Thoracic endovascular aortic repair (TEVAR) for saccular aneurysms located just distal to the left subclavian artery (LSA) often necessitates proximal landing in Zone 2. Preserving LSA perfusion in such cases typically requires additional devices such as Viabahn® stents or surgical debranching, which may be invasive, costly, or off-label in Japan.
Case Presentation
We report the case of a 67-year-old man with multiple comorbidities, including prior abdominal aortic aneurysm repair, who was found to have a 33-mm saccular aneurysm located 7 mm distal to the LSA. To preserve LSA perfusion without using adjunctive devices, we modified a Valiant® thoracic stent graft by creating a 1-cm square fenestration in the non-stented portion of the graft fabric. The fenestration was reinforced with 5–0 Prolene sutures and marked with an l-shaped radiopaque marker using a Micropuncture® sheath. The stent graft was deployed in a “Zone 2.5″ position, wherein the fenestration partially overlapped the LSA ostium. Intraoperative angiography confirmed adequate LSA perfusion via the fenestration. No additional stent or bypass procedure was required.
Outcome
The postoperative course was uneventful. Six-month follow-up computed tomography angiography confirmed complete aneurysm exclusion, appropriate graft positioning, and sustained LSA perfusion without endoleak or complications.
Conclusion
Homemade fenestrated TEVAR with Zone 2.5 deployment using a self-modified stent graft represents a safe, effective, and economical alternative to conventional techniques requiring adjunctive devices. This strategy may be particularly beneficial for elderly or high-risk patients.
{"title":"Zone 2.5 homemade fenestrated tevar for a saccular aneurysm just distal to the left subclavian artery without additional devices","authors":"Norimasa Haijima , Mikihiko Kudo , Satoru Murata , Takuya Ono , Hideyuki Shimizu","doi":"10.1016/j.avsurg.2026.100424","DOIUrl":"10.1016/j.avsurg.2026.100424","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic endovascular aortic repair (TEVAR) for saccular aneurysms located just distal to the left subclavian artery (LSA) often necessitates proximal landing in Zone 2. Preserving LSA perfusion in such cases typically requires additional devices such as Viabahn® stents or surgical debranching, which may be invasive, costly, or off-label in Japan.</div></div><div><h3>Case Presentation</h3><div>We report the case of a 67-year-old man with multiple comorbidities, including prior abdominal aortic aneurysm repair, who was found to have a 33-mm saccular aneurysm located 7 mm distal to the LSA. To preserve LSA perfusion without using adjunctive devices, we modified a Valiant® thoracic stent graft by creating a 1-cm square fenestration in the non-stented portion of the graft fabric. The fenestration was reinforced with 5–0 Prolene sutures and marked with an <span>l</span>-shaped radiopaque marker using a Micropuncture® sheath. The stent graft was deployed in a “Zone 2.5″ position, wherein the fenestration partially overlapped the LSA ostium. Intraoperative angiography confirmed adequate LSA perfusion via the fenestration. No additional stent or bypass procedure was required.</div></div><div><h3>Outcome</h3><div>The postoperative course was uneventful. Six-month follow-up computed tomography angiography confirmed complete aneurysm exclusion, appropriate graft positioning, and sustained LSA perfusion without endoleak or complications.</div></div><div><h3>Conclusion</h3><div>Homemade fenestrated TEVAR with Zone 2.5 deployment using a self-modified stent graft represents a safe, effective, and economical alternative to conventional techniques requiring adjunctive devices. This strategy may be particularly beneficial for elderly or high-risk patients.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"6 1","pages":"Article 100424"},"PeriodicalIF":0.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978099","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 : 2026-01-07DOI: 10.1016/j.avsurg.2026.100423
Huu Uoc NGUYEN , Quoc Hung DOAN , Duc Hung DUONG , Duy Hong Son PHUNG , Huu Lu PHAM , Trong Hai HOANG , Minh Tri NGUYEN , Van Dan NGUYEN , Xuan Hiep VU , Thi Thu Hien DO , Ngoc Thang DUONG
Background
Visceral artery aneurysms (VAAs) are rare vascular lesions with potentially life-threatening complications, particularly when rupture occurs. The role of open surgery in managing VAAs is evolving in the context of expanding endovascular therapies.
