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Abstract
Tuberculous pseudoaneurysm of the aorta is a rare disease that is uniformly fatal if not treated properly. The authors present a case of a recurrent tuberculous false aneurysm of the descending thoracic aorta that was treated surgically with excision and primary repair of the lesion. To their knowledge, this is the first reported case of recurrent disease after a successful surgical treatment.
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MESH Headings
- Aged
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Aorta, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/surgery
- Aortography
- Blood Vessel Prosthesis Implantation
- Diagnosis, Differential
- Follow-Up Studies
- Humans
- Male
- Mycobacterium tuberculosis/isolation & purification
- Thoracotomy
- Tomography, X-Ray Computed
- Tuberculosis, Cardiovascular/diagnostic imaging
- Tuberculosis, Cardiovascular/microbiology
- Tuberculosis, Cardiovascular/surgery
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Affiliation(s)
- Mustafa Sirvanci
- Department of Radiology, University of Kadir Has, School of Medicine, Florence Nightingale Hospital, Istanbul, Turkey.
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2
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Ramasamy R, Yagan N, Schlegel P. Structural and Functional Changes to the Testis After Conventional Versus Microdissection Testicular Sperm Extraction. J Urol 2006. [DOI: 10.1016/s0022-5347(05)00117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- R. Ramasamy
- Department of Urology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, New York
| | - N. Yagan
- Department of Urology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, New York
| | - P.N. Schlegel
- Department of Urology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, New York
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3
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Demirsoy E, Unal M, Arbatli H, Yagan N, Tukenmez F, Sonmez B. Extra-anatomic coronary artery bypass graftings in patients with porcelain aorta. J Cardiovasc Surg (Torino) 2004; 45:111-5. [PMID: 15179344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
AIM Severely atherosclerotic (porcelain) ascending aorta is associated with increased morbidity and mortality during coronary artery bypass grafting (CABG) due to the increased risk of perioperative atheroembolism. Three maneuvers during CABG can cause atheromatous embolism from the diseased ascending aorta: 1) cannulation of the ascending aorta; 2) cross- clamping; 3) partial clamping for the construction of the proximal anastomosis. METHODS In our hospital, extra-anatomic CABG was performed in 8 patients with heavily calcified ascending aorta: 6 patients were men and 2 women. Operations were performed on the beating heart in 5 patients, 2 patients operated on beating heart and another patient on fibrillating heart with supportive cardiopulmonary bypass (CPB). Arterial cannulation was done through the right femoral artery on these patients. Apart from internal mammary artery (IMA) grafts, proximal anastomotic sites were the right axillary, right subclavian and innominate arteries. RESULTS One patient who preoperatively had dialysis dependent chronic renal failure, died as a result of dialysis complication on the 5th day. The postoperative course was uneventful in the other patients and no patient experienced either any cerebrovascular or visceral organ injury as a result of atheroemboli. CONCLUSION We think that extra-anatomic CABG procedures are safe and reliable in patients with severely atherosclerotic (porcelain) ascending aorta to minimize the prevalence of perioperative stroke and systemic embolization.
