Pub Date : 2025-11-28DOI: 10.1016/j.jvscit.2025.102078
Brett J. Salomon MD , Ryan Z. Taylor MD , Reagan W. Bollig MD , Michael B. Freeman MD , Lauren B. Grimsley MD
Trauma to the celiac artery may require ligation as a life-saving maneuver. Our patient sustained a gunshot wound resulting in celiac artery ligation during trauma laparotomy. Abdominal closure occurred the following day with drains placed owing to grade II pancreatic injury. Abdominal drainage was consistent with amylase-rich pancreatic fistula. Serial cross-sectional imaging demonstrated an enlarging celiac artery stump over 2 weeks. On day 15, a ruptured celiac artery pseudoaneurysm was found and treated with embolization and aortic stent graft cuff. This case highlights the importance of aggressive treatment for any enlarging artery in the setting of a pancreatic fistula.
{"title":"Celiac pseudoaneurysm rupture after ligation in the setting of a pancreatic fistula following penetrating trauma","authors":"Brett J. Salomon MD , Ryan Z. Taylor MD , Reagan W. Bollig MD , Michael B. Freeman MD , Lauren B. Grimsley MD","doi":"10.1016/j.jvscit.2025.102078","DOIUrl":"10.1016/j.jvscit.2025.102078","url":null,"abstract":"<div><div>Trauma to the celiac artery may require ligation as a life-saving maneuver. Our patient sustained a gunshot wound resulting in celiac artery ligation during trauma laparotomy. Abdominal closure occurred the following day with drains placed owing to grade II pancreatic injury. Abdominal drainage was consistent with amylase-rich pancreatic fistula. Serial cross-sectional imaging demonstrated an enlarging celiac artery stump over 2 weeks. On day 15, a ruptured celiac artery pseudoaneurysm was found and treated with embolization and aortic stent graft cuff. This case highlights the importance of aggressive treatment for any enlarging artery in the setting of a pancreatic fistula.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 2","pages":"Article 102078"},"PeriodicalIF":0.7,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145845531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/j.jvscit.2025.102072
Srikanth Pillai BS, Kiana Bennett BS, Jacqueline DeMarco BS, William F. Oppat MD
Myopericytomas (MPCs) are a rare type of benign, perivascular, soft tissue tumor. The intravascular subtype of this tumor is particularly rare, with <200 cases reported in the literature. This case report describes the diagnosis and surgical management of a popliteal fossa intravascular subtype of MPC in a 77-year-old man presenting with claudication and a mass behind the knee. After months of extensive diagnostic workup, excisional biopsy both confirmed the diagnosis and resolved his symptoms. This report highlights how highly vascularized soft tissue masses can present extensive diagnostic uncertainty and operative complexity.
{"title":"Diagnosis and surgical management of a distal popliteal intravascular myopericytoma in a patient with limited access to health care","authors":"Srikanth Pillai BS, Kiana Bennett BS, Jacqueline DeMarco BS, William F. Oppat MD","doi":"10.1016/j.jvscit.2025.102072","DOIUrl":"10.1016/j.jvscit.2025.102072","url":null,"abstract":"<div><div>Myopericytomas (MPCs) are a rare type of benign, perivascular, soft tissue tumor. The intravascular subtype of this tumor is particularly rare, with <200 cases reported in the literature. This case report describes the diagnosis and surgical management of a popliteal fossa intravascular subtype of MPC in a 77-year-old man presenting with claudication and a mass behind the knee. After months of extensive diagnostic workup, excisional biopsy both confirmed the diagnosis and resolved his symptoms. This report highlights how highly vascularized soft tissue masses can present extensive diagnostic uncertainty and operative complexity.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102072"},"PeriodicalIF":0.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/j.jvscit.2025.102069
Benson Law MSc , Melissa Côté MSc , Arielle Muyal BSc , Ian Ball MD , Shane Smith MD
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a controversial intervention for managing noncompressible torso hemorrhage in hemodynamically unstable trauma patients. This case highlights the ideal use of zone 3 REBOA in a patient who sustained severe pelvic trauma after a tree fell on him. Zone 3 REBOA was rapidly deployed as part of the institution's zone 3 REBOA protocol, leading to immediate hemodynamic improvement. Despite ongoing controversies around the use of REBOA in trauma, this case demonstrates how timely zone 3 REBOA, executed within an established trauma protocol by a clinician with sufficient training, can serve as a life-saving intervention.