Objective
To evaluate the clinical presentation, imaging features, surgical management strategies, and early outcomes of patients undergoing open surgical repair for VAAs at a tertiary referral center.
Methods
A retrospective cross-sectional study was conducted, including adult patients treated for VAAs via open surgery between June 2021 and December 2024 at Viet Duc university hospital. Data collected included demographic characteristics, aneurysm location and morphology, surgical techniques, and perioperative outcomes.
Results
Nine patients underwent open surgery. Six had renal artery aneurysms, two had superior mesenteric artery aneurysms, and one had a common hepatic artery aneurysm. Renal aneurysms were mostly asymptomatic, with a mean diameter of 30.8 ± 8.78 mm. All patients underwent midline laparotomy. One hepatic aneurysm caused biliary obstruction and was treated with saphenous vein interposition graft. No perioperative mortality was observed. Two patients experienced self-limited postoperative complications.
Conclusion
Open surgical repair remains a safe and effective option for patients with complex or symptomatic VAAs, particularly in settings where endovascular treatment is not feasible. Careful preoperative planning and tailored surgical techniques are essential to achieving good outcomes.
{"title":"Is surgical management of visceral artery aneurysms still relevant in the endovascular era?","authors":"Huu Uoc NGUYEN , Quoc Hung DOAN , Duc Hung DUONG , Duy Hong Son PHUNG , Huu Lu PHAM , Trong Hai HOANG , Minh Tri NGUYEN , Van Dan NGUYEN , Xuan Hiep VU , Thi Thu Hien DO , Ngoc Thang DUONG","doi":"10.1016/j.avsurg.2026.100423","DOIUrl":"10.1016/j.avsurg.2026.100423","url":null,"abstract":"<div><h3>Background</h3><div>Visceral artery aneurysms (VAAs) are rare vascular lesions with potentially life-threatening complications, particularly when rupture occurs. The role of open surgery in managing VAAs is evolving in the context of expanding endovascular therapies.</div></div><div><h3>Objective</h3><div>To evaluate the clinical presentation, imaging features, surgical management strategies, and early outcomes of patients undergoing open surgical repair for VAAs at a tertiary referral center.</div></div><div><h3>Methods</h3><div>A retrospective cross-sectional study was conducted, including adult patients treated for VAAs via open surgery between June 2021 and December 2024 at Viet Duc university hospital. Data collected included demographic characteristics, aneurysm location and morphology, surgical techniques, and perioperative outcomes.</div></div><div><h3>Results</h3><div>Nine patients underwent open surgery. Six had renal artery aneurysms, two had superior mesenteric artery aneurysms, and one had a common hepatic artery aneurysm. Renal aneurysms were mostly asymptomatic, with a mean diameter of 30.8 ± 8.78 mm. All patients underwent midline laparotomy. One hepatic aneurysm caused biliary obstruction and was treated with saphenous vein interposition graft. No perioperative mortality was observed. Two patients experienced self-limited postoperative complications.</div></div><div><h3>Conclusion</h3><div>Open surgical repair remains a safe and effective option for patients with complex or symptomatic VAAs, particularly in settings where endovascular treatment is not feasible. Careful preoperative planning and tailored surgical techniques are essential to achieving good outcomes.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"6 1","pages":"Article 100423"},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978098","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 : 2026-01-03DOI: 10.1016/j.avsurg.2026.100422
Abdel Kémal Bori Bata , Eulalie Sansuamou , Ahmad Ibrahim , Tola Zounon , Caleb Gbegnide
Arteriovenous malformations of the head and neck are rare vascular anomalies composed of a complex network of interconnected arteries and veins. They are most often congenital but may, more rarely, occur following trauma. We report the case of a 17-year-old adolescent presenting with a pulsatile mass in the left parietofrontal region, which appeared ten years after a cranial trauma. Doppler ultrasound confirmed the diagnosis of an arteriovenous malformation supplied by the left superficial temporal artery. A complete surgical resection was successfully performed. The immediate postoperative course was marked by transient partial paralysis of the facial nerve, secondary to injury of its left temporofrontal branch. No other complications were noted during a six-month follow-up.
