Acute hypersensitivity reaction to femoral drug-coated balloons.

We describe a case of an acute hypersensitivity reaction to a paclitaxel-coated balloon used in the peripheral arterial circulation. Clinicians using these products should be aware of this potential risk.

Treatment of aortoiliac aneurysms with the iliac bifurcated device for preservation of internal iliac artery flow.

INTRODUCTION: The iliac bifurcated device (IBD) is an innovative endovascular device for aortoiliac aneurysm repair. The objective of this study is to provide further evidence on the efficacy and safety of the device. STUDY DESIGN: Case series study with retrospective analysis of prospectively collected nonrandomized data. METHODS: Between 2007 and 2010, all consecutive IBD placements were analyzed. The main outcomes included (1) technical failure; (2) morbidity and mortality; and (3) late outcomes. Prospective follow-up was performed by interval computed tomography scanning. RESULTS: In all, 27 consecutive patients had elective placement of 28 IBDs. Mean operating time was 251.1 ± 65.4 minutes, mean fluoroscopy time was 63.9 ± 27.2 minutes, and mean contrast volume used was 186.2 ± 106.7 mL. Periprocedural type I endoleak occurred in 2 patients. No aneurysm-related adverse events were recorded. CONCLUSION: We demonstrate that IBDs can be used in patients with aortoiliac aneurysms and are associated with satisfactory medium-term results as expressed by high patency and low reintervention rates.

Endovascular repair of aortic arch false aneurysm with branched endograft.

This case report describes the use of a customized branched device for the treatment of a distal anastomotic false aneurysm in an ascending to descending interposition graft in a 34-year-old Jehovah's Witness with congenital aortic arch interruption. A single branched customized stent graft device was used to successfully exclude the false aneurysm. The procedure was challenging due to the abnormal congenital anatomy. The planning, operative technique, and successful execution are described in this case report.

The chimney technique in endovascular aortic aneurysm repair: late ruptures after successful single renal chimney stent grafts.

BACKGROUND: The chimney graft technique has been proposed as an alternative endovascular treatment of juxtarenal aortic aneurysms, extending the landing zone and enabling successful exclusion of the aneurysm with standard endograft devices. METHODS: A prospective observational study assigning patients with juxtarenal aortic aneurysm treated with single renal chimney grafts in a tertiary vascular center in the United Kingdom was conducted. Primary outcome endpoints were defined as technical success, perioperative morbidity and mortality, and freedom from any type of endoleak, reintervention, and aneurysm-related death. RESULTS: Nine patients were enrolled. Successful aortic and chimney graft implantation was achieved in all patients. A proximal type I endoleak noticed on completion angiogram was treated with an aortic extension cuff. None of the patients died within 30 days of treatment. Two patients developed a type IA endoleak during follow-up, resulting in aneurysm rupture and death. Both patients had had uneventful chimney procedures, and no endoleak was evident on previous surveillance computed tomographic scans. All chimney grafts remained patent, and none of the patients developed renal impairment during the follow-up period. CONCLUSIONS: Proximal type I endoleak constitutes a weak point of chimney graft interventions. Increased vigilance in surveillance of such patients to prevent late aneurysm-related complications is required. Additional research to identify potential poor prognostic morphologic indicators is expected.

Chimney technique in the endovascular management of complex aortic disease.

The objective of this study was to systematically review the literature reporting on the chimney technique and perform an analysis of the outcomes. A search of electronic databases was undertaken to identify all studies reporting on the outcome of the chimney technique. The selected articles were divided into those reporting on the treatment of aortic pathology involving the visceral and those involving the supra-aortic branches. Twenty-one articles reporting on the treatment of juxta/supra-renal aorta and aortic arch disease in 102 and 37 patients, respectively, were identified. In the visceral group, an overall technical success rate of 91% was achieved, the perioperative major morbidity and mortality rates were 17 and 5%, respectively, and an early type I endoleak developed in 13 patients (13%). During follow-up, one patient died of intestinal ischemia. In the supra-aortic group, the technical success rate was recorded in 95%, and three patients (8%) developed an early type I endoleak. Three patients (13%) required conversion to open surgery during follow-up. In conclusion, this technique may be viewed as a complementary technique in high-surgical-risk patients.

Arteriovenous fistula failure: is there a role for accessory draining vein embolization?

PURPOSE: Arterio-venous fistulae (AVFs) are accepted as the best form of haemodialysis vascular access (VA) but are plagued by high primary failure. Accessory drainage veins (ADVs) may account for up to 40% of these failures. Furthermore, they may also lead to low flow in 'mature' AVFs. METHODS: We analysed the results of 42 patients who underwent endovascular coiling of ADVs at our centre over a 4-year period. RESULTS: Indications were failure to mature in 34%, low flow or cannulation difficulty in 56% and thrombosis in 10% of cases. 95% procedures involved a combination of angioplasty and coiling with only 5% patients having coiling of ADV alone. Forearm AVFs constituted the majority of the cases as opposed to upper arm AVFs (74% vs. 26% respectively). Primary patency at 3, 6, 12, 18 and 24 months was 90%, 87%, 76%, 70% and 55% respectively. Successful dialysis was achieved in 10 of the 14 fistulae that had hitherto failed to mature. Coil migration was observed in 1 patient, which led to fistula occlusion. CONCLUSION: Coil embolisation of ADVs is an effective treatment option for dysfunctional fistulae that can be performed at the same time as angioplasty.

