Aortic Disease

Emphysematous aortitis is a form of septic aortitis. It is a rare disease with a high mortality rate, necessitating prompt diagnosis and aggressive treatment. We present the computed tomography features of emphysematous aortitis leading to esophageal rupture and esophageal-pleural fistula in a 76-year-old female with rheumatoid arthritis.

Background/Aims: The aim of this study was to investigate all-cause and cardiovascular mortality in chronic hemodialysis patients (CHP) and to identify the determinants of mortality predictors. Methods: In this study with 3 years of follow-up period, we studied a cohort of 80 CHPs. Mean age at entry was 59.3 ± 11.8 years (duration of dialysis 5.47 ± 5.16 years). At entry, together with standard clinical and biochemical analyses, pulse wave velocity (PWV) was determined from time diversity propagation of the common carotid artery and common femoral artery flow signals by Doppler ultrasound. Results: The mean PWV (m/s) was presented at entry: in survived (12.5 ± 2.01) and deceased (13.13 ± 1.70) patients. The PWV cutoff point (by ROC curves) was 11.8. The regression coefficients (b) and Exp (b) hazard ratio coefficients of covariates in Cox-regression survival analysis in all-cause and CV outcomes was: PWV (b = 0.2617, Exp[b] = 1.2992, p = 0.0027; b = 0.3569, Exp[b] = 1.4289, p = 0.0005), CRP (b = 0.0776, Exp[b] = 1.0807, p = 0.0001; b = 0.0832, Exp[b] = 1.0868, p = 0.0001) and albumin (b = −0.1302, Exp[b] = 0.8779, p = 0.0089; b = −0.1881, 0.8285, p = 0.0030), respectively. Relative risk for exposed groups according to all-cause and CV events was 4.2976 (95% CI = 1.6051–11.5071) and 14.3590 (95% CI = 1.6051–11.5071), p = 0.0037, respectively. Conclusions: We conclude that PWV, CRP and serum albumin are strong independent predictors of overall and CV mortality in patients undergoing dialysis.

El propósito principal de la presente publicación consiste en la determinación adecuada del orden fraccional en el modelo viscoelástico de Zener y el análisis de las implicaciones que se derivan de la precisión en la obtención del mismo. Esto se realiza empleando el método numérico de Levenberg-Marquardt a partir de valores reportados en la literatura. Los parámetros utilizados son obtenidos para un segmento de arte-ria empleando un experimento de relajación a los esfuerzos. Una vez determinado el orden fraccional se procede a determinar la solución del modelo empleando la función de dos parámetros de Mittag-Leffler y la operación de convolución, con la finalidad de comparar el comportamiento del modelo de orden fraccional con el de orden entero e identificar sus principales diferencias. Se obtienen además las deformaciones que experimenta la arteria bajo el estímulo de un pulso sanguíneo normal y otros disímiles,simulando el efecto provocado en el flujo sanguíneo por una arritmia y el ocasionado por el proceso de ventilación mecánica. Por último se analiza la respuesta dinámica del material bajo una serie de pulsos,utilizando la operación de convolución y el método numérico de Gauss-Kronrod, identificando la precisión en la reproducción de los mismos en el modelo de orden fraccional comparado con el de orden entero.

The development of the frozen elephant trunk (FET) technique for a simplified treatment of complex lesions of the thoracic aorta originated as an evolution of the classic elephant trunk technique, described for the first time by Borst et al. [1] in 1983. Novel technologies and standardization of the surgical approach produced a progressive improvement of early and late outcomes. Most of the time and for specific indications, FET procedure allows physicians to treat lesions involving extensive portions of the thoracic aorta in one single step. Spinal cord injury remains one of the main complications of this procedure, even though spinal protection strategies have led to better results. We hereby report our opinions and recommendations based on our experience started in 2007.

Aorto-esophageal fistula is often a terminal event in many patients. The commonest causes are thoracic aortic aneurysm and esophageal malignancy. To achieve a good outcome in this condition, a MDT approach is required that combines the expertize of vascular surgeons, radiologists, and emergency physicians. A 50-year-old man presented to the Emergency Department (ED) with hematemesis and epigastric pain. This was on a background of a 1-week history of progressive chest and upper abdominal pain and he had been taking regular ibuprofen for analgesia. Seven months previously, he had been diagnosed with a lower esophageal adenocar-cinoma, for which he underwent esophageal stenting and neoadjuvant chemoradiotherapy. One week prior to his presentation, he had undergone a restaging CT and was awaiting multidisciplinary team (MDT) discussion later that week. On arrival, he was in hypovolemic shock, with a heart rate of 110 bpm and blood pressure of 90/41 mmHg. The emergency department team resuscitated him successfully, but further large volume hematemesis resulted in profound refractory hypotension. The anesthetic team, medical registrar, and emergency endoscopy registrar were called at this point. Initial blood gas results showed a hemoglobin of 8.8 g/dL. Once stabilized, the patient was prepared for an urgent esophagogastroduodenoscopy (OGD) under general anesthetic in the operating theater. The OGD identified frank bleeding originating from the lower esophagus. A bleeding point could not be identified but appeared to originate from the same region as the tumor. The hemorrhage was unresponsive to endo-scopic coagulation attempts and the interventional radiol-ogists and vascular surgeons were therefore contacted, with a view to performing embolization of the culprit vessel. However, the patient's past medical history of esopha-geal adenocarcinoma and briskness of the bleeding encountered on OGD also raised a possibility of an aorto-esophageal fistula. Hence, as the patient was being prepped for angiography, a contingency plan to place an aortic endograft was also made, if a fistula was identified. The patient was too unstable to undergo CT imaging to determine the aortic dimensions for potential stent graft placement. However, liaison with the radiologists at the ter-tiary center managing his esophageal cancer allowed for axial measurements of the aorta to be made from his recent staging CT scan and this information was relayed verbally