Treatment options for complex aortic aneurysms ­ own experiences / Complex aortaaneurysmák kezelési lehetoségei - saját tapasztalatok

Complex aortic aneurysms extend to more aortic segments, and/or include one or more orifices of highly important side branches. Meanwhile complex aneurysms need reconstructive solutions in one sitting or hybrid procedures timely close to each other, multiple aneurysms can be treated technically and timely separated. Previously, open surgery was the only opportunity to intervene, which was associated with significant surgical trauma and was not suitable for high risk patients when devastating complications were likely. Recently combination of lower risk surgery with endovascular treatment options ­ the so called hybrid techniques ­ resulted in that indications for treatment remarkably widened. In addition, permanent technical progress made available pure endovascuar solutions, so a wide range of surgical procedures provide number of options for treatment. In this paper we report on the treatment options of complex aortic aneurysms, and present our own relevant experience.

Kommerell diverticulum ­ rare complications of a rare disease / Kommerell diverticulum - egy ritka betegség ritka szövodményei

Incidence of anomalies of the aortic arch is estimated 1-2 per cent in newborn babies. Lusory artery may arise either from left sided aortic arch in 0.7­2 per cent, or from right sided aortic arch in 0.4 per cent. Leading symptoms develop from compression of the oesophagus or trachea, or both. If lusory artery dilates conically over the time reaching 3 cm or more we call it Kommerell diverticulum. Very rare complications of this are the Type B aortic dissection, which may turn into chronic thoracoabdominal aneurysm, or its shaggy inner surface can be the source of upper extremity embolism. Rupture is extremely rare complication. In our report we focus on five cases of the mentioned complications with their clinical workups and technical solutions. In a female patient with right sided arch transection of the lusory artery was followed by transposition into the right common carotid artery. The central stump 10 years later gradually expanded and the saccular aneurysm indicated intervention. After complete arch debranching thoracic endograft was implanted. In this group of patients with variable surgical and hybrid procedures neither complication nor mortality occurred.

A mellkasi aorta tompa sérülése - kezelési taktika, eredmények.

The blunt injury of the thoracic aorta constitutes one of the most severe chapter of traumatology. Open and transmural aortic injury leads to death on site, but its blunt trauma provides chance for survival if expeditious transport, diagnostic workup and proper selection of treatment are given. The blunt trauma of the aorta usually is a part of multiple injuries which determines the final outcome significantly. To select among acute, subacute interventions and conservative treatment options needs great experience following personalized algorithm. The wide variety of the clinical picture makes difficult to formulate an individualized clear guideline - so we think it is important to summarise own experiences and overview related literature.

[Late complications and treatment options of aortic coarctation operated in childhood]. / Gyermekkorban operált aortacoarctatiók késoi szövodményei és ellátásuk.

INTRODUCTION: The prevalence of congenital aortic coarctation is 4 in 10 000 live birth. Aortic coarctation is typically located in the aortic isthmus, but it may occur at atypical sites. Treatment options include both surgical and endovascular interventions. In patients undergoing surgical or endovascular intervention late complications such as recoarctation or aortic aneurysm may develop. AIM: The aim of the authors was to analyse their own experience in late complication and treatment options of aortic coarctation operated in childhood. METHOD: Retrospective analysis of data of 32 patients treated between 1980 and 2014 for late complications 8-42 years after surgical treatment of aortic coarctation. RESULTS: In 28 patients aneurysm formation after isthmic patch plasty was found. Two patients had aortobronchial fistula, 2 patients showed anastomosis disruption and 2 patients had graft stenosis. During operation hybrid solution was performed in 23 patients, isthmic aorto-aortic inlay graft interposition in 5 patients, aorto-aortic bypass in 2 patients, subclavio-aortic bypass in 2 patients, graft patch plasty in one patient and ilio-renal bypass in one patient. Complications included severe intraoperative bleeding in one patient and pneumothorax in one patient. No early or late mortality occurred. CONCLUSIONS: The authors conclude that life long control is mandatory in order to detect late complications in patients who underwent operation of aortic coarctation in childhood.

[Penetrating atheromatous ulcer of the thoracic aorta. Treatment options]. / A mellkasi aorta penetráló atheromás ulcusa. Kezelési lehetoségek.

INTRODUCTIONS: Atherosclerosis is a generalized degenerative disease of arteries. A rare manifestation of that is the penetrating atheromatous aortic ulceration of the aortic wall which may be complicated by subintimal hematoma, dissection, false aneurysm and rupture (acute aortic syndrome). AIM: The aim of the authors was to analyse their experience with this rare disease. METHOD: In the department of the authors 10,212 patients underwent surgery for cardiovascular diseases. Among these, 18 patients were diagnosed with penetrating atheromatous aortic ulceration located in the thoracic aorta (ascending aorta 2, aortic arch 8, descending aorta 6 and thoracoabdominal aorta 2 patients). Severe comorbidities were present in the majority of patients. RESULTS: Depending on the localisation the authors used various treatment options such as open surgery (4 patients), hybrid techniques (7 patients) and pure endografting (7 patients). One patient died on postoperative day 3. Two patients had late complications due to endoleaks treated successfully by open surgery. CONCLUSIONS: The authors conclude that when this dangerous condition detected in time, a wide variety of open, hybrid and endovascular methods can be applied with good results.

[A diabetic patient with asymptomatic multiple arterial disease]. / Diabeteses beteg tünetmentes sokér-betegsége.

The authors present the case of a 73-year-old diabetic woman who was referred to hospital because of the suspicion of lower limb peripheral arterial stenosis. During evaluations signs of the subclavian artery occlusion were found. In addition to diabetes, the patient had several risk factors revealed by medical history. Subclavian artery occlusion was solved by angiography guided stenting, and angiography also showed the presence of abnormalities in renal arteries. This case draws the attention to the importance of screening old diabetic patients for arterial stenosis and the importance of accurate risk factor assessment.

[Mandibular reconstruction with free osteocutaneous fibula flap using the occipital artery as recipient vessel]. / Mandibularekonstrukció arteria occipitalisra varrt szabad osteocutan fibulalebennyel.

Authors performed reconstructive surgery for extensive skin and mandibular bone defect following gunshot injury to the left side of the face. The soft tissue and bone defect was reconstructed with the free osteocutaneous fibula flap harvested from the left lower leg, as suitable local reconstructive flap was not available. The bony continuity was reestablished with a 7 cm long fibula segment. Microvascular anastomoses were performed to the left occipital artery and the left internal jugular vein. The occipital artery was chosen as the external carotid system was completely missing on the right side and was missing several branches on the left side due to the trauma. The fibular segment became fully incorporated and 95% of the flap healed by primary intention.