{"title":"Zone 3 resuscitative endovascular balloon occlusion of the aorta: Deflating doubts, one trauma at a time","authors":"Benson Law MSc , Melissa Côté MSc , Arielle Muyal BSc , Ian Ball MD , Shane Smith MD","doi":"10.1016/j.jvscit.2025.102069","DOIUrl":"10.1016/j.jvscit.2025.102069","url":null,"abstract":"<div><div>Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a controversial intervention for managing noncompressible torso hemorrhage in hemodynamically unstable trauma patients. This case highlights the ideal use of zone 3 REBOA in a patient who sustained severe pelvic trauma after a tree fell on him. Zone 3 REBOA was rapidly deployed as part of the institution's zone 3 REBOA protocol, leading to immediate hemodynamic improvement. Despite ongoing controversies around the use of REBOA in trauma, this case demonstrates how timely zone 3 REBOA, executed within an established trauma protocol by a clinician with sufficient training, can serve as a life-saving intervention.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102069"},"PeriodicalIF":0.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/j.jvscit.2025.102077
Aidan P. Wiley BA, Georges Jreij MD, Sarah Rosenberger MS, CRNP, Shahab Toursavadkohi MD
An 84-year-old man previously treated with endovascular aneurysm repair had enlargement of a right iliac artery aneurysm sac from 3.5 to 4.3 cm over 1 year. Two years later, he presented to the clinic with a weeklong history of severe swelling in his left leg. Computed tomography scan revealed left iliac vein compression by an enlarging, 4.8-cm iliac artery aneurysm sac. Intravascular ultrasound examination confirmed near complete occlusion of the left iliac vein without thrombosis. This was treated with a 16 × 10 mm venous stent and postdilated with a 16 × 20 mm balloon. The patient reported relief of symptoms within 24 hours postoperatively.
{"title":"Pressurized iliac artery aneurysm causing atypical May-Thurner syndrome","authors":"Aidan P. Wiley BA, Georges Jreij MD, Sarah Rosenberger MS, CRNP, Shahab Toursavadkohi MD","doi":"10.1016/j.jvscit.2025.102077","DOIUrl":"10.1016/j.jvscit.2025.102077","url":null,"abstract":"<div><div>An 84-year-old man previously treated with endovascular aneurysm repair had enlargement of a right iliac artery aneurysm sac from 3.5 to 4.3 cm over 1 year. Two years later, he presented to the clinic with a weeklong history of severe swelling in his left leg. Computed tomography scan revealed left iliac vein compression by an enlarging, 4.8-cm iliac artery aneurysm sac. Intravascular ultrasound examination confirmed near complete occlusion of the left iliac vein without thrombosis. This was treated with a 16 × 10 mm venous stent and postdilated with a 16 × 20 mm balloon. The patient reported relief of symptoms within 24 hours postoperatively.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102077"},"PeriodicalIF":0.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/j.jvscit.2025.102074
Abdel Kémal Bori Bata MD , Serge Metchihoungbe MD , Ahmad Ibrahim MD , Koto Toualouth Lafia MD , Patrick Stéphane Mfin Kouomboua MD , Ernest Ahounou MD
Nutcracker syndrome is a rare condition usually caused by compression of the left renal vein between the aorta and superior mesenteric artery. The middle mesenteric artery (MMA) is an exceptional anatomical variant, reported in only 27 cases, most often incidentally. We describe an 18-year-old patient with chronic left flank pain and left varicocele. Computed tomography angiography confirmed compression of the left renal vein by the MMA (compression ratio, 3.0; angle. 14°). Surgical division, transposition, and orthotopic reimplantation were performed successfully. Recognition of rare vascular variants such as the MMA is crucial for accurate diagnosis and appropriate surgical management.
