Syphilitic Popliteal Pseudoaneurysm Complicated by Acute Lower-Limb Ischemia.

Case presentation: We present a case of a patient with a syphilitic popliteal pseudoaneurysm who developed acute lower-limb ischemia secondary to thromboembolism related to the pseudoaneurysm. The diagnosis of a syphilitic popliteal aneurysm was made due to positive syphilitic serological testing and with exclusion of all other potential causes. The pseudoaneurysm was surgically repaired using a great saphenous vein patch angioplasty, which was done without delay to prevent further thromboembolic complications. This was then followed by a course of intravenous benzyl penicillin. Discussion: Peripheral arterial involvement of tertiary syphilis remains exceedingly rare, with the vast majority of reported cases of vascular syphilis relating to aortic involvement. Given the paucity of literature on this condition, there is no good evidence to guide current management. Conclusion: With the globally increasing rates of syphilis, more cases of peripheral arterial involvement may become apparent, as was the case in the early 20th century.

Management of primary mycotic aneurysms and prosthetic graft infections: an 8-year experience with in-situ cryopreserved allograft reconstruction.

BACKGROUND: Primary mycotic aneurysms and prosthetic graft infections are traditionally managed by resection of infected vascular tissue and revascularisation with an extra-anatomical bypass. Long-term patency for this method has been reported to be poor with associated high reinfection and limb amputation rates. The aim of this study was to analyse the outcomes of those patients in our department between 2010 and 2018 whom had revascularisation with in-situ arterial reconstruction using cryopreserved allograft as a conduit. METHODS: The data were retrospectively reviewed and 13 patients were identified. There were five patients with primary mycotic aneurysms and eight patients with prosthetic graft infections, three of which were complicated by aortoenteric fistulae (AEF). RESULTS: There were three peri-operative mortalities (23%) with all three mortalities related to graft re-infection and post-implantation haemorrhage; two of these from uncontrolled bile leaks related to the original AEF with persistent graft contamination. The 10 surviving patients were followed up for a mean duration of 15.8 months with an overall primary graft patency of 89% and no incidence of graft re-infection or aneurysmal degeneration. CONCLUSION: Patients that survived the peri-operative period demonstrated acceptable medium-term allograft durability, with the most favourable outcomes observed in those patients who had arterial infections uncomplicated by AEF. The main barrier to more wide-spread use in our state remains inadequate supply of banked cryopreserved tissue.

Outcomes of covered expandable stents for the treatment of TASC D aorto-iliac occlusive lesions.

INTRODUCTION: Aortoiliac arterial occlusive disease is frequently encountered in the management of lower limb vascular insufficiency. We report our experience with covered balloon-expandable stents for treatment of TASC D lesions of the abdominal aorta and common iliac arteries. METHODS: A retrospective study of 30 patients who underwent aortoiliac stenting with the Atrium Advanta V12 from March 2010 to September 2012 was conducted. Patient demographic data, clinical signs and symptoms and procedural details were recorded. Outcomes assessed were primary patency, secondary patency, technical success, complications, limb salvage and survival. RESULTS: Median age was 67 years (range 48-84) and 40% of patients underwent treatment for critical limb ischaemia. Median follow-up was 13 months (range 3-38 months). Stent configuration comprised of long iliac stents in 20 patients, a large diameter aortic stent with iliac stenting in six patients, and aortic stent alone in four patients. Radiological success was achieved in 100% and the complication rate was 6%. Primary patency at 6, 12 and 24 months was 97%, 90% and 79%, respectively. Four cases of in-stent stenosis were reported, with three of these undergoing re-interventions resulting in a secondary patency rate of 97% at the end of follow-up. One patient death occurred within the follow-up period. DISCUSSION: This case series demonstrates that treatment of complex aortoiliac occlusive disease with covered balloon-expandable stents can have acceptable results with good patency and good clinical outcome. Secondary patency rates are comparable to open surgical revascularisation, with lower morbidity.

Intraoperative salvage of a renal artery occlusion during fenestrated stent grafting.

A 79-year-old man with a 6-cm juxtarenal abdominal aortic aneurysm was treated by endovascular means with a fenestrated stent graft. The completion angiogram revealed a left renal artery occlusion. A retroperitoneal surgical approach allowed for retrograde catheterization of the occluded covered stent through the left renal artery. The covered stent was reopened by balloon angioplasty. After 2 months, the left renal artery was patent and renal function normal. At 6 months, both renal arteries were fully open on duplex imaging. The open retroperitoneal approach with retrograde catheterization is a bailout technique to avoid loss of a kidney in fenestrated stent grafting.

The iliac bifurcation device for endovascular iliac aneurysm repair: indications, deployment options and results at 1-year follow-up of 25 cases.

BACKGROUND: The iliac bifurcation device (William A Cook Australia, Brisbane, QLD, Australia) is a new endovascular device for iliac aneurysm repair. We review the indications for use, device characteristics, deployment options and the results of our case series. METHODS: The most common indication for deployment is endovascular aortic aneurysm repair (EVAR) with common iliac aneurysm repair. The standard deployment sequence can be adapted to increase the utility of the device. Data were collected prospectively. Follow-up was performed with plain X-ray, ultrasound and computed tomography (CT) scan. RESULTS: Between 2004 and 2007, 25 patients had their common iliac artery aneurysm repaired using the iliac bifurcation device. There were 23 male and 2 female patients. Median age was 75 years (range 60-85). The median follow-up was 12 months (range 1-38). Twenty-one procedures were combined with EVAR. The median abdominal aortic aneurysm diameter was 60 mm (range 31-97), and the median common iliac artery aneurysm diameter was 37 mm (range 24-71). Technical success was achieved in 100% of cases. There were no acute branch vessel occlusions. There was one early type I endoleak (4%). There was one death (4%) in the 30-day period post-procedure. There was one late type I endoleak (4%). CONCLUSIONS: The iliac bifurcation device achieves endovascular common iliac artery aneurysm repair with preservation of internal iliac artery flow. There are multiple different applications of the device and complementary deployment techniques. High rates of technical success and low rates of branch vessel occlusion are possible.

Inhaled NO and markers of oxidant injury in infants with respiratory failure.

BACKGROUND: Inhaled nitric oxide (iNO) is an effective adjunct in the treatment of infants with respiratory failure. Although there are clear benefits to this therapy, potential toxicity could result from reactive nitrosylated species. OBJECTIVE: To evaluate whether iNO therapy is associated with increased serum markers of oxidative stress. DESIGN/METHOD: Multiple markers were prospectively evaluated in the serum of term infants with severe respiratory failure treated with iNO for 1 to 72 hours. These were compared to those of patients exposed to greater than 80% oxygen for more than 6 hours and room air controls. RESULTS: After 24 hours of exposure, the iNO-treated infants had increased serum lipid hydroperoxides (LPO), protein carbonyls and nitrotyrosine residues as well as increased serum total glutathione (GSH) content. The increase in LPO peaked at 24 hours and correlated with the cumulative dose of iNO whereas other markers did not. The presence of chronic lung disease (CLD) did not correlate with serum markers of oxidative injury. CONCLUSIONS: In term infants with respiratory failure, prolonged iNO exposure is associated with a transient increase in markers of oxidative stress, but this finding does not appear to predict the development of CLD.