•Brachial artery mycotic aneurysm (BAMA) secondary to infective endocarditis.•Only case reported to be caused by haematogenous spread of Enterococcus faecalis.•BAMAs are rare and can be potentially limb or life threatening.•One must acknowledge bacterial endocarditis as a cause of BAMA.•Prompt diagnosis and intervention are essential for good outcomes.
•Iatrogenic aortic injuries during non-aortic related procedures are rare.•Such injuries can be catastrophic.•Most reported injuries involve orthopaedic hardware from spine surgery.•This is a case of thoracostomy tube placement leading to acute aortic injury.•Endovascular aortic endografts have simplified treatment of acute aortic injuries.
An 82 year old male presented eight years after left popliteal endovascular aneurysm repair (PEVAR) for a 58 mm popliteal artery aneurysm (PAA) using 10 mm Viabahn endoprostheses (WL Gore and Associates, Flagstaff, USA). He had undergone prior contralateral bypass for chronic limb threatening ischaemia due to an occluded PAA in 2010 (patent). He took up cycling after this, resulting in multiple redo PEVAR episodes to treat migration (2011, stent graft extension) and fracture (2014, relined), with eventual graft failure and fractures with no endoleak noted (Fig. 1), diagnosed when he presented with left calf pain (deep vein thrombosis excluded). Throughout there was continued PAA shrinkage (currently 47 mm). As there was now new PAA formation distal to the distal landing zone of the stent graft, this was treated with a reversed great saphenous vein bypass graft which remains patent at six months. This report indicates that PEVAR endografts can be maintained for a reasonably long time despite repeated complications.
Post-endarterectomy pseudoaneurysms (PEPA) are a rare complication of carotid endarterectomy (CEA), but are associated with high morbidity risk. Therefore, once they are diagnosed, treatment is urgent to prevent possible complications such as rupture, embolisation, thrombosis, or airway and cranial nerve compression. In this video, the surgical procedure is shown in a case of PEPA 10 years after CEA with patch angioplasty, which was successfully managed by surgical excision and interposition of great saphenous vein graft. Follow up duplex examination at six months was normal, with patency of the vein graft. This case reiterates the importance of open surgery as the treatment of choice for this difficult clinical setting.
We read the commentary from Alric and Canaud1Alric P. Canaud L. Is chimney EVAR an acceptable endovascular technique?.EJVES Short Rep. 2019; 42: 43https://doi.org/10.1016/j.ejvssr.2019.01.001Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar regarding our case of a symptomatic patient unfit for open repair symptomatic with persistent gutter related type Ia endoleak after chimney endovascular aneurysm repair (ch-EVAR).2Ballesteros-Pomar M. Taneva G.T. Austermann M. Fernández-Samos R. Torsello G. Donas K.P. Successful management of a type B gutter related endoleak after chimney EVAR by coil assisted onyx embolisation.EJVES Short Rep. 2019; 42: 38-42https://doi.org/10.1016/j.ejvssr.2018.12.002Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar The goal of our case presentation was to provide information about possible solutions for suboptimal performance, as a lesson learned after 10 years of clinical experience and treatment of more than 250 cases by ch-EVAR.3Donas K.P. Lee J.T. Lachat M. Torsello G. Veith F.J. Dalman R.L. et al.Collected world experience about the performance of the snorkel/chimney endovascular technique in the treatment of complex aortic pathologies: the PERICLES registry.Ann Surg. 2015; 262: 546-552https://doi.org/10.1097/SLA.0000000000001405Crossref PubMed Scopus (221) Google Scholar, 4Donas K.P. Torsello G.B. Piccoli G. Pitoulias G.A. Torsello G.F. Bisdas T. et al.The PROTAGORAS study to evaluate the performance of the Endurant stent graft for patients with pararenal pathologic processes treated by the chimney/snorkel endovascular technique.J Vasc Surg. 2016; 63: 1-7https://doi.org/10.1016/j.jvs.2015.07.080Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar As the authors published when they reported on the role of physician modified endografts “to break the rules you must first master them.”5Canaud L. Gandet T. Ozdemir B.A. Sfeir J. Alric P. Commentary: physician-modified thoracic stent-graft: to break the rules you must first master them.J Endovasc Ther. 2018; 25: 464-465https://doi.org/10.1177/1526602818779394Crossref PubMed Scopus (1) Google Scholar And, in this context, we believe that presentation of successful management of challenging cases with persistent post-operative flow to the aneurysm sack is of particular importance, having as a sustained goal of optimising the outcome in favour of the patient. The authors are wondering whether ch-EVAR is in general, an alternative option. The answer could be very easily given from recommendation 97 of the European Society for Vascular Surgery (ESVS)'s newest guidelines regarding juxtarenal aneurysms.6Wanhainen A. Verzini F. Herzeele I Van Allaire E. Bown M. Cohnert T. et al.European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms.Eur J Vasc Endovasc Surg 2019. 2018; https://doi.org/10.1016/j.ejvs.2018.09.020Abstract Full Text Full Text PDF Scopus (1165) Google Scholar It is stated that ch-EVAR can be considered as an alternative option when fenestrated endografting (f-EVAR) is not indicated or not available. The level of evidence (C) is the same as for f-EVAR,6Wanhainen A. Verzini F. Herzeele I Van Allaire E. Bown M. Cohnert T. et al.European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms.Eur J Vasc Endovasc Surg 2019. 2018; https://doi.org/10.1016/j.ejvs.2018.09.020Abstract Full Text Full Text PDF Scopus (1165) Google Scholar and our case is in full alignment with this recommendation. There is no evidence in the new guidelines supporting other alternative therapies rather than chimney grafts as the authors of the commentary suggested. In summary, the use of chimney grafts is no longer a matter of faith but a fact. The evidence in the literature supports its complementary role for the treatment of juxtarenal aneurysms and in agreement with that the ongoing ENCHANT Study as a fully prospective multicentre trial of ch-EVAR (clinicaltrials.gov identifier: NCT03320252) will provide further evidence bringing the technique to a higher level of evidence (B) than f-EVAR (C). Do we want to keep looking at the tree and not the forest?
•Popliteal access for percutaneous management of deep vein thrombosis may require the patient to be supine.•A technique of puncturing the popliteal vein in the supine position is proposed.•Popliteal access was performed successfully in eight patients.•Complete recanalisation of occluded vein segments was achieved successfully.•Veins and stents were patent on duplex ultrasound at the six month follow up.
•Metastatic carcinoma can spread far, appearing years later and in unusual locations/forms.•Arteriovenous malformation mimicking vascular tumour 10 years after renal cell carcinoma (RCC).•Later confirmed after surgical removal to be metastatic RCC.•Biopsy is mandatory in any new lesion appearing even years after a primary cancer.•A high index of suspicion must be maintained during follow up of RCC.
•Isolated spontaneous superior mesenteric artery (SMA) dissecting aneurysm is rare.•SMA dissecting aneurysm is life-threatening.•SMA dissecting aneurysm was previously usually treated by open or hybrid approach.•Management of SMA dissecting aneurysm with pure endovascular approach is effective.
•Progress has been made in recent years in understanding the process of abdominal aortic aneurysm progression and rupture.•It remains unclear why giant abdominal aortic aneurysms continue to grow without rupturing.•Open repair seems to be the treatment of choice for most giant aneurysms, both ruptured and unruptured.
•About 40 cases of spontaneous rupture of the aorta have been described to date.•The idiopathic form is rare and there are few reports in the literature.•The reported case demonstrates that symptoms may be non-specific and indolent.•The endovascular technique was safe and resolved the patient's symptoms.
