Introduction: Superficial venous thrombophlebitis (SVT) may have potential morbidity as a consequence of extension to the deep venous system and subsequent pulmonary embolism. Report: A 72-year-old male with several varicose veins consulted because of right leg radicular pain. An electromyography was performed. After 24 hours the patient developed severe pain in the right calf with erythema on the medial aspect. A diagnosis of SVT was made. Discussion: The need for invasive studies, such as an electromyography, in patients with varicose veins should be carefully considered to minimise the possibility of this potential ‘major’ complication. Superficial Venous Thrombophlebitis Following ElectromyographyEJVES ExtraVol. 27Issue 2PreviewSuperficial venous thrombophlebitis (SVT) may have potential morbidity as a consequence of extension to the deep venous system and subsequent pulmonary embolism. Full-Text PDF Open Access
Introduction: Pyoderma gangrenosum is a rare cause of ulceration that may be confused with post-operative wound infection. Report: A 74-year-old man presented with a painful ulcer after long saphenous vein harvesting. On examination, a 7 × 5 cm ulcer was noted overlying the distal end of the wound. The ulcer had a patchy necrotic base and well-demarcated violet edges with surrounding erythematous, indurated skin. Review of the clinical history revealed previous delayed wound healing. The diagnosis of pyoderma gangrenosum was confirmed by histological analysis. Discussion: This case highlights the importance of the pre-operative medical history in identifying patients at risk of pyoderma gangrenosum. A Case of Pyoderma Gangrenosum After Long Saphenous Vein HarvestingEJVES ExtraVol. 27Issue 2PreviewPyoderma gangrenosum is a rare cause of ulceration that may be confused with post-operative wound infection. Full-Text PDF Open Access
Introduction: Lumbar arteries are a common cause of type 2 endoleaks. Standard transarterial embolisation and direct aneurysm sac puncture techniques are well described, but technical success of the former is frequently limited by tortuous and small communicating vessels, precluding microcatheter advancement into the endoleak nidus. Report: We describe a technique of successful lumbar endoleak nidus embolisation from a remote arterial location with low viscosity Onyx, despite inability to physically catheterise the endoleak nidus. Discussion: Onyx is a versatile embolic agent, and in conjunction with our described technique, should increase the technical success rates of these procedures. Technical Note: “Remote” Transarterial Embolisation Technique of Lumbar Artery Type 2 Endoleaks with OnyxEJVES ExtraVol. 27Issue 4PreviewLumbar arteries are a common cause of type 2 endoleaks. Standard transarterial embolisation and direct aneurysm sac puncture techniques are well described, but technical success of the former is frequently limited by tortuous and small communicating vessels, precluding microcatheter advancement into the endoleak nidus. Full-Text PDF Open Access
Introduction: Intimal angiosarcoma of the carotid artery is extremely rare. Report: We report the case of a 77-year-old-man who presented with a 2-month history of a right-lateral cervical mass and paralysis of cranial nerves with a chronic occlusion of the carotid artery. The patient underwent en-bloc tumour resection. Diagnosis was made using immunohistochemical testing: tumour cells were positive for CD31, vimentin, and CD68 (in this case), and negative for CD34 and cytokeratin. Discussion: Even after successful removal of the tumour and adjuvant therapy, prognosis is poor. Intimal Angiosarcoma of the Carotid ArteryEJVES ExtraVol. 27Issue 2PreviewIntimal angiosarcoma of the carotid artery is extremely rare. Full-Text PDF Open Access
Introduction: Aortoduodenal syndrome is exceedingly rare and characterized by duodenal obstruction from a large abdominal aortic aneurysm. Traditionally, treatment is by open aneurysm repair, aneurysmorraphy, and duodenal release. This approach carries a significant mortality. Endovascular aneurysm repair has not been used before in this condition as it was felt that the duodenal obstruction would still require surgical decompression. Report: We report two patients with aortoduodenal syndrome successfully treated by endovascular stent graft alone. Discussion: The pathophysiology of this syndrome is reviewed and a new hypothesis of a dynamic element in aortoduodenal syndrome presented. Endovascular Management of Aortoduodenal Syndrome: A Novel Treatment for a Rare ConditionEJVES ExtraVol. 27Issue 3PreviewAortoduodenal syndrome is exceedingly rare and characterized by duodenal obstruction from a large abdominal aortic aneurysm. Traditionally, treatment is by open aneurysm repair, aneurysmorraphy, and duodenal release. This approach carries a significant mortality. Endovascular aneurysm repair has not been used before in this condition as it was felt that the duodenal obstruction would still require surgical decompression. Full-Text PDF Open Access
There is no evidence on which to base the ideal technique for the treatment of aorto-enteric fistulas (AEFs). A 54-year-old man presented with an AEF. He had previously undergone aortobifemoral bypass with an end-to-side proximal anastomosis. An Endurant II aorto-uni-iliac endograft and a Complete SE stent soaked in rifampicin were implanted. After 12 hours, a second staged intervention was performed. The original graft was removed and the communication with the duodenum was repaired. A staged combination of endovascular repair for acute bleeding control and open surgical treatment, combined with systemic and local antibiotics might be considered the option of choice.
