Popliteal Arteriovenous Fistula Following Total Knee Arthroplasty.

Postoperative popliteal arteriovenous fistula is a very rare complication. We report a unique asymptomatic fistula in a 77-year-old male patient, seven months after total knee replacement. The diagnosis was suspected by a clinical palpable thrill and confirmed with a typical doppler ultrasound signaling. This vascular malformation was successfully treated by surgical resection of the fistula. Referring to the literature, considering the management of popliteal aneurysms, we suggest to prefer an open procedure in patients who are in good general condition.

The therapeutic implications of an abdominal aortic aneurysm with coincident horseshoe kidney.

Two male patients were admitted to the department of vascular surgery for treatment of a large infrarenal abdominal aortic aneurysm (AAA) and an associated horseshoe kidney (HSK). Both patients were successfully treated by endovascular aneurysm repair (EVAR). Horseshoe kidney is a rare and complex congenital anomaly, which increases significantly the technical difficulty of conventional surgical repair of an associated AAA. Appropriate preoperative evaluation of the vascular supply of the HSK by CT- angiography and renal function is mandatory for optimal planning of the treatment strategy. EVAR is regarded as a valuable alternative to open surgical therapy, in the absence of renal failure and provided that accessory renal arteries are absent or small.

Floating aortic thrombus: the endovascular approach.

CASE REPORT: We report a 71-year-old obese white female who presented with sudden right calf pain after a long distance flight. Symptoms were initially regarded as venous in origin. Duplex investigation ruled out deep vein thrombosis. Ultimately she presented to our department with complaints of claudication. Clinical evaluation and a new duplex scan showed occlusion of the right popliteal artery. Further evaluation with CT-angiography showed, besides occlusion of the right popliteal artery, a floating thrombus in the infrarenal abdominal aorta. The thrombus was treated with a bare-metal stent placed through a femoral approach. CT-scans at 1 and 3 months demonstrated complete exclusion of the thrombus. The claudication of the right calf resolved spontaneously. Floating thrombus of the infrarenal abdominal aorta is a rare cause of distal arterial embolisation. CT-scan with contrast enhancement is the preferred diagnostic technique. Endovascular repair seems to be the treatment of choice and in our opinion a covered stent is not required. Anticoagulation therapy needs to be guided on an individual patient basis

Endovascular treatment of a chronic contained ruptured abdominal aortic aneurysm.

CASE REPORT: We report a 69-year-old Caucasian male who presented with irreversible ischemia to the left foot. CT-scan showed, besides occlusion of both superficial femoral arteries, a chronic contained rupture of an abdominal aortic aneurysm. The aneurysm was excluded with a stent graft placed through a femoral approach in a semi-urgent procedure. CT-scans at 1, 3 and 6 months demonstrated continued exclusion of the aneurysm. Chronic ruptures are a rare but important subset of ruptured abdominal aortic aneurysms. CT-scan with contrast enhancement is the gold standard diagnosing technique. Treatment consists of prompt surgical intervention with endovascular repair being increasingly used as an alternative to an open surgical approach.