{"title":"Surgical management of Nutcracker syndrome caused by a middle mesenteric artery in an adolescent","authors":"Abdel Kémal Bori Bata MD , Serge Metchihoungbe MD , Ahmad Ibrahim MD , Koto Toualouth Lafia MD , Patrick Stéphane Mfin Kouomboua MD , Ernest Ahounou MD","doi":"10.1016/j.jvscit.2025.102074","DOIUrl":"10.1016/j.jvscit.2025.102074","url":null,"abstract":"<div><div>Nutcracker syndrome is a rare condition usually caused by compression of the left renal vein between the aorta and superior mesenteric artery. The middle mesenteric artery (MMA) is an exceptional anatomical variant, reported in only 27 cases, most often incidentally. We describe an 18-year-old patient with chronic left flank pain and left varicocele. Computed tomography angiography confirmed compression of the left renal vein by the MMA (compression ratio, 3.0; angle. 14°). Surgical division, transposition, and orthotopic reimplantation were performed successfully. Recognition of rare vascular variants such as the MMA is crucial for accurate diagnosis and appropriate surgical management.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102074"},"PeriodicalIF":0.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/j.jvscit.2025.102075
Punit Vyas MD, Grant Woodruff MD, Thomas Naslund MD
We present a case of a 64-year-old man with a history of endovascular abdominal aortic aneurysm repair endovascular aneurysm repair in 2015, who developed a graft infection owing to Histoplasma capsulatum in 2025. The patient underwent a neoaortoiliac system procedure using autologous femoral veins for reconstruction with continued itraconazole therapy in the outpatient setting. This case underscores the importance of considering fungal pathogens in graft infections and highlights the effectiveness of the neoaortoiliac system procedure in conjunction with antimicrobials in managing such complex cases.
{"title":"Neoaortoiliac reconstruction for a Histoplasma capsulatum endograft infection","authors":"Punit Vyas MD, Grant Woodruff MD, Thomas Naslund MD","doi":"10.1016/j.jvscit.2025.102075","DOIUrl":"10.1016/j.jvscit.2025.102075","url":null,"abstract":"<div><div>We present a case of a 64-year-old man with a history of endovascular abdominal aortic aneurysm repair endovascular aneurysm repair in 2015, who developed a graft infection owing to <em>Histoplasma capsulatum</em> in 2025. The patient underwent a neoaortoiliac system procedure using autologous femoral veins for reconstruction with continued itraconazole therapy in the outpatient setting. This case underscores the importance of considering fungal pathogens in graft infections and highlights the effectiveness of the neoaortoiliac system procedure in conjunction with antimicrobials in managing such complex cases.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102075"},"PeriodicalIF":0.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/j.jvscit.2025.102071
Alexander Cartwright BS , Ellie Gamradt BS , Brayan Marino MD , Ambika Singh BS , Beckett Peterson , David Peterson MD , Duangnapa Cuddy DO
To address the limitations of conventional management of limb graft occlusion after endovascular aortic aneurysm repair and endoprosthetic stent graft placement for aortoiliac occlusive disease, our team pioneered an innovative technique known as first-order percutaneous mechanical arterial advanced thrombectomy technology (FOPMAATT). We previously reported a single case where the benefits of the technique were demonstrated in 2022 by Willhite et al. The case report described the use of the FOPMAATT protocol in a patient with limb graft occlusion after EVAR endoprosthetic stent graft implantation for abdominal aortic aneurysm endovascular repair. In this consecutive case series, five patients underwent the FOPMAATT protocol procedure, resulting in positive patient outcomes such as a low postoperative complication rate. Each patient was followed for ≥2 years to assess long-term outcomes. Of the five cases reported, we did not observe a significant adverse perioperative event, no blood loss significant enough to require transfusion, or length of stay of >1 day owing to any surgical cause. Additionally, we did not use adjuvant pharmacological thrombolytic therapy in the FOPMAATT protocol, which may decrease the risk of perioperative bleeding.
