Annals of vascular surgery. Brief reports and innovations最新文献

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Intravascular lipoma with extravascular extension, a rare phenomena and review of the literature

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-02-17 DOI: 10.1016/j.avsurg.2025.100370

Mennatalla Hegazi , Charlene Yuan , Nii-Kabu Kabutey , Roy M Fujitani , Hari Keshava , Ali Mahtabifard , Anthony H Chau

Lipomas are the most common soft tissue tumors, accounting for half of all soft tissue masses. However, intravascular lipomas (IVLs) are rare. IVLs have been described in case reports in the various major veins. They are often asymptomatic and found incidentally. Given the risk of malignancy, as liposarcomas are the second most common soft tissue sarcoma in adults and account for 1 % of all malignancies, histological differentiation is important, and surgical excision remains the mainstay of treatment in the literature. We present the case of a 61-year-old male who presented with left chest pain that radiated to his left shoulder and arm. On further evaluation, the patient endorsed left-hand swelling and weakness and increased prominence of veins in the left upper extremity. He underwent a CT scan that showed a hypodense mass with fat attenuation in the left innominate vein extending extra-vascularly and into the left internal jugular vein, measuring 2.3 × 2.0 × 5.2 cm. Successful surgical excision and reconstruction of the innominate vein with reimplantation of the left internal jugular vein was performed through median sternotomy and left cervical incision. The postoperative course was unremarkable, and the patient recovered well. The clinical presentation of an intravascular lipoma in a large caliber vessel can be subtle and nonspecific. This case report characterizes this rare vascular tumor and includes a contemporary literature review, summarizing the diagnosis and treatment options.

{"title":"Intravascular lipoma with extravascular extension, a rare phenomena and review of the literature","authors":"Mennatalla Hegazi , Charlene Yuan , Nii-Kabu Kabutey , Roy M Fujitani , Hari Keshava , Ali Mahtabifard , Anthony H Chau","doi":"10.1016/j.avsurg.2025.100370","DOIUrl":"10.1016/j.avsurg.2025.100370","url":null,"abstract":"<div><div>Lipomas are the most common soft tissue tumors, accounting for half of all soft tissue masses. However, intravascular lipomas (IVLs) are rare. IVLs have been described in case reports in the various major veins. They are often asymptomatic and found incidentally. Given the risk of malignancy, as liposarcomas are the second most common soft tissue sarcoma in adults and account for 1 % of all malignancies, histological differentiation is important, and surgical excision remains the mainstay of treatment in the literature. We present the case of a 61-year-old male who presented with left chest pain that radiated to his left shoulder and arm. On further evaluation, the patient endorsed left-hand swelling and weakness and increased prominence of veins in the left upper extremity. He underwent a CT scan that showed a hypodense mass with fat attenuation in the left innominate vein extending extra-vascularly and into the left internal jugular vein, measuring 2.3 × 2.0 × 5.2 cm. Successful surgical excision and reconstruction of the innominate vein with reimplantation of the left internal jugular vein was performed through median sternotomy and left cervical incision. The postoperative course was unremarkable, and the patient recovered well. The clinical presentation of an intravascular lipoma in a large caliber vessel can be subtle and nonspecific. This case report characterizes this rare vascular tumor and includes a contemporary literature review, summarizing the diagnosis and treatment options.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"5 1","pages":"Article 100370"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453840","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}

引用次数: 0

Paget-Schroetter Syndrome secondary to anomalous right-sided aortic arch: A case report

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-02-09 DOI: 10.1016/j.avsurg.2025.100368

Katrina Pardo , Sofia Steger , Edgar Galinanes , Juan Carlos Pereda

Thoracic Outlet Syndrome (TOS) is a rare condition, with an estimated prevalence of about 3 in 100,000 individuals.¹ Venogenic TOS, also referred to as Paget-Schroetter Syndrome (PSS), is rarer than neurogenic TOS with an estimated prevalence of 1 in 100,000.¹ In this case report, we present a rare case of PSS secondary to an anomalous right-sided aortic arch with branching anomalies, which are described poorly in the literature. The patient, a 41-year-old male with no significant past medical history, presented with classic PSS symptoms that include left neck swelling and pain, intermittent numbness, and swelling in the left arm. Following admission, a chest CT with contrast revealed a right-sided aortic arch along with a left common carotid artery and left subclavian artery that share a common trunk. Ultrasound revealed thrombosis of the left subclavian and innominate veins consistent with PSS. He underwent an aspiration thrombectomy and catheter-directed thrombolytic therapy. The patient is currently symptom-free and successfully managed in the short term with anticoagulation therapy.

