Pub Date : 2024-11-14DOI: 10.1016/j.avsurg.2024.100349
Antoine Mathivet, Eric Picard, Pascal Branchereau, Elsa Faure
Arteriovenous fistulas (AVFs) of the splenic pedicle are rare entities. They are sometimes encountered at the stage of complications. The challenge is to treat patients at an early stage, to avoid complications, and possibly reverse it. Here, we discuss the case of a 72-year-old female patient, that we saw in the Vascular Surgery Unit at Nîmes University Hospital, with an incidentally discovered asymptomatic arteriovenous fistula. The patient presented with a large, asymptomatic arteriovenous fistula of the splenic pedicle, responsible of an isolated heart failure, which was treated by embolization in interventional radiology. The treatment was successful, as the follow-up CT scan showed that the fistula had disappeared. It appears necessary to treat patient patients with AVFs, even if asymptomatic, at an early stage to avoid persistence of a heart failure even after a successful treatment.
{"title":"Spontaneous arteriovenous fistula of the splenic pedicle with isolated heart failure: A case report and litterature review","authors":"Antoine Mathivet, Eric Picard, Pascal Branchereau, Elsa Faure","doi":"10.1016/j.avsurg.2024.100349","DOIUrl":"10.1016/j.avsurg.2024.100349","url":null,"abstract":"<div><div>Arteriovenous fistulas (AVFs) of the splenic pedicle are rare entities. They are sometimes encountered at the stage of complications. The challenge is to treat patients at an early stage, to avoid complications, and possibly reverse it. Here, we discuss the case of a 72-year-old female patient, that we saw in the Vascular Surgery Unit at Nîmes University Hospital, with an incidentally discovered asymptomatic arteriovenous fistula. The patient presented with a large, asymptomatic arteriovenous fistula of the splenic pedicle, responsible of an isolated heart failure, which was treated by embolization in interventional radiology. The treatment was successful, as the follow-up CT scan showed that the fistula had disappeared. It appears necessary to treat patient patients with AVFs, even if asymptomatic, at an early stage to avoid persistence of a heart failure even after a successful treatment.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100349"},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-03DOI: 10.1016/j.avsurg.2024.100348
Sai Xiang , Xiaodong Wang , Jifu Lai
Median Arcuate Ligament Syndrome (MALS) is characterized by clinical manifestations resulting from the direct compression of the celiac trunk by the median arcuate ligament. Symptoms typically include postprandial abdominal pain, nausea, vomiting, and weight loss. The patient, a 69-year-old female, presented with complaints of coughing, abdominal pain, and weight loss following positional changes. Physical examination revealed a systolic vascular murmur in the mid and upper abdomen, which was accentuated during exhalation. Abdominal aortic CTA indicated severe stenosis at the origin of the celiac trunk and localized dilation of the splenic artery. These findings strongly suggested MALS. In this case, we proceeded with endovascular treatment, achieving early symptom relief. Given the rarity of MALS and its nature as a diagnosis of exclusion, the diagnosis and treatment approach may lack clarity. Symptom relief can be achieved with a variety of interventions including celiac ganglionectomy as well as open, laparoscopic, or robotic intervention. Endovascular treatment for MALS has been questioned in the past, the diagnosis and treatment of MALS must be patient-centered, tailored to the individual needs of each patient.
