Metal in motion: a case report of inferior vena cava filter migration.

Background: Inferior vena cava (IVC) filter migration, particularly to the heart, is a rare complication. Small metal fragments may be inadequately characterized on transthoracic echocardiography and may be missed entirely on chest radiograph. Managing the adverse outcomes of IVC filters is a formidable challenge as retrieval carries the risk of arrhythmia, right ventricular perforation, and damage to the tricuspid valve. Case summary: A woman in her fifties underwent routine computed tomography (CT) calcium score screening and was found to have a metallic fragment in the right ventricle of her heart. Subsequent contrast enhanced, ECG-gated cardiac CTA was completed and images were reconstructed to yield cine images on syngo.via (Siemens, Erlangen, Germany) and vitrea workstation (version: 6.6.3; Vital, Toshiba Medical Systems) to guide heart team discussion and clinical management. Discussion: Our case illustrates the benefit of CTA with cineography in characterizing the location, size, and extent of fragment involvement within the myocardium. Moreover, this case serves as a reminder to medical professionals to carefully consider IVC filter placement in the appropriate patient, remain vigilant regarding potential complications, and to aspire follow-up of removable filters.

Endovascular management of an iatrogenic injury to the supra-aortic trunk after attempted central venous catheter placement.

We have presented the successful endovascular management of an injury to the proximal left common carotid artery following attempted cannulation of the right internal jugular vein in a critically ill patient with multisystem organ failure secondary to infection with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2).

Preliminary Experience With the Human Acellular Vessel: A Descriptive Case Series Detailing Early Use of a Bioengineered Blood Vessel for Arterial Repair.

BACKGROUND: An infection-resistant, immediately available conduit for trauma and urgent vascular reconstruction remains a critical need for successful limb salvage. While autologous vein remains the gold standard, vein-limited patients and size mismatch are common issues. The Human Acellular Vessel (HAV) (Humacyte, Inc., Durham, NC) is a bioengineered conduit with off-the-shelf availability and resistance to infection, ideal characteristics for patients with challenging revascularization scenarios. This report describes HAV implantation in patients with complex limb-threatening ischemia and limited conduit options who may have otherwise faced limb loss. METHODS: The Food and Drug Administration (FDA) expanded-access program was used to allow urgent implantation of the HAV for arterial reconstruction. Electronic medical records were reviewed with extraction of relevant data including patient demographics, surgical implantation, patency, infectious complications, and mortality. RESULTS: The HAV was implanted in 8 patients requiring vascular reconstruction. Graft or soft tissue infection was present in 2 patients. One patient with severe penetrating pelvic injury had 4 HAV placed to repair bilateral external iliac artery and vein injuries. There was 1 technical failure due to poor outflow, 2 patients died unrelated to HAV use, and 5 lower extremity bypasses maintained patency at an average of 11.4 months (range: 4-20 months). No HAV infectious complications were identified. CONCLUSIONS: This report is the first United States series describing early outcomes using the HAV under the FDA expanded-access program for urgent vascular reconstruction. The HAV demonstrates resistance to infection, reliable patency, and offers surgeons an immediate option when confronted with complex revascularization scenarios. Assessment of long-term outcomes will be important for future studies.

Endovascular management of penetrating and non-penetrating aortic injury.

Aortic trauma is a devastating injury often associated with significant polytrauma. Penetrating injury of the aorta is highly lethal and therefore rarely encountered in the hospital setting. The management of blunt trauma of the aorta has changed significantly over the past decade, principally due to improved imaging technology and the development of endovascular therapy. The most common site of injury is the proximal descending thoracic aorta. The degree of aortic wall injury guides the indication for therapy, while a combination of the degree of injury and the extent of co-morbid injuries drives the timing of repair. Lower grade injuries frequently do not require any surgical intervention. Thoracic aortic endograft repair can be performed in a safe, expeditious fashion. Short-term and mid-term outcomes appear excellent, with patient survival based mainly on concomitant traumatic injuries. Long-term outcomes are less well known. Future endeavors will be guided toward gaining a better understanding of the indications for repair and the long-term outcomes for endograft devices designed for this purpose.