Annals of vascular surgery. Brief reports and innovations最新文献_第5页

Idiopathic brachial artery true aneurysm in 28-year-old female 28岁女性特发性肱动脉真动脉瘤

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-06-01 DOI: 10.1016/j.avsurg.2025.100386

Sujay Edavalapati , Charles Hamilton , Steve I. Curtiss

Background

True brachial artery aneurysms (BAA) are considerably rare dilatations of the brachial artery, including all three layers of the vessel wall, which can have potentially devastating limb-threatening complications.⁴ The gold standard of treatment remains as open surgical resection, oftentimes requiring the utilization of autogenous or prosthetic conduit. We present a case of idiopathic true left brachial aneurysm in a 28-year-old female treated with excision and primary repair.

Methods

A 28-year-old female initially presents with an incidentally found pulsatile mass in her left arm. She was asymptomatic and incidentally noticed a lump which was found to be the aneurysm on further imaging workup. There was no other abnormal pulsatility noticed concerning aneurysms of other sites i.e., femoral, popliteal, abdominal, contra brachial. She denied a history of trauma to the area and injection and denied a family history of connective tissue disorder. Further workup, including duplex ultrasound and MRA, confirmed a true brachial artery aneurysm without evidence of aneurysms in the remainder of the body. The aneurysm was treated with surgical excision and primary repair with pathology negative for any connective tissue disorder.

Results

Postoperatively, the patient recovered well and was discharged on post-op day 2. Pathology report was negative for any connective tissue abnormalities and genetic testing without causative factors. On follow-up, the patient has been doing well on an aspirin with palpable distal pulses.

Conclusions

True brachial artery aneurysms are estimated to have an incidence of 0.17 %⁵ and represent an exceedingly uncommon cause of limb-threatening sequelae if not treated. Those identified should undergo thorough investigation, including genetic testing and imaging for other aneurysms. Surgical excision and repair with or without a conduit (autogenous or prosthetic) remain the gold standard of treatment with documented good outcomes.

背景：真正的肱动脉动脉瘤（BAA）是相当罕见的肱动脉扩张，包括所有三层血管壁，它可能有潜在的毁灭性的肢体威胁并发症治疗的金标准仍然是开放手术切除，通常需要使用自体或假体导管。我们报告一位28岁女性的特发性真左臂动脉瘤，经切除及初步修复治疗。方法1例28岁女性患者最初表现为左臂偶发搏动性肿块。她没有症状，偶然发现了一个肿块，在进一步的影像学检查中被发现是动脉瘤。其他部位如股、腘、腹、对臂动脉瘤均未见异常搏动。她否认有创伤史和注射史，否认有结缔组织疾病家族史。进一步的检查，包括双工超声和核磁共振成像，证实了一个真正的肱动脉瘤，在身体的其余部分没有动脉瘤的证据。动脉瘤被手术切除和初步修复病理阴性的任何结缔组织疾病。结果患者术后恢复良好，于术后第2天出院。病理报告无结缔组织异常，基因检测无致病因素。在随访中，患者服用阿司匹林情况良好，远端脉搏可触及。结论真正的臂动脉瘤的发生率估计为0.17% 5，如果不治疗，它是一种非常罕见的危及肢体的后遗症。那些被确诊的动脉瘤应该进行彻底的调查，包括基因检测和其他动脉瘤的影像学检查。手术切除和修复有或没有导管（自体或假体）仍然是治疗的金标准，记录良好的结果。

{"title":"Idiopathic brachial artery true aneurysm in 28-year-old female","authors":"Sujay Edavalapati , Charles Hamilton , Steve I. Curtiss","doi":"10.1016/j.avsurg.2025.100386","DOIUrl":"10.1016/j.avsurg.2025.100386","url":null,"abstract":"<div><h3>Background</h3><div>True brachial artery aneurysms (BAA) are considerably rare dilatations of the brachial artery, including all three layers of the vessel wall, which can have potentially devastating limb-threatening complications.<sup>4</sup> The gold standard of treatment remains as open surgical resection, oftentimes requiring the utilization of autogenous or prosthetic conduit. We present a case of idiopathic true left brachial aneurysm in a 28-year-old female treated with excision and primary repair.</div></div><div><h3>Methods</h3><div>A 28-year-old female initially presents with an incidentally found pulsatile mass in her left arm. She was asymptomatic and incidentally noticed a lump which was found to be the aneurysm on further imaging workup. There was no other abnormal pulsatility noticed concerning aneurysms of other sites i.e., femoral, popliteal, abdominal, contra brachial. She denied a history of trauma to the area and injection and denied a family history of connective tissue disorder. Further workup, including duplex ultrasound and MRA, confirmed a true brachial artery aneurysm without evidence of aneurysms in the remainder of the body. The aneurysm was treated with surgical excision and primary repair with pathology negative for any connective tissue disorder.</div></div><div><h3>Results</h3><div>Postoperatively, the patient recovered well and was discharged on post-op day 2. Pathology report was negative for any connective tissue abnormalities and genetic testing without causative factors. On follow-up, the patient has been doing well on an aspirin with palpable distal pulses.</div></div><div><h3>Conclusions</h3><div>True brachial artery aneurysms are estimated to have an incidence of 0.17 %<sup>5</sup> and represent an exceedingly uncommon cause of limb-threatening sequelae if not treated. Those identified should undergo thorough investigation, including genetic testing and imaging for other aneurysms. Surgical excision and repair with or without a conduit (autogenous or prosthetic) remain the gold standard of treatment with documented good outcomes.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"5 2","pages":"Article 100386"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144194459","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}