{"title":"Angioplasty in the treatment of median arcuate ligament compression syndrome combined with splenic aneurysm: A case report","authors":"Sai Xiang , Xiaodong Wang , Jifu Lai","doi":"10.1016/j.avsurg.2024.100348","DOIUrl":"10.1016/j.avsurg.2024.100348","url":null,"abstract":"<div><div>Median Arcuate Ligament Syndrome (MALS) is characterized by clinical manifestations resulting from the direct compression of the celiac trunk by the median arcuate ligament. Symptoms typically include postprandial abdominal pain, nausea, vomiting, and weight loss. The patient, a 69-year-old female, presented with complaints of coughing, abdominal pain, and weight loss following positional changes. Physical examination revealed a systolic vascular murmur in the mid and upper abdomen, which was accentuated during exhalation. Abdominal aortic CTA indicated severe stenosis at the origin of the celiac trunk and localized dilation of the splenic artery. These findings strongly suggested MALS. In this case, we proceeded with endovascular treatment, achieving early symptom relief. Given the rarity of MALS and its nature as a diagnosis of exclusion, the diagnosis and treatment approach may lack clarity. Symptom relief can be achieved with a variety of interventions including celiac ganglionectomy as well as open, laparoscopic, or robotic intervention. Endovascular treatment for MALS has been questioned in the past, the diagnosis and treatment of MALS must be patient-centered, tailored to the individual needs of each patient.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100348"},"PeriodicalIF":0.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.1016/j.avsurg.2024.100347
Jenna H.C. Beijers , Anne M. Daniels , Anne C.M. Cuijpers , Martine G. Samyn
Arterial pseudoaneurysms as a result of blunt trauma are exceptionally rare, especially when developing in the posterior tibial artery. We describe a case of a 19-year-old patient with a pseudoaneurysm of the right posterior tibial artery following a blunt trauma with compression on the posterior tibial nerve leading to numbness in the sole of the foot. The pseudoaneurysm was successfully treated by open surgical repair with the use of an autologous venous patch from the greater saphenous vein. To the best of our knowledge, only one previous case of a posterior tibial artery pseudoaneurysm following blunt trauma has been described in previous literature. Our patient made an almost complete recovery, with only a persistent sensory deficit of the sole of the foot at three weeks postoperatively.
{"title":"Posttraumatic pseudoaneurysm of the posterior tibial artery – A case report","authors":"Jenna H.C. Beijers , Anne M. Daniels , Anne C.M. Cuijpers , Martine G. Samyn","doi":"10.1016/j.avsurg.2024.100347","DOIUrl":"10.1016/j.avsurg.2024.100347","url":null,"abstract":"<div><div>Arterial pseudoaneurysms as a result of blunt trauma are exceptionally rare, especially when developing in the posterior tibial artery. We describe a case of a 19-year-old patient with a pseudoaneurysm of the right posterior tibial artery following a blunt trauma with compression on the posterior tibial nerve leading to numbness in the sole of the foot. The pseudoaneurysm was successfully treated by open surgical repair with the use of an autologous venous patch from the greater saphenous vein. To the best of our knowledge, only one previous case of a posterior tibial artery pseudoaneurysm following blunt trauma has been described in previous literature. Our patient made an almost complete recovery, with only a persistent sensory deficit of the sole of the foot at three weeks postoperatively.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100347"},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554259","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}
Our surgical strategy for secondary aorto-enteric fistula (sAEF) encompasses one-stage open repair consisting of in situ anatomical prosthetic graft replacement with omentopexy following fistula repair. This study aimed to evaluate the midterm outcomes of our comprehensive surgical strategies for sAEF in a single-center series.
Methods
Between 2010 and 2022, 16 patients (14 male individuals; median age, 76.3 years) who underwent surgical repair of sAEF were reviewed. Nine and seven patients previously underwent open repair (OR-AEF) and endovascular repair (EVAR-AEF) for abdominal aortic aneurysm (AAA), respectively.
Results
Among patients who underwent OR-AEF (56.3 %) and EVAR-AEF (43.7 %), there were no significant differences in all variables, except for age (74.2 ± 4.8 vs. 79.1 ± 4.6 years, p = 0.028), interval from primary operation for AAA (66.9 ± 16.3 vs. 12.0 ± 11.4 months, p = 0.043), and clinical presentation with melena (77.8 % vs. 28.6 %, p = 0.049). Thirteen (81.3 %) patients were repaired with in situ anatomical graft replacement, whereas three (18.7 %) patients were unintentionally repaired with extra-anatomical bypass grafting based on intraoperative findings. Fistula repair was performed with duodenectomy in 14 (87.6 %) patients, direct suture closure in 1 (6.2 %), and sigmoid colectomy in 1 (6.2 %). The in-hospital mortality rate was 25.0 %. The 1- and 5-year overall survival and AEF-related event-free survival rates were 72.7 % and 49.8 %, and 77.0 % and 67.4 %, respectively. Patients who underwent complete removal of the contaminated prosthesis required suprarenal aortic clamping more frequently (72.7 % vs. 0 %, p = 0.007) than those who underwent partial removal. However, most were discharged without further oral antibiotic treatment (72.7 % vs. 0 %, p = 0.007). Patients who underwent complete removal had higher 5-year AEF-related event-free survival rate than those who underwent partial removal (69.3 % vs. 25.0 %, p = 0.069).
