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We report a case of combined colon cancer and Clostridium septicum aortitis involving the suprarenal abdominal aorta with rupture. An 82-year-old male presented with fever, abdominal pain, and back pain associated with constipation. He was successfully treated by in situ aortic graft placement with polytetrafluroethylene and concomitant colon resection. Only 20 other cases of C. septicum mycotic aneurysm, aortitis, or aortic dissection have been reported. Concomitant surgical treatment for Clostridium aortitis or mycotic abdominal aortic aneurysm and colon cancer can be accomplished successfully in selected cases when the diagnosis of both conditions is made preoperatively.

Objective: Our objective was to report the long-term follow-up results of endovascular aneurysm repair of inflammatory aortic aneurysms., Conclusion: Endovascular aneurysm repair of inflammatory aortic aneurysms excludes the aneurysm and seems to reduce the size of the aneurysmal sac and the extent of periaortic fibrosis with acceptable periinterventional and long-term morbidity.

Purpose: To determine clinical and radiological features, using computed tomography (CT-scan) in patients with aortic involvement related to giant cell arteritis (GCA), and to assess both clinical and CT-scan outcome after therapy institution., Methods: Aortic involvement due to GCA was investigated in all patients, using CT-scan at diagnosis, and at 3, 6 and 12 months follow-up after therapy institution., Results: The 11 consecutive patients consisted of 4 men and 7 women with mean age of 64.5 years. Patients exhibited: constitutional symptoms (N=9; 82%), dorsalgia (N=3; 27%), clinical signs of GCA (N=3; 27%) and of upper limb large vessel impairment (N=6; 55%). CT-scan showed aortitis involving both thoracic and abdominal aorta (N=6; 55%), abdominal (N=2; 18%) or thoracic aorta (N=2; 18%) and thoracic aortic aneurysm (N=1; 9%). At one-year follow-up, CT-scan revealed: complete resolution (N=7; 64%) and improvement (N=3; 27%) of aortic damage; the patient, who had thoracic aortic aneurysm, underwent surgical treatment, as aortic lesion remained unchanged on CT-scan., Conclusion: Our study underlines that CT-scan is a helpful test in diagnosis and follow-up of aortic involvement in patients with GCA.

Purpose: To report a meta-analysis of results from endovascular aneurysm repair (EVAR) of inflammatory aortic aneurysms (IAA)., Methods: A comprehensive literature review was performed to identify all studies reporting the results of EVAR in patients with IAA. To be included in the analysis, an article had to provide a minimum follow-up of 6 months, information about primary technical success, details of immediate and long-term complications, and evaluation of at least one of the basic outcome criteria: changes in aneurysm sac diameter, periaortic fibrosis (PAF), and/ or renal impairment. All studies were reviewed by 2 independent observers for the inclusion criteria. Data were retrieved on the technical and clinical success, outcome criteria, mortality in follow-up, and reinterventions from 14 articles selected from among 701 initially identified., Results: The 14 articles encompassed 46 patients (45 men [97.8%]; mean age 65 years, range 59-75) with a mean follow-up of 18 months after endovascular repair of IAAs located in the abdominal aorta. The primary technical success rate was 95.6% (44/46) and the 30-day clinical success rate was 93.4% (43/46). The median aneurysm sac diameter regression was 11 mm. Of 43 patients with PAF prior to the intervention, 22 (51.2%) patients showed complete regression, 18 (41.8%) remained unchanged, and 3 (7.0%) showed progression after EVAR. Renal impairment disappeared in 11 (45.8%) of 24 patients. Reinterventions were reported in 8 patients. The procedure-related and follow-up mortality rates were 0% and 13.0%, respectively., Conclusions: EVAR of IAA is feasible, excludes the aneurysm effectively, and reduces PAF and renal impairment in most patients with very low periprocedural and midterm mortality and an acceptable reintervention rate.