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引用次数: 0

Facial flushing can be a rare presentation of SVC syndrome

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-02-09 DOI: 10.1016/j.avsurg.2025.100369

Claire Elizabeth Cassianni , Noora Jabeen , Tiziano Tallarita , Michel K Barsoum , Vaibhav R. Vaidya , Indrani Sen

Facial plethora is a rare presentation of superior vena cava syndrome (SVCS). We report facial plethora and feeling of fullness in the head and neck in a 37-year-old female with cardiomyopathy and implantable cardioverter defibrillator (ICD) placement. She remained undiagnosed for a year despite computed tomogram (CT) imaging. Based on her symptoms, a diagnosis of SVCS was suspected and confirmed with diagnostic venogram. Symptoms resolved transiently with initial venoplasty. She presented with recurrent incapacitating symptoms in a year. This required repeat venoplasty, lead extraction and placement of subcutaneous ICD. She remains asymptomatic a year after this procedure.

引用次数: 0

Initial experience and early outcomes of treatment of complex deep vein thrombosis with flowtriever and clottriever mechanical thrombectomy systems in conjunction with protrieve sheath

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-02-07 DOI: 10.1016/j.avsurg.2025.100367

Nicole Ilonzo, Dana Harrison, Olivia Watman, Gabriela Abril, Michael Segal, Rajesh Malik

Introduction

The study aims to establish that the ClotTriever and/or Flowtriever Systems, used in conjunction with the Protrieve sheath, can safely remove large thrombus burden associated with complex DVT while, in pertinent cases, also preserving the structural integrity of the IVC filter during catheter deployment, thus minimizing complications and reducing case complexity.

Methods

A retrospective review of all patients who underwent mechanical thrombectomy for complex DVT at New York Presbyterian-Brooklyn Methodist Hospital from February 2022 to August 2024 was conducted. Patient demographics as well as baseline characteristics including comorbidities, presenting symptoms, and initial imaging findings were collected. Intraoperative and postoperative outcomes were analyzed.

Results

The mean age was 76.5 years old, and 60 % were female. Of the anatomical location of thrombus, 60 % of thrombi extended into in the IVC. Concomitant subsegmental pulmonary embolism was found in 85 % (6/7) of these patients. Native vein thrombectomy was successfully achieved in all cases using a Triever catheter in 90 % (9/10) of cases and a ClotTriever device in 40 % (4/10) of cases. The Protrieve sheath was used to capture intraprocedural emboli in 90 % (9/10) of cases. Thrombectomy of an IVC filter was performed in 40 % (4/10) cases. Intraoperative patency improvement of treated vessels was confirmed via imaging in 100 % of cases. No serious adverse events occurred. 90 % of patients had complete resolution of edema and pain.

Conclusion

The initial single-center experience with the Protrieve sheath used in combination with the FlowTriever and/or ClotTriever mechanical thrombectomy devices for the treatment of proximal DVT that is bilateral, involves thrombosis of the IVC, and/or thrombosed IVC filters appears safe and effective with 100 % flow restoration, no serious adverse events including iaotrogenic PE, and no rethrombosis during the follow-up period.

