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A 65-year-old man with ischaemic encephalomalacia following surgery for an aortic arch aneurysm experienced episodes of stereotyped formed visual hallucinations uniquely provoked by television viewing. In addition he noted vertical diplopia of cerebral origin. These symptoms are discussed in the light of what is known about visual hallucinations, television-induced epilepsy, and cerebral polyopia.

Summary Two cases of severe tracheal compression caused by aortic arch aneurysm are reported. There was a marked similarity in the clinical presentation of these patients but the different outcomes of surgical resection appeared to be related to the content of the aneurysms. The first patient had a fixed obstruction due to solid clot, which proved irreversible; while the second had an aneurysm containing fluid blood. The anaesthetic management of this complication is discussed.

A case of relapsing polychondritis with aortic arch aneurysm and aortic arch syndrome is described. The pattern of vascular involvement supports the inclusion of relapsing polychondritis within the spectrum of systemic vasculitides.

Resection of a syphilitic aortic arch aneurysm in a 62-yearold woman was accomplished using a trifurcation temporary bypass system. The bifurcation graft was sutured end-to-side to the ascending thoracic aorta, to the brachiocephalic trunk and to the left common carotid artery, respectively. The attached third limb end was anastomosed end-to-side to the infrarenal abdominal aorta. This technique enabled a larger shunt into the abdominal aorta. Occlusion of the iliac arteries proved to be effective in coping with hypotension while attending to the bypass and the volume replacement. The post-operative recovery was uneventful and the patient has remained well after 43 months.

Hereditary hemorrhagic telangiectasia (Osler's disease) is a well-defined entity transmitted as a simple mendelian dominant. It is characterized by typical vascular lesions of the skin and mucous membranes, and by hemorrhagic manifestations—most commonly epistaxis—appearing in late adult life. A classical and accurate description of this disease was written by Osier 1 ; subsequent pathologic and clinical studies have been summarized in a thorough review by Bean. 2 In the last 15 years the occurrence of pulmonary arteriovenous shunts, 3 hemangiomas of the liver associated with portal fibrosis, 4 and reports of aneurysms of the splenic 5 and hepatic 2 arteries have led to the recognition that these patients may have a generalized derangement in blood vessel structure and function. The following report deals with the presence of an aortic aneurysm in a patient with this disease. Such an occurrence has not been previously recorded. Report of Case A 77-year-old woman of Norwegian origin was admitted to

International audience; Total endovascular repair of the aortic arch represents a promising option for patients ineligible to open surgery. Custom-made design of stent-grafts (SG), such as the Terumo Aortic® RelayBranch device (DB), requires complex preoperative measures. Accurate SG deployment is required to avoid intraoperative or postoperative complications, which is extremely challenging in the aortic arch. In that context, our aim is to develop a computational tool able to predict SG deployment in such highly complex situations. A patient-specific case is performed with complete deployment of the DB and its bridging stents in an aneurysmal aortic arch. Deviations of our simulation predictions from actual stent positions are estimated based on post-operative scan and a sensitivity analysis is performed to assess the effects of material parameters. Results show a very good agreement between simulations and post-operative scan, with especially a torsion effect, which is successfully reproduced by our simulation. Relative diameter, transverse and longitudinal deviations are of 3.2±4.0%, 2.6±2.9mm and 5.2±3.5mm respectively. Our numerical simulations show their ability to successfully predict the DB deployment in complex anatomy. The results emphasize the potential of computational simulations to assist practitioners in planning and performing complex and secure interventions.

A 78-year-old man, who had previously undergone coronary artery bypass graft surgery, was admitted to our department for treatment of a distal aortic arch aneurysm. A total aortic arch replacement with a patent left internal thoracic artery (LITA) graft was successfully performed without cardiac ischemic or neurological complications. Use of retrograde cardioplegia with intermittent pressure-augmented retrograde cerebral perfusion without clamping and dissecting the LITA graft were effective in myocardial and cerebral protection.

Thehistoryofprevious chesttrauma,eventhoughremote,andthelackofevidence ofothercauses suggest thatthesaccular aneurysm inthiscasehasatraumatic origin.Thelocation ofasaccular aneurysm attheisthmus ofanormalleftaorticarchissufficiently characteristic that,intheproperclinicalsetting, itisvirtually diagnostic ofatraumatic origin

Eur J Vasc Endovasc Surg 25, 188–189 (2003)

Endovascular treatment for aortic aneurysms carries a lower mortality than open surgery, especially for thoracic aortic aneurysms (TAA) which usually affect a high-risk patient population. Furthermore when the aneurysm is located in the aortic arch, the surgical approach presents additional problems such as recurrent laryngeal nerve and phrenic nerve lesions, cerebrovascular complications and pulmonary parenchymal damage. Nevertheless the endovascular approach, even if less invasive, can be difficult because of the curvature of the aortic arch and because of the need to keep the cerebral vessels open. This paper describes a combined approach, surgical and endovascular, where cerebral vessel reconstruction was carried out before endovascular surgery.

BACKGROUND Surgery of the aortic arch aneurysm presents 2 fundamental challenges: Cerebral perfusion and myocardial protection. False aneurysms of the traumatic aortic arch are rare, and 2% to 5% of patients with aortic injury develop false aneurisms. The basic technique of cerebral protection is deep hypothermic circulatory arrest, which can (or cannot) be combined with selective anterior perfusion or retrograde cerebral perfusion (RCP). The best results are obtained by combining moderate hypothermic circulatory arrest and selective anterior perfusion. We present

Five patients in end-stage irreversible renal failure required surgery for major cardiovascular problems. Two patients underwent emergency pericardiectomy for relief of cardiac tamponade, one had an aortic arch aneurysm wrapped with a tailored synthetic graft, and two underwent prosthetic heart valve replacement. Cardiovascular surgery can be performed safely in the face of severe renal failure if the proper teamwork and facilities are available.

Background: To compare the outcomes of hybrid endovascular and open surgical repair for proximal aortic arch diseases. Methods: A total of 55 consecutive patients with an aortic arch aneurysm or aortic dissection involving any of zone 0 to 1 (39 male, age 63.4±14.3 years) who underwent a hybrid endovascular repair (n=35) or open surgical repair (n=20) from 2006 to 2014 were included in a retrospective analysis. Perioperative and late outcomes were compared. Results: The two groups had similar baseline characteristics, except age and EuroSCORE II, which were higher in the hybrid group. Perioperative mortality or stroke did not differ significantly between the two groups, but tended to be lower in the hybrid repair group than in the open repair group (11.4% vs. 30.0%, p=0.144). Incidences of other morbidities did not differ. During follow-up, similar over-all survival was observed between the hybrid group and the open repair group (87.3% vs. 79.7% at 1 year and 83.8% vs. 72.4% at 3 years; p=0.319). However,...

To report our early experience with total endovascular repair of aortic arch aneurysm using additional trans-carotidal double chimney-grafts to preserve blood flow to supraaortic arteries. The double chimney-graft technique was performed in six male patients. Main diagnoses were ruptured aneurysm

Following most recent scan, mean sac size increased by 13mm ( 20 to +26) with 17% having a reduction in sac size (n 1⁄4 2). Conclusion: Our results show a low success rate which is in keeping with current data. Given the small patient numbers, larger study is required to confirm our preliminary findings. To this end we are planning to review all EVAR procedures, re-intervention rates and post-operative outcomes.