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To investigate the midterm results after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection.Between October 2014 and April 2021, 196 patients underwent zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection. The true lumen area, aortic lumen area, and false lumen status were assessed at four aortic levels, the proximal and distal descending thoracic aorta (level A and level B, respectively), celiac artery branching (level C), and terminal aorta (level D). Aortic remodeling (postoperative area as a percentage of the preoperative area) was classified into 3 groups, positive (true lumen area ≥120% with aortic lumen120% or true lumen area ≥80% with aortic lumen80%), minimal (80% ≤ true lumen area and aortic lumen area120%), and negative remodeling (all other changes).In-hospital mortality was 13 (6.6%) patients. The overall survival rate was 85.1% at 5 years. The freedom from distal aortic reintervention was 89.9% at 5 years. The prevalence of completely thrombosed or obliterated false lumen at 2 years was 96.8% at level A, 88.4% at level B, 47.2% at level C, and 27.6% at level D. The prevalence of positive aortic remodeling at 2 years was 84.7% at level A, 75.0% at level B, 29.2% at level C, and 16.7% at level D.Zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection can avoid invasive aortic arch resection and facilitate aortic remodeling of the descending thoracic aorta. The FET effect on aortic remodeling is limited at the aortic level below the FET stent end.

Objective The aim of this study was to investigate the effect of frozen elephant trunk deployment from the zone 0 aorta to the descending aorta on early and midterm postoperative results in patients with acute type A aortic dissection. Methods Between October 2014 and April 2018, 108 patients underwent a combined strategy of frozen elephant trunk deployment, ascending aortic replacement, and arch vessel reconstruction ("zone 0 arch repair" strategy) for acute type A aortic dissection (excluding DeBakey type II). Of the 108 patients, 32 (29.6%) had primary tears of the aortic arch or descending aorta. Results The 30-day mortality rate was 2.8% (3 patients), and in-hospital mortality rate was 6.5% (7 patients). New-onset permanent neurologic dysfunction and spinal cord injury occurred in 3.7% and 0% of patients, respectively. Five of the 101 survivors underwent thoracic endovascular aortic repair during hospitalization (2 for rapid false lumen enlargement; 3 for true lumen stenosis). The overall survival was 89.8%, 88.1%, and 88.1% at 1, 2, and 3 years, respectively. The cumulative incidence of distal aortic reintervention was 5.8%, 9.1%, and 9.1% at 1, 2, and 3 years, respectively. Two patients underwent thoracic endovascular aortic repair for distal aortic enlargement after discharge. Conclusions The use of the "zone 0 arch repair" strategy can eliminate the need for invasive aortic arch resection. It also eliminates the false lumen and produces satisfactory early and midterm postoperative results. Therefore, it can be an alternative to hemiarch and total arch replacements, which are based on a conventional "tear-oriented resection" strategy.

Background Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare complication of infective endocarditis and aortic valve replacement. Ruptured P-MAIVF and angina due to compression of the coronary arteries are severe complications of this condition. Case presentation We report a case of P-MAIVF that was diagnosed accidentally during a routine checkup. The patient was asymptomatic; however, she had a systolic murmur. She had a history of infective endocarditis, which was treated conservatively without open-heart surgery. In addition, she was diagnosed with aortic valve stenosis, aortic valve regurgitation, bicuspid aortic valve, right coronary artery stenosis, and an ascending aortic aneurysm. She was treated with surgery, which involved patch closure of P-MAIVF with aortic valve replacement, coronary artery bypass grafting, and ascending aorta replacement. After the operation, echocardiography showed no leakage from the P-MAIVF. Conclusions It is necessary to have knowledge of P-MAIVF. Following up cases of infective endocarditis and post-aortic valve replacement using echocardiography is important for both, diagnosing P-MAIVF and preventing serious complications such rupture and angina.