A 38-year-old woman who had undergone an original Bentall operation in December 1995 for annuloaortic ectasia associated with ulcerative colitis required reoperation for ascending aortic aneurysm, coronary ostial aneurysm, and patent Cabrol trick. The initial Bentall operation included aortic root replacement using a valved conduit and reconstruction of the coronary arteries. Both coronary ostia were directly anastomosed to the composite valved graft, which was wrapped with the dilated aortic wall, and a Cabrol trick was added at the same time. She underwent reoperation for a 60 mm ascending aortic aneurysm which had been used for wrapping at the initial operation. The findings at reoperation were a patent Cabrol trick, leakage from the distal anastomosis, aneurysm of both coronary ostia, and paravalvular leakage. The repairs included graft replacement, leaving the valvular prosthesis, reconstruction of both coronary arteries by the Piehler method and Carrel patch technique, repair of the paravalvular leakage, and closure of the Cabrol trick. Her postoperative course was uneventful, and the serum concentration of C-reactive protein remained within normal limits. Strict follow-up care is required to avoid further anastomotic dehiscence.

Background: Retroperitoneal fibrosis (RPF) and inflammatory aneurysm of the abdominal aorta (IAAA) are regarded as two manifestations of the same disease, termed "chronic periaortitis"., Objective: To determine the optimal therapeutic and diagnostic approaches to IAAA., Methods: The outcome of medical immunosuppressive and surgical treatment of 20 patients was examined. Measurements of the C reactive protein (CRP) were compared with contrast enhanced imaging studies in the follow up of the patients., Results: The diameter of the periaortic mantle and its contrast enhancement improved in 13/15 (87%) patients given immunosuppressive treatment for a period of more than 6 months. Strong contrast enhancement was associated with a substantial rise in CRP, but no correlation between the CRP value and thickness of the fibrotic mass was found, even at intraindividual follow up., Conclusions: Immunosuppressive treatment should be included in the first line treatment of patients with RPF and should be maintained long term. Imaging studies are better than CRP measurements in the evaluation of response to treatment.

Objectives: To investigate the results following endovascular treatment of patients with inflammatory abdominal aortic aneurysms (IAAA)., Design: Retrospective study based on the EUROSTAR registry., Material and Methods: Patients included in the EUROSTAR registry with IAAA (n=52, 1.4%) were compared to those having aneurysms without aortic fibrosis (n=3613, 98.6%). The mean follow-up period in patients with IAAA was 23 months (range 1-60). In 11 of the patients detailed information on the effect of endovascular repair and perianeurysmal fibrosis and ureteral entrapment was obtained by a dedicated questionnaire., Results: Twelve patients (23%) with IAAA had preoperative impairment of renal function and five had known hydronephrosis. Variables that were significantly associated with IAAA included younger age (p<.0001, mean difference 5.9, CI 3.7-7.9) and lower pulmonary risks score (OR 0.38, CI 0.19-0.74). At completion of the endovascular procedure, device stenosis was more frequently observed in patients with IAAA (OR 18.1, CI 3.52-93.0). There were no differences with regard to the rates of mortality, rupture or conversion in patients with IAAA and controls. In the majority, the aneurysm size regressed irrespective of nature of aneurysm. Of the 11 patients with a detailed assessment three had deterioration of renal function and three still had ureteral entrapment during follow-up., Conclusion: Despite persistence of perianeurysmal inflammation in a proportion of patients operative and midterm results of endovascular repair were comparable in the patients with inflammatory and standard AAA.

We report a rare case of an inflammatory descending aneurysm. At surgery, the patient had multiple aneurysms on the descending aorta. Histology of the specimen demonstrated an infiltration of chronic inflammatory cells in the aortic media.