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Affiliation(s)
- E Demirsoy
- Department of Cardiovascular Surgery, Istanbul Memorial Hospital, Istanbul, Turkey. ,
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4
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Sönmez B, Arbatli H, Tansal S, Yagan N, Unal M, Demirsoy E, Tükenmez F, Yilmaz O. Real-time patency control with thermal coronary angiography in 1401 coronary artery bypass grafting patients. Eur J Cardiothorac Surg 2004; 24:961-6. [PMID: 14643815 DOI: 10.1016/s1010-7940(03)00519-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Intraoperative coronary angiography has always been favoured by cardiac surgeons. Thermal coronary angiography (TCA) is a useful method for intraoperative control of graft patency. It detects heat differences between tissues, provides easy-to-interpret angiographic images and even measures the flow of the grafts quantitatively. METHODS Between January 2000 and January 2002, TCA has been used in scheduled coronary bypass operations. Upon completion of each distal anastomosis, the perfusion of the distal arterial tree from the graft was evaluated with a thermal camera. RESULTS TCA was applied to 1401 patients, mean age 60.97+/-9.61 years, who underwent simple coronary artery bypass grafting (CABG) procedures. A total of 4105 thermal images were obtained including 2161 venous, 1355 single internal thoracic artery (ITA), 56 bilateral ITA and 477 radial artery grafts. Image quality was not sufficient in 34 grafts (1.57%) due to either deep intramyocardial vessels or excessive epicardial fat tissue. Technical failures in three ITA anastomoses were detected and revised before the cross-clamp was removed. Flow-restricting lesions distal to the anastomosis on the left anterior descending artery (LAD) in nine patients were managed with a secondary distal bypass graft (five patients) or plaque splitting and anastomotic revision (four patients). Endarterectomy was combined in seven patients since the graft flow and the distal visualization was not satisfactory, although the anastomoses were performed on a good lumen. Angiographically undetected diagonal arteries were revascularized in 11 patients with totally occluded LAD vessels. CONCLUSION Thermal imaging provides decisive coronary angiographies, and detects the perfusion area and flow of the implanted graft. It allows real-time detection of technical failures, reveals unexpected occluding plaques or any kind of flow-restricting lesions, and gives the chance of refinement of the anastomosis during the arrest period. We believe that the thermal imaging technique is a safe, noninvasive and feasible method to document the quality of the myocardial revascularization intraoperatively.
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Affiliation(s)
- Bingür Sönmez
- Department of Cardiovascular Surgery, Istanbul Memorial Hospital, Piyalepasa Bulvari, Okmeydani, 80270, Istanbul, Turkey
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Demirsoy E, Arbatli H, Unal M, Yagan N, Tukenmez F, Sonmez B. Atrial septal defect repair with minithoracotomy using two stage single venous cannula. J Cardiovasc Surg (Torino) 2004; 45:21-5. [PMID: 15041931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
AIM Repair of atrial septal defect (ASD) via minimal access has been the preferred method to improve cosmesis and fast rehabilitation. A 2-stage single venous cannula introduced via the femoral route allows better vision of the surgical field and improves surgical acts through a limited incision. METHODS From February 1999 to December 2001 a minithoracotomy approach was used for closure of secundum type ASD by using single bicaval venous cannula in 17 adult patients. A 6 to 7 cm anterior minithoracotomy (submammary) approach with femoral arterial and 2-stage single venous cannula were utilized. Defects were closed primarily by running suture in 14 and with a patch in 3 patients. RESULTS Calculated flow levels were maintained with a single venous cannula without assisted venous drainage in all patients. The postoperative course was uneventful in all patients except 1 who required revision for bleeding which was done through the same incision. Extension of the thoracotomy or shifting to the classic sternotomy was never required. CONCLUSION Single venous bicaval cannula allows efficient drainage of both vena cavae and improves the surgical vision and manipulation through the right minithoracotomy. With this technique, repair of ASD can be done safely with good cosmesis.
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Affiliation(s)
- E Demirsoy
- Department of Cardiovascular Surgery, Istanbul Memorial Hospital, Istanbul, Turkey.
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6
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Demirsoy E, Arbatli H, Korkut AK, Yagan N, Sönmez B. A new technique for abdominal heart transplantation in rats. J Cardiovasc Surg (Torino) 2003; 44:747-50. [PMID: 14735039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Experimental studies in animals play a major role in the progress of medicine. Different surgical techniques have been described for heterotopic heart transplantation in rats. In this study we introduce a new technique for heart transplantation in the abdominal cavity of rats. Fifteen Sprague Dawley rats have been used as recipients and 15 others as donors. Following preparation of recipient abdominal aorta and left renal vein, the donor heart including proximal arcus aorta was harvested. Donor aorta was anastomosed to the recipient's aorta; donor pulmonary artery was anastomosed to the left renal vein of the recipient using continuous suture technique. Graft function was evaluated daily by palpation of the rat abdomen. The mean operating time was 38.46+/-2.66 min and the mean ischemia time was 23.93+/-2.11 min. One death was seen because of bleeding of the aorto-aortic anastomosis. In this study we evaluated advantages and disadvantages of our technique and compared it to other techniques. This modification provides a more anatomical position, reduces exploration time, has a low incidence of morbidity and mortality. We conclude that, this implantation technique is more suitable for heterotopic heart transplantation in rats.
