Genetic and metabolic causes of arterial disease

Ruptured thoracoabdominal aortic aneurysm in a renal transplant patient with Alport's syndrome

Alport's syndrome is a rare genetic disorder of type IV basement membrane collagen synthesis that typically presents with nephropathy, deafness, and ocular abnormalities. To the best of our knowledge, this is the first report in the world's literature of ruptured thoracoabdominal aortic aneurysm in a young patient with Alport's syndrome and a renal transplant. Hypotheses on an association between collagen disease in Alport's syndrome and aortic aneurysms are discussed.

[Surgical management of peripheral arterial disease. Operative methods and results]

Various operative and interventional methods are available to treat patients with peripheral arterial disease (PAD). The selection of the appropriate therapy should be made after a careful review of the patient's general condition, the morphology of the arterial occlusion, the risk of possible complications, and the likelihood of long-term success for each type of treatment. The different procedures complement one another in their technical possibilities and their risk profile The combination of surgical and interventional methods offers new therapeutic possibilities. The different surgical procedures and their long-term outcome are presented in this publication.

Uncommon arteriopathies: what the vascular surgeon needs to know

Uncommon arteriopathies encompass a diverse range of diseases, including inherited collagen vascular disorders such as Marfan syndrome, Ehlers-Danlos Type IV, and pseudoxanthoma elasticum; vasculitides, including Takayasu's arteritis, extracranial giant cell arteritis, and Behçet's disease; neurofibromatosis type 1; intimal fibromuscular dysplasia; unusual bacterial and viral infections; and drug-induced arteriopathies. Patients with uncommon arterial disorders may present to the vascular surgeon with common surgical problems, including intermittent claudication, renovascular hypertension, Raynaud's phenomenon, and aneurysmal disease. However, the disease manifestations, expected course, and outcomes may be much different than more common arterial disorders and this can have important surgical implications. This review centers around several interesting cases and the differential diagnoses that should be considered when encountering an unusual clinical presentation. Reference is made to the literature for diagnostic criteria, clinical pearls, and how to avoid pitfalls in the evaluation and management of patients with unusual arteriopathies.

Ehlers-Danlos syndrome type IV: a heterogeneous disease

The Ehlers-Danlos syndrome is an inherited disorder of connective tissue, consisting of at least 10 different clinical subtypes. Type IV Ehlers-Danlos syndrome is an autosomal dominant condition characterized by the joint and dermal manifestations as in other forms of the syndrome but also by the proneness to spontaneous rupture of bowel and large arteries. The authors describe their experience with three patients presenting type IV Ehlers-Danlos syndrome: the first presented with several subsequent arterial ruptures, the second with multiple aneurysms, and the third with a dissection of the internal carotid artery. Clinical features, incidence, diagnosis, and treatment of the syndrome are discussed.

Homocystinuria presenting as fatal common carotid artery occlusion

A patient with homocystinuria presenting with fatal cerebral infarction that resulted from left common carotid artery occlusion is reported. This 13-year-old, healthy and intelligent girl presented with progressive cerebral infarction. Angiography revealed total occlusion of the left common carotid artery and stenosis of the right common carotid artery. Distal stenosis of bilateral vertebral arteries was also observed. Initially Takayasu arteritis with unusual manifestation was considered. However, later investigations revealed homocystinuria was the underlying cause. The sudden onset of fatal stroke as the initial clinical presentation of homocystinuria, as observed in this previous healthy teenager, is noteworthy. We suggest metabolic screening for homocystinuria when treating a patient with unusual vascular lesions.