Intrinsic structural failure of Dacron prostheses is a late exceptional complication, resulting from a loss of structural integrity of the graft. The authors report six cases of non-anastomotic false aneurysms in the mid-portion of a vascular Dacron graft, observed at a mean of 12 years after insertion. It concerns four femoro-popliteal bypass grafts, one cross-over graft and a branch of a bifurcated aorto-bifemoral graft, implanted between 1980 and 1990. This represents 0.2% of all vascular Dacron grafts implanted in authors' department since 1980. The degenerated prosthesis was excised, and a new bypass graft was inserted. In three cases, histological analysis revealed a foreign body giant cell reaction against fragmented Dacron fibers. In none of the cases there was evidence of graft infection. The authors discuss the evidence and etiopathogeny of this late, unusual complication, inherent to the Dacron graft material. The most probable causative factor is material fatigue, leading to gradual breakdown and fragmentation of individual fibers, and subsequent biodegradation of the basic material. Such an intrinsic weakness of prosthetic fabric has only be observed in first and second generation Dacron grafts.

Surgery for abdominal aortic aneurysm may be challenging when rare renal or venous anomalies are present. This article reports two similar cases of aortic abdominal aneurysm associated with horseshoe kidney and left-sided inferior vena cava treated with a transperitoneal approach. Preoperative knowledge of the anatomic situation enabled appropriate aneurysm repair. Operative strategy is discussed. This report describes an uncommon venous vascular malformation complex and stresses the importance of computed tomography imaging not only in assessing the characteristics of the aneurysmal disease but also in detecting variations in pertinent vascular or parenchymal anatomy.

Aortoesophageal fistula due to thoracic aortic aneurysm is an uncommon cause of gastrointestinal bleeding and has an extremely poor prognosis. In the English literature, we found only 27 successfully managed cases of primary aortoesophageal fistula due to thoracic aortic aneurysm. We present a case of 74-year-old man who experienced the erosion of a thoracoabdominal aortic aneurysm into the esophagus. We successfully performed resection and replacement of the thoracoabdominal aorta with a cryopreserved allograft and total thoracic esophagectomy. A few months later, the esophagus was reconstructed with orthotopic colonic interposition. The patient recovered well and resumed a normal life (12 months' follow-up).

We report the case of a woman who received spinal anaesthesia for peripheral vascular surgery of the lower limbs and subsequently developed a spinal subarachnoid haematoma. Interestingly, low back pain was the only symptom of this spinal subarachnoid haemorrhage. During the following days, blood migrated from the spinal haematoma towards the cerebral subarachnoid spaces. The patient presented with stupor, nausea and vomiting that resolved within 2 weeks with conservative treatment.

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for the Vascular Quality Initiative, Rochester and Minneapolis, Minnesota; Salt Lake City, Utah; Boston and Worcester, Massachusetts; Ann Arbor, Michigan; and Hanover, New HampshireBackground: Blood transfusions are associated with adverse events. We examined perioperative transfusion practices and associated complications following open vascular procedures nationwide in the Vascular Quality Initiative (VQI). Methods: Adults undergoing open abdominal aortic aneurysm repair (OAR) and lower extremity arterial bypass (Bypass) within VQI (2003e2016) were identified. All emergent cases, patients with preoperative hemoglobin <7 g/dL, preoperative hospitalization >1 day, or a return to operating room during the index hospitalization were excluded. Units of red blood cells transfused were the primary outcome. Secondary outcomes were postoperative myocardial infarction (MI) and death. Patient, center, and procedural factors were evaluated. Multivariable mixed effects negative binomial regression and multivariable logistic regression were performed. Results: We identified 24,131 procedures (OAR 3885, 16.1%; Bypass 20,246, 83.9%) among 22,532 patients (10.1% had >1 procedure). Overall, 37.5% of OAR and 19.5% of Bypass were transfused. Transfusion rates varied across estimated blood loss quartiles and across various preoperative hemoglobin levels. The overall rate of postoperative MI and death was 4.0% and 1.8% for OAR, and 2.2% and 0.7% for Bypass, respectively. In univariate and multivariable

A unique case of mycotic aneurysm of the abdominal aorta caused by Streptococcus agalactiae in an afebrile patient presenting with abdominal pain is described. Although this bacterium is associated with a variety of infections in human beings, aortitis is uncommon. Chronic alcoholism and diabetes mellitus are the 2 major predisposing conditions for group B Streptococci infection and both were present in this case. The abdominal pain and elevated inflammatory markers in the absence of fever were elusive in presentation; however, the diagnosis of mycotic aneurysm was established by abdominal computed tomography scan. The patient was treated successfully by resection of the diseased aorta and aortic allograft replacement. Culture of the excised tissue grew Streptococcus agalactiae sensitive to penicillin G and (other commonly tested antibiotics) fluoroquinolones. A prolonged course of moxifloxacin (for 6 months) was administered due to the persistence of elevated inflammatory markers and was remarkably well tolerated. Sixteen months after stopping the antibiotics, the patient is doing well, and the control imaging studies are satisfactory.

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