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Affiliation(s)
- E Demirsoy
- Department of Cardiovascular Surgery, Kadir Has University, Florence Nightingale Hospital, Istanbul, Turkey.
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Arbatli H, Demirsoy E, Aytekin S, Rizaoglu E, Unal M, Yagan N, Sonmez B. The role of posterior pericardiotomy on the incidence of atrial fibrillation after coronary revascularization. J Cardiovasc Surg (Torino) 2003; 44:713-7. [PMID: 14735032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
AIM Pericardial effusion and atrial fibrillation (AF) are two common complications in coronary revascularization surgery. The aim of this study was to evaluate the efficiency of posterior pericardiotomy in pericardial effusion and AF. METHODS This randomized prospective study includes 113 patients who underwent isolated CABG procedure between May 2000 and December 2000 in our hospital. Posterior pericardiotomy incision was done in Group I (n=54). Group II constituted the control group (n=59). Postoperative pericardial effusion was assessed by echocardiography and rhythm follow-up was done by the same cardiologist. RESULTS There was no significant difference between study group and the control group considering the chest drainage (940.18+/-367.96 vs 894.92+/-360.65; p=0.507). The number of patients with remarkable intrapericardial effusion (>50 ml) was significantly lower in the posterior pericardiotomy group (25.93% vs 47.45%, p=0.020). The incidence of postoperative AF was no different between the posterior pericardiotomy group and the control group (12.96% vs 20.34%; p=0.32). In both groups, the incidence of AF was significantly higher in patients with mild or moderate pericardial effusion (29%), compared to patients with no or minimal pericardial effusion (10%), (p=0.017). CONCLUSION Posterior pericardiotomy significantly reduces the pericardial effusion in coronary bypass procedure postoperatively. Patients with pericardial effusion were subjected to AF more frequently.
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Affiliation(s)
- H Arbatli
- Department of Cardiovascular Surgery, Kadir Has University, Florence Nightingale Hospital, Istanbul, Turkey.
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8
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Sonmez B, Demirsoy E, Yagan N, Unal M, Arbatli H, Sener D, Baran T, Ilkova F. A fatal complication due to radiofrequency ablation for atrial fibrillation: atrio-esophageal fistula. Ann Thorac Surg 2003; 76:281-3. [PMID: 12842562 DOI: 10.1016/s0003-4975(03)00006-7] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Treatment of chronic atrial fibrillation with intraoperative radiofrequency ablation is gaining more acceptance in patients with rheumatic valve disease. This article reports a case of fatal atrio-esophageal fistula after radiofrequency ablation in a patient with rheumatic mitral and aortic valve disease with chronic atrial fibrillation.
