Underwent Aneurysm Resection Research Articles

Masson Hemangioma in a Brachial Artery Aneurysm

Masson hemangioma is a rare benign vascular tumor characterized by intravascular papillary endothelial hyperplasia (IPEH). Numerous case reports have described lesions in the digits, neck, oral cavity, and intracranially. IPEH involving primary brachial artery aneurysm is extremely rare, with only a handful of reported cases. We present a 43-year-old female with a true distal brachial artery aneurysm who presented with a painful pulsatile mass in the antecubital region. She underwent aneurysm resection and end-to-end repair with a saphenous vein graft. Histology confirmed the diagnosis of IPEH with characteristic features of papillary hyperplasia within the intravascular thrombus.

Idiopathic proximal ulnar artery aneurysm

Ulnar artery aneurysms are very rare, usually caused by repetitive blunt trauma to the ulnar artery, leading to the formation of an aneurysm. Other etiologies reported in the literature were vasculitis, anatomic abnormalities, or infections. This case report is regarding a 29-year-old male who presented with proximal ulnar artery aneurysm with distal embolization. He underwent aneurysm resection with ligation of the ulnar artery. Histopathology of the aneurysmal wall showed true aneurysm of the ulnar artery.

Clinic features and echocardiographic evaluation of patients with idopathic submitral left ventricular aneurysm

Objective To study cinical features of patients with idopathic submitral left ventricular aneurysm(ISLVA) and evaluate their global and segmental systolic function as well as diastolic function through echocardiography.Methods Clinical features of eight patients with ISLVA were analysed retrospectively.Standard 2-dimentional and real-time 3-dimentional echocardiography were performed in all the eight cases and other twenty subjects with normal left ventricular(LV) function (defined as control group).Results Two patients were diagnosed as ISLVA due to ventricular arrythmia and the other six case sowing to congestive heart failure.Coronary angiography was normal in all patients.Apical systolic murmur was audible in 6 cases.Four patients received mitral valve surgical repair,one underwent aneurysm resection and radiofrequency ablation,implantable cardioverter defibrillator was implanted in one case,one was only treated by medication.One case died.Patients with ISLVA demonstrated significanly larger left atrium(LA) and LV diameter (both end-diastolic and end systolic),thinner LV posterior wall,and lower LV ejection fraction (LVEF) than controls (P ＜0.05).Indexes of the LV 17 segments time-volume curves including the time to minimal systolic volume(Tmsv) 16-SD,Tmsv 12 SD,Tmsv 6-SD,Tmsv 16-Dif,Tmsv 12-Dif,Tmsv 6-Dif,Tmsv 16-SD％,Tmsv 12-SD％,Tmsv 6-SD％,Tmsv 16-Dif％,Tmsv 12-Dif％,Tmsv 6-Dif％ were significantly higher in patients with ISLVA than those in controls(all P ＜0.05).All patients with ISLVA showed mitral regurgitation and decreased LV diastolic function in varying degrees,five patients accompanied by elevated LA pressure.Conclusions Clinical features of patients with ISLVA are nonspecific.Echocardiography can evaluate systematically their functional and structural abnormalities. Key words: Echocardiography; Heart aneurysm ; Ventricular function, left

Valve surgery in active endocarditis patients complicated by intracranial haemorrhage: the influence of the timing of surgery on neurological outcomes