Surgical treatment of two female patients aged 32 and 41 years, with neurological problems causes by type I Takayasu's aortoarteritis, are presented here. Both of them were treated with by pass from ascending aorta to left common carotid and left subclavian arteries, using transsternal approach. During the follow up period (3.5 years for the first, and 2 years for the second patient) both patients were free of neurologic symptoms. Corticosteroid therapy was given to the first patient for controlling of active diseases, immediatelly after the operation and during the first three postoperative months. By this reason an infection af the proximal part of sternal wound was developed. MRI showed involvement of the vascular graft. Due to high risk of reoperation, medical treatment was performed. Takayasu's aortoarteritis is very unsommon in our country, as well as in other countries which don't belong to Far East. In cases with hemodinamic important arterial lesions produced disabling symptoms, a standard PTA and reconstructive vascular procedures are indicated. Takayasu's aortoarteritis is a complex disease. It requires combined dignostic and therapeutic approaches which produce satisffied long-term results.

In this paper the clinical condition of two male patients, aged 58 and 65 years are presented, after being admitted as a consequence of a rare complication of an inflammatory aneurysm of the abdominal aorta, which is an ureteral compression, with hydronephrosis, anuria and acute renal failure. After having an urgent haemodialysis session, the etiology of the process was diagnosed by echography and abdominal CT-scans, followed by ureteral catheterization, restoration of diuresis and normalization of renal function. Conventional surgery was performed later, in elective conditions, and the post operative course was normal, without complications. The main features of this clinical entity, its diagnosis and multidisciplinary management are presented and discussed.

Abiotrophia defectiva, one of several nutritionally variant Streptococcus species, is an uncommon but important cause of endocarditis in children. We describe an unusual case complicated by extensive aortitis with pits in the ascending aorta and the proximal aortic arch.

While endovascular repair (ER) has become a routine procedure in the treatment of arteriosclerotic abdominal aortic aneurysms with a suitable configuration, only rare reports of interventional treatment of inflammatory aortic abdominal aneurysms (IAAA) exist. We present a case study of a male patient with IAAA, who presented with inflammatory thickening involving the entire circumference of the aortic vessel wall. The MRI performed 8 months after successful ER demonstrated complete regression of vessel wall induration. A patient with the appropriate anatomical configuration of IAAA should benefit from the lower morbidity and mortality of endovascular aneurysm repair (EVAR). In our view, EVAR is preferable to open surgical repair in the specific situation of IAAA.

The incidence of inflammatory abdominal aortic aneurysm (IAAA) in a late review of the literature is estimated about 2-15% overall aortic aneurysms. In our data this type of aneurysm is 3.6 overall aortic aneurysms treated. In the majority of the cases, IAAA is juxtarenal or infrarenal. Ethiopathogenesis of IAAA till today is not certain. Recent hypothesis on IAAA attribute the same ethiopathogenesis in both atherosclerotic and inflammatory aneurysm. The interaction of genetic, environmental and infective factors should be able to determine an autoimmune inflammatory reaction of variable severity. 80% of the patients suffering from IAAA present abdominal or lumbar pain, loss of weight and increase of the RC sedimentation velocity. The IAAA's natural history goes to rupture. Entrapment of nearstanding organs totally involved in the fibrotic process is the most frequent complication. Usually there is a compression of the ureter and the duodenum with consequenced hydroureteronephrosis and bowel obstruction. Preoperative diagnosis is possible; CT scan and MRI guarantee and accuracy about 90%. Intraoperatively the external wall of IAAA appears whitish and translucent and always there are tenacious adhesion given by the avventital wounds inflammation. Confirm is given by the histological examination of the aneurysmatic wall and peravventitial tissues. Our experience and a late review of the literature concorde that surgical indication for the treatment of IAAA is the same for the atherosclerotic one. This conviction is supported by the fact that the diagnostic methodical evolution and the improvement in mininvasive surgical technique lowered perioperating morbility and mortaliy. We prefer, according with many authors, retroperitoneal approach to juxtarenal IAAA, instead of standardized transperitoneal access with xifo-pubical or transversal under costal incision. This approach offers some advantages as easier exposition of aorta, whose postero-lateral wall is hardly ever involved in inflammatory process, little duodenum's and left renal veins manipulation and low incidence of paralytic ileum and respiratory disease. Endovascular surgery hasn't in this moment any role in juxtarenal IAAA treatment because this type of aneurysm has inadequate proximal neck. In the future, probably, endovascular repair will be possible using a new type of endograft with renal legs. Often surgical treatment is inadequate to control retroperitorenal fibrosis and so surgeon has to use perioperating pharmacolocical therapy.