{"title":"Post-traumatic superficial temporal artery arteriovenous malformation: A case report and surgical insight in Sub-Saharan Africa","authors":"Abdel Kémal Bori Bata , Eulalie Sansuamou , Ahmad Ibrahim , Tola Zounon , Caleb Gbegnide","doi":"10.1016/j.avsurg.2026.100422","DOIUrl":"10.1016/j.avsurg.2026.100422","url":null,"abstract":"<div><div>Arteriovenous malformations of the head and neck are rare vascular anomalies composed of a complex network of interconnected arteries and veins. They are most often congenital but may, more rarely, occur following trauma. We report the case of a 17-year-old adolescent presenting with a pulsatile mass in the left parietofrontal region, which appeared ten years after a cranial trauma. Doppler ultrasound confirmed the diagnosis of an arteriovenous malformation supplied by the left superficial temporal artery. A complete surgical resection was successfully performed. The immediate postoperative course was marked by transient partial paralysis of the facial nerve, secondary to injury of its left temporofrontal branch. No other complications were noted during a six-month follow-up.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"6 1","pages":"Article 100422"},"PeriodicalIF":0.0,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037754","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 : 2025-12-26DOI: 10.1016/j.avsurg.2025.100420
Sandra Iskandar , Silvana Iskandar , Benjamin Fegale
Tracheoinnominate fistula (TIF) is a fatal complication that can occur following tracheostomy. Innominate artery stenting has been reported as an effective intervention for managing this condition. This report presents a 72-year-old patient with a complex surgical history who experienced recurrent tracheostomy bleeding three months after innominate artery stenting due to erosion of the previously placed stent. The patient underwent embolization of the innominate artery and a left-to-right subclavian artery bypass. This case suggests that innominate artery stenting can serve as a temporizing measure and bridge to definitive management, and it highlights the need for further research to evaluate its long-term efficacy and role in the treatment of TIF.
{"title":"Recurrent innominate artery hemorrhage after stent erosion treated with embolization and subclavian bypass","authors":"Sandra Iskandar , Silvana Iskandar , Benjamin Fegale","doi":"10.1016/j.avsurg.2025.100420","DOIUrl":"10.1016/j.avsurg.2025.100420","url":null,"abstract":"<div><div>Tracheoinnominate fistula (TIF) is a fatal complication that can occur following tracheostomy. Innominate artery stenting has been reported as an effective intervention for managing this condition. This report presents a 72-year-old patient with a complex surgical history who experienced recurrent tracheostomy bleeding three months after innominate artery stenting due to erosion of the previously placed stent. The patient underwent embolization of the innominate artery and a left-to-right subclavian artery bypass. This case suggests that innominate artery stenting can serve as a temporizing measure and bridge to definitive management, and it highlights the need for further research to evaluate its long-term efficacy and role in the treatment of TIF.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"6 1","pages":"Article 100420"},"PeriodicalIF":0.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977573","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 : 2025-12-24DOI: 10.1016/j.avsurg.2025.100421
Leopoldo Marine, Ana Sutherland, Fernanda Castro, Jose Francisco Vargas, Michel Bergoeing, Francisco Valdes, Sebastian Sepulveda
Introduction
: Axillo-subclavian venous thrombosis (ASVT) is a complication of venous thoracic outlet syndrome (vTOS).
Objective
: To describe our 25 years of experience in the endovascular and surgical management of ASVT.
Materials and Methods
: Retrospective, single-center analysis between 2000 and 2025 of sequential patients over 15 years of age with AVST. Patients who consulted for venous thrombosis lasting more than 30 days and/or those who underwent surgery at another center were excluded. Long-term functional disability was measured using the QuickDASH Score and UEFI-15 surveys.
