Traumatic rupture of the vertebral artery is a rare condition, treatment does not usually allow to preserve its permeability. We present a case of a endovascular treatment with preservation of the flow using two covered stents placed in emergency context.
Popliteal vascular lesions following total knee replacement surgery are extremely rare and its radiologic diagnosis may be compromised by the artefact caused by the prosthesis. In an era where the endovascular technique dominates the treatment of these lesions, the authors present a rare case report of a patient presenting with a popliteal arteriovenous fistula, following total knee replacement surgery, who was successfully treated by conventional surgery.
The case report refers to a female patient who presented to the Vascular Surgery office complaining of left leg pain and swelling, six years after a total left knee replacement surgery. The patient was studied with arterial and venous lower limb doppler ultrasonography, angiographic computerized tomography and digital subtraction angiography, which demonstrated findings consistent with a popliteal arteriovenous fistula. The patient was then submitted to exclusion of this fistula by conventional surgery. At 12 months follow‐up, the patient remained free of symptoms and of arteriovenous fistula recurrence, as well as of other vascular complications.
Extracranial mycotic carotid pseudoaneurysms are rare and challenging to manage. Surgical approaches are technically demanding and can be associated with a high morbidity and mortality. This article presents a review of the literature on this condition.
The authors searched in August 2015 the PubMed database with the keywords “mycotic”, “carotid artery”, “pseudoaneurysm”, “aneurysm” Until that date they found 108 cases reported in the literature.
In this article they describe the origin of the condition, its clinical presentation and the current surgical options.
Endovascular treatment of the thoracic aorta is a technique which has revolutionized the treatment of different aortic pathologies.
Our purpose is to evaluate our institutional experience
We present a retrospective analysis of a consecutive series of patients who underwent TEVAR at our Instituition. Patients who received fenestrated/branched abdominal devices were excluded.
From April 2005 to Abril 2014, 79 patients with a mean age of 66 ± 12.83 years (range 14 to 86) underwent TEVAR. The indications included: 46 thoracic aortic aneurysms (TAA) (58%), 17 aortic dissections (AD) Stanford B (22%), 13 due to other acute aortic syndromes (AAS) (16%), 2 due to atheroembolism (3%) e 1 due to an aortic‐esophageal fistula (1%).
The aortic aneurysms were located to the ascending aortic and arch in 5 cases (11%), the descending thoracic aorta in 35 (76%) and the thoracoabdominal aorta in 6 (13%).
Mean aneurysm diameter was 69.64 mm (max 150 mm). Rupture was the clinical presentation in 21.5% of the patients (n = 17). 20.9% of the patients had previous aortic surgery.
TEVAR was performed for acute complicated Stanford type B AD in 13 patients (76%) and for chronic AD in 4 (24%). AD‐related complications included aneurysmatic dilatation in 35% (n = 6), organ malperfusion in 47% (n = 8). The Petticoat technique was performed in 9 cases (41.2%) and adjuvant procedures were necessary in 18% (renal artery stenting in 2; iliac artery stenting in 1).
Regarding the other AAS, TEVAR was performed due to penetrating aortic ulcer in 4 cases, intra‐mural hematome in 4 and in 5 cases due to rupture/pseudoaneurysm.
The deployed endografts included 32 Valiant Medtronic®, 15 TAG Gore®, 25 Zenith TX2 Cook®, 2 Zenith TX1 Cook®, 1 Relay Plus®, 3 Talent Medtronic®. The median length of stay in the intensive care unit was 2 days (range 0‐42) and median 2 units of erythrocytes was transfused per patient.
Thirty‐day/intrahospitalar mortality was 18% (n = 14). Mortality in elective procedures was 8% (4 in a total of 50) and 35% in urgent cases (10/29). Intraoperative additional interventions were required in 7 patients due to access vessel complications, in 2 due to iatrogenic AD, in 1 case due to acute limb thromboembolic ischemia and in 1 case to to a type IA endoleak. Reintervention rate was 17%, with the following indications: 9 endoleaks, 2 mesenteric ischemias and 2 aortic‐esophageal fistulae.
Our series represents an encouraging institutional experience, with reproducible outcomes. TEVAR is a safe and effective intervention for the management of different thoracic aortic pathologies, when co
Dynamic hip screw fixation is a routinely performed procedure for internal fixation of intertrochanteric fractures. Arterial injury following surgical fixation is a rare but serious event. We report the case of a 79‐year‐old man who developed a pseudoaneurysm of a branch of the profunda femoris artery after fixation of intertrochanteric fracture with a dynamic hip screw. The computed tomographic (CT) angiography revealed the diagnosis, and the pseudoaneurysm was embolized with coils. At six months of follow‐up the patient is asymptomatic and the CT angiography performed showed the aneurysm exclusion.
The aim of this study was to determine the incidence of neck bleeding, requiring or not surgical intervention, after carotid endarterectomy (CE) and to identify its predictive parameters and its influence in stroke, myocardial infarction (MI) and mortality.
This was a retrospective review of 200 CEs carried out in 194 patients between 2010 and 2014 in our institution. The endpoints were: postoperative major cervical bleeding MB (that required reintervention) and global cervical bleeding GB (registered neck bleeding) as also its major post reintervention complications. Patient demographics, antiplatelet and anticoagulant therapy (pre, intra and postoperative), anesthetic data, surgical technique, and perioperative management data were collected. Univariate analysis with Pearson chi-Squared or Fisher Test was applied for categorical variables and t-test for continuous variables.
Neck bleeding after CE occurred in 25 cases (12%), requiring reoperation in 8 cases (4.0%). Univariate analysis (Pearson chi-squared test) showed significance (p < 0.05) for global hematoma in which concerns clopidogrel use until surgery (p = 0.04), elevated mean arterial pressure during hospitalar stay (p = 0.006). For major hematoma it has significance previous dual antiplatelet therapy (p = 0.039), patch use compared to other techniques (p = 0.017), and neurological repercurssion after clamping (p = 0.03). Individual analysis of surgical technique did not show significant value for major or global hematoma. There were to 2 deaths, one related to reeintervention, 2 strokes and one MI nonprocedure associated.
Carotid hematoma is a devastating and relatively common complication in our institution although the incidence of major hematoma is reduced. The main factors associated with reeintervention were previous double anti-platelet therapy, non-patch surgical techniques and patient neurological instability (shunt use), probably associated with less accurate hemostasis. Global bleeding is related to the use of clopidogrel 24 h before, and as post-operative factors poor tensional control (high)
Presentation of a clinical case with below the knee bypass failure treated by a total femoropopliteal recanalization and stenting.
It is presented a patient with history of two previous femoropopliteal bypass with prosthetic graft, admitted by acute occlusion and severe ischemia. After chemical and mechanical bypass thrombectomy failure, without venous conduit available, with good infra‐popliteal outflow, patient was submitted to total femoropopliteal endovascular recanalization.
An anterograde total subtintimal recanalization was performed, with intraluminal reentrance in the distal popliteal artery, and 3 stents implantation. There was no final stenosis observed, with good stent inflow and outflow.
The new endovascular devices with highly flexibility and resistance allowed a notorious transformation of the therapeutic strategies, with excellent patency rates.
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