PubMed · 10654555
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Y R Baribeau. 2000. Axillary cannulation.. https://doi.org/10.1016/s0003-4975(99)01259-x
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A 49-year-old woman was admitted with profuse bleeding from the urostoma. She had been treated for a gynaecological and colon cancer and had a sigmoidostomy, an ileal conduit, and bilateral ureteral stents. Perioperatively, an aorto-ureteral fistula was found at the cross-point between the left ureter and the aorta. Strictures and fistulae are generally caused by ischaemia, radiation therapy, urinary leak, or infection. Surgery and ureteral stenting are the major risk factors. The optimal investigation is a retrograde pyelogram with digital subtraction angiography.
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Although a heavily-calcified so-called "porcelain" aorta is encountered infrequently, its association presents a formidable problem in cardiac surgery. Here we describe a case of severe aortic stenosis and coronary artery disease combined with the circumferentially calcified aorta. The patient was a 63-year-old man who successfully underwent double coronary artery bypass grafting and aortic valve replacement during hypothermic perfusion through the right axillary artery with endoaortic balloon occlusion, followed by minimal endarterectomy of the calcified plate along the aortotomy, and closure of the aorta buttressed with bovine pericardium under circulatory arrest.