In patients with a congenitally corrected transposition of the great arteries (ccTGA), the regurgitation of the systemic atrioventricular valve (SAVV) increases and anatomical right ventricular (ARV) dysfunction often progressively develops. A low systemic ventricular ejection fraction( SVEF) is a risk factor for mortality. However, in patients with a low ejection fraction of ARV, it is unclear how to best perform valve replacement for patients with regurgitation of SAVV. A 70-year-old female with respirator discomfort was admitted to our hospital and diagnosed to have situs solitus ccTGA, severe SAVV regurgitation, and ARV dysfunction. Her ARV ejection fraction was 25% and she was therefore dependent on inotropic agents. We successfully performed a tricuspid valve replacement while preserving the leaflets, the chorda tendineae's, and papillary muscles, and placing the lead for cardiac resynchronization therapy on the ARV. Her postoperative course was uneventful. Thereafter, she was discharged 6 weeks after surgery.

We herein report a case of thoracic endovascular aortic repair( TEVAR) for chronic aortic dissection with an aberrant left vertebral artery( LVA) originating from the aortic arch. A 51-year-old man with a medical history of Stanford type B acute aortic dissection 2 years ago was transferred to our institution for the treatment of an aortic expansion. Computed tomography showed a large entry just distal to the takeoff of the left subclavian artery and a dilated dissected thoracic aorta. A left cervical incision over the anterior border of the sternocleidomastoid was made, and the LVA was identified. The proximal LVA was ligated and anastomosed to the left common carotid artery in an end-to-side fashion. After completion of the carotid-subclavian bypass, TEVAR was performed in the usual fashion. The postoperative course was uneventful without stroke or spinal cord injury. At the 1-year follow-up, the false lumen had shrunk and the LVA remained patent.

Background Left atrial dissection is a rare complication of cardiac surgery, most commonly associated with mitral valve surgery. Herein, we report on the successful conservative treatment of left atrial dissection while avoiding anticoagulation therapy. Case presentation A 64-year-old man developed left atrial dissection during operation for acute type A aortic dissection, most likely due to retrograde cardioplegia cannulation. As there was no connection between the left atrial dissection cavity and the left atrium on enhanced computed tomography, we did not administer anticoagulants to prevent expansion of the left atrial dissection cavity. However, the patient developed atrial fibrillation, which was successfully managed by beta-blocker and amiodarone administration. Follow-up imaging showed gradual left atrial dissection reduction, and the patient was started on anticoagulation therapy. Conclusion We were able to resolve left atrial dissection by preventing the use of anticoagulation therapy in the acute stage by managing the atrial fibrillation with antiarrhythmic drugs.

Aortic and arterial calcification is a complication of advanced atherosclerosis and is a critical intraoperative issue that can reduce the ability to achieve safe and adequate access for stent graft introduction. Different vascular access sites are used to deliver stent grafts when a standard transfemoral or iliac access is not feasible. We report a challenging case of a direct transabdominal aortic thoracic endovascular aortic repair for a thoracic aortic aneurysm complicated with severe aortic and arterial calcification, in which the noncalcified area of the infrarenal abdominal aorta was extremely limited. This may be a reasonable access site, especially for patients with severe aortic and arterial calcification.

