Vascular最新文献

Objectives: Previous reports on aortic arch variations have emphasized on its cardiovascular significance. We present a case of a rare variation of aortic arch complicated with multiple ruptured intracranial aneurysms.

Methods: This case report reviews the effects of the diameter of internal carotid artery of isolated origins on cerebral vessels.

Results: The brachiocephalic trunk, left external carotid artery, left internal carotid artery, left vertebral artery, and the left subclavian artery originating from the aortic arch complicated with multiple ruptured intracranial aneurysms have not been reported.

Conclusions: Variation of the aortic arch may affect carotid and cerebral vessel structures as well as blood flow and is a potential risk factor for stroke. Third aortic arch degeneration, or dorsal aorta non-degeneration, is a potential embryologic mechanism for the absence of the left common carotid artery.

Background: The progress of visceral artery aneurysms (VAAs) after the endovascular repair of artery aneurysms is often accompanies by the potential risks of stent fracture. The clinical reported cases of VAAs stent fractures with stent displacement were extremely rare but severe complication, particularly for the superior mesenteric artery aneurysm (SMAA).

Method: We here reported a 62-year-old female patient with recurrent symptoms of SMAA 2 years after the successful endovascular repair using coil embolization and two partial overlapping stent-grafts in SMAA. The open surgery was performed instead of secondary endovascular intervention.

Result and conclusion: The patient experienced a good recovery. As one of the complications after endovascular repair, stent fracture maybe more dangerous than SMAA itself, the stent fracture after endovascular repair treated by open surgery with satisfactory results is alternative and feasible.

Objective: Thoracic Endovascular Aortic Repair (TEVAR) is well established in humans. Despite widespread use, additional research questions related to thoracic aortic stenting and endovascular innovation require large animal models. Translating human TEVAR devices and techniques into animal models, however, is a challenge even for experienced endovascular surgeons looking to develop a large animal TEVAR model.This article describes swine-specific strategies to deploy human TEVAR stent grafts, delineate how to select, size, prepare, and re-use human stents and deployment systems in swine, and how to translate human imaging modalities to large animal TEVAR.

Methods: We describe a selection of related TEVAR models and techniques in Yorkshire swine to support scientific inquiry. This includes an animal husbandry and pre-operative preparation and planning program. All imaged specimens in this paper are castrated male Yorkshire swine in the 60-80 kg range and underwent TEVAR with the Medtronic Navion stent and deployment system.

Results: To study human aortic stent grafts in swine, the animals generally must be at least 50 kgs to guarantee a 2 cm internal aortic diameter at the left subclavian, and for the iliac arteries to accommodate the human deployment system. Swine will have longer torsos and shorter iliofemoral segments than a human of the same weight which can make human deployment systems too short to reach the left subclavian from the femoral arteries in larger animals. We provide techniques to overcome this, including open iliac access or upside-down carotid TEVAR, which may be particularly useful if the scientific data would be confounded by iliofemoral access.Unlike humans that present clinically with axial imaging, swine will generally not have preoperative imaging, and many translational research laboratories do not have access to inexpensive preoperative CT, or any intraoperative CT scanning, which we are fortunate to have. We describe, therefore, several strategies for imaging in this setting including TEVAR via C-arm fluoroscopy and with or without in-laboratory CT scanning. Due to the low-resource setting of most large animal laboratories, as compared to a human hybrid room, we also describe several techniques to reduce cost and reuse materials, including the stent grafts, which at the end of non-survival experiments can be recovered during necropsy, cleaned, reinserted into the deployment device and reused on additional animals.

Conclusions: This article describes a collection of related techniques and tips to translate human TEVAR imaging, sizing/selection, deployment, and anatomy to swine research. Using this framework alone, an experienced human vascular or endovascular surgeon may develop a complete aortic stenting animal model with strategies for scientific data acquisition.

