Porto-mesenteric venous thrombosis is a rare disorder, which can occur as a complication of many diseases. Porto-mesenteric venous thrombosis leads to venous hypertension, outpouring of blood into the bowel lumen and mesentery, distension and rupture of venules, and hemorrhgae and edema of the bowel wall. In cases of mild porto-mesenteric venous thrombosis, nonoperative management-consisting of fluid resuscitation, anticoagulation, and thrombolysis-may be acceptable in clinically stable patients with early diagnosis. If patients show clinical signs of peritonitis or deteriorates on medical management, prompt surgical intervention is warranted. At laparotomy, segmental resection of the involved bowel with primary anastomosis is easily accomplished, because the hemorrhagic infarction associated with porto-mesenteric venous thrombosis is limited. The optimal duration of anticoagulation therapy has not been defined. However, recommendation is that anticoagulation should be continued indefinitely, as it reduces the incidence of porto-mesenteric venous thrombosis recurrence. The patient in our study presented with a severely edematous duodenum and proximal jejunum in CT scan with signs of peritonitis due to perforation of the upper-jejunum. We had performed a percutaneous drainage for intraabdominal abscess which occurred the jejunal infarction. About 1 month later, a resection of a well-controlled fistula tract was done.
Abscess ; Drainage ; Duodenum ; Early Diagnosis ; Edema ; Fistula ; Humans ; Hypertension ; Incidence ; Infarction ; Jejunum ; Laparotomy ; Mesentery ; Peritonitis ; Recurrence ; Resuscitation ; Rupture ; Tomography, X-Ray Computed ; Venous Thrombosis* ; Venules

Blue digit syndrome, peripheral atheroembolism, and atheromatous embolization, all refer to microembolization and occlusion of the smaller distal arteries. Despite the longstanding recognition that atheroemboli arise from severely degenerative atherosclerotic plaques in the proximal circulation, many questions remain about the pathophysiology and natural history of this disorder. The threat to the survival of a single digit may not appear to be of great consequence, but repeated episodes of atheroembolism with continued destruction of the collateral circulation may portend disaster for the digit. Diagnostic efforts should be promptly concentrated on the location, stabilization and preferably, eradication of the embolic source. We report 2 cases of blue digit syndrome were managed by endarterectomy and intra-arterial stenting. Case 1: A 61-year-old man was presented with the blue toe syndrome at the third, fourth, fifth toes. The bilateral pedal pulses were normally palpable and ankle-brachial pressure indices (ABI) were within normal range. At the findings of duplex ultrasonography and CT angiography, right common femoral artery showed a focal eccentric stenosis with mural thrombus. The right common femoral artery endarterectomy was performed for the athersclerotic ulcerating plaque. Case 2: A 64-year-old man was presented with 11-month history of his left leg pain and 1-week history of his left third, fourth fingers. He had a history of flap operation for his left fourth finger tip due to necrosis. At the findings of angiography, multiple stenosis of left common iliac and left subclavian arteries were found. The lesion of left subclavian artery lesion was presumed to be the source of blue finger syndrome and treated with intra-arterial stent placement after balloon angioplasty.
Angiography ; Angioplasty, Balloon ; Arteries ; Blue Toe Syndrome ; Collateral Circulation ; Constriction, Pathologic ; Disasters ; Embolism, Cholesterol ; Endarterectomy* ; Femoral Artery ; Fingers ; Humans ; Leg ; Middle Aged ; Natural History ; Necrosis ; Plaque, Atherosclerotic ; Reference Values ; Stents* ; Subclavian Artery ; Thrombosis ; Toes ; Ulcer ; Ultrasonography