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Affiliation(s)
- Bingur Sonmez
- Departments of Cardiovascular Surgery, Istanbul Memorial Hospital, Istanbul, Turkey
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Bedirhan MA, Turna A, Yagan N, Taşçi O. Aprotinin reduces postoperative bleeding and the need for blood products in thoracic surgery: results of a randomized double-blind study. Eur J Cardiothorac Surg 2001; 20:1122-7. [PMID: 11717015 DOI: 10.1016/s1010-7940(01)01016-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Bleeding complications have been a major concern in certain thoracic surgery operations, especially decortication and pulmonary resection for inflammatory pulmonary infection. Prevention of plasminogen activation and fibrinolysis by aprotinin administration has been shown to reduce perioperative bleeding during operations associated with high blood consumption. METHODS Use of blood products (packed red cells, whole blood), chest tube drainage, analgesic requirement, chest tube duration for the patients undergoing major thoracic operations were recorded. In a double blind randomized fashion, patients were assigned to two groups receiving aprotinin (n=51) at a loading dose of 10(6) kallikrein inhibitory units (KIU) followed by an infusion of the same dose during chest closure or receiving placebo (n=52). On a daily basis, red-cell percentages of total fluid from drainage bottles were recorded and using the blood hematocrit level of the patient of the day before, the corrected value for the patient's blood volume equivalent of daily drainage was calculated. RESULTS There was a significant reduction in perioperative use of donor blood (0.98+/-0.92 vs. 0.45+/-0.32 unit; P=0.0026), and total chest tube drainage (corrected value for the corresponding blood volume) (28.2+/-36.9 vs. 76.9+/-53.3 ml, P=0.0004) (mean+/-standard deviation) in the aprotinin group. However, aprotinin did not reduce postoperative transfusion or decrease in hematocrit level due to thoracic operations. In high transfusion-risk thoracic surgery patients (patients who underwent decortication, pulmonary resection for inflammatory lung disease and chest wall resection), the perioperative transfusion was only 0.50+/-1.08 units in aprotinin group, compared with 1.94+/-0.52 units in control group (P=0.003). Postoperative transfusion was also reduced in aprotinin administrated group (0.53+/-0.56 vs. 1.38+/-0.97 units; P=0.02). The mean total blood loss was decreased to nearly one third of the blood loss of the control group (41+/-28 ml vs. 121+/-68 ml; P=0.001). CONCLUSION Aprotinin significantly reduced perioperative transfusion requirement and postoperative bleeding during major thoracic operations. Aprotinin decreased perioperative transfusion needs. Moreover, patients who were at risk of greater blood loss during and after certain thoracic operations had a greater potential to benefit from prophylactic perioperative aprotinin treatment.
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Affiliation(s)
- M A Bedirhan
- Yedikule Hospital for Chest Disease and Thoracic Surgery, Department of Thoracic Surgery, Zeytinburnu, Istanbul, Turkey
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Sonmez B, Tansal S, Unal M, Korkut A, Yagan N, Demirsoy E, Arbatli H, Aytekin V. A left pulmonary artery aneurysm secondary to pulmonary hypertension. J Cardiovasc Surg (Torino) 2001; 42:629-32. [PMID: 11562589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
We report a case of pulmonary trunk aneurysm extending into the left pulmonary artery, due to pulmonary hypertension secondary to mitral valve disease. The mitral valve was replaced with a bileaflet mechanical prosthesis. A Dacron graft interposed between main trunk and left pulmonary artery branch, and right pulmonary branch attached to the graft in an end-to-side fashion. Early postoperative angiogram revealed a very successful treatment.
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Affiliation(s)
- B Sonmez
- Department of Thoracic and Cardiovascular Surgery, Kadir Has University, Medical Faculty, Florence Nightingale Hospital, Istanbul 80320, Turkey.
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11
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Abstract
PURPOSE To determine the ultrasonographic (US) abnormalities that may be encountered after testicular biopsy. MATERIALS AND METHODS Testicular US studies in 33 patients (64 testes) who had undergone unilateral or bilateral testicular biopsy were retrospectively reviewed for evidence of postbiopsy changes. Biopsy had been performed in 55 testes. RESULTS US abnormalities were found in 49 (89%) of 55 testes. These abnormalities included focal, hypoechoic, round lesions in five (9%) testes; focal hypoechoic lesions with linear margins in 27 (49%); ill-defined, localized, hypoechoic areas in four (7%); peritesticular echogenic foci in 40 (73%); linear hypoechoic striations in five (9%); and focal contour defects in three (5%). CONCLUSION A range of US findings are encountered after testicular biopsy. The US appearance of a round hypoechoic lesion seen after biopsy can overlap with that of testicular malignancy. Other findings, such as hypoechoic lesion with linear margins, peritesticular echogenic foci, linear hypoechoic striations, and testicular contour defect, can be regarded as the benign sequelae of biopsy. In a patient with a focal, nonpalpable, hypoechoic, intratesticular lesion, a history of testicular biopsy should remind the radiologist of the increased likelihood of a benign change after biopsy, in which case follow-up US may be performed.
