deficit. Postoperative angiographic evaluation has revealed complete resection or obliteration of patent false lumen within the aortic arch and ascending aorta in all patients. Use of this adjunct in the operative management of aortic arch dissection has allowed bloodless inspection and repair of extensive intimal tears, complete intimal adventitial reapproximation or resection, avoidance of clamp injury to fragile dissected aortic tissue, and assurance of patent arch-cerebral revascularization.

Fibromuscular dysplasia and thrombosed aneurysm of the popliteal artery in a child.

A case is reported of bilateral congenital popliteal aneurysms in a 10-year-old girl. Spontaneous thrombosis of the left aneurysm resulted in acute ischemia of the left leg below the knee, and the aneurysm was bypassed with an autogenous saphenous vein graft. Elective resection of the right aneurysm revealed fibromuscular dysplasia, of the medial hyperplasia type, as the cause of the aneurysm. One year after operation, the grafts remained patent, and the patient was asymptomatic.