Despite advancements in surgical techniques and critical care, managing complications of type A and B aortic dissections remains challenging. Common morbidities include paraplegia, renal failure, stroke, and intestinal ischemia. Risks are especially high in extensive repairs, such as Crawford extent II thoracoabdominal aortic aneurysms, and in older patients or those with heart failure, poor pulmonary function, or renal disease. To mitigate these risks, less invasive techniques like total endovascular and hybrid approaches have been developed. We present a case of a 69-year-old female with an 8.5-cm type II thoracoabdominal aortic aneurysm with chronic dissection, successfully treated with a staged hybrid repair.
{"title":"Complex staged hybrid repair of extent II thoracoabdominal aortic aneurysm secondary to type A aortic dissection","authors":"Apoorva Bhandari MD, MSc , Michael W.A. Chu MD, FRCSC , Audra Duncan MD, FACS, FRCSC","doi":"10.1016/j.jvscit.2024.101701","DOIUrl":"10.1016/j.jvscit.2024.101701","url":null,"abstract":"<div><div>Despite advancements in surgical techniques and critical care, managing complications of type A and B aortic dissections remains challenging. Common morbidities include paraplegia, renal failure, stroke, and intestinal ischemia. Risks are especially high in extensive repairs, such as Crawford extent II thoracoabdominal aortic aneurysms, and in older patients or those with heart failure, poor pulmonary function, or renal disease. To mitigate these risks, less invasive techniques like total endovascular and hybrid approaches have been developed. We present a case of a 69-year-old female with an 8.5-cm type II thoracoabdominal aortic aneurysm with chronic dissection, successfully treated with a staged hybrid repair.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"11 2","pages":"Article 101701"},"PeriodicalIF":0.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report the case of a previously independent 82-year-old female who experienced acute hemodynamic and respiratory deterioration requiring inotropic support due to a fat embolism during revision hip arthroplasty. Computed tomography pulmonary angiography demonstrated fat embolism, and transesophageal echocardiogram showed evidence of right ventricle strain and fat embolism in-transit in the right heart, as well as a moderate patent foramen ovale. Under transesophageal echocardiogram and intravascular ultrasound guidance, the Inari FlowTriever thrombectomy device was used successfully to retrieve the fat embolism with immediate hemodynamic improvement, no complications, and uneventful recovery.
{"title":"Percutaneous thrombectomy of fat embolism in-transit","authors":"Erin Cihat Saricilar BMed, MD, MS, MM , Cartan Costello MB, BCH, BAO, FCICM, FACRRM, FRACGP, DRANZCOG , Alexander Misono MD, MBA, RPVI , Laurencia Villalba MD, FRACS Vasc","doi":"10.1016/j.jvscit.2024.101702","DOIUrl":"10.1016/j.jvscit.2024.101702","url":null,"abstract":"<div><div>We report the case of a previously independent 82-year-old female who experienced acute hemodynamic and respiratory deterioration requiring inotropic support due to a fat embolism during revision hip arthroplasty. Computed tomography pulmonary angiography demonstrated fat embolism, and transesophageal echocardiogram showed evidence of right ventricle strain and fat embolism in-transit in the right heart, as well as a moderate patent foramen ovale. Under transesophageal echocardiogram and intravascular ultrasound guidance, the Inari FlowTriever thrombectomy device was used successfully to retrieve the fat embolism with immediate hemodynamic improvement, no complications, and uneventful recovery.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"11 2","pages":"Article 101702"},"PeriodicalIF":0.7,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/S2468-4287(24)00253-3
{"title":"Information for Readers","authors":"","doi":"10.1016/S2468-4287(24)00253-3","DOIUrl":"10.1016/S2468-4287(24)00253-3","url":null,"abstract":"","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"10 6","pages":"Article 101669"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/S2468-4287(24)00254-5
{"title":"Events of Interest","authors":"","doi":"10.1016/S2468-4287(24)00254-5","DOIUrl":"10.1016/S2468-4287(24)00254-5","url":null,"abstract":"","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"10 6","pages":"Article 101670"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We describe a 54-year-old man with type 2 diabetes mellitus, ischemic myopathy, pulmonary hypertension, and end-stage renal disease who was admitted for heart failure and listed for a dual cardiac-renal transplantation. Extensive calcification in the iliac arteries prevented clamping. Proximal endovascular balloon control of the left iliac artery was achieved using contralateral access; distal control was established by passing a Fogarty catheter distally through an iliac arteriotomy, later used for anastomosis of the cadaveric conduit. Postoperative Doppler imaging confirmed adequate renal perfusion. The patient was discharged in stable condition. This report presents a novel one-stage intravascular occlusion method for calcified arteries.