Results
: Seventeen patients with ASVT were treated, with a mean age of 30.6±10.2 years17-57, predominantly male (58.8%). They consulted for edema (100%) and pain (88.2%) in the affected limb. The diagnosis was confirmed by Doppler ultrasound (58.8%), venous angiography (23.5%), or both (17.6%). All patients were started on intravenous heparin at therapeutic doses. They then underwent catheter-directed thrombolysis (35.3%), pharmacomechanical thrombectomy (35.3%), or mechanical thrombectomy alone (29.4%), followed by venous angioplasty in 16 patients (94.1%), without stent placement. Finally, resection of the first rib and vein release were performed in 16 patients (94.1%). The median time between symptom onset and endovascular treatment was 10 days1-30, and between endovascular treatment and first rib resection was 9 days2-150. The most frequent postoperative complication was pneumothorax in 2 cases. The average follow-up was 51.5 months1-110. Seventy-point-six percent were asymptomatic, and 29.4% presented with pain and mild edema, with a new ASVT diagnosed in two cases (13.3%). One of these cases corresponded to a patient who refused rib resection, and the other to a patient who did not undergo angioplasty after thrombolysis. One patient underwent reoperation 32 months after rib resection due to recurrence of symptoms. In the assessment of functional disability, 81.3% had no disability.
Conclusion
: In our experience, the management of ASVT is based on a combination of anticoagulation, endovascular procedures with angioplasty, and the need for subsequent decompression surgery.
{"title":"Axillo-subclavian venous thrombosis due to venous thoracic outlet syndrome: experience at a Chilean center (2000-2025)","authors":"Leopoldo Marine, Ana Sutherland, Fernanda Castro, Jose Francisco Vargas, Michel Bergoeing, Francisco Valdes, Sebastian Sepulveda","doi":"10.1016/j.avsurg.2025.100421","DOIUrl":"10.1016/j.avsurg.2025.100421","url":null,"abstract":"<div><h3>Introduction</h3><div><strong>:</strong> Axillo-subclavian venous thrombosis (ASVT) is a complication of venous thoracic outlet syndrome (vTOS).</div></div><div><h3>Objective</h3><div><strong>:</strong> To describe our 25 years of experience in the endovascular and surgical management of ASVT.</div></div><div><h3>Materials and Methods</h3><div><strong>:</strong> Retrospective, single-center analysis between 2000 and 2025 of sequential patients over 15 years of age with AVST. Patients who consulted for venous thrombosis lasting more than 30 days and/or those who underwent surgery at another center were excluded. Long-term functional disability was measured using the QuickDASH Score and UEFI-15 surveys.</div></div><div><h3>Results</h3><div><strong>:</strong> Seventeen patients with ASVT were treated, with a mean age of 30.6±10.2 years<sup>17-57</sup>, predominantly male (58.8%). They consulted for edema (100%) and pain (88.2%) in the affected limb. The diagnosis was confirmed by Doppler ultrasound (58.8%), venous angiography (23.5%), or both (17.6%). All patients were started on intravenous heparin at therapeutic doses. They then underwent catheter-directed thrombolysis (35.3%), pharmacomechanical thrombectomy (35.3%), or mechanical thrombectomy alone (29.4%), followed by venous angioplasty in 16 patients (94.1%), without stent placement. Finally, resection of the first rib and vein release were performed in 16 patients (94.1%). The median time between symptom onset and endovascular treatment was 10 days<sup>1-30</sup>, and between endovascular treatment and first rib resection was 9 days<sup>2-150</sup>. The most frequent postoperative complication was pneumothorax in 2 cases. The average follow-up was 51.5 months<sup>1-110</sup>. Seventy-point-six percent were asymptomatic, and 29.4% presented with pain and mild edema, with a new ASVT diagnosed in two cases (13.3%). One of these cases corresponded to a patient who refused rib resection, and the other to a patient who did not undergo angioplasty after thrombolysis. One patient underwent reoperation 32 months after rib resection due to recurrence of symptoms. In the assessment of functional disability, 81.3% had no disability.</div></div><div><h3>Conclusion</h3><div><strong>:</strong> In our experience, the management of ASVT is based on a combination of anticoagulation, endovascular procedures with angioplasty, and the need for subsequent decompression surgery.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"6 1","pages":"Article 100421"},"PeriodicalIF":0.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078377","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}
Femoral artery aneurysm and rupture are rare. Deep vein thrombosis (DVT) from compression typically aids in detection, yet this aneurysm evaded ultrasound. A 74-year-old male with right thigh pain and swelling was diagnosed with right popliteal and femoral vein DVT. He presented to the emergency department with worsening pain and swelling in the medial thigh despite anticoagulation. Imaging revealed a 12-cm ruptured superficial femoral artery (SFA) aneurysm. A SFA to below-knee popliteal artery bypass was performed without postoperative complications. Vascular labs and practitioners should consider peripheral aneurysm as a rare but important cause for DVT that is unresponsive to anticoagulation.