The risk of neurological deterioration during valve surgery using cardiopulmonary bypass under systemic heparinization in infective endocarditis (IE) patients with intracranial haemorrhage (ICH) is unknown. The objective of this retrospective study was to investigate the stratified risk related to the timing of valve surgery on neurological outcomes in patients with active IE and preoperative ICH. From 2004 to 2012, 246 patients underwent valve surgery for IE in hospitals enrolled in the Osaka Cardiovascular Research Group. Of these, a group of 30 patients had preoperative ICH, and they included 18 patients with cerebral haemorrhage, 8 with subarachnoid haemorrhage and 4 with haemorrhagic infarction. The preoperative characteristics, neurological statuses and postoperative results of these patients were retrospectively explored to analyse the effects of the timing of surgery on neurological outcomes. Twenty-one patients had symptomatic ICH, and the median modified Rankin score was 1.5 (95% confidence interval [CI] 1.2-2.8). Eight patients were diagnosed with mycotic aneurysms, and 7 of these patients underwent aneurysm resection or clipping before valve surgery. All 30 patients underwent valve surgery, and the median interval between ICH onset and surgery was 22.5 (95% CI 15.5-39.4) days. Four patients died of multiple organ dysfunction or heart failure. The interval between ICH onset and valve surgery was within 7 days for 5 cases, between 8 and 14 days for 6, between 15 and 28 days for 9 and >29 days for 10. Postoperative neuroimaging showed that neither neurological deterioration nor exacerbation of haemorrhagic lesions had occurred among the 30 patients, regardless of the timing of surgery. However, 2 cases who underwent valve surgery 8 and 81 days after the onset of ICH developed new ectopic asymptomatic haemorrhages postoperatively. The risk of postoperative neurological deterioration resulting from the exacerbation of haemorrhagic lesions seemed relatively low, even in IE patients who underwent valve surgery within 2 weeks of ICH onset. However, further evaluation of the sizes and aetiologies of haemorrhagic lesions is vital to establish a safe interval between the ICH onset and surgery.

Surgical management of a primary external iliac venous aneurysm causing pulmonary thromboembolism: report of a case

Primary iliac venous aneurysm is an extremely rare clinical entity. We report a case of primary external iliac venous aneurysm containing an intraluminal thrombus that caused pulmonary thromboembolism in a 22-year-old woman. The aneurysm and pulmonary emboli were detected during examination for sudden onset of dyspnea. After receiving anticoagulation and thrombolytic therapy, the patient underwent aneurysm resection. We devised venoplasty using a dual-row saphenous vein patch to cover the large defect of the vessel wall. Primary iliac venous aneurysms associated with pulmonary thromboembolism are uncommon and surgical repair is made difficult by the fragility of the affected vessel. We reviewed the clinical features of this unusual entity.

Percutaneous cardiopulmonary support in surgery for descending thoracic aortic aneurysms

There is uncertainty regarding the optimal method of intraoperative management of patients with aneurysm of the descending thoracic aorta. Although the percutaneous cardiopulmonary support (PCPS) was developed for use in patients with severe heart failure, it has been applied during the resection of descending thoracic aortic aneurysms in our department since 1993. The purpose of this study was to retrospectively compare conventional axillo-iliac temporary bypass to PCPS in patients undergoing repair of a thoracic aortic aneurysm. We retrospectively reviewed 18 consecutive patients with thoracic aortic aneurysms who underwent repair between January 1989 and March 1995. There were 10 patients who underwent aneurysm resection using axillo-iliac temporary bypass (Group I) and 8 who underwent resection using PCPS (Group II). The clamp time, bypass time, estimated blood loss and transfusion requirement did not differ significantly between the two groups. The operating and anesthesia times in Group II (390±91 minutes and 598.8±26.3 minutes, respectively) were significantly shorter than those in Group I (514±100 minutes and 821.5±32.5 minutes, respectively). The duration of postoperative intubation, intensive care unit (ICU) stay, and postoperative hospitalization were significantly shorter in Group II (1.6±0.9, 5.3±1.0, and 17.6±5.6 days, respectively) than in Group I (5.0±2.4, 2.8±0.3, and 24.3±4.8 days, respectively). Percutaneous cardiopulmonary support is a useful technique in surgery for thoracic aortic aneurysms. The advantages of this technique over conventional axillo-iliac temporary bypass are shortened operative time, duration of intubation, ICU stay, and postoperative hospitalization. In addition, it is easy to maintain the bypass flow using a centrifugal pump, and to maintain the body temperature using a heating exchanger.

