Annals of vascular diseases最新文献

Objectives: Peri-aortitis following endovascular aneurysm repair (EVAR) is a rare phenomenon with unclear pathogenesis. In this study, we investigated its clinical features and sac prognosis. Methods: A retrospective analysis was conducted on 1369 EVAR. Peri-aortitis was defined using post-EVAR computed tomography. Clinical and imaging data were assessed. Results: Peri-aortitis following EVAR was identified in 12 patients (0.89%) with a mean age of 74 ± 8.9 years; 83.3% were male, and 41.7% had allergic or autoimmune histories. There were eight symptomatic cases (66.7%), including seven with fever, three with back or abdominal pain, and one with hydronephrosis. Precautionary antibiotic treatment was administered in five febrile cases. Although persistent and recurrent inflammation was observed in two cases (16.7%) each, inflammation resolved spontaneously in seven patients (58.3%). One (8.3%) needed steroid therapy for severe back pain. Aneurysm shrinkage was observed in seven cases (58.3%), while enlargement was noted in one case (8.3%) with type II endoleak. No correlation was found between aneurysm growth and peri-aortitis development. Conclusions: Peri-aortitis following EVAR may present significant challenges, including differentiation from infection, management of symptomatic cases requiring medical therapy, and addressing recurrences. Accurate diagnosis, individualized treatment, and meticulous follow-up are essential for favorable outcomes.

A 41-year-old woman with a 1-year history of right chest pain, with normal cardiology and pulmonology assessments. The chest pain was reproducible upon upper limb elevation. Computed tomography (CT) angiography in the arm-elevated position revealed subclavian artery and vein stenosis at the costoclavicular space, and the diagnosis was neurogenic thoracic outlet syndrome (TOS). Surgery involving endoscopic-assisted infraclavicular resection of the first rib and scalene muscles resulted in immediate postoperative symptom improvement. When chest pain persists after ruling out other conditions, neurogenic TOS should be considered in the differential diagnosis.

Intravenous leiomyomatosis (IVL) remains scarcely reported, and complete tumor resection is the recommended treatment. Herein, we present a comprehensive review of the case of a 52-year-old woman who suffered from recurrent syncope episodes due to IVL with intracardiac extension to the right atrium. Partial tumor resection and postoperative hormone therapy were conducted first. However, the 6-month postoperative follow-up computed tomography scan revealed a tendency for the IVL to increase in size, and complete resection was conducted. In this article, we would like to emphasize that partial resection followed by hormone therapy is insufficient for IVL, and complete resection should be chosen.

Objectives: Surgical thrombectomy has been established as an effective treatment for acute limb ischemia (ALI). Nevertheless, manipulation via the common femoral artery (CFA) to retrieve thrombus in the infra-popliteal artery sometimes proves less effective. Methods: We retrospectively reviewed patients undergoing surgical thrombectomy for infra-inguinal ALI from January 2010 to December 2022. The primary endpoint was the rate of amputation. Secondary endpoints were technical and clinical success rates, incidence of distal embolism, and freedom from reintervention. Results: A total of 35 patients underwent surgical thrombectomy where the popliteal artery or below is occluded. The CFA approach was utilized in 13, and the below-knee popliteal artery (BKPA) approach in 22. There were no differences in background between groups. The reintervention rate was lower in the BKPA group (BKPA group: 0% vs. CFA group: 30.8%; P = 0.01). The BKPA group showed a significantly lower incidence of distal embolism (BKPA group: 4.5% vs. CFA group: 38.5%; P = 0.02) and freedom from reintervention (BKPA group 100% at 12 months vs. CFA group: 68.7% at 12 months; log-rank P = 0.01). Conclusions: The BKPA approach-first strategy for surgical thrombectomy in the management of ALI is feasible with better outcomes compared with the CFA approach.

