Endovascular infrarenal aortic aneurysm repair combined with laparoscopic cholecystectomy

Management of Abdominal Aortic Aneurysm With Concomitant Acute Cholecystitis in the Era of Endovascular Surgery

The incidence of symptomatic acute cholecystitis with large (greater than 5.5 cm) abdominal aortic aneurysm is an uncommon occurrence. Guidelines on concomitant repair in this setting remain elusive, particularly in the era of endovascular repair. We present a case of acute cholecystitis in a 79-year-old female presenting to a local rural emergency room with abdominal pain and known abdominal aortic aneurysm (AAA). Abdominal computed tomography (CT) revealed a 5.5 cm infrarenal abdominal aortic aneurysm, significantly greater in size compared to previous imaging, as well as a distended gallbladder with mild wall thickening and cholelithiasis concerning for acute cholecystitis. The two conditions were found to be unrelated to each other, but concerns were raised on appropriate timing of care. Following diagnosis, the patient underwent concomitant treatment of acute cholecystitis and large abdominal aortic aneurysm with laparoscopic and endovascular techniques, respectively. In this report, we take the opportunity to discuss the treatment of patients with AAA and concomitant symptomatic acute cholecystitis.

One-step Endovascular Aortic Aneurysm Repair With CO2 contrast and Robotic Partial Nephrectomy for Renal Cell Carcinoma: Case Report

INTRODUCTION

Although rare, as the population ages, abdominal aortic aneurysm synchronous to abdominal malignancies, as renal cell carcinoma, is expected to become more prevalent. There are only two case reports of minimally invasive surgeries to treat these synchronous diseases, with endovascular aortic repair and laparoscopic nephrectomy, but they were performed in two stages, with iodinated contrast and without robotic assistance.

CASE REPORT

We herein present a case of a 71-year-old patient with chronic kidney disease, a 6.4 cm infra-renal abdominal aortic aneurysm associated and a suspicious 6 cm solid-cystic expansile lesion in the right kidney, successfully treated at one stage with endovascular aortic repair using carbon dioxide as a contrast medium and with robotic right partial nephrectomy, aiming to preserve the renal function as much as possible. The patient's postoperative course was free of complications with hospital discharge on the fifth postoperative day, with a serum creatinine of 0.84 mg/dL.

CONCLUSION

single-stage minimally invasive surgical treatment of AAA and RCC can be a safe and feasible approach. Combining a robot-assisted laparoscopic partial nephrectomy with an EVAR using carbon dioxide as a contrast medium was safe and successfully preserved renal function.

Simultaneous Laparoscopic Cholecystectomy and Endovascular Infrarenal Aortic Aneurysm Repair

Background/Aim: With the increasing use of endovascular aneurysm repair (EVAR) and the availability of laparoscopic cholecystectomy (LC) for treating abdominal aortic aneurysms (AAA) and cholelithiasis, respectively, the association between these elective treatments is not yet well-defined. Thus, this study aimed to evaluate the results of elective and simultaneous EVAR and LC.

Methods: Thirteen patients (mean age, 72 years) with concomitant large and asymptomatic AAA and asymptomatic cholelithiasis underwent simultaneous EVAR and LC.

Results: Post-operative mortality was absent, and the morbidity rate was 7%. The mean total duration of the procedure was 142 min. The mean duration of fluoroscopy was 19 min, and the mean radiation dose was 65 mGy. The mean amount of iodinated contrast injected was 49 mL. The timing of oral fluid intake was 28 h (range, 24–48 h) and that of the oral low-fat diet was 53 h (range, 48–72 h). No patient presented with an aortic graft infection during the entire follow-up period (mean duration, 41 months). The mean length of post-operative hospital stay was 6 days (range, 5–8 days). Late survival was 85%, and the exclusion of AAA was 100%.

Conclusion: Simultaneous EVAR and LC can be performed safely, allowing effective and durable treatment under both AAA and cholelithiasis conditions.

