Arterial tumor embolization is a severe but rare complication in lung cancer, especially during surgical interventions. We present the case of acute lower limb ischemia developed during a bilobectomy surgery for non-small cell lung carcinoma. Postoperative embolectomy was performed after a CT angiogram identified an occlusive thrombus in the left common iliac artery. Pathological analysis confirmed non-small cell lung carcinoma within the thrombus. Despite successful surgery, the patient later developed cerebral metastasis and chose medical assistance in dying. This case underscores the importance of adopting an open revascularization approach for patients suspected of acute arterial occlusion caused by intraluminal tumors.
{"title":"Neoplastic material inducing acute limb ischemia during bilobectomy surgery for the treatment of lung cancer","authors":"Caroline Marchand, Ievgen Gegiia, Félix H. Savoie-White MD, MSc, Pascal Rhéaume","doi":"10.1016/j.avsurg.2024.100339","DOIUrl":"10.1016/j.avsurg.2024.100339","url":null,"abstract":"<div><div>Arterial tumor embolization is a severe but rare complication in lung cancer, especially during surgical interventions. We present the case of acute lower limb ischemia developed during a bilobectomy surgery for non-small cell lung carcinoma. Postoperative embolectomy was performed after a CT angiogram identified an occlusive thrombus in the left common iliac artery. Pathological analysis confirmed non-small cell lung carcinoma within the thrombus. Despite successful surgery, the patient later developed cerebral metastasis and chose medical assistance in dying. This case underscores the importance of adopting an open revascularization approach for patients suspected of acute arterial occlusion caused by intraluminal tumors.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100339"},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423216","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 : 2024-10-02DOI: 10.1016/j.avsurg.2024.100338
Tiffany Kippenberger, Marcos Aranda, Todd Simon, Andrew Soo Hoo
<div><h3>Introduction</h3><div>Splenic artery pseudoaneurysms<span><span><sup>a</sup></span></span> (SAPA) are rare, with overall incidence reported at 0.01–0.2 % per 100,000. There are only around 200 cases described in the literature to date. The splenic artery is the most common site for a pseudoaneurysm, accounting for 46 % of visceral artery pseudoaneurysms. They occur more commonly in males, with risk factors including pancreatitis, trauma, and iatrogenic injuries from pancreatic surgery. Pseudoaneurysms can be symptomatic, and symptoms can include vague abdominal pain, hematochezia, melena, or hematemesis. Sizes of splenic artery pseudoaneurysms can vary from 0.3 to 17 cm, with lesions greater than 5 cm classified as giant pseudoaneurysms, which are very rare. Diagnosis is typically made with a computed tomography angiography<span><span><sup>b</sup></span></span> (CTA), which shows a contrast-filled vessel wall outpouching. Because risk of rupture can reach 47 % and this risk is unrelated to the size of the pseudoaneurysm, all pseudoaneurysms should be treated. Failure to intervene resulting in rupture can result in a mortality reaching 90 %. Endovascular interventions are the preferred treatment; however, if the patient is unstable, open ligation of the lesion is required.</div></div><div><h3>Methods</h3><div>A 35-year-old active-duty male with no history of abdominal trauma was transferred to our facility after a 12 cm splenic artery pseudoaneurysm was found incidentally on computed tomography<span><span><sup>c</sup></span></span> (CT) scan performed for elevated liver enzymes during a hospitalization for new-onset diabetes. This CT also demonstrated new findings of two suspected pancreatic intraductal papillary mucinous neoplasms<span><span><sup>d</sup></span></span> (IPMN), but no evidence of pancreatitis. He denied abdominal pain, nausea, vomiting, and changes in bowel habits. The patient's physical exam was unremarkable and vital signs were within normal limits. Laboratory studies on arrival were notable for hemoglobin of 8.2 g/dL with no prior baseline available, as well as elevated liver enzymes and alkaline phosphatase. A mononucleosis test was positive.</div></div><div><h3>Results</h3><div>: Patient underwent angiography, which confirmed a splenic artery pseudoaneurysm. Wire advancement distal to the pseudoaneurysm revealed normal antegrade flow into the spleen without filling of the pseudoaneurysm sac. Inflow and outflow to the pseudoaneurysm was embolized with Azur CX coils (Terumo, Somerset, NJ, USA), and completion angiography demonstrated complete occlusion of the pseudoaneurysm. On postoperative day two, a CTA was obtained which was limited by coil artifact. Mesenteric duplex ultrasound on postoperative day three confirmed a thrombosed splenic artery pseudoaneurysm with no active flow. He recovered without difficulty and was discharged with strict mononucleosis precautions and follow up for his suspected IPMNs.</div></div><
