Aneurysms of the splenic artery that anomalously arise from a splenomesenteric trunk are a rarity. Aneurysmal disease of visceral arteries is found in only 0.2% of the general population. The celiac trunk and superior mesenteric artery (SMA) are involved in less than 10% of all visceral aneurysms. Although rupture seems to occur in 20% to 22% of patients, the related mortality rate can rise as high as 100%. Anomalies of the celiac trunk and SMA, more common than previously claimed, include the splenic artery arising from the SMA, which occurs in only 1% of patients. We present two cases of young patients who had 4-cm aneurysms behind the pancreas that involved an anomalous splenic artery. The first patient required dissection of the entire splenopancreatic bloc through a transverse abdominal incision to excise the aneurysm and repair the SMA. The second patient was treated by the classic approach, through a median incision and by entering the mesenteric root. There do not seem to be reports of similar cases, except for two cases of aneurysms involving the celiomesenteric trunk. The cause of these aneurysms can be attributed to mesenchymal alterations during the embryonic formation of aortic collateral branches. A correct surgical approach to splanchnic aneurysms calls for awareness of potential vascular variations of the arteries and their collateral pathways.

PA and MA both achieved satisfactory results in primary and secondary patency rates, as well as limb salvage, during long-term follow-up. The differences between the two groups were small and not statistically significant. PA was burdened by similar postoperative nerve and wound complications compared with MA. The in-hospital stay after PA was significantly lower.

Deep venous thrombosis is very frequent after general surgery, and its major complication, pulmonary embolism, is today the most frequent cause of postoperative death. The reduction of this cause of mortality is mainly based on its prevention rather than its therapy. This purpose was achieved by using physical and pharmacological means. During

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Results:In the 96 patient study, mean effective dose for EVAR was 12.6mSv (.23 -80.9), and mean FT was 18.8mins (.2 -64.6). Phantom studies determined patient entrance dose for selected FOV (36, 28, 20 and 14cm) as 3.65, 5.32, 8.46 and 15.6mGy/min for Flouroscopy and 1.1, 1.94, 3.15 and 3.83mGy/frame for DSA. The 7 patient study showed mean number of digital frames was 191 (100 -376) and maximum calculated skin dose was 1.3Gy, below deterministic injury threshold. Stochastic risk for EVAR and associated CT was Ͻ 1/800.Conclusions: Our data confirms a significant variation in radiation exposure during EVAR. We have combined clinical and phantom data to calculate the radiation dose per individual step. This has the potential to be used as an educational tool and to support optimization and dose reduction.