Objectives: Thoracic endovascular aortic repair (TEVAR) has recently emerged as a less invasive alternative to open thoracotomy for the treatment of Kommerell's diverticulum (KD). However, anatomical challenges, including an acute aortic arch and an aberrant subclavian artery, often limit its feasibility. This study aimed to evaluate the outcomes of TEVAR for KD.

Methods: Between February 2012 and July 2023, 6 patients with KD underwent TEVAR at 3 institutions. Subclavian artery embolization or reconstruction was performed when necessary. Morphological parameters, including the Kommerell's diverticulum diameter (KDd) and the distance to the opposite aortic wall (DAW), were assessed.

Results: Four patients underwent subclavian artery embolization, including 1 requiring bilateral embolization. Subclavian artery reconstruction was performed in 2 cases. Intraoperative type 1a endoleaks were observed in 3 cases and were successfully managed with additional stent grafts. During a follow-up period ranging from 13 to 83 months, 1 patient required open surgical conversion due to graft infection. No other severe complications or aneurysmal progression were noted.

Conclusions: Despite the limited follow-up period and lack of long-term data, TEVAR for KD demonstrated favorable short- to mid-term outcomes and may represent an effective treatment option in selected patients.

A 50-year-old male with diabetes mellitus, who experienced recurrent sternal dehiscence secondary to a deep sternal wound infection, failed to respond to treatment with both pectoralis major muscle and greater omental flaps. Consequently, we performed a vertical rectus abdominis muscle flap in a double-pedicle fashion, utilizing the internal mammary artery and the 12th intercostal artery perforator. This intervention successfully addressed the condition. This novel technique offers an excellent therapeutic option for managing this life-threatening complication.

A 56-year-old woman with recurrent acute pulmonary embolism was diagnosed with a left popliteal venous aneurysm (PVA) by venous echocardiography. During anticoagulation therapy with heparin for acute pulmonary embolism, she was found to be positive for heparin-induced thrombocytopenia (HIT) antibodies. Surgery was performed with argatroban for anticoagulation, removal of the thrombus in the PVA, and suturing of the vein. Postoperatively, the popliteal vein showed shrinkage, and no recurrence of thromboembolism was observed. We report a case in which a patient with a PVA positive for HIT antibodies was successfully treated with PVA resection and anticoagulation therapy with argatroban.

We report a case of an abdominal aortic rupture without aneurysm associated with giant cell arteritis. A 67-year-old woman presented with lower back pain. Contrast-enhanced computed tomography revealed a massive retroperitoneal hematoma with contrast leakage from the abdominal aorta, suggestive of abdominal aortic rupture. During emergency surgery, a rupture site was identified on the anterior wall of the abdominal aorta, while no aneurysmal changes or dilatation of the abdominal aorta were observed. Histopathological examination of the resected aortic wall revealed infiltration of giant cells positive for CD68, leading to the diagnosis of giant cell arteritis.

A single-stage extensive aortic replacement is necessary for infected stent graft explantation after thoracic endovascular aortic repair (TEVAR). However, establishing selective cerebral perfusion and antegrade myocardial protection while ensuring a clear view of the distal aorta is challenging. We adopted a semi-clamshell approach with rib cross for a case of infection following hybrid TEVAR. This approach provides visualization of the ascending aorta, aortic arch, and the descending aorta down to the diaphragm. It is a viable option for cases requiring total arch and distal descending aorta replacement, offering reliable cerebral and myocardial protection, particularly in open conversion of hybrid TEVAR.

A 74-year-old man with hypertension and hyperuricemia was incidentally diagnosed with a 39-mm brachiocephalic artery aneurysm. Because of a sufficient proximal sealing zone, a hybrid repair was performed, consisting of a right common carotid-axillary bypass with a prosthetic graft, followed by endovascular exclusion using covered stents, a vascular plug, and coils. Completion angiography confirmed complete aneurysm exclusion without endoleak and satisfactory bypass flow. The postoperative course was uneventful. Computed tomography (CT) angiography demonstrated persistent aneurysm exclusion without endoleak and a patent bypass. At 12 months, plain CT confirmed no aneurysm enlargement.