Letter to the Editor
Endovascular Infrarenal Aortic Aneurysm Repair Combined With Laparoscopic Cholecystectomy
Nelson Wolosker, Cynthia de Almeida Mendes
, Carlos Eduardo Jacob, Angela Maria Borri Wolosker, Pedro Puech-Leão
Corresponding author
Disciplina de Cirurgia Vascular, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo/SP, Brazil
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"multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 416 "Ancho" => 557 "Tamanyo" => 58581 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Eccrine Porocarcinoma – Histology. <span class="elsevierStyleBold">A.</span> diffuse infiltrative pattern, <span class="elsevierStyleBold">B.</span> atypical elongated cells and central groove, <span class="elsevierStyleBold">C.</span> duct formation, <span class="elsevierStyleBold">D.</span> mitotic figure (arrow)</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Murilo de Almeida Luz, Daniel Cury Ogata, Marcos Flávio Gomes Montenegro, Luciano José Biasi, Leandro Carvalho Ribeiro" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Murilo" "apellidos" => "de Almeida Luz" ] 1 => array:2 [ "nombre" => "Daniel Cury" "apellidos" => "Ogata" ] 2 => array:2 [ "nombre" => "Marcos Flávio Gomes" "apellidos" => "Montenegro" ] 3 => array:2 [ "nombre" => "Luciano José" "apellidos" => "Biasi" ] 4 => array:2 [ "nombre" => "Leandro Carvalho" "apellidos" => "Ribeiro" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222023845?idApp=UINPBA00004N" "url" => "/18075932/0000006500000007/v1_202212010714/S1807593222023845/v1_202212010714/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Endovascular Infrarenal Aortic Aneurysm Repair Combined With Laparoscopic Cholecystectomy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "743" "paginaFinal" => "744" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nelson Wolosker, Cynthia de Almeida Mendes, Carlos Eduardo Jacob, Angela Maria Borri Wolosker, Pedro Puech-Leão" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Nelson" "apellidos" => "Wolosker" ] 1 => array:4 [ "nombre" => "Cynthia" "apellidos" => "de Almeida Mendes" "email" => array:1 [ 0 => "ynthiamendes35@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 2 => array:2 [ "nombre" => "Carlos Eduardo" "apellidos" => "Jacob" ] 3 => array:2 [ "nombre" => "Angela Maria Borri" "apellidos" => "Wolosker" ] 4 => array:2 [ "nombre" => "Pedro" "apellidos" => "Puech-Leão" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Disciplina de Cirurgia Vascular, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo/SP, Brazil" "identificador" => "aff1" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Tel.: 55 11 3885-5361" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 213 "Ancho" => 413 "Tamanyo" => 9557 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Control CT Scan</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">The incidence of concomitant abdominal aortic aneurysm (AAA) and asymptomatic cholelithiasis is 5% to 6%.<a class="elsevierStyleCrossRef" href="#bib1">1</a> In such situations, isolated standard AAA repair is associated with acute cholecystitis in up to 18% of these concomitant cases,<a class="elsevierStyleCrossRef" href="#bib2">2</a> which justifies correcting these two diseases together. When a median route is used, it can lead to infection of the prosthesis. A good alternative for preventing this complication is the use of endovascular techniques that are rarely associated with perioperative cholecystitis<a class="elsevierStyleCrossRef" href="#bib3">3</a> or the use of two different surgical routes during the same operation.<a class="elsevierStyleCrossRef" href="#bib4">4</a></p><p id="para20" class="elsevierStylePara elsevierViewall">With the development of endovascular and videolaparoscopic techniques, a further possibility described in this case report enables correction of the two diseases in the same operation with the aim of diminishing the risk of infection: endovascular treatment of infrarenal AAA associated with laparoscopically assisted cholecystectomy.</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">CASE REPORT</span><p id="para30" class="elsevierStylePara elsevierViewall">A 66-year-old man was found to have an asymptomatic 5.7-cm infrarenal AAA and cholelithiasis on a computed tomography (CT) scan of his abdomen. He had a history of controlled systemic arterial hypertension, myocardial infarction (14 years previously), coronary revascularization (one year previously) and chronic kidney failure. He was undergoing hemodialysis three days a week and awaiting a kidney transplant.