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引用次数: 0

A rare case of acute arterial thrombosis revealing undifferentiated arterial leiomyosarcoma

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-01-23 DOI: 10.1016/j.avsurg.2025.100365

Masato Tsuchimochi , Shigeta Miyake , Taisuke Akimoto , Yuta Otomo , Yasunobu Nakai , Kotaro Oshio , Tetsuya Yamamoto

Aortic leiomyosarcoma, a rare and elusive malignancy, presents diagnostic and therapeutic dilemmas due to its nonspecific symptoms and aggressive course. We report a unique case where the incidental discovery of arterial leiomyosarcoma occurred during acute cerebral infarction management. A previously healthy 58-year-old woman, initially presenting with severe neurological deficits indicative of acute ischemic stroke, underwent prompt recanalization therapy that resulted in successful restoration. Unexpectedly, a histopathological examination of the extracted thrombus revealed arterial leiomyosarcoma. The diagnostic process involved immunohistochemistry and contrast-enhanced computed tomography, confirming the presence of leiomyosarcoma originating from the ascending aorta. Given the patient's severe disability, a palliative care approach was chosen to prioritize comfort and quality of life. This case underscores the diagnostic potential of acute recanalization therapy for functional recovery as well as histopathological examination, shedding light on rare diseases. Further case accumulation is essential to refine treatment strategies and improve prognostic outcomes for vascular sarcomas.

{"title":"A rare case of acute arterial thrombosis revealing undifferentiated arterial leiomyosarcoma","authors":"Masato Tsuchimochi , Shigeta Miyake , Taisuke Akimoto , Yuta Otomo , Yasunobu Nakai , Kotaro Oshio , Tetsuya Yamamoto","doi":"10.1016/j.avsurg.2025.100365","DOIUrl":"10.1016/j.avsurg.2025.100365","url":null,"abstract":"<div><div>Aortic leiomyosarcoma, a rare and elusive malignancy, presents diagnostic and therapeutic dilemmas due to its nonspecific symptoms and aggressive course. We report a unique case where the incidental discovery of arterial leiomyosarcoma occurred during acute cerebral infarction management. A previously healthy 58-year-old woman, initially presenting with severe neurological deficits indicative of acute ischemic stroke, underwent prompt recanalization therapy that resulted in successful restoration. Unexpectedly, a histopathological examination of the extracted thrombus revealed arterial leiomyosarcoma. The diagnostic process involved immunohistochemistry and contrast-enhanced computed tomography, confirming the presence of leiomyosarcoma originating from the ascending aorta. Given the patient's severe disability, a palliative care approach was chosen to prioritize comfort and quality of life. This case underscores the diagnostic potential of acute recanalization therapy for functional recovery as well as histopathological examination, shedding light on rare diseases. Further case accumulation is essential to refine treatment strategies and improve prognostic outcomes for vascular sarcomas.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"5 1","pages":"Article 100365"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139032","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}

引用次数: 0

Retroperitoneal approach for redo median arcuate ligament release

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-01-21 DOI: 10.1016/j.avsurg.2025.100366

Matthew Fastiggi, Arash Bornak, Matthew Sussman, Hilene DeAmorim, Naixin Kang

Median arcuate ligament syndrome (MALS) is a cause of chronic abdominal pain that can be difficult to diagnose and treat, as the pathophysiology is not completely understood and there is no definitive diagnostic and treatment algorithm. We present the case of a 39-year-old man with debilitating symptoms of MALS for 18 years. His symptoms began after a blunt abdominal and flank trauma. He had failed two transabdominal surgeries and was successfully treated at our institution with an open retroperitoneal median arcuate ligament release with relief of symptoms. This case adds open retroperitoneal MALS release as a surgical option for this complex disease. Future clinicians can draw on this case when faced with similar circumstances in patients with chronic, life-limiting abdominal pain from MALS.

引用次数: 0

Recurrent disconnection of Gore Iliac Branch Endoprosthesis: Case report and review of contributing factors

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-01-20 DOI: 10.1016/j.avsurg.2025.100363

Catherine Boudreau, Caroline Caradu, Xavier Bérard, Eric Ducasse

Introduction

Iliac artery aneurysms (IAAs) which may coexist with abdominal aortic aneurysms (AAAs) or appear as isolated lesions, represent around 2 % of intra-abdominal aneurysms. Endovascular repair using iliac branch devices (IBDs) helps preserve internal iliac artery (IIA) perfusion, reducing complications like buttock claudication. However, device displacement and type III endoleaks are significant challenges, especially in tortuous anatomy.

