Pub Date : 2025-11-20DOI: 10.1016/j.jvscit.2025.102065
Daemar H. Jones MD, Nicole A. Heidt MD, Laura B. Pride MD, Chandler A. Long MD, Young Kim MD, MS
In this report, we present a 67-year-old man who was transferred from an outside facility with complaints of severe back pain. Computed tomography imaging demonstrated a type IIIa endoleak with complete junctional dissociation of his prior fenestrated endograft, between the visceral and the bifurcated components. Given the perpendicular configuration of the dissociated stent grafts, no endovascular salvage was feasible, and open explantation was indicated. His preoperative evaluation was significant for a positive cardiac stress test warranting coronary artery stenting. The patient underwent subsequent open graft explantation and aortic repair, and was ultimately discharged home after an uncomplicated hospital course.
{"title":"Explantation of fenestrated endograft complicated by complete junctional dissociation and symptomatic type IIIa endoleak","authors":"Daemar H. Jones MD, Nicole A. Heidt MD, Laura B. Pride MD, Chandler A. Long MD, Young Kim MD, MS","doi":"10.1016/j.jvscit.2025.102065","DOIUrl":"10.1016/j.jvscit.2025.102065","url":null,"abstract":"<div><div>In this report, we present a 67-year-old man who was transferred from an outside facility with complaints of severe back pain. Computed tomography imaging demonstrated a type IIIa endoleak with complete junctional dissociation of his prior fenestrated endograft, between the visceral and the bifurcated components. Given the perpendicular configuration of the dissociated stent grafts, no endovascular salvage was feasible, and open explantation was indicated. His preoperative evaluation was significant for a positive cardiac stress test warranting coronary artery stenting. The patient underwent subsequent open graft explantation and aortic repair, and was ultimately discharged home after an uncomplicated hospital course.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102065"},"PeriodicalIF":0.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736323","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.2025.102064
Pharis B. Sasa MD , Naiem Nassiri MD
The aim of this study was to demonstrate a novel, office-based treatment of life-threatening hand arteriovenous malformations (AVMs) via Venaseal cyanoacrylate embolization. Two adult male patients with debilitating Yakes II hand AVMs underwent staged, transarterial, and direct-stick Venaseal embolization in an office-based setting over a period of 12 (7 sessions) and 8 (4 sessions) months. Technical success was 100% with no complications. Clinical success was achieved with ulcer and cardiopulmonary overload alleviation, nonrestricted restoration of hand function, and reduction in lesion volume confirmed by Doppler flow rate measurements. Interim results after 9-month follow-up revealed sustained relief with no recurrence clinically or ultrasonographically. We present a novel, office-based approach to safe, effective, and durable embolization of advanced hand AVMs using Venaseal cyanoacrylate and have found AVM nidal flow rate measurements on Doppler useful for objective assessment of AVM hemodynamics and response to treatment.
{"title":"Staged, office-based treatment of debilitating, limb-threatening hand arteriovenous malformations with a Venaseal cyanoacrylate-based embolization strategy","authors":"Pharis B. Sasa MD , Naiem Nassiri MD","doi":"10.1016/j.jvscit.2025.102064","DOIUrl":"10.1016/j.jvscit.2025.102064","url":null,"abstract":"<div><div>The aim of this study was to demonstrate a novel, office-based treatment of life-threatening hand arteriovenous malformations (AVMs) via Venaseal cyanoacrylate embolization. Two adult male patients with debilitating Yakes II hand AVMs underwent staged, transarterial, and direct-stick Venaseal embolization in an office-based setting over a period of 12 (7 sessions) and 8 (4 sessions) months. Technical success was 100% with no complications. Clinical success was achieved with ulcer and cardiopulmonary overload alleviation, nonrestricted restoration of hand function, and reduction in lesion volume confirmed by Doppler flow rate measurements. Interim results after 9-month follow-up revealed sustained relief with no recurrence clinically or ultrasonographically. We present a novel, office-based approach to safe, effective, and durable embolization of advanced hand AVMs using Venaseal cyanoacrylate and have found AVM nidal flow rate measurements on Doppler useful for objective assessment of AVM hemodynamics and response to treatment.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102064"},"PeriodicalIF":0.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790012","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 : 2025-11-19DOI: 10.1016/j.jvscit.2025.102067
Mark S. Zemela MD , Benjamin Feng MD , Abigail Clark MD , Katherine McMackin MD , Joseph V. Lombardi MD, MBA
A 72-year-old female presented to an outside hospital after her legs gave out and she fell at home. Computed tomography angiography revealed an aortoenteric fistula. Given her extensive and complex revascularization history, including an aortobifemoral bypass, femoral-femoral bypass, and multiple lower extremity revascularizations, she was transferred to our facility for further management and definitive repair. She underwent staged endovascular exclusion of the aortoenteric fistula followed by definitive open aortic repair and lower extremity revascularization 3 days later. Her postoperative course was uneventful, and she was discharged on hospital day 10.
