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Independently of well known pulmonary risk factors, an intact diaphragm during thoracoabdominal aortic repair results in a higher probability of early ventilator weaning.

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Within the pediatric population, the rare aortic aneurysm is most often brought on by congenital cardiovascular malformation or connective tissue disorder, trauma, inflammatory disease, or infection. Thus our 8-year-old patient who had multiple aortic aneurysms and evidence of mucopolysaccharidosis presented a doubly unique case. Three and one-half months after the patient underwent emergency aortic valve replacement, we performed resection and graft replacement of both her descending thoracic aorta and thoracoabdominal aorta. Histologic analysis of the aneurysm wall displayed severe medial degeneration with large deposits of acid mucopolysaccharides. Subsequent evaluation, although negative for connective tissue disorders, showed glycosaminoglycans, chondroitin sulfate, and heparan sulfate in the patient's urine. These findings are diagnostic for a heterogeneous group of storage diseases termed mucopolysaccharidoses, although testing of the patient's cultured fibroblasts failed to reveal any specific previously described enzymatic defect. After reviewing the literature, we believe that this is the first known successfully treated pediatric aortic aneurysm associated with mucopolysaccharidosis.

Internal iliac artery (hypogastric) aneurysms are most commonly associated with common iliac or other arterial aneurysms. Isolated internal iliac aneurysms are quite rare and represent about 1/2% of intracorporal aneurysms. The occurrence of an isolated internal iliac artery aneurysm many years after repair of an abdominal aortic aneurysm, and its successful surgical management have not been previously reported. An 84-year-old Caucasian male presented with acute left femoro-popliteal deep vein thrombosis 11 years after repair of an abdominal aortic aneurysm with insertion of a knitted Dacron tube graft. In the course of his workup he was found to have an isolated 5-cm right, hypogastric, arterial aneurysm. After treating the patient for this deep vein thrombosis, the internal iliac artery aneurysm was repaired via a transperitoneal approach, using the technique of obliterative endoaneurysmorrhaphy. The natural history, diagnosis, and options for treatment modalities of isolated internal iliac arterial aneurysms are presented with a review of the literature.

A canine model for inferior vena cava resection was devised to study the biomechanical and clinical applications o f the cartridge stapler, which applies a triple staggered staple line. Eighteen mongrel dogs were subjected to subhepatic, suprarenal inferior vena cava occlusion with excision o f the excluded segment. A t I hour, six dogs were killed and inferior vena cava sizes and pressures were measured. All staple lines were intact. The inferior vena cava bursting pressure was 150 to 300 m m Hg. Ten dogs survived to 6 weeks and underwent repeat laparotomy with excision and measurement o f the remaining inferior vena cava. Mean diameter was 1.9 cm. N o evidence o f staple line leakage was found despite chronic pressures to 39 cm H 2 0 : median static bursting pressures were 250 m m Hg. Vein wall thickness o f >0.24 m m were all satisfactorily stapled. Histologic examination revealed normal reendothelialization, with improved healing at higher chronic pressures. N o evidence o f inflammation at the staple line or foreign body reaction was found. We conclude that a triple staple line provides secure, rapid venous occlusion that can withstand supraphysiologic stresses immediately and at 6 weeks.