Annals of Vascular Surgery

Endovascular repair of abdominal aortic aneurysms (AAA) requires regular surveillance for early detection of endograft failure. CT scanning is the gold standard surveillance procedure. The purpose of this study was to assess the reliability of color duplex ultrasound (CDU) in comparison to CT scanning for detection of endoleaks and changes in aneurysmal diameter. From November 1996 to September 1999, a total of 41 patients treated by aortic endografting underwent regular surveillance with both CT scanning and CDU. There were 39 men and 2 women with a mean age of 71 years (range, 50-83). Endovascular treatment involved deployment of a straight aorto-aortic stent in 6 cases, bifurcated stent in 33, and aorta-to-unilateral iliac artery stent in 2. Stent deployment failed in one case; the procedure was conversion to open surgery. Primary or secondary endoleaks were detected in 17 patients (42%). Our findings indicated that CDU is less reliable than the CT scan for detection of endoleaks, but that reliability of CDU for surveillance of aneurysmal diameter is fair.

With broader indications for renal transplantation and improved allograft survival, it is anticipated that the problem of aortic disease in the post-transplant patient will be encountered with increasing frequency. We report a technique of protecting the transplant kidney from ischemic damage during distal aortic surgery. A 30-year-old renal transplant patient who had undergone an operation for ruptured chronic type III dissection 3 years previously underwent abdominal aortic aneurysm repair under hypothermic circulatory arrest. The patient recovered uneventfully and is presently doing well 1 year after the operation. Hypothermic circulatory arrest could be used in selected cases as a useful alternative for transplant kidney protection.

Several techniques for bypass of the superior vena cava have been described, including spiraled saphenous vein graft, femoral vein graft, and polytetrafluoroethylene graft as conduits. We present two cases of superior vena cava obstruction treated with juguloatrial bypass using harvested superficial femoral vein. We feel that the superficial femoral vein, with its diameter similar to that of the internal jugular vein, provides several advantages compared to other conduits in a juguloatrial bypass.

From January 1977 through December 1986, 134 patients with symptomatic AAAs were examined in the emergency room; 24 patients (mean age 72.4 years) had an initial misdiagnosis of “nephrolithiasis.” Ten patients had the correct diagnosis of a ruptured AAA established within five hours of the initial examination and were promptly taken to surgery. Fourteen patients had delay greater than five hours while extensive diagnostic evaluations were performed (intravenous pyelograms in 12, computerized tomographic scans in 7, ultrasonography in 6). All patients underwent emergency surgery and six patients operated upon within five hours of initial examination survived. All patients who had extensive diagnostic evaluation lasting more than five hours died. The only diagnostic procedure that definitively established a ruptured aneurysm in all cases was the CT scan. In patients with confusing physical and laboratory findings but in whom the diagnosis of a ruptured AAA is entertained, an emergency CT scan is recommended as the diagnostic procedure of choice.