</p><p id="para40" class="elsevierStylePara elsevierViewall">An infrarenal AAA measuring 5.7 cm was found while investigating a condition of abdominal pain in the right hypochondrium. On this occasion, chronic calculous cholecystopathy was also diagnosed.</p><p id="para50" class="elsevierStylePara elsevierViewall">Initially, the patient underwent endovascular treatment of AAA, using a Talent bifurcated endoprosthesis measuring 24 × 12 × 140 mm (main body), 14 × 12 × 75 mm (main body extension) and 12 x 12 x 90 mm (left branch) by dissection of the bilateral femoral arteries under general anesthesia. The operation lasted 85 minutes, 180 ml of iodide contrast agent was used, and there were no complications. After closure of the skin and reversion of anticoagulation, the patient underwent laparoscopy-assisted cholecystectomy. During the procedure, gallbladder empyema was observed, and, when drained, it caused extravasation of pus into the abdominal cavity. The bile was sent for bacteriological analysis. Cholecystectomy and intra-operative cholangiography were successfully performed, and a drain was left in the subhepatic space. Empirical antibiotic therapy consisting of endovenous ceftriaxone and metronidazole was started during the operation.</p><p id="para60" class="elsevierStylePara elsevierViewall">The patient demonstrated good postoperative evolution and did not require vasoactive drugs. He underwent hemodialysis soon after the surgical procedure and had the tubes removed in the operation room. Nasogastric intubation was stopped and fluid intake was started after 24 hours. Food intake was started 12 hours later. The drain in the right hypochondrium was removed on the fourth day after the operation.</p><p id="para70" class="elsevierStylePara elsevierViewall">Multisensitive <span class="elsevierStyleItalic">Escherichia coli</span> was identified in the liquid aspirated from the gallbladder. Oral ciprofloxacin treatment was therefore started, and this was maintained for 14 days.</p><p id="para80" class="elsevierStylePara elsevierViewall">The patient’s postoperative course was free of complications, and he was discharged from the hospital on the seventh day after the operation. One month after the surgery, the patient had resumed a normal life.</p><p id="para90" class="elsevierStylePara elsevierViewall">A control CT scan taken six months after the operation is presented in <a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>.</p><elsevierMultimedia ident="fig1"></elsevierMultimedia></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">DISCUSSION</span><p id="para100" class="elsevierStylePara elsevierViewall">The surgical approach used with patients having AAA and cholelithiasis is controversial. If we choose to treat only the aneurysm by an intraperitoneal route, the patient may present acute cholecystitis during the immediate postoperative period,<a class="elsevierStyleCrossRefs" href="#bib1">1,5</a> although endovascular techniques reduce this complication.<a class="elsevierStyleCrossRef" href="#bib3">3</a> If we treat the cholecystopathy alone, the aneurysm might rupt after the operation because of collagenase activity on the aortic wall following the intra-abdominal procedure.<a class="elsevierStyleCrossRef" href="#bib7">7</a> Simultaneous repair through an intraperitoneal route may cause infection in the prosthesis,<a class="elsevierStyleCrossRef" href="#bib5">5</a> especially in cases such as the one discussed in this paper, in which silent acute cholecystitis (oligosymptomatic) was diagnosed only during the operation, along with extravasation of its infected content. If the procedure had been carried out using an intraperitoneal route, the prosthesis would certainly have become contaminated. Due to the technique used in this case, the gallbladder contents did not come into contact with the prosthesis at any time, because the two accesses used were not directly accessible to each other. Thus, there was no contamination of the prosthesis and, consequently, no infectious complications. The endovascular repair of aneurysms appears to have a minor incidence of acute cholecystitis in the perioperative period,<a class="elsevierStyleCrossRef" href="#bib3">3</a> but in a case such as this, in which silent acute cholecystitis was observed, the combined approach was shown to be safe.