Ulnar artery aneurysms (UAAs) are rare vascular lesions, most commonly associated with repetitive hand trauma and hypothenar hammer syndrome. Simultaneous involvement of both the ulnar and radial arteries is exceptionally uncommon. We report the case of a 61-year-old female patient with a true distal UAA in the dominant hand and concomitant ipsilateral radial artery occlusion, possibly associated with prolonged occupational repetitive trauma from sewing machine use. The patient presented with a progressively enlarging pulsatile wrist mass and sensory symptoms in the ulnar nerve distribution. Computed tomography angiography demonstrated a fusiform UAA and complete radial artery occlusion. Because the ulnar artery represented the only patent major arterial inflow to the hand, aneurysm excision and direct end-to-end spatulated reconstruction were performed under local anesthesia. At 2-year follow-up, the patient remained asymptomatic, with a patent reconstruction and preserved hand perfusion. This case highlights the importance of arterial reconstruction in dual-vessel disease.
Intentional celiac artery (CA) coverage during thoracic endovascular aortic repair (TEVAR) may be required to achieve an adequate distal landing zone; however, this strategy remains controversial owing to concerns regarding visceral ischemia, particularly in patients with infective native aortic aneurysms with compromised physiology and hostile anatomy. We retrospectively reviewed three patients who underwent TEVAR with planned CA coverage after angiographic assessment of collateral circulation using balloon occlusion testing and selective superior mesenteric artery angiography, with CA embolization. All patients demonstrated robust collateral perfusion, underwent CA embolization, and subsequently TEVAR with intentional CA coverage. One patient developed a type Ib endoleak on surveillance imaging without sac expansion. No hepatic, gastric, or splenic ischemic events occurred during follow-up. This case series suggests that intentional CA coverage may be feasible in carefully selected patients when guided by meticulous collateral assessment, offering a pragmatic option in urgent or anatomically constrained settings.
Complete endograft occlusion involving the main body and both limbs after endovascular aneurysm repair (EVAR) is rare, and the optimal treatment remains unclear. We report an 85-year-old male with late complete endograft occlusion after EVAR for an abdominal aortic aneurysm. Computed tomography (CT) showed complete thrombotic occlusion extending from just below the renal arteries to both iliac limbs and distally to the level of the external iliac arteries. A hybrid procedure was performed. After proximal recanalization under right renal artery protection, thrombectomy was performed through the left groin. Next, unilateral endograft relining was carried out using Ovation iX limbs, followed by femoro-femoral bypass. Postoperative CT confirmed patency of the relined limb, femoro-femoral bypass, and left external iliac artery reconstruction, with preserved bilateral renal perfusion. The ankle-brachial index improved from 0.58/0.49 to 0.95/0.88. Hybrid revascularization based on unilateral inflow reconstruction may be an effective option for selected patients with this rare complication.
Chronic peri-aortic inflammation after endovascular aneurysm repair (EVAR) is rare and may reflect sterile postoperative inflammation, immune-mediated periaortitis, or graft-associated infection. Differentiating between these entities is challenging but essential for appropriate management. An 84-year-old male with prior infrarenal EVAR in 2005 presented with persistent inflammation and peri-aortic fluid collection, initially considered immune-mediated periaortitis based on a partial response to corticosteroids. Computed tomography (CT) showed progressive enlargement of the lesion, and contrast-enhanced ultrasound demonstrated early arterial enhancement within it, supporting an active inflammatory process. Two CT-guided peri-aortic sampling yielded Listeria monocytogenes, confirming localized graft-associated infection despite negative blood cultures. The patient was treated with intravenous ampicillin for 6 weeks, followed by oral trimethoprim-sulfamethoxazole for 2 months, which led to clinical and radiological improvement. This case highlights the diagnostic value of invasive sampling and the potential role of targeted antimicrobial therapy with close imaging surveillance in selected high-risk patients with localized infection.