Introduction: Occipital artery pseudoaneurysm is an extremely rare complication of head trauma with fewer than 15 reported cases in the literature. Report: A 91-year-old man presented with a pulsatile, bleeding occipital mass 4 weeks following a fall. A clinical diagnosis of occipital artery pseudoaneurysm was made. The lesion was treated with surgery under local anaesthetic without complication. Discussion: Occipital artery pseudoaneurysm following trauma can be diagnosed clinically or radiologically. Proposed treatments include conservative management, surgery, or endovascular treatment. In our case we made a clinical diagnosis and found surgery under local anaesthetic to be a very effective treatment. Occipital Artery Pseudoaneurysm: A Rare Complication of Head TraumaEJVES ExtraVol. 27Issue 4PreviewOccipital artery pseudoaneurysm is an extremely rare complication of head trauma with fewer than 15 reported cases in the literature. Full-Text PDF Open Access
Intravenous leiomyomatosis is a rare, life-threatening intravenous tumor associated with uterine leiomyomata. This report describes the case of a 45-year-old woman with a history of weakness and exertional dyspnea, and an extensive intracaval mass extending to the right side of the heart. The tumor was successfully removed in a two-stage surgical procedure with an inferior vena cava (IVC) filter deployed before the second stage. An extensive DVT was observed postoperatively. Surgical removal is the only effective treatment for intravenous leiomyomatosis, and the rate of recurrence remains unclear. An IVC filter should be placed routinely to prevent postoperative or late (in case of recurrence) pulmonary embolism.
There are few reports in the literature of gastroepiploic artery aneurysm (GEAA). Therefore, there are still no established guidelines for its management. A 55-year-old woman presented to the emergency department with abdominal pain. Computed tomography revealed a large hematoma around the stomach with contrast extravasation at the right GEAA. An emergency laparoscopic aneurysmectomy was performed. We report our experience of successful laparoscopic aneurysmectomy for a ruptured GEAA.
Introduction: Aortoduodenal syndrome is exceedingly rare and characterized by duodenal obstruction from a large abdominal aortic aneurysm.Traditionally, treatment is by open aneurysm repair, aneurysmorraphy, and duodenal release.This approach carries a significant mortality.Endovascular aneurysm repair has not been used before in this condition as it was felt that the duodenal obstruction would still require surgical decompression.Report: We report two patients with aortoduodenal syndrome successfully treated by endovascular stent graft alone.
Spinal cord ischaemia (SCI) is a devastating complication of endovascular abdominal aortic aneurysm repair (EVAR), with a reported incidence of 0.2%. Interventions for SCI are largely derived from thoracic and thoracoabdominal aortic repairs. We report a case of acute neurological injury complicating an EVAR that was altered by spinal drain insertion and removal. This case highlights the need for appropriate consent of EVAR patients and the early utilisation of a spinal drain in the management of SCI.
Thermal ablation is increasingly being used for the treatment of varicose veins. We report a novel use of thermal ablation. We report a patient who presented with showers of pulmonary emboli arising in an area of superficial thrombophlebitis in varicose veins of the left leg. The patient underwent urgent endovenous radiofrequency thermal ablation of the patent segment of the great saphenous vein in order to obliterate the origin of the pulmonary embolizati. There was rapid resolution of symptoms. Endovenous ablation of the great saphenous vein has not been used before for the treatment of this condition.
Clinical manifestations of hypertrophic bifurcated distal biceps tendons are rarely described. We report the first known case of brachial arterial entrapment resulting from this unusual anatomical variable. A 24-year-old gentleman presented with positional upper limb ischaemic symptoms. Initial investigation was unremarkable. Operative exposure of the ante-cubital fossa revealed compression of the brachial artery by a hypertrophic bifurcated distal biceps tendon. Partial division of the tendon led to resolution of symptoms. In challenging cases of upper limb ischaemia surgical, intervention may be justified for both diagnostic and therapeutic purposes.