Congenital-idiopathic superficial femoral artery aneurysm in a 7-year-old child

Superficial femoral artery aneurysm in children is distinctly uncommon, and usually results from infection, vasculitis, connective tissue disorder, or trauma. We report a 7-year-old girl who had multiple fusiform aneurysms of the right superficial femoral artery, with no evidence of related disorders. The patient successfully underwent aneurysm resection and femoral artery reconstruction with autogenous saphenous vein. Histologic examination revealed intimal thickening with fibroplasia without severe inflammatory infiltrates or cystic medial necrosis, suggesting a congenital-idiopathic arterial aneurysm. Three years after the procedure, the saphenous vein graft is fully patent and the patient is in good condition.

Congenital External Carotid Artery Aneurysm

An 8-month-old child presented with a right pulsatile neck mass. The tumor's rapid increase in size and respiratory problems prompted image evaluation. An external carotid artery aneurysm was found, which was compressing other neck structures. The patient underwent aneurysm resection and ligation at its insertion on the common carotid artery. Recovery was uneventful and no further aneurysms on other arteries were found.

Surgical Repair of Carotid Artery Aneurysms: A 10-Year, Single-Center Experience

The aim of this study was to evaluate the surgical management of carotid artery aneurysms (CAAs) presenting to a tertiary care center over a 10-year period of time. The medical records of patients undergoing repair of CAA between 1998 and 2008 were reviewed. Demographics, clinical presentation, and operative interventions were recorded. Postoperative outcomes were assessed, and patency and survival rates were calculated using life-table analysis. Two patients (11%) had a history of neck dissection, one (5%) neck irradiation, and three (16%) a combination of neck dissection and irradiation for cancer. Five (26%) had previous carotid endarterectomy, while three (16%) had prior carotid artery stenting for occlusive disease. Eight (42%) patients presented with neurologic symptoms, all transient in nature. Aneurysms were isolated to the internal carotid artery in eight (42%) cases, the common carotid artery in one (5%) case, and both regions in the remaining 53%. The etiologies of the aneurysms were divided among atherosclerotic aneurysms (36.8%), mycotic pseudoaneurysms (36.8%), and patch aneurysms (26.3%).Twelve (63%) underwent resection and interposition grafting, six underwent aneurysm resection and patch repair, and one (5%) had end-to-end reconstruction. Postoperative complications included one transient ischemic attach (5%), two strokes (10%), and one cranial nerve deficit (5%). Primary patency at 30 months was 90% (standard error [SE] = 0.10), and survival at 48 months was 92% (SE = 0.10). Assisted primary patency was maintained at 90% at 30 months (SE = 0.10). CAA surgery, while rare, can be performed safely and with durable patency. Future studies will be necessary to assess the efficacy of endovascular therapy for this disease.

Sinus of Valsalva Aneurysm

63-year-old man was in good health with well-controlled hypertension and dyslipidemia when he developed progressive dyspnea one day following an uncomplicated and unrevealing routine screening colonoscopy. Physical examination, electrocardiogram, and chest radiograph revealed hypotension, tachycardia, jugular venous distension, cardiomegaly, grade III/VI holosystolic murmur at the apex, and bilateral basilar pulmonary rales. Laboratory investigation disclosed mild troponemia, azotemia, elevated brain natriuretic peptide, and elevated acute-phase reactants. Echocardiography revealed an unruptured noncoronary sinus of Valsalva aneurysm (SVA) protruding into the left atrium, obstructing mitral outflow while also causing acute severe mitral regurgitation (Figure ​(Figure11). Figure 1 Preoperative echocardiogram: (a) two-dimensional apical four-chamber view, (b) same view with color flow. SVAs are exceedingly rare congenital or acquired degenerations of connective tissue from atherosclerosis, infection, or trauma resulting in dilations of one of three aortic sinuses: most commonly right, occasionally noncoronary, and rarely left. Unruptured SVAs are usually clinically silent and found incidentally during routine echocardiography. Occasionally, the physical presence of SVAs can precipitate arrhythmias, obstruct a coronary artery resulting in myocardial ischemia, or disrupt normal hemodynamics. Ruptured SVAs have a varied presentation, ultimately depending on the size, progression, and chamber into which rupture occurs. Surgical correction is indicated for ruptured SVAs and unruptured SVAs of large size and those with complications, including but not limited to altered hemodynamics or conduction abnormalities (1). Our patient presented with uncompensated New York Heart Association class III–IV heart failure and was medically stabilized. He then underwent aneurysm resection followed by valve-sparing patch repair of the aortic root along with mitral valve repair with an annuloplasty ring. The patient is currently symptom free 12 months postoperatively following uncomplicated surgical correction (Figure ​(Figure22). Figure 2 Postoperative echocardiogram: two-dimensional apical four-chamber view.

