A hybrid approach to persistent sciatic artery fusiform aneurysm repair.

A persistent sciatic artery is a rare vascular anomaly that is prone to early atherosclerotic development and aneurysmal degeneration. Repair of the degenerative aneurysm is critical because it can lead to rupture, thrombosis, distal embolization, and sciatic nerve damage from compression. We report a case of a symptomatic unilateral persistent sciatic artery fusiform aneurysm that was treated using a simultaneous open surgical and endovascular approach. The patient underwent right common femoral to below-knee popliteal artery bypass and percutaneous endovascular embolization of the right sciatic artery aneurysm. Proper surgical intervention determined by the patient's comorbidities and unique anatomy achieved favorable outcomes.

Acute occlusion of aortic endovascular aneurysm repair stent graft with bilateral limb ischemia.

Endovascular aneurysm repair has dramatically changed the management of abdominal aortic aneurysms as an alternative to open repair. However, complications can occur, including stent graft migration, kinking, and occlusion, leading to compromise of the excluded aneurysm walls and acute limb ischemia. In the present report, we have described a case of migration and kinking of an abdominal aortic stent graft in the main body that led to occlusion of the abdominal aorta and bilateral acute limb ischemia. The patient required emergent explantation of the stent graft and open repair of the abdominal aneurysm with a rifampin-soaked Dacron graft, which achieved a favorable outcome.

Red blood cell transfusion requirements for patients on extracorporeal membrane oxygenation.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a rescue procedure used for cardiac and pulmonary dysfunction. Patients on ECMO often require blood transfusions to maintain oxygen delivery and recover from bleeding complications. Goals of the current study were to determine transfusion requirements while on ECMO, and incidence and transfusion requirements for bleeding complications. METHODS: Packed red blood cell (PRBC) transfusions and bleeding complications were identified by retrospective chart review of patients on ECMO from 2010 to 2018 at our institution. Patients were categorized into those who did not bleed (group A) and those who bled (group B). Incidence, sites of bleed, and transfusion requirement for each bleeding were analyzed. RESULTS: Among 217 patients including veno-arterial (VA) (n = 148) and veno-venous (VV) (n = 69) ECMO, we identified 62 patients without bleeding complications (group A) and 155 patients with bleeding complications (group B). In group A, transfusion requirement was 0.6 PRBC/day for VA-ECMO (n = 42) and 0.2 PRBC/day for VV-ECMO (n = 20) (p = 0.0015). In group B, number of PRBC given per event per day for bleeding complications during ECMO was mediastinal/thoracic bleed (83 events, 4.7 PRBC/event/day), gastrointestinal bleed (59 events, 4.8 PRBC/event/day), cannulation site bleed (88 events, 3.6 PRBC/event/day), and nasopharyngeal bleed (103 events, 2.8 PRBC/event/day). Thirty-day hospital mortality rate was co-related to transfusion requirement (area under ROC curve: 0.70). CONCLUSION: Patients without clinical bleeding still required transfusion, with higher rates observed with VA- than VV-ECMO. Transfusion requirements dramatically increased when patients developed various bleeding complications and had a significant impact on 30-day mortality rate.

A multiscale computational model predicts distribution of anti-angiogenic isoform VEGF165b in peripheral arterial disease in human and mouse.

Angiogenesis is the growth of new blood vessels from pre-existing microvessels. Peripheral arterial disease (PAD) is caused by atherosclerosis that results in ischemia mostly in the lower extremities. Clinical trials including VEGF-A administration for therapeutic angiogenesis have not been successful. The existence of anti-angiogenic isoform (VEGF165b) in PAD muscle tissues is a potential cause for the failure of therapeutic angiogenesis. Experimental measurements show that in PAD human muscle biopsies the VEGF165b isoform is at least as abundant if not greater than the VEGF165a isoform. We constructed three-compartment models describing VEGF isoforms and receptors, in human and mouse, to make predictions on the secretion rate of VEGF165b and the distribution of various isoforms throughout the body based on the experimental data. The computational results are consistent with the data showing that in PAD calf muscles secrete mostly VEGF165b over total VEGF. In the PAD calf compartment of human and mouse models, most VEGF165a and VEGF165b are bound to the extracellular matrix. VEGF receptors VEGFR1, VEGFR2 and Neuropilin-1 (NRP1) are mostly in 'Free State'. This study provides a computational model of VEGF165b in PAD supported by experimental measurements of VEGF165b in human and mouse, which gives insight of VEGF165b in therapeutic angiogenesis and VEGF distribution in human and mouse PAD model.

Pelvic actinomycosis confirmed after surgery: single center experience.

PURPOSE: To review pelvic actinomycosis confirmed by surgery and summarize clinical aspects. METHOD: The authors retrospectively reviewed 16 cases that underwent surgical procedures for pelvic actinomycosis between January 1998 and January 2006. RESULTS: Twelve of the cases (75%) had used intrauterine contraceptive devices for a period of between 8 months and 12 years (mean duration: 5.2 years). Most of the cases presented elevated white blood cell count, neutrophil percentage, CRP value and CA 125 value. Four of the eight cases that were checked by computed tomography presented the possibility of pelvic malignancies. All patients underwent surgery. The mean duration of intravenous antibiotics was 11.8 days and that of peroral antibiotics was 4.3 months. After treatment, there were no complications or recurrences, with the exception of one case of preoperative unilateral ureter obliteration. CONCLUSION: In diagnosis of pelvic actinomycosis, it is not necessary to consider whether an intrauterine device was being used or not. To distinguish from pelvic malignancy, various methods (including imaging study) should be considered. As for antibiotic treatment, it is believed that shorter and high dose antibiotics therapy will be sufficient treatment.