Vascular and endovascular surgery最新文献

AimTo report on a case of renal vein anterior nutcracker syndrome (ANCS) that was treated using saphenous vein bypass after a failed attempt of renal vein transposition.CaseA 42-year-old female presented with gross hematuria and flank pain. Computed tomography revealed a left renal vein (LRV) anterior nutcracker syndrome. An attempt to perform LRV transposition failed due to short vein length. A saphenous bypass was then harvested to perform a bypass between the inferior vena cava and LRV. At 6-month follow-up, the patient remained symptom-free, and imaging confirmed graft patency.ConclusionSaphenous vein bypass presents a viable option in patients with short renal vein or failed renal vein transposition in cases of ANCS.

BackgroundSecondary aortoenteric fistulas (SAEF) following endovascular aortic repair (EVAR) is an extremely rare event but life threatening. Our review offers comprehensive knowledge on pathophysiology, clinical presentation, diagnosis, and treatment options.AimTo summarize the current literature regarding pathophysiology, clinical, diagnostic and therapeutic approach of aortoenteric fistulas secondary to EVAR.MethodsWe performed a literature search in Pubmed/MEDLINE to identify the literature published about SAEF after EVAR. Cases were summarized in a table and prevalences. Other relevant literature was included in the results sections.ResultsA total of 35 reports (single cases and small series) with 45 patients were included. SAEF after EVAR can result from infection, inflammation, or mechanical factors. Clinical presentation is often non-specific, ranging from a gastrointestinal herald bleed to hemorrhagic shock, or malaise and general infection-related symptoms. Cross-sectional imaging plays a critical role in diagnosing SAEF. The treatment approach involves a multidisciplinary team approach and requires broad-spectrum intravenous antibiotics, endovascular intervention for urgent hemorrhage control, and open surgical intervention for definitive repair. Long-term antimicrobial therapy is essential to avoid reinfection.ConclusionsSAEF following EVAR represents a complex, life-threatening condition with limited evidence-based management strategies. Given the growing prevalence of endovascular procedures, comprehensive knowledge of SAEF is crucial for all health care providers to improve early diagnosis and outcomes.

IntroductionTrue aneurysms of the upper limb, particularly in the hands, are rare and challenging to manage. We aim to report two cases of true arterial palmar arch aneurysms surgically treated.Case ReportThe first case involved a 45-year-old male professional martial artist with an ulnar artery aneurysm extending to the superficial palmar arch in the right hand. The second case was a 32-year-old female administrative assistant with a radial artery aneurysm in the left hand. Despite their respective professions, neither patient had a history of significant trauma, recent excessive training, or prolonged work hours. Clinically, both presented with local pain. Diagnostic imaging confirmed the aneurysms. The surgical interventions included proximal and distal vessel ligation and aneurysm resection under local anesthesia. Both patients were discharged on the first postoperative day without complications and showed no vascular complications during a 5-year follow-up.ConclusionAneurysms with marked rarity require individualized treatment with surgical options tailored to the clinical presentation and vascular status.

BackgroundArteriovenous malformations (AVM) of the digits are rare and carry a poor prognosis after surgical resection and embolisation and usually end up in digital amputation. We present a unique case of a digit AVM treated using glue by dual approach, ie, transarterial and percutaneous route with a proximal tourniquet, where we could completely salvage the digit involved with a significant reduction in symptoms.Case PresentationWe report a case of a 20-year-old male who presented with swelling of the right ring finger for the past 10 years, with new onset pain and increased swelling size in the last 2 years. A diagnosis of arteriovenous malformation was made on ultrasound and magnetic resonance angiography (MRA) imaging. To salvage the digit, meticulous planning and multidisciplinary discussion for embolization using super-selective angiography were done. Successful embolisation of nidus with feeder from both metacarpal arteries of the ring finger was done using glue by transarterial and percutaneous route with a proximal tourniquet. Near total obliteration of nidus was achieved with no early opacification of the draining vein. Short-term follow-up of 4 months revealed a significant reduction of swelling and pain with no major complication.ConclusionsGlue embolization with a dual approach and proximal tourniquet is safe and effective in digital AVM for symptom reduction with no major complication.