{"title":"A novel technique for external iliac artery reconstruction in renal transplant patients with extensively atherosclerotic lower limb vasculature","authors":"Daanish Sheikh BS , Shri Timbalia MD , Mahnoor Zia MD , Yusuf Mufti BS , Maham Rahimi MD, PhD","doi":"10.1016/j.jvscit.2024.101698","DOIUrl":"10.1016/j.jvscit.2024.101698","url":null,"abstract":"<div><div>We describe a 54-year-old man with type 2 diabetes mellitus, ischemic myopathy, pulmonary hypertension, and end-stage renal disease who was admitted for heart failure and listed for a dual cardiac-renal transplantation. Extensive calcification in the iliac arteries prevented clamping. Proximal endovascular balloon control of the left iliac artery was achieved using contralateral access; distal control was established by passing a Fogarty catheter distally through an iliac arteriotomy, later used for anastomosis of the cadaveric conduit. Postoperative Doppler imaging confirmed adequate renal perfusion. The patient was discharged in stable condition. This report presents a novel one-stage intravascular occlusion method for calcified arteries.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"11 2","pages":"Article 101698"},"PeriodicalIF":0.7,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-30DOI: 10.1016/j.jvscit.2024.101697
Adnan Hirad MD, PhD , Faisal S. Fakhouri PhD , Brian Raterman BS , Ronald Lakony BS , Maxwell Wang MD , Dakota Gonring MD , Baqir Kedwai MD , Arunark Kolipaka PhD , Doran Mix MD
Type B aortic dissection (TBAD) represents a serious medical emergency with up to a 50% associated 5-year mortality caused by thoracic aorta, dissection-associated aneurysmal (DAA) degeneration, and rupture. Unfortunately, conventional size-related diagnostic methods cannot distinguish high-risk DAAs that benefit from surgical intervention from stable DAAs. Our goal is to use DAA stiffness measured with magnetic resonance elastography (MRE) as a biomarker to distinguish high-risk DAAs from stable DAAs. This is a feasibility study using MRE to (1) fabricate human-like geometries TBAD phantoms with different stiffnesses, (2) measure stiffness in TBAD phantoms with rheometry, and (3) demonstrate the first successful application of MRE to the thoracic aorta of a human volunteer. AD phantoms with heterogenous wall stiffness demonstrated the correlation between MRE-derived stiffness and rheometric measured stiffness. A pilot scan was performed in a healthy volunteer to test the technique's feasibility in the thoracic aorta.
{"title":"Feasibility of measuring magnetic resonance elastography-derived stiffness in human thoracic aorta and aortic dissection phantoms","authors":"Adnan Hirad MD, PhD , Faisal S. Fakhouri PhD , Brian Raterman BS , Ronald Lakony BS , Maxwell Wang MD , Dakota Gonring MD , Baqir Kedwai MD , Arunark Kolipaka PhD , Doran Mix MD","doi":"10.1016/j.jvscit.2024.101697","DOIUrl":"10.1016/j.jvscit.2024.101697","url":null,"abstract":"<div><div>Type B aortic dissection (TBAD) represents a serious medical emergency with up to a 50% associated 5-year mortality caused by thoracic aorta, dissection-associated aneurysmal (DAA) degeneration, and rupture. Unfortunately, conventional size-related diagnostic methods cannot distinguish high-risk DAAs that benefit from surgical intervention from stable DAAs. Our goal is to use DAA stiffness measured with magnetic resonance elastography (MRE) as a biomarker to distinguish high-risk DAAs from stable DAAs. This is a feasibility study using MRE to (1) fabricate human-like geometries TBAD phantoms with different stiffnesses, (2) measure stiffness in TBAD phantoms with rheometry, and (3) demonstrate the first successful application of MRE to the thoracic aorta of a human volunteer. AD phantoms with heterogenous wall stiffness demonstrated the correlation between MRE-derived stiffness and rheometric measured stiffness. A pilot scan was performed in a healthy volunteer to test the technique's feasibility in the thoracic aorta.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"11 2","pages":"Article 101697"},"PeriodicalIF":0.7,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-30DOI: 10.1016/j.jvscit.2024.101699
Khaled El-Qawaqzeh MD, Romeo Mateo MD, Heepeel Chang MD, Arun Goyal MD, Sateesh Babu MD, Daniel J. Ventarola MD
We present a case of an 86-year-old female with chronic mesenteric ischemia secondary to long-segment flush occlusion of the superior mesenteric artery and near-total occlusion of the celiac artery. The superior mesenteric artery was unable to be revascularized by conventional antegrade approaches. Successful transcollateral crossing of the occluded superior mesenteric artery and body-flossing, followed by antegrade balloon angioplasty, shockwave lithotripsy, and stent implantation were performed. This case demonstrates that retrograde recanalization via collateral pathways is a viable alternative for patients with superior mesenteric artery flush occlusion when conventional antegrade approaches fail.