{"title":"A ruptured giant femoral artery aneurysm presents as DVT","authors":"Stuthi Iyer , Edward Oh , Yash Pandya , Ulka Sachdev","doi":"10.1016/j.avsurg.2025.100418","DOIUrl":"10.1016/j.avsurg.2025.100418","url":null,"abstract":"<div><div>Femoral artery aneurysm and rupture are rare. Deep vein thrombosis (DVT) from compression typically aids in detection, yet this aneurysm evaded ultrasound. A 74-year-old male with right thigh pain and swelling was diagnosed with right popliteal and femoral vein DVT. He presented to the emergency department with worsening pain and swelling in the medial thigh despite anticoagulation. Imaging revealed a 12-cm ruptured superficial femoral artery (SFA) aneurysm. A SFA to below-knee popliteal artery bypass was performed without postoperative complications. Vascular labs and practitioners should consider peripheral aneurysm as a rare but important cause for DVT that is unresponsive to anticoagulation.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"6 1","pages":"Article 100418"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939621","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 : 2025-12-15DOI: 10.1016/j.avsurg.2025.100419
Daniel Couto Guimarães
The Wrapsody™ cell-impermeable endoprosthesis is primarily indicated for central vein stenosis and dialysis access dysfunction. This case series describes its off-label use in three challenging scenarios involving arterial and venous interventions: 1) a femoropopliteal aneurysm, 2) stenosis of the right common iliac artery, and 3) venous outflow reconstruction in a patient with central venous occlusion. Post-procedural imaging confirmed adequate stent deployment and sustained flow in all treated segments. The 7-month, 5-month, and 26-month follow-ups for cases 1, 2, and 3, respectively, showed no need for additional interventions. This case series highlights the versatility of Wrapsody™ beyond its conventional use. Long-term comparative studies are needed to further evaluate Wrapsody™'s role in vascular reconstructions, but these findings suggest it may be a valuable alternative for select high-risk cases.
{"title":"Expanding the applications of Wrapsody™: A case series on aneurysm repair, aortoiliac disease, and venous outflow reconstruction","authors":"Daniel Couto Guimarães","doi":"10.1016/j.avsurg.2025.100419","DOIUrl":"10.1016/j.avsurg.2025.100419","url":null,"abstract":"<div><div>The Wrapsody™ cell-impermeable endoprosthesis is primarily indicated for central vein stenosis and dialysis access dysfunction. This case series describes its off-label use in three challenging scenarios involving arterial and venous interventions: 1) a femoropopliteal aneurysm, 2) stenosis of the right common iliac artery, and 3) venous outflow reconstruction in a patient with central venous occlusion. Post-procedural imaging confirmed adequate stent deployment and sustained flow in all treated segments. The 7-month, 5-month, and 26-month follow-ups for cases 1, 2, and 3, respectively, showed no need for additional interventions. This case series highlights the versatility of Wrapsody™ beyond its conventional use. Long-term comparative studies are needed to further evaluate Wrapsody™'s role in vascular reconstructions, but these findings suggest it may be a valuable alternative for select high-risk cases.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"6 1","pages":"Article 100419"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939622","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 : 2025-12-01DOI: 10.1016/j.avsurg.2025.100417
Ines Zekhnini, Xavier Bérard, Eric Ducasse, Caroline Caradu
Background
Type IV carotid artery aneurysms are uncommon; mycotic variants are rarer and challenging. We report a distal internal carotid aneurysm managed with a two-stage hybrid approach.