{"title":"Case series report on long-term result of endovascular approach to thrombosed limb or limb graft occlusion of aortoiliac endoprosthetic stent graft using the first-order percutaneous mechanical arterial advanced thrombectomy technology protocol","authors":"Alexander Cartwright BS , Ellie Gamradt BS , Brayan Marino MD , Ambika Singh BS , Beckett Peterson , David Peterson MD , Duangnapa Cuddy DO","doi":"10.1016/j.jvscit.2025.102071","DOIUrl":"10.1016/j.jvscit.2025.102071","url":null,"abstract":"<div><div>To address the limitations of conventional management of limb graft occlusion after endovascular aortic aneurysm repair and endoprosthetic stent graft placement for aortoiliac occlusive disease, our team pioneered an innovative technique known as first-order percutaneous mechanical arterial advanced thrombectomy technology (FOPMAATT). We previously reported a single case where the benefits of the technique were demonstrated in 2022 by Willhite et al. The case report described the use of the FOPMAATT protocol in a patient with limb graft occlusion after EVAR endoprosthetic stent graft implantation for abdominal aortic aneurysm endovascular repair. In this consecutive case series, five patients underwent the FOPMAATT protocol procedure, resulting in positive patient outcomes such as a low postoperative complication rate. Each patient was followed for ≥2 years to assess long-term outcomes. Of the five cases reported, we did not observe a significant adverse perioperative event, no blood loss significant enough to require transfusion, or length of stay of >1 day owing to any surgical cause. Additionally, we did not use adjuvant pharmacological thrombolytic therapy in the FOPMAATT protocol, which may decrease the risk of perioperative bleeding.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 2","pages":"Article 102071"},"PeriodicalIF":0.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/j.jvscit.2025.102068
Shirin Soleimani BA , Snehita Bonthu BA , John L. Crawford MD, FACS , Charles A. West MD, FACS
We present the case of an 18-year-old woman diagnosed with median arcuate ligament syndrome (MALS) who presented with celiac artery (CA) occlusion. An open surgical approach was used, the MAL was released, and luminal patency was restored in the CA. The patient's symptoms were completely relieved. Computed tomography angiography performed 5 weeks postoperatively demonstrated sustained luminal patency of the CA. The sine qua non of MALS is the presence of severe compression of the CA. CA luminal patency can be restored in adolescent patients with MALS presenting with CA occlusion by ligament release alone avoiding the need for more complicated CA revascularization. This finding has not been described previously in the contemporary MALS literature.
{"title":"Restoration of luminal patency of the celiac artery after division of the median arcuate ligament in an adolescent with median arcuate ligament syndrome presenting with celiac artery occlusion","authors":"Shirin Soleimani BA , Snehita Bonthu BA , John L. Crawford MD, FACS , Charles A. West MD, FACS","doi":"10.1016/j.jvscit.2025.102068","DOIUrl":"10.1016/j.jvscit.2025.102068","url":null,"abstract":"<div><div>We present the case of an 18-year-old woman diagnosed with median arcuate ligament syndrome (MALS) who presented with celiac artery (CA) occlusion. An open surgical approach was used, the MAL was released, and luminal patency was restored in the CA. The patient's symptoms were completely relieved. Computed tomography angiography performed 5 weeks postoperatively demonstrated sustained luminal patency of the CA. The sine qua non of MALS is the presence of severe compression of the CA. CA luminal patency can be restored in adolescent patients with MALS presenting with CA occlusion by ligament release alone avoiding the need for more complicated CA revascularization. This finding has not been described previously in the contemporary MALS literature.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102068"},"PeriodicalIF":0.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.jvscit.2025.102060
Hisato Takagi MD, PhD
{"title":"Below-knee popliteal-artery injury due to open-wedge high-tibial osteotomy","authors":"Hisato Takagi MD, PhD","doi":"10.1016/j.jvscit.2025.102060","DOIUrl":"10.1016/j.jvscit.2025.102060","url":null,"abstract":"","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102060"},"PeriodicalIF":0.7,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.jvscit.2025.102061
Federico Pascucci MD , Mauro Cassese MD
{"title":"Vertebral artery to common carotid artery transposition during total arch replacement with frozen elephant trunk technique","authors":"Federico Pascucci MD , Mauro Cassese MD","doi":"10.1016/j.jvscit.2025.102061","DOIUrl":"10.1016/j.jvscit.2025.102061","url":null,"abstract":"","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102061"},"PeriodicalIF":0.7,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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