Venous Thromboembolism in a Patient with Interrupted Inferior Vena Cava and Compressed Azygos Continuation: A Case Report and Review of Literature.

We report an unusual case of a 40-year-old male patient who experienced painful swelling of the left lower limb that persisted for 1 week. Imaging modalities not only confirmed the diagnosis of acute iliofemoral venous thrombosis and pulmonary embolism (PE), but also an incidental finding of interrupted inferior vena cava (IVC). This congenital anomaly is uncommon but rarely associated with venous thromboembolism (VTE). The azygos continuation was compressed by the descending aorta against the 11th thoracic vertebrae, which was identified as the cause of VTE. He was treated successfully with anticoagulation and compression therapy. The patient was discharged with lifelong oral Rivaroxaban and remained asymptomatic. In the literature, only 9 cases of interrupted IVC-associated PE were identified but none was due to significant venous compression.

Acute Thrombosis of an Infrarenal Abdominal Aortic Aneurysm Presenting as Bilateral Critical Lower Limb Ischemia.

BACKGROUND: Intraluminal thrombosis in the aneurysm sac is commonly seen in abdominal aortic aneurysm (AAA). Complete acute thrombosis of an AAA is a rare and catastrophic event. METHOD: We report a patient with acute AAA thrombosis presenting as bilateral lower limbs critical ischemia. A79-year-old male with a past history of AAA presented with acute onset of bilateral leg pain, coolness, weakness and numbness. His lower extremity pulses including femorals were absent bilaterally on physical examination. Urgent computed tomography angiography showed an infrarenal AAA measuring 45 mm in diameter. The aneurysm sac and bilateral common iliac arteries were completely occluded. Emergency open repair of AAA and bilateral iliac thrombectomy were successfully performed under general anesthesia. RESULT: Bilateral femoral pulses were present and the neurological deficits were completely resolved after operation. Patient recovered well and was asymptomatic at 3-month follow-up. CONCLUSION: Acute thrombosis of aortic aneurysm could be an unusual cause of lower limb ischemia, prompt diagnosis followed by surgical revascularization is essential to avoid prolonged ischemia.

Predictors of Primary Functional Maturation of Autogenous Radiocephalic Arteriovenous Fistula in a Cohort of Asian Patients.

BACKGROUND: The aim of this study was to investigate the predictors of autogenous radiocephalic arteriovenous fistula (RCAVF) maturation. METHODS: This was a retrospective analysis of patients undergoing RCAVF creation from June 2013 to December 2018 at a single medical center. Comparison of the variables between the matured and nonmatured group was performed. RESULTS: A total of 277 patients (men, 173; 62.5%) with a mean age of 56.6 ± 16.9 years underwent primary RCAVF creation during the study period. The mean diameter of the cephalic vein and radial artery were 2.4 ± 0.6 mm (range 1.5 to 4.3 mm) and 2.3 ± 0.5 mm (range 1.5 to 4.0 mm), respectively. Primary functional maturation was achieved in 236 patients (236/277, 85%). There was no statistical significance between the matured and nonmatured group in terms of age (56.4 ± 14.8 vs. 58.1 ± 15.1, respectively; P = 0.498), coronary arterial disease (12% vs. 17%, respectively; P = 0.449), diabetes mellitus (42% vs. 39%, respectively; P = 0.864), smoking (26% vs. 22%, respectively; P = 0.699), or antiplatelet therapy (23% vs. 24%, respectively; P = 0.844). However, female gender (35% vs. 54%, respectively; P = 0.024), peripheral arterial disease (9% vs. 22%, respectively; P = 0.025), and small vein (2.4 ± 0.5 mm vs. 2.0 ± 0.5 mm, respectively; P < 0.01) and artery (2.4 ± 0.5 vs. 2.1 ± 0.4, respectively; P < 0.01) diameter were associated with the failure of maturation. The best cutoff diameter for the cephalic vein and radial artery was 1.85 mm and 2.05 mm, respectively. CONCLUSIONS: In this cohort of patients undergoing RCAVF creation, vein and artery diameter on preoperative ultrasound mapping was the predictor of functional maturation. Female gender and presence of peripheral arterial disease were associated with failure of maturation.

Prevalence and Predictor of Pulmonary Embolism in a Cohort of Chinese Patients with Acute Proximal Deep Vein Thrombosis.

BACKGROUND: The aim of this study is to investigate the incidence of pulmonary embolism (PE) in a cohort of Chinese patients with acute (<14 days) proximal (above-knee) deep vein thrombosis (DVT) in the lower limbs, and to evaluate whether the location of thrombosis is associated with the existence of PE. METHODS: A retrospective review of patients diagnosed with acute proximal DVT from January 2014 to June 2018 at a single center was performed. Helical computed tomography angiography was performed to screen PE within 48 hr after admission. Multiple factors associated with PE were compared between the PE group and the non-PE group. RESULTS: A total of 100 patients with acute proximal DVT were screened for PE. The mean age was 56.9 ± 18.1 (range 21-88) years, and 55% were male. The most common risk factors of DVT were immobilization (38%), malignancy (27%), and trauma or surgery (21%). Majority of the patients' thrombosis was located at the left leg (66%) and 8 patients had bilateral lower limb DVT. Femoral vein was involved in 52 patients (52%), while iliofemoral thrombosis was identified in 48 patients (48%). PE was identified in 58 patients (58%), including 3 massive and 55 nonmassive PE. There was no statistical difference between the PE group and the non-PE group in terms of age, sex, and risk factors. The D-dimer level was associated with the existence of PE (P = 0.038). Patients with iliofemoral thrombosis had a similar incidence of PE compared with those with femoral thrombosis alone (P = 1.000). CONCLUSIONS: PE occurred in more than half of patients with acute proximal DVT, despite the fact that most of them were asymptomatic. In this study, existence of PE did not correlate with pelvic thrombosis. Increasing D-dimer level was statistically associated with the presence of PE.

Successful Endovascular Aneurysm Repair for Brucella Mycotic Aneurysm Acquired from Ingestion of Sheep Placenta.

An aortic aneurysm infected by Brucella is rarely seen. In this case report, we describe a Brucella mycotic abdominal aortic aneurysm acquired from ingestion of sheep placenta. Clinical symptoms included fever, fatigue, and abdominal pain. Diagnosis was confirmed by blood culture and computed tomography (CT) angiography. The patient had increased abdominal pain during hospitalization, and repeated CT showed a rapidly enlarging mycotic aneurysm. Emergent endovascular repair was successfully performed using a bifurcated stent graft, and combined intravenous and oral antibiotics were administrated. The patient was asymptomatic after operation, and follow-up CT showed thrombosis in the aneurysmal sac and significant decrease of aneurysmal size.