To our knowledge, no previous study has described the measurement of the tensile strength of the human aortic adventitia. In the present study, we examined the relationship between the tension and length of the aortic adventitia resected from the aortic wall of patients with acute aortic dissection. Method: We obtained rectangular specimens from the aortic adventitia that was resected in patients with acute aortic dissection during surgery. The specimens were placed on a tension meter (Digital Force Gauge FGS-10, SHIMPO, Kyoto) within 15 minutes after resection and stretched until they were pulled apart, and the tension and length were recorded. Results: We obtained 18 specimens during surgery from 11 cases of acute aortic dissection. When the specimen was being pulled apart, the mean tension recorded was 10.2 ± 4.9 N/cm specimen width, whereas the mean elongated length recorded was 4.2 ± 1.1 mm/cm specimen length. Discussion: We determined that the aortic adventitia is elastic and expandable up to 140% of its original length. This indicates that dilation of the aorta to >4.2 cm in diameter may result in a rupture if the original aortic diameter prior to dissection was 3 cm.
A 40-year-old man was transferred to our emergency unit complaining of severe left lower abdominal pain. He underwent a living renal transplant from his mother 8 years prior to admission. Preoperative abdominal computed tomography demonstrated ruptured abdominal aortic aneurysm. An emergency operation was performed. During aortic cross clamping, the kidney was protected with cold renal perfusion with 4 degree C ringer acetate by direct cannulation to the donor renal artery. Following aneurysmotomy, a prosthetic bifurcated graft was replaced in the aorta. He recovered uneventfully and his renal function returned to preoperative values.
We report a rare case of duodenal obstruction caused by superior mesenteric artery syndrome (SMAS) associated with a huge abdominal aortic aneurysm (AAA). An 89 year-old male was admitted to our hospital due to massive hematemesis. Gastrointestinal endoscopy showed gastroesophageal reflux disease and Mallory-Weiss syndrome. Computed tomography revealed duodenal obstruction due to SMAS caused by a 9.0 cm-diameter infrarenal AAA. After his condition was ameliorated by hydration therapy and blood transfusion, a graft replacement of the abdominal aorta was performed. The post operative course was uneventful. Graft replacement of AAA is useful to release ileus by SMAS and is strongly recommended.