True Aneurysm of Ovarian and Uterine Arteries:a Comprehensive Review

Background: Gonadal artery aneurysm represents an extremely rare condition often unrecognized until rupture. Methods: A literature review was undertaken on Pubmed from 1990 to 2020 to identify reported cases of ovarian and uterine artery aneurysms, including the index case presented here. Data about the clinical presentation, diagnostic approach, and treatment were collected. Results: Twenty-one articles reporting on data about 22 patients, including the index case, were included. The patients's median age was 46.7 years (range 30–80) and aneurysm maximal diameter 2.6 cm (range 0.75–5 cm). Except for one asymptomatic patient, the aneurysm's clinical presentation was abdominal/back pain in the majority of cases (n = 20, 90.9%). Rupture with retroperitoneal hematoma occurred in 16 cases (72.7%) and hemorrhagic shock in one case (4.5%). No history of vaginal bleeding was reported in any case. The majority of the aneurysms were diagnosed in women of childbearing age: in 50% (n = 11) of cases during the peripartum period and in 22.7% (n = 5) of cases during the postmenstruation period. The remaining cases (n = 6, 27.3%) were detected during the postmenopausal period. The majority of patients (n = 15, 68.2%) were emergently treated with an endovascular approach by embolization, achieving the total exclusion of the aneurysm in 86.7% of cases (13 patients). In 7 cases (31.8%), surgical ligation was performed, of which 2 (9.1%) were for the failure of a primarily attempted coils embolization. The spontaneous thrombosis of the uterine aneurysm was noted 3 months after the initial diagnosis in one patient. Conclusions: The Gonadal artery aneurysms are unrecognized entities until an acute rupture occurs. Endovascular treatment by embolization is progressively becoming the first-line treatment with satisfactory results

Undiagnosed Aorto-caval Fistula During Total Laparoscopic Abdominal Aortic Aneurysm Repair: A Cause of Conversion

AbstractTotal laparoscopic aortic repair is evolving and is now the technique of choice for the treatment of infrarenal abdominal aortic aneurysms (AAA) in our department. With growing experience, surgeons will be confronted with the same peroperative situations than open surgery. We report a case of total laparoscopic AAA repair with peroperative diagnosis of aorto-caval fistula (ACF)

Total Laparoscopic Aortic Surgery: Transperitoneal Direct Approach

AbstractObjectiveWe describe the laparoscopic transperitoneal direct approach to the abdominal aorta.Operative techniqueThe patient is placed in the right lateral decubitus position, which allows dropping of the small bowel into right side of the abdomen. Anatomical exposure of the abdominal aorta follows the same steps as in open surgery.DiscussionLaparoscopic transperitoneal direct approach allows a reproducible exposure of the abdominal aorta. This technique was useful when retrocolic and/or retrorenal approaches were not possible because of previous left nephrectomy

Bentall Procedure: A Systematic Review and Meta-Analysis

Background. The Bentall procedure is considered the gold standard in the treatment of patients requiring aortic root replacement. An up-to-date overview of outcomes after the Bentall procedure is lacking. Methods. We conducted a systematic review and meta-analysis of characteristics of and long-term outcome after the Bentall procedure with a mechanical valve prosthesis. Pooling was performed using the inverse variance method within a random-effects model. Outcome events are reported as linearized occurrence rates (percentage per patient year) with 95% confidence intervals. Results. In total, 46 studies with 7,629 patients (mean age, 50 years; 76% men) were selected. Pooled early mortality was 6% (422 patients). During a mean follow-up of 6 years (49,175 patient-years), the annual linearized occurrence rate for late mortality was 2.02% (1.77%-2.31%; 892 patients), for aortic root reoperation it was 0.46% (0.36%-0.59%), for hemorrhage it was 0.64% (0.47%-0.87%), for thromboemboli it was 0.77% (0.60%-1.00%), for endocarditis it was 0.39% (0.33%-0.46%), and for major adverse valve-related events it was 2.66% (2.17%-3.24%). Operations performed in more recent years were associated with lower rates of aortic root reoperation (beta = -0.452; p = 0.015). Conclusions. This systematic review illustrates that rates of aortic root reoperation after the Bentall procedure have decreased over the years. However, late mortality, major bleeding, and thromboembolic complications remain a concern. This report may be used to benchmark the potential therapeutic benefit of novel surgical approaches, such as valve-sparing aortic root replacement. (C) 2016 by The Society of Thoracic Surgeon