Conclusions
Midterm outcomes of our surgical strategy may be acceptable in patients with sAEF. AEF-related event-free survival is potentially affected by complete infected prosthesis removal.
{"title":"Midterm outcomes of surgical strategy for secondary aorto-enteric fistula","authors":"Shuhei Miura, Ayaka Arihara, Yutaka Iba, Tomohiro Nakajima, Junji Nakazawa, Tsuyoshi Shibata, Yu Iwashiro, Kei Mukawa, Nobuyoshi Kawaharada","doi":"10.1016/j.avsurg.2024.100346","DOIUrl":"10.1016/j.avsurg.2024.100346","url":null,"abstract":"<div><h3>Objectives</h3><div>Our surgical strategy for secondary aorto-enteric fistula (sAEF) encompasses one-stage open repair consisting of in situ anatomical prosthetic graft replacement with omentopexy following fistula repair. This study aimed to evaluate the midterm outcomes of our comprehensive surgical strategies for sAEF in a single-center series.</div></div><div><h3>Methods</h3><div>Between 2010 and 2022, 16 patients (14 male individuals; median age, 76.3 years) who underwent surgical repair of sAEF were reviewed. Nine and seven patients previously underwent open repair (OR-AEF) and endovascular repair (EVAR-AEF) for abdominal aortic aneurysm (AAA), respectively.</div></div><div><h3>Results</h3><div>Among patients who underwent OR-AEF (56.3 %) and EVAR-AEF (43.7 %), there were no significant differences in all variables, except for age (74.2 ± 4.8 vs. 79.1 ± 4.6 years, <em>p</em> = 0.028), interval from primary operation for AAA (66.9 ± 16.3 vs. 12.0 ± 11.4 months, <em>p</em> = 0.043), and clinical presentation with melena (77.8 % vs. 28.6 %, <em>p</em> = 0.049). Thirteen (81.3 %) patients were repaired with in situ anatomical graft replacement, whereas three (18.7 %) patients were unintentionally repaired with extra-anatomical bypass grafting based on intraoperative findings. Fistula repair was performed with duodenectomy in 14 (87.6 %) patients, direct suture closure in 1 (6.2 %), and sigmoid colectomy in 1 (6.2 %). The in-hospital mortality rate was 25.0 %. The 1- and 5-year overall survival and AEF-related event-free survival rates were 72.7 % and 49.8 %, and 77.0 % and 67.4 %, respectively. Patients who underwent complete removal of the contaminated prosthesis required suprarenal aortic clamping more frequently (72.7 % vs. 0 %, <em>p</em> = 0.007) than those who underwent partial removal. However, most were discharged without further oral antibiotic treatment (72.7 % vs. 0 %, <em>p</em> = 0.007). Patients who underwent complete removal had higher 5-year AEF-related event-free survival rate than those who underwent partial removal (69.3 % vs. 25.0 %, <em>p</em> = 0.069).</div></div><div><h3>Conclusions</h3><div>Midterm outcomes of our surgical strategy may be acceptable in patients with sAEF. AEF-related event-free survival is potentially affected by complete infected prosthesis removal.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100346"},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-20DOI: 10.1016/j.avsurg.2024.100344
Said Adnor, Mehdi EL Kourchi, Soukaina Wakrim
The persistence of the left superior vena cava is a rare and benign congenital malformation. This malformation is usually asymptomatic and is detected incidentally by imaging exams performed for other causes. We report two cases of persistence of the left superior vena cava, the first in a 62-year-old patient admitted for chronic renal failure for whom a thoracic radiograph after venous catheterization objectified this malformation; and the second in a 60-year-old patient for whom we performed a CT scan with contrast agent which objectified a double superior vena cava.