Background Rupture of an iliac artery aneurysm is rare but could be catastrophic unless it is treated with an appropriate strategy. We reviewed our 10-year institutional experience in treating iliac artery aneurysms to elucidate the effectiveness of open surgical repair strategies for ruptured iliac artery aneurysms in terms of short- and long-term postoperative results. Methods A total of 26 patients (men/women = 22/4), with a mean age of 72 years, underwent open repair of iliac artery aneurysm with or without rupture (unruptured/ruptured = 15/11) between January 2001 and April 2010. There was no difference in the distribution of aneurysm morphology between the unruptured and ruptured groups, and 20 (76.9%) of the 26 patients had aneurysms involving unilateral or bilateral internal iliac arteries. Long-term event-free survival rates and freedom from secondary intervention were analyzed using the Kaplan–Meier method (follow-up: 55 ± 39 and 40 ± 25 months in the unruptured and ruptured groups, respectively). Results There was no difference in the time of surgery between the two groups (351 ± 118 and 348 ± 152 minutes in the unruptured and ruptured groups, respectively), but the ruptured group showed greater blood loss/min (time of surgery) and transfusion volume than the unruptured group. The early postoperative mortality was 6.7% in the unruptured group and 0% in the ruptured group ( p = 0.557). There was no difference in the number of postoperative morbidities between the two groups, but the ruptured group showed significantly greater C-reactive protein, lactate dehydrogenase, and total bilirubin levels than the unruptured group. The cardiovascular event-free survival rate at 5 years was 93.3% and 100.0% in the unruptured and ruptured groups, respectively. The secondary intervention-free rate at 5 years was 100.0% and 90.0% in the unruptured and ruptured groups, respectively. Conclusions The short- and long-term postoperative mortality rates after open repair for iliac artery aneurysms were satisfactorily low and similar in unruptured and ruptured groups. This suggests that open repair strategies remain as a reliable treatment option to obtain successful postoperative results in patients with rupture of an iliac artery aneurysm.

Introduction La rupture d’anevrysme iliaque est rare mais peut avoir des consequences catastrophiques sans traitement approprie. Nous revoyions l’experience de notre institution sur 10 ans dans le traitement des anevrysmes iliaques afin d’examiner l’efficacite du traitement chirurgical ouvert pour anevrysme iliaque rompu en termes de resultats postoperatoires a court et long termes. Methode A total, 26 patients (hommes/femmes = 22/4) d’âge moyen 72 ans, avaient un traitement chirurgical ouvert pour anevrysme iliaque avec ou sans rupture (non rompus/rompus = 15/11) entre Janvier 2001 et Avril 2010. Il n'y avait pas de difference en termes de morphologie anevrysmale entre les anevrysmes rompus et non rompus, et 20 (76,9%) patients sur 26 avaient des anevrysmes impliquant une ou deux iliaques internes. Les taux de survie a long terme sans evenement et d’indemnite d’intervention secondaire etaient analysees en utilisant la methode de Kaplan–Meier (survie : 55 ± 39 mois et 40 ± 25 mois dans les groupes non rompus et rompus, respectivement). Resultats Il n'y avait pas de difference concernant la duree operatoire entre les deux groupes (351 ± 118 et 348 ± 152 minutes dans les groupes non rompus et rompus, respectivement), mais le groupe rompus presentait d’avantage de pertes sanguines/min (duree operatoire) et de transfusions en comparaison au groupe non rompus. La mortalite postoperatoire precoce etait de 6,7% dans le groupe non rompus et de 0% dans le groupe rompus (p = 0,557). Il n'y avait pas de difference concernant la morbidite postoperatoire entre les deux groupes, mais le groupe rompus avait des taux plus eleves de C-reactive proteine, lactate deshydrogenase et bilirubine totale que le groupe non rompus. Le taux de survie sans evenement cardiovasculaire a 5 ans etait de 93,3% et 100,0% dans les groupes non rompus et rompus, respectivement. Le taux de survie sans intervention secondaire a 5 ans etait de 100,0% et 90,0% dans les groupes non rompus et rompus, respectivement. Conclusions Les taux de mortalite postoperatoire a court et long termes apres chirurgie ouverte pour anevrysme iliaque etaient bas et similaires dans les groupes non rompus et rompus. Ceci suggere que le traitement chirurgical ouvert demeure un traitement fiable pour obtenir des resultats postoperatoires satisfaisants chez les patients presentant une rupture d’anevrysme iliaque.