An endovascular solution to treating type IIIa endoleaks with component misalignment is presented. A 68-year-old male presented with an enlarging 10 cm left common iliac artery aneurysm due to a type IIIa endoleak. Component gaps were successfully bridged by relining the left iliac circuit with new limbs deployed over a brachiofemoral pull-through wire. Type IIIa endoleaks may be not straightforward to repair if limb components are misaligned. A planned pullthrough wire allows for component re-alignment and successful treatment of this complication.
Bartonella spp. is a highly unusual cause of mycotic aneurysms. We describe the first case of an infected aortic aneurysm secondary to Bartonella henselae endocarditis in an immunocompromised patient. A 72-year-old woman presented with severe left lower quadrant pain. Computed tomography angiography showed an infrarenal mycotic aneurysm, and transoesophageal echocardiogram revealed aortic valve vegetation. Serology confirmed the presence of B. henselae endocarditis. Given the patient's comorbidities, the aneurysm was successfully treated by endovascular repair and antibiotic therapy. Endovascular stent-grafting is an alternative treatment option for mycotic aneurysms in high-risk patients who are unsuitable for open repair.
Introduction: We report an extremely rare case of rapid progressive calcification in the vascular prosthesis after aortobiiliac bypass surgery. Report: A 56-year-old man presented to our institution with bilateral intermittent claudication. We performed aortobiiliac bypass with a gelatin-coated woven bifurcated graft. One and a half years later, the patient complained of recurrence of intermittent claudication, and abdominal computed tomography scan showed a localized severely calcified stenosis in the right leg of the vascular prosthesis. Discussion: Few reports have been published on when, where, and how graft occlusion occurs. Physicians and surgeons should be aware of the possibility of such a condition after bypass procedures. Rapid Progressive Graft Calcification After Aortobiiliac BypassEJVES ExtraVol. 27Issue 2PreviewWe report an extremely rare case of rapid progressive calcification in the vascular prosthesis after aortobiiliac bypass surgery. Full-Text PDF Open Access
Introduction: Dural venous sinus thrombosis (DVST) is a rare but potentially fatal cerebrovascular condition. Pregnant women are at greater risk of DVST because of their hypercoagulable state. Report: A 20-year-old post-partum woman presented to the emergency department after an episode of seizure and complained only of a headache and chest pain. A T1-weighted magnetic resonance (MR) image of her brain with contrast revealed an empty delta sign in her super sagittal sinus. Discussion: Management of dural venous sinus thrombosis during or after pregnancy is a difficult issue that requires an approach based on the individual patient profile. Management of Dural Venous Sinus Thrombosis in PregnancyEJVES ExtraVol. 27Issue 5PreviewDural venous sinus thrombosis (DVST) is a rare but potentially fatal cerebrovascular condition. Pregnant women are at greater risk of DVST because of their hypercoagulable state. Full-Text PDF Open Access
For critical limb ischemia patients, although presence of below-the-ankle (BTA) disease is an independent predictor of major amputation, recanalization techniques for BTA disease have not been standardized. We report a case of successful Endovascular therapy (EVT) using transcollateral retrograde approach for a BTA occlusive lesion. EVT for BTA disease is challenging. When the antegrade approach fails, pedal or metatarsal puncture is one of the options for retrograde wiring. However, these vessels are sometimes not suitable candidates for the puncture. In such situations, a trans-collateral retrograde approach is one of the optional techniques for below the ankle recanalization.
INTRODUCTION:Chronic mesenteric ischemia (CMI) is a challenging problem, with revascularization the mainstay of treatment. Management of CMI is especially challenging in the patient with superior mesenteric artery (SMA) and celiac artery (CA) occlusions. REPORT:We report a case series of four patients with chronic mesenteric ischemia who were not candidates for CA or SMA revascularization who were successfully treated with inferior mesenteric artery (IMA) angioplasty and stent placement to improve collateral circulation and palliate symptoms. DISCUSSION:To our knowledge, this is the largest case series to date reporting the use of an IMA stent to improve collateral circulation in patients with CMI.
Bilateral superficial femoral artery aneurysms are a rare entity, managed here via a synchronous endovascular approach. An 84-year-old male presented with bilateral peri-anastomotic superficial femoral artery aneurysms 3 years after femoropopliteal bypass for bilateral popliteal aneurysms. He underwent successful synchronous bilateral endobypass using overlapped 13 × 100 mm (proximal) and 11 × 100 mm (distal) heparin-bonded endoprostheses. Calibre mismatch between ectatic vessel and narrower vein graft may be related to peri-anastomotic aneurysm formation in a patient who has a predilection for aneurysm formation. Bilateral superficial femoral artery aneurysms can be managed by synchronous endobypass with the attendant benefits of avoiding repeat admission/anaesthetic episodes.