BackgroundSpontaneous iliac vein rupture is a rare but life-threatening condition, often associated with deep vein thrombosis (DVT). Current treatment options include surgical repair and endovascular interventions, but consensus on optimal management is lacking.Case ReportA 74-year-old woman presented with hypotension, altered consciousness, and left leg swelling. Imaging revealed a massive retroperitoneal hematoma with active bleeding from a ruptured left external iliac vein. Successful hemostasis was achieved using coil embolization, followed by anticoagulation for DVT management.ConclusionThis case demonstrates that coil embolization can be an effective minimally invasive treatment option for spontaneous iliac vein rupture, particularly in patients who may not tolerate surgical intervention.

Introduction: Primary aortic malignancy is a very rare pathology, with only 190 cases of aortic tumors reported in the literature to date. Usually, symptoms are insidious and nonspecific, so the disease is diagnosed at an advanced stage. Objective: Here, we present a case report of a primary malignant tumor of the aorta. In our case, the diagnosis was established using computed tomography angiography (CTA) and biopsy of indeterminate masses obtained during aortography. Methods: The patient underwent surgical resection of the affected aortic segment along with a tumor. Histopathological examination revealed the diagnosis of a primary malignant tumor of the aorta - angiosarcoma. Postoperatively, patient received adjuvant chemotherapy according to the standard treatment regimen for sarcoma. Results: One month later, postoperative CT of a chest, abdomen and pelvis was performed, revealing no evidence of metastases or pathological lymph nodes in the examined areas. Conclusion: Combined surgical and systemic therapies may improve overall survival.

A 49-year-old man with hypertension for 2 years, was incidentally found to have right intrarenal aneurysms during a routine abdominal ultrasound examination. He reported fluctuating blood pressure readings over the past 18 months. Laboratory parameters were within normal limits, with a serum creatinine level of 1.05 mg/dL. An abdominal CT angiogram revealed a large lobulated intrarenal aneurysm in the lower pole, which communicated with another smaller cortical aneurysm. Additional features suggested the presence of an arteriovenous (AV) fistula. Upon further questioning, the patient disclosed a history of blunt abdominal trauma following a motor vehicle accident 3 years ago. This trauma likely explains the CT findings and the development of hypertension secondary to renovascular disease in this patient. Angiography confirmed the presence of 2 renal artery pseudoaneurysms in the midpolar region, for which selective coil embolization was performed. The patient was stable and asymptomatic at his 2-week follow-up. His blood pressure reading was 110/80 mmHg, showing improvement compared to his pre-procedure recordings. There are very few reported cases of renal pseudoaneurysms causing secondary hypertension. Additionally, this case highlights that successful embolization can result in a substantial improvement in hypertension in these patients.

BackgroundThe influence of presence/absence chronic kidney disease (CKD) on the clinical course and outcomes of patients with peripheral artery disease (PAD) has not been extensively investigated. We aimed to measure the relative rates of amputation and mortality in individuals with different stages of CKD compared to those without CKD, and to assess whether revascularization treatments might reduce these risks for PAD patients.MethodsWe conducted a thorough search of the literature across multiple databases, including MEDLINE, EMBASE, the Cochrane Library, and Web of Science. The risk of bias assessment was assessed using the Newcastle-Ottawa Quality Assessment scale. All studies that reported relevant results in PAD patients were included. The statistical analysis involved the calculation of pooled prevalence estimates using a random-effects model, along with the performance of subgroup analyses and meta-regression to evaluate heterogeneity.ResultsWe included fourteen observational studies encompassing a total of 554,270 patients with PAD that met the predefined inclusion criteria. Eleven studies reported on amputation rates in patients with and without CKD. Our analysis showed that CKD patients faced nearly double the risk of amputation compared to those without CKD (1.94; 1.90 to 1.97; P < 0.001; I² = 96.8%, P < 0.001). Additionally, a significant rise in mortality risk among CKD patients was observed across 14 studies, in comparison to patients without CKD (OR 2.04; 95% CI 1.99 to 2.08; P < 0.001; I² = 78.6%, P < 0.001). Moreover, we observed a graded increase in both amputation and mortality rates with the progression of CKD severity. In terms of therapeutic interventions, the potential of revascularization procedures to lower mortality and amputation rates appeared to be attenuated in the presence of CKD in PAD patients. Meta-regression analysis revealed that only a baseline diabetic population exceeding 50% exhibited a borderline association with amputation rate (β 0.422; 95% CI [-0.189; 1.035]) after adjusting for other covariates, including sample size, percentage of patients with critical limb ischemia, and follow-up time.ConclusionThe significant association noted between CKD and risk of amputation and mortality with PAD, with this risk intensifying as renal insufficiency progresses. Furthermore, the effectiveness of revascularization procedures in reducing amputation and mortality rates is diminished in patients with PAD who also have CKD.

