ABSTRACT
A 58-year-old woman presented with gangrene of the left upper arm stump caused by an arteriovenous malformation originating from the subclavian artery. She had been treated unsuccessfully in the past with repeated attempts of coil embolization and débridement, but finally she underwent arm amputation. A 14 mm diameter occlusion self-expandable stent was placed in the left subclavian artery via ipsilateral brachial artery access, with immediate and complete interruption of arterial supply to the vascular malformation. This minimally invasive treatment provides an alternative method of management of arteriovenous malformations in the subclavian region.
Subject(s)
Arteriovenous Malformations/therapy , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Stents , Subclavian Artery/abnormalities , Upper Extremity/blood supply , Amputation, Surgical , Angiography, Digital Subtraction , Arteriovenous Malformations/diagnostic imaging , Female , Humans , Middle Aged , Prosthesis Design , Subclavian Artery/diagnostic imaging , Treatment OutcomeABSTRACT
End-stage renal diabetic patients undergoing dialysis through an arteriovenous graft (AVG) often present with multiple graft complications which demand a combined therapeutic approach. We report a case of a male suffering from a pseudoaneurysm and venous outflow stenosis of his thigh AVG, as well as from critical limb ischemia caused by multiple significant stenoses of the femoropopliteal arterial segment. The patient was managed in a single session with a combination of classic open surgical and endovascular techniques in order to treat his aneurysm, salvage the AVG and to revascularize his leg. This case illustrates the prospect of combining classic open surgical and endovascular techniques for the optimal management of complicated AVGs. Using the hybrid approach in these cases one can succeed in optimizing the result, while simultaneously minimizing the overall risk for the patient.
Subject(s)
Aneurysm, False/surgery , Arterial Occlusive Diseases/surgery , Arteriovenous Shunt, Surgical/adverse effects , Blood Vessel Prosthesis Implantation/adverse effects , Graft Occlusion, Vascular/surgery , Ischemia/surgery , Lower Extremity/blood supply , Vascular Surgical Procedures , Aged , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Angiography, Digital Subtraction , Angioplasty/instrumentation , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/etiology , Constriction, Pathologic , Endarterectomy , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/etiology , Humans , Ischemia/diagnostic imaging , Ischemia/etiology , Kidney Failure, Chronic/therapy , Male , Renal Dialysis , Reoperation , Stents , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Infolding of an aortic endograft, usually characterized as endograft collapse, is a quite rare complication reported to occur mainly in thoracic aortic grafts. This report presents a case of an early proximal collapse of an endoprosthesis in an abdominal aortic aneurysm. The complication was diagnosed during the first month of follow-up and was not associated with any endoleak. It was treated with the deployment of a proximal endograft cuff with suprarenal fixation. Endograft collapse may complicate endovascular repair of the abdominal aorta in rare situations. Upon diagnosis of the problem, endovascular repair of graft collapse seems to be feasible.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Prosthesis Failure , Aged , Aortography , Humans , Male , Prosthesis Design , Reoperation , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Surgical management of coexisting severe coronary artery disease and large or symptomatic abdominal aortic aneurysm may be required in patients who are unsuitable candidates for minimally invasive interventions. Although several options have been proposed, the optimal timing to deal with both entities, in order to achieve the best outcome, is still debatable. This report presents a modified approach based on a two-stage treatment in a single anesthetic session.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Coronary Artery Disease/surgery , Vascular Surgical Procedures , Aortic Aneurysm, Abdominal/complications , Coronary Artery Bypass , Coronary Artery Disease/complications , Humans , Male , Middle AgedABSTRACT
BACKGROUND: The aim of this study was to investigate pancreatic injury after 45 min of thoracoabdominal aortic occlusion in a porcine model. METHODS: Twenty-four pigs were used. Six pigs underwent sham operation and 18 intravascular balloon thoracoabdominal aortic occlusions for 45 min. The animals were randomly killed at 12, 48 and 120 h after reperfusion. After killing, all pancreata were examined macroscopically for any signs of acute pancreatitis, whereas gland specimens were harvested for histological study to evaluate pancreatic injury (haematoxylin and eosin staining) and acinar cell apoptosis (Terminal deoxynucleotidyl transferase mediated dUTP Nick-End Labelling staining). RESULTS: Pancreatic injury severity score was mildly increased in terms of oedematous features at 12 h after reperfusion, but normalized to sham levels by the second day and thereafter. Necrotic injury was not statistically significant at any time point. Acinar cell apoptotic index was mildly increased at 12 and 48 h, but showed a tendency to decrease towards sham levels by the fifth day. One animal developed acute pancreatitis. CONCLUSION: Acute pancreatitis is unlikely to occur after 45 min of thoracoabdominal aortic occlusion. However, an early, mild oedematous and apoptotic injury that occurs subclinically seems to be a constant event. This injury might have clinical significance when combined with pre-existent pancreatic pathologies.
