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Vascular Ehlers-Danlos syndrome is a rare genetic and hereditary disorder that affects and weakens the structure and sustentability of medium and large size arteries, causing severe clinical complications, often fatal, such as is the case of spontaneous ruptures, aneurysms or arterial dissections. Concomitantly, spontaneous intestinal perforations may occur, as well as uterine ruptures, following a pregnancy and during the peripartum period. The authors report the clinical cases of three young females of the same family, with the diagnosis of vascular Ehlers-Danlos syndrome, coursing with severe involvement of the aorta (ascending aortic anerysm, dissection of the thoracoabdominal aorta), who underwent successful surgical management and were evaluated from 6 to 18 years after the operations. To complete the clinical presentation of the cases, the authors review the most recent literature and discuss the main features of this entity, namely its genetic origin, the arterial morphology and structural alterations, its clinical expression, the diagnosis and the challenges faced by the therapeutical approach, wether it would be the conventional arterial reconstructive surgery or the most recently introduced endovascular intervention.

Abdominal aorta aneurysms are quite common in elderly people, coexisting frequently with manifestations of atherosclerotic degenerative disease and in patients with already known risk factors such as hypertension, hyperlipidemia or tobacco habits. According to the most recent pathogenic concepts, the disease is caused by the inflammation of the arterial wall, leading to the destruction of elastin, and apoptosis of the smooth muscle cells of the media, associated to biomechanical factors, rendering the aortic cylinder into a sphere, with progressive expansion, coursing with growing risks of rupture, often fatal. The enormous progress noticed in the field of cellular and molecular biology and a better understanding of the intimal mechanisms involved in the pathogenesis of the disease, together with the new achievements occurred in pharmacotherapy and genetic therapy, will be able to offer in the near future, the creation of new alternatives for the medical management of this entity, preventing and controlling its progressive and expansive nature, as well as the severe and even lethal complications that can cause. In this paper the author makes an update on the new etiopathogenic concepts and new therapeutic modalities that have been tested in the medical management of the abdominal aortic aneurysm.

Abdominal aortic pseudoaneurysms are rare, particularly when they are related to blunt abdominal trauma. The authors report the clinical case of a 65 years old man with an abdominal aortic pseudoaneurysm related to a blunt abdominal trauma, that occurred three years ago. The patient complained of a diffuse abdominal pain, increased while walking. The diagnosis was confirmed by angiography and by angio-CT. An aortic resection and interposition graft was performed, according to the age of the patient and the low operative risk. A discussion on the therapeutic option was made, followed by a revision of the literature on the subject, and the authors conclude by emphasizing the need of a detection of this type of pathology, particularly in patients who had suffered in the past violent trauma.

A 49-year-old woman with classic manifestations of Marfan's syndrome, having previously been submitted to two surgical procedures for ascending aorta and aortic valve replacement, was admitted with diagnosis of a large dissecting thoracoabdominal aortic aneurysm, with indication for surgical repair. The patient underwent a successful reconstruction of the aorta by means of the "simplified technique" introduced by ourselves in 1984, as an alternative to the conventional S. Crawford's "inclusion technique", for the management of thoracoabdominal aortic aneurysms. Assessed two years after the operation, the patient was found to be in excellent clinical condition and a control angiography showed the vascular prosthesis and its side branches working properly. This unusual aortic complication of Marfan's syndrome and the usefulness of the unique and original technique employed to replace the thoracoabdominal aorta justify the presentation of this clinical case.

Background: A study in old patients on the incidence of aneurysms in abdominal arteries (AAA) and on the maximum diameter of the aorta below the renal arteries in those patients without arterial dilatation., Material and Methods: The study comprised 411 individuals, 218 women and 153 men with an average age of 74.4 years. Physical examination of the abdomen (EF) and abdominal ultrasonography (US) were done, and the latter was considered the "golden standard" of reference. In relation to the aorta, it was considered as an aneurysm the maximum artery diameter larger than 30 mm and for the iliac arteries, the maximum diameter larger than 15 mm., Results: The US showed the presence of aneurysm in the aortic-iliac territory in nine patients, one woman and eight men, corresponding to a prevalence of 2.1%, 4.1% in men and 0.4% in women. Two such aneurysms were in the iliac arteries (one aneurysm in a common iliac artery) and the other seven in the aorta below the renal arteries. The bearers of iliac aneurysm are men. The prevalence of the AAA was of 1.7% (7/411), 3.1% in men and 0.4% in women. The EF showed suspicion of the presence of aneurysm in 3 of these patients. The other 6 patients had no aneurysm. Considering all the aneurysms of the aortic-iliac territory, the EF had a sensitivity of 33.3%, a specificity of 99% and a positive prediction value of 33.3%. Considering only AAA, the sensitivity of the EF was 42.8%, the specificity 98.5%, and the positive prediction value, 33%. In the 402 patients without arterial aneurysm the maximum diameter of the aorta varied from 11 to 29 mm, with an average value of 16-21 mm., Conclusions: US is a non-invasive diagnostic procedure that should be used for the old age population.