Ascending aorta graft pseudoaneurysm and aortobronchial fistula caused by a fractured sternal wire: a case report

Background Pseudoaneurysm of ascending aorta is a rare but serious complication of cardiovascular surgeries and it infrequently occurs in the normal prosthetic graft materials. We share our experience with an unusual case of ascending aorta Dacron graft pseudoaneurysm caused by a fractured sternal wire. Case presentation A 34-year-old man, known case of Marfan syndrome, with history of two prior aortic surgeries for aneurysm of ascending aorta, arch and thoracoabdominal aorta, presented with hemoptysis. The hemoptysis originated from an aortobronchial fistula secondary to a huge ascending aorta Dacron graft pseudoaneurysm. The graft erosion and subsequent pseudoaneurysm was caused by a fractured sternal wire. Surgical repair of the pseudoaneurysm was performed successfully and a Gore-tex patch was placed behind the sternum over the graft to prevent further direct contact of the wire and the graft. Conclusion Sternal wires can damage the adjacent vascular grafts and lead to fatal complications such as pseudoaneurysm formation. Thus, preventive measures such as using sternal bands and placing a covering layer between the sternal wires and aortic grafts are recommended in patients with dilated or replaced ascending aorta.

Right cervical aortic arch with aneurysm and stenotic tract of left descending aorta and aberrant left subclavian artery: case report of a 13-years-old patient

Background: Cervical aortic arch (CAA) is a rare anomaly that could be associated with aortic stenosis, aneurysm or heart malformations. To correct this anomaly, symptomatic patients undergo surgery, usually consisting of a prosthetic graft repair. Moreover, circulatory arrest and deep hypothermia are often needed. Case presentation: A 13-years-old patient underwent correction of an aortic arch stenosis with a post-stenotic aneurysm between the origin of the right carotid artery (RCA) and right subclavian artery (RSA) in a right CAA. A resection with direct end-to-end anastomosis was performed, with mild hypothermic cardiopulmonary by-pass. Conclusions: Surgical correction of cervical aortic arch anomalies without the use of prosthetic grafts and circulatory arrest may be a safe alternative approach, especially in the pediatric population.

Custom-Made Bifurcated Prosthetic Graft for Aortoiliac Aneurysm Repair

Revascularization of the internal iliac artery during open repair of aortoiliac aneurysms can be challenging, especially if there is a significant distance between the orifices of the internal and external iliac arteries owing to common iliac aneurysmal dilatation. We describe a technique involving insertion of an 18-mm tube graft between the proximal aortic neck and aneurysmal common iliac artery bifurcation. Revascularization of the contralateral external iliac artery is accomplished through an 8-mm side arm graft.

Expanding Perigraft Seroma after A scending Aorta Replacement

BackgroundPerigraft seroma is a persistent and sterile fluid confined within a fibrous pseudomembrane surrounding a graft that develops after graft replacement. Development of perigraft seroma is an uncommon complication that occurs after the surgical repair of the thoracic aorta using woven polyester grafts. mechanism underlying perigraft seroma formation remains unclear.Case presentationHerein, we describe the case of 77-year-old man who underwent repeat sternotomy for the treatment of large perigraft seroma 1 year after ascending aorta replacement for acute type A dissection. After removing a cloudy yellow fluid, we covered the prosthetic graft with fibrin glue and wrapped it with a new graft. Bacterial culture and laboratory examination of the fluid confirmed the final diagnosis of perigraft seroma, and there was no evidence of recurrence. The area in which fluid accumulated around the graft shrunk 1 year after surgery.ConclusionsThe cause of a expanding perigraft after repair of the thoracic aorta remains unknown. Physicians should be aware that chronic expanding mediastinal seroma with Dacron grafts is one of the rare postoperative complications of thoracic aortic surgery. Applying fibrin glue to the graft surface might effectively prevent the recurrence of perigraft seroma.

Case Report: Duodenoscopy diagnosis of a secondary aorto-duodenal fistula: A case report and review of literature.

Secondary aorto-enteric fistula (SAEF) is a rare life-threatening complication occurring in patients with previous infrarenal aortic prosthetic reconstruction. The main symptom is a gastrointestinal bleeding. Its diagnosis is challenging due to the lack of a specific clinical signs. The failure of early diagnosis and treatment of this entity can lead to fatal issue. Actually, the abdominal computed tomography angiogram represents the principal exploration to confirm the diagnosis, but it is associated with a moderate specificity and sensibility. Duodenoscopy can highlight the communication between the duodenum and the prosthetic graft, but it is often inconclusive. We report in this manuscript a case of secondary aorto-enteric fistula revealed by occult gastrointestinal bleeding in an elderly patient who is admitted for severe anemia. The SAEF diagnosis was suspected by the computed tomography scan and confirmed by the duodenoscopy showing an exceptional image of Dacron graft protruding in the third duodenum lumen. Unfortunately, the patient died from cataclysmic shock before intervention. We overview also the rare previous published case reports concerning the endoscopic images of secondary aortoenteric fistula and we contrast our findings with those reported in the literature.

The role of the pedicle omental flap in ruptured abdominal aortic aneurysm: a case report and literature review

A ruptured infrarenal abdominal aortic aneurysm (rAAA) is associated with an in-hospital mortality rate of 40% and an overall mortality rate of 60–80%. Open surgical repair for rAAA remains the principal method of treatment when endovascular repair is not available. Graft infection occurs in 1–4% of patients at 5 years, with a high incidence following emergency treatment. Other graft-related complications include pseudoaneurysm, graft occlusion and aorto-enteric fistula. This case report describes a 66-year-old male patient that was admitted to hospital complaining of intense abdominal pain, low blood pressure and tachycardia. He was diagnosed with a rAAA and treated using segmental resection of the abdominal aorta followed by reconstruction with a synthetic Dacron prosthesis. A pedicle omental flap was wrapped around the prosthetic graft and it was also used to fill the retroperitoneal cavity in order to reduce the risk of graft-related complications. Computed tomography angiography after 6 months showed good integration of the aortic prosthetic graft and the viability of the omental flap. In our opinion, vascular surgeons should consider the pedicle omental flap when they perform open surgical repair for rAAA in order to reduce the incidence of graft-related complications.

USG GUIDED FEMORAL & LATERAL CUTANEOUS NERVE BLOCK AS SAVIOUR- ANAESTHETIC MANAGEMENT OF PATIENT OF CKD-ESRD WITH DIFFICULT AIRWAY & COAGULOPATHY POSTED FOR NOVEL PROSTHETIC FEMORO-FEMORAL AV FISTULA.

Anaesthetic management for creation of a novel prosthetic femoro-femoral arteriovenous stula (AV) in 65 years old male patient k/c/o hypertension with CKD (Stage V, [ESRD] haemodialysis dependent for last 1.5 years with difcult airway and deranged coagulation prole. AV stula was initially created in upper limb which blocked 6 weeks back. Subsequently dialysis was done by dialysis catheter as temporary method and femoro-femoral AV stula creation using prosthetic graft was planned due to its early maturation time (7 days). Central neuraxial blocks were contraindicated because of deranged coagulation prole. Patient is also high risk for GA i/v/o ESRD and difcult airway. Therefore we planned for RA in the form of USG guided Femoral Nerve Block and Lateral Cutaneous Nerve (LCN) of thigh block. Femoral Nerve Block (FNB) and Lateral Cutaneous Nerve block (LCN) was performed under ultrasound guidance in real time using 20 and 10ml of 0.25% Bupivacaine respectively. After establishing block effect, surgery was performed solely under block with stable perioperative course.