Arteriocutaneous Fistula Associated with Bilateral Femoral Pseudoaneurysms Caused by Bacillus Calmette-Guérin. Apropos of a Case and Review of Literature.

Vascular complications of intravesical instillation of bacillus Calmette-Guérin (BCG) are rare. BCG is an attenuated strain of Mycobacterium bovis that was initially developed for vaccination against tuberculosis, but it has also been used as an adjuvant treatment for bladder transitional carcinoma. We report a patient with a history of instillation of BCG 2 years before, who underwent surgical treatment of 2 pseudoaneurysms. The first, located in the left superficial femoral artery (SFA), was resected, and the artery was ligated because he had a history of femoropopliteal occlusion. After 4 weeks, he presented another one associated with hemorrhage by cutaneous fistula, in the right common femoral artery. In this case, revascularization was performed by means a common-to-deep femoral artery bypass with polytetrafluorethylene graft and reimplantation of SFA. Initially, bacterial cultures were negative, but bacilli cultures identified M. bovis after 3 weeks. Antituberculosis therapy was administered. After 13 months, the patient was asymptomatic and duplex ultrasound showed no signs of recurrent infection. This exposure should be considered if presentation of the false aneurysm is spontaneous and there is a history of bladder carcinoma.

Combined non-surgical treatment for Paget-Schröetter syndrome: a case report.

BACKGROUND: Paget-Schröetter syndrome is an uncommon form of venous thrombosis, which is related to thoracic outlet syndrome. Axillary-subclavian vein thrombosis typically presents in healthy young adults. We present this case of particular interest because it indicates that a combined treatment involving thrombolysis, anticoagulation therapy, rehabilitation, and elastic compression sleeves can be a valid non-surgical alternative for some patients with Paget-Schröetter syndrome. CASE PRESENTATION: This report describes a case of a 38-year-old white woman, a swimmer, who presented with a sudden episode of swelling and pain in her right upper extremity. After duplex ultrasound diagnosis of venous thrombosis, computed tomography (CT) showed extrinsic compression of the vessel. Catheter-directed thrombolysis was performed in the first 24 hours, followed by anticoagulant therapy with bemiparin at a dose of 7500 IU/24 hours for the first week, and then reduced to 3500 IU/24 hours for the next 3 months. After treatment there was restoration of her venous flow and she returned to work 2 weeks later. Anticoagulant treatment was continued for 3 months; decompression surgery was not performed. At 6 months she was asymptomatic. CONCLUSION: Combined treatment involving thrombolysis, anticoagulant therapy, rehabilitation, and elastic compression sleeves may be a valid non-surgical alternative for a selected subset of patients with Paget-Schröetter syndrome.

Mid-Term Outcomes of Endovascular Treatment for TASC-II D Femoropopliteal Occlusive Disease with Critical Limb Ischemia.

PURPOSE: The purpose of the study was to assess the safety and midterm effectiveness of endovascular treatment in Trans-Atlantic Inter-Society Consensus II (TASC-II) D femoropopliteal occlusions in patients with critical limb ischemia (CLI). METHODS: Patients with CLI who underwent endovascular treatment for TASC-D de novo femoropopliteal occlusive disease between September 2008 and December 2013 were selected. Data included anatomic features, pre- and postprocedure ankle-brachial index, duplex ultrasound, and periprocedural complications. Sustained clinical improvement, limb salvage rate, freedom from target lesion revascularization (TLR), and freedom from target extremity revascularization (TER) were assessed by Kaplan-Meier estimation and predictors of restenosis/occlusion with Cox analysis. RESULTS: Thirty-two patients underwent treatment of 35 TASC-D occlusions. Mean age was 76 ± 9. Mean lesion length was 23 ± 5 cm. Twenty-eight limbs (80 %) presented tissue loss. Seventeen limbs underwent treatment by stent, 13 by stent-graft, and 5 by angioplasty. Mean follow-up was 29 ± 20 months. Seven patients required major amputation and six patients died during follow-up. Eighteen endovascular and three surgical TLR procedures were performed due to restenosis or occlusion. Estimated freedom from TLR and TER rates at 2 years were 41 and 76%, whereas estimated primary and secondary patency rates were 41 and 79%, respectively. CONCLUSIONS: Endovascular treatment for TASC II D lesions is safe and offers satisfying outcomes. This patient subset would benefit from a minimally invasive approach. Follow-up is advisable due to a high rate of restenosis. Further follow-up is necessary to know the long-term efficacy of these procedures.