Outcomes of Elective Endovascular Aneurysmal Repair for Abdominal Aortic Aneurysms in Jordan

PURPOSE: The outcomes of endovascular aneurysmal repair (EVAR) for infrarenal abdominal aortic aneurysms (AAAs) in the Middle East have rarely been reported. We analyzed the outcomes of EVAR in a Jordanian population.MATERIALS AND METHODS: We conducted a retrospective review of the medical records of patients with infrarenal AAA who were treated with elective EVAR between January 2004 and January 2017 at a single center in Jordan. Patient characteristics, anatomical characteristics, procedural details, and early and late postoperative outcomes were analyzed.RESULTS: A total of 288 patients (mean age, 70 years; 77.8% males) underwent EVAR for infrarenal AAA (median aneurysm size, 64 mm). Bifurcated endografts were used in 265 patients, and aorto-uni-iliac devices were used in 22 patients. Successful endograft deployment was achieved in all patients with no open conversion. Early complications included localized groin hematoma in 15, femoral artery dissection in 4, wound infection in 3, and seroma in 3 patients. With a mean follow-up of 60 months, 50 endoleaks were detected, including 9 type I, 38 type II, and 3 type III. Seven patients had unilateral graft limb occlusion. The 30-day mortality was 1.7%, and long-term mortality was 7.0%, mostly due to non-AAA-related causes.CONCLUSION: EVAR was safely performed in Jordanian patients with minimal complications. However, long-term surveillance is important due to the risk of endoleaks and consequent intervention.

Ruptured Suprarenal Abdominal Aortic Pseudoaneurysm with Superior Mesenteric and Celiac Arteries Occlusion, Revealing Behçet’s Disease: A Case Report

Behçet’s disease (BD) is a multisystemic, chronic autoimmune inflammatory vasculitic disease with an unknown etiology. Although the literature reports that vascular involvement occurs in 7% to 38% of all BD cases, the arteries are rarely involved; however, arterial involvement is usually associated with significant mortality and morbidity. We report the case of a young female patient who presented to the emergency department with severe abdominal pain and a history of weight loss. The patient was evaluated using computed tomography angiography, which revealed a ruptured suprarenal aortic pseudoaneurysm with occlusion of both the superior mesenteric and celiac arteries. Urgent surgery was performed with aortic repair with an interposition graft and superior mesenteric artery embolectomy. The patient’s clinical history and radiological imaging findings were strongly suggestive of the diagnosis of BD with vascular involvement.

Carotid body tumors: 16 years experience at the Jordanian Royal Medical Services

Of all the paragangliomas in the head and neck, carotid body tumors are the most common. They are rare hyper- vascular neoplastic lesions derived from the neural crest paraganglion cells. In this study, we present our 16 years experience in dealing with this neoplasm. The medical records of 33 patients with 37 surgically treated carotid body tumors between the year 1993 and 2009 at the Vascular Unit of Queen Alia Military Hospital and King Hussein Medical Center were retrospectively reviewed. Twenty patients were females and 13 were males. The mean age was 46 years. All the patients presented with a painless neck mass that was investigated by duplex ultrasound, CT angiogram and arteriography. Two patients had hoarseness of voice and dyspnea, one had dysphagia and one had vertigo. Complete surgical excision was performed in all the patients with close follow-up in respect to complications, recurrence and behavior of the tumor. According to Shamblin Classification, 5 tumors were type I, 22 were type II and 10 were type III confirmed intraoperatively. Four patients had bilateral involvement at the time of presentation. Six patients had positive family history of the tumor. After successful surgical resection, a mean follow-up period of 24 months showed a zero mortality rate and no evidence of recurrence. Transient neuropraxia of the facial nerve was noticed in one patient, injury of recurrent laryngeal nerve in another patient while post operative localized hematoma had to be evacuated in two patients. Although rare, carotid body tumor should be kept in mind in the differential diagnosis of anterior triangle neck mass. Complete surgical excision after adequate investigations is the treatment of choice. This is best achieved in a specialized centre with experienced vascular surgeons to get the finest outcome

Ultrasound guided compression therapy for treatment of post catheterization femoral pseudoaneurysms

To assess the efficacy of ultrasound guided compression therapy for the treatment of post catheterization femoral pseudoaneurysms. A retrospective review of 21 patients who underwent ultrasound guided compression for treatment of post catheterization pseudoaneurysm at King Hussein Medical Center / Vascular unit between February 2009 and March 2010 was conducted. Fifteen patients were males and 6 were females with mean age of 62 years. Eight patients had diagnostic catheterization while 13 had interventional cardiac procedures. All patients were diagnosed using Duplex scan and were treated with compression. Analysis of the results, efficacy and safety of the ultrasound guided compression treatment modality were discussed. Successful pseudoaneurysm compression was obtained in 16 patients [76%] whereas 5 patients failed compression and underwent surgical repair. Pseudoaneurysm size ranged between 2.0 -4.5 cm. The mean compression time to accomplish closure was 25 minutes. Two patients required more than one session to get a successful result. Pseudoaneurysm involved the common femoral artery in 8 patients while in 13 patients the origin was distal to the femoral artery bifurcation. All patients were followed up one week after successful compression procedure by a new Duplex scan with no recurrence of pseudoaneurysm and no arterial or venous complications were reported. Ultrasound guided compression for the treatment of post catheterization pseudoaneurysm is an effective alternative to surgical repair. It is non invasive and safe modality with high success rate and low complications. It should be considered as a first line of management of uncomplicated femoral pseudoaneurysms

Infragenicular bypass procedure for critical lower limb ischemia

To assess the outcome of infragenicular arterial revascularization for lower limb salvage in critical isehemia. A retrospective analysis was conducted on 33 patients who underwent infragenicular bypass procedure for critical limb isehemia at Queen Alia Military Hospital/Vascular Unit between the years 2002 and 2004. Twenty seven patients were males and 6 were females with a mean age of 63 years. Rest pain and gangrene were the presentation in most of the patients. Twenty two patients were diabetics. Long saphenons vein was used for the bypass in 3M patients. Analysis of the graft patency, limb salvage and patient survival was considered. The early patency rate within the first 30 days was 64%. At 12 and 24 months, the patency was 47% and 39% and the limb salvage rate was 51% and 45%, respectively. A total of 14 major limb amputations has been performed, S of which were at above knee level. Three cases of death within the first 6 months were reported due to acute myocardial infarction. Reconstructive procedure should be attempted before considering major limb amputation as long as there is an opportunity of saving a critically ischemic limb. infragenicular revascularization to the tibial and pedal arteries is an effective procedure in limb salvage and improving the quality of patient's life