We surgically replaced the aortic root and the complex arch in a patient with aortitis syndrome with total occlusion of the cervical branches. Cerebral perfusion was being maintained through the reversed flow of the vertebral artery from the bilateral mammary arteries. Though cerebral perfusion was continued through the prosthetic grafts attached to the subclavian arteries during the procedure, bilateral watershed cerebral infarction corresponding to the most distal part of the anterior- and middle cerebral arterial system developed. With regard to the near infrared spectroscopy as a brain monitoring method, we sought to discuss the limitations.

Cardiac involvement in hydatid disease is uncommon. We report a case of a surgically treated ruptured left ventricular hydatid cyst, which presented with acute stroke and was later complicated by distal aortic embolism due to perioperative dislodgement of the germinative membrane.

Infective aortitis is a rare condition, which occurs most commonly in association with some form of structural abnormality of the heart or vessel wall. We describe the successful excision of an infected, nonpatent remnant of the ductus arteriosus.

Background: Infections of arterial vascular grafts are among the most dreaded complications in vascular surgery. Infection in a thoracic aorta graft poses particular challenges. Depending on the local anatomy, extraanatomic bypass, otherwise the cornerstone in the management of infected vascular grafts, is usually impossible., Material and Methods: We present a case report on a patient with an infected thoracic aorta graft and discuss the choice of antibiotics for long-term suppressive therapy., Results: In the course of the 52 months since the insertion of the aortic graft, the patient experienced eight serious episodes of staphylococcal septicaemia, with Staphylococcus aureus in blood culture on each occasion. A combination therapy of three orally administered anti-staphylococcal antibiotics has kept him free from recurrent septic episodes over the last 25 months, with a good quality of life and without signs of systemic infection., Interpretation: Life-long antibiotic suppressive therapy for infected thoracic aorta graft offers the prospect of long-term survival with a good quality of life, even when there are recurrent serious septic complications. The choice of antibiotics should take into account the feasibility of the proposed treatment; parenteral antibiotics are not a realistic option in the long run. The antibiotics should be well absorbed after oral administration, have a high intrinsic activity against the offending pathogen, and be given at intervals leading to inhibitory blood concentrations throughout most of the day. In our patient, a triple combination therapy was necessary.

Tuberculous aortitis generally develops at the distal aortic arch and the descending aorta that are close to specific groups of mediastinal lymph nodes, but exceptionally it develops in the ascending aorta. We report a case of rupture of the ascending aorta after tuberculous aortitis in a 53-year-old man without a history of tuberculosis or evidence of a primary foci who underwent cardiopulmonary resuscitation due to severe hemoptysis with subsequent cardiac arrest. The tuberculous aortitis associated with rupture of the ascending aorta was treated with surgical resection and in situ graft placement.

We herein report a case of aortic root replacement using cryopreserved allograft. A 52-year-old man received aortic valve replacement using a mechanical prosthesis for aortic stenosis. He was complicated by postoperative methicillin-resistant staphylococcus aureus mediastinitis involving the ascending aorta. Surgical therapy including debridement, omental transposition, patch closure using pericardium had not achieved satisfied result. Aortic root replacement using cryopreserved allograft was mandatory for refractory aortic infection. He had an uneventful postoperative course. The cryopreserved allograft was effective for a patient with refractory aortic root infection due to postoperative mediastinitis.

Aortic rupture during balloon angioplasty for in-stent restenosis without attempting to overexpand it is a rarity. We report a case of a young woman with aortoarteritis who had aortic rupture during angioplasty for in-stent restenosis. The balloon used was of the same diameter as the previously implanted stent and was completely within the stent during inflation. The disruption was successfully treated by percutaneous placement of a self-expandable endovascular stent graft., (Copyright 2003 Wiley-Liss, Inc.)

