Urgent Endovascular Treatment of Thoraco-abdominal Aneurysms Using a Sandwich Technique and Chimney Grafts - A Technical Description

Introduction: So far the only endovascular option to treat patients with thoraco abdominal aortic aneurysms is the deployment of branched grafts. We describe a technique consisting of the deployment of standard off-the- shelf grafts to treat urgent cases.Material and Methods: The sandwich technique consists of the deployment of ViaBahn chimney grafts in combination with standard thoracic and abdominal aortic stent grafts. The chimney grafts are deployed using a transbrachial and transaxillary access. These coaxial grafts are placed inside the thoracic tube graft. After deployment of the infrarenal bifurcated abdominal graft a bridging stent-a short tube graft is positioned inside the thoracic graft further stabilizing the chimney grafts.Results: 5 patients with symptomatic thoraco abdominal aneurysms were treated. There was one Type I endoleak that resolved after 2 months. In all patients 3 stentgrafts had to be used When possible all visceral and renal branches were revascularized. A total number of 17 arteries were reconnected with covered branches. During follow up we lost one target vessel the right renal artery.Conclusion: The sandwich technique in combination with chimney grafts permits a total endovascular exclusion of thoraco abdominal aortic aneurysms. In all cases off-the shelf products and grafts could be used. The number of patients treated so far is still too small to draw further more robust conclusions with regard to long term performance and durability. (C) 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Aneurysm of the Superior Labial Artery

This is a case report of a true and dissecting aneurysm of the superior labial artery in a 51-year-old patient without risk factors for vascular pathology. The patient complained of swelling of the upper lip, mostly on the left side. A Doppler ultrasonography was used in the diagnosis. The definitive treatment was surgical resection, and the histopathological analysis confirmed the diagnosis. The progress of the patient was satisfactory, leaving a slight change in sensitivity in the area. This seems to be the first reported case of true and dissecting aneurysm of the superior labial artery in the medical literature.

Total Endovascular Debranching of the Aortic Arch

Background: Significant morbidity and mortality are related to conventional aortic replacement surgery. Endovascular debranching techniques, fenestrated or branched endografts are time consuming and costly.Objective: We alternatively propose to use endovascular approach with parallel grafts for debranching of aortic arch.Methods: Under general anesthesia, 12 F sheaths were inserted in the femoral, axillary and common carotid arteries for vascular accesses. ViaBahn grafts 10 - 15 cm in length were placed into the aortic arch from right common carotid, left common carotid and left axillary arteries, until the tip of each graft reached into the ascending aorta. Through one femoral artery, the aortic stent-graft was positioned and delivered. Soon after, the parallel grafts were sequentially delivered. Self-spanding Wallstents(R) were used for parallel grafts reinforcement. Ballooning was routinely used for parallel grafts and rarely for aortic graft.Results: This technique was used in 2 cases. The first one was a lady with 72 years old, with an aortic retrograde dissection from left subclavian artery and involving remaining arch branches. Through right common carotid artery a stent-graft was placed in the ascending aorta and through the left common carotid artery a ViaBahn was inserted parallel to the former. A thoracic endograft then covered all the aortic arch dissection extending into the ascending aorta close to the sinu-tubular junction. The second case was a 82 year old male patient with a 7 cm aortic arch aneurysm. Through both common carotid arteries ViaBahn grafts were introduced and positioned into the ascending aorta. Soon after, the deployment of the thoracic stent graft covered all parallel grafts of the aortic arch, excluding the aneurysm. Both cases did not have neurologic or cardiac complications and were discharged 10 days after the procedure.Conclusions: This technique may be a good minimal invasive off-the-shelf technical option for aortic arch "debranching". More data and further improvements are required before this promising technique can be widely advocated. (C) 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Experimental myocardial hypertrophy induced by a minimally invasive ascending aorta coarctation

Ascending aorta coarctation was produced by a minimally invasive technique in rabbits. Animal mortality was 5%. Morphometric and hemodynamic parameters were evaluated. A parabiotically isolated heart model was used to assess the hemodynamic parameters. Left ventricular weight/body weight ratio and muscle area showed clear evidence of hypertrophy when compared to control. The hemodynamic changes in the isolated heart model suggested decreased diastolic and systolic function in the coarcted group. The present model produced hypertrophy with low mortality rates as a result of its less invasive nature.