Klippel-Trenaunay syndrome is a rare congenital anomaly that is associated with abnormalities in the deep venous system. Operative intervention is often used only when patients fail conservative management for chronic venous insufficiency. We present a case of a deep venous abnormality requiring a saphenous vein crossover Palma procedure, in combination with a left femoral arteriovenous PTFE fistula to manage a non-healing wound from chronic venous insufficiency in a 22-year-old man. This case highlights updates for modern treatment tips for technical and medical management decisions to avoid early graft thrombosis.

Objectives: Primary arterial dissection in peripheral arteries of the extremities is exceedingly rare. Isolated dissection of peripheral arteries (femoropopliteal or popliteal) primarily has been reported in aneurysmal arteries. Spontaneous dissection limited to a non-aneurysmal popliteal artery was first described in 1999 by Rabkin et al.

Methods: We report a case of a non-aneurysmal popliteal artery dissection to emphasize its rare condition.

Results: A 61-year-old man consulted because of sudden onset of pain and cramps in his left leg after walking 60 metres. A high-resolution duplex ultrasonography could identify a dissection of a non-aneurysmal popliteal artery. Computed tomography angiography could confirm the diagnosis. An operative repair was scheduled 3 weeks later and the patient was put on antiplatelet medication (acetylsalicylic acid 80 mg 1x/day) in the meantime. After 3 weeks the dissection was resolved spontaneously and the patient didn't undergo surgery. Check-ups remained reassuring and we scheduled a duplex ultrasonography within one year. Antiplatelet medication was continued.

Conclusions: Spontaneous dissection limited to a non-aneurysmal popliteal artery is extremely rare. Diagnosis can be made by duplex ultrasonography and/or CT angiography. Treatment options consist of conservative management or operative treatment. Operative treatments consist of an open repair with bypass or interposition graft or minimal invasive endovascular stent grafting. A standardized protocol for conservative treatment in this specific condition is not available. Annual follow-up of these patients is essential.

Objective: To assess the complex management of arterial anomalies in Vascular Ehlers-Danlos Syndrome (vEDS).

Methods: We report the case of a 34-year-old male, diagnosed with vEDS, who presented with acute intraperitoneal hemorrhage caused by the rupture of a splenic artery aneurysm, treated in emergency with coil embolization and splenectomy. Computed Tomography (CT) scan showed the concomitant presence of right renal artery (RRA) and common hepatic artery (CHA) aneurysms.

Results: Both aneurysms were conservatively managed and the patient went through serial CT imaging. After 3 months, rapid regression of the vascular abnormalities led to complete disappearing of RRA and CHA aneurysms, confirmed at 24-month imaging follow-up. In the same time span, two pseudoaneurysms developed in other sites used for transarterial access, requiring two secondary interventions. The present case emphasizes the unpredictability of disease's evolution and arterial complications in vEDS. Conservative management of complex lesions such as visceral artery aneurysms, which in this case resulted to be the best strategy, avoided the risks associated with surgical intervention in such fragile tissues. The reported complications underline that operative indications should be carefully weighed in these patients.

Purpose: The worst complication during cannulation of the contralateral gate during complex endovascular aortic repair is deployment of the limb extension behind the main graft body.

Case report: A patient with a 5.7 cm juxtarenal abdominal aortic aneurysm was taken to the operating room for fenestrated endovascular aortic repair and iliac branch device. Percutaneous femoral access was used to deploy a Gore Iliac Branch Endoprosthesis, followed by a physician modified Cook Alpha thoracic stent graft with four fenestrations. Next a Gore Excluder was deployed to bridge the fenestrated component to the iliac branch and native left common iliac artery creating distal seal. Due to the severe tortuosity, a buddy wire technique, using a stiff lunderquist wire, was used to cannulate the contralateral gate. Unfortunately, after cannulation, the limb was advanced over the buddy lunderquist wire instead of the luminal wire. We used a backtable modified guide catheter to provide the necessary pushability to navigate wires between the aberrantly deployed limb extension and the iliac branch device. Using through-and-through access, we then successfully deployed a parallel flared limb in the correct plane.