A case of bilateral coronary ostial aortoarteritis, which presented with angina pectoris, is reported. Emergency total arterial revascularization was performed using the bilateral mammary artery and radial artery, and the radial artery was hanged "Y" on the left internal mammary artery. The patient was discharged on low-dose steroid. He was asymptomatic at 1-year follow-up.

Four cases of giant cell arteritis causing severe aortic regurgitation secondary to an aneurysm of the ascending aorta are described. In two cases, the nature of the aortic pathology could be suspected considering the past clinical evidence of temporal arteritis and/or polymyalgia rheumatica. In the two other cases, the cardiothoracic manifestations represented the onset of Horton disease.

Relapsing polychondritis (RP) is a rare inflammatory multiorgan disorder affecting cartilaginous structures and other connective tissues. Serious cardiovascular complications have been reported in patients with RP, the most frequent being aortic or mitral regurgitation and aortic aneurysms. Aortitis is a very rare complication. An unusual case of active aortitis in a patient with RP, despite intensive immunosuppressive treatment, is described with a special emphasis on the pathological findings.

Purpose: The purpose of this study was to determine the benefits and the indications of performing a minilaparotomy during laparoscopic abdominal aortoiliac reconstructions., Methods: This prospective study was approved by the Commission Consultative de Protection des Personnes dans la Recherche Biomédicale of the University of Marseilles, and all patients gave their informed consent. Between January 1998 and March 2000, 27 patients (23 men; 4 women) with a mean age of 58.2 years (range, 42-76 years) underwent aortoaortic (n = 3), aortounifemoral (n = 4), or aortobifemoral (n = 20) bypass graft for aortoiliac occlusive disease (n = 20), emboligenic aortitis (n = 1), or abdominal aortic aneurysm (AAA) (n = 6). At the beginning of the trial, the decision was made to perform an intraoperative conversion to open surgery in case of bleeding (group 0), when a totally laparoscopic procedure was possible (group I), or when a 6- to 8-cm supraumbilical minilaparotomy was needed in case of technical difficulty (group II). In each case of AAA, the remaining lumbar arteries were controlled (group III); and for the last six patients of this series (group IV), a minilaparotomy was systematically performed., Results: One patient was admitted with multiple organ failure and died on day 12 (3.7%) with a patent graft. One intraoperative conversion to open surgery (3.7%, group 0) was performed for bleeding; recovery was uneventful. Seven postoperative surgical procedures (26%) were necessary, including two cases of aortic bleeding because of hypertensive access. Seven procedures were totally laparoscopic (group I), and a minilaparotomy was performed in the other 19 cases, including seven cases of technical difficulty (group II). The mean operative and clamping times and the mean postoperative hospital stay were globally (P =.021) and individually (P < or =.016) significantly shorter in group IV when compared with those of the other three groups. Twenty patients (74%) had a postoperative hospital stay of 6 days or less (3-6 days), with minimal complaints of pain, tolerance of oral feeding on day 2, and mobilization on day 2 or 3. All bypass grafts remained patent after a mean follow-up of 11 months (1-26 months)., Conclusion: With regard to the instrumentation presently available, this study shows the benefit of a minilaparotomy when performing a laparoscopic aortoaortic or aortofemoral bypass graft for the treatment of aortoiliac occlusive disease and AAA.

From 1990 to 1999, 19 patients underwent aortic root replacement. Annulo-aortic ectasia was observed in 14 patients, aortic dissection in 4, and aortitis in 1. Mean aortic cross-clamp times and cardiopulmonary bypass times were 163 +/- 44 and 247 +/- 99 min, respectively. Concomitant procedures were coronary artery bypass grafting in 3 patients, aortic arch replacement in 1 and aortic arch replacement and elephant trunk method in 2. There were two hospital deaths due to cardiac failure. There was one late death because of pharyngeal cancer 1.7 years after the operation. Seventeen survivors were followed for a mean duration of 4.4 years (0.6-9.3 years). There were no complications during this period. In conclusion, good results were obtained by modified Bentall operation.