{"title":"Persistent Left Superior Vena Cava: An Unusual Radiographic Discovery","authors":"Said Adnor, Mehdi EL Kourchi, Soukaina Wakrim","doi":"10.1016/j.avsurg.2024.100344","DOIUrl":"10.1016/j.avsurg.2024.100344","url":null,"abstract":"<div><div>The persistence of the left superior vena cava is a rare and benign congenital malformation. This malformation is usually asymptomatic and is detected incidentally by imaging exams performed for other causes. We report two cases of persistence of the left superior vena cava, the first in a 62-year-old patient admitted for chronic renal failure for whom a thoracic radiograph after venous catheterization objectified this malformation; and the second in a 60-year-old patient for whom we performed a CT scan with contrast agent which objectified a double superior vena cava.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100344"},"PeriodicalIF":0.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.avsurg.2024.100345
Javad Jalili, Sarah Vaseghi, Mahdiyeh Baastani Khajeh, Ali Abzirakan Aslanduz
Retrievable filters of Inferior vena cava (IVC) are used to prevent venous thromboembolism (VTE) in high-risk patients, but can result in rare and serious complications like filter penetration into adjacent structures leading to pseudoaneurysm formation. We present a unique case of an 87-year-old male patient with a history of bilateral lower limb deep vein thrombosis (DVT) who developed a large pseudoaneurysm of the third right lumbar artery following prophylactic IVC filter placement before femoral neck fracture surgery. The patient was re-admitted after he experienced dull abdominal pain in the periumbilical region for three days before admission. Abdominal Doppler ultrasound and CT angiography identified an abdominal hematoma and a third right lumbar artery pseudoaneurysm. Angiography confirmed a large pseudoaneurysm resulting from the IVC filter penetration. Endovascular treatment with coil embolization was successfully performed to exclude the pseudoaneurysm. However, the filter could not be retrieved due to the incorporated strut penetration into the IVC wall. The patient had recovered without any complications. He was discharged with therapeutic anticoagulation. This case highlights the importance of anticipating potential complications with indwelling IVC filters, as well as the implications for management in elderly patients undergoing major surgeries.
{"title":"Endovascular management of an inferior vena cava (IVC) filter penetration and related lumbar artery pseudoaneurysm in an elderly patient","authors":"Javad Jalili, Sarah Vaseghi, Mahdiyeh Baastani Khajeh, Ali Abzirakan Aslanduz","doi":"10.1016/j.avsurg.2024.100345","DOIUrl":"10.1016/j.avsurg.2024.100345","url":null,"abstract":"<div><div>Retrievable filters of Inferior vena cava (IVC) are used to prevent venous thromboembolism (VTE) in high-risk patients, but can result in rare and serious complications like filter penetration into adjacent structures leading to pseudoaneurysm formation. We present a unique case of an 87-year-old male patient with a history of bilateral lower limb deep vein thrombosis (DVT) who developed a large pseudoaneurysm of the third right lumbar artery following prophylactic IVC filter placement before femoral neck fracture surgery. The patient was re-admitted after he experienced dull abdominal pain in the periumbilical region for three days before admission. Abdominal Doppler ultrasound and CT angiography identified an abdominal hematoma and a third right lumbar artery pseudoaneurysm. Angiography confirmed a large pseudoaneurysm resulting from the IVC filter penetration. Endovascular treatment with coil embolization was successfully performed to exclude the pseudoaneurysm. However, the filter could not be retrieved due to the incorporated strut penetration into the IVC wall. The patient had recovered without any complications. He was discharged with therapeutic anticoagulation. This case highlights the importance of anticipating potential complications with indwelling IVC filters, as well as the implications for management in elderly patients undergoing major surgeries.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100345"},"PeriodicalIF":0.0,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.avsurg.2024.100340
Bernhard Hruschka, Alexander Gombert, Panagiotis Doukas, Christian Uhl, Moustafa Elfeky
Endovascular techniques have become the preferred method for treating complex aortic aneurysms, but some cases require individualized strategies beyond manufacturer specifications. We report a 62-year-old male with a 64 mm juxtarenal abdominal aortic aneurysm, right above-knee amputation, and dependence on the right hypogastric artery. The patient's complex anatomy necessitated a custom solution including fEVAR. Access was gained through the left femoral and brachial arteries due to an occluded right external iliac artery. The right hypogastric artery was treated with covered stents via transbrachial access. This case highlights the potential for treating complex aortic aneurysms using patient-individualized endoprostheses and creative endovascular solutions outside standard instructions-for-use.
