Floating thoracic aortic thrombus are rare but carry high risk of systemic embolization. We report a 58-year-old hypertensive smoker with one week of abdominal pain. Computed tomography angiography (CTA) revealed a floating thrombus measuring 13 × 3 cm in the descending thoracic aorta, extending up to 1 cm above the celiac trunk, complicated by distal embolization to the celiac trunk and splenic artery resulting in splenic infarction. She underwent thoracic endovascular repair guided by intravascular ultrasound. To prevent further distal embolization, superior mesenteric artery balloon occlusion and bilateral femoral clamping were employed as adjunctive protection strategies. The thrombus was completely excluded without complications; she remained asymptomatic at 14 months of follow-up. IVUS-guided TEVAR with visceral protection is safe and effective for large floating aortic thrombus.
Adventitial cystic disease rarely affects high-performance female athletes or causes suspected nerve compression. A 45-year-old professional pickleball player developed disabling exertional calf claudication, toe paresthesia, and weakness despite palpable resting pulses. Imaging demonstrated circumferential popliteal artery cysts and the scimitar sign. The involved segment was resected posteriorly and reconstructed with reversed contralateral great saphenous vein. Pathology confirmed cystic adventitial disease. Postoperative neuropraxia resolved within five weeks. At 14 months, the graft remained patent without stenosis and unrestricted activity had resumed. Extensive symptomatic disease may warrant posterior resection and vein reconstruction, with counseling regarding temporary neuropraxia.
A functional, pain free below the knee amputation (BKA) has been proven to be effective for a patient to maintain independent ambulation. Following an ankle disarticulation or guillotine transtibial amputation for source control in the two-stage approach, the BKA with targeted muscle reinnervation (TMR) has been shown to decrease phantom limb pain and allow functional ambulation. Here we describe our algorithm, operative technique, perioperative management, and indications on the final stage in the two-stage approach to the BKA for the nonsalvageable extremity. Level of evidence IV.
Separation of modular aortic endograft components resulting in a type IIIa endoleak is a rare and life-threatening complication of endovascular aneurysm repair (EVAR). Herein is reported a case of spontaneous type IIIa endoleak causing rupture of a right common iliac aneurysm in an 88-year-old man years after EVAR, identified during a rapid response called for hypotension while hospitalized for an unrelated condition. The patient was successfully managed with urgent endovascular reintervention without post-operative complication.
May-Thurner syndrome is a recognized cause of iliac vein thrombosis, but its role in recurrent distal deep vein thrombosis (DVT) is less well-defined. This case report describes a 28-year-old man with recurrent femoropopliteal DVT despite anticoagulation, found to have severe non-thrombotic iliac vein compression. He underwent iliac vein stenting with complete symptom resolution and no recurrence over 6 years, allowing discontinuation of anticoagulation. This case highlights the potential role of iliac vein outflow obstruction in recurrent distal DVT and suggests that stenting may improve outcomes in selected patients.