Aortic rupture in association with a contiguous intraabdominal abscess is rare. We report an unusual case of aortic rupture in association with a polymicrobial abscess and review the related literature. Cultures grew Eikenella corrodens, a rare intraabdominal pathogen, as well as betahemolytic streptococcus and S. viridans. The patient was successfully managed by aortic ligation followed by an extraanatomic bypass.

The authors present a technique consisting of retroperitoneal exposure, but not dissection of the inflammatory aneurysm, anastomosis of a bypass graft through a short thoracotomy to the lowermost thoracic aorta, carrying it down retroperitoneally to both femoral arteries and under brief occlusion of the descending thoracic aorta, opening of the aneurysm and intra-aneurysmal occlusion of the inflow and outflow to the aneurysm. An illustrative case is presented.

A 58-years-old man, with no medical past history, was examined for abdominal pain and weight loss. An enlarged kidney could be palpated, and abdominal echography showed left hydronephrosis due to ureteral compression by abdominal aortic aneurysm. Laboratory data showed an inflammatory syndrome. CT scan suggested the diagnosis of inflammatory abdominal aortic aneurysm. The use of corticosteroids brought about the regression of the symptoms and the resolution of the ureteral obstruction, permitting aneurysmectomy and prosthesis replacement without ureterolysis. This report shows the interest of preoperative radiological diagnosis of the inflammatory character of abdominal aneurysm. For uncomplicated cases, preoperative treatment using corticosteroids could allow partial regression of the periaortic inflammation and easier surgical repair.

The aortitis syndrome is a chronic inflammatory arterial disease with an unknown etiology that may present as a variety of vascular lesions. The surgical treatment of aortitis syndrome is associated with many potential difficulties due to the inflammatory nature of the disease. A patient with the aortitis syndrome underwent the Bentall operation for annulo-aortic ectasia and aortic regurgitation 11 years prior to presentation. The operation was not performed during the active inflammatory phase. An anastomotic dehiscence required reoperation, which was performed with Piehler's method. In the aortitis syndrome, the exclusion technique, Carrel patch repair of the coronary arteries and pledgeted anastomoses should be performed for aortic root reconstruction.

Primary bacterial aortitis represents a rare disease with a high lethality. From June 1997 to April 1999 5 patients with an abdominal aortic infection were treated by resection of the infected aorta and in-situ reconstruction or by extra-anatomic bypass. There was no treatment in one case because of the infaust prognosis. 3 patients survived, one with a paraparesis as a result of spinal ischemia. On the basis of our patients the pathogenesis, clinical symptoms with diagnosis and the therapeutic options are discussed.

Objectives: to assess the long-term outcome of patients with inflammatory abdominal aortic aneurysms., Materials and Methods: over a fifteen-year period 598 cases of abdominal aortic aneurysm were treated and, of these, 32 cases (5.3%) were inflammatory in nature. The diagnosis was made on preoperative (CT) computed tomography in fifteen cases. Twenty-six patients were symptomatic on presentation and ten cases were repaired on an emergency basis. Only six were repaired electively. The transabdominal transaortic approach without dissection on the nearby adherent structures was used routinely., Results: there was one postoperative death from a respiratory arrest leading to a thirty-day mortality of 3.1%. Early graft thrombosis occurred in three cases (9.3%) and all underwent successful thrombectomy. Colonic ischaemia was encountered in one patient who later developed an aortoenteric fistula. Two patients suffered a non-fatal myocardial infarction postoperatively leading to an overall morbidity of 18.7%., Conclusions: patients with inflammatory aortic aneurysms fare worse than patients with aortic aneurysms in general. Preoperative suspicion assists in planning surgery. We believe that the transperitoneal approach with an anterolateral aortotomy and minimal dissection of adherent structures offers excellent results in dealing with this difficult group of patients., (Copyright 1999 Harcourt Publishers Ltd.)