Report

We report two cases of type III endoleak due to displacement of Gore Iliac Branch Endoprosthesis (IBE). In the first case, a 60-year-old male with a left IAA experienced immediate postoperative IBE migration and type III endoleak, necessitating urgent reintervention with bridging stents. In the second, a 74-year-old male treated for a right IAA had recurrent IBE displacements over four years, with repeated type III endoleaks, managed by repeated stenting. Severe iliac tortuosity contributed to both cases.

Discussion

These cases highlight the complexities of IAA endovascular repair with IBDs, particularly the risk of device migration and endoleaks, with severe iliac tortuosity, device properties (e.g. conformability, low friction coefficient), and response to cardiac pulsatility increasing migration risk. Future studies should address these challenges, focusing on device design improvements and predictive imaging techniques, including artificial intelligence, to enhance long-term outcomes in IAA repair.

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引用次数: 0

Endovascular coil embolization of a symptomatic profunda femoris artery aneurysm in a patient with a complex vascular history through a transbrachial approach

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-01-19 DOI: 10.1016/j.avsurg.2025.100364

W.M. Yu , D.K. Shan , S.M. Saravitz , N. Udgiri

Profunda femoris artery (PFA) aneurysms, though rare, pose significant risks if untreated. Guidelines predominantly address femoral artery aneurysms as a whole, leaving gaps in management of PFA aneurysms. We present a case of a 65-year-old male with a ruptured 4.6 cm x 7.6 cm x 5.0 cm distal PFA aneurysm alongside proximal PFA and CFA aneurysms. Endovascular coil embolization successfully treated the aneurysm, with concurrent thigh fasciotomy for compartment syndrome. The patient's complex medical history influenced treatment selection. This underscores the importance of early recognition and tailored management, advocating for endovascular interventions in high-risk patients. Further research is imperative to establish consensus guidelines for optimal management of PFA aneurysms.

引用次数: 0

Surgical extremity preservation in severe acute limb ischemia in a 4-week-old newborn

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-01-08 DOI: 10.1016/j.avsurg.2025.100362

Manuela Schulz , Johannes Hatzl , Katrin Meisenbacher , Christian Gille , Andreas S. Peters , Dittmar Böckler

This case report describes a successful revascularisation of severe acute limb ischemia (ALI) in a 4-week-old newborn following common femoral artery dissection due to catheterization for invasive blood pressure measurement during cardiac arrest in the intensive care unit. Iatrogenic acute limb ischemia in childhood is very rare and, in selected cases, a fatal condition potentially associated with limb loss and lifelong mobility impairments. The most common cause of acute limb ischemia in newborns is catheter-associated thrombosis. Current clinical guidelines recommend primary conservative management with heparin administration (level of recommendation: Class 1C) for children under 2 years of age. If revascularization is needed and indicated, open surgical techniques are typically performed. The following case report describes successful surgical treatment of acute limb ischemia in the context of current literature on ALI in childhood, including clinical presentation, diagnosis, treatment, and follow-up.

{"title":"Surgical extremity preservation in severe acute limb ischemia in a 4-week-old newborn","authors":"Manuela Schulz , Johannes Hatzl , Katrin Meisenbacher , Christian Gille , Andreas S. Peters , Dittmar Böckler","doi":"10.1016/j.avsurg.2025.100362","DOIUrl":"10.1016/j.avsurg.2025.100362","url":null,"abstract":"<div><div>This case report describes a successful revascularisation of severe acute limb ischemia (ALI) in a 4-week-old newborn following common femoral artery dissection due to catheterization for invasive blood pressure measurement during cardiac arrest in the intensive care unit. Iatrogenic acute limb ischemia in childhood is very rare and, in selected cases, a fatal condition potentially associated with limb loss and lifelong mobility impairments. The most common cause of acute limb ischemia in newborns is catheter-associated thrombosis. Current clinical guidelines recommend primary conservative management with heparin administration (level of recommendation: Class 1C) for children under 2 years of age. If revascularization is needed and indicated, open surgical techniques are typically performed. The following case report describes successful surgical treatment of acute limb ischemia in the context of current literature on ALI in childhood, including clinical presentation, diagnosis, treatment, and follow-up.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"5 1","pages":"Article 100362"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139017","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}

引用次数: 0

Takayasu arteritis beyond the young: What to consider?