Efeitos da Histerectomia Total Abdominal sobre o Fluxo Sangüíneo Ovariano

Objetivo: avaliar os efeitos da histerectomia total abdominal (HTA) sobre o fluxo sangüíneo ovariano, em mulheres no menacme, por meio da dopplervelocimetria e ultra-sonografia transvaginal. Métodos: estudo prospectivo no qual foram incluídas 61 mulheres, com idade igual ou inferior a 40 anos. As pacientes foram divididas em dois grupos: G1, com 31 pacientes submetidas à HTA, e G2, com 30 mulheres normais não submetidas à cirurgia. Somente foram incluídas pacientes eumenorréicas, ovulatórias, não-obesas ou fumantes, sem cirurgias ou doenças ovarianas prévias. Avaliou-se o fluxo sangüíneo das artérias ovarianas, inicialmente e aos 6 e 12 meses, pelo índice de pulsatilidade (IP) na dopplervelocimetria, e o volume ovariano pela ultra-sonografia transvaginal (US). Para análise estatística empregou-se teste t pareado, análise de perfil, teste de Friedman e teste de Mann-Whitney. Resultados: na comparação estatística inicial os grupos foram homogêneos quanto às características epidemiológicas e quanto aos demais parâmetros avaliados neste estudo. Nas pacientes submetidas à histerectomia, observaram-se aos 6 e 12 meses aumento do volume ovariano ao US e diminuição do IP avaliado pela dopplervelocimetria (p<0,05), quando confrontadas ao controle. Aos 12 meses, em 8 das 31 pacientes pós-HTA (25,5%) verificou-se ocorrência de cistos ovarianos de aspecto benigno. No grupo controle não houve alteração de nenhum desses parâmetros. Conclusão: a redução do IP na dopplervelocimetria das artérias ovarianas sugere aumento do fluxo sangüíneo ovariano pós-histerectomia total abdominal em mulheres no menacme.

Iatrogenic cortical aneurysm post-craniotomy

Taking into account the number of craniotomies performed every day around the world, iatrogenic aneurysm post-craniotomy is extremely rare with only anecdotal cases reported in literature. We report an iatrogenic aneurysm affecting a cortical vessel which probably developed during dural closure of a conventional craniotomy. The aneurysm was discovered 6 months after surgery on a routine control angiography. The patient was successfully treated by trapping the parent vessel and excising the aneurysm. Histopathological findings were compatible with a true type of traumatic aneurysm. The possibility of this rare condition occurring highlights the risk of arterial injury during craniotomy.

GIANT FUSIFORM ANEURYSM ARISING FROM FENESTRATED POSTERIOR CEREBRAL ARTERY and BASILAR TIP VARIATION: CASE REPORT

OBJECTIVE: A giant fusiform aneurysm in the posterior cerebral artery (PCA) is rare, as is fenestration of the PCA and basilar apex variation. We describe the angiographic and surgical findings of a giant fusiform aneurysm in the P1-P2 PCA segment associated with PCA bilateral fenestration and superior cerebellar artery double origin.CLINICAL PRESENTATION: A 26-year-old woman presented with a 2-month history of visual blurring. Digital subtraction angiography showed a giant (2.5 cm) fusiform PCA aneurysm in the right P1-P2 segment. The 3-dimensional view showed a caudal fusion pattern from the upper portion of the basilar artery associated with a bilateral long fenestration of the P1 and P2 segments and superior cerebellar artery double origin.INTERVENTION: Surgical trapping of the right P1 -P2 segment, including the posterior communicating artery, was performed by a pretemporal approach. Angiograms performed 3 and 13 months after surgery showed complete aneurysm exclusion, and the PCA was permeated and filled the PCA territory. Clinical follow-up at 14 months showed the patient with no deficits and a return to normal life.CONCLUSION: To our knowledge, this is the first report of a giant fusiform aneurysm of the PCA associated with P1-P2 segment fenestration and other variations of the basilar apex (bilateral superior cerebellar artery duplication and caudal fusion). Comprehension of the embryology and anatomy of the PCA and its related vessels and branches is fundamental to the decision-making process for a PCA aneurysm, especially when parent vessel occlusion is planned.

Short-term evaluation of non-absorbable microgranular hydroxyapatite infiltration in the guinea pig subepidermal abdominal region

Non-absorbable microgranular hydroxyapatite was infiltrated into the subepidermal abdominal region of guinea pigs in order to assess the possibility of using this material to correct deficiencies in orbital volume. Microgranular hydroxyapatite (2.0 ml) was subepidermally infiltrated into the abdominal region of 20 guinea pigs. The animals were divided into four experimental groups of 5 animals each, which were killed 7 (G1), 15 (G2), 30 (G3) and 60 (G4) days after infiltration. The area and the largest and smallest diameters of the nodules formed by infiltration were evaluated at the site of infiltration and histological examination was performed. The mean granuloma area was similar in all groups. Histopathological examination showed that the material remained isolated from surrounding tissues by a pseudocapsule that became denser throughout the experiment. A host reaction started with young fibroblastic tissue that evolved to dense tissue until cartilaginous tissue was formed in G4, progressively advancing towards the center of the granuloma from G1 to G4. Non-absorbable microgranular hydroxyapatite is an inert material that was well tolerated by the animals studied, with maintenance of the infiltrated volume, and may perhaps be useful to fill anophthalmic cavities.