•In children, idiopathic, true popliteal aneurysms are a rare clinical entity, with only three cases reported previously.•Surgical options are limited; femoral popliteal bypass was performed with reversed long saphenous vein.•There is minimal good quality data to guide treatment of these presentations in children; management should be undertaken in specialised centres.
•FlowTriever system is recently cleared by FDA for mechanical thrombectomy of pulmonary embolism.•This is the first case of mechanical thrombectomy in the right atrium or ventricle under echocardiography guidance.•The mechanical thrombectomy in the right atrium/ventricle was safe and resolved the patient's symptoms.
•Giant ruptured visceral aneurysm successfully treated endovascularly.•Visceral aneurysms are rare and mostly asymptomatic.•Rupture is associated with high mortality.•Endovascular approach for treatment is fast and safe.•Wide consensus on treatment threshold is lacking.
Introduction: The vascular pathology of patients with type 1 neurofibromatosis (NF-1) is known. Aneurysms of the brachial artery in NF-1 patients are rare and surgical treatment remains a challenge. Report: A patient known to have NF-1 presented with swelling of the left arm. Computed tomography angiography showed a ruptured aneurysm of the brachial artery. Operative reconstruction was performed using reversed saphenous vein. Discussion: Up to now four cases had been published describing brachial aneurysms in NF-1 patients. This case describes the successful reconstruction of a ruptured brachial aneurysm, using a saphenous vein. Keywords: Aneurysm, von Recklinghausen, Neurofibromatosis, Vasculopathy
Introduction: Injury to the popliteal vessels during total knee replacement is rare but can lead to catastrophic outcomes. Report: An 81 year old female presented with Rutherford IIb acute left limb ischaemia (ALI) 13 years after total knee replacement. The polyethylene insert in the knee implant had dislocated from the other components and had moved into the popliteal fossa, leading to popliteal artery compression. She underwent emergency multidisciplinary surgery including removal of the polyethylene component, thrombectomy, and popliteal artery stenting, but major amputation was required. The popliteal artery and the stent were removed and submitted to histological analysis. The stent was well expanded but focal malapposition was observed. Conclusion: Regular follow up is mandatory in order to anticipate malfunction of the prosthesis and avoid long term complications. Keywords: Arthroplasty, Replacement knee, Ischaemia, Amputation, Knee dislocation
Introduction: In patients with popliteal artery aneurysm lacking a suitable vein for bypass, prosthetic graft, or endovascular stent graft are alternative treatment options. However, durability is limited. Construction of an autologous spiral vein graft has previously been used to replace infected aortic grafts and arteriovenous fistulas. Technical summary: Five patients underwent surgery for popliteal arterial aneurysm with the spiral vein graft technique. Technical success was 100%. Operative technique and results are reported. Conclusion: The spiral vein graft technique can be used for popliteal artery aneurysm with good short term results, avoiding use of prosthetic grafts. Keywords: Popliteal artery aneurysm, spiral vein graft, posterior approach
•C3 Excluder enables repositioning of both level and rotational orientation.•Ipsilateral leg twist can occur from rotational reorientation of the C3 Excluder.•Ipsilateral leg twist should be checked carefully during EVAR.
•Peri-aortitis is a rare complication after endovascular aortic aneurysm repair.•Peri-aortitis commonly presents with abdominal pain or ureteric obstruction.•Peri-aortitis can be diagnosed with positron emission tomography-computed tomography and labelled white cell scan.•Peri-aortitis can be treated appropriately with oral steroids.
•Internal carotid artery aneurysms are rare.•Higher incidence is noted in patients with connective tissue disorders.•Open repair with primary end to end closure or vein interposition graft are feasible options.•Surveillance is required in connective tissue disorders patients to monitor for recurrence.
•Aortic dissection in a patient with previous endovascular aneurysm repair is rare.•Anatomic, device, and procedure factors could be the cause of this situation.•Type B dissections could lead to collapse of the graft, sac growth, and rupture.•Aggressive treatment must be considered to prevent serious complications.