Acute aortic occlusion is a rare but catastrophic pathology with high mortality even after revascularization. We describe four patients who underwent thrombectomy or bypass surgery for acute aortic occlusion with concomitant internal iliac artery occlusion. Two patients (82- and 75-year-old men), who had insufficient reperfusion of bilateral internal iliac arteries after treatment (thrombectomy alone and axillobifemoral bypass, respectively), died on postoperative day three of uncontrollable hyperkalemia and multiple organ failure, respectively (mortality: 50%). The third patient (74-year-old man), in whom the left internal iliac artery was reperfused after an axillobifemoral bypass, underwent right lower limb amputation but survived. The fourth patient (63-year-old man) with sufficient internal iliac artery reperfusion bilaterally after aortobifemoral and right internal iliac artery reconstruction, had an uneventful postoperative course. Elevated creatine phosphokinase and myoglobinuria levels were observed in all four patients but were notably higher in the two patients with no reperfusion in either of the internal iliac arteries. Our results suggest that reperfusion of one or more internal iliac arteries may be a crucial factor in reducing mortality in revascularization treatment of acute aortic occlusion with concomitant internal iliac artery occlusion.

An 84-year-old woman with a history of surgery for cholangiocarcinoma presented to Akita University Hospital with severe right lower abdominal pain, respiratory distress, and hypotension. Computed tomography scanning revealed a ruptured right common iliac artery aneurysm with a massive right retroperitoneal hematoma and a right internal iliac artery aneurysm. Under the bilateral retroperitoneal approach, we preformed an in-situ repair of an aneurysm rupture from the aorta to the left common and right external iliac arteries using a bifurcated knitted Dacron graft, and then we ligated the right internal iliac artery. The postoperative course of the patient was uneventful. The patient was discharged from hospital 52 days after surgery. In conclusion, a bilateral retroperitoneal approach may be a safe and useful strategy for in-situ repair of a right iliac artery aneurysm rupture in patients with peritoneal adhesions after transperitoneal abdominal surgery.

The patient, a 55-year-old female Jehovah's Witness who had suffered type B aortic dissection since the age of 53 years, presented with enlargement of the false lumen in the distal aortic arch and was subsequently admitted to our hospital. While hospitalized, her enlarged false lumen ruptured and she underwent replacement of the distal aortic arch and descending thoracic aorta without blood transfusion. Blood conservation strategies for this patient included the following: 1) meticulous hemostasis when incising muscle or soft tissue, 2) minimal use of gauze and discard suckers, 3) exclusive use of a cell salvage device "from skin to skin," 4) low-prime cardiopulmonary bypass, 5) minimal laboratory blood sampling, and 6) preoperative and postoperative erythropoietin treatment. Hemoglobin (Hb) values were 12.5, 15.5, 10.0, and 9.7 g/dL on admission, before rupture, after rupture, and just after the operation, respectively. The patient had an uneventful postoperative course, except for prolonged rehabilitation. The postoperative lowest Hb value was 5.2 g/dL on postoperative day 5, and the Hb value at hospital discharge (postoperative day 55) was 11.0 g/dL. Our experience with blood conservation surgery on this Jehovah's Witness patient suggests that ruptured chronic type B aortic dissection can be safely repaired on bypass through a left thoracotomy with no blood transfusion if the preoperative Hb value is >10.0 g/dL.

We describe a 74-year-old male who underwent open stent repair for an infrarenal abdominal aortic aneurysm with a severely calcified aortic neck. The stent graft was constructed by covering a 50-mm long Gianturco Z stent (diameter: 20 mm) with a Dacron prosthesis (diameter: 20 mm). The stented Dacron graft was inserted into the calcified aortic neck, was then sutured to the trimmed aneurysmal wall, and was anastomosed to a bifurcated prosthesis. The distal ends of the bifurcated prosthesis were anastomosed to both common femoral arteries, and the terminal aorta was closed. The patient had an uneventful postoperative course. This procedure may be a feasible and safe way to repair infrarenal abdominal aortic aneurysm with a severely calcified aortic neck.