引用次数: 0

A rare presentation of post COVID-19 inflammatory aortitis 罕见的COVID-19后炎症性主动脉炎

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-06-01 DOI: 10.1016/j.avsurg.2025.100388

Hoi Yee Annie Lo , Pouria Parsa

The COVID-19 pandemic has affected over 60 million individuals globally, resulting in >15 million deaths. While the virus predominantly targets the respiratory system, it can also affect other organ systems, including the cardiovascular system. There have been limited reports on COVID-19-associated aortic pathology. We aim to contribute to the current literature by presenting the case of a 70-year-old female from Southern California with post-COVID-19 inflammatory aortitis.

The patient, who had been diagnosed with COVID-19 without respiratory symptoms, initially presented with failure to thrive. A comprehensive workup revealed rapidly progressing penetrating aortic ulcers involving the ascending and descending thoracic aorta as well as the infrarenal abdominal aorta. Within two weeks, these ulcers evolved into saccular aneurysms measuring up to 4 cm. After evaluating surgical repair versus medical therapy, the patient and family collectively elected to pursue nonoperative management with high-dose pulse corticosteroids with close observation. Under this regimen, the aneurysms showed slight growth but remained below 6 cm, with no immediate need for surgical intervention.

This case underscores the potential for life-threatening vascular complications of COVID-19 and highlights the importance of early recognition and individualized treatment strategies. As our understanding of COVID-19-associated vascular inflammation evolves, further studies are needed to refine management approaches and improve outcomes for affected patients.

2019冠状病毒病大流行已影响到全球6000多万人，造成1500万人死亡。虽然该病毒主要针对呼吸系统，但它也可以影响其他器官系统，包括心血管系统。关于covid -19相关主动脉病理的报道有限。我们的目标是通过介绍南加州一名患有covid -19后炎症性大动脉炎的70岁女性病例，为当前文献做出贡献。该患者被诊断为COVID-19，没有呼吸道症状，最初表现为无法茁壮成长。全面检查发现进展迅速的穿透性主动脉溃疡累及胸升、降主动脉和腹下主动脉。在两周内，这些溃疡演变成直径达4厘米的囊状动脉瘤。在评估手术修复与药物治疗后，患者和家属共同选择在密切观察的情况下使用大剂量脉冲皮质类固醇进行非手术治疗。在这个方案下，动脉瘤显示出轻微的生长，但保持在6厘米以下，不需要立即进行手术干预。该病例强调了COVID-19可能导致危及生命的血管并发症，并强调了早期识别和个性化治疗策略的重要性。随着我们对covid -19相关血管炎症的了解不断加深，需要进一步研究以完善管理方法并改善受影响患者的预后。

{"title":"A rare presentation of post COVID-19 inflammatory aortitis","authors":"Hoi Yee Annie Lo , Pouria Parsa","doi":"10.1016/j.avsurg.2025.100388","DOIUrl":"10.1016/j.avsurg.2025.100388","url":null,"abstract":"<div><div>The COVID-19 pandemic has affected over 60 million individuals globally, resulting in >15 million deaths. While the virus predominantly targets the respiratory system, it can also affect other organ systems, including the cardiovascular system. There have been limited reports on COVID-19-associated aortic pathology. We aim to contribute to the current literature by presenting the case of a 70-year-old female from Southern California with post-COVID-19 inflammatory aortitis.</div><div>The patient, who had been diagnosed with COVID-19 without respiratory symptoms, initially presented with failure to thrive. A comprehensive workup revealed rapidly progressing penetrating aortic ulcers involving the ascending and descending thoracic aorta as well as the infrarenal abdominal aorta. Within two weeks, these ulcers evolved into saccular aneurysms measuring up to 4 cm. After evaluating surgical repair versus medical therapy, the patient and family collectively elected to pursue nonoperative management with high-dose pulse corticosteroids with close observation. Under this regimen, the aneurysms showed slight growth but remained below 6 cm, with no immediate need for surgical intervention.</div><div>This case underscores the potential for life-threatening vascular complications of COVID-19 and highlights the importance of early recognition and individualized treatment strategies. As our understanding of COVID-19-associated vascular inflammation evolves, further studies are needed to refine management approaches and improve outcomes for affected patients.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"5 2","pages":"Article 100388"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231700","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}

引用次数: 0

Comparing the outcomes of femoral vein transposition versus lower extremity arteriovenous graft in dialysis patients with exhausted upper extremity access 股静脉转位与下肢动静脉移植物治疗上肢通路衰竭透析患者的疗效比较

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-06-01 DOI: 10.1016/j.avsurg.2025.100387

Hossein Hemmati , Mohammad Taghi Ashoobi , Seyyed Mostafa Zia Ziabari , Habib Eslami Kenarsari , Mohaya Farzin , Sepideh Atef Rad

Introduction

Finding suitable vascular access for dialysis is a significant challenge in advanced kidney failure. Patients with end-stage renal disease (ESRD) need urgent lower extremity vascular access. This study compares the outcomes of Femoral vein transposition (FVT) and Arterovenous Grafts (AVG) in patients without viable upper limb access, in alignment with KDOQI guidelines and individualized Life Plan strategies.