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Affiliation(s)
- N Yagan
- Department of Radiology, New York Presbyterian Hospital-Cornell Medical Center, New York, NY 10021, USA.
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Abstract
PURPOSE To determine the computed tomographic (CT) findings that are indicative of bowel disease in patients with cystic fibrosis. MATERIALS AND METHODS CT scans in patients with cystic fibrosis were retrospectively reviewed for evidence of colonic abnormalities, including wall thickening, mural striation, fatty proliferation of the mesentery, and soft-tissue infiltration of pericolonic fat. RESULTS Ten patients with colonic abnormalities on CT scans (case patients) and 16 patients with normal CT results (cohort patients) were identified. Colonic abnormalities in case patients included wall thickening (mean thickness, 6.4 mm) and mesenteric infiltration in all, increased pericolonic fat in six, and mural striation in five. The right colon was involved in all case patients; contiguous extension involved the transverse colon in five, the descending colon in two, and all segments in one. Wall thickness in cohort patients was less than 2 mm. Eight case patients had abdominal pain; one had bloody diarrhea. Histopathologic examination results included nonspecific mucosal inflammation in four case patients, wall edema in one, and no abnormality in one. No patient had identifiable infectious colitis, colonic stricture, bowel obstruction, fibrosis, or Crohn disease. Mean dose of pancreatic enzyme replacement was similar in both groups. CONCLUSION Proximal colonic wall thickening without stricture, pericolonic fat proliferation, and mesenteric infiltration are CT findings of colonic disease associated with cystic fibrosis.
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Affiliation(s)
- P J Pickhardt
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
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Abstract
PURPOSE To determine the potential risk of aspiration pneumonitis associated with use of oral contrast material in computed tomography (CT) performed for evaluation of abdominal trauma. MATERIALS AND METHODS In 510 consecutive adult patients, a dilute 2.5% solution of diatrizoate meglumine and sodium was administered orally or by means of a nasogastric tube as part of a routine protocol for CT evaluation of acute abdominal trauma. A retrospective review of medical records was performed to determine evidence of aspiration pneumonitis occurring before or after CT. RESULTS None of the patients had aspiration of contrast material or gastric contents attributable to the CT examination. CONCLUSION Use of contrast material for stomach and bowel opacification during CT for evaluation of abdominal trauma appears to be safe. Proper preparation and administration of contrast material and control of the patient's airway are essential to ensure the safety of this procedure.
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Affiliation(s)
- M P Federle
- Department of Radiology, University of Pittsburgh Medical Center, PA 15213, USA
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14
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Affiliation(s)
- J J Brown
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
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Sonmez B, Kargi A, Yagan N, Onursal E, Cesmeci S, Barlas C. Ruptured abdominal aortic aneurysm with fistula into the right iliac vein. J Cardiovasc Surg (Torino) 1988; 29:486-7. [PMID: 3047137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Arteriovenous fistula between major abdominal vessels is an unusual complication of ruptured abdominal aortic aneurysm. It most frequently occurs between the aorta and the inferior vena cava, however, it is rare when occurring between the aorta and iliac veins. A case of an arteriovenous fistula (AVF), secondary to erosion of an arteriosclerotic abdominal aortic aneurysm into both the retroperitoneum and the iliac vein is presented. The literature is reviewed and the symptoms and the treatment are discussed.
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Affiliation(s)
- B Sonmez
- Department of Thoracic and Cardiovascular Surgery, Istanbul University, Faculty of Medicine, Turkey
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