{"title":"An unusual enemy: Case report of a giant splenic artery pseudoaneurysm of unknown etiology in a young soldier","authors":"Tiffany Kippenberger, Marcos Aranda, Todd Simon, Andrew Soo Hoo","doi":"10.1016/j.avsurg.2024.100338","DOIUrl":"10.1016/j.avsurg.2024.100338","url":null,"abstract":"<div><h3>Introduction</h3><div>Splenic artery pseudoaneurysms<span><span><sup>a</sup></span></span> (SAPA) are rare, with overall incidence reported at 0.01–0.2 % per 100,000. There are only around 200 cases described in the literature to date. The splenic artery is the most common site for a pseudoaneurysm, accounting for 46 % of visceral artery pseudoaneurysms. They occur more commonly in males, with risk factors including pancreatitis, trauma, and iatrogenic injuries from pancreatic surgery. Pseudoaneurysms can be symptomatic, and symptoms can include vague abdominal pain, hematochezia, melena, or hematemesis. Sizes of splenic artery pseudoaneurysms can vary from 0.3 to 17 cm, with lesions greater than 5 cm classified as giant pseudoaneurysms, which are very rare. Diagnosis is typically made with a computed tomography angiography<span><span><sup>b</sup></span></span> (CTA), which shows a contrast-filled vessel wall outpouching. Because risk of rupture can reach 47 % and this risk is unrelated to the size of the pseudoaneurysm, all pseudoaneurysms should be treated. Failure to intervene resulting in rupture can result in a mortality reaching 90 %. Endovascular interventions are the preferred treatment; however, if the patient is unstable, open ligation of the lesion is required.</div></div><div><h3>Methods</h3><div>A 35-year-old active-duty male with no history of abdominal trauma was transferred to our facility after a 12 cm splenic artery pseudoaneurysm was found incidentally on computed tomography<span><span><sup>c</sup></span></span> (CT) scan performed for elevated liver enzymes during a hospitalization for new-onset diabetes. This CT also demonstrated new findings of two suspected pancreatic intraductal papillary mucinous neoplasms<span><span><sup>d</sup></span></span> (IPMN), but no evidence of pancreatitis. He denied abdominal pain, nausea, vomiting, and changes in bowel habits. The patient's physical exam was unremarkable and vital signs were within normal limits. Laboratory studies on arrival were notable for hemoglobin of 8.2 g/dL with no prior baseline available, as well as elevated liver enzymes and alkaline phosphatase. A mononucleosis test was positive.</div></div><div><h3>Results</h3><div>: Patient underwent angiography, which confirmed a splenic artery pseudoaneurysm. Wire advancement distal to the pseudoaneurysm revealed normal antegrade flow into the spleen without filling of the pseudoaneurysm sac. Inflow and outflow to the pseudoaneurysm was embolized with Azur CX coils (Terumo, Somerset, NJ, USA), and completion angiography demonstrated complete occlusion of the pseudoaneurysm. On postoperative day two, a CTA was obtained which was limited by coil artifact. Mesenteric duplex ultrasound on postoperative day three confirmed a thrombosed splenic artery pseudoaneurysm with no active flow. He recovered without difficulty and was discharged with strict mononucleosis precautions and follow up for his suspected IPMNs.</div></div><","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100338"},"PeriodicalIF":0.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423215","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 : 2024-09-24DOI: 10.1016/j.avsurg.2024.100337
Liang Xie , Zhengdong Fang
Purpose
Developing pseudoaneurysms following stent fracture is a rare complication of stent implantation in patients with chronic lower limb ischemia. We presented a case of pseudoaneurysm secondary to a femoral artery stenting fracture in the left lower extremity, which was successfully managed with vascular intervention under local anesthesia and followed up for 36 months.