Superior mesenteric artery (SMA) aneurysm is rare but shows high risk of rupture. Mycotic aneurysm is the most common cause of SMA aneurysm, followed by atherosclerosis. Diagnosis is usually made by ultrasonography or abdominal CT scanning. Because of its particular anatomy, surgical treatment is often challenging for the surgeons. We present a successful reconstruction of the SMA after ligation of SMA aneurysm in a 43-year-old man who suffering from epigastric and back pain for 5 months.
Adult ; Aneurysm* ; Aneurysm, Infected ; Atherosclerosis ; Back Pain ; Diagnosis ; Humans ; Ligation ; Mesenteric Artery, Superior* ; Rupture ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUND: Type A ascending aortic dissection, either acute or chronic, requires surgical treatment to prevent death from proximal aortic rupture or malperfusion. The application of deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP), which has originally been used for the cerebral protection during aortic arch surgery, to apply to type A ascending aortic dissection for the open distal anastomosis has been suggested. A retrospective study was conducted to evaluate the efficacy of DHCA with RCP in patients with type A aortic dissection. METHOD: From May 1998 to April 2002, eleven patients (7 men and 4 women; mean age=55.4 years) underwent repair of type A aortic dissection (9 acute and 2 chronic). All patients underwent resection and graft replacement of the ascending aorta and/or aortic arch. Open distal anastomosis was performed under DHCA (less than 19oC) with RCP, while the retrograde flow rate through the superior vena cava ranged from 200 to 500 ml/minute, to maintain internal jugular venous pressure between 15 and 25 mmHg. RESULT: Mean DHCA/RCP duration was 49.2 (27~85) minutes. Postoperatively, three patients died of arch rupture, right ventricular failure, and brain edema, and operative mortality was 27.3%. Eight patients survived and recovered their consciousness in 3 to 70 hours (mean, 11.6 hours) after operation. Among the eight patients whose DHCA/RCP duration was longer than 40 minutes, six patients survived with little neurological complications. During the follow-up period (mean, 22.8 months), one patient who underwent composite valve graft replacement died of ventricular tachyarrhythmia, However, the remaining seven patients were free from major events. CONCLUSION: This limited data indicates that RCP can provide an improved cerebral protection, by extending the safe time limit of DHCA, as well as an open distal anastomosis without aortic cross-clamping for the repair of type A aortic dissection.
Aorta ; Aorta, Thoracic ; Aortic Rupture ; Brain Edema ; Circulatory Arrest, Deep Hypothermia Induced ; Consciousness ; Female ; Follow-Up Studies ; Humans ; Male ; Mortality ; Perfusion* ; Retrospective Studies ; Rupture ; Tachycardia ; Transplants ; Vena Cava, Superior ; Venous Pressure

Primary aortoenteric fistulae (AEFs) are extremely rare vascular disease entities, with a mortality ranging from 33 to 85%. Only two cases of Salmonella mycotic aortic aneurysms causing primary AEFs have been reported. We experienced a rare case of a 57-year-old man with intermittent gastrointestinal bleeds and who was diagnosed as having primary aortoenteric fistula with abdominal aortic aneurysm, confirmed by CT. In the operation room, the fistula was closed and a temporary proximal duodenojejunostomy was created. The aneurysm was replaced with an aorto-biiliac bypass using Dacron Graft with an inter-positioning omental flap. The microbiology report of aneurysm wall, blood and periaortic tissue showed infection with group D salmonella. He was treated with ciprofloxacin and discharged in good general condition on the 21st post-operative day.
Aneurysm ; Aortic Aneurysm* ; Aortic Aneurysm, Abdominal ; Ciprofloxacin ; Fistula* ; Humans ; Middle Aged ; Mortality ; Polyethylene Terephthalates ; Salmonella* ; Transplants ; Vascular Diseases

Infection is one of the most feared complications in vascular surgery, especially when it involves the aortoiliac segment. There are many controversies in the treatment of aortoiliac graft infection with varying results reported. The author treated 2 cases of graft infection after an aortobiiliac bypass. These patients had an abdominal aortic aneurysm with aortoenteric fistula before or after the bypass surgery. Both developed graft infection within about 1 year after the first operation. One was treated with an extra-anatomic bypass after complete removal of the infected graft; and the other was treated with a re-aortobifemoral bypass with bilateral femoral vein graft. Both patients showed no recurrence of infection nor limb loss.
Aortic Aneurysm, Abdominal* ; Extremities ; Femoral Vein ; Fistula ; Humans ; Recurrence ; Transplants*

