Management and therapeutic options for abdominal aortic aneurysm coexistent with horseshoe kidney.

BACKGROUND: Horseshoe kidney (HSK), referring to the abnormal fusion of the lower renal poles, represents one of the most common renal anomalies. One of its most significant features is the anomalous vasculature, with a number of accessory renal arteries originating from the aorta, the mesenteric arteries, and even the iliac arteries supplying both the renal kidneys and the renal isthmus. METHODS: A literature review was performed to identify and to present the most recent data regarding classification and imaging evaluation of HSK concomitant with abdominal aortic aneurysm (AAA). Furthermore, an in-depth analysis of both open surgical and endovascular repair is made for management of this rare medical condition. RESULTS: The anomalous renal vasculature of HSK has led to the introduction of a number of classification systems, with Eisendrath's being currently the most commonly used. The concomitant presence of HSK in patients suffering from AAA plays a major role in preoperative planning, with a number of factors taken into consideration in deciding on either an open repair or an endovascular approach. Open repair requires careful decision-making between a transperitoneal and a left retroperitoneal approach to reach the aneurysm sac. In addition, technical points include the decision to divide the renal isthmus or not and the necessity of salvage or reimplantation of anomalous renal vessels. On the other hand, an endovascular approach requires careful preoperative imaging and evaluation of both the renal function and vasculature to decide on catheterization and salvage of accessory renal arteries or their exclusion. CONCLUSIONS: The concomitant presence of AAA and HSK poses a challenge for the modern vascular surgeon, who must possess all required technical skills-both endovascular and open repair-to deal accordingly with this rarely encountered medical condition. Preoperative determination of the perfusion pattern is necessary for the treatment strategy.

Primary Stenting of Right-Sided Subclavian Artery Stenosis Presenting as Subclavian Steal Syndrome: Report of 3 Cases and Literature Review.

BACKGROUND: Right-sided subclavian artery stenosis (SAS) is a rare cerebrovascular disease involving the upper extremities. Considering an endovascular approach for its management requires increased endovascular and catheterization skills when compared with the left side, due to the close approximation of the right subclavian artery origin, vertebral, and common carotid arteries. METHODS: Three patients suffering from proximal right-sided SAS were treated in our center through primary stenting. Percutaneous transfemoral and transbrachial approaches were used for vascular access, whereas in 2 cases an additional carotid protection device was deployed intraoperatively. RESULTS: Technical success was met in all 3 cases, with no intraoperative or postoperative complications being observed. All patients resumed ambulation and were uneventfully discharged the next day with dual antiplatelet medication. No recurrent stenosis was reported in duplex ultrasound scan during 6-month follow-up, with all patients reporting resolution of their symptoms. DISCUSSION: Subclavian artery stenosis is an uncommon vascular disease, showing a 4-fold left, rather than right-sided predisposition. Although a low-grade stenosis is usually asymptomatic and may remain unobserved, a severe stenosis may cause retrograde blood flow in the ipsilateral vertebral artery, leading to a medical condition with various clinical symptoms, known as subclavian steal syndrome. A number of open surgical techniques exist for management of subclavian artery stenosis, although a paradigm shift in the 21st century has led to the introduction of minimally invasive techniques for its treatment, with available modalities including angioplasty, stenting, and the kissing stent technique.

Fenestrated and Branched Stent Grafting in Complex Aneurysmatic Aortic Disease: A Single-Center Early Experience.

BACKGROUND: The aim of this study is to present our early experience and highlight the technical difficulties associated with the use of fenestrated and branched stent grafts to treat patients with juxtarenal abdominal aortic aneurysm (AAA), pararenal AAA, and thoracoabdominal aortic aneurysms (TAAAs). METHODS: A prospectively held database maintained at our department was queried for patients who have undergone branched and fenestrated stent grafting for AAA or TAAA treatment. Indication for repair, comorbidity precluding open repair, technical challenges associated with the repair, as well as operative mortality, morbidity, and reintervention rate were evaluated. RESULTS: A total of 8 patients underwent repair with a fenestrated or branched stent graft. All patients had aneurysmal degeneration of the juxtarenal aorta, pararenal aorta, and thoracoabdominal aorta not suitable to standard endovascular techniques. Two patients had a prior aortic repair, a failed migrated stent graft, and an old surgical tube graft after an open repair. One patient had a type III TAAA and 1 patient had a postdissection TAAA type I. For all patients, target vessel success rate was 96.4% (27/28) and mean hospital stay was 6.0 days (range 3-21). Thirty-day and 1-year mortality were 0%. Mean follow-up was 23 months (range 7-45). Two endoleaks occurred, 1 type III and 1 type II, which were treated endovascularly. No death or major complication occurred during follow-up. CONCLUSIONS: Fenestrated and branched endovascular stent grafts can be used to repair juxtarenal AAA, pararenal AAA, and TAAA in patients with significant comorbidities. However, several technical challenges have to be overcome due to the unique complex aortic pathology of each patient.

Synchronous occurrence of breast cancer and pulmonary sclerosing hemangioma: management and review of the literature.

Pulmonary sclerosing hemangioma (PSH) is a rare tumor accounting for 0.2-1% of all primary lung tumors. Simultaneous occurrence of PSH with breast cancer has very rarely been reported in the literature. We describe here a case of simultaneous occurrence of PSH with breast cancer. A pathological diagnosis of PSH was confirmed by computed tomography (CT)-guided biopsy. Due to the patient's poor performance status and the benign nature of PSH, surgical excision was not considered and the patient was managed conservatively with regular follow-up. Although surgical excision is the preferred treatment for PSH, conservative management may be a reasonable option in carefully selected patients.

Radial artery angioplasty after perforation during diagnostic cardiac catheterisation.

The use of the radial artery as an access site for diagnostic and interventional cardiac procedures has been extensively developed in recent years as a result of reduced complications at puncture site, reduced costs and the improvement in the patients' quality of life. The complications of trans-radial procedures are rarely major and very rarely life threatening--a key benefit of the radial approach. We describe the case of a patient who underwent percutaneous radial artery angioplasty, because of perforation caused during diagnostic cardiac catheterisation, in order to complete the catheterisation procedure before the patient proceeded to endovascular treatment of a sub-renal abdominal aortic aneurysm.

Preoperative diagnosis of obscure gastrointestinal bleeding due to a GIST of the jejunum: a case report.

Gastrointestinal stromal tumours are rare mesenchymal neoplasms affecting the digestive tract or nearby structures within the abdomen. We present a case of a 66-year-old female patient who presented with obscure anemia due to gastrointestinal bleeding and underwent exploratory laparotomy during which a large gastrointestinal stromal tumour of the small intestine was discovered. Examining the preoperative results of video capsule endoscopy, computed tomography, and angiography and comparing them with the operative findings we discuss which of these investigations plays the most important role in the detection and localization of gastrointestinal stromal tumours. A sort review of the literature is also conducted on these rare mesenchymal tumours.

Preoperative diagnosis of obscure gastrointestinal bleeding due to a GIST of the jejunum: a case report.

Gastrointestinal stromal tumours (GISTs) are rare mesenchymal neoplasms affecting the digestive tract or nearby structures within the abdomen. We present a case of a 66-year-old female patient who presented with obscure anemia due to gastrointestinal bleeding and underwent exploratory laparotomy during which a large GIST of the small intestine was discovered. Examining the preoperative results of video capsule endoscopy, computed tomography, and angiography and comparing them with the operative findings we discuss which of these investigations plays the most important role in the detection and localization of GIST. A sort review of the literature is also conducted on these rare mesenchymal tumours.