Extrahepatic Portal Vein Aneurysm—Report of Six Patients and Review of the Literature

Extrahepatic portal vein aneurysm is a rare condition. We report six patients with extrahepatic portal vein aneurysm, four of whom were surgically treated. In addition, a review of the literature was performed to examine natural history, management, and outcomes regarding portal vein aneurysm. Patients seen at our institution with extrahepatic portal vein aneurysm greater than 1.9 cm in diameter were reviewed (1998 to 2006). There were five females and one male; median age was 66.5 (30–77). Computed tomography (CT) scan was utilized for diagnosis in all cases. The median diameter of the aneurysm was 4.7 cm (2.7–6.0). Indications for surgery included gallstone pancreatitis, mass effect on the adjacent duodenum, a peripancreatic mass, and liver cirrhosis. Three patients underwent aneurysm resection, and one patient had an orthotropic liver transplant. Two patients were managed with observation. The median follow-up from first presentation and surgery was 50 months (9–181) and 5 months (2–73), respectively. At last follow-up, five patients were alive with radiologically proven portal vein patency. One patient died 2 months after liver transplantation. There was no case of aneurysmal rupture. One patient had intramural thrombus at presentation that resolved with conservative treatment. This report suggests that symptomatic aneurysms can be safely resected with excellent patency.

Arterial Infections in the New Millenium: An Old Problem Revisited

The natural history of infected aneurysms or arterial infections is characterized by rapid expansion leading to rupture, pseudoaneurysm formation, and sepsis. Treatment options include in situ grafting either with prosthetic or autogenous grafts or with cryopreserved allografts (CPAs), resection of the aneurysm with remote bypass grafting, and ligation. The purpose of this study was to review our recent experience with these infections and to present long-term follow-up with in situ CPAs. From January 2000 through June 2005, we treated nine patients with infected aneurysms and one patient with an infection without aneurysm formation. The infection involved the infrarenal abdominal aorta in six patients and the femoral artery in three patients. One patient had an infected splenic artery aneurysm. Aortic rupture occurred in five of the six patients with infected aortas. Two of the three patients with infected femoral aneurysms presented with recurrent hemorrhage. Of the six patients with aortic infections, five were treated with in situ CPAs. One patient was treated with aortic resection and axillofemoral grafting. Two patients with femoral aneurysms were treated with in situ CPAs, and the third patient underwent aneurysm resection and prosthetic grafting through the obturator foramen. The patient with the splenic aneurysm underwent combined valve replacement, aneurysm resection, and splenectomy. Three of the six patients with aortic infections died postoperatively, all of whom were septic at presentation. The cause of death in these three patients was multiple organ failure in two and overwhelming sepsis in one. The three survivors are alive and well with up to 5-year follow-up. The three patients with infected femoral aneurysms are alive and well with follow-up extending to 44 months. The patient with the splenic aneurysm is doing well. No recurrent infections have been noted among the survivors. The CPAs have remained structurally intact in all. The mortality rate among patients with abdominal aortic infections remains high and is likely related to their preoperative septic state. In situ grafting with CPAs appears to be a reasonable treatment option for arterial infections. CPAs appear to maintain their structural integrity and to be resistant to recurrent infection.