Clinical evaluation of covered stents in the treatment of superficial femoral artery pseudoaneurysm in drug abusers

The present study aimed to investigate the technical feasibility and initial clinical outcomes of a covered stent for the endovascular treatment of superficial femoral artery (SFA) pseudoaneurysm in drug abusers. A total of 29 drug abuse patients with SFA pseudoaneurysm, as confirmed by color Doppler sonography, were enrolled to the present study between January 2012 and May 2014. All patients were treated percutaneously by implantation of a covered stent. Physical examination and lower extremity computed tomography angiography were performed at 1 and 9 months postoperation. Furthermore, the ankle-brachial index (ABI) of all patients was measured. The results indicated that placement of the covered stent was technically successful in all 29 patients. All of the ruptured pseudoaneurysms were successfully sealed with no cases of intraprocedural mortality. In addition, all patients' conditions improved rapidly; active hemorrhage subsidence and vascular bruit disappearance were immediately detected following implantation of the covered stent. During the follow-up period, pain was markedly alleviated and pulsatile mass was decreased as time increased. No complaints or complications were documented. A total of 9 months postoperation, pain and pulsatile mass were not detected. The patency rate of the stent was 100%, and no migration, occlusion or infection was detected. In addition, the ABI was significantly improved, from 0.52±0.09 to 0.97±0.37 (P<0.01). In conclusion, the placement of a covered stent may be considered a promising approach to provide an effective, safe and minimally invasive option for the treatment of SFA pseudoaneurysm in drug abusers.

Characteristics and treatment of vascular injuries: a review of 387 cases at a Chinese center

OBJECTIVE

To assess clinical characteristics and treatment outcomes of patients with vascular injuries.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of 378 consecutive patients with vascular injuries treated at our hospital from January 2000 to December 2012. Basic characteristics (such as gender; age; cause, site, and type of injury; and concomitant injuries) were recorded, and efficacy was compared between treatments for same type/site injuries.

RESULTS

Vascular injuries occurred most frequently in patients aged 19-50 years, secondary to trauma, and in extremities (73%, 63%, and 84% of cases, respectively), particularly lower ones. Amputation was more common in popliteal artery injury (52.6% of cases); overall, inappropriate diagnosis or treatment or poor vascular anastomosis led to amputation in 17 cases. Extremity vascular patency, while comparable at 12 months, was significantly lower at 24 months after artificial blood-vessel implantation than autogenous vein grafting. Treatment of femoral artery pseudoaneurysm secondary to drug abuse yielded similar amputation but significantly lower limb ischemia rates after bypass graft surgery than arterial ligation.

CONCLUSION

Initial and temporal outcome differentiation reported here for treatments for peripheral vascular injuries according to type and site underscores the importance of further defining treatment choice consequences, particularly long term ones because most affected patients are aged 19-50 years old.

Abdominal aortic aneurysm with symptomatic cholelithiasis: report of a case treated by simultaneous endovascular aneurysm repair and laparoscopic cholecystectomy

Asymptomatic cholelithiasis with abdominal aortic aneurysm (AAA) is one of few ideal fields for simultaneous "open" repair. In AAA cases with acute lithiasic cholecystitis, the simultaneous open repair is debatable due to increased possibility for prosthetic graft contamination. We report a case of a 78-year-old, ASA IV patient suffering from acute cholecystitis and concomitant (62 mm) AAA. The patient was treated by simultaneous endovascular AAA repair with a bifurcated prosthesis Endurant and laparoscopic cholecystectomy. Operative time was 165 minutes with total blood loss <100 mL. The patient fed and mobilized the second postoperative day, and the course until patients' discharge the sixth day was uneventful. Follow-up imaging at first month confirmed the successful aneurysm's exclusion without endoleak or migration. The simultaneous endovascular AAA repair and laparoscopic cholecystectomy seems to be simple, safe, and effective technique and minimized the possibility of local and systemic postoperative complications.