Case Reports in Vascular Medicine最新文献

Implantable subcutaneous chemoports are routinely employed for delivering chemotherapy in oncology. Spontaneous catheter dislodgement and embolization of the catheters are rare complications of the procedure. Herein, we report our experience with a patient presenting with spontaneous dislodgement and migration of the catheter to the pulmonary artery. The patient having familial adenomatous polyposis with adenocarcinoma of the right colon underwent total proctocolectomy and had placement of the chemoport through the internal jugular vein for adjuvant FOLFOX chemotherapy. The entrapped catheter was successfully managed by percutaneous retrieval by an interventional cardiologist.

May-Thurner syndrome (MTS) is characterized by the formation of an intravenous scar or venous "spur" resulting from chronic pulsatile compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) against the fourth or fifth lumbar vertebral body. This pulsatile compression creates a flow-limiting stenosis of the LCIV, leading to increased intravenous pressure in the veins draining the left lower extremity (LLE). Consequently, this elevated venous pressure manifests as a spectrum of chronic symptoms including unilateral LLE edema, pain, tenderness, warmth, skin inflammation, and discoloration, along with pelvic symptoms such as sensation of fullness and dyspareunia. Furthermore, MTS significantly elevates the risk of venous thromboembolism characterized by LCIV deep vein thrombosis (DVT) and potentially fatal pulmonary embolism (PE). Treatment options for MTS range from anticoagulant therapy to, in severe cases, operative intervention. Herein, we present a case of a 79-year-old male with MTS who experienced a near-fatal DVT that led to PE, compounded by a chronically distended urinary bladder, necessitating immediate operative removal of the PE.

Jugular venous compression syndrome (JVCS) is caused by internal jugular vein compression, leading to headaches, neck discomfort, tinnitus, vertigo, confusion, and blurred vision. These impairments can diminish functional outcomes and compromise quality of life for patients. Literature-based treatments focus on surgical approaches and do not include chemodenervation. However, chemodenervation may be an additional treatment modality to consider. We present the first published case of chemodenervation utilized to successfully treat debilitating neck pain, headaches, and vertigo symptoms for JVCS, resulting in improved functionality and quality of life. This chemical denervation to the anterior neck musculature was trialed in hopes of avoiding surgical intervention. After three treatments, significant symptomatic relief with improved ability to work, improved performance of activities of daily living, and enhanced quality of life were noted. Educating physicians about JVCS and the various treatment modalities available is essential, as less invasive treatment options may not only become available to assist with the functional component of the condition but could also serve as potential alternatives to surgical and endovascular management in carefully selected patients, with the goal of optimizing function and improving quality of life among patients.

Peripheral arterial disease (PAD) affects more than 230 million adults worldwide. Revascularization via angioplasty is a common method to manage stenosis in the superficial femoral artery (SFA). In-stent restenosis, however, is a common complication in endovascular interventions, especially in the SFA. Here, we present a case that involves recanalization of the SFA in a patient with a previously occluded stent and failed surgical revascularization. This patient initially presented with an occluded SFA which was stented. Four years later, the stent was reoccluded and surgical endarterectomy of the artery was performed with partial removal of the stent. Ten years later, the SFA is again occluded. Recanalization of the SFA using laser atherectomy and restenting of the occluded stent with GORE VIABAHN endoprosthesis was performed successfully. The combination of such methods is a suitable way to manage chronic lesions and minimize restenosis in patients with PAD.

This case report describes an instance of vulvar lymphangioma occurring in the setting of May-Thurner syndrome (MTS), an association between two vascular conditions that we do not believe has been previously reported. Lymphangioma, also known as lymphatic malformation, is a benign lesion typified by dilatation of endothelial-lined lymphatic channels involving the skin and subcutis, which can occur either as a congenital abnormality or as a result of acquired damage to lymphatic channels. Lymphangioma is a rare lesion in the vulva. MTS, also known as iliac vein compression syndrome or Cockett's syndrome, is a condition of left iliac vein obstruction due to overriding the right common iliac artery which can lead to iliofemoral deep vein thrombosis. In this report, we describe the case of a 29-year-old woman with MTS diagnosed at 7 years of age with poor lymphatic drainage and pelvic pain requiring left iliac vein stenting. She presented with left vulvar discomfort and chronic lower extremity edema and was found to have warty vulvar masses, with histopathological examination showing lymphangioma of the vulva. We believe that this is the first report of vulvar lymphangioma recognized in the setting of MTS, and we will discuss the clinical features, etiology, and possible pathophysiologic association between these two entities.