Case
A 28-year-old man had an enlarging left cervical mass with transient dysphagia and dysphonia. CT showed a distal internal carotid aneurysm measuring 71 × 49 mm, extending to the pre-foraminal segment. FDG-PET/CT demonstrated avid uptake (SUV 8.9). Work-up excluded endocarditis; Quantiferon was positive. Multidisciplinary review deemed endografting unsuitable and bypass unsafe given absent distal control.
Intervention
Under local anesthesia, a 50-minute balloon occlusion test of the petrous internal carotid artery was followed by coil embolization and proximal vascular plug, completing arterial sacrifice. Post-procedure transient monocular visual loss corresponded to a small watershed infarct; hemodynamic augmentation achieved full recovery within 24 hours. Six days later, aneurysmectomy was performed with ligation of the common and external carotid arteries. Cultures grew Cutibacterium acnes; clindamycin then six weeks of amoxicillin were given. The patient was discharged day seven. At day 22 the wound had healed, dysphonia improved, and inflammatory markers fell without new neurologic events.
Conclusion
When anatomy precludes reconstruction, staged sacrifice after a successful balloon occlusion test can enable definitive aneurysmectomy while preserving cerebral perfusion.
{"title":"Two-stage hybrid management of a distal internal carotid mycotic aneurysm in a young adult: A case report","authors":"Ines Zekhnini, Xavier Bérard, Eric Ducasse, Caroline Caradu","doi":"10.1016/j.avsurg.2025.100417","DOIUrl":"10.1016/j.avsurg.2025.100417","url":null,"abstract":"<div><h3>Background</h3><div>Type IV carotid artery aneurysms are uncommon; mycotic variants are rarer and challenging. We report a distal internal carotid aneurysm managed with a two-stage hybrid approach.</div></div><div><h3>Case</h3><div>A 28-year-old man had an enlarging left cervical mass with transient dysphagia and dysphonia. CT showed a distal internal carotid aneurysm measuring 71 × 49 mm, extending to the pre-foraminal segment. FDG-PET/CT demonstrated avid uptake (SUV 8.9). Work-up excluded endocarditis; Quantiferon was positive. Multidisciplinary review deemed endografting unsuitable and bypass unsafe given absent distal control.</div></div><div><h3>Intervention</h3><div>Under local anesthesia, a 50-minute balloon occlusion test of the petrous internal carotid artery was followed by coil embolization and proximal vascular plug, completing arterial sacrifice. Post-procedure transient monocular visual loss corresponded to a small watershed infarct; hemodynamic augmentation achieved full recovery within 24 hours. Six days later, aneurysmectomy was performed with ligation of the common and external carotid arteries. Cultures grew <em>Cutibacterium acnes</em>; clindamycin then six weeks of amoxicillin were given. The patient was discharged day seven. At day 22 the wound had healed, dysphonia improved, and inflammatory markers fell without new neurologic events.</div></div><div><h3>Conclusion</h3><div>When anatomy precludes reconstruction, staged sacrifice after a successful balloon occlusion test can enable definitive aneurysmectomy while preserving cerebral perfusion.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"5 4","pages":"Article 100417"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617694","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 : 2025-12-01DOI: 10.1016/j.avsurg.2025.100416
Carter Colwell, Bernard Boateng, Marisa Doran, Cole Pieroni, Esmaeel Dadashzadeh, Joshua D. Adams
Background
Endovascular therapy is the preferred treatment for superior vena cava (SVC) syndrome, providing rapid symptom relief and high technical success. Lesions involving the confluence of the bilateral innominate veins and SVC, however, remain challenging due to complex anatomy and limited durability of standard stents.
