An 86-year-old man presented with lumbago and gait disturbance, initially attributed to T12 and L1 vertebral fractures. Contrast-enhanced computed tomography revealed a large left profunda femoris artery aneurysm measuring 56 × 70 mm, ascending aortic dilation, and situs inversus totalis. He underwent open aneurysm resection with revascularization using an autologous great saphenous vein graft. His gait disturbance resolved postoperatively, indicating that femoral nerve compression by the aneurysmal mass, rather than the vertebral fractures, was the cause of his symptoms. True profunda femoris artery aneurysms are rare, and their coexistence with situs inversus totalis is exceedingly uncommon.
We present a case of total endovascular repair using a physician-modified endograft for type A aortic dissection in a patient with a patent vein graft from coronary artery bypass grafting surgery.
A tracheoinnominate fistula (TIF) is an uncommon but lethal complication of tracheostomy that requires rapid intervention to prevent exsanguination. Here, we report the management of a tracheoinnominate fistula using bronchial blockade and endovascular tools to protect the airway, stop bleeding, and stabilize the patient. Twelve days later, repair was performed through a sternotomy with debridement of the injured innominate and reconstruction of the right carotid and subclavian arteries using a rifampin-soaked Dacron graft from the ascending aorta. The tracheal injury was repaired and soft tissue coverage achieved with a thymic flap. The patient recovered without complications and is in good general condition 2 years after the event.
Recurrent popliteal venous aneurysms (PVAs) are exceptionally rare, and their operative management has not been previously described. A 68-year-old man presented with a recurrent 5.2-cm above-knee PVA containing thrombus 6 years after excision and primary lateral venorrhaphy through a medial approach. Prior venous reconstruction and post-thrombotic fibrosis precluded conventional exposures. A lateral approach provided access to the popliteal fossa through undisturbed tissue planes, facilitating aneurysm excision and reconstruction with an 8-mm bovine pericardial patch venoplasty. This paper describes the first reported lateral approach for preoperative above-knee PVA repair.
Endovascular repair for aortocaval fistula remains a critical challenge. An 82-year-old man presented with high-output heart failure due to an abdominal aortic aneurysm with a 7-mm aortocaval fistula. To stabilize the patient, we performed temporary occlusion of the fistula by cannulating it from the venous side and wedging a 12-mm balloon into the fistula. This immediately restored patient hemodynamics. In this controlled state, we achieved precise coil embolization of a patent lumbar artery and successfully deployed an iliac branch endoprosthesis and stent graft. Transvenous balloon wedging of an ACF provides immediate hemodynamic control, allowing essential time to safely perform complex endovascular reconstructions.