{"title":"Patient-individualized treatment concept in a case of a juxtarenal AAA repair with limited transfemoral access using custom-made fenestrated aortic endografts","authors":"Bernhard Hruschka, Alexander Gombert, Panagiotis Doukas, Christian Uhl, Moustafa Elfeky","doi":"10.1016/j.avsurg.2024.100340","DOIUrl":"10.1016/j.avsurg.2024.100340","url":null,"abstract":"<div><div>Endovascular techniques have become the preferred method for treating complex aortic aneurysms, but some cases require individualized strategies beyond manufacturer specifications. We report a 62-year-old male with a 64 mm juxtarenal abdominal aortic aneurysm, right above-knee amputation, and dependence on the right hypogastric artery. The patient's complex anatomy necessitated a custom solution including fEVAR. Access was gained through the left femoral and brachial arteries due to an occluded right external iliac artery. The right hypogastric artery was treated with covered stents via transbrachial access. This case highlights the potential for treating complex aortic aneurysms using patient-individualized endoprostheses and creative endovascular solutions outside standard instructions-for-use.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100340"},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.avsurg.2024.100343
Dorothy Han , Alyssa J Pyun , Mark Mueller , Wesley Lew , Sukgu M Han
We present a case of a 65-year-old male who previously underwent left axillofemoral bypass, left carotid stenting, and right iliac stenting followed by ascending and hemiarch repair for type A aortic dissection, complicated by left external iliac artery occlusion. He presented to our center with a symptomatic 8.5 cm post-dissection extent II thoracoabdominal aortic aneurysm. A staged repair was performed to decrease spinal cord ischemia. The first stage employed the novel use of a jump graft from the left axillary-femoral bypass to the left internal iliac artery to restore pelvic circulation, combined with zone 2 thoracic branched endoprosthesis (TBE). The second stage included thoracic endovascular repair (TEVAR) extension and 3-vessel custom-modified fenestrated/branched endovascular repair (FBEVAR).
我们报告了一例 65 岁男性患者的病例，他曾因 A 型主动脉夹层并发左侧髂外动脉闭塞而接受过左侧腋股动脉搭桥术、左侧颈动脉支架植入术和右侧髂动脉支架植入术，随后进行了升支和半弓修补术。他因主动脉夹层后出现 8.5 厘米无症状的胸腹主动脉瘤（II 度）来我中心就诊。为了减少脊髓缺血，我们对他进行了分期修复。第一阶段新颖地使用了从左侧腋窝-股旁路到左侧髂内动脉的跳跃式移植物来恢复骨盆循环，并结合 2 区胸腔分支内假体（TBE）。第二阶段包括胸腔内血管修补术（TEVAR）扩展和三血管定制改良栅栏式/分支式血管内修补术（FBEVAR）。
{"title":"Axillary-femoral hypogastric bypass for spinal cord protection during fenestrated, branched endovascular repair of post-dissection thoracoabdominal aortic aneurysm","authors":"Dorothy Han , Alyssa J Pyun , Mark Mueller , Wesley Lew , Sukgu M Han","doi":"10.1016/j.avsurg.2024.100343","DOIUrl":"10.1016/j.avsurg.2024.100343","url":null,"abstract":"<div><div>We present a case of a 65-year-old male who previously underwent left axillofemoral bypass, left carotid stenting, and right iliac stenting followed by ascending and hemiarch repair for type A aortic dissection, complicated by left external iliac artery occlusion. He presented to our center with a symptomatic 8.5 cm post-dissection extent II thoracoabdominal aortic aneurysm. A staged repair was performed to decrease spinal cord ischemia. The first stage employed the novel use of a jump graft from the left axillary-femoral bypass to the left internal iliac artery to restore pelvic circulation, combined with zone 2 thoracic branched endoprosthesis (TBE). The second stage included thoracic endovascular repair (TEVAR) extension and 3-vessel custom-modified fenestrated/branched endovascular repair (FBEVAR).</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100343"},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142442527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.avsurg.2024.100341
Tiequan Yang , Dehai Lang , Zuanbiao Yu
Bone cement pulmonary embolism (CPE) is not a rare complication. Most cases are asymptomatic and detected incidentally. In this study, we reported a female patient who was suffering from hemoptysis. To address this condition, our clinical group performed a percutaneous procedure to successfully retrieve the cement embolism on the right pulmonary artery.