Case Report
An 80-year-old male with a history of hypertension and cerebral infarction presented with a mass in the left lower limb accompanied by swelling and pain. Doppler ultrasound revealed a pseudoaneurysm measuring 6 × 7 cm in the left superficial femoral artery. Subsequent digital subtraction angiography indicated a fracture of the original stent overlap and a ruptured pseudoaneurysm measuring 8 cm in diameter. Following intravenous heparin administration, a 7 × 150 mm self-expanding membrane-covered stent was successfully implanted to address this issue. Final angiography confirmed proper stent placement, exclusion of the aneurysm, and absence of internal leakage. No obstruction was observed in the sub patellar artery. The patient's symptoms gradually improved without requiring further surgical intervention. Oral aspirin and clopidogrel were administered for 36 months after surgery, and there was no recurrence of symptoms.
Conclusion
Active surgical intervention is the optimal treatment approach for patients with pseudoaneurysm caused by stent fracture, whereas endovascular therapy remains a dependable option for such scenarios. The crucial step in the procedure involved inserting the guidewire into both ends of the fractured stent to establish the operative pathway, followed by the introduction of the self-expanding covered stent and isolation of the aneurysm. This endeavor aimed to offer significant insights for treating similar conditions.
{"title":"A case report of superficial femoral artery pseudoaneurysm caused by stent fracture","authors":"Liang Xie , Zhengdong Fang","doi":"10.1016/j.avsurg.2024.100337","DOIUrl":"10.1016/j.avsurg.2024.100337","url":null,"abstract":"<div><h3>Purpose</h3><div>Developing pseudoaneurysms following stent fracture is a rare complication of stent implantation in patients with chronic lower limb ischemia. We presented a case of pseudoaneurysm secondary to a femoral artery stenting fracture in the left lower extremity, which was successfully managed with vascular intervention under local anesthesia and followed up for 36 months.</div></div><div><h3>Case Report</h3><div>An 80-year-old male with a history of hypertension and cerebral infarction presented with a mass in the left lower limb accompanied by swelling and pain. Doppler ultrasound revealed a pseudoaneurysm measuring 6 × 7 cm in the left superficial femoral artery. Subsequent digital subtraction angiography indicated a fracture of the original stent overlap and a ruptured pseudoaneurysm measuring 8 cm in diameter. Following intravenous heparin administration, a 7 × 150 mm self-expanding membrane-covered stent was successfully implanted to address this issue. Final angiography confirmed proper stent placement, exclusion of the aneurysm, and absence of internal leakage. No obstruction was observed in the sub patellar artery. The patient's symptoms gradually improved without requiring further surgical intervention. Oral aspirin and clopidogrel were administered for 36 months after surgery, and there was no recurrence of symptoms.</div></div><div><h3>Conclusion</h3><div>Active surgical intervention is the optimal treatment approach for patients with pseudoaneurysm caused by stent fracture, whereas endovascular therapy remains a dependable option for such scenarios. The crucial step in the procedure involved inserting the guidewire into both ends of the fractured stent to establish the operative pathway, followed by the introduction of the self-expanding covered stent and isolation of the aneurysm. This endeavor aimed to offer significant insights for treating similar conditions.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100337"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322056","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 : 2024-09-18DOI: 10.1016/j.avsurg.2024.100336
Jordyn O'Dell , Samantha D. Minc , Michael C. Ost , Robert Grammer , Brian Markovich , Lakshmikumar Pillai
There are a limited number of case reports describing the division of a horseshoe kidney (HSK) during trans- peritoneal repair of an abdominal aortic aneurysm (AAA). We present case of a juxta-renal AAA overlaid by an L shaped HSK, repaired trans- peritoneal with division of the isthmus. This was complicated by post-operative urinoma which was successfully treated interventionally.
This approach was chosen due to the presence of the juxta-renal AAA with the majority of the HSK being perfused by a large left renal artery originating at the neck of the AAA. Temporary bilateral ureteral stents were placed. The isthmus of the HSK was divided followed by open tube graft repair of the AAA. Postoperative workup revealed an abdominal urinoma, which was successfully treated by urinary diversion and selective renal arterial branch embolization. Two years later, patient remains well with no evidence of hydronephrosis or graft infection.