Materials and Methods

A retrospective study involving 52 patients with end-stage renal disease (ESRD) and no suitable upper extremity access, including those with suitable femoral veins or adequate lower extremity vasculature, analyzed either FVT (n = 26) or lower extremity AVG (n = 26) over a one-year period. The procedure involved freeing the femoral vein, transferring it to a subcutaneous tunnel in the thigh, and connecting it to the femoral artery. Outcomes measured were success rate, complications, and primary and secondary patency rates over nine months.

Results

In our study, 26 patients were evaluated, comprising 14 (53.8 %) males and 12 (46.2 %) females. The mean age of the patients was 60.32 years. At the 9-month follow-up, successful dialysis was achieved in 92.3 % of FVT cases compared to 53.8 % of AVG cases (p = 0.001). Primary patency was significantly higher in FVT (84.6 %) than AVG (50 %) (p = 0.01). Notably, no thrombosis or infection occurred in FVT patients, whereas the AVG group experienced 26.9 % thrombosis and 11.5 % infection. Wound healing complications were more frequent in the FVT group (42.3 % vs. 15.4 %, p = 0.032), though all resolved with conservative

Discussion

The FVT procedure has shown a high success rate and low complication rate, making it a viable option for patients lacking upper extremity vascular access. However, its complexity and limited familiarity among practitioners have hindered broader adoption. Our findings confirm that with proper training, FVT can significantly benefit patients with advanced chronic kidney disease (CKD) who need reliable dialysis access, highlighting its potential to the medical community.

Conclusion

Our study demonstrated that AVG remains a viable option when FVT is contraindicated. FVT is a low-complication and reliable method for establishing dialysis access in patients with no upper extremity vascular access.

在晚期肾衰竭患者中，寻找合适的透析血管通路是一个重大挑战。终末期肾病（ESRD）患者迫切需要下肢血管通路。根据KDOQI指南和个性化生活计划策略，本研究比较了没有可行上肢通道的患者的股静脉转位（FVT）和动静脉移植物（AVG）的结果。材料和方法一项回顾性研究纳入了52例终末期肾病（ESRD）患者，这些患者没有合适的上肢通路，包括合适的股静脉或足够的下肢血管，分析了一年时间内FVT （n = 26）或下肢AVG （n = 26）。手术过程包括释放股静脉，将其转移到大腿的皮下隧道，并将其连接到股动脉。测量的结果是9个月内的成功率、并发症、原发性和继发性通畅率。结果本组共纳入26例患者，其中男性14例（53.8%），女性12例（46.2%）。患者平均年龄60.32岁。在9个月的随访中，92.3%的FVT患者透析成功，而AVG患者透析成功的比例为53.8% （p = 0.001）。FVT组原发性通畅率（84.6%）明显高于AVG组（50%）（p = 0.01）。值得注意的是，FVT患者没有血栓形成或感染，而AVG组有26.9%的血栓形成和11.5%的感染。伤口愈合并发症在FVT组更常见（42.3%比15.4%,p = 0.032），尽管所有的问题都通过保守治疗得以解决。讨论FVT手术显示出高成功率和低并发症，使其成为上肢血管通路不足的患者的可行选择。然而，它的复杂性和从业者之间有限的熟悉程度阻碍了它的广泛采用。我们的研究结果证实，通过适当的训练，FVT可以显着使需要可靠透析途径的晚期慢性肾脏疾病（CKD）患者受益，这突出了其在医学界的潜力。结论：我们的研究表明，当FVT禁忌时，AVG仍然是一个可行的选择。对于没有上肢血管通路的患者，FVT是一种低并发症和可靠的建立透析通路的方法。