Persistent sciatic artery (PSA) is a rare congenital vascular malformation. In this article, we have described the case of a 66-year-old woman presenting with a pulsatile mass in the left buttock and bilateral lower limb ischemia, who underwent surgical therapy. Preoperative computed tomography scanning showed a left thrombosed PSA aneurysm (PSAA) with concomitant occlusion of bilateral iliac, bilateral common femoral, and left popliteal arteries. After recanalization of the left common femoral artery occlusion with a systemic heparin treatment, the patient underwent bypass surgery (left femoropopliteal bypass, right iliofemoral bypass) and PSAA exclusion. Postoperative computed tomography scanning 20 months after surgery revealed that the excluded PSAA was thrombosed with no refilling collateral flow, and that the bypass grafts were patent in both legs. In addition to this case report, a literature review of PubMed articles published between 1965 and 2009 that included the treatment and intermediate/long-term management of symptomatic PSAs was conducted. We found 45 articles (67 limbs), of which 24 (29 limbs) described the intermediate/long-term outcomes in patients treated for symptomatic PSA. Regardless of the method of arterial reconstruction or PSAA repair, intermediate/long-term outcomes of different treatments for lower limb ischemia and PSAAs were satisfactory, and the patients were asymptomatic during the follow-up period which ranged from 2 months to 10 years.

A 56-year-old man with a painful, progressively enlarging pulsatile mass in the bilateral popliteal fossae was diagnosed with a bilateral popliteal artery aneurysm (PAA) and referred to our hospital to undergo surgical therapy. Computed tomographic scanning demonstrated a large, middle-type PAA with a rich mural thrombus in the bilateral popliteal arteries. Following aneurysm exclusion posteriorly, the patient underwent bypass surgery using a ringed polytetrafluoroethylene graft bilaterally. This procedure was chosen to prevent nerve injury caused by mobilization of the adherent nerves and aneurysmal resection. The patient had a satisfactory postoperative course. This procedure may be recommended for large, middle-type PAAs because (1) the adherent tibial nerve trunk and its branch nerves can be protected by aneurysm exclusion with arterial branch ligation and (2) frequently occurring postexclusion expansion of the aneurysm caused by insufficient branch ligation using the medial approach can be avoided.

L'artere sciatique persistante (PSA) est une malformation vasculaire congenitale rare. Dans cet article, nous decrivons le cas d'une femme de 66 ans se presentant avec une masse pulsatile de la fesse gauche et une ischemie bilaterale des membres inferieurs, traitee chirurgicalement. Le scanner preoperatoire montrait un anevrysme thrombose de la PSA gauche (PSAA) avec occlusion iliaque et femorale commune bilaterale et occlusion de l’artere poplitee gauche. Apres recanalisation de l'occlusion de l'artere femorale commune gauche avec un traitement systemique par l'heparine, la patiente a eu une revascularisation (femoropoplitee gauche et ilio-femorale droite) avec exclusion du PSAA. Le scanner postoperatoire 20 mois apres chirurgie montrait que le PSAA exclu etait thrombose sans reflux collateral, et que les pontages etaient permeables. En plus de ce cas, une revue de la litterature PubMed publiee entre 1965 et 2009 qui incluait le traitement et le suivi intermediaires/a long terme des PSA symptomatiques a ete faite. Nous avons trouve 45 articles (67 membres), dont 24 (29 membres) decrivaient les resultats intermediaires/a long terme chez les patients traites pour PSA symptomatique. Independamment de la methode de reconstruction arterielle ou de reparation du PSAA, les resultats intermediaires/a long terme des differents traitements pour ischemie des membres inferieurs avec PSAAs etaient satisfaisants, et les patients etaient asymptomatiques au cours de la periode de suivi allant de 2 mois a 10 ans.

