A previously healthy 25-year-old man with no known risk factors was presented at the emergency room with a 3 h history of abdominal and loin pain.Physical examination and lab data showed no specific findings except te...A previously healthy 25-year-old man with no known risk factors was presented at the emergency room with a 3 h history of abdominal and loin pain.Physical examination and lab data showed no specific findings except tenderness,slight white cell count elevation and decreased haemoglobin level.The patient’s condition deteriorated over the following hours and he died despite resuscitation attempts.Autopsy revealed a 2.5-cm longitudinal tear in the intima of the right common iliac artery,which formed a thrombosed false lumen extending to the abdominal aorta proximally and to the left common iliac artery.Histopathologic examination revealed the characteristic changes of fibromuscular dysplasia(FMD).FMD involving the common iliac arteries is extremely rare;only six cases have been reported previously,and only two of those included forensic findings.The presented case is the first case of FMD with intimal tearing in the right common iliac artery,with propagation to the left common iliac artery and abdominal aorta.When a previously healthy young adult without hypertension or other risk factors presents with acute abdominal and loin pain,systemic vascular disease should be on the list of differential diagnoses.Careful and complete evaluation of multiple arteries can be critical.展开更多
BACKGROUND Surgical repair of complex abdominal aortic aneurysm is associated with a higher perioperative mortality and morbidity.The advent of endovascular aortic repair(EVAR)has reduced perioperative complications,a...BACKGROUND Surgical repair of complex abdominal aortic aneurysm is associated with a higher perioperative mortality and morbidity.The advent of endovascular aortic repair(EVAR)has reduced perioperative complications,although the utilization of such techniques is limited by lesion characteristics,such as involvement of the visceral or renal arteries(RA)and/or presence of a sealing zone.CASE SUMMARY A 60-year-old male presented with a Crawford type IV complex thoracoabdominal aortic aneurysm(CAAA)starting directly distal to the diaphragm extending to both common iliac arteries(CIAs).The CAAA consist of a proximal and distal aneurysmal sac separated by a 1 cm-healthy zone in the infrarenal level.Due to the poor performance of the patient and the expansive disease,we planned a stepwise-combined surgery and EVAR to minimize invasiveness.A branched graft was implanted after surgical debranching of the visceral and RA.Since the patient had renal and liver injury after surgery,the second stage EVAR was performed 10 mo later.The stent graft was implanted from the distal portion of surgical branched graft to both CIAs during EVAR.The patient has been uneventful for 5-years after discharge and is being followed in the outpatient clinic.CONCLUSION The current case demonstrates that the surgical graft can provide a landing zone for second stage EVAR to avoid aggressive surgery in patients with poor performance with a long hostile CAAA.展开更多
文摘A previously healthy 25-year-old man with no known risk factors was presented at the emergency room with a 3 h history of abdominal and loin pain.Physical examination and lab data showed no specific findings except tenderness,slight white cell count elevation and decreased haemoglobin level.The patient’s condition deteriorated over the following hours and he died despite resuscitation attempts.Autopsy revealed a 2.5-cm longitudinal tear in the intima of the right common iliac artery,which formed a thrombosed false lumen extending to the abdominal aorta proximally and to the left common iliac artery.Histopathologic examination revealed the characteristic changes of fibromuscular dysplasia(FMD).FMD involving the common iliac arteries is extremely rare;only six cases have been reported previously,and only two of those included forensic findings.The presented case is the first case of FMD with intimal tearing in the right common iliac artery,with propagation to the left common iliac artery and abdominal aorta.When a previously healthy young adult without hypertension or other risk factors presents with acute abdominal and loin pain,systemic vascular disease should be on the list of differential diagnoses.Careful and complete evaluation of multiple arteries can be critical.
文摘BACKGROUND Surgical repair of complex abdominal aortic aneurysm is associated with a higher perioperative mortality and morbidity.The advent of endovascular aortic repair(EVAR)has reduced perioperative complications,although the utilization of such techniques is limited by lesion characteristics,such as involvement of the visceral or renal arteries(RA)and/or presence of a sealing zone.CASE SUMMARY A 60-year-old male presented with a Crawford type IV complex thoracoabdominal aortic aneurysm(CAAA)starting directly distal to the diaphragm extending to both common iliac arteries(CIAs).The CAAA consist of a proximal and distal aneurysmal sac separated by a 1 cm-healthy zone in the infrarenal level.Due to the poor performance of the patient and the expansive disease,we planned a stepwise-combined surgery and EVAR to minimize invasiveness.A branched graft was implanted after surgical debranching of the visceral and RA.Since the patient had renal and liver injury after surgery,the second stage EVAR was performed 10 mo later.The stent graft was implanted from the distal portion of surgical branched graft to both CIAs during EVAR.The patient has been uneventful for 5-years after discharge and is being followed in the outpatient clinic.CONCLUSION The current case demonstrates that the surgical graft can provide a landing zone for second stage EVAR to avoid aggressive surgery in patients with poor performance with a long hostile CAAA.