Sagital abdominal diameter, but not waist circumference is strongly associated with glycemia, triacilglycerols and HDL-c levels in overweight adults

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Accuracy of sagittal abdominal diameter as predictor of abdominal fat among Brazilian adults: a comparation with waist circumference

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Efeitos da energia da dieta sobre desempenho, rendimento de carcaça e gordura abdominal de frangos de corte

Um experimento foi realizado com o objetivo de avaliar o efeito do nível de energia da dieta sobre desempenho, rendimento de carcaça e porcentagem de gordura abdominal de frangos de corte. Foram utilizados 2400 pintos de um dia da linhagem Ross 308, criados em boxes até 42 dias de idade. O delineamento experimental adotado foi o inteiramente casualizado em esquema fatorial 6 x 2 (energia x sexo). Os tratamentos consistiram de combinações de seis níveis de energia (2.900, 2.960, 3.020, 3.080, 3.140 e 3.200 kcal EM/kg) e dos sexos, com quatro repetições de 50 aves cada. No período de 1 a 42 dias de idade, houve redução no consumo de ração e melhora na conversão alimentar à medida que se aumentou o nível de energia da ração. Os machos apresentaram melhores resultados de desempenho que as fêmeas, exceto para mortalidade. À medida que se acrescentou energia na dieta, houve efeito linear na porcentagem de gordura abdominal e no rendimento de asas, mas não houve efeito sobre o rendimento de carcaça e das demais partes. Os machos apresentaram maiores porcentagens de pernas e de carne de pernas e menores de carne de peito e de gordura abdominal que as fêmeas.

Contribution to the study of aortic mural structure of opossum (Didelphis albiventris)

Opossum is considered one of the most primitive mammals, with transition evolutive characteristics. In mammals, the aorta artery is referred as the main body blood vessel. The arteries wall structural organization follows a basic pattern, being contituted of three tunics: Intima, Median and Adventicial. After euthanasia, three samples of opossum had segments from the aorta artery ascendent, thoracic descending and abdominal descending portions removed, fixed in phormalin at 10% for 48 hours. Then, the material was washed in alcohol 70% several times, dehydrated in alcohois of growing concentrations, diafanized in xylol and included in "paraplast". Cuts with 5 to 7 mu m of thickness were placed in histological laminae and submitted to color methods of Hematoxilin-Eosin, Masson, Mallory and Calleja Tricromics. It was observed that in the different portions ascendent, thoracic and abdominal descending of aorta, the intima tunic presents much thick, made up of a layer of smooth muscular cells and elastic fibers, forming a limiting internal elastic membrane. In the three portions studied, the median tunic was the most evident layer, constituted of colagen fibers, smooth muscular cells arranged in a circular manner and elastic fibers, showing a variation in the mural elements proportion. It was evidenced the presence of a external elastic lamina, marking the transition between the median and adventicial tunic, formed by elastic fibers condensation. The aortic adventicial tunic showed to be little organized, having in its structure predominantely colagen fibers beans with some isolated smooth muscular fibers or in small fascicules among a few elastic fibers.

Effects of castration on alpha(1)-adrenoceptor subtypes in the rat aorta

The expression of alpha(1)-adrenoceptor subtypes in several tissues is regulated by gonadal hormones. In this study, we investigated whether castration regulates the alpha(1)-adrenoceptor subtypes mediating the contractions of the aorta from male rats to noradrenaline. Noradrenaline induced similar concentration-dependent contractions in the aorta from control and castrated rats. Treatment of the aorta from both control and castrated rats with the alpha(1B)/alpha(1D)-adrenoceptor alkylating agent chloroethylclonidine resulted in approximate to1600-fold rightward shift in the concentration-response curves to noradrenaline. The pA(2) values found for WB 4101, benoxathian (alpha(1A)-selective) and BMY 7378 (alpha(1D)-selective) indicate that alpha(1D)-adrenoceptors are involved in the contractions of the aorta from control and castrated rats to noradrenaline. However, there was a 15-fold difference between the pK(B) estimated through the lowest effective concentrations of the alpha(1A)-adrenoceptor selective antagonist 5-methyl-urapidil in the aorta from control and castrated rats. The pK(B) estimated in aorta from control rats is consistent with the interaction with alpha(1D)-adrenoceptors (7.58 +/- 0.06), while that calculated in organs from control rats is consistent with alpha(1A)-adrenoceptors (8.76 +/- 0.09). These results suggest that castration induces plasticity in the alpha(1)-adrenoceptor subtypes involved in the contractions of the aorta to noradrenaline. (C) 2003 Elsevier B.V. All rights reserved.