描述经腹膜修复腹主动脉瘤（AAA）时马蹄肾（HSK）分割的病例报告数量有限。我们介绍了一例由 L 型马蹄肾（HSK）覆盖的并肾 AAA 病例，该病例经腹膜修复并分割了峡部。之所以选择这种方法，是因为存在并肾AAA，HSK的大部分由起源于AAA颈部的大左肾动脉灌注。放置了临时双侧输尿管支架。在分割HSK峡部后，对AAA进行了开管移植修复。术后检查发现了腹腔尿瘤，通过尿路改道和选择性肾动脉分支栓塞成功治疗了该瘤。两年后，患者的情况依然良好，没有出现肾积水或移植物感染的迹象。
{"title":"Trans-peritoneal repair of a juxta-renal abdominal aortic aneurysm with horseshoe kidney complicated by urine leak successfully managed with urinary diversion and selective renal artery embolization","authors":"Jordyn O'Dell , Samantha D. Minc , Michael C. Ost , Robert Grammer , Brian Markovich , Lakshmikumar Pillai","doi":"10.1016/j.avsurg.2024.100336","DOIUrl":"10.1016/j.avsurg.2024.100336","url":null,"abstract":"<div><div>There are a limited number of case reports describing the division of a horseshoe kidney (HSK) during trans- peritoneal repair of an abdominal aortic aneurysm (AAA). We present case of a juxta-renal AAA overlaid by an L shaped HSK, repaired trans- peritoneal with division of the isthmus. This was complicated by post-operative urinoma which was successfully treated interventionally.</div><div>This approach was chosen due to the presence of the juxta-renal AAA with the majority of the HSK being perfused by a large left renal artery originating at the neck of the AAA. Temporary bilateral ureteral stents were placed. The isthmus of the HSK was divided followed by open tube graft repair of the AAA. Postoperative workup revealed an abdominal urinoma, which was successfully treated by urinary diversion and selective renal arterial branch embolization. Two years later, patient remains well with no evidence of hydronephrosis or graft infection.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100336"},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320181","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 : 2024-09-11DOI: 10.1016/j.avsurg.2024.100335
Aakanksha Gupta , Yekaterina Koshkareva , Bruce L. Tjaden Jr.
About 0.5–1 % of patients undergoing carotid endarterectomy (CEA) with patch repairs develop patch infections. This is the case of an 81-year-old woman with a past surgical history of right parotidectomy (thirty years ago) and right CEA (three years ago) who presented with a 3 × 4 cm right neck mass with intermittent drainage and bleeding. Fine needle aspiration biopsy was notable for pleomorphic adenoma and imaging demonstrated a mass in the parotid bed. Cultures of the discharge were negative for bacterial growth. However, in the OR, the patient was found to have an infected carotid patch. The case report describes patch excision and interposition bypass using greater saphenous vein.
Although the incidence of CEA patch infections is low, clinicians dealing with this pathology should have a high index of suspicion in patients presenting with an ipsilateral neck mass that bleeds intermittently. Patch infection may not be able to be ruled out even in the setting of negative culture data and biopsy results. Saphenous vein is an excellent conduit for repair and can be used with a shunt to maintain perfusion to the brain while the repair is performed.
