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Purpose. The literature describes a high rate of mortality in cases of intrapelvic acetabular component migration, which is a rare but serious complication. Our aim is to establish and propose a treatment protocol according to our results and experience. Material and Methods. We performed eight (8) total hip revisions with acetabular cup migration between 2006 and 2012. A vascular graft was needed in four (4) of these cases. Two (2) cases were revisions after a spacer for infected arthroplasties. The protocol included the following: X-Ray examination (frontal and lateral views), CT angiography, a biological evaluation, a suitable pre-operative plan, at least six (6) units of blood stock, an experienced anesthesiologist, an experienced surgical team that included a vascular surgeon and a versatile arsenal of revision prostheses, bone grafts and vascular grafts. The anterolateral approach was generally used for hip revisions and the retroperitoneal approach in the dorsal decubitus position was used when vascular risk was involved. Results: The acetabular defect was reconstructed using bone grafts and tantalum revision cups in 4 cases, Burch-Schneider cages in 2 cases, a Kerboull ring in 1 case and a cementless oblong cup (Cotyle Espace) in 1 case. In 4 cases, an iliac vessel graft procedure was conducted by the vascular surgeon. All patients survived the revision procedures and returned regularly for subsequent check-ups, during which they did not show any septic complications. Conclusions: Intrapelvic acetabular cup migration is a rare but serious complication that can occur after total hip arthroplasty in either septic or aseptic cases. An experienced, multidisciplinary team of surgeons should be involved in planning and conducting such complicated revisions.

With the introduction into clinical practice and increasingly frequent application of endovascular repair of abdominal aortic aneurysms (EVAR), along with the well-known benefits of minimally invasive interventions, controversies arise associated to new treatment methods. These controversies include the medium and long-term results of EVAR influenced by the potential occurrence of procedure-specific complications. To maintain the long-term success of EVAR, namely to eliminate the risk of aneurysm rupture, lifelong, regular imaging surveillance must redocument and reassure the exclusion of the aneurysm sac from the systemic circulation. We hereby propose an effective and safe duplex ultrasound/contrast-enhanced ultrasound-based surveillance protocol that would lead to a significant reduction in the number of computed tomography scans required as part of the postoperative surveillance with a resultant reduction in exposure to both ionizing radiation and intravenous nephrotoxic contrast and a significant cost saving.

Abdominal aortic aneurysm (AAA) represents a major health problem affecting 2%–8% of males over the age of 60 and 1% of women older than 64 years. A lot of patients with AAA remain asymptomatic until the rupture occurs. Early diagnostic and prophylactic surgical intervention (open or endovascular) is essential to prevent rupture. The open repair remains the most durable intervention but the actual approach moves to endovascular aneurysmal repair (EVAR) in most countries. EVAR is nowadays considered the technique of first choice for infrarenal AAAs with suitable aortic anatomy. There are new evolving technologies making endovascular approach suitable to almost all type of aortic morphology as well as acute or chronic pathologies. Patient selection is crucial in the successful treatment of AAA. We should carefully investigate and consider the anatomy of the abdominal aorta but also the comorbidities of the patient when we establish the treatment we propose. Medium and long-term results have improved over the years both in open and endovascular approaches due to better preoperative planning and postoperative management but also to new and refined devices for endovascular treatment.

Acute massive pulmonary embolism (PE) is a life threatening condition requiring quick diagnosis and intervention. The mortality rate in this acute entity is high despite progress in therapeutically strategies. Acute PE is the third most common cause of death among hospitalized patients. Currently, multidisciplinary teams with cardiovascular surgeons’ involvement have introduced again the surgical embolectomy on cardiopulmonary bypass for high risk patients with PE and also for selected patients with intermediate-high risk, particularly if thrombolysis is contraindicated or failed. There is also recent evidence data that supports prompt multidisciplinary approach and individualized indication of surgery before hemodynamic collapse, while the mortality rates are of 6% or less. Complete removal of thrombotic material from pulmonary arteries is the best predictor to avoid persistent pulmonary artery hypertension. Acute pulmonary embolectomy on cardiopulmonary bypass is safe and it has good and long-lasting results in patients with severe right ventricular dysfunction.