Methods
This case series describes the off-label use of the Gore Iliac Branch Endoprosthesis (IBE) for reconstruction of the SVC confluence in four patients with SVC syndrome: three with malignant etiologies and one with benign catheter-associated thrombosis.
Results
Technical success was achieved in all patients, with immediate restoration of venous flow and symptom resolution. In malignant cases, patency was maintained until death from cancer at 5–20 months. The benign case demonstrated durable patency and complete symptom relief at 18-month follow-up. No procedural complications or early device failures occurred.
Conclusions
The Gore IBE offers a feasible approach for anatomic reconstruction of the SVC confluence, accommodating bilateral venous inflow while maintaining luminal integrity. This technique may overcome limitations of parallel stenting, providing durable symptom relief in both malignant and benign SVC syndrome. Further investigation is warranted to evaluate long-term outcomes and broader applicability.
{"title":"Endovascular treatment of superior vena cava syndrome utilizing an iliac branch endoprosthesis","authors":"Carter Colwell, Bernard Boateng, Marisa Doran, Cole Pieroni, Esmaeel Dadashzadeh, Joshua D. Adams","doi":"10.1016/j.avsurg.2025.100416","DOIUrl":"10.1016/j.avsurg.2025.100416","url":null,"abstract":"<div><h3>Background</h3><div>Endovascular therapy is the preferred treatment for superior vena cava (SVC) syndrome, providing rapid symptom relief and high technical success. Lesions involving the confluence of the bilateral innominate veins and SVC, however, remain challenging due to complex anatomy and limited durability of standard stents.</div></div><div><h3>Methods</h3><div>This case series describes the off-label use of the Gore Iliac Branch Endoprosthesis (IBE) for reconstruction of the SVC confluence in four patients with SVC syndrome: three with malignant etiologies and one with benign catheter-associated thrombosis.</div></div><div><h3>Results</h3><div>Technical success was achieved in all patients, with immediate restoration of venous flow and symptom resolution. In malignant cases, patency was maintained until death from cancer at 5–20 months. The benign case demonstrated durable patency and complete symptom relief at 18-month follow-up. No procedural complications or early device failures occurred.</div></div><div><h3>Conclusions</h3><div>The Gore IBE offers a feasible approach for anatomic reconstruction of the SVC confluence, accommodating bilateral venous inflow while maintaining luminal integrity. This technique may overcome limitations of parallel stenting, providing durable symptom relief in both malignant and benign SVC syndrome. Further investigation is warranted to evaluate long-term outcomes and broader applicability.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"5 4","pages":"Article 100416"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618259","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 : 2025-11-17DOI: 10.1016/j.avsurg.2025.100415
Ibraheem M. Bade , Joshua A. Gabel , Reagan W. Quan
Transcarotid artery revascularization (TCAR) offers an alternative to carotid endarterectomy for the treatment of surgically indicated carotid occlusive disease in patients with complex arterial anatomy. We present the first reported case to our knowledge of a patient with bilateral retropharyngeal carotid arteries who underwent bilateral TCAR. TCAR should be considered for the treatment of patients with surgically indicated carotid occlusive disease who have retropharyngeal carotid arteries.
{"title":"Transcarotid artery revascularization (TCAR) in a patient with high grade stenoses of bilateral retropharyngeal carotid arteries","authors":"Ibraheem M. Bade , Joshua A. Gabel , Reagan W. Quan","doi":"10.1016/j.avsurg.2025.100415","DOIUrl":"10.1016/j.avsurg.2025.100415","url":null,"abstract":"<div><div>Transcarotid artery revascularization (TCAR) offers an alternative to carotid endarterectomy for the treatment of surgically indicated carotid occlusive disease in patients with complex arterial anatomy. We present the first reported case to our knowledge of a patient with bilateral retropharyngeal carotid arteries who underwent bilateral TCAR. TCAR should be considered for the treatment of patients with surgically indicated carotid occlusive disease who have retropharyngeal carotid arteries.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"6 1","pages":"Article 100415"},"PeriodicalIF":0.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718977","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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