A unique case of thrombosed giant popliteal aneurysm.

We report a unique case of a giant, thrombosed, and ruptured popliteal aneurysm measuring 13.8 cm x 14.0 cm x 14.0 cm in a 93-year-old man. The patient is a hypertensive smoker with asymptomatic swelling behind the knee for several years who developed pain in the swelling with ecchymosis for 2 weeks before presentation. Despite rupture of the aneurysm, this patient exhibited no ischemic symptoms. The patient underwent emergency surgery in which most of the aneurysmal sac was excised and because of satisfactory collateral circulation, the proximal and distal popliteal artery was suture-ligated. Remarkably, the patient did not require a bypass graft and at follow up is pain-free and ambulating with no clinical signs or symptoms of ischemia. This case is unique in several ways: (1) to our knowledge, this is the largest popliteal aneurysm compared with any case that has been documented in the literature, (2) this is also the oldest reported age ever associated with a popliteal aneurysm, and (3) exclusion suture ligation proximally and distally has resulted in an exceptional outcome.

Repair of a mycotic aneurysm of the infrarenal aorta in a patient with HIV, using a Palmaz stent and autologous femoral vein graft.

With the widespread use of endovascular surgery, aneurysms can be managed selectively with the use of stent grafts. Standard treatment of mycotic aneurysms usually requires resection and extraanatomic bypass. Although stent graft repair of a mycotic femoral aneurysm with autologous graft has been reported, we present a case of an infrarenal mycotic aneurysm in a patient with the human immunodeficiency virus (HIV) that was successfully treated with a novel endovascular approach.

Management of carotid body paragangliomas and review of a 30-year experience.

Carotid body tumors are rare neoplasms and must be considered in the evaluation of all lateral neck masses; early surgical removal has been recommended. In this study, the medical records of 29 patients with 34 carotid body paragangliomas who were treated at our institution between 1971 and 2001 were retrospectively reviewed. An overview is provided of this lesion, including diagnosis, classification, metastatic potential, possible secretory function, operative techniques, and nonsurgical methods of management. Carotid body tumors may be familial and are more often bilateral in these instances; five patients (17%) had bilateral tumors in this series. The criterion for malignancy is demonstrated by metastatic tumor in lymph nodes or distant organs. Three patients (10%) had malignant tumors, one with hepatic metastases. One patient (3%) in our series exhibited abnormal serotonin production. Vascular reconstruction was necessary in eight cases (28%). No stroke occurred, however, two arterial thromboses (7%), five permanent cranial nerve deficits (17%), and one death (3%) from massive pulmonary embolism were seen. Our experience demonstrates that early operative management is warranted to avoid the possibility of eventual metastasis and progressive local invasion to the point of inoperability.

Prospective evaluation of endoluminal venous stents in the treatment of the May-Thurner syndrome.

The May-Thurner syndrome is an acquired stenosis of the left common iliac vein causing pain, edema, or deep venous thrombosis (DVT). The patency and behavior of endoluminal venous stents for this condition was evaluated in this study. Patients with the May-Thurner lesion treated with endoluminal stenting from 1997 to 2000 were evaluated according to an institutional review board-approved protocol. Wallstents (n = 14) or Smart stents (n = 1) were placed into the left common iliac. Patency was evaluated with duplex ultrasonography using a 5 mHz linear array probe (HP 4500) at 6-month intervals. Our results showed that treatment of the May-Thurner syndrome with endoluminal stenting is associated with low morbidity and high patency rates. Longitudinal evaluation of this group of patients is ongoing to confirm these findings.