{"title":"Staged endovascular and open surgical repair of an aortoenteric fistula with complex autologous lower extremity revascularization","authors":"Mark S. Zemela MD , Benjamin Feng MD , Abigail Clark MD , Katherine McMackin MD , Joseph V. Lombardi MD, MBA","doi":"10.1016/j.jvscit.2025.102067","DOIUrl":"10.1016/j.jvscit.2025.102067","url":null,"abstract":"<div><div>A 72-year-old female presented to an outside hospital after her legs gave out and she fell at home. Computed tomography angiography revealed an aortoenteric fistula. Given her extensive and complex revascularization history, including an aortobifemoral bypass, femoral-femoral bypass, and multiple lower extremity revascularizations, she was transferred to our facility for further management and definitive repair. She underwent staged endovascular exclusion of the aortoenteric fistula followed by definitive open aortic repair and lower extremity revascularization 3 days later. Her postoperative course was uneventful, and she was discharged on hospital day 10.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102067"},"PeriodicalIF":0.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736326","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 describe a technique for repairing Crawford type IV thoracoabdominal aortic aneurysms using a midline abdominal incision with left transverse extension, performed in the supine position without thoracotomy. Six patients (median age, 73 years) underwent this approach for true aneurysms, chronic dissection, or aortoduodenal fistula. Aortic reconstruction was performed with four-branched or bifurcated grafts under selective visceral perfusion. All patients were discharged home; one required reoperation for bleeding, and one developed an abdominal wall incisional hernia. This approach provided sufficient exposure for proximal and distal anastomoses and facilitated concurrent abdominal procedures while minimizing respiratory complications.
{"title":"Midline abdominal incision with left transverse extension for type IV thoracoabdominal aortic aneurysm repair","authors":"Yorihiko Matsumoto MD, PhD , Tsutomu Ito MD, PhD , Norimasa Haijima MD, PhD , Hirofumi Kasahara MD, PhD , Motohiko Osako MD, PhD , Hideyuki Shimizu MD, PhD","doi":"10.1016/j.jvscit.2025.102062","DOIUrl":"10.1016/j.jvscit.2025.102062","url":null,"abstract":"<div><div>We describe a technique for repairing Crawford type IV thoracoabdominal aortic aneurysms using a midline abdominal incision with left transverse extension, performed in the supine position without thoracotomy. Six patients (median age, 73 years) underwent this approach for true aneurysms, chronic dissection, or aortoduodenal fistula. Aortic reconstruction was performed with four-branched or bifurcated grafts under selective visceral perfusion. All patients were discharged home; one required reoperation for bleeding, and one developed an abdominal wall incisional hernia. This approach provided sufficient exposure for proximal and distal anastomoses and facilitated concurrent abdominal procedures while minimizing respiratory complications.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102062"},"PeriodicalIF":0.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736327","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 : 2025-11-18DOI: 10.1016/S2468-4287(25)00330-2
{"title":"Information for Readers","authors":"","doi":"10.1016/S2468-4287(25)00330-2","DOIUrl":"10.1016/S2468-4287(25)00330-2","url":null,"abstract":"","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"11 6","pages":"Article 102048"},"PeriodicalIF":0.7,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578525","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 : 2025-11-18DOI: 10.1016/S2468-4287(25)00331-4
Peter Gloviczki, Peter F. Lawrence (Editors)
{"title":"Info for Authors","authors":"Peter Gloviczki, Peter F. Lawrence (Editors)","doi":"10.1016/S2468-4287(25)00331-4","DOIUrl":"10.1016/S2468-4287(25)00331-4","url":null,"abstract":"","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"11 6","pages":"Article 102049"},"PeriodicalIF":0.7,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578526","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 : 2025-11-18DOI: 10.1016/S2468-4287(25)00332-6