{"title":"Transcollateral retrograde recanalization of superior mesenteric artery occlusion through the pancreaticoduodenal arcade","authors":"Khaled El-Qawaqzeh MD, Romeo Mateo MD, Heepeel Chang MD, Arun Goyal MD, Sateesh Babu MD, Daniel J. Ventarola MD","doi":"10.1016/j.jvscit.2024.101699","DOIUrl":"10.1016/j.jvscit.2024.101699","url":null,"abstract":"<div><div>We present a case of an 86-year-old female with chronic mesenteric ischemia secondary to long-segment flush occlusion of the superior mesenteric artery and near-total occlusion of the celiac artery. The superior mesenteric artery was unable to be revascularized by conventional antegrade approaches. Successful transcollateral crossing of the occluded superior mesenteric artery and body-flossing, followed by antegrade balloon angioplasty, shockwave lithotripsy, and stent implantation were performed. This case demonstrates that retrograde recanalization via collateral pathways is a viable alternative for patients with superior mesenteric artery flush occlusion when conventional antegrade approaches fail.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"11 2","pages":"Article 101699"},"PeriodicalIF":0.7,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-27DOI: 10.1016/j.jvscit.2024.101696
Vanessa Prado dos Santos MD, PhD , Lucas de Mello Ferreira MD , André Brito Queiroz MD, PhD , Carlos Alberto Silveira Alves MD
Objective
The integrity of the plantar flap is important for transmetatarsal amputation (TMA) classic closure. However, in ischemic wounds, the plantar flap can be compromised, making the TMA coverage difficult. The aim of this study was to compare the outcomes of rotational vs long plantar flaps for transmetatarsal amputation closure in patients with dysvascular partial foot amputations.
Methods
We conducted an observational study including revascularized patients with established forefoot gangrene who required TMA. The coverage was performed by classical long plantar flap or rotational flap due to the lack of adequate plantar skin. Seventeen patients were included in the study. TMA was performed after lower limb revascularization in all cases. We compared the wound healing and functional outcomes of the two groups (rotational vs long plantar flap).
Results
The mean age of the sample was 66.5 years (±8.3 years). Eight cases (47%) had open surgical bypass, and nine (53%) had endovascular procedures. Eight cases of rotational flaps (7 medial plantar rotational flaps) and nine classical long plantar flaps were analyzed. Our results demonstrated an overall healing rate of 77% in the sample. There was no significant difference between the surgical techniques evaluated. The healing percentage for the rotational flap group was 75% (6 cases) and 78% (7 cases) for the classical long plantar flap closure (P = .6).
Conclusions
Rotational flap provides a feasible alternative to classical long plantar flap for TMA coverage, showing a satisfactory healing rate for dysvascular foot following revascularization.