Management of Brachial Artery Pseudoaneurysms Secondary to Drug Abuse

Arterial pseudoaneurysm secondary to parenteral drug abuse poses a difficult problem to vascular surgeons. This study prospectively evaluates the outcome of surgical treatment for brachial artery pseudoaneurysms secondary to drug abuse. From February 1996 to July 2003, all brachial artery pseudoaneurysms secondary to drug abuse as diagnosed by duplex imaging were recruited for the study. Aneurysm excision, ligation, and radical debridement along with revascularization by axial reanastomosis were performed for all patients except one with chronic degenerative fusiform aneurysm, who received aneurysm resection and interposition reverse saphenous vein graft. Upper limb arterial flow was evaluated clinically and with hand-held Doppler in the perioperative period and during subsequent follow-up. During the study period, nine consecutive patients presented with cubital fossa swelling following deliberate drug arterial injections. Two of them suffered from thromboembolic complications and were managed conservatively by heparinization. Seven patients (six male, one female), aged 32-53, were confirmed to have brachial artery pseudoaneurysms by duplex scan and recruited for data analysis. Pseudoaneurysms ranged 10-40 mm in size. One ex-heroin abuser, who presented with median nerve palsy, underwent aneurysm resection and reversed saphenous vein interposition. The other six patients presented with painful pulsatile cubital fossa swellings. They underwent aneurysm resection, extensive debridement, and primary axial reanastomosis. There were no perioperative procedure-related complications. With an average follow-up of 38.7 months, no recurrences or neurovascular complications were detected. Routine revascularization by aneurysm resection and axial anastomosis for brachial artery pseudoaneurysm secondary to drug abuse is a safe, effective approach with low associated morbidity.

In situ reconstruction of septic aortic pseudoaneurysm due to Salmonella or Streptococcus microbial aortitis: long-term follow-up.

This study was undertaken to illustrate the safety of in situ reconstruction of septic aortic pseudoaneurysm (SAP) secondary to microbial aortitis, with or without long-term antibiotic treatment. Data for patients with SAP (11 abdominal, 4 thoracic) operated on between 1993 and 1999 were reviewed. Computed tomography and aortography showed septic pseudoaneurysm in all patients before surgery. After diagnosis of SAP, all patients underwent aneurysm resection and extensive debridement, with in situ prosthetic grafting or patch repair angioplasty. The graft in 10 of the 11 patients with abdominal SAP was also wrapped with an omental pedicle. In vitro active parenteral antibiotic therapy was prescribed for all patients for at least 2 to 8 weeks after surgery. All 15 patients had positive preoperative blood cultures or intraoperative tissue cultures for Salmonella spp (n = 12), viridans Streptococcus (n = 1), group G Streptococcus (n = 1), or Streptococcus pneumoniae (n = 1). There were two perioperative deaths (13.3%), one 6 days after surgery and the other 19 days after surgery, and two late deaths, at 8 and 10 months after surgery, neither of which was related to aortic repair. One patient was unavailable for follow-up. The other 10 patients have been regularly followed up with abdominal ultrasound or computed tomography (mean, 84 months; range, 47-118 months). To date, there has been no graft infection, thrombosis, false aneurysm, or subsequent aortic surgery in these 10 patients. SAP due to Salmonella and streptococcal microbial aortitis can be successfully treated with resection of the aneurysm and extensive debridement, followed by in situ prosthetic graft interposition or patch repair aortoplasty. This is a safe and effective treatment that may result in complete remission of SAP. Postoperative parenteral antibiotic therapy should be continued for 2 to 8 weeks. Although usually recommended, lifelong suppressive antibiotic therapy appears to be nonessential with this approach.

Management of Extracranial Carotid Artery Aneurysms:17 Years» Experience

Objectives:a retrospective review of seventeen-year (1980–1996) experience of the management of extracranial carotid artery aneurysms.Patients and methods:sixty-six aneurysms of extracranial carotid artery were seen in 63 patients. The diagnosis was confirmed by angiography in 51 patients and duplex ultrasonography in twelve. Twenty-eight (42%) patients had an atherosclerotic aneurysm, twenty-two (33%) had false aneurysms secondary to trauma, nine were congenital and seven were mycotic. All underwent aneurysm resection with saphenous-vein-graft interposition as the most common means of reconstruction.Results:one death occurred due to septicaemia in a diabetic patient with a mycotic aneurysm, giving an operative mortality of 1.5%. One patient had an immediate hemiparesis after carotid artery ligation, and three had a hemiparesis within 48 hours of operation (6.1%). After a change in technique to avoid a residual carotid stump, no further neurological problems were encountered in the following 28 patients.Conclusion:extracranial carotid aneurysms may be successfully managed with resection and reconstruction with autogenous saphenous vein. End-to-side anastomosis avoids a blind-ending stump which may be the source of emboli.

