A 78-year-old man with a history of surgery for rectal cancer three years before underwent hybrid surgery for a 35-mm right subclavian artery aneurysm. First, the vertebral artery was transposed to the common carotid artery to maintain its bloodstream. Second, axillo-common carotid artery ipsilateral bypass was constructed to preserve the carotid-artery flow. Finally, endovascular repair was performed via the axillary artery to exclude the subclavian artery aneurysm. A 13-mm×10-cm GORE VIABAHN and subsequently an upside-down 27-mm×14-cm GORE EXCLUDER Contralateral Leg were placed from the brachiocephalic artery to the subclavian artery distal to the aneurysm with coiling of the internal thoracic artery and ligation of the proximal common carotid artery. No postprocedural neurological complication occurred despite occlusion of the transposed vertebral artery on contrast-enhanced computed tomography (CT). The patient was uneventfully discharged 11 days after the hybrid surgery. Less invasive hybrid surgery may be useful to repair a right subclavian artery aneurysm.
AIMS:Risk factors associated with readmission due to worsening heart failure (HF) after discharge may differ between patients with and without a history of HF hospitalization. This study aimed to identify the risk factors for HF readmission in older patients with and without a history of HF hospitalization. METHODS AND RESULTS:A total of 899 older inpatients who underwent cardiac rehabilitation were enrolled from a multicenter retrospective cohort study. Patients were classified based on their history of hospitalization for HF, and 1-year HF readmission was investigated. During the 1-year follow-up period, 27.8% were readmitted for HF: 18.7% and 39.7% in those without and with a history of HF hospitalization, respectively. Multivariable regression analysis identified beta-blocker prescription at discharge [hazard ratio (HR): 0.624, 95% confidence interval (CI): 0.410-0.950] and discharge to home (HR: 1.993, 95% CI: 1.026-3.872) as significant risk factors in the group without a history of HF hospitalization. Hemoglobin (HR: 0.896, 95% CI: 0.802-0.997, per 1 g/dL increase) and estimated glomerular filtration rate (e-GFR) levels (HR: 0.987, 95% CI: 0.976-0.998, per 1 mL/min/1.73 m2 increase) were significant risk factors in the group with a history of HF hospitalization. CONCLUSION:In older patients without a history of HF hospitalization, the absence of a beta-blocker prescription at discharge and direct discharge to home were risk factors for 1-year HF readmission. Lower hemoglobin and e-GFR levels were predictive of readmission in patients with a history of HF hospitalization.
Hepatic cyst, left external inguinal hernia, and type-A aortic dissection in an apparently healthy 51-year-old man with untreated hypertension and a history of surgery for right inguinal hernia in preschool age are herein reported. When multiple structural lesions coexist, a possible shared connective-tissue vulnerability should be considered.
Renal arteriovenous fistula (RAVF) is a rare vascular anomaly, and it becomes exceedingly uncommon when accompanied by a renal vein aneurysm (RVA). While several cases of renal artery aneurysm (RAA) accompanied by RAVF have been sporadically reported, progression from RAA to RAVF and then to RVA has not been previously documented. We present a unique case of a 75-year-old man with chronic kidney disease and hypertension who had a huge RAA and RVA connected by a RAVF. Contrast-enhanced computed tomography revealed an aneurysmal dilation of both the renal artery and renal vein, connected by a high-flow fistulous tract. Given the high risk of rupture and the patient's frailty and comorbidities, endovascular treatment was selected as the initial management strategy. Coil embolization of the renal artery aneurysm was successfully performed, and an aortic extender was deployed using a chimney technique to preserve contralateral renal perfusion. Postoperative imaging demonstrated successful occlusion of the RAA and significant reduction in blood flow through the fistula. During the 3-year follow-up, no enhancement was observed in the RAA, and slight reductions in the size of both the RAA and RVA were noted. To our knowledge, this is the first reported case of a huge RAA and RVA connected by a non-aneurysmal RAVF successfully treated with endovascular therapy, with documented long-term outcomes. This case underscores the feasibility and safety of endovascular intervention in select high-risk patients, even in anatomically complex lesions with high-flow dynamics. As device technology continues to evolve, endovascular repair may increasingly become a first-line option for managing such rare and challenging vascular anomalies.