{"title":"Chronic carotid patch infection masquerading as recurrent head/neck cancer treated with saphenous interposition bypass","authors":"Aakanksha Gupta , Yekaterina Koshkareva , Bruce L. Tjaden Jr.","doi":"10.1016/j.avsurg.2024.100335","DOIUrl":"10.1016/j.avsurg.2024.100335","url":null,"abstract":"<div><div>About 0.5–1 % of patients undergoing carotid endarterectomy (CEA) with patch repairs develop patch infections. This is the case of an 81-year-old woman with a past surgical history of right parotidectomy (thirty years ago) and right CEA (three years ago) who presented with a 3 × 4 cm right neck mass with intermittent drainage and bleeding. Fine needle aspiration biopsy was notable for pleomorphic adenoma and imaging demonstrated a mass in the parotid bed. Cultures of the discharge were negative for bacterial growth. However, in the OR, the patient was found to have an infected carotid patch. The case report describes patch excision and interposition bypass using greater saphenous vein.</div><div>Although the incidence of CEA patch infections is low, clinicians dealing with this pathology should have a high index of suspicion in patients presenting with an ipsilateral neck mass that bleeds intermittently. Patch infection may not be able to be ruled out even in the setting of negative culture data and biopsy results. Saphenous vein is an excellent conduit for repair and can be used with a shunt to maintain perfusion to the brain while the repair is performed.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 4","pages":"Article 100335"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772687824000874/pdfft?md5=ed4f10f3121af647d5df4f5ff220b02c&pid=1-s2.0-S2772687824000874-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311800","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 : 2024-09-01DOI: 10.1016/j.avsurg.2024.100330
Yicong Pan , Xiao Qin , Min Hu
Persistent sciatic artery (PSA) is a rare vascular anomaly that may cause serious complications such as arterial embolism, aneurysm, and rupture. We report the case of a 51-year-old man presenting with septic rupture of a persistent sciatic artery aneurysm. Based on Ahn-Min's classification, we designed a treatment plan, including initial endovascular stent repair followed by staged debridement and drainage surgery. Soon after the treatment, the patient fully recovered from the pain and movement restriction. The case and treatment plan are described in detail in this report.
{"title":"Case Report: Septic rupture of a persistent sciatic artery aneurysm","authors":"Yicong Pan , Xiao Qin , Min Hu","doi":"10.1016/j.avsurg.2024.100330","DOIUrl":"10.1016/j.avsurg.2024.100330","url":null,"abstract":"<div><p>Persistent sciatic artery (PSA) is a rare vascular anomaly that may cause serious complications such as arterial embolism, aneurysm, and rupture. We report the case of a 51-year-old man presenting with septic rupture of a persistent sciatic artery aneurysm. Based on Ahn-Min's classification, we designed a treatment plan, including initial endovascular stent repair followed by staged debridement and drainage surgery. Soon after the treatment, the patient fully recovered from the pain and movement restriction. The case and treatment plan are described in detail in this report.</p></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 3","pages":"Article 100330"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772687824000825/pdfft?md5=0bb003ec7dd763a317fe3792995feb6f&pid=1-s2.0-S2772687824000825-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164454","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 : 2024-09-01DOI: 10.1016/j.avsurg.2024.100333
Apoorva Bhandari , John Landau , Stewart Kribs , Adam Power , Audra Duncan , Luc Dubois
Background
Autologous venous bypasses effectively treat extensive infrainguinal arterial occlusive disease with excellent long-term patency rates. However, one-third of patients will experience significant vein graft stenosis, particularly within the first-year post-bypass. Current endovascular interventions yield suboptimal results, with reported re-stenosis rates of 20–50 %. This study investigates the efficacy of cutting balloon (‘slash’) followed by a drug-eluting balloon (‘splash’) angioplasty in treating vein graft stenosis.
Methods
This single-centre retrospective review examines consecutive patients who underwent the ‘Slash and Splash’ technique for treating significant stenosis (>70 % stenosis and/or PSV >300 cm/s) in infrainguinal autologous bypasses from June 2017 to January 2023. Follow-up duplex ultrasound was conducted at three months, six months, and yearly thereafter. Primary outcomes assessed technical success and graft patency. Secondary outcomes included major adverse limb events (MALEs), and major amputations
Results
Twenty-three patients (mean age 67.4 ± 8.1 years, 44 % male) with significant vein graft stenoses underwent the ‘Slash and Splash’ method to salvage their bypasses. Most patients (91 %) had critical limb-threatening ischemia. Nine patients received femoral-popliteal grafts and 14 received femoral-tibial grafts, with18 utilizing saphenous in-situ conduits. The average follow-up duration was 26.1 ± 16.7 months, with no losses to follow-up. The median time from initial bypass to angioplasty was 10 months. Primary technical success was 100 % and primary patency was 95 %, with only one restenosis requiring repeat angioplasty during follow-up. Primary-assisted and secondary patency rates were 100 %. Freedom from MALEs was 90 %, with two patients requiring amputations secondary to diabetic foot infections, although bypasses remained patent at the time of amputation.