{"title":"Events of Interest","authors":"","doi":"10.1016/S2468-4287(25)00332-6","DOIUrl":"10.1016/S2468-4287(25)00332-6","url":null,"abstract":"","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"11 6","pages":"Article 102050"},"PeriodicalIF":0.7,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578524","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 : 2025-11-18DOI: 10.1016/S2468-4287(25)00329-6
Anton N. Sidawy, Bruce A. Perler (Editors)
{"title":"Information for Authors","authors":"Anton N. Sidawy, Bruce A. Perler (Editors)","doi":"10.1016/S2468-4287(25)00329-6","DOIUrl":"10.1016/S2468-4287(25)00329-6","url":null,"abstract":"","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"11 6","pages":"Article 102047"},"PeriodicalIF":0.7,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578522","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 : 2025-11-13DOI: 10.1016/j.jvscit.2025.102051
Sneha Thandra BS , Olivia Fuson MD , Victor Pretorius MBChB , Mark Onaitis MD , Mark Kearns MD, FRCSC , Ann Gaffey MD, MS
Aortoesophageal fistula is a rare but fatal complication commonly arising from thoracic aortic aneurysms or secondarily from thoracic endovascular aortic repair. Management remains challenging with few reports of durable repair. We present a 52-year-old woman with prior type A aortic dissection repair who developed persistent pain requiring arch replacement and thoracic endovascular aortic repair. She presented 4 months later with sepsis and imaging revealing extraluminal gas consistent with aortoesophageal fistula. She underwent graft explantation, debridement, and esophageal resection with delayed esophagostomy. Thirty months postoperatively, she remains stable. This case highlights early recognition and aggressive staged surgical management as critical for favorable outcomes.
{"title":"Staged open surgical repair of an aortic esophageal fistula in the setting of an aortic dissection","authors":"Sneha Thandra BS , Olivia Fuson MD , Victor Pretorius MBChB , Mark Onaitis MD , Mark Kearns MD, FRCSC , Ann Gaffey MD, MS","doi":"10.1016/j.jvscit.2025.102051","DOIUrl":"10.1016/j.jvscit.2025.102051","url":null,"abstract":"<div><div>Aortoesophageal fistula is a rare but fatal complication commonly arising from thoracic aortic aneurysms or secondarily from thoracic endovascular aortic repair. Management remains challenging with few reports of durable repair. We present a 52-year-old woman with prior type A aortic dissection repair who developed persistent pain requiring arch replacement and thoracic endovascular aortic repair. She presented 4 months later with sepsis and imaging revealing extraluminal gas consistent with aortoesophageal fistula. She underwent graft explantation, debridement, and esophageal resection with delayed esophagostomy. Thirty months postoperatively, she remains stable. This case highlights early recognition and aggressive staged surgical management as critical for favorable outcomes.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102051"},"PeriodicalIF":0.7,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736438","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 : 2025-11-13DOI: 10.1016/j.jvscit.2025.102054
Aslyn E. Mattson BS , John C. Motta MD , Eileen de Grandis MD , W. Anthony Lee MD
Objective
In situ fenestration (ISF) is a technique for fenestrated endovascular aortic repair (FEVAR) that can be used for urgent repairs of abdominal aortic aneurysms (AAAs) when there is an inadequate infrarenal landing zone for use of a conventional aortic endograft. It involves deliberate endograft coverage of indispensable branch vessels with ISF of the endograft fabric followed by a bridging covered stent. The aim of this series was to review the indications, early clinical outcomes, and technical feasibility of ISF technique for FEVAR of complex AAAs.