A 55-year-old female who undergone mitral valve replacement eight years ago with a mechanical graft, presented accusing sudden decrease of effort tolerance and two episodes of pulmonary edema in the last month. Anamnesis, physical examination, electrocardiogram (ECG), transthoracic echocardiography and coronarography were performed. The mechanical valve leaflets and the tissue surrounding the prosthetic ring were evaluated by: optical microscopy (hematoxylin eosin stain and immunohistochemistry), scanning electron microscopy (SEM) and EDAX analysis (Energy Dispersive X-ray spectroscopy). Anamnesis: inferior myocardial infarction in 2006, congestive cardiac insufficiency, pulmonary hypertension, and arterial hypertension. Clinical examination and ECG: minimal perimaleolar edema bilateral, sinus rhythm on admission. Transthoracic echocardiography: 55% ejection fraction, a pression gradient across the mitral valve (Gmax/Gmed= 24/11 mmHg), tricuspid regurgitation, and pulmonary hypertension. A mitral prosthetic valve’s leaflet was found immobile. No thrombus was evidenced. Coronarography: an immobile graft’s leaflet, stenoses on the right coronary artery, stenosis on left anterior descending artery and occlusion at the circumflex artery emergence. The prosthesis was replaced, and two coronary artery bypasses were performed. Macroscopic examination: a fibroconjunctive tissue expansion in close contact with the leaflet. Histopathological evaluation: muscle cells with altered phenotypes, fibroblasts along with fibrous connective tissue and calcium depots areas. SEM evaluation: tissue depots on the immobile leaflet, suggesting that the connective tissue expansion was blocking the leaflet’s movements. EDAX analysis: the metallic leaflets surface was made of tantalum; sodium, calcium and chloride deposits were also detected. Graft failure was caused by the tissue proliferation affecting leaflet’s mobility. SEM is a viable method for failed cardiovascular grafts investigation.

Endovascular aneurysm repair (EVAR) is an attractive alternative to open surgical approach in treating abdominal aortic aneurysms (AAA). In Nuerenberg in our 14-year experience of 1502 cases (ending December 2007) we used 13 different endografts. The median follow-up was 41 months (1.0-98) and the AAA had a mean diameter of 52.4 mm. Five-hundred and nineteen cases were done using Powerlink grafts. The 30 day mortality was 1.7%. The total reintervention rate was 5.3%, while no distal migration, conversion or post EVAR rupture occurred. At the Army's Center for Cardiovascular Diseases, Bucharest, between July 2008 and December 2009, 15 patients underwent EVAR for AAA. We used the following types of endografts: one Anaconda, three Medtronic Talent, seven Endologix Powerlink and four EVITA Jotec. The mean hospitalization time was three days. Follow-up was done by CT-scan at one, three, six, and 12 months. No endoleaks or infection were seen in the short and medium term follow-up. EVAR is an appropriate treatment for selected patients, especially those at high risk for open surgical repair. The future of EVAR as the potential gold standard for aortic aneurysm therapy rests upon the vision and creativity of both surgeons and technology innovators to realize the potential of endovascular interventions.

Background In order to elucidate the diagnosis and the correct therapeutic approaches, the present high degree of specialization, as well as the complex, frequent “borderline” pathology, impose an inter-disciplinary cooperation. We presented the main infections that imposed an inter-disciplinary cooperation; we enunciate the main imposed problems, as well as a unitary vision for these approaches.

Cardiovascular disease is a leading cause of death in all developed countries. In response to this need, endovascular management techniques have been developed across a large range of medical specialties. Minimally invasive percutaneous interventions were initially complex and challenging, but with the continued development of equipment and expertise their use has become routine in many fields. With routine use, it has become important to establish the safety and efficacy of endovascular treatments against the respective "gold standard" procedures, especially in light of their initial intended use for the management of patients at unacceptably high risk for standard therapy only. Such evaluation has to take into account the variety and diversity of devices and techniques, as well as the effects of operator dependability. Endovascular techniques are increasingly recognised as valid alternative management options for a variety of conditions, and it is anticipated that the current trend towards minimally invasive techniques will continue in the future, with moves towards increasingly complex endovascular techniques and hybrid interventions.

Heart failure patients present an important thrombo-embolic risk, including symptomatic or silent peripheral arterial embolism, pulmonary embolism, and stroke. Patients in sinus rhythm who have concomitant depressed (< 35%) left ventricular ejection fraction have a 4% rate of embolic events. Several prospective randomized trials of anticoagulation in this group of patients were either underpowered or had a short period of follow-up. Even though in two studies warfarin had a slight advantage over aspirin (in the WATCH and WARCEF trials), it was at the cost of an increased risk in major hemorrhage. To decrease bleeding rates and to improve anticoagulant effect, new treatment strategies have to be tested. Novel anticoagulants (dabigatran, rivaroxaban, and apixaban) seem to be a promising alternative.

Abdominal aortic aneurysms are identified in the elderly population; only a few patients die because of AAA rupture prior to the age of 60. The incidence of the disease in the general population is 60/1000 inhabitants [4] and between 1.8% and 6.6% in autopsies studies. In studies of natural history of AAA the rate of aneurysm rupture and death could exceed 60% within 3 years of the initial diagnosis. [5]