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There has been an increase in superior vena cava (SVC) syndrome secondary to the growing use of indwelling catheters and pacemaker wire insertions. These 2 factors can account up to 74% cases of benign SVC syndrome. Endovascular t...
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There has been an increase in superior vena cava (SVC) syndrome secondary to the growing use of indwelling catheters and pacemaker wire insertions. These 2 factors can account up to 74% cases of benign SVC syndrome. Endovascular therapy is considered the first line of treatment. Surgery is an excellent option and is generally reserved for SVC syndrome not amenable to traditional endovascular procedures. We report a case of central venous reconstruction including an SVC reconstruction using the femoropopliteal vein as a panel graft in a patient with SVC syndrome due to pacemaker wires who failed multiple endovascular interventions.
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According to the 2007 TransAtlantic Inter-Society Consensus (TASC II) guidelines, surgery is the preferred treatment for extensive (TASC II type C and D) aortoiliac occlusive disease (AIOD). Recent studies, however, have shown tha...
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According to the 2007 TransAtlantic Inter-Society Consensus (TASC II) guidelines, surgery is the preferred treatment for extensive (TASC II type C and D) aortoiliac occlusive disease (AIOD). Recent studies, however, have shown that endovascular management can be an effective first-line treatment option for TASC II type C and D categories. While endovascular therapy is now commonly performed in patients with TASC II type D lesions, very few studies have investigated the feasibility and effectiveness of extending endovascular therapy to the most severe subcategory of TASC II D lesions, chronic infrarenal aortoiliac occlusion (CIAO). Herein, we present our technique for endovascular treatment of CIAO which relies on bidirectional subintimal aortoiliac dissection, wire snare for true lumen reentry, and combined balloon-expandable and self-expanding covered stent reconstruction of the aortic bifurcation and bilateral iliac arteries. This technique safely extends the reach of endovascular therapy to the most severe subcategory of TASC II D AIOD, CIAO. It is a viable minimally invasive alternative to aortobifemoral bypass surgery. Long-term follow-up of larger cohorts is needed to verify clinical efficacy and durability of therapy.
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The antiphospholipid syndrome (APS), either primary or secondary form, is considered an autoimmune disease with the presence of at least 1 clinical and 1 laboratory abnormalities as defined by the Sydney criteria. Clinical criteri...
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The antiphospholipid syndrome (APS), either primary or secondary form, is considered an autoimmune disease with the presence of at least 1 clinical and 1 laboratory abnormalities as defined by the Sydney criteria. Clinical criteria include vascular thrombosis of venous, artery, small vessel in any organ, and recurrent pregnancy pathologies. Mesenteric ischemia is a rare and threatening manifestation of APS. We herein report a case of a 34-year-old pregnant woman referred to our Emergency Room with thoracic and abdominal acute pain. Her past medical history was remarkable for positivity to antiphospholipid antibodies, deep vein thrombosis of the right lower limb, chronic occlusion of celiac trunk, and superior mesenteric artery and recurrent abortions. Imaging revealed acute occlusion of inferior mesenteric artery (IMA). Both a surgical and endovascular thrombectomy were ineffective to obtain durable IMA patency and so the patient underwent antegrade aorta-inferior mesenteric bypass with saphenous vein and resection of an ischemic ileal loop. The medical treatment at discharge was lifelong oral anticoagulant associated with double antiplatelet therapy. To the best of our knowledge, this is the first case reporting a young pregnant woman with APS and mesenteric ischemia submitted to several attempts of revascularization. Aggressive oral anticoagulant and antiplatelet long-term therapy is advised. Moreover, we recommend strict follow-up in those patients in order to early diagnose thrombotic recurrence.
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Snorkel endovascular aortic repair (SEVAR) is reported to be effective for the treatment of pararenal or juxtarenal aortic aneurysms. SEVAR can be performed with an off-the-self device, which is applied for emergency cases. Howeve...
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Snorkel endovascular aortic repair (SEVAR) is reported to be effective for the treatment of pararenal or juxtarenal aortic aneurysms. SEVAR can be performed with an off-the-self device, which is applied for emergency cases. However, there is a concern that SEVAR lead to gutter leak due to insertion of multiple stents. Previously, we performed 2-staged treatment for gutter leak after SEVAR. However, the gutter leaks can also occur late, and it is often difficult to close. Therefore, if a significant gutter leak is identified intraoperatively, performing concomitant gutter coil embolization at the time of the initial surgery may be reasonable.
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Aortoesophageal (AEF) and aortobronchial fistula (ABF) after thoracic endovascular aortic repair (TEVAR) are rare complications with catastrophic consequences without treatment. In this case report, we presented a patient with AEF...