Nous decrivons un malade presentant une occlusion aortique due a l’expansion du faux chenal apres la reparation d’une rupture aortique abdominale au cours d’une dissection aortique aigue de type B. Un homme de 70 ans se presentait a un hopital voisin avec des douleurs lombo-sacrees importantes, et nous etait adresse avec le diagnostic de rupture aortique abdominale. La tomodensitometrie a l’admission montrait une dissection aortique de type B avec rupture concomitante du faux chenal au niveau d’un anevrysme de l’aorte abdominale sous-renal preexistant. Le malade avait un remplacement aortique abdominal avec reconstruction de la vraie lumiere avec une prothese tricotee bifurquee en Dacron. Au 2eme jour postoperatoire, le malade developpait une ischemie severe de l’hemicorps inferieur. La tomodensitometrie montrait l’occlusion complete de la vraie lumiere au niveau de l’artere renale en raison de l’expansion du faux chenal. Le malade eut une fenestration ouverte en ouvrant le lambeau saillant avec un distal prothetotomie transversale en aval de l’anastomose proximale. Apres fenestration, le patient developpa des complications metaboliques graves (syndrome myo-nephropathique metabolique) et est mort un jour plus tard d’arret cardiaque par l’hyperkaliemie. Le remplacement aortique abdominal avec reconstruction de la vraie lumiere chez les malades ayant une rupture aortique abdominale dans les dissections aortiques aigues de type B peut egalement mener a l’occlusion aortique aigue due a une re-dissection ou a l’alteration de la vraie lumiere accompagnant une propagation retrograde de la thrombose du faux chenal. Cette complication mortelle apres reconstruction de la vraie lumiere pourrait etre empechee par un procede adjuvant tel que la fenestration concomitante.

We describe a patient with aortic occlusion due to false-lumen expansion after repair of abdominal aortic rupture in acute type B aortic dissection. A 70-year-old man presented to a nearby hospital with severe lower back pain, and was subsequently referred to our hospital with a diagnosis of abdominal aortic rupture. Computed tomography scanning on admission revealed type B aortic dissection with concomitant false-lumen rupture at the level of pre-existing infrarenal abdominal aortic aneurysm. The patient underwent abdominal aortic replacement with the true lumen reconstructed using a bifurcated knitted Dacron graft. On postoperative day 2, the patient developed severe lower body ischemia. Computed tomography scanning revealed complete true-lumen occlusion at the renal artery level because of false-lumen expansion. The patient underwent open fenestration by opening the bulging flap with a transverse graftotomy distal to the proximal graft anastomosis. After fenestration, the patient developed severe metabolic complications (i.e., myonephropathic-metabolic syndrome) and died a day later of cardiac arrest resulting from hyperkalemia. Abdominal aortic replacement with true-lumen reconstruction in patients with abdominal aortic rupture in type B acute aortic dissection could also lead to acute aortic occlusion due to re-dissection or true-lumen compromise accompanying retrograde propagation of false-lumen thrombosis. This lethal sequela after true-lumen reconstruction might be prevented by an adjuvant procedure such as concomitant fenestration.

We describe a rare case of an arteriosclerotic aneurysm in the right-sided descending thoracic aorta with a left-sided aortic arch and concomitant aberrant right subclavian artery. A 76-year-old woman, who was found to have an aneurysm of the right-sided descending thoracic aorta, was referred to our hospital for surgical treatment. Contrast computed tomography scan revealed a left-sided aortic arch with an aberrant right subclavian artery, a descending thoracic aorta passing downward behind the esophagus, and an aneurysm of the right-sided and distal (level between the 8th and 10th vertebral bodies) descending thoracic aorta. With a right posterolateral thoracotomy, the patient underwent descending thoracic aorta replacement using an 18-mm woven Dacron prosthesis. The patient had an uneventful postoperative course and was discharged 24 days after surgery. Histological microscopic examination of the resected aneurysmal wall revealed an arteriosclerotic aneurysm. The postoperative computed tomography scan 18 days after surgery revealed no anastomotic aneurysm or abnormal fluid collection.

