RESUMO
Inferior mesenteric artery aneurysm (IMAA) is a rare disease among visceral aneurysms. We encountered an open repair of IMAA in association with arteriosclerosis obliterans (ASO). The case was 74-year-old man who had progressive intermittent claudication for 10 years. Preoperative enhanced CT demonstrated IMAA and ASO due to the occlusion of right common iliac artery, the coil embolization was initially considered as a therapeutic option. However, since CT also revealed the occlusion of superior mesenteric artery, the open repair of the aneurysmal resection and subsequent IMA reconstruction were performed in order to avoid mesenteric necrosis. During the procedure, we confirmed bilateral arterial flow of the lower extremities and the good color of the small intestine before closing the abdomen. The patient was started on food intake on postoperative day (POD) 3, and CT showed intact arterial flow of the inferior mesentery. Postoperative course was uneventful and the patient was discharged on POD 16.
RESUMO
Congenital factor XI deficiency is a rare intrinsic coagulation factor. We treated a 67-year-old man with abdominal aortic aneurysm, in whom activated partial thromboplastin time (APTT) found to be prolonged preoperatively. After fresh frozen plasma (FFP) was given before surgery, aneurysm was successfully replaced by a woven Dacron graft. No bleeding tendency was noted during the operation and FFP was also administered during and after surgery. The patient recovered without incident and left the hospital 13 days after the operation. Since several days are required to determine factor XI activity, APTT is useful as a parameter of coagulation factor activity in the perioperative period.
RESUMO
We describe the case of an 80-year-old man who underwent surgical repair for abdominal aortic aneurysm with horseshoe kidney. We performed open surgery by a transperitoneal approach via a standard median laparotomy, and noted that the right accessory renal artery had 1 branch and the left accessory renal artery had 2. We safely dissected these arteries using a Harmonic scalpel. The aneurysm was successfully replaced using a Dacron straight graft, and all renal arteries were preserved. Renal infarction and renal dysfunction did not occur during the uneventful postoperative course.
RESUMO
Myocardial bridge (MB), which covers a part of the left anterior descending coronary artery (LAD), is a normal anatomical variant structure (45% in frequency by autopsy) in LAD. MB contraction plays the role of a "double-edged sword" on the coronary events, suppressing coronary atherosclerosis under the MB, yet generating abnormal blood flow associated with coronary heart diseases (CHDs). High shear stress driven by MB compression causes the suppression of vascular permeability and vasoactive protein expression such as e-NOS and endothelin-1, which leads to the suppression of atherosclerosis in the LAD segment under the MB. However, despite the prevalent view of MB as benignancy by conventional coronary angiography (5-6% in frequency), with advance of imaging technique such as multislice spiral computed tomography [(MSCT); 16% in frequency], cardiologists are now frequently aware of symptomatic MB occurring not only in hospitalized patients, but also in young athletes free from atherosclerosis. Moreover, the large mass volume of MB muscle induces atherosclerosis evolution at the settled site in LAD proximal to MB and contributes to the occurrence of myocardial infarction. These events upon the coronary events result from the different pathophysiological mechanisms induced by contractile force of MB, which is solely determined just by the integration of anatomical properties of MB, such as the location, length and thickness of MB in an individual LAD. A recent MSCT provides the objective quantification of the anatomical variables that correlate with the histopathological results in relation to the occurrence of CHD. In this review, we therefore discuss the necessity to explore MB as a inherent chance anatomical risk factor for CHD.