</p><p id="para110" class="elsevierStylePara elsevierViewall">Endovascular treatment of aneurysms is already well-established.<a class="elsevierStyleCrossRef" href="#bib9">9</a> It is indicated for patients presenting high surgical risk who are in a good anatomical condition.<span class="elsevierStyleSup">10</span> In this case, in addition to presenting these two premises, the patient was waiting for a donor kidney for transplantation. We sought to avoid open procedures to avoid surgical manipulation of the retroperitoneum and thereby to facilitate the kidney transplantation in the iliac fossa.</p><p id="para120" class="elsevierStylePara elsevierViewall">Another advantage of this technique is the shorter duration of ileal paralysis, thus making it possible to resume feeding at an early stage.<span class="elsevierStyleSup">11</span> Our patient began receiving food after 36 hours and was able to walk after only six hours. We chose to do the endovascular treatment first because pneumoperitoneum is not a problem when using a non-compressible metallic endoprosthesis.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "cesec10" "titulo" => "INTRODUCTION" ] 1 => array:2 [ "identificador" => "cesec20" "titulo" => "CASE REPORT" ] 2 => array:2 [ "identificador" => "cesec30" "titulo" => "DISCUSSION" ] 3 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 213 "Ancho" => 413 "Tamanyo" => 9557 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Control CT Scan</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" 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\n \t\t\t\t\t\t\t\t """ 1 => """ P Puech-Leão \n \t\t\t\t\t\t\t\t """ 2 => """ ES Silva \n \t\t\t\t\t\t\t\t """ 3 => """ DG Silva \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s1807-59322008000100012" "Revista" => array:6 [ "tituloSerie" => "Clinics" "fecha" => "2008" "volumen" => "63" "paginaInicial" => "67" "paginaFinal" => "70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18297209" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of ultrasonography, computed tomography, and magnetic ressonance imaging with intraoperative measurements in the evaluation of abdominal aortic aneurysms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ F das Chagas de Azevedo \n \t\t\t\t\t\t\t\t """ 1 => """ AE Zerati \n \t\t\t\t\t\t\t\t """ 2 => """ R Blasbalg \n \t\t\t\t\t\t\t\t """ 3 => """ N Wolosker \n \t\t\t\t\t\t\t\t """ 4 => """ P Puech-Leão \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s1807-59322005000100006" "Revista" => array:6 [ "tituloSerie" => "Clinics" "fecha" => "2005" "volumen" => "60" "paginaInicial" => "21" "paginaFinal" => "28" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15838577" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review of recent evidence for the safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ D Drury \n \t\t\t\t\t\t\t\t """ 1 => """ JA Michaels \n \t\t\t\t\t\t\t\t """ 2 => """ L Jones \n \t\t\t\t\t\t\t\t """ 3 => """ L Ayiku \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/bjs.5123" "Revista" => array:6 [ "tituloSerie" => "Br J Surg" "fecha" => "2005" "volumen" => "92" "paginaInicial" => "937" "paginaFinal" => "946" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16034817" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/18075932/0000006500000007/v1_202212010714/S1807593222023857/v1_202212010714/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/18075932/0000006500000007/v1_202212010714/S1807593222023857/v1_202212010714/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222023857?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 0 | 4 |
| 2024 October | 25 | 21 | 46 |
| 2024 September | 34 | 11 | 45 |
| 2024 August | 26 | 15 | 41 |
| 2024 July | 14 | 14 | 28 |
| 2024 June | 20 | 15 | 35 |
| 2024 May | 24 | 11 | 35 |
| 2024 April | 14 | 12 | 26 |
| 2024 March | 14 | 11 | 25 |
| 2024 February | 14 | 17 | 31 |
| 2024 January | 19 | 6 | 25 |
| 2023 December | 9 | 15 | 24 |
| 2023 November | 11 | 21 | 32 |
| 2023 October | 17 | 20 | 37 |
| 2023 September | 15 | 22 | 37 |
| 2023 August | 14 | 7 | 21 |
| 2023 July | 6 | 11 | 17 |
| 2023 June | 12 | 4 | 16 |
| 2023 May | 26 | 3 | 29 |
| 2023 April | 34 | 0 | 34 |
| 2023 March | 58 | 1 | 59 |
| 2023 February | 13 | 1 | 14 |
| 2023 January | 4 | 9 | 13 |
| 2022 December | 11 | 5 | 16 |
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