Long-term complications in two patients after aortoaortic bypass for midaortic syndrome.

The midaortic syndrome (MAS) refers to descending thoracic and abdominal aortic coarctation, which is rare and most common in the pediatric population. Open surgical repair, often with aortoaortic bypass, remains a highly effective treatment and is traditionally thought to be definitive despite concerns over patient growth postoperatively. This article presents 2 cases of MAS treated with aortoaortic bypass who developed long-term complications, one related to patient growth and the other to graft-enteric fistula.

Pediatric thoracic outlet syndrome: a disorder with serious vascular complications.

Background: Thoracic outlet syndrome (TOS), caused by compression of the neurovascular structures between the clavicle and scalene muscles, typically presents with neurologic symptoms in adults. We reviewed our experience with 25 adolescents and propose a diagnostic/treatment algorithm for pediatric TOS.

Methods: From 1993 to 2005, 25 patients were treated with TOS.

Vertical ramus osteotomy allows exposure of the distal internal carotid artery to the base of the skull.

Exposure of the distal internal carotid artery (ICA) above the level of the second cervical vertebra can be difficult and often require maneuvers such as division of the digastric muscle or mandibular subluxation. These techniques increase exposure but may not provide adequate access. We report a series of eight cases in which vertical division of the mandibular ramus provided access of the ICA up to the base of the skull.

Arteriovenous fistulae complicating cardiac pacemaker lead extraction: recognition, evaluation, and management.

Transvenous pacemaker lead extraction has become a commonly performed procedure that is associated with a small but significant risk. We report two cases where lead extraction was complicated by arteriovenous fistulae between branches of the aortic arch and the left brachiocephalic vein. Presenting signs and symptoms included severe chest or back pain, persistent or copious bleeding from the venous puncture site, unexplained hypotension or anemia, superior vena cava syndrome, and signs of central venous hypertension or acute heart failure.

Antegrade visceral revascularisation via a thoracoabdominal approach for chronic mesenteric ischaemia.

Objectives: It has been suggested that patients with chronic visceral ischaemia are elderly and emaciated hence they may not tolerate antegrade visceral revascularisation via a thoracoabdominal approach. There are no studies to support this assumption. The purpose of this study is to assess the efficacy of this approach for the treatment of chronic visceral ischaemia.