Operation for chronic traumatic aortic aneurysm: when and how?

Background. There are few guidelines for surgical intervention late after unoperated traumatic aortic rupture. We reviewed our experience and the literature to determine when and how to operate. Methods. Between 1987 and 1997, we treated 9 patients aged 22 to 82 years with chronic traumatic aneurysm. Seven patients underwent aneurysm resection. Two patients have not been operated on. The injury-to-operation interval ranged from 8 weeks to 18 years (mean, 4.1 years). One patient underwent median sternotomy and patch repair during hypothermic circulatory arrest. Six patients underwent left thoracotomy: 2 were operated on with left atrio–femoral bypass, and 4 with hypothermic circulatory arrest and ascending aortic cannulation. Results. There was no surgical mortality or morbidity. The 2 patients who were not operated on remained asymptomatic without radiologic change in the aneurysm after follow-up of 2 and 9 years. Conclusions. From this limited experience and literature review, we make the following subjective observations: (1) all patients with new symptoms should be operated on promptly, and (2) asymptomatic densely calcified aneurysms detected more than 2 years after the accident can be observed by repeated tomography unless new symptoms arise.

Percutaneous cardiopulmonary support in surgery for descending thoracic aortic aneurysms

There is uncertainty regarding the optimal method of intraoperative management of patients with aneurysm of the descending thoracic aorta. Although the percutaneous cardiopulmonary support (PCPS) was developed for use in patients with severe heart failure, it has been applied during the resection of descending thoracic aortic aneurysms in our department since 1993. The purpose of this study was to retrospectively compare conventional axillo-iliac temporary bypass to PCPS in patients undergoing repair of a thoracic aortic aneurysm. We retrospectively reviewed 18 consecutive patients with thoracic aortic aneurysms who underwent repair between January 1989 and March 1995. There were 10 patients who underwent aneurysm resection using axillo-iliac temporary bypass (Group I) and 8 who underwent resection using PCPS (Group II). The clamp time, bypass time, estimated blood loss and transfusion requirement did not differ significantly between the two groups. The operating and anesthesia times in Group II (390 ± 91 minutes and 598.8 ± 26.3 minutes, respectively) were significantly shorter than those in Group I (514 ± 100 minutes and 821.5 ± 32.5 minutes, respectively). The duration of postoperative intubation, intensive care unit (ICU) stay, and postoperative hospitalization were significantly shorter in Group II (1.6 ± 0.9, 5.3 ± 1.0, and 17.6 ± 5.6 days, respectively) than in Group I (5.0 ± 2.4, 2.8 ± 0.3, and 24.3 ± 4.8 days, respectively). Percutaneous cardiopulmonary support is a useful technique in surgery for thoracic aortic aneurysms. The advantages of this technique over conventional axillo-iliac temporary bypass are shortened operative time, duration of intubation, ICU stay, and postoperative hospitalization. In addition, it is easy to maintain the bypass flow using a centrifugal pump, and to maintain the body temperature using a heating exchanger.