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-01-07 DOI: 10.1016/j.avsurg.2025.100361

Suci Indriani , Averina Geffanie Suwana , Suko Adiarto , Taofan , Ruth Grace Aurora , Iwan Dakota

Background

Takayasu arteritis (TA), also known as the pulseless disease, is a rare systemic inflammatory condition that damages medium and larger arteries. With an incidence rate of 2–6 per million, it predominantly affects individuals aged 20–40. Clinical manifestations vary from asymptomatic cases to severe vascular damage, often complicating diagnosis. This report aims to shed light on diagnosing Takayasu arteritis in older women.

Case Summary

A 57-year-old Southeast Asian woman presented with intermittent claudication of the upper and lower limbs. Examination revealed a significant systolic blood pressure discrepancy of 60 mmHg between the left and right leg, and vascular bruits over the subclavian arteries. Laboratory tests showed high inflammatory markers and positive ANA. Imaging with duplex ultrasound and CT scan revealed total occlusion of bilateral superficial femoral artery and stenosis of the subclavian arteries. Based on the findings, the patient was diagnosed with Takayasu arteritis. Treatment with high-dose corticosteroids and methotrexate (Methotrexate), along with antihypertensive and antiplatelet drugs, led to symptom improvement and no adverse events at the 1-year follow-up.

Discussion

Takayasu arteritis, while primarily affecting the young, can manifest in older individuals, presenting diagnostic challenges due to its rarity and non-specific symptoms. This case underscores the importance of including TA in the differential diagnosis for older patients with vascular symptoms. Individualized and tailored management of immunosuppressive therapy and regular monitoring are essential to control disease progression and improve outcomes.

{"title":"Takayasu arteritis beyond the young: What to consider?","authors":"Suci Indriani , Averina Geffanie Suwana , Suko Adiarto , Taofan , Ruth Grace Aurora , Iwan Dakota","doi":"10.1016/j.avsurg.2025.100361","DOIUrl":"10.1016/j.avsurg.2025.100361","url":null,"abstract":"<div><h3>Background</h3><div>Takayasu arteritis (TA), also known as the pulseless disease, is a rare systemic inflammatory condition that damages medium and larger arteries. With an incidence rate of 2–6 per million, it predominantly affects individuals aged 20–40. Clinical manifestations vary from asymptomatic cases to severe vascular damage, often complicating diagnosis. This report aims to shed light on diagnosing Takayasu arteritis in older women.</div></div><div><h3>Case Summary</h3><div>A 57-year-old Southeast Asian woman presented with intermittent claudication of the upper and lower limbs. Examination revealed a significant systolic blood pressure discrepancy of 60 mmHg between the left and right leg, and vascular bruits over the subclavian arteries. Laboratory tests showed high inflammatory markers and positive ANA. Imaging with duplex ultrasound and CT scan revealed total occlusion of bilateral superficial femoral artery and stenosis of the subclavian arteries. Based on the findings, the patient was diagnosed with Takayasu arteritis. Treatment with high-dose corticosteroids and methotrexate (Methotrexate), along with antihypertensive and antiplatelet drugs, led to symptom improvement and no adverse events at the 1-year follow-up.</div></div><div><h3>Discussion</h3><div>Takayasu arteritis, while primarily affecting the young, can manifest in older individuals, presenting diagnostic challenges due to its rarity and non-specific symptoms. This case underscores the importance of including TA in the differential diagnosis for older patients with vascular symptoms. Individualized and tailored management of immunosuppressive therapy and regular monitoring are essential to control disease progression and improve outcomes.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"5 1","pages":"Article 100361"},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139018","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}

引用次数: 0

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Annals of vascular surgery. Brief reports and innovations

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