Conclusions
The ‘Slash and Splash’ technique effectively treats severe infrainguinal vein bypass graft stenosis, offering excellent mid-term patency and freedom from MALEs. Adoption of this technique should be considered in the treatment of hemodynamically significant vein graft stenoses.
{"title":"Slash and splash technique for treatment of infrainguinal vein bypass graft stenosis","authors":"Apoorva Bhandari , John Landau , Stewart Kribs , Adam Power , Audra Duncan , Luc Dubois","doi":"10.1016/j.avsurg.2024.100333","DOIUrl":"10.1016/j.avsurg.2024.100333","url":null,"abstract":"<div><h3>Background</h3><p>Autologous venous bypasses effectively treat extensive infrainguinal arterial occlusive disease with excellent long-term patency rates. However, one-third of patients will experience significant vein graft stenosis, particularly within the first-year post-bypass. Current endovascular interventions yield suboptimal results, with reported re-stenosis rates of 20–50 %. This study investigates the efficacy of cutting balloon (‘slash’) followed by a drug-eluting balloon (‘splash’) angioplasty in treating vein graft stenosis.</p></div><div><h3>Methods</h3><p>This single-centre retrospective review examines consecutive patients who underwent the ‘Slash and Splash’ technique for treating significant stenosis (>70 % stenosis and/or PSV >300 cm/s) in infrainguinal autologous bypasses from June 2017 to January 2023. Follow-up duplex ultrasound was conducted at three months, six months, and yearly thereafter. Primary outcomes assessed technical success and graft patency. Secondary outcomes included major adverse limb events (MALEs), and major amputations</p></div><div><h3>Results</h3><p>Twenty-three patients (mean age 67.4 ± 8.1 years, 44 % male) with significant vein graft stenoses underwent the ‘Slash and Splash’ method to salvage their bypasses. Most patients (91 %) had critical limb-threatening ischemia. Nine patients received femoral-popliteal grafts and 14 received femoral-tibial grafts, with18 utilizing saphenous in-situ conduits. The average follow-up duration was 26.1 ± 16.7 months, with no losses to follow-up. The median time from initial bypass to angioplasty was 10 months. Primary technical success was 100 % and primary patency was 95 %, with only one restenosis requiring repeat angioplasty during follow-up. Primary-assisted and secondary patency rates were 100 %. Freedom from MALEs was 90 %, with two patients requiring amputations secondary to diabetic foot infections, although bypasses remained patent at the time of amputation.</p></div><div><h3>Conclusions</h3><p>The ‘Slash and Splash’ technique effectively treats severe infrainguinal vein bypass graft stenosis, offering excellent mid-term patency and freedom from MALEs. Adoption of this technique should be considered in the treatment of hemodynamically significant vein graft stenoses.</p></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 3","pages":"Article 100333"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772687824000850/pdfft?md5=799a280b4808230da151002c6515ef3d&pid=1-s2.0-S2772687824000850-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164455","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 : 2024-09-01DOI: 10.1016/j.avsurg.2024.100334
Aslyn E. Mattson , W. Anthony Lee
A 48-year-old woman with a complex aortic history, beginning with an acute type A dissection repair 14 years prior to presentation, followed by endovascular repair of her residual type B dissection and thoracoabdominal aortic aneurysm, presented with an incidental finding of a new, aortic pseudoaneurysm originating from her ascending graft. Given the prohibitive risk of redo open surgery, this was successfully repaired using proximal aortic extension cuffs from the TAG-TBE endograft system (W.L. Gore, Flagstaff, AZ) with complete exclusion of the pseudoaneurysm. To our knowledge, this is the first reported use of this newly commercially available thoracic endograft for this application.
一位 48 岁的女性有复杂的主动脉病史，14 年前曾接受过急性 A 型夹层修复手术，之后又接受过残余 B 型夹层和胸腹主动脉瘤的血管内修复手术。考虑到重新进行开放手术的风险过高，我们使用 TAG-TBE 内植物系统（W.L. Gore，Flagstaff, AZ）的近端主动脉延伸袖带进行了成功修复，并完全排除了假动脉瘤。据我们所知，这是首次报道将这种新上市的胸腔内移植物用于这种应用。
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Pub Date : 2024-09-01DOI: 10.1016/j.avsurg.2024.100332
Eleni Georgiadi, Georgios S. Sfyroeras, Georgia Papavassileiou, John D. Kakisis
Introduction
Bilateral internal carotid artery (ICA) occlusion is a rare type of cerebrovascular disease that carries a high risk for recurrent transient ischemic attacks.