Multilayer stent in the treatment of popliteal artery aneurysms.

Endovascular repair of popliteal artery aneurysms is an emerging treatment in high risk surgical patients. The location in a functionally demanding anatomical area creates limitations in terms of endograft patency. Technological advancements have been conscripted in an effort to circumvent such constraints. The multilayer stent technology effects through haemodynamic modulation. We used the multilayer stent to treat 6 asymptomatic popliteal artery aneurysms in 3 patients. All procedures were successfully accomplished without any complications. Over a mean follow up period of 9 months, thrombosis occurred in two limbs, and blood flow was restored with thrombolysis, achieving a primary and secondary patency rate at 6 months of 67 % and 100 %, respectively. Partial or complete thrombosis of the aneurysm sac was achieved in all aneurysms. Even though the use of the multilayer stent in popliteal artery aneurysms was safe in the short term, our experience showed that close surveillance is required.

Endovascular repair of complex aortic aneurysms.

Since the first published report of a fenestrated endovascular aneurysm repair, we have seen an expansion in the range of custom-made devices used to manage complex aortic aneurysms. Fenestrated devices, branched devices, and chimneys are now frequently used in many centers to repair these aneurysms. Similar to standard endovascular aneurysm repair, the advantages of less operative blood loss, decreased hospital stay, and reduced risk of morbidity and mortality hold true for endovascular repair of complex aneurysms as well. This is contrasted by the requirement for long-term surveillance and increased incidence of secondary interventions.

A ruptured thoracoabdominal aortic aneurysm managed endovascularly using the telescoping chimney technique.

Extending the proximal landing zone to facilitate endovascular repair of aortic aneurysms with short proximal necks using the chimney, top-fenestration, or snorkel technique has been previously reported. In addition, extending the distal landing zone using the periscope technique has also been recently described. In this study, we used an extended chimney technique, the "telescoping technique," to successfully treat a ruptured Crawford type III thoracoabdominal aortic aneurysm in a patient with pre-existing renal failure and an occluded superior mesenteric artery.

Rupture of an abdominal aortic aneurysm post EVAR: a rare presentation of retroperitoneal liposarcoma.

Endoleak is the classical cause of rupture of aneurysms previously treated by endovascular means. We report a rare case of a retroperitoneal liposarcoma (LIS) invading an abdominal aortic aneurysm (AAA), previously treated by endovascular repair (EVAR), causing rupture. Furthermore, a brief discussion of the diagnostic challenges posed by retroperitoneal tumors is presented with a closing note on their management.

Pseudoachalasia of the esophagus caused by encapsulating peritoneal sclerosis.

Encapsulating peritoneal sclerosis is a severe complication of peritoneal dialysis. Progressive sclerotic thickening of the peritoneum results in tethering and cocooning of the bowel, leading to chronic bowel obstruction, malabsorption, malnutrition, and high mortality. Conservative treatment is often unsuccessful and a surgical enterolysis is required for management. Pseudoachalasia is a rare condition that mimics the clinical and radiological features of achalasia of the cardia. Pseudoachalasia is most commonly caused by infiltrating or metastasizing cancers. In this report, we present a case of pseudoachalasia associated with encapsulating peritoneal sclerosis. The clinical symptoms settled after peritonectomy and enterolysis.

Endovascular repair of aorto-bi-iliac aneurysm.

Iliac bifurcated devices (IBDs) are used in the endovascular treatment of aorto-iliac and common iliac artery aneurysms to preserve the flow to at least one internal iliac artery thereby decreasing the risk of pelvic ischemic complications. We report the use of IBDs in preserving both the internal iliac arteries.

Abdominal aortic aneurysm repair: The carotid approach.

We present the case of a 61-year-old man with a 5.8 cm infrarenal aortic aneurysm with extensive iliac disease that did not permit conventional EVAR, who was also judged to be too high risk for open surgery. Despite these factors, the aneurysm was still successfully repaired using endovascular means and an alternative access technique. This involved a specially commissioned Zenith aorto-uniliac endograft reverse mounted onto a TX2 delivery device, delivered via the carotid artery.

Pseudoaneurysms occurring as a result of fractures giving rise to the appearance of pseudotumors: a short series.

Pseudoaneurysms are focal enlargements of the vascular lumen due to partial or complete disruption of the arterial wall. These are an uncommon complication of fractures. The presence of a pseudoaneurysm adjacent to a fracture fragment can cause a pressure effect. This pressure not only impairs fracture healing but sometimes can erode the adjacent bone, producing the appearance of a pseudotumor. We present two such cases and discuss the management of these patients.