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Aortoesophageal (AEF) and aortobronchial fistula (ABF) after thoracic endovascular aortic repair (TEVAR) are rare complications with catastrophic consequences without treatment. In this case report, we presented a patient with AEF and ABF after TEVAR successfully treated with endograft explantation and replaced by Dacron graft followed by esophagectomy and left principal bronchus repairing. We report a patient with AEF and ABF after TEVAR who was evaluated due to dysphagia and chest pain followed by hematemesis and hemoptysis. Endoscopic examination revealed lesion of the esophageal wall with chronic abscess formation and stent-graft protrusion into the cavity. Patient was operated on with extracorporeal circulation. AEF and ABF were confirmed intraoperatively. Endograft was explanted and in situ reconstruction of thoracic aorta was carried out with tubular Dacron 22-mm prosthesis wrapped with omental flap. After aortic reconstruction, esophageal mucosal stripping was performed with cervical esophagostomy, pyloromyotomy, and Stamm-Kader gastrostomy for nutrition. In addition, omentoplasty of the defect in the left principal bronchus was performed. To re-establish peroral food intake esophagocoloplasty was carried out 8 months after previous surgery utilizing transversosplenic segment of the colon and retrosternal route. In very selective cases, stent-graft explantation and in situ reconstruction with Dacron graft covered by omental flap followed by esophagectomy and bronchus repairing permit adequate debridement reducing the risk of mediastinitis and graft infection and allow a safe esophageal reconstruction in a second procedure.
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Background Peripheral pseudoaneurysms are a known complication of vascular access procedures. Complex lesionsthose with short, wide necks or other complex arrangementswould conventionally require open repair, but we believe that e...
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Background Peripheral pseudoaneurysms are a known complication of vascular access procedures. Complex lesionsthose with short, wide necks or other complex arrangementswould conventionally require open repair, but we believe that even these lesions could be managed with an endovascular approach. Methods Four patients with complex pseudoaneurysms were offered an open repair or thrombin injection with the use of flow-reducing balloons. Results In our series of 4 patients with complex pseudoaneurysms, all were safely treated with percutaneous thrombin injection in conjunction with endovascular flow reduction. All patients recovered from their procedures without incident and are free from recurrence at follow-up. Conclusions Flow reductionaided thrombin injection may have particular utility in complex femoral pseudoaneurysms, especially in a patient population that may not tolerate open repair. High-risk lesions may merit special consideration for this technique, and further study is warranted.
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Background Nutcracker syndrome, caused by mesoaortic compression of the left renal vein leading to symptoms related to venous hypertension, is an uncommon entity that may require operative intervention. Traditional open transposit...
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Background Nutcracker syndrome, caused by mesoaortic compression of the left renal vein leading to symptoms related to venous hypertension, is an uncommon entity that may require operative intervention. Traditional open transposition of the left renal vein to the vena cava has been shown to have a reintervention rate of up to 30%, while also having additional morbidity associated with laparotomy. More recently, endovascular stenting has been described in several small series but have reported stent fracture, thrombosis, and migration. Methods We report the case of a 26-year-old woman with 4爉onths of intermittent flank pain and hematuria, diagnosed with nutcracker syndrome by both duplex ultrasound and axial based imaging. Results The patient underwent catheter venography confirming left renal vein compression, which also demonstrated a dilated gonadal vein measuring 11爉m leading to significant pelvic varices. Through a left lower quadrant retroperitoneal exposure, the gonadal vein was transposed to the left common iliac vein with completion venography demonstrating relief of renal venous congestion. The patient was discharged uneventfully with immediate resolution of symptoms and remains symptom-free at 6-month follow-up. Conclusions Gonadal vein transposition is an effective alternative surgical treatment for nutcracker syndrome.
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A venous aneurysm is a relatively rare disease defined by cystic vasodilated lesions in a general vein. Popliteal venous aneurysm (PVA) is a rare clinical entity, and the first signs may be a thromboembolic event. They can cause p...
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A venous aneurysm is a relatively rare disease defined by cystic vasodilated lesions in a general vein. Popliteal venous aneurysm (PVA) is a rare clinical entity, and the first signs may be a thromboembolic event. They can cause potentially life-threatening diseases, such as pulmonary embolism and deep venous thrombosis. A left-sided inferior vena cava (IVC) is a common anomaly associated with venous thrombus, resulting in anatomical variations in the venous return from the lower limbs. The general vascular malformation of PVA and left-sided IVC should also be preoperatively understood because of the unpredictable risk of thromboembolic complications.
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Abdominal aortic aneurysms (AAAs) are usually asymptomatic. The compressive effects of internal iliac aneurysms are well described in the literature; however, we report what we believe to be the first case of rupture of the renal ...
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Abdominal aortic aneurysms (AAAs) are usually asymptomatic. The compressive effects of internal iliac aneurysms are well described in the literature; however, we report what we believe to be the first case of rupture of the renal pelvis caused by compression by an infrarenal AAA. We describe the subsequent management and briefly review the literature.
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Chronic totally thrombosed abdominal aortic aneurysms (AAAs) comprise a rare medical situation, with only a few cases reported in literature. Optimal management has been controversial, although an early risk for rupture is present...
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Chronic totally thrombosed abdominal aortic aneurysms (AAAs) comprise a rare medical situation, with only a few cases reported in literature. Optimal management has been controversial, although an early risk for rupture is present. Therefore, we present a rare case of late rupture in a patient with a totally thrombosed AAA, and we discuss proper treatment.
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