Conclusion: Careful communication, wire marking, and attention to intraoperative flow can minimize risks of complication, but knowledge of bail out techniques remains imperative.

Background: Half of those undergoing major lower limb amputation for peripheral arterial disease die within 1 year. Advance care planning reduces days in hospital and increases the chance of dying in a preferred place.

Aim: To investigate the prevalence and content of advance care planning for people having a lower limb amputation due to acute or chronic limb-threatening ischaemia or diabetes. Secondary aims were to explore its association with mortality, and length of hospital stay.

Design: A retrospective observational cohort study. The intervention was advance care planning.

Setting/participants: Patients admitted to the South West England Major Arterial Centre between 1 January 2019 and 1 January 2021 who received unilateral or bilateral below, above, or through knee amputation due to acute or chronic limb-threatening ischaemia or diabetes.

Results: 116 patients were included in the study. 20.7% (n = 24) died within 1 year. 40.5% (n = 47) had an advance care planning discussion of which all included cardiopulmonary resuscitation decisions with few exploring other options. Patients who were more likely to have advance care planning discussions were ≥75 years (aOR = 5.58, 95%CI 1.56-20.0), female (aOR = 3.24, 95%CI 1.21-8.69), and had multimorbidity (Charlson Comorbidity Index ≥5, aOR = 2.97, 95%CI 1.11-7.92). Discussions occurred more often in the emergency pathway and were predominantly initiated by physicians. Advance care planning was associated with increased mortality (aHR = 2.63, 95%CI 1.01, 5.02) and longer hospital stay (aHR = 0.52, 95%CI 0.32-0.83).

Conclusions: Despite a high risk of death for all patients in the months following amputation, advance care planning occurred in fewer than half of people and mostly focused on resuscitation.

Introduction: Ulnar artery aneurysms are rare with less than 250 previously reported in the literature. Most ulnar artery aneurysms occur distally near the palmar arch (hypothenar hammer syndrome). There are five previous reports of true ulnar artery aneurysms in the forearm; however, there are no reported cases of ulnar artery aneurysms proximal to the cubital fossa.

Case presentation: An 87-year-old man presented with pain and a rapidly progressive median nerve palsy with a pulsatile mass in the arm. Duplex ultrasound showed an aneurysm of what was thought to be the brachial artery. CT angiography shows a high bifurcating brachial artery and true aneurysm of the ulnar artery proximal to the cubital fossa. The artery was explored and the decision was made to excise the aneurysm and ligate the artery. The patient's symptoms improved and full function was regained.

Conclusion: This is a rare case of such a diagnosis in the absence of a history of arterial puncture or trauma. This case demonstrates the value in obtaining detailed imaging in the work-up to aid operative decision making. We highlight the thought processes on the table in our approach to this aneurysm and report a favourable post-operative outcome at follow up.

Background: Ocular Ischemic Syndrome (OIS) is a rare, vision threatening condition associated with severe carotid artery disease. There are few cases of OIS reported in the literature.

Methods: We present the case of a 54-year-old male with history of multiple previous carotid interventions including a right carotid stent, who presented with right-sided OIS.

Results: CTA and angiogram showed a severe calcific plaque causing restenosis of the right carotid stent, with a patent right internal carotid artery (ICA) in the very distal neck. The right common carotid artery (CCA) was patent but diseased with ulcerated plaque extending proximally to below the level of the clavicle. The left CCA was chronically occluded from its origin all the way to the bifurcation. Given our patient's surgical history, the imperative to revascularize the ipsilateral carotid, and a diffusely diseased ipsilateral CCA, he was successfully treated with an ipsilateral subclavian to internal carotid bypass.

Conclusion: There is paucity of data regarding the best approach for carotid revascularization in OIS. This case report discusses our unique perioperative decision making as well as relevant literature.