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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