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}
We report the case of a 69-year-old man with chronic type B aortic dissection and progressive aneurysmal dilatation. Zone 2 thoracic endovascular aortic repair was performed with carotid-subclavian bypass. Nonobstructive general angioscopy identified additional tiny entry tears in the descending aorta, guiding adequate stent graft coverage. Subsequent left subclavian artery coil embolization under balloon occlusion revealed satisfactory packing on fluoroscopy, but angioscopy revealed residual flow through coil gaps, prompting additional coil placement. Blood flow cessation was confirmed by angioscopy. Completion angiography revealed no antegrade false lumen flow or endoleaks. Follow-up computed tomography at 3 months showed favorable aortic remodeling with complete thoracic false lumen thrombosis.
{"title":"Angioscopy-assisted thoracic endovascular aortic repair for chronic type B aortic dissection: Optimizing stent graft coverage and left subclavian artery coil embolization","authors":"Yukihisa Ogawa MD, PhD, FJCR , Hiroyuki Nishi MD, PhD , Hidekazu Furuya MD , Ryuichi Tamimoto MD , Satoru Takahashi MD , Shunsuke Kamei MD","doi":"10.1016/j.jvscit.2025.102058","DOIUrl":"10.1016/j.jvscit.2025.102058","url":null,"abstract":"<div><div>We report the case of a 69-year-old man with chronic type B aortic dissection and progressive aneurysmal dilatation. Zone 2 thoracic endovascular aortic repair was performed with carotid-subclavian bypass. Nonobstructive general angioscopy identified additional tiny entry tears in the descending aorta, guiding adequate stent graft coverage. Subsequent left subclavian artery coil embolization under balloon occlusion revealed satisfactory packing on fluoroscopy, but angioscopy revealed residual flow through coil gaps, prompting additional coil placement. Blood flow cessation was confirmed by angioscopy. Completion angiography revealed no antegrade false lumen flow or endoleaks. Follow-up computed tomography at 3 months showed favorable aortic remodeling with complete thoracic false lumen thrombosis.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102058"},"PeriodicalIF":0.7,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736328","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 : 2025-11-21DOI: 10.1016/j.jvscit.2025.102059
George Apostolidis MD, MSc , Petroula Nana PhD , Daour Yousef al Sarhan MD , Lennart Bax MD , Tilo Kölbel PhD , Giuseppe Panuccio PhD
Maintaining left subclavian artery (LSA) patency is essential for preventing spinal cord ischemia before extensive aortic coverage. We present a case of in situ fenestration on a zone 2 frozen elephant trunk graft to restore the native LSA perfusion after a prior LSA bypass occlusion. Fenestration was performed using the electrified wire technique, followed by balloon-expandable covered stent implantation. The procedure was completed with distal thoracic extensions. The postoperative imaging confirmed LSA patency. This approach offers a feasible, reproducible solution for selected patients requiring LSA recanalization after frozen elephant trunk.
{"title":"In situ fenestration of a frozen elephant trunk prosthesis to recanalize the left subclavian artery","authors":"George Apostolidis MD, MSc , Petroula Nana PhD , Daour Yousef al Sarhan MD , Lennart Bax MD , Tilo Kölbel PhD , Giuseppe Panuccio PhD","doi":"10.1016/j.jvscit.2025.102059","DOIUrl":"10.1016/j.jvscit.2025.102059","url":null,"abstract":"<div><div>Maintaining left subclavian artery (LSA) patency is essential for preventing spinal cord ischemia before extensive aortic coverage. We present a case of in situ fenestration on a zone 2 frozen elephant trunk graft to restore the native LSA perfusion after a prior LSA bypass occlusion. Fenestration was performed using the electrified wire technique, followed by balloon-expandable covered stent implantation. The procedure was completed with distal thoracic extensions. The postoperative imaging confirmed LSA patency. This approach offers a feasible, reproducible solution for selected patients requiring LSA recanalization after frozen elephant trunk.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102059"},"PeriodicalIF":0.7,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736331","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}
Iliac branch endoprosthesis is an effective method for preserving the internal iliac artery blood flow during endovascular aortic repair. We describe the case of a right common iliac artery aneurysm complicated by a left internal iliac artery occlusion in a 74-year-old man. To preserve perfusion of the right internal iliac artery in a patient with a short common iliac artery, an iliac branch endoprosthesis device was connected to the AFX and deployed 15 mm above the aortic bifurcation. The absence of an endoleak on postoperative computed tomography indicated technical success and potential effectiveness of the procedure.
{"title":"Endovascular aortic repair with iliac branch endoprosthesis for short common iliac aneurysm","authors":"Satoshi Sakakibara MD , Kazuo Shimamura MD, PhD , Yoshiki Watanabe MD, PhD , Takashi Shirakawa MD, PhD , Fumio Yamana MD , Shigeru Miyagawa MD, PhD","doi":"10.1016/j.jvscit.2025.102066","DOIUrl":"10.1016/j.jvscit.2025.102066","url":null,"abstract":"<div><div>Iliac branch endoprosthesis is an effective method for preserving the internal iliac artery blood flow during endovascular aortic repair. We describe the case of a right common iliac artery aneurysm complicated by a left internal iliac artery occlusion in a 74-year-old man. To preserve perfusion of the right internal iliac artery in a patient with a short common iliac artery, an iliac branch endoprosthesis device was connected to the AFX and deployed 15 mm above the aortic bifurcation. The absence of an endoleak on postoperative computed tomography indicated technical success and potential effectiveness of the procedure.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102066"},"PeriodicalIF":0.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839178","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 : 2025-11-20DOI: 10.1016/j.jvscit.2025.102057
Mark L. Lessne MD, FSIR , Charles Y. Kim MD, FSIR
Venous in-stent reocclusion can result in recurrent obstructive symptoms. Occlusions that are recalcitrant to traditional crossing techniques are inaccessible to effective therapies. However, radiofrequency-assisted recanalization techniques can mitigate the risk of therapy failure and allow treatment of previously untreatable lesions. The feature of automatic disabling of the radiofrequency wire upon metal contact can be exploited to increase the safety of crossing by ensuring intraluminal traversal and avoidance of unintended perforation of adjacent structures.
{"title":"Radiofrequency wire-assisted recanalization of chronic venous stent occlusions","authors":"Mark L. Lessne MD, FSIR , Charles Y. Kim MD, FSIR","doi":"10.1016/j.jvscit.2025.102057","DOIUrl":"10.1016/j.jvscit.2025.102057","url":null,"abstract":"<div><div>Venous in-stent reocclusion can result in recurrent obstructive symptoms. Occlusions that are recalcitrant to traditional crossing techniques are inaccessible to effective therapies. However, radiofrequency-assisted recanalization techniques can mitigate the risk of therapy failure and allow treatment of previously untreatable lesions. The feature of automatic disabling of the radiofrequency wire upon metal contact can be exploited to increase the safety of crossing by ensuring intraluminal traversal and avoidance of unintended perforation of adjacent structures.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102057"},"PeriodicalIF":0.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790011","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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