{"title":"Comparing the outcomes of femoral vein transposition versus lower extremity arteriovenous graft in dialysis patients with exhausted upper extremity access","authors":"Hossein Hemmati , Mohammad Taghi Ashoobi , Seyyed Mostafa Zia Ziabari , Habib Eslami Kenarsari , Mohaya Farzin , Sepideh Atef Rad","doi":"10.1016/j.avsurg.2025.100387","DOIUrl":"10.1016/j.avsurg.2025.100387","url":null,"abstract":"<div><h3>Introduction</h3><div>Finding suitable vascular access for dialysis is a significant challenge in advanced kidney failure. Patients with end-stage renal disease (ESRD) need urgent lower extremity vascular access. This study compares the outcomes of Femoral vein transposition (FVT) and Arterovenous Grafts (AVG) in patients without viable upper limb access, in alignment with KDOQI guidelines and individualized Life Plan strategies.</div></div><div><h3>Materials and Methods</h3><div>A retrospective study involving 52 patients with end-stage renal disease (ESRD) and no suitable upper extremity access, including those with suitable femoral veins or adequate lower extremity vasculature, analyzed either FVT (<em>n</em> = 26) or lower extremity AVG (<em>n</em> = 26) over a one-year period. The procedure involved freeing the femoral vein, transferring it to a subcutaneous tunnel in the thigh, and connecting it to the femoral artery. Outcomes measured were success rate, complications, and primary and secondary patency rates over nine months.</div></div><div><h3>Results</h3><div>In our study, 26 patients were evaluated, comprising 14 (53.8 %) males and 12 (46.2 %) females. The mean age of the patients was 60.32 years. At the 9-month follow-up, successful dialysis was achieved in 92.3 % of FVT cases compared to 53.8 % of AVG cases (<em>p</em> = 0.001). Primary patency was significantly higher in FVT (84.6 %) than AVG (50 %) (<em>p</em> = 0.01). Notably, no thrombosis or infection occurred in FVT patients, whereas the AVG group experienced 26.9 % thrombosis and 11.5 % infection. Wound healing complications were more frequent in the FVT group (42.3 % vs. 15.4 %, <em>p</em> = 0.032), though all resolved with conservative</div></div><div><h3>Discussion</h3><div>The FVT procedure has shown a high success rate and low complication rate, making it a viable option for patients lacking upper extremity vascular access. However, its complexity and limited familiarity among practitioners have hindered broader adoption. Our findings confirm that with proper training, FVT can significantly benefit patients with advanced chronic kidney disease (CKD) who need reliable dialysis access, highlighting its potential to the medical community.</div></div><div><h3>Conclusion</h3><div>Our study demonstrated that AVG remains a viable option when FVT is contraindicated. FVT is a low-complication and reliable method for establishing dialysis access in patients with no upper extremity vascular access.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"5 2","pages":"Article 100387"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239693","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}

引用次数: 0

Treatment of persistent sciatic artery with limb length discrepancy 持续性坐骨动脉伴肢长不齐的治疗

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-05-16 DOI: 10.1016/j.avsurg.2025.100384

Ramsey Sitta , Emily Onufer , Alexander Fairman

This case report describes the treatment of a five-year-old male with a persistent sciatic artery and significant limb-length discrepancy due to chronic ischemia. The patient presented with asymptomatic hypertension and was found to have left renal artery stenosis, and a Pillet-Gauffre Type 2a incomplete persistent sciatic artery. Surgical intervention involved an iliac-femoral bypass using a cadaveric superficial femoral artery to restore normal blood flow. Post-operative care included anticoagulation and aspirin therapy, with follow-up ultrasounds confirming patency. The report highlights the rarity of a persistent sciatic artery, its classification, and the importance of surgical management in pediatric cases to mitigate long-term morbidity associated with limb length discrepancy. Further research is needed on long-term outcomes of cadaveric arterial reconstructions in children.

这个病例报告描述了治疗一个五岁的男性持续性坐骨动脉和显著肢体长度差异，由于慢性缺血。患者表现为无症状性高血压，发现左肾动脉狭窄，并有一个Pillet-Gauffre 2a型不完全持续性坐骨动脉。手术干预包括利用尸体股浅动脉进行髂股搭桥，以恢复正常的血液流动。术后护理包括抗凝和阿司匹林治疗，随访超声确认通畅。该报告强调了持续性坐骨动脉的罕见性，其分类，以及在儿科病例中外科治疗的重要性，以减轻与肢体长度差异相关的长期发病率。对儿童尸体动脉重建的长期结果需要进一步的研究。

引用次数: 0

Common hepatic artery true aneurysm: Case report and review of the literature 肝总动脉真动脉瘤：病例报告及文献复习

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-05-06 DOI: 10.1016/j.avsurg.2025.100383

Ismaïl Ben Ayad , Luis Carlos Silva Corten , Cabri Mathieu , Vincent Scavee

Background

Hepatic artery aneurysms (HAAs) are rare but potentially life-threatening vascular conditions that can be life-threatening. Their natural history remains poorly understood, and management guidelines are based on limited evidence due to their rarity.

Case Report

We describe the case of a 70-year-old male diagnosed incidentally with a saccular HAA during an oncologic workup for right colon adenocarcinoma. Due to aneurysm's size, its inherent risk of rupture, and the patient's history of carotid artery dissection, surgical intervention was indicated. A multidisciplinary approach was adopted, prioritizing right hemicolectomy, followed by open aneurysmectomy and primary vascular reconstruction. Histopathology confirmed an atherosclerotic aneurysm with no signs of vasculopathy. The patient recovered well after surgery.

Discussion

HAAs’ most frequent etiology is atherosclerosis, with other etiologies including infections, connective tissue disorders, and trauma. Most HAAs are asymptomatic and therefore are detected incidentally. Rupture is the primary concern since it carries high mortality. Current SVS guidelines recommend intervention for symptomatic HAAs of any size and those exceeding 2 cm. While an “endovascular first” approach is preferred due to multiple benefits, open surgery remains essential in complex cases, particularly when anatomical variations pose technical challenges.

Conclusion

The management of HAAs requires individualized decision-making. In our case, open surgery allowed for the simultaneous treatment of two pathologies and addressed anatomical constraints. A collaborative, multidisciplinary strategy is key to achieving the best outcomes. Further case reporting of this rare condition is essential to refine current management strategies.

