Aortic graft infection is usually caused by surgical contamination and presents as an indolent infection. Case 1 presented as such; Case 2 presented more acutely. Both grafts were iatrogenically misplaced through the colon at the index operation. The patients underwent extra-anatomic bypass and graft explantation and subsequently recovered.
We report the case of a 44-year-old woman who developed an acute type B aortic dissection caused by an entry tear from an aneurysmal left common iliac artery that extended retrograde to the proximal descending thoracic aorta. She experienced refractory chest pain despite optimal medical management, thereby indicating repair. Endovascular aortic repair was subsequently performed. Intraoperatively, fibromuscular dysplasia was diagnosed by the characteristic appearance of her renal arteries. The patient tolerated the procedure and had resolution of her chest pain. In summary, we present a highly unusual case of type B aortic dissection resulting from a retrograde common iliac artery tear in a patient with fibromuscular dysplasia.
Context: Aortic graft infections are a rare but devastating complication of aortic revascularization. Often infections occur due to contamination at the time of surgery. Iatrogenic misplacement of the limbs of an aortobifemoral graft is exceedingly rare, and principles of evaluation and treatment are not well defined. We report two cases of aortobifemoral bypass graft malposition through the colon.Case report: Case 1 is a 54 year old male who underwent aortobifemoral bypass grafting for acute limb ischemia. He had previously undergone a partial sigmoid colectomy for diverticulitis. Approximately six months after vascular surgery, he presented with an occult graft infection. Preoperative imaging and intraoperative findings were consistent with graft placement through the sigmoid colon. Case 2 is a 60 year old male who underwent aorto bifemoral bypass grafting due to a nonhealing wound after toe amputation. His postoperative course was complicated by pneumonia, bacteremia thought to be secondary to the pneumonia, general malaise, and persistent fevers. Approximately ten weeks after the vascular surgery, he presented with imaging and intraoperative findings of graft malposition through the cecum.
Conclusions:Aortic graft infection is usually caused by surgical contamination, and presents as an indolent infection. Case 1 presented as such; Case 2 presented more acutely. Both grafts were iatrogenically misplaced through the colon at the index operation. The patients underwent extra-anatomic bypass and graft explantation and subsequently recovered.
2, and manganese superoxide dismutase activities; myofiber shape; and carbonyl adducts).Conclusions: Our study shows that revascularization improves hemodynamics, walking performance, QoL, and calf muscle disease in claudicating PAD patients. Baseline SPP15sec (cutoff ¼ 50 mm Hg) strongly predicts which patients will experience >20 m improvement of SMWD.
Objective: We have described the sex-based differences in survival after repair of ruptured abdominal aortic aneurysms (rAAAs).Methods: We performed a single-center retrospective review of data from the institutional Clinical Research Data Warehouse. Adults who had undergone either open surgery (OS) or endovascular aneurysm repair (EVAR) for rAAAs between January 1996 and December 2018 were included in the present study. Patients whose EVAR was converted to OS were included in the OS group. Patients with untreated rAAAs, rAAAs treated at an outside hospital, or ruptured thoracic or thoracoabdominal aortic aneurysms were excluded. The primary outcome was survival. The secondary outcomes included mode of repair, postoperative complications, and discharge disposition.Results: We identified 193 patients (20.7% women) who had undergone rAAA repair (35.2% EVAR). No significant association was found between sex and mode of repair. The 1-and 5-year survival was 32.5% and 29.8% for the women and 55.8% and 40.8% for the men, respectively (P ¼ .001). The 1-and 5-year survival stratified by sex and mode of repair was EVAR and male sex, 69% and 50.7%; OS and male sex, 48% and 35.8%; EVAR and female sex, 45.5% and 34.1%; and OS and female sex, 27.6% and 27.6%, respectively (P ¼ .002; Fig). Multivariable analysis showed that men undergoing OS had lower mortality compared with women undergoing OS (adjusted hazard ratio, 0.51; 95% confidence interval, 0.32-0.81; P ¼ .04). No difference was found in mortality between the men and women undergoing EVAR, between the women undergoing EVAR and the women undergoing OS, and between the men undergoing EVAR and the men undergoing OS (Table ). The men undergoing OS had a greater incidence of renal failure requiring renal replacement therapy (29.9%; P ¼ .026), bowel ischemia (23.3%; P < .001), and pneumonia (28.9%; P ¼ .022) compared with the other groups. The men undergoing EVAR had a greater incidence of urinary tract infection (9.3%; P ¼ .037), and the women undergoing OS had a greater incidence of prolonged intubation (66.7%; P < .001) compared with the other groups. Fewer women were discharged to home (10.0% vs 39.9%; P < .001) and more were discharged to hospice or had died compared with the men (60.0% vs 32.7%; P ¼ .002). No difference was found in the rates of discharge to a rehabilitation facility for the men and women.Conclusions: OS for men was associated with lower mortality compared with OS for women for treatment of rAAAs. No difference was found in the mortality of men and women who had undergone EVAR for rAAAs. OS for the men with a rAAA was associated with more complications compared with the other groups. The women were less likely to be discharged home and were more likely to be discharged to hospice care or to have died after rAAA repair.
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