{"title":"Rotational flap versus long plantar flap for transmetatarsal amputation closure following revascularization","authors":"Vanessa Prado dos Santos MD, PhD , Lucas de Mello Ferreira MD , André Brito Queiroz MD, PhD , Carlos Alberto Silveira Alves MD","doi":"10.1016/j.jvscit.2024.101696","DOIUrl":"10.1016/j.jvscit.2024.101696","url":null,"abstract":"<div><h3>Objective</h3><div>The integrity of the plantar flap is important for transmetatarsal amputation (TMA) classic closure. However, in ischemic wounds, the plantar flap can be compromised, making the TMA coverage difficult. The aim of this study was to compare the outcomes of rotational vs long plantar flaps for transmetatarsal amputation closure in patients with dysvascular partial foot amputations.</div></div><div><h3>Methods</h3><div>We conducted an observational study including revascularized patients with established forefoot gangrene who required TMA. The coverage was performed by classical long plantar flap or rotational flap due to the lack of adequate plantar skin. Seventeen patients were included in the study. TMA was performed after lower limb revascularization in all cases. We compared the wound healing and functional outcomes of the two groups (rotational vs long plantar flap).</div></div><div><h3>Results</h3><div>The mean age of the sample was 66.5 years (±8.3 years). Eight cases (47%) had open surgical bypass, and nine (53%) had endovascular procedures. Eight cases of rotational flaps (7 medial plantar rotational flaps) and nine classical long plantar flaps were analyzed. Our results demonstrated an overall healing rate of 77% in the sample. There was no significant difference between the surgical techniques evaluated. The healing percentage for the rotational flap group was 75% (6 cases) and 78% (7 cases) for the classical long plantar flap closure (<em>P</em> = .6).</div></div><div><h3>Conclusions</h3><div>Rotational flap provides a feasible alternative to classical long plantar flap for TMA coverage, showing a satisfactory healing rate for dysvascular foot following revascularization.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"11 2","pages":"Article 101696"},"PeriodicalIF":0.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-26DOI: 10.1016/j.jvscit.2024.101695
Imam T.P. Ritonga MD , Giuseppe Asciutto MD, PhD , Kevin Mani MD, PhD, FEBVS , Yousef Shehada MD , Marco Virgilio Usai MD
Iatrogenic arterial injury is an infrequent but limb-threatening complication of total knee arthroplasty (TKA). Open surgical reconstruction may not always be feasible or optimal, particularly in patients who have recently just undergone complex TKA procedures. In this report, we describe the treatment of a patient who developed popliteal artery occlusion following a complex TKA procedure performed the previous day. Although endovascular advancement allows comprehensive endovascular treatment of acute limb ischemia, their application in the context of iatrogenic arterial injury after TKA is limited, with only a few cases documented. This case is notable due to the presence of both penetrating trauma to the popliteal artery and subsequent thrombosis of the artery. These complications were successfully managed entirely through endovascular therapy, employing AngioJet rheolytic thrombolysis and the implantation of a covered stent. This case adds to the growing body of evidence supporting the use of endovascular techniques for managing this rare and complex complication of TKA.
{"title":"Endovascular therapy for iatrogenic occlusion of the popliteal artery after complex total knee arthroplasty: A case report","authors":"Imam T.P. Ritonga MD , Giuseppe Asciutto MD, PhD , Kevin Mani MD, PhD, FEBVS , Yousef Shehada MD , Marco Virgilio Usai MD","doi":"10.1016/j.jvscit.2024.101695","DOIUrl":"10.1016/j.jvscit.2024.101695","url":null,"abstract":"<div><div>Iatrogenic arterial injury is an infrequent but limb-threatening complication of total knee arthroplasty (TKA). Open surgical reconstruction may not always be feasible or optimal, particularly in patients who have recently just undergone complex TKA procedures. In this report, we describe the treatment of a patient who developed popliteal artery occlusion following a complex TKA procedure performed the previous day. Although endovascular advancement allows comprehensive endovascular treatment of acute limb ischemia, their application in the context of iatrogenic arterial injury after TKA is limited, with only a few cases documented. This case is notable due to the presence of both penetrating trauma to the popliteal artery and subsequent thrombosis of the artery. These complications were successfully managed entirely through endovascular therapy, employing AngioJet rheolytic thrombolysis and the implantation of a covered stent. This case adds to the growing body of evidence supporting the use of endovascular techniques for managing this rare and complex complication of TKA.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"11 2","pages":"Article 101695"},"PeriodicalIF":0.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-23DOI: 10.1016/j.jvscit.2024.101694
Alina Reeg MD, Maani Hakimi MD
{"title":"Standardized reporting to enable dose level comparison across institutions","authors":"Alina Reeg MD, Maani Hakimi MD","doi":"10.1016/j.jvscit.2024.101694","DOIUrl":"10.1016/j.jvscit.2024.101694","url":null,"abstract":"","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"11 2","pages":"Article 101694"},"PeriodicalIF":0.7,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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