Primary infected abdominal aortic aneurysm: surgical procedures, early mortality rates, and a survey of the prevalence of infectious organisms over a 30-year period.

PURPOSE: The purpose of this study was to analyze the surgical procedures, culture results, and outcomes, and to survey the prevalence of the infectious organisms over a 30-year period in patients with a primary infected abdominal aortic aneurysm (PIAAA). METHODS: A total of 11 patients (1.8%) with PIAAA were surgically treated between 1982 and June 2009. All patients had back pain, leukocytosis, and elevated C-reactive protein level. All of the patients underwent either urgent or emergency operations. RESULTS: Cultures of aortic wall specimens and blood were positive in 10 patients and included Salmonella in 2, Streptococcus in 2, Campylobacter fetus in 2, and Listeria, Haemophilus influenzae, Serratia marcescens, Bacteroides thetaiotaomicron, and an unknown organism in 1 patient each. The 10 patients underwent in situ prosthetic grafting with excision of the infected tissue and lavage using 10 l saline solution; omentum plasty was required in four patients. An axillofemoral bypass was performed in one patient with pus surrounding the AAA. All 10 patients with in situ replacement survived and were administered intravenous antibiotic therapy for 1 month postoperatively. All of these patients left the hospital without any further complications. However, one patient who underwent an axillofemoral bypass died of overwhelming sepsis. CONCLUSION: In situ replacement with excision of infected tissue, lavage using 10 l saline solution, and omentum plasty for PIAAA successfully resolved the condition. High local concentrations of rifampin-soaked grafts or superficial femoral vein may also be an alternative for an in situ replacement conduit.

New treatment with human atrial natriuretic peptide for postoperative myonephropathic metabolic syndrome.

A 49-year-old man had sudden chest pain and paralysis of the lower right limb. An acute aortic dissection was diagnosed in a computed tomography scan and the patient underwent an emergency operation. After the operation, myonephropathic metabolic syndrome developed, and human atrial natriuretic peptide was administered for 11 days until the volume of daily urine output reached at least 10,000 mL, which would facilitate limb salvage and the preservation of life without hemodialysis. This report documents that postoperative myonephropathic metabolic syndrome improved due to the strong diuretic action of human atrial natriuretic peptide without hemodialysis.

Effects of atorvastatin on angiogenesis in hindlimb ischemia and endothelial progenitor cell formation in rats.

AIM: To investigate the mechanisms underlying the pro-angiogenic effects of statin, the effects of atorvastatin were investigated on the expression of angiogenic factors in ischemic hindlimbs of rats. The function and number of endothelial progenitor cells (EPCs) were investigated in hypertensive rats. METHODS: Hindlimb ischemia rats were administered 10 or 30 mg/kg/day atorvastatin orally for 2 weeks. Angiogenesis was evaluated by a laser Doppler and by Isolectin-B4 immunostaining. The expressions of VEGF, IL-8, angiopoietin (Ang)-1, Ang-2, eNOS, and hemoxidase (HO)-1 were evaluated by Western blotting and immunohistochemistry. Spontaneously hypertensive rats (SHR) were administered 10 mg/kg/day atorvastatin. EPC function was evaluated by colony formation and migration. The EPC number was evaluated by CD34-positive cells. RESULTS: A lowdose of atorvastatin, but not a highdose, significantly increased regional blood flow. Atorvastatin significantly increased the expressions of VEGF, IL-8, Ang-1, Ang-2, eNOS, and HO-1 proteins in ischemic hindlimbs. Atorvastatin significantly increased the number and colony formation of EPCs and decreased oxidation in mononuclear cells from SHR. CONCLUSION: Atorvastatin strongly induced angiogenesis with increases in angiogenic cytokines, HO-1 and EPC numbers. Statins are thus considered potertial agents for therapeutic angiogenesis.

Splenic artery aneurysm performed vascular reconstruction: a case report.

A 58-year-old man was found by abdominal echography to have a pancreatic cyst while undergoing a health examination. Later, a multidetector CT and enhanced CT revealed a splenic artery aneurysm. After consultation he was admitted to our hospital for surgery. Multislice CT and magnetic resonance angiography demonstrated a saccular aneurysm, 22 mm in size, located in the proximal portion of the splenic artery. It was resected, and the splenic artery was reconstructed by an end-to-end anastomosis. The patient's postoperative course was favorable, and, after improvement, he was discharged on the 7th postoperative day. As Doppler ultrasound echography is being increasingly used during health examinations, these lesions are being detected with greater frequency. When splenic artery aneurysms rupture, mortality rates increase; we must therefore avoid simplistic observations. There are various treatment strategies available, and we must select which one is appropriate on a case-by-case basis.

An impending rupture of a celiac artery aneurysm in a patient with Behçet's disease -- extra-anatomic aorto-common hepatic artery bypass: report of a case.

A celiac artery aneurysm associated with Behçet's disease is extremely rare. We herein present the case of successful surgical treatment for an impending rupture of a large celiac artery aneurysm with a wide proximal neck in a patient associated with Behçet's disease. To our knowledge, this is the first report of a procedure involving extra-anatomic aorto-common hepatic artery (CHA) bypass through the retroperitoneal space implanting a 6-mm expanded polytetrafluoroethylene graft. An 18-month postoperative magnetic resonance angiography scan showed a good patency of the aorto-CHA graft without an anastomotic pseudoaneurysm in a closure of aorta and anastomoses.

Surgery for ruptured abdominal aortic aneurysm with an aortocaval and iliac vein fistula.

The purpose of this study was evaluate the operative procedure and outcome of abdominal aortic aneurysm (AAA) patients with aortocaval fistula (ACF) and iliac vein fistula. From 1982 through 2004, we experienced five AAA patients associated with spontaneous aortocaval and aortoiliac venous fistula who underwent repair of AAA. Three patients were in hypovolemic shock, including one patient with cardiopulmonary arrest on admission who required cardiopulmonary resuscitation before surgery. These three ACF patients with hypovolemic shock underwent emergency operation and two patients with stable hemodynamic state underwent urgent operation. One of two ACF patients with stable condition was associated with unstable angina. One AAA patient with ACF-complicated angina underwent AAA repair with coronary artery bypass grafting; the remaining four patients underwent 3 bifurcated graft and 1 tube graft implantation. All surgical treatment of the fistula included direct closure within the aorta under digital compression in four patients and inferior vena cava clamp in one. The mortality rate was 25%. One ACF patient with retroperitoneal hematoma died of bleeding. Survival for ACF depends on early diagnosis and prompt surgical repair. Aortocaval fistula complicated with a rupture of aneurysm into retroperitoneal space had a severe fatal prognosis compared with uncomplicated ACF.