Case report
We report a case involving a 67-year-old man presenting with bilateral internal carotid artery (ICA) occlusion, along with an additional occlusion in the right vertebral artery. Imaging revealed adequate collateral flow through the posterior circulation and external carotid artery (ECA) collaterals. He was treated with antiplatelet therapy. During follow up, neurologic examination showed no focal deficits.
Conclusion
While bilateral ICA occlusion can have devastating clinical outcomes, it may be a relatively benign condition if there is sufficient collateral circulation.
{"title":"A rare case of bilateral internal carotid artery and right vertebral artery occlusion","authors":"Eleni Georgiadi, Georgios S. Sfyroeras, Georgia Papavassileiou, John D. Kakisis","doi":"10.1016/j.avsurg.2024.100332","DOIUrl":"10.1016/j.avsurg.2024.100332","url":null,"abstract":"<div><h3>Introduction</h3><p>Bilateral internal carotid artery (ICA) occlusion is a rare type of cerebrovascular disease that carries a high risk for recurrent transient ischemic attacks.</p></div><div><h3>Case report</h3><p>We report a case involving a 67-year-old man presenting with bilateral internal carotid artery (ICA) occlusion, along with an additional occlusion in the right vertebral artery. Imaging revealed adequate collateral flow through the posterior circulation and external carotid artery (ECA) collaterals. He was treated with antiplatelet therapy. During follow up, neurologic examination showed no focal deficits.</p></div><div><h3>Conclusion</h3><p>While bilateral ICA occlusion can have devastating clinical outcomes, it may be a relatively benign condition if there is sufficient collateral circulation.</p></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 3","pages":"Article 100332"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772687824000849/pdfft?md5=4bef47bb607421e7c18266c7cdc98e78&pid=1-s2.0-S2772687824000849-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164453","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}
Open thoracoabdominal aortic aneurysm (TAAA) repair remains associated with significant morbidity and mortality rates despite advancements in surgical techniques. In our technique, we describe partial aortic clamping for debranching of the visceral and renal arteries and the use of extracorporeal membrane oxygenation (ECMO) as an alternative perfusion strategy. The advantage of using our technique is the reduced need for heparinization, a less inflammatory response, no need for cooling of the patient, the reduction of cardiac overload and limited ischemia time to all intra-abdominal organs and lower extremities.
Central message
ECMO and abdominal debranching with partial thoracic clamping during TAAA repair are ideal for reducing ischemia.
{"title":"Extracorporeal membrane oxygenation (ECMO) for open thoracoabdominal aortic aneurysm repair (TAAA): How we do it","authors":"Mohamed Rajab , Basar Sareyyupoglu , Camilo Polania-Sandoval , Houssam Farres , Young Erben","doi":"10.1016/j.avsurg.2024.100331","DOIUrl":"10.1016/j.avsurg.2024.100331","url":null,"abstract":"<div><p>Open thoracoabdominal aortic aneurysm (TAAA) repair remains associated with significant morbidity and mortality rates despite advancements in surgical techniques. In our technique, we describe partial aortic clamping for debranching of the visceral and renal arteries and the use of extracorporeal membrane oxygenation (ECMO) as an alternative perfusion strategy. The advantage of using our technique is the reduced need for heparinization, a less inflammatory response, no need for cooling of the patient, the reduction of cardiac overload and limited ischemia time to all intra-abdominal organs and lower extremities.</p></div><div><h3>Central message</h3><p>ECMO and abdominal debranching with partial thoracic clamping during TAAA repair are ideal for reducing ischemia.</p></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"4 3","pages":"Article 100331"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772687824000837/pdfft?md5=48476515bf1d0ba10d6ed860c48a7902&pid=1-s2.0-S2772687824000837-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136260","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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