RESUMEN
Infectious aneurysms of the superior mesenteric artery are a rare but life-threatening condition due to the risk of visceral ischemia, sepsis, or hemorrhage. In this study, we report the case of a superior mesenteric artery aneurysm (SMAA) secondary to a bioprosthetic valve endocarditis, successfully managed with aneurysm resection and saphenous vein interposition graft. We performed an extensive PubMed-based rewiew of the literature of the last 10 years on SMAA, which include the detection of 38 articles quoting 41 SMAAs. The case histories were divided in 2 groups: 18 cases belonged to nonmycotic group A and 23 cases were included in mycotic group B. In group A, 44.4% of patients were treated surgically, whereas in group B, 90.5%. The 2 study groups significantly differed (P = .01) in terms of surgical treatment. The surgical approach still remains the first choice of treatment in mycotic aneurysm.
Asunto(s)
Aneurisma Infectado/microbiología , Válvula Aórtica/microbiología , Endocarditis Bacteriana/microbiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/efectos adversos , Arteria Mesentérica Superior/microbiología , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Estreptocócicas/microbiología , Streptococcus salivarius/aislamiento & purificación , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/terapia , Antibacterianos/uso terapéutico , Válvula Aórtica/cirugía , Angiografía por Tomografía Computarizada , Remoción de Dispositivos , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/terapia , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Humanos , Arteria Mesentérica Superior/diagnóstico por imagen , Arteria Mesentérica Superior/cirugía , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/terapia , Reoperación , Vena Safena/trasplante , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/terapia , Resultado del TratamientoRESUMEN
BACKGROUND: Fast-track recovery programs have led to reduced patient morbidity and mortality after surgery. Minimally invasive surgery and anesthesia, with programs of early postoperative recovery are the main aspects of fast-track recovery programs. The optimization of pain control, early mobilization, and oral feeding allows for a rapid functional rehabilitation, which leads to minor morbidity and early discharge from the hospital to home. METHODS: We enrolled all nonemergent patients treated for elective abdominal aortic surgery for an aneurysm or obstructive disease from April 2000 to June 2014. The fast-track protocol was applied to all these patients. A transperitoneal aortic approach was used through a left subcostal incision and was complemented with epidural anesthesia-analgesia and a protocol of early rehabilitation. RESULTS: A total of 1,014 patients were treated for elective aortic surgery. For 980 patients (96.6%), clear liquids followed by a semisolid diet were tolerated starting on the afternoon of the day of intervention (day 0). Nine hundred eighty-seven patients (97.3%) began early ambulation on day 0, and for 81.2% of the population, regular colonic function returned within the second postoperative day. Seventeen deaths (1.7%) occurred. Nine hundred ten patients (89.7%) had no complications. The median hospital length of stay was 3 days for the entire series, and 80.4% of patients (n = 815) were discharged to their homes between the second and fifth days after surgery. CONCLUSIONS: The fast-track program can be efficiently and safely applied to aortic surgery and that this program improves surgical outcomes, allows for earlier discharge, and reduces costs.
Asunto(s)
Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Enfermedades de la Aorta/cirugía , Arteriopatías Oclusivas/cirugía , Procedimientos Quirúrgicos Vasculares , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/mortalidad , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/mortalidad , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/mortalidad , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Alta del Paciente , Complicaciones Posoperatorias/etiología , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/mortalidadRESUMEN
OBJECTIVE: To investigate the mode of presentation, diagnosis, association with other aneurysms, operative management, and outcomes of superficial femoral artery (SFA) aneurysms. METHODS: Records of all patients who underwent surgery for isolated, true SFA aneurysms (not due to infection, vasculitis, or tissue disorders) from 2002 to 2012 in two European centers were retrospectively analyzed. Demographic (sex, age), clinical (cardiovascular risk factors, location of the aneurysm, symptoms, presentation, emergency setting), surgical and radiological data (diameter, surgical technique, runoff vessels patency, presence of aneurysms elsewhere) were obtained for analysis. Follow-up was undertaken with clinical and ultrasound examinations at 1 month, 3 months, 6 months, 12 months, and yearly thereafter. The patency of the graft and the status of the anastomoses and inflow and outflow vessels were assessed. Main end points were represented by 30 days and long-term mortality and amputation-free survival. RESULTS: A total of 27 cases of SFA aneurysm were analyzed. Mean age at operation was 78 years ± 8.5. At presentation, SFA aneurysms were often symptomatic (rupture was present in 7/27 cases and acute distal ischemia in 6/27 cases), large (mean diameter, 54 mm ± 33.1 mm), bilateral (38% of the cases), and associated with aneurysms elsewhere (84%). Sixteen patients underwent resection of the aneurysm and polytetrafluoroethylene interposition graft, seven patients exclusion of the aneurysm with a femoropopliteal bypass (autogenous bypass in five cases, prosthetic in two), three patients simple ligation, and one patient underwent primary amputation. Mean follow-up was 41.47 months (range, 0.43-128.67 months). Early (<30 days) mortality and amputation rate were 4% and 7%, respectively. Estimated 5-year survival, limb salvage, and graft patency rates were 62%, 88%, and 85%, respectively. CONCLUSIONS: Degenerative aneurysms of the SFA display peculiar characteristics (in terms of clinical onset, diagnostic timing, and clinical behavior) so that they differ from other peripheral aneurysms. In fact, they often grow to reach a considerable diameter before medical attention is sought, presenting with rupture or ischemia at diagnosis. SFA aneurysms preferentially affect elderly men and are often associated with aneurysms elsewhere. However, despite their rarity, the treatment is usually feasible, and long-term outcomes are good.