BackgroundRenal vein entrapment is compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta. When symptomatic, this condition is referred to as nutcracker syndrome (NCS).MethodsThis retrospective study reviews outcomes of 53 patients who underwent surgical correction of NCS at a tertiary care university medical center. Preoperatively, each patient underwent outpatient workup, including diagnostic venography with intravascular ultrasound (IVUS).ResultsThe patients were 98% female, average age of 33.6 years, and body mass index of 21.5 kg/m². Those who became surgical candidates, had either left flank or left upper quadrant abdominal pain. Preoperative venography and IVUS demonstrated a mean left renal vein (LRV) stenosis of 74%, and dilated LRV collaterals were identified in 64%. Presenting symptoms were provoked with catheter advancement, and with contrast injection into the LRV or its tributaries in 74% and 45% of venograms, respectively. Surgery consisted of renal vein transposition (RVT) in 43 patients, autotransplantation (AT) in 6, and gonadal vein transposition (GVT) in 4. Renal artery denervation was done in 39/47 patients (83%) who had RVT or GVT. LRV reconstruction was needed in 15/43 patients (35%) who had RVT because the vein was too short or scarred for transposition. There were 7 renal vascular complications after RVT (none with AT or GVT), most following bovine pericardial neoconduit. After 11.2 ± 1.2 months of follow up, patients in this study reported that their symptoms had resolved in 43%, improved in 36%, improved then recurred in 13%, and had not changed in 8%. Good outcome was achieved after AT in 100%, after RVT in 79%, and after GVT in 50%.ConclusionsAlgorithm-based surgical management of NCS leads to symptom resolution or improvement in most patients. Renal vein reconstruction with bovine pericardial neoconduit is associated with a high rate of vascular complications.

Background: Renal artery aneurysms (RAA) carry significant rupture risks, yet wide-neck variants challenge conventional endovascular techniques. Purpose: We report the successful exclusion of a wide-neck RAA using the Comaneci neck-bridging devide in a patient with renal fibromuscular dysplasia (FMD), highlighting its utility and limitations. Research design: Single-case report. Study sample: A 50-year-old hypertensive female with renal FMD presenting with a 27-mm saccular, wide-neck RAA. Data collection: Following multidiscplinary discussion favoring renal parenchyma preservation, endovascular coiling using the Comaneci device was performed via brachial access. The device stabilized the aneurysm neck during sequential coil (Hydroframe, Cosmos, Complex) placement. Posprocedural and 24-month follow-up imaging assesed occlusion, renal perfusion, and complication. Results: Postprocedural imaging confirmed complete aneurysm occlusion, preserved renal perfusion, and the abscense of complications, which was sustained at the 24-month follow-up. Conclusion: This case demonstrated the Comaneci device's safety and efficacy for excluding anatomically complex RAAs, particularly in FMD-associated vessels where permanent stents risk endothelial injury. Technical challenges include device sizing limitations in larger visceral arteries and the need for dual microcatheter strategies, underscoring operator expertise importance. Critical gaps identified are the lack of standarized protocols for visceral applications and insufficient long-term coil stability data. Findings advocate for device modifications for non-cerebral anatomies and prospective trials compating outcomes with balloon-assisted coiling or flow diversion. While highlighting the Comaneci's niche role in RAA management, cautious adoption is urged pending robust evidence.