背景：肝动脉动脉瘤（HAAs）是一种罕见但可能危及生命的血管疾病。它们的自然历史仍然知之甚少，由于它们的稀有，管理指南基于有限的证据。病例报告我们描述了一个70岁的男性病例，在右结肠腺癌的肿瘤检查中偶然被诊断为囊性HAA。由于动脉瘤的大小，其固有的破裂风险，以及患者的颈动脉夹层史，建议手术干预。采用多学科方法，优先进行右半结肠切除术，其次是开放式动脉瘤切除术和原发性血管重建。组织病理学证实为动脉粥样硬化性动脉瘤，无血管病变迹象。手术后病人恢复得很好。haas最常见的病因是动脉粥样硬化，其他病因包括感染、结缔组织疾病和创伤。大多数haa是无症状的，因此是偶然发现的。破裂是主要问题，因为它具有高死亡率。目前的SVS指南建议对任何大小和超过2厘米的有症状的haa进行干预。虽然“血管内优先”的方法是首选的，因为有多种好处，但在复杂的情况下，开放手术仍然是必不可少的，特别是当解剖变异带来技术挑战时。结论HAAs的管理需要个性化决策。在我们的病例中，开放手术允许同时治疗两种病理并解决解剖限制。协作的多学科战略是实现最佳结果的关键。进一步的病例报告对于完善当前的管理策略至关重要。

{"title":"Common hepatic artery true aneurysm: Case report and review of the literature","authors":"Ismaïl Ben Ayad , Luis Carlos Silva Corten , Cabri Mathieu , Vincent Scavee","doi":"10.1016/j.avsurg.2025.100383","DOIUrl":"10.1016/j.avsurg.2025.100383","url":null,"abstract":"<div><h3>Background</h3><div>Hepatic artery aneurysms (HAAs) are rare but potentially life-threatening vascular conditions that can be life-threatening. Their natural history remains poorly understood, and management guidelines are based on limited evidence due to their rarity.</div></div><div><h3>Case Report</h3><div>We describe the case of a 70-year-old male diagnosed incidentally with a saccular HAA during an oncologic workup for right colon adenocarcinoma. Due to aneurysm's size, its inherent risk of rupture, and the patient's history of carotid artery dissection, surgical intervention was indicated. A multidisciplinary approach was adopted, prioritizing right hemicolectomy, followed by open aneurysmectomy and primary vascular reconstruction. Histopathology confirmed an atherosclerotic aneurysm with no signs of vasculopathy. The patient recovered well after surgery.</div></div><div><h3>Discussion</h3><div>HAAs’ most frequent etiology is atherosclerosis, with other etiologies including infections, connective tissue disorders, and trauma. Most HAAs are asymptomatic and therefore are detected incidentally. Rupture is the primary concern since it carries high mortality. Current SVS guidelines recommend intervention for symptomatic HAAs of any size and those exceeding 2 cm. While an “endovascular first” approach is preferred due to multiple benefits, open surgery remains essential in complex cases, particularly when anatomical variations pose technical challenges.</div></div><div><h3>Conclusion</h3><div>The management of HAAs requires individualized decision-making. In our case, open surgery allowed for the simultaneous treatment of two pathologies and addressed anatomical constraints. A collaborative, multidisciplinary strategy is key to achieving the best outcomes. Further case reporting of this rare condition is essential to refine current management strategies.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"5 2","pages":"Article 100383"},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947890","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}

引用次数: 0

Concomitant presentation and surgical management of bilateral serotonin-producing carotid body tumor and thyroid carcinoma

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-04-30 DOI: 10.1016/j.avsurg.2025.100381

Astrid Varela-Arzate , Carlos D. Franco-Gonzalez , Aliberth Bonilla-Salas , Osvaldo A. Gamboa-Abundis , Rafael H. Pérez-Soto , Hugo Laparra-Escareno , Javier E. Anaya-Ayala

Carotid body tumors (CBTs) are rare neuroendocrine neoplasms, and approximately 2% are catecholamine and dopamine producers. While CBTs may coexist with other neck neoplasms, the presence of a serotonin-producing CBT with malignancies, such as papillary thyroid carcinoma, is uncommon, with limited published data. We present the case of a 66-year-old woman with progressive weight loss who was found to have bilateral palpable neck masses. A comprehensive evaluation led to the diagnosis of a bilateral serotonin-producing carotid body tumor and papillary thyroid carcinoma. The initial surgical intervention included a total thyroidectomy and resection of the right CBT with our retrocarotid dissection technique. Eight months later, our vascular surgery team performed the resection of the contralateral CBT. At seventeen months of follow-up serotonin levels gradually decreased until reaching normal values. This case illustrates a rare clinical occurrence and successful management of bilateral serotonin-producers CBTs with papillary thyroid carcinoma.