{"title":"Percutaneous retrieval of symptomatic bone cement embolus from the pulmonary artery","authors":"Tiequan Yang , Dehai Lang , Zuanbiao Yu","doi":"10.1016/j.avsurg.2024.100341","DOIUrl":"10.1016/j.avsurg.2024.100341","url":null,"abstract":"<div><div>Bone cement pulmonary embolism (CPE) is not a rare complication. Most cases are asymptomatic and detected incidentally. In this study, we reported a female patient who was suffering from hemoptysis. To address this condition, our clinical group performed a percutaneous procedure to successfully retrieve the cement embolism on the right pulmonary artery.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100341"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.avsurg.2024.100342
Jorge Rey MD, Karen Manzur-Pineda MD, Christopher Montoya MD, Stefan Kenel-Pierre MD, Naixin Kang MD, Kathy Gonzalez MD, Arash Bornak MD
Objective
Limb loss carries a high risk of morbidity and mortality in patients with chronic limb-threatening ischemia (CLTI). Multiple medical and surgical strategies have been studied to address complications and lower amputation rates, especially in patients with poor outflow in the infrageniculate arteries. Our case series highlights the use of the peroneal bypass without angiographic runoff but acceptable intraoperative back-bleed as an option for patients with CLTI.
Methods
A single-center retrospective review was performed on adult patients who underwent lower extremity bypass using the peroneal artery as the outflow for CLTI from 2012 to 2022. Two subgroups were classified as blind peroneal arteries and non-blind peroneal arteries, according to the Darling et al.'s 1998 classification.
Results
A total of twenty-five patients with lower extremity bypass for CLTI with the peroneal artery as the outflow target were included. From those, seventeen were classified as non-blind and eight were defined as blind peroneal, according to preoperative angiography runoff. Blind peroneal bypass primary patency rate was 45%, primary-assisted was 60%, and secondary was 60%, with a limb loss rate of 25.0%. Among the seventeen non-blind peroneal bypasses, primary patency was 64.5%, primary assisted was 77%, and secondary was 77%, with a limb loss rate of 5.9%. There were no significantly different p-values observed between both groups.
Conclusion
Blind peroneal bypasses serve as a last resort strategy to attempt limb salvage before amputation if adequate back-bleed is observed intraoperatively.
{"title":"Blind peroneal artery outflow bypass for limb salvage in patients with severe CLTI: A case series","authors":"Jorge Rey MD, Karen Manzur-Pineda MD, Christopher Montoya MD, Stefan Kenel-Pierre MD, Naixin Kang MD, Kathy Gonzalez MD, Arash Bornak MD","doi":"10.1016/j.avsurg.2024.100342","DOIUrl":"10.1016/j.avsurg.2024.100342","url":null,"abstract":"<div><h3>Objective</h3><div>Limb loss carries a high risk of morbidity and mortality in patients with chronic limb-threatening ischemia (CLTI). Multiple medical and surgical strategies have been studied to address complications and lower amputation rates, especially in patients with poor outflow in the infrageniculate arteries. Our case series highlights the use of the peroneal bypass without angiographic runoff but acceptable intraoperative back-bleed as an option for patients with CLTI.</div></div><div><h3>Methods</h3><div>A single-center retrospective review was performed on adult patients who underwent lower extremity bypass using the peroneal artery as the outflow for CLTI from 2012 to 2022. Two subgroups were classified as blind peroneal arteries and non-blind peroneal arteries, according to the Darling et al.'s 1998 classification.</div></div><div><h3>Results</h3><div>A total of twenty-five patients with lower extremity bypass for CLTI with the peroneal artery as the outflow target were included. From those, seventeen were classified as non-blind and eight were defined as blind peroneal, according to preoperative angiography runoff. Blind peroneal bypass primary patency rate was 45%, primary-assisted was 60%, and secondary was 60%, with a limb loss rate of 25.0%. Among the seventeen non-blind peroneal bypasses, primary patency was 64.5%, primary assisted was 77%, and secondary was 77%, with a limb loss rate of 5.9%. There were no significantly different p-values observed between both groups.</div></div><div><h3>Conclusion</h3><div>Blind peroneal bypasses serve as a last resort strategy to attempt limb salvage before amputation if adequate back-bleed is observed intraoperatively.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100342"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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