Iliolumbar artery injury is a rare but well-known complication of abdominal trauma and is usually associated with pelvic bone fracture. If a pseudoaneurysm develops and ruptures, it is a serious condition due to the enduing massive intraperitoneal or retroperitoneal bleeding. Superselective embolization has become the most effective treatment for pelvic hemorrhage caused by iliolumbar artery injury in which early detection and treatment are very important. We report a case of successful transarterial embolization of a pseudoaneurysm following blunt trauma in 32-year-old female.
Adult ; Aneurysm, False* ; Arteries* ; Female ; Hemorrhage ; Humans ; Pelvic Bones ; Rupture

A case of coil embolization in right superior thyroid artery pseudoaneurysm by stab wound is reported. A fifty-six-year old female, laceration and some bulging in right neck side. Aortic arch angiography, right common carotid angiography was done. Angiography shows 4 2 cm sized right thyroid artery pseudoaneurysm (Fig. 1) and (Fig. 2). We selected right superior thyroid artery by 3F micorofert (CooK, Bloomington, Ind.) and embolized by 2 4 mm (diameter), 2 cm (length) sized micro tornaido coil (CooK, Bloomington, Ind.). Post procedure right common carotid angiography was done. Angiography shows no visualized right thyroid artery pseudoaneurysm (Fig. 3).
Aneurysm, False* ; Angiography ; Aorta, Thoracic ; Arteries* ; Embolization, Therapeutic* ; Female ; Humans ; Lacerations ; Neck ; Thyroid Gland* ; Wounds, Stab*

Renal artery aneurysms are rare, in less than 1% of consecutive abdominal aortograms. Renal artery aneurysms are bilateral in about 10% of cases. Controversy persists regarding the indications for repair of renal artery aneurysms and optimal method of repair. The authors report a case of left renal artery aneurysm with right renal atrophy in a 37-year-old male patient. This patient has no past medical history including hypertension. On physical examination, a pulsatile mass was palpated in left upper abdomen. Preoperative abdominal CT showed right renal atrophy and 8 cm diameter left renal aneurysm. Abdominal aortogram and left renal angiogram showed huge lobulated outpouching contrast collection at the proximal left renal artery without definite neck and diffuse irregularity at the proximal left renal artery. This patient was treated by splenectomy, thrombectomy, aneurysm resection and end to end splenorenal bypass. No remarkable postoperative complication was observed. The patient was discharged postoperative 12 days.
Abdomen ; Adult ; Aneurysm* ; Atrophy ; Humans ; Hypertension ; Male ; Neck ; Physical Examination ; Postoperative Complications ; Renal Artery ; Splenectomy ; Thrombectomy ; Tomography, X-Ray Computed

Combined carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) has been traditionally advocated for patients in whom symptomatic disease has been elicited in both vascular territories. This rationale has related to the concern for an increased myocardial infarction rate following CEA with untreated coronary artery disease and conversely, the potential for stroke in patients receiving CABG with untreated carotid stenosis. Although significant cardiac and cerebral complication rates have been identified in these combined cases, justification for the procedure has stemmed from combined rates obtained which were lower than those encountered for either procedure performed in isolation. There has been a trend toward performance of combined CEA/CABG in patients with asymptomatic carotid stenosis. Release of the Asymptomatic Carotid Atherosclerosis Study (ACAS) in 1995 appears to have played a significant role in changing trend. Interpreting the ACAS data finding is problematic for the combined procedure. Yet controversy continues concerning the most appropriate management for patients with severe coronary artery disease who also have asymptomatic carotid stenosis. Recently we have successfully managed two cases of coronary artery disease and asymptomatic carotid stenosis patients by combined CEA and CABG without any surgical complication. We report these 2 cases and briefly review the literature.
Carotid Artery Diseases ; Carotid Stenosis ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Endarterectomy, Carotid* ; Humans ; Myocardial Infarction ; Stroke ; Transplants