颈动脉体肿瘤（CBTs）是罕见的神经内分泌肿瘤，约2%是儿茶酚胺和多巴胺的产生者。虽然CBT可能与其他颈部肿瘤共存，但产生5 -羟色胺的CBT与恶性肿瘤（如甲状腺乳头状癌）的存在并不常见，发表的数据有限。我们提出的情况下，66岁的妇女进行性体重减轻谁被发现有双侧可触及颈部肿块。综合评价诊断为双侧颈动脉体肿瘤和甲状腺乳头状癌。最初的手术干预包括全甲状腺切除术和用颈动脉后夹层技术切除右侧CBT。8个月后，我们的血管外科团队切除了对侧CBT。在17个月的随访中，血清素水平逐渐下降，直到达到正常值。这个病例说明了一个罕见的临床发生和成功的管理双侧血清素产生cbt与乳头状甲状腺癌。

{"title":"Concomitant presentation and surgical management of bilateral serotonin-producing carotid body tumor and thyroid carcinoma","authors":"Astrid Varela-Arzate , Carlos D. Franco-Gonzalez , Aliberth Bonilla-Salas , Osvaldo A. Gamboa-Abundis , Rafael H. Pérez-Soto , Hugo Laparra-Escareno , Javier E. Anaya-Ayala","doi":"10.1016/j.avsurg.2025.100381","DOIUrl":"10.1016/j.avsurg.2025.100381","url":null,"abstract":"<div><div>Carotid body tumors (CBTs) are rare neuroendocrine neoplasms, and approximately 2% are catecholamine and dopamine producers. While CBTs may coexist with other neck neoplasms, the presence of a serotonin-producing CBT with malignancies, such as papillary thyroid carcinoma, is uncommon, with limited published data. We present the case of a 66-year-old woman with progressive weight loss who was found to have bilateral palpable neck masses. A comprehensive evaluation led to the diagnosis of a bilateral serotonin-producing carotid body tumor and papillary thyroid carcinoma. The initial surgical intervention included a total thyroidectomy and resection of the right CBT with our retrocarotid dissection technique. Eight months later, our vascular surgery team performed the resection of the contralateral CBT. At seventeen months of follow-up serotonin levels gradually decreased until reaching normal values. This case illustrates a rare clinical occurrence and successful management of bilateral serotonin-producers CBTs with papillary thyroid carcinoma.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"5 2","pages":"Article 100381"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143943052","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}

引用次数: 0

Late effect of an embolized coronary stent in the lower extremities 下肢栓塞冠状动脉支架的晚期效应

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-04-29 DOI: 10.1016/j.avsurg.2025.100382

Mauricio Gonzalez-Urquijo, Francisco Valdes, Leopoldo Marine, Jose Francisco Vargas, Michel Bergoeing

Purpose

To report a late complication involving an embolized stent that migrated into the peripheral circulation during an emergency coronary intervention.

Case Report

A 69-year-old man with a history of myocardial infarction 12 years prior, during which he experienced prolonged cardiac arrest following a failed coronary stenting attempt and subsequent aorto-coronary bypass surgery, presented to the emergency department with acute limb ischemia in the right lower limb. A CT angiogram revealed complete occlusion of the popliteal artery and a hyperdense image at the tibioperoneal trunk. Popliteal artery exploration and embolectomy successfully restored proximal blood flow; however, a firm occlusion at the tibioperoneal trunk necessitated an arteriotomy. This procedure uncovered a coronary stent adhered to the endothelium, which was removed via endarterectomy. The patient was prescribed rivaroxaban for six months. At a six-year follow-up, he remains well and asymptomatic, continuing on aspirin and a reduced dose of rivaroxaban.

Conclusion

This case underscores the importance of monitoring long-term complications following coronary interventions and highlights the need for vigilance in managing patients at risk for device embolization.

目的：报道一例急诊冠状动脉介入手术中栓塞支架移入外周循环的晚期并发症。病例报告：一名69岁男性，12年前有心肌梗死史，在冠状动脉支架置入失败和随后的主动脉-冠状动脉搭桥手术后出现了长时间的心脏骤停，右下肢急性肢体缺血。CT血管造影显示腘动脉完全闭塞，胫腓干呈高密度。腘动脉探查及栓塞术成功恢复近端血流；然而，胫骨腓骨干的牢固闭塞需要动脉切开术。该手术发现冠状动脉支架粘附在内皮上，并通过动脉内膜切除术将其移除。患者服用利伐沙班6个月。在六年的随访中，他保持良好无症状，继续服用阿司匹林和减少剂量的利伐沙班。结论本病例强调了监测冠状动脉介入术后长期并发症的重要性，并强调了在管理有器械栓塞风险的患者时需要保持警惕。

