Ruptured aneurysm of the splenic artery associated with fibromuscular dysplasia.

Rupture of a splenic artery aneurysm is a rare event associated with high mortality rates. Aneurysm of the splenic artery associated with fibromuscular dysplasia (FMD) is even rarer, with only 3 previously reported cases. We report a patient with previously undiagnosed FMD who required emergent intervention because of a ruptured splenic aneurysm. In discussion, we present an overview of literature on splenic aneurysms and FMD, together with pathology and treatment.

Primary endoanchoring in the endovascular repair of abdominal aortic aneurysms with an unfavorable neck.

PURPOSE: To investigate the feasibility and early results of endoanchoring (endostapling) using a new commercially available device as an adjunctive procedure during endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) with an unfavorable proximal neck. METHODS: Between June 2010 and May 2012, 13 consecutive patients (all men; median age 73 years, range 62-82) were prospectively enrolled in a 2-center registry to follow outcomes of adjunctive primary endoanchoring (Aptus HeliFX Aortic Securement System) of the proximal endograft to enhance proximal graft fixation and sealing during EVAR. Indications for proximal neck endoanchoring included at least one of the following: neck angulation 45° to 90°, length 8 to 15 mm, diameter 29 to 33 mm, conical neck configuration, or an irregularly shaped neck. The median AAA diameter was 56 mm (range 50-98). The Endurant stent-graft was implanted in 4 patients and the Zenith device in 9. RESULTS: A median of 4 endoanchors were implanted per patient (range 3-10) in adjunctive procedures that required a median 12 minutes (range 7-20). Intraoperatively, 2 proximal type I endoleaks were present following endoanchor implantation (85% primary technical success); a cuff was deployed in 1 case, which successfully sealed the endoleak (92% assisted primary technical success). The second proximal type I endoleak was minute and sealed spontaneously within 30 days. No further major device-related complications occurred intraoperatively. In the 30-day perioperative period, the only procedure-related complications were 2 type II endoleaks, which required no intervention. Over a median follow-up of 7 months (range 2-17), no further complications occurred apart from an asymptomatic internal iliac artery occlusion and a non-lethal myocardial infarction at 9 months. The type II endoleaks spontaneously sealed. No endograft migration was noticed nor loss of endoanchor integrity. No deaths occurred throughout follow-up. CONCLUSION: Primary endoanchoring using the HeliFX aortic securement system is feasible, and early results were promising in this series.

Endovascular retrieval of a dislodged femoral arterial closure device with Alligator forceps.

The Angio-Seal (St. Jude Medical, Minnetonka, Minn) is a frequently used percutaneous femoral artery closure device to obtain hemostasis after arterial catheterization. Separation and migration of the device, leading to distal embolization and limb-threatening ischemia necessitating emergency surgery, is reported but extremely rare. We present a unique case of successful endovascular bailout management of a dislocated Angio-Seal with use of an Alligator Tooth Retrieval forceps (Cook Medical, London, United Kingdom).

Superior mesenteric artery stent fracture leading to recurrent mesenteric ischemia.

We report 2 cases of patients with recurrent symptoms of mesenteric ischemic disease after percutaneous transluminal angioplasty (PTA) and stenting due to superior mesenteric artery stent fracture. Both patients were treated by redo PTA and stenting successfully. Stent fractures, their complications, and management are discussed.

Fentanyl-fluanisone-midazolam combination results in more stable hemodynamics than does urethane alpha-chloralose and 2,2,2-tribromoethanol in mice.

Near-physiologic hemodynamic conditions for several hours were needed to study cardiovascular physiology in a murine model. We compared two commonly used anesthetic treatments, urethane alpha-chloralose (U-alphaCh; 968 mg U and 65 mg alphaCh/kg) and 2,2,2-tribromoethanol (TBE; 435 mg/kg) and fentanyl fluanisone midazolam (FFM; 3.313 mg fentanyl, 104.8 mg fluanisone, and 52.42 mg midazolam/kg) with respect to mean arterial blood pressure (MAP) and heart rate (HR) for 100 min at similar levels of surgical anesthesia. Assessed every 10 to 15 min, the U-alphaCh+TBE group maintained a significantly (P < 0.001) lower mean MAP (49 4 mmHg) than did the FFM group (78 5 mmHg). Mean HR in the U-alphaCh+TBE group significantly (P < 0.001) increased from 308 34 bpm at the beginning to 477 43 bpm at the end of the experiment. In comparison, the FFM group showed a stable HR of 431 37 bpm. The MAP and HR of the U-alphaCh+TBE group were extremely unstable, with sudden and unpredictable changes in MAP when examined at 1-min intervals. The results of our study show that U-alphaCh+TBE anesthesia should not be used in murine models in which stable, near-physiologic hemodynamics are needed for cardiovascular studies.