Severely calcified carotid arteries have been excluded from all prior clinical trials evaluating transfemoral and transcarotid artery stenting. The objective of this study was to evaluate the effects of carotid calcification on 1-year carotid duplex ultrasound findings in routine clinical practice after transcarotid artery revascularization (TCAR). All patients who underwent TCAR from 2017 to 2019 at two institutions were identified. All patients who underwent TCAR had their preoperative computed tomography angiography study independently retrospectively reviewed and graded by a blinded radiologist based on severity of calcification circumference and thickness. Patients were divided into high-risk groups on the basis of the computed tomography angiography findings. High-risk groups were broken down into three groups: those with >75% calcification circumference but <3-mm thickness; those with <75% calcification circumference but >3-mm thickness; and those with >75% calcification circumference and >3-mm thickness. The primary end point was peak systolic velocity, end-diastolic velocity, and internal carotid artery to common carotid artery ratio at 1 year. Secondary end points were transient ischemic attack, stroke, and reintervention at 1 year. During the study period, 75 patients underwent TCAR. We identified 11 patients who had >75% circumferential calcification but <3-mm calcification thickness, 7 patients with <75% circumferential calcification but >3-mm calcification thickness, and 7 patients who were believed to be at highest risk for restenosis or stent compression who had >75% circumferential calcification and >3-mm calcification thickness. All other patients were considered to have low calcific plaque burden. The primary end points of peak systolic velocity, end-diastolic velocity, and internal carotid artery to common carotid artery ratio were compared between all groups. At 1 year, there was no statistically significant difference in patients with high calcific plaque burden and those with low calcific plaque burden. Secondary end point analysis also showed no difference in stroke, transient ischemic attack, or secondary intervention. The effects of carotid calcification on long-term duplex ultrasound findings after TCAR are unknown. Further long-term studies need to be performed to evaluate these effects on duplex ultrasound and restenosis now that TCAR is being performed in routine clinical practice. Early initial findings suggest that TCAR is effective, safe, and durable even in severe calcium diseases.

Whereas systemic to portal shunts have been reported in the literature, their existence and consequences come to mind less frequently than the more common portal to systemic counterpart. Congenital and acquired obstructions within normally high flow central systemic veins are increasingly being discovered in both symptomatic and asymptomatic patients because of the widespread use of cross-sectional imaging. The diagnosis can be easily missed in favor of a more common explanation of symptoms, overlooking the potential contribution of venous hypertension to the patient’s complaints.

Vessel patency and complications of retrievable inferior vena cava (IVC) filters have not been studied. This is a comprehensive review of the literature initiated by the case of a patient. This is a case report and comprehensive literature review. A 50-year-old man with a complicated medical history underwent successful gastric bypass surgery in 2004. He developed an intracranial aneurysm requiring clipping in 2010 and then a posterior cerebral artery dissection in 2014 and associated hydrocephalus. A retrievable IVC filter was placed for temporary indications in 2014 but was not removed until 2016. The IVC was patent at the time of filter removal. The patient developed progressively increasing lower extremity edema subsequent to filter removal. He presented with bilateral deep venous thrombosis of the lower extremities and was treated with anticoagulation, which was complicated by a gastrointestinal bleed from a suture line ulcer. IVC filter placement was attempted, but a chronically occluded IVC with collaterals was identified. No long-term studies are available for assessment of caval patency or vessel patency after retrievable IVC filters are removed. Even though the filter is removed, long-term complications can occur. Further research should be conducted as these filters are placed frequently.

As intravascular robotics technology continues to evolve, so do the potential applications. The present case describes the use of the Magellan Robotic System within the pulmonary artery. A 61-year-old female was referred for retrieval of a transected port catheter, which had embolized into the pulmonary artery. After a failed attempt using a conventional technique, retrieval was ultimately successful with assistance of the Magellan system. The unique navigational capabilities and stability of the system may make it a valuable tool in pulmonary artery interventions.