Percutaneous Cardiopulmonary Support in Surgery for Descending Thoracic Aortic Aneurysms

There is uncertainty regarding the optimal method of intraoperative management of patients with aneurysm of the descending thoracic aorta. Although the percutaneous cardiopulmonary support (PCPS) was developed for use in patients with severe heart failure, it has been applied during the resection of descending thoracic aortic aneurysms in our department since 1993. The purpose of this study was to retrospectively compare conventional axillo-iliac temporary bypass to PCPS in patients undergoing repair of a thoracic aortic aneurysm. We retrospectively reviewed 18 consecutive patients with thoracic aortic aneurysms who underwent repair between January 1989 and March 1995. There were 10 patients who underwent aneurysm resection using axillo-iliac temporary bypass (Group I) and 8 who underwent resection using PCPS (Group II). The clamp time, bypass time, estimated blood loss and transfusion requirement did not differ significantly between the two groups. The operating and anesthesia times in Group II (390 ± 91 minutes and 598.8 ± 26.3 minutes, respectively) were significantly shorter than those in Group I (514 ± 100 minutes and 821.5 ± 32.5 minutes, respectively). The duration of postoperative intubation, intensive care unit (ICU) stay, and postoperative hospitalization were significantly shorter in Group II (1.6 ± 0.9, 5.3 ± 1.0, and 17.6 ± 5.6 days, respectively) than in Group I (5.0 ± 2.4, 2.8 ± 0.3, and 24.3 ± 4.8 days, respectively). Percutaneous cardiopulmonary support is a useful technique in surgery for thoracic aortic aneurysms. The advantages of this technique over conventional axillo-iliac temporary bypass are shortened operative time, duration of intubation, ICU stay, and postoperative hospitalization. In addition, it is easy to maintain the bypass flow using a centrifugal pump, and to maintain the body temperature using a heating exchanger.

Surgical treatment of left ventricular aneurysm — assessment of risk factors for early and late mortality

Consecutive patients operated on for left ventricular aneurysm from 1970 through August 1989 (n = 303) were evaluated with respect to survival. Early mortality, i.e. within 30 days, was 8.9%; 23% in patients who underwent aneurysm resection alone, 8.1% in cases of aneurysm resection with coronary artery bypass grafting (CABG), and 6.3% in those undergoing CABG only. Multivariate logistic regression revealed that advanced New York Heart Association (NYHA) functional class, non-use of the internal mammary artery as a graft and thromboendarterectomy increased the early risk. The total observed survival was 86% at 1 year, 72% at 5 years and 45% at 10 years. Multivariate analysis based on observed survival, using the Cox proportional hazards model, identified advanced NYHA functional class and non-use of the internal mammary artery as independent indicators of poor survival. Relative mortality, defined as the ratio of observed mortality in the study group to mortality among comparable persons from the general Swedish population, was used as a measure of disease-specific mortality. An apparent excess mortality in patients operated on for left ventricular aneurysm was found. A notable finding was that the use of the internal mammary artery to graft the left anterior descending artery improved the outcome substantially in patients with a left ventricular aneurysm.

Diagnosis and management of 17 consecutive patients with inflammatory abdominal aortic aneurysm

This report reviews the authors' experience in diagnosing and managing 17 consecutive patients with inflammatory abdominal aortic aneurysm (AAA). Among 491 patients undergoing repair for AAA during a 10-year period, 17 (3%) had evidence of associated periaortic fibrosis, which was confirmed histologically. No patient had acute rupture, and two patients (12%) had chronic contained rupture. Ureteral obstruction was evident in seven patients. In 41% of the patients, available surgical correlation demonstrated that computed tomographic (CT) scan accurately delineated the extent of the disease. Sixteen patients underwent aneurysm resection. Ureteral obstruction was relieved by ureterolysis in three patients treated early in this series. In the last period of the study, well-documented hydronephrosis spontaneously subsided in two patients without special treatment. Of these 17 patients, 15 (88%) were early (30-day) survivors. There were two late deaths at 2 months and 5 years; 12 (71%) patients are still alive and free of symptoms up to 10 years after operation. On the basis of our study, we conclude the following: (1) precise preoperative diagnosis and detailed anatomic information are widely available with CT; (2) aneurysm resection is the treatment of choice because the risk of rupture still exists, and this procedure seems to reverse the inflammatory process; (3) good early and late results can be expected with proper surgical technique; and (4) routine follow-up with CT is recommended to document resolution or progression of the fibrotic process after aneurysm resection.