Open Thrombectomy for Acute Abdominal Aortic Occlusion Due to Tumor Embolism after Lung Resection.

Arterial tumor embolization is a rare but often catastrophic complication of lung resection for malignancy. This case describes tumor embolization to the abdominal aorta in a patient with metastatic sarcoma. After partial pneumonectomy he developed acute kidney injury, bilateral lower limb ischemia and spinal cord ischemia. Computed tomography angiogram demonstrated complete occlusion of the paravisceral aorta. Perfusion was restored with open thromboembolectomies of the abdominal aorta, superior mesenteric artery and bilateral lower limbs. For perioperative lung cancer patients with acute arterial occlusion intraluminal tumor should be considered and thereby an open approach to revascularisation adopted.

A Binational Need Assessment to Define the Level of Endovascular Expertise Required by Vascular Surgical Trainees.

BACKGROUND: There has been a shift toward competency-based surgical education programs to improve trainee performance and achieve better patient outcomes. Endovascular procedures comprise a significant volume of vascular surgery, but the current methods for assessing the endovascular competence of vascular trainees in Australia and New Zealand are suboptimal. The objective of this study was to perform a need assessment to define the scope of endovascular expertise required by vascular surgical trainees to later aid in the development of novel surgical training assessment tools. METHODS: A modified Delphi method was used to achieve expert consensus. Fifty-three key stakeholders in vascular surgical education and training (SET) in Australia and New Zealand were invited to take part in the 2-stage survey. Experts were asked which procedures they considered to be requisite for vascular surgery trainees and at which SET level competence should be achieved. The results were reiterated to the expert panel in the second stage, and consensus considered achieved if over 75% of experts were in agreement. RESULTS: In the first stage 25 experts reached consensus that competence in 18 of the 26 procedures should be requisite for SET trainees. Twenty-two experts responded to the second stage and consensus was achieved for 12 out of 14 of the procedural items with mean percentage of experts in agreement being 90%. CONCLUSIONS: A need assessment using a modified Delphi method has achieved consensus among experts in vascular surgery regarding the endovascular procedures considered to be requisite for vascular surgery trainees in Australia and New Zealand.

Endovascular treatment of critical lower limb ischemia caused by giant cell arteritis.

Giant cell arteritis (GCA) is a well-known cause of cranial vasculitis often presenting with headache and jaw claudication. Here we report the case of a woman suffering GCA who presented with critical lower limb ischemia. Despite best medical therapy, she developed progressive calf claudication and ulceration of the right foot. The findings on workup were highly suggestive of GCA involving the superficial femoral artery. The limb was successfully revascularized with angioplasty and placement of a drug-eluting stent. GCA is an important cause of lower limb ischemia and should be considered in patients without evidence of atherosclerosis. Endovascular intervention is a feasible treatment of critical limb ischemia due to GCA and has been shown to be safe in this case.