Purpose: The long-term outcome and the development of retroperitoneal fibrosis after surgery on an inflammatory aortic aneurysm was studied., Methods: Between 1989 and 1997, 1035 patients underwent surgery for an abdominal aneurysm, 42 of whom (4.1%) had typical signs of inflammation. All patients underwent computed tomography (CT) scans before operation, and 26 patients were followed up with a CT scan after a median of 36 months (range, 10 to 91 months)., Results: The inflammatory layer resolved completely in only 23% of the patients. One patient had marked progression, 35% of patients showed improvement, and the remaining patients had no change, compared with the preoperative findings. Although clinical symptoms subsided in 90% of patients, in five cases an involvement of the ureter or intestine that did not exist at the time of operation developed. Although ureteral involvement to the inflammation tends to subside after surgery, persisting fibrosis was associated with ureteral entrapment in 30% of these cases and resulted in renal compromise in 49%. Hydronephrosis that was not present at the time of operation was found in 19% of patients, despite improving or stable inflammatory lesions., Conclusion: This case-control study supports the findings that retroperitoneal fibrosis persists longer than previously thought, and progression might even occur. Formerly uninvolved organs might become included in the process despite regression of the layer, leading to considerable problems if the condition is not treated in institutions familiar with this complex disease. We advocate a moderated follow-up scheme, as in the case of ordinary abdominal aortic aneurysm, and the need for long-term surveillance of inflammatory aneurysms.

Introduction: Primary bacterial infection of an artery is difficult to diagnose, especially at the beginning of the illness. Most of the patients come for emergency treatment in the phase of rupture., Methods: The course of illness in four patients serves as background for discussion of the problems of diagnosis and therapy., Results: Bacterial infection of arteries shows a high rate of complications and, for the aorta, high mortality., Conclusion: If fever of uncertain origin is combined with pain of the stomach or of the back, or with a painful reddish swelling on a limb, this rare disease should be considered in the differential diagnosis.

We report here a case of infrarenal aortic disruption and aortoduodenal fistula secondary to tuberculous aortitis in a 77-year-old man. From a review of experience with operative management of tuberculous infection of the descending thoracic and abdominal aorta reported in the English-language literature, including the current report, we found that operative repair was attempted in 26 patients with tuberculous aortitis of the abdominal (n = 16), thoracic (n = 8), and thoracoabdominal (n = 2) aorta. Six patients had emergent operations for massive hemoptysis (n = 2), aortoduodenal fistula (n = 2), or abdominal rupture (n = 2), with an associated 30-day mortality of 50%. Elective or semi-elective repair was undertaken in 20 patients, of whom 19 (95%) survived for at least 30 days. On the basis of limited experience with this rare entity, in situ graft replacement is an appropriate treatment of tuberculous aneurysms and pseudoaneurysms of the descending thoracic and abdominal aorta.

We report a rare case of a 50-year-old woman with intermittent gastrointestinal (GI) bleeding and diagnosed as having primary aortoenteric fistula (PAEF) with inflammatory abdominal aortic aneurysm (IAAA). She was transferred to our institution with suspected PAEF as assessed by duodenoscopy and CT scan. As the patient was in shock due to massive GI-bleeding two days after admission, we performed an emergency laparotomy. The fistula was closed and the aneurysm replaced by a Woven Dacron Graft with an inter-positioning omental flap. A high index of suspicion is the most important diagnostic aid to prevent overlooking this often fatal disease.

We report one case of salmonellosis aortitis in a 70 years old man after an episode of gastroenteritis due to Salmonella enteritidis successfully resolved with extraanatomic by-pass and prolonged antibiotic administration.

Most abdominal aortic aneurysms (AAA) and thoracoabdominal aortic aneurysms (TAAA) are asymptomatic and are found on physical exam or incidentally during radiological studies for other indications. These aneurysms are repaired primarily because their risk of rupture increases geometrically as the size exceeds 5 cm. The potential morbidity of intraoperative visceral and spinal ischemia involved with TAAA repair may be reduced with various adjunctive maneuvers.