{"title":"Late effect of an embolized coronary stent in the lower extremities","authors":"Mauricio Gonzalez-Urquijo, Francisco Valdes, Leopoldo Marine, Jose Francisco Vargas, Michel Bergoeing","doi":"10.1016/j.avsurg.2025.100382","DOIUrl":"10.1016/j.avsurg.2025.100382","url":null,"abstract":"<div><h3>Purpose</h3><div>To report a late complication involving an embolized stent that migrated into the peripheral circulation during an emergency coronary intervention.</div></div><div><h3>Case Report</h3><div>A 69-year-old man with a history of myocardial infarction 12 years prior, during which he experienced prolonged cardiac arrest following a failed coronary stenting attempt and subsequent aorto-coronary bypass surgery, presented to the emergency department with acute limb ischemia in the right lower limb. A CT angiogram revealed complete occlusion of the popliteal artery and a hyperdense image at the tibioperoneal trunk. Popliteal artery exploration and embolectomy successfully restored proximal blood flow; however, a firm occlusion at the tibioperoneal trunk necessitated an arteriotomy. This procedure uncovered a coronary stent adhered to the endothelium, which was removed via endarterectomy. The patient was prescribed rivaroxaban for six months. At a six-year follow-up, he remains well and asymptomatic, continuing on aspirin and a reduced dose of rivaroxaban.</div></div><div><h3>Conclusion</h3><div>This case underscores the importance of monitoring long-term complications following coronary interventions and highlights the need for vigilance in managing patients at risk for device embolization.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"5 2","pages":"Article 100382"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069948","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}

引用次数: 0

Recurrent sepsis resulting from an aorto-appendicular fistula 由主动脉-阑尾瘘引起的复发性败血症

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-04-19 DOI: 10.1016/j.avsurg.2025.100380

K.W. Roskamp, H.S.M. Ammerlaan, J. Nederend, I.H.J.T. de Hingh

A 75-year-old patient with a history of endovascular aorta repair, low anterior bowel resection and small bowel resection presented with episodes of recurrent sepsis. Radiological imaging and laparotomy revealed an aortoenteric fistula connecting the appendix to the aneurysmatic aorta as the cause of the recurrent sepsis. Surgical removal of the appendix and dismantling of the fistula allowed the patient to recover.

The patient in this report consented to the publication of anonymised case details and images.

患者75岁，曾行血管内主动脉修复术、低位前肠切除术及小肠切除术，术后出现反复脓毒症。放射影像和剖腹手术显示连接阑尾和动脉瘤主动脉的主动脉肠瘘是复发性败血症的原因。手术切除阑尾并拆除瘘管使患者得以康复。本报告中的患者同意匿名发表病例细节和图像。

引用次数: 0

Anterior lumbar interbody fusion in the setting of ectopic pelvic kidney 骨盆异位肾的前路腰椎椎间融合术

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-04-18 DOI: 10.1016/j.avsurg.2025.100379

Antonio Ayerdi , Austin G Helton , Juan Ayerdi , James E McGrory

Objective

We present the case of a 69-year-old female with an ectopic pelvic kidney (EPK) who was indicated for an anterior lumbar interbody fusion (ALIF). We describe the use of a trans-abdominal transperitoneal approach with medial visceral rotation and the details of this patient’s unique renal anatomy.

Summary of background data

ALIF has been associated with decreased pain, enhanced recovery, and increased fusion rates compared with other lumbar fusion techniques. This approach involves dissection through the lower abdomen to the spine, requiring a thorough understanding of relevant anatomy and anatomic variations.

Methods

A 69-year-old female with an EPK presented with left lower extremity radicular pain. She had failed conservative management and an ALIF was recommended. Preoperative MRI and CT imaging delineated the unique location of the kidney and numerous renal vascular anatomic variations. However, other anomalous vascular and ureterovesical structures could not be excluded. For this reason, the authors opted to use a transabdominal transperitoneal approach.

Results

Our approach consisted of a midline-transabdominal-transperitoneal incision to include the skin, subcutaneous tissue, and linea alba. Once the peritoneum was entered, the omentum was packed cephalad, and the small bowel was wrapped and mobilized to the right. The EPK was rotated cephalo-medially and its three renal arteries were located, dissected, and carefully protected. After adequate exposure of the L4-L5 interbody space, a discectomy was performed, followed by implantation of a lumbar interbody fusion cage filled with allograft bone. The patient proceeded to have an uneventful recovery, with a mild increase in creatinine on postoperative day one, which normalized by her discharge on postoperative day four.

Conclusion

EPK is a congenital anomaly that can present with complex and variable anatomy. When planning to perform an ALIF in the setting of EPK, complex and anomalous vascular anatomy should be expected. Therefore, strong consideration may be given to imaging, though underlying vascular structure cannot be ruled out. We describe a trans-abdominal transperitoneal approach with medial visceral rotation, as this approach may provide the highest flexibility to avoid inadvertent complications during ALIF in patients with EPK.

Level of evidence

Level IV.

目的：我们报告一名69岁女性盆腔肾盂异位（EPK）的病例，她需要行前路腰椎椎间融合术（ALIF）。我们描述了使用内侧内脏旋转的经腹经腹膜入路和该患者独特肾脏解剖结构的细节。与其他腰椎融合技术相比，alif与减轻疼痛、增强恢复和提高融合率有关。这种方法包括从下腹部到脊柱的解剖，需要对相关解剖和解剖变异有透彻的了解。方法69岁女性，EPK表现为左下肢神经根痛。保守治疗失败，建议行ALIF。术前MRI和CT成像描绘了肾脏的独特位置和许多肾脏血管解剖变异。然而，其他异常血管和输尿管膀胱结构不能排除。因此，作者选择了经腹经腹膜入路。结果我们的方法包括中线-经腹-经腹膜切口，包括皮肤、皮下组织和白线。一旦进入腹膜，大网膜被包裹在头部，小肠被包裹并向右移动。将EPK向头内侧旋转，定位、解剖并小心保护其三条肾动脉。在充分暴露L4-L5椎间间隙后，行椎间盘切除术，然后植入充满同种异体骨的腰椎椎间融合器。患者顺利恢复，术后第一天肌酐轻度升高，术后第四天出院时恢复正常。结论epk为先天性畸形，解剖结构复杂多变。当计划在EPK背景下进行ALIF时，应预料到复杂和异常的血管解剖。因此，虽然不能排除潜在血管结构的可能性，但仍需考虑影像学检查。我们描述了一种内侧内脏旋转的经腹经腹膜入路，因为这种入路可以提供最高的灵活性，以避免EPK患者在ALIF期间的意外并发症。证据等级：四级。