Nutcracker syndrome (NCS), a rare but impactful vascular condition, emerges from the compression of the left renal vein by adjacent major arteries, leading to a diverse array of symptoms such as hematuria, flank pain, and renal challenges. Highlighting the case of a 30-year-old male with an atypical presentation of NCS, this report explores the diagnostic complexities arising from its varied presentations and therapeutic options. It emphasizes the critical role of computed tomography (CT) in unveiling the underlying vascular constriction. Through this lens, the case underscores the necessity of considering NCS in the differential diagnosis of abdominal pain, advocating for a prompt and accurate diagnosis to guide effective management strategies, ranging from conservative approaches to surgical intervention. This stresses the importance of heightened awareness and ongoing research for optimizing patient outcomes in the face of this elusive condition.

Background: Previous reports have revealed various endovascular intervention techniques for prosthetic femoropopliteal bypass occlusion (PFPBO); however, treatment for PFPBO remains challenging for most interventionalists and vascular surgeons because the procedure is complicated. Most of the reported techniques involve device implantation. In the present study, we performed a combination of surgical graft thrombectomy and drug-coated balloon angioplasty for PFPBO without implanting any additional devices. Furthermore, we determined the favorable long-term results of this treatment using follow-up angiography. Case Presentation. A 77-year-old man with a history of chronic kidney disease and coronary artery disease presented to our clinic with rest pain on his left leg. Seven years prior to the current consult, he underwent femoropopliteal bypass (FPB) surgery using a prosthetic graft due to in-stent occlusion of the left superficial femoral artery (SFA). Four years after surgery, a duplex ultrasound scan revealed stenosis of the proximal anastomosis site; hence, medical therapy was continued. On the current consult, diagnostic angiography revealed occlusion of the FPB and infrapopliteal vessels. In the first attempt at recanalization, the guidewire was unable to pass through the occluded SFA. Therefore, another technique was performed to revascularize the FPBO and infrapopliteal vessels. We obtained an angiography of the left leg after inserting the guiding sheath via the right common femoral artery (CFA). First, surgical thrombectomy using a Fogarty catheter via the exposed left CFA was performed. Following endovascular therapy via the right CFA, we performed drug-coated balloon angioplasty for anastomotic stenosis and recanalized occlusive infrapopliteal vessels. Restenosis was not observed on follow-up angiograms. On further follow-up angiography, there was notable regression of the residual stenosis at the proximal anastomosis of the prosthetic graft.

Conclusion: This novel revascularization strategy may be a viable treatment option for PFPBO.

Materials and methods: Between January 2018 and December 2020, twenty patients (7 men and 13 women) with peripheral high-flow arteriovenous malformations who were treated primarily with arterial embolization using squid were retrospectively included. Anatomical sites being treated included the head and neck (16), extremities (2), uterus (1), and pelvis (1). Squid was used as the sole embolic agent in 15 patients, and transarterial embolization was employed in all cases except one where direct puncture embolization was used. Treatments were delivered over one or two sessions, with or without surgery. A total of 27 sessions were carried out with an interval time ranging from 6 to 36 months between sessions.

Results: Technical success was achieved in all cases. In those patients treated with squid alone, 13 exhibited total devascularization following embolization, and a further 4 required surgical excision to achieve complete obliteration of the arteriovenous malformation. There were no major complications, cases of microcatheter entrapment, or dimethyl sulfoxide-related pain recorded. On follow-up, one patient reported persistent pain, and another patient developed a garlicky taste. All other patients reported complete resolution of symptoms following treatment.

Conclusion: This study demonstrates the successful use of squid in managing peripheral arteriovenous malformations with low complication rates and long-term stable results, therefore validating its efficacy when used alone or in combination with other embolic agents. Squid may be the preferred embolic agent in any interventional radiologist's armamentarium as it offers formulations with varying viscosities (squid-18 and squid-12). We conclude that squid should be considered as a first-line embolic agent in the management of peripheral arteriovenous malformations.