Nous decrivons un rare cas d’anevrisme atheromateux d’une aorte thoracique descendante droite avec une crosse aortique gauche et une artere sous-claviere droite anormale concomitante. Une femme de 76 ans, qui avait un anevrisme d'uneaorte thoracique descendante droite, etait adressee a notre hopital pour le traitement chirurgical. Le scanner de contraste montrait une crosse aortique gauche avec une artere sous-claviere droite anormale, une aorte thoracique descendante passant derriere l’oesophage, et un anevrisme (situe entre les 8eme et 10eme corps vertebraux) de l’aorte thoracique descendante droite distale. Par thoracotomie postero-laterale droite, la patiente a eu le remplacement de l’aorte thoracique descendante avec une prothese en Dacron tisse de 18 mm. La patiente a eu des suites postoperatoires simples et est sortie 24 jours apres la chirurgie. L’examen histologique de la paroi anevrismale resequee montrait un anevrisme arteriosclereux. Le scanner 18 jours apres la chirurgie ne montrait ni anevrisme anastomotique ni collection liquidienne anormale.

Une femme de 78 ans, qui avait un antecedent de resection abdomino-perineale avec stomie gauche pour cancer du rectum, avait un anevrysme de l’aorte abdominale sous-renale interessant les arteres iliaques commune et interne droites. Elle etait traitee par remplacement prothetique in situ (Dacron bifurque) avec un abord retroperitoneal droit en raison d’un acces limite a l’aorte et aux arteres iliaques lie a la stomie gauche. Les anastomoses distales de la prothese bifurquee etaient faites sur l’artere iliaque externe droite et l’artere femorale gauche, et l’artere iliaque commune gauche etait exclue en ligaturant les collaterales. Le patient a eu des suites simples, et le scanner 13 mois apres la chirurgie montrait l’occlusion de l’anevrysme iliaque commun gauche exclu. En conclusion, un abord retroperitoneal droit peut etre une option pour les patients ayant un anevrysme de l’aorte abdominale qui ont des antecedents de chirurgie abdominale transperitoneale et une stomie gauche.

A 78-year-old woman, who had a history of abdominoperineal resection with the associated left-side stoma for rectal cancer, was diagnosed with an infrarenal abdominal aortic aneurysm involving both common and right internal iliac arteries. She underwent in situ graft (bifurcated Dacron) replacement through a right retroperitoneal approach because of limited accessibility to the aorta and iliac arteries due to the left-side stoma. The distal anastomosis of the bifurcated graft was placed to the right external iliac artery and left femoral artery, and the left common iliac artery was excluded by ligating the branching arteries. The patient had an uneventful postoperative course, and the computed tomography scanning at 13 months after surgery revealed thrombosed occlusion of the excluded left common iliac aneurysm. In conclusion, a right retroperitoneal approach may be an option for abdominal aortic aneurysm patients who had a history of transperitoneal abdominal surgery and an associated left-side stoma.

Un diagnostique d’anevrysme poplite (AP) bilateral a ete etabli chez un homme de 56 ans devant la presence de masses pulsatiles evolutives et douloureuses au niveau des deux creux poplites. Le patient a ete adresse dans notre institution pour prise en charge chirurgicale. Un angioscanner a confirme la presence de deux larges AP avec thrombus mural. Apres exclusion des deux AP par voie posterieure, deux pontages prothetiques en polytetrafluoroethylene annele ont ete realises de chaque cote. Cette technique a ete choisie pour eviter la survenue de blessures nerveuses consecutivement a la mobilisation des nerfs tibiaux durant la dissection de l’anevrysme. Les suites operatoires ont ete simples. Cette procedure peut etre envisagee pour les AP larges en raison (1) d’une diminution du risque de blessure du nerf tibial et de ses branches, du fait d’une simple exclusion de l’anevrysme avec ligature des branches, et (2) de la possibilite d’eviter la croissance anevrysmale postoperatoire par ligature insuffisante des branches collaterales naissant de la zone anevrysmale lorsque l’abord est realise par voie mediale.