{"title":"Anterior lumbar interbody fusion in the setting of ectopic pelvic kidney","authors":"Antonio Ayerdi , Austin G Helton , Juan Ayerdi , James E McGrory","doi":"10.1016/j.avsurg.2025.100379","DOIUrl":"10.1016/j.avsurg.2025.100379","url":null,"abstract":"<div><h3>Objective</h3><div>We present the case of a 69-year-old female with an ectopic pelvic kidney (EPK) who was indicated for an anterior lumbar interbody fusion (ALIF). We describe the use of a trans-abdominal transperitoneal approach with medial visceral rotation and the details of this patient’s unique renal anatomy.</div></div><div><h3>Summary of background data</h3><div>ALIF has been associated with decreased pain, enhanced recovery, and increased fusion rates compared with other lumbar fusion techniques. This approach involves dissection through the lower abdomen to the spine, requiring a thorough understanding of relevant anatomy and anatomic variations.</div></div><div><h3>Methods</h3><div>A 69-year-old female with an EPK presented with left lower extremity radicular pain. She had failed conservative management and an ALIF was recommended. Preoperative MRI and CT imaging delineated the unique location of the kidney and numerous renal vascular anatomic variations. However, other anomalous vascular and ureterovesical structures could not be excluded. For this reason, the authors opted to use a transabdominal transperitoneal approach.</div></div><div><h3>Results</h3><div>Our approach consisted of a midline-transabdominal-transperitoneal incision to include the skin, subcutaneous tissue, and linea alba. Once the peritoneum was entered, the omentum was packed cephalad, and the small bowel was wrapped and mobilized to the right. The EPK was rotated cephalo-medially and its three renal arteries were located, dissected, and carefully protected. After adequate exposure of the L4-L5 interbody space, a discectomy was performed, followed by implantation of a lumbar interbody fusion cage filled with allograft bone. The patient proceeded to have an uneventful recovery, with a mild increase in creatinine on postoperative day one, which normalized by her discharge on postoperative day four.</div></div><div><h3>Conclusion</h3><div>EPK is a congenital anomaly that can present with complex and variable anatomy. When planning to perform an ALIF in the setting of EPK, complex and anomalous vascular anatomy should be expected. Therefore, strong consideration may be given to imaging, though underlying vascular structure cannot be ruled out. We describe a trans-abdominal transperitoneal approach with medial visceral rotation, as this approach may provide the highest flexibility to avoid inadvertent complications during ALIF in patients with EPK.</div></div><div><h3>Level of evidence</h3><div>Level IV.</div></div>","PeriodicalId":72235,"journal":{"name":"Annals of vascular surgery. Brief reports and innovations","volume":"5 2","pages":"Article 100379"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874305","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}

引用次数: 0

A case of arterial reconstruction for multiple hepatic artery aneurysms complicated by hereditary hemorrhagic telangiectasia 多发性肝动脉瘤并发遗传性出血性毛细血管扩张的动脉重建1例

Annals of vascular surgery. Brief reports and innovations

Pub Date : 2025-04-13 DOI: 10.1016/j.avsurg.2025.100378

Yasutake Momokawa, Koji Maeda

Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant genetic disorder that manifests as mucous telangiectasia and arteriovenous malformations (AVMs) in the major organs. Although HHT type 2 often involves intrahepatic AVMs or aneurysms, which lead to high output and portal hypertension, extrahepatic aneurysm is a rare condition. Herein, we report a case of successful surgical intervention for an extrahepatic aneurysm in a patient with HHT type 2. Pathological findings of the resected aneurysm included hypoplasia of the media and absence of the intimal elastic lamina without atherosclerotic change. We believe that surgical resection is a favorable procedure for a patient with hepatic artery aneurysms concomitant with HHT.

遗传性出血性毛细血管扩张症（HHT）是一种罕见的常染色体显性遗传病，表现为主要器官的粘膜毛细血管扩张和动静脉畸形（AVMs）。虽然HHT 2型常涉及肝内avm或动脉瘤，导致高输出和门脉高压，但肝外动脉瘤是一种罕见的疾病。在此，我们报告一例成功的手术干预肝外动脉瘤患者HHT 2型。切除动脉瘤的病理表现包括中膜发育不全和内膜弹性层缺失，无动脉粥样硬化改变。我们认为手术切除是肝动脉瘤合并HHT患者的一种有利的治疗方法。

引用次数: 0