Surgical repair of a symptomatic celiac artery aneurysm with resection and end-to-end anastomosis.

A true aneurysm of the celiac artery is a rare form of a visceral aneurysm, constituting ∼4% of visceral aneurysms. Mortality in ruptured cases is high; thus, early recognition and treatment are crucial. Recent guidelines suggest endovascular therapy; however, numerous complications are associated with endoluminal treatment. Open repair in select cases, using an individualized strategy fit for the patient's anatomy still provides excellent early and long-term results. Our patient was treated with open surgical resection and end-to-end anastomosis of the celiac and common hepatic arteries. A 43-month follow-up computed tomography angiogram revealed excellent hepatic artery patency and no pseudoaneurysm formation.

Early and Mid-Term Results of Native and Abdominal Aortic Graft Infection Treatment via Surgeon-Constructed Porcine Pericardial Aortic Tubes.

The search for optimal material for aortic infection reconstruction is ongoing. Our study presents the early and mid-term results of surgeon-constructed porcine pericardial tubes in the in-situ reconstruction of abdominal aortic infections, focusing on the safety as well as the durability of surgeon-created tubes. We performed a retrospective analysis of 8 patients treated for native aortic (n = 3) and aortic graft infections (n = 5) with surgeon-created tubes made of porcine pericardium patch (8 × 14 cm NO-REACT Ⓡ, BioIntegral Surgical Inc., Mississauga, ON, Canada). There were 7 males and 1 female, aged 68.5 (±4.8 years). Three patients had an aorto-enteric fistula. Technical success was obtained in all patients. Thirty-day mortality was 12.5% (n = 1). Mid-term follow-up was 12 months (2-63 months). One-year mortality was 37.5% (n = 3). Reintervention rate was 28.5% (n = 2). False aneurysm rate in the follow-up was 14.2% (n = 1). Surgeon-constructed porcine pericardial tubes seem to be a promising alternative as a replacement for native as well as graft-related abdominal aortic infections. The mid-term durability is encouraging, once the infection is controlled in cases with successful fistula repair and in native aortic infections patients. Further observations on larger groups, in longer follow-ups are necessary to confirm these preliminary observations.

REBOA - new era of bleeding control, literature review.

It is extremely difficult to provide non-compressible torso hemorrhage control particularly in trauma setting. A vast majority of cases present inability of successful exsanguination arrest, leading to cardiovascular collapse, myocardial and cerebral hypoperfusion and death eventually. The only possible treatment for these patients is prompt bleeding control, either open or endovascular. Aortic occlusion seems to be the most rapid and convenient way to restrain blood loss and possibly increase survival. However, it is not proven yet. Traditional aortic occlusion for trauma consisted of supradiaphragmatic thoracic aorta cross-clamping through resuscitative thoracotomy (RT). This complicated and devastating procedure triggered the necessity to work on a simpler, less invasive resuscitation bridge which can be implemented in emergency departments or even in prehospital setting. Resuscitative balloon occlusion of the aorta (REBOA) provides a novel method of hemorrhagic shock stabilization in bleeding below the diaphragm. The mechanism lies in improving myocardial and cerebral perfusion and ceasing major bleeding itself. This method together with invasive endovascular and surgical procedures creates a new approach of choice for trauma patients. It is called Endovascular Hybrid Trauma and Resuscitation Management (EVTM) and introduces this concept to modern clinical practice. Through a detailed review, this article aims to introduce REBOA procedure to a broader recipient and present REBOA details, benefits and limitations.

Late Aortic Remodeling after Endovascular Repair of Complicated Type B Aortic Dissection-TEVAR Protects Only the Covered Segment of Thoracic Aorta.

BACKGROUND: TEVAR is the preferred way of treatment of complicated type B aortic dissection. The purpose of the study was to assess the impact of TEVAR on aortic remodeling in the thoracic and abdominal segment in long-term follow-up. METHODS: Twenty-three patients with complicated type B aortic dissection were treated by TEVAR in years 2004-2012 in our department. Aortic remodeling was rated based on preoperative and final follow-up computed tomography angiography. Aorta was measured at the level of left bronchus, the diaphragm, celiac trunk, and the aorta below the renal arteries. Diameter of the aorta (da), total aortic area (taa), true lumen area (tla), and false lumen area (fla) were measured. RESULTS: Primary technical success was obtained in 100%. Primary clinical success rate was 82.6%. Early mortality was 13% (3 patients). Mean follow-up was 57.9 months (26-123; standard deviation, ±30.5). All patients remain in the follow-up. Diameter of the aorta increased significantly only at the B level-from baseline 35,6 mm to 40,5 mm in the follow-up (P = 0.005). Total aortic area (taa) was stable only at the A level but increased significantly at the B, C, and D levels. Area of the true lumen (tla) increased significantly at A, B, C, and D levels; area of false lumen (fla) decreased significantly at A and B levels, but the area of false lumen (fla) did not change at C and D levels. CONCLUSIONS: TEVAR for complicated acute aortic type B dissection is a safe and effective method of protecting thoracic aorta. The procedure was effective in majority of patients, and in 80% of the cases, there was no need for additional distal aortic coverage. The abdominal aorta is relatively stable over a long period of observation in complicated type B aortic dissection.

Traumatic aortic injury: does the anatomy of the aortic arch influence aortic trauma severity?

PURPOSE: Traumatic aortic injury (TAI) is a rare but life-threatening type of injury. We investigate whether the anatomy of the aortic arch influences the severity of aortic injury. METHODS: This is a retrospective study of twenty-two cases treated with TEVAR for TAI in our department from 2009 to 2014. Aortic injury was assessed in accordance with the recommendations of the Society of Vascular Surgery. We measured the aortic arch angle and the aortic arch index, based on the initial angio-CT scan, in each of the analyzed cases. RESULTS: The mean aortic arch index and mean aortic arch angle were 6.8 cm and 58.3°, respectively, in the type I injury group; 4.4 cm and 45.9° in the type III group; 3.3 cm and 37° in the type IV group. There were substantial differences in both the aortic arch index and the aortic arch angle of the type III and IV groups. A multivariate analysis confirmed that the aortic arch angle was significantly associated with the occurrence of type III damage (OR 1.5; 95% CI 1.03-2.2). CONCLUSIONS: The severity of TAI is influenced by the sharpness of the aortic arch. There is an inverse relationship between the severity of aortic injury and the aortic arch index.

Superficial femoral vein and superficial femoral artery as replacement for infected axillofemoral graft.

We report successful replacement of infected axillofemoral bypass with a combined femoral vein and superficial femoral artery graft. The new graft was transferred through the tunnel left after infected prosthesis removal. Good early and long-term results indicate that this may be a sufficient procedure.