Methods
This single-center retrospective case series included all patients with complex aortic aneurysms involving visceral branch vessels requiring urgent repair who were selected for FEVAR using the ISF technique. Briefly, the minimum length of proximal landing zone was determined for each patient. The branch vessels in this segment were prestented as radiographic markers. A polyester-based endograft was fully deployed. Using a steerable sheath, fenestrations were created using a CVX-300 excimer laser and covered, balloon-expandable stents were used to restore perfusion to the target vessels.
Results
From February 2023 to December 2024, 12 patients underwent ISF-FEVAR with 33 intended target vessels. Technical success per Society for Vascular Surgery reporting standards was 91% (30/33). Perioperative complications included 30-day mortality (n = 2), failure to create a fenestration (n = 1), target vessel dissection (n = 2), transient acute kidney injury (n = 1), spinal cord ischemia (n = 1), and femoral artery pseudoaneurysm (n = 1). There were one type II (n = 1) and one type IIIb endoleak at 1 month, and three secondary interventions performed during the follow-up period. There was no aneurysm growth and one patient experienced sac shrinkage.
Conclusions
ISF of aortic stent grafts is a feasible and useful technique for urgent FEVAR of complex AAAs.
{"title":"Fenestrated endovascular aortic repair for complex abdominal aortic aneurysms using in situ laser fenestrations","authors":"Aslyn E. Mattson BS , John C. Motta MD , Eileen de Grandis MD , W. Anthony Lee MD","doi":"10.1016/j.jvscit.2025.102054","DOIUrl":"10.1016/j.jvscit.2025.102054","url":null,"abstract":"<div><h3>Objective</h3><div>In situ fenestration (ISF) is a technique for fenestrated endovascular aortic repair (FEVAR) that can be used for urgent repairs of abdominal aortic aneurysms (AAAs) when there is an inadequate infrarenal landing zone for use of a conventional aortic endograft. It involves deliberate endograft coverage of indispensable branch vessels with ISF of the endograft fabric followed by a bridging covered stent. The aim of this series was to review the indications, early clinical outcomes, and technical feasibility of ISF technique for FEVAR of complex AAAs.</div></div><div><h3>Methods</h3><div>This single-center retrospective case series included all patients with complex aortic aneurysms involving visceral branch vessels requiring urgent repair who were selected for FEVAR using the ISF technique. Briefly, the minimum length of proximal landing zone was determined for each patient. The branch vessels in this segment were prestented as radiographic markers. A polyester-based endograft was fully deployed. Using a steerable sheath, fenestrations were created using a CVX-300 excimer laser and covered, balloon-expandable stents were used to restore perfusion to the target vessels.</div></div><div><h3>Results</h3><div>From February 2023 to December 2024, 12 patients underwent ISF-FEVAR with 33 intended target vessels. Technical success per Society for Vascular Surgery reporting standards was 91% (30/33). Perioperative complications included 30-day mortality (n = 2), failure to create a fenestration (n = 1), target vessel dissection (n = 2), transient acute kidney injury (n = 1), spinal cord ischemia (n = 1), and femoral artery pseudoaneurysm (n = 1). There were one type II (n = 1) and one type IIIb endoleak at 1 month, and three secondary interventions performed during the follow-up period. There was no aneurysm growth and one patient experienced sac shrinkage.</div></div><div><h3>Conclusions</h3><div>ISF of aortic stent grafts is a feasible and useful technique for urgent FEVAR of complex AAAs.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":"12 1","pages":"Article 102054"},"PeriodicalIF":0.7,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790008","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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