No abstract

En bloc vascular resection and reconstruction for contiguous tumor involvement is feasible and safe in selected patients. Advanced pelvic tumors involving iliac vessels should not be precluded from curative surgery in specialized institutions.

1 We have identi®ed the P 2 receptors mediating vasomotor responses in the rabbit pulmonary artery. 2 Neither ATP nor UTP contracted intact or endothelium-denuded rings. However, both relaxed intact rings of rabbit pulmonary artery that had been preconstricted with phenylephrine (pD 2 5.2 and 5.6, respectively). 3 The vasodilator e ect of UTP was endothelium-dependent and abolished by the nitric oxide synthaseThe vasodilator e ect of ATP was only partially inhibited by removal of endothelium or addition of L-NOARG, suggesting an additional direct e ect on vascular smooth muscle. 5 The endothelium-dependent vasodilator responses to UTP and ATP were competitively antagonized by suramin. 6 Preconstricted, endothelium-denuded rings were also relaxed by 2-methylthio ATP (pD 2 6.6), a P 2Y receptor agonist. 7 Ca 2+ -mobilizing P 2U receptors were identi®ed on smooth muscle cells on the basis of single cell responses to ATP (pD 2 7.8) and UTP (pD 2 7.9; 6.7 in the presence of 100 mM suramin). 8 There was no evidence of a Ca 2+ -mobilizing P 2Y receptor in these cultured cells. 9 The data suggest the presence of (i) a suramin-sensitive P 2U receptor on endothelial cells that induces vasorelaxation through NO release, (ii) a suramin-sensitive P 2U receptor on cultured smooth muscle cells that mobilizes Ca 2+ but is not coupled to vasomotor responses and (iii) a putative P 2Y receptor on vascular smooth muscle cells that induces relaxation via a Ca 2+ -independent signal transduction pathway.

Aortoduodenal fistula 2 years after elective endovascular repair of an abdominal aortic aneurysm Aortoenteric fistula (AEF) is a rare complication after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). 1 An AEF is a pathological connection between the aorta and gastrointestinal tract that is invariably life-threatening. Primary AEFs occur de novo due to mechanical factors, aortic inflammation or infection. Secondary AEFs commonly involve a previously placed aortic graft. Almost all secondary AEF occur after open AAA repair but cases following EVAR are reported. 1-6 We present our experience with this rare complication, which is unique because it was only identified at time of operation. An 85-year-old female with a history of chronic lymphocytic leukaemia on ibrutinib and atrial fibrillation on rivaroxaban was referred to a vascular surgeon with a 38 × 30 mm incidental saccular infrarenal aortic aneurysm. There was no clinical evidence that the aneurysm was mycotic. She underwent an uncomplicated endovascular graft repair using a Gore Excluder AAA Endograft (W. L. Gore & Associates, Inc.; Newark, Delaware, US). Follow-up duplex ultrasound at 24 months post-operatively demonstrated a patent stent graft with no evidence of endoleak. Twenty-five months post-operatively, the patient developed left lower quadrant abdominal pain, night sweats and constipation. She denied any gastrointestinal bleeding